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AGREEMENT
THIS AGREEMENT is made and entered into this 12th
Agreement No. 18-327
day of _ ___...J,...un ...... e.__ _ _,, 2018, by
3 and between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and, Turning Point of Central California, Inc., a private, non-profit, 501 (c) (3),
5 corporation, whose address is P.O. Box 7447, Visalia, CA, 93290, hereinafter referred to as
6 "CONTRACTOR," collectively, "the parties."
7 WIT N ES S ET H:
8 WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), is in need of a qualified
9 agency to operate a Rural Full Service Partnership (FSP) program, an Intensive Case Management (ICM)
10 program, and an Outpatient (OP) mental health program for children, adult and older adult clients who
11 have serious emotional disturbance and/or serious and persistent mental illness in Pinedale, Sanger,
12 Reedley, Selma, Kerman, and Coalinga and other rural sites as may be needed;
13 WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), is a Mental Health Plan
14 (MHP) as defined in Title 9 of the California Code of Regulations (C.C.R.), section 1810.226; and
15 WHEREAS, CONTRACTOR is qualified and willing to operate said Rural FSP program, Rural ICM
16 Program, and Rural OP mental health Program pursuant to the terms and conditions of this Agreement.
17 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties hereto
18 agree as follows:
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1. SERVICES
A. CONTRACTOR shall perform all services and fulfill all responsibilities as set forth in
21 Exhibit A, attached hereto and by this reference incorporated herein and made part of this Agreement.
22 B. CONTRACTOR shall also perform all services and fulfill all responsibilities as
23 specified in COUNTY's Request for Proposal (RFP) No. 18-034 dated March 14, 2018, and Addendum
24 No. One (1) to COUNTY's RFP No. 18-034 dated April 3, 2018, and CONTRACTOR's response to said
25 Revised RFP dated April 12, 2018 all incorporated herein by reference and made part of this Agreement.
26 In the event of any inconsistency among these documents, the inconsistency shall be resolved by giving
27 precedence in the following order of priority: 1) to this Agreement, including all Exhibits; 2) to the Revised
28 RFP; and 3) to the Response to the Revised RFP. A copy of COUNTY's Revised RFP No. 18-034 and
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CONTRACTOR’s response thereto shall be retained and made available during the term of this
Agreement by COUNTY’s DBH Contracts Division.
C. It is acknowledged by all parties hereto that COUNTY's DBH shall monitor the
services provided by CONTRACTOR, in accordance with Section Fourteen (14) of this Agreement.
D. CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
consisting of staff from COUNTY's DBH to discuss service requirements, data reporting, training, policies
and procedures, overall program operations and any problems or foreseeable problems that may arise.
E. CONTRACTOR shall perform all FSP services as set forth in Exhibit A, in
accordance with the Full Service Partnership Service Delivery Model - Exhibit C, attached hereto and
incorporated herein by reference.
2. TERM
This Agreement shall become effective on the 1st day of July 2018 and shall terminate on
the 30th day of June 2021.
This Agreement may be extended for two (2) additional twelve (12) month periods upon the
written approval of both parties not later than sixty (60) days prior to the close of the then current
Agreement term. The COUNTY’s DBH Director or his or her designee is authorized to execute such
written approval on behalf of COUNTY based on CONTRCTOR’s satisfactory performance.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR thirty (30) days advance written notice.
B. Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to COUNTY;
4) Improperly performed service.
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In no event shall any payment by COUNTY constitute a waiver by COUNTY of any breach
of this Agreement or any default which may then exist on the part of CONTRACTOR. Neither shall such
payment impair or prejudice any remedy available to COUNTY with respect to the breach or default. The
COUNTY shall have the right to demand of the CONTRACTOR the repayment to the COUNTY of any
funds disbursed to CONTRACTOR under this Agreement, which in the judgment of COUNTY were not
expended in accordance with the terms of this Agreement. The CONTRACTOR shall promptly refund any
such funds upon demand or at COUNTY’s option such repayment shall be deducted from future payments
owing to CONTRACTOR under this Agreement.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY upon the giving of sixty (60) days advance written notice of an
intention to terminate to CONTRACTOR.
D. CONTRACTOR may terminate this Agreement. If terminated by CONTRACTOR,
termination shall require sixty (60) days advance written notice of intent to terminate (with allowance for
appropriate clinical transition of clients prior to termination of services), transmitted by CONTRACTOR to
COUNTY by Certified or Registered U.S. Mail, Return Receipt Requested, addressed to the office of
COUNTY as follows:
Director (or his or her designee) Department of Behavioral Health 3133 N. Millbrook Fresno, CA 93703 4. COMPENSATION
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation in accordance with the budget set forth in Exhibit B, attached hereto and by this reference
incorporated herein and made part of this Agreement.
A. Maximum Contract Amount
The maximum amount payable to CONTRACTOR for the period of July 1, 2018
through June 30, 2019 shall not exceed Eleven Million Six Hundred Ninety-Six Thousand Five Hundred
Twenty-Five and No/100 Dollars ($11,696,525.00).
The maximum amount payable to CONTRACTOR for the period of July 1, 2019
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through June 30, 2020 shall not exceed Twelve Million Two Hundred Two Thousand Nine Hundred Forty-
Eight and No/100 Dollars ($12,202,948.00).
The maximum amount payable to CONTRACTOR for the period of July 1, 2020
through June 30, 2021 shall not exceed Twelve Million Six Hundred Ninety-Nine Thousand Two Hundred
Eighteen and No/100 Dollars ($12,699,218.00).
The maximum amount payable to CONTRACTOR for the period of July 1, 2021
through June 30, 2022 shall not exceed Thirteen Million One Hundred Sixty-Seven Thousand Four
Hundred Sixty-Seven and No/100 Dollars ($13,167,467.00).
The maximum amount payable to CONTRACTOR for the period of July 1, 2022
through June 30, 2023 shall not exceed Thirteen Million Six Hundred Thirty-Seven Thousand Four
Hundred Twenty-Seven and No/100 Dollars ($13,637,427.00).
In no event shall the maximum contract amount for all the services provided by the
CONTRACTOR to COUNTY under the terms and conditions of this Agreement be in excess of Sixty-Three
Million Four Hundred Three Thousand Five Hundred Eighty-Five and No/100 Dollars ($63,403,585.00)
during the total term of this Agreement.
Payment shall be made upon certification or other proof satisfactory to COUNTY’s
DBH that services have actually been performed by CONTRACTOR as specified in this Agreement.
B. If CONTRACTOR fails to generate the Medi-Cal revenue and/or client fee
reimbursement amounts set forth in Exhibit B, the COUNTY shall not be obligated to pay the difference
between these estimated amounts and the actual amounts generated.
It is further understood by COUNTY and CONTRACTOR that any Medi-Cal
revenue and/or client fee reimbursements above the amounts stated herein will be used to directly offset
the COUNTY’s contribution of COUNTY funds identified in Exhibit B. The offset of funds will also be
clearly identified in monthly invoices received from CONTRACTOR as further described in Section Five (5)
of this Agreement.
Travel shall be reimbursed based on actual expenditures and mileage
reimbursement shall be at CONTRACTOR’s adopted rate per mile, not to exceed the Federal Internal
Revenue Services (IRS) published rate.
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C. It is understood that all expenses incidental to CONTRACTOR’s performance of
services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails to comply with
any provision of this Agreement, COUNTY shall be relieved of its obligation for further compensation.
D. Payments shall be made by COUNTY to CONTRACTOR in arrears, for services
provided during the preceding month, within forty-five (45) days after the date of receipt and approval by
COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments shall be made after
receipt and verification of actual expenditures incurred by CONTRACTOR for monthly program costs, as
identified in Exhibit B, in the performance of this Agreement and shall be documented to COUNTY on a
monthly basis by the tenth (10th) of the month following the month of said expenditures. The parties
acknowledge that the CONTRACTOR will be performing hiring, training, and credentialing of staff, and the
COUNTY will be performing additional staff credentialing to ensure compliance with State and Federal
regulations.
E. COUNTY shall not be obligated to make any payments under this Agreement if the
request for payment is received by COUNTY more than sixty (60) days after this Agreement has
terminated or expired.
All final invoices shall be submitted by CONTRACTOR within sixty (60) days
following the final month of service for which payment is claimed. No action shall be taken by COUNTY on
invoices submitted beyond the sixty (60) day closeout period. Any compensation which is not expended
by CONTRACTOR pursuant to the terms and conditions of this Agreement shall automatically revert to
COUNTY.
F. The services provided by CONTRACTOR under this Agreement are funded in
whole or in part by the State of California. In the event that funding for these services is delayed by the
State Controller, COUNTY may defer payments to CONTRACTOR. The amount of the deferred payment
shall not exceed the amount of funding delayed by the State Controller to the COUNTY. The period of
time of the deferral by COUNTY shall not exceed the period of time of the State Controller’s delay of
payment to COUNTY plus forty-five (45) days.
G. CONTRACTOR shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR’s deficiency discovered through the State audit
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process and COUNTY utilization review during the course of this Agreement. At COUNTY’s election, the
disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall be
withheld from subsequent payments to CONTRACTOR. CONTRACTOR shall not receive reimbursement
for any units of services rendered that are disallowed or denied by the Fresno County Mental Health Plan
(Mental Health Plan) utilization review process or through the State Department of Health Care Services
(DHCS) cost report audit settlement process for Medi-Cal eligible clients. Notwithstanding the above,
COUNTY must notify CONTRACTOR prior to any State audit process and/or COUNTY utilization review.
To the extent allowable by law, CONTRACTOR shall have the right to be present during each phase of
any State audit process and/or COUNTY utilization review and shall be provided all documentation related
to each phase of any State audit process and/or COUNTY utilization review. Additionally, prior to any
disallowances/audit exceptions becoming final, CONTRACTOR shall be given at least 10 business days to
respond to such proposed disallowances/audit exceptions.
H. It is understood by CONTRACTOR and COUNTY that this Agreement is funded
with mental health funds to serve adult individuals with Severely Mentally Ill (SMI) disorders and
children/youth with Seriously Emotionally Disturbed (SED) disorders, many of whom have co-occurring
substance use disorders. It is further understood by CONTRACTOR and COUNTY that funds shall be
used to support appropriately integrated and documented treatment services for co-occurring mental
health and substance use disorders.
5. INVOICING
A. CONTRACTOR shall invoice COUNTY in arrears by the tenth (10th) day of each
month for the prior month’s actual services rendered to DBH-Invoices@co.fresno.ca.us. After
CONTRACTOR renders service to referred clients, CONTRACTOR will invoice COUNTY for payment,
certify the expenditure, and submit electronic claiming data into COUNTY’s electronic information system
for all clients, including those eligible for Medi-Cal as well as those that are not eligible for Medi-Cal,
including contracted cost per unit and actual cost per unit. COUNTY must pay CONTRACTOR before
submitting a claim to DHCS for Federal reimbursement for Medi-Cal eligible clients.
B. At the discretion of COUNTY’s DBH Director, or his or her designee, if an invoice is
incorrect or is otherwise not in proper form or substance, COUNTY’s DBH Director, or his or her designee,
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shall have the right to withhold payment as to only that portion of the invoice that is incorrect or improper
after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to provide services
for a period of ninety (90) days after notification of an incorrect or improper invoice. If after the ninety (90)
day period, the invoice(s) is still not corrected to COUNTY DBH’s satisfaction, COUNTY’s DBH Director, or
his or her designee, may elect to terminate this Agreement, pursuant to the termination provisions stated in
Section Three (3) of this Agreement. In addition, for invoices received 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 his or her designee, COUNTY’s DBH shall have the right to deny payment of any additional
invoices received.
C. Monthly invoices shall include a client roster, identifying volume reported by payer
group clients served (including third party payer of services) by month and year-to-date, including
percentages.
D. CONTRACTOR shall submit to the COUNTY by the tenth (10th) of each month a
detailed general ledger (GL), itemizing costs incurred in the previous month. Failure to submit GL reports
and supporting documentation shall be deemed sufficient cause for COUNTY to withhold payments until
there is compliance, as further described in Section Five (5) herein.
E. CONTRACTOR will remit annually within ninety (90) days from June 30, a schedule
to provide the required information on published charges for all authorized direct specialty mental health
services. The published charge listing will serve as a source document to determine the CONTRACTOR’s
usual and customary charge prevalent in the public mental health sector that is used to bill the general
public, insurers or other non-Medi-Cal third party payers during the course of business operations.
F. CONTRACTOR shall submit monthly staffing reports that identify all direct service
and support staff, applicable licensure/certifications, and full time hours worked to be used as a tracking
tool to determine if CONTRACTOR’s program is staffed according to the services provided under this
Agreement.
G. If CONTRACTOR chooses to utilize the COUNTY’s electronic health record system
as their own full electronic health records system, COUNTY’s DBH shall invoice CONTRACTOR in arrears
by the fifth (5th day of each month for the prior month’s hosting fee for access to the COUNTY’s electronic
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information system in accordance with the fee schedule as set forth in Exhibit D, “Electronic Health
Records Software Charges” attached hereto and incorporated herein by reference. COUNTY shall invoice
CONTRACTOR annually for the annual maintenance and licensing fee for access to the COUNTY’s
electronic information system in accordance with the fee schedule as set forth in Exhibit D. COUNTY shall
invoice CONTRACTOR annually for the Reaching Recovery fee for access to the COUNTY’s electronic
information system in accordance with the fee schedule as set forth in Exhibit D.
CONTRACTOR shall provide payment for these expenditures to COUNTY’s Fresno
County Department of Behavioral Health, Accounts Receivable, P.O. Box 712, Fresno, CA 93717-0712,
Attention: Business Office, within forty-five (45) days after the date of receipt by CONTRACTOR of the
invoicing provided by COUNTY.
H. CONTRACTOR must maintain financial records for a period of ten (10) years or
until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible for
any disallowances related to inadequate documentation.
I. CONTRACTOR is responsible for collection and managing of data in a manner to
be determined by DHCS and the COUNTY’s Mental Health Plan in accordance with applicable rules and
regulations. COUNTY’s electronic information system is a critical source of information for purposes of
monitoring service volume and obtaining reimbursement.
J. CONTRACTOR shall submit service data into COUNTY’s electronic information
system according to COUNTY’s DBH documentation standards to allow the COUNTY to bill Medi-Cal, and
any other third-party source, for services and meet State and Federal reporting requirements.
K. CONTRACTOR must comply with all laws and regulations governing the Federal
Medicare program, including, but not limited to: 1) the requirement of the Medicare Act, 42 U.S.C. section
1395 et seq; and 2) the regulations and rules promulgated by the Federal Centers for Medicare and
Medicaid Services as they relate to participation, coverage and claiming reimbursement. CONTRACTOR
will be responsible for compliance as of the effective date of each Federal, State or local law or regulation
specified.
L. If a client has dual coverage, such as other health coverage (OHC) or Federal
Medicare, the CONTRACTOR will be responsible for billing the carrier and obtaining a payment/denial or
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have validation of claiming with no response ninety (90) days after the claim was mailed before the service
can be entered into the COUNTY’s electronic information system. CONTRACTOR must report all third
party collections for Medicare, third party or client pay or private pay in each monthly invoice and in the
annual cost report that is required to be submitted. A copy of explanation of benefits or CMS 1500 form is
required as documentation. CONTRACTOR must report all revenue collected from OHC, third-party,
client-pay or private-pay in each monthly invoice and in the cost report that is required to be submitted.
CONTRACTOR shall submit monthly invoices for reimbursement that equal the amount due
CONTRACTOR less any funding sources not eligible for Federal and State reimbursement.
CONTRACTOR must comply with all laws and regulations governing the Federal Medicare program,
including, but not limited to: 1) the requirement of the Medicare Act, 42 U.S.C. section 1395 et seq; and 2)
the regulation and rules promulgated by the Federal Centers for Medicare and Medicaid Services as they
relate to participation, coverage and claiming reimbursement. CONTRACTOR will be responsible for
compliance as of the effective date of each Federal, State or local law or regulation specified.
M. Data entry shall be the responsibility of the CONTRACTOR. COUNTY shall
monitor the volume of services and cost of services entered into the COUNTY’s electronic information
system. Any and all audit exceptions resulting from the provision and reporting of specialty mental health
services by CONTRACTOR shall be the sole responsibility of the CONTRACTOR. CONTRACTOR will
comply with all applicable policies, procedures, directives and guidelines regarding the use of COUNTY’s
electronic information system.
N. Medi-Cal Certification and Mental Health Plan Compliance
CONTRACTOR shall comply with any and all requests and directives associated
with COUNTY maintaining State Medi-Cal site certification. CONTRACTOR shall provide specialty mental
health services in accordance with the COUNTY’s Mental Health Plan. CONTRACTOR must comply with
the “Fresno County Mental Health Plan Compliance Program and Code of Conduct” set forth in Exhibit E,
attached hereto and incorporated herein by reference and made part of this Agreement. CONTRACTOR
shall comply with any and all requests associated with any State/Federal reviews or audits.
