HomeMy WebLinkAboutAgreement A-21-214 with Kings View.pdf-1-
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A G R E E M E N T
THIS AGREEMENT is made and entered into this day of June, 2021, by and between the
COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as
"COUNTY", and KINGS VIEW CORPORATION, a private Non-profit, 501 (c) (3), Organization, whose
address is 7170 N Financial Dr, Ste 110, Fresno, CA 93720, hereinafter referred to as
“CONTACTOR” (collectively the “parties”).
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 to operate a Projects for Assistance in Transition from Homelessness (PATH) program to deliver
integrated mental health and supportive housing services to adults who are homeless, or who are at
imminent risk of becoming homeless, and have a severe mental illness and/or co-occurring disorder, in an
effort to enable this population to live in the community and to avoid homelessness, hospitalization and/or
jail detention.
WHEREAS, COUNTY, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of the
California Code of Regulations (C.C.R.), section 1810.226; and
WHEREAS, CONTRACTOR is qualified and willing to operate said PATH program and provide
PATH services pursuant to the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of the mutual covenants, terms and conditions herein
contained, the parties hereto agree as follows:
1.SERVICES
A.CONTRACTOR shall perform all services and fulfill all responsibilities as set forth in
Exhibit A, “Projects for Assistance in Transition from Homelessness (PATH) Program, Scope of
Work,” attached hereto and by this reference incorporated herein and made part of this
Agreement.
B.CONTRACTOR shall also perform all services and fulfill all responsibilities as specified in
COUNTY’s Request for Proposal (RFP) No. 20-044 dated February 19, 2020, Addendum No.
One (1) to COUNTY’S RFP No. 20-044 dated March 16, 2020 and Addendum No. Two (2) to
Agreement No. 21-214
22nd
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COUNTY’s RFP NO. 20-044 dated March 19, 2020, herein collectively referred to as COUNTY’s
Revised RFP, and CONTRACTOR’s Response to said Revised RFP dated May 28, 2020, all
incorporated herein by reference and made part of this Agreement. In the event of any
inconsistency among these documents, the inconsistency shall be resolved by giving
precedence in the following order of priority to: 1) this Agreement, including all Exhibits, 2) the
Revised RFP, and 3) CONTRACTOR’s Response to the Revised RFP. A copy of COUNTY’s
Revised RFP No. 20-044 and CONTRACTOR’s Response thereto shall be retained and made
available during the term of this Agreement by COUNTY’s DBH Contracted Services Division.
C. CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
consisting of staff from COUNTY’s DBH Administrative unit to discuss PATH requirements, data
reporting, training, policies and procedures, overall program operations and any problems or
foreseeable problems that may arise.
D.CONTRACTOR shall provide Outreach, Engagement, Linkage, and Specialty Mental
Health Services in accordance with the vision, mission, and guiding principles of the COUNTY’s
DBH, as further described in Exhibit B, “Guiding Principles of Care Delivery,” attached hereto
and by this reference incorporated herein and made part of this Agreement.
E.CONTRACTOR shall maintain requirements as an organizational provider throughout the
term of this Agreement, as described in Section Fifteen (15) of this Agreement. If for any reason,
this status is not maintained, COUNTY may terminate this Agreement pursuant to Section Three
(3) of this Agreement.
F.It is acknowledged by all parties hereto that COUNTY’s DBH Administrative unit shall
monitor PATH program operated by CONTRACTOR, in accordance with Section Thirteen (13) of
this Agreement.
2.TERM
The term of this Agreement shall be for a period of three (3) years, commencing on the 1st day of
July, 2021 and terminating on the 30th day of June, 2024. This Agreement may be extended for two (2)
additional consecutive twelve (12) month periods upon written approval of both parties no later than thirty
(30) days prior to the first day of the next twelve (12) month extension period. The Director or their
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designee is authorized to execute such written approval on behalf of COUNTY based on CONTRACTOR’S
satisfactory performance. The Director or their designee is authorized to execute such written approval on
behalf of COUNTY based on CONTRACTOR’S satisfactory performance.
This Agreement, subject to satisfactory outcomes performance and subject to available State
funding each year, shall automatically be extended for two (2) additional twelve (12) month periods upon
the same terms and conditions herein set forth, unless written notice of non-renewal is given by COUNTY
or CONTRACTOR or COUNTY’s DBH Director or designee, not later than thirty (30) days prior to the close
of the current Agreement term.
3.TERMINATION
A.Non-Allocation of Funds - The terms of this Agreement, and the services to be provided
hereunder, 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 the CONTRACTOR thirty (30) days advance
written notice.
B.Breach of Contract - The COUNTY may immediately suspend or terminate this Agreement
in whole or in part, where in the determination of the COUNTY there is:
1)An illegal or improper use of funds;
2)A failure to comply with any term of this Agreement;
3)A substantially incorrect or incomplete report submitted to the COUNTY;
4)Improperly performed service.
In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any breach
of this Agreement or any default which may then exist on the part of the CONTRACTOR. Neither shall such
payment impair or prejudice any remedy available to the COUNTY with respect to the breach or default.
The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the COUNTY of any
funds disbursed to the CONTRACTOR under this Agreement, which in the judgment of the COUNTY were
not expended in accordance with the terms of this Agreement. The CONTRACTOR shall promptly refund
any such funds upon demand.
C.Without Cause - Under circumstances other than those set forth above, this Agreement may
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be terminated by COUNTY upon the giving of sixty (60) days advance written notice of an
intention to terminate to CONTRACTOR.
4.COMPENSATION:
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive compensation for
actual expenditures incurred in accordance with the CONTRACTOR’s budget documents approved by the
COUNTY’s DBH Director or designee and attached hereto as Exhibit C and incorporated herein by this
reference.
The maximum amount to be paid to CONTRACTOR by COUNTY under this Agreement for the
twelve (12) month period, (July 1, 2021 through June 30, 2022), shall not exceed Six Hundred Seventy-
One Thousand, Two Hundred Seventy-Two and No/100 Dollars ($671,272.00). This is comprised of the
following funding streams: Three Hundred-Eight Thousand and No/100 Dollars ($308,000.00) in PATH
Grant funds, Sixty-Six Thousand, Four Hundred Sixty-Eight and No/100 Dollars ($66,468.00) in HHAP
Grant funds, One Hundred Seventy-Two Thousand, Five Hundred Thirty-Three and No/100 Dollars
($172,533.00) in local MHSA funds, One Hundred Twenty-Three Thousand, Two Hundred Sixty-Nine and
No/100 Dollars ($123,269.00) in Federal Financial Participation (FFP), and One Thousand-Two and No/100
Dollars ($1,002.00) in Client Rents to offset CONTRACTOR’s program costs as set forth in Exhibit C.
The maximum amount to be paid to CONTRACTOR by COUNTY under this Agreement for the
following twelve (12) month period, (July 1, 2022 through June 30, 2023), shall not exceed Six Hundred
Thirty-Nine Thousand, Sixty-Six and No/100 Dollars ($639,066.00). This is comprised of the following
funding streams: Three Hundred-Eight Thousand and No/100 Dollars ($308,000.00) in PATH Grant funds,
One Hundred Seventy-Two Thousand, Five Hundred Thirty-Three and No/100 Dollars ($172,533.00) in
local MHSA funds, One Hundred Fifty-Seven Thousand, Five Hundred Thirty-One and No/100 Dollars in
FFP ($157,531.00), and One Thousand-Two and No/100 Dollars ($1,002.00) in Client Rents to offset the
CONTRACTOR’s program costs as set forth in Exhibit C.
The maximum amount to be paid to CONTRACTOR by COUNTY under this Agreement for the
following twelve (12) month period, (July 1, 2023 through June 30, 2024), shall not exceed Six Hundred
Thirty-Nine Thousand, Sixty-Six and No/100 Dollars ($639,066.00). This is comprised of the following
funding streams: Three Hundred-Eight Thousand and No/100 Dollars ($308,000.00) in PATH Grant funds,
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One Hundred Seventy-Two Thousand, Five Hundred Thirty-Three and No/100 Dollars ($172,533.00) in
local MHSA funds, One Hundred Fifty-Seven Thousand, Five Hundred Thirty-One and No/100 Dollars in
FFP ($157,531.00), and One Thousand-Two and No/100 Dollars ($1,002.00) in Client Rents to offset the
CONTRACTOR’s program costs as set forth in Exhibit C.
The maximum amount to be paid to CONTRACTOR by COUNTY under this Agreement for the
following twelve (12) month period, (July 1, 2024 through June 30, 2025), shall not exceed Six Hundred
Thirty-Nine Thousand, Sixty-Six and No/100 Dollars ($639,066.00). This is comprised of the following
funding streams: Three Hundred-Eight Thousand and No/100 Dollars ($308,000.00) in PATH Grant funds,
One Hundred Seventy-Two Thousand, Five Hundred Thirty-Three and No/100 Dollars ($172,533.00) in
local MHSA funds, One Hundred Fifty-Seven Thousand, Five Hundred Thirty-One and No/100 Dollars in
FFP ($157,531.00), and One Thousand-Two and No/100 Dollars ($1,002.00) in Client Rents to offset the
CONTRACTOR’s program costs as set forth in Exhibit C.
The maximum amount to be paid to CONTRACTOR by COUNTY under this Agreement for the
following twelve (12) month period, (July 1, 2025 through June 30, 2026), shall not exceed Six Hundred
Thirty-Nine Thousand, Sixty-Six and No/100 Dollars ($639,066.00). This is comprised of the following
funding streams: Three Hundred-Eight Thousand and No/100 Dollars ($308,000.00) in PATH Grant funds,
One Hundred Seventy-Two Thousand, Five Hundred Thirty-Three and No/100 Dollars ($172,533.00) in
local MHSA funds, One Hundred Fifty-Seven Thousand, Five Hundred Thirty-One and No/100 Dollars in
FFP ($157,531.00), and One Thousand-Two and No/100 Dollars ($1,002.00) in Client Rents to offset the
CONTRACTOR’s program costs as set forth in Exhibit C.
In no event shall services performed under this Agreement be in excess of Three Million, Two
Hundred Twenty-Seven Thousand, Five Hundred Thirty-Six and No/100 Dollars ($3,227,536.00) during the
term of this Agreement. It is understood that all expenses incidental to CONTRACTOR'S performance of
services under this Agreement shall be borne by CONTRACTOR.
It is understood by COUNTY and CONTRACTOR that any Medi-Cal FFP above the amounts stated
herein will be used to directly offset COUNTY’s contribution of PATH grant and MHSA funds as identified in
Exhibit C, and may be used to expand program services to clients and/or increase client program capacity
with the written approval of COUNTY’s DBH Director. The offset of funds will also be clearly identified in
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monthly invoices received from CONTRACTOR as further described in Section Five (5) of this Agreement.
If CONTRACTOR fails to generate the Medi-Cal revenue and/or client rent payment amounts set
forth in Exhibit C, COUNTY shall not be obligated to pay the difference between these estimated amounts
and the actual amounts generated.
Prior to March 1st of each contract year, CONTRACTOR may provide to COUNTY’s DBH an
updated budget and budget narrative in the format identified in Exhibit C for the upcoming twelve (12)
month period. Each budget shall require justification by the CONTRACTOR, and written approval of
COUNTY’s DBH Director or designee, prior to April 1st for the upcoming twelve (12) month period covered
by said budget. An approved updated budget and budget narrative shall become part of this Agreement
upon written approval of COUNTY’s DBH Director or designee. If said budget is not received by the March
1st due date, the budget for the upcoming twelve (12) month period will remain at the prior year’s funding
level. The amount of said approved budget shall not exceed the maximum compensation for the current
Agreement period.
Travel shall be reimbursed based on actual expenditures and mileage reimbursement shall be at
CONTRACTOR’s adopted rate per mile, not to exceed the Federal Internal Revenue Services (IRS)
published rate.
If CONTRACTOR fails to comply with any provision of this Agreement, COUNTY shall be relieved
of its obligation for further compensation.
Payments shall be made by COUNTY to CONTRACTOR in arrears for services provided during the
preceding month, within forty-five (45) days after the date of receipt and approval by COUNTY of the
monthly invoicing as described in Section Five (5) herein. Payments shall be made after receipt and
verification of actual expenditures incurred by CONTRACTOR for monthly program costs, as identified in
Exhibit C, in the performance of this Agreement and shall be documented to COUNTY on a monthly basis
by the tenth (10th) of the month following the month of said expenditures.
COUNTY shall not be obligated to make any payments under this Agreement if the request for
payment is received by COUNTY more than sixty (60) days after this Agreement has terminated or expired.
All final invoices and/or any final budget modification requests shall be submitted by
CONTRACTOR within sixty (60) days following the final month of service for which payment is claimed. No
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action shall be taken by COUNTY on invoices submitted beyond the sixty (60) day closeout period. Any
compensation which is not expended by CONTRACTOR pursuant to the terms and conditions of this
Agreement shall automatically revert to COUNTY.
The services provided by CONTRACTOR under this Agreement are funded in whole or in part by
the State of California. In the event that funding for these services is delayed by the State Controller,
COUNTY may defer payments to CONTRACTOR. The amount of the deferred payment shall not exceed
the amount of funding delayed by the State Controller to the COUNTY. The period of time of the deferral
by COUNTY shall not exceed the period of time of the State Controller’s delay of payment to COUNTY plus
forty-five (45) days.
CONTRACTOR shall be held financially liable for any and all future disallowances/audit exceptions
due to CONTRACTOR deficiency 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
CONTRACTOR. CONTRACTOR shall not receive reimbursement for any units of services rendered that
are disallowed or denied by the COUNTY’s DBH utilization review process or through the State Department
of Health Care Services (DHCS) cost report audit settlement process for Medi-Cal eligible clients.
Notwithstanding the above, COUNTY must notify CONTRACTOR prior to any State audit process and/or
COUNTY utilization review. To the extent allowable by law, CONTRACTOR shall have the right to be
present during each phase of any State audit process and/or COUNTY utilization review and shall be
provided all documentation related to each phase of any State audit process and/or COUNTY utilization
review. Additionally, prior to any disallowances/audit exceptions becoming final, CONTRACTOR shall be
given at least ten (10) business days to respond to such proposed disallowances/audit exceptions.
It is understood by CONTRACTOR and COUNTY that this Agreement is funded with PATH grant,
HHAP grant, MHSA funds, Medi-Call FFP, and client rents funds to serve adults, many of whom have
mental health and co-occurring substance use disorders. It is further understood by CONTRACTOR and
COUNTY that funds shall be used to support appropriately integrated and documented treatment services
for co-occurring mental health and substance use disorders and that integrated services can be
documented in assessments, interventions, and program notes documenting linkages and services.
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5.INVOICING
CONTRACTOR 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 COUNTY’s DBH Staff Analyst. After CONTRACTOR renders service to referred clients,
CONTRACTOR shall invoice COUNTY for payment, certify the expenditure, and submit electronic claiming
data into COUNTY’s electronic information system for all clients, including those eligible for Medi-Cal as
well as those that are not eligible for Medi-Cal. Invoices and reports shall be in such detail as acceptable to
COUNTY’s DBH, as described herein and in Section Fourteen (14) of this Agreement. Billing information
must include the client’s name, client ID number, date of service, type of mental health service provided,
duration of service, client’s International Classification of Diseases (ICD) diagnosis, service provider name,
units of service provided, rate of service provided, and actual amount of service. No reimbursement for
costs incurred by CONTRACTOR for services delivered under this Agreement shall be made until the
invoice and supporting documentation is received, verified, and approved by COUNTY’s DBH. COUNTY
must pay CONTRACTOR before submitting a claim to DHCS for Federal reimbursement for Medi-Cal
eligible clients.
If CONTRACTOR 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,
COUNTY’s DBH shall invoice CONTRACTOR in arrears by the fifth (5th) day of each month for the prior
month’s hosting fee for access to the COUNTY’s electronic information system. COUNTY shall invoice
CONTRACTOR annually for the annual maintenance and licensing fee for access to the COUNTY’s
electronic information system. COUNTY shall invoice CONTRACTOR annually for the Reaching Recovery
fee, as applicable, for access to the COUNTY’s electronic information system. CONTRACTOR shall
provide payment for these expenditures to COUNTY’s Fresno County Department of Behavioral Health,
Accounts Receivable, P.O. Box 712, Fresno, CA 93717-0712, Attention: Business Office, within forty-five
(45) days after the date of receipt by CONTRACTOR of the invoicing provided by COUNTY.
At the discretion of COUNTY’s DBH Director or designee, if an invoice is incorrect or is otherwise not
in proper form or substance, COUNTY’s DBH Director or designee, shall have the right to withhold payment
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as to only that portion of the invoice that is incorrect or improper after five (5) days prior notice to
CONTRACTOR. CONTRACTOR agrees to continue to provide services for a period of ninety (90) days
after notification of an incorrect or improper invoice. If after the ninety (90) day period, the invoice is still not
corrected to COUNTY DBH’s satisfaction, COUNTY’s DBH 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 ninety (90) days after the expiration of each term of this Agreement or
termination of this Agreement, at the discretion of COUNTY’s DBH Director or designee, COUNTY’s DBH
shall have the right to deny payment of any additional invoices received.
CONTRACTOR shall submit monthly invoices and general ledgers to COUNTY’s DBH that itemize
the line item charges for monthly program costs. 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 CONTRACTOR’s program costs are in accordance with its budgeted cost.
Failure to submit reports and other supporting documentation shall be deemed sufficient cause for
COUNTY to withhold payments until there is compliance, as further described in Section Five (5) herein.
CONTRACTOR must report all third party collections from other funding sources for Medicare,
private insurance, client private pay or any other third party. Monthly invoices for reimbursement must
equal the amount due CONTRACTOR less any funding sources not eligible for Federal reimbursement and
any other revenues generated by CONTRACTOR (i.e., private insurance, etc.).
CONTRACTOR shall submit monthly staffing reports that identify all direct service and support staff,
applicable licensure/certifications, and full time hours worked to be used as a tracking tool to determine if
CONTRACTOR’s program is staffed according to the services provided under this Agreement.
CONTRACTOR must maintain financial records for a period of seven (7) years or until any dispute,
audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible for any
disallowances related to inadequate documentation.
CONTRACTOR is responsible for collecting and managing of data in a manner to be determined by
DHCS and COUNTY’s DBH 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. CONTRACTOR must attend the COUNTY’s DBH training on equipment
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reporting for assets, intangible and sensitive minor assets, COUNTY’s electronic information system, and
related cost reporting.
CONTRACTOR shall submit service data into COUNTY’s electronic information system within thirty
(30) calendar days from the date of services were rendered.
CONTRACTOR must provide all necessary data to allow COUNTY to bill Medi-Cal, and any other
third-party source, for services and meet State and Federal reporting requirements. The necessary data
can be provided by a variety of means, including but not limited to: 1) direct data entry into COUNTY’s
electronic information system; 2) providing an electronic file compatible with COUNTY’s electronic
information system; or 3) integration between COUNTY’s electronic information system and
CONTRACTOR’s information system(s).
If a client has dual coverage, such as other health coverage (OHC) or Federal Medicare,
CONTRACTOR 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. CONTRACTOR must report all third-party collections or
revenue 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 or CMS 1500 form is required as
documentation. CONTRACTOR shall submit monthly invoices for reimbursement that equal the amount
due CONTRACTOR less any funding sources not eligible for Federal and State reimbursement.
CONTRACTOR must comply with all laws and regulations governing the Federal Medicare program,
including, but not limited to: 1) the requirement of the Medicare Act, 42 U.S.C. section 1395 et seq; and 2)
the regulation and rules promulgated by the Federal Centers for Medicare and Medicaid Services as they
relate to participation, coverage and claiming reimbursement. CONTRACTOR will be responsible for
compliance as of the effective date of each Federal, State or local law or regulation specified.
Data entry into the COUNTY’s electronic information system shall be the responsibility of
CONTRACTOR. COUNTY shall monitor the volume of services and cost of services entered into
COUNTY’s electronic information system. Any and all audit exceptions resulting from the provision and
reporting of specialty mental health services by CONTRACTOR shall be the sole responsibility of
CONTRACTOR. CONTRACTOR will comply with all applicable policies, procedures, directives and
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guidelines regarding the use of COUNTY’s electronic information system.
Medi-Cal and Mental Health Plan Compliance
CONTRACTOR shall establish and maintain Medi-Cal certification or become certified within ninety
(90) days of the execution of this Agreement through COUNTY’s DBH. In addition, CONTRACTOR shall
work with COUNTY’s DBH to execute the process if not currently certified by COUNTY for credentialing of
staff. Service location must be approved by COUNTY’s DBH during the Medi-Cal certification process.
During this process, the CONTRACTOR shall obtain a legal entity number established by DHCS as this is a
requirement for maintaining COUNTY’s MHP Organizational Provider status throughout the term of this
Agreement. CONTRACTOR shall become Medi-Cal certified prior to providing services to Medi-Cal eligible
clients and seeking reimbursement from the COUNTY. CONTRACTOR will not be reimbursed by COUNTY
for any services rendered prior to Medi-Cal certification. CONTRACTOR shall comply with any and all
requests and directives associated with COUNTY maintaining State Medi-Cal site certification.
