HomeMy WebLinkAboutAgreement A-21-377 with FCSS and RC - Handle with Care Plus.pdfCOUNTY OF FRESNO
Fresno, CA
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AGREEMENT
THIS AGREEMENT is made and entered into this ___________day of _____________, 2021,
by and between the COUNTY OF FRESNO, a political subdivision of the State of California, hereinafter
referred to as “COUNTY”, and each provider listed in Exhibit A “Provider List”, attached hereto and by
this reference incorporated herein and made part of this Agreement, and collectively referred to
hereinafter as, “CONTRACTORS”. Reference in this Agreement to “Party” or “Parties” shall be
understood to refer to COUNTY and each individual CONTRACTOR, unless otherwise spercified.
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), is in need of a
qualified agency, or agencies, to operate a Mental Health Services Act (MHSA) Innovation-funded
school-based trauma response program, which will respond to children and families immediately after a
traumatic or stressful life event to provide early support, including, but not limited to, screening and
assessing children for early indicators of mental health symptoms, empowerment of families with the
tools they need to cope and recover, and connect children and families to any additional necessary
resources, while reduing stigma and discrimination against mental illness; and
WHEREAS, COUNTY, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of
the California Code of Regulations, section 1810.226; and
WHEREAS, CONTRACTORS are qualified, have the staffing, facilities, support services, and
are willing to provide said mental health services at school, home, and/or community locations
throughout Fresno County, pursuant to the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the Parties
hereto agree as follows:
1.SERVICES
A.CONTRACTORS shall perform all services and fulfill all responsibilities as set
forth in Exhibit B, “Scope of Work,” and B-2, “Handle with Care Plus Flow Chart,” which are attached
hereto and incorporated herein by reference and made part of this Agreement.
B.CONTRACTORS shall also perform all services and fulfill all responsibilities as
specified in the MHSA Innovation Plan approved by the Board on July 7, 2020 and submitted to the
21st September
Agreement No. 21-377
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Mental Health Services Oversight and Accountability Commission’s (MHSOAC), which is incorporated
herein by reference and, to the extent this Agreement differs from the MHSA Innovation Plan, is revised
by this Agreement.
C. CONTRACTORS shall align programs, services, and practices with the vision,
mission, and guiding principles of the County of Fresno, Department of Behavioral Health, as further
described in Exhibit D, “Fresno County Department of Behavioral Health Guiding Principles of Care
Delivery”, attached hereto and by this reference incorporated herein and made part of this Agreement.
D. CONTRACTORS shall send to DBH, upon execution of this Agreement, a detailed
plan ensuring appropriate leadership and supervision of their portion of the program described in this
Agreement. Recruitment and retention of leadership to oversee services and program design presented
herein shall be included in this plan. A description and monitoring of this plan shall be provided to DBH.
E.It is the expectation of the COUNTY that CONTRACTORS provide timely access to
services. COUNTY requires that CONTRACTORS monitor and track the timeliness of services to clients
from actual service request to actual first service session. CONTRACTORS shall also provide tracking
tools and measurements for effectiveness, efficiency, and client satisfaction indicators as required by
Commission on Accreditation of Rehabilitation Facilities (CARF) standards and as further detailed in
Exhibit B-1, DBH’s Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes Measures,
attached hereto and incorporated in this Agreement by reference.
F.It is acknowledged by all Parties hereto that DBH’s Contracts Division unit shall
monitor this program operated by CONTRACTORS, in accordance with Section Fourteen (14) of this
Agreement.
G.CONTRACTORS shall participate in monthly, or as needed, workgroup meetings
consisting of staff from DBH to discuss service requirements, data reporting, training, policies and
procedures, overall program operations and any problems or foreseeable problems that may arise.
CONTRACTORS shall also participate in other COUNTY meetings, such as but not limited to QI
meetings, provider meetings, Behavioral Health Board meetings, etc.
H.It is acknowledged by all Parties hereto that there will be up to a 30 day ramp up
period following the full execution of this contract to allow for staff hires, staff trainings, and other
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program-related factors. The dates of the ramp up period may be adjusted with the written approval of
the Parties.
I.It is acknowledged by all Parties hereto that CONTRACTORS’s service sites
shall be as identified in Exhibit B. Any change/addition/deletion to CONTRACTORS(S) location of the
service sites may be made only upon 30 (thirty) days advance written notification to DBH’s Director and
upon written agreement of the Parties.
J.It is mutually agreed by Parties to this Agreement, that the program funded under
this Agreement shall be identified as Handle with Care Plus. All print of media materials, including
program branding and program preferences shall be reviewed and approved in partnership between
CONTRACTORS and DBH. The program funded under this Agreement shall be identified as a joint
program of CONTRACTORS and DBH.
2.TERM
The term of this Agreement shall become effective upon execution and shall terminate
on the 30th day of June 2024. There are no options to extend this Agreement as these are the terms
funded by the MHSA Innovations Plan via the MHSOAC.
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 CONTRACTORS thrity (30) days advance written notice.
B.Breach of Contract – A Party may terminate this Agreement only upon the other
Party’s material breach of one or more provisions of this Agreement; after the non-breaching Party has
(Parties have) given the breaching Party thirty (30) days advance written notice of the termination; and,
an opportunity has been provided within 30 days of the date on which the non-breaching Party(ies)
received the breaching Party’s notice, to cure the material breach and to notify the other Party(ies) in
writing when such cure has been completed. If the breaching Party has not cured the material breach
upon expiration of the 30 days or any extension thereof agreed upon by the Parties, this Agreement
shall terminate effective 12:00 midnight on the 30th day or the last day of the extension (if any) without
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any further notice or action by any Party.
C.Rights and Obligations Upon Termination – Upon termination of this Agreement,
COUNTY shall pay CONTRACTOR(S) for all invoices and services that CONTRACTOR(S) performs
before the effective date of termination of this Agreement. Such payment to be made within forty-five
(45)days of the effective date of termination of this Agreement and COUNTY’s receipt of
CONTRACTOR’S(S’) invoice. The provisions of this Subsection shall survive the termination of this
Agreement.
D.Force Majeure – A Party is not liable for failing or delaying performance of its
obligations under this Agreement due to events that are beyond the Party’s reasonable control and
occurring without its fault or negligence, for example, acts of God such as epidemics or pandemics
(nationally, statewide, or locally declared), tornadoes, lightning, earthquakes, hurricanes, floods, or
other natural disasters (collectively “Force Majeure”), provided that the Party has promptly notified the
other Party in writing of the occurrence of the Force Majeure, except that a Force Majeure shall not
excuse COUNTY’s payment to CONTRACTOR(S) of any portion of compensation that is due to
CONTRACTOR(S).
E.Without Cause - Under circumstances other than those set forth in A-D of this
Section, this Agreement may be terminated without cause by CONTRACTORS or COUNTY or DBH’s
Director, or designee, upon the giving of thirty (30) days’ advance written notice.
4.COMPENSATION
COUNTY agrees to pay CONTRACTORS and CONTRACTORS agrees to receive
compensation in accordance with the Budgets set forth in Exhibits C-1 and C-2, attached hereto and by
this reference incorporated herein and made part of this Agreement. FCSS’s “Service Rate Sheet” off
of which FCSS’s budget is based, in part, is attached hereto and incorporated by this reference into this
Agreement at Exhibit C-3.
A.Maximum Contract Amount
The maximum amount payable to CONTRACTORS for the period upon execution of this
Agreement through June 30, 2022 shall not exceed three hundred fourty one thousand, five hundred
thirty nine and No/100 Dollars ($341,539.00).
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The maximum amount payable to CONTRACTORS for the period of July 1, 2022
through June 30, 2023 shall not exceed three hundred fifty seven thousand, two hundred eighty nine
and No/100 Dollars ($357,289.00).
The maximum amount payable to CONTRACTORS for the period of July 1, 2024
through June 30, 2024 shall not exceed three hundred sixty two thousand, six hundred thirty two and
No/100 Dollars ($362,632.00).
In no event shall the maximum contract amount, for the full contract term upon execution
of this Agreement through June 30, 2024, for all the services provided by the CONTRACTORS to
COUNTY under the terms and conditions of this Agreement be in excess of one million, sixty one
thousand, four hundred sixty and No/100 Dollars ($1,061,460.00) during the total term of this
Agreement.
B.It is understood by COUNTY and CONTRACTORS that if there is the capability of
Medi-Cal revenue being generated due to services provided from the program, any Medi-Cal revenue
and/or client fee reimbursement will be used to directly offset the COUNTY’s contribution of MHSA
Innovation Plan funds identified in Exhibits C-1 and C-2. The offset of funds will be clearly identified in
monthly invoices received from CONTRACTORS as further described in Section Five (5) of this
Agreement.
C.Travel shall be reimbursed based on actual expenditures and mileage
reimbursement shall be at CONTRACTORS’s adopted rate per mile, not to exceed the Federal Internal
Revenue Services (IRS) published rate.
D.It is understood that all expenses incidental to CONTRACTORS’s performance of
services under this Agreement shall be borne by CONTRACTORS.
E.Payments shall be made by COUNTY to CONTRACTORS 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) of this Agreement. Payments shall be
made after receipt and verification of actual expenditures incurred by CONTRACTORS for monthly
program costs, as identified in Exhibits C-1 and C-2, 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
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expenditures.
F.All final invoices and/or any final budget modification requests shall be submitted by
CONTRACTORS within sixty (60) days of June 30, 2024. COUNTY shall not be obligated to make any
payments under this Agreement if the request is received by COUNTY more than sixty (60) days after
June 30, 2024. Any compensation which is not expended by CONTRACTORS pursuant to the terms and
conditions of this Agreement shall automatically revert to COUNTY.
G.The services provided by CONTRACTORS 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 CONTRACTORS. 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 forty-five (45) days from the date funds are
received by COUNTY from the State.
H.A CONTRACTOR shall be held financially liable for any and all future
disallowances/audit exceptions due to that CONTRACTOR’s defiency discovered through the State audit
process and COUNTY utilization review during the course of this Agreement. At COUNTY’s election, the
disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall be
withheld from subsequent payments to that CONTRACTOR. CONTRACTORS shall not receive
reimbursement for any units of service rendered that are disallowed or denied by the Frenso 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 CONTRACTORS prior to any State audit process and/or
COUNTY utilization review. To the extent allowable by law, CONTRACTORS 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, the relevant
CONTRACTOR shall be given at least ten (10) business days to respond to such proposed
disallowances/audit exceptions.
I.Settlements with State Department of Health Care Services (DHCS)
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COUNTY and CONTRACTORS agree to settle dollar amounts disallowed or settled in
accordance with DHCS audit settlement findings related to the reimbursement provided under this
Agreement. CONTRACTORS will participate in the several phases of settlements between
COUNTY/CONTRACTORS and State 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 CONTRACTORS’ 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, State 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 reported on
the CONTRACTORS’ legal entity cost report. COUNTY may choose to appeal and therefore reserves
the right to defer payback settlement with CONTRACTORS until resolution of the appeal. State 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 CONTRACTORS, it will require the
CONTRACTORS to repay the Medi-Cal related overpayment back to the COUNTY.
5. INVOICING
A. CONTRACTORS shall invoice COUNTY in arrears by the tenth (10th) day of each
month for actual expenses incurred during the prior month electronically to: 1)
dbhinvoicereview@fresnocountyca.gov, 2) dbh-invoices@fresnocountyca.gov; and 3)
dbhcontractedservicesdivision@fresnocountyca.gov with a copy to the assigned DBH Staff Analyst.
After CONTRACTORS render service to referred clients, CONTRACTOR will invoice COUNTY for
payment, certify the expenditures, 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
to Medi-Cal, including contracted cost per unit and actual cost per unit. COUNTY must pay
CONTRACTORS before submitting a claim to DHCS for Federal Reimbursement for Medi-Cal eligible
clients.
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B.At the discretion of DBH ‘s Director or designee, if an invoice is incorrect or is
otherwise not in proper form or substance as provided for in Section Five (5) of this Agreement, DBH ‘s
Director or designee, shall have the right to withhold payment as to only that portion of the invoice that is
incorrect or improper after five (5) days prior notice to CONTRACTORS. CONTRACTORS 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 is still not corrected to DBH’s satisfaction, DBH ‘s
Director or designee, may elect to terminate this Agreement, pursuant to the termination provisions stated
in Section Three (3) of this Agreement. In addition, for invoices received sixty (60) days after the expiration
of each term of this Agreement or termination of this Agreement, at the discretion of DBH’s Director or
designee, DBH shall have the right to deny payment of any additional invoices received.
C.If DBH does not provide notice of incorrect or otherwise improper invoices and
causes delay in the reimbursement process, CONTRACTORS will follow the escalation process through
the DBH Business Office’s Invoice Review Team, up to the Business Manager, and including the DBH
Director and/or designee for the timely reimbursement of payment to CONTRACTORS.
D.CONTRACTORS shall submit to the COUNTY by the tenth (10th) of each month, an
invoice and a detailed general ledger (GL), itemizing costs incurred in the previous month. Unallowable
costs such as lobbying or political donations must be deducted from the monthly invoice reimbursements.
The invoices and general ledgers will serve as tracking tools to determine if CONTRACTORS’s program
costs are in accordance with its budgeted cost. Failure to submit reports and other supporting
documentation will result in an incomplete invoice submission and shall be deemed sufficient cause for
COUNTY to withhold payments until there is compliance, as further described in Section Five (5) herein.
Invoices shall be provided in the format requested by DBH. If there are changes to the invoicing
requirements or processes, DBH will informed CONTRACTORS of changes at least thirty (30) days in
advance of when the invoice is due.
E.CONTRACTORS 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
CONTRACTORS’ usual and customary charge prevalent in the public mental health sector that is used to
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bill the general public, insurers or other non-Medi-Cal third party payers during the course of business
operations.
F.CONTRACTORS must maintain financial records for a period of ten (10) years or
until any dispute, audit or inspection is resolved, whichever is later. CONTRACTORS will be responsible
for any disallowances related to inadequate documentation.
G.If CONTRACTORS chooses to utilize the COUNTY’s electronic health record
system (currently AVATAR, the preferred EHR system by DBH) method as their own full electronic health
records system, DBH shall invoice CONTRACTORS in arrears by the fifth (5th) day of each month for the
prior month’s hosting fee for access to the COUNTY’s electronic information system in accordance with the
fee schedule as set forth in Exhibit E, “Electronic Health Records Software Charges” attached hereto and
incorporated herein by this reference and made part of this Agreement. COUNTY shall invoice
CONTRACTORS 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 E. COUNTY shall
invoice CONTRACTORS annually for the Reaching Recovery fee, as applicable, for access to the
COUNTY’s electronic information system in accordance with the fee schedule as set forth in Exhibit E.
CONTRACTORS 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 CONTRACTORS of the invoicing provided by
COUNTY. COUNTY agrees that any charges for this EHR may be added to CONTRACTORS budgets at
Exhibits C-1 and C-2 as a cost related to running the program provided for in this agreement. COUNTY
further agrees not to double-charge FCSS for any fees already paid for the EHR system in place under the
June 5, 2018 All 4 Youth Partnership Agreement (Agreement Number 18-208.)
H.It is further understood that CONTRACTORS providing Medi-Cal services and
activities, as part of this Innovation Project, will track and report such services and revenue according to
regulations of the Mental Health Plan although CONTRACTORS providing Medi-Cal services and activities
are not held to any Federal and State reimbursement and/or revenue goals, as such, none are proposed in
this Agreement. For Federal and State reimbursement claiming for provided Medi-Cal services and
activities, CONTRACTORS will use already established rates of service (or cost per unit) within
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CONTRACTORS’ currently approved Organization Provider status with the Mental Health Plan.
6. DISPUTE RESOLUTION
The Parties shall meet and confer in good faith to resolve any dispute between them
arising out of, resulting from, or relating to this Agreement, including any Claim or Loss for which a
Party seeks indemnity pursuant to Section Seven (7) of this Agreement and any dispute relating to this
Agreement that arises related to, or occurs after, the termination of this Agreement. During a dispute
regarding payment under this Agreement, COUNTY shall pay CONTRACTOR(S) the portion of the
compensation that is undisputed and due to CONTRACTOR(S); if a disputed portion of the
compensation is determined in a Final Determination to be due to CONTRACTOR(S), COUNTY shall
pay such amount to CONTRACTOR(S) within forty-five (45) days of the date of the Final Determination,
unless a different date is stated in the Final Determination or in an agreement executed by the Parties,
in which case, COUNTY shall pay CONTRACTOR(S) in accordance therewith. Except for an action to
preserve the status quo and/or prevent irreparable harm, a Party shall not commence any cause of
action, action, lawsuit, or proceeding arising out of, resulting from, or relating to this Agreement until
after the Party has complied with the provisions of this Section. The provisions of this Section shall
survive the termination of this Agreement.
7. INDEMNITY
Each Party’s indemnity, defense, and hold harmless obligations to the other Party under
or related to this Agreement shall be governed solely by this Article. A Party (“Indemnitor”) shall: (A)
indemnify and hold harmless the other Party (“Indemnitee”) to the full extent permitted by California
laws for any Loss sustained by Indemnitee or a Third Party only in proportion to Indemnitor’s liability
based on a Final Determination; and (B) defend and pay for all of Indemnitor’s attorney’s fees and
litigation costs related to any Claim or Loss without any right against or from the Indemnitee for
indemnity and/or hold harmless of such costs and fees, or any right for defense. A Party who intends to
seek or seeks indemnity and/or hold harmless for any Loss from the other Party shall notify the other
Party in writing and within a reasonable time after the Party knows or becomes aware of any Claim that
may or will result in a Loss, describing, if known or determinable, the pertinent circumstances, all
entities and persons involved, and the amount being claimed. A Party’s obligations under this Article
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are not limited to or by any insurance that it maintains or the lack of insurance but apply to the full
extent permitted by California laws, and shall survive the termination of this Agreement. “Claim” means
any claim, demand, lawsuit, cause of action, action, cross-complaint, cross-action, and/or proceeding
arising out of, resulting from, or relating to this Agreement where there has been no Final
Determination. “Loss” means any bodily injury, property damage, personal injury, advertising injury,
liability, loss, damage, judgment, expense, and/or cost (excluding attorney’s fees and litigation costs
that a Party or a Third Party incurred or paid related to a Loss or Claim) arising out of, resulting from, or
relating to this Agreement and for which there has been a Final Determination that a Party is or both
Parties are liable. “Third Party” means a person who or an entity that is not any of the following: (A) a
Party; (B) an owner, director, officer, employee, or agent of COUNTY; (C) an officer, employee, or
agent of either CONTRACTOR; or, (D) contracted with (whether directly or through a subcontract of
any level) or otherwise retained by a Party to act for or on the Party’s behalf. “Final Determination”
means any judgment, order, or decision, each a “Determination,” by a court of competent jurisdiction or
a governmental entity with jurisdiction to render the Determination where the Determination is not
subject to appeal or the period for an appeal has expired.
8.INDEPENDENT CONTRACTOR, ASSIGNMENT, AND TRANSFER
Each Party is an independent contractor, and it and its officers, employees, and agents
are not, and shall not represent themselves as, officers, employees, or agents of the other Party. This
Agreement does not and shall not be construed to create an employment or agency relationship,
partnership, or joint venture between the Parties. Each Party shall not assign or transfer any or all of its
obligations and/or rights under this Agreement, including by operation of law or change of control or
merger or through subcontract, without the other Parties’ prior written consent.
Because of their status as independent contractors, the Parties shall have absolutely no
right to employment rights and benefits available to other Parties’ employees. Each Party shall be solely
liable and responsible for providing to, or on behalf of, its employees all legally-required employee benefits.
In addition, the Parties shall be solely responsible and save each other harmless from all matters relating
to payment of each Party’s own employees, including compliance with Social Security, withholding, and all
other regulations governing such matters. It is acknowledged that during the term of this Agreement, the
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Parties may be providing services to others unrelated to each other and/or to this Agreement.
9.MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent of
all the Parties without, in any way, affecting the remainder.
