HomeMy WebLinkAboutAgreement A-25-377 with Central Star.pdf Agreement No. 25-377
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2 SERVICE AGREEMENT
3 This Service Agreement ("Agreement") is dated August 5, 2025 and is between Central
4 Star Behavioral Health, Inc., a California S corporation, and a subsidiary of Stars Behavioral
5 Health Group Holding Company, Inc. ("Contractor"), and the County of Fresno, a political
6 subdivision of the State of California ("County").
7 Recitals
8 A. The Fresno County Department of Behavioral Health (DBH) is in need of a qualified
9 agency to operate a Youth Full-Service Partnership (FSP) Continuum of Care program
10 including; an FSP program as defined in Title 9 of the California Code of Regulations (C.C.R)
11 sections 32000.130 and 3620, an Intensive Case Management (ICM) program, and an
12 Outpatient (OP) program for underserved or unserved high-risk youth between the ages of 11-
13 18 years with Serious Emotional Disturbance (SED);
14 B. County, through its DBH, is a Behavioral Health Plan (BHP) as defined by C.C.R. Title 9,
15 Section 1810.226.
16 C. On March 14, 2025, the County released Request for Proposals ("RFP") No. 25-070
17 seeking a qualified Contractor for Youth Full-Service Partnership Continuum of Care.
18 Addendum No 1 to the RFP was released on March 24, 2025, and Addendum No. 2 to the RFP
19 was released on April 1, 2025, to provide a response to potential bidder questions and to revise
20 the Medi-Cal Fee For Service reimbursement rates. RFP 25-070 closed on April 14, 2025.
21 D. County has determined that Contractor is qualified and willing to operate said Youth Full-
22 Service Partnership Continuum of Care, including FSP, ICM, and OP levels and provide
23 services pursuant to the terms and conditions of this agreement.
24 E. This Agreement supersedes County Agreement No. 23-280 as amended by Agreement
25 No. 24-081 and Agreement No. 25-288.
26 The parties therefore agree as follows:
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1 Article 1
2 Contractor's Services
3 1.1 Scope of Services. The Contractor shall perform all of the services provided in
4 Exhibit A to this agreement, titled "Fresno County Department of Behavioral Health Scope of
5 Work".
6 1.2 Contractor shall also perform all services and fulfill all responsibilities as specified in
7 County's Request for Proposal (RFP) issued under the name of Youth Continuum of Care
8 Program RFP No. 25-070 dated March 14, 2025, and Addendum No. One (1) to County's RFP
9 No. 25-070 dated March 24, 2025, and Addendum No. Two (2) to County's RFP No. 25-070
10 dated April 1, 2025, (collectively referred to herein as County's Revised RFP) and Contractor's
11 response to County's Revised RFP dated April 14, 2025, all incorporated herein by reference
12 and made part of this Agreement. In the event of any inconsistency among these documents,
13 the inconsistency shall be resolved by giving precedence in the following order of priority: (1) to
14 the Agreement, including all Exhibits; (2) to the Revised RFP; and (3) to the Response to the
15 Revised RFP. A copy of County's Revised RFP and Contractor's response thereto shall be
16 retained and made available during the term of this Agreement by County's Department of
17 Behavioral Health (DBH) Plan Administration Division.
18 1.3 Representation. The Contractor represents that it is qualified, ready, willing, and
19 able to perform all of the services provided in this Agreement.
20 1.4 Compliance with Laws. The Contractor shall, at its own cost, comply with all
21 applicable federal, state, and local laws and regulations in the performance of its obligations
22 under this Agreement, including but not limited to workers compensation, labor, and
23 confidentiality laws and regulations. Additionally, Contractor shall comply with laws, regulations,
24 and requirements in Exhibit B to this agreement, titled "Fresno County Behavioral Health
25 Requirements".
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1 Article 2
2 County's Responsibilities
3 2.1 The County shall provide oversight and collaborate with Contractor, other County
4 Departments and community agencies to help achieve program goals and outcomes. In addition
5 to contractor monitoring of program, oversight includes, but not limited to, coordination with
6 Department of Health Care Services (DHCS) in regard to program administration and outcomes.
7 2.2 County shall participate in evaluating the progress of the overall program, levels of
8 care components, and the efficiency of collaboration with the Contractor staff and will be
9 available to Contractor for ongoing consultation. County shall receive and analyze statistical
10 outcome data from Contractor throughout the term of contract. County shall notify the
11 Contractor when additional participation is required. The performance outcome measurement
12 process will not be limited to survey instruments but will also include, as appropriate, persons
13 served and staff surveys, chart reviews, and other methods of obtaining required information.
14 Article 3
15 Compensation, Invoices, and Payments
16 3.1 The County agrees to pay, and the Contractor agrees to receive compensation for
17 the performance of its services under this Agreement as described in Exhibit C to this
18 agreement, titled "Fresno County Department of Behavioral Health Financial Terms and
19 Conditions".
20 3.2 Additional Fiscal Requirements. The Contractor shall comply with all additional
21 requirements in Exhibit C to this Agreement.
22 Article 4
23 Term of Agreement
24 4.1 Term. This Agreement is effective on August 5, 2025, and terminates on June 30,
25 2028, except as provided in section 4.2, "Extension," or Article 6, "Termination and Suspension,"
26 below.
27 4.2 Extension. The term of this Agreement may be extended for no more than two, one-
28 year periods only upon written approval of both parties at least thirty (30) days before the first
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1 day of the next one-year extension period. The County's DBH Director or his or her designee is
2 authorized to sign the written approval on behalf of the County based on the Contractor's
3 satisfactory performance. The extension of this Agreement by the County is not a waiver or
4 compromise of any default or breach of this Agreement by the Contractor existing at the time of
5 the extension whether or not known to the County.
6 Article 5
7 Notices
8 5.1 Contact Information. The persons and their addresses having authority to give and
9 receive notices provided for or permitted under this Agreement include the following:
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For the County:
11 Director, Department of Behavioral Health
County of Fresno
12 1925 E Dakota Avenue
Fresno, CA 93726
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For the Contractor:
14 President/CEO
1501 Hughes Way, Suite 150
15 Long Beach, Ca. 90810
kdunlap@starsinc.com
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5.2 Change of Contact Information. Either party may change the information in section
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5.1 by giving notice as provided in section 5.3.
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5.3 Method of Delivery. Each notice between the County and the Contractor provided
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for or permitted under this Agreement must be in writing, state that it is a notice provided under
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this Agreement, and be delivered either by personal service, by first-class United States mail, by
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an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
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Document Format (PDF) document attached to an email.
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(A) A notice delivered by personal service is effective upon service to the recipient.
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(B) A notice delivered by first-class United States mail is effective three County
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business days after deposit in the United States mail, postage prepaid, addressed to the
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recipient.
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(C)A notice delivered by an overnight commercial courier service is effective one
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County business day after deposit with the overnight commercial courier service,
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1 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
2 the recipient.
3 (D)A notice delivered by telephonic facsimile transmission or by PDF document
4 attached to an email is effective when transmission to the recipient is completed (but, if
5 such transmission is completed outside of County business hours, then such delivery is
6 deemed to be effective at the next beginning of a County business day), provided that
7 the sender maintains a machine record of the completed transmission.
8 5.4 Claims Presentation. For all claims arising from or related to this Agreement,
9 nothing in this Agreement establishes, waives, or modifies any claims presentation
10 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
11 of Title 1 of the Government Code, beginning with section 810).
12 Article 6
13 Termination and Suspension
14 6.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
15 contingent on the approval of funds by the appropriating government agency. If sufficient funds
16 are not allocated, then the County, upon at least 30 days' advance written notice to the
17 Contractor, may:
18 (A) Modify the services provided by the Contractor under this Agreement; or
19 (B) Terminate this Agreement.
20 6.2 Termination for Breach.
21 (A) Upon determining that a breach (as defined in paragraph (C) below) has
22 occurred, the County may give written notice of the breach to the Contractor. The written
23 notice may suspend performance under this Agreement, and must provide at least 30
24 days for the Contractor to cure the breach.
25 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
26 time stated in the written notice, the County may terminate this Agreement immediately.
27 (C) For purposes of this section, a breach occurs when, in the determination of the
28 County, the Contractor has:
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1 (1) Obtained or used funds illegally or improperly;
2 (2) Failed to comply with any part of this Agreement;
3 (3) Submitted a substantially incorrect or incomplete report to the County; or
4 (4) Improperly performed any of its obligations under this Agreement.
5 6.3 Termination without Cause. In circumstances other than those set forth above, the
6 County may terminate this Agreement by giving at least 30 days advance written notice to the
7 Contractor.
8 6.4 Economic Sanctions. In accordance with Executive Order N-6-22 regarding
9 Economic Sanctions against Russia and Russian entities and individuals, the County may
10 terminate this Agreement if the Contractor is a target of Economic Sanctions or is conducting
11 prohibited transactions with sanctioned individuals or entities. The County shall provide at least
12 thirty (30) days advance written notice to the Contractor.
13 6.5 No Penalty or Further Obligation. Any termination of this Agreement by the County
14 under this Article 6 is without penalty to or further obligation of the County.
15 6.6 County's Rights upon Termination. Upon termination for breach under this Article
16 6, the County may demand repayment by the Contractor of any monies disbursed to the
17 Contractor under this Agreement that, in the County's sole judgment, were not expended in
18 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
19 demand. This section survives the termination of this Agreement.
20 Article 7
21 Independent Contractor
22 7.1 Status. In performing under this Agreement, the Contractor, including its officers,
23 agents, employees, and volunteers, is at all times acting and performing as an independent
24 contractor, in an independent capacity, and not as an officer, agent, servant, employee, joint
25 venturer, partner, or associate of the County.
26 7.2 Verifying Performance. The County has no right to control, supervise, or direct the
27 manner or method of the Contractor's performance under this Agreement, but the County may
28 verify that the Contractor is performing according to the terms of this Agreement.
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1 7.3 Benefits. Because of its status as an independent contractor, the Contractor has no
2 right to employment rights or benefits available to County employees. The Contractor is solely
3 responsible for providing to its own employees all employee benefits required by law. The
4 Contractor shall save the County harmless from all matters relating to the payment of
5 Contractor's employees, including compliance with Social Security withholding and all related
6 regulations.
7 7.4 Services to Others. The parties acknowledge that, during the term of this
8 Agreement, the Contractor may provide services to others unrelated to the County.
9 Article 8
10 Indemnity and Defense
11 8.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
12 County (including its officers, agents, employees, and volunteers) against all claims, demands,
13 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
14 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
15 the performance or failure to perform by the Contractor(or any of its officers, agents,
16 subcontractors, or employees) under this Agreement. The County may conduct or participate in
17 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
18 defend the County.
19 8.2 Survival. This Article 8 survives the termination of this Agreement.
20 Article 9
21 Insurance
22 9.1 The Contractor shall comply with all the insurance requirements in Exhibit D to this
23 Agreement.
24 Article 10
25 Inspections, Audits, and Public Records
26 10.1 Inspection of Documents. The Contractor shall make available to the County, and
27 the County may examine at any time during business hours and as often as the County deems
28 necessary, all of the Contractor's records and data with respect to the matters covered by this
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1 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
2 request by the County, permit the County to audit and inspect all of such records and data to
3 ensure the Contractor's compliance with the terms of this Agreement.
4 10.2 State Audit Requirements. If the compensation to be paid by the County under this
5 Agreement exceeds $10,000, the Contractor is subject to the examination and audit of the
6 California State Auditor, as provided in Government Code section 8546.7, for a period of three
7 years after final payment under this Agreement. This section survives the termination of this
8 Agreement.
9 10.3 Public Records. The County is not limited in any manner with respect to its public
10 disclosure of this Agreement or any record or data that the Contractor may provide to the
11 County. The County's public disclosure of this Agreement or any record or data that the
12 Contractor may provide to the County may include but is not limited to the following:
13 (A) The County may voluntarily, or upon request by any member of the public or
14 governmental agency, disclose this Agreement to the public or such governmental
15 agency.
16 (B) The County may voluntarily, or upon request by any member of the public or
17 governmental agency, disclose to the public or such governmental agency any record or
18 data that the Contractor may provide to the County, unless such disclosure is prohibited
19 by court order.
20 (C)This Agreement, and any record or data that the Contractor may provide to the
21 County, is subject to public disclosure under the Ralph M. Brown Act (California
22 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
23 (D)This Agreement, and any record or data that the Contractor may provide to the
24 County, is subject to public disclosure as a public record under the California Public
25 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
26 with section 6250) ("CPRA").
27 (E) This Agreement, and any record or data that the Contractor may provide to the
28 County, is subject to public disclosure as information concerning the conduct of the
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1 people's business of the State of California under California Constitution, Article 1,
2 section 3, subdivision (b).
3 (F) Any marking of confidentiality or restricted access upon or otherwise made with
4 respect to any record or data that the Contractor may provide to the County shall be
5 disregarded and have no effect on the County's right or duty to disclose to the public or
6 governmental agency any such record or data.
7 10.4 Public Records Act Requests. If the County receives a written or oral request
8 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
9 and which the County has a right, under any provision of this Agreement or applicable law, to
10 possess or control, then the County may demand, in writing, that the Contractor deliver to the
11 County, for purposes of public disclosure, the requested records that may be in the possession
12 or control of the Contractor. Within five business days after the County's demand, the
13 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's
14 possession or control, together with a written statement that the Contractor, after conducting a
15 diligent search, has produced all requested records that are in the Contractor's possession or
16 control, or (b) provide to the County a written statement that the Contractor, after conducting a
17 diligent search, does not possess or control any of the requested records. The Contractor shall
18 cooperate with the County with respect to any County demand for such records. If the
19 Contractor wishes to assert that any specific record or data is exempt from disclosure under the
20 CPRA or other applicable law, it must deliver the record or data to the County and assert the
21 exemption by citation to specific legal authority within the written statement that it provides to
22 the County under this section. The Contractor's assertion of any exemption from disclosure is
23 not binding on the County, but the County will give at least 10 days' advance written notice to
24 the Contractor before disclosing any record subject to the Contractor's assertion of exemption
25 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs
26 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption,
27 failure to produce any such records, or failure to cooperate with the County with respect to any
28 County demand for any such records.
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1 Article 11
2 Data Security
3 11.1 The Contractor shall be responsible for the privacy and security safeguards, as
4 identified in Exhibit E, entitled "Data Security." To the extent required to carry out the
5 assessment and authorization process and continuous monitoring, to safeguard against threats
6 and hazards to the security, integrity, and confidentiality of any County data collected and stored
7 by the Contractor, the Contractor shall afford the County access as necessary at the
8 Contractor's reasonable discretion, to the Contractor's facilities, installations, and technical
9 capabilities. If new or unanticipated threats or hazards are discovered by either the County or
10 the Contractor, or if existing safeguards have ceased to function, the discoverer shall
11 immediately bring the situation to the attention of the other party.
12 Article 12
13 Disclosure of Self-Dealing Transactions
14 12.1 Applicability. This Article 12 applies if the Contractor is operating as a corporation,
15 or changes its status to operate as a corporation.
16 12.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
17 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
18 "Self-Dealing Transaction Disclosure Form" (Exhibit F to this Agreement) and submitting it to the
19 County before commencing the transaction or immediately after.
20 12.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
21 a party and in which one or more of its directors, as an individual, has a material financial
22 interest.
23 Article 13
24 Disclosure of Ownership and/or Control Interest Information
25 13.1 Applicability. This provision is only applicable if Contractor is disclosing entities,
26 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
27 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
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1 13.2 Duty to Disclose. Contractor must disclose the following information as requested in
2 the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement,
3 Exhibit G:
4 (A) Disclosure of 5% or More Ownership Interest:
5 (1) In the case of corporate entities with an ownership or control interest in the
6 disclosing entity, the primary business address as well as every business location
7 and P.O. Box address must be disclosed. In the case of an individual, the date of
8 birth and Social Security number must be disclosed.
9 (2) In the case of a corporation with ownership or control interest in the
10 disclosing entity or in any subcontractor in which the disclosing entity has a five
11 percent (5%) or more interest, the corporation tax identification number must be
12 disclosed.
13 (3) For individuals or corporations with ownership or control interest in any
14 subcontractor in which the disclosing entity has a five percent (5%) or more interest,
15 the disclosure of familial relationship is required.
16 (4) For individuals with five percent (5%) or more direct or indirect ownership
17 interest of a disclosing entity, the individual shall provide evidence of completion of a
18 criminal background check, including fingerprinting, if required by law, prior to
19 execution of Contract. (42 C.F.R. §455.434)
20 (B) Disclosures Related to Business Transactions:
21 (1) The ownership of any subcontractor with whom Contractor has had business
22 transactions totaling more than $25,000 during the 12-month period ending on the
23 date of the request.
24 (2) Any significant business transactions between Contractor and any wholly
25 owned supplier, or between Contractor and any subcontractor, during the 5-year
26 period ending on the date of the request. (42 C.F.R. § 455.105(b).)
27 (C) Disclosures Related to Persons Convicted of Crimes:
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1 (1) The identity of any person who has an ownership or control interest in the
2 provider or is an agent or managing employee of the provider who has been
3 convicted of a criminal offense related to that person's involvement in any program
4 under the Medicare, Medicaid, or the Title XXI services program since the inception
5 of those programs. (42 C.F.R. § 455.106.)
6 (2) County shall terminate the enrollment of Contractor if any person with five
7 percent (5%) or greater direct or indirect ownership interest in the disclosing entity
8 has been convicted of a criminal offense related to the person's involvement with
9 Medicare, Medicaid, or Title XXI program in the last 10 years.
10 13.3 Contractor must provide disclosure upon execution of Contract, extension for
11 renewal, and within thirty-five (35) days after any change in Contractor ownership or upon
12 request of County. County may refuse to enter into an agreement or terminate an existing
13 agreement with Contractor if Contractor fails to disclose ownership and control interest
14 information, information related to business transactions and information on persons convicted
15 of crimes, or if Contractor did not fully and accurately make the disclosure as required.
16 13.4 Contractor must provide the County with written disclosure of any prohibited
17 affiliations under 42 C.F.R. § 438.610. Contractor must not employ or subcontract with providers
18 or have other relationships with providers Excluded from participation in Federal Health Care
19 Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42 C.F.R.
20 §438.610.
21 13.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
22 uoi ir-ianAdmi,IIZWdL,unCa)-fresr L)countyca.c,L. with a copy sent via email to the assigned DBH
23 Contract Analyst. County may deny enrollment or terminate this Agreement where any person
24 with five (5) percent or greater direct or indirect ownership interest in Contractor has been
25 convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid,
26 or Title XXI program in the last ten (10) years. County may terminate this Agreement where any
27 person with five (5) percent or greater direct or indirect ownership interest in the Contractor did
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1 not submit timely and accurate information and cooperate with any screening method required
2 in C.F,R, Title 42, Section 455.416
3 Article 14
4 Disclosure of Criminal History and Civil Actions
5 14.1 Applicability. Contractor is required to disclose if any of the following conditions
6 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
7 referred to as "Contractor"):
8 (A) Within the three (3) year period preceding the Agreement award, they have been
9 convicted of, or had a civil judgment tendered against them for:
10 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
11 or performing a public (federal, state, or local) transaction or contract under a public
12 transaction;
13 (2) Violation of a federal or state antitrust statute;
14 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
15 or
16 (4) False statements or receipt of stolen property.
17 (B) Within a three (3) year period preceding their Agreement award, they have had a
18 public transaction (federal, state, or local) terminated for cause or default.
19 14.2 Duty to Disclose. Disclosure of the above information will not automatically
20 eliminate Contractor from further business consideration. The information will be considered as
21 part of the determination of whether to continue and/or renew this Agreement and any additional
22 information or explanation that Contractor elects to submit with the disclosed information will be
23 considered. If it is later determined that the Contractor failed to disclose required information,
24 any contract awarded to such Contractor may be immediately voided and terminated for
25 material failure to comply with the terms and conditions of the award.
26 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
27 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit H.
28 Additionally, Contractor must immediately advise the County in writing if, during the term of the
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1 Agreement: (1) Contractor becomes suspended, debarred, excluded or ineligible for
2 participation in Federal or State funded programs or from receiving federal funds as listed in the
3 excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions
4 become applicable to Contractor. Contractor shall indemnify, defend, and hold County harmless
5 for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility, or other
6 matter listed in the signed Certification Regarding Debarment, Suspension, and Other
7 Responsibility Matters.
8 Article 15
9 General Terms
10 15.1 Modification. Except as provided in Article 6, "Termination and Suspension," this
11 Agreement may not be modified, and no waiver is effective, except by written agreement signed
12 by both parties. The Contractor acknowledges that County employees have no authority to
13 modify this Agreement except as expressly provided in this Agreement.
14 (A) Notwithstanding the above, non-material changes to services, staffing, and
15 responsibilities of the Contractor, as needed, to accommodate changes in the laws
16 relating to service requirements, may be made with the signed written approval of
17 County's DBH Director, or designee, and Contractor through an amendment approved
18 by County's County Counsel and the County's Auditor-Controller/Treasurer-Tax
19 Collector's Office. Said modifications shall not result in any change to the maximum
20 compensation amount payable to Contractor, as stated herein.
21 (B) Rate Modification. In addition, changes to service rates on Exhibit C—
22 Attachment A that do not exceed five percent (5%) of the approved rate, or that are
23 needed to accommodate state-mandated rate increases, may be made with the written
24 approval of the DBH Director, or designee, subject to applicable legislation, availability of
25 funds and review of Contractor performance. These rate changes may not add or alter
26 any other terms or conditions of the Agreement. Said modifications shall not result in any
27 change to the annual maximum compensation amount payable to Contractor, as stated
28 herein.
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1 15.2 Budget Modification. Changes to Account/Line Item amounts, which, when
2 aggregated, do not exceed ten percent (10%) of the total maximum compensation payable to
3 Contractor for the entire contract term, may be made with the written approval of Contractor(s)
4 and County's DBH Director or designee. Said modifications are subject to County's DBH review
5 in accordance with the Budget Modification Request Guide available at
6 https://www.fresnocountyca.gov/Departments/Behavioral-Health/Providers/Contract-Provider-
7 Resources/Notifications-Associated-Documents.
8 15.3 Non-Assignment. Neither party may assign its rights or delegate its obligations
9 under this Agreement without the prior written consent of the other party.
10 15.4 Governing Law. The laws of the State of California govern all matters arising from
11 or related to this Agreement.
12 15.5 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
13 County, California. Contractor consents to California jurisdiction for actions arising from or
14 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
15 brought and maintained in Fresno County.
16 15.6 Construction. The final form of this Agreement is the result of the parties' combined
17 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
18 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
19 against either party.
20 15.7 Days. Unless otherwise specified, "days" means calendar days.
21 15.8 Headings. The headings and section titles in this Agreement are for convenience
22 only and are not part of this Agreement.
23 15.9 Severability. If anything in this Agreement is found by a court of competent
24 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
25 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
26 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
27 intent.
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1 15.10 Nondiscrimination. During the performance of this Agreement, the Contractor shall
2 not unlawfully discriminate against any employee or applicant for employment, or recipient of
3 services, because of race, religious creed, color, national origin, ancestry, physical disability,
4 mental disability, medical condition, genetic information, marital status, sex, gender, gender
5 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
6 all applicable State of California and federal statutes and regulation.
7 Contractor shall take affirmative action to ensure that services to intended Medi-Cal
8 beneficiaries are provided without use of any policy or practice that has the effect of
9 discriminating on the basis of race, color, religion, ancestry, marital status, national origin, ethnic
10 group identification, sex, sexual orientation, gender, gender identity, age, medical condition,
11 genetic information, health status or need for health care services, or mental or physical
12 disability.
13 15.11 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
14 of the Contractor under this Agreement on any one or more occasions is not a waiver of
15 performance of any continuing or other obligation of the Contractor and does not prohibit
16 enforcement by the County of any obligation on any other occasion.
17 15.12 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
18 between the Contractor and the County with respect to the subject matter of this Agreement,
19 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
20 publications, and understandings of any nature unless those things are expressly included in
21 this Agreement. If there is any inconsistency between the terms of this Agreement without its
22 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
23 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
24 exhibits.
25 15.13 No Third-Party Beneficiaries. This Agreement does not and is not intended to
26 create any rights or obligations for any person or entity except for the parties.
27 15.14 Authorized Signature. The Contractor represents and warrants to the County that:
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1 (A) The Contractor is duly authorized and empowered to sign and perform its
2 obligations under this Agreement.
3 (B) The individual signing this Agreement on behalf of the Contractor is duly
4 authorized to do so and his or her signature on this Agreement legally binds the
5 Contractor to the terms of this Agreement.
6 15.15 Electronic Signatures. The parties agree that this Agreement may be executed by
7 electronic signature as provided in this section.
8 (A) An "electronic signature" means any symbol or process intended by an individual
9 signing this Agreement to represent their signature, including but not limited to (1) a
10 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
11 electronically scanned and transmitted (for example by PDF document) version of an
12 original handwritten signature.
13 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
14 equivalent to a valid original handwritten signature of the person signing this Agreement
15 for all purposes, including but not limited to evidentiary proof in any administrative or
16 judicial proceeding, and (2) has the same force and effect as the valid original
17 handwritten signature of that person.
18 (C)The provisions of this section satisfy the requirements of Civil Code section
19 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
20 Part 2, Title 2.5, beginning with section 1633.1).
21 (D) Each party using a digital signature represents that it has undertaken and
22 satisfied the requirements of Government Code section 16.5, subdivision (a),
23 paragraphs (1) through (5), and agrees that each other party may rely upon that
24 representation.
25 (E) This Agreement is not conditioned upon the parties conducting the transactions
26 under it by electronic means and either party may sign this Agreement with an original
27 handwritten signature.
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1 15.16 Counterparts. This Agreement may be signed in counterparts, each of which is an
2 original, and all of which together constitute this Agreement.
3 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Agreement on the date stated in the introductory clause.
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Central Star Behavioral Health, Inc. COUNTY OF FRESNO
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Kent Dunlap, President and CEO Ernest Buddy Mendes, Chairman of the
6 1501 Hughes Way, Suite 150 Board of Supervisors of the County of Fresno
7 Long Beach, CA 90810 Attest:
Bernice E. Seidel
8 Clerk of the Board of Supervisors
County of Fresno, State of California
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10 By: �r
Deputy
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For accounting use only:
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Org No.: 56304351
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56304353
14 Account No.: 7295
Fund No.: 0001
15 Subclass No.: 10000
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EXHIBIT A
Page 1 of 15
FRESNO COUNTY
DEPARTMENT OF BEHAVIORAL HEALTH
SCOPE OF WORK
I. PROGRAM NAME
Youth Continuum of Care
II. BACKGROUND
The Youth Continuum of Care program includes Full-Service Partnership (FSP), Intensive
Case Management (ICM), and Outpatient (OP) levels of care for youth ages 11-18. This
program serves youth who are experiencing a range of symptoms qualifying for Specialty
Mental Health Services (SMHS), including those who have serious emotional disturbance
(SED) that is impacting their functioning in various domains such as school, home, family and
within their communities. FSP services encompass a unified team approach, in which the
provider commits to do "whatever-it-takes"* and "meet the person served where they are"** to
assist the individual to reach their personal recovery, resiliency and wellness goals and aim to
reduce the number of days of hospitalization, and juvenile justice involvement. ICM and OP
services provide an opportunity for youth to step-down their level of care as their symptoms
improve, with minimal disruption to services. Additionally, youth making a new request for
services, who are eligible for SMHS may access the ICM and OP levels of care via phone-call
or walk-in.
*"Whatever it takes": Using any method necessary to engage a person served, determine
their needs for recovery, and creating collaborative services and supports to meet those
needs.
**"Meeting the person served where they are": Being accessible and available to persons
served at any time, meeting in a location convenient for them, communicating in a way that
meets their cognitive and linguistic needs, and considering their stage of recovery when
developing a treatment plan. Meeting persons served where they are also means tailoring
services and approaches to align with the cultural identity of the person served. The term
"culture" in this context, should not be limited to race and ethnicity, but should also extend to
other cultural identities, including but not limited to: foster youth, persons with disabilities,
gender, LGBTQ persons, and persons with religious and spiritual affiliations.
III. TARGET POPULATION
The target population includes youth, 11-18 years old, who meet specialty mental health
criteria, present with severe impairment, and those who have a diagnosable SED as set forth
in the California Welfare and Institutions Code, section 5600.3(a).
In addition, siblings, caregivers, and other significant support persons involved in the well-
being of youth enrolled in FSP services may receive SMHS from this program, as clinically
EXHIBIT A
Page 2 of 15
appropriate and medically necessary, while the identified person served is enrolled, to
optimize the youth's ability to reach wellness and recovery.
Persons served (including any significant support persons receiving SMHS) must be enrolled,
disenrolled, and/or reenrolled in the EHR program listing that aligns with the level of care in
which they are receiving services (either FSP, OP, or ICM), as that level changes.
I. Entry Criteria for FSP Level Services
Identified persons served shall meet the following criteria for FSP Level services:
A. Persons shall meet Specialty Mental Health Services eligibility criteria as
found in: https://www.dhcs.ca.gov/Documents/BHIN-21-073-Criteria-for-
Beneficiary-to-Specialty-M HS-Medical-Necessity-and-Other-Coverage-
Reg.pdf and other relevant letters and updates published from time to time
by DHCS.
B. Persons selected for participation in the FSP Service Category must meet
the eligibility criteria based on age group as found in California Code WIC
5600.3.
C. Referrals to the FSP level of care shall be reviewed and approved by
Fresno County DBH.
II. Entry Criteria for ICM and OP Level Services
Identified persons served shall meet the following criteria for ICM and OP services:
A. Persons shall meet Specialty Mental Health Services eligibility criteria for
ICM and OP as found in: https://www.dhcs.ca.aov/Documents/BHIN-21-
073-Criteria-for-Beneficiary-to-Specialty-M HS-Medical-Necessity-and-
Other-Coverage-Reg.pdf and other relevant letters and updates published
from time to time by DHCS.
B. Individuals enrolled in the ICM level of care receive a high frequency of
services to prevent significant decompensation. These individuals do not
fully meet FSP criteria.
C. Individuals enrolled in the OP level of care have achieved some stability in
their severe mental illness yet still require SMHS to maintain that stability.
IV. DESCRIPTION OF SERVICES
I. Agreement Start Date: August 5, 2025
II. Summary of Services
Contractor shall provide a continuum of care, including the following three (3) levels of
care: FSP, ICM, and OP. The expectations for each level of care are detailed below.
A. For all levels of care, Contractor shall:
EXHIBIT A
Page 3 of 15
1. Contractor must have the capability of supporting persons in need
of substance use disorder treatment services in addition to specialty
mental health services. Contractor must have an effective referral
process and coordination of care process with county-contracted
substance use disorder programs.
2. Provide services appropriate to the age, culture, gender, sexual
identity, and preferred language of persons served and
accommodations for physical disabilities.
3. Make appropriate referrals and linkages to services that are beyond
that of the scope of work. Contractor shall coordinate services with
any other community mental health, substance use disorders
providers, and non-mental health providers as well as other medical
professionals. Methods for service coordination and communication
between Contractor and other service providers for each person
served shall be implemented consistent with Fresno County
confidentiality rules.
4. Provide support to the family and/or primary care provider of the
person served and other members of the person's social network to
help them support the person in managing symptoms and illness
and reduce family and social stress associated with the illness.
5. Assist person served, their family, and/or their primary care provider
with accessing all entitlements or benefits for which they are eligible
(i.e. Medi-Cal, Supplemental Security Income (SSI), Section 8
vouchers, etc.).
6. Develop family support and involvement whenever possible.
7. Refer individuals to supported education, as appropriate.
8. Provide or link to transportation services to access necessary
support services or gain entitlements or benefits.
9. Provide and claim for peer support activities, as appropriate.
10. Ensure that clinically appropriate Evidence-Based Practices (EBP)
are utilized in service delivery.
11. Provide ongoing clinical assessment of the mental health and
substance use disorders of the person served symptoms and
response to treatment.
12. Provide services in the areas of medication evaluation, prescription,
administration, monitoring, and documentation via in person or
telepsychiatry, including all psychiatric medications that are
considered the standard of care in management of serious
psychiatric conditions.
13. Educate the person served regarding their mental illness and the
effects (including side effects) of prescribed medications.
EXHIBIT A
Page 4 of 15
14. Provide symptom management skills and help the person served
identify the symptoms and their occurrence patterns, and develop
methods (internal behavioral, adaptive) to lessen their effects.
15. Provide, both planned and on an "as needed" basis, psychological
support as is necessary to help person served accomplish their
personal goals and cope with the stresses of day-to-day living.
16. Provide training, instruction, support, and assistance to the person
served in developing/maintaining daily living skills.
17. Develop and support the participation of the person served in social
interactions, including, when possible, recreational social activities,
and relationships. Priority shall be given to supporting persons
served in establishing positive social relationships in normative
community settings.
18. Act to minimize the involvement of the person served in the juvenile
justice system.
19. Assist the person served, family and other members of their social
network to relate in a positive and supportive manner.
20. Monitor service outcomes to determine if the person served has
meaningful use of their time, stays in school, has reduced numbers
of hospitalizations, incarcerations, and periods of homelessness.
DBH will use State identified criteria for measuring these outcomes.
The treatment services will be monitored to ensure appropriate
service delivery and adherence to MHSA philosophies.
21. Provide comprehensive services, including intensive mental health
treatment, rehabilitation, and case management with the goal of
increasing adaptive functioning in the community and preventing
unnecessary re-admissions to Institutes of Mental Disease (IMD),
acute inpatient facilities, or other higher levels of care.
22. Assist the person served in accessing and participating in the
education programs offered in the community, as appropriate.
23. Services, publications, and buildings will be fully accessible to meet
the physical and linguistic abilities of all persons served. Contractor
must have the availability of language assistance for persons
served when their language of choice is not available through
existing staff. At a minimum, Contractor must offer interpreter
services either in-person or through a contract with a language line
provider.
24. Be responsible for developing a plan to continually engage targeted
populations through outreach and engagement services. Contractor
shall distribute literature and informational brochures in appropriate
languages and request feedback as to how access to care could be
improved for the intended population. Contractor will be expected to
EXHIBIT A
Page 5 of 15
collaborate with agencies that are recognized and accepted by the
target population.
25. Distribute literature and informational brochures in appropriate
languages and request feedback as to how access to care could be
improved for the intended population.
26. Collaborate with agencies that are recognized and accepted by
persons served.
27. Deliver a comprehensive specialty mental health program including
the following services, provided by appropriately credentialed staff:
a. Assessment
b. Care planning/Goal setting
c. Psychiatry/Medication Support
d. Individual/Family therapy
e. Group therapy
f. Targeted Case Management
g. Peer Support Services
h. Rehabilitation
i. Intensive Care Coordination
j. Intensive Home-Based Services
k. Linkage to additional services and supports including but
not limited to medication services, educational services,
and transportation
I. Contractor must ensure access to the following:
i. Hospitalization/ Post-Hospitalization Support
ii. Crisis Intervention
B. Full-Service Partnerships (FSP)
Implementation of regulatory changes resulting from Proposition 1 are
pending at this time. Those pending changes will include changes to the
Full-Service Partnership level of care. Contracts will require amendments
to align with new regulations and requirements. For the first year of the
contract or until the contract is amended, the staffing shall be reflective of
the high level of acuity and needs of this population. Typically, a person at
this level of care would receive at least three (3) contacts per week, or as
EXHIBIT A
Page 6 of 15
clinically appropriate, with most contacts being face-to-face/in-person
unless individual person-centered clinical factors warrant another modality
of service contact. Persons who do not require this frequency of contacts
and in-person engagement are typically better suited for OP or ICM level of
care. FSP contacts with person served may include, and are not limited to,
individual and group rehabilitation, case management, peer support
services, individual or group psychotherapy, and medication management.
Clinical services may be delivered by a range of both licensed and non-
licensed approved provider types, depending on the individual needs of the
person served and the specific service to be delivered. Non-licensed
provider types include: Associate Clinical Social Worker (ASW), Associate
Marriage and Family Therapist (AMFT), and Associate Professional Clinical
Counselor (APCC). The overall care of each person served must be
directed by a licensed or waivered mental health professional who is a
member of the multi-disciplinary treatment team, has met with the person
served and remains sufficiently engaged with the person served to
meaningfully direct treatment. The expected ratio of provider to person
services is, on average, 1:15, and may be achieved through the variety of
provider types on the multi-disciplinary team.
FSPs provide the full spectrum of community services necessary to attain
the goals identified in each Individual Services and Supports Plan (ISSP),
as well as any services that may be deemed necessary through
collaborative planning between the County, the person served and/or their
family to address unforeseen circumstances in the person's life that could
be, but has not yet been, included in the ISSP. Each person served must
have a Personal Services Coordinator (PSC) who acts as an ally and a
"single point of responsibility" for the person served. The PSC is
responsible for developing the ISSP with the person served. The ISSP
must be updated every six (6) months, or as clinically appropriate.
The FSP program services shall be provided utilizing the FSP Service
Delivery Model, as referenced in the FSP Toolkit available at:
htti)s:Hdrive.google.com/drive/folders/1 z9LeCiO9gswHdrohZkcimTeOhxlk3
dLc, for creating a team structure for comprehensive and coordinated
services that support and promote recovery. The FSP Toolkit is intended
to provide FSP supervisors and team members with written guidance to
support the ongoing development of the programs and integration of
practices. This publication series encompasses a Tool Kit for each age
group in recognition of the programmatic differences that exist across the
four age groups.
Contractor will adhere to FSP regulations, which can be found in their
entirety in the California Code of Regulations, Title 9, Sections 3620,
3620.05 and 3620.10 which are available at:
htti)s:Hgovt.westlaw.com/calregs/Browse/Home/California/Californ iaCodeof
EXHIBIT A
Page 7 of 15
Regulations?quid=14F8301404C61311 EC93A8000D3A7C4BC3&transitionT
ype=Defau It&contextData=%28sc.Default%29.
FSP programs shall:
1. Be available to provide crisis assessment and intervention 24/7,
including telephone and face-to-face in-person contacts, as needed
with a person known to the person served. FSP providers shall be
responsive to persons served who may be admitted to emergency
departments, crisis stabilization center, inpatient psychiatric facilities, or
jail.
2. Provide whatever direct assistance is necessary and reasonable to
ensure that the person served obtains the basic necessities of daily life,
such as food, housing, clothing, medical and dental services. Selected
bidder(s) will be expected to collaborate with County in detailed
categorizing of all expenditures.
3. Ensure that each FSP team member shall have access to an adequate
amount of financial resources to make emergency purchases of food,
shelter, clothing, prescriptions, transportation, or other items for person
served, as needed, during regular working hours (and appropriate on-
call hours), with sound accounting practices for recording and
monitoring the use of these funds to prevent fraud, waste and abuse.
C. Intensive Case Management (ICM)
A person at this level of care would benefit from regularly scheduled case
management and 1 to 2 mental health contacts per week. This can include
but is not limited to individual therapy, group therapy, rehabilitation, case
management, peer support services, and medication management.
Minimum of one face-to-face contact per week (persons at this level need
to be seen in-person to evaluate their functioning and Activities of Daily
Living (ADLs).
D. Outpatient (OP)
Persons served at this level shall receive a minimum of one (1) contact per
week with at least one (1) face-to-face contact per month. This can include
but is not limited to individual therapy, group therapy, rehabilitation, case
management, peer support services, and medication management. This
level of treatment focuses primarily on therapeutic appointments for
individual and group treatment as well as case management and
medication services, as needed.
III. Location of Services:
Services shall be provided throughout Fresno County, primarily in the community, as
opposed to services being performed at traditional clinical offices, to increase the
likelihood of persons served accepting services, as some persons served may be
reluctant to seek services provided in traditional mental health settings.
EXHIBIT A
Page 8of15
Services can also be delivered in the home, school, or other community-based
settings as determined in collaboration with all relevant parties. Locations must
provide easy access for the person served.
Services may be offered by telehealth, if necessary to meet the person served's
needs, should be the last resort, and must be documented in the EHR to explain
person served's need. The expectations for provision of telehealth services are
subject to change by DHCS.
A. FSP
FSP level services shall be primarily provided within the community as
opposed to services being performed at traditional clinical offices to increase
the likelihood of persons served accepting services, as some persons served
may be reluctant to seek services provided in traditional mental health settings.
FSP services can be delivered in the home, community, school, or other
community-based settings as determined in collaboration with all relevant
parties. Locations must provide easy access for the person served. Contractor
should follow best practices and exercise clinical judgement to maintain
confidentiality and will be responsible for obtaining any releases for disclosure
to third parties necessary to gain access.
Telehealth, mobile services, and co-location in natural supports and gathering
places for the intended population are additional options to increase the
frequency of persons served obtaining needed services.
For office-based hours, Contractor must provide the hours of highest need for
this target population. Contractor should have a plan for transportation or
access to services for this target population. FSP services shall be delivered
wherever the intended target population resides, throughout Fresno County.
B. ICM and OP
Contractor shall provide Field-based and/or Clinic-based service delivery for
ICM and OP level services as needed. Contractor should have a written plan
to explain how ICM and OP level services would be provided with the following
understanding of the difference between Field-based and Clinic-based service
delivery:
Clinic-based service delivery means less than fifty percent (50%) of services
are in the field. Field-based service delivery are services that do not occur
through telehealth and do not occur in designated sites in which the contractor
is afforded regular access. Designated sites shall be identified by Contactor
within their written plan.
IV. Hours of Operation:
EXHIBIT A
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A. Standard hours of operation during which all levels of care can access
services shall be Monday through Friday, 8:00 AM — 5:00 PM.
B. Contractor shall temporarily extend office hours for all levels of care, as
needed, to accommodate the needs of the individuals served and improve
timeliness of services.
C. A PSC, Case Manager, or other qualified individual employed by
Contractor and known to FSP persons served and/or their family shall be
available to persons served and their family 24 hours a day, 7 days a week,
including holidays and weekends, to provide after-hours interventions as
needed. Other existing resources such as 988, mobile crisis services, etc.
do not suffice.
V. Length of Stay
Contractor shall ensure periodic evaluation of persons served for appropriate
placement or movement to another level of care. Contractor shall coordinate with DBH
to ensure continuing eligibility for persons served.
VI. Referral Sources and Referral Process:
A. Referrals may come from various sources including but not limited to
mental health providers, school employees, primary care physicians, other
community supports, or family members.
B. FSP Referrals must be completed on the Fresno County Youth FSP
Referral Form and will be reviewed and processed by Fresno County DBH.
C. ICM and OP referrals may be made via phone call, walk-in, or messaging
through Fresno County's EHR, directly to Contractor.
D. All referrals must be processed in a timely manner as outlined by DHCS
and CalAIM and may not be waitlisted.
VI I.Care Coordination/Transition Plans:
A. Intake and Initial Assessment
Contractor must complete "Fresno County Department of Behavioral
Health Attestation to Legal Right to Consent" or"Caregivers Authorization
Affidavit", which can be access by the following link: Continuum of Care
Info/Referrals OP/ICM/FSP - County of Fresno as needed, to ensure the
timely provision of services.
Contractor shall follow their established plans to process referrals and
begin the intake process within the timeliness standards outlined below,
including a plan for outreach and engagement activities as needed.
For all levels of care, Contractor shall adhere to the timeliness standards
set forth by the DHCS and Fresno County's DBH. An initial mental health
EXHIBIT A
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assessment shall be completed within a clinically appropriate timeframe. If
the timeframe exceeds thirty (30) days,justification for this delay shall be
clearly represented in the clinical documentation.
B. Transition and Discharge
Contractor shall ensure that transition and discharge procedures are
supportive, minimally disruptive, and clinically appropriate.
Persons served referred for services may be denied services if the referred
individual does not meet medical necessity for specialty mental health
services or meets medical necessity for a mental health diagnosis that is
not covered by the County's MHP. Individuals who are determined to be
ineligible for services shall be assessed and linked to the appropriate
services.
Persons served shall be transitioned between levels of care as clinically
appropriate. Transitional supports shall be provided (i.e., a warm handoff)
to ensure that persons served are appropriately linked and engaged in
services before terminating services.
Discharge is determined on a case-by-case basis, as clinically appropriate.
Reasons for discharge include: the person served, or caregiver refuses or
terminates services; the person served is transferred to another program
mutually agreed upon by the treatment team, person served (and their
guardian, if applicable) agrees that the treatment goals have been met,
and/or the target person served is 18 years old or older.
Vill. Level of Care/Modality of Services:
Persons served will be assigned to a level of care based on symptoms and level of
need: FSP, ICM, or OP.
A. Full-Service Partnership (FSP)
Persons served in the FSP level of care benefit from the "whatever it takes"
approach to services, which focus on innovative "no fail" services. Youth at
this level meet the State-defined FSP criteria and require higher intensity
services to meet their needs. FSP has an increased focus on engagement,
collaboration with the youth/family, and stabilization to achieve mutually
agreed upon treatment goals. Persons served at this level of care receive
at least three (3) contacts per week, or as clinically appropriate, with most
contacts being in-person, face-to-face, unless individual person-centered
clinical factors warrant another modality of service contact.
1. Caseload
a. Maximum caseload: 1:15
2. Length of Stay
EXHIBIT A
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a. Suggested length of stay is eighteen (18) to twenty-four
(24) months, with the assigned provider evaluating the
needs of each person served on an ongoing basis to
ensure that the level of care is clinically appropriate.
B. Intensive Case Management (ICM)
Persons served in the ICM level of care benefit from regularly scheduled
case management, individual rehabilitation and/or individual therapy.
Persons served at this level receive a minimum of one (1) to two (2) mental
health contacts per week with one (1) of those contacts being in-person,
face-to-face.
1. Caseload
a. Maximum caseload: 1:30
2. Length of Stay
a. Suggested length of stay is twelve (12) to twenty-four
(24) months, with the assigned provider evaluating the
needs of each person served on an ongoing basis to
ensure that the level of care is clinically appropriate.
C. Outpatient (OP)
Persons served in the OP level of care benefit from therapeutic
appointments for individual/group treatment, and case management and
medication services, as needed. Persons served at this level receive a
minimum of one (1) contact per week with at least one (1) in-person, face-
to-face contact per month.
1. Caseload
a. Maximum caseload: 1:40
2. Length of Stay
a. Suggested length of stay is twelve (12) to eighteen (18)
months, with assigned provider evaluating the needs of
each person served on an ongoing basis to ensure that
the level of care is clinically appropriate.
Persons served (including any significant support persons receiving SMHS)
must be enrolled, disenrolled, and/or reenrolled in the EHR program listing
that aligns with the level of care in which they are receiving services (either
FSP, OP, or ICM), as that level changes.
IX. Evidence-Based Practice(s):
EXHIBIT A
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Contractor shall utilize EBPs and interventions to offer clinically appropriate,
unduplicated services and maintain fidelity to the FSP model, including provision of
psychiatric services.
Contractor shall utilize Dialectical Behavior Therapy (DBT), and Trauma Informed
Care (TIC), as well as other EBPs throughout their programming as clinically
appropriate, to employ harm reduction and strength-based approaches. Examples of
EBPs include but are not limited to:
A. Motivational Interviewing (MI)
B. Cognitive Behavioral Therapy (CBT)
C. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
D. Seeking Safety
E. Wellness Recovery Action Plan (WRAP)
F. Aggression Replacement Training
G. Transition to Independence Process (TIP)
H. Cognitive Behavioral Therapy for Psychosis (CBTp)
Other evidence-based practice models recognized as effective in improving
functioning of the target population, and as befitting the Contractor's program vision
may also be utilized if deemed appropriate.
X. COUNTY shall:
A. Assist Contractor's efforts to evaluate the needs of each person served on
an ongoing basis to ensure that the level of care they are receiving is
clinically appropriate.
B. Provide oversight and collaborate with Contractor 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 DHCS and or other oversight agencies regarding
program administration and outcomes.
C. Assist Contractor in making linkages with the total mental health system of
care. This will be accomplished through regularly scheduled meetings as
well as formal and informal consultation.
D. Participate in evaluating overall program progress and efficiency and be
available to Contractor for ongoing consultation.
E. Gather outcome information from target person served groups and
Contractor throughout each term of the Agreement. County shall notify
Contractors when their participation is required. The performance outcome
EXHIBIT A
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measurement process shall not be limited to survey instruments but will
also include, as appropriate, person served and staff interviews, chart
reviews, data analysis and other methods of obtaining required information.
To comply with changing regulations, outcome and data tracking
requirements are expected to change and County will inform and work with
the Contractor to adapt throughout the term of the Agreement.
F. Assist Contractor's efforts toward cultural and linguistic responsiveness by
providing technical assistance regarding cultural responsiveness
requirements
XI. STAFFING
Contractor shall maintain staffing plans/patterns sufficient to deliver the volume of
services needed to meet the community's need by keeping referrals open at all times
and never placing persons served/to be served on a waitlist.
Clinical Supervisors and the clinical training program must meet the California Board
of Behavioral Sciences and/or California Board of Psychology standards.
Contractor will be encouraged to hire and recruit those with lived experience including
persons served or their family members that have previously received behavioral
health services. Peer support services are required as part of the program design.
XI I.CONTRACTOR shall:
A. Provide staffing appropriate for services needed at each level of care,
including clinicians, rehabilitation specialists, case managers, therapists,
peer support specialists, psychiatrists, and nurses.
B. Follow the projected team size and staffing pattern outlined in their
proposal and defined in job classifications and responsibilities of each
position including staff supervision responsibilities.
a. Staffing shall include the following classifications:
1. Team Leader/Program Director
2. Licensed/Registered/Waivered Mental Health Clinician
3. Personal Service Coordinator/Case Manager
4. Certified Peer Support Specialist
5. Registered Nurse, Licensed Vocational Nurse, or Nurse
Practitioner
6. Licensed Psychiatrist
C. Consider the linguistic and cultural needs of the community when recruiting
for all positions, as well as personal and professional experiences.
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D. Maintain an up-to-date caseload record of all persons enrolled in services,
and provide person, programmatic, and other demographic information to
the County.
E. Ensure their psychiatrist meets with persons served monthly at a minimum
and is available during normal business hours and on-call during off-hour
periods. This position may be subcontracted out.
F. Maintain sufficient staffing to ensure each FSP enrolled person served is
assigned to a Personal Service Coordinator, community needs are met,
that there are no waitlists for any of the three levels of care, and that
referrals are open at all times.
G. Require staff members working directly with persons served to provide
outreach outside of the office setting and have the capacity to provide as
many contacts as needed with persons served to meet their
recovery/resiliency and wellness goals.
H. Have a plan for how they will minimize staff turnover and cultivate staff
retention. Contractor will also do salary market research to assure
competitive salaries for positions to curb staff turnover.
I. Offer Peer Support resources:
MHSA funding incorporates a person served/family-focused peer support
component that enhances bi-cultural and bilingual peer-centered services.
Services will include but not be limited to: support groups, one-on-one
assistance, linkages with a peer navigator, and support. The ISSP can
include the use of Peer Support resources. Peer support services are
Medi-Cal billable when the Peer Support Specialist has completed the
County-approved Peer Support Specialist Training and has received their
certification, and the designated supervisor has completed the County-
approved Peer Support Supervisor training.
J. Ensure staff meet required trainings and training expectations.
Contractor's employees, volunteers, interns, and student trainees or
subcontractors of Contractor, in each case, are expected to perform
professional services per an agreement with County. Contractor will comply
with the training requirements and expectations referenced in Exhibit B,
Attachment D, Training Requirements Reference Guide.
Trainings are to be completed by Contractor's staff after contract execution,
in a timely manner. Completion deadlines for trainings are listed in Exhibit
B, Attachment D 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.
EXHIBIT A
Page 15 of 15
K. Provide a sufficient number of licensed staff 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)
Exhibit B
Page 1 of 24
Fresno County Behavioral Health Requirements
I. General Requirements
a. Guiding Principles. Contractor shall align programs, services, and practices with the
vision, mission, and guiding principles of the DBH, as further described in Exhibit B—
Attachment A to this Agreement,titled "Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery".
b. Rights of Persons Served. Contractor shall post signs informing persons served of their
right to file a complaint or grievance, appeals, and expedited appeals. In addition,
Contractor shall inform every person served of their rights as set forth in Exhibit B—
Attachment B to this agreement,titled "Rights of Persons Served".
c. Records. Contractor shall maintain records in accordance with Exhibit B—Attachment C
to this Agreement,titled "Documentation Standards for Persons Served Records".All
records of the person served shall be maintained for a minimum of ten (10)years from
the date of the end of this Agreement.
d. Licenses/Certificates.Throughout the term of this Agreement, Contractor and
Contractor's staff shall maintain all necessary licenses, permits, approvals, certificates,
waivers and exemptions necessary for the provision of the services hereunder and
required by the laws and regulations of the United States of America, State of California,
the County of Fresno, and any other applicable governmental agencies. Contractor shall
notify County immediately in writing of its inability to obtain or maintain such licenses,
permits, approvals, certificates,waivers and exemptions irrespective of the pendency of
any appeal related thereto.Additionally, Contractor and Contractor's staff shall comply
with all applicable laws, rules or regulations, as may now exist or be hereafter changed.
e. Organizational Provider. Contractor shall maintain requirements 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 agrees that prior to providing services under the terms and
conditions of this Agreement, Contractor shall have staff hired and in place for program
services and operations or County may, in addition to other remedies it may have,
1
Exhibit B
Page 2 of 24
suspend referrals or terminate this Agreement, in accordance to Article 6 of this
Agreement.
g. Training. Contractor agrees that its employees,volunteers, interns, and student trainees
or subcontractors of Contractor, in each case, are expected to perform professional
services per an agreement with County. Contractor will comply with the training
requirements and expectations referenced in Exhibit B—Attachment D to this
Agreement,titled "Department of Behavioral Health Selected Bidder Training
Requirements Reference Guide".
h. Credentialing and Recredentialing. Each individual Contractor staff shall not provide any
specialty mental health services without an approved credentialing application from
County. Contractor and their respective staff must follow the uniform process for
credentialing and recredentialing of service providers established by County, including
disciplinary actions such as reducing, suspending, or terminating provider's privileges.
Failure to comply with specified requirements can result in suspension or termination of
an individual or provider.
Upon request, the Contractor must demonstrate to the County that each of its
providers are qualified in accordance with current legal, professional, and technical
standards, and that they are appropriately licensed, registered,waivered, and/or
certified.
Contractor must not employ or subcontract with providers debarred, suspended
or otherwise excluded (individually, and collectively referred to as"Excluded")from
participation in Federal Health Care Programs, including Medi-Cal/Medicaid or
procurement activities, as set forth in 42 C.F.R. §438.610. See section IV below.
Contractor is required to verify and document at a minimum every three years that each
network provider that delivers covered services continues to possess valid credentials,
including verification of each of the credentialing requirements as per the County's
uniform process for credentialing and recredentialing. If any of the requirements are not
up-to-date, updated information should be obtained from network providers to
complete the re-credentia ling process.
i. Criminal Background Check. Contractor shall ensure that all providers and/or
subcontracted providers consent to a criminal background check, including
fingerprinting to the extent required under state law and 42 C.F.R. §455.434(a).
2
Exhibit B
Page 3 of 24
Contractor shall provide evidence of completed consents when requested by the County,
DHCS or the US Department of Health & Human Services (US DHHS).
j. Clinical Leadership. Contractor 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,the Contractor will hire,train, and credential staff, and County will perform
additional staff credentialing to ensure compliance with State and Federal regulations, if
applicable.
I. Subcontracts. Contractor shall obtain written approval from County's Department of
Behavioral Health Director, or designee, before subcontracting any of the services
delivered under this Agreement. County's Department of Behavioral Health Director, or
designee, retains the right to approve or reject any request for subcontracting services.
Any transferee, assignee, or subcontractor will be subject to all applicable provisions of
this Agreement, and all applicable State and Federal regulations.
Contractor shall be held primarily responsible by County for the performance of
any transferee, assignee, or subcontractor unless otherwise expressly agreed to in
writing by County's Department of Behavioral Health Director, or designee.The use of
subcontractors by Contractor shall not entitle Contractor to any additional compensation
that is provided for under this Agreement.
m. Reports.The Contractor shall submit the following reports and data:
i. Outcome Data. Contractor shall submit to County program performance
outcome data, as requested. Outcome data and outcome requirements are
listed in Exhibit B—Attachment E to this Agreement,titled "Program Outcomes
and Performance Measurements". Outcome data and outcome requirements
are subject to change at County's discretion.
ii. Additional Reports. Contractor shall also furnish to County such statements,
records, reports, data, and other information as County may request pertaining
to matters covered by this Agreement. In the event that Contractor fails to
provide such reports or other information required hereunder, it shall be
3
Exhibit B
Page 4 of 24
deemed sufficient cause for County to withhold monthly payments until there is
compliance. In addition, Contractor shall provide written notification and
explanation to County within five (5) days of any funds received from another
source to conduct the same services covered by this Agreement.
n. Timely Access. It is the expectation of the County that Contractor provide timely access
to services that meet the State of California standards for care. Contractor shall track
timeliness of services to persons served and provide a monthly report showing the
monitoring or tracking tool that captures this data. County and Contractor shall meet to
go over this 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 with timely access
standards.
o. Compliance with Behavioral Health Specific Laws.
i. Contractor shall provide services in conformance with all applicable State and
Federal statutes, regulations and sub regulatory guidance, as from time to time
amended, including but not limited to:
1. California Code of Regulations,Title 9;
2. California Code of Regulations,Title 22;
3. California Welfare and Institutions Code, Division 5;
4. United States Code of Federal Regulations (CFR),Title 42, including but
not limited to Parts 438 and 455;
5. United States CFR,Title 45;
6. United States Code,Title 42 (The Public Health and Welfare), as
applicable;
7. Balanced Budget Act of 1997;
8. Health Insurance Portability and Accountability Act (HIPAA); and
9. Applicable Medi-Cal laws and regulations, including applicable sub-
regulatory guidance, such as Behavioral Health Information Notices
(BHINs), Mental Health and Substance Use Disorder Services
Information Notices (MHSUDS INs), and provisions of County's, state or
federal contracts governing services for persons served.
ii. In the event any law, regulation, or guidance referred to in this section is
amended during the term of this Agreement, the parties agree to comply with
4
Exhibit B
Page 5 of 24
the amended authority as of the effective date of such amendment without
amending this Agreement.
iii. Contractor recognizes that County operates its mental health programs under an
agreement with DHCS, and that under said agreement the State imposes certain
requirements on County and its subcontractors. Contractor shall adhere to all
State requirements, including those identified in Exhibit B—Attachment F to this
Agreement,titled "State Behavioral Health Requirements".
p. Meetings. Contractor shall participate in monthly, or as needed,workgroup meetings
consisting of staff from County's DBH to discuss service requirements, data reporting,
training, policies and procedures, overall program operations and any problems or
foreseeable problems that may arise. Contractor shall also participate in other County
meetings, such as but not limited to quality improvement meetings, provider meetings,
audit meetings, Behavioral Health Board meetings, bi-monthly contractor meetings, etc.
Schedule for these meetings may change based on the needs of the County.
q. Monitoring. Contractor agrees to extend to County's staff, County's DBH and the
California Department of Health Care Services (DHCS), or their designees,the right to
review and monitor records, programs, or procedures, at any time, in regard to persons
served, as well as the overall operation of Contractor's programs, in order to ensure
compliance with the terms and conditions of this Agreement.
r. Electronic Health Record. Contractor currently maintains and may continue to maintain
its records in County's EHR system in accordance with Exhibit B—Attachment G,
"Electronic Health Record Requirements and Service Data", free of charge, as licenses
become available.The person served record shall begin with registration and intake, and
include person served authorizations, assessments, plans of care, and progress notes, as
well as other documents as approved by County. County shall be allowed to review
records of all and any services provided. If Contractor determines to maintain its records
in the County's EHR, it shall provide County's DBH Director, or designee,with a thirty
(30) day notice. If at any time Contractor chooses not to maintain its records in the
County's EHR, it shall provide County's DBH Director, or designee, with thirty(30) days
advance written notice and Contractor will be responsible for obtaining its own system,
at its own cost, for electronic health records management.
5
Exhibit B
Page 6 of 24
Disclaimer
County makes no warranty or representation that information entered into the
County's DBH EHR system by Contractor will be accurate, adequate, or satisfactory for
Contractor's own purposes or that any information in Contractor's possession or control,
or transmitted or received by Contractor, is or will be secure from unauthorized access,
viewing, use, disclosure, or breach. Contractor is solely responsible for person served
information entered by Contractor into the County's DBH EHR system. Contractor agrees
that all Private Health Information (PHI) maintained by Contractor in County's DBH EHR
system will be maintained in conformance with all HIPAA laws, as stated in section IX,
"Federal and State Laws."
s. Generative Artificial Intelligence Technology Use& Reporting
i. During the term of the Agreement, Contractor must notify the County in writing
if their services or any work under this Agreement includes, or makes available,
any previously unreported Generative Artificial Intelligence (GenAl)technology,
including GenAl from third parties or subcontractors. Contractor must provide
information by submitting a "Generative Artificial Intelligence (GenAl) Reporting
and Factsheet (STD 1000)" In addition, Contractor must notify the County of
any new or previously unreported GenAl technology. At the direction of the
County, Contractor shall discontinue the use of any new or previously
undisclosed GenAl technology that materially impacts functionality, risk or
contract performance, until use of such GenAl technology has been approved by
the County.
ii. Failure to disclose GenAl use to the County and failure to submit the GenAl
Reporting and Factsheet(STD 1000) may be considered a breach of this
Agreement and are grounds for immediate termination in accordance with
Article 6 of this Agreement.
t. Confidentiality.
i. The County and the Contractor may have access to information that the other
considers to be a trade secret as defined in California Government Code section
7924.510(f).
ii. Each party shall use the other's Information only to perform its obligations
under, and for the purposes of, the Agreement. Neither party shall use the
6
Exhibit B
Page 7 of 24
Information of the other Party for the benefit of a third party. Each Party shall
maintain the confidentiality of all Information in the same manner in which it
protects its own information of like kind, but in no event shall either Party take
less than reasonable precautions to prevent the unauthorized disclosure or use
of the Information.
iii. The Contractor shall not disclose the County's data except to any third parties as
necessary to operate the Contractor Products and Services (provided that the
Contractor hereby grants to the County, at no additional cost, a non-perpetual,
noncancelable, worldwide, nonexclusive license to utilize any data, on an
anonymous or aggregate basis only,that arises from the use of the Contractor
Products and Services by the Contractor,whether disclosed on, subsequent to,
or prior to the Effective Date,to improve the functionality of the Contractor
Products and Services and any other legitimate business purpose,subject to all
legal restrictions regarding the use and disclosure of such information).
iv. Upon termination of the Agreement, or upon a Party's request, each Party shall
return to the other all Information of the other in its possession. All provisions of
the Agreement relating to confidentiality, ownership, and limitations of liability
shall survive the termination of the Agreement.
v. All services performed by the Contractor shall be in strict conformance with all
applicable Federal, State of California, and/or local laws and regulations relating
to confidentiality, including but not limited to, California Civil Code, California
Welfare and Institutions Code, California Health and Safety Code, California
Code of Regulations, and the Code of Federal Regulations.
u. Physical Accessibility. Physical Accessibility. In accordance with the accessibility
requirements of section 508 of the Rehabilitation Act and the Americans with Disabilities
Act of 1973, Contractor must provide physical access, reasonable accommodations, and
accessible equipment for Medi-Cal beneficiaries with physical or mental disabilities.
v. Publicity Prohibition.
i. Self-Promotion. None of the funds, materials, property, or services provided
directly or indirectly under this Agreement shall be used for Contractor's
advertising,fundraising, or publicity(i.e., purchasing of tickets/tables, silent
auction donations, etc.)for the purpose of self-promotion.
