HomeMy WebLinkAboutAgreement A-21-295 with The Fresno Center.pdf1
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AGREEMENT
This Agreement is made and entered into this ______ day of ___________ 2021, by and between
the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as
“COUNTY”, and The Fresno Center, a California non-profit corporation, whose address is 4879 E. Kings
Canyon Road, Fresno, CA 93727, hereinafter referred to as "CONTRACTOR," (collectively the “parties”).
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), Mental Health Services
Act (MHSA), Prevention and Early Intervention (PEI) component, and through input from the community
stakeholder process, recognizes the need to provide Prevention and Early Intervention Cultural Based
Access Navigation Support (CBANS) Services, as specified in this Agreement and as part of Fresno
County’s approved State PEI plan, to help improve timely access to mental health services for individuals
and families from underserved populations; and
WHEREAS, CONTRACTOR, is qualified, willing and able to provide services required by the
COUNTY, pursuant to the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties hereto
agree as follows:
1.SERVICES
A.CONTRACTOR shall perform all services and fulfill all responsibilities identified in
COUNTY’s Request for Proposal (RFP) No. 21-039, dated March 3, 2021, and Addendum No. One (1) to
COUNTY’s RFP No. 21-039, dated March 22, 2021, hereinafter collectively referred to as COUNTY
Revised RFP No. 21-039, and CONTRACTOR’s response to said RFP #21-039, dated April 5, 2021, all
incorporated herein by reference and made part of this Agreement.
B.CONTRACTOR shall perform all services and fulfill all responsibilities as set forth in
Exhibit A “Summary of Services” attached hereto and by this reference incorporated herein and made
part of this Agreement.
C.CONTRACTOR shall align services and practices with the vision, mission, and
guiding principles of the DBH, as further described in Exhibit B, "Fresno County Department
of Behavioral Health Guiding Principles of Care Delivery", attached hereto and by this reference
10th August
Agreement No. 21-295
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incorporated herein and made part of this Agreement.
D.In the event of any inconsistency among these documents, the inconsistency shall
be resolved by giving precedence in the following order: 1) to this Agreement, including all Exhibits, 2) to
the Revised RFP No. 21-039, and 3) to the Response to the Revised RFP No. 21-039. A copy of
COUNTY’s Revised RFP No. 21-039, and CONTRACTOR’s response, shall be retained and made
available during the term of this Agreement by COUNTY’s Purchasing Division.
2.T ERM
The Agreement shall become effective July 1, 2021 and shall terminate on the 30th of
June, 2024. This Agreement may be extended for two (2) additional consecutive twelve (12) month
periods upon written approval of both parties no later than thirty (30) days prior to the first day of the next
extension period. The DBH Director, or designee, is authorized to execute such written approval on
behalf of COUNTY based on CONTRACTOR’s satisfactory performance.
3.T ERMINATION
A.Non Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR thirty (30) days advance written notice.
B.Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1)An illegal or improper use of funds;
2)A failure to comply with any term of this Agreement;
3)A substantially incorrect or incomplete report submitted to COUNTY;
4)Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of any
breach of this Agreement or any default which may then exist on the part of CONTRACTOR. Neither
shall such payment impair or prejudice any remedy available to COUNTY with respect to the breach or
default. COUNTY shall have the right to demand of CONTRACTOR the repayment to COUNTY of any
funds disbursed to CONTRACTOR under this Agreement, which in the judgment of COUNTY were not
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expended in accordance with the terms of this Agreement. CONTRACTOR shall promptly refund any
such funds upon demand or, at COUNTY’s option, such repayment shall be deducted from future
payments owing to CONTRACTOR under this Agreement.
C.Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by CONTRACTOR or COUNTY upon thirty (30) days advance written
notice of an intention to terminate the Agreement. COUNTY’s DBH Director, or designee, is authorized to
execute such written notice on behalf of COUNTY.
4.COMPENSATION
For actual services provided as identified in the terms and conditions of this Agreement,
including Exhibit A, COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation in accordance with Exhibit C, “Budget Summary,” attached hereto and by this reference
incorporated herein. Payment shall be made upon certification or other proof satisfactory to COUNTY’s
DBH that services have actually been performed by CONTRACTOR as specified in this Agreement.
The maximum amount payable to CONTRACTOR for the period effective July 1,2021
through June 30, 2022 shall not exceed Five Hundred Fifty Thousand and No/100 Dollars ($550,000.00).
The maximum amount payable to CONTRACTOR for the period effective July 1, 2022
through June 30, 2023 shall not exceed Five Hundred Fifty Thousand and No/100 Dollars ($550,000.00).
The maximum amount payable to CONTRACTOR for the period effective July 1, 2023
through June 30, 2024 shall not exceed Five Hundred Fifty Thousand and No/100 Dollars ($550,000.00).
If this agreement is renewed for an additional one-year period pursuant to Section 2,
TERM, for the period July 1, 2024 through June 30, 2025, in no event shall actual services performed be
in excess of Five Hundred Fifty Thousand and No/100 Dollars ($550,000.00).
If this agreement is renewed for an additional one-year period pursuant to Section 2,
TERM, for the period July 1, 2025 through June 30, 2026, in no event shall actual services performed be
in excess of Five Hundred Fifty Thousand and No/100 Dollars ($550,000.00).
In no event shall services performed under this Agreement be in excess of Two Million
Seven Hundred Fifty Thousand, and No/100 Dollars ($2,750,000.00). It is understood that all expenses
incidental to CONTRACTOR’s performance of services under this Agreement shall be borne by
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CONTRACTOR.
Except as provided below regarding State payment delays, payments shall be made by
COUNTY to CONTRACTOR in arrears, for services provided during the preceding month, within forty-five
(45)days after the date of receipt, verification, and approval of CONTRACTOR’s invoices by COUNTY’s
DBH.
If CONTRACTOR should fail to comply with any provision of this Agreement, COUNTY
shall be relieved of its obligation for further compensation. All final invoices shall be submitted by
CONTRACTOR within sixty (60) days following the final month of service for which payment is claimed.
No action shall be taken by COUNTY on claims submitted beyond the sixty (60) day closeout period. Any
compensation which is not expended by CONTRACTOR pursuant to the terms and conditions of this
Agreement shall automatically revert to COUNTY.
The services provided by CONTRACTOR under this Agreement are funded in whole or in
part by the State of California. In the event that funding for these services is delayed by the State
Controller, COUNTY may defer payment to CONTRACTOR. The amount of the deferred payment shall
not exceed the amount of funding delayed by the State Controller to COUNTY. The period of time of the
deferral by COUNTY shall not exceed the period of time of the State Controller’s delay of payment to
COUNTY plus forty-five (45) days.
COUNTY agrees to the extent permitted by State and Federal rules and regulations,
advanced payment of up to twenty percent (20%) of the compensation under this Agreement if requested
of COUNTY by CONTRACTOR. The amount of the advanced payment shall be deducted in equal
installments from claims submitted in the final six (6) months of this Agreement.
5.INVOICING
CONTRACTOR shall invoice COUNTY in arrears by the tenth (10th) day of each month for
actual expenses incurred and services rendered in the previous month electronically to
dbh-invoices@fresnocountyca.gov, with a carbon copy email to the assigned COUNTY’s DBH Staff
Analyst.
CONTRACTOR shall submit to the COUNTY by the tenth (10th) of each month a detailed
general ledger (GL), itemizing costs incurred in the previous month. Failure to submit GL reports and
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supporting documentation shall be deemed sufficient cause for COUNTY to withhold payments until there
is compliance, as further described in Section Five (5) herein. Supporting documentation shall include but
is not limited to receipts, invoices received, and documented administrative / overhead costs. No
reimbursement for services shall be made until invoices, reports and outcomes are received, reviewed
and approved by COUNTY’s DBH. Support documents will be made available upon request.
At the discretion of COUNTY’s DBH Director or designee, if an invoice is incorrect or is
otherwise not in proper form or substance, COUNTY’s DBH Director or designee shall have the right to
withhold payment as to only that portion of the invoice that is incorrect or improper after five (5) days prior
notice to CONTRACTOR. CONTRACTOR agrees to continue to provide services for a period of ninety
(90)days after notification of an incorrect or improper invoice. If after the ninety (90) day period, the
invoice(s) is still not corrected to COUNTY’s DBH satisfaction, COUNTY’s DBH Director or designee may
elect to terminate this Agreement, pursuant to the termination provisions stated in Paragraph Three (3) of
this Agreement. In addition, for invoices received ninety (90) days after the expiration of each term of this
Agreement or termination of this Agreement, at the discretion of COUNTY’s DBH Director or designee,
COUNTY’s DBH shall have the right to deny payment of any additional invoices received.
CONTRACTOR must maintain such financial records for a period of three (3) years or until
any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible for
any disallowances related to inadequate documentation.
CONTRACTOR shall provide a monthly activity report with each invoice, further described
in Section Thirteen (13). In addition, each monthly invoice will be in the format as identified in Exhibit C,
showing each budget line item, expenses incurred, and the balance remaining for each budget line item
for all services and items as identified in Exhibit C.
CONTRACTOR shall submit monthly staff reports that identify all direct services and
support staff, applicable licensure/certifications, and full time hours worked to be used as a tracking tool to
determine if CONTRACTOR’s program is staffed according to the services provided under this
Agreement.
CONTRACTOR must attend COUNTY DBH’s Business Office trainings on equipment
reporting for assets, intangible and sensitive minor assets, when offered.
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6.INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under this
Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
CONTRACTOR’s officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have no right to
control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and
function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules and
regulations, if any, of governmental authorities having jurisdiction over matters which are directly or
indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely
no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
solely liable and responsible for providing to, or on behalf of, its employees all legally required employee
benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all
matters relating to payment of CONTRACTOR's employees, including compliance with Social Security,
withholding, and all other regulations governing such matters. It is acknowledged that during the term of
this Agreement, CONTRACTOR may be providing services to others unrelated to COUNTY or to this
Agreement.
7.MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent of
all the parties without, in any way, affecting the remainder.
Changes to expense category (i.e., Salary & Benefits, Client Support, Facilities/Equipment,
Operating Expenses, Administrative Expenses, Special Expenses, Fixed Assets, etc.) subtotals in the
budgets, and changes to the volume of units of services/types of service units to be provided as set forth
in Exhibit C, that do not exceed 10% of the maximum compensation payable to the CONTRACTOR may
be made with the written approval of COUNTY’s DBH Director, or designee. Said modifications shall not
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result in any change to the annual maximum compensation amount payable to CONTRACTOR, as stated
in this Agreement.
8.NON-ASSIGNMENT
Neither party shall assign, transfer or subcontract this Agreement nor their rights or duties
under this Agreement without the prior written consent of the other party.
9.HOLD HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY’s request,
defend COUNTY, its officers, agents and employees from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to COUNTY in
connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents or
employees of covenants and duties under this Agreement, and from any and all costs and expenses,
including attorney fees and court costs damages, liabilities, claims and losses occurring or resulting to
any person, firm or corporation who may be injured or damaged by the performance, or failure to perform,
of CONTRACTOR, their officers, agents or employees of covenants and duties under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal and/or State of California audit
exceptions resulting from noncompliance herein on the part of the CONTRACTOR.
10.INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or any third
parties, CONTRACTOR, at its sole expense, shall maintain in full force and 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 Four Million
Dollars ($4,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverages including completed operations, product
liability, contractual liability, Explosion-Collapse-Underground, fire legal liability or
any other liability insurance deemed necessary because of the nature of this
contract.
B.Automobile Liability
Comprehensive Automobile Liability Insurance with limits no less than One Million
Dollars ($1,000,000) per accident for bodily injury and property damage. Coverage
should include any automobile used in connection with this Agreement.
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C.Professional Liability
If CONTRACTOR employs licensed professional staff (e.g. Ph.D., R.N., L.C.S.W.,
L.M.F.T., etc.) in providing services, Professional Liability Insurance with limits of
not less than One Million Dollars ($1,000,000) per occurrence, Three Million Dollars
($3,000,000) annual aggregate. CONTRACTOR agrees that it shall maintain, at its
sole expense, in full force and effect for a period of three (3) years following the
termination of this Agreement, one or more policies of professional liability
insurance with limits of coverage as specified herein.
D.Property Insurance
CONTRACTOR shall maintain a policy of insurance for all risk personal property
coverage which shall be endorsed naming the County of Fresno as an additional
loss payee. The personal property coverage shall be in an amount that will cover
the total COUNTY purchase and owned property, at a minimum, as discussed in
Section Twenty (20) of this Agreement.
E.All Risk Property Insurance
CONTRACTOR will provide property coverage for the full replacement value of the
COUNTY’s personal property in possession of CONTRACTOR and/or used in the
execution of this Agreement. COUNTY will be identified on an appropriate
certificate of insurance as the certificate holder and will be named as an Additional
Loss Payee on the Property Insurance Policy.
F.Worker’s Compensation
A policy of Worker's Compensation Insurance as may be required by the California
Labor Code.
G.Molestation
CONTRACTOR shall have either separate policy or an umbrella policy with
endorsements covering sexual abuse/molestation coverage or have a specific
endorsement on their General Commercial liability policy covering sexual
abuse/molestation. The policy limits for this policy shall be One Million Dollars
($1,000,000) per occurrence with a Two Million Dollars ($2,000,000) annual
aggregate. The policy shall be on a per occurrence basis.
CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are concerned. Such
coverage for additional insured shall apply as primary insurance and any other insurance, or self-
insurance, maintained by COUNTY, its officers, agents and employees shall be excess only and not
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contributing with insurance provided under CONTRACTOR’s policies herein. This insurance shall not be
cancelled or changed without a minimum of thirty (30) days advance written notice given to COUNTY.
CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
employees any amounts paid by the policy of worker’s compensation insurance required by this
Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
necessary to accomplish such waiver of subrogation, but CONTRACTOR’s waiver of subrogation under
this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
Within thirty (30) days from the date each CONTRACTOR signs this Agreement, said
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 1925 E.
Dakota Ave, Fresno, California, 93726, Attention: Public Behavioral Health 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 for such worker’s
compensation insurance the CONTRACTOR has waived its right to recover from the COUNTY, its
officers, agents, and employees any amounts paid under the insurance policy and that waiver does not
invalidate the insurance policy; that such Commercial General Liability insurance names the County of
Fresno, its officers, agents and employees, individually and collectively, as additional insured, but only
insofar as the operations under this Agreement are concerned; that such coverage for additional insured
shall apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its
officers, agents and employees, shall be excess only and not contributing with insurance provided under
CONTRACTOR policies herein; and that this insurance shall not be cancelled or changed without a
minimum of thirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this Agreement
upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of California.
Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of A FSC VII or
better.
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11.LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR’s staff shall
maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for
the provision of the services hereunder and required by the laws and regulations of the United States of
America, State of California, County of Fresno, and any other applicable governmental agencies.
CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
licenses, permits, approvals, certificates, waivers and exemptions irrespective of pendency of any appeal
related thereto. Additionally, CONTRACTOR and CONTRACTOR’s staff shall comply with all applicable
laws, rules or regulations, as may now exist or be hereafter changed.
12.RECORDS
Financial, statistical and demographic data shall be kept and reports made as required by
the County’s Department of Behavioral Health Director and State. COUNTY shall be allowed to review all
records of services provided, including the goals and objectives of services, and how the services
provided is achieving the goals and objectives. All such records shall be available for inspection by the
designated Auditors of COUNTY or State at reasonable times during normal business hours. All such
records shall be maintained through the end of this Agreement. All records shall be considered property
of COUNTY and shall be retained by COUNTY at the termination or expiration of this Agreement.
13.REPORTS
A.Activity Reports
CONTRACTOR shall submit to COUNTY's DBH by the tenth (10th) of each
month all monthly activity and budget reports for the preceding month.
B.Staffing Reports
CONTRACTOR shall submit monthly staff reports that identify all direct services
and support staff, applicable licensure/certifications, and full-time hours worked to be used as a tracking
tool to determine if CONTRACTOR’s program is staffed according to the services provided under this
Agreement.
C.Additional Reports
In addition, CONTRACTOR shall also furnish to COUNTY such statements,
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records, reports, data, and other information as COUNTY’s DBH may reasonably request pertaining to
matters covered by this Agreement. In the event that CONTRACTOR fails to provide such reports or
other information required hereunder, it shall be deemed sufficient cause for COUNTY to withhold
monthly payments until there is compliance. In addition, CONTRACTOR shall provide written notification
and explanation to COUNTY within five (5) days of any funds received from another source to conduct
the same services covered by this Agreement.
14.MONITORING
CONTRACTOR agrees to extend to COUNTY’s staff, COUNTY’s DBH Director and the
State Department of Mental Health, or their designees, the right to review and monitor records, program
or procedures, at any time, in regard to clients, as well as the overall operation of CONTRACTOR’s
program, in order to ensure compliance with the terms and conditions of this Agreement.
15.REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended during
the term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
such amendment.
16.COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates its mental health programs under an
agreement with the State Department of Health Care Services, and that under said agreement the State
imposes certain requirements on COUNTY and its subcontractors. CONTRACTOR shall adhere to all
State requirements, including those identified in Exhibit D, “State Mental Health Requirements”, attached
hereto and by this reference incorporated herein and made part of this Agreement.
17.CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating to
confidentiality.
18.HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
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104-191(HIPAA) and agree to use and disclose protected health information as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of protected health
information between them is only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of
Protected Health Information (PHI) pursuant to the Agreement in compliance with HIPAA, the Health
Information Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and
regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI,
as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of
Federal Regulations (CFR).
19.DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into
a contractual relationship with the COUNTY for the purpose of providing services under this Agreement
must employ adequate data security measures to protect the confidential information provided to
CONTRACTOR by the COUNTY, including but not limited to the following:
A.CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1)CONTRACTOR has received authorization by COUNTY for
telecommuting purposes;
2)Current virus protection software is in place;
3)Mobile device has the remote wipe feature enabled; and
4)A secure connection is used.
B.CONTRACTOR-Owned Computers or Computer Peripherals
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CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief Information
Officer, and/or his or her designee(s), including but not limited to mobile storage devices. If data is
approved to be transferred, data must be stored on a secure server approved by the COUNTY and
transferred by means of a Virtual Private Network (VPN) connection, or another type of secure
connection. Said data must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR may not use COUNTY computers or computer peripherals on non-
COUNTY premises without prior authorization from the COUNTY’s Chief Information Officer, and/or his or
her designee(s).
D. CONTRACTOR may not store COUNTY’s private, confidential or sensitive data on
any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E.CONTRACTOR shall be responsible to employ strict controls to ensure the integrity
and security of COUNTY’s confidential information and to prevent unauthorized access, viewing, use or
disclosure of data maintained in computer files, program documentation, data processing systems, data
files and data processing equipment which stores or processes COUNTY data internally and externally.
F.Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128
BIT or higher. Additionally, a password or pass phrase must be utilized.
G.CONTRACTOR is responsible to immediately notify COUNTY of any violations,
breaches or potential breaches of security related to COUNTY’s confidential information, data maintained
in computer files, program documentation, data processing systems, data files and data processing
equipment which stores or processes COUNTY data internally or externally.
H.COUNTY shall provide oversight to CONTRACTOR’s response to all incidents
arising from a possible breach of security related to COUNTY’s confidential client information provided to
CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected individuals as
required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will be
responsible for all costs incurred as a result of providing the required notification.
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20.PROPERTY OF COUNTY
A.COUNTY and CONTRACTOR recognize that fixed assets are tangible and
intangible property obtained or controlled under COUNTY's Mental Health Plan for use in operational
capacity and will benefit COUNTY for a period more than one year. Depreciation of the qualified items
will be on a straight-line basis.
For COUNTY purposes, fixed assets must fulfill three qualifications:
1)Asset must have life span of over one year
2)The asset is not a repair part
3)The asset must be valued at or greater than the capitalization thresholds for the
asset type.
Asset type Threshold
•land $0
•buildings and improvements $100,000
•infrastructure $100,000
•be tangible $5,000
o equipment
o vehicles
•or intangible asset $100,000
o Internally generated software
o Purchased software
o Easements
o Patents
•capital lease equipment $5,000
Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
approved and identified as an asset it will be tagged with a COUNTY program number. A "Fixed Asset
Log'', attached hereto as Exhibit E and by this reference incorporated herein, will be maintained by
COUNTY's Asset Management System and inventoried annually until the asset is fully depreciated.
During the terms of this Agreement, CONTRACTOR's fixed assets may be inventoried in comparison
to COUNTY's DBH Asset Inventory System.
B.Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) with
over one-year life span and are mobile and high risk of theft or loss a1·e sensitive assets. Such
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sensitive items are not limited to computers, copiers, televisions, cameras and other sensitive items as
determined by COUNTY's DBH Director or designee. CONTRACTOR(S) maintains a tracking system
on the items that are not required to be capitalized or depreciated. The items are subject to annual
inventory for compliance.
C.Assets shall be retained by COUNTY, as COUNTY property, in the event this
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in
an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this
Agreement CONTRACTOR shall be physically present when fixed and inventoried assets are returned
to COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all COUNTY owned
undepreciated fixed and inventoried assets, or the monetary value of said assets if unable to produce
the assets at the expiration or termination of this Agreement.
CONTRACTOR further agrees to the following:
1)To maintain all items of equipment in good working order and condition,
normal wear and tear is expected;
2)To label all items of equipment with COUNTY assigned program number,
to perform periodic inventories as required by COUNTY and to maintain
an inventory list showing where and how the equipment is being used, in
accordance with procedures developed by COUNTY. All such lists shall
be submitted to COUNTY within ten (10) days of any request; therefore,
and
3)To report in writing to COUNTY immediately after discovery, the lost or
theft of any items of equipment. For stolen items, the local law
enforcement agency must be contacted, and a copy of the police report
submitted to COUNTY.
D.The purchase of any equipment by CONTRACTOR with funds provided
hereunder shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions of this
Agreement as appropriate, and must be directly related to CONTRACTOR's services or activity under
the terms of this Agreement. COUNTY's DBH may refuse reimbursement for any costs resulting from
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equipment purchased, which are incurred by CONTRACTOR, if prior written approval has not been
obtained from COUNTY.
E.CONTRACTOR must obtain prior written approval from COUNTY's DBH
whenever there is any modification or change in the use of any property acquired or improved, in
whole or in part, using funds under this Agreement. If any real or personal property acquired or
improved with said funds identified herein is sold and/or is utilized by CONTRACTOR for a use which
does not qualify under this Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal
to the current fair market value of the property, less any portion thereof attributable to expenditures of
funds not provided under this Agreement. These requirements shall continue in effect for the life of the
property. In the event this Agreement expires, or terminates, the requirements for this Section shall
remain in effect for activities or property funded with said funds, unless action is taken by the State
government to relieve COUNTY of these obligations
21.NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR and its subcontractors shall not
deny the contract’s benefits to any person on the basis of race, religious creed, color, national origin,
ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex,
gender, gender identity, gender expression, age, sexual orientation, or military and veteran status, nor
shall they discriminate unlawfully against any employee or applicant for employment because of race,
religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition,
genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual
orientation, or military or veteran status. CONTRACTOR shall insure that the evaluation and treatment of
employees and applicants for employment are free of such discrimination.
CONTRACTOR and subcontractors shall comply with the provisions of the Fair
Employment and Housing Act (Gov. Code §12800 et seq.), the regulations promulgated thereunder (Cal.
Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter 1, Part 1, Division 3, Title 2 of
the Government Code (Gov. Code §11135-11139.5), and the regulations or standards adopted by the
awarding state agency to implement such article. CONTRACTOR shall permit access by representatives
of the Department of Fair Employment and Housing and the awarding state agency upon reasonable
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notice at any time during the normal business hours, but in no case less than twenty-four (24) hours
notice, to such of its books, records, accounts, and all other sources of information and its facilities as
said Department or Agency shall require to ascertain compliance with this clause. CONTRACTOR and
its subcontractors shall give written notice of their obligations under this clause to labor organizations with
which they have a collective bargaining or other agreement. (See Cal. Code Regs., tit. 2, §11105).
CONTRACTOR shall include the Non-Discrimination and compliance provisions of this clause in all
subcontracts to perform work under this Agreement.
22.CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR(S) shall comply with:
A.Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R.
Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
from discriminating against persons based on race, color, national origin, sex, disability or religion.
This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access
and participation in federally funded programs through the provision of comprehensive and quality
bilingual services.
B.Policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP consumers, including, but not limited to,
assessing the cultural and linguistic needs of its consumers, training of staff on the policies and
procedures, and monitoring its language assistance program. The CONTRACTOR's procedures must
include ensuring compliance of any sub-contracted providers with these requirements.
C.CONTRACTOR shall not use minors as interpreters.
D.CONTRACTOR shall provide and pay for interpreting and translation services to
persons participating in CONTRACTOR’s services who have limited or no English language
proficiency, including services to persons who are deaf or blind. Interpreter and translation services
shall be provided as necessary to allow such participants meaningful access to the programs, services
and benefits provided by CONTRACTOR. Interpreter and translation services, including translation of
CONTRACTOR's "vital documents" (those documents that contain information that is critical for
accessing CONTRACTOR's services or are required by law) shall be provided to participants at no
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cost to the participant. CONTRACTOR shall ensure that any employees, agents, subcontractors, or
partners who interpret or translate for a program participant, or who directly communicate with a
program participant in a language other than English, demonstrate proficiency in the participant's
language and can effectively communicate any specialized terms and concepts peculiar to
CONTRACTOR's services.
E.In compliance with the State mandated Culturally and Linguistically Appropriate
Services standards as published by the Office of Minority Health, CONTRACTOR’s must submit to
COUNTY for approval, within 60 days from date of contract execution, CONTRACTOR’s plan to
address all fifteen national cultural competency standards as set forth in the “National Standards on
Culturally and Linguistically Appropriate Services (CLAS).”
(http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf). COUNTY's annual on-site review of
CONTRACTOR shall include collection of documentation to ensure all national standards are
implemented. As the national competency standards are updated, CONTRACTOR's plan must be
updated accordingly.
23.CONFLICT OF INTEREST
No officer, agent, or employee of COUNTY who exercises any function or responsibility for
planning and carrying out the services provided under this Agreement shall have any direct or indirect
personal financial interest in this Agreement. In addition, no employee of COUNTY shall be employed by
CONTRACTOR to fulfill any contractual obligations with COUNTY.
CONTRACTOR shall also comply with all Federal, State of California, and local conflict of
interest laws, statutes, and regulations, which shall be applicable to all parties and beneficiaries under this
Agreement and any officer, agent, or employee of COUNTY.
24.SINGLE AUDIT CLAUSE
A.If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars and No/100
Dollars ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees to
conduct an annual audit in accordance with the requirements of the Single Audit Standards as set forth in
Office of Management and Budget (OMB) 2 CFR 200. CONTRACTOR shall submit said audit and
management letter to COUNTY. The audit must include a statement of findings or a statement that there
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were no findings. If there were negative findings, CONTRACTOR must include a corrective action plan
signed by an authorized individual. CONTRACTOR agrees to take action to correct any material non-
compliance or weakness found as a result of such audit. Such audit shall be delivered to COUNTY’s
DBH Business Office for review within nine (9) months of the end of any fiscal year in which funds were
expended and/or received for the program. Failure to perform the requisite audit functions as required by
this Agreement may result in COUNTY performing the necessary audit tasks, or at COUNTY’s option,
contracting with a public accountant to perform said audit, or, may result in the inability of COUNTY to
enter into future agreements with CONTRACTOR. All audit costs related to this Agreement are the sole
responsibility of CONTRACTOR.
B.A single audit report is not applicable if CONTRACTOR’s Federal contracts do not
exceed the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
CONTRACTOR’s only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a
program audit must be performed and a program audit report with management letter shall be submitted
by CONTRACTOR to COUNTY as a minimum requirement to attest to CONTRACTOR’s solvency. Said
audit report shall be delivered to COUNTY’s DBH Business Office for review, no later than nine (9)
months after the close of the fiscal year in which the funds supplied through this Agreement are
expended. Failure to comply with this Act may result in COUNTY performing the necessary audit tasks or
contracting with a qualified accountant to perform said audit. All audit costs related to this Agreement are
the sole responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under
this Section shall be billed to the CONTRACTOR at COUNTY’s cost, as determined by COUNTY’s
Auditor-Controller/Treasurer-Tax Collector.
C. CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other pending
matters, whichever is later.
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25.ASSURANCES
In entering into this Agreement, CONTRACTOR certifies that it is not currently excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs: that it
has not been convicted of a criminal offense related to the provision of health care items or services; nor
has it been reinstated to participation in the Federal Health Care Programs after a period of exclusion,
suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that
CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility
for, or involvement with, COUNTY’s business operations related to the Federal Health Care Programs
and shall remove such CONTRACTOR from any position in which CONTRACTOR’s compensation, or
the items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part,
directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until such
time as CONTRACTOR is reinstated into participation in the Federal Health Care Programs.
A.If COUNTY has notice that CONTRACTOR has been charged with a criminal
offense related to any Federal Health Care Program, or is proposed for exclusion during the term of any
contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the accuracy of any
claims submitted to any Federal Health Care Program. At its discretion given such circumstances,
COUNTY may request that CONTRACTOR cease providing services until resolution of the charges or the
proposed exclusion.
B.CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
under this Agreement, will be queried as to whether: (1) they are now or ever have been excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) they
have been convicted of a criminal offense related to the provision of health care items or services; and or
(3) they have been reinstated to participation in the Federal Health Care Programs after a period of
exclusion, suspension, debarment, or ineligibility.
1)In the event the potential employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR hires
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or engages such potential employee or subcontractor, CONTRACTOR will ensure that said employee or
subcontractor does no work, either directly or indirectly relating to services provided to COUNTY.
2)Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Two (2) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
Such demand for adequate assurance shall be effective upon a timeframe to be determined by COUNTY
to protect the interests of COUNTY consumers.
C. CONTRACTOR shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are expected
to perform professional services under this Agreement (1) are not currently excluded, suspended,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been
convicted of a criminal offense related to the provision of health care items or services; and (3) have not
been reinstated to participation in the Federal Health Care Program after a period of exclusion,
suspension, debarment, or ineligibility. In the event any existing employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible to participate in
the Federal Health Care Programs, or has been convicted of a criminal offense relating to the provision of
health care services, CONTRACTOR will ensure that said employee or subcontractor does no work,
either direct or indirect, relating to services provided to COUNTY.
1)CONTRACTOR agrees to notify COUNTY immediately during the term of
this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case,
is providing professional services under this Agreement is excluded, suspended, debarred or otherwise
ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating
to the provision of health care services.
2)Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
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Such demand for adequate assurance shall be effective upon a timeframe to be determined by COUNTY
to protect the interests of COUNTY clients.
D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY, which may be necessary to complete any internal or external audits relating to
CONTRACTOR’s compliance with the provisions of this Section.
E.CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of
CONTRACTOR’s obligations as described in this Section.
26.PUBLIC PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under this
Agreement shall be used for CONTRACTOR’s advertising, fundraising, or publicity (i.e., purchasing of
tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the
above, publicity of the services described in Section One (1) of this Agreement shall be allowed as
necessary to raise public awareness about the availability of such specific services when approved in
advance by COUNTY’s DBH Director, or his or her designee, and at a cost to be provided in Exhibit C for
such items as written/printed materials, the use of media (i.e., radio, television, newspapers) and any
other related expense(s).
27.COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from clients and
clients’ families. CONTRACTOR shall provide a copy of the detailed complaint log entries concerning
COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (10th) day of the following
month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide details and
attach documentation of each complaint with the log. CONTRACTOR shall post signs informing clients of
their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all incidents reportable
to State licensing bodies that affect COUNTY clients within twenty-four (24) hours of receipt of a
complaint.
Within ten (10) days after each incident or complaint affecting COUNTY-sponsored clients,
CONTRACTOR shall provide COUNTY with information relevant to the complaint, investigative details of
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the complaint, the complaint and CONTRACTOR’s disposition of, or corrective action taken to resolve the
complaint. In addition, CONTRACTOR shall inform every client of their rights as set forth in Exhibit F
“Incident Reporting,” attached hereto and by this reference incorporated herein.
28.DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104, and
455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit G, “Disclosure of
Ownership and Control Interest Statement”, attached hereto and by this reference incorporated herein
and made part of this Agreement. CONTRACTOR shall submit this form to COUNTY’s DBH within thirty
(30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall report any changes
to this information within thirty-five (35) days of occurrence by completing Exhibit G. CONTRACTOR is
required to submit a set of fingerprints for any person with a five (5) percent or greater direct or indirect
ownership interest in CONTRACTOR. COUNTY may terminate this Agreement where any person with a
five (5) percent or greater direct or indirect ownership interest in the CONTRACTOR did not submit timely
and accurate information and cooperate with any screening method required in CFR, Title 42, Section
455.416. Submissions shall be scanned portable document format (pdf) copies and are to be sent via
email to DBHAdministration@fresnocountyca.gov, Attention: Contracts Administration. COUNTY may
deny enrollment or terminate this Agreement where any person with a five (5) percent or greater direct or
indirect ownership interest in CONTRACTOR has been convicted of a criminal offense related to that
person’s involvement with the Medicare, Medicaid, or Title XXI program in the last ten (10) years.
29.DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR is required to disclose if any of the following conditions apply to them, their
owners, officers, corporate managers and partners (hereinafter collectively referred to as
“CONTRACTOR”):
A.Within the three (3) year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
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1)Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or
contract under a public transaction;
2)Violation of a federal or state antitrust statute;
3)Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
or
4)False statements or receipt of stolen property.
B.Within a three (3) year period preceding their Agreement award, they have had a
public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate CONTRACTOR from
further business consideration. The information will be considered as part of the determination of whether
to continue and/or renew the Agreement and any additional information or explanation that a
CONTRACTOR elects to submit with the disclosed information will be considered. If it is later determined
that the CONTRACTOR failed to disclose required information, any contract awarded to such
CONTRACTOR may be immediately voided and terminated for material failure to comply with the terms
and conditions of the award.
CONTRACTOR must sign a “Certification Regarding Debarment, Suspension, and Other
Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit H, attached hereto
and by this reference incorporated herein and made part of this Agreement. Additionally, CONTRACTOR
must immediately advise the COUNTY in writing if, during the term of this Agreement: (1)
CONTRACTOR becomes suspended, debarred, excluded or ineligible for participation in federal or state
funded programs or from receiving Federal funds as listed in the excluded parties’ list system
(http://www.epls.gov); or (2) any of the above listed conditions become applicable to CONTRACTOR.
CONTRACTOR shall indemnify, defend and hold the COUNTY harmless for any loss or damage
resulting from a conviction, debarment, exclusion, ineligibility or other matter listed in the signed
Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
30.DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a for-
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profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR changes its
status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this Agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR is
a party and in which one or more of its directors has a material financial interest. Members of the Board
of Directors shall disclose any self-dealing transactions that they are a party to by completing and signing
a “Self-Dealing Transaction Disclosure Form”, attached hereto as Exhibit I and incorporated herein by
reference and made part of this Agreement, and submitting it to the COUNTY prior to commencing with
the self-dealing transaction or immediately thereafter.
31.COMPLIANCE
CONTRACTOR agrees to comply with the COUNTY’s Contractor Code of Conduct and
Ethics and the COUNTY’s Compliance Program in accordance with Exhibit K, attached hereto and
incorporated herein by reference and made part of this Agreement. Within thirty (30) days of entering into
this Agreement with the COUNTY, CONTRACTOR shall have all of the CONTRACTOR’s employees,
agents and subcontractors providing services under this Agreement certify in writing, that he or she has
received, read, understood, and shall abide by the Contractor Code of Conduct and Ethics.
CONTRACTOR shall ensure that within thirty (30) days of hire, all new employees, agents, and
subcontractors providing services under this Agreement shall certify in writing that he or she has received,
read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR
understands that the promotion of and adherence to the Code of Conduct is an element in evaluation the
performance of CONTRACTOR and its employees, agents and subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agents, and subcontractors providing services under this Agreement shall complete general
compliance training and appropriate employees, agents and subcontractors shall complete
documentation and billing or billing/reimbursement training. All new employees, agents and
subcontractors shall attend the appropriate training within 30 days of hire. Each individual who is required
to attend training shall certify in writing that he or she has received the required training. The certification
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shall specify the type of training received and the date received. The certification shall be provided to the
COUNTY’s Compliance Officer at 1925 E. Dakota Avenue, Fresno, California 93726. CONTRACTOR
agrees to reimburse COUNTY for the entire cost of any penalty imposed upon COUNTY by the Federal
Government as a result of CONTRACTOR’s violation of the terms of this Agreement.
32.SUBCONTRACTS
CONTRACTOR shall obtain written approval from COUNTY’s DBH Director, or designee,
before subcontracting any of the services delivered under this Agreement, unless previously budgeted at
time of award. COUNTY’s DBH Director, or designee, retains the right to approve or reject any request for
subcontracting services. Any transferee, assignee, or subcontractor will be subject to all applicable
provisions of this Agreement, and all applicable State and Federal regulations. CONTRACTOR shall be
held primarily responsible by COUNTY for the performance of any transferee, assignee, or subcontractor
unless otherwise expressly agreed to in writing by COUNTY’s DBH Director, or designee. The use of
subcontractors by CONTRACTOR shall not entitle CONTRACTOR to any additional compensation that is
provided for under this Agreement.
33.AUDITS AND INSPECTIONS
CONTRACTOR shall at any time during business hours, and as often as COUNTY may
deem necessary, make available to COUNTY for examination all of its records and data with respect to
the matters covered by this Agreement. CONTRACTOR shall, upon request by COUNTY, permit
COUNTY to audit and inspect all such records and data necessary to ensure CONTRACTOR's
compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR shall be subject to the examination and audit of the State of California Auditor General
for a period of three (3) years after final payment under contract (California Government Code section
8546.7).
34.NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
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COUNTY CONTRACTOR
Director, County of Fresno The Fresno Center
Department of Behavioral Health Cc to: Pao Yang, CEO
1925 E. Dakota Ave 4879 E. Kings Canyon
Fresno, CA 93726 Fresno, CA 93727
All notices between the COUNTY and CONTRACTOR provided for or permitted under this Agreement
must be in writing and delivered either by personal service, by first-class United States mail, by an
overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
personal service is effective upon service to the recipient. A notice delivered by first-class United States
mail is effective three (3) COUNTY business days after deposit in the United States mail, postage
prepaid, addressed to the recipient. A notice delivered by an overnight commercial courier service is
effective one (1) COUNTY business day after deposit with the overnight commercial courier service,
delivery fees prepaid, with delivery instructions given for next day delivery, addressed to the recipient. A
notice delivered by telephonic facsimile is effective when transmission to the recipient is completed (but, if
such transmission is completed outside of COUNTY business hours, then such delivery shall be deemed
to be effective at the next beginning of a COUNTY business day), provided that the sender maintains a
machine record of the completed transmission. For all claims arising out of or related to this Agreement,
nothing in this Section establishes, waives, or modifies any claims presentation requirements or
procedures provided by law, including but not limited to the Government Claims Act (Division 3.6 of Title 1
of the Government Code, beginning with Section 810).
35.SEVERABILITY
If any non-material term, provision, covenant, or condition of this Agreement is held by a
court of competent jurisdiction to be invalid, void or unenforceable, the remainder of the provisions shall
remain in full force and effect, and shall in no way be affected, impaired or invalidated.
36.GOVERNING LAW
Venue for any action arising out of or related to the Agreement shall only be in Fresno
County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
28
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37.ENTIRE AGREEMENT
This Agreement, including all Exhibits, RFP No. 21-039, Addendum I, and
CONTRACTOR’s responses thereto, constitute the entire Agreement between the CONTRACTOR and
COUNTY with respect to the subject matter hereof and supersedes all previous negotiations, proposals,
commitments, writings, advertisements, publications, and understandings of any nature whatsoever
unless expressly included in this Agreement.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year
2 first hereinabove written.
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The Fresno Center:
,--~~-... ~ ~ ,.,_ ... ··
(Authorized Signat~
Pao Yang, President and CEO
Print Name & Title
1725 N. Fine Ave .
Fresno, CA 93727
Mailing Address
Steve Br ndau , Chairman of the Board of
Supervisors of the County of Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
ttiJ 'r) .;&~ By: d, J\t.'1 Cv ~~ L..:..(A-"-u"'"'th..:..o...J<r-iz.µ';d/e:.::· F-S!C...ig:....,nc...:..a=-tu-re_)________ _ _ _:,,,,.,L4>------'~o"""e"""~ ........ l""-------
Rita Byrum
Print Name
Board Treasurer
Title: Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
FOR ACCOUNTING USE ONLY:
Fund :
Subclass:
ORG :
Account:
0001
10000
56304764
7295/0
29
Exhibit A - Page 1 of 6
SUMMARY OF SERVICES
ORGANIZATION: The Fresno Center
SERVICE: Cultural Based Access Navigation Support (CBANS) Services
OFFICE ADDRESS: 4879 E. Kings Canyon Rd
Fresno, CA 93727
OFFICE TELEPHONE: (559) 255-8395
CONTACT(S): Pao Yang, Chief Executive Officer
CONTRACT PERIOD: July 1, 2021 – June 30, 2024
(Two optional 12-month extensions through June 30, 2026)
AMOUNT: FY 21-22: $ 550,000
FY 22-23: $ 550,000
FY 23-24: $ 550,000
FY 24-25: $ 550,000
FY 25-26: $ 550,000
Total: $ 2,750,000
A.SUMMARY OF SERVICES
CONTRACTOR, hereinafter referred to as “Provider,” shall provide a Cultural Based
Access Navigations Support (CBANS) program to serve all age groups of unserved and/or
underserved culturally diverse populations in Fresno County. These populations include,
but are not limited to, Hispanic/Latinos, Southeast Asians, American Indian/Alaska
Native, African Americans, Lesbian, Gay, Bisexual, Transgender, Questioning (LGBTQ+),
Veterans, homeless individuals, and those with disabilities. The CBANS program will
focus on improving timely access to mental health services for individuals and their
families from underserved populations.
The CBANS program is modeled significantly on an evidence-based, community-based
health model. The program utilizes community healthcare outreach workers, such as
Community Health Workers (CHW) and Peer Support Specialists (PSS), to disseminate
information, and act as the bridge between behavioral health providers, system of care
and the unserved/underserved communities by facilitating linkages to services.
Exhibit A - Page 2 of 6
B. CONTRACTOR RESPONSIBILITIES
Provider shall perform the activities below.
1) Services
Provider shall assist underserved and unserved populations through
culturally responsive navigation to increase and improve timely access to
behavioral health services.
Provider shall use Community Health Workers and Peer Support Specialists
to disseminate information and act as a bridge between the behavioral
health system and underserved communities.
Provider shall provide culturally appropriate community engagement,
referrals, and navigation for those identified as culturally unserved or
underserved groups to behavioral health services in Fresno County.
Provider shall bridge cultural and language divides through, but not limited
to, advocacy, education, referrals, and linkage for individuals experiencing
mental health challenges, onset and/or who have a mental illness/emotional
disturbance.
Provider shall be culturally responsive.
o Provider’s staff shall be knowledgeable, responsive, and aware about
the cultures and communities in which they work, and the unique
needs of the populations being served.
o Provider’s services shall adhere to the National CLAS standards,
attached to the Agreement as Exhibit J.
o Provider’s services shall meet the language and cultural needs of the
individuals being served, including sensitivity to sexual orientation,
gender, ethnicity, and culture.
Provider shall help individuals develop skills, resilient traits, and problem
solve when there are barriers to wellness by providing training and education
within the community. Such services shall be provided within the community
in a natural community setting (i.e. faith-based location, schools, community
centers, etc.), not of clinical or medical nature.
Provider shall facilitate referrals and linkages and will include a warm
handoff, if preferred by the individual served.
Provider shall conduct follow-ups and check-ins with individuals served for
referrals and linkages to ensure services were appropriately provided,
effective, and in a timely manner. Check-ins and follow-ups will be at the
preference of the individual served.
Provider shall align all services with DBH’s Guiding Principles of Care Delivery .
Provider shall have clearly defined and measurable goals.
Provider shall evaluate the program periodically to assess progress and
refine, improve, and strengthen the program’s effectiveness.
Provider shall participate in program evaluation activities, including third-
party evaluations.
Exhibit A - Page 3 of 6
Provider shall maintain a Pandemic/Natural Disaster Plan for when services
will need to be modified.
Provider will abide by the Fresno County Mental Health Plan (MHP) grievance
process, attached to the Agreement as Exhibit K and notify County of all
incidents reportable to state licensing bodies that affect County consumers
within twenty-four (24) hours of receipt of a complaint. Provider shall use
existing County Department Incident Report form (Exhibit F) and submit to
County a copy of the Incident Report within 24 hours. Within fifteen (15)
days after each incident or complaint affecting County-sponsored consumers,
Provider shall provide County with the complaint and Provider’s disposition
of, or corrective action taken to resolve the complaint or incident.
2) Data Collection
Provider shall collect all data required by MHSA PEI regulations, attached to
the Agreement as Exhibit L.
o Demographics
Age group
Race
Ethnicity
Primary Language
Sexual Orientation
Disability
Veteran Status
Gender Assigned at Birth
Current Gender Identity
o Outcomes
Identify the specific underserved populations for whom the
County intended to increase timely access to services.
Number of referrals for individuals served in underserve
populations to a Prevention Program, an Early Intervention
Program, and/or to treatment beyond early onset.
Number of individuals who followed through on the referral,
defined as the number of individuals who participated at least
once in the Program to which they were referred.
Average interval between referral and participation in services
to which individual served was referred, defined as
participating at least once in services to which referred, and
standard deviation.
Description of ways the Provider encouraged access to
services and follow-though on referrals.
Exhibit A - Page 4 of 6
3) Reporting Requirements
Provider shall submit measurable outcomes on an annual basis, as identified
in the Departments Policy and Procedure Guide (PPG) 1.2.7 Performance
Outcomes Measures, attached to the Agreement as Exhibit M.
Provider shall get approval by DBH to ensure all outcomes reporting will
satisfy all State and local mandates.
Provider shall ensure all performance indicators reflect the four domains
identified by CARF, which include Effectiveness, Efficiency, Access, and
Satisfaction.
Provider shall meet reporting requirements for MHSA PEI regulations in the
category of improving timely access to services for underserve populations.
4) Performance Goals
TFC shall track all performance goals for each fiscal year of services. It is expected to
serve at least 6,000 individuals. The goal is to increase services to 3% of individuals
each year.
Fiscal
Year
Number of
Individuals
Served Number of Linkages Number of Referrals
Number of Transports to
need community services
2021-22 6,000
95% of those identified to
need linkage
85% of those identified to
need referral
75% of those identified to
need transportation
2022-23 6,180
95% of those identified to
need linkage
85% of those identified to
need referral
75% of those identified to
need transportation
2023-24 6,365
95% of those identified to
need linkage
85% of those identified to
need referral
75% of those identified to
need transportation
2024-25 6,556
95% of those identified to
need linkage
85% of those identified to
need referral
75% of those identified to
need transportation
2025-26 6,753
95% of those identified to
need linkage
85% of those identified to
need referral
75% of those identified to
need transportation
5) Training and Education
Provider shall provide staff and community ongoing culturally and ethnically
appropriate training on relevant health-related topics, including but not limited
to Mental Health First Aid, suicide prevention, anti-stigma, depression, anxiety,
homelessness, and mental wellness.
