HomeMy WebLinkAbout32083AGT. # 15-157
STATE REPRESENTATION AGREEMENT
County of Fresno, California Children's Services Program (County), hereby
designates the State Department of Health Care Services (Sta,e} to represent
and defend the County in the fair hearing appeal regarding the
denial/discontinuation of program eligibility or benefits for M.T ., Fair Hearing
Appeal No. CS15..0315-713. To the extent that this arrangement rnay be
considered to create any conflicts of interest between the State and County,
County hereby waives such conflicts. State may provide legal counsel, if
necessary, and rnay settle any or all claims if the State believes it is proper with
respect to this appeaL County agrees to be bound by the outcome of the appeal,
whether It is a negotiated settlement or a final decision by the Director of Health
Care Services, and agrees to cooperate fully with representatives from the State
in the preparation and presentation of the case.
COUNTY REPRESENTATION
This is to confirm that this County has decided ·NoT TO AUTHORIZE the
Department of Health Care Services to represent/defend the County in this Fair
Hearing Appeal.
DATED: .. By: ------------
RETURN TO: Martha Perez
Office of Legal Services
Department of Health Care Services
MS 0010
P.O. Box 997413
Sacramento, CA 95899-7413
SEND COPY TO: Robert Dimand, M.D.
Chief Medical Officer
Children's Medical Services Branch
Department of Health Care Services
1515 K Street, Suite 400
Sacramento, CA 95814
STATE REPRESENTATION AGREEMENT
BETWEEN THE COUNTY OF FRESNO AND THE STATE OF CALIFORNIA
No.: California Health and Human Services Agency
Department of Health Care Services, Office of Legal Services
APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG
COUNTY COUNSEL
REVIEWED AND RECOMMENDED FOR APPROVAL:
By dJ,r/lJ(
David Pomaville
Director
Department of Public Health
Fund/Subclass:
Organization#:
rb
0001/10000
56201600