HomeMy WebLinkAboutAgreement A-15-594-1 with Exodus Recovery Inc..pdfAgreement No. 15-594-1
AMENDMENT I TO AGREEMENT 1
2 THIS AMENDMENT , hereinafter referred to as "Amendment I", is made and entered into this
3 ..1filb.. day of June , 2019, by and between the COUNTY OF FRESNO , a Political Subdivision of the
4 State of California , hereinafter referred to as "COUNTY", and EXODUS RECOVERY, INC, a for-profit
5 California corporat ion , whose address is 9808 Venice Blvd , Suite 700 , Culver City , CA 90232 ,
6 hereinafter referred to as "CONTRACTOR" (collectively as the "parties").
7 WHEREAS , the parties entered into that certain Agreement, identified as COUNTY Agreement
8 No. 15-594, effective November 17, 2015, whereby CONTRACTOR agreed to operate an adult
9 sixteen (16) bed acute inpatient psychiatric health facility (PHF) to provide psychiatric services to adult
10 cl ients who may be admitted on a voluntary basis or involuntary basis and may include Medi-Cal
11 beneficiaries , Medicare and Medicare/Medi-Cal benefic iar ies, indigent/uninsured clients , and jail
12 inmates who are referred by the Department of Behavioral Health (DBH), DBH contract providers ,
13 hospital emergency rooms , other COUNTY departments and other agencies . In addition ,
14 conservatees of the COUNTY that are placed in other residential settings and attending court in
15 Fresno County will be temporarily placed at the PHF operated by CONTRACTOR until each such
16 conservatee 's court proceeding is completed.
17 WHEREAS , CONTRACTOR has requested greater access to the COUNTY's DBH electronic
18 health record system (Avatar); and
19 WHEREAS , COUNTY , through DBH , is willing to provide CONTRACTOR with greater access to
20 its electronic health record system ; and
21 WHEREAS , the parties desire to amend COUNTY Agreement No . 15-594 , regard ing changes
22 as stated below and restate the Agreement in its entirety.
23 NOW, THEREFORE , for good and valuable consideration, the rece ipt and adequacy of which is
24 hereby acknowledged , the parties agree to amend the Agreement as follows :
25 1. That the following section shall be inserted into COUNTY Agreement No . 15-594, at
26 Page Three (3), Paragraph One (1), Line Thirteen (13):
27 "J . CONTRACTOR shall align programs , serv ices, and practices with the vision ,
28 mission , and guiding principles of the DBH , as further described in Exhibit M, "Fresno County
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Department of Behavioral Health Guiding Principles of Care Delivery”, attached hereto and by this
reference incorporated herein and made part of this Agreement.
K.CONTRACTOR shall send to County’s DBH upon execution of this Agreement, a
detailed plan ensuring clinically appropriate leadership and supervision of their clinical program.
Recruitment and retaining clinical leadership with the clinical competencies to oversee services based
on the level of care and program design presented herein shall be included in this plan. A description
and monitoring of this plan shall be provided.
L.CONTRACTOR shall participate in utilizing and integrating the Reaching
Recovery and other clinical tools and measures as directed by the DBH.
M.It is the expectation of the COUNTY that CONTRACTOR provide timely access
to services that meet the State of California standards for care. CONTRACTOR shall track timeliness
of services to clients and provide a monthly report showing the monitoring or tracking tool that
captures this data. COUNTY and CONTRACTOR shall meet to go over this monitoring tool on a
monthly basis as needed. COUNTY shall take corrective action if there is a failure to comply by
CONTRACTOR with the above timely access standards. CONTRACTOR shall also provide tracking
tools and measurements for effectiveness, efficiency, and client satisfaction indicators as required by
Commission on Accreditation of Rehabilitation Facilities (CARF) standards and as further detailed in
Exhibit A.
N.CONTRACTOR may maintain its records in COUNTY’s electronic health record
(EHR) system (currently Avatar, the preferred EHR system by DBH) in accordance with Exhibit D,
“Documentation Standards for Client Records”, as licenses become available. The client record shall
begin with registration and intake, and include client authorizations, assessments, plans of care, and
progress notes, as well as other documents as approved by COUNTY’s DBH. COUNTY shall be
allowed to review records of services provided, including the goals and objectives of the treatment
plan, and how the therapy provided is achieving the goals and objectives. If CONTRACTOR
determines to maintain its records in Avatar, it shall provide COUNTY’s DBH Director, or his or her
designee, with a thirty (30) day notice. If at any time CONTRACTOR chooses not to maintain its
records in Avatar, it shall provide COUNTY’s DBH Director, or his or her designee, with a thirty (30)
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days advance written notice and CONTRACTOR will be responsible for obtaining its own system, at its
own cost, for electronic health records management.
Disclaimer
COUNTY makes no warranty or representation that information entered into the
COUNTY’s DBH EHR system by CONTRACTOR will be accurate, adequate or satisfactory for
CONTRACTOR’s own purposes or that any information in CONTRACTOR’s possession or control, or
transmitted or received by CONTRACTOR, is or will be secure from unauthorized access, viewing,
use, disclosure, or breach. CONTRACTOR is solely responsible for client information entered by
CONTRACTOR into the COUNTY’s DBH EHR system. CONTRACTOR agrees that all Private Health
Information (PHI) maintained by CONTRACTOR in COUNTY’s DBH EHR system will be maintained in
conformance with all HIPAA laws, as stated in Paragraph Nineteen (19), “Health Insurance Portability
and Accountability Act.”
2.That the existing COUNTY Agreement No. 15-594, all text in reference to “Exhibit B”
shall be replaced with text “Revised Exhibit B”. Revised Exhibit B is attached hereto and incorporated
herein by this reference.
3.That the existing COUNTY Agreement No. 15-594, Page Five (5), Paragraph Four (4),
beginning with Line Two (2), with the word “The” and ending on Line Fourteen (14) with the word,
“Agreement” be deleted and the following inserted in its place:
“The maximum amount for the third period of automatic renewal (July 1, 2018 through
June 30, 2019) shall not exceed Four Million Two Hundred Ninety One Thousand Three Hundred
Forty Five and No/100 Dollars ($4,291,345.00).
The maximum amount for the fourth period of renewal (July 1, 2019 through June 30,
2020) shall not exceed Four Million Three Hundred Ninety Seven Thousand Eight Hundred Seventy
Seven and No/100 Dollars ($4,397,877.00).
The maximum amount for the fifth period of renewal (July 1, 2020 through June 30,
2021) shall not exceed Four Million Five Hundred Twenty Five Thousand One Hundred Twenty and
No/100 Dollars ($4,525,120.00).
In no event shall the maximum contract amount for the services provided by the
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CONTRACTOR to COUNTY under the terms and conditions of this Agreement be in excess of
Twenty Two Million Seven Hundred Seventy Two Thousand Two Hundred Eighty Three and No/100
Dollars ($22,772,283.00) during the total five (5) year nine month (9) month term of this Agreement.”
4.That the following section shall be inserted into COUNTY Agreement No. 15-594 at
Page Seven (7), Paragraph Five (5), Line Twenty-Six (26):
“B. COUNTY’s DBH shall invoice CONTRACTOR by the fifth (5th) day of each
month for the prior month’s expenditures for building maintenance, landscaping, and utilities for the
Adult PHF. CONTRACTOR shall provide payment for these expenditures to COUNTY’s Fresno
County Department of Behavioral Health, Accounts Receivable, P.O. Box 712, Fresno, Ca. 93717-
0712, Attention: Business Office, within forty-five (45) days after the date of receipt by CONTRACTOR
of the monthly invoicing provided by COUNTY.
C.COUNTY’s DBH shall invoice CONTRACTOR in arrears by the fifth (5th) day of
each month for the prior month’s fees for hosting, maintenance and applicable licenses for access to
Avatar in accordance with the fee schedule provided by COUNTY’s DBH. CONTRACTOR shall
provide payment for these expenditures to COUNTY’s Fresno County Department of Behavioral
Health, Accounts Receivable, P.O. Box 712, Fresno, CA 93717-0712, Attention: Business Office,
within forty-five (45) days after the date of receipt by CONTRACTOR of the invoicing provided by
COUNTY. Should an EHR system not be implemented, CONTRACTOR will not be able make any
modifications to budget line items that reference costs for Avatar or an EHR.”
5.That the existing COUNTY Agreement No. 15-594 Paragraph 5.B through Paragraph
5.M be renumbered as Paragraph 5.D through Paragraph 5.O.
6.That the following shall be inserted into COUNTY Agreement No. 15-594 at Page Ten
(10), Paragraph Five (5), Line Twenty-One (21):
“If CONTRACTOR elects to use their own EHR system, the EHR must have Certification
Commission for Healthcare Information Technology (CCHIT) certification for Security Access Control,
Audit and Authentication. CONTRACTOR’S billers in the EHR system will need to sign an Electronic
Signature Certification (ESR).”