Provider shall train and educate staff to ensure referrals made to multiple
outside agencies are pivotal in complementing warm handoffs in linking
individuals to resources, including but not limited to, counseling services,
rehabilitation, and other mental health services.
Provider staff shall receive training in wellness recovery action plans, person-
centered thinking, trauma informed crisis management, stress management,
suicide prevention training, features of medication sensitivity trainings, anti-
Exhibit A - Page 5 of 6
stigma training, case management training, community resources and services
training, assessment and intake, and data collection and tracking.
Provider shall rely on community partners, resources and collaborations to assist
in ongoing training for staff and community.
6) Compliance with County
A. Provider shall comply with all contract monitoring and compliance protocols,
procedures, data collection methods, and reporting requirements conducted by
the COUNTY.
B. Provider shall attend trainings on an as-needed basis.
C. Provider shall follow all of Fresno County Department of Behavioral Health’s
branding requirements and receive approval prior to distribution. This includes
naming, branding, marketing, signage, website/webpage, brochures,
promotional materials, and communications that involve the CBANS program.
7) Participation in DBH and Third-Party Evaluations
Provide shall participate in all program evaluations, including those by third-party
evaluators. This may include evaluation meetings, data findings, or contract issues
as requested by DBH or provider. DBH shall coordinate the meetings and data
exchange.
8) Staffing
Provider staff shall reflect the identified underserved populations.
Provider shall meet Fresno County’s three threshold languages of English,
Spanish, and Hmong.
Provider shall be bi-cultural and bilingual, trained and receive ongoing
training to provide services that are culturally responsive, including providing
translation and interpreter services available for clients, sensitivity to sexual
orientation and gender, addressing issues based upon cultural, ethnicity,
gender and sexual orientation.
At a minimum, Provider shall maintain 6.15 Full Time Employees (FTE) as
follows:
0.15 FTE Program Director
1 FTE Community Health Worker (CHW)/Coordinator
1 FTE Community Health Worker (CHW)/Data Specialist
4 FTE Peer Support Specialists (PSS)
6.15 FTE Total
Exhibit A - Page 6 of 6
C. COUNTY RESPONSIBILITIES
County shall:
1) Participate in monthly meetings with Provider to discuss program, contractual
issues, and/or findings. Meetings frequency may be changed after the first year of
implementation. DBH will be responsible for coordination of these meetings.
2) Participate in evaluation of the progress of the overall program and the efficiency of
the collaboration with Provider and will be available to Provider for ongoing
consultation.
3) Gather outcome information from Provider throughout each term of this
Agreement. COUNTY DBH staff shall notify the Provider when its participation is
required.
4) DBH shall include Provider in DBH trainings that are relevant to the services as
described in this Agreement, if there is sufficient space available, at no cost.
Guiding Principles of Care Delivery
1
rev 2017 Dec
DBH VISION:
Health and well-being for our community.
DBH MISSION:
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,
families and communities in Fresno County who are affected by, or are at risk of, mental illness
and/or substance use disorders through cultivation of strengths toward promoting recovery in
the least restrictive environment.
DBH GOALS:
Quadruple Aim
•Deliver quality care
•Maximize resources while focusing on efficiency
•Provide an excellent care experience
•Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1.Principle One - Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
Exhibit B - Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2
rev 2017 Dec
2.Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3.Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4.Principle Four - Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person’s quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5.Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and client values and preferences
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
Exhibit B - Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
3
rev 2017 Dec
6.Principle Six - Culturally Responsive
o Values, traditions, and beliefs specific to an individual’s or family’s culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7.Principle Seven - Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8.Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9.Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the client’s stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
Exhibit B - Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
4
rev 2017 Dec
10.Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11.Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
Exhibit B - Page 4 of 4
Fresno County Department of Behavioral Health
EXHIBIT C 1 of 40
Employee Salaries
Acct # Position FTE Admin Direct Total
1101 Program Director 0.15 -$ 14,250$ 14,250$
1102 Community Health Worker/Coordinator 1.00 - 49,920 49,920
1103 Peer Support Specialist 1.00 - 33,280 33,280
1104 Peer Support Specialist 1.00 - 33,280 33,280
1105 Peer Support Specialist 1.00 - 33,280 33,280
1106 Peer Support Specialist 1.00 - 33,280 33,280
1107 Community Health Worker/Data Specialist 1.00 - 37,440 37,440
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 6.15 -$ 234,730$ 234,730$
Employee Benefits
Acct #Admin Direct Total
1101 7,042$ 7,042$
1102 1,432 1,432
1103 35,740 35,740
1104 - - -
1105 - - -
1106 - - -
-$ 44,214$ 44,214$
0.17$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 17,957 17,957
1203 2,669$ 2,669
1204 - - -
1205 - - -
1206 - - -
-$ 20,626$ 20,626$
-$ 299,570$ 299,570$
Other (specify)
Employee Benefits Subtotal:
Employee Benefits %:
Description
1000: SALARIES & BENEFITS
Retirement
Worker's Compensation
Health Insurance
Other (specify)
Other (specify)
OASDI
FICA/MEDICARE
SUI
Other (specify)
PROGRAM EXPENSES
The Fresno Center
Culturally-Based Access Navigation Support (CBANS) Services
Fiscal Year (FY 2021-22)
Description
Payroll Taxes & Expenses Subtotal:
Other (specify)
Other (specify)
EMPLOYEE SALARIES & BENEFITS TOTAL:
EXHIBIT C 2 of 40
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 2,000
2004 -
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 18,000
2012 -
2013 -
2014 -
2015 -
2016 -
20,000$
3000: OPERATING EXPENSES
Acct #Amount
3001 4,200$
3002 9,600
3003 17,763
3004 2,400
3005 14,400
3006 8,387
3007 1,200
3008
3009 -
3010 -
3011 -
3012 -
57,950$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 15,410$
4002 32,280
4003 6,000
4004 -
4005 3,600
4006 11,250
4007 Other (specify)-
4008 Other (specify)-
4009 Other (specify)-
4010 Other (specify)-
68,540$
5000: SPECIAL EXPENSES
Other (specify)
Other (specify)
Clothing, Food, & Hygiene
Other (specify)
Other (specify)
Office, Household & Program Supplies
Utility Vouchers
Program Supplies - Medical
Medication Supports
Household Items for Clients
Employment Support
Staff Mileage
Subscriptions & Memberships
Other (specify)
Other (specify)
Other (specify)
Telecommunications
Printing/Postage
Client Transportation & Support
Client Housing Support
Child Care
Other (specify)
Rent/Lease Vehicles
Security
Utilities
Rent/Lease Equipment
FACILITIES/EQUIPMENT TOTAL:
OPERATING EXPENSES TOTAL:
Staff Development & Training
Vehicle Maintenance
Line Item Description
Line Item Description
Line Item Description
DIRECT CLIENT CARE TOTAL
Other (specify)
Other (specify) - PEI Theraputic Supplies
Advertising
Rent/Lease Building
Building Maintenance
Education Support
EXHIBIT C 3 of 40
Acct #Amount
5001 8,000$
5002 -
5003 10,000
5004 -
5005 Other (specify)-
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
18,000$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 71,740$
6002 -
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (specify)-
6009 Other (specify)-
6010 Other (specify)-
6011 Other (specify)-
6012 Other (specify)-
71,740$
7000: FIXED ASSETS
Acct #Amount
7001 6,000$
7002 4,200
7003 4,000
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
14,200$
Contractual/Consulting Services (Specify)
Translation Services
Consultant (Network & Data Management)
Furniture & Fixtures
Line Item Description
Administrative Overhead
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
HMIS (Health Management Information System)
External Audit
Line Item Description
Computer Equipment
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Other Assets over $500 with Lifespan of 2 Years +
550,000$ TOTAL PROGRAM EXPENSES
FIXED ASSETS EXPENSES TOTAL
ADMINISTRATIVE EXPENSES TOTAL
SPECIAL EXPENSES TOTAL:
Line Item Description
Professional Liability Insurance
Accounting/Bookkeeping
Leasehold/Tenant/Building Improvements
EXHIBIT C 4 of 40
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention 550,000
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
550,000$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)-
8404 Other Revenue 1 -
8405 Other Revenue 2 -
-$
Cultural Based Access Navigation Support
8200 - REALIGNMENT
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Federal Financial Participation (FFP) %
MHSA Program Name
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
Line Item Description
REALIGNMENT TOTAL
NET PROGRAM COST:
PROGRAM FUNDING SOURCES
TOTAL PROGRAM FUNDING SOURCES:550,000$
-$
SUBSTANCE USE DISORDER FUNDS TOTAL
MEDI-CAL FFP TOTAL
MHSA TOTAL
Line Item Description
Line Item Description
8100 - SUBSTANCE USE DISORDER FUNDS
OTHER REVENUE TOTAL
Line Item Description
8400 - OTHER REVENUE
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
EXHIBIT C 5 of 40
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 299,570
Employee Salaries 234,730
1101 Program Director 14,250 Program Director at $7,916.66/mon. x 12 months x 15% FTE = $14,250. The
Program Director will oversee the overall development and management of the
program. Program Director works directly with the invidiuals served by providing
mental health and strengths-based trainings, provides event engagement and
provides occassional client check-in.
1102 Community Health Worker/Coordinator 49,920 Community Health Worker/Coordinator at $4,160/mon. x 12 months x 100% FTE =
$49,920. The Community Health Worker/Coordinator will assist the program
director with day-to-day management and help navigate all ages of unserved and
underserved groups with access to behavioral health services.
1103 Peer Support Specialist 33,280 Peer Support Specialist at $2,773.33/mon. x 12 months x 100% FTE = $33,280.
The Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1104 Peer Support Specialist 33,280 Peer Support Specialist at $2,773.33/mon. x 12 months x 100% FTE = $33,280. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1105 Peer Support Specialist 33,280 Peer Support Specialist at $2,773.33/mon. x 12 months x 100% FTE = $33,280. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1106 Peer Support Specialist 33,280 Peer Support Specialist at $2,773.33/mon. x 12 months x 100% FTE = $33,280. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1107 Community Health Worker/Data Specialist 37,440 Community Health Worker/Data Specialist at $3,120/mon. x 12 months x 100% FTE
= $37,440. The Community Health Worker/Data Specialist is responsible to ensure
client information is properly stored and safeguarded. This associate will track and
monitor internal data on partnerships, sign-in sheets, unique clients, and input into
the approved data collection tools and create reports as requested. The Community
Health Worker/Data Specialist will also help navigate all ages of unserved and
underserved groups with access to behavioral health services.
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 44,214
1101 Retirement 7,042 Retirement @ $234,730 total salaries x 3% of salaries = $7,042
1102 Worker's Compensation 1,432 Worker's Compensation @ $234,730 total salaries x .61 (%) = $1,432
1103 Health Insurance 35,740 Health Insurance (medical + vision + dental + life Insurance @ $484.28 per month x
12 months x 6.15 FTE = $35,740
1104 Other (specify)-
1105 Other (specify)-
1106 Other (specify)-
Payroll Taxes & Expenses:20,626
1201 OASDI -
1202 FICA/MEDICARE 17,957 FICA/MEDICARE @ $234,7300 total salaries x 7.65 (%) = $17,957
Culturally-Based Access Navigation Support (CBANS) Services
The Fresno Center
Fiscal Year (FY 2021-22)
EXHIBIT C 6 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1203 SUI 2,669 SUI @ first 7000 x 6.20% x 6.15 FTE = $2,669
1204 Other (specify)-
1205 Other (specify)-
1206 Other (specify)-
2000: CLIENT SUPPORT 20,000
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support 2,000 Bus tokens given to each client visit. They get 2 bus tokens with $2.50 equivalent
estimates at $2.50 per client x 800 tokens (estimated) = $2,000 annually.
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (specify) - PEI Theraputic Supplies 18,000 PEI Therapeutic Supplies will be used to carry out activities for family, group, and
individual. Supplies may include but are not limited to : Wellness kits, arts and crafts
supplies, etc., estimates @ $1,500 per month x 12 months = $18,000 annually.
2012 Other (specify)-
2013 Other (specify)-
2014 Other (specify)-
2015 Other (specify)-
2016 Other (specify)-
3000: OPERATING EXPENSES 57,950
3001 Telecommunications 4,200 Telecommunications - Internet, cell phone services (stipend), land line services,
installment fees, etc., estimates @ $350/month x 12 months = $4,200 annually.
3002 Printing/Postage 9,600 Printing/Postage - Includes: postage & delivery, in-house printing, flyers, handouts,
workshop information, binding, brochures, etc., estimates @ $800 per month x 12
months = $9,600 annually.
3003 Office, Household & Program Supplies 17,763 Office, Household & Program Supplies - Includes: general office supplies, toner,
papers, office décor, water service, sanitizing material, background checks, Software
licenses ( set up, and monthly fees including outlook, , Conference call, Microsoft,
Adobe professional, etc.,) costs are estimates @ $1,480 per month x 12 months =
$17,763 annually.
3004 Advertising 2,400 Advertising - video, radio station, social media advertisements, etc., costs are
estimated @ $200 per month x 12 months = $2,400 annually.
3005 Staff Development & Training 14,400 Staff Development & Training – Staff onboarding training, WRAP, mental health first
aide, resource training, mental health system navigation, case management, etc.,
estimates @ $1,200 per month x 12 months = $14,400 annually
3006 Staff Mileage 8,387 Staff Mileage - Mileage reimbursement for staff to travel locally and in rural areas
estimates at 208 miles monthly x 12 months x .56/mile x 6 FTE = $8,387 annually
3007 Subscriptions & Memberships 1,200 Subscriptions & Memberships - Amazon prime, zoom, member calls, live webinars,
online content subscription associate with program, remote access, etc., estimates
@ $100 per month x 12 months = $1,200 annually
3008 Vehicle Maintenance -
3009 Other (specify)-
3010 Other (specify)-
3011 Other (specify)-
3012 Other (specify)-
4000: FACILITIES & EQUIPMENT 68,540
4001 Building Maintenance 15,410 Building Maintenance – Includes: Janitorial services, pest control, alarm, keys, doors,
window, cooling and heating, locksmith, etc., estimates @ $1,284.17 per month x 12
months = $15,410 annually.
4002 Rent/Lease Building 32,280 Rent/Lease Building estimated @ 1,250 sq. ft. x $2 per sq. ft x 12 months = $30,000
($2,500/month)
Other building rent/lease at rural areas for other activities estimated @ $190 per
month x 12 months = $2,280
Total Rent/Lease Building = $32,280 ($30,000 + $2,280 = $32,280)
EXHIBIT C 7 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4003 Rent/Lease Equipment 6,000 Rent/Lease Equipment - Copy machine, other equipment rental estimates @ $500
per month x 12 months = $6,000 annually
4004 Rent/Lease Vehicles -
4005 Security 3,600 Security will cover the security system and services @ $300 x 12 months = $3,600.
4006 Utilities 11,250 Utilities cost estimate @ $937.50 per month x 12 months = $11,250 annually
4007 Other (specify)- Other -
4008 Other (specify)-
4009 Other (specify)-
4010 Other (specify)-
5000: SPECIAL EXPENSES 18,000
5001 Consultant (Network & Data Management)8,000 Consultant (Network & Data Management) estimates @ $666.67 per month x 12
months = $8,000. Network & Data Management Consultant will help the program
members with setting up pc, projectors, network, mobile connection, remote
meetings and sessions with their clients, before, during, and after. Network & Data
Management Consultant will help with troubleshooting staff members' pc, network
connections, installations, and with cloud management. Network & Data
Management Consultant will also help clients with their computer login and network
to ensure their remote access is working when participating in a CBANS activity.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)10,000 Contractual/Consulting Services on evaluation and others consultant to develop
instruments, analysis and compile reports on data form, cost estimates @ $833.33
per month x 12 months = $10,000. Consultant will provide external evaluation and
support to the program and will be responsible for compiling demographic
information as well as satisfaction and efficiency information for outcome reports.
Consultant may also conduct focus groups to help provide qualitative feedback from
program participants for the continual improvement of the program.
5004 Translation Services -
5005 Other (specify)-
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
6000: ADMINISTRATIVE EXPENSES 71,740
6001 Administrative Overhead 71,740 Administrative Overhead is at 15% of $478,260 = $71,740
$550,000-$71,740= $478,260 $71,740/$478,260 = 15%
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (specify)-
6009 Other (specify)-
6010 Other (specify)-
6011 Other (specify)-
6012 Other (specify)-
7000: FIXED ASSETS 14,200
7001 Computer Equipment 6,000 Computer Equipment - (Laptops, desktops, and monitors) estimated @ $1,000 per
unit x 6 FTE = $6,000
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
4,200 Land Line Phone, Cell Phones, Tablets, Devices to Contain HIPAA Data estimated @
$700 per unit x 6 FTE = $4,200
7003 Furniture & Fixtures 4,000 Furniture & Fixtures - desks is at $500 per unit x 6 units = $3,000, chairs is at $70 per
unit x 6 units = $420, Cabinets is at $290 per unit x 2 units = $580. Total furniture &
fixtures costs = $4,000 (3,000+420+580)
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
EXHIBIT C 8 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:550,000
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:550,000
-
EXHIBIT C 9 of 40
Employee Salaries
Acct # Position FTE Admin Direct Total
1101 Program Director 0.15 -$ 14,678$ 14,678$
1102 Community Health Worker/Coordinator 1.00 - 51,418 51,418
1103 Peer Support Specialist 1.00 - 34,278 34,278
1104 Peer Support Specialist 1.00 - 34,278 34,278
1105 Peer Support Specialist 1.00 - 34,278 34,278
1106 Peer Support Specialist 1.00 - 34,278 34,278
1107 Community Health Worker/Data Specialist 1.00 - 38,563 38,563
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 6.15 -$ 241,771$ 241,771$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 7,253$ 7,253$
1102 1,475 1,475
1103 37,542 37,542
1104 - -
1105 - - -
1106 - - -
-$ 46,270$ 46,270$
0.175974382
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 18,496 18,496
1203 2,669 2,669
1204 - - -
1205 - -
1206 - -
-$ 21,165$ 21,165$
-$ 309,206$ 309,206$
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Employee Benefits Subtotal:
Employee Benefits %:
Description
OASDI
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
The Fresno Center
Culturally-Based Access Navigation Support (CBANS) Services
Fiscal Year (FY 2022-23)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
EXHIBIT C 10 of 40
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 2,000
2004 -
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 18,000
2012 -
2013 -
2014 -
2015 -
2016 -
20,000$
3000: OPERATING EXPENSES
Acct #Amount
3001 4,200
3002 9,600
3003 18,927
3004 2,400
3005 14,400
3006 8,387
3007 1,200
3008 -
3009 -
3010 -
3011 -
3012 -
59,114$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 15,410$
4002 32,280
4003 6,000
4004 -
4005 3,600
4006 11,250
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
68,540$
5000: SPECIAL EXPENSES
FACILITIES/EQUIPMENT TOTAL:
Security
Utilities
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Specify) - PEI theraputic supplies
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
EXHIBIT C 11 of 40
Acct #Amount
5001 8,000$
5002 -
5003 10,000
5004 -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
18,000$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 71,740
6002 -
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
71,740$
7000: FIXED ASSETS
Acct #Amount
7001 2,000$
7002 1,400
7003 -
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
3,400$ FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 550,000$
Line Item Description
Computer Equipment
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify) - Evaluation and other consultant
Translation Services
EXHIBIT C 12 of 40
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment (0)$
(0)$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention Cultural Based Access Navigation Support 550,000
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
550,000$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)
8404 Other (Specify)
8405 Other (Specify) -
-$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:550,000$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
EXHIBIT C 13 of 40
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 309,206
Employee Salaries 241,771
1101 Program Director 14,678 Program Director at $8,154.17/mon. x 12 months x 15% FTE = $14,678. The
Program Director will oversee the overall development and management of the
program. Program Director works directly with the invidiuals served by providing
mental health and strengths-based trainings, provides event engagement and
provides occassional client check-in.
1102 Community Health Worker/Coordinator 51,418 Community Health Worker/Coordinator at $4,284.80/mon. x 12 months x 100% FTE
= $51,418. The Community Health Worker/Coordinator will assist the program
director with day-to-day management and help navigate all ages of unserved and
underserved groups with access to behavioral health services.
1103 Peer Support Specialist 34,278 Peer Support Specialist at $2,856.53/mon. x 12 months x 100% FTE = $34,278.
The Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1104 Peer Support Specialist 34,278 Peer Support Specialist at $2,856.53/mon. x 12 months x 100% FTE = $34,278. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1105 Peer Support Specialist 34,278 Peer Support Specialist at $2,856.53/mon. x 12 months x 100% FTE = $34,278.
The Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1106 Peer Support Specialist 34,278 Peer Support Specialist at $2,856.53/mon. x 12 months x 100% FTE = $34,278. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1107 Community Health Worker/Data Specialist 38,563 Community Health Worker/ Data Specialist at $3,213.58/mon. x 12 months x 100%
FTE = $38,563. The Community Health Worker/Data Specialist is responsible to
ensure client information is properly stored and safeguarded. This associate will
track and monitor internal data on partnerships, sign-in sheets, unique clients, and
input into the approved data collection tools and create reports as requested. The
Community Health Worker/Data Specialist will also help navigate all ages of
unserved and underserved groups with access to behavioral health services.
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 46,270
1101 Retirement 7,253 Retirement @ $241,771 total salaries x 3% = $7,253
1102 Worker's Compensation 1,475 Worker's Compensation @ $241,771 total salaries * .61 (%) = $1,475
1103 Health Insurance 37,542 Health Insurance (medical + vision + dental + life Insurance @ $508.70 per month x
12 months x 6.15 FTE = $37,542
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:21,165
1201 OASDI -
1202 FICA/MEDICARE 18,496 FICA/MEDICARE @ $241,771 total salaries x 7.65 (%) = $18,496
The Fresno Center
Culturally-Based Access Navigation Support (CBANS) Services
Fiscal Year (FY 2022-23)
EXHIBIT C 14 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1203 SUI 2,669 SUI @ first 7000 x 6.20% x 6.15 FTE = $2,669
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 20,000
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support 2,000 Bus tokens given to each client visit. They get 2 bus tokens with $2.50 equivalent
estimates at $2.50 per client x 800 tokens (estimated) = $2,000 annually.
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Specify) - PEI theraputic supplies 18,000 PEI Therapeutic Supplies will be used to carry out activities for family, group, and
individual. Supplies may include but are not limited to : Wellness kits, arts and crafts
supplies, etc., estimates @ $1,500 per month x 12 months = $18,000 annually.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 59,114
3001 Telecommunications 4,200 Telecommunications - Internet, cell phone services (stipend), land line services,
installment fees, etc., estimates @ $350/month x 12 months = $4,200 annually.
3002 Printing/Postage 9,600 Printing/Postage - Includes: postage & delivery, in-house printing, flyers, handouts,
workshop information, binding, brochures, etc., estimates @ $800 per month x 12
months = $9,600 annually.
3003 Office, Household & Program Supplies 18,927 Office, Household & Program Supplies - Includes: general office supplies, toner,
papers, office décor, water service, sanitizing material, background checks, Software
licenses( set up, and monthly fees including outlook, , Conference call, Microsoft,
Adobe professional, etc.) costs are estimates @ $1,577 per month x 12 months =
$18,927 annually
3004 Advertising 2,400 Advertising - video, radio station, social media advertisements, etc., costs are
estimated @ $200 per month x 12 months = $2,400 annually.
3005 Staff Development & Training 14,400 Staff Development & Training – Staff onboarding training, WRAP, mental health first
aide, resource training, mental health system navigation, case management, etc.,
estimates @ $1,200 per month x 12 months = $14,400 annually.
3006 Staff Mileage 8,387 Staff Mileage - Mileage reimbursement for staff to travel locally and in rural areas
estimates at 208 miles monthly x 12 months x .56/mile x 6 FTE = $8,387 annually.
3007 Subscriptions & Memberships 1,200 Subscriptions & Memberships - Amazon prime, zoom, member calls, live webinars,
online content subscription associate with program, remote access, etc., estimates
@ $100 per month x 12 months = $1,200 annually.
3008 Vehicle Maintenance -
3009 Other (Specify)-
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 68,540
4001 Building Maintenance 15,410 Building Maintenance – Includes: Janitorial services, pest control, alarm, keys, doors,
window, cooling and heating, locksmith, etc., estimates @ $1,284.17 per month x 12
months = $15,410 annually.
EXHIBIT C 15 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4002 Rent/Lease Building 32,280 Rent/Lease Building estimated @ 1,250 sq. ft. x $2 per sq. ft x 12 months = $30,000
($2,500/month)
Other building rent/lease for rural area estimated @ $190 per month x 12 months =
$2,280
Total Rent/Lease Building = $32,280 ($30,000 + $2,280 = $32,280)
4003 Rent/Lease Equipment 6,000 Rent/Lease Equipment - Copy machine and other equipment rental costs are
estimated @ $500 per month x 12 months = $6,000 annually.
4004 Rent/Lease Vehicles -
4005 Security 3,600 Security will cover the security system and services @ $300 x 12 months = $3,600.
4006 Utilities 11,250 Utilities cost is estimated @ $937.50 per month x 12 months = $11,250 annually.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 18,000
5001 Consultant (Network & Data Management)8,000 Consultant (Network & Data Management) estimates @ $666.67 per month x 12
months = $8,000. Network & Data Management Consultant will help the program
members with setting up pc, projectors, network, mobile connection, remote
meetings and sessions with their clients, before, during, and after. Network & Data
Management Consultant will help with troubleshooting staff members' pc, network
connections, installations, and with cloud management. Network & Data
Management Consultant will also help clients with their computer login and network
to ensure their remote access is working when participating in a CBANS activity.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify) -
Evaluation and other consultant
10,000 Contractual/Consulting Services on evaluation and other consultant estimates @
$833.33 per month x 12 months = $10,000. Consultant will provide external
evaluation and support to the program and will be responsible for compiling
demographic information as well as satisfaction and efficiency information for
outcome reports. Consultant may also conduct focus groups to help provide
qualitative feedback from program participants for the continual improvement of
the program.
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 71,740
6001 Administrative Overhead 71,740 Administrative Overhead is at 15% of $478,260 = $71,740
$550,000-$71,740= $478,260 $71,740/$478,260 = 15%
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS 3,400
7001 Computer Equipment 2,000 Computer Equipment - Laptops, desktops, and monitors repair and maintenance
estimated @ $1,000 per unit x 2 FTE = $2,000
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
1,400 Land Line Phone, Cell Phones, Tablets, Devices to Contain HIPAA Data repair and
maintenance estimates @ $700 per unit x 2 FTE = $1,400
7003 Furniture & Fixtures -
EXHIBIT C 16 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:550,000
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:550,000
-
EXHIBIT C 17 of 40
Employee Salaries
Acct # Position FTE Admin Direct Total
1101 Program Director 0.15 -$ 15,118$ 15,118$
1102 Community Health Worker/Coordinator 1.00 - 52,960 52,960
1103 Peer Support Specialist 1.00 - 35,307 35,307
1104 Peer Support Specialist 1.00 - 35,307 35,307
1105 Peer Support Specialist 1.00 - 35,307 35,307
1106 Peer Support Specialist 1.00 - 35,307 35,307
1107 Community Health Worker/Data Specialist 1.00 - 39,720 39,720
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - -
Personnel Salaries Subtotal 6.15 -$ 249,026$ 249,026$
Employee Benefits
Acct #Admin Direct Total
1101 7,471$ 7,471$
1102 1,519 1,519
1103 39,340 39,340
1104 - - -
1105 - - -
1106 - - -
-$ 48,330$ 48,330$
0.178507452
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 19,050 19,050
1203 2,669 2,669
1204 - - -
1205 - -
1206 - -
-$ 21,719$ 21,719$
-$ 319,075$ 319,075$
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Employee Benefits Subtotal:
Employee Benefits %:
Description
OASDI
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
The Fresno Center
Culturally-Based Access Navigation Support (CBANS) Services
Fiscal Year (FY 2023-24)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
EXHIBIT C 18 of 40
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -$
2003 2,000$
2004 -$
2005 -$
2006 -$
2007 -$
2008 -$
2009 -$
2010 -$
2011 18,000$
2012 -$
2013 -$
2014 -$
2015 -$
2016 -$
20,000$
3000: OPERATING EXPENSES
Acct #Amount
3001 4,200$
3002 9,600$
3003 17,198$
3004 2,400$
3005 8,000$
3006 8,387$
3007 1,200$
3008 -$
3009 -$
3010 -$
3011 -$
3012 -$
50,985$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 15,410$
4002 32,280
4003 6,000
4004 -
4005 3,600
4006 11,210
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
68,500$
5000: SPECIAL EXPENSES
FACILITIES/EQUIPMENT TOTAL:
Security
Utilities
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
EXHIBIT C 19 of 40
Acct #Amount
5001 8,000$
5002 -
5003 10,000
5004 -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
18,000$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 71,740
6002 -
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
71,740$
7000: FIXED ASSETS
Acct #Amount
7001 1,000$
7002 700
7003 -
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
1,700$ FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 550,000$
Line Item Description
Computer Equipment
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
EXHIBIT C 20 of 40
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment (0)$
(0)$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention Cultural Based Access Navigation Support 550,000
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
550,000$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)-
8404 Other (Specify) -
8405 Other (Specify) -
-$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:550,000$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
EXHIBIT C 21 of 40
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 319,075
Employee Salaries 249,026
1101 Program Director 15,118 Program Director at $8,398.83/mon. x 12 months x 15% FTE = $15,118. The
Program Director will oversee the overall development and management of the
program. Program Director works directly with the invidiuals served by providing
mental health and strengths-based trainings, provides event engagement and
provides occassional client check-in.
1102 Community Health Worker/Coordinator 52,960 Community Health Worker/Coordinator at $4,413.33/mon. x 12 months x 100% FTE
=$52,960. The Community Health Worker/Coordinator will assist the program
director with day-to-day management and help navigate all ages of unserved and
underserved groups with access to behavioral health services.
1103 Peer Support Specialist 35,307 Peer Support Specialist at $2,942.23/mon. x 12 months x 100% FTE = $35,307. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1104 Peer Support Specialist 35,307 Peer Support Specialist at $2,942.23/mon. x 12 months x 100% FTE = $35,307. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1105 Peer Support Specialist 35,307 Peer Support Specialist at $2,942.23/mon. x 12 months x 100% FTE = $35,307. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1106 Peer Support Specialist 35,307 Peer Support Specialist at $2,942.23/mon. x 12 months x 100% FTE = $35,307. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1107 Community Health Worker/Data Specialist 39,720 Community Health Worker/Data Specialist at $3,310/mon. x 12 months x 100% FTE
= $39,720. The Community Health Worker/Data Specialist is responsible to ensure
client information is properly stored and safeguarded. This associate will track and
monitor internal data on partnerships, sign-in sheets, unique clients, and input into
the approved data collection tools and create reports as requested. The Community
Health Worker/Data Specialist will also help navigate all ages of unserved and
underserved groups with access to behavioral health services.
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 48,330
1101 Retirement 7,471 Retirement @ $249,026 total salaries x 3% = $7,471
1102 Worker's Compensation 1,519 Worker's Compensation @ $249,026 total salaries x .61 (%) = $1,519
1103 Health Insurance 39,340 Health Insurance (medical + vision + dental + life Insurance @ $533.06 per month x
12 months x 6.15 FTE = $39,340
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:21,719
1201 OASDI -
1202 FICA/MEDICARE 19,050 FICA/MEDICARE @ $249,026 total salaries x 7.65 (%) = $19,050
The Fresno Center
Culturally-Based Access Navigation Support (CBANS) Services
Fiscal Year (FY 2023-24)
EXHIBIT C 22 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1203 SUI 2,669 SUI @ first 7000 x 6.20% x 6.15 FTE = $2,669
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 20,000
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support 2,000 Bus tokens given to each client visit. They get 2 bus tokens with $2.50 equivalent
estimates at $2.50 per client x 800 tokens (estimated) = $2,000 annually.
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Specify)18,000 PEI Therapeutic Supplies will be used to carry out activities for family, group, and
individual. Supplies may include but are not limited to : Wellness kits, arts and crafts
supplies, etc., estimates @ $1,500 per month x 12 months = $18,000 annually.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 50,985
3001 Telecommunications 4,200 Telecommunications - Internet, cell phone services (stipend), land line services,
installment fees, etc., estimates @ $350/month x 12 months = $4,200 annually.
3002 Printing/Postage 9,600 Printing/Postage - Includes: postage & delivery, in-house printing, flyers, handouts,
workshop information, binding, brochures, etc., estimates @ $800 per month x 12
months = $9,600 annually.
3003 Office, Household & Program Supplies 17,198 Office, Household & Program Supplies - Includes: general office supplies, toner,
papers, office décor, water service, sanitizing material, background checks, Software
licenses ( set up, and monthly fees including outlook, Conference call, Microsoft,
Adobe professional, etc.) costs are estimates @ $1,433 per month x 12 months =
$17,198 annually.
3004 Advertising 2,400 Advertising - video, radio station, social media advertisements, etc., costs are
estimated @ $200 per month x 12 months = $2,400 annually.
3005 Staff Development & Training 8,000 Staff Development & Training – Staff onboarding training, WRAP, mental health first
aide, resource training, mental health system navigation, case management, etc.,
estimates @ $666.67 per month x 12 months = $8,000 annually.
3006 Staff Mileage 8,387 Staff Mileage - Mileage reimbursement for staff to travel locally and in rural areas
estimates at 208 miles monthly x 12 months x .56/mile x 6 FTE = $8,387 annually.
3007 Subscriptions & Memberships 1,200 Subscriptions & Memberships - Amazon prime, zoom, member calls, live webinars,
online content subscription associate with program, remote access, etc., estimates
@ $100 per month x 12 months = $1,200 annually.
3008 Vehicle Maintenance -
3009 Other (Specify)-
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 68,500
4001 Building Maintenance 15,410 Building Maintenance – Includes: Janitorial services, pest control, alarm, keys, doors,
window, cooling and heating, locksmith, etc., estimates @ $1,284.17 per month x 12
months = $15,410 annually.
EXHIBIT C 23 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4002 Rent/Lease Building 32,280 Rent/Lease Building estimated @ 1,250 sq. ft. x $2 per sq. ft x 12 months = $30,000
($2,500/month)
Other building rent/lease for rural areas estimated @ $190 per month x 12 months =
$2,280
Total Rent/Lease Building = $32,280 ($30,000 + $2,280 = $32,280)
4003 Rent/Lease Equipment 6,000 Rent/Lease Equipment - Copy machine and other equipment rental costs are
estimated @ $500 per month x 12 months = $6,000 annually.
4004 Rent/Lease Vehicles -
4005 Security 3,600 Security will cover the security system and services @ $300 x 12 months = $3,600.
4006 Utilities 11,210 Utilities cost is estimated @ $934.17 per month x 12 months = $11,210 annually.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 18,000
5001 Consultant (Network & Data Management)8,000 Consultant (Network & Data Management) estimates @ $666.67 per month x 12
months = $8,000. Network & Data Management Consultant will help the program
members with setting up pc, projectors, network, mobile connection, remote
meetings and sessions with their clients, before, during, and after. Network & Data
Management Consultant will help with troubleshooting staff members' pc, network
connections, installations, and with cloud management. Network & Data
Management Consultant will also help clients with their computer login and network
to ensure their remote access is working when participating in a CBANS activity.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)10,000 Contractual/Consulting Services on evaluation and other consultant estimates @
$833.33 per month x 12 months = $10,000. Consultant will provide external
evaluation and support to the program and will be responsible for compiling
demographic information as well as satisfaction and efficiency information for
outcome reports. Consultant may also conduct focus groups to help provide
qualitative feedback from program participants for the continual improvement of
the program.
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 71,740
6001 Administrative Overhead 71,740 Administrative Overhead is at 15% of $478,260 = $71,740
$550,000-$71,740= $478,260 $71,740/$478,260 = 15%
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS 1,700
7001 Computer Equipment 1,000 Computer Equipment - Laptops, desktops, and monitors repair and maintenance
estimated @ $1,000 per unit x 1 FTE = $1,000
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
700 Land Line Phone, Cell Phones, Tablets, Devices to Contain HIPAA Data repair and
maintenance estimates @ $700 per unit x 1 FTE = $700
7003 Furniture & Fixtures -
EXHIBIT C 24 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:550,000
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:550,000
-
EXHIBIT C 25 of 40
Employee Salaries
Acct # Position FTE Admin Direct Total
1101 Program Director 0.15 -$ 15,571$ 15,571$
1102 Community Health Worker/Coordinator 1.00 - 54,549 54,549
1103 Peer Support Specialist 1.00 - 36,366 36,366
1104 Peer Support Specialist 1.00 - 36,366 36,366
1105 Peer Support Specialist 1.00 - 36,366 36,366
1106 Peer Support Specialist 1.00 - 36,366 36,366
1107 Community Health Worker/Data Specialist 1.00 - 40,912 40,912
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - -
Personnel Salaries Subtotal 6.15 -$ 256,496$ 256,496$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 7,695$ 7,695$
1102 - 1,565 1,565
1103 - 41,122 41,122
1104 - - -
1105 - - -
1106 - - -
-$ 50,382$ 50,382$
0.180718613
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 19,622 19,622
1203 - 2,669 2,669
1204 - - -
1205 - - -
1206 - - -
-$ 22,291$ 22,291$
-$ 329,169$ 329,169$
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Employee Benefits Subtotal:
Employee Benefits %:
Description
OASDI
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
The Fresno Center
Culturally-Based Access Navigation Support (CBANS) Services
Fiscal Year (FY 2024-25)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
EXHIBIT C 26 of 40
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 2,000$
2004
2005
2006
2007
2008
2009
2010
2011 18,000$
2012 -
2013 -
2014 -
2015 -
2016 -
20,000$
3000: OPERATING EXPENSES
Acct #Amount
3001 4,200
3002 8,400
3003 14,264
3004 2,400
3005 6,000
3006 8,387
3007 1,200
3008 -
3009 -
3010 -
3011 -
3012 -
44,851$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 14,410
4002 32,280
4003 4,000
4004 -
4005 3,600
4006 10,250
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
64,540$
5000: SPECIAL EXPENSES
FACILITIES/EQUIPMENT TOTAL:
Security
Utilities
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
EXHIBIT C 27 of 40
Acct #Amount
5001 8,000$
5002 -
5003 10,000
5004 -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
18,000$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 71,740
6002 -
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
71,740$
7000: FIXED ASSETS
Acct #Amount
7001 1,000$
7002 700
7003 -
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
1,700$ FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 550,000$
Line Item Description
Computer Equipment
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
EXHIBIT C 28 of 40
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment (0)$
(0)$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention Cultural Based Access Navigation Support 550,000
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
550,000$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)-
8404 Other (Specify) -
8405 Other (Specify) -
-$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:550,000$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
EXHIBIT C 29 of 40
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 329,169
Employee Salaries 256,496
1101 Program Director 15,571 Program Director at $8,650.75/mon. x 12 months x 15% FTE = $15,571. The
Program Director will oversee the overall development and management of the
program. Program Director works directly with the invidiuals served by providing
mental health and strengths-based trainings, provides event engagement and
provides occassional client check-in.
1102 Community Health Worker/Coordinator 54,549 Community Health Worker/Coordinator at $4,545.75/mon. x 12 months x 100% FTE
= $54,549. The Community Health Worker/Coordinator will assist the program
director with day-to-day management and help navigate all ages of unserved and
underserved groups with access to behavioral health services.
1103 Peer Support Specialist 36,366 Peer Support Specialist at $3,030.50/mon. x 12 months x 100% FTE = $36,366. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1104 Peer Support Specialist 36,366 Peer Support Specialist at $3,030.50/mon. x 12 months x 100% FTE = $36,366. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1105 Peer Support Specialist 36,366 Peer Support Specialist at $3,030.50/mon. x 12 months x 100% FTE = $36,366. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1106 Peer Support Specialist 36,366 Peer Support Specialist at $3,030.50/mon. x 12 months x 100% FTE = $36,366. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1107 Community Health Worker/Data Specialist 40,912 Community Health Worker/Data Specialist at $3,409.33/mon. x 12 months x 100%
FTE = $40,912. The Community Health Worker/Data Specialist is responsible to
ensure client information is properly stored and safeguarded. This associate will
track and monitor internal data on partnerships, sign-in sheets, unique clients, and
input into the approved data collection tools and create reports as requested. The
Community Health Worker/Data Specialist will also help navigate all ages of
unserved and underserved groups with access to behavioral health services.
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 50,382
1101 Retirement 7,695 Retirement @ $256,496 total salaries x 3% = $7,695
1102 Worker's Compensation 1,565 Worker's Compensation @ $256,496 total salaries x .61 (%) = $1,565
1103 Health Insurance 41,122 Health Insurance (medical + vision + dental + life Insurance @ $557.21 per month x
12 months x 6.15 FTE = $41,122
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:22,291
1201 OASDI -
1202 FICA/MEDICARE 19,622 FICA/MEDICARE @ $256,496 total salaries x 7.65 (%) = $19,622
The Fresno Center
Culturally-Based Access Navigation Support (CBANS) Services
Fiscal Year (FY 2024-25)
EXHIBIT C 30 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1203 SUI 2,669 SUI @ first 7000 x 6.20% x 6.15 FTE = $2,669
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 20,000
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support 2,000 Bus tokens given to each client visit. They get 2 bus tokens with $2.50 equivalent
estimates at $2.50 per client x 800 tokens (estimated) = $2,000 annually.
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Specify)18,000 PEI Therapeutic Supplies will be used to carry out activities for family, group, and
individual. Supplies may include but are not limited to : Wellness kits, arts and crafts
supplies, etc., estimates @ $1,500 per month x 12 months = $18,000 annually.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 44,851
3001 Telecommunications 4,200 Telecommunications - Internet, cell phone services (stipend), land line services,
installment fees, etc., estimates @ $350/month x 12 months = $4,200 annually.
3002 Printing/Postage 8,400 Printing/Postage - Includes: postage & delivery, in-house printing, flyers, handouts,
workshop information, binding, brochures, etc., estimates @ $700 per month x 12
months = $8,400 annually.
3003 Office, Household & Program Supplies 14,264 Office, Household & Program Supplies - Includes: general office supplies, toner,
papers, office décor, water service, sanitizing material, background checks, Software
licenses (set up, and monthly fees including outlook, Conference call, Microsoft,
Adobe professional, etc.) costs are estimates @ $1,189 per month x 12 months =
$14,264 annually.
3004 Advertising 2,400 Advertising - video, radio station, social media advertisements, etc., costs are
estimated @ $200 per month x 12 months = $2,400 annually.
3005 Staff Development & Training 6,000 Staff Development & Training – Staff onboarding training, WRAP, mental health first
aide, resource training, mental health system navigation, case management, etc.,
estimates @ $500 per month x 12 months = $6000 annually.
3006 Staff Mileage 8,387 Staff Mileage - Mileage reimbursement for staff to travel locally and in rural areas
estimates at 208 miles monthly x 12 months x .56/mile x 6 FTE = $8,387 annually.
3007 Subscriptions & Memberships 1,200 Subscriptions & Memberships - Amazon prime, zoom, member calls, live webinars,
online content subscription associate with program, remote access, etc., estimates
@ $100 per month x 12 months = $1,200 annually.
3008 Vehicle Maintenance -
3009 Other (Specify)-
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 64,540
4001 Building Maintenance 14,410 Building Maintenance – Includes: Janitorial services, pest control, alarm, keys, doors,
window, cooling and heating, locksmith, etc., costs are estimated @ $1,200.83 per
month x 12 months = $14,410 annually.
4002 Rent/Lease Building 32,280 Rent/Lease Building estimated @ 1,250 sq. ft. x $2 per sq. ft x 12 months = $30,000
($2,500/month)
Other building rent/lease for rural areas estimated @ $190 per month x 12 months =
$2,280
Total Rent/Lease Building = $32,280 ($30,000 + $2,280 = $32,280)
EXHIBIT C 31 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4003 Rent/Lease Equipment 4,000 Rent/Lease Equipment - Copy machine and other equipment rental costs are
estimated @ $333.33 per month x 12 months = $4,000 annually.
4004 Rent/Lease Vehicles -
4005 Security 3,600 Security will cover the security system and services @ $300 x 12 months = $3,600.
4006 Utilities 10,250 Utilities cost is estimated @ $854.17 per month x 12 months = $10,250 annually.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 18,000
5001 Consultant (Network & Data Management)8,000 Consultant (Network & Data Management) estimates @ $666.67 per month x 12
months = $8,000. Network & Data Management Consultant will help the program
members with setting up pc, projectors, network, mobile connection, remote
meetings and sessions with their clients, before, during, and after. Network & Data
Management Consultant will help with troubleshooting staff members' pc, network
connections, installations, and with cloud management. Network & Data
Management Consultant will also help clients with their computer login and network
to ensure their remote access is working when participating in a CBANS activity.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)10,000 Contractual/Consulting Services on evaluation and other consultant estimates @
$833.33 per month x 12 months = $10,000. Consultant will provide external
evaluation and support to the program and will be responsible for compiling
demographic information as well as satisfaction and efficiency information for
outcome reports. Consultant may also conduct focus groups to help provide
qualitative feedback from program participants for the continual improvement of
the program.
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 71,740
6001 Administrative Overhead 71,740 Administrative Overhead is at 15% of $478,260 = $71,740
$550,000-$71,740= $478,260 $71,740/$478,260 = 15%
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS 1,700
7001 Computer Equipment 1,000 Computer Equipment - Laptops, desktops, and monitors repair and maintenance
estimated @ $1,000 per unit x 1 FTE = $1,000.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
700 Copier, Cell Phones, Tablets, Devices to Contain HIPAA Data, and Land Line phone
maintenance estimated @ $700 per unit x 1 FTE = $700.
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
EXHIBIT C 32 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:550,000
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:550,000
-
EXHIBIT C 33 of 40
Employee Salaries
Acct # Position FTE Admin Direct Total
1101 Program Director 0.15 -$ 16,039$ 16,039$
1102 Community Health Worker/Coordinator 1.00 - 56,185 56,185
1103 Peer Support Specialist 1.00 - 37,457 37,457
1104 Peer Support Specialist 1.00 - 37,457 37,457
1105 Peer Support Specialist 1.00 - 37,457 37,457
1106 Peer Support Specialist 1.00 - 37,457 37,457
1107 Community Health Worker/Data Specialist 1.00 - 42,139 42,139
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 6.15 -$ 264,191$ 264,191$
Employee Benefits
Acct #Admin Direct Total
1101 7,926$ 7,926$
1102 1,612 1,612
1103 42,774 42,774
1104 - - -
1105 - - -
1106 - - -
-$ 52,312$ 52,312$
0.182226697
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 20,211 20,211
1203 2,669 2,669
1204 - -
1205 - -
1206 - -
-$ 22,880$ 22,880$
-$ 339,383$ 339,383$
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Employee Benefits Subtotal:
Employee Benefits %:
Description
OASDI
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
The Fresno Center
Culturally-Based Access Navigation Support (CBANS) Services
Fiscal Year (FY 2025-26)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
EXHIBIT C 34 of 40
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 2,000
2004
2005
2006
2007
2008
2009
2010
2011 18,000
2012 -
2013 -
2014 -
2015 -
2016 -
20,000$
3000: OPERATING EXPENSES
Acct #Amount
3001 4,200
3002 6,000
3003 12,000
3004 2,400
3005 3,299
3006 4,838
3007 1,200
3008 -
3009 -
3010 -
3011 -
3012 -
33,937$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 13,760$
4002 32,280
4003 6,000
4004 -
4005 3,600
4006 9,600
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
65,240$
5000: SPECIAL EXPENSES
FACILITIES/EQUIPMENT TOTAL:
Security
Utilities
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
EXHIBIT C 35 of 40
Acct #Amount
5001 8,000$
5002 -
5003 10,000
5004 -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
18,000$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 71,740
6002 -
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
71,740$
7000: FIXED ASSETS
Acct #Amount
7001 1,000$
7002 700
7003 -
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
1,700$ FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 550,000$
Line Item Description
Computer Equipment
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
EXHIBIT C 36 of 40
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment 0$
0$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention Cultural Based Access Navigation Support 550,000
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
550,000$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)-
8404 Other (Specify) -
8405 Other (Specify) -
-$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:550,000$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
EXHIBIT C 37 of 40
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 339,383
Employee Salaries 264,191
1101 Program Director 16,039 Program Director at $8,910.25/mon. x 12 months x 15% FTE = $16,039. The
Program Director will oversee the overall development and management of the
program. Program Director works directly with the invidiuals served by providing
mental health and strengths-based trainings, provides event engagement and
provides occassional client check-in.
1102 Community Health Worker/Coordinator 56,185 Community Health Worker/Coordinator at $4,682.08/mon. x 12 months x 100% FTE
= $56,185. The Community Health Worker/Coordinator will assist the program
director with day-to-day management and help navigate all ages of unserved and
underserved groups with access to behavioral health services.
1103 Peer Support Specialist 37,457 Peer Support Specialist at $3,121.41/mon. x 12 months x 100% FTE = $37,457. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1104 Peer Support Specialist 37,457 Peer Support Specialist at $3,121.41/mon. x 12 months x 100% FTE = $37,457. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1105 Peer Support Specialist 37,457 Peer Support Specialist at $3,121.41/mon. x 12 months x 100% FTE = $37,457. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1106 Peer Support Specialist 37,457 Peer Support Specialist at $3,121.41/mon. x 12 months x 100% FTE = $37,457. The
Peer Support Specialist is responsible for assisting in reducing health disparities
through referral and navigation for those identified as culturally unserved and
underserved groups to behavioral health services.
1107 Community Health Worker/Data Specialist 42,139 Community Health Worker/Data Specialist at $3,511.58/mon. x 12 months x 100%
FTE = $42,139. The Community Health Worker/Data Specialist is responsible to
ensure client information is properly stored and safeguarded. This associate will
track and monitor internal data on partnerships, sign-in sheets, unique clients, and
input into the approved data collection tools and create reports as requested. The
Community Health Worker/Data Specialist will also help navigate all ages of
unserved and underserved groups with access to behavioral health services.ection
tools and create reports as requested.
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 52,312
1101 Retirement 7,926 Retirement @ $264,191 total salaries x 3% = $7,926
1102 Worker's Compensation 1,612 Worker's Compensation @ $264,191 total salaries x .61 (%) = $1,612
1103 Health Insurance 42,774 Health Insurance (medical + vision + dental + life Insurance @ $579.59 per month x
12 months x 6.15 FTE = $42,774
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:22,880
1201 OASDI -
1202 FICA/MEDICARE 20,211 FICA/MEDICARE @ $264,191 total salaries x 7.65 (%) = $20,211
The Fresno Center
Culturally-Based Access Navigation Support (CBANS) Services
Fiscal Year (FY 2025-26)
EXHIBIT C 38 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1203 SUI 2,669 SUI @ first 7000 x 6.20% x 6.15 FTE = $2,669
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 20,000
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support 2,000 Bus tokens given to each client visit. They get 2 bus tokens with $2.50 equivalent
estimates at $2.50 per client x 800 tokens (estimated) = $2,000 annually.
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Specify)18,000 PEI Therapeutic Supplies will be used to carry out activities for family, group, and
individual. Supplies may include but are not limited to : Wellness kits, arts and crafts
supplies, etc., estimates @ $1,500 per month x 12 months = $18,000 annually.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 33,937
3001 Telecommunications 4,200 Telecommunications - Internet, cell phone services (stipend), land line services,
installment fees etc., costs are estimated @ $350/month x 12 months = $4,200
annually.
3002 Printing/Postage 6,000 Printing/Postage - Includes: postage & delivery, in-house printing, flyers, handouts,
workshop information, binding, brochures, etc., costs are estimated @ $500 per
month x 12 months = $6,000 annually.
3003 Office, Household & Program Supplies 12,000 Office, Household & Program Supplies - Includes: general office supplies, toner,
papers, office décor, water service, sanitizing material, background checks, Software
licenses (set up, and monthly fees including outlook, Conference call, Microsoft,
Adobe professional, etc.) costs are estimates @ $1,000 per month x 12 months =
$12,000 annually.
3004 Advertising 2,400 Advertising - video, radio station, social media advertisements, etc., estimates @
$200 per month x 12 months = $2,400 annually.
3005 Staff Development & Training 3,299 Staff Development & Training – Staff onboarding training, WRAP, mental health first
aide, resource training, mental health system navigation, case management, etc.,
estimates @ $274.92 per month x 12 months = $3,299 annually
3006 Staff Mileage 4,838 Staff Mileage - Mileage reimbursement for staff to travel locally and rural area
estimated at 120 miles monthly x 12 months x .56/mile x 6 FTE = $4,838 annually.
3007 Subscriptions & Memberships 1,200 Subscriptions & Memberships - Amazon prime, zoom, member calls, live webinars,
online content subscription associate with program, remote access, etc., estimates
@ $100 per month x 12 months = $1,200 annually.
3008 Vehicle Maintenance -
3009 Other (Specify)-
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 65,240
4001 Building Maintenance 13,760 Building Maintenance – Includes: Janitorial services, pest control, alarm, keys, doors,
window, cooling and heating, locksmith, etc., estimates @ $1,146.67 per month x 12
months = $13,760 annually.
EXHIBIT C 39 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4002 Rent/Lease Building 32,280 Rent/Lease Building estimated @ 1,250 sq. ft. x $2 per sq. ft x 12 months = $30,000
($2,500/month)
Other building rent/lease for rural areas estimated @ $190 per month x 12 months =
$2,280
Total Rent/Lease Building = $32,280 ($30,000 + $2,280 = $32,280)
4003 Rent/Lease Equipment 6,000 Rent/Lease Equipment - Copy machine, other equipment rental costs estimates @
$500 per month x 12 months = $6,000 annually.
4004 Rent/Lease Vehicles -
4005 Security 3,600 Security will cover the security system and services @ $300 x 12 months = $3,600.
4006 Utilities 9,600 Utilities cost estimate @ $800 per month x 12 months = $9,600 annually.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 18,000
5001 Consultant (Network & Data Management)8,000 Consultant (Network & Data Management) estimates @ $666.67 per month x 12
months = $8,000. Network & Data Management Consultant will help the program
members with setting up pc, projectors, network, mobile connection, remote
meetings and sessions with their clients, before, during, and after. Network & Data
Management Consultant will help with troubleshooting staff members' pc, network
connections, installations, and with cloud management. Network & Data
Management Consultant will also help clients with their computer login and network
to ensure their remote access is working when participating in a CBANS activity.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)10,000 Contractual/Consulting Services on evaluation and other consultant estimates @
$833.33 per month x 12 months = $10,000. Consultant will provide external
evaluation and support to the program and will be responsible for compiling
demographic information as well as satisfaction and efficiency information for
outcome reports. Consultant may also conduct focus groups to help provide
qualitative feedback from program participants for the continual improvement of
the program.
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 71,740
6001 Administrative Overhead 71,740 Administrative Overhead is at 15% of $478,260 = $71,740
$550,000-$71,740= $478,260 $71,740/$478,260 = 15%
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS 1,700
7001 Computer Equipment 1,000 Computer Equipment - Laptops, desktops, and monitors repair and maintenance
estimated @ $1,000 per unit x 1 FTE = $1,000.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
700 Copier, Cell Phones, Tablets, Devices to Contain HIPAA Data, and Land Line phone
maintenance estimated @ $700 per unit x 1 FTE = $700.
7003 Furniture & Fixtures -
EXHIBIT C 40 of 40
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:550,000
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:550,000
-
Exhibit D - Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1.CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2.PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business
and Professions and Welfare and Institutions Codes.
3.CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4.NON-DISCRIMINATION
A.Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B.Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates
of pay or other forms of compensation, use of facilities, and other terms
and conditions of employment.
Exhibit D - Page 2 of 6
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY’s Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f)
and CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply
with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-
free workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is prohibited and
specifying actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
c. Every employee who works on this Agreement will:
1) receive a copy of the company's drug -free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
Exhibit D - Page 3 of 6
Failure to comply with these requirements may result in suspension of payments under
this Agreement or termination of this Agreement or both and CONTRACTOR may be
ineligible for award of any future State agreements if the department determines that any
of the following has occurred: the CONTRACTOR has made false certification, or
violated the certification by failing to carry out the requirements as noted above. (Gov.
Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1) final unappealable finding of contempt of court by a
Federal court has been issued against CONTRACTOR within the immediately preceding
two (2) year period because of CONTRACTOR’s failure to comply with an order of a
Federal court, which orders CONTRACTOR to comply with an order of the National
Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will comply with
the requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the lessor of
30 multiplied by the number of full time attorneys in the firm’s offices in the State, with
the number of hours prorated on an actual day basis for any contract period of less than
a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the
State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of equipment,
materials, or supplies, other than procurement related to a public works contract, declare
under penalty of perjury that no apparel, garments or corresponding accessories,
equipment, materials, or supplies furnished to the state pursuant to the contract have
been laundered or produced in whole or in part by sweatshop labor, forced labor, convict
labor, indentured labor under penal sanction, abusive forms of child labor or exploitation
of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor,
convict labor, indentured labor under penal sanction, abusive forms of child labor or
exploitation of children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the
California Department of Industrial Relations website located at www.dir.ca.gov, and
Public Contract Code Section 6108.
Exhibit D - Page 4 of 6
b. CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR’s records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the Department of
Industrial Relations, or the Department of Justice to determine the contractor’s
compliance with the requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or has a financial
interest and which is sponsored or funded by any state agency, unless the employment,
activity or enterprise is required as a condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he or she
engaged in any of the negotiations, transactions, planning, arrangements or any part of
the decision-making process relevant to the contract while employed in any capacity by
any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a contract with any state
agency if he or she was employed by that state agency in a policy-making position in the
same general subject area as the proposed contract within the twelve (12) month period
prior to his or her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
Exhibit D - Page 5 of 6
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance with the
provisions, and CONTRACTOR affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR’s name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment. Payment of
invoices presented with a new name cannot be paid prior to approval of said
amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently qualified to do
business in California in order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit. Although there
are some statutory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do business in California.
Agencies will determine whether a corporation is in good standing by calling the Office of
the Secretary of State.
6. RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local governing
body, which by law has authority to enter into an agreement, authorizing execution of the
agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not subject to
review promulgated by the State Air Resources Board or an air pollution control district;
(2) subject to cease and desist order not subject to review issued pursuant to Section
13301 of the Water Code for violation of waste discharge requirements or discharge
prohibitions; or (3) finally determined to be in violation of provisions of federal law
relating to air or water pollution.
Exhibit D - Page 6 of 6
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General, and their
designees may, at any time, inspect and audit any records or documents of
CONTRACTOR or its subcontractors, and may, at any time, inspect the premises,
physical facilities, and equipment where Medicaid-related activities or work is conducted.
The right to audit under this section exists for ten (10) years from the final date of the
contract period or from the date of completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must confirm the
identity and determine the exclusion status of CONTRACTOR, any subcontractor, as
well as any person with an ownership or control interest, or who is an agent or managing
employee of CONTRACTOR through routine checks of Federal databases. This
includes the Social Security Administration's Death Master File, the National Plan and
Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE),
the System for Award Management (SAM), and any other databases as the State or
Secretary may prescribe. These databases must be consulted upon contracting and no
less frequently than monthly thereafter. If the State finds a party that is excluded, it must
promptly notify the CONTRACTOR and take action consistent with § 438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or financial
institution located outside of the U.S. are considered in the development of actuarially
sound capitation rates.
Vendor: Contract#
Item Make/Brand Model I Serial#
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Date Prepared:
1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Date Received:
Contact Person Contact#
.&.&.....I ......,.., I P I 1 ft I I� I Pr • I P P I L.I L.P: a I It l I P f
li !? Date Date Ill � EE Requested Approved ( Purchase Location "Cl Ill GI (If Fixed If Fixed Date c-GI GI ->C Cl) Asset) Assset) ii: I
X 3/27/2008 4/1/2008 4/10/2008 Heritage
X n/a n/a 4/1/2008 Heritage
Condition
New
New
Fresno
County
Exhibit E
Page 1 of 2
Inventory Cost
Number
$6,500.00
$450.00
Fi el d l'wnber
Header
Header
Header
Header
Header
Header
a
b
C
d
e
f
g
h
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k
I
m
Fl XED �ET AND SENSI Tl VE I TEM TRACl<I NG
Field
Descr i pt i on
Vendor
Program
Contract #
Cont act Per son
Cont act #
Cate Prepared
I tern
Mike/ Brand
M>del
Seri al #
Fixed Asset
Sensi ti ve I t em
Cate Requested
Cate Approved
Purchase Cate
Location
Condition
Fresno County
I nvent or y
l\tlrrber
Cost
I nst r uct i on or Corment s
I ndi cat e the I egal narre of the agency contracted to
provide services.
Indicate the till e of the pr oj eel as described in the
contract v.i t h t he County.
Indicate the assigned County contract nurrber. I f not
know,, County staff can pr ovi de.
I ndi cat e the f i r st and I ast narre of the pr i rrar y agency
cont act for t he cont r act .
I ndi cat e the rrost appropriate telephone nurrber of the
pri rrary agency contact for the contract.
I ndi cat e the rrost current date that t he t r acki ng form
v.as corrpl eted by the vendor.
I dent i f y the i t em by pr ovi di ng a comronly recognized
descr i pt i on of the it em
I dent i f v the corrpany t hat rranufactured the
I dent i f y t he rrodel nurrber for the i tern i f
I dent i f y t he serial nurrber for the i tern i f
appl i cabl e.
Mir k t he box v.i t h an II X'I if the cost of the
$5,000 or rror e to i ndi cat e t hat the it em is
asset.
it em
appl i cabl e.
it em is
a fixed
Mir k the box v.i th an II X'I if the i t em rreet s t he
criteria of a sensi ti ve i t em as defined by the County.
Indicate the date that t he agency subni t t ed a request
to t he County to purchase t he i t em
Indicate the date that the County approved the request
to purchase the it em
Indicate the date the aqencv purchased the it em
I ndi cat e the phvsi cal I ocat ion of the it em
I ndi cat e the general condi t i on of the it em ( New, G:>od,
W>rn, Bad).
I ndi cat e the FR# provided by the County for the it em
I ndi cat e the tot al purchase price of the it em
including sales tax and other costs, such as shipping.
Exhibit E
Page 2 of 2
Required or
Condi t i onal
Required
Required
Required
Required
Required
Required
Required
Required
Condi t i onal
Condi t i onal
Condi t i onal
Condi t i onal
Required
Required
Required
Required
Required
Condi t i onal
Required
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
The Incident Report must be completed for all incidents involving individuals served through
DBH's current incident reporting portal, Logic Manager, at
https://fresnodbh .logicmanager .com/incidents/?t=9&p= 1 &k= 182be0c5cdcd5072bb 1864cdee
4d3d6e
•The reporting portal is available 24 hours a day, every day.
•Any employee of the CONTRACTOR can submit an incident using the reporting
portal at any time. No login is required.
•The designated administrator of the CONTRACTOR can add information to the
follow up section of the report after submission.
•When an employee submits an incident within 24 hours from the time of the incident
or first knowledge of the incident, the CONTRACTOR's designated administrator, the
assigned contract analyst and the Incident Reporting email inbox will be notified
immediately via email from the Logic Manager system that there is a new incident to
review.
•Meeting the 24 hour incident reporting requirements will be easier as there are no
signatures to collect.
•The user guide attached identifies the reporting process and the reviewer process,
and is subject to updates based on DBH's selected incident reporting portal system.
Questions about incident reporting, how to use the incident reporting portal, or
designating/changing the name of the administrator who will review incidents for the
CONTRACTOR should be emailed to DBHlncidentReporting@fresnocountyca.gov and the
assigned contract analyst.
Exhibit F
Page 1 of 9
• • Mental Health Plan (MHP) and Substance Use Disorder (SUD) serv1ce
Incident Reporting System
INCIDENT REVIEWER ROLE -User Guide
Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted
providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete
a written report of any incidents compromising the health and safety of persons served, employees, or
community members.
Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's
an easier way for any employee to report an incident at any time. A few highlights:
•No supervisor signature is immediately required.
•Additional information can be added to the report by the program supervisor/manager without
having to resubmit the incident.
•When an incident is submitted, the assigned contract analyst, program supervisor/manager,
clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email
notification of a new incident and can log in any time to review the incident. Everything that
was on the original paper/electronic form matches the on line form.
•Do away with submitting a paper version with a signature.
•This on line submission allows for timely action for the health and safety of the persons-served,
as well as compliance with state reporting timelines when necessary.
As an Incident Reviewer, the responsibility is to:
•Log in to Logic Manager and review incident submitted within 48 hours of notification of incident.
•Review incident for clarity, missing information and add in additional information deemed
appropriate.
•Notify DBHlncidentReporting@fresnocountyca.gov if there is additional information to be report
after initial submission
•Contact DBHincidentReporting@fresnocountyca.gov if there are any concerns, questions or
comments with Logic Manager or incident reporting.
Below is the link to report incidents
https://fresnodbh.logicmanager.com/incidents/?t=9&p=l&k=182be0c5cdcd5072bb1864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
Exhibit F
Page 2 of 9
..t.. LogicManager
(- C 6 i
Incident Report
Please complete: this form
• ([ient Jnformatlgn
Fodlll)' Addr<«'
F"acJlity Phone Number·
Cllant O..i.teofBinh
Client Add�ss
C.lic-nllO
county of ortglft"
• Summ:uy
Subje<:\0
lnckh;nt (cht'Ck alt th.at apply)
Oe�riptionof the incid•nl'
"
Exhibit F
Page 3 of 9
Similar to the paper version, multiple incident categories can be selected
lncldenl (<heck all that applyf
Medic.al Emergency x Death ofCl/ent W'
Homldd�/Homldde:Attempt
AWOL/Etopvnwnt from lockid f.iclUt)I
Vloh;,nao/.A.buse/As.sault (toward oihit,s, dlitnt and/or property
Attempted Suk.Ide {reslllflng Jn serious lnJury)
Injury (s.elf-lnRkted or by accident)
Medication Error
o.uoof lnddont·
Tlmeofloddent'
Location of lncideont·
Key PitapleOlrectlylnvolved tn lncldent {wrtni;isses, stafW
Did the Injured Party s.eek MedicalAttenllonl
Artac.h any additional d�i.a!ls.
Reported By Name·
�orted6yfmau·
Reported On
10/30/2019
4 � or Drop rn" �gro
..
Exhibit F
Page 4 of 9
As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on
Add File to upl ad a file.
f-C o
�oportodOn
10/30/2019
• FollowUp
Action Taken (check all that applyr
Please specify if other
Out(ame·
SURMIJ
Similar to the paper version, multiple Action Taken categories can be selected.
• FollowUp
Llw enrorume-nt cont.lcted
Consulted wlth Ph�kl.aon
FlrstAid/CPR Adminbtete<I
cOont romc,vod r,om bul ld1ns
Pareot/tega1 Gu.ardlan Contacte<I
Othe<
C:slled 911/EMS
When done entering all the information, simply click submit.
Any fields that have a red asterisk, require information an will prevent submission of the form if left blank.
Outcom .-------------
A "Thank you for your submission" statement will pop up if an incident is successfully submitted. Click "Reload the
Thank you for your submission I
Exhibit F
Page 5 of 9
A Notification email will be received when a new incident is reported, or a new comment has been made regarding
an incident. Click on "Open this incident in Logic Manager" and the Logic Manager login screen will show.
Wed 10/30/2019 10:40 AM
SL SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@logicmanager.com> 0 Notification -
To DBH Incident Reporting
(D If there are problems with how this message is displayed, dick here to view it in a web owser.
Click here to download pictures. To help protect your privacy, Outlook prevented autom ic download of some pictures in this message.
CAUTION!!! -EXTERNAL EMAIL-THINK BEFORE YOU CLICK
G Right-click er lap -,d hold h•• ID d01M>lmd pichnH_. Tohalp pr<Dd ya.Jr
pnvxy, Outkd: p,....,,t.d aulzmalbc d.....,load ai !hos pcb.Jr• from lrui Internet. �ic:Manag•,lnc.
Hi Mila Arevalo,
You have received a notification through LogicManager. Please see the details
below.
Type: Incident Report
Subject: 102:
Notification To: Mila Arevalo
Open this incident in LogicManager
If using Internet Explorer, click here to open the notification.
This email was generated by LogicManager. If you have any technical issues,
please email support@logicmanager.com
Enter in email address and password. First time users will be prompted to set up a password.
� C 0 i fresnodbh.my.logicmanager.com/login
.:. LogicManager·
LOGIN
Forgot your password?
Exhibit F
Page 6 of 9
Once logged in, the main screen will show reviewer task (incidents to review). Click on analyst/supervisor follow up
,( -/1 �
This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and
facility information.
Analyst Follow Up
Wf:uitf.tlCl'tM \,fO!,l,111!4 I 'Kli,WOOff ,iop-.r-·�·-�..,
Analyst Follow Up
i.w,,c�fd,c,cl! .. l���l'
t11;,«•otC1iHi1
B / M S- II
« • I ' lot
No edits can be made to this section.
-/ ;,, -
(( ( J ) ,�
Exhibit F
Page 7 of 9
The next tab is Follow up: This section can be edited. Add to th areas below or make corrections to these fields. Be
,_...21,1..1...C........,_>J..L!,,J>.......j=.J(E w en edits are made. Then Cancel to Exi
Analyst Follow Up
"4.1ion Taken .dlctkalltbat119pty1
Uwllllotol'Mtl, !.ontK(ff 1'I
006t,dJn;o,mia�
o�Olde)tll•Onc,t,1pc:l(OIO!Wfl(l,3l I�
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"
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The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding
documents. Then Cancel to Exit out of the incident.
Analyst Follow Up
1.1�.1,, Det� I• Cit n• 1n!, nTJtli summ:irv follow u., oocumen,u a
N.ame
J,nk ID: JU $01.ltce,;. lO]·null
--v -l
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«
Uplo.adD.11t.1' Uploadrd By
CA�C.H
"
Add Doc:umPnt ..,
If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once
submitted, the incident will be removed from the task list and no further edits can be made. Notice the SUBMIT
butt n is on ever tab. If further information needs to be included email
DBHlncidentReporting@fresnocountyca.gov
Exhibit F
Page 8 of 9
To get back to the home view, click on the Lo ic Manager icon at any time. Any incidents that still need review will
Your Task List I)
TASK NAME SOURCE :!.TATUS ASSIGNED TO ASSIGNED BY DUE DATE "' .......
Exhibit F
Page 9 of 9
Exhibit G – Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I.Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II.Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses of individuals or corporations under “Remarks” on page 2. Identify each item number to be continued.
A.Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
B.Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? ...................................................................................... ❒ ❒
C.Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution’s, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
III.A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under “Remarks” on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under “Remarks.”
NAME ADDRESS EIN
B.Type of entity: ❒ Sole proprietorship ❒Partnership ❒Corporation❒Unincorporated Associations ❒Other (specify)
C.If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under “Remarks.”
D.Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers. .......................................................................................................... ❒❒
NAME ADDRESS PROVIDER NUMBER
Exhibit G – Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V.Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
If yes, give date of change in operations.
VI.Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
B.If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) Title
Signature Date
Remarks
Exhibit H - Page 1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1.By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2.The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3.The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4.The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5.The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1)The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a)Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b)Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
Exhibit H - Page 2 of 2
(c)Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2)Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
Exhibit I - Page 1 of 2
SELF-DE ALING TRANSAC TION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “COUNTY”),
members of a CONTRACTOR(S)’ board of directors (hereinafter referred to as “County
Contractor”), must disclose any self-dealing transactions that they are a party to while
providing goods, performing services, or both for the COUNTY. A self-dealing transaction is
defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1)Enter board member’s name, job title (if applicable), and date this disclosure is being
made.
(2)Enter the board member’s company/agency name and address.
(3)Describe in detail the nature of the self-dealing transaction that is being disclosed to
the COUNTY. At a minimum, include a description of the following:
a.The name of the agency/company with which the corporation has the
transaction; and
b.The nature of the material financial interest in the corporation’s transaction that
the board member has.
(4)Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5)Form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
Exhibit I - Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date:
Exhibit J
Page 1 of
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health services.
Mental health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its employees
and subcontractors to attend a compliance training that will be provided by Fresno County. After
completion of this training, each contractor, contractor’s employee and subcontractor must sign the
Contractor Acknowledgment and Agreement form and return this form to the Compliance officer or
designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and billing
for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their
professional dealing related to their contract with the County and avoid any conduct that could
reasonably be expected to reflect adversely upon the integrity of the County.
3. Treat County employees, consumers, and other mental health contractors fairly and with
respect.
4. NOT engage in any activity in violation of the County’s Compliance Program, nor engage in
any other conduct which violates any applicable law, regulation, rule or guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely and are
consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement
of any kind are submitted.
7. Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
Exhibit J
Page 2 of
8. Act promptly to investigate and correct problems if errors in claims or billing are discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of Conduct
and Ethics by County employees or other mental health contractors, or report any activity that
they believe may violate the standards of the Compliance Program, or any other applicable
law, regulation, rule or guideline. Fresno County prohibits retaliation against any person
making a report. Any person engaging in any form of retaliation will be subject to disciplinary
or other appropriate action by the County. Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible person
and therefore excluded from participation in the Federal Health Care Programs.
Exhibit K
Pa e 1 of 2
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help
eliminate health care disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1.Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and
practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and
allocated resources.
3.Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in
the service area.
4.Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate
timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters
should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
Engagement, Continuous Improvement, and Accountability:
9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization's
planning and operations.
10.Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous
quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to
inform service delivery.
12.Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the
cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.
14.Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts
or complaints.
15.Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.
�i �o M H U.S. Department of /:f.l Health and Human services
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Think Cultural Health
https://www.thinkculturalhealth.hhs.gov/
contact@thinkculturalhealth.hhs.gov
The Case for the National CLAS Standards
Exhibit K
Pa e 2 of 2
Health equity is the attainment of the highest level of health for all people.1 Currently, individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of health, or those conditions in which
individuals are born, grow, live, work, and age,2 such as socioeconomic status, education level, and the availability of health services.3
Though health inequities are directly related to the existence of historical and current discrimination
and social injustice, one of the most modifiable factors is the lack of culturally and linguistically
appropriate services, broadly defined as care and services that are respectful of and responsive to
the cultural and linguistic needs of all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health
disparities adversely affect neighborhoods, communities, and the broader society, thus making
the issue not only an individual concern but also a public health concern. In the United States, it
has been estimated that the combined cost of health disparities and subsequent deaths due to
inadequate and/or inequitable care is $1.24 trillion.•
Culturally and linguistically appropriate services are increasingly recognized as effective in improving
the quality of care and services.5·6 By providing a structure to implement culturally and linguistically
appropriate services, the National CLAS Standards will improve an organization's ability to address
health care disparities.
Of all the forms of
inequality, injustice in
health care is the most
shocking and inhumane.
- Dr. Martin Luther King, Jr.
The National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities' and the National Stakeholder Strategy for
Achieving Health Equity,8 which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial
and ethnic health disparities across the country.
Similar to these initiatives, the National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities
by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. Adoption of
these Standards will help advance better health and health care in the United States.
Bibliography
1. U.S. Department of Health and Human Services, Office of Minority Health (2011). National Partnership for Action to End Health Disparities. Retrieved from http://minorityhealth.hhs.gov/npa
2. World Health Organization. (2012). Social determinants of health. Retrieved from http://www.who.int/social_determinants/en/
3. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthy people 2020: Social determinants of health. Retrieved from http:/ /www.
healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39
4. LaVeist, T. A., Gaskin, D. J., & Richard, P. (2009). The economic burden of health inequalities in the United States. Retrieved from the Joint Center for Political and Economic Studies website: http:/ /www.
jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2 0Burden%20of%20Health%201nequalities%20in%20the%20United%20States.pdf
5. Beach, M. C., Cooper, L.A., Robinson, K. A., Price, E. G., Gary, T. L., Jenckes, M. W., Powe, N.R. (2004). Strategies for improving minority healthcare quality. (AHRQ Publication No. 04-EOOS-02). Retrieved
from the Agency of Healthcare Research and Quality website: http://www.ahrq.gov/downloads/pub/evidence/pdf/minqualjminqual.pdf
6. Goode, T. D., Dunne, M. C., & Bronheim, S. M. (2006). The evidence base for cultural and linguistic competency in health care. (Commonwealth Fund Publication No. 962). Retrieved from The
Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
7. U.S. Department of Health and Human Services. (2011). HHS action plan to reduce racial and ethnic health disparities: A nation free of disparities in health and health care. Retrieved from http://
minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
8. National Partnership for Action to End Health Disparities. (2011). National stakeholder strategy for achieving health equity. Retrieved from U.S. Department of Health and Human Services, Office of
Minority Health website: http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
�i �o M H U.S. Deportment of /ii Health and Human services
\�
Office of Minority Health
Think Cultural Health
https://www.thlnkculturalhealth.hhs.gov/
contact@thinkculturalhealth.hhs.gov
FRESNO COUNTY MENTAL HEALTH PLAN
Grievances
Exhibit L
Page 1 of 2
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance and
appeal process and an expedited appeal process to resolve grievances and disputes at
the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-for-service
providers give verbal and written information to Medi-Cal beneficiaries regarding the
following:
•How to access specialty mental health services
•How to file a grievance about services
•How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
the individuals served copies of all current beneficiary information annually at the time
their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800)654-3937 (for more information)
( 559)488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process -the provider may first speak to a Provider
Relations Specialist (PRS) regarding his or her complaint or concern.
Exhibit L
Page 2 of 2
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process - the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for MHP
payment authorization, or the process or payment of a provider's claim to the MHP.
Payment authorization issues - the provider may appeal a denied or modified request
for payment authorization or a dispute with the MHP regarding the processing or
payment of a provider's claim to the MHP. The written appeal must be submitted to the
MHP within 90 calendar days of the date of the receipt of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the decision
that addresses each issue raised by the provider, and any action required by the
provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request, the
MHP utilizes a Managed Care staff who was not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within 30 calendar days of receipt of the decision
Other complaints - if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the MHP. The provider will receive a written response from the MHP within 60 calendar
days of receipt of the complaint. The decision rendered buy the MHP is final.
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 1 of 27
Title 9 California Code of Regulations, Division 1, Chapter 14 MHSA
Article 2. Definitions
Section 3200.245. Prevention and Early Intervention Component.
(a)“Prevention and Early Intervention Component” means the section of the Three-Year Program and
Expenditure Plan intended to prevent mental illnesses from becoming severe and disabling.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5840 and 5847,
Welfare and Institutions Code.
Section 3200.246. Prevention and Early Intervention Fund.
(a)“Prevention and Early Intervention funds” means the Mental Health Services funds allocated for
prevention and early intervention programs pursuant to Welfare and Institutions Code section 5892,
subdivision (a)(3).
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Section 5892, Welfare
and Institutions Code.
Article 5. Reporting Requirements
Section 3510.010. Prevention and Early Intervention Annual Revenue and Expenditure Report.
(a)As part of the Mental Health Services Act Annual Revenue and Expenditure Report the County shall
report the following:
(1)The total funding source dollar amounts expended during the reporting period, which is the
previous fiscal year, on each Program funded with Prevention and Early Intervention funds by
the following funding sources:
(A)Prevention and Early Intervention funds
1.The County shall identify each Program funded with Prevention and Early Intervention
funds as a Prevention Program, Early Intervention Program, Outreach for Increasing
Recognition of Early Signs of Mental Illness Program, Stigma and Discrimination
Reduction Program, Suicide Prevention Program, Access and Linkage to Treatment
Program, or Program to Improve Timely Access to Services for Underserved
Populations. If the Programs are combined, the County shall estimate the percentage
of funds dedicated to each Program.
(B)Medi-Cal Federal Financial Participation
(C)1991 Realignment
(D)Behavioral Health Subaccount
Exhibit M
Page 1 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 2 of 27
(E)Any other funding
(2)The amount of funding expended for Prevention and Early Intervention Component
Administration by the following funding sources:
(A)Prevention and Early Intervention funds
(B)Medi-Cal Federal Financial Participation
(C)1991 Realignment
(D)Behavioral Health Subaccount
(E)Any other funding
(3)The amount of funding expended for evaluation of the Prevention and Early Intervention
Component by the following funding sources:
(A)Prevention and Early Intervention funds
(B)Medi-Cal Federal Financial Participation
(C)1991 Realignment
(D)Behavioral Health Subaccount
(E)Any other funds
(4)The amount of Prevention and Early Intervention funds voluntarily assigned by the County to
California Mental Health Services Authority or any other organization in which counties are
acting jointly.
(b)The County shall within 30 days of submitting to the state the Mental Health Services Act Annual
Revenue and Expenditure Report:
(1)Post a copy on the County’s website; and
(2)Provide a copy to the County’s Mental Health Board
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5840, 5845,
5847, and 5899, Welfare and Institutions Code; Uncodified Sections 2 and 3 of Proposition 63, the
Mental Health Services Act.
Section 3560. Prevention and Early Intervention Reporting Requirements.
(a) The County shall submit to the Mental Health Services Oversight and Accountability Commission the
following:
(1)The Annual Prevention and Early Intervention report as specified in Section 3560.010.
(2) The Three- Year Prevention and Early Intervention Evaluation Report as specified in Section
3560.020.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5840,
5845(d)(6) and 5847, Welfare and Institutions Code.
Exhibit M
Page 2 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 3 of 27
Section 3560.010. Annual Prevention and Early Intervention Report.
(a) The requirements set forth in this section shall apply to the Annual Prevention and Early
Intervention Report.
(1)The first Annual Prevention and Early Intervention Report is due to the Mental Health Services
Oversight and Accountability Commission on or before December 30, 2017 as part of an Annual
Update or Three-Year Program and Expenditure Plan. Each Annual Prevention and Early
Intervention Report thereafter is due as part of an Annual Update or Three-Year Program and
Expenditure Plan within 30 calendar days of Board of Supervisors approval but no later than
June 30 of the same fiscal year whichever occurs first. The Annual Prevention and Early
Intervention Report is not due in years in which a Three-Year Prevention and Early Intervention
Evaluation Report is due.
(2) The Annual Prevention and Early Intervention Report shall report on the required data for the
fiscal year prior to the due date. For example, the Report that is due no later than June 30, 2020
is to report the required data from fiscal year 2018-19 (i.e. July 1, 2018 through June 30, 2019).
(3) The County shall exclude from the Annual Prevention and Early Intervention Report personally
identifiable information as defined by the Health Insurance Portability and Accountability Act of
1996 (HIPAA), the Health Information Technology for Economic and Clinical Health Act (HITECH)
and their implementing privacy and security regulations, the California Information Practices
Act, and any other applicable state or federal privacy laws.
(A) When the County has excluded information pursuant subdivision (3) above, the County shall
submit to the Mental Health Services Oversight and Accountability Commission one of the
following:
1.A supplemental Annual Prevention and Early Intervention Report that contains all of the
information including the information that was excluded pursuant to subdivision (3).
This supplemental report shall be marked “confidential.”
2.A supplement to the Annual Prevention and Early Intervention Report that contains the
information that was excluded pursuant to subdivision (3). This supplement to the
report shall be marked “confidential.”
(b)The County shall report the following information annually as part of the Annual Update or Three-
Year Program and Expenditure Plan. The report shall include the following information for the
reporting period:
(1) For each Prevention Program and each Early Intervention Program list:
(A)The Program name.
(B) Unduplicated numbers of individuals served in the preceding fiscal year
1.If a Program served both individuals at risk of a mental illness (Prevention) and individuals
with early onset of a mental illness (Early Intervention), the County shall report numbers
served separately for each category.
2.If a Program served families the County shall report the number of individual family
members served.
Exhibit M
Page 3 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 4 of 27
(2) For each Outreach for Increasing Recognition of Early Signs of Mental Illness Program or
Strategy within a Program, the County shall report:
(A)The Program name
(B)The number of potential responders
(C) The setting(s) in which the potential responders were engaged
1.Settings providing opportunities to identify early signs of mental illness include, but are
not limited to, family resource centers, senior centers, schools, cultural organizations,
churches, faith-based organizations, primary health care, recreation centers, libraries,
public transit facilities, support groups, law enforcement departments, residences,
shelters, and clinics.
(D) The type(s) of potential responders engaged in each setting (e.g. nurses, principals, parents)
(3) For each Access and Linkage to Treatment Strategy or Program the County shall report:
(A)The Program name
(B) Number of individuals with serious mental illness referred to
1.Treatment that is provided, funded administered, or overseen by county mental health
programs, and the kind of treatment to which the individual was referred.
2.Treatment that is not provided, funded, administered, or overseen by county mental
health, and the kind of treatment to which the individual was referred.
(C) For referrals to treatment that are provided, funded, administered, or overseen by county
mental health, the number of individuals who followed through on the referral and engaged
in treatment, defined as the number of individuals who participated at least once in the
Program to which they were referred.
(D) For referrals to treatment that are provided, funded, administered, or overseen by county
mental health, the average duration of untreated mental illness as defined in Section 3750,
subdivision (f)(3)(A) and standard deviation.
(E) For referrals to treatment that are provide, funded, administered, or overseen by county
mental health, the average interval between the referral and participation in treatment,
defined as participating at least once in the treatment to which referred, and standard
deviation.
(F)“Referral” as used in this subdivision means the process by which an individual is given a
recommendation in writing to one or more specific service providers for a higher level of
care and treatment. Distributing a list of community resources to an individual does not
constitute a referral under this subdivision.
(4) For each Improve Timely Access to Services for Underserved Populations Strategy or Program
the County shall report:
(A) The program name
(B) Identify the specific underserved populations for whom the County intended to increase
timely access to services.
Exhibit M
Page 4 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 5 of 27
(C) Number of referrals of members of underserved populations to a Prevention Program, an
Early Intervention Program and/or to treatment beyond early onset.
(D) Number of individuals who followed through on the referral, defined as the number of
individuals who participated at least once in the Program to which they were referred.
(E) Average interval between referral and participation in services to which referred, defined as
participating at least once in the service to which referred, and standard deviation.
(F) Description of ways the County encouraged access to services and follow-through on
referrals
(G)“Referral” as used in this subdivision means the process by which a member of an
underserved population is given a recommendation in writing to one or more specific
service providers for a Prevention Program, an Early Intervention Program and/or a program
providing treatment beyond early onset. Distributing a list of community resources to an
individual does not constitute a referral under this subdivision.
(5) For the information reported under subdivisions (1) through (4) of this section, disaggregate
numbers served, number of potential responders engaged, and number of referrals for
treatment and other services by:
(A) The following age groups:
1.0-15 (children/youth)
2. 16-25 (transition age youth)
3. 26-59 (adult)
4.ages 60+ (older adults)
5.Number of respondents who declined to answer the question
(B) Race by the following categories:
1.American Indian or Alaska Native
2.Asian
3.Black or African American
4.Native Hawaiian or other Pacific Islander
5.White
6.Other
7.More than one race
8.Number of respondents who declined to answer the question
(C) Ethnicity by the following categories:
1.Hispanic or Latino as follows
a.Caribbean
b.Central American
c.Mexican/Mexican-American/Chicano
d.Puerto Rican
e.South American
f.Other
g.Number of respondents who declined to answer the question
2.Non-Hispanic or Non-Latino as follows
a.African
Exhibit M
Page 5 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 6 of 27
b.Asian Indian/South Asian
c.Cambodian
d.Chinese
e.Eastern European
f.European
g.Filipino
h.Japanese
i.Korean
j.Middle Eastern
k.Vietnamese
l.Other
m.Number of respondents who declined to answer the question
3.More than one ethnicity
4.Number of respondents who declined to answer the question
(D) Primary language used listed by threshold languages for the individual county
(E) Sexual orientation,
1.Gay or Lesbian
2.Heterosexual or Straight
3.Bisexual
4.Questioning or unsure of sexual orientation
5.Queer
6.Another sexual orientation
7.Number of respondents who declined to answer the question
(F) Disability, defined as a physical or mental impairment or medical condition lasting at least
six months that substantially limits a major life activity, which is not the result of a severe
mental illness
1.Yes, report the number that apply in each domain of disability(ies)
a.Communication domain separately by each of the following
(i) Difficulty seeing,
(ii) Difficulty hearing, or having speech understood
(iii) Other (specify)
b.Mental domain not including a mental illness (including but not limited to a learning
disability, developmental disability, dementia)
c.Physical/mobility domain
d.Chronic health condition (including, but not limited to, chronic pain)
e.Other (specify)
2.No
3.Number of respondents who declined to answer the question
(G) Veteran status,
1.Yes
2.No
Exhibit M
Page 6 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 7 of 27
3.Number of respondents who declined to answer the question
(H) Gender
1.Assigned sex at birth:
a.Male
b.Female
c.Number of respondents who declined to answer the question
2.Current gender identity:
a.Male
b.Female
c.Transgender
d.Genderqueer
e.Questioning or unsure of gender identity
f.Another gender identity
g.Number of respondents who declined to answer the question
(6) Any other data the County considers relevant, for example, data for additional demographic
groups that are particularly prevalent in the County, at elevated risk of or with high rates of
mental illness, unserved or underserved, and/or the focus of one or more Prevention and Early
Intervention funded services.
(7) For Stigma and Discrimination Reduction Programs and Suicide Prevention Programs, the
County may report available numbers of individuals reached, including demographic
breakdowns. An example would be the number of individuals who received training and
education or who clicked on a web site.
(8) For all programs and Strategies, the County may report implementation challenges, successes,
lessons learned, and relevant examples.
(c) For a program serving children or youth younger than 18 years of age, the demographic information
required under subdivision (b)(5) of this section relating to children or youth younger than 18 years
of age shall be collected and reported only to the extent permissible by California Education Code,
Family Educational Rights and Privacy Act (FERPA), Health Insurance Portability and Accountability
Act of 1996 (HIPAA), California Information Practices Act, and other applicable state and federal
privacy laws.
(d) Except for sexual orientation, current gender identity, and veteran status, a county shall collect the
demographic information required under subdivision (b)(5) of this section from a minor younger
than 12 years of age. Information that cannot be obtained directly from the minor may be obtained
from the minor’s parent, legal guardian, or other authorized source.
(e) A County with a population under 100,000, according to the most recent projection by the California
State Department of Finance, may report the demographic information required under subdivision
(b)(5) of this section for the County’s entire Prevention and Early Intervention Component instead of
by each Program or Strategy.
Exhibit M
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Prevention and Early Intervention Regulations
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NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5840,
5845(d)(6), and 5847, Welfare and Institutions Code; Uncodified Sections 2 and 3 of Proposition 63, the
Mental Health Services Act.
Section 3560.020. Three-Year Prevention and Early Intervention Evaluation Report.
(a)The County shall submit the Three-Year Prevention and Early Intervention Evaluation Report to the
Mental Health Services Oversight and Accountability Commission every three years as part of a
Three-Year Program and Expenditure Plan or Annual Update. The Three-Year Prevention and Early
Intervention Evaluation Report answers questions about the impacts of Prevention and Early
Intervention Component Programs on individuals with risk or early onset of serious mental illness
and on the mental health and related systems.
(1)The first Three-Year Prevention and Early Intervention Evaluation Report is due to the Mental
Health Services Oversight and Accountability Commission as part of a Three-Year Program and
Expenditure Plan or Annual Update within 30 calendar days of Board of Supervisors approval but
no later than June 30, 2019 whichever occurs first. The first Three-Year Prevention and Early
Intervention Evaluation Report shall report the required evaluations from fiscal year 2017-2018
and from fiscal year 2016-2017 if available. Each subsequent Three-Year Prevention and Early
Intervention Evaluation Report shall be due within 30 calendar days of Board of Supervisors
approval but no later than June 30th every third year thereafter whichever occurs first, as part
of a Three-Year Program and Expenditure Plan or Annual Update and shall report on the
evaluation(s) for the three prior fiscal years.
(2) The County shall exclude from the Three-Year Prevention and Early Intervention Evaluation
Report personally identifiable information as defined by the Health Insurance Portability and
Accountability Act of 1996 (HIPAA), the Health Information Technology for Economic and Clinical
Health Act (HITECH) and their implementing privacy and security regulations, the California
Information Practices Act, and any other applicable state or federal privacy laws.
(A) When the County has excluded information pursuant subdivision (2) above, the County shall
submit to the Mental Health Services Oversight and Accountability Commission one of the
following:
1.A supplemental Three-Year Prevention and Early Intervention Evaluation Report that
contains all of the information including the information that was excluded pursuant to
subdivision (2). This supplemental report shall be marked “confidential.”
2.A supplement to the Three-Year Prevention and Early Intervention Evaluation Report
that contains the information that was excluded pursuant to subdivision (2). This
supplement to the report shall be marked “confidential.”
(b) The Three-Year Prevention and Early Intervention Evaluation Report shall describe the evaluation of
each Prevention and Early Intervention Component Program and two Strategies: Access and Linkage
to Treatment and Improving Timely Access to Services for Underserved Populations. The Report
shall include the following:
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(1) The name of each Program for which the county is reporting
(2) The outcomes and indicators selected for each Prevention, Early Intervention, Stigma and
Discrimination Reduction, or Suicide Prevention Program
(3) The approaches used to select the outcomes and indicators, collect data, and determine results
for the evaluation of each Program and the Access and Linkage to Treatment and Improving
Timely Access to Services for Underserved Populations Strategies
(4) How often the data were collected for the evaluation of each Program and for the Access and
Linkage to Treatment and Improving Timely Access to Services for Underserved Populations
Strategies
(c) The Three-Year Prevention and Early Intervention Evaluation Report shall provide results and
analysis of results for all required evaluations set forth in Section 3750 for the three fiscal years prior
to the due date.
(d) The County may also include in the Three-Year Prevention and Early Intervention Evaluation Report
any additional evaluation data on selected outcomes and indicators, including evaluation results
related to the impact of Prevention and Early Intervention Component Programs on mental health
and related systems.
(e) The County shall include the same information for the previous fiscal year that otherwise would be
reported in the Annual Prevention and Early Intervention Report in response to requirements
specified in 3560.010(b).
(f) The County may report any other available evaluation results in the County’s Annual Updates.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5840,
5845(d)(6), and 5847, Welfare and Institutions Code; Uncodified Sections 2 and 3 of Proposition 63, the
Mental Health Services Act.
Article 7. Prevention and Early Intervention
Section 3700. Rule of General Application.
(a) The use of Prevention and Early Intervention funds shall be governed by the provisions specified in
this Article and Articles 1 through 5, unless otherwise specified.
Section 3701. Definitions.
(a)“Prevention and Early Intervention regulations” means sections 3200.245 and 3200.246 of Article 2,
sections 3510.010, 3560, 3560.010, and 3560.020 of Article 5, and Article 7.
(b)“Program” as used in the Prevention and Early Intervention regulations means a stand-alone
organized and planned work, action or approach that evidence indicates is likely to bring about
positive mental health outcomes either for individuals and families with or at risk of serious mental
illness or for the mental health system.
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(c)“Strategy” as used in the Prevention and Early Intervention regulations means a planned and
specified method within a Program intended to achieve a defined goal.
(d)“Mental illness” and “mental disorder” as used in the Prevention and Early Intervention regulations
means, a syndrome characterized by clinically significant disturbance in an individual’s cognition,
emotion regulation, or behavior that reflects a dysfunction in the psychological or biological
processes underlying mental functioning. Mental illness is usually associated with significant distress
or disability in social, occupational, or other important activities. An expected or culturally approved
response to a common stressor or loss, such as the death of a loved one, is not a mental illness.
Socially variant behavior (e.g. political, religious, or sexual) and conflicts that are primarily between
the individual and society are not mental illness unless the variance or conflict results from a
dysfunction in the individual, as described above.
(e)“Serious mental illness,” “serious mental disorder” and “severe mental illness” as used in the
Prevention and Early Intervention regulations means, a mental illness that is severe in degree and
persistent in duration, which may cause behavioral functioning which interferes substantially with
the primary activities of daily living, and which may result in an inability to maintain stable
adjustment and independent functioning without treatment, support, and rehabilitation for a long
or indefinite period of time. These mental illnesses include, but are not limited to, schizophrenia,
bipolar disorder, post-traumatic stress disorder, as well as major affective disorders or other
severely disabling mental disorders.
(f)The definition in subdivision (d) is applicable to serious emotional disturbance for individuals under
the age of 18, other than a primary substance use disorder or developmental disorder, which results
in behavior inappropriate to the individual’s age according to expected developmental norms.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5600.3, 5840,
Welfare and Institutions Code.
Section 3705. Prevention and Early Intervention Component General Requirements.
(a) The County shall include in its Prevention and Early Intervention Component:
(1) At least one Early Intervention Program as defined in Section 3710.
(2) At least one Outreach for Increasing Recognition of Early Signs of Mental Illness Program as
defined in Section 3715.
(3) At least one Prevention Program as defined in Section 3720
(A) Small counties may opt out of the requirement to have at least one Prevention Program if:
1.The Small County obtains a resolution from the Board of Supervisors that the County
cannot meet this requirement.
(B) A Small County that opts out of the requirement in (a)(3) above shall include in its Three-
year Program and Expenditure Plan and/or Annual Update documentation describing the
rationale for the County’s decision and how the County ensured meaningful stakeholder
involvement in the decision to opt out.
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(4) At least one Access and Linkage to Treatment Program as defined in Section 3726
(A) A County with a population under 100,000, according to the most recent projection by the
California State Department of Finance, may opt out of the requirement to have at least one
Access and Linkage to Treatment Program if:
1.The County obtains a resolution from the Board of Supervisors that the County cannot
meet this requirement.
(B) A County that opts out of the requirement in (a)(4) above shall include in its Three-year
Program and Expenditure Plan and/or Annual Update documentation describing the
rationale for the County’s decision and how the County ensured meaningful stakeholder
involvement in the decision to opt out.
(5) At least one Stigma and Discrimination Reduction Program as defined in Section 3725
(6)The Strategies defined in Section 3735.
(b) The County may include in its Prevention and Early Intervention Component:
(1) One or more Suicide Prevention Programs as defined in Section 3730.
(c) A County with a population under 100,000, according to the most recent projection by the California
State Department of Finance, may satisfy the requirements in subdivisions (a)(1) through (a)(5) of
this Section by combining and/or integrating the Early Intervention Program, the Outreach for
Increasing Recognition of Early Signs of Mental Illness Program, the Prevention Program, the Access
and Linkage to Treatment Program, and the Stigma and Discrimination Reduction Program.
(1) A county that utilizes this provision shall not also opt-out of the requirement to have at least
one Prevention Program under subdivision (a)(3) or of the requirement to have at least one
Access and Linkage to Treatment Program under subdivision (a)(4).
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Section 5840, Welfare
and Institutions Code.
Section 3706. General Requirements for Services.
(a) The County shall serve all ages in one or more Programs of the Prevention and Early Intervention
Component.
(b) At least 51 percent of the Prevention and Early Intervention Fund shall be used to serve individuals
who are 25 years old or younger.
(c) Programs that serve parents, caregivers, or family members with the goal of addressing MHSA
outcomes for children or youth at risk of or with early onset of a mental illness can be counted as
meeting the requirements in (a) and (b) above.
(d) A Small County may opt out of the requirements in (a) and/or (b) above if:
(1) The Small County obtains a declaration from the Board of Supervisors that the County cannot
meet the requirements because of specified local conditions.
(e) A Small County that opts out of the requirements in (a) and/or (b) shall include in its Three-year
Program and Expenditure Plan and/or Annual Update documentation describing the rationale for
the County’s decision and how the County ensured meaningful stakeholder involvement in the
decision to opt out.
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NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5840, 5847, and
5848, Welfare and Institutions Code; Uncodified Sections 2 and 3 of Proposition 63, the Mental Health
Services Act.
Section 3710. Early Intervention Program.
(a) The County shall offer at least one Early Intervention Program as defined in this section.
(b)“Early Intervention Program” means treatment and other services and interventions, including
relapse prevention, to address and promote recovery and related functional outcomes for a mental
illness early in its emergence, including the applicable negative outcomes listed in Welfare and
Institutions Code Section 5840, subdivision (d) that may result from untreated mental illness.
(c) Early Intervention Program services shall not exceed eighteen months, unless the individual
receiving the service is identified as experiencing first onset of a serious mental illness or emotional
disturbance with psychotic features, in which case early intervention services shall not exceed four
years.
(1) For purpose of this section, "serious mental illness or emotional disturbance with psychotic
features" means, schizophrenia spectrum and other psychotic disorders including schizophrenia,
other psychotic disorders, disorders with psychotic features, and schizotypal (personality)
disorder). These disorders include abnormalities in one or more of the following five domains:
delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal
motor behavior (including catatonia), and negative symptoms.
(d) Early Intervention Program services may include services to parents, caregivers, and other family
members of the person with early onset of a mental illness, as applicable.
(e) The County may combine an Early Intervention Program with a Prevention Program, as long as the
requirements in Section 3710 and Section 3720 are met
(f) The County shall include all of the Strategies in each Early Intervention Program as referenced in
Section 3735
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Section 5840, Welfare
and Institutions Code.
Section 3715. Outreach for Increasing Recognition of Early Signs of Mental Illness.
(a) The County shall offer at least one Outreach for Increasing Recognition of Early Signs of Mental
Illness Program as defined in this section.
(b)“Outreach” is a process of engaging, encouraging, educating, and/or training, and learning from
potential responders about ways to recognize and respond effectively to early signs of potentially
severe and disabling mental illness.
(c)“Potential responders” include, but are not limited to, families, employers, primary health care
providers, visiting nurses, school personnel, community service providers, peer providers, cultural
brokers, law enforcement personnel, emergency medical service providers, people who provide
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services to individuals who are homeless, family law practitioners such as mediators, child protective
services, leaders of faith-based organizations, and others in a position to identify early signs of
potentially severe and disabling mental illness, provide support, and/or refer individuals who need
treatment or other mental health services.
(d) Outreach for Increasing Recognition of Early Signs of Mental Illness may include reaching out to
individuals with signs and symptoms of a mental illness, so they can recognize and respond to their
own symptoms.
(e) In addition to offering the required Outreach for Increasing Recognition of Early Signs of Mental
Illness Program, the County may also offer Outreach for Increasing Recognition of Early Signs of
Mental Illness as a Strategy within a Prevention Program, a Strategy within an Early Intervention
Program, a Strategy within another Program funded by Prevention and Early Intervention funds, or a
combination thereof.
(f) An Outreach for Increasing Recognition of Early Signs of Mental Illness Program may be provided
through other Mental Health Services Act components as long as it meets all of the requirements in
this section.
(g) The County shall include all of the Strategies in each Outreach for Increasing Recognition of Early
Signs of Mental Illness Program as referenced in Section 3735.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Section 5840, Welfare
and Institutions Code.
Section 3720. Prevention Program.
(a) The County shall offer at least one Prevention Program as defined in this section.
(b)“Prevention Program” means a set of related activities to reduce risk factors for developing a
potentially serious mental illness and to build protective factors. The goal of this Program is to bring
about mental health including reduction of the applicable negative outcomes listed in Welfare and
Institutions Code Section 5840, subdivision (d) as a result of untreated mental illness for individuals
and members of groups or populations whose risk of developing a serious mental illness is greater
than average and, as applicable, their parents, caregivers, and other family members.
(c)“Risk factors for mental illness” means conditions or experiences that are associated with a greater
than average risk of developing a potentially serious mental illness. Risk factors include, but are not
limited to, biological including family history and neurological, behavioral, social/economic, and
environmental.
(1) Examples of risk factors include, but are not limited to, a serious chronic medical condition,
adverse childhood experiences, experience of severe trauma, ongoing stress, exposure to drugs
or toxins including in the womb, poverty, family conflict or domestic violence, experiences of
racism and social inequality, prolonged isolation, traumatic loss (e.g. complicated, multiple,
prolonged, severe), having a previous mental illness, a previous suicide attempt, or having a
family member with a serious mental illness.
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(d) Prevention Program services may include relapse prevention for individuals in recovery from a
serious mental illness.
(e) Prevention Programs may include universal prevention if there is evidence to suggest that the
universal prevention is an effective method for individuals and members of groups or populations
whose risk of developing a serious mental illness is greater than average.
(f) The County may combine an Early Intervention Program with a Prevention Program, as long as the
requirements in Section 3710 and Section 3720 are met.
(g) The County shall include all of the Strategies in each Prevention Program as referenced in Section
3735.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Section 5840, Welfare
and Institutions Code.
Section 3725. Stigma and Discrimination Reduction Program.
(a) The County shall offer at least one Stigma and Discrimination Reduction Program as defined in this
section.
(b)“Stigma and Discrimination Reduction Program” means the County’s direct activities to reduce
negative feelings, attitudes, beliefs, perceptions, stereotypes and/or discrimination related to being
diagnosed with a mental illness, having a mental illness, or to seeking mental health services and to
increase acceptance, dignity, inclusion, and equity for individuals with mental illness, and members
of their families.
(1) Examples of Stigma and Discrimination Reduction Programs include, but are not limited to,
social marketing campaigns, speakers’ bureaus and other direct-contact approaches, targeted
education and training, anti-stigma advocacy, web-based campaigns, efforts to combat multiple
stigmas that have been shown to discourage individuals from seeking mental health services,
and efforts to encourage self-acceptance for individuals with a mental illness.
(2) Stigma and Discrimination Reduction Programs shall include approaches that are culturally
congruent with the values of the populations for whom changes in attitudes, knowledge, and
behavior are intended.
(c) The County shall include all of the Strategies in each Stigma and Discrimination Reduction Program
as referenced in Section 3735.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Section 5840, Welfare
and Institutions Code.
Section 3726. Access and Linkage to Treatment Program.
(a) The County shall offer at least one Access and Linkage to Treatment Program as defined in this
section.
(b)“Access and Linkage to Treatment Program” means a set of related activities to connect children
with severe mental illness, as defined in Welfare and Institutions Code Section 5600.3, and adults
and seniors with severe mental illness, as defined in Welfare and Institutions Code Section 5600.3,
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as early in the onset of these conditions as practicable, to medically necessary care and treatment,
including, but not limited to, care provided by county mental health programs.
(1) Examples of Access and Linkage to Treatment Programs, include but are not limited to,
Programs with a primary focus on screening, assessment, referral, telephone help lines, and
mobile response.
(c) In addition to offering the required Access and Linkage to Treatment Program, the County is also
required to offer Access and Linkage to Treatment as a Strategy within all Prevention and Early
Intervention Programs.
(d) The County shall include all of the Strategies in each Access and Linkage to Treatment Program as
referenced in Section 3735.
(e) An Access and Linkage to Treatment Program may be provided through other Mental Health
Services Act components as long as it meets all of the requirements in this section.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5600.3 and
5840, Welfare and Institutions Code.
Section 3730. Suicide Prevention Programs.
(a) The County may offer one or more Suicide Prevention Programs as defined in this section.
(b) Suicide Prevention Programs means organized activities that the County undertakes to prevent
suicide as a consequence of mental illness. This category of Programs does not focus on or have
intended outcomes for specific individuals at risk of or with serious mental illness.
(1) Suicide prevention activities that aim to reduce suicidality for specific individuals at risk of or
with early onset of a potentially serious mental illness can be a focus of a Prevention Program
pursuant to Section 3720 or a focus of an Early Intervention Program pursuant to Section 3710.
(d) Suicide Prevention Programs pursuant to this section include, but are not limited to, public and
targeted information campaigns, suicide prevention networks, capacity building programs, culturally
specific approaches, survivor-informed models, screening programs, suicide prevention hotlines or
web-based suicide prevention resources, and training and education.
(e) The County shall include all of the Strategies in each Suicide Prevention Program as referenced in
Section 3735.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Section 5840, Welfare
and Institutions Code.
Section 3735. Prevention and Early Intervention Strategies.
(a) The County shall include all of the following Strategies as part of each Program listed in Sections
3710 through 3730 of Article 7:
(1) Be designed and implemented to help create Access and Linkage to Treatment.
(A)“Access and Linkage to Treatment” means connecting children with severe mental illness, as
defined in Welfare and Institutions Code Section 5600.3, and adults and seniors with severe
mental illness, as defined in Welfare and Institutions Code Section 5600.3, as early in the
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onset of these conditions as practicable, to medically necessary care and treatment,
including but not limited to care provided by county mental health programs.
(2) Be designed, implemented, and promoted in ways that Improve Timely Access to Mental Health
Services for Individuals and/or Families from Underserved Populations.
(A)“Improving Timely Access to Services for Underserved Populations” means to increase the
extent to which an individual or family from an underserved population as defined in Title 9
California Code of Regulations Section 3200.300 who needs mental health services because
of risk or presence of a mental illness receives appropriate services as early in the onset as
practicable, through program features such as accessibility, cultural and language
appropriateness, transportation, family focus, hours available, and cost of services.
(B) Services shall be provide in convenient, accessible, acceptable, culturally appropriate
settings such as primary healthcare, schools, family resource centers, community-based
organizations, places of worship, shelters, and public settings unless a mental health setting
enhances access to quality services and outcomes for underserved populations.
(C) In addition to offering the required Improve Timely Access to Services for Underserved
Populations Strategy, the County may also offer Improve Timely Access to Services for
Underserved Populations as a Program.
(3) Be designed, implemented, and promoted using Strategies that are Non-Stigmatizing and Non-
Discriminatory
(A)“Strategies that are Non-Stigmatizing and Non-Discriminatory” means promoting, designing,
and implementing Programs in ways that reduce and circumvent stigma, including self-
stigma, and discrimination related to being diagnosed with a mental illness, having a mental
illness or seeking mental health services, and making services accessible, welcoming, and
positive.
(B) Non-Stigmatizing and Non-Discriminatory approaches include, but are not limited to, using
positive, factual messages and approaches with a focus on recovery, wellness, and
resilience; use of culturally appropriate language, practices, and concepts; efforts to
acknowledge and combat multiple social stigmas that affect attitudes about mental illness
and/or about seeking mental health services, including but not limited to race and sexual
orientation; co-locating mental health services with other life resources; promoting positive
attitudes and understanding of recovery among mental health providers; inclusion and
welcoming of family members; and employment of peers in a range of roles.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Section 5840, Welfare
and Institutions Code.
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Section 3740. Effective Methods.
(a) For each Program and each Strategy in Article 7, the County shall use effective methods likely to
bring about intended outcomes, based on one of the following standards, or a combination of the
following standards:
(1) Evidence-based practice standard: Evidence-based practice means activities for which there is
scientific evidence consistently showing improved mental health outcomes for the intended
population, including, but not limited to, scientific peer-reviewed research using randomized
clinical trials.
(2) Promising practice standard: Promising practice means Programs and activities for which there
is research demonstrating effectiveness, including strong quantitative and qualitative data
showing positive outcomes, but the research does not meet the standards used to establish
evidence-based practices and does not have enough research or replication to support
generalizable positive public health outcomes.
(3) Community and or practice-based evidence standard: Community and or practice-based
evidence means a set of practices that communities have used and determined to yield positive
results by community consensus over time, which may or may not have been measured
empirically. Community and or practice-defined evidence takes a number of factors into
consideration, including worldview, historical, and social contexts of a given population or
community, which are culturally rooted.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Section 5840, Welfare
and Institutions Code.
Section 3745. Changed Program.
(a) If the County determines a need to make a substantial change to a Program or Strategy described in
the County’s most recent Three-Year Program and Expenditure Plan or Annual Update that was
adopted by the local county board of supervisors as referenced in Welfare and Institutions Code
Section 5847, the County shall ensure that stakeholders contributed meaningfully to the planning
process that resulted in the decision to make the change.
(b)“Substantial change” as used in this section means, change(s) to the essential elements of a Program
or Strategy or change(s) to the intended outcomes or target population.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5840 and 5848,
Welfare and Institutions Code.
Section 3750. Prevention and Early Intervention Component Evaluation.
(a) For each Early Intervention Program the County shall evaluate the reduction of prolonged suffering
as referenced in Welfare and Institutions Code Section 5840, subdivision (d) that may result from
untreated mental illness by measuring reduced symptoms and/or improved recovery, including
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mental, emotional, and relational functioning. The County shall select, define, and measure
appropriate indicators that are applicable to the Program.
(b) For each Prevention Program the County shall measure the reduction of prolonged suffering as
referenced in Welfare and Institutions Code Section 5840, subdivision (d) that may result from
untreated mental illness by measuring a reduction in risk factors, indicators, and/or increased
protective factors that may lead to improved mental, emotional, and relational functioning. The
County shall select, define, and measure appropriate indicators that are applicable to the Program.
(c)For each Early Intervention and each Prevention Program that the County designates as intended to
reduce any of the other Mental Health Services Act negative outcomes referenced in Welfare and
Institutions Code Section 5840, subdivision (d) that may result from untreated mental illness, the
County shall select, define, and measure appropriate indicators that the County selects that are
applicable to the Program.
(d) For each Stigma and Discrimination Reduction Program referenced in Section 3725, the County shall
select and use a validated method to measure one or more of the following:
(1) Changes in attitudes, knowledge, and/or behavior related to mental illness that are applicable to
the specific Program.
(2) Changes in attitudes, knowledge, and/or behavior related to seeking mental health services that
are applicable to the specific Program.
(e) If the County chooses to offer a Suicide Prevention Program referenced in Section 3730, the County
shall select and use a validated method to measure changes in attitudes, knowledge, and/or
behavior regarding suicide related to mental illness that are applicable to the specific Program.
(f) For each Strategy or Program to provide Access and Linkage to Treatment the County shall track:
(1) Number of referrals as defined in subdivision (b)(3)(F) of section 3560.010 to treatment, and
kind of treatment to which person was referred.
(2) Number of persons who followed through on the referral as defined in subdivision (b)(3)(F) of
section 3560.010 and engaged in treatment, defined as the number of individuals who
participated at least once in the Program to which the person was referred.
(A) The County may use a methodologically sound random sampling method to satisfy this
requirement. The sample must be statistically generalizable to the larger population and
representative of all relevant demographic groups included in the larger population.
(3) Duration of untreated mental illness.
(A) Duration of untreated mental illness shall be measured for persons who are referred as
defined in subdivision (b)(3)(F) of section 3560.010 to treatment and who have not
previously received treatment as follows:
1.The time between the self-reported and/or parent-or-family-reported onset of
symptoms of mental illness and entry into treatment, defined as participating at least
once in treatment to which the person was referred.
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(B) The County may use a methodologically sound random sampling method to satisfy this
requirement. The sample must be statistically generalizable to the larger population and
representative of all relevant demographic groups included in the larger population.
(4)The interval between the referral as defined in subdivision (b)(3)(F) of section 3560.010 and
engagement in treatment, defined as participating at least once in the treatment to which
referred
(A)The County may use a methodologically sound random sampling method to satisfy this
requirement. The sample must be statistically generalizable to the larger population and
representative of all relevant demographic groups included in the larger population.
(g) For each Strategy or Program to Improve Timely Access to Services for Underserved Populations the
County shall measure:
(1) Number of referrals as defined in subdivision (b)(4)(G) of section 3560.010 of members of
underserved populations to a Prevention Program, an Early Intervention Program, and/or
treatment beyond early onset.
(2) Number of persons who followed through on the referral as defined in subdivision (b)(4)(G) of
section 3560.010 and engaged in services, defined as the number of individuals who
participated at least once in the Program to which the person was referred.
(A) The County may use a methodologically sound random sampling method to satisfy this
requirement. The sample must be statistically generalizable to the larger population and
representative of all relevant demographic groups included in the larger population.
(3) Timeliness of care.
(A) Timeliness of care for individuals from underserved populations with a mental illness is
measured by the interval between referral as defined in subdivision (b)(4)(G) of section
3560.010 and engagement in services, defined as participating at least once in the service
to which referred.
(h)The County shall design the evaluations to be culturally competent and shall include the perspective
of diverse people with lived experience of mental illness, including their family members, as
applicable.
(i) In addition, to the required evaluations listed in this section, the County may also, as relevant and
applicable, define and measure the impact of Programs funded by Prevention and Early Intervention
funds on the mental health and related systems, including, but not limited to education, physical
healthcare, law enforcement and justice, social services, homeless shelters and other services, and
community supports specific to age, racial, ethnic, and cultural groups. Examples of system
outcomes include, but are not limited to, increased provision of services by ethnic and cultural
community organizations, hours of operation, integration of services including co-location,
involvement of clients and families in key decisions, identification and response to co-occurring
substance-use disorders, staff knowledge and application of recovery principles, collaboration with
diverse community partners, or funds leveraged.
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(j) A County with a population under 100,000, according to the most recent projection by the California
State Department of Finance, is exempt from the evaluation requirements in this section for one
year from the effective date of this section.
(k) A County with a population under 100,000, according to the most recent projection by the California
State Department of Finance, electing to follow subdivision (c) of section 3705 may satisfy the
requirements of subdivisions (a) through (g) of this section by selecting, defining, and measuring
appropriate indicators that the County selects to evaluate the negative outcomes referenced in
Welfare and Institutions Code section 5840, subdivision (d), identified in the County’s Three-year
Program and Expenditure Plan and/or Annual Update pursuant to subdivision (o)(3) of section 3755.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5840 and 5847,
Welfare and Institutions Code; Uncodified Sections 2 and 3 of Proposition 63, the Mental Health Services
Act.
Section 3755. Prevention and Early Intervention Component of the Three-Year Program and
Expenditure Plan and Annual Update.
(a) The requirements set forth in this section shall apply to the Annual Update due for the fiscal year
2016-17 and each Annual Update and/or Three-Year Program and Expenditure Plan thereafter.
(b) The Prevention and Early Intervention Component of the Three-Year Program and Expenditure Plan
or Annual Update shall include the following general information:
(1) A description of how the County ensured that staff and stakeholders involved in the Community
Program Planning process required by Title 9 California Code of Regulations, Section 3300, were
informed about and understood the purpose and requirements of the Prevention and Early
Intervention Component.
(2)A description of the County’s plan to involve community stakeholders meaningfully in all phases
of the Prevention and Early Intervention Component of the Mental Health Services Act,
including program planning and implementation, monitoring, quality improvement, evaluation,
and budget allocations.
(3) A brief description, with specific examples of how each Program and/or Strategy funded by
Prevention and Early Intervention funds will reflect and be consistent with all applicable Mental
Health Services Act General Standards set forth in Title 9 California Code of Regulations, Section
3320.
(c) Except as provided in subdivision (o), the Prevention and Early Intervention Component of the
Three-Year Program and Expenditure Plan and Annual Update shall include a description of each
Early Intervention Program as defined in Section 3710 including, but not limited to:
(1)The Program name
(2) Identification of the target population for the specific Program including:
(A) Demographics relevant to the intended target population for the specific Program,
including, but not limited to, age, race/ethnicity, gender or gender identity, primary
language used, military status, and sexual orientation.
Exhibit M
Page 20 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 21 of 27
(B) The mental illness or illnesses for which there is early onset.
(C)Brief description of how each participant’s early onset of a potentially serious mental illness
will be determined.
(3) Identification of the type(s) of problem(s) and need(s) for which the Program will be directed
and the activities to be included in the Program that are intended to bring about mental health
and related functional outcomes including reduction of the negative outcomes referenced in
Welfare and Institutions Code Section 5840, subdivision (d) for individuals with early onset of
potentially serious mental illness.
(4) The Mental Health Services Act negative outcomes as a consequence of untreated mental illness
referenced in Welfare and Institutions Code Section 5840, subdivision (d) that the Program is
expected to affect, including the reduction of prolonged suffering as a consequence of
untreated mental illness, as defined in Section 3750, subdivision (a).
(A) List the mental health indicators that the County will use to measure reduction of prolonged
suffering as referenced in Section 3750, subdivision (a).
(B) For any other specified Mental Health Services Act negative outcome as a consequence of
untreated mental illness, as referenced in Section 3750, subdivision (c), list the indicators
that the County will use to measure the intended reductions.
(C) Explain the evaluation methodology, including, how and when outcomes will be measured,
how data will be collected and analyzed, and how the evaluation will reflect cultural
competence.
(5) Specify how the Early Intervention Program is likely to reduce the relevant Mental Health
Services Act negative outcomes as referenced in Welfare and Institutions Code Section 5840,
subdivision (d) by providing the following information:
(A) If the County used the evidence-based standard or promising practice standard to
determine the Program’s effectiveness as referenced in Section 3740, subdivisions (a)(1) and
(a)(2), provide a brief description of or reference to the relevant evidence applicable to the
specific intended outcome, explain how the practice’s effectiveness has been demonstrated
for the intended population, and explain how the County will ensure fidelity to the practice
according to the practice model and program design in implementing the Program.
(B) If the County used the community and/or practice-based standard to determine the
Program’s effectiveness as referenced in Section 3740, subdivision (a)(3), describe the
evidence that the approach is likely to bring about applicable Mental Health Services Act
outcomes for the intended population(s) and explain how the County will ensure fidelity to
the practice according to the practice model and program design in implementing the
Program.
(d) Except as provided in subdivision (o), the Prevention and Early Intervention Component of the
Three-Year Program and Expenditure Plan and Annual Update shall include a description of the
Prevention Program including but not limited to the following information:
(1)The Program name
Exhibit M
Page 21 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 22 of 27
(2) Identification of the target population for the specific Program, including:
(A)Participants’ risk of a potentially serious mental illness, either based on individual risk or
membership in a group or population with greater than average risk of a serious mental
illness, i.e. the condition, experience, or behavior associated with greater than average risk.
(B) How the risk of a potentially serious mental illness will be defined and determined, i.e. what
criteria and process the County will use to establish that the intended beneficiaries of the
Program have a greater than average risk of developing a potentially severe mental illness.
(C) Demographics relevant to the intended target population for the specific Program including
but not limited to age, race/ethnicity, gender or gender identity, sexual orientation, primary
language used, and military status.
(3) Specify the type of problem(s) and need(s) for which the Prevention Program will be directed
and the activities to be included in the Program that are intended to bring about mental health
and related functional outcomes including reduction of the negative outcomes referenced in
Welfare and Institutions Code Section 5840, subdivision (d) for individuals with greater than
average risk of potentially serious mental illness.
(4) Specify any Mental Health Services Act negative outcomes as a consequence of untreated
mental illness as referenced in Welfare and Institutions Code Section 5840, subdivision (d) that
the Program is expected to affect, including reduction of prolonged suffering, as defined in
Section 3750, subdivision (b).
(A) List the mental health indicators that the County will use to measure reduction of prolonged
suffering as referenced in Section 3750, subdivision (b).
(B) If the County intends the Program to reduce any other specified Mental Health Services Act
negative outcome as a consequence of untreated mental illness as referenced in Section
3750, subdivision (c), list the indicators that the County will use to measure the intended
reductions.
(C) Explain the evaluation methodology, including, how and when outcomes will be measured,
how data will be collected and analyzed, and how the evaluation will reflect cultural
competence.
(5) Specify how the Prevention Program is likely to bring about reduction of relevant Mental Health
Services Act negative outcomes referenced in Welfare and Institutions Code Section 5840,
subdivision (d) for the intended population by providing the following information:
(A) If the County used the evidence-based standard or promising practice standard to
determine the Program’s effectiveness as referenced in Section 3740, subdivisions (a)(1) and
(a)(2), provide a brief description of or reference to the relevant evidence applicable to the
specific intended outcome, explain how the practice’s effectiveness has been demonstrated
for the intended population, and explain how the County will ensure fidelity to the practice
according to the practice model and program design in implementing the Program.
(B) If the County used the community and/or practice-based standard to determine the
Program’s effectiveness as referenced in Section 3740, subdivision (a)(3), describe the
Exhibit M
Page 22 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 23 of 27
evidence that the approach is likely to bring about applicable Mental Health Services Act
outcomes for the intended population(s) and explain how the County will ensure fidelity to
the practice according to the practice model and program design in implementing the
Program.
(e) Except as provided in subdivision (o), the Prevention and Early Intervention Component of the
Three-Year Program and Expenditure Plan and Annual Update shall include a description of each
Outreach for Increasing Recognition of Early Signs of Mental Illness Program and for any Strategy
within a Program, including, but not limited to:
(1)The Program name
(2) Identify the types and settings of potential responders the Program intends to reach.
(A)Describe briefly the potential responders’ setting(s), as referenced in Section 3750,
subdivisions (d)(3)(A), and the opportunity the potential responders will have to identify
diverse individuals with signs and symptoms of potentially serious mental illness.
(3) Specify the methods to be used to reach out and engage potential responders and the methods
to be used for potential responders and public mental health service providers to learn together
about how to identify and respond supportively to signs and symptoms of potentially serious
mental illness.
(f) Except as provided in subdivision (o), the Prevention and Early Intervention Component of the
Three-Year Program and Expenditure Plan and Annual Update shall include a description of each
Stigma and Discrimination Reduction Program, including, but not limited to:
(1)The Program name
(2) Identify whom the Program intends to influence.
(3) Specify the methods and activities to be used to change attitudes, knowledge, and/or behavior
regarding being diagnosed with mental illness, having mental illness and/or seeking mental
health services, consistent with requirements in Section 3750, subdivision (e), including
timeframes for measurement.
(4) Specify how the proposed method is likely to bring about the selected outcomes by providing
the following information:
(A) If the County used the evidence-based standard or promising practice standard, to
determine the Program’s effectiveness as referenced in Section 3740, subdivisions (a)(1) and
(a)(2), provide a brief description of or reference to the relevant evidence applicable to the
specific intended outcome, explain how the practice’s effectiveness has been demonstrated
for the intended population and explain how the County will ensure fidelity to the practice
according to the practice model and Program design in implementing the Program.
(B) If the County used the community and/or practice-based standard to determine the
Program’s effectiveness as referenced in Section 3740, subdivision (a)(3), describe the
evidence that the approach is likely to bring about applicable Mental Health Services Act
outcomes for the intended population and explain how the County will ensure fidelity to the
practice according to the practice model and Program design in implementing the Program.
Exhibit M
Page 23 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 24 of 27
(g) Except as provided in subdivision (o), the Prevention and Early Intervention Component of the
Three-Year Program and Expenditure Plan and Annual Update shall include a description of each
Suicide Prevention Program including, but not limited to:
(1)The Program name
(2) Specify the methods and activities to be used to change attitudes and behavior to prevent
mental illness-related suicide.
(3) Indicate how the County will measure changes in attitude, knowledge, and /or behavior related
to reducing mental illness-related suicide consistent with requirements in Section 3750,
subdivision (f) including timeframes for measurement.
(4) Specify how the proposed method is likely to bring about suicide prevention outcomes selected
by the County by providing the following information:
(A) If the County used the evidence-based standard or promising practice standard to
determine the Program’s effectiveness as referenced in Section 3740, subdivisions (a)(1) and
(a)(2), explain how the practice’s effectiveness has been demonstrated and explain how the
County will ensure fidelity to the practice according to the practice model and Program
design in implementing the Program.
(B) If the County used the community and/or practice-based standard to determine the
Program’s effectiveness as referenced in Section 3740, subdivision (a)(3), describe the
evidence that the approach is likely to bring about applicable Mental Health Services Act
outcomes and explain how the County will ensure fidelity to the practice according to the
practice model and Program design in implementing the Program.
(h) Except as provided in subdivision (o), the Prevention and Early Intervention Component of the
Three-Year Program and Expenditure Plan and Annual Update shall include a description of the
Access and Linkage to Treatment Program and Strategy within each Program including, but not
limited to:
(1) Program name
(2) An explanation of how the Program and Strategy within each Program will create Access and
Linkage to Treatment for individuals with serious mental illness as referenced in Section 3735,
subdivision (a)(1)
(3) Explain how individuals will be identified as needing assessment or treatment for a serious
mental illness or serious emotional disturbance that is beyond the scope of an Early Intervention
Program.
(4) Explain how individuals, and, as applicable, their parents, caregivers, or other family members,
will be linked to county mental health services, a primary care provider, or other mental health
treatment.
(5) Explain how the Program will follow up with the referral to support engagement in treatment.
(6) Indicate if the County intends to measure outcomes in addition to those required in Section
3750, subdivision (f) and if so, specify what outcome(s) and how will it be measured, including
timeframes for measurement.
Exhibit M
Page 24 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 25 of 27
(i) Except as provided in subdivision (o), the Prevention and Early Intervention Component of the
Three-Year Program and Expenditure Plan and Annual Update shall include for all Programs:
(1) Program name
(2) An explanation of how the Program will be implemented to help Improve Access to Services for
Underserved Populations, as required in Section 3735, subdivision (a)(2)
(3) For each Program, the County shall indicate the intended setting(s) and why the setting
enhances access for specific, designated underserved populations. If the County intends to
locate the Program in a mental health setting, explain why this choice enhances access to
quality services and outcomes for the specific underserved population.
(4) Indicate if the County intends to measure outcomes in addition to those required in Section
3750, subdivision (g) and, if so, what outcome(s) and how will it be measured, including
timeframes for measurement.
(j) Except as provided in subdivision (o), the Prevention and Early Intervention Component of the
Three-Year Program and Expenditure Plan and Annual Update shall include for all Programs:
(1)The Program name
(2) An explanation of how the Program will use Strategies that are Non-Stigmatizing and
Non-Discriminatory, including a description of the specific Strategies to be employed and the
reasons the County believes they will be successful and meet intended outcomes.
(k) Except as provided in subdivision (o), the Prevention and Early Intervention Component of the
Three-Year Program and Expenditure Plan and Annual Update shall include for all Programs the
following information for the fiscal year after the plan is submitted.
(1) Estimated number of children, adults, and seniors to be served in each Prevention Program and
each Early Intervention Program.
(2) The County may also include estimates of the number of individuals who will be reached by
Outreach for Increasing Recognition of Early Signs of Mental Illness Program, Access and Linkage
to Treatment Program, Suicide Prevention Programs, and Stigma and Discrimination Reduction
Programs.
(l) Except as provided in subdivision (o), the Prevention and Early Intervention Component of the
Three-Year Program and Expenditure Plan and Annual Update shall include projected expenditures
for each Program funded with Prevention and Early Intervention funds by fiscal year
(1) Projected expenditures by the following sources of funding:
(A) Estimated total mental health expenditures
(B) Prevention and Early Intervention funds
(C) Medi-Cal Federal Financial Participation
(D) 1991 Realignment
(E) Behavioral Subaccount
(F) Any other funding
(2) The County shall identify each Program funded with Prevention and Early Intervention funds as
a Prevention Program, an Early Intervention Program, Outreach for Increasing Recognition of
Exhibit M
Page 25 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 26 of 27
Early Signs of Mental Illness Program, Stigma and Discrimination Reduction Program, Suicide
Prevention Program, Access and Linkage to Treatment Program, or Program to Improve Timely
Access to Services for Underserved Populations and shall estimate expected expenditures for
each Program. If the Programs are combined, the County shall estimate the percentage of funds
dedicated to each Program.
(A) The County shall estimate the amount of Prevention and Early Intervention funds for
Administration of the Prevention and Early Intervention Component.
(m) The Prevention and Early Intervention Component of the Three-Year Program and Expenditure Plan
and Annual Update shall include the previous fiscal years’ unexpended Prevention and Early
Intervention funds and the amount of those funds that will be used to pay for the Programs listed in
the Annual Update and/or Three-year Program and Expenditure Plan.
(n) The Prevention and Early Intervention Component of the Three-Year Program and Expenditure Plan
and Annual Update shall include an estimate of the amount of Prevention and Early Intervention
funds voluntarily assigned by the County to California Mental Health Services Authority or any other
organization in which counties are acting jointly.
(o) A County with a population under 100,000, according to the most recent projection by the California
State Department of Finance, electing to follow subdivision (c) of section 3705 shall include in the
Prevention and Early Intervention Component of the Three-Year Program and Expenditure Plan and
Annual Update a description of the combined and/or integrated program including but not limited:
(1) Name of the combined and/or integrated program.
(2) Description of how the five required programs were combined and/or integrated.
(3) Identification of the negative outcomes referenced in Welfare and Institutions Code Section
5840, subdivision (d) the combined and/or integrated program is intended to reduce.
(4) Description of how the combined and/or integrated program is likely to reduce the outcomes
identified in part (3) above.
(5) Identification of the indicators that the County will use to measure the intended outcomes
identified in part (3) above.
(6) Explanation of how the combined and/or integrated program will be implemented to help
Improve Access to Services for Underserved Population, as required in Section 3735, subdivision
(a)(2).
(7) Explanation of how the combined and/or integrated program will use Strategies that are Non-
Stigmatizing and Non-Discriminatory, as required in Section 3735, subdivision (a)(3).
(8) Estimated numbers of children, adults, and seniors, respectively, to be served in the combined
and/or integrated program.
(9) List of the projected expenditures for the combined and/or integrated program funded with
Prevention and Early Intervention funds by fiscal year and by the following sources of funding:
(A) Estimated total mental health expenditures
(B) Prevention and Early Intervention funds
(C) Medi-Cal Federal Financial Participation
(D) 1991 Realignment
(E) Behavioral Subaccount
Exhibit M
Page 26 of 27
Prevention and Early Intervention Regulations
As of July 1, 2018
Page 27 of 27
(F) Any other funding
(10) Estimated amount of Prevention and Early Intervention funds budgeted for Administration of
the Prevention and Early Intervention Component.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5840, 5847, and
5848 Welfare and Institutions Code.
Section 3755.010. Prevention and Early Intervention Program Change Report.
(a) If the County determines a need to make a substantial change to a Program, Strategy, or target
population as described in Section 3745, the County shall in the next Three-Year Program and
Expenditure Plan or Annual Update, whichever is closest in time to the planned change, include the
following information:
(1) A brief summary of the Program as initially set forth in the originally adopted Three-Year
Program and Expenditure Plan or Annual Update.
(2) A description of the change including the resulting changes in the intended outcomes and the
planned evaluation.
(3) Explanation for the change including, stakeholder involvement in the decision and, if any,
evaluation data supporting the change.
NOTE: Authority cited: Section 5846, Welfare and Institutions Code. Reference: Sections 5840 and 5847,
Welfare and Institutions Code.
Exhibit M
Page 27 of 27
�co �� ii\ '6 �% 1s5�o/
PR"£;'
Section:
Effective Date:
Policy Title:
Department of Behavioral Health
Administration
os/30/2011
Performance Outcome Measures
Policy and Procedure Guide
PPG 1.2.7
Revised Date: os/30/2011
- ------· --- -------·· ------ -----·----···-·····-
Approved by: Dawan Utecht (Director of Behavioral Health), Francisco Escobedo (Sr. Staff Analyst - QA), Kannika
POLICY:
PURPOSE:
REFERENCE:
DEFINITIONS:
Toonnachat (Division Manager -Technology and Quality Management)
It is the policy of Fresno County Department of Behavioral Health and the
Fresno County Mental Health Plan (FCMHP) to ensure procedures for
developing performance measures which accurately reflect vital areas of
performance and provide for systematic, ongoing collection and analysis
of valid and reliable data. Data collection is not intended to be an
additional task for FCMHP programs/providers but rather embedded within
the various non-treatment, treatment and clinical documentation.
To determine the effectiveness and efficiency of services provided by
measuring performance outcomes/results achieved by the persons served
during service delivery or following service completion, delivery of service,
and of the individuals' satisfaction. This is a vital management tool used to
clarify goals, document the efforts toward achieving those goals, and thus
measure the benefit the service delivery to the persons served.
Performance measurement selection is part of the planning and
developing process design of the program. Performance measurement is
the ongoing monitoring and reporting of progress towards pre-established
objectives/goals.
California Code of Regulations, Title 9, Chapter 11, Section
1810.380(a)(1 ): State Oversight
DHCS Service, Administrative and Operational Requirements
Mental Health Services Act (MHSA}, California Code of Regulations, Title
9, Section 3320, 3200.050, and 3200.120
Commission on Accreditation of Rehabilitation Facilities (CARF)
1.Indicator: Qualitative or quantitative measure(s) that tell if the outcomes have been
accomplished. Indicators evaluate key performance in relation to objectives. It indicates
what the program is accomplishing and if the anticipated results are being achieved.
---�------·-------·----·-·--·---· ---· -·--------·---···--
MISSION STATEMENT
The Department of Behallioral Health Is dedicated to supporting the wellness of Individuals, families and communities In Fresno County who are affected by, or ore at risk
of, mental Illness and/or substance use disorders through cultivation of strengths toward promoting recollf!f)I In the least restrictive environment
Template Review Date 3/28/16
Exhibit N Page 1 of 6
� co�-<V fi!' � t>% 185��
Policy and Procedure Guide
PR�� Section: Administration Effective Date: 05/30/2017 PPG 1.2.7
Policy Title: Performance Outcome Measures
2.Intervention: A systematic plan of action consciously adapted in an attempt to address
and reduce the causes of failure or need to improve upon system.
3.Fresno County Mental Health Plan (FCMHP): Fresno County's contract with the State
Department of Health and Human Services that allows for the provision of specialty
mental health services. Services may be delivered by county-operated programs,
contracted organizational, or group providers.
4.Objective (Goal): Intended results or the impact of learning, programs, or activities.
5.Outcomes: Specific results or changes achieved as a consequence of the program or
intervention. Outcomes are connected to the objectives/goals identified by the program
or intervention.
PROCEDURE:
I.Each FCMHP program/provider shall engage in measurement of outcomes in order
to generate reliable and valid data on the effectiveness and efficiency of programs or
interventions. Programs/providers will establish/select objectives (goals), decide on
a methodology and timeline for the collection of data, and use an appropriate data
collection tool. This occurs during the program planning and development process.
Outcomes should be in alignment with the program/provider goals.
II.Outcomes should be measureable, obtainable, clear, accurately reflect the expected
result, and include specific time frames. Once the measures have been selected, it
is necessary to design a way to gather the information. For each service delivery
performance indicator, FCMHP program/provider shall determine: to whom the
indicator will be applied; who is responsible for collecting the data; the tool from
which data will be collected; and a performance target based on an industry
benchmark, or a benchmark set by the program/provider.
Ill. Performance measures are subject to review and approval by FCMHP
Administration.
IV.Performance measurement is the ongoing monitoring and reporting of progr ess
towards pre-established objectives/goals. Annually, each FCMHP program/provider
must measure service delivery performance in each of the areas/domains listed
below. Dependent on the program/provider service deliverables, exceptions must be
approved by the FCMHP Administration.
Exhibit N
Department of Behavioral Health
Page 2 of 6
� � col<-<V-
�
� � Policy and Procedure Guide
� 185�0
�R£Y Section: Administration Effective Date: 05/30/2017 PPG 1.2.7
Policy Title: Performance Outcome Measures
a.Effectiveness of services -How well programs performed and the results
achieved. Effectiveness measures address the quality of care through
measuring change over time. Examples include but are not limited to: reduction
of hospitalization, reduction of symptoms, employment and housing status, and
reduction of recidivism rate and incidence of relapse.
b.Efficiency of services -The relationship between the outcomes and the
resources used. Examples include but are not limited to: service delivery cost per
service unit, length of stay, and direct service hours of clinical and medical staff.
c.Services access -Changes or improvements in the program/provider's capacity
and timeliness to provide services to those who request them. Examples include
but are not limited to: wait/length of time from first request/referral to first service
or subsequent appointment, convenience of service hours and locations, number
of clients served by program capacity, and no-show and cancellation rates.
d.Satisfaction and feedback from persons served and stakeholders-Changes or
increased positive/negative feedback regarding the experiences of the persons
served and others (families, referral sources, payors/guarantors, etc.).
Satisfaction measures are usually oriented toward clients, family members,
personnel, the community, and funding sources. Examples include but are not
limited to: did the organization/program focus on the recovery of the person
served, were grievances or concerns addressed, overall feelings of satisfa ction,
and satisfaction with physical facilities, fees, access, service effectiveness, and
efficiency.
V.Each FCMHP program/provider shall use the following templates to document the
defined goals, intervention(s), specific indicators, and outcomes.
1.FCMHP Outcome Report template (see Attachment A)
2.FCMHP Outcome Analysis template (see Attachment C)
Exhibit N
1 Department of Behavioral Health
Page 3 of 6
Exhibit N Page 4 of 6
Page 5 of 6Exhibit N
Page 6 of 6Exhibit N