Notwithstanding the above, minor changes to services, staffing, and responsibilities of
CONTRACTORS, as needed, to accommodate changes in the laws relating to mental health treatment, as
set forth in Exhibits B and B-2 may be made with the signed written approval of DBH’s Director or
designee and CONTRACTORS through an amendment approved by COUNTY’s County Counsel and the
COUNTY’s Auditor-Controller/Treasurer-Tax Collector’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, as set forth
in Exhibits C-1 and C-2 that do not exceed ten percent (10%) of the maximum compensation payable to
the CONTRACTORS, may be made with the written approval of DBH’s Director, or designee, and
CONTRACTORS. Modifications shall not result in any change to the maximum compensation amounts
payable to CONTRACTORS, as stated in this Agreement.
10.INSURANCE
Each Party, at its sole expense and throughout the term of this Agreement, shall maintain in
effect insurance or self-insurance providing coverage that complies, at a minimum, with the following
requirements, and shall provide written proof of such insurance to the other Parties upon another Party’s
request as follows:
A.Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million
Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million
Dollars ($4,000,000). This policy shall be issued on a per occurrence basis.
B.Automobile Liability
Automobile Liability Insurance with limits of not less than One Million Dollars
($1,000,000) per occurrence. Coverage must include any auto used in
connection with this Agreement.
C.Real and Property Insurance
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CONTRACTORS 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 COUNTY purchase and owned property, at a minimum, as
discussed in Section Twenty Four (24) of this Agreement.
All Risk Property Insurance
As applicable, CONTRACTORS will provide property coverage for the full
replacement value of the COUNTY’S personal property in possession of
CONTRACTORS 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
If Parties employ licensed professional staff (e.g. Ph.D., R.N., L.C.S.W., M.F.T.)
in providing services, Professional Liability Insurance with limits of not less than
One Million Dollars ($1,000,000) per occurrence, Three Million Dollars
($3,000,000) annual aggregate. Parties agree that each 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. Worker's Compensation
A policy of Worker’s Compensation Insurance as may be required by the
California Labor Code.
Each Party waives its right to recover from the other Party, its Board, officers,
agents, and employees, any amounts paid by the policy of worker’s compensation
insurance required by this Agreement. Each Party is solely responsible to obtain
any endorsement to such policy that may be necessary to accomplish such waiver
of subrogation, but the Party’s waiver of subrogation under this Subsection is
effective whether or not the Party obtains such an endorsement.
F. Child Abuse/Molestation and Social Services Coverage
Either separate policies or an umbrella policy with endorsements covering
Molestation and Social Services Liability coverage or have a specific
endorsement on their General Commercial liability policy covering 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.
G. Cyber Liability
Cyber Liability Insurance, with limits not less than Two Million Dollars
($2,000,000) per occurrence or claim, Two Million Dollars ($2,000,000)
aggregate. Coverage shall be sufficiently broad to respond to duties and
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obligations undertaken by CONTRACTORS 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.Additional Requirements Relating to Insurance
Endorsements to the Commercial General Liability insurance naming the other
Party, its boards, officers, agents, and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primary insurance
and any other insurance, or self-insurance, maintained by the other Party, its
boards, officers, agents, and employees shall be excess only and not contributing
with insurance provided under the policies herein. This insurance shall not be
cancelled or changed without a minimum of thirty (30) days advance written notice
given to the other Party.
Should the law pertaining to this Agreement or any Party to this Agreement change
during the term of this Agrement in a way that would affect the insurance amounts
or types described in Section Ten (10) of this Agreement, the affected Party or
Parties agrees/agree to obtain said legally required change in insurance amounts or
type within the timeframe required by the change in law. Within thirty (30) days of
obtaining this insurance, proof of coverage shall be provided to the other Parties.
Within thirty (30) days from the date of the Full Execution of this Agreement, the Parties
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: Mental Health Contracted Services Division or electronically to
dbhcontractedservicesdivision@fresnocountyca.gov with a copy to the assigned DBH Staff Analyst and to
the CONTRACTORS’ agents listed in Exhibit A, stating that such insurance coverages have been obtained
and are in full force.
In the event that any Party fails to keep in effect at all times insurance coverage as herein
provided, any Party may, in addition to other remedies it may have, suspend or terminate with cause in
accordance with Section Three (3), Subsection (B), above.
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 or equivalent self insurance.
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11.LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTORS and CONTRACTORS’ staff
shall maintain all necessary licenses, permits, approvals, certificates, waivers, and exemptions necessary
for the provision of the services provided for in this Agreement 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. Each CONTRACTOR shall notify COUNTY immediately in writing of its inability
to obtain or maintain such licenses, permits, approvals, certificates, waivers and exemptions irrespective of
the pendency of any appeal related thereto. Additionally, CONTRACTORS and CONTRACTORS’ staff
shall comply with all applicable laws, rules or regulations, as may now exist or be hereafter changed
regarding all necessary licenses, permits, approvals, certificates, waivers, and exemptions.
12.RECORDS
CONTRACTORS 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 records of services provided, including the
goals and objectives of the treatment plan, and how the therapy provided is achieving the goals and
objectives. All records shall be maintained for a minimum of 10 years from the date of the end of this
Agreement.
13.REPORTS
A.Outcome Reports
CONTRACTORS shall submit to DBH service outcome reports as described in
Exhibit B-1. The Parties agree to complete any additional outcome reports required by the State of
California during the term of this Agreement. Any additional outcome reporting shall be agreed upon in
partnership with all Parties.
B.Staffing Reports
CONTRACTORS shall submit monthly staffing reports. These reports shall identify
all staff related to this agreement only, ethnicity and lanauge detail of this staff, and actual hours (FTE)
worked by this staff. This report shall also include, if applicable, any relevanat staff licensure and the dates
of validity of that relevant licensure. Montly staffing reports shall be submitted by the tenth (10th) of each
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month for the prior month’s staff to dbhcontractedservicesdivision@fresnocounty.gov with a copy to the
assigned DBH Staff Analyst.
B.MHSA Innovation Reporting
It is understood that COUNTY and CONTRACTORS are responsible for providing
reports and contributing to the evaluation of this pilot project to the MHSOAC as outlined in the approved
MHSA Innovation Plan submitted and approved by COUNTY’s Board of Supervisors on July 7, 2020,
which is incorporated herein by reference. Outcomes data and report requirements may be changed in
consulation and agreement with all Parties.
C. Additional Reports
In addition, CONTRACTORS shall submit to DBH by the tenth (10th) of each
month all monthly activity and budget reports for the preceding month. CONTRACTORS shall also
furnish to COUNTY such statements, records, reports, data, and other information as DBH may request
pertaining to matters covered by this Agreement as required by MHSOAC. In the event that
CONTRACTORS 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, CONTRACTORS 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.
D.Cost Report
CONTRACTORS agree to submit a complete and accurate detailed cost report to the
DBH on an annual basis for each fiscal year ending June 30 in the format prescribed by the State
DHCS for the purposes of Short Doyle Medi-Cal reimbursements and total costs for programs. The
cost report will be the source document for several phases of settlement with the State DHCS for the
purposes of Short Doyle Medi-Cal reimbursement. CONTRACTORS shall report costs under their
approved legal entity number established during the Medi-Cal certification process. The information
provided applies to CONTRACTORS for program related costs for services rendered to Medi-Cal and
non Medi-Cal clients. The CONTRACTORS will remit a schedule to provide the required information on
published charges for all authorized services. The report will serve as a source document to determine
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each 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 payors during the course of
business operations. CONTRACTORS must report all collections for Medi-Cal/Medicare services and
collections. The CONTRACTORS shall also submit with the cost report a copy of each
CONTRACTOR’s general ledger that supports revenues and expenditures and reconciled detailed
report of reported total units of services rendered under this Agreement to the units of services reported
by CONTRACTORS to COUNTY’S electronic information system.
Each fiscal year ending June 30, CONTRACTOR shall remit a hard copy of their annual
cost report with a signed cover letter and requested support documents to County of Fresno, Attention:
DBH Cost Report Team, PO Box 45003, Fresno CA 93718. In addition, CONTRACTOR shall remit an
electronic copy or any inquiries to DBHcostreportteam@co.fresno.ca.us. COUNTY shall provide
instructions for the cost report, cost report training, State DHCS cost report template worksheets, and
deadlines to submit the cost reports as determined by the State each fiscal year.
All cost reports must be prepared in accordance with General 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.
If the CONTRACTOR does not submit the cost report by the deadline, including any
extension period granted by the COUNTY, the COUNTY may withhold payments of pending invoicing
under compensation until the cost report has been submitted and clears COUNTY desk audit for
completeness.
14.MONITORING
CONTRACTORS agree to extend to COUNTY’s staff and DBH’s Director or designee, and
the State DHCS or its designee, the right to review and monitor records, services, or procedures, at any
time, in regard to those served under this Agreement, as well as the overall operation of CONTRACTORS
performance related to this Agreement so long as such review is permitted by law. Any review must be in
accordance with the partnership duties of DBH under this Agreement.
///
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15.COMPLIANCE WITH APPLICABLE LAW AND GRANT
Each Party shall comply with all laws and related regulations applicable to its
performance of this Agreement, and all laws and related regulations for which it agrees to comply under
this Agreement (collectively and separately referred to as “Applicable Law” and shall include any
amendment thereto and laws and related regulations that are effective as of the Effective Date or that
become effective during the Agreement Term). Each Applicable Law is deemed inserted herein;
however, if any conflict or inconsistency exists between a provision in this Agreement and a provision in
an Applicable Law, the provision in this Agreement shall govern except where the provision in this
Agreement is specifically prohibited or void by the Applicable Law in which case the provision in the
Applicable Law shall govern to the extent provided in the Applicable Law. Each Party shall comply with
the terms and conditions of each grant (if any) that provides funding for this Agreement and all
applicable laws, regulations, and requirements.
16.COMPLIANCE WITH FRESNO COUNTY MENTAL HEALTH PLAN COMPLIANCE
PROGRAM CODE OF CONDUCT AND ETHICS
CONTRACTORS agree to comply with the COUNTY’s Contractor Code of Conduct and
Ethics and the COUNTY’s Compliance Program in accordance with Exhibit G 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, CONTRACTORS shall have all of CONTRACTOR’s employees
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. CONTRACTORS shall
ensure that within thirty (30) days of hire, all new employees providing services under this Agreement
shall certify in writing that he or she has received, read, understood, and shall abide by the Contractor
Code of Conduct and Ethics. CONTRACTORS understand that the promotion of and adherence to the
Code of Conduct is an element in evaluating the performance of CONTRACTORS and their
employees. Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees providing services under this Agreement shall complete general compliance training and
appropriate employees complete documentation and billing or billing/reimbursement training. All new
employees shall attend the appropriate training within thirty (30) days of hire. Each individual who is
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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. Each
CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed upon
COUNTY by the Federal Government as a result of that CONTRACTOR’s violation of the terms of this
Section of the Agreement.
17.COMPLIANCE WITH STATE MENTAL HEALTH REQUIREMENTS AND INCIDENT
REPORTING
CONTRACTORS recognize 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. CONTRACTORS shall
adhere to all State requirements, including those identified in Exhibit H, “State Mental Health
Requirements”, attached hereto and by this reference incorporated herein and made part of this
Agreement.
CONTRACTORS shall also file an incident report for all incidents involving consumers,
following the Protocol for Completion of Incident Report as described in Exhibit I, attached hereto and
by this reference incorporated herein and made part of this Agreement.
18.COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTORS shall be required to maintain organizational provider certification by
COUNTY. CONTRACTORS must meet Medi-Cal organization provider standards as listed in Exhibit J,
“Medi-Cal Organizational Provider Standards”, attached hereto and by this reference incorporated herein
and made part of this Agreement. It is acknowledged that all references to Organizational Provider and/or
Provider in Exhibit J shall refer to CONTRACTORS.
CONTRACTORS shall inform every client of their rights under the COUNTY's Mental
Health Plan as described in Exhibit K, “Mental Health Plan Grievances and Appeals Process”, attached
hereto and by this reference incorporated herein and made part of this Agreement.
CONTRACTORS shall also file an incident report for all incidents involving clients, following
the DBH “Incident Reporting and Intensive Analysis” policy and procedure guide and using the “Incident
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Report” protocol and user guide identified in Exhibit I.
Each CONTRACTOR is responsible for collecting and managing data in a manner to be
determined by DHCS and COUNTY’s Mental Health Plan (MHP) 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. CONTRACTORS must attend the DBH
training on equipment reporting for assets, intangible and sensitive minor assets, COUNTY’s electronic
information system, and related cost reporting.
CONTRACTORS shall submit service data into COUNTY’s electronic information system,
in accordance with DBH documentation standards, to allow COUNTY to bill Medi-Cal, and any other third-
party source, for services and meet State and Federal reporting requirements.
CONTRACTORS 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. CONTRACTORS
will be responsible for compliance as of the effective date of each Federal, State, or local law or regulation
specified.
If a client has dual coverage, such as other health coverage (OHC) or Federal Medicare,
CONTRACTORS will be responsible for billing the carrier and obtaining a payment/denial or have
validation of claiming with no response ninety (90) days after the claim was mailed before the service can
be entered into COUNTY’s electronic information system. CONTRACTORS must report all third party
collections for Medicare, third party, 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 ro CMS 1500 form is required
as documentation. CONTRACTORS must reorpt 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.
CONTRACTORS shall submit monthly invoices for reimbursement that equal the amount due
CONTRACTORS less any funding sources not eligible for Federal and State reimbursement.
CONTRACTORS must comply with all laws and regulations governing the Federal Medicare program,
including, but not limited to: 1) the requirement of Medicare Act, 42, U.S.C. section 1395 et seq.; and 2) the
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regulation and rules promulgated by the Federal Centers for Medicare and Medicaid Services as they
related to participation, coverage and claiming reimbursement. COTNRACTORS will be responsible for
compliance as of the effective date of each Federal, State or local law or regulation specified.
Data entry shall be the responsibility of CONTRACTORS. COUNTY shall monitor the
volume of services and cost for 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
CONTRACTORS shall be the sole responsibility of CONTRACTORS. CONTRACTORS will comply with
all applicable policies, procedures, directives and guidelines regarding the use of COUTNY’s electronic
information system.
Medi-Cal Certification and Mental Health Plan Compliance
CONTACTORS shall comply with any and all requests and directives associated with
COUNTY maintaining State Medi-Cal site certification. CONTRACTORS shall provide specialty mental
health services in accordance with COUNTY’s Mental Health Plan. CONTRACTORS must comply with the
“Fresno County Mental Health Plan Compliance Program and Code of Conduct” set forth in Exhibit G.
CONTRACTORS shall compy with any and all requests associated with any State and/or Federal reviews
or audits.
CONTRACTORS may provide direct specialty mental health services using unlicensed
staff as long as the individual is approved as a provider by the Mental Health Plan, is supervised by
licensed staff who meet the Board of Behavioral Sciences requirements for supervision, works within
his/her scope, and only delivers allowable direct specialty mental health services. Unlicensed staff must
also be credentialed by COUNTY’s Mental Health Plan.
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. CONTRACTORS
shall be responsible for audit exceptions to ineligible dates of services or incorrect application of utilization
review requirements. CONTRACTOR shall comply with any and all requests associated with any State
and/or Federal reviews or audits.
19.CONFIDENTIALITY
If any documents and/or information (for example, and not as a limitation, employee or
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student records, or protected health information (PHI)) that are subject to nondisclosure or protection
under federal and/or California laws (collectively and separately “Confidential Material”) are provided to,
or created by, a Party for or pursuant to this Agreement, each Party shall: (A) not release, disseminate,
publish, or disclose the Confidential Material, except as required by law or a court order or as this
Agreement may permit; (B) unless specifically permitted by applicable laws, not use the Confidential
Materials for any purpose not related to a Party’s performance of this Agreement; (C) protect and
secure the Confidential Material, including Confidential Material saved or stored in an electronic form, to
ensure that it is safe from theft, loss, destruction, erasure, alteration, and unauthorized viewing,
duplication, and use; (D) acknowledge that any Confidential Material related to students shall be the
property of and under the control of the Party whose student it relates to, notwithstanding any use
authorized under this Agreement or its status as Work; and (E) not retain any Confidential Material
related to a student of the other Party upon the expiration of this Agreement, which shall be
accomplished by either the return of or the destruction of such Confidential Material. The provisions of
this Subsection shall survive the termination of this Agreement.
20.FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT
FCSS considers and represents itself as an educational agency as defined in the Family
Education Rights and Privacy Act (“FERPA”), which is found in Title 20 of the United States Code section
1232g and Title 34 of the Code of Federal Regulations Part 99. FCSS is also a “school district” as defined
in California Education Code section 49061 and must comply with California’s pupil records laws as found
in California Education Code sections 49060 et seq. and title 5 of the California Code of Regulations
sections 430 et seq. As such, FCSS agrees to use and disclosure pupil records as required by law.
The Parties agree that, pursuant to Title 34 of the Code of Federal Regulations section
99.31(a)(1)(i)(B) and California Education Code section 49076(a)(2)(G), COUNTY and RESILIENCY
CENTER are contractors and consultants within the meaning of FERPA to whom FCSS has outsourced
institutional services or functions that provide a legitimate educational interest for sharing personally
identifiable information (“PII”) from pupil records in order to accomplish the functions, activities, or
services provided for in this Agreement. The uses and disclosures of PII may not be more expansive
than those afforded to FCSS employees. COUNTY and RESILIENCY CENTER shall comply with all
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rules and laws related to contractors and consultants under FERPA.
This provision allows FCSS to share information and records regarding those served
under this Agreement with COUNTY and RESILIENCY CENTER. Morever, FCSS can share
information under both FERPA and related California law due to the emergency nature of the services
provided pursuant to this Agreement.
21.HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY considers and represents itself as a covered entity as defined by the
UnitedStates’ Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA),
and the California Medical Information Act (CMIA), California Civil Code section 56 et. seq., and agrees to
use and disclose PHI as required by law.
COUNTY acknowledges that the exchange of PHI pursuant to this Agreement is only for
treatment, payment, and health care operations.
COUNTY intends to protect the privacy and provide for the security of PHI pursuant to the
Agreement in compliance with HIPAA, the Health Information Technology for Economic and Clinical Health
Act, Public Law 111-005 (HITECH), and regulations promulgated thereunder by the United States’
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 COUNTY
to enter into a contract containing specific requirements prior to the disclosure of PHI, as set forth in, but
not limited to, Title 45, sections 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal
Regulations.
The Parties agree that, pursuant to Title 45 of the Code of Federal Regulations section
164.506 and California Civil Code section 56.10, both HIPAA and CMIA permit COUNTY to share PHI
with FCSS staff because they are other behavioral health care professionals and the information is
being shared for purposes of treatment of the individuals targeted by this Agreement. Moreover, given
the nature of the life impacting events and trauma situtations that are intended to give rise to those
served under this Agreement, information can be shared by COUNTY under the emergency
circumstances exceptions of HIPAA and CMIA.
COUNTY further agrees that CONTRACTORS are Business Associates of COUNTY as
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set forth in the following Section of this Agreement. As such, COUNTY, may share PHI with
CONTRACTORS.
22.BUSINESS ASSOCIATE UNDER HIPAA
A.The Parties to this Agreement shall be in strict conformance with all applicable
Federal and State of California laws and regulations, including but not limited to sections 5328, 10850,
and 14100.2 et seq. of the Welfare and Institutions Code, sections 2.1 and 431.300 et seq. of Title 42,
Code of Federal Regulations (“CFR”), CMIA, sections 11977 and 11812 of Title 22 of the California
Code of Regulations, and HIPAA, including but not limited to section 1320d et seq. of Title 42, United
States Code (“USC”) and its implementing regulations, including, but not limited to Title 45, CFR,
sections 142, 160, 162, and 164, and HITECH regarding the confidentiality and security of client
information.
Except as otherwise provided in this Agreement, CONTRACTORS, as Business
Associates of COUNTY, may use or disclose PHI to perform functions, activities or services for, or on
behalf of COUNTY, as specified in this Agreement, provided that such use or disclosure shall not
violate the HIPAA. The uses and disclosures of PHI may not be more expansive than those applicable
to COUNTY as the “Covered Entity” under the HIPAA Privacy Rule (45 CFR 164.500 et seq), except as
authorized for management, administrative, or legal responsibilities of the Business Associate.
B.The Parties shall protect, from unauthorized access, use, or disclosure of names
and other identifying information concerning persons receiving services pursuant to this Agreement,
except where permitted in order to carry out data aggregation purposes for health care operations. (45
CFR sections 164.504 (e)(2)(i), 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i).) This pertains to any and all
persons receiving services pursuant to a COUNTY funded program. The Parties shall not use such
identifying information for any purpose other than carrying out the Parties’ obligations under this
Agreement.
C.The Parties shall not disclose any such identifying information to any person or
entity, except as otherwise specifically permitted by this Agreement, authorized by law, or authorized by
the client.
D.For purposes of the above Subsections, identifying information shall include, but
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not be limited to name, identifying number, symbol, or other identifying particular assigned to the
individual, such as finger or voice print, or a photograph.
E.CONTRACTORS shall provide access, at the request of COUNTY, and in the
time and manner designated by COUNTY, to PHI in a designated record set (as defined in 45 CFR
section 164.501), to an individual or to COUNTY in order to meet the requirements of 45 CFR
section164.524 regarding access by individuals to their PHI.
CONTRACTORS shall make any amendment(s) to PHI in a designated record
set at the request of COUNTY, and in the time and manner designated by COUNTY in accordance with
45 CFR section 164.526.
CONTRACTORS shall provide to COUNTY or to an individual, in a time and
manner designated by COUNTY, information collected in accordance with 45 CFR section 164.528, to
permit COUNTY to respond to a request by the individual for an accounting of disclosures of PHI in
accordance with 45 CFR section 164.528.
F.CONTRACTORS shall report to COUNTY, in writing, any knowledge or
reasonable belief that there has been unauthorized access, viewing, use, disclosure, or breach of PHI
not permitted by this Agreement, and any breach of unsecured PHI of which it becomes aware,
immediately and without reasonable delay and in no case later than two (2) business days of discovery.
Immediate notification shall be made to COUNTY’s Information Security Officer and Privacy Officer and
DBH’s HIPAA Representative, within two (2) business days of discovery. The notification shall include,
to the extent possible, the identification of each individual whose unsecured PHI has been, or is
reasonably believed to have been, accessed, acquired, used, disclosed, or breached.
CONTRACTORS shall take prompt corrective action to cure any deficiencies and any action pertaining
to such unauthorized disclosure required by applicable Federal and State Laws and regulations.
CONTRACTORS shall investigate such breaches and are responsible for all notifications required by
law and regulation or deemed necessary by COUNTY and shall provide a written report of the
investigation and reporting required to COUNTY’s Information Security Officer and Privacy Officer and
DBH’s HIPAA Representative. This written investigation and description of any reporting necessary
shall be postmarked within the thirty (30) working days of the discovery of the breach to the addresses
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below:
County of Fresno County of Fresno County of Fresno
Department of Behavioral Health Dept. of Public Health Information Technology Services
HIPAA Representative Privacy Officer Information Security Officer
(559)600-6798 (559)600-6405 (559)600-5800
3147 N. Millbrook Ave (559)600-6439 333 W. Pontiac Way
Fresno, CA 93703 P.O1221 Fulton Mall Clovis, CA 93612
Fresno, CA 93775
G.CONTRACTORS shall make their internal practices, books, and records relating
to the use and disclosure of PHI received from COUNTY, or created or received by CONTRACTORS
on behalf of COUNTY, available to the United States Department of Health and Human Services upon
demand.
H.Safeguards
CONTRACTORS shall implement administrative, physical, and technical
safeguards as required by 45 CFR 164.308, 164.310, and 164.312 that reasonably and appropriately
protect the confidentiality, integrity, and availability of PHI, including electronic PHI, that it creates,
receives, maintains or transmits on behalf of COUNTY; and to prevent access, use or disclosure of PHI
other than as provided for by this Agreement. CONTRACTORS shall develop and maintain a written
information privacy and security program that includes administrative, technical and physical
safeguards appropriate to the size and complexity of CONTRATORS’ operations and the nature and
scope of its activities. Upon COUNTY’s request, CONTRACTORS shall provide COUNTY with
information concerning such safeguards.
CONTRACTORS shall implement strong access controls and other security
safeguards and precautions in order to restrict logical and physical access to confidential, personal
(e.g., PHI) or sensitive data to authorized users only.
I.Mitigation of Harmful Effects
CONTRACTORS shall mitigate, to the extent practicable, any harmful effect that
is known to CONTRACTORS of an unauthorized access, viewing, use, disclosure, or breach of PHI by
CONTRACTORS or its subcontractors in violation of the requirements of these provisions.
J.Contractor’s Subcontractors
CONTRACTORS shall ensure that any of its subcontractors, if applicable, to
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whom CONTRACTORS provides PHI received from or created or received by CONTRACTORS on
behalf of COUNTY, agree to the same restrictions and conditions that apply to CONTRACTORS with
respect to such PHI; and to incorporate, when applicable, the relevant provisions of these provisions
into each subcontract or sub-award to such subcontractors.
K. Effect of Termination
To the extent that it does not violate any other laws, upon termination or
expiration of this Agreement for any reason, CONTRACTORS shall return or destroy all PHI received
from COUNTY (or created or received by CONTRACTORS on behalf of COUNTY) that
CONTRACTORS still maintains in any form, and shall retain no copies of such PHI. If return or
destruction of PHI is not feasible, it shall continue to extend the protections of these provisions to such
information, and limit further use of such PHI to those purposes that make the return or destruction of
such PHI infeasible. This provision shall apply to PHI that is in the possession of subcontractors or
agents, if applicable, of CONTRACTORS. If a CONTRACTOR destroys the PHI data, a certification of
date and time of destruction shall be provided to the COUNTY by that CONTRACTOR.
L. Interpretation
The terms and conditions in these provisions shall be interpreted as broadly as
necessary to implement and comply with HIPAA, the HIPAA regulations and applicable State laws. The
parties agree that any ambiguity in the terms and conditions of these provisions shall be resolved in
favor of a meaning that complies and is consistent with HIPAA and the HIPAA regulations.
M. Regulatory References
A reference in the terms and conditions of these provisions to a section in the
HIPAA regulations means the section as in effect or as amended.
N. Survival
The respective rights and obligations of CONTRACTORS as stated in this
Section shall survive the termination or expiration of this Agreement.
23. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of the Parties’ data including sensitive or personal information regarding those
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served under this Agreement; abuse of the Parties’ resources; and/or disruption to a Party’s operations,
Parties must employ adequate data security measures to protect the confidential information provided
between Parties.
A.Mobile, Wireless, or Handheld Devices
Parties may not connect to each other’s networks via mobile, wireless, or handheld
devices, unless the following conditions are met:
1) The connecting Party has received authorization from the network-owning
Party;
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.Computers or Computer Peripherals
Parties may not bring Party-owned computers or computer peripherals into each
other’s properties for use without prior authorization unless the following conditions are met:
1)The Party has obtained authoriazation to bring the computer or computer
peripheral into the other Party’s property;
2)Data must be encrypted and stored on a secure server and transferred by
means of a virtual private network (VPN) connection, or another type of secure connection; and,
3)Said data must be encrypted.
D.Parties may not store private, confidential or sensitive data related to the work
provided for in this Agreement on any hard-disk drive, portable storage device, or remote storage
installation unless encrypted.
E.Parties shall be responsible to employ strict controls to ensure the integrity and
security of confidential information and 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 data internally and externally.
F.Confidential information transmitted to one Party by the other by means of
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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.If it relates to information for the project provided for in this Agreement, each Party
is responsible to immediately notify the other Parties of any violations, breaches, or potential breaches of
security related to confidential information, data maintained in computer files, program documentation,
data processing systems, data files and data processing equipment which stores or processes data
internally or externally.
H.COUNTY shall support each CONTRACTORS’ response to all incidents arising
from a possible breach of security related to COUNTY’s confidential client information provided to
CONTRACTORS. CONTRACTORS will be responsible to issue any notification to affected individuals as
required by law or as deemed necessary by COUNTY in its sole discretion. Each Party shall be
responsible for all costs incurred as a result of providing the required notification.
24.PROPERTY OF COUNTY
A.COUNTY and CONTRACTORS recognize that fixed assets are tangible and
intangible property obtained or controlled under COUNTY for use in operational capacity and will benefit
COUNTY for a period more than one year. Depreciation of the qualified items will be on a straight-line
basis.
For COUNTY purposes, fixed assets must fulfill three (3) qualifications:
1)Have life span of over one year;
2)Is not a repair part; and
3)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
•Tangible $5,000
o Equipment
o Vehicles
•Intangible $100,000
o Internally Generated Software
o Purchased Software
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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, attached hereto as Exhibit L, and by this reference incorporated herein and made part of this
Agreement, will be maintained by COUNTY’s Asset Management System and annually inventoried until
the asset is fully depreciated. During the terms of this Agreement, CONTRACTORS’s fixed assets may be
inventoried in comparison to DBH’s Asset Inventory System.
B.Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
more than One Thousand and No/100 Dollars ($1,000.00), with over one year life span, and/or 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 DBH’s Director or designee.
CONTRACTORS will maintain a tracking system on the items on Exhibit L. Items are not required to be
capitalized or depreciated and 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. CONTRACTORS agrees to participate in
an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this
Agreement, CONTRACTORS shall be physically present when fixed and inventoried assets are returned
to COUNTY possession. CONTRACTORS 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.
CONTRACTORS further agrees to the following:
1)Maintain all items of equipment in good working order and condition, normal
wear and tear is expected;
2)Label all items of equipment with COUNTY assigned program number,
perform periodic inventories as required by COUNTY, and 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
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3)Report in writing to COUNTY immediately after discovery, the loss 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 CONTRACTORS with funds provided
hereunder shall require the prior written approval of DBH, shall fulfill the provisions of this Agreement as
appropriate, and must be directly related to CONTRACTORSS services or activities under the terms of this
Agreement. DBH may refuse reimbursement for any costs resulting from equipment purchased, which are
incurred by CONTRACTORS, if prior written approval has not been obtained from COUNTY.
E.CONTRACTORS must obtain prior written approval from 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 CONTRACTORS for a use which does not qualify under this
Agreement, CONTRACTORS shall reimburse COUNTY in an amount equal to the current fair market
value of the property, less any portion thereof attributable to expenditures of funds not provided under this
Agreement. These requirements shall continue in effect for the life of the property. In the event this
Agreement expires, or terminates, the requirements for this Section shall remain in effect for activities or
property funded with said funds, unless action is taken by the State government to relieve COUNTY of
these obligations.
25.NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTORS and its subcontractos shall
not deny the contract’s benefits to any person on the basis of race, religious creed, color, national origin,
ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex,
gender, gender identity, gender expression, age, sexual orientation, or military and veteran status, nor
shall they discriminate unlawfully against any employee or applicant for employment because of race,
religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition,
genetic information, marital status, sex, gender identity, gender expression, age, sexual orientation, or
military and veteran status.
CONTRACTORS shall ensure that the evaluation and treatment of employees and
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applicants for employment are free of such discrimination. CONTRACTORS and subcontractors shall
comply with the provisions of the Fair Employment and Housing Act (Gov. Code §12800 et seq.), the
regulations promulgated thereunder (Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5,
Chapter 1, Part 1, Division 3, Title 2 of the Government Code (Gov. Code §§11135-11139.5), and the
regulations or standards adopted by the awarding state agency to implement such article.
CONTRACTORS shall permit access by representatives of the Department of Fair Employment and
Housing and the awarding state agency upon reasonable notice at any time during the normal business
hours, but in no case less than twenty-four (24) hours notice, to such of its books, records, accounts, and
all other sources of information and its facilities as said department or agency shall require to ascertain
compliance with this clause. CONTRACTORS and its subcontractorsshall give written notice of their
obligations under this clause to labor organizations with which they have a collective bargaining or other
agreement. (See Cal. Code Regs., tit. 2, §11105.) CONTRACTORS shall include the non-discrimination
and compliance provisions of this clause in all subcontracts to perform work under this Agreement.
26.CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence:
A.CONTRACTORS shall not discriminate against beneficiaries based on race, color,
national origin, sex, disability, or religion. CONTRACTORS shall ensure that a limited and/or no
English proficient beneficiary is entitled to equal access and participation in federally funded programs
through the provision of comprehensive and quality bilingual services pursuant to 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.
B.CONTRACTORS shall comply with requirements of policies and procedures for
ensuring access and appropriate use of trained interpreters and material translation services for all
limited and/or no English proficient beneficiaries, including, but not limited to, assessing the cultural and
linguistic needs of the beneficiaries, training of staff on the policies and procedures, and monitoring its
language assistance program. CONTRACTORS’s policies and procedures shall ensure compliance of
any subcontracted providers with these requirements.
C. CONTRACTORS shall notify its beneficiaries that oral interpretation is available for
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any language and written translation is available in prevalent languages and that auxiliary aids and
services are available upon request, at no cost and in a timely manner for limited and/or no English
proficient beneficiaries and/or beneficiaries with disabilities. CONTRACTORS shall avoid relying on an
adult or minor child accompanying the beneficiary to interpret or facilitate communication; however, if the
beneficiary refuses language assistance services, the CONTRACTORS must document the offer, refusal
and justification in the beneficiary’s file.
D. CONTRACTORS shall ensure that employees, agents, subcontractors, and/or
partners who interpret or translate for a beneficiary or who directly communicate with a beneficiary in a
language other than English (1) have completed annual training provided by COUNTY at no cost to
CONTRACTORS; (2) have demonstrated proficiency in the beneficiary’s language; (3) can effectively
communicate any specialized terms and concepts specific to CONTRACTORS’s services; and (4) adheres
to generally accepted interpreter ethic principles. As requested by COUNTY, CONTRACTORS shall
identify all who interpret for or provide direct communication to any program beneficiary in a language
other than English and identify when the CONTRACTORS last monitored the interpreter for language
competence.
E. CONTRACTORS shall submit to COUNTY for approval, within ninety (90) days
from date of contract execution, CONTRACTORS’s plan to address all fifteen (15) National Standards for
Culturally and Linguistically Appropriate Service (CLAS), as published by the Office of Minority Health and
as set forth in Exhibit M “National Standards on Culturally and Linguistically Appropriate Services”,
attached hereto and incorporated herein by reference and made part of this Agreement. As the CLAS
standards are updated, CONTRACTORS’s plan must be updated accordingly. As requested by COUNTY,
CONTRACTORS shall be responsible for conducting an annual CLAS self-assessment and providing the
results of the self-assessment to the COUNTY. The annual CLAS self-assessment instruments shall be
reviewed by the COUNTY and revised as necessary to meet the approval of the COUNTY.
F. Cultural competency training for CONTRACTORS staff should be substantively
integrated into health professions education and training at all levels, both academically and functionally,
including core curriculum, professional licensure, and continuing professional development programs. As
requested by COUNTY, CONTRACTORS shall report on the completion of cultural competency trainings
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to ensure direct service providers are completing a minimum of one (1) cultural competency training
annually.
G.CONTRACTORS shall create and sustain a forum that includes staff at all agency
levels to discuss cultural competence. COUNTY encourages a representative from CONTRACTORS’s
forum to attend COUNTY’s Cultural Humility Committee.
27.AMERICANS WITH DISABILITIES ACT
CONTRACTORS 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.
28.TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section
1861(v)(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four (4)
years after the furnishing of services under this Agreement, CONTRACTORS 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 CONTRACTORS
under this Agreement. CONTRACTORS further agree that in the event a 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
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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.
29.ASSURANCES
In entering into this Agreement, CONTRACTORS certify that neither they, nor any of their
officers, are currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
Health Care Programs; that neither they, nor any of their officers, have been convicted of a criminal
offense related to the provision of health care items or services; nor have they, nor any of their 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 either
CONTRACTOR is ineligible on these grounds, COUNTY will remove that 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 such CONTRACTOR’s
compensation, or the items or services rendered, ordered or prescribed by such 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 such CONTRACTOR is reinstated into participation in the Federal Health
Care Programs.
A.If COUNTY has notice that a CONTRACTOR, or its officers, have been charged
with a criminal offense related to any Federal Health Care Program, or are proposed for exclusion during
the term of any contract, said 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 said CONTRACTOR cease providing services until resolution
of the charges or the proposed exclusion.
B.CONTRACTORS agree that all potential new employees of CONTRACTORS or
subcontractors of CONTRACTORS 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 (3)
they have been reinstated to participate in the Federal Health Care Programs after a period of exclusion,
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suspension, debarment, or ineligibility.
C.In the event the potential employee or subcontractor informs a 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 that CONTRACTOR hires or engages such
potential employee or subcontractor, that potential employee or subcontractor may not be hired or
engaged to do work under this Agreement.
D.CONTRACTORS agree to cooperate fully with any reasonable requests for
information from COUNTY which may be necessary to complete any internal or external audits relating to
CONTRACTORS’ compliance with the provision of this Section.
30.PUBLICITY PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under this
Agreement shall be used for COUNTY’S or CONTRACTORS’ 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 this Agreement shall be allowed as
necessary to raise public awareness about the availability of such specific services when agreed upon in
advance by the Parties to this Agreement and at a cost to be provided in Exhibits C-1 and C-2 for such
items as written/printed materials, the use of media (i.e., radio, television, newspapers), and any other
related expense(s).
31.COMPLAINTS AND GRIEVANCES
In accordance with Exhibit K, CONTRACTORS shall log complaints and the disposition of all
complaints from those served under this Agreement. CONTRACTORS shall provide a copy of the detailed
complaint log to COUNTY at monthly intervals by the tenth (10th) day of the following month, in a format
that is mutually agreed upon by DBH and CONTRACTORS. In addition, CONTRACTORS shall provide
details and attach documentation of each complaint with the log. CONTRACTORS shall post signs
informing those served under this Agreement of their right to file a complaint or grievance.
Should DBH decide to follow-up regarding any of the complaints contained in a CONTRACTOR’S
log, the CONTRACTOR shall cooperate in the follow-up process and provide any additional information
and/or documentation to DBH within ten (10) days of DBH’s request.
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32.DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTORS are disclosing entities, fiscal agents, or
managed care entities, 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 CONTRACTORS by completing Exhibit N, “Disclosure of
Ownership and Control Interest Statement”, attached hereto and by this reference incorporated herein and
made part of this Agreement. CONTRACTORS shall submit this form to the DBH within thirty (30) days of
the effective date of this Agreement. Additionally, CONTRACTORS shall report any changes to this
information within thirty-five (35) days of occurrence by completing Exhibit N. Submissions shall be
scanned portable document format (pdf) copies and are to be sent via email to DBH’s assigned Staff
Analyst.
CONTRACTORS, as applicable to their organization, is required to submit a set of
fingerprints for any person with a five (5) percent or greater direct or indirect ownership interest in
CONTRACTORS. COUNTY may terminate this Agreement for breach of agreement in accordance
with Section Three (3), Subsection (B) above where any person with a five (5) percent or greater direct
or indirect ownership interest in the CONTRACTORS did not submit timely and accurate information
and cooperate with any screening method required in CFR, Title 42, section 455.416. Submissions
shall be scanned pdf copies and are to be sent via email to
DBHContractedServicesDivision@fresnocountyca.gov. COUNTY may deny enrollment or terminate
this Agreement in accordance with Section Three (3), Subsection (B) above where any person with a
five (5) percent or greater direct or indirect ownership interest in CONTRACTORS has been convicted
of a criminal offense related to that person’s involvement with the Medicare, Medicaid, or Title XXI
program in the last ten (10) years.
33.DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
If applicable to the CONTRACTOR’s organization, the CONTRACTOR is required to
disclose if any of the following conditions apply to it its owners, officers, corporate managers, and partners
(hereinafter collectively referred to in this Section as “OFFICIALS”):
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A.Within the three (3) year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
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 the three (3) year period preceding the 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 the applicable
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 the applicable CONTRACTOR elects to submit with the disclosed information will be
considered. If it is later determined that CONTRACTOR or its OFFICIALS failed to disclose required
information, any contract awarded to such CONTRACTOR may be terminated in accordance with Section
Three (3), Subsection (B) above.
OFFICIALS must sign a “Certification Regarding Debarment, Suspension, and Other
Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit O, attached hereto
and by this reference incorporated herein and made part of this Agreement. Additionally, the applicable
CONTRACTOR must immediately advise DBH in writing if, during the term of this Agreement: (1)
OFFICIALS become suspended, debarred, excluded, or ineligible for participation in Federal or State
funded programs or from receiving federal funds as listed in the excluded parties’ list system
(https://www.sam.gov/SAM); or (2) any of the above listed conditions become applicable to OFFICIALS.
The applicable CONTRACTOR shall indemnify, defend, and hold 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.
34.DISCLOSURE OF SELF-DEALING TRANSACTIONS
COUNTY OF FRESNO
Fresno, CA
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This provision is only applicable if a CONTRACTOR is operating as a corporation (a for-
profit or non-profit corporation) or if during the term of this Agreement, a CONTRACTOR changes its
status to operate as a corporation.
Members of a CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while the 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 of the CONTRACTOR 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 P and
incorporated herein by reference and made part of this Agreement, and submitting it to COUNTY prior to
commencing with the self-dealing transaction or immediately thereafter.
35.AUDITS AND INSPECTIONS
After reasonable notice to CONTRACTORS, CONTRACTORS shall, at any time during
business hours and as often as COUNTY may deem necessary, make available to COUNTY for
examination all of its records and data with respect to the matters covered by this Agreement.
CONTRACTORS shall, upon request by COUNTY, permit COUNTY to audit and inspect all such records
and data necessary to ensure CONTRACTORS’s compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTORS 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).
36.NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY CONTRACTORS
Director, Fresno County See Exhibit A Department of Behavioral Health 1925 E. Dakota Ave Fresno, CA 93726
All notices between COUNTY and CONTRACTORS provided for or permitted under this
COUNTY OF FRESNO
Fresno, CA
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Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
personal service is effective upon service to the recipient. A notice delivered by first-class United States
mail is effective three (3) COUNTY or CONTRACTOR business days, whichever date is later in time, after
deposit in the United States mail, postage prepaid, addressed to the recipient. A notice delivered by an
overnight commercial courier service is effective one (1) COUNTY or CONTRACTOR business day,
whichever date is later in time, 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 or CONTRACTOR business hours, then such delivery shall
be deemed to be effective at the next beginning of a COUNTY or CONTRACTOR business day,
whichever is later in time), 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).
37.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.
38.ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire agreement between
CONTRACTORS and COUNTY with respect to the subject matter hereof and supersedes all previous
agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understandings of any nature whatsoever unless expressly included in this Agreement.
Exhibit A Provider List
Exhibit B Scope of Work
COUNTY OF FRESNO
Fresno, CA
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Exhibit B-1 DBH Policy and Procedure Guide PPG 1.2.7
Exhibit B-2 Handle with Care Plus Flowchart
Exhibit C-1 Fresno Resiliency Center Budgets and Narratives
Exhibit C-2 Fresno County Superintendent of Schools Budgets and Narratives
Exhibit C-3 Fresno County Superintendent of Schools Service Rate Sheet
Exhibit D DBH Guiding Principles of Care Delivery
Exhibit E Electronic Health Records Software Charges
Exhibit F Documentation Standards for Client Records
Exhibit G FCMHP Compliance Program Code of Conduct and Ethics
Exhibit H State Mental Health Requirements
Exhibit I Incident Reporting
Exhibit J Medi-Cal Organizational Provider Standards
Exhibit K FCMHP Grievances and Appeals Process
Exhibit L Fixed Asset and Sensitive Item Tracking Log
Exhibit M National CLAS Standards
Exhibit N Disclosure of Ownership and Control Interest Statement
Exhibit O Certification Regarding Debarment
Exhibit P Self-Dealing Transaction Disclosure Form
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1 IN WITNESS WHEREOF , the Parties hereto have executed this Agreement as of the day and
2 year first hereinabove written .
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CONTRACTOR:
Please see attached signatures
Fund/Subclass : 0001/10000
Account/Program : 7295/0
COUNTY OF ~
By : ',/""
Steve Brf mda,
Chairman of the Board of Supervisors of the
County of Fresno
Date : ~. l.\, ~
ATTEST :
Bernice E. Seidel ,
Clerk to the Board of Superv isors
County of Fresno , State of Cal iforn ia
By:_~~·-w~---~
Organization/Cost Centers: 56304794 ($1 ,061,460)
FY 2021-22 $341 ,539 , FY 2022-23 $357 ,289 , FY 2023-24 $362 ,632
-42 -COUNTY OF FRESNO
Fresno , CA
Exhibit A
Page 1 of 1
Mental Health Services Act – Innovations Project
Handle with Care Plus
Schools and Community Innovation Services to Children/Youth (Ages 4-11 Years) and Family
Provider List
__________________________________________________________________________________
Fresno County Superintendent of Schools (FCSS)
1111 Van Ness Ave.
Fresno, CA 93721
Phone: (559) 265-3010
Contact: Jim Yovino, Fresno County Superintendent of Schools
Fresno Police Chaplaincy – The Fresno Resiliency Center
3845 N. Clark ST Suite 201
Fresno, CA 93726
Phone: (559) 621-2121
Contact: Rodney Lowery, Executive Director
__________________________________________________________________________________
Exhibit B
Page 1 of 14
Mental Health Services Act – Innovations Project
SCOPE OF WORK
PROGRAM NAME: Handle with Care Plus
CONTRACTOR(S): Fresno County Superintendent of Schools (FCSS)
1111 Van Ness Ave. Fresno CA 93721
(559)265 – 3010
Jim Yovino, Fresno County Superintendent of Schools
The Resiliency Center
3845 N Clark ST. Suite 201. Fresno CA 93726
(559)621 – 2121
Rodney Lowery, Executive Director
SERVICES: Schools and Community Innovation Services to Children/Youth
–Ages 4-11 Years and Family
SERVICE SITES: See Section V
CONTRACT TERM: Three Year MHSA – Innovation Project
Upon Contract Execution – June 30, 2024
CONTRACT AMOUNT: Fiscal Year Total Contract
2021 – 2022 $ 341,539.00
2022 – 2023 $ 357,289.00
2023 – 2024 $ 362,632.00
Maximum Compensation All Three (3) Years: $1,061,460.00
I.SCHEDULE OF SERVICES
The standard hours of operations for this project will generally be Monday through Friday from
8:00 AM to 5:00 PM. FCSS will provide services throughout the school year and abide by their
8-hour employee workday and 12-month employee work calendar. The Resiliency Center will
operate the Parent Cafés and host pre-scheduled or by appointment only non-traditional hours
of operations to meet the needs of families. In general, operational hours of each component
will be flexible to meet the needs of youths and families who are unavailable for services during
standard business hours, including scheduled appointments on Saturdays and Sunday as
needed.
The hours of operations for this innovation project may be modified, with written approval from
all Parties involved, based on the need to be effective and efficient. Hours of operation will be
reviewed and discussed for appropriate changes.
II.TARGET POPULATION
The target population for this innovation project are children, ages 4-11 years of age and
families who have experienced a life impacting event or trauma who attends one of the four
Exhibit B
Page 2 of 14
identified schools (in Section V). These students and families will vary in age, gender,
ethnicity, and lower socio-economic backgrounds and from neighborhoods surrounding
identified schools. Although the target population for this project will revolve around the
individuals of the four targeted schools, all youths identified will be referred and/or linked to
appropriate community resources.
III.PROJECT DESCRIPTION AND CONTRACTOR(S) RESPONSIBLITIES
In Fresno County, many children, teens, and communities have been exposed to some sort of
trauma and significant stressful life event(s). These traumatic events can include but are not
limited to; violence in the home or community; loss of loved ones through divorce, death,
incarceration, and other separations; and any major life changes from natural disasters,
accidents, and other life altering incidents. If traumatic events are not addressed, it can have
many effects on a person’s behavior, body, emotions, and way of thinking. If these children do
not develop resilience post-trauma, they may experience health problems, including serious
mental health illness and mental health crises.
In accordance with the Innovation Plan approved on July 7, 2020 by the Fresno County Board
of Supervisors, the proposed innovations program, Handle with Care Plus, is intended to
measure the outcomes of a trauma response team and determine if a psychoeducational parent
café component can assist in reducing effects of trauma. If this project is successful, it will
provide a viable and replicable model to be applied to other parts of the county and the state for
proactive response to mental health rather than reacting with more costly intervention in the
future.
This project is a collaboration with Fresno County’s Department of Behavioral Health’s (DBH)
community partners, Fresno County Superintendent of Schools (FCSS) and Fresno Police
Chaplaincy’s Resiliency Center (Resiliency Center), that will respond to children and families
immediately after a trauma or a stressful life event(s). The focus is to provide early support,
screening, and assessment of children for early indicators of mental health symptoms, empower
the family with the tools they need to cope and recover, and connect children and families to
any additional necessary resources. This focus on parent education and empowerment
distinguishes this innovation program from similar Handle with Care programs provided in
California.
When the Fresno Police Department responds to calls, they enter call data into a secure smart
application developed and operated by the Fresno Police Chaplaincy. The app allows real-time,
accessible data that allow for timely response and notification of traumatic events. The
Resiliency Center will access and review this data to screen for all calls to consist of a traumatic
or life impacting event in which children were involved and quickly notify FCSS of the event.
FCSS will notify the child’s school via the Handle with Care notice, that the student has
experienced a potentially traumatic event and may experience difficulties performing their daily
activities (without violating any Family Educational Rights and Privacy Act (FERPA), related
California Education Code sections and/or other applicable state or privacy laws) so that the
school can notify relevant staff – such as school administration, teachers, counselors, and other
appropriate service providers. FCSS will screen and assess the child and connect the family to
Exhibit B
Page 3 of 14
support—such as the Parent Cafés to help the child and family in their recovery from the life-
impacting or traumatic event.
If the child is in one of the four targeted schools (in Section V), the Triage Team will screen the
child to identify the potential need for additional individual support and family supports including
resources offered by the Resiliency Center’s Parent Café. If the child is not in one of the
targeted schools, FCSS will have already sent the Handle with Care notice to the child’s school
and refer to the Resiliency Center or All 4 Youth program, which will respond with their available
resources.
During the screening process, the Triage Team will determine if the student has existing
supports through a community provider. If they do, the student will be connected to those
providers for follow-up services. Families will be provided with information on the Parent Café
program to access education and supports that increase resilience following exposure to a
traumatic life event.
If the individual has no existing community support, they will be linked to the appropriate
resources in the community and families will be referred to the Resiliency Center’s Parent Café
program and any other appropriate educational opportunities. All processes and referrals will
abide by confidentiality and privacy laws applicable to the agency.
FCSS staff will also notify other schools (not targeted in this innovations project) to connect any
siblings or other household members who reside with the involved student but attend a different
school. This step is intended to bring awareness to school staff (not at the targeted schools) that
there is a Handle with Care situation and the potential that siblings and other relatives who may
need supports from school-based services.
Handle with Care Process:
When the Triage Team receives notification from the Resiliency Center of a student is involved
in a traumatic event, FCSS will identify the school that the child attends and immediately send
the school a Handle with Care notice. This notice has no confidential or clinical information, only
the child’s name and grade (the Handle with Care notice form will be developed by the Parties
involved and will maintain the confidentiality of the child as required by applicable laws).
Step 1: Upon FCSS sending Handle with Care notice to the targeted school, the student
and their family will be assigned to the Triage Team consisting of the FCSS Clinician
and Resiliency Center Family Partner.
Step 2: The responding team will search DBH’s electronic health record system
(currently Avatar) to determine whether the student has a history in the behavioral health
system (if they are currently receiving services so to avoid any duplication), etc. If the
student has an open record in Avatar, FCSS will reach out to the parent/guardian to
request approval to inform their child’s provider in the community of the life impacting or
traumatic event.
The student’s family will be provided with information on the Resiliency Center’s Parent
Café program that could support and educate family on being resilient after being
Exhibit B
Page 4 of 14
exposed to trauma.
If the family declines authorization for notification of existing provider and/or the Parent
Café program, the referral will then be closed by FCSS, and referred to the Resiliency
Center for resources.
If the student has no history in Avatar or does not have an active case, the Triage Team will:
Step 1: Contact the family to offer support services. If the parent/guardian declines
services, FCSS will ask if they can mail the family information on services, the Parent
Café program, and other educational opportunities in case the family would like to
access information later. FCSS will inform the Resiliency Center that the family declines
services, FCSS will then close out the referral and families will be referred to the Fresno
Police Chaplaincy for resources.
Step 2: If the parent/guardian accepts the services for their child, Triage Team clinician
will screen for the impact of trauma on the child and provide mental health services or
resources based on the results. If at that time the child does not show any symptoms the
parents will still be provided with Parent Café information. The school will be notified of
the results of the screening and ask to re-refer the child if symptoms manifest in the future.
Although the Triage Team will have the child as their primary focus, this program can
assist parents with access and linkage for them or other family members as well.
Step 3: If, based on the screening, the child may need additional services or treatment,
the FCSS Triage Team Clinician will conduct a clinical assessment to determine the
need. If the intervention will take beyond six sessions, a warm handoff will be provided to
link them into the services they are needing (either school-based or with another
provider). If the symptoms can be addressed in short intervention, then the Triage Team
will provide up to six session. This is to ensure the child is not without services while
awaiting to access clinical services.
FCSS will also notify other schools not targeted in this project, for any siblings or other
household members who reside with the student but attend a different school (i.e. a sibling or
cousin who is in junior high or high school), to ensure that the school is aware of the handling
with care situation, and they can refer those students, not in the four participating elementary
schools to the school based services available there or other community resources for screening
and/or assessment.
Screening tools considered are; Pediatric ACES and Related Life-event Screener (PEARLS),
the Pediatric Symptom Checklist (PSC-35), along with other screeners in The National Child
Traumatic Stress Network database. However, utilization will be determined based on its
compatibility with the target population and setting, and responsiveness. A convening of all
Parties will decide upon the appropriate screening tool for this project.
The Handle with Care Plus Flowchart, attached hereto and referenced herein as Exhibit B-3,
provides a general outline for FCSS and the Resiliency Center to follow through with care
coordination for the individuals identified and may be modified and/or amended to meet the
needs of the clients and/or as agreed upon by all Parties: DBH Director or designee, FCSS,
and The Resiliency Center.
Exhibit B
Page 5 of 14
Parent Café:
The Parent Café component will assist in the development of the parent or caregiver’s
understanding of the trauma or life impacting event that affected them and their child, increase
their understanding about the protective factors of their family and build a sense of community
within the Parent Café where mental health stigma can be discussed, addressed, and reduced.
Parent Cafés have various curriculum designs. Based on the Innovation Project proposal, we
are implementing a curriculum similar to the Strengthening Families curriculum. This curriculum
was designed as a resource for those training or conducting professional development with child
welfare workers but has since been adapted by many other programs to create content that is
relevant for their target audience. This researched-informed approach was designed to increase
family strengths, enhance child development, and reduce the likelihood of child abuse and
neglect. It is based on engaging families, programs, and communities in building five (5) key
Protective Factors: parental resilience, social resilience, knowledge of parenting and child
development, concreate support in times of need, and social and emotional competence of
children. DBH has partnered with Brain Wise Solutions Group, INC via a separate agreement to
develop the Parent Café curriculum. Brain Wise will incorporate the five protective factors and
modify the curriculum appropriately for our communities’ children and families exposed to
trauma.
The Resiliency Center will implement the developed Parent Café curriculum and seek to create
a coffee house environment to welcome gatherings of parents who are identified as potentially
benefiting from group learning and sharing. The Resiliency Center will offer psychoeducation to
parents centered on trauma informed skills and the impact of ACES on children. The Parent
Café curriculum will be an eight-week course covering social determinants to health, peer roles
and empowerment, and whole family resilience.
When the Resiliency Center receives the referral from FCSS, they will contact the student and
family members and schedule them for an initial Parent Café meeting. Voluntary participation
will also be reviewed for appropriateness.
The Parent Café will be staffed by a Clinician and a Parent Partner. The Parent Partner will
create meaningful relationships and engaging conversation while demonstrating respect,
trustworthiness, empathy, and collaboration with the families. The Parent Partner will support
the Parent Cafes’ strength-based framework that emphasizes physical, psychological, and
emotional safety and help support resiliency in the community. The Parent Partner will
facilitate the workshops in the Parent Café and will be accompanied by a clinician to ensure
fidelity and provide any answers to clinical inquires. The Parent Partner will work to coordinate
and provide warm hand-offs to parents seeking other services, both at the Resiliency Center
as well as in the community.
The Resiliency Center will provide monthly trainings to staff, staying up to date on current
methodologies for trauma informed interventions and tools, by a mental health clinician who is
onsite that has received Trauma-Informed training from the Community Resilience Initiative.
The clinician provides on-going training to the Resiliency Center staff and clinicians with a
research-based approach to responding to trauma.
Exhibit B
Page 6 of 14
The Resiliency Center will also leverage ongoing resources at the center to complement
services to the Parent Café participants. Currently, ongoing services at the center are
educational mentorship programs, counseling and linkage services. Parent Café participants
will earn incentives and prizes to encourage ongoing engagement.
At the conclusion of the trauma-informed training for parents at the Parent Café, an evaluation
will be completed by each participant to determine the effectiveness and impact of the
instruction. Utilizing its current MOU with Fresno Unified School District (FUSD), the Resiliency
Center will receive quarterly data on attendance, grades, and behavior for each child in their
school who is receiving services from the Resiliency Center. This information will be helpful in
assessing the child’s current state as well as informing the Resiliency Center on its impact on
the child in their educational environment.
IV. STAFFING
The Resiliency Center will staff the Parent Cafés:
.80 FTE - Associate Marriage and Family Therapist
Bilingual mental health clinician who will provide the didactical presentations to the
parents as well as any support for the participants, to ensure accurate information is
presented, and to be able to properly interview and mitigate any possible crisis.
.80 FTE - Triage Liaison/Case Manager
This will be a position that will support the Resiliency Center and the Fresno Police
Chaplaincy in their overall efforts to screen and process calls for both this program and
for overall efforts for family engagement. The focus for this position will be to prioritize
efforts to screen all calls and to identify calls which meet the project criteria and narrow
them to the four participating schools and neighborhoods. This position will then share
the relevant calls with the trauma response school team. This position ensures the
project has dedicated staff to assist with screenings and ensure the real-time/timely
acquisition of data to generate referrals and response. When not reviewing data and call
information for the project, the Triage Liaison will screen other calls to support the
outreach of the Resiliency Center. For cases where families decline services from the
trauma response team, those cases will be submitted to the Triage Liaison, who will then
forward those cases on to the Resiliency Center.
.68 FTE - Parent Peer/Liaison
A Parent Peer/Liaison, who will possess lived experience involving behavioral health
(these individuals have experience living with mental health illness and/or supports
someone living with mental illness) will create meaningful relationships and engaging
conversation while demonstrating respect, trustworthiness, empathy and collaboration
with the families. The Parent Partner will support the Parent Cafes’ strength-based
framework that emphasizes physical, psychological, and emotional safety and help
support resiliency in the community. The Parent Partner will facilitate most of the
workshops in the Parent Café. The Parent Partner will work to coordinate and provide
warm hand-offs to parents seeking other services, both at the center as well as in the
community.
Exhibit B
Page 7 of 14
1 FTE - Family Partner/Peer Professional
A Family Partner/Peer Professional, who will possess lived experience involving
behavioral health (these individuals have experience living with mental health illness
and/or supports someone living with mental illness) under general supervision, will
engage children and their families as part of the Triage Team with the FCSS Clinician as
a tandem or individually to; deliver peer to peer support services to behavioral health
clients and their family members/caregivers; provide peer-to-peer support services
including: monitoring, informing, supporting, assisting and empowering clients and their
family members/caregivers who directly or indirectly receive behavioral health services;
develop and coordinate activities, programs and resources which directly support clients
and family members/caregivers in achieving wellness and recovery oriented goals;
facilitate peer-to-peer assistance as a part of a team setting; conduct outreach to clients,
family members/caregivers and the community; and, acting in a liaison role between
clients, family members/caregivers, and community service providers.
Collaboration between both the Resiliency Center and FCSS will be essential in the
overall effectiveness of this position because this individual will be part of the Triage
Team with FCSS’s Clinician. The Resiliency Center will oversee and supervise this
individual. FCSS will work in collaboration and coordination with the Resiliency Center
to create and support the Triage Team. This position’s responsibilities may be modified
as the project develops and as agreed upon by the Parties and DBH Director, or
designee.
The Fresno County Superintendent of Schools (FCSS) will staff:
1 FTE - Bilingual Behavioral Health Clinician (BHC II)
A licensed Bilingual Behavioral Health clinician position, under the direction of the
assigned supervisor, will coordinate and provide behavioral health services to students
and families within Fresno County; provide assessment and assistance with the goal of
facilitating and promoting appropriate behavioral health and personal growth; provide
clinical supervision of assigned interns/associates and student interns/trainees to ensure
the delivery of a clinically sound comprehensive program; identify the behavioral health
needs of students and develop therapy goals and objectives for implementation through
an individual therapy plan; provide supervision, consultation, and technical assistance to
pre-licensed Behavioral Health Counselors. This position can provide both direct
services and lead the project. The clinician will be able to leverage from FCSS existing
All 4 Youth school-based clinicians at these school sites for any additional clinical
support (assessment, evaluation) and/or treatment.
V. SERVICE LOCATIONS
While services will mainly be relegated to the service locations identified below, services can
be arranged by CONTRACTOR(S) and families to be receive in the home, school, or other
community space as agree upon by all Parties. Any referrals where the children are not linked
to these piloted schools will be referred/linked to resources in the community for behavioral
health services.
Exhibit B
Page 8 of 14
Targeted Schools and service locations:
1. Del Mar Elementary – 4122 N. Del Mar AVE. Fresno, CA 93704
2. Lowell Elementary – 171 N. Poplar AVE. Fresno, CA 93701
3. Pyle Elementary – 4140 Augusta ST. Fresno, CA. 93726
4. Heaton Elementary – 1533 N. San Pablo AVE. Fresno, CA. 93728
Parent Café service locations:
1. Resiliency Center – 3845 N. Clark ST. Suite 201. Fresno CA. 93726
2. Resiliency Center – 905 N. Fulton ST. Fresno, CA. 93728
VI. SERVICE START DATE
Ramp-Up Period – Up to 30 days upon contract execution date
• CONTRACTOR(S) to secure and/or develop space and recruit and hire staff (including
orientation, training, and any necessary onboarding protocols).
Phase 1 – Upon contract execution date to June 30, 2022
• CONTRACTOR(S) to begin direct services, including, but not limited to; screening calls,
making referrals, notification of schools, screening of students, parent engagement, and
facilitation of the Parent Café.
• Lowell Elementary and Heaton Elementary to begin participation.
• CONTRACTOR(S) to assist evaluators with the evaluation process, including
participation in meetings, services and data collection, and evaluation coordination.
Phase 2 – July 1, 2022 to June 30, 2024 (2 Fiscal Years)
• Program direct services and project evaluation supports to continue.
• Del Mar Elementary and Pyle Elementary to begin participation.
• Resiliency Center will develop a second Parent Café site in the community around the
two new schools to increase accessibility of support services.
Transition Plan Phase – April 1, 2024 to June 30, 2024
• DBH, FCSS, and Resiliency Center will collaborate to develop a transition plan for the
project, as well as working with evaluators in developing a final report.
VII. CULTURAL COMPETENCY
A. CONTRACTOR(S) shall provide the following as it relates to cultural competency
services:
1. CONTRACTOR(S) shall recruit and hire staff that have demonstrated experience
working with Fresno’s diverse communities and to reflect the population of the
Exhibit B
Page 9 of 14
projects targeted schools and other underserved and inappropriately served
populations and have knowledge about the culture of these targeted groups as well
as other diverse communities.
2. CONTRACTOR(S)’s staff shall attend annual trainings on cultural competency,
awareness, and diversity as provided by CONTRACTOR(S). CONTRACTOR(S)’s
staff shall be appropriately trained in providing services in a culturally responsive or
appropriate manner.
3. CONTRACTOR(S)’s staff shall attend civil rights training as provided by
CONTRACTOR(S).
4. CONTRACTOR(S) are recommended to hire bilingual staff, whom are at a
minimum, competent in Spanish and Hmong as these are the identified threshold
languages in Fresno County.
5. CONTRACTOR(S) shall secure the services of trained translators/interpreters as
may be necessary. Translators/interpreters may prove invaluable for languages
such as Cambodian, Russian, Arabic, Armenian, Punjabi, and others.
Translators/interpreters shall be appropriately trained in providing services in a
culturally sensitive manner.
6. CONTRACTOR(S) shall train staff on best practice for utilizing interpreters to
ensure effective communication with monolingual consumers and families to assist
in the delivery of culturally/linguistically appropriate services.
7. CONTRACTOR(S) shall provide services by placing importance on traditional
values, beliefs, and family histories. Cultural values and traditions offer special
strengths in treating clients and this should help guide health care messages and
wellness and recovery plans.
8. CONTRACTOR(S) shall provide services within the most relevant and meaningful
cultural, gender-sensitive, and age-appropriate context for the target population.
9. CONTRACTOR(S) shall develop plans to continually engage targeted populations.
10. CONTRACTOR(S) shall distribute literature/informational brochures in the County’s
current threshold languages and request feedback as to how access to care could
be improved for these culturally diverse communities.
11. CONTRACTOR(S) shall conduct an annual cultural competency self-assessment
and provide the results of said self-assessment to the COUNTY. The annual
cultural competency self-assessment instruments shall be reviewed by the
COUNTY and revised as necessary to meet the approval of the COUNTY. The
CONTRACTOR(S) can create their own cultural competency self-assessment tools
or utilize instruments to be provided by COUNTY.
12. CONTRACTOR(S) shall provide services for the project’s pilot areas, the
community and home as needed, to increase the frequency of clients obtaining
needed services as some children/families are reluctant to seek services at school
sites.
Exhibit B
Page 10 of 14
13. CONTRACTOR(S) shall promote system of care accountability for performance
outcomes which enable children and their families to live independently, work,
maintain community supports, stay in good health, and avoid substance abuse and
incarceration.
14. CONTRACTOR(S) shall provide family support and the creation of family
partnerships utilizing peer support for families and parenting support.
15. CONTRACTOR(S) shall use culturally specific multidisciplinary treatment teams
responsible for assuring and providing needed services.
16. CONTRACTOR(S) shall provide Parent Café in the preferred language of the
participant client/families using interpreters if needed.
17. CONTRACTOR(S)’s staff will be trained to keep an open mind and maintain non-
judgmental interaction with clients/families.
18. CONTRACTOR(S)’s hiring and contracting practices shall be based on local data
and reflect the needs of the population to be served.
19. CONTRACTOR(S) shall attend the COUNTY’s Cultural Humility Committee
monthly meetings, maintain its own cultural competence oversight committee, and
develop a cultural competency plan to address and evaluate cultural competency
issues.
20. COUNTY shall provide technical assistance and demographic data to
CONTRACTOR(S) in relation to cultural competency planning.
VIII. COUNTY RESPONSBILITIES
A. COUNTY shall:
1. Provide oversight, through its DBH Director, or designee, and collaborate with
CONTACTOR(S) and other COUNTY Departments and community agencies to
help achieve State program goals and outcomes. In addition to contract monitoring
of program(s), oversight includes, but not limited to, coordination with the State
Department of Health Care Services in regard to program administration and
outcomes.
2. Assist the CONTRACTOR(S) 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 CONTRACTOR(S)’s staff and will be available to the
CONTRACTOR(S) for ongoing consultation.
4. Gather outcome information from CONTRACTOR(S) throughout each term of this
Agreement. COUNTY DBH staff shall notify the CONTRACTOR(S) when its
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.
Exhibit B
Page 11 of 14
5. Assist the CONTRACTOR(S)’s efforts towards cultural and linguistic competency
by providing the following to CONTRACTOR(S):
a. Technical assistance and training regarding cultural competency requirements.
b. Mandatory cultural competency training for CONTRACTOR(S) personnel, at
minimum once per year.
c. Technical assistance for translating information into COUNTY’s threshold
languages (Spanish and Hmong). Translation services and costs associated
will be the responsibility of the CONTRACTOR(S).
IX. REPORTING REQUIREMENTS AND PERFORMANCE OUTCOMES MONITORING
This collaboration is a Mental Health Services Act (MHSA) Innovations funded project and
throughout the process of services, CONTRACTOR(S) will provide regular updates to DBH
summarizing how the goals and objectives are being met through the provision of services.
During the term of this Agreement, additional data collection opportunities may be identified
and implemented to support the MHSA Innovation research aspects of the Handle with Care
Plus program.
DBH and CONTRACTOR(S) will review additional outcomes, MHSA INN requirements and
CARF standards to establish and further agreed upon outcomes to be tracked.
CONTRACTOR(S) will actively collaborate with DBH and a third-party consultant to develop
and refine data collection and reporting processes to ensure compliance with MHSA
Innovation Plan requirements.
CONTRACTOR(S) shall submit measurable outcomes on an annual basis, as identified in
the Departments Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes
Measures, attached hereto, and referenced herein as Exhibit B-1. Performance outcomes
measures must be approved by the Department and satisfy all State and local mandates.
The Department will provide technical assistance and support in defining measurable
outcomes. All performance indicators will reflect the four domains identified by the
Commission Accreditation of Rehabilitation Facilities (CARF). The domains are
Effectiveness, Efficiency, Access, and Satisfaction. These are defined and listed below.
The Fresno County Department of Behavioral Health collects data about the characteristics
of the persons served and measures service delivery performance indicators in each of the
following CARF Domains: At minimum, one performance indicator will be identified for each
of the four CARF domains listed below.
1. Effectiveness: A performance dimension that assesses the degree to which an
intervention or services have achieved the desired outcome/result/quality of care through
measuring change over time. The results achieved and outcomes observed are for
persons served.
Examples of indicators include: Persons get a job with benefits, or receive supports
needed to live in the community, increased function, activities, or participation, and
improvement of health, employment/earnings, or plan of care goal attainment.
Exhibit B
Page 12 of 14
2. Efficiency: Relationship between results and resources used, such as time, money, and
staff. The demonstration of the relationship between results and the resources used to
achieve them. A performance dimension addressing the relationship between the
outputs/results and the resources used to deliver the service.
Examples of indicators include: Direct staff cost per person served, amount of time it
takes to achieve an outcome, gain in scores per days of service, service hours per
person achieving some positive outcome, total budget (actual cost) per person served,
length of stay and direct service hours of clinical and medical staff.
3. Access: Organizations’ capacity to provide services of those who desire or need
services. Barriers or lack thereof for persons obtaining services. The ability of clients to
receive the right service at the right time. A performance dimension addressing the
degree to which a person needing services is able to access those services.
Examples of indicators include: Timeliness of program entry (From 1st request for service
to 1st service), ongoing wait times/wait lists, minimizing barriers to getting services, and
no-show/cancellation rates.
4. Satisfaction: Satisfaction Measures are usually orientated towards consumers, family,
staff, and stakeholders. The degree to which clients, the County and other stakeholders
are satisfied with services. A performance dimension that describes reports or ratings
from persons served about services received from an organization.
Examples of indicators include: opinion of persons served or other key stakeholders in
regard to access, process, or outcome of services received, Consumer and/or Treatment
Perception Survey. Providers can develop their respective satisfaction survey for
distribution which will require County approval.
A. Data Collection
1. Data collection and evaluation methods may include, but are not limited to, staff,
participant, and family interviews; and case file reviews.
2. CONTRACTOR(S) shall also conduct consumer satisfaction surveys to see if there
is a strong correlation of the efficacy of the evidence-based program with specific
ethnicities and languages as well as to identify gaps in meeting cultural needs of
clients/families, if any.
3. CONTRACTOR(S) shall ensure all program clients/families participate in the semi-
annual State Consumer Perception Survey (CPS). CPS surveys will be distributed to
all clients/families to fill out and return to CONTRACTOR(S).
4. CONTRACTOR(S) shall collect data regarding the ethnicity and language of each
client/family receiving services as well as directing staff to follow-up with the
culturally diverse clients/families for suggestions on how to improve the programs
and also how to help make the programs more culturally relevant according to
MHSA INN regulations.
Exhibit B
Page 13 of 14
5. CONTRACTOR(S) shall maintain all client data in permanent electronic case
records. CONTRACTOR(S) shall have established policies and procedures for
data collection and client confidentiality.
B. Performance Goals
CONTRACTOR(S)’s performance shall also be evaluated according to its scope of work
goals and effectiveness indicators listed below and any further agreed upon outcomes to be
tracked and reported throughout this Innovation project.
CONTRACTOR(S) shall be evaluated on by COUNTY DBH utilizing the following
performance outcomes:
Effectiveness:
Goal/Objective: Children and families will have their needs identified and linked
to appropriate services.
Outcome: Children and families will be screened to identify needs.
Measure: Screening tool (For example: ACE’s, PSC-35, ASQ-3, and
PEARLS).
Efficiency:
Goal/Objective: When the Triage Team receives the notification from the
Resiliency Center, they will identify the school that the child
attends and immediately send the school a Handle with Care
notice.
Outcome: Schools will receive a Handle with Care notice from FCSS for
identified youth/family.
Measure: The number of Handle with Care notices given to the identified
two schools in year one of the innovation project. The number
of Handle with Care notices given to the identified four schools
in subsequent years of the innovation project.
Access:
Goal/Objective: Engage children and/or families into clinical services or link to
care after receiving education from the Handle with Care staff
member.
Outcome: Engage children and/or families into clinical services or link to
care after receiving education from the Handle with Care staff
Exhibit B
Page 14 of 14
member.
Measure: Engage children and/or families into clinical services or link to
care after receiving education from the Handle with Care staff
member.
Satisfaction:
Objective: School and family will be satisfied with Handle with Care staff
engagement.
Outcome: School and families will report satisfaction with engagement,
linkage, resources, and clinical care.
Measure: Handle with Care Satisfaction Surveys.
C. Reports
1. CONTRACTOR(S) shall prepare an evaluation report annually and submit to the
COUNTY’s DBH and make said reports available to partnering and interested local
agencies and organizations such as the project collaborators, other community
agencies and mental health treatment providers. Each annual evaluation report will
comply with all State regulations regarding State Performance Outcomes
measurement requirements, including MHSA Innovations regulations, and participate
in the outcomes measurement process as required by DBH. General performance
outcomes reporting contains the following information: demographics of the target
population served, services provided to each participant, number of hospitalization,
enrollment in school, results of data analysis compared to planned process, output
and outcome measures, barriers to program implementation and measures taken to
overcome those barriers, accomplishments of program participants, lessons learned,
and the final result of any and all satisfactory survey(s).
2. CONTRACTOR(S) shall be expected to comply with all contract monitoring and
compliance protocols, procedures, data collection methods, and reporting
requirements conducted by the COUNTY.
3. Additional reports/outcomes may also be requested by the COUNTY’s Department of
Behavioral Health, based on among other things, identification of client/family
specific needs as well as State required reports/outcomes as needed.
�co �� ii\ '6 �% 1s5�o/
PR"£;'
Section:
Effective Date:
Policy Title:
Department of Behavioral Health
Administration
os/30/2011
Performance Outcome Measures
Policy and Procedure Guide
PPG 1.2.7
Revised Date: os/30/2011
- ------· --- -------·· ------ -----·----···-·····-
Approved by: Dawan Utecht (Director of Behavioral Health), Francisco Escobedo (Sr. Staff Analyst - QA), Kannika
POLICY:
PURPOSE:
REFERENCE:
DEFINITIONS:
Toonnachat (Division Manager -Technology and Quality Management)
It is the policy of Fresno County Department of Behavioral Health and the
Fresno County Mental Health Plan (FCMHP) to ensure procedures for
developing performance measures which accurately reflect vital areas of
performance and provide for systematic, ongoing collection and analysis
of valid and reliable data. Data collection is not intended to be an
additional task for FCMHP programs/providers but rather embedded within
the various non-treatment, treatment and clinical documentation.
To determine the effectiveness and efficiency of services provided by
measuring performance outcomes/results achieved by the persons served
during service delivery or following service completion, delivery of service,
and of the individuals' satisfaction. This is a vital management tool used to
clarify goals, document the efforts toward achieving those goals, and thus
measure the benefit the service delivery to the persons served.
Performance measurement selection is part of the planning and
developing process design of the program. Performance measurement is
the ongoing monitoring and reporting of progress towards pre-established
objectives/goals.
California Code of Regulations, Title 9, Chapter 11, Section
1810.380(a)(1 ): State Oversight
DHCS Service, Administrative and Operational Requirements
Mental Health Services Act (MHSA}, California Code of Regulations, Title
9, Section 3320, 3200.050, and 3200.120
Commission on Accreditation of Rehabilitation Facilities (CARF)
1.Indicator: Qualitative or quantitative measure(s) that tell if the outcomes have been
accomplished. Indicators evaluate key performance in relation to objectives. It indicates
what the program is accomplishing and if the anticipated results are being achieved.
---�------·-------·----·-·--·---· ---· -·--------·---···--
MISSION STATEMENT
The Department of Behallioral Health Is dedicated to supporting the wellness of Individuals, families and communities In Fresno County who are affected by, or ore at risk
of, mental Illness and/or substance use disorders through cultivation of strengths toward promoting recollf!f)I In the least restrictive environment
Template Review Date 3/28/16
Exhibit B-1 Page 1 of 6
� co�-<V fi!' Department of Behavioral Health
� t> % 185��
Policy and Procedure Guide
PR�� Section: Administration Effective Date: 05/30/2017 PPG 1.2.7
Policy Title: Performance Outcome Measures
2.Intervention: A systematic plan of action consciously adapted in an attempt to address
and reduce the causes of failure or need to improve upon system.
3.Fresno County Mental Health Plan (FCMHP): Fresno County's contract with the State
Department of Health and Human Services that allows for the provision of specialty
mental health services. Services may be delivered by county-operated programs,
contracted organizational, or group providers.
4.Objective (Goal): Intended results or the impact of learning, programs, or activities.
5.Outcomes: Specific results or changes achieved as a consequence of the program or
intervention. Outcomes are connected to the objectives/goals identified by the program
or intervention.
PROCEDURE:
I.Each FCMHP program/provider shall engage in measurement of outcomes in order
to generate reliable and valid data on the effectiveness and efficiency of programs or
interventions. Programs/providers will establish/select objectives (goals), decide on
a methodology and timeline for the collection of data, and use an appropriate data
collection tool. This occurs during the program planning and development process.
Outcomes should be in alignment with the program/provider goals.
II.Outcomes should be measureable, obtainable, clear, accurately reflect the expected
result, and include specific time frames. Once the measures have been selected, it
is necessary to design a way to gather the information. For each service delivery
performance indicator, FCMHP program/provider shall determine: to whom the
indicator will be applied; who is responsible for collecting the data; the tool from
which data will be collected; and a performance target based on an industry
benchmark, or a benchmark set by the program/provider.
Ill. Performance measures are subject to review and approval by FCMHP
Administration.
IV.Performance measurement is the ongoing monitoring and reporting of progr ess
towards pre-established objectives/goals. Annually, each FCMHP program/provider
must measure service delivery performance in each of the areas/domains listed
below. Dependent on the program/provider service deliverables, exceptions must be
approved by the FCMHP Administration.
Exhibit B-1 Page 2 of 6
� � col<-<V-Department of Behavioral Health
�
� � Policy and Procedure Guide
� 185�0
�R£Y Section: Administration Effective Date: 05/30/2017 PPG 1.2.7
Policy Title: Performance Outcome Measures
a.Effectiveness of services -How well programs performed and the results
achieved. Effectiveness measures address the quality of care through
measuring change over time. Examples include but are not limited to: reduction
of hospitalization, reduction of symptoms, employment and housing status, and
reduction of recidivism rate and incidence of relapse.
b.Efficiency of services -The relationship between the outcomes and the
resources used. Examples include but are not limited to: service delivery cost per
service unit, length of stay, and direct service hours of clinical and medical staff.
c.Services access -Changes or improvements in the program/provider's capacity
and timeliness to provide services to those who request them. Examples include
but are not limited to: wait/length of time from first request/referral to first service
or subsequent appointment, convenience of service hours and locations, number
of clients served by program capacity, and no-show and cancellation rates.
d.Satisfaction and feedback from persons served and stakeholders-Changes or
increased positive/negative feedback regarding the experiences of the persons
served and others (families, referral sources, payors/guarantors, etc.).
Satisfaction measures are usually oriented toward clients, family members,
personnel, the community, and funding sources. Examples include but are not
limited to: did the organization/program focus on the recovery of the person
served, were grievances or concerns addressed, overall feelings of satisfa ction,
and satisfaction with physical facilities, fees, access, service effectiveness, and
efficiency.
V.Each FCMHP program/provider shall use the following templates to document the
defined goals, intervention(s), specific indicators, and outcomes.
1.FCMHP Outcome Report template (see Attachment A)
2.FCMHP Outcome Analysis template (see Attachment C)
Exhibit B-1 Page 3 of 6
Page 4 of 6Exhibit B-1
Page 5 of 6Exhibit B-1
Page 6 of 6Exhibit B-1
Trauma occurs
Resiliency
Center (Triage
Liaison) screens
calls for piloting
area
Call entered into
Fresno PD
smartphone app
(law enforcement)
FCSS determines
if child is in one of
four pilot schools
Family
Declines
Triage Liaison
forwards identified
cases to FCSS
Triage Team informs
provider and informs family
of Parent Café
FCSS check Avatar
for history
Active in
care in
Avatar
Not
active in
care in
Avatar
Triage Team
contacts the
parent/guardian
to ask if we can
contact provider Family
Accepts
Triage Team
contacts the
family to offer
support
Declines
Services
Accepts
Services
FCSS screen,
assess and treat
child as needed
Triage Team
informs of Parent
Café and asks if
resources can be
sent
FCSS closes case and
refer back to RC
Warm handoff to
service provider of
parents’ choice
FCSS
recommends
family to Parent
Café
School point
person sends
HWC notice to
teacher(s) &
necessary staff
If child is in
pilot
school
If child is
not in pilot
school
FCSS sends HWC
notice to school
School refers to All 4
Youth and RC for
services, as needed
FCSS sends HWC
notice to school
RC Triage Liaison
reviews Avatar
Triage Team does not Inform
provider but informs family
of Parent Café/resources
School monitors for any
changes in behavior or
academics
RC Parent Liaison
contacts families
informing them of
HWC program and
inviting them to
Parent Café
RC to follow up in
30 day with the
family
Handle with Care Plus Flowchart Exhibit B-2
Page 1 of 1
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Associate Marriage & Family Therapist 0.80 -$ 41,600$ 41,600$
1102 Triage Liaison / Case Manager 0.80 - 36,608 36,608
1103 Parent Peer / Liaison 0.68 - 30,888 30,888
1104 Peer Support Specialist II 1.00 4,992 33,280 38,272
1105 - - -
1106 - - -
1107 - - -
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 3.28 4,992$ 142,376$ 147,368$
Employee Benefits
Acct #Admin Direct Total
1101 -$ -$ -$
1102 - - -
1103 - - -
1104 - - -
1105 - - -
1106 - - -
-$ -$ -$
-$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 10,892 10,892
1203 - 3,702 3,702
1204 - - -
1205 - - -
1206 - - -
-$ 14,594$ 14,594$
4,992$ 156,970$ 161,962$
Handle with Care Plus
The Fresno Resiliency Center
Fiscal Year 2021-22
Description
Payroll Taxes & Expenses Subtotal:
Other (specify)
Other (specify)
EMPLOYEE SALARIES & BENEFITS TOTAL:
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Retirement
Worker's Compensation
Health Insurance
Other (specify)
Other (specify)
OASDI
FICA/MEDICARE
SUI
Other (specify)
Other (specify)
Employee Benefits Subtotal:
Employee Benefits %:
Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 1 of 18
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 -
2012 -
2013 -
2014 -
2015 -
2016 -
-$
3000: OPERATING EXPENSES
Acct #Amount
3001 -$
3002 -
3003 -
3004 -
3005 -
3006 -
3007 -
3008 -
3009 -
3010 -
3011 -
3012 -
-$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 5,403
4003 1,267
4004 -
4005 -
4006 325
4007 Other (specify)
4008 Other (specify)
4009 Other (specify)
4010 Other (specify)
6,995$
5000: SPECIAL EXPENSES
Acct #Amount
Line Item Description
Line Item Description
Line Item Description
Line Item Description
DIRECT CLIENT CARE TOTAL
Other (specify)
Other (specify)
Advertising
Rent/Lease Building
Building Maintenance
Education Support
FACILITIES/EQUIPMENT TOTAL:
OPERATING EXPENSES TOTAL:
Staff Development & Training
Vehicle Maintenance
Rent/Lease Vehicles
Security
Utilities
Rent/Lease Equipment
Other (specify)
Other (specify)
Other (specify)
Telecommunications
Printing/Postage
Client Transportation & Support
Client Housing Support
Child Care
Other (specify)
Other (specify)
Other (specify)
Clothing, Food, & Hygiene
Tables and Chairs
Industrial Coffee Grinders
Signage and Menu Board
Supplies, Glassware, Register
Other (specify)
Other (specify)
Office, Household & Program Supplies
Utility Vouchers
Program Supplies - Medical
Medication Supports
Household Items for Clients
Employment Support
Staff Mileage
Subscriptions & Memberships
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 2 of 18
5001 -$
5002 1,344
5003 -
5004 -
5005 Parent Café 11,500
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
12,844$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 -$
6002 -
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (specify)-
6009 Other (specify)-
6010 Other (specify)-
6011 Other (specify)-
6012 Other (specify)-
-$
7000: FIXED ASSETS
Acct #Amount
7001
7002 -
7003
7004 -
7005
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
-$
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Professional Liability Insurance
Accounting/Bookkeeping
Leasehold/Tenant/Building Improvements
PROGRAM FUNDING SOURCES
181,801$ TOTAL PROGRAM EXPENSES
FIXED ASSETS EXPENSES TOTAL
ADMINISTRATIVE EXPENSES TOTAL
SPECIAL EXPENSES TOTAL:
Line Item Description
External Audit
Estimated Specialty Mental Health Services Billing Totals:
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Other Assets over $500 with Lifespan of 2 Years +
Administrative Overhead
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
HMIS (Health Management Information System)
Consultant (Network & Data Management)
Furniture & Fixtures
Line Item Description
Contractual/Consulting Services (Specify)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 3 of 18
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations 181,801
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
181,801$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)-
8404 Other Revenue 1 -
8405 Other Revenue 2 -
-$
8400 - OTHER REVENUE
NET PROGRAM COST:
TOTAL PROGRAM FUNDING SOURCES:181,801$
-$
SUBSTANCE USE DISORDER FUNDS TOTAL
MEDI-CAL FFP TOTAL
MHSA TOTAL
Line Item Description
8100 - SUBSTANCE USE DISORDER FUNDS
OTHER REVENUE TOTAL
Line Item Description
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Federal Financial Participation (FFP) %
MHSA Program Name
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
Line Item Description
REALIGNMENT TOTAL
8200 - REALIGNMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 4 of 18
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 161,962
Employee Salaries 147,368
1101 Associate Marriage & Family Therapist 41,600 Provide counseling & associated documentation in a 32 hr work week
1102 Triage Liaison / Case Manager 36,608 Assist children and families exposed to trauma
1103 Parent Peer / Liaison 30,888 Provide parent training on associated trauma topics
1104 Peer Support Specialist II 38,272 Working with FCSS Clinician
1105 0 -
1106 0 -
1107 0 -
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits -
1101 Retirement -
1102 Worker's Compensation -
1103 Health Insurance -
1104 Other (specify)-
1105 Other (specify)-
1106 Other (specify)-
Payroll Taxes & Expenses:14,594
1201 OASDI -
1202 FICA/MEDICARE 10,892
1203 SUI 3,702
1204 Other (specify)-
1205 Other (specify)-
1206 Other (specify)-
2000: CLIENT SUPPORT -
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (specify)-
2012 Other (specify)-
2013 Other (specify)-
2014 Other (specify)-
2015 Other (specify)-
2016 Other (specify)-
3000: OPERATING EXPENSES -
3001 Telecommunications -
3002 Printing/Postage -
3003 Office, Household & Program Supplies -
The Fresno Resiliency Center
Handle with Care Plus
Fiscal Year 2021-22
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-1
Page 5 of 18
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage -
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Other (specify)-
3010 Other (specify)-
3011 Other (specify)-
3012 Other (specify)-
4000: FACILITIES & EQUIPMENT 6,995
4001 Building Maintenance -
4002 Rent/Lease Building 5,403 25% of rent for location in Tower district
4003 Rent/Lease Equipment 1,267 Leasing 2 computers tied to Police Department data
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 325 less than 8% of utilities expense for location in Tower district
4007 Other (specify)-
4008 Other (specify)-
4009 Other (specify)-
4010 Other (specify)-
5000: SPECIAL EXPENSES 12,844
5001 Consultant (Network & Data Management)-
5002 HMIS (Health Management Information
System)
1,344 Avatar expense for two Case Managers/Clinicians
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services -
5005 Parent Café 11,500 8.5 % of rent/utilities, etc. at Clark St. location, materials, printing, guest speakers,
childcare, food, incentives, supplies, training
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
6000: ADMINISTRATIVE EXPENSES -
6001 Administrative Overhead -
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (specify)-
6009 Other (specify)-
6010 Other (specify)-
6011 Other (specify)-
6012 Other (specify)-
7000: FIXED ASSETS -
7001 Computer Equipment & Software -
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:181,801
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:181,801
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-1
Page 6 of 18
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Associate Marriage & Family Therapist 0.80 -$ 41,600$ 41,600$
1102 Triage Liaison / Case Manager 0.80 - 36,608 36,608
1103 Parent Peer / Liaison 0.68 - 30,888 30,888
1104 Peer Support Specialist II 1.00 4,992 33,280 38,272
1105 - - -
1106 - - -
1107 - - -
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 3.28 4,992$ 142,376$ 147,368$
Employee Benefits
Acct #Admin Direct Total
1101 -$ -$ -$
1102 - - -
1103 - - -
1104 - - -
1105 - - -
1106 - - -
-$ -$ -$
0
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 10,892 10,892
1203 - 3,702 3,702
1204 - - -
1205 - -
1206 - -
-$ 14,594$ 14,594$
4,992$ 156,970$ 161,962$
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Handle with Care Plus
The Fresno Resiliency Center
Fiscal Year 2022-23
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Employee Benefits Subtotal:
Employee Benefits %:
Description
OASDI
FICA/MEDICARE
SUI
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 7 of 18
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 -
2012 -
2013 -
2014 -
2015 -
2016 -
-$
3000: OPERATING EXPENSES
Acct #Amount
3001 -$
3002 -
3003 -
3004 -
3005 -
3006 -
3007 -
3008 -
3009 -
3010 -
3011 -
3012 -
-$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 5,403
4003 1,267
4004 -
4005 -
4006 325
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
6,995$
5000: SPECIAL EXPENSES
Acct #Amount
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Security
Utilities
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 8 of 18
5001 -$
5002 1,344
5003 -
5004 -
5005 Parent Café 16,891
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
18,235$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 -$
6002 -
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
-$
7000: FIXED ASSETS
Acct #Amount
7001 -$
7002 -
7003 -
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
-$
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 187,192$
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 9 of 18
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations 187,192
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
187,192$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)
8404 Other (Specify)
8405 Other (Specify) -
-$
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:187,192$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 10 of 18
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 161,962
Employee Salaries 147,368
1101 Associate Marriage & Family Therapist 41,600 Provide counseling & associted documentation in a 32 hr work week
1102 Triage Liaison / Case Manager 36,608 Assist children and families exposed to trauma
1103 Parent Peer / Liaison 30,888 Provide parent training on associated trauma topics
1104 Peer Support Specialist II 38,272 Working with FCSS Clinician
1105 0 -
1106 0 -
1107 0 -
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits -
1101 Retirement -
1102 Worker's Compensation -
1103 Health Insurance -
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:14,594
1201 OASDI -
1202 FICA/MEDICARE 10,892
1203 SUI 3,702
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT -
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Specify)-
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES -
3001 Telecommunications -
3002 Printing/Postage -
3003 Office, Household & Program Supplies -
Handle with Care Plus
The Fresno Resiliency Center
Fiscal Year 2022-23
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-1
Page 11 of 18
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage -
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Other (Specify)-
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 6,995
4001 Building Maintenance -
4002 Rent/Lease Building 5,403 25% of rent for location in Tower district
4003 Rent/Lease Equipment 1,267 Leasing 2 computers tied to Police Department data
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 325 less than 8% of utilities expense for location in Tower district
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 18,235
5001 Consultant (Network & Data Management)-
5002 HMIS (Health Management Information
System)
1,344 Avatar expense for two Case Managers/Clinicians
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services -
5005 Parent Café 16,891 8.5% of rent/utilities etc. at Clark St. location, materials, printing, guest speakers,
childcare, food, incentives, supplies, training
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES -
6001 Administrative Overhead -
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS -
7001 Computer Equipment & Software -
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:187,192
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:187,192
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-1
Page 12 of 18
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Associate Marriage & Family Therapist 0.80 -$ 41,600$ 41,600$
1102 Triage Liaison / Case Manager 0.80 - 36,608 36,608
1103 Parent Peer / Liaison 0.68 - 30,888 30,888
1104 Peer Support Specialist II 1.00 4,992 33,280 38,272
1105 - - -
1106 - - -
1107 - - -
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - -
Personnel Salaries Subtotal 3.28 4,992$ 142,376$ 147,368$
Employee Benefits
Acct #Admin Direct Total
1101 -$ -$ -$
1102 - - -
1103 - - -
1104 - - -
1105 - - -
1106 - - -
-$ -$ -$
0
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 10,892 10,892
1203 - 3,702 3,702
1204 - - -
1205 - -
1206 - -
-$ 14,594$ 14,594$
4,992$ 156,970$ 161,962$
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Handle with Care Plus
The Fresno Resiliency Center
Fiscal Year 2023-24
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Employee Benefits Subtotal:
Employee Benefits %:
Description
OASDI
FICA/MEDICARE
SUI
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 13 of 18
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 -
2012 -
2013 -
2014 -
2015 -
2016 -
-$
3000: OPERATING EXPENSES
Acct #Amount
3001 -$
3002 -
3003 -
3004 -
3005 -
3006 -
3007 -
3008 -
3009 -
3010 -
3011 -
3012 -
-$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 5,403
4003 1,266
4004 -
4005 -
4006 325
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
6,994$
5000: SPECIAL EXPENSES
Acct #Amount
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Security
Utilities
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 14 of 18
5001 -$
5002 1,344
5003 -
5004 -
5005 Parent Café 16,891
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
18,235$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 -$
6002 -
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
-$
7000: FIXED ASSETS
Acct #Amount
7001 -$
7002 -
7003 -
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
-$
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 187,191$
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 15 of 18
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations 187,191
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
187,191$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)-
8404 Other (Specify) -
8405 Other (Specify) -
-$
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:187,191$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-1
Page 16 of 18
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 161,962
Employee Salaries 147,368
1101 Associate Marriage & Family Therapist 41,600 Provide counseling & associated documentation in a 32 hr work week
1102 Triage Liaison / Case Manager 36,608 Assist children and families exposed to trauma
1103 Parent Peer / Liaison 30,888 Provide parent training on associated trauma topics
1104 Peer Support Specialist II 38,272 Work with FCSS Clinician
1105 0 -
1106 0 -
1107 0 -
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits -
1101 Retirement -
1102 Worker's Compensation -
1103 Health Insurance -
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:14,594
1201 OASDI -
1202 FICA/MEDICARE 10,892
1203 SUI 3,702
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT -
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Specify)-
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES -
3001 Telecommunications -
3002 Printing/Postage -
3003 Office, Household & Program Supplies -
Handle with Care Plus
The Fresno Resiliency Center
Fiscal Year 2023-24
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-1
Page 17 of 18
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage -
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Other (Specify)-
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 6,994
4001 Building Maintenance -
4002 Rent/Lease Building 5,403 25% of rent for location in Tower district
4003 Rent/Lease Equipment 1,266 Leasing 2 computers tied to Police Department data
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 325 less than 8% of utilities expense for location in Tower district
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 18,235
5001 Consultant (Network & Data Management)-
5002 HMIS (Health Management Information
System)
1,344 Avatar expense for two Case Managers/Clinicians
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services -
5005 Parent Café 16,891 8.5% of rent/utilities, etc. for Clark St. location, materials, printing, guest speakers,
childcare, food, incentives, supplies, training
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES -
6001 Administrative Overhead -
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS -
7001 Computer Equipment & Software -
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:187,191
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:187,191
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-1
Page 18 of 18
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Bilingual Behavioral Health Clinician II 1.00 -$ 94,841$ 94,841$
1102 -
1103 - - -
1104 - - -
1105 - - -
1106 - - -
1107 - - -
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 1.00 -$ 94,841$ 94,841$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 21,529$ 21,529$
1102 - 1,963 1,963
1103 - 14,500 14,500
1104 - - -
1105 - - -
1106 - - -
-$ 37,992$ 37,992$
0.37$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$
1202 - 7,255 7,255
1203 - 47 47
1204 - -
1205 - - -
1206 - - -
-$ 7,303$ 7,303$
-$ 140,136$ 140,136$
Other (specify)
Employee Benefits Subtotal:
Employee Benefits %:
Description
1000: SALARIES & BENEFITS
Retirement
Worker's Compensation
Health Insurance
Other (specify)
Other (specify)
OASDI
FICA/MEDICARE
SUI
Other (specify)
PROGRAM EXPENSES
Handle With Care Plus
Fresno County Superintendent of Schools
Fiscal Year 2021-22
Description
Payroll Taxes & Expenses Subtotal:
Other (specify)
Other (specify)
EMPLOYEE SALARIES & BENEFITS TOTAL:
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 1 of 21
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 -
2012 -
2013 -
2014 -
2015 -
2016 -
-$
3000: OPERATING EXPENSES
Acct #Amount
3001
3002 -
3003 1,000
3004 -
3005 -
3006 3,000
3007 -
3008 -
3009 936
3010 -
3011 -
3012 -
4,936$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 -
4003 -
4004 -
4005 -
4006 -
4007 Other (specify)-
4008 Other (specify)-
4009 Other (specify)-
4010 Other (specify)-
-$
5000: SPECIAL EXPENSES
Acct #Amount
Other (specify)
Other (specify)
Clothing, Food, & Hygiene
Other (specify)
Other (specify)
Office, Household & Program Supplies
Utility Vouchers
Program Supplies - Medical
Medication Supports
Household Items for Clients
Employment Support
Staff Mileage
Subscriptions & Memberships
Other (specify)
Other (specify)
Other (specify)
Telecommunications
Printing/Postage
Client Transportation & Support
Client Housing Support
Child Care
Professional Services
Rent/Lease Vehicles
Security
Utilities
Rent/Lease Equipment
FACILITIES/EQUIPMENT TOTAL:
OPERATING EXPENSES TOTAL:
Staff Development & Training
Vehicle Maintenance
Line Item Description
Line Item Description
Line Item Description
Line Item Description
DIRECT CLIENT CARE TOTAL
Other (specify)
Other (specify)
Advertising
Rent/Lease Building
Building Maintenance
Education Support
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 2 of 21
5001 -$
5002 -
5003 -
5004 -
5005 Other (specify)-
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
-$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 12,071$
6002 95
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (specify)-
6009 Other (specify)-
6010 Other (specify)-
6011 Other (specify)-
6012 Other (specify)-
12,166$
7000: FIXED ASSETS
Acct #Amount
7001 2,500$
7002 -
7003 -
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
2,500$
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
Contractual/Consulting Services (Specify)
Translation Services
Consultant (Network & Data Management)
Furniture & Fixtures
Line Item Description
Administrative Overhead
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
HMIS (Health Management Information System)
External Audit
Estimated Specialty Mental Health Services Billing Totals:
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Other Assets over $500 with Lifespan of 2 Years +
PROGRAM FUNDING SOURCES
159,738$ TOTAL PROGRAM EXPENSES
FIXED ASSETS EXPENSES TOTAL
ADMINISTRATIVE EXPENSES TOTAL
SPECIAL EXPENSES TOTAL:
Line Item Description
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Professional Liability Insurance
Accounting/Bookkeeping
Leasehold/Tenant/Building Improvements
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 3 of 21
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations 159,738
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
159,738$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)-
8404 Other Revenue 1 -
8405 Other Revenue 2 -
-$
8200 - REALIGNMENT
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Federal Financial Participation (FFP) %
MHSA Program Name
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
Line Item Description
REALIGNMENT TOTAL
NET PROGRAM COST:
TOTAL PROGRAM FUNDING SOURCES:159,738$
(0)$
SUBSTANCE USE DISORDER FUNDS TOTAL
MEDI-CAL FFP TOTAL
MHSA TOTAL
Line Item Description
8100 - SUBSTANCE USE DISORDER FUNDS
OTHER REVENUE TOTAL
Line Item Description
8400 - OTHER REVENUE
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 4 of 21
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 140,136
Employee Salaries 94,841
1101 Bilingual Behavioral Health Clinician II 94,841 Position will lead the project and provide direct behavioral health services to student
and families within Fresno County; provide assessment and assistance with the goal
of facilitating and promoting appropriate behavioral health and person personal
growth.
1102 0 -
1103 0 -
1104 0 -
1105 0 -
1106 0 -
1107 0 -
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 37,992
1101 Retirement 21,529 Employee Benefits will be paid in a like manner as other employees of FCSS
1102 Worker's Compensation 1,963
1103 Health Insurance 14,500
1104 Other (specify)-
1105 Other (specify)-
1106 Other (specify)-
Payroll Taxes & Expenses:7,303
1201 OASDI -
1202 FICA/MEDICARE 7,255 Payroll Taxes will be paid in a like manner as other employees of FCSS
1203 SUI 47
1204 Other (specify)-
1205 Other (specify)-
1206 Other (specify)-
2000: CLIENT SUPPORT -
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (specify)-
2012 Other (specify)-
2013 Other (specify)-
2014 Other (specify)-
2015 Other (specify)-
2016 Other (specify)-
3000: OPERATING EXPENSES 4,936
Fresno County Superintendent of Schools
Handle With Care Plus
Fiscal Year 2021-22
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-2
Page 5 of 21
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3001 Telecommunications -
3002 Printing/Postage -
3003 Office, Household & Program Supplies 1,000 Reflects cost for office supplies, programming materials and other items essential
for job functions, such as paper, scissors, tape, hole-punch, pens, wastebaskets,
envelopes, paper clips, gloves, first aid supplies, kleenex, toys crayons etc.
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage 3,000 Cost of staff mileage reimbursement per year for traveling to schools, Hubs, parent
homes or in the community in order to provide services.
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Professional Services 936 This includes intangible technology costs for employees such as copier use, internet,
and cell phone reibursement.
3010 Other (specify)-
3011 Other (specify)-
3012 Other (specify)-
4000: FACILITIES & EQUIPMENT -
4001 Building Maintenance -
4002 Rent/Lease Building -
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities -
4007 Other (specify)-
4008 Other (specify)-
4009 Other (specify)-
4010 Other (specify)-
5000: SPECIAL EXPENSES -
5001 Consultant (Network & Data Management)-
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services -
5005 Other (specify)-
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
6000: ADMINISTRATIVE EXPENSES 12,166
6001 Administrative Overhead 12,071 Cost of general management that consist of expenditures for adminstrative activities
necessary for the general operation of FCSS. The indirect cost rate is based on the
CDE's federally approved indirect cost plan for K-12 LEA and county offices of
education.
6002 Professional Liability Insurance 95 Expense will be paid in the manner as other employees of FCSS, line is recorded by
FCSS as an operating expense.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (specify)-
6009 Other (specify)-
6010 Other (specify)-
6011 Other (specify)-
6012 Other (specify)-
7000: FIXED ASSETS 2,500
7001 Computer Equipment & Software 2,500 Reflects cost of Laptop to be used by Clinician.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-2
Page 6 of 21
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:159,738
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:159,738
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-2
Page 7 of 21
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Bilingual Behavioral Health Clinician II 1.00 -$ 102,481$ 102,481$
1102 - -
1103 - - -
1104 - - -
1105 - - -
1106 - - -
1107 - - -
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 1.00 -$ 102,481$ 102,481$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 25,210$ 25,210$
1102 - 2,121 2,121
1103 - 14,500 14,500
1104 - - -
1105 - - -
1106 - - -
-$ 41,832$ 41,832$
0.379006167
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 7,840 7,840
1203 - 51 51
1204 - - -
1205 - -
1206 - -
-$ 7,891$ 7,891$
-$ 152,204$ 152,204$
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Employee Benefits Subtotal:
Employee Benefits %:
Description
OASDI
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Handle With Care Plus
Fresno County Superintendent of Schools
Fiscal Year 2022-23
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 8 of 21
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 -
2012 -
2013 -
2014 -
2015 -
2016 -
-$
3000: OPERATING EXPENSES
Acct #Amount
3001 -$
3002 -
3003 1,000
3004 -
3005 -
3006 3,000
3007 -
3008 -
3009 936
3010 -
3011 -
3012 -
4,936$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 -
4003 -
4004 -
4005 -
4006 -
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
-$
5000: SPECIAL EXPENSES
Acct #Amount
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Security
Utilities
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Professional Services
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 9 of 21
5001 -$
5002 -
5003 -
5004 -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
-$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 12,862$
6002 95
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
12,957$
7000: FIXED ASSETS
Acct #Amount
7001 -$
7002 -
7003 -
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
-$
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 170,097$
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 10 of 21
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment (0)$
(0)$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations 170,097
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
170,097$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)
8404 Other (Specify)
8405 Other (Specify) -
-$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:170,097$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 11 of 21
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 152,204
Employee Salaries 102,481
1101 Bilingual Behavioral Health Clinician II 102,481 Position will lead the project and provide direct behavioral health services to student
and families within Fresno County; provide assessment and assistance with the goal
of facilitating and promoting appropriate behavioral health and person personal
growth.
1102 0 -
1103 0 -
1104 0 -
1105 0 -
1106 0 -
1107 0 -
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 41,832
1101 Retirement 25,210 Employee Benefits will be paid in a like manner as other employees of FCSS
1102 Worker's Compensation 2,121
1103 Health Insurance 14,500
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:7,891
1201 OASDI -
1202 FICA/MEDICARE 7,840 Payroll Taxes will be paid in a like manner as other employees of FCSS
1203 SUI 51
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT -
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Specify)-
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 4,936
Handle With Care Plus
Fresno County Superintendent of Schools
Fiscal Year 2022-23
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-2
Page 12 of 21
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3001 Telecommunications -
3002 Printing/Postage -
3003 Office, Household & Program Supplies 1,000 Reflects cost for office supplies, programming materials and other items essential
for job functions, such as paper, scissors, tape, hole-punch, pens, wastebaskets,
envelopes, paper clips, gloves, first aid supplies, kleenex, toys crayons etc.
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage 3,000 Cost of staff mileage reimbursement per year for traveling to schools, Hubs, parent
homes or in the community in order to provide services.
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Professional Services 936 This includes intangible technology costs for employees such as copier use, internet,
and cell phone reibursement.
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT -
4001 Building Maintenance -
4002 Rent/Lease Building -
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities -
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES -
5001 Consultant (Network & Data Management)-
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 12,957
6001 Administrative Overhead 12,862 Cost of general management that consist of expenditures for adminstrative activities
necessary for the general operation of FCSS. The indirect cost rate is based on the
CDE's federally approved indirect cost plan for K-12 LEA and county offices of
education.
6002 Professional Liability Insurance 95 Expense will be paid in the manner as other employees of FCSS, line is recorded by
FCSS as an operating expense.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS -
7001 Computer Equipment & Software -
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-2
Page 13 of 21
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:170,097
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:170,097
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-2
Page 14 of 21
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Bilingual Behavioral Health Clinician II 1.00 -$ 105,525$ 105,525$
1102 - -
1103 - - -
1104 - - -
1105 - - -
1106 - - -
1107 - - -
1108 - - -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - -
Personnel Salaries Subtotal 1.00 -$ 105,525$ 105,525$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 26,803$ 26,803$
1102 - 2,184 2,184
1103 - 14,500 14,500
1104 - - -
1105 - - -
1106 - - -
-$ 43,488$ 43,488$
0.38264969
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 8,073 8,073
1203 - 51 51
1204 - - -
1205 - -
1206 - -
-$ 8,124$ 8,124$
-$ 157,137$ 157,137$
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Employee Benefits Subtotal:
Employee Benefits %:
Description
OASDI
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Handle With Care Plus
Fresno County Superintendent of Schools
Fiscal Year 2023-24
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 15 of 21
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 -
2003 -
2004 -
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 -
2012 -
2013 -
2014 -
2015 -
2016 -
-$
3000: OPERATING EXPENSES
Acct #Amount
3001 -$
3002 -
3003 1,000
3004 -
3005 -
3006 3,000
3007 -
3008 -
3009 936
3010 -
3011 -
3012 -
4,936$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 -$
4002 -
4003 -
4004 -
4005 -
4006 -
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
-$
5000: SPECIAL EXPENSES
Acct #Amount
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Security
Utilities
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Subscriptions & Memberships
Vehicle Maintenance
Professional Services
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 16 of 21
5001 -$
5002 -
5003 -
5004 -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
-$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 13,266$
6002 102
6003 -
6004 -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
13,368$
7000: FIXED ASSETS
Acct #Amount
7001
7002 -
7003 -
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
-$
Acct #Service Units Rate Amount
8001 Mental Health Services 0 - -$
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
0 -$
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 175,441$
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 17 of 21
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment 0$
0$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports -$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations 175,441
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
175,441$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)-
8404 Other (Specify) -
8405 Other (Specify) -
-$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:175,441$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Line Item Description
REALIGNMENT TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI-CAL FFP TOTAL
8100 - SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 - REALIGNMENT
Estimated % of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C-2
Page 18 of 21
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 157,137
Employee Salaries 105,525
1101 Bilingual Behavioral Health Clinician II 105,525 Position will lead the project and provide direct behavioral health services to student
and families within Fresno County; provide assessment and assistance with the goal
of facilitating and promoting appropriate behavioral health and person personal
growth.
1102 0 -
1103 0 -
1104 0 -
1105 0 -
1106 0 -
1107 0 -
1108 0 -
1109 0 -
1110 0 -
1111 0 -
1112 0 -
1113 0 -
1114 0 -
1115 0 -
1116 0 -
1117 0 -
1118 0 -
1119 0 -
1120 0 -
Employee Benefits 43,488
1101 Retirement 26,803 Employee Benefits will be paid in a like manner as other employees of FCSS
1102 Worker's Compensation 2,184
1103 Health Insurance 14,500
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:8,124
1201 OASDI -
1202 FICA/MEDICARE 8,073 Payroll Taxes will be paid in a like manner as other employees of FCSS
1203 SUI 51
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT -
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene -
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Specify)-
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 4,936
Handle With Care Plus
Fresno County Superintendent of Schools
Fiscal Year 2023-24
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-2
Page 19 of 21
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3001 Telecommunications -
3002 Printing/Postage -
3003 Office, Household & Program Supplies 1,000 Reflects cost for office supplies, programming materials and other items essential
for job functions, such as paper, scissors, tape, hole-punch, pens, wastebaskets,
envelopes, paper clips, gloves, first aid supplies, kleenex, toys crayons etc.
3004 Advertising -
3005 Staff Development & Training -
3006 Staff Mileage 3,000 Cost of staff mileage reimbursement per year for traveling to schools, Hubs, parent
homes or in the community in order to provide services.
3007 Subscriptions & Memberships -
3008 Vehicle Maintenance -
3009 Professional Services 936 This includes intangible technology costs for employees such as copier use, internet,
and cell phone reibursement.
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT -
4001 Building Maintenance -
4002 Rent/Lease Building -
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities -
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES -
5001 Consultant (Network & Data Management)-
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 13,368
6001 Administrative Overhead 13,266 Cost of general management that consist of expenditures for adminstrative activities
necessary for the general operation of FCSS. The indirect cost rate is based on the
CDE's federally approved indirect cost plan for K-12 LEA and county offices of
education.
6002 Professional Liability Insurance 102 Expense will be paid in the manner as other employees of FCSS, line is recorded by
FCSS as an operating expense.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Specify):-
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
7000: FIXED ASSETS -
7001 Computer Equipment & Software -
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-2
Page 20 of 21
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7003 Furniture & Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:175,441
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:175,441
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C-2
Page 21 of 21
Exhibit C-3
Handle with Care Plus - Service Rate Sheet
Provider: Fresno County Superintendent of Schools (FCSS)
FY 2021-22 FY 2022-23 FY 2023-24
Service Time Base Rate per Minute Rate per Minute Rate per Minute
Mental Health Services (Individual/Family/Group Therapy) Staff Minute $1.66 $1.77 $1.82
Case Management Staff Minute $1.28 $1.37 $1.41
Crisis Services Staff Minute $2.47 $2.63 $2.71
Medication Support - - - -
Collateral Staff Minute $1.66 $1.77 $1.82
Plan Development Staff Minute $1.66 $1.77 $1.82
Assessment Staff Minute $1.66 $1.77 $1.82
Rehabilitation Staff Minute $1.66 $1.77 $1.82
Intensive Case Coordination (ICC) Staff Minute $1.66 $1.77 $1.82
Intensive Home Base Services (IHBS) Staff Minute $1.66 $1.77 $1.82
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
1
rev 01-02-2020
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
•Deliver quality care
•Maximize resources while focusing on efficiency
•Provide an excellent care experience
•Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1.Principle One - Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
Exhibit D
Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2
rev 01-02-2020
2.Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3.Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4.Principle Four - Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person’s quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5.Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
Exhibit D
Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
3
rev 01-02-2020
6.Principle Six - Culturally Responsive
o Values, traditions, and beliefs specific to an individual’s or family’s culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7.Principle Seven - Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8.Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9.Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person’s stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
Exhibit D
Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
4
rev 01-02-2020
10.Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11.Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
Exhibit D
Page 4 of 4
Exhibit E
Page 1 of 1
ELECTRONIC HEALTH RECORD SOFTWARE CHARGES
CONTRACTOR understands that COUNTY utilizes NetSmart’s Avatar for its Electronic Health Records Management.
CONTRACTOR agrees to reimburse COUNTY for all user license fees for accessing NetSmart’s Avatar, as set forth below.
Description FY 2021-22 FY 2022-23 FY 2023-24 FY 2024-25 FY 2025-26
General Users
Avatar Named User Hosting
(per active user per month; every Avatar “active” log on
ID is a named user) $37.00 $37.00 $37.00 $37.00 $37.00
Avatar Named User Maintenance*
(per active user per month) $14.85 $15.30 $15.76 $16.23 $16.72
Cloud Hosting- Perceptive Disaster Recovery
(per active user per month) $4.66 $4.66 $4.66 $4.66 $4.66
eRx Users
Full Suite Prescriber
(per active user per month; applicable to an active
Prescriber user)
$104.00 $104.00 $104.00 $104.00 $104.00
ePrescribing Controlled Substances Tokens
(per active user per month; applicable to an active
Prescriber user of Controlled Substances)
$8.00 $8.00 $8.00 $8.00 $8.00
Non-Prescribing User
(per active user per month; applicable to an active Non-
Prescriber user)
$13.00 $13.00 $13.00 $13.00 $13.00
Reaching Recovery Users
Reaching Recovery
(per adult client/person served per year; applicable to
adult treatment programs except contracted triage/CI,
CSU or PHF)
$10.00 $10.00 $10.00 $10.00 $10.00
ProviderConnect Users
Individual Subscription
(per user per month; applicable to provider-user whose
claims are reviewed and posted by Managed Care)
$41.25 $41.25 $41.25 $41.25 $41.25
Should CONTRACTOR choose not to utilize NetSmart’s Avatar for its Electronic Health Records management, CONTRACTOR will
be responsible for obtaining its own system for Electronic Health Records management.
______________________________________________________________________________________________________________________
*Annual Maintenance increases by 3% each FY on July 1st and may be subject to change pending the COUNTY’s agreement terms with NetSmart.
Exhibit F
Page 1 of 3
DOCUMENTATION STANDARDS FOR CLIENT RECORDS
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the
record have a specific document or section addressing these topics. All medical records shall
be maintained for a minimum of 10 years from the date of the end of the Agreement.
A.Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client
record.
•Relevant physical health conditions reported by the client will be prominently
identified and updated as appropriate.
•Presenting problems and relevant conditions affecting the client’s physical health and
mental health status will be documented, for example: living situation, daily activities,
and social support.
•Documentation will describe client’s strengths in achieving client plan goals.
•Special status situations that present a risk to clients or others will be prominently
documented and updated as appropriate.
•Documentations will include medications that have been described by mental health
plan physicians, dosage of each medication, dates of initial prescriptions and refills,
and documentations of informed consent for medications.
•Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
•A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data, relevant
family information and relevant results of relevant lab tests and consultations reports.
•For children and adolescents, pre-natal and perinatal events and complete
developmental history will be documented.
•Documentations will include past and present use of tobacco, alcohol, and caffeine,
as well as illicit, prescribed and over-the-counter drugs.
•A relevant mental status examination will be documented.
•A DSM-5 diagnosis, or a diagnosis from the most current ICD, will be documented,
consistent with the presenting problems, history mental status evaluation and/or
other assessment data.
Exhibit F
Page 2 of 3
2.Timeliness/Frequency Standard for Assessment
•An assessment will be completed at intake and updated as needed to document
changes in the client’s condition.
•Client conditions will be assessed at least annually and, in most cases, at more
frequent intervals.
B.Client Plans
1.Client plans will:
•have specific observable and/or specific quantifiable goals
•identify the proposed type(s) of intervention
•have a proposed duration of intervention(s)
•be signed (or electronic equivalent) by:
the person providing the service(s), or
a person representing a team or program providing services, or
a person representing the MHP providing services
when the client plan is used to establish that the services are provided under the
direction of an approved category of staff, and if the below staff are not the
approved category,
a physician
a licensed/ “waivered” psychologist
a licensed/ “associate” social worker
a licensed/ registered/marriage and family therapist or
a registered nurse
•In addition,
Client plans will be consistent with the diagnosis, and the focus of intervention
will be consistent with the client plan goals, and there will be documentation of
the client’s participation in and agreement with the plan. Examples of the
documentation include, but are not limited to, reference to the client’s
participation and agreement in the body of the plan, client signature on the plan,
or a description of the client’s participation and agreement in progress notes.
Exhibit F
Page 3 of 3
Client signature on the plan will be used as the means by which the
CONTRACTOR documents the participation of the client.
When the client’s signature is required on the client plan and the client refuses or
is unavailable for signature, the client plan will include a written explanation of the
refusal or unavailability.
•The CONTRACTOR will give a copy of the client plan to the client on request.
2.Timeliness/Frequency of Client Plan:
•Will be updated at least annually.
•The CONTRACTOR(S) will establish standards for timeliness and frequency for the
individual elements of the client plan described in item 1.
C.Progress Notes
1.Items that must be contained in the client record related to the client’s progress in
treatment include:
•The client record will provide timely documentation of relevant aspects of client care.
•Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions.
•All entries in the client record will include the signature of the person providing the
service (or electronic equivalent); the person’s professional degree, licensure or job
title; and the relevant identification number, if applicable.
•All entries will include the date services were provided.
•The record will be legible.
•The client record will document follow-up care, or as appropriate, a discharge
summary.
2.Timeliness/Frequency of Progress Notes:
•Progress notes shall be documented at the frequency by type of service indicated
below:
a.Every Service Contact
•Mental Health Services
•Medication Support Services
•Crisis Intervention
Exhibit G
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws, regulations,
rules and guidelines that apply to the provision and payment of mental health services. Mental
health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. CONTRACTOR(S) shall require its
employees and subcontractors to attend a compliance training that will be provided by Fresno
County. After completion of this training, CONTRACTOR(S), CONTRACTOR(S)’ employees and
subcontractors must sign the Contractor Acknowledgment and Agreement form and return this form
to the Compliance Officer or designee.
Contractor and its employees and subcontractor shall:
1.Comply with all applicable laws, regulations, rules or guidelines when providing and
billing for mental health services.
2.Conduct themselves honestly, fairly, courteously and with a high degree of integrity in
their professional dealing related to their contract with the COUNTY and avoid any
conduct that could reasonably be expected to reflect adversely upon the integrity of the
COUNTY.
3.Treat COUNTY employees, consumers, and other mental health contractors fairly and
with respect.
4.NOT engage in any activity in violation of the COUNTY’s Compliance Program, nor
engage in any other conduct which violates any applicable law, regulation, rule or
guideline
5.Take precautions to ensure that claims are prepared and submitted accurately, timely
and are consistent with all applicable laws, regulations, rules or guidelines.
6.Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or
reimbursement of any kind are submitted.
Exhibit G
Page 2 of 3
7.Bill only for eligible services actually rendered and fully documented. Use billing codes
that accurately describe the services provided.
8.Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9.Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by COUNTY employees or other mental health contractors, or
report any activity that they believe may violate the standards of the Compliance
Program, or any other applicable law, regulation, rule or guideline. Fresno County
prohibits retaliation against any person making a report. Any person engaging in any
form of retaliation will be subject to disciplinary or other appropriate action by the
COUNTY. CONTRACTOR(S) may report anonymously.
10.Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or
guideline.
11.Immediately notify the Compliance Officer if they become or may become an Ineligible
person and therefore excluded from participation in the Federal Health Care Programs.
Exhibit G
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 H
Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1.CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2.PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business
and Professions and Welfare and Institutions Codes.
3.CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4.NON-DISCRIMINATION
A.Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B.Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates
of pay or other forms of compensation, use of facilities, and other terms
and conditions of employment.
Exhibit H
Page 2 of 6
C.Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D.Nepotism
Except by consent of COUNTY’s Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5.PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1.STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990
(a-f) and CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2.DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply
with the requirements of the Drug-Free Workplace Act of 1990 and will provide a
drug-free workplace by taking the following actions:
a.Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is
prohibited and specifying actions to be taken against employees for
violations.
b.Establish a Drug-Free Awareness Program to inform employees about:
1)the dangers of drug abuse in the workplace;
2)the person's or organization's policy of maintaining a drug-free
workplace;
3)any available counseling, rehabilitation and employee assistance
programs; and,
4)penalties that may be imposed upon employees for drug abuse
violations.
c.Every employee who works on this Agreement will:
1)receive a copy of the company's drug-free workplace policy
statement; and,
2)agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and
Exhibit H
Page 3 of 6
CONTRACTOR may be ineligible for award of any future State agreements if the
department determines that any of the following has occurred: the
CONTRACTOR has made false certification, or violated the certification by failing
to carry out the requirements as noted above. (Gov. Code §8350 et seq.)
3.NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1) final unappealable finding of contempt of court
by a Federal court has been issued against CONTRACTOR within the
immediately preceding two (2) year period because of CONTRACTOR’s failure to
comply with an order of a Federal court, which orders CONTRACTOR to comply
with an order of the National Labor Relations Board. (Pub. Contract Code
§10296) (Not applicable to public entities.)
4.CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will
comply with the requirements of Section 6072 of the Business and Professions
Code, effective January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number
of hours of pro bono legal services during each year of the contract equal to the
lessor of 30 multiplied by the number of full time attorneys in the firm’s offices in
the State, with the number of hours prorated on an actual day basis for any
contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5.EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the
meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to
contract with the State of California.
6.SWEATFREE CODE OF CONDUCT:
a.All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of
equipment, materials, or supplies, other than procurement related to a
public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been
laundered or produced in whole or in part by sweatshop labor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, or with the
benefit of sweatshop labor, forced labor, convict labor, indentured labor
under penal sanction, abusive forms of child labor or exploitation of
children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as
set forth on the California Department of Industrial Relations website
located at www.dir.ca.gov, and Public Contract Code Section 6108.
Exhibit H
Page 4 of 6
b.CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR’s records, documents, agents or employees, or
premises if reasonably required by authorized officials of the contracting
agency, the Department of Industrial Relations, or the Department of
Justice to determine the contractor’s compliance with the requirements
under paragraph (a).
7.DOMESTIC PARTNERS: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8.GENDER IDENTITY: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1.CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has
any questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he
or she engaged in any of the negotiations, transactions, planning,
arrangements or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a
contract with any state agency if he or she was employed by that state
agency in a policy-making position in the same general subject area as
Exhibit H
Page 5 of 6
the proposed contract within the twelve (12) month period prior to his or
her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not
receive payment other than payment of each meeting of the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code §10430 (e))
2.LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against
liability for Worker's Compensation or to undertake self-insurance in accordance
with the provisions, and CONTRACTOR affirms to comply with such provisions
before commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3.AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which
prohibits discrimination on the basis of disability, as well as all applicable
regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4.CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR’s name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval
of said amendment.
5.CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a.When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently
qualified to do business in California in order to ensure that all obligations
due to the state are fulfilled.
b."Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit.
Although there are some statutory exceptions to taxation, rarely will a
corporate contractor performing within the state not be subject to the
franchise tax.
c.Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do
business in California. Agencies will determine whether a corporation is
in good standing by calling the Office of the Secretary of State.
6.RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local
governing body, which by law has authority to enter into an agreement,
authorizing execution of the agreement.
Exhibit H
Page 6 of 6
7.AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not
subject to review promulgated by the State Air Resources Board or an air
pollution control district; (2) subject to cease and desist order not subject to
review issued pursuant to Section 13301 of the Water Code for violation of waste
discharge requirements or discharge prohibitions; or (3) finally determined to be
in violation of provisions of federal law relating to air or water pollution.
8.PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9.INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General,
and their designees may, at any time, inspect and audit any records or
documents of CONTRACTOR or its subcontractors, and may, at any time,
inspect the premises, physical facilities, and equipment where Medicaid-related
activities or work is conducted. The right to audit under this section exists for ten
(10)years from the final date of the contract period or from the date of
completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must
confirm the identity and determine the exclusion status of CONTRACTOR, any
subcontractor, as well as any person with an ownership or control interest, or
who is an agent or managing employee of CONTRACTOR through routine
checks of Federal databases. This includes the Social Security Administration's
Death Master File, the National Plan and Provider Enumeration System
(NPPES), the List of Excluded Individuals/Entities (LEIE), the System for Award
Management (SAM), and any other databases as the State or Secretary may
prescribe. These databases must be consulted upon contracting and no less
frequently than monthly thereafter. If the State finds a party that is excluded, it
must promptly notify the CONTRACTOR and take action consistent with §
438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under
this part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
The Incident Report must be completed for all incidents involving individuals served through
DBH’s current incident reporting portal, Logic Manager, at
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bb1864cdee
4d3d6e
•The reporting portal is available 24 hours a day, every day.
•Any employee of the CONTRACTOR can submit an incident using the reporting
portal at any time. No login is required.
•The designated administrator of the CONTRACTOR can add information to the
follow up section of the report after submission.
•When an employee submits an incident within 24 hours from the time of the incident
or first knowledge of the incident, the CONTRACTOR’s designated administrator, the
assigned contract analyst and the Incident Reporting email inbox will be notified
immediately via email from the Logic Manager system that there is a new incident to
review.
•Meeting the 24 hour incident reporting requirements will be easier as there are no
signatures to collect.
•The user guide attached identifies the reporting process and the reviewer process,
and is subject to updates based on DBH’s selected incident reporting portal system.
Questions about incident reporting, how to use the incident reporting portal, or
designating/changing the name of the administrator who will review incidents for the
CONTRACTOR should be emailed to DBHIncidentReporting@fresnocountyca.gov and the
assigned contract analyst.
Exhibit I
Page 1 of 9
INCIDENT REVIEWER ROLE – User Guide
Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted
providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete
a written report of any incidents compromising the health and safety of persons served, employees, or
community members.
Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It’s
an easier way for any employee to report an incident at any time. A few highlights:
•No supervisor signature is immediately required.
•Additional information can be added to the report by the program supervisor/manager without
having to resubmit the incident.
•When an incident is submitted, the assigned contract analyst, program supervisor/manager,
clinical supervisor and the DBHIncidentReporting mailbox automatically receives an email
notification of a new incident and can log in any time to review the incident. Everything that
was on the original paper/electronic form matches the online form.
•Do away with submitting a paper version with a signature.
•This online submission allows for timely action for the health and safety of the persons-served,
as well as compliance with state reporting timelines when necessary.
As an Incident Reviewer, the responsibility is to:
•Log in to Logic Manager and review incident submitted within 48 hours of notification of incident.
•Review incident for clarity, missing information and add in additional information deemed
appropriate.
•Notify DBHIncidentReporting@fresnocountyca.gov if there is additional information to be report
after initial submission
•Contact DBHIncidentReporting@fresnocountyca.gov if there are any concerns, questions or
comments with Logic Manager or incident reporting.
Below is the link to report incidents
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bb1864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
Mental Health Plan (MHP) and Substance Use Disorder (SUD) services
Incident Reporting System
Exhibit I
Page 2 of 9
Exhibit I
Page 3 of 9
Similar to the paper version, multiple incident categories can be selected
Exhibit I
Page 4 of 9
As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on
Add File to upload a file.
Similar to the paper version, multiple Action Taken categories can be selected.
When done entering all the information, simply click submit.
Any fields that have a red asterisk, require information and will prevent submission of the form if left blank.
A “Thank you for your submission” statement will pop up if an incident is successfully submitted. Click “Reload the
Form” to submit another incident.
Exhibit I
Page 5 of 9
A Notification email will be received when a new incident is reported, or a new comment has been made regarding
an incident. Click on “Open this incident in Logic Manager” and the Logic Manager login screen will show.
Enter in email address and password. First time users will be prompted to set up a password.
Exhibit I
Page 6 of 9
Once logged in, the main screen will show reviewer task (incidents to review). Click on analyst/supervisor follow up
to view the incident.
This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and
facility information. No edits can be made to this section.
The next tab is Summary: No edits can be made to this section.
Exhibit I
Page 7 of 9
The next tab is Follow up: This section can be edited. Add to the areas below or make corrections to these fields. Be
sure to click SAVE when edits are made. Then Cancel to Exit out of the incident.
The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding
documents. Then Cancel to Exit out of the incident.
If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once
submitted, the incident will be removed from the task list and no further edits can be made. Notice the SUBMIT
button is on every tab. If further information needs to be included, email
DBHIncidentReporting@fresnocountyca.gov
Exhibit I
Page 8 of 9
To get back to the home view, click on the Logic Manager icon at any time. Any incidents that still need review will
show on this screen, click on the next incident and start the review process again.
Exhibit I
Page 9 of 9
Exhibit J
Page 1 of 2
COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall be required to maintain organizational provider certification by the host
county. A copy of this renewal certificate must be furnished to COUNTY within thirty (30) days
of receipt of certificate from host county. The CONTRACTOR must meet Medi-Cal organization
provider standards as stated below. It is acknowledged that all references to Organizational
Provider and/or Provider below shall refer to the CONTRACTOR.
Medi-Cal Organizational Provider Standards
1.The organizational provider possesses the necessary license to operate, if applicable,
and any required certification.
2.The space owned, leased or operated by the provider and used for services or staff
meets local fire codes.
3.The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4.The organizational provider establishes and implements maintenance policies for any
site owned, leased, or operated by the provider and used for services or staff to ensure
the safety and well-being of beneficiaries and staff.
5.The organizational provider has a current administrative manual which includes:
personnel policies and procedures, general operating procedures, service delivery
policies, and procedures for reporting unusual occurrences relating to health and
safety issues.
6.The organizational provider maintains client records in a manner that meets applicable
state and federal standards.
7.The organization provider has staffing adequate to allow the COUNTY to claim federal
financial participation for the services the Provider delivers to beneficiaries, as
described in Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8.The organizational provider has as head of service a licensed mental health
professional or other appropriate individual as described in Title 9, CCR, Sections 622
through 630.
9.For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A.All drugs obtained by prescription are labeled in compliance with federal and state
laws. Prescription labels are altered only by persons legally authorized to do so.
B.Drugs intended for external use only or food stuffs are stored separately from drugs
for internal use.
C.All drugs are stored at proper temperatures, room temperature drugs at 59-86
degrees F and refrigerated drugs at 36-46 degrees F.
Exhibit J
Page 2 of 2
D.Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E.Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F.A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal
laws.
G.Policies and procedures are in place for dispensing, administering and storing
medications.
10. The COUNTY may accept the host county’s site certification and reserves the right to
conduct an on-site certification review at least every three years. The COUNTY may
also conduct additional certification reviews when:
•The provider makes major staffing changes.
•The provider makes organizational and/or corporate structure changes
(example: conversion from a non-profit status).
•The provider adds day treatment or medication support services when
medications shall be administered or dispensed from the provider site.
•There are significant changes in the physical plant of the provider site (some
physical plant changes could require a new fire clearance).
•There is change of ownership or location.
•There are complaints against the provider.
•There are unusual events, accidents, or injuries requiring medical treatment for
clients, staff or members of the community.
Exhibit K
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
the individuals served copies of all current beneficiary information annually at the time
their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process – the provider may first speak to a Provider
Relations Specialist (PRS) regarding his or her complaint or concern.
Exhibit K
Page 2 of 2
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process – the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for MHP
payment authorization, or the process or payment of a provider’s claim to the MHP.
Payment authorization issues – the provider may appeal a denied or modified request
for payment authorization or a dispute with the MHP regarding the processing or
payment of a provider’s claim to the MHP. The written appeal must be submitted to the
MHP within 90 calendar days of the date of the receipt of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the decision
that addresses each issue raised by the provider, and any action required by the
provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request, the
MHP utilizes a Managed Care staff who was not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within 30 calendar days of receipt of the decision
Other complaints – if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the MHP. The provider will receive a written response from the MHP within 60 calendar
days of receipt of the complaint. The decision rendered buy the MHP is final.
Exhibit L
Page 1 of 2
Vendor:Contract#Contact Person Contact#
Item Make/Brand Model Serial #Fixed AssetSensitive ItemDate
Requested
(If Fixed
Asset)
Date
Approved (
If Fixed
Assset)
Purchase
Date Location Condition
Fresno
County
Inventory
Number
Cost
ExampleCopier Canon 27CRT 9YHJY65R x 3/27/2008 4/1/2008 4/10/2008 Heritage New $6,500.00
ExampleDVD Player Sony DV2230 PXC4356A x n/a n/a 4/1/2008 Heritage New $450.00
Date Prepared:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Date Received:
Fixed Asset and Sensitive Item Tracking
Exhibit L
Page 2 of 2
Fi el d Number
Fi el d
Descri pt i on
I nst r uct i on or Comment s
Requi r ed or
Condi t i onal
Header Vendor I ndi cat e t he l egal name of t he agency cont r act ed t o
pr ovi de ser vi ces.
Requi r ed
Header Pr ogr am
I ndi cat e t he t i t l e of t he pr oj ect as descr i bed i n t he
cont r act wi t h t he Count y.
Requi r ed
Header Cont r act #
I ndi cat e t he assi gned Count y cont r act number . I f not
known, Count y st af f can pr ovi de.
Requi r ed
Header Cont act Per son
I ndi cat e t he f i r st and l ast name of t he pr i mar y agency
cont act f or t he cont r act .
Requi r ed
Header Cont act #
I ndi cat e t he most appr opr i at e t el ephone number of t he
pr i mar y agency cont act f or t he cont r act .
Requi r ed
Header Dat e Pr epar ed
I ndi cat e t he most cur r ent dat e t hat t he t r acki ng f or m
was compl et ed by t he vendor .
Requi r ed
a Item I dent i f y t he i t em by pr ovi di ng a commonl y r ecogni zed
descr i pt i on of t he i t em.
Requi r ed
b Make/ Br and I dent i f y t he company t hat manuf act ur ed t he i t em.Requi r ed
c Model I dent i f y t he model number f or t he i t em, i f appl i cabl e.Condi t i onal
d Ser i al #
I dent i f y t he ser i al number f or t he i t em, i f
appl i cabl e.
Condi t i onal
e Fi xed Asset
Mar k t he box wi t h an " X" i f t he cost of t he i t em i s
$5, 000 or mor e t o i ndi cat e t hat t he i t em i s a f i xed
asset .
Condi t i onal
f Sensi t i ve I t em
Mar k t he box wi t h an " X" i f t he i t em meet s t he
cr i t er i a of a sensi t i ve i t em as def i ned by t he Count y.
Condi t i onal
g Dat e Request ed
I ndi cat e t he dat e t hat t he agency submi t t ed a r equest
t o t he Count y t o pur chase t he i t em.
Requi r ed
h Dat e Appr oved
I ndi cat e t he dat e t hat t he Count y appr oved t he r equest
t o pur chase t he i t em.
Requi r ed
i Pur chase Dat e I ndi cat e t he dat e t he agency pur chased t he i t em.Requi r ed
j Locat i on I ndi cat e t he physi cal l ocat i on of t he i t em Requi r ed
k Condi t i on
I ndi cat e t he gener al condi t i on of t he i t em ( New, Good,
Wor n, Bad) .
Requi r ed
l
Fr esno Count y
I nvent or y
Number
I ndi cat e t he FR # pr ovi ded by t he Count y f or t he i t em.Condi t i onal
m Cos t
I ndi cat e t he t ot al pur chase pr i ce of t he i t em
i ncl udi ng sal es t ax and ot her cost s, such as shi ppi ng.
Requi r ed
FI XED ASSET AND SENSI TI VE I TEM TRACKI NG
1
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help
eliminate health care disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1.Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and
practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce:
2.Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and
allocated resources.
3.Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in
the service area.
4.Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.
Communication and Language Assistance:
5.Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate
timely access to all health care and services.
6.Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.
7.Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters
should be avoided.
8.Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
Engagement, Continuous Improvement, and Accountability:
9.Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s
planning and operations.
10.Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous
quality improvement activities.
11.Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to
inform service delivery.
12.Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the
cultural and linguistic diversity of populations in the service area.
13.Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.
14.Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts
or complaints.
15.Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.
Think Cultural Health
https://www.thinkculturalhealth.hhs.gov/
contact@thinkculturalhealth.hhs.gov
Exhibit M
Page 1 of 2
2
The Case for the National CLAS Standards
Health equity is the attainment of the highest level of health for all people.1 Currently, individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of health, or those conditions in which
individuals are born, grow, live, work, and age,2 such as socioeconomic status, education level, and the availability of health services.3
Though health inequities are directly related to the existence of historical and current discrimination
and social injustice, one of the most modifiable factors is the lack of culturally and linguistically
appropriate services, broadly defined as care and services that are respectful of and responsive to
the cultural and linguistic needs of all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health
disparities adversely affect neighborhoods, communities, and the broader society, thus making
the issue not only an individual concern but also a public health concern. In the United States, it
has been estimated that the combined cost of health disparities and subsequent deaths due to
inadequate and/or inequitable care is $1.24 trillion.4
Culturally and linguistically appropriate services are increasingly recognized as effective in improving
the quality of care and services.5,6 By providing a structure to implement culturally and linguistically
appropriate services, the National CLAS Standards will improve an organization’s ability to address
health care disparities.
The National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities7 and the National Stakeholder Strategy for
Achieving Health Equity,8 which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial
and ethnic health disparities across the country.
Similar to these initiatives, the National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities
by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. Adoption of
these Standards will help advance better health and health care in the United States.
Of all the forms of
inequality, injustice in
health care is the most
shocking and inhumane.
— Dr. Martin Luther King, Jr.
Bibliography
1. U.S. Department of Health and Human Services, Office of Minority Health (2011). National Partnership for Action to End Health Disparities. Retrieved from http://minorityhealth.hhs.gov/npa
2. World Health Organization. (2012). Social determinants of health. Retrieved from http://www.who.int/social_determinants/en/
3. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthy people 2020: Social determinants of health. Retrieved from http://www.
healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39
4. LaVeist, T. A., Gaskin, D. J., & Richard, P. (2009). The economic burden of health inequalities in the United States. Retrieved from the Joint Center for Political and Economic Studies website: http://www.
jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2 0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
5. Beach, M. C., Cooper, L. A., Robinson, K. A., Price, E. G., Gary, T. L., Jenckes, M. W., Powe, N.R. (2004). Strategies for improving minority healthcare quality. (AHRQ Publication No. 04-E008-02). Retrieved
from the Agency of Healthcare Research and Quality website: http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minqual.pdf
6. Goode, T. D., Dunne, M. C., & Bronheim, S. M. (2006). The evidence base for cultural and linguistic competency in health care. (Commonwealth Fund Publication No. 962). Retrieved from The
Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
7. U.S. Department of Health and Human Services. (2011). HHS action plan to reduce racial and ethnic health disparities: A nation free of disparities in health and health care. Retrieved from http://
minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
8. National Partnership for Action to End Health Disparities. (2011). National stakeholder strategy for achieving health equity. Retrieved from U.S. Department of Health and Human Services, Office of
Minority Health website: http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
Think Cultural Health
https://www.thinkculturalhealth.hhs.gov/
contact@thinkculturalhealth.hhs.gov
Exhibit M
Page 2 of 2
Exhibit N
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 N
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 O
Page 1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1.By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2.The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3.The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4.The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5.The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1)The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a)Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b)Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
Exhibit O
Page 2 of 2
(c)Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2)Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
Exhibit P
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 P
Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date: