HomeMy WebLinkAboutAgreement A-22-264 with Turning Point.pdf Agreement No. 22-264
1 AGREEMENT
2 THIS AGREEMENT ("Agreement") is made and entered into this 21 st day of June , 2022, by and
3 between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to
4 as "COUNTY", and TURNING POINT OF CENTRAL CALIFORNIA, INC., a California non-profit 501 (c) (3)
5 corporation, whose address is P.O. Box 7447, Visalia, CA 93290, hereinafter referred to as
6 "CONTRACTOR" (collectively the parties).
7 WITNESSETH:
8 WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), has determined a need
9 for certain Fresno County residents to receive substance use disorder (SUD) and mental health outpatient,
10 full service partnership, and assertive community treatment services under California Assembly Bill (AB)
11 109 Public Safety Realignment and the Post-Release Community Supervision Act of 2011; and mental
12 health diversion under AB 1810, California Senate Bill (SB) 317 and Penal Code 1001.36; and
13 WHEREAS, COUNTY is authorized through its Intergovernmental Agreement with the California
14 State Department of Health Care Services, hereinafter referred to as State or DHCS, to subcontract for
15 Drug Medi-Cal services (DMC) in Fresno County; and
16 WHEREAS, COUNTY is authorized to contract with privately operated agencies for the provision
17 of alcohol and other drug treatment services, pursuant to Title 9, Division 4 of the California Code of
18 Regulations and Division 10.5 (commencing with Section 11750) of the California Health and Safety
19 Code; and
20 WHEREAS, COUNTY, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of the
21 California Code of Regulations, Section 1810.226; and
22 WHEREAS, CONTRACTOR is certified by the State to provide services required by the
23 COUNTY, pursuant to the terms and conditions of this Agreement; and
24 WHEREAS, CONTRACTOR is qualified and willing to operate a forensic behavioral health program
25 pursuant with said services to the terms and conditions of this Agreement.
26 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties hereto
27 agree as follows:
28 1. SERVICES
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1 A. CONTRACTOR shall perform all services and fulfill all responsibilities in a manner
2 consistent with the objectives and person served outcomes as set forth in the Scope of Work, attached
3 hereto as Exhibit A and incorporated herein by reference and made part of this Agreement.
4 B. CONTRACTOR shall also perform all services and fulfill all responsibilities as
5 specified in COUNTY's Request for Proposal (RFP) No. 22-047 dated March 7, 2022 and Addendum No.
6 One (1) to COUNTY'S RFP No. 22-047 dated March 23, 2022, collectively referred to herein as COUNTY's
7 Revised RFP, and CONTRACTOR's response to said Revised RFP dated April 4, 2022; all incorporated
8 herein by reference and made part of this Agreement. In the event of any inconsistency among these
9 documents, the inconsistency shall be resolved by giving precedence in the following order of priority: 1)to
10 this Agreement, including all Exhibits, 2)to the Revised RFP No. 22-047, 3)to the Response to the Revised
11 RFP No. 22-047. A copy of COUNTY's Revised RFP No. 22-047 and CONTRACTOR's response shall be
12 retained and made available during the term of this Agreement by COUNTY's DBH.
13 C. CONTRACTOR shall align programs, services, and practices with the vision,
14 mission, and guiding principles of the COUNTY's DBH, as further described in Exhibit B "Guiding Principles
15 of Care Delivery", attached hereto and by this reference incorporated herein and made part of this
16 Agreement.
17 D. CONTRACTOR shall send to COUNTY's DBH upon execution of this Agreement, a
18 detailed plan ensuring clinically appropriate leadership and supervision of their clinical program.
19 Recruitment and retention of clinical leadership with the clinical competencies to oversee services based on
20 the level of care and program design presented herein shall be included in this plan. A description and
21 monitoring of this plan shall be provided.
22 E. CONTRACTOR shall participate in utilizing and integrating Reaching Recovery,
23 Child and Adolescent Needs and Strengths (CANS) and other clinical tools and measures as directed by
24 the COUNTY's DBH.
25 F. It is the expectation of the COUNTY that CONTRACTOR provide timely access to
26 services that meet the State of California standards for care. CONTRACTOR must complete intake for all
27 persons served (including persons served referred by Court or Probation) within time-frames specified below
28 from initial contact:
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1 1) CONTRACTOR shall provide non-urgent services within ten (10)
2 business days from request/referral to first appointment;
3 2) CONTRACTOR shall provide psychiatry services within fifteen (15)
4 business days from request/referral to first appointment;
5 3) CONTRACTOR shall provide urgent services as soon as needed based
6 on each person's needs; and
7 4) CONTRACTOR shall comply with reporting requirements of Superior
8 Court of Fresno and Fresno County Probation Department relating to beneficiary status change and
9 treatment progress if an appropriate Release of Information (ROI) is in place within two (2) business days
10 from next court appearance or upon request.
11 CONTRACTOR shall track timeliness of services to persons served and provide a
12 monthly report showing the monitoring or tracking tool that captures this data. COUNTY and
13 CONTRACTOR shall meet to go over this monitoring tool on a monthly basis or as needed. COUNTY shall
14 take corrective action if there is a failure to comply by CONTRACTOR with the above timely access
15 standards. CONTRACTOR shall also provide tracking tools and measurements for effectiveness,
16 efficiency, and person served satisfaction indicators as required by Commission on Accreditation of
17 Rehabilitation Facilities (CARF) standards and as further detailed in Exhibit A.
18 G. This Agreement provides for forensic behavioral health services that includes SUD
19 and mental health outpatient services, full service partnership services and assertive community treatment
20 services as detailed in Exhibit A. CONTRACTOR shall collect, maintain and report all data and person
21 served information for the service categories independent of one another, including but not limited to: Medi-
22 Cal billing, other insurance or revenue billing and reports; staff schedules and reports; performance
23 measures; monthly invoices and general ledgers; and other data as required.
24 H. It is acknowledged by all parties hereto that COUNTY's DBH shall monitor said
25 services operated by CONTRACTOR, in accordance with Section Fourteen (14), MONITORING, of this
26 Agreement, Title 9, Title 22, and all other applicable local, state, and federal laws and policies.
27 I. CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
28 consisting of staff from COUNTY's DBH to discuss service requirements, data reporting, outcomes
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1 measurement, training, policies and procedures, overall program operations, and any problems or
2 foreseeable problems that may arise.
3 J. CONTRACTOR's administrative level agency representative, who is duly
4 authorized to act on behalf of the CONTRACTOR, must attend regularly scheduled monthly Behavioral
5 Health Board, Forensic and SUD subcommittees and regularly scheduled provider meetings.
6 K. Any change to CONTRACTOR's location of the service site may be made only
7 upon sixty (60) days advance written notification to COUNTY's DBH Director and upon written approval
8 from the COUNTY's DBH Director or his or her designee.
9 L. CONTRACTOR shall maintain, at CONTRACTOR's cost, a computer system
10 compatible with COUNTY's current billing and electronic health record (EHR) system for the provision of
11 submitting SUD information required under the terms and conditions of this Agreement. CONTRACTOR
12 shall complete billing and EHR data entry as follows: initial contact, when applicable; admissions;
13 California Outcomes Measurement System (CaIOMS) reporting; American Society of Addiction Medicine
14 (ASAM) level of care reporting; discharge; and no show/missed appointments and referrals.
15 M. CONTRACTOR shall comply with requirements stated within the Intergovernmental
16 Agreement as listed in Exhibit C, Drug Medi-Cal Specific Requirements, attached hereto and by this
17 reference incorporated herein; and with all other provisions set forth in the Intergovernmental Agreement,
18 made available by the COUNTY's DBH at the following web address and by this reference incorporated
19 herein: https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract-
20 providers/substance-use-disorder-providers. CONTRACTOR is referred to therein as "Subcontractor" and
21 COUNTY is referred to therein as "Contractor."
22 N. CONTRACTOR shall maintain requirements as an organizational provider
23 throughout the term of this Agreement, as described in Section Seventeen (17), COMPLIANCE WITH
24 STATE MEDI-CAL REQUIREMENTS, of this Agreement. If for any reason, this status is not maintained,
25 the COUNTY may terminate this Agreement pursuant to Section Three (3), TERMINATION, of this
26 Agreement.
27 O. CONTRACTOR agrees that prior to providing services under the terms and
28 conditions of this Agreement, it shall have appropriate staff hired and in place for program services and
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1 operations or COUNTY may, in addition to other remedies it may have, suspend referrals or terminate
2 this Agreement in accordance with Section Three (3), TERMINATION, of this Agreement. The parties
3 acknowledge that CONTRACTOR will be performing hiring, training, and credentialing of staff, and
4 COUNTY will be performing additional staff credentialing to ensure compliance with State and Federal
5 regulations.
6 P. It is mutually agreed by all parties to this Agreement, that the program funded
7 under this Agreement shall be identified and subsequently named/branded through the review and
8 approval of the COUNTY's DBH director or his or her designee. All print or media materials, including
9 program branding and program references shall be reviewed and approved by the COUNTY'S DBH
10 Director, or his or her designee. The program funded under this Agreement shall be identified as a
11 "County of Fresno, Department of Behavioral Health funded program", and operated by the
12 CONTRACTOR under the terms and conditions of this Agreement.
13 2. TERM: The term of this Agreement shall be for a period of three (3) years, commencing
14 on July 1, 2022 through and including June 30, 2025. This Agreement may be extended for two (2)
15 additional consecutive twelve (12) month periods upon written approval of both parties no later than
16 sixty (60) days prior to the first day of the next twelve (12) month extension period. The COUNTY's
17 DBH Director or his or her designee is authorized to execute such written approval on behalf of
18 COUNTY based on CONTRACTOR'S satisfactory performance.
19 3. TERMINATION
20 A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
21 provided hereunder, are contingent on the approval of funds by the appropriating government agency.
22 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
23 terminated, at any time by giving the CONTRACTOR thirty (30) days advance written notice.
24 B. Breach of Contract- The COUNTY may immediately suspend or terminate this
25 Agreement in whole or in part, where in the determination of the COUNTY there is:
26 1) An illegal or improper use of funds;
27 2) A failure to comply with any term of this Agreement;
28 3) A substantially incorrect or incomplete report submitted to the COUNTY;
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1 4) Improperly performed service.
2 In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any
3 breach of this Agreement or any default which may then exist on the part of the CONTRACTOR. Neither
4 shall such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or
5 default. The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the
6 COUNTY of any funds disbursed to the CONTRACTOR under this Agreement, which in the judgment of
7 the COUNTY were not expended in accordance with the terms of this Agreement. The CONTRACTOR
8 shall promptly refund any such funds upon demand.
9 C. Without Cause - Under circumstances other than those set forth above, this
10 Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY's DBH Director or designee
11 upon the giving of sixty (60) days advance written notice of an intention to terminate.
12 4. COMPENSATION
13 A. COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
14 compensation for actual expenditures incurred in accordance with the CONTRACTOR's "budget"
15 documents approved by the COUNTY's DBH Director or designee and attached hereto as Exhibit D and
16 incorporated herein by this reference.
17 The maximum amount to be paid to CONTRACTOR by COUNTY under this
18 Agreement for the operating period of July 1, 2022 through June 30, 2023, shall not exceed Five Million,
19 Two Hundred Seven Thousand, Five Hundred Ninety-Nine and No/100 Dollars ($5,207,599.00).
20 The maximum amount to be paid to CONTRACTOR by COUNTY under this
21 Agreement for the twelve (12) month period, (July 1, 2023 through June 30, 2024), shall not exceed Five
22 Million, Two Hundred Twenty-One Thousand, Seven Hundred Eighty-Three and No/100 Dollars
23 ($5,221,783.00).
24 The maximum amount to be paid to CONTRACTOR by COUNTY under this
25 Agreement for the twelve (12) month period, (July 1, 2024 through June 30, 2025), shall not exceed Five
26 Million, Three Hundred Twenty-Six Thousand, Eighty-Five and No/100 Dollars ($5,326,085.00).
27 The maximum amount to be paid to CONTRACTOR by COUNTY under this
28 Agreement for the twelve (12) month period, (July 1, 2025 through June 30, 2026), shall not exceed Five
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1 Million, Four Hundred Fourteen Thousand, Six Hundred Eighty-Three and No/100 Dollars
2 ($5,414,683.00).
3 The maximum amount to be paid to CONTRACTOR by COUNTY under this
4 Agreement for the twelve (12) month period, (July 1, 2026 through June 30, 2027), shall not exceed Five
5 Million, Five Hundred Twelve Thousand, Seven Hundred Forty-Five and No/100 Dollars
6 ($5,512,745.00).
7 In no event shall compensation for services performed under this Agreement be in
8 excess of Twenty-Six Million, Six Hundred Eighty-Two Thousand, Eight Hundred Ninety-Five and
9 No/100 Dollars ($26,682,895.00) during the term of this Agreement.
10 B. It is understood by COUNTY and CONTRACTOR that any Medi-Cal Federal
11 Financial Participation (FFP) and client reimbursements above the amounts stated herein will be used to
12 directly offset the COUNTY's contribution of AB109 and MHSA funds as identified in Exhibit D, and may
13 be used to expand program services to persons served and/or increase program capacity with the written
14 approval of the COUNTY's DBH Director or his or her designee. CONTRACTOR shall submit a written
15 request to the COUNTY's DBH Director or his or her designee for such approval. The offset of funds will
16 also be clearly identified in monthly invoices received from CONTRACTOR as further described in Section
17 Five (5), INVOICING, of this Agreement.
18 C. If CONTRACTOR fails to generate the Medi-Cal revenue and/or client fee
19 reimbursement amounts set forth in Exhibit D, COUNTY shall not be obligated to pay the difference
20 between these estimated amounts and the actual amounts generated.
21 D. Travel shall be reimbursed based on actual expenditures and mileage
22 reimbursement shall be at CONTRACTOR's adopted rate per mile, not to exceed the Federal Internal
23 Revenue Services (IRS) published rate.
24 E. Payment shall be made upon certification or other proof satisfactory to COUNTY's
25 DBH that services have actually been performed by CONTRACTOR as specified in this Agreement
26 F. For services rendered herein, CONTRACTOR shall assure that an ongoing quality
27 assurance component is in place and is occurring. CONTRACTOR shall assure that clinical records for
28 each person served are of such detail and length that a review of said record will verify that appropriate
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1 services were provided. If the record is unclear, incomplete, and/or indicates that appropriate services were
2 not provided, COUNTY reserves the right to withhold payment for the applicable unit(s) of services. It is
3 understood that all expenses incidental to CONTRACTOR's performance of services under this Agreement
4 shall be borne by CONTRACTOR. If CONTRACTOR fails to comply with any provision of this Agreement,
5 COUNTY shall be relieved of its obligation for further compensation.
6 G. Payments shall be made by COUNTY to CONTRACTOR in arrears for services
7 provided during the preceding month, within forty-five (45) days after the date of receipt and approval by
8 COUNTY of the monthly invoicing as described in Section Five (5), INVOICING, herein. Payments shall be
9 made after receipt and verification of actual expenditures incurred by CONTRACTOR for monthly program
10 costs, as identified in Exhibit D, in the performance of this Agreement and shall be documented to
11 COUNTY on a monthly basis by the tenth (10th) of the month following the month of said expenditures.
12 H. COUNTY shall not be obligated to make any payments under this Agreement if the
13 request for payment is received by COUNTY more than sixty (60) days after this Agreement has terminated
14 or expired.
15 I. All final invoices and/or any final budget modification requests shall be submitted by
16 CONTRACTOR within sixty (60) days following the final month of service for which payment is claimed. No
17 action shall be taken by COUNTY on invoices submitted beyond the sixty (60) day closeout period. Any
18 compensation which is not expended by CONTRACTOR pursuant to the terms and conditions of this
19 Agreement shall automatically revert to COUNTY.
20 J. The services provided by CONTRACTOR under this Agreement are funded in whole
21 or in part by the State of California. In the event that funding for these services is delayed by the State
22 Controller, COUNTY may defer payments to CONTRACTOR. The amount of the deferred payment shall
23 not exceed the amount of funding delayed by the State Controller to the COUNTY. The period of time of
24 the deferral by COUNTY shall not exceed the period of time of the State Controller's delay of payment to
25 COUNTY plus forty-five (45) days.
26 K. CONTRACTOR shall be held financially liable for any and all future
27 disallowances/audit exceptions due to CONTRACTOR deficiency discovered through the State audit
28 process and COUNTY utilization review during the course of this Agreement. At COUNTY's election, the
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1 disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall be
2 withheld from subsequent payments to CONTRACTOR. CONTRACTOR shall not receive reimbursement
3 for any units of services rendered that are disallowed or denied by the COUNTY's DBH utilization review
4 process or through the State Department of Health Care Services (DHCS) cost report audit settlement
5 process for Medi-Cal eligible persons served. Notwithstanding the above, COUNTY must notify
6 CONTRACTOR prior to any State audit process and/or COUNTY utilization review. To the extent allowable
7 by law, CONTRACTOR shall have the right to be present during each phase of any State audit process
8 and/or COUNTY utilization review and shall be provided all documentation related to each phase of any
9 State audit process and/or COUNTY utilization review. Additionally, prior to any disallowances/audit
10 exceptions becoming final, CONTRACTOR shall be given at least ten (10) business days to respond to
11 such proposed disallowances/audit exceptions.
12 L. It is understood by CONTRACTOR and COUNTY that this Agreement is funded with
13 mental health and substance use disorder funds to serve adults, many of whom have mental health and co-
14 occurring substance use disorders. It is further understood by CONTRACTOR and COUNTY that funds
15 shall be used to support appropriately integrated and documented treatment services for co-occurring
16 mental health and substance use disorders and that integrated services can be documented in
17 assessments, interventions, and program notes documenting linkages and services.
18 M. FUNDING SOURCES— It shall be the obligation of CONTRACTOR to determine
19 and claim all revenue possible from private pay sources and third party payers. CONTRACTOR shall not
20 use any funds under this Agreement for services covered by Drug Medi-Cal, Medi-Cal or other health
21 insurance for eligible beneficiaries.
22 N. PUBLIC INFORMATION — CONTRACTOR shall disclose its funding source in all
23 public information. Communication products must follow DBH graphic standards, including typefaces and
24 colors, to communicate our authority and project a unified brand. This includes all media types and
25 channels and all materials on and offline that are created as part of DBH's efforts to provide information to
26 the public. Communication products must include a funding acknowledgement determined by the level of
27
28
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1 funding provided by DBH as follows:
2 1) A Program of Fresno County Department of Behavioral Health (100%funded);
3 2) Funding provided by Fresno County Department of Behavioral Health (50% or
4 more funded); and
5 3) Funded, in part, by County of Fresno Department of Behavioral Health (less
6 than 50% funded).
7 O. LOBBYING ACTIVITY—CONTRACTOR shall not directly or indirectly use any of
8 the funds provided under this Agreement for publicity, lobbying, or propaganda purposes designed to
9 support or defeat legislation pending before the Congress of the United States or the Legislature of the
10 State of California.
11 P. POLITICAL ACTIVITY—CONTRACTOR shall not directly or indirectly use any of
12 the funds under this Agreement for any political activity or to further the election or defeat of any candidate
13 for public office.
14 5. INVOICING
15 A. CONTRACTOR shall invoice COUNTY in arrears by the twentieth (20th) day of
16 each month for actual expenses incurred during the prior month electronically to: 1)
17 dbhinvoicereview@fresnocountyca.gov, 2) dbh-invoices@fresnocountyca.gov; and 3)
18 dbhcontractedservicesdivision@fresnocountyca.gov with a copy to the assigned COUNTY's DBH Staff
19 Analyst. After CONTRACTOR renders service to referred persons served, CONTRACTOR shall invoice
20 COUNTY for payment, certify the expenditure, and submit electronic claiming data into COUNTY's
21 electronic information system for all persons served, including those eligible for Medi-Cal as well as those
22 that are not eligible for Medi-Cal, including contracted cost per unit and actual cost per unit. Invoices and
23 reports shall be in such detail as acceptable to COUNTY's DBH, as described herein and in Section
24 Thirteen (13), REPORTS, of this Agreement. Billing information must include the name of the person
25 served, identification number, date of service, type of mental health service provided, duration of service,
26 International Classification of Diseases (ICD) diagnosis, service provider name, units of service provided,
27 rate of service provided, and actual amount of service. No reimbursement for costs incurred by
28 CONTRACTOR for services delivered under this Agreement shall be made until the invoice and supporting
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1 documentation is received, verified, and approved by COUNTY's DBH. COUNTY must pay
2 CONTRACTOR before submitting a claim to DHCS for Federal reimbursement for Medi-Cal eligible
3 persons served.
4 B. If CONTRACTOR chooses to utilize the COUNTY's electronic health record system
5 (EHR) as their own full electronic health records system, COUNTY's DBH shall invoice CONTRACTOR in
6 arrears by the fifth (5th) day of each month for the prior month's hosting fee for access to the COUNTY's
7 electronic information system in accordance with the fee schedule as set forth in Exhibit E, "Electronic
8 Health Records Software Charges" attached hereto and incorporated herein by this reference and made
9 part of this Agreement. COUNTY shall invoice CONTRACTOR annually for the annual maintenance and
10 licensing fee for access to the COUNTY's electronic information system in accordance with the fee
11 schedule as set forth in Exhibit E. COUNTY shall invoice CONTRACTOR annually for the Reaching
12 Recovery fee, as applicable, for access to the COUNTY's electronic information system in accordance with
13 the fee schedule as set forth in Exhibit E. CONTRACTOR shall provide payment for these expenditures to
14 COUNTY's Fresno County Department of Behavioral Health, Accounts Receivable, P.O. Box 712, Fresno,
15 CA 93717-0712, Attention: Business Office, within forty-five (45) days after the date of receipt by
16 CONTRACTOR of the invoicing provided by COUNTY.
17 C. At the discretion of COUNTY's DBH Director or designee, if an invoice is incorrect or
18 is otherwise not in proper form or substance, COUNTY's DBH Director or his or her designee, shall have
19 the right to withhold payment as to only that portion of the invoice that is incorrect or improper after five (5)
20 days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to provide services for a period of
21 ninety (90) days after notification of an incorrect or improper invoice. If after the ninety(90) day period, the
22 invoice is still not corrected to COUNTY DBH's satisfaction, COUNTY's DBH Director or his or her
23 designee, may elect to terminate this Agreement, pursuant to the termination provisions stated in Section
24 Three (3), TERMINATION, of this Agreement. In addition, for invoices received ninety (90) days after the
25 expiration of each term of this Agreement or termination of this Agreement, at the discretion of COUNTY's
26 DBH Director or his or her designee, COUNTY's DBH shall have the right to deny payment of any
27 additional invoices received.
28 D. CONTRACTOR shall submit monthly invoices and general ledgers to COUNTY's
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1 DBH that itemize the line item charges for monthly program costs (per applicable budget, as identified in
2 Exhibit D), including the cost per unit calculation based on persons served within that month, and excluding
3 unallowable costs. Unallowable costs such as lobbying or political donations must be deducted from the
4 monthly invoice reimbursements. The invoices and general ledgers will serve as tracking tools to determine
5 if CONTRACTOR's program costs are in accordance with its budgeted cost, and cost per unit negotiated by
6 service modes compared to actual cost per unit, as set forth in Exhibit D. The actual cost per unit will be
7 based upon total costs and total units of service. It will also serve for the COUNTY to certify the public funds
8 expended for purposes of claiming Federal and State reimbursement for the cost of Medi-Cal services and
9 activities. Failure to submit reports and other supporting documentation shall be deemed sufficient cause
10 for COUNTY to withhold payments until there is compliance, as further described in Section Five (5),
11 INVOICING, herein.
12 E. Monthly invoices shall include a roster of persons served, identifying volume
13 reported by payer group (including third party payer of services) by month and year-to-date, including
14 percentages.
15 F. In addition to billing for SUD outpatient services, CONTRACTOR shall submit on a
16 monthly basis by the twentieth (20th), an Operational Expense Report, per modality of service, along with a
17 general ledger, payroll register and supporting documentation for any line items selected. For the purposes
18 of verifying that costs are allowable and equitable, CONTRACTOR shall submit any additional
19 documentation as deemed necessary by COUNTY's DBH.
20 G. CONTRACTOR must report all third party collections from other funding sources for
21 Medicare, private insurance, client private pay or any other third party. Monthly invoices for reimbursement
22 must equal the amount due CONTRACTOR less any funding sources not eligible for Federal
23 reimbursement and any other revenues generated by CONTRACTOR (i.e., private insurance, etc.).
24 H. CONTRACTOR shall remit annually within ninety (90) days from June 30t", a
25 schedule to provide the required information on published charges for all authorized direct specialty mental
26 health services. The published charge listing will serve as a source document to determine the
27 CONTRACTOR's usual and customary charge prevalent in the public mental health sector that is used to
28 bill the general public, insurers or other non-Medi-Cal third party payers during the course of business
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1 operations.
2 I. CONTRACTOR shall submit monthly staffing reports that identify all direct service
3 and support staff, applicable licensure/certifications, and full time hours worked to be used as a tracking tool
4 to determine if CONTRACTOR's program is staffed according to the services provided under this
5 Agreement.
6 J. CONTRACTOR must maintain financial records for a period of seven (7)years or
7 until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible for
8 any disallowances related to inadequate documentation.
9 K. CONTRACTOR is responsible for collecting and managing of data in a manner to be
10 determined by DHCS and COUNTY's DBH in accordance with applicable rules and regulations.
11 COUNTY's electronic information system is a critical source of information for purposes of monitoring
12 service volume and obtaining reimbursement. CONTRACTOR must attend the COUNTY's DBH training
13 on equipment reporting for assets, intangible and sensitive minor assets, COUNTY's electronic information
14 system, and related cost reporting.
15 L. CONTRACTOR shall submit service data into COUNTY's electronic information
16 system within ten (10) calendar days from the date of services were rendered. Federal and State
17 reimbursement for Medi-Cal specialty mental health services is based on public expenditures certified by
18 the CONTRACTOR.
19 M. CONTRACTOR must provide all necessary data to allow COUNTY to bill Medi-Cal,
20 and any other third-party source, for services and meet State and Federal reporting requirements. The
21 necessary data can be provided by a variety of means, including but not limited to: 1) direct data entry into
22 COUNTY's electronic information system; 2) providing an electronic file compatible with COUNTY's
23 electronic information system; or 3) integration between COUNTY's electronic information system and
24 CONTRACTOR's information system(s).
25 N. If a person served has dual coverage, such as other health coverage (OHC)or
26 Federal Medicare, CONTRACTOR will be responsible for billing the carrier and obtaining a payment/denial
27 or have validation of claiming with no response ninety (90) days after the claim was mailed before the
28 service can be entered into COUNTY's electronic information system. CONTRACTOR must report all third
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1 party collections or revenue for Medicare, third party, client pay, or private pay in each monthly invoice and
2 in the annual cost report that is required to be submitted. A copy of explanation of benefits or CMS 1500
3 form is required as documentation. CONTRACTOR shall submit monthly invoices for reimbursement that
4 equal the amount due CONTRACTOR less any funding sources not eligible for Federal and State
5 reimbursement. CONTRACTOR must comply with all laws and regulations governing the Federal
6 Medicare program, including, but not limited to: 1)the requirement of the Medicare Act, 42 U.S.C. section
7 1395 et seq; and 2)the regulation and rules promulgated by the Federal Centers for Medicare and
8 Medicaid Services as they relate to participation, coverage and claiming reimbursement. CONTRACTOR
9 will be responsible for compliance as of the effective date of each Federal, State or local law or regulation
10 specified.
11 O. Data entry into the COUNTY's electronic information system shall be the
12 responsibility of CONTRACTOR. The direct specialty mental health services data must be reconciled by
13 the CONTRACTOR to the monthly invoices submitted for payment. COUNTY shall monitor the volume of
14 services and cost of services entered into COUNTY's electronic information system. Any and all audit
15 exceptions resulting from the provision and reporting of specialty mental health services by CONTRACTOR
16 shall be the sole responsibility of CONTRACTOR. CONTRACTOR will comply with all applicable policies,
17 procedures, directives and guidelines regarding the use of COUNTY's electronic information system. If
18 CONTRACTOR elects to use their own Electronic Health Record (EHR) system, the EHR must have
19 Certification Commission for Healthcare Information Technology (CCHIT) certification for Security Access
20 Control, Audit and Authentication. CONTRACTOR's billers in the EHR system will need to sign an
21 Electronic Signature Certification (ESR).
22 P. Medi-Cal Certification and Mental Health Plan Compliance
23 CONTRACTOR shall establish and maintain Medi-Cal certification or become
24 certified within ninety (90) days of the issuance of the facility's occupancy notice and fire clearance through
25 COUNTY's DBH for services to be delivered under this Agreement through COUNTY to provide
26 reimbursable services to Medi-Cal eligible persons. In addition, CONTRACTOR shall work with COUNTY's
27 DBH to execute the process if not currently certified by COUNTY for credentialing of staff. Service location
28 must be approved by COUNTY's DBH during the Medi-Cal certification process. During this process, the
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1 CONTRACTOR shall obtain a legal entity number established by DHCS, as this is a requirement for
2 maintaining Mental Health Plan Organizational Provider status throughout the term of this Agreement.
3 CONTRACTOR shall become Medi-Cal certified prior to providing services to Medi-Cal eligible persons and
4 seeking reimbursement from the COUNTY for costs associated with direct specialty mental health services.
5 CONTRACTOR will not be reimbursed by COUNTY for any services rendered prior to Medi-Cal
6 certification. CONTRACTOR shall comply with any and all requests and directives associated with
7 COUNTY maintaining State Medi-Cal site certification.
8 Q. CONTRACTOR shall provide specialty mental health services in accordance with
9 COUNTY's MHP. CONTRACTOR must comply with the "Fresno County Mental Health Plan Compliance
10 Program and Code of Conduct" set forth in Exhibit F, attached hereto and incorporated herein by reference
11 and made part of this Agreement.
12 R. CONTRACTOR may provide direct specialty mental health services using unlicensed
13 staff as long as the CONTRACTOR is approved as an Organizational Provider by the COUNTY's MHP and
14 the individual is supervised by licensed staff who meet the Board of Behavioral Sciences requirements for
15 supervision, works within his/her scope, and only delivers allowable direct specialty mental health services.
16 Unlicensed staff must also be credentialed by COUNTY's MHP.
17 S. It is understood that each service is subject to audit for compliance with Federal and
18 State regulations, and that COUNTY may be making payments in advance of said review. In the event that
19 a service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set off from other
20 payments due the amount of said disapproved services. CONTRACTOR shall be responsible for audit
21 exceptions to ineligible dates of services or incorrect application of utilization review requirements.
22 CONTRACTOR shall comply with any and all requests associated with any State and/or Federal reviews or
23 audits.
24 6. INDEPENDENT CONTRACTOR: In performance of the work, duties and obligations
25 assumed by CONTRACTOR under this Agreement, it is mutually understood and agreed that
26 CONTRACTOR, including any and all of the CONTRACTOR's officers, agents, and employees will at all
27 times be acting and performing as an independent contractor, and shall act in an independent capacity and
28 not as an officer, agent, servant, employee,joint venturer, partner, or associate of the COUNTY.
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1 Furthermore, COUNTY shall have no right to control or supervise or direct the manner or method by which
2 CONTRACTOR shall perform its work and function. However, COUNTY shall retain the right to administer
3 this Agreement so as to verify that CONTRACTOR is performing its obligations in accordance with the
4 terms and conditions thereof.
5 CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules and
6 regulations, if any, of governmental authorities having jurisdiction over matters the subject thereof.
7 Because of its status as an independent contractor, CONTRACTOR shall have absolutely no right
8 to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be solely liable
9 and responsible for providing to, or on behalf of, its employees all legally-required employee benefits. In
10 addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all matters relating
11 to payment of CONTRACTOR'S employees, including compliance with Social Security withholding and all
12 other regulations governing such matters. It is acknowledged that during the term of this Agreement,
13 CONTRACTOR may be providing services to others unrelated to the COUNTY or to this Agreement.
14 7. MODIFICATION: Any matters of this Agreement maybe modified from time to time by the
15 written consent of all the parties without, in any way, affecting the remainder.
16 In addition, changes to expense category (i.e., Salary & Benefits, Facilities/Equipment, Operating,
17 Financial Services, Special Expenses, Fixed Assets, etc.) subtotals in the individual program budgets, as
18 set forth in Exhibit D, that do not exceed ten percent (10%) of the maximum compensation payable to
19 CONTRACTOR, and movement of funds between the individual program budgets that does not exceed ten
20 percent (10%) of the maximum compensation payable to the CONTRACTOR, may be made with the
21 written approval of COUNTY's DBH Director or designee. Modifications shall not result in any change to
22 the maximum compensation amounts payable to CONTRACTOR, as stated in this Agreement.
