HomeMy WebLinkAboutAgreement A-22-208 with Kings View.pdf Agreement No.22-208
1 AGREEMENT
2
3 THIS AGREEMENT is made and entered into this 17th day of May, 2022, by and between the
4 COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as
5 "COUNTY", and KINGS VIEW, a private Non-profit, 501 (c) (3), Organization, whose address is 7170 N
6 Financial Dr, Ste 110, Fresno, CA 93720, hereinafter referred to as "CONTRACTOR" (collectively the
7 "parties").
8 WITNESSETH:
9 WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), is in need of a qualified
10 agency to operate a Projects for Assistance in Transition from Homelessness (PATH) program to deliver
11 integrated mental health and supportive housing services to adults who are homeless, or who are at
12 imminent risk of becoming homeless, and have a severe mental illness and/or co-occurring disorder, in an
13 effort to enable this population to live in the community and to avoid homelessness, hospitalization and/or
14 jail detention.
15 WHEREAS, COUNTY, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of the
16 California Code of Regulations (C.C.R.), section 1810.226; and
17 WHEREAS, CONTRACTOR is qualified and willing to operate said PATH program and provide
18 PATH services pursuant to the terms and conditions of this Agreement.
19 WHEREAS, COUNTY entered into Agreements No. A-21-214 and No. A-21-214-1 with
20 CONTRACTOR, whose legal entity name was incorrectly referred to as "KINGS VIEW CORPORATION."
21 WHEREAS, this Agreement shall be retroactive to July 1, 2021, and shall replace, restate, and
22 supersede Agreements No. A-21-214 and No. A-21-214-1 in their entirety.
23 NOW, THEREFORE, in consideration of the mutual covenants, terms and conditions herein
24 contained, the parties hereto agree as follows:
25 1. SERVICES
26 A. CONTRACTOR shall perform all services and fulfill all responsibilities as set forth in
27 Exhibit A, "Projects for Assistance in Transition from Homelessness (PATH) Program, Scope of
28
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1 Work," attached hereto and by this reference incorporated herein and made part of this
2 Agreement.
3 B. CONTRACTOR shall also perform all services and fulfill all responsibilities as specified in
4 COUNTY's Request for Proposal (RFP) No. 20-044 dated February 19, 2020, Addendum No.
5 One (1) to COUNTY'S RFP No. 20-044 dated March 16, 2020 and Addendum No. Two (2) to
6 COUNTY's RFP NO. 20-044 dated March 19, 2020, herein collectively referred to as COUNTY's
7 Revised RFP, and CONTRACTOR's Response to said Revised RFP dated May 28, 2020, all
8 incorporated herein by reference and made part of this Agreement. In the event of any
9 inconsistency among these documents, the inconsistency shall be resolved by giving
10 precedence in the following order of priority to: 1) this Agreement, including all Exhibits, 2) the
11 Revised RFP, and 3) CONTRACTOR's Response to the Revised RFP. A copy of COUNTY's
12 Revised RFP No. 20-044 and CONTRACTOR's Response thereto shall be retained and made
13 available during the term of this Agreement by COUNTY's DBH Contracted Services Division.
14 C. CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
15 consisting of staff from COUNTY's DBH Administrative unit to discuss PATH requirements, data
16 reporting, training, policies and procedures, overall program operations and any problems or
17 foreseeable problems that may arise.
18 D. CONTRACTOR shall provide Outreach, Engagement, Linkage, and Specialty Mental
19 Health Services in accordance with the vision, mission, and guiding principles of the COUNTY's
20 DBH, as further described in Exhibit B, "Guiding Principles of Care Delivery," attached hereto
21 and by this reference incorporated herein and made part of this Agreement.
22 E. CONTRACTOR shall maintain requirements as an organizational provider throughout the
23 term of this Agreement, as described in Section Fifteen (15) of this Agreement. If for any reason,
24 this status is not maintained, COUNTY may terminate this Agreement pursuant to Section Three
25 (3) of this Agreement.
26 F. It is acknowledged by all parties hereto that COUNTY's DBH Administrative unit shall
27 monitor PATH program operated by CONTRACTOR, in accordance with Section Thirteen (13) of
28 this Agreement.
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1 2. TERM
2 The term of this Agreement shall be for a period of three (3) years, commencing on the 1 st day of
3 July, 2021 and terminating on the 30' day of June, 2024. This Agreement may be extended for two (2)
4 additional consecutive twelve (12) month periods upon written approval of both parties no later than thirty
5 (30) days prior to the first day of the next twelve (12) month extension period. The Director or their
6 designee is authorized to execute such written approval on behalf of COUNTY based on CONTRACTOR'S
7 satisfactory performance. The Director or their designee is authorized to execute such written approval on
8 behalf of COUNTY based on CONTRACTOR'S satisfactory performance.
9 This Agreement, subject to satisfactory outcomes performance and subject to available State
10 funding each year, shall automatically be extended for two (2) additional twelve (12) month periods upon
11 the same terms and conditions herein set forth, unless written notice of non-renewal is given by COUNTY
12 or CONTRACTOR or COUNTY's DBH Director or designee, not later than thirty (30) days prior to the close
13 of the current Agreement term.
14 3. TERMINATION
15 A. Non-Allocation of Funds- The terms of this Agreement, and the services to be provided
16 hereunder, are contingent on the approval of funds by the appropriating government agency.
17 Should sufficient funds not be allocated, the services provided may be modified, or this
18 Agreement terminated, at any time by giving the CONTRACTOR thirty (30) days advance
19 written notice.
20 B. Breach of Contract- The COUNTY may immediately suspend or terminate this Agreement
21 in whole or in part, where in the determination of the COUNTY there is:
22 1) An illegal or improper use of funds;
23 2) A failure to comply with any term of this Agreement;
24 3) A substantially incorrect or incomplete report submitted to the COUNTY;
25 4) Improperly performed service.
26 In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any breach
27 of this Agreement or any default which may then exist on the part of the CONTRACTOR. Neither shall such
28 payment impair or prejudice any remedy available to the COUNTY with respect to the breach or default.
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1 The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the COUNTY of any
2 funds disbursed to the CONTRACTOR under this Agreement, which in the judgment of the COUNTY were
3 not expended in accordance with the terms of this Agreement. The CONTRACTOR shall promptly refund
4 any such funds upon demand.
5 C. Without Cause - Under circumstances other than those set forth above, this Agreement may
6 be terminated by COUNTY upon the giving of sixty (60) days advance written notice of an
7 intention to terminate to CONTRACTOR.
8 4. COMPENSATION:
9 COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive compensation for
10 actual expenditures incurred in accordance with the CONTRACTOR's budget documents approved by the
11 COUNTY's DBH Director or designee and attached hereto as Exhibit C and incorporated herein by this
12 reference.
13 The maximum amount to be paid to CONTRACTOR by COUNTY under this Agreement for the
14 twelve (12) month period, (July 1, 2021 through June 30, 2022), shall not exceed Nine Hundred-Five
15 Thousand, One Hundred Seventy-Two and No/100 Dollars ($905,172). This is comprised of the
16 following funding streams: Three Hundred-Eight Thousand and No/100 Dollars ($308,000.00) in PATH
17 Grant funds, Sixty-Six Thousand, Four Hundred Sixty-Eight and No/100 Dollars ($66,468.00) in HHAP
18 Grant funds, One Hundred Seventy-Two Thousand, Five Hundred Thirty-Three and No/100 Dollars
19 ($172,533.00) in local MHSA funds, One Hundred Twenty-Three Thousand, Two Hundred Sixty-Nine
20 and No/100 Dollars ($123,269.00) in Federal Financial Participation (FFP), One Thousand-Two and
21 No/100 Dollars ($1,002.00) in Client Rents, One Hundred-Forty Thousand and No/100 Dollars
22 ($140,000.00) in CARES Act funds, Ninety-Three Thousand, and Nine Hundred and No/100 Dollars
23 ($93,900.00) in CDBG-CV funds, to offset CONTRACTOR's program costs as set forth in Exhibit C.
24 The maximum amount to be paid to CONTRACTOR by COUNTY under this Agreement for the
25 following twelve (12) month period, (July 1, 2022 through June 30, 2023), shall not exceed One Million,
26 One Hundred Thirty-Eight Thousand, Two Hundred-Seven and No/100 Dollars ($1,138,207.00). This is
27 comprised of the following funding streams: Four Hundred Ninety-nine Thousand, One Hundred Forty-
28 One and No/100 ($499,141.00) in ARPA funds, Three Hundred-Eight Thousand and No/100 Dollars
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1 ($308,000.00) in PATH Grant funds, One Hundred Seventy-Two Thousand, Five Hundred Thirty-Three
2 and No/100 Dollars ($172,533.00) in local MHSA funds, One Hundred Fifty-Seven Thousand, Five
3 Hundred Thirty-One and No/100 Dollars in FFP ($157,531.00), and One Thousand-Two and No/100
4 Dollars ($1,002.00) in Client Rents to offset the CONTRACTOR's program costs as set forth in Exhibit
5 C.
6 The maximum amount to be paid to CONTRACTOR by COUNTY under this Agreement for the
7 following twelve (12) month period, (July 1, 2023 through June 30, 2024), shall not exceed One Million,
8 One Hundred Sixty Thousand, Seven Hundred Thirty-Nine, and No/100 Dollars ($1,160,739.00). This is
9 comprised of the following funding streams: Five Hundred Twenty-One Thousand, Six Hundred
10 Seventy-Three and No/100 Dollars ($521,673.00) in ARPA funds, Three Hundred-Eight Thousand and
11 No/100 Dollars ($308,000.00) in PATH Grant funds, One Hundred Seventy-Two Thousand, Five
12 Hundred Thirty-Three and No/100 Dollars ($172,533.00) in local MHSA funds, One Hundred Fifty-Seven
13 Thousand, Five Hundred Thirty-One and No/100 Dollars in FFP ($157,531.00), and One Thousand-Two
14 and No/100 Dollars ($1,002.00) in Client Rents to offset the CONTRACTOR's program costs as set forth
15 in Exhibit C.
16 The maximum amount to be paid to CONTRACTOR by COUNTY under this Agreement for the
17 following twelve (12) month period, (July 1, 2024 through June 30, 2025), shall not exceed Six Hundred
18 Thirty-Nine Thousand, Sixty-Six and No/100 Dollars ($639,066.00). This is comprised of the following
19 funding streams: Three Hundred-Eight Thousand and No/100 Dollars ($308,000.00) in PATH Grant
20 funds, One Hundred Seventy-Two Thousand, Five Hundred Thirty-Three and No/100 Dollars
21 ($172,533.00) in local MHSA funds, One Hundred Fifty-Seven Thousand, Five Hundred Thirty-One and
22 No/100 Dollars in FFP ($157,531.00), One Thousand-Two and No/100 Dollars ($1,002.00) in Client
23 Rents to offset the CONTRACTOR's program costs as set forth in Exhibit C.
24 The maximum amount to be paid to CONTRACTOR by COUNTY under this Agreement for the
25 following twelve (12) month period, (July 1, 2025 through June 30, 2026), shall not exceed Six Hundred
26 Thirty-Nine Thousand, Sixty-Six and No/100 Dollars ($639,066.00). This is comprised of the following
27 funding streams: Three Hundred-Eight Thousand and No/100 Dollars ($308,000.00) in PATH Grant
28 funds, One Hundred Seventy-Two Thousand, Five Hundred Thirty-Three and No/100 Dollars
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1 ($172,533.00) in local MHSA funds, One Hundred Fifty-Seven Thousand, Five Hundred Thirty-One and
2 No/100 Dollars in FFP ($157,531.00), and One Thousand-Two and No/100 Dollars ($1,002.00) in Client
3 Rents to offset the CONTRACTOR's program costs as set forth in Exhibit C.
4 In no event shall services performed under this Agreement be in excess of Four Million, Four Hundred
5 Eighty-Two Thousand, Two Hundred Fifty and No/100 Dollars ($4,482,250.00) during the term of this
6 Agreement. It is understood that all expenses incidental to CONTRACTOR'S performance of services
7 under this Agreement shall be borne by CONTRACTOR.
8 It is understood by COUNTY and CONTRACTOR that any Medi-Cal FFP above the amounts stated
9 herein will be used to directly offset COUNTY's contribution of PATH grant and MHSA funds as identified in
10 Exhibit C, and may be used to expand program services to clients and/or increase client program capacity
11 with the written approval of COUNTY's DBH Director. The offset of funds will also be clearly identified in
12 monthly invoices received from CONTRACTOR as further described in Section Five (5) of this Agreement.
13 If CONTRACTOR fails to generate the Medi-Cal revenue and/or client rent payment amounts set
14 forth in Exhibit C, COUNTY shall not be obligated to pay the difference between these estimated amounts
15 and the actual amounts generated.
16 Prior to March 1 st of each contract year, CONTRACTOR may provide to COUNTY's DBH an
17 updated budget and budget narrative in the format identified in Exhibit C for the upcoming twelve (12)
18 month period. Each budget shall require justification by the CONTRACTOR, and written approval of
19 COUNTY's DBH Director or designee, prior to April 1 st for the upcoming twelve (12) month period covered
20 by said budget. An approved updated budget and budget narrative shall become part of this Agreement
21 upon written approval of COUNTY's DBH Director or designee. If said budget is not received by the March
22 1 st due date, the budget for the upcoming twelve (12) month period will remain at the prior year's funding
23 level. The amount of said approved budget shall not exceed the maximum compensation for the current
24 Agreement period.
25 Travel shall be reimbursed based on actual expenditures and mileage reimbursement shall be at
26 CONTRACTOR's adopted rate per mile, not to exceed the Federal Internal Revenue Services (IRS)
27 published rate.
28 If CONTRACTOR fails to comply with any provision of this Agreement, COUNTY shall be relieved
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1 of its obligation for further compensation.
2 Payments shall be made by COUNTY to CONTRACTOR in arrears for services provided during the
3 preceding month, within forty-five (45) days after the date of receipt and approval by COUNTY of the
4 monthly invoicing as described in Section Five (5) herein. Payments shall be made after receipt and
5 verification of actual expenditures incurred by CONTRACTOR for monthly program costs, as identified in
6 Exhibit C, in the performance of this Agreement and shall be documented to COUNTY on a monthly basis
7 by the tenth (10th) of the month following the month of said expenditures.
8 COUNTY shall not be obligated to make any payments under this Agreement if the request for
9 payment is received by COUNTY more than sixty (60) days after this Agreement has terminated or expired.
10 All final invoices and/or any final budget modification requests shall be submitted by
11 CONTRACTOR within sixty (60) days following the final month of service for which payment is claimed. No
12 action shall be taken by COUNTY on invoices submitted beyond the sixty (60) day closeout period. Any
13 compensation which is not expended by CONTRACTOR pursuant to the terms and conditions of this
14 Agreement shall automatically revert to COUNTY.
15 The services provided by CONTRACTOR under this Agreement are funded in whole or in part by
16 the State of California. In the event that funding for these services is delayed by the State Controller,
17 COUNTY may defer payments to CONTRACTOR. The amount of the deferred payment shall not exceed
18 the amount of funding delayed by the State Controller to the COUNTY. The period of time of the deferral
19 by COUNTY shall not exceed the period of time of the State Controller's delay of payment to COUNTY plus
20 forty-five (45) days.
21 CONTRACTOR shall be held financially liable for any and all future disallowances/audit exceptions
22 due to CONTRACTOR deficiency discovered through the State audit process and COUNTY utilization
23 review during the course of this Agreement. At COUNTY's election, the disallowed amount will be remitted
24 within forty-five (45) days to COUNTY upon notification or shall be withheld from subsequent payments to
25 CONTRACTOR. CONTRACTOR shall not receive reimbursement for any units of services rendered that
26 are disallowed or denied by the COUNTY's DBH utilization review process or through the State Department
27 of Health Care Services (DHCS) cost report audit settlement process for Medi-Cal eligible clients.
28 Notwithstanding the above, COUNTY must notify CONTRACTOR prior to any State audit process and/or
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1 COUNTY utilization review. To the extent allowable by law, CONTRACTOR shall have the right to be
2 present during each phase of any State audit process and/or COUNTY utilization review and shall be
3 provided all documentation related to each phase of any State audit process and/or COUNTY utilization
4 review. Additionally, prior to any disallowances/audit exceptions becoming final, CONTRACTOR shall be
5 given at least ten (10) business days to respond to such proposed disallowances/audit exceptions.
6 It is understood by CONTRACTOR and COUNTY that this Agreement is funded with PATH grant,
7 HHAP grant, MHSA funds, Medi-Call FFP, and client rents funds to serve adults, many of whom have
8 mental health and co-occurring substance use disorders. It is further understood by CONTRACTOR and
9 COUNTY that funds shall be used to support appropriately integrated and documented treatment services
10 for co-occurring mental health and substance use disorders and that integrated services can be
11 documented in assessments, interventions, and program notes documenting linkages and services.
12 5. INVOICING
13 CONTRACTOR shall invoice COUNTY in arrears by the tenth (10t")day of each month for actual
14 expenses incurred during the prior month electronically to: 1) dbhinvoicereview(a-)_fresnocountyca.gov, 2)
15 dbh-invoices(c�fresnocountyca.gov; and 3) dbhcontractedservicesdivision(c�fresnocountyca.gov with a copy
16 to the assigned COUNTY's DBH Staff Analyst. After CONTRACTOR renders service to referred clients,
17 CONTRACTOR shall invoice COUNTY for payment, certify the expenditure, and submit electronic claiming
18 data into COUNTY's electronic information system for all clients, including those eligible for Medi-Cal as
19 well as those that are not eligible for Medi-Cal. Invoices and reports shall be in such detail as acceptable to
20 COUNTY's DBH, as described herein and in Section Fourteen (14) of this Agreement. Billing information
21 must include the client's name, client ID number, date of service, type of mental health service provided,
22 duration of service, client's International Classification of Diseases (ICD) diagnosis, service provider name,
23 units of service provided, rate of service provided, and actual amount of service. No reimbursement for
24 costs incurred by CONTRACTOR for services delivered under this Agreement shall be made until the
25 invoice and supporting documentation is received, verified, and approved by COUNTY's DBH. COUNTY
26 must pay CONTRACTOR before submitting a claim to DHCS for Federal reimbursement for Medi-Cal
27 eligible clients.
28 If CONTRACTOR chooses to utilize the COUNTY's electronic health record system (currently
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1 AVATAR, the preferred EHR system by DBH) method as their own full electronic health records system,
2 COUNTY's DBH shall invoice CONTRACTOR in arrears by the fifth (5th) day of each month for the prior
3 month's hosting fee for access to the COUNTY's electronic information system. COUNTY shall invoice
4 CONTRACTOR annually for the annual maintenance and licensing fee for access to the COUNTY's
5 electronic information system. COUNTY shall invoice CONTRACTOR annually for the Reaching Recovery
6 fee, as applicable, for access to the COUNTY's electronic information system. CONTRACTOR shall
7 provide payment for these expenditures to COUNTY's Fresno County Department of Behavioral Health,
8 Accounts Receivable, P.O. Box 712, Fresno, CA 93717-0712, Attention: Business Office, within forty-five
9 (45) days after the date of receipt by CONTRACTOR of the invoicing provided by COUNTY.
10 At the discretion of COUNTY's DBH Director or designee, if an invoice is incorrect or is otherwise not
11 in proper form or substance, COUNTY's DBH Director or designee, shall have the right to withhold payment
12 as to only that portion of the invoice that is incorrect or improper after five (5) days prior notice to
13 CONTRACTOR. CONTRACTOR agrees to continue to provide services for a period of ninety (90) days
14 after notification of an incorrect or improper invoice. If after the ninety (90) day period, the invoice is still not
15 corrected to COUNTY DBH's satisfaction, COUNTY's DBH Director or designee, may elect to terminate
16 this Agreement, pursuant to the termination provisions stated in Section Three (3) of this Agreement. In
17 addition, for invoices received ninety (90) days after the expiration of each term of this Agreement or
18 termination of this Agreement, at the discretion of COUNTY's DBH Director or designee, COUNTY's DBH
19 shall have the right to deny payment of any additional invoices received.
20 CONTRACTOR shall submit monthly invoices and general ledgers to COUNTY's DBH that itemize
21 the line item charges for monthly program costs. Unallowable costs such as lobbying or political donations
22 must be deducted from the monthly invoice reimbursements. The invoices and general ledgers will serve
23 as tracking tools to determine if CONTRACTOR's program costs are in accordance with its budgeted cost.
24 Failure to submit reports and other supporting documentation shall be deemed sufficient cause for
25 COUNTY to withhold payments until there is compliance, as further described in Section Five (5) herein.
26 CONTRACTOR must report all third party collections from other funding sources for Medicare,
27 private insurance, client private pay or any other third party. Monthly invoices for reimbursement must
28 equal the amount due CONTRACTOR less any funding sources not eligible for Federal reimbursement and
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1 any other revenues generated by CONTRACTOR (i.e., private insurance, etc.).
2 CONTRACTOR shall submit monthly staffing reports that identify all direct service and support staff,
3 applicable licensure/certifications, and full time hours worked to be used as a tracking tool to determine if
4 CONTRACTOR's program is staffed according to the services provided under this Agreement.
5 CONTRACTOR must maintain financial records for a period of seven (7) years or until any dispute,
6 audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible for any
7 disallowances related to inadequate documentation.
8 CONTRACTOR is responsible for collecting and managing of data in a manner to be determined by
9 DHCS and COUNTY's DBH in accordance with applicable rules and regulations. COUNTY's electronic
10 information system is a critical source of information for purposes of monitoring service volume and
11 obtaining reimbursement. CONTRACTOR must attend the COUNTY's DBH training on equipment
12 reporting for assets, intangible and sensitive minor assets, COUNTY's electronic information system, and
13 related cost reporting.
14 CONTRACTOR shall submit service data into COUNTY's electronic information system within thirty
15 (30) calendar days from the date of services were rendered.
16 CONTRACTOR must provide all necessary data to allow COUNTY to bill Medi-Cal, and any other
17 third-party source, for services and meet State and Federal reporting requirements. The necessary data
18 can be provided by a variety of means, including but not limited to: 1) direct data entry into COUNTY's
19 electronic information system; 2) providing an electronic file compatible with COUNTY's electronic
20 information system; or 3) integration between COUNTY's electronic information system and
21 CONTRACTOR's information system(s).
22 If a client has dual coverage, such as other health coverage (OHC) or Federal Medicare,
23 CONTRACTOR will be responsible for billing the carrier and obtaining a payment/denial or have validation
24 of claiming with no response ninety (90) days after the claim was mailed before the service can be entered
25 into COUNTY's electronic information system. CONTRACTOR must report all third-party collections or
26 revenue for Medicare, third party, client pay, or private pay in each monthly invoice and in the annual cost
27 report that is required to be submitted. A copy of explanation of benefits or CMS 1500 form is required as
28 documentation. CONTRACTOR shall submit monthly invoices for reimbursement that equal the amount
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1 due CONTRACTOR less any funding sources not eligible for Federal and State reimbursement.
2 CONTRACTOR must comply with all laws and regulations governing the Federal Medicare program,
3 including, but not limited to: 1)the requirement of the Medicare Act, 42 U.S.C. section 1395 et seq; and 2)
4 the regulation and rules promulgated by the Federal Centers for Medicare and Medicaid Services as they
5 relate to participation, coverage and claiming reimbursement. CONTRACTOR will be responsible for
6 compliance as of the effective date of each Federal, State or local law or regulation specified.
7 Data entry into the COUNTY's electronic information system shall be the responsibility of
8 CONTRACTOR. COUNTY shall monitor the volume of services and cost of services entered into
9 COUNTY's electronic information system. Any and all audit exceptions resulting from the provision and
10 reporting of specialty mental health services by CONTRACTOR shall be the sole responsibility of
11 CONTRACTOR. CONTRACTOR will comply with all applicable policies, procedures, directives and
12 guidelines regarding the use of COUNTY's electronic information system.
13 Medi-Cal and Mental Health Plan Compliance
14 CONTRACTOR shall establish and maintain Medi-Cal certification or become certified within ninety
15 (90) days of the execution of this Agreement through COUNTY's DBH. In addition, CONTRACTOR shall
16 work with COUNTY's DBH to execute the process if not currently certified by COUNTY for credentialing of
17 staff. Service location must be approved by COUNTY's DBH during the Medi-Cal certification process.
18 During this process, the CONTRACTOR shall obtain a legal entity number established by DHCS as this is a
19 requirement for maintaining COUNTY's MHP Organizational Provider status throughout the term of this
20 Agreement. CONTRACTOR shall become Medi-Cal certified prior to providing services to Medi-Cal eligible
21 clients and seeking reimbursement from the COUNTY. CONTRACTOR will not be reimbursed by COUNTY
22 for any services rendered prior to Medi-Cal certification. CONTRACTOR shall comply with any and all
23 requests and directives associated with COUNTY maintaining State Medi-Cal site certification.
24 CONTRACTOR shall provide specialty mental health services in accordance with COUNTY's MHP.
25 CONTRACTOR must comply with the "Fresno County Mental Health Plan Compliance Program and Code
26 of Conduct" set forth in Exhibit D, attached hereto and incorporated herein by reference and made part of
27 this Agreement.
28 CONTRACTOR may provide direct specialty mental health services using unlicensed staff as long
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1 as the CONTRACTOR is approved as an Organizational Provider by the COUNTY's MHP and the
2 individual is supervised by licensed staff who meet the Board of Behavioral Sciences requirements for
3 supervision, works within his/her scope, and only delivers allowable direct specialty mental health services.
4 Unlicensed staff must also be credentialed by COUNTY's MHP.
5 It is understood that each service is subject to audit for compliance with Federal and State
6 regulations, and that COUNTY may be making payments in advance of said review. In the event that a
7 service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set off from other
8 payments due the amount of said disapproved services. CONTRACTOR shall be responsible for audit
9 exceptions to ineligible dates of services or incorrect application of utilization review requirements.
10 CONTRACTOR shall comply with any and all requests associated with any State and/or Federal reviews or
11 audits.
12 6. INDEPENDENT CONTRACTOR:
13 In performance of the work, duties and obligations assumed by CONTRACTOR under this
14 Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of the
15 CONTRACTOR'S officers, agents, and employees will at all times be acting and performing as an
16 independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
17 employee,joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right
18 to control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and
19 function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
20 CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
21 CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules and
22 regulations, if any, of governmental authorities having jurisdiction over matters the subject thereof.
23 Because of its status as an independent contractor, CONTRACTOR shall have absolutely no right
24 to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be solely liable
25 and responsible for providing to, or on behalf of, its employees all legally-required employee benefits. In
26 addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all matters relating
27 to payment of CONTRACTOR'S employees, including compliance with Social Security withholding and all
28 other regulations governing such matters. It is acknowledged that during the term of this Agreement,
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1 CONTRACTOR may be providing services to others unrelated to the COUNTY or to this Agreement.
2 7. MODIFICATION
3 Any matters of this Agreement may be modified from time to time by the written consent of all the
4 parties without, in any way, affecting the remainder.
5 Notwithstanding the above, changes to staffing, services, and responsibilities of the
6 CONTRACTOR, as needed, to accommodate changes in the laws relating to mental health treatment, as
7 set forth in Exhibit C, may be made with the signed written approval of COUNTY's DBH Director or
8 designee CONTRACTOR through an amendment approved by COUNTY's Counsel and the COUNTY's
9 Auditor-Controller/Treasurer-Tax Collector's Office.
10 In addition, changes to expense category (i.e., Salary & Benefits, Facilities/Equipment, Operating,
11 Financial Services, Special Expenses, Fixed Assets, etc.) subtotals in the individual program budgets, and
12 changes to the volume of units of service/types of service units to be provided as set forth in Exhibit C, that
13 do not exceed ten percent (10%) of the maximum compensation payable to CONTRACTOR, may be made
14 with the written approval of COUNTY's DBH Director or designee.
15 Modifications shall not result in any change to the maximum compensation amounts payable to
16 CONTRACTOR, as stated in this Agreement
17 8. NON-ASSIGNMENT
18 No party shall assign, transfer or sub-contract this Agreement nor their rights or duties under this
19 Agreement without the prior written consent of COUNTY.
20 9. HOLD HARMLESS
21 CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY'S request, defend the
22 COUNTY, its officers, agents, and employees from any and all costs and expenses (including attorney's
23 fees and costs), damages, liabilities, claims, and losses occurring or resulting to COUNTY in connection
24 with the performance, or failure to perform, by CONTRACTOR, its officers, agents, or employees under this
25 Agreement, and from any and all costs and expenses (including attorney's fees and costs), damages,
26 liabilities, claims, and losses occurring or resulting to any person, firm, or corporation who may be injured
27 or damaged by the performance, or failure to perform, of CONTRACTOR, its officers, agents, or
28 employees under this Agreement.
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1 CONTRACTOR agrees to indemnify COUNTY for Federal, State of California and/or local audit
2 exceptions resulting from noncompliance herein on the part of CONTRACTOR.
3 10. INSURANCE
4 Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any third
5 parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following insurance
6 policies or a program of self-insurance, including but not limited to, an insurance pooling arrangement or
7 Joint Powers Agreement (JPA)throughout the term of the Agreement:
8 A. Commercial General Liability
9 Commercial General Liability Insurance with limits of not less than Two Million Dollars
10 ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00). This
11 policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
12 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
13 liability or any other liability insurance deemed necessary because of the nature of this contract.
14 B. Automobile Liability
15 Comprehensive Automobile Liability Insurance with limits of not less than Two Million Dollars
16 ($2,000,000.00) per accident for bodily injury and for property damages. Coverage should include any auto
17 used in connection with this Agreement.
18 C. Professional Liability
19 If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W., M.F.C.C.) in
20 providing services, Professional Liability Insurance with limits of not less than One Million Dollars
21 ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
22 D. Worker's Compensation
23 A policy of Worker's Compensation insurance as may be required by the California Labor Code.
24 E. Sexual Abuse / Molestation Liability
25 Sexual abuse/molestation liability insurance with limits of not less than One Million Dollars
26 ($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This policy
27 shall be issued on a per occurrence basis.
28
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1 In the event, the CONTRACTOR purchases an Umbrella or Excess insurance policy(ies) to meet
2 the "Minimum Limits of Insurance," this insurance policy(ies) shall "follow form" and afford no less
3 coverage than the primary insurance policy(ies). In addition, such Umbrella or Excess insurance
4 policy(ies) shall also apply on a primary and non-contributory basis for the benefit of the COUNTY, its
5 officers, officials, employees, agents and volunteers.
6 F. Real and Personal Property
7 CONTRACTOR shall maintain a policy of insurance for all risk personal property coverage which
8 shall be endorsed naming the County of Fresno as an additional loss payee. The personal property
9 coverage shall be in an amount that will cover the total of the County purchased and owned property, at
10 a minimum, as discussed in Section Twenty (20) of this Agreement.
11 G. All Risk Personal Property
12 CONTRACTOR will provide property coverage for the full replacement value of the County's
13 Personal Property in the possession of Contractor and/or used in the execution of this agreement.
14 County will be identified on an appropriate certificate of insurance as the certificate holder and will be
15 named as an Additional Loss Payee on the Property Insurance Policy.
16 H. Cyber Liability
17 Effective May 17, 2022, CONTRACTOR shall maintain Cyber Liability Insurance, with limits not
18 less than $2,000,000 per occurrence or claim, $2,000,000 aggregate. Coverage shall be sufficiently
19 broad to respond to the duties and obligations as is undertaken by CONTRACTOR in this Agreement
20 and shall include, but not be limited to, claims involving infringement of intellectual property, including
21 but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations,
22 information theft, damage to or destruction of electronic information, release of private information,
23 alteration of electronic information, extortion and network security. The policy shall provide coverage for
24 breach response costs as well as regulatory fines and penalties as well as credit monitoring expenses
25 with limits sufficient to respond to these obligations.
26 Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security Breaches, which may
27 include Disclosure of Personal Information to an Unauthorized Third Party; (ii) breach of any of the
28 Contractor's obligations under Section # of this Agreement; (iii) infringement of intellectual property,
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1 including but not limited to infringement of copyright, trademark, and trade dress; (iv) invasion of privacy,
2 including release of private information; (v) information theft; (vi) damage to or destruction or alteration
3 of electronic information; (vii) extortion related to the Contractor's obligations under this Agreement
4 regarding electronic information, including Personal Information; (viii) network security; (ix) data breach
5 response costs, including Security Breach response costs; (x) regulatory fines and penalties related to
6 the Contractor's obligations under this Agreement regarding electronic information, including Personal
7 Information; and (xi) credit monitoring expenses.
8 I. Technology Professional Liability(Errors and Omissions)
9 Effective May 17, 2022, CONTRACTOR shall maintain technology professional liability (errors and
10 omissions) with limits of not less than Two Million Dollars ($2,000,000) per occurrence. Coverage must
11 encompass all of the Contractor's obligations under this Agreement, including but not limited to claims
12 involving Cyber Risks.
13 Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security Breaches,
14 which may include Disclosure of Personal Information to an Unauthorized Third Party; (ii) breach of any
15 of the Contractor's obligations under Section # of this Agreement; (iii) infringement of intellectual
16 property, including but not limited to infringement of copyright, trademark, and trade dress; (iv) invasion
17 of privacy, including release of private information; (v) information theft; (vi) damage to or destruction or
18 alteration of electronic information; (vii) extortion related to the Contractor's obligations under this
19 Agreement regarding electronic information, including Personal Information; (viii) network security; (ix)
20 data breach response costs, including Security Breach response costs; (x) regulatory fines and
21 penalties related to the Contractor's obligations under this Agreement regarding electronic information,
22 including Personal Information; and (xi) credit monitoring expenses.
23 Additional Requirements Relating to Insurance
24 CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance naming
25 the County of Fresno, its officers, agents, and employees, individually and collectively, as additional
26 insured, but only insofar as the operations under this Agreement are concerned. Such coverage for
27 additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained
28 by COUNTY, its officers, agents and employees shall be excess only and not contributing with insurance
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1 provided under CONTRACTOR's policies herein. This insurance shall not be cancelled or changed without
2 a minimum of thirty (30) days advance written notice given to COUNTY.
3 CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
4 employees any amounts paid by the policy of worker's compensation insurance required by this
5 Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
6 necessary to accomplish such waiver of subrogation, but CONTRACTOR's waiver of subrogation under
7 this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
8 Within Thirty (30) days from the date CONTRACTOR signs and executes this Agreement,
9 CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the
10 foregoing policies, as required herein, to the County of Fresno, (Name and Address of the official who will
11 administer this contract or electronically to dbh contracted servicesdivis ion(a)fresnocountyca.gov with a copy
12 to the assigned COUNTY's DBH Staff Analyst), stating that such insurance coverages have been obtained
13 and are in full force; that the County of Fresno, its officers, agents and employees will not be responsible for
14 any premiums on the policies; that such Commercial General Liability insurance names the County of
15 Fresno, its officers, agents and employees, individually and collectively, as additional insured, but only
16 insofar as the operations under this Agreement are concerned; that such coverage for additional insured
17 shall apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its
18 officers, agents and employees, shall be excess only and not contributing with insurance provided under
19 CONTRACTOR's policies herein; and that this insurance shall not be cancelled or changed without a
20 minimum of thirty (30) days advance, written notice given to COUNTY.
21 In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
22 provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
23 Agreement upon the occurrence of such event.
24 All policies shall be issued by admitted insurers licensed to do business in the State of California,
25 and such insurance shall be purchased from companies possessing a current A.M. Best, Inc. rating of A
26 FSC VI or better.
27 HI
28 11. LICENSES/CERTIFICATES
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1 Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR's staff shall
2 maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for the
3 provision of the services hereunder and required by the laws and regulations of the United States of
4 America, State of California, the County of Fresno, and any other applicable governmental agencies.
5 CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
6 licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
7 appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR's staff shall comply with all
8 applicable laws, rules or regulations, as may now exist or be hereafter changed.
9 12. RECORDS
10 CONTRACTOR shall maintain its records in COUNTY's EHR system (currently Avatar) in
11 accordance with Exhibit E, "Documentation Standards for Client Records," attached hereto and
12 incorporated herein by reference and made part of this Agreement. The client record shall begin with
13 registration and intake and include client authorizations, assessments, plans of care, and progress notes,
14 as well as other documents as approved by the COUNTY's DBH. COUNTY shall be allowed to review
15 records of services provided, including the goals and objectives of the treatment plan, and how the therapy
16 provided is achieving the goals and objectives. If CONTRACTOR determines to maintain its records in
17 COUNTY's EHR system, it shall provide COUNTY's DBH Director, or designee, with a thirty (30) day
18 notice. If at any time CONTRACTOR chooses not to maintain its records in COUNTY's EHR system, it
19 shall provide COUNTY'S DBH Director, or designee, with a thirty (30) day notice and CONTRACTOR will
20 be responsible for obtaining its own system, at its own cost, for Electronic Health Record management.
21 Disclaimer—COUNTY makes no warranty or representation that information entered into the COUNTY's
22 EHR system by CONTRACTOR will be accurate, adequate or satisfactory for CONTRACTOR's own
23 purposes or that any information in CONTRACTOR's possession or control, or transmitted or received by
24 CONTRACTOR, is or will be secure from unauthorized access, viewing, use, disclosure, or breach.
25 CONTRACTOR is solely responsible for client information entered by CONTRACTOR into the COUNTY's
26 EHR system. CONTRACTOR agrees that all Private Health Information (PHI) maintained by
27 CONTRACTOR in COUNTY's EHR system will be maintained in conformance with all Health Insurance
28 Portability and Accountability Act (HIPAA) laws, as stated in Section Eighteen (18), "Health Insurance
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1 Portability and Accountability Act".
2 COUNTY shall be allowed to review all records of services provided, including the goals and
3 objectives of the treatment plan, and how the therapy provided is achieving the goals and objectives. All
4 mental health records shall be considered the property of the COUNTY and shall be retained by the
5 COUNTY upon termination or expiration of this Agreement.
6 13. REPORTS
7 A. Outcome Reports
8 CONTRACTOR shall submit to COUNTY's DBH service outcome reports as requested by
9 COUNTY's DBH. Outcome reports and outcome requirements are subject to change at COUNTY's
10 DBH discretion.
11 CONTRACTOR shall submit to COUNTY's designated Staff Analyst, quarterly and annual
12 reports detailing the status of meeting objectives as stated and described in Exhibit F, attached hereto
13 and incorporated herein by reference. COUNTY will require an explanation of any deviation greater than
14 10% from the stated objective.
15 B. PATH Annual Report
16 COUNTY is responsible for providing an annual report to the State which will describe and
17 evaluate the PATH program for essential planning purposes, maintaining program accountability, and
18 monitoring. Therefore, CONTRACTOR is required to submit to the COUNTY's DBH Director or
19 Designee data in accordance with Exhibit G, "PATH PDX Annual Report," attached hereto and
20 incorporated herein by reference.
21 C. Additional Reports
22 CONTRACTOR shall also furnish to COUNTY such statements, records, reports, data, and other
23 information as COUNTY's DBH may request pertaining to matters covered by this Agreement. In the
24 event that CONTRACTOR fails to provide such reports or other information required hereunder, it shall
25 be deemed sufficient cause for COUNTY to withhold monthly payments until there is compliance. In
26 addition, CONTRACTOR shall provide written notification and explanation to COUNTY within five (5)
27 days of any funds received from another source to conduct the same services covered by this
28 Agreement.
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1 D. Cost Report
2 CONTRACTOR agrees to submit a complete and accurate detailed cost report on an annual
3 basis for each fiscal year ending June 30th in the format prescribed by the DHCS for the purposes of
4 Short Doyle Medi-Cal reimbursements and total costs for programs. The cost report will be the source
5 document for several phases of settlement with the DHCS for the purposes of Short Doyle Medi-Cal
6 reimbursement. CONTRACTOR shall report costs under their approved legal entity number established
7 during the Medi-Cal certification process. The information provided applies to CONTRACTOR for
8 program related costs for services rendered to Medi-Cal and non-Medi-Cal clients. CONTRACTOR will
9 remit a schedule to provide the required information on published charges (PC) for all authorized
10 services. The report will serve as a source document to determine their usual and customary charge
11 prevalent in the public mental health sector that is used to bill the general public, insurers, or other non-
12 Medi-Cal third party payers during the course of business operations. CONTRACTOR must report all
13 collections for Medi-Cal/Medicare services and collections. The CONTRACTOR shall also submit with
14 the cost report a copy of the CONTRACTOR's general ledger that supports revenues and expenditures
15 and reconciled detailed report of reported total units of services rendered under this Agreement to the
16 units of services reported by CONTRACTOR to COUNTY's electronic information system.
17 Cost Reports must be submitted to the COUNTY as a hard copy with a signed cover letter and
18 electronic copy of completed DHCS cost report form along with requested support documents following
19 each fiscal year ending June 30th. During the month of September of each year this Agreement is
20 effective, COUNTY will issue instructions of the annual cost report which indicates the training session,
21 DHCS cost report template worksheets, and deadlines to submit, as determined by State DHCS
22 annually. CONTRACTOR shall remit a hard copy of cost report to County of Fresno, Attention: Cost
23 Report Team, PO BOX 45003, Fresno CA 93718. CONTRACTOR shall remit the electronic copy or any
24 inquiries to DBHcostreportteam@fresnocountyca.gov.
25 All Cost Reports must be prepared in accordance with General Accepted Accounting Principles
26 (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3) and 5718(c).
27 Unallowable costs such as lobby or political donations must be deducted on the cost report and invoice
28 reimbursement.
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1 If the CONTRACTOR does not submit the cost report by the deadline, including any extension
2 period granted by the COUNTY, the COUNTY may withhold payments of pending invoicing under
3 compensation until the cost report has been submitted and clears COUNTY desk audit for
4 completeness.
5 E. Settlements with State Department of Health Care Services (DHCS)
6 During the term of this Agreement and thereafter, COUNTY and CONTRACTOR agree to settle
7 dollar amounts disallowed or settled in accordance with DHCS audit settlement findings related to the
8 reimbursement provided under this Agreement. CONTRACTOR will participate in the several phases of
9 settlements between COUNTY/CONTRACTOR and DHCS. The phases of initial cost reporting for
10 settlement according to State reconciliation of records for paid Medi-Cal services and audit settlement
11 are: State DHCS audit 1) initial cost reporting — after an internal review by COUNTY, the COUNTY files
12 the cost report with State DHCS on behalf of CONTRACTOR's legal entity for the fiscal year; 2)
13 Settlement— State reconciliation of records for paid Medi-Cal services, approximately 18 to 36 months
14 following the State close of the fiscal year, DHCS will send notice for any settlement under this provision
15 to COUNTY; and 3) Audit Settlement-State DHCS audit. After final reconciliation and settlement DHCS
16 may conduct a review of medical records, cost report along with support documents submitted to
17 COUNTY in initial submission to determine accuracy and may disallow costs and/or units of services.
18 COUNTY may choose to appeal and therefore reserves the right to defer payback settlement with
19 CONTRACTOR until resolution of the appeal. DHCS Audits will follow Federal Medicaid procedures for
20 managing overpayments.
21 If at the end of the Audit Settlement, COUNTY determines that it overpaid CONTRACTOR, it will
22 require CONTRACTOR to repay the Medi-Cal related overpayment back to COUNTY. Funds owed to
23 COUNTY will be due within forty-five (45) days of notification by COUNTY, or COUNTY shall withhold
24 future payments until all excess funds have been recouped by means of an offset against any payments
25 then or thereafter owing to COUNTY under this or any other Agreement between the COUNTY and
26 CONTRACTOR.
27 14. MONITORING
28
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1 CONTRACTOR agrees to extend to COUNTY's staff, COUNTY's DBH Director, and the State
2 Department of Health Care Services or their designees, the right to review and monitor records,
3 services, or procedures, at any time, in regard to clients, as well as the overall operation of
4 CONTRACTOR's performance, in order to ensure compliance with the terms and conditions of this
5 Agreement.
6 15. REFERENCES TO LAWS AND RULES
7 In the event any law, regulation, or policy referred to in this Agreement is amended during the
8 term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
9 such amendment.
10 16. COMPLIANCE WITH STATE REQUIREMENTS
11 CONTRACTOR recognizes that COUNTY operates its mental health programs under an
12 agreement with the State of California Department Health Care Services, and that under said agreement
13 the State imposes certain requirements on COUNTY and its subcontractors. CONTRACTOR shall adhere
14 to all State requirements, including those identified in Exhibit H, "State Mental Health Requirements",
15 attached hereto and by this reference incorporated herein and made part of this Agreement.
16 17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
17 CONTRACTOR shall be required to maintain organizational provider certification by COUNTY.
18 CONTRACTOR must meet Medi-Cal organization provider standards as listed in Exhibit I, "Compliance
19 with State Medi-Cal Requirements", attached hereto and by this reference incorporated herein and made
20 part of this Agreement. It is acknowledged that all references to Organizational Provider and/or Provider in
21 Exhibit G/I shall refer to CONTRACTOR.
22 CONTRACTOR shall inform every client of their rights under the COUNTY's Mental Health Plan as
23 described in Exhibit J, "Mental Health Plan Grievances and Appeals Process", attached hereto and by this
24 reference incorporated herein and made part of this Agreement.
25 CONTRACTOR shall also file an incident report for all incidents involving clients, following the
26 COUNTY's DBH "Incident Reporting and Intensive Analysis" policy and procedure guide and using the
27 "Incident Report" protocol and user guide identified in Exhibit K, attached hereto and by this reference
28 incorporated herein and made part of this Agreement.
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1 18. CONFIDENTIALITY
2 All services performed by CONTRACTOR under this Agreement shall be in strict conformance with
3 all applicable Federal, State of California and/or local laws and regulations relating to confidentiality.
4 19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
5 COUNTY and CONTRACTOR each consider and represent themselves as covered entities as
6 defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-191
7 (HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by law.
8 COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is only for
9 treatment, payment, and health care operations.
10 COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of PHI
11 pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for Economic and
12 Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated thereunder by the U.S.
13 Department of Health and Human Services (HIPAA Regulations) and other applicable laws. As part of the
14 HIPAA Regulations, the Privacy Rule and the Security Rule require CONTRACTOR to enter into a contract
15 containing specific requirements prior to the disclosure of PHI, as set forth in, but not limited to, Title 45,
16 Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal Regulations.
17 20. DATA SECURITY
18 For the purpose of preventing the potential loss, misappropriation or inadvertent access, viewing,
19 use or disclosure of COUNTY data including sensitive or personal client information; abuse of COUNTY
20 resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into a
21 contractual relationship with COUNTY for the purpose of providing services under this Agreement must
22 employ adequate data security measures to protect the confidential information provided to
23 CONTRACTOR by COUNTY, including but not limited to the following:
24 A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
25 CONTRACTOR may not connect to COUNTY networks via personally-owned mobile, wireless or
26 handheld devices, unless the following conditions are met:
27 1. CONTRACTOR has received authorization by COUNTY for telecommuting
28 purposes;
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1 2. Current virus protection software is in place;
2 3. Mobile device has the remote wipe feature enable; and
3 4. A secure connection is used.
4 B. CONTRACTOR-Owned Computers or Computer Peripherals
5 CONTRACTOR may not bring contractor-owned computers or computer peripherals into
6 COUNTY for use without prior authorization from COUNTY's Chief Information Officer and/or
7 designee(s), including but not limited to mobile storage devices. If data is approved to be transferred,
8 data must be encrypted and stored on a secure server approved by COUNTY and transferred by means
9 of a Virtual Private Network (VPN) connection, or another type of secure connection.
10 C. COUNTY-Owned Computer Equipment
11 CONTRACTOR may not use COUNTY computers or computer peripherals on non-County
12 premises without prior authorization from COUNTY's Chief Information Officer and/or designee(s).
13 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive data on any hard-disk
14 drive, portable storage device, or remote storage installation unless encrypted.
15 E. CONTRACTOR shall be responsible to employ strict controls to ensure the integrity and security of
16 COUNTY's confidential information and prevent unauthorized access, viewing, use, or disclosure of
17 data maintained in computer files, program documentation, data processing systems, data files, and
18 data processing equipment which stores or processes COUNTY data internally and externally.
19 F. Confidential client information transmitted to one party by the other by means of electronic
20 transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128 BIT or
21 higher. Additionally, a password or pass phrase must be utilized.
22 G. CONTRACTOR is responsible to immediately notify COUNTY of any violations, breaches or
23 potential breaches of security related to COUNTY's confidential information, data maintained in
24 computer files, program documentation, data processing systems, data files and data processing
25 equipment which stores or processes COUNTY data internally or externally.
26 H. COUNTY shall provide oversight to CONTRACTOR's response to all incidents arising from a
27 possible breach of security related to COUNTY's confidential client information provided to
28 CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected individuals
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1 as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will
2 be responsible for all costs incurred as a result of providing the required notification.
3 21. PROPERTY OF COUNTY
4 A. COUNTY and CONTRACTOR recognize that fixed assets are tangible and intangible
5 property obtained or controlled under COUNTY for use in operational capacity and will
6 benefit COUNTY for a period more than one year. Depreciation of the qualified items will
7 be on a straight-line basis.
8 For COUNTY purposes, fixed assets must fulfill three (3) qualifications:
9 1. Have a life span of over one year;
10 2. Is not a repair part; and
11 3. Must be valued at or greater than the capitalization thresholds for the asset
12 type.
13 Asset Type Threshold
14 Land $0
15 Buildings and Improvements $100,000
16 Infrastructure $100,000
17 Tangible $5,000
18 - Equipment
19 - Vehicles
20 Intangible $100,000
21 - Internally Generated Software
22 - Purchased Software
23 - Easements
24 - Patents
25 Capital Lease $5,000
26 Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is approved
27 and identified as an asset, it will be tagged with a COUNTY program number. A Fixed Asset Log,
28 attached hereto as Exhibit L and by this reference incorporated herein and made part of this Agreement,
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1 will be maintained by COUNTY's Asset Management System and annually inventoried until the asset is
2 fully depreciated. During the terms of this Agreement, CONTRACTOR's fixed assets may be
3 inventoried in comparison to COUNTY's DBH Asset Inventory System.
4 Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but more than One
5 Thousand and No/100 Dollars ($1,000.00), with over one year life span, and/or are mobile and high risk
6 of theft or loss are sensitive assets. Such sensitive items are not limited to computers, copiers,
7 televisions, cameras and other sensitive items as determined by COUNTY's DBH Director or designee.
8 CONTRACTOR will maintain a tracking system on the items on Exhibit L. Items are not required to be
9 capitalized or depreciated and are subject to annual inventory for compliance.
10 B. Assets shall be retained by COUNTY, as COUNTY property, in the event this Agreement is
11 terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in an annual
12 inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this
13 Agreement, CONTRACTOR shall be physically present when fixed and inventoried assets are
14 returned to COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all
15 COUNTY-owned undepreciated fixed and inventoried assets, or the monetary value of said assets
16 if unable to produce the assets at the expiration or termination of this Agreement.
17 CONTRACTOR further agrees to the following:
18 1. Maintain all items of equipment in good working order and condition, normal
19 wear and tear is expected;
20 2. Label all items of equipment with COUNTY assigned program number, perform
21 periodic inventories as required by COUNTY, and maintain an inventory list showing
22 where and how the equipment is being used, in accordance with procedures developed
23 by COUNTY. All such lists shall be submitted to COUNTY within ten (10) days of any
24 request therefore; and
25 3. Report in writing to COUNTY immediately after discovery, the loss or theft of
26 any items of equipment. For stolen items, the local law enforcement agency must be
27 contacted and a copy of the police report submitted to COUNTY.
28
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1 C. The purchase of any equipment by CONTRACTOR with funds provided hereunder shall require the
2 prior written approval of COUNTY's DBH, shall fulfill the provisions of this Agreement as
3 appropriate, and must be directly related to CONTRACTORS services or activities under the terms
4 of this Agreement. COUNTY's DBH may refuse reimbursement for any costs resulting from
5 equipment purchased, which are incurred by CONTRACTOR, if prior written approval has not been
6 obtained from COUNTY.
7 D. CONTRACTOR shall be the registered owner of two (2) vehicles, including equipped vans, and one
8 (1) shower trailer purchased for the PATH Program in A-15-257 with the COUNTY as first
9 lienholder. In the event of termination of this Agreement, COUNTY will immediately invoke the right
10 to repossession of the vehicles and shower trailer, which were purchased through this Agreement,
11 and CONTRACTOR shall cooperate with COUNTY, including but not limited to making vehicles
12 available at 4551 E. Hamilton, Fresno, CA 93702 and immediately transferring title in the vehicles
13 and shower trailer to COUNTY.
14 E. CONTRACTOR must obtain prior written approval from COUNTY's DBH whenever there is any
15 modification or change in the use of any property acquired or improved, in whole or in part, using
16 funds under this Agreement. If any real or personal property acquired or improved with said funds
17 identified herein is sold and/or is utilized by CONTRACTOR for a use which does not qualify under
18 this Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal to the current fair
19 market value of the property, less any portion thereof attributable to expenditures of funds not
20 provided under this Agreement. These requirements shall continue in effect for the life of the
21 property. In the event this Agreement expires, or terminates, the requirements for this Section shall
22 remain in effect for activities or property funded with said funds, unless action is taken by the State
23 government to relieve COUNTY of these obligations.
24
25
26 22. NON-DISCRIMINATION
27 During the performance of this Agreement, CONTRACTOR and its subcontractors shall not deny
28 the contract's benefits to any person on the basis of race, religious creed, color, national origin,
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1 ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex,
2 gender, gender identity, gender expression, age, sexual orientation, or military and veteran status, nor
3 shall they discriminate unlawfully against any employee or applicant for employment because of race,
4 religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition,
5 genetic information, marital status, sex, gender identity, gender expression, age, sexual orientation, or
6 military and veteran status.
7 CONTRACTOR shall ensure that the evaluation and treatment of employees and applicants for
8 employment are free of such discrimination. CONTRACTOR and subcontractors shall comply with the
9 provisions of the Fair Employment and Housing Act (Gov. Code §12800 et seq.), the regulations
10 promulgated thereunder(Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter
11 1, Part 1, Division 3, Title 2 of the Government Code (Gov. Code §11135-11139.5), and the regulations
12 or standards adopted by the awarding state agency to implement such article. CONTRACTOR shall
13 permit access by representatives of the Department of Fair Employment and Housing and the awarding
14 state agency upon reasonable notice at any time during the normal business hours, but in no case less
15 than twenty-four (24) hours notice, to such of its books, records, accounts, and all other sources of
16 information and its facilities as said department or agency shall require to ascertain compliance with this
17 clause. CONTRACTOR and its subcontractors shall give written notice of their obligations under this
18 clause to labor organizations with which they have a collective bargaining or other agreement. (See
19 Cal. Code Regs., tit. 2, §11105.) CONTRACTOR shall include the non-discrimination and compliance
20 provisions of this clause in all subcontracts to perform work under this Agreement.
21 23. CULTURAL COMPETENCY
22 As related to Cultural and Linguistic Competence:
23 A. CONTRACTOR shall not discriminate against beneficiaries based on race, color, national
24 origin, sex, disability, or religion. CONTRACTOR shall ensure that a limited and/or no
25 English proficient beneficiary is entitled to equal access and participation in federally funded
26 programs through the provision of comprehensive and quality bilingual services pursuant to
27 Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R. Part 80) and
28 Executive Order 12250 of 1979.
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1 B. CONTRACTOR shall comply with requirements of policies and procedures for ensuring
2 access and appropriate use of trained interpreters and material translation services for all
3 limited and/or no English proficient beneficiaries, including, but not limited to, assessing the
4 cultural and linguistic needs of the beneficiaries, training of staff on the policies and
5 procedures, and monitoring its language assistance program. CONTRACTOR's policies and
6 procedures shall ensure compliance of any subcontracted providers with these requirements.
7 C. CONTRACTOR shall notify its beneficiaries that oral interpretation is available for any
8 language and written translation is available in prevalent languages and that auxiliary aids
9 and services are available upon request, at no cost and in a timely manner for limited and/or
10 no English proficient beneficiaries and/or beneficiaries with disabilities. CONTRACTOR shall
11 avoid relying on an adult or minor child accompanying the beneficiary to interpret or facilitate
12 communication; however, if the beneficiary refuses language assistance services, the
13 CONTRACTOR must document the offer, refusal and justification in the beneficiary's file.
14 D. CONTRACTOR shall ensure that employees, agents, subcontractors, and/or partners who
15 interpret or translate for a beneficiary or who directly communicate with a beneficiary in a
16 language other than English (1) have completed annual training provided by COUNTY at no
17 cost to CONTRACTOR; (2) have demonstrated proficiency in the beneficiary's language; (3)
18 can effectively communicate any specialized terms and concepts specific to
19 CONTRACTOR's services; and (4) adheres to generally accepted interpreter ethic principles.
20 As requested by COUNTY, CONTRACTOR shall identify all who interpret for or provide
21 direct communication to any program beneficiary in a language other than English and
22 identify when the CONTRACTOR last monitored the interpreter for language competence.
23 E. CONTRACTOR shall submit to COUNTY for approval, within ninety (90) days from date of
24 contract execution, CONTRACTOR's plan to address all fifteen (15) National Standards for
25 Culturally and Linguistically Appropriate Service (CLAS), as published by the Office of
26 Minority Health and set forth in Exhibit M "National Standards on Culturally and Linguistically
27 Appropriate Services," attached hereto and incorporated herein by reference and made part
28 of this agreement. As the CLAS standards are updated, CONTRACTOR's plan must be
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1 updated accordingly. As requested by COUNTY, CONTRACTOR shall be responsible for
2 conducting an annual CLAS self-assessment and providing the results of the self-
3 assessment to the COUNTY. The annual CLAS self-assessment instruments shall be
4 reviewed by the COUNTY and revised as necessary to meet the approval of the COUNTY.
5 F. Cultural competency training for CONTRACTOR staff should be substantively integrated into
6 health professions education and training at all levels, both academically and functionally,
7 including core curriculum, professional licensure, and continuing professional development
8 programs. As requested by COUNTY, CONTRACTOR shall report on the completion of
9 cultural competency trainings to ensure direct service providers are completing a minimum of
10 one (1) cultural competency training annually.
11 G. CONTRACTOR shall create and sustain a forum that includes staff at all agency levels to
12 discuss cultural competence. COUNTY encourages a representative from CONTRACTOR's
13 forum to attend COUNTY's Cultural Humility Committee.
14 24. AMERICANS WITH DISABILITIES ACT
15 CONTRACTOR agrees to ensure that deliverables developed and produced, pursuant to this
16 Agreement, shall comply with the accessibility requirements of Section 508 of the Rehabilitation Act and
17 the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)), and regulations
18 implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal Regulations. In 1998,
19 Congress amended the Rehabilitation Act of 1973 to require Federal agencies to make their electronic
20 and information technology (EIT) accessible to people with disabilities. California Government Code
21 section 11135 codifies section 508 of the Act requiring accessibility of electronic and information
22 technology.
23 25. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
24 To the extent necessary to prevent disallowance of reimbursement under section 1861(v)(1) (1)
25 of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[1]), until the expiration of four (4) years after
26 the furnishing of services under this Agreement, CONTRACTOR shall make available, upon written
27 request to the Secretary of the United States Department of Health and Human Services, or upon
28 request to the Comptroller General of the United States General Accounting Office, or any of their duly
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1 authorized representatives, a copy of this Agreement and such books, documents, and records as are
2 necessary to certify the nature and extent of the costs of these services provided by CONTRACTOR
3 under this Agreement. CONTRACTOR further agrees that in the event CONTRACTOR carries out any
4 of its duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and
5 No/100 Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such
6 Agreement shall contain a clause to the effect that until the expiration of four (4) years after the
7 furnishing of such services pursuant to such subcontract, the related organizations shall make available,
8 upon written request to the Secretary of the United States Department of Health and Human Services,
9 or upon request to the Comptroller General of the United States General Accounting Office, or any of
10 their duly authorized representatives, a copy of such subcontract and such books, documents, and
11 records of such organization as are necessary to verify the nature and extent of such costs.
12 26. SINGLE AUDIT CLAUSE
13 A. If CONTRACTOR expends Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) or
14 more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual
15 audit in accordance with the requirements of the Single Audit Standards as set forth in Office of
16 Management and Budget (OMB) 2 CFR 200. CONTRACTOR shall submit said audit and
17 management letter to COUNTY. The audit must include a statement of findings or a statement that
18 there were no findings. If there were negative findings, CONTRACTOR must include a corrective
19 action plan signed by an authorized individual. CONTRACTOR agrees to take action to correct any
20 material non-compliance or weakness found as a result of such audit. Such audit shall be delivered
21 to COUNTY's DBH Finance Division for review within nine (9) months of the end of any fiscal year
22 in which funds were expended and/or received for the program. Failure to perform the requisite
23 audit functions as required by this Agreement may result in COUNTY performing the necessary
24 audit tasks, or at COUNTY's option, contracting with a public accountant to perform said audit, or
25 may result in the inability of COUNTY to enter into future agreements with CONTRACTOR. All
26 audit costs related to this Agreement are the sole responsibility of CONTRACTOR.
27 B. A single audit report is not applicable if CONTRACTOR's Federal contracts do not exceed the
28 Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or CONTRACTOR's
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1 only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a program audit
2 must be performed and a program audit report with management letter shall be submitted by
3 CONTRACTOR to COUNTY as a minimum requirement to attest to CONTRACTOR solvency.
4 Said audit report shall be delivered to COUNTY's DBH Finance Division for review no later than
5 nine (9) months after the close of the fiscal year in which the funds supplied through this Agreement
6 are expended. Failure to comply with this Act may result in COUNTY performing the necessary
7 audit tasks or contracting with a qualified accountant to perform said audit. All audit costs related to
8 this Agreement are the sole responsibility of CONTRACTOR who agrees to take corrective action to
9 eliminate any material noncompliance or weakness found as a result of such audit. Audit work
10 performed by COUNTY under this paragraph shall be billed to CONTRACTOR at COUNTY cost, as
11 determined by COUNTY's Auditor-Controller/Treasurer-Tax Collector.
12 C. CONTRACTOR shall make available all records and accounts for inspection by COUNTY, the State
13 of California, if applicable, the Comptroller General of the United States, the Federal Grantor
14 Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
15 least three (3) years following final payment under this Agreement or the closure of all other pending
16 matters, whichever is later.
17 27. COMPLIANCE
18 CONTRACTOR agrees to comply with COUNTY's Contractor Code of Conduct and Ethics and
19 the COUNTY's Compliance Program in accordance with Exhibit D. Within thirty (30) days of entering
20 into this Agreement with COUNTY, CONTRACTOR shall have all of CONTRACTOR's employees,
21 agents, and subcontractors providing services under this Agreement certify in writing, that he or she has
22 received, read, understood, and shall abide by the Contractor Code of Conduct and Ethics.
23 CONTRACTOR shall ensure that within thirty (30) days of hire, all new employees, agents, and
24 subcontractors providing services under this Agreement shall certify in writing that they have received,
25 read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR
26 understands that the promotion of and adherence to the Contractor Code of Conduct is an element in
27 evaluating the performance of CONTRACTOR and its employees, agents, and subcontractors.
28
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1 Within thirty (30) days of entering into this Agreement, and annually thereafter, all employees,
2 agents, and subcontractors providing services under this Agreement shall complete general compliance
3 training, and appropriate employees, agents, and subcontractors shall complete documentation and
4 billing or billing/reimbursement training. All new employees, agents, and subcontractors shall attend the
5 appropriate training within thirty (30) days of hire. Each individual who is required to attend training shall
6 certify in writing that he or she has received the required training. The certification shall specify the type
7 of training received and the date received. The certification shall be provided to COUNTY's DBH
8 Compliance Officer at 1925 E. Dakota Ave, Fresno, California 93726. CONTRACTOR agrees to
9 reimburse COUNTY for the entire cost of any penalty imposed upon COUNTY by the Federal
10 Government as a result of CONTRACTOR's violation of the terms of this Agreement.
11 28. ASSURANCES
12 In entering into this Agreement, CONTRACTOR certifies that neither they, nor any of their officers,
13 are currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal Health
14 Care Programs; that neither they, nor any of their officers, have been convicted of a criminal offense
15 related to the provision of health care items or services; nor have they, nor any of their officers, been
16 reinstated to participate in the Federal Health Care Programs after a period of exclusion, suspension,
17 debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that
18 CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility
19 for, or involvement with, COUNTY's business operations related to the Federal Health Care Programs
20 and shall remove such CONTRACTOR from any position in which CONTRACTOR's compensation, or
21 the items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part,
22 directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until
23 such time as CONTRACTOR is reinstated into participation in the Federal Health Care Programs.
24 A. If COUNTY has notice that either CONTRACTOR, or its officers, have been charged with a
25 criminal offense related to any Federal Health Care Program, or are proposed for exclusion
26 during the term of any contract, CONTRACTOR and COUNTY shall take all appropriate
27 actions to ensure the accuracy of any claims submitted to any Federal Health Care Program.
28
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1 At its discretion, given such circumstances, COUNTY may request that CONTRACTOR
2 cease providing services until resolution of the charges or the proposed exclusion.
3 B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
4 subcontractors of CONTRACTOR who, in each case, are expected to perform professional
5 services under this Agreement, will be queried as to whether: (1) they are now or ever have
6 been excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
7 Health Care Programs; (2) they have been convicted of a criminal offense related to the
8 provision of health care items or services; and (3) they have been reinstated to participate in
9 the Federal Health Care Programs after a period of exclusion, suspension, debarment, or
10 ineligibility.
11 1) In the event the potential employee or subcontractor informs CONTRACTOR that he
12 or she is excluded, suspended, debarred, or otherwise ineligible, or has been
13 convicted of a criminal offense relating to the provision of health care services, and
14 CONTRACTOR hires or engages such potential employee or subcontractor,
15 CONTRACTOR will ensure that said employee or subcontractor does no work, either
16 directly or indirectly relating to services provided to COUNTY.
17 2) Notwithstanding the above, COUNTY, at its discretion, may terminate this Agreement
18 in accordance with Section Three (3) of this Agreement, or require adequate
19 assurance (as defined by COUNTY) that no excluded, suspended, or otherwise
20 ineligible employee or subcontractor of CONTRACTOR will perform work, either
21 directly or indirectly, relating to services provided to COUNTY. Such demand for
22 adequate assurance shall be effective upon a time frame to be determined by
23 COUNTY to protect the interests of COUNTY consumers.
24 C. CONTRACTOR shall verify (by asking the applicable employees and subcontractors) that all
25 current employees and existing subcontractors who, in each case, are expected to perform
26 professional services under this Agreement: (1) are not currently excluded, suspended,
27 debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have
28 not been convicted of a criminal offense related to the provision of health care items or
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1 services; and (3) have not been reinstated to participate in the Federal Health Care Program
2 after a period of exclusion, suspension, debarment, or ineligibility. In the event any existing
3 employee or subcontractor informs CONTRACTOR that he or she is excluded, suspended,
4 debarred, or otherwise ineligible to participate in the Federal Health Care Programs, or has
5 been convicted of a criminal offense relating to the provision of health care services,
6 CONTRACTOR will ensure that said employee or subcontractor does no work, either direct
7 or indirect, relating to services provided to COUNTY.
8 1) CONTRACTOR agrees to notify COUNTY immediately during the term of this
9 Agreement whenever CONTRACTOR learns that an employee or subcontractor who,
10 in each case, is providing professional services under this Agreement is excluded,
11 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care
12 Programs, or is convicted of a criminal offense relating to the provision of health care
13 services.
14 2) Notwithstanding the above, COUNTY, at its discretion, may terminate this Agreement
15 in accordance with Section Three (3) of this Agreement, or require adequate
16 assurance (as defined by COUNTY) that no excluded, suspended, or otherwise
17 ineligible employee or subcontractor of CONTRACTOR will perform work, either
18 directly or indirectly, relating to services provided to COUNTY. Such demand for
19 adequate assurance shall be effective upon a time frame to be determined by
20 COUNTY to protect the interests of COUNTY clients.
21 D. CONTRACTOR agrees to cooperate fully with any reasonable requests for information from
22 COUNTY which may be necessary to complete any internal or external audits relating to
23 CONTRACTOR's compliance with the provisions of this Section.
24 E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed
25 upon COUNTY by the Federal Government as a result of CONTRACTOR's violation of
26 CONTRACTOR's obligations as described in this Section.
27
28 29. PUBLICITY PROHIBITION
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1 None of the funds, materials, property or services provided directly or indirectly under this
2 Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e., purchasing of
3 tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the
4 above, publicity of the services described in Section One (1) of this Agreement shall be allowed as
5 necessary to raise public awareness about the availability of such specific services when approved in
6 advance by COUNTY's DBH Director or designee and at a cost to be provided in Exhibit A for such
7 items as written/printed materials, the use of media (i.e., radio, television, newspapers), and any other
8 related expense(s).
9 30. COMPLAINTS
10 CONTRACTOR shall log complaints and the disposition of all complaints from a client or a
11 client's family. CONTRACTOR shall provide a copy of the detailed complaint log entries concerning
12 COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (10t") day of the following
13 month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide details and
14 attach documentation of each complaint with the log. CONTRACTOR shall post signs informing clients
15 of their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all incidents
16 reportable to State licensing bodies that affect COUNTY clients within twenty-four (24) hours of receipt
17 of a complaint.
18 Within ten (10) days after each incident or complaint affecting COUNTY clients, CONTRACTOR
19 shall provide COUNTY with information relevant to the complaint, investigative details of the complaint,
20 the complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the complaint.
21 In addition, CONTRACTOR shall inform every client of their rights as set forth in Exhibit K.
22 CONTRACTOR shall file an incident report for all incidents involving clients, following the protocol and
23 user guide identified in Exhibit K.
24 31. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
25 This provision is only applicable if CONTRACTOR is disclosing entities, fiscal agents, or
26 managed care entities, as defined in Code of Federal Regulations (C.F.R.), Title 42 §§ 455.101,
27 455.104 and 455.106(a)(1),(2).
28
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1 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2), the
2 following information must be disclosed by CONTRACTOR by completing Exhibit N, "Disclosure of
3 Ownership and Control Interest Statement", attached hereto and by this reference incorporated herein
4 and made part of this Agreement. CONTRACTOR shall submit this form to the COUNTY's DBH within
5 thirty (30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall report any
6 changes to this information within thirty-five (35) days of occurrence by completing Exhibit N.
7 Submissions shall be scanned portable document format (pdf) copies and are to be sent via email to
8 COUNTY's DBH assigned Staff Analyst.
9 CONTRACTOR is required to submit a set of fingerprints for any person with a five (5) percent or
10 greater direct or indirect ownership interest in CONTRACTOR. COUNTY may terminate this Agreement
11 where any person with a five (5) percent or greater direct or indirect ownership interest in the
12 CONTRACTOR did not submit timely and accurate information and cooperate with any screening
13 method required in CFR, Title 42, Section 455.416. Submissions shall be scanned pdf copies and are
14 to be sent via email to DBHContractedServicesDivision@fresnocountyca.gov. COUNTY may deny
15 enrollment or terminate this Agreement where any person with a five (5) percent or greater direct or
16 indirect ownership interest in CONTRACTOR has been convicted of a criminal offense related to that
17 person's involvement with the Medicare, Medicaid, or Title XXI program in the last ten (10) years.
18 32. DISCLOSURE — CRIMINAL HISTORY AND CIVIL ACTIONS:
19 CONTRACTOR is required to disclose if any of the following conditions apply to them, their owners,
20 officers, corporate managers, and partners (hereinafter collectively referred to in this Section as
21 "CONTRACTOR"):
22 A. Within the three (3) year period preceding the Agreement award, they have been convicted
23 of, or had a civil judgment rendered against them for:
24 1) Fraud or a criminal offense in connection with obtaining, attempting to obtain, or
25 performing a public (federal, state, or local) transaction or contract under a public
26 transaction;
27 2) Violation of a federal or state antitrust statute;
28 3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records; or
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1 4) False statements or receipt of stolen property.
2 B. Within the three (3) year period preceding the Agreement award, they have had a public
3 transaction (federal, state, or local) terminated for cause or default.
4 Disclosure of the above information will not automatically eliminate CONTRACTOR from further
5 business consideration. The information will be considered as part of the determination of whether to
6 continue and/or renew this Agreement and any additional information or explanation that
7 CONTRACTOR elects to submit with the disclosed information will be considered. If it is later
8 determined that CONTRACTOR failed to disclose required information, any contract awarded to such
9 CONTRACTOR may be immediately voided and terminated for material failure to comply with the terms
10 and conditions of the award.
11 CONTRACTOR must sign a "Certification Regarding Debarment, Suspension, and Other
12 Responsibility Matters- Primary Covered Transactions" in the form set forth in Exhibit O, attached hereto
13 and by this reference incorporated herein and made part of this Agreement. Additionally,
14 CONTRACTOR must immediately advise COUNTY's DBH in writing if, during the term of this
15 Agreement: (1) CONTRACTOR becomes suspended, debarred, excluded, or ineligible for participation
16 in Federal or State funded programs or from receiving federal funds as listed in the excluded parties' list
17 system (http://www.epls.gov); or (2) any of the above listed conditions become applicable to
18 CONTRACTOR. CONTRACTOR shall indemnify, defend, and hold COUNTY harmless for any loss or
19 damage resulting from a conviction, debarment, exclusion, ineligibility, or other matter listed in the
20 signed Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
21 33. DISCLOSURE OF SELF-DEALING TRANSACTIONS
22 This provision is only applicable if a CONTRACTOR is operating as a corporation (a for-profit or
23 non-profit corporation) or if during the term of this Agreement, CONTRACTOR changes its status to
24 operate as a corporation.
25 Members of a CONTRACTOR's Board of Directors shall disclose any self-dealing transactions
26 that they are a party to while CONTRACTOR is providing goods or performing services under this
27 Agreement. A self-dealing transaction shall mean a transaction to which CONTRACTOR is a party and
28 in which one or more of its directors has a material financial interest. Members of the Board of Directors
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1 shall disclose any self-dealing transactions that they are a party to by completing and signing a "Self-
2 Dealing Transaction Disclosure Form", attached hereto as Exhibit P and incorporated herein by
3 reference and made part of this Agreement, and submitting it to COUNTY prior to commencing with the
4 self-dealing transaction or immediately thereafter.
5 34. AUDITS AND INSPECTIONS:
6 CONTRACTOR shall at any time during business hours, and as often as the COUNTY may deem
7 necessary, make available to the COUNTY for examination all of its records and data with respect to the
8 matters covered by this Agreement. The CONTRACTOR shall, upon request by the COUNTY, permit the
9 COUNTY to audit and inspect all of such records and data necessary to ensure CONTRACTOR'S
10 compliance with the terms of this Agreement.
11 If this Agreement exceeds ten thousand dollars ($10,000.00), CONTRACTOR shall be subject to
12 the examination and audit of the Auditor General for a period of three (3) years after final payment under
13 contract (Government Code Section 8546.7).
14 35. NOTICES:
15 The persons and their addresses having authority to give and receive notices under this Agreement
16 include the following:
17 COUNTY CONTRACTOR
18 Director, Fresno County Chief Executive Officer
19 Department of Behavioral Health Kings View
20 1925 E. Dakota Ave. 7170 N. Financial Dr. Ste. 110
21 Fresno, CA 93726 Fresno, CA 93720
22 All notices between the COUNTY and CONTRACTOR provided for or permitted under this
23 Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
24 an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
25 personal service is effective upon service to the recipient. A notice delivered by first-class United States
26 mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid,
27 addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
28 COUNTY business day after deposit with the overnight commercial courier service, delivery fees prepaid,
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1 with delivery instructions given for next day delivery, addressed to the recipient. A notice delivered by
2 telephonic facsimile is effective when transmission to the recipient is completed (but, if such transmission is
3 completed outside of COUNTY business hours, then such delivery shall be deemed to be effective at the
4 next beginning of a COUNTY business day), provided that the sender maintains a machine record of the
5 completed transmission. For all claims arising out of or related to this Agreement, nothing in this section
6 establishes, waives, or modifies any claims presentation requirements or procedures provided by law,
7 including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government Code,
8 beginning with section 810).
9 36. GOVERNING LAW:
10 Venue for any action arising out of or related to this Agreement shall only be in Fresno County,
11 California.
12 The rights and obligations of the parties and all interpretation and performance of this Agreement
13 shall be governed in all respects by the laws of the State of California.
14 37. ENTIRE AGREEMENT
15 This Agreement, including all Exhibits, constitutes the entire agreement between the
16 CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
17 Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
18 understanding of any nature whatsoever unless expressly included in this Agreement. In the event of any
19 inconsistency in interpreting the documents which constitute this Agreement, the inconsistency shall be
20 resolved by giving precedence in the following order of priority: (1) the text of this Agreement (excluding
21 Attachment "A", the COUNTY'S Request for Quotation/Proposal No. Revised RFP No. 20-044 and the
22 CONTRACTOR'S Quote/Proposal in response thereto); (2)Attachment"A"; (3)the COUNTY'S Request for
23 Quotation/Proposal No. Revised RFP No. 20-044; and (4)the CONTRACTOR'S quotation/proposal made
24 in response to COUNTY'S Request for Quotation/Proposal No. Revised RFP No. 20-044. A copy of
25 COUNTY's Revised RFP No. 20-044 and CONTRACTOR's response thereto shall be retained and made
26 available during the term of this Agreement by COUNTY's DBH.
27 Exhibit A—Scope of Work
28 Exhibit B— DBH Guiding Principles of Care Delivery
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1 Exhibit C—Budget and Budget Narrative
2 Exhibit D— FCMHCP (Contractor Code of Conduct and Ethics)
3 Exhibit E— Documentation Standards for Client Records
4 Exhibit F— Program Objectives
5 Exhibit G — PATH PDX Annual Report
6 Exhibit H —State Mental Health Requirements
7 Exhibit I —Compliance with State Medi-Cal Requirements
8 Exhibit J — FCMHP (Grievance and Appeals Process)
9 Exhibit K.1 — Protocol for Completion of Incident Report
10 Exhibit K.2— Incident Reviewer User Guide
11 Exhibit L— Fixed Asset and Sensitive Item Log
12 Exhibit M — National Standards for Culturally and Linguistically Appropriate Services
13 Exhibit N — Disclosure of Ownership
14 Exhibit O—Certification Regarding Debarment, Suspension, and Other Responsibility Matters
15 Exhibit P— Self-Dealing Transaction Disclosure Form
16 HI
17 N
18 W
19 N
20 HI
21 HI
22 HI
23 HI
24 HI
25 HI
26 HI
27 HI
28 HI
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ii
DocuSign Envelope ID:3C2ED552-5BA9-4059-80C4-F8DA637507A8
1 IN WITNESS WHEREOF,the parties hereto have executed this Agreement as of the day and year
2 first hereinabove written.
3
4 C T-RAGMOR: KINGS VIEW COUYPF FRESNO
6 (Authorize Ignature) Brian Pacheco, Chairman of the Board of
Supervisors of the County of Fresno
7 Amanda Nugent Divine, PhD, CEO
Print Name & Title
8
9 Kings View
7170 N Financial Dr. Ste. 110
10 Fresno, CA 93720
11 Mailing Address ATTEST:
Bernice E. Seidel
12 Clerk of the Board of Supervisors
County of Fresno, State of California
13
14
15
16 By:
Deputy
17 FOR ACCOUNTING USE ONLY:
18 Fund: 0001
19 Subclass: 10000
20 ORG: 56302493
21 Account: 7295/0
22
23
24
25
26
27
28
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Exhibit A
Page 1 of 7
PROJECTS FOR ASSISTANCE IN TRANSITION FROM HOMELESSNESS
(PATH) PROGRAM
Scope of Work
ORGANIZATION Kings View
CORPORATE ADDRESS 7170 N Financial Dr, Ste 110, Fresno, CA 93720
HOURS OF OPERATION 8AM to 5PM, Monday through Friday
CONTRACT PERIOD July 1, 2021—June 30, 2026
CONTRACT AMOUNT FY 2021-2022 $905,172
FY 2022-2023 $1,138,207
FY 2023-2024 $1,160,739
FY 2024-2025 $639,066
FY 2025-2026 $639,066
Total $4,482,250
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 7
A third component, Mobile Outreach Project (MOP), is to operate from July 1, 2021 through June 30, 2022.Through
PATH-MOP, Kings View will dedicate an outreach team for rural and unincorporated areas of Fresno County for the
provision of outreach, engagement, and linkage services to persons served akin to those provided in PATH-OEL.As
necessary, Kings View will implement COVID-19 screening, education, assessment, and linkage capabilities in the field.
From FY 2022-23 through FY 2023-24,this component will transition to Street Outreach Team and Rural Support
(STARS), offering the same services at an expanded capacity.
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 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"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.
Exhibit A
Page 3 of 7
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 needed accommodations for physical disabilities.
5. Employ harm reduction and motivational interviewing techniques and principles.
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. Linkages 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 persons 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 the scope of the PATH
program to individuals with coexisting alcohol, tobacco, drug use and other addictive disorders.
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 impairments in daily living.
IV. PATH-OEL SERVICES
1. At least 350 persons will receive outreach, engagement, and linkage services and at least 200 persons
served will be enrolled into PATH and HMIS.
Exhibit A
Page 4 of 7
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 to assist them in
accessing behavioral and physical health care, financial, education,vocational, rehabilitative, or 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 any
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 be created and include and identification of current symptoms,treatment goals,
and planned 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 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 negative
effects; and
Exhibit A
Page 5 of 7
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
c. Intervention to resolve conflict
d. Referral of 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 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. In locating, securing, maintaining and financing safe, clean and affordable housing which is
appropriate to their levels of functioning.
13. Provide alcohol, tobacco, and drug use disorder 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 possible.
14. Provide information, in an educational format, on the use of alcohol,tobacco, prescribed medications,
and other drugs and the impact that chemicals have on the ability to function in major life areas.
Exhibit A
Page 6 of 7
Information shall also include eating disorders, gambling, overspending, sexual and other addiction
disorders, 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.
17. Negotiate and establish relationships with apartment owners/landlords and/or utilize alternative
housing resources as available and appropriate.
VI. PATH-MOP/STARS SERVICES
1. Provide outreach, engagement, and linkage services and enroll persons served into 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 to assist them in
accessing behavioral and physical health care, financial, education,vocational, rehabilitative, or 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.
VII. 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
regarding 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 of care 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, by providing 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
Exhibit A
Page 7 of 7
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
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
1
rev 01-02-2020
Exhibit B
Page 2 of 4
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
2
rev 01-02-2020
Exhibit B
Page 3 of 4
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
3
rev 01-02-2020
Exhibit B
Page 4 of 4
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
4
rev 01-02-2020
Exhibit C
Page 1 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year(FY)2021-22
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program 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 Admin Specialist 0.26 12,628 12,628
1105 Accountant 0.05 2,805 2,805
1106 Quality Improvement Data Analyst 0.05 3,189 3,189
1107 - -
1108 -
1109 - -
1110 -
1111 - -
1112 - -
1113 - -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.39 $ 22,258 $ 22,258
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.70 $ 73,739 $ 73,739
1117 Outreach Worker 2.00 73,840 73,840
1118 Case Managers 1.20 50,482 50,482
1119 - -
1120 -
1121 - -
1122 -
1123 - -
1124 -
1125 - -
1126 -
1127 - -
1128 -
1129 - -
1130 -
1131 - -
1132 -
1133 - -
1134 -
Direct Personnel Program Salaries Subtotall 3.90 1 $ 198,061 1 $ 198,061
Admin Program Total
Direct Personnel Salaries Subtotal 4.29 $ 22,258 $ 198,061 $ 220,319
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 281 $ 2,505 $ 2,786
1202 Worker's Compensation 541 4,817 5,358
1203 Health Insurance 2,404 21,387 23,791
1204 Other(specify) - - -
1205 10ther(specify) - - -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 2 of 134
1206 10ther(specify) - - -
Direct Employee Benefits Subtotal:1 $ 3,226 1 $ 28,709 1 $ 31,935
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 1,656 14,739 16,395
1303 SUI 195 1,734 1,929
1304 Other(specify) - - -
1305 10ther(specify) - - -
1306 10ther(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 1,851 $ 16,473 $ 18,324
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 27,335 $ 243,243 $ 270,578
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
10% 90%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 17,158
2003 Client Transportation&Support 4,000
2004 Clothing, Food,&Hygiene 18,100
2005 Education Support 255
2006 Employment Support 255
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(Program Supplies) 15,400
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 10ther(specify) -
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 55,168
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 4,006
3002 Printing/Postage 300
3003 Office Supplies&Equipment 2,250
3004 Advertising -
3005 Staff Development&Training 1,000
3006 Staff Mileage 250
3007 Subscriptions&Memberships 200
3008 Vehicle Maintenance 23,475
3009 Other(Staff Recruitment) 260
3010 Other(specify) -
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 31,741
4000: DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 3 of 134
Acct# Line Item Description Amount
4001 Building Maintenance $ 9,046
4002 Rent/Lease Building 8,640
4003 Rent/Lease Equipment 2,160
4004 Rent/Lease Vehicles 13,012
4005 Security -
4006 Utilities 3,720
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 36,578
5000: DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 10,192
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (specify) -
5004 Translation Services 200
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 10,392
6000: INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 51,133
Administrative Overhead
6002 Professional Liability Insurance 3,300
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Liability): 9,360
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify) -
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 63,793
INDIRECT COST RATE 15.43%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 6,375
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,620
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ d-
Fresno 7006 Assets over$5,000/unit(Specify)7007 Other(specify)County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 4 of 134
7008 Other(specify) IJ95
FIXED ASSETS EXPENSES TOTAL $ 8,
TOTAL PROGRAM EXPENSES $ 477,245
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description 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 -
8009 Other(Specify) -
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ -
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name 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 -
MHSA TOTAL $ 102,777
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(PATH) 308,000
8404 Other(HHAP) 66,468
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 374,468
TOTAL PROGRAM FUNDING SOURCES: $ 477,245
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 5 of 134
PATH Program- OEL
Kings View
Fiscal Year(FY) 2021-22
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
Blue Sky/Fresno 0.05
Rural Triage East/Fresno 0.10
Rural Triage West/Fresno 0.10
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Kings 0.23
CVSPH/California State,Tualre, Calaveras,Tuolumi 0.09
Fresno City 0.05
Shasta 0.06
Tulare 0.26
Madera 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Executive Assistant PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
Blue Sky/Fresno 0.05
Rural Triage East/Fresno 0.10
Rural Triage West/Fresno 0.10
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Kings 0.23
CVSPH/California State,Tualre, Calaveras,Tuolurni 0.09
Fresno City 0.05
Shasta 0.06
Tulare 0.26
Madera 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
Blue Sky/Fresno 0.10
Rural Triage East/Fresno 0.22
Exhibit C
Page 6 of 134
Rural Triage West/Fresno 0.22
Metro CIT/Fresno 0.22
Map Point/Fresno 0.02
CVSPH/California State,Tualre, Calaveras,Tuolumi 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Admin Specialist PATH SMHS/Fresno 0.08
PATH OEL/Fresno 0.26
Rural Triage East/Fresno 0.40
Rural Triage West/Fresno 0.26
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.70
Total 1.00
Position Contract#/Name/Department/County FTE
Case Managers PATH SMHS/Fresno 0.80
PATH OEL/Fresno 1.20
Total 2.00
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Exhibit C
Page 7 of 134
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolumi 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality& Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C
Page 8 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year(FY)2021-22 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 270,578
Administrative Positions 22,258
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 Admin Specialist 12,628 Provides administrative support for the program and assist with medical billing and
records.
1105 Accountant 2,805 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1106 Quality Improvement Data Analyst 3,189 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1107 0 -
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 198,061
1116 Program Manager 73,739 Provides supervision of all staff and direct oversight of program management.
1117 Case Managers 73,840 Provides outreach and engagement services,provides linkage to needed services.
1118 Outreach Worker 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.
1119 0 -
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 31,935
1201 Retirement 2,786 Cost of 401K
1202 Worker's Compensation 5,358 Workers Comp Insurance
1203 Health Insurance 23,791 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 18,324
1301 OASDI -
1302 FICA/MEDICARE 16,395 Cost of FICA/Medicare
1303 SUI 1,929 Cost of SUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 55,168
2001 Child Care -
2002 Client Housing Support 17,158 Support clients with rent,security deposits,board and care,emergency housing such as
hotels/motels,groceries and household supplies.
2003 Client Transportation&Support 4,000
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
Fresno County Department ofBehavioral Fleahh Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 9 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2006 Employment Support 255
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(Program Supplies) 15,400 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:DIRECT OPERATING EXPENSES 31,741
3001 Telecommunications 4,006 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 300 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 2,250 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 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 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) 260 Thorough background check and drug testing.
3010 Other(specify) -
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 36,578
4001 Building Maintenance 9,046 Shared copier maintenance and minor building repairs and maintenance.
4002 Rent/Lease Building 8,640 Building space lease,anticipating moving locations.
4003 Rent/Lease Equipment 2,160 Shared copier lease.
4004 Rent/Lease Vehicles 13,012 The cost of 2 shared lease vehicles to assist with program needs.
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:DIRECT SPECIAL EXPENSES 10,392
5001 Consultant(Network&Data Management) 10,192 Kings View Information Technology Department(KVIT)will provide hardware and
software support for successful data collection.A database will be designed for this
program.WIT will procure equipment,software&other services from approved&
authorized vendors. Provide online,onsite,or phone-based emergency support-24/7
from the WIT Help Desk.
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (specify) - Yearly cost to contract with Physician to provide services and treatments to clients at 4
hours per week.
5004 Translation Services 200
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 63,793
6001 Administrative Overhead 51,133 Expenses provides program management,fiscal services,payroll,human resources,
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
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
Fresno County Department ofBehaviorel Health Contract Budgetl hnative Revised 2/7/2020
Exhibit C
Page 10 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT 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 -
7003 Furniture&Fixtures 2,620 Anticipating 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 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 477,245
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 477,245
BUDGET CHECK: -
Fresno County Department of Behavioral Fleahh Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 11 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.01 $ 1,802 $ 1,802
1102 Regional Director 0.01 1,207 1,207
1103 Admin Specialist 0.05 2,576 2,576
1104 Accountant 0.07 3,841 3,841
1105 Quality Improvement Data Analyst 0.05 3,366 3,366
1106 - -
1107 - -
1108 -
1109 - -
1110 -
1111 - -
1112 -
1113 - -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.19 $ 12,792 $ 12,792
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.60 $ 71,625 $ 71,625
1117 Outreach Worker 2.00 76,056 76,056
1118 Case Managers 0.94 40,730 40,730
1119 - -
1120 -
1121 - -
1122 -
1123 - -
1124 -
1125 - -
1126 -
1127 - -
1128 -
1129 - -
1130 -
1131 - -
1132 -
1133 - -
1134 -
Direct Personnel Program Salaries Subtotall 3.54 1 $ 188,411 1 $ 188,411
Admin Program Total
Direct Personnel Salaries Subtotal 3.73 $ 12,792 $ 188,411 $ 201,203
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 198 $ 2,921 $ 3,119
1202 Worker's Compensation 320 4,710 5,030
1203 Health Insurance 1,612 23,739 25,351
1204 Other(specify) - - -
1205 10ther(specify) - - -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 12 of 134
1206 10ther(specify) - - I -
Direct Employee Benefits Subtotal:1 $ 2,130 $ 31,370 $ 33,500
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 979 14,413 15,392
1303 SUI 89 1,319 1,408
1304 Other(specify) - - -
1305 10ther(specify) - -
1306 10ther(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 1,068 $ 15,732 $ 16,800
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 15,990 $ 235,513 $ 251,503
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
6%1 94%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 8,700
2003 Client Transportation&Support 3,000
2004 Clothing, Food,&Hygiene 6,003
2005 jEclucation Support 230
2006 Employment Support 230
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(Program Supplies) 5,600
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 Other(specify) -
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 23,763
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 4,625
3002 Printing/Postage 800
3003 Office Supplies&Equipment 4,065
3004 Advertising -
3005 Staff Development&Training 2,545
3006 Staff Mileage 300
3007 Subscriptions&Memberships 100
3008 Vehicle Maintenance 17,750
3009 Other(Staff Recruitment) 350
3010 Other(specify)
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 30,535
4000: DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 13 of 134
Acct# Line Item Description Amount
4001 Building Maintenance $ 11,413
4002 Rent/Lease Building 8,899
4003 Rent/Lease Equipment 1,710
4004 Rent/Lease Vehicles 13,312
4005 Security -
4006 Utilities 3,720
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 39,054
5000: DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 11,686
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (specify) -
5004 Translation Services 200
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 11,886
6000: INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 37,343
Administrative Overhead
6002 Professional Liability Insurance 3,783
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Liability): 9,910
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(Operating)
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL 1 $ 51,036
INDIRECT COST RATE 14.19%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 2,900
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ d-
Fresno 7006 Assets over$5,000/unit(Specify)7007 Other(specify)County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 14 of 134
7008 Other(specify) I -
FIXED ASSETS EXPENSES TOTAL $ 3,000
TOTAL PROGRAM EXPENSES $ 410,777
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description 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 -
8009 Other(Specify) -
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ -
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name 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 -
MHSA TOTAL $ 102,777
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(PATH) 308,000
8404 Other(Specify)
8405 10ther(Specify) -
OTHER REVENUE TOTAL $ 308,000
TOTAL PROGRAM FUNDING SOURCES: $ 410,777
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 15 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year (FY) 2022-23
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position lContract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.17
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.06
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.25
Map Point/Fresno 0.05
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuoluml 0.22
Madera 1 0.11
Total 1.00
Position Contract#/Name/Department/County FTE
Admin Specialist PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.05
Rural Crisis Intervention/Fresno 0.65
Total 1.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 16 of 134
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position lContract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality & Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.12
PATH OEL/Fresno 0.60
PATH MOP/Fresno 0.28
Total 1.00
Position Contract#/Name/Department/County FTE
Case Managers PATH SMHS/Fresno 1.06
PATH OEL/Fresno 0.94
Total 2.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 17 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year(FY)2022-23 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 251,503
Administrative Positions 12,792
1101 Executive Director 1,802 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 1,207 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1103 Admin Specialist 2,576 Provides administrative support for the program.
1104 Accountant 3,841 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1105 Quality Improvement Data Analyst 3,366 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1106 0 -
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 188,411
1116 Program Manager 71,625 Provides supervision of all staff and direct oversight of program management.
1117 Outreach Worker 76,056 Provides outreach and engagement services,provides linkage to needed services.
1118 Case Managers 40,730 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.
1119 0 -
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 33,500
1201 Retirement 3,119 Cost of 401K
1202 Worker's Compensation 5,030 Workers Comp Insurance
1203 Health Insurance 25,351 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 16,800
1301 OASDI -
1302 FICA/MEDICARE 15,392 Cost of FICA/Medicare
1303 SUI 1,408 Cost of SUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT 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.
Fresno County Departrrrent ofBehavioral Fleahh Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 18 of 134
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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
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:DIRECT OPERATING EXPENSES 30,535
3001 Telecommunications 4,625 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 800 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 4,065 Includes desk supplies&minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development&Training 2,545 Minor shared cost for continuation of staff development and training.Also,includes
H M IS training fees.
3006 Staff Mileage 300 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 17,750 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 DVM fees.
3009 Other(Staff Recruitment) 350 Thorough background check and drug testing.
3010 Other(specify) -
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 39,054
4001 Building Maintenance 11,413 Shared copier maintenance and minor building repairs and maintenance.Annual
Janitorial Services to maintain client showers clean.
4002 Rent/Lease Building 8,899 Share cost of building space,anticipating moving locations.
4003 Rent/Lease Equipment 1,710 Shared copier lease.
4004 Rent/Lease Vehicles 13,312 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:DIRECT 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 (specify) -
5004 Translation Services 200 Anticipating translation services to assist clients.
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 51,036
6001 Administrative Overhead 37,343 Expenses provides corporate management,fiscal services,payroll,human resources,
6002 Professional Liability Insurance 3,783 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Liability): 9,910 Cost of personal property,accidental and auto insurance.