CONTRACTOR shall provide specialty mental health services in accordance with COUNTY’s MHP.
CONTRACTOR must comply with the “Fresno County Mental Health Plan Compliance Program and Code
of Conduct” set forth in Exhibit D, attached hereto and incorporated herein by reference and made part of
this Agreement.
CONTRACTOR may provide direct specialty mental health services using unlicensed staff as long
as the CONTRACTOR is approved as an Organizational Provider by the COUNTY’s MHP and the
individual 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 MHP.
It is understood that each service is subject to audit for compliance with Federal and State
regulations, and that COUNTY may be making payments in advance of said review. In the event that a
service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set off from other
payments due the amount of said disapproved services. CONTRACTOR shall be responsible for audit
exceptions to ineligible dates of services or incorrect application of utilization review requirements.
CONTRACTOR shall comply with any and all requests associated with any State and/or Federal reviews or
audits.
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6.INDEPENDENT CONTRACTOR:
In performance of the work, duties and obligations assumed by CONTRACTOR under this
Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of the
CONTRACTOR'S officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right
to control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and
function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules and
regulations, if any, of governmental authorities having jurisdiction over matters the subject thereof.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely no right
to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be solely liable
and responsible for providing to, or on behalf of, its employees all legally-required employee benefits. In
addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all matters relating
to payment of CONTRACTOR'S employees, including compliance with Social Security withholding and all
other regulations governing such matters. It is acknowledged that during the term of this Agreement,
CONTRACTOR may be providing services to others unrelated to the COUNTY or to this Agreement.
7.MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent of all the
parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to staffing, services, and responsibilities of the
CONTRACTOR, as needed, to accommodate changes in the laws relating to mental health treatment, as
set forth in Exhibit C, may be made with the signed written approval of COUNTY’s DBH Director or
designee CONTRACTOR through an amendment approved by COUNTY’s 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 individual program budgets, and
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changes to the volume of units of service/types of service units to be provided as set forth in Exhibit C, that
do not exceed ten percent (10%) of the maximum compensation payable to CONTRACTOR, may be made
with the written approval of COUNTY’s DBH Director or designee.
Modifications shall not result in any change to the maximum compensation amounts payable to
CONTRACTOR, as stated in this Agreement
8.NON-ASSIGNMENT
No party shall assign, transfer or sub-contract this Agreement nor their rights or duties under this
Agreement without the prior written consent of COUNTY.
9.HOLD HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY'S request, defend the
COUNTY, its officers, agents, and employees from any and all costs and expenses (including attorney’s
fees and costs), damages, liabilities, claims, and losses occurring or resulting to COUNTY in connection
with the performance, or failure to perform, by CONTRACTOR, its officers, agents, or employees under this
Agreement, and from any and all costs and expenses (including attorney’s fees and costs), damages,
liabilities, claims, and losses occurring or resulting to any person, firm, or corporation who may be injured
or damaged by the performance, or failure to perform, of CONTRACTOR, its officers, agents, or
employees under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal, State of California and/or local audit
exceptions resulting from noncompliance herein on the part of CONTRACTOR.
10.INSURANCE
Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any third
parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following insurance
policies or a program of self-insurance, including but not limited to, an insurance pooling arrangement or
Joint Powers Agreement (JPA) throughout the term of the Agreement:
A.Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million Dollars
($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00). This
policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
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completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
liability or any other liability insurance deemed necessary because of the nature of this contract.
B.Automobile Liability
Comprehensive Automobile Liability Insurance with limits of not less than Two Million Dollars
($2,000,000.00) per accident for bodily injury and for property damages. Coverage should include any auto
used in connection with this Agreement.
C.Professional Liability
If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W., M.F.C.C.) in
providing services, Professional Liability Insurance with limits of not less than One Million Dollars
($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
D.Worker's Compensation
A policy of Worker's Compensation insurance as may be required by the California Labor Code.
E.Sexual Abuse / Molestation Liability
Sexual abuse / molestation liability insurance with limits of not less than One Million Dollars
($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This policy shall
be issued on a per occurrence basis.
In the event, the CONTRACTOR purchases an Umbrella or Excess insurance policy(ies) to meet
the “Minimum Limits of Insurance,” this insurance policy(ies) shall “follow form” and afford no less
coverage than the primary insurance policy(ies). In addition, such Umbrella or Excess insurance
policy(ies) shall also apply on a primary and non-contributory basis for the benefit of the COUNTY, its
officers, officials, employees, agents and volunteers.
F.Real and Personal Property
CONTRACTOR shall maintain a policy of insurance for all risk personal property coverage which
shall be endorsed naming the County of Fresno as an additional loss payee. The personal property
coverage shall be in an amount that will cover the total of the County purchased and owned property, at
a minimum, as discussed in Section Twenty (20) of this Agreement.
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G.All Risk Personal Property
CONTRACTOR will provide property coverage for the full replacement value of the County's
Personal Property in the possession of Contractor and/or used in the execution of this agreement.
County will be identified on an appropriate certificate of insurance as the certificate holder and will be
named as an Additional Loss Payee on the Property Insurance Policy.
Additional Requirements Relating to Insurance
CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance naming
the County of Fresno, its officers, agents, and employees, individually and collectively, as additional
insured, but only insofar as the operations under this Agreement are concerned. Such coverage for
additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained
by COUNTY, its officers, agents and employees shall be excess only and not contributing with insurance
provided under CONTRACTOR's policies herein. This insurance shall not be cancelled or changed without
a minimum of thirty (30) days advance written notice given to COUNTY.
CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
employees any amounts paid by the policy of worker’s compensation insurance required by this
Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
necessary to accomplish such waiver of subrogation, but CONTRACTOR’s waiver of subrogation under
this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
Within Thirty (30) days from the date CONTRACTOR signs and executes this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, (Name and Address of the official who will
administer this contract or electronically to dbhcontractedservicesdivision@fresnocountyca.gov with a copy
to the assigned COUNTY’s DBH Staff Analyst), stating that such insurance coverages have been obtained
and are in full force; that the County of Fresno, its officers, agents and employees will not be responsible for
any premiums on the policies; that such Commercial General Liability insurance names the County of
Fresno, its officers, agents and employees, individually and collectively, as additional insured, but only
insofar as the operations under this Agreement are concerned; that such coverage for additional insured
shall apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its
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officers, agents and employees, shall be excess only and not contributing with insurance provided under
CONTRACTOR's policies herein; and that this insurance shall not be cancelled or changed without a
minimum of thirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be issued by admitted insurers licensed to do business in the State of California,
and such insurance shall be purchased from companies possessing a current A.M. Best, Inc. rating of A
FSC VII or better.
11.LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR’s staff shall
maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for the
provision of the services hereunder and required by the laws and regulations of the United States of
America, State of California, the County of Fresno, and any other applicable governmental agencies.
CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR’s staff shall comply with all
applicable laws, rules or regulations, as may now exist or be hereafter changed.
12.RECORDS
CONTRACTOR shall maintain its records in COUNTY’s EHR system (currently Avatar) in
accordance with Exhibit E, “Documentation Standards for Client Records,” attached hereto and
incorporated herein by reference and made part of this Agreement. The client record shall begin with
registration and intake and include client authorizations, assessments, plans of care, and progress notes,
as well as other documents as approved by the COUNTY’s DBH. 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. If CONTRACTOR determines to maintain its records in
COUNTY’s EHR system, it shall provide COUNTY’s DBH Director, or designee, with a thirty (30) day
notice. If at any time CONTRACTOR chooses not to maintain its records in COUNTY’s EHR system, it
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shall provide COUNTY’S DBH Director, or designee, with a thirty (30) day notice and CONTRACTOR will
be responsible for obtaining its own system, at its own cost, for Electronic Health Record management.
Disclaimer – COUNTY makes no warranty or representation that information entered into the COUNTY’s
EHR system by CONTRACTOR will be accurate, adequate or satisfactory for CONTRACTOR’s own
purposes or that any information in CONTRACTOR’s possession or control, or transmitted or received by
CONTRACTOR, is or will be secure from unauthorized access, viewing, use, disclosure, or breach.
CONTRACTOR is solely responsible for client information entered by CONTRACTOR into the COUNTY’s
EHR system. CONTRACTOR agrees that all Private Health Information (PHI) maintained by
CONTRACTOR in COUNTY’s EHR system will be maintained in conformance with all Health Insurance
Portability and Accountability Act (HIPAA) laws, as stated in Section Eighteen (18), “Health Insurance
Portability and Accountability Act”.
COUNTY shall be allowed to review all records of services provided, including the goals and
objectives of the treatment plan, and how the therapy provided is achieving the goals and objectives. All
mental health records shall be considered the property of the COUNTY and shall be retained by the
COUNTY upon termination or expiration of this Agreement.
13.REPORTS
A.Outcome Reports
CONTRACTOR shall submit to COUNTY’s DBH service outcome reports as requested by
COUNTY’s DBH. Outcome reports and outcome requirements are subject to change at COUNTY’s
DBH discretion.
CONTRACTOR shall submit to COUNTY’s designated Staff Analyst, quarterly and annual
reports detailing the status of meeting objectives as stated and described in Exhibit F, attached hereto
and incorporated herein by reference. COUNTY will require an explanation of any deviation greater than
10% from the stated objective.
B.PATH Annual Report
COUNTY is responsible for providing an annual report to the State which will describe and
evaluate the PATH program for essential planning purposes, maintaining program accountability, and
monitoring. Therefore, CONTRACTOR is required to submit to the COUNTY’s DBH Director or
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Designee data in accordance with Exhibit G, “PATH PDX Annual Report,” attached hereto and
incorporated herein by reference.
C. Additional Reports
CONTRACTOR shall also furnish to COUNTY such statements, records, reports, data, and other
information as COUNTY’s DBH may request pertaining to matters covered by this Agreement. In the
event that CONTRACTOR fails to provide such reports or other information required hereunder, it shall
be deemed sufficient cause for COUNTY to withhold monthly payments until there is compliance. In
addition, CONTRACTOR shall provide written notification and explanation to COUNTY within five (5)
days of any funds received from another source to conduct the same services covered by this
Agreement.
D. Cost Report
CONTRACTOR agrees to submit a complete and accurate detailed cost report on an annual
basis for each fiscal year ending June 30th in the format prescribed by the 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 DHCS for the purposes of Short Doyle Medi-Cal
reimbursement. CONTRACTOR shall report costs under their approved legal entity number established
during the Medi-Cal certification process. The information provided applies to CONTRACTOR for
program related costs for services rendered to Medi-Cal and non-Medi-Cal clients. CONTRACTOR will
remit a schedule to provide the required information on published charges (PC) for all authorized
services. The report will serve as a source document to determine their usual and customary charge
prevalent in the public mental health sector that is used to bill the general public, insurers, or other non-
Medi-Cal third party payers during the course of business operations. CONTRACTOR must report all
collections for Medi-Cal/Medicare services and collections. The CONTRACTOR shall also submit with
the cost report a copy of the 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 CONTRACTOR to COUNTY’s electronic information system.
Cost Reports must be submitted to the COUNTY as a hard copy with a signed cover letter and
electronic copy of completed DHCS cost report form along with requested support documents following
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each fiscal year ending June 30th. During the month of September of each year this Agreement is
effective, COUNTY will issue instructions of the annual cost report which indicates the training session,
DHCS cost report template worksheets, and deadlines to submit, as determined by State DHCS
annually. CONTRACTOR shall remit a hard copy of cost report to County of Fresno, Attention: Cost
Report Team, PO BOX 45003, Fresno CA 93718. CONTRACTOR shall remit the electronic copy or any
inquiries to DBHcostreportteam@fresnocountyca.gov.
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 lobby or political donations must be deducted on the cost report and invoice
reimbursement.
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.
E.Settlements with State Department of Health Care Services (DHCS)
During the term of this Agreement and thereafter, COUNTY and CONTRACTOR agree to settle
dollar amounts disallowed or settled in accordance with DHCS audit settlement findings related to the
reimbursement provided under this Agreement. CONTRACTOR will participate in the several phases of
settlements between COUNTY/CONTRACTOR and DHCS. The phases of initial cost reporting for
settlement according to State reconciliation of records for paid Medi-Cal services and audit settlement
are: State DHCS audit 1) initial cost reporting – after an internal review by COUNTY, the COUNTY files
the cost report with State DHCS on behalf of CONTRACTOR’s legal entity for the fiscal year; 2)
Settlement – State reconciliation of records for paid Medi-Cal services, approximately 18 to 36 months
following the State close of the fiscal year, DHCS will send notice for any settlement under this provision
to COUNTY; and 3) Audit Settlement-State DHCS audit. After final reconciliation and settlement DHCS
may conduct a review of medical records, cost report along with support documents submitted to
COUNTY in initial submission to determine accuracy and may disallow costs and/or units of services.
COUNTY may choose to appeal and therefore reserves the right to defer payback settlement with
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CONTRACTOR until resolution of the appeal. DHCS Audits will follow Federal Medicaid procedures for
managing overpayments.
If at the end of the Audit Settlement, COUNTY determines that it overpaid CONTRACTOR, it will
require CONTRACTOR to repay the Medi-Cal related overpayment back to COUNTY. Funds owed to
COUNTY will be due within forty-five (45) days of notification by COUNTY, or COUNTY shall withhold
future payments until all excess funds have been recouped by means of an offset against any payments
then or thereafter owing to COUNTY under this or any other Agreement between the COUNTY and
CONTRACTOR.
14.MONITORING
CONTRACTOR agrees to extend to COUNTY’s staff, COUNTY’s DBH Director, and the State
Department of Health Care Services or their designees, the right to review and monitor records,
services, or procedures, at any time, in regard to clients, as well as the overall operation of
CONTRACTOR’s performance, in order to ensure compliance with the terms and conditions of this
Agreement.
15.REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended during the
term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
such amendment.
16.COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates its mental health programs under an
agreement with the State of California Department Health Care Services, and that under said agreement
the State imposes certain requirements on COUNTY and its subcontractors. CONTRACTOR shall adhere
to all State requirements, including those identified in Exhibit H, “State Mental Health Requirements”,
attached hereto and by this reference incorporated herein and made part of this Agreement.
17.COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall be required to maintain organizational provider certification by COUNTY.
CONTRACTOR must meet Medi-Cal organization provider standards as listed in Exhibit I, “Compliance
with State Medi-Cal Requirements”, attached hereto and by this reference incorporated herein and made
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part of this Agreement. It is acknowledged that all references to Organizational Provider and/or Provider in
Exhibit G/I shall refer to CONTRACTOR.
CONTRACTOR shall inform every client of their rights under the COUNTY's Mental Health Plan as
described in Exhibit J, “Mental Health Plan Grievances and Appeals Process”, attached hereto and by this
reference incorporated herein and made part of this Agreement.
CONTRACTOR shall also file an incident report for all incidents involving clients, following the
COUNTY’s DBH “Incident Reporting and Intensive Analysis” policy and procedure guide and using the
“Incident Report” protocol and user guide identified in Exhibit K, attached hereto and by this reference
incorporated herein and made part of this Agreement.
18.CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict conformance with
all applicable Federal, State of California and/or local laws and regulations relating to confidentiality.
19.HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered entities as
defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-191
(HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is only for
treatment, payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of PHI
pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for Economic and
Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated thereunder by the U.S.
Department of Health and Human Services (HIPAA Regulations) and other applicable laws. As part of the
HIPAA Regulations, the Privacy Rule and the Security Rule require CONTRACTOR to enter into a contract
containing specific requirements prior to the disclosure of PHI, as set forth in, but not limited to, Title 45,
Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal Regulations.
20.DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access, viewing,
use or disclosure of COUNTY data including sensitive or personal client information; abuse of COUNTY
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resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into a
contractual relationship with COUNTY for the purpose of providing services under this Agreement must
employ adequate data security measures to protect the confidential information provided to
CONTRACTOR by COUNTY, including but not limited to the following:
A.CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned mobile, wireless or
handheld devices, unless the following conditions are met:
1.CONTRACTOR has received authorization by COUNTY for telecommuting
purposes;
2.Current virus protection software is in place;
3.Mobile device has the remote wipe feature enable; and
4.A secure connection is used.
B.CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR may not bring contractor-owned computers or computer peripherals into
COUNTY for use without prior authorization from COUNTY’s Chief Information Officer and/or
designee(s), including but not limited to mobile storage devices. If data is approved to be transferred,
data must be encrypted and stored on a secure server approved by COUNTY and transferred by means
of a Virtual Private Network (VPN) connection, or another type of secure connection.
C. COUNTY-Owned Computer Equipment
CONTRACTOR may not use COUNTY computers or computer peripherals on non-County
premises without prior authorization from COUNTY’s Chief Information Officer and/or designee(s).
D. CONTRACTOR may not store COUNTY’s private, confidential or sensitive data on any hard-disk
drive, portable storage device, or remote storage installation unless encrypted.
E.CONTRACTOR shall be responsible to employ strict controls to ensure the integrity and security of
COUNTY’s confidential information and prevent unauthorized access, viewing, use, or disclosure of
data maintained in computer files, program documentation, data processing systems, data files, and
data processing equipment which stores or processes COUNTY data internally and externally.
F.Confidential client information transmitted to one party by the other by means of electronic
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transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128 BIT or
higher. Additionally, a password or pass phrase must be utilized.
G.CONTRACTOR is responsible to immediately notify COUNTY of any violations, breaches or
potential breaches of security related to COUNTY’s confidential information, data maintained in
computer files, program documentation, data processing systems, data files and data processing
equipment which stores or processes COUNTY data internally or externally.
H. COUNTY shall provide oversight to CONTRACTOR’s response to all incidents arising from a
possible breach of security related to COUNTY’s confidential client information provided to
CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected individuals
as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will
be responsible for all costs incurred as a result of providing the required notification.
21.PROPERTY OF COUNTY
A.COUNTY and CONTRACTOR recognize that fixed assets are tangible and intangible
property obtained or controlled under COUNTY 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 a 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
-Equipment
-Vehicles
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Intangible $100,000
-Internally Generated Software
-Purchased Software
-Easements
-Patents
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, CONTRACTOR’s fixed assets may be
inventoried in comparison to COUNTY’s DBH Asset Inventory System.
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 COUNTY’s DBH Director or designee.
CONTRACTOR 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.
///
///
B.Assets shall be retained by COUNTY, as COUNTY property, in the event this Agreement is
terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in an annual
inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this
Agreement, CONTRACTOR shall be physically present when fixed and inventoried assets are
returned to COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all
COUNTY-owned undepreciated fixed and inventoried assets, or the monetary value of said assets
if unable to produce the assets at the expiration or termination of this Agreement.
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CONTRACTOR 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
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.
C.The purchase of any equipment by CONTRACTOR with funds provided hereunder shall require the
prior written approval of COUNTY’s DBH, shall fulfill the provisions of this Agreement as
appropriate, and must be directly related to CONTRACTORS services or activities under the terms
of this Agreement. COUNTY’s DBH may refuse reimbursement for any costs resulting from
equipment purchased, which are incurred by CONTRACTOR, if prior written approval has not been
obtained from COUNTY.
D. CONTRACTOR shall be the registered owner of two (2) vehicles, including equipped vans, and one
(1)shower trailer purchased for the PATH Program in A-15-257 with the COUNTY as first
lienholder. In the event of termination of this Agreement, COUNTY will immediately invoke the right
to repossession of the vehicles and shower trailer, which were purchased through this Agreement,
and CONTRACTOR shall cooperate with COUNTY, including but not limited to making vehicles
available at 4551 E. Hamilton, Fresno, CA 93702 and immediately transferring title in the vehicles
and shower trailer to COUNTY.
E.CONTRACTOR must obtain prior written approval from COUNTY’s DBH whenever there is any
modification or change in the use of any property acquired or improved, in whole or in part, using
funds under this Agreement. If any real or personal property acquired or improved with said funds
identified herein is sold and/or is utilized by CONTRACTOR for a use which does not qualify under
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this Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal to the current fair
market value of the property, less any portion thereof attributable to expenditures of funds not
provided under this Agreement. These requirements shall continue in effect for the life of the
property. In the event this Agreement expires, or terminates, the requirements for this Section shall
remain in effect for activities or property funded with said funds, unless action is taken by the State
government to relieve COUNTY of these obligations.
22.NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR and its subcontractors shall not deny
the contract’s benefits to any person on the basis of race, religious creed, color, national origin,
ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex,
gender, gender identity, gender expression, age, sexual orientation, or military and veteran status, nor
shall they discriminate unlawfully against any employee or applicant for employment because of race,
religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition,
genetic information, marital status, sex, gender identity, gender expression, age, sexual orientation, or
military and veteran status.
CONTRACTOR shall ensure that the evaluation and treatment of employees and applicants for
employment are free of such discrimination. CONTRACTOR and subcontractors shall comply with the
provisions of the Fair Employment and Housing Act (Gov. Code §12800 et seq.), the regulations
promulgated thereunder (Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter
1, Part 1, Division 3, Title 2 of the Government Code (Gov. Code §11135-11139.5), and the regulations
or standards adopted by the awarding state agency to implement such article. CONTRACTOR shall
permit access by representatives of the Department of Fair Employment and Housing and the awarding
state agency upon reasonable notice at any time during the normal business hours, but in no case less
than twenty-four (24) hours notice, to such of its books, records, accounts, and all other sources of
information and its facilities as said department or agency shall require to ascertain compliance with this
clause. CONTRACTOR and its subcontractors shall give written notice of their obligations under this
clause to labor organizations with which they have a collective bargaining or other agreement. (See
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Cal. Code Regs., tit. 2, §11105.) CONTRACTOR shall include the non-discrimination and compliance
provisions of this clause in all subcontracts to perform work under this Agreement.
23.CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence:
A.CONTRACTOR shall not discriminate against beneficiaries based on race, color, national
origin, sex, disability, or religion. CONTRACTOR 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.CONTRACTOR 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. CONTRACTOR’s policies and
procedures shall ensure compliance of any subcontracted providers with these requirements.
C. CONTRACTOR shall notify its beneficiaries that oral interpretation is available for 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. CONTRACTOR 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
CONTRACTOR must document the offer, refusal and justification in the beneficiary’s file.
D. CONTRACTOR 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 CONTRACTOR; (2) have demonstrated proficiency in the beneficiary’s language; (3)
can effectively communicate any specialized terms and concepts specific to
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CONTRACTOR’s services; and (4) adheres to generally accepted interpreter ethic principles.
As requested by COUNTY, CONTRACTOR shall identify all who interpret for or provide
direct communication to any program beneficiary in a language other than English and
identify when the CONTRACTOR last monitored the interpreter for language competence.
E.CONTRACTOR shall submit to COUNTY for approval, within ninety (90) days from date of
contract execution, CONTRACTOR’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 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, CONTRACTOR’s plan must be
updated accordingly. As requested by COUNTY, CONTRACTOR 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 CONTRACTOR 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, CONTRACTOR shall report on the completion of
cultural competency trainings to ensure direct service providers are completing a minimum of
one (1) cultural competency training annually.
G.CONTRACTOR shall create and sustain a forum that includes staff at all agency levels to
discuss cultural competence. COUNTY encourages a representative from CONTRACTOR’s
forum to attend COUNTY’s Cultural Humility Committee.
24.AMERICANS WITH DISABILITIES ACT
CONTRACTOR agrees to ensure that deliverables developed and produced, pursuant to this
Agreement, shall comply with the accessibility requirements of Section 508 of the Rehabilitation Act and
the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)), and regulations
implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal Regulations. In 1998,
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Congress amended the Rehabilitation Act of 1973 to require Federal agencies to make their electronic
and information technology (EIT) accessible to people with disabilities. California Government Code
section 11135 codifies section 508 of the Act requiring accessibility of electronic and information
technology.
25.TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section 1861(v)(1) (I)
of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four (4) years after
the furnishing of services under this Agreement, CONTRACTOR shall make available, upon written
request to the Secretary of the United States Department of Health and Human Services, or upon
request to the Comptroller General of the United States General Accounting Office, or any of their duly
authorized representatives, a copy of this Agreement and such books, documents, and records as are
necessary to certify the nature and extent of the costs of these services provided by CONTRACTOR
under this Agreement. CONTRACTOR further agrees that in the event CONTRACTOR carries out any
of its duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and
No/100 Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such
Agreement shall contain a clause to the effect that until the expiration of four (4) years after the
furnishing of such services pursuant to such subcontract, the related organizations shall make available,
upon written request to the Secretary of the United States Department of Health and Human Services,
or upon request to the Comptroller General of the United States General Accounting Office, or any of
their duly authorized representatives, a copy of such subcontract and such books, documents, and
records of such organization as are necessary to verify the nature and extent of such costs.
26.SINGLE AUDIT CLAUSE
A.If CONTRACTOR expends Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) or
more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual
audit in accordance with the requirements of the Single Audit Standards as set forth in Office of
Management and Budget (OMB) 2 CFR 200. CONTRACTOR shall submit said audit and
management letter to COUNTY. The audit must include a statement of findings or a statement that
there were no findings. If there were negative findings, CONTRACTOR must include a corrective
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action plan signed by an authorized individual. CONTRACTOR agrees to take action to correct any
material non-compliance or weakness found as a result of such audit. Such audit shall be delivered
to COUNTY’s DBH Finance Division for review within nine (9) months of the end of any fiscal year
in which funds were expended and/or received for the program. Failure to perform the requisite
audit functions as required by this Agreement may result in COUNTY performing the necessary
audit tasks, or at COUNTY’s option, contracting with a public accountant to perform said audit, or
may result in the inability of COUNTY to enter into future agreements with CONTRACTOR. All
audit costs related to this Agreement are the sole responsibility of CONTRACTOR.
B.A single audit report is not applicable if CONTRACTOR’s Federal contracts do not exceed the
Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or CONTRACTOR’s
only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a program audit
must be performed and a program audit report with management letter shall be submitted by
CONTRACTOR to COUNTY as a minimum requirement to attest to CONTRACTOR solvency.
Said audit report shall be delivered to COUNTY’s DBH Finance Division for review no later than
nine (9) months after the close of the fiscal year in which the funds supplied through this Agreement
are expended. Failure to comply with this Act may result in COUNTY performing the necessary
audit tasks or contracting with a qualified accountant to perform said audit. All audit costs related to
this Agreement are the sole responsibility of CONTRACTOR who agrees to take corrective action to
eliminate any material noncompliance or weakness found as a result of such audit. Audit work
performed by COUNTY under this paragraph shall be billed to CONTRACTOR at COUNTY cost, as
determined by COUNTY’s Auditor-Controller/Treasurer-Tax Collector.
C.CONTRACTOR shall make available all records and accounts for inspection by COUNTY, the State
of California, if applicable, the Comptroller General of the United States, the Federal Grantor
Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other pending
matters, whichever is later.
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27.COMPLIANCE
CONTRACTOR agrees to comply with COUNTY’s Contractor Code of Conduct and Ethics and
the COUNTY’s Compliance Program in accordance with Exhibit D. Within thirty (30) days of entering
into this Agreement with COUNTY, CONTRACTOR shall have all of CONTRACTOR’s employees,
agents, and subcontractors providing services under this Agreement certify in writing, that he or she has
received, read, understood, and shall abide by the Contractor Code of Conduct and Ethics.
CONTRACTOR shall ensure that within thirty (30) days of hire, all new employees, agents, and
subcontractors providing services under this Agreement shall certify in writing that they have received,
read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR
understands that the promotion of and adherence to the Contractor Code of Conduct is an element in
evaluating the performance of CONTRACTOR and its employees, agents, and subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all employees,
agents, and subcontractors providing services under this Agreement shall complete general compliance
training, and appropriate employees, agents, and subcontractors shall complete documentation and
billing or billing/reimbursement training. All new employees, agents, and subcontractors shall attend the
appropriate training within thirty (30) days of hire. Each individual who is required to attend training shall
certify in writing that he or she has received the required training. The certification shall specify the type
of training received and the date received. The certification shall be provided to COUNTY’s DBH
Compliance Officer at 1925 E. Dakota Ave, Fresno, California 93726. CONTRACTOR agrees to
reimburse COUNTY for the entire cost of any penalty imposed upon COUNTY by the Federal
Government as a result of CONTRACTOR’s violation of the terms of this Agreement.
28.ASSURANCES
In entering into this Agreement, CONTRACTOR certifies 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
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CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility
for, or involvement with, COUNTY’s business operations related to the Federal Health Care Programs
and shall remove such CONTRACTOR from any position in which CONTRACTOR’s compensation, or
the items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part,
directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until
such time as CONTRACTOR is reinstated into participation in the Federal Health Care Programs.
A.If COUNTY has notice that either CONTRACTOR, or its officers, 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, CONTRACTOR and COUNTY shall take all appropriate
actions to ensure the accuracy of any claims submitted to any Federal Health Care Program.
At its discretion, given such circumstances, COUNTY may request that CONTRACTOR
cease providing services until resolution of the charges or the proposed exclusion.
B.CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional
services under this Agreement, will be queried as to whether: (1) they are now or ever have
been excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
Health Care Programs; (2) they have been convicted of a criminal offense related to the
provision of health care items or services; and (3) they have been reinstated to participate in
the Federal Health Care Programs after a period of exclusion, suspension, debarment, or
ineligibility.
1)In the event the potential employee or subcontractor informs CONTRACTOR that he
or she is excluded, suspended, debarred, or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and
CONTRACTOR hires or engages such potential employee or subcontractor,
CONTRACTOR will ensure that said employee or subcontractor does no work, either
directly or indirectly relating to services provided to COUNTY.
2)Notwithstanding the above, COUNTY, at its discretion, may terminate this Agreement
in accordance with Section Three (3) of this Agreement, or require adequate
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assurance (as defined by COUNTY) that no excluded, suspended, or otherwise
ineligible employee or subcontractor of CONTRACTOR will perform work, either
directly or indirectly, relating to services provided to COUNTY. Such demand for
adequate assurance shall be effective upon a time frame to be determined by
COUNTY to protect the interests of COUNTY consumers.
C. CONTRACTOR shall verify (by asking the applicable employees and subcontractors) that all
current employees and existing subcontractors who, in each case, are expected to perform
professional services under this Agreement: (1) are not currently excluded, suspended,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have
not been convicted of a criminal offense related to the provision of health care items or
services; and (3) have not been reinstated to participate in the Federal Health Care Program
after a period of exclusion, suspension, debarment, or ineligibility. In the event any existing
employee or subcontractor informs CONTRACTOR that he or she is excluded, suspended,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs, or has
been convicted of a criminal offense relating to the provision of health care services,
CONTRACTOR will ensure that said employee or subcontractor does no work, either direct
or indirect, relating to services provided to COUNTY.
1)CONTRACTOR agrees to notify COUNTY immediately during the term of this
Agreement whenever CONTRACTOR learns that an employee or subcontractor who,
in each case, is providing professional services under this Agreement is excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care
Programs, or is convicted of a criminal offense relating to the provision of health care
services.
2)Notwithstanding the above, COUNTY, at its discretion, may terminate this Agreement
in accordance with Section Three (3) of this Agreement, or require adequate
assurance (as defined by COUNTY) that no excluded, suspended, or otherwise
ineligible employee or subcontractor of CONTRACTOR will perform work, either
directly or indirectly, relating to services provided to COUNTY. Such demand for
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adequate assurance shall be effective upon a time frame to be determined by
COUNTY to protect the interests of COUNTY clients.
D. CONTRACTOR agrees to cooperate fully with any reasonable requests for information from
COUNTY which may be necessary to complete any internal or external audits relating to
CONTRACTOR’s compliance with the provisions of this Section.
E.CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed
upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of
CONTRACTOR’s obligations as described in this Section.
29.PUBLICITY PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under this
Agreement shall be used for CONTRACTOR’s advertising, fundraising, or publicity (i.e., purchasing of
tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the
above, publicity of the services described in Section One (1) of this Agreement shall be allowed as
necessary to raise public awareness about the availability of such specific services when approved in
advance by COUNTY’s DBH Director or designee and at a cost to be provided in Exhibit A for such
items as written/printed materials, the use of media (i.e., radio, television, newspapers), and any other
related expense(s).
30.COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a client or a
client's family. CONTRACTOR shall provide a copy of the detailed complaint log entries concerning
COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (10th) day of the following
month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide details and
attach documentation of each complaint with the log. CONTRACTOR shall post signs informing clients
of their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all incidents
reportable to State licensing bodies that affect COUNTY clients within twenty-four (24) hours of receipt
of a complaint.
Within ten (10) days after each incident or complaint affecting COUNTY clients, CONTRACTOR
shall provide COUNTY with information relevant to the complaint, investigative details of the complaint,
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the complaint and CONTRACTOR’s disposition of, or corrective action taken to resolve the complaint.
In addition, CONTRACTOR shall inform every client of their rights as set forth in Exhibit K.
CONTRACTOR shall file an incident report for all incidents involving clients, following the protocol and
user guide identified in Exhibit K.
31.DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is 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 CONTRACTOR 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. CONTRACTOR shall submit this form to the COUNTY’s DBH within
thirty (30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall report any
changes to this information within thirty-five (35) days of occurrence by completing Exhibit N.
Submissions shall be scanned portable document format (pdf) copies and are to be sent via email to
COUNTY’s DBH assigned Staff Analyst.
CONTRACTOR is required to submit a set of fingerprints for any person with a five (5) percent or
greater direct or indirect ownership interest in CONTRACTOR. COUNTY may terminate this Agreement
where any person with a five (5) percent or greater direct or indirect ownership interest in the
CONTRACTOR did not submit timely and accurate information and cooperate with any screening
method required in CFR, Title 42, Section 455.416. Submissions shall be scanned pdf copies and are
to be sent via email to DBHContractedServicesDivision@fresnocountyca.gov. COUNTY may deny
enrollment or terminate this Agreement where any person with a five (5) percent or greater direct or
indirect ownership interest in CONTRACTOR has been convicted of a criminal offense related to that
person’s involvement with the Medicare, Medicaid, or Title XXI program in the last ten (10) years.
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32.DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS:
CONTRACTOR is required to disclose if any of the following conditions apply to them, their owners,
officers, corporate managers, and partners (hereinafter collectively referred to in this Section as
“CONTRACTOR”):
A.Within the three (3) year period preceding the Agreement award, they have been convicted
of, or had a civil judgment rendered against them for:
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 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
CONTRACTOR elects to submit with the disclosed information will be considered. If it is later
determined that CONTRACTOR failed to disclose required information, any contract awarded to such
CONTRACTOR may be immediately voided and terminated for material failure to comply with the terms
and conditions of the award.
CONTRACTOR must sign a “Certification Regarding Debarment, Suspension, and Other
Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit O, attached hereto
and by this reference incorporated herein and made part of this Agreement. Additionally,
CONTRACTOR must immediately advise COUNTY’s DBH in writing if, during the term of this
Agreement: (1) CONTRACTOR becomes suspended, debarred, excluded, or ineligible for participation
in Federal or State funded programs or from receiving federal funds as listed in the excluded parties’ list
system (http://www.epls.gov); or (2) any of the above listed conditions become applicable to
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CONTRACTOR. 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.
33.DISCLOSURE OF SELF-DEALING TRANSACTIONS
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, 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 CONTRACTOR is providing goods or performing services under this
Agreement. A self-dealing transaction shall mean a transaction to which CONTRACTOR is a party and
in which one or more of its directors has a material financial interest. Members of the Board of Directors
shall disclose any self-dealing transactions that they are a party to by completing and signing a “Self-
Dealing Transaction Disclosure Form”, attached hereto as Exhibit 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.
34.AUDITS AND INSPECTIONS:
CONTRACTOR shall at any time during business hours, and as often as the COUNTY may deem
necessary, make available to the COUNTY for examination all of its records and data with respect to the
matters covered by this Agreement. The CONTRACTOR shall, upon request by the COUNTY, permit the
COUNTY to audit and inspect all of such records and data necessary to ensure CONTRACTOR'S
compliance with the terms of this Agreement.
If this Agreement exceeds ten thousand dollars ($10,000.00), CONTRACTOR shall be subject to
the examination and audit of the Auditor General for a period of three (3) years after final payment under
contract (Government Code Section 8546.7).
35.NOTICES:
The persons and their addresses having authority to give and receive notices under this Agreement
include the following:
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COUNTY
Director, Fresno County
Department of Behavioral Health
1925 E. Dakota Ave.
Fresno, CA 93726
CONTRACTOR
Chief Executive Officer,
Kings View Corporation
7170 N. Financial Dr. Ste.
110 Fresno, CA 93720
All notices between the COUNTY and CONTRACTOR provided for or permitted under this
Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
personal service is effective upon service to the recipient. A notice delivered by first-class United States
mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid,
addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
COUNTY business day after deposit with the overnight commercial courier service, delivery fees prepaid,
with delivery instructions given for next day delivery, addressed to the recipient. A notice delivered by
telephonic facsimile is effective when transmission to the recipient is completed (but, if such transmission is
completed outside of COUNTY business hours, then such delivery shall be deemed to be effective at the
next beginning of a COUNTY business day), provided that the sender maintains a machine record of the
completed transmission. For all claims arising out of or related to this Agreement, nothing in this section
establishes, waives, or modifies any claims presentation requirements or procedures provided by law,
including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government Code,
beginning with section 810).
36.GOVERNING LAW:
Venue for any action arising out of or related to this Agreement shall only be in Fresno County,
California.
The rights and obligations of the parties and all interpretation and performance of this Agreement
shall be governed in all respects by the laws of the State of California.
37.ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire agreement between the
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
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Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understanding of any nature whatsoever unless expressly included in this Agreement. In the event of any
inconsistency in interpreting the documents which constitute this Agreement, the inconsistency shall be
resolved by giving precedence in the following order of priority: (1) the text of this Agreement (excluding
Attachment "A", the COUNTY'S Request for Quotation/Proposal No. Revised RFP No. 20-044 and the
CONTRACTOR'S Quote/Proposal in response thereto); (2) Attachment "A"; (3) the COUNTY'S Request for
Quotation/Proposal No. Revised RFP No. 20-044; and (4) the CONTRACTOR'S quotation/proposal made
in response to COUNTY'S Request for Quotation/Proposal No. Revised RFP No. 20-044. A copy of
COUNTY’s Revised RFP No. 20-044 and CONTRACTOR’s response thereto shall be retained and made
available during the term of this Agreement by COUNTY’s DBH.
Exhibit A – Scope of Work
Exhibit B – DBH Guiding Principles of Care Delivery
Exhibit C – Budget and Budget Narrative
Exhibit D – FCMHCP (Contractor Code of Conduct and Ethics)
Exhibit E – Documentation Standards for Client Records
Exhibit F – Program Objectives
Exhibit G – PATH PDX Annual Report
Exhibit H – State Mental Health Requirements
Exhibit I – Compliance with State Medi-Cal Requirements
Exhibit J – FCMHP (Grievance and Appeals Process)
Exhibit K.1 – Protocol for Completion of Incident Report
Exhibit K.2 – Incident Reviewer User Guide
Exhibit L – Fixed Asset and Sensitive Item Log
Exhibit M – National Standards for Culturally and Linguistically Appropriate Services
Exhibit N – Disclosure of Ownership
Exhibit O – Certification Regarding Debarment, Suspension, and Other Responsibility Matters
Exhibit P – Self-Dealing Transaction Disclosure Form
///
IN WITNESS WHEREOF, the part ies hereto have executed this Agreement as of the day and year
2 first hereinabove written .
3
4 CONT RACTOR:
5 KINGS VIEW CORPORATION
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f, marvlo. A1:Jd l}v,ne__
Print Name
14 Mailing Address :
15 Kings View
16 7170 N. Financial Dr. Ste. 110
17 Fresno, CA 93720
18
19 Phone No . (559) 256-7611
20 Contact: Amanda Nugent-Divine, CEO
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24
25 FOR ACCOUNTING USE ONLY:
26 Fund/Subclass : 0001/10000
27 Organization : 56302493
28 Account/Program : 7295/0
COUNTY OF FRESNO
Steve Brandau, Chairman of the Board
of Supervisors of the County of Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno , S1ate of Cal ifornia
By: cl~~
Deputy
-40-
Exhibit A
Page 1 of 6
PROJECTS FOR ASSISTANCE IN TRANSITION FROM HOMELESSNESS
(PATH) PROGRAM
Scope of Work
ORGANIZATION
REGIONAL DIRECTOR
CORPORATE ADDRESS
HOURS OF OPERATION
CONTRACT PERIOD
Kings View Corporation
Virginia Sparks, LMFT
7170 N Financial Dr, Ste 110, Fresno, CA 93720
8AM to 5PM, Monday through Friday
July 1, 2021 – June 30, 2027
CONTRACT AMOUNT FY 2021-2022 $671,272
FY 2022-2023 $639,066
FY 2023-2024 $639,066
FY 2024-2025 $639,066
FY 2025-2026
Total
$639,066
$3,227,536
SERVICES Outreach, Case Management, Mental Health, and Supportive Housing Services
TARGET POPULATION
Adults (18 years and older) living in metro, rural, or unincorporated areas in Fresno County who are experiencing serious
mental illness and/or co-occurring substance use disorders and are homeless or at imminent risk of becoming homeless.
Participation in the PATH Program is voluntary.
PROJECT DESCRIPTION
The Stewart B McKinney Homeless Assistance Amendments Act of 1990 authorizes a federal grant program, Projects for
Assistance in Transition from Homelessness (PATH). This funding source is used to address the needs of the target
population through a PATH Program operated by Kings View. A primary goal is to reduce and end chronic homelessness
and enable persons served to live in the community and to avoid homelessness, hospitalization, and/or jail detention. It
is a vital resource to the community, serving as a front door for persons served into continuum of care services and
mainstream mental health, primary healthcare, and the substance abuse services system.
The PATH Program is comprised of two main components:
1.Outreach, Engagement, and Linkage (OEL)2.Specialty Mental Health Services (SMHS)
Through PATH-OEL, Kings View will provide services to at least three hundred-fifty (350) persons per year, at least two
hundred (200) of which will be enrolled into HMIS and be linked to the appropriate services or referred to PATH-SMHS.
They will receive case management, linkage, consultation, peer support services, and supportive interim or bridge
housing services as needed. As necessary, Kings View will implement COVID-19 screening, education, assessment, and
linkage capabilities in the field.
Up to thirty-six (36) persons at a given time will be enrolled in PATH-SMHS where they will receive intensive mental
health treatment, case management, linkage, consultation, peer support services, and supportive housing services; up to
ten (10 individuals at a given time will receive housing support). Service goals are to help stabilize and transition persons
served into other County or community mental health programs.
Exhibit A
Page 2 of 6
Kings View will commit to “meet persons where they are” and collaborate with other agencies across the system of care
to assist persons served in achieving their personal recovery and wellness goals. Services will incorporate safety,
emergency and crisis procedures in the field and in the organization’s offices, personal services coordination, psychiatric
services in the areas of medication, prescription, administration, monitoring and documentation, mental health services,
linkage services, supportive housing services, and mobile outreach services.
COUNTY’S administrative staff shall monitor and oversee program outcomes and coordinate reporting requirements.
CONTRACTOR RESPONSIBILITIES
I.ADMINISTRATIVE SERVICES
1.Participate in the Fresno/Madera Continuum of Care (FMCoC) as a member. COUNTY will provide
technical assistance as needed.
2.Provide appropriate data and measurable outcomes as requested or required by the County and State.
Such data reports include quarterly performance reports, Behavioral Health Board annual update
reports, inclusive of demographics, caseload, and measurable outcomes.
3.Participate and utilize the Homeless Management Information System (HMIS) to enter data on persons
served.
4.Ensure that operating staff are able to have on hand, in their possession, during regular working hours
and when appropriate, an adequate amount of petty cash with which to make emergency purchases of
food, shelter, clothing, prescriptions, transportation, or other items and services as needed for persons
served. This may include security deposits, rent subsidy, and other items needed by persons served.
CONTRACTOR shall provide policies and procedures as to the handling of petty cash.
5.Evaluate the staff’s competency for performance purposes and establish medication policies and
procedures which identify processes to administer medications to persons served and train other staff
and family members regarding medication education, medication delivery, medication side effects,
observation of self administration of medication and medication monitoring.
6.Ensure billable Mental Health Specialty Services meet any/all County, State, and Federal regulations
including any utilization review and quality assurance standards.
II.STAFFING REQUIREMENTS
1.CONTRACTOR’s program staff shall reflect the target population through social characteristics of the
community, such as culture, ethnicity, gender, and sexual orientation.
2.Operate with a multidisciplinary treatment team including licensed/unlicensed mental health
professionals, case managers, and other specialists to support persons served in reaching their goals.
III.SERVICES ACROSS PROGRAM
1.Commit to “meeting individuals where they are” in order to assist persons served in achieving their
personal recovery and wellness goals.
2.Integrate physical and mental health services in collaboration with primary care physicians.
3.Provide culturally responsive evidence-based or promising clinical services that are integrated with
overall service planning, supportive housing, and employment support and/or education goals.
4.Provide treatment services that account for the age, culture, gender, and language of persons served, as
well as possible accommodations for physical disabilities.
5.Employ harm reduction and motivational interviewing techniques and principles.
Exhibit A
Page 3 of 6
6.Empower persons served to take an active role in the recovery process, provide housing options, and
maintain independent living by providing needed services, accessing resources, and encouragement to
be independent, productive, and responsible.
7.Collaborate with other agencies for the provision of non-direct mental health services. Linkage must be
provided to persons served for the full range of services.
8.Coordinate services with other community mental health and non-mental health providers, as well as
other medical professionals in a manner consistent with Fresno County confidentiality rules.
9.Collaborate with community law enforcement, probation, and courts.
10.Link persons served to appropriate social services, legal advocacy, and other representation; provide
transportation as necessary; serve as a “representative payee” or refer them to other payee services for
SSI/SSD benefits.
11.CONTRACTOR will provide reasonable direct assistance as needed to ensure that person served obtain
the basic necessities of daily life, including but not limited to:
a.Safe, clean, affordable housing;
b.Food and clothing;
c.Appropriate financial support, which may include housing deposits, Supplemental Security
Income, Social Security Disability Insurance, General Relief, and money management services.
d.Bus tokens/passes
e.Vehicles available to staff to transport persons served to appointments and social group
activities
12.Provide assistance and advocacy in obtaining available public assistance benefits, general relief, SSI/SSDI
and accessing needed behavioral health and physical health care for persons served.
13.Make appropriate referrals and linkages to addiction services that are beyond that of the PATH program
to individuals with coexisting alcohol, tobacco, drug abuse and other addictive symptoms.
14.Provide a rapid and flexible response to crisis during working hours, including crisis assessment and
intervention by telephone or face-to-face contact. Should crisis housing, short-term care, and inpatient
treatment (voluntary or involuntary) be needed, staff shall collaborate with designated staff at
psychiatric facilities and/or hospitals. CONTRACTOR will provide support to the maximum extent
possible, including accompanying persons served to the County’s Urgent Wellness Center and remain
with them during the assessment.
15.Initiate voluntary commitment, should there be a need. CONTACTOR will work with County staff within
the Adult Services Division; county staff will sign the involuntary commitment papers.
16.CONTRACTOR shall have the flexibility to increase service intensity for an individual in response to their
needs. Staff shall have the capacity to provide as many contacts as needed to persons served
experiencing significant problems in daily living.
IV.PATH-OEL SERVICES
1.At least 350 persons will be receive outreach, engagement, and linkage services and at least 200 persons
served will be enrolled into PATH and HMIS.
2.Utilize various engagement tools, such as personal protective equipment, disinfectant supplies, clothing,
food, shoes, blankets, bus passes, hygiene kits etc., to address barriers to engagement such as
transportation, pet care, property storage, etc.
3.Provide frequent contacts with individuals where they live or are most comfortable in order to assist
them in accessing behavioral and physical health care, financial, education, vocational, rehabilitative, or
Exhibit A
Page 4 of 6
other needed community services, especially as these services relate to meeting the person’s mental
health and housing needs.
4.Assess and document mental illness symptoms and behavior of persons served in response to
medication and monitor for medication side-effects during the provision of observed self-administration
and during ongoing face-to-face contacts.
V.PATH-SMHS SERVICES
1.Up to thirty-six (36) persons at a given time will be enrolled to receive intensive mental health treatment
services on an ongoing basis, inclusive of supportive housing services for up to ten (10) persons at a
given time.
2.The PATH - SMHS program’s persons served to staff ratio will be no more than eighteen (18) persons to
each staff. A ratio of 1:17, or one staff serving seventeen (17) persons, will not be exceeded until at
least one person served by a staff member is transitioning out of the program (a transition period will be
at least three months prior to exit). During a transitional period, the ratio can be 1:18.
3.Assign a case manager within 24 hours of enrollment into the PATH SMHS Program.
4.A Plan of Care must include and identify current symptoms, treatment goals, and interventions of
persons served.
5.Implement mental health service strategies to reduce the number of days persons served experience
hospitalization, incarceration, and homelessness.
6.Minimize the involvement of persons served with the criminal justice system, with services to include,
but not be limited to:
a.Helping identify precipitants to their criminal involvement;
b.Providing necessary treatment, support, and education to help eliminate any unlawful activities
or criminal involvement that may be of consequence to the individual’s mental illness; and
c.Collaborating with police, court personnel, jail/prison officials, and psychiatric staff to ensure
appropriate use of legal and mental health services.
7.Incorporate the Supplemental Security Income/Social Security Disability Income (SSI/SSDI), SSI/SSDI
Outreach, Access, and Recovery (SOAR) as part of the case management services. SOAR provides the
program the tools to expedite access to Social Security disability benefits that result in improved housing
and treatment outcomes.
8.Provide symptom assessment, personal service coordination and supportive counseling as needed to
assist persons served to cope with and gain a mastery of symptoms and disabilities due to mental illness
and/or substance abuse. These services shall include, but not be limited to, the following:
a.Ongoing assessment of mental illness symptoms and response to treatment;
b.Education of the individual regarding their mental illness and the effects (including side effects)
of prescribed medications;
c.Symptom management efforts directed to help person served identify symptoms and their
occurrence patterns and to develop methods (internal, behavioral, adaptive) to lessen their effects;
and
d.Provide psychological support, planned and as needed, to help persons served accomplish their
personal goals and to cope with the stresses of day-to-day living.
9.Assist person served, family, and other members of the individual’s social network to relate in a positive
and supportive manner through such means as:
a.Education about the individual’s illness and their role in the therapeutic process;
b.Supportive counseling;
Exhibit A
Page 5 of 6
c. Intervention to resolve conflict;
d. Referral of the family to therapy, self-help and other family support services as appropriate; and
e. Provision to other support systems with education and information about serious mental
illnesses and treatment services and supports.
10. Provide education to persons served and their family and/or caregivers (as appropriate) about the
nature of medications, the expected benefits and potential side effects, and alternatives to medication.
11. Provide support and help establish positive social relationships and activities in community settings.
Such services shall include, but not to be limited to:
a. Developing social skills, including the skills to develop meaningful personal relationships;
b. Planning appropriate and productive use of leisure time, including familiarizing individuals with
available social and recreational opportunities and increasing their use of these activities;
c. Interacting with landlords, neighbors, and others effectively and appropriately;
d. Developing assertiveness and self-esteem; and
e. Using existing self-help centers, self-help groups and other social, church, and recreational
groups to combat isolation and withdrawal experienced by many persons coping with serious and
persistent mental illness.
12. Provide training and instruction, including individual support, problem solving, skill development,
modeling and supervision, in home and community settings, to teach persons served to:
a. Carry out personal hygiene tasks;
b. Perform household chores, including housekeeping, cooking, laundry and shopping;
c. Develop or improve money management skills;
d. Use community transportation;
e. Provide training and assistance to persons served in locating, securing, maintaining and
financing safe, clean and affordable housing which is appropriate to their levels of functioning; and
f. Provide training and instruction, including individual support, problem solving, skill
development, modeling and supervision, in home and community settings.
13. Provide alcohol, tobacco, and drug abuse services as needed. This will include, but is not limited to,
individual and group interventions to assist in:
a. Identifying alcohol, tobacco and drug abuse effects and patterns;
b. Recognizing the interactive effects of alcohol, tobacco and drug use, psychiatric symptoms, and
psychotropic medications;
c. Developing motivation for decreasing alcohol, tobacco and drug use;
d. Developing coping skills and alternatives to minimize alcohol, tobacco and drug use;
e. Achieving periods of abstinence and stability;
f. Attending appropriate recovery or self-help meetings; and
g. Achieving an alcohol and drug free lifestyle, if at all possible.
14. Provide information, in an educational format, on the use of alcohol, tobacco, prescribed medications,
and other drugs of abuse and the impact that chemicals have on the ability to function in major life
areas. Information shall also include eating disorders, gambling, overspending, sexual and other
addictions, as appropriate.
15. Ensure persons served maintain their respective housing and utilize supportive housing resources by
providing supportive and independent housing, as appropriate.
16. Ensure rapid access to assistance funds for purchase of furniture, and other items needed by persons
served.
Exhibit A
Page 6 of 6
17. Negotiate and establish relationships with apartment owners/landlords and/or utilize alternative
housing resources as available and appropriate.
VI. COUNTY RESPONSIBILITIES
1. Provide oversight of the PATH Program. In addition to contract monitoring of program, oversight
includes, but is not limited to, coordination with the State Department of Health Care Services in regard
to program administration and outcomes. COUNTY will coordinate meetings with CONTRACTOR on a
monthly basis to discuss program client issues, concerns, measurable outcomes and reports, and any
other items.
2. Assist CONTRACTOR in making linkages with the total mental health system through regularly scheduled
meetings as well as formal and informal consultation.
3. Evaluate the progress of the overall program.
4. Receive and analyze statistical data outcome information throughout the term of contract. COUNTY will
notify CONTRACTOR when additional participation is required. The performance outcome
measurement process will include surveys, client and staff interviews, chart reviews, and other methods
of obtaining required information as needed.
5. Recognize that cultural responsiveness is a goal toward which professionals, agencies, and systems
should strive. Becoming culturally responsiveness is a developmental process and incorporates at all
levels the importance of culture, the assessment of cross-cultural relations, vigilance towards the
dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation
of services to meet culturally-unique needs. Offering those services in a manner that fails to achieve its
intended result due to cultural and linguistic barriers is not cost effective. COUNTY will assist program
towards cultural and linguistic competency, COUNTY shall provide the following at no cost to
CONTRACTOR:
a. Technical assistance regarding cultural responsiveness requirements and sexual orientation and
gender identity training.
b. Mandatory cultural responsiveness training including sexual orientation and gender identity and
cultural sensitivity training for program personnel, at minimum once per year. COUNTY will provide
technical assistance and when possible, training regarding the unique needs of the diverse
population. Cultural responsiveness training recommendations will be based on trends in data
collected and will be included in the counties Culturally Responsive Plan. Sensitivity to sexual
orientation and gender identity is a basic cultural responsiveness principle and shall be included in
the cultural responsiveness training(s). Literature suggests that the behavioral health needs of
lesbian, gay, bisexual, and transgender (LGBT+) individuals may be at increased risk for behavioral
disorders and behavioral health problems due to exposure to societal stressors such as
stigmatization, prejudice and homophobic and/or transphobic violence. Social support may be
critical for this population.
c. CONTRACTOR materials for public use on behavioral health and substance abuse services
information shall be in DBH’s current threshold languages (English, Spanish, and Hmong).
Translation services and costs associated will be the responsibility of the vendor. Promotional
and/or program materials shall be reviewed by DBH’s Public Behavioral Health Division for branding
requirements prior to implementation.
Exhibit B
Page 1 of 4
1
rev 01-02-2020
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
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
Exhibit B
Page 2 of 4
2
rev 01-02-2020
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
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
Exhibit B
Page 3 of 4
3
rev 01-02-2020
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
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
Exhibit B
Page 4 of 4
4
rev 01-02-2020
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
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
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Executive Director 0.01 -$ 790$ 790$
1102 Executive Assistant 0.01 - 252 252
1103 Regional Director 0.02 - 2,594 2,594
1104 Program Manager 0.70 - 73,739 73,739
1105 Admin Specialist 0.26 - 12,628 12,628
1106 Outreach Worker 2.00 - 73,840 73,840
1107 Case Managers 1.20 - 50,482 50,482
1108 -
1109 -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 4.19 -$ 214,325$ 214,325$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 2,786$ 2,786$
1102 - 5,358 5,358
1103 - 28,291 28,291
1104 - -
1105 - - -
1106 - - -
-$ 36,435$ 36,435$
0.16$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 16,395 16,395
1203 - 1,929 1,929
1204 - - -
1205 - - -
1206 - - -
-$ 18,324$ 18,324$
-$ 269,084$ 269,084$
Projects For Assistance in Transition From Homelessness -OEL
Kings View Corporation
Fiscal Year (FY 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
Page 1 of 70
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 17,158
2003 4,000
2004 18,100
2005 255
2006 255
2007 -
2008 -
2009 -
2010 -
2011 15,400
2012
2013 -
2014 -
2015 -
2016 -
55,168$
3000: OPERATING EXPENSES
Acct #Amount
3001 4,006$
3002 300
3003 2,250
3004 -
3005 1,000
3006 250
3007 200
3008 23,475
3009 260
3010
3011 -
3012 -
31,741$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 9,046$
4002 8,640
4003 2,160
4004 13,012
4005 -
4006 3,720
4007 Other (specify)
4008 Other (specify)
4009 Other (specify)
4010 Other (specify)
36,578$
5000: SPECIAL EXPENSES
Acct #Amount
Line Item Description
Line Item Description
Line Item Description
Line Item Description
DIRECT CLIENT CARE TOTAL
Other (specify)
Other (Program Supplies)
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 (Staff Recruitment)
Other (specify)
Other (specify)
Clothing, Food, & Hygiene
Other (specify)
Other (specify)
Office Supplies & Equipment
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
Page 2 of 70
5001 11,686$
5002 -
5003 -
5004 200
5005 Other (specify)
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
11,886$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 51,133$
6002 3,300
6003 -
6004 -
6005 Insurance (Liability)9,360
6006 Payroll Services -
6007 -
6008 Other (specify)
6009 Other (specify)
6010 Other (specify)
6011 Other (specify)-
6012 Other (specify)-
63,793$
7000: FIXED ASSETS
Acct #Amount
7001 6,375$
7002 -
7003 2,620
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
8,995$
Acct #Service Units Rate Amount
8001 Mental Health Services -$
8002 Case Management -
8003 Crisis Services -
8004 Medication Support -
8005 Collateral -
8006 Plan Development -
8007 Assessment -
8008 Rehabilitation -
0 -$
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Professional Liability Insurance
Accounting/Bookkeeping
Leasehold/Tenant/Building Improvements
PROGRAM FUNDING SOURCES
477,245$ 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 $500 with Lifespan of 2 Years +
Administrative Overhead
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
HMIS (Health Management Information System)
Consultant (Network & Data Management)
Furniture & Fixtures
Line Item Description
Contractual/Consulting Services (Psychiatrist Fees)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 3 of 70
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 102,777$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
102,777$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)308,000
8404 Other Revenue 1 66,468
8405 Other Revenue 2 -
374,468$
8400 - OTHER REVENUE
NET PROGRAM COST:
TOTAL PROGRAM FUNDING SOURCES:477,245$
-$
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
HHAP
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) %
PATH
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
Page 4 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 269,084
Employee Salaries 214,325
1101 Executive Director 790 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Executive Assistant 252 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1103 Regional Director 2,594 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1104 Program Manager 73,739 Provides supervision of all staff and direct oversight of program management.
1105 Admin Specialist 12,628 Provides administrative support for the program and assist with medical billing and
records.
1106 Outreach Worker 73,840 Provides outreach and engagement services, provides linkage to needed services.
1107 Case Managers 50,482 Provides case management and oversees the physical and mental wellness of
individuals to ensure they are supported and can achieve the best outcomes, and
referrals to appropriate linkages.
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 36,435
1101 Retirement 2,786 Cost of 401K
1102 Worker's Compensation 5,358 Workers Comp Insurance
1103 Health Insurance 28,291 Cost of Medical, Vision, Dental, Life and Long Term Disability Insurance
1104 Other (Specify)-
1105 Other (specify)-
1106 Other (specify)-
Payroll Taxes & Expenses:18,324
1201 OASDI -
1202 FICA/MEDICARE 16,395 Cost of FICA/Medicare
1203 SUI 1,929 Cost of SUI
1204 Other (specify)-
1205 Other (specify)-
1206 Other (specify)-
2000: CLIENT SUPPORT 55,168
2001 Child Care -
2002 Client Housing Support 17,158 Support clients with things such as rent, security deposits, board and care,
emergency housing such as hotels/motels, groceries, utilities, and household
supplies.
2003 Client Transportation & Support 4,000 Provides bus passes, bus tokens or any transportation assistance for clients, such as
taxi service or gas.
2004 Clothing, Food, & Hygiene 18,100 Outreach expenses that supports clients with clothing, food, water, blankets, and
hygiene supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support 255 Assist with education expenses such as books and registration.
2006 Employment Support 255 Cost of employment assistance such as interview clothes, DMV records, ID Cards or
birth certificates.
2007 Household Items for Clients -
2008 Medication Supports -
Projects For Assistance in Transition From Homelessness -OEL
Kings View Corporation
Fiscal Year (FY 2021-22) Budget Narrative
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 5 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Program Supplies)15,400 Cost to supply showers trailer with items such as soap, shampoo, and towels for
client usage.
2012 Other (specify)-
2013 Other (specify)-
2014 Other (specify)-
2015 Other (specify)-
2016 Other (specify)-
3000: OPERATING EXPENSES 31,741
3001 Telecommunications 4,006 Cost of landline telephone services, cell phones service, data connectivity.
3002 Printing/Postage 300 Anticipated courier services and postage necessary for program. Business cards and
other special printing in bulk that are less cost effective to outsource rather than
utilization of a copier.
3003 Office Supplies & Equipment 2,250 Includes desk supplies & minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development & Training 1,000 Minor shared cost for continuation of staff development and training. Also, includes
HMIS training fees.
3006 Staff Mileage 250 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees, such as parking fees.
3007 Subscriptions & Memberships 200 Minor shared cost of special subscription necessary for staff to provide services or
job tasks, such as an online subscription.