7.That the existing COUNTY Agreement No. 15-594, Page Twelve (12), Paragraph Seven
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(7), beginning with Line Thirteen (13), with the word “Notwithstanding” and ending on Line Eighteen
(18)with the word, “herein” be deleted and the following inserted in its place:
“Notwithstanding the above, changes to expense category (i.e., Personnel Expenses,
Operating Expenses, Financial Services Expenses, etc.) subtotals in the budget, as set forth in
Revised Exhibit B, that do not exceed ten percent (10%) of the maximum compensation payable to the
CONTRACTOR, and changes to the volume of units/types of service units to be provided, may be
made with the signed written approval of COUNTY’s DBH Director, or his or her designee, and
CONTRACTOR. Changes to the expense category subtotals in the budget that exceed ten percent
(10%) of the maximum compensation payable to the CONTRACTOR may be made with the signed
written approval of COUNTY’s DBH Director, or his or her designee, and CONTRACTOR through an
amendment approved by COUNTY’s Counsel and COUNTY’s Auditor-Controller/Treasurer-Tax
Collector’s Office. Said expense category subtotal changes shall not result in any change to the
annual maximum compensation amount payable to CONTRACTOR, as stated in this Agreement.”
8.That the existing COUNTY Agreement No. 15-594, all text in reference to “Exhibit D”
shall be replaced with text “Revised Exhibit D”. Revised Exhibit D is attached hereto and incorporated
herein by this reference.
9.That the existing COUNTY Agreement No. 15-594, all text in reference to “Exhibit F”
shall be replaced with text “Revised Exhibit F”. Revised Exhibit F is attached hereto and incorporated
herein by this reference.
10.That the existing COUNTY Agreement No. 15-594, all text in reference to “Exhibit I” shall
be replaced with text “Revised Exhibit I”. Revised Exhibit I is attached hereto and incorporated herein
by this reference.
11.That the following shall be inserted into COUNTY Agreement No. 15-594 at Page Fifteen
(15), Paragraph Twelve (12), Line Twenty-Eight (28):
“All medical records shall be maintained for a minimum of ten (10) years from the date of
the end of the Agreement.”
12.That the existing COUNTY Agreement No. 15-594, Page Twenty-Four (24), Paragraph
Twenty-Three (23), beginning with Line Fourteen (14), with the word “During” and ending on Line
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Seventeen (17) with the word “regulations” be deleted and the following inserted in its place:
“During the performance of this Agreement, CONTRACTOR and its subcontractors shall
not deny the contract’s benefits to any person on the basis of race, religious creed, color, national
origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital
status, sex, gender, gender identity, gender expression, age, sexual orientation, or military and
veteran status, nor shall they discriminate unlawfully against any employee or applicant for
employment because of race, religious creed, color, national origin, ancestry, physical disability,
mental disability, medical condition, genetic information, marital status, sex, gender, gender identity,
gender expression, age, sexual orientation, or military and veteran status. CONTRACTOR shall
insure that the evaluation and treatment of employees and applicants for employment are free of such
discrimination. CONTRACTOR and subcontractors shall comply with the provisions of the Fair
Employment and Housing Act (Gov. Code §12900 et seq.), the regulations promulgated thereunder
(Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter 1, Part 1, Division 3,
Title 2 of the Government Code (Gov. Code §§11135-11139.5), and the regulations or standards
adopted by the awarding state agency to implement such article. Contractor shall permit access by
representatives of the Department of Fair Employment and Housing and the awarding state agency
upon reasonable notice at any time during the normal business hours, but in no case less than twenty
(24) hours’ notice, to such of its books, records, accounts, and all other sources of information and its
facilities as said Department or Agency shall require to ascertain compliance with this clause.
CONTRACTOR and its subcontractors shall give written notice of their obligations under this clause to
labor organizations with which they have a collective bargaining or other agreement. (See Cal. Code
Regs., tit. 2, §11105.) CONTRACTOR shall include the Non-Discrimination and compliance provisions
of this clause in all subcontracts to perform work under the Agreement.”
13. That the following section shall be inserted into COUNTY Agreement No. 15-594 at
Page Twenty-Five (25), Paragraph Twenty-Three (23), Line Twenty-Four (24):
“F. CONTRACTOR shall be responsible for conducting an annual cultural
competency self-assessment and provide the results of said self-assessment to the COUNTY’S DBH.
The annual cultural competency self-assessment instruments shall be reviewed by the COUNTY and
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revised as necessary to meet the approval of the COUNTY.
G.Cultural competency training for CONTRACTOR staff should be substantively
integrated into health professions education and training at all levels, both academic and functional,
including core curriculum, professional licensure, and continuing professional development programs.
On an annual basis, CONTRACTOR’s direct service providers shall complete eight (8) hours of
cultural competency training. CONTRACTOR on a monthly basis shall provide COUNTY DBH a
monthly monitoring tool/report that shows cultural competency trainings completed.
H. CONTRACTOR shall attend the COUNTY’s Cultural Competency Committee
monthly meetings, maintain its own cultural competence oversight committee, and develop a cultural
competency plan to address and evaluate cultural competency issues.”
“24. AMERICANS WITH DISABILITIES ACT
CONTRACTOR agrees to ensure that deliverables developed and produced,
pursuant to this Agreement shall comply with the accessibility requirements of Section 508 of the
Rehabilitation Act and the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)),
and regulations implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal
Regulations. In 1998, Congress amended the Rehabilitation Act of 1973 to require Federal agencies
to make their electronic and information technology (EIT) accessible to people with disabilities.
California Government Code section 11135 codifies section 508 of the Act requiring accessibility of
electronic and information technology.”
14.That the existing COUNTY Agreement No. 15-594 Paragraph Twenty-Four (24) through
Paragraph Thirty-Six (36) be renumbered as Paragraph Twenty-Five (25) through Paragraph Thirty-
Seven (37).
15.That the existing COUNTY Agreement No. 15-594, Page Twenty-Six (26), Paragraph
Twenty-Five (25), beginning with Line Fifteen (15), with the word “If” and ending on Line Eighteen (18)
with the word “A-133”, be deleted and the following inserted in its place:
“If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00) or
more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual audit
in accordance with the requirements of the Single Audit Standards as set forth in Office of
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Management and Budget (OMB) 2 CFR 200.”
16. That the existing COUNTY Agreement No. 15-594, Page Thirty-Two (32), Paragraph
Thirty (30), beginning with Line Four (4), with the word “Submissions” and ending on Line Six (6) with
the word “Administration”, be deleted and the following inserted in its place:
“CONTRACTOR is required to submit a set of fingerprints for any person with a five (5)
percent or greater direct or indirect ownership interest in CONTRACTOR. COUNTY may terminate
this Agreement where any person with a five (5) percent or greater direct or indirect ownership interest
in the CONTRACTOR and did not submit timely and accurate information and cooperate with any
screening method required in CFR, title 42, section 455.416. Submissions shall be scanned pdf
copies and are to be sent via email to DBHAdministration@co.fresno.ca.us, Attention: Contracts
Administration. COUNTY may deny enrollment or terminate this Agreement where any person with a
five (5) percent or greater direct or indirect ownership interest in CONTRACTOR has been convicted
of a criminal offense related to that person’s involvement with the Medicare, Medicaid, or title XXI
program in the last (ten) 10 years.”
17. COUNTY and CONTRACTOR agree that this Amendment I is sufficient to amend the
Agreement; and that upon execution of this Amendment I, the Agreement and Amendment I together
shall be considered the Agreement.
The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
covenants, conditions and promises contained in the Agreement, and not amended herein, shall
remain in full force and effect. This Amendment I shall become effective upon execution by all parties.
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EXECUTED AND EFFECTIVE as of the date first above set forth.
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Luana Murphy
Print Name
PRESIDENT/CEO
Title (Chairman of Board , or President,
~~
(Authorized Signature)
LeeAnn Skorohod
Print Name
Secretary/CFO/COO
Title (Secretary of Corporation , or Chief
Financial Officer/Treasurer, or any
Assistant Secretary or Treasurer
MAILING ADDRESS :
17 Exodus Recovery , Inc .
9808 Venice Boulevard , Suite 700
18 Culver City , CA 90232
Contact: Luana Murphy , President/CEO
19 Phone No .: (310) 945 -3350
20
FOR ACCOUNTING USE ONLY :
21 Fund/Subclass : 0001/10000
Org No .: 56302490
22 Account No.: 7295
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Fiscal Year
FY 2015-16
FY 2016-17
FY 2017-18
FY 2018-19
FY 2019-20
FY 2020-21
Total :
$ 2 ,048 ,296
$ 3,698 ,759
$ 3 ,810 ,886
$ 4 ,291 ,345
$ 4 ,397,877
$ 4,525,120
$22 ,772 ,283
COUNTY OF FRESNO?
~
Nathan Magsig , Chairman of the Board of
Supervisors of the County of Fresno
ATTEST:
Bernice E . Seidel
Clerk to the Board of Supervisors
County of Fresno, State of California
By: s~ fu~D:()
Deputy
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REVISED EXHIBIT B
Page 1 of 29
(security, and janitorial costs at bidders cost)
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Title Program Director 1.00 $30,000 $30,000
0002 Title Program Support 1.00 $12,480 $12,480
0003 Title Administrator 0.10 $3,575 $3,575
SALARY TOTAL 2.10 $46,055 $0 $46,055
PAYROLL TAXES:
0030 OASDI $414 $0 $414
0031 FICA/MEDICARE $3,523 $0 $3,523
0032 U.I.$500 $0 $500
PAYROLL TAX TOTAL $4,437 $0 $4,437
EMPLOYEE BENEFITS:
0040 Retirement 1842 $0 $1,842
0041 Workers Compensation 2722 $0 $2,722
0042 $4,606 $0 $4,606
EMPLOYEE BENEFITS TOTAL $9,170 $0 $9,170
SALARY & BENEFITS GRAND TOTAL $59,662
OPERATING EXPENSES:
1060 $0
1061 $0
1062 $0
1063 $0
1064 $0
1065 $0
1066 Office Supplies & Equipment $0
1067 $0
1068 Food $0
1069 Program Supplies - Therapeutic $0
1070 Program Supplies - Medical $0
1071 $0
1072 $0
1073 $0
1074 $46,000
1075 $0
1076 Other - One Time Costs $62,642
1077 Other - One Time Costs Contingency $0
OPERATING EXPENSES TOTAL $108,642
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $0
1082 Liability Insurance $0
1083 Other - Administrative Overhead $30,609
FINANCIAL SERVICES TOTAL $30,609
TOTAL PROGRAM EXPENSES $198,913
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Start-Up/Implementation Budget - October 1, 2015 through June 30, 2016 (9 months)
Publications
Budget Categories - Total Proposed Budget
Line Item Description (Must be itemized)
Telephone
Health Insurance (medical vision, life, dental)
Answering Service
Postage
Printing/Reproduction
Lodging
Legal Notices/Advertising
Household Supplies
Staff Travel (Out of County)
Staff Orientation/Recruitment
Staff Mileage/vehicle maintenance
Transportation of Clients
REVISED EXHIBIT B
Page 2 of 29
(security, and janitorial costs at bidders cost)
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Title Program Director (RN)1.00 $59,998 $59,998
0002 Title Rehab Specialist Coord (OT/RT)1.00 $4,680 $42,120 $46,800
0003 Title Mental Health Workers 8.40 $139,776 $139,776
0004 Title LMFT/LCSW 1.00 $36,400 $36,400
0005 Title Peer Advocate/Counselor 1.00 $12,480 $12,480
0006 Title Data Specialist 1.00 $17,680 $17,680
0007 Title Program Support 1.00 $24,960 $24,960
0008 Title Administrator 0.10 $7,150 $7,150
0009 Title (MD/NP/Nursing found on Line 1097)$0
SALARY TOTAL 14.50 $114,468 $230,776 $345,244
PAYROLL TAXES:
0030 OASDI $1,030 $2,077 $3,107
0031 FICA/MEDICARE $8,757 $17,654 $26,411
0032 U.I.$1,144 $2,307 $3,451
PAYROLL TAX TOTAL $10,931 $22,038 $32,969
EMPLOYEE BENEFITS:
0040 Retirement $4,579.00 $9,231 $13,810
0041 Workers Compensation $6,765.00 $13,639 $20,404
0042 $11,447 $23,078 $34,525
EMPLOYEE BENEFITS TOTAL $22,791 $45,948 $68,739
SALARY & BENEFITS GRAND TOTAL $446,952
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $8,250
1012 Utilities $62,365
1013 Janitorial $42,663
1014 Maintenance (facility)$5,331
1015 Security $47,500
1016 Maintenance (durable medical equipment)$0
1017 Other $0
1018 Other $0
FACILITY/EQUIPMENT TOTAL $166,109
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Start-Up/Implementation Budget- October 1, 2015 through June 30, 2016 (9 months)
Budget Categories - Total Proposed Budget
Line Item Description (Must be itemized)
Health Insurance (medical vision, life, dental)
REVISED EXHIBIT B
Page 3 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Start-Up/Implementation Budget- October 1, 2015 through June 30, 2016 (9 months)
OPERATING EXPENSES:
1060 $30,000
1061 $0
1062 $1,500
1063 $1,250
1064 $0
1065 $1,000
1066 Office Supplies & Equipment $10,000
1067 $0
1068 Food $0
1069 Program Supplies - Therapeutic $3,000
1070 Program Supplies - Medical $15,000
1071 $6,000
1072 $1,250
1073 $350
1074 $17,500
1075 $0
1076 Other - License/Business Tax $750
1077 Other - Recovery 360 Training $1,750
OPERATING EXPENSES TOTAL $89,350
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $7,500
1081 External Audit $2,500
1082 Liability Insurance $5,000
1083 Other - Administrative Overhead $241,224
FINANCIAL SERVICES TOTAL $256,224
Legal Notices/Advertising
Household Supplies
Publications
Telephone
Answering Service
Postage
Printing/Reproduction
Staff Travel (Out of County)
Staff Training/Registration
Staff Mileage/vehicle maintenance
Transportation of Clients
Lodging
REVISED EXHIBIT B
Page 4 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Start-Up/Implementation Budget- October 1, 2015 through June 30, 2016 (9 months)
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant (network & data management)$15,000
1088 Translation Services $900
1089 Medication Supports $32,500
1090 Food Service $84,000
1091 Laundry service $16,200
1092 Medical Waste Disposal $1,250
1093 Nutritionist Services $0
1094 X-ray and EKG services $2,700
1095 Pharmaceutical Consultant $0
1096 Medical Services $0
1097 Other - Contracted Services $728,598
1098 Other - Registry $9,600
SPECIAL EXPENSES TOTAL $890,748
FIXED ASSETS:
2000 Computers & Software $0
2001 Furniture & Fixtures $0
2002 Other $0
2003 Other $0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $1,849,383
DIRECT SERVICE REVENUE:
Vol/Units
of Svc Rate $ Amt.
3000
Mental Health Services
(Individual/Family/Group Therapy)$0
3100 Case Management $0
3200 Crisis Services $0
3300 Medication Support $0
3400 Psychiatric Health Facility Services 2,926 $632.00 $1,849,383
3500 other $0
DIRECT SERVICE REVENUE TOTAL 2,926 $1,849,383
$1,387,038
Cost Per Unit $632.00
Funding Streams Reimbursement Population Served Percentage
4000 Private Insurance -
4100 Uninsured 25%462,346
4200 Medi-Cal FFP 75%693,519
4300 Behavioral Health Realignment 693,519
OTHER REVENUE TOTAL $1,849,383
TOTAL PROGRAM REVENUE $1,849,383
Medi-cal Revenue
REVISED EXHIBIT B
Page 5 of 29
(security, and janitorial costs at bidder cost)
Item Price Qty Amount Notes
Telepsych Equipment $12,000.00 2 $12,000.00 Connection to other Exodus sites
Phone System Upgrade $12,000.00 1 $12,000.00 Module to add PHF phones into existing system
Medical Supplies $3,000.00 1 $3,000.00 Drug testing supplies, syringes, medicine cups
Stock Medications $3,000.00 1 $3,000.00 Initial stock medication supply
Network/Security Equipment $4,500.00 1 $4,500.00 Connection to other Exodus sites
Cabling $8,000.00 1 $8,000.00 Fiber cabling due to distance from program to phone closet in Bldg and Phone System
Computers $3,357.00 6 $20,142.00 Replacement of old desktops, including peripherals/softward
TOTAL $62,642.00
ONE TIME COSTS
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
One Time Costs - Details
REVISED EXHIBIT B
Page 6 of 29
(security, and janitorial costs at bidder cost)
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Title Program Director (RN)1.00 $119,995 $119,995
0002 Title Rehab Specialist Coord (OT/RT) 1.00 $9,360 $84,240 $93,600
0003 Title Mental Health Workers 8.40 $279,552 $279,552
0004 Title LMFT/LCSW 1.00 $72,800 $72,800
0005 Title Peer Advocate/Counselor 1.00 $24,960 $24,960
0006 Title Data Specialist 1.00 $35,360 $35,360
0007 Title Program Support 1.00 $49,920 $49,920
0008 Title Administrator 0.10 $14,300 $14,300
0009 Title (MD/NP/Nursing found on Line 1097)$0
SALARY TOTAL 14.50 $228,935 $461,552 $690,487
PAYROLL TAXES:
0030 OASDI $2,060 $4,154 $6,214
0031 FICA/MEDICARE $17,514 $35,309 $52,823
0032 U.I.$2,288 $4,614 $6,902
PAYROLL TAX TOTAL $21,862 $44,077 $65,939
EMPLOYEE BENEFITS:
0040 Retirement $9,157.00 $18,462 $27,619
0041 Workers Compensation $13,530.00 $27,278 $40,808
0042 $22,894 $46,155 $69,049
EMPLOYEE BENEFITS TOTAL $45,581 $91,895 $137,476
SALARY & BENEFITS GRAND TOTAL $893,902
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $16,500
1012 Utilities $124,729
1013 Janitorial $85,325
1014 Maintenance (facility)$10,661
1015 Security $95,000
1016 Maintenance (durable medical equipment)$0
1017 Other $0
1018 Other $0
FACILITY/EQUIPMENT TOTAL $332,215
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2016 through June 30, 2017 (12 months)
Budget Categories - Total Proposed Budget
Line Item Description (Must be itemized)
Health Insurance (medical vision, life, dental)
REVISED EXHIBIT B
Page 7 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2016 through June 30, 2017 (12 months)
OPERATING EXPENSES:
1060 $60,000
1061 $0
1062 $3,000
1063 $2,500
1064 $0
1065 $2,000
1066 Office Supplies & Equipment $20,000
1067 $0
1068 Food $0
1069 Program Supplies - Therapeutic $6,000
1070 Program Supplies - Medical $30,000
1071 $12,000
1072 $2,500
1073 $700
1074 $35,000
1075 $0
1076 Other - License/Business Tax $1,500
1077 Other - Recovery 360 Training $3,500
OPERATING EXPENSES TOTAL $178,700
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $15,000
1081 External Audit $5,000
1082 Liability Insurance $10,000
1083 Other - Administrative Overhead $482,447
FINANCIAL SERVICES TOTAL $512,447
Postage
Printing/Reproduction
Lodging
Legal Notices/Advertising
Household Supplies
Staff Travel (Out of County)
Staff Training/Registration
Staff Mileage/vehicle maintenance
Transportation of Clients
Publications
Telephone
Answering Service
REVISED EXHIBIT B
Page 8 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2016 through June 30, 2017 (12 months)
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant (network & data management)$30,000
1088 Translation Services $1,800
1089 Medication Supports $65,000
1090 Food Service $168,000
1091 Laundry service $32,400
1092 Medical Waste Disposal $2,500
1093 Nutritionist Services $0
1094 X-ray and EKG services $5,400
1095 Pharmaceutical Consultant $0
1096 Medical Services $0
1097 Other - Contracted Services $1,457,195
1098 Other - Registry $19,200
SPECIAL EXPENSES TOTAL $1,781,495
FIXED ASSETS:
2000 Computers & Software $0
2001 Furniture & Fixtures $0
2002 Other $0
2003 Other $0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $3,698,759
DIRECT SERVICE REVENUE:
Vol/Units
of Svc Rate $ Amt.
3000
Mental Health Services
(Individual/Family/Group Therapy)$0
3100 Case Management $0
3200 Crisis Services $0
3300 Medication Support $0
3400 Psychiatric Health Facility Services 5,843 $633.00 $3,698,759
3500 other $0
DIRECT SERVICE REVENUE TOTAL 5,843 $3,698,759
$2,774,069
Cost Per Unit $633.00
Funding Streams Reimbursement Population Served Percentage
4000 Private Insurance -
4100 Uninsured 25%924,690
4200 Medi-Cal FFP 75%1,387,035
4300 Behavioral Health Realignment 1,387,035
OTHER REVENUE TOTAL $3,698,759
TOTAL PROGRAM REVENUE $3,698,759
Medi-cal Revenue
REVISED EXHIBIT B
Page 9 of 29
(security, and janitorial costs at Bidder cost)
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Title Program Director (RN)$122,995 $122,995
0002 Title Rehab Specialist Coord (OT/RT)$9,594 $86,346 $95,940
0003 Title Mental Health Workers $286,541 $286,541
0004 Title LMFT/LCSW $74,620 $74,620
0005 Title Peer Advocate/Counselor $25,584 $25,584
0006 Title Data Specialist $36,244 $36,244
0007 Title Program Support $51,168 $51,168
0008 Title Administrator $14,658 $14,658
0009 Title (MD/NP/Nursing found on Line 1097)$0
SALARY TOTAL 0.00 $234,659 $473,091 $707,750
PAYROLL TAXES:
0030 OASDI $2,182 $4,400 $6,582
0031 FICA/MEDICARE $18,491 $37,280 $55,771
0032 U.I.$2,426 $4,892 $7,318
PAYROLL TAX TOTAL $23,099 $46,572 $69,671
EMPLOYEE BENEFITS:
0040 Retirement $9,386.00 $18,924 $28,310
0041 Workers Compensation $14,291.00 $28,811 $43,102
0042 $24,170 $48,728 $72,898
EMPLOYEE BENEFITS TOTAL $47,847 $96,463 $144,310
SALARY & BENEFITS GRAND TOTAL $921,731
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $16,995
1012 Utilities $128,471
1013 Janitorial $87,885
1014 Maintenance (facility)$10,981
1015 Security $97,850
1016 Maintenance (durable medical equipment)$0
1017 Other $0
1018 Other $0
FACILITY/EQUIPMENT TOTAL $342,182
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2017 through June 30, 2018 (12 months)
Budget Categories - Total Proposed Budget
Line Item Description (Must be itemized)
Health Insurance (medical vision, life, dental)
REVISED EXHIBIT B
Page 10 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2017 through June 30, 2018 (12 months)
OPERATING EXPENSES:
1060 $61,800
1061 $0
1062 $3,090
1063 $2,575
1064 $0
1065 $2,060
1066 Office Supplies & Equipment $20,600
1067 $0
1068 Food $0
1069 Program Supplies - Therapeutic $6,180
1070 Program Supplies - Medical $30,900
1071 $12,360
1072 $2,575
1073 $721
1074 $36,050
1075 $0
1076 Other - License/Business Tax $1,545
1077 Other - Recovery 360 Training $3,605
OPERATING EXPENSES TOTAL $184,061
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $15,450
1081 External Audit $5,150
1082 Liability Insurance $10,300
1083 Other - Administrative Overhead $497,072
FINANCIAL SERVICES TOTAL $527,972
Postage
Printing/Reproduction
Lodging
Legal Notices/Advertising
Household Supplies
Staff Travel (Out of County)
Staff Training/Registration
Staff Mileage/vehicle maintenance
Transportation of Clients
Publications
Telephone
Answering Service
REVISED EXHIBIT B
Page 11 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2017 through June 30, 2018 (12 months)
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant (network & data management)$30,900
1088 Translation Services $1,854
1089 Medication Supports $66,950
1090 Food Service $173,040
1091 Laundry service $33,372
1092 Medical Waste Disposal $2,575
1093 Nutritionist Services $0
1094 X-ray and EKG services $5,562
1095 Pharmaceutical Consultant $0
1096 Medical Services $0
1097 Other - Contracted Services $1,500,911
1098 Other - Registry $19,776
SPECIAL EXPENSES TOTAL $1,834,940
FIXED ASSETS:
2000 Computers & Software $0
2001 Furniture & Fixtures $0
2002 Other $0
2003 Other $0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $3,810,886
DIRECT SERVICE REVENUE:
Vol/Units
of Svc Rate $ Amt.
3000
Mental Health Services
(Individual/Family/Group Therapy)$0
3100 Case Management $0
3200 Crisis Services $0
3300 Medication Support $0
3400 Psychiatric Health Facility Services 5,836 $653.00 $3,810,886
3500 other $0
DIRECT SERVICE REVENUE TOTAL 5,836 $3,810,886
$2,858,164
Cost Per Unit $653.00
Funding Streams Reimbursement Population Served Percentage
4000 Private Insurance -
4100 Uninsured 25%952,721
4200 Medi-Cal FFP 75%1,429,082
4300 Behavioral Health Realignment 1,429,082
OTHER REVENUE TOTAL $3,810,886
TOTAL PROGRAM REVENUE $3,810,886
Medi-cal Revenue
REVISED EXHIBIT B
Page 12 of 29
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Title Program Director (RN)1.00 $141,288 $141,288
0002 Title Rehab Specialist Coord (OT/RT)1.00 $68,193 $68,193
0003 Title Mental Health Workers 14.59 $587,888 $587,888
0004 Title LMFT/LCSW 1.60 $117,800 $117,800
0005 Title Peer Advocate/Counselor 1.91 $89,883 $89,883
0006 Title Data Specialist 1.00 $44,589 $44,589
0007 Title Program Support 1.00 $43,331 $43,331
0008 Title Administrator 0.10 $13,300 $13,300
0009 Title Program Nurses (RN)3.58 $358,827 $358,827
0009 Title Program Nurses (LPTN)1.45 $62,381 $62,381
0009 Title Program Nurses (LVN)5.98 $373,028 $373,028
SALARY TOTAL 33.21 $242,508 $1,657,999 $1,900,507
PAYROLL TAXES:
0030 OASDI $19,005
0031 FICA/MEDICARE $171,046
0032 U.I.$19,005
PAYROLL TAX TOTAL $0 $209,056
EMPLOYEE BENEFITS:
0040 Retirement $80,500
0041 Workers Compensation $115,500
0042 $154,000
EMPLOYEE BENEFITS TOTAL $0 $0 $350,000
SALARY & BENEFITS GRAND TOTAL $2,459,563
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $14,684
1012 Utilities $155,704
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2018 through June 30, 2019 (12 months)
Budget Categories -
Health Insurance (medical vision, life, dental)
Total Proposed Budget
Line Item Description (Must be itemized)
REVISED EXHIBIT B
Page 13 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2018 through June 30, 2019 (12 months)
1013 Janitorial $63,356
1014 Maintenance (facility)$20,942
1015 Security $208,734
1016 Maintenance (durable medical equipment)$0
1017 Other $0
1018 Other $0
FACILITY/EQUIPMENT TOTAL $463,420
OPERATING EXPENSES:
1060 $22,434
1061 $0
1062 $172
1063 $0
1064 $0
1065 $1,000
1066 Office Supplies & Equipment $39,873
1067 $0
1068 Food $0
1069 Program Supplies - Therapeutic $11,900
1070 Program Supplies - Medical $8,611
1071 $0
1072 $100
1073 $0
1074 $8,523
1075 $0
1076 Other - License/Business Tax $1,389
1077 Other - Recovery 360 Training $0
OPERATING EXPENSES TOTAL $94,001
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $1,000
1081 External Audit $0
1082 Liability Insurance $9,996
Publications
Postage
Telephone
Staff Mileage/vehicle maintenance
Transportation of Clients
Answering Service
Printing/Reproduction
Lodging
Legal Notices/Advertising
Household Supplies
Staff Travel (Out of County)
Staff Training/Registration
REVISED EXHIBIT B
Page 14 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2018 through June 30, 2019 (12 months)
1083 Other - Administrative Overhead $559,741
FINANCIAL SERVICES TOTAL $570,737
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant (network & data management)$10,516
1088 Translation Services $32
1089 Medication Supports $22,011
1090 Food Service $233,205
1091 Laundry service $16,402
1092 Medical Waste Disposal $13,510
1093 Nutritionist Services $0
1094 X-ray and EKG services $4,113
1095 Pharmaceutical Consultant $0
1096 Medical Services $0
1097 Other - Contracted Services $378,269
1098 Other - Registry $0
SPECIAL EXPENSES TOTAL $678,057
FIXED ASSETS:
2000 Computers & Software $5,110
2001 Furniture & Fixtures $6,000
2002 Other $0
2003 Other - EHR Avatar Cost $14,457
FIXED ASSETS TOTAL $25,567
TOTAL PROGRAM EXPENSES $4,291,345
DIRECT SERVICE REVENUE:
Vol/Units
of Svc Rate $ Amt.
3000
Mental Health Services
(Individual/Family/Group Therapy)$0
3100 Case Management $0
3200 Crisis Services $0
3300 Medication Support $0
3400 Psychiatric Health Facility Services 6,102 $703.24 $4,291,344
3500 other $0
DIRECT SERVICE REVENUE TOTAL 6,102 $4,291,344
$1,832,404
Cost Per Unit
Medi-cal Revenue
REVISED EXHIBIT B
Page 15 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2018 through June 30, 2019 (12 months)
Funding Streams Reimbursement Population Served Percentage
4000 Private Insurance 4%154,488
4100 Uninsured 11%472,049
4200 Medi-Cal FFP 43%1,832,404
4300 Behavioral Health Realignment 43%1,832,404
OTHER REVENUE TOTAL $4,291,345
TOTAL PROGRAM REVENUE $4,291,345
REVISED EXHIBIT B
Page 16 of 29
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
$2,459,563
Salary Total $1,900,507
Payroll Taxes
OASDI $19,005
FICA/MEDICARE $171,046
SUI $19,005
Payroll Taxes Total $209,056
Employee Benefits
Retirement $80,500
Workers Compensation $115,500
Health Insurance (medical vision, life, dental) $154,000
Employee Benefits $350,000
Facilities/Equipment Expenses – Line Items 1010-1014
$463,420
Operating Expenses - Line Items 1060-1077
$94,001
Program Nurses (LVN) FTE 5.98 Direct Services - proposed salary $373,028
Telephone - Cost of phone usage expense for the program $22,434
Postage - Program related postage cost $172
Security - Cost for security personnel for the program $208,734
Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.). Attach copy of lease
agreements if available.
Rent/Equipment Leases - Lease cost for computers, printers, copier, and faxes for the program $14,684
Utilities - Cost for program utilities $155,704
Janitorial - Cost for janitorial Service for the program $63,356
Maintenance - Cost for maintenance and repairs for the facility $20,942
Program Nurses (LPTN) FTE 1.45 Direct Services - proposed salary $62,381
Acute Inpatient Psychiatric Services
Exodus Recovery, Inc.
2018-2019
BUDGET NARRATIVE - EXPENSES
These amounts reflect FTE positions, part-time positions and whether the positions are administrative or direct service. Employee benefits
should be limited to a maximum of 20% of total salaries.
Program Support FTE 1.00 Administrative Services - proposed annual salary $43,331
Administrator FTE 0.10 Administrative Services - proposed annual salary $13,300
Program Nurses (RN) FTE 3.58 Direct Services - proposed salary $358,827
Program Director (RN) 1.00 FTE, Administrative Services - proposed annual salary $141,288
Rehab Specialist Coord (OT/RT) 1.00 FTE Direct Services - proposed annual salary $68,193
Mental Health Workers FTE 14.59 Direct Services - proposed annual salary $587,888
LMFT/LCSW FTE 1.60 Direct Services - proposed annual salary $117,800
Peer Advocate/Counselor Direct Services FTE 1.91 - proposed annualy salary $89,883
Data Specialist FTE 1.00 Administrative Services - proposed annual salary $44,589
REVISED EXHIBIT B
Page 17 of 29
Acute Inpatient Psychiatric Services
Exodus Recovery, Inc.
2018-2019
BUDGET NARRATIVE - EXPENSES
Financial Services Expenses – Line Items 1080-1085
$570,737
Special Expenses – Line Items 1090-1092
$678,057
Fixed Assets – Line Items 1190-1193
$25,567
Furniture & Fixtures $6,000
Other - License/Business Tax $1,389
Medical Waste Disposal - Cost for medical waste disposal service $13,510
X-ray and EKG services - $4113
Other - Contracted Services - Personnel related expenses including registry nurses as needed, parking, relocation
costs, etc. $378,269
Laundry Service - Cost for linen service for the program $16,402
Accounting/Bookkeeping - Cost of financial auditing and monthly financial reviews $1,000
Liability Insurance - Cost of insurance expense for liability, business property and vehicle policy $9,996
Other Administrative Overhead - Administrative overhead expense related to the program $559,741
Include all purchases over Five Thousand Dollars ($5,000) including sales tax, and certain purchases under said amount such as camera,
televisions, VCRs/DVDs and other sensitive items, made during the life of the Agreement resulting from this Request for Proposal, with
funds paid pursuant to this Agreement and that will outlive the life of this Agreement.
Office Supplies & Equipment - Cost for office supplies and equipment for the program $39,873
Program Supplies - Medical - Cost for medical supplies for the program $8,611
Staff Mileage/Vehicle Maintenance - Cost for mileage, parking, travel expense for program staff $100
Staff Training/Registration - Cost of ongoing training for staff $8,523
Program Supplies - Therapeutic - Cost for medical supplies for the program $11,900
Computers & Software $5,110
TOTAL PROGRAM EXPENSES:$4,291,345
Consultant (network & data mgmt) Cost for consultant IT firm support, network monitoring, and off-site back-up for
program IT System $10,516
Translation Services - Cost for translation services for the program $32
Medication Supports (Pharmaceuticals) Medication costs for clients $22,011
Food Service - Cost for food services for program clients $233,205
Other - HER Avatar Cost $14,457
Legal Notices/Advertising - Cost for advertising for staff recruitment and other program related advertising or legal
notices $1000
REVISED EXHIBIT B
Page 18 of 29
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Title Program Director (RN)1.00 $145,527 $145,527
0002 Title Rehab Specialist Coord (OT/RT)1.00 $70,239 $70,239
0003 Title Mental Health Workers 14.59 $605,525 $605,525
0004 Title LMFT/LCSW 1.60 $121,334 $121,334
0005 Title Peer Advocate/Counselor 1.91 $92,579 $92,579
0006 Title Data Specialist 1.00 $45,927 $45,927
0007 Title Program Support 1.00 $44,631 $44,631
0008 Title Administrator 0.10 $13,699 $13,699
0009 Title Program Nurses (RN)3.58 $369,592 $369,592
0009 Title Program Nurses (LPTN)1.45 $64,252 $64,252
0009 Title Program Nurses (LVN)5.98 $384,218 $384,218
SALARY TOTAL 33.21 $249,783 $1,707,739 $1,957,522
PAYROLL TAXES:
0030 OASDI $19,575
0031 FICA/MEDICARE $176,177
0032 U.I.$19,575
PAYROLL TAX TOTAL $0 $215,327
EMPLOYEE BENEFITS:
0040 Retirement $82,915.00 $82,915
0041 Workers Compensation $118,965.00 $118,965
0042 $158,620 $158,620
EMPLOYEE BENEFITS TOTAL $360,500 $0 $360,500
SALARY & BENEFITS GRAND TOTAL $2,533,350
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $15,124
Health Insurance (medical vision, life, dental)
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2019 through June 30, 2020 (12 months)
Budget Categories - Total Proposed Budget
Line Item Description (Must be itemized)
REVISED EXHIBIT B
Page 19 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2019 through June 30, 2020 (12 months)
1012 Utilities $160,375
1013 Janitorial $65,256
1014 Maintenance (facility)$21,571
1015 Security $214,996
1016 Maintenance (durable medical equipment)$0
1017 Other $0
1018 Other $0
FACILITY/EQUIPMENT TOTAL $477,322
OPERATING EXPENSES:
1060 $23,107
1061 $0
1062 $177
1063 $0
1064 $0
1065 $1,030
1066 Office Supplies & Equipment $41,069
1067 $0
1068 Food $0
1069 Program Supplies - Therapeutic $12,257
1070 Program Supplies - Medical $8,870
1071 $0
1072 $103
1073 $0
1074 $8,778
1075 $0
1076 Other - License/Business Tax $1,430
1077 Other - Recovery 360 Training $0
OPERATING EXPENSES TOTAL $96,821
FINANCIAL SERVICES EXPENSES:
Telephone
Answering Service
Lodging
Publications
Household Supplies
Staff Training/Registration
Staff Travel (Out of County)
Printing/Reproduction
Legal Notices/Advertising
Transportation of Clients
Staff Mileage/vehicle maintenance
Postage
REVISED EXHIBIT B
Page 20 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2019 through June 30, 2020 (12 months)
1080 Accounting/Bookkeeping $1,030
1081 External Audit $0
1082 Liability Insurance $10,296
1083 Other - Administrative Overhead $566,286
FINANCIAL SERVICES TOTAL $577,612
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant (network & data management)$10,832
1088 Translation Services $33
1089 Medication Supports $22,671
1090 Food Service $240,201
1091 Laundry service $16,894
1092 Medical Waste Disposal $13,916
1093 Nutritionist Services $0
1094 X-ray and EKG services $4,236
1095 Pharmaceutical Consultant $0
1096 Medical Services $0
1097 Other - Contracted Services $378,269
1098 Other - Registry $0
SPECIAL EXPENSES TOTAL $687,051
FIXED ASSETS:
2000 Computers & Software $5,264
2001 Furniture & Fixtures $6,000
2002 Other $0
2003 Other - EHR Avatar Cost $14,457
FIXED ASSETS TOTAL $25,721
TOTAL PROGRAM EXPENSES $4,397,877
DIRECT SERVICE REVENUE:
Vol/Units
of Svc Rate $ Amt.
3000
Mental Health Services
(Individual/Family/Group Therapy)$0
REVISED EXHIBIT B
Page 21 of 29Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2019 through June 30, 2020 (12 months)
3100 Case Management $0
3200 Crisis Services $0
3300 Medication Support $0
3400 Psychiatric Health Facility Services 6,083 723.01 $4,397,876
3500 other $0
DIRECT SERVICE REVENUE TOTAL 6,083 $4,397,876
$1,877,893
Cost Per Unit
Funding Streams Reimbursement Population Served Percentage
4000 Private Insurance 4%158,324
4100 Uninsured 11%483,767
4200 Medi-Cal FFP 43%1,877,893
4300 Behavioral Health Realignment 43%1,877,893
OTHER REVENUE TOTAL $4,397,877
TOTAL PROGRAM REVENUE $4,397,877
Medi-cal Revenue
REVISED EXHIBIT B
Page 22 of 29
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
$2,533,350
Salary Total $1,957,522
Payroll Taxes
OASDI $19,575
FICA/MEDICARE $176,177
SUI $19,575
Payroll Taxes Total $215,327
Employee Benefits
Retirement $82,915
Workers Compensation $118,965
Health Insurance (medical vision, life, dental) $158,620
Employee Benefits $360,500
Facilities/Equipment Expenses – Line Items 1010-1014
$477,322
Operating Expenses - Line Items 1060-1077
$96,821
Program Nurses (RN) FTE 3.58 Direct Services - proposed salary $369,592
Program Nurses (LPTN) FTE 1.45 Direct Services - proposed salary $64,252
Program Nurses (LVN) FTE 5.98 Direct Services - proposed salary $384,218
Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.). Attach copy of lease
agreements if available.
Rent/Equipment Leases - Lease cost for computers, printers, copier, and faxes for the program $15,124
Utilities - Cost for program utilities $160,375
Janitorial - Cost for janitorial Service for the program $65,256
Maintenance - Cost for maintenance and repairs for the facility $21,571
Security - Cost for security personnel for the program $214,996
Acute Inpatient Psychiatric Services
Exodus Recovery, Inc.
2019-2020
BUDGET NARRATIVE - EXPENSES
These amounts reflect FTE positions, part-time positions and whether the positions are administrative or direct service. Employee
benefits should be limited to a maximum of 20% of total salaries.
Data Specialist FTE 1.00 Administrative Services - proposed annual salary $45,927
Program Support FTE 1.00 Administrative Services - proposed annual salary $44,631
Administrator FTE 0.10 Administrative Services - proposed annual salary $13,699
Telephone - Cost of phone usage expense for the program $23,107
Postage - Program related postage cost $177
Program Director (RN) 1.00 FTE, Administrative Services - proposed annual salary $145,527
Rehab Specialist Coord (OT/RT) 1.00 FTE Direct Services - proposed annual salary $70,239
Mental Health Workers FTE 14.59 Direct Services - proposed annual salary $605,525
LMFT/LCSW FTE 1.60 Direct Services - proposed annual salary $121,334
Peer Advocate/Counselor Direct Services FTE 1.91 - proposed annualy salary $92,579
REVISED EXHIBIT B
Page 23 of 29
Acute Inpatient Psychiatric Services
Exodus Recovery, Inc.
2019-2020
BUDGET NARRATIVE - EXPENSES
Financial Services Expenses – Line Items 1080-1085
$577,612
Special Expenses – Line Items 1090-1092
$687,051
Fixed Assets – Line Items 1190-1193
$25,721
Furniture & Fixtures $6,000
Consultant (network & data mgmt) Cost for consultant IT firm support, network monitoring, and off-site back-
up for program IT System $10,832
Translation Services - Cost for translation services for the program $33
Medication Supports (Pharmaceuticals) Medication costs for clients $22,671
Food Service - Cost for food services for program clients $240,201
Computers and Software $5,264
TOTAL PROGRAM EXPENSES:$4,397,877
Laundry Service - Cost for linen service for the program $16,894
X-ray and EKG services - $4,236
Other - Contracted Services - Personnel related expenses including registry nurses as needed, parking,
relocation costs, etc. $378,269
Medical Waste Disposal - Cost for Medical Disposal Services $13,916
Include all purchases over Five Thousand Dollars ($5,000) including sales tax, and certain purchases under said amount such as
camera, televisions, VCRs/DVDs and other sensitive items, made during the life of the Agreement resulting from this Request for
Proposal, with funds paid pursuant to this Agreement and that will outlive the life of this Agreement.
Liability Insurance - Cost of insurance expense for liability, business property and vehicle policy $10,296
Other Administrative Overhead - Administrative overhead expense related to the program $566,286
Other - EHR Avatar Cost $14,457
Staff Training/Registration - Cost of ongoing training for staff $8,778
Other - License/Business Tax $1,430
Accounting/Bookkeeping - Cost of financial auditing and monthly financial reviews $1,030
Program Supplies - Therapeutic - Cost for medical supplies for the program $12,257
Program Supplies - Medical - Cost for medical supplies for the program $8,870
Staff Mileage/Vehicle Maintenance - Cost for mileage, parking, travel expense for program staff $103
Office Supplies & Equipment - Cost for office supplies and equipment for the program $41,069
Legal Notices/Advertising - Cost for advertising for staff recruitment and other program related advertising or
legal notices $1030
REVISED EXHIBIT B
Page 24 of 29
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Title Program Director (RN)1.00 $149,893 $149,893
0002 Title Rehab Specialist Coord (OT/RT)1.00 $72,346 $72,346
0003 Title Mental Health Workers 14.59 $623,691 $623,691
0004 Title LMFT/LCSW 1.60 $124,974 $124,974
0005 Title Peer Advocate/Counselor 1.91 $95,356 $95,356
0006 Title Data Specialist 1.00 $47,305 $47,305
0007 Title Program Support 1.00 $45,970 $45,970
0008 Title Administrator 0.10 $14,110 $14,110
0009 Title Program Nurses (RN)3.58 $380,680 $380,680
0009 Title Program Nurses (LPTN)1.45 $66,180 $66,180
0009 Title Program Nurses (LVN)5.98 $395,745 $395,745
SALARY TOTAL 33.21 $257,278 $1,758,971 $2,016,249
PAYROLL TAXES:
0030 OASDI $20,162
0031 FICA/MEDICARE $181,462
0032 U.I.$20,162
PAYROLL TAX TOTAL $0 $221,787
EMPLOYEE BENEFITS:
0040 Retirement $85,402.45 $85,402
0041 Workers Compensation $122,533.95 $122,534
0042 $163,379 $163,379Health Insurance (medical vision, life, dental)
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2020 through June 30, 2021 (12 months)
Budget Categories - Total Proposed Budget
Line Item Description (Must be itemized)
REVISED EXHIBIT B
Page 25 of 29
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2020 through June 30, 2021 (12 months)
EMPLOYEE BENEFITS TOTAL $371,315 $0 $371,315
SALARY & BENEFITS GRAND TOTAL $2,609,351
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $15,578
1012 Utilities $165,186
1013 Janitorial $67,214
1014 Maintenance (facility)$22,218
1015 Security $221,446
1016 Maintenance (durable medical equipment)$0
1017 Other $0
1018 Other $0
FACILITY/EQUIPMENT TOTAL $491,642
OPERATING EXPENSES:
1060 $23,800
1061 $0
1062 $182
1063 $0
1064 $0
1065 $1,061
1066 Office Supplies & Equipment $42,301
1067 $0
1068 Food $0
1069 Program Supplies - Therapeutic $12,625
1070 Program Supplies - Medical $9,136
Telephone
Answering Service
Printing/Reproduction
Legal Notices/Advertising
Publications
Household Supplies
Postage
REVISED EXHIBIT B
Page 26 of 29
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2020 through June 30, 2021 (12 months)
1071 $0
1072 $106
1073 $0
1074 $9,041
1075 $0
1076 Other - License/Business Tax $1,473
1077 Other - Recovery 360 Training $0
OPERATING EXPENSES TOTAL $99,726
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $1,061
1081 External Audit $0
1082 Liability Insurance $10,605
1083 Other - Administrative Overhead $590,233
FINANCIAL SERVICES TOTAL $601,899
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant (network & data management)$11,157
1088 Translation Services $34
1089 Medication Supports $23,660
1090 Food Service $247,407
1091 Laundry service $17,401
1092 Medical Waste Disposal $14,333
1093 Nutritionist Services $0
1094 X-ray and EKG services $4,363
1095 Pharmaceutical Consultant $0
Staff Training/Registration
Lodging
Staff Travel (Out of County)
Transportation of Clients
Staff Mileage/vehicle maintenance
REVISED EXHIBIT B
Page 27 of 29
Acute Inpatient Psychiatric Services (16 bed PHF)
Exodus Recovery
Budget- July 1, 2020 through June 30, 2021 (12 months)
1096 Medical Services $0
1097 Other - Contracted Services $378,269
1098 Other - Registry $0
SPECIAL EXPENSES TOTAL $696,624
FIXED ASSETS:
2000 Computers & Software $5,422
2001 Furniture & Fixtures $6,000
2002 Other $0
2003 Other $14,457
FIXED ASSETS TOTAL $25,879
TOTAL PROGRAM EXPENSES $4,525,120
DIRECT SERVICE REVENUE:
Vol/Units
of Svc Rate $ Amt.
3000
(Individual/Family/Group
Therapy)$0
3100 Case Management $0
3200 Crisis Services $0
3300 Medication Support $0
3400 Psychiatric Health Facility Services 6,088 743.34 $4,525,119
3500 other $0
DIRECT SERVICE REVENUE TOTAL 6,088 $4,525,119
$1,932,226
Cost Per Unit
Funding Streams Reimbursement Population Served Percentage
4000 Private Insurance 4%162,904
4100 Uninsured 11%497,764
4200 Medi-Cal FFP 43%1,932,226
4300 Behavioral Health Realignment 43%1,932,226
OTHER REVENUE TOTAL $4,525,120
TOTAL PROGRAM REVENUE $4,525,120
Medi-cal Revenue
REVISED EXHIBIT B
Page 28 of 29
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
$2,609,351
Salary Total $2,016,249
Payroll Taxes
OASDI $20,162
FICA/MEDICARE $181,462
SUI $20,162
Payroll Taxes Total $221,787
Employee Benefits
Retirement $85,402
Workers Compensation $122,534
Health Insurance (medical vision, life, dental) $163,379
Employee Benefits $371,315
Facilities/Equipment Expenses – Line Items 1010-1014
$491,642
Operating Expenses - Line Items 1060-1077
$99,726
Rent/Equipment Leases - Lease cost for computers, printers, copier, and faxes for the program $15,578
Utilities - Cost for program utilities $165,186
Janitorial - Cost for janitorial Service for the program $67,214
Maintenance - Cost for maintenance and repairs for the facility $22,218
Security - Cost for security personnel for the program $221,446
Acute Inpatient Psychiatric Services
Exodus Recovery, Inc.
2020-2021
BUDGET NARRATIVE - EXPENSES
These amounts reflect FTE positions, part-time positions and whether the positions are administrative or direct service. Employee
benefits should be limited to a maximum of 20% of total salaries.
Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.). Attach copy of lease
agreements if available.
Program Support FTE 1.00 Administrative Services - proposed annual salary $45,970
Administrator FTE 0.10 Administrative Services - proposed annual salary $14,110
Data Specialist FTE 1.00 Administrative Services - proposed annual salary $47,305
Program Director (RN) 1.00 FTE, Administrative Services - proposed annual salary $149,893
Rehab Specialist Coord (OT/RT) 1.00 FTE Direct Services - proposed annual salary $72,346
Mental Health Workers FTE 14.59 Direct Services - proposed annual salary $623,691
LMFT/LCSW FTE 1.60 Direct Services - proposed annual salary $124,974
Peer Advocate/Counselor Direct Services FTE 1.91 - proposed annualy salary $95,356
Data Specialist FTE 1.00 Administrative Services - proposed annual salary $47,305
Program Nurses (RN) FTE 3.58 Direct Services - proposed salary $380,680
Program Nurses (LPTN) FTE 1.45 Direct Services - proposed salary $66,180
Program Nurses (LVN) FTE 5.98 Direct Services - proposed salary $395,445
Telephone - Cost of phone usage expense for the program $23,800
REVISED EXHIBIT B
Page 29 of 29
Acute Inpatient Psychiatric Services
Exodus Recovery, Inc.
2020-2021
BUDGET NARRATIVE - EXPENSES
Financial Services Expenses – Line Items 1080-1085
$601,899
Special Expenses – Line Items 1090-1092
$696,624
Fixed Assets – Line Items 1190-1193
$25,879
Computers & Software $5,422
TOTAL PROGRAM EXPENSES:$4,525,120
Laundry Service - Cost for linen service for the program $17401
X-ray and EKG services - $4363
Other - Contracted Services - Personnel related expenses including registry nurses as needed, parking,
relocation costs, etc. $378,269
Medical Waste Disposal - Cost for Medical Disposal Services $14333
Include all purchases over Five Thousand Dollars ($5,000) including sales tax, and certain purchases under said amount such as
camera, televisions, VCRs/DVDs and other sensitive items, made during the life of the Agreement resulting from this Request for
Proposal, with funds paid pursuant to this Agreement and that will outlive the life of this Agreement.
Furniture & Fixtures $6,000
Consultant (network & data mgmt) Cost for consultant IT firm support, network monitoring, and off-site back-
up for program IT System $11,157
Translation Services - Cost for translation services for the program $34
Medication Supports (Pharmaceuticals) Medication costs for clients $23660
Food Service - Cost for food services for program clients $247,407
Other - EHR Avatar Cost $14,457
Liability Insurance - Cost of insurance expense for liability, business property and vehicle policy $10,605
Other Administrative Overhead - Administrative overhead expense related to the program $590,233
Postage - Program related postage cost $182
Program Supplies - Therapeutic - Cost for medical supplies for the program $12,625
Program Supplies - Medical - Cost for medical supplies for the program $9136
Staff Mileage/Vehicle Maintenance - Cost for mileage, parking, travel expense for program staff $106
Office Supplies & Equipment - Cost for office supplies and equipment for the program $42,301
Legal Notices/Advertising - Cost for advertising for staff recruitment and other program related advertising or
legal notices $1061
Staff Training/Registration - Cost of ongoing training for staff $9041
Other - License/Business Tax $1,473
Accounting/Bookkeeping - Cost of financial auditing and monthly financial reviews $1,061
REVISED EXHIBIT D
Page 1 of 3
Documentation Standards for Client Records
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the
record have a specific document or section addressing these topics. All medical records shall be
maintained for a minimum of ten (10) years from the date of the end of the Agreement.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client
record.
• Relevant physical health conditions reported by the client will be prominently
identified and updated as appropriate.
• Presenting problems and relevant conditions affecting the client’s physical health and
mental health status will be documented, for example: living situation, daily activities,
and social support.
• Documentation will describe client’s strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently
documented and updated as appropriate.
• Documentations will include medications that have been described by mental health
plan physicians, dosage of each medication, dates of initial prescriptions and refills,
and documentations of informed consent for medications.
• Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
• A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data, relevant
family information and relevant results of relevant lab tests and consultations reports.
• For children and adolescents, pre-natal and perinatal events and complete
developmental history will be documented.
• Documentations will include past and present use of tobacco, alcohol, and caffeine,
as well as illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A DSM-5 diagnosis, or a diagnosis from the most current ICD, will be documented,
consistent with the presenting problems, history mental status evaluation and/or
other assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document
changes in the client’s condition.
• Client conditions will be assessed at least annually and, in most cases, at more
frequent intervals.
B. Client Plans
1. Client plans will:
• have specific observable and/or specific quantifiable goals
REVISED EXHIBIT D
Page 2 of 3
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent) by:
the person providing the service(s), or
a person representing a team or program providing services, or
a person representing the MHP providing services
when the client plan is used to establish that the services are provided under
the direction of an approved category of staff, and if the below staff are not
the approved category,
a physician
a licensed/ “waivered” psychologist
a licensed/ “associate” social worker
a licensed/ registered/marriage and family therapist or
a registered nurse
• In addition,
client plans will be consistent with the diagnosis, and the focus of intervention
will be consistent with the client plan goals, and there will be documentation
of the client’s participation in and agreement with the plan. Examples of the
documentation include, but are not limited to, reference to the client’s
participation and agreement in the body of the plan, client signature on the
plan, or a description of the client’s participation and agreement in progress
notes.
client signature on the plan will be used as the means by which the
CONTRACTOR(S) documents the participation of the client
when the client’s signature is required on the client plan and the client refuses
or is unavailable for signature, the client plan will include a written explanation
of the refusal or unavailability.
• The CONTRACTOR(S) will give a copy of the client plan to the client on request.
2. Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for the
individual elements of the client plan described in Item 1.
C. Progress Notes
1. Items that must be contained in the client record related to the client’s progress in
treatment include:
• The client record will provide timely documentation of relevant aspects of client care
• Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
• All entries in the client record will include the signature of the person providing the
service (or electronic equivalent); the person’s professional degree, licensure or job
title; and the relevant identification number, if applicable
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge
summary
REVISED EXHIBIT D
Page 3 of 3
2. Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated below:
A. Every Service Contact
• Mental Health Services
• Medication Support Services
• Crisis Intervention
REVISED EXHIBIT F
Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business
and Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates
of pay or other forms of compensation, use of facilities, and other terms
and conditions of employment.
REVISED EXHIBIT F
Page 2 of 6
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY’s Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f)
and CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply
with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-
free workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is prohibited and
specifying actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
c. Every employee who works on this Agreement will:
1) receive a copy of the company's drug -free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
Failure to comply with these requirements may result in suspension of payments under
this Agreement or termination of this Agreement or both and CONTRACTOR may be
REVISED EXHIBIT F
Page 3 of 6
ineligible for award of any future State agreements if the department determines that any
of the following has occurred: the CONTRACTOR has made false certification, or
violated the certification by failing to carry out the requirements as noted above. (Gov.
Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1) final unappealable finding of contempt of court by a
Federal court has been issued against CONTRACTOR within the immediately preceding
two (2) year period because of CONTRACTOR’s failure to comply with an order of a
Federal court, which orders CONTRACTOR to comply with an order of the National
Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will comply with
the requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the lessor of
30 multiplied by the number of full time attorneys in the firm’s offices in the State, with
the number of hours prorated on an actual day basis for any contract period of less than
a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the
State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of equipment,
materials, or supplies, other than procurement related to a public works contract, declare
under penalty of perjury that no apparel, garments or corresponding accessories,
equipment, materials, or supplies furnished to the state pursuant to the contract have
been laundered or produced in whole or in part by sweatshop labor, forced labor, convict
labor, indentured labor under penal sanction, abusive forms of child labor or exploitation
of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor,
convict labor, indentured labor under penal sanction, abusive forms of child labor or
exploitation of children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the
California Department of Industrial Relations website located at www.dir.ca.gov, and
Public Contract Code Section 6108.
b. CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR’s records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the Department of
REVISED EXHIBIT F
Page 4 of 6
Industrial Relations, or the Department of Justice to determine the contractor’s
compliance with the requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or has a financial
interest and which is sponsored or funded by any state agency, unless the employment,
activity or enterprise is required as a condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he or she
engaged in any of the negotiations, transactions, planning, arrangements or any part of
the decision-making process relevant to the contract while employed in any capacity by
any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a contract with any state
agency if he or she was employed by that state agency in a policy-making position in the
same general subject area as the proposed contract within the twelve (12) month period
prior to his or her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
REVISED EXHIBIT F
Page 5 of 6
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance with the
provisions, and CONTRACTOR affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR’s name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment. Payment of
invoices presented with a new name cannot be paid prior to approval of said
amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently qualified to do
business in California in order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit. Although there
are some statutory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do business in California.
Agencies will determine whether a corporation is in good standing by calling the Office of
the Secretary of State.
6. RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local governing
body, which by law has authority to enter into an agreement, authorizing execution of the
agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not subject to
review promulgated by the State Air Resources Board or an air pollution control district;
(2) subject to cease and desist order not subject to review issued pursuant to Section
13301 of the Water Code for violation of waste discharge requirements or discharge
prohibitions; or (3) finally determined to be in violation of provisions of federal law
relating to air or water pollution.
REVISED EXHIBIT F
Page 6 of 6
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General, and their
designees may, at any time, inspect and audit any records or documents of
CONTRACTOR or its subcontractors, and may, at any time, inspect the premises,
physical facilities, and equipment where Medicaid-related activities or work is conducted.
The right to audit under this section exists for ten (10) years from the final date of the
contract period or from the date of completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must confirm the
identity and determine the exclusion status of CONTRACTOR, any subcontractor, as
well as any person with an ownership or control interest, or who is an agent or managing
employee of CONTRACTOR through routine checks of Federal databases. This
includes the Social Security Administration's Death Master File, the National Plan and
Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE),
the System for Award Management (SAM), and any other databases as the State or
Secretary may prescribe. These databases must be consulted upon contracting and no
less frequently than monthly thereafter. If the State finds a party that is excluded, it must
promptly notify the CONTRACTOR and take action consistent with § 438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or financial
institution located outside of the U.S. are considered in the development of actuarially
sound capitation rates.
REVISED EXHIBIT I
Page 1 of 2
FRESNO COUNTY MENTAL HEALTH PLAN
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes the form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed for
each client.
Where the forms should be sent – within 24 hours from the time of the incident or first
knowledge of the incident:
• Incident Report should be sent to:
DBHIncidentreporting@fresnocountyca.gov and designated Contract Analyst
Fresno County Department of Behavioral Health-Incident Report
Send completed forms to dbhincidentreporting@fresnocountyca.gov and designated contract analyst within 24 hours of an
incident or knowledge of an incident. DO NOT COPY OR REPRODUCE/NOT part of the medical record.
Client Information
Last Name: Click or tap here to enter text. First Name: Click or tap here to enter text. Middle Initial: Click or tap here to enter text.
Date of Birth:Click or tap here to enter text. Client ID#:Click or tap here to enter text. Gender: ☐ Male ☐ Female
County of Origin: Click or tap here to enter text.
Name of Reporting Party:Click or tap here to enter text. Name of Facility:Click or tap here to enter text.
Facility Address:Click or tap here to enter text. Facility Phone Number:Click or tap here to enter text.
Incident (check all that apply)
☐Homicide/Homicide Attempt ☐ Attempted Suicide (resulting in serious injury) ☐ Death of Client ☐ Medical Emergency
☐Injury (self-inflicted or by accident)☐Violence/Abuse/Assault (toward others, client and/or property)
☐Other- Specify (i.e. medication errors, client escaping from locked facility, fire, poisoning, epidemic outbreaks, other
catastrophes/events that jeopardize the welfare and safety of clients, staff and /or members of the community): Click or tap here to
enter text.
Date of Incident: Click or tap here to enter text. Time of Incident: Click or tap here to enter text.☐am ☐pm
Location of Incident: Click or tap here to enter text.
Description of the Incident (Attach additional sheet if needed): Click or tap here to enter text.
Key People Directly Involved in Incident (witnesses, staff): Click or tap here to enter text.
Action Taken (check all that apply) ☐Consulted with Physician ☐ Called 911/EMS ☐ First Aid/CPR Administered ☐Law Enforcement Contacted☐Client removed from building ☐ Parent/Legal Guardian Contacted ☐Other (Specify): Click or tap here to enter text.
Description of Action Taken: Click or tap here to enter text.
Outcome of Incident (If Known): Click or tap here to enter text.
Form Completed by: __________________________________ _______________________________ _____________
Printed Name Signature Date
Reviewed by Supervisor/Program Manager: _____________________________ ___________________________ ________
Printed Name Signature Date
For Internal Use only:
☐Report to Administration ☐ Report to Intensive Analysis Committee for additional review ☐Request Additional Information
☐No Action ☐ Unusual Occurrence ☐ Other: Click or tap here to enter text.
Revised 08/18
REVISED EXHIBIT I
Page 2 of 2
Guiding Principles of Care Delivery
1
rev 2017 Dec
DBH VISION:
Health and well-being for our community.
DBH MISSION:
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,
families and communities in Fresno County who are affected by, or are at risk of, mental illness
and/or substance use disorders through cultivation of strengths toward promoting recovery in
the least restrictive environment.
DBH GOALS:
Quadruple Aim
•Deliver quality care
•Maximize resources while focusing on efficiency
•Provide an excellent care experience
•Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1.Principle One - Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
EXHIBIT M
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2
rev 2017 Dec
2.Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3.Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4.Principle Four - Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person’s quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5.Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and client values and preferences
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
EXHIBIT M
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
3
rev 2017 Dec
6.Principle Six - Culturally Responsive
o Values, traditions, and beliefs specific to an individual’s or family’s culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7.Principle Seven - Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8.Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9.Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the client’s stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
EXHIBIT M
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
4
rev 2017 Dec
10.Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11.Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
EXHIBIT M
Fresno County Department of Behavioral Health