Attachment C5.pdf

AGREEMENT FOR SUBSTANCE USE TREATMENT AND PREVENTION SERVICES BETWEEN THE COUNTY OF

SANTA CLARA AND [CONTRACTOR NAME] FOR FISCAL YEAR[S] 20XX

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ATTACHMENT C5

Legend:

FY23 Updates

AGREEMENT FOR SUBSTANCE USE TREATMENT AND PREVENTION SERVICES

BETWEEN THE COUNTY OF SANTA CLARA AND [CONTRACTOR NAME] FOR

FISCAL YEAR[S] 20XX

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

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

Exhibit A-1 Description of [Insert Program Name] Services Exhibit B Summary of Budget Exhibit B-1 Estimated Budget for Description of [Insert Program Name] Services Exhibit C Insurance Requirements for Professional Service Contracts Exhibit D Uniform Administrative Standards Exhibit E Service Requirements and Performance Measures Exhibit F Federally Required Contract Provisions Exhibit G Contractor Certification of Vaccination Status

II. TERM. Unless modified, amended, or terminated as provided herein, this AGREEMENT begins [insert date] and expires [insert date] (“TERM”).

III. SUBCONTRACTING.

A. CONTRACTOR may not subcontract for any substance use 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 treatment 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

ATTACHMENT C

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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 Department of Health Care Services (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 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 EE., of this AGREEMENT (“Maintenance, Retention and Confidentiality of Client Records”).

IV. COMPLIANCE AND LEGAL REQUIREMENTS.

A. Drug Medi-Cal Organized Delivery System (DMC-ODS) Program Licensure and Certification. The Medi-Cal DMC-ODS waiver program covers only Drug Medi-Cal services and is limited to the coverage of DMC-ODS services. Substance use treatment services shall be available to Medi-Cal beneficiaries through utilization of federal and state funds available pursuant to Title XIX or Title XXI of the Social Security Act for reimbursable covered services rendered by certified

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DMC contractors. These services shall be provided through a Prepaid Inpatient Hospital Plan (PIHP) as defined in 42 Code of Federal Regulations (C.F.R.) 438.2.

Contractors of services that are subject to reimbursement from Medicare or Medi- Cal shall be licensed, registered, DMC certified and/or approved in accordance with applicable laws and regulations. By signing this AGREEMENT, CONTRACTOR agrees to comply with the following regulations and guidelines:

1. Title 21, C.F.R. Part 1300 et seq., Title 42, C.F.R., Part 8;

2. Drug Medi-Cal Certification Standards for Substance Abuse Clinics;

3. Title 22, California Code of Regulations (C.C.R.), Sections 51341.1, 51490.1 and 51516.1;

4. Standards for Drug Treatment Programs (October 21, 1981);

5. Title 9, C.C.R., Division 4, Chapter 4, Subchapter 1, Sections 10000, et seq.;

and

6. Title 22, C.C.R., Division 3, Chapter 3, sections 51000 et. Seq.

B. In the event of conflicts, the most stringent provision shall control.

CONTRACTOR acknowledges that if it is under investigation by Department of Health Care Services (DHCS) or any state, local or federal law enforcement agency for fraud or abuse, the State may temporarily suspend CONTRACTOR from the DMC program, pursuant to Welfare and Institutions Code (WIC) Section 14043.36(a). Information about CONTRACTOR’s administrative sanction status is confidential until such time as the action is either completed or resolved. The DHCS may also issue a Payment Suspension to a contractor pursuant to WIC, Section 14107.11 and C.F.R., Title 42, section 455.23. COUNTY will withhold payments from a DMC contractor during the time a Payment Suspension is in effect. If, at any time, a CONTRACTOR’s license, registration, certification or approval to operate a substance abuse treatment program or provide covered services, is revoked suspended, modified, or not renewed, the COUNTY may amend or terminate this AGREEMENT. CONTRACTOR’s certification to participate in the DMC program shall automatically terminate in the event that CONTRACTOR or its owners, officers or directors are convicted of Medi-Cal fraud, abuse or malfeasance. For purposes of this section, a conviction shall include a plea of guilty or nolo contendere. CONTRACTOR shall comply with state and federal law and regulations related to program integrity, including, but not limited to, 42 C.F.R. 433.32, 42 C.F.R. 433.51, 42 C.F.R. 431.800 et. Seq., 42 C.F.R.

440.230, 42 C.F.R. 440.260, 42 C.F.R. 455 et. Seq., 42 C.F.R. 456 et. Seq., 42 C.F.R. 456.23, 22 C.C.R. 51490, 22 C.C.R 51490.1, 22 C.C.R 51341.1, 22 C.C.R 51159, WIC 14124.1, and WIC 14124.2; 42 C.F.R 438.600, 42 C.F.R. 438.602, 438.608.

C. Drug Program Certification Provisions. CONTRACTOR shall comply with all State and COUNTY requirements regarding program licensure or certification, including but not limited to state licensure for residential facilities, state certification for non-residential contractors, and/or COUNTY certification of residential facilities and Recovery Residences. CONTRACTOR shall comply with any program instituted by the Board of Supervisors for evaluation, inspection or certification of CONTRACTOR’s facilities, employees, or programs including, but

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D. Certification Regarding Debarment and Suspension. CONTRACTOR shall comply with applicable clauses relating to this provision as set forth in the contract, as amended, between the DHCS and County of Santa Clara (DHCS Contract), which is not attached but is incorporated by this reference, and which is available to CONTRACTOR upon request, including provisions not specifically set forth in this

AGREEMENT.

E. Notice to Clients/Beneficiaries Regarding Referrals to Alternate Provider. If CONTRACTOR is a faith based or religious organization, CONTRACTOR must give a notice regarding the right to receive alternative services to each Client/Beneficiary receiving services pursuant to this AGREEMENT. The notice shall state the following, in accordance with 42 C.F.R., parts 54 and 54(a):

1. “No provider of substance abuse services receiving Federal funds from the U.S. Substance Abuse and Mental Health Services Administration, including this organization, may discriminate against you on the basis of religion, a religious belief, a refusal to hold a religious belief, or a refusal to actively participate in a religious practice. If you object to the religious character of this organization, Federal law gives you the right to a referral to another provider of substance abuse services. The referral, and your receipt of alternative services, must occur within a reasonable period of time after you request them. The alternative provider must be accessible to you and have the capacity to provide substance abuse services. The services provided to you by the alternative provider must be of a value not less than the value of the services you would have received from this organization.”

F. Information to Client/Beneficiaries. Authorized beneficiary handbook will be distributed to beneficiaries at intake and as requested.

G. Client/Beneficiary Rights. Pursuant to WIC 5325 and 42 C.F.R. 438.100, CONTRACTOR shall comply with any applicable federal and state laws that pertain to beneficiary rights and shall ensure that its staff and affiliated contractors do the same when furnishing services.

H. Medical Necessity and Residence in Santa Clara County. DMC-ODS Services shall be available as a Medi-Cal benefit for individuals who meet the medical necessity criteria and reside in Santa Clara County. CONTRACTOR shall determine medical necessity pursuant to Title 9, C.C.R., sections 1820.205, 1830.205, or 1830.210, prior to providing any Medi-Cal covered services to clients who are Medi-Cal beneficiaries. Determination of who may receive the DMC-ODS benefit shall be performed pursuant to 42 C.F.R. 438.210:

1. CONTRACTOR must verify the Medicaid eligibility determination of an individual. When CONTRACTOR conducts the initial eligibility verification, that verification shall be reviewed and approved by COUNTY prior to payment for services, unless the individual is eligible to receive services from tribal health programs operating under the Indian Self Determination and Education Assistance Act (ISDEAA – Pub.L 93-968, as amended) and urban Indian organizations operating under Title V of the IHCIA.

2. The initial medical necessity determination for an individual to receive a

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DMC-ODS benefit must be performed through a face-to-face review or telehealth by the CONTRACTOR’s Medical Director, licensed physician, or LPHA. After establishing a diagnosis, the American Society of Addiction Medicine (ASAM) Criteria shall be applied by the CONTRACTOR’s Medical Director, licensed physician, or LPHA.

3. For an individual to receive ongoing DMC-ODS services, the CONTRACTOR’s Medical Director, licensed physician or LPHA shall reevaluate the individual’s medical necessity qualification at least every six

(6) months through the reauthorization process and determine that those services are still clinically appropriate for that individual.

I. Mandatory Covered Services. CONTRACTOR shall provide medically necessary Mandatory Covered Services in the County in compliance with 42 C.F.R.

438.210(a)(1), 438.210(a)(2), and 438.210(a)(3). CONTRACTOR shall deliver the Covered Services within a continuum of care as defined in the ASAM criteria.

J. Minor Consent Clients/Beneficiaries. If DMC services are provided to minor client/beneficiaries, CONTRACTOR shall comply with California Family Code (FAM) Section 6929, and C.C.R., Title 22, Section 50147.1, 50030, 50063.5, 50157(f)(3), 50167(a)(6)(D), and 50195(d) and all applicable laws and regulations.

K. Access to Services. CONTRACTOR shall maintain continuous availability and accessibility of contracted services.

1. Pursuant to 42 C.F.R. 438.6(m), CONTRACTOR shall allow each beneficiary to choose his or her health professional to the extent possible and appropriate.

2. CONTRACTOR shall require that treatment programs are accessible to people with disabilities in accordance with Title 45, C.F.R., Part 84 and the Americans with Disabilities Act.

3. CONTRACTOR shall make oral interpretation services available for clients/beneficiaries, as needed.

L. Timely Access. CONTRACTOR will establish mechanisms to ensure that their capacity, referral, and intake procedures comply with the timely access requirements; and take corrective action if there is failure to comply with timely access requirements. In accordance with 42 C.F.R. 438.206 (c)(1), CONTRACTOR shall comply with the following requirements:

1. Meet DHCS standards for timely access to care and services, taking into account the urgency of need for services, including making services available to beneficiaries twenty-four (24) hours a day, seven (7) days a week, when medically necessary. Hours of operation shall be posted in public view.

2. Have hours of operation during which services are provided to Medi-Cal beneficiaries that are no less than the hours of operation during which CONTRACTOR offers services to non-Medi-Cal beneficiaries.

M. Coordination and Continuity of Care. CONTRACTOR shall assure coordination and continuity of care within the standards prescribed by 42 C.F.R. 438.208.

1. The Contractor shall coordinate the services that CONTRACTOR either furnishes or arranges to be furnished to the beneficiary with services that the beneficiary receives from any other Medi-Cal managed care plan or CONTRACTOR in accordance with 42 C.F.R. 438.208(3)(b)(2).

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2. CONTRACTOR shall ensure that, in the course of coordinating care, each beneficiary’s privacy is protected in accordance with all federal and state privacy laws, including but not limited to 45 C.F.R. 160 and 164, to the extent that such provisions are applicable.

N. Medical Records. Pursuant to 42 C.F.R. 438.100, CONTRACTOR shall have written policies and procedures in place for beneficiaries to request and receive copies of their medical records, and to request that they be amended or corrected.

O. Beneficiary Problem Resolution Processes. CONTRACTOR shall comply with the beneficiary problem resolution process related to grievance, appeal, and fair hearing procedures and timeframes as specified in 42 C.F.R. 438.400 through 438.424, which includes the following:

1. The beneficiary’s right to a State Fair Hearing, how to obtain a hearing and the representation rules at the hearing.

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

3. The beneficiary’s right to give written consent to allow a contractor, acting on behalf of the beneficiary, to file an appeal.

4. The beneficiary may file a grievance either orally or in writing and, as determined by DHCS, either with the DHCS or with COUNTY.

5. The availability of assistance with filing grievances and appeals.

6. Provide beneficiaries with the available toll-free numbers to file oral grievances and appeals.

7. The beneficiary’s right to request continuation of benefits during an appeal or

State fair hearing filing although the beneficiary may be liable for the cost of any continued benefits if the action is upheld.

8. Any State determined contractor’s appeal rights to challenge the failure of the Contractor to cover a service.

9. Pursuant to 438 Subpart F, CONTRACTOR must post notices explaining grievance, appeal, and expedited appeal process procedures in locations at all CONTRACTOR sites. Notices shall be sufficient to ensure that the information is readily available to both beneficiaries and CONTRACTOR staff.

10. Pursuant to 42 C.F.R. 438.10, making available forms that may be used to file grievances, appeals, and expedited appeals and self-addressed envelopes that beneficiaries can access at all CONTRACTOR sites without having to make a verbal or written request to anyone.

11. A beneficiary shall not be subject to discrimination or any other penalty for filing a grievance, appeal, or expedited appeal.

12. Pursuant to 42 C.F.R. 438.240 related to record keeping and review requirements, identify in its grievance, appeal, and expedited appeal documentation, the roles and responsibilities of COUNTY, CONTRACTOR, and the beneficiary.

13. Pursuant to 42 C.F.R. 438.410(b), ensure that punitive action is not taken against a beneficiary or a contractor because they request an expedited appeal or support a beneficiary’s request for an expedited appeal..

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14. CONTRACTOR shall notify County if an action will be taken which warrants a 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).

P. Monitoring Compliance. CONTRACTOR will be held accountable by COUNTY for any functions and responsibilities that it performs consistent with 42 C.F.R.

438.6(l); 42 C.F.R. 438.230(a); 42 C.F.R. 438.230(b)(1), (2), (3), including:

1. CONTRACTOR must fulfill the requirements of 42 C.F.R. 438 that are appropriate to the service or activity delegated under this AGREEMENT.

2. Evaluate the CONTRACTOR’s ability to perform the contracted activities.

3. Specify the activities and report responsibilities of CONTRACTOR; and provides for revoking the contract or imposing other sanctions if CONTRACTOR’s performance is inadequate.

4. COUNTY will monitor CONTRACTOR’s performance on an ongoing basis and provide an annual onsite review, consistent with statutes and regulations.

5. COUNTY will identify deficiencies or areas for improvement, CONTRACTOR must take corrective actions and COUNTY shall ensure that CONTRACTOR implements these corrective actions.

Q. External Quality Review Organizations (EQRO) Monitoring. All contractors must comply and participate as requested in EQRO activities pursuant to 42 C.F.R.

438.350.

R. Contractor Preventable Conditions. CONTRACTOR shall cooperate with County Quality Management (QM) in addressing Contractor Preventable Conditions as referenced in the County’s DMC-ODS agreement with DHCS (Agreement Np 19-96220).

S. 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.

T. 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.

U. 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:

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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).

V. 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.

W. 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. Certification of "non-excluded provider" status. CONTRACTOR certifies that none of its staff including all employees and agents (whether or not such employee or agent is providing services pursuant to this AGREEMENT), applicants for hire, directors, board members, volunteers and owners of five percent interest or more, have been convicted of a criminal offense related to health care, nor have any staff been listed by any federal or state agency as debarred, excluded, or otherwise ineligible for participation in Medicare, Medi-Cal, or any other federal or state funded health care program.

3. Office of the Inspector General's List (OIG List) of Excluded Individuals/ Entities and the Medi-Cal Suspended and Ineligible Provider List (S & I List). CONTRACTOR shall check monthly the OIG and S & I List to prevent employment of, or payments to, any individuals or entities on the list, this must be satisfied prior to Medi-Cal certification of any individual or organizational provider. If the provider is listed on these lists, the County shall not certify or pay any provider with Medi-Cal funds, and any such inappropriate payments or overpayments may be subject to recovery and/or be the basis for other sanctions by the appropriate authority.

4. CONTRACTOR will screen all staff prior to making this certification, and will screen all applicants for employment with Provider on the OIG website at https://oig.hhs.gov/exclusions/exclusions_list.asp/ and the S& I website at https://files.medi-cal.ca.gov/pubsdoco/SandILanding.aspx.

5. CONTRACTOR will establish a system to monitor the status of all staff on a monthly basis. CONTRACTOR will draft a policy regarding the monitoring system CONTRACTOR establishes to monitor all staff and will make such Policy available to County for review at County's request. CONTRACTOR https://oig.hhs.gov/exclusions/exclusions_list.asp https://files.medi-cal.ca.gov/pubsdoco/SandILanding.aspx

Last reviewed by County Counsel on 3/9/22 Page 9 of 57 will maintain documentation verifying that CONTRACTOR has screened all staff. CONTRACTOR will make such documentation available to County at County's request. CONTRACTOR will notify County immediately by sending a written notice to the Department Director upon CONTRACTOR's learning that any staff person has been debarred, excluded, or otherwise listed as ineligible to participate in Medicare, Medi-Cal, or any other federal or state funded Program.

6. CONTRACTOR agrees to notify County immediately should any staff person be investigated, charged, or convicted of a criminal offense related to health care. CONTRACTOR will cooperate with County's requests regarding the staff person who is subject of the investigation including but not limited to, removing the staff person from any responsibility for, or involvement in, the provision of services under this Agreement. CONTRACTOR will inform County regarding the status of any such investigation. CONTRACTOR will not take any action regarding the investigation without receiving prior approval from County.

7. This Agreement may be terminated immediately by COUNTY if CONTRACTOR fails to comply with the requirements of this section.

CONTRACTOR will indemnify, defend, and hold harmless the COUNTY for all losses, and damages resulting from Providers failure to abide by the provisions of this section.

8. Federal Database Checks. Consistent with the requirements in 42 C.F.R.

455.436, CONTRACTOR shall check federal databases. This includes the Social Security Administration’s Death Master File, the National Plan and Contractor Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), and the System for Award Management (SAM).

These databases shall be checked monthly to prevent employment of, or payments to, any individuals or entities on the list, this must be satisfied prior to Medi-Cal certification of any individual or organizational contractor. If the CONTRACTOR is listed on these lists, the COUNTY shall not certify or pay CONTRACTOR with Medi-Cal or SABG funds, and any such inappropriate payments or overpayments may be subject to recovery and/or be the basis for other sanctions by the appropriate authority. CONTRACTOR will screen all staff prior to making this certification and will screen all applicants for employment with CONTRACTOR on the federal databases. CONTRACTOR will establish a system to monitor the status of all staff on a monthly basis.

CONTRACTOR will draft a policy regarding the monitoring system CONTRACTOR establishes to monitor all staff and will make such Policy available to COUNTY for review at COUNTY's request. CONTRACTOR will maintain documentation verifying that CONTRACTOR has screened all staff. CONTRACTOR will make such documentation available to COUNTY at COUNTY's request. CONTRACTOR will notify COUNTY immediately by sending a written notice to the BHSD Director upon CONTRACTOR 's learning that any staff person has been debarred, excluded, or otherwise listed

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9. CONTRATOR agrees to notify COUNTY immediately should any staff person be investigated, charged, or convicted of a criminal offense related to health care. CONTRACTOR will cooperate with COUNTY's requests regarding the staff person who is subject of the investigation, including but not limited to, removing the staff person from any responsibility for, or involvement in, the provision of services under this AGREEMENT.

CONTRACTOR will inform COUNTY regarding the status of any such investigation. CONTRACTOR will not take any action regarding the investigation without receiving prior approval from COUNTY.

10. This AGREEMENT may be terminated immediately by COUNTY if COUNTY fails to comply with the requirements of this AGREEMENT.

CONTRACTOR will indemnify, defend, and hold harmless COUNTY for all losses, and damages resulting from CONTRACTOR’s failure to abide by the provisions of this section.

11. Certification of license status. Professional staff must be licensed, registered, certified or recognized under California scope of practice statutes.

Professional staff shall provide services within their individual scope of practice and receive supervision required under their scope of practice laws.

The following positions qualify as Licensed Practitioner of the Healing Arts

(LPHA):

a. Physician

b. Nurse Practitioners

c. Physician Assistants

d. Registered Nurses

e. Registered Pharmacists

f. Licensed Clinical Psychologists

g. Licensed Clinical Social Worker

h. Licensed Professional Clinical Counselor

i. Licensed Marriage and Family Therapists

j. License Eligible Practitioners working under the supervision of Licensed

Clinicians:

1) Associate Clinical Social Worker

2) Associate Marriage and Family Therapist

3) Associate Professional Clinical Counselor

4) Registered Psychologist

12. CONTRACTOR certifies that all staff performing services pursuant to this AGREEMENT possess the required licenses and/or certification and that such licenses and/or certifications are in good standing, and that all staff performing services pursuant to this AGREEMENT are acting in accordance with any restrictions or limitations of these licenses and/or certifications.

CONTRACTOR shall have a system in place for monitoring the license or certification status of each staff person providing services pursuant to this Agreement. CONTRACTOR shall make available all documentation verifying

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13. LPHAs shall receive a minimum of five (5) hours of continuing education related to addiction medicine each year.

14. 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.

15. 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.

16. 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.

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

18. 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.

19. Compliance Program and False Claims Act. If CONTRACTOR utilizes COUNTY facilities, CONTRACTOR agrees to read and abide by the requirements set forth in the Compliance Program policies and procedures of

Last reviewed by County Counsel on 3/9/22 Page 12 of 57 the County of Santa Clara Health System (“Health System”), including, but not limited to, the Compliance Program Code of Conduct, Compliance Program Manual and False Claim Act-Fraud, Abuse and Waste. CONTRACTOR will, at the request of the COUNTY, attend compliance workshops provided by the Health System. If the CONTRACTOR does not utilize COUNTY facilities, CONTRACTOR will implement a Compliance Program that includes, at a minimum, a compliance plan, staff training, and a code of conduct. CONTRACTOR will attend workshops hosted by the COUNTY regarding Compliance training. CONTRACTOR will provide a copy of its compliance plan to COUNTY at COUNTY's request.

The basic elements that should be included in a compliance plan, as recommended by the Office of the Inspector General, are: 1) Compliance Standards; 2) High Level of Responsibility; 3) Trustworthy Individuals; 4) Education and Training; 5) Monitoring and Auditing; 6) Response and Prevention; and 7) Open Lines of Communication. Contractor must also distribute copies of the False Claims Act to its Contractors, agents and employees, as appropriate. The compliance plan shall be approved by the CONTRACTOR’s Board of Directors or Executive Director.

X. Non-Discrimination.

1. Client/Beneficiary Discrimination.

a. The 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.

b. Enrollment is voluntary, except in the case of mandatory enrollment programs that meet conditions set forth in 42 CFR 438.50(a).

c. The Contractor will not, on the basis of health status or need for health care services, discriminate against individuals.

d. Contractor will not discriminate against individuals under the laws of the United States and the State of California and will not use any policy or practice that has the effect of discriminating.

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. CONTRACTOR will ensure language capability for threshold languages and additional languages as described in the Exhibit A(s). In the event of a loss of language capability, CONTRACTOR shall continue to provide services and maintain language capability as identified in the Exhibit A(s).

f. The BHSD shall provide the CONTRACTOR their agency’s PIN number and instructions to access over the phone interpreter language services to serve clients that require language interpretations services. The BHSD will use the PIN number to track interpretation service usage by agency.

g. Culturally and Linguistically Appropriate Services (CLAS)

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Standards. Substance use disorder Contractors 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.hh.gov/

h. Information Access for Individuals with Limited English Proficiency.

Contractor shall comply with all applicable provisions of the Dymally- Alatorre Bilingual Services Act (Government Code sections 7290-7299.8) regarding access to materials that explain services available to the public as well as providing language interpretation services. Contractor shall comply with the applicable provisions of Section 1557 of the Affordable Care Act (45 CFR Part 92), including but not limited to, 45 CFR 92.201, when providing access to: (a) materials explaining services available to the public, (b) language assistance, (c) language interpreter and translation services, and (d) video remote language interpreting services.

i. 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.

Y. 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 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 http://www.minorityhealth.hh.gov/

Last reviewed by County Counsel on 3/9/22 Page 14 of 57 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.

Z. 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 WIC Section 5600 et seq.

CONTRACTOR will comply with BHSD’s discharge policy, which is described in Exhibit A(s) attached herein.

AA. Referrals and Admissions. CONTRACTOR will accept all referrals and will admit all clients from BHSD. Referrals for program admission will be made by BHSD

Last reviewed by County Counsel on 3/9/22 Page 15 of 57 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.

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

CC. 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 or any other statute or regulation if applicable.

DD. Staffing/Personnel.

1. Equal employment opportunity. The County of Santa Clara is an equal opportunity employer. CONTRACTOR shall comply with all applicable Federal, State, and local laws and regulations including Santa Clara County’s equal opportunity requirements. Such laws include but are not limited to the following: Title VII of the Civil Rights Act of 1964 as amended; Americans with Disabilities Act of 1990; The Rehabilitation Act of 1973 (Section 503 and 504); California Fair Employment and Housing Act (Government Code Sections 12900 et seq. and C.C.R., Title II, Division 4, Chapter 5); and California Labor Code sections 1101 and 1102.

2. Posting of notices. CONTRACTOR agrees to post in conspicuous places, notices available to all employees and applicants for employment, setting forth the provisions of the Equal Opportunity Act (42 USC Section 2000(e)) in conformance with Federal Executive Order No. 11246, Section 503 of the Rehabilitation Act of 1973 and the affirmative action clause required by the Vietnam Era Veterans’ Readjustment Assistance Act of 1974 (38 U.S.C.

4212). Contractor agrees to comply with the provisions of the Rehabilitation Act of 1973 (29 U.S.C. Section 794).

3. Personnel standards. CONTRACTOR shall comply with all personnel standards and training requirements set forth in this AGREEMENT.

4. Notice of changes in key personnel. CONTRACTOR shall inform COUNTY immediately and in writing of any changes in the CONTRACTOR’s Executive Director, Program Director, and fiscal staff.

5. Notice of changes in direct service staff. CONTRACTOR shall inform the COUNTY immediately and in writing of any changes in the CONTRACTOR’s clinical staff. CONTRACTOR shall also copy the COUNTY’s Quality Improvement and Data Support (QIDS) division on this written notice. Notwithstanding the requirements the notices and notification provisions of this AGREEMENT, and in addition to the written notice requirements in this AGREEMENT, CONTRACTOR shall also notify the COUNTY by telephone immediately of any such changes and by electronic mail, which should include any changes to the CONTRACTOR’s clinical staff. Staff Certification Report shall be submitted quarterly to SUTS. If Contractor fails to comply with the requirement set forth in the preceding sentence, CONTRACTOR shall not receive any payments under this contract

Last reviewed by County Counsel on 3/9/22 Page 16 of 57 or under any renewal or new contract.

6. Alternate Contacts. On an annual basis, CONTRACTOR shall submit emergency contacts when the Executive Director is unavailable for communications.

7. Unprofessional Conduct. CONTRACTOR shall prohibit any unprofessional conduct, including contact of a sexual nature between Clients/Beneficiaries and CONTRACTOR’s paid and unpaid personnel, agent, employee, volunteer or subcontractors. CONTRACTOR shall inform all staff, members of its Board of Directors, and Clients/Beneficiaries of this prohibition. If CONTRACTOR learns of or suspects any unprofessional conduct between Clients/Beneficiaries and CONTRACTOR’s paid and unpaid personnel, agent, employee, volunteer or subcontractor, the Contractor must notify the BHSD Director and Compliance Officer in writing within 48 hours.

Additionally, CONTRACTOR may be subject to additional applicable disciplinary action, including as set forth in Sections 4982 and 4992.3 of the Business and Professions Code.

8. Prohibition of financial relationship. CONTRACTOR shall prohibit any financial relationship between Clients/Beneficiaries and Contractor’s staff or members of its Board of Directors. If CONTRACTOR learns of such a relationship, the Contractor must notify the County immediately.

9. Restrictions on Salaries. CONTRACTOR agrees that no part of any federal funds provided under this AGREEMENT shall be used by CONTRACTOR to pay the salary and wages of an individual at a rate in excess of Level II of the Executive Schedule. Salary and wages schedules may be found at:

http://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/17tables/exec/html/EX.aspx. Substance Abuse Prevention and Treatment Block Grants (SABG) funds used to pay a salary in excess of the rate of basic pay for Level II of the Executive Schedule shall be subject to disallowance. The amount disallowed shall be determined by subtracting the individual’s actual salary from the Level II rate of basic pay and multiplying the results by the percentage of the individual’s salary that was paid with SABG funds.

10. Consequence of noncompliance. In the event CONTRACTOR fails to comply with the nondiscrimination provisions of this AGREEMENT or of State or Federal law, this AGREEMENT may be terminated or suspended by County in whole or in part.

11. Drug Free Workplace Act. By signing this AGREEMENT, CONTRACTOR certifies that it will comply with the requirements of the Drug Free Workplace Act of 1990 (California Government Code, Title 2, Chapter 1, Division 5.5, Section 8350 et seq.) and will provide drug free workplaces by taking the following actions:

a. Publish a statement notifying all employees that the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance is prohibited in the person’s or organization’s work place and specifying the actions that will be taken against employees for violations of the http://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/17tables/exec/html/EX.aspx http://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/17tables/exec/html/EX.aspx

Last reviewed by County Counsel on 3/9/22 Page 17 of 57 prohibitions as required by Government Code, Section 8355(a).

b. Establish a drug-free awareness program as required by Government Code

Section 8355(b) to inform employees about all of the following:

1) The dangers of drug abuse in the workplace; the person’s or organization’s policy of maintaining a drug-free work-place;

2) Any available drug counseling, rehabilitation, and employee assistance programs; and

3) The penalties that may be imposed upon employees for drug abuse violations.

c. Provide, as required by Government Code Section 8355(c), that every employee engaged in the performance of the services pursuant to this

AGREEMENT:

1) Be given a copy of the Contractor’s drug-free policy statement; and

2) As a condition of employment, agree to abide by the terms of the statement.

d. Failure to comply with these requirements for a drug-free work-place may result in suspension of payments under, or termination of this AGREEMENT or both, and CONTRACTOR may be ineligible for future COUNTY agreements if the County determines that any of the following has occurred:

1) CONTRACTOR has made false certification; or

2) CONTRACTOR has violated the certification by failing to carry out the requirements as noted above.

12. Messages regarding drugs. CONTRACTOR agrees that information produced through these funds, and which pertains to drug- and alcohol-related programs, shall contain a clearly written statement that there shall be no unlawful use of…