Attachment C1.pdf

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

OF SANTA CLARA AND [CONTRACTOR NAME] FOR FISCAL YEAR 2024

Last Reviewed by County Counsel on 6/1/2023

ATTACHMENT C1

SAMPLE SD/MHSA AGREEMENT

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT

(MHSA) [DIVISION] SERVICES BETWEEN THE COUNTY OF SANTA CLARA AND

[CONTRACTOR NAME] FOR FISCAL YEAR 2024

County Department Behavioral Health Services Department

County Contract Representa�ve Sherri Terao, Ed.D, Director

Contractor Insert Name of Contractor Agency

Contractor Representa�ve Insert Name of Contractor Agency Representa�ve [Contact listed below in notices]

Contract Term July 1, 2023 – June 30, 2024

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

OF SANTA CLARA AND [CONTRACTOR NAME] FOR FISCAL YEAR 2024

Last Reviewed by County Counsel on 6/1/2023

Table of Contents Ar�cle 1. DEFINITIONS 3

Ar�cle 2. GENERAL PROVISIONS 4

Ar�cle 3. SERVICES AND ACCESS PROVISIONS 10

Ar�cle 4. AUTHORIZATION AND DOCUMENTATION PROVISIONS 15

Ar�cle 5. CHART AUDITING AND REASONS FOR RECOUPMENT 19

Ar�cle 6. CLIENT PROTECTIONS 22

Ar�cle 7. PROGRAM INTEGRITY 23

Ar�cle 8. QUALITY IMPROVEMENT PROGRAM 29

Ar�cle 9. FINANCIAL TERMS 34

Ar�cle 10. ADDITIONAL FINAL RULE PROVISIONS 38

Ar�cle 11. DATA, PRIVACY AND SECURITY REQUIREMENTS 43

Ar�cle 12. CLIENT RIGHTS 44

Ar�cle 13. RIGHT TO MONITOR 45

Ar�cle 14. SITE INSPECTION 47

Atached and Incorporated:

Exhibit (FY24) A1 – [Program Name], [Repor�ng Unit(s)]

Exhibit (FY24) A2 – [Program Name], [Repor�ng Unit(s)] Exhibit

(FY24) A3 – [Program Name], [Repor�ng Unit(s)]

Exhibit (FY24) B – Summary

Exhibit (FY24) B – Outpa�ent Programs Es�mated Budget and Provider Rate Table [if applicable]

Exhibit (FY24) B – Outpa�ent Programs Indirect/Cost Es�mated Budget Supplemental [if applicable]

Exhibit (FY24) B – Residen�al Programs Es�mated Budget and Rate [if applicable]

Exhibit (FY24) B – Cost-Based Programs Es�mated Budget [if applicable]

Exhibit (FY24) C – Staffing

Exhibit D – Insurance Requirements for Professional Services Contracts

Exhibit E – Standard County Provisions

Exhibit F – County of Santa Clara Federally Required Contract Provisions

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

Exhibit G – Contractor Cer�fica�on of Compliance with COVID-19 Vaccine Requirements

Exhibit H – Defini�ons for FSP [if applicable]

Exhibit I – Lease Addendum between Landlord and County of Santa Clara Service Provider [if applicable]

Exhibit I-1 – Consent to Release Confiden�al Health Informa�on [if applicable]

Exhibit J – Facility Use Addendum [if applicable]

Exhibit K – Homeless Management Informa�on Systems (HMIS) Client Consent to Data Collec�on and Release of Informa�on [if applicable]

Exhibit # – Other exhibits that are specific to the contract (e.g., Con�nuum of Care Subrecipient Requirements, etc.) [if applicable]

This Agreement for mental health services (Agreement) is entered by and between the County of Santa

Clara, a poli�cal subdivision of the State of California (“County”), and a

California [non-profit/for-profit] corpora�on licensed to provide mental health services, whose principal address is [Contractor Address] (“Contractor”) (collec�vely, “Par�es”).

RECITALS

WHEREAS, County is under contract with the State of California to provide or arrange for the provision of certain mandated services, including outpa�ent Specialty Mental Health Services (SMHS), for Medi-

Cal beneficiaries served by the County; and

WHEREAS, County has determined that it will arrange for a contractor to provide the Adult and Older

Adult Short-Doyle/Mental Health Services Act services to eligible beneficiaries; and

WHEREAS, Contractor has represented, through a proposal in response to County’s request for proposals or through another means acceptable to the County, that it is able and willing to provide such services;

NOW, THEREFORE, BHSD and Contractor agree that Contractor will provide services pursuant to this

Agreement and in accordance with the purpose and goals of the Short-Doyle Act and Mental Health

Service Act as follows:

TERMS

Ar�cle 1. DEFINITIONS

1. BEHAVIORAL HEALTH INFORMATION NOTICE (BHIN)

[Name of Contractor Agency], AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

“Behavioral Health Informa�on No�ce” or “BHIN” means guidance from DHCS to inform coun�es and contractors of changes in policy or procedures at the federal or state levels. These were previously referred to as Mental Health and Substance Use Disorder Services Informa�on

No�ces (MHSUDS IN). BHINs and MHSUDS INs are available on the DHCS website.

2. BENEFICIARY OR CLIENT

“Beneficiary” or “client” mean the individual(s) receiving services. 3.

DHCS

“DHCS” means the California Department of Health Care Services.

4. DIRECTOR

“Director” means the Director of the Santa Clara County Behavioral Health Services Department, unless otherwise specified.

5. PROVIDER MANUAL

Provider Manual means the opera�ons manual developed by the County and modified from

�me to �me that iden�fies the methods of administra�on of this Agreement, including but not limited to creden�aling procedures, quality management ac�vi�es, u�liza�on management programs (“UM Programs”), referral procedures, claims filing, and adjudica�on policies and procedures and accoun�ng of Covered Services rendered hereunder.

Ar�cle 2. GENERAL PROVISIONS

1. TERM

This Agreement shall govern the period beginning July 1, 2023 and ending on June 20, 2024, inclusive, unless terminated earlier pursuant to Ar�cle 2, Paragraph 8 of this Agreement. 2.

SCOPE OF WORK

Contractor shall provide the services set forth in Exhibit A(s).

3. COMPENSATION

A. This Agreement shall be subject to any restric�ons, limita�ons, and/or condi�ons imposed by County, state, or federal funding sources that may in any way affect the fiscal provisions of, or funding for this Agreement. This Agreement is also con�ngent upon sufficient funds being made available by County, state, or federal funding sources for the term of the

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

Agreement. If the federal or state governments reduce financial par�cipa�on in the MediCal program, County agrees to meet with Contractor to discuss renego�a�ng the services required by this Agreement.

B. Funding is provided by fiscal year. For purposes of this Agreement, the fiscal year begins July

1 and ends the following June 30. Any unspent fiscal year appropria�on does not roll over and is not available for services provided in subsequent years.

C. The Maximum Financial Obliga�on (MFO) of the County under this Agreement shall not exceed the MFO for the services as defined in this Agreement, including all applicable exhibits, is as stated in the Exhibit B Summary Page per fiscal year, which is not a guaranteed sum but shall be paid only for services rendered and received.

4. NOTICE TO PARTIES

A. Unless otherwise specified, all no�ces to be given by either Party shall be in wri�ng, by U.S.

mail and electronic mail, and addressed as follows:

1) No�ces to County:

One copy to:

County of Santa Clara, Board of Supervisors

70 West Hedding Street

San Jose, California 95110

One copy to:

Behavioral Health Services Department

Sherri Terao, Ed.D, Director

828 South Bascom Avenue, Suite 200

San Jose, California 95128

2) No�ces to Contractor:

Legal En�ty Name

CCP Contact Name

Street Address

City, CA ZIP

A. Contractor shall no�fy County in wri�ng of any change in organiza�onal name, Head of

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

Organiza�on, or principal place of business at least 15 business days in advance of the change.

Contractor shall no�fy County of a change of service loca�on at least six months in advance to allow County sufficient �me to comply with site cer�fica�on requirements.

B. Contractor shall no�fy County in wri�ng of the following changes: new programs, full or par�al moves, temporary or permanent closures, addi�ons of modes of services, major renova�on, school-linked services school changes, services and ac�vi�es that require modifica�on, facility licensure changes, inability to obtain fire clearance approval, legal en�ty name change, and new tax iden�fica�on. These changes must be submited at least 30 business days in advance of the change.

C. Contractor shall immediately provide writen no�ce to County of a change in ownership, organiza�onal status, licensure, or ability of Contractor to provide the quan�ty or quality of the contracted services in a �mely fashion.

D. Contractor shall provide County a list of their current contracted programs, by loca�on, and update the list on an annual basis. The list of programs and loca�ons shall include the physical loca�on that staff are serving beneficiaries or distant loca�on from which telehealth services are coordinated. The list shall include the site(s) name, physical address, site Na�onal Provider

Iden�fier (NPI) Number, head of organiza�on name and contact number, and the number of staff located at each site which must correspond to a program listed in Exhibit A(s).

5. INDEPENDENT CONTRACTOR

A. Contractor understands and agrees that the services performed hereunder by its officers, agents, employees, or contrac�ng persons or en��es are performed in an independent capacity and not in the capacity of officers, agents, or employees of the County for any purpose, including workers’ compensa�on, tax withholding, and employee benefits.

Contractor shall determine the method and manner of performing its du�es under this

Agreement, and County may monitor the work performed by Contractor.

B. Contractor shall provide all personnel, supplies, and opera�ng expenses of any kind required for the performance of this Agreement.

6. SUBCONTRACTS

A. Contractor shall obtain prior writen approval from the Director before subcontrac�ng any of its obliga�ons to provide services under this Agreement. Approval is at the discre�on of the

Director but shall not be unreasonably withheld. Contractor subcontracts are subject to the applicable terms and condi�ons of this Agreement, including, without limita�on, the

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY licensing, cer�fica�on, privacy, data security and confiden�ality requirements set forth herein, and include the applicable provisions of 42 C.F.R. 438.230.

B. Contractor shall remain legally responsible for the performance of all terms and condi�ons of this Agreement, including, without limita�on, all SMHS provided by third par�es under subcontracts, whether approved by the County or not.

7. MODIFICATION AND AMENDMENT

A. Except as specifically provided, this Agreement may only be modified or amended in wri�ng signed by both Par�es.

B. Contractor will closely monitor and manage client capacity based on available reports.

Contractor will no�fy the BHSD program monitor assigned to this Agreement as soon as possible to ensure that Contractor does not exceed the capacity agreed to in the exhibits atached to this Agreement. Contractor shall provide writen no�ce to the County BHSD program monitor and submit a Program Modifica�on request when the total amount billed and the es�mated amount of work in progress total 75 percent of the MFO.

C. Program modifica�on requests are required to make any changes to the terms as agreed to in the Exhibits atached to this Agreement or the maximum financial obliga�on of the en�re contract through a process County will specify at the beginning of the fiscal year. County will provide no�fica�on to Contractor of that process. Changes to the maximum financial obliga�on will also require execu�ng a formal amendment to this Agreement.

D. For changes related to staffing during the term of this Agreement, Contractor shall submit by email to the BHSD program monitor a revised Staffing Exhibit. Changes to staffing will not require execu�ng a formal amendment to this Agreement.

8. TERMINATION

A. This Agreement may be terminated at any �me by the mutual writen concurrence of both

Par�es.

B. In addi�on to any other remedies it may have, the County may terminate this Agreement for cause in the event Contractor fails to perform its obliga�ons under this Agreement in a

�mely and proper manner or violates any local, state or federal law, regula�on, or standard applicable to its performance under the Agreement, provided Contractor fails to cure the breach within five days of receiving writen no�ce of County’s intent to terminate. The waiver of any breach or viola�on of any requirement of this Agreement shall not be deemed to be a waiver of any such breach in the future, or of the breach of any other requirement of

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY this Agreement. County reserves the right to terminate immediately, without a period to cure such breach, if Contractor fails to comply with the requirements of Ar�cle 8, subsec�on

9 of this Agreement (“REPORTING UNUSUAL OCCURRENCES”).

C. Either Party may terminate this Agreement without cause by providing at least 90 days’ advance writen no�ce of the effec�ve date of termina�on.

D. In the event this Agreement is terminated, Contractor shall be en�tled to compensa�on for all SMHS sa�sfactorily provided pursuant to the terms and condi�ons of this Agreement through and including the effec�ve date of termina�on. This provision shall not limit or reduce any damages owed to the County due to a breach of this Agreement by Contractor.

Contractor shall par�cipate in and make arrangements for the orderly transi�on of clients.

Contractor may use its alloca�on of funding for services under this Agreement during transi�oning, as long as it is within the maximum financial obliga�on allowed under this

Agreement. Within ten (10) business days from the date on the no�ce of termina�on, Contractor must provide to the BHSD a list of clients who received mental health or substance use treatment services or who were seen on a regular basis by Contractor. The informa�on on the list shall include: name of client, recent phone number, address and/or contact informa�on.

9. INTERPRETATION; VENUE

A. The headings used herein are for reference only. The terms of the Agreement are set out in the text under the headings.

B. This Agreement has been executed and delivered in, and shall be construed and enforced in accordance with, the laws of the State of California. Proper venue for legal ac�on regarding this Agreement shall be in the County of Santa Clara.

10. ENTIRE AGREEMENT

This Agreement, including all schedules, addenda, exhibits and atachments, contains the en�re understanding of the Par�es regarding Contractor ’s provision of the services specified in Exhibit

A (“Scope of Work”) and supersedes all prior representa�ons regarding the same subject mater, whether writen or oral.

11. SEVERABILITY

If any provision of this Agreement, or any por�on thereof, is found by any court of competent jurisdic�on to be unenforceable or invalid for any reason, such provision shall be severable and shall not in any way impair the enforceability of any other provision of this Agreement.

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

12. AUTHORITY TO CONTRACT

County and Contractor warrant that they are legally permited and otherwise have the authority to enter into this Agreement, the signatories to this Agreement are authorized to execute this

Agreement on behalf of their respec�ve en��es, and that any ac�on necessary to bind each

Party has been taken prior to execu�on of this Agreement.

13. CONFORMITY WITH STATE AND FEDERAL LAWS AND REGULATIONS

A. Contractor shall provide services in conformance with all applicable state and federal statutes, regula�ons and subregulatory guidance, as from �me to �me amended, including but not limited to:

1) California Code of Regula�ons, Title 9;

2) California Code of Regula�ons, Title 22;

3) California Welfare and Ins�tu�ons Code, Division 5;

4) United States Code of Federal Regula�ons, Title 42, including but not limited to Parts

438 and 455;

5) United States Code of Federal Regula�ons, Title 45;

6) United States Code, Title 42 (The Public Health and Welfare), as applicable;

7) Balanced Budget Act of 1997;

8) The Rehabilita�on Act of 1973;

9) Title IX of the Educa�on Amendments of 1972;

10) The Americans with Disabili�es Act;

11) Health Insurance Portability and Accountability Act (HIPAA); and

12) Applicable Medi-Cal laws and regula�ons, including applicable sub-regulatory guidance, such as BHINs, MHSUDS INs, and provisions of County’s, state or federal contracts governing client services.

B. In the event any law, regula�on, or guidance referred to in subsec�on (A), above, is amended during the term of this Agreement, the Par�es agree to comply with the amended authority as of the effec�ve date of such amendment without amending this Agreement.

14. COMPLIANCE WITH PROVDER MANUAL

A. Contractor shall adhere to the requirements set forth in the Provider Manual. The Provider

Manual is hereby incorporated into this Agreement by reference. If any provision of the

Provider Manual is inconsistent with the terms of this Agreement, the terms of this

Agreement shall govern. The Manual is available on BHSD’s website, AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY htps://bhsd.sccgov.org/home. Providers may email BHSDBusinessOffice@hhs.sccgov.org to request a printed copy of the Manual.

B. The Provider Manual may be revised from �me to �me, and County shall provide no�ce of amendments, as outlined in Ar�cle 2 Sec�on 4, iden�fying the changes that County has determined are material, not less than thirty (30) business days prior to the amendment date. No�ce of amendments to the Provider Manual that are necessary to comply with state or federal law or regula�ons may be less than thirty (30) business days if a shorter �me for compliance is required. Contractor has the right to provide feedback regarding any change. The Par�es shall meet and confer in good faith regarding the change. If the Par�es are unable to agree to the amendment within the foregoing thirty (30) business day period, the Contractor may terminate this Agreement pursuant to Ar�cle 2 Sec�on 8.

Ar�cle 3. SERVICES AND ACCESS PROVISIONS

1. CERTIFICATION OF ELIGIBILITY

Contractor will, in coopera�on with County, comply with Sec�on 14705.5 of California Welfare and Ins�tu�ons Code to obtain a cer�fica�on of a client’s eligibility for SMHS under Medi-Cal. 2.

ACCESS TO SPECIALTY MENTAL HEALTH SERVICES

A. In collabora�on with the County, Contractor will work to ensure that individuals to whom the Contractor provides SMHS meet access criteria, as per DHCS guidance specified in BHIN

21-073. Specifically, the Contractor will ensure that the clinical record for each client includes informa�on as a whole indica�ng that client’s presenta�on and needs are aligned with the criteria applicable to their age at the �me of service provision as specified below.

B. For enrolled clients under 21 years of age, Contractor shall provide all medically necessary

SMHS required pursuant to Sec�on 1396d(r) of Title 42 of the United States Code. Covered

SMHS shall be provided to enrolled clients who meet either of the following criteria, (I) or (II) below. If a client under age 21 meets the criteria as described in (I) below, the beneficiary meets criteria to access SMHS; it is not necessary to establish that the beneficiary also meets the criteria in (II) below.

I. The client has a condi�on 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

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY under a trauma screening tool approved by DHCS, involvement in the child welfare system, juvenile jus�ce involvement, or experiencing homelessness.

II. The client has at least one of the following:

a. A significant impairment

b. A reasonable probability of significant deteriora�on in an important area of life func�oning

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 client’s condi�on as described in subparagraph (II a-d) above is due to one of the following:

e. A diagnosed mental health disorder, according to the criteria in the current edi�ons of the Diagnos�c and Sta�s�cal Manual of Mental Disorders (DSM) and the

Interna�onal Classifica�on of Diseases and Related Health Problems (ICD).

f. A suspected mental health disorder that has not yet been diagnosed.

g. Significant trauma placing the client at risk of a future mental health condi�on, based on the assessment of a licensed mental health professional.

C. For clients 21 years of age or older, Contractor shall provide covered SMHS for clients who meet both of the following criteria, (I) and (II) below: I. The client has one or both of the following:

a. Significant impairment, where impairment is defined as distress, disability, or dysfunc�on in social, occupa�onal, or other important ac�vi�es.

b. A reasonable probability of significant deteriora�on in an important area of life func�oning.

II. The client’s condi�on as described in paragraph (I) is due to either of the following:

a. A diagnosed mental health disorder, according to the criteria in the current edi�ons of the DSM and ICD.

b. A suspected mental disorder that has not yet been diagnosed.

3. REFERRAL AND INTAKE PROCESS

A. Contractor and County shall follow the referral and intake process as specified herein:

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

I. The County shall use reasonable, good-faith efforts to screen referrals in advance to determine the appropriate level of care required and to avoid making referrals that do not meet the criteria for specialty mental health services or that require a level of care not provided by Contractor.

II. Contractor shall accept all referrals that are generated through the BHSD Call Center or direct referrals from beneficiaries or providers.

III.

a. These may include referrals from other coun�es for beneficiaries that have benefits associated with Santa Clara County.

b. The Contractor shall serve clients as determined by County policies, procedures, direc�ves, and guidelines promulgated by BHSD and provided to Contractor. The

Contractor shall accept referrals according to the BHSD guidelines as outlined in the

BHSD Policy and the Provider Manual.

c. The Contractor shall provide a weekly report of the number of intake slots available

(Capacity Report) to the BHSD Call Center. Contractor shall submit Capacity Reports by each Friday for the following week's capacity.

d. During agency closure due to holidays, the Contractor shall iden�fy a point of contact to receive referrals from the BHSD Call Center to meet all �mely access requirements.

e. Referrals that do not meet the criteria for specialty mental health services or that are for individuals that provider determines need a different level of care should follow County policies and procedures for transi�on of care and care coordina�on.

f. The Contractor shall comply with a Feedback Loop Process to ensure that referral sources are no�fied of the status of the referral, provided the appropriate sec�ons of the assessment, and informed of outcomes and/or next steps. Feedback should include client’s Primary Care Physician (PCP) to ensure care coordina�on.

g. Contractor should not refuse or fail to provide services to any client unless

Contractor is incapable of providing the necessary services or as otherwise provided in the Closing a Program sec�on that follows. Contractor is expected to provide services to clients in the same manner, in accordance with the same standards, and with the same �me availability as provided to other clients.

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

4. ADDITIONAL CLARIFICATIONS

A. Criteria

I. A clinically appropriate and covered mental health preven�on, screening, assessment, treatment, or recovery service listed within Exhibit A of this Agreement can be provided and submited 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 client had a co-occurring substance use disorder.

B. Diagnosis Not a Prerequisite

I. 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.

5. MEDICAL NECESSITY

A. Contractor will ensure that services provided are medically necessary in compliance with

BHIN 21-073 and pursuant to Welfare and Ins�tu�ons Code sec�on 14184.402(a). Services provided to a client must be medically necessary and clinically appropriate to address the client’s presen�ng condi�on. Documenta�on in each client’s chart as a whole will demonstrate medical necessity as defined below, based on the client’s age at the �me of service provision.

B. 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 disability, or to alleviate severe pain as set forth in Welfare and Ins�tu�ons

Code sec�on 14059.5.

C. 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 Sec�on 1396d(r)(5) of Title 42 of the United States Code.

6. COORDINATION OF CARE

A. Contractor shall ensure that all care, treatment and services provided pursuant to this

Agreement are coordinated among all providers who are serving the client, including all

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY 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 clientcentered and whole-person approach to services.

B. Contractor shall ensure that care coordina�on ac�vi�es support the monitoring and treatment of comorbid substance use disorder and/or health condi�ons.

C. Contractor shall include in care coordina�on ac�vi�es efforts to connect, refer and link clients to community-based services and supports, including but not limited to educa�onal, social, prevoca�onal, voca�onal, housing, nutri�onal, criminal jus�ce, transporta�on, childcare, child development, family/marriage educa�on, cultural sources, and mutual aid support groups.

D. Contractor shall engage in care coordina�on ac�vi�es beginning at intake and throughout the treatment and discharge planning processes.

E. To facilitate care coordina�on, Contractor will request a HIPAA and California law compliant client authoriza�on to share client informa�on with and among all other providers involved in the client’s care, in sa�sfac�on of state and federal privacy laws and regula�ons.

7. CO-OCCURRING TREATMENT AND NO WRONG DOOR

A. Per BHIN 22-011, Specialty and Non-Specialty Mental Health Services can be provided concurrently, if those services are clinically appropriate, coordinated, and not duplica�ve.

When a client meets criteria for both NSMHS and SMHS, the client should receive services based on individual clinical need and established therapeu�c rela�onships. Clinically appropriate and covered SMHS can also be provided when the client has a co-occurring mental health condi�on and substance use disorder.

B. Under this Agreement, Contractor will ensure that clients receive �mely mental health services without delay according to standards and procedures outlined in the County BHSD

Provider Manual. Services are reimbursable to Contractor by County even when:

I. Services are provided prior to determina�on of a diagnosis, during the assessment or prior to determina�on of whether SMHS access criteria are met, even if the assessment ul�mately indicates the client does not meet criteria for SMHS.

II. If Contractor is serving a client receiving both SMHS and NSMHS, Contractor holds responsibility for documen�ng coordina�on of care and ensuring that services are nonduplica�ve.

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

C. Contractor shall have the ability to address the symptoms and func�onal impairment related to co-occurring illnesses of clients/beneficiaries who are not so impaired as to substan�ally interfere with the clients/beneficiary’s treatment, which includes the ability to recognize symptoms and make appropriate referrals and linkages to Contractors who may treat those symptoms of severe impairment beyond the scope of an individual’s cooccurring capability.

D. Contractor shall have psychiatric services available to support all ages and the ability to provide treatment to clients with co-occurring disorders as part of the service con�nuum.

Ar�cle 4. AUTHORIZATION AND DOCUMENTATION PROVISIONS

1. SERVICE AUTHORIZATION

A. Contractor shall collaborate with County to complete authoriza�on requests in line with

County and DHCS policy.

B. Contractor shall have in place, and follow, writen policies and procedures for comple�ng requests for ini�al and con�nuing authoriza�ons of services, as required by County guidance.

C. Contractor shall respond to County in a �mely manner when consulta�on is necessary for

County to make appropriate authoriza�on determina�ons.

D. County shall provide Contractor with writen no�ce of authoriza�on determina�ons within the �meframes set forth in BHINs 22-016 and 22-017, or any subsequent DHCS no�ces.

E. Contractor shall alert County when an expedited authoriza�on decision (no later than 72 hours) is necessary due to a client’s specific needs and circumstances that could seriously jeopardize the client’s life or health, or ability to atain, maintain, or regain maximum func�on.

2. DOCUMENTATION REQUIREMENTS

A. Contractor will follow all documenta�on requirements as specified in Ar�cle 4.2-4.8 inclusive in compliance with federal, state and County requirements.

B. All Contractor documenta�on shall be accurate, complete, contain a coherent narra�ve of service, shall list each date of service, and include the face-to-face �me for each service.

Contractor shall record documenta�on �me for each service separately from face-to-face

�me and provide this informa�on to County upon request. Services must be iden�fied as provided in-person, by telephone, or by telehealth.

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

C. All services shall be documented u�lizing an Electronic Health Record system which complies with state, federal, and County requirements. Contractor agrees to sa�sfy the chart documenta�on requirements set forth in BHIN 22-019 and the contract between County and

DHCS. Failure to comply with documenta�on standards specified in this Ar�cle requires correc�ve ac�on plans.

3. ASSESSMENT

A. Contractor shall ensure that all client medical records include an assessment of each client's need for mental health services.

B. Contractor shall u�lize the seven uniform assessment domains and include other required elements as iden�fied in BHIN 22-019 and document the assessment in the client’s medical record.

C. For clients receiving services within the Children, Youth and Family System of Care, aged 025, the Child and Adolescent Needs and Strengths (CANS) CANS 5+ or CANS-EC (Early

Childhood), and for clients 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. The �me period for providers to complete an ini�al assessment and subsequent assessments for SMHS are up to clinical discre�on; however, Contractor’s providers shall complete assessments within a reasonable

�me and in accordance with generally accepted standards of prac�ce. County reserves the right to determine if ini�al and subsequent assessments for SMHS were completed in a

�mely manner.

4. ICD-10

A. Contractor shall use the criteria set forth in the current edi�on of the DSM as the clinical tool to make diagnos�c determina�ons.

B. Once a DSM diagnosis is determined, the Contractor shall determine the corresponding mental health diagnosis in the current edi�on of ICD. Contractor shall use the ICD diagnosis code(s) to submit a claim for SMHS to receive reimbursement from County.

C. 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.

5. PROBLEM LIST

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

A. Contractor will create and maintain a Problem List for each client served under this

Agreement. The problem list is a list of symptoms, condi�ons, diagnoses, and/or risk factors iden�fied through assessment, psychiatric diagnos�c evalua�on, crisis encounters, or other types of service encounters.

B. Contractor must document a problem list that adheres to industry standards u�lizing at minimum current SNOMED Interna�onal, Systema�zed Nomenclature of Medicine Clinical

Terms (SNOMED CT®) U.S. Edi�on, September 2022 Release, and ICD-10-CM 2023.

C. A problem iden�fied during a service encounter may be addressed by the service provider during that service encounter and subsequently added to the problem list.

D. The problem list shall include, but is not limited to, all elements specified in BHIN 22-019.

E. County does not require the problem list to be updated within a specific �meframe or have a requirement about how frequently the problem list should be updated a�er a problem has ini�ally been added. However, Contractor shall update the problem list within a reasonable

�me such that the problem list reflects the current issues facing the client, in accordance with generally accepted standards of prac�ce and in specific circumstances specified in BHIN

22-019.

6. TREATMENT AND CARE PLANS

A. Contractor is not required to complete treatment or care plans for clients under this

Agreement, except in the circumstances specified in BHIN 22-019 and addi�onal guidance from DHCS that may follow a�er execu�on of this Agreement.

7. PROGRESS NOTES

A. Contractor shall create progress notes for the provision of all SMHS services provided under this Agreement.

B. Each progress note shall provide sufficient detail to support the service code selected for the service type as indicated by the service code descrip�on.

C. Progress notes shall include all elements specified in BHIN 22-019, whether the note be for an individual or a group service.

D. Contractor shall complete progress notes within three business days of providing a service, with the excep�on of notes for crisis services, which shall be completed within 24 hours.

E. Providers shall complete a daily progress note for services that are billed on a daily basis, such as residen�al and day treatment services, if applicable.

8. TRANSITION OF CARE TOOL

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

A. Contractor shall use a Transi�on of Care Tool for any clients whose exis�ng services will be transferred from Contractor Medi-Cal Managed Care Plan (MCP) provider or when NSMHS will be added to the exis�ng mental health treatment provided by Contractor, as specified in

BHIN 22-065 in order to ensure con�nuity of care.

B. Determina�ons to transi�on care or add services from a MCP shall be made in alignment with County policies and via a client-centered, shared decision-making process.

C. Contractor must use the DHCS-provided Transi�on of Care Tool, found at htps://www.dhcs.ca.gov/Pages/Screening-and-Transi�on-of-Care-Tools-for-Medi-CalMental-

Health-Services.aspx , Contractor may create the Transi�on of Care Tool in its Electronic

Health Record (EHR). However, the contents of the Transi�on of Care Tool, including the specific wording and order of fields, shall remain iden�cal to the DHCS provided form. The only excep�on to this requirement is when the tool is translated into languages other than

English.

9. TELEHEALTH

A. 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 defini�ons and meet the requirements included in the

Medi-Cal Provider Manual: Telehealth, available in the DHCS Telehealth Resources page at:

htps://www.dhcs.ca.gov/provgovpart/Pages/TelehealthResources.aspx.

B. All telehealth equipment and service loca�ons must ensure that client confiden�ality is maintained.

C. Licensed providers and staff may provide services via telephone and telehealth as long as the service is within their scope of prac�ce.

D. Medical records for clients served by Contractor under this Agreement must include documenta�on of writen or verbal consent for telehealth or telephone services if such services are provided by Contractor. Such consent must be obtained at least once prior to ini�a�ng applicable health care services and consent must include all elements as specified in BHIN 22-019.

E. County may at any �me audit Contractor’s telehealth prac�ces, and Contractor must allow access to all materials needed to adequately monitor Contractor’s adherence to telehealth standards and requirements.

https://www.dhcs.ca.gov/Pages/Screening-and-Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-Services.aspx https://www.dhcs.ca.gov/Pages/Screening-and-Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-Services.aspx https://www.dhcs.ca.gov/Pages/Screening-and-Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-Services.aspx https://www.dhcs.ca.gov/Pages/Screening-and-Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-Services.aspx https://www.dhcs.ca.gov/provgovpart/Pages/TelehealthResources.aspx https://www.dhcs.ca.gov/provgovpart/Pages/TelehealthResources.aspx

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

10. DISCHARGE PLANNING

A. Contractor shall have writen policies and procedures or shall adopt the County’s policies and procedures regarding discharge. These procedures shall contain the following: I. Writen criteria for discharge defining:

a. Successful comple�on of program;

b. Administra�ve discharge;

c. Involuntary discharge;

d. Transfers and referrals.

II. A discharge summary that includes:

a. Reason for discharge, including whether the discharge was voluntary or involuntary and whether the client successfully completed the program;

b. Descrip�on of treatment episodes;

c. Descrip�on of recovery services completed;

d. Current alcohol and/or other drug usage;

e. Voca�onal and educa�onal achievements;

f. Client’s con�nuing recovery or discharge plan signed by an LPHA, or registered or cer�fied counselor and client;

g. Transfers and referrals; and

h. Client’s comments.

Ar�cle 5. CHART AUDITING AND REASONS FOR RECOUPMENT

1. MAINTENANCE OF RECORDS

A. Contractor shall maintain proper clinical and fiscal records rela�ng to clients served under the terms of this Agreement, as required by the County, DHCS, and all applicable state and federal statutes and regula�ons. Client records shall include but not be limited to admission records, diagnos�c studies and evalua�ons, client interviews and progress notes, and records of services provided. All such records shall be maintained in sufficient detail to permit evalua�on of the services provided and to meet claiming requirements.

2. ACCESS TO RECORDS

A. Contractor shall provide County with access to all documenta�on of services provided under this Agreement for County’s use in administering this Agreement. Contractor shall allow

County, CMS, the Office of the Inspector General, the Controller General of the United

States, and any other authorized federal and state agencies to evaluate performance under

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY this Agreement, and to inspect, evaluate, and audit any and all records, documents, and the premises, equipment and facili�es maintained by the Contractor pertaining to such services at and as otherwise required under this Agreement.

3. FEDERAL, STATE AND COUNTY AUDITS

A. In accordance with the California Code of Regula�ons, Title 9, Chapter 11, Sec�on

1810.380(a), County will conduct monitoring and oversight ac�vi�es to review Contractor’s

SMHS programs and opera�ons. The purpose of these oversight ac�vi�es is to verify that medically necessary services are provided to clients, who meet medical necessity and criteria for access to SMHS as established in BHIN 21-073, in compliance with the applicable state and federal laws and regula�ons, and/or the terms of the Agreement between

Contractor and County, and future BHINs which may add or clarify other specific requirements.

B. Contractor shall comply with all audits performed by the County including regularly scheduled audits and evalua�on of Contractor for compliance and quality assurance. These include monitoring and review ac�vi�es such as chart audits, administra�ve review of Contractor’s organiza�on, policies, personnel, and fiscal reviews. The annual audit as performed by the

County may lead to a Correc�ve Ac�on Plan. The Contractor shall follow �melines and follow-up as outlined in the Provider Manual as well as in the No�ce of Correc�on that is issued by the County.

4. CONFIDENTIALITY IN AUDIT PROCESS

A. Contractor and County mutually agree to maintain the confiden�ality of Contractor’s client records and informa�on, in compliance with all applicable state and federal statutes and regula�ons, including but not limited to HIPAA and California Welfare and Ins�tu�ons Code, Sec�on 5328. Contractor shall inform all its officers, employees, and agents of the confiden�ality provisions of all applicable statutes.

B. 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 accoun�ng principles.

C. Contractor’s records shall be maintained as required by the Director and DHCS on forms furnished by DHCS or the County. All sta�s�cal data or informa�on requested by the Director shall be provided by the Contractor in a complete and �mely manner.

5. REASONS FOR RECOUPMENT

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

A. County will conduct periodic audits of Contractor files to ensure appropriate clinical documenta�on, high quality service provision and compliance with applicable federal, state and county regula�ons.

B. Such audits may result in requirements for Contractor to reimburse County for services previously paid and/or withholding of compensa�on for services subsequently rendered in the following circumstances:

I. Iden�fica�on of Fraud, Waste or Abuse as defined in federal regula�on

a. Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code, sec�on

14107.11, subdivision (d).

b. Defini�ons for “fraud,” “waste,” and “abuse” can also be found in the Medicare

Managed Care Manual available at www.cms.gov/Regula�on-and-

Guidance/Guidance/Manuals/Downloads/mc86c21.pdf

II. Overpayment of Contractor by County due to errors in claiming or documenta�on.

Contractor assumes financial responsibility for claims that are inaccurate, invalid or lack suppor�ng documenta�on or if any claims are denied or disallowed. However, Contractor shall not be financially responsible for claims denied or disallowed due to errors atributable solely to County.

III. Other reasons specified in the SMHS Reasons for Recoupment document released annually by DHCS and posted on the DHCS BHIN website.

C. Contractor shall reimburse County for all overpayments iden�fied by Contractor, County, and/or state or federal oversight agencies as an audit excep�on within the �meframes required by law, County, or state or federal agency.

6. COOPERATION WITH AUDITS

A. Contractor shall cooperate with County in any review and/or audit ini�ated by County, DHCS, or any other applicable regulatory body. This coopera�on may include such ac�vi�es as onsite program, fiscal, or chart reviews and/or audits.

B. In addi�on, Contractor shall comply with all requests for any documenta�on or files including, but not limited to, client and personnel files related to services provided under this agreement.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c21.pdf https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c21.pdf https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c21.pdf

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

C. Contractor shall no�fy the County of any scheduled or unscheduled external evalua�on or site visits when it becomes aware of such visit. County shall reserve the right to atend any or all parts of external review processes.

D. Contractor shall allow inspec�on, evalua�on and audit of its records, documents and facili�es for ten years from the term end date of this Agreement or in the event Contractor has been no�fied that an audit or inves�ga�on of this Agreement has been commenced, un�l such �me as the mater under audit or inves�ga�on has been resolved, including the exhaus�on of all legal remedies, whichever is later pursuant to 42 C.F.R.§§ 438.3(h) and

438.230I(3)(i-iii).

Ar�cle 6. CLIENT PROTECTIONS

1. GRIEVANCES, APPEALS AND NOTICES OF ADVERSE BENEFIT DETERMINATION

A. All grievances (as defined by 42 C.F.R. § 438.400) received by Contractor must be immediately forwarded to the County’s Quality Management Department or other designated persons via a secure method (e.g., encrypted email or by fax) to allow ample

�me for the County’s Quality Management staff to acknowledge receipt of the grievance and complaints and issue appropriate responses.

B. Contractor shall not discourage the filing of grievances and clients do not need to use the term “grievance” for a complaint to be captured as an expression of dissa�sfac�on and, therefore, a grievance.

C. Aligned with MHSUDS IN 18-010E and 42 C.F.R. §438.404, the appropriate and delegated

No�ce of Adverse Benefit Determina�on (NOABD) must be issued by Contractor within the specified �meframes using the template provided by the County.

D. Contractor shall issue NOABDs to beneficiaries as outlined in the Provider Manual.

E. NOABDs must be issued to clients any�me the Contractor has made or intends to make an adverse benefit determina�on that includes the reduc�on, suspension, or termina�on of a previously authorized service and/or the failure to provide services in a �mely manner. The no�ce must have a clear and concise explana�on of the reason(s) for the decision as established by DHCS and the County. The Contractor must inform the County immediately a�er issuing a NOABD.

F. Procedures and �meframes for responding to grievances, issuing and responding to adverse benefit determina�ons, appeals, and state hearings must be followed as per 42 C.F.R., Part

438, Subpart F (42 C.F.R. §§ 438.400 – 438.424).

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY

G. Contractor must provide clients any reasonable assistance in comple�ng forms and taking other procedural steps related to a grievance or appeal such as auxiliary aids and interpreter services.

H. Contractor must maintain records of grievances and appeals and must review the informa�on as part of its ongoing monitoring procedures. The record must be accurately maintained in a manner accessible to the County and available upon request to DHCS.

2. ADVANCED DIRECTIVES

Contractor must comply with all County policies and procedures regarding Advanced

Direc�ves in compliance with the requirements of 42 C.F.R. §§ 422.128 and 438.6(i) (l), (3) and (4).

3. CONTINUITY OF CARE

Contractor shall follow the County’s con�nuity of care policy that is in accordance with applicable state and federal regula�ons, MHSUDS IN 18-059 and any BHINs issued by DHCS for parity in mental health and substance use disorder benefits subsequent to the effec�ve date of this Agreement (42 C.F.R. § 438.62(b)(1)-(2).)

Ar�cle 7. PROGRAM INTEGRITY

1. GENERAL

As a condi�on of receiving payment under a Medi-Cal managed care program, the

Contractor shall comply with the provisions of 42 C.F.R. §§ 438.604, 438.606, 438.608 and

438.610. (42 C.F.R. § 438.600(b)).

2. CREDENTIALING AND RE-CREDENTIALING OF PROVIDERS

A. Contractor must follow the uniform process for creden�aling and recreden�aling of service providers established by County, through the County’s Managed Services Organiza�on, MSO, en�ty as specified in the Provider Manual, including disciplinary ac�ons such as reducing, suspending, or termina�ng provider’s privileges.