HomeMy WebLinkAboutAmendment 16-221-2 Fully Executed.pdf- 1 -
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AMENDMENT II
THIS SECOND AMENDMENT TO AGREEMENT (hereinafter “Amendment II”) is made and
entered into this ______ day of _________, 2021, by and between COUNTY OF FRESNO, a Political
Subdivision of the State of California (hereinafter “COUNTY”), and EXODUS RECOVERY, INC, a for-
profit California corporation, whose address is 9808 Venice Blvd, Suite 700, Culver City, CA 90232
(hereinafter “CONTRACTOR”).
WITNESSETH:
WHEREAS, COUNTY and CONTRACTOR entered into COUNTY Agreement Number 16-221,
effective July 1, 2016, as amended by COUNTY Amendment No. 16-221-1, dated June 18, 2019
(hereinafter collectively referred to as “COUNTY Agreement No. 16-221”), whereby CONTRACTOR
agreed to operate an Adult Crisis Stabilization Center (Adult CSC) to provide crisis stabilization
services to adults, age eighteen (18) and older, and a Youth Crisis Stabilization Center (Youth CSC) to
provide crisis stabilization services to children and youth up to age eighteen (18), who may be
admitted on a voluntary or involuntary basis regardless of the source of payment, and who are referred
by the COUNTY’s Department of Behavioral Health (DBH), a contracted provider with DBH, law
enforcement, hospital emergency departments, and Emergency Medical Services Transports; and
WHEREAS, under COUNTY Agreement No. 16-221, CONTRACTOR also agreed to operate a
State-mandated toll-free answering service (Access Line) in accordance with state and federal
regulations; and
WHEREAS, COUNTY, through DBH, is in need of a qualified agency to operate a Family
Urgent Response System (FURS) to provide a mobile response system twenty-four (24) hours per
day, seven (7) days per week (24/7) for current and former foster youth and/or current and/or former
probation youth; and
WHEREAS, CONTRACTOR is willing to operate a mobile response system 24/7 for current
and former foster youth as part of the FURS requirements; and
WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement, regarding
changes as stated below and restate the Agreement in its entirety.
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Agreement No. 16-221-2
8th June
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NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
is hereby acknowledged, COUNTY and CONTRACTOR agree as follows:
1.That all references in existing COUNTY Agreement No. 16-221 to “Exhibit A-1” be
changed to read “Revised Exhibit A-1”, attached hereto and incorporated herein by reference.
2.That all references in existing COUNTY Agreement No. 16-221 to “Exhibit A-2” be
changed to read “Revised Exhibit A-2”, attached hereto and incorporated herein by reference.
3.That all references in existing COUNTY Agreement No. 16-221 to “Revised Exhibit A-3”
be changed to read “Revised Exhibit A-3-a”, attached hereto and incorporated herein by reference.
4. That all references in existing COUNTY Agreement No. 16-221 to “Revised Exhibit B-1”
be changed to read “Revised Exhibit B-1-a”, attached hereto and incorporated herein by reference.
5.That all references in existing COUNTY Agreement No. 16-221 to “Revised Exhibit B-2”
be changed to read “Revised Exhibit B-2-a”, attached hereto and incorporated herein by reference.
6.That all references in Existing COUNTY Agreement No. 16-221 to “Exhibit B-3” be
changed to read “Revised Exhibit B-3”, attached hereto and incorporated herein by reference.
7. That the existing COUNTY Agreement No. 16-221, Page Two (2), beginning with Line
Four (4) with the letter “A.” and ending on Line Seven (7) with the word, “Agreement” be deleted and
the following inserted in its place:
"A. CONTRACTOR shall perform all services and fulfill all responsibilities as set
forth in Revised Exhibit A-1, “Adult Crisis Stabilization Center Scope of Work,” Revised Exhibit A-2,
“Youth Crisis Stabilization Center Scope of Work,” Revised Exhibit A-3-a, “Access Line Scope of
Work”, and Exhibit A-4, “Family Urgent Response System (FURS) Scope of Work,” all attached hereto
and by this reference incorporated herein and made part of this Agreement."
8.That the existing COUNTY Agreement No. 16-221, Page Two (2), beginning with Line
Eighteen (18) with the letter “C.” and ending on Line Twenty-Four (24), with the word “arise” be deleted
and the following inserted in its place:
“C. It is acknowledged by all parties hereto that COUNTY’s DBH Contracted
Services Division shall monitor the Adult CSC, Youth CSC, Access Line, and Family Urgent Response
System operated by CONTRACTOR, in accordance with Section Fourteen (14) of this Agreement.
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D.CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
consisting of staff from COUNTY’s DBH to discuss CSC requirements, Access Line requirements,
FURS requirements, data reporting, training, policies and procedures, overall program operations and
any problems or foreseeable problems that may arise.”
9. That the existing COUNTY Agreement No. 16-221, Section Two (2) “TERM”, shall be
revised by adding the following at Page Four (4), Line Four (4) after the word “performance”:
“The term of this Agreement shall be extended for a period of one (1) year beginning
July 1, 2021 through June 30, 2022.”
10. That the existing COUNTY Agreement No. 16-221, as set forth in Amendment I to
COUNTY Agreement No. 16-221, Page Four (4), Line Twenty-Five (25) with the word “In” and ending
on Line Twenty-Eight (28), with the word “Agreement” be deleted and the following inserted in its
place:
“The maximum amount for the period July 1, 2021 through June 30, 2022, shall not
exceed Eight Million Two Hundred Seventeen Thousand Seven Hundred Fifty-Nine and No/100
Dollars ($8,217,759.00).
For the period July 1, 2021 through June 30, 2022, it is understood by CONTRACTOR
and COUNTY that CONTRACTOR estimates to generate Three Million Four Hundred Ninety Two
Thousand, Five Hundred, Forty Eight and No/100 Dollars ($3,492,548.00) in Medi-Cal Federal
Financial Participation (FFP) with Four Million Seven Hundred Twenty Five Thousand Two Hundred
Eleven and No/100 Dollars ($4,725,211.00) in other revenue sources to offset CONTRACTOR’s
program costs, as set forth in Revised Exhibit B-1-a.
In no event shall the total maximum compensation for actual adult crisis stabilization
services performed at the Adult CSC under the terms and conditions of this Agreement be in excess of
Forty Five Million Two Hundred Forty Nine Thousand Nine Hundred Twenty Eight and No/100 Dollars
($45,249,928.00) during the total six (6) year term of this Agreement.”
11. That the existing COUNTY Agreement No. 16-221, as set forth in Amendment I of
Agreement No. 16-221, Page Six (6), Line Three (3), with the word “In” and ending on Line Six (6),
with the word “Agreement”, be deleted and the following inserted in its place:
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“The maximum amount for the period July 1, 2021 through June 30, 2022, shall not
exceed Three Million Three Hundred Fifty Nine Thousand Two Hundred Seventy Five and No/100
Dollars ($3,359,275.00).
For the period July 1, 2021 through June 30, 2022, it is understood by CONTRACTOR
and COUNTY that CONTRACTOR estimates to generate One Million Four Hundred Forty Four
Thousand, Four Hundred, Eighty Eight and No/100 Dollars ($1,444,488.00) in Medi-Cal FFP; with One
Million Nine Hundred Fourteen Thousand Seven Hundred Eighty Seven and No/100 Dollars
($1,914,787.00) in other revenue sources to offset CONTRACTOR’s program costs, as set forth in
Revised Exhibit B-2-a.
In no event shall the total maximum compensation for actual youth crisis stabilization
services performed at the Youth CSC under the terms and conditions of this Agreement be in excess
of Eighteen Million Four Hundred Thirty Five Thousand Three Hundred Ninety Four and No/100
Dollars ($18,435,394.00) during the total six (6) year term of this Agreement.”
12. That the existing COUNTY Agreement No. 16-221, as set forth in Amendment I of
Agreement No. 16-221, Page Six (6), Line Ten (10), with the word “In” and ending on Line Thirteen
(13)with “Agreement”, be deleted and the following inserted in its place:
“The maximum amount for the period July 1, 2021 through June 30, 2022, shall not
exceed Three Hundred Twenty Nine Thousand Seven Hundred Thirteen and No/100 Dollars
($329,713.00).
In no event shall the total maximum compensation for actual Access Line services
performed under the terms and conditions of this Agreement be in excess of One Million Eight
Hundred Forty Eight Thousand Four Hundred Twenty Three and No/100 Dollars ($1,848,423.00)
during the total six (6) year term of this Agreement.
(4)FAMILY URGENT RESPONSE SYSTEM:
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation based on actual costs for FURS services in accordance with Exhibit B-4, “Family Urgent
Response System Budget,” attached hereto and by this reference incorporated herein.
The maximum amount for the FURS operational period July 1, 2021 through
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June 30, 2022 shall not exceed Three Hundred Sixty Nine Thousand Four Hundred Forty Seven and
No/100 Dollars ($369,447.00).”
13.That in the existing County Agreement No. 16-221, Paragraph 5.H on Page Fourteen
(14), Lines Fifteen (15) through Seventeen (17) be deleted and the following inserted in its place:
“H. CONTRACTOR shall submit budgets for FY 2018-19, FY 2019-20, FY 20-21,
and FY 21-22 to the DBH Director, or designee, by March 1st, prior to the next FY for written review
and approval.”
14. That in the existing COUNTY Agreement No. 16-221, Section 10, “Insurance”, Page
Nineteen (19), Line Three (3), beginning with the number “10” and ending on Page Twenty One (21),
Line Thirteen (13) with the word “better” be deleted and the following inserted in its place:
“10. INSURANCE
Without limiting the COUNTY’s right to obtain indemnification from
CONTRACTOR or any third parties, CONTRACTOR, at its sole expense shall maintain in full force
and effect 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
Million Dollars ($2,000,000) per occurrence and an annual aggregate of Five
Million Dollars ($5,000,000). This policy shall be issued on a per occurrence
basis. COUNTY may require specific coverage including completed
operations, product liability, contractual liability, Explosion, Collapse, and
Underground (XCU), fire legal liability or any other liability insurance deemed
necessary because of the nature of the Agreement.
B.Automobile Liability
Comprehensive Automobile Liability Insurance with limits of not less than
One Million Dollars ($1,000,000.00) per accident for bodily injury and for
property damages. Coverage should include any auto used in connection
with this Agreement.
C.Real and Property Insurance
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CONTRACTOR shall maintain a policy of insurance for all risk real and
personal property coverage which shall be endorsed naming the County of
Fresno as an additional loss payee. The real and personal property
coverage shall be in an amount that will cover the total of the COUNTY
purchase and owned property, at a minimum, as discussed in Section
Twenty (21) of this Agreement.
D.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.
E.Professional Liability
If CONTRACTOR employs licensed professional staff (e.g. Ph.D., R.N.,
L.C.S.W., M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than Two Million Dollars ($2,000,000) per occurrence, Five
Million Dollars ($5,000,000) annual aggregate. CONTRACTOR agrees that it
shall maintain, at its sole expense, in full force and effect for a period of
three (3) years following the termination of this Agreement, one or more
policies of professional liability insurance with limits of coverage as specified
herein.
F.Worker’s Compensation
A policy of Worker’s Compensation Insurance as may be required by the
California Labor Code.
G.Molestation
Sexual abuse / molestation liability insurance with limits of not less than One
Million Dollars ($1,000,000.00) per occurrence, Two Million Dollars
($2,000,000.00) annual aggregate. This policy shall be issued on a per
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occurrence basis.
H.Cyber Liability
Cyber liability Insurance with limits not less than $2,000,000 per occurrence
or claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to
respond to the duties and obligations as is undertaken by Vendor in this
agreement and shall include, but not be limited to, claims involving
infringement of intellectual property, including but not limited to infringement
of copyright, trademark, trade dress, invasion of privacy violations,
information theft, damage to or destruction 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.
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.
CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents,
and employees any amounts paid by the policy of worker’s compensation insurance required by this
Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may
be necessary to accomplish such waiver of subrogation, but CONTRACTOR’s waiver of subrogation
under this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
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
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foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 3133
N.Millbrook Ave, Fresno, California, 93703, Attention: Contracted Services 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.
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.”
15.COUNTY and CONTRACTOR agree that this Amendment is sufficient to amend the
Agreement and, that upon execution of this Amendment, the Agreement, the First Amendment and
this Second Amendment together shall be considered the Agreement.
16.The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
covenants, conditions and promises contained in the Agreement and not amended herein shall remain
in full force and effect.
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IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment as of the
day and year first hereinabove written .
4 ,~~~~-~....:......::..-1,::::5:::.~~_/
5
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Luana Murphy , President/CEO
Print Name & Title
8 i+,,,,<:;__--',,i::;_-= ___ ;;;._ __ ___;:~--
(Authorized Signature)
9
LeeAnn Skorohod, Secretary/COO
10 l+-----------'-------Pri nt Name & Title
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13 MAILING ADDRESS :
Exodus Recovery, Inc.
9808 Venice Boulevard , Suite 700
Culver C ity , CA 90232
Contact: Luana Murphy , President/CEO
(310) 945-3350
FOR ACCOUNTING USE ONLY:
Fund :0001
Subclass : 10000
COUNTY
Bran au , Chairman of the Board
of Supervisors of the County of Fresno
ATTEST:
Bernice E. Seidel
C lerk of the Board of Supervisors
County of Fresno , State of Californ ia
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Org : 56302110 (Adult CSC ), 56302111 (You th CSC ), 56302011 (Access Line), 5630 (FURS )
Account: 7295
Fisca l Year Adult CSC Yo uth CSC
FY 2016-17 $6,527,765 $2 ,640 ,397
FY 2017-18 $6 ,723 ,623 $2 ,719 ,657
FY 2018-19 $ 7,536 ,051 $3,078 ,105
FY 2019-20 $8 ,026 ,971 $3,278 ,685
FY 2020-21 $8 ,217 ,759 $3 ,359 ,275
FY 2021 -22 $8,217 ,759 $3 ,359 ,275
Total : $ 45 ,249 ,928 $18 ,435 ,394
Access Lin e
$266 ,285
$296 ,883
$307,445
$318,384
$329,713
$329 ,713
$1 ,848 ,423
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$369,447
$369,447
$9 ,434 ,447
$9 ,740 ,1 63
$10,921 ,601
$ 11,624,040
$ 11,906 ,747
$12 ,276 ,194
$65,903,192
Revised Exhibit A-1
Page 1 of 11
ADULT CRISIS STABILIZATION CENTER
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA 93702 (Bldg 319)
SERVICES: Adult Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: July 1, 2016 – June 30, 2019, with three (3) twelve (12) month renewal options
CONTRACT AMOUNT:
Fiscal Year Contract Maximum
FY 2016-17 $6,527,765
FY 2017-18 $6,723,623
FY 2018-19 $7,536,051
FY 2019-20 $8,026,971
FY 2020-21 $8,217,759
FY 2021-22 $8,217,759
SCHEDULE OF SERVICES:
CONTRACTOR shall operate the Adult Crisis Stabilization Center (Adult CSC) twenty-four (24) hours per day,
seven (7) days per week. The Adult CSC shall be located at the Kings Canyon Campus at 4411 E. Kings
Canyon Road, Fresno, California 93702 (Building 319), a COUNTY-owned building, pursuant to a separate
lease agreement (and any related amendments) between COUNTY and Exodus Foundation, Inc., an affiliate
of CONTRACTOR.
TARGET POPULATION:
The target population will include clients 18 years of age and older from Fresno County, who are exhibiting
acute psychiatric symptoms and have either been placed on a Welfare and Institution Code (W&IC) 5150
designation or who request admittance to the Adult CSC on a voluntary status. CONTRACTOR will provide
crisis stabilization services to adult clients with a twenty (20) bed maximum at any given time. However,
CONTRACTOR may be in the process of assessing or evaluating additional clients, as necessary.
CONTRACTOR will accept voluntary or involuntarily admitted clients regardless of source of payment;
clients will include Medi-Cal beneficiaries, Medicare and Medicare/Medi-Cal beneficiaries, privately insured
and indigent/uninsured clients who are referred by the Department of Behavioral Health (DBH), a contract
provider with the DBH, a hospital emergency room (aka emergency department), law enforcement, or
Emergency Medical Services (EMS). Clients may also be family or self-referred.
These services shall be performed pursuant to W&IC, sections 5704.5(b), 5704.6(c), and 5614(b)(3) and
program principles and the array of treatment options required under W&IC, sections 5600.2 to 5600.9
inclusive.
PROJECT DESCRIPTION:
CONTRACTOR shall be responsible to comply with the requirements of the Fresno County Mental Health Plan
(FCMHP) and must complete and submit supporting clinical and any other such documentation as may be
Revised Exhibit A-1
Page 2 of 11
required by the COUNTY for every client served in the Adult CSC. The FCMHP will perform a utilization
review of all admissions to determine that the documentation demonstrates that medical necessity criteria as
defined by the California Department of Health Care Services (DHCS) was met for each duration of the
hospitalization, except for the episode of discharge.
CONTRACTOR shall be responsible to enter all Client Service Information, admission data and billing
information into the COUNTY data system (AVATAR) and will be responsible for any and all audit exceptions
pertaining to the delivery of services.
CONTRACTOR’S RESPONSIBILITIES:
A.CONTRACTOR shall ensure that the Adult CSC provides the following services:
1. Management and alleviation of client’s acute psychiatric symptoms through effective therapeutic
interventions and supportive services to avoid the need for a higher level of psychiatric care
when clinically appropriate.
2.A recovery/strength based clinical program which has appropriate professional staffing on a
twenty-four (24) hour, seven (7) day a week basis.
3.A safe, secure environment for clients that encourages wellness and recovery.
4.A comprehensive multi-disciplinary evaluation and client-centered treatment plan.
5.Dietary services through the availability of nourishment or snacks in accordance with Title 22,
Division 5, Chapter 9, Article 3, Section 77077.
6.Admission procedures for clients, who are not on involuntary holds in accordance with Welfare
and Institutions Code 5150 and also individuals placed on W&I 5150 involuntary holds.
7.Crisis consultation services to rural service providers (e.g. emergency departments, etc.) that
may not have timely access to the centrally located crisis stabilization facilities and may require
consultation to support client care planning and/or mitigate unnecessary long transports of clients
to the Adult CSC from remote areas. Crisis consultation may occur via teleconference, tele-
behavioral health (i.e. utilization of video and computer equipment), and/or other method
presented by CONTRACTOR and deemed acceptable by the department.
8.Treatment Planning – Under the clinical direction of the mental health clinician, the multi-
disciplinary treatment team formed by the Crisis Stabilization staff shall provide the following
services:
a.Mental Status Examination
b.Medical Evaluation
c.Full Clinical Assessment
d.Nursing Assessment
e.Multi-Disciplinary Milieu Treatment Program
f.Client Centered Treatment Planning
g.Aftercare Planning and Wellness Recovery Action Plan (WRAP)
9.Staffing
a.The staffing pattern for the crisis stabilization program shall meet all current State
licensing and regulatory requirements including medical staff standards, nursing staff
standards, social work and rehabilitation staff requirements pursuant to Title 9, Division 1,
Revised Exhibit A-1
Page 3 of 11
Chapter 11, Article 3, Section 1840.348 of the California Code of Regulations (CCR) for
Crisis Stabilization services. All staff requiring federal/state licensure or certification will
be required to be licensed or certified in the State of California and be in good standing
with the state licensing or certification board. CONTRACTOR shall remain up-to-date with
all current regulatory changes and adhere to all new and/or modified requirements.
b.All facility staff who provide direct client care or perform coding/billing functions must meet
the requirements of the FCMHP Compliance Program. This includes the screening for
excluded persons and entities by accessing or querying the applicable licensing board(s),
the National Practitioner Data Bank (NPDB), Office of Inspector General’s List of Excluded
Individuals/Entities (LEIE), Excluded Parties List System (EPLS) and Medi-Cal Suspended
and Ineligible List prior to hire and annually thereafter. In addition, all
licensed/registered/waivered staff must complete a FCMHP Provider Application and be
credentialed by the FCMHP’s Credentialing Committee. All of CONTRACTOR’s staff who
have direct contact with the clients, shall have Department of Justice (DOJ), Federal
Bureau of Investigation (FBI), and Sheriff fingerprinting (Livescan) executed.
c.Peer and/or family support staff will be an active and key member of the multi-disciplinary
team to assist with treatment planning, mentoring, support and advocate with
clients/families during their time at the Adult CSC facility and will assist with discharge
planning and facilitate the client’s transition to the appropriate lower level of care.
d.The staffing requirements defined by CCR, Title 9, Section 1840.348 for the Adult CSC is
as follows:
(a) A physician shall be on call at all times for the provision of those Crisis Stabilization
Services that may only be provided by a physician.
(b) There shall be a minimum of one Registered Nurse, Psychiatric Technician, or
Licensed Vocational Nurse on site at all times beneficiaries are present.
(c)At a minimum there shall be a ratio of at least one licensed mental health or
waivered/registered professional on site for each four beneficiaries or other patients
receiving Crisis Stabilization at any given time.
(d)If the client is evaluated as needing service activities that can only be provided by a
specific type of licensed professional, such persons shall be available.
(e)Other persons may be utilized by the program, according to need.
(f) If Crisis Stabilization services are co-located with other specialty mental health
services, persons providing Crisis Stabilization must be separate and distinct from persons
providing other services.
(g)Persons included in required Crisis Stabilization ratios and minimums may not be
counted toward meeting ratios and minimums for other services.
e.CONTRACTOR shall submit daily staffing reports that identify all direct service and
support staff by first and last name, applicable licensure/certifications, full time hours
worked, and the licensed/waivered/registered mental health professionals to client ratio.
10.Medical Records
a. The CONTRACTOR shall maintain records in accordance with Exhibit D, “Documentation
Standards for Client Records.” During site visits, COUNTY shall be allowed to review
records of services provided, including the goals and objectives of the treatment plan, and
how the therapy provided is achieving the goals and objectives.
Revised Exhibit A-1
Page 4 of 11
b. The CONTRACTOR will be responsible for “release of information” requests for the Adult
CSC facility and shall adhere to applicable federal and state regulations.
11.Clinical Staff - The clinical staff of CONTRACTOR shall be composed of all licensed mental
health or waivered/registered professionals as included in CCR, Title 9, Division 1, Chapter 11,
Article 3, Section 1840.348 (Crisis Stabilization Staffing Requirements).
12.Medical Staff – The medical staff shall include a physician and a registered nurse, psychiatric
technician or licensed vocational nurse and any other type of licensed professional needed to
address client needs, pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 (Crisis Stabilization Staffing Requirements).
13.Pharmaceutical Services – CONTRACTOR shall provide for medication services on an as
needed basis and the staffing must reflect this availability, pursuant to CCR, Title 9, Division 1,
Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site Requirements) and
all other applicable federal/state regulations.
14.Assessment of Physical Health and Medical Backup Services – Pursuant to CCR, Title 9,
Division 1, Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site
Requirements), CONTRACTOR shall provide admission history and physical examination, and
maintain a written agreement for medical services with one or more general acute care hospitals.
15.Utilization Review, Billing and Cost Report:
a.CONTRACTOR shall notify the COUNTY of any admission of a COUNTY client within
twenty-four (24) hours or the next business day in a manner approved by the COUNTY.
The notification method shall be approved by the COUNTY.
b.CONTRACTOR shall be responsible to insure that documentation in the client’s medical
record meets medical necessity criteria for the hours of service submitted to COUNTY for
reimbursement by federal intermediaries, third-party payers and other responsible parties.
c.CONTRACTOR shall enter all mental health data and billing information into the
COUNTY’s electronic information system and will be responsible for any and all audit
exceptions pertaining to the delivery of services.
d.CONTRACTOR shall submit a complete and accurate DHCS Short/Doyle Medi-Cal Cost
Report for each fiscal year ending June 30th affected by the proposed agreement within
120 days following the end of each fiscal year.
e.CONTRACTOR shall insure that cost reports are prepared in accordance with General
Accepted Accounting Principles (GAAP) and the standards set forth by the DHCS and the
COUNTY.
16. Patients’ Rights and Certification Review Hearings:
a.CONTRACTOR shall adopt and post in a conspicuous place a written policy on patient
rights in accordance with section 70707 of Title 22 of the California Code of Regulations
and section 5325.1 of the California Welfare and Institutions Code and Title 42 Code of
Federal Regulations section 438.100.
b.CONTRACTOR shall allow access to COUNTY clients by the Patients’ Rights Advocate
designated by the COUNTY.
17.Family Advocate - CONTRACTOR shall promote and allow client access to the Family Advocacy
Services representative (Family Advocate) who is contracted by the COUNTY to advocate and
assist clients, families and support systems who are seeking or receiving mental health services.
Revised Exhibit A-1
Page 5 of 11
18.Grievances and Incident Reports
CONTRACTOR shall have all grievance forms readily available at the Adult CSC facility.
CONTRACTOR shall log all grievances and the disposition of all grievances received from a
client or a client’s family in accordance with FCMHP policies and procedures as indicated within
Exhibit G. CONTRACTOR shall provide a summary of the grievance log entries concerning
COUNTY-sponsored clients to the DBH Director, or designee, at monthly intervals, by the
fifteenth (15th) day of the following month, in a format that is mutually agreed upon.
CONTRACTOR shall post signs, provided by the COUNTY, informing clients of their right to file a
grievance and appeal.
CONTRACTOR shall notify COUNTY of all incidents or unusual occurrences reportable to state
licensing bodies that affect COUNTY clients within twenty-four (24) hours. The CONTRACTOR
shall use the Incident Report form as indicated within Exhibit H for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-sponsored clients,
CONTRACTOR shall provide County with the complaint and CONTRACTOR’s disposition of, or
corrective action taken to resolve the complaint or incident.
Within fifteen (15) days after CONTRACTOR submits a corrective action plan to a California
State licensing and/or accrediting body concerning any sentinel event, as the term is defined by
the licensing or accrediting agency, and within fifteen (15) days after CONTRACTOR receives a
corrective action order from a California State licensing and/or accrediting body to address a
sentinel event, CONTRACTOR shall provide a summary of such plans and orders to COUNTY.
19.Provide a safe and secure environment to provide for clinical and medical assessment,
diagnostic formulation, crisis intervention, medication management, and clinical treatment for
mental health clients with acute psychiatric symptoms. This includes the manner in which
seclusion and restraint will be administered when necessary for the safety of the clients, other
clients in the program, and staff.
20.Provide the appropriate type and level of staffing to provide for a clinically effective program
design that adheres to State staffing requirements.
21.Provide staff training in the areas of non-violent crisis intervention, evidence-based practice, best
practice, or promising practices to insure staff are competent and proficient in the therapeutic
interventions and practices in serving adult clients accessing the Adult CSC.
22.CONTRACTOR shall utilize cost containment strategies for the provision of stock and
prescription medications to clients (i.e. by contracting with a pharmaceutical benefits
management company) and provide the COUNTY with the type of formulary utilized by the
program as well as information regarding co-pays and/or generic substitutions.
23.Provide an intensive treatment program which has individualized treatment plans.
24.Stabilize the clients’ acute psychiatric symptoms in the most expedient manner possible while
adhering to appropriate clinical care standards. This may include initiating a Treatment
Authorization Request (TAR) to the pharmacy and providing justification when psychotropic
medications are needed on an emergency basis.
25.Effectively partner with other programs in the COUNTY and community system (i.e. law
enforcement, local emergency departments, etc.) in accepting COUNTY clients for admission for
crisis stabilization services.
26.Effectively partner with rural services providers (i.e. emergency departments, etc.) to provide
crisis stabilization services via teleconference, tele-behavioral health (i.e. utilization of video and
computer equipment), and/or other method deemed acceptable by COUNTY.
Revised Exhibit A-1
Page 6 of 11
27.Work collaboratively with the COUNTY and community resources in discharge planning to
ensure appropriate referral and direct linkage to ongoing outpatient specialty mental health
treatment services, substance use disorder treatment services, etc. are provided. Discharge
planning would also include working collaboratively with out-of-county Mental Health Plans to
ensure clients in foster care who reside within Fresno County are linked to appropriate ongoing
specialty mental health services, substance use disorder treatment services, etc. as appropriate.
28.Identify clients with frequent admissions during the fiscal year and develop strategies with other
COUNTY and community agencies to reduce readmissions and improve clients’ overall well-
being through coordination of care.
29.Effectively interact with community agencies, other mental health programs and providers,
natural support systems, and families to assist clients to be discharged to the appropriate level of
care.
30.Work effectively with the DBH Conservatorship Team as appropriate for clients presenting to the
Adult CSC as gravely disabled who may require consideration for a temporary conservatorship.
31.Integrate mental health and substance use disorder services. The CONTRACTOR shall perform
the following:
a.Develop a formal written Continuous Quality Improvement CQI action plan to identify
measurable objectives toward the achievement of co-occurring disorders (COD) treatment
capability that will be addressed by the program during the contract period. These objectives
should be achievable and realistic for the program, based on a self-assessment and the
program priorities, but need to include attention to making progress on the following issues, at
minimum:
1.Welcoming policies, practices, and procedures related to the engagement of
individuals with co-occurring issues and disorders;
2.Removal or reduction of access barriers to admission based on co-occurring diagnosis
or medication;
3.Improvement in routine integrated screening, and identification in the data system of
how many clients served have co-occurring issues;
4.Developing the goal of basic co-occurring competency for all treatment and support
staff, regardless of licensure or certification, and
5.Documentation of coordination of care with collaborative mental health and/or
substance use disorder providers for each client.
B.Regarding 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 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 subcontracted providers with these requirements.
Revised Exhibit A-1
Page 7 of 11
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 COUNTY’s DBH Cultural Diversity Committee scheduled
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 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. Sensitivity to gender and sexual orientation must be covered in
annual training.
10. Utilize existing community supports, referrals to transgender support groups, etc., when
appropriate.
11. Attend annual Cultural Competence, Compliance, Health Insurance Portability and Accountability
Act (HIPAA), Billing, and Documentation training provided by COUNTY’s DBH.
12. 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, any resulting actions regarding 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.
C. Regarding Conservatees, CONTRACTOR agrees to the following:
CONTRACTOR shall work with COUNTY’s DBH Client Placement Team to find placement for
COUNTY conservatees that are discharged from the CONTRACTOR-operated Adult CSC.
D. Regarding direct admissions to the Adult CSC from COUNTY’s DBH programs or its contracted
providers, the CONTRACTOR agrees to the following:
1. To allow direct admits from COUNTY’s DBH programs or its contracted providers when the Adult
CSC has the capacity to accept clients for services.
2. Said direct admits shall not require medical clearance, if client would otherwise meet the
Emergency Medical Services 5150 Destination Policy requirements as mentioned hereinbelow in
Revised Exhibit A-1
Page 8 of 11
Subsection F. However, in the event a referred client is known to possess a contagious medical
condition, said patient shall be medically cleared by a local hospital prior to admission to the Adult
CSC operated by CONTRACTOR.
E.Regarding the placement of a client at another designated facility:
1.CONTRACTOR shall notify COUNTY DBH when a client will remain at the CSC for a period in
excess of 24 hours, while awaiting placement and/or transportation. The COUNTY’s Patients
Rights Advocate will be included in this notification
2.CONTRACTOR shall provide the following services to clients who remain at the CSC for a period
in excess of 24 hours and who are awaiting placement and/or transportation:
a.Three meal periods and three snack times per 24 hours
b.Daily encouragement and support with activities of daily living i.e. showering, washing of
clothes, teeth brushing, hair combing etc.
c.Daily psychiatric evaluation by both the provider and licensed nursing staff to
evaluate/determine the clients most appropriate level of care
d.Daily medication evaluation, administration and education
e.Daily group activities (e.g. 12-Step Meetings, WRAP, Goals Group, etc.)
f.Daily one-on-one peer support provided by designated Peer Advocate
g.Daily activities such as meditation, art, entertainment and outdoor activities provided in the
outside courtyard
h.Daily education in relation to mental health diagnosis, treatments, and community resources
.
F.Regarding the provision of court testimony related to Adult CSC clients, CONTRACTOR agrees to
the following:
CONTRACTOR’s staff shall provide court testimony relevant to Adult CSC clients, when required.
G.Regarding the Emergency Medical Services (EMS) 5150 Destination Policy, CONTRACTOR
agrees to the following:
CONTRACTOR agrees to follow the then-current Emergency Medical Services 5150 Destination
Policy as identified in Exhibit L, attached hereto and incorporated herein. Said policy may be
updated periodically throughout the term of this Agreement; CONTRACTOR must adhere to the
most recent policies designated by the EMS 5150 Destination Policy. References to the
Children’s Crisis Assessment Intervention Resolution (CCAIR) Unit in Exhibit L reflect services to
be performed by CONTRACTOR at the COUNTY’s Youth CSC
H.CONTRACTOR shall participate in the following meetings:
1.CONTRACTOR shall participate in periodic workgroup meetings scheduled by staff from
COUNTY’s DBH Mental Health Contracted Services Unit. The meetings shall be held monthly, or
as needed, to discuss contract requirements, data reporting, outcomes measurement, training,
policies and procedures, and overall program operations.
2.CONTRACTOR’s administrative level agency representative, who is duly authorized to act on
behalf of CONTRACTOR, shall attend regularly scheduled monthly Behavioral Health Board
meetings.
Revised Exhibit A-1
Page 9 of 11
3.CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider Meetings, as
scheduled by staff from COUNTY’s Mental Health Contracted Services Unit, when deemed
necessary by the DBH Director, or designee.
4.CONTRACTOR may also be asked to make presentations in the community about the program
and services that are available.
I.Regarding the development of policies and protocols:
CONTRACTOR and COUNTY’s DBH shall collaborate on the development of specific policies
and protocols related to the daily operation of the Adult CSC. Such policies will include, but not
be limited to, the following: placement of adults in psychiatric health facilities or other inpatient
programs either locally or outside the county, facility limitations, and special client populations.
Such policies and protocols shall be mutually agreed upon between CONTRACTOR and
COUNTY’s DBH Director, or designee. Any changes to such policies and protocols shall be
mutually agreed upon between CONTRACTOR and COUNTY’s DBH Director, or designee.
PROGRAM OUTCOMES
The Department of Behavioral Health is dedicated to supporting the wellness of individuals, families and
communities in Fresno County who are affected by, or at the risk of, mental illness and/or substance use
disorders through cultivation of strengths toward promoting recovery in the least restrictive environment.
Five (5) Work Plans will be utilized to support DBH’s mission statement. The work plans were developed as
a concept of a Transformation Plan that would encompass system planning, implementation and oversight
to be reflective of a comprehensive system of care. These work plans are provided below and represent
program goals to be achieved by CONTRACTOR in addition to CONTRACTOR-developed outcomes. DBH
may adjust the outcome measurements needed under this program periodically, so as to best measure the
success of clients and program as determined by the County.
CONTRACTOR will utilize a computerized tracking system with which outcome measures and other
relevant consumer data, such as demographics, will be maintained.
1. Behavioral Health Integrated Access – timeliness between client referral to admission, admission
to treatment, and treatment to discharge; penetration rate; effectiveness of discharge planning as
demonstrated by referral and linkage to other DBH programs, community providers, and other
community resources; and services that provide screening and access to ensure clients are linked to
the services they need, including mental health substance use disorders and physical health
services.
2.Wellness, Recovery, and Resiliency Supports – collaborative approach to treatment strategies to
reduce readmission of consumers with frequent admissions to the facility; effectiveness of services
as demonstrated by the number of consumers who are able to be discharged to the community and
avoid inpatient hospitalization; measurement of recidivism rates, including measuring percentage of
recidivism within 30 days. State the Evidence Based Practices (EBP) that shall be used.
3.Cultural/Community Defined Practices – services or philosophical practices which support the
unique cultural-specific needs of individuals receiving care. Focus on behavioral health practices
which reflect the unique needs of various cultures and communities who reside within Fresno
County.
4.Behavioral Health Clinical Care – services where direct therapeutic treatment is provided. Include
the framework of “Levels of Care” where client’s needs, as identified through assessment/screening,
are matched with a complexity and intensity of services meets those needs.
Revised Exhibit A-1
Page 10 of 11
5.Infrastructure Supports – includes all personnel, equipment, programs, and facilities which exist to
support the delivery of care to the clients served. Includes safety, quality improvement and
regulatory compliance functions, along with outcome assessment/program evaluation, training, and
technology.
6.Denial rate for Crisis Stabilization billing will be decreased by 5% within the first six months, based on
previous program denial rates. Rates will be determined by the utilization review performed by
FCMHP.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1.Perform a utilization review, annually at a minimum, (through its FCMHP) of ten percent (10%) of all
admissions to determine that the documentation demonstrates that medical necessity criteria as defined
by the DHCS were met throughout the duration of the crisis stabilization episode. The FCMHP will
maintain discretion regarding possible subsequent utilization review beyond ten percent (10%), as
necessary.
2.Provide oversight of the CONTRACTOR’s Adult CSC program. In addition to contract monitoring of
program(s), oversight includes, but is not limited to, coordination with the DHCS in regard to program
administration and outcomes.
3.Assist the CONTRACTOR in making linkages to the appropriate level of care within the behavioral
health system of care to insure continuity of care. This will be accomplished through regularly
scheduled meetings as well as formal and informal consultation.
4.Participate in evaluating the progress of the overall program and the efficiency of collaboration with the
CONTRACTOR staff and will be available to the contractor for ongoing consultation.
5.Receive and analyze statistical outcome data from CONTRACTOR throughout the term of contract on a
monthly basis. DBH will notify the CONTRACTOR 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 methods of obtaining
required information.
6. 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
CONTRACTOR:
A.Mandatory cultural competency training including sexual orientation and sensitivity training for
CONTRACTOR personnel, at minimum once per year. COUNTY will provide mandatory training
regarding the special needs of this diverse population and will be included in the cultural
competence training(s). Sexual orientation and sensitivity to gender differences is a basic cultural
competence principle and shall be included in the cultural competency training. Literature suggests
that the mental health needs of lesbian, gay, bisexual, transgender (LGBT) individuals may be at
increased risk for mental disorders and mental health problems due to exposure to societal
stressors such as stigmatization, prejudice and anti-gay violence. Social support may be critical for
this population. Access to care may be limited due to concerns about providers’ sensitivity to
differences in sexual orientation.
Revised Exhibit A-1
Page 11 of 11
B.Assistance to CONTRACTOR in locating appropriate providers who can translate behavioral health
and substance abuse services information into COUNTY’s threshold languages (English, Spanish,
and Hmong). Translation services and costs associated will be the responsibility of the
CONTRACTOR.
Revised Exhibit A-2
Page 1 of 11
YOUTH CRISIS STABILIZATION CENTER
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA, 93702 (Bldg 319)
SERVICES: Youth Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559)453-6271
CONTRACT PERIOD: July 1, 2016 – June 30, 2019, with three (3) twelve (12) month renewal options
CONTRACT AMOUNT:
Fiscal Year Contract Maximum
FY 2016-17 $2,640,397
FY 2017-18 $2,719,657
FY 2018-19 $3,078,105
FY 2019-20 $3,278,685
FY 2020-21 $3,359,275
FY 2021-22 $3,359,275
SCHEDULE OF SERVICES:
CONTRACTOR shall operate the Youth Crisis Stabilization Center (Youth CSC) twenty-four (24) hours per
day, seven (7) days per week. The Youth CSC shall be located at the Kings Canyon Campus at 4411 E. Kings
Canyon Road, Fresno, California 93702 (Building 319), a COUNTY-owned building, pursuant to a separate
lease agreement (and any related amendments) between COUNTY and Exodus Foundation, Inc., an affiliate
of CONTRACTOR.
TARGET POPULATION:
The target population will include children and youth up to 18 years of age from Fresno County, who are
exhibiting acute psychiatric symptoms and have either been placed on a Welfare and Institutions Code
(W&IC) 5150 designation or who request admittance to the Youth CSC on a voluntary status.
CONTRACTOR will provide crisis stabilization services to children and youth clients with an eight (8) bed
maximum at any given time. However, CONTRACTOR may be in the process of assessing or evaluating
additional clients, as necessary. CONTRACTOR will accept voluntary or involuntarily admitted clients
regardless of source of payment; clients may include Medi-Cal beneficiaries, Medicare and Medicare/Medi-
Cal beneficiaries, privately insured and indigent/uninsured clients who are referred by the Department of
Behavioral Health (DBH), a contract provider with the DBH, a hospital emergency department, law
enforcement, or Emergency Medical Services (EMS). Clients may also be family or self-referred. The Youth
CSC will also serve foster children and youth who reside in Fresno County and remain under the original
jurisdiction of another county.
These services shall be performed pursuant to W&IC, sections 5704.5(b), 5704.6(c), and 5614(b)(3) and
program principles and the array of treatment options required under W&IC, sections 5600.2 to 5600.9
inclusive.
Revised Exhibit A-2
Page 2 of 11
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid.
Federal statutes and regulations state that children under age 21 who are enrolled in Medicaid are entitled to
EPSDT benefits and that States must cover a broad array of preventive and treatment services to include
crisis stabilization. The requirement is to maintain its funding for children’s services at a level equal to or
more than the proportion expended for children’s program services in FY 83-84.
PROJECT DESCRIPTION:
CONTRACTOR shall be responsible to comply with the requirements of the Fresno County Mental Health Plan
(FCMHP) and must complete and submit supporting clinical and any other such documentation as may be
required by the COUNTY for every client served in the Youth CSC. The FCMHP will perform a utilization
review of all admissions to determine that the documentation demonstrates that medical necessity criteria as
defined by the California Department of Health Care Services (DHCS) was met for each duration of the crisis
stabilization services claimed for reimbursement.
CONTRACTOR shall be responsible to enter all Client Service Information, admission data and billing
information into the COUNTY data system (AVATAR) and will be responsible for any and all audit exceptions
pertaining to the delivery of services.
CONTRACTOR’S RESPONSIBILITIES:
A.CONTRACTOR shall ensure that the Youth CSC provides the following services:
1.Management and alleviation of client’s acute psychiatric symptoms through effective therapeutic
interventions and supportive services to avoid the need for a higher level of psychiatric care
when clinically appropriate.
2.A recovery/strength based clinical program which has appropriate professional staffing on a
twenty-four (24) hour, seven (7) day a week basis.
3.A safe, secure environment for clients that encourages wellness and recovery.
4.A comprehensive multi-disciplinary evaluation and client-centered treatment plan.
5.Dietary services through the availability of nourishment or snacks in accordance with Title 22,
Division 5, Chapter 9, Article 3, Section 77077.
6.Admission procedures for clients, who are not on involuntary holds in accordance with Welfare
and Institutions Code 5150 and also individuals placed on W&I 5150 involuntary holds.
7.Crisis consultation services to rural service providers (e.g. emergency departments, etc.) that
may not have timely access to the centrally located crisis stabilization facilities and may require
consultation to support client care planning and/or mitigate unnecessary long transports of clients
to the Youth CSC from remote areas. Crisis consultation may occur via teleconference, tele-
behavioral health (i.e. utilization of video and computer equipment), and/or other method
presented by CONTRACTOR and deemed acceptable by the department.
8.Treatment Planning – Under the clinical direction of the mental health clinician, the multi-
disciplinary treatment team formed by the Youth Crisis Stabilization staff shall provide the
following services:
a.Mental Status Examination
b.Medical Evaluation
c.Full Clinical Assessment
d.Nursing Assessment
Revised Exhibit A-2
Page 3 of 11
e.Multi-Disciplinary Milieu Treatment Program
f.Client Centered Treatment Planning
g.Aftercare Planning and Wellness Recovery Action Plan (WRAP)
9.Staffing
a.The staffing pattern for the crisis stabilization program shall meet all current State
licensing and regulatory requirements including medical staff standards, nursing staff
standards, social work and rehabilitation staff requirements pursuant to Title 9, Division 1,
Chapter 11, Article 3, Section 1840.348 of the California Code of Regulations (CCR) for
Crisis Stabilization services. All staff requiring federal/state licensure or certification will
be required to be licensed or certified in the State of California and be in good standing
with the state licensing or certification board. CONTRACTOR shall remain up-to-date wit h
all current regulatory changes and adhere to all new and/or modified requirements.
b.All facility staff who provide direct client care or perform coding/billing functions must meet
the requirements of the FCMHP Compliance Program. This includes the screening for
excluded persons and entities by accessing or querying the applicable licensing board(s),
the National Practitioner Data Bank (NPDB), Office of Inspector General’s List of Excluded
Individuals/Entities (LEIE), Excluded Parties List System (EPLS) and Medi-Cal Suspended
and Ineligible List prior to hire and annually thereafter. In addition, all
licensed/registered/waivered staff must complete a FCMHP Provider Application and be
credentialed by the FCMHP’s Credentialing Committee. All of CONTRACTOR’s staff who
will have direct contact with the clients, shall have Department of Justice (DOJ), Federal
Bureau of Investigation (FBI), and Sheriff fingerprinting (Livescan) executed.
c.Peer and/or family support staff will be an active and key member of the multi-disciplinary
team to assist with treatment planning, mentoring, support and advocate with
clients/families during their time at the YOUTH CSC facility and will assist with discharge
planning and facilitate the client’s transition to the appropriate lower level of care.
d.At the time of execution of this Agreement, the staffing requirements defined by the
California Code of Regulations, Title 9, Section 1840.348 for the Youth CSC are as
follows:
(a)A physician shall be on call at all times for the provision of those Crisis Stabilization
Services that may only be provided by a physician.
(b) There shall be a minimum of one Registered Nurse, Psychiatric Technician, or
Licensed Vocational Nurse on site at all times beneficiaries are present.
(c)At a minimum there shall be a ratio of at least one licensed mental health or
waivered/registered professional on site for each four beneficiaries or other patients
receiving Crisis Stabilization at any given time.
(d) If the client is evaluated as needing service activities that can only be provided by a
specific type of licensed professional, such persons shall be available.
(e)Other persons may be utilized by the program, according to need.
(f) If Crisis Stabilization services are co-located with other specialty mental health
services, persons providing Crisis Stabilization must be separate and distinct from persons
providing other services.
(g)Persons included in required Crisis Stabilization ratios and minimums may not be
counted toward meeting ratios and minimums for other services.
Revised Exhibit A-2
Page 4 of 11
e.CONTRACTOR shall submit daily staffing reports that identify all direct service and
support staff by first and last name, applicable licensure/certifications, full time hours
worked, and the licensed/waivered/registered mental health professionals to client ratio.
10.Medical Records
a.The CONTRACTOR shall maintain records in accordance with Exhibit D, “Documentation
Standards for Client Records.” During site visits, COUNTY shall be allowed to review
records of services provided, including the goals and objectives of the treatment plan, and
how the therapy provided is achieving the goals and objectives.
b. The CONTRACTOR will be responsible for “release of information” requests for the Youth
CSC facility and shall adhere to applicable federal and state regulations.
11.Clinical Staff - The clinical staff of CONTRACTOR shall be composed of all licensed mental
health or waivered/registered professionals as included in CCR, Title 9, Division 1, Chapter 11,
Article 3, Section 1840.348 (Crisis Stabilization Staffing Requirements).
12.Medical Staff – The medical staff shall include a physician and a registered nurse, psychiatric
technician or licensed vocational nurse and any other type of licensed professional needed to
address client needs pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 (Crisis Stabilization Staffing Requirements).
13.Pharmaceutical Services – CONTRACTOR shall provide for medication services on an as
needed basis and the staffing must reflect this availability pursuant to CCR, Title 9, Division 1,
Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site Requirements) and
all other applicable federal/state regulations. The administration of a psychotropic medication(s)
to children and youth in the Foster Care System will adhere to federal/state regulations, the
requirements of pharmaceutical vendors and the coordination with the Department of Social
Services-Child Welfare as it relates to the completion of forms, provision of information, etc.
14.Assessment of Physical Health and Medical Backup Services – Pursuant to CCR, Title 9,
Division 1, Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site
Requirements), CONTRACTOR shall provide admission history and physical examination, and
maintain a written agreement for medical services with one or more general acute care hospitals.
15.Utilization Review, Billing and Cost Report:
a.CONTRACTOR shall notify the COUNTY of any admission of a COUNTY client within
twenty-four (24) hours or the next business day in a manner approved by the COUNTY.
The notification method shall be approved by the COUNTY.
b.CONTRACTOR shall be responsible to insure that documentation in the client’s medical
record meets medical necessity criteria for the hours of service submitted to COUNTY for
reimbursement by federal intermediaries, third-party payers and other responsible parties.
c.CONTRACTOR shall enter all mental health data and billing information into the
COUNTY’s electronic information system and will be responsible for any and all audit
exceptions pertaining to the delivery of services.
d.CONTRACTOR shall submit a complete and accurate DHCS Short/Doyle Medi-Cal Cost
Report for each fiscal year ending June 30th affected by the proposed agreement within
120 days following the end of each fiscal year.
e.CONTRACTOR shall insure that cost reports are prepared in accordance with General
Accepted Accounting Principles (GAAP) and the standards set forth by the DHCS and the
COUNTY.
Revised Exhibit A-2
Page 5 of 11
16.Patients’ Rights and Certification Review Hearings:
a.CONTRACTOR shall adopt and post in a conspicuous place a written policy on patient
rights in accordance with section 70707 of Title 22 of the California Code of Regulations
and section 5325.1 of the California W&IC and Title 42 Code of Federal Regulations
section 438.100.
b.CONTRACTOR shall allow access to COUNTY clients by the Patients’ Rights Advocate
designated by the COUNTY.
17.Family Advocate - CONTRACTOR shall promote and allow client access to the Family Advocacy
Services representative (Family Advocate) who is contracted by the COUNTY to advocate and
assist clients, families and support systems who are seeking or receiving mental health services.
18.Grievances and Incident Reports
CONTRACTOR shall have all grievance forms readily available at the Youth CSC facility.
CONTRACTOR shall log all grievances and the disposition of all grievances received from a
client or a client’s family in accordance with FCMHP policies and procedures as indicated within
Exhibit G. CONTRACTOR shall provide a summary of the grievance log entries concerning
COUNTY-sponsored clients to the DBH Director, or designee, at monthly intervals, by the
fifteenth (15th) day of the following month, in a format that is mutually agreed upon.
CONTRACTOR shall post signs, provided by the COUNTY, informing clients of their right to file a
grievance and appeal.
CONTRACTOR shall notify COUNTY of all incidents or unusual occurrences reportable to state
licensing bodies that affect COUNTY clients within twenty-four (24) hours. The CONTRACTOR
shall use the Incident Report form as indicated within Exhibit H for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-sponsored clients,
CONTRACTOR shall provide County with the complaint and CONTRACTOR’s disposition of, or
corrective action taken to resolve the complaint or incident.
Within fifteen (15) days after CONTRACTOR submits a corrective action plan to a California
State licensing and/or accrediting body concerning any sentinel event, as the term is defined by
the licensing or accrediting agency, and within fifteen (15) days after CONTRACTOR receives a
corrective action order from a California State licensing and/or accrediting body to address a
sentinel event, CONTRACTOR shall provide a summary of such plans and orders to COUNTY.
19.Provide a safe and secure environment to provide for clinical and medical assessment,
diagnostic formulation, crisis intervention, medication management, and clinical treatment for
mental health clients with acute psychiatric symptoms. This includes the manner in which
seclusion and restraint will be administered when necessary for the safety of the clients, other
clients in the program, and staff.
20. Provide the appropriate type and level of staffing to provide for a clinically effective program
design that adheres to State staffing requirements.
21.Provide staff training in the areas of non-violent crisis intervention, evidence-based practice, best
practice, or promising practices to insure staff are competent and proficient in the therapeutic
interventions and practices in serving youth clients accessing the Youth CSC.
22.CONTRACTOR shall utilize cost containment strategies for the provision of stock and
prescription medications to clients (i.e. by contracting with a pharmaceutical benefits
management company) and provide the COUNTY with the type of formulary utilized by the
program as well as information regarding co-pays and/or generic substitutions.
Revised Exhibit A-2
Page 6 of 11
23.Provide an intensive treatment program which has individualized treatment plans.
24.Stabilize the clients’ acute psychiatric symptoms in the most expedient manner possible while
adhering to appropriate clinical care standards. This may include initiating a Treatment
Authorization Request (TAR) to the pharmacy and providing justification when psychotropic
medications are needed on an emergency basis.
25.Effectively partner with other programs in the COUNTY and community system (i.e. law
enforcement, local emergency departments, etc.) in accepting COUNTY clients for admission for
crisis stabilization services.
26.Effectively partner with rural services providers (i.e. emergency departments, etc.) to provide
crisis stabilization services via teleconference, tele-behavioral health (i.e. utilization of video and
computer equipment), and/or other method deemed acceptable by COUNTY.
27.Work collaboratively with the COUNTY and community resources in discharge planning to
ensure appropriate referral and direct linkage to ongoing outpatient specialty mental health
treatment services, substance use disorder treatment services, etc. are provided. Discharge
planning would also include working collaboratively with out-of-county Mental Health Plans to
ensure clients in foster care who reside within Fresno County are linked to appropriate ongoing
specialty mental health services, substance use disorder treatment services, etc. as appropriate.
28.Identify clients with frequent admissions during the fiscal year and develop strategies with other
COUNTY and community agencies to reduce readmissions and improve clients’ overall well-
being through coordination of care.
29.Effectively interact with community agencies, other mental health programs and providers,
natural support systems, and families to assist clients to be discharged to the appropriate level of
care.
30.Integrate mental health and substance use disorder services. The CONTRACTOR shall perform
the following:
a.Develop a formal written Continuous Quality Improvement CQI action plan to identify
measurable objectives toward the achievement of co-occurring disorders (COD) treatment
capability that will be addressed by the program during the contract period. These objectives
should be achievable and realistic for the program, based on a self-assessment and the
program priorities, but need to include attention to making progress on the following issues, at
minimum:
1.Welcoming policies, practices, and procedures related to the engagement of
individuals with co-occurring issues and disorders;
2.Removal or reduction of access barriers to admission based on co-occurring diagnosis
or medication;
3.Improvement in routine integrated screening, and identification in the data system of
how many clients served have co-occurring issues;
4.Developing the goal of basic co-occurring competency for all treatment and support
staff, regardless of licensure or certification, and
5.Documentation of coordination of care with collaborative mental health and/or
substance use disorder providers for each client.
Revised Exhibit A-2
Page 7 of 11
B.Regarding 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 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 subcontracted 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 COUNTY’s DBH Cultural Diversity Committee scheduled
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 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. Sensitivity to gender and sexual orientation must be covered in
annual training.
10.Utilize existing community supports, referrals to transgender support groups, etc., when
appropriate.
11.Attend annual Cultural Competence, Compliance, Health Insurance Portability and Accountability
Act (HIPAA), Billing, and Documentation training provided by COUNTY’s DBH.
12.Report its efforts to evaluation 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, any resulting actions regarding complaints and
Revised Exhibit A-2
Page 8 of 11
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.
C.Regarding direct admissions to the YOUTH CSC from COUNTY’s DBH programs or its contracted
providers, the CONTRACTOR agrees to the following:
1.To allow direct admits from COUNTY’s DBH programs or its contracted providers when Youth
CSC has the capacity to accept clients for services.
2.Said direct admits shall not require medical clearance, if client would otherwise meet the
Emergency Medical Services 5150 Destination Policy requirements as mentioned herein below
in Subsection F. However, in the event a referred client is known to possess a contagious
medical condition, said client shall be medically cleared by a local hospital prior to admission to
the Youth CSC operated by CONTRACTOR.
D.Regarding the provision of court testimony related to Youth CSC clients, CONTRACTOR agrees to
the following:
CONTRACTOR’s staff shall provide court testimony relevant to Youth CSC clients, when
required.
E.Regarding placements of Youth in a Psychiatric Health Facility or other inpatient level of care:
CONTRACTOR’s staff shall locate and coordinate transfer for any youth being treated at the
Youth CSC who is in need of further services and placement into a psychiatric health facility
(PHF) or other appropriate acute psychiatric inpatient facility. This includes working
collaboratively with the staffs of Central Star to coordinate the transfer of youth ages 12 to 17 to
their Youth Psychiatric Health Facility. CONTRACTOR acknowledges that transfer of youth may
occur at all hours of the day and agrees to attend promptly to the needs of the youth and will
conduct the transfer as soon as feasibly possible.
F.Regarding the placement of a Youth at another designated facility:
1.CONTRACTOR shall notify COUNTY DBH when a client will remain at the CSC for a period in
excess of 24 hours, while awaiting placement and/or transportation. The COUNTY’s Patients
Rights Advocate will be included in this notification
2.CONTRACTOR shall provide the following services to clients who remain at the CSC for a period
in excess of 24 hours and who are awaiting placement and/or transportation:
a.Three meal periods and three snack times per 24 hours
b.Daily encouragement and support with activities of daily living i.e. showering, washing of
clothes, teeth brushing, hair combing etc.
c.Daily psychiatric evaluation by both the provider and licensed nursing staff to
evaluate/determine the clients most appropriate level of care
d.Daily medication evaluation, administration and education
e.Daily group activities (e.g. 12-Step Meetings, WRAP, Goals Group, etc.)
f.Daily one-on-one peer support provided by designated Peer Advocate
g.Daily activities such as meditation, art, entertainment and outdoor activities provided in the
outside courtyard
h.Daily education in relation to mental health diagnosis, treatments, and community resources
Revised Exhibit A-2
Page 9 of 11
G.Regarding the Emergency Medical Services (EMS) 5150 Destination Policy, CONTRACTOR
agrees to the following:
CONTRACTOR agrees to follow the then-current Emergency Medical Services 5150 Destination
Policy as identified in Exhibit L, attached hereto and incorporated herein. Said policy may be
updated periodically throughout the term of this Agreement; CONTRACTOR must adhere to the
most recent policies designated by the EMS 5150 Destination Policy. References to the
Children’s Crisis Assessment Intervention Resolution (CCAIR) in Exhibit L, reflect services to be
performed at COUNTY’s Youth CSC
H.CONTRACTOR shall participate in the following meetings:
1.CONTRACTOR shall participate in periodic workgroup meetings scheduled by staff from
COUNTY’s DBH Mental Health Contracted Services Unit. The meetings shall be held monthly,
or as needed, to discuss contract requirements, data reporting, outcomes measurement,
training, policies and procedures, and overall program operations.
2.CONTRACTOR’s administrative level agency representative, who is duly authorized to act on
behalf of CONTRACTOR, shall attend regularly scheduled monthly Behavioral Health Board
meetings and its Children’s Services Committee.
3.CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider Meetings, as
scheduled by staff from COUNTY’s Mental Health Contracted Services Unit, when deemed
necessary by the DBH Director, or designee.
4.CONTRACTOR may also be asked to make presentations in the community about the program
and services that are available
I.Regarding the development of policies and protocols:
CONTRACTOR and COUNTY’s DBH shall collaborate on the development of specific policies
and protocols related to the daily operation of the Youth CSC. Such policies will include, but not
be limited to, the following: placement of youth in psychiatric health facilities or other inpatient
programs either locally or outside the county, facility limitations, and special client populations.
Such policies and protocols shall be mutually agreed upon between CONTRACTOR and
COUNTY’s DBH Director, or designee. Any changes to such policies and protocols shall be
mutually agreed upon between CONTRACTOR and COUNTY’s DBH Director, or designee.
PROGRAM OUTCOMES
The Department of Behavioral Health is dedicated to supporting the wellness of individuals, families and
communities in Fresno County who are affected by, or at the risk of, mental illness and/or substance use
disorders through cultivation of strengths toward promoting recovery in the least restrictive environment.
Five (5) Work Plans will be utilized to support DBH’s mission statement. The work plans were developed as
a concept of a Transformation Plan that would encompass system planning, implementation and oversight
to be reflective of a comprehensive system of care. These work plans are provided below and represent
program goals to be achieved by CONTRACTOR in addition to CONTRACTOR-developed outcomes. DBH
may adjust the outcome measurements needed under this program periodically, so as to best measure the
success of clients and program as determined by the County.
CONTRACTOR will utilize a computerized tracking system with which outcome measures and other
relevant consumer data, such as demographics, will be maintained.
Revised Exhibit A-2
Page 10 of 11
1.Behavioral Health Integrated Access – timeliness between client referral to admission, admission
to treatment, and treatment to discharge; penetration rate; effectiveness of discharge planning as
demonstrated by referral and linkage to other DBH programs, community providers, and other
community resources; and services that provide screening and access to ensure clients are linked to
the services they need, including mental health substance use disorders and physical health
services.
2.Wellness, Recovery, and Resiliency Supports – collaborative approach to treatment strategies to
reduce readmission of consumers with frequent admissions to the facility; effectiveness of services
as demonstrated by the number of consumers who are able to be discharged to the community and
avoid inpatient hospitalization; measurement of recidivism rates, including measuring percentage of
recidivism within 30 days. State the Evidence Based Practices (EBP) that shall be used.
3.Cultural/Community Defined Practices – services or philosophical practices which support the
unique cultural-specific needs of individuals receiving care. Focus on behavioral health practices
which reflect the unique needs of various cultures and communities who reside within Fresno County.
4.Behavioral Health Clinical Care – services where direct therapeutic treatment is provided. Include
the framework of “Levels of Care” where client’s needs, as identified through assessment/screening,
are matched with a complexity and intensity of services meets those needs.
5.Infrastructure Supports – includes all personnel, equipment, programs, and facilities which exist to
support the delivery of care to the clients served. Includes safety, quality improvement and
regulatory compliance functions, along with outcome assessment/program evaluation, training, and
technology.
6.Denial rate for Crisis Stabilization billing will be decreased by 5% within the first six months, based on
previous program denial rates. Rates will be determined by the utilization review performed by
FCMHP.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1.Perform a utilization review, annually at a minimum, (through its FCMHP) of ten percent (10%) of all
admissions to determine that the documentation demonstrates that medical necessity criteria as defined
by the DHCS were met throughout the duration of the crisis stabilization episode. The FCMHP will
maintain discretion regarding possible subsequent utilization review beyond ten percent (10%), as
necessary.
2.Provide oversight of the CONTRACTOR’s Youth CSC program. In addition to contract monitoring of
program(s), oversight includes, but is not limited to, coordination with the DHCS in regard to program
administration and outcomes.
3.Assist the CONTRACTOR in making linkages to the appropriate level of care within the behavioral
health system of care to ensure continuity of care. This will be accomplished through regularly
scheduled meetings as well as formal and informal consultation.
4.Participate in evaluating the progress of the overall program and the efficiency of collaboration with the
CONTRACTOR staff and will be available to the CONTRACTOR for ongoing consultation.
5.Receive and analyze statistical outcome data from CONTRACTOR throughout the term of contract on a
monthly basis. DBH will notify the CONTRACTOR when additional participation is required. The
performance outcome measurement process will not be limited to survey instruments but will also
Revised Exhibit A-2
Page 11 of 11
include, as appropriate, client and staff interviews, chart reviews, and other methods of obtaining
required information.
6.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
CONTRACTOR:
A.Mandatory cultural competency training including sexual orientation and sensitivity training for
CONTRACTOR personnel, at minimum once per year. COUNTY will provide mandatory training
regarding the special needs of this diverse population and will be included in the cultural
competence training(s). Sexual orientation and sensitivity to gender differences is a basic cultural
competence principle and shall be included in the cultural competency training. Literature suggests
that the mental health needs of lesbian, gay, bisexual, transgender (LGBT) individuals may be at
increased risk for mental disorders and mental health problems due to exposure to societal
stressors such as stigmatization, prejudice and anti-gay violence. Social support may be critical for
this population. Access to care may be limited due to concerns about providers’ sensitivity to
differences in sexual orientation.
B.Assistance to CONTRACTOR in locating appropriate providers who can translate behavioral health
and substance abuse services information into COUNTY’s threshold languages (English, Spanish,
and Hmong). Translation services and costs associated will be the responsibility of the
CONTRACTOR.
REVISED EXHIBIT A-3-a
Page 1 of 6
ACCESS LINE
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA 93702 (Bldg. 319)
SERVICES: Access Line Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: July 1, 2016 – August 31, 2016 (Ramp Up Period)
September 1, 2016 – June 30, 2019, with three (3) twelve (12) month renewal
options
CONTRACT AMOUNT: Contract Maximum Fiscal Year
07/1/2016 through 08/31/2016 (Ramp Up Period)
09/01/2016 through 06/30/2017 (Initial Operating Period)
FY 2017-18
FY 2018-19
FY 2019-20
FY 2020-21
$23,678
$242,607
$296,883
$307,445
$318,384
$329,713
$329,713 FY 2021-22
SCHEDULE OF SERVICES:
CONTRACTOR shall operate a State-mandated toll-free answering service (Access Line) twenty-four (24)
hours per day, seven (7) days per week. The Access Line shall be located at the Kings Canyon Campus at
4411 E. Kings Canyon Road, Fresno, California 93702 (Building 319), a COUNTY-owned building, pursuant to
a separate lease agreement (and any related amendments) between COUNTY and Exodus Foundation, Inc.,
an affiliate of CONTRACTOR.
PROJECT DESCRIPTION:
CONTRACTOR shall provide answering services for the Department of Behavioral Health in accordance with
State and Federal Regulations and utilize the Access Line Database to log all calls. Access line services are
not to be subcontracted out. The 1 (800) 654-3937 access line will be a separate phone line from the Adult
and Youth Crisis Stabilization (CSC) main lines. Calls received on the access line will be monitored and
recorded separately.
1.The Department of Behavioral Health (DBH) is mandated by the State of California to maintain a written
log of all requests for specialty mental health services. The log must include specific information about
each call.1
2.State regulations require that the toll-free, 24/7, Access Line established by DBH also provides
information to Medi-Cal beneficiaries about how to access specialty mental health services, including
information about the grievance and appeals processes and the State’s fair hearing system.2
1 California Code of Regulations (CCR): Title 9, Chapter 11, Section 1810.405(f) & State Department of Health Care Services Program Oversight and
Compliance - Annual Review Protocol for Consolidated Specialty Mental Health Services and Other Funded Services” Section A – Access.
REVISED EXHIBIT A-3-a
Page 2 of 6
3.The Access Line database (“Database”) is developed with intuitive, decision-tree type functionality, and
incorporates the requirements stated within the state regulations referenced above. The Database
shall be the mechanism used for collection of caller/client information received by phone and to provide
callers with information as required by the State.
4.Outcomes and expectations for the Access Line may evolve over time, based on changes to State and
Federal Regulations as well as departmental needs and goals. Any changes to Access Line will be
made at the discretion of the Department of Behavioral Health.
5.The Access line shall assess and screen the needs of the caller. The Access line shall triage the call to
meet the needs of each client. Triage shall be provided by staff appropriate to the needs of the client
(nursing staff, clinical staff, etc. as needed). Direct linkage with an appropriate plan for each client shall
be provided. When available, scheduling to make client appointments would also be provided.
6.Access line screening shall be provided for mental health and substance use disorder services. For
substance use disorder only calls, CONTRACTOR will transfer or warm hand off to the substance use
disorder-specific Access Line. The access line services shall be flexible to meet the growing and
changing needs of the Department’s program and client needs. CONTRACTOR Access Line staffing
pattern will be based on call volume. The Department and CONTRACTOR shall work jointly on future
changing needs of the Department, as needed.
CONTRACTOR’S RESPONSIBILITIES:
CONTRACTOR will utilize the Access Line to triage all calls received and provide linkage, as appropriate.
Calls requiring Emergency Services or Crisis Stabilization Services will be transferred to the appropriate
agency for follow up. Calls not requiring Emergency Services or Crisis Stabilization services will be evaluated
for mental health and/or substance use linkage. Access Line operators will utilize resources including but not
limited to client information within COUNTY’s Avatar Electronic Health Record system (Avatar), knowledge of
Department of Behavioral Health programs, and community programs to evaluate the caller’s need and form
an action plan with the caller. Callers will be provided with clear instruction regarding next steps. All calls
received, including those transferred to Emergency Services or Crisis Stabilization Services, will be
documented in the Access Line Database, identifying, at minimum, callers Name, Date of Call, and Disposition.
1.Access Line Database: The Database is located at https://www.FCMHPAccessline.com and will be
made available to designated staff. Effective January 1, 2019, the Database will be available via
COUNTY’s Avatar. The Database is designed to assist answering service operators handle calls of the
following nature. Each call type requires specific information to be gathered as indicated by the
corresponding call screen. All calls logged within the Access Log will be identified as an Emergency
Call or Non-Emergency call, as listed below in subsection “a” and “b.”
a.Emergency Calls. These calls may require a warm hand-off to emergency medical services
dispatchers. When a call is received and the caller reports self or other to be in crisis or you
cannot be sure of their safety, the following five-step suicide assessment, evaluation, and triage
should be conducted:
1)Identify Risk Factors. Note those that can be modified to reduce risk. Determine if the caller
is alone.
2) Identify Protective Factors. Not those that can be enhanced. If caller is with someone, ask
caller if they are feeling unsafe (harm to self or others, risk of harm by others). If no risk of
harm by others, ask permission to speak to the person to obtain their input and information
2 California Code of Regulations (CCR): Title 9, Section 1850.205, and Code of Federal Regulations (CFR): Title 42, Part 438, Subpart F.
REVISED EXHIBIT A-3-a
Page 3 of 6
about the present situation and history. Ask the caller if they have a therapist and if so, when
is their next appointment.
3)Conduct Suicide Inquiry. Suicidal thoughts, behavior, intent, plan and means, and lethality of
means. Ask about previous suicide attempts and by what means.
4)Determine Risk Level/Intervention. Determine risk. Choose appropriate intervention to
address and reduce risk.
5)Document. Document your assessment of risk, rationale, intervention, and follow up. Inform
treating provider of the call and interventions.
i.If it is determined that the caller is in danger, you may offer to call 9-1-1 for them
to do a safety check and determine if a 5150 hold should be written.
ii.If the caller is with someone who is safe and feels they can transport the caller to
the CSU, recommend that they bring the caller in for an immediate evaluation.
b.Non-Emergency Calls
1)The caller is requesting only information about mental health services and does not wish
to access services at the time nor receive a call back.
2)The caller is requesting mental health services.
3)The caller wishes to leave a message for his/her current care provider.
4)The caller is requesting a Medi-Cal Mental Health Booklet or Provider List.
5)The caller wishes to file or obtain information about how to file a complaint, grievance, or
appeal with the Fresno County Mental Health Plan.
6)The caller is calling for information about services from the Fresno County Mental Health
Plan (DBH) or about something other than what is mentioned above.
c.User Accounts: Access to the Database for designated CONTRACTOR staff shall be restricted
to inputting call data only.
1)New User Account: CONTRACTOR must submit the following for each designated staff
member requiring access to the Database to set up a user account:
i.First and last name,
ii.Hire date (mm/dd/yyyy), and
iii.Unique identification number (employee ID, clock-in ID, etc.) as assigned by
CONTRACTOR.
2) Account: CONTRACTOR shall notify DBH within 24 hours of any change to user status
or when a user is no longer employed by CONTRACTOR.
d.Password Resets:
1)During Normal Business Hours: A user can request his/her password to be reset by
personally calling DBH’s Information Systems Division Services (ISDS) during normal
business hours. User must verify his/her identity by providing ISDS their full name, hire
date and unique Identification. A new temporary password will be provided upon
satisfactory self-identification.
2)After Normal Business Hours: User will not be able to have his/her password reset after
normal business hours as ISDS will be closed. It is expected that CONTRACTOR staff
assigned to operate the Access Line will set their user accounts during DBH business
hours.
REVISED EXHIBIT A-3-a
Page 4 of 6
2.Log All Calls:
a.All calls received on the Access Line phone number and by any DBH program utilizing the
phone service shall be logged into the Database, including calls patched to 911 as well as non-
mental health related requests.
b.Information about programs and services requested by callers shall be provided in accordance
to instructions in the Database decision tree.
c.If a user is unable to access the Database temporarily for any reason to log calls (including staff
without an appropriate user account), the user shall document the call by gathering the following
information about the call/caller/client. This information will then be transmitted to DBH via a
facsimile machine to a designated confidential electronic fax number provided by DBH: For
adults, FAX will be transmitted to (559) 600-7615. For children (less than 18 years of age) FAX
will be transmitted to (559) 600-7701.
1)Call Type
2)Interpreter Needed? (No/Yes)
3)Language (Specify)
4)Info is for Caller/Client (Identify)
5)First Name
6)Last Name
7)Call Back Phone #
8)Date of Birth (of person seeking services)
9)Estimated Age (Ask for this information only after DOB has been requested and cannot
be provided)
10)Comments (Specify the reason for call: caller wants to file an appeal, hearing voices
and wants to talk to a therapist, connected to 911, etc.)
If the frequency of such occurrences (inability to access the database) reaches a level, as
determined by DBH and regardless of cause that warrants more detailed information to be
logged, CONTRACTOR may be requested to provide up to the level of detail as is collected by
the Database. It is the responsibility of CONTRACTOR to notify DBH, ISDS staff, or designated
staff if the Database Access Log is not accessible.
3.Language Interpreter Services: CONTRACTOR shall utilize the account set up through Fresno
County’s contracted language line provider, currently Linguistica International, to provide interpreter
services to callers when necessary or appropriate. A Language Line Quick Reference Guide is
embedded in the Database as part of the decision tree to assist operators with accessing this service.
a. Instances considered necessary or appropriate include, but are not limited to, when such
services is being requested or is accepted by the caller; the operator does not speak the caller’s
language; or the operator feels such services are necessary for effective communication with
the caller.
b.All costs related to the use of language line services through this account will be paid for by
Fresno County directly to the contracted language line provider and shall not be a part of this
Agreement.
c.DBH is not responsible for costs related to interpreter services provided to callers by any other
party or agency.
REVISED EXHIBIT A-3-a
Page 5 of 6
4.TDD/Relay Service: CONTRACTOR shall utilize either a Telecommunication Device for the Deaf
(TDD) service or Telecommunication Relay Services (TRS) when handling calls from clients who are
Deaf, Hard of Hearing, Speech-Disabled or Deaf and Blind. CONTRACTOR may utilize the TRS if
unable to secure TDD equipment, to communicate with a caller whom the operator determines may be
deaf, hearing-impaired or speech-disabled.
5.Evaluation of Protocols: CONTRACTOR and DBH will collaborate in the ongoing evaluation of
protocols for the design and flow of Access Line services. Changes to the Access Line will be mutually
agreed upon by CONTRACTOR and DBH and be in accordance with mandates by the State of
California.
PERFORMANCE MEASUREMENTS AND MONITORING
As mandated by the State, CONTRACTOR shall meet all performance goals on a monthly basis as detailed
below in Table A. The Database is designed to enable telephone operators to appropriately handle calls
received on the Access Line and to collect the required information within the Access Log.
1.Performance Measures:
Table A: Performance Measures
# Performance Measure Goal
1. Call was logged in Access Line Database 100%
2. Operator asked if the caller’s/client’s situation is an emergency 100%
3. Operator asked for caller’s/client’s name 100%
4. Operator logged caller’s/client’s name accurately in Database. Calls where
caller does not provide a name will be recorded as such, “No Name Provided.”
100%
5. Operator asked for caller’s/client’s call back phone number 100%
6. Operator logged caller’s/client’s call back phone number accurately in Database 100%
7. Operator asked for the reason for call 100%
8. Operator logged the reason for call accurately in Database 100%
9. Operator utilized language line service when applicable
a.Caller requests/accepts interpreter services
b.Operator does not speak the caller’s language
c.Operator feels interpreter services are necessary
100%
10. Operator provided appropriate linkages to mental health services
a.To the adult services program(s) as indicated in the Access Line
Database
b.To the children’s services program(s) as indicated in the Access Line
Database
100%
11. Operator provided information on the grievances/appeals/State fair hearing
process
100%
2.Performance Monitoring: DBH will conduct test calls of the Access Line on a monthly basis to monitor
the performance measures described in Table A.
a.Test calls may be made in English and/or non-English languages as deemed appropriated by
DBH.
REVISED EXHIBIT A-3-a
Page 6 of 6
b.The number of test calls performed by DBH to the Access Line each month shall, at minimum,
match the number of test calls conducted by the State during their review of the Access Line as
stated in the most recent version of the State Medi-Cal Protocol. For Fiscal Year 2016-17, the
number of test calls will be, at minimum, seven (7) per month.
c.Test Call Outcomes Feedback: DBH will provide feedback on test call outcomes to
CONTRACTOR designated staff overseeing the Access Line as follows:
1)The results of test calls shall be provided to CONTRACTOR designated staff as soon as
possible after all calls are performed and the “Access Line Test Call Feedback Form”
(Revised Exhibit M) is completed. Form is to be completed by Test Caller. The form may
be updated to reflect new reporting needs as appropriate.
2)The results of individual test calls shall be provided to CONTRACTOR designated staff
within 24 hours or as soon as possible, if needed, if immediate concerns arises as the
result of the call.
3)A monthly Test Call Outcomes Summary Report of all test calls performed during the
preceding month shall be provided to CONTRACTOR within 14 days after month end.
3.Corrective Action Plan: An “Access Line Statement of Deficiencies and Plan of Correction” (Revised
Exhibit N) shall accompany the monthly Test Call Outcomes Summary Report if any goal was unmet
(outcome falls below 100%) or issues related to test calls were not resolved satisfactorily. The form
may be updated to reflect new reporting needs as appropriate.
a.The “Category” and “Summary Statement of Deficiencies” will be completed by DBH based
upon findings from the monthly report.
b.CONTRACTOR shall complete the “Provider’s Plan of Correction” and “Completion Date”
sections, sign and date the form and return it to the department within 14 calendar days from
the date of receipt.
c.The completed form shall be returned to the designated DBH staff, in compliance with HIPAA
regulations regarding safeguarding client information when applicable.
E-MAILING PROTECTED HEALTH INFORMATION (PHI)
Any e-mail communication with/to DBH staff containing client Protected Health Information (PHI) shall be done
so in compliance with HIPAA regulations on PHI as follows:
1.Include the Confidentiality Statement below at the beginning of all e-mails containing PHI and at the
beginning of each e-mail in a string of emails that contain PHI.
2.Confidentiality Statement:
Confidentiality Statement: This e-mail message, including any attachments, is for the
sole use of the intended recipient(s) and may contain confidential and privileged
information. Any unauthorized review, use, disclosure or distribution is prohibited. If you
are not the intended recipient, please contact the sender without using reply e-mail and
destroy all copies of the original message.
3.Examples of PHI: Client Name, Address, Phone Number, Date of Birth, Social Security Number
4.Do not include the client’s name in the “Subject” line of the e-mail.
5.All phone calls and messages emailed to DBH staff containing PHI shall be sent as an encrypted
attachment. A standard password will be provided by DBH. Do not list the password within the body of
the e-mail.
Note: when appropriate, DBH ISDS staff is available to provide technical support.
Exhibit A-4
Page 1 of 11
FAMILY URGENT RESPONSE SYSTEM (FURS) MOBILE RESPONSE TEAM
Scope of Work (SOW)
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 3520 E Shields Ave, Fresno, CA 93726
SERVICES: FURS Mobile Response Team
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: July 1, 2021 – June 30, 2022
SOW AMOUNT: $369,447
TARGET POPULATION:
The target population will include individuals who are current or former foster child or youth,
which is defined to include “a child or youth adjudicated under Section 300, 601, or 602 and who
is served by a county child welfare agency or probation department, and a child or youth who has
exited foster care to reunification, guardianship, or adoption. A current or former foster child or
youth shall be eligible for services under this chapter until they attain 21 years of age.” There is
no time restriction on when an exit must have occurred for a former foster youth. The former
foster youth may have been adopted, re-unified, or appointed a legal guardian at an early age
and can still access FURS.
PROJECT DESCRIPTION:
Family Urgent Response System (FURS) for Caregivers and Children or Youth, originally enacted
through Section 107 of Senate Bill 80 (Statute of 2019) and amended by Assembly Bill 79
(Statutes of 2020), is a coordinated statewide, regional, and county-level system designed to
provide collaborative and timely state-level phone-based response, as well as county-level in-
home/community, in-person mobile response during situations of instability for purposes of
preserving the relationship of the caregiver and the child or youth.
FURS is intended to provide support to current and former foster youth as well as their caregivers.
FURS also requires the COUNTY Department of Social Services (DSS) Child Welfare, Probation
Department (Probation), and Department of Behavioral Health (DBH) to establish a joint county-
based Mobile Response System, including a mobile crisis team to provide in-person support and
stabilization, as needed. FURS builds upon the Continuum of Care Reform and the State’s recent
System of Care development to assist current and former foster youth and their caregivers with
trauma-informed supports intended to have multiple effects, including:
•Preventing placement disruptions and preserving the relationship between the child or
youth and their caregiver;
•Preventing the need for a 911 call or law enforcement involvement and avoiding the
Exhibit A-4
Page 2 of 11
criminalization of traumatized youth;
•Preventing formal engagement or re-engagement of the Child Welfare System;
•Preventing psychiatric hospitalization and placement into congregate care; and
•Promoting healing as a family in order to provide current and former foster youth and their
caregivers with immediate, trauma-informed support when needed.
To meet the requirements of FURS, the COUNTY’s DSS, Probation, and DBH are required to
establish a joint COUNTY-based Mobile Response System that includes a FURS Mobile Response
Team. The services provided by the FURS Mobile Response Team will be provided by
CONTRACTOR. The FURS Mobile Response Team shall provide face-to-face, in home (or in
community) response on a twenty-four (24) hours per day, seven (7) days a week (24/7) basis, 365
days of the year, to provide supportive services to address situations of instability, preserve the
relationship of the caregiver and the child or youth, develop healthy conflict resolution and
relationship skills, promote healing as a family, and stabilize the situation. These services are
intended to support the youth and families and foster a trusting and healing environment.
CONTRACTOR’s Mobile Response Team shall be a mobilized coordinated response by
COUNTY’s DSS and DBH staff (as well as COUNTY’s Probation staff, when applicable). In
accordance with the terms and conditions of this Agreement, CONTRACTOR shall respond on
behalf of COUNTY’s DBH. COUNTY’s DSS Child Welfare System will assist CONTRACTOR with
any relevant current or former foster youth and will respond with CONTRACTOR for any calls that
require an in-person response. COUNTY’s Probation shall assist when validation or information is
necessary for individuals that are or were a part of the Probation system.
CONTRACTOR’s FURS program will operate a culturally competent, person-centered delivery
model that will meet the multiple systemic needs of this population in the least restrictive
environment. These needs include in-home coaching for individuals, families and caregivers,
coordination between multiple agencies including mental health providers, schools, hospitals,
courts, Probation and a host of other systems that become involved in the lives of these youth and
families.
CONTRACTOR’S RESPONSIBILITIES:
A.Timeline
CONTRACTOR shall begin claiming for Medi-Cal specialty mental health services after
becoming officially Medi-Cal site certified and staff fully credentialed by DBH Managed
Care.
B.Location of Services
Services shall be provided wherever the current or former foster youth is currently located.
CONRACTOR’s Mobile Crisis Team shall be able to respond to any location necessary
within Fresno County.
C.Hours of Operation
Services shall be provided on a 24/7 basis.
Exhibit A-4
Page 3 of 11
CONTRACTOR’s required response times are as follows:
1.Urgent Response: The Mobile Response Team must be prepared and able to provide
immediate, in-person support 24/7, including during normal business hours. Immediate
is defined as preferably within one (1) hour, but not to exceed three (3) hours in
extenuating circumstances for urgent needs.
2.Non Urgent Response: For non-urgent situations, same-day response (or within 24
hours) is required.
D.Description of Services
The California Department of Social Services (CDSS) operates the established statewide
hotline that will receive the initial call from the caregiver or foster care youth (current or
former) in order to effectively engage caregivers and youth who are experiencing instability,
including tension or conflict, in their relationships, emotional distress, or behavioral or other
difficulties that may threaten their relationships. The CDSS FURS statewide hotline will
triage the calls received to determine when an immediate response is required and will
route all immediate calls to the COUNTY. CONTRACTOR wil receive said calls on behalf
of the COUNTY.
If in-person support is warranted, the CDSS FURS hotline worker will seek to engage each
caller to establish a direct and live connection through a three-way call that includes the
hotline worker, caregiver, youth, and the COUNTY’s mobile response contact
(CONTRACTOR) in order to conduct a “warm handoff” to the COUNTY’s FURS Mobile
Response Team. The warm handoff allows for the transfer of information between the
CDSS statewide hotline and the COUNTY’S Mobile Response System without requiring the
family to repeat information or undergo a second triage process.
CONTRACTOR will incorporate COUNTY’s DSS into the call for additional information
required from the Child Welfare System/Case Management System (CWS/CMS), as
appropriate. If the youth is currently or formerly in the COUNTY Probation system, then
CONTRACTOR will incorporate COUNTY’s Probation into the phone call. Once all
necessary information is obtained, CONTRACTOR will deploy their FURS Mobile
Response Team to provide the youth, caregiver and family with immediate support in an
effort to stabilize the situation and prevent placement disruption. This support will ultimately
improve overall placement stability and help reduce some of the negative short- and long-
term effects from placement disruptions in foster care.
During the warm handoff, CDSS FURS hotline staff will remain on the line with the
CONTRACTOR until it is clinically appropriate to complete the process of transferring the
call. During the warm handoff, the CDSS FURS hotline staff will assure that there is a
supportive handoff that supports the youth and/or caregiver throughout the entire process.
Youth and family voice and choice shall be honored and respected throughout this process
to provide individualized support. Additionally, the CDSS FURS hotline staff will confirm
that there is a clear plan to provide in-person support, including arrangements for location
and expected timeline.
If direct three-way communication cannot be established, the CDSS FURS hotline worker
will make a referral directly to the COUNTY-based service and a follow-up call to ensure
that a connection to the caregiver, or youth occurs.
Exhibit A-4
Page 4 of 11
When the call involves a child or youth who is a member of an Indian Tribe, a Tribal Agency
or other identified service provider may be an appropriate support. Additionally, an involved
Foster Family Agency (FFA) may be an appropriate support if it provides case
management, conflict resolution and support to their resource parents.
CONTRACTOR should utilize the information provided by the CDSS FURS statewide
hotline during the warm handoff to determine how to respond, which COUNTY
Department(s) will need to be involved, and when the CONTRACTOR’s Mobile Response
Team will need to respond (i.e., urgent or non-urgent response).
CONTRACTOR’s FURS Mobile Response Team may provide services such as de-
escalation, crisis stabilization, and/or reconnection to social services or mental health
services. In addition to providing trauma-informed, in-person support, the CONTRACTOR’s
FURS Mobile Response Team will be expected to provide the family with a plan of action to
address identified additional support or ongoing stabilization needs and connect them to
needed ongoing services through the existing local network of care service systems.
The CONTRACTOR’s responsibilities include the following:
1.Receive live phone response from CDSS FURS statewide hotline that facilitates entry of
the caregivers and current or former foster youth into mobile response services;
2.Establishing a process for determining which COUNTY Department(s) will respond with
the CONTRACTOR’s FURS Mobile Response Team;
3.CONTRACTOR’s FURS Mobile Response Team shall be available 24/7 and able to
provide immediate, in-person, face-to-face response preferably within one (1) hour, but not
to exceed three (3) hours in extenuating circumstances for urgent needs, or same-day
response within twenty-four (24) hours for non-urgent situations;
4.Utilization of Mobile Response Team staff with specialized training in trauma of children
or youth and the foster care system.
5.Provision of in-home/community de-escalation, stabilization, and support services,
including all of the following:
a)Establishing in-person, face-to-face contact with the youth and caregiver;
b) Identifying the underlying causes of, and precursors to, the situation that led to the
instability;
c)Identifying the caregiver interventions attempted;
d) Observing the child and caregiver interaction;
e)Diffusing the immediate situation;
f)Coaching and working with the caregiver and the youth in order to preserve the
family unit and maintain the current living situation or create a healthy transition
plan, if necessary;
Exhibit A-4
Page 5 of 11
g)Establishing connections to other COUNTY- or community-based supports and
services to ensure continuity of care, including, but not limited to, linkage to
additional trauma-informed and culturally and linguistically responsive family
supportive services and youth and family wellness resources;
h)Following up after the initial face-to-face mobile response to determine if additional
supports or services are needed; and
i)Identifying any additional support or ongoing stabilization needs for the family and
developing a plan for, or referral to, appropriate youth and family supportive services
within the COUNTY. Supportive services may also be available through community-
based organizations, foster family agencies, or tribal agencies.
E.Types of Services
Ongoing supportive face-to-face services including, but are not limited to
1) Motivational Interviewing and Positive Psychology
2)Harm Reduction
3)Develop healthy conflict resolution skills
4)Relationships /social skills
5)Stabilize crisis situation
6)Trauma informed care
7)Develop plan of action with family input
8)Identify additional services needed and assist with linkage and barriers
9)Assess safety, potential for psychiatric hold, coordinate with CONTRACTOR’s Youth
Crisis Stabilization Center as well as other related providers
F.Staffing
CONTRACTOR shall staff its FURS Mobile Response Team with individuals with
specialized training in trauma informed care of children or youth and the foster care
system.
CONTRACTOR’s staff for the FURS Mobile Response Team must be separate and
distinct from other staff already employed to provide services under this Agreement for
the CONTRACTOR’s Crisis Stabilization Center.
CONTRACTOR shall make efforts to include peer partners and those with lived
experience in the FURS Mobile Response Team, whenever possible. There should be
one peer partner for the youth and one peer partner for the caregiver, if possible.
Clinical Staff - The clinical staff of CONTRACTOR shall be composed of all licensed
mental health or waivered/registered professionals as included in CCR, Title 9, Division 1,
Chapter 11, Article 3, Section 1840.348 (Crisis Stabilization Staffing Requirements).
Exhibit A-4
Page 6 of 11
G. Training
Once qualified staff members are hired, they are all given extensive training in the
population being served, in the multi-systemic collaboration that is expected, and in the
specific psychoeducational modality that is employed. All staff would be expected to
participate in all of the training provided in the FURS model. Training will include
information on crisis prevention, calming children in crisis, trauma informed practices, in-
home coaching and provider support. This twenty-eight hours (28) of online and in-
person training developed by CONTRACTOR’s education department is to address the
needs of the clients.
1. CONTRACTOR’s staff must receive the typical COUNTY-required training as described
within this Agreement for Medi-Cal site certified/credential staff.
2. CONTRACTOR must also provide trauma informed care and conflict resolution training
to all staff on its FURS Mobile Response Team.
3. CONTRACTOR will be required to develop and submit a training plan for all FURS
Mobile Response Team staff. The training plan should include hours of training for new staff
as well as ongoing training for existing staff. The detailed training plan for FURS staff should
include topics important to the program scope such as:
a) Child Welfare/Probation Overview (including a review of Foster Youth Rights).
b) De-escalation, crisis intervention and conflict resolution.
c) Trauma Informed Care and the impact of trauma on child and youth development
and behavior.
d) Short-term intervention strategies.
e) Principles of behavior management/modification.
f) Sexual Orientation and Gender Identity and Expression (SOGIE).
g) Healthy Parenting Skills and Positive Discipline Coaching.
h) Healthy Coping Skills.
i) Mandated Reporter Training.
j) Suicide Prevention.
k) Secondary Trauma.
H. Data Collection and Data Elements
Data Collection Requirements
CONTRACTOR must establish protocols for data collection including, but not limited to:
Exhibit A-4
Page 7 of 11
1.Data collection efforts to track all incoming calls (including all Data Elements listed
below) as well as the number of individuals with follow up case management needs
(including length of time that CONTRACTOR provides service to each individual)
2.Transitions from mobile response and stabilization services to ongoing services;
3.A process for identifying if the child or youth has an existing child and family team so
that efforts can be coordinated to address the instability, and a plan can be made for
ongoing care to support that relationship in a trusting and healing environment;
4.A process and criteria for determining mobile responses;
5.The composition of the staff on the FURS Mobile Response Team, including efforts to
include peer partners and those with lived experience in the response team, whenever
possible;
6.Both existing and new services that will be used to support the mobile response and
stabilization services;
7.Response protocols for the child or youth in family-based and congregate care settings
based on guidelines developed by California Department of Social Services (CDSS), in
consultation with stakeholders. The response protocols shall ensure protections for
children and youth to minimize use of congregate care settings, psychiatric institutions,
and hospital settings;
8.A process for identifying whether the child or youth has an existing mental health
treatment plan and a placement preservation strategy through child welfare or
probation, and for coordinating response and services consistent with the plan and
strategy; and
9.A plan for the mobile response and stabilization team to provide supportive services in
the least intrusive and most child, youth, and family friendly manner, such that mobile
response and stabilization teams do not trigger further trauma to the child or youth.
Data Elements
The following data elements must be tracked as required by CDSS and submitted to DBH
on a monthly basis (or different rate of frequency as established by DBH),
CONTRACTOR must abide by all then-enacted requirements.
1.CWS/CMS client identifier
2.FURS youth identifier (for all children/youth, including those with no CWS/CMS client
identifier)
3.Status of youth as current or former foster youth or current or former probation youth
4.First name of youth
5.Last name of youth
6.Date of birth of youth
Exhibit A-4
Page 8 of 11
7.Gender of youth (values as defined by CDSS)
8.Race/Ethnicity of youth (values as defined by CDSS)
9.Date of call/response
10. Call initiated by caregiver or youth
11.Incident type
I.Medical Records
1.The CONTRACTOR shall maintain records in accordance with Exhibit D,
“Documentation Standards for Client Records.” During site visits, COUNTY shall be
allowed to review records of services provided.
2. The CONTRACTOR will be responsible for “release of information” requests and shall
adhere to applicable federal and state regulations.
J.Utilization Review, Billing and Cost Report:
1.CONTRACTOR shall enter all mental health data and billing information into the
COUNTY’s electronic information system and will be responsible for any and all audit
exceptions pertaining to the delivery of services.
2.CONTRACTOR shall ensure that cost reports are prepared in accordance with General
Accepted Accounting Principles (GAAP) and the standards set forth by the DHCS and
the COUNTY.
K.Grievances and Incident Reports
1.CONTRACTOR shall have all grievance forms readily available for clients and their
families.
2.CONTRACTOR shall log all grievances and the disposition of all grievances received
from a client or a client’s family in accordance with FCMHP policies and procedures as
indicated within Exhibit G. CONTRACTOR shall provide a summary of the grievance
log entries concerning COUNTY-sponsored clients to the DBH Director, or designee, at
monthly intervals, by the fifteenth (15th) day of the following month, in a format that is
mutually agreed upon. CONTRACTOR shall post signs, provided by the COUNTY,
informing clients of their right to file a grievance and appeal.
Within fifteen (15) days after each grievance or incident affecting COUNTY-sponsored
clients, CONTRACTOR shall provide COUNTY with the complaint and
CONTRACTOR’s disposition of, or corrective action taken to resolve the complaint or
incident.
L.Cultural Competency
1.Ensure compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section
Exhibit A-4
Page 9 of 11
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 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
subcontracted 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 COUNTY’s DBH Cultural Diversity Committee
scheduled 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 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. Sensitivity to gender and sexual
orientation must be covered in annual training.
10.Utilize existing community supports, referrals to transgender support groups, etc.,
when appropriate.
Exhibit A-4
Page 10 of 11
11. Attend annual Cultural Competence, Compliance, Health Insurance Portability and
Accountability Act (HIPAA), Billing, and Documentation training provided by COUNTY’s
DBH.
12.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, any resulting
actions regarding 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.
M.Administrative Meetings
1.CONTRACTOR shall participate in periodic workgroup meetings scheduled by staff
from COUNTY’s DBH Mental Health Contracted Services Division. The meetings shall
be held monthly, or as needed, to discuss contract requirements, data reporting,
outcomes measurement, training, policies and procedures, and overall program
operations.
2.CONTRACTOR’s administrative level agency representative, who is duly authorized to
act on behalf of CONTRACTOR, shall attend regularly scheduled monthly Behavioral
Health Board meetings.
3.CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider Meetings,
as scheduled by staff from COUNTY’s Mental Health Contracted Services Division,
when deemed necessary by the DBH Director, or designee.
4.CONTRACTOR may also be asked to make presentations in the community about the
program and services that are available.
N.Program Outcomes
CONTRACTOR’s FURS will collect and manage the specific outcomes identified by SB
80. Any additional measures identified by COUNTY’s DSS and/or DBH will be completed.
The following outcomes are designed to reduce the number of crises each individuals’
experiences annually during participation in the CONTRACTOR’s FURS Program and
achievement percentages to be determined in collaboration with COUNTY’s DBH and
DSS.
CONTRACTOR’S FURS Program will:
1.Reduce the need for a 911 call or law enforcement involvement, avoiding
criminalization and traumatized youth.
2.Prevent psychiatric hospitalizations and placement into a short term residential
therapeutic program setting.
3.Help in preventing placement disruptions and preserving the relationship between the
child or youth and their caregiver.
4.Work towards promoting healing as a family for foster youth and caregivers.
Exhibit A-4
Page 11 of 11
COUNTY RESPONSIBILITIES:
COUNTY shall:
1.Perform a utilization review, annually at a minimum, (through its FCMHP) of ten percent
(10%) of all admissions to determine that the documentation demonstrates that medical
necessity criteria as defined by the DHCS were met throughout the duration of the crisis
stabilization episode. The FCMHP will maintain discretion regarding possible subsequent
utilization review beyond ten percent (10%), as necessary.
2.Provide oversight of the CONTRACTOR’s FURS Mobile Response Team. In addition to
contract monitoring of program(s), oversight includes, but is not limited to, coordination with
the DHCS in regard to program administration and outcomes.
3.Assist the CONTRACTOR in making linkages to the appropriate level of care within the
behavioral health system of care to ensure continuity of care. This will be accomplished
through regularly scheduled meetings as well as formal and informal consultation.
4.Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the CONTRACTOR staff and will be available to the contractor for ongoing
consultation.
5.Receive and analyze statistical outcome data from CONTRACTOR throughout the term of
contract on a monthly basis. DBH will notify the CONTRACTOR 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 methods of obtaining required information.
6.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.
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Director of Education & Quality 0.71 102,053$ -$ 102,053$
1102 Program Director (RN)0.53 - 78,676 78,676
1103 Program Nurses (RN)7.65 - 675,406 675,406
1104 Program Nurses (LVN)14.09 - 901,265 901,265
1105 Program Nurses (LPTN)2.51 - 116,293 116,293
1106 Social Services Coordinators 3.37 - 250,864 250,864
1107 Mental Health Worker 16.26 - 793,231 793,231
1108 Data Specialist 0.71 26,814 - 26,814
1109 Benefits/PAP Coordinator 0.71 35,241 - 35,241
1110 Program Assistant 0.71 36,945 - 36,945
1111 Driver 0.71 31,333 - 31,333
1112 Peer Counselor 1.92 90,439 - 90,439
1113 Intake Coordinator 0.36 19,365 - 19,365
1114 Billing Supervisor 0.14 9,583 - 9,583
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 50.38 351,773$ 2,815,735$ 3,167,507$
Employee Benefits
Acct #Admin Direct Total
1201 136,863$ -$ 136,863$
1202 196,370 - 196,370
1203 261,826 - 261,826
1204 - - -
1205 - - -
1206 - - -
595,059$ -$ 595,059$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1301 30,243$ -$ 30,243$
1302 214,447 - 214,447
1303 30,243 - 30,243
1304 - - -
1305 - - -
1306 - - -
274,933$ -$ 274,933$
1,221,765$ 2,815,735$ 4,037,499$
2000: CLIENT SUPPORT
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)
Adult Crisis Stabilization Center (CSC)
Exodus Recovery Inc.
FY 2021-2022
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Revised Exhibit B-1-a
Page 1 of 7
Acct #Amount
2001 -$
2002 -
2003 6,526
2004 -
2005 -
2006 -
2007 -
2008 18,596
2009 56,510
2010 -
2011 81,577
2012 -
2013 -
2014 -
2015 -
2016 -
163,209$
3000: OPERATING EXPENSES
Acct #Amount
3001 33,544$
3002 1,333
3003 100,734
3004 1,464
3005 25,400
3006 3,258
3007 -
3008 1,410,824
3009 Other - Flex Funds 34,045
3010 30,599
3011 1,164
3012 -
1,642,363$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 28,456$
4002 -
4003 38,549
4004 -
4005 959,242
4006 89,688
4007 9,310
4008 58,283
4009 -
4010 -
1,183,528$
5000: SPECIAL EXPENSES
Acct #Amount
5001 40,885$
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Consultant (Network & Data Management)
Security
Utilities
Other - Businesss Taxes/Licenses - Permits
Other - Janitorial
Other (specify)
Other (specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Other - Personnel Related Exp/Contracted PR Exp/Parking
Other - Laundry Service
Other - Staff Travel (Out of Office)
Other (specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Legal Notices/Advertising
Staff Development and Training
Staff Mileage/Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports (Pharmaceuticals)
Program Supplies - Medical
Utility Vouchers
Other - Food Service
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
Revised Exhibit B-1-a
Page 2 of 7
5002 -
5003 -
5004 1,552
5005 1,552
5006 -
5007 -
5008 -
43,989$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 1,075,302$
6002 22,512
6003 1,092
6004 1,507
6005 -
6006 -
6007 -
6008 -
6009 -
6010 -
6011 -
6012 -
1,100,413$
7000: FIXED ASSETS
Acct #Amount
7001 7,100$
7002
7003 7,532
7004 -
7005 -
7006 -
7007 32,126
7008 -
46,758$
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 63,147 130.14 8,217,759
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
63,147 8,217,759$
85%
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
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 8,217,759$
Assets over $5,000/unit (Specify)
Other - EHR Avatar Cost
Other (specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Services
Pharmaceutical Consultants
Other (specify)
Other (specify)
Other (specify)
Insurance (Specify):
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Revised Exhibit B-1-a
Page 3 of 7
6,985,095
50%3,492,548
3,492,548$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment 3,492,548$
3,492,548$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
-$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance 164,355
8403 -
8404 1,068,309
8405 -
1,232,664$
Grants (Specify)
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:8,217,759$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Other - Uninsured
Other (Specify)
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
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Revised Exhibit B-1-a
Page 4 of 7
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 4,037,499
Employee Salaries 3,167,507
1101 Director of Education & Quality 102,053 Replaced VP position 0.71 FTE, Administrative Services - proposed annual salary
$143,736, total annual budget $102,053. 71% of annual salary allocated to CSC
Adult.
1102 Program Director (RN)78,676 0.53 FTE, Administrative Services - proposed annual salary $110,811, total annual
budget $78,677. 71% of annual salary allocated to CSC Adult
1103 Program Nurses (RN)675,406 7.65 FTE, Direct Services - total annual budget $675,406
1104 Program Nurses (LVN)901,265 14.09 FTE, Direct Services - total annual budget $901,265
1105 Program Nurses (LPTN)116,293 2.51 FTE, Direct Services -total annual budget $116,293
1106 Social Services Coordinators 250,864 3.37 FTE, Direct Services - proposed annual salary $74,385, total annual budget
$250,864. 71% of annual salary allocated to CSC Adult.
1107 Mental Health Worker 793,231 16.26 FTE Direct Services - average annual salary $48,787, proposed annual budget
$793,231. 71% of annual salary allocated to CSC Adult.
1108 Data Specialist 26,814 0.71 FTE, Administrative Services - average annual salary $37,766, proposed annual
budget $26,814. 71% of annual salary allocated to CSC Adult.
1109 Benefits/PAP Coordinator 35,241 0.71 FTE, Administrative Services - average annual salary $49,635, proposed annual
budget $35,241. 71% of annual salary allocated to CSC Adult.
1110 Program Assistant 36,945 0.71 FTE, Administrative Services - average annual salary $52,035, proposed annual
budget $36,945. 71% of annual salary allocated to CSC Adult.
1111 Driver 31,333 0.71 FTE, Administrative Services - average annual salary $44,130, proposed annual
budget $31,333. 71% of annual salary allocated to CSC Adult.
1112 Peer Counselor 90,439 1.92 FTE, Direct Services - average annual salary $47,177, proposed annual budget
$90,439. 71% of annual salary allocated to CSC Adult.
1113 Intake Coordinator 19,365 0.36 FTE, Administrative Services - average annual salary $27,274, proposed annual
budget $19,365. 71% of annual salary allocated to CSC Adult.
1114 Billing Supervisor 9,583 0.14, Administrative Services - average annual salary $13,497, proposed annual
budget $9,583. 71% of annual salary allocated to CSC Adult.
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 595,059
1201 Retirement 136,863 Employer contributions to a pool of funds set aside for employees future benefit
1202 Worker's Compensation 196,370 Business Insurance that provides beenfits to employees who suffer work-related
injuries
1203 Health Insurance 261,826 Employer covered health insurance plan
1204 Other (specify)-
1205 Other (specify)-
1206 Other (specify)-
Payroll Taxes & Expenses:274,933
1301 OASDI 30,243 Old-Age, Survivors, and Disability Insurance Program
1302 FICA/MEDICARE 214,447 Federal Payroll Tax
1303 SUI 30,243 State Unemploymet Insurance
1304 Other (Specify)-
1305 Other (Specify)-
1306 Other (Specify)-
2000: CLIENT SUPPORT 163,209
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support 6,526 Cost for lease of vehicle, gas, and maintenance for client transportation
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
Adult Crisis Stabilization Center (CSC)
Exodus Recovery Inc.
FY 2021-2022
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit B-1-a
Page 5 of 7
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2008 Medication Supports (Pharmaceuticals)18,596 Medication Cost for clients
2009 Program Supplies - Medical 56,510 Medical Supplies for Clients
2010 Utility Vouchers -
2011 Other - Food Service 81,577 Cost for food services for program clients
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 1,642,363
3001 Telecommunications 33,544 Cost of phone usage expense for the program
3002 Printing/Postage 1,333 Program related printing/postage cost
3003 Office, Household & Program Supplies 100,734 Cost for office supplies and equipment for the program
3004 Legal Notices/Advertising 1,464 Cost for advertising for staff recruitment and other program related advertising or
legal notices
3005 Staff Development and Training 25,400 Cost of ongoing training for staff
3006 Staff Mileage/Vehicle Maintenance 3,258 Cost for mileage, parking, travel expense for program staff
3007 Subscriptions & Memberships -
3008 Other - Personnel Related Exp/Contracted PR
Exp/Parking
1,410,824 Personnel related expenses including registry nurses as needed, parking, relocation
costs, etc. Filled open MD position (0.75 FTE at $240/HR) totaling additional
$374,400 (71% charged to Adult CSC) annually. $1,410,824 annual budget
3009 Other - Flex Funds 34,045 Cost of client supportive services including toiletries, food, bus tokens, etc.
3010 Other - Laundry Service 30,599 Cost for linen service for the program
3011 Other - Staff Travel (Out of Office)1,164 Cost for Employee Travel
3012 Other (specify)-
4000: FACILITIES & EQUIPMENT 1,183,528
4001 Building Maintenance 28,456 Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.).
Attach copy of lease agreements if available.
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 38,549 Lease cost for computers, printers, copier, and faxes for the program
4004 Rent/Lease Vehicles -
4005 Security 959,242 Cost for security personnel for the program
4006 Utilities 89,688 Cost for program utilities
4007 Other - Businesss Taxes/Licenses - Permits 9,310 Cost of related to business tax expense for the program
4008 Other - Janitorial 58,283 Cost for janitorial Service for the program
4009 Other (specify)-
4010 Other (specify)-
5000: SPECIAL EXPENSES 43,989
5001 Consultant (Network & Data Management)40,885 Cost for consultant IT firm support, network monitoring, and off-site backup for
program IT System
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services 1,552 Cost for translation services for the program
5005 Pharmaceutical Consultants 1,552 Cost medical and office related waste for the program
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
6000: ADMINISTRATIVE EXPENSES 1,100,413
6001 Administrative Overhead 1,075,302 Administrative overhead expense related to the program
6002 Professional Liability Insurance 22,512 Cost of insurance expense for liability, business property and vehicle policy
6003 Accounting/Bookkeeping 1,092 Cost of financial auditing and monthly financial reviews
6004 External Audit 1,507 Cost of External Audit Services
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit B-1-a
Page 6 of 7
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS 46,758
7001 Computer Equipment & Software 7,100 Computers replacementor repair and software for program
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 7,532 Furniture & fixtures replacement or repair
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other - EHR Avatar Cost 32,126 Cost for access to County-run HER
7008 Other (specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:8,217,759
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:8,217,759
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit B-1-a
Page 7 of 7
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Director of Education & Quality 0.29 41,684$ -$ 41,684$
1102 Program Director (RN)0.22 - 32,135 32,135
1103 Program Nurses (RN)3.12 - 275,871 275,871
1104 Program Nurses (LVN)5.75 - 368,122 368,122
1105 Program Nurses (LPTN)1.03 - 47,500 47,500
1106 Social Services Coordinators 1.38 - 102,464 102,464
1107 Mental Health Worker 6.64 - 323,996 323,996
1108 Data Specialist 0.29 10,952 - 10,952
1109 Benefits/PAP Coordinator 0.29 14,394 - 14,394
1110 Program Assistant 0.29 15,091 - 15,091
1111 Driver 0.29 12,798 - 12,798
1112 Peer Counselor 0.78 36,940 - 36,940
1113 Intake Coordinator 0.15 7,910 - 7,910
1114 Billing Supervisor 0.06 3,915 - 3,915
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 20.57 143,684$ 1,150,088$ 1,293,772$
Employee Benefits
Acct #Admin Direct Total
1201 55,902$ -$ 55,902$
1202 80,207 - 80,207
1203 106,943 - 106,943
1204 - - -
1205 - - -
1206 - - -
243,052$ -$ 243,052$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1301 12,353$ -$ 12,353$
1302 87,591 - 87,591
1303 12,353 - 12,353
1304 - - -
1305 - - -
1306 - - -
112,297$ -$ 112,297$
499,033$ 1,150,088$ 1,649,121$
2000: CLIENT SUPPORT
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)
Youth Crisis Stabilization Center (CSC)
Exodus Recovery Inc.
FY 2021-2022
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Revised Exhibit B-2-a
Page 1 of 7
Acct #Amount
2001 -$
2002 -
2003 2,666
2004 -
2005 -
2006 -
2007 -
2008 7,596
2009 23,081
2010 -
2011 33,321
2012 -
2013 -
2014 -
2015 -
2016 -
66,664$
3000: OPERATING EXPENSES
Acct #Amount
3001 13,701$
3002 544
3003 41,144
3004 598
3005 10,374
3006 1,332
3007 -
3008 576,252
3009 13,905
3010 12,498
3011 475
3012 -
670,823$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 11,624$
4002 -
4003 15,746
4004 -
4005 391,803
4006 36,633
4007 3,804
4008 23,805
4009 -
4010 -
483,415$
5000: SPECIAL EXPENSES
Acct #Amount
5001 16,698$
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Consultant (Network & Data Management)
Security
Utilities
Other - Businesss Taxes/Licenses - Permits
Other - Janitorial
Other (specify)
Other (specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Other - Personnel Related Exp/Contracted PR Exp/Parking
Other - Flex Funds
Other - Laundry Service
Other Staff Travel (Out of Office)
Other (specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Legal Notices/Advertising
Staff Development & Training
Staff Mileage/Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports (Pharmaceuticals)
Program Supplies - Medical
Utility Vouchers
Other - Food Service
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
Revised Exhibit B-2-a
Page 2 of 7
5002 -
5003 -
5004 633
5005 633
5006 -
5007 -
5008 -
17,964$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 441,934$
6002 9,195
6003 446
6004 615
6005 -
6006 -
6007 -
6008 -
6009 -
6010 -
6011 -
6012 -
452,190$
7000: FIXED ASSETS
Acct #Amount
7001 2,900$
7002 3,076
7003 -
7004 -
7005 -
7006 -
7007 13,122
7008 -
19,098$
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 25,813 130.14 3,359,275
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
25,813 3,359,275$
86%
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
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 3,359,275$
Assets over $5,000/unit (Specify)
Other - EHR Avatar Cost
Other (specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Services
Medical Waste Disposal
Other (specify)
Other (specify)
Other (specify)
Insurance (Specify):
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Revised Exhibit B-2-a
Page 3 of 7
2,888,976
50%1,444,488
1,444,488$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment 1,444,488$
1,444,488$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
-$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance 369,521
8403 -
8404 100,778
8405 -
470,299$
Grants (Specify)
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:3,359,275$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Other - Uninsured
Other (Specify)
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
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Revised Exhibit B-2-a
Page 4 of 7
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 1,649,121
Employee Salaries 1,293,772
1101 Director of Education & Quality 41,684 Replaced VP position 0.29 FTE, Administrative Services - proposed annual salary
$143,736, total annual budget $41,684. 29% of annual salary allocated to CSC Youth
1102 Program Director (RN)32,135 0.22 FTE, Administrative Services - proposed annual salary $110,811, total annual
budget $32,135. 29% of annual salary allocated to CSC Youth
1103 Program Nurses (RN)275,871 3.12 FTE, Direct Services - total annual budget $275,871
1104 Program Nurses (LVN)368,122 5.75 FTE, Direct Services - total annual budget $368,122
1105 Program Nurses (LPTN)47,500 1.03 FTE, Direct Services -total annual budget $47,500
1106 Social Services Coordinators 102,464 1.38 FTE, Direct Services - proposed annual salary $74,385, total annual budget
$102,464. 29% of annual salary allocated to CSC Youth.
1107 Mental Health Worker 323,996 6.64 FTE Direct Services - average annual salary $48,787, proposed annual budget
$323,996. 29% of annual salary allocated to CSC Youth.
1108 Data Specialist 10,952 0.29 FTE, Administrative Services - average annual salary $37,766, proposed annual
budget $10,952. 29% of annual salary allocated to CSC Youth.
1109 Benefits/PAP Coordinator 14,394 0.29 FTE, Administrative Services - average annual salary $49,635, proposed annual
budget $14,394. 29% of annual salary allocated to CSC Youth.
1110 Program Assistant 15,091 0.29 FTE, Administrative Services - average annual salary $52,035, proposed annual
budget $15,091. 29% of annual salary allocated to CSC Youth.
1111 Driver 12,798 0.29 FTE, Administrative Services - average annual salary $44,130, proposed annual
budget $12,798. 29% of annual salary allocated to CSC Youth.
1112 Peer Counselor 36,940 0.78 FTE, Direct Services - average annual salary $47,177, proposed annual budget
$36,940. 29% of annual salary allocated to CSC Youth.
1113 Intake Coordinator 7,910 0.15 FTE, Administrative Services - average annual salary $27,274, proposed annual
budget $7,910. 29% of annual salary allocated to CSC Youth.
1114 Billing Supervisor 3,915 0.06, Administrative Services - average annual salary $13,497, proposed annual
budget $3,915. 29% of annual salary allocated to CSC Youth.
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 243,052
1201 Retirement 55,902 Employer contributions to a pool of funds set aside for employees future benefit
1202 Worker's Compensation 80,207 Business Insurance that provides beenfits to employees who suffer work-related
injuries
1203 Health Insurance 106,943 Employer covered health insurance plan
1204 Other (specify)-
1205 Other (specify)-
1206 Other (specify)-
Payroll Taxes & Expenses:112,297
1301 OASDI 12,353 Old-Age, Survivors, and Disability Insurance Program
1302 FICA/MEDICARE 87,591 Federal Payroll Tax
1303 SUI 12,353 State Unemploymet Insurance
1304 Other (Specify)-
1305 Other (Specify)-
1306 Other (Specify)-
2000: CLIENT SUPPORT 66,664
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support 2,666 Cost for lease of vehicle, gas, and maintenance for client transportation
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
Youth Crisis Stabilization Center (CSC)
Exodus Recovery Inc.
FY 2021-2022
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit B-2-a
Page 5 of 7
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2008 Medication Supports (Pharmaceuticals)7,596 Medication Cost for clients
2009 Program Supplies - Medical 23,081 Medical Supplies for Clients
2010 Utility Vouchers -
2011 Other - Food Service 33,321 Cost for food services for program clients
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 670,823
3001 Telecommunications 13,701 Cost of phone usage expense for the program
3002 Printing/Postage 544 Program related printing/postage cost
3003 Office, Household & Program Supplies 41,144 Cost for office supplies and equipment for the program
3004 Legal Notices/Advertising 598 Cost for advertising for staff recruitment and other program related advertising or
legal notices
3005 Staff Development & Training 10,374 Cost of ongoing training for staff
3006 Staff Mileage/Vehicle Maintenance 1,332 Cost for mileage, parking, travel expense for program staff
3007 Subscriptions & Memberships -
3008 Other - Personnel Related Exp/Contracted PR
Exp/Parking
576,252 Other Personnel Related Exp/Contracted PR Exp/Parking - Personnel related
expenses including registry nurses as needed, parking, relocation costs, etc. Filled
open MD position (0.75 FTE at $240/HR) totaling additional $374,400 (29% charged
to Youth CSC) annually.
3009 Other - Flex Funds 13,905 Cost of client supportive services including toiletries, food, bus tokens, etc.
3010 Other - Laundry Service 12,498 Cost for linen service for the program
3011 Other Staff Travel (Out of Office)475 Cost for Employee Travel
3012 Other (specify)-
4000: FACILITIES & EQUIPMENT 483,415
4001 Building Maintenance 11,624 Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.).
Attach copy of lease agreements if available.
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 15,746 Lease cost for computers, printers, copier, and faxes for the program
4004 Rent/Lease Vehicles -
4005 Security 391,803 Cost for security personnel for the program
4006 Utilities 36,633 Cost for program utilities
4007 Other - Businesss Taxes/Licenses - Permits 3,804 Cost of related to business tax expense for the program
4008 Other - Janitorial 23,805 Cost for janitorial Service for the program
4009 Other (specify)-
4010 Other (specify)-
5000: SPECIAL EXPENSES 17,964
5001 Consultant (Network & Data Management)16,698 Cost for consultant IT firm support, network monitoring, and off-site backup for
program IT System
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services 633 Cost for translation services for the program
5005 Medical Waste Disposal 633 Cost medical and office related waste for the program
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
6000: ADMINISTRATIVE EXPENSES 452,190
6001 Administrative Overhead 441,934 Administrative overhead expense related to the program
6002 Professional Liability Insurance 9,195 Cost of insurance expense for liability, business property and vehicle policy
6003 Accounting/Bookkeeping 446 Cost of financial auditing and monthly financial reviews
6004 External Audit 615 Cost of External Audit Services
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit B-2-a
Page 6 of 7
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS 19,098
7001 Computer Equipment & Software 2,900 Computers replacementor repair and software for program
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
3,076
7003 Furniture & Fixtures - Furniture & fixtures replacement or repair
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other - EHR Avatar Cost 13,122 Cost for access to County-run HER
7008 Other (specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:3,359,275
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:3,359,275
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit B-2-a
Page 7 of 7
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Supervisor (CSC Program Director)0.25 38,616$ -$ 38,616$
1102 Licensed Staff (Full Time)2.00 149,826 149,826
1103 Licensed Staff (CSC
Afterhours/Weekends/Holidays)0.50 11,411 11,411
1104 - - -
1105 - - -
1106 - - -
1107 - - -
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 2.75 38,616$ 161,237$ 199,853$
Employee Benefits
Acct #Admin Direct Total
1201 7,531$ -$ 7,531$
1202 12,521 - 12,521
1203 21,087 - 21,087
1204 - - -
1205 - - -
1206 - - -
41,139$ -$ 41,139$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1301 1,620$ -$ 1,620$
1302 15,747 - 15,747
1303 3,035 - 3,035
1304 - - -
1305 - - -
1306 - - -
20,402$ -$ 20,402$
100,157$ 161,237$ 261,394$
Access Line
Exodus Recovery
Fiscal Year 2021 - 2022
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Employee Benefits Subtotal:
Description
OASDI
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Revised Exhibit B-3
Page 1 of 7
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 -
2012 -
2013 -
2014 -
2015 -
2016 -
-$
3000: OPERATING EXPENSES
Acct #Amount
3001 8,910$
3002 -
3003 5,344
3004 -
3005 6,013
3006 -
3007 -
3008 -
3009 2,733
3010 -
3011 -
3012 -
23,000$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 -
4003 -
4004 -
4005 -
4006 -
4007 -
4008 -
4009 -
4010 -
-$
5000: SPECIAL EXPENSES
Acct #Amount
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
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)
Other (Specify)
Subscriptions & Memberships
Vehicle Maintenance
Other - Business License Tax
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
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
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Revised Exhibit B-3
Page 2 of 7
5001 -$
5002 -
5003 -
5004 -
5005 -
5006 -
5007 -
5008 -
-$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 43,021$
6002 2,298
6003 -
6004 -
6005 -
6006 -
6007 -
6008 -
6009 -
6010 -
6011 -
6012 -
45,319$
7000: FIXED ASSETS
Acct #Amount
7001 -$
7002 -
7003 -
7004 -
7005 -
7006 -
7007 -
7008 -
-$
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Insurance (Specify):
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Assets over $5,000/unit (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Services
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 329,713$
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Revised Exhibit B-3
Page 3 of 7
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment 329,713$
329,713$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
-$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 -
8404 -
8405 -
-$
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
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
Grants (Specify)
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:329,713$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Other (Specify)
Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Revised Exhibit B-3
Page 4 of 7
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 261,394
Employee Salaries 199,853
1101 Supervisor (CSC Program Director)38,616 Director will be allocated 2 hrs per day to this service. 10 hrs weekly.
1102 Licensed Staff (Full Time)149,826 Nursing Staff who answer Access Line Calls. 2 staff 8 hrs each per day, Mon. - Fri.
1103 Licensed Staff (CSC
Afterhours/Weekends/Holidays)
11,411 CSC Nursing Staff who will answer Access Line Calls afterhours, weekends and
holidays.
1104 0 -
1105 0 -
1106 0 -
1107 0 -
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 41,139
1201 Retirement 7,531 Employer contributions to a pool of funds set aside for employees future benefit
1202 Worker's Compensation 12,521 Business Insurance that provides beenfits to employees who suffer work-related
injuries
1203 Health Insurance 21,087 Employer covered health insurance plan
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
Payroll Taxes & Expenses:20,402
1301 OASDI 1,620 Old-Age, Survivors, and Disability Insurance Program
1302 FICA/MEDICARE 15,747 Federal Payroll Tax
1303 SUI 3,035 State Unemploymet Insurance
1304 Other (Specify)-
1305 Other (Specify)-
1306 Other (Specify)-
2000: CLIENT SUPPORT -
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 -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Specify)-
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 23,000
Access Line
Exodus Recovery
Fiscal Year 2021 - 2022
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit B-3
Page 5 of 7
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3001 Telecommunications 8,910 Voice, data, router expenses
3002 Printing/Postage -
3003 Office, Household & Program Supplies 5,344 General office supplies (paper, pens, files, chart covers, etc.) and minor equipment
(calculators, pencil sharpeners, etc.)
3004 Advertising -
3005 Staff Development & Training 6,013 Training of new Access Line/cross-train CSC staff
3006 Staff Mileage -
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Other - Business License Tax 2,733 Business Tax License Fee
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 -
5001 Consultant (Network & Data Management)-
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 45,319
6001 Administrative Overhead 43,021 Support, Compliance, Quality Management staff and operations
6002 Professional Liability Insurance 2,298 Professional and General Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
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 $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit B-3
Page 6 of 7
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:329,713
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:329,713
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit B-3
Page 7 of 7
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Program Director 0.20 21,998$ -$ 21,998$
1102 Clinical Coordinator 1.00 - 72,800 72,800
1103 Therapeutic Coach 1.00 - 60,320 60,320
1104 Program Support Specialist 0.20 7,488 - 7,488
1105 On-Call - 8,588 8,588
1106 - - -
1107 - - -
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 2.40 29,486$ 141,708$ 171,194$
Employee Benefits
Acct #Admin Direct Total
1201 1,179$ 5,668$ 6,848$
1202 1,769 8,502 10,272
1203 2,359 11,337 13,696
1204 - - -
1205 - - -
1206 - - -
5,307$ 25,507$ 30,815$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1301 442$ 2,126$ 2,568$
1302 2,123 10,203 12,326
1303 442 2,126 2,568
1304 - - -
1305 - - -
1306 - - -
3,008$ 14,454$ 17,462$
37,801$ 181,670$ 219,471$
Family Urgent Response System (FURS)
Exodus Recovery, Inc.
Fiscal Year (FY 2021-22)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Employee Benefits Subtotal:
Description
OASDI
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit B-4
Page 1 of 6
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 7,800
2004
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011
2012 -
2013 -
2014 -
2015 -
2016 -
7,800$
3000: OPERATING EXPENSES
Acct #Amount
3001 13,516$
3002 -
3003 9,237
3004 -
3005 2,684
3006 18,981
3007 -
3008 -
3009 3,000
3010 -
3011 -
3012 -
47,418$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 900$
4002 7,800
4003 8,280
4004 -
4005 -
4006 1,500
4007
4008 -
4009 -
4010 -
18,480$
5000: SPECIAL EXPENSES
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
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)
Other (Specify)
Subscriptions & Memberships
Vehicle Maintenance
Recruitment/New Hire Processing
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
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
FACILITIES/EQUIPMENT TOTAL:
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit B-4
Page 2 of 6
Acct #Amount
5001 12,000$
5002 -
5003 -
5004 -
5005 -
5006 -
5007 -
5008 -
12,000$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 48,189$
6002 8,100
6003 3,000
6004 -
6005 -
6006 4,389
6007 -
6008 600
6009 -
6010 -
6011 -
6012 -
64,278$
7000: FIXED ASSETS
Acct #Amount
7001 -$
7002 -
7003 -
7004 -
7005 -
7006 -
7007 -
7008 -
-$
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Insurance (Specify):
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Assets over $5,000/unit (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping/Legal
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
License/Permits
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Services
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 369,447$
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit B-4
Page 3 of 6
Acct #Service Units Rate Amount
8001 Mental Health Services 9,360 3.92 36,691$
8002 Case Management 8,184 3.04 24,879
8003 Crisis Services 2,880 5.96 17,165
8004 Medication Support 0 - -
8005 Collateral 1,800 3.92 7,056
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
22,224 85,791$
100%
85,791
50%42,896
42,896$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment 326,552$
326,552$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
-$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 -
8404 -
8405 -
-$
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
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
Grants (Specify)
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:369,447$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Other (Specify)
Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit B-4
Page 4 of 6
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 219,471
Employee Salaries 171,194
1101 Program Director 21,998 Directs all of the program clinical/administrative aspects
1102 Clinical Coordinator 72,800 Licensed clinician, performs assessment and treatment, team lead
1103 Therapeutic Coach 60,320 Provides client case management, support services, care coordination
1104 Program Support Specialist 7,488 Provides clerical support to program director/staff and data collection
1105 On-Call 8,588 Therapeutic Coach $125/week plus estimated 4 hours/month response OT
1106 0 -
1107 0 -
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 30,815
1201 Retirement 6,848 Match up to 4%
1202 Worker's Compensation 10,272 Current rate
1203 Health Insurance 13,696 Medical, dental vision
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
Payroll Taxes & Expenses:17,462
1301 OASDI 2,568 Current rate
1302 FICA/MEDICARE 12,326 Current rate
1303 SUI 2,568 Current rate
1304 Other (Specify)-
1305 Other (Specify)-
1306 Other (Specify)-
2000: CLIENT SUPPORT 7,800
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support 7,800 Estimation of 12 clients annually
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Specify)-
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 47,418
3001 Telecommunications 13,516 Telephone, data, mobile
3002 Printing/Postage -
3003 Office, Household & Program Supplies 9,237 General office supplies plus program supplies
Family Urgent Response System (FURS)
Exodus Recovery, Inc.
Fiscal Year (FY 2021-22)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B-4
Page 5 of 6
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3004 Advertising -
3005 Staff Development & Training 2,684 eLearning, trainings
3006 Staff Mileage 18,981 Estimation based upon 1 response per month plus 6 week follow-up
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Recruitment/New Hire Processing 3,000 Recruitment, background checks, medical clearance
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 18,480
4001 Building Maintenance 900 Shared allocation based upon staff/space for this program
4002 Rent/Lease Building 7,800 Shared space - 1,000 sq ft allocated for this program
4003 Rent/Lease Equipment 8,280 Copier/Printer
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 1,500 Water, electrical
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 12,000
5001 Consultant (Network & Data Management)12,000 Network Management/Support
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 64,278
6001 Administrative Overhead 48,189 15% indirect
6002 Professional Liability Insurance 8,100 Pursuant to contractual obligations
6003 Accounting/Bookkeeping/Legal 3,000 Covers contracted CFO plus legal fees
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services 4,389 2% of total SWB
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 License/Permits 600 Business Tax Fee
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:369,447
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:369,447
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B-4
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