Fresno County Department ofBehaviorel Heahh Contract BudgetI h rative Revised 2/7/2020
Exhibit C
Page 19 of 134
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(Operating)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 3,000
7001 Computer Equipment&Software 2,900 Computer software needs to support staff&anticipating shared cost for replacement
of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 100 Anticipating 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 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 410,777
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 410,777
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 20 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.01 $ 1,874 $ 1,874
1102 Regional Director 0.01 1,255 1,255
1103 Admin Specialist 0.05 2,679 2,679
1104 Accountant 0.07 4,292 4,292
1105 Quality Improvement Data Analyst 0.05 3,500 3,500
1106 - -
1107 - -
1108 - -
1109 - -
1110 -
1111 - -
1112 -
1113 - -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.19 $ 13,600 $ 13,600
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.60 $ 74,490 $ 74,490
1117 Outreach Worker 2.00 79,086 79,086
1118 Case Managers 0.94 42,367 42,367
1119 - -
1120 -
1121 - -
1122 -
1123 - -
1124 -
1125 - -
1126 -
1127 - -
1128 -
1129 - -
1130 -
1131 - -
1132 -
1133 - -
1134 -
Direct Personnel Program Salaries Subtotall 3.54 1 $ 195,943 1 $ 195,943
Admin Program Total
Direct Personnel Salaries Subtotal 3.73 $ 13,600 $ 195,943 $ 209,543
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 211 $ 3,037 $ 3,248
1202 Worker's Compensation 340 4,899 5,239
1203 Health Insurance 1,713 24,689 26,402
1204 Other(specify) - - -
1205 10ther(specify) - - i -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 21 of 134
1206 10ther(specify) - - I -
Direct Employee Benefits Subtotal:1 $ 2,264 1 $ 32,625 1 $ 34,889
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 1,040 14,990 16,030
1303 SUI 95 1,372 1,467
1304 Other(specify) - - -
1305 10ther(specify) - - -
1306 10ther(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 1,135 $ 16,362 $ 17,497
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 16,999 $ 244,930 $ 261,929
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
6%1 94%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 5,500
2003 Client Transportation&Support 3,000
2004 Clothing, Food,&Hygiene 3,550
2005 Education Support 225
2006 Employment Support 225
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(Program Supplies) 4,000
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 10ther(specify) -
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 16,500
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 7,205
3002 Printing/Postage 270
3003 Office Supplies&Equipment 3,050
3004 Advertising -
3005 Staff Development&Training 2,205
3006 Staff Mileage 180
3007 Subscriptions&Memberships 100
3008 Vehicle Maintenance 16,250
3009 Other(Staff Recruitment) 170
3010 Other(Insurance) 12,843
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 42,273
4000: DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 22 of 134
Acct# Line Item Description Amount
4001 Building Maintenance $ 10,031
4002 Rent/Lease Building 8,640
4003 Rent/Lease Equipment 2,160
4004 Rent/Lease Vehicles 13,012
4005 Security -
4006 Utilities 3,757
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) j
4010 Other(specify) DIRECTFACILITIES/EQUIPMENTTOTAL: $ 37,60
5000: DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 11,732
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (specify) -
5004 Translation Services 200
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 11,932
6000: INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) 28,007
6009 Other(Operating) 9,336
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL 1 $ 37,343
INDIRECT COST RATE 10.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,000
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 200
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ d-
Fresno 7006 Assets over$5,000/unit(Specify)7007 Other(specify)County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 23 of 134
7008 Other(specify) I -
FIXED ASSETS EXPENSES TOTAL $ 3,200
TOTAL PROGRAM EXPENSES $ 410,777
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description 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
8009 Other(Specify) -
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ -
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name 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 -
MHSA TOTAL $ 102,777
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(PATH) 308,000
8404 Other(Specify) -
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 308,000
TOTAL PROGRAM FUNDING SOURCES: $ 410,777
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 24 of 134
PATH PROGRAM- OEL
Kings View
Fiscal Year (FY) 2023-24
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position lContract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.17
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.06
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.25
Map Point/Fresno 0.05
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuoluml 0.22
Madera 1 0.11
Total 1.00
Position Contract#/Name/Department/County FTE
Admin Specialist PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.05
Rural Crisis Intervention/Fresno 0.65
Total 1.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 25 of 134
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position lContract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality & Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.12
PATH OEL/Fresno 0.60
PATH MOP/Fresno 0.28
Total 1.00
Position Contract#/Name/Department/County FTE
Case Managers PATH SMHS/Fresno 1.06
PATH OEL/Fresno 0.94
Total 2.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 26 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year(FY)2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 261,929
Administrative Positions 13,600
1101 Executive Director 1,874 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 1,255 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1103 Admin Specialist 2,679 Provides administrative support for the program.
1104 Accountant 4,292 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1105 Quality Improvement Data Analyst 3,500 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1106 0 -
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 195,943
1116 Program Manager 74,490 Provides supervision of all staff and direct oversight of program management.
1117 Outreach Worker 79,086 Provides outreach and engagement services,provides linkage to needed services.
1118 Case Managers 42,367 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.
1119 0 -
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0 -
Direct Employee Benefits 34,889
1201 Retirement 3,248 Cost of 401K
1202 Worker's Compensation 5,239 Workers Comp Insurance
1203 Health Insurance 26,402 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 17,497
1301 OASDI -
1302 FICA/MEDICARE 16,030 Cost of FICA/Medicare
1303 SUI 1,467 Cost of SUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT 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.
Fresno County Department ofBehavioral Fleahh Contract Budget Mnative Revised 2/7/2020
Exhibit C
Page 27 of 134
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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
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:DIRECT OPERATING EXPENSES 42,273
3001 Telecommunications 7,205 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 270 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 3,050 Includes desk supplies&minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development&Training 2,205 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 16,250 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 DVM fees.
3009 Other(Staff Recruitment) 170 Thorough background check and drug testing.
3010 Other(Insurance) 12,843 Direct expense to program for general,professional liability,personal property,
accidental,and auto insurance.
3011 Other(specify) -
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 37,600
4001 Building Maintenance 10,031 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:DIRECT 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 (specify) -
5004 Translation Services 200 Anticipating translation services to assist clients.
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 37,343
6001 Administrative Overhead
6002 Professional Liability Insurance
Fresno County Department ofBehavioml Heakh Contract BudgetI h rative Revised 2/7/2020
Exhibit C
Page 28 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) 28,007 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6009 Other(Operating) 9,336 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
7000:DIRECT FIXED ASSETS 3,200
7001 Computer Equipment&Software 3,000 Computer software needs to support staff&anticipating shared cost for replacement
of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 200 Anticipating 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 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 410,777
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 410,777
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 29 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.01 $ 1,950 $ 1,950
1102 Regional Director 0.02 2,610 2,610
1103 Admin Specialist 0.05 2,787 2,787
1104 Accountant 0.07 4,464 4,464
1105 Quality Improvement Data Analyst 0.05 3,640 3,640
1106 - -
1107 - -
1108 - -
1109 - -
1110 - -
1111 -
1112 -
1113 -
1114 -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.20 $ 15,451 $ 15,451
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.60 $ 77,469 $ 77,469
1117 Outreach Worker 2.00 82,250 82,250
1118 Case Managers 0.80 37,498 37,498
1119 - -
1120 -
1121 -
1122 -
1123 -
1124 -
1125 -
1126 -
1127 -
1128 -
1129 -
1130 -
1131 -
1132 -
1133 -
1134 - -
Direct Personnel Program Salaries Subtotal 3.40 $ 197,217 $ 197,217
Admin Program Total
Direct Personnel Salaries Subtotal 3.60 $ 15,451 $ 197,217 $ 212,668
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 239 $ 3,057 $ 3,296
1202 Worker's Compensation 386 4,931 5,317
1203 Health Insurance 1,947 24,849 26,796
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 30 of 134
1204 Other(specify) - - -
1205 Other(specify) - - -
1206 Other(specify) - - -
Direct Employee Benefits Subtotal: $ 2,572 $ 32,837 $ 35,409
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 1,182 15,087 16,269
1303 SUI 108 1,381 1,489
1304 Other(specify) - - -
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 1,290 $ 16,468 $ 17,758
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 19,313 $ 246,522 $ 265,835
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
7%1 93%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 5,000
2003 Client Transportation&Support 3,000
2004 Clothing, Food,&Hygiene 4,073
2005 Education Support 225
2006 Employment Support 225
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(Program Supplies) 4,000
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify) -
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 16,523
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 7,205
3002 Printing/Postage 270
3003 Office Supplies&Equipment 2,050
3004 Advertising -
3005 Staff Development&Training 2,205
3006 Staff Mileage 180
3007 Subscriptions&Memberships 100
3008 Vehicle Maintenance 16,250
3009 Other(Staff Recruitment) 170
3010 Other(Insurance) 12,843
3011 Other(specify) -
3012 Other(specify) -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 31 of 134
DIRECT OPERATING EXPENSES TOTAL: $ 41,273
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 9,515
4002 Rent/Lease Building 8,640
4003 Rent/Lease Equipment 2,160
4004 Rent/Lease Vehicles 13,012
4005 Security -
4006 Utilities 3,757
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 1 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL:j $ 37,084
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 11,744
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (specify) -
5004 Translation Services 200
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 11,944
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits) 28,007
6009 Other(Operating) 9,336
6010 Other(specify) -
6011 Other(specify)
6012 10ther(specify)
6013 1 Other(specify)
INDIRECT EXPENSES TOTAL $ 37,343
INDIRECT COST RATE 10.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 675
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 32 of 134
7003 Furniture&Fixtures 100
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)
FIXED ASSETS EXPENSES TOTAL $ 775
TOTAL PROGRAM EXPENSES $ 410,777
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description 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
8009 Other(Specify)
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 1 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 102,777
8302 PEI- Prevention &Early Intervention -
8303 INN- Innovations
8304 WET-Workforce Education &Training
8305 jCFTN-Capital Facilities&Technology
MHSA TOTAL $ 102,777
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 33 of 134
8403 Grants(PATH) 308,000
8404 Other(Specify) -
8405 10ther(Specify) -
OTHER REVENUE TOTAL $ 308,000
TOTAL PROGRAM FUNDING SOURCES: 1 $ 410,777
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 34 of 134
PATH PROGRAM- OEL
Kings View
Fiscal Year (FY) 2024-25
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.17
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.06
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.25
Map Point/Fresno 0.05
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.22
Madera 0.11
Total 1.00
Position Contract#/Name/Department/County FTE
Admin Specialist PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.05
Rural Crisis Intervention/Fresno 0.65
Total 1.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 35 of 134
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality& Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.12
PATH OEL/Fresno 0.60
PATH MOP/Fresno 0.28
Total 1.00
Position Contract#/Name/Department/County FTE
Case Managers PATH SMHS/Fresno 1.20
PATH OEL/Fresno 0.80
Total 2.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 36 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 265,835
Administrative Positions 15,451
1101 Executive Director 1,950 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 2,610 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1103 Admin Specialist 2,787 Provides administrative support for the program.
1104 Accountant 4,464 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1105 Quality Improvement Data Analyst 3,640 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1106 0 -
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 197,217
1116 Program Manager 77,469 Provides supervision of all staff and direct oversight of program management.
1117 Outreach Worker 82,250 Provides outreach and engagement services,provides linkage to needed services.
1118 Case Managers 37,498 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.
1119 0 -
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 35,409
1201 Retirement 3,296 Cost of 401K
1202 Worker's Compensation 5,317 Workers Comp Insurance
1203 Health Insurance 26,796 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 17,758
1301 OASDI -
1302 FICA/MEDICARE 16,269 Cost of FICA/Medicare
1303 SUI 1,489 Cost of SUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 16,523
2001 Child Care -
2002 Client Housing Support 5,000 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 3,000 Provides bus passes,bus tokens or any transportation assistance for clients,such as
taxi service or gas.
2004 Clothing,Food,&Hygiene 4,073 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.
Fresno County Departrrrent ofBehavioral Fleahh Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 37 of 134
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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
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:DIRECT OPERATING EXPENSES 41,273
3001 Telecommunications 7,205 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 270 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 2,050 Includes desk supplies&minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development&Training 2,205 Minor shared cost for continuation of staff development and training.Also,includes
H M IS 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 16,250 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 DVM fees.
3009 Other(Staff Recruitment) 170 Thorough background check and drug testing.
3010 Other(Insurance) 12,843 Direct expense to program for general,professional liability,personal property,
accidental,and auto insurance.
3011 Other(specify) -
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 37,084
4001 Building Maintenance 9,515 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:DIRECT 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 Anticipating translation services to assist clients.
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 37,343
6001 Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
Fresno County Department ofBehaviorel Fleakh Contract BudgetI h rative Revised 2/7/2020
Exhibit C
Page 38 of 134
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) 28,007 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6009 Other(Operating) 9,336 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
7000:DIRECT FIXED ASSETS 775
7001 Computer Equipment&Software 675 Computer software needs to support staff&anticipating shared cost for replacement
of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 100 Anticipating 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 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 410,777
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 410,777
BUDGET CHECK: -
Fresno County Department of Behavioral Fleahh Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 39 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.01 $ 2,008 $ 2,008
1102 Regional Director 0.02 2,688 2,688
1103 Admin Specialist 0.05 2,870 2,870
1104 Accountant 0.07 4,598 4,598
1105 Quality Improvement Data Analyst 0.05 3,750 3,750
1106 - -
1107 - -
1108 -
1109 - -
1110 -
1111 - -
1112 -
1113 - -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.20 $ 15,914 $ 15,914
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.60 $ 79,793 $ 79,793
1117 Outreach Worker 2.00 84,718 84,718
1118 Case Managers 0.80 38,623 38,623
1119 - -
1120 -
1121 - -
1122 -
1123 - -
1124 -
1125 - -
1126 -
1127 - -
1128 -
1129 - -
1130 - -
1131 - -
1132 - -
1133 - -
1134 - -
Direct Personnel Program Salaries Subtotall 3.40 1 $ 203,134 1 $ 203,134
Admin Program Total
Direct Personnel Salaries Subtotal 3.60 $ 15,914 $ 203,134 $ 219,048
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 246 $ 3,149 $ 3,395
1202 Worker's Compensation 398 5,078 5,476
1203 Health Insurance 2,005 25,595 27,600
1204 Other(specify) -
1205 10ther(specify) - - -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 40 of 134
1206 10ther(specify) - - I -
Direct Employee Benefits Subtotal:1 $ 2,649 1 $ 33,822 1 $ 36,471
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 1,217 15,540 16,757
1303 SUI 112 1,422 1,534
1304 Other(specify) - - -
1305 10ther(specify) - -
1306 10ther(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 1,329 $ 16,962 $ 18,291
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 19,892 $ 253,918 $ 273,810
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
7%1 93%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 3,400
2003 Client Transportation&Support 2,100
2004 Clothing, Food,&Hygiene 2,920
2005 Education Support 200
2006 Employment Support 200
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(Program Supplies) 2,000
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 10ther(specify) -
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 10,820
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 7,205
3002 Printing/Postage 70
3003 Office Supplies&Equipment 1,240
3004 Advertising -
3005 Staff Development&Training 1,205
3006 Staff Mileage 180
3007 Subscriptions&Memberships 100
3008 Vehicle Maintenance 16,250
3009 Other(Staff Recruitment) 170
3010 Other(Insurance) 12,843
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 39,263
4000: DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 41 of 134
Acct# Line Item Description Amount
4001 Building Maintenance $ 9,253
4002 Rent/Lease Building 8,640
4003 Rent/Lease Equipment 2,160
4004 Rent/Lease Vehicles 13,012
4005 Security -
4006 Utilities 3,757
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 36,822
5000: DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 11,744
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (specify) -
5004 Translation Services 200
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL:1 $ 11,944
6000: INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) 28,007
6009 Other(Operating) 9,336
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL 1 $ 37,343
INDIRECT COST RATE 10.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 675
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ d-
Fresno 7006 Assets over$5,000/unit(Specify)7007 Other(specify)County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 42 of 134
7008 Other(specify) I -
FIXED ASSETS EXPENSES TOTAL $ 775
TOTAL PROGRAM EXPENSES $ 410,777
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description 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 -
8009 Other(Specify) -
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ -
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name 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 -
MHSA TOTAL $ 102,777
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(PATH) 308,000
8404 Other(Specify) -
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 308,000
TOTAL PROGRAM FUNDING SOURCES: $ 410,777
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit C
Page 43 of 134
PATH PROGRAM- OEL
Kings View
Fiscal Year (FY) 2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolum 0.17
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.06
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.25
Map Point/Fresno 0.05
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolurnj 0.22
Madera 0.11
Total 1.00
Position Contract#/Name/Department/County FTE
Admin Specialist PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.05
Rural Crisis Intervention/Fresno 0.65
Exhibit C
Page 44 of 134
Total 1.00
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality& Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.12
PATH OEL/Fresno 0.60
PATH MOP/Fresno 0.28
Total 1.00
Position Contract#/Name/Department/County FTE
Case Managers PATH SMHS/Fresno 1.20
PATH OEL/Fresno 0.80
Exhibit C
Page 45 of 134
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C
Page 46 of 134
PATH PROGRAM-OEL
Kings View
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 273,810
Administrative Positions 15,914
1101 Executive Director 2,008 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 2,688 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1103 Admin Specialist 2,870 Provides administrative support for the program.
1104 Accountant 4,598 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1105 Quality Improvement Data Analyst 3,750 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1106 0 -
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 203,134
1116 Program Manager 79,793 Provides supervision of all staff and direct oversight of program management.
1117 Outreach Worker 84,718 Provides outreach and engagement services,provides linkage to needed services.
1118 Case Managers 38,623 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.
1119 0 -
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 36,471
1201 Retirement 3,395 Cost of 401K
1202 Worker's Compensation 5,476 Workers Comp Insurance
1203 Health Insurance 27,600 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 18,291
1301 OASDI -
1302 FICA/MEDICARE 16,757 Cost of FICA/Medicare
1303 SUI 1,534 Cost of SUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 10,820
2001 Child Care -
2002 Client Housing Support 3,400 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 2,920 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.
Fresno County Departrrrent ofBehavioral Fleahh Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 47 of 134
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(Program Supplies) 2,000 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:DIRECT OPERATING EXPENSES 39,263
3001 Telecommunications 7,205 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 70 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 1,240 Includes desk supplies&minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development&Training 1,205 Minor shared cost for continuation of staff development and training.Also,includes
H M IS 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 16,250 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 DVM fees.
3009 Other(Staff Recruitment) 170 Thorough background check and drug testing.
3010 Other(Insurance) 12,843 Direct expense to program for general,professional liability,personal property,
accidental,and auto insurance.
3011 Other(specify) -
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 36,822
4001 Building Maintenance 9,253 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:DIRECT 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 Anticipating translation services to assist clients.
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 37,343
6001 Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
Fresno County Department ofBehaviorel Fleakh Contract BudgetI h rative Revised 2/7/2020
Exhibit C
Page 48 of 134
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) 28,007 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6009 Other(Operating) 9,336 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
7000:DIRECT FIXED ASSETS 775
7001 Computer Equipment&Software 675 Computer software needs to support staff&anticipating shared cost for replacement
of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 100 Anticipating 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 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 410,777
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 410,777
BUDGET CHECK: -
Fresno County Department of Behavioral Fleahh Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 49 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year(FY)2021-22
PROGRAM EXPENSES
1000: DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program 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 Admin Specialist 0.08 3,885 3,885
1105 Accountant 0.03 1,792 1,792
1106 Quality Improvement Data Analyst 0.02 1,268 1,268
1107 - -
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.16 $ 10,580 $ 10,580
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.30 $ 31,603 $ 31,603
1117 Case Managers 0.80 33,654 33,654
1118 - -
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 1.10 $ 65,257 $ 65,257
Admin Program Total
Direct Personnel Salaries Subtotal 1.26 $ 10,580 $ 65,257 $ 75,837
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 192 $ 1,183 $ 1,375
Exhibit C
Page 50 of 134
1202 Worker's Compensation 253 1,559 1,812
1203 Health Insurance 776 4,783 5,559
1204 Other(specify) - - -
1205 Other(specify)
1206 Other(specify)
Direct Employee Benefits Subtotal: $ 1,221 $ 7,525 $ 8,746
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 777 4,791 5,568
1303 SUI 61 376 437
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 838 $ 5,167 $ 6,005
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 12,639 $ 77,949 $ 90,588
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
14% 86%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 25,000
2003 Client Transportation&Support
2004 Clothing, Food,&Hygiene 740
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
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 Other(specify) -
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 28,112
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 1,330
3002 Printing/Postage 350
3003 Office Supplies&Equipment 1,023
3004 Advertising -
3005 Staff Development&Training 640
3006 Staff Mileage 150
3007 Subscriptions&Memberships 50
Exhibit C
Page 51 of 134
3008 Vehicle Maintenance 2,167
3009 Other(Staff Recruitment) 300
3010 Other(specify) -
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTA1:1 $ 6,010
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 1,324
4002 Rent/Lease Building 2,052
4003 Rent/Lease Equipment 240
4004 Rent/Lease Vehicles 1,953
4005 Security -
4006 Utilities 675
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 6,244
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 4,046
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Psychiatrist Fees) 32,438
5004 Translation Services -
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 36,484
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 20,789
Administrative Overhead
6002 1 Professional Liability Insurance 1,961
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Liability): 689
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify) -
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 23,439
Exhibit C
Page 52 of 134
INDIRECT COST RATE 13.74%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,050
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture& Fixtures 100
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)
FIXED ASSETS EXPENSES TOTAL $ 3,150
TOTAL PROGRAM EXPENSES $ 194,027
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
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
8009 Other(Specify) 0 - -
8010 Other(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 140,7321 $ 193,363
Estimated%of Clients who are Medi-Cal Beneficiaries 75%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 145,022
Federal Financial Participation (FFP)% 1 85% 123,269
MEDI-CAL FFP TOTAL $ 123,269
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ 0
REALIGNMENT TOTAL $ 0
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 69,756
8302 PEI- Prevention& Early Intervention -
Exhibit C
Page 53 of 134
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology -
MHSATOTAL $ 69,756
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
8404 Other(Client Rents) 1,002
8405 1 Other(Specify) -
OTHER REVENUE TOTALI $ 1,002
TOTAL PROGRAM FUNDING SOURCES: $ 194,027
NET PROGRAM COST: $ -
Exhibit C
Page 54 of 134
PATH Program- SMHS
Kings View
Fiscal Year (FY) 2021-22
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
Blue Sky/Fresno 0.05
Rural Triage East/Fresno 0.10
Rural Triage West/Fresno 0.10
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Kings 0.23
CVSPH/California State,Tualre, Calaveras,Tuolum 0.09
Fresno City 0.05
Shasta 0.06
Tulare 0.26
Madera 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Executive Assistant PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
Blue Sky/Fresno 0.05
Rural Triage East/Fresno 0.10
Rural Triage West/Fresno 0.10
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Kings 0.23
CVSPH/California State,Tualre, Calaveras,Tuolum 0.09
Fresno City 0.05
Shasta 0.06
Tulare 0.26
Madera 0.02
Total 1.00
Position lContract#/Name/Department/County F!0..
Regional Director PATH SMHS/Fresno 02PATH OEL/Fresno 05
Exhibit C
Page 55 of 134
Blue Sky/Fresno 0.10
Rural Triage East/Fresno 0.22
Rural Triage West/Fresno 0.22
Metro CIT/Fresno 0.22
Map Point/Fresno 0.02
CVSPH/California State,Tualre, Calaveras,Tuolum 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Admin Specialist PATH SMHS/Fresno 0.08
PATH OEL/Fresno 0.26
Rural Triage East/Fresno 0.40
Rural Triage West/Fresno 0.26
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.70
Total 1.00
Position Contract#/Name/Department/County FTE
Case Managers PATH SMHS/Fresno 0.80
PATH OEL/Fresno 1.20
Total 2.00
Position lContract#/Name/Department/County F!0..
Accountant PATH SMHS/Fresno 04PATH OEL/Fresno 07
Exhibit C
Page 56 of 134
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality & Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position lContract#/Name/Department/County FTE
Exhibit C
Page 57 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year(FY)2021-22 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 90,588
Administrative Positions 10,580
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 Admin Specialist 3,885 Provides administrative support for the program and assist with medical billing and
records.
1105 Accountant 1,792 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1106 Quality Improvement Data Analyst 1,268 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1107 0 -
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10 1 -
Program Positions 65,257
1116 Program Manager 31,603 Provides supervision of all staff and direct oversight of program management.
1117 Case Managers 33,654 Provides administrative support for the program and assist with medical billing and
records.
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10
Direct Employee Benefits 8,746
1201 Retirement 1,375 Cost of401K
1202 Worker's Compensation 1,812 Workers Comp Insurance
1203 Health Insurance 5,559 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 6,005
1301 OASDI -
1302 FICA/MEDICARE 5,568 Cost of FICA/Medicare
1303 SUI 437 Cost ofSUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT 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 -
Exhibit C
Page 58 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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.
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify)
2015 Other(specify) -
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 6,010
3001 Telecommunications 1,330 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 350 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 1,023 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 orjob
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:DIRECT FACILITIES&EQUIPMENT 6,244
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 1,953 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:DIRECT SPECIAL EXPENSES 36,484
5001 Consultant(Network&Data Management) 4,046 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) 32,438 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:INDIRECT EXPENSES 23,439
6001 Administrative Overhead 20,789 Expenses provides program management,fiscal services,payroll,human resources,
6002 Professional Liability Insurance 1,961 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit
6005 Insurance(Liability): 689 Cost of personal property,accidental and auto insurance.
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify) -
6010 Other(specify)
Exhibit C
Page 59 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6011 Other(specify) -
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 3,150
7001 Computer Equipment&Software 3,050 Computer software needs to support staff&anticipating shared cost for replacement
of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 100 Anticipating 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)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management Based on annualizing current reports
8003 Crisis Services Based on annualizing current reports
8004 Medication Support Based on annualizing current reports
8005 Collateral
8006 Plan Development Based on annualizing current reports
8007 Assessment Based on annualizing current reports
8008 Rehabilitation Based on annualizing current reports
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 194,027
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 194,027
BUDGET CHECK: -
Exhibit C
Page 60 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.01 $ 1,802 $ 1,802
1102 Regional Director 0.06 7,239 7,239
1103 Admin Specialist 0.30 15,457 15,457
1104 Accountant 0.04 2,358 2,358
1105 Quality Improvement Data Analyst 0.02 1,346 1,346
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.43 $ 28,202 $ 28,202
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.12 $ 14,325 $ 14,325
1117 Case Managers 1.06 45,930 45,930
1118 - -
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 1.18 $ 60,255 $ 60,255
Admin Program Total
Direct Personnel Salaries Subtotal 1.61 $ 28,202 $ 60,255 $ 88,457
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 533 $ 1,139 $ 1,672
1202 Worker's Compensation 702 1,501 2,203
1203 Health Insurance 2,642 5,646 8,288
1204 Other(specify) - -
Exhibit C
Page 61 of 134
1205 10ther(specify)
1206 10ther(specify)
Direct Employee Benefits Subtotal: $ 3,877 $ 8,286 $ 12,163
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 2,158 4,609 6,767
1303 SUI 169 362 531
1304 Other(specify) - - -
1305 10ther(specify)
1306 10ther(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 2,327 $ 4,971 $ 7,298
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 34,406 $ 73,512 $ 107,918
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
32% 68%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 36,781
2003 Client Transportation&Support
2004 Clothing, Food,&Hygiene 2,115
2005 jEclucation Support
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(Program Supplies) 2,000
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 40,896
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 1,750
3002 Printing/Postage 250
3003 Office Supplies&Equipment 1,174
3004 Advertising -
3005 IStaff Development&Training 1,256
3006 Staff Mileage 150
3007 Subscriptions&Memberships 50
3008 Vehicle Maintenance 1,020
3009 Other(Staff Recruitment) 300
3010 Other(Insurance) 2,410
3011 Other(specify) -
3012 10ther(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 8,360
Exhibit C
Page 62 of 134
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 1,324
4002 Rent/Lease Building 2,200
4003 Rent/Lease Equipment 240
4004 Rent/Lease Vehicles 830
4005 Security
4006 Utilities 675
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 5,269
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 4,980
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Psychiatrist Fees) 34,571
5004 Translation Services -
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 39,551
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(Indirect Salaries&Benefits) 18,071
6009 Other(Operating) 6,024
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 24,095
INDIRECT COST RATE 11.80%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 2,100
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 100
7004 Leasehold/Tenant/Building Improvements -
Exhibit C
Page 63 of 134
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 2,200
TOTAL PROGRAM EXPENSES $ 228,289
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 164 3.75 615
8003 Crisis Services 61 6.75 412
8004 Medication Support 2,981 8.25 24,593
8005 lCollateral -
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
8009 Other(Specify) 0 -
8010 Other(Specify) 0 -
Estimated Specialty Mental Health Services Billing Totals: 148,0001 $ 247,108
Estimated%of Clients who are Medi-Cal Beneficiaries 75%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 185,331
Federal Financial Participation(FFP)% 1 85% 157,531
MEDI-CAL FFP TOTAL $ 157,531
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ (0)
REALIGNMENT TOTAL $ (0)
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name 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
MHSA TOTAL $ 69,756
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance
8403 Grants(Specify) -
8404 Other(Client Rents) 1,002
8405 Other(Specify)
Exhibit C
Page 64 of 134
I OTHER REVENUE TOTALI $ 1,002 I
TOTAL PROGRAM FUNDING SOURCES: $ 228,289
NET PROGRAM COST: $ -
Exhibit C
Page 65 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year (FY) 2022-23
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolum 0.17
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.06
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.25
Map Point/Fresno 0.05
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolurnj 0.22
Madera 0.11
Total 1.00
Position Contract#/Name/Department/County FTE
Admin Specialist PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.05
Rural Crisis Intervention/Fresno 0.65
Exhibit C
Page 66 of 134
Total 1.00
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality& Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.12
PATH OEL/Fresno 0.60
PATH MOP/Fresno 0.28
Total 1.00
Position Contract#/Name/Department/County FTE
Case Managers PATH SMHS/Fresno 1.06
PATH OEL/Fresno 0.94
Exhibit C
Page 67 of 134
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C
Page 68 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year(FY)2022-23 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 107,918
Administrative Positions 28,202
1101 Executive Director 1,802 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 7,239 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1103 Admin Specialist 15,457 Provides administrative support for the program and assist with medical billing and
records.
1104 Accountant 2,358 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1105 Quality Improvement Data Analyst 1,346 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1106 0 -
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions 60,255
1116 Program Manager 14,325 Provides supervision of all staff and direct oversight of program management.
1117 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.
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10
Direct Employee Benefits 12,163
1201 Retirement 1,672 Cost of 401K
1202 Worker's Compensation 2,203 Workers Comp Insurance
1203 Health Insurance 8,288 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 7,298
1301 OASDI -
1302 FICA/MEDICARE 6,767 Cost of FICA/Medicare
1303 SUI 531 Cost of SUI
1304 Other(specify) -
1305 Other(specify) -
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 40,896
2001 Child Care -
2002 Client Housing Support 36,781 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
Exhibit C
Page 69 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2006 Employment Support -
2007 Household Items for Clients
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers -
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 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 8,360
3001 Telecommunications 1,750 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 1,174 Includes all supplies and minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development&Training 1,256 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 orjob
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(Insurance) 2,410 Direct expense to program for general,professional liability,personal property,
accidental,and auto insurance.
3011 Other(specify) -
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 5,269
4001 Building Maintenance 1,324 Shared copier maintenance,minor building repairs and maintenance to facility.
4002 Rent/Lease Building 2,200 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:DIRECT SPECIAL EXPENSES 39,551
5001 Consultant(Network&Data Management) 4,980 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:INDIRECT EXPENSES 24,095
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit
6005 Insurance(Specify): -
6006 Payroll Services
Exhibit C
Page 70 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) 18,071 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6009 Other(Operating) 6,024 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 2,200
7001 Computer Equipment&Software 2,100 Computer software needs to support staff&anticipating shared cost for replacement
of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 100 Anticipating 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)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management Based on annualizing current reports
8003 Crisis Services Based on annualizing current reports
8004 Medication Support Based on annualizing current reports
8005 Collateral
8006 Plan Development Based on annualizing current reports
8007 Assessment Based on annualizing current reports
8008 Rehabilitation Based on annualizing current reports
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 228,289
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 228,289
BUDGET CHECK: -
Exhibit C
Page 71 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.01 $ 1,874 $ 1,874
1102 Regional Director 0.06 7,528 7,528
1103 Admin Specialist 0.30 16,076 16,076
1104 Accountant 0.04 2,453 2,453
1105 Quality Improvement Data Analyst 0.02 1,387 1,387
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.43 $ 29,318 $ 29,318
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.12 $ 14,898 $ 14,898
1117 Case Managers 1.06 47,774 47,774
1118 - -
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 1.18 $ 62,672 $ 62,672
Admin Program Total
Direct Personnel Salaries Subtotal 1.61 $ 29,318 $ 62,672 $ 91,990
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 554 $ 1,185 $ 1,739
1202 Worker's Compensation 730 1,560 2,290
1203 Health Insurance 2,747 5,872 8,619
1204 Other(specify) - -
Exhibit C
Page 72 of 134
1205 10ther(specify)
1206 10ther(specify)
Direct Employee Benefits Subtotal: $ 4,031 $ 8,617 $ 12,648
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 2,243 4,794 7,037
1303 SUI 176 376 552
1304 Other(specify) - - -
1305 10ther(specify)
1306 10ther(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 2,419 $ 5,170 $ 7,589
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 35,768 $ 76,459 $ 112,227
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
32% 68%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 31,135
2003 Client Transportation&Support -
2004 Clothing, Food,&Hygiene 2,115
2005 jEclucation Support -
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(Program Supplies) 2,000
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 35,250
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 1,750
3002 Printing/Postage 250
3003 Office Supplies&Equipment 1,271
3004 Advertising -
3005 IStaff Development&Training 1,355
3006 Staff Mileage 150
3007 Subscriptions&Memberships 50
3008 Vehicle Maintenance 1,520
3009 Other(Staff Recruitment) 300
3010 Other(Insurance) 2,440
3011 Other(specify) -
3012 10ther(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 9,086
Exhibit C
Page 73 of 134
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 1,324
4002 Rent/Lease Building 2,266
4003 Rent/Lease Equipment 240
4004 Rent/Lease Vehicles 830
4005 Security
4006 Utilities 695
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 5,355
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 4,980
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Psychiatrist Fees) 35,096
5004 Translation Services -
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 40,076
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(Indirect Salaries&Benefits) 18,071
6009 Other(Operating) 6,024
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 24,095
INDIRECT COST RATE 11.80%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 2,100
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 100
7004 Leasehold/Tenant/Building Improvements -
Exhibit C
Page 74 of 134
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 2,200
TOTAL PROGRAM EXPENSES $ 228,289
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 164 3.75 615
8003 Crisis Services 61 6.75 412
8004 Medication Support 2,981 8.25 24,593
8005 lCollateral -
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
8009 Other(Specify) 0 -
8010 Other(Specify) 0 -
Estimated Specialty Mental Health Services Billing Totals: 148,0001 $ 247,108
Estimated%of Clients who are Medi-Cal Beneficiaries 75%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 185,331
Federal Financial Participation(FFP)% 1 85% 157,531
MEDI-CAL FFP TOTAL $ 157,531
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ 0
REALIGNMENT TOTAL $ 0
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name 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
MHSA TOTAL $ 69,756
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance
8403 Grants(Specify) -
8404 Other(Client Rents) 1,002
8405 Other(Specify)
Exhibit C
Page 75 of 134
I OTHER REVENUE TOTALI $ 1,002 I
TOTAL PROGRAM FUNDING SOURCES: $ 228,289
NET PROGRAM COST: $ -
Exhibit C
Page 76 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year (FY) 2023-24
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolum 0.17
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.06
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.25
Map Point/Fresno 0.05
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolurnj 0.22
Madera 0.11
Total 1.00
Position Contract#/Name/Department/County FTE
Admin Specialist PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.05
Rural Crisis Intervention/Fresno 0.65
Exhibit C
Page 77 of 134
Total 1.00
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality& Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.12
PATH OEL/Fresno 0.60
PATH MOP/Fresno 0.28
Total 1.00
Position Contract#/Name/Department/County FTE
Case Managers PATH SMHS/Fresno 1.06
PATH OEL/Fresno 0.94
Exhibit C
Page 78 of 134
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C
Page 79 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year(FY)2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 112,227
Administrative Positions 29,318
1101 Executive Director 1,874 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 7,528 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1103 Admin Specialist 16,076 Provides administrative support for the program and assist with medical billing and
records.
1104 Accountant 2,453 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1105 Quality Improvement Data Analyst 1,387 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1106 0 -
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10 1 -
Program Positions 62,672
1116 Program Manager 14,898 Provides supervision of all staff and direct oversight of program management.
1117 Case Managers 47,774 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.
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0 -
Direct Employee Benefits 12,648
1201 Retirement 1,739 Cost of 401K
1202 Worker's Compensation 2,290 Workers Comp Insurance
1203 Health Insurance 8,619 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 7,589
1301 OASDI -
1302 FICA/MEDICARE 7,037 Cost ofFICA/Medicare
1303 SUI 552 Cost ofSUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 35,250
2001 Child Care -
2002 Client Housing Support 31,135 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.
Exhibit C
Page 80 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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) 2,000 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 1 Other(specify) -
3000:DIRECT OPERATING EXPENSES 9,086
3001 Telecommunications 1,750 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 1,271 Includes all supplies and minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development&Training 1,355 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 orjob
tasks,such as an online subscription.
3008 Vehicle Maintenance 1,520 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(Insurance) 2,440 Direct expense to program for general,professional liability,personal property,
accidental,and auto insurance.
3011 Other(specify) -
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 5,355
4001 Building Maintenance 1,324 Shared copier maintenance,minor building repairs and maintenance to facility.
4002 Rent/Lease Building 2,266 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 695 Shared cost of gas and electric.
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 40,076
5001 Consultant(Network&Data Management) 4,980 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:INDIRECT EXPENSES 24,095
6001 Administrative Overhead -
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit -
6005 Insurance(Specify):
Exhibit C
Page 81 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) 18,071 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6009 Other(Operating) 6,024 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify) -
6013 Other(specify) -
7000:DIRECT FIXED ASSETS 2,200
7001 Computer Equipment&Software 2,100 Computer software needs to support staff&anticipating shared cost for replacement
of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 100 Anticipating shared cost for replacement of furniture needs.
7004 Leasehold/Tenant/Bu lid!ng Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify)
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management Based on annualizing current reports
8003 Crisis Services Based on annualizing current reports
8004 Medication Support Based on annualizing current reports
8005 Collateral
8006 Plan Development Based on annualizing current reports
8007 Assessment Based on annualizing current reports
8008 Rehabilitation Based on annualizing current reports
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 228,289
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 228,289
BUDGET CHECK: -
Exhibit C
Page 82 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.01 $ 1,949 $ 1,949
1102 Regional Director 0.06 7,829 7,829
1103 Admin Specialist 0.30 16,719 16,719
1104 Accountant 0.04 2,551 2,551
1105 Quality Improvement Data Analyst 0.02 1,442 1,442
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.43 $ 30,490 $ 30,490
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.12 $ 15,494 $ 15,494
1117 Case Managers 1.20 56,244 56,244
1118 - -
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 1.32 $ 71,738 $ 71,738
Admin Program Total
Direct Personnel Salaries Subtotal 1.75 $ 30,490 $ 71,738 $ 102,228
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 576 $ 1,356 $ 1,932
1202 Worker's Compensation 759 1,786 2,545
1203 Health Insurance 2,857 6,722 9,579
1204 Other(specify) - -
Exhibit C
Page 83 of 134
1205 10ther(specify)
1206 10ther(specify)
Direct Employee Benefits Subtotal: $ 4,192 $ 9,864 $ 14,056
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 2,333 5,488 7,821
1303 SUI 183 430 613
1304 Other(specify) - - -
1305 10ther(specify)
1306 10ther(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 2,516 $ 5,918 $ 8,434
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 37,198 $ 87,520 $ 124,718
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
30% 70%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 20,070
2003 Client Transportation&Support -
2004 Clothing, Food,&Hygiene 1,747
2005 jEclucation Support -
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(Program Supplies) 2,000
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 23,817
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 1,750
3002 Printing/Postage 200
3003 Office Supplies&Equipment 873
3004 Advertising -
3005 IStaff Development&Training 895
3006 Staff Mileage 150
3007 Subscriptions&Memberships 50
3008 Vehicle Maintenance 1,520
3009 Other(Staff Recruitment) 300
3010 Other(Insurance) 2,440
3011 Other(specify) -
3012 10ther(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 8,178
Exhibit C
Page 84 of 134
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 1,174
4002 Rent/Lease Building 2,266
4003 Rent/Lease Equipment 240
4004 Rent/Lease Vehicles 830
4005 Security
4006 Utilities 695
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 5,205
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 4,980
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Psychiatrist Fees) 35,096
5004 Translation Services -
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 40,076
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes)
6008 Personnel(Indirect Salaries&Benefits) 18,071
6009 Other(Operating) 6,024
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 24,095
INDIRECT COST RATE 11.80%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 2,100
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 100
7004 Leasehold/Tenant/Building Improvements -
Exhibit C
Page 85 of 134
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 2,200
TOTAL PROGRAM EXPENSES $ 228,289
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 164 3.75 615
8003 Crisis Services 61 6.75 412
8004 Medication Support 2,981 8.25 24,593
8005 lCollateral -
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
8009 Other(Specify) 0 -
8010 Other(Specify) 0 -
Estimated Specialty Mental Health Services Billing Totals: 148,0001 $ 247,108
Estimated%of Clients who are Medi-Cal Beneficiaries 75%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 185,331
Federal Financial Participation(FFP)% 1 85% 157,531
MEDI-CAL FFP TOTAL $ 157,531
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ (0)
REALIGNMENT TOTAL $ (0)
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name 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
MHSA TOTAL $ 69,756
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance
8403 Grants(Specify) -
8404 Other(Client Rents) 1,002
8405 Other(Specify)
Exhibit C
Page 86 of 134
I OTHER REVENUE TOTALI $ 1,002 I
TOTAL PROGRAM FUNDING SOURCES: $ 228,289
NET PROGRAM COST: $ -
Exhibit C
Page 87 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year (FY) 2024-25
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolum 0.17
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.06
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.25
Map Point/Fresno 0.05
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolurnj 0.22
Madera 0.11
Total 1.00
Position Contract#/Name/Department/County FTE
Admin Specialist PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.05
Rural Crisis Intervention/Fresno 0.65
Exhibit C
Page 88 of 134
Total 1.00
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality& Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.12
PATH OEL/Fresno 0.60
PATH MOP/Fresno 0.28
Total 1.00
Position Contract#/Name/Department/County FTE
Case Managers PATH SMHS/Fresno 1.20
PATH OEL/Fresno 0.80
Exhibit C
Page 89 of 134
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C
Page 90 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 124,718
Administrative Positions 30,490
1101 Executive Director 1,949 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 7,829 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1103 Admin Specialist 16,719 Provides administrative support for the program and assist with medical billing and
records.
1104 Accountant 2,551 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1105 Quality Improvement Data Analyst 1,442 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1106 0 -
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions 71,738
1116 Program Manager 15,494 Provides supervision of all staff and direct oversight of program management.
1117 Case Managers 56,244 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.
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10
Direct Employee Benefits 14,056
1201 Retirement 1,932 Cost of 401K
1202 Worker's Compensation 2,545 Workers Comp Insurance
1203 Health Insurance 9,579 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 8,434
1301 OASDI -
1302 FICA/MEDICARE 7,821 Cost of FICA/Medicare
1303 SUI 613 Cost of SUI
1304 Other(specify) -
1305 Other(specify) -
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 23,817
2001 Child Care -
2002 Client Housing Support 20,070 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 1,747 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
Exhibit C
Page 91 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2006 Employment Support -
2007 Household Items for Clients
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers -
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 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 8,178
3001 Telecommunications 1,750 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 200 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 873 Includes all supplies and minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development&Training 895 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 orjob
tasks,such as an online subscription.
3008 Vehicle Maintenance 1,520 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(Insurance) 2,440 Direct expense to program for general,professional liability,personal property,
accidental,and auto insurance.
3011 Other(specify) -
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 5,205
4001 Building Maintenance 1,174 Shared copier maintenance,minor building repairs and maintenance to facility.
4002 Rent/Lease Building 2,266 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 695 Shared cost of gas and electric.
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify) -
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 40,076
5001 Consultant(Network&Data Management) 4,980 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:INDIRECT EXPENSES 24,095
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit
6005 Insurance(Specify): -
6006 Payroll Services
Exhibit C
Page 92 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) 18,071 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6009 Other(Operating) 6,024 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 2,200
7001 Computer Equipment&Software 2,100 Computer software needs to support staff&anticipating shared cost for replacement
of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 100 Anticipating 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)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management Based on annualizing current reports
8003 Crisis Services Based on annualizing current reports
8004 Medication Support Based on annualizing current reports
8005 Collateral
8006 Plan Development Based on annualizing current reports
8007 Assessment Based on annualizing current reports
8008 Rehabilitation Based on annualizing current reports
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 228,289
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 228,289
BUDGET CHECK: -
Exhibit C
Page 93 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.01 $ 2,008 $ 2,008
1102 Regional Director 0.06 8,064 8,064
1103 Admin Specialist 0.30 17,218 17,218
1104 Accountant 0.04 2,627 2,627
1105 Quality Improvement Data Analyst 0.02 1,486 1,486
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.43 $ 31,403 $ 31,403
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.12 $ 15,959 $ 15,959
1117 Case Managers 1.06 57,934 57,934
1118 - -
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 1.18 $ 73,893 $ 73,893
Admin Program Total
Direct Personnel Salaries Subtotal 1.61 $ 31,403 $ 73,893 $ 105,296
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 594 $ 1,396 $ 1,990
1202 Worker's Compensation 782 1,840 2,622
1203 Health Insurance 2,942 6,924 9,866
1204 Other(specify) - -
Exhibit C
Page 94 of 134
1205 10ther(specify)
1206 10ther(specify)
Direct Employee Benefits Subtotal: $ 4,318 $ 10,160 $ 14,478
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 2,402 5,653 8,055
1303 SUI 189 443 632
1304 Other(specify) - - -
1305 10ther(specify)
1306 10ther(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 2,591 $ 6,096 $ 8,687
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 38,312 $ 90,149 $ 128,461
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
30% 70%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 17,225
2003 Client Transportation&Support -
2004 Clothing, Food,&Hygiene 1,746
2005 jEclucation Support -
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(Program Supplies) 2,000
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 20,971
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 1,750
3002 Printing/Postage 200
3003 Office Supplies&Equipment 873
3004 Advertising -
3005 IStaff Development&Training 895
3006 Staff Mileage 150
3007 Subscriptions&Memberships 50
3008 Vehicle Maintenance 1,520
3009 Other(Staff Recruitment) 300
3010 Other(Insurance) 2,440
3011 Other(specify) -
3012 10ther(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 8,178
Exhibit C
Page 95 of 134
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 1,174
4002 Rent/Lease Building 2,266
4003 Rent/Lease Equipment 240
4004 Rent/Lease Vehicles 830
4005 Security
4006 Utilities 695
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 5,205
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 4,980
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Psychiatrist Fees) 36,149
5004 Translation Services -
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 41,129
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(Indirect Salaries&Benefits) 18,071
6009 Other(Operating) 6,024
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 24,095
INDIRECT COST RATE 11.80%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 150
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 100
7004 Leasehold/Tenant/Building Improvements -
Exhibit C
Page 96 of 134
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 250
TOTAL PROGRAM EXPENSES $ 228,289
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $
8002 Case Management 164 3.75 615
8003 Crisis Services 61 6.75 412
8004 Medication Support 2,981 8.25 24,593
8005 lCollateral -
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
8009 Other(Specify) 0 -
8010 Other(Specify) 0 -
Estimated Specialty Mental Health Services Billing Totals: 148,0001 $ 247,108
Estimated%of Clients who are Medi-Cal Beneficiaries 75%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 185,331
Federal Financial Participation(FFP)% 1 85% 157,531
MEDI-CAL FFP TOTAL $ 157,531
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ (0)
REALIGNMENT TOTAL $ (0)
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name 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
MHSA TOTAL $ 69,756
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance
8403 Grants(Specify) -
8404 Other(Client Rents) 1,002
8405 Other(Specify)
Exhibit C
Page 97 of 134
I OTHER REVENUE TOTALI $ 1,002 I
TOTAL PROGRAM FUNDING SOURCES: $ 228,289
NET PROGRAM COST: $ -
Exhibit C
Page 98 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year (FY) 2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolum 0.17
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.06
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.25
Map Point/Fresno 0.05
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolurnj 0.22
Madera 0.11
Total 1.00
Position Contract#/Name/Department/County FTE
Admin Specialist PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.05
Rural Crisis Intervention/Fresno 0.65
Exhibit C
Page 99 of 134
Total 1.00
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality& Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.12
PATH OEL/Fresno 0.60
PATH MOP/Fresno 0.28
Total 1.00
Position Contract#/Name/Department/County FTE
Case Managers PATH SMHS/Fresno 1.20
PATH OEL/Fresno 0.80
Exhibit C
Page 100 of 134
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C
Page 101 of 134
PATH PROGRAM-SMHS
Kings View
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 128,461
Administrative Positions 31,403
1101 Executive Director 2,008 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 8,064 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1103 Admin Specialist 17,218 Provides administrative support for the program and assist with medical billing and
records.
1104 Accountant 2,627 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1105 Quality Improvement Data Analyst 1,486 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1106 0 -
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 73,893
1116 Program Manager 15,959 Provides supervision of all staff and direct oversight of program management.
1117 Case Managers 57,934 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.
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 14,478
1201 Retirement 1,990 Cost of 401K
1202 Worker's Compensation 2,622 Workers Comp Insurance
1203 Health Insurance 9,866 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 8,687
1301 OASDI -
1302 FICA/MEDICARE 8,055 Cost of FICA/Medicare
1303 SUI 632 Cost of SUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 20,971
2001 Child Care -
2002 Client Housing Support 17,225 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 1,746 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 -
Fresno County Departrrrent ofBehavioral Fleahh Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 102 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
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 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 8,178
3001 Telecommunications 1,750 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 200 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 873 Includes all supplies and minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development&Training 895 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 1,520 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(Insurance) 2,440 Direct expense to program for general,professional liability,personal property,
accidental,and auto insurance.
3011 Other(specify) -
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 5,205
4001 Building Maintenance 1,174 Shared copier maintenance,minor building repairs and maintenance to facility.
4002 Rent/Lease Building 2,266 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 695 Shared cost of gas and electric.
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 41,129
5001 Consultant(Network&Data Management) 4,980 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:INDIRECT EXPENSES 24,095
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
Fresno County Department ofBehaviorel Heakh Contract Budgetl hnative Revised 2/7/2020
Exhibit C
Page 103 of 134
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6008 Personnel(Indirect Salaries&Benefits) 18,071 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6009 Other(Operating) 6,024 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 250
7001 Computer Equipment&Software 150 Computer software needs to support staff&anticipating shared cost for replacement
of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 100 Anticipating 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 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management Based on annualizing current reports
8003 Crisis Services Based on annualizing current reports
8004 Medication Support Based on annualizing current reports
8005 Collateral
8006 Plan Development Based on annualizing current reports
8007 Assessment Based on annualizing current reports
8008 Rehabilitation Based on annualizing current reports
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 228,289
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 228,289
BUDGET CHECK: -
Fresno County Department ofBehavioral Fleahh Contract Budget Narrative Revised 2/7/2020
Exhibit C
Page 104 of 134
Mobile Outreach Project
Kings View
Fiscal Year(FY)2021-22
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Regional Director 0.03 $ 3,890 $ 3,890
1102 Executive Director 0.01 1,580 1,580
1103 Executive Director Assistant 0.01 504 504
1104 Accountant 0.03 1,952 1,952
1105 Quality Improvement Data Analyst 0.06 3,660 3,660
1106 - -
1107 - -
1108 - -
1109 - -
1110 - -
1111 - -
1112 - -
1113 - -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.14 $ 11,586 $ 11,586
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.03 2,686 $ 2,686
1117 Outreach Workers 2.50 93,600 93,600
1118 -
1119 - -
1120 - -
1121 - -
1122 - -
1123 - -
1124 - -
1125 - -
1126 - -
1127 - -
1128 - -
1129 - -
1130 - -
1131 - -
1132 - -
1133 - -
1134 - -
Direct Personnel Program Salaries Subtotal 2.53 $ 96,286 $ 96,286
Admin Program Total
Direct Personnel Salaries Subtotal 2.67 $ 11,586 $ 96,286 $ 107,872
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 110 $ 913 $ 1,023
1202 Worker's Compensation 165 1,369 1,534
Exhibit C
Page 105 of 134
1203 Health Insurance 1,254 10,426 11,680
1204 Other(specify) - - -
1205 Other(specify) - - -
1206 Other(specify) - - -
Direct Employee Benefits Subtotal:l $ 1,529 1 $ 12,708 1 $ 14,237
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 840 6,983 7,823
1303 SUI 99 821 920
1304 Other(specify) - - -
1305 10ther(specify) - - -
1306 10ther(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 939 $ 7,804 $ 8,743
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 14,054 $ 116,798 $ 130,852
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
11% 89%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 19,550
2003 Client Transportation&Support 740
2004 Clothing, Food,&Hygiene 10,098
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify)
2013 Other(specify) -
2014 Other(specify) -
2015 10ther(specify) -
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 30,388
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 2,340
3002 Printing/Postage 150
3003 Office Supplies&Equipment 1,676
3004 Advertising -
3005 Staff Development&Training 1,100
3006 Staff Mileage 300
3007 Subscriptions&Memberships
3008 Vehicle Maintenance 8,350
3009 Other(specify) 900
Exhibit C
Page 106 of 134
3010 Other(specify) -
3011 10ther(specify) -
3012 10ther(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 14,816
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 4,120
4002 Rent/Lease Building 10,600
4003 Rent/Lease Equipment 800
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities 1,920
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 10ther(specify) -
DIRECTFACILITIES/EQUIPMENTTOTAL: $ 17,440
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 8,993
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (specify)
5004 Translation Services
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL:1 $ 8,993
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 25,061
Administrative Overhead
6002 113rofessional Liability Insurance 2,000
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Other): 3,950
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify) -
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 31,011
INDIRECT COST RATE 15.28%
Exhibit C
Page 107 of 134
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 400
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
7008 Other(specify) -
FIXED ASSETS EXPENSES TOTAL $ 400
TOTAL PROGRAM EXPENSES $ 233,900
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description 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 -
8009 Other(Specify) -
8010 1 Other(Specify) -
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 1 0% -
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment 1 $ -
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 JCFTN-Capital Facilities&Technology -
MHSA TOTAL $
Exhibit C
Page 108 of 134
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(PATH)
8404 Other(CARES Act) 140,000
8405 Other(CDBG-CV) 93,900
OTHER REVENUE TOTAL $ 233,900
TOTAL PROGRAM FUNDING SOURCES: $ 233,900
NET PROGRAM COST: $ -
Exhibit C
Page 109 of 134
Mobile Outreach Project
Kings View
Fiscal Year (FY) 2021-22
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.01
Blue Sky/Fresno 0.05
Rural Triage East/Fresno 0.10
Rural Triage West/Fresno 0.10
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Kings 0.22
CVSPH/California State,Tualre, Calaveras,Tuolum 0.09
Fresno City 0.05
Shasta 0.06
Tulare 0.26
Madera 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Executive Assistant PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.01
Blue Sky/Fresno 0.05
Rural Triage East/Fresno 0.10
Rural Triage West/Fresno 0.10
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Kings 0.22
CVSPH/California State,Tualre, Calaveras,Tuolum 0.09
Fresno City 0.05
Shasta 0.06
Tulare 0.26
Madera 0.02
Total 1.00
Position lContract#/Name/Department/County FTE
Exhibit C
Page 110 of 134
Regional Director PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.10
Rural Triage East/Fresno 0.22
Rural Triage West/Fresno 0.22
Metro CIT/Fresno 0.19
Map Point/Fresno 0.02
CVSPH/California State,Tualre, Calaveras,Tuolum 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.30
PATH OEL/Fresno 0.67
PATH MOP/Fresno 0.03
Total 1.00
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras,Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Exhibit C
Page 111 of 134
Kings 0.27
Quality & Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C
Page 112 of 134
Mobile Outreach Project
Kings View
Fiscal Year(FY)2021-22 Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 130,852
Administrative Positions 11,586
1101 Regional Director 3,890 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1102 Executive Director 1,580 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1103 Executive Director Assistant 504 This position will assist Executive Director with staff oversight and representing and
maintaining the collaborative relationship between agencies.
1104 Accountant 1,952 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1105 Quality Improvement Data Analyst 3,660 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1106 0 -
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions 96,286
1116 Program Manager 2,686 Provides supervision of all staff and direct oversight of program management.
1117 Outreach Workers 93,600 Provides outreach and engagement services,provide linkage to needed services.It
would be 3FTE the first 6 months and 2FTE the second half of the year.
1118 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10
Direct Employee Benefits 14,237
1201 Retirement 1,023 Cost of 401K
1202 Worker's Compensation 1,534 Workers Comp Insurance
1203 Health Insurance 11,680 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 8,743
1301 OASDI -
1302 FICA/MEDICARE 7,823 Cost ofFICA/Medicare
1303 SUI 920 Cost ofSUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 30,388
2001 Child Care -
2002 Client Housing Support 19,550 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 740 Provides bus passes,bus tokens or any transportation assistance for clients,such as taxi
service or gas.
2004 Clothing,Food,&Hygiene 10,098 Outreach expenses that support 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 -
Exhibit C
Page 113 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2006 Employment Support -
2007 Household Items for Clients
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 14,816
3001 Telecommunications 2,340 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 150 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 1,676 Includes desk supplies&minor equipment used by staff while providing services.
3004 Advertising -
3005 Staff Development&Training 1,100 Minor shared cost for continuation of staff development and training.
3006 Staff Mileage 300 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 -
3008 Vehicle Maintenance 8,350 Minor auto repairs&maintenance required to maintain 1 van for client transportation
and program needs,such as oil changes and car washes.Cost of GPS,vehicle tracking
service,and auto fuel.
3009 Other(specify) 900 Thorough background checks and drug testing.
3010 Other(specify) -
3011 Other(specify)
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 17,440
4001 Building Maintenance 4,120 Estimate shared cost on copier maintenance,minor building repairs&maintenance
such as janitorial services and security alarm services.
4002 Rent/Lease Building 10,600 Shared cost of building lease.
4003 Rent/Lease Equipment 800 Estimate cost for shared copier lease.
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 1,920 Estimate shared cost for gas&electric,water&sewer.
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify) -
4010 Other(specify) -
5000:DIRECT SPECIAL EXPENSES 8,993
5001 Consultant(Network&Data Management) 8,993 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
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify) -
5008 Other(specify) -
6000:INDIRECT EXPENSES 31,011
6001 Administrative Overhead 25,061 Expenses provides corporate management,fiscal services,payroll,human resources,
6002 Professional Liability Insurance 2,000 Cost general and professional liability insurance.
6003 Accounting/Bookkeeping -
6004 External Audit
6005 Insurance(Other): 3,950 Cost of personal property,accidental,and auto insurance.
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify) -
6010 Other(specify)
6011 Other(specify) -
Exhibit C
Page 114 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6012 Other(specify) -
6013 Other(specify)
7000:DIRECT FIXED ASSETS 400
7001 Computer Equipment&Software 400 Computer software needs to support staff&anticipating minor shared cost for
replacement of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Bu lid!ng Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 233,900
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 233,900
BUDGET CHECK: -
Exhibit C
Page 115 of 134
Street Outreach Team and Rural Support
Kings View
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.03 $ 4,506 $ 4,506
1102 Regional Director 0.06 7,238 7,238
1103 Accountant 0.06 3,292 3,292
1104 Quality Improvement Data Analyst 0.05 3,366 3,366
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.20 $ 18,402 $ 18,402
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.28 31,224 $ 31,224
1117 Outreach Worker 6.00 241,020 241,020
1118
1119 -
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 6.28 $ 272,244 $ 272,244
Admin Program Total
Direct Personnel Salaries Subtotal 6.48 $ 18,402 $ 272,244 $ 290,646
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 84 $ 1,240 $ 1,324
1202 Worker's Compensation 239 3,526 3,765
1203 Health Insurance 2,556 37,814 40,370
1204 Other(specify) - -
Exhibit C
Page 116 of 134
1205 10ther(specify)
1206 10ther(specify)
Direct Employee Benefits Subtotal: $ 2,879 $ 42,580 $ 45,459
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 1,408 20,826 22,234
1303 SUI 130 1,927 2,057
1304 Other(specify) - -
1305 10ther(specify)
1306 10ther(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 1,538 $ 22,753 $ 24,291
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 22,819 $ 337,577 $ 360,396
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
6% 94%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 16,600
2003 Client Transportation&Support 800
2004 Clothing, Food,&Hygiene 12,000
2005 jEclucation Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 29,400
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications 6,200
3002 Printing/Postage 450
3003 Office Supplies&Equipment 1,300
3004 Advertising -
3005 IStaff Development&Training 1,000
3006 Staff Mileage 150
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 8,385
3009 Other(Staff Recruitment) 700
3010 Other(Insurance) 7,788
3011 Other(specify) -
3012 10ther(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 25,973
Exhibit C
Page 117 of 134
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 3,885
4002 Rent/Lease Building 10,920
4003 Rent/Lease Equipment 1,005
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 2,500
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT T0TAL:j 18,310
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 8,778
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 8,778
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Liability):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(Indirect Salaries&Benefits) 38,611
6009 Other(Operating) 12,870
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 51,481
INDIRECT COST RATE 11.50%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 4,803
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements -
Exhibit C
Page 118 of 134
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 4,803
TOTAL PROGRAM EXPENSES $ 499,141
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 lCollateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance -
8403 Grants(American Rescue Plan) 499,141
8404 Other(Specify)
8405 Other(Specify)
Exhibit C
Page 119 of 134
I OTHER REVENUE TOTALI $ 499,141 I
TOTAL PROGRAM FUNDING SOURCES: $ 499,141
NET PROGRAM COST: $ -
Exhibit C
Page 120 of 134
Street Outreach Team & Rural Support
Kings View
Fiscal Year (FY) 2022-23
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolum 0.17
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.06
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.25
Map Point/Fresno 0.05
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolurnj 0.22
Madera 0.11
Total 1.00
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Exhibit C
Page 121 of 134
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality& Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.12
PATH OEL/Fresno 0.60
PATH MOP/Fresno 0.28
Total 1.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C
Page 122 of 134
Street Outreach Team and Rural Support
Kings View
Fiscal Year(FY)2022-23 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 360,396
Administrative Positions 18,402
1101 Executive Director 4,506 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 7,238 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1103 Accountant 3,292 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1104 Quality Improvement Data Analyst 3,366 This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1105 0 -
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10 1 -
Program Positions 272,244
1116 Program Manager 31,224 Provides supervision of all staff and direct oversight of program management.
1117 Outreach Worker 241,020 Provides outreach and engagement services,provides linkage to needed services.
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10
Direct Employee Benefits 45,459
1201 Retirement 1,324 Cost of 401K
1202 Worker's Compensation 3,765 Workers Comp Insurance
1203 Health Insurance 40,370 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 24,291
1301 OASDI -
1302 FICA/MEDICARE 22,234 Cost ofFICA/Medicare
1303 SUI 2,057 Cost of SUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 29,400
2001 Child Care -
2002 Client Housing Support 16,600 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 800 Provides bus passes,bus tokens or any transportation assistance for clients,such as taxi
service or gas.
2004 Clothing,Food,&Hygiene 12,000 Outreach expenses that support 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 -
Exhibit C
Page 123 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 25,973
3001 Telecommunications 6,200 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 450 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 1,300 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.
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 -
3008 Vehicle Maintenance 8,385 Minor auto repairs&maintenance required to maintain 2 vans for client transportation
and program needs,such as oil changes and car washes.Cost of GPS,vehicle tracking
service,and auto fuel.
3009 Other(Staff Recruitment) 700 Thorough background check and drug testing.
3010 Other(Insurance) 7,788 Direct expense to program for general,professional liability,personal property,
accidental,and auto insurance.
3011 Other(specify) -
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 18,310
4001 Building Maintenance 3,885 Estimate shared cost on copier maintenance,minor building repairs&maintenance
such as janitorial services and security alarm services.
4002 Rent/Lease Building 10,920 Shared cost of building lease.
4003 Rent/Lease Equipment 1,005 Estimate cost for shared copier lease.
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 2,500 Estimate shared cost for gas&electric.
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 8,778
5001 Consultant(Network&Data Management) 8,778 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 -
5005 Other(specify)
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 51,481
6001 Administrative Overhead -
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Liability):
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) 38,611 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6009 Other(Operating) 12,870 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
Exhibit C
Page 124 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6011 Other(specify) -
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 4,803
7001 Computer Equipment&Software 4,803 Purchase of 3 new computers for expansion of program staff and software needs to
support staff.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures -
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify)
7007 Other(specify) -
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 499,141
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 499,141
BUDGET CHECK: -
Exhibit C
Page 125 of 134
Street Outreach Team and Rural Support
Kings View
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Executive Director 0.03 $ 4,731 $ 4,731
1102 Regional Director 0.06 7,600 7,600
1103 Accountant 0.06 3,457 3,457
1104 Quality Improvement Data Analyst 0.05 3,534 3,534
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.20 $ 19,322 $ 19,322
Acct# Program Position FTE Admin Program Total
1116 Program Manager 0.28 $ 32,789 $ 32,789
1117 Outreach Worker 6.00 253,082 253,082
1118
1119 -
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 6.28 $ 285,871 $ 285,871
Admin Program Total
Direct Personnel Salaries Subtotal 6.48 $ 19,322 $ 285,871 $ 305,193
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 88 $ 1,302 $ 1,390
1202 Worker's Compensation 250 3,703 3,953
1203 Health Insurance 2,714 40,422 43,136
1204 Other(specify) - -
Exhibit C
Page 126 of 134
1205 10ther(specify)
1206 10ther(specify)
Direct Employee Benefits Subtotal: $ 3,052 $ 45,427 $ 48,479
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 1,478 21,869 23,347
1303 SUI 137 2,023 2,160
1304 Other(specify) - -
1305 10ther(specify)
1306 10ther(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 1,615 $ 23,892 $ 25,507
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 23,989 $ 355,190 $ 379,179
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
6% 94%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care
2002 Client Housing Support 16,165
2003 Client Transportation&Support 800
2004 Clothing, Food,&Hygiene 12,000
2005 jEclucation Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(Program Supplies)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 28,965
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 6,510
3002 Printing/Postage 473
3003 Office Supplies&Equipment 1,370
3004 Advertising -
3005 IStaff Development&Training 1,050
3006 Staff Mileage 158
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 10,258
3009 Other(Staff Recruitment) 735
3010 Other(Insurance) 8,178
3011 Other(specify) -
3012 10ther(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 28,732
Exhibit C
Page 127 of 134
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 4,080
4002 Rent/Lease Building 11,466
4003 Rent/Lease Equipment 1,056
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 2,625
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT T0TAL:j 19,227
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 9,165
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 9,165
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(Indirect Salaries&Benefits) 40,668
6009 Other(Operating) 13,556
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 54,224
INDIRECT COST RATE 11.60%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 2,181
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements -
Exhibit C
Page 128 of 134
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 2,181
TOTAL PROGRAM EXPENSES $ 521,673
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 lCollateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance -
8403 Grants(American Rescue Plan) 521,673
8404 Other(Specify) -
8405 Other(Specify)
Exhibit C
Page 129 of 134
I OTHER REVENUE TOTALI $ 521,673 I
TOTAL PROGRAM FUNDING SOURCES: $ 521,673
NET PROGRAM COST: $ -
Exhibit C
Page 130 of 134
Street Outreach Team & Rural Support
Kings View
Fiscal Year (FY) 2023-24
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Executive Director PATH SMHS/Fresno 0.01
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.03
Blue Sky/Fresno 0.05
Rural Crisis Intervention/Fresno 0.03
Metro CIT/Fresno 0.02
Map Point/Fresno 0.01
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolum 0.17
Shasta 0.09
Tulare 0.26
Madera 0.06
Kings 0.23
Administrative Department 0.02
Total 1.00
Position Contract#/Name/Department/County FTE
Regional Director PATH SMHS/Fresno 0.06
PATH OEL/Fresno 0.01
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.11
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.25
Map Point/Fresno 0.05
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolurnj 0.22
Madera 0.11
Total 1.00
Position Contract#/Name/Department/County FTE
Accountant PATH SMHS/Fresno 0.04
PATH OEL/Fresno 0.07
PATH MOP/Fresno 0.06
Blue Sky/Fresno 0.10
Rural Crisis Intervention/Fresno 0.12
Metro CIT/Fresno 0.10
Exhibit C
Page 131 of 134
Suicide Prevention Follow-up Call/Fresno 0.01
CVSPH/California State,Tualre, Calaveras, Tuolum 0.05
Shasta 0.07
Finance Department 0.38
Total 1.00
Position Contract#/Name/Department/County FTE
Quality Improvement Data Analyst PATH SMHS/Fresno 0.02
PATH OEL/Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural Crisis Intervention/Fresno 0.25
Metro CIT/Fresno 0.12
Map Point/Fresno 0.07
Shasta 0.04
Kings 0.27
Quality& Performance Improvement Deparment 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager PATH SMHS/Fresno 0.12
PATH OEL/Fresno 0.60
PATH MOP/Fresno 0.28
0.01
Total 1.01
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C
Page 132 of 134
Street Outreach Team and Rural Support
Kings View
Fiscal Year(FY)2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
Direct Employee Salaries 379,179
Administrative Positions 19,322
1101 Executive Director 4,731 Position will provide agency specific staff oversight and represent and maintain the
collaborative relationship between agencies.
1102 Regional Director 7,600 Provide program management and direction.Ensures operations are running smoothly
and in compliance with contract requirements.
1103 Admin Specialist 3,457 Provides administrative support for the program.
1104 Accountant 3,534 Prepares and provides budget guidance,monthly invoicing and other fiscal services.
1105 Quality Improvement Data Analyst - This position will perform a wide range of duties to support data collection,
management,and reporting needs for all collaborative partnerships.
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Program Positions 285,871
1116 Program Manager 32,789 Provides supervision of all staff and direct oversight of program management.
1117 Outreach Worker 253,082 Provides outreach and engagement services,provides linkage to needed services.
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0 -
Direct Employee Benefits 48,479
1201 Retirement 1,390 Cost of401K
1202 Worker's Compensation 3,953 Workers Comp Insurance
1203 Health Insurance 43,136 Cost of Medical,Vision,Dental,Life and Long Term Disability Insurance
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 25,507
1301 OASDI -
1302 FICA/MEDICARE 23,347 Cost of FICA/Medicare
1303 SUI 2,160 Cost ofSUI
1304 Other(specify) -
1305 Other(specify) -
1306 Other(specify) #REF!
Budget FY3'!B77 28,965
2001 Child Care -
2002 Client Housing Support 16,165 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 800 Provides bus passes,bus tokens or any transportation assistance for clients,such as taxi
service or gas.
2004 Clothing,Food,&Hygiene 12,000 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 -
Exhibit C
Page 133 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2006 Employment Support -
2007 Household Items for Clients
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(Program Supplies) -
2012 Other(Specify) -
2013 Other(Specify)
2014 Other(Specify) -
2015 Other(Specify)
2016 Other(Specify)
3000:DIRECT OPERATING EXPENSES 28,732
3001 Telecommunications 6,510 Cost of landline telephone services,cell phones service,data connectivity.
3002 Printing/Postage 473 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 1,370 Includes desk supplies&minor equipment used by staff in the course of providing
services.
3004 Advertising -
3005 Staff Development&Training 1,050 Minor shared cost for continuation of staff development and training.Also,includes
HMIS training fees.
3006 Staff Mileage 158 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 - Minor shared cost of special subscription necessary for staff to provide services orjob
tasks,such as an online subscription.
3008 Vehicle Maintenance 10,258 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 DVM fees.
3009 Other(Staff Recruitment) 735 Thorough background check and drug testing.
3010 Other(Insurance) 8,178 Direct expense to program for general,professional liability,personal property,
accidental,and auto insurance.
3011 Other(Specify) -
3012 Other(S eci )
4000:DIRECT FACILITIES&EQUIPMENT 19,227
4001 Building Maintenance 4,080 Shared copier maintenance and minor building repairs and maintenance.Annual
Janitorial Services to maintain client showers clean.
4002 Rent/Lease Building 11,466 Share cost of building space,anticipating moving locations.
4003 Rent/Lease Equipment 1,056 Shared copier lease.
4004 Rent/Lease Vehicles - 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 2,625 Shared cost of gas and electric.
4007 Other(Specify) -
4008 Other(Specify)
4009 Other(Specify) -
4010 Other(Specify) -
5000:DIRECT SPECIAL EXPENSES 9,165
5001 Consultant(Network&Data Management) 9,165 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
5005 Other(Specify) -
5006 Other(Specify)
5007 Other(Specify) -
5008 Other(Specify)
6000:INDIRECT EXPENSES 54,224
6001 Use this line and only this line for approved indirect -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit
Exhibit C
Page 134 of 134
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6005 Insurance(Specify) -
6006 Payroll Services
6007 Depreciation -
6008 Personnel(Indirect Salaries&Benefits) 40,668 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6009 Other(Operating) 13,556 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(Specify) -
6011 Other(Specify) -
6012 Other(Specify)
6013 Other(Specify)
7000:DIRECT FIXED ASSETS 2,181
7001 Computer Equipment&Software 2,181 Computer software needs to support staff&anticipating shared cost for replacement
of computer equipment.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures -
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify)
7007 Other(Specify) -
7008 Other(Specify)
PROGRAM FUNDING SOURCES
#REFI
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 521,673
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 521,673
BUDGET CHECK: -
DocuSign Envelope ID:3C2ED552-5BA9-4059-80C4-F8DA637507A8
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.
DocuSign Envelope ID:3C2ED552-5BA9-4059-80C4-F8DA637507A8
Exhibit D
Page 2of3
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.
DocuSign Envelope ID:3C2ED552-5BA9-4059-80C4-F8DA637507A8
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): Kings View
Employee Name (print): Amanda Nugent Divine, PhD. CEO
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
❑ Other:
Job Title (if dirA=Nug44
Qjscipline): Chief Executive Officer
Nvz,-t
Signature: Date: 04/ 12022
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 2of3
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.
S. 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.
Exhibit G
Page 1 of 9
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 received
this reporting year
3. Total funds dedicated this year, agency wide, to persons who have serious mental
illness 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 with
serious 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
7. Type of organization in which your PATH program operates (select one)
Q, Community Mental Health Center
C Consumer-run Mental Health Agency
C Other Mental Health Agency
C Social Service Agency
C Health Care for Homeless/Other Health Agency
C Substance Use Treatment Agency
C Shelter or Other Temporary Housing Resource
C Other Housing Agency
C Other
Section 2: Persons Served During This Reporting Period Exhibit
Page 2 of 9
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 Outreach
project
10. Number of new persons contacted this reporting period in a PATH Services Only
project
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 enrolled
because of ineligibility for PATH
13b. Number of new persons contacted this reporting period who could not be enrolled
because 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 services
through 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 did
they 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
171. Security deposits
17m. One-time rent for eviction prevention
Section 4: Referrals Provided Exhibit G
18. Referrals Provided (unduplicated count of PATH-enrolled inviduals only) Page 3 of 9
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. NUMBER 18B. NUMBER WHO
RECEIVING EACH ATTAINED THE SERVICE
REFERRAL FROM THE REFERRAL
Community mental health 18a1. 18b1.
Substance use treatment 18a2. 18b2.
Primary health/dental care 18a3. 18b3.
Job training 18a4. 18b4.
Educational Services 18a5. 18b5.
Housing Services 18a6. 18b6.
Permanent housing 18a7. 18b7.
Temporary housing 18a8. 18b8.
Income assistance 18a9. 18b9.
Employment assistance 18a10. 18b10.
Medical insurance 18a11. 18b11.
Section 5: Outcomes Exhibit G
Outcomes (unduplicated count of PATH-enrolled individuals only) Page 4 of 9
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 PROJECT AT PATH PROJECT AT REPORT END
ENTRY EXIT (FOR CLIENTS DATE (FOR CLIENTS
WHO WERE EXITED WHO WERE STILL
FROM PATH THIS ACTIVE IN PATH AS
YEAR - LEAVERS) OF REPORT END
DATE - STAYERS)
19. INCOME FROM ANY SOURCE
Yes 19a1. 19a2. 19a3.
No 19b1. 19b2. 19b3.
Client doesn't know 190. 19c2. 19c3.
Client refused 19d1. 19d2. 190.
Data not collected 19e1. 19e2. 19e3.
TOTAL 19f1. 0 19f2. 0 19f3. 0
20. SSI/SSDI
Yes 20a1. 20a2. 20a3.
No 20b1. 20b2. 20b3.
TOTAL 200. 0 20c2. 0 200. 0
21. NON-CASH BENEFITS FROM ANY SOURCE
Yes 21 al. 21 a2. 21 a3.
No 21 b1. 21 b2. 21 b3.
Client doesn't know 21 c1. 21 c2. 21 c3.
Client refused 21d1. 21d2. 21d3.
Data not collected 21 el. 21 e2. 21 e3.
TOTAL 21 f1. 0 21 f2. 0 21 Q. 0
22. COVERED BY HEALTH INSURANCE
Yes 22a1. 22a2. 22a3.
No 22b1. 22b2. 22b3.
Client doesn't know 22c1. 22c2. 22c3.
Client refused 22d1. 22d2. 220.
Data not collected 22e1. 22e2. 22e3.
TOTAL 22f1. 0 22f2. 0 22f3. 0
23. MEDICAID/MEDICARE
Yes 23a1. 23a2. 23a3.
No 23b1. 23b2. 23b3.
TOTAL 23c1. 0 23c2. 0 23c3. 0
24. ALL OTHER HEALTH INSURANCE
Yes 24a1. 24a2. 24a3.
No 24b1. 202. 203.
TOTAL 24c1. 0 24c2. 0 24c3. 0
Destination at Exit Section 6: Housing Outcomes Exhibit G
Page 5 of 9
For each category, record the number of PATH-enrolled individuals who exited the PATH program to each
response 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 shelter 25a1.
voucher, or RHY-funded Host Home shelter
Moved from one HOPWA funded project to another HOPWA TH 25a2.
Transitional housing for homeless persons 25a3.
Staying or living in a family member's room, apartment, or house, temporary 25a4.
tenure
Staying or living in a friend's room, apartment, or house, temporary tenure 25a5.
Place not meant for habitation (e.g., a vehicle, an abandoned building, 25a6.
bus/train/subway station/airport, or anywhere outside
Safe Haven 25a7.
Hotel or motel paid for without emergency shelter voucher 25a8.
Host Home (non-crisis) 25a9.
SUBTOTAL 25a10. 0
INSTITUTIONAL SITUATION
Foster care home or foster care group home 25a11.
Psychiatric hospital or other psychiatric facility 25a12.
Substance abuse treatment facility or detox center 25a13.
Hospital or other residential non-psychiatric medical facility 25a14.
Jail, prison, or juvenile detention facility 25a15.
Long-term care facility or nursing home 25a16.
SUBTOTAL 25a17. 0
PERMANENT DESTINATIONS
Moved from one HOPWA funded project to another HOPWA PH 25a18.
Owned by client, no ongoing housing subsidy 25a19.
Owned by client, with ongoing housing subsidy 25a20.
Permanent housing (other than RRH)for formerly homeless persons 25a21.
Rental by client, no ongoing housing subsidy 25a22.
Rental by client, with RRH or equivalent subsidy 25a23.
Rental by client, with VASH subsidy 25a24.
Rental by client, with GPD TIP subsidy 25a25.
Rental by client, with other ongoing housing subsidy 25a26.
Rental by client, with HCV voucher(tenant or project based) 25a27.
Rental by client in a public housing unit 25a28.
Residential project or halfway house with no homeless criteria 25a29.
Staying or living in a family member's room, apartment, or house, permanent 25a30.
tenure
Staying or living in a friend's room, apartment, or house, permanent tenure 25a31.
SUBTOTAL 25a32. 0
OTHER DESTINATIONS
Deceased 25a33.
Other 25a34.
No exit interview completed 25a35.
Client doesn't know 25a36.
Client refused 25a37.
Data not collected 25a38.
SUBTOTAL 25a39. 0
PATH-enrolled clients still active as of report end date (Stayers) 25a40.
TOTAL 25a41. 0
Section 7: Demographics - Gender Exhibit G
Demographics - Gender Page 6 of 9
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each of
the following categories?
26A. NUMBER ENROLLED
Female 26a1.
Male 26a2.
Trans Female (MTF or Male to Female) 26a3.
Trans Male (FTM or Female to Male) 26a4.
Gender non-conforming 26a5.
Client doesn't know 26a6.
Client refused 26a7.
Data not collected 26a8.
TOTAL 26a9. 0
Section 8: Demographics - Age
Demographics -Age
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each of
the following categories?
26B. NUMBER ENROLLED
17 and under 26b1.
(Youth 17 and under should not be enrolled in the
PATH Project unless they meet all the eligibility
requirements. This includes extended family
members)
18 - 23 26b2.
24 - 30 26b3.
31 -40 26b4.
41 - 50 26b5.
51 - 61 26b6.
62 and over 26b7.
Client doesn't know 26b8.
Client refused 26b9.
Data not collected 26b10.
TOTAL 26b11. 0
Section 9: Demographics - Race
Demographics - Race
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each of
the following categories? (Note:An individual who identifies as multiracial should be counted in all applicable
categories. This demographic element will not sum to total persons enrolled.)
26C. NUMBER ENROLLED
American Indian or Alaskan Native 26c1.
Asian 26c2.
Black or African American 260.
Native Hawaiian or Other Pacific Islander 26c4.
White 26c5.
Client doesn't know 26c6.
Client refused 26c7.
Data not collected 26c8.
TOTAL 26c9. 0
Section 10: Demographics - Ethnicity Exhibit G
Demographics - Ethnicity Page 7 of 9
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each of
the following categories?
26D. NUMBER ENROLLED
Non-Hispanic/Non-Latino 26d1.
Hispanic/Latino 26d2.
Client doesn't know 260.
Client refused 26d4.
Data not collected 26d5.
TOTAL 26d6. 0
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 the
following categories?
26E. NUMBER ENROLLED
Veteran 26e1.
Non-Veteran 26e2.
Client doesn't know 26e3.
Client refused 26e4.
Data not collected 26e5.
TOTAL 26e6. 0
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 of
the following categories?
26F. NUMBER ENROLLED
Co-occurring substance use disorder 26f1.
No co-occurring substance use disorder 26f2.
Unknown 26f3.
TOTAL 26f4. 0
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 of
the following categories?
26G. NUMBER ENROLLED
Yes 26g1.
No 26g2.
Client doesn't know 26g3.
Client refused 26g4.
Data not collected 26g5.
TOTAL 26g6. 0
Section 14: Demographics - Prior Living Situation Exhibit
Demographics - Prior Living Situation Page 8 of 9
Of those with an active, enrolled PATH status during this reporting period, how many individuals are in each of
the following categories?
26H. NUMBER ENROLLED
LITERALLY HOMELESS
Place not meant for habitation 26h1.
(e.g., a vehicle, an abandoned building, a
bus/train/subway station, airport, or anywhere outside
Emergency shelter, including hotel or motel paid for 26h2.
with emergency shelter voucher, or RHY-funded Host
Home shelter
Safe Haven 26h3.
INSTITUTIONAL SITUATION
Foster care home or foster care group home 26h4.
Hospital or other residential non-psychiatric medical 26h5.
facility
Jail, prison, or juvenile detention facility 26h6.
Long-term care facility or nursing home 26h7.
Substance abuse treatment facility or detox center 26h8.
Psychiatric hospital or other psychiatric facility 26h9.
TRANSITIONAL AND PERMANENT HOUSING SITUATION
Hotel or motel paid for without emergency shelter 26h10.
voucher
Owned by client, no ongoing housing subsidy 26h11.
Owned by client, with ongoing housing subsidy 26h12.
Permanent housing (other than RRH)for formerly 261113.
homeless persons
(such as CoC project, HUD legacy programs, or
HOPWA PH
Rental by client, no ongoing housing subsidy 26h14.
Rental by client, with VASH subsidy 26h15.
Rental by client, with GPD TIP subsidy 26h16.
Rental by client, with RRH or equivalent subsidy 26h17.
Rental by client, with other ongoing housing subsidy 26h18.
(including RRH
Rental by client, with HCV voucher(tenant or project 26h19.
based
Rental by client in a public housing unit 26h20.
Residential project or halfway house with no homeless 261121.
criteria
Staying or living in a family member's room, 26h22.
apartment, or house
Staying or living in a friend's room, apartment, or 26h23.
house
Transitional housing for homeless persons 26h24.
including homelessyouth)
Host Home (non-crisis) 26h25.
Client doesn't know 26h26.
Client refused 26h27.
Data not collected 26h28.
TOTAL 26h29. 0
Section 15: Demographics - Length of Stay Exhibit
Pa e9of9
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 Emergency
shelter (26h2), record the length of time these individuals have been in this living situation. The total of this
category must equal the sum of 26h1 + 26h2.
261. LENGTH OF STAY
One night or less 2611.
Two to six nights 26i2.
One week or more, but less than one month 26i3.
One month or more, but less than 90 days 26i4.
90 days or more, but less than one year 26i5.
One year or longer 26i6.
Client doesn't know 2617.
Client refused 26i8.
Data not collected 2619.
TOTAL 26i10. 0
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 of
the following categories?
26J. NUMBER ENROLLED
Yes 26j1.
No 26j2.
Unknown 26j3.
TOTAL 26j4. 0
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 the
following categories?
26K. NUMBER ENROLLED
Yes 26k1.
No 26k2.
Client doesn't know 26k3.
Client refused 26k4.
Data not collected 261k5.
TOTAL 26k6. 0
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:Hfresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182beOc5cdcd5072bb1864cdee
4d3d6e
• The reporting portal is available 24 hours a day, every day.
• Any employee of the CONTRACTOR can submit an incident using the reporting
portal at any time. No login is required.
• The designated administrator of the CONTRACTOR can add information to the
follow up section of the report after submission.
• When an employee submits an incident within 24 hours from the time of the incident
or first knowledge of the incident, the CONTRACTOR's designated administrator, the
assigned contract analyst and the Incident Reporting email inbox will be notified
immediately via email from the Logic Manager system that there is a new incident to
review.
• Meeting the 24 hour incident reporting requirements will be easier as there are no
signatures to collect.
• The user guide attached identifies the reporting process and the reviewer process,
and is subject to updates based on DBH's selected incident reporting portal system.
Questions about incident reporting, how to use the incident reporting portal, or
designating/changing the name of the administrator who will review incidents for the
CONTRACTOR should be emailed to DBHlncidentReporting@fresnocountyca.gov and the
assigned contract analyst.
Mental Health Plan (MHP) and Substance Use Disorder(SUD) services
Co�,4 Incident Reporting System
19
INCIDENT REVIEWER ROLE — User Guide
Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted
providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete
a written report of any incidents compromising the health and safety of persons served, employees, or
community members.
Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's
an easier way for any employee to report an incident at any time. A few highlights:
• No supervisor signature is immediately required.
• Additional information can be added to the report by the program supervisor/manager without
having to resubmit the incident.
• When an incident is submitted, the assigned contract analyst, program supervisor/manager,
clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email
notification of a new incident and can log in any time to review the incident. Everything that
was on the original paper/electronic form matches the 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 DBHlncidentReporting@fresnocountVca.gov if there is additional information to be report
after initial submission
• Contact.DBHlncidentReporting@fresnocountVca.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=182be0c5cdcd5072bbl864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
Exhibit K.2
Page 1 of 9
E C O � Iresrodhhlegicmeivycican/uiedrnts!'l=9iLp=17ttk=182L Oc5cdcd5177�hL78hdcdrn7d3d6�
LogicManager
Incident Report
Please complete this form
Client Information
N amo ar Faculty'
Name of Reporting Party'
Fadllty Adds:'
Facility Phone Number
Alantar Ninth or Substance Uso Dlsurdnr Progam7'
Client First Name'
VIM Last Name'
❑lam one o!Elnn
Coontaddrass
CllentlD
Gerd.'
Coonry of Origin'
- Swnmary
svb w P
imldent lcheck all that appal'
if Dther-spealfy li.e,fire,poisoning,epidemic optb,.",othercatashophesleverts thatjeopardlae the welfare and salety of clients,stall and for members of the commenityl:
De.O.Uon of the incident'
Exhibit K.2
Page 2 of 9
Similar to the paper version, multiple incident categories can be selected
lw Idenl It11.6.all that apply('
I.Iedic.l . neathofelleni: I -
Numidde/Mntnidde Aumpt
AWOL.Elopement lr om locked fad llty
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dtt—O.d S.Kide(rewlting rn 5e 1—mluryy
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oateol In�laenr
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,mach any addltl-A dells
49 Add Ed ar Brop File Here
Reported By Name'
Reported By Email'
Reponed On
1013012019
Exhibit K.2
Page 3 of 9
As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on
Add File to upl ad a file.
E C 4 (rctrodhhJdgicmaregor.t_u.-.t >_tl,o_th:ha+l`;rnnt'n!?h1,t Ni>SrnArddbdl,:
d&dt_EU4 or atop Fila Hare
Reported By Namt
Reported By Email'
Reported on
10i30i3019
- F41IOW Up
Action iaNtn tcheep all that applyl'
PIaaSG SPeoll'y I othef
13—ption of Action Taken'
Outcome'
Similar to the paper version, multiple Action Taken categories can be selected.
- FnI—ll.
Alflon Taken CI11,•.I;that tpplyI
kaW Enforcement Cnntaered s Called 911/FMS
Cantu lied wlth PhyM—n
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Cl1Fnt remnred tram build Ina
Perm.Upl Guardlan Contacted
Other
When done entering all the information, simply click submit.
Any fields that have a red asterisk, require information an will prevent submission of the form if left blank.
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 4 of 9
'LogicManager
Thank you for your submissions
A Notification email will be received when a new incident is reported, or a new comment has been made regarding
an incident. Click on "Open this incident in Logic Manager" and the Logic Manager login screen will show.
Wed 10/30/2019 10:40 AM
SL SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@ log icmanager.com>
Notification-
Ta OBH Incident Reporting
Oi H there are problems with how this message is displayed,click here to view it in a web
Click here to download pictures.To help protect your privacy,Outlook prevented autom is download of some pictures in this message.
CAUTION!!!-EXTERNAL EMAIL-THINK BEFORE YOU CLICK
❑x Pgnead,P.mP a�a lwN n>emaw.��a PKmr¢.To ndP Prmnvw.
P P Cutlmk rrmdd wmnvEc dw.nbd dMu cmrehontlx
Infr�i�0.
' Iv,tlAa�x,r,IM.
Hi Mlla Arevalo,
You have received a notification through LogicManager.Please see the details
below.
Type:Incident Report
Subject:102
Notification To:Mild Arevalo
Open this incident in LogicManager
If using Internet Explorer,click here to open the notification.
This email was generated by LogicManager If you have any technical issues,
please email support(rDlogicmanager.com.
Exhibit K.2
Page 5 of 9
Enter in email address and password. First time users will be prompted to set up a password.
fresnodbh.my.logicmanageccom/login
LogicManager'
Forgot your password?
Once logged in,the main screen will show reviewer task(incidents to review). Click on analyst/supervisor follow up
to view the incident.
Your Task List
TMKMWE IGUPCF T;ii ..,iGri EC'C .,s_iEL>6r �uC UNIE-
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 6 of 9
Analyst Follow Up
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rwl x.m
:x,.t..e x...
-.an v.w,�al.�� •• ,, —Ift
Pool
The next tab is Sum ary: No edits can be made to this section.
Analyst Fallow Up
w1..T..
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O..FP.lcIwR M
Ir nl MrIWTI OY Mf.Yrxg4eOtllmN eJlgMr,Wxr HYxrt�G'�+�nk INI Ig1y,Wv xro�WntntlYfM,eRrlxpk.W1 M,'a mm�Eerl tl UFiamx�lYl
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Y
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1
lmJbenallM<fN`
1
The next tab is Follow up: This section can be edited. Add to th areas below or make corrections to these fields. Be
sure to E w en edits are made.Then Cancel to Exi ut of the incident.
Exhibit K.2
Page 7 of 9
Analyst Follow Up
Mllen ialen„t,.rll N II,al.pllhl'
Uw pdYllwMtA'aM.ctW% -
rvN..W.eJ,n.,l•e,
tllfOA{IM of ANw I.M.
1
a..en,Motnwlwn
crux al d.rff tamed prcetcner 1P]i!'✓
rL41o:nsw,rr lm.uull CAlICFI O
The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding
documents.Then Cancel to Exit out of the incident.
Analyst Follow Up
Qadd b......t x
a.. IyP• sonic. upload In,.
4! �~
No da,rtnnds yrl.
41ap AW hv.at diO..th.Add N.Wmenl d,wd"IU
n,k in M Sa 103 11 N l d 1 • rANIF' O
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
DBHlncidentReporting@fresnocountyca.gov
Exhibit K.2
Page 8 of 9
To get back to the home view, cli�thheis Manager icon at any time. Any incidents that still need review will
show on this screen, click o and start the review process again.
Your Task List
TASK N"E SOURCE sT:•i 'U 6, Li'C Uc11
Exhibit K.2
Page 9 of 9
Exhibit L
Page 1 of 1
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
Business ffice
4417 E.Inyo Ave
563ODBIE7 ier ni to chub G050 KM-C2230 Copiers Ink 1/1/2013 5,25988 1 5,25988 X New Fresno,CA 93702
/ \ 11 IF 4417 E.Inyo Ave
FR253256 Camera Canon 516913003 1980124 Best Buy 1/1/2013 59523 11 59523 X Used Fresno,CA 93702
Exhibit M
Page 1 of 2
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.
��� 1 Think Cultural Health
F
S(_ U.S.Deporfinentof https://www.thinkculturalhealth.hhs.gov/
�O M H Health and Human Services
Office of Minority Health contact@thinkculturalhealth.hhs.gov
o��
Exhibit M
Page 2 of 2
2
The Case for the National CLAS Standards
Health equity is the attainment of the highest level of health for all people.'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.
Of all the forms of
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 inequality, injustice in
the issue not only an individual concern but also a public health concern. In the United States,it health care is the most
has been estimated that the combined cost of health disparities and subsequent deaths due to shocking and inhumane.
inadequate and/or inequitable care is$1.24 trillion.4
Culturally and linguistically appropriate services are increasingly recognized as effective in improving —Dr. Martin Luther King,Jr.
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 Disparities'and the National Stakeholder Strategy for
Achieving Health Equity,8 which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial
and ethnic health disparities across the country.
Similar to these initiatives,the National CLAS Standards are intended to advance health equity,improve quality,and help eliminate health care disparities
by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.Adoption of
these Standards will help advance better health and health care in the United States.
Bibliography
1. U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from http://minorityhealth.hhs.gov/npa
2.World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
3. U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved from http://www.
hea lthypeopl e.gov/2020/to picsobjectives2O20/overvi ew.as px?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.
jointeenter.org/sites/default/files/upload/research/files/The%20Economic%2 OBurden%20of%2OHealth%201nequalities%20in%20the%2OUnited%2OStates.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-EO08-02).Retrieved
from the Agency of Healthcare Research and Quality website:http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minquai.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_evidencebasecultiinguisticcomp_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/f les/Plans/HHS/H HS_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
��� 1 Think Cultural Health
F
S(_ U.S.Deportment of https://www.thinkculturalhealth.hhs.gov/
1O M H Health and Human Services
Office of Minority Health contact@thinkculturalhealth.hhs.gov
o��
DocuSign Envelope ID:3C2ED552-5BA9-4059-80C4-F8DA637507A8
Exhibit N
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Kings View
Address(number,street) City State ZIP code
7170 N.Financial Dr.Suite 110 Fresno CA 93720
CLIA number Taxpayer ID number(EIN) Telephone number
94-1412648 ( 559 )256-0100
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.
YES NO
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
by Titles XVIII, XIX, or XX? ......................................................................................................................... o r;�
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 XVI Il, XIX, or XX?...................................................................................... o
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)........... o X1
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
N/A
B. Type of entity: o Sole proprietorship o Partnership o Corporation
n Unincorporated Associations 5� Other(specify) Not-for-profit
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
ofindividuals, and provider numbers........................................................................................................... 71 o
NAME ADDRESS PROVIDER NUMBER
N/A
DocuSign Envelope ID:3C2ED552-5BA9-4059-80C4-F8DA637507A8
Exhibit N
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... o 50
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... o Q
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... n n
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?......... o 50
VII. A. Is this facility chain affiliated? ...................................................................................................................... o
If yes, list name, address of corporation, and EIN.
Name EIN
Kings View Foundation 01-0946385
Address(number,name) City State ZIP code
7170 N.Financial Dr.Suite 110 Fresno CA 93720
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
Amanda Nugent Divine,PhD
Chief Executive Officer
Signature DocuSigned by: Date
[A#014 .o(�c N�.j"4 1Dzv e 04/26/2022
Remarks
DocuSign Envelope ID:3C2ED552-5BA9-4059-80C4-F8DA637507A8
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;
DocuSign Envelope ID:3C2ED552-5BA9-4059-80C4-F8DA637507A8
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.
DocuSigned by:
Signature: A N4g"4 Date: 04/26/2022
Amanda Nugent Divine, PhD, CEO Kings View
(Printed Name & Title) (Name of Agency or Company)
DocuSign Envelope ID:3C2ED552-5BA9-4059-80C4-F8DA637507A8
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).
DocuSign Envelope ID:3C2ED552-5BA9-4059-80C4-F8DA637507A8
Exhibit P
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(1)Company Board Member Information:
Name: Amanda Nugent Divinw Date: 04 26 2022
Job Title: Chief Executive Officer
(2)Company/Agency Name and Address:
Kings View
7170 N. Financial Dr. Suite 110
Fresno CA 93720
(3) Disclosure(Please describe the nature of the self-dealing transaction you are a party to):
Kings View is a nonprofit organization with no self-dealing transactions to
disclose.
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a):
N/A
(5)Authorized Signatu e
Signature: pow N4g4.z Nv+,•t Date: 04/26/2022