7
Exhibit B
Page 8 of 24
ii. Public Awareness. Notwithstanding the above, publicity of the services
described in Exhibit A of this Agreement shall be allowed as necessary to raise
public awareness about the availability of such specific services when approved
in advance by County's DBH Director or designee. Communication products
must follow DBH branding standards, including typefaces and colors,to
communicate our authority and project a unified brand.This includes all media
types, platforms, and all materials on and offline that are created as part of
DBH's efforts to provide information to the public.
w. Child Abuse Reporting Act.
i. Contractor shall establish a procedure acceptable to the County's DBH Director,
or designee,to ensure that all of the Contractor's employees, consultants,
subcontractors or agents described in the Child Abuse Reporting Act, section
1116 et seq. of the Penal Code, and performing services under this Agreement
shall report all known or suspected child abuse or neglect to a child protective
agency as defined in Penal Code section 11165.9.This procedure shall include:
1. A requirement that all Contractor's employees, consultants,
subcontractors or agents performing services shall sign a statement that
they know of and will comply with the reporting requirements as
defined in Penal Code section 11166(a).
2. Establishing procedures to ensure reporting even when employees,
consultants, subcontractors, or agents who are not required to report
child abuse under Penal Code section 11166(a),gain knowledge of or
reasonably suspect that a child has been a victim of abuse or neglect.
II. Informing Materials for Persons Served
a. Basic Information Requirements. Contractor shall provide information in a manner and
format that is easily understood and readily accessible to the persons served (42 C.F.R. §
438.10(c)(1)). Contractor shall provide all written materials for persons served in easily
understood language,format, and alternative formats that take into consideration the
special needs of individuals in compliance with 42 C.F.R. §438.10(d)(6). Contractor shall
inform the persons served that information is available in alternate formats and how to
access those formats in compliance with 42 C.F.R. §438.10.
Contractor shall provide the required information in this section to each
8
Exhibit B
Page 9 of 24
individual receiving Specialty Mental Health Services (SMHS) under this Agreement and
upon request (1915(b) Medi-Cal Specialty Mental Health Services Waiver, § (2), subd.
(d), at p. 26., attachments 3, 4; Cal. Code Regs.,tit. 9, §1810.360(e)).
Contractor shall utilize the County's website that provides the content required
in this section and 42 C.F.R. §438.10 and complies with all requirements regarding the
same set forth in 42 C.F.R. §438.10.
Contractor shall use the DHCS/County-developed beneficiary handbook and
persons served notices (42 C.F.R. §§438.10(c)(4)(ii),438.62(b)(3)).
b. Electronic Submission. Persons served information required in this section may only be
provided electronically by the Contractor if all the following conditions are met:
i. The format is readily accessible;
ii. The information is placed in a location on the Contractor's website that
is prominent and readily accessible;
iii. The information is provided in an electronic form which can be
electronically retained and printed;
iv. The information is consistent with the content and language
requirements of this Agreement;
v. The individual is informed that the information is available in paper form
without charge upon request and the Contractor shall provide it upon
request within five (5) business days(42 C.F.R. §438.10(c)(6)).
c. Language and Format. Contractor shall provide all written materials, including taglines,
for persons served or potential persons served in a font size no smaller than twelve (12)
point (42 C.F.R. 438.10(d)(6)(ii)). Contractor shall ensure its written materials that are
critical to obtaining services are available in alternative formats, upon request of the
person served or potential person served at no cost.
Contractor shall make its written materials that are critical to obtaining services,
including, at a minimum, provider directories, beneficiary handbook, appeal and
grievance notices, denial and termination notices, and the Contractor's mental health
education materials, available in the prevalent non-English languages in the County (42
C.F.R. §438.10(d)(3)).
Contractor notify persons served, prospective persons served, and members of
the public that written translation is available in prevalent languages free of cost and
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Exhibit B
Page 10 of 24
how to access those materials (42 C.F.R. §438.10(d)(5)(i), (iii); Welfare& Inst. Code §
14727(a)(1); Cal. Code Regs.tit. 9 § 1810.410, subd. (e), para. (4)). Contractor shall make
auxiliary aids and services available upon request and free of charge to each person
served (42 C.F.R. §438.10(d)(3)-(4)).
Contractor shall make oral interpretation and auxiliary aids, such as
Teletypewriter Telephone/Text Telephone (TTY/TDY) and American Sign Language (ASL),
available and free of charge for any language in compliance with 42 C.F.R. §438.10(d)(2),
(4)-(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. 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
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 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
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Exhibit B
Page 11 of 24
6. Change of Provider form
7. Suggestions brochure
All beneficiary informing written materials will use easily understood language and
format (i.e. material written and formatted at a 6th grade reading level), and will use a
font size no smaller than twelve (12) point.All beneficiary informing written materials
shall inform beneficiaries of the availability of information in alternative formats and
how to make a request for an alternative format. Inventory and maintenance of all
beneficiary informing materials will be maintained by the County's DBH Plan
Administration Division. Contractor will ensure that its written materials include taglines
or that an additional taglines document is available.
e. Beneficiary Handbook. Contractor shall provide each person served with a beneficiary
handbook at the time the individual first accesses services and thereafter upon request.
The beneficiary handbook shall be provided to beneficiaries within fourteen (14)
business days after receiving notice of enrollment. Contractor shall give each individual
notice of any significant change to the information contained in the beneficiary
handbook at least thirty(30) days before the intended effective date of change as per
BHIN 22-060.
f. Accessibility. Required informing materials must be electronically available on
Contractor's website and must be physically available at the Contractor's facility lobby
for individuals' access.
Informing materials must be made available upon request, at no cost, in
alternate formats(i.e., Braille or audio) and auxiliary aids(i.e., California Relay Service
(CRS) 711 and American Sign Language) and must be provided to persons served within
five (5) business days. Large print materials shall be in a minimum of eighteen (18) point
font size.
Informing materials will be considered provided to the individual if Contractor
does one or more of the following:
i. Mails a printed copy of the information to the persons served's mailing
address before the individual receives their first specialty mental health
service;
ii. Mails a printed copy of the information upon the individual's request to
their mailing address;
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Exhibit B
Page 12 of 24
iii. Provides the information by email after obtaining the agreement of the
person served to receive the information by email;
iv. Posts the information on the Contractor's website and advises the
person served in paper or electronic form that the information is
available on the internet and includes applicable internet addresses,
provided that individuals with disabilities who cannot access this
information online are provided auxiliary aids and services upon request
and at no cost; or,
v. Provides the information by any other method that can reasonably be
expected to result in the person served receiving that information. If
Contractor provides informing materials in person, when the individual
first receives specialty mental health services,the date and method of
delivery shall be documented in the file of the person served.
g. Provider Directory. Contractor must follow the County's provider directory policy, in
compliance with MHSUDS IN 18-020.
Contractor must make available to persons served, in paper form upon request
and electronic form,specified information about the County provider network as per 42
C.F.R. §438.10(h).The most current provider directory is electronically available on the
County website and is updated by the County no later than thirty(30) calendar days
after information is received to update provider information.A paper provider directory
must be updated at least monthly as set forth in 42 C.F.R. §438.10(h)(3)(i).
Any changes to information published in the provider directory must be
reported to the County within two (2)weeks of the change.
Contractor will only need to report changes/updates to the provider directory
for licensed,waivered, or registered mental health providers.
III. Assurances
Certification of Non-exclusion or Suspension from Participation in a Federal Health Care
Program.
a. In entering into this Agreement, Contractor certifies that it is not excluded from
participation in Federal Health Care Programs under either Section 1128 or 1128A of the
Social Security Act. Failure to so certify will render all provisions of this Agreement null
and void and may result in the immediate termination of this Agreement.
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Exhibit B
Page 13 of 24
b. In entering into this Agreement, Contractor certifies,that the Contractor does not
employ or subcontract with providers or have other relationships with providers
excluded from participation in Federal Health Care Programs, including Medi-
Cal/Medicaid or procurement activities, as set forth in 42 C.F.R. §438.610. Contractor
shall conduct initial and monthly exclusion and suspension searches of the following
databases and provide evidence of these completed searches when requested by
County, DHCS or the US Department of Health and Human Services (DHHS):
i. www.oig.hhs.gov/exclusions-Office of Inspector General's List of Excluded
Individuals/Entities (LEIE) Federal Exclusions
ii. www.sam.gov/content/exclusions-General Service Administration (GSA)
Exclusions Extract
iii. www.Medi-Cal.ca.gov-Suspended & Ineligible Provider List
iv. https://nppes.cros.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 certifies,that Contractor does not employ
staff or individual contractors/vendors that are on the Social Security Administration's
Death Master File. Contractor shall check the database prior to employing staff or
individual contractors/vendors and provide evidence of these completed searches when
requested by the County, DHCS or the US DHHS.
d. Contractor is required to notify County immediately if Contractor becomes aware of any
information that may indicate their(including employees/staff and individual
contractors/vendors) potential placement on an exclusions list.
e. Contractor shall screen and periodically revalidate all network providers in accordance
with the requirements of 42 C.F.R., Part 455,Subparts B and E.
f. Contractor must confirm the identity and determine the exclusion status of all its
providers, as well as any person with an ownership or control interest, or who is an
agent or managing employee of the contracted agency through routine checks of federal
and state databases.This includes the Social Security Administration's Death Master File,
NPPES, the Office of Inspector General's LEIE,the Medi-Cal Suspended and Ineligible
Provider List (S&I List) as consistent with the requirements of 42 C.F.R. §455.436.
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Exhibit B
Page 14 of 24
g. If Contractor finds a provider that is excluded, it must promptly notify the County as per
42 C.F.R. §438.608(a)(2), (4).The Contractor shall not certify or pay any excluded
provider with Medi-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 shall institute and conduct a Quality Assurance Process for
all services provided hereunder.
Contractor shall provide County with notification and a summary of any internal
audit exceptions and the specific corrective actions taken to sufficiently reduce the
errors that are discovered through Contractor's internal audit process. Contractor shall
provide this notification and summary to County as requested by the County.
b. Access to Records. Contractor shall provide County with access to all documentation of
services provided under this Agreement for County's use in administering this
Agreement. Contractor shall allow County,the Centers for Medicare and Medicaid
Services (CMS),the Office of the Inspector General,the Controller General of the United
States, and any other authorized Federal and State agencies to evaluate performance
under this Agreement, and to inspect, evaluate, and audit any and all records,
documents, and the premises, equipment and facilities maintained by the Contractor
pertaining to such services at any time and as otherwise required under this Agreement.
V. Right to Monitor
a. Right to Monitor. County or any subdivision or appointee thereof, and the State of
California or any subdivision or appointee thereof, including the Auditor General, shall
have absolute right to review and audit all records, books, papers, documents, corporate
minutes,financial records, staff information, records of persons served, other pertinent
items as requested, and shall have absolute right to monitor the performance of
Contractor in the delivery of services provided under this Agreement. Full cooperation
shall be given by the Contractor in any auditing or monitoring conducted, according to
this agreement.
b. Accessibility. Contractor shall make all of its premises, physical facilities, equipment,
books, records, documents, agreements, computers, or other electronic systems
pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities
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Exhibit B
Page 15 of 24
furnished under the terms of this Agreement, or determinations of amounts payable
available at any time for inspection, examination, or copying by County, the State of
California or any subdivision or appointee thereof, CMS, U.S. Department of Health and
Human Services (HHS) Office of Inspector General,the United States Controller General
or their designees, and other authorized federal and state agencies.This audit right will
exist for at least ten (10)years from the final date of the Agreement period or in the
event the Contractor has been notified that an audit or investigation of this Agreement
has commenced, until such time as the matter under audit or investigation has been
resolved, including the exhaustion of all legal remedies, whichever is later(42 CFR
§438.230(c)(3)(I)-(ii)).
The County, DHCS, CMS, or the HHS Office of Inspector General may inspect,
evaluate, and audit the Contractor at any time if there is a reasonable possibility of fraud
or similar risk. The Department's inspection shall occur at the Contractor's place of
business, premises, or physical facilities (42 CFR §438.230(c)(3)(iv))
c. Cooperation. Contractor 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, County may audit,
monitor, and/or request information from Contractor to ensure compliance with laws,
regulations, and requirements, as applicable.
d. Probationary Status. County reserves the right to place Contractor on probationary
status, as referenced in the Probationary Status Article, should Contractor fail to meet
performance requirements; including, but not limited to violations such as failure to
report incidents and changes as contractually required,failure to correct issues,
inappropriate invoicing, untimely and inaccurate data entry, not meeting performance
outcomes expectations, and violations issued directly from the State. Additionally,
Contractor may be subject to Probationary Status or termination if agreement
monitoring and auditing corrective actions are not resolved within specified timeframes.
e. Record Retention. Contractor shall retain all records and documents originated or
prepared pursuant to Contractor's performance under this Agreement, including
grievance and appeal records, and the data, information and documentation specified in
42 CFR parts 438.604,438.606,438.608, and 438.610 for a period of no less than ten
15
Exhibit B
Page 16 of 24
(10)years from the term end date of this Agreement or until such time as the matter
under audit or investigation has been resolved. Records and documents include but are
not limited to all physical and electronic records and documents originated or prepared
pursuant to Contractor's or subcontractor's performance under this Agreement including
working papers, reports,financial records and documents of account, records of persons
served, prescription files, subcontracts, and any other documentation pertaining to
covered services and other related services for persons served.
f. Facilities and Assistance. Contractor shall provide all reasonable facilities and assistance
for the safety and convenience of the County's representatives in the performance of
their duties.All inspections and evaluations shall be performed in such a manner that
will not unduly delay the work of Contractor.
g. County Discretion to Revoke. County has the discretion to revoke full or partial
provisions of the Agreement, delegated activities or obligations, or application of other
remedies permitted by state or federal law when the County or DHCS determines
Contractor has not performed satisfactorily.
h. Site Inspection.Without limiting any other provision related to inspections or audits
otherwise set forth in this Agreement, Contractor shall permit authorized County, state,
and/or federal agency(ies),through any authorized representative,the right to inspect
or otherwise evaluate the work performed or being performed hereunder including
subcontract support activities and the premises which it is being performed. Contractor
shall provide all reasonable assistance for the safety and convenience of the authorized
representative in the performance of their duties. All inspections and evaluations shall
be made in a manner that will not unduly delay the work of the Contractor.
VI. Complaint Logs and Grievances
a. Documentation. Contractor shall log complaints and the disposition of all complaints
from a person served or their family. Contractor shall provide a copy of the detailed
complaint log entries concerning County-sponsored persons served to County at
monthly intervals by the tenth (10th) day of the following month, in a format that is
mutually agreed upon. Contractor shall allow persons served or their representative to
file a grievance either orally, or in writing at any time with the Behavioral Health Plan. In
the event Contractor is notified by a person served or their representative of a
discrimination grievance, Contractor shall report discrimination grievances to the County
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Exhibit B
Page 17 of 24
within 24 hours.The Contractor shall not require a person served or their representative
to file a Discrimination Grievance with the County before filing the complaint directly
with the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for
Civil Rights.
b. Rights of Persons Served. Contractor shall comply with applicable laws and regulations
relating to patients' rights, including but not limited to Wel. & Inst. Code 5325, Cal. Code
Regs.,tit. 9,sections 862 through 868, and 42 CFR §438.100.The Contractor shall
ensure that its subcontractors comply with all applicable patients' rights laws and
regulations.
c. Incident Reporting. Contractor shall file an incident report for all incidents involving
persons served,following County DBH's Incident Reporting protocol.
VII. Compliance Requirements
a. Internal Monitoring and Auditing
i. Contractor shall be responsible for conducting internal monitoring and auditing
of its agency. Internal monitoring and auditing include, but are not limited to
billing practices, licensure/certification verification and adherence to County,
State and Federal regulations.
1. Contractor shall not submit false, fraudulent, inaccurate or fictitious
claims for payment or reimbursement of any kind.
2. Contractor shall bill only for those eligible services actually rendered
which are also fully documented.
3. Contractor shall ensure all employees/service providers maintain
current licensure/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 identify improper procedures, actions or circumstances,
including fraud/waste/abuse and/or systemic issue(s), Contractor shall take
prompt steps to correct said problem(s). Contractor shall report to DBH any
overpayments discovered as a result of such problems no later than five (5)
business days from the date of discovery,with the appropriate documentation,
and a thorough explanation of the reason for the overpayment. Prompt
mitigation, corrective action and reporting shall be in accordance with the DBH
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Exhibit B
Page 18 of 24
Overpayment Policy and PPG Prevention, Detection, Correction of Fraud, Waste
and Abuse which will be provided to Contractor 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 shall either adopt DBH's Compliance Plan/Program or establish its
own Compliance Plan/Program and provide documentation to County DBH to
evaluate whether the Program is consistent with the elements of a Compliance
Program as recommended by the United States Department of Health and
Human Services, Office of Inspector General.
ii. Contractor's Compliance Program must include the following elements:
1. Designation of a compliance officer who reports directly to the Chief
Executive Officer and the Contactor's Board of Directors and compliance
committee comprised of senior management who are charged with
overseeing the Contractor's compliance program and compliance with
the requirements of this account.The committee shall be accountable
to the Contractor's Board of Directors.
iii. Policies and Procedures
1. Contractor shall have written policies and procedures that articulate the
Contractor's commitment to comply with all applicable Federal and
State standards. Contractor shall adhere to applicable County DBH
Policies and Procedures relating to the Compliance Program or develop
its own compliance-related policies and procedures.
iv. Contractor shall establish and implement procedures and a system with
dedicated staff for routine internal monitoring and auditing of compliance risks,
prompt response to compliance issues as they arise, investigation of potential
compliance problems as identified in the course of self-evaluation and audits,
correction of such problems promptly and thoroughly(or coordination of
suspected criminal acts with law enforcement agencies)to reduce the potential
for recurrence, and ongoing compliance with the requirements under this
Agreement.
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Exhibit B
Page 19 of 24
v. Contractor shall implement and maintain written policies for all County DBH-
funded employees, and of any contractor or agent,that provide detailed
information about the False Claims Act and other Federal and State laws,
including information about rights of employees to be protected as
whistleblowers.
vi. Contractor shall maintain documentation,verification or acknowledgement that
the Contractor's employees, subcontractors, interns,volunteers, and members
of Board of Directors are aware of these Policies and Procedures and the
Contractor's Compliance Program.
vii. Contractor shall have a Compliance Plan demonstrating the seven (7) elements
of a Compliance Plan. Contractor has the option to develop its own or adopt
County DBH's Compliance Plan.Should Contractor develop its own Plan,
Contractor shall submit the Plan prior to implementation for review and
approval to:
Fresno County DBH Compliance Office
1925 E. Dakota Ave.Ste A
Fresno, California 93726
Or send via email to: DBHCompliance@fresnocountyca.gov
c. Program Integrity Requirements
i. As a condition for receiving payment under a Medi-Cal managed care program,
Contractor shall comply with the provisions of Title 42 CFR Sections 438.604,
438.606,438.608 and 438.610. Contractor must have administrative and
management processes or procedures, including a mandatory compliance plan,
that are designed to detect and prevent fraud,waste or abuse.
ii. If Contractor identifies an issue or receives notification of a complaint
concerning an incident of possible fraud,waste, or abuse, Contractor shall
immediately notify County DBH; conduct an internal investigation to determine
the validity of the issue/complaint; and develop and implement corrective
action if needed.
iii. If Contractor's internal investigation concludes that fraud or abuse has occurred
or is suspected, the issue if egregious, or beyond the scope of the Contractor's
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Exhibit B
Page 20 of 24
ability to pursue,the Contractor shall immediately report to the County DBH
Compliance Office for investigation, review and/or disposition.
iv. Contractor shall immediately report to DBH any overpayments identified or
recovered, specifying the overpayments due to potential fraud.
v. Contractor shall immediately report any information about changes in the
circumstances of the person served that may affect the person's eligibility,
including changes in the residence of the person served or the death of the
individual.
vi. Contractor shall immediately report any information about a change in
Contractor's or Contractor's staff circumstances that may affect eligibility to
participate in the behavioral health program.
vii. Contractor understands DBH, CMS, or the HHS Inspector General may inspect,
evaluate, and audit the Contractor at any time if there is a reasonable possibility
of fraud or similar risk.
d. Code of Conduct
i. Contractor shall take precautions to ensure that claims are prepared and
submitted accurately,timely and are consistent with all applicable laws,
regulations, rules or guidelines.
ii. Contractor shall ensure that no false,fraudulent, inaccurate or fictitious claims
for payment or reimbursement of any kind are submitted.
iii. Contractor shall bill only for eligible services actually rendered and fully
documented.
iv. Contractor shall act promptly to investigate and correct problems if errors in
claims or billing are discovered.
v. Contractor shall comply with County's Code of Conduct and Ethics and the
County's Compliance Program in accordance with Exhibit B—Attachment H to
this Agreement,titled "Fresno County Mental Health Compliance Program".
e. Network Adequacy. Contractor shall ensure that all services covered under this
Agreement are available and accessible to persons served in a timely manner and in
accordance with the network adequacy standards required by regulation. (42 C.F.R.
§438.206(a), (c)).
Contractor shall submit, when requested by County and in a manner and format
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Exhibit B
Page 21 of 24
determined by the County, network adequacy certification information to the County,
utilizing a provided template or other designated format.
Contractor shall submit updated network adequacy information to the County
any time there has been a significant change that would affect the adequacy and
capacity of services.