23 8. NON-ASSIGNMENT: Neither party shall assign, transfer or sub-contract this Agreement
24 nor their rights or duties under this Agreement without the prior written consent of the other party.
25 9. INDEMNITY AND DEFENSE
26 A. Indemnity. CONTRACTOR shall indemnify and hold harmless and defend
27 the COUNTY (including its officers, agents, employees, and volunteers) against all claims,
28 demands, injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties,
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1 and liabilities of any kind to the COUNTY, the CONTRACTOR, or any third party that arise from or
2 relate to the performance or failure to perform by the CONTRACTOR (or any of its officers,
3 agents, subcontractors, or employees) under this Agreement. The COUNTY may conduct or
4 participate in its own defense without affecting the CONTRACTOR's obligation to indemnify and
5 hold harmless or defend the COUNTY.
6 B. CONTRACTOR agrees to indemnify COUNTY for Federal, State of California audit
7 exceptions resulting from noncompliance herein on the part of the CONTRACTOR.
8 The provisions of this Section Nine (9), Indemnity and Defense, shall survive termination of this
9 Agreement.
10 10. INSURANCE: The CONTRACTOR shall comply with all the insurance requirements in
11 Exhibit G to this Agreement.
12 A. Waiver of Subrogation
13 CONTRACTOR hereby grants to COUNTY a waiver of any right to subrogation
14 which any insurer of said CONTRACTOR may acquire against the COUNTY by virtue of the payment of,
15 any loss, incurred or alleged, under such insurance. CONTRACTOR agrees to obtain any endorsement
16 that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether
17 or not the COUNTY has received a waiver of subrogation endorsement from the insurer.
18 11. LICENSES/CERTIFICATES: Throughout each term of this Agreement, CONTRACTOR
19 and CONTRACTOR's staff shall maintain all necessary licenses, permits, approvals, certificates, waivers
20 and exemptions necessary for the provision of the services hereunder and required by the laws and
21 regulations of the United States of America, State of California, the County of Fresno, and any other
22 applicable governmental agencies. CONTRACTOR shall notify COUNTY immediately in writing of its
23 inability to obtain or maintain such licenses, permits, approvals, certificates, waivers and exemptions
24 irrespective of the pendency of any appeal related thereto. Additionally, CONTRACTOR and
25 CONTRACTOR's staff shall comply with all applicable laws, rules or regulations, as may now exist or be
26 hereafter changed.
27 12. RECORDS:
28 A. CONTRACTOR shall maintain its records in accordance with Exhibit H,
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1 "Documentation Standards for Client Records," attached hereto and incorporated herein by reference and
2 made part of this Agreement. The person served record shall begin with registration and intake and include
3 authorizations, assessments, plans of care, and progress notes, as well as other documents as approved
4 by the COUNTY's DBH. COUNTY shall be allowed to review records of services provided, including the
5 goals and objectives of the treatment plan, and how the therapy provided is achieving the goals and
6 objectives. All mental health records shall be considered the property of the COUNTY and shall be
7 retained by the COUNTY upon termination or expiration of this Agreement. All medical records shall be
8 maintained for a minimum of ten (10) years from the date of the end of the Agreement.
9 B. If CONTRACTOR determines to maintain its records in COUNTY's EHR system, it
10 shall provide COUNTY's DBH Director, or his or her designee, with a thirty (30) day notice. If at any time
11 CONTRACTOR chooses not to maintain its records in COUNTY's EHR system, it shall provide COUNTY'S
12 DBH Director, or his or her designee, with a thirty (30) day notice and CONTRACTOR will be responsible
13 for obtaining its own system, at its own cost, for electronic health record management. COUNTY shall be
14 allowed to review records of services provided, including the goals and objectives of the treatment plan,
15 and how the therapy provided is achieving the goals and objectives. All mental health records shall be
16 considered the property of the COUNTY and shall be retained by the COUNTY upon termination or
17 expiration of this Agreement. All medical records shall be maintained for a minimum of ten (10) years from
18 the date of the end of the Agreement.
19 C. Disclaimer—COUNTY makes no warranty or representation that information entered
20 into the COUNTY's EHR system by CONTRACTOR will be accurate, adequate or satisfactory for
21 CONTRACTOR's own purposes or that any information in CONTRACTOR's possession or control, or
22 transmitted or received by CONTRACTOR, is or will be secure from unauthorized access, viewing, use,
23 disclosure, or breach. CONTRACTOR is solely responsible for person served information entered by
24 CONTRACTOR into the COUNTY's EHR system. CONTRACTOR agrees that all Private Health
25 Information (PHI) maintained by CONTRACTOR in COUNTY's EHR system will be maintained in
26 conformance with all Health Insurance Portability and Accountability Act (HIPAA) laws, as stated in Section
27 Nineteen (19), HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT.
28 D. Documentation — CONTRACTOR shall maintain adequate records in sufficient detail
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1 to make possible an evaluation of services, and contain all the data necessary in reporting to the State of
2 California and/or Federal agency. All person served records shall be maintained pursuant to applicable
3 State of California and Federal requirements concerning confidentiality.
4 E. Suspension of Compensation — In the event that CONTRACTOR fails to provide
5 reports specified in this Agreement, it shall be deemed sufficient cause for COUNTY to withhold payments
6 until CONTRACTOR is in compliance with reporting requirements.
7 F. Client Confidentiality— CONTRACTOR shall conform to and COUNTY shall monitor
8 compliance with all State and Federal statutes and regulations regarding confidentiality, including but not
9 limited to confidentiality of information requirements of 42 Code of Federal Regulations § 2.1 et seq.,
10 Welfare and Institutions Code § 5328, 10850 and 14100.2, Health and Safety Code § 11977 and 11812,
11 Civil Code, Division 1, Part 2.6, and 22 California Code of Regulations § 51009.
12 13. REPORTS
13 A. Outcome Reports
14 CONTRACTOR shall submit to COUNTY's DBH service outcome reports as
15 requested by COUNTY's DBH. Outcome reports and outcome requirements are subject to change at
16 COUNTY's DBH discretion.
17 B. AB109 Public Safety Realignment Reporting
18 COUNTY's Community Corrections Partnership Council is responsible for providing
19 a report to the State which will describe and evaluate the Public Safety Realignment Act, AB109
20 Implementation Plan funding for essential planning purposes, maintaining program accountability and
21 program monitoring. CONTRACTOR is required to submit quarterly and annually to the COUNTY's
22 Community Corrections Partnership Council, with a copy to COUNTY's DBH, such statutory outcome data
23 reporting. Outcome data and report requirements are subject to change at State and COUNTY's
24 discretion.
25 C. Additional Reports
26 CONTRACTOR shall also furnish to COUNTY such statements, records, reports,
27 data, and other information as COUNTY's DBH may request pertaining to matters covered by this
28 Agreement. In the event that CONTRACTOR fails to provide such reports or other information required
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1 hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments until there is
2 compliance. In addition, CONTRACTOR shall provide written notification and explanation to COUNTY
3 within five (5) days of any funds received from another source to conduct the same services covered by this
4 Agreement.
5 D. Cost Report
6 CONTRACTOR agrees to submit a complete and accurate detailed cost report on
7 an annual basis for each fiscal year ending June 30th in the format prescribed by the DHCS for the
8 purposes of Short Doyle Medi-Cal reimbursements and total costs for programs. The cost report will be the
9 source document for several phases of settlement with the DHCS for the purposes of Short Doyle Medi-Cal
10 reimbursement. CONTRACTOR shall report costs under their approved legal entity number established
11 during the Medi-Cal certification process. The information provided applies to CONTRACTOR for program
12 related costs for services rendered to Medi-Cal and non-Medi-Cal persons served. CONTRACTOR will
13 remit a schedule to provide the required information on published charges (PC)for all authorized services.
14 The report will serve as a source document to determine their usual and customary charge prevalent in the
15 public mental health sector that is used to bill the general public, insurers, or other non-Medi-Cal third party
16 payers during the course of business operations. CONTRACTOR must report all collections for Medi-
17 Cal/Medicare services and collections. The CONTRACTOR shall also submit with the cost report a copy of
18 the CONTRACTOR's general ledger that supports revenues and expenditures and reconciled detailed
19 report of reported total units of services rendered under this Agreement to the units of services reported by
20 CONTRACTOR to COUNTY's electronic information system.
21 Cost Reports must be submitted to the COUNTY as a hard copy with a signed cover
22 letter and electronic copy of completed DHCS cost report form along with requested support documents
23 following each fiscal year ending June 30th. During the month of September of each year this Agreement
24 is effective, COUNTY will issue instructions of the annual cost report which indicates the training session,
25 DHCS cost report template worksheets, and deadlines to submit, as determined by State DHCS annually.
26 CONTRACTOR shall remit a hard copy of cost report to County of Fresno, Attention: Cost Report Team,
27 PO BOX 45003, Fresno CA 93718. CONTRACTOR shall remit the electronic copy or any inquiries to
28 DBHcostreportteam@fresnocountyca.gov.
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1 All Cost Reports must be prepared in accordance with General Accepted Accounting
2 Principles (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3) and 5718(c).
3 Unallowable costs such as lobby or political donations must be deducted on the cost report and invoice
4 reimbursement.
5 If the CONTRACTOR does not submit the cost report by the deadline, including any
6 extension period granted by the COUNTY, the COUNTY may withhold payments of pending invoicing
7 under compensation until the cost report has been submitted and clears COUNTY desk audit for
8 completeness.
9 E. Settlements with State Department of Health Care Services (DHCS)
10 During the term of this Agreement and thereafter, COUNTY and CONTRACTOR
11 agree to settle dollar amounts disallowed or settled in accordance with DHCS audit settlement findings
12 related to the reimbursement provided under this Agreement. CONTRACTOR will participate in the several
13 phases of settlements between COUNTY/CONTRACTOR and DHCS. The phases of initial cost reporting
14 for settlement according to State reconciliation of records for paid Medi-Cal services and audit settlement
15 are: State DHCS audit 1) initial cost reporting —after an internal review by COUNTY, the COUNTY files the
16 cost report with State DHCS on behalf of CONTRACTOR's legal entity for the fiscal year; 2) Settlement—
17 State reconciliation of records for paid Medi-Cal services, approximately eighteen (18) to thirty-six (36)
18 months following the State close of the fiscal year, DHCS will send notice for any settlement under this
19 provision to COUNTY; and 3)Audit Settlement-State DHCS audit. After final reconciliation and settlement
20 DHCS may conduct a review of medical records, cost report along with support documents submitted to
21 COUNTY in initial submission to determine accuracy and may disallow costs and/or units of services.
22 COUNTY may choose to appeal and therefore reserves the right to defer payback settlement with
23 CONTRACTOR until resolution of the appeal. DHCS Audits will follow Federal Medicaid procedures for
24 managing overpayments.
25 If at the end of the Audit Settlement, COUNTY determines that it overpaid
26 CONTRACTOR, it will require CONTRACTOR to repay the Medi-Cal related overpayment back to
27 COUNTY. Funds owed to COUNTY will be due within forty-five (45) days of notification by COUNTY, or
28 COUNTY shall withhold future payments until all excess funds have been recouped by means of an offset
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1 against any payments then or thereafter owing to COUNTY under this or any other Agreement between the
2 COUNTY and CONTRACTOR.
3 14. MONITORING: CONTRACTOR agrees to extend to COUNTY's staff, COUNTY's DBH
4 Director, and the State Department of Health Care Services or their designees, the right to review and
5 monitor records, services, or procedures, at any time, in regard to persons served, as well as the overall
6 operation of CONTRACTOR's performance, in order to ensure compliance with the terms and conditions of
7 this Agreement
8 15. REFERENCES TO LAWS AND RULES: In the event any law, regulation, or policy referred
9 to in this Agreement is amended during the term thereof, the parties hereto agree to comply with the
10 amended provision as of the effective date of such amendment.
11 16. COMPLIANCE WITH STATE REQUIREMENTS: CONTRACTOR recognizes that
12 COUNTY operates its mental health programs under an agreement with the State of California Department
13 Health Care Services, and that under said agreement the State imposes certain requirements on COUNTY
14 and its subcontractors. CONTRACTOR shall adhere to all State requirements, including those identified in
15 Exhibit I, "State Mental Health Requirements", attached hereto and by this reference incorporated herein
16 and made part of this Agreement.
17 17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS: CONTRACTOR shall be
18 required to maintain organizational provider certification by COUNTY. CONTRACTOR must meet Medi-
19 Cal organization provider standards as listed in Exhibit J, "Medi-Cal Organizational Provider Standards",
20 attached hereto and by this reference incorporated herein and made part of this Agreement. It is
21 acknowledged that all references to Organizational Provider and/or Provider in Exhibit J shall refer to
22 CONTRACTOR.
23 CONTRACTOR shall inform every person served of their rights under the COUNTY's
24 Mental Health Plan as described in Exhibit K, "Mental Health Plan Grievances and Appeals Process",
25 attached hereto and by this reference incorporated herein and made part of this Agreement.
26 CONTRACTOR shall also file an incident report for all incidents involving persons served,
27 following the COUNTY's DBH "Incident Reporting and Intensive Analysis" policy and procedure guide and
28 using the "Incident Report" protocol and user guide identified in Exhibit L, attached hereto and by this
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1 reference incorporated herein and made part of this Agreement.
2 18. CONFIDENTIALITY: All services performed by CONTRACTOR under this Agreement
3 shall be in strict conformance with all applicable Federal, State of California and/or local laws and
4 regulations relating to confidentiality.
5 19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT: COUNTY and
6 CONTRACTOR each consider and represent themselves as covered entities as defined by the U.S. Health
7 Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA) and agree to use and
8 disclose Protected Health Information (PHI) as required by law.
9 COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is only
10 for treatment, payment, and health care operations.
11 COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of
12 PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for Economic
13 and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated thereunder by the
14 U.S. Department of Health and Human Services (HIPAA Regulations) and other applicable laws. As part of
15 the HIPAA Regulations, the Privacy Rule and the Security Rule require CONTRACTOR to enter into a
16 contract containing specific requirements prior to the disclosure of PHI, as set forth in, but not limited to,
17 Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal Regulations.
18 20. DATA SECURITY
19 For the purpose of preventing the potential loss, misappropriation or inadvertent access,
20 viewing, use or disclosure of COUNTY data including sensitive or personal person served information;
21 abuse of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that
22 enter into a contractual relationship with COUNTY for the purpose of providing services under this
23 Agreement must employ adequate data security measures to protect the confidential information provided
24 to CONTRACTOR by COUNTY, including but not limited to the following:
25 A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
26 CONTRACTOR may not connect to COUNTY networks via personally-owned
27 mobile, wireless or handheld devices, unless the following conditions are met:
28 1) CONTRACTOR has received authorization by COUNTY for
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1 telecommuting purposes;
2 2)Current virus protection software is in place;
3 3)Mobile device has the remote wipe feature enabled; and
4 4)A secure connection is used.
5 B. CONTRACTOR-Owned Computers or Computer Peripherals
6 CONTRACTOR may not bring contractor-owned computers or computer peripherals
7 into COUNTY for use without prior authorization from COUNTY's Chief Information Officer and/or
8 designee(s), including but not limited to mobile storage devices. If data is approved to be transferred, data
9 must be encrypted and stored on a secure server approved by COUNTY and transferred by means of a
10 Virtual Private Network (VPN) connection, or another type of secure connection.
11 C. COUNTY-Owned Computer Equipment
12 CONTRACTOR may not use COUNTY computers or computer peripherals on non-
13 County premises without prior authorization from COUNTY's Chief Information Officer and/or designee(s).
14 ///
15 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive data on
16 any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
17 E. CONTRACTOR shall be responsible to employ strict controls to ensure the integrity
18 and security of COUNTY's confidential information and prevent unauthorized access, viewing, use, or
19 disclosure of data maintained in computer files, program documentation, data processing systems, data
20 files, and data processing equipment which stores or processes COUNTY data internally and externally.
21 F. Confidential person served information transmitted to one party by the other by
22 means of electronic transmissions must be encrypted according to Advanced Encryption Standards (AES)
23 of 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
24 G. CONTRACTOR is responsible to immediately notify COUNTY of any violations,
25 breaches or potential breaches of security related to COUNTY's confidential information, data maintained in
26 computer files, program documentation, data processing systems, data files and data processing
27 equipment which stores or processes COUNTY data internally or externally.
28 H. COUNTY shall provide oversight to CONTRACTOR's response to all incidents
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1 arising from a possible breach of security related to COUNTY's confidential person served information
2 provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected
3 individuals as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR
4 will be responsible for all costs incurred as a result of providing the required notification.
5 21. PROPERTY OF COUNTY
6 A. COUNTY and CONTRACTOR recognize that fixed assets are tangible and intangible
7 property obtained or controlled under COUNTY for use in operational capacity and will benefit COUNTY for
8 a period more than one year. Depreciation of the qualified items will be on a straight-line basis.
9 For COUNTY purposes, fixed assets must fulfill three (3)qualifications:
10 1) Have life span of over one year;
11 2) Is not a repair part; and
12 3) Must be valued at or greater than the capitalization thresholds for the asset
13 type.
14 Asset Type Threshold
• Land $0
15 . Buildings and Improvements $100,000
16 • Infrastructure $100,000
• Tangible $5,000
17 o Equipment
o Vehicles
18 • Intangible $100,000
o Internally Generated Software 19
o Purchased Software
20 o Easements
o Patents
21 • And Capital Lease $5,000
22 Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
23 approved and identified as an asset, it will be tagged with a COUNTY program number. A Fixed Asset Log,
24 attached hereto as Exhibit M and by this reference incorporated herein and made part of this Agreement,
25 will be maintained by COUNTY's Asset Management System and annually inventoried until the asset is
26 fully depreciated. During the terms of this Agreement, CONTRACTOR's fixed assets may be inventoried in
27 comparison to COUNTY's DBH Asset Inventory System.
28
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1 B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
2 more than One Thousand and No/100 Dollars ($1,000.00), with over one year life span, and/or are mobile
3 and high risk of theft or loss are sensitive assets. Such sensitive items are not limited to computers,
4 copiers, televisions, cameras and other sensitive items as determined by COUNTY's DBH Director or
5 designee. CONTRACTOR will maintain a tracking system on the items on Exhibit M. Items are not
6 required to be capitalized or depreciated and are subject to annual inventory for compliance.
7 C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
8 Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in an
9 annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this
10 Agreement, CONTRACTOR shall be physically present when fixed and inventoried assets are returned to
11 COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all COUNTY-owned
12 undepreciated fixed and inventoried assets, or the monetary value of said assets if unable to produce the
13 assets at the expiration or termination of this Agreement.
14 CONTRACTOR further agrees to the following:
15 1) Maintain all items of equipment in good working order and condition, normal
16 wear and tear is expected;
17 2) Label all items of equipment with COUNTY assigned program number,
18 perform periodic inventories as required by COUNTY, and maintain an inventory list showing where and
19 how the equipment is being used, in accordance with procedures developed by COUNTY. All such lists
20 shall be submitted to COUNTY within ten (10) days of any request therefore; and
21 3) Report in writing to COUNTY immediately after discovery, the loss or theft of
22 any items of equipment. For stolen items, the local law enforcement agency must be contacted and a copy
23 of the police report submitted to COUNTY.
24 D. The purchase of any equipment by CONTRACTOR with funds provided hereunder
25 shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions of this Agreement as
26 appropriate, and must be directly related to CONTRACTOR's services or activities under the terms of this
27 Agreement. COUNTY's DBH may refuse reimbursement for any costs resulting from equipment
28 purchased, which are incurred by CONTRACTOR, if prior written approval has not been obtained from
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1 COUNTY.
2 E. CONTRACTOR must obtain prior written approval from COUNTY's DBH whenever
3 there is any modification or change in the use of any property acquired or improved, in whole or in part,
4 using funds under this Agreement. If any real or personal property acquired or improved with said funds
5 identified herein is sold and/or is utilized by CONTRACTOR for a use which does not qualify under this
6 Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal to the current fair market value
7 of the property, less any portion thereof attributable to expenditures of funds not provided under this
8 Agreement. These requirements shall continue in effect for the life of the property. In the event this
9 Agreement expires, or terminates, the requirements for this Section shall remain in effect for activities or
10 property funded with said funds, unless action is taken by the State government to relieve COUNTY of
11 these obligations.
12 22. NON-DISCRIMINATION
13 During the performance of this Agreement, CONTRACTOR and its subcontractors shall not
14 deny the contract's benefits to any person on the basis of race, religious creed, color, national origin,
15 ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex,
16 gender, gender identity, gender expression, age, sexual orientation, or military and veteran status, nor shall
17 they discriminate unlawfully against any employee or applicant for employment because of race, religious
18 creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic
19 information, marital status, sex, gender identity, gender expression, age, sexual orientation, or military and
20 veteran status.
21 CONTRACTOR shall ensure that the evaluation and treatment of employees and applicants
22 for employment are free of such discrimination. CONTRACTOR and subcontractors shall comply with the
23 provisions of the Fair Employment and Housing Act (Gov. Code §12800 et seq.), the regulations
24 promulgated thereunder(Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter 1,
25 Part 1, Division 3, Title 2 of the Government Code (Gov. Code §11135-11139.5), and the regulations or
26 standards adopted by the awarding state agency to implement such article. CONTRACTOR shall permit
27 access by representatives of the Department of Fair Employment and Housing and the awarding state
28 agency upon reasonable notice at any time during the normal business hours, but in no case less than
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1 twenty-four(24) hours notice, to such of its books, records, accounts, and all other sources of information
2 and its facilities as said department or agency shall require to ascertain compliance with this clause.
3 CONTRACTOR and its subcontractors shall give written notice of their obligations under this clause to labor
4 organizations with which they have a collective bargaining or other agreement. (See Cal. Code Regs., tit.
5 2, §11105.) CONTRACTOR shall include the non-discrimination and compliance provisions of this clause
6 in all subcontracts to perform work under this Agreement.
7 22. CULTURAL COMPETENCY
8 As related to Cultural and Linguistic Competence:
9 A. CONTRACTOR shall not discriminate against beneficiaries based on race, color,
10 national origin, sex, disability, or religion. CONTRACTOR shall ensure that a limited and/or no English
11 proficient beneficiary is entitled to equal access and participation in federally funded programs through
12 the provision of comprehensive and quality bilingual services pursuant to Title 6 of the Civil Rights Act of
13 1964 (42 U.S.C. Section 2000d, and 45 C.F.R. Part 80) and Executive Order 12250 of 1979.
14 B. CONTRACTOR shall comply with requirements of policies and procedures for
15 ensuring access and appropriate use of trained interpreters and material translation services for all
16 limited and/or no English proficient beneficiaries, including, but not limited to, assessing the cultural and
17 linguistic needs of the beneficiaries, training of staff on the policies and procedures, and monitoring its
18 language assistance program. CONTRACTOR's policies and procedures shall ensure compliance of any
19 subcontracted providers with these requirements.
20 C. CONTRACTOR shall notify its beneficiaries that oral interpretation is available for
21 any language and written translation is available in prevalent languages and that auxiliary aids and services
22 are available upon request, at no cost and in a timely manner for limited and/or no English proficient
23 beneficiaries and/or beneficiaries with disabilities. CONTRACTOR shall avoid relying on an adult or minor
24 child accompanying the beneficiary to interpret or facilitate communication; however, if the beneficiary
25 refuses language assistance services, the CONTRACTOR must document the offer, refusal and
26 justification in the beneficiary's file.
27 D. CONTRACTOR shall ensure that employees, agents, subcontractors, and/or
28 partners who interpret or translate for a beneficiary or who directly communicate with a beneficiary in a
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1 language other than English (1) have completed annual training provided by COUNTY at no cost to
2 CONTRACTOR; (2) have demonstrated proficiency in the beneficiary's language; (3) can effectively
3 communicate any specialized terms and concepts specific to CONTRACTOR's services; and (4) adheres
4 to generally accepted interpreter ethic principles. As requested by COUNTY, CONTRACTOR shall identify
5 all who interpret for or provide direct communication to any program beneficiary in a language other than
6 English and identify when the CONTRACTOR last monitored the interpreter for language competence.
7 E. CONTRACTOR shall submit to COUNTY for approval, within ninety (90) days from
8 date of contract execution, CONTRACTOR's plan to address all fifteen (15) National Standards for
9 Culturally and Linguistically Appropriate Service (CLAS), as published by the Office of Minority Health and
10 as set forth in Exhibit N "National Standards on Culturally and Linguistically Appropriate Services", attached
11 hereto and incorporated herein by reference and made part of this Agreement. As the CLAS standards are
12 updated, CONTRACTOR's plan must be updated accordingly. As requested by COUNTY, CONTRACTOR
13 shall be responsible for conducting an annual CLAS self-assessment and providing the results of the self-
14 assessment to the COUNTY. The annual CLAS self-assessment instruments shall be reviewed by the
15 COUNTY and revised as necessary to meet the approval of the COUNTY.
16 F. Cultural competency training for CONTRACTOR staff should be substantively
17 integrated into health professions education and training at all levels, both academically and functionally,
18 including core curriculum, professional licensure, and continuing professional development programs. As
19 requested by COUNTY, CONTRACTOR shall report on the completion of cultural competency trainings to
20 ensure direct service providers are completing a minimum of one (1) cultural competency training annually.
21 G. CONTRACTOR shall create and sustain a forum that includes staff at all agency
22 levels to discuss cultural competence. COUNTY encourages a representative from CONTRACTOR's
23 forum to attend COUNTY's Diversity, Equity and Inclusion (DEI) Committee, formerly known as Cultural
24 Humility Committee.
25 23. AMERICANS WITH DISABILITIES ACT: CONTRACTOR agrees to ensure that
26 deliverables developed and produced, pursuant to this Agreement, shall comply with the accessibility
27 requirements of Section 508 of the Rehabilitation Act and the Americans with Disabilities Act of 1973 as
28 amended (29 U.S.C. § 794 (d)), and regulations implementing that Act as set forth in Part 1194 of Title 36
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1 of the Code of Federal Regulations. In 1998, Congress amended the Rehabilitation Act of 1973 to require
2 Federal agencies to make their electronic and information technology (EIT) accessible to people with
3 disabilities. California Government Code section 11135 codifies section 508 of the Act requiring
4 accessibility of electronic and information technology.
5 24. TAX EQUITY AND FISCAL RESPONSIBILITY ACT: To the extent necessary to prevent
6 disallowance of reimbursement under section 1861(v)(1) (1) of the Social Security Act, (42 U.S.C. § 1395x,
7 subd. (v)(1)[I]), until the expiration of four(4) years after the furnishing of services under this Agreement,
8 CONTRACTOR shall make available, upon written request to the Secretary of the United States
9 Department of Health and Human Services, or upon request to the Comptroller General of the United
10 States General Accounting Office, or any of their duly authorized representatives, a copy of this Agreement
11 and such books, documents, and records as are necessary to certify the nature and extent of the costs of
12 these services provided by CONTRACTOR under this Agreement. CONTRACTOR further agrees that in
13 the event CONTRACTOR carries out any of its duties under this Agreement through a subcontract, with a
14 value or cost of Ten Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month period,
15 with a related organization, such Agreement shall contain a clause to the effect that until the expiration of
16 four(4) years after the furnishing of such services pursuant to such subcontract, the related organizations
17 shall make available, upon written request to the Secretary of the United States Department of Health and
18 Human Services, or upon request to the Comptroller General of the United States General Accounting
19 Office, or any of their duly authorized representatives, a copy of such subcontract and such books,
20 documents, and records of such organization as are necessary to verify the nature and extent of such
21 costs.
22 25. SINGLE AUDIT CLAUSE
23 A. If CONTRACTOR expends Seven Hundred Fifty Thousand and No/100 Dollars
24 ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an
25 annual audit in accordance with the requirements of the Single Audit Standards as set forth in Office of
26 Management and Budget (OMB) 2 CFR 200. CONTRACTOR shall submit said audit and management
27 letter to COUNTY. The audit must include a statement of findings or a statement that there were no
28 findings. If there were negative findings, CONTRACTOR must include a corrective action plan signed by
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1 an authorized individual. CONTRACTOR agrees to take action to correct any material non-compliance or
2 weakness found as a result of such audit. Such audit shall be delivered to COUNTY's DBH Finance
3 Division for review within nine (9) months of the end of any fiscal year in which funds were expended and/or
4 received for the program. Failure to perform the requisite audit functions as required by this Agreement
5 may result in COUNTY performing the necessary audit tasks, or at COUNTY's option, contracting with a
6 public accountant to perform said audit, or may result in the inability of COUNTY to enter into future
7 agreements with CONTRACTOR. All audit costs related to this Agreement are the sole responsibility of
8 CONTRACTOR.
9 B. A single audit report is not applicable if CONTRACTOR's Federal contracts do not
10 exceed the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
11 CONTRACTOR's only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a
12 program audit must be performed and a program audit report with management letter shall be submitted by
13 CONTRACTOR to COUNTY as a minimum requirement to attest to CONTRACTOR solvency. Said audit
14 report shall be delivered to COUNTY's DBH Finance Division for review no later than nine (9) months after
15 the close of the fiscal year in which the funds supplied through this Agreement are expended. Failure to
16 comply with this Act may result in COUNTY performing the necessary audit tasks or contracting with a
17 qualified accountant to perform said audit. All audit costs related to this Agreement are the sole
18 responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
19 noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under this
20 paragraph shall be billed to CONTRACTOR at COUNTY cost, as determined by COUNTY's Auditor-
21 Controller/Treasurer-Tax Collector.
22 C. CONTRACTOR shall make available all records and accounts for inspection by
23 COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
24 Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
25 least three (3) years following final payment under this Agreement or the closure of all other pending
26 matters, whichever is later.
27 26. COMPLIANCE
28 CONTRACTOR agrees to comply with COUNTY's Contractor Code of Conduct and Ethics
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1 and the COUNTY's Compliance Program in accordance with Exhibit F. Within thirty (30) days of entering
2 into this Agreement with COUNTY, CONTRACTOR shall have all of CONTRACTOR's employees, agents,
3 and subcontractors providing services under this Agreement certify in writing, that he or she has received,
4 read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR shall
5 ensure that within thirty (30) days of hire, all new employees, agents, and subcontractors providing services
6 under this Agreement shall certify in writing that he or she has received, read, understood, and shall abide
7 by the Contractor Code of Conduct and Ethics. CONTRACTOR understands that the promotion of and
8 adherence to the Contractor Code of Conduct is an element in evaluating the performance of
9 CONTRACTOR and its employees, agents and subcontractors.
10 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
11 employees, agents, and subcontractors providing services under this Agreement shall complete general
12 compliance training, and appropriate employees, agents, and subcontractors shall complete documentation
13 and billing or billing/reimbursement training. All new employees, agents, and subcontractors shall attend
14 the appropriate training within thirty (30) days of hire. Each individual who is required to attend training
15 shall certify in writing that he or she has received the required training. The certification shall specify the
16 type of training received and the date received. The certification shall be provided to COUNTY's DBH
17 Compliance Officer at 1925 E. Dakota Ave, Fresno, California 93726. CONTRACTOR agrees to reimburse
18 COUNTY for the entire cost of any penalty imposed upon COUNTY by the Federal Government as a result
19 of CONTRACTOR's violation of the terms of this Agreement.
20 27. ASSURANCES
21 In entering into this Agreement, CONTRACTOR certifies that neither they, nor any of their
22 officers, are currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
23 Health Care Programs; that neither they, nor any of their officers, have been convicted of a criminal offense
24 related to the provision of health care items or services; nor have they, nor any of their officers, been
25 reinstated to participate in the Federal Health Care Programs after a period of exclusion, suspension,
26 debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that CONTRACTOR
27 is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility for, or involvement
28 with, COUNTY's business operations related to the Federal Health Care Programs and shall remove such
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1 CONTRACTOR from any position in which CONTRACTOR's compensation, or the items or services
2 rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, directly or indirectly, by
3 Federal Health Care Programs or otherwise with Federal Funds at least until such time as CONTRACTOR
4 is reinstated into participation in the Federal Health Care Programs.
5 A. If COUNTY has notice that either CONTRACTOR, or its officers, have been charged
6 with a criminal offense related to any Federal Health Care Program, or are proposed for exclusion during
7 the term of any contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the
8 accuracy of any claims submitted to any Federal Health Care Program. At its discretion, given such
9 circumstances, COUNTY may request that CONTRACTOR cease providing services until resolution of the
10 charges or the proposed exclusion.
11 B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
12 subcontractors of CONTRACTOR who, in each case, are expected to perform professional services under
13 this Agreement, will be queried as to whether: (1)they are now or ever have been excluded, suspended,
14 debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)they have been
15 convicted of a criminal offense related to the provision of health care items or services; and (3)they have
16 been reinstated to participate in the Federal Health Care Programs after a period of exclusion, suspension,
17 debarment, or ineligibility.
18 1) In the event the potential employee or subcontractor informs CONTRACTOR
19 that he or she is excluded, suspended, debarred, or otherwise ineligible, or has been convicted of a criminal
20 offense relating to the provision of health care services, and CONTRACTOR hires or engages such
21 potential employee or subcontractor, CONTRACTOR will ensure that said employee or subcontractor does
22 no work, either directly or indirectly relating to services provided to COUNTY.
23 2) Notwithstanding the above, COUNTY, at its discretion, may terminate this
24 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
25 defined by COUNTY)that no excluded, suspended, or otherwise ineligible employee or subcontractor of
26 CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
27 Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
28 to protect the interests of COUNTY consumers.
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1 C. CONTRACTOR shall verify (by asking the applicable employees and
2 subcontractors)that all current employees and existing subcontractors who, in each case, are expected to
3 perform professional services under this Agreement: (1) are not currently excluded, suspended, debarred,
4 or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted of a
5 criminal offense related to the provision of health care items or services; and (3) have not been reinstated to
6 participate in the Federal Health Care Program after a period of exclusion, suspension, debarment, or
7 ineligibility. In the event any existing employee or subcontractor informs CONTRACTOR that he or she is
8 excluded, suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs,
9 or has been convicted of a criminal offense relating to the provision of health care services, CONTRACTOR
10 will ensure that said employee or subcontractor does no work, either direct or indirect, relating to services
11 provided to COUNTY.
12 1) CONTRACTOR agrees to notify COUNTY immediately during the term of
13 this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case, is
14 providing professional services under this Agreement is excluded, suspended, debarred, or otherwise
15 ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating to
16 the provision of health care services.
17 2) Notwithstanding the above, COUNTY, at its discretion, may terminate this
18 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
19 defined by COUNTY)that no excluded, suspended, or otherwise ineligible employee or subcontractor of
20 CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
21 Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
22 to protect the interests of COUNTY persons served.
23 D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
24 information from COUNTY which may be necessary to complete any internal or external audits relating to
25 CONTRACTOR's compliance with the provisions of this Section.
26 E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
27 imposed upon COUNTY by the Federal Government as a result of CONTRACTOR's violation of
28 CONTRACTOR's obligations as described in this Section.
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1 28. PUBLICITY PROHIBITION: None of the funds, materials, property or services provided
2 directly or indirectly under this Agreement shall be used for CONTRACTOR's advertising, fundraising, or
3 publicity(i.e., purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
4 Notwithstanding the above, publicity of the services described in Section One (1), SERVICES, of this
5 Agreement shall be allowed as necessary to raise public awareness about the availability of such specific
6 services when approved in advance by COUNTY's DBH Director, or his or her designee, and at a cost to
7 be provided for such items as written/printed materials, the use of media (i.e., radio, television, newspapers)
8 and any other related expense(s). Communication products must follow COUNTY's DBH graphic
9 standards, including typefaces and colors, to communicate our authority and project a unified brand. This
10 includes all media types and channels and all materials on and offline that are created as part of
11 COUNTY's DBH's efforts to provide information to the public.
12 29. COMPLAINTS
13 CONTRACTOR shall log complaints and the disposition of all complaints from a person
14 served or their family. CONTRACTOR shall provide a copy of the detailed complaint log entries concerning
15 COUNTY-sponsored persons served to COUNTY at monthly intervals by the tenth (10th) day of the
16 following month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide details
17 and attach documentation of each complaint with the log. CONTRACTOR shall post signs informing
18 persons served of their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all
19 incidents reportable to State licensing bodies that affect COUNTY persons served within twenty-four (24)
20 hours of receipt of a complaint.
21 Within ten (10) days after each incident or complaint affecting COUNTY persons served,
22 CONTRACTOR shall provide COUNTY with information relevant to the complaint, investigative details of
23 the complaint, the complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the
24 complaint. In addition, CONTRACTOR shall inform every person served of their rights as set forth in
25 Exhibit K. CONTRACTOR shall file an incident report for all incidents involving persons served, following
26 the protocol and user guide identified in Exhibit L.
27 30. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
28 This provision is only applicable if CONTRACTOR is disclosing entities, fiscal agents, or
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1 managed care entities, as defined in Code of Federal Regulations (C.F.R.), Title 42 §§455.101, 455.104
2 and 455.106(a)(1),(2).
3 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
4 the following information must be disclosed by CONTRACTOR by completing Exhibit O, "Disclosure of
5 Ownership and Control Interest Statement", attached hereto and by this reference incorporated herein and
6 made part of this Agreement. CONTRACTOR shall submit this form to the COUNTY's DBH within thirty
7 (30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall report any changes to
8 this information within thirty-five (35) days of occurrence by completing Exhibit O. Submissions shall be
9 scanned portable document format (pdf) copies and are to be sent via email to COUNTY's DBH assigned
10 Staff Analyst.
11 CONTRACTOR is required to submit a set of fingerprints for any person with a five (5)
12 percent or greater direct or indirect ownership interest in CONTRACTOR. COUNTY may terminate this
13 Agreement where any person with a five (5) percent or greater direct or indirect ownership interest in the
14 CONTRACTOR did not submit timely and accurate information and cooperate with any screening
15 method required in CFR, Title 42, Section 455.416. Submissions shall be scanned pdf copies and are
16 to be sent via email to DBHContractedServicesDivision(a)fresnocountyca.gov. COUNTY may deny
17 enrollment or terminate this Agreement where any person with a five (5) percent or greater direct or
18 indirect ownership interest in CONTRACTOR has been convicted of a criminal offense related to that
19 person's involvement with the Medicare, Medicaid, or Title XXI program in the last ten (10) years.
20 31. DISCLOSURE— CRIMINAL HISTORY AND CIVIL ACTIONS
21 CONTRACTOR is required to disclose if any of the following conditions apply to them, their
22 owners, officers, corporate managers, and partners (hereinafter collectively referred to in this Section as
23 "CONTRACTOR"):
24 A. Within the three (3) year period preceding the Agreement award, they have been
25 convicted of, or had a civil judgment rendered against them for:
26 1) Fraud or a criminal offense in connection with obtaining, attempting to obtain,
27 or performing a public (federal, state, or local)transaction or contract under a public transaction;
28 2) Violation of a federal or state antitrust statute;
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1 3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
2 or
3 4) False statements or receipt of stolen property.
4 B. Within the three (3)year period preceding the Agreement award, they have had a
5 public transaction (federal, state, or local) terminated for cause or default.
6 Disclosure of the above information will not automatically eliminate CONTRACTOR
7 from further business consideration. The information will be considered as part of the determination of
8 whether to continue and/or renew this Agreement and any additional information or explanation that
9 CONTRACTOR elects to submit with the disclosed information will be considered. If it is later determined
10 that CONTRACTOR failed to disclose required information, any contract awarded to such CONTRACTOR
11 may be immediately voided and terminated for material failure to comply with the terms and conditions of
12 the award.
13 CONTRACTOR must sign a "Certification Regarding Debarment, Suspension, and Other
14 Responsibility Matters- Primary Covered Transactions" in the form set forth in Exhibit P, attached hereto
15 and by this reference incorporated herein and made part of this Agreement. Additionally, CONTRACTOR
16 must immediately advise COUNTY's DBH in writing if, during the term of this Agreement: (1)
17 CONTRACTOR becomes suspended, debarred, excluded, or ineligible for participation in Federal or State
18 funded programs or from receiving federal funds as listed in the excluded parties' list system
19 (http://www.epls.gov); or (2) any of the above listed conditions become applicable to CONTRACTOR.
20 CONTRACTOR shall indemnify, defend, and hold COUNTY harmless for any loss or damage resulting
21 from a conviction, debarment, exclusion, ineligibility, or other matter listed in the signed Certification
22 Regarding Debarment, Suspension, and Other Responsibility Matters.
23 32. DISCLOSURE OF SELF-DEALING TRANSACTIONS: This provision is only applicable
24 if the CONTRACTOR is operating as a corporation (a for-profit or non-profit corporation) or if during the
25 term of the agreement, the CONTRACTOR changes its status to operate as a corporation.
26 Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing transactions
27 that they are a party to while CONTRACTOR is providing goods or performing services under this
28 agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR is a party
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1 and in which one or more of its directors has a material financial interest. Members of the Board of
2 Directors shall disclose any self-dealing transactions that they are a party to by completing and signing a
3 Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit Q and incorporated herein by
4 reference, and submitting it to the COUNTY prior to commencing with the self-dealing transaction or
5 immediately thereafter.
6 33. AUDITS AND INSPECTIONS: The CONTRACTOR shall at any time during business
7 hours, and as often as the COUNTY may deem necessary, make available to the COUNTY for examination
8 all of its records and data with respect to the matters covered by this Agreement. The CONTRACTOR
9 shall, upon request by the COUNTY, permit the COUNTY to audit and inspect all of such records and data
10 necessary to ensure CONTRACTOR'S 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 California State Auditor for a period of three (3) years after final payment
13 under contract (Government Code Section 8546.7).
14 34. NOTICES: The persons and their addresses having authority to give and receive notices
15 under this Agreement include the following:
16 COUNTY CONTRACTOR
Director, Fresno County Chief Executive Officer
17 Department of Behavioral Health Turninq Point of Central California, Inc.
1925 E. Dakota Ave P.O. Box 7447
18 Fresno, CA 93726 Visalia, CA 93290-7447
19 All notices between the COUNTY and CONTRACTOR provided for or permitted under this
20 Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
21 an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
22 personal service is effective upon service to the recipient. A notice delivered by first-class United States
23 mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid,
24 addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
25 COUNTY business day after deposit with the overnight commercial courier service, delivery fees prepaid,
26 with delivery instructions given for next day delivery, addressed to the recipient. A notice delivered by
27 telephonic facsimile is effective when transmission to the recipient is completed (but, if such transmission is
28 completed outside of COUNTY business hours, then such delivery shall be deemed to be effective at the
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1 next beginning of a COUNTY business day), provided that the sender maintains a machine record of the
2 completed transmission. For all claims arising out of or related to this Agreement, nothing in this section
3 establishes, waives, or modifies any claims presentation requirements or procedures provided by law,
4 including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government Code,
5 beginning with section 810).
6 35. GOVERNING LAW: Venue for any action arising out of or related to this Agreement shall
7 only be in Fresno County, California.
8 The rights and obligations of the parties and all interpretation and performance of this Agreement
9 shall be governed in all respects by the laws of the State of California.
10 36. SEVERABILITY: If anything in this Agreement is found by a court of competent jurisdiction
11 to be unlawful or otherwise unenforceable, the balance of this Agreement remains in effect, and the parties
12 shall make best efforts to replace the unlawful or unenforceable part of this Agreement with lawful and
13 enforceable terms intended to accomplish the parties' original intent.
14 37. ELECTRONIC SIGNATURE: The parties agree that this Agreement maybe executed by
15 electronic signature as provided in this section. An "electronic signature" means any symbol or process
16 intended by an individual signing this Agreement to represent their signature, including but not limited to (1)
17 a digital signature; (2) a faxed version of an original handwritten signature; or(3)an electronically scanned
18 and transmitted (for example by PDF document)of a handwritten signature. Each electronic signature
19 affixed or attached to this Agreement (1) is deemed equivalent to a valid original handwritten signature of
20 the person signing this Agreement for all purposes, including but not limited to evidentiary proof in any
21 administrative or judicial proceeding, and (2) has the same force and effect as the valid original handwritten
22 signature of that person. The provisions of this section satisfy the requirements of Civil Code section
23 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5,
24 beginning with section 1633.1). Each party using a digital signature represents that it has undertaken and
25 satisfied the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)through (5),
26 and agrees that each other party may rely upon that representation. This Agreement is not conditioned
27 upon the parties conducting the transactions under it by electronic means and either party may sign this
28 Agreement with an original handwritten signature.
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1 38. ENTIRE AGREEMENT: This Agreement constitutes the entire agreement between the
2 CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
3 Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
4 understanding of any nature whatsoever unless expressly included in this Agreement.
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1 IN WITNESS WHEREOF,the parties hereto have executed this Agreement as of the day and year
2 first hereinabove written.
3
4 CONTRACTOR: COUNTY OF FRESNO
5 TURNING POINT OF
CENTRAL CALIFORNIA, INC.
6 9aZrt.�
7 V
By. '� _
Brian Pacheco,
8 Chairman of the Board of Supervisors of the
9 Print Name: Raymond R. Banks County of Fresno
10
Title: Chief Executive Officer
11
Chairman of Board, or President
12 or any Vice President ATTEST:
13 Bernice E.Seidel
Clerk of the Board of Supervisors
14 County of Fresno, State of California
By:
15
16 Q �s
Print Name: ^TAfI (.�Q By_
17 Deputy
18 Titi$:DeQ _ � D Q nF�;
19 Secretary of Corporation, or
any Assistant Secretary, or
20 Chief Financial Officer, or
21 any Assistant Treasurer
22 MAILING ADDRESS:
23 615 S.Atwood St.
24 Visalia, CA 93277
Phone No.: (559)732-8086
25 Contact: Sharon Ross, COO
26 FOR ACCOUNTING USE ONLY:
27 Fund/Subclass: 0001/10000
28 ORG No.: 56302081, 56302070, 56304784, 56304525
Account: 7295/0
-41-
Exhibit A
Page 1 of 26
FORENSIC BEHAVIORAL HEALTH — CONTINUUM OF CARE
SCOPE OF WORK
CONTRACTOR: Turning Point of Central California, Inc. (Turning Point)
CONTACT:
LOCATION OF SERVICES: 3636 N. First Street, Suite 135
I. BACKGROUND
The 2011 Public Safety Realignment contained in AB 109 specifies local responsibilities for
managing certain adult offenders. The intent of realignment is to allow maximum local flexibility
within the statutory framework for the adult population transfers set forth in AB 109. The authors
of this bill have identified several community interventions to assist this population lead a
productive crime-free life. It is recognized that a number of these people would benefit from
mental health and/or substance use disorder treatment and support services.
Under Assembly Bill (AB) 1810 on June 27, 2018, pre-trial jail diversion is defined as the
"postponement of prosecution, either temporarily or permanently, at any point in the judicial
process from the point at which the accused is charged until adjudication, to allow the defendant
to undergo mental health treatment." Essentially, pre-trial jail diversion will allow mental health
services treatment in lieu of trial and sentencing by a jury or judge for those who have been
deemed to have a mental health illness, which significantly contributed to the act of the crime.
Senate Bill (SB) 317 authorized the ability for the court to suspend proceedings and grant
diversion to individuals charged with misdemeanors who have been found incompetent to stand
trial. Currently individuals that are found incompetent to stand trial are either referred to an out of
county inpatient facility for restoration services or a Full-Service Partnership (FSP) within the
DBH system of care for mental health services. With the passing of SB 317, IST individuals are
more likely to be diverted to community based supports for both mental health and restoration
services.
The Forensic Behavioral Health Continuum of Care (FBH-COC) will be comprised of an
evidence-based, 2-tiered, outpatient, mental health and co-occurring SUD treatment and support
services program specifically tailored to meet the unique needs of the target population. The
benefit to the 2-tiered system will be the flexibility to move the individuals seamlessly from one
level of care to another level of care based on clinical need — all under the same program.
The FBH-COC will include the following levels of care: Assertive Community Treatment (ACT),
Full-Service Partnership (FSP), and Outpatient (OP).
CONTRACTOR shall include, at a minimum, the following services in all levels of care:
• Mental health treatment
• Substance use disorder treatment
• Medication support
• Case management
• Crisis intervention
• Housing support
• Peer support
• Criminal justice support
Exhibit A
Page 2 of 26
• Educational and vocational services
• Rehabilitative services
• Transportation services
• Assistance with child services
• Medi-Cal enrollment
• SSI or SSDI enrollment
• Anger management
• Faith-based support
• Food support
• Outreach and engagement
The FBH-COC is new program and involves many partners. Processes are being developed and
are expected to change to improve service delivery. CONTRACTOR shall be flexible and is
welcomed to propose improvements and communicate concerns to County's Department of
Behavioral Health (DBH).
II. SERVICES START DATE
In the first 90 days, the CONTRACTOR will complete a series of tasks and deliverables that are
outlined in the Training and Education Start-Up Timeline summarized below:
First 30 days- RECRUITMENT AND INFRASTRUCTURE ENHANCEMENTS
• Purchase infrastructure enhancements (e.g. laptops, equipment etc.).
• Post job openings and begin recruitment/staff orientation/staff credentialing by FCMHP.
• Begin to develop outreach materials.
• Begin filming web-based outreach training videos.
First 60 days- COORDINATE OUTREACH TRAININGS
• Finalize printed flyers in PDF format for hardcopy and/or electronic distribution.
• Continue filming web-based outreach training videos.
• Finalize individual referral processes.
First 90 days- ENGAGE COMMUNITY PARTNERS
• Distribute updated brochures reflecting program structure, services and referral process.
• Schedule in-person trainings with stakeholder groups to show training videos & answer
questions.
• Begin conducting outreach trainings.
III. TARGET POPULATION
The program is designed to provide services to adults and older adults with criminogenic needs,
including but not limited to individuals who qualify for AB 109 services, AB 1810 services, and
those who have been declared Incompetent to Stand Trial (IST). The target population will include
those who may have little to no criminogenic risk factors.. This proposal is intended to detail costs
and services provided to 100 FSP/ACT persons served at any given time. The program will serve,
at any given time, 20% at Tier I (ACT) and 80% at Tier II (FSP). The program will provide a range
of services that will be tailored to each individual's needs for service type, intensity and duration.
Exhibit A
Page 3 of 26
The SAMHSA Risk-Needs-Responsivity (RNR) model identifies that this target population needs
specialized treatment approaches that are dependent upon the needs/risk of each individual — both
psychiatric and criminogenic. Persons served will therefore be assigned to one of three primary
levels of care upon completion of the intake/assessment: ACT, FSP and OP. Within each level are
additional sub-levels that specifically focus treatment on the achievement of competencies and
milestones that form the building blocks to ensure that the individual gradually builds and maintains
earned progress in treatment. In this way, treatment is continually meeting the individual where
they are, and providing the necessary scaffolding to help them improve functioning and life
satisfaction. It is expected that the majority of persons served will be at the OP level of care.
IV. LOCATION OF SERVICES
The program will be located in a safe, welcoming office setting, close to community resources and
public transportation. Transportation will be provided by staff through the use of agency vehicles
and individuals will be taught how to use public transportation and provided bus passes or tokens
when appropriate, to further reduce barriers while providing them with a level of assistance that
matches their functional ability. The offices are located at 3636 N. First Street, Suites 162 & 135,
Fresno, CA 93726. The CONTRACTORS has housed multiple programs at this facility for several
years, individuals have consistently affirmed that this location is easily accessible. Additionally, the
majority of services are expected to be provided in the field, literally meeting the individuals where
they are in the community.
Both suites are located in the same building complex, and both are currently site certified by the
FCMHP to provide specialty mental health services to the AB109 FSP and OP populations. The
ACT/FSP services are expected to be served in suite 162, and the OP services are to be provided
in suite 135. The majority of services, however, are expected to be provided in the field, at
locations that are most convenient for individuals. Telehealth services will be offered if preferred by
the person served, or if there is a public health order to discontinue face to face services.
V. HOURS OF OPERATION
The ACT, FSP and OP programs maintain office hours of operation Monday through Friday from
8:00 a.m. to 5:00 p.m. Each individual will have a single point of responsibility through a Mental
Health Specialist (MHS). The caseload of each MHS will be low enough to ensure their
availability to the individual and family is appropriate to their service needs; they are able to
provide intensive services and supports when needed, and they can give the individual and/or
family member considerable personal attention. Other members of the team the individual and/or
family members will have access to will include a program psychiatrist, a nurse, social workers
and marriage and family therapists, and peer supports.
The ACT/FSP and OP programs also have 24/7 crisis availability. A trained staff member is
prepared to respond to all crisis situations through rotating scheduled staff of the day (like officer of
the day) during normal work hours and on-call coverage for after-hours. All on-call staff are mental
health professionals and management staff. Updates on person served are readily updated to
these staff members and they have full access to the HER to reference Plan of Care and recent
intervention/medication support. These staff carry a cell phone and remain within 25 miles of the
city to be able to respond to situations within one hour. Telephone interventions are utilized when
sufficient to the purpose; however, staff provide face-to-face services to the extent necessary to
Exhibit A
Page 4 of 26
ensure individual safety and resolve the crisis. Emergency housing is available, and staff are
trained to access crisis services if needed. Staff are trained that use of crisis services should be
avoided if safely preventable, as the goals of the program are to reduce/eliminate use of these
services. Staff coordinate care with crisis service workers and residential program staff and seek
to return persons served to supported independence as quickly as is appropriate. Services include
the ability of the MHS, or other team members known to the individual or family to respond to
persons served and family members 24 hours a day, seven days a week. This level of
accessibility for the individual and/or family helps to reduce and prevent negative outcomes for
persons served including unnecessary hospitalizations, incarcerations, or evictions.
VI. DESCRIPTION OF SERVICES
The intended benefit of creating a program such as the FBH-COC with multiple tiers and levels of
care is for maximum flexibility to move individuals seamlessly between levels, as clinically
indicated. Most of the persons served will need ongoing, long-term treatment and support. The
CONTRACTOR shall provide a level of service and support that will reflect each participant's
unique and individual needs.
1. Behavioral Health
A. CONTRACTOR shall provide "core" services to all individuals in the program. Services
will include are but are not limited to the following:
i. Engagement;
ii. Transportation Services;
iii. Personal Needs (food, clothing, hygiene, etc.);
iv. Social Activities;
V. Access/linkage to Medical/doctor/Primary Care Physician (PCP);
vi. Housing;
vii. Life Skills Classes;
viii. Ancillary Services;
ix. Peer Support Services;
X. Crisis Intervention Services;
xi. Securing Legal Documents;
xii. Entitlements/Benefits;
xiii. Legal Assistance;
xiv. Educational/Employment Support.
B. CONTRACTOR shall provide the following clinical services:
i. Treatment Plan/Plan of Care;
ii. Assessment;
iii. Reaching Recovery Tools;
iv. Pediatric Symptom Checklist (PSC) 35 and the Child and Adolescent Needs and
Strengths (CANS) assessment;
V. Individual Therapy;
vi. Group Therapy;
vii. Case Management;
viii. Consultation;
ix. Collateral;
X. Breath/Saliva Testing;
A. Individual & Group SUD services;
xii. Linkage to intensive Outpatient SUD services;
xiii. Linkage to Withdrawal Management;
Exhibit A
Page 5 of 26
xiv. Linkage to In-Patient Residential Services;
xv. Linkage to Recovery Residence;
xvi. Changing Offender Behavior (COB) Curriculum;
xvii. Hospitalization/Post Hospitalization Support,
xviii. Post Incarceration Support;
xix. Homelessness Support.
C. CONTRACTOR will ensure that all services:
i. Be values-driven, strengths based, individual-driven, and co-occurring capable;
ii. Be culturally and linguistically competent;
iii. Be age, culture, gender, and language appropriate;
iv. Include accommodations for individuals with physical disability(ies);
V. Include close and constant communication and collaboration between
CONTRACTOR , the criminal justice system (including the Courts, Public Defender
and Probation);
vi. Include evidence-based practices (EBPs) appropriate for the target population.
D. Methods for service coordination and communication between program and other
service providers shall be developed and implemented consistent with Fresno County
Mental Health Plan (MHP) confidentiality rules.
E. CONTRACTOR shall maintain up to date caseload record of all individuals enrolled in
services, and provide individual, programmatic, and other demographic information to
DBH.
F. CONTRACTOR shall utilize the SAMHSA Risk-Needs-Responsivity (RNR) model to
inform and determine level of intensity of CONTRACTOR supervision and the specific
interventions that will be applied based on each individual's level of risk, criminogenic
needs and capacity to respond effectively.
G. CONTRACTOR shall ensure billable specialty mental health services meet any/all
County, State, Federal regulations including any utilization review and quality assurance
standards, and provide all pertinent and appropriate information in a timely manner to
DBH to bill Medi-Cal services rendered.
2. Levels of Treatment
A. "Tier V —Assertive Community Treatment (ACT)
i. Many of the individuals will be released from jail and enter the FBH-COC at this
level of care. Individuals eligible for this level of intervention may have been
provided services at the level of in-patient psychiatric hospitalization however, due
to diversion, will instead require a high-intensity, wrap-around services in the
community. The ACT Evidence-Based Practice (EBP) is an individual-focused,
community-based, time-unlimited model of delivering comprehensive and effective
services to individuals such as this, who have needs not well met by traditional
approaches to delivering services. Their needs are often complex with disorders that
are often under-managed and further complicated by varying degrees of
involvement with the criminal justice system. For the individuals with the greatest
need, who are admitted to the FBH-COC at the ACT level of care, CONTRACTOR
is committed to offering those individuals treatment that is consistent with the full
fidelity ACT model.
ii. CONTRACTOR shall ensure the following minimum staffing levels:
a. 10 individuals/clinician or fewer: The ACT team will maintain a low consumer to
staff ratio in the range of 10:1 in order to ensure adequate intensity and
individualization of services
Exhibit A
Page 6 of 26
b. 90% or more individuals have face-to-face contact with more than staff member
in 2 weeks: The entire team shares responsibility for each individual; each
clinician contributes expertise as appropriate. The team approach ensures
continuity of care for individuals, and creates a supportive organizational
environment for practitioners.
c. ACT Team will meet at least 4 days/week and reviews each individual each
time, even if only briefly: Daily team meetings allow ACT practitioners to discuss
individuals, solve problems, and plan treatment and rehabilitation efforts,
ensuring all individuals receive optimal service.
d. Supervisor provides services at least 50% of the time: Research has shown this
factor was among the five most strongly related to better outcomes. Team
leaders who also have direct clinical contact are better able to model
appropriate clinical interventions and remain in touch with the individual served
by the team.
e. Less than 20%turnover in 2 years: Whenever possible, the CONTRACTOR will
strive to maintain a consistent staffing team to enhance team cohesion;
additionally, consistent staffing enhances the therapeutic relationships between
individuals and providers.
f. ACT Team will operate at 95% or more of full staffing over each 12 month
period:-Whenever possible, we strive to maintain consistent, multidisciplinary
services with minimal position vacancies.
g. A psychiatric prescriber is assigned directly to the ACT Team: The
psychiatrist/psychiatric prescriber serves as medical director for the team; in
addition to medication monitoring, the psychiatrist/psychiatric prescriber
functions as a fully integrated team member, participating in treatment planning
and rehabilitation efforts.
h. Two full-time nurses or more are members for the ACT Team: The full-time
nursing staff has been found to be a critical ingredient in successful ACT Teams.
The nurses function as full members of the team, which includes conducting
home visits, treatment planning, and daily team meetings. Nurses can help
monitor needed medications and serve to educate the team about important
medication issues.
i. Staff with Substance Use Disorder (SUD) training or supervised SUD
experience: Concurrent substance use disorders are common in persons with
severe mental illness. Appropriate assessment and intervention strategies are
critical.
j. Two FTEs or more with 1 year educational/employment rehabilitation training
or supervised VR experience: ACT teams emphasize skill development and
support in natural settings. Fully integrated ACT teams include vocational
services that enable individuals to find and keep jobs in integrated work settings.
k. ACT Team will maintain appropriate staff-to-individual ratio: The ACT team
provides an integrated approach to mental health services, through which
the range of treatment issues are addressed from a variety of
perspectives; it is critical to maintain adequate staff size and disciplinary
background in order to provide comprehensive, individualized service and
adequate access/coverage to each individual.
CONTRACTOR shall ensure that its ACT Team:
a. Actively recruits a defined population and all cases comply with explicit
admission criteria. ACT is best suited to individuals who do not effectively use
less intensive mental health services.
b. Provides 24-hour coverage: An immediate response can help minimize
distress when persons with severe mental illness are faced with crisis.
When the ACT team provides crisis intervention, continuity of care is
maintained. Non-crisis services are available after hours as appropriate.
Exhibit A
Page 7 of 26
c. Will be involved in 95% or more hospital admissions. More appropriate use of
psychiatric hospitalization occurs, and continuity of care is maintained, when
the ACT Team is involved with psychiatric hospitalizations.
d. Is jointly involved in the planning of 95% or more of hospital discharges of
individuals served. Ongoing participation of the ACT Team during an individual's
hospitalization and discharge planning allows the team to help maintain
community supports (e.g., housing), and continuity of service.
e. Serves individuals on a time-unlimited basis, with fewer than 5% graduating
annually: Individuals often regress when they are terminated from short-term
ACT Teams. Time-unlimited services encourage the development of stable,
ongoing therapeutic relationships.
f. Provides 80% or more of total face-to-face contacts in the community: Contacts
in natural settings (i.e., where individuals live, work, and interact with other
people) are thought to be more effective than when they occur in hospital or
office settings, as skills may not transfer well to natural settings.
Furthermore, more accurate assessment of the person served can occur in
his or her community setting because the clinician can make direct
observations rather than relying on self-report. Medication delivery, crisis
intervention, and networking are more easily accomplished through home
visits.
g. Retains 95% or more of caseload over a 12-month period: Outreach efforts,
both initially and after an individual is enrolled on an ACT team, help build
relationships and ensure individuals receive ongoing services.
h. Will demonstrate consistently well-thought-out strategies and use street
outreach and legal mechanisms whenever appropriate: Individuals are not
immediately discharged from the ACT Team due to failure to keep
appointments. Retention of persons served is a high priority for ACT teams.
Persistent, caring attempts to engage individuals in treatment helps foster a
trusting relationship between the person served and the ACT team. Assertive
outreach is considered a critical feature of the ACT team.
i. Provides an average of 2 hours/week or more of face-to-face contact per
individual: In order to help individuals with severe and persistent symptoms
maintain and improve their function within the community, high service intensity
is often required.
j. Provides an average of 4 or more face-to-face contacts per week per individual:
ACT Teams are highly invested in their individuals, and maintain frequent
contact in order to provide ongoing, responsive support as needed. Frequent
contacts are associated with improved outcomes.
k. Provides four or more contacts per month per individual with support system in
the community: Developing and maintaining community support further
enhances individual's integration and functioning.
I. Provides individuals with substance use disorders spend, on average, 24
minutes/week or more in formal substance abuse treatment (as determined by
medical necessity): substance use disorders often occur concurrently in
persons with SMI; these co-occurring disorders require treatment that directly
addresses them.
m. Encourages 50% or more of the individuals with substance use disorders attend
at least one substance abuse treatment group meeting during a month (as
determined by medical necessity): Group treatment has been shown to
positively influence recovery for persons with dual disorders (DD).
n. Is fully based in DD treatment principles (stage-wise treatment model that is
non- confrontational, follows behavioral principles, considers interactions of
mental illness and substance abuse, and has gradual expectations of
abstinence), with treatment provided by ACT Team staff: The DD model attends
Exhibit A
Page 8 of 26
to the concerns of both SMI and substance abuse for maximum opportunity for
recovery and symptom management.
o. Has peer support staff that are employed full-time: Some research has
concluded that including persons served as staff on case management teams
improves the practice culture, making it more attuned to consumer
perspectives.
p. Provides an Integrated Approach: Individuals benefit when services are
integrated into a single team, rather than when they are referred to many
different service providers. Furthermore, an integrated approach allows
services to be tailored to each individual.
B. "Tier 2" — Full Service Partnership (FSP)
i. Service Approach:
a. CONTRACTOR shall include the use of innovative approaches resulting in
increased access to services and encouraging and assisting individuals in
transition towards growth, stability, wellness, recovery and self-sufficiency.
b. CONTRACTOR shall deliver services with a focus of"meeting the individuals
where they are" utilizing a "whatever it takes" approach.
C. CONTRACTOR shall utilize a peer to peer support network that includes
hiring recovering individuals/family members of recovering individuals. Staff
shall employ harm reduction in philosophy and motivational interviewing
techniques and principles. Peer counselors shall be equal partners in the
multi-disciplinary team and play a critical role in developing the recovery
culture and person-centered focus of the team. The team will provide peer
recovery and self-help services and use resources such as Wellness
Recovery Action Plans (WRAP); the UCLA Program for Social and
Independent Living Skills; Trauma Recovery and Empowerment Model
(TREM); and a module for living cooperatively with roommates and
housemates in group residential settings.
d. CONTRACTOR shall abide by the FSP Service Delivery Model and the FSP
Objectives and Performance Measures.
ii. CONTRACTOR shall ensure the following minimum staffing levels:
a. FSP services will be provided by a multi-disciplinary team.
b. CONTRACTOR shall assign a Personal Service Coordinator (PSC) to each
individual who will act as a "single point of responsibility" within the ACT
Team for coordination services and supports. The PSC will be readily
available to the individual and family as needed and will be culturally
competent and know the community resources of the individual's
racial/ethnic community.
C. A low person served to staff ratio:
(i) 12:1
iii. CONTRACTOR shall ensure the following availability of services:
a. CONTRACTOR's PSC staff shall be available to provide crisis assessment
and intervention twenty-four hours per day, seven days per week throughout
the year, including telephone and face-to-face contact as needed. There
shall be no barrier to access crisis services based solely on active substance
use. Response to crisis shall be rapid and flexible. The vendor shall
collaborate with facilities and designated COUNTY staff to provide
emergency placement should crisis housing, short-term care and inpatient
treatment (voluntary or involuntary) be needed. CONTRACTOR's staff shall
provide support to the maximum extent possible, including accompanying
the individual to the facility, performing a face to face visit if admitted to crisis
facility and remaining with the individual during the assessment. As soon as
Exhibit A
Page 9 of 26
possible CONTRACTOR staff shall begin the process of planning for
discharge and return to the community.
b. Case management services will be available twenty-four hours per day,
seven days a week throughout the year.
iv. CONTRACTOR shall ensure that its FSP Team services:
a. "Core" services referenced on page 4, section VI "Description of Services will
be provided by the multi-disciplinary team.
b. The PSC will work closely with the individual to develop an Integrated
Services and Supports Plan (ISSP). The ISSP will provide a map of steps
the individual identifies as necessity to move along their recovery path. The
ISSP will operationalize the fundamental concepts of individual/family
directedness, wellness/recovery/ resiliency focus, community collaboration,
integrated service experience, and cultural competency
C. In conjunction with the multi-disciplinary team, the PSC will coordinate
linkages to all of the services or benefits that have been defined by the
individual/family and the multi-disciplinary team, and which will be delivered
by community partners in the full-service partnership.
V. CONTRACTOR shall ensure the following frequency of services:
a. CONTRACTOR shall offer the full array of services and supports, including a
minimum of three (3) face to face contacts per week or as clinically
appropriate.
C. "Tier 3" — Outpatient (OP)
i. Service Approach:
a. Each individual will be provided integrated dual treatment for both Mild to Moderate as
well as Severe Mental Illness (SMI) and Substance Use Disorder (SUD) diagnoses
being addressed as the primary focus of clinical attention. However, to assess,
conceptualize and identify treatment strategies for an individual, assessment of
symptoms and impairments specific to an individual's SUD helps the treatment team
employ targeted interventions that are evidence-based and proven effective for those
specific issues. SUD diagnosis-specific services are also culturally/linguistically
competent, values-driven, and focused on restoring the dignity of every person.
SUD services will be based on the individual's stage of change and based in harm
reduction theory in order to help individuals reduce barriers to treatment. The role
of the Turning Point FBH-COC staff will be to help the individual achieve
measurable goals towards sobriety, stability and physical health with the use of
coping skills and peer support.
ii. CONTRACTOR shall ensure that the following OP services meet Drug Medi-Cal -
Organized Delivery System (DMC-ODS) and Mental Health Plan (MHP) provider manual
requirements:
a. Intake Services;
b. Breath/Urine testing;
c. Treatment Plan/POC/Update;
d. Individual therapy;
e. Group therapy;
f. Case Management;
g. Collateral;
h. Consultation;
i. Linkage to Recovery Residences;
j. Contingency Management(pending completion and evaluation of DHCS contingency
management pilot; and
k. Recovery Services.
Exhibit A
Page 10 of 26
iii. CONTRACTOR shall ensure the following linkages to services as needed:
a. Withdrawal Management;
b. In-Patient Residential Treatment Services;
c. Recovery Homes; and
d. Medication Assisted Treatment (MAT).
iv. Availability of Services:
a. CONTRACTOR shall make available outpatient services eight (8) hours a day,
five (5) days a week.
V. CONTRACTOR shall ensure the following frequency of services:
a. Frequency of services will be provided as clinically indicated.
3. Housing
Housing services are vital to provide stability, reduce hospital/jail visits, and allow for recovery
and the building of resiliency. Individuals living with severe mental illnesses can successfully
live in and maintain housing with frequent, consistent team contact and support. With this in
mind, the CONTRACTOR shall offer linkages and financial assistance for a variety of housing options
for persons served including crisis housing, transitional or low-barrier housing, recovery residence,
residential drug treatment, board and care homes, and room and board homes. Because the FBH-
COC population is known to experience many barriers to securing and maintaining housing, the
CONTRACTOR provides specialty training to mitigate some of the barriers and to individually
support the persons served with obtaining the least restrictive housing option appropriate for
the individual.
Housing support needs to match the individual's unique needs at a particular point in time. Housing
options range based on individual's level of need with the goal of supporting the individual to
achieve the highest level of independence possible for them individually. FBH-COC persons
served who are parenting children are offered opportunities and options for appropriate housing
as well. Mental Health Service Act (MHSA) program funds are used to subsidize a variety of
housing needs for including emergency housing, rental payments, deposits, utilities, and the
purchase of household goods. The program staff may accompany the individual to meet with
landlords or housing managers to support and advocate as needed. Program staff educate
persons served about expectations of tenancy, lease/rental agreement requirements, and the
importance of remaining courteous of other tenants. Staff regularly visits the housing
environment to ensure it is appropriate to individual needs. Staff work to help persons served
eliminate any problems before an eviction or other negative consequence arises.
The ACT team initially assists persons served with obtaining assistance with rent and utilities
as a part of developing a long-term plan for sustainable independence. Persons served are
assisted with determining eligibility and completing application processes for housing subsidies.
As many individuals may initially require room and board or board and care level housing while
they stabilize, the FBH-COC program will rely on relationships that have been developed
between room and board operators and board and care operators who work solely with the
FSP population in other Turning Point programs and are willing to be patient in working with the
unique set of challenges tied to housing individuals in these difficult stages of recovery. Step up
and permanent housing options are facilitated through the use of community partners such as
Falcon Court, STASIS housing, The Californian apartments, or privately leased apartments.
FSP individuals often have difficulty maintaining housing, therefore the CONTRACTOR offers
and pursues housing options to overcome barriers experienced by persons served. The goal is
for each individual to be able to maintain safe and sustainable housing at the individual's
highest level of independence.
Exhibit A
Page 11 of 26
4. Discharge Planning
Before active program participation is concluded and prior to an approved discharge from the
program; program staff will meet with the individual to develop an individualized strategy that
will assist the individual in maintaining a continued alcohol and drug free lifestyle. This meeting
with the individual must be completed in 30 days prior to the last face to face treatment session
by the counselor. The discharge planning process will include individual's recovery plan, which
the individual will need to identify their relapse triggers, explain how each trigger could cause
them to relapse, then identify their plan to avoid those relapse when confronted by each of the
trigger. Individual will also need to generate a support plan that includes a list of individuals
and/or organizations and activities that can provide support and assistance for individual to
maintain sobriety. Individual and counselor must review the discharge plan; both must sign and
date the discharge plan. After individual and counselor have signed it, then the physician must
review, sign, date, and approve the discharge plan. Once the individual, counselor, and
physician had signed and dated the discharge plan, a copy is given to the individual. Discharge
planning will no longer be dictated by the probation term, it will focus on medical necessity to
determine when appropriately necessary.
5. Collaboration with Probation
The CONTRACTOR shall collaborate with the Fresno County Probation Department (the
"Probation Department") to provide screenings on-site at the AB 109 office to individuals who
may need MH and/or SUD services. Individuals who are screened to need services are to be
referred to the appropriate level of care for services. The CONTRACTOR shall also make
arrangements to provide assessments to EOP individuals outside of regular business hours
as needed.
The CONTRACTOR shall participate with the Probation Department in Pre-Release
Coordinated Clinical Assessment Team (CCAT) teleconferences to discuss EOP incarcerated
individual's case prior to release. This is most helpful as it is often the only time that there is
direct access to California Department of Corrections and Rehabilitation (CDCR) doctors and
clinicians to ask questions related to an EOP incarcerated individual. These teleconferences
are done during regular business hours.
6. Collaboration with Court Services
All individuals who are placed in the FBH-COC will have intermittent requirements to report
back to the collaborative treatment courts regarding the individual's progress. The
CONTRACTOR shall identify an individual who will communicate and coordinate with court
services and/or law enforcement, as needed. The CONTRACTOR shall work with court
partners to create and use a standardized form for court reporting. Court reporting should be
completed in a timely fashion and be submitted to the court a minimum of 48 hours in
advance of the next scheduled court hearing.
The CONTRACTOR will need to be able to provide court attendance assistance to
participants by hosting them in their office for Virtual Court sessions or helping the individual
arrange transportation to hearings as necessary.
The CONTRACTOR shall designate staff to attend specialty treatment court hearings,
including but not limited to Mental Health Diversion (MHD) Court and Mental Health
Incompetent to Stand Trial (MHIST) Court. Staff will attend hearings on a frequency to be
determined by DBH.
Exhibit A
Page 12 of 26
7. Other Collaborative Relationships
The CONTRACTOR shall establish and maintain collaborative relationships with agencies
and individuals who have frequent contact with hospitalized, homeless, or incarcerated
adults. Examples of collaborative relationships include but are not limited to local law
enforcement agencies, Veterans Administration, Marjorie Mason Center, Fresno County
Human Services Departments, Faith Organization, acute psychiatric facilities, schools,
community centers, etc. Letters of introduction, including a description of services and how
to contact the FBH-COC program shall be distributed to potential community partners. There
may be a need for a Memorandum of Understanding (MOU) or Data Use Agreement between
the CONTRACTOR and one or more of the community partners if data is to be shared and
collected. HIPAA regulations must always be considered and adhered to when discussing
protected health information (PHI) with another agency.
At some point during the resulting contract, there may be an increased need for collaborative
efforts initiated with other County Departments (such as the Public Defender ["PD"], District
Attorney ["DA"], Sheriff-Coroner ["Sheriff"], Probation Department, Social Services, etc.) that
will require full cooperation by the CONTRACTOR.
The CONTRACTOR shall be willing to provide information on the program services through
trainings and infographics to our community and criminal justice partners (PD, DA, Sheriff,
Probation, Jail, Social Services, etc.)
8. County Responsibilities
A. Provide oversight and collaborate with CONTRACTOR and other County Departments
and community agencies to help achieve State program goals and outcomes. In
addition to contract monitoring of program(s), oversight includes, but not limited to,
coordination with the Department of Health Care Services (DHCS) in regard to program
administration and outcomes.
B. Assist CONTRACTOR in making linkages to the appropriate level of care within the
behavioral health system of care to ensure continuity of care. This will be accomplished
through regularly scheduled meetings as well as formal and informal consultation.
C. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the CONTRACTOR staff and will be available to CONTRACTOR for
ongoing consultation.
D. Receive and analyze statistical outcome data from CONTRACTOR throughout the term
of contract on a monthly basis. DBH will notify the CONTRACTOR when additional
participation is required. The performance outcome measurement process will not be
limited to survey instruments but will also include, as appropriate, individual and staff
interviews, chart reviews, and other methods of obtaining required information.
E. Recognize that cultural competence is a goal toward which professionals, agencies, and
systems should strive. Becoming culturally competent is a developmental process and
incorporates at all levels the importance of culture, the assessment of cross-cultural
relations, vigilance towards the dynamics that result from cultural differences, the
expansion of cultural knowledge, and the adaptation of services to meet culturally-
unique needs. Offering those services in a manner that fails to achieve its intended
result due to cultural and linguistic barriers is not cost effective. To assist the
CONTRACTOR's efforts towards cultural and linguistic competency, County shall
provide the following at no cost to CONTRACTOR:
Exhibit A
Page 13 of 26
i. Mandatory cultural competency training including sexual orientation and sensitivity
training for CONTRACTOR personnel, at minimum once per year. County will
provide mandatory training regarding the special needs of this diverse population
and will be included in the cultural competence training(s), if CONTRACTOR does
not have a similar training in place. Sexual orientation and sensitivity to gender
differences is a basic cultural competence principle and shall be included in the
cultural competency training. Literature suggests that the mental health needs of
lesbian, gay, bisexual, transgender (LGBT) individuals may be at increased risk for
mental disorders and mental health problems due to exposure to societal stressors
such as stigmatization, prejudice and anti-gay violence. Social support may be
critical for this population. Access to care may be limited due to concerns about
providers' sensitivity to differences in sexual orientation.
ii. Assistance to CONTRACTOR in locating appropriate providers who can translate
behavioral health and substance abuse services information into County's threshold
languages (English, Spanish, and Hmong). Translation services and costs
associated will be the responsibility of the CONTRACTOR.
VII. STAFFING
CONTRACTOR shall provide a staffing plan that is clear and concise and allows for full
implementation of all services described in the program. Staff shall be qualified in education,
experience, clinical, and cultural competencies according to DMC-ODS and MHP provider manual
requirements. Staffing pattern shall include Addiction Specialists, Psychiatrists and
Nurses, Housing Specialists, Employment Specialists, Personal Service Coordinators, Peer
Support Specialists and Outreach and Engagement Coordinators.
CONTRACTOR shall maintain staffing levels adequate in relation to the number of open individual
cases at any given point to ensure quality service that meets the requirements of the program.
CONTRACTOR shall provide robust, comprehensive and ongoing training and mentoring
to staff in evidence-based practices (EBP) of the program to ensure fidelity and to build
competency and expertise of their staff. In addition to EBPs, CONTRACTOR shall provide
training to on co-occurring and trauma informed practice.
CONTRACTOR shall demonstrate staff proficiency (training and certification) in suicide and crisis
intervention procedures and other training subjects that would benefits the individuals in their
wellness goals.
CONTRACTOR shall ensure clinical supervisor(s) will oversee the work of the clinicians, including
approving documentation and claiming in the electronic medical records as required. The clinical
supervisor(s) shall be able to provide Board of Behavioral Sciences (BBS) supervision.
All staff, who provide direct care or perform coding/billing functions, must meet the requirements of
the Fresno County Mental Health Plan (FCMHP) Compliance Program. This includes the screening
for excluded persons and entities by accessing or querying the applicable licensing board(s), the
National Provide Data Bank (NPDB), Office of Inspector General's List of Excluded
Individuals/Entities (LEIE), Excluded Parties List System (EPLS) and Medi-Cal Suspended and
Ineligible List prior to hire and monthly thereafter. In addition, all licensed/registered/waivered staff
must complete a FCMHP Provider Application and be credentialed by the FCMHP's Credentialing
Committee. All licensed staff shall have Department of Justice (DOJ), Federal Bureau of
Investigation (FBI), and Sherriff fingerprinting (Live scan) executed.
Exhibit A
Page 14 of 26
VIII. PEER SUPPORT RESOURCES
The CONTRACTOR recognizes the value of the use of individual directed peer-to-peer support
networks. As part of an individual's recovery, a variety of peer activities are made available for
persons served. FBH-COC will employ peer support staff who have lived mental health /criminal
justice involvement/substance use disorder experience and has a heart to give back as part of the
FBH-COC treatment team. Individuals often struggle in social situations and having peer-run
activities is a way to have persons served begin to interact in a social situation. Individuals are
encouraged to participate in existing peer support programs in the community and FBH-COC will
sponsor peer support activities facilitated by the Peer Support Specialist at the program site as well.
Peer support services are promoted in a manner that encourages individual responsibility and
participation in their own recovery and seeks to assist individuals in understanding and combating
stigmatization including their own self-imposed stigma. Staff will continue to assist individuals to
develop their own program-based formal and informal support groups.
This approach to treatment provides vital opportunities to engage in pro-social activities while
establishing hope, dignity, and engagement. The Turning Point FBH-COC program will cultivate an
active peer led leadership team that allows opportunity for persons served to build leadership skills
in planning and promoting monthly program events for other persons served. The leadership team
role will instill a sense of purpose for individuals as they volunteer to be greeters, introduce new
individuals to the program, and hold peers accountable to engage in respectful behavior.
IX. AVERAGE CLIENT LENGTH OF STAY
Individuals will remain in the ACT program for as long as clinically necessary. ACT Teams will
decrease the intensity of services to individuals who are experiencing progress, but should
maintain enough contact so that if circumstances change —they can step in quickly to avoid
symptoms from worsening and prevent minor problems from decompensating into crisis.
