Attachment D.pdf

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

OF SANTA CLARA AND [CONTRACTOR NAME] FOR FISCAL YEAR 2025

Last Reviewed by County Counsel on 6/4/2024

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT

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

[CONTRACTOR NAME] FOR FISCAL YEAR 2025

County Department Behavioral Health Services Department

County Contract Representative Sherri Terao, Ed.D, Director

Contractor Insert Name of Contractor Agency

Contractor Representative Insert Name of Contractor Agency Representative [Contact listed below in notices]

Contract Term July 1, 2024 – June 30, 2025

ATTACHMENT C

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

OF SANTA CLARA AND [CONTRACTOR NAME] FOR FISCAL YEAR 2025

Last Reviewed by County Counsel on 6/4/2024

Table of Contents

Article 1. DEFINITIONS 4

Article 2. GENERAL PROVISIONS 4

Article 3. SERVICES AND ACCESS PROVISIONS 10

Article 4. AUTHORIZATION AND DOCUMENTATION PROVISIONS 15

Article 5. CHART AUDITING AND REASONS FOR RECOUPMENT 20

Article 6. CLIENT PROTECTIONS 23

Article 7. PROGRAM INTEGRITY 24

Article 8. QUALITY IMPROVEMENT PROGRAM 31

Article 9. FINANCIAL TERMS 36

Article 10. ADDITIONAL FINAL RULE PROVISIONS 41

Article 11. DATA, PRIVACY AND SECURITY REQUIREMENTS 46

Article 12. CLIENT RIGHTS 49

Article 13. RIGHT TO MONITOR 49

Article 14. SITE INSPECTION 52

Attached and Incorporated:

Exhibit (FY25) A1 – [Program Name], [Reporting Unit(s)]

Exhibit (FY25) A2 – [Program Name], [Reporting Unit(s)]

Exhibit (FY25) A3 – [Program Name], [Reporting Unit(s)]

Exhibit (FY25) B – Summary

Exhibit (FY25) B – [AOA/CYF/FDR/SHS] Outpatient Services Estimated Budget and Provider Rate Table [if applicable]

Exhibit (FY25) B – [AOA/CYF/FDR/SHS] Outpatient Services Indirect/Cost Estimated Budget Supplemental [if applicable]

Exhibit (FY25) B – [AOA/CYF/FDR/SHS] Residential Services Estimated Budget and Rate [if applicable]

Exhibit (FY25) B – [AOA/CYF/FDR/SHS] Cost-Based Programs Estimated Budget [if applicable]

Exhibit (FY25) C – Staffing

Exhibit D – Insurance Requirements for Professional Services Contracts

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

Exhibit E – Standard County Provisions

Exhibit F – County of Santa Clara Federally Required Contract Provisions

Exhibit G – Definitions for FSP [if applicable]

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

Exhibit H-1 – Consent to Release Confidential Health Information [if applicable]

Exhibit I – Facility Use Addendum [if applicable]

Exhibit J – Homeless Management Information Systems (HMIS) Client Consent to Data Collection and Release of Information [if applicable]

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

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

Clara, a political subdivision of the State of California (“County”), and [Name of Contractor Agency], a

California [non-profit/for-profit] corporation licensed to provide mental health services, whose principal address is [Contractor Address] (“Contractor”) (collectively, “Parties”).

RECITALS

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

Cal beneficiaries served by the County; and

WHEREAS, County has determined that it will arrange for a contractor to provide the [Division Name]

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

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

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

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

Service Act as follows:

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

TERMS

Article 1. DEFINITIONS

1. BEHAVIORAL HEALTH INFORMATION NOTICE (BHIN)

“Behavioral Health Information Notice” or “BHIN” means guidance from DHCS to inform counties and contractors of changes in policy or procedures at the federal or state levels. These were previously referred to as Mental Health and Substance Use Disorder Services Information

Notices (MHSUDS IN). BHINs and MHSUDS INs are available on the DHCS website.

2. BENEFICIARY OR CLIENT

“Beneficiary” or “client” means a Santa Clara County Medi-Cal beneficiary or Unsponsored Santa

Clara County resident who is eligible to receive Specialty Mental Health Services.

“Unsponsored” refers to an individual who does not have any private or government-sponsored health coverage.

3. DHCS

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

4. DIRECTOR

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

5. PROVIDER MANUAL

Provider Manual means the operations manual developed by the County and modified from time to time that identifies the methods of administration of this Agreement, including but not limited to credentialing procedures, quality management activities, utilization management programs (“UM Programs”), referral procedures, claims filing, guidance for inpatient psychiatric facilities, information on emergency services, and acute psychiatric inpatient services, and adjudication policies and procedures and accounting of Covered Services rendered here under.

Article 2. GENERAL PROVISIONS

1. TERM

This Agreement shall govern the period beginning July 1, 2024 and ending on June 30, 2025, inclusive, unless terminated earlier pursuant to Article 2, Paragraph 8 of this Agreement.

2. SCOPE OF WORK

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

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

3. COMPENSATION

A. This Agreement shall be subject to any restrictions, limitations, and/or conditions imposed by County, state, or federal funding sources that may in any way affect the fiscal provisions of, or funding for this Agreement. This Agreement is also contingent upon sufficient funds being made available by County, state, or federal funding sources for the term of the

Agreement. If the federal or state governments reduce financial participation in the Medi-

Cal program, County agrees to meet with Contractor to discuss renegotiating the services required by this Agreement.

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

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

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

4. NOTICE TO PARTIES

A. Unless otherwise specified, all notices to be given by either Party shall be in writing, by U.S.

mail and electronic mail, and addressed as follows:

1) Notices to County:

One copy to:

County of Santa Clara, Board of Supervisors

70 West Hedding Street

San Jose, California 95110

One copy to:

Behavioral Health Services Department

Sherri Terao, Ed.D, Director

828 South Bascom Avenue, Suite 200

San Jose, California 95128

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

2) Notices to Contractor:

Legal Entity Name

CCP Contact Name

Street Address

City, CA ZIP

B. Contractor shall notify County in writing of any change in organizational name, Head of

Organization, or principal place of business at least 15 business days in advance of the change by completing the network change request form as described in the Provider Manual. Contractor shall notify County of a change of service location at least six months in advance to allow County sufficient time to comply with site certification requirements.

C. Contractor shall notify County in writing of the following changes: new programs, full or partial moves, temporary or permanent closures, additions of modes of services, major renovation, school-linked services school changes, services and activities that require modification, facility licensure changes, inability to obtain fire clearance approval, legal entity name change, and new tax identification. These changes must be submitted at least 30 business days in advance of the change. This process is described in the Provider Manual.

D. Contractor shall immediately provide written notice to County of a change in ownership, organizational status, licensure, or ability of Contractor to provide the quantity or quality of the contracted services in a timely fashion. This notification requires completion of the network change request form as described in the Provider Manual.

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

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

5. INDEPENDENT CONTRACTOR

A. Contractor understands and agrees that the services performed hereunder by its officers, agents, employees, or contracting persons or entities are performed in an independent capacity and not in the capacity of officers, agents, or employees of the County for any

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY purpose, including workers’ compensation, tax withholding, and employee benefits.

Contractor shall determine the method and manner of performing its duties under this

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

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

6. SUBCONTRACTS

A. Contractor shall obtain prior written approval from the Director before subcontracting any of its obligations to provide services under this Agreement. Approval is at the discretion of the Director but shall not be unreasonably withheld. Contractor subcontracts are subject to the applicable terms and conditions of this Agreement, including, without limitation, the licensing, certification, privacy, data security and confidentiality requirements set forth herein, and include the applicable provisions of 42 C.F.R. 438.230.

B. Contractor shall remain legally responsible for the performance of all terms and conditions of this Agreement, including, without limitation, all SMHS provided by third parties under subcontracts, whether approved by the County or not.

7. MODIFICATION AND AMENDMENT

A. Except as specifically provided, this Agreement may only be modified or amended in writing signed by both Parties.

B. Contractor shall provide written notice to the County BHSD provider liaison and submit a

Program Modification request when the total amount billed and the estimated amount of work in progress total 75 percent of the MFO.

C. Program modification requests are required to make any changes to the terms as agreed to in the Exhibits attached to this Agreement or the maximum financial obligation of the entire contract through a process County will specify at the beginning of the fiscal year. County will provide notification to Contractor of that process. Changes to the maximum financial obligation will also require executing a formal amendment to this Agreement.

D. For changes related to staffing during the term of this Agreement, Contractor shall submit by email to the BHSD assigned program monitor that is listed on the impacted Exhibit A, a revised Staffing Exhibit. Changes to staffing will not require executing a formal amendment to this Agreement.

8. TERMINATION

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

A. This Agreement may be terminated at any time by the mutual written concurrence of both

Parties.

B. In addition to any other remedies it may have, the County may terminate this Agreement for cause in the event Contractor fails to perform its obligations under this Agreement in a timely and proper manner or violates any local, state or federal law, regulation, or standard applicable to its performance under the Agreement, provided Contractor fails to cure the breach within five days of receiving written notice of County’s intent to terminate. The waiver of any breach or violation of any requirement of this Agreement shall not be deemed to be a waiver of any such breach in the future, or of the breach of any other requirement of this Agreement. County reserves the right to terminate immediately, without a period to cure such breach, if Contractor fails to comply with the requirements of Article 8, subsection

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

C. Either Party may terminate this Agreement without cause by providing at least 90 days’ advance written notice of the effective date of termination.

D. In the event this Agreement is terminated, Contractor shall be entitled to compensation for all SMHS satisfactorily provided pursuant to the terms and conditions of this Agreement through and including the effective date of termination. This provision shall not limit or reduce any damages owed to the County due to a breach of this Agreement by Contractor.

Contractor shall participate in and make arrangements for the orderly transition of clients.

Within ten (10) business days from the date on the notice of termination, Contractor must provide to the BHSD a list of clients who received mental health or substance use treatment services or who were seen on a regular basis by Contractor. The information on the list shall include: name of client, recent phone number, address and/or contact information, and all relevant clinical information necessary to transition the client to another provider.

9. INTERPRETATION; VENUE

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

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

10. ENTIRE AGREEMENT

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

This Agreement, including all schedules, addenda, exhibits and attachments, contains the entire understanding of the Parties regarding Contractor ’s provision of the services specified in Exhibit

A (“Scope of Work”) and supersedes all prior representations regarding the same subject matter, whether written or oral.

11. SEVERABILITY

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

12. AUTHORITY TO CONTRACT

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

Agreement on behalf of their respective entities, and that any action necessary to bind each

Party has been taken prior to execution of this Agreement.

13. CONFORMITY WITH STATE AND FEDERAL LAWS AND REGULATIONS

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

I. California Code of Regulations, Title 9;

II. California Code of Regulations, Title 22;

III. California Welfare and Institutions Code, Division 5;

IV. United States Code of Federal Regulations, Title 42, including but not limited to

Parts 438 and 455;

V. United States Code of Federal Regulations, Title 45;

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

VII. Balanced Budget Act of 1997;

VIII. The Rehabilitation Act of 1973;

IX. Title IX of the Education Amendments of 1972;

X. The Americans with Disabilities Act;

XI. Health Insurance Portability and Accountability Act (HIPAA); and

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

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

B. In the event any law, regulation, or guidance referred to in subsection (A), above, is amended during the term of this Agreement, the Parties agree to comply with the amended authority as of the effective date of such amendment without amending this Agreement.

14. COMPLIANCE WITH PROVDER MANUAL

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

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

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

Agreement shall govern. The Manual is available on BHSD’s website, Provider portal |

Behavioral Health Services | County of Santa Clara (santaclaracounty.gov). Providers may email BHSDBusinessOffice@hhs.sccgov.org to request a printed copy of the Manual.

B. The Provider Manual may be revised from time to time, and County shall provide notice of amendments, as outlined in Article 2 Section 4, identifying the changes that County has determined are material, not less than thirty (30) business days prior to the amendment date. Notice of amendments to the Provider Manual that are necessary to comply with state or federal law or regulations may be less than thirty (30) business days if a shorter time for compliance is required. Contractor has the right to provide feedback regarding any change. The Parties shall meet and confer in good faith regarding the change. If the Parties are unable to agree to the amendment within the foregoing thirty (30) business day period, the Contractor may terminate this Agreement pursuant to Article 2 Section 8.

Article 3. SERVICES AND ACCESS PROVISIONS

1. CERTIFICATION OF ELIGIBILITY

Contractor will, in cooperation with County, comply with Section 14705.5 of California Welfare and Institutions Code to obtain a certification of a client’s eligibility for SMHS under Medi-Cal.

2. ACCESS TO SPECIALTY MENTAL HEALTH SERVICES

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

21-073. Specifically, the Contractor will ensure that the clinical record for each client https://bhdp.santaclaracounty.gov/home https://bhdp.santaclaracounty.gov/home

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time of service provision as specified below.

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

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

SMHS shall be provided to enrolled clients who meet either of the following criteria, (I) or

(II) below. If a client under age 21 meets the criteria as described in (I) below, the beneficiary meets criteria to access SMHS; it is not necessary to establish that the beneficiary also meets the criteria in (II) below.

I. The client has a condition placing them at high risk for a mental health disorder due to experience of trauma evidenced by any of the following: scoring in the high-risk range under a trauma screening tool approved by DHCS, involvement in the child welfare system, juvenile justice involvement, or experiencing homelessness.

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

a. A significant impairment

b. A reasonable probability of significant deterioration in an important area of life functioning

c. A reasonable probability of not progressing developmentally as appropriate.

d. A need for SMHS, regardless of presence of impairment, that are not included within the mental health benefits that a Medi-Cal Managed Care Plan (MCP) is required to provide.

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

e. A diagnosed mental health disorder, according to the criteria in the current editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the

International Classification of Diseases and Related Health Problems (ICD).

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

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

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

I. The client has one or both of the following:

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

a. Significant impairment, where impairment is defined as distress, disability, or dysfunction in social, occupational, or other important activities.

b. A reasonable probability of significant deterioration in an important area of life functioning.

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

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

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

3. REFERRAL AND INTAKE PROCESS

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

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

II. Contractor shall accept all referrals that are generated through the BHSD Call Center or direct referrals from beneficiaries or providers. These may include referrals from other counties for beneficiaries that have benefits associated with Santa Clara County.

III. The Contractor shall serve clients as determined by County policies, procedures, directives, and guidelines promulgated by BHSD and provided to Contractor. The

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

BHSD Policy and the Provider Manual.

IV. The Contractor shall notify the County through the Provider Network Change (PNC) process if they will be closing a level of care for the following month. The Provider

Manual outlines additional details on process.

a. These requests will be evaluated based on assessment of the Contractors current performance.

b. County reserves the right to deny Contractor’s request to close a program to referrals.

V. During agency closure due to holidays, the Contractor shall identify a point of contact to receive referrals from the BHSD Call Center to meet all timely access requirements.

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

VI. Referrals that do not meet the criteria for specialty mental health services or that are for individuals that provider determines need a different level of care should follow

County policies and procedures for transition of care and care coordination.

VII. The Contractor shall comply with a Feedback Loop Process to ensure that referral sources are notified of the status of the referral, provided the appropriate sections of the assessment, and informed of outcomes and/or next steps. Feedback should include client’s Primary Care Physician (PCP) to ensure care coordination.

VIII. Contractor should not refuse or fail to provide medically necessary services to any client unless Contractor is incapable of providing the services necessary or has an approved temporary program closure as outlined in the Provider Manual. Contractor is expected to provide services to clients in the same manner, in accordance with the same standards, and with the same time availability as provided to other clients.

4. ADDITIONAL CLARIFICATIONS

A. Criteria

I. A clinically appropriate and covered mental health prevention, screening, assessment, treatment, or recovery service listed within Exhibit A of this Agreement can be provided and submitted to the County for reimbursement under any of the following circumstances:

a. The services were provided prior to determining a diagnosis, including clinically appropriate and covered services provided during the assessment process;

b. The service was not included in an individual treatment plan; or

c. The client had a co-occurring substance use disorder.

B. Diagnosis Not a Prerequisite

I. Per BHIN 21-073, a mental health diagnosis is not a prerequisite for access to covered

SMHS. This does not eliminate the requirement that all Medi-Cal claims, including SMHS claims, include a current Centers for Medicare & Medicaid Services (CMS) approved ICD diagnosis code.

5. MEDICAL NECESSITY

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

BHIN 21-073, or any subsequent superseding DHCS notices, and pursuant to Welfare and

Institutions Code section 14184.402(a). Services provided to a client must be medically

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY necessary and clinically appropriate to address the client’s presenting condition.

Documentation in each client’s chart as a whole will demonstrate medical necessity as defined below, based on the client’s age at the time of service provision.

B. For individuals 21 years of age or older, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain as set forth in Welfare and Institutions

Code section 14059.5.

C. For individuals under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service meets the standards set forth in Section 1396d(r)(5) of Title 42 of the United States Code.

6. COORDINATION OF CARE

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

Agreement are coordinated among all providers who are serving the client, including all other SMHS providers, as well as providers of Non-Specialty Mental Health Services

(NSMHS), substance use disorder treatment services, physical health services, dental services, regional center services and all other services as applicable to ensure a client-centered and whole-person approach to services.

B. Contractor shall ensure that care coordination activities support the monitoring and treatment of comorbid substance use disorder and/or health conditions.

C. Contractor shall include in care coordination activities efforts to connect, refer and link clients to community-based services and supports, including but not limited to educational, social, prevocational, vocational, housing, nutritional, criminal justice, transportation, childcare, child development, family/marriage education, cultural sources, and mutual aid support groups.

D. Contractor shall engage in care coordination activities beginning at intake and throughout the treatment and discharge planning processes.

E. To facilitate care coordination, Contractor will request a HIPAA and California law compliant client authorization to share client information with and among all other providers involved in the client’s care, in satisfaction of state and federal privacy laws and regulations.

7. CONTINUITY OF CARE

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

Contractor shall follow the County’s continuity of care policy that is in accordance with applicable state and federal regulations, MHSUDS IN 18-059 and any BHINs issued by DHCS for parity in mental health and substance use disorder benefits subsequent to the effective date of this Agreement (42 C.F.R. §

438.62(b)(1)-(2).

8. CO-OCCURRING TREATMENT AND NO WRONG DOOR

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

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

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

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

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

II. If Contractor is serving a client receiving both SMHS and NSMHS, Contractor holds responsibility for documenting coordination of care and ensuring that services are non-duplicative.

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

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

Article 4. AUTHORIZATION AND DOCUMENTATION PROVISIONS

1. SERVICE AUTHORIZATION

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

A. Contractor shall collaborate with County to complete authorization requests in line with

County and DHCS policy.

B. Contractor shall have in place, and follow, written policies and procedures for completing requests for initial and continuing authorizations of services, as required by County guidance.

C. Contractor shall respond to County in a timely manner when consultation is necessary for

County to make appropriate authorization determinations.

D. County shall provide Contractor with written notice of authorization determinations within the timeframes set forth in BHINs 22-016 and 22-017, or any subsequent DHCS notices.

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

3. CONCURRENT REVIEWS

A. Programs that do not require prior authorization may utilize the initial referral from the

County as initial authorization for the service in the County’s referral. However, the

Contractor shall provide all necessary documentation to the County for the purpose of reauthorization and concurrent reviews of such programs. The documentation shall clearly indicate the client’s mental health condition and justification of medical necessity.

B. If concurrent review results in denial of services, the Contractor shall not discontinue treatment until an appropriate care plan for the client has been identified and agreed upon with the County. The County will reimburse the Contractor for denied days at the

Administrative Day Rate as outlined in Exhibit B and according to the requirements detailed in Exhibit A.

4. DOCUMENTATION REQUIREMENTS

A. Contractor will follow all documentation requirements as specified in Article 4.2-4.8 inclusive in compliance with federal, state and County requirements.

B. All Contractor documentation shall be accurate, complete, contain a coherent narrative of service, shall list each date of service, and include the face-to-face time for each service.

Contractor shall record documentation time for each service separately from face-to-face time and provide this information to County upon request. Services must be identified as provided in-person, by telephone, or by telehealth.

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

C. All services shall be documented utilizing an Electronic Health Record system which complies with state, federal, and County requirements. Contractor agrees to satisfy the chart documentation requirements set forth in BHIN 22-019, or any subsequent superseding

DHCS notices, and the contract between County and DHCS. Failure to comply with documentation standards specified in this Article requires corrective action plans.

5. ASSESSMENT

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

B. Contractor shall utilize the seven uniform assessment domains and include other required elements as identified in BHIN 22-019 or any subsequent superseding DHCS notices and document the assessment in the client’s medical record.

C. For clients receiving services within the Children, Youth and Family System of Care, aged 0-

25, the Child and Adolescent Needs and Strengths (CANS) CANS 5+ or CANS-EC (Early

Childhood), and for clients aged 3 through 18, the Pediatric Symptom Checklist-35 (PSC-35) tools are required at intake, every six months during treatment, and at discharge, as specified in DHCS MHSUDS INs 17-052 and 18-048 or any subsequent DHCS notices. The time period for providers to complete an initial assessment and subsequent assessments for

SMHS are up to clinical discretion; however, Contractor’s providers shall complete assessments within a reasonable time and in accordance with generally accepted standards of practice. County reserves the right to determine if initial and subsequent assessments for

SMHS were completed in a timely manner.

D. ICC/IHBS Screening

6. ICD-10

A. Contractor shall use the criteria set forth in the current edition of the DSM as the clinical tool to make diagnostic determinations.

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

C. The ICD Tabular List of Diseases and Injuries is maintained by CMS and may be updated during the term of this Agreement. Changes to the lists of ICD diagnoses do not require an

AGREEMENT FOR SHORT-DOYLE AND MENTAL HEALTH SERVICES ACT (MHSA) [DIVISION NAME] SERVICES BETWEEN THE COUNTY amendment to this Agreement, and County may implement these changes as provided by

CMS.

7. PROBLEM LIST

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

Agreement. The problem list is a list of symptoms, conditions, diagnoses, and/or risk factors identified through assessment, psychiatric diagnostic evaluation, crisis encounters, or other types of service encounters.

B. Contractor must document a problem list that adheres to industry standards utilizing at minimum current SNOMED International, Systematized Nomenclature of Medicine Clinical

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

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

D. The problem list shall include, but is not limited to, all elements specified in BHIN 22-019 or any subsequent superseding DHCS notices.

E. County does not require the problem list to be updated within a specific timeframe or have a requirement about how frequently the problem list should be updated after a problem has initially been added. However, Contractor shall update the problem list within a reasonable time such that the problem list reflects the current issues facing the client, in accordance with generally accepted standards of practice and in specific circumstances specified in BHIN

22-019, or any subsequent superseding DHCS notices.

8. TREATMENT AND CARE PLANS

Contractor is not required to complete treatment or care plans for clients under this Agreement, except in the circumstances specified in BHIN 22-019 and additional guidance from DHCS that may follow after execution of this Agreement.

9. PROGRESS NOTES

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

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

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

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

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

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

10. TRANSITION OF CARE TOOL

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

BHIN 22-065 or any subsequent superseding DHCS notices, in order to ensure continuity of care.

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

C. Contractor must use the DHCS-provided Transition of Care Tool, found at https://www.dhcs.ca.gov/Pages/Screening-and-Transition-of-Care-Tools-for-Medi-Cal-

Mental-Health-Services.aspx , Contractor may create the Transition of Care Tool in its

Electronic Health Record (EHR). However, the contents of the Transition of Care Tool, including the specific wording and order of fields, shall remain identical to the DHCS provided form. The only exception to this requirement is when the tool is translated into languages other than those languages provided by DHCS.

11. TELEHEALTH

A. Contractor may use telehealth, when it deems clinically appropriate, as a mode of delivering behavioral health services in accordance with all applicable County, state, and federal requirements, including those related to privacy/security, efficiency, and standards of care.

Such services will conform to the definitions and meet the requirements included in the

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

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

B. All telehealth equipment and service locations must ensure that client confidentiality is maintained.

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

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

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

D. Medical records for clients served by Contractor under this Agreement must include documentation of written or verbal consent for telehealth or telephone services if such services are provided by Contractor. Such consent must be obtained at least once prior to initiating applicable health care services and consent must include all elements as specified in BHIN 22-019 or any subsequent superseding DHCS notices.

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

12. DISCHARGE PLANNING

A. Contractor shall have written policies and procedures or shall adopt the County’s policies and procedures regarding discharge. These procedures shall contain the following:

I. Written criteria for discharge defining:

a. Successful completion of program;

b. Administrative discharge;

c. Involuntary discharge;

d. Transfers and referrals.

II. A discharge summary that includes:

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

b. Description of treatment episodes;

c. Description of recovery services completed;

d. Current alcohol and/or other drug usage;

e. Vocational and educational achievements;

f. Client’s continuing recovery or discharge plan signed by an LPHA, or registered or certified counselor and client;

g. Transfers and referrals; and

h. Client’s comments.

Article 5. CHART AUDITING AND REASONS FOR RECOUPMENT SUBSEQUENT TO AUDIT OR REVIEW

1. MAINTENANCE OF RECORDS

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

Contractor shall maintain proper clinical and fiscal records relating to clients served under the terms of this Agreement, as required by the County, DHCS, and all applicable state and federal statutes and regulations. Client records shall include but not be limited to admission records, diagnostic studies and evaluations, client interviews and progress notes, and records of services provided. All such records shall be maintained in sufficient detail to permit evaluation of the services provided and to meet claiming requirements.

2. ACCESS TO RECORDS

Contractor shall provide County with access to all documentation of services provided under this

Agreement for County’s use in administering this Agreement. Contractor shall allow County, CMS, the Office of the Inspector General, the Controller General of the United States, and any other authorized federal and state agencies to evaluate performance under this Agreement, and to inspect, evaluate, and audit any and all records, documents, and the premises, equipment and facilities maintained by the Contractor pertaining to such services at and as otherwise required under this Agreement.

3. FEDERAL, STATE AND COUNTY AUDITS

A. In accordance with the California Code of Regulations, Title 9, Chapter 11, Section

1810.380(a), County will conduct monitoring and oversight activities to review Contractor’s

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

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

B. Contractor shall comply with all audits performed by the County including regularly scheduled audits and evaluation of Contractor for compliance and quality assurance. These include monitoring and review activities such as chart audits, administrative review of

Contractor’s organization, policies, personnel, and fiscal reviews. The annual audit as performed by the County may lead to a Corrective Action Plan. The Contractor shall follow timelines and follow-up as outlined in the Provider Manual as well as in the Notice of

Correction that is issued by the County.

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

I. County reserves the right to consider the findings of any audits, reviews, or Corrective

Action Plans in future contracting and solicitation decisions.

4. CONFIDENTIALITY IN AUDIT PROCESS

A. Contractor and County mutually agree to maintain the confidentiality of Contractor’s client records and information, in compliance with all applicable state and federal statutes and regulations, including but not limited to HIPAA and California Welfare and Institutions Code, Section 5328. Contractor shall inform all its officers, employees, and agents of the confidentiality provisions of all applicable statutes.

B. Contractor’s fiscal records shall contain sufficient data to enable auditors to perform a complete audit and shall be maintained in conformance with standard procedures and accounting principles.

C. Contractor’s records shall be maintained as required by the Director and DHCS on forms furnished by DHCS or the County. All statistical data or information requested by the

Director shall be provided by the Contractor in a complete and timely manner.

5. REASONS FOR RECOUPMENT SUBSEQUENT TO AUDIT OR REVIEW BY COUNTY OR STATE

A. County will conduct periodic audits of Contractor files to ensure appropriate clinical documentation, high quality service provision and compliance with applicable federal, state and county regulations.

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

I. Identification of Fraud, Waste or Abuse as defined in federal regulation

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

14107.11, subdivision (d).

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

Managed Care Manual available at www.cms.gov/Regulation-and-

Guidance/Guidance/Manuals/Downloads/mc86c21.pdf.

II. Overpayment of Contractor by County due to errors in claiming or documentation.

Contractor assumes financial responsibility for claims that are inaccurate, invalid or lack supporting documentation or if any claims are denied or disallowed. However, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c21.pdf https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c21.pdf

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

Contractor shall not be financially responsible for claims denied or disallowed due to errors attributable solely to County.

C. Contractor shall reimburse County for all overpayments identified by Contractor, County, and/or state or federal oversight agencies as an audit exception within the timeframes required by law, County, or state or federal agency.

6. COOPERATION WITH AUDITS

A. Contractor shall cooperate with County in any review and/or audit initiated by County, DHCS, or any other applicable regulatory body. This cooperation may include such activities as onsite program, fiscal, or chart reviews and/or audits.

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

C. Contractor shall notify the County of any scheduled or unscheduled external evaluation or site visits when it becomes aware of such visit. County shall reserve the right to attend any or all parts of external review processes.

D. Contractor shall allow inspection, evaluation and audit of its records, documents and facilities for ten years from the term end date of this Agreement or in the event Contractor has been notified that an audit or investigation of this Agreement has been commenced, until such time as the matter under audit or investigation has been resolved, including the exhaustion of all legal remedies, whichever is later pursuant to 42 C.F.R.§§ 438.3(h) and

438.230I(3)(i-iii).

Article 6. CLIENT PROTECTIONS

1. GRIEVANCES, APPEALS AND NOTICES OF ADVERSE BENEFIT DETERMINATION

A. All grievances (as defined by 42 C.F.R. § 438.400) received by Contractor must be immediately forwarded to the County’s Quality Management Department or other designated persons via a secure method (e.g., encrypted email or by fax) to allow ample time for the County’s Quality Management staff to acknowledge receipt of the grievance and complaints and issue appropriate responses.

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

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

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

D. Aligned with MHSUDS IN 18-010E and 42 C.F.R.