HomeMy WebLinkAboutAgreement A-16-222-1 with Exodus Recovery Inc..pdf- 1 -
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FIRST AMENDMENT TO FACILITY USE AGREEMENT
THIS FIRST AMENDMENT TO AGREEMENT (hereinafter “Amendment”) is made and entered
into this _____ day of ____________, 2021, by and between COUNTY OF FRESNO, a Political
Subdivision of the State of California, Fresno, California (hereinafter “COUNTY”), and EXODUS
FOUNDATION, INC, a non-profit California corporation, whose address is 9808 Venice Boulevard,
Suite 700, Culver City, California 90232 (hereinafter “EXODUS”).
WITNESSETH:
WHEREAS, COUNTY owns the building located at 4411 E Kings Canyon, Fresno, CA 93702
(Building 319), Fresno, CA 93702 (hereinafter “Building”); and
WHEREAS, COUNTY entered into an agreement (“Exodus Recovery Agreement”) with
EXODUS”S affiliate, Exodus Recovery, Inc. (“Exodus Recovery”), to operate a Crisis Stabilization
Center Facility at the Building; and
WHEREAS, at the time COUNTY Exodus entered into the Exodus Recovery Agreement, the
Board of Supervisors of COUNTY, pursuant to Government Code section 26227, found that the
operation of a Crisis Stabilization Center Facility providing psychiatric health services for adults and
youths was necessary to meet the social needs of the population of the County of Fresno; and was, to
wit, a necessary mental health program that will meet the health needs of Fresno County and was in
the public interest and found that the Building would not be needed for COUNTY purposes and the
Building would be used to carry out the provision of crisis stabilization services for adults and youths of
the county of Fresno by EXODUS’s affiliate, Exodus Recovery; and
WHEREAS, the COUNTY and EXODUS entered into a Facility Use Agreement (County
Agreement No. 16-222) to allow for and ensure the ongoing provision of psychiatric health services at
the Building by EXODUS’s affiliate, Exodus Recovery; and
WHEREAS, the COUNTY and EXODUS’s affiliate, Exodus Recovery, have reached
agreement to extend the term of the Exodus Recovery Agreement for an additional year; and
WHEREAS, the COUNTY and EXODUS desire to extend the term of the Facility Use
Agreement (County Agreement No. 16-222) to extend the term for an additional year to be co-
terminous with the Exodus Recovery Agreement to allow for and ensure the ongoing provision of
Agreement No. 16-222-1
8th June
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psychiatric health services for adults and youths at the Building by EXODUS’s affiliate, Exodus
Recovery; and
WHEREAS, the Board of Supervisors of COUNTY, pursuant to Government Code section
26227 hereby finds that the operation of a Crisis Stabilization Services providing psychiatric health
services for adults and youths continues to be necessary to meet the social needs of the population of
the County of Fresno, including but not limited to, the areas of health, law enforcement, public safety,
rehabilitation, welfare, and education; and, is serving a public purpose, and is, to wit, a necessary
mental health program that will meet the health needs of Fresno County and is in the public interest
and finds that the Building will not be needed for COUNTY purposes and the Building will be used to
carry out the provision of psychiatric health services for adults of the County of Fresno by EXODUS’s
affiliate, Exodus Recovery for an additional one year period; and
WHEREAS, EXODUS represents and covenants that it is a duly organized and existing
nonprofit corporation under the laws of the State of Nevada and that it is tax-exempt under Internal
Revenue Code section 501(c)(3).
NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
is hereby acknowledged, COUNTY and EXODUS agree as follows:
1.That the existing COUNTY Agreement No. 16-222, Section Two (2) “TERM AND
TERMINATION”, Page Two (2), Line Nine (9), with the word “TERM” and ending on Page Two (2),
Line Fifteen (15) with the number “2021” be deleted and the following inserted in its place:
“TERM AND TERMINATION - The initial term of this AGREEMENT shall be for the
three (3) year period of July 1, 2016 through June 30, 2019 (“Initial Term”). Beginning July 1, 2019,
this AGREEMENT will renew automatically for three (3) consecutive one-year periods, upon the same
terms and conditions herein. Automatic renewal will occur unless either Party provides thirty (30) days
written notice of non-renewal prior to the end of the Initial Term or the then current renewal term of this
AGREEMENT. In no event shall the term of this AGREEMENT extend beyond June 30, 2022.”
2.That all reference in COUNTY Agreement No. 16-222 to Exhibit B be changed to read
“Revised Exhibit B”, attached hereto and incorporated herein by this reference.
3.That the existing COUNTY Agreement No. 16-222, Section 10, “Hold Harmless”, Page
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Five (5), Line Eighteen (18), beginning with the number “10” and ending on Page Six (6), Line Twenty
Seven (27) with the word “invitees” be deleted and the following inserted in its place:
“10. HOLD HARMLESS - EXODUS agrees to indemnify, save, hold harmless, and at
COUNTY'S request, defend the COUNTY, its officers, agents, and employees from any and all costs
and expenses, (including attorney’s fees and costs), damages, liabilities, claims, and losses occurring
or resulting to COUNTY in connection with the performance, or failure to perform, by EXODUS, its
officers, agents, affiliates,or employees under this AGREEMENT, and from any and all costs and
expenses, damages, liabilities, claims, and loses occurring or resulting to any person, firm, or
corporation who may be injured or damaged by the performance, or failure to perform of EXODUS, its
officers, agents, affiliates or employees under this AGREEMENT
The parties acknowledge that as between COUNTY and EXODUS each is responsible
for the negligence of its own employees and invitees.”
4. That the existing COUNTY Agreement No. 16-222, Section 12, “Insurance”, Page Six
(6), Line Four (4), beginning with the number “12” and ending on Page Eight (8), Line Seven (7) with
the word “insurance” be deleted and the following inserted in its place:
“12. INSURANCE - Without limiting the COUNTY’s right to obtain indemnification
from EXODUS or any third parties, EXODUS, 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
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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
EXODUS 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
EXODUS will provide property coverage for the full replacement value of the
COUNTY’S personal property in possession of EXODUS 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 EXODUS 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. EXODUS 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
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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
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.
EXODUS 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 EXODUS’s policies herein. This insurance shall not be
cancelled or changed without a minimum of thirty (30) days advance written notice given to COUNTY.
EXODUS 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. EXODUS is solely responsible to obtain any endorsement to such policy that may be
necessary to accomplish such waiver of subrogation, but EXODUS’s waiver of subrogation under this
paragraph is effective whether or not EXODUS obtains such an endorsement.
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Within thirty (30) days from the date EXODUS signs this Agreement, EXODUS shall
provide certificates of insurance and endorsements as stated above for all of the foregoing policies, as
required herein, to the County of Fresno, Department of Behavioral Health, 3133 N. Millbrook Ave,
Fresno, California, 93703, Attention: 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 EXODUS’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 EXODUS 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.
COUNTY shall maintain during the term of this AGREEMENT the following policies of
insurance, which coverages may be provided in whole or in part through one or more programs of self-
insurance:
a.Commercial General liability insurance with limits of not less than One Million Dollars
($1,000,000) per occurrence and an annual aggregate of not less than Two Million
Dollars ($2,000,000). This policy shall be issued on an occurrence basis.
b.All-Risk property insurance.”
5.The parties agree that this Amendment may be executed by electronic signature as
provided in this section. An “electronic signature” means any symbol or process intended by an
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individual signing this Amendment to represent their signature, including but not limited to (1) a digital
signature; (2) a faxed version of an original handwritten signature; or (3) an electronically scanned and
transmitted (for example by PDF document) of a handwritten signature. Each electronic signature
affixed or attached to this Amendment (1) is deemed equivalent to a valid original handwritten
signature of the person signing this Amendment for all purposes, including but not limited to
evidentiary proof in any administrative or judicial proceeding, and (2) has the same force and effect as
the valid original handwritten signature of that person. The provisions of this section satisfy the
requirements of Civil Code section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act
(Civil Code, Division 3, Part 2, Title 2.5, beginning with section 1633.1). Each party using a digital
signature represents that it has undertaken and satisfied the requirements of Government Code
section 16.5, subdivision (a), paragraphs (1) through (5), and agrees that each other party may rely
upon that representation. This Amendment is not conditioned upon the parties conducting the
transactions under it by electronic means and either party may sign this Amendment with an original
handwritten signature.
6.COUNTY and EXODUS agree that this Amendment is sufficient to amend the
Agreement and, that upon execution of this Amendment, the Agreement and this Amendment together
shall be considered the Agreement.
7.The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
covenants, conditions and promises contained in the Agreement and not amended herein shall remain
in full force and effect. This First Amendment shall be effective July 1, 2021.
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1 IN WITNESS WHEREOF , the parties hereto have executed this First Amendment to Fac ility Use
2 Agreement as of the day and year first hereinabove written .
3
4 EXODUS
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Luana Murphy, President/CEO
Print Name & Title
w----"""""-----'--=-----"""'---(Authorized Signature)
LeeAnn Skorohod , Secretary/COO
Print Name & Title
FOR ACCOUNTING USE ONLY:
Fund: 0001
Subclass : 10000
ORG : 56302111
Account: 7295
Steve an u , Chairman of the Board
of Supervisors of the County of Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno , State of Californ ia
By: ~~~ ~
De
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Revised Exhibit B
Page 1 of 27
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 B
Page 2 of 27
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, Chapter 11,
Article 3, Section 1840.348 of the California Code of Regulations (CCR) for Crisis
Revised Exhibit B
Page 3 of 27
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 B
Page 4 of 27
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 B
Page 5 of 27
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 B
Page 6 of 27
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.
3.Ensure that minors shall not be used as interpreters.
Revised Exhibit B
Page 7 of 27
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 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.
Revised Exhibit B
Page 8 of 27
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.
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.
Revised Exhibit B
Page 9 of 27
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.
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.
Revised Exhibit B
Page 10 of 27
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.
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 B
Page 11 of 27
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.
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
Revised Exhibit B
Page 12 of 27
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:
B.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
e.Multi-Disciplinary Milieu Treatment Program
f.Client Centered Treatment Planning
g.Aftercare Planning and Wellness Recovery Action Plan (WRAP)
Revised Exhibit B
Page 13 of 27
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 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
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.
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
Revised Exhibit B
Page 14 of 27
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.
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.
Revised Exhibit B
Page 15 of 27
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.
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.
Revised Exhibit B
Page 16 of 27
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.
C.Regarding cultural and linguistic competence requirements, CONTRACTOR shall:
13.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.
14.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
Revised Exhibit B
Page 17 of 27
procedures, and monitoring its language assistance program. The CONTRACTOR’s procedures
must include ensuring compliance of any subcontracted providers with these requirements.
15.Ensure that minors shall not be used as interpreters.
16.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.
17.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.
18.Develop recruitment and retention initiatives to establish contracted program staffing that is
reflective and responsive to the needs of the program and target population.
19.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.
20.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.
21.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.
22.Utilize existing community supports, referrals to transgender support groups, etc., when
appropriate.
23.Attend annual Cultural Competence, Compliance, Health Insurance Portability and Accountability
Act (HIPAA), Billing, and Documentation training provided by COUNTY’s DBH.
24.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
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.
Revised Exhibit B
Page 18 of 27
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:
3.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
4.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
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.
Revised Exhibit B
Page 19 of 27
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.
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 B
Page 20 of 27
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:
7.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.
8.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.
9.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.
10.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.
11.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.
12.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,
Revised Exhibit B
Page 21 of 27
and Hmong). Translation services and costs associated will be the responsibility of the
CONTRACTOR.
Revised Exhibit B
Page 22 of 27
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
$23,678 07/1/2016 through 08/31/2016 (Ramp Up Period)
$242,607 09/01/2016 through 06/30/2017 (Initial Operating Period)
$296,883 FY 2017-18
$307,445 FY 2018-19
$318,384 FY 2019-20
$329,713 FY 2020-21
$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.
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 B
Page 23 of 27
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
about the present situation and history. Ask the caller if they have a therapist and if so, when
is their next appointment.
Revised Exhibit B
Page 24 of 27
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.
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.
Revised Exhibit B
Page 25 of 27
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.
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.
Revised Exhibit B
Page 26 of 27
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.
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.
Revised Exhibit B
Page 27 of 27
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.