HomeMy WebLinkAboutAgreement A-25-562 Master Agreement for Locum Tenens Psychiatric Services.pdf Agreement No. 25-562
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated November 4, 2025 and is between
3 each Contractor listed in Exhibit A"List of Contractors" collectively hereinafter referred to as
4 ("Contractor"), and the County of Fresno, a political subdivision of the State of California
5 ("County"). Reference in this Agreement to party or"parties" shall be understood to refer to
6 County and each individual Contractor, unless otherwise specified.
7 Recitals
8 A. The County, through its Department of Behavioral Health (DBH), has a need for licensed
9 psychiatrists and psychiatric nurse practitioners (psychiatric providers) to deliver psychiatric
10 services on a locum tenens basis to individuals living in Fresno County with moderate to severe
11 mental health conditions.
12 B. The County has faced ongoing challenges to fill psychiatric service positions through
13 traditional methods due to a competitive market and shortage of local qualified licensed
14 psychiatric providers in the County's region. However, the County has been successful in
15 securing sufficient levels of psychiatric providers through locum tenens providers. Locum tenens
16 is defined as "holding the place of, or substituting for, someone temporarily." Locum tenens
17 psychiatric providers are hired on a short-term basis and may be retained for longer-termed
18 assignments.
19 C. Psychiatric providers may deliver services in person at a County-operated outpatient
20 facility or remotely through telehealth. The service modality flexibility is beneficial to persons
21 served who, for various reasons, may find it difficult to consistently attend appointments in
22 person. Telehealth options also expand the County's opportunity to build a sufficient network of
23 psychiatric providers to meet the needs of the service population.
24 D. This agreement is intended to mitigate the immediate need to ensure sufficient
25 psychiatric services to the service population, and thus, supplements a separate agreement for
26 the procurement of full-time, permanent, in-person psychiatrists and psychiatric nurse
27 practitioners until all permanent positions have been filled or until there is sufficient permanent
28 psychiatric service providers in place to resolve the need for locum tenens providers.
1
1 The parties therefore agree as follows:
2 Article 1
3 Contractor's Services
4 1.1 Scope of Services. The Contractor shall perform all of the services provided in
5 Exhibit B to this Agreement, titled "Fresno County Department of Behavioral Health Scope of
6 Work."
7 1.2 Representation. The Contractor represents that it is qualified, ready, willing, and
8 able to perform all of the services provided in this Agreement.
9 1.3 Compliance with Laws. The Contractor shall, at its own cost, comply with all
10 applicable federal, state, and local laws and regulations in the performance of its obligations
11 under this Agreement, including but not limited to workers compensation, labor, and
12 confidentiality laws and regulations. Additionally, Contractor shall comply with laws, regulations,
13 and requirements in Exhibit C to this Agreement, titled "Fresno County Behavioral Health
14 Requirements".
15 Article 2
16 County's Responsibilities
17 2.1 The County shall provide services as described in Exhibit B to this Agreement.
18 2.2 The County shall provide oversight and collaborate with Contractor, other County
19 Departments and community agencies to help achieve program goals and outcomes. In addition
20 to Contractor monitoring of program, oversight includes, but not limited to, coordination with
21 Department of Health Care Services (DHCS) in regard to program administration and outcomes.
22 2.3 County shall participate in evaluating the progress of the overall program, levels of
23 care components, and the efficiency of collaboration with the Contractor staff, or psychiatric
24 providers they represent, and will be available to Contractor for ongoing consultation. County
25 shall receive and analyze statistical outcome data from Contractor throughout the term of
26 contract. County shall notify the Contractor when additional participation is required. The
27 performance outcome measurement process will not be limited to survey instruments but will
28 also include, as appropriate, persons served and staff surveys, chart reviews, and other
2
1 methods of obtaining required information.
2 Article 3
3 Compensation, Invoices, and Payments
4 3.1 The County agrees to pay, and the Contractor agrees to receive compensation for
5 the performance of its services under this Agreement as described in Exhibit D to this
6 Agreement, titled "Fresno County Department of Behavioral Health Financial Terms and
7 Conditions".
8 3.2 Additional Fiscal Requirements. The Contractor shall comply with all Fiscal
9 requirements in Exhibit D to this Agreement.
10 Article 4
11 Term of Agreement
12 4.1 Term. This Agreement is effective January 1, 2026 and terminates on June 30, 2028
13 except as provided in section 4.2, "Extension," or Article 6, "Termination and Suspension,"
14 below.
15 4.2 Extension. The term of this Agreement may be extended for no more than two, one-
16 year periods only upon written approval of both parties at least thirty (30) days before the first
17 day of the next one-year extension period. The County's DBH Director or his or her designee is
18 authorized to sign the written approval on behalf of the County based on the Contractor's
19 satisfactory performance. The extension of this Agreement by the County is not a waiver or
20 compromise of any default or breach of this Agreement by the Contractor existing at the time of
21 the extension whether or not known to the County.
22 Article 5
23 Notices
24 5.1 Contact Information. The persons and their addresses having authority to give and
25 receive notices provided for or permitted under this Agreement include the following:
26
For the County:
27 Director, Department of Behavioral Health
County of Fresno
28 1925 E Dakota Avenue
Fresno, CA 93726
3
1
For the Contractor:
2 See Exhibit A
3 5.2 Change of Contact Information. Either party may change the information in section
4 5.1 by giving notice as provided in section 5.3.
5 5.3 Method of Delivery. Each notice between the County and the Contractor provided
6 for or permitted under this Agreement must be in writing, state that it is a notice provided under
7 this Agreement, and be delivered either by personal service, by first-class United States mail, by
8 an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
9 Document Format (PDF) document attached to an email.
10 (A) A notice delivered by personal service is effective upon service to the recipient.
11 (B) A notice delivered by first-class United States mail is effective three (3) County
12 business days after deposit in the United States mail, postage prepaid, addressed to the
13 recipient.
14 (C)A notice delivered by an overnight commercial courier service is effective one (1)
15 County business day after deposit with the overnight commercial courier service,
16 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
17 the recipient.
18 (D)A notice delivered by telephonic facsimile transmission or by PDF document
19 attached to an email is effective when transmission to the recipient is completed (but, if
20 such transmission is completed outside of County business hours, then such delivery is
21 deemed to be effective at the next beginning of a County business day), provided that
22 the sender maintains a machine record of the completed transmission.
23 5.4 Claims Presentation. For all claims arising from or related to this Agreement,
24 nothing in this Agreement establishes, waives, or modifies any claims presentation
25 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
26 of Title 1 of the Government Code, beginning with section 810).
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 thirty (30) days' advance written notice to each
6 individual Contractor, may:
7 (A) Modify the services provided by the Contractor under this Agreement; or
8 (B) Terminate this Agreement.
9 6.2 Termination for Breach.
10 (A) Upon determining that a breach (as defined in paragraph (C) below) has
11 occurred, the County may give written notice of the breach to the applicable Contractor.
12 The written notice may suspend performance under this Agreement and must provide at
13 least thirty (30) days for applicable Contractor to cure the breach.
14 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
15 time stated in the written notice, the County may terminate this Agreement immediately.
16 (C) For purposes of this section, a breach occurs when, in the determination of the
17 County, the Contractor has:
18 (1) Obtained or used funds illegally or improperly;
19 (2) Failed to comply with any part of this Agreement;
20 (3) Submitted a substantially incorrect or incomplete report to the County; or
21 (4) Improperly performed any of its obligations under this Agreement.
22 6.3 Termination without Cause. In circumstances other than those set forth above, the
23 County may terminate this Agreement by giving at least thirty (30) days advance written notice
24 to the applicable Contractor.
25 6.4 Economic Sanctions. In accordance with Executive Order N-6-22 regarding
26 Economic Sanctions against Russia and Russian entities and individuals, the County may
27 terminate this Agreement if the Contractor is a target of Economic Sanctions or is conducting
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 applicable Contractor.
3 6.5 No Penalty or Further Obligation. Any termination of this Agreement by the County
4 under this Article 6 is without penalty to or further obligation of the County.
5 6.6 County's Rights upon Termination. Upon termination for breach under this Article
6 6, the County may demand repayment by the Contractor of any monies disbursed to the
7 Contractor under this Agreement that, in the County's sole judgment, were not expended in
8 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
9 demand. This section survives the termination of this Agreement.
10 Article 7
11 Independent Contractor
12 7.1 Status. In performing under this Agreement, each individual Contractor, including its
13 officers, agents, employees, and volunteers, is at all times acting and performing as an
14 independent contractor, in an independent capacity, and not as an officer, agent, servant,
15 employee, joint venturer, partner, or associate of the County.
16 7.2 Verifying Performance. The County has no right to control, supervise, or direct the
17 manner or method of the Contractor's performance under this Agreement, but the County may
18 verify that the Contractor is performing according to the terms of this Agreement.
19 7.3 Benefits. Because of its status as an independent contractor, each individual
20 Contractor has no right to employment rights or benefits available to County employees.
21 Contractor is solely responsible for providing to its own employees all employee benefits
22 required by law. Contractor shall save the County harmless from all matters relating to the
23 payment of Contractor's employees, including compliance with Social Security withholding and
24 all related regulations.
25 7.4 Services to Others. The parties acknowledge that, during the term of this
26 Agreement, the Contractor may provide services to others unrelated to the County.
27
28
6
1 Article 8
2 Indemnity and Defense
3 8.1 Indemnity. Contractor shall indemnify and hold harmless and defend the County
4 (including its officers, agents, employees, and volunteers) against all claims, demands, injuries,
5 damages, costs, expenses (including attorney fees and costs), fines, penalties, and liabilities of
6 any kind to the County, Contractor, or any third party that arise from or relate to the performance
7 or failure to perform by the Contractor (or any of its officers, agents, subcontractors, or
8 employees) under this Agreement. The County may conduct or participate in its own defense
9 without affecting the Contractor's obligation to indemnify and hold harmless or defend the
10 County.
11 8.2 Survival. This Article 8 survives the termination of this Agreement.
12 Article 9
13 Insurance
14 9.1 Contractor shall comply with all the insurance requirements in Exhibit E to this
15 Agreement, titled "Insurance Requirements".
16 Article 10
17 Inspections, Audits, and Public Records
18 10.1 Inspection of Documents. Contractor shall make available to the County, and the
19 County may examine at any time during business hours and as often as the County deems
20 necessary, all of the Contractor's records and data with respect to the matters covered by this
21 Agreement, excluding attorney-client privileged communications. Contractor shall, upon request
22 by the County, permit the County to audit and inspect all of such records and data to ensure the
23 Contractor's compliance with the terms of this Agreement.
24 10.2 State Audit Requirements. If the compensation to be paid by the County under this
25 Agreement exceeds $10,000, Contractor is subject to the examination and audit of the
26 California State Auditor, as provided in Government Code section 8546.7, for a period of three
27 (3) 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 Contractor may provide to the County.
3 The County's public disclosure of this Agreement or any record or data that Contractor may
4 provide to the County may include but is not limited to the following:
5 (A) The County may voluntarily, or upon request by any member of the public or
6 governmental agency, disclose this Agreement to the public or such governmental
7 agency.
8 (B) The County may voluntarily, or upon request by any member of the public or
9 governmental agency, disclose to the public or such governmental agency any record or
10 data that Contractor may provide to the County, unless such disclosure is prohibited by
11 court order.
12 (C)This Agreement, and any record or data that Contractor may provide to the
13 County, is subject to public disclosure under the Ralph M. Brown Act (California
14 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
15 (D) This Agreement, and any record or data that Contractor may provide to the
16 County, is subject to public disclosure as a public record under the California Public
17 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
18 with section 6250) ("CPRA").
19 (E) This Agreement, and any record or data that Contractor may provide to the
20 County, is subject to public disclosure as information concerning the conduct of the
21 people's business of the State of California under California Constitution, Article 1,
22 section 3, subdivision (b).
23 (F) Any marking of confidentiality or restricted access upon or otherwise made with
24 respect to any record or data that Contractor may provide to the County shall be
25 disregarded and have no effect on the County's right or duty to disclose to the public or
26 governmental agency any such record or data.
27 10.4 Public Records Act Requests. If the County receives a written or oral request
28 under the CPRA to publicly disclose any record that is in Contractor's possession or control, and
8
1 which the County has a right, under any provision of this Agreement or applicable law, to
2 possess or control, then the County may demand, in writing, that Contractor deliver to the
3 County, for purposes of public disclosure, the requested records that may be in the possession
4 or control of Contractor. Within five (5) business days after the County's demand, Contractor
5 shall (a) deliver to the County all of the requested records that are in Contractor's possession or
6 control, together with a written statement that Contractor, after conducting a diligent search, has
7 produced all requested records that are in Contractor's possession or control, or (b) provide to
8 the County a written statement that Contractor, after conducting a diligent search, does not
9 possess or control any of the requested records. Contractor shall cooperate with the County
10 with respect to any County demand for such records. If Contractor wishes to assert that any
11 specific record or data is exempt from disclosure under the CPRA or other applicable law, it
12 must deliver the record or data to the County and assert the exemption by citation to specific
13 legal authority within the written statement that it provides to the County under this section.
14 Contractor's assertion of any exemption from disclosure is not binding on the County, but the
15 County will give at least ten (10) days' advance written notice to Contractor before disclosing
16 any record subject to Contractor's assertion of exemption from disclosure. Contractor shall
17 indemnify the County for any court-ordered award of costs or attorney's fees under the CPRA
18 that results from Contractor's delay, claim of exemption, failure to produce any such records, or
19 failure to cooperate with the County with respect to any County demand for any such records.
20 Article 11
21 Data Security
22 11.1 Contractor shall be responsible for the privacy and security safeguards, as identified
23 in Exhibit F, entitles "Data Security". To the extent required to carry out the assessment and
24 authorization process and continuous monitoring, to safeguard against threats and hazards to
25 the security, integrity, and confidentiality of any County data collected and stored by Contractor,
26 Contractor shall afford the County access as necessary at Contractor's reasonable discretion, to
27 Contractor's facilities, installations, and technical capabilities. If new or unanticipated threats or
28 hazards are discovered by either the County or Contractor, or if existing safeguards have
9
1 ceased to function, the discoverer shall immediately bring the situation to the attention of the
2 other party.
3 Article 12
4 Disclosure of Self-Dealing Transactions
5 12.1 Applicability. This Article 12 applies if the Contractor is operating as a corporation,
6 or changes its status to operate as a corporation.
7 12.2 Duty to Disclose. If any member of Contractor's board of directors is party to a self-
8 dealing transaction, he or she shall disclose the transaction by completing and signing a "Self-
9 Dealing Transaction Disclosure Form" (Exhibit G to this Agreement) and submitting it to the
10 County before commencing the transaction or immediately after.
11 12.3 Definition. "Self-dealing transaction" means a transaction to which Contractor is a
12 party and in which one or more of its directors, as an individual, has a material financial interest.
13 Article 13
14 Disclosure of Ownership and/or Control Interest Information
15 13.1 Applicability. This provision is only applicable if Contractor is disclosing entities,
16 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
17 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
18 13.2 Duty to Disclose. Contractor must disclose the following information as requested in
19 the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement,
20 Exhibit H:
21 (A) Disclosure of Five Percent (5%) or More Ownership Interest:
22 (1) In the case of corporate entities with an ownership or control interest in the
23 disclosing entity, the primary business address as well as every business location
24 and P.O. Box address must be disclosed. In the case of an individual, the date of
25 birth and Social Security number must be disclosed.
26 (2) In the case of a corporation with ownership or control interest in the
27 disclosing entity or in any subcontractor in which the disclosing entity has a five
28
10
1 percent (5%) or more interest, the corporation tax identification number must be
2 disclosed.
3 (3) For individuals or corporations with ownership or control interest in any
4 subcontractor in which the disclosing entity has a five percent (5%) or more interest,
5 the disclosure of familial relationship is required.
6 (4) For individuals with five percent (5%) or more direct or indirect ownership
7 interest of a disclosing entity, the individual shall provide evidence of completion of a
8 criminal background check, including fingerprinting, if required by law, prior to
9 execution of Contract. (42 C.F.R. § 455.434)
10 (B) Disclosures Related to Business Transactions:
11 (1) The ownership of any subcontractor with whom Contractor has had business
12 transactions totaling more than $25,000 during the twelve (12) month period ending
13 on the date of the request.
14 (2) Any significant business transactions between Contractor and any wholly
15 owned supplier, or between Contractor and any subcontractor, during the five (5)
16 year period ending on the date of the request. (42 C.F.R. § 455.105(b).)
17 (C) Disclosures Related to Persons Convicted of Crimes:
18 (1) The identity of any person who has an ownership or control interest in the
19 provider or is an agent or managing employee of the provider who has been
20 convicted of a criminal offense related to that person's involvement in any program
21 under the Medicare, Medicaid, or the Title XXI services program since the inception
22 of those programs. (42 C.F.R. § 455.106.)
23 (2) County shall terminate the enrollment of Contractor if any person with five
24 percent (5%) or greater direct or indirect ownership interest in the disclosing entity
25 has been convicted of a criminal offense related to the person's involvement with
26 Medicare, Medicaid, or Title XXI program in the last ten (10) years.
27 13.3 Contractor must provide disclosure upon execution of Contract, extension for
28 renewal, and within thirty-five (35) days after any change in Contractor's ownership or upon
11
1 request of County. County may refuse to enter into an agreement or terminate an existing
2 agreement with a Contractor if that Contractor fails to disclose ownership and control interest
3 information, information related to business transactions and information on persons convicted
4 of crimes, or if Contractor did not fully and accurately make the disclosure as required.
5 13.4 Contractor must provide the County with written disclosure of any prohibited
6 affiliations under 42 C.F.R. § 438.610. Contractor must not employ or subcontract with providers
7 or have other relationships with providers Excluded from participation in Federal Health Care
8 Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42 C.F.R.
9 §438.610.
10 13.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
11 DBHPlanAdministration(a�fresnocountyca.gov with a copy sent via email to the assigned DBH
12 Contract Analyst. County may deny enrollment or terminate this Agreement where any person
13 with five percent (5%) or greater direct or indirect ownership interest in Contractor has been
14 convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid,
15 or Title XXI program in the last ten (10) years. County may terminate this Agreement where any
16 person with five (5) percent or greater direct or indirect ownership interest in Contractor did not
17 submit timely and accurate information and cooperate with any screening method required in
18 C.F.R. Title 42, Section 455.416.
19 Article 14
20 Disclosure of Criminal History and Civil Actions
21 14.1 Applicability. Contractor is required to disclose if any of the following conditions
22 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
23 referred to as "Contractor"):
24 (A) Within the three (3) year period preceding the Agreement award, they have been
25 convicted of, or had a civil judgment tendered against them for:
26 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
27 or performing a public (federal, state, or local) transaction or contract under a public
28 transaction;
12
1 (2) Violation of a federal or state antitrust statute;
2 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
3 or
4 (4) False statements or receipt of stolen property.
5 (B) Within a three (3) year period preceding their Agreement award, they have had a
6 public transaction (federal, state, or local) terminated for cause or default.
7 14.2 Duty to Disclose. Disclosure of the above information will not automatically
8 eliminate Contractor from further business consideration. The information will be considered as
9 part of the determination of whether to continue and/or renew this Agreement and any additional
10 information or explanation that Contractor elects to submit with the disclosed information will be
11 considered. If it is later determined that Contractor failed to disclose required information, any
12 contract awarded to such Contractor may be immediately voided and terminated for material
13 failure to comply with the terms and conditions of the award.
14 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
15 Responsible Matters — Primary Covered Transactions" in the form set forth in Exhibit I.
16 Additionally, Contractor must immediately advise the County in writing if, during the term of the
17 Agreement: (1) Contractor becomes suspended, debarred, excluded or ineligible for
18 participation in Federal or State funded programs or from receiving federal funds as listed in the
19 excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions
20 become applicable to Contractor. Contractor shall indemnify, defend, and hold County harmless
21 for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility, or other
22 matter listed in the signed Certification Regarding Debarment, Suspension, and Other
23 Responsibility Matters.
24 Article 15
25 General Terms
26 15.1 Modification. Except as provided in Article 6, "Termination and Suspension," this
27 Agreement may not be modified, and no waiver is effective, except by written agreement signed
28
13
1 by both parties. Contractor acknowledges that County employees have no authority to modify
2 this Agreement except as expressly provided in this Agreement.
3 (A) Notwithstanding the above, non-material changes to services, staffing, and
4 responsibilities of Contractor, as needed, to accommodate changes in the laws relating
5 to service requirements, may be made with the signed written approval of County's DBH
6 Director, or designee, and Contractor through an amendment approved by County's
7 County Counsel and the County's Auditor-Controller/Treasurer-Tax Collector's Office.
8 Said modifications shall not result in any change to the maximum compensation amount
9 payable to Contractor, as stated herein.
10 (B) Rate Modification. In addition, changes to service rates in each individual
11 Contractor's Exhibit D subpart that do not exceed five percent (5%) of the approved rate,
12 or that are needed to accommodate state-mandated rate increases, may be made with
13 the written approval of the DBH Director, or designee. These rate changes may not add
14 or alter any other terms or conditions of the Agreement. Said modifications shall not
15 result in any change to the annual maximum compensation amount payable to
16 Contractor, as stated herein.
17 15.2 Separate Agreement. It is mutually understood by the parties that this Agreement
18 does not, in any way, create a joint venture among Contractors. By execution of this Agreement,
19 Contractors understand that a separate Agreement is formed between each individual
20 Contractor and County.
21 15.3 Addition/Deletion of Contractor(s). The County reserves the right at any time
22 during the term of this Agreement to add Contractors to and remove Contractors from the list
23 contained on Exhibit A. It is understood that any such additions and removals will not affect
24 compensation paid to the other Contractors, and therefore such additions and removals may be
25 made by County without notice or approval of other Contractors under this Agreement. The
26 County's DBH Director, or designee, may remove a Contractor from the Agreement where there
27 is mutual written consent between the DBH Director and Contractor.
28
14
1 15.4 Non-Assignment. Neither party may assign its rights or delegate its obligations
2 under this Agreement without the prior written consent of the other party.
3 15.5 Governing Law. The laws of the State of California govern all matters arising from
4 or related to this Agreement.
5 15.6 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
6 County, California. Contractor consent to California jurisdiction for actions arising from or related
7 to this Agreement, and, subject to the Government Claims Act, all such actions must be brought
8 and maintained in Fresno County.
9 15.7 Construction. The final form of this Agreement is the result of the parties' combined
10 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
11 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
12 against either party.
13 15.8 Days. Unless otherwise specified, "days" means calendar days.
14 15.9 Headings. The headings and section titles in this Agreement are for convenience
15 only and are not part of this Agreement.
16 15.10 Severability. If anything in this Agreement is found by a court of competent
17 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
18 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
19 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
20 intent.
21 15.11 Nondiscrimination. During the performance of this Agreement, Contractor shall not
22 unlawfully discriminate against any employee or applicant for employment, or recipient of
23 services, because of race, religious creed, color, national origin, ancestry, physical disability,
24 mental disability, medical condition, genetic information, marital status, sex, gender, gender
25 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
26 all applicable State of California and federal statutes and regulation.
27 Contractor shall take affirmative action to ensure that services to intended beneficiaries are
28 provided without use of any policy or practice that has the effect of discriminating on the basis of
15
1 race, color, religion, ancestry, marital status, national origin, ethnic group identification, sex,
2 sexual orientation, gender, gender identity, age, medical condition, genetic information, health
3 status or need for health care services, or mental or physical disability.
4 15.12 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
5 of Contractor under this Agreement on any one or more occasions is not a waiver of
6 performance of any continuing or other obligation of the Contractor and does not prohibit
7 enforcement by the County of any obligation on any other occasion.
8 15.13 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
9 between the Contractor and the County with respect to the subject matter of this Agreement,
10 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
11 publications, and understandings of any nature unless those things are expressly included in
12 this Agreement. If there is any inconsistency between the terms of this Agreement without its
13 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
14 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
15 exhibits.
16 15.14 No Third-Party Beneficiaries. This Agreement does not and is not intended to
17 create any rights or obligations for any person or entity except for the parties.
18 15.15 Authorized Signature. Contractor represent and warrant to the County that:
19 (A) Each Contractor is duly authorized and empowered to sign and perform its
20 obligations under this Agreement.
21 (B) The individual signing this Agreement on behalf of each Contractor are duly
22 authorized to do so and their signatures on this Agreement legally bind Contractor to the
23 terms of this Agreement.
24 15.16 Electronic Signatures. The parties agree that this Agreement may be executed by
25 electronic signature as provided in this section.
26 (A) An "electronic signature" means any symbol or process intended by an individual
27 signing this Agreement to represent their signature, including but not limited to (1) a
28 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
16
1 electronically scanned and transmitted (for example by PDF document) version of an
2 original handwritten signature.
3 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
4 equivalent to a valid original handwritten signature of the person signing this Agreement
5 for all purposes, including but not limited to evidentiary proof in any administrative or
6 judicial proceeding, and (2) has the same force and effect as the valid original
7 handwritten signature of that person.
8 (C) The provisions of this section satisfy the requirements of Civil Code section
9 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
10 Part 2, Title 2.5, beginning with section 1633.1).
11 (D) Each party using a digital signature represents that it has undertaken and
12 satisfied the requirements of Government Code section 16.5, subdivision (a),
13 paragraphs (1) through (5), and agrees that each other party may rely upon that
14 representation.
15 (E) This Agreement is not conditioned upon the parties conducting the transactions
16 under it by electronic means and either party may sign this Agreement with an original
17 handwritten signature.
18 15.17 Counterparts. This Agreement may be signed in counterparts, each of which is an
19 original, and all of which together constitute this Agreement.
20 [SIGNATURE PAGE FOLLOWS]
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 Men s, 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
By: U
10 a uty
11 For accounting use only:
12 Org No.: 56302175
56302246
13 56302920
Account No.: 7295/0
14 Fund No.: 0001
Subclass No. 10000
15
16
17
18
19
20
21
22
23
24
25
26
27
28
18
ii
Docusign Envelope ID:009989F3-5F17-48E1-9616-A0978B1B5A6F
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
3 Contractor: AEQUOR HEALTHCARE SOLUTIONS, LLC
4 Signed by:
6
Print Name: Stephanie Jensen
7
8 Title: Vice President
g Chairman of Board, or President or any Vice President
8/29/2025
10 Date:
11
Signed by:
12 (�Ad Ci"
13 By. AFRAA47QAngQ4RS
14 Michael Gillen
Print Name:
15
16 Title: CFO
17 Secretary (of Corporation), or any Assistant Secretary,
or Chief Financial Officer or any Assistant Treasurer
18 Date: 8/29/2025
19
20
Mailing Address:
21 377 Hoes Lane, Suite 300
22 Piscataway, NJ 08854
23 Phone No.: (678)
Contact: Stephanie Jensen
24
25
26
27
28
1 - COUNTY OF FRESNO
Fresno,CA
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
3 Contractor: ALOHA PSYCHIATRY, INC.
4
5 By: =
6
Print Name: Jonathan Sy
7
8 Title: President & CEO
g Chairman of Board, or President or any Vice President
10 Date: 09/04/2025
11
12
13 By.
Tbn-et ,loan
14 Forrest Doan
Print Name:
15
16 Title: Chief Financial Officer
17 Secretary (of Corporation), or any Assistant Secretary,
or Chief Financial Officer or any Assistant Treasurer
18 Date: 09/04/2025
19
20
Mailing Address:
21 4473 Prospect Ave
22 Yorba Linda, CA 92886
23 Phone No.: (714) 660-7245
Contact: Jonathan Sy, MD
24
25
26
27
28
1 — COUNTY OF FRESNO
Fresno,CA
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
3 Contractor: AMERGIS LOCUM TENENS, LLC
4 Jennifer "g"ally signed by
Jennifer Heymann
Date:2025.10.14
5 By: Heyrnann13,09:15-04'00'
6 Print Name: Jennifer Heymann
7
8 Title: Assistant Controller
9
10 Date: 10/14/2025
11
12
13
14 Mailing Address:
15 5001 Lyndon B Johnson Fwy, Suite 200
Dallas, TX 75244
16
Phone No.: (469) 904-4004
17 Contact: Coby Bryant
18
19
20
21
22
23
24
25
26
27
28
COUNTY OF FRESNO
Fresno,CA
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
3 Contractor: DR. JOHN L. SCHAEFFER, INC., dba AMERICAN TELEPSYCHIATRISTS
4
5 By:
6
7 Print Name: I'1
8 Title. G�
9 Chairman of Board, or President or any Vice President
10 ZL 2
Date:
11
12
13
By: L-4 �\
14
15 Print Name: ske I
16
17 Title: C FO
18 Secretary (of Corporation), or any Assistant Secretary,
or Chief Financial Officer or any Assistant Treasurer
19 V 2k
Date:
20
21
22 Mailing Address:
330 El Camino Ave, #300-136
23 Sacramento, CA 95821
24 Phone No.: (916) 320-4422
25 Contact: Dr. John L. Schaeffer
26
27
28
1 - COUNTY OF FRESNO
Fresno,CA
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
3 Contractor: EXMED, INC.
4
5 _
By. wn w,ika(sop a, msisainror
6
7 Print Name: William Kulka
8
Title: President
9 Chairman of Board, or President or any Vice President
10 Date: 09/03/2025
11
12
13 By: 7;r 477
14
15
Print Name: Tony Rico
16 Title: Principal Chief Executive Officer
17 Secretary (of Corporation), or any Assistant Secretary,
or Chief Financial Officer or any Assistant Treasurer
18 Date: 09/02/2025
19
20
21 Mailing Address:
3500 West Olive Avenue, Suite 300
22 Burbank, CA 91505
23 Phone No.: (801) 557-3380
24 Contact: Tony Rico, COO
25
26
27
28
1 — COUNTY OF FRESNO
Fresno,CA
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
3 Contractor: JACKSON & COKER LOCUMTENENS, LLC
4 Matt tfaGe
5 By: Matt Hale(Sep 4,2025 22:08:45 EDT)
6
Print Name: Matt Hale
7
8 Title: SVP Finance
9 Chairman of Board, or President or any Vice President
10 Date: 09/04/25
11
12 a 1*` C eU
13 By: Jay Mi c ell(Sep 5,2025 08:29:21 EDT)
14 Print Name: Jay Mitchell
15
16 Title: secretary
17 Secretary (of Corporation), or any Assistant Secretary,
or Chief Financial Officer or any Assistant Treasurer
18 Date: 09/05/25
19
20
Mailing Address:
21 2655 Northwinds Parkway
22 Alpharetta, GA 30009
23 Phone No.: (678) 690-7964
Contact: Matt Hale
24
25
26
27
28
1 - COUNTY OF FRESNO
Fresno,CA
The parties are signing this Agreement on the date stated in the introductory clause.
Contractor: LAVACA STREET VENTURES, LLC dba MONROE & WEISBROD, LLC
By:
�� nn
Print Name: Cp 1651c adLis���
Title: Pre 5;L.
Chairman of Board, or President or any Vice President
LL Date: S<g 3 2 a z s
11
12
13 By:
14
15 Print Name: Cr ^moo.^ /\A'+Sc-�,�
16 n
Title: Gk;e �,na--c«1 O rt;ce r
17 Secretary (of Corporation), or any Assistant Secretary,
or Chief Financial Officer or any Assistant Treasurer
18
Date: Seek 3� 20- 25
1 �+
20
21 Mailing Address:
7514 N. Mopac Expressway, Suite 200
22 Austin, TX 78731
23 Phone No.: (512) 270-2886
Contact: Celeste Madison
24
25
26
27
28
1 - COUNTY OF FRESNO
Fresno.CA
I The parties are signing this Agreement on the date stated in the introductory clause.
2
3 Contractor: LOCUMTENENS.COM, LLC
4
5 By. Zach Ri ardson (Oct 8, 2025 09:34:41 EDT)
6 Zach Richardson
Print Name:
7
g Title: Associate Vice President
9 Chairman of Board, or President or any Vice President
10 Date: 10/08/2025
11
12
By:
13
14 Leslie Kurtz
Print Name:
15
16 Title: Chief Financial Officer
17 Secretary (of Corporation), or any Assistant Secretary,
or Chief Financial Officer or any Assistant Treasurer
18 Date: 10/08/2025
19
20
Mailing Address:
21 2575 Northwinds Parkway
22 Alpharetta, GA 30009
23 Phone No.: (678) 690-7358
Contact: Kristophor Ware
24
25
26
27
28
1 - COUNTY OF FRESNO
Fresno,CA
The parties are signing this Agreement on the date stated in the introductory clause.
Contractor: ORBIT HEALTH, A PROFESSIONAL CORPORATION
By: -E,6o Wm�,.
Print Name: Edward Kaftarian
Title: CEO/Chairman of the Board
Chairman of Board, or President or any Vice President
Date: 10/13/2025
By: Ma{{b1s
Print Name: Matt Crisafulli
Title: Chief Financial Officer
Secretary (of Corporation), or any Assistant Secretary,
or Chief Financial Officer or any Assistant Treasurer
Date: 10/13/2025
Mailing Address:
26565 West Agoura Road, Suite 200
Calabasas, CA 91302
Phone No.: (844) 672-4863
Contact: Edward Kaftarian, MD
- 1 -
COUNTY OF FRESNO
Fresno,CA
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Contractor: SetLine Health, LLC.
3
4
By
5 —
6 Print Name: Julianne Bharucha
7
8 Title: CFO
Chairman of the Board, President,
9 or Vice President
10
Date: 10/7/2025
11
12
13 -�-
By
14
15 Print Name: David Spaccarelli
16
17 Title: CEO
Secretary (of Corporation), Assistant
18 Secretary, Chief Financial Officer, or
Assistant Treasurer
19
20 Date: 10/7/2025
21
22
23
24
25
26
27
28
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
3 Contractor: THOMAS MILAM MD, INC. dba IRIS TELEHEALTH MEDICAL GROUP
4
5 By:
,_...
6 Thomas Milam
Print Name:
7
Chief Medical Officer
8 Title:
9 Chairman of Board, or President or any Vice President
10
Date: 10/15/2025
11
12 G -1
By: Caroline Burton(Oct 15 2025 1122:30 CDT)
13
14 Print Name: Caroline Burton
15
16
Title: CFO
Secretary (of Corporation), or any Assistant Secretary,
17 or Chief Financial Officer or any Assistant Treasurer
18 Date: 10/15/2025
19
20 Mailing Address:
21 13740 N. Highway 183, Ste L2 #221
Austin, TX 78750
22
Phone No.: (888) 285-2269
23 Contact: Thomas Milam, MD
24
25
26
27
28
1 - COUNTY OF FRESNO
Fresno,CA
LOCUM TENENS PSYCHIATRIC SERVICES Exhibit A
LIST OF CONTRACTORS Page 1 of 2
CONTRACTOR EXHIBIT D Sub-Part
(Rates of Reimbursement)
Aequor Healthcare Services, LLC
377 Hoes Lane, Suite 300
1 Piscataway, NJ 08854 Exhibit D-1
Contact: Stephanie Jensen, Vice President
Phone: (678) 719-9927
Email: stephanie.jensen@aequor.com
Aloha Psychiatry, Inc.
4473 Prospect Ave
2 Yorba Linda, CA 92886 Exhibit D-2
Contact: Jonathan Sy, MD
Phone: (714) 660-7245
Email: admin@alohapsychiatry.org
Amergis Healthcare Staffing, Inc.
7223 Lee DeForest Dr.
3 Columbia, MD 21046 Exhibit D-3
Contact: Tyreen Crape
Phone: (213) 296-3759
Email: tycrape@amergis.com
Dr. John L. Schaeffer, Inc. dba American Telepsychiatrists
3308 El Camino Ave., #300-136
4 Sacramento, CA 95821 Exhibit D-4
Contact: Dr. John L. Schaeffer
Phone: (916) 320-4422
Email:jchaeffer@atpsnetwork.com
ExMed, Inc.
3500 West Olive Avenue, Suite 300
5 Burbank, CA 91505 Exhibit D-5
Contact: Tony Rico, Chief Operating Officer
Phone: (801) 557-3380
Email: trico@exmedinc.com
Jackson & Coker LocumTenens, LLC
2655 Northwinds Parkway
6 Alpharetta, GA 30009 Exhibit D-6
Contact: Darla Lopez
Phone: (800) 272-2707
Email: government@jacksonandcoker.com
LOCUM TENENS PSYCHIATRIC SERVICES Exhibit A
LIST OF CONTRACTORS Page 2 of 2
CONTRACTOR EXHIBIT D Sub-Part
(Rates of Reimbursement)
Lavaca Street Ventures, LLC dba Monroe &Weisbrod, LLC
7514 N. Mopac Expy Ste 200
7 Austin, TX 78731 Exhibit D-7
Contact: Celeste Madison
Phone: (512) 270-2886
Email: cm@psyrec.com
LocumTenens.com LLC
2575 Northwinds Parkway
8 Alpharetta, GA 30009 Exhibit D-8
Contact: Kristophor Ware
Phone: (678) 690-7358
Email: kware@locumtenens.com
Orbit Health, A Professional Corporation
26565 West Agoura Road, Suite 200
9 Calabasas, CA 91302 Exhibit D-9
Contact: Arshya Vahabzadeh, MD
Phone: (404) 857-7179
Email: arshya@orbithealth.com
SetLine Health LLC
900 Larkspur Landing Circle, Ste 285
10 Larkspur, CA 94939 Exhibit D-10
Contact: Julianne Bharucha
Phone: (707) 258-8757
Email:julianne.bharucha@tbhcare.com
Thomas Milam MD, Inc. dba Iris Telehealth Medical Group
13740 N. Highway 183 Ste L2#221
11 Austin, TX 78750 Exhibit D-11
Contact: Thomas Milam, MD
Phone: (888) 285-2269
Email: tom.milam@iristelehealth.com
EXHIBIT B
Page 1 of 6
FRESNO COUNTY
DEPARTMENT OF BEHAVIORAL HEALTH
SCOPE OF WORK
I. PROGRAM NAME
Locum Tenens Psychiatric Services
II. BACKGROUND
The County of Fresno, on behalf of the Department of Behavioral Health (DBH), has
partnered with the contracted staffing agencies to provide qualified Psychiatrist and
Psychiatric Nurse Practitioner locum tenens (psychiatric providers) candidates for the
delivery of outpatient specialty mental health services to adult and child/adolescent
populations in Fresno County DBH-operated behavioral health clinics. Services include
health assessments, diagnosis, intervention, consultation, supervision, medication
management, case management, and participation in care coordination activities.
Locum tenens is defined as "holding the place of, or substituting for, someone temporarily,"
thus, psychiatric providers under this agreement are hired on a short-term basis and may be
retained for longer-termed assignments. Locum tenens candidates shall be requested,
vetted, selected, and retained based on the County's need.
III. TARGET POPULATION
The service population includes adults and children/adolescents with moderate to severe
mental health conditions living in Fresno County.
IV. DESCRIPTION OF SERVICES
A. Services Start Date
Contract services shall begin January 1, 2026.
B. Summary of Services
The Contractor shall deliver psychiatric providers who shall offer the following services:
EXHIBIT B
Page 2 of 6
i. Case Management Services:Assist persons served with access to medical,
educational, social, prevocational, vocational, rehabilitative, or other community
services. Service activities may include, but are not limited to, communication, care
coordination and referral, monitoring service delivery and progress, and plan
development.
ii. Medication Support Services: Services may include prescription, administering
dispensing, and monitoring psychiatric medications or other biological interventions
necessary to alleviate the symptoms of mental illness. Services may include
evaluation of the need for medication, evaluation of clinical effectiveness and side
effects, obtaining informed consent, medication education and treatment plan
development related to the delivery of the service and/or assessment of the person
served.
iii. Other Services: As determined by the County's DBH, activities such as care
coordination, case consultation, and other services as requested are appropriate to
meet the County's anticipated mental health coverage needs.
C. Location and Modality of Services
Services shall be delivered in person within a DBH-operated outpatient facility, or
remotely through telehealth modalities. DBH will provide clerical and nursing staff for
specific intake and scheduling functions to complement psychiatric service delivery.
Psychiatric providers who deliver services on site shall be required to utilize telehealth
equipment to serve individuals who opt for telehealth appointments. Telehealth
psychiatric providers will strictly use telehealth equipment to deliver telehealth services
and are not required to be on site at any time. Persons served may use personal
equipment or equipment available on County premises to receive telehealth services.
Psychiatric providers may choose to deliver services both in-person and via telehealth
modalities. The schedule of service modality must remain constant and be approved
ninety (90) days in advance of start of schedule. On days in which a Psychiatric provider
is scheduled to deliver in-person services, the psychiatric provider must be present on
County premises and use County-provided office space and equipment to treat persons
served. On days in which a psychiatric provider is scheduled to deliver telehealth
services, the psychiatric provider must use telehealth equipment and workspace made
EXHIBIT B
Page 3 of 6
available by the Contractor—or through agreed upon terms between the psychiatric
provider and their respective Contractor—and shall be compliant with contract
requirements for HIPAA, data security, and other relevant standards and requirements.
D. Hours of Operation
County-operated outpatient clinics are open Monday through Friday from 8:00am-
5:00pm PST. Administrative time is allotted based on scheduling and service needs, and
should be used to review charts of persons served, complete chart documentation,
medication orders, and forms for persons served, or other related clinical activities. A
one-hour lunch will be scheduled for 12:OOpm-1:OOpm PST; clerical and nursing support
are unavailable during this time.
Contractor and psychiatric providers will be notified immediately should this information
change due to adjustments in the County's DBH system of care.
E. Contractor shall:
i. Present qualified psychiatric provider candidates upon request of the County:
present credentials, screen candidates, complete background checks, obtain
curricula vitae and reference checks, and obtain reasonable evidence of licensure
and National Provider Identifier (NPI) registration.
ii. Present psychiatric provider candidates who are not debarred, excluded or
suspended by any local, State, or Federal regulatory agency from practicing.
iii. Present psychiatric provider candidates who have been vetted for technological
proficiency. Psychiatric providers are not required to be expert users but should be
familiar with, or capable of learning to use in a reasonable length of time, general
office systems for psychiatric service delivery (e.g., Microsoft Outlook, Word, and
Teams), electronic health systems, interpreting service lines, and medication
ordering applications, among others.
iv. Provide to County an assignment confirmation for each psychiatric provider selected
by the County's DBH before starting service delivery; to be signed by the Contractor
and the County. The assignment confirmation should state the psychiatric provider's
name, hourly reimbursement rate per service modality, assignment duration, weekly
schedule of availability, and service modality.Any services provided outside of the
assigned and agreed upon weekly schedule must be approved in advance and in
writing by County's DBH director or designee. Except for emergency situations, the
EXHIBIT B
Page 4 of 6
County must be informed of proposed changes to the psychiatric provider's schedule
no less than ninety (90) days prior to the intended implementation of said change.
v. Ensure psychiatric providers request planned time off to the County no less than
ninety (90) days prior to the date(s) requested off to avoid negative impacts to
persons served. Short-notice time off requests should be minimal and only used for
unplanned emergencies such as illness, family emergencies, and extreme weather
conditions that make service delivery challenging or impossible (e.g., hurricane,
tornado, power outage, etc.).All leave requests shall follow the policy/protocol
provided by the County.
vi. Ensure psychiatric providers adhere to the County's DBH Policies and Procedures
and protocols to enter services provided into the County's electronic health record
(EHR), with special consideration to Medi-Cal billing and timeliness.
vii. Provide telehealth equipment, maintenance, and technical support, including
hardware and software, for use by telehealth psychiatric providers. The County shall
provide maintenance and support for equipment and facilities provided by the County
for use within County facilities.
viii. Provide written notice to the County thirty (30) days prior to the psychiatric provider's
resignation date, should the Contractor or psychiatric provider desire to terminate
their assignment prior to the established end date.
ix. Work with the County and psychiatric provider to ensure all pending documentation
and service actions are completed correctly and thoroughly prior to the end of the
psychiatric provider's assignment. Documentation not completed in a timely manner
may result in financial penalties, such as payment withholdings, to the Contractor.
x. Provide a laptop or computer equipment including hardware, software, and technical
support needed to deliver and support telehealth sessions for telehealth psychiatric
providers. No tablets shall be used. Required equipment includes, but is not limited
to the following:
1. Laptop or desktop computer
2. Audio and visual devices to conduct remote two-way face-to-face sessions
3. Printer/scanner
4. Telephone
5. Appropriate Operating Systems, browsers, and hardware requirements,
including, but not limited to, those listed below. Equipment specifications are
subject to change.
EXHIBIT B
Page 5 of 6
a) Windows 10 or later, or Apple IOS 11+
b) Google Chrome, or Microsoft Edge (Windows only)
c) 2.0+ GHz multi-core processor; 8GB of free RAM; 10GB of free disk
space; Broadband (10MBps+) Internet Connection
F. County shall:
i. Request psychiatric provider candidate presentations for service needs, screen
presented candidates, arrange interviews, and advance timely offers when
appropriate. DBH shall determine which presented candidates are accepted for
assignment and reserves the right to reject candidates.
ii. Conduct additional credentialing of selected psychiatric provider to ensure
compliance with State and Federal regulations prior to providing services.
iii. Initiate onboarding activities for psychiatric providers upon credentialing approval,
which include providing access to necessary systems and applications, coordinating
orientation and required trainings, and providing facility access, as appropriate.
iv. Provide reasonable office space, including computer and telephone, to psychiatric
provider who deliver in-person services.
v. Provide real-time access to the EHR of persons served to enable timely
documentation of services provided.
vi. Provide Information Technology support as needed to access and use the
Department's EHR system to assist with the resolution of system issues (i.e.,
software updates, County platform and/or security changes, etc.).
vii. Bill Medi-Cal or third-party source for services delivered and entered by the
psychiatric provider into the Department's EHR.
viii. Provide clerical staff to schedule appointments for psychiatric provider.
ix. Provide nursing staff for initial medical intake and triage of persons served prior to
commencing each appointment with the psychiatric provider.
x. Determine the need for psychiatric provider assignment continuation and/or renewals
based on individual performance, compatibility (clinical and non-clinical) with the
County's system of care, funding availability, and capacity needs.
A. Issue notice of release of psychiatric provider thirty (30) days in advance of the
release date, should County's DBH desire to terminate a psychiatric provider prior to
the confirmed end date, unless such notification is waived by the Contractor.
County's DBH reserves the right to request removal of a psychiatric provider within
EXHIBIT B
Page 6 of 6
seven (7) days of initial placement if DBH is not satisfied with the psychiatric
provider.
V. OUTCOMES/PERFORMANCE MONITORING
Contractor shall ensure that psychiatric providers complete the necessary documentation
and notes for each clinical service delivered to person served, including time and activities,
into the County's EHR within three (3) days of services being rendered. In the event of no-
shows and cancellations, psychiatric providers shall be required to indicate "No-Show" or
"Cancellation" in the chart notes of the person served. Information entered into the County's
EHR shall be used for Medi-Cal and third-party billing and contribute to the psychiatric
provider's overall performance and productivity.
Exhibit C
Page 1 of 18
FRESNO COUNTY BEHAVIORAL HEALTH REQUIREMENTS
I. General Requirements
a. Guiding Principles. Contractor shall align programs, services, and practices
with the vision, mission, and guiding principles of the DBH, as further described
in Exhibit C—Attachment A to this Agreement, titled "Fresno County Department
of Behavioral Health Guiding Principles of Care Delivery."
b. Rights of Persons Served. Contractor shall post signs informing persons
served of their right to file a complaint or grievance, appeals, and expedited
appeals. In addition, Contractor shall inform every person served of their rights
as set forth in Exhibit C—Attachment B to this agreement, titled "Fresno County
Behavioral Health Plan Rights of Persons Served".
c. Licenses/Certificates. Throughout the term of this Agreement, Contractor and
Contractor's staff shall maintain all necessary licenses, permits, approvals,
certificates, waivers and exemptions necessary for the provision of the services
hereunder and required by the laws and regulations of the United States of
America, State of California, the County of Fresno, and any other applicable
governmental agencies. Contractor shall notify County immediately in writing of
its inability to obtain or maintain such licenses, permits, approvals, certificates,
waivers and exemptions irrespective of the pendency of any appeal related
thereto. Additionally, Contractor and Contractor's staff shall comply with all
applicable laws, rules or regulations, as may now exist or be hereafter changed.
d. Training. Contractor agrees that its employees, volunteers, interns, and student
trainees or subcontractors of Contractor, in each case, are expected to perform
professional services per an agreement with County. Contractor will comply with
the training requirements and expectations referenced in Exhibit C—Attachment
C to this Agreement, titled "Fresno County Department of Behavioral Health
Contractor Training Requirements Reference Guide".
e. Credentialing and Recredentialing. Each individual Contractor staff shall not
provide any specialty mental health services without an approved credentialing
application from County. Contractor and their respective staff must follow the
uniform process for credentialing and recredentialing of service providers
established by County, including disciplinary actions such as reducing,
Revised 8/21/25
Exhibit C
Page 2 of 18
suspending, or terminating provider's privileges. Failure to comply with specified
requirements can result in suspension or termination of an individual or provider.
Upon request, the Contractor must demonstrate to the County that eachof
its providers are qualified in accordance with current legal, professional, and
technical standards, and that they are appropriately licensed, registered,
waivered, and/or certified.
Contractor must not employ or subcontract with providers debarred,
suspended or otherwise excluded (individually, and collectively referred to as
"Excluded") from participation in Federal Health Care Programs, including Medi-
Cal/Medicaid or procurement activities, as set forth in 42 C.F.R. §438.610. See
section IV below. Contractor is required to verify and document at a minimum
every three years that each network provider that delivers covered services
continues to possess valid credentials, including verification of each of the
credentialing requirements as per the County's uniform process for credentialing
and recredentialing. If any of the requirements are not up-to-date, updated
information should be obtained from network providers to complete the re-
credentialing process.
f. Criminal Background Check. Contractor shall ensure that all providers and/or
subcontracted providers consent to a criminal background check, including
fingerprinting to the extent required under state law and 42 C.F.R. § 455.434(a).
Contractor shall provide evidence of completed consents when requested by the
County, DHCS or the US Department of Health & Human Services (US DHHS).
g. Additional Responsibilities. The parties acknowledge that, during the term of
this Agreement, the Contractor will hire, train, and credential staff, and County will
perform additional staff credentialing to ensure compliance with State and
Federal regulations, if applicable.
h. Subcontracts. Contractor shall obtain written approval from County's
Department of Behavioral Health Director, or designee, before subcontracting
any of the services delivered under this Agreement. County's Department of
Behavioral Health Director, or designee, retains the right to approve or reject any
request for subcontracting services.Any transferee, assignee, or subcontractor
will be subject to all applicable provisions of this Agreement, and all applicable
State and Federal regulations.
Revised 8/21/25
Exhibit C
Page 3 of 18
Contractor shall be held primarily responsible by County for the
performance of any transferee, assignee, or subcontractor unless otherwise
expressly agreed to in writing by County's Department of Behavioral Health
Director, or designee. The use of subcontractors by Contractor shall not entitle
Contractor to any additional compensation that is provided for under this
Agreement.
i. Reports. The Contractor shall submit the following reports and data:
i. Additional Reports. Contractor shall also furnish to County such
statements, records, reports, data, and other information as County may
request pertaining to matters covered by this Agreement. In the event that
Contractor fails to provide such reports or other information required
hereunder, it shall be deemed sufficient cause for County to withhold
monthly payments until there is compliance. In addition, Contractor shall
provide written notification and explanation to County within five (5) days
of any funds received from another source to conduct the same services
covered by this Agreement.
j. Compliance with Behavioral Health Specific Laws.
i. Contractor shall provide services in conformance with all applicable State
and Federal statutes, regulations and sub regulatory guidance, as from
time to time amended, including but not limited to:
1. California Code of Regulations, Title 9;
2. California Code of Regulations, Title 22;
3. California Welfare and Institutions Code, Division 5;
4. United States Code of Federal Regulations (CFR), Title 42,
including but not limited to Parts 438 and 455;
5. United States CFR, Title 45;
6. United States Code, Title 42 (The Public Health and Welfare), as
applicable;
7. Balanced Budget Act of 1997;
8. Health Insurance Portability and Accountability Act (HIPAA); and
9. Applicable Medi-Cal laws and regulations, including applicable
sub-regulatory guidance, such as Behavioral Health Information
Notices (BHINs), Mental Health and Substance Use Disorder
Services Information Notices (MHSUDS INs), and provisions of
Revised 8/21/25
Exhibit C
Page 4 of 18
County's, state or federal contracts governing services for persons
served.
ii. In the event any law, regulation, or guidance referred to in this section is
amended during the term of this Agreement, the parties agree to comply
with the amended authority as of the effective date of such amendment
without amending this Agreement.
iii. Contractor recognizes that County operates its behavioral health
programs under an agreement with DHCS, and that under said
agreement the State imposes certain requirements on County and its
subcontractors. Contractor shall adhere to all State requirements,
including those identified in Exhibit C —Attachment D to this Agreement,
titled "State Behavioral Health Requirements".
k. Meetings. Contractor shall participate in monthly, or as needed, workgroup
meetings consisting of staff from County's DBH to discuss service requirements,
data reporting, training, policies and procedures, overall program operations and
any problems or foreseeable problems that may arise. Contractor shall also
participate in other County meetings, such as but not limited to quality
improvement meetings, provider meetings, audit meetings, Behavioral Health
Board meetings, bi-monthly contractor meetings, etc. Schedule for these
meetings may change based on the needs of the County.
I. Monitoring. Contractor agrees to extend to County's staff, County's DBH and the
California Department of Health Care Services (DHCS), or their designees, the
right to review and monitor records, programs, or procedures, at any time, in
regard to persons served, as well as the overall operation of Contractor's
programs, in order to ensure compliance with the terms and conditions of this
Agreement.
m. Generative Artificial Intelligence Technology Use & Reporting
i. During the term of the Agreement, Contractor must notify the County in
writing if their services or any work under this Agreement includes, or
makes available, any previously unreported Generative Artificial
Intelligence (GenAI) technology, including GenAl from third parties or
subcontractors. Contractor must provide information by submitting a
"Generative Artificial Intelligence (GenAI) Reporting and Factsheet (STD
1000)". In addition, Contractor must notify the County of any new or
Revised 8/21/25
Exhibit C
Page 5 of 18
previously unreported GenAl technology.At the direction of the County,
Contractor shall discontinue the use of any new or previously undisclosed
GenAl technology that materially impacts functionality, risk or contract
performance, until use of such GenAl technology has been approved by
the County.
ii. Failure to disclose GenAl use to the County and failure to submit the
GenAl Reporting and Factsheet (STD 1000) may be considered a breach
of this Agreement and are grounds for immediate termination in
accordance with Article 6 of this Agreement.
n. Confidentiality.
i. The County and the Contractor may have access to information that the
other considers to be a trade secret as defined in California Government
Code section 7924.510(f).
ii. Each party shall use the other's Information only to perform its obligations
under, and for the purposes of, the Agreement. Neither party shall use the
Information of the other Party for the benefit of a third party. Each Party
shall maintain the confidentiality of all Information in the same manner in
which it protects its own information of like kind, but in no event shall
either Party take less than reasonable precautions to prevent the
unauthorized disclosure or use of the Information.
iii. The Contractor shall not disclose the County's data except to any third
parties as necessary to operate the Contractor Products and Services
(provided that the Contractor hereby grants to the County, at no additional
cost, a non-perpetual, noncancelable, worldwide, nonexclusive license to
utilize any data, on an anonymous or aggregate basis only, that arises
from the use of the Contractor Products and Services by the Contractor,
whether disclosed on, subsequent to, or prior to the Effective Date, to
improve the functionality of the Contractor Products and Services and any
other legitimate business purpose, subject to all legal restrictions
regarding the use and disclosure of such information).
iv. Upon termination of the Agreement, or upon a Party's request, each Party
shall return to the other all Information of the other in its possession.All
provisions of the Agreement relating to confidentiality, ownership, and
limitations of liability shall survive the termination of the Agreement.
Revised 8/21/25
Exhibit C
Page 6 of 18
v. All services performed by the Contractor shall be in strict conformance
with all applicable Federal, State of California, and/or local laws and
regulations relating to confidentiality, including but not limited to, California
Civil Code, California Welfare and Institutions Code, California Health and
Safety Code, California Code of Regulations, and the Code of Federal
Regulations.
o. Physical Accessibility. In accordance with the accessibility requirements of
section 508 of the Rehabilitation Act and the Americans with Disabilities Act of
1973, Contractor must provide physical access, reasonable accommodations,
and accessible equipment for Medi-Cal beneficiaries with physical or mental
disabilities.
p. Publicity Prohibition.
i. Self-Promotion. None of the funds, materials, property, or services
provided directly or indirectly under this Agreement shall be used for
Contractor's advertising, fundraising, or publicity (i.e., purchasing of
tickets/tables, silent auction donations, etc.)for the purpose of self-
promotion.
ii. Public Awareness. Notwithstanding the above, publicity of the services
described in Exhibit 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.
q. Child Abuse Reporting Act.
i. Contractor shall establish a procedure acceptable to the County's DBH
Director, or designee, to ensure that all of the Contractor's employees,
consultants, subcontractors or agents described in the Child Abuse
Reporting Act, section 1116 et seq. of the Penal Code, and performing
services under this Agreement shall report all known or suspected child
abuse or neglect to a child protective agency as defined in Penal Code
section 11165.9. This procedure shall include:
Revised 8/21/25
Exhibit C
Page 7 of 18
1. A requirement that all Contractor's employees, consultants,
subcontractors or agents performing services shall sign a
statement that they know of and will comply with the reporting
requirements as defined in Penal Code section 11166(a).
2. Establishing procedures to ensure reporting even when
employees, consultants, subcontractors, or agents who are not
required to report child abuse under Penal Code section 11166(a),
gain knowledge of or reasonably suspect that a child has been a
victim of abuse or neglect.
II. Assurances
Certification of Non-exclusion or Suspension from Participation in a Federal Health Care
Program.
a. In entering into this Agreement, Contractor certifies that it is not excluded from
participation in Federal Health Care Programs under either Section 1128 or
1128A of the Social Security Act. Failure to so certify will render all provisions of
this Agreement null and void and may result in the immediate termination of this
Agreement.
b. In entering into this Agreement, Contractor certifies, that the Contractor does not
employ or subcontract with providers or have other relationships with providers
excluded from participation in Federal Health Care Programs, including Medi-
Cal/Medicaid or procurement activities, as set forth in 42 C.F.R. §438.610.
Contractor shall conduct initial and monthly exclusion and suspension searches
of the following databases and provide evidence of these completed searches
when requested by County, DHCS or the US Department of Health and Human
Services (DHHS):
i. www.oig.hhs.gov/exclusions - Office of Inspector General's List of
Excluded Individuals/Entities (LEIE) Federal Exclusions
ii. www.sam.gov/content/exclusions - General Service Administration (GSA)
Exclusions Extract
iii. www.Medi-Cal.ca.gov- Suspended & Ineligible Provider List
iv. https://nppes.cros.hhs.gov/#/ - National Plan and Provider Enumeration
System (NPPES)
v. Any other database required by DHCS or US DHHS.
Revised 8/21/25
Exhibit C
Page 8 of 18
c. In entering into this Agreement, Contractor certifies, that Contractor does not
employ staff or individual contractors/vendors that are on the Social Security
Administration's Death Master File. Contractor shall check the database prior to
employing staff or individual contractors/vendors and provide evidence of these
completed searches when requested by the County, DHCS or the US DHHS.
d. Contractor is required to notify County immediately if Contractor becomes aware
of any information that may indicate their (including employees/staff and
individual contractors/vendors) potential placement on an exclusions list.
e. Contractor shall screen and periodically revalidate all network providers in
accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E.
f. Contractor must confirm the identity and determine the exclusion status of all its
providers, as well as any person with an ownership or control interest, or who is
an agent or managing employee of the contracted agency through routine checks
of federal and state databases. This includes the Social Security Administration's
Death Master File, NPPES, the Office of Inspector General's LEIE, the Medi-Cal
Suspended and Ineligible Provider List (S&I List) as consistent with the
requirements of 42 C.F.R. § 455.436.
g. If Contractor finds a provider that is excluded, it must promptly notify the County
as per 42 C.F.R. § 438.608(a)(2), (4). The Contractor shall not certify or pay any
excluded provider with Medi-Cal funds, must treat any payments made to an
excluded provider as an overpayment, and any such inappropriate payments
may be subject to recovery.
III. Inspection and Audit Requirements
a. Internal Auditing. Contractor shall institute and conduct a Quality Assurance
Process for all services provided hereunder.
Contractor shall provide County with notification and a summary of any
internal audit exceptions and the specific corrective actions taken to sufficiently
reduce the errors that are discovered through Contractor's internal audit process.
Contractor shall provide this notification and summary to County as requested by
the County.
b. Access to Records. Contractor shall provide County with access to all
documentation of services provided under this Agreement for County's use in
administering this Agreement. Contractor shall allow County, the Centers for
Medicare and Medicaid Services (CMS), the Office of the Inspector General, the
Revised 8/21/25
Exhibit C
Page 9 of 18
Controller General of the United States, and any other authorized Federal and
State agencies to evaluate performance under this Agreement, and to inspect,
evaluate, and audit any and all records, documents, and the premises,
equipment and facilities maintained by the Contractor pertaining to such services
at any time and as otherwise required under this Agreement.
IV. Right to Monitor
a. Right to Monitor. County or any subdivision or appointee thereof, and the State
of California or any subdivision or appointee thereof, including the Auditor
General, shall have absolute right to review and audit all records, books, papers,
documents, corporate minutes, financial records, staff information, records of
persons served, other pertinent items as requested, and shall have absolute right
to monitor the performance of Contractor in the delivery of services provided
under this Agreement. Full cooperation shall be given by the Contractor in any
auditing or monitoring conducted, according to this Agreement.
b. Accessibility. Contractor shall make all of its premises, physical facilities,
equipment, books, records, documents, agreements, computers, or other
electronic systems pertaining to Medi-Cal enrollees, Medi-Cal-related activities,
services, and activities furnished under the terms of this Agreement, or
determinations of amounts payable available at any time for inspection,
examination, or copying by County, the State of California or any subdivision or
appointee thereof, CMS, U.S. Department of Health and Human Services (HHS)
Office of Inspector General, the United States Controller General or their
designees, and other authorized federal and state agencies. This audit right will
exist for at least ten (10) years from the final date of the Agreement period or in
the event the Contractor has been notified that an audit or investigation of this
Agreement has commenced, until such time as the matter under audit or
investigation has been resolved, including the exhaustion of all legal remedies,
whichever is later (42 CFR §438.230(c)(3)(I)-(ii)).
The County, DHCS, CMS, or the HHS Office of Inspector General may
inspect, evaluate, and audit the Contractor at any time if there is a reasonable
possibility of fraud or similar risk. The Department's inspection shall occur at the
Contractor's place of business, premises, or physical facilities (42 CFR
§438.230(c)(3)(iv))
Revised 8/21/25
Exhibit C
Page 10 of 18
c. Cooperation. Contractor shall cooperate with County in the implementation,
monitoring and evaluation of this Agreement and comply with any and all
reporting requirements established by County. Should County identify an issue or
receive notification of a complaint or potential/actual/suspected violation of
requirements, County may audit, monitor, and/or request information from
Contractor to ensure compliance with laws, regulations, and requirements, as
applicable.
d. Probationary Status. County reserves the right to place Contractor on
probationary status should Contractor fail to meet performance requirements;
including, but not limited to violations such as failure to report incidents and
changes as contractually required, failure to correct issues, inappropriate
invoicing, untimely and inaccurate data entry, not meeting performance outcomes
expectations, and violations issued directly from the State. Additionally,
Contractor may be subject to Probationary Status or termination if agreement
monitoring and auditing corrective actions are not resolved within specified
timeframes.
e. Record Retention. Contractor shall retain all records and documents originated
or prepared pursuant to Contractor's performance under this Agreement,
including grievance and appeal records, and the data, information and
documentation specified in 42 CFR parts 438.604, 438.606, 438.608, and
438.610 for a period of no less than ten (10) years from the term end date of this
Agreement or until such time as the matter under audit or investigation has been
resolved. Records and documents include but are not limited to all physical and
electronic records and documents originated or prepared pursuant to
Contractor's or subcontractor's performance under this Agreement including
working papers, reports, financial records and documents of account, records of
persons served, prescription files, subcontracts, and any other documentation
pertaining to covered services and other related services for persons served.
f. County Discretion to Revoke. County has the discretion to revoke full or partial
provisions of the Agreement, delegated activities or obligations, or application of
other remedies permitted by state or federal law when the County or DHCS
determines Contractor has not performed satisfactorily.
V. Complaint Logs and Grievances
Revised 8/21/25
Exhibit C
Page 11 of 18
a. Documentation. Contractor shall log complaints and the disposition of all
complaints from a person served or their family. Contractor shall provide a copy
of the detailed complaint log entries concerning County-sponsored persons
served to County at monthly intervals by the tenth (10th) day of the following
month, in a format that is mutually agreed upon. Contractor shall allow persons
served or their representative to file a grievance either orally, or in writing at any
time with the Behavioral Health Plan. In the event Contractor is notified by a
person served or their representative of a discrimination grievance, Contractor
shall report discrimination grievances to the County within twenty-four (24) hours.
The Contractor shall not require a person served or their representative to file a
Discrimination Grievance with the Behavioral Health Plan before filing the
complaint directly with the DHCS Office of Civil Rights and the U.S. Health and
Human Services Office for Civil Rights.
b. Rights of Persons Served. Contractor shall comply with applicable laws and
regulations relating to patients' rights, including but not limited to Wel. & Inst.
Code 5325, Cal. Code Regs., tit. 9, sections 862 through 868, and 42 CFR §
438.100. The Contractor shall ensure that its subcontractors comply with all
applicable patients' rights laws and regulations.
c. Incident Reporting. Contractor shall file an incident report for all incidents
involving persons served, following County DBH's Incident Reporting protocol.
VI. Compliance Requirements
a. Internal Monitoring and Auditing
i. Contractor shall be responsible for conducting internal monitoring and
auditing of its agency. Internal monitoring and auditing include, but are not
limited to billing practices, licensure/certification verification and
adherence to County, State and Federal regulations.
1. Contractor shall not submit false, fraudulent, inaccurate or
fictitious claims for payment or reimbursement of any kind.
2. Contractor shall bill only for those eligible services actually
rendered which are also fully documented.
3. Contractor shall ensure all employees/service providers maintain
current I ice nsure/certification/registration/waiver status as required
by the respective licensing/certification Board, applicable
Revised 8/21/25
Exhibit C
Page 12 of 18
governing State agency(ies) and Title 9 of the California Code of
Regulations.
ii. Should Contractor identify improper procedures, actions or
circumstances, including fraud/waste/abuse and/or systemic issue(s),
Contractor shall take prompt steps to correct said problem(s). Contractor
shall report to DBH any overpayments discovered as a result of such
problems no later than five (5) business days from the date of discovery,
with the appropriate documentation, and a thorough explanation of the
reason for the overpayment. Prompt mitigation, corrective action and
reporting shall be in accordance with the DBH Overpayment Policy and
PPG Prevention, Detection, Correction of Fraud, Waste and Abuse which
will be provided to Contractor at its request.
b. Compliance Program
i. The County DBH has established a Compliance Office for purposes of
ensuring adherence to all standards, rules and regulations related to the
provision of services and expenditure of funds in Federal and State health
care programs. Contractor shall either adopt DBH's Compliance
Plan/Program or establish its own Compliance Plan/Program and provide
documentation to County DBH to evaluate whether the Program is
consistent with the elements of a Compliance Program as recommended
by the United States Department of Health and Human Services, Office of
Inspector General.
ii. Contractor's Compliance Program must include the following elements:
1. Designation of a compliance officer who reports directly to the
Chief Executive Officer and the Contactor's Board of Directors and
compliance committee comprised of senior management who are
charged with overseeing the Contractor's compliance program and
compliance with the requirements of this account. The committee
shall be accountable to the Contractor's Board of Directors.
iii. Policies and Procedures
1. Contractor shall have written policies and procedures that
articulate the Contractor's commitment to comply with all
applicable Federal and State standards. Contractor shall adhere
to applicable County DBH Policies and Procedures relating to the
Revised 8/21/25
Exhibit C
Page 13 of 18
Compliance Program or develop its own compliance related
policies and procedures.
iv. Contractor shall establish and implement procedures and a system with
dedicated staff for routine internal monitoring and auditing of compliance
risks, prompt response to compliance issues as they arise, investigation
of potential compliance problems as identified in the course of self-
evaluation and audits, correction of such problems promptly and
thoroughly (or coordination of suspected criminal acts with law
enforcement agencies) to reduce the potential for recurrence, and
ongoing compliance with the requirements under this Agreement.
v. Contractor shall implement and maintain written policies for all County
DBH-funded employees, and of any contractor or agent, that provide
detailed information about the False Claims Act and other Federal and
State laws, including information about rights of employees to be
protected as whistleblowers.
vi. Contractor shall maintain documentation, verification or
acknowledgement that the Contractor's employees, subcontractors,
interns, volunteers, and members of Board of Directors are aware of
these Policies and Procedures and the Contractor's Compliance
Program.
vii. Contractor shall have a Compliance Plan demonstrating the seven (7)
elements of a Compliance Plan. Contractor has the option to develop its
own or adopt County DBH's Compliance Plan. Should Contractor develop
its own Plan, Contractor shall submit the Plan prior to implementation for
review and approval to:
Fresno County DBH Compliance Office
1925 E. Dakota Ave. Ste A
Fresno, California 93726
Or send via email to: DBHCompliance@fresnocountyca.gov
c. Program Integrity Requirements
i. As a condition for receiving payment under a Medi-Cal managed care
program, Contractor shall comply with the provisions of Title 42 CFR
Sections 438.604, 438.606, 438.608 and 438.610. Contractor must have
administrative and management processes or procedures, including a
Revised 8/21/25
Exhibit C
Page 14 of 18
mandatory compliance plan, that are designed to detect and prevent
fraud, waste or abuse.
ii. If Contractor identifies an issue or receives notification of a complaint
concerning an incident of possible fraud, waste, or abuse, Contractor
shall immediately notify County DBH; conduct an internal investigation to
determine the validity of the issue/complaint; and develop and implement
corrective action if needed.
iii. If Contractor's internal investigation concludes that fraud or abuse has
occurred or is suspected, the issue if egregious, or beyond the scope of
the Contractor's ability to pursue, the Contractor shall immediately report
to the County DBH Compliance Office for investigation, review and/or
disposition.
iv. Contractor shall immediately report to DBH any overpayments identified
or recovered, specifying the overpayments due to potential fraud.
v. Contractor shall immediately report any information about changes in
circumstances of the person served that may affect the person's eligibility,
including changes in the residence of the person served or the death of
the individual.
vi. Contractor shall immediately report any information about a change in
Contractor's or Contractor's staff circumstances that may affect eligibility
to participate in the behavioral health program.
vii. Contractor understands DBH, CMS, or the HHS Inspector General may
inspect, evaluate, and audit the Contractor at any time if there is a
reasonable possibility of fraud or similar risk.
d. Code of Conduct
i. Contractor shall take precautions to ensure that claims are prepared and
submitted accurately, timely and are consistent with all applicable laws,
regulations, rules or guidelines.
ii. Contractor shall ensure that no false, fraudulent, inaccurate or fictitious
claims for payment or reimbursement of any kind are submitted.
iii. Contractor shall bill only for eligible services actually rendered and fully
documented.
iv. Contractor shall act promptly to investigate and correct problems if errors
in claims or billing are discovered.
Revised 8/21/25
Exhibit C
Page 15 of 18
v. Contractor shall comply with County's Code of Conduct and Ethics and
the County's Compliance Program in accordance with Exhibit C—
Attachment E to this Agreement, titled "Fresno County Behavioral Health
Plan Compliance Program Code of Conduct".
VII. Federal and State Laws
a. Health Insurance Portability and Accountability Act. County and Contractor each
consider and represent themselves as covered entities as defined by the U.S. Health
Insurance Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and
agree to use and disclose Protected Health Information (PHI) as required by law.
County and Contractor acknowledge that the exchange of PHI between them is
only for treatment, payment, and health care operations.
County and Contractor intend to protect the privacy and provide for the security
of PHI pursuant to this Agreement in compliance with HIPAA, the Health Information
Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and
regulations promulgated thereunder by the U.S. Department of Health and Human
Services (HIPAA Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
Contractor to enter into an agreement containing specific requirements prior to the
disclosure of PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a),
164.502(e) and 164.504(e) of the Code of Federal Regulations.
b. Contractor and County mutually agree to maintain the confidentiality of records and
information of persons served in compliance with all applicable State and Federal
statutes and regulations, including, but not limited to, HIPAA, California
Confidentiality of Medical Information Act (CMIA), and California Welfare and
Institutions Code section 5328. The Parties shall inform all of their employees and
agents who perform services under this Agreement of the confidentiality provisions of
all applicable statutes.
c. The County is a "Covered Entity," and the Contractor is a "Business Associate," as
these terms are defined by 45 CFR 160.103.As a Business Associate, Contractor
agrees to comply with the terms of Exhibit C—Attachment F to this Agreement, titled
"Health Insurance Portability and Accountability Act (HIPAA) Business Associate
Agreement".
Vill. Quality Management Requirements
Revised 8/21/25
Exhibit C
Page 16 of 18
a. Quality Improvement Activities and Participation. Contractor shall comply
with the County's ongoing comprehensive Quality Assessment and Performance
Improvement (QAPI) Program (42 CFR. § 438.330(a)) and work with the County
to improve established outcomes by following structural and operational
processes and activities that are consistent with current practice standards.
Contractor shall participate in quality improvement (QI) activities,
including clinical and non-clinical performance improvement projects (PIPs), as
requested by the County in relation to State and Federal requirements and
responsibilities, to improve health outcomes and individuals' satisfaction with
services over time. Other QI activities include quality assurance, collection and
submission of performance measures specified by the County, mechanisms to
detect both underutilization and overutilization of services, individual and system
outcomes, utilization management, utilization review, provider appeals, provider
credentialing and recredentialing, and person served grievances. Contractor shall
measure, monitor, and annually report to the County on its performance.
IX. Cultural and Linguistic Competency
a. General.All services, policies and procedures shall be culturally and linguistically
appropriate. Contractor shall participate in the implementation of the most recent
Cultural Competency Plan for the County and shall adhere to all Culturally and
Linguistically Appropriate Service (CLAS) standards and requirements as set
forth in Exhibit C—Attachment G to this Agreement, titled "National Standards for
Culturally and Linguistically Appropriate Services". Contractor shall participate in
the County's efforts to promote the delivery of services in a culturally responsive
and equitable manner to all individuals, including those with limited English
proficiency and diverse cultural and ethnic backgrounds, disabilities, and
regardless of gender, sexual orientation, or gender identity including active
participation in the County's Diversity, Equity and Inclusion Committee.
b. Policies and Procedures. Contractor shall comply with requirements of policies
and procedures for ensuring access and appropriate use of trained interpreters
and material translation services for all limited and/or no English proficient
persons served, including, but not limited to, assessing the cultural and linguistic
needs of the persons served, training of staff on the policies and procedures, and
monitoring its language assistance program. Contractor's policies and
Revised 8/21/25
Exhibit C
Page 17 of 18
procedures shall ensure compliance of any subcontracted providers with these
requirements.
c. Interpreter Services. Contractor shall notify its persons served that oral
interpretation is available for any language and written translation is available in
prevalent languages and that auxiliary aids and services are available upon
request, at no cost and in a timely manner for limited and/or no English proficient
persons served and/or persons served with disabilities. Contractor shall avoid
relying on an adult or minor child accompanying the person served to interpret or
facilitate communication; however, if the person served refuses language
assistance services, the Contractor must document the offer, refusal, and
justification in the file of the person served.
d. Interpreter Qualifications. Contractor shall ensure that employees, agents,
subcontractors, and/or partners who interpret or translate for a person served or
who directly communicate with a person in a language other than English (1)
have completed annual training provided by County at no cost to Contractor; (2)
have demonstrated proficiency in the language of the person served; (3) can
effectively communicate any specialized terms and concepts specific to
Contractor's services; and (4) adheres to generally accepted interpreter ethic
principles.As requested by County, Contractor shall identify all who interpret for
or provide direct communication to any program person served in a language
other than English and identify when the Contractor last monitored the interpreter
for language competence.
e. CLAS Standards. Contractor shall submit to County for approval, within ninety
(90) days from date of contract execution, Contractor's plan to address all fifteen
(15) National Standards for Culturally and Linguistically Appropriate Service
(CLAS), as published by the Office of Minority Health and as set forth in Exhibit C
—Attachment G "National Standards for Culturally and Linguistically Appropriate
Services".As the CLAS standards are updated, Contractor's plan must be
updated accordingly.As requested by County, Contractor shall be responsible for
conducting an annual CLAS self-assessment and providing the results of the
self-assessment to the County. The annual CLAS self-assessment instruments
shall be reviewed by the County and revised as necessary to meet the approval
of the County.
Revised 8/21/25
Exhibit C
Page 18 of 18
f. Training Requirements. Cultural responsiveness training for Contractor staff
should be substantively integrated into health professions education and training
at all levels, both academically and functionally, including core curriculum,
professional licensure, and continuing professional development programs. As
requested by County, Contractor shall report on the completion of cultural
responsiveness trainings to ensure direct service providers are completing
annual cultural responsiveness training.
g. Continuing Cultural Responsiveness. Contractor shall create and sustain a
forum that includes staff at all agency levels to discuss cultural responsiveness.
Contractor shall designate a representative from Contractor's team to attend
County's Diversity, Equity and Inclusion Committee.
Revised 8/21/25
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
Revised 7/17/25
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
Revised 7/17/25
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
Revised 7/17/25
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
Revised 7/17/25
Exhibit C—Attachment B
Page 1 of 2
FRESNO COUNTY BEHAVIORAL HEALTH PLAN
RIGHTS OF PERSONS SERVED
I. 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)
II. 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.
Revised 8/7/25
Exhibit C—Attachment B
Page 2 of 2
a. 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).
b. 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.
C. 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 ninety (90) calendar days of the date of the receipt of the non-approval of payment.
The BHP shall have sixty (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 thirty (30) calendar days of receipt of the decision.
d. 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 sixty (60) calendar days
of receipt of the complaint. The decision rendered by the BHP is final.
Revised 8/7/25
Exhibit C—Attachment C
Page 1 of 8
FRESNO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH
CONTRACTOR TRAINING REQUIREMENTS REFERENCE GUIDE
This Training Requirements Reference Guide identifies the required trainings that
Contractor is responsible for offering to all employees, volunteers, interns, and student trainees
of Contractor or its subcontractors who, in each case, are expected to perform professional
services while contracted by County. There are some trainings offered by the County at no cost
to Contractor, and those are identified within this document. The remaining trainings are the
responsibility of Contractor to provide and cover associated costs. The expectations for
Contractor staff attending County-offered trainings are included within this guide. Contractor
must consider and include sufficient time and funds for required trainings.
I. Trainings Provided by the Department of Behavioral Health (DBH)
a. DBH Annual General Compliance Refresher Training
Duration: 60 Minutes
General Compliance Refresher Training is an annual requirement for all employees,
contractors, volunteers, interns, and student trainees working in behavioral health
programs who are in their second or more years of service. This training is a
modified version of the self-paced General Compliance Training and Contractor shall
be assigned this training in Quarter 4 of each calendar year.
An announcement from the DBH Compliance Program, DBH Staff Development, or
your contract analyst regarding this training will be made prior to the assignment of
this training. Contractor will have the option to complete the training either through
the Relias Learning Management System (LMS) or through the DBH website.
Contractors are given approximately a 60-day window to complete this training from
the training announcement date.
b. 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
Revised 8/8/25
Exhibit C—Attachment C
Page 2 of 8
completed it with their agency. Contractor shall be required to complete this training
as a prerequisite for providing direct services, processing billing, conducting quality
assurance services, clinical supervision, or other similar services under this
agreement. Contractor is expected to contact their assigned contract analysts if they
are unsure about training requirements for any specific classifications.
Documentation & Billing is a training provided at least one time per month.
Registration is completed via Eventbrite for each session; links to register can be
found on the webpage below:
https://www.fresnocountyca.gov/Departments/Behavioral-Health/Providers/Contract-
Provider-Resources/New-Hire-ComplianceDoc-Billing-Training
The expectation is that Contractor will register their County-funded employees at
least one week in advance of the training date. For any registration issues or other
questions about the training, they can contact
DBHStaffDeve lop ment(a-)_fresnocountyca.gov.
c. DBH New Hire General Compliance Training
Duration: 40 Minutes
Contractor shall have their employees, subcontractors, volunteers, interns, and
student trainees who, in each case, are expected to provide services under this
Agreement with County, complete the New Hire Compliance Training within 30
business days of hire or effective date of this Agreement, per Compliance Exhibit B,
Attachment H. If contract effective date is for a renewed agreement, existing staff will
not need to retake the training if the staff member has already completed the training
within the same calendar year as the effective date of the renewed agreement.
New Hire General Compliance is self-paced and can be completed either through
Relias Learning Management System (LMS) or on the DBH website. Additional
information on how to complete the training can be found on the following webpage:
https://www.fresnocountyca.gov/Departments/Behavioral-Health/Care-
Services/Behavioral-Health-Compliance/New-Hire-General-Compliance-Training
Contractor shall require its County-funded employees and subcontractors to
complete this compliance training. After completion of this training, participants must
Revised 8/8/25
Exhibit C—Attachment C
Page 3 of 8
sign the Contractor Acknowledgment and Agreement form and return this form to the
DBH Compliance officer or designee. For additional questions about the training,
please contact your contract analyst or the DBH Compliance team at:
DBHCompliance(cDfresnocountyca.gov.
d. Invoicing Training
Duration: To be Confirmed
Contractor shall be responsible for collection and managing data in a manner to be
determined by the California Department of Health Care Services (DHCS) and
Mental Health Plan in accordance with applicable rules and regulations. DBH's
Electronic Health Record (EHR) is a critical source of information for purposes of
monitoring service volume and obtaining reimbursement. Contractor's staff
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.
e. Notice of Adverse Benefit Determination (NOABD) Training
Duration: 8 Minutes
A Notice of Adverse Benefit Determination (NOABD) is a formal mechanism for
notifying a person served of an adverse benefit determination in writing (e.g., denial
or limited authorization of a requested service, denial of payment for a service, or
failure to provide services in a timely manner).
This training outlines usage practices, timelines, and examples for each type of
NOABD. Contractor can find the training in the Announcements section on the
following webpage: https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/Contract-Provider-Resources/Notifi cation s-Associated-Documents.
Contractor shall be responsible for completing this training within 60 days of hire or
contract effective date.
f. 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
Revised 8/8/25
Exhibit C—Attachment C
Page 4 of 8
will have the opportunity to apply CaIMHSA'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:
htti)s://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.
Although this training is not required, Contractor is responsible for understanding and
utilizing SmartCare as indicated once contracted with County DBH.
g. SmartCare Electronic Health Record New User Front Desk Training*
Duration: 4 Hours
This is a basic training for new users who are employed by Contractors that will be
using SmartCare as their full EHR. Participants will have the opportunity to review
how to navigate SmartCare, perform coverage information set up, error corrections,
set up Appointments, and basic troubleshooting of common issues.
Training dates and reference material can be found on the following link:
htti)s://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.
Although this training is not required, Contractor is responsible for understanding and
utilizing SmartCare as indicated once contracted with County DBH.
h. 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.
Revised 8/8/25
Exhibit C—Attachment C
Page 5 of 8
Required prerequisite material can be found on the following link:
htti)s://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.
Although this training is not required, Contractor is responsible for understanding and
utilizing SmartCare as indicated once contracted with County DBH.
II. Trainings for Specialty Mental Health Providers by Specialization
a. 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.
b. California Integrated Practice Child &Adolescent Needs & Strengths (CA IP
CANS)
Duration: 6 Hours 30 Minutes
The CA IP CANS is a structured assessment for identifying youth and family
actionable needs and useful strengths. It provides a framework for developing and
communicating about a shared vision and uses youth, ages 6 and youth up to age
20, and family information to inform planning, support decisions, and monitor
outcomes.
DBH provides this training to prepare attendees for certification testing and use of
the tool. For any questions about the training or assistance with registration, please
contact DBHStaffDevelopment(a)fresnocountyca.gov.
III. Contractor is Responsible for Ensuring and/or Providing These Trainings are
Offered and Completed
a. CalAIM Behavioral Health Quality Improvement Program (BHQIP) Training
Revised 8/8/25
Exhibit C—Attachment C
Page 6 of 8
Any contracted clinical provider is required to complete the CalAIM BHQIP Modules
in CalMHSA's web-based training system, Moodle. Providers are expected to
complete training within 60 days of beginning employment.
CalMHSA's web-based training system, https://moodle.calmhsalearns.org_
b. Cultural Responsiveness Trainings
Duration: May vary based on Contractor's training preference
Contracted Provider Organization shall have DBH-funded providers complete annual
trainings on cultural competency, awareness, and diversity as identified by
Contractor, and/or via the County's eLearning system. Contractor's DBH-funded
providers shall be appropriately trained in providing services in a culturally sensitive
manner and shall attend civil rights training as identified by Contractor, 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 should contact their assigned contract
analyst.
DBH is available to assist Contractor's efforts toward cultural and linguistic
responsiveness by providing the following:
i. Technical assistance regarding culturally responsive training requirements.
ii. Mandatory cultural responsiveness training for Contractor's DBH-
funded staff if training capacity allows.
iii. 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.
Revised 8/8/25
Exhibit C—Attachment C
Page 7 of 8
c. Health Insurance Portability and Accountability Act (HIPAA) Training
Duration: May vary based on selected training
As a covered entity, or a business associate of a covered entity, providers shall meet
the training requirements described in the HIPAA Privacy Rule 45 CFR §
164.530(b)(1) and the HIPAA Security Rule 45 CFR § 164.308(a)(5). Providers may
use their discretion to select an appropriate HIPAA training. Training shall be
completed by all DBH-funded staff within 30 days of contract execution or hire and
annually thereafter.
d. Language Assistance Program Training
Contractor shall be responsible for implementing policies and procedures and
training staff to ensure access and appropriate use of trained interpreters and
material translation services for all Limited English Proficient (LEP) persons served.
This includes, but is not limited to, assessing the cultural and linguistic needs of its
persons served. The Contractor's procedures shall include ensuring compliance of
any sub-contracted providers with these requirements.
IV. Training Expectations for County-Provided Trainings
a. 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.
b. Interested attendees shall register at least one week in advance of the training date.
c. 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.
d. 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.
Revised 8/8/25
Exhibit C—Attachment C
Page 8 of 8
e. 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.
f. 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.
g. Attendees shall be expected to complete pre- and/or post-training evaluations, when
available.
h. 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.
V. Use of DBH Training Facilities
a. 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.
b. 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.
Revised 8/8/25
Exhibit C—Attachment D
Page 1 of 22
STATE BEHAVIORAL HEALTH REQUIREMENTS
I. CONTROL REQUIREMENTS
The County and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
II. PROFESSIONAL LICENSURE
All (professional level) persons employed by the County Mental Health Plan (directly or
through contract) providing Short-Doyle/Medi-Cal services have met applicable
professional licensure requirements pursuant to Business and Professions and Welfare
and Institutions Codes.
III. CONFIDENTIALITY
Contractor shall conform to and County shall monitor compliance with all State of
California and Federal statutes and regulations regarding confidentiality, including but
not limited to confidentiality of information requirements at 42, Code of Federal
Regulations sections 2.1 et seq; California Welfare and Institutions Code, sections
14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the California Health and Safety
Code; Title 22, California Code of Regulations, section 51009; and Division 1, Part 2.6,
Chapters 1-7 of the California Civil Code.
IV. NON-DISCRIMINATION
a. Eligibility for Services
Contractor shall prepare and make available to County and to the public all
eligibility requirements to participate in the program plan set forth in the
Agreement. No person shall, because of ethnic group identification, age, gender,
color, disability, medical condition, national origin, race, ancestry, marital status,
religion, religious creed, political belief or sexual preference be excluded from
participation, be denied benefits of, or be subject to discrimination under any
program or activity receiving Federal or State of California assistance.
b. Employment Opportunity
Contractor shall comply with County policy, and the Equal Employment
Opportunity Commission guidelines, which forbids discrimination against any
person on the grounds of race, color, national origin, sex, religion, age, disability
status, or sexual preference in employment practices. Such practices include
Revised 8/1/25
Exhibit C—Attachment D
Page 2 of 22
retirement, recruitment advertising, hiring, layoff, termination, upgrading,
demotion, transfer, rates of pay or other forms of compensation, use of facilities,
and other terms and conditions of employment.
c. Suspension of Compensation
If an allegation of discrimination occurs, County may withhold all further funds,
until Contractor can show clear and convincing evidence to the satisfaction of
County that funds provided under this Agreement were not used in connection
with the alleged discrimination.
d. Nepotism
Except by consent of County's Department of Behavioral Health Director, or
designee, no person shall be employed by Contractor who is related by blood or
marriage to, or who is a member of the Board of Directors or an officer of
Contractor.
V. PATIENTS' RIGHTS
Contractor shall comply with applicable laws and regulations, including but not limited to,
laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
I. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the
non-discrimination program requirements. (Gov. Code§ 12990 (a-f) and CCR, Title 2,
Section 111 02) (Not applicable to public entities.)
II. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free
workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture, distribution,
dispensation, possession or use of a controlled substance is prohibited and
specifying actions to be taken against employees for violations.
i. Establish a Drug-Free Awareness Program to inform employees about:
ii. the dangers of drug abuse in the workplace;
iii. the person's or organization's policy of maintaining a drug-free workplace;
iv. any available counseling, rehabilitation and employee assistance
programs; and,
Revised 8/1/25
Exhibit C—Attachment D
Page 3 of 22
v. penalties that may be imposed upon employees for drug abuse violations.
b. Every employee who works on this Agreement will:
i. receive a copy of the company's drug-free workplace policy statement;
and,
ii. 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 Contractor may be ineligible
for award of any future State agreements if the department determines that any of the
following has occurred: the Contractor has made false certification, or violated the
certification by failing to carry out the requirements as noted above. (Gov. Code §8350
et seq.)
III. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that
no more than one (1)final unappealable finding of contempt of court by a Federal court
has been issued against Contractor within the immediately preceding two (2) year period
because of Contractor's failure to comply with an order of a Federal court, which orders
Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract
Code §10296) (Not applicable to public entities.)
IV. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective January
1, 2003.
Contractor agrees to make a good faith effort to provide a minimum number of hours of
pro bono legal services during each year of the contract equal to the lessor of 30
multiplied by the number of full time attorneys in the firm's offices in the State, with the
number of hours prorated on an actual day basis for any contract period of less than a
full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
Revised 8/1/25
Exhibit C—Attachment D
Page 4 of 22
V. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate
corporation or subsidiary of an expatriate corporation within the meaning of Public
Contract Code Section 10286 and 10286.1, and is eligible to contract with the State of
California.
VI. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel,
garments or corresponding accessories, or the procurement of equipment,
materials, or supplies, other than procurement related to a public works contract,
declare under penalty of perjury that no apparel, garments or corresponding
accessories, equipment, materials, or supplies furnished to the state pursuant to
the contract have been laundered or produced in whole or in part by sweatshop
labor, forced labor, convict labor, indentured labor under penal sanction, abusive
forms of child labor or exploitation of children in sweatshop labor, or with the
benefit of sweatshop labor, forced labor, convict labor, indentured labor under
penal sanction, abusive forms of child labor or exploitation of children in
sweatshop labor. Contractor further declares under penalty of perjury that they
adhere to the Sweatfree Code of Conduct as set forth on the California
Department of Industrial Relations website located at www.dir.ca.gov, and Public
Contract Code Section 6108.
b. Contractor agrees to cooperate fully in providing reasonable access to the
Contractor's records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the
Department of Industrial Relations, or the Department of Justice to determine the
Contractor's compliance with the requirements under paragraph (a).
VII. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractor certifies that
Contractor is in compliance with Public Contract Code Section 10295.3.
Vill. GENDER IDENTITY: For contracts of$100,000 or more, Contractor certifies that
Contractor is in compliance with Public Contract Code Section 10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of California.
Revised 8/1/25
Exhibit C—Attachment D
Page 5 of 22
I. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions
regarding current or former state employees. If Contractor has any questions on the
status of any person rendering services or involved with this Agreement, the awarding
agency shall be contacted immediately for clarification.
a. Current State Employees (Pub. Contract Code §10410):
i. 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.
ii. No officer or employee shall contract on their own behalf as an
independent Contractor with any state agency to provide goods or
services.
b. Former State Employees (Pub. Contract Code §10411):
i. 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.
ii. For the twelve (12) month period from the date they left state
employment, no former state officer or employee may enter into a
contract with any state agency if they were employed by that state agency
in a policy-making position in the same general subject area as the
proposed contract within the twelve (12) month period prior to them
leaving state service.
If Contractor violates any provisions of above paragraphs, such action by Contractor
shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
II. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the
provisions which require every employer to be insured against liability for Worker's
Compensation or to undertake self-insurance in accordance with the provisions, and
Revised 8/1/25
Exhibit C—Attachment D
Page 6 of 22
Contractor affirms to comply with such provisions before commencing the performance
of the work of this Agreement. (Labor Code Section 3700)
III. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies
with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on
the basis of disability, as well as all applicable regulations and guidelines issued
pursuant to the ADA. (42 U.S.C. 12101 et seq.)
IV. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal documentation of
the name change the State will process the amendment. Payment of invoices presented
with a new name cannot be paid prior to approval of said amendment.
V. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the Contractor is currently qualified to
do business in California in order to ensure that all obligations due to the state
are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any
transaction for the purpose of financial or pecuniary gain or profit. Although there
are some statutory exceptions to taxation, rarely will a corporate Contractor
performing within the state not be subject to the franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of California)
shall be in good standing in order to be qualified to do business in California.
Agencies will determine whether a corporation is in good standing by calling the
Office of the Secretary of State.
VI. 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.
VII. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall
not be: (1) in violation of any order or resolution not subject to review promulgated by
the State Air Resources Board or an air pollution control district; (2) subject to cease and
desist order not subject to review issued pursuant to Section 13301 of the Water Code
Revised 8/1/25
Exhibit C—Attachment D
Page 7 of 22
for violation of waste discharge requirements or discharge prohibitions; or (3) finally
determined to be in violation of provisions of federal law relating to air or water pollution.
Vill. PAYEE DATA RECORD FORM STD. 204: This form shall be completed by all
Contractors that are not another state agency or other governmental entity.
IX. INSPECTION AND AUDIT OF RECORDS AND ACCESS TO FACILITIES:
The State, CMS, the Office of the Inspector General, the Comptroller General, and their
designees may, at any time, inspect and audit any records or documents of Contractor
or its subcontractors, and may, at any time, inspect the premises, physical facilities, and
equipment where Medicaid-related activities or work is conducted. The right to audit
under this section exists for ten (10) years from the final date of the contract period or
from the date of completion of any audit, whichever is later.
a. Federal database checks
Consistent with the requirements at § 455.436 of this chapter, the State shall
confirm the identity and determine the exclusion status of Contractor, any
subcontractor, as well as any person with an ownership or control interest, or
who is an agent or managing employee of Contractor through routine checks of
Federal databases. This includes the Social Security Administration's Death
Master File, the National Plan and Provider Enumeration System (NPPES), the
List of Excluded Individuals/Entities (LEIE), the System for Award Management
(SAM), and any other databases as the State or Secretary may prescribe. These
databases shall be consulted upon contracting and no less frequently than
monthly thereafter. If the State finds a party that is excluded, it shall promptly
notify the Contractor and take action consistent with § 438.610(c).
The State shall ensure that Contractor with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
Contractor to a network provider, out-of-network provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
Revised 8/1/25
Exhibit C—Attachment D
Page 8 of 22
CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM)
REQUIREMENTS
I. SERVICES AND ACCESS PROVISIONS
a. Certification of Eligibility
i. Contractor will, in cooperation with County, comply with Section
14705.5 of California Welfare and Institutions Code to obtain a
certification of an individual's eligibility for Specialty Mental Health
Services (SMHS) under Medi-Cal.
b. Access to Specialty Mental Health Services
i. In collaboration with the County, Contractor will work to ensure that
individuals to whom the Contractor provides SMHS meet access
criteria, as per Department of Health Care Services (DHCS) guidance
specified in Behavioral Health Information Notice (BHIN) 21-073.
Specifically, the Contractor will ensure that the clinical record for each
individual includes information as a whole indicating that individual's
presentation and needs are aligned with the criteria applicable to their
age at the time of service provision as specified below.
ii. For enrolled individuals under 21 years of age, Contractor shall provide
all medically necessary SMHS required pursuant to Section 1396d(r) of
Title 42 of the United States Code. Covered SMHS shall be provided to
enrolled individuals who meet either of the following criteria, (I) 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:
Revised 8/1/25
Exhibit C—Attachment D
Page 9 of 22
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 (II a-d)
above is due to one of the following:
a. A diagnosed mental health disorder, according to the
criteria in the current editions of the Diagnostic and
Statistical Manual of Mental Disorders (DSM) and the
International Classification of Diseases and Related Health
Problems (ICD).
b. A suspected mental health disorder that has not yet been
diagnosed.
c. Significant trauma placing the individual at risk of a future
mental health condition, based on the assessment of a
licensed mental health professional.
iii. For individuals 21 years of age or older, Contractor shall provide
covered SMHS for persons served who meet both of the following
criteria, (a) and (b) below:
1. The individual has one or both of the following:
a. Significant impairment, where impairment is defined as
distress, disability, or dysfunction in social, occupational,
or other important activities.
b. A reasonable probability of significant deterioration in an
important area of life functioning.
2. The individual's condition as described in paragraph (a) is due
to either of the following:
a. A diagnosed mental health disorder, according to the
criteria in the current editions of the DSM and ICD.
Revised 8/1/25
Exhibit C—Attachment D
Page 10 of 22
b. A suspected mental disorder that has not yet been
diagnosed.
c. Additional Clarifications
i. Criteria
1. A clinically appropriate and covered mental health prevention,
screening, assessment, treatment, or recovery service listed
within Exhibit A of this Agreement can be provided and
submitted to the County for reimbursement under any of the
following circumstances:
a. The services were provided prior to determining a
diagnosis, including clinically appropriate and covered
services provided during the assessment process;
b. The service was not included in an individual treatment
plan; or
c. The individual had a co-occurring substance use disorder.
ii. Diagnosis Not a Prerequisite
1. Per BHIN 21-073, a mental health diagnosis is not a
prerequisite for access to covered SMHS. This does not
eliminate the requirement that all Medi-Cal claims, including
SMHS claims, include a current Centers for Medicare &
Medicaid Services (CMS) approved ICD diagnosis code
d. Medical Necessity
i. Contractor will ensure that services provided are medically necessary
in compliance with BHIN 21-073 and pursuant to Welfare and
Institutions Code section 14184.402(a). Services provided to a person
served shall be medically necessary and clinically appropriate to
address the individual's presenting condition. Documentation in each
individual's chart as a whole will demonstrate medical necessity as
defined below, based on the age of the individual at the time of service
provision.
ii. For individuals 21 years of age or older, a service is "medically
necessary" or a "medical necessity" when it is reasonable and
necessary to protect life, to prevent significant illness or significant
Revised 8/1/25
Exhibit C—Attachment D
Page 11 of 22
disability, or to alleviate severe pain as set forth in Welfare and
Institutions Code section 14059.5.
iii. For individuals under 21 years of age, a service is "medically
necessary" or a "medical necessity" if the service meets the standards
set forth in Section 1396d(r)(5) of Title 42 of the United States Code.
e. Coordination of Care
i. Contractor shall ensure that all care, treatment and services provided
pursuant to this Agreement are coordinated among all providers who
are serving the individual, including all other SMHS providers, as well
as providers of Non-Specialty Mental Health Services (NSMHS),
substance use disorder treatment services, physical health services,
dental services, regional center services and all other services as
applicable to ensure a person served-centered and whole-person
approach to services.
ii. Contractor shall ensure that care coordination activities support the
monitoring and treatment of comorbid substance use disorder and/or
health conditions.
iii. Contractor shall include in care coordination activities efforts to
connect, refer and link individual s to community-based services and
supports, including but not limited to educational, social, prevocational,
vocational, housing, nutritional, criminal justice, transportation,
childcare, child development, family/marriage education, cultural
sources, and mutual aid support groups.
iv. Contractor shall engage in care coordination activities beginning at
intake and throughout the treatment and discharge planning
processes.
v. To facilitate care coordination, Contractor will request a HIPAA and
California law compliant person served authorization to share the
individual's information with and among all other providers involved in
the individual's care, in satisfaction of state and federal privacy laws
and regulations.
f. Co-Occurring Treatment and No Wrong Door
i. Per BHIN 22-011, Specialty and Non-Specialty Mental Health Services
can be provided concurrently, if those services are clinically
Revised 8/1/25
Exhibit C—Attachment D
Page 12 of 22
appropriate, coordinated, and not duplicative. When a person served
meets criteria for both NSMHS and SMHS, the individual should
receive services based on individual clinical need and established
therapeutic relationships. Clinically appropriate and covered SMHS
can also be provided when the individual has a co-occurring mental
health condition and substance use disorder.
ii. Under this Agreement, Contractor will ensure that individual s receive
timely mental health services without delay. Services are reimbursable
to Contractor by County even when:
1. Services are provided prior to determination of a diagnosis,
during the assessment or prior to determination of whether
SMHS access criteria are met, even if the assessment
ultimately indicates the individual does not meet criteria for
SMHS.
2. If Contractor is serving an individual receiving both SMHS and
NSMHS, Contractor holds responsibility for documenting
coordination of care and ensuring that services are non-
duplicative.
II. AUTHORIZATION AND DOCUMENTATION PROVISIONS
a. Service Authorization
i. Contractor will collaborate with County to complete authorization
requests in line with County and DHCS policy.
ii. Contractor shall have in place, and follow, written policies and
procedures for completing requests for initial and continuing
authorizations of services, as required by County guidance.
iii. Contractor shall respond to County in a timely manner when
consultation is necessary for County to make appropriate authorization
determinations.
iv. County shall provide Contractor with written notice of authorization
determinations within the timeframes set forth in BHINs 22-016 and 22-
017, or any subsequent DHCS notices.
v. Contractor shall alert County when an expedited authorization decision
(no later than 72 hours) is necessary due to an individual's specific
Revised 8/1/25
Exhibit C—Attachment D
Page 13 of 22
needs and circumstances that could seriously jeopardize the individual
s life or health, or ability to attain, maintain, or regain maximum
function.
b. Documentation Requirements
i. Contractor will follow all documentation requirements which includes
compliance with federal, state and County requirements.
ii. All Contractor documentation shall be accurate, complete, and legible,
shall list each date of service, and include the face-to-face time for
each service. Contractor shall document travel and documentation
time for each service separately from face-to-face time and provide this
information to County upon request. Services shall be identified as
provided in-person, by telephone, or by telehealth.
iii. All services shall be documented utilizing County-approved templates
and contain all required elements. Contractor agrees to satisfy the
chart documentation requirements set forth in BHIN 22-019 and the
contract between County and DHCS. Failure to comply with
documentation standards specified in this Article require corrective
action plans.
c. Assessment
i. Contractor shall ensure that all individuals' medical records include an
assessment of each individual's need for mental health services.
ii. Contractor will utilize the seven uniform assessment domains and
include other required elements as identified in BHIN 22-019 and
document the assessment in the individual's medical record.
iii. For individual s aged 6 through 20, the Child and Adolescent Needs
and Strengths (CANS), and for individual s aged 3 through 18, the
Pediatric Symptom Checklist-35 (PSC-35) tools are required at intake,
every six months during treatment, and at discharge, as specified in
DHCS MHSUDS INs 17-052 and 18-048.
iv. The time period for providers to complete an initial assessment and
subsequent assessments for SMHS are up to clinical discretion of
County; however, Contractor's providers shall complete assessments
within a reasonable time and in accordance with generally accepted
standards of practice.
Revised 8/1/25
Exhibit C—Attachment D
Page 14 of 22
d. ICD-10
i. Contractor shall use the criteria set forth in the current edition of the
DSM as the clinical tool to make diagnostic determinations.
ii. Once a DSM diagnosis is determined, the Contractor shall determine
the corresponding mental health diagnosis in the current edition of
ICD. Contractor shall use the ICD diagnosis code(s) to submit a claim
for SMHS to receive reimbursement from County.
iii. The ICD Tabular List of Diseases and Injuries is maintained by CMS
and may be updated during the term of this Agreement. Changes to
the lists of ICD diagnoses do not require an amendment to this
Agreement, and County may implement these changes as provided by
CMS
e. Problem List
i. Contractor will create and maintain a Problem List for each individual
served under this Agreement. The problem list is a list of symptoms,
conditions, diagnoses, and/or risk factors identified through
assessment, psychiatric diagnostic evaluation, crisis encounters, or
other types of service encounters.
ii. Contractor shall document a problem list that adheres to industry
standards utilizing at minimum current SNOMED International,
Systematized Nomenclature of Medicine Clinical Terms (SNOMED
CT®) U.S. Edition, September 2022 Release, and ICD-1 0-CM 2023.
iii. A problem identified during a service encounter may be addressed by
the service provider during that service encounter and subsequently
added to the problem list.
iv. The problem list shall include, but is not limited to, all elements
specified in BHIN 22-019.
v. County does not require the problem list to be updated within a specific
timeframe or have a requirement about how frequently the problem list
should be updated after a problem has initially been added. However,
Contractor shall update the problem list within a reasonable time such
that the problem list reflects the current issues facing the person
served, in accordance with generally accepted standards of practice
and in specific circumstances specified in BHIN 22-019.
Revised 8/1/25
Exhibit C—Attachment D
Page 15 of 22
f. Treatment and Care Plans
i. Contractor is not required to complete treatment or care plans for
persons served under this Agreement, except in the circumstances
specified in BHIN 22-019 and additional guidance from DHCS that may
follow after execution of this Agreement.
g. Progress Notes
i. Contractor shall create progress notes for the provision of all SMHS
services provided under this Agreement.
ii. Each progress note shall provide sufficient detail to support the service
code selected for the service type as indicated by the service code
description.
iii. Progress notes shall include all elements specified in BHIN 22-019,
whether the note be for an individual or a group service.
iv. Contractor shall complete progress notes within three business days of
providing a service, with the exception of notes for crisis services,
which shall be completed within 24 hours.
v. Providers shall complete a daily progress note for services that are
billed on a daily basis, such as residential and day treatment services,
if applicable.
h. Transition of Care Tool
i. Contractor shall use a Transition of Care Tool for any individual whose
existing services will be transferred from Contractor to an Medi-Cal
Managed Care Plan (MCP) provider or when NSMHS will be added to
the existing mental health treatment provided by Contractor, as
specified in BHIN 22-065, in order to ensure continuity of care.
ii. Determinations to transition care or add services from an MCP shall be
made in alignment with County policies and via a person-centered,
shared decision-making process.
iii. Contractor may directly use the DHCS-provided Transition of Care
Tool, found at https://www.dhcs.ca.gov/Pages/Screening-and-
Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-Services.aspx, or
obtain a copy of that tool provided by the County. Contractor may
create the Transition of Care Tool in its Electronic Health Record
(EHR). However, the contents of the Transition of Care Tool, including
Revised 8/1/25
Exhibit C—Attachment D
Page 16 of 22
the specific wording and order of fields, shall remain identical to the
DHCS provided form. The only exception to this requirement is when
the tool is translated into languages other than English.
i. Telehealth
i. Contractor may use telehealth, when it deems clinically appropriate, as
a mode of delivering behavioral health services in accordance with all
applicable County, state, and federal requirements, including those
related to privacy/security, efficiency, and standards of care. Such
services will conform to the definitions and meet the requirements
included in the Medi-Cal Provider Manual: Telehealth, available in the
DHCS Telehealth Resources page at:
https://www.dhcs.ca.gov/provgovpart/Pages/TeleheaIthResources.asp
X.
ii. All telehealth equipment and service locations shall ensure that person
served confidentiality is maintained.
iii. Licensed providers and staff may provide services via telephone and
telehealth as long as the service is within their scope of practice.
iv. Medical records for individuals served by Contractor under this
Agreement shall include documentation of written or verbal consent for
telehealth or telephone services if such services are provided by
Contractor. Such consent shall be obtained at least once prior to
initiating applicable health care services and consent shall include all
elements as specified in BHIN 22-019.
v. County may at any time audit Contractor's telehealth practices, and
Contractor shall allow access to all materials needed to adequately
monitor Contractor's adherence to telehealth standards and
requirements.
III. PROTECTIONS FOR PERSONS SERVED
a. Grievances, Appeals, and Notices of Adverse Benefit Determination
i. All grievances (as defined by 42 C.F.R. § 438.400) and complaints
received by Contractor shall be immediately forwarded to the County's
DBH Plan Administration Division or other designated persons via a
secure method (e.g., encrypted email or by fax) to allow ample time for
Revised 8/1/25
Exhibit C—Attachment D
Page 17 of 22
the DBH Plan Administration staff to acknowledge receipt of the
grievance and complaints and issue appropriate responses.
ii. Contractor shall not discourage the filing of grievances and individual s
do not need to use the term "grievance" for a complaint to be captured
as an expression of dissatisfaction and, therefore, a grievance.
iii. Aligned with MHSUDS IN 18-010E and 42 C.F.R. §438.404, the
appropriate and delegated Notice of Adverse Benefit Determination
(NOABD) shall be issued by Contractor within the specified timeframes
using the template provided by the County.
iv. NOABDs shall be issued to individuals anytime the Contractor has
made or intends to make an adverse benefit determination that
includes the reduction, suspension, or termination of a previously
authorized service and/or the failure to provide services in a timely
manner. The notice shall have a clear and concise explanation of the
reason(s) for the decision as established by DHCS and the County.
The Contractor shall inform the County immediately after issuing a
NOABD.
v. Procedures and timeframes for responding to grievances, issuing and
responding to adverse benefit determinations, appeals, and state
hearings shall be followed as per 42 C.F.R., Part 438, Subpart F (42
C.F.R. §§ 438.400 —438.424).
vi. Contractor shall provide individuals any reasonable assistance in
completing forms and taking other procedural steps related to a
grievance or appeal such as auxiliary aids and interpreter services.
vii. Contractor shall maintain records of grievances and appeals and shall
review the information as part of its ongoing monitoring procedures.
The record shall be accurately maintained in a manner accessible to
the County and available upon request to DHCS.
b. Advanced Directives
i. Contractor shall comply with all County policies and procedures
regarding Advanced Directives in compliance with the requirements of
42 C.F.R. §§ 422.128 and 438.6(i) (1), (3) and (4).
c. Continuity of Care
Revised 8/1/25
Exhibit C—Attachment D
Page 18 of 22
i. Contractor shall follow the County's continuity of care policy that is in
accordance with applicable state and federal regulations, MHSUDS IN
18-059 and any BHINs issued by DHCS for parity in mental health and
substance use disorder benefits subsequent to the effective date of
this Agreement (42 C.F.R. § 438.62(b)(1)-(2).)
IV. QUALITY IMPROVEMENT PROGRAM
a. Quality Improvement Activities and Participation
i. Contractor shall implement mechanisms to assess person
served/family satisfaction based on County's guidance. The Contractor
shall assess individual/family satisfaction by:
1. Surveying person served/family satisfaction with the
Contractor's services at least annually.
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. Contractor, if applicable, shall implement mechanisms to monitor the
safety and effectiveness of medication practices. This mechanism shall
be under the supervision of a person licensed to prescribe or dispense
prescription drugs, at least annually and as required by DBH.
iii. Contractor shall implement mechanisms to monitor appropriate and
timely intervention of occurrences that raise quality of care concerns.
The Contractor shall take appropriate follow-up action when such an
occurrence is identified. The results of the intervention shall be
evaluated by the Contractor at least annually and shared with the
County.
iv. Contractor shall assist County, as needed, with the development and
implementation of Corrective Action Plans.
v. Contractor shall collaborate with County to create a QI Work Plan with
documented annual evaluations and documented revisions as needed.
Revised 8/1/25
Exhibit C—Attachment D
Page 19 of 22
The QI Work Plan shall evaluate the impact and effectiveness of its
quality assessment and performance improvement program.
vi. Contractor shall attend and participate in the County's Quality
Improvement Committee (QIC) to recommend policy decisions, review
and evaluate results of QI activities, including PIPs, institute needed QI
actions, and ensure follow-up of QI processes. Contractor shall ensure
that there is active participation by the Contractor's practitioners and
providers in the QIC.
vii. Contractor shall participate, as required, in annual, independent
external quality reviews (EQR) of the quality, timeliness, and access to
the services covered under this Contract, which are conducted
pursuant to Subpart E of Part 438 of the Code of Federal Regulations.
(42 C.F.R. §§ 438.350(a) and 438.320)
b. Timely Access
i. Timely access standards include:
1. Contractor shall have hours of operation during which services
are provided to Medi-Cal individuals that are no less than the
hours of operation during which the provider offers services to
non-Medi-Cal individual s. If the Contractor's provider only
serves Medi-Cal beneficiaries, the provider shall provide hours
of operation comparable to the hours the provider makes
available for Medi-Cal services that are not covered by the
Agreement or another County.
2. Appointments data, including wait times for requested services,
shall be recorded and tracked by Contractor, and submitted to
the County on a monthly basis in a format 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.
Revised 8/1/25
Exhibit C—Attachment D
Page 20 of 22
4. Non-urgent non-psychiatry mental health services, including,
but not limited to Assessment, Targeted Case Management,
and Individual and Group Therapy appointments (for both adult
and children/youth) shall be made available to Medi-Cal
individuals within 10 business days from the date the individual
or a provider acting on behalf of the individual, requests an
appointment for a medically necessary service. Non-urgent
psychiatry appointments (for both adult and children/youth)
shall be made available to Medi-Cal individual s within 15
business days from the date the person served or a provider
acting on behalf of the individual, requests an appointment for a
medically necessary service.
5. Applicable appointment time standards may be extended if the
referring or treating provider has determined and noted in the
individual's record that a longer waiting period will not have a
detrimental impact on the health of the individual.
6. Periodic office visits to monitor and treat mental health
conditions may be scheduled in advance consistent with
professionally recognized standards of practice as determined
by the treating licensed mental health provider acting within the
scope of their practice.
c. Provider Application and Validation for Enrollment (PAVE)
i. Contractor shall ensure that all of its required clinical staff, who are
rendering SMHS to Medi-Cal individuals on behalf of Contractor, are
registered through DHCS' Provider Application and Validation for
Enrollment (PAVE) portal, pursuant to BHIN 20-071 requirements, the
21st 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,
Revised 8/1/25
Exhibit C—Attachment D
Page 21 of 22
Physician (MD and DO), Physician Assistant, Registered
Pharmacist/Pharmacist, Certified Pediatric/Family Nurse Practitioner,
Nurse Practitioner, Occupational Therapist, and Speech-Language
Pathologist. Interns, trainees, and associates are not eligible for
enrollment.
d. Physician Incentive Plan
i. If Contractor wants to institute a Physician Incentive Plan, Contractor
shall submit the proposed plan to the County which will in turn submit
the Plan to the State for approval, in accordance with the provisions of
42 C.F.R. § 438.6(c).
V. DATA, PRIVACY AND SECURITY REQUIREMENTS
a. Electronic Privacy and Security
i. Contractor shall have a secure email system and send any email
containing PII or PHI in a secure and encrypted manner. Contractor's
email transmissions shall display a warning banner stating that data is
confidential, systems activities are monitored and logged for
administrative and security purposes, systems use is for authorized
users only, and that users are directed to log off the system if they do
not agree with these requirements.
ii. Contractor shall institute compliant password management policies
and procedures, which shall include but not be limited to procedures
for creating, changing, and safeguarding passwords. Contractor shall
establish guidelines for creating passwords and ensuring that
passwords expire and are changed at least once every 90 days.
iii. Any Electronic Health Records (EHRs) maintained by Contractor that
contain PHI or PII for individuals served through this Agreement shall
contain a warning banner regarding the PHI or PII contained within the
EHR. Contractors that utilize an EHR shall maintain all parts of the
clinical record that are not stored in the EHR, including but not limited
to the following examples of person served signed documents:
discharge plans, informing materials, and health questionnaire.
Revised 8/1/25
Exhibit C—Attachment D
Page 22 of 22
iv. Contractor entering data into any County electronic systems shall
ensure that staff are trained to enter and maintain data within this
system.
VI. PROGRAM INTEGRITY
a. Credentialing and Re-credentialing of Providers
i. Contractor shall ensure that all of their network providers delivering
covered services, sign and date an attestation statement on a form
provided by County, in which each provider attests to the following:
1. Any limitations or inabilities that affect the provider's ability to
perform any of the position's essential functions, with or without
accommodation;
2. A history of loss of license or felony convictions;
3. A history of loss or limitation of privileges or disciplinary activity;
4. A lack of present illegal drug use; and
5. The application's accuracy and completeness
ii. Contractor shall file and keep track of attestation statements,
credentialing applications and credentialing status for all of their
providers and shall make those available to the County upon request
at any time.
iii. Contractor is required to sign an annual attestation statement at the
time of Agreement renewal in which they will attest that they will follow
County's Credentialing Policy and MHSUDS IN 18-019 and ensure that
all of their rendering providers are credentialed as per established
guidelines.
Revised 8/1/25
Exhibit C—Attachment E
Page 1 of 2
FRESNO COUNTY BEHAVIORAL HEALTH PLAN
COMPLIANCE PROGRAM CODE OF CONDUCT
All Fresno County Behavioral/Mental Health Employees, Contractors (including Contractor's
Employees/Subcontractors), Volunteers and Students will:
I. Read, acknowledge, and abide by this Code of Conduct.
II. 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.
III. 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.
IV. Practice good faith in transactions occurring during the course of business and never use or
exploit professional relationships or confidential information for personal purposes.
V. 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.
VI. 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.
VI I. 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.
VIII. 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
Revised 8/7/25
Exhibit C—Attachment E
Page 2 of 2
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.
IX. 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.
Revised 8/7/25
Exhibit C—Attachment F
Page 1 of 8
HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT (HIPAA)
BUSINESS ASSOCIATE AGREEMENT
I. County is a "Covered Entity," and 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 Contractor will create and/or receive Protected Health Information ("PHI")
from or on behalf of 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.
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.
Except as otherwise provided in this Agreement, Contractor, as a business associate of
County, may use or disclose Protected Health Information ("PHI") to perform functions, activities
or services for or on behalf of 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 County, as the "Covered Entity" under the HIPAA Rules,
except as authorized for management, administrative or legal responsibilities of Contractor.
II. Contractor, including its subcontractors and employees, shall protect from unauthorized
access, use, or disclosure of names and other identifying information, including genetic
information, concerning persons receiving services pursuant to this Agreement, except where
permitted in order to carry out data aggregation purposes for health care operations [45 CFR §§
164.504(e)(2)(i), 164.504(e)(2)(ii)(A), and 164.504(e)(4)(i)]. This pertains to any and all persons
receiving services pursuant to a County-funded program. This requirement applies to electronic
PHI. Contractor shall not use such identifying information or genetic information for any
purpose other than carrying out Contractor's obligations under this Agreement.
Revised 8/13/25
Exhibit C—Attachment F
Page 2 of 8
III. Contractor, including its subcontractors and employees, shall not disclose any such
identifying information or genetic information to any person or entity, except as otherwise
specifically permitted by this Agreement, authorized by Subpart E of 45 CFR Part 164 or other
law, required by the Secretary of the United States Department of Health and Human Services
("Secretary"), or authorized by the client/patient in writing. In using or disclosing PHI that is
permitted by this Agreement or authorized by law, Contractor shall make reasonable efforts to
limit PHI to the minimum necessary to accomplish intended purpose of use, disclosure or
request.
IV. 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 fingerprint or voiceprint, or photograph.
V. For purposes of the above sections, genetic information shall include genetic tests of
family members of an individual or individual(s), manifestation of disease or disorder of family
members of an individual, or any request for or receipt of genetic services by individual or family
members. Family member means a dependent or any person who is first, second, third, or
fourth degree relative.
VI. Contractor shall provide access, at the request of County, and in the time and manner
designated by County, to PHI in a designated record set (as defined in 45 CFR§ 164.501), to
an individual or to County in order to meet the requirements of 45 CFR § 164.524 regarding
access by individuals to their PHI. With respect to individual requests, access shall be provided
within thirty (30) days from request. Access may be extended if Contractor cannot provide
access and provides the individual with the reasons for the delay and the date when access
may be granted. PHI shall be provided in the form and format requested by the individual or
County.
Contractor shall make any amendment(s) to PHI in a designated record set at the
request of County or individual, and in the time and manner designated by County in
accordance with 45 CFR § 164.526.
Contractor shall provide to County or to an individual, in a time and manner designated
by County, information collected in accordance with 45 CFR§ 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§ 164.528.
VII. Contractor shall report to County, in writing, any knowledge or reasonable belief that
there has been unauthorized access, viewing, use, disclosure, security incident, or breach of
unsecured PHI not permitted by this Agreement of which Contractor becomes aware,
Revised 8/13/25
Exhibit C—Attachment F
Page 3 of 8
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 County's Department of Public Health ("DPH") HIPAA Representative, within
two (2) business days of discovery. The notification shall include, to the extent possible, the
identification of each individual whose unsecured PHI has been, or is reasonably believed to
have been, accessed, acquired, used, disclosed, or breached. Contractor shall take prompt
corrective action to cure any deficiencies and any action pertaining to such unauthorized
disclosure required by applicable federal and State laws and regulations. Contractor shall
investigate such breach and is responsible for all notifications required by law and regulation or
deemed necessary by County and shall provide a written report of the investigation and
reporting required to County's Information Security Officer and Privacy Officer and County's
DPH 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 Office of Information Security
HIPAA Representative Privacy Officer Chief Information Security Officer
(559) 600-6439 (559) 600-6405 (559) 600-5810
P.O. Box 11867 P.O. Box 11867 333 W. Pontiac Way
Fresno, California 93775 Fresno, California 93775 Clovis CA, 93612
Vill. Contractor shall make its internal practices, books, and records relating to the use and
disclosure of PHI received from County, or created or received by Contractor on behalf of
County, in compliance with Parts the HIPAA Rules. Contractor shall make its internal practices,
books, and records relating to the use and disclosure of PHI received from County, or created or
received by Contractor on behalf of County, available to the Secretary upon demand. Contractor
shall cooperate with the compliance and investigation reviews conducted by the Secretary. PHI
access to the Secretary must be provided during Contractor's normal business hours; however,
upon exigent circumstances access at any time must be granted. Upon the Secretary's
compliance or investigation review, if PHI is unavailable to Contractor and in possession of a
subcontractor of Contractor, Contractor must certify to the Secretary its efforts to obtain the
information from the subcontractor.
IX. Safeguards
Revised 8/13/25
Exhibit C—Attachment F
Page 4 of 8
Contractor shall implement administrative, physical, and technical safeguards as
required by the HIPAA Security Rule, Subpart C of 45 CFR Part 164, 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
unauthorized access, viewing, use, disclosure, or breach of PHI other than as provided for by
this Agreement. Contractor shall conduct an accurate and thorough assessment of the potential
risks and vulnerabilities to the confidentiality, integrity and availability of electronic PHI.
Contractor shall develop and maintain a written information privacy and security program that
includes administrative, technical and physical safeguards appropriate to the size and
complexity of Contractor's operations and the nature and scope of its activities. Upon County's
request, Contractor shall provide County with information concerning such safeguards.
Contractor shall implement strong access controls and other security safeguards and
precautions in order to restrict logical and physical access to confidential, personal (e.g., PHI) or
sensitive data to authorized users only. Said safeguards and precautions shall include the
following administrative and technical password controls for all systems used to process or store
confidential, personal, or sensitive data:
a. Passwords must not be:
i. Shared or written down where they are accessible or recognizable by
anyone else; such as taped to computer screens, stored under keyboards, or visible
in a work area;
ii. A dictionary word; or
iii. Stored in clear text
b. Passwords must be:
i. Eight (8) characters or more in length;
ii. Changed every ninety (90) days;
iii. Changed immediately if revealed or compromised; and
iv. Composed of characters from at least three (3) of the following four (4)
groups from the standard keyboard:
1. Upper case letters (A-Z);
2. Lowercase letters (a-z);
3. Arabic numerals (0 through 9); and
4. Non-alphanumeric characters (punctuation symbols).
Contractor shall implement the following security controls on each workstation or
portable computing device (e.g., laptop computer) containing confidential, personal, or sensitive
Revised 8/13/25
Exhibit C—Attachment F
Page 5 of 8
data:
a. Network-based firewall and/or personal firewall;
b. Continuously updated anti-virus software; and
c. Patch management process including installation of all operating
system/software vendor security patches.
Contractor shall utilize a commercial encryption solution that has received FIPS 140-2
validation to encrypt all confidential, personal, or sensitive data stored on portable electronic
media (including, but not limited to, compact disks and thumb drives) and on portable computing
devices (including, but not limited to, laptop and notebook computers).
Contractor shall not transmit confidential, personal, or sensitive data via e-mail or other
internet transport protocol unless the data is encrypted by a solution that has been validated by
the National Institute of Standards and Technology (NIST) as conforming to the Advanced
Encryption Standard (AES)Algorithm. Contractor must apply appropriate sanctions against its
employees who fail to comply with these safeguards. Contractor must adopt procedures for
terminating access to PHI when employment of employee ends.
X. Mitigation of Harmful Effects
Contractor shall mitigate, to the extent practicable, any harmful effect that is suspected
or known to Contractor of an unauthorized access, viewing, use, disclosure, or breach of PHI by
Contractor or its subcontractors in violation of the requirements of these provisions. Contractor
must document suspected or known harmful effects and the outcome.
XI. Contractor's Subcontractors
Contractor shall ensure that any of its contractors, including subcontractors, if applicable,
to whom Contractor provides PHI received from or created or received by Contractor on behalf
of County, agree to the same restrictions, safeguards, and conditions that apply to Contractor
with respect to such PHI and to incorporate, when applicable, the relevant provisions of these
provisions into each subcontract or sub-award to such agents or subcontractors.
Nothing in this section XI or this exhibit authorizes Contractor to perform services under
this Agreement using subcontractors.
XII. Employee Training and Discipline
Contractor shall train and use reasonable measures to ensure compliance with the
requirements of these provisions by employees who assist in the performance of functions or
activities on behalf of County under this Agreement and use or disclose PHI, and discipline such
employees who intentionally violate any provisions of these provisions, which may include
termination of employment.
Revised 8/13/25
Exhibit C—Attachment F
Page 6 of 8
XIII. Termination for Cause
Upon County's knowledge of a material breach of these provisions by Contractor,
County will either:
a. Provide an opportunity for Contractor to cure the breach or end the violation,
and County may terminate this Agreement if Contractor does not cure the
breach or end the violation within the time specified by County; or
b. Immediately terminate this Agreement if Contractor has breached a material
term of this exhibit and cure is not possible, as determined by County.
c. If neither cure nor termination is feasible, County's Privacy Officer will report the
violation to the Secretary of the U.S. Department of Health and Human
Services.
XIV. Judicial or Administrative Proceedings
County may terminate this Agreement if: (1) Contractor is found guilty in a criminal
proceeding for a violation of the HIPAA Privacy or Security Laws or the HITECH Act; or (2) there
is a finding or stipulation in an administrative or civil proceeding in which Contractor is a party
that Contractor has violated a privacy or security standard or requirement of the HITECH Act,
HIPAA or other security or privacy laws.
XV. Effect of Termination
Upon termination or expiration of this Agreement for any reason, Contractor shall return
or destroy all PHI received from County (or created or received by Contractor on behalf of
County) that Contractor still maintains in any form, and shall retain no copies of such PHI. If
return or destruction of PHI is not feasible, Contractor 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 applies to PHI that is in the
possession of subcontractors or agents, if applicable, of Contractor. If Contractor destroys the
PHI data, a certification of date and time of destruction shall be provided to County by
Contractor.
XVI. Compliance with Other Laws
To the extent that other state and/or federal laws provide additional, stricter and/or more
protective privacy and/or security protections to PHI or other confidential information covered
under this BAA, Contractor agrees to comply with the more protective of the privacy and
security standards set forth in the applicable state or federal laws to the extent such standards
provide a greater degree of protection and security than HIPAA Rules or are otherwise more
favorable to the individual.
Revised 8/13/25
Exhibit C—Attachment F
Page 7 of 8
XVII. Disclaimer
County makes no warranty or representation that compliance by Contractor with these
provisions, the HITECH Act, or the HIPAA Rules, will be adequate or satisfactory for
Contractor's own purposes or that any information in Contractor's possession or control, or
transmitted or received by Contractor, is or will be secure from unauthorized access, viewing,
use, disclosure, or breach. Contractor is solely responsible for all decisions made by Contractor
regarding the safeguarding of PHI.
XVIII. Amendment
The parties acknowledge that Federal and State laws relating to electronic data security
and privacy are rapidly evolving and that amendment of this exhibit may be required to provide
for procedures to ensure compliance with such developments. The parties specifically agree to
take such action as is necessary to amend this agreement in order to implement the standards
and requirements of the HIPAA Rules, the HITECH Act and other applicable laws relating to the
security or privacy of PHI. County may terminate this Agreement upon thirty (30) days written
notice in the event that Contractor does not enter into an amendment providing assurances
regarding the safeguarding of PHI that County in its sole discretion, deems sufficient to satisfy
the standards and requirements of the HIPAA Rules, and the HITECH Act.
XIX. No Third-Party Beneficiaries
Nothing expressed or implied in the provisions of this exhibit is intended to confer, and
nothing in this exhibit does confer, upon any person other than County or Contractor and their
respective successors or assignees, any rights, remedies, obligations or liabilities whatsoever.
XX. Interpretation
The provisions of this exhibit shall be interpreted as broadly as necessary to implement
and comply with the HIPAA Rules, 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 the HIPAA Rules.
XXI. Regulatory References
A reference in the terms and conditions of these provisions to a section in the HIPAA
Rules means the section as in effect or as amended.
XXII. Survival
The respective rights and obligations of Contractor as stated in this exhibit survive the
termination or expiration of this Agreement.
XXIII. No Waiver of Obligation
Change, waiver or discharge by County of any liability or obligation of Contractor under
Revised 8/13/25
Exhibit C—Attachment F
Page 8 of 8
this exhibit on any one or more occasions is not a waiver of performance of any continuing or
other obligation of Contractor and does not prohibit enforcement by County of any obligation on
any other occasion.
Revised 8/13/25
Exhibit C -Attachment G
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 G
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 12
FRESNO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH
FINANCIAL TERMS AND CONDITIONS
Fresno County Department of Behavioral Health is committed to ensuring timely and
accurate compensation for the delivery of services in our communities and fulfilling all
associated responsibilities of the funding sources related to this Agreement. This document
provides guidance on this Agreement's financial terms and conditions, responsibilities of each
party, which includes but not limited to, maximum compensation, compensation structure,
invoicing, payments, billing, recoupments, audits, reviews, examinations, and other fiscal related
requirements.
I. Compensation
The County agrees to pay, and the Contractor agrees to receive, compensation in
accordance with each individual Contractor's rates of reimbursement set forth in in each
individual Contractor's Exhibit D Sub-Part.
a. Maximum Compensation
The maximum compensation payable to the Contractor under this Agreement for the
period of January 1, 2026 through June 30, 2026 is Eleven Million and No/100 Dollars
($11,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered
and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2026 through June 30, 2027 is Eleven Million Five Hundred Thousand and
No/100 Dollars ($11,500,000.00), which is not a guaranteed sum but shall be paid only for
services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2027 through June 30, 2028 is Twelve Million and No/100 Dollars
($12,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered
and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2028 through June 30, 2029 is Twelve Million Five Hundred Thousand and
No/100 Dollars ($12,500,000.00), which is not a guaranteed sum but shall be paid only for
services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2029 through June 30, 2030 is Thirteen Million and No/100 Dollars
($13,000,000.00), which is not a guaranteed sum but shall be paid only for services rendered
and received.
Exhibit D
Page 2 of 12
b. Total Maximum Compensation.
In no event shall the maximum contract amount for all the services provided by the
Contractor to County under the terms and conditions of this Agreement be in excess of Sixty
Million and No/100 Dollars ($60,000,000.00) during the entire term of this Agreement.
The Contractor acknowledges that the County is a local government entity, and does so
with notice that the County's powers are limited by the California Constitution and by State law,
and with notice that the Contractor may receive compensation under this Agreement only for
services performed according to the terms of this Agreement and while this Agreement is in
effect, and subject to the maximum amount payable under this section.
The Contractor further acknowledges that County employees have no authority to pay
the Contractor except as expressly provided in this Agreement.
The hourly rate found in each Contractor respective rates sheet shall be prorated on a
sixty (60) minute basis in the event the psychiatric provider does not provide the full eight (8)
hours of service each day to the Department. Overtime hours must be approved in advance in
writing by County and are subject to each Contractor's respective rate sheet. County shall only
pay for actual hours worked by referred psychiatric providers. County shall not pay Contractor
when their psychiatric provider takes time off for vacation, sick leave, or in the event the
psychiatric provider works during any unauthorized time. Further, in the event that the
psychiatric provider leaves incomplete documentation, County may withhold signature on the
psychiatric provider's time sheet until such documentation is completed, provided that County
has trained the psychiatric provider on County's medical records system, County has provided
psychiatric provider with ample time during each shift to complete necessary documentation,
and County provides Contractor with at least two (2) weeks' written notice of such incomplete
documentation and County's intent to withhold signature, County shall inform Contractor a
reasonable time prior to the end of the psychiatric provider's assignment of any incomplete
person served charts so that Contractor has the opportunity to resolve the issue prior to the
psychiatric provider's departure.
II. Invoices
The Contractor shall submit monthly invoices to, in arrears by the fifteenth (151") day of each
month, in the format directed by County. The Contractor shall submit invoices electronically to:
1) dbhinvoicereview@fresnocountyca.gov;
2) dbh-invoices@fresnocountyca.gov; and
3) the assigned County's DBH Staff Analyst.
At the discretion of County's DBH Director or designee, if an invoice is incorrect or is
Exhibit D
Page 3 of 12
otherwise not in proper form or substance, County's DBH Director, or designee, shall have the
right to withhold payment as to only the portion of the invoice that is incorrect or improper after
five (5) days prior notice to Contractor. Contractor agrees to continue to provide services for a
period of ninety (90) days after notification of an incorrect or improper invoice. If after the ninety
(90) day period, the invoice is still not corrected to County's satisfaction, County's DBH Director,
or designee, may elect to terminate this Agreement, pursuant to the termination provisions
stated in Article 6 of this Agreement. If County's DBH does not provide notice of incorrect or
otherwise improper invoices and causes delay in the reimbursement process, Contractor will
follow the escalation process through the County's DBH Finance Division's Invoice Review
Team, up to the DBH Finance Division Manager, and including the County's DBH Director
and/or designee for the timely reimbursement of payment to Contractor.
Withholdings to an invoice by County's DBH shall be addressed by the Contractor and/or
Contractor shall communicate any delays in resolving the incorrect or improper form with
County's DBH within ninety (90) days of receiving notice or the withholdings will stand in
perpetuity, or subject to County's discretion.
All final invoices for any fiscal year shall be submitted by Contractor within one hundred and
twenty (120) days following the final month for which payment is claimed in that fiscal year. No
action may be taken by County on any invoices submitted after one hundred and twenty (120)
days of the end of the fiscal year where services are performed.
III. Payment
Payments shall be made by County to Contractor in arrears, for services provided during the
preceding month, within forty-five (45) days after the date of receipt, verification, and approval
by County. All final invoices shall be submitted by Contractor within one hundred and twenty
(120) days following the final month of service for which payment is claimed for each fiscal year.
No action shall be taken by County on claims submitted beyond the one hundred and twenty
(120) day closeout period of each fiscal year. Any compensation which is not expended by
Contractor pursuant to the terms and conditions of this Agreement shall automatically revert to
County.
Payments shall be made upon certification or other proof satisfactory to the County that
services have been performed or actual expenditures incurred by the Contractor, as specified in
this Agreement.
a. Incidental Expenses.
Exhibit D
Page 4 of 12
The Contractor is solely responsible for all of its costs and expenses that are not
specified as payable by the County under this Agreement. If Contractor fails to comply with any
provision of this Agreement, County shall be relieved of its obligation for further compensation.
IV. Specialty Mental Health Services Claiming Responsibilities
Contractor shall enter claims data into the County's EHR/billing and transactional database
system using the California Mental Health Services Authority (CaIMHSA) Smart Care Procedure
Codes (available at nttps://2023.calmhsa.org/procedure-code-definitions/) by the fifteenth (15m)
of every month for actual services rendered in the previous month. County's EHR/billing and
transactional database system will convert the CaIMHSA Procedure Codes to Current
Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS)
codes, as provided in the DHCS Billing Manual available at
https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx, as from time to time
amended.
Claims shall be complete and accurate and must include all required information regarding
the claimed services. Claims data entry into the County's EHR system shall be the responsibility
of Contractor. County shall monitor the volume of services, billing amounts and service types
entered into County's EHR system.Any and all audit exceptions resulting from the provision and
reporting of specialty mental health services by Contractor shall be the sole responsibility of
Contractor. Contractor will comply with all applicable policies, procedures, directives, and
guidelines regarding the use of County's EHR/information system.
Contractor must provide all necessary data to allow County to bill Medi-Cal for services and
meet State and Federal reporting requirements. The necessary data can be provided by a
variety of means, including but not limited to: 1) direct data entry into County's electronic health
record/information system; 2) providing an electronic file compatible with County's electronic
health record/information system; or 3) integration between County's electronic health
record/information system and Contractor's information system(s). Contractor shall maximize
the Federal Financial Participation (FFP) reimbursement by claiming all possible Medi-Cal
services and correcting denied services for resubmission as needed.
If a person served has dual coverage, such as other health coverage (OHC) or Federal
Medicare, Contractor will be responsible for billing the carrier and obtaining a payment/denial or
have validation of claiming with no response for ninety (90) days after the claim was mailed
Contractor must report all third-party collections for Medicare, third-party or client-pay or private-
pay in each month.A copy of an explanation of benefits or CMS 1500 form (if no response is
received from the carrier after 90 days from date of submission of the CMS 1500) is required as
Exhibit D
Page 5 of 12
documentation. Contractor must comply with all laws and regulations governing the Federal
Medicare program, including, but not limited to: 1)the requirement of the Medicare Act, 42
U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the Federal Centers
for Medicare and Medicaid Services as they relate to participation, coverage and claiming
reimbursement. To the extent they are applicable, Contractor will be responsible for compliance
as of the effective date of each Federal, State or local law or regulation specified.
V. Recoupments, Audits, Reviews, and Examinations
County shall recapture from Contractor the value of any services or other expenditures
determined to be ineligible based on the County or State monitoring results. The County
reserves the right to enter into a repayment agreement with Contractor, with the term of the
repayment agreement not to exceed twelve (12) months from the date of the repayment
agreement, to recover the amount of funds to be recouped. The County has the discretion to
extend the term of repayment plan up to a total of twenty-four (24) months from the date of the
repayment Agreement. The repayment agreement may be made with the signed written
approval of County's DBH Director, or designee, and respective Contractor through a
repayment Agreement. The monthly repayment amounts may be netted against the Contractor's
monthly billing for services rendered during the month, or the County may, in its sole discretion,
forego a repayment agreement and recoup all funds immediately. This remedy is not exclusive,
and County may seek requital from any other means, including, but not limited to, a separate
agreement with Contractor.
a. Reasons for Recoupment.
County will conduct periodic audits of Contractor files to ensure appropriate high quality
service provision and compliance with applicable federal, state and county or other funding
source regulations.
Such audits may result in requirements for Contractor to reimburse County for services
previously paid in the following circumstances:
i. 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
ii. Overpayment of Contractor by County due to errors in documentation.
Exhibit D
Page 6 of 12
Contractor shall reimburse County for all overpayments identified by Contractor, County,
and/or state or federal oversight agencies as an audit exception within the timeframes required
by law or Country or state or federal agency. Funds owed to County will be due within forty-five
(45) days of notification by County, or County shall withhold future payments until all excess
funds have been recouped by means of an offset against any payments then or thereafter owing
to County under this or any other Agreement between the County and Contractor.
b. Confidentiality in Audit/Review Process.
Contractor and County mutually agree to maintain the confidentiality of Contractor's
records and information of persons served, in compliance with all applicable State and Federal
statutes and regulations, including but not limited to HIPAA and California Welfare and
Institutions Code, Section 5328. Contractor shall inform all of its officers, employees, and agents
of the confidentiality provisions of all applicable statutes.
Contractor's fiscal records shall contain sufficient data to enable auditors to perform a
complete audit and shall be maintained in conformance with standard procedures and
accounting principles.
Contractor's records shall be maintained as required by DBH and DHCS on forms
furnished by DHCS or the County. All statistical data or information requested by the County's
DBH Director, or designee shall be provided by the Contractor in a complete and timely manner.
c. Cooperation with Audits/Reviews.
Contractor shall cooperate with County in any review and/or audit initiated by County,
DHCS, or any other applicable regulatory body. This cooperation may include such activities as
onsite program, fiscal, or chart reviews and/or audits.
In addition, Contractor shall comply with all requests for any documentation or files
including, but not limited to, files for persons served and personnel files.
Contractor shall notify the County of any scheduled or unscheduled external evaluation
or site visits when it becomes aware of such visit. County shall reserve the right to attend any or
all parts of external review processes.
Contractor shall allow inspection, evaluation and audit of its records, documents and
facilities for ten (10) years from the term end date of this Agreement or in the event Contractor
has been notified that an audit or investigation of this Agreement has been commenced, until
such time as the matter under audit or investigation has been resolved, including the exhaustion
of all legal remedies, whichever is later pursuant to 42 C.F.R.§§438.3(h) and 438.2301(3)(i-iii).
d. Single Audit Clause
Exhibit D
Page 7 of 12
If Contractor expends One Million and No/100 Dollars ($1,000,000.00) or more in
Federal and Federal flow-through monies, Contractor agrees to conduct an annual audit in
accordance with the requirements of the Single Audit Standards as set forth in Office of
Management and Budget (OMB) 2 CFR 200. Contractor shall submit said audit and
management letter to County. The audit must include a statement of findings or a statement that
there were no findings. If there were negative findings, Contractor must include a corrective
action plan signed by an authorized individual. Contractor agrees to take action to correct any
material non-compliance or weakness found as a result of such audit. Such audit shall be
delivered to County's DBH Finance Division for review within nine (9) months of the end of any
fiscal year in which funds were expended and/or received for the program. Failure to perform
the requisite audit functions as required by this Agreement may result in County performing the
necessary audit tasks, or at County's option, contracting with a public accountant to perform
said audit, or may result in the inability of County to enter into future agreements with
Contractor. All audit costs related to this Agreement are the sole responsibility of Contractor.
A single audit report is not applicable if Contractor's Federal contracts do not exceed the
One Million and No/100 Dollars ($1,000,000.00) requirement. If a single audit is not applicable,
a program audit must be performed and a program audit report with management letter shall be
submitted by Contractor to County as a minimum requirement to attest to Contractor's solvency.
Said audit report shall be delivered to County's DBH Finance Division for review no later than
nine (9) months after the close of the fiscal year in which the funds supplied through this
Agreement are expended. Failure to comply with this Act may result in County performing the
necessary audit tasks or contracting with a qualified accountant to perform said audit. All audit
costs related to this Agreement are the sole responsibility of Contractor who agrees to take
corrective action to eliminate any material noncompliance or weakness found as a result of such
audit. Audit work performed by County under this paragraph shall be billed to Contractor at
County cost, as determined by County's Auditor-Controller/Treasurer-Tax Collector.
Contractor shall make available all records and accounts for inspection by County, the
State of California, if applicable, the Controller General of the United States, the Federal Grantor
Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other
pending matters, whichever is later.
e. Financial Audit Report Requirements for Pass-Through Entities
If County determines that Contractor is a "subrecipient" (also known as a "pass-through
entity") as defined in 2 C.F.R. § 200 et seq., Contractor represents that it will comply with the
Exhibit D
Page 8 of 12
applicable cost principles and administrative requirements including claims for payment or
reimbursement by County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time
to time. Contractor shall observe and comply with all applicable financial audit report
requirements and standards.
Financial audit reports must contain a separate schedule that identifies all funds included
in the audit that are received from or passed through the County. County programs must be
identified by Agreement number, Agreement amount, Agreement period, and the amount
expended during the fiscal year by funding source.
Contractor will provide a financial audit report including all attachments to the report and
the management letter and corresponding response within six months of the end of the audit
year to the County's DBH Director or designee. The County's Director or designee is
responsible for providing the audit report to the County Auditor.
Contractor must submit any required corrective action plan to the County simultaneously
with the audit report or as soon thereafter as it is available. The County shall monitor
implementation of the corrective action plan as it pertains to services provided pursuant to this
Agreement.
In the event this Agreement is terminated, Contractor shall be entitled to compensation
for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant to the terms
and conditions of this Agreement through and including the effective date of termination. This
provision shall not limit or reduce any damages owed to the County due to a breach of this
Agreement by Contractor.
VI. Property of County
This section shall only apply to the program components and services provided under
Cost Reimbursement. County and Contractor recognize that fixed assets are tangible and
intangible property obtained or controlled under County for use in operational capacity and will
benefit County for a period more than one (1) year.
a. Agreement Assets
Assets shall be tracked on an agreement-by-agreement basis. All assets shall fall into
the "Equipment" category unless funding source allows for additional types of assets. Items of
sensitive nature shall be purchased and allocated to a single agreement. All items containing
Health Insurance Portability and Accountability Act (HIPAA)/Protected Health Information (PHI)
data are considered sensitive. At a minimum, the following types of items are considered to be
assets:
i. Computers (desktops and laptops);
Exhibit D
Page 9 of 12
ii. Copiers, cell phones, tablets, and other devices with any HIPAA data
iii. Modular furniture
iv. Land
V. Any items over$5,000
vi. Items of$500 or more with a Iifespan of at least two (2) years:
1. Televisions
2. Washers/Dryers
3. Printers
4. Digital Cameras;
5. Other equipment/furniture
6. Items in total when purchased or used as a group fall into one or more of
the above categories
Contractor shall ensure proper tracking for contact assets that include the following
asset attributes at a minimum:
i. Description of the asset;
ii. The unique identifier of the asset if applicable, i.e., serial number;
iii. The acquisition date;
iv. The quantity of the asset;
V. The location of the asset or to whom the asset is assigned;
vi. The cost of the asset at the time of acquisition;
vii. The source of grant funding if applicable;
viii. The disposition date, and
ix. The method of disposition (surplus, transferred, destroyed, lost).
b. Retention and Maintenance
Assets shall be retained by County, as County property, in the event this Agreement is
terminated or upon expiration of this Agreement. Contractor agrees to participate in an annual
inventory of all County fixed and inventoried assets. Upon termination or expiration of this
Agreement, Contractor shall be physically present when fixed and inventoried assets are
returned to County possession. Contractor is responsible for returning to County all County
owned undepreciated fixed and inventoried assets, or the monetary value of said assets if
unable to produce the assets at the expiration or termination of this Agreement. Contractor
further agrees to the following:
i. Maintain all items of equipment in good working order and condition, normal wear
and tear excepted;
Exhibit D
Page 10 of 12
ii. Label all items of equipment with County assigned program number, to perform
periodic inventories as required by County and to maintain an inventory list
showing where and how the equipment is being used in accordance with
procedures developed by County. All such lists shall be submitted to County
within ten (10) days of any request therefore; and
iii. Report in writing to County immediately after discovery, the loss or theft of any
items of equipment. For stolen items, the local law enforcement agency must be
contacted, and a copy of the police report submitted to County.
c. Equipment Purchase
The purchase of any equipment by Contractor with funds provided hereunder shall
require the prior written approval of County's DBH Director or designee, shall fulfill the
provisions of this Agreement as appropriate, and must be directly related to Contractor's
services or activity under the terms of this Agreement. County may refuse reimbursement for
any costs resulting from equipment purchased, which are incurred by Contractor, if prior written
approval has not been obtained from County.
d. Modification of Assets
Contractor must obtain prior written approval from County's DBH whenever there is any
modification or change in the use of any property acquired or improved, in whole or in part,
using funds under this Agreement. If any real or personal property acquired or improved with
said funds identified herein is sold and/or is utilized by Contractor for a use which does not
qualify under this Agreement, Contractor shall reimburse County in an amount equal to the
current fair market value of the property, less any portion thereof attributable to expenditures of
funds not provided under this Agreement. These requirements shall continue in effect for the life
of the property. In the event this Agreement expires, the requirements for this paragraph shall
remain in effect for activities or property funded with said funds, unless action is taken by the
State government to relieve County of these obligations.
VII. Other Financial Requirements
a. Notification of Changes
Contractor shall notify County in writing of any change in organizational name, Head of
Service or principal business at least fifteen (15) business days in advance of the change.
Contractor shall notify County of a change of service location at least six (6) months in advance
to allow County sufficient time to comply with site certification requirements. Said notice shall
become part of this Agreement upon acknowledgment in writing by the County, and no further
Exhibit D
Page 11 of 12
amendment of this Agreement shall be necessary provided that such change of address does
not conflict with any other provisions of this Agreement.
Contractor must immediately notify County of a change in ownership, organizational
status, licensure, or ability of Contractor to provide the quantity or quality of the contracted
services in no event more than fifteen (15) days of the change.
b. Record Maintenance
Contractor shall maintain all records and management books pertaining to service
delivery and demonstrate accountability for agreement performance and maintain all fiscal,
statistical, and management books and records pertaining to the program. Records should
include, but not be limited to, monthly summary sheets 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.
Contractor shall comply with all Federal, State and County laws, rules and regulations
regarding relinquishing or maintaining medical records.
Contractor shall agree to maintain and retain all appropriate service and financial
records for a period of at least ten (10) years from the date of final payment, the final date of this
Agreement, final settlement, or until audit findings are resolved, whichever is later.
c. Financial Reports
Contractor shall submit audited financial reports on an annual basis to the County. The
audit shall be conducted in accordance with Generally Accepted Accounting Principles and
generally accepted auditing standards.
d. Agreement Termination
In the event this Agreement is terminated, ends its designated term, or Contractor
ceases operation of its business, Contractor shall deliver or make available to County all
financial records that may have been accumulated by Contractor or subcontractor under this
Agreement, whether completed, partially completed or in progress within seven (7) calendar
days of said termination/end date.
Exhibit D
Page 12 of 12
e. 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.
Funding is provided by fiscal year. Any unspent fiscal year appropriation does not roll
over and is not available for services provided in subsequent years.
In the event that funding for these services is delayed by the State Controller, County
may defer payments to Contractor. The amount of the deferred payment shall not exceed the
amount of funding delayed by the State Controller to the County. The period of time of the
deferral by County shall not exceed the period of time of the State Controller's delay of payment
to County plus forty-five (45) days.
f. Additional Financial Requirements
Contractor must comply with the False Claims Act employee training and policy
requirements set forth in 42 U.S.C. 1396a(a)(68) and as the Secretary of the United States
Department of Health and Human Services may specify.
Contractor agrees that no part of any federal funds provided under this Agreement shall
be used to pay the salary of an individual per fiscal year at a rate in excess of Level 1 of the
Executive Schedule at https://www.opm.gov/ (U.S. Office of Personnel Management), as from
time to time amended.
Contractor must maintain financial records for a minimum period of ten (10) years or until
any dispute, audit or inspection is resolved, whichever is later. Contractor will be responsible for
any disallowances related to inadequate documentation.
g. Contractor Prohibited from Redirection of Contracted Funds
Contractor may not redirect or transfer funds from one funded program to another
funded program under which Contractor provides services pursuant to this Agreement except
through a duly executed amendment to this Agreement.
Contractor may not charge services delivered to an eligible person served under one
funded program to another funded program unless the person served is also eligible for services
under the second funded program.
Exhibit D-1
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: Aequor Healthcare Services, LLC
• - • •
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 300 $ 385 $ 300 $ 405 $ 185 $ 215 $ 300 $ 315
2026-27 $ 300 $ 399 $ 300 $ 415 $ 195 $ 225 $ 305 $ 335
2027-28 $ 315 $ 405 $ 315 $ 420 $ 200 $ 230 $ 315 $ 350
2028-29 $ 325 $ 425 $ 325 $ 445 $ 205 $ 240 $ 325 $ 360
2029-30 $ 335 $ 445 $ 335 $ 450 $ 210 $ 250 $ 335 $ 373
TELEHEALTH PROVIDER HOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 230 $ 280 $ 250 $ 280 $ 175 $ 210 $ 300 $ 315
2026-27 $ 235 $ 286 $ 255 $ 295 $ 180 $ 218 $ 305 $ 335
2027-28 $ 240 $ 295 $ 245 $ 305 $ 195 $ 220 $ 315 $ 350
2028-29 $ 245 $ 300 $ 255 $ 310 $ 200 $ 225 $ 325 $ 360
2029-30 $ 250 $ 310 $ 260 $ 325 $ 225 $ 235 $ 335 $ 373
11/4/2025
Exhibit D-2
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: Aloha Psychiatry, Inc.
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 -- -- -- -- -- --
2026-27 -- -- -- -- --
2027-28 -- -- -- -- -- --
2028-29 -- -- -- -- --
2029-30 -- -- -- -- -- --
TELEHEALTH PROVIDER HOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 260 $ 275 $ 266 $ 279 $ 170 $ 193 $ 285 $ 318
2026-27 $ 268 $ 283 $ 274 $ 288 $ 175 $ 199 $ 294 $ 328
2027-28 $ 276 $ 292 $ 282 $ 296 $ 180 $ 205 $ 302 $ 337
2028-29 $ 284 $ 300 $ 291 $ 305 $ 186 $ 211 $ 311 $ 348
2029-30 $ 293 $ 310 $ 300 $ 315 $ 191 $ 217 $ 321 $ 358
11/4/2025
Exhibit D-3
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: Amergis Healthcare Staffing, Inc.
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 -- $ 330 -- $ 380 -- $ 195 -- $ 320
2026-27 -- $ 340 -- $ 391 -- $ 201 -- $ 330
2027-28 -- $ 350 -- $ 403 -- $ 207 -- $ 339
2028-29 -- $ 361 -- $ 415 -- $ 213 -- $ 350
2029-30 -- $ 371 -- $ 428 -- $ 219 -- $ 360
TELEHEALTH PROVIDER HOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 -- $ 275 -- $ 280 -- $ 166 -- $ 275
2026-27 -- $ 283 -- $ 288 -- $ 171 -- $ 283
2027-28 -- $ 292 -- $ 297 -- $ 176 -- $ 292
2028-29 -- $ 300 -- $ 306 -- $ 181 -- $ 300
2029-30 -- $ 310 -- $ 315 -- $ 187 -- $ 310
11/4/2025
Exhibit D-4
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: Dr. John L. Schaeffer, Inc. dba American Telepsychiatrists
ONSITE PROVIDER •
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 -- -- -- -- -- --
2026-27 -- -- -- -- --
2027-28 -- -- -- -- -- --
2028-29 -- -- -- -- --
2029-30EL TELEHEALTH-- -- -- -- -- --
PROVIDER HOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 250 $ 261 $ 275 $ 289 -- $ 223 Included Included
2026-27 $ 258 $ 269 $ 283 $ 298 -- $ 230 Included Included
2027-28 $ 266 $ 277 $ 291 $ 307 -- $ 237 Included Included
2028-29 $ 274 $ 285 $ 300 $ 316 -- $ 244 Included Included
2029-30 $ 282 $ 294 $ 309 $ 326 -- $ 251 Included Included
11/4/2025
Exhibit D-5
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: ExMed, Inc.
ONSITE PROVIDER •
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 377 $ 399 $ 389 $ 409 $ 199 $ 219 $ 315 $ 335
2026-27 $ 388 $ 411 $ 400 $ 421 $ 205 $ 225 $ 325 $ 345
2027-28 $ 399 $ 423 $ 412 $ 434 $ 211 $ 232 $ 335 $ 355
2028-29 $ 408 $ 431 $ 420 $ 442 $ 215 $ 237 $ 346 $ 366
2029-30 $ 416 $ 440 $ 429 $ 451 $ 219 $ 241 $ 357 $ 377
TELEHEALTH PROVIDER HOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 249 $ 261 $ 259 $ 279 $ 190 $ 209 $ 315 $ 335
2026-27 $ 256 $ 269 $ 266 $ 287 $ 196 $ 215 $ 325 $ 345
2027-28 $ 264 $ 276 $ 274 $ 296 $ 201 $ 222 $ 335 $ 355
2028-29 $ 269 $ 282 $ 280 $ 301 $ 205 $ 226 $ 346 $ 366
2029-30 $ 275 $ 288 $ 285 $ 308 $ 209 $ 230 $ 357 $ 377
11/4/2025
Exhibit D-6
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: Jackson & Coker LocumTenens, LLC
• - • •
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 402 $ 412 $ 402 $ 412 $ 217 $ 227 $ 325 $ 335
2026-27 $ 414 $ 424 $ 414 $ 424 $ 223 $ 233 $ 335 $ 345
2027-28 $ 427 $ 437 $ 427 $ 437 $ 230 $ 240 $ 345 $ 355
2028-29 $ 440 $ 450 $ 440 $ 450 $ 238 $ 248 $ 356 $ 366
2029-30 $ 454 $ 464 $ 454 $ 464 $ 245 $ 255 $ 367 $ 377
TELEHEALTH PROVIDER HOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 279 $ 289 $ 279 $ 289 $ 204 $ 214 $ 325 $ 335
2026-27 $ 288 $ 298 $ 288 $ 298 $ 211 $ 221 $ 335 $ 345
2027-28 $ 297 $ 307 $ 297 $ 307 $ 217 $ 227 $ 345 $ 355
2028-29 $ 306 $ 316 $ 306 $ 316 $ 224 $ 234 $ 356 $ 366
2029-30 $ 316 $ 326 $ 316 $ 326 $ 231 $ 241 $ 367 $ 377
11/4/2025
Exhibit D-7
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: Lavaca Street Ventures, LLC dba Monroe & Weisbrod, LLC
• - • •
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 -- $ 407 -- $ 412 -- $ 227 -- $ 335
2026-27 -- $ 419 -- $ 424 -- $ 233 -- $ 345
2027-28 -- $ 432 -- $ 437 -- $ 240 -- $ 355
2028-29 -- $ 445 -- $ 450 -- $ 248 -- $ 366
2029-30 -- $ 459 -- $ 464 -- $ 255 -- $ 377
TELEHEALTH PROVIDER HOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 -- $ 284 -- $ 289 -- $ 214 -- $ 335
2026-27 -- $ 293 -- $ 298 -- $ 221 -- $ 345
2027-28 -- $ 302 -- $ 307 -- $ 227 -- $ 355
2028-29 -- $ 311 -- $ 316 -- $ 234 -- $ 366
2029-30 -- $ 321 -- $ 326 -- $ 241 -- $ 377
11/4/2025
Exhibit D-8
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: LocurnTenens.com LLC
ONSITE PROVIDERHOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 280 $ 400 $ 295 $ 412 $ 196 $ 227 $ 315 $ 335
2026-27 $ 288 $ 412 $ 304 $ 424 $ 202 $ 233 $ 324 $ 345
2027-28 $ 297 $ 424 $ 313 $ 437 $ 208 $ 240 $ 334 $ 355
2028-29 $ 306 $ 437 $ 322 $ 450 $ 214 $ 248 $ 344 $ 366
2029-30 $ 315 $ 450 $ 332 $ 464 $ 220 $ 255 $ 354 $ 377
PROVIDERTELEHEALTH •
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 273 $ 282 $ 275 $ 289 $ 185 $ 214 $ 305 $ 335
2026-27 $ 281 $ 290 $ 283 $ 298 $ 191 $ 221 $ 314 $ 345
2027-28 $ 289 $ 299 $ 291 $ 307 $ 197 $ 227 $ 323 $ 355
2028-29 $ 298 $ 308 $ 300 $ 316 $ 203 $ 234 $ 332 $ 366
2029-30 $ 306 $ 317 $ 309 $ 326 $ 209 $ 241 $ 342 $ 377
11/4/2025
Exhibit D-9
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: Orbit Health, A Professional Corporation
ONSITE PROVIDER •
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 -- $ 412 -- $ 412 -- $ 227 -- $ 335
2026-27 -- $ 424 -- $ 424 -- $ 233 -- $ 345
2027-28 -- $ 437 -- $ 437 -- $ 240 -- $ 355
2028-29 -- $ 450 -- $ 450 -- $ 248 -- $ 366
2029-30 -- $ 464 -- $ 464 -- $ 255 -- $ 377
TELEHEALTH PROVIDER HOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 -- $ 289 -- $ 289 -- $ 214 -- $ 335
2026-27 -- $ 298 -- $ 298 -- $ 221 -- $ 345
2027-28 -- $ 307 -- $ 307 -- $ 227 -- $ 355
2028-29 -- $ 316 -- $ 316 -- $ 234 -- $ 366
2029-30 -- $ 326 -- $ 326 -- $ 241 -- $ 377
11/4/2025
Exhibit D-10
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: SetLine Health, LLC
ONSITE PROVIDER •
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 280 $ 412 $ 290 $ 412 $ 200 $ 227 $ 300 $ 335
2026-27 $ 288 $ 424 $ 299 $ 424 $ 206 $ 233 $ 309 $ 345
2027-28 $ 298 $ 437 $ 308 $ 437 $ 212 $ 240 $ 318 $ 355
2028-29 $ 306 $ 450 $ 317 $ 450 $ 218 $ 248 $ 328 $ 366
2029-30 $ 315 $ 464 $ 326 $ 464 $ 225 $ 255 $ 338 $ 377
TELEHEALTH PROVIDER HOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 252 $ 289 $ 261 $ 289 $ 200 $ 214 $ 300 $ 335
2026-27 $ 260 $ 298 $ 269 $ 298 $ 206 $ 221 $ 309 $ 345
2027-28 $ 267 $ 307 $ 277 $ 307 $ 212 $ 227 $ 318 $ 355
2028-29 $ 275 $ 316 $ 285 $ 316 $ 218 $ 234 $ 328 $ 366
2029-30 $ 283 $ 326 $ 294 $ 326 $ 225 $ 241 $ 338 $ 377
11/4/2025
Exhibit D-11
LOCUM TENENS PSYCHIATRIC SERVICES
Psychiatric Provider Maximum Hourly Rates
Contractor: Thomas Milam MD, Inc. dba Iris Telehealth Medical Group
• I I z1a- • •
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 -- -- -- -- -- --
2026-27 -- -- -- -- --
2027-28 -- -- -- -- -- --
2028-29 -- -- -- -- --
2029-30 -- -- -- -- -- --
TELEHEALTH PROVIDER HOURLY
Psychiatrist Psychiatrist Nurse Practitioner Collaborator
(Board Eligible) (Board Certified) (NP) (MD/DO)
Fiscal Year Minimum Maximum Minimum Maximum Minimum Maximum Minimum Maximum
2025-26 $ 243 $ 289 $ 243 $ 289 $ 155 $ 205 -- $ 325
2026-27 $ 250 $ 298 $ 250 $ 298 $ 160 $ 211 -- $ 325
2027-28 $ 261 $ 307 $ 261 $ 307 $ 165 $ 217 -- $ 325
2028-29 $ 269 $ 316 $ 269 $ 316 $ 170 $ 224 -- $ 325
2029-30 $ 277 $ 326 $ 277 $ 306 $ 175 $ 231 -- $ 325
11/4/2025
Exhibit E
Page 1 of 5
INSURANCE REQUIREMENTS
I. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
a. Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
b. Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) combined single limit for bodily injury and for property
damages. Coverage must include any auto used in connection with this Agreement.
c. All-Risk Property Insurance. All-Risk Property Insurance with no coinsurance penalty
provision in an amount that will cover the total of County purchased and owned property
in possession of Contractor(s) and/or used in the execution of this Agreement.
Contractor must name the County as an Additional Loss Payee.
d. Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits. Coverage must include an Alternate
Employer Endorsement at least as broad as WC 11 03 01 A naming the County as the
Alternate Employer.
e. 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.
f. Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1) the retroactive date must
be prior to the date on which services began under this Agreement; (2) the Contractor
Revised 8/11/25
Exhibit E
Page 2 of 5
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
g. 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). If this is a claims-made policy, then (1) the retroactive
date must be prior to the date on which services began under this Agreement; (2)
Contractor(s) shall maintain the policy and provide to the County annual evidence of
insurance for not less than five years after completion of services under this Agreement;
and (3) if the policy is canceled or not renewed, and not replaced with another claims-
made policy with a retroactive date prior to the date on which services begin under this
Agreement, then Contractor(s) shall purchase extended reporting coverage on its
claims-made policy for a minimum of five years after completion of services under this
Agreement.
h. Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Contractor.
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under Article 11
of this Agreement; (iv) system failure; (v) data recovery; (vi) failure to timely disclose
data breach or Security Breach; (vii) failure to comply with privacy policy; (viii) payment
card liabilities and costs; (ix) infringement of intellectual property, including but not
limited to infringement of copyright, trademark, and trade dress; (x) invasion of privacy,
including release of private information; (xi) information theft; (xii) damage to or
destruction or alteration of electronic information; (xiii) cyber extortion; (xiv) extortion
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; (xv) fraudulent instruction; (xvi) funds
transfer fraud; (xvii) telephone fraud; (xviii) network security; (xix) data breach response
Revised 8/11/25
Exhibit E
Page 3 of 5
costs, including Security Breach response costs; (xx) regulatory fines and penalties
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; and (xxi) credit monitoring expenses.
i. Excess/Umbrella Liability Insurance. Contractor may use a combination of primary
and excess insurance policies which provide coverage as broad as the underlying
primary policies, to satisfy the Required Insurance provisions. If any Excess or Umbrella
Liability policies are used to meet the limits of liability required by this agreement, then
those policies must be "following form" of the underlying policy coverage, terms,
conditions, and provisions and must meet all of the insurance requirements stated in this
Agreement, including, but not limited to, the additional insured, contractual liability &
"insured contract" definition for indemnity, occurrence, indemnity and defense, waivers of
subrogation, and primary & non-contributory insurance requirements stated therein.
II. Additional Requirements
a. Verification of Coverage. Within 30 days after Contractor(s) signs this Agreement, and
at any time during the term of this Agreement as requested by the County, Contractor(s)
shall 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(a)-fresnocountyca.gov with a
copy to the assigned County's DBH Staff Analyst, certificates of insurance and
endorsements for all of the coverages, except Molestation Liability, required under this
Agreement.
i. Verification of Coverage for Molestation Liability. Prior to placement of any
locum tenens with the County, and at any time thereafter as requested by the
County, Contractor shall mail and email or cause its broker or producer to mail and
email, to the County of Fresno, Department of Behavioral Health -Attention Plan
Administration, 1925 E Dakota Ave, Fresno CA 93726, or electronically to
DBHPlanAdmin(a�_fresnocountyca.gov with a copy to the assigned County's DBH
Staff Analyst, certificates of insurance for Molestation Liability.
b. Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by 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.
Revised 8/11/25
Exhibit E
Page 4 of 5
c. Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, the Contractor shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, the Contractor shall, or shall
cause the insurer to, provide written notice to the County not less than 30 days in
advance of cancellation or change. The County in its sole discretion may determine that
the failure of the Contractor or its insurer to timely provide a written notice required by
this paragraph is a breach of this Agreement.
d. County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance
with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Contractor shall deliver, or cause its broker or producer
to deliver, to the County's Risk Manager certificates of insurance and endorsements for
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
e. Waivers of Subrogation. The Contractor waives any right to recover from the County,
its officers, agents, employees, and volunteers any amounts paid under any insurance
policy insurance required by this Agreement. The Contractor is solely responsible to
obtain any policy endorsement that may be necessary to accomplish those waivers, but
the Contractor's waivers of subrogation under this paragraph are effective whether or not
the Contractor obtains such endorsements.
f. County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep
in effect at all times any insurance coverage required under this Agreement, the County
may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Contractor. The County may offset such
charges against any amounts owed by the County to the Contractor under this
Agreement.
g. Subcontractors. The Contractor shall require and verify that all subcontractors used by
the Contractor to provide services under this Agreement maintain insurance meeting all
Revised 8/11/25
Exhibit E
Page 5 of 5
insurance requirements provided in this Agreement. This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
Revised 8/11/25
Exhibit F
Page 1 of 10
DATA SECURITY
I. Definitions
Capitalized terms used in this Exhibit have the meanings set forth in this section I.
a. "Authorized Employees" means the Contractor's employees who have access to
Personal Information.
b. "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all
of the Contractor's subcontractors, representatives, agents, outsourcers, and
consultants, and providers of professional services to the Contractor, who have access
to Personal Information and are bound by law or in writing by confidentiality obligations
sufficient to protect Personal Information in accordance with the terms of this Exhibit.
c. "Director" means the County's Director of the Department of Behavioral Health or his or
her designee.
d. "Disclose" or any derivative of that word means to disclose, release, transfer,
disseminate, or otherwise provide access to or communicate all or any part of any
Personal Information orally, in writing, or by electronic or any other means to any person.
e. "Person" means any natural person, corporation, partnership, limited liability company,
firm, or association.
f. "Personal Information" means any and all information, including any data, provided, or
to which access is provided, to the Contractor by or upon the authorization of the
County, under this Agreement, including but not limited to vital records, that: (i) identifies,
describes, or relates to, or is associated with, or is capable of being used to identify,
describe, or relate to, or associate with, a person (including, without limitation, names,
physical descriptions, signatures, addresses, telephone numbers, e-mail addresses,
education, financial matters, employment history, and other unique identifiers, as well as
statements made by or attributable to the person); (ii) is used or is capable of being used
to authenticate a person (including, without limitation, employee identification numbers,
government-issued identification numbers, passwords or personal identification numbers
(PINs), financial account numbers, credit report information, answers to security
questions, and other personal identifiers); or(iii) is personal information within the
meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision
(e). Personal Information does not include publicly available information that is lawfully
made available to the general public from federal, state, or local government records.
Revised 8/7/25
Exhibit F
Page 2 of 10
g. "Privacy Practices Complaint" means a complaint received by the County relating to
the Contractor's (or any Authorized Person's) privacy practices, or alleging a Security
Breach. Such complaint shall have sufficient detail to enable the Contractor to promptly
investigate and take remedial action under this Exhibit.
h. "Security Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by the Contractor (or any Authorized
Persons) that relate to the protection of the security, confidentiality, value, or integrity of
Personal Information. Security Safeguards shall satisfy the minimal requirements set
forth in section Ill.c of this Exhibit.
i. "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.
II. Standard of Care
a. The Contractor acknowledges that, in the course of its engagement by the County under
this Agreement, the Contractor, or any Authorized Persons, may Use Personal
Information only as permitted in this Agreement.
b. The Contractor acknowledges that Personal Information is deemed to be confidential
information of, or owned by, the County (or persons from whom the County receives or
has received Personal Information) and is not confidential information of, or owned or by,
the Contractor, or any Authorized Persons. The Contractor further acknowledges that all
right, title, and interest in or to the Personal Information remains in the County (or
persons from whom the County receives or has received Personal Information)
regardless of the Contractor's, or any Authorized Person's, Use of that Personal
Information.
c. The Contractor agrees and covenants in favor of the Country that the Contractor shall:
i. keep and maintain all Personal Information in strict confidence, using such degree
of care under this section as is reasonable and appropriate to avoid a Security
Breach;
Revised 8/7/25
Exhibit F
Page 3 of 10
ii. use Personal Information exclusively for the purposes for which the Personal
Information is made accessible to the Contractor pursuant to the terms of this
Exhibit;
iii. not Use, Disclose, sell, rent, license, or otherwise make available Personal
Information for the Contractor's own purposes or for the benefit of anyone other
than the County, without the County's express prior written consent, which the
County may give or withhold in its sole and absolute discretion; and
iv. not, directly or indirectly, Disclose Personal Information to any person (an
"Unauthorized Third Party") other than Authorized Persons pursuant to this
Agreement, without the Director's express prior written consent.
d. Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it,
or any Authorized Person, is required to disclose Personal Information to government
regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be
required by applicable law, Contractor shall (i) immediately notify the County of the
specific demand for, and legal authority for the disclosure, including providing County
with a copy of any notice, discovery demand, subpoena, or order, as applicable,
received by the Contractor, or any Authorized Person, from any government regulatory
authorities, or in relation to any legal proceeding, and (ii) promptly notify the County
before such Personal Information is offered by the Contractor for such disclosure so that
the County may have sufficient time to obtain a court order or take any other action the
County may deem necessary to protect the Personal Information from such disclosure,
and the Contractor shall cooperate with the County to minimize the scope of such
disclosure of such Personal Information.
e. The Contractor shall remain liable to the County for the actions and omissions of any
Unauthorized Third Party concerning its Use of such Personal Information as if they
were the Contractor's own actions and omissions.
III. Information Security
a. The Contractor covenants, represents and warrants to the County that the Contractor's
Use of Personal Information under this Agreement does and will at all times comply with
all applicable federal, state, and local, privacy and data protection laws, as well as all
other applicable regulations and directives, including but not limited to California Civil
Code, Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song-
Beverly Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3,
beginning with section 1747). If the Contractor Uses credit, debit or other payment
Revised 8/7/25
Exhibit F
Page 4 of 10
cardholder information, the Contractor shall at all times remain in compliance with the
Payment Card Industry Data Security Standard ("PCI DSS") requirements, including
remaining aware at all times of changes to the PCI DSS and promptly implementing and
maintaining all procedures and practices as may be necessary to remain in compliance
with the PCI DSS, in each case, at the Contractor's sole cost and expense.
b. The Contractor covenants, represents and warrants to the County that, as of the
effective date of this Agreement, the Contractor has not received notice of any violation
of any privacy or data protection laws, as well as any other applicable regulations or
directives, and is not the subject of any pending legal action or investigation by, any
government regulatory authority regarding same.
c. Without limiting the Contractor's obligations under section Ill.a of this Exhibit, the
Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than
accepted industry practices and, at a minimum, include the following:
i. limiting Use of Personal Information strictly to the Contractor's and Authorized
Persons' technical and administrative personnel who are necessary for the
Contractor's, or Authorized Persons', Use of the Personal Information pursuant to
this Agreement;
ii. ensuring that all of the Contractor's connectivity to County computing systems will
only be through the County's security gateways and firewalls, and only through
security procedures approved upon the express prior written consent of the
Director;
iii. to the extent that they contain or provide access to Personal Information, (a)
securing business facilities, data centers, paper files, servers, back-up systems
and computing equipment, operating systems, and software applications, including,
but not limited to, all mobile devices and other equipment, operating systems, and
software applications with information storage capability; (b) 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
Revised 8/7/25
Exhibit F
Page 5 of 10
remote wipe feature always enabled, all of which is subject to express prior written
consent of the Director;
iv. encrypting all Personal Information at advance encryption standards of Advanced
Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile devices,
including but not limited to hard disks, portable storage devices, or remote
installation, or (b) transmitted over public or wireless networks (the encrypted
Personal Information must be subject to password or pass phrase, and be stored
on a secure server and transferred by means of a Virtual Private Network (VPN)
connection, or another type of secure connection, all of which is subject to express
prior written consent of the Director);
V. strictly segregating Personal Information from all other information of the
Contractor, including any Authorized Person, or anyone with whom the Contractor
or any Authorized Person deals so that Personal Information is not commingled
with any other types of information;
vi. having a patch management process including installation of all operating system
and software vendor security patches;
vii. maintaining appropriate personnel security and integrity procedures and practices,
including, but not limited to, conducting background checks of Authorized
Employees consistent with applicable law; and
viii. providing appropriate privacy and information security training to Authorized
Employees.
d. During the term of each Authorized Employee's employment by the Contractor, the
Contractor shall cause such Authorized Employees to abide strictly by the Contractor's
obligations under this Exhibit. The Contractor shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
e. The Contractor shall, in a secure manner, backup daily, or more frequently if it is the
Contractor's practice to do so more frequently, Personal Information received from the
County, and the County shall have immediate, real-time access, at all times, to such
backups via a secure, remote access connection provided by the Contractor, through the
Internet.
f. The Contractor shall provide the County with the name and contact information for each
Authorized Employee (including such Authorized Employee's work shift, and at least one
alternate Authorized Employee for each Authorized Employee during such work shift)
who shall serve as the County's primary security contact with the Contractor and shall be
Revised 8/7/25
Exhibit F
Page 6 of 10
available to assist the County twenty-four (24) hours per day, seven (7) days per week
as a contact in resolving the Contractor's and any Authorized Persons' obligations
associated with a Security Breach or a Privacy Practices Complaint.
g. The Contractor shall not knowingly include or authorize any Trojan Horse, back door,
time bomb, drop dead device, worm, virus, or other code of any kind that may disable,
erase, display any unauthorized message within, or otherwise impair any County
computing system, with or without the intent to cause harm.
IV. Security Breach Procedures
a. Immediately upon the Contractor's awareness or reasonable belief of a Security Breach,
the Contractor shall (i) notify the Director of the Security Breach, such notice to be given
first by telephone at the following telephone number, followed promptly by email at the
following email addresses: incidents(a-)-fresnocountyca.gov, 559-600-5900, (which
telephone number and email address the County may update by providing notice to the
Contractor), and (ii) preserve all relevant evidence (and cause any affected Authorized
Person to preserve all relevant evidence) relating to the Security Breach. The notification
shall include, to the extent reasonably possible, the identification of each type and the
extent of Personal Information that has been, or is reasonably believed to have been,
breached, including but not limited to, compromised, or subjected to unauthorized Use,
Disclosure, or modification, or any loss or destruction, corruption, or damage.
b. Immediately following the Contractor's notification to the County of a Security Breach, as
provided pursuant to section IV.a of this Exhibit, the Parties shall coordinate with each
other to investigate the Security Breach. The Contractor agrees to fully cooperate with
the County, including, without limitation:
i. assisting the County in conducting any investigation;
ii. providing the County with physical access to the facilities and operations affected;
iii. facilitating interviews with Authorized Persons and any of the Contractor's other
employees knowledgeable of the matter; and
iv. making available all relevant records, logs, files, data reporting and other materials
required to comply with applicable law, regulation, industry standards, or as
otherwise reasonably required by the County.
To that end, the Contractor shall, with respect to a Security Breach, be solely
responsible, at its cost, for all notifications required by law and regulation, or deemed
reasonably necessary by the County, and the Contractor shall provide a written report of
Revised 8/7/25
Exhibit F
Page 7 of 10
the investigation and reporting required to the Director within 30 days after the
Contractor's discovery of the Security Breach.
c. County shall promptly notify the Contractor of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint, and upon the Contractor's receipt of that
notification, the Contractor shall promptly address such Privacy Practices Complaint,
including taking any corrective action under this Exhibit, all at the Contractor's sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
In the event the Contractor discovers a Security Breach, the Contractor shall treat the
Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractor's
receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the
County whether the matter is a Security Breach, or otherwise has been corrected and
the manner of correction, or determined not to require corrective action and the reason
for that determination.
d. The Contractor shall take prompt corrective action to respond to and remedy any
Security Breach and take mitigating actions, including but not limiting to, preventing any
reoccurrence of the Security Breach and correcting any deficiency in Security
Safeguards as a result of such incident, all at the Contractor's sole expense, in
accordance with applicable privacy rights, laws, regulations and standards. The
Contractor shall reimburse the County for all reasonable costs incurred by the County in
responding to, and mitigating damages caused by, any Security Breach, including all
costs of the County incurred relation to any litigation or other action described section
IV.e of this Exhibit.
e. The Contractor agrees to cooperate, at its sole expense, with the County in any litigation
or other action to protect the County's rights relating to Personal Information, including
the rights of persons from whom the County receives Personal Information.
V. Oversight of Security Compliance
a. The Contractor shall have and maintain a written information security policy that
specifies Security Safeguards appropriate to the size and complexity of the Contractor's
operations and the nature and scope of its activities.
b. Upon the County's written request, to confirm the Contractor's compliance with this
Exhibit, as well as any applicable laws, regulations and industry standards, the
Contractor grants the County or, upon the County's election, a third party on the
County's behalf, permission to perform an assessment, audit, examination or review of
all controls in the Contractor's physical and technical environment in relation to all
Revised 8/7/25
Exhibit F
Page 8 of 10
Personal Information that is Used by the Contractor pursuant to this Agreement. The
Contractor shall fully cooperate with such assessment, audit or examination, as
applicable, by providing the County or the third party on the County's behalf, access to
all Authorized Employees and other knowledgeable personnel, physical premises,
documentation, infrastructure and application software that is Used by the Contractor for
Personal Information pursuant to this Agreement. In addition, the Contractor shall
provide the County with the results of any audit by or on behalf of the Contractor that
assesses the effectiveness of the Contractor's information security program as relevant
to the security and confidentiality of Personal Information Used by the Contractor or
Authorized Persons during the course of this Agreement under this Exhibit.
c. The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit. that apply to the Contractor
with respect to such Personal Information by incorporating the relevant provisions of
these provisions into a valid and binding written agreement between the Contractor and
such Authorized Persons, or amending any written agreements to provide same.
VI. Return or Destruction of Personal Information. Upon the termination of this Agreement,
the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the
County all Personal Information, whether in written, electronic or other form or media, in its
possession or the possession of such Authorized Persons, in a machine readable form used
by the County at the time of such return, or upon the express prior written consent of the
Director, securely destroy all such Personal Information, and certify in writing to the County
that such Personal Information have been returned to the County or disposed of securely,
as applicable. If the Contractor is authorized to dispose of any such Personal Information, as
provided in this Exhibit, such certification shall state the date, time, and manner (including
standard) of disposal and by whom, specifying the title of the individual. The Contractor shall
comply with all reasonable directions provided by the Director with respect to the return or
disposal of Personal Information and copies of Personal Information. If return or disposal of
such Personal Information or copies of Personal Information is not feasible, the Contractor
shall notify the County according, specifying the reason, and continue to extend the
protections of this Exhibit to all such Personal Information and copies of Personal
Information. The Contractor shall not retain any copy of any Personal Information after
returning or disposing of Personal Information as required by this section 6. The
Contractor's obligations under this section survive the termination of this Agreement and
Revised 8/7/25
Exhibit F
Page 9 of 10
apply to all Personal Information that the Contractor retains if return or disposal is not
feasible and to all Personal Information that the Contractor may later discover.
VII. Equitable Relief. The Contractor acknowledges that any breach of its covenants or
obligations set forth in this Exhibit may cause the County irreparable harm for which
monetary damages would not be adequate compensation and agrees that, in the event of
such breach or threatened breach, the County is entitled to seek equitable relief, including a
restraining order, injunctive relief, specific performance and any other relief that may be
available from any court, in addition to any other remedy to which the County may be
entitled at law or in equity. Such remedies shall not be deemed to be exclusive but shall be
in addition to all other remedies available to the County at law or in equity or under this
Agreement.
Vill. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its
officers, employees, and agents, (each, a "County Indemnitee") from and against any and
all infringement of intellectual property including, but not limited to infringement of copyright,
trademark, and trade dress, invasion of privacy, information theft, and extortion,
unauthorized Use, Disclosure, or modification of, or any loss or destruction of, or any
corruption of or damage to, Personal Information, Security Breach response and remedy
costs, credit monitoring expenses, forfeitures, losses, damages, liabilities, deficiencies,
actions, judgments, interest, awards, fines and penalties (including regulatory fines and
penalties), costs or expenses of whatever kind, including attorneys' fees and costs, the cost
of enforcing any right to indemnification or defense under this Exhibit and the cost of
pursuing any insurance providers, arising out of or resulting from any third party claim or
action against any County Indemnitee in relation to the Contractor's, its officers, employees,
or agents, or any Authorized Employee's or Authorized Person's, performance or failure to
perform under this Exhibit or arising out of or resulting from the Contractor's failure to
comply with any of its obligations under this section. The provisions of this section do not
apply to the acts or omissions of the County. The provisions of this section are cumulative to
any other obligation of the Contractor to, defend, indemnify, or hold harmless any County
Indemnitee under this Agreement. The provisions of this section shall survive the
termination of this Agreement.
IX. Survival. The respective rights and obligations of the Contractor and the County as stated
in this Exhibit shall survive the termination of this Agreement.
X. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit is
intended to confer, nor shall anything in this Exhibit confer, upon any person other than the
Revised 8/7/25
Exhibit F
Page 10 of 10
County or the Contractor and their respective successors or assignees, any rights,
remedies, obligations or liabilities whatsoever.
XI. No County Warranty. The County does not make any warranty or representation whether
any Personal Information in the Contractor's (or any Authorized Person's) possession or
control, or Use by the Contractor (or any Authorized Person), pursuant to the terms of this
Agreement is or will be secure from unauthorized Use, or a Security Breach or Privacy
Practices Complaint.
Revised 8/7/25
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
1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit 1
2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) (d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)