CONTRACTOR may provide direct specialty mental health services using pre-
licensed staff as long as the individual is approved as a provider by the Mental Health Plan, is supervised
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by licensed staff, works within his/her scope and only delivers allowable direct specialty mental health
services. It is understood that each service is subject to audit for compliance with Federal and State
regulations, and that COUNTY may be making payments in advance of said review. In the event that a
service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set off from other
payments due the amount of said disapproved services. CONTRACTOR shall be responsible for audit
exceptions to ineligible dates of services or incorrect application of utilization review requirements.
6. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under this
Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
CONTRACTOR’s officers, agents, and employees will at all times be acting and performing as an
independent CONTRACTOR, and shall act in an independent capacity and not as an officer, agent,
servant, employee, joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have no
right to control or supervise or direct the manner or method by which CONTRACTOR shall perform its
work and function. However, COUNTY shall retain the right to administer this Agreement so as to verify
that CONTRACTOR is performing their obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject
thereof.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely
no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
solely liable and responsible for providing to, or on behalf of, its employees all legally-required employee
benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all
matters relating to payment of CONTRACTOR’s employees, including compliance with Social Security,
withholding, and all other regulations governing such matters. It is acknowledged that during the term of
this Agreement, CONTRACTOR may be providing services to others unrelated to COUNTY or to this
Agreement.
7. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent of
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all the parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to services, staffing, and responsibilities of the
CONTRACTOR, as needed, to accommodate changes in the laws relating to mental health treatment, as
set forth in Exhibit A, may be made with the signed written approval of COUNTY’s DBH Director or his or
her designee and CONTRACTOR through an amendment approved by COUNTY’s County Counsel and
the COUNTY’s Auditor-Controller’s Office.
In addition, changes to expense category (i.e., Salary & Benefits, Facilities/Equipment,
Operating, Financial Services, Special Expenses, Fixed Assets, etc.) subtotals in the budgets, and
changes to the volume of units of services/types of service units to be provided as set forth in Exhibit B,
that do not exceed 10% of the maximum compensation payable to the CONTRACTOR may be made with
the written approval of COUNTY’s DBH Director, or his or her designee. Changes to the expense
categories in the budget that exceed ten percent (10%) of the maximum compensation payable to the
CONTRACTOR, may be made with the signed written approval of COUNTY’s DBH Director, or his or her
designee through an amendment approved by COUNTY’s Counsel and COUNTY’s Auditor-Controller’s
Office. Changes to the fee scheduled identified in Exhibit C, “Electronic Health Records Software
Charges,” may be made with the written approval of COUNTY’s DBH Director, or his or her designee.
Said modifications shall not result in any change to the annual maximum compensation
amount payable to CONTRACTOR, as stated in this Agreement.
8. NON-ASSIGNMENT
No party shall assign, transfer or subcontract this Agreement nor their rights or duties under
this Agreement without the prior written consent of COUNTY.
9. HOLD-HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
defend COUNTY, its officers, agents and employees from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to COUNTY
in connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents or
employees under this Agreement, and from any and all costs and expenses, including attorney fees
and court costs, damages, liabilities, claims and losses occurring or resulting to any person, firm or
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corporation who may be injured or damaged by the performance, or failure to perform, of
CONTRACTOR, their officers, agents or employees under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal and/or State of California audit
exceptions resulting from noncompliance herein on the part of CONTRACTOR.
10. INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or any third
parties, CONTRACTOR, at its sole expense, shall maintain in full force and affect the following insurance
policies throughout the term of this Agreement:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of Five Million Dollars ($5,000,000). This policy shall be issued on a per occurrence basis. COUNTY may require specific coverage including completed operations, product liability, contractual liability, Explosion, Collapse, and Underground (XCU), fire legal liability or any other liability insurance deemed necessary because of the nature of the Agreement.
B. Automobile Liability
Insurance Services Office Form Number CA 0001 covering, Code 1 (any auto), or if Consultant has no owned autos, Code 8 (hired) and 9 (non-owned).with limits of not less than) One Million Dollars ($1,000,000) per accident for bodily injury and property damage.
C. Real and Property Insurance
CONTRACTOR shall maintain a policy of insurance for all risk personal 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 of the COUNTY purchase and owned property, at a minimum, as discussed in Section Twenty (21) of this Agreement.
All Risk Property Insurance
CONTRACTOR will provide property coverage for the full replacement value of the COUNTY’S personal property in possession of CONTRACTOR and/or used in the execution of this Agreement. COUNTY will be identified on an appropriate certificate of insurance as the certificate holder and will be named as an Additional Loss Payee on the Property Insurance Policy.
D. Professional Liability
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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. E. Child Abuse/Molestation and Social Services Coverage
CONTRACTOR shall have either separate policies or an umbrella policy with endorsements covering Child Abuse/Molestation and Social Services Liability coverage or have a specific endorsement on their General Commercial liability policy covering Child Abuse/Molestation and Social Services Liability. The policy limits for these policies shall be One Million Dollars ($1,000,000) per occurrence with a Two Million Dollars ($2,000,000) annual aggregate. The policies are to be on a per occurrence basis.
F. Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the California Labor Code. G. Cyber Liability Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to duties and obligations undertaken by CONTRACTOR in this agreement and shall include, but not be limited to, claims involving infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of electronic information, release of private information, alteration of electronic information, extortion and network security. The policy shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations. H. Waiver of Subrogation CONTRACTOR hereby grants to COUNTY a waiver of any right to subrogation which any insurer of said CONTRACTOR may acquire against the COUNTY by virtue of the payment of any loss under insurance. CONTRACTOR agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the COUNTY has received a waiver of subrogation endorsement from the insurer. CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are concerned. Such coverage
for additional insured shall apply as primary insurance and any other insurance, or self-insurance,
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maintained by COUNTY, its officers, agents and employees shall be excess only and not contributing with
insurance provided under CONTRACTOR’s policies herein. This insurance shall not be cancelled or
changed without a minimum of thirty (30) days advance written notice given to COUNTY.
Within thirty (30) days from the date CONTRACTOR signs this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 3133 N.
Millbrook Ave, Fresno, California, 93703, Attention: Contracts Division, stating that such insurance
coverages have been obtained and are in full force; that the County of Fresno, its officers, agents and
employees will not be responsible for any premiums on the policies; that such Commercial General
Liability insurance names the County of Fresno, its officers, agents and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are concerned;
that such coverage for additional insured shall apply as primary insurance and any other insurance, or self-
insurance, maintained by COUNTY, its officers, agents and employees, shall be excess only and not
contributing with insurance provided under CONTRACTOR’s policies herein; and that this insurance shall
not be cancelled or changed without a minimum of thirty (30) days advance, written notice given to
COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this Agreement
upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of California.
Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of A FSC VII or
better.
11. LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR’s staff shall
maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for the
provision of the services hereunder and required by the laws and regulations of the United States of
America, State of California, the County of Fresno, and any other applicable governmental agencies.
CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
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licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR’s staff shall comply with all
applicable laws, rules or regulations, as may now exist or be hereafter changed.
12. RECORDS
CONTRACTOR shall maintain records in accordance with Exhibit F, "Documentation
Standards for Client Records", attached hereto and by this reference incorporated herein and made part of
this Agreement. COUNTY shall be allowed to review all records of services provided, including the goals
and objectives of the treatment plan, and how the therapy provided is achieving the goals and objectives.
13. REPORTS
1. Outcome Reports
CONTRACTOR shall submit to COUNTY’s DBH service outcome reports as
reasonably requested by COUNTY’s DBH. Outcome reports and outcome requirements are subject to
change at COUNTY’s DBH discretion.
2. Additional Reports
CONTRACTOR shall also furnish to COUNTY such statements, records, reports,
data, and other information as COUNTY’s DBH may reasonably request pertaining to matters covered by
this Agreement. In the event that CONTRACTOR fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments until
there is compliance. In addition, CONTRACTOR shall provide written notification and explanation to
COUNTY within five (5) days of any funds received from another source to conduct the same services
covered by this Agreement.
3. Cost Report
CONTRACTOR shall provide financial data to identify all direct and indirect costs
incurred by the CONTRACTOR for all services delivered under this Agreement. All Cost Reports must be
prepared in accordance with Generally Accepted Accounting Principles (GAAP) and Welfare and
Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3) and 5718(c). Unallowable costs such as lobbying or
political donations must be deducted on the cost report and monthly invoice reimbursements.
4. Settlements with State Department of Health Care Services (DHCS)
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During the term of this Agreement and thereafter, COUNTY and CONTRACTOR
agree to settle dollar amounts disallowed or settled in accordance with DHCS audit settlement findings
related to the reimbursement provided under this Agreement. CONTRACTOR will participate in the several
phases of settlements between COUNTY/CONTRACTOR and DHCS. The phases of initial cost reporting
for settlement according to State reconciliation of records for paid Medi-Cal services and audit settlement
are: State DHCS audit 1) initial cost reporting - after an internal review by COUNTY, the COUNTY files the
cost report with State DHCS on behalf of the CONTRACTOR’s legal entity for the fiscal year; 2) Settlement
–State reconciliation of records for paid Medi-Cal services, approximately 18 to 36 months following the
State close of the fiscal year, DHCS will send notice for any settlement under this provision to the
COUNTY; 3) Audit Settlement-State DHCS audit. After final reconciliation and settlement DHCS may
conduct a review of medical records, cost report along with support documents submitted to COUNTY in
initial submission to determine accuracy and may disallow costs and/or units of services. COUNTY may
choose to appeal and therefore reserves the right to defer payback settlement with CONTRACTOR until
resolution of the appeal. DHCS Audits will follow Federal Medicaid procedures for managing
overpayments. If at the end of the Audit Settlement, the COUNTY determines that it overpaid the
CONTRACTOR, it will require the CONTRACTOR to repay the Medi-Cal related overpayment back to the
COUNTY.
Funds owed to COUNTY will be due within forty-five (45) days of notification by the
COUNTY, or COUNTY shall withhold future payments until all excess funds have been recouped by
means of an offset against any payments then or thereafter owing to COUNTY under this or any other
Agreement between the COUNTY and CONTRACTOR.
14. MONITORING
CONTRACTOR agrees to extend to COUNTY’s staff, COUNTY’s DBH Director and the
State Department of Health Care Services, or their designees, the right to review and monitor records,
services or procedures, at any time, in regard to clients, as well as the overall operation of
CONTRACTOR’s performance, in order to ensure compliance with the terms and conditions of this
Agreement.
15. REFERENCES TO LAWS AND RULES
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In the event any law, regulation, or policy referred to in this Agreement is amended during
the term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
such amendment.
16. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates its mental health programs under an
agreement with the State of California Department Health Care Services, and that under said agreement
the State imposes certain requirements on COUNTY and its subcontractors. CONTRACTOR shall adhere
to all State requirements, including those identified in Exhibit G “State Mental Health Requirements”,
attached hereto and by this reference incorporated herein and made part of this Agreement.
CONTRACTOR shall also file an incident report for all incidents involving clients, following the Protocol and
using the W orksheet identified in Exhibit H, attached hereto and by this reference incorporated herein and
made part of this Agreement or a protocol and worksheet presented by CONTRACTOR that is accepted
by COUNTY’s DBH Director or his or her designee.
17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall inform every client of their rights under the COUNTY's Mental Health
Plan as described in Exhibit I, attached hereto and by this reference incorporated herein and made part of
this Agreement.
18. CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating to
confidentiality.
19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-
191 (HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is only for treatment,
payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of
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PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for
Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated thereunder
by the U.S. Department of Health and Human Services (HIPAA Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI, as
set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504€ of the Code of
Federal Regulations.
20. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into
a contractual relationship with the COUNTY for the purpose of providing services under this Agreement
must employ adequate data security measures to protect the confidential information provided to
CONTRACTOR by the COUNTY, including but not limited to the following:
A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR has received authorization by COUNTY for telecommuting
purposes;
2) Current virus protection software is in place;
3) Mobile device has the remote wipe feature enabled; and
4) A secure connection is used.
B. CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief Information
Officer, and/or his or her designee(s), including but not limited to mobile storage devices. If data is
approved to be transferred, data must be stored on a secure server approved by the COUNTY and
transferred by means of a Virtual Private Network (VPN) connection, or another type of secure connection.
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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.
21. PROPERTY OF COUNTY
A. COUNTY and CONTRACTOR recognize that fixed assets are tangible and
intangible property obtained or controlled under COUNTY’s Mental Health Plan for use in operational
capacity and will benefit COUNTY for a period more than one year. Depreciation of the qualified items will
be on a straight-line basis.
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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
• and capital lease $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
will be maintained by COUNTY’s Asset Management System and annual inventoried until the asset is fully
depreciated. During the terms of this Agreement, CONTRACTOR’s fixed assets may be inventoried in
comparison to COUNTY’s DBH Asset Inventory System.
B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
more than $1,000, with over one year life span, and are mobile and high risk of theft or loss are sensitive
assets. Such sensitive items are not limited to computers, copiers, televisions, cameras and other sensitive
items as determined by COUNTY’s DBH Director or his or her designee. CONTRACTOR maintains a
tracking system on the items and are not required to be capitalize or depreciated. The items are subject to
annual inventory for compliance.
C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in an
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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 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
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Agreement expires, or terminates, the requirements for this Section shall remain in effect for activities or
property funded with said funds, unless action is taken by the State government to relieve COUNTY of
these obligations
22. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of race,
religion, color, national origin, ancestry, physical handicap, medical condition, marital status, age or
gender, pursuant to all applicable State and Federal statutes and regulations.
23. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. section 2000d, and 45 C.F.R. Part
80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance from
discriminating against persons based on race, color, national origin, sex, disability or religion. This is
interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access and
participation in federally funded programs through the provision of comprehensive and quality bilingual
services.
B. Policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP clients, including, but not limited to, assessing the
cultural and linguistic needs of its clients, training of staff on the policies and procedures, and monitoring its
language assistance program. The CONTRACTOR’s procedures must include ensuring compliance of any
sub-contracted providers with these requirements.
C. CONTRACTOR shall not use minors as interpreters.
D. CONTRACTOR shall provide and pay for interpreting and translation services to
persons participating in CONTRACTOR’s services who have limited or no English language proficiency,
including services to persons who are deaf or blind. Interpreter and translation services shall be provided
as necessary to allow such participants meaningful access to the programs, services and benefits provided
by CONTRACTOR. Interpreter and translation services, including translation of CONTRACTOR’s “vital
documents” (those documents that contain information that is critical for accessing CONTRACTOR’s
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services or are required by law) shall be provided to participants at no cost to the participant.
CONTRACTOR shall ensure that any employees, agents, subcontractors, or partners who interpret or
translate for a program participant, or who directly communicate with a program participant in a language
other than English, demonstrate proficiency in the participant's language and can effectively communicate
any specialized terms and concepts peculiar to CONTRACTOR’s services.
E. In compliance with the State mandated Culturally and Linguistically Appropriate
standards as published by the Office of Minority Health, CONTRACTOR must submit to COUNTY for
approval, within sixty (60) days from date of contract execution, CONTRACTOR’s plan to address all
fifteen (15) national cultural competency standards as set forth in the “National Standards on Culturally and
Linguistically Appropriate Services (CLAS)”. COUNTY’s annual on-site review of CONTRACTOR shall
include collection of documentation to ensure all national standards are implemented. As the national
competency standards are updated, CONTRACTOR’s plan must be updated accordingly. Cultural
competency training for CONTRACTOR’s staff should be substantively integrated into health professions
education and training at all levels, both academic and functional, including core curriculum, professional
licensure, and continuing professional development programs. CONTRACTOR on a monthly basis shall
provide COUNTY DBH a monthly monitoring tool/report that shows all CONTRACTOR’s staff cultural
competency trainings completed.
24. AMERICANS WITH DISABILITIES ACT
CONTRACTOR agrees to ensure that deliverables developed and produced, pursuant to
this Agreement shall comply with the accessibility requirements of Section 508 of the Rehabilitation Act
and the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)), and regulations
implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal Regulations. In 1998,
Congress amended the Rehabilitation Act of 1973 to require Federal agencies to make their electronic and
information technology (EIT) accessible to people with disabilities. California Government Code section
11135 codifies section 508 of the Act requiring accessibility of electronic and information technology.
25. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section
1861(v)(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four (4)
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years after the furnishing of services under this Agreement, CONTRACTOR shall make available, upon
written request to the Secretary of the United States Department of Health and Human Services, or upon
request to the Comptroller General of the United States General Accounting Office, or any of their duly
authorized representatives, a copy of this Agreement and such books, documents, and records as are
necessary to certify the nature and extent of the costs of these services provided by CONTRACTOR under
this Agreement. CONTRACTOR further agrees that in the event CONTRACTOR carries out any of its
duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and No/100
Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such Agreement
shall contain a clause to the effect that until the expiration of four (4) years after the furnishing of such
services pursuant to such subcontract, the related organizations shall make available, upon written request
to the Secretary of the United States Department of Health and Human Services, or upon request to the
Comptroller General of the United States General Accounting Office, or any of their duly authorized
representatives, a copy of such subcontract and such books, documents, and records of such organization
as are necessary to verify the nature and extent of such costs.
26. SINGLE AUDIT CLAUSE
A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00)
or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual audit in
accordance with the requirements of the Single Audit Standards as set forth in Office of Management and
Budget (OMB) Circular A-133. CONTRACTOR shall submit said audit and management letter to
COUNTY. The audit must include a statement of findings or a statement that there were no findings. If
there were negative findings, CONTRACTOR must include a corrective action plan signed by an
authorized individual. CONTRACTOR agrees to take action to correct any material non-compliance or
weakness found as a result of such audit. Such audit shall be delivered to COUNTY’s DBH Business
Office, for review within nine (9) months of the end of any fiscal year in which funds were expended and/or
received for the program. Failure to perform the requisite audit functions as required by this Agreement
may result in COUNTY performing the necessary audit tasks, or at COUNTY’s option, contracting with a
public accountant to perform said audit, or, may result in the inability of COUNTY to enter into future
agreements with CONTRACTOR. All audit costs related to this Agreement are the sole responsibility of
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CONTRACTOR.
B. A single audit report is not applicable if CONTRACTOR’s Federal contracts do not
exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR’s only
funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must be
performed and a program audit report with management letter shall be submitted by CONTRACTOR to
COUNTY as a minimum requirement to attest to CONTRACTOR’s solvency. Said audit report shall be
delivered to COUNTY’s DBH Business Office, for review no later than nine (9) months after the close of
the fiscal year in which the funds supplied through this Agreement are expended. Failure to comply with
this Act may result in COUNTY performing the necessary audit tasks or contracting with a qualified
accountant to perform said audit. All audit costs related to this Agreement are the sole responsibility of
CONTRACTOR who agrees to take corrective action to eliminate any material noncompliance or
weakness found as a result of such audit. Audit work performed by COUNTY under this paragraph shall
be billed to the CONTRACTOR at COUNTY cost, as determined by COUNTY’s Auditor-
Controller/Treasurer-Tax Collector.
C. CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other pending
matters, whichever is later.
27. COMPLIANCE
CONTRACTOR agrees to comply with the COUNTY’s Contractor Code of Conduct and
Ethics and the COUNTY’s Compliance Program in accordance with Exhibit E, attached hereto and
incorporated herein by reference and made part of this Agreement. Within thirty (30) days of entering into
this Agreement with the COUNTY, CONTRACTOR shall have all of CONTRACTOR’s employees, agents
and subcontractors providing services under this Agreement certify in writing, that he or she has received,
read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR shall
ensure that within thirty (30) days of hire, all new employees, agents and subcontractors providing services
under this Agreement shall certify in writing that he or she has received, read, understood, and shall abide
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by the Contractor Code of Conduct and Ethics. CONTRACTOR understands that the promotion of and
adherence to the Code of Conduct is an element in evaluating the performance of CONTRACTOR and its
employees, agents and subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agents and subcontractors providing services under this Agreement shall complete general
compliance training and appropriate employees, agents and subcontractors shall complete documentation
and billing or billing/reimbursement training. All new employees, agents and subcontractors shall attend
the appropriate training within 30 days of hire. Each individual who is required to attend training shall
certify in writing that he or she has received the required training. The certification shall specify the type of
training received and the date received. The certification shall be provided to the COUNTY’s Compliance
Officer at 3133 N. Millbrook, Fresno, California 93703. CONTRACTOR agrees to reimburse COUNTY for
the entire cost of any penalty imposed upon COUNTY by the Federal Government as a result of
CONTRACTOR’s violation of the terms of this Agreement.
28. ASSURANCES
In entering into this Agreement, CONTRACTOR certifies that neither it, nor any of its
officers, are currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
Health Care Programs; that neither it, nor any of its officers, have been convicted of a criminal offense
related to the provision of health care items or services; nor has it, or any of its officers, been reinstated to
participate in the Federal Health Care Programs after a period of exclusion, suspension, debarment, or
ineligibility. If COUNTY learns, subsequent to entering into a contract, that CONTRACTOR is ineligible on
these grounds, COUNTY will remove CONTRACTOR from responsibility for, or involvement with,
COUNTY’s business operations related to the Federal Health Care Programs and shall remove such
CONTRACTOR from any position in which CONTRACTOR’s compensation, or the items or services
rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, directly or indirectly, by
Federal Health Care Programs or otherwise with Federal Funds at least until such time as CONTRACTOR
is reinstated into participation in the Federal Health Care Programs.
A. If COUNTY has notice that either CONTRACTOR, or its officers, has been charged
with a criminal offense related to any Federal Health Care Program, or is proposed for exclusion during the
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term of any contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the
accuracy of any claims submitted to any Federal Health Care Program. At its discretion given such
circumstances, COUNTY may request that CONTRACTOR cease providing services until resolution of the
charges or the proposed exclusion.
B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional services under
this Agreement, will be queried as to whether (1) they are now or ever have been excluded, suspended,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) they have been
convicted of a criminal offense related to the provision of health care items or services; and or (3) they
have been reinstated to participate in the Federal Health Care Programs after a period of exclusion,
suspension, debarment, or ineligibility.
1. In the event the potential employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR hires
or engages such potential employee or subcontractor, CONTRACTOR will ensure that said employee or
subcontractor does no work, either directly or indirectly relating to services provided to COUNTY.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
to protect the interests of COUNTY consumers.
C. CONTRACTOR shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are expected to
perform professional services under this Agreement (1) are not currently excluded, suspended, debarred,
or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted of a
criminal offense related to the provision of health care items or services; and (3) have not been reinstated
to participate in the Federal Health Care Program after a period of exclusion, suspension, debarment, or
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ineligibility. In the event any existing employee or subcontractor informs CONTRACTOR that he or she is
excluded, suspended, debarred or otherwise ineligible to participate in the Federal Health Care Programs,
or has been convicted of a criminal offense relating to the provision of health care services,
CONTRACTOR will ensure that said employee or subcontractor does no work, either direct or indirect,
relating to services provided to COUNTY.
1. CONTRACTOR agrees to notify COUNTY immediately during the term of
this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case, is
providing professional services under this Agreement is excluded, suspended, debarred or otherwise
ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating
to the provision of health care services.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section 3 of this Agreement, or require adequate assurance (as defined by
COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
to protect the interests of COUNTY consumers.
D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY which may be necessary to complete any internal or external audits relating to
CONTRACTOR’s compliance with the provisions of this Section.
E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of
CONTRACTOR’s obligations as described in this Section.
29. PUBLICITY PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under this
Agreement shall be used for CONTRACTOR’s advertising, fundraising, or publicity (i.e., purchasing of
tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the above,
publicity of the services described in Section One (1) of this Agreement shall be allowed as necessary to
raise public awareness about the availability of such specific services when approved in advance by
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COUNTY’s DBH Director or his or her designee and at a cost to be provided in Exhibit B for such items as
written/printed materials, the use of media (i.e., radio, television, newspapers) and any other related
expense(s).
30. COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a client or a
client's family. CONTRACTOR shall provide a copy of the detailed complaint log entries concerning
COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (l 0th) day of the following month,
in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide details and attach
documentation of each complaint with the log. CONTRACTOR shall post signs informing clients of their
right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all incidents reportable to
State licensing bodies that affect COUNTY clients within twenty-four (24) hours of receipt of a complaint.
Within ten (10) days after each incident or complaint affecting COUNTY clients,
CONTRACTOR shall provide COUNTY with information relevant to the complaint, investigative details of
the complaint, the complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the
complaint. In addition, CONTRACTOR shall inform every client of their rights as set forth in Exhibit I.
CONTRACTOR shall file an incident report for all incidents involving clients, following the protocol and
using the worksheet identified in Exhibit H and incorporated herein by reference and made part of this
Agreement.
31. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104, and
455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit J, “Disclosure of
Ownership and Control Interest Statement”, attached hereto and by this reference incorporated herein and
made part of this Agreement. CONTRACTOR shall submit this form to the COUNTY’s DBH within thirty
(30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall report any changes to
this information within thirty-five (35) days of occurrence by completing Exhibit J, “Disclosure of Ownership
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and Control Interest Statement.” Submissions shall be scanned pdf copies and are to be sent via email to
DBHAdministration@co.fresno.ca.us attention: Contracts Administration.
32. DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR is required to disclose if any of the following conditions apply to them, their
owners, officers, corporate managers and partners (hereinafter collectively referred to as
“CONTRACTOR”):
A. Within the three-year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1. Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction;
2. Violation of a federal or state antitrust statute;
3. Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
or
4. False statements or receipt of stolen property.
B. Within a three-year period preceding their Agreement award, they have had a
public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate CONTRACTOR from
further business consideration. The information will be considered as part of the determination of whether
to continue and/or renew this Agreement and any additional information or explanation that a
CONTRACTOR elects to submit with the disclosed information will be considered. If it is later determined
that the CONTRACTOR failed to disclose required information, any contract awarded to such
CONTRACTOR may be immediately voided and terminated for material failure to comply with the terms
and conditions of the award.
CONTRACTOR must sign a “Certification Regarding Debarment, Suspension, and Other
Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit K, attached hereto
and by this reference incorporated herein and made part of this Agreement. Additionally, CONTRACTOR
must immediately advise the COUNTY’s DBH in writing if, during the term of this Agreement: (1)
CONTRACTOR becomes suspended, debarred, excluded or ineligible for participation in federal or state
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funded programs or from receiving federal funds as listed in the excluded parties’ list system
(http://www.epls.gov); or (2) any of the above listed conditions become applicable to CONTRACTOR.
CONTRACTOR shall indemnify, defend and hold the COUNTY harmless for any loss or damage resulting
from a conviction, debarment, exclusion, ineligibility or other matter listed in the signed Certification
Regarding Debarment, Suspension, and Other Responsibility Matters.
33. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a for-
profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR changes its
status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services under
this Agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR is a party
and in which one or more of its directors has a material financial interest. Members of the Board of
Directors shall disclose any self-dealing transactions that they are a party to by completing and signing a
Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit L and incorporated herein by
reference and made part of this Agreement, and submitting it to the COUNTY prior to commencing with
the self-dealing transaction or immediately thereafter.
34. AUDITS AND INSPECTIONS
The CONTRACTOR shall at any time during business hours, and as often as the COUNTY
may deem necessary, make available to the COUNTY for examination all of its records and data with
respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request by the
COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to ensure
CONTRACTOR’s compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR shall be subject to the examination and audit of the State Auditor General for a period of
three (3) years after final payment under contract (California Government Code section 8546.7).
35. NOTICES
The persons having authority to give and receive notices under this Agreement and their
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addresses include the following:
COUNTY CONTRACTOR Director, Fresno County Chief Executive Officer Department of Behavioral Health Turning Point of Central California 3133 N. Millbrook Ave P.O. Box 7447 Fresno, CA 93702 Visalia, CA 93290-7447 All notices between the COUNTY and CONTRACTOR provided for or permitted under this
Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
personal service is effective upon service to the recipient. A notice delivered by first-class United States
mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid,
addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
COUNTY business day after deposit with the overnight commercial courier service, delivery fees prepaid,
with delivery instructions given for next day delivery, addressed to the recipient. A notice delivered by
telephonic facsimile is effective when transmission to the recipient is completed (but, if such transmission
is completed outside of COUNTY business hours, then such delivery shall be deemed to be effective at
the next beginning of a COUNTY business day), provided that the sender maintains a machine record of
the completed transmission. For all claims arising out of or related to this Agreement, nothing in this
section establishes, waives, or modifies any claims presentation requirements or procedures provided by
law, including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government
Code, beginning with section 810).
36. GOVERNING LAW
Venue for any action arising out of or related to the Agreement shall only be in Fresno
County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
37. ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire agreement between
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
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agreement 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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5 TURNING POINT OF CENTRAL
CALIFORNIA, INC.
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COUNTY OF FRESNO
ATTEST:
Bernice E . Seidel
Clerk of the Board of Supervisors
County of Fresno , State of California
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By: .SU.SU'vv\ ~s)yo·i)
Deputy
FOR ACCOUNTING USE ONLY :
Org No .:
22 Account No.:
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56304528 (ICM/OP: $52,694,620)
56304529 (FSP: $10,708 ,965)
7295
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Exhibit A
Page 1 of 8
0302adbh
Mental Health Services Act (MHSA)
Rural Mental Health Services Program
Scope of Work
ORGANIZATION: Turning Point of Central California, Inc.
CORPORATE ADDRESS: P.O. Box 7447, Visalia Ca 93290
SERVICE ADDRESSES: Pinedale: 34 & 40 East Minarets, Pinedale, CA 93650
Reedley: 1131 I Street, Reedley, CA 93654
Sanger: 225 Academy, Sanger, CA 93657
Selma: 3800 & 3810 McCall Avenue, Selma, CA 93662
Kerman: 275 S. Madera Street, Suite 404, Kerman, CA 93630
Coalinga: 311 Coalinga Plaza, Coalinga, CA 93210
PROGRAM DIRECTOR: David Tan; (559) 476-2176
CONTRACT PERIOD: July 1, 2018 – June 30, 2021, with an option for two (2) twelve (12) month renewal
terms
BACKGROUND:
The Rural Mental Health Services program includes three distinct levels of care - Full Service Partnership (FSP),
Intensive Case Management (ICM), and Outpatient (OP) services. These programs are designed to serve clients
within Fresno County rural areas that have a severe mental illness (schizophrenia, major depression with psychotic
features or bi-polar disorder) and are in need of on-going community based services. The CONTRACTOR’S rural
mental health services program will provide the services described below.
TARGET POPULATION:
The Full Service Partnership (FSP) program will serve an estimated 84 un-duplicated clients at any given point
and time, and 176 un-duplicated clients on an annual basis.
FSP services will be provided with a focus on recovery, resiliency and wellness. The target population includes
adults and children that live in rural Fresno County and have been assessed and determined to be in need of Full
Service Partnership (FSP) level of mental health services. This population includes adults with severe mental
illness (schizophrenia, major depression with psychotic features or bi-polar disorders), children with serious
emotional disturbance, and those adults and/or children who have had recent admissions to the county’s crisis
intervention services (CIS), acute inpatient or have been incarcerated.
The ICM and OP programs combined will serve approximately 3,200 clients on an annual basis.
The Outpatient population includes those who are Medi-Cal eligible and meet the State Department of Mental
Health’s medical necessity criteria. CONTRACTOR will provide office based outpatient mental services to include
individual, group and family therapy and medication support services. The outpatient mental health services will be
accessed through the County’s managed care program and will require prior authorization for services. The vendor
staff will provide short-term psychotherapy and medication support services. For individuals who need medications
only and do not require mental health specialty services, the vendor will work with United Health Center or other like
agencies to develop a collaborative agreement for the provision of primary care services.
The Intensive Case Management population includes adults with severe mental illness (schizophrenia, major
depression with psychotic features or bi-polar disorders) and children with serious emotional disturbance who are in
Exhibit A
Page 2 of 8
0302adbh
need of on-going community based services.
For those clients who have been assessed and determined in need of Rural Mental Health services, services
will be provided at six established rural service sites including: Reedley, Pinedale, Sanger, Selma, Kerman, and
Coalinga. In addition, those rural clients that do not reside in one of the rural service cities identified will be
sought for delivery of services and/or for transportation to services at one of the established rural sites.
LOCATION OF SERVICES:
CONTRACTOR shall provide FSP, ICM, and OP services at the following established sites: Coalinga, Kerman,
Pinedale, Reedley, Selma, and Sanger.
Additionally, CONTRACTOR has identified two locations to develop additional program sites; in Mendota and
Huron. CONTRACTOR has identified these two locations as a way to provide easier access to services,
further increase penetration rates in rural areas, and reducing wait times in nearby communities such as
Coalinga and Kerman.
DESCRIPTION OF SERVICES:
Full Service Partnership
CONTRACTOR shall provide case management and crisis outreach services will be available 24 hours a day/7
days a week both telephonically and in person. There shall be a minimum of providing 3 person to person
contacts a week with each client. Services include, but may not be limited to: case management, crisis services,
medication support, collateral, plan development, assessment, and rehabilitation services as needed.
CONTRACTOR shall provide the following specific Full Service Partnership services as it relates to mental health:
1. Provide the following:
• Staffing ratio of not more than 1 staff to 15 clients.
• Assist clients in accessing all entitlements or benefits for which they are eligible (i.e. Medi-Cal,
SSI, Section 8 vouchers etc.).
• Develop family support and involvement whenever possible
• Develop and maintenance access to supported education and employment opportunities.
• Develop and maintain a “representative payee” service to those clients who could benefit from this
service.
• Develop and provide transportation to enable clients to access health care, mental health services
and education, recreational or peer support services in the community.
2. Provide Medication Evaluation either in person or via tele-psychiatry.
3. Provide Peer Support services.
4. Provide Supported Independent Permanent Housing (including locating residences and assisting
clients to successfully live in the community).
5. Provide services for Co-Occurring substance abuse disorders.
• Identify alcohol, tobacco and drug abuse effects and patterns.
Exhibit A
Page 3 of 8
0302adbh
• Education regarding the interaction of alcohol, tobacco and drug use with psychiatric symptoms
and medications.
• Developing motivation for deceasing alcohol, tobacco and drug use.
• Achieving periods of abstinence and stability.
• Use of clinical interventions and peer support recovery groups and activities.
• Assisting clients to achieve an alcohol, tobacco and drug free life style.
• Education regarding relapse prevention.
6. Develop client self-directed plan of care/wellness and recovery plan.
7. Provide Education and training in independent living skills to include.
• Carry out personal hygiene tasks.
• Perform household chores, including cooking, laundry and shopping.
• Development of money management skills.
• Use of community transportation.
8. Transport clients to and from rural service sites as needed.
9. Collaborate with local communities to provide additional services at their locations, as well as
establishing new rural sites as circumstances and needs warrant.
10. Outreach to rural clients who are un-served and/or underserved to improve rural penetration rates,
with an emphasis on the penetration rates of rural Hispanics. Penetration rates should improve by a
minimum of 20% in the first term, and by at least 10% per subsequent term.
Intensive Case Management
CONTRACTOR shall provide case management and community-based crisis intervention services and shall be
available 8 hours a day/ 5 days a week. There shall be a minimum of 1 person to person contact a week with
clients. Services include, but may not be limited to: case management, crisis services, medication support,
collateral, plan development, assessment, and rehabilitation services as needed.
CONTRACTOR shall provide the following specific Intensive Case Management services as it relates to mental
health:
1. Provide the following:
• Assist clients with accessing all entitlements or benefits for which they are eligible (i.e. Medi-Cal,
SSI, Section 8 vouchers etc.).
• Develop family support and involvement whenever possible.
• Refer clients to supported education and employment opportunities.
• Provide transportation service when it is critical to initially access a support service or gain
entitlements or benefits.
• Provide and services to enable clients to access peer support activities.
Exhibit A
Page 4 of 8
0302adbh
2. Provide Medication Evaluation either in person or via tele-psychiatry.
3. Assist clients to locate appropriate housing in the community.
4. Refer or provide peer support activities.
5. Provide services for Co-Occurring substance abuse disorders.
• Identify alcohol, tobacco and drug abuse effects and patterns.
• Education regarding the interaction of alcohol, tobacco and drug use with psychiatric symptoms
and medications.
• Developing motivation for deceasing alcohol, tobacco and drug use.
• Achieving periods of abstinence and stability.
• Use of clinical interventions and peer support recovery groups and activities.
• Assisting clients to achieve an alcohol, tobacco and drug free life style.
• Education regarding relapse prevention.
6. Develop client self-directed plan of care.
7. Transport clients to and from rural service sites as needed.
8. Collaborate with local communities to provide additional services at their locations, as well as
establishing new rural sites as circumstances and needs warrant.
9. Outreach to rural clients who are un-served and/or underserved to improve rural penetration rates,
with an emphasis on the penetration rates of rural Hispanics. Penetration rates should improve by a
minimum of 20% in the first term, and by at least 10% per subsequent term.
Outpatient
CONTRACTOR shall provide mental health outpatient services (individual, group and family therapy, and
medication support) to adult clients. Services include, but may not be limited to: case management, crisis services,
medication support, collateral, plan development, assessment, and rehabilitation services as needed.
CONTRACTOR shall provide the following specific Full Service Partnership services as it relates to mental health:
1. Ensure CONTRACTOR staff provides appropriate age, culture, gender and language services and
accommodations for physical disability(ies) to clients.
2. Make appropriate referrals and linkages to addiction services that are beyond that of the Rural
Outpatient Mental Health services program to individuals with coexisting alcohol, tobacco and drug
abuse and other addictive symptoms.
3. Provide support to the client’s family and other members of the client’s social network to help them
manage the symptoms and illness of the client and reduce the level of family and social stress
associated with the illness.
4. Coordinate services with other community mental health and non-mental health providers, as well as
other medical professionals. Methods for service coordination and communication between vendor
and other service providers serving the same clients shall be developed and implemented consistent
with Fresno County confidentiality rules.
Exhibit A
Page 5 of 8
0302adbh
5. Selected Vendor shall maintain an up to date caseload record of all clients enrolled in services, and
provide client, programmatic, and other demographic information to the County. Reports are to be
submitted to the DBH Mental Health Services Act Division Manager or MHSA Staff Analyst on a
monthly basis.
6. Selected bidder(s) shall compile quarterly reports indicating the total number of clients served in a
particular Fiscal Year.
7. Ensure billable Mental Health Specialty Services meet any/all County, State, Federal regulations
including any utilization review and quality assurance standards. Provide all pertinent and
appropriate information in a timely manner to County to bill Medi-Cal for services rendered.
8. Transport clients to and from rural service sites as needed.
9. Collaborate with local communities to provide additional services at their locations, as well as
establishing new rural sites as circumstances and needs warrant.
10. Outreach to rural clients who are un-served and/or underserved to improve rural penetration rates,
with an emphasis on the penetration rates of rural Hispanics. Penetration rates should improve by a
minimum of 20% in the first term, and by at least 10% per subsequent term.
STAFFING:
CONTRACTOR’s staff shall be trained in the purpose, mission, philosophy, and method of the FSP Program during
their new hire orientation and annually throughout the course of their employment. Ongoing training shall include
topics such as clinical, administrative, operational, human resource, cultural, and information technology areas.
Additionally, cultural competency, motivational interviewing, W RAP skills, Criminogenic Risk Factors, and
specialized clinical training shall also be utilized.
Specific FSP service delivery training shall include:
• Trauma Informed and Trauma Responsive Methods and Processes
• Cultural Awareness and Responsiveness
• Strength Based, Person Driven Plan Development and Natural Support Inclusion
• Health and Wellness Promotion, Illness and Harm Prevention, and Stigma Reduction
HOURS OF OPERATION:
CONTRACTOR shall provide direct service appointments at all rural locations within the following schedule:
Monday - Friday: 8:00AM – 5:00PM
Additionally, CONTRACTOR shall provide operational and clinical services in the field as needed, and temporarily
extend office hours in order to accommodate and increase timeliness of services. CONTRACTOR staff shall be
available to provide crisis services to clients 24 hours per day, seven (7) days per week. CONTRACTOR shall
respond within 1 hour of initial inquiry from clients.
AVERAGE CLIENT LEGNTH OF STAY:
The average length of stay for clients is 2.5 years for the FSP Program, 0.5 years for the ICM Program, and 2
years for the OP Program.
Exhibit A
Page 6 of 8
0302adbh
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Provide oversight (through the County Department of Behavioral Health (DBH), Adult System of Care, and
the Mental Health Services Act, Division Managers or designees) of the CONTRACTOR’S Rural FSP
program. In addition to contract monitoring of program, oversight includes, but not limited to, coordination
with the State Department of Mental Health, Mental Health Services Act in regard to program administration
and outcomes.
2. Assist the CONTRACTOR in making linkages with the total mental health system. This will be accomplished
through regularly scheduled meetings as well as formal and informal consultation,
3. Participate in evaluating the progress of the overall program and the efficiency of collaboration with the
vendor staff and will be available to the contractor for ongoing consultation.
4. Receive and analyze statistical data outcome information from vendor throughout the term of contract on a
monthly basis. DBH will notify the vendor when additional participation is required. The performance
outcome measurement process will not be limited to survey instruments but will also include, as appropriate,
client and staff interviews, chart reviews, and other methods of obtaining required information.
5. Recognize that cultural competence is a goal toward which professionals, agencies, and systems should
strive. Becoming culturally competent is a developmental process and incorporates at all levels the
importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that result
from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet
culturally-unique needs. Offering those services in a manner that fails to achieve its intended result due to
cultural and linguistic barriers is not cost effective. To assist the vendor efforts towards cultural and
linguistic competency, DBH shall provide the following at no cost to vendor(s):
A. Technical assistance to vendor regarding cultural competency requirements and sexual orientation
training.
B. Mandatory cultural competency training including sexual orientation and sensitivity training for DBH and
vendor personnel, at minimum once per year. County will provide mandatory training regarding the
special needs of this diverse population and will be included in the cultural competence training(s).
Sexual orientation and sensitivity to gender differences is a basic cultural competence principle and
shall be included in the cultural competency training. Literature suggests that the mental health needs
of lesbian, gay, bisexual, transgender (LGBT) individuals may be at increased risk for mental disorders
and mental health problems due to exposure to societal stressors such as stigmatization, prejudice and
anti-gay violence. Social support may be critical for this population. Access to care may be limited due
to concerns about providers’ sensitivity to differences in sexual orientation.
C. Technical assistance for vendor in translating behavioral health and substance abuse services
information into DBH’s threshold languages (Spanish, Laotian, Cambodian and Hmong). Translation
services and costs associated will be the responsibility of the vendor.
PROGRAM OBJECTIVES AND OUTCOMES
CONTRACTOR shall utilize a computerized tracking system with which performance and outcome measures and
other relevant client data, such as demographics, will be maintained. The data tracking system may be
incorporated into CONTRACTOR’S electronic health records (EHR) system or be a stand-alone database. DBH
must be afforded read only access to the data tracking system.
The following items listed below represent program goals to be tracked and achieved by the vendor during the
contract terms.
Exhibit A
Page 7 of 8
0302adbh
Full Service Partnership
1. Effectiveness
a. Psychiatric Hospitalizations – To assess the degree of effectiveness for FSP level
services, CONTRACTOR will track decreases in the number of days hospitalized post-
enrollment and compare to the total number of days spent in the psychiatric setting 12
months prior to program enrollment.
b. Incarcerations – To reduce the total number of days spent confined in a jail or prison
setting, CONTRACTOR will track decreases and compare to the total number of days
spent incarcerated 12 months prior to program enrollment
c. Homelessness – To reduce the total number of days spent homeless, CONTRACTOR
will track decreases and compare to the total number of days spent homeless 12
months prior to program enrollment.
d. Medical Hospitalizations – To reduce the total number of days spent in a hospital or
emergency department setting, CONTRACTOR will track decreases and compare to
the total number of days hospitalized 12 months prior to program enrollment.
e. Housing – Clients in independent housing will develop a plan for assisting in paying their
own housing costs. Clients will assume responsibility for housing costs when deemed
ready and appropriate.
f. Supplemental Security Income – Within six months of enrollment, ninety-nine percent
(99%) of clients without SSI will have made SSI applications. CONTRACTOR shall
provide a written report regarding these goals on a semi-annual basis.
g. Productivity – Direct service productivity rate shall be a minimum of eighty percent (80%).
h. Reaching Recovery – To track the degree of change across multiple domains of
wellness, CONTRACTOR will utilize tools designed to measure recovery.
2. Efficiency
a. Cost Per Client – CONTRACTOR will efficiently use resources and maintain or
minimize costs per client. Costs include all staffing and overhead costs associated with
program operations.
3. Access
a. Length of Time from Referral to First Contact – CONTRACTOR will provide timely
service for clients requesting services. The goal wait time from referral to first contact
is within 3 business days.
b. Length of Time from Referral to First Intake/Assessment Appointment – The goal
wait time from referral to first intake/assessment appointment is within 10 business
days.
c. Length of Time from Referral to First Psychiatry Appointment – The goal wait time
from referral to first psychiatry appointment is within 15 business days.
4. Satisfaction
a. Consumer Perception Survey – CONTRACTOR will gauge satisfaction of clients and
collect data for service planning and quality improvement. The surveys are conducted
every six months over a week period. Program beneficiaries are encouraged to
Exhibit A
Page 8 of 8
0302adbh
participate in completing the survey. The goal is for 75% of clients to be satisfied for
each domain.
Intensive Case Management / Outpatient
1. Effectiveness
a. Psychiatric Hospitalization – To prevent hospitalizations and re-admissions for
clients, CONTRACTOR will provide effective preventive interventions and provide
timely post-hospitalization follow up services. The goal expectancy is for 10% or less
of ICM/OP clients served to experience a psychiatric hospitalization. Post-
hospitalization follow up services will occur within 10 days or less.
b. Inpatient Crisis Stabilization Services – To prevent crisis stabilization services and
re-occurrence of crisis stabilization services, CONTRACTOR will provide effective
preventative interventions and timely post-crisis stabilization follow up services. The
goal is for 10% or less of ICM/OP clients served to experience a crisis stabilization
service.
c. Compliance – CONTRACTOR will comply with all requirements of the Department of
Behavioral Health Managed Care Organizational Provider Manual.
d. Supplemental Security Income – Within six months of enrollment, ninety-nine percent
(99%) of clients without SSI will have made SSI applications. CONTRACTOR shall
provide a written report regarding these goals on a semi-annual basis.
e. Productivity – Direct service productivity rate shall be a minimum of eighty percent (80%).
f. Reaching Recovery – CONTRACTOR will track the degree of change across multiple
domains of wellness utilizing tools designed to measure recovery.
2. Efficiency
a. Cost Per Client – CONTRACTOR will efficiently use resources and maintain or
minimize costs per client.
3. Access
a. Length of Time from Referral to First Contact – CONTRACTOR will provide timely
service for clients requesting services. The goal wait time from referral to first contact
is within 3 business days.
b. Length of Time from Referral to First Intake/Assessment Appointment – The goal
wait time from referral to first intake/assessment appointment is within 10 business
days.
c. Length of Time from Referral to First Psychiatry Appointment – The goal wait time
from referral to first psychiatry appointment is within 15 business days.
4. Satisfaction
a. Consumer Perception Survey – CONTRACTOR will gauge satisfaction of clients and
collect data for service planning and quality improvement. The surveys are conducted
every six months over a week period. Program beneficiaries are encouraged to
participate in completing the survey. The goal is for 75% of clients to be satisfied for
each domain.
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PROGRAM DIRECTOR 0.16 $16,417 $16,417
0002 ASSISTANT PROGRAM DIRECTOR 0.64 $54,719 $54,719
0003 MHP/TEAM LEAD 4.21 $319,656 $319,656
0004 SUPERVISING PSC 0.48 $25,991 $25,991
0005 CASE MANAGER 3.84 $185,863 $185,863
0006 DRIVER 0.48 $12,568 $12,568
0007 NURSE 1.28 $69,275 $69,275
0008 NURSE SUPERVISOR 0.16 $9,265 $9,265
0009 PEER SUPPORT 0.48 $14,583 $14,583
0010 ADMITTING INTERVIEWER/SECRETARY 2.24 $82,768 $82,768
0011 BILLING CLERK 0.32 $12,914 $12,914
0012 ADMINISTRATIVE ASSISTANT 0.16 $7,669 $7,669
0013 ADMINISTRATIVE SUPERVISOR 0.16 $7,616 $7,616
SALARY TOTAL 14.61 $0 $819,304 $819,304
PAYROLL TAXES:
0030 OASDI $0 $0
0031 FICA/MEDICARE $68,492 $68,492
0032 SUI $3,031 $3,031
0033 ACCRUED PAID LEAVE $87,747 $87,747
PAYROLL TAX TOTAL $0 $159,270 $159,270
EMPLOYEE BENEFITS:
0040 Retirement $13,343 $13,343
0041 Workers Compensation $11,664 $11,664
0042 Health Insurance (medical, vision, life, dental)$124,512 $124,512
EMPLOYEE BENEFITS TOTAL $0 $149,519 $149,519
SALARY & BENEFITS GRAND TOTAL $1,128,093
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $54,400
1011 Rent/Lease Equipment $0
1012 Utilities $6,728
1013 Building Maintenance $10,744
1014 Equipment Maintenance $2,920
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $74,792
Line Item Description (Must be itemized)
RURAL MENTAL HEALTH FULL SERVICE PARTNERSHIP (FSP) PROGRAM
TURNING POINT OF CENTRAL CALIFORNIA
FY 2018-2019
Budget Categories - Total Proposed Budget
BUDGET - EXPENSES FOR EXISTING SIX CLINICS AND EXPANSION
Exhibit B
OPERATING EXPENSES:
1060 Telephone $25,840
1061 Answering Service $0
1062 Postage $800
1063 Printing/Reproduction $2,536
1064 Publications $1,520
1065 Legal Notices/Advertising/Program Enhancement $0
1066 Office Supplies & Equipment $3,840
1067 Household Supplies $3,040
1068 Food $1,976
1069 Program Supplies - Therapeutic $4,640
1070 Program Supplies - Medical $3,760
1071 Transportation of Clients $0
1072 Staff Mileage/Vehicle Maintenance $44,136
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $4,000
1075 Lodging $824
1076 Other - (Vehicle Insurance/ Vehicle Lease)$23,904
1077 Other - (Client Activities/Outreach Events)$5,020
1078 Other - (Taxes,Bank Charges,Interest,Depreciation)$2,912
1078 Other - (Recruitment)$784
1078 Other - (Employee-Employer Relations)$2,800
1079 Licenses $14,400
OPERATING EXPENSES TOTAL $146,732
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $896
1082 Liability Insurance $4,816
1083 Administrative Overhead $256,918
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $262,630
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (Network & Data management)$4,160
1091 Translation Services $5,760
1092 Medication Supports $17,800
1093 O/S Labor Clinical - Counselor $5,280
1094 O/S Labor Clinical - Nurse $480
1095 O/S Labor Clinical - Psychiatrist $216,323
SPECIAL EXPENSES TOTAL $249,803
FIXED ASSETS:
1190 Computers & Software $3,420
1191 Furniture & Fixtures $5,400
1192 Other - (Expendable Equipment)$8,004
1193 Other - (Expendable Furniture)$0
1194 Other - (Identify)$0
FIXED ASSETS TOTAL $16,824
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$75,905
2001 Client Housing Operating Expenditures (SFC 71)$1,400
2002.1 Clothing, Food & Hygiene (SFC 72)$15,100
2002.2 Client Transportation & Support (SFC 72)$1,216
2002.3 Education Support (SFC 72)$1,090
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $94,711
TOTAL PROGRAM EXPENSES $1,973,585
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)50,373 $2.59 $130,561
3100 Case Management 73,492 $1.22 $89,830
3200 Crisis Services 9,354 $2.35 $21,961
3300 Medication Support 43,878 $4.01 $176,048
3400 Collateral 24,842 $2.59 $64,388
3500 Plan Development 5,596 $2.59 $14,504
3600 Assessment 8,719 $2.59 $22,599
3700 Rehabilitation 144,291 $2.59 $373,987
Estimated Specialty Mental Health Services Billing Totals 360,545 $893,878
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $893,878
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP)(Blended ACA,EPSDT,S/D)78.13%$698,391
State M/Cal Share of Cost % (BH Realignment/EPSDT) 21.87%$195,487
MEDI-CAL REVENUE TOTAL $893,878
OTHER REVENUE:
4000 Other - (Client Fees)$1,500
4100 Other - (Client Insurance)$0
4200 Other - (Identify)$0
OTHER REVENUE TOTAL $1,500
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $0
5100 Community Services & Supports (CSS) Funds $1,078,207
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $1,078,207
TOTAL PROGRAM REVENUE $1,973,585
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PROGRAM DIRECTOR 0.16 $16,912 $16,912
0002 ASSISTANT PROGRAM DIRECTOR 0.64 $56,367 $56,367
0003 MHP/TEAM LEAD 4.21 $336,178 $336,178
0004 SUPERVISING PSC 0.48 $27,450 $27,450
0005 CASE MANAGER 3.84 $194,759 $194,759
0006 DRIVER 0.48 $13,285 $13,285
0007 NURSE 1.28 $71,960 $71,960
0008 NURSE SUPERVISOR 0.16 $9,546 $9,546
0009 PEER SUPPORT 0.48 $15,262 $15,262
0010 ADMITTING INTERVIEWER/SECRETARY 2.24 $86,088 $86,088
0011 BILLING CLERK 0.32 $13,306 $13,306
0012 ADMINISTRATIVE ASSISTANT 0.16 $7,902 $7,902
0013 ADMINISTRATIVE SUPERVISOR 0.16 $8,160 $8,160
SALARY TOTAL 14.61 $0 $857,175 $857,175
PAYROLL TAXES:
0030 OASDI $0 $0
0031 FICA/MEDICARE $71,656 $71,656
0032 SUI $3,031 $3,031
0033 ACCRUED PAID LEAVE $91,771 $91,771
PAYROLL TAX TOTAL $0 $166,458 $166,458
EMPLOYEE BENEFITS:
0040 Retirement $13,959 $13,959
0041 Workers Compensation $12,203 $12,203
0042 Health Insurance (medical, vision, life, dental)$124,525 $124,525
EMPLOYEE BENEFITS TOTAL $0 $150,687 $150,687
SALARY & BENEFITS GRAND TOTAL $1,174,320
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $57,120
1011 Rent/Lease Equipment $0
1012 Utilities $7,064
1013 Building Maintenance $11,281
1014 Equipment Maintenance $3,066
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $78,531
Line Item Description (Must be itemized)
RURAL MENTAL HEALTH FULL SERVICE PARTNERSHIP (FSP) PROGRAM
TURNING POINT OF CENTRAL CALIFORNIA
FY 2019-2020
Budget Categories - Total Proposed Budget
BUDGET - EXPENSES FOR EXISTING SIX CLINICS AND EXPANSION
OPERATING EXPENSES:
1060 Telephone $27,132
1061 Answering Service $0
1062 Postage $840
1063 Printing/Reproduction $2,663
1064 Publications $1,596
1065 Legal Notices/Advertising/Program Enhancement $0
1066 Office Supplies & Equipment $4,032
1067 Household Supplies $3,192
1068 Food $2,075
1069 Program Supplies - Therapeutic $4,872
1070 Program Supplies - Medical $3,948
1071 Transportation of Clients $0
1072 Staff Mileage/Vehicle Maintenance $46,343
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $4,200
1075 Lodging $865
1076 Other - (Vehicle Insurance/ Vehicle Lease)$25,099
1077 Other - (Client Activities/Outreach Events)$5,271
1078 Other - (Taxes,Bank Charges,Interest,Depreciation)$3,058
1078 Other - (Recruitment)$823
1078 Other - (Employee-Employer Relations)$2,940
1079 Licenses $15,120
OPERATING EXPENSES TOTAL $154,069
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $941
1082 Liability Insurance $5,057
1083 Administrative Overhead $268,236
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $274,234
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (Network & Data management)$4,368
1091 Translation Services $6,048
1092 Medication Supports $18,690
1093 O/S Labor Clinical - Counselor $5,544
1094 O/S Labor Clinical - Nurse $504
1095 O/S Labor Clinical - Psychiatrist $227,139
SPECIAL EXPENSES TOTAL $262,293
FIXED ASSETS:
1190 Computers & Software $672
1191 Furniture & Fixtures $0
1192 Other - (Expendable Equipment)$16,153
1193 Other - (Expendable Furniture)$0
1194 Other - (Identify)$0
FIXED ASSETS TOTAL $16,825
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$79,700
2001 Client Housing Operating Expenditures (SFC 71)$1,470
2002.1 Clothing, Food & Hygiene (SFC 72)$15,855
2002.2 Client Transportation & Support (SFC 72)$1,277
2002.3 Education Support (SFC 72)$1,145
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $99,447
TOTAL PROGRAM EXPENSES $2,059,719
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)54,792 $2.59 $142,015
3100 Case Management 84,015 $1.22 $102,693
3200 Crisis Services 9,472 $2.35 $22,238
3300 Medication Support 46,814 $4.01 $187,827
3400 Collateral 26,133 $2.59 $67,734
3500 Plan Development 6,374 $2.59 $16,521
3600 Assessment 11,202 $2.59 $29,034
3700 Rehabilitation 148,945 $2.59 $386,049
Estimated Specialty Mental Health Services Billing Totals 387,747 $954,111
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $954,111
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP)(Blended ACA,EPSDT,S/D)78.13%$745,451
State M/Cal Share of Cost % (BH Realignment/EPSDT) 21.87%$208,660
MEDI-CAL REVENUE TOTAL $954,111
OTHER REVENUE:
4000 Other - (Client Fees)$1,500
4100 Other - (Client Insurance)$0
4200 Other - (Identify)$0
OTHER REVENUE TOTAL $1,500
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $0
5100 Community Services & Supports (CSS) Funds $1,104,108
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $1,104,108
TOTAL PROGRAM REVENUE $2,059,719
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PROGRAM DIRECTOR 0.16 $17,422 $17,422
0002 ASSISTANT PROGRAM DIRECTOR 0.64 $58,066 $58,066
0003 MHP/TEAM LEAD 4.21 $350,539 $350,539
0004 SUPERVISING PSC 0.48 $29,003 $29,003
0005 CASE MANAGER 3.84 $203,241 $203,241
0006 DRIVER 0.48 $13,861 $13,861
0007 NURSE 1.28 $74,767 $74,767
0008 NURSE SUPERVISOR 0.16 $9,835 $9,835
0009 PEER SUPPORT 0.48 $15,847 $15,847
0010 ADMITTING INTERVIEWER/SECRETARY 2.24 $89,124 $89,124
0011 BILLING CLERK 0.32 $13,709 $13,709
0012 ADMINISTRATIVE ASSISTANT 0.16 $8,141 $8,141
0013 ADMINISTRATIVE SUPERVISOR 0.16 $8,744 $8,744
SALARY TOTAL 14.61 $0 $892,299 $892,299
PAYROLL TAXES:
0030 OASDI $0 $0
0031 FICA/MEDICARE $74,590 $74,590
0032 SUI $3,031 $3,031
0033 ACCRUED PAID LEAVE $95,503 $95,503
PAYROLL TAX TOTAL $0 $173,124 $173,124
EMPLOYEE BENEFITS:
0040 Retirement $14,531 $14,531
0041 Workers Compensation $12,703 $12,703
0042 Health Insurance (medical, vision, life, dental)$124,536 $124,536
EMPLOYEE BENEFITS TOTAL $0 $151,770 $151,770
SALARY & BENEFITS GRAND TOTAL $1,217,193
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $59,976
1011 Rent/Lease Equipment $0
1012 Utilities $7,418
1013 Building Maintenance $11,845
1014 Equipment Maintenance $3,219
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $82,458
Line Item Description (Must be itemized)
RURAL MENTAL HEALTH FULL SERVICE PARTNERSHIP (FSP) PROGRAM
TURNING POINT OF CENTRAL CALIFORNIA
FY 2020-2021
Budget Categories - Total Proposed Budget
BUDGET - EXPENSES FOR EXISTING SIX CLINICS AND EXPANSION
OPERATING EXPENSES:
1060 Telephone $28,489
1061 Answering Service $0
1062 Postage $882
1063 Printing/Reproduction $2,796
1064 Publications $1,676
1065 Legal Notices/Advertising/Program Enhancement $0
1066 Office Supplies & Equipment $4,234
1067 Household Supplies $3,352
1068 Food $2,179
1069 Program Supplies - Therapeutic $5,116
1070 Program Supplies - Medical $4,145
1071 Transportation of Clients $0
1072 Staff Mileage/Vehicle Maintenance $48,660
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $4,410
1075 Lodging $908
1076 Other - (Vehicle Insurance/ Vehicle Lease)$26,354
1077 Other - (Client Activities/Outreach Events)$5,535
1078 Other - (Taxes,Bank Charges,Interest,Depreciation)$3,210
1078 Other - (Recruitment)$864
1078 Other - (Employee-Employer Relations)$3,087
1079 Licenses $15,876
OPERATING EXPENSES TOTAL $161,773
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $988
1082 Liability Insurance $5,310
1083 Administrative Overhead $279,270
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $285,568
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (Network & Data management)$4,586
1091 Translation Services $6,350
1092 Medication Supports $19,625
1093 O/S Labor Clinical - Counselor $5,821
1094 O/S Labor Clinical - Nurse $529
1095 O/S Labor Clinical - Psychiatrist $238,496
SPECIAL EXPENSES TOTAL $275,407
FIXED ASSETS:
1190 Computers & Software $706
1191 Furniture & Fixtures $0
1192 Other - (Expendable Equipment)$16,961
1193 Other - (Expendable Furniture)$0
1194 Other - (Identify)$0
FIXED ASSETS TOTAL $17,667
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$83,685
2001 Client Housing Operating Expenditures (SFC 71)$1,544
2002.1 Clothing, Food & Hygiene (SFC 72)$16,648
2002.2 Client Transportation & Support (SFC 72)$1,341
2002.3 Education Support (SFC 72)$1,202
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $104,419
TOTAL PROGRAM EXPENSES $2,144,485
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)54,792 $2.59 $142,015
3100 Case Management 84,016 $1.22 $102,694
3200 Crisis Services 9,473 $2.35 $22,241
3300 Medication Support 46,814 $4.01 $187,827
3400 Collateral 26,133 $2.59 $67,734
3500 Plan Development 6,373 $2.59 $16,518
3600 Assessment 11,202 $2.59 $29,034
3700 Rehabilitation 148,945 $2.59 $386,049
Estimated Specialty Mental Health Services Billing Totals 387,748 $954,112
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $954,112
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP)(Blended ACA,EPSDT,S/D)78.13%$745,452
State M/Cal Share of Cost % (BH Realignment/EPSDT) 21.87%$208,660
MEDI-CAL REVENUE TOTAL $954,112
OTHER REVENUE:
4000 Other - (Client Fees)$1,500
4100 Other - (Client Insurance)$0
4200 Other - (Identify)$0
OTHER REVENUE TOTAL $1,500
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $0
5100 Community Services & Supports (CSS) Funds $1,188,873
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $1,188,873
TOTAL PROGRAM REVENUE $2,144,485
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PROGRAM DIRECTOR 0.16 $17,948 $17,948
0002 ASSISTANT PROGRAM DIRECTOR 0.64 $59,815 $59,815
0003 MHP/TEAM LEAD 4.21 $361,818 $361,818
0004 SUPERVISING PSC 0.48 $30,249 $30,249
0005 CASE MANAGER 3.84 $211,220 $211,220
0006 DRIVER 0.48 $14,467 $14,467
0007 NURSE 1.28 $77,356 $77,356
0008 NURSE SUPERVISOR 0.16 $10,133 $10,133
0009 PEER SUPPORT 0.48 $16,458 $16,458
0010 ADMITTING INTERVIEWER/SECRETARY 2.24 $91,824 $91,824
0011 BILLING CLERK 0.32 $14,124 $14,124
0012 ADMINISTRATIVE ASSISTANT 0.16 $8,388 $8,388
0013 ADMINISTRATIVE SUPERVISOR 0.16 $9,369 $9,369
SALARY TOTAL 14.61 $0 $923,169 $923,169
PAYROLL TAXES:
0030 OASDI $0 $0
0031 FICA/MEDICARE $77,168 $77,168
0032 SUI $3,031 $3,031
0033 ACCRUED PAID LEAVE $98,768 $98,768
PAYROLL TAX TOTAL $0 $178,967 $178,967
EMPLOYEE BENEFITS:
0040 Retirement $15,033 $15,033
0041 Workers Compensation $13,142 $13,142
0042 Health Insurance (medical, vision, life, dental)$124,546 $124,546
EMPLOYEE BENEFITS TOTAL $0 $152,721 $152,721
SALARY & BENEFITS GRAND TOTAL $1,254,857
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $62,975
1011 Rent/Lease Equipment $0
1012 Utilities $7,789
1013 Building Maintenance $12,438
1014 Equipment Maintenance $3,380
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $86,582
Line Item Description (Must be itemized)
RURAL MENTAL HEALTH FULL SERVICE PARTNERSHIP (FSP) PROGRAM
TURNING POINT OF CENTRAL CALIFORNIA
FY 2021-2022
Budget Categories - Total Proposed Budget
BUDGET - EXPENSES FOR EXISTING SIX CLINICS AND EXPANSION
OPERATING EXPENSES:
1060 Telephone $29,913
1061 Answering Service $0
1062 Postage $926
1063 Printing/Reproduction $2,936
1064 Publications $1,760
1065 Legal Notices/Advertising/Program Enhancement $0
1066 Office Supplies & Equipment $4,445
1067 Household Supplies $3,519
1068 Food $2,287
1069 Program Supplies - Therapeutic $5,371
1070 Program Supplies - Medical $4,353
1071 Transportation of Clients $0
1072 Staff Mileage/Vehicle Maintenance $51,093
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $4,631
1075 Lodging $954
1076 Other - (Vehicle Insurance/ Vehicle Lease)$27,672
1077 Other - (Client Activities/Outreach Events)$5,811
1078 Other - (Taxes,Bank Charges,Interest,Depreciation)$3,371
1078 Other - (Recruitment)$908
1078 Other - (Employee-Employer Relations)$3,241
1079 Licenses $16,670
OPERATING EXPENSES TOTAL $169,861
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $1,037
1082 Liability Insurance $5,575
1083 Administrative Overhead $289,753
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $296,365
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (Network & Data management)$4,816
1091 Translation Services $6,668
1092 Medication Supports $20,606
1093 O/S Labor Clinical - Counselor $6,112
1094 O/S Labor Clinical - Nurse $556
1095 O/S Labor Clinical - Psychiatrist $250,421
SPECIAL EXPENSES TOTAL $289,179
FIXED ASSETS:
1190 Computers & Software $741
1191 Furniture & Fixtures $0
1192 Other - (Expendable Equipment)$17,809
1193 Other - (Expendable Furniture)$0
1194 Other - (Identify)$0
FIXED ASSETS TOTAL $18,550
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$87,870
2001 Client Housing Operating Expenditures (SFC 71)$1,621
2002.1 Clothing, Food & Hygiene (SFC 72)$17,480
2002.2 Client Transportation & Support (SFC 72)$1,408
2002.3 Education Support (SFC 72)$1,262
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $109,641
TOTAL PROGRAM EXPENSES $2,225,035
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)54,792 $2.59 $142,015
3100 Case Management 84,016 $1.22 $102,694
3200 Crisis Services 9,472 $2.35 $22,238
3300 Medication Support 46,814 $4.01 $187,827
3400 Collateral 26,133 $2.59 $67,734
3500 Plan Development 6,373 $2.59 $16,518
3600 Assessment 11,203 $2.59 $29,037
3700 Rehabilitation 148,945 $2.59 $386,049
Estimated Specialty Mental Health Services Billing Totals 387,748 $954,112
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $954,112
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP)(Blended ACA,EPSDT,S/D)78.13%$745,452
State M/Cal Share of Cost % (BH Realignment/EPSDT) 21.87%$208,660
MEDI-CAL REVENUE TOTAL $954,112
OTHER REVENUE:
4000 Other - (Client Fees)$1,500
4100 Other - (Client Insurance)$0
4200 Other - (Identify)$0
OTHER REVENUE TOTAL $1,500
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $0
5100 Community Services & Supports (CSS) Funds $1,269,423
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $1,269,423
TOTAL PROGRAM REVENUE $2,225,035
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PROGRAM DIRECTOR 0.16 $18,489 $18,489
0002 ASSISTANT PROGRAM DIRECTOR 0.64 $61,618 $61,618
0003 MHP/TEAM LEAD 4.21 $373,030 $373,030
0004 SUPERVISING PSC 0.48 $31,560 $31,560
0005 CASE MANAGER 3.84 $218,218 $218,218
0006 DRIVER 0.48 $14,905 $14,905
0007 NURSE 1.28 $80,045 $80,045
0008 NURSE SUPERVISOR 0.16 $10,441 $10,441
0009 PEER SUPPORT 0.48 $16,957 $16,957
0010 ADMITTING INTERVIEWER/SECRETARY 2.24 $94,607 $94,607
0011 BILLING CLERK 0.32 $14,552 $14,552
0012 ADMINISTRATIVE ASSISTANT 0.16 $8,642 $8,642
0013 ADMINISTRATIVE SUPERVISOR 0.16 $10,039 $10,039
SALARY TOTAL 14.61 $0 $953,103 $953,103
PAYROLL TAXES:
0030 OASDI $0 $0
0031 FICA/MEDICARE $79,668 $79,668
0032 SUI $3,031 $3,031
0033 ACCRUED PAID LEAVE $101,940 $101,940
PAYROLL TAX TOTAL $0 $184,639 $184,639
EMPLOYEE BENEFITS:
0040 Retirement $15,520 $15,520
0041 Workers Compensation $13,567 $13,567
0042 Health Insurance (medical, vision, life, dental)$124,556 $124,556
EMPLOYEE BENEFITS TOTAL $0 $153,643 $153,643
SALARY & BENEFITS GRAND TOTAL $1,291,385
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $66,124
1011 Rent/Lease Equipment $0
1012 Utilities $8,178
1013 Building Maintenance $13,059
1014 Equipment Maintenance $3,549
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $90,910
Line Item Description (Must be itemized)
RURAL MENTAL HEALTH FULL SERVICE PARTNERSHIP (FSP) PROGRAM
TURNING POINT OF CENTRAL CALIFORNIA
FY 2022-2023
Budget Categories - Total Proposed Budget
BUDGET - EXPENSES FOR EXISTING SIX CLINICS AND EXPANSION
OPERATING EXPENSES:
1060 Telephone $31,409
1061 Answering Service $0
1062 Postage $972
1063 Printing/Reproduction $3,083
1064 Publications $1,848
1065 Legal Notices/Advertising/Program Enhancement $0
1066 Office Supplies & Equipment $4,668
1067 Household Supplies $3,695
1068 Food $2,402
1069 Program Supplies - Therapeutic $5,640
1070 Program Supplies - Medical $4,570
1071 Transportation of Clients $0
1072 Staff Mileage/Vehicle Maintenance $53,648
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $4,862
1075 Lodging $1,002
1076 Other - (Vehicle Insurance/ Vehicle Lease)$29,055
1077 Other - (Client Activities/Outreach Events)$6,102
1078 Other - (Taxes,Bank Charges,Interest,Depreciation)$3,540
1078 Other - (Recruitment)$953
1078 Other - (Employee-Employer Relations)$3,403
1079 Licenses $17,503
OPERATING EXPENSES TOTAL $178,355
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $1,089
1082 Liability Insurance $5,854
1083 Administrative Overhead $300,312
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $307,255
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (Network & Data management)$5,057
1091 Translation Services $7,001
1092 Medication Supports $21,636
1093 O/S Labor Clinical - Counselor $6,418
1094 O/S Labor Clinical - Nurse $583
1095 O/S Labor Clinical - Psychiatrist $262,942
SPECIAL EXPENSES TOTAL $303,637
FIXED ASSETS:
1190 Computers & Software $778
1191 Furniture & Fixtures $0
1192 Other - (Expendable Equipment)$18,699
1193 Other - (Expendable Furniture)$0
1194 Other - (Identify)$0
FIXED ASSETS TOTAL $19,477
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$92,263
2001 Client Housing Operating Expenditures (SFC 71)$1,702
2002.1 Clothing, Food & Hygiene (SFC 72)$18,354
2002.2 Client Transportation & Support (SFC 72)$1,478
2002.3 Education Support (SFC 72)$1,325
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $115,122
TOTAL PROGRAM EXPENSES $2,306,141
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)54,792 $2.59 $142,015
3100 Case Management 84,016 $1.22 $102,694
3200 Crisis Services 9,473 $2.35 $22,241
3300 Medication Support 46,814 $4.01 $187,827
3400 Collateral 26,133 $2.59 $67,734
3500 Plan Development 6,373 $2.59 $16,518
3600 Assessment 11,202 $2.59 $29,034
3700 Rehabilitation 148,945 $2.59 $386,049
Estimated Specialty Mental Health Services Billing Totals 387,748 $954,112
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $954,112
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP)(Blended ACA,EPSDT,S/D)78.13%$745,452
State M/Cal Share of Cost % (BH Realignment/EPSDT) 21.87%$208,660
MEDI-CAL REVENUE TOTAL $954,112
OTHER REVENUE:
4000 Other - (Client Fees)$1,500
4100 Other - (Client Insurance)$0
4200 Other - (Identify)$0
OTHER REVENUE TOTAL $1,500
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $0
5100 Community Services & Supports (CSS) Funds $1,350,529
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $1,350,529
TOTAL PROGRAM REVENUE $2,306,141
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PROGRAM DIRECTOR 0.84 $86,189 $86,189
0002 ASSISTANT PROGRAM DIRECTOR 3.36 $287,274 $287,274
0003 MHP/TEAM LEAD 22.09 $1,678,195 $1,678,195
0004 SUPERVISING PSC 2.52 $136,450 $136,450
0005 CASE MANAGER 20.16 $975,778 $975,778
0006 DRIVER 2.52 $65,984 $65,984
0007 NURSE 6.72 $363,696 $363,696
0008 NURSE SUPERVISOR 0.84 $48,644 $48,644
0009 PEER SUPPORT 2.52 $76,561 $76,561
0010 ADMITTING INTERVIEWER/SECRETARY 11.76 $434,533 $434,533
0011 BILLING CLERK 1.68 $67,801 $67,801
0012 ADMINISTRATIVE ASSISTANT 0.84 $40,265 $40,265
0013 ADMINISTRATIVE SUPERVISOR 0.84 $39,981 $39,981
SALARY TOTAL 76.69 $0 $4,301,351 $4,301,351
PAYROLL TAXES:
0030 OASDI $0 $0
0031 FICA/MEDICARE $359,581 $359,581
0032 SUI $15,913 $15,913
0033 ACCRUED PAID LEAVE $460,672 $460,672
PAYROLL TAX TOTAL $0 $836,166 $836,166
EMPLOYEE BENEFITS:
0040 Retirement $70,048 $70,048
0041 Workers Compensation $61,236 $61,236
0042 Health Insurance (medical, vision, life, dental)$653,690 $653,690
EMPLOYEE BENEFITS TOTAL $0 $784,974 $784,974
SALARY & BENEFITS GRAND TOTAL $5,922,491
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $285,600
1011 Rent/Lease Equipment $0
1012 Utilities $35,322
1013 Building Maintenance $56,406
1014 Equipment Maintenance $15,330
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $392,658
Line Item Description (Must be itemized)
RURAL MENTAL HEALTH OUTPATIENT / INTENSIVE CASE MANAGEMENT (OP/ICM) PROGRAM
TURNING POINT OF CENTRAL CALIFORNIA
FY 2018-2019
Budget Categories - Total Proposed Budget
BUDGET - EXPENSES FOR EXISTING SIX CLINICS AND EXPANSION
OPERATING EXPENSES:
1060 Telephone $135,660
1061 Answering Service $0
1062 Postage $4,200
1063 Printing/Reproduction $13,314
1064 Publications $7,980
1065 Legal Notices/Advertising/Program Enhancement $0
1066 Office Supplies & Equipment $20,160
1067 Household Supplies $15,960
1068 Food $10,374
1069 Program Supplies - Therapeutic $24,360
1070 Program Supplies - Medical $19,740
1071 Transportation of Clients $0
1072 Staff Mileage/Vehicle Maintenance $231,714
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $21,000
1075 Lodging $4,326
1076 Other - (Vehicle Insurance/ Vehicle Lease)$125,496
1077 Other - (Client Activities/Outreach Events)$26,355
1078 Other - (Taxes,Bank Charges,Interest,Depreciation)$15,288
1078 Other - (Recruitment)$4,116
1078 Other - (Employee-Employer Relations)$14,700
1079 Licenses $75,600
OPERATING EXPENSES TOTAL $770,343
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $4,704
1082 Liability Insurance $25,284
1083 Administrative Overhead $1,268,063
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $1,298,051
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (Network & Data management)$21,840
1091 Translation Services $30,240
1092 Medication Supports $4,200
1093 O/S Labor Clinical - Counselor $27,720
1094 O/S Labor Clinical - Nurse $2,520
1095 O/S Labor Clinical - Psychiatrist $1,135,697
SPECIAL EXPENSES TOTAL $1,222,217
FIXED ASSETS:
1190 Computers & Software $25,080
1191 Furniture & Fixtures $32,600
1192 Other - (Expendable Equipment)$30,646
1193 Other - (Expendable Furniture)$0
1194 Other - (Identify)$0
FIXED ASSETS TOTAL $88,326
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$22,470
2001 Client Housing Operating Expenditures (SFC 71)$0
2002.1 Clothing, Food & Hygiene (SFC 72)$0
2002.2 Client Transportation & Support (SFC 72)$6,384
2002.3 Education Support (SFC 72)$0
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $28,854
TOTAL PROGRAM EXPENSES $9,722,940
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)436,342 $2.59 $1,130,952
3100 Case Management 199,204 $1.22 $243,490
3200 Crisis Services 10,865 $2.35 $25,509
3300 Medication Support 446,312 $4.01 $1,790,695
3400 Collateral 117,293 $2.59 $304,011
3500 Plan Development 80,054 $2.59 $207,491
3600 Assessment 264,925 $2.59 $686,657
3700 Rehabilitation 368,482 $2.59 $955,067
Estimated Specialty Mental Health Services Billing Totals 1,923,477 $5,343,872
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $5,343,872
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP)(Blended ACA,EPSDT,S/D)78.13%$4,175,190
State M/Cal Share of Cost % (BH Realignment/EPSDT) 21.87%$1,168,682
MEDI-CAL REVENUE TOTAL $5,343,872
OTHER REVENUE:
4000 Other - (Client Fees)$0
4100 Other - (Client Insurance)$0
4200 Other - (Identify)$0
OTHER REVENUE TOTAL $0
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $0
5100 Community Services & Supports (CSS) Funds $4,379,068
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $4,379,068
TOTAL PROGRAM REVENUE $9,722,940
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PROGRAM DIRECTOR 0.84 $88,788 $88,788
0002 ASSISTANT PROGRAM DIRECTOR 3.36 $295,928 $295,928
0003 MHP/TEAM LEAD 22.09 $1,764,935 $1,764,935
0004 SUPERVISING PSC 2.52 $144,114 $144,114
0005 CASE MANAGER 20.16 $1,022,485 $1,022,485
0006 DRIVER 2.52 $69,749 $69,749
0007 NURSE 6.72 $377,788 $377,788
0008 NURSE SUPERVISOR 0.84 $50,118 $50,118
0009 PEER SUPPORT 2.52 $80,128 $80,128
0010 ADMITTING INTERVIEWER/SECRETARY 11.76 $451,965 $451,965
0011 BILLING CLERK 1.68 $69,855 $69,855
0012 ADMINISTRATIVE ASSISTANT 0.84 $41,484 $41,484
0013 ADMINISTRATIVE SUPERVISOR 0.84 $42,841 $42,841
SALARY TOTAL 76.69 $0 $4,500,178 $4,500,178
PAYROLL TAXES:
0030 OASDI $0 $0
0031 FICA/MEDICARE $376,192 $376,192
0032 SUI $15,913 $15,913
0033 ACCRUED PAID LEAVE $481,795 $481,795
PAYROLL TAX TOTAL $0 $873,900 $873,900
EMPLOYEE BENEFITS:
0040 Retirement $73,284 $73,284
0041 Workers Compensation $64,065 $64,065
0042 Health Insurance (medical, vision, life, dental)$653,755 $653,755
EMPLOYEE BENEFITS TOTAL $0 $791,104 $791,104
SALARY & BENEFITS GRAND TOTAL $6,165,182
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $299,880
1011 Rent/Lease Equipment $0
1012 Utilities $37,089
1013 Building Maintenance $59,227
1014 Equipment Maintenance $16,097
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $412,293
Line Item Description (Must be itemized)
RURAL MENTAL HEALTH OUTPATIENT / INTENSIVE CASE MANAGEMENT (OP/ICM) PROGRAM
TURNING POINT OF CENTRAL CALIFORNIA
FY 2019-2020
Budget Categories - Total Proposed Budget
BUDGET - EXPENSES FOR EXISTING SIX CLINICS AND EXPANSION
OPERATING EXPENSES:
1060 Telephone $142,441
1061 Answering Service $0
1062 Postage $4,410
1063 Printing/Reproduction $13,980
1064 Publications $8,379
1065 Legal Notices/Advertising/Program Enhancement $0
1066 Office Supplies & Equipment $21,168
1067 Household Supplies $16,758
1068 Food $10,893
1069 Program Supplies - Therapeutic $25,578
1070 Program Supplies - Medical $20,727
1071 Transportation of Clients $0
1072 Staff Mileage/Vehicle Maintenance $243,300
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $22,050
1075 Lodging $4,543
1076 Other - (Vehicle Insurance/ Vehicle Lease)$131,771
1077 Other - (Client Activities/Outreach Events)$27,673
1078 Other - (Taxes,Bank Charges,Interest,Depreciation)$16,052
1078 Other - (Recruitment)$4,322
1078 Other - (Employee-Employer Relations)$15,435
1079 Licenses $79,380
OPERATING EXPENSES TOTAL $808,860
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $4,939
1082 Liability Insurance $26,548
1083 Administrative Overhead $1,323,449
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $1,354,936
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (Network & Data management)$22,932
1091 Translation Services $31,752
1092 Medication Supports $4,410
1093 O/S Labor Clinical - Counselor $29,106
1094 O/S Labor Clinical - Nurse $2,646
1095 O/S Labor Clinical - Psychiatrist $1,192,482
SPECIAL EXPENSES TOTAL $1,283,328
FIXED ASSETS:
1190 Computers & Software $3,528
1191 Furniture & Fixtures $0
1192 Other - (Expendable Equipment)$84,805
1193 Other - (Expendable Furniture)$0
1194 Other - (Identify)$0
FIXED ASSETS TOTAL $88,333
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$23,594
2001 Client Housing Operating Expenditures (SFC 71)$0
2002.1 Clothing, Food & Hygiene (SFC 72)$0
2002.2 Client Transportation & Support (SFC 72)$6,703
2002.3 Education Support (SFC 72)$0
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $30,297
TOTAL PROGRAM EXPENSES $10,143,229
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)459,536 $2.59 $1,191,068
3100 Case Management 254,447 $1.22 $311,014
3200 Crisis Services 11,498 $2.35 $26,995
3300 Medication Support 461,729 $4.01 $1,852,551
3400 Collateral 124,066 $2.59 $321,566
3500 Plan Development 84,136 $2.59 $218,071
3600 Assessment 277,965 $2.59 $720,455
3700 Rehabilitation 392,916 $2.59 $1,018,396
Estimated Specialty Mental Health Services Billing Totals 2,066,293 $5,660,116
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $5,660,116
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP)(Blended ACA,EPSDT,S/D)78.13%$4,422,273
State M/Cal Share of Cost % (BH Realignment/EPSDT) 21.87%$1,237,843
MEDI-CAL REVENUE TOTAL $5,660,116
OTHER REVENUE:
4000 Other - (Client Fees)$0
4100 Other - (Client Insurance)$0
4200 Other - (Identify)$0
OTHER REVENUE TOTAL $0
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $0
5100 Community Services & Supports (CSS) Funds $4,483,113
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $4,483,113
TOTAL PROGRAM REVENUE $10,143,229
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PROGRAM DIRECTOR 0.84 $91,466 $91,466
0002 ASSISTANT PROGRAM DIRECTOR 3.36 $304,844 $304,844
0003 MHP/TEAM LEAD 22.09 $1,840,329 $1,840,329
0004 SUPERVISING PSC 2.52 $152,265 $152,265
0005 CASE MANAGER 20.16 $1,067,016 $1,067,016
0006 DRIVER 2.52 $72,771 $72,771
0007 NURSE 6.72 $392,529 $392,529
0008 NURSE SUPERVISOR 0.84 $51,637 $51,637
0009 PEER SUPPORT 2.52 $83,198 $83,198
0010 ADMITTING INTERVIEWER/SECRETARY 11.76 $467,899 $467,899
0011 BILLING CLERK 1.68 $71,972 $71,972
0012 ADMINISTRATIVE ASSISTANT 0.84 $42,742 $42,742
0013 ADMINISTRATIVE SUPERVISOR 0.84 $45,901 $45,901
SALARY TOTAL 76.69 $0 $4,684,569 $4,684,569
PAYROLL TAXES:
0030 OASDI $0 $0
0031 FICA/MEDICARE $391,598 $391,598
0032 SUI $15,913 $15,913
0033 ACCRUED PAID LEAVE $501,392 $501,392
PAYROLL TAX TOTAL $0 $908,903 $908,903
EMPLOYEE BENEFITS:
0040 Retirement $76,285 $76,285
0041 Workers Compensation $66,688 $66,688
0042 Health Insurance (medical, vision, life, dental)$653,815 $653,815
EMPLOYEE BENEFITS TOTAL $0 $796,788 $796,788
SALARY & BENEFITS GRAND TOTAL $6,390,260
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $314,874
1011 Rent/Lease Equipment $0
1012 Utilities $38,942
1013 Building Maintenance $62,188
1014 Equipment Maintenance $16,902
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $432,906
Line Item Description (Must be itemized)
RURAL MENTAL HEALTH OUTPATIENT / INTENSIVE CASE MANAGEMENT (OP/ICM) PROGRAM
TURNING POINT OF CENTRAL CALIFORNIA
FY 2020-2021
Budget Categories - Total Proposed Budget
BUDGET - EXPENSES FOR EXISTING SIX CLINICS AND EXPANSION
OPERATING EXPENSES:
1060 Telephone $149,563
1061 Answering Service $0
1062 Postage $4,631
1063 Printing/Reproduction $14,679
1064 Publications $8,798
1065 Legal Notices/Advertising/Program Enhancement $0
1066 Office Supplies & Equipment $22,226
1067 Household Supplies $17,596
1068 Food $11,437
1069 Program Supplies - Therapeutic $26,857
1070 Program Supplies - Medical $21,764
1071 Transportation of Clients $0
1072 Staff Mileage/Vehicle Maintenance $255,465
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $23,153
1075 Lodging $4,770
1076 Other - (Vehicle Insurance/ Vehicle Lease)$138,360
1077 Other - (Client Activities/Outreach Events)$29,055
1078 Other - (Taxes,Bank Charges,Interest,Depreciation)$16,856
1078 Other - (Recruitment)$4,538
1078 Other - (Employee-Employer Relations)$16,207
1079 Licenses $83,349
OPERATING EXPENSES TOTAL $849,304
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $5,186
1082 Liability Insurance $27,875
1083 Administrative Overhead $1,377,148
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $1,410,209
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (Network & Data management)$24,079
1091 Translation Services $33,340
1092 Medication Supports $4,630
1093 O/S Labor Clinical - Counselor $30,561
1094 O/S Labor Clinical - Nurse $2,779
1095 O/S Labor Clinical - Psychiatrist $1,252,106
SPECIAL EXPENSES TOTAL $1,347,495
FIXED ASSETS:
1190 Computers & Software $3,704
1191 Furniture & Fixtures $0
1192 Other - (Expendable Equipment)$89,044
1193 Other - (Expendable Furniture)$0
1194 Other - (Identify)$0
FIXED ASSETS TOTAL $92,748
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$24,773
2001 Client Housing Operating Expenditures (SFC 71)$0
2002.1 Clothing, Food & Hygiene (SFC 72)$0
2002.2 Client Transportation & Support (SFC 72)$7,038
2002.3 Education Support (SFC 72)$0
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $31,811
TOTAL PROGRAM EXPENSES $10,554,733
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)459,536 $2.59 $1,191,067
3100 Case Management 254,448 $1.22 $311,015
3200 Crisis Services 11,498 $2.35 $26,995
3300 Medication Support 461,729 $4.01 $1,852,550
3400 Collateral 124,066 $2.59 $321,565
3500 Plan Development 84,136 $2.59 $218,071
3600 Assessment 277,965 $2.59 $720,455
3700 Rehabilitation 392,917 $2.59 $1,018,397
Estimated Specialty Mental Health Services Billing Totals 2,066,293 $5,660,115
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $5,660,115
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP)(Blended ACA,EPSDT,S/D)78.13%$4,422,272
State M/Cal Share of Cost % (BH Realignment/EPSDT) 21.87%$1,237,843
MEDI-CAL REVENUE TOTAL $5,660,115
OTHER REVENUE:
4000 Other - (Client Fees)$0
4100 Other - (Client Insurance)$0
4200 Other - (Identify)$0
OTHER REVENUE TOTAL $0
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $0
5100 Community Services & Supports (CSS) Funds $4,894,618
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $4,894,618
TOTAL PROGRAM REVENUE $10,554,733
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PROGRAM DIRECTOR 0.84 $94,224 $94,224
0002 ASSISTANT PROGRAM DIRECTOR 3.36 $314,031 $314,031
0003 MHP/TEAM LEAD 22.09 $1,899,546 $1,899,546
0004 SUPERVISING PSC 2.52 $158,808 $158,808
0005 CASE MANAGER 20.16 $1,108,903 $1,108,903
0006 DRIVER 2.52 $75,949 $75,949
0007 NURSE 6.72 $406,117 $406,117
0008 NURSE SUPERVISOR 0.84 $53,201 $53,201
0009 PEER SUPPORT 2.52 $86,407 $86,407
0010 ADMITTING INTERVIEWER/SECRETARY 11.76 $482,077 $482,077
0011 BILLING CLERK 1.68 $74,153 $74,153
0012 ADMINISTRATIVE ASSISTANT 0.84 $44,036 $44,036
0013 ADMINISTRATIVE SUPERVISOR 0.84 $49,187 $49,187
SALARY TOTAL 76.69 $0 $4,846,639 $4,846,639
PAYROLL TAXES:
0030 OASDI $0 $0
0031 FICA/MEDICARE $405,133 $405,133
0032 SUI $15,913 $15,913
0033 ACCRUED PAID LEAVE $518,531 $518,531
PAYROLL TAX TOTAL $0 $939,577 $939,577
EMPLOYEE BENEFITS:
0040 Retirement $78,922 $78,922
0041 Workers Compensation $68,993 $68,993
0042 Health Insurance (medical, vision, life, dental)$653,867 $653,867
EMPLOYEE BENEFITS TOTAL $0 $801,782 $801,782
SALARY & BENEFITS GRAND TOTAL $6,587,998
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $330,618
1011 Rent/Lease Equipment $0
1012 Utilities $40,889
1013 Building Maintenance $65,297
1014 Equipment Maintenance $17,747
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $454,551
Line Item Description (Must be itemized)
RURAL MENTAL HEALTH OUTPATIENT / INTENSIVE CASE MANAGEMENT (OP/ICM) PROGRAM
TURNING POINT OF CENTRAL CALIFORNIA
FY 2021-2022
Budget Categories - Total Proposed Budget
BUDGET - EXPENSES FOR EXISTING SIX CLINICS AND EXPANSION
OPERATING EXPENSES:
1060 Telephone $157,043
1061 Answering Service $0
1062 Postage $4,862
1063 Printing/Reproduction $15,412
1064 Publications $9,237
1065 Legal Notices/Advertising/Program Enhancement $0
1066 Office Supplies & Equipment $23,338
1067 Household Supplies $18,476
1068 Food $12,010
1069 Program Supplies - Therapeutic $28,200
1070 Program Supplies - Medical $22,851
1071 Transportation of Clients $0
1072 Staff Mileage/Vehicle Maintenance $268,238
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $24,310
1075 Lodging $5,008
1076 Other - (Vehicle Insurance/ Vehicle Lease)$145,277
1077 Other - (Client Activities/Outreach Events)$30,509
1078 Other - (Taxes,Bank Charges,Interest,Depreciation)$17,698
1078 Other - (Recruitment)$4,764
1078 Other - (Employee-Employer Relations)$17,017
1079 Licenses $87,516
OPERATING EXPENSES TOTAL $891,766
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $5,446
1082 Liability Insurance $29,270
1083 Administrative Overhead $1,427,744
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $1,462,460
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (Network & Data management)$25,282
1091 Translation Services $35,007
1092 Medication Supports $4,862
1093 O/S Labor Clinical - Counselor $32,090
1094 O/S Labor Clinical - Nurse $2,917
1095 O/S Labor Clinical - Psychiatrist $1,314,711
SPECIAL EXPENSES TOTAL $1,414,869
FIXED ASSETS:
1190 Computers & Software $3,890
1191 Furniture & Fixtures $0
1192 Other - (Expendable Equipment)$93,497
1193 Other - (Expendable Furniture)$0
1194 Other - (Identify)$0
FIXED ASSETS TOTAL $97,387
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$26,011
2001 Client Housing Operating Expenditures (SFC 71)$0
2002.1 Clothing, Food & Hygiene (SFC 72)$0
2002.2 Client Transportation & Support (SFC 72)$7,390
2002.3 Education Support (SFC 72)$0
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $33,401
TOTAL PROGRAM EXPENSES $10,942,432
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)459,536 $2.59 $1,191,068
3100 Case Management 254,448 $1.22 $311,016
3200 Crisis Services 11,498 $2.35 $26,995
3300 Medication Support 461,729 $4.01 $1,852,551
3400 Collateral 124,066 $2.59 $321,566
3500 Plan Development 84,136 $2.59 $218,071
3600 Assessment 277,964 $2.59 $720,453
3700 Rehabilitation 392,916 $2.59 $1,018,396
Estimated Specialty Mental Health Services Billing Totals 2,066,293 $5,660,116
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $5,660,116
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP)(Blended ACA,EPSDT,S/D)78.13%$4,422,273
State M/Cal Share of Cost % (BH Realignment/EPSDT) 21.87%$1,237,843
MEDI-CAL REVENUE TOTAL $5,660,116
OTHER REVENUE:
4000 Other - (Client Fees)$0
4100 Other - (Client Insurance)$0
4200 Other - (Identify)$0
OTHER REVENUE TOTAL $0
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $0
5100 Community Services & Supports (CSS) Funds $5,282,316
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $5,282,316
TOTAL PROGRAM REVENUE $10,942,432
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PROGRAM DIRECTOR 0.84 $97,067 $97,067
0002 ASSISTANT PROGRAM DIRECTOR 3.36 $323,496 $323,496
0003 MHP/TEAM LEAD 22.09 $1,958,407 $1,958,407
0004 SUPERVISING PSC 2.52 $165,691 $165,691
0005 CASE MANAGER 20.16 $1,145,646 $1,145,646
0006 DRIVER 2.52 $78,251 $78,251
0007 NURSE 6.72 $420,239 $420,239
0008 NURSE SUPERVISOR 0.84 $54,812 $54,812
0009 PEER SUPPORT 2.52 $89,025 $89,025
0010 ADMITTING INTERVIEWER/SECRETARY 11.76 $496,684 $496,684
0011 BILLING CLERK 1.68 $76,400 $76,400
0012 ADMINISTRATIVE ASSISTANT 0.84 $45,371 $45,371
0013 ADMINISTRATIVE SUPERVISOR 0.84 $52,705 $52,705
SALARY TOTAL 76.69 $0 $5,003,794 $5,003,794
PAYROLL TAXES:
0030 OASDI $0 $0
0031 FICA/MEDICARE $418,260 $418,260
0032 SUI $15,913 $15,913
0033 ACCRUED PAID LEAVE $535,185 $535,185
PAYROLL TAX TOTAL $0 $969,358 $969,358
EMPLOYEE BENEFITS:
0040 Retirement $81,479 $81,479
0041 Workers Compensation $71,229 $71,229
0042 Health Insurance (medical, vision, life, dental)$653,918 $653,918
EMPLOYEE BENEFITS TOTAL $0 $806,626 $806,626
SALARY & BENEFITS GRAND TOTAL $6,779,778
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $347,148
1011 Rent/Lease Equipment $0
1012 Utilities $42,934
1013 Building Maintenance $68,562
1014 Equipment Maintenance $18,634
1015 Equipment Purchase $0
FACILITY/EQUIPMENT TOTAL $477,278
Line Item Description (Must be itemized)
RURAL MENTAL HEALTH OUTPATIENT / INTENSIVE CASE MANAGEMENT (OP/ICM) PROGRAM
TURNING POINT OF CENTRAL CALIFORNIA
FY 2022-2023
Budget Categories - Total Proposed Budget
BUDGET - EXPENSES FOR EXISTING SIX CLINICS AND EXPANSION
OPERATING EXPENSES:
1060 Telephone $164,895
1061 Answering Service $0
1062 Postage $5,106
1063 Printing/Reproduction $16,183
1064 Publications $9,699
1065 Legal Notices/Advertising/Program Enhancement $0
1066 Office Supplies & Equipment $24,504
1067 Household Supplies $19,400
1068 Food $12,610
1069 Program Supplies - Therapeutic $29,610
1070 Program Supplies - Medical $23,994
1071 Transportation of Clients $0
1072 Staff Mileage/Vehicle Maintenance $281,649
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $25,526
1075 Lodging $5,258
1076 Other - (Vehicle Insurance/ Vehicle Lease)$152,542
1077 Other - (Client Activities/Outreach Events)$32,035
1078 Other - (Taxes,Bank Charges,Interest,Depreciation)$18,582
1078 Other - (Recruitment)$5,003
1078 Other - (Employee-Employer Relations)$17,868
1079 Licenses $91,893
OPERATING EXPENSES TOTAL $936,357
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $5,718
1082 Liability Insurance $30,733
1083 Administrative Overhead $1,478,483
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $1,514,934
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (Network & Data management)$26,546
1091 Translation Services $36,757
1092 Medication Supports $5,105
1093 O/S Labor Clinical - Counselor $33,694
1094 O/S Labor Clinical - Nurse $3,064
1095 O/S Labor Clinical - Psychiatrist $1,380,447
SPECIAL EXPENSES TOTAL $1,485,613
FIXED ASSETS:
1190 Computers & Software $4,084
1191 Furniture & Fixtures $0
1192 Other - (Expendable Equipment)$98,172
1193 Other - (Expendable Furniture)$0
1194 Other - (Identify)$0
FIXED ASSETS TOTAL $102,256
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$27,310
2001 Client Housing Operating Expenditures (SFC 71)$0
2002.1 Clothing, Food & Hygiene (SFC 72)$0
2002.2 Client Transportation & Support (SFC 72)$7,760
2002.3 Education Support (SFC 72)$0
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $35,070
TOTAL PROGRAM EXPENSES $11,331,286
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)459,536 $2.59 $1,191,068
3100 Case Management 254,449 $1.22 $311,017
3200 Crisis Services 11,497 $2.35 $26,993
3300 Medication Support 461,728 $4.01 $1,852,547
3400 Collateral 124,066 $2.59 $321,566
3500 Plan Development 84,136 $2.59 $218,071
3600 Assessment 277,965 $2.59 $720,455
3700 Rehabilitation 392,917 $2.59 $1,018,399
Estimated Specialty Mental Health Services Billing Totals 2,066,294 $5,660,116
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $5,660,116
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP)(Blended ACA,EPSDT,S/D)78.13%$4,422,273
State M/Cal Share of Cost % (BH Realignment/EPSDT) 21.87%$1,237,843
MEDI-CAL REVENUE TOTAL $5,660,116
OTHER REVENUE:
4000 Other - (Client Fees)$0
4100 Other - (Client Insurance)$0
4200 Other - (Identify)$0
OTHER REVENUE TOTAL $0
MENTAL HEALTH SERVICES ACT (MHSA) REVENUE:
5000 Prevention & Early Intervention (PEI) Funds $0
5100 Community Services & Supports (CSS) Funds $5,671,170
5200 Innovation (INN) Funds $0
5300 Workforce Education & Training (WET) Funds $0
MHSA FUNDS TOTAL $5,671,170
TOTAL PROGRAM REVENUE $11,331,286
EXHIBIT C--FSP SERVICE DELIVERY MODEL
Page 1 of 4
FULL SERVICE PARTNERSHIP SERVICE DELIVERY MODEL
This document outlines requirements for Full Service Partnership collaborations and can be found in its
entirety at http://www.dmh.ca.gov/MHSA/docs/CSSfinal 8.1.05.pd f.
Full Service Partnerships (FSP) are designed as a partnership between enrollees and the service
provider. The FSP service delivery ethic incorporates recovery and cultural competence into the services
and supports offered to consumers. In this partnership, the service provider commits to do "whatever it
takes" and to "meet the client where they are" in order to assist the enrollee achieve their personal
recovery/resiliency and wellness goals.
1.The Target Population is consistent with the population identified in the Fresno County MHSA
Community Planning Process
The target population must meet requirements for SMI/SED diagnosis; and must address reduction of
specific ethnic disparities, as indicated in the MHSA Community Services and Supports proposal on
which the RFP is based.
The target population will include individuals who are not currently served
and meet one or more of the following criteria:
•Homeless•At risk of homelessness -such as youth aging out of foster care or•persons coming out of jail•Involved in the criminal justice system (including adults with child•protection issues)•Frequent users of hospital and emergency room services
or are so underserved that they are at risk of: •Homelessness -such as persons living in institutions or nursing homes
•Criminal justice involvement•Institutionalization
Diagnoses that serve as criteria for inclusion in the target population will be based on definitions found in
5600.3 California Welfare and Institutions code defining severe mental disorder. The operational
definition of "diagnosis" for programs serving the chronically homeless may also include: co-occurring
disorders, personality disorders, general anxiety/mood disorders, and Post Traumatic Stress Disorder).
2.FSP Program Components:
All MHSA FSP Programs must include the following in their program descriptions
•Providers who are part of the multidisciplinary, community based "treatment" teams serve
as an ally to the consumer's recovery process. The partnership allows clients and family
members opportunities for informed choice
o The team description must demonstrate commitment and capacity to do "whatever it
takes" to assist the enrolled member, specifically:•Low staff to client ratio (approximately 1: 12; or the ratio that has been specified in
the RF P's statement of work)•24/7 availability of the multidisciplinary team;•Team culture is created where each member of the team knows each client and
the clients are familiar with each member of the team.
EXIDBTT C--FSP SERVICE DELIVERY MODEL
Page 2 of 4 •Members of the team speak the client's language, are familiar with community
resources that reflect the healing beliefs of the client's culture, and are positioned
to assist the client make meaningful connection with those resources.•Crisis response comes from a person known to the client.•Staff is given the administrative flexibility and flex-funding to connect consumers
with non-mental health services and same day needs. Examples include: Housing;
Primary Care; Dual Disorder Services, Education Services and Supports;
Vocational services and supports; Payee services/benefits advocacy; Community
recreational activities (YMCA classes, libraries, movie theaters); Social Services,
Food, Transportation, and Clothing.•Availability of Integrated Dual Diagnosis Treatment or other dual recovery
intervention that will provide effective treatment for the target population.
•Outreach and engagement. The team's outreach and engagement strategy must be voluntary
and driven by the values of client culture. This means that consumers will be engaged "where
they are" in terms of their community location, their need for clinical and non-clinical
services/supports and their phase of recovery. Outreach workers will have culturally competent
language skills and will function as an ally to the consumer's decision to receive services. Peer
Support will be included in the outreach and engagement of new clients.
•Procedures for enrollment and dis-enrollment will be easily understood, clearly
communicated and non-coercive. Enrollment is voluntary. A condition of enrollment is that the
client indicates that they want services from the assertive-community treatment model team.
•Each adult, older adult, and transition age youth enrollee must have a Personal Service
Coordinator (PSC). The PSC is an ally to the enrollee and acts as a "single point of
responsibility" within the multidisciplinary team for coordinating services and supports. "Personal
Service Coordinators (PSCs) for adults -case managers for children and youth -must have a
caseload that is low enough so that: (1) their availability to the individual and family is appropriate
to their service needs, (2) they are able to provide intensive services and supports when needed,
and (3) they can give the individual served and/or family member considerable personal
attention ... PSCs/case managers must be culturally competent, and know the community
resources of the client's racial ethnic community." (Source: DMH Planning Requirements,
Section Ill Identifying Populations for Full Service Partnerships, Aug 2005)
•Each enrollee must have an Integrated Services and Supports Plan that is developed with
their Personal Services Coordinator. This ISSP is a planning tool that builds on the consumer's
strengths. It includes goals and provides a map of the steps that the enrollee identifies as
necessary to move along his/her recovery path. "Integrated _Services and Supports Plans must
operationalize the five fundamental concepts( identified listed in section three of this Exhibit) and
should reflect community collaboration, be culturally competent, be client/family driven with a
wellness/recovery/resiliency focus and they must provide an integrated service experience for the
client/family. In addition, the ISSP will be person/child-centered, and give individuals and their
families' sufficient information to allow them to make informed choices about the services in which
they participate. Services should also include linkage to, or provision of, all needed services or
benefits as defined by the client and or family in consultation with the PSC!case manager. This
includes the capability of increasing or decreasing service intensity as needed ." (Source: DMH
Planning Requirements, Section Ill Identifying Populations for Full Service Partnerships, Aug
2005)
•Peer support services will be made available to the client. At least two staff (a minimum of 1
FTE) who act in peer support roles will be employed in each MHSA program.
o The enrollee is given significant access to peer recovery and self-help services. Tools
such as Advanced Directives are made available to adult and older adult clients, and
EXHIBIT C--FSP SERVICE DELIVERY MODEL
Page 3 of 4
Wellness Recovery Action Plans (WRAP) are made available to adult, transition age
youth and older adult clients.
o Peer Counselors are included as equal partners in the multidisciplinary team, and play a
critical role in developing the recovery culture and client orientation of the team.
3.The Five (5) Core MHSA Concepts are embedded in each program
Concept 1: Recovery/resiliency orientation:
FSPs will embody the values of recovery and resiliency (i.e., hope, personal responsibility, self
advocacy, choice, respect) and the program principles of recovery and resiliency, including:
•Client-driven goal setting and Individualized Services and Supports Plans
•Providers are allies to the client's recovery process.
•A harm-reduction approach to substance abuse that encourages recovery and
abstinence but does not penalize consumers or withdraw help from them if they are
using.
•A built in understanding and expectation of setbacks as part of recovery.
•Links to a range of services that are part of the consumers "pathway to wellness" (i.e.,
employment, health care, peer support, housing, medications, food and clothing)
FSPs will collaborate with the MHSA Family Education Center which makes support services
available to family members and the MHSA Wellness Recovery Resource Hub which makes
wellness recovery training and technical assistance available to FSP staff.
Concept 2: Cultural Competence Orientation: The program's structure, staffing and service
delivery values will reflect the cultural values and orientation of the program's target populations.
The FSP program will embody principals of cultural competence including: •Diverse staff, representative of the primary ethnic groups to be reached through the program•Staff trained regarding common access barriers for racial and ethnic groups targeted
(including the impact of housing discrimination)•Links to community-based organizations that share the healing beliefs and practices of ethnic
communities served by the FSP.
The FSP program must also be able to deal with gender and sexual orientation diversity. Training
in sensitivity to gender and sexuality issues is a key component for staff on the Team.
Concept 3: Community Collaboration: FSP Collaborations ensure that community resources
are made available to enrollees. These collaborations include subcontracts between the vendor
and other agencies, memoranda of understanding with community non-profits and businesses
regarding providing services to clients, and informal relationships built between FSP staff and
community stakeholders that result in improved access and decreased discrimination.
Concept 4: Client/Family Driven program: In FSPs, the Integrated Services and Supports Plan
(ISSP) is used by adult clients and families of children and youth to identify their needs and
preferences which lead to the services and supports that will be most effective for them.
Providers work in full partnership with clients to develop these ISSPs. Their needs and
preferences drive the policy and financing decisions that affect them.
Concept 5: Integrated Service Experience: FSP programs were incorporated into the MHSA to
ensure that these dollars funded "integrated service experiences." This means that services are
"seamless" to clients and that clients do not have to negotiate multiple agencies and funding
sources to get critical needs met and to move towards recovery and develop resiliency. Services
are delivered, or at a minimum, coordinated through a single agency or a system of care. The
EXHIBIT C--FSP SERVICE DELIVERY MODEL
Page 4 of 4
integrated service experience centers on the individual/family, uses a strength-based approach,
and includes multi-agency programs and joint planning to best address the individual/family's
needs using the full range of community-based treatment, case management, and interagency
system components required by children/transition age youth/adults/older adults.
Exhibit D
Page 1 of 1
Electronic Health Record Software Charges
CONTRACTOR(S) understand that COUNTY utilizes NetSmart’s Avatar for its Electronic Health Records Management.
CONTRACTOR(S) agree to reimburse COUNTY for all user license fees for accessing NetSmart’s Avatar, as set forth below.
Description FY 2018-19 FY 2019-20 FY 2020-21 FY 2021-22 FY 2022-23
Fee Per User/License
NetSmart Avatar Monthly
Hosting Service
(per named user per month)
$ 37.00 $ 37.00 $ 37.00 $ 37.00 $ 37.00
NetSmart Avatar Annual
Maintenance/License*
(per named license per year)
$ 249.95 $ 249.95 $ 249.95 $ 249.95 $ 249.95
OrderConnect License1
(per named license per year)
$ 1,278.00 $ 1,278.00 $ 1,278.00 $ 1,278.00 $ 1,278.00
Reaching Recovery
(per named user per year)
$ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00
Should CONTRACTOR(S) choose not to utilize NetSmart’s Avatar for its Electronic Health Records management, CONTRACTOR(S) will
be responsible for obtaining its own system for Electronic Health Records management.
______________________________________________________________________________________________________________________
*Annual Maintenance increases by 3% each FY on July 1st.
1Includes 100 faxed pages per month. An additional fee of $0.20 per faxed page will apply thereafter.
Exhibit E
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health services.
Mental health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor 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 E
Page 2 of 3
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 E
Page 3 of 3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print): _____________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Signature :________________________________ Date : ___/____/___
For Group or Organizational Providers
Group/Org. Name (print): _______________________________________
Employee Name (print): ________________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Other:___________________________________________
Job Title (if different from Discipline): ___________________________
Signature: _________________________________ Date: ____/___/____
Exhibit F
Page 1 of 3
Documentation Standards For Client Records
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the record
have a specific document or section addressing these topics. All medical records shall be
maintained for a minimum of 10 years from the date of the end of the Agreement.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client record.
• Relevant physical health conditions reported by the client will be prominently identified
and updated as appropriate.
• Presenting problems and relevant conditions affecting the client’s physical health and
mental health status will be documented, for example: living situation, daily activities,
and social support.
• Documentation will describe client’s strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently
documented and updated as appropriate.
• Documentations will include medications that have been described by mental health plan
physicians, dosage of each medication, dates of initial prescriptions and refills, and
documentations of informed consent for medications.
• Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
• A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data, relevant
family information and relevant results of relevant lab tests and consultations reports.
• For children and adolescents, pre-natal and perinatal events and complete developmental
history will be documented.
• Documentations will include past and present use of tobacco, alcohol, and caffeine, as
well as illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A DSM-5 diagnosis, or a diagnosis from the most current ICD, will be documented,
consistent with the presenting problems, history mental status evaluation and/or other
assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document changes in
the client’s condition.
• Client conditions will be assessed at least annually and, in most cases, at more frequent
intervals.
B. Client Plans
Exhibit F
Page 2 of 3
1. Client plans will:
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent) by:
the person providing the service(s), or
a person representing a team or program providing services, or
a person representing the MHP providing services
when the client plan is used to establish that the services are provided under the
direction of an approved category of staff, and if the below staff are not the approved
category,
a physician
a licensed/ “waivered” psychologist
a licensed/ “associate” social worker
a licensed/ registered/marriage and family therapist or
a registered nurse
• In addition,
client plans will be consistent with the diagnosis, and the focus of intervention will be
consistent with the client plan goals, and there will be documentation of the client’s
participation in and agreement with the plan. Examples of the documentation include,
but are not limited to, reference to the client’s participation and agreement in the body
of the plan, client signature on the plan, or a description of the client’s participation
and agreement in progress notes.
client signature on the plan will be used as the means by which the
CONTRACTOR(S) documents the participation of the client
when the client’s signature is required on the client plan and the client refuses or is
unavailable for signature, the client plan will include a written explanation of the
refusal or unavailability.
• The CONTRACTOR(S) will give a copy of the client plan to the client on request.
2. Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for the
individual elements of the client plan described in item 1.
C. Progress Notes
1. Items that must be contained in the client record related to the client’s progress in treatment
include:
• The client record will provide timely documentation of relevant aspects of client care
• Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
Exhibit F
Page 3 of 3
• All entries in the client record will include the signature of the person providing the
service (or electronic equivalent); the person’s professional degree, licensure or job title;
and the relevant identification number, if applicable
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge summary
2. Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated below:
A. Every Service Contact
• Mental Health Services
• Medication Support Services
• Crisis Intervention
Exhibit G
Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with
all State of California and Federal statutes and regulations regarding
confidentiality, including but not limited to confidentiality of information
requirements at 42, Code of Federal Regulations sections 2.1 et seq; California
Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division
10.5 and 10.6 of the California Health and Safety Code; Title 22, California Code
of Regulations, section 51009; and Division 1, Part 2.6, Chapters 1-7 of the
California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer,
Exhibit G
Page 2 of 6
rates of pay or other forms of compensation, use of facilities, and other
terms and conditions of employment.
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 the proposed Agreement will:
1) receive a copy of the company's drug-free workplace policy statement; and,
Exhibit G
Page 3 of 6
2) agree to abide by the terms of the company's statement as a condition of employment
on the Agreement.
Failure to comply with these requirements may result in suspension of payments under
the Agreement or termination of the 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-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
Exhibit G
Page 4 of 6
penal sanction, abusive forms of child labor or exploitation of children in sweatshop
labor. The contractor further declares under penalty of perjury that they adhere to the
Sweatfree Code of Conduct as set forth on the California Department of Industrial
Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108.
b. The 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 the Agreement, the awarding
agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
1). 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.
2). 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):
1). For the two-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.
2). For the twelve-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
Exhibit G
Page 5 of 6
employed by that state agency in a policy-making position in the same general subject
area as the proposed contract within the 12-month period prior to his or her leaving state
service.
If Contractor violates any provisions of above paragraphs, such action by Contractor shall
render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the
provisions which require every employer to be insured against liability for Worker's
Compensation or to undertake self-insurance in accordance with the provisions, and
Contractor affirms to comply with such provisions before commencing the performance
of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it
complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal documentation of
the name change the State will process the amendment. Payment of invoices presented
with a new name cannot be paid prior to approval of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the contracting
agencies will be verifying that the contractor is currently qualified to do business in
California in order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any
transaction for the purpose of financial or pecuniary gain or profit. Although there are
some statutory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of California) must
be in good standing in order to be qualified to do business in California. Agencies will
determine whether a corporation is in good standing by calling the Office of the Secretary
of State.
6. RESOLUTION: A county, city, district, or other local public body must provide the
State with a copy of a resolution, order, motion, or ordinance of the local governing body
Exhibit G
Page 6 of 6
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.
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 10 years from the final date of the contract
period or from the date of completion of any audit, whichever is later.
Federal database checks. Consistent with the requirements at § 455.436 of this chapter,
the State must confirm the identity and determine the exclusion status of
CONTRACTOR, any subcontractor, as well as any person with an ownership or control
interest, or who is an agent or managing employee of CONTRACTOR through routine
checks of Federal databases. This includes the Social Security Administration's Death
Master File, the National Plan and Provider Enumeration System (NPPES), the List of
Excluded Individuals/Entities (LEIE), the System for Award Management (SAM), and
any other databases as the State or Secretary may prescribe. These databases must be
consulted upon contracting and no less frequently than monthly thereafter. If the State
finds a party that is excluded, it must promptly notify the CONTRACTOR and take
action consistent with § 438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under this part
is not located outside of the United States and that no claims paid by a CONTRACTOR
to a network provider, out-of-network provider, subcontractor or financial institution
located outside of the U.S. are considered in the development of actuarially sound
capitation rates.
Exhibit I
Page 1 of 2
FFRREESSNNOO CCOOUUNNTTYY MMEENNTTAALL HHEEAALLTTHH PPLLAANN
GGRRIIEEVVAANNCCEESS AANNDD IINNCCIIDDEENNTT RREEPPOORRTTIINNGG
PPRROOTTOOCCOOLL FFOORR CCOOMMPPLLEETTIIOONN OOFF IINNCCIIDDEENNTT RREEPPOORRTT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit I
Page 2 of 2
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) Where did this happen?
Name/DMH #
1. Background information of the incident:
2. Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
3. Preliminary findings: How did it happen? Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent inconsequential consequential death not applicable unknown
4. Response: a) corrective action, b) Plan of Action, c) other
Completed by (print name)
Completed by (signature) Date completed
Reviewed by Supervisor (print name)
Supervisor Signature Date
Exhibit I
Page 1 of 2
Fresno County Mental Health Plan
Grievances
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 their clients 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.
Exhibit I
Page 2 of 2
Informal provider problem resolution process – the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
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.
Exhibit J
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II. Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses of individuals or corporations under “Remarks” on page 2. Identify each item number to be continued.
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? ...................................................................................... ❒ ❒
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution’s, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under “Remarks” on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under “Remarks.”
NAME ADDRESS EIN
B. Type of entity: ❒ Sole proprietorship ❒ Partnership ❒ Corporation
❒ Unincorporated Associations ❒ Other (specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under “Remarks.”
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers. ..........................................................................................................
❒ ❒
NAME ADDRESS PROVIDER NUMBER
Exhibit J
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) Title
Signature Date Remarks
Exhibit K
Page 1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit K
Page 2 of 2
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;
(c) (d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)
Exhibit L
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”), members
of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must disclose any
self-dealing transactions that they are a party to while providing goods, performing services, or both
for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit L
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(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: