HomeMy WebLinkAboutAgreement A-21-083 with Exodus Recovery.pdf1
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AGREEMENT
THIS AGREEMENT is made and entered into this ___________day of _____________, 2021, by
and between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
referred to as “COUNTY”, and, EXODUS RECOVERY, INC. a for-profit California S-Corporation, whose
address is 9808 Venice Blvd, Suite 700 Culver City, CA, 90232, hereinafter referred to as
“CONTRACTOR,” collectively, “the parties.”
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), is in need of a qualified
agency to provide Housing Supportive Services and Specialty Mental Health Services to tenants living in
No Place Like Home (NPLH) developments.
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), is a Mental Health Plan
(MHP) as defined in Title 9 of the California Code of Regulations (C.C.R.), section 1810.226; and
WHEREAS, CONTRACTOR is qualified and willing to operate said Housing Supportive Services
and Specialty Mental Health Services pursuant to the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties hereto
agree as follows:
1.SERVICES
A.CONTRACTOR shall perform all services and fulfill all responsibilities as set forth in
Exhibit A, attached hereto and by this reference incorporated herein and made part of this Agreement.
B.CONTRACTOR shall also perform all services and fulfill all responsibilities as
specified in COUNTY’s Request for Proposal (RFP) No. 20-060 dated June 9, 2020, Addendum No. One
(1) to COUNTY’s RFP No. 20-060 dated June 24, 2020, and Addendum No. Two (2) to COUNTY’s RFP
No. 20-060 dated June 25, 2020 (collectively referred to herein as “the Revised RFP”) and
CONTRACTOR’s response to said Revised RFP dated July 16, 2020 all incorporated herein by reference
and made part of this Agreement. In the event of any inconsistency among these documents, the
inconsistency shall be resolved by giving precedence in the following order of priority: 1) to this
Agreement, including all Exhibits; 2) to the Revised RFP; and 3) to the Response to the Revised RFP. A
copy of COUNTY’s Revised RFP No. 20-060 and CONTRACTOR’s response thereto shall be retained
23rd March
Agreement No. 21-083
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and made available during the term of this Agreement by COUNTY’s DBH Contracts Division.
C.CONTRACTOR shall provide Housing Supportive Services and Specialty Mental
Health Services at Villages at Paragon in accordance with the vision, mission, and guiding principles of the
COUNTY’s DBH, as further described in Exhibit B “Guiding Principles of Care Delivery”, attached hereto
and by this reference incorporated herein and made part of this Agreement. Additional sites may be added
through a written amendment of this Agreement.
D.It is acknowledged by all parties hereto that COUNTY's DBH shall monitor the
services provided by CONTRACTOR, in accordance with Section Fourteen (14) of this Agreement.
E.CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
consisting of staff from COUNTY's DBH to discuss service requirements, data reporting, training, policies
and procedures, overall program operations and any problems or foreseeable problems that may arise.
2.TERM
This Agreement shall become effective on the 1st day of April 2021 and shall terminate on
the 30th day of June 2023.
This Agreement may be extended for two (2) additional twelve (12) month periods upon the
written approval of both parties not later than sixty (60) days prior to the close of the then current
Agreement term. The COUNTY’s DBH Director or his or her designee is authorized to execute such
written approval on behalf of COUNTY based on CONTRCTOR’s satisfactory performance.
3.TERMINATION
A.Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR thirty (30) days advance written notice.
B.Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1)An illegal or improper use of funds;
2)A failure to comply with any term of this Agreement;
3)A substantially incorrect or incomplete report submitted to COUNTY;
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4)Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of any breach
of this Agreement or any default which may then exist on the part of CONTRACTOR. Neither shall such
payment impair or prejudice any remedy available to COUNTY with respect to the breach or default. The
COUNTY shall have the right to demand of the CONTRACTOR the repayment to the COUNTY of any
funds disbursed to CONTRACTOR under this Agreement, which in the judgment of COUNTY were not
expended in accordance with the terms of this Agreement. The CONTRACTOR shall promptly refund any
such funds upon demand or at COUNTY’s option such repayment shall be deducted from future payments
owing to CONTRACTOR under this Agreement.
C.Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY’s DBH Director, or designee,
upon the giving of sixty (60) days advance written notice of an intention to terminate.
4.COMPENSATION
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation in accordance with the budget set forth in Exhibit C, attached hereto and by this reference
incorporated herein and made part of this Agreement.
A.Maximum Contract Amount
The maximum amount payable to CONTRACTOR for the period of April 1, 2021
through June 30, 2021 shall not exceed Ninety-Three Thousand One Hundred Ninety-Two and No/100
Dollars ($93,192.00).
The maximum amount payable to CONTRACTOR for the period of July 1, 2021
through June 30, 2022 shall not exceed Two Hundred Eighty-One Thousand Seven Hundred Sixty-Two
and No/100 Dollars ($281,762.00).
The maximum amount payable to CONTRACTOR for the period of July 1, 2022
through June 30, 2023 shall not exceed Two Hundred Eighty-One Thousand Seven Hundred Sixty-Two
and No/100 Dollars ($281,762.00).
The maximum amount payable to CONTRACTOR for the period of July 1, 2023
through June 30, 2024 shall not exceed Two Hundred Eighty-Seven Thousand Four Hundred Fifty-Three
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and No/100 Dollars ($287,453.00).
The maximum amount payable to CONTRACTOR for the period of July 1, 2024
through June 30, 2025 shall not exceed Three Hundred Thousand Three Hundred Eighty-Seven and
No/100 Dollars ($300,387.00).
In no event shall the maximum contract amount for all the services provided by the
CONTRACTOR to COUNTY under the terms and conditions of this Agreement be in excess of One Million
Two Hundred Forty-Four Thousand Five Hundred Fifty-Six and No/100 Dollars ($1,244,556.00) during the
total term of this Agreement.
Payment shall be made upon certification or other proof satisfactory to COUNTY’s
DBH that services have actually been performed by CONTRACTOR as specified in this Agreement.
B.If CONTRACTOR fails to generate the Medi-Cal revenue and/or client fee
reimbursement amounts set forth in Exhibit C, the COUNTY shall not be obligated to pay the difference
between these estimated amounts and the actual amounts generated.
It is further understood by COUNTY and CONTRACTOR that any Medi-Cal
revenue and/or client fee reimbursements above the amounts stated herein will be used to directly offset
the COUNTY’s contribution of COUNTY funds identified in Exhibit C. The offset of funds will also be
clearly identified in monthly invoices received from CONTRACTOR as further described in Section Five (5)
of this Agreement.
Travel shall be reimbursed based on actual expenditures and mileage
reimbursement shall be at CONTRACTOR’s adopted rate per mile, not to exceed the Federal Internal
Revenue Services (IRS) published rate.
C.It is understood that all expenses incidental to CONTRACTOR’s performance of
services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails to comply with
any provision of this Agreement, COUNTY shall be relieved of its obligation for further compensation.
D.Payments shall be made by COUNTY to CONTRACTOR in arrears, for services
provided during the preceding month, within forty-five (45) days after the date of receipt and approval by
COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments shall be made after
receipt and verification of actual expenditures incurred by CONTRACTOR for monthly program costs, as
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identified in Exhibit C, in the performance of this Agreement and shall be documented to COUNTY on a
monthly basis by the tenth (10th) of the month following the month of said expenditures. The parties
acknowledge that the CONTRACTOR will be performing hiring, training, and credentialing of staff, and the
COUNTY will be performing additional staff credentialing to ensure compliance with State and Federal
regulations.
E. COUNTY shall not be obligated to make any payments under this Agreement if the
request for payment is received by COUNTY more than sixty (60) days after this Agreement has
terminated or expired.
All final invoices shall be submitted by CONTRACTOR within sixty (60) days
following the final month of service for which payment is claimed. No action shall be taken by COUNTY on
invoices submitted beyond the sixty (60) day closeout period. Any compensation which is not expended
by CONTRACTOR pursuant to the terms and conditions of this Agreement shall automatically revert to
COUNTY.
F. The services provided by CONTRACTOR under this Agreement are funded in
whole or in part by the State of California. In the event that funding for these services is delayed by the
State Controller, COUNTY may defer payments to CONTRACTOR. The amount of the deferred payment
shall not exceed the amount of funding delayed by the State Controller to the COUNTY. The period of
time of the deferral by COUNTY shall not exceed the period of time of the State Controller’s delay of
payment to COUNTY plus forty-five (45) days.
G. CONTRACTOR shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR’s deficiency discovered through the State audit
process and COUNTY utilization review during the course of this Agreement. At COUNTY’s election, the
disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall be
withheld from subsequent payments to CONTRACTOR. CONTRACTOR shall not receive reimbursement
for any units of services rendered that are disallowed or denied by the Fresno County Mental Health Plan
(Mental Health Plan) utilization review process or through the State Department of Health Care Services
(DHCS) cost report audit settlement process for Medi-Cal eligible clients. Notwithstanding the above,
COUNTY must notify CONTRACTOR prior to any State audit process and/or COUNTY utilization review.
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To the extent allowable by law, CONTRACTOR shall have the right to be present during each phase of
any State audit process and/or COUNTY utilization review and shall be provided all documentation related
to each phase of any State audit process and/or COUNTY utilization review. Additionally, prior to any
disallowances/audit exceptions becoming final, CONTRACTOR shall be given at least 10 business days to
respond to such proposed disallowances/audit exceptions.
H.It is understood by CONTRACTOR and COUNTY that this Agreement is funded
with mental health funds to serve adult individuals with Severely Mentally Ill (SMI) disorders and
children/youth with Seriously Emotionally Disturbed (SED) disorders, many of whom have co-occurring
substance use disorders. It is further understood by CONTRACTOR and COUNTY that funds shall be
used to support appropriately integrated and documented treatment services for co-occurring mental
health and substance use disorders.
5.INVOICING
A.CONTRACTOR shall invoice COUNTY in arrears by the tenth (10th) day of each
month for the prior month’s actual services rendered to DBH-Invoices@co.fresno.ca.us. After
CONTRACTOR renders service to referred clients, CONTRACTOR will invoice COUNTY for payment,
certify the expenditure, and submit electronic claiming data into COUNTY’s electronic information system
for all clients, including those eligible for Medi-Cal as well as those that are not eligible for Medi-Cal,
including contracted cost per unit and actual cost per unit. COUNTY must pay CONTRACTOR before
submitting a claim to DHCS for Federal reimbursement for Medi-Cal eligible clients.
B.At the discretion of COUNTY’s DBH Director, or his or her designee, if an invoice is
incorrect or is otherwise not in proper form or substance, COUNTY’s DBH Director, or his or her designee,
shall have the right to withhold payment as to only that portion of the invoice that is incorrect or improper
after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to provide services
for a period of ninety (90) days after notification of an incorrect or improper invoice. If after the ninety (90)
day period, the invoice(s) is still not corrected to COUNTY DBH’s satisfaction, COUNTY’s DBH Director, or
his or her designee, may elect to terminate this Agreement, pursuant to the termination provisions stated in
Section Three (3) of this Agreement. In addition, for invoices received sixty (60) days after the expiration
of each term of this Agreement or termination of this Agreement, at the discretion of COUNTY’s DBH
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Director, or his or her designee, COUNTY’s DBH shall have the right to deny payment of any additional
invoices received.
C. Monthly invoices shall include a client roster, identifying volume reported by payer
group clients served (including third party payer of services) by month and year-to-date, including
percentages.
D. CONTRACTOR shall submit to the COUNTY by the tenth (10th) of each month a
detailed general ledger (GL), itemizing costs incurred in the previous month. Failure to submit GL reports
and supporting documentation shall be deemed sufficient cause for COUNTY to withhold payments until
there is compliance, as further described in Section Five (5) herein.
E. CONTRACTOR will remit annually within ninety (90) days from June 30, a schedule
to provide the required information on published charges for all authorized direct specialty mental health
services. The published charge listing will serve as a source document to determine the CONTRACTOR’s
usual and customary charge prevalent in the public mental health sector that is used to bill the general
public, insurers or other non-Medi-Cal third party payers during the course of business operations.
F. CONTRACTOR shall submit monthly staffing reports that identify all direct service
and support staff, applicable licensure/certifications, and full time hours worked to be used as a tracking
tool to determine if CONTRACTOR’s program is staffed according to the services provided under this
Agreement.
G. If CONTRACTOR chooses to utilize the COUNTY’s electronic health record system
as their own full electronic health records system, COUNTY’s DBH shall invoice CONTRACTOR in arrears
by the fifth (5th) day of each month for the prior month’s hosting fee for access to the COUNTY’s electronic
information system in accordance with the fee schedule as set forth in Exhibit D, “Electronic Health
Records Software Charges” attached hereto and incorporated herein by reference. COUNTY shall invoice
CONTRACTOR annually for the annual maintenance and licensing fee for access to the COUNTY’s
electronic information system in accordance with the fee schedule as set forth in Exhibit D. COUNTY shall
invoice CONTRACTOR annually for the Reaching Recovery fee for access to the COUNTY’s electronic
information system in accordance with the fee schedule as set forth in Exhibit D.
CONTRACTOR shall provide payment for these expenditures to COUNTY’s Fresno
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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.
H.CONTRACTOR must maintain financial records for a period of ten (10) years or
until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible for
any disallowances related to inadequate documentation.
I.CONTRACTOR is responsible for collection and managing of data in a manner to
be determined by DHCS and the COUNTY’s Mental Health Plan in accordance with applicable rules and
regulations. COUNTY’s electronic information system is a critical source of information for purposes of
monitoring service volume and obtaining reimbursement.
J.CONTRACTOR shall submit service data into COUNTY’s electronic information
system according to COUNTY’s DBH documentation standards to allow the COUNTY to bill Medi-Cal, and
any other third-party source, for services and meet State and Federal reporting requirements.
K.CONTRACTOR must comply with all laws and regulations governing the Federal
Medicare program, including, but not limited to: 1) the requirement of the Medicare Act, 42 U.S.C. section
1395 et seq; and 2) the regulations and rules promulgated by the Federal Centers for Medicare and
Medicaid Services as they relate to participation, coverage and claiming reimbursement. CONTRACTOR
will be responsible for compliance as of the effective date of each Federal, State or local law or regulation
specified.
L.If a client has dual coverage, such as other health coverage (OHC) or Federal
Medicare, the CONTRACTOR will be responsible for billing the carrier and obtaining a payment/denial or
have validation of claiming with no response ninety (90) days after the claim was mailed before the service
can be entered into the COUNTY’s electronic information system. CONTRACTOR must report all third
party collections for Medicare, third party or client pay or private pay in each monthly invoice and in the
annual cost report that is required to be submitted. A copy of explanation of benefits or CMS 1500 form is
required as documentation. CONTRACTOR must report all revenue collected from OHC, third-party,
client-pay or private-pay in each monthly invoice and in the cost report that is required to be submitted.
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CONTRACTOR shall submit monthly invoices for reimbursement that equal the amount due
CONTRACTOR less any funding sources not eligible for Federal and State reimbursement.
M.Data entry shall be the responsibility of the CONTRACTOR. COUNTY shall
monitor the volume of services and cost of services entered into the COUNTY’s electronic information
system. Any and all audit exceptions resulting from the provision and reporting of specialty mental health
services by CONTRACTOR shall be the sole responsibility of the CONTRACTOR. CONTRACTOR will
comply with all applicable policies, procedures, directives and guidelines regarding the use of COUNTY’s
electronic information system.
N.Medi-Cal Certification and Mental Health Plan Compliance
CONTRACTOR shall comply with any and all requests and directives associated
with COUNTY maintaining State Medi-Cal site certification. CONTRACTOR shall provide specialty mental
health services in accordance with the COUNTY’s Mental Health Plan. CONTRACTOR must comply with
the “Fresno County Mental Health Plan Compliance Program and Code of Conduct” set forth in Exhibit E,
attached hereto and incorporated herein by reference and made part of this Agreement. CONTRACTOR
shall comply with any and all requests associated with any State/Federal reviews or audits.
CONTRACTOR may provide direct specialty mental health services using pre-
licensed staff as long as the individual is approved as a provider by the Mental Health Plan, is supervised
by licensed staff, works within his/her scope and only delivers allowable direct specialty mental health
services. It is understood that each service is subject to audit for compliance with Federal and State
regulations, and that COUNTY may be making payments in advance of said review. In the event that a
service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set off from other
payments due the amount of said disapproved services. CONTRACTOR shall be responsible for audit
exceptions to ineligible dates of services or incorrect application of utilization review requirements.
6.INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under this
Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
CONTRACTOR’s officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
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employee, joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have no right to
control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and
function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
CONTRACTOR is performing their obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject
thereof.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely
no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
solely liable and responsible for providing to, or on behalf of, its employees all legally-required employee
benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all
matters relating to payment of CONTRACTOR’s employees, including compliance with Social Security,
withholding, and all other regulations governing such matters. It is acknowledged that during the term of
this Agreement, CONTRACTOR may be providing services to others unrelated to COUNTY or to this
Agreement.
7.MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent of
all the parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to services, staffing, and responsibilities of the
CONTRACTOR, as needed, to accommodate changes in the laws relating to mental health treatment, as
set forth in Exhibit A, 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 County Counsel and
the COUNTY’s Auditor-Controller’s Office.
In addition, changes to expense category (i.e., Salary & Benefits, Facilities/Equipment,
Operating, Financial Services, Special Expenses, Fixed Assets, etc.) subtotals in the budgets, and
changes to the volume of units of services/types of service units to be provided as set forth in Exhibit C,
that do not exceed 10% of the maximum compensation payable to the CONTRACTOR may be made with
the written approval of COUNTY’s DBH Director, or his or her designee. Said modifications shall not
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result in any change to the annual maximum compensation amount payable to CONTRACTOR, as stated
in this Agreement.
8.NON-ASSIGNMENT
No party shall assign, transfer or subcontract this Agreement nor their rights or duties under
this Agreement without the prior written consent of COUNTY.
9.HOLD-HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
defend COUNTY, its officers, agents and employees from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to COUNTY
in connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents or
employees under this Agreement, and from any and all costs and expenses, including attorney fees
and court costs, damages, liabilities, claims and losses occurring or resulting to any person, firm or
corporation who may be injured or damaged by the performance, or failure to perform, of
CONTRACTOR, their officers, agents or employees under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal and/or State of California audit
exceptions resulting from noncompliance herein on the part of CONTRACTOR.
10.INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or any third
parties, CONTRACTOR, at its sole expense, shall maintain in full force and affect the following insurance
policies throughout the term of this Agreement:
A.Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two MillionDollars ($2,000,000) per occurrence and an annual aggregate of Five MillionDollars ($5,000,000). This policy shall be issued on a per occurrence basis.COUNTY may require specific coverage including completed operations, productliability, contractual liability, Explosion, Collapse, and Underground (XCU), firelegal liability or any other liability insurance deemed necessary because of thenature of the Agreement.
B.Automobile Liability
Insurance Services Office Form Number CA 0001 covering, Code 1 (any auto),or if Consultant has no owned autos, Code 8 (hired) and 9 (non-owned).with
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limits of not less than) One Million Dollars ($1,000,000) per accident for bodily injury and property damage.
C.Real and Property Insurance
CONTRACTOR shall maintain a policy of insurance for all risk personal propertycoverage which shall be endorsed naming the County of Fresno as an additionalloss payee. The personal property coverage shall be in an amount that will coverthe total of the COUNTY purchase and owned property, at a minimum, asdiscussed in Section Twenty (21) of this Agreement.
All Risk Property Insurance
CONTRACTOR will provide property coverage for the full replacement value of the COUNTY’S personal property in possession of CONTRACTOR and/or used in the execution of this Agreement. COUNTY will be identified on an appropriate certificate of insurance as the certificate holder and will be named as an Additional Loss Payee on the Property Insurance Policy.
D.Professional Liability
Professional Liability Insurance with limits of not less than One Million Dollars($1,000,000) per occurrence, Three Million Dollars ($3,000,000) annualaggregate. CONTRACTOR agrees that it shall maintain, at its sole expense, infull force and effect for a period of three (3) years following the termination of thisAgreement, one or more policies of professional liability insurance with limits ofcoverage as specified herein.
E.Child Abuse/Molestation and Social Services Coverage
CONTRACTOR shall have either separate policies or an umbrella policy withendorsements covering Child Abuse/Molestation and Social Services Liabilitycoverage or have a specific endorsement on their General Commercial liabilitypolicy covering Child Abuse/Molestation and Social Services Liability. The policylimits for these policies shall be One Million Dollars ($1,000,000) per occurrencewith a Two Million Dollars ($2,000,000) annual aggregate. The policies are to beon a per occurrence basis.
F.Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by theCalifornia Labor Code.
G.Cyber Liability
Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence orclaim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond toduties and obligations undertaken by CONTRACTOR in this agreement and shallinclude, but not be limited to, claims involving infringement of intellectualproperty, including but not limited to infringement of copyright, trademark, tradedress, invasion of privacy violations, information theft, damage to or destruction
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of electronic information, release of private information, alteration of electronic information, extortion and network security. The policy shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations.
H.Waiver of Subrogation
CONTRACTOR hereby grants to COUNTY a waiver of any right to subrogationwhich any insurer of said CONTRACTOR may acquire against the COUNTY byvirtue of the payment of any loss under insurance. CONTRACTOR agrees toobtain any endorsement that may be necessary to affect this waiver ofsubrogation, but this provision applies regardless of whether or not the COUNTYhas received a waiver of subrogation endorsement from the insurer.
CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are concerned. Such coverage
for additional insured shall apply as primary insurance and any other insurance, or self-insurance,
maintained by COUNTY, its officers, agents and employees shall be excess only and not contributing with
insurance provided under CONTRACTOR’s policies herein. This insurance shall not be cancelled or
changed without a minimum of thirty (30) days advance written notice given to COUNTY.
Within thirty (30) days from the date CONTRACTOR signs this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 3133 N.
Millbrook Ave, Fresno, California, 93703, Attention: Contracts Division, stating that such insurance
coverages have been obtained and are in full force; that the County of Fresno, its officers, agents and
employees will not be responsible for any premiums on the policies; that such Commercial General
Liability insurance names the County of Fresno, its officers, agents and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are concerned;
that such coverage for additional insured shall apply as primary insurance and any other insurance, or self-
insurance, maintained by COUNTY, its officers, agents and employees, shall be excess only and not
contributing with insurance provided under CONTRACTOR’s policies herein; and that this insurance shall
not be cancelled or changed without a minimum of thirty (30) days advance, written notice given to
COUNTY.
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In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this Agreement
upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of California.
Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of A FSC VII or
better.
11. LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR’s staff shall
maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for the
provision of the services hereunder and required by the laws and regulations of the United States of
America, State of California, the County of Fresno, and any other applicable governmental agencies.
CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR’s staff shall comply with all
applicable laws, rules or regulations, as may now exist or be hereafter changed.
12. RECORDS
CONTRACTOR shall maintain records in accordance with Exhibit F, "Documentation
Standards for Client Records", attached hereto and by this reference incorporated herein and made part of
this Agreement. COUNTY shall be allowed to review all records of services provided, including the goals
and objectives of the treatment plan, and how the therapy provided is achieving the goals and objectives.
13. REPORTS
1. Outcome Reports
CONTRACTOR shall submit to COUNTY’s DBH service outcome reports as
reasonably requested by COUNTY’s DBH. Outcome reports and outcome requirements are subject to
change at COUNTY’s DBH discretion.
2. Additional Reports
CONTRACTOR shall also furnish to COUNTY such statements, records, reports,
data, and other information as COUNTY’s DBH may reasonably request pertaining to matters covered by
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this Agreement. In the event that CONTRACTOR fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments until
there is compliance. In addition, CONTRACTOR shall provide written notification and explanation to
COUNTY within five (5) days of any funds received from another source to conduct the same services
covered by this Agreement.
3.Cost Report
CONTRACTOR shall provide financial data to identify all direct and indirect costs
incurred by the CONTRACTOR for all services delivered under this Agreement. All Cost Reports must be
prepared in accordance with Generally Accepted Accounting Principles (GAAP) and Welfare and
Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3) and 5718(c). Unallowable costs such as lobbying or
political donations must be deducted on the cost report and monthly invoice reimbursements.
4.Settlements with State Department of Health Care Services (DHCS)
During the term of this Agreement and thereafter, COUNTY and CONTRACTOR
agree to settle dollar amounts disallowed or settled in accordance with DHCS audit settlement findings
related to the reimbursement provided under this Agreement. CONTRACTOR will participate in the several
phases of settlements between COUNTY/CONTRACTOR and DHCS. The phases of initial cost reporting
for settlement according to State reconciliation of records for paid Medi-Cal services and audit settlement
are: State DHCS audit 1) initial cost reporting - after an internal review by COUNTY, the COUNTY files the
cost report with State DHCS on behalf of the CONTRACTOR’s legal entity for the fiscal year; 2) Settlement
–State reconciliation of records for paid Medi-Cal services, approximately 18 to 36 months following the
State close of the fiscal year, DHCS will send notice for any settlement under this provision to the
COUNTY; 3) Audit Settlement-State DHCS audit. After final reconciliation and settlement DHCS may
conduct a review of medical records, cost report along with support documents submitted to COUNTY in
initial submission to determine accuracy and may disallow costs and/or units of services. COUNTY may
choose to appeal and therefore reserves the right to defer payback settlement with CONTRACTOR until
resolution of the appeal. DHCS Audits will follow Federal Medicaid procedures for managing
overpayments. If at the end of the Audit Settlement, the COUNTY determines that it overpaid the
CONTRACTOR, it will require the CONTRACTOR to repay the Medi-Cal related overpayment back to the
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COUNTY.
Funds owed to COUNTY will be due within forty-five (45) days of notification by the
COUNTY, or COUNTY shall withhold future payments until all excess funds have been recouped by
means of an offset against any payments then or thereafter owing to COUNTY under this or any other
Agreement between the COUNTY and CONTRACTOR.
14. MONITORING
CONTRACTOR agrees to extend to COUNTY’s staff, COUNTY’s DBH Director and the
State Department of Health Care Services, or their designees, the right to review and monitor records,
services or procedures, at any time, in regard to clients, as well as the overall operation of
CONTRACTOR’s performance, in order to ensure compliance with the terms and conditions of this
Agreement.
15. REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended during
the term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
such amendment.
16. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates its mental health programs under an
agreement with the State of California Department Health Care Services, and that under said agreement
the State imposes certain requirements on COUNTY and its subcontractors. CONTRACTOR shall adhere
to all State requirements, including those identified in Exhibit G “State Mental Health Requirements”,
attached hereto and by this reference incorporated herein and made part of this Agreement.
CONTRACTOR shall also file an incident report for all incidents involving clients, following the Protocol and
using the Worksheet identified in Exhibit G, attached hereto and by this reference incorporated herein and
made part of this Agreement or a protocol and worksheet presented by CONTRACTOR that is accepted
by COUNTY’s DBH Director or his or her designee.
17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall inform every client of their rights under the COUNTY's Mental Health
Plan as described in Exhibit H, attached hereto and by this reference incorporated herein and made part of
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this Agreement.
18.CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating to
confidentiality.
19.HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-
191 (HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is only for treatment,
payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of
PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for
Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated thereunder
by the U.S. Department of Health and Human Services (HIPAA Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI, as
set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504€ of the Code of
Federal Regulations.
20.DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into
a contractual relationship with the COUNTY for the purpose of providing services under this Agreement
must employ adequate data security measures to protect the confidential information provided to
CONTRACTOR by the COUNTY, including but not limited to the following:
A.CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
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mobile, wireless or handheld devices, unless the following conditions are met:
1)CONTRACTOR has received authorization by COUNTY for telecommuting
purposes;
2)Current virus protection software is in place;
3)Mobile device has the remote wipe feature enabled; and
4)A secure connection is used.
B.CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief Information
Officer, and/or his or her designee(s), including but not limited to mobile storage devices. If data is
approved to be transferred, data must be stored on a secure server approved by the COUNTY and
transferred by means of a Virtual Private Network (VPN) connection, or another type of secure connection.
Said data must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR may not use COUNTY computers or computer peripherals on non-
COUNTY premises without prior authorization from the COUNTY’s Chief Information Officer, and/or his or
her designee(s).
D.CONTRACTOR may not store COUNTY’s private, confidential or sensitive data on
any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E.CONTRACTOR shall be responsible to employ strict controls to ensure the integrity
and security of COUNTY’s confidential information and to prevent unauthorized access, viewing, use or
disclosure of data maintained in computer files, program documentation, data processing systems, data
files and data processing equipment which stores or processes COUNTY data internally and externally.
F.Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128
BIT or higher. Additionally, a password or pass phrase must be utilized.
G.CONTRACTOR is responsible to immediately notify COUNTY of any violations,
breaches or potential breaches of security related to COUNTY’s confidential information, data maintained
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in computer files, program documentation, data processing systems, data files and data processing
equipment which stores or processes COUNTY data internally or externally.
H.COUNTY shall provide oversight to CONTRACTOR’s response to all incidents
arising from a possible breach of security related to COUNTY’s confidential client information provided to
CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected individuals as
required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will be
responsible for all costs incurred as a result of providing the required notification.
21.PROPERTY OF COUNTY
A.COUNTY and CONTRACTOR recognize that fixed assets are tangible and
intangible property obtained or controlled under COUNTY’s Mental Health Plan for use in operational
capacity and will benefit COUNTY for a period more than one year. Depreciation of the qualified items will
be on a straight-line basis.
For COUNTY purposes, fixed assets must fulfill three qualifications:
1.Asset must have life span of over one year.
2.The asset is not a repair part
3.The asset must be valued at or greater than the capitalization thresholds for
the asset type
Asset type Threshold
•land $0
•buildings and improvements $100,000 •infrastructure $100,000
•be tangible $5,000 o equipmentovehicles
•or intangible asset $100,000 o Internally generated softwareoPurchased softwareoEasementsoPatents
•and capital lease $5,000
Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
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approved and identified as an asset it will be tagged with a COUNTY program number. A Fixed asset log
will be maintained by COUNTY’s Asset Management System and annual inventoried until the asset is fully
depreciated. During the terms of this Agreement, CONTRACTOR’s fixed assets may be inventoried in
comparison to COUNTY’s DBH Asset Inventory System.
B.Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
more than $1,000, with over one year life span, and are mobile and high risk of theft or loss are sensitive
assets. Such sensitive items are not limited to computers, copiers, televisions, cameras and other sensitive
items as determined by COUNTY’s DBH Director or his or her designee. CONTRACTOR maintains a
tracking system on the items and are not required to be capitalize or depreciated. The items are subject to
annual inventory for compliance.
C.Assets shall be retained by COUNTY, as COUNTY property, in the event this
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in an
annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this
Agreement CONTRACTOR shall be physically present when fixed and inventoried assets are returned to
COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all COUNTY owned
undepreciated fixed and inventoried assets, or the monetary value of said assets if unable to produce the
assets at the expiration or termination of this Agreement.
CONTRACTOR further agrees to the following:
1.To maintain all items of equipment in good working order and condition,
normal wear and tear is expected;
2.To label all items of equipment with COUNTY assigned program number, to
perform periodic inventories as required by COUNTY and to maintain an inventory list showing where and
how the equipment is being used, in accordance with procedures developed by COUNTY. All such lists
shall be submitted to COUNTY within ten (10) days of any request therefore; and
3.To report in writing to COUNTY immediately after discovery, the lost or theft
of any items of equipment. For stolen items, the local law enforcement agency must be contacted and a
copy of the police report submitted to COUNTY.
D.The purchase of any equipment by CONTRACTOR with funds provided hereunder
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shall require the prior written approval of COUNTY’s DBH, shall fulfill the provisions of this Agreement as
appropriate, and must be directly related to CONTRACTOR’s services or activity under the terms of this
Agreement. COUNTY’s DBH may refuse reimbursement for any costs resulting from equipment
purchased, which are incurred by CONTRACTOR, if prior written approval has not been obtained from
COUNTY.
E. CONTRACTOR must obtain prior written approval from COUNTY’s DBH whenever
there is any modification or change in the use of any property acquired or improved, in whole or in part,
using funds under this Agreement. If any real or personal property acquired or improved with said funds
identified herein is sold and/or is utilized by CONTRACTOR for a use which does not qualify under this
Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal to the current fair market value
of the property, less any portion thereof attributable to expenditures of funds not provided under this
Agreement. These requirements shall continue in effect for the life of the property. In the event this
Agreement expires, or terminates, the requirements for this Section shall remain in effect for activities or
property funded with said funds, unless action is taken by the State government to relieve COUNTY of
these obligations
22. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of race,
religion, color, national origin, ancestry, physical handicap, medical condition, marital status, age or
gender, pursuant to all applicable State and Federal statutes and regulations.
23. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. section 2000d, and 45 C.F.R. Part
80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance from
discriminating against persons based on race, color, national origin, sex, disability or religion. This is
interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access and
participation in federally funded programs through the provision of comprehensive and quality bilingual
services.
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B.Policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP clients, including, but not limited to, assessing the
cultural and linguistic needs of its clients, training of staff on the policies and procedures, and monitoring its
language assistance program. The CONTRACTOR’s procedures must include ensuring compliance of any
sub-contracted providers with these requirements.
C. CONTRACTOR shall not use minors as interpreters.
D. CONTRACTOR shall provide and pay for interpreting and translation services to
persons participating in CONTRACTOR’s services who have limited or no English language proficiency,
including services to persons who are deaf or blind. Interpreter and translation services shall be provided
as necessary to allow such participants meaningful access to the programs, services and benefits provided
by CONTRACTOR. Interpreter and translation services, including translation of CONTRACTOR’s “vital
documents” (those documents that contain information that is critical for accessing CONTRACTOR’s
services or are required by law) shall be provided to participants at no cost to the participant.
CONTRACTOR shall ensure that any employees, agents, subcontractors, or partners who interpret or
translate for a program participant, or who directly communicate with a program participant in a language
other than English, demonstrate proficiency in the participant's language and can effectively communicate
any specialized terms and concepts peculiar to CONTRACTOR’s services.
E.In compliance with the State mandated Culturally and Linguistically Appropriate
standards as published by the Office of Minority Health, CONTRACTOR must submit to COUNTY for
approval, within sixty (60) days from date of contract execution, CONTRACTOR’s plan to address all
fifteen (15) national cultural competency standards as set forth in the “National Standards on Culturally and
Linguistically Appropriate Services (CLAS)”. COUNTY’s annual on-site review of CONTRACTOR shall
include collection of documentation to ensure all national standards are implemented. As the national
competency standards are updated, CONTRACTOR’s plan must be updated accordingly. Cultural
competency training for CONTRACTOR’s 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. CONTRACTOR on a monthly basis shall
provide COUNTY DBH a monthly monitoring tool/report that shows all CONTRACTOR’s staff cultural
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competency trainings completed.
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.
25.TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section
1861(v)(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four (4)
years after the furnishing of services under this Agreement, CONTRACTOR shall make available, upon
written request to the Secretary of the United States Department of Health and Human Services, or upon
request to the Comptroller General of the United States General Accounting Office, or any of their duly
authorized representatives, a copy of this Agreement and such books, documents, and records as are
necessary to certify the nature and extent of the costs of these services provided by CONTRACTOR under
this Agreement. CONTRACTOR further agrees that in the event CONTRACTOR carries out any of its
duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and No/100
Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such Agreement
shall contain a clause to the effect that until the expiration of four (4) years after the furnishing of such
services pursuant to such subcontract, the related organizations shall make available, upon written request
to the Secretary of the United States Department of Health and Human Services, or upon request to the
Comptroller General of the United States General Accounting Office, or any of their duly authorized
representatives, a copy of such subcontract and such books, documents, and records of such organization
as are necessary to verify the nature and extent of such costs.
26.SINGLE AUDIT CLAUSE
A.If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00)
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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 Management and
Budget (OMB) Circular A-133. CONTRACTOR shall submit said audit and management letter to
COUNTY. The audit must include a statement of findings or a statement that there were no findings. If
there were negative findings, CONTRACTOR must include a corrective action plan signed by an
authorized individual. CONTRACTOR agrees to take action to correct any material non-compliance or
weakness found as a result of such audit. Such audit shall be delivered to COUNTY’s DBH Business
Office, for review within nine (9) months of the end of any fiscal year in which funds were expended and/or
received for the program. Failure to perform the requisite audit functions as required by this Agreement
may result in COUNTY performing the necessary audit tasks, or at COUNTY’s option, contracting with a
public accountant to perform said audit, or, may result in the inability of COUNTY to enter into future
agreements with CONTRACTOR. All audit costs related to this Agreement are the sole responsibility of
CONTRACTOR.
B.A single audit report is not applicable if CONTRACTOR’s Federal contracts do not
exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR’s only
funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must be
performed and a program audit report with management letter shall be submitted by CONTRACTOR to
COUNTY as a minimum requirement to attest to CONTRACTOR’s solvency. Said audit report shall be
delivered to COUNTY’s DBH Business Office, for review no later than nine (9) months after the close of
the fiscal year in which the funds supplied through this Agreement are expended. Failure to comply with
this Act may result in COUNTY performing the necessary audit tasks or contracting with a qualified
accountant to perform said audit. All audit costs related to this Agreement are the sole responsibility of
CONTRACTOR who agrees to take corrective action to eliminate any material noncompliance or
weakness found as a result of such audit. Audit work performed by COUNTY under this paragraph shall
be billed to the CONTRACTOR at COUNTY cost, as determined by COUNTY’s Auditor-
Controller/Treasurer-Tax Collector.
C.CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
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Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other pending
matters, whichever is later.
27.COMPLIANCE
CONTRACTOR agrees to comply with the COUNTY’s Contractor Code of Conduct and
Ethics and the COUNTY’s Compliance Program in accordance with Exhibit E, attached hereto and
incorporated herein by reference and made part of this Agreement. Within thirty (30) days of entering into
this Agreement with the COUNTY, CONTRACTOR shall have all of CONTRACTOR’s employees, agents
and subcontractors providing services under this Agreement certify in writing, that he or she has received,
read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR shall
ensure that within thirty (30) days of hire, all new employees, agents and subcontractors providing services
under this Agreement shall certify in writing that he or she has received, read, understood, and shall abide
by the Contractor Code of Conduct and Ethics. CONTRACTOR understands that the promotion of and
adherence to the Code of Conduct is an element in evaluating the performance of CONTRACTOR and its
employees, agents and subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agents and subcontractors providing services under this Agreement shall complete general
compliance training and appropriate employees, agents and subcontractors shall complete documentation
and billing or billing/reimbursement training. All new employees, agents and subcontractors shall attend
the appropriate training within 30 days of hire. Each individual who is required to attend training shall
certify in writing that he or she has received the required training. The certification shall specify the type of
training received and the date received. The certification shall be provided to the COUNTY’s Compliance
Officer at 3133 N. Millbrook, Fresno, California 93703. CONTRACTOR agrees to reimburse COUNTY for
the entire cost of any penalty imposed upon COUNTY by the Federal Government as a result of
CONTRACTOR’s violation of the terms of this Agreement.
28.ASSURANCES
In entering into this Agreement, CONTRACTOR certifies that neither it, nor any of its
officers, are currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
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Health Care Programs; that neither it, nor any of its officers, have been convicted of a criminal offense
related to the provision of health care items or services; nor has it, or any of its officers, been reinstated to
participate in the Federal Health Care Programs after a period of exclusion, suspension, debarment, or
ineligibility. If COUNTY learns, subsequent to entering into a contract, that CONTRACTOR is ineligible on
these grounds, COUNTY will remove CONTRACTOR from responsibility for, or involvement with,
COUNTY’s business operations related to the Federal Health Care Programs and shall remove such
CONTRACTOR from any position in which CONTRACTOR’s compensation, or the items or services
rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, directly or indirectly, by
Federal Health Care Programs or otherwise with Federal Funds at least until such time as CONTRACTOR
is reinstated into participation in the Federal Health Care Programs.
A.If COUNTY has notice that either CONTRACTOR, or its officers, has been charged
with a criminal offense related to any Federal Health Care Program, or is proposed for exclusion during the
term of any contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the
accuracy of any claims submitted to any Federal Health Care Program. At its discretion given such
circumstances, COUNTY may request that CONTRACTOR cease providing services until resolution of the
charges or the proposed exclusion.
B.CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional services under
this Agreement, will be queried as to whether (1) they are now or ever have been excluded, suspended,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) they have been
convicted of a criminal offense related to the provision of health care items or services; and or (3) they
have been reinstated to participate in the Federal Health Care Programs after a period of exclusion,
suspension, debarment, or ineligibility.
1.In the event the potential employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR hires
or engages such potential employee or subcontractor, CONTRACTOR will ensure that said employee or
subcontractor does no work, either directly or indirectly relating to services provided to COUNTY.
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2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
to protect the interests of COUNTY consumers.
C. CONTRACTOR shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are expected to
perform professional services under this Agreement (1) are not currently excluded, suspended, debarred,
or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted of a
criminal offense related to the provision of health care items or services; and (3) have not been reinstated
to participate in the Federal Health Care Program after a period of exclusion, suspension, debarment, or
ineligibility. In the event any existing employee or subcontractor informs CONTRACTOR that he or she is
excluded, suspended, debarred or otherwise ineligible to participate in the Federal Health Care Programs,
or has been convicted of a criminal offense relating to the provision of health care services,
CONTRACTOR will ensure that said employee or subcontractor does no work, either direct or indirect,
relating to services provided to COUNTY.
1. CONTRACTOR agrees to notify COUNTY immediately during the term of
this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case, is
providing professional services under this Agreement is excluded, suspended, debarred or otherwise
ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating
to the provision of health care services.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section 3 of this Agreement, or require adequate assurance (as defined by
COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
to protect the interests of COUNTY consumers.
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D.CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY which may be necessary to complete any internal or external audits relating to
CONTRACTOR’s compliance with the provisions of this Section.
E.CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of
CONTRACTOR’s obligations as described in this Section.
29.PUBLICITY PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under this
Agreement shall be used for CONTRACTOR’s advertising, fundraising, or publicity (i.e., purchasing of
tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the above,
publicity of the services described in Section One (1) of this Agreement shall be allowed as necessary to
raise public awareness about the availability of such specific services when approved in advance by
COUNTY’s DBH Director or his or her designee and at a cost to be provided in Exhibit C for such items as
written/printed materials, the use of media (i.e., radio, television, newspapers) and any other related
expense(s).
30.COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a client or a
client's family. CONTRACTOR shall provide a copy of the detailed complaint log entries concerning
COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (l 0th) day of the following month,
in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide details and attach
documentation of each complaint with the log. CONTRACTOR shall post signs informing clients of their
right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all incidents reportable to
State licensing bodies that affect COUNTY clients within twenty-four (24) hours of receipt of a complaint.
Within ten (10) days after each incident or complaint affecting COUNTY clients,
CONTRACTOR shall provide COUNTY with information relevant to the complaint, investigative details of
the complaint, the complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the
complaint. In addition, CONTRACTOR shall inform every client of their rights as set forth in Exhibit I.
CONTRACTOR shall file an incident report for all incidents involving clients, following the protocol and
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using the worksheet identified in Exhibit I and incorporated herein by reference and made part of this
Agreement.
31.DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104, and
455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit J, “Disclosure of
Ownership and Control Interest Statement”, attached hereto and by this reference incorporated herein and
made part of this Agreement. CONTRACTOR shall submit this form to the COUNTY’s DBH within thirty
(30)days of the effective date of this Agreement. Additionally, CONTRACTOR shall report any changes to
this information within thirty-five (35) days of occurrence by completing Exhibit J, “Disclosure of Ownership
and Control Interest Statement.” Submissions shall be scanned pdf copies and are to be sent via email to
DBHAdministration@co.fresno.ca.us attention: Contracts Administration.
32.DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR is required to disclose if any of the following conditions apply to them, their
owners, officers, corporate managers and partners (hereinafter collectively referred to as
“CONTRACTOR”):
A.Within the three-year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1.Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction;
2.Violation of a federal or state antitrust statute;
3.Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
or
4.False statements or receipt of stolen property.
B.Within a three-year period preceding their Agreement award, they have had a
public transaction (federal, state, or local) terminated for cause or default.
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Disclosure of the above information will not automatically eliminate CONTRACTOR from
further business consideration. The information will be considered as part of the determination of whether
to continue and/or renew this Agreement and any additional information or explanation that a
CONTRACTOR elects to submit with the disclosed information will be considered. If it is later determined
that the CONTRACTOR failed to disclose required information, any contract awarded to such
CONTRACTOR may be immediately voided and terminated for material failure to comply with the terms
and conditions of the award.
CONTRACTOR must sign a “Certification Regarding Debarment, Suspension, and Other
Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit K, attached hereto
and by this reference incorporated herein and made part of this Agreement. Additionally, CONTRACTOR
must immediately advise the COUNTY’s DBH in writing if, during the term of this Agreement: (1)
CONTRACTOR becomes suspended, debarred, excluded or ineligible for participation in federal or state
funded programs or from receiving federal funds as listed in the excluded parties’ list system
(http://www.epls.gov); or (2) any of the above listed conditions become applicable to CONTRACTOR.
CONTRACTOR shall indemnify, defend and hold the COUNTY harmless for any loss or damage resulting
from a conviction, debarment, exclusion, ineligibility or other matter listed in the signed Certification
Regarding Debarment, Suspension, and Other Responsibility Matters.
33.DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a for-
profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR changes its
status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services under
this Agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR is a party
and in which one or more of its directors has a material financial interest. Members of the Board of
Directors shall disclose any self-dealing transactions that they are a party to by completing and signing a
Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit L and incorporated herein by
reference and made part of this Agreement, and submitting it to the COUNTY prior to commencing with
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the self-dealing transaction or immediately thereafter.
34.AUDITS AND INSPECTIONS
The CONTRACTOR shall at any time during business hours, and as often as the COUNTY
may deem necessary, make available to the COUNTY for examination all of its records and data with
respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request by the
COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to ensure
CONTRACTOR’s compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR shall be subject to the examination and audit of the State Auditor General for a period of
three (3) years after final payment under contract (California Government Code section 8546.7).
35.NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY CONTRACTOR
Director, Fresno County Chief Executive Officer Department of Behavioral Health Exodus Recovery 1925 E. Dakota Ave 9808 Venice Blvd, Suite 700 Fresno, CA 93726 Culver City, CA, 90232
All notices between the COUNTY and CONTRACTOR provided for or permitted under this
Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
personal service is effective upon service to the recipient. A notice delivered by first-class United States
mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid,
addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
COUNTY business day after deposit with the overnight commercial courier service, delivery fees prepaid,
with delivery instructions given for next day delivery, addressed to the recipient. A notice delivered by
telephonic facsimile is effective when transmission to the recipient is completed (but, if such transmission
is completed outside of COUNTY business hours, then such delivery shall be deemed to be effective at
the next beginning of a COUNTY business day), provided that the sender maintains a machine record of
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the completed transmission. For all claims arising out of or related to this Agreement, nothing in this
section establishes, waives, or modifies any claims presentation requirements or procedures provided by
law, including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government
Code, beginning with section 810).
36.GOVERNING LAW
Venue for any action arising out of or related to the Agreement shall only be in Fresno
County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
37.ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire agreement between
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understandings of any nature whatsoever unless expressly included in this Agreement.
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Mailing Address
COUNTY OF FRESNO
Stev Br ndau , Chairman of the Board of
Supervisors of the County of Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno , State of California
By : _ _cLl)o : . c_., tr
Deputy
33
Exhibit A
Page 1 of 5
HOUSING SUPPORTIVE SERVICES SCOPE OF WORK
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Blvd Suite 700 Culver City, CA 90232
SITE ADDRESS: 4411 E Kings Canyon Rd Fresno, CA 93702 Bldg 319
SERVICES: Housing Supportive Services
PROJECT DIRECTOR: Luana Murphy, President/CEO
PHONE NUMBER: (310) 945-3350
CONTRACT PERIOD: April 1, 2021 – June 30, 2023, with two optional one- year
renewals
CONTRACT AMOUNT: $93,192 FY 2020-21
$281,762 FY 2021-22
$281,762 FY 2022-23
$287,453 FY 2023-24
$300,387 FY 2024-25
I. LOCATION OF SERVICES:
CONTRACTOR shall provide housing supportive service at Villages at
Paragon. Additional sites may be added upon mutual written agreement of both
parties.
II. TARGET POPULATION:
Individuals targeted for housing will be homeless individuals considered to be
Chronically Homeless, Homeless, or At Risk of becoming Chronically Homeless,
living with complex and long-term social and mental health conditions. Each
individual’s history of homelessness and lived experience will require an
individualized approach to assessment of strengths, needs and goals. Many of
these individuals live with a severe mental illness or a severe emotional
disturbance and/or co-occurring substance use disorder and are at high risk of
severe health complications, including death, if they remain disconnected from
housing, health services, and the community.
Also included in the target population are adults who are transitioning from
institutions. Such institutions include places of custody for justice-involved
individuals such as jail, prison, and juvenile detention centers. Institutions also
include places of institutional behavioral health care including a state hospital,
psychiatric health facility, psychiatric or behavioral health hospital or unit, hospital
emergency room, institute for mental disease, mental health rehabilitation center,
skilled nursing facility, developmental center, residential treatment program,
residential care facility, community crisis center, board and care facility, or foster
care setting.
Exhibit A
Page 2 of 5
III. CONTRACTOR’S RESPONSIBILITIES:
CONTRACTOR must make participation in supportive services by tenants voluntary.
Access to or continued occupancy in housing cannot be conditioned on participation in
services or on sobriety
CONTRACTOR shall make available supportive services necessary to support
tenants in remaining housed based on tenant need. Key supportive services will
utilize the Critical Time Intervention (CTI) Model to make available support to
tenants living with serious mental illness. Available supportive services will
include, but may not be limited to the following:
1. Case management and coordination/provision of supportive services;
2. On-going assessment of needs and response to services;
3. Education to tenants regarding their individual behavioral health condition(s);
4. Behavioral health management efforts directed to assist tenants to manage their
wellness, create plans of action, and to identify personal patterns in order to
maximize results of their recovery services and supports;
5. Coordination of services, including linkages to primary health care, mental health
care, substance abuse services, and peer support;
6. Coordination and securing appropriate permanent housing;
7. Engagement of family and other supportive individuals;
8. Team support building to include tenant council, recreational activities, social
activities, and positive relationship building;
9. Psychological supports to help tenants accomplish personal goals and to
develop strategies to deal with challenges;
10. Benefits counseling and advocacy to assist tenants in accessing and securing
any benefits of which they made be eligible, including Medi-Cal enrollment and
Social Security benefits (SSI/SSP);
11. Life-skills development services and support to include: personal care and
hygiene, housekeeping, nutritional meal preparation, grocery shopping, money-
management, and how to access and use public transportation;
12. Clinical support services including assistance with accessing, understanding,
and utilizing all aspects of an individualized treatment plan, including but not
limited to medication services, case management, therapy, psychiatric
rehabilitation, and peer support.
Exhibit A
Page 3 of 5
IV. CULTURAL AND LINGUISTIC COMPETENCE REQUIREMENTS:
CONTRACTOR shall:
1. Ensure compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section
2000d, and 45 C.F.R. Part 80) and Executive Order 12250 of 1979 which
prohibits recipients of Federal financial assistance from discriminating against
persons based on race, color, national origin, sex, disability or religion. This is
interpreted to mean that a limited English proficient (LEP) individual is entitled to
equal access and participation in federally funded programs through the
provision of comprehensive and quality bilingual services.
2. Create and maintain policies and procedures for ensuring access and
appropriate use of trained interpreters and material translation services for all
LEP consumers, including, but not limited to, assessing the cultural and linguistic
needs of its clients, training of staff on the policies and procedures, and
monitoring its language assistance program. The CONTRACTOR's procedures
must include ensuring compliance of any sub-contracted providers with these
requirements.
3. Ensure that minors shall not be used as interpreters.
4. Conduct and submit to County an annual cultural and linguistic needs
assessment to promote the provision and utilization of appropriate services for
its diverse client population. The needs assessment report shall include findings
and a plan outlining the proposed services to be improved or implemented as a
result of the assessment findings, with special attention to addressing cultural
and linguistic barriers and reducing racial, ethnic, language, abilities, gender,
and age disparities.
5. Develop internal systems to meet the cultural and linguistic needs of the
CONTRACTOR's client census including the incorporation of cultural
competency in the CONTRACTOR's mission; establishing and maintaining a
process to evaluate and determine the need for special - administrative, clinical,
welcoming, billing, etc. - initiatives related to cultural competency.
6. Develop recruitment and retention initiatives to establish contracted program
staffing that is reflective and responsive to the needs of the program and target
population.
7. Establish designated staff person to coordinate and facilitate the integration of
cultural competency guidelines and attend the Fresno County Department of
Behavioral Health Cultural Competency Committee monthly meetings. The
designated person will provide an array of communication tools to distribute
information to staff relating to cultural competency issues.
8. Keep abreast of evidence-based and best practices in cultural competency in
mental health care and treatment to ensure that the CONTRACTOR maintains
Exhibit A
Page 4 of 5
current information and an external perspective in its policies. The
CONTRACTOR shall evaluate the effectiveness of strategies and programs in
improving the health status of cultural-defined populations.
9. Ensure that an assessment of a client’s sexual orientation is included in the bio-
psychosocial intake process. CONTRACTOR's staff shall assume that the
population served may not be in heterosexual relationships. Gender sensitivity
and sexual orientation must be covered in annual training.
10. Utilize existing community supports, referrals to transgender support groups,
etc., when appropriate.
11. Report its efforts to evaluate cultural and linguistic activities as part of the
CONTRACTOR's ongoing quality improvement efforts in the monthly activities
report. Reported information may include clients’ complaints and grievances,
results from client satisfaction surveys, and utilization and other clinical data that
may reveal health disparities as a result of cultural and linguistic barriers.
V. TRAINING REQUIREMENTS:
CONTRACTOR shall:
1. Attend annual Cultural Competence training.
2. Attend annual Compliance, Billing and Documentation training.
3. Attend other required trainings provided by the County.
VI. COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Identify and determine homeless individuals having the highest health risk and
the most need of housing specifically, those individuals defined as Chronically
Homeless, Homeless or At-Risk of Chronic Homelessness utilizing the Fresno
Madera Continuum of Care (FMCoC) the Coordinated Entry System (CES).
2. Assist the CONTRACTOR in making linkages with the total mental health
system. This will be accomplished through regularly scheduled meetings as well
as formal and informal consultation.
3. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the vendor staff and will be available to the contractor for
ongoing consultation.
4. Receive and analyze statistical data outcome information from CONTRACTOR
throughout the term of contract on a monthly basis. DBH will notify the vendor
when additional participation is required. The performance outcome
measurement process will not be limited to survey instruments but will also
include, as appropriate, client and staff interviews, chart reviews, and other
Exhibit A
Page 5 of 5
methods of obtaining required information.
5. Recognize that cultural competence is a goal toward which professionals,
agencies, and systems should strive. Becoming culturally competent is a
developmental process and incorporates at all levels the importance of culture,
the assessment of cross-cultural relations, vigilance towards the dynamics that
result from cultural differences, the expansion of cultural knowledge, and the
adaptation of services to meet culturally-unique needs. Offering those services
in a manner that fails to achieve its intended result due to cultural and linguistic
barriers is not cost effective. To assist the CONTRACTOR'S efforts towards
cultural and linguistic competency, DBH shall provide the following at no cost to
vendor(s):
a. Technical assistance to CONTRACTOR regarding cultural competency
requirements and sexual orientation training.
b. Technical assistance for CONTRACTOR in translating behavioral health and
substance abuse services information into DBH's threshold languages
(Spanish and Hmong). Translation services and costs associated will be the
responsibility of the vendor.
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
1
rev 01-02-2020
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
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 B
Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2
rev 01-02-2020
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 values and preferences of those we serve
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
Exhibit B
Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
3
rev 01-02-2020
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 person’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 B
Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
4
rev 01-02-2020
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 B
Page 4 of 4
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Program Director 0.13 5,417$ 5,417$
1102 LMHP Team Lead 0.38 2,810 5,621 8,431
1103 Program Nurse 0.25 - 4,507 4,507
1104 Nurse Practitioner (see line 5003)0.06 - - -
1105 Supervising Psychiatrist (see line 5003)0.00 - - -
1106 Care Manager 0.51 - 8,486 8,486
1107 Peer Advocate 0.25 - 2,600 2,600
1108 CTI Specialist 0.51 - 8,486 8,486
1109 Care Manager/SUD 0.25 - 4,160 4,160
1110 Data Specialist 0.13 1,622 - 1,622
1111 Program Support Assistant 0.13 1,532 - 1,532
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 2.60 11,382$ 33,860$ 45,242$
Employee Benefits
Acct #Admin Direct Total
1201 455$ 1,354$ 1,810$
1202 683 2,032 2,715
1203 911 2,709 3,619
1204 - - -
1205 - - -
1206 - - -
2,049$ 6,095$ 8,144$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1301 171$ 508$ 679$
1302 825 2,455 3,280
1303 171 508 679
1304 - - -
1305 - - -
1306 - - -
1,167$ 3,471$ 4,637$
14,597$ 43,426$ 58,023$
Retirement
Worker's Compensation
Health Insurance
Other (specify)
Other (specify)
OASDI
FICA/MEDICARE
SUI
Other (specify)
Other (specify)
Employee Benefits Subtotal:
Description
PROGRAM NAME
Exodus Recovery, Inc -Villages at Paragon Housing Supportive Services
Fiscal Year (FY 2020-21)
Description
Payroll Taxes & Expenses Subtotal:
Other (specify)
Other (specify)
EMPLOYEE SALARIES & BENEFITS TOTAL:
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 1 of 30
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 13,500
2008 -
2009 -
2010 -
2011 333
2012 -
2013 -
2014 -
2015 -
2016 -
13,833$
3000: OPERATING EXPENSES
Acct #Amount
3001 260$
3002 -
3003 262
3004 -
3005 -
3006 1,876
3007 -
3008 -
3009 -
3010 -
3011 -
3012 -
2,398$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 -
4003 -
4004 -
4005 -
4006 -
4007 -
4008 -
4009 -
4010 -
-$
5000: SPECIAL EXPENSES
Other (specify)
Other (specify)
Staff Mileage
Subscriptions & Memberships
Other (specify)
Other (specify)
Rent/Lease Equipment
Rent/Lease Building
Staff Development & Training
Vehicle Maintenance
Other (specify)
Office, Household & Program Supplies
Telecommunications
Printing/Postage
Rent/Lease Vehicles
Security
Other (specify)
Utilities
Client Transportation & Support
Client Housing Support
Child Care
Other (specify)
Other (specify)
Clothing, Food, & Hygiene
Education Support
Household Items for Clients
Employment Support
Utility Vouchers
Program Supplies - Medical
Medication Supports
OPERATING EXPENSES TOTAL:
Other (specify)
Other (specify)
Other (specify)
Building Maintenance
Line Item Description
Line Item Description
Line Item Description
DIRECT CLIENT CARE TOTAL
Other (specify)
Other (specify): Recreational Supplies
Advertising
FACILITIES/EQUIPMENT TOTAL:
Other (specify)
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 2 of 30
Acct #Amount
5001 1,733$
5002 -
5003 4,784
5004 -
5005 -
5006 -
5007 -
5008 -
6,517$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 12,155$
6002 -
6003 -
6004 -
6005 266
6006 -
6007 -
6008 -
6009 -
6010 -
6011 -
6012 -
12,421$
7000: FIXED ASSETS
Acct #Amount
7001 -$
7002 -
7003 -
7004 -
7005 -
7006 -
7007 -
7008 -
-$
Leasehold/Tenant/Building Improvements
Payroll Services
Line Item Description
External Audit
Other (specify)
Other (specify)
Other (specify)
Insurance (Specify): Professional Liability
Other (specify)
Other (specify)
Other (specify)
Other (specify)
Furniture & Fixtures
Line Item Description
HMIS (Health Management Information System)
Administrative Overhead
Other (specify)
Other (specify)
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
Consultant (Network & Data Management)
SPECIAL EXPENSES TOTAL:
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Other (specify)
Contractual/Consulting Services (Specify)
Translation Services
93,192$ TOTAL PROGRAM EXPENSES
Other Assets over $500 with Lifespan of 2 Years +
Other (specify)
Assets over $5,000/unit (Specify)
FIXED ASSETS EXPENSES TOTAL
Line Item Description
Professional Liability Insurance
Accounting/Bookkeeping
ADMINISTRATIVE EXPENSES TOTAL
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 3 of 30
Acct #Service Units Rate Amount
8001 Mental Health Services 716 3.92 2,807$
8002 Case Management 3,779 3.04 11,488
8003 Crisis Services 391 5.96 2,330
8004 Medication Support 2,357 7.40 17,442
8005 Collateral 386 3.92 1,513
8006 Plan Development 143 3.92 561
8007 Assessment 56 3.92 220
8008 Rehabilitation 6,495 3.92 25,460
14,323 61,821$
59%
36,165
53%19,204
19,204$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 49,417$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
49,417$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403
8404 24,571
8405 -
24,571$
MEDI-CAL FFP TOTAL
MHSA TOTAL
Line Item Description
Line Item Description
8100 - SUBSTANCE USE DISORDER FUNDS
OTHER REVENUE TOTAL
MHSA Program Name
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
Line Item Description
REALIGNMENT TOTAL
8200 - REALIGNMENT
NET PROGRAM COST:
PROGRAM FUNDING SOURCES
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Federal Financial Participation (FFP) %
Grants (Specify)
Fresno Housing Authority Supportive Service Commitment
Other (Specify)
Line Item Description
8400 - OTHER REVENUE
TOTAL PROGRAM FUNDING SOURCES:93,192$
0$
SUBSTANCE USE DISORDER FUNDS TOTAL
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 4 of 30
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 58,023
Employee Salaries 45,242
1101 Program Director 5,417 Directing all of the program clinical aspects
1102 LMHP Team Lead 8,431 Support, guide, supervise as team lead and provide assessments & treatment
1103 Program Nurse 4,507 Screening, assessments, health education, crisis intervention, medication svcs
1104 Nurse Practitioner (see line 5003)- Assessments, crisis intervention, medication services
1105 Supervising Psychiatrist (see line 5003)- Supervises NP and provides case consulation as needed
1106 Care Manager 8,486 Performs strength/needs assessment, ongoing care coordination
1107 Peer Advocate 2,600 Initial client engagement and improved tenant engagement
1108 CTI Specialist 8,486 Assisting clients transitioning from homelessness to permanent tenancy
1109 Care Manager/SUD 4,160 Provide SU counseling and services
1110 Data Specialist 1,622 Data entry, billing, productivity reports
1111 Program Support Assistant 1,532 Data collection, maintains administrative and medical records
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 8,144
1201 Retirement 1,810 Match up to 4%
1202 Worker's Compensation 2,715 Current rate
1203 Health Insurance 3,619 Medical, dental, vision benefits
1204 Other (specify)-
1205 Other (specify)-
1206 Other (specify)-
Payroll Taxes & Expenses:4,637
1301 OASDI 679 Current rate
1302 FICA/MEDICARE 3,280 Current rate
1303 SUI 679 Current rate
1304 Other (specify)-
1305 Other (specify)-
1306 Other (specify)-
2000: CLIENT SUPPORT 13,833
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients 13,500 Client emergency fund, tenant supports
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (specify): Recreational Supplies 333 Recreational activity supplies
2012 Other (specify)-
2013 Other (specify)-
2014 Other (specify)-
2015 Other (specify)-
2016 Other (specify)-
3000: OPERATING EXPENSES 2,398
3001 Telecommunications 260 Phone and data services
3002 Printing/Postage -
3003 Office, Household & Program Supplies 262 Standard Office Supplies: paper, pens, paper clips, etc.
Exodus Recovery, Inc -Villages at Paragon Housing Supportive Services
PROGRAM NAME
Fiscal Year (FY 2020-21)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 5 of 30
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage 1,876 Based up current IRS rate ($.58) est. 20 miles per day per FTE
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Other (specify)-
3010 Other (specify)-
3011 Other (specify)-
3012 Other (specify)-
4000: FACILITIES & EQUIPMENT -
4001 Building Maintenance -
4002 Rent/Lease Building -
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities -
4007 Other (specify)-
4008 Other (specify)-
4009 Other (specify)-
4010 Other (specify)-
5000: SPECIAL EXPENSES 6,517
5001 Consultant (Network & Data Management)1,733 Copier, printers, computers and network equipment
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)4,784 Nurse Practitioner and Supervising Psychiatrist
5004 Translation Services -
5005 Other (specify)-
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
6000: ADMINISTRATIVE EXPENSES 12,421
6001 Administrative Overhead 12,155 15% Indirect
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify): Professional Liability 266 Pursuant to contractual requirements
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (specify)-
6009 Other (specify)-
6010 Other (specify)-
6011 Other (specify)-
6012 Other (specify)-
7000: FIXED ASSETS -
7001 Computer Equipment & Software -
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:93,192
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:93,192
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 6 of 30
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Program Director 0.13 16,739$ -$ 16,739$
1102 LMHP Team Lead 0.38 8,684 17,368 26,052
1103 Program Nurse 0.25 - 13,926 13,926
1104 Nurse Practitioner (see line 5003)0.06 - - -
1105 Supervising Psychiatrist (see line 5003)0.00 - - -
1106 Care Manager 0.51 - 26,223 26,223
1107 Peer Advocate 0.25 - 8,034 8,034
1108 CTI Specialist 0.51 - 26,223 26,223
1109 Care Manager/SUD 0.25 - 12,854 12,854
1110 Data Specialist 0.13 5,013 - 5,013
1111 Program Support Assistant 0.13 4,735 - 4,735
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 2.60 35,170$ 104,628$ 139,798$
Employee Benefits
Acct #Admin Direct Total
1201 1,407$ 4,185$ 5,592$
1202 2,110 6,278 8,388
1203 2,814 8,370 11,184
1204 - - -
1205 - - -
1206 - - -
6,331$ 18,833$ 25,164$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1301 528$ 1,569$ 2,097$
1302 2,550 7,586 10,135
1303 528 1,569 2,097
1304 - - -
1305 - -
1306 - -
3,605$ 10,724$ 14,329$
45,106$ 134,185$ 179,291$
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
PROGRAM NAME
Exodus Recovery, Inc -Villages at Paragon Housing Supportive Services
Fiscal Year (FY 2021-22)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 7 of 30
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 40,500
2008 -
2009 -
2010 -
2011 1,000
2012 -
2013 -
2014 -
2015 -
2016 -
41,500$
3000: OPERATING EXPENSES
Acct #Amount
3001 780$
3002 -
3003 787
3004 -
3005 -
3006 1,876
3007 -
3008 -
3009 -
3010 -
3011 -
3012 -
3,443$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 -
4003 -
4004 -
4005 -
4006 -
4007 -
4008 -
4009 -
4010 -
-$
5000: SPECIAL EXPENSES
FACILITIES/EQUIPMENT TOTAL:
Security
Utilities
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (specify): Recreational Supplies
Other (Specify)
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
Child Care
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 8 of 30
Acct #Amount
5001 5,200$
5002 -
5003 14,783
5004 -
5005 -
5006 -
5007 -
5008 -
19,983$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 36,752$
6002 -
6003 -
6004 -
6005 793
6006 -
6007 -
6008 -
6009 -
6010 -
6011 -
6012 -
37,545$
7000: FIXED ASSETS
Acct #Amount
7001 -$
7002 -
7003 -
7004 -
7005 -
7006 -
7007 -
7008 -
-$ FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 281,762$
Assets over $5,000/unit (Specify)
Other (Specify)
Other (Specify)
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
Payroll Services
SPECIAL EXPENSES TOTAL:
Line Item Description
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Insurance (Specify): Professional Liability
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 9 of 30
Acct #Service Units Rate Amount
8001 Mental Health Services 2,149 3.92 8,424$
8002 Case Management 11,337 3.04 34,464
8003 Crisis Services 1,173 5.96 6,991
8004 Medication Support 7,070 7.40 52,318
8005 Collateral 1,159 3.92 4,543
8006 Plan Development 429 3.92 1,682
8007 Assessment 169 3.92 662
8008 Rehabilitation 19,485 3.92 76,381
42,971 185,466$
59%
108,498
53%57,612
57,612$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment (0)$
(0)$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 125,866$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
125,866$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403
8404 98,284
8405 -
98,284$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:281,762$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Grants (Specify)
Fresno Housing Authority Supportive Services Commitment
Other (Specify)
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 10 of 30
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 179,291
Employee Salaries 139,798
1101 Program Director 16,739 Directing all of the program clinical aspects
1102 LMHP Team Lead 26,052 Support, guide, supervise as team lead and provide assessments & treatment
1103 Program Nurse 13,926 Screening, assessments, health education, crisis intervention, medication svcs
1104 Nurse Practitioner (see line 5003)- Assessments, crisis intervention, medication services
1105 Supervising Psychiatrist (see line 5003)- Supervises NP and provides case consulation as needed
1106 Care Manager 26,223 Performs strength/needs assessment, ongoing care coordination
1107 Peer Advocate 8,034 Initial client engagement and improved tenant engagement
1108 CTI Specialist 26,223 Assisting clients transitioning from homelessness to permanent tenancy
1109 Care Manager/SUD 12,854 Provide SU counseling and services
1110 Data Specialist 5,013 Data entry, billing, productivity reports
1111 Program Support Assistant 4,735 Data collection, maintains administrative and medical records
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 25,164
1201 Retirement 5,592 Match up to 4%
1202 Worker's Compensation 8,388 Current rate
1203 Health Insurance 11,184 Medical, dental, vision benefits
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
Payroll Taxes & Expenses:14,329
1301 OASDI 2,097 Current rate
1302 FICA/MEDICARE 10,135 Current rate
1303 SUI 2,097 Current rate
1304 Other (Specify)-
1305 Other (Specify)-
1306 Other (Specify)-
2000: CLIENT SUPPORT 41,500
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients 40,500 Client emergency fund, tenant supports
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (specify): Recreational Supplies 1,000 Recreational activity supplies
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 3,443
3001 Telecommunications 780 Phone and data services
3002 Printing/Postage -
3003 Office, Household & Program Supplies 787 Standard Office Supplies: paper, pens, paper clips, etc.
PROGRAM NAME
Exodus Recovery, Inc -Villages at Paragon Housing Supportive Services
Fiscal Year (FY 2021-22)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 11 of 30
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage 1,876 Based up current IRS rate ($.58) est. 20 miles per day per FTE
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Other (Specify)-
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT -
4001 Building Maintenance -
4002 Rent/Lease Building -
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities -
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 19,983
5001 Consultant (Network & Data Management)5,200 Copier, printers, computers and network equipment
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)14,783 Nurse Practitioner and Supervising Psychiatrist
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 37,545
6001 Administrative Overhead 36,752 15% Indirect
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify): Professional Liability 793 Pursuant to contractual requirements
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS -
7001 Computer Equipment & Software -
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:281,762
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:281,762
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 12 of 30
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Program Director 0.13 17,241$ -$ 17,241$
1102 LMHP Team Lead 0.38 8,944 17,889 26,833
1103 Program Nurse 0.25 - 14,343 14,343
1104 Nurse Practitioner (see line 5003)0.06 - - -
1105 Supervising Psychiatrist (see line 5003)0.00 - - -
1106 Care Manager 0.51 - 27,010 27,010
1107 Peer Advocate 0.25 - 8,275 8,275
1108 CTI Specialist 0.51 - 27,010 27,010
1109 Care Manager/SUD 0.25 - 13,240 13,240
1110 Data Specialist 0.13 5,164 - 5,164
1111 Program Support Assistant 0.13 4,877 - 4,877
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - -
Personnel Salaries Subtotal 2.60 36,225$ 107,767$ 143,992$
Employee Benefits
Acct #Admin Direct Total
1201 1,449$ 4,311$ 5,760$
1202 2,174 6,466 8,640
1203 2,898 8,621 11,519
1204 - - -
1205 - - -
1206 - - -
6,521$ 19,398$ 25,919$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1301 543$ 1,616$ 2,160$
1302 2,626 7,813 10,439
1303 543 1,616 2,160
1304 - - -
1305 - -
1306 - -
3,713$ 11,046$ 14,759$
46,459$ 138,211$ 184,670$
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
PROGRAM NAME
Exodus Recovery, Inc -Villages at Paragon Housing Supportive Services
Fiscal Year (FY 2022-23)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 13 of 30
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 40,500
2008 -
2009 -
2010 -
2011 1,000
2012 -
2013 -
2014 -
2015 -
2016 -
41,500$
3000: OPERATING EXPENSES
Acct #Amount
3001 780$
3002 -
3003 787
3004 -
3005 -
3006 1,876
3007 -
3008 -
3009 -
3010 -
3011 -
3012 -
3,443$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 -
4003 -
4004 -
4005 -
4006 -
4007 -
4008 -
4009 -
4010 -
-$
5000: SPECIAL EXPENSES
FACILITIES/EQUIPMENT TOTAL:
Security
Utilities
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (specify): Recreational Supplies
Other (Specify)
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
Child Care
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 14 of 30
Acct #Amount
5001 5,200$
5002 -
5003 14,783
5004 -
5005 -
5006 -
5007 -
5008 -
19,983$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 31,386$
6002 -
6003 -
6004 -
6005 780
6006 -
6007 -
6008 -
6009 -
6010 -
6011 -
6012 -
32,166$
7000: FIXED ASSETS
Acct #Amount
7001 -$
7002 -
7003 -
7004 -
7005 -
7006 -
7007 -
7008 -
-$ FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 281,762$
Other (Specify)
Other (Specify)
Assets over $5,000/unit (Specify)
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
Payroll Services
SPECIAL EXPENSES TOTAL:
Line Item Description
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Insurance (Specify): Professional Liability
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 15 of 30
Acct #Service Units Rate Amount
8001 Mental Health Services 2,149 3.92 8,424$
8002 Case Management 11,337 3.04 34,464
8003 Crisis Services 1,173 5.96 6,991
8004 Medication Support 7,070 7.40 52,318
8005 Collateral 1,159 3.92 4,543
8006 Plan Development 429 3.92 1,682
8007 Assessment 169 3.92 662
8008 Rehabilitation 19,485 3.92 76,381
42,971 185,466$
59%
108,498
53%57,612
57,612$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment 0$
0$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 125,865$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
125,865$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 -
8404 98,284
8405 -
98,284$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:281,762$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Grants (Specify)
Fresno Housing Authority Supportive Services Commitment
Other (Specify)
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 16 of 30
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 184,670
Employee Salaries 143,992
1101 Program Director 17,241 Directing all of the program clinical aspects
1102 LMHP Team Lead 26,833 Support, guide, supervise as team lead and provide assessments & treatment
1103 Program Nurse 14,343 Screening, assessments, health education, crisis intervention, medication svcs
1104 Nurse Practitioner (see line 5003)- Assessments, crisis intervention, medication services
1105 Supervising Psychiatrist (see line 5003)- Supervises NP and provides case consulation as needed
1106 Care Manager 27,010 Performs strength/needs assessment, ongoing care coordination
1107 Peer Advocate 8,275 Initial client engagement and improved tenant engagement
1108 CTI Specialist 27,010 Assisting clients transitioning from homelessness to permanent tenancy
1109 Care Manager/SUD 13,240 Provide SU counseling and services
1110 Data Specialist 5,164 Data entry, billing, productivity reports
1111 Program Support Assistant 4,877 Data collection, maintains administrative and medical records
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 25,919
1201 Retirement 5,760 Match up to 4%
1202 Worker's Compensation 8,640 Current rate
1203 Health Insurance 11,519 Medical, dental, vision benefits
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
Payroll Taxes & Expenses:14,759
1301 OASDI 2,160 Current rate
1302 FICA/MEDICARE 10,439 Current rate
1303 SUI 2,160 Current rate
1304 Other (Specify)-
1305 Other (Specify)-
1306 Other (Specify)-
2000: CLIENT SUPPORT 41,500
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients 40,500 Client emergency fund, tenant supports
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (specify): Recreational Supplies 1,000 Recreational activity supplies
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 3,443
3001 Telecommunications 780 Phone and data services
3002 Printing/Postage -
3003 Office, Household & Program Supplies 787 Standard Office Supplies: paper, pens, paper clips, etc.
PROGRAM NAME
Exodus Recovery, Inc -Villages at Paragon Housing Supportive Services
Fiscal Year (FY 2022-23)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 17 of 30
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage 1,876 Based up current IRS rate ($.58) est. 20 miles per day per FTE
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Other (Specify)-
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT -
4001 Building Maintenance -
4002 Rent/Lease Building -
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities -
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 19,983
5001 Consultant (Network & Data Management)5,200 Copier, printers, computers and network equipment
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)14,783 Nurse Practitioner and Supervising Psychiatrist
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 32,166
6001 Administrative Overhead 31,386 15% Indirect
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify): Professional Liability 780 Pursuant to contractual requirements
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS -
7001 Computer Equipment & Software -
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:281,762
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:281,762
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 18 of 30
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Program Director 0.13 17,758$ -$ 17,758$
1102 LMHP Team Lead 0.38 9,213 18,425 27,638
1103 Program Nurse 0.25 - 14,774 14,774
1104 Nurse Practitioner (see line 5003)0.06 - - -
1105 Supervising Psychiatrist (see line 5003)0.00 - - -
1106 Care Manager 0.51 - 27,820 27,820
1107 Peer Advocate 0.25 - 8,523 8,523
1108 CTI Specialist 0.51 - 27,820 27,820
1109 Care Manager/SUD 0.25 - 13,637 13,637
1110 Data Specialist 0.13 5,319 - 5,319
1111 Program Support Assistant 0.13 5,023 - 5,023
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - -
Personnel Salaries Subtotal 2.60 37,312$ 111,000$ 148,312$
Employee Benefits
Acct #Admin Direct Total
1201 1,492$ 4,440$ 5,932$
1202 2,239 6,660 8,899
1203 2,985 8,880 11,865
1204 - - -
1205 - - -
1206 - - -
6,716$ 19,980$ 26,696$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1301 560$ 1,665$ 2,225$
1302 2,705 8,047 10,753
1303 560 1,665 2,225
1304 - - -
1305 - - -
1306 - - -
3,825$ 11,377$ 15,202$
47,853$ 142,357$ 190,210$
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
PROGRAM NAME
Exodus Recovery, Inc -Villages at Paragon Housing Supportive Services
Fiscal Year (FY 2023-24)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 19 of 30
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 40,500
2008 -
2009 -
2010 -
2011 1,000
2012 -
2013 -
2014 -
2015 -
2016 -
41,500$
3000: OPERATING EXPENSES
Acct #Amount
3001 780$
3002 -
3003 787
3004 -
3005 -
3006 1,876
3007 -
3008 -
3009 -
3010 -
3011 -
3012 -
3,443$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 -
4003 -
4004 -
4005 -
4006 -
4007 -
4008 -
4009 -
4010 -
-$
5000: SPECIAL EXPENSES
FACILITIES/EQUIPMENT TOTAL:
Security
Utilities
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (specify): Recreational Supplies
Other (Specify)
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
Child Care
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 20 of 30
Acct #Amount
5001 5,200$
5002 -
5003 14,352
5004 -
5005 -
5006 -
5007 -
5008 -
19,552$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 31,968$
6002 -
6003 -
6004 -
6005 780
6006 -
6007 -
6008 -
6009 -
6010 -
6011 -
6012 -
32,748$
7000: FIXED ASSETS
Acct #Amount
7001 -$
7002 -
7003 -
7004 -
7005 -
7006 -
7007 -
7008 -
-$ FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 287,453$
Assets over $5,000/unit (Specify)
Other (Specify)
Other (Specify)
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
Payroll Services
SPECIAL EXPENSES TOTAL:
Line Item Description
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Insurance (Specify): Professional Liability
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 21 of 30
Acct #Service Units Rate Amount
8001 Mental Health Services 2,149 3.92 8,424$
8002 Case Management 11,337 3.04 34,464
8003 Crisis Services 1,173 5.96 6,991
8004 Medication Support 7,070 7.40 52,318
8005 Collateral 1,159 3.92 4,543
8006 Plan Development 429 3.92 1,682
8007 Assessment 169 3.92 662
8008 Rehabilitation 19,485 3.92 76,381
42,971 185,466$
59%
108,498
53%57,612
57,612$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment 0$
0$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 131,556$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
131,556$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 -
8404 98,284
8405 -
98,284$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:287,453$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Grants (Specify)
Fresno Housing Authority Supportive Serv ices Commitment
Other (Specify)
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 22 of 30
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 190,210
Employee Salaries 148,312
1101 Program Director 17,758 Directing all of the program clinical aspects
1102 LMHP Team Lead 27,638 Support, guide, supervise as team lead and provide assessments & treatment
1103 Program Nurse 14,774 Screening, assessments, health education, crisis intervention, medication svcs
1104 Nurse Practitioner (see line 5003)- Assessments, crisis intervention, medication services
1105 Supervising Psychiatrist (see line 5003)- Supervises NP and provides case consulation as needed
1106 Care Manager 27,820 Performs strength/needs assessment, ongoing care coordination
1107 Peer Advocate 8,523 Initial client engagement and improved tenant engagement
1108 CTI Specialist 27,820 Assisting clients transitioning from homelessness to permanent tenancy
1109 Care Manager/SUD 13,637 Provide SU counseling and services
1110 Data Specialist 5,319 Data entry, billing, productivity reports
1111 Program Support Assistant 5,023 Data collection, maintains administrative and medical records
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 26,696
1201 Retirement 5,932 Match up to 4%
1202 Worker's Compensation 8,899 Current rate
1203 Health Insurance 11,865 Medical, dental, vision benefits
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
Payroll Taxes & Expenses:15,202
1301 OASDI 2,225 Current rate
1302 FICA/MEDICARE 10,753 Current rate
1303 SUI 2,225 Current rate
1304 Other (Specify)-
1305 Other (Specify)-
1306 Other (Specify)-
2000: CLIENT SUPPORT 41,500
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients 40,500 Client emergency fund, tenant supports
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (specify): Recreational Supplies 1,000 Recreational activity supplies
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 3,443
3001 Telecommunications 780 Phone and data services
3002 Printing/Postage -
3003 Office, Household & Program Supplies 787 Standard Office Supplies: paper, pens, paper clips, etc.
PROGRAM NAME
Exodus Recovery, Inc -Villages at Paragon Housing Supportive Services
Fiscal Year (FY 2023-24)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 23 of 30
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage 1,876 Based up current IRS rate ($.58) est. 20 miles per day per FTE
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Other (Specify)-
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT -
4001 Building Maintenance -
4002 Rent/Lease Building -
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities -
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 19,552
5001 Consultant (Network & Data Management)5,200 Copier, printers, computers and network equipment
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)14,352 Nurse Practitioner and Supervising Psychiatrist
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 32,748
6001 Administrative Overhead 31,968 15% Indirect
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify): Professional Liability 780 Pursuant to contractual requirements
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS -
7001 Computer Equipment & Software -
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:287,453
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:287,453
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 24 of 30
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Program Director 0.13 18,291$ -$ 18,291$
1102 LMHP Team Lead 0.38 9,489 18,978 28,467
1103 Program Nurse 0.25 - 15,217 15,217
1104 Nurse Practitioner (see line 5003)0.06 - - -
1105 Supervising Psychiatrist (see line 5003)0.00 - - -
1106 Care Manager 0.51 - 28,655 28,655
1107 Peer Advocate 0.25 - 8,779 8,779
1108 CTI Specialist 0.51 - 28,655 28,655
1109 Care Manager/SUD 0.25 - 14,046 14,046
1110 Data Specialist 0.13 5,478 - 5,478
1111 Program Support Assistant 0.13 5,174 - 5,174
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 2.60 38,432$ 114,329$ 152,761$
Employee Benefits
Acct #Admin Direct Total
1201 1,537$ 4,573$ 6,110$
1202 2,306 6,860 9,166
1203 3,075 9,146 12,221
1204 - - -
1205 - - -
1206 - - -
6,918$ 20,579$ 27,497$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1301 576$ 1,715$ 2,291$
1302 2,786 8,289 11,075
1303 576 1,715 2,291
1304 - - -
1305 - -
1306 - -
3,939$ 11,719$ 15,658$
49,289$ 146,628$ 195,916$
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
PROGRAM NAME
Exodus Recovery, Inc -Villages at Paragon Housing Supportive Services
Fiscal Year (FY 2024-25)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 25 of 30
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 40,500
2008 -
2009 -
2010 -
2011 1,000
2012 -
2013 -
2014 -
2015 -
2016 -
41,500$
3000: OPERATING EXPENSES
Acct #Amount
3001 780$
3002 -
3003 787
3004 -
3005 -
3006 1,876
3007 -
3008 -
3009 -
3010 -
3011 -
3012 -
3,443$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 -
4003 -
4004 -
4005 -
4006 -
4007 -
4008 -
4009 -
4010 -
-$
5000: SPECIAL EXPENSES
FACILITIES/EQUIPMENT TOTAL:
Security
Utilities
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (specify): Recreational Supplies
Other (Specify)
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
Child Care
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 26 of 30
Acct #Amount
5001 5,200$
5002 -
5003 14,352
5004 -
5005 -
5006 -
5007 -
5008 -
19,552$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 39,181$
6002 -
6003 -
6004 -
6005 795
6006 -
6007 -
6008 -
6009 -
6010 -
6011 -
6012 -
39,976$
7000: FIXED ASSETS
Acct #Amount
7001 -$
7002 -
7003 -
7004 -
7005 -
7006 -
7007 -
7008 -
-$ FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 300,387$
Assets over $5,000/unit (Specify)
Other (Specify)
Other (Specify)
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
Payroll Services
SPECIAL EXPENSES TOTAL:
Line Item Description
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Insurance (Specify): Professional Liability
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 27 of 30
Acct #Service Units Rate Amount
8001 Mental Health Services 2,149 3.92 8,424$
8002 Case Management 11,337 3.04 34,464
8003 Crisis Services 1,173 5.96 6,991
8004 Medication Support 7,070 7.40 52,318
8005 Collateral 1,159 3.92 4,543
8006 Plan Development 429 3.92 1,682
8007 Assessment 169 3.92 662
8008 Rehabilitation 19,485 3.92 76,381
42,971 185,466$
59%
108,498
53%57,612
57,612$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment (0)$
(0)$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 144,491$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
144,491$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 -
8404 98,284
8405 -
98,284$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:300,387$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Grants (Specify)
Fresno Housing Authority Supportive Services Commitment
Other (Specify)
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C
Page 28 of 30
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 195,916
Employee Salaries 152,761
1101 Program Director 18,291 Directing all of the program clinical aspects
1102 LMHP Team Lead 28,467 Support, guide, supervise as team lead and provide assessments & treatment
1103 Program Nurse 15,217 Screening, assessments, health education, crisis intervention, medication svcs
1104 Nurse Practitioner (see line 5003)- Assessments, crisis intervention, medication services
1105 Supervising Psychiatrist (see line 5003)- Supervises NP and provides case consulation as needed
1106 Care Manager 28,655 Performs strength/needs assessment, ongoing care coordination
1107 Peer Advocate 8,779 Initial client engagement and improved tenant engagement
1108 CTI Specialist 28,655 Assisting clients transitioning from homelessness to permanent tenancy
1109 Care Manager/SUD 14,046 Provide SU counseling and services
1110 Data Specialist 5,478 Data entry, billing, productivity reports
1111 Program Support Assistant 5,174 Data collection, maintains administrative and medical records
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 27,497
1201 Retirement 6,110 Match up to 4%
1202 Worker's Compensation 9,166 Current rate
1203 Health Insurance 12,221 Medical, dental, vision benefits
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
Payroll Taxes & Expenses:15,658
1301 OASDI 2,291 Current rate
1302 FICA/MEDICARE 11,075 Current rate
1303 SUI 2,291 Current rate
1304 Other (Specify)-
1305 Other (Specify)-
1306 Other (Specify)-
2000: CLIENT SUPPORT 41,500
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients 40,500 Client emergency fund, tenant supports
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (specify): Recreational Supplies 1,000 Recreational activity supplies
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 3,443
3001 Telecommunications 780 Phone and data services
3002 Printing/Postage -
3003 Office, Household & Program Supplies 787 Standard Office Supplies: paper, pens, paper clips, etc.
PROGRAM NAME
Exodus Recovery, Inc -Villages at Paragon Housing Supportive Services
Fiscal Year (FY 2024-25)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 29 of 30
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage 1,876 Based up current IRS rate ($.58) est. 20 miles per day per FTE
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Other (Specify)-
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT -
4001 Building Maintenance -
4002 Rent/Lease Building -
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities -
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 19,552
5001 Consultant (Network & Data Management)5,200 Copier, printers, computers and network equipment
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)14,352 Nurse Practitioner and Supervising Psychiatrist
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 39,976
6001 Administrative Overhead 39,181 15% Indirect
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify): Professional Liability 795 Pursuant to contractual requirements
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS -
7001 Computer Equipment & Software -
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:300,387
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:300,387
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 30 of 30
Exhibit D
Page 1 of 1
ELECTRONIC HEALTH RECORD SOFTWARE CHARGES
CONTRACTOR understands that COUNTY utilizes NetSmart’s Avatar for its Electronic Health Records Management.
CONTRACTOR agrees to reimburse COUNTY for all user license fees for accessing NetSmart’s Avatar, as set forth below.
Description FY 2020-21 FY 2021-22 FY 2022-23 FY 2023-24 FY 2024-25
General Users
Avatar Named User Hosting
(per active user per month; every Avatar “active” log on
ID is a named user) $37.00 $37.00 $37.00 $37.00 $37.00
Avatar Named User Maintenance*
(per active user per month) $14.85 $15.30 $15.76 $16.23 $16.72
Cloud Hosting- Perceptive Disaster Recovery
(per active user per month) $4.66 $4.66 $4.66 $4.66 $4.66
eRx Users
Full Suite Prescriber
(per active user per month; applicable to an active
Prescriber user)
$104.00 $104.00 $104.00 $104.00 $104.00
ePrescribing Controlled Substances Tokens
(per active user per month; applicable to an active
Prescriber user of Controlled Substances)
$8.00 $8.00 $8.00 $8.00 $8.00
Non-Prescribing User
(per active user per month; applicable to an active Non-
Prescriber user)
$13.00 $13.00 $13.00 $13.00 $13.00
Reaching Recovery Users
Reaching Recovery
(per adult client/person served per year; applicable to
adult treatment programs except contracted triage/CI,
CSU or PHF)
$10.00 $10.00 $10.00 $10.00 $10.00
ProviderConnect Users
Individual Subscription
(per user per month; applicable to provider-user whose
claims are reviewed and posted by Managed Care)
$41.25 $41.25 $41.25 $41.25 $41.25
Should CONTRACTOR choose not to utilize NetSmart’s Avatar for its Electronic Health Records management, CONTRACTOR will
be responsible for obtaining its own system for Electronic Health Records management.
______________________________________________________________________________________________________________________
*Annual Maintenance increases by 3% each FY on July 1st and may be subject to change pending the COUNTY’s agreement terms with NetSmart.
Exhibit E
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws, regulations,
rules and guidelines that apply to the provision and payment of mental health services. Mental
health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. CONTRACTOR(S) shall require its
employees and subcontractors to attend a compliance training that will be provided by Fresno
County. After completion of this training, CONTRACTOR(S), CONTRACTOR(S)’ employees and
subcontractors must sign the Contractor Acknowledgment and Agreement form and return this form
to the Compliance Officer or designee.
Contractor and its employees and subcontractor shall:
1.Comply with all applicable laws, regulations, rules or guidelines when providing and
billing for mental health services.
2.Conduct themselves honestly, fairly, courteously and with a high degree of integrity in
their professional dealing related to their contract with the COUNTY and avoid any
conduct that could reasonably be expected to reflect adversely upon the integrity of the
COUNTY.
3.Treat COUNTY employees, consumers, and other mental health contractors fairly and
with respect.
4.NOT engage in any activity in violation of the COUNTY’s Compliance Program, nor
engage in any other conduct which violates any applicable law, regulation, rule or
guideline
5.Take precautions to ensure that claims are prepared and submitted accurately, timely
and are consistent with all applicable laws, regulations, rules or guidelines.
6.Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or
reimbursement of any kind are submitted.
Exhibit E
Page 2 of 3
7.Bill only for eligible services actually rendered and fully documented. Use billing codes
that accurately describe the services provided.
8.Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9.Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by COUNTY employees or other mental health contractors, or
report any activity that they believe may violate the standards of the Compliance
Program, or any other applicable law, regulation, rule or guideline. Fresno County
prohibits retaliation against any person making a report. Any person engaging in any
form of retaliation will be subject to disciplinary or other appropriate action by the
COUNTY. CONTRACTOR(S) may report anonymously.
10.Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or
guideline.
11.Immediately notify the Compliance Officer if they become or may become an Ineligible
person and therefore excluded from participation in the Federal Health Care Programs.
Exhibit E
Page 3 of 3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print): _____________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Signature: _______________________________ Date: ___/____/___
For Group or Organizational Providers
Group/Org. Name (print): ______________________________________
Employee Name (print): _______________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Other:_________________________________________________
Job Title (if different from Discipline): ___________________________
Signature: _______________________________ Date: ___/____/___
Exhibit F
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 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.
Exhibit F
Page 2 of 3
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
•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.
Exhibit F
Page 3 of 3
Client signature on the plan will be used as the means by which the
CONTRACTOR 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 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.
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
Exhibit G
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.
Exhibit G
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
Exhibit G
Page 3 of 6
CONTRACTOR may be 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.
Exhibit G
Page 4 of 6
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 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
Exhibit G
Page 5 of 6
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)
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.
Exhibit G
Page 6 of 6
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.
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.
Exhibit H
Page 1 of 2
COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall be required to maintain organizational provider certification by the host
county. A copy of this renewal certificate must be furnished to COUNTY within thirty (30) days
of receipt of certificate from host county. The CONTRACTOR must meet Medi-Cal organization
provider standards as stated below. It is acknowledged that all references to Organizational
Provider and/or Provider below shall refer to the CONTRACTOR.
Medi-Cal Organizational Provider Standards
1.The organizational provider possesses the necessary license to operate, if applicable,
and any required certification.
2.The space owned, leased or operated by the provider and used for services or staff
meets local fire codes.
3.The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4.The organizational provider establishes and implements maintenance policies for any
site owned, leased, or operated by the provider and used for services or staff to ensure
the safety and well-being of beneficiaries and staff.
5.The organizational provider has a current administrative manual which includes:
personnel policies and procedures, general operating procedures, service delivery
policies, and procedures for reporting unusual occurrences relating to health and
safety issues.
6.The organizational provider maintains client records in a manner that meets applicable
state and federal standards.
7.The organization provider has staffing adequate to allow the COUNTY to claim federal
financial participation for the services the Provider delivers to beneficiaries, as
described in Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8.The organizational provider has as head of service a licensed mental health
professional or other appropriate individual as described in Title 9, CCR, Sections 622
through 630.
9.For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A.All drugs obtained by prescription are labeled in compliance with federal and state
laws. Prescription labels are altered only by persons legally authorized to do so.
B.Drugs intended for external use only or food stuffs are stored separately from drugs
for internal use.
C.All drugs are stored at proper temperatures, room temperature drugs at 59-86
degrees F and refrigerated drugs at 36-46 degrees F.
Exhibit H
Page 2 of 2
D.Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E.Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F.A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal
laws.
G.Policies and procedures are in place for dispensing, administering and storing
medications.
10. The COUNTY may accept the host county’s site certification and reserves the right to
conduct an on-site certification review at least every three years. The COUNTY may
also conduct additional certification reviews when:
•The provider makes major staffing changes.
•The provider makes organizational and/or corporate structure changes
(example: conversion from a non-profit status).
•The provider adds day treatment or medication support services when
medications shall be administered or dispensed from the provider site.
•There are significant changes in the physical plant of the provider site (some
physical plant changes could require a new fire clearance).
•There is change of ownership or location.
•There are complaints against the provider.
•There are unusual events, accidents, or injuries requiring medical treatment for
clients, staff or members of the community.
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
The Incident Report must be completed for all incidents involving individuals served through
DBH’s current incident reporting portal, Logic Manager, at
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bb1864cdee
4d3d6e
•The reporting portal is available 24 hours a day, every day.
•Any employee of the CONTRACTOR can submit an incident using the reporting
portal at any time. No login is required.
•The designated administrator of the CONTRACTOR can add information to the
follow up section of the report after submission.
•When an employee submits an incident within 24 hours from the time of the incident
or first knowledge of the incident, the CONTRACTOR’s designated administrator, the
assigned contract analyst and the Incident Reporting email inbox will be notified
immediately via email from the Logic Manager system that there is a new incident to
review.
•Meeting the 24 hour incident reporting requirements will be easier as there are no
signatures to collect.
•The user guide attached identifies the reporting process and the reviewer process,
and is subject to updates based on DBH’s selected incident reporting portal system.
Questions about incident reporting, how to use the incident reporting portal, or
designating/changing the name of the administrator who will review incidents for the
CONTRACTOR should be emailed to DBHIncidentReporting@fresnocountyca.gov and the
assigned contract analyst.
Exhibit I
Page 1 of 9
INCIDENT REVIEWER ROLE – User Guide
Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted
providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete
a written report of any incidents compromising the health and safety of persons served, employees, or
community members.
Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It’s
an easier way for any employee to report an incident at any time. A few highlights:
•No supervisor signature is immediately required.
•Additional information can be added to the report by the program supervisor/manager without
having to resubmit the incident.
•When an incident is submitted, the assigned contract analyst, program supervisor/manager,
clinical supervisor and the DBHIncidentReporting mailbox automatically receives an email
notification of a new incident and can log in any time to review the incident. Everything that
was on the original paper/electronic form matches the online form.
•Do away with submitting a paper version with a signature.
•This online submission allows for timely action for the health and safety of the persons-served,
as well as compliance with state reporting timelines when necessary.
As an Incident Reviewer, the responsibility is to:
•Log in to Logic Manager and review incident submitted within 48 hours of notification of incident.
•Review incident for clarity, missing information and add in additional information deemed
appropriate.
•Notify DBHIncidentReporting@fresnocountyca.gov if there is additional information to be report
after initial submission
•Contact DBHIncidentReporting@fresnocountyca.gov if there are any concerns, questions or
comments with Logic Manager or incident reporting.
Below is the link to report incidents
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bb1864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
Mental Health Plan (MHP) and Substance Use Disorder (SUD) services
Incident Reporting System
Exhibit I
Page 2 of 9
Exhibit I
Page 3 of 9
Similar to the paper version, multiple incident categories can be selected
Exhibit I
Page 4 of 9
As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on
Add File to upload a file.
Similar to the paper version, multiple Action Taken categories can be selected.
When done entering all the information, simply click submit.
Any fields that have a red asterisk, require information and will prevent submission of the form if left blank.
A “Thank you for your submission” statement will pop up if an incident is successfully submitted. Click “Reload the
Form” to submit another incident.
Exhibit I
Page 5 of 9
A Notification email will be received when a new incident is reported, or a new comment has been made regarding
an incident. Click on “Open this incident in Logic Manager” and the Logic Manager login screen will show.
Enter in email address and password. First time users will be prompted to set up a password.
Exhibit I
Page 6 of 9
Once logged in, the main screen will show reviewer task (incidents to review). Click on analyst/supervisor follow up
to view the incident.
This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and
facility information. No edits can be made to this section.
The next tab is Summary: No edits can be made to this section.
Exhibit I
Page 7 of 9
The next tab is Follow up: This section can be edited. Add to the areas below or make corrections to these fields. Be
sure to click SAVE when edits are made. Then Cancel to Exit out of the incident.
The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding
documents. Then Cancel to Exit out of the incident.
If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once
submitted, the incident will be removed from the task list and no further edits can be made. Notice the SUBMIT
button is on every tab. If further information needs to be included, email
DBHIncidentReporting@fresnocountyca.gov
Exhibit I
Page 8 of 9
To get back to the home view, click on the Logic Manager icon at any time. Any incidents that still need review will
show on this screen, click on the next incident and start the review process again.
Exhibit I
Page 9 of 9
Exhibit J
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I.Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II.Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses of individuals or corporations under “Remarks” on page 2. Identify each item number to be continued.
A.Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
B.Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? ...................................................................................... ❒ ❒
C.Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution’s, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
III.A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under “Remarks” on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under “Remarks.”
NAME ADDRESS EIN
B.Type of entity: ❒ Sole proprietorship ❒Partnership ❒Corporation❒Unincorporated Associations ❒Other (specify)
C.If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under “Remarks.”
D.Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers. .......................................................................................................... ❒ ❒
NAME ADDRESS PROVIDER NUMBER
Exhibit J
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V.Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
If yes, give date of change in operations.
VI.Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
B.If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) Title
Signature Date
Remarks
Exhibit K
Page 1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1.By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2.The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3.The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4.The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5.The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1)The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a)Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b)Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
Exhibit K
Page 2 of 2
(c)Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2)Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
Exhibit L
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “COUNTY”),
members of a CONTRACTOR’s board of directors (hereinafter referred to as “County
Contractor”), must disclose any self-dealing transactions that they are a party to while
providing goods, performing services, or both for the COUNTY. A self-dealing transaction is
defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1)Enter board member’s name, job title (if applicable), and date this disclosure is being
made.
(2)Enter the board member’s company/agency name and address.
(3)Describe in detail the nature of the self-dealing transaction that is being disclosed to
the COUNTY. At a minimum, include a description of the following:
a.The name of the agency/company with which the corporation has the
transaction; and
b.The nature of the material financial interest in the corporation’s transaction that
the board member has.
(4)Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5)Form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
Exhibit L
Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date: