Attachment C1.pdf

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

COUNTY OF SANTA CLARA AND [ORGANIZATION NAME] FOR FISCAL YEAR 2023

Last Reviewed by County Counsel on 3/9/2022

BACKGROUND/PURPOSE

Whereas, the Short-Doyle Act was approved in 1957 requiring counties to provide mental health services utilizing a system that included county-operated contract providers; and

Whereas, the County of Santa Clara Health System (“Health System”) Behavioral Health Services Department (BHSD) executes a contract with the State Department of Health Care Services (DHCS) to provide or arrange for the provision of specialty mental health services to eligible Medi-Cal beneficiaries of Santa Clara County; and

Whereas, the BHSD maintains numerous Short-Doyle contracts with Community Based Organizations for a broad range of mental health services to all age populations and to all geographic areas of the County; and

Whereas, CONTRACTOR has developed mental health program(s) that further the BHSD’s goal of providing services to Seriously Mentally Ill (SMI) youth, adults and older adults from all ethnic and cultural populations represented in Santa Clara County; and

Whereas, in 2004, the voters of the State of California enacted Proposition 63, the Mental Health Services Act (MHSA), to expand access to mental health services in California; and

Whereas, the BHSD implemented the MHSA to ensure necessary mental health services reach children, adults and older adults with serious mental illness; and

Whereas, pursuant to the MHSA, the BHSD expanded access to services by focusing on innovation, prevention and early intervention based on individualized goals, strengths, needs, race, culture, concerns and motivation, and the BHSD has implemented programs such as Full Service Partnerships;

Community Services and Supports; Prevention and Early Intervention; and Innovation.

Whereas, CONTRACTOR has developed mental health programs that further the BHSD’s goal of expanding access to mental health services in Santa Clara County in accordance with the MHSA;

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 MHSA as follows:

AGREEMENT

I. SCOPE. This AGREEMENT, including the following Exhibits attached hereto and incorporated herein by reference, establishes the terms and conditions by which CONTRACTOR and BHSD will provide behavioral health services to COUNTY residents during the TERM:

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ATTACHMENT C1

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA)

[DIVISION NAME] SERVICES BETWEEN THE COUNTY OF SANTA CLARA AND

[ORGANIZATION NAME] FOR FISCAL YEAR 2023

This Agreement ("AGREEMENT") is by and between County of Santa Clara ("COUNTY"), a political subdivision of the State of California and [organization name], a non-profit entity ("CONTRACTOR").

COUNTY OF SANTA CLARA AND [ORGANIZATION NAME] FOR FISCAL YEAR 2023

Last Reviewed by County Counsel on 3/9/2022

Exhibit (FY23) A1 Exhibit (FY23) A2 Exhibit (FY23) B-Summary Program Budget Summary Exhibit (FY23) B1 Estimated Budget, Exhibit (FY23) B2 Estimated Budget, Exhibit C Insurance Requirements for Professional Service Contracts Exhibit D County of Santa Clara Federally Required Contract Provisions Exhibit E Contractor Certification of Vaccination Status Exhibit F Definitions for FSP Exhibit G Lease Addendum between Landlord and County of Santa Clara

Service Provider Exhibit G-1 Consent to Release Confidential Health Information Exhibit (FY23) 1 Caseloads Exhibit (FY23) 2 Staffing

II. TERM. Unless modified, amended, or terminated as provided herein, this AGREEMENT begins July 1, 2022 and expires June 30, 2023 (“TERM”).

III. SUBCONTRACTING.

A. CONTRACTOR may not subcontract for any mental health services under this AGREEMENT without the prior written approval of COUNTY. COUNTY will not approve any subcontract for Medi-Cal reimbursable mental health and substance use services provided under this AGREEMENT. CONTRACTOR may, however, hire qualified contract employees to provide Medi- Cal reimbursable services under the terms of this contract following approval by COUNTY.

B. CONTRACTOR retains all obligations and responsibilities to COUNTY under this AGREEMENT during the term of an approved subcontract.

C. All subcontracts will be in writing and in a format approved by COUNTY.

D. Each subcontract must contain at a minimum the following:

1. Full disclosure of the method and amount of compensation or other consideration to be received by the SUBCONTRACTOR from the CONTRACTOR.

2. Specification of the services to be provided.

3. Declaration that the subcontract shall be governed by and construed in accordance with all laws, regulations, and contractual obligations of the CONTRACTOR.

4. Specification of the term of the subcontract including the beginning and ending dates as well as methods for amendment, termination and, if applicable, extension of the subcontract.

5. SUBCONTRACTOR’s agreement that SUBCONTRACTOR shall comply with and be bound by all terms of this AGREEMENT, including but not limited to Section IV of this AGREEMENT (“Compliance and Legal Requirements”).

6. Inclusion of the requirements set forth in Section X, subsection B., of this AGREEMENT (“Non-Payment to Entity/Provider”).

7. SUBCONTRACTOR’s agreement to submit reports as required by the COUNTY.

8. SUBCONTRACTOR’s agreement to make all of its books and records, pertaining to the goods and services furnished under the terms of the subcontract, available for inspections, examination, or copying by the COUNTY; the State of California, including but not limited to officials from the State DHCS; any designated official of Federal Centers for Medicare & Medicaid Services (CMS); the Comptroller General of the United States; and other authorized federal and state agencies, or their duly authorized representatives, at all

COUNTY OF SANTA CLARA AND [ORGANIZATION NAME] FOR FISCAL YEAR 2023

Last Reviewed by County Counsel on 3/9/2022 reasonable times at the SUBCONTRACTOR’s place of business or at such other mutually agreeable location in California, in a form maintained in accordance with general standards applicable to such books or record keeping, and for at least ten (10) years from the close of the COUNTY’s fiscal year in which the subcontract was in effect.

9. SUBCONTRACTOR’s agreement that assignment or delegation of the subcontract shall be void unless prior written approval is obtained from the COUNTY.

10. SUBCONTRACTOR’s agreement that SUBCONTRACTOR will be paid only by

CONTRACTOR.

E. CONTRACTOR must give written notice to each client served on a regular basis, and to the BHSD, of termination of an approved subcontract with an individual, group, or organizational provider no later than fifteen (15) days from the date of termination. During the term of the subcontract, CONTRACTOR will maintain documentation of compliance with this requirement for the time specified under Section IV, subsection R., of this AGREEMENT (“Maintenance, Retention and Confidentiality of Client Records”).

IV. COMPLIANCE AND LEGAL REQUIREMENTS.

A. Licensure.

1. Facilities. Facilities used in performance of services pursuant to this AGREEMENT must meet all applicable requirements contained in federal, state, and local laws, statutes, or regulations.

2. Personnel. All persons performing services pursuant to this AGREEMENT must meet all applicable licensing, certification, or other federal, state, and local laws and regulations.

B. Medicare Rules. CONTRACTOR must comply with all laws and regulations governing the Medicare program, including, but not limited to: (1) the requirements of the Medicare Act, 42 U.S.C.

sections 1395 et seq.; and (2) the regulations and rules promulgated by the CMS as they relate to conditions of certification, participation, coverage, and reimbursement. CONTRACTOR will be responsible for compliance as of the effective date of each federal, state, or local law or regulation specified.

C. Medi-Cal Rules. CONTRACTOR must comply with all laws and regulations governing the Medi- Cal and Medicaid programs imposed by federal, state, and local statutes, regulations, and rules governing certification, participation, coverage, and reimbursement including, but not limited to applicable provisions of the following:

1. California Welfare and Institutions Code section 5600, et seq. (Short-Doyle/Bronzan- McCorquodale Acts)

2. Titles 9 and 22 of the California Code of Regulations

3. Title XIX of the Social Security Act, and any applicable regulations promulgated thereunder

4. Title VI of the Civil Rights Act (CRA) of 1964

5. The Age Discrimination Act of 1975

6. The Rehabilitation Act of 1973

7. Title IX of the Education Amendments of 1972

8. The Americans with Disabilities Act

9. Section 1557 of the Patient Protection and Affordable Care Act (ACA)

10. CONTRACTOR is required to comply with any applicable federal and state laws that pertain to enrollee rights and ensure that its employees and contracted providers observe and protect those rights.

11. CONTRACTOR shall comply with all applicable Medicaid laws, regulations, including applicable subregulatory guidance and contract provisions.

12. CONTRACTOR shall comply with all applicable laws and regulations relating to patients’ rights, including but not limited to, Welfare and Institution Code Section 5325 and 42 Code of Federal Regulations (C.F.R.) Section 438.100. CONTRACTOR shall ensure its subcontractors comply with these provisions.

13. As a condition for receiving payment under a Medi-Cal managed care program, CONTRACTOR shall comply with the provisions of 42 C.F.R. sections 438.604, 438.606, 438.608, and 438.610.

14. Network Adequacy Standards

a) CONTRACTOR shall meet the state standards for timely access to care and services, taking into account the urgency of need for services. CONTRACTOR shall offer hours of operation that are no less than the hours offered to commercial enrollees or that are comparable to Medicaid Fee-For-Service (FFS), if the provider serves only Medicaid enrollees. CONTRACTOR shall make services available twenty-four (24) hours a day, seven (7) days a week, when medically necessary.

b) CONTRACTOR shall establish mechanisms to ensure that it complies with the timely access requirements and shall monitor staff and services regularly to determine compliance with the timely access requirements. CONTRACTOR shall take corrective action if there is a failure to comply with the timely access requirements according to 42 C.F.R. Section 438.206(c)(1)(i)-(vi).

c) CONTRACTOR shall ensure the provision of physical access, reasonable accommodations, and accessible equipment for Medicaid enrollees with physical or mental disabilities according to 42 C.F.R. Section 438.203(c)(3).

15. For all services that CONTRACTOR is required to provide to adults, each service must be furnished in an amount, duration, and scope that is no less than the amount, duration and scope for the same services provided under FFS Medicaid. CONTRACTOR must provide the same extent of services to enrollees under the age of twenty-one (21) as furnished to individuals under the age of twenty-one (21) under FFS Medicaid. CONTRACTOR is prohibited from arbitrarily denying or reducing the amount, duration, or scope of a required service solely because of the diagnosis, type of illness, or condition of the enrollee.

16. CONTRACTOR is required to share the result of any identification and assessment of enrollee’s needs to prevent duplication of those activities with the State or other Managed Care Organizations (MCO), Prepaid Inpatient Health Plans (PIHP), and Prepaid Ambulatory Health Plans (PAHP) serving that enrollee.

D. Medi-Cal Enrollment. CONTRACTOR must assist clients who are currently enrolled beneficiaries in Medi-Cal in maintaining their Medi-Cal enrollment, including by helping clients timely and accurately prepare and submit their re-enrollments and/or re-certifications.

E. Privacy. CONTRACTOR must comply with all state and federal laws regarding the privacy of medical information, including but not limited to the following:

1. The Health Insurance Portability and Accountability Act, 45 C.F.R parts 160, 162 and 164

(“HIPAA”);

2. The Health Information Technology for Economic and Clinical Health Act (“HITECH” Act), Pub. L. 111-5, Div. A, Title XIII, § 130001 et seq., Div. B, Title IV, § 4001 et seq., Feb. 17, 2009, 123 Stat. 226, 467, 42 U.S.C.A. § 300ii, et seq., and 4U.S.C.A. § 17901, et seq.;

3. California Welfare and Institutions Code section 5328 et seq.;

4. California Evidence Code section 1010 et seq.;

5. Confidentiality Related to Housing/Homeless Programs:

a) All entities/agencies/clinics participating in Homeless Management Information System (HMIS) are required to maintain confidentiality of individual information pursuant to HMIS policies and procedures. In addition, all entities/agencies/clinics participating in

COUNTY OF SANTA CLARA AND [ORGANIZATION NAME] FOR FISCAL YEAR 2023

Last Reviewed by County Counsel on 3/9/2022

HMIS who are covered entities for purposes of the Health Insurance and Portability Act (“HIPAA”) or are health or mental health care providers pursuant to state or federal law, or are business associates of the County of Santa Clara are required to comply with federal and state laws governing the privacy and confidentiality of patient health information, including mental health and drug and alcohol information, and to obtain HIPAA-compliant authorizations from clients/patients prior to providing any such information to HMIS or the BHSD in connection with the HMIS program.

b) The CONTRACTOR is responsible for ensuring that all required authorizations are obtained and in place for all patient health information, including mental health and drug and alcohol information, that is or has been provided in connection with the HMIS program, and for taking all appropriate actions with respect to any privacy breaches that may result or may have resulted from the failure to obtain appropriate authorizations or comply with federal and state laws. CONTRACTOR shall use a HIPAA-compliant authorization in substantially the same format as the document attached hereto as Attachment 1 if applicable.

F. Other Applicable Laws. CONTRACTOR will provide services under this AGREEMENT in accordance with all other applicable federal, state, and local laws, rules, regulations, policies, and codes, including BHSD Policies and Procedures, effective at the inception of this AGREEMENT and that become effective during the TERM of this AGREEMENT.

G. Clean Air Act & Federal Water Pollution Control Act. CONTRACTOR will comply with all applicable standards, orders or regulations issued pursuant to the provisions of Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act (33 U.S.C. 1251 et seq.), as amended, and will include such provision in all subcontracts of amounts in excess of one hundred thousand dollars ($100,000). Violations will be reported to CMS.

H. Business Conduct. CONTRACTOR will comply with all applicable laws regarding the conduct of CONTRACTOR’s respective business and profession. CONTRACTOR will also comply with all laws or regulations governing conflict of interest and referral of clients, which are in effect or will become effective during the TERM of this AGREEMENT, including but not limited to the following:

1. Cal. Business and Professions Code section 650; Cal. Labor Code section 3215; and section 1128B of the Social Security Act (prohibition on payments for referral of clients); and

2. Cal. Labor Code sections 139.3 and 139.31; Cal. Business and Professions Code sections

650.01 and 650.02; and section 1877 of the Social Security Act (prohibition on referrals of clients by a contractor for certain designated health care services to an entity with which the contractor (or the referring party’s immediate family) have a financial relationship).

I. Grant Agreements. CONTRACTOR will comply with all federal and state funding contracts under which the COUNTY is a Grantee that apply to the services performed under this AGREEMENT and said grant provisions are a part of this AGREEMENT as if fully set forth herein. CONTRACTOR may request a copy of any pertinent grant agreement.

J. Certification of Health Care Providers.

1. CONTRACTOR certifies that neither CONTRACTOR nor its employees, directors, board members, subcontractors, or agents have been convicted of a criminal offense related to health care, nor is CONTRACTOR or its employees, directors, board members, subcontractors or agents listed by any federal or state agency as debarred, excluded, or otherwise ineligible for participation in federal or state funded health care programs.

2. CONTRACTOR certifies that it has performed an appropriate screening of all its employees, directors, board members, subcontractors, and agents prior to making the aforementioned certification.

COUNTY OF SANTA CLARA AND [ORGANIZATION NAME] FOR FISCAL YEAR 2023

Last Reviewed by County Counsel on 3/9/2022

3. CONTRACTOR will screen on a regular basis all CONTRACTOR employees, directors, board members, subcontractors and agents to determine whether they are excluded or otherwise ineligible for participation in federal or state funded health care programs.

CONTRACTOR further agrees to screen all new employees. The screening procedure will meet the screening requirements set forth in the BHSD Policies and Procedures relating to excluded provider’s status. At a minimum, CONTRACTOR will screen each person against

(1) the CMS Office of Inspector General (OIG) List of Excluded Individuals/Entities, and (2) the State Medi-Cal Suspended and Ineligible Provider List ("Excluded Provider Lists"). If CONTRACTOR employees, directors, board members, subcontractors, and agents are found to be on the Excluded Provider Lists, or if they are being investigated for an offense that may lead to exclusion, CONTRACTOR agrees to immediately send a written notice to BHSD’s Compliance Manager to determine appropriate action. If CONTRACTOR’s employees, directors, board members, subcontractors, or agents is excluded or debarred, or charged with a criminal offense, CONTRACTOR will remove the individual from any responsibility for, or involvement in, the provision of services under this AGREEMENT for an amount of time determined by COUNTY. If CONTRACTOR is excluded or debarred, or charged with a criminal offense, COUNTY may terminate the contract immediately.

a) CONTRACTOR certifies that its license and the licenses of all persons providing services pursuant to this AGREEMENT are in good standing and are not subject to any pending license investigations or citations. CONTRACTOR shall notify COUNTY immediately by sending written notice to the BHSD Compliance Officer upon learning that its license, or the license of any person providing services pursuant to this AGREEMENT, is being investigated, has been cited for a license violation, is restricted in any way, or is no longer in good standing.

b) COUNTY may terminate this AGREEMENT immediately if CONTRACTOR violates any of the provisions in this subsection.

c) CONTRACTOR will defend, indemnify and hold harmless COUNTY for any loss or damage resulting from any conviction, debarment, or any exclusion of CONTRACTOR or its employees, directors, board members, subcontractors or agents.

d) If CONTRACTOR utilizes COUNTY facilities while performing services pursuant to this AGREEMENT, CONTRACTOR will read and abide by the BHSD Program Policy, Code of Conduct, and Compliance Program Plan and will attend a compliance workshop provided by the COUNTY. CONTRACTORS utilizing non-COUNTY facilities must provide COUNTY with a copy of their compliance program, upon request.

K. Non-Discrimination.

1. Non-Discrimination in Services, Benefits and Facilities.

a) Consistent with the requirements of applicable federal or state law, CONTRACTOR will not engage in any unlawful discriminatory practices in the admission of clients, assignments of accommodations, treatment, evaluation, employment of personnel, or in any other respect on the basis of age, race, color, national origin, ancestry, religion, sex/gender, sexual orientation, mental disability, physical disability, medical condition, political beliefs, organizational affiliation, or marital status.

b) CONTRACTOR will comply with the provisions of Section 504 of the Rehabilitation Act of 1973, as amended, pertaining to the prohibition of discrimination against qualified handicapped persons in all federally assisted programs or activities, as detailed in regulations signed by the Secretary of Health and Human Services, COUNTY OF SANTA CLARA AND [ORGANIZATION NAME] FOR FISCAL YEAR 2023

Last Reviewed by County Counsel on 3/9/2022 effective June 1977, and found in the Federal Register, Volume 42, No. 86, Page 22675 et seq., dated May 4, 1977.

c) CONTRACTOR will include the nondiscrimination and compliance provisions of this AGREEMENT in all subcontracts for the provision of services pursuant to this

AGREEMENT.

d) CONTRACTOR will serve clients as determined by COUNTY’s policies, procedures, directives, guidelines, and Cultural Competency Plan to ensure that all eligible clients receive services from clinical staff that is culturally, ethnically, and linguistically competent. In addition, services will be delivered in a manner that is considerate of clients’ and family members’ cultures while preserving clients’ dignity and respecting their right to choose. For the Cultural Competency Plan, refer to:

https://www.sccgov.org/sites/mhd/AboutUs/LearningPartnershipDivision/Pages/CLC CDSDivisions.aspx

e) In order to serve bilingual clients, COUNTY will assess bilingual needs and require CONTRACTOR to recruit, employ, and maintain bilingual staff at a level designated by the COUNTY in support of the programs provided by CONTRACTOR and described in Exhibit A(s) attached herein.

f) Notwithstanding other provisions of this section, CONTRACTOR may require a determination of medical necessity pursuant to Title 9, California Code of Regulations, sections 1820.205, 1830.205, or 1830.210, prior to providing any Medi- Cal covered services to clients who are Medi-Cal beneficiaries.

g) Culturally and Linguistically Appropriate Services (CLAS) Standards.

CONTRACTOR shall ensure equal access to quality care by diverse populations and shall adopt the federal Office of Minority Health CLAS national standards. Refer to:

http://www.minorityhealth.hhs.gov/.

2. Appropriate Facilities. CONTRACTOR facilities will have access for the disabled to the extent required by Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, and any other applicable laws requiring such access.

L. COUNTY Ordinances, Resolutions, Policies, Procedures, Directives, and Guidelines.

1. CONTRACTOR must provide services under this AGREEMENT in accordance with the ordinances and resolutions of the COUNTY Board of Supervisors and the applicable policies, procedures, directives, and guidelines of the COUNTY, BHSD, and the County of Santa Clara Health System (“Health System”), including, but not limited to the BHSD Provider Manual. CONTRACTOR shall also read and abide by all related BHSD policies and procedures in the provision of services. COUNTY will notify CONTRACTOR of material modifications to the BHSD Provider Manual and/or BHSD policies and procedures.

CONTRACTOR must be in compliance with the BHSD Provider Manual and any new or modified policy, procedure, or directive within thirty (30) days from the date on which CONTRACTOR receives notice of such new or modified policy, procedure, or directive, or sooner if required by federal, state, or local regulations.

2. All Hazards. If CONTRACTOR receives training from BHSD in pandemic and other disasters (“All Hazards”) including, but not limited to: identifying high risk populations, monitoring psychosocial reactions to All Hazards, disseminating appropriate educational materials, providing safe intervention as needed, and making appropriate referrals, CONTRACTOR will, at the discretion of the Director of BHSD, be involved in planning and response activities related to All Hazards.

3. No Smoking Policy. CONTRACTOR and its employees, agents and subcontractors must comply with the COUNTY’s No Smoking Policy set forth in Board Policy section 3.47 (as

Sam http://www.minorityhealth.hhs.gov/

COUNTY OF SANTA CLARA AND [ORGANIZATION NAME] FOR FISCAL YEAR 2023

Last Reviewed by County Counsel on 3/9/2022 amended from time to time), which prohibits smoking: (1) at the Santa Clara Valley Medical Center Campus and all County-owned and operated health facilities, (2) within 30 feet surrounding County-owned buildings and leased buildings where the County is the sole occupant, and (3) in all County vehicles.

4. Beverage Nutritional Criteria. Except in the event of an emergency or medical necessity, the following nutritional standards shall apply to any foods and/or beverages purchased by CONTRACTOR with COUNTY funds for COUNTY-sponsored meetings or events. If food is to be provided, healthier food options shall be offered. “Healthier food options” include (1) fruits, vegetables, whole grains, and low fat and low calorie foods; (2) minimally processed foods without added sugar and with low sodium; (3) foods prepared using healthy cooking techniques; and (4) foods with less than 0.5 grams of trans fat per serving. Whenever possible, CONTRACTOR shall (1) offer seasonal and local produce; (2) serve fruit instead of sugary, high calorie desserts; (3) attempt to accommodate special, dietary and cultural needs;

and (4) post nutritional information and/or a list of ingredients for items served. If meals are to be provided, a vegetarian option shall be provided, and the CONTRACTOR should consider providing a vegan option. If pre-packaged snack foods are provided, the items shall contain: (1) no more than 35% of calories from fat, unless the snack food items consist solely of nuts or seeds; (2) no more than 10% of calories from saturated fat; (3) zero trans fat; (4) no more than 35% of total weight from sugar and caloric sweeteners, except for fruits and vegetables with no added sweeteners or fats; and (5) no more than 360 mg of sodium per serving. If beverages are to be provided, beverages that meet the COUNTY’s nutritional criteria are (1) water with no caloric sweeteners; (2) unsweetened coffee or tea, provided that sugar and sugar substitutes may be provided as condiments; (3) unsweetened, unflavored, reduced fat (either nonfat or 1% low fat) dairy milk; (4) plant-derived milk (e.g., soy milk, rice milk, and almond milk) with no more than 130 calories per 8 ounce serving; (5) 100% fruit or vegetable juice (limited to a maximum of 8 ounces per container); and (6) other low-calorie beverages (including tea and/or diet soda) that do not exceed 40 calories per 8 ounce serving. Sugar-sweetened beverages shall not be provided.

5. Pharmaceutical Company Prohibitions. During the term of this Agreement, CONTRACTOR will not accept any gifts, samples, promotional items, meals, food, travel, honoraria, expense reimbursement, speaking engagements, employment, or any other compensation from pharmaceutical or healthcare device or supply companies with the exception of research related activities that have been approved by an Institutional Review Board.

M. Admission and Discharge Procedures. CONTRACTOR will maintain its client admission procedures and eligibility criteria in writing and must make such procedures and eligibility criteria available to the public upon request. Such admissions procedures must be in conformance with Welfare and Institutions Code § 5600 et seq. CONTRACTOR will comply with BHSD’s discharge policy, which is described in Exhibit A(s) attached herein.

N. Referrals and Admissions. CONTRACTOR will accept all referrals and will admit all clients from BHSD. Referrals for program admission will be made by BHSD according to its guidelines, CONTRACTOR’s eligibility criteria, the client’s preference, and the terms of this AGREEMENT.

CONTRACTOR is expected to assess and refer beyond the initial referral.

O. Eligible Client Population. CONTRACTOR will serve the clients as outlined in the Exhibit A(s) attached herein.

P. Consent for Treatment. CONTRACTOR will obtain a signed “consent to treatment” form that includes consent for treatment services for each client covered by this AGREEMENT using a legally adequate consent form or format pursuant to California Welfare and Institutions Code section 5326.2

COUNTY OF SANTA CLARA AND [ORGANIZATION NAME] FOR FISCAL YEAR 2023

Last Reviewed by County Counsel on 3/9/2022 or any other statute or regulation if applicable.

Q. Program Capacity.

1. CONTRACTOR is not obligated to provide services to individuals whose participation exceeds the specified client capacity of programs as set forth in this AGREEMENT and all applicable exhibits.

2. If demand for services exceeds contracted capacity as set forth in this AGREEMENT and all applicable exhibits, CONTRACTOR will immediately notify BHSD.

3. CONTRACTOR will, in cooperation with the BHSD, develop a strategy for managing excess demand to ensure that there is no abrupt termination of services to any client. The strategy may include, but should not be limited to, systematic management of discharges and referrals through a Utilization Management process prior to services being offered and/or provided, waiting lists, and timely discharges of clients ready for transition to other service providers.

The COUNTY agrees the CONTRACTOR will make the final decision regarding discharge of a client based on the CONRACTOR’s professional assessment of client readiness.

4. CONTRACTOR will cooperate with BHSD to reasonably maintain consistent service levels throughout the TERM of this AGREEMENT, consistent with normal fluctuations agreed upon in advance, such as those related to school terms, or program and policy changes related to the changing fiscal environment, AGREEMENT reductions, and other impacts that may affect the staffing patterns as set forth in the Exhibit A(s), attached herein.

R. Maintenance, Retention, and Confidentiality of Client Records.

1. Maintenance of Records. CONTRACTOR must maintain legible and adequate medical, clinical, and/or rehabilitation records on each client as required by all applicable laws based on program type and funding source. Such records will, at a minimum, include: (a) diagnostic studies, if applicable; (b) a description of the goals set for each client's care; (c) documentation describing services provided by various professionals and paraprofessionals;

(d) documentation regarding client interviews and/or progress notes. CONTRACTOR will maintain such records in the form determined or approved by federal, state, and COUNTY laws, rules, and regulations. Such records will be in sufficient detail to facilitate evaluation of the services provided pursuant to this AGREEMENT and will contain all data necessary to prepare any reports required by the State DHCS.

2. Record Retention. CONTRACTOR will maintain client medical and/or clinical records as required by the California Code of Regulations or any other applicable laws. At a minimum, records will be retained for adult clients for a period of ten (10) years from the date of discharge, and records of persons who are under the age of eighteen (18) at the time of treatment must be retained until either one (1) year beyond the client's eighteenth (18th) birthday, or a period of ten (10) years from the date of discharge, whichever is later.

3. Confidentiality. CONTRACTOR will maintain the confidentiality of medical, psychiatric, and substance use treatment records of clients as required by applicable state and federal laws including, but not limited to those referenced in Section IV, subsection E., of this AGREEMENT (“Privacy”).

4. Access to Client records at Conclusion of Agreement. Upon expiration or termination of this AGREEMENT, CONTRACTOR will deliver copies of all client records to COUNTY within fifteen (15) working days of the date of expiration or termination. Client records include all medical/clinical records, utilization and peer review records, medication monitoring records, all data entered into the COUNTY’s electronic client tracking and billing system (“Billing System”), and all fiscal records related to funding received under this

AGREEMENT.

5. If CONTRACTOR is required to retain such records, CONTRACTOR will supply copies of

COUNTY OF SANTA CLARA AND [ORGANIZATION NAME] FOR FISCAL YEAR 2023

Last Reviewed by County Counsel on 3/9/2022 the records to COUNTY, at CONTRACTOR’s expense, and will allow inspection of the original records by COUNTY upon request during the duration of the applicable retention period. Although CONTRACTOR will, in this event, have possession of client records and information, COUNTY will own all such information and records notwithstanding the provisions of Section VII., of this AGREEMENT (“COUNTY Client Tracking and Billing Services System”).

6. CONTRACTOR is required to submit data that allows COUNTY to verify the accuracy, timeliness, completeness, logic, and consistency of the data reported. Data must be submitted in standardized formats to the extent feasible and appropriate, including in secure information exchanges and technologies utilized for State Medicaid quality improvement and care coordination efforts. CONTRACTOR is required to make all collected data available to the State and upon request to CMS.

7. CONTRACTOR shall allow the State, the Office of the Inspector General (OIG), the Comptroller General, and their designees to inspect and audit any records or documents at any time; inspect the premises, physical facilities, and equipment where Medicaid-related activities are conducted at any time; and audit records or documents for ten (10) years from the final date of the Agreement period or from the date of completion of any audit, whichever is later.

8. CONTRACTOR is required to retain, as applicable, enrollee grievance and appeal records in accordance with 42 C.F.R. Section 438.416; base data in accordance with 42 C.F.R. Section 438.5(c); Medical Loss Ratio (MLR) reports in accordance with 42 C.F.R. Section 438.8(k);

and the data, information, and documentation specified in 42 C.F.R. Sections 438.604, 438.606, 438.608, and 438.610 for a period of no less than ten (10) years.

9. CONTRACTOR is required to allow the State, CMS, the Department of Health and Human Services (DHHS) Inspector General, the Comptroller General, or their designees to audit, evaluate, and inspect any books, records, contracts, computer or other electronic systems of the CONTRACTOR or of the CONTRACTOR’s contractor, that pertain to any aspect of the services and activities performed, or determined of amounts payable, under the Agreement.

10. CONTRACTOR is required to make available for the purposes of an audit, evaluation, or inspection by the State, CMS, the DHHS Inspector General, the Comptroller General or their designees, its premises, physical facilities, equipment, books, records, contracts, computer or other electronic systems relating to its Medicaid enrollees. The right to audit by the State, CMS, the DHHS Inspector General, the Comptroller General or their designees, will exist through ten (10) years from the final date of the Agreement period or from the date of completion of any audit, whichever is later. If the State, CMS, the DHHS Inspector General, or their designees determine that there is a reasonable possibility of fraud or similar risk, the State, CMS, the DHHS Inspector General, or their designees may inspect, evaluate, and audit the CONTRACTOR at any time.

S. Trauma-informed Approach/Trauma-Informed Systems (TIS) 101.

1. CONTRACTOR will implement, utilize and sustain a coordinated system of care that is trauma-informed, client guided, family-driven and culturally responsive. A program, organization, or system that is trauma-informed is one that:

a) Realizes the widespread impact of trauma and understands potential paths for recovery;

b) Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;

c) Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and

d) Seeks to actively resist re-traumatization.

2. Trauma-informed practices include the following components:

a) Trauma-informed care approach, which involves looking at all practices through a trauma lens.

b) Trauma-informed practices are not interventions but are approaches that are infused through all levels of the organization.

c) Trauma-informed practices include, among others, creating a safe, supportive, welcoming, and respectful environment; educating and training all staff including administrators, direct care staff, case managers, and support staff about the impact of trauma;

implementing screening and assessment tools and procedures to identify clients who have experienced trauma and determine the impact of that trauma; and training clinical staff in trauma-specific treatments.

d) It is essential that providers are aware of their own cultural attitudes and beliefs, as well as those of their clients, and provide culturally relevant approaches.

3. CONTRACTOR will ensure that all direct service staff are trained in TIS 101. BHSD will offer trainings.

a) If CONTRACTOR has adopted another trauma-informed curriculum, a copy of that curriculum shall be submitted to BHSD in order to conduct a crosswalk and for approval.

4. CONTRACTOR will provide a plan by the end of the first quarter of the fiscal year of how their organization will become trauma-informed and sustained, and how success will be measured.

T. Notifications.

1. Within a reasonable time after receiving notice of beneficiary’s enrollment, CONTRACTOR and its subcontractors shall inform beneficiaries about:

a) Beneficiary grievance, appeal, and fair hearing procedures and timeframes as specified in 42 C.F.R. Section 438.400 through 42 C.F.R. Section 438.424.

b) The beneficiary’s right to file grievances and appeals and the requirements and timeframes for filing.

c) The availability of assistance to the beneficiary with filing grievances and appeals.

d) The beneficiary’s right to request a State fair hearing after the COUNTY has made a determination on an enrollee's appeal, which is adverse to the beneficiary.

e) The beneficiary’s right to request continuation of benefits that the COUNTY seeks to reduce or terminate during an appeal or state fair hearing filing, if filed within the allowable timeframes, although the beneficiary may be liable for the cost of any continued benefits while the appeal or state fair hearing is pending if the final decision is adverse to the beneficiary.

2. CONTRACTOR shall notify County if an action will be taken which warrants an Notice of Adverse Benefit Determination (NOABD) as set forth in the County’s governing NOABD policy and procedure(s) consistent with all applicable rules and regulations, including but not limited to 42 C.F.R. 438.10; 42 CFR 438.400; and 42 C.F.R 438.404. CONTRACTOR shall not issue an NOABD directly to the client/beneficiary. CONTRACTOR is expected to meet the notification timelines outlined in the NOABD policy and procedure(s).

U. Medi-Cal Certification. CONTRACTOR will establish and maintain certification through COUNTY to provide Medi-Cal reimbursable services (“Medi-Cal Certification”) before providing and billing for Medi-Cal services to clients. CONTRACTOR will not be reimbursed by COUNTY for any Medi-Cal services rendered prior to certification.

V. Provider Application and Validation for Enrollment (PAVE) and Medi-Cal Rx Enrollment.

CONTRACTOR shall ensure that all staff with the specified license types are enrolled in the DHCS PAVE system upon initiation of their employment. Applications shall be submitted through the DHCS PAVE Provider Portal (https://pave.dhcs.ca.gov/sso/login.do). Additionally, all prescribing staff must be registered in the Medi-Cal Rx Provider Portal (https://www.dhcs.ca.gov/provgovpart/pharmacy/Pages/Medi-CalRX.aspx).

Sam ple https://pave.dhcs.ca.gov/sso/login.do https://www.dhcs.ca.gov/provgovpart/pharmacy/Pages/Medi-CalRX.aspx

W. Credentialing Requirement. CONTRACTOR shall ensure that all of CONTRACTOR’s Practitioners are credentialed/re-credentialed as required by law and as required by the COUNTY for the services under this Agreement, through Valley Health Plan, the COUNTY’s designated Managed Services Organization (MSO) entity. CONTRACTOR shall ensure that staff comply in a timely manner with requests for Council for Affordable Quality Healthcare (CAQH) ProView applications, and other relevant applications to ensure credentialing is completed prior to initiation of services.

CONTRACTOR shall ensure that none of CONTRACTOR’s Practitioners or staff provide services under this AGREEMENT until after each Practitioner’s/staff’s credentialing/re-credentialing process through Valley Health Plan is complete. CONTRACTOR shall provide COUNTY (BHSD and VHP) with an updated credentialed staff list on a monthly basis at minimum.

V. DISCLOSURE OF VIOLATIONS AND UNUSUAL INCIDENTS.

A. CONTRACTOR will notify COUNTY by telephone of any potential violations of any provision of this AGREEMENT and unusual incidents within twenty-four (24) hours of the occurred incident. In addition, a written notice must be sent to the Director of BHSD within seventy-two (72) hours from the occurred incident.

B. CONTRACTOR will comply with COUNTY policies, procedures, and requirements concerning the reporting of unusual occurrences and incidents.

1. CONTRACTOR will provide COUNTY information and records about or related to: (a) complaints, grievances, appeals, and state fair hearings referenced in Section IV (T)(1) of this Agreement; (b) NOABDs referenced in Section IV (T)(2) of this Agreement; (c) violations, unusual incidents, fraud, waste, and abuse referenced in Section V (C) of this Agreement; and (d) claims, litigation, or administrative proceedings commenced against COUNTY arising from CONTRACTOR’s, or its employees’, agents’, or subcontractors’, performance under this Agreement. CONTRACTOR shall make a good faith effort to cooperate and assist COUNTY in COUNTY’s reasonable investigation of all such incidents listed in this subsection V (B)(1) of this Agreement.

2. CONTRACTOR shall notify COUNTY within forty-eight (48) hours of receiving notice of any litigation or administrative proceedings commenced against CONTRACTOR or its agents or subcontractors arising from CONTRACTOR’s, or its employees’, agents’, or subcontractors’ performance under this Agreement.

C. CONTRACTOR must report potential fraud, waste, and abuse information to the COUNTY.

CONTRACTOR shall implement and maintain arrangements or procedures designed to detect and prevent fraud, waste, and abuse that include prompt reporting to the COUNTY about the following:

1. Any potential fraud, waste, or abuse.

2. All overpayments identified or recovered, specifying the overpayments due to potential fraud.

3. Information about changes in a beneficiary’s circumstances that may affect the beneficiary’s eligibility including changes in the beneficiary’s residence or the death of beneficiary.

4. Services Verification.

D. In the event, and annually thereafter and upon request, that any person obtains an interest of five percent (5%) or more of any mortgage, deed of trust, note, or other obligation secured by CONTRACTOR, and that interest equals at least five percent (5%) of CONTRACTOR’s property or assets, CONTRACTOR will make the disclosures set forth in the section below:

1. The name and address of any person (individual or corporation) with an ownership or control interest in the CONTRACTOR’s network provider. The address for corporate entities shall include, as applicable, a primary business address, every business location, and a P.O. Box address;

2. Date of birth and Social Security Number (in the case of an individual);

3. Other tax identification number (in the case of a corporation with an ownership or control interest in the managed care entity or in any subcontractor in which the managed care entity has a five percent (5%)or more interest);

4. Whether the person (individual or corporation) with an ownership or control interest in the Contractor’s network provider is related to another person with ownership or control interest in the same or any other network provider of the CONTRACTOR as a spouse, parent, child, or sibling; or whether the person (individual or corporation) with an ownership or control interest in any subcontractor in which the managed care entity has a five percent (5%) or more interest is related to another person with ownership or control interest in the managed care entity as a spouse, parent, child, or sibling;

5. The name of any other disclosing entity in which the CONTRACTOR or subcontracting network provider has an ownership or control interest; and

6. The name, address, date of birth, and Social Security Number of any managing employee of the CONTRACTOR’s organization.

7. COUNTY would require any person or provider with a 5% or more direct or indirect ownership interest in the provider to submit a set of fingerprints per 42 C.F.R. 455.434(b)(2).

E. CONTRACTOR must submit disclosures and updated disclosures to the COUNTY including information regarding certain business transactions within thirty-five (35) days, upon request. The following information must be disclosed:

1. The ownership of any subcontractor with whom the CONTRACTOR has had business transactions totaling more than twenty-five thousand dollars ($25,000) during the twelve (12) month period ending on the date of the request; and

2. Any significant business transactions between the CONTRACTOR and any wholly owned supplier, or between CONTRACTOR and any subcontractor, during the five (5) year period ending on the date of the request.

3. CONTRACTOR must obligate network providers to submit the same disclosures regarding network providers within thirty-five (35) days upon request.

F. CONTRACTOR shall submit the following disclosures to the COUNTY regarding the CONTRACTOR’s management:

1. The identity of any person who is a managing employee of CONTRACTOR who has been convicted of a crime related to federal health care programs according to 42 C.F.R. Section 455.106(a)(1)-(2).

2. The identity of any person who is an agent of the CONTRACTOR who has been convicted of a crime related to federal health care programs. (42 C.F.R. Section 455.106(a)(1), (2).) For this purpose, the word "agent" has the meaning described in 42 C.F.R. Section 455.101.

3. CONTRACTOR shall supply the disclosures before entering into the contract and at any time upon the COUNTY’s request.

VI. DATA COLLECTION. CONTRACTOR is responsible for collecting and managing data in a manner to be determined by DHCS and/or BHSD. At a minimum CONTRACTOR will submit reports to COUNTY as required by COUNTY.

VII. COUNTY CLIENT TRACKING AND BILLING SYSTEM.

A. COUNTY's Billing System is a critical source of information for purposes of monitoring the provision of services and obtaining payment for such services. COUNTY will provide

CONTRACTOR with access to the Billing System at CONTRACTOR’s expense.

B. CONTRACTOR will use the Billing System in accordance with the COUNTY’s license with the vendor of the Billing System. Any violation by CONTRACTOR of the appropriate COUNTY license provision between COUNTY and manufacturer is a material breach of this AGREEMENT.

CONTRACTOR will defend, indemnify, and hold COUNTY harmless against all claims, losses, and damages brought against or imposed upon COUNTY for CONTRACTOR’s breach of the

AGREEMENT.

C. CONTRACTOR will be responsible for purchasing, at CONTRACTOR’s expense, all equipment necessary to access and use the Billing System, including but not limited to computers, printers and any other hardware.

D. CONTRACTOR is required to input all data regarding client services into the Billing System within ten (10) business days from the date the services were rendered. In the event CONTRACTOR cannot satisfy this requirement because the Billing System is malfunctioning, CONTRACTOR will not be in breach of this AGREEMENT. COUNTY agrees to use reasonable efforts to modify, coordinate or implement systems that reduce double data entry for CONTRACTOR into system.

E. COUNTY owns all data in the Billing System. Upon termination, CONTRACTOR may retain a copy of records that CONTRACTOR has a legal right to retain.

F. CONTRACTOR will comply with all applicable COUNTY policies, procedures, directives, and guidelines regarding the use of COUNTY’s Billing System.

G. CONTRACTOR shall not bill enrollees for covered services any amount greater than would be owed if the entity provided the services directly (i.e., no balance billing by providers) per Section 1932(b)(6) of the Act; 42 C.F.R. Section 438.3(k); and 42 C.F.R. Section 438.230(c)(1)-(2).

VIII. PERFORMANCE OUTCOMES.

A. CONTRACTOR will comply with the performance outcomes and measurements established in this

AGREEMENT, all applicable laws and regulations, as well as the Exhibits attached to this

AGREEMENT.

B. BHSD will monitor all services provided under this AGREEMENT on a regular basis. The information gathered through the use of the data collection reports and performance outcome measurements as described in the Exhibit A(s) attached herein where applicable, will be used to monitor the progress and success of programs included in this AGREEMENT.CONTRACTOR must routinely validate data as outlined in the BHSD Contract Monitoring Tool and other data reporting requirements as stipulated in the Exhibit A(s), with the understanding that this data will be discussed through the monthly meetings with BHSD.