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HomeMy WebLinkAboutAgreement A-25-563 Participation Agreement with CalMHSA.pdf Agreement No. 25-563 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 CALIFORNIA MENTAL HEALTH SERVICES AUTHORITY PARTICIPATION AGREEMENT Credentialing and Recredentialing for California County Behavioral Health Plans Fresno County ("Participant") desires to participate in the Credentialing and Recredentialing for California County Behavioral Health Plans Program ("Program") offered by the California Mental Health Services Authority ("CaIMHSA") on the terms provided in this Participation Agreement ("Agreement'). Participant acknowledges that the Program also will be governed by CalMHSA's Joint Powers Agreement and its Bylaws. The Agreement is effective upon execution through June 30,2026("Term").The following exhibits are attached and form part of this Agreement: b Exhibit A Detailed Program Description, Requirements, Restrictions b Exhibit B General Terms and Conditions b Attachment A Work Order Form b Attachment B Credentialing and Recredentialing Cost by Provider Type 1. Summary of Program: CaIMHSA is offering the following Program to Counties: CaIMHSA has entered into an Agreement with Compliance Made Easy, Inc., DBA CertifyOS,a National Committee for Quality Assurance (NCQA) certified Credentials Verification Organization (CVO), to support California County Mental Health Plans (MHPs), Drug Medi-Cal Organized Delivery System (DMC-ODS) Plans, and Drug Medi-Cal (DMC) State Plans, hereinafter refer to as the Participant, to comply with the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Care Services (DHCS) uniform provider Credentialing and recredentialing requirements as per DHCS Mental Health and Substance Use Disorder Services (MHSUDS) Information Notice (IN) Number 18- 019: Provider Credentialing and Recredentialing for MHPs and DMC-ODS Counties and DHCS Behavioral Health (BH) IN Number 22-070: Parity Requirements for DMC State Plan Counties. 2. Funding:The Program requires the following funding and payments: The Program involves the Participant paying a One-Time Implementation fee plus optional services within the first 45 days of Agreement execution. For Credentialing, Recredentialing, and Ongoing Monitoring, CaIMHSA will invoice Participant for all services incurred on a quarterly basis. Participant will pay invoice within 45 days of receipt. Participant will pay in arrears for services utilized. Additional optional services can be purchased as needed via the Work Order Form (Attachment A).The DBH Director, or designee, is authorized to make these additional purchases on behalf of Participant. 3. The maximum amount payable under this Agreement is not to exceed $166,965.81. [Authorized Signors follow on the next page] Fresno County—Participation Agreement for Credentialing and Recredentialing Program Docusign Envelope ID:283ACB44-B6CB-489A-8840-C9964329DCD7 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 CalMHSA o se d1, Signed: fir. fimit, /lg,hr Name(Printed): Dr. Arnie Miller, Psy.D., LMFT 82E,«o..o7...446_ Title: Executive Director Date: 11/7/2025 Participant: FRESNO COUNTY Signed: ame(Printed): Ernest Buddy Mendes Title: Chairman of the Board of Supervisors Date: of the County of Fresno ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors County of Fresno,State of California By,4WWX4.1,A)-4, Deputy For accounting use only: Org No.:56302019 Account No.:7295 Fund No.:0001 Subclass No.: 10000 Fresno County—Participation Agreement for Credentialing and Recredentialing Program 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 Participation Agreement EXHIBIT A—Detailed Program Description,Obligations, Restrictions I. Detailed Program Description: CaIMHSA has entered into an Agreement with Compliance Made Easy, Inc., DBA CertifyOS, a National Committee for Quality Assurance (NCQA) certified Credentials Verification Organization (CVO),to support California County Mental Health Plans (MHPs), Drug Medi- Cal Organized Delivery System (DMC-ODS) Plans, and Drug Medi-Cal (DMC) State Plans, hereinafter refer to as the Participant, to comply with the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Care Services (DHCS) uniform provider credentialing and recredentialing requirements as per DHCS Mental Health and Substance Use Disorder Services (MHSUDS) Information Notice (IN) Number 18-019: Provider Credentialing and Recredentialing for MHPs and DMC-ODS Counties and DHCS Behavioral Health (BH) IN Number 22-070: Parity Requirements for DMC State Plan Counties. The services offered under the CaIMHSA Credentialing Program will ensure that each Participant provider is qualified in accordance with current legal, professional, and technical standards, and is appropriately licensed, registered,waivered, and/or certified as required by state and federal law. II. Obligations: Participant shall: • Provide CertifyOS with required data for all network providers being credentialed/recredentialed. • Set up and/or have its own NPDB account, must add CertifyOS as authorized agent to the Participant's account, and provide CertifyOS with the Participant's NPDB Data Bank ID. • Provide CertifyOS with the designated program's liaison(s) contact information. • Provide CertifyOS with contact information for credentialing platform users needing training, have each user attend the training and complete a Credentialing Platform User Access Form. • Provide CertifyOS with the designated Participant's email address to be included in automated emails generated by the credentialing platform. • Make available to Participant providers requiring credentialing/recredentialing the link to the Provider Credentialing Application. • Provide CertifyOS with a copy of the Participant's professional liability insurance blanket policy, if applicable. • If CAQH Integration option is selected: Set up and/or have its own active account of the CAQH Participating Organization (PO) Provider Data Portal and add CertifyOS as an authorized user. • If CertifyOS Credentialing Committee Facilitation/Oversight option selected: Work with CertifyOS to schedule monthly credentialing committee meetings. • Retain the right to approve, suspend and/or terminate individual providers. • Retain the responsibility of ensuring that provider information published to the public in the form of beneficiary informing materials, including provider directories, is consistent with the information obtained during the credentialing/recredentialing process. Fresno County—Exhibit 8— General Terms and Conditions Page 3 of 13 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 • Grant CaIMHSA the authority to monitor and oversee the credentialing activities to be performed by CertifyOS on behalf of the Participant(CaIMHSA agrees to report to the Participant on CertifyOS performance annually at a minimum. CaIMHSA shall: To support Participants to comply with the above-mentioned regulations, CaIMHSA shall: • Verify that CertifyOS conducts provider credentialing that meets DHCS requirements and NCQA standards and guidelines to ensure that providers have valid credentials. • Periodically check, via file audits,to confirm that CertifyOS is verifying the required items through a primary source and documenting these in a primary source verification (PSV)file, as applicable by the provider type. • Verify that CertifyOS tracks and conducts provider recredentialing that meets DHCS requirements and NCQA standards and guidelines, at a minimum every three years. • Confirm that CertifyOS integrates the respective Participant's Credentialing Platform with each participating County's NPDB account within two (2) weeks after such Participant adds CertifyOS as an Authorized Agent to its respective NPDB county account and provides CertifyOS with the County's NPDB Data Bank ID, allowing for primary source verification and validation of providers credentialing data. • Track and verify that CertifyOS maintains its certification as an NCQA Credentials Verification Organization (CVO), in all 11 certification options,throughout the term of the Agreement. • Verify that CertifyOS provider credentialing and recredentialing policies and procedures are compliant with DHCS credentialing regulations and NCQA credentialing standards and guidelines. • Oversee CertifyOS performance on behalf of the Participant by reviewing and ensuring that specific service level agreements and/or key performance indicators are reported monthly to CaIMHSA to ensure compliance with previously agreed metrics during the term of the Agreement. Furthermore, CaIMHSA and CertifyOS will meet periodically, at a mutually agreeable date/time, to discuss matters related to credentialing functions. • Assist the Participant during the CertifyOS Credentialing Platform implementation and confirm that the Participant implements a separate, secure instance of the credentialing platform and receives platform and process user training. • Verify that customer support for Participant and providers by CertifyOS is available Monday through Friday from 8:00 AM to 6:OOPM, Pacific Standard Time. Customer support must be provided via email, and fax. • Confirm that Participant has the credentialing platform dashboard functionality available with real-time data to ensure transparency of credentialing activities performed by CertifyOS. • Confirm that Participant has access to and can download CertifyOS credentialing platform built- in reports, including individual provider PSV files. • Confirm that CertifyOS makes available to Participant its Virtual Credentialing Committee management module, within the credentialing platform, which allows for adjudication of all files presented to the committee. Fresno County—Exhibit 8— General Terms and Conditions Page 4 of 13 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 • Verify that CertifyOS assist Participant with federal and/or state audit preparation, including reporting,that involves provider credentialing and recredentialing activities. • Verify that all provider information obtained through the credentialing and recredentialing activities is secured and protected from unauthorized access in accordance NCQA and industry standards, including multi-factor authentication (MFA)for remote user access, in addition to standard data security and management protocols. III. Obligations Specific to Participant Opt-In Selected Options If the Participant elects to participate in any of the optional services offered under the CalMHSA Credentialing Program,the following applies, as applicable by the chosen optional service(s). Provider Ongoing Monitoring • CaIMHSA shall verify that active Participant network providers uploaded to the CertifyOS credentialing platform are monitored monthly in accordance with NCQA standards to ensure quality and safety of care. • CaIMHSA shall verify, if any of the monitored items above become an issue,that the CertifyOS credentialing platform flags the information and that an automated alert is triggered and sent to an identified Participant user(s). CertifyOS Credentialing Committee Facilitation/Oversight • CaIMHSA shall confirm that CertifyOS provides one staff member to prepare the PSV files to be reviewed by committee members, facilitate, and record meeting minutes for the Participant credentialing committee meetings conducted utilizing the CertifyOS Virtual Credentialing Committee module. • CaIMHSA shall confirm that CertifyOS facilitates and oversees Participant credentialing committee meetings once a month or twelve (12)times in one (1)year, on a date/time specified and mutually agreed by both parties. CAQH Integration • CaIMHSA will verify that CertifyOS successfully implements the Council for Affordable Quality Healthcare (CAQH) integration selected by the Participant. • CaIMHSA shall verify that CertifyOS retrieves provider credentialing applications via the CAHQ Integration and automatically rosters providers to the Participant's CAQH roster. Program Restrictions: • CaIMHSA shall not be responsible for any credentialing functions not specified in this Agreement. Fresno County—Exhibit 8— General Terms and Conditions Page 5 of 13 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 Participation Agreement EXHIBIT B—General Terms and Conditions I. Definitions The following words, as used throughout this Participation Agreement,shall be construed to have the following meaning, unless otherwise apparent from the context in which they are used: A. CaIMHSA — California Mental Health Services Authority, a Joint Powers Authority (JPA) created by counties in 2009 at the instigation of the California Mental Health Directors Association to jointly develop and fund mental health services and education programs. B. Member — A County (or JPA of two or more Counties) that has joined CaIMHSA and executed the CaIMHSA Joint Powers Agreement. C. Participant—Any County participating in the Program either as Member of CaIMHSA or under a Memorandum of Understanding with CaIMHSA. D. Program—The program identified in the Cover Sheet. II. Responsibilities A. Responsibilities of CaIMHSA: 1. Act as the Fiscal and Administrative agent for the Program. 2. Manage funds received from, Participant in a manner consistent with the requirements of any applicable laws, regulations, guidelines and/or contractual obligations. 3. Provide regular fiscal reports to Participant and/or other public agencies with a right to such reports. 4. Comply with CaIMHSA's Joint Powers Agreement and Bylaws. B. Responsibilities of Participant: 1. Participant will pay for individual program services as defined in the fiscal provisions in Exhibit B—Section V. 2. Provide CaIMHSA and any other parties deemed necessary with requested information and assistance in order to fulfill the purpose of the Program. 3. Responsible for any and all assessments, creation of individual case plans, and providing or arranging for services. 4. Cooperate by providing CaIMHSA with requested information and assistance in order to fulfill the purpose of the Program, including but not limited to information related to the Credentialing and Recredentialing requirements set forth by DHCS Mental Health and Substance Use Disorder Services (MHSUDS) Information Notice (IN) Number 18-01 and detailed in Exhibit A-Program Description. 5. Provide feedback on Program performance. Fresno County—Exhibit 8— General Terms and Conditions Page 6 of 13 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 6. Comply with applicable laws, regulations, guidelines, contractual agreements, JPAs, and bylaws. III. Duration,Term,and Amendment A. This Agreement may be supplemented, amended, or modified only by the mutual agreement of CaIMHSA and the Participant, expressed in writing and signed by an authorized representative of both parties. IV. Withdrawal,Cancellation,and Termination A. Participant may withdraw from the Program and terminate the Agreement upon six (6) months' written notice to CaIMHSA. Notice shall be deemed served on the date of mailing. B. Member Cost Sharing. The withdrawal of a Participant from the Program shall not automatically terminate its responsibility for its share of the expense and liabilities of the Program.The contributions of current and past Participants are chargeable for their share of unavoidable expenses and liabilities arising during their participation period. C. CaIMHSA may terminate, cancel, change, or limit the Program due to circumstances, including but not limited to, lack of County participation,government restrictions, issues with vendors or their services/platforms/products, lack of funding, governmental funding changes, inability to provide the Program due to vendor(s), regulatory changes, force majeure, or other issues. D. If applicable, upon cancellation, termination, or other conclusion of the Program, any funds remaining undisbursed after CaIMHSA satisfies all obligations arising under the Program shall be returned to Participant. However, funds used to pay for completed deliverables,services rendered,upfront fees to create the Program,orfees for any portal or platform,ongoing services etc.are not subject to such reversion(subject to applicable laws). Unused funds that were paid for by a joint effort will be returned pro rata to Participant in proportion to payments made. Adjustments may be made if disproportionate benefit was conveyed to a particular Participant. Excess funds at the conclusion of county-specific efforts will be returned to the particular County that paid them per the Program. VI. Indemnification and No Responsibility for Mental Health Services A. Indemnification. To the fullest extent permitted by law, each party shall hold harmless, defend and indemnify the other party, including its governing board, employees and agents from and against any and all claims, losses, damages, liabilities, disallowances, recoupments, and expenses, including but not limited to reasonable attorney's fees, arising out of or resulting from the indemnifying party's negligence or willful conduct in the performance of its obligations under this Agreement, including the performance of the other's subcontractors, except that each party shall have no obligation to indemnify the other for damages to the extent resulting from the negligence or willful misconduct of any indemnitee. Each party may participate in the defense of any such claim without relieving the other of any obligation hereunder. Fresno County—Exhibit 8— General Terms and Conditions Page 7 of 13 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 B. No Responsibility for Mental Health Services. CaIMHSA is not undertaking responsibility for assessments, creation of case or treatment plans, providing or arranging services, and/or selecting, contracting with, or supervising providers (collectively, "mental health services"). Participant will defend and indemnify CaIMHSA for any claim, demand, disallowance, suit, or damages arising from Participant's acts or omissions in connection with the provision of mental health services. V. Fiscal Provisions A. Total Funding Limits - While adhering to, and under no circumstances exceeding, the approved total maximum programmatic funding amount of $166,965.81 the Fresno County Behavioral Health Department is explicitly authorized to utilize unallocated program funds within the previously approved total maximum programmatic funding amount for the purchase of optional services. Notwithstanding the above, any change in the total maximum programmatic funding amount shall require approval of the Board of Supervisors of Fresno County. B. Services Offered - REQUIRED Item Description Cost Unit Tier 1: The start-up fee Ca1MHSA charges $7,400 Per implementation all counties to participate in this project. This includes the cost of the One-Time Program initial CertifyOS platform set-up and Implementation Fee training with each Participant. This fee is calculated based on the county's network provider size and includes costs associated with the (0-50 Providers) implementation of the program, including the work completed to select a CVO provider and setting up of the program. Tier 2: The start-up fee Ca1MHSA charges $7,600 Per implementation all counties to participate in this One-Time Program project. This includes the cost of the Implementation Fee initial CertifyOS platform set-up and training with each Participant. This fee is calculated based on the (50-100 Providers) county's network provider size and includes costs associated with the implementation of the program, including the work completed to Fresno County—Exhibit 8— General Terms and Conditions Page 8 of 13 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 select a CVO provider and setting up of the program. Tier 3: The start-up fee Ca1MHSA charges $17,000 Per implementation all counties to participate in this One-Time Program project. This includes the cost of the Implementation Fee initial CertifyOS platform set-up and training with each Participant. This fee is calculated based on the (101-1000 Providers) county's network provider size and includes costs associated with the implementation of the program, including the work completed to select a CVO provider and setting up of the program. Tier 4: The start-up fee CalMHSA charges $25,000 Per implementation all counties to participate in this One-Time Program project. This includes the cost of the Implementation Fee initial CertifyOS platform set-up and training with each Participant. This fee is calculated based on the (1001-2000 Providers) county's network provider size and includes costs associated with the implementation of the program, including the work completed to select a CVO provider and setting up of the program. Tier 5: The start-up fee Ca1MHSA charges $91,000 Per implementation all counties to participate in this One-Time Program project. This includes the cost of the Implementation Fee initial CertifyOS platform set-up and training with each Participant. This fee is calculated based on the (2001+ Providers) county's network provider size and includes costs associated with the implementation of the program, including the work completed to select a CVO provider and setting up of the program. Credentialing Service* Equates to the initial primary source Dependent on Per credentialing event verification of all required elements Provider Type— for one provider based on Please see discipline/type. Attachment B Fresno County—Exhibit 8— General Terms and Conditions Page 9 of 13 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 Recredentialing Equates to the periodic primary Dependent on Per Recredentialing event Service* source verification of all required Provider Type— elements for one provider based on Please see discipline/type. Attachment B OPTIONAL Item Description Cost Unit Ongoing Monitoring Equates to periodically querying $6.00 Per year, per provider Services including different databases to checkfor expirables- (optional) sanctions, malpractice claims and settlements,jurisdictional sanctions, limitations on licensure, and other adverse actions for all enrolled network providers. *Credentialing or Recredentialing certain provider types will require additional pass-through costs.These costs will be applied as needed depending on the provider type and specialty board association and will be included in the total cost of the credentialing/recredentialing service. C. Payment Method— Participant will pay for all items listed below due within 45 days of Agreement execution. Specifically, this includes the following items: • One-Time Program Implementation Fee (Tier 1, Tier 2, Tier 3, Tier 4, or Tier 5 based on number of providers) • CAQH Integration—(optional) • Credentialing Committee Oversight/Facilitation—(optional) For all other services, excluding Credentialing and Recredentialing Services (See Exhibit B, Section V -Item D) and Ongoing Monitoring Services (See Exhibit B, Section V — Item Q. Participants will submit a work order form to managedcare@calmhsa.org. CaIMHSA will invoice counties for all services incurred on a quarterly basis. Participant will pay invoice within 45 days of receipt. Participant will pay in arrears for services utilized. D. Requesting Credentialing, Recredentialing Services: Participant will submit the names of the Providers who require Credentialing services via the CertifyOS platform. Recredentialing services will incur automatically once the Provider is entered into the CertifyOS Credentialing Platform and is due for Recredentialing. CalMHSA will invoice counties all services incurred on a quarterly basis. Participant will pay invoice within 45 days of receipt. Participant will pay in arrears for services utilized. E. Ongoing Monitoring Services: Fresno County—Exhibit 8— General Terms and Conditions Page 10 of 13 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 If a Participant opts into Ongoing Monitoring Services, these will apply automatically to all Providers entered into the CertifyOS Credentialing Platform. Participant will pay invoice within 45 days of receipt. CaIMHSA will invoice counties all services incurred on a quarterly basis. Participant will pay in arrears for services utilized. F. Service Fee: Participant will be charged an inclusive service fee incorporated in the total cost of each service. Fresno County—Exhibit 8— General Terms and Conditions Page 11 of 13 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 Participation Agreement Attachment A—Work Order Form [ORDER FORM#] [DATE] PARTICIPANT: PAYMENT MADE TO: California Mental Health Services Authority 1610 Arden Way, STE 175 Sacramento, CA 95815 Work Order Form Item (Yes/No) Ongoing Monitoring Services including Yes expirables- (optional) Item Cost Unit Total CAQH Integration - (optional) $3,000.00 Credentialing Committee $36,000 Oversight/Facilitation - (optional) Authorized Signatory: Name• Date: Fresno County—Attachment A—Order Form Template 12327-FC-CRED-25_26 Credentialing and Recredentialing for California County Behavioral Health Plans Participation Agreement August 11, 2025 Participation Agreement Attachment B—Credentialing and Recredentialing Cost by Provider Type PROVIDER TYPE APPLICABLE PLAN CREDENTIALING EW COST** Certified/Registered Alcohol and Other Drug Counselors (AOD Counselors) DMC-ODS/State Plan $33.00 Licensed Practitioner of the Healing Arts (LPHA)* MHP/DMC-ODS/State Plan $33.00 Licensed/Waivered Psychologist MHP/DMC-ODS/State Plan $33.00 Nurse Practitioner(NP) MHP/DMC-ODS/State Plan $141.00 Physician Assistant(PA) MHP/DMC-ODS/State Plan $61.80 Licensed/Registered Pharmacist MHP/DMC-ODS/State Plan $33.00 Registered Nurse (RN) MHP/DMC-ODS/State Plan $69.00 Clinical Nurse Specialist(CNS) MHP $93.00 Licensed Vocational Nurse (LVN) MHP/DMC-ODS/State Plan $69.00 Occupational Therapist(OT) MHP/DMC-ODS/State Plan $33.00 Licensed Psychiatric Technician (PT) MHP/DMC-ODS/State Plan $33.00 Certified Medical Assistant(CMA) MHP/DMC-ODS/State Plan $33.00 Certified Medi-Cal Peer Support Specialist MHP $33.00 United States Medical Graduate Physician Physician (Medical Doctor- MD) MHP/DMC-ODS/State Plan $102.20 Physician (Doctor of Osteopathy- DO) MHP/DMC-ODS/State Plan $132.20 Licensed Psychiatrist MHP/DMC-ODS/State Plan $132.20 International Medical Graduate Physician Physician (Medical Doctor-MD) MHP/DMC-ODS/State Plan $202.20 Physician (Doctor of Osteopathy- DO) MHP/DMC-ODS/State Plan $232.20 Licensed Psychiatrist MHP/DMC-ODS/State Plan $232.20 *LPHA in this context includes licensed or registered clinical social workers, marriage and family therapists or professional clinical counselors. "Note that any relevant pass-through fees not already included in the cost above may be added to the total credentialing fee as applicable. While the total credentialing fees listed in Attachment B may vary, these should not exceed the amounts currently listed in the table above. Fresno County-Attachment e—Credentialing and Recredentialing Cost by Provider Type