HomeMy WebLinkAboutAgreement A-25-498 Certificate of Compliance Medi-Cal.pdf Agreement No. 25-498
STATE OF CALIFORNIA GAVIN NEWSOM,Govemor
DEPARTMENT OF VETERANS AFFAIRS �,*�:�sr,,f*
1227 O Street p;
SACRAMENTO,CALIFORNIA 95814 a• ,;,,.,,�
Telephone: (800)952-5626
Fax:(916)653-2456
xt.
Annual Medi-Cal Cost Avoidance Certificate of Compliance
Fiscal Year 2025/2026
1 certify that Fresno County has an appointed veteran serving
as the County Veterans Service Officer (CVSO) in compliance with California
Code of Regulations, Title 12, Subchapter 4. Please consider this as our
application to participate in the Medi-Cal Cost Avoidance Program
authorized by Military and Veterans Code Section 972.5
1 understand and will comply with the following:
1. All activities of the CVSO for which payment is made by the CalVet
under this agreement will reasonably benefit the Department of Health
Care Services (DHCS) or realize cost avoidance to the Medi-Cal
program. All State and County Medi-Cal Eligibility Workers who
generate a Form MC 05 (Military Verification and Referral form) will be
instructed to indicate the applicant's Aid Code on the face of the
form.
2. All monies received under this agreement shall be allocated to
and spent on the salaries and expenses of the CVSO.
3. This agreement is binding only if federal funds are available to
CalVet from the DHCS.
4.The CVSO is responsible for administering this program in accordance
with California Code of Regulations, Title 12, Subchapter 4 and the CalVet
Procedure Manual for Subvention and Medi-Cal Cost Avoidance for the
current state fiscal year.
1, _n�� - %L,%-_- _ 9-,2.3 a oa 5-
Ernest Buddy Mendes,15airman Date
of the Board of Supervisors of the
County of Fresno
SCAN AND UPLOAD THIS COMPLETED FORM VIA THE AGENCY ATTACHMENTS IN VETPRO
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
Rev(06/25) County of Fresno,State of C lifornia
By Deputy
Agreement California Department of Veterans Affairs: Medi-Cal Certificate of
Compliance (FY 2025-26), and Subvention Certificate of Compliance (FY 2025-26)
County of Fresno
Fund/Subclass: 0001/10000
Organization: 7110
Account/Program: 3560/0