To the extent possible and appropriately consistent with CCR,Title 9, §1830.225
and 42 C.F.R. §438.3 (1),the Contractor shall provide a person served the ability to
choose the person providing services to them.
VIII. Federal and State Laws.
a. Health Insurance Portability and Accountability Act. County and Contractor each consider
and represent themselves as covered entities as defined by the U.S. Health Insurance
Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and agree to use and
disclose Protected Health Information (PHI) as required by law.
County and Contractor acknowledge that the exchange of PHI between them is only for
treatment, payment, and health care operations.
County and Contractor intend to protect the privacy and provide for the security of PHI
pursuant to this Agreement in compliance with HIPAA, the Health Information Technology
for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
promulgated thereunder by the U.S. Department of Health and Human Services(HIPAA
Regulations) and other applicable laws.
As part of the HIPAA Regulations,the Privacy Rule and the Security Rule require
Contractor to enter into an agreement containing specific requirements prior to the
disclosure of PHI, as set forth in, but not limited to,Title 45, Sections 164.314(a), 164.502(e)
and 164.504(e) of the Code of Federal Regulations.
b. Contractor and County mutually agree to maintain the confidentiality of records and
information of persons served in compliance with all applicable State and Federal statutes
and regulations, including, but not limited to, HIPAA, California Confidentiality of Medical
Information Act (CMIA), and California Welfare and Institutions Code section 5328. The
Parties shall inform all of their employees and agents who perform services under this
Agreement of the confidentiality provisions of all applicable statutes.
c. The County is a "Covered Entity," and the Contractor is a "Business Associate," as these
terms are defined by 45 CFR 160.103. As a Business Associate, Contractor agrees to comply
21
Exhibit B
Page 22 of 24
with the terms of Exhibit B—Attachment I to this Agreement,titled "Health Insurance
Portability and Accountability Act(HIPAA) Business Associate Agreement".
d. Physical Accessibility. In accordance with the accessibility requirements of section 508 of
the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor must
provide physical access, reasonable accommodations, and accessible equipment for Medi-
Cal beneficiaries with physical or mental disabilities.
IX. Quality Management Requirements.
a. Reporting.
i. Outcomes Reports. Contractor shall complete Outcomes Reports in the format
set by County. Outcomes reports shall be submitted to County's DBH for review
within thirty(30) days of the end of each quarter.
b. Quality Improvement Activities and Participation. Contractor shall comply with the
County's ongoing comprehensive Quality Assessment and Performance Improvement
(QAPI) Program (42 CFR. §438.330(a)) and work with the County to improve established
outcomes by following structural and operational processes and activities that are
consistent with current practice standards.
Contractor shall participate in quality improvement(QI) activities, including
clinical and non-clinical performance improvement projects (PIPS), as requested by the
County in relation to State and Federal requirements and responsibilities, to improve
health outcomes and individuals' satisfaction with services 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 recredentialing, and person served
grievances. Contractor 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 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
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Exhibit B
Page 23 of 24
Exhibit B—Attachment J to this Agreement,titled "National Standards on Culturally and
Linguistically Appropriate Services". Contractor shall participate in the County's efforts to
promote the delivery of services in a culturally responsive and equitable manner to all
individuals, including those with limited English proficiency and diverse cultural and
ethnic backgrounds, disabilities, and regardless of gender, sexual orientation, or gender
identity including active participation in the County's Diversity, Equity and Inclusion
Committee.
b. Policies and Procedures. Contractor shall comply with requirements of policies and
procedures for ensuring access and appropriate use of trained interpreters and material
translation services for all limited and/or no English proficient persons served, including,
but not limited to, assessing the cultural and linguistic needs of the person served,
training of staff on the policies and procedures, and monitoring its language assistance
program. Contractor's policies and procedures shall ensure compliance of any
subcontracted providers with these requirements.
c. Interpreter Services. Contractor shall notify its persons served that oral interpretation is
available for any language and written translation is available in prevalent languages and
that auxiliary aids and services are available upon request, at no cost and in a timely
manner for limited and/or no English proficient persons served and/or persons served
with disabilities. Contractor shall avoid relying on an adult or minor child accompanying
the person served to interpret or facilitate communication; however, if the person
refuses language assistance services, the Contractor must document the offer, refusal,
and justification in the file of the person served.
d. Interpreter Qualifications. Contractor shall ensure that employees, agents,
subcontractors, and/or partners who interpret or translate for a person served or who
directly communicate with a person in a language other than English (1) have completed
annual training provided by County at no cost to Contractor; (2) have demonstrated
proficiency in the language of the person served; (3) can effectively communicate any
specialized terms and concepts specific to Contractor's services; and (4) adheres to
generally accepted interpreter ethic principles. As requested by County, Contractor shall
identify all who interpret for or provide direct communication to any program person
served in a language other than English and identify when the Contractor last monitored
the interpreter for language competence.
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Exhibit B
Page 24 of 24
e. CLAS Standards. Contractor shall submit to County for approval, within ninety (90) days
from date of contract execution, Contractor's plan to address all fifteen (15) National
Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by
the Office of Minority Health and as set forth in Exhibit B—Attachment J, "National
Standards on Culturally and Linguistically Appropriate Services".As the CLAS standards
are updated, Contractor's plan must be updated accordingly. As requested by County,
Contractor shall be responsible for conducting an annual CLAS self-assessment and
providing the results of the self-assessment to the County. The annual CLAS self-
assessment instruments shall be reviewed by the County and revised as necessary to
meet the approval of the County.
f. Training Requirements. Cultural responsiveness training for Contractor staff should be
substantively integrated into health professions education and training at all levels, both
academically and functionally, including core curriculum, professional licensure, and
continuing professional development programs.As requested by County, Contractor
shall report on the completion of cultural responsiveness trainings to ensure direct
service providers are completing annual cultural responsiveness training.
g. Continuing Cultural Responsiveness. Contractor shall create and sustain a forum that
includes staff at all agency levels to discuss cultural responsiveness. Contractor shall
designate a representative from Contractor's team to attend County's Diversity, Equity
and Inclusion Committee.
24
Exhibit B -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 B -Attachment A
Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
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 B -Attachment A
Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
6. Principle Six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
3
rev 01-02-2020
Exhibit B -Attachment A
Page 4 of 4
Fresno County Department of Behavioral 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 B—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 BHP 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 BHP has developed a Consumer Guide, a beneficiary rights poster, a grievance form, an
appeal form, and Request for Change of Provider Form. All of these beneficiary 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 BHP 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 BHP address (listed above).
Exhibit B—Attachment B
Page 2 of 2
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 BHP payment authorization, or
the process or payment of a provider's claim to the BHP.
Payment authorization issues—the provider may appeal a denied or modified request for
payment authorization or a dispute with the BHP regarding the processing or payment of a
provider's claim to the BHP. The written appeal must be submitted to the BHP within 90
calendar days of the date of the receipt of the non-approval of payment.
The BHP 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 BHP
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 BHP. The
provider will receive a written response from the BHP within 60 calendar days of receipt of the
complaint. The decision rendered buy the BHP is final.
Exhibit B—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 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 B—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 the Contractor documents the participation of the person served. When
Rev 04/2023 C-2
Exhibit B—Attachment C
Page 3 of 3
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.
➢ The Contractor 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
COS Exhibit B—Attachment D
Page 1 of 7
o� s6 o Fresno County Department of Behavioral Health
�xES� Contractor Training Requirements Reference Guide
Contractor must consider and include sufficient time and funds for required trainings.
This Training Requirements Reference Guide identifies the required trainings that
Contractor is responsible for offering to all employees, volunteers, interns, and student
trainees of Contractor or its subcontractors who, in each case, are expected to perform
professional services while contracted by County. There are some trainings offered by
the County at no cost to Contractor, and those are identified within this document. The
remaining trainings are the responsibility of Contractor to provide and cover associated
costs. The expectations for Contractor staff attending County-offered trainings are
included within this guide.
I. 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 shall
be assigned this training in Quarter 4 of each calendar year.
An announcement from the DBH Compliance Program, DBH Staff Development, or
your Contract Analyst regarding this training will be made prior to the assignment of
this training. Contractor will have the option to complete the training either through
the Relias Learning Management System (LMS) or through Department of
Behavioral Health's website. Contractors are given approximately a 60-day window
to complete this training from the training announcement date.
Mental Health Documentation & Billing Training
Duration: 1 Hour 30 Minutes
All contracted provider organization employees, subcontractors, volunteers, interns,
and students providing services are to complete Documentation & Billing Training
within 30 business days of hire or contract effective date. If contract effective date is
a renewal, existing staff will not need to retake the training if they have already
completed it with their agency. Contractor shall be required to complete this training
as a prerequisite for providing direct services, processing billing, conducting quality
assurance services, clinical supervision, or other similar services under this
agreement. Contractor is expected to contact their assigned contract analysts if they
are unsure about training requirements for any specific classifications.
Training for Providers of Specialty Mental Health Service
Exhibit B—Attachment D
Page 2 of 7
Documentation & Billing is a training provided at least one time per month.
Registration is completed via Eventbrite for each session; links to register can be
found on the webpage below:
https://www.fresnocountyca.gov/Departments/Behavioral-Health/Providers/Contract-
Provider-Resources/New-Hire-ComplianceDoc-Billing-Training
The expectation is that Contractor will register their County-funded employees at
least one week in advance of the training date. For any registration issues or other
questions about the training, they can contact
DBH Staff DevelopmentCcD_fresnocountycca.gov.
DBH New Hire General Compliance Training
Duration: 40 Minutes
Contractor 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 B,
Attachment I. 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.fresnocountyca.gov/Departments/Behavioral-Health/Care-
Services/Behavioral-Health-Compliance/New-Hire-General-Compliance-Training
Contractor shall require its County-funded employees and subcontractors to
complete this compliance training. After completion of this training, participants must
sign the Contractor Acknowledgment and Agreement form and return this form to the
DBH Compliance officer or designee. For additional questions about the training,
please contact your Contract Analyst or the DBH Compliance team at:
DBHComplianceCcDfresnocountyca.gov.
Invoicing Training
Duration: To be Confirmed
Contractor shall be responsible for collection and managing data in a manner to be
determined by the California Department of Health Care Services (DHCS) and
Mental Health Plan in accordance with applicable rules and regulations. DBH's
Electronic Health Record (EHR) is a critical source of information for purposes of
Exhibit B—Attachment D
Page 3 of 7
monitoring service volume and obtaining reimbursement. Contractor'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.
Notice of Adverse Benefit Determination (NOABD) Training
Duration: 8 Minutes
A Notice of Adverse Benefit Determination (NOABD) is a formal mechanism for
notifying a person served of an adverse benefit determination in writing (e.g., denial
or limited authorization of a requested service, denial of payment for a service, or
failure to provide services in a timely manner).
This training outlines usage practices, timelines, and examples for each type of
NOABD. Contractor can find the training in the Announcements section on the
following webpage: https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/Contract-Provider-Resources/Notifications-Associated-Documents.
Contractor shall be responsible for completing this training within 60 days of hire or
contract effective date.
SmartCare Full Electronic Health Record New User Mental Health Training*
Duration: 4 Hours
This is a basic training for new users who are direct clinical service providers
employed by Contractors that will be using SmartCare as their full EHR. Participants
will have the opportunity to apply CalMHSA's SmartCare training materials and
review relevant SmartCare workflows, clinical documents, and forms.
Training dates and reference material can be found on the following link:
https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.Although this training is not required,
selected Contractor is responsible for understanding and utilizing SmartCare as indicated once contracted with County
DBH.
SmartCare Electronic Health Record New User Front Desk Training*
Duration: 4 Hours
This is a basic training for new users who are employed by Contractors that will be
using SmartCare as their full EHR. Participants will have the opportunity to review
how to navigate SmartCare, perform coverage information set up, error corrections,
set up Appointments, and basic troubleshooting of common issues.
Exhibit B—Attachment D
Page 4 of 7
Training dates and reference material can be found on the following link:
https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.Although this training is not required,
selected Contractor is responsible for understanding and utilizing SmartCare as indicated once contracted with County
DBH.
SmartCare Lite Electronic Health Record Mental Health Training* (Provider
Entry Only Training)
Duration: Time may vary
This training is for select Contractors that do not intend to fully use County DBH's
SmartCare EHR system but rather only some functions, otherwise referred to as a
"SmartCare Lite User". This training is intended to supplement and reinforce the
CaIMHSA SmartCare trainings, user guide, and workflow information SmartCare Lite
Users. This supplemental training/technical support is offered by the DBH Planning
and Quality Management Division's Quality Improvement Team upon request.
Required prerequisite material can be found on the following link:
https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.Although this training is not required,
selected Contractor is responsible for understanding and utilizing SmartCare as indicated once contracted with County
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(@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
Exhibit B—Attachment D
Page 5 of 7
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 is Responsible for Ensuring and/or Providing
These Trainings are Offered and Completed
CalAIM Behavioral Health Quality Improvement Program (BHQIP) Training
Any contracted clinical provider is required to complete the CalAIM BHQIP Modules
in CaIMHSA's web-based training 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 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 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 efforts toward cultural and linguistic
responsiveness by providing the following:
• Technical assistance regarding culturally responsive training requirements.
• Mandatory cultural responsiveness training for Contractor's DBH-funded
staff if training capacity allows.
• Technical assistance for translating information into County's threshold
languages (currently Spanish and Hmong and subject to change). Selected
Contractors are responsible for securing translation services and all
Exhibit B—Attachment D
Page 6 of 7
associated costs.
Health Insurance Portability and Accountability Act (HIPAA) Training
Duration: May vary based on selected training
As a covered entity, or 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
Contractor shall be responsible for implementing policies and procedures and
training staff to ensure access and appropriate use of trained interpreters and
material translation services for all Limited English Proficient (LEP) persons served.
This includes, but is not limited to, assessing the cultural and linguistic needs of its
persons served. The vendor(s) procedures shall include ensuring compliance of any
sub-contracted providers with these requirements.
IV. Training Expectations for Contractor Employees when
Attending County-provided Training
Expectations for Attendees:
1) Attendees are to adhere to wearing business casual attire, broadly defined as
a code of dress that blends traditional business wear with a more relaxed style
that is still professional and appropriate for an office environment, unless
specifically directed otherwise or instructed by Trainers. Attendees are
expected to dress in respectful, culturally inclusive attire.
2) Interested attendees shall register at least one week in advance of the training
date.
3) Attendees shall be expected to be ready and prepared to be engaged by the
training start time. Attendees are also expected to arrive back on time from
breaks, including lunch, and attend the training through completion.
4) Attendees who arrive 15 minutes late, or more, shall be requested to return to
their work site and their organization will be notified. Similarly, attendees may
not leave a training prior to the scheduled end time. Those who miss 15 minutes
or more of training in total throughout the day may be asked to re-enroll for a
later training date if one is available.
Exhibit B—Attachment D
Page 7 of 7
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.
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(cD-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 B—Attachment E
Page 1 of 5
Mental Health Program and Full-Service Partnership Outcomes
Data Gathering Methods
Contractor shall adhere to the following outcome elements.
* Items indicated with a single asterisk will be collected via DBH's electronic health record (EHR)
for all contracted providers.
** 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.
Contractors who opt to not fully utilize DBH's EHR will be responsible for collecting and reporting data
points that are not collected by DBH's EHR. DBH will assist Contractor 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 non-
psychiatric service offered by the program*
1.2 Timeliness from the initial urgent/non-urgent request for services until the first non-
psychiatric 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 Timeliness of follow-up after discharge from the emergency department for behavioral
health visits for individuals who are currently enrolled with the program*
1.6 Timeliness of follow-up after discharge from acute inpatient hospitalization for behavioral
health visits for individuals who are currently enrolled with the program*
2. Network Adequacy:Timeliness to Psychiatric Service (if applicable)
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
Exhibit B—Attachment E
Page 2 of 5
Mental Health Program and Full-Service Partnership Outcomes
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 Average number of services provided to an individual outside of standard office hours by the
program*
1.4 Utilization of clinical tools, when appropriate*
1.5 Utilization of evidence-based practices,when appropriate*
2. Care Coordination
2.1 Referrals received by the Program from DBH and community partner agencies***
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***
2.2.3 Disposition/outcomes of referral, including date of first offered service***
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 program.
2. Incident Reporting
2.1 The count, category, and trends of incidents reported regarding individuals served by the
program.
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
Exhibit B—Attachment E
Page 3 of 5
Mental Health Program and Full-Service Partnership Outcomes
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**
General Data for Full-Service Partnerships
1. Residential status, including hospitalization or incarceration
1.1. Cost per person per month
2. Educational status
3. Employment status
4. Legal issues/designation
5. Sources of financial support
6. Health status
7. Substance abuse issues
8. Assessment of daily living functions, when appropriate
9. Emergency interventions
10. Outreach and Engagement
10.1. Number of attempts***
10.2. Method of outreach attempt (i.e., in-person, phone call, etc.)***
11. Supportive Services
11.1. Supportive services that individuals were linked to (i.e., housing,food, clothing,
education, employment,transportation, medical/dental, and supplemental mental health
services), with documentation of clinical purpose noted in electronic health record**
11.2. Outcome of supportive service linkage
Key Event Data(to be tracked in the State Department of Health Care Services' Data Collection and
Reporting(DCR)System)
1. Emergency interventions
2. Changes in:
2.1 Administrative data
2.2 Residential status
2.3 Educational status
2.4 Employment status
2.5 Legal issues/designation
Exhibit B—Attachment E
Page 4 of 5
Mental Health Program and Full-Service Partnership Outcomes
Quarterly Assessment Data (to be tracked in the DCR)
1. Educational status
2. Sources of financial support
3. Legal issues/designation
4. Health status
5. Substance abuse issues
Program-specific Goals/Outcomes:
Contractor 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 shall complete the CANS assessment tool through a collaborative process, which includes
children and youth ages 6 up to age 20, 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, as clinically indicated throughout treatment, and at the end of
treatment.The timeline for completion does not reset when a youth transitions between levels of care
or programs.
Contractor's performance shall be evaluated according to its scope of work goals and effectiveness
indicators stated in Exhibit A. Other goals that Contractor shall be evaluated on by County DBH utilizing
the following performance outcomes:
- The baseline for these Outcome Indicators shall be established using data from the first fiscal
year of the contract.
- These Outcomes shall be reported separately for each level of care.
Outcome Indicator#1
#1a: Demonstrate a percentage increase, or maintenance of highest previously reported percentage, for
number of persons served that had a clinically significant change* from risk to non-risk.
Exhibit B—Attachment E
Page 5 of 5
Mental Health Program and Full-Service Partnership Outcomes
#1b: Demonstrate a percentage decrease, or maintenance of lowest previously reported percentage,for
number of persons served that had a clinically significant change* from non-risk to risk.
*Measurement of clinically significant change:Defined as a change in the score of six or more from the
previous total score, and a change from risk to non-risk and non-risk to risk. (Risk score=>28)Source:
Mass General. Pediatric Symptom Checklist
Outcome Indicator#2
#2a: Demonstrate a percentage increase, or maintenance of highest previously reported percentage, for
number of persons served that had a clinically significant change** from risk to non-risk for each
subscale.
#2b: Demonstrate a percentage decrease, or maintenance of lowest previously reported percentage,for
number of persons served that had a clinically significant change** from non-risk to risk for each sub
scale.
"Measurement of clinically significant change:Defined as a change score of two or greater on each of
the 3 subscale scores(attention, internalizing, externalizing)and a change from risk to non-risk and non-
risk to risk. (attention, externalizing Risk score=> 7) (Internalizing risk score=>5) Source:Mass
General. Pediatric Symptom Checklist
Outcome Indicator#3
Demonstrate a decrease or maintenance of lowest previously reported average psychiatric hospital in-
patient admissions for persons served from the previous fiscal year.
Outcome Indicator#4
Demonstrate a decrease or maintenance of lowest previously reported average Jail/JJC custody holds
(detentions/incarcerations)from the previous fiscal year of the contract.
Outcome Indicator#5
Demonstrate a decrease or maintenance of lowest previously reported average of school
suspensions/expulsions from the previous fiscal year.
Notwithstanding changes and timelines implemented by legislation or Behavioral Health Information
Notices,the Plan may also add additional required data elements with 30 days' notice to facilities.
Exhibit B —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 shall conform to and County shall monitor compliance with all State of
California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
Contractor shall prepare and make available to County and to the public
all eligibility requirements to participate in the program plan set forth in the
Agreement. No person shall, because of ethnic group identification, age,
gender, color, disability, medical condition, national origin, race, ancestry,
marital status, religion, religious creed, political belief or sexual
preference be excluded from participation, be denied benefits of, or be
subject to discrimination under any program or activity receiving Federal
or State of California assistance.
B. Employment Opportunity
Contractor shall comply with County policy, and the Equal Employment
Opportunity Commission guidelines, which forbids discrimination against
any person on the grounds of race, color, national origin, sex, religion,
age, disability status, or sexual preference in employment practices.
Such practices include retirement, recruitment advertising, hiring, layoff,
termination, upgrading, demotion, transfer, rates of pay or other forms of
compensation, use of facilities, and other terms and conditions of
employment.
i
Exhibit B —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 B —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: the Contractor 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 B —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 the
Contractor'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 the Contractor'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 $10410):
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 M 0411):
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 B —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 CODE/WORKERS' 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 the
Contractor'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 the Contractor 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 B —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, the
Contractor 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 the Contractor 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 B —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 the Contractor provides SMHS meet
access criteria, as per Department of Health Care Services
(DHCS) guidance specified in Behavioral Health Information
Notice (BHIN) 21-073. Specifically, the Contractor 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 B —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 B —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
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Exhibit B —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 B —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, the Contractor 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.
ii
Exhibit B —Attachment F
Page 12 of 18
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 B —Attachment F
Page 13 of 18
iii. Contractor may directly use the DHCS-provided Transition of Care
Tool, found at htti)s://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/Telehealth Resources
.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 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.
13
Exhibit B —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 the Contractor 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. The Contractor 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. The
Contractor shall assess individual/family satisfaction by:
1. Surveying person served/family satisfaction with the
Contractor's services at least annually.
14
Exhibit B —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. The Contractor shall take appropriate follow-up action
when such an occurrence is identified. The results of the
intervention shall be evaluated by the Contractor 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 QI actions, and ensure follow-up of QI processes.
Contractor shall ensure that there is active participation by the
Contractor'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 the
Contractor'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
15
Exhibit B —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,
16
Exhibit B —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;
1,7
Exhibit B —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.
18
Exhibit B—Attachment G
Page 1 of 1
Electronic Health Record Requirements and Service Data
Contractor will provide accurate and timely input of services provided in the County's Electronic Health
Record (EHR).The current EHR is a web-based application and requires a computer with a minimum of
16 GB RAM using either Edge or Chrome as the browser, and a stable high speed internet connection.
Additional drivers may be needed to scan documents into the EHR. Contractor will be responsible for
equipment to support the using of the EHR. Contractor may be required to utilize data entry forms,
portals, or related systems for compliance with County data reporting requirements during the duration
of this Agreement.
Data entry shall be the responsibility of the Contractor.The County shall monitor the number and
amount of services entered into the EHR.Any and all audit exceptions resulting from the provision and
billing of Medi-Cal services by the Contractor shall be the sole responsibility of the Contractor.
Contractor will utilize the County's EHR for all Behavioral Health Plan billing and reporting functions and
may elect to utilize the County's EHR for all clinical documentation, at no additional cost to Contractor.
If Contractor elects to not use the County's EHR for all clinical documentation,the Contractor must
ensure all necessary requirements involving electronic health information exchange between the
Contractor and the County will be met.
Exhibit B -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.
1
Exhibit B —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 B —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 DBH's HIPAA Representative, within two (2) business days of discovery.
The notification shall include, to the extent possible, the identification of each individual whose
2
Exhibit B —Attachment I
Page 3 of 5
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
information concerning such safeguards.
3
Exhibit B —Attachment I
Page 4 of 5
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
be resolved in favor of a meaning that complies and is consistent with HIPAA and the HIPAA
4
Exhibit B —Attachment I
Page 5 of 5
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 B -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.
1 THINK
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Heath and Hunan SWAM
O M H Office o1~rMV Hearth HEALTH
Exhibit B -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-EO08-02).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.I.,&Richard,P.(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic
Studies website:http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
OBurden%20of%2OHealth%2OInequalities%20in%20the%2OUnited%2OStates.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/
1 THINK
O M H H:Depw nlof www.ThiiikCulturalHealth.hhs.gov CULTURAL —
Health and Humors S.—e, HEALTH •
Ofl�ce of fdinorlN Health
Exhibit C
Page 1 of 16
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 the Contractor 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 the Contractor under this Agreement for the
period of August 5, 2025, through August 6, 2025 for Ramp up is One Thousand Six Hundred
Sixty-Seven and No/100 Dollars ($1,667.00), which will be reimbursed by actual cost in
accordance with the budget in Exhibit C —Attachment B.
The maximum compensation payable to the Contractor under this Agreement for the
period of August 7, 2025, through June 30, 2026, for SMHS is Three Million Five Hundred
Ninety-One Thousand, Nine Hundred Forty-Six and No/100 ($3,591,946.00) which is not a
guaranteed sum but shall be paid only for services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2026, through June 30, 2027, for SMHS is Four Million Five Hundred Ninety-
Six Thousand, Six Hundred Fifty-One and No/100 Dollars ($4,596,651.00), which is not a
guaranteed sum but shall be paid only for services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2027, through June 30, 2028, for SMHS is Four Million Five Hundred Ninety-
Six Thousand, Six Hundred Fifty-One and No/100 Dollars ($4,596,651.00), which is not a
guaranteed sum but shall be paid only for services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2028, through June 30, 2029, for SMHS is Four Million Five Hundred Ninety-
Six Thousand, Six Hundred Fifty-One and No/100 Dollars ($4,596,651.00), which is not a
guaranteed sum but shall be paid only for services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2029, through June 30, 2030, for SMHS is Four Million Five Hundred Ninety-
Six Thousand Six Hundred Fifty-One and No/100 Dollars ($4,596,651.00), which is not a
guaranteed sum but shall be paid only for services rendered and received.
2. Non-Treatment Supports Maximum Compensation
Exhibit C
Page 2 of 16
The maximum compensation payable to the Contractor under this Agreement for the
period of August 7, 2025, through June 30, 2026, is Ten Thousand Eight Hundred Forty-Nine
and No/100 Dollars ($10,849.00), which will be reimbursed base by actual cost in accordance
with the budget in Exhibit C —Attachment B.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2026, through June 30, 2027, is Twelve Thousand and No/100 Dollars
($12,000.00), which will be reimbursed base by actual cost in accordance with the budget in
Exhibit C —Attachment B.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2027, through June 30, 2028, is Twelve Thousand and No/100 Dollars
($12,000.00), which will be reimbursed base by actual cost in accordance with the budget in
Exhibit C —Attachment B.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2028, through June 30, 2029, is Twelve Thousand and No/100 Dollars
($12,000.00), which will be reimbursed base by actual cost in accordance with the budget in
Exhibit C —Attachment B.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2029, through June 30, 2030, is Twelve Thousand and No/100 Dollars
($12,000.00), which will be reimbursed base by actual cost in accordance with the budget in
Exhibit C —Attachment B.
3. Total Maximum Compensation.
In no event shall the maximum contract amount for all the services provided by the
Contractor to County under the terms and conditions of this Agreement be in excess of Twenty-
Two Million Thirty-Nine Thousand Sixty-Six and No/100 Dollars ($22,039,066.00) during the
entire term of this Agreement.
The Contractor acknowledges that the County is a local government entity and does so
with notice that the County's powers are limited by the California Constitution and by State law,
and with notice that the Contractor may receive compensation under this Agreement only for
services performed according to the terms of this Agreement and while this Agreement is in
effect, and subject to the maximum amount payable under this section.
The Contractor further acknowledges that County employees have no authority to pay
the Contractor except as expressly provided in this Agreement.
See table below for compensation breakdown by Fiscal Year and Total Maximum
Compensation for this Agreement.
Exhibit C
Page 3 of 16
Fiscal Year SMHS SMHS SMHS Non- Non- Total FY
(FY) Maximum FY Maximum FY Maximum FY Treatment Treatment Maximum
Compensation Compensation Compensation Maximum FY Ramp-Up Compensation
FSP ICM OP Compensation Compensation
FSP
25-26 $2,916,002.00 $337,972.00 $337,972.00 $10,849.00 $1,667.00 $3,604,462.00
26-27 $3,745,719.00 $425,466.00 $425,466.00 $12,000.00 $0.00 $4,608,651.00
27-28 $3,745,719.00 $425,466.00 $425,466.00 $12,000.00 $0.00 $4,608,651.00
28-29 $3,745,719.00 $425,466.00 $425,466.00 $12,000.00 $0.00 $4,608,651.00
29-30 $3,745,719.00 $425,466.00 $425,466.00 $12,000.00 $0.00 $4,608,651.00
Aggregate $17,898,878.00 $2,039,836.00 $2,039,836.00 $58,849.00 $1,667 $22,039,066
Maximums
4. Fee-For-Service Reimbursement Rate Categories.
The Full-Service Partnership (FSP) services provided by the Contractor under this Agreement
shall be reimbursed according to the FSP rate schedule as indicated in Exhibit C —Attachment
A, attached hereto and incorporated herein by reference and made part of this Agreement. The
Outpatient and Intensive Case Management services provided by the Contractor under this
Agreement shall be categorized as Field Based and the Contractor shall be compensated
according to the Field Based rate schedule as indicated on Exhibit C—Attachment A, attached
hereto and incorporated herein by reference and made part of this Agreement:
(A) Clinic-Site Based: Clinic-Site Based programs shall be defined as programs who
provide less than fifty percent (50%) of services in the field. In the field services are
those services that do not occur through telehealth and do not occur in designated
sites in which the Contractor is afforded regular access. Designated sites shall be
identified by the Contractor and approved by County's DBH Director or designee in
writing. Only billable services will be considered for the purpose of this calculation.
(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:
CSBH's Clinic/Office Site, Telehealth Provided Other than in Patient's
Home, Telehealth Provided in Patient's Home, and all locations where the
mode of delivery is Video Conference/Telephone/Written.
All other SmartCare (EHR) Locations (CMS Places of Service) will be
considered as Field Based services under this Agreement.
(B) Field Based: Field based programs shall be defined as programs that provide more
than fifty percent (50%) of services in the field.
Exhibit C
Page 4 of 16
(i) During the term of this Agreement, Contractor is eligible to submit a
proposal for compensation at the Field Base reimbursement rate category
ninety (90) days prior to each new fiscal year to County's DBH for
consideration. County's DBH will provide a decision to Contractor prior to
the start of the next fiscal year. If approved, County's DBH will issue a
rate change notification according to the modification section below and
Contractor's performance will be monitored for the Field Based mode of
service delivery requirements as outlined above.
(ii) If Contractor is deemed eligible to receive compensation at the Field
Based reimbursement rates in accordance with the above paragraph and
Contractor is subsequently unable to meet the mode of service delivery
requirements, as defined above, Contractor will be subjected to
recoupment at County's discretion.
(iii) County's DBH will complete Field Based mode of service delivery
analysis and recoupment reconciliation for said Contractor within ninety
(90) days following the end of the targeted quarter or within ninety (90)
days after all billable services for the targeted quarter has been entered in
the Electronic Health Record (EHR) by the Contractor, whichever is later.
The recoupment amount will be the difference in value of any services
paid to Contractor throughout the targeted quarter after being reconciled
at the respective fiscal year's Clinic-Site Based rate schedule and after
any claiming adjustments may have been applied, if any. County's DBH
will inform the Contractor of the result and, if necessary, the recoupment
shall be processed and applied based on terms, conditions, and
limitations as set forth herein.
(iv) If Contractor does not meet the Field Based mode of service delivery
requirements after any targeted quarterly review, County's DBH shall
recommend and reassign the Contractor to the Clinic-Site Based rate
category. Contractor may appeal the rate category reassignment to
County's DBH within thirty (30) days of receiving notice or the rate
category change will stand with a written notification as set forth below.
County's DBH shall continuously monitor the Contractor and analyze data to review
accuracy of rate categories assigned. County's DBH Director or designee shall have the
authority to reassign rate categories, and the Contractor will be notified in writing of any such
changes, as outlined in Article 5.
5. Specialty Mental Health Services Fee-For-Service Performance Incentives.
Contractor is eligible to receive performance-based incentives to promote growth,
increase service delivery and overall wellness to our unserved and/or underserved
communities. If the Contractor meets the performance metrics outlined by County's DBH below,
Contractor is eligible to a portion of the Medi-Cal reimbursements received and recorded by
County's DBH.
Exhibit C
Page 5 of 16
This opportunity, subject to County's discretion, is only available after the second fiscal
year term of this Agreement for Contractor providing SMHS and reimbursed through the
County's Fee-for-Service reimbursement structure. The initial performance actual claimed
baseline will be set by the Contractor's performance in fiscal year one (1). County's DBH will
use the Contractor's State-approved claimed dollar amount, as received and recorded by
County's DBH, for services that were performed, claimed, and approved by the State in fiscal
year one (1) and adjust it with any subsequent State rate changes, if any, to finalize a
performance baseline for fiscal year two (2). After completing the claiming of services and
receipt of Medi-Cal reimbursements for fiscal year two (2), if the Contractor exceeds the
established performance baseline, the Contractor is eligible to be compensated for eight percent
(8%) of the Medi-Cal reimbursements that were generated above the established performance
baseline amount of fiscal year two (2).
Each subsequent fiscal year's performance baselines will be adjusted annually to either
the prior fiscal year's actual State-approved claimed amount plus adjusted for any subsequent
State rate increases, or any of the previously established performance baseline amounts plus
adjusted for any State rate increases for the upcoming fiscal year, whichever is higher. The new
performance baseline shall always be calculated from the higher value between the State-
approved claimed amount and the previous fiscal year's performance baseline amount
regardless of projected performance in the upcoming fiscal year. The rate adjustment shall
always be a positive amount and the performance base shall not decrease from one fiscal year
to the next.
The table below illustrates the annual baseline adjustments. This table is an example
only and is not binding. The actual details will be determined and finalized between both parties
at the conclusion of year one (1).
Example:
Fiscal Rate State Amount Additional
Year Increase Baseline Approved Exceeding Amount Paid
Claim Amount Baseline 8%
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 must
be in satisfactory standing with the Agreement's performance outcomes and reporting
requirements prior to being awarded the incentive payment. At the discretion of County's DBH
Director or designee, if it is determined that the required outcomes are not met and/or reports
are not submitted in full and on time, the Contractor shall be ineligible for performance
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 of the award amounts, if any, within
ninety (90) days after all of Contractor's State-approved claimed services are received and
recorded by County's DBH for the targeted fiscal year or within nine (9) months following the
end of the targeted fiscal year, whichever is later. County's payments to Contractor for
Exhibit C
Page 6 of 16
performance-based incentives, if any, shall be made within forty-five (45) days after approval by
County.
Invoices
The Contractor shall submit monthly invoices, in arrears by the fifteenth (15rn) day of
each month, in the format directed by the County. The Contractor 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. Contractor agrees to continue to provide services for a
period of ninety (90) days after notification of an incorrect or improper invoice. If after the ninety
(90) day 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 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.
Withholdings to an invoice by County's DBH shall be addressed by the Contractor and/or
Contractor 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 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 C—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
Exhibit C
Page 7 of 16
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.
County's payments to Contractor 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. Cost Reimbursement Based Invoices.
Invoices for cost reimbursement services shall be based on actual expenses incurred in
the month of service. Contractor shall submit monthly invoices and general ledgers to County
that itemize the line item charges for monthly program costs. The invoices and general ledgers
will serve as tracking tools to determine if Contractor's costs are in accordance with its budgeted
cost. Failure to submit reports and other supporting documentation shall be deemed sufficient
cause for County to withhold payments until there is compliance.
Contractor must report all revenue collected from a third-party, client-pay or private-pay
in each monthly invoice. In addition, Contractor shall submit monthly invoices for reimbursement
that equal the amount due less any revenue collected and/or unallowable cost such as lobbying
or political donations from the monthly invoice reimbursements.
3. Corrective Action Plans.
Contractor shall enter services into the County's EHR/billing and transactional database
and submit invoices in accordance with the specified deadlines, ensuring all information is
accurate. Failure to meet the requirements set forth above will result in the implementation of 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 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 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 pursuant to the terms and conditions of this Agreement shall
automatically revert to County.
Payments shall be made upon certification or other proof satisfactory to the County that
services have been performed or actual expenditures incurred by the Contractor, as specified in
this Agreement.
1. Incidental Expenses.
Exhibit C
Page 8 of 16
The Contractor is solely responsible for all of its costs and expenses that are not
specified as payable by the County under this Agreement. If Contractor fails to comply with any
provision of this Agreement, County shall be relieved of its obligation for further compensation.
2. Applicable Fees.
Contractor shall not charge any persons served or third-party payers any fee for service
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 shall use the uniform
billing and collection guidelines prescribed by DHCS.
Contractor 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.
Contractor 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).
The Contractor must not bill persons served, for covered services, any amount greater
than would be owed if the County provided the services directly and otherwise not bill persons
served as set forth in 42 C.F.R. § 438.106.
Specialty Mental Health Services Claiming Responsibilities
Contractor 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 (15rh) 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-Library.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. 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 shall be the sole
responsibility of Contractor. Contractor will comply with all applicable policies, procedures,
directives, and guidelines regarding the use of County's EHR/information system.
Contractor must provide all necessary data to allow County to bill Medi-Cal for services
and meet State and Federal reporting requirements. The necessary data can be provided by a
variety of means, including but not limited to:
Exhibit C
Page 9 of 16
If a person served has dual coverage, such as other health coverage (OHC) or Federal
Medicare, Contractor will be responsible for billing the carrier and obtaining a payment/denial or
have validation of claiming with no response for ninety (90) days after the claim was mailed
Contractor must report all third-party collections for Medicare, third-party or client-pay or private-
pay in each month. A copy 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 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 will be responsible for compliance
as of the effective date of each Federal, State or local law or regulation specified.
Recoupments, Audits, Reviews, and Examinations
County shall recapture from Contractor the value of any services or other expenditures
determined to be ineligible based on the County or State monitoring results. The County
reserves the right to enter into a repayment agreement with Contractor, with the term of the
repayment agreement not to exceed twelve (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 through a
repayment agreement. The monthly repayment amounts may be netted against the Contractor'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.
Contractor shall be held financially liable for any and all future disallowances/audit
exceptions due to Contractor's deficiency discovered through the State audit process and
County utilization review for services provided during the course of this Agreement. At County's
election, the disallowed amount will be remitted within forty-five (45) days to County upon
notification or shall be withheld from subsequent payments to Contractor. Contractor shall not
receive reimbursement for any units of services rendered that are disallowed or denied by the
Fresno County MHP utilization review process or claims review process or through the State of
California 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 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 to reimburse County for services
previously paid in the following circumstances:
(A) Identification of Fraud, Waste or Abuse as defined in federal regulation
Exhibit C
Page 10 of 16
(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 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 shall reimburse County for all overpayments identified by Contractor, County,
and/or state or federal oversight agencies as an audit exception within the timeframes required
by law or Country or state or federal agency. Funds owed to County will be due within forty-five
(45) days of notification by County, or County shall withhold future payments until all excess
funds have been recouped by means of an offset against any payments then or thereafter owing
to County under this or any other Agreement between the County and Contractor.
2. Internal Audits/Reviews.
Contractor 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 must also ensure that all supporting documentation is accurate, complete, and
reflects the services actually rendered.
In addition, Contractors with medication prescribing authority shall adhere to County's
medication monitoring review practices. Contractor shall provide County with notification and a
summary of any internal audit exceptions, and the specific corrective actions taken to sufficiently
reduce the errors that are discovered through Contractor's internal audit process. Contractor
shall provide this notification and summary to County as requested by the County.
3. Confidentiality in Audit/Review Process.
Contractor and County mutually agree to maintain the confidentiality of Contractor's
records and information of persons served, in compliance with all applicable State and Federal
statutes and regulations, including but not limited to HIPAA and California Welfare and
Institutions Code, Section 5328. Contractor shall inform all of its officers, employees, and agents
of the confidentiality provisions of all applicable statutes.
Contractor'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 records shall be maintained as required by DBH and DHCS on forms
furnished by DHCS or the County. All statistical data or information requested by the County's
DBH Director or designee shall be provided by the Contractor in a complete and timely manner.
4. Cooperation with Audits/Reviews.
Exhibit C
Page 11 of 16
Contractor shall cooperate with County in any review and/or audit initiated by County,
DHCS, or any other applicable regulatory body. This cooperation may include such activities as
onsite program, fiscal, or chart reviews and/or audits.
In addition, Contractor shall comply with all requests for any documentation or files
including, but not limited to, files for persons served and personnel files.
Contractor shall notify the County of any scheduled or unscheduled external evaluation
or site visits when it becomes aware of such visit. County shall reserve the right to attend any or
all parts of external review processes.
Contractor shall allow inspection, evaluation and audit of its records, documents and
facilities for ten (10) years from the term end date of this Agreement or in the event Contractor
has been notified that an audit or investigation of this Agreement has been commenced, until
such time as the matter under audit or investigation has been resolved, including the exhaustion
of all legal remedies, whichever is later pursuant to 42 C.F.R.§§438.3(h) and 438.2301(3)(i-iii).
5. Single Audit Clause.
If Contractor expends One Million and No/100 Dollars ($1,000,000.00) or more in
Federal and Federal flow-through monies, Contractor agrees to conduct an annual audit in
accordance with the requirements of the Single Audit Standards as set forth in Office of
Management and Budget (OMB) 2 CFR 200. Contractor shall submit said audit and
management letter to County. The audit must include a statement of findings or a statement that
there were no findings. If there were negative findings, Contractor must include a corrective
action plan signed by an authorized individual. Contractor agrees to take action to correct any
material non-compliance or weakness found as a result of such audit. Such audit shall be
delivered to County's DBH Finance Division for review within nine (9) months of the end of any
fiscal year in which funds were expended and/or received for the program. Failure to perform
the requisite audit functions as required by this Agreement may result in County performing the
necessary audit tasks, or at County's option, contracting with a public accountant to perform
said audit, or may result in the inability of County to enter into future agreements with
Contractor. All audit costs related to this Agreement are the sole responsibility of Contractor.
A single audit report is not applicable if Contractor's Federal contracts do not exceed the
One Million and No/100 Dollars ($1,000,000.00) requirement or Contractor's only funding is
through Drug-related Medi-Cal. If a single audit is not applicable, a program audit must be
performed and a program audit report with management letter shall be submitted by Contractor
to County as a minimum requirement to attest to Contractor solvency. Said audit report shall be
delivered to County's DBH Finance Division for review no later than nine (9) months after the
close of the fiscal year in which the funds supplied through this Agreement are expended.
Failure to comply with this Act may result in County performing the necessary audit tasks or
contracting with a qualified accountant to perform said audit. All audit costs related to this
Agreement are the sole responsibility of Contractor who agrees to take corrective action to
eliminate any material noncompliance or weakness found as a result of such audit. Audit work
performed by County under this paragraph shall be billed to Contractor at County cost, as
determined by County's Auditor-Controller/Treasurer-Tax Collector.
Contractor shall make available all records and accounts for inspection by County, the
State of California, if applicable, the Controller General of the United States, the Federal Grantor
Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
Exhibit C
Page 12 of 16
least three (3) years following final payment under this Agreement or the closure of all other
pending matters, whichever is later.
6. Financial Audit Report Requirements for Pass-Through Entities
If County determines that Contractor is a "subrecipient" (also known as a "pass-through
entity") as defined in 2 C.F.R. § 200 et seq., Contractor represents that it will comply with the
applicable cost principles and administrative requirements including claims for payment or
reimbursement by County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time
to time. Contractor shall observe and comply with all applicable financial audit report
requirements and standards.
Financial audit reports must contain a separate schedule that identifies all funds included
in the audit that are received from or passed through the County. County programs must be
identified by Agreement number, Agreement amount, Agreement period, and the amount
expended during the fiscal year by funding source.
Contractor will provide a financial audit report including all attachments to the report and
the management letter and corresponding response within six months of the end of the audit
year to the County's DBH Director or designee. The County's Director or designee is
responsible for providing the audit report to the County Auditor.
Contractor must submit any required corrective action plan to the County simultaneously
with the audit report or as soon thereafter as it is available. The County shall monitor
implementation of the corrective action plan as it pertains to services provided pursuant to this
Agreement.
In the event this Agreement is terminated, Contractor shall be entitled to compensation
for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant to the terms
and conditions of this Agreement through and including the effective date of termination. This
provision shall not limit or reduce any damages owed to the County due to a breach of this
Agreement by Contractor.
Property of County
This section shall only apply to the program components and services provided under
Cost Reimbursement. County and Contractor recognize that fixed assets are tangible and
intangible property obtained or controlled under County for use in operational capacity and will
benefit County for a period more than one (1) year.
1. Agreement Assets.
Assets shall be tracked on an agreement-by-agreement basis. All assets shall fall into
the "Equipment" category unless funding source allows for additional types of assets. Items of
sensitive nature shall be purchased and allocated to a single agreement. All items containing
Health Insurance Portability and Accountability Act (HIPAA)/Protected Health Information (PHI)
data are considered sensitive. At a minimum, the following types of items are considered to be
assets:
(A) Computers (desktops and laptops);
(B) Copiers, cell phones, tablets, and other devices with any HIPAA data
Exhibit C
Page 13 of 16
(C) Modular furniture
(D) Land
(E) Any items over $5,000
(F) Items of$500 or more with a lifespan of at least two (2) years:
a. Televisions
b. Washers/Dryers
c. Printers
d. Digital Cameras;
e. Other equipment/furniture
f. Items in total when purchased or used as a group fall into one or more of the
above categories
Contractor shall ensure proper tracking for contact assets that include the following
asset attributes at a minimum:
(A) Description of the asset;
(B) The unique identifier of the asset if applicable, i.e., serial number;
(C) The acquisition date;
(D) The quantity of the asset;
(E) The location of the asset or to whom the asset is assigned;
(F) The cost of the asset at the time of acquisition;
(G) The source of grant funding if applicable;
(H) The disposition date, and
(1) The method of disposition (surplus, transferred, destroyed, lost).
2. Retention and Maintenance.
Assets shall be retained by County, as County property, in the event this Agreement is
terminated or upon expiration of this Agreement. Contractor agrees to participate in an annual
inventory of all County fixed and inventoried assets. Upon termination or expiration of this
Agreement, Contractor shall be physically present when fixed and inventoried assets are
returned to County possession. Contractor is responsible for returning to County all County
owned undepreciated fixed and inventoried assets, or the monetary value of said assets if
unable to produce the assets at the expiration or termination of this Agreement. Contractor
further agrees to the following:
(A) Maintain all items of equipment in good working order and condition, normal wear
and tear excepted;
(B) Label all items of equipment with County assigned program number, to perform
periodic inventories as required by County and to maintain an inventory list
showing where and how the equipment is being used in accordance with
procedures developed by County. All such lists shall be submitted to County
within ten (10) days of any request therefore; and
(C) Report in writing to County immediately after discovery, the loss or theft of any
items of equipment. For stolen items, the local law enforcement agency must be
contacted, and a copy of the police report submitted to County.
3. Equipment Purchase.
The purchase of any equipment by Contractor with funds provided hereunder shall
require the prior written approval of County's DBH Director or designee, shall fulfill the
Exhibit C
Page 14 of 16
provisions of this Agreement as appropriate, and must be directly related to Contractor's
services or activity under the terms of this Agreement. County may refuse reimbursement for
any costs resulting from equipment purchased, which are incurred by Contractor, if prior written
approval has not been obtained from County.
4. Modification of Assets.
Contractor must obtain prior written approval from County's DBH whenever there is any
modification or change in the use of any property acquired or improved, in whole or in part,
using funds under this Agreement. If any real or personal property acquired or improved with
said funds identified herein is sold and/or is utilized by Contractor for a use which does not
qualify under this Agreement, Contractor shall reimburse County in an amount equal to the
current fair market value of the property, less any portion thereof attributable to expenditures of
funds not provided under this Agreement. These requirements shall continue in effect for the
life of the property. In the event this Agreement expires, the requirements for this paragraph
shall remain in effect for activities or property funded with said funds, unless action is taken by
the State government to relieve County of these obligations.
Other Financial Requirements
1. Notification of Changes.
Contractor shall notify County in writing of any change in organizational name, Head of
Service or principal business at least fifteen (15) business days in advance of the change.
Contractor shall notify County of a change of service location at least six (6) months in advance
to allow County sufficient time to comply with site certification requirements. Said notice shall
become part of this Agreement upon acknowledgment in writing by the County, and no further
amendment of the Agreement shall be necessary provided that such change of address does
not conflict with any other provisions of this Agreement.
Contractor must immediately notify County of a change in ownership, organizational
status, Iicensure, or ability of Contractor to provide the quantity or quality of the contracted
services in no event more than 15 days of the change.
2. Record Maintenance.
Contractor shall maintain all records and management books pertaining to service
delivery and demonstrate accountability for agreement performance and maintain all fiscal,
statistical, and management books and records pertaining to the program. Records should
include, but not be limited to, monthly summary sheets, sign-in sheets, and other primary source
documents. Fiscal records shall be kept in accordance with Generally Accepted Accounting
Principles and must account for all funds, tangible assets, revenue and expenditures. Fiscal
records must also comply with the Code of Federal Regulations (CFR), Title 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 C
Page 15 of 16
Contractor shall maintain records of persons served and community service in
compliance with all regulations set forth by local, state, and federal requirements, laws, and
regulations, and provide access to clinical records by County staff.
Contractor shall comply with all local, state, and federal laws and regulations regarding
relinquishing or maintaining medical records.
Contractor shall agree to maintain and retain all appropriate service and financial
records for a period of at least ten (10) years from the date of final payment, the final date of this
Agreement, final settlement, or until audit findings are resolved, whichever is later.
3. Financial Reports.
Contractor 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
ceases operation of its business, Contractor shall deliver or make available to County all
financial records that may have been accumulated by Contractor or subcontractor under this
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 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. 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 C
Page 16 of 16
Contractor 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 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 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 will be responsible for
any disallowances related to inadequate documentation.
7. Contractor Prohibited from Redirection of Contracted Funds
Contractor may not redirect or transfer funds from one funded program to another funded
program under which Contractor provides services pursuant to this Agreement except through a
duly executed amendment to this Agreement.
Contractor 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 C—Attachment A
Page 1 of 3
FEE-FOR-SERVICE RATE(S)
**Fee-for-Service rates are established by the Department of Health Care Services.
Contractor acknowledges that the provider rates in the table below are all-inclusive rates
which account for program operating expenses. This includes, but 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 the Contractor under the Fee-
for-Service reimbursement structure.
FSP
Provider Rate Per
Provider Type Hour
Licensed Physician $1,212.47
Physicians Assistant $543.78
Nurse Practitioner $602.93
Registered Nurse $492.49
Certified Nurse Specialist $602.93
Licensed Vocational Nurse $258.71
Registered Pharmacist $580.38
Licensed Psychiatric Technician $221.79
Psychologist(Licensed or Waivered) $487.61
LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA
(MFT LCSW LPCC) $315.55
Occupational Therapist $420.05
Mental Health Rehab Specialist $237.41
Peer Support Specialists $249.28
Community Health Worker $243.35
Medical Assistant $177.85
Other Qualified Providers $237.41
Exhibit C—Attachment A
Page 2 of 3
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
Field Based
(at least 50% of services are provided in the field)
Provider Rate Per
Provider Type Hour
Licensed Physician $1,050.80
Physicians Assistant $471.28
Nurse Practitioner $522.54
Registered Nurse $426.82
Certified Nurse Specialist $522.54
Licensed Vocational Nurse $224.22
Registered Pharmacist $503.00
Licensed Psychiatric Technician $192.22
Psychologist(Licensed or Waivered) $422.60
LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA $273.47
(MFT LCSW LPCC)
Occupational Therapist $364.04
Mental Health Rehab Specialist $205.75
Peer Support Specialists $216.04
Community Health Worker $210.89
Medical Assistant $154.13
Other Qualified Providers $205.75
Exhibit C—Attachment A
Page 3 of 3
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 C -Attachment B
Youth Continuum of Care
Central Star Behavioral Health,Inc.
FY 2025-26 August 5,2025-August 6,2025 FSP Ramp Up Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ - $
Acct# Program Position FTE Admin Program Total
1116 $ $
1117
1118
1119
1120
1121
1122 -
1123 -
1124 -
1125 -
1126 -
1127 -
1128 -
1129 -
1130 -
1131 -
1132 -
1133 -
1134 -
Direct Personnel Program Salaries Subtotal 0.00 $ $
Admin Program Total
Direct Personnel Salaries Subtotal 0.00 $
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ $
1202 Worker's Compensation
1203 Health Insurance
1204 Other(specify)
1
Exhibit C -Attachment B
1205 10ther(specify)
1206 10ther(specify)
Direct Employee Benefits Subtotal: $ - I $ I $
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ $
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 10ther(specify)
1306 10ther(specify)
Direct Payroll Taxes&Expenses Subtotal:
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ $
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
#DIV/01 #DIV/0!
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing, Food,&Hygiene
2005 jEclucation Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 IStaff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 10ther(specify)
DIRECT OPERATING EXPENSES TOTAL: $
2
Exhibit C -Attachment B
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) 1,667
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 1,667
INDIRECT COST RATE #DIV/0!
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
3
Exhibit C -Attachment B
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $
TOTAL PROGRAM EXPENSES $ 1,667
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $
8002 Client Fees
8003 Client Insurance
8004 Grants(Specify)
8005 10ther(Specify)
8006 10ther(Specify)
TOTAL PROGRAM REVENUES $
TOTAL PROGRAM ESTIMATED REVENUES: $ -
NET PROGRAM COST: $ 1,667
4
Exhibit C -Attachment B
Youth Continuum of Care
Central Star Behavioral Health,Inc.
FY 2025-26 FSP I August 5,2025-August 6,2025 Ramp Up Budget FTE Details
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
5
Exhibit C-Attachment B
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
6
Exhibit C-Attachment B
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Tota 1 0.00
7
Exhibit C -Attachment B
Youth Continuum of Care
Central Star Behavioral Health,Inc.
FY 2025-26 August 5,2025-August 6,2025 FSP Ramp Up Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS
Administrative Positions
1101 10
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 10
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions
1116 0
1117 0
1118 0
1119 0
1120 0
1121 0
1122 10
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits
1201 Retirement
1202 Worker's Compensation
1203 Health Insurance
1204 Other(specify)
1205 Other(specify)
1206 Other(specify)
Direct Payroll Taxes&Expenses:
1301 OASDI
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
8
Exhibit C -Attachment B
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 1,667
6001 lAdministrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used 1,667 Depreciation cost for vehicle use to transport clients to services and program activities
for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
9
Exhibit C -Attachment B
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,667
10
Exhibit C-Attachment B
Youth Continuum of Care
Central Star Behavioral Health Inc.
Fiscal Year 2025-26 1 August 7,2025-June 30,2026 FSP Cost Reimbursement Budget
PROGRAM EXPENSES
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care
2002 Client Housing Support 1,349
2003 Client Transportation&Support 3,600
2004 Clothing, Food,&Hygiene 3,100
2005 jEclucation Support 1,800
2006 Employment Support -
2007 Household Items for Clients 1,000
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL 1 $ 10,849
TOTAL PROGRAM EXPENSES $ 10,849
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $
8002 Client Fees
8003 Client Insurance
8004 Grants(Specify)
8005 10ther(Specify)
8006 10ther(Specify)
TOTAL PROGRAM REVENUES $
TOTAL PROGRAM ESTIMATED REVENUES: $ -
NET PROGRAM COST: $ 10,849
11
Exhibit C -Attachment B
Youth Continuum of Care
Central Star Behavioral Health Inc.
Fiscal Year 2025-26 August 7,2025-June 30,2026 FSP Cost Reimbursement Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2000:DIRECT CLIENT SUPPORT 10,849
2001 Child Care -
2002 Client Housing Support 1,349 Cost of rent,security deposits,hotel,moving expenses,etc.
2003 Client Transportation&Support 3,600 Cost of car payment,gas,insurance,registration,repairs,bus pases,taxi.
2004 Clothing,Food,&Hygiene 3,100 Cost of garments,groceries,and hygiene cost.
2005 Education Support 1,800 Cost of uniforms,licenses,birth certificates,tools of trade,etc.
2006 Employment Support -
2007 Household Items for Clients 1,000 Furniture appliances,kitchenware,linens,cleaning products,etc.
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 I Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 10,849
12
Exhibit C-Attachment B
Youth Continuum of Care
Central Star Behavioral Health Inc.
Fiscal Year 2026-27 1 July 1,2026-June 30,2027 FSP Cost Reimbursement Budget
PROGRAM EXPENSES
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care
2002 Client Housing Support 1,500
2003 Client Transportation&Support 4,000
2004 Clothing, Food,&Hygiene 3,500
2005 jEclucation Support 2,000
2006 Employment Support -
2007 Household Items for Clients 1,000
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL 1 $ 12,000
TOTAL PROGRAM EXPENSES $ 12,000
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $
8002 Client Fees
8003 Client Insurance
8004 Grants(Specify)
8005 10ther(Specify)
8006 10ther(Specify)
TOTAL PROGRAM REVENUES $
TOTAL PROGRAM ESTIMATED REVENUES: $ -
NET PROGRAM COST: $ 12,000
13
Exhibit C -Attachment B
Youth Continuum of Care
Central Star Behavioral Health Inc.
Fiscal Year 2026-27 July 1,2026-June 30,2027 FSP Cost Reimbursement Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2000:DIRECT CLIENT SUPPORT 12,000
2001 Child Care -
2002 Client Housing Support 1,500 Cost of rent,security deposits,hotel,moving expenses,etc.
2003 Client Transportation&Support 4,000 Cost of car payment,gas,insurance,registration,repairs,bus pases,taxi.
2004 Clothing,Food,&Hygiene 3,500 Cost of garments,groceries,and hygiene cost.
2005 Education Support 2,000 Cost of uniforms,licenses,birth certificates,tools of trade,etc.
2006 Employment Support -
2007 Household Items for Clients 1,000 Furniture appliances,kitchenware,linens,cleaning products,etc.
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 I Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 12,000
14
Exhibit C-Attachment B
Youth Continuum of Care
Central Star Behavioral Health Inc.
Fiscal Year 2027-28 1 July 1,2027-June 30,2028 FSP Cost Reimbursement Budget
PROGRAM EXPENSES
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care
2002 Client Housing Support 1,500
2003 Client Transportation&Support 4,000
2004 Clothing, Food,&Hygiene 3,500
2005 jEclucation Support 2,000
2006 Employment Support -
2007 Household Items for Clients 1,000
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL 1 $ 12,000
TOTAL PROGRAM EXPENSES $ 12,000
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $
8002 Client Fees
8003 Client Insurance
8004 Grants(Specify)
8005 10ther(Specify)
8006 10ther(Specify)
TOTAL PROGRAM REVENUES $
TOTAL PROGRAM ESTIMATED REVENUES: $ -
NET PROGRAM COST: $ 12,000
15
Exhibit C -Attachment B
Youth Continuum of Care
Central Star Behavioral Health Inc.
Fiscal Year 2027-28 July 1,2027-June 30,2028 FSP Cost Reimbursement Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2000:DIRECT CLIENT SUPPORT 12,000
2001 Child Care -
2002 Client Housing Support 1,500 Cost of rent,security deposits,hotel,moving expenses,etc.
2003 Client Transportation&Support 4,000 Cost of car payment,gas,insurance,registration,repairs,bus pases,taxi.
2004 Clothing,Food,&Hygiene 3,500 Cost of garments,groceries,and hygiene cost.
2005 Education Support 2,000 Cost of uniforms,licenses,birth certificates,tools of trade,etc.
2006 Employment Support -
2007 Household Items for Clients 1,000 Furniture appliances,kitchenware,linens,cleaning products,etc.
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 I Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 12,000
16
Exhibit C-Attachment B
Youth Continuum of Care
Central Star Behavioral Health Inc.
Fiscal Year 2028-29 1 July 1,2028-June 30,2029 FSP Cost Reimbursement Budget
PROGRAM EXPENSES
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care
2002 Client Housing Support 1,500
2003 Client Transportation&Support 4,000
2004 Clothing, Food,&Hygiene 3,500
2005 jEclucation Support 2,000
2006 Employment Support -
2007 Household Items for Clients 1,000
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL 1 $ 12,000
TOTAL PROGRAM EXPENSES $ 12,000
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $
8002 Client Fees
8003 Client Insurance
8004 Grants(Specify)
8005 10ther(Specify)
8006 10ther(Specify)
TOTAL PROGRAM REVENUES $
TOTAL PROGRAM ESTIMATED REVENUES: $ -
NET PROGRAM COST: $ 12,000
17
Exhibit C -Attachment B
Youth Continuum of Care
Central Star Behavioral Health Inc.
Fiscal Year 2028-29 July 1,2028-June 30,2029 FSP Cost Reimbursement Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2000:DIRECT CLIENT SUPPORT 12,000
2001 Child Care -
2002 Client Housing Support 1,500 Cost of rent,security deposits,hotel,moving expenses,etc.
2003 Client Transportation&Support 4,000 Cost of car payment,gas,insurance,registration,repairs,bus pases,taxi.
2004 Clothing,Food,&Hygiene 3,500 Cost of garments,groceries,and hygiene cost.
2005 Education Support 2,000 Cost of uniforms,licenses,birth certificates,tools of trade,etc.
2006 Employment Support -
2007 Household Items for Clients 1,000 Furniture appliances,kitchenware,linens,cleaning products,etc.
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 I Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 12,000
18
Exhibit C-Attachment B
Youth Continuum of Care
Central Star Behavioral Health Inc.
Fiscal Year 2029-30 1 July 1,2029-June 30,2030 FSP Cost Reimbursement Budget
PROGRAM EXPENSES
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care
2002 Client Housing Support 1,500
2003 Client Transportation&Support 4,000
2004 Clothing, Food,&Hygiene 3,500
2005 Education Support 2,000
2006 Employment Support -
2007 Household Items for Clients 1,000
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 12,000
TOTAL PROGRAM EXPENSES $ 12,000
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $
8002 Client Fees
8003 Client Insurance
8004 Grants(Specify)
8005 10ther(Specify)
8006 10ther(Specify)
TOTAL PROGRAM REVENUES $
TOTAL PROGRAM ESTIMATED REVENUES: $ -
NET PROGRAM COST: $ 12,000
19
Exhibit C -Attachment B
Youth Continuum of Care
Central Star Behavioral Health Inc.
Fiscal Year 2029-30 July 1,2029-June 30,2030 FSP Cost Reimbursement Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2000:DIRECT CLIENT SUPPORT 12,000
2001 Child Care -
2002 Client Housing Support 1,500 Cost of rent,security deposits,hotel,moving expenses,etc.
2003 Client Transportation&Support 4,000 Cost of car payment,gas,insurance,registration,repairs,bus pases,taxi.
2004 Clothing,Food,&Hygiene 3,500 Cost of garments,groceries,and hygiene cost.
2005 Education Support 2,000 Cost of uniforms,licenses,birth certificates,tools of trade,etc.
2006 Employment Support -
2007 Household Items for Clients 1,000 Furniture appliances,kitchenware,linens,cleaning products,etc.
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 I Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 22,000
20
Exhibit D
Page 1 of 3
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1) the retroactive date must
be prior to the date on which services began under this Agreement; (2) the Contractor
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Contractor.
D-1
Exhibit D
Page 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 the Contractor's obligations under Article 11
of this Agreement; (iv) system failure; (v) data recovery; (vi)failure to timely disclose
data breach or Security Breach; (vii) failure to comply with privacy policy; (viii) payment
card liabilities and costs; (ix) infringement of intellectual property, including but not
limited to infringement of copyright, trademark, and trade dress; (x) invasion of privacy,
including release of private information; (xi) information theft; (xii) damage to or
destruction or alteration of electronic information; (xiii) cyber extortion; (xiv) extortion
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; (xv)fraudulent instruction; (xvi) funds
transfer fraud; (xvii) telephone fraud; (xviii) network security; (xix) data breach response
costs, including Security Breach response costs; (xx) regulatory fines and penalties
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; and (xxi) credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement,
and at any time during the term of this Agreement as requested by the County, the
Contractor 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(a�_fresnocountyca.gov with a
copy to the assigned County's DBH Staff Analyst, certificates of insurance and
endorsements for all of the coverages required under this Agreement.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VI I.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, the Contractor shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, the Contractor shall, or shall
cause the insurer to, provide written notice to the County not less than 30 days in
advance of cancellation or change. The County in its sole discretion may determine that
the failure of the Contractor or its insurer to timely provide a written notice required by
this paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance
with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Contractor shall deliver, or cause its broker or producer
to deliver, to the County's Risk Manager certificates of insurance and endorsements for
D-2
Exhibit D
Page 3of3
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E) Waiver of Subrogation. The Contractor waives any right to recover from the County, its
officers, agents, employees, and volunteers any amounts paid under any insurance
policy required by this Agreement. The Contractor is solely responsible to obtain any
policy endorsement that may be necessary to accomplish that waiver, but the
Contractor's waiver of subrogation under this paragraph is effective whether or not the
Contractor obtains such an endorsement.
(F) County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep
in effect at all times any insurance coverage required under this Agreement, the County
may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Contractor. The County may offset such
charges against any amounts owed by the County to the Contractor under this
Agreement.
(G)Subcontractors. The Contractor shall require and verify that all subcontractors used by
the Contractor to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement. This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
D-3
Exhibit E
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 the Contractor's employees who have access to
Personal Information.
(B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all
of the Contractor's subcontractors, representatives, agents, outsourcers, and
consultants, and providers of professional services to the Contractor, who have access
to Personal Information and are bound by law or in writing by confidentiality obligations
sufficient to protect Personal Information in accordance with the terms of this Exhibit.
(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 the Contractor by or upon the authorization of the
County, under this Agreement, including but not limited to vital records, that: (i) identifies,
describes, or relates to, or is associated with, or is capable of being used to identify,
describe, or relate to, or associate with, a person (including, without limitation, names,
physical descriptions, signatures, addresses, telephone numbers, e-mail addresses,
education, financial matters, employment history, and other unique identifiers, as well as
statements made by or attributable to the person); (ii) is used or is capable of being used
to authenticate a person (including, without limitation, employee identification numbers,
government-issued identification numbers, passwords or personal identification numbers
(PINs), financial account numbers, credit report information, answers to security
questions, and other personal identifiers); or (iii) is personal information within the
meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision
(e). Personal Information does not include publicly available information that is lawfully
made available to the general public from federal, state, or local government records.
(G)"Privacy Practices Complaint" means a complaint received by the County relating to
the Contractor's (or any Authorized Person's) privacy practices, or alleging a Security
Breach. Such complaint shall have sufficient detail to enable the Contractor to promptly
investigate and take remedial action under this Exhibit.
(H) "Security Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by the Contractor (or any Authorized
Persons) that relate to the protection of the security, confidentiality, value, or integrity of
Personal Information. Security Safeguards shall satisfy the minimal requirements set
forth in section 3(C) of this Exhibit.
F-1
Exhibit E
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) The Contractor acknowledges that, in the course of its engagement by the County under
this Agreement, the Contractor, or any Authorized Persons, may Use Personal
Information only as permitted in this Agreement.
(B) The Contractor acknowledges that Personal Information is deemed to be confidential
information of, or owned by, the County (or persons from whom the County receives or
has received Personal Information) and is not confidential information of, or owned or by,
the Contractor, or any Authorized Persons. The Contractor further acknowledges that all
right, title, and interest in or to the Personal Information remains in the County (or
persons from whom the County receives or has received Personal Information)
regardless of the Contractor's, or any Authorized Person's, Use of that Personal
Information.
(C) The Contractor agrees and covenants in favor of the Country that the Contractor shall:
(i) keep and maintain all Personal Information in strict confidence, using such
degree of care under this section 2 as is reasonable and appropriate to avoid a
Security Breach;
(ii) use Personal Information exclusively for the purposes for which the Personal
Information is made accessible to the Contractor pursuant to the terms of this
Exhibit;
(iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal
Information for the Contractor's own purposes or for the benefit of anyone other
than the County, without the County's express prior written consent, which the
County may give or withhold in its sole and absolute discretion; and
(iv) not, directly or indirectly, Disclose Personal Information to any person (an
"Unauthorized Third Party") other than Authorized Persons pursuant to this
Agreement, without the Director's express prior written consent.
(D) Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it,
or any Authorized Person, is required to disclose Personal Information to government
regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be
required by applicable law, Contractor shall (i) immediately notify the County of the
specific demand for, and legal authority for the disclosure, including providing County
with a copy of any notice, discovery demand, subpoena, or order, as applicable,
received by the Contractor, or any Authorized Person, from any government regulatory
authorities, or in relation to any legal proceeding, and (ii) promptly notify the County
F-2
Exhibit E
Page 3 of 8
before such Personal Information is offered by the Contractor for such disclosure so that
the County may have sufficient time to obtain a court order or take any other action the
County may deem necessary to protect the Personal Information from such disclosure,
and the Contractor shall cooperate with the County to minimize the scope of such
disclosure of such Personal Information.
(E) The Contractor shall remain liable to the County for the actions and omissions of any
Unauthorized Third Party concerning its Use of such Personal Information as if they
were the Contractor's own actions and omissions.
3. Information Security
(A) The Contractor covenants, represents and warrants to the County that the Contractor's
Use of Personal Information under this Agreement does and will at all times comply with
all applicable federal, state, and local, privacy and data protection laws, as well as all
other applicable regulations and directives, including but not limited to California Civil
Code, Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song-
Beverly Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3,
beginning with section 1747). If the Contractor Uses credit, debit or other payment
cardholder information, the Contractor shall at all times remain in compliance with the
Payment Card Industry Data Security Standard ("PCI DSS") requirements, including
remaining aware at all times of changes to the PCI DSS and promptly implementing and
maintaining all procedures and practices as may be necessary to remain in compliance
with the PCI DSS, in each case, at the Contractor's sole cost and expense.
(B) The Contractor covenants, represents and warrants to the County that, as of the
effective date of this Agreement, the Contractor has not received notice of any violation
of any privacy or data protection laws, as well as any other applicable regulations or
directives, and is not the subject of any pending legal action or investigation by, any
government regulatory authority regarding same.
(C)Without limiting the Contractor's obligations under section 3(A) of this Exhibit, the
Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than
accepted industry practices and, at a minimum, include the following:
(i) limiting Use of Personal Information strictly to the Contractor's and Authorized
Persons' technical and administrative personnel who are necessary for the
Contractor's, or Authorized Persons', Use of the Personal Information pursuant to
this Agreement;
(ii) ensuring that all of the Contractor's connectivity to County computing systems
will only be through the County's security gateways and firewalls, and only
through security procedures approved upon the express prior written consent of
the Director;
(iii) to the extent that they contain or provide access to Personal Information, (a)
securing business facilities, data centers, paper files, servers, back-up systems
and computing equipment, operating systems, and software applications,
including, but not limited to, all mobile devices and other equipment, operating
systems, and software applications with information storage capability; (b)
F-3
Exhibit E
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 the
Contractor, including any Authorized Person, or anyone with whom the
Contractor or any Authorized Person deals so that Personal Information is not
commingled with any other types of information;
(vi) having a patch management process including installation of all operating system
and software vendor security patches;
(vii) maintaining appropriate personnel security and integrity procedures and
practices, including, but not limited to, conducting background checks of
Authorized Employees consistent with applicable law; and
(viii) providing appropriate privacy and information security training to Authorized
Employees.
(D) During the term of each Authorized Employee's employment by the Contractor, the
Contractor shall cause such Authorized Employees to abide strictly by the Contractor's
obligations under this Exhibit. The Contractor shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
(E) The Contractor shall, in a secure manner, backup daily, or more frequently if it is the
Contractor's practice to do so more frequently, Personal Information received from the
County, and the County shall have immediate, real-time access, at all times, to such
backups via a secure, remote access connection provided by the Contractor, through the
Internet.
(F) The Contractor shall provide the County with the name and contact information for each
Authorized Employee (including such Authorized Employee's work shift, and at least one
alternate Authorized Employee for each Authorized Employee during such work shift)
who shall serve as the County's primary security contact with the Contractor and shall be
F-4
Exhibit E
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 the Contractor's and any Authorized Persons' obligations
associated with a Security Breach or a Privacy Practices Complaint.
(G)The Contractor shall not knowingly include or authorize any Trojan Horse, back door,
time bomb, drop dead device, worm, virus, or other code of any kind that may disable,
erase, display any unauthorized message within, or otherwise impair any County
computing system, with or without the intent to cause harm.
4. Security Breach Procedures
(A) Immediately upon the Contractor's awareness or reasonable belief of a Security Breach,
the Contractor shall (i) notify the Director of the Security Breach, such notice to be given
first by telephone at the following telephone number, followed promptly by email at the
following email addresses: incidents(a�fresnocountyca.gov, 559-600-5900, (which
telephone number and email address the County may update by providing notice to the
Contractor), and (ii) preserve all relevant evidence (and cause any affected Authorized
Person to preserve all relevant evidence) relating to the Security Breach. The notification
shall include, to the extent reasonably possible, the identification of each type and the
extent of Personal Information that has been, or is reasonably believed to have been,
breached, including but not limited to, compromised, or subjected to unauthorized Use,
Disclosure, or modification, or any loss or destruction, corruption, or damage.
(B) Immediately following the Contractor's notification to the County of a Security Breach, as
provided pursuant to section 4(A) of this Exhibit, the Parties shall coordinate with each
other to investigate the Security Breach. The Contractor agrees to fully cooperate with
the County, including, without limitation:
(i) assisting the County in conducting any investigation;
(ii) providing the County with physical access to the facilities and operations
affected;
(iii) facilitating interviews with Authorized Persons and any of the Contractor's other
employees knowledgeable of the matter; and
(iv) making available all relevant records, logs, files, data reporting and other
materials required to comply with applicable law, regulation, industry standards,
or as otherwise reasonably required by the County.
To that end, the Contractor shall, with respect to a Security Breach, be solely
responsible, at its cost, for all notifications required by law and regulation, or deemed
reasonably necessary by the County, and the Contractor shall provide a written report of
the investigation and reporting required to the Director within 30 days after the
Contractor's discovery of the Security Breach.
(C) County shall promptly notify the Contractor of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint, and upon the Contractor's receipt of that
notification, the Contractor shall promptly address such Privacy Practices Complaint,
including taking any corrective action under this Exhibit, all at the Contractor's sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
F-5
Exhibit E
Page 6 of 8
In the event the Contractor discovers a Security Breach, the Contractor shall treat the
Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractor's
receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the
County whether the matter is a Security Breach, or otherwise has been corrected and
the manner of correction, or determined not to require corrective action and the reason
for that determination.
(D) The Contractor shall take prompt corrective action to respond to and remedy any
Security Breach and take mitigating actions, including but not limiting to, preventing any
reoccurrence of the Security Breach and correcting any deficiency in Security
Safeguards as a result of such incident, all at the Contractor's sole expense, in
accordance with applicable privacy rights, laws, regulations and standards. The
Contractor shall reimburse the County for all reasonable costs incurred by the County in
responding to, and mitigating damages caused by, any Security Breach, including all
costs of the County incurred relation to any litigation or other action described section
4(E) of this Exhibit.
(E) The Contractor agrees to cooperate, at its sole expense, with the County in any litigation
or other action to protect the County's rights relating to Personal Information, including
the rights of persons from whom the County receives Personal Information.
5. Oversight of Security Compliance
(A) The Contractor shall have and maintain a written information security policy that
specifies Security Safeguards appropriate to the size and complexity of the Contractor's
operations and the nature and scope of its activities.
(B) Upon the County's written request, to confirm the Contractor's compliance with this
Exhibit, as well as any applicable laws, regulations and industry standards, the
Contractor grants the County or, upon the County's election, a third party on the
County's behalf, permission to perform an assessment, audit, examination or review of
all controls in the Contractor's physical and technical environment in relation to all
Personal Information that is Used by the Contractor pursuant to this Agreement. The
Contractor shall fully cooperate with such assessment, audit or examination, as
applicable, by providing the County or the third party on the County's behalf, access to
all Authorized Employees and other knowledgeable personnel, physical premises,
documentation, infrastructure and application software that is Used by the Contractor for
Personal Information pursuant to this Agreement. In addition, the Contractor shall
provide the County with the results of any audit by or on behalf of the Contractor that
assesses the effectiveness of the Contractor's information security program as relevant
to the security and confidentiality of Personal Information Used by the Contractor or
Authorized Persons during the course of this Agreement under this Exhibit.
(C) The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit. that apply to the Contractor
with respect to such Personal Information by incorporating the relevant provisions of
these provisions into a valid and binding written agreement between the Contractor and
such Authorized Persons, or amending any written agreements to provide same.
F-6
Exhibit E
Page 7 of 8
6. Return or Destruction of Personal Information. Upon the termination of this Agreement,
the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the County
all Personal Information, whether in written, electronic or other form or media, in its possession
or the possession of such Authorized Persons, in a machine readable form used by the County
at the time of such return, or upon the express prior written consent of the Director, securely
destroy all such Personal Information, and certify in writing to the County that such Personal
Information have been returned to the County or disposed of securely, as applicable. If the
Contractor is authorized to dispose of any such Personal Information, as provided in this Exhibit,
such certification shall state the date, time, and manner (including standard) of disposal and by
whom, specifying the title of the individual. The Contractor shall comply with all reasonable
directions provided by the Director with respect to the return or disposal of Personal Information
and copies of Personal Information. If return or disposal of such Personal Information or copies
of Personal Information is not feasible, the Contractor shall notify the County according,
specifying the reason, and continue to extend the protections of this Exhibit to all such Personal
Information and copies of Personal Information. The Contractor shall not retain any copy of any
Personal Information after returning or disposing of Personal Information as required by this
section 6. The Contractor's obligations under this section 6 survive the termination of this
Agreement and apply to all Personal Information that the Contractor retains if return or disposal
is not feasible and to all Personal Information that the Contractor may later discover.
7. Equitable Relief. The Contractor acknowledges that any breach of its covenants or
obligations set forth in this Exhibit may cause the County irreparable harm for which monetary
damages would not be adequate compensation and agrees that, in the event of such breach or
threatened breach, the County is entitled to seek equitable relief, including a restraining order,
injunctive relief, specific performance and any other relief that may be available from any court,
in addition to any other remedy to which the County may be entitled at law or in equity. Such
remedies shall not be deemed to be exclusive but shall be in addition to all other remedies
available to the County at law or in equity or under this Agreement.
8. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its
officers, employees, and agents, (each, a "County Indemnitee")from and against any and all
infringement of intellectual property including, but not limited to infringement of copyright,
trademark, and trade dress, invasion of privacy, information theft, and extortion, unauthorized
Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage
to, Personal Information, Security Breach response and remedy costs, credit monitoring
expenses, forfeitures, losses, damages, liabilities, deficiencies, actions, judgments, interest,
awards, fines and penalties (including regulatory fines and penalties), costs or expenses of
whatever kind, including attorneys' fees and costs, the cost of enforcing any right to
indemnification or defense under this Exhibit and the cost of pursuing any insurance providers,
arising out of or resulting from any third party claim or action against any County Indemnitee in
relation to the Contractor's, its officers, employees, or agents, or any Authorized Employee's or
Authorized Person's, performance or failure to perform under this Exhibit or arising out of or
resulting from the Contractor's failure to comply with any of its obligations under this section 8.
The provisions of this section 8 do not apply to the acts or omissions of the County. The
provisions of this section 8 are cumulative to any other obligation of the Contractor to, defend,
indemnify, or hold harmless any County Indemnitee under this Agreement. The provisions of
this section 8 shall survive the termination of this Agreement.
F-7
Exhibit E
Page 8 of 8
9. Survival. The respective rights and obligations of the Contractor 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 the Contractor and their respective successors or assignees, any rights, remedies,
obligations or liabilities whatsoever.
11. No County Warranty. The County does not make any warranty or representation whether
any Personal Information in the Contractor's (or any Authorized Person's) possession or control,
or Use by the Contractor (or any Authorized Person), pursuant to the terms of this Agreement is
or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint.
F-8
Exhibit F
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County'),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit F
Page 2 of 2
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3) Disclosure(Please describe the nature of the self-dealing transaction you are a party to)
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a)
(5)Authorized Signature
Signature: Date:
Exhibit G
Page 1 of 3
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of Entity D/B/A
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 XVII I, XIX, or XX?......................................................................................................................... o 0
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVI II, 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 -j 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 G
Page 2 of 3
YES NO
IV. A. Has there been a change in ownership or control within the last year?....................................................... o 0
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... o 0
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
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 EIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
Exhibit G
Page 3 of 3
INSTRUCTIONS FOR COMPLETING DISCLOSURE OF CONTROL AND INTEREST STATEMENT
Please answer all questions as of the current date.If the yes block for any item is checked,list requested additional information under
the Remarks Section on page 2,referencing the item number to be continued. If additional space is needed use an attached sheet.
DETAILED INSTRUCTIONS
These instructions are designed to clarify certain questions on the form.Instructions are listed in question order for easy reference.No
instructions have been given for questions considered self-explanatory.
IT IS ESSENTIAL THAT ALL APPLICABLE QUESTIONS BE ANSWERED ACCURATELY AND THAT ALL INFORMATION
BE CURRENT.
Item I-Under"Identifying Information"specify in what capacity the entity is doing business as(DBA)(e.g.name of trade or
corporation).
Item II- Self-explanatory
Item III-List the names of all individuals and organizations having direct or indirect ownership interests, or controlling interest
separately or in combination amounting to an ownership interest of 5 percent or more in the disclosing entity.
Direct ownership interest-is defined as the possession of stock,equity in capital or any interest in the profits of the disclosing entity.
A disclosing entity is defined as a Medicare provider or supplier,or other entity that furnishes services or arranges for furnishing
services under Medicaid or the Maternal and Child Health program,or health related services under the social services program.
Indirect ownership interest-is defined as ownership interest in an entity that has direct or hospital-based home health agencies,are not
indirect ownership interest in the disclosing entity.The amount of indirect ownership in the disclosing entity that is held by any other
entity is determined by multiplying the percentage of ownership interest at each level. An indirect ownership interest must beds in the
facility now and the previous be reported if it equates to an ownership interest of 5 percent or more in the disclosing entity.Example:
if A owns 10 percent of the stock in a corporation that owns 80 percent of the stock of the disclosing entity,A's interest equates to an 8
percent indirect ownership and must be reported.
Controlling interest-is defined as the operational direction or management of disclosing entity which may be maintained by any or all
of the following devices:the ability or authority,expressed or reserved,to amend or change the corporate identity(i.e.,joint venture
agreement,unincorporated business status)of the disclosing entity;the ability or authority to nominate or name members of the Board
of Directors or Trustees of the disclosing entity;the ability or authority,expressed or reserved,to amend or change the by-laws,
constitution,or other operating or management direction of the disclosing entity;the right to control any or all of the assets or other
property of the disclosing entity upon the sale or dissolution of that entity;the ability or authority,expressed or reserved,to control the
sale of any or all of the assets,to encumber such assets by way of mortgage or other indebtedness,to dissolve the entity or to arrange
for the sale or transfer of the disclosing entity to new ownership or control.
Item IV-VII-(Changes in Provider Status)For Items IV-VII,if the yes box is checked,list additional information requested under
Remarks. Clearly identify which item is being continued.
Change in provider status-is defined as any change in management control. Examples of such changes would include;a change in
Medical or Nursing Director, a new Administrator,contracting the operation of the facility to a management corporation,a change in
the composition of the owning partnership which under applicable State law is not considered a change in ownership, or the hiring or
dismissing of any employees with 5 percent or more financial interest in the facility or in an owning corporation,or any change of
ownership.
Item IV-(A&B)If there has been a change in ownership within the last year or if you anticipate a change,indicate the date in the
appropriate space.
Item V-If the answer is yes,list name of the management firm and employer identification number(EIN),or the name of the leasing
organization.A management company is defined as any organization that operates and manages a business on behalf of the owner of
that business,with the owner retaining ultimate legal responsibility for operation of the facility.
Item VI-If the answer is yes,identify which has changed(Administrator,Medical Director,or Director of Nursing)and the date the
change was made.Be sure to include name of the new Administrator,Director of Nursing or Medical Director,as appropriate.
Item VII-A chain affiliate is any free-standing health care facility that is either owned,controlled,or operated under lease or contract
by an organization consisting of two or more free-standing health care facilities organized within or across State lines which is under
the ownership or through any other device,control and direction of a common party. Chain affiliates include such facilities whether
public,private,charitable or proprietary. They also include subsidiary organizations and holding corporations. Provider-based
facilities,such as hospital-based home health agencies,are not considered to be chain affiliates.
Exhibit H
1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit H
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: �i _�� Date: 7/13/2025
Kent Dunlap, President and CEO Central Star Behavioral Health, Inc.
(Printed Name & Title) (Name of Agency or
Company)