HomeMy WebLinkAbout32413Agreement No. 15-343
CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS
MEDI-CAL CERTIFICATE OF COMPLIANCE
FISCAL YEAR 2015-2016
FRESNO COUNTY
MEDI-CAL COST A VOIDANCE PROGRAM
I certify that Fresno County has appointed a County Veterans Service Officer (CVSO) in
compliance with California Code of Regulations, Title 12, Subchapter 4. Please consider this as
our application to participate in the Medi-Cal Cost Avoidance Program authorized by Military
and Veterans Code Section 972.5.
I understand and will comply with the following:
1. All activities ofthe CVSO for which payment is made by CalVet under this agreement
will reasonably benefit the Department of Health Care Services (DHCS) or realize cost
avoidance to the Medi-Cal program. All County Medi-Cal Eligibility Workers who
generate a Form CW-5 (Veterans Benefits Referral) will be instructed to indicate the
applicant's Aid Code on the face ofthe form.
2. All monies received under this agreement shall be allocated to and spent on the salaries
and expenses of the CVSO.
3. This agreement is binding only if federal funds are available to CalVet from the DHCS.
4. The CVSO is responsible for administering this program in accordance with California
Code of Regulations, Title 12, Subchapter 4 and the Ca!Vet Procedure Manual for
Subvention and Medi-Cal Cost Avoidance for the current state fiscal year.
Deborah A. Poochigian, Chairm
County Board of Supervisors
ATTEST:
County of Fresno Signature Page For
California Department of Veterans Affairs
Medi-Cal Certificate of Compliance (FY 2015-16) and
Subvention Certificate of Compliance (FY 2015-16)
Recommended For Approval
Approved as to Legal Form:
Approved as to Accounting Form:
Vicki Crow, C.P.A., Auditor-Controllerffreasurer-Tax Collector
By: (li:A ( uf-vt #
Date: -----------------------------------------
County of Fresno
Fund/Subclass: 0001/10000
Organization: 7110
Account/Program: 3560/0
Agreement No. 15-343