3008 Vehicle Maintenance 23,475 Auto repairs & maintenance required to maintain 1 leased truck to haul client
showers, 1 shared leased vehicle, and 2 county owned vans for client
transportation and program needs, such as oil changes and car washes. Yearly
cost of GPS vehicle tracking service, fuel and DMV fees.
3009 Other (Staff Recruitment)260 Thorough background check and drug testing.
3010 Other (specify)-
3011 Other (specify)-
3012 Other (specify)-
4000: FACILITIES & EQUIPMENT 36,578
4001 Building Maintenance 9,046 Copier maintenance and minor building repairs and maintenance. Annual Janitorial
Services to maintain client showers clean.
4002 Rent/Lease Building 8,640 Building space lease, anticipating moving locations.
4003 Rent/Lease Equipment 2,160 Copier lease.
4004 Rent/Lease Vehicles 13,012 The cost of 1 shared lease vehicles to assist with program and client needs and cost
of 1 lease truck to haul client showers.
4005 Security -
4006 Utilities 3,720 The cost of gas and electric.
4007 Other (specify)-
4008 Other (specify)-
4009 Other (specify)-
4010 Other (specify)-
5000: SPECIAL EXPENSES 11,886
5001 Consultant (Network & Data Management)11,686 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management, technology procurement, telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Psychiatrist
Fees)
-
5004 Translation Services 200 Anticipated translation services to assist clients.
5005 Other (specify)-
5006 Other (specify)-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 6 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5007 Other (specify)-
5008 Other (specify)-
6000: ADMINISTRATIVE EXPENSES 63,793
6001 Administrative Overhead 51,133 Expenses provide corporate management, fiscal services, payroll, human resources,
accounts payable and other administrative functions.
6002 Professional Liability Insurance 3,300 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Liability)9,360 Cost of personal property, accidental and auto insurance.
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 8,995
7001 Computer Equipment & Software 6,375 Computer software needs to support staff & anticipating shared cost for
replacement of computer equipment.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 2,620 Anticipated shared cost for replacement furniture needs.
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:477,245
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:477,245
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 7 of 70
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Executive Director 0.01 -$ 813$ 813$
1102 Executive Assistant 0.01 - 259 259
1103 Regional Director 0.02 - 2,671 2,671
1104 Program Manager 0.70 - 75,951 75,951
1105 Admin Specialist 0.26 - 13,007 13,007
1106 Outreach Worker 2.00 - 76,056 76,056
1107 Case Managers 0.94 - 40,732 40,732
1108 -
1109 -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 3.93 -$ 209,489$ 209,489$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 2,723$ 2,723$
1102 - 5,237 5,237
1103 - 27,653 27,653
1104 - -
1105 - - -
1106 - - -
-$ 35,613$ 35,613$
0.15660881
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 16,026 16,026
1203 - 1,886 1,886
1204 - - -
1205 - -
1206 - -
-$ 17,912$ 17,912$
-$ 263,014$ 263,014$
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Projects For Assistance in Transition From Homelessness -OEL
Kings View Corporation
Fiscal Year (FY 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
Page 8 of 70
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 8,700
2003 3,000
2004 6,003
2005 230
2006 230
2007 -
2008 -
2009 -
2010 -
2011 5,600
2012 -
2013 -
2014 -
2015 -
2016 -
23,763$
3000: OPERATING EXPENSES
Acct #Amount
3001 4,125$
3002 67
3003 2,460
3004 -
3005 750
3006 180
3007 100
3008 15,750
3009 170
3010 -
3011 -
3012 -
23,602$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 8,194$
4002 8,640
4003 2,160
4004 13,012
4005 -
4006 3,720
4007 Other (Specify)
4008 Other (Specify)
4009 Other (Specify)-
4010 Other (Specify)-
35,726$
5000: SPECIAL EXPENSES
Acct #Amount
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Program Supplies)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Telecommunications
Printing/Postage
Office Supplies & Equipment
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 (Staff Recruitment)
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
Page 9 of 70
5001 11,686$
5002 -
5003 -
5004 200
5005 Other (Specify)
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
11,886$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 37,343$
6002 3,483
6003 -
6004 -
6005 Insurance (Liability):9,360
6006 Payroll Services -
6007 -
6008 Other (Specify)
6009 Other (Specify)
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
50,186$
7000: FIXED ASSETS
Acct #Amount
7001 2,500$
7002 -
7003 100
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
2,600$
Acct #Service Units Rate Amount
8001 Mental Health Services -$
8002 Case Management -
8003 Crisis Services -
8004 Medication Support -
8005 Collateral -
8006 Plan Development -
8007 Assessment -
8008 Rehabilitation -
0 -$
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Psychiatrist Fees)
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 $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 410,777$
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 10 of 70
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 102,777$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
102,777$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)308,000
8404 Other (Specify)
8405 Other (Specify) -
308,000$
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:410,777$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
PATH
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 11 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 263,014
Employee Salaries 209,489
1101 Executive Director 813 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Executive Assistant 259 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1103 Regional Director 2,671 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1104 Program Manager 75,951 Provides supervision of all staff and direct oversight of program management.
1105 Admin Specialist 13,007 Provides administrative support for the program.
1106 Outreach Worker 76,056 Provides outreach and engagement services, provides linkage to needed services.
1107 Case Managers 40,732 Provides case management and oversees the physical and mental wellness of
individuals to ensure they are supported and can achieve the best outcomes, and
referrals to appropriate linkages.
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 35,613
1101 Retirement 2,723 Cost of 401K
1102 Worker's Compensation 5,237 Workers Comp Insurance
1103 Health Insurance 27,653 Cost of Medical, Vision, Dental, Life and Long Term Disability Insurance
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:17,912
1201 OASDI -
1202 FICA/MEDICARE 16,026 Cost of FICA/Medicare
1203 SUI 1,886 Cost of SUI
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 23,763
2001 Child Care -
2002 Client Housing Support 8,700 Support clients with things such as rent, security deposits, board and care,
emergency housing such as hotels/motels, groceries, utilities, and household
supplies.
2003 Client Transportation & Support 3,000 Provides bus passes, bus tokens or any transportation assistance for clients, such as
taxi service or gas.
2004 Clothing, Food, & Hygiene 6,003 Outreach expenses that supports clients with clothing, food, water, blankets, and
hygiene supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support 230 Assist with education expenses such as books and registration.
2006 Employment Support 230 Cost of employment assistance such as interview clothes, DMV records, ID Cards or
birth certificates.
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
Projects For Assistance in Transition From Homelessness -OEL
Kings View Corporation
Fiscal Year (FY 2022-23) Budget Narrative
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 12 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2010 Utility Vouchers -
2011 Other (Program Supplies)5,600 Cost to supply showers trailer with items such as soap, shampoo, and towels for
client usage.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 23,602
3001 Telecommunications 4,125 Cost of landline telephone services, cell phones service, data connectivity.
3002 Printing/Postage 67 Anticipated courier services and postage necessary for program. Business cards and
other special printing in bulk that is less cost effective to outsource rather than
utilization of a copier.
3003 Office Supplies & Equipment 2,460 Includes desk supplies & minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development & Training 750 Minor shared cost for continuation of staff development and training. Also, includes
HMIS training fees.
3006 Staff Mileage 180 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees, such as parking fees.
3007 Subscriptions & Memberships 100 Minor shared cost of special subscription necessary for staff to provide services or
job tasks, such as an online subscription.
3008 Vehicle Maintenance 15,750 Auto repairs & maintenance required to maintain 1 leased truck to haul client
showers, 1 shared leased vehicle, and 2 county owned vans for client transportation
and program needs, such as oil changes and car washes. Yearly cost of GPS vehicle
tracking service, fuel and DMV fees.
3009 Other (Staff Recruitment)170 Thorough background check and drug testing.
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 35,726
4001 Building Maintenance 8,194 Shared copier maintenance and minor building repairs and maintenance. Annual
Janitorial Services to maintain client showers clean.
4002 Rent/Lease Building 8,640 Share cost of building space, anticipating moving locations.
4003 Rent/Lease Equipment 2,160 Shared copier lease.
4004 Rent/Lease Vehicles 13,012 The cost of 1 shared lease vehicles to assist with program and client needs and cost
of 1 lease truck to haul client showers.
4005 Security -
4006 Utilities 3,720 Shared cost of gas and electric.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 11,886
5001 Consultant (Network & Data Management)11,686 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management, technology procurement, telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Psychiatrist
Fees)
-
5004 Translation Services 200 Anticipated translation services to assist clients.
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 13 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 50,186
6001 Administrative Overhead 37,343 Expenses provides corporate management, fiscal services, payroll, human resources,
accounts payable and other administrative functions. Limited at 10% per PATH Grant
maximum.
6002 Professional Liability Insurance 3,483 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Liability):9,360 Cost of personal property, accidental and auto insurance.
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 2,600
7001 Computer Equipment & Software 2,500 Computer software needs to support staff & anticipating shared cost for
replacement of computer equipment.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 100 Anticipated shared cost for replacement of furniture needs.
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:410,777
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:410,777
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 14 of 70
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Executive Director 0.01 -$ 838$ 838$
1102 Executive Assistant 0.01 - 267 267
1103 Regional Director 0.02 - 2,752 2,752
1104 Program Manager 0.70 - 78,223 78,223
1105 Admin Specialist 0.26 - 13,396 13,396
1106 Outreach Worker 2.00 - 78,326 78,326
1107 Case Managers 0.94 - 41,959 41,959
1108 -
1109 -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - -
Personnel Salaries Subtotal 3.93 -$ 215,761$ 215,761$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 2,805$ 2,805$
1102 - 5,394 5,394
1103 - 28,480 28,480
1104 - - -
1105 - - -
1106 - - -
-$ 36,679$ 36,679$
0.156607987
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 16,506 16,506
1203 - 1,942 1,942
1204 - - -
1205 - -
1206 - -
-$ 18,448$ 18,448$
-$ 270,888$ 270,888$
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Projects For Assistance in Transition From Homelessness -OEL
Kings View Corporation
Fiscal Year (FY 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
Page 15 of 70
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 5,500
2003 3,000
2004 3,550
2005 225
2006 225
2007 -
2008 -
2009 -
2010 -
2011 4,000
2012 -
2013 -
2014 -
2015 -
2016 -
16,500$
3000: OPERATING EXPENSES
Acct #Amount
3001 4,100$
3002 67
3003 1,791
3004 -
3005 750
3006 180
3007 100
3008 15,750
3009 170
3010 -
3011 -
3012 -
22,908$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 8,194$
4002 8,640
4003 2,160
4004 13,012
4005 -
4006 3,757
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
35,763$
5000: SPECIAL EXPENSES
Acct #Amount
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Program Supplies)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Telecommunications
Printing/Postage
Office Supplies & Equipment
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 (Staff Recruitment)
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
Page 16 of 70
5001 11,732$
5002 -
5003 -
5004 200
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
11,932$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 37,343$
6002 3,483
6003 -
6004 -
6005 Insurance (Liability):9,360
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
50,186$
7000: FIXED ASSETS
Acct #Amount
7001 2,500$
7002 -
7003 100
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
2,600$
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 (Psychiatrist Fees)
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 $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 410,777$
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 17 of 70
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 102,777$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
102,777$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)308,000
8404 Other (Specify) -
8405 Other (Specify) -
308,000$
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:410,777$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
PATH
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 18 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 270,888
Employee Salaries 215,761
1101 Executive Director 838 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Executive Assistant 267 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1103 Regional Director 2,752 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1104 Program Manager 78,223 Provides supervision of all staff and direct oversight of program management.
1105 Admin Specialist 13,396 Provides administrative support for the program.
1106 Outreach Worker 78,326 Provides outreach and engagement services, provides linkage to needed services.
1107 Case Managers 41,959 Provides case management and oversees the physical and mental wellness of
individuals to ensure they are supported and can achieve the best outcomes, and
referrals to appropriate linkages.
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 36,679
1101 Retirement 2,805 Cost of 401K
1102 Worker's Compensation 5,394 Workers Comp Insurance
1103 Health Insurance 28,480 Cost of Medical, Vision, Dental, Life and Long Term Disability Insurance
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:18,448
1201 OASDI -
1202 FICA/MEDICARE 16,506 Cost of FICA/Medicare
1203 SUI 1,942 Cost of SUI
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 16,500
2001 Child Care -
2002 Client Housing Support 5,500 Support clients with things such as rent, security deposits, board and care,
emergency housing such as hotels/motels, groceries, utilities, and household
supplies.
2003 Client Transportation & Support 3,000 Provides bus passes, bus tokens or any transportation assistance for clients, such as
taxi service or gas.
2004 Clothing, Food, & Hygiene 3,550 Outreach expenses that supports clients with clothing, food, water, blankets, and
hygiene supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support 225 Assist with education expenses such as books and registration.
2006 Employment Support 225 Cost of employment assistance such as interview clothes, DMV records, ID Cards or
birth certificates.
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
Projects For Assistance in Transition From Homelessness -OEL
Kings View Corporation
Fiscal Year (FY 2023-24) Budget Narrative
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 19 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2010 Utility Vouchers -
2011 Other (Program Supplies)4,000 Cost to supply showers trailer with items such as soap, shampoo, and towels for
client usage.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 22,908
3001 Telecommunications 4,100 Cost of landline telephone services, cell phones service, data connectivity.
3002 Printing/Postage 67 Anticipated courier services and postage necessary for program. Business cards and
other special printing in bulk that is less cost effective to outsource rather than
utilization of a copier.
3003 Office Supplies & Equipment 1,791 Includes desk supplies & minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development & Training 750 Minor shared cost for continuation of staff development and training. Also, includes
HMIS training fees.
3006 Staff Mileage 180 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees, such as parking fees.
3007 Subscriptions & Memberships 100 Minor shared cost of special subscription necessary for staff to provide services or
job tasks, such as an online subscription.
3008 Vehicle Maintenance 15,750 Auto repairs & maintenance required to maintain 1 leased truck to haul client
showers, 1 shared leased vehicle, and 2 county owened vans for client
transportation and program needs, such as oil changes and car washes. Yearly
cost of GPS vehicle tracking service, fuel and DMV fees.
3009 Other (Staff Recruitment)170 Thorough background check and drug testing.
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 35,763
4001 Building Maintenance 8,194 Shared copier maintenance and minor building repairs and maintenance. Annual
Janitorial Services to maintain client showers clean.
4002 Rent/Lease Building 8,640 Share cost of building space, anticipating moving locations.
4003 Rent/Lease Equipment 2,160 Shared copier lease.
4004 Rent/Lease Vehicles 13,012 The cost of 1 shared lease vehicles to assist with program and client needs and cost
of 1 lease truck to haul client showers.
4005 Security -
4006 Utilities 3,757 Shared cost of gas and electric.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 11,932
5001 Consultant (Network & Data Management)11,732 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management, technology procurement, telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Psychiatrist
Fees)
-
5004 Translation Services 200 Anticipated translation services to assist clients.
5005 Other (Specify)-
5006 Other (Specify)-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 20 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 50,186
6001 Administrative Overhead 37,343 Expenses provides corporate management, fiscal services, payroll, human resources,
accounts payable and other administrative functions. Limited at 10% per PATH Grant
maximum.
6002 Professional Liability Insurance 3,483 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Liability):9,360 Cost of personal property, accidental and auto insurance.
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 2,600
7001 Computer Equipment & Software 2,500 Computer software needs to support staff & anticipating shared cost for
replacement of computer equipment.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 100 Anticipated shared cost for replacement of furniture needs.
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:410,777
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:410,777
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 21 of 70
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Executive Director 0.01 -$ 863$ 863$
1102 Executive Assistant 0.01 - 275 275
1103 Regional Director 0.02 - 2,834 2,834
1104 Program Manager 0.70 - 80,563 80,563
1105 Admin Specialist 0.26 - 13,798 13,798
1106 Outreach Worker 2.00 - 80,683 80,683
1107 Case Managers 0.80 - 36,780 36,780
1108 -
1109 -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - -
Personnel Salaries Subtotal 3.79 -$ 215,796$ 215,796$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 2,805$ 2,805$
1102 - 5,395 5,395
1103 - 28,486 28,486
1104 - - -
1105 - - -
1106 - - -
-$ 36,686$ 36,686$
0.156613133
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 16,508 16,508
1203 - 1,942 1,942
1204 - - -
1205 - - -
1206 - - -
-$ 18,450$ 18,450$
-$ 270,932$ 270,932$
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Projects For Assistance in Transition From Homelessness -OEL
Kings View Corporation
Fiscal Year (FY 2024-25)
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
Page 22 of 70
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 5,800
2003 3,000
2004 4,600
2005 225
2006 225
2007 -
2008 -
2009 -
2010 -
2011 5,000
2012 -
2013 -
2014 -
2015 -
2016 -
18,850$
3000: OPERATING EXPENSES
Acct #Amount
3001 4,100$
3002 67
3003 1,791
3004 -
3005 750
3006 180
3007 100
3008 15,750
3009 170
3010 -
3011 -
3012 -
22,908$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 8,113$
4002 8,640
4003 2,160
4004 13,012
4005 -
4006 3,757
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
35,682$
5000: SPECIAL EXPENSES
Acct #Amount
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Program Supplies)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Telecommunications
Printing/Postage
Office Supplies & Equipment
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 (Staff Recruitment)
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
Page 23 of 70
5001 11,744$
5002
5003 -
5004 200
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
11,944$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 37,343$
6002 3,483
6003 -
6004 -
6005 Insurance (Liability):9,360
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
50,186$
7000: FIXED ASSETS
Acct #Amount
7001 175$
7002 -
7003 100
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
275$
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 $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 410,777$
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 24 of 70
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 102,777$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
102,777$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)308,000
8404 Other (Specify) -
8405 Other (Specify) -
308,000$
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:410,777$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
PATH
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 25 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 270,932
Employee Salaries 215,796
1101 Executive Director 863 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Executive Assistant 275 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1103 Regional Director 2,834 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1104 Program Manager 80,563 Provides supervision of all staff and direct oversight of program management.
1105 Admin Specialist 13,798 Provides administrative support for the program.
1106 Outreach Worker 80,683 Provides outreach and engagement services, provides linkage to needed services.
1107 Case Managers 36,780 Provides case management and oversees the physical and mental wellness of
individuals to ensure they are supported and can achieve the best outcomes, and
referrals to appropriate linkages.
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 36,686
1101 Retirement 2,805 Cost of 401K
1102 Worker's Compensation 5,395 Workers Comp Insurance
1103 Health Insurance 28,486 Cost of Medical, Vision, Dental, Life and Long Term Disability Insurance
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:18,450
1201 OASDI -
1202 FICA/MEDICARE 16,508 Cost of FICA/Medicare
1203 SUI 1,942 Cost of SUI
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 18,850
2001 Child Care -
2002 Client Housing Support 5,800 Support clients with things such as rent, security deposits, board and care,
emergency housing such as hotels/motels, groceries, utilities, and household
supplies.
2003 Client Transportation & Support 3,000 Provides bus passes, bus tokens or any transportation assistance for clients, such as
taxi service or gas.
2004 Clothing, Food, & Hygiene 4,600 Outreach expenses that supports clients with clothing, food, water, blankets, and
hygiene supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support 225 Assist with education expenses such as books and registration.
2006 Employment Support 225 Cost of employment assistance such as interview clothes, DMV records, ID Cards or
birth certificates.
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
Projects For Assistance in Transition From Homelessness -OEL
Kings View Corporation
Fiscal Year (FY 2024-25) Budget Narrative
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 26 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2010 Utility Vouchers -
2011 Other (Program Supplies)5,000 Cost to supply showers trailer with items such as soap, shampoo, and towels for
client usage.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 22,908
3001 Telecommunications 4,100 Cost of landline telephone services, cell phones service, data connectivity.
3002 Printing/Postage 67 Anticipating courier services and postage necessary for program. Business cards and
other special printing in bulk that is less cost effective to outsource rather than
utilization of a copier.
3003 Office Supplies & Equipment 1,791 Includes desk supplies & minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development & Training 750 Minor shared cost for continuation of staff development and training. Also, includes
HMIS training fees.
3006 Staff Mileage 180 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees, such as parking fees.
3007 Subscriptions & Memberships 100 Minor shared cost of special subscription necessary for staff to provide services or
job tasks, such as an online subscription.
3008 Vehicle Maintenance 15,750 Auto repairs & maintenance required to maintain 1 leased truck to haul client
showers, 1 shared leased vehicle, and 2 county owened vans for client
transportation and program needs, such as oil changes and car washes. Yearly
cost of GPS vehicle tracking service, fuel and DMV fees.
3009 Other (Staff Recruitment)170 Thorough background check and drug testing.
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 35,682
4001 Building Maintenance 8,113 Shared copier maintenance and minor building repairs and maintenance. Annual
Janitorial Services to maintain client showers clean.
4002 Rent/Lease Building 8,640 Share cost of building space, anticipating moving locations.
4003 Rent/Lease Equipment 2,160 Shared copier lease.
4004 Rent/Lease Vehicles 13,012 The cost of 1 shared lease vehicles to assist with program and client needs and cost
of 1 lease truck to haul client showers.
4005 Security -
4006 Utilities 3,757 Shared cost of gas and electric.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 11,944
5001 Consultant (Network & Data Management)11,744 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management, technology procurement, telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services 200 Anticipated translation services to assist clients.
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 27 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 50,186
6001 Administrative Overhead 37,343 Expenses provides corporate management, fiscal services, payroll, human resources,
accounts payable and other administrative functions. Limited at 10% per PATH Grant
maximum.
6002 Professional Liability Insurance 3,483 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Liability):9,360 Cost of personal property, accidental and auto insurance.
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 275
7001 Computer Equipment & Software 175 Computer software needs to support staff & anticipating shared cost for
replacement of computer equipment.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 100 Anticipated shared cost for replacement of furniture needs.
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:410,777
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:410,777
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 28 of 70
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Executive Director 0.01 -$ 889$ 889$
1102 Executive Assistant 0.01 - 283 283
1103 Regional Director 0.02 - 2,919 2,919
1104 Program Manager 0.70 - 82,977 82,977
1105 Admin Specialist 0.26 - 14,210 14,210
1106 Outreach Worker 2.00 - 83,082 83,082
1107 Case Managers 0.80 - 37,886 37,886
1108 -
1109 -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 3.79 -$ 222,246$ 222,246$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 2,890$ 2,890$
1102 - 5,556 5,556
1103 - 29,337 29,337
1104 - - -
1105 - - -
1106 - - -
-$ 37,783$ 37,783$
0.15661477
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 17,002 17,002
1203 - 2,000 2,000
1204 - - -
1205 - -
1206 - -
-$ 19,002$ 19,002$
-$ 279,031$ 279,031$
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Projects For Assistance in Transition From Homelessness -OEL
Kings View Corporation
Fiscal Year (FY 2025-26)
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
Page 29 of 70
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 4,000
2003 2,100
2004 2,900
2005 200
2006 200
2007 -
2008 -
2009 -
2010 -
2011 2,326
2012 -
2013 -
2014 -
2015 -
2016 -
11,726$
3000: OPERATING EXPENSES
Acct #Amount
3001 4,100$
3002 67
3003 866
3004 -
3005 750
3006 180
3007 100
3008 15,750
3009 170
3010 -
3011 -
3012 -
21,983$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 8,113$
4002 8,640
4003 2,160
4004 13,012
4005 -
4006 3,757
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
35,682$
5000: SPECIAL EXPENSES
Acct #Amount
Line Item Description
Household Items for Clients
Medication Supports
Program Supplies - Medical
Utility Vouchers
Other (Program Supplies)
Other (Specify)
Child Care
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Telecommunications
Printing/Postage
Office Supplies & Equipment
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 (Staff Recruitment)
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
Page 30 of 70
5001 11,744$
5002 -
5003 -
5004 200
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
11,944$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 37,343$
6002 3,483
6003 -
6004 -
6005 Insurance (Liability):9,360
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
50,186$
7000: FIXED ASSETS
Acct #Amount
7001 175$
7002 -
7003 50
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
225$
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 $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
PROGRAM FUNDING SOURCES
8000 - SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 410,777$
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 31 of 70
0%
-
0%-
-$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 102,777$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
102,777$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)308,000
8404 Other (Specify) -
8405 Other (Specify) -
308,000$
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:410,777$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
PATH
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 32 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 279,031
Employee Salaries 222,246
1101 Executive Director 889 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Executive Assistant 283 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1103 Regional Director 2,919 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1104 Program Manager 82,977 Provides supervision of all staff and direct oversight of program management.
1105 Admin Specialist 14,210 Provides administrative support for the program and assist with medical billing and
records.
1106 Outreach Worker 83,082 Provides outreach and engagement services, provides linkage to needed services.
1107 Case Managers 37,886 Provides case management and oversees the physical and mental wellness of
individuals to ensure they are supported and can achieve the best outcomes, and
referrals to appropriate linkages.
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 37,783
1101 Retirement 2,890 Cost of 401K
1102 Worker's Compensation 5,556 Workers Comp Insurance
1103 Health Insurance 29,337 Cost of Medical, Vision, Dental, Life and Long Term Disability Insurance
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:19,002
1201 OASDI -
1202 FICA/MEDICARE 17,002 Cost of FICA/Medicare
1203 SUI 2,000 Cost of SUI
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 11,726
2001 Child Care -
2002 Client Housing Support 4,000 Support clients with things such as rent, security deposits, board and care,
emergency housing such as hotels/motels, groceries, utilities, and household
supplies.
2003 Client Transportation & Support 2,100 Provides bus passes, bus tokens or any transportation assistance for clients, such as
taxi service or gas.
2004 Clothing, Food, & Hygiene 2,900 Outreach expenses that supports clients with clothing, food, water, blankets, and
hygiene supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support 200 Assist with education expenses such as books and registration.
2006 Employment Support 200 Cost of employment assistance such as interview clothes, DMV records, ID Cards or
birth certificates.
2007 Household Items for Clients -
2008 Medication Supports -
Projects For Assistance in Transition From Homelessness -OEL
Kings View Corporation
Fiscal Year (FY 2025-26) Budget Narrative
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 33 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Program Supplies)2,326 Cost to supply showers trailer with items such as soap, shampoo, and towels for
client usage.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 21,983
3001 Telecommunications 4,100 Cost of landline telephone services, cell phones service, data connectivity.
3002 Printing/Postage 67 Anticipating courier services and postage necessary for program. Business cards and
other special printing in bulk that is less cost effective to outsource rather than
utilization of a copier.
3003 Office Supplies & Equipment 866 Includes desk supplies & minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development & Training 750 Minor shared cost for continuation of staff development and training. Also, includes
HMIS training fees.
3006 Staff Mileage 180 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees, such as parking fees.
3007 Subscriptions & Memberships 100 Minor shared cost of special subscription necessary for staff to provide services or
job tasks, such as an online subscription.
3008 Vehicle Maintenance 15,750 Auto repairs & maintenance required to maintain 1 leased truck to haul client
showers, 1 shared leased vehicle, and 2 county owned vans for client transportation
and program needs, such as oil changes and car washes. Yearly cost of GPS vehicle
tracking service, fuel and DMV fees.
3009 Other (Staff Recruitment)170 Thorough background check and drug testing.
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 35,682
4001 Building Maintenance 8,113 Shared copier maintenance and minor building repairs and maintenance. Annual
Janitorial Services to maintain client showers clean.
4002 Rent/Lease Building 8,640 Share cost of building space, anticipating moving locations.
4003 Rent/Lease Equipment 2,160 Shared copier lease.
4004 Rent/Lease Vehicles 13,012 The cost of 1 shared lease vehicles to assist with program and client needs and cost
of 1 lease truck to haul client showers.
4005 Security -
4006 Utilities 3,757 Shared cost of gas and electric.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 11,944
5001 Consultant (Network & Data Management)11,744 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management, technology procurement, telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Specify)-
5004 Translation Services 200 Anticipated translation services to assist clients.
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 34 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 50,186
6001 Administrative Overhead 37,343 Expenses provides corporate management, fiscal services, payroll, human resources,
accounts payable and other administrative functions. Limited at 10% per PATH Grant
maximum.
6002 Professional Liability Insurance 3,483 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Liability):9,360 Cost of personal property, accidental and auto insurance.
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 225
7001 Computer Equipment & Software 175 Computer software needs to support staff & anticipating shared cost for
replacement of computer equipment.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 50 Anticipated shared cost for replacement of furniture needs.
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:410,777
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:410,777
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 35 of 70
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Executive Director 0.01 -$ 790$ 790$
1102 Executive Assistant 0.01 - 252 252
1103 Regional Director 0.02 - 2,593 2,593
1104 Program Manager 0.30 - 31,603 31,603
1105 Admin Specialist 0.08 - 3,885 3,885
1106 Case Managers 0.80 - 33,654 33,654
1107 -
1108 -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 1.21 -$ 72,777$ 72,777$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 1,375$ 1,375$
1102 - 1,812 1,812
1103 - 6,819 6,819
1104 - -
1105 - - -
1106 - - -
-$ 10,006$ 10,006$
0.13$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 5,568 5,568
1203 - 437 437
1204 - - -
1205 - - -
1206 - - -
-$ 6,005$ 6,005$
-$ 88,788$ 88,788$
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
PATH Program- SMHS
Kings View Corporation
Fiscal Year (FY 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
Page 36 of 70
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 25,000
2003
2004 740
2005
2006
2007 -
2008 -
2009 -
2010 -
2011 2,372
2012 -
2013 -
2014 -
2015 -
2016 -
28,112$
3000: OPERATING EXPENSES
Acct #Amount
3001 1,330$
3002 350
3003 1,023
3004 -
3005 640
3006 150
3007 50
3008 2,167
3009 300
3010
3011 -
3012 -
6,010$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 1,324$
4002 2,052
4003 240
4004 830
4005 -
4006 675
4007 Other (specify)
4008 Other (specify)
4009 Other (specify)
4010 Other (specify)
5,121$
5000: SPECIAL EXPENSES
Acct #Amount
Other (specify)
Other (specify)
Clothing, Food, & Hygiene
Other (specify)
Other (specify)
Office Supplies & Equipment
Utility Vouchers
Program Supplies - Medical
Medication Supports
Household Items for Clients
Employment Support
Staff Mileage
Subscriptions & Memberships
Other (specify)
Other (specify)
Other (specify)
Telecommunications
Printing/Postage
Client Transportation & Support
Client Housing Support
Child Care
Other (Staff Recruitment)
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 (Program Supplies)
Advertising
Rent/Lease Building
Building Maintenance
Education Support
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 37 of 70
5001 5,046$
5002 -
5003 34,571
5004 -
5005 Other (specify)
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
39,617$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 20,789$
6002 1,680
6003 -
6004 -
6005 Insurance (Liability)360
6006 Payroll Services -
6007 -
6008 Other (specify)
6009 Other (specify)
6010 Other (specify)
6011 Other (specify)-
6012 Other (specify)-
22,829$
7000: FIXED ASSETS
Acct #Amount
7001 3,050$
7002
7003 500
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
3,550$
Acct #Service Units Rate Amount
8001 Mental Health Services - -$
8002 Case Management 160 3.75 600
8003 Crisis Services 64 6.75 432
8004 Medication Support 2,870 8.00 22,960
8005 Collateral -
8006 Plan Development 850 4.50 3,825
8007 Assessment 2,950 4.50 13,275
8008 Rehabilitation 33,838 4.50 152,271
40,732 193,363$
Contractual/Consulting Services (Psychiatrist Fees)
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 $500 with Lifespan of 2 Years +
PROGRAM FUNDING SOURCES
194,027$ 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
Page 38 of 70
75%
145,022
85%123,268.91
123,269$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment -$
-$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 69,756$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
69,756$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)-
8404 Other Revenue 1 1,002
8405 Other Revenue 2 -
1,002$
8200 - REALIGNMENT
Client Rents
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:194,027$
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
Page 39 of 70
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 88,788
Employee Salaries 72,777
1101 Executive Director 790 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Executive Assistant 252 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1103 Regional Director 2,593 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1104 Program Manager 31,603 Provides supervision of all staff and direct oversight of program management.
1105 Admin Specialist 3,885 Provides administrative support for the program and assist with medical billing and
records.
1106 Case Managers 33,654 Provides case management and oversees the physical and mental wellness of
individuals to ensure they are supported and can achieve the best outcomes, and
referrals to appropriate linkages.
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 10,006
1101 Retirement 1,375 Cost of 401K
1102 Worker's Compensation 1,812 Workers Comp Insurance
1103 Health Insurance 6,819 Cost of Medical, Vision, Dental, Life and Long Term Disability Insurance
1104 Other (Specify)-
1105 Other (specify)-
1106 Other (specify)-
Payroll Taxes & Expenses:6,005
1201 OASDI -
1202 FICA/MEDICARE 5,568 Cost of FICA/Medicare
1203 SUI 437 Cost of SUI
1204 Other (specify)-
1205 Other (specify)-
1206 Other (specify)-
2000: CLIENT SUPPORT 28,112
2001 Child Care -
2002 Client Housing Support 25,000 Support clients with rent, security deposits, board and care, emergency housing
such as hotels/motels, groceries and household supplies.
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene 740 Outreach expenses that supports clients with clothing, food, water, blankets, and
hygiene supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
2011 Other (Program Supplies)2,372 Cost of supplies for client groups such as notepads, therapy balls, puzzles or art
supplies.
PATH Program- SMHS
Kings View Corporation
Fiscal Year (FY 2021-22)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 40 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012 Other (specify)-
2013 Other (specify)-
2014 Other (specify)-
2015 Other (specify)-
2016 Other (specify)-
3000: OPERATING EXPENSES 6,010
3001 Telecommunications 1,330 Cost of landline telephone services, cell phones service, data connectivity.
3002 Printing/Postage 350 Anticipated courier services and postage necessary for program. Business cards and
other special printing in bulk that are less cost effective to outsource rather than
utilization of a copier.
3003 Office Supplies & Equipment 1,023 Includes all supplies used by staff in the course of providing services. Also, includes
program supplies such as snacks for clients or outreach supplies.
3004 Advertising -
3005 Staff Development & Training 640 Minor shared cost for continuation of staff development and training. Also includes
HMIS training fees.
3006 Staff Mileage 150 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees, such as parking fees.
3007 Subscriptions & Memberships 50 Minor shared cost of special subscription necessary for staff to provide services or
job tasks, such as an online subscription.
3008 Vehicle Maintenance 2,167 Minor auto repairs & maintenance required to maintain 1 shared leased vehicle for
client transportation and program needs, such as oil changes and car washes. Yearly
cost of GPS vehicle tracking service, auto fuel, and DMV fees.
3009 Other (Staff Recruitment)300 Thorough background check and drug testing.
3010 Other (specify)-
3011 Other (specify)-
3012 Other (specify)-
4000: FACILITIES & EQUIPMENT 5,121
4001 Building Maintenance 1,324 Shared copier maintenance and minor building repairs and maintenance.
4002 Rent/Lease Building 2,052 Building space lease, anticipating moving locations.
4003 Rent/Lease Equipment 240 Shared copier lease.
4004 Rent/Lease Vehicles 830 The cost of 2 shared lease vehicles to assist with program needs.
4005 Security -
4006 Utilities 675 The cost of gas and electric.
4007 Other (specify)-
4008 Other (specify)-
4009 Other (specify)-
4010 Other (specify)-
5000: SPECIAL EXPENSES 39,617
5001 Consultant (Network & Data Management)5,046 Kings View Information Technology Department (KVIT) will provide hardware and
software support for successful data collection. A database will be designed for this
program. KVIT will procure equipment, software & other services from approved &
authorized vendors. Provide online, onsite, or phone-based emergency support-
24/7 from the KVIT Help Desk.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Psychiatrist
Fees)
34,571 Yearly cost to contract with Physician to provide services and treatments to clients at
4 hours per week.
5004 Translation Services -
5005 Other (specify)-
5006 Other (specify)-
5007 Other (specify)-
5008 Other (specify)-
6000: ADMINISTRATIVE EXPENSES 22,829
6001 Administrative Overhead 20,789 Expenses provides program management, fiscal services, payroll, human resources,
accounts payable and other administrative functions.
6002 Professional Liability Insurance 1,680 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Liability)360 Cost of personal property, accidental and auto insurance.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 41 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6006 Payroll Services -
6007 Depreciation (Provider-Owned Equipment to
be Used for Program Purposes)
-
6008 Other (specify)-
6009 Other (specify)-
6010 Other (specify)-
6011 Other (specify)-
6012 Other (specify)-
7000: FIXED ASSETS 3,550
7001 Computer Equipment & Software 3,050 Computer software needs to support staff & anticipated shared cost for
replacement of computer equipment.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 500 Anticipated shared cost for replacement furniture needs.
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (specify)-
7008 Other (specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:194,027
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:194,027
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 42 of 70
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Executive Director 0.01 813$ 813$
1102 Executive Assistant 0.01 259 259
1103 Regional Director 0.02 2,671 2,671
1104 Program Manager 0.30 32,551 32,551
1105 Admin Specialist 0.08 4,002 4,002
1106 Case Managers 1.06 45,930 45,930
1107 -
1108 -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 1.47 -$ 86,226$ 86,226$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 1,630$ 1,630$
1102 - 2,147 2,147
1103 - 8,080 8,080
1104 - -
1105 - - -
1106 - - -
-$ 11,857$ 11,857$
0.127031573
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$
1202 - 6,596 6,596
1203 - 517 517
1204 - - -
1205 - -
1206 - -
-$ 7,113$ 7,113$
-$ 105,196$ 105,196$
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)
PATH Program- SMHS
Kings View Corporation
Fiscal Year (FY 2022-23)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 43 of 70
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 39,691
2003
2004 2,115
2005
2006
2007 -
2008 -
2009 -
2010 -
2011 2,000
2012 -
2013 -
2014 -
2015 -
2016 -
43,806$
3000: OPERATING EXPENSES
Acct #Amount
3001 1,330$
3002 250
3003 1,174
3004 -
3005 835
3006 150
3007 50
3008 1,020
3009 300
3010 -
3011 -
3012 -
5,109$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 1,224$
4002 2,052
4003 240
4004 830
4005
4006 675
4007 Other (Specify)
4008 Other (Specify)
4009 Other (Specify)-
4010 Other (Specify)-
5,021$
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
Other (Staff Recruitment)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office Supplies & Equipment
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 (Program Supplies)
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
Page 44 of 70
5001 5,937$
5002
5003 34,571
5004 -
5005 Other (Specify)
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
40,508$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 24,459$
6002 1,680
6003
6004
6005 Insurance (Liability):360
6006 Payroll Services
6007 -
6008 Other (Specify)
6009 Other (Specify)
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
26,499$
7000: FIXED ASSETS
Acct #Amount
7001 2,050$
7002
7003 100
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
2,150$
Acct #Service Units Rate Amount
8001 Mental Health Services -$
8002 Case Management 164 3.75 615
8003 Crisis Services 61 6.75 412
8004 Medication Support 2,981 8.25 24,593
8005 Collateral -
8006 Plan Development 2,000 4.50 9,000
8007 Assessment 2,965 4.50 13,343
8008 Rehabilitation 39,829 5.00 199,145
48,000 247,108$
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 228,289$
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Psychiatrist Fees)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 45 of 70
75%
185,331
85%157,531
157,531$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment (0)$
(0)$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 69,756$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
69,756$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)
8404 Other (Specify) 1,002
8405 Other (Specify) -
1,002$
Client Rents
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:228,289$
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
Page 46 of 70
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 105,196
Employee Salaries 86,226
1101 Executive Director 813 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Executive Assistant 259 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1103 Regional Director 2,671 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1104 Program Manager 32,551 Provides supervision of all staff and direct oversight of program management.
1105 Admin Specialist 4,002 Provides administrative support for the program and assist with medical billing and
records.
1106 Case Managers 45,930 Provides case management and oversees the physical and mental wellness of
individuals to ensure they are supported and can achieve the best outcomes, and
referrals to appropriate linkages.
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 11,857
1101 Retirement 1,630 Cost of 401K
1102 Worker's Compensation 2,147 Workers Comp Insurance
1103 Health Insurance 8,080 Cost of Medical, Vision, Dental, Life and Long Term Disability Insurance
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:7,113
1201 OASDI -
1202 FICA/MEDICARE 6,596 Cost of FICA/Medicare
1203 SUI 517 Cost of SUI
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 43,806
2001 Child Care -
2002 Client Housing Support 39,691 Support clients with things such as rent, security deposits, board and care,
emergency housing such as hotels/motels, groceries, utilities, and household
supplies.
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene 2,115 Outreach expenses that supports clients with clothing, food, water, blankets, and
hygiene supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
PATH Program- SMHS
Kings View Corporation
Fiscal Year (FY 2022-23)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 47 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2011 Other (Program Supplies)2,000 Cost of supplies for client groups such as notepads, therapy balls, puzzles or art
supplies.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 5,109
3001 Telecommunications 1,330 Cost of landline telephone services, cell phones service, data connectivity.
3002 Printing/Postage 250 Anticipated courier services and postage necessary for program. Business cards and
other special printing in bulk that are less cost effective to outsource rather than
utilization of a copier.
3003 Office Supplies & Equipment 1,174 Includes all supplies and minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development & Training 835 Minor shared cost for continuation of staff development and training. Also, includes
HMIS training fees.
3006 Staff Mileage 150 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees, such as parking fees.
3007 Subscriptions & Memberships 50 Minor shared cost of special subscription necessary for staff to provide services or
job tasks, such as an online subscription.
3008 Vehicle Maintenance 1,020 Minor auto repairs & maintenance required to maintain 1 shared leased vehicle for
client transportation and program needs, such as oil changes and car washes. Yearly
cost of GPS vehicle tracking service, auto fuel, and DMV fees.
3009 Other (Staff Recruitment)300 Thorough background check and drug testing.
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 5,021
4001 Building Maintenance 1,224 Shared copier maintenance, minor building repairs and maintenance to facility.
4002 Rent/Lease Building 2,052 Share cost of building space, anticipating moving locations.
4003 Rent/Lease Equipment 240 Shared copier lease.
4004 Rent/Lease Vehicles 830 The cost of 1 shared lease vehicles to assist with program needs.
4005 Security -
4006 Utilities 675 Shared cost of gas and electric.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 40,508
5001 Consultant (Network & Data Management)5,937 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management, technology procurement, telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Psychiatrist
Fees)
34,571 Yearly cost to contract with Physician to provide services and treatments to clients at
4 hours per week.
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 26,499
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 48 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6001 Administrative Overhead 24,459 Expenses provides corporate management, fiscal services, payroll, human resources,
accounts payable and other administrative functions.
6002 Professional Liability Insurance 1,680 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Liability):360 Cost of personal property, accidental and auto insurance.
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 2,150
7001 Computer Equipment & Software 2,050 Computer software needs to support staff & anticipated shared cost for
replacement of computer equipment.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 100 Anticipated shared cost for replacement of furniture needs.
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:228,289
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:228,289
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 49 of 70
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Executive Director 0.01 838$ 838$
1102 Executive Assistant 0.01 267 267
1103 Regional Director 0.02 2,752 2,752
1104 Program Manager 0.30 33,524 33,524
1105 Admin Specialist 0.08 4,122 4,122
1106 Case Managers 1.06 47,314 47,314
1107 -
1108 -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - -
Personnel Salaries Subtotal 1.47 -$ 88,817$ 88,817$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 1,679$ 1,679$
1102 - 2,212 2,212
1103 - 8,322 8,322
1104 - - -
1105 - - -
1106 - - -
-$ 12,213$ 12,213$
0.127026886
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$
1202 - 6,795 6,795
1203 - 533 533
1204 - - -
1205 - -
1206 - -
-$ 7,328$ 7,328$
-$ 108,358$ 108,358$
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)
PATH Program- SMHS
Kings View Corporation
Fiscal Year (FY 2023-24)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 50 of 70
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 36,004
2003 -
2004 2,115
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 2,000
2012 -
2013 -
2014 -
2015 -
2016 -
40,119$
3000: OPERATING EXPENSES
Acct #Amount
3001 1,330$
3002 250
3003 1,174
3004 -
3005 835
3006 150
3007 50
3008 1,020
3009 300
3010 -
3011 -
3012 -
5,109$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 1,224$
4002 2,052
4003 240
4004 830
4005
4006 675
4007 Other (Specify)
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5,021$
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
Other (Staff Recruitment)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office Supplies & Equipment
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 (Program Supplies)
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
Page 51 of 70
5001 5,937$
5002
5003 35,096
5004 -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
41,033$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 24,459$
6002 1,680
6003
6004
6005 Insurance (Liability):360
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
26,499$
7000: FIXED ASSETS
Acct #Amount
7001 2,050$
7002 -
7003 100
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
2,150$
Acct #Service Units Rate Amount
8001 Mental Health Services -$
8002 Case Management 164 3.75 615
8003 Crisis Services 61 6.75 412
8004 Medication Support 2,981 8.25 24,593
8005 Collateral -
8006 Plan Development 2,000 4.50 9,000
8007 Assessment 2,965 4.50 13,343
8008 Rehabilitation 39,829 5.00 199,145
48,000 247,108$
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 228,289$
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Psychiatrist Fees)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 52 of 70
75%
185,331
85%157,531
157,531$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment (0)$
(0)$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 69,756$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
69,756$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)-
8404 Other (Specify) 1,002
8405 Other (Specify) -
1,002$
Client Rents
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:228,289$
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
Page 53 of 70
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 108,358
Employee Salaries 88,817
1101 Executive Director 838 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Executive Assistant 267 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1103 Regional Director 2,752 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1104 Program Manager 33,524 Provides supervision of all staff and direct oversight of program management.
1105 Admin Specialist 4,122 Provides administrative support for the program and assist with medical billing and
records.
1106 Case Managers 47,314 Provides case management and oversees the physical and mental wellness of
individuals to ensure they are supported and can achieve the best outcomes, and
referrals to appropriate linkages.
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 12,213
1101 Retirement 1,679 Cost of 401K
1102 Worker's Compensation 2,212 Workers Comp Insurance
1103 Health Insurance 8,322 Cost of Medical, Vision, Dental, Life and Long Term Disability Insurance
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:7,328
1201 OASDI -
1202 FICA/MEDICARE 6,795 Cost of FICA/Medicare
1203 SUI 533 Cost of SUI
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 40,119
2001 Child Care -
2002 Client Housing Support 36,004 Support clients with things such as rent, security deposits, board and care,
emergency housing such as hotels/motels, groceries, utilities, and household
supplies.
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene 2,115 Outreach expenses that supports clients with clothing, food, water, blankets, and
hygiene supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
PATH Program- SMHS
Kings View Corporation
Fiscal Year (FY 2023-24)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 54 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2011 Other (Program Supplies)2,000 Cost of supplies for client groups such as notepads, therapy balls, puzzles or art
supplies.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 5,109
3001 Telecommunications 1,330 Cost of landline telephone services, cell phones service, data connectivity.
3002 Printing/Postage 250 Anticipated courier services and postage necessary for program. Business cards and
other special printing in bulk that is less cost effective to outsource rather than
utilization of a copier.
3003 Office Supplies & Equipment 1,174 Includes all supplies and minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development & Training 835 Minor shared cost for continuation of staff development and training. Also, includes
HMIS training fees.
3006 Staff Mileage 150 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees, such as parking fees.
3007 Subscriptions & Memberships 50 Minor shared cost of special subscription necessary for staff to provide services or
job tasks, such as an online subscription.
3008 Vehicle Maintenance 1,020 Minor auto repairs & maintenance required to maintain 1 shared leased vehicle for
client transportation and program needs, such as oil changes and car washes. Yearly
cost of GPS vehicle tracking service, auto fuel, and DMV fees.
3009 Other (Staff Recruitment)300 Thorough background check and drug testing.
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 5,021
4001 Building Maintenance 1,224 Shared copier maintenance, minor building repairs and maintenance to facility.
4002 Rent/Lease Building 2,052 Share cost of building space, anticipating moving locations.
4003 Rent/Lease Equipment 240 Shared copier lease.
4004 Rent/Lease Vehicles 830 The cost of 1 shared lease vehicles to assist with program needs.
4005 Security -
4006 Utilities 675 Shared cost of gas and electric.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 41,033
5001 Consultant (Network & Data Management)5,937 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management, technology procurement, telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Psychiatrist
Fees)
35,096 Yearly cost to contract with Physician to provide services and treatments to clients at
4 hours per week.
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 26,499
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 55 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6001 Administrative Overhead 24,459 Expenses provides corporate management, fiscal services, payroll, human resources,
accounts payable and other administrative functions.
6002 Professional Liability Insurance 1,680 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Liability):360 Cost of personal property, accidental and auto insurance.
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 2,150
7001 Computer Equipment & Software 2,050 Computer software needs to support staff & anticipated shared cost for
replacement of computer equipment.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 100 Anticipated shared cost for replacement of furniture needs.
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:228,289
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:228,289
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 56 of 70
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Executive Director 0.01 863$ 863$
1102 Executive Assistant 0.01 275 275
1103 Regional Director 0.02 2,834 2,834
1104 Program Manager 0.30 34,527 34,527
1105 Admin Specialist 0.08 4,245 4,245
1106 Case Managers 1.20 55,171 55,171
1107 -
1108 -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - -
Personnel Salaries Subtotal 1.61 -$ 97,915$ 97,915$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 1,851$ 1,851$
1102 - 2,438 2,438
1103 - 9,175 9,175
1104 - - -
1105 - - -
1106 - - -
-$ 13,464$ 13,464$
0.127027257
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 7,491 7,491
1203 - 587 587
1204 - - -
1205 - - -
1206 - - -
-$ 8,078$ 8,078$
-$ 119,457$ 119,457$
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)
PATH Program- SMHS
Kings View Corporation
Fiscal Year (FY 2024-25)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 57 of 70
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 23,798
2003 -
2004 2,115
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 2,000
2012 -
2013 -
2014 -
2015 -
2016 -
27,913$
3000: OPERATING EXPENSES
Acct #Amount
3001 1,330$
3002 250
3003 974
3004 -
3005 835
3006 150
3007 50
3008 1,020
3009 300
3010 -
3011 -
3012 -
4,909$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 1,224$
4002 2,177
4003 240
4004 830
4005
4006 740
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5,211$
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
Other (Staff Recruitment)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office Supplies & Equipment
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 (Program Supplies)
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
Page 58 of 70
5001 5,937$
5002
5003 36,149
5004 -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
42,086$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 24,459$
6002 1,730
6003
6004
6005 Insurance (Liability):374
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
26,563$
7000: FIXED ASSETS
Acct #Amount
7001 2,050$
7002 -
7003 100
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
2,150$
Acct #Service Units Rate Amount
8001 Mental Health Services -$
8002 Case Management 164 3.75 615
8003 Crisis Services 61 6.75 412
8004 Medication Support 2,981 8.25 24,593
8005 Collateral -
8006 Plan Development 2,000 4.50 9,000
8007 Assessment 2,965 4.50 13,343
8008 Rehabilitation 39,829 5.00 199,145
48,000 247,108$
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 228,289$
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Psychiatrist Fees)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 59 of 70
75%
185,331
85%157,531
157,531$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment (0)$
(0)$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 69,756$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
69,756$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)1,002
8404 Other (Specify) -
8405 Other (Specify) -
1,002$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:228,289$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Client Rents
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
Page 60 of 70
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 119,457
Employee Salaries 97,915
1101 Executive Director 863 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Executive Assistant 275 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1103 Regional Director 2,834 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1104 Program Manager 34,527 Provides supervision of all staff and direct oversight of program management.
1105 Admin Specialist 4,245 Provides administrative support for the program and assist with medical billing and
records.
1106 Case Managers 55,171 Provides case management and oversees the physical and mental wellness of
individuals to ensure they are supported and can achieve the best outcomes, and
referrals to appropriate linkages.
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 13,464
1101 Retirement 1,851 Cost of 401K
1102 Worker's Compensation 2,438 Workers Comp Insurance
1103 Health Insurance 9,175 Cost of Medical, Vision, Dental, Life and Long Term Disability Insurance
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:8,078
1201 OASDI -
1202 FICA/MEDICARE 7,491 Cost of FICA/Medicare
1203 SUI 587 Cost of SUI
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 27,913
2001 Child Care -
2002 Client Housing Support 23,798 Support clients with things such as rent, security deposits, board and care,
emergency housing such as hotels/motels, groceries, utilities, and household
supplies.
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene 2,115 Outreach expenses that supports clients with clothing, food, water, blankets, and
hygiene supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
PATH Program- SMHS
Kings View Corporation
Fiscal Year (FY 2024-25)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 61 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2011 Other (Program Supplies)2,000 Cost of supplies for client groups such as notepads, therapy balls, puzzles or art
supplies.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 4,909
3001 Telecommunications 1,330 Cost of landline telephone services, cell phones service, data connectivity.
3002 Printing/Postage 250 Anticipated courier services and postage necessary for program. Business cards and
other special printing in bulk that is less cost effective to outsource rather than
utilization of a copier.
3003 Office Supplies & Equipment 974 Includes all supplies and minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development & Training 835 Minor shared cost for continuation of staff development and training. Also, includes
HMIS training fees.
3006 Staff Mileage 150 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees, such as parking fees.
3007 Subscriptions & Memberships 50 Minor shared cost of special subscription necessary for staff to provide services or
job tasks, such as an online subscription.
3008 Vehicle Maintenance 1,020 Minor auto repairs & maintenance required to maintain 1 shared leased vehicle for
client transportation and program needs, such as oil changes and car washes. Yearly
cost of GPS vehicle tracking service, auto fuel, and DMV fees.
3009 Other (Staff Recruitment)300 Thorough background check and drug testing.
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 5,211
4001 Building Maintenance 1,224 Shared copier maintenance, minor building repairs and maintenance to facility.
4002 Rent/Lease Building 2,177 Share cost of building space, anticipating moving locations.
4003 Rent/Lease Equipment 240 Shared copier lease.
4004 Rent/Lease Vehicles 830 The cost of 1 shared lease vehicles to assist with program needs.
4005 Security -
4006 Utilities 740 Shared cost of gas and electric.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 42,086
5001 Consultant (Network & Data Management)5,937 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management, technology procurement, telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Psychiatrist
Fees)
36,149 Yearly cost to contract with Physician to provide services and treatments to clients at
4 hours per week.
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 26,563
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 62 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6001 Administrative Overhead 24,459 Expenses provides corporate management, fiscal services, payroll, human resources,
accounts payable and other administrative functions.
6002 Professional Liability Insurance 1,730 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Liability):374 Cost of personal property, accidental and auto insurance.
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 2,150
7001 Computer Equipment & Software 2,050 Computer software needs to support staff & anticipated shared cost for
replacement of computer equipment.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 100 Anticipated shared cost for replacement of furniture needs.
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over $500 with Lifespan of 2
Years +
-
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:228,289
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:228,289
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 63 of 70
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Executive Director 0.01 889$ 889$
1102 Executive Assistant 0.01 283 283
1103 Regional Director 0.02 2,919 2,919
1104 Program Manager 0.30 35,562 35,562
1105 Admin Specialist 0.08 4,372 4,372
1106 Case Managers 1.20 56,830 56,830
1107 -
1108 -
1109 - - -
1110 - - -
1111 - - -
1112 - - -
1113 - - -
1114 - - -
1115 - - -
1116 - - -
1117 - - -
1118 - - -
1119 - - -
1120 - - -
Personnel Salaries Subtotal 1.61 -$ 100,855$ 100,855$
Employee Benefits
Acct #Admin Direct Total
1101 -$ 1,906$ 1,906$
1102 - 2,511 2,511
1103 - 9,451 9,451
1104 - - -
1105 - - -
1106 - - -
-$ 13,868$ 13,868$
0.127025418
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1201 -$ -$ -$
1202 - 7,715 7,715
1203 - 605 605
1204 - - -
1205 - -
1206 - -
-$ 8,320$ 8,320$
-$ 123,043$ 123,043$
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)
PATH Program- SMHS
Kings View Corporation
Fiscal Year (FY 2025-26)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 64 of 70
2000: CLIENT SUPPORT
Acct #Amount
2001 -$
2002 22,055
2003 -
2004 2,115
2005 -
2006 -
2007 -
2008 -
2009 -
2010 -
2011 2,000
2012 -
2013 -
2014 -
2015 -
2016 -
26,170$
3000: OPERATING EXPENSES
Acct #Amount
3001 1,330$
3002 250
3003 974
3004 -
3005 835
3006 150
3007 50
3008 1,020
3009 300
3010 -
3011 -
3012 -
4,909$
4000: FACILITIES & EQUIPMENT
Acct #Amount
4001 1,224$
4002 2,243
4003 240
4004 830
4005
4006 740
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5,277$
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
Other (Staff Recruitment)
Other (Specify)
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office Supplies & Equipment
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 (Program Supplies)
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
Page 65 of 70
5001 5,937$
5002
5003 36,149
5004 -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
42,086$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 24,459$
6002 1,734
6003
6004
6005 Insurance (Liability):411
6006 Payroll Services -
6007 -
6008 Other (Specify)-
6009 Other (Specify)-
6010 Other (Specify)-
6011 Other (Specify)-
6012 Other (Specify)-
26,604$
7000: FIXED ASSETS
Acct #Amount
7001 100$
7002 -
7003 100
7004 -
7005 -
7006 Assets over $5,000/unit (Specify)-
7007 Other (Specify)-
7008 Other (Specify)-
200$
Acct #Service Units Rate Amount
8001 Mental Health Services -$
8002 Case Management 164 3.75 615
8003 Crisis Services 61 6.75 412
8004 Medication Support 2,981 8.25 24,593
8005 Collateral -
8006 Plan Development 2,000 4.50 9,000
8007 Assessment 2,965 4.50 13,343
8008 Rehabilitation 39,829 5.00 199,145
48,000 247,108$
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 228,289$
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider-Owned Equipment to be Used for Program Purposes)
SPECIAL EXPENSES TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Psychiatrist Fees)
Translation Services
Fresno County Department of Behavioral Health Contract Budget Template Revised 9/12/2019
Exhibit C
Page 66 of 70
75%
185,331
85%157,531
157,531$
Acct #Amount
8101 Drug Medi-Cal -$
8102 SABG -$
-$
Acct #Amount
8201 Realignment (0)$
(0)$
Acct #MHSA Component Amount
8301 CSS - Community Services & Supports 69,756$
8302 PEI - Prevention & Early Intervention -
8303 INN - Innovations -
8304 WET - Workforce Education & Training -
8305 CFTN - Capital Facilities & Technology -
69,756$
Acct #Amount
8401 Client Fees -$
8402 Client Insurance -
8403 Grants (Specify)1,002
8404 Other (Specify) -
8405 Other (Specify) -
1,002$ OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:228,289$
NET PROGRAM COST: -$
MHSA TOTAL
8400 - OTHER REVENUE
Line Item Description
Client Rents
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
Page 67 of 70
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 123,043
Employee Salaries 100,855
1101 Executive Director 889 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Executive Assistant 283 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1103 Regional Director 2,919 Provide program management and direction. Ensures operations are running
smoothly and in compliance with contract requirements.
1104 Program Manager 35,562 Provides supervision of all staff and direct oversight of program management.
1105 Admin Specialist 4,372 Provides administrative support for the program and assist with medical billing and
records.
1106 Case Managers 56,830 Provides case management and oversees the physical and mental wellness of
individuals to ensure they are supported and can achieve the best outcomes, and
referrals to appropriate linkages.
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 13,868
1101 Retirement 1,906 Cost of 401K
1102 Worker's Compensation 2,511 Workers Comp Insurance
1103 Health Insurance 9,451 Cost of Medical, Vision, Dental, Life and Long Term Disability Insurance
1104 Other (Specify)-
1105 Other (Specify)-
1106 Other (Specify)-
Payroll Taxes & Expenses:8,320
1201 OASDI -
1202 FICA/MEDICARE 7,715 Cost of FICA/Medicare
1203 SUI 605 Cost of SUI
1204 Other (Specify)-
1205 Other (Specify)-
1206 Other (Specify)-
2000: CLIENT SUPPORT 26,170
2001 Child Care -
2002 Client Housing Support 22,055 Support clients with things such as rent, security deposits, board and care,
emergency housing such as hotels/motels, groceries, utilities, and household
supplies.
2003 Client Transportation & Support -
2004 Clothing, Food, & Hygiene 2,115 Outreach expenses that supports clients with clothing, food, water, blankets, and
hygiene supplies. Also, includes miscellaneous client support items such as pet food,
groceries, DMV identification, and birth certificates.
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies - Medical -
2010 Utility Vouchers -
PATH Program- SMHS
Kings View Corporation
Fiscal Year (FY 2025-26)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 68 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2011 Other (Program Supplies)2,000 Cost of supplies for client groups such as notepads, therapy balls, puzzles or art
supplies.
2012 Other (Specify)-
2013 Other (Specify)-
2014 Other (Specify)-
2015 Other (Specify)-
2016 Other (Specify)-
3000: OPERATING EXPENSES 4,909
3001 Telecommunications 1,330 Cost of landline telephone services, cell phones service, data connectivity.
3002 Printing/Postage 250 Anticipating courier services and postage necessary for program. Business cards and
other special printing in bulk that is less cost effective to outsource rather than
utilization of a copier.
3003 Office Supplies & Equipment 974 Includes all supplies and minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development & Training 835 Minor shared cost for continuation of staff development and training. Also, includes
HMIS training fees.
3006 Staff Mileage 150 Reimbursements to staff for personal vehicle use when lease vehicle not available
and require to provide services or other program needs, paid at IRS rate. Any travel
transportation fees, such as parking fees.
3007 Subscriptions & Memberships 50 Minor shared cost of special subscription necessary for staff to provide services or
job tasks, such as an online subscription.
3008 Vehicle Maintenance 1,020 Minor auto repairs & maintenance required to maintain 1 shared leased vehicle for
client transportation and program needs, such as oil changes and car washes. Yearly
cost of GPS vehicle tracking service, auto fuel, and DMV fees.
3009 Other (Staff Recruitment)300 Thorough background check and drug testing.
3010 Other (Specify)-
3011 Other (Specify)-
3012 Other (Specify)-
4000: FACILITIES & EQUIPMENT 5,277
4001 Building Maintenance 1,224 Shared copier maintenance, minor building repairs and maintenance to facility.
4002 Rent/Lease Building 2,243 Share cost of building space, anticipating moving locations.
4003 Rent/Lease Equipment 240 Shared copier lease.
4004 Rent/Lease Vehicles 830 The cost of 1 shared lease vehicles to assist with program needs.
4005 Security -
4006 Utilities 740 Shared cost of gas and electric.
4007 Other (Specify)-
4008 Other (Specify)-
4009 Other (Specify)-
4010 Other (Specify)-
5000: SPECIAL EXPENSES 42,086
5001 Consultant (Network & Data Management)5,937 Kings View Information Technology Department (KVIT) will provide hardware and
software support successful data collection. Information services and management
consisting of managed internet service provider, network and desktop management,
project management, technology procurement, telecommunication management,
strategic technology planning, system documentation, application/data hosting,
access to data/documents/application 24/7. After hours support via email and
phone 24/7.
5002 HMIS (Health Management Information
System)
-
5003 Contractual/Consulting Services (Psychiatrist
Fees)
36,149 Yearly cost to contract with Physician to provide services and treatments to clients at
4 hours per week.
5004 Translation Services -
5005 Other (Specify)-
5006 Other (Specify)-
5007 Other (Specify)-
5008 Other (Specify)-
6000: ADMINISTRATIVE EXPENSES 26,604
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 69 of 70
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6001 Administrative Overhead 24,459 Expenses provides corporate management, fiscal services, payroll, human resources,
accounts payable and other administrative functions.
6002 Professional Liability Insurance 1,734 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance (Liability):411 Cost of personal property, accidental and auto insurance.
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 200
7001 Computer Equipment & Software 100 Computer software needs to support staff & anticipated shared cost for
replacement of computer equipment.
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
-
7003 Furniture & Fixtures 100 Anticipated shared cost for replacement of furniture needs.
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:228,289
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:228,289
-
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 9/12/2019
Exhibit C
Page 70 of 70
Exhibit D
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 D
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 D
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 E
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 E
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 E
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 F
Page 1 of 2
Program Objectives
Annual Outcomes Report
The following items listed below represent program goals to be tracked and achieved by CONTRACTOR
each fiscal year of the contract term. CONTRACTOR will utilize a computerized tracking system with
which outcome measures and other relevant data, such as demographics, will be maintained. Reports
will be provided to COUNTY quarterly, annually, and as requested.
Outreach, Engagement, and Linkage (OEL) Annual Outcomes Report Objectives
1. Outreach 350 individuals experiencing homelessness with SMI/Co-Occurring disorders in Fresno
County who are receptive to engagement and linkage services.
2. Enroll 200 persons served into the PATH Program and HMIS.
3. Capture the satisfaction of at least 80% of persons served with PATH agency services will be
shown through a survey provided to enrolled persons served by the PATH OEL Team.
4. Capture the satisfaction of at least 80% of persons served with PATH staff’s knowledge,
competency, and professionalism will be shown through a survey provided to enrolled persons
served by the PATH OEL Team.
5. Capture the satisfaction of at least 80% of persons served with linkages to resources they need
will be shown through a survey provided to enrolled persons by the PATH OEL Team.
6. Pursue a number of actions to quickly link at least 80% of persons served to housing, including
diversion through natural supports or linkage to a navigator.
7. Link at least 50% of individuals enrolled in the PATH Program and HMIS to temporary or
permanent housing when such resources are available.
8. Demonstrate a capacity to engage the target population by tracking the number of contacts
needed for enrollment in the PATH program and HMIS with a goal of less than five contacts
needed.
9. Track where persons were served, distinguishing between the Fresno Metro area and the
various rural/unincorporated areas of Fresno County.
10. Track what services are provided to persons served by the PATH OEL Team.
Specialty Mental Health Services (SMHS) Annual Outcomes Report Objectives
1. Track the prevention and reduction in the number of incarceration occurrences for at least 70%
of persons enrolled in the SMHS program by comparing incidents during the 12-month period
before an individual’s enrollment to incidents while enrolled.
2. Track the prevention and reduction in the number of psychiatric hospitalization occurrences for
at least 70% of persons enrolled in the SMHS program by comparing incidents during the 12-
month period before an individual’s enrollment to incidents while enrolled.
3. Track the prevention and reduction in the number of homeless occurrences for at least 70% of
persons enrolled in the SMHS program by comparing incidents during the 12-month period
before an individual’s enrollment to incidents while enrolled.
4. Ensure that at least 60% of persons served will successfully exit the SMHS Program by meeting
their individual care plan goals within 18 months.
5. Show that at least 80% of persons served will report satisfaction with PATH agency services
through a survey provided to persons enrolled in the SMHS program for at least 6 months.
Exhibit F
Page 2 of 2
6. Show that least 80% of persons served will report satisfaction with accessibility of services
through a survey provided to persons enrolled in the SMHS program for at least 6 months.
7. Show that at least 70% of persons served will report satisfaction with life functioning through a
survey provided to persons enrolled in the SMHS program for at least 6 months.
8. Ensure that at least 75% of persons referred to the SMHS program will be offered a timely
assessment appointment. The data shown will account for individuals who were referred within
the reporting period.
7. Type of organization in which your PATH program operates (select one)
CA-008 Fresno County Department of
Behavioral Health (formerly, Fresno County
Department of Adult Services)
Annual Report:
HMIS Vendor:
Section 1: Budget Information
1. Federal PATH funds received this reporting year
2. Matching funds from state, local, or other sources used in support of PATH receivedthis reporting year
3. Total funds dedicated this year, agency wide, to persons who have serious mentalillness and are experiencing homelessness or are at risk of homelessness
(include PATH, matching, and non-PATH funds) (only include dollars that are dedicated to persons withserious mental illness who are homeless or at risk of homelessness)
4. Number of staff supported by PATH and matching funds
5. Full-time equivalent (FTE) of staff supported by PATH and matching funds
(see instructions in the PATH Annual Report Manual to compute FTEs)
6. Number of trainings provided by PATH-funded staff this reporting year
Community Mental Health Center
Consumer-run Mental Health Agency
Other Mental Health Agency
Social Service Agency
Health Care for Homeless/Other Health Agency
Substance Use Treatment Agency
Shelter or Other Temporary Housing Resource
Other Housing Agency
Other
Exhibit G
Page 1 of 9
Section 2: Persons Served During This Reporting Period
8. Number of persons contacted by PATH-funded staff this reporting period
9. Number of new persons contacted this reporting period in a PATH Street Outreachproject
10. Number of new persons contacted this reporting period in a PATH Services Onlyproject
11. Total number of new persons contacted this reporting period (#9+#10)
12a. Instances of contact this reporting period prior to date of enrollment
12b. Total instances of contact during the reporting period
13a. Number of new persons contacted this reporting period who could not be enrolledbecause of ineligibility for PATH
13b. Number of new persons contacted this reporting period who could not be enrolledbecause provider was unable to locate the client
14. Number of new persons contacted this reporting period who became enrolled in PATH
15. Number with active, enrolled PATH status at any point during the reporting period
16. Number of active, enrolled PATH clients receiving community mental health servicesthrough any funding source at any point during the reporting period
Section 3: Services Provided
17. Services Provided (unduplicated count of PATH-enrolled individuals only)
Of those with an active, enrolled PATH status during this reporting period, which PATH-funded services didthey receive?
NUMBER RECEIVING EACH SERVICE
17a. Reengagement
17b. Screening
17c. Clinical Assessment
17d. Habilitation/rehabilitation
17e. Community mental health
17f. Substance use treatment
17g. Case management
17h. Residential supportive services
17i. Housing minor renovation
17j. Housing moving assistance
17k. Housing eligibility determination
17l. Security deposits
17m. One-time rent for eviction prevention
Exhibit G
Page 2 of 9
Section 4: Referrals Provided
18. Referrals Provided (unduplicated count of PATH-enrolled inviduals only)
Of those with an active, enrolled PATH status during this reporting period, which referrals did they receive? Note: Referrals provided prior to PATH enrollment should not be counted here.
18A. NUMBERRECEIVING EACHREFERRAL
18B. NUMBER WHOATTAINED THE SERVICEFROM THE REFERRAL
Community mental health
Substance use treatment
Primary health/dental care
Job training
Educational Services
Housing Services
Permanent housing
Temporary housing
Income assistance
Employment assistance
Medical insurance
18a1. 18b1.
18a2. 18b2.
18a3. 18b3.
18a4. 18b4.
18a5. 18b5.
18a6. 18b6.
18a7. 18b7.
18a8. 18b8.
18a9. 18b9.
18a10. 18b10.
18a11. 18b11.
Exhibit G
Page 3 of 9
Section 5: Outcomes
Outcomes (unduplicated count of PATH-enrolled individuals only)
Of those with an active, enrolled PATH status during this reporting period, how many were receiving the items
below at PATH project entry and at PATH project exit or at the end of the reporting period?
AT PATH PROJECTENTRY AT PATH PROJECTEXIT (FOR CLIENTSWHO WERE EXITEDFROM PATH THISYEAR - LEAVERS)
AT REPORT ENDDATE (FOR CLIENTSWHO WERE STILLACTIVE IN PATH ASOF REPORT ENDDATE - STAYERS)
19. INCOME FROM ANY SOURCE
Yes
No
Client doesn't know
Client refused
Data not collected
TOTAL
20. SSI/SSDI
Yes
No
TOTAL
21. NON-CASH BENEFITS FROM ANY SOURCE
Yes
No
Client doesn't know
Client refused
Data not collected
TOTAL
22. COVERED BY HEALTH INSURANCE
Yes
No
Client doesn't know
Client refused
Data not collected
TOTAL
23. MEDICAID/MEDICARE
Yes
No
TOTAL
24. ALL OTHER HEALTH INSURANCE
Yes
No
TOTAL
19a1. 19a2. 19a3.
19b1. 19b2. 19b3.
19c1. 19c2. 19c3.
19d1. 19d2. 19d3.
19e1. 19e2. 19e3.
19f1. 0 19f2. 0 19f3. 0
20a1. 20a2. 20a3.
20b1. 20b2. 20b3.
20c1. 0 20c2. 0 20c3. 0
21a1. 21a2. 21a3.
21b1. 21b2. 21b3.
21c1. 21c2. 21c3.
21d1. 21d2. 21d3.
21e1. 21e2. 21e3.
21f1. 0 21f2. 0 21f3. 0
22a1. 22a2. 22a3.
22b1. 22b2. 22b3.
22c1. 22c2. 22c3.
22d1. 22d2. 22d3.
22e1. 22e2. 22e3.
22f1. 0 22f2. 0 22f3. 0
23a1. 23a2. 23a3.
23b1. 23b2. 23b3.
23c1. 0 23c2. 0 23c3. 0
24a1. 24a2. 24a3.
24b1. 24b2. 24b3.
24c1. 0 24c2. 0 24c3. 0
Exhibit G
Page 4 of 9
Destination at Exit
For each category, record the number of PATH-enrolled individuals who exited the PATH program to eachresponse category. The total of all Destinations 25a1 - 25a36 must match the total number of active, PATH-enrolled individuals (Q#15).
25. DESTINATION AT EXIT
TEMPORARY DESTINATIONS
Emergency shelter, including hotel or motel paid for with emergency sheltervoucher, or RHY-funded Host Home shelter
Moved from one HOPWA funded project to another HOPWA TH
Transitional housing for homeless persons
Staying or living in a family member's room, apartment, or house, temporarytenure
Staying or living in a friend's room, apartment, or house, temporary tenure
Place not meant for habitation (e.g., a vehicle, an abandoned building,bus/train/subway station/airport, or anywhere outside)
Safe Haven
Hotel or motel paid for without emergency shelter voucher
Host Home (non-crisis)
SUBTOTAL
INSTITUTIONAL SITUATION
Foster care home or foster care group home
Psychiatric hospital or other psychiatric facility
Substance abuse treatment facility or detox center
Hospital or other residential non-psychiatric medical facility
Jail, prison, or juvenile detention facility
Long-term care facility or nursing home
SUBTOTAL
PERMANENT DESTINATIONS
Moved from one HOPWA funded project to another HOPWA PH
Owned by client, no ongoing housing subsidy
Owned by client, with ongoing housing subsidy
Permanent housing (other than RRH) for formerly homeless persons
Rental by client, no ongoing housing subsidy
Rental by client, with RRH or equivalent subsidy
Rental by client, with VASH subsidy
Rental by client, with GPD TIP subsidy
Rental by client, with other ongoing housing subsidy
Rental by client, with HCV voucher (tenant or project based)
Rental by client in a public housing unit
Residential project or halfway house with no homeless criteria
Staying or living in a family member's room, apartment, or house, permanenttenure
Staying or living in a friend's room, apartment, or house, permanent tenure
SUBTOTAL
OTHER DESTINATIONS
Deceased
Other
No exit interview completed
Client doesn't know
Client refused
Data not collected
SUBTOTAL
PATH-enrolled clients still active as of report end date (Stayers)
TOTAL
25a1.
25a2.
25a3.
25a4.
25a5.
25a6.
25a7.
25a8.
25a9.
25a10. 0
25a11.
25a12.
25a13.
25a14.
25a15.
25a16.
25a17. 0
25a18.
25a19.
25a20.
25a21.
25a22.
25a23.
25a24.
25a25.
25a26.
25a27.
25a28.
25a29.
25a30.
25a31.
25a32. 0
25a33.
25a34.
25a35.
25a36.
25a37.
25a38.
25a39. 0
25a40.
25a41. 0
Section 6: Housing Outcomes Exhibit G
Page 5 of 9
Section 7: Demographics - Gender
Demographics - Gender
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each ofthe following categories?
26A. NUMBER ENROLLED
Female
Male
Trans Female (MTF or Male to Female)
Trans Male (FTM or Female to Male)
Gender non-conforming
Client doesn't know
Client refused
Data not collected
TOTAL
Section 8: Demographics - Age
Demographics - Age
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each ofthe following categories?
26B. NUMBER ENROLLED
17 and under(Youth 17 and under should not be enrolled in thePATH Project unless they meet all the eligibilityrequirements. This includes extended familymembers)
18 - 23
24 - 30
31 - 40
41 - 50
51 - 61
62 and over
Client doesn't know
Client refused
Data not collected
TOTAL
Section 9: Demographics - Race
Demographics - Race
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each ofthe following categories? (Note: An individual who identifies as multiracial should be counted in all applicablecategories. This demographic element will not sum to total persons enrolled.)
26C. NUMBER ENROLLED
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Client doesn't know
Client refused
Data not collected
TOTAL
26a1.
26a2.
26a3.
26a4.
26a5.
26a6.
26a7.
26a8.
26a9. 0
26b1.
26b2.
26b3.
26b4.
26b5.
26b6.
26b7.
26b8.
26b9.
26b10.
26b11. 0
26c1.
26c2.
26c3.
26c4.
26c5.
26c6.
26c7.
26c8.
26c9. 0
Exhibit G
Page 6 of 9
Section 10: Demographics - Ethnicity
Demographics - Ethnicity
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each ofthe following categories?
26D. NUMBER ENROLLED
Non-Hispanic/Non-Latino
Hispanic/Latino
Client doesn't know
Client refused
Data not collected
TOTAL
Section 11: Demographics - Veteran Status
Demographics - Veteran Status (Adults Only)
Of those with an active, enrolled PATH status during this reporting period, how many adults are in each of thefollowing categories?
26E. NUMBER ENROLLED
Veteran
Non-Veteran
Client doesn't know
Client refused
Data not collected
TOTAL
Section 12: Demographics - Co-Occurring Disorder
Demographics - Co-Occurring Disorder
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each ofthe following categories?
26F. NUMBER ENROLLED
Co-occurring substance use disorder
No co-occurring substance use disorder
Unknown
TOTAL
Section 13: Demographics - SOAR Connection
Demographics - SOAR Connection
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each ofthe following categories?
26G. NUMBER ENROLLED
Yes
No
Client doesn't know
Client refused
Data not collected
TOTAL
26d1.
26d2.
26d3.
26d4.
26d5.
26d6. 0
26e1.
26e2.
26e3.
26e4.
26e5.
26e6. 0
26f1.
26f2.
26f3.
26f4. 0
26g1.
26g2.
26g3.
26g4.
26g5.
26g6. 0
Exhibit G
Page 7 of 9
Section 14: Demographics - Prior Living Situation
Demographics - Prior Living Situation
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each ofthe following categories?
26H. NUMBER ENROLLED
LITERALLY HOMELESS
Place not meant for habitation(e.g., a vehicle, an abandoned building, abus/train/subway station, airport, or anywhere outside)
Emergency shelter, including hotel or motel paid forwith emergency shelter voucher, or RHY-funded HostHome shelter
Safe Haven
INSTITUTIONAL SITUATION
Foster care home or foster care group home
Hospital or other residential non-psychiatric medicalfacility
Jail, prison, or juvenile detention facility
Long-term care facility or nursing home
Substance abuse treatment facility or detox center
Psychiatric hospital or other psychiatric facility
TRANSITIONAL AND PERMANENT HOUSING SITUATION
Hotel or motel paid for without emergency sheltervoucher
Owned by client, no ongoing housing subsidy
Owned by client, with ongoing housing subsidy
Permanent housing (other than RRH) for formerlyhomeless persons(such as CoC project, HUD legacy programs, orHOPWA PH)
Rental by client, no ongoing housing subsidy
Rental by client, with VASH subsidy
Rental by client, with GPD TIP subsidy
Rental by client, with RRH or equivalent subsidy
Rental by client, with other ongoing housing subsidy(including RRH)
Rental by client, with HCV voucher (tenant or projectbased)
Rental by client in a public housing unit
Residential project or halfway house with no homelesscriteria
Staying or living in a family member's room,apartment, or house
Staying or living in a friend's room, apartment, orhouse
Transitional housing for homeless persons(including homeless youth)
Host Home (non-crisis)
Client doesn't know
Client refused
Data not collected
TOTAL
26h1.
26h2.
26h3.
26h4.
26h5.
26h6.
26h7.
26h8.
26h9.
26h10.
26h11.
26h12.
26h13.
26h14.
26h15.
26h16.
26h17.
26h18.
26h19.
26h20.
26h21.
26h22.
26h23.
26h24.
26h25.
26h26.
26h27.
26h28.
26h29. 0
Exhibit G
Page 8 of 9
Section 15: Demographics - Length of Stay
Length of stay in prior living situation (emergency shelter or place not meant for human habitation
ONLY)
Of those identified in #26h (Living Situation) as staying in Place not meant for habitation (26h1) or Emergencyshelter (26h2), record the length of time these individuals have been in this living situation. The total of thiscategory must equal the sum of 26h1 + 26h2.
26I. LENGTH OF STAY
One night or less
Two to six nights
One week or more, but less than one month
One month or more, but less than 90 days
90 days or more, but less than one year
One year or longer
Client doesn't know
Client refused
Data not collected
TOTAL
Section 16: Demographics - Chronically Homeless
Demographics - Chronically Homeless
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each ofthe following categories?
26J. NUMBER ENROLLED
Yes
No
Unknown
TOTAL
Section 17: Demographics - Domestic Violence History
Demographics - Domestic Violence History (Adults Only)
Of those with an active, enrolled PATH status during this reporting period, how many adults are in each of thefollowing categories?
26K. NUMBER ENROLLED
Yes
No
Client doesn't know
Client refused
Data not collected
TOTAL
26i1.
26i2.
26i3.
26i4.
26i5.
26i6.
26i7.
26i8.
26i9.
26i10. 0
26j1.
26j2.
26j3.
26j4. 0
26k1.
26k2.
26k3.
26k4.
26k5.
26k6. 0
Exhibit G
Page 9 of 9
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.
Exhibit I
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 I
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 J
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 J
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 K.1
Page 1 of 1
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 K.2
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 K.2
Page 2 of 9
Exhibit K.2
Page 3 of 9
Similar to the paper version, multiple incident categories can be selected
Exhibit K.2
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 K.2
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.
Exhibit K.2
Page 6 of 9
Enter in email address and password. First time users will be prompted to set up a password.
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.
Exhibit K.2
Page 7 of 9
The next tab is Summary: No edits can be made to this section.
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.
Exhibit K.2
Page 8 of 9
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 K.2
Page 9 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.
FIXED ASSET AND SENSITIVE ITEM LOG
Program: PATH
Contract #: 21-0420
Contact Name & No.:
fixed assets Sensitive assets
Tag Number Item Make/Brand Model Serial #Vendor Purchase Price QTY Cost >$5,000 $500-$4999 Condition Location Comments
(If applicable)Date
5630DBH Copier Konica Minolta Bizhub C350 KM-C2230 Copiers Ink 1/1/2013 5,259.88 1 5,259.88 X New
Business Office
4417 E. Inyo Ave
Fresno, CA 93702
FR253256 Camera Canon 5169B003 1980124 Best Buy 1/1/2013 595.23 1 595.23 X Used
Business Office
4417 E. Inyo Ave
Fresno, CA 93702
Exhibit L
Page 1 of 1
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
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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
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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: