HomeMy WebLinkAboutAgreement A-25-321 Master Agreement.pdf Agreement No. 25-321
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated June 24, 2025 and is between
3 Contractor(s) listed in Exhibit A "List of Contractors"("Contractors"), and the County of Fresno, a
4 political subdivision of the State of California ("County").
5 Recitals
6 A. County is a Behavioral Health Plan (BHP) as defined in Title 9 of the California Code of
7 Regulations (C.C.R.) section 1810.226 and California Welfare and Institutions Code §14680-
8 14685.
9 B. County, as a Behavioral Health Plan, is authorized to provide outpatient specialty
10 mental health services.
11 C. County is in need of a qualified contractors to provide outpatient specialty mental health
12 services for persons eligible for Medi-Cal.
13 D. On March 21, 2025, the County issued a Request for Statement of Qualifications
14 (RFSQ) No. 25-085 for Individual and Group Provider Specialty Mental Health Services.
15 E. On April 23, 2025, all Contractors listed in Exhibit A submitted acceptable responses to
16 RFSQ No. 25-085 to provide outpatient specialty mental health services for persons eligible for
17 Medi-Cal.
18 The parties therefore agree as follows:
19 Article 1
20 Contractor's Services
21 1.1 Scope of Services. The Contractors shall perform all of the services provided in
22 Exhibit B to this agreement, titled "Fresno County Department of Behavioral Health Scope of
23 Work".
24 1.2 Contractors shall also perform all services and fulfill all responsibilities as specified in
25 County's Request for Statement of Qualifications (RFSQ) issued under the name of Individual
26 and Group Provider Specialty Mental Health Services RFSQ No. 25-085 dated March 21, 2025
27 and Addendum No. One (1) to COUNTY's RFSQ No. 25-085 dated April 10, 2025 (collectively
28 referred to herein as County's Revised RFSQ) and Contractors' responses to County's Revised
1
1 RFSQ dated April 23, 2025, all incorporated herein by reference and made part of this
2 Agreement. In the event of any inconsistency among these documents, the inconsistency shall
3 be resolved by giving precedence in the following order of priority: (1) to the Agreement,
4 including all Exhibits; (2) to the Revised RFSQ; and (3) to the Response to the Revised RFSQ.
5 A copy of County's Revised RFSQ and Contractors' responses thereto shall be retained and
6 made available during the term of this Agreement by County's Department of Behavioral Health
7 (DBH) Plan Administration Division.
8 1.3 Representation. The Contractors represent that they are qualified, ready, willing,
9 and able to perform all of the services provided in this Agreement.
10 1.4 Compliance with Laws. The Contractors shall, at their own cost, comply with all
11 applicable federal, state, and local laws and regulations in the performance of its obligations
12 under this Agreement, including but not limited to workers compensation, labor, and
13 confidentiality laws and regulations. Additionally, Contractors shall comply with laws,
14 regulations, and requirements in Exhibit C to this agreement, titled "Fresno County Behavioral
15 Health Requirements".
16 Article 2
17 County's Responsibilities
18 2.1 The County shall provide oversight and collaborate with Contractors, other County
19 Departments and community agencies to help achieve program goals and outcomes. In addition
20 to Contractors' monitoring of programs, oversight includes, but not limited to, coordination with
21 Department of Health Care Services (DHCS) in regard to program administration and outcomes.
22 2.2 County shall participate in evaluating the progress of the overall program, levels of
23 care components, and the efficiency of collaboration with the Contractors' staff and will be
24 available to Contractors for ongoing consultation. County shall receive and analyze statistical
25 outcome data from Contractors throughout the term of contract. County shall notify the
26 Contractors when additional participation is required. The performance outcome measurement
27 process will not be limited to survey instruments but will also include, as appropriate, persons
28 served and staff surveys, chart reviews, and other methods of obtaining required information.
2
1 Article 3
2 Compensation, Invoices, and Payments
3 3.1 The County agrees to pay, and the Contractors agree to receive compensation for
4 the performance of its services under this Agreement as described in Exhibit D to this
5 agreement, titled "Fresno County Department of Behavioral Health Financial Terms and
6 Conditions".
7 3.2 Additional Fiscal Requirements. The Contractors shall comply with all additional
8 requirements in Exhibit D to this Agreement.
9 Article 4
10 Term of Agreement
11 4.1 Term. This Agreement is effective on July 1, 2025 and terminates on June 30, 2028
12 except as provided in section 4.2, "Extension," or Article 6, "Termination and Suspension,"
13 below.
14 4.2 Extension. The term of this Agreement may be extended for no more than two, one-
15 year periods only upon written approval of both parties at least thirty (30) days before the first
16 day of the next one-year extension period. The County's DBH Director or his or her designee is
17 authorized to sign the written approval on behalf of the County based on the Contractors'
18 satisfactory performance. The extension of this Agreement by the County is not a waiver or
19 compromise of any default or breach of this Agreement by the Contractors existing at the time of
20 the extension whether or not known to the County.
21 Article 5
22 Notices
23 5.1 Contact Information. The persons and their addresses having authority to give and
24 receive notices provided for or permitted under this Agreement include the following:
25
For the County:
26 Director, Department of Behavioral Health
County of Fresno
27 1925 E Dakota Avenue
Fresno, CA 93726
28
For the Contractors:
3
1 See List of Contractors (Exhibit A)
2 5.2 Change of Contact Information. Either party may change the information in section
3 5.1 by giving notice as provided in section 5.3.
4 5.3 Method of Delivery. Each notice between the County and the Contractors provided
5 for or permitted under this Agreement must be in writing, state that it is a notice provided under
6 this Agreement, and be delivered either by personal service, by first-class United States mail, by
7 an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
8 Document Format (PDF) document attached to an email.
9 (A) A notice delivered by personal service is effective upon service to the recipient.
10 (B) A notice delivered by first-class United States mail is effective three County
11 business days after deposit in the United States mail, postage prepaid, addressed to the
12 recipient.
13 (C)A notice delivered by an overnight commercial courier service is effective one
14 County business day after deposit with the overnight commercial courier service,
15 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
16 the recipient.
17 (D)A notice delivered by telephonic facsimile transmission or by PDF document
18 attached to an email is effective when transmission to the recipient is completed (but, if
19 such transmission is completed outside of County business hours, then such delivery is
20 deemed to be effective at the next beginning of a County business day), provided that
21 the sender maintains a machine record of the completed transmission.
22 5.4 Claims Presentation. For all claims arising from or related to this Agreement,
23 nothing in this Agreement establishes, waives, or modifies any claims presentation
24 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
25 of Title 1 of the Government Code, beginning with section 810).
26
27
28
4
1 Article 6
2 Termination and Suspension
3 6.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
4 contingent on the approval of funds by the appropriating government agency. If sufficient funds
5 are not allocated, then the County, upon at least 30 days' advance written notice to the
6 Contractors, may:
7 (A) Modify the services provided by the Contractors under this Agreement; or
8 (B) Terminate this Agreement.
9 6.2 Termination for Breach.
10 (A) Upon determining that a breach (as defined in paragraph (C) below) has
11 occurred, the County may give written notice of the breach to the Contractors. The
12 written notice may suspend performance under this Agreement, and must provide at
13 least 30 days for the Contractors to cure the breach.
14 (B) If a Contractor fails to cure the breach to the County's satisfaction within the time
15 stated in the written notice, the County may terminate their Agreement immediately.
16 (C) For purposes of this section, a breach occurs when, in the determination of the
17 County, a Contractor has:
18 (1) Obtained or used funds illegally or improperly;
19 (2) Failed to comply with any part of this Agreement;
20 (3) Submitted a substantially incorrect or incomplete report to the County; or
21 (4) Improperly performed any of its obligations under this Agreement.
22 6.3 Termination without Cause. In circumstances other than those set forth above, the
23 County may terminate this Agreement by giving at least 30 days advance written notice to the
24 Contractors.
25 6.4 Economic Sanctions. In accordance with Executive Order N-6-22 regarding
26 Economic Sanctions against Russia and Russian entities and individuals, the County may
27 terminate their Agreement if a Contractor is a target of Economic Sanctions or is conducting
28
5
1 prohibited transactions with sanctioned individuals or entities. The County shall provide at least
2 thirty (30) days advance written notice to the Contractors.
3 6.5 No Penalty or Further Obligation. Any termination of this Agreement by the County
4 under this Article 6 is without penalty to or further obligation of the County.
5 6.6 County's Rights upon Termination. Upon termination for breach under this Article
6 6, the County may demand repayment by the Contractors of any monies disbursed to the
7 Contractors under this Agreement that, in the County's sole judgment, were not expended in
8 compliance with this Agreement. The Contractors shall promptly refund all such monies upon
9 demand. This section survives the termination of this Agreement.
10 Article 7
11 Independent Contractor
12 7.1 Status. In performing under this Agreement, the Contractors, including their officers,
13 agents, employees, and volunteers, are at all times acting and performing as an independent
14 contractors, in an independent capacity, and not as an officer, agent, servant, employee,joint
15 venturer, partner, or associate of the County.
16 7.2 Verifying Performance. The County has no right to control, supervise, or direct the
17 manner or method of the Contractors' performance under this Agreement, but the County may
18 verify that the Contractors are performing according to the terms of this Agreement.
19 7.3 Benefits. Because of their status as an independent contractor, the Contractors
20 have no right to employment rights or benefits available to County employees. The Contractors
21 are solely responsible for providing to their own employees all employee benefits required by
22 law. The Contractors shall save the County harmless from all matters relating to the payment of
23 Contractors' employees, including compliance with Social Security withholding and all related
24 regulations.
25 7.4 Services to Others. The parties acknowledge that, during the term of this
26 Agreement, the Contractors may provide services to others unrelated to the County.
27
28
6
1 Article 8
2 Indemnity and Defense
3 8.1 Indemnity. The Contractors shall indemnify and hold harmless and defend the
4 County (including its officers, agents, employees, and volunteers) against all claims, demands,
5 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
6 liabilities of any kind to the County, the Contractors, or any third party that arise from or relate to
7 the performance or failure to perform by the Contractors (or any of its officers, agents,
8 subcontractors, or employees) under this Agreement. The County may conduct or participate in
9 its own defense without affecting the Contractors' obligation to indemnify and hold harmless or
10 defend the County.
11 8.2 Survival. This Article 8 survives the termination of this Agreement.
12 Article 9
13 Insurance
14 9.1 The Contractors shall comply with all the insurance requirements in Exhibit E to this
15 Agreement.
16 Article 10
17 Inspections, Audits, and Public Records
18 10.1 Inspection of Documents. The Contractors shall make available to the County, and
19 the County may examine at any time during business hours and as often as the County deems
20 necessary, all of the Contractors' records and data with respect to the matters covered by this
21 Agreement, excluding attorney-client privileged communications. The Contractors shall, upon
22 request by the County, permit the County to audit and inspect all of such records and data to
23 ensure the Contractors' compliance with the terms of this Agreement.
24 10.2 State Audit Requirements. If the compensation to be paid by the County under this
25 Agreement exceeds $10,000, the Contractors are subject to the examination and audit of the
26 California State Auditor, as provided in Government Code section 8546.7, for a period of three
27 years after final payment under this Agreement. This section survives the termination of this
28 Agreement.
7
1 10.3 Public Records. The County is not limited in any manner with respect to its public
2 disclosure of this Agreement or any record or data that the Contractors may provide to the
3 County. The County's public disclosure of this Agreement or any record or data that the
4 Contractors may provide to the County may include but is not limited to the following:
5 (A) The County may voluntarily, or upon request by any member of the public or
6 governmental agency, disclose this Agreement to the public or such governmental
7 agency.
8 (B) The County may voluntarily, or upon request by any member of the public or
9 governmental agency, disclose to the public or such governmental agency any record or
10 data that the Contractors may provide to the County, unless such disclosure is prohibited
11 by court order.
12 (C)This Agreement, and any record or data that the Contractors may provide to the
13 County, is subject to public disclosure under the Ralph M. Brown Act (California
14 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
15 (D)This Agreement, and any record or data that the Contractors may provide to the
16 County, is subject to public disclosure as a public record under the California Public
17 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
18 with section 6250) ("CPRA").
19 (E) This Agreement, and any record or data that the Contractors may provide to the
20 County, is subject to public disclosure as information concerning the conduct of the
21 people's business of the State of California under California Constitution, Article 1,
22 section 3, subdivision (b).
23 (F) Any marking of confidentiality or restricted access upon or otherwise made with
24 respect to any record or data that the Contractors may provide to the County shall be
25 disregarded and have no effect on the County's right or duty to disclose to the public or
26 governmental agency any such record or data.
27 10.4 Public Records Act Requests. If the County receives a written or oral request
28 under the CPRA to publicly disclose any record that is in the Contractors' possession or control,
8
1 and which the County has a right, under any provision of this Agreement or applicable law, to
2 possess or control, then the County may demand, in writing, that the Contractors deliver to the
3 County, for purposes of public disclosure, the requested records that may be in the possession
4 or control of the Contractors. Within five business days after the County's demand, the
5 Contractors shall (a) deliver to the County all of the requested records that are in the
6 Contractors' possession or control, together with a written statement that the Contractors, after
7 conducting a diligent search, has produced all requested records that are in the Contractors'
8 possession or control, or (b) provide to the County a written statement that the Contractors, after
9 conducting a diligent search, does not possess or control any of the requested records. The
10 Contractors shall cooperate with the County with respect to any County demand for such
11 records. If the Contractors wishes to assert that any specific record or data is exempt from
12 disclosure under the CPRA or other applicable law, it must deliver the record or data to the
13 County and assert the exemption by citation to specific legal authority within the written
14 statement that it provides to the County under this section. The Contractors' assertion of any
15 exemption from disclosure is not binding on the County, but the County will give at least 10
16 days' advance written notice to the Contractors before disclosing any record subject to the
17 Contractors' assertion of exemption from disclosure. The Contractors shall indemnify the County
18 for any court-ordered award of costs or attorney's fees under the CPRA that results from the
19 Contractors' delay, claim of exemption, failure to produce any such records, or failure to
20 cooperate with the County with respect to any County demand for any such records.
21 Article 11
22 Data Security
23 11.1 Contractors shall comply with data security requirements in Exhibit F to this
24 Agreement.
25 Article 12
26 Disclosure of Self-Dealing Transactions
27 12.1 Applicability. This Article 12 applies if the Contractors are operating as a
28 corporation, or changes its status to operate as a corporation.
9
1 12.2 Duty to Disclose. If any member of the Contractors' board of directors is party to a
2 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
3 "Self-Dealing Transaction Disclosure Form" (Exhibit G to this Agreement) and submitting it to
4 the County before commencing the transaction or immediately after.
5 12.3 Definition. "Self-dealing transaction" means a transaction to which the Contractors
6 are a party and in which one or more of its directors, as an individual, has a material financial
7 interest.
8 Article 13
9 Disclosure of Ownership and/or Control Interest Information
10 13.1 Applicability. This provision is only applicable if Contractors are disclosing entities,
11 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
12 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
13 13.2 Duty to Disclose. Contractors must disclose the following information as requested
14 in the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement,
15 Exhibit H:
16 (A) Disclosure of 5% or More Ownership Interest:
17 (1) In the case of corporate entities with an ownership or control interest in the
18 disclosing entity, the primary business address as well as every business location
19 and P.O. Box address must be disclosed. In the case of an individual, the date of
20 birth and Social Security number must be disclosed.
21 (2) In the case of a corporation with ownership or control interest in the
22 disclosing entity or in any subcontractor in which the disclosing entity has a five
23 percent (5%) or more interest, the corporation tax identification number must be
24 disclosed.
25 (3) For individuals or corporations with ownership or control interest in any
26 subcontractor in which the disclosing entity has a five percent (5%) or more interest,
27 the disclosure of familial relationship is required.
28
10
1 (4) For individuals with five percent (5%) or more direct or indirect ownership
2 interest of a disclosing entity, the individual shall provide evidence of completion of a
3 criminal background check, including fingerprinting, if required by law, prior to
4 execution of Contract. (42 C.F.R. § 455.434)
5 (B) Disclosures Related to Business Transactions:
6 (1) The ownership of any subcontractor with whom Contractors have had
7 business transactions totaling more than $25,000 during the 12-month period ending
8 on the date of the request.
9 (2) Any significant business transactions between Contractors and any wholly
10 owned supplier, or between Contractors and any subcontractor, during the 5-year
11 period ending on the date of the request. (42 C.F.R. § 455.105(b).)
12 (C) Disclosures Related to Persons Convicted of Crimes:
13 (1) The identity of any person who has an ownership or control interest in the
14 provider or is an agent or managing employee of the provider who has been
15 convicted of a criminal offense related to that person's involvement in any program
16 under the Medicare, Medicaid, or the Title XXI services program since the inception
17 of those programs. (42 C.F.R. § 455.106.)
18 (2) County shall terminate the enrollment of Contractors if any person with five
19 percent (5%) or greater direct or indirect ownership interest in the disclosing entity
20 has been convicted of a criminal offense related to the person's involvement with
21 Medicare, Medicaid, or Title XXI program in the last 10 years.
22 13.3 Contractors must provide disclosure upon execution of Contract, extension for
23 renewal, and within thirty-five (35) days after any change in Contractors' ownership or upon
24 request of County. County may refuse to enter into an agreement or terminate an existing
25 agreement with Contractors if Contractors fail to disclose ownership and control interest
26 information, information related to business transactions and information on persons convicted
27 of crimes, or if Contractors did not fully and accurately make the disclosure as required.
28
11
1 13.4 Contractors must provide the County with written disclosure of any prohibited
2 affiliations under 42 C.F.R. § 438.610. Contractors must not employ or subcontract with
3 providers or have other relationships with providers Excluded from participation in Federal
4 Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42
5 C.F.R. §438.610.
6 13.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
7 DBHPlanAdministration@fresnocountyca.gov with a copy sent via email to the assigned DBH
8 Contract Analyst. County may deny enrollment or terminate this Agreement where any person
9 with five (5) percent or greater direct or indirect ownership interest in Contractors has been
10 convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid,
11 or Title XXI program in the last ten (10) years. County may terminate this Agreement where any
12 person with five (5) percent or greater direct or indirect ownership interest in the Contractors did
13 not submit timely and accurate information and cooperate with any screening method required
14 in C.F,R, Title 42, Section 455.416.
15 Article 14
16 Disclosure of Criminal History and Civil Actions
17 14.1 Applicability. Contractors are required to disclose if any of the following conditions
18 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
19 referred to as "Contractors"):
20 (A) Within the three (3) year period preceding the Agreement award, they have been
21 convicted of, or had a civil judgment tendered against them for:
22 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
23 or performing a public (federal, state, or local) transaction or contract under a public
24 transaction;
25 (2) Violation of a federal or state antitrust statute;
26 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
27 or
28 (4) False statements or receipt of stolen property.
12
1 (B) Within a three (3) year period preceding their Agreement award, they have had a
2 public transaction (federal, state, or local) terminated for cause or default.
3 14.2 Duty to Disclose. Disclosure of the above information will not automatically
4 eliminate Contractors from further business consideration. The information will be considered as
5 part of the determination of whether to continue and/or renew this Agreement and any additional
6 information or explanation that Contractors elect to submit with the disclosed information will be
7 considered. If it is later determined that Contractors failed to disclose required information, any
8 contract awarded to such Contractors may be immediately voided and terminated for material
9 failure to comply with the terms and conditions of the award.
10 Contractors must sign a "Certification Regarding Debarment, Suspension, and Other
11 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit I.
12 Additionally, Contractors must immediately advise the County in writing if, during the term of the
13 Agreement: (1) Contractors becomes suspended, debarred, excluded or ineligible for
14 participation in Federal or State funded programs or from receiving federal funds as listed in the
15 excluded parties list system (http://www.epis.gov); or (2) any of the above listed conditions
16 become applicable to Contractors. Contractors shall indemnify, defend, and hold County
17 harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility,
18 or other matter listed in the signed Certification Regarding Debarment, Suspension, and Other
19 Responsibility Matters.
20 Article 15
21 General Terms
22 15.1 Modification. Except as provided in Article 6, "Termination and Suspension," this
23 Agreement may not be modified, and no waiver is effective, except by written agreement signed
24 by both parties. The Contractors acknowledge that County employees have no authority to
25 modify this Agreement except as expressly provided in this Agreement.
26 (A) Notwithstanding the above, non-material changes to services, staffing, and
27 responsibilities of the Contractors, as needed, to accommodate changes in the laws
28 relating to service requirements, may be made with the signed written approval of
13
1 County's DBH Director, or designee, and Contractors through an amendment approved
2 by County's County Counsel and the County's Auditor-Controller/Treasurer-Tax
3 Collector's Office. Said modifications shall not result in any change to the maximum
4 compensation amount payable to Contractors, as stated herein.
5 15.2 Rate Modification. In addition, changes to service rates on Exhibit D —Attachment
6 A that do not exceed 3% of the approved rate, or that are needed to accommodate state-
7 mandated rate increases, may be made with the written approval of the DBH Director, or
8 designee, subject to applicable legislation, availability of funds and review of Contractors'
9 performance. These rate changes may not add or alter any other terms or conditions of the
10 Agreement. Said modifications shall not result in any change to the annual maximum
11 compensation amount payable to Contractors, as stated herein.
12 15.3 Separate Agreement. It is mutually understood by the parties that this Agreement
13 does not, in any way, create a joint venture among Contractors. By execution of this Agreement,
14 Contractors understand that a separate Agreement is formed between each individual
15 Contractors and County.
16 15.4 Addition/Deletion of Providers. The County reserves the right at any time during
17 the term of this Agreement to add Contractors to and remove Contractors from the list contained
18 on Exhibit A. It is understood that any such additions and removals will not affect compensation
19 paid to the other Contractors, and therefore such additions and removals may be made by
20 County without notice or approval of other Contractors under this Agreement. The County's
21 DBH Director, or designee, may remove a Contractors from the Agreement where there is
22 mutual written consent between the DBH Director and Contractors.
23 15.5 Non-Assignment. Neither party may assign its rights or delegate its obligations
24 under this Agreement without the prior written consent of the other party.
25 15.6 Governing Law. The laws of the State of California govern all matters arising from
26 or related to this Agreement.
27 15.7 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
28 County, California. Contractors consent to California jurisdiction for actions arising from or
14
1 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
2 brought and maintained in Fresno County.
3 15.8 Construction. The final form of this Agreement is the result of the parties' combined
4 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
5 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
6 against either party.
7 15.9 Days. Unless otherwise specified, "days" means calendar days.
8 15.10 Headings. The headings and section titles in this Agreement are for convenience
9 only and are not part of this Agreement.
10 15.11 Severability. If anything in this Agreement is found by a court of competent
11 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
12 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
13 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
14 intent.
15 15.12 Nondiscrimination. During the performance of this Agreement, the Contractors
16 shall not unlawfully discriminate against any employee or applicant for employment, or recipient
17 of services, because of race, religious creed, color, national origin, ancestry, physical disability,
18 mental disability, medical condition, genetic information, marital status, sex, gender, gender
19 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
20 all applicable State of California and federal statutes and regulation.
21 Contractors shall take affirmative action to ensure that services to intended Medi-Cal
22 beneficiaries are provided without use of any policy or practice that has the effect of
23 discriminating on the basis of race, color, religion, ancestry, marital status, national origin, ethnic
24 group identification, sex, sexual orientation, gender, gender identity, age, medical condition,
25 genetic information, health status or need for health care services, or mental or physical
26 disability.
27 15.13 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
28 of the Contractors under this Agreement on any one or more occasions is not a waiver of
15
1 performance of any continuing or other obligation of the Contractors and does not prohibit
2 enforcement by the County of any obligation on any other occasion.
3 15.14 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
4 between the Contractors and the County with respect to the subject matter of this Agreement,
5 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
6 publications, and understandings of any nature unless those things are expressly included in
7 this Agreement. If there is any inconsistency between the terms of this Agreement without its
8 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
9 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
10 exhibits.
11 15.15 No Third-Party Beneficiaries. This Agreement does not and is not intended to
12 create any rights or obligations for any person or entity except for the parties.
13 15.16 Authorized Signature. The Contractors represent and warrant to the County that:
14 (A) The Contractors are duly authorized and empowered to sign and perform its
15 obligations under this Agreement.
16 (B) The individual signing this Agreement on behalf of the Contractors are duly
17 authorized to do so and his or her signature on this Agreement legally binds the
18 Contractors to the terms of this Agreement.
19 15.17 Electronic Signatures. The parties agree that this Agreement may be executed by
20 electronic signature as provided in this section.
21 (A) An "electronic signature" means any symbol or process intended by an individual
22 signing this Agreement to represent their signature, including but not limited to (1) a
23 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
24 electronically scanned and transmitted (for example by PDF document) version of an
25 original handwritten signature.
26 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
27 equivalent to a valid original handwritten signature of the person signing this Agreement
28 for all purposes, including but not limited to evidentiary proof in any administrative or
16
1 judicial proceeding, and (2) has the same force and effect as the valid original
2 handwritten signature of that person.
3 (C)The provisions of this section satisfy the requirements of Civil Code section
4 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
5 Part 2, Title 2.5, beginning with section 1633.1).
6 (D) Each party using a digital signature represents that it has undertaken and
7 satisfied the requirements of Government Code section 16.5, subdivision (a),
8 paragraphs (1) through (5), and agrees that each other party may rely upon that
9 representation.
10 (E) This Agreement is not conditioned upon the parties conducting the transactions
11 under it by electronic means and either party may sign this Agreement with an original
12 handwritten signature.
13 15.18 Counterparts. This Agreement may be signed in counterparts, each of which is an
14 original, and all of which together constitute this Agreement.
15 [SIGNATURE PAGE FOLLOWS]
16
17
18
19
20
21
22
23
24
25
26
27
28
17
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
CONTRACTORS COUNTY OFFRESNO
3
4 SEE FOLLOWING SIGNATURE PAGES
5 Ernest Buddy Mend ', Chairman of the Board
of Supervisors of the County of Fresno
6
Attest:
7 Bernice E. Seidel
Clerk of the Board of Supervisors
8 County of Fresno, State of California
9
By:
10 Deputy
11 For accounting use only:
12 Org No.: 56302666
Account No.: 7295
13 Fund No.: 0001
Subclass No. 10000
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
18
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Contractor ERICA MCCLINCY
3
4
5
6 Print Name:
Title. _ local 5oc�0I ('Go�—vc
'(—
Chairman of the Board, President, or Vice President
I 9
10 Date:
G
11 �'
12
13 BY
14
Print Name:
15
16 Title:
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Contractor: KIMBERLY JONES,----,,
3
4
B
5 11I
6 'nt N l V
7 0 8 Title: ul-eR,
Chairman ofj1h oard, President, or Vice President
9
10 Date:
11
12
13 BY
14
Print Name:
15
16 Title:
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2 Contractor: JUAN QUINTANILLA
3
4 —
By
5
6 Print Name: JU�w
7
8 Title:
Chairman of the Board, President, or Vice President
9
10 Date:
11
12
13 By
14
Print Name: �`!Yj`/ ?7l
15
16 Title:
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2 Contractor: MICHAEL TUCIBAT
3
4
By °✓'T \
5 11��
6 Print Name: ��
7
8 Title: ��
Chairman of the Board, President or`Vlce President
9
10 Date:
11
12
I �
13 BY
14
Print Name:
15
16
17 Secretary (of Corpora ion), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2 Contractor: A HOPEFUL ENCOUNTER, INC.
3
4
By S:�5�
5
a
6 Print Name:; � C. '
7
8 Title: �1�� SZ
Chair an of the Board, President, or Vice President
9
10 Date:
11
12
13
14 � xt U
Print Name:
15
16 Title: Avrl'- —fimnaxf 644'C:ow
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date: 5Yj 2.t 2S'
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2 Contractor: CALIFORNIA PSYCHOLOGICAL INSTITUTE, INC.
3
4
B
5
6 Print
7
8 Title: ?ask&V4,
Chairman of the Board, President, or Vice President
9
10 Date:
11
12
13 By
14 Print Name:
15
16 Title:
17 Secretary (of Corporaticrn), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the dale staled in the introductory clause.
2 Contractor: COURAGEOUS EARTS COUNSELING CENTER, LLC
3
4
5 By
6 Print Name:
7
8 Till& 0
Chairman of the oard, President, or Vice President
9
10 Date: L J �J
11
12
13 By
14
Print Name:
15
16 Title:
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Contractor: ESPERANZA FAMILY COUNSELING, INC.
3
4
By
5
6 Print Name: Sergio Pereyra
7
8 Title: CEO & President
Chairman of the Board, President, or Vice President
9
10 Date: 5/28/25
11
12
13 By
14
Print Name:
15
16 Title:
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Contractor: FRESNO NEW CONNECTION. INC.
3
By
5
6 Print Name: �� ht,.p )`-�O` ih���`���
7
8 Title: -A AQ4-A
Chairman of the Board, President, or Vice President
9
10 Date:
11
12
13 By
14 `
Print Name: ��n l�� 6u\A
15
16 Title: C�C2�C`
17 Secretary (of Corporation), Assista Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date: S—Z 7 r2 S
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Contractor: HOUSE PSYCHIATRIC CLINIC, INC.
3
4
By
5
6 Print Name:
7 D
8 Title: r �5� ✓�
Chairman of the Board, President, or Vice President
9
10 Date:
—z
11
12
13 By
14
Print Name:
15
16 Title:
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Contractor: JOINT OPPORTUNITIES
3 ! i
By
5
6 Print Name:
7
8 Title: R&A� ��
Chairman of the Board, President, or Vice President
9
10 Date: '
11
12
13 By
14
Print Name:
15
16 Title:
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Contractor: MARJAREE MASON CENTER, INC.
3
4 By
5
6 Print Name: Nicole Linder
7
8 Title: CEO
Chairman of the Board, President, or Vice President
9
10 Date: 05/22/2025
11
12
13 By
14
Print Name: Marcus Martin
15
16 Title: Chief Financial Officer
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date: 05/22/2025
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Contractor: NORTH STAR WELLNESS CENTER, INC.
3
5 By
6 Print Name: ( Af0 I Jk�L
8 Title: <���- d,�
Chairman of the Board, President, or Vice President
9
10 Date: aZ
11
12
13 ByIL
14 �1 /�)
Print Name: l��l�� I 11VI� Accz�r-A
15
16 Title:4Scret!tl
117 ( (of orporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date: 05 1271Z 2 2 r
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2 Contractor: OMID COUNSELING CENTER, INC.
3
4
By
5
6 Print Name: ROH I MA FA-ZI L
7
8 Title: 1�=(D
Chairman of the Board, President, or Vice President
9 ( I n
10 Date:
11
12
13 By
14
Print Name:
15
16 Title: coo
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18 II
19 Date: 11��
20
21
22
23
24
25
26
27
28
The parties are signing this Agreement on the date stated in the introductory clause.
Contractor: PROMESA BEHAVIORAL HEALTH
By
Print Name: M I MN-j oV E l_
7
Title: �1,t;ESr Ej.J
Chairman of the Board, President, or Vice President
c�
10 Date: V z-12 S
11
12
13 By
14
Print Name: EKED oLMS 1 tk�
15 T
16 Title: 19EASUKEIK
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
ell19 Date:
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2 Contractor: THE HEALING CIRCLE: A MARRIAGE & FAMILY THERAPY
3 PROFESSIONAL CORPORATION
4
5
6 By
7 Print Name: �Grt�"
8
9 Title: C/t�-o
Chairman of the Board, President, or Vice President
10
11 Date: � z( ('4`Z
12
13
14 By
15
Print Name:
16
17 Title:
18 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
19
20 Date:
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2 Contractor: WESTCARE CALIFORNIA, INC.
3
5 y
6 Print Name: &OLL.)() �LS.v��tn5
7
8 Title: CC-�(3
Chairman of the Board, President, or Vice President
9
10 Date: 5/30/25
12 c �7U car,
W c_c_!13
o2s-cs I
By
14int Ne: nn
15
16 Title: ni_
17 Secretary (of Corporation), Assist Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date: CAS I �Ao jcga z<
20
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2 Contractor: WEST SIDE CHURCH OF GOD
3
By JCj
5
6 Print Name: �C ! �
7
g Title:
Chairman of the ard, President, or Vice President
9
10 Date:,., `IV7
11
12
13 By
14
Print Name:
15
16 Title:
17 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
18
19 Date:
20
21
22
23
24
25
26
27
28
Exhibit A
Page 1 of 2
List of Contractors
Individual Providers
Name Address Contact
Erica McClincy 1100 W. Shaw Ave.Ste Ericamcclincy.lcsw@gmail.com Erica McClincy
120 Fresno, CA 93711
Kimberly Jones 2547 W Shaw Ave Suite Drkimjones02(a)gmail.com Kimberly Jones
114 Fresno, CA 93711
Juan Quintanilla 5588 N. Palm Ave. archaicvegan outlook.com Juan Quintanilla
Fresno, CA 93704
MichaelTucibat 6777 N Willow Ave. Suite Mike.Tucibat.LMFT(&infinitewebs.net MichaelTucibat
#142 Fresno, CA 93710
Group Providers
Name Address Email Contact
A Hopeful Encounter, Inc. 3253 E. Shields Ave susanxiong(a-)hopefulencounter.org Susan Xiong
Fresno, CA 93726
California Psychological 1470 W Herndon Ave michelleo(a)caifresno.com Michelle Zavala
Institute, Inc. Fresno, CA 93711
Courageous Hearts 2547 W Shaw Ave Suite Drkim-*ones02(a)cou rageoushea rtscounselingcenter.net Kimberly Jones
Counseling Center, LLC 114 Fresno, CA 93711
Esperanza Family 575 E. Locust Ste 101 Sergio p.esperanzafcPgmaiLcom Sergio Pereyra
Counseling, Inc. Fresno, CA 93720
Fresno New Connection, Inc. 4411 N. Cedar Ave. rmartin(&teamfnc.com Rob Martin
Fresno, CA 93726
House Psychiatric Clinic, Inc. 1322 E. Shaw Ave Suite staff _ houseclinic.org Matthew House
410 Fresno, CA 93710
Joint Opportunities 1424 W. California Ave mickievalentinePicloud.com Mickie Valentine
Fresno, CA 93706
Marjaree Mason Center, Inc. 1600 M Street Fresno, LauraePmmcenter.org Nicole Linder
CA 93721
Exhibit A
Page 2 of 2
North Star Wellness Center 6051 N. Fresno St. Ste Carol.dltrr@gmail.com Carol DeLa Torre
Inc. 103 Fresno, CA 93710
Omid Counseling Center, Inc. 3451 W.Shaw Ave Ste rfazil@omidcounselingcenter.org Rohina Fazil
102 Fresno, CA 93711
Promesa Behavioral Health 7120 N. Marks Ave 1Romero@prom esabehavioral.org; Lisa K Weigant
Fresno, CA 93711 lmcclain@prom esabehavioral.org;
lweigant@promesabehavioral.org;
ezuniga@promesabehavioral.org;
The Healing Circle:A Marriage 1033 N. Fulton St. GmadrigaIM5bgmail.com_ Gerardo Madrigal
& Family Therapy Professional Fresno, CA 93728
Corporation
WestCare California, Inc. 1900 N. Gateway Blvd. Maryann.knoy@westcare.com Maryann Knoy
Suite 100 Fresno, CA
93727
West Side Church of God 1424 W. California Ave mickievalentine@icloud.com Mickie Valentine
Fresno, CA 93706
Exhibit B
Page 1 of 5
FRESNO COUNTY
DEPARTMENT OF BEHAVIORAL HEALTH
SCOPE OF WORK
I. PROGRAM NAME
Individual and Group Providers — Outpatient Specialty Mental Health Services (SMHS)
II. BACKGROUND
The Fresno County Behavioral Health Plan (BHP) is responsible for ensuring Medi-Cal
beneficiaries of all ages have access to medically necessary outpatient specialty mental
health services. This master agreement allows for mental health services to be delivered
through the broadest base of SMHS providers including psychiatrists, psychologists, as well
as licensed and licensed-eligible clinical social workers, marriage and family therapists, and
professional clinical counselors or a 104 Nurse Practitioner.
III. TARGET POPULATION
Services provided under this master agreement are available to all Medi-Cal eligible persons
living in Fresno County who meet medical necessity criteria, are clinically appropriate for
specialty mental health services, and have a confirmed mental health diagnosis.
IV. DESCRIPTION OF SERVICES
A. Services Start Date:
July 1, 2025
B. Summary of Services
Individual or Group providers fitting the definitions below may be eligible to provide
services through this master agreement.
"Individual Provider" means licensed mental health professionals whose scope of practice
permits the practice of psychotherapy without supervision who provide specialty mental
health services directly to beneficiaries. "Individual provider" includes licensed physicians,
licensed psychologists, licensed clinical social workers, licensed marriage and family
therapists, and registered nurses with a master's degree within their scope of practice.
"Individual provider" does not include licensed mental health professionals when they are
acting as employees of any organizational provider or contractors of organizational
providers other than the BHP.
"Group Provider" means an organization that provides specialty mental health services
through two or more individual providers. "Group provider" includes entities such as
independent practice associations, hospital outpatient departments, health care service
plans, and clinics.
Exhibit B
Page 2of5
All providers must enroll in DHCS's PAVE system in accordance with Behavioral Health
Information Notice 20-071.
Contractors will render covered specialty mental health services in accordance with
requirements as identified in the current Fresno County Behavioral Health Plan
Individual/Group Provider Manual which may be amended or changed to accommodate
changes in DHCS guidance or policy as appropriate. Covered services include, but are
not limited to:
• Rehabilitative services, including mental health services, and medication
• Targeted case management
• Psychiatric services
• Psychologist services
• Early and Periodic Screening Diagnosis and Treatment (EPSDT) supplemental
specialty mental health services
The Fresno County Behavioral Health Plan Provider manual can be found at the following
location: https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/Contract-Provider-Resources/Provider-Manual
DHCS SMHS service tables and manuals can be found at:
https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-LibrarV.aspx
These covered services are subject to the limitations set forth in the statewide Medi-Cal
program, which is in accordance with Title 9, California Code of Regulations, Chapter 11,
Medi-Cal Specialty Mental Health Services, unless specifically exempted by the County.
Exempted services shall be only those services identified as excepted, authorized in
advance as exempted, and shall only apply to a specific and discreet time-period and
number of authorized exempted services. Any one authorization to a Contractor for
exempted services to a person served shall not infer nor constitute subsequent or
combined authorization for additional exempted services to that person, nor to any other
person, nor to the Contractor, nor to any other Contractor.
Contractors will use and integrate clinical tools and peer review tools as directed by DBH.
Contractors must demonstrate ability to access competent and appropriate linguistic
services in the identified individual's language of choice and have a working knowledge of
accessing and utilizing qualified staff/third-party interpreters or language lines during
provision of services. Interpretation/Translation services will be at the cost of the
Contractors.
Contractors may be required to utilize data entry forms, portals, or related systems for
compliance with County billing and data reporting requirements during the duration of the
contract.
Contractors must attend DBH's monthly meetings to remain informed on changes to
services and other administrative matters.
Exhibit B
Page 3 of 5
C. Location of Services:
Services can be provided throughout the community. Sites must be site-certified by the
Department of Behavioral Health prior to rendering services. Providers must be Medicare
certified in order to bill services for persons who have both Medicare and Medi-Cal. If a
provider is not Medicare certified at the time of contract execution or at the time they are
added to the master agreement, they must apply for Medicare certification within 6
months.
Services may be provided via telehealth, but Contractors must have a site certified
location that serves as the primary service location within Fresno County. If telehealth
services are provided, persons receiving services must be offered an opportunity to
request and receive in-person services at their discretion in compliance with DHCS
guidance.
D. Hours of Operation:
Hours of operation are at the discretion of the Contractors, but should allow for persons to
participate in treatment through evening or weekend hours, if needed.
E. Average Person Served Length of Stay:
Persons may continue to receive services in the least restrictive setting, provided they
meet medical necessity, it is clinically appropriate, and they have a confirmed mental
health diagnosis.
F. Referral Sources and Referral Process:
Referrals may come from DBH's Urgent Care Wellness Center, Youth Wellness Center, or
other internally operated programs. Persons served may also access services by
contacting Contractors directly in-person, by phone, or by email. Contractors must verify
eligibility for Medi-Cal services before rendering services and monthly thereafter.
G. Care Coordination/Transition Plan:
Contractors must furnish sufficient information on county approved forms to ensure that
enrollments and discharges from programs are timely and accurate. Contractors should
engage with persons served to ensure that they collaborate with other treatment
providers, such as other mental health, substance use, and physical health providers, to
work toward common goals and positive outcomes.
H. Level of Care/Modality of Services:
Outpatient
I. Evidence-Based Practice(s):
Services must be provided using evidence-based practices which include, but are not
limited to: Dialectical Behavioral Therapy, Eye Movement Desensitization and
Reprocessing, Cognitive Behavioral Therapy, Structural Family Therapy, Motivational
Interviewing, among others.
Exhibit B
Page 4 of 5
J. Contractors shall:
1. Review the Fresno County Behavioral Health Plan Individual and Group Provider
Manual.
2. Have staff attend all required trainings.
3. Work with mental health providers across DBH and its contracted providers for the
coordination of care, services, and supports.
4. Be familiar with DBH policies and practices.
5. Ensure clinically appropriate leadership and supervision of clinical programs and staff.
K. County shall:
1. Provide oversight and collaborate to achieve program goals and outcomes.
2. Provide technical assistance towards meeting cultural responsiveness requirements.
3. Evaluate overall program progress and efficiency and be available for consultation.
4. Gather outcome information from the program throughout the term of the agreement.
V. STAFFING
A. Staffing/Person Served Ratio:
Staff eligible to provide services under this master agreement include psychiatrists,
psychologists, as well as licensed and licensed-eligible clinical social workers, marriage
and family therapists, and professional clinical counselors or a 104 Nurse Practitioner.
Staff must complete DBH's credentialing process prior to rendering any services. The
credentialing application can be found at the following location:
https://www.fresnocountVca.gov/Departments/Behavioral-Health/Providers/Contract-
Provider-Resources/Become-a-Provider
Licensed staff supervising unlicensed/license-eligible staff must be credentialed, have
completed appropriate supervision training, and be credentialed with DBH. Licensed staff
serving as supervisors over unlicensed/licensed-eligible staff are subject to the
supervision ratios established by the California Board of Behavioral Sciences.
Contractors must report termination dates of staff when they have left the program to
ensure accurate reporting and tracking.
B. Staff Training
Contractors agree that their employees, volunteers, interns, and student trainees or
subcontractors, in each case, are expected to perform professional services per an
agreement with County. Contractors will comply with the training requirements and
expectations referenced in Exhibit C —Attachment D, Department of Behavioral Health
Contractor Training Requirements Reference Guide.
Trainings are to be completed by Contractors staff after contract execution, in a timely
manner. Completion deadlines for trainings are listed in the exhibit 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.
C. Reports
Exhibit B
Page 5 of 5
Providers will be required to submit the following to DBH monthly or on an as needed
basis:
• 274 Network Adequacy Reports
• Person Served Face Sheets
o Provide sufficient information to identify the person served, confirm Medi-
Cal eligibility, enroll, and discharge person from DBH's electronic health
record, and referring program or contact type
• Timeliness to Non-Psychiatric and Timeliness to Psychiatric forms
• Grievances
• Incident Reporting
• Consumer Perception Survey
• Notice of Adverse Benefit Determinations
Exhibit C
Page 1 of 23
Fresno County Behavioral Health Requirements
I. General Requirements
a. Guiding Principles. Contractors shall align programs, services, and practices with the
vision, mission, and guiding principles of the DBH, as further described in Exhibit C—
Attachment A to this Agreement, titled "Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery".
b. Rights of Persons Served. Contractors shall post signs informing persons served of their
right to file a complaint or grievance, appeals, and expedited appeals. In addition,
Contractors shall inform every person served of their rights as set forth in Exhibit C—
Attachment B to this agreement, titled "Rights of Persons Served".
c. Records. Contractors shall maintain records in accordance with Exhibit C—Attachment C
to this Agreement,titled "Documentation Standards for Persons Served Records".All
records of the person served shall be maintained for a minimum of ten (10)years from
the date of the end of this Agreement.
d. Licenses/Certificates.Throughout the term of this Agreement, Contractors and
Contractors' 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. Contractors 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, Contractors and Contractors' staff shall comply
with all applicable laws, rules or regulations, as may now exist or be hereafter changed.
e. Staffing. Contractors agree that prior to providing services under the terms and
conditions of this Agreement, Contractors shall have staff hired and in place for program
services and operations or County may, in addition to other remedies it may have,
suspend referrals or terminate this Agreement, in accordance to Article 6 of this
Agreement.
f. Training. Contractors agree that its employees,volunteers, interns, and student trainees
or subcontractors of Contractors, in each case, are expected to perform professional
Exhibit C
Page 2 of 23
services per an agreement with County. Contractors will comply with the training
requirements and expectations referenced in Exhibit C—Attachment D to this
Agreement,titled "Department of Behavioral Health Contractor Training Requirements
Reference Guide".
g. Credentialing and Recredentialing. Each individual Contractors' staff shall not provide
any specialty mental health services without an approved credentialing application from
County. Contractors 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 Contractors 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.
Contractors 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.
Contractors are required to verify and document at a minimum every three years that
each network provider that delivers covered services continues to possess valid
credentials, including verification of each of the credentialing requirements as per the
County's uniform process for credentialing and recredentialing. If any of the
requirements are not up-to-date, updated information should be obtained from network
providers to complete the re-credentialing process.
h. Criminal Background Check. Contractors 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).
Contractors shall provide evidence of completed consents when requested by the
County, DHCS or the US Department of Health & Human Services (US DHHS).
Exhibit C
Page 3 of 23
i. Clinical Leadership. Contractors 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.
j. Additional Responsibilities.The parties acknowledge that, during the term of this
Agreement,the Contractors will hire,train, and credential staff, and County will perform
additional staff credentialing to ensure compliance with State and Federal regulations, if
applicable.
k. Subcontracts. Contractors 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.
Contractors 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 Contractors shall not entitle Contractors to any additional
compensation that is provided for under this Agreement.
I. Reports.The Contractors shall submit the following reports and data:
i. Outcome Data. Contractors shall submit to County program performance
outcome data, as requested. Outcome data and outcome requirements are
subject to change at County's discretion.
ii. Additional Reports. Contractors 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 Contractors fail to
provide such reports or other information required hereunder, it shall be
deemed sufficient cause for County to withhold monthly payments until there is
compliance. In addition, Contractors 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.
Exhibit C
Page 4 of 23
m. Timely Access. It is the expectation of the County that Contractors provide timely access
to services that meet the State of California standards for care. Contractors 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 Contractors 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 Contractors with timely access
standards. Contractors shall also provide tracking tools and measurements for
effectiveness, efficiency, and persons served satisfaction.
n. Compliance with Behavioral Health Specific Laws.
i. Contractors 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
the amended authority as of the effective date of such amendment without
amending this Agreement.
Exhibit C
Page 5 of 23
iii. Contractors recognize that County operates its behavioral health programs
under an agreement with DHCS, and that under said agreement the State
imposes certain requirements on County and its subcontractors. Contractors
shall adhere to all State requirements, including those identified in Exhibit C—
Attachment E to this Agreement, titled "State Behavioral Health Requirements".
o. Meetings. Contractors 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. Contractors 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 contractors' meetings,
etc. Schedule for these meetings may change based on the needs of the County.
p. Monitoring. Contractors agree 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 Contractors' programs, in order to ensure
compliance with the terms and conditions of this Agreement.
q. Electronic Health Record.At the County's discretion, Contractors may maintain their
records in County's EHR system in accordance with Exhibit C—Attachment F, "Electronic
Health Record Requirements and Service Data",free of charge, as indicated on Exhibit B,
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 Contractors decide to
maintain their records in the County's EHR,they shall provide County's DBH Director, or
designee,with a thirty(30) day notice. If at any time Contractors choose not to maintain
their records in the County's EHR,they shall provide County's DBH Director, or designee,
with thirty(30) days advance written notice and Contractors will be responsible for
obtaining their own system, at their own cost,for electronic health records
management.
Disclaimer
County makes no warranty or representation that information entered into the
Exhibit C
Page 6 of 23
County's DBH EHR system by Contractors will be accurate, adequate, or satisfactory for
Contractors' own purposes or that any information in Contractors' possession or control,
or transmitted or received by Contractors, is or will be secure from unauthorized access,
viewing, use, disclosure, or breach. Contractors are solely responsible for person served
information entered by Contractors' staff into the County's DBH EHR system. Contractors
agree that all Private Health Information (PHI) maintained by Contractors in County's
DBH EHR system will be maintained in conformance with all HIPAA laws, as stated in
section IX, "Federal and State Laws."
r. Generative Artificial Intelligence Technology Use& Reporting
i. During the term of the Agreement, Contractors 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. Contractors must provide
information by submitting a "Generative Artificial Intelligence (GenAl) Reporting
and Factsheet (STD 1000)" In addition, Contractors must notify the County of
any new or previously unreported GenAl technology.At the direction of the
County, Contractors 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.
s. Confidentiality. All services performed by Contractors under this Agreement shall be in
strict conformance with all applicable Federal, State of California and/or local laws and
regulations relating to confidentiality.
t. Physical Accessibility. In accordance with the accessibility requirements of section 508
of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractors
must provide physical access, reasonable accommodations, and accessible equipment
for Medi-Cal beneficiaries with physical or mental disabilities.
u. Publicity Prohibition.
Exhibit C
Page 7 of 23
i. Self-Promotion. None of the funds, materials, property, or services provided
directly or indirectly under this Agreement shall be used for Contractors'
advertising,fundraising, or publicity(i.e., purchasing of tickets/tables, silent
auction donations, etc.) for the purpose of self-promotion.
ii. Public Awareness. Notwithstanding the above, publicity of the services
described in Exhibit B 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.
v. Child Abuse Reporting Act.
i. Contractors shall establish a procedure acceptable to the County's DBH Director,
or designee,to ensure that all of the Contractors' 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 Contractors' 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. Contractors 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)). Contractors shall provide all written materials for persons served in easily
understood language, format, and alternative formats that take into consideration the
Exhibit C
Page 8 of 23
special needs of individuals in compliance with 42 C.F.R. §438.10(d)(6). Contractors 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.
Contractors shall provide the required information in this section to each
individual receiving Specialty Mental Health Services (SMHS) under this Agreement and
upon request (1915(b) Medi-Cal Specialty Mental Health Services Waiver, § (2), subd.
(d), at p. 26., attachments 3, 4; Cal. Code Regs.,tit. 9, §1810.360(e)).
Contractors 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.
Contractors 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 Contractors if all the following conditions are met:
i. The format is readily accessible;
ii. The information is placed in a location on the Contractors' 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 Contractors shall provide it upon
request within five (5) business days (42 C.F.R. §438.10(c)(6)).
c. Language and Format. Contractors 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)). Contractors 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.
Contractors 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 Contractors' mental
Exhibit C
Page 9 of 23
health education materials, available in the prevalent non-English languages in the
County(42 C.F.R. §438.10(d)(3)).
Contractors shall notify persons served, prospective persons served, and
members of the public that written translation is available in prevalent languages free of
cost and how to access those materials(42 C.F.R. §438.10(d)(5)(i), (iii); Welfare& Inst.
Code § 14727(a)(1); Cal. Code Regs. tit. 9 § 1810.410, subd. (e), para. (4)). Contractors
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)).
Contractors 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 Contractors. 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. Contractors 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
Exhibit C
Page 10 of 23
2. Provider Directory
3. Grievance form
4. Appeal/Expedited Appeal form
5. Advance Directives brochure
6. Change of Provider form
7. Suggestions brochure
All beneficiary informing written materials will use easily understood language and
format (i.e. material written and formatted at a 6th grade reading level), and will use a
font size no smaller than twelve (12) point. All beneficiary informing written materials
shall inform beneficiaries of the availability of information in alternative formats and
how to make a request for an alternative format. Inventory and maintenance of all
beneficiary informing materials will be maintained by the County's DBH Plan
Administration Division. Contractors will ensure that its written materials include
taglines or that an additional taglines document is available.
e. Beneficiary Handbook. Contractors 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. Contractors 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
Contractors' website and must be physically available at the Contractors'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 Contractors
do one or more of the following:
Exhibit C
Page 11 of 23
i. Mails a printed copy of the information to the mailing address of the
person served before the individual receives their first specialty mental
health service;
ii. Mails a printed copy of the information upon the individual's request to
their mailing address;
iii. Provides the information by email after obtaining the agreement of the
person served to receive the information by email;
iv. Posts the information on the Contractors' 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
Contractors provide 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. Contractors must follow the County's provider directory policy, in
compliance with MHSUDS IN 18-020.
Contractors 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.
Contractors will only need to report changes/updates to the provider directory
for licensed,waivered, or registered mental health providers.
III. Assurances
Exhibit C
Page 12 of 23
Certification of Non-exclusion or Suspension from Participation in a Federal Health Care
Program.
a. In entering into this Agreement, Contractors certify that it is not excluded from
participation in Federal Health Care Programs under either Section 1128 or 1128A of the
Social Security Act. Failure to so certify will render all provisions of this Agreement null
and void and may result in the immediate termination of this Agreement.
b. In entering into this Agreement, Contractors certify, that the Contractors do 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. Contractors 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, Contractors certify,that Contractors do not employ staff
or individual contractors/vendors that are on the Social Security Administration's Death
Master File. Contractors 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. Contractors are required to notify County immediately if Contractors become aware of
any information that may indicate their(including employees/staff and individual
contractors/vendors) potential placement on an exclusions list.
e. Contractors shall screen and periodically revalidate all network providers in accordance
with the requirements of 42 C.F.R., Part 455, Subparts B and E.
Exhibit C
Page 13 of 23
f. Contractors must confirm the identity and determine the exclusion status of all their
providers, as well as any person with an ownership or control interest, or who is an
agent or managing employee of the contracted agency through routine checks of federal
and state databases.This includes the Social Security Administration's Death Master File,
NPPES,the Office of Inspector General's LEIE,the Medi-Cal Suspended and Ineligible
Provider List(S&I List) as consistent with the requirements of 42 C.F.R. §455.436.
g. If Contractors find a provider that is excluded, it must promptly notify the County as per
42 C.F.R. §438.608(a)(2), (4).The Contractors 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. Contractors shall institute and conduct a Quality Assurance Process
for all services provided hereunder.
Contractors 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 Contractors' internal audit process. Contractors shall
provide this notification and summary to County as requested by the County.
b. Access to Records. Contractors shall provide County with access to all documentation of
services provided under this Agreement for County's use in administering this
Agreement. Contractors 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 Contractors
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
Exhibit C
Page 14 of 23
Contractors in the delivery of services provided under this Agreement. Full cooperation
shall be given by the Contractors in any auditing or monitoring conducted, according to
this agreement.
b. Accessibility. Contractors shall make all of its premises, physical facilities, equipment,
books, records, documents, agreements, computers, or other electronic systems
pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities
furnished under the terms of this Agreement, or determinations of amounts payable
available at any time for inspection, examination, or copying by County, the State of
California or any subdivision or appointee thereof, CMS, U.S. Department of Health and
Human Services (HHS) Office of Inspector General,the United States Controller General
or their designees, and other authorized federal and state agencies.This audit right will
exist for at least ten (10)years from the final date of the Agreement period or in the
event the Contractors have 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 Contractors at any time if there is a reasonable possibility of
fraud or similar risk.The Department's inspection shall occur at the Contractors' place of
business, premises, or physical facilities (42 CFR §438.230(c)(3)(iv))
c. Cooperation. Contractors 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 Contractors to ensure
compliance with laws, regulations, and requirements, as applicable.
d. Probationary Status. County reserves the right to place Contractors on probationary
status, as referenced in the Probationary Status Article, should Contractors 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,
Exhibit C
Page 15 of 23
Contractors may be subject to Probationary Status or termination if agreement
monitoring and auditing corrective actions are not resolved within specified timeframes.
e. Record Retention. Contractors shall retain all records and documents originated or
prepared pursuant to Contractors' performance under this Agreement, including
grievance and appeal records, and the data, information and documentation specified in
42 CFR parts 438.604,438.606,438.608, and 438.610 for a period of no less than ten
(10)years from the term end date of this Agreement or until such time as the matter
under audit or investigation has been resolved. Records and documents include but are
not limited to all physical and electronic records and documents originated or prepared
pursuant to Contractors' 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. Contractors 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 the Contractors.
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 the
Contractors have not performed satisfactorily.
h. Site Inspection.Without limiting any other provision related to inspections or audits
otherwise set forth in this Agreement, Contractors 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. Contractors
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 Contractors.
VI. Complaint Logs and Grievances
a. Documentation. Contractors shall log complaints and the disposition of all complaints
from a person served or their family. Contractors shall provide a copy of the detailed
Exhibit C
Page 16 of 23
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. Contractors 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 Contractors are notified by a person served or their representative of a
discrimination grievance, Contractors shall report discrimination grievances to the
County within twenty-four(24) hours.The Contractors 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. Contractors 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 Contractors shall
ensure that their subcontractors comply with all applicable patients' rights laws and
regulations.
c. Incident Reporting. Contractors 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. Contractors 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. Contractors shall not submit false,fraudulent, inaccurate or fictitious
claims for payment or reimbursement of any kind.
2. Contractors shall bill only for those eligible services actually rendered
which are also fully documented.
3. Contractors shall ensure all employees/service providers maintain
current I ice nsure/certification/registration/waiver status as required by
the respective licensing/certification Board, applicable governing State
agency(ies) and Title 9 of the California Code of Regulations.
Exhibit C
Page 17 of 23
ii. Should Contractors identify improper procedures, actions or circumstances,
including fraud/waste/abuse and/or systemic issue(s), Contractors shall take
prompt steps to correct said problem(s). Contractors shall report to DBH any
overpayments discovered as a result of such problems no later than five (5)
business days from the date of discovery,with the appropriate documentation,
and a thorough explanation of the reason for the overpayment. Prompt
mitigation, corrective action and reporting shall be in accordance with the DBH
Overpayment Policy and PPG Prevention, Detection, Correction of Fraud,Waste
and Abuse which will be provided to Contractors at their 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.
Contractors 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. Contractors' Compliance Programs 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 Contractors' compliance program and compliance with
the requirements of this account.The committee shall be accountable
to the Contractors' Board of Directors.
iii. Policies and Procedures
1. Contractors shall have written policies and procedures that articulate
the Contractors' commitment to comply with all applicable Federal and
State standards. Contractors shall adhere to applicable County DBH
Policies and Procedures relating to the Compliance Program or develop
its own compliance-related policies and procedures.
Exhibit C
Page 18 of 23
iv. Contractors shall establish and implement procedures and a system with
dedicated staff for routine internal monitoring and auditing of compliance risks,
prompt response to compliance issues as they arise, investigation of potential
compliance problems as identified in the course of self-evaluation and audits,
correction of such problems promptly and thoroughly(or coordination of
suspected criminal acts with law enforcement agencies)to reduce the potential
for recurrence, and ongoing compliance with the requirements under this
Agreement.
v. Contractors shall implement and maintain written policies for all County DBH-
funded employees, and of any contractors 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. Contractors shall maintain documentation,verification or acknowledgement
that the Contractors' employees, subcontractors, interns,volunteers, and
members of Board of Directors are aware of these Policies and Procedures and
the Contractors' Compliance Program.
vii. Contractors shall have a Compliance Plan demonstrating the seven (7) elements
of a Compliance Plan. Contractors have the option to develop its own or adopt
County DBH's Compliance Plan. Should Contractors develop their own Plan,
Contractors 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,
Contractors shall comply with the provisions of Title 42 CFR Sections 438.604,
438.606, 438.608 and 438.610. Contractors must have administrative and
management processes or procedures, including a mandatory compliance plan,
that are designed to detect and prevent fraud, waste or abuse.
Exhibit C
Page 19 of 23
ii. If Contractors identify an issue or receives notification of a complaint concerning
an incident of possible fraud, waste, or abuse, Contractors 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 Contractors' internal investigation concludes that fraud or abuse has occurred
or is suspected,the issue if egregious, or beyond the scope of the Contractors'
ability to pursue,the Contractors shall immediately report to the County DBH
Compliance Office for investigation, review and/or disposition.
iv. Contractors shall immediately report to DBH any overpayments identified or
recovered, specifying the overpayments due to potential fraud.
v. Contractors 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. Contractors shall immediately report any information about a change in
Contractors' or Contractors' staff circumstances that may affect eligibility to
participate in the behavioral health program.
vii. Contractors understand DBH, CMS, or the HHS Inspector General may inspect,
evaluate, and audit the Contractors at any time if there is a reasonable
possibility of fraud or similar risk.
d. Code of Conduct
i. Contractors 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. Contractors shall ensure that no false,fraudulent, inaccurate or fictitious claims
for payment or reimbursement of any kind are submitted.
iii. Contractors shall bill only for eligible services actually rendered and fully
documented.
iv. Contractors shall act promptly to investigate and correct problems if errors in
claims or billing are discovered.
Exhibit C
Page 20 of 23
v. Contractors shall comply with County's Code of Conduct and Ethics and the
County's Compliance Program in accordance with Exhibit C—Attachment G to
this Agreement, titled "Fresno County Mental Health Compliance Program".
e. Network Adequacy. Contractors 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)).
Contractors shall submit,when requested by County and in a manner and
format determined by the County, network adequacy certification information to the
County, utilizing a provided template or other designated format.
Contractors 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 Contractors 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 Contractors 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 Contractors acknowledge that the exchange of PHI between them is only for
treatment, payment, and health care operations.
County and Contractors 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
Contractors 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.
Exhibit C
Page 21 of 23
b. Contractors 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 each Contractor is a "Business Associate," as these
terms are defined by 45 CFR 160.103.As a Business Associate, Contractors agree to comply
with the terms of Exhibit C—Attachment H to this Agreement,titled "Health Insurance
Portability and Accountability Act (HIPAA) Business Associate Agreement".
IX. Quality Management Requirements.
a. Quality Improvement Activities and Participation. Contractors 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.
Contractors 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. Contractors 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. Contractors shall participate in the implementation of the most recent
Cultural Competency Plan for the County and shall adhere to all Culturally and
Linguistically Appropriate Service (CLAS) standards and requirements as set forth in
Exhibit C
Page 22 of 23
Exhibit C—Attachment I to this Agreement,titled "National Standards on Culturally and
Linguistically Appropriate Services". Contractors 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. Contractors 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. Contractors' policies and procedures shall ensure compliance of any
subcontracted providers with these requirements.
c. Interpreter Services. Contractors shall notify 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. Contractors 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 Contractors must document the offer, refusal,
and justification in the file of the person served.
d. Interpreter Qualifications. Contractors 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 Contractors; (2) have demonstrated
proficiency in the language of the person served; (3) can effectively communicate any
specialized terms and concepts specific to Contractors' services; and (4) adheres to
generally accepted interpreter ethic principles. As requested by County, Contractors 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 Contractors last
monitored the interpreter for language competence.
Exhibit C
Page 23 of 23
e. CLAS Standards. Contractors shall submit to County for approval,within ninety(90) days
from date of contract execution, Contractors' plan to address all fifteen (15) National
Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by
the Office of Minority Health and as set forth in Exhibit C—Attachment I, "National
Standards on Culturally and Linguistically Appropriate Services".As the CLAS standards
are updated, Contractors' plan must be updated accordingly. As requested by County,
Contractors 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 Contractors' 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, Contractors
shall report on the completion of cultural responsiveness trainings to ensure direct
service providers are completing annual cultural responsiveness training.
g. Continuing Cultural Responsiveness. Contractors shall create and sustain a forum that
includes staff at all agency levels to discuss cultural responsiveness. Contractors shall
designate a representative from Contractors'team to attend County's Diversity, Equity
and Inclusion Committee.
Exhibit C - Attachment A
Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
1
rev 01-02-2020
Exhibit C - Attachment A
Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
2
rev 01-02-2020
Exhibit C - Attachment A
Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
6. Principle Six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
3
rev 01-02-2020
Exhibit C - Attachment A
Page 4 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
4
rev 01-02-2020
Exhibit C—Attachment B
Page 1 of 2
FRESNO COUNTY BEHAVIORAL HEALTH PLAN
RIGHTS OF PERSONS 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 C—Attachment B
Page 2of2
Formal provider appeal process—the provider has the right to access the provider appeal
process at any time before, during, or after the provider problem resolution process has begun,
when the complaint concerns a denied or modified request for 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 C—Attachment C
Page 1 of 3
DOCUMENTATION STANDARDS FOR PERSON SERVED RECORDS
The documentation standards are described below under key topics related to care for persons
served. All standards must be addressed in the record of each person served; however, there is
no requirement that the record have a specific document or section addressing these topics. All
medical records shall be maintained for a minimum of 10 years from the date of the end of the
Agreement.
A. Assessments
1. The following areas will be included as a part of a comprehensive record for each
person served:
• Presenting problems, including impairments in function, and current mental
status exam.
• Traumatic incidents which include trauma exposures, trauma reactions, trauma
screenings, and systems involvement if relevant
• Behavioral health history including mental health history, substance use/abuse,
and previous services
• Medical history including physical health conditions, medications, and
developmental history
• Psychosocial factors including family, social and life circumstances, cultural
considerations
• Strengths, risks, and protective factors, including safety planning
• Clinical summary, treatment recommendations, and level of care determination
including diagnostic and clinical impression with a diagnosis
• The assessment shall include a typed or legibly printed name, signature of the
service provider and date of signature.
2. Timeliness/Frequency Standard for Assessment
• The time period to complete an initial assessment and subsequent assessments
for 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
Exhibit C—Attachment C
Page 2 of 3
• The name and title of the provider that identified, added, or removed the problem,
and the date the problem was identified, added, or removed
C. Treatment and Care Plan Requirements
1. Targeted Case Management
• Specifies the goals, treatment, service activities, and assistance to address the
negotiated objectives of the plan and the medical, social, educational, and other
services needed by the person in care
• Identifies a course of action to respond to the assessed needs of the person in
care
• Includes development of a transition plan when the person in care has achieved
the goals of the care plan
• Peer support services must be based on an approved care plan
• Must be provided in a narrative format in the person's progress notes
• Updated at least annually
2. Services requiring Treatments Plans
• Therapeutic Behavioral Services (TBS)
• Must have specific observable and/or specific quantifiable goals
• Must identify the proposed type(s) of intervention
• Must be signed (or electronic equivalent) by:
➢ the person providing the service(s), or
➢ a person representing a team or program providing services, or
➢ a person representing the BHP 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 Contractors document the participation of the person served. When
Rev 04/2023
Exhibit C—Attachment C
Page 3of3
the signature of the person served is required on the plan for the person served
and the person served refuses or is unavailable for signature, the plan for the
person served plan will include a written explanation of the refusal or
unavailability.
➢ The Contractors will give a copy of the plan for the person served to the person
served upon 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
CO U Exhibit C—Attachment D
Page 1 of 7
O� g6 Fresno County Department of Behavioral Health
ESQ Contractor Training Requirements Reference Guide
Contractors must consider and include sufficient time and funds for required trainings.
This Training Requirements Reference Guide identifies the required trainings that
Contractors are responsible for offering to all employees, volunteers, interns, and
student trainees of Contractors or their 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 Contractors, and those are identified within this
document. The remaining trainings are the responsibility of Contractors to provide and
cover associated costs. The expectations for Contractors 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 Contractors
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. Contractors 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. Contractors 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. Contractors are 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 C—Attachment D
Page 2 of 7
Documentation & Billing is a training provided at least one time per month.
Registration is completed via Eventbrite for each session; links to register can be
found on the webpage below:
https://www.fresnocountVca.gov/Departments/Behavioral-Health/Providers/Contract-
Provider-Resources/New-Hire-ComplianceDoc-Billing-Training
The expectation is that Contractors 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 Development(a-).fresnocountyca.gov.
DBH New Hire General Compliance Training
Duration: 40 Minutes
Contractors shall have their employees, subcontractors, volunteers, interns, and
student trainees who, in each case, are expected to provide services under this
Agreement with County, complete the New Hire Compliance Training within 30
business days of hire or effective date of this Agreement, per Compliance (Exhibit C,
Attachment G). If contract effective date is for a renewed agreement, existing staff
will not need to retake the training if the staff member has already completed the
training within the same calendar year as the effective date of the renewed
agreement.
New Hire General Compliance is self-paced and can be completed either through
Relias Learning Management System (LMS) or on the Department of Behavioral
Health's website. Additional information on how to complete the training can be
found on the following webpage:
https://www.fresnocountVca.gov/Departments/Behavioral-Health/Care-
Services/Behavioral-Health-Compliance/New-Hire-General-Compliance-Training
Contractors shall require its County-funded employees and subcontractors to
complete this compliance training. After completion of this training, participants must
sign the Contractor Acknowledgment and Agreement form and return this form to the
DBH Compliance officer or designee. For additional questions about the training,
please contact your Contract Analyst or the DBH Compliance team at:
DBHComplianceCcD_fresnocountyca.gov.
Invoicing Training
Duration: To be Confirmed
Contractors shall be responsible for collection and managing data in a manner to be
determined by the California Department of Health Care Services (DHCS) and
Behavioral Health Plan in accordance with applicable rules and regulations. DBH's
Exhibit C—Attachment D
Page 3of7
Electronic Health Record (EHR) is a critical source of information for purposes of
monitoring service volume and obtaining reimbursement. Contractors' 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. Contractors 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.
Contractors 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 Contractors at no cost and highly recommended.Although this training is not required,
Contractors are 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 C—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 Contractors at no cost and highly recommended.Although this training is not required,
Contractors are 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 Contractors at no cost and highly recommended.Although this training is not required,
Contractors are responsible for understanding and utilizing SmartCare as indicated once contracted with County DBH.
II. Trainings for Specialty MH Providers by Specialization
Mobile Crisis Services Trainings
Duration: 21 Hours
Any contracted provider providing mobile crisis services shall complete the state-
required training series. For example, the current training series is provided by the
Medi-Cal Mobile Crisis Training and Technical Assistance Center (M-TAC). This ten-
part training series is available on the DBH Relias learning management system. For
assistance with assigning the trainings, please contact
DBHRelias(a�Fresnocountyca.gov.
California Integrated Practice Child &Adolescent Needs & Strengths (CA IP
CANS)
Duration: 6 Hours 30 Minutes
The CA IP CANS is a structured assessment for identifying youth and family
actionable needs and useful strengths. It provides a framework for developing and
communicating about a shared vision and uses youth, ages 6 and youth up to age
Exhibit C—Attachment D
Page 5of7
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. Contractors are 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 CalMHSA's web-based training system, Moodie. 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 Contractors' training preference
Contracted Provider Organization shall have DBH-funded providers complete annual
trainings on cultural competency, awareness, and diversity as identified by
Contractors, and/or via the County's eLearning system. Contractors' DBH-funded
providers shall be appropriately trained in providing services in a culturally sensitive
manner and shall attend civil rights training as identified by Contractors, 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, Contractors are to contact their
assigned contract analyst.
DBH is available to assist Contractors' efforts toward cultural and linguistic
responsiveness by providing the following:
• Technical assistance regarding culturally responsive training requirements.
• Mandatory cultural responsiveness training for Contractors' 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).
Contractors are responsible for securing translation services and all
associated costs.
Exhibit C—Attachment D
Page 6of7
Health Insurance Portability and Accountability Act (HIPAA) Training
Duration: May vary based on selected training
As 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
Contractors 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 Contractors' 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 C—Attachment D
Page 7of7
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 DBHStaffDeve lop ment(a)_fresnocountyca.gov at the earliest
possible date if they can no longer attend a training for which they have
registered.
Use of DBH Training Facilities
Parking
Attendees shall park in undesignated stalls at DBH training sites. Any parking
restrictions shall be communicated prior to the training date or prior to the training start
time.
Use of Facilities
Attendees shall be respectful while occupying the training space, keeping it and the
surrounding area neat and clean. Attendees are encouraged to bring a reusable water
bottle but shall be cognizant of and clean any spills. If the training allows for food,
attendees shall ensure that their area is clean and dispose of any waste prior to leaving
the training space.
Exhibit C —Attachment E
Page 1 of 17
STATE BEHAVIORAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The County and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the County Behavioral Health Plan
(directly or through contract) providing Short-Doyle/Medi-Cal services have met
applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
Contractors 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
Contractors 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
Contractors shall comply with County policy, and the Equal Employment
Opportunity Commission guidelines, which forbids discrimination against
any person on the grounds of race, color, national origin, sex, religion,
age, disability status, or sexual preference in employment practices.
Such practices include retirement, recruitment advertising, hiring, layoff,
termination, upgrading, demotion, transfer, rates of pay or other forms of
compensation, use of facilities, and other terms and conditions of
employment.
C. Suspension of Compensation
If an allegation of discrimination occurs, County may withhold all further
funds, until Contractors can show clear and convincing evidence to the
Exhibit C —Attachment E
Page 2 of 17
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 Contractors who is related
by blood or marriage to, or who is a member of the Board of Directors or
an officer of Contractors.
5. PATIENTS' RIGHTS
Contractors shall comply with applicable laws and regulations, including but not
limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTORS CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractors have, 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: Contractors 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.
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and Contractors
may be ineligible for award of any future State agreements if the department
determines that any of the following has occurred: the Contractors have made
false certification, or violated the certification by failing to carry out the
requirements as noted above. (Gov. Code §8350 et seq.)
Exhibit C —Attachment E
Page 3 of 17
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractors certify
that no more than one (1) final unappealable finding of contempt of court by a
Federal court has been issued against Contractors within the immediately
preceding two (2) year period because of Contractors' failure to comply with an
order of a Federal court, which orders Contractors 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: Contractors hereby certify that they will comply with the
requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
Contractors agree 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: Contractors hereby declare 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. Contractors further declare under penalty of
perjury that they adhere to the Sweatfree Code of Conduct as set forth on
the California Department of Industrial Relations website located at
www.dir.ca.gov, and Public Contract Code Section 6108.
b. Contractors agree to cooperate fully in providing reasonable access to the
Contractors' 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
Exhibit C —Attachment E
Page 4 of 17
determine the Contractors' compliance with the requirements under
paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractors certify
that they are in compliance with Public Contract Code Section 10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, Contractors certify that
they are 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: Contractors need to be aware of the following
provisions regarding current or former state employees. If Contractors have 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 �10411):
a). For the two (2) year period from the date they left state employment, no
former state officer or employee may enter into a contract in which they
engaged in any of the negotiations, transactions, planning, arrangements
or any part of the decision-making process relevant to the contract while
employed in any capacity by any state agency.
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 Contractors violate any provisions of above paragraphs, such action by
Contractors shall render this Agreement void. (Pub. Contract Code §10420)
Exhibit C —Attachment E
Page 5 of 17
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: Contractors need 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 Contractors affirm to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractors assure 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
Contractors' 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 Contractors are 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
corporate Contractors 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.
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
Contractors 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
Exhibit C —Attachment E
Page 6 of 17
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 Contractors or their 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 Contractors, any
subcontractors, as well as any person with an ownership or control interest, or
who is an agent or managing employee of Contractors 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 Contractors and take action consistent with § 438.610(c).
The State shall ensure that Contractors with which the State contracts under this
part is not located outside of the United States and that no claims paid by
Contractors to a network provider, out-of-network provider, subcontractors or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
Exhibit C —Attachment E
Page 7 of 17
CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM)
REQUIREMENTS
1. SERVICES AND ACCESS PROVISIONS
a. CERTIFICATION OF ELIGIBILITY
i. Contractors 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, Contractors will work to ensure
that individuals to whom the Contractors provide SMHS meet
access criteria, as per Department of Health Care Services
(DHCS) guidance specified in Behavioral Health Information
Notice (BHIN) 21-073. Specifically, the Contractors 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, Contractors shall
provide all medically necessary SMHS required pursuant to
Section 1396d(r) of Title 42 of the United States Code. Covered
SMHS shall be provided to enrolled individuals who meet either of
the following criteria, (1) or (11) below. If an individual under age 21
meets the criteria as described in (1) below, the beneficiary meets
criteria to access SMHS; it is not necessary to establish that the
beneficiary also meets the criteria in (b) below.
1. The individual has a condition placing them at high risk for
a mental health disorder due to experience of trauma
evidenced by any of the following: scoring in the high-risk
range under a trauma screening tool approved by DHCS,
involvement in the child welfare system, juvenile justice
involvement, or experiencing homelessness.
OR
2. The individual has at least one of the following:
a. A significant impairment
b. A reasonable probability of significant deterioration
in an important area of life functioning
c. A reasonable probability of not progressing
developmentally as appropriate.
d. A need for SMHS, regardless of presence of
impairment, that are not included within the mental
health benefits that a Medi-Cal Managed Care Plan
(MCP) is required to provide.
AND the individual's condition as described in subparagraph
(11 a-d) above is due to one of the following:
Exhibit C —Attachment E
Page 8 of 17
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, Contractors 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 B 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
Medicare & Medicaid Services (CMS) approved ICD
diagnosis code
Exhibit C —Attachment E
Page 9 of 17
d. MEDICAL NECESSITY
i. Contractors 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. Contractors 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. Contractors shall ensure that care coordination activities support
the monitoring and treatment of comorbid substance use disorder
and/or health conditions.
iii. Contractors 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. Contractors shall engage in care coordination activities beginning
at intake and throughout the treatment and discharge planning
processes.
v. To facilitate care coordination, Contractors 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
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
Exhibit C —Attachment E
Page 10 of 17
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, Contractors will ensure that individual s
receive timely mental health services without delay. Services are
reimbursable to Contractors 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 Contractors are serving an individual receiving both
SMHS and NSMHS, Contractors hold responsibility for
documenting coordination of care and ensuring that
services are non-duplicative.
2. AUTHORIZATION AND DOCUMENTATION PROVISIONS
a. SERVICE AUTHORIZATION
i. Contractors will collaborate with County to complete authorization
requests in line with County and DHCS policy.
ii. Contractors 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. Contractors shall respond to County in a timely manner when
consultation is necessary for County to make appropriate
authorization determinations.
iv. County shall provide Contractors with written notice of
authorization determinations within the timeframes set forth in
BHINs 22-016 and 22-017, or any subsequent DHCS notices.
v. Contractors 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. Contractors will follow all documentation requirements as
specified in Article 4.2-4.8 inclusive in compliance with federal,
state and County requirements.
ii. All Contractors' documentation shall be accurate, complete, and
legible, shall list each date of service, and include the face-to-face
time for each service. Contractors shall document travel and
documentation time for each service separately from face-to-face
time and provide this information to County upon request.
Services shall be identified as provided in-person, by telephone,
or by telehealth.
Exhibit C —Attachment E
Page 11 of 17
iii. All services shall be documented utilizing County-approved
templates and contain all required elements. Contractors agree 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. Contractors shall ensure that all individuals' medical records
include an assessment of each individual's need for mental health
services.
ii. Contractors 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, Contractors' providers shall
complete assessments within a reasonable time and in
accordance with generally accepted standards of practice.
d. ICD-10
i. Contractors 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 Contractors shall
determine the corresponding mental health diagnosis in the
current edition of ICD. Contractors 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. Contractors 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. Contractors shall document a problem list that adheres to industry
standards utilizing at minimum current SNOMED International,
Systematized Nomenclature of Medicine Clinical Terms
(SNOMED CTO) U.S. Edition, September 2022 Release, and ICD-
10-CM 2023.
Exhibit C —Attachment E
Page 12 of 17
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, Contractors 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. Contractors are 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. Contractors 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. Contractors 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. Contractors shall use a Transition of Care Tool for any individual
whose existing services will be transferred from Contractors to an
Medi-Cal Managed Care Plan (MCP) provider or when NSMHS
will be added to the existing mental health treatment provided by
Contractors, 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.
iii. Contractors may directly use the DHCS-provided Transition of
Care Tool, found at https://www.dhcs.ca.gov/Pages/Screening-
and-Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-
Services.aspx, or obtain a copy of that tool provided by the
County. Contractors may create the Transition of Care Tool in its
Electronic Health Record (EHR). However, the contents of the
Exhibit C —Attachment E
Page 13 of 17
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. Contractors may use telehealth, when it deems clinically
appropriate, as a mode of delivering behavioral health services in
accordance with all applicable County, state, and federal
requirements, including those related to privacy/security,
efficiency, and standards of care. Such services will conform to
the definitions and meet the requirements included in the Medi-Cal
Provider Manual: Telehealth, available in the DHCS Telehealth
Resources page at:
https://www.dhcs.ca.gov/provgovpart/Pages/TelehealthResources
.aspx.
ii. All telehealth equipment and service locations shall ensure that
person served confidentiality is maintained.
iii. Licensed providers and staff may provide services via telephone
and telehealth as long as the service is within their scope of
practice.
iv. Medical records for individuals served by Contractors under this
Agreement shall include documentation of written or verbal
consent for telehealth or telephone services if such services are
provided by Contractors. 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 Contractors' telehealth practices,
and Contractors shall allow access to all materials needed to
adequately monitor Contractors' 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 Contractors 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.
ii. Contractors 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 Contractors within the
specified timeframes using the template provided by the County.
Exhibit C —Attachment E
Page 14 of 17
iv. NOABDs shall be issued to individuals anytime the Contractors
have 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 Contractors 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. Contractors 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. Contractors 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. Contractors 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. Contractors 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. Contractors shall implement mechanisms to assess person
served/family satisfaction based on County's guidance. The
Contractors shall assess individual/family satisfaction by:
1. Surveying person served/family satisfaction with the
Contractors' services at least annually.
2. Evaluating grievances of the person served, 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. Contractors, 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
Exhibit C —Attachment E
Page 15 of 17
prescribe or dispense prescription drugs, at least annually and as
required by DBH.
iii. Contractors shall implement mechanisms to monitor appropriate
and timely intervention of occurrences that raise quality of care
concerns. The Contractors shall take appropriate follow-up action
when such an occurrence is identified. The results of the
intervention shall be evaluated by the Contractors at least
annually and shared with the County.
iv. Contractors shall assist County, as needed, with the development
and implementation of Corrective Action Plans.
v. Contractors 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. Contractors 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.
Contractors shall ensure that there is active participation by the
Contractors' practitioners and providers in the QIC.
vii. Contractors 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. Contractors 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
Contractors' 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 Contractors,
and submitted to the County on a monthly basis in a format
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
Exhibit C —Attachment E
Page 16 of 17
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. Contractors shall ensure that all of their required clinical staff, who
are rendering SMHS to Medi-Cal individuals on behalf of
Contractors, 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,
Occupational Therapist, and Speech-Language Pathologist.
Interns, trainees, and associates are not eligible for enrollment.
d. PHYSICIAN INCENTIVE PLAN
i. If Contractors want to institute a Physician Incentive Plan,
Contractors 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
Exhibit C —Attachment E
Page 17 of 17
a. ELECTRONIC PRIVACY AND SECURITY
i. Contractors shall have a secure email system and send any email
containing PII or PHI in a secure and encrypted manner.
Contractors' 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. Contractors shall institute compliant password management
policies and procedures, which shall include but not be limited to
procedures for creating, changing, and safeguarding passwords.
Contractors 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 Contractors
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. Contractors 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. Contractors 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;
4. A lack of present illegal drug use; and
5. The application's accuracy and completeness
ii. Contractors 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. Contractors are 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.
Exhibit C—Attachment F
Page 1 of 1
Electronic Health Record Requirements and Service Data
Contractors 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. Contractors will be responsible for
equipment to support the using of the EHR. Contractors 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.At the discretion of County, Contractors may submit services and billing data via CMS
1500 forms.
Data entry shall be the responsibility of the Contractors.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 Contractors shall be the sole responsibility of the Contractors.
Contractors will utilize the County's EHR for all Behavioral Health Plan billing and reporting functions
and, at the County's discretion, may elect to utilize the County's EHR for all clinical documentation, at no
additional cost to Contractors.
If Contractors elect to not use the County's EHR for all clinical documentation,the Contractors must
ensure all necessary requirements involving electronic health information exchange between the
Contractors and the County will be met.
Exhibit C-Attachment G
Fresno County Mental Health
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 C —Attachment H
Page 1 of 5
Health Insurance Portability and Accountability Act (HIPAA)
Business Associate Agreement
1. The County is a "Covered Entity," and each 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 Contractors 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 Contractors, as business
associates 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 Contractors.
4. Contractors shall protect, from unauthorized access, use, or disclosure of names
and other identifying information concerning persons receiving services pursuant to this
Agreement, except where permitted in order to carry out data aggregation purposes for health
I
Exhibit C —Attachment H
Page 2 of 5
care operations. (45 CFR Sections 164.504 (e)(2)(i), 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i).)
This pertains to any and all persons receiving services pursuant to a County funded program.
Contractors shall not use such identifying information for any purpose other than carrying out
Contractors' obligations under this Agreement.
5. Contractors 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 person served.
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. Contractors 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.
Contractors 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.
Contractors 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. Contractors 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 C —Attachment H
Page 3 of 5
unsecured PHI has been, or is reasonably believed to have been, accessed, acquired, used,
disclosed, or breached. Contractors 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. Contractors 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. Contractors 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 Contractors on
behalf of County, available to the United States Department of Health and Human Services
upon demand.
10. Safeguards
Contractors 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. Contractors 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 Contractors'
operations and the nature and scope of its activities. Upon County's request, Contractors shall
provide County with information concerning such safeguards.
3
Exhibit C —Attachment H
Page 4 of 5
Contractors 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
Contractors shall mitigate, to the extent practicable, any harmful effect that is
known to Contractors of an unauthorized access, viewing, use, disclosure, or breach of PHI by
Contractors or their subcontractors in violation of the requirements of these provisions.
12. Contractors' Subcontractors
Contractors shall ensure that any of their subcontractors, if applicable, to whom
Contractors provide PHI received from or created or received by Contractors on behalf of
County, agree to the same restrictions and conditions that apply to Contractors 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, Contractors
shall return or destroy all PHI received from County (or created or received by Contractors on
behalf of County) that Contractors still maintain 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 Contractors. If Contractors destroy
the PHI data, a certification of date and time of destruction shall be provided to the County by
Contractors.
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 C —Attachment H
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 Contractors as stated in this Section
shall survive the termination or expiration of this Agreement.
5
Exhibit C-Attachment I
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.
THINK
O M H U.&DeDaf wntof www.ThinkCulturalHealth.hhs.gov CULTURAL —
HeoM and Human Ser0cae •
Office Of Mlno'V HeaRn HEALTH
Exhibit C -Attachment I
Page 2 of 2
The Case for the Enhanced National CLAS Standards
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
—Dr. Martin Luther King, Jr.
Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human
Services [HHS] Office of Minority Health, 2011). Currently, individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of
health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease Prevention
and Health Promotion, 2010). Though health inequities are directly related to the existence of historical and current
discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate
services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of
all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely
affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but
also a public health concern. In the United States, it has been estimated that the combined cost of health disparities and
subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin, & Richard, 2009).
Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care
and services (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CLAS Standards will improve an organization's ability to address
health care disparities.
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities
(HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to
End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide
collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the
enhanced National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and
linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the
United States.
Bibliography:
Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ
Publication No.04-E008-02).Retrieved from the Agency of Healthcare Research and Quality website:
http://www.a h rq.gov/down loads/pub/evidence/pdf/m i nq ua l/m i nq ua I.pdf
Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).
Retrieved from The Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
LaVeist,T.A.,Gaskin,D.J.,&Richard,P.(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic
Studies website: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and
Human Services,Office of Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.
Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved
from http://www.healthypeople.gov/2020/topicsobjectives2O2O/overview.aspx?topicid=39
U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from
http://minorityhealth.hhs.gov/npa
World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
1 THINK
loz—O M H U. DepoftwHof �+ww.ThinkCulturalHealth.hhs.gov CULTURAL
HeoM and Human Ser0cae HEALTH •
Office of Nno'V HeoRn
Exhibit D
Page 1 of 11
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 Contractors agree 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 Contractors under this Agreement for the
period of July 1, 2025 through June 30, 2026 for SMHS is Nine Million and No/100 Dollars
($9,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered and
received.
The maximum compensation payable to the Contractors under this Agreement for the
period of July 1, 2026 through June 30, 2027 for SMHS is Nine Million and No/100 Dollars
($9,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered and
received.
The maximum compensation payable to the Contractors under this Agreement for the
period of July 1, 2027 through June 30, 2028 for SMHS is Nine Million and No/100 Dollars
($9,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered and
received.
The maximum compensation payable to the Contractors under this Agreement for the
period of July 1, 2028 through June 30, 2029 for SMHS is Nine Million and No/100 Dollars
($9,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered and
received.
The maximum compensation payable to the Contractors under this Agreement for the
period of July 1, 2029 through June 30, 2030 for SMHS is Nine Million and No/100 Dollars
($9,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered and
received.
2. Total Maximum Compensation.
In no event shall the maximum contract amount for all the services provided by the
Contractors to County under the terms and conditions of this Agreement be in excess of Forty-
Five Million and No/100 Dollars ($45,000,000.00) during the entire term of this Agreement.
The Contractors acknowledge 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 Contractors may receive compensation under this Agreement only for
Exhibit D
Page 2 of 11
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 Contractors further acknowledge that County employees have no authority to pay
the Contractors except as expressly provided in this Agreement.
See table below for compensation breakdown by Fiscal Year and Total Maximum
Compensation for this Agreement.
Fiscal Year Total FY Maximum
(FY) Compensation
FY 25-26 $9,000,000
FY 26-27 $9,000,000
FY 27-28 $9,000,000
FY 28-29 $9,000,000
FY 29-30 $9,000,000
$45,000,000
Invoices
The Contractors shall submit monthly invoices, in arrears by the fifteenth (15m) day of
each month, in the format directed by the County. The Contractors shall submit invoices
electronically or via hardcopy to:
1) DBHAOA@fresnocountyca.gov; and
2) The assigned County's DBH Staff Analyst or designee; or
3) Adult and Older Adult Services 3688 E Shields Ave Fresno, CA 93726.
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 Contractors. Contractors agree 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, Contractors 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 Contractors.
Exhibit D
Page 3 of 11
Withholdings to an invoice by County's DBH shall be addressed by the Contractors
and/or Contractors 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 Contractors within one hundred
and twenty (120) days following the final month for which payment is claimed in that fiscal year.
No action may be taken by County on any invoices submitted after one hundred and twenty
(120) days of the end of the fiscal year where services are performed.
1. Specialty Mental Health Claimable Services Invoices.
For specialty mental health services, invoices shall be based on claims entered into the
County's electronic health record (EHR) for the prior month.
Monthly payments for claimable services shall only be based on the units of time
assigned to each CPT or HCPCS code entered in the County's billing and transactional
database multiplied by the practitioner service rates in Exhibit D —Attachment A.
Any claimable services pending determination from Medicare, OHC, and any other third-
party source will not be reimbursed until Explanation of Benefits (EOB) are processed and the
balance is transferred to the Medi-Cal coverage plan, and ready to claim to the Medi-Cal
coverage plan, or the appropriate coverage plan(s), as deemed appropriate by the Agreement's
funding resources or approval by County's DBH. Claimable services that are pending
determinations must be addressed and invoiced to County's DBH within one hundred and
twenty (120) days following the month of service. Any delays to invoicing must be
communicated to and approved by County's DBH within one hundred and twenty (120) days
following the month of service or the services may be ineligible for payment at County's
discretion.
County's payments to Contractors 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.
Mail backs are denied claims that are mailed back to the Contractors for corrections.
Contractors shall submit corrections within 30 days from the date on the mail back notice.
Corrections must include the corrected claim and the mail back letter. No approval shall be
given to corrected claims that are submitted without the mail back letter attached. Opportunity
for mail backs will be limited at the discretion of the County.
2. Corrective Action Plans.
Contractors 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.
Exhibit D
Page 4 of 11
Payment
Payments shall be made by County to Contractors 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 Contractors 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 Contractors 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 Contractors, as specified
in this Agreement.
1. Incidental Expenses.
The Contractors are solely responsible for all of their costs and expenses that are not
specified as payable by the County under this Agreement. If Contractors fail to comply with any
provision of this Agreement, County shall be relieved of its obligation for further compensation.
2. Applicable Fees.
Contractors 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, Contractors shall use the uniform
billing and collection guidelines prescribed by DHCS.
Contractors 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.
Contractors 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 Contractors 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
Contractors 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 (15cn) 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
Exhibit D
Page 5 of 11
Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System
(HCPCS) codes, as provided in the DHCS Billing Manual available at
https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-LibrarV.aspx, as from time to time
amended. At County's discretion, Contractors may also submit CMS 1500 forms to County for
payment for specialty mental health services provided by individuals and groups through this
agreement.
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 Contractors. 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 Contractors shall be the sole
responsibility of Contractors. Contractors will comply with all applicable policies, procedures,
directives, and guidelines regarding the use of County's EHR/information system.
Contractors must provide all necessary data to allow County to bill Medi-Cal for services
and meet State and Federal reporting requirements. The necessary data can be provided by a
variety of means, including but not limited to:
If a person served has dual coverage, such as other health coverage (OHC) or Federal
Medicare, Contractors 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
Contractors 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. Contractors 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, Contractors 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 Contractors 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 Contractors, 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 Contractors through a
repayment agreement. The monthly repayment amounts may be netted against the Contractors'
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 Contractors.
Contractors shall be held financially liable for any and all future disallowances/audit
exceptions due to Contractors' deficiency discovered through the State audit process and
County utilization review for services provided during the course of this Agreement. At County's
Exhibit D
Page 6 of 11
election, the disallowed amount will be remitted within forty-five (45) days to County upon
notification or shall be withheld from subsequent payments to Contractors. Contractors shall not
receive reimbursement for any units of services rendered that are disallowed or denied by the
Fresno County BHP 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 Contractors' 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 Contractors to reimburse County for services
previously paid in the following circumstances:
(A) Identification of Fraud, Waste or Abuse as defined in federal regulation
(1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code,
section 14107.11, subdivision (d).
(2) Definitions for"fraud," "waste," and "abuse" can also be found in the
Medicare Managed Care Manual available at https://www.cros.gov/Regulations-
and-Guidance/Guidance/Manuals
(B) Overpayment of Contractors 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.
Contractors shall reimburse County for all overpayments identified by Contractors,
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
Contractors.
2. Internal Audits/Reviews.
Contractors are 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.
Contractors 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. Contractors 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 Contractors' internal audit process. Contractors
shall provide this notification and summary to County as requested by the County.
3. Confidentiality in Audit/Review Process.
Exhibit D
Page 7 of 11
Contractors and County mutually agree to maintain the confidentiality of Contractors'
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. Contractors shall inform all of its officers, employees, and
agents of the confidentiality provisions of all applicable statutes.
Contractors' 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.
Contractors' 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 Contractors in a complete and timely
manner.
4. Cooperation with Audits/Reviews.
Contractors 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, Contractors shall comply with all requests for any documentation or files
including, but not limited to, files for persons served and personnel files.
Contractors 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.
Contractors 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 Contractors
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 Contractors expend Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00)
or more in Federal and Federal flow-through monies, Contractors agree 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. Contractors 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, Contractors must include a corrective
action plan signed by an authorized individual. Contractors agree 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
Contractors. All audit costs related to this Agreement are the sole responsibility of Contractors.
Exhibit D
Page 8 of 11
A single audit report is not applicable if Contractors' Federal contracts do not exceed the
Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or Contractors'
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
Contractors to County as a minimum requirement to attest to Contractors 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 Contractors who agree 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 Contractors at County cost, as
determined by County's Auditor-Controller/Treasurer-Tax Collector.
Contractors shall make available all records and accounts for inspection by County, the
State of California, if applicable, the Controller General of the United States, the Federal Grantor
Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other
pending matters, whichever is later.
6. Financial Audit Report Requirements for Pass-Through Entities
If County determines that Contractors is a "subrecipient" (also known as a "pass-through
entity") as defined in 2 C.F.R. § 200 et seq., Contractors represent 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. Contractors 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.
Contractors 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.
Contractors 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, Contractors 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 Contractors.
Exhibit D
Page 9 of 11
Other Financial Requirements
1. Notification of Changes.
Contractors 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.
Contractors 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.
Contractors must immediately notify County of a change in ownership, organizational
status, licensure, or ability of Contractors to provide the quantity or quality of the contracted
services in no event more than 15 days of the change.
2. Record Maintenance.
Contractors 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.
Contractors 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.
Contractors shall comply with all local, state, and federal laws and regulations regarding
relinquishing or maintaining medical records.
Contractors 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.
Contractors 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.
Exhibit D
Page 10 of 11
In the event this Agreement is terminated, ends its designated term, or Contractors
cease operation of their businesses, Contractors shall deliver or make available to County all
financial records that may have been accumulated by Contractors or subcontractors 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 Contractors 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 Contractors. 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.
Contractors 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.
Contractors agree 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)].
Contractors must maintain financial records for a minimum period of ten (10) years or
until any dispute, audit or inspection is resolved, whichever is later. Contractors will be
responsible for any disallowances related to inadequate documentation.
7. Contractors Prohibited from Redirection of Contracted Funds
Exhibit D
Page 11 of 11
Contractors may not redirect or transfer funds from one funded program to another funded
program under which Contractors provide services pursuant to this Agreement except through a
duly executed amendment to this Agreement.
Contractors may not charge services delivered to an eligible person served under one funded
program to another funded program unless the person served is also eligible for services under
the second funded program.
Exhibit D —Attachment A
FEE-FOR-SERVICE RATE(S)
**Fee-for-Service rates are established by the Department of Health Care Services.
Contractors acknowledge 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 Contractors under the
Fee-for-Service reimbursement structure.
Specialty Mental Health Individual and Group Provider Outpatient Rates
Rate per Hour*
Provider Type FY 2025-26 Rate
Psychiatrist $301.97
Nurse Practitioner $287.59
Psychologist Licensed/Re istered/Waivered $124.04
Licensed — LCSW/ASW, LMFT/AMFT, LPCC/APCC, RF-MS $124.04
Unlicensed — LCWS/ASW, LMFT/AMFT, LPCC/APCC, RN-MS $124.04
Supplemental/Add-On Codes
Service Unit Maximum Units That Rate per Unit
Can Be Billed
Interactive 15 mins per unit 1 per allowed $18.32
Complexity procedure per
provider per
beneficiary
Sign Language or 15 mins per unit Variable $30.92
Oral Interpretive
Services
*Hourly rates are for reference only to demonstrate an example rate per hour for a service
provided and claimed using CPT or HCPCS units that equate, based on actual minutes
documented, to CPT or HCPCS units equating to one hour; actual reimbursement is based on
CPT or HCPCS codes for services rendered, as provided in the DHCS Billing Manual available
at: https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-LibrarV.aspx
Exhibit E
Page 1 of 3
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractors or any third
parties, Contractors, at their 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 Contractors 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 Contractors'
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 Contractors
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 Contractors 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 Contractors.
Exhibit E
Page 2of3
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Contractors' 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 Contractors' 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 Contractors' 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 Contractors signs this Agreement,
and at any time during the term of this Agreement as requested by the County, the
Contractors shall mail and email, or cause its broker or producer to mail and email, to
the County of Fresno, Department of Behavioral Health -Attention Plan Administration,
1925 E Dakota Ave, Fresno CA 93726, or electronically to
DBHPlanAdmin@fresnocountyca.gov with a copy to the assigned County's DBH Staff
Analyst, certificates of insurance and endorsements for all of the coverages required
under this Agreement.
(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 Contractors 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 Contractors 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 Contractors 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 Contractors or their insurers 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 Contractors have or obtain
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 Contractors shall deliver, or cause its broker or producer
Exhibit E
Page 3 of 3
to deliver, to the County certificates of insurance and endorsements for all of the
coverages that have such broader coverage, higher limits, or both, as required under
this Agreement.
(E) Waivers of Subrogation. The Contractors waive 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 Contractors are solely responsible to obtain any
policy endorsement that may be necessary to accomplish each waiver, but the
Contractors' waivers of subrogation under this paragraph are effective whether or not the
Contractors obtain such an endorsement.
(F) County's Remedy for Contractors' Failure to Maintain. If the Contractors fail 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 Contractors. The County may offset such
charges against any amounts owed by the County to the Contractors under this
Agreement.
(G)Subcontractors. The Contractors shall require and verify that all subcontractors used
by the Contractors to provide services under this Agreement maintain insurance meeting
all insurance requirements provided in this Agreement. This paragraph does not
authorize the Contractors to provide services under this Agreement using
subcontractors.
Exhibit F
Page 1 of 8
Data Security
1. Definitions
Capitalized terms used in this Exhibit have the meanings set forth in this section 1.
(A) "Authorized Employees" means the Contractors' employees who have access to
Personal Information.
(B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all
of the Contractors' subcontractors, representatives, agents, outsourcers, and
consultants, and providers of professional services to the Contractors, 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 F.
(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 Contractors 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 Contractors' (or any Authorized Person's) privacy practices, or alleging a Security
Breach. Such complaint shall have sufficient detail to enable the Contractors to promptly
investigate and take remedial action under this Exhibit F.
(H) "Security Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by the Contractors (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.
Exhibit F
Page 2of8
(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 Contractors acknowledge that, in the course of its engagement by the County under
this Agreement, the Contractors, or any Authorized Persons, may Use Personal
Information only as permitted in this Agreement.
(B) The Contractors acknowledge 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 Contractors, or any Authorized Persons. The Contractors further acknowledge 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 Contractors', or any Authorized Person's, Use of that Personal
Information.
(C)The Contractors agree and covenant in favor of the Country that the Contractors 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 Contractors pursuant to the terms of this
Exhibit F;
(iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal
Information for the Contractors' 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 a 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, Contractors 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 Contractors, or any Authorized Person, from any government regulatory
authorities, or in relation to any legal proceeding, and (ii) promptly notify the County
Exhibit F
Page 3 of 8
before such Personal Information is offered by the Contractors 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 Contractors shall cooperate with the County to minimize the scope of
such disclosure of such Personal Information.
(E) The Contractors 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 Contractors' own actions and omissions.
3. Information Security
(A) The Contractors covenant, represents and warrants to the County that the Contractors'
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 Contractors Use credit, debit or other payment
cardholder information, the Contractors 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 Contractors' sole cost and expense.
(B) The Contractors covenant, represents and warrants to the County that, as of the
effective date of this Agreement, the Contractors have 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 Contractors' obligations under section 3(A) of this Exhibit F, the
Contractors' (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 Contractors' and Authorized
Persons' technical and administrative personnel who are necessary for the
Contractors', or Authorized Persons', Use of the Personal Information pursuant to
this Agreement;
(ii) ensuring that all of the Contractors' 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)
Exhibit F
Page 4 of 8
employing adequate controls and data security measures, both internally and
externally, to protect (1) the Personal Information from potential loss or
misappropriation, or unauthorized Use, and (2) the County's operations from
disruption and abuse; (c) having and maintaining network, device application,
database and platform security; (d) maintaining authentication and access
controls within media, computing equipment, operating systems, and software
applications; and (e) installing and maintaining in all mobile, wireless, or
handheld devices a secure internet connection, having continuously updated
anti-virus software protection and a remote wipe feature always enabled, all of
which is subject to express prior written consent of the Director;
(iv) encrypting all Personal Information at advance encryption standards of Advanced
Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile
devices, including but not limited to hard disks, portable storage devices, or
remote installation, or (b) transmitted over public or wireless networks (the
encrypted Personal Information must be subject to password or pass phrase, and
be stored on a secure server and transferred by means of a Virtual Private
Network (VPN) connection, or another type of secure connection, all of which is
subject to express prior written consent of the Director);
(v) strictly segregating Personal Information from all other information of the
Contractors, including any Authorized Person, or anyone with whom the
Contractors 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 Contractors, the
Contractors shall cause such Authorized Employees to abide strictly by the Contractors'
obligations under this Exhibit F. The Contractors shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
(E) The Contractors shall, in a secure manner, backup daily, or more frequently if it is the
Contractors' 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 Contractors, through
the Internet.
(F) The Contractors 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 Contractors and shall
Exhibit F
Page 5 of 8
be available to assist the County twenty-four (24) hours per day, seven (7) days per
week as a contact in resolving the Contractors' and any Authorized Persons' obligations
associated with a Security Breach or a Privacy Practices Complaint.
(G)The Contractors 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 Contractors' awareness or reasonable belief of a Security Breach,
the Contractors 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
Contractors), 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 Contractors' notification to the County of a Security Breach, as
provided pursuant to section 4(A) of this Exhibit F, the Parties shall coordinate with each
other to investigate the Security Breach. The Contractors agree 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 Contractors' 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 Contractors 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 Contractors shall provide a written report
of the investigation and reporting required to the Director within 30 days after the
Contractors' discovery of the Security Breach.
(C) County shall promptly notify the Contractors of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint, and upon the Contractors' receipt of that
notification, the Contractors shall promptly address such Privacy Practices Complaint,
including taking any corrective action under this Exhibit F, all at the Contractors' sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
Exhibit F
Page 6 of 8
In the event the Contractors discover a Security Breach, the Contractors shall treat the
Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractors'
receipt of notification of such Privacy Practices Complaint, the Contractors 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 Contractors 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 Contractors' sole expense, in
accordance with applicable privacy rights, laws, regulations and standards. The
Contractors 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 F.
(E) The Contractors agree 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 Contractors shall have and maintain a written information security policy that
specifies Security Safeguards appropriate to the size and complexity of the Contractors'
operations and the nature and scope of its activities.
(B) Upon the County's written request, to confirm the Contractors' compliance with this
Exhibit F, as well as any applicable laws, regulations and industry standards, the
Contractors grant 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 Contractors' physical and technical environment in relation to all
Personal Information that is Used by the Contractors pursuant to this Agreement. The
Contractors 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 Contractors
for Personal Information pursuant to this Agreement. In addition, the Contractors shall
provide the County with the results of any audit by or on behalf of the Contractors that
assesses the effectiveness of the Contractors' information security program as relevant
to the security and confidentiality of Personal Information Used by the Contractors or
Authorized Persons during the course of this Agreement under this Exhibit F.
(C)The Contractors shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit F. that apply to the
Contractors with respect to such Personal Information by incorporating the relevant
provisions of these provisions into a valid and binding written agreement between the
Contractors and such Authorized Persons, or amending any written agreements to
provide same.
Exhibit F
Page 7 of 8
6. Return or Destruction of Personal Information. Upon the termination of this Agreement,
the Contractors 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
Contractors are authorized to dispose of any such Personal Information, as provided in this
Exhibit F, such certification shall state the date, time, and manner (including standard) of
disposal and by whom, specifying the title of the individual. The Contractors 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 Contractors shall notify the
County according, specifying the reason, and continue to extend the protections of this Exhibit F
to all such Personal Information and copies of Personal Information. The Contractors shall not
retain any copy of any Personal Information after returning or disposing of Personal Information
as required by this section 6. The Contractors' obligations under this section 6 survive the
termination of this Agreement and apply to all Personal Information that the Contractors retain if
return or disposal is not feasible and to all Personal Information that the Contractors may later
discover.
7. Equitable Relief. The Contractors acknowledge that any breach of its covenants or
obligations set forth in this Exhibit F 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 Contractors 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 F 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 Contractors', its officers, employees, or agents, or any Authorized
Employee's or Authorized Person's, performance or failure to perform under this Exhibit F or
arising out of or resulting from the Contractors' 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
Contractors 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.
Exhibit F
Page 8 of 8
9. Survival. The respective rights and obligations of the Contractors and the County as stated
in this Exhibit F shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit F
is intended to confer, nor shall anything in this Exhibit F confer, upon any person other than the
County or the Contractors 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 Contractors' (or any Authorized Person's) possession or control
or Use by the Contractors (or any Authorized Person), pursuant to the terms of this Agreement
is or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint.
Exhibit G
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County'),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit G
Page 2 of 2
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3)Disclosure(Please describe the nature of the self-dealing transaction you are a party to)
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a)
(5)Authorized Signature
Signature: Date:
Exhibit H
Page 1 of 3
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of Entity D/B/A
Address(number,street) City State ZIP Code
CILIA Number Taxpayer ID Number(EIN)/Social Security Number Telephone Number
( )
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list all names
and addresses (primary, every business location, and P.O. Box address)of individuals or corporations under"Remarks"on
page 2. Identify each item number to be continued.
A. Are there any individuals or organizations having a direct or indirect ownership or control interest YES No
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVIII, XIX, or XX?......................................................................................................................... n n
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX?...................................................................................... o 0
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 0
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses (primary, every business location, and P.O. Box address) under "Remarks" on page 2. If more than
one individual is reported and any of these persons are related to each other, this must be reported under"Remarks."
NAME DOB ADDRESS EIN
B. Type of entity: o Sole proprietorship o Partnership o Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... o 0
NAME DOB ADDRESS PROVIDER
Exhibit H
Page 2 of 3
YES NO
IV. A. Has there been a change in ownership or control within the last year?....................................................... n n
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... n n
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o n
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name 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 H
Page 3 of 3
INSTRUCTIONS FOR COMPLETING DISCLOSURE OF CONTROL AND INTEREST STATEMENT
Please answer all questions as of the current date. If the yes block for any item is checked,list requested additional information under
the Remarks Section on page 2,referencing the item number to be continued. If additional space is needed use an attached sheet.
DETAILED INSTRUCTIONS
These instructions are designed to clarify certain questions on the form.Instructions are listed in question order for easy reference.No
instructions have been given for questions considered self-explanatory.
IT IS ESSENTIAL THAT ALL APPLICABLE QUESTIONS BE ANSWERED ACCURATELY AND THAT ALL INFORMATION
BE CURRENT.
Item I-Under"Identifying Information"specify in what capacity the entity is doing business as(DBA)(e.g.name of trade or
corporation).
Item II- Self-explanatory
Item III-List the names of all individuals and organizations having direct or indirect ownership interests,or controlling interest
separately or in combination amounting to an ownership interest of 5 percent or more in the disclosing entity.
Direct ownership interest-is defined as the possession of stock,equity in capital or any interest in the profits of the disclosing entity.
A disclosing entity is defined as a Medicare provider or supplier,or other entity that furnishes services or arranges for furnishing
services under Medicaid or the Maternal and Child Health program,or health related services under the social services program.
Indirect ownership interest-is defined as ownership interest in an entity that has direct or hospital-based home health agencies,are not
indirect ownership interest in the disclosing entity. The amount of indirect ownership in the disclosing entity that is held by any other
entity is determined by multiplying the percentage of ownership interest at each level. An indirect ownership interest must beds in the
facility now and the previous be reported if it equates to an ownership interest of 5 percent or more in the disclosing entity.Example:
if A owns 10 percent of the stock in a corporation that owns 80 percent of the stock of the disclosing entity,A's interest equates to an 8
percent indirect ownership and must be reported.
Controlling interest-is defined as the operational direction or management of disclosing entity which may be maintained by any or all
of the following devices:the ability or authority,expressed or reserved,to amend or change the corporate identity(i.e.,joint venture
agreement,unincorporated business status)of the disclosing entity;the ability or authority to nominate or name members of the Board
of Directors or Trustees of the disclosing entity;the ability or authority,expressed or reserved,to amend or change the by-laws,
constitution,or other operating or management direction of the disclosing entity;the right to control any or all of the assets or other
property of the disclosing entity upon the sale or dissolution of that entity;the ability or authority,expressed or reserved,to control the
sale of any or all of the assets,to encumber such assets by way of mortgage or other indebtedness,to dissolve the entity or to arrange
for the sale or transfer of the disclosing entity to new ownership or control.
Item IV-VII-(Changes in Provider Status)For Items IV-VII,if the yes box is checked,list additional information requested under
Remarks. Clearly identify which item is being continued.
Change in provider status-is defined as any change in management control. Examples of such changes would include;a change in
Medical or Nursing Director,a new Administrator,contracting the operation of the facility to a management corporation,a change in
the composition of the owning partnership which under applicable State law is not considered a change in ownership, or the hiring or
dismissing of any employees with 5 percent or more financial interest in the facility or in an owning corporation,or any change of
ownership.
Item IV-(A&B)If there has been a change in ownership within the last year or if you anticipate a change,indicate the date in the
appropriate space.
Item V-If the answer is yes,list name of the management firm and employer identification number(EIN),or the name of the leasing
organization.A management company is defined as any organization that operates and manages a business on behalf of the owner of
that business,with the owner retaining ultimate legal responsibility for operation of the facility.
Item VI-If the answer is yes,identify which has changed(Administrator,Medical Director,or Director of Nursing)and the date the
change was made. Be sure to include name of the new Administrator,Director of Nursing or Medical Director,as appropriate.
Item VII-A chain affiliate is any free-standing health care facility that is either owned,controlled,or operated under lease or contract
by an organization consisting of two or more free-standing health care facilities organized within or across State lines which is under
the ownership or through any other device,control and direction of a common party. Chain affiliates include such facilities whether
public,private,charitable or proprietary. They also include subsidiary organizations and holding corporations. Provider-based
facilities,such as hospital-based home health agencies,are not considered to be chain affiliates.
Exhibit I
Page 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 I
Page 2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) (d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)