Individuals are able to remain in the FBH-COC as long as services are clinically justified. When
services for those individuals with a length of stay longer than the maximum 24-month period under
AB 1810 pre-trial jail diversion, they will be allowed to continue receiving treatment until it is no
longer clinically necessary. DBH may require treatment reauthorization every 60 days for
individuals who have completed their pre-trial probation term or AB1810 diversion term if the
program is at capacity and unable to accept new referrals from the Court or Probation.
X. REPORTING
CONTRACTOR shall comply with the following reporting requirements:
1. AB 109 Reporting:
A. Quarterly Program Statistics;
B. Fiscal Reporting, including monthly invoicing; and
C. CONTRACTOR shall complete all reports mandated by the CCP.
2. MHSA Reporting
A. Demographics to be collected must include the following data points:
i. Age
ii. Race
iii. Ethnicity
iv. Primary Language
Exhibit A
Page 15 of 26
V. Gender Identification at Present
vi. Gender assigned at birth
vii. Sexual Orientation
viii. Veteran Status
ix. Any Disabilities
X. Note: Support services for each participant need to be documented in the
participants chart and be related to their wellness plan.
A. All expense for support services need to be documented, and included in the chart,
and be justified by the wellness plan. All providers do need to provide a cost per
individual served for support services.
3. FSP/ACT Reporting
A. CONTRACTOR shall complete quarterly reports, as mandated by the State for FSPs
and ACTs under CCR Title 9, sections 3620.10 and 3530.90. Reports shall be made
directly into the Data Collection and Reporting (DCR) system.
4. CSI Reporting
A. CONTRACTOR shall work with DBH to capture and enter all Client Service Information
(CSI), admission data, and billing information into DBH's data system for the purposes
of effective care coordination and State reporting. CONTRACTOR shall provide all
necessary data to allow DBH to capture all CSI data for services provided and to meet
all State and Federal reporting requirements. Methods of providing such information
include, but are not limited to, the following:
i. Direct data entry in DBH's electronic information system; or
ii. Provide an electronic file compatible with DBH's electronic information system.
5. CONTRACTOR shall comply with all reporting requests made by DBH. Reporting
requirements are subject to change as the program develops.
XI. PERFORMANCE AND OUTCOME MEASUREMENTS
CONTRACTOR shall comply with all project monitoring and compliance protocols, procedures,
data collection methods, and reporting requirements requested by the COUNTY. COUNTY
and CONTRACTOR shall use performance outcome measures for evaluating program and
system effectiveness to ensure services and service delivery strategies are positively impacting
the service population.
In addition, these measures shall be used to ensure the FBHP is in alignment with MHSA
guiding principles which are inclusive of: an integrated service experience; community
collaboration; cultural competence; individual/family driven service; and wellness, resilience,
and recovery-focused services.
Performance outcome measures shall be tracked on an ongoing basis and used to update the
COUNTY monthly (by the 101" of the month following the report period). In addition,
performance outcome measures are reported to the COUNTY annually in accumulative reports
for overall program and contract evaluation. Forms and tools used to gather, and report data
reflecting services provided, populations served, and impact of those services are to be
developed by the COUNTY and CONTRACTOR. CONTRACTOR will work closely with the
COUNTY to analyze the data and make necessary adjustments to service delivery and
reporting requirements before the start of each new fiscal year and at appropriate intervals
during the fiscal year.
Measurable outcomes may be reviewed for input and approval by a designated DBH work
group upon contract execution and adjusted as needed each new fiscal year. The purpose of
Exhibit A
Page 16 of 26
this review process is to ensure a comprehensive system wide approach to the evaluation of
programs through an effective outcome reporting process.
The following items listed below represent program goals to be achieved by CONTRACTOR.
The program's success will be based on the number of goals it can achieve, resulting from
performance outcomes. CONTRACTOR will utilize a computerized tracking system with which
outcome measures and other relevant individual data, such as demographics, will be
maintained.
CONTRACTOR will collect data about the characteristics of the individuals served and
measure service delivery performance indicators in the four Commission on Accreditation of
Rehabilitation Facilities (CARF) domains, with at least one performance indicator for each of
the four domains. CONTRACTOR shall submit annual outcomes on a report template to be
provided by the County for each level of care provided.
Assertive Community Treatment
1 . Effectiveness-
a. Psychiatric Hospitalization
Hospitalization refers to any hospital admission captured in Fresno County's electronic health
record, Avatar. Data may be entered by any hospital that utilizes Avatar including Exodus
PHF, Community Behavioral Health Center (CBHC), and Kaweah Delta Psychiatric Hospital.
Objective: To prevent and minimize the total number of individuals and days spent
in a psychiatric hospital post incarceration.
Indicator: Percentage of individuals enrolled in FSP services that experienced no
psychiatric hospitalizations post incarceration, and the total number of individuals
and days hospitalized post incarceration.
iii. Who Applied: ACT individuals served by the program for a minimum of one year.
iv. Time of Measure: Fiscal Year
v. Data Source: DCR/ITWS State database.
vi. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP services
will experience no episodes of psychiatric hospitalization post enrollment.
b. Incarcerations
Incarceration refers to individuals confined in a jail or prison setting.
Indicator: A reduction of the number of individuals experiencing arrests, the
frequency of arrests, and the numbers of days spent incarcerated compared to
pre-enrollment.
ii. Who Applied: ACT individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v_. Target Goal Expectancy: To reduce the total number of individuals arrested, the
frequency of arrests, and the total number of days incarcerated.
c. Homelessness
Homelessness refers to individuals without a place to live, who are living in a place
not meant for human habitation, or who are living in an emergency shelter.
Indicator: Percentage of individuals that experienced no episodes of
homelessness and the total number of days spent homeless compared to pre-
enrollment.
ii. Who Applied: ACT individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectancy A minimum of 70% of individuals enrolled in FSP services
will experience no episodes of homelessness. The total number of days spent
Exhibit A
Page 17 of 26
homeless will be reduced when compared to 12 months prior to program
enrollment.
d. Medical Hospitalizations
Medical hospitalization refers to individuals who frequently require hospitalization at a
local hospital or emergency department as a result of chronic or untreated physical
health related conditions.
Indicator: Percentage of individuals that experienced no episodes of medical
hospitalizations or ED admissions, and total number of days spent in a hospital
or ED setting compared to pre-enrollment.
ii. Who Applied: ACT individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v_. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP services
will experience no episodes of medical hospitalizations or ED admissions. The total
number of days admitted in a medical hospital or ED will be reduced when
compared to 12 months prior to program enrollment.
e. Participation in Educational Settings
Educational setting refers to any learning environment or institution that offers
educational services and curriculum according to specific objectives. Examples may
include adult schools, vocational schools, community colleges, universities, and high
schools.
i. Indicator: Annual percentage of program individuals enrolled in educational
settings.
ii. Who Applied: ACT individuals served by the program enrolled in educational
settings.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v_. Target Goal Expectancy: To have a minimum of 15% of ACT individuals enrolled in
educational settings annually.
f. Participation in Employment or Volunteerism
Employment refers to work environments where individuals are paid competitive
wages in exchange for job related activities performed. Volunteerism refers to
environments where persons served are willingly provide services or complete tasks
without any expectation of financial compensation, but may gain work experience and
job related skills.
Indicator: Annual percentage of individuals engaged in employment or volunteer
activities.
Who Applied: ACT individuals served by the program and that participated in
employment or volunteer activities.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v_. Target Goal Expectancy: To have a minimum of 15% of ACT individuals participate
in employment or volunteer activities annually.
g. Reaching Recovery: Consumer Recovery Measure and Recovery Marker Inventory
The First Street Center-FSP program implemented the use of Reaching Recovery tools
in October of 2016. Reaching Recovery is a tool that was developed by the Mental Health
Center of Denver; its major focus is tracking change across multiple domains of wellness.
With Reaching Recovery in place, ACT began to utilize several tools designed to measure
Exhibit A
Page 18 of 26
recovery for FSP level individuals: the Recovery Needs Level Marker, Consumer
Recovery Measure, and the Recovery Marker Inventory.
Recovery Needs Level (RNL)
Indicator: Recovery Needs Level (RNL) records the status of observed needs
across 17 domains. RNL scores are compared at 6 month intervals to show
trends of recovery through time. Reduced scores indicate positive recovery
growth and movement towards reduced levels of service.
ii. Who Applied: ACT individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Electronic Health Record
v_. Target Goal Expectancy: To have a minimum of 50% of individuals that participated
in services realize positive recovery growth and a minimum of 25% transition to
lower levels of service.
Recovery Marker Inventory (RMI)
Indicator: Recovery Marker Inventory (RMI) A practitioner's rating of the
individual's recovery on 8 objective factors associated with recovery:
employment, education, active growth, level of symptom management,
participation in services, housing. RMI scores are compared at quarterly
intervals to show trends of recovery through time. Increased scores indicate
positive recovery growth.
ii. Who Applied: ACT individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Electronic Health Record
v_. Target Goal Expectances To have a minimum of 50% of individuals that participated
in services realize positive RMI recovery growth trends.
Consumer Recovery Measure (CRM)
Indicator: Consumer Recovery Measure (CRM) A quarterly rating of an
individual's perception of recovery across 5 dimensions: hope, symptom
management, personal sense of safety, active growth orientation, satisfaction
with social networks. Increased scores indicate positive recovery growth from
the individual's perspective.
ii. Who Applied: ACT individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Electronic Health Record
v_. Target Goal Expectancy: To have a minimum of 50% of individuals that participated
in services perceive positive recovery growth trends.
2. Efficiency-
a. Cost per Individual Served
Costs include all staffing and overhead costs associated with operation of the program.
i. Indicator: Total program costs compared to number of unique AB 109 individuals
served.
ii. Who Applied: ACT individuals served by the program in Fiscal Year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar and Financial Records
v. Target Goal Expectancy: To keep within budgeted costs for the program.
3.Access-
Exhibit A
Page 19 of 26
a. Length of time from referral to first contact
i. Indicator: Percentage of individuals that received first contact attempts within 7
business days of the referral date.
ii. Who Applied: Individuals referred to the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar
v. Target Goal Expectancy: 70% of individuals will attempt to be contacted within 7
business days of the referral date.
vi. Outcome: The average wait time from referral to first contact was 1 day. 98% of
individuals were contacted within 7 days of the referral date.
b. Length of time from first contact to first assessment appointment offered
i. Indicator: Percentage of individuals offered their first assessment appointment within
10 business days of the first contact date.
ii. Who Applied: Individuals referred to the program and offered an assessment
appointment.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Access Form
v_. Target Goal Expectancy: 70% of individuals will be offered their first assessment
appointment within 10 business days of the first contact date.
C. Length of time from assessment to first psychiatry appointment offered
i. Indicator: Percentage of individuals offered their first psychiatry appointment within
15 business days of their assessment date.
ii. Who Applied: Individuals assessed and enrolled into program services
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Referral Form
v_. Target Goal Expectancy: 70% of individuals will be offered their first psychiatry
appointment date within 15 business days of their assessment date.
4. Satisfaction & Feedback of Persons Served & Stakeholders-
a. Consumer Perception Survey
Consumer Perception Surveys (CPS) are conducted every six months over a one week
period. Beneficiaries of the MHP are encouraged to participate in filling out the CPS surveys
which are available to individuals served and family members at County and contracted
provider organizations.
Indicator: Average percent of individuals served who complete the survey and
response was 'Agree' or 'Strongly Agree' for the following domains: General
Satisfaction, Perception of Access, Perception of Quality and Appropriateness,
Perception of Treatment Participation, Perception of Outcomes of Services,
Perception of Functioning, and Perception of Social Connectedness.
ii. Who Applied: Persons served who completed the survey in November of 2019
for the program.
iii. Time of Measure: The survey was conducted in November of 2019.
iv. Data Source: Consumer Perception Survey data
v_. Target Goal Expectancy: More than 50% of individuals served will respond that they
are satisfied with the services they received
Exhibit A
Page 20 of 26
Full Service Partnership
1 . Effectiveness-
a. Psychiatric Hospitalization
Hospitalization refers to any hospital admission captured in Fresno County's electronic health
record, Avatar. Data may be entered by any hospital that utilizes Avatar including Exodus
PHF, Community Behavioral Health Center (CBHC), and Kaweah Delta Psychiatric Hospital.
Indicator: Percentage of individuals enrolled in FSP services that experienced no
psychiatric hospitalizations post incarceration, and the total number of individuals
and days hospitalized post incarceration.
ii. Who Applied: FSP individuals served by the program for a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectances A minimum of 70% of individuals enrolled in FSP services
will experience no episodes of psychiatric hospitalization post enrollment.
b. Incarcerations
Incarceration refers to individuals confined in a jail or prison setting.
Indicator: A reduction of the number of individuals experiencing arrests, the
frequency of arrests, and the numbers of days spent incarcerated compared to
pre-enrollment.
ii. Who Applied: FSP individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v_. Target Goal Expectancy: To reduce the total number of individuals arrested, the
frequency of arrests, and the total number of days incarcerated.
c. Homelessness
Homelessness refers to individuals without a place to live, who are living in a place
not meant for human habitation, or who are living in an emergency shelter.
Indicator: Percentage of individuals that experienced no episodes of
homelessness and the total number of days spent homeless compared to pre-
enrollment.
ii. Who Applied: FSP individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v_. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP services
will experience no episodes of homelessness. The total number of days spent
homeless will be reduced when compared to 12 months prior to program
enrollment.
d. Medical Hospitalizations
Medical hospitalization refers to individuals who frequently require hospitalization at a
local hospital or emergency department as a result of chronic or untreated physical
health related conditions.
Indicator: Percentage of individuals that experienced no episodes of medical
hospitalizations or ED admissions, and total number of days spent in a hospital
or ED setting compared to pre-enrollment.
Who Applied: FSP individuals served by the program a minimum of one year.
Exhibit A
Page 21 of 26
Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v_. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP services
will experience no episodes of medical hospitalizations or ED admissions. The total
number of days admitted in a medical hospital or ED will be reduced when
compared to 12 months prior to program enrollment.
e. Participation in Educational Settings
Educational setting refers to any learning environment or institution that offers
educational services and curriculum according to specific objectives. Examples may
include adult schools, vocational schools, community colleges, universities, and high
schools.
Indicator: Annual percentage of program individuals enrolled in educational
settings.
ii. Who Applied: FSP individuals served by the program enrolled in educational
settings.
Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectancy: To have a minimum of 15% of FSP individuals enrolled in
educational settings annually.
f. Participation in Employment or Volunteerism
Employment refers to work environments where individuals are paid competitive
wages in exchange for job related activities performed. Volunteerism refers to
environments where persons served are willingly provide services or complete tasks
without any expectation of financial compensation, but may gain work experience and
job related skills.
Indicator: Annual percentage of individuals engaged in employment or volunteer
activities.
ii. Who Applied: FSP individuals served by the program and that participated in
employment or volunteer activities.
Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v_. Target Goal Expectances To have a minimum of 15% of FSP individuals participate
in employment or volunteer activities annually.
g. Reaching Recovery: Consumer Recovery Measure and Recovery Marker Inventory
The First Street Center-FSP program implemented the use of Reaching Recovery tools
in October of 2016. Reaching Recovery is a tool that was developed by the Mental Health
Center of Denver; its major focus is tracking change across multiple domains of wellness.
With Reaching Recovery in place, FSP began to utilize several tools designed to measure
recovery for FSP level individuals: the Recovery Needs Level Marker, Consumer
Recovery Measure, and the Recovery Marker Inventory.
Recovery Needs Level (RNL)
Indicator: Recovery Needs Level (RNL) records the status of observed needs
across 17 domains. RNL scores are compared at 6 month intervals to show
trends of recovery through time. Reduced scores indicate positive recovery
growth and movement towards reduced levels of service.
ii. Who Applied: FSP individuals served by the program a minimum of one year.
Time of Measure: Fiscal Year
iv. Data Source: Avatar Electronic Health Record
Exhibit A
Page 22 of 26
Target Goal Expectancy: To have a minimum of 50% of individuals that participated
in services realize positive recovery growth and a minimum of 25% transition to
lower levels of service.
Recovery Marker Inventory (RMI)
Indicator: Recovery Marker Inventory (RMI) A practitioner's rating of the
individual's recovery on 8 objective factors associated with recovery:
employment, education, active growth, level of symptom management,
participation in services, housing. RMI scores are compared at quarterly
intervals to show trends of recovery through time. Increased scores indicate
positive recovery growth.
ii. Who Applied: FSP individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Electronic Health Record
v_. Target Goal Expectancy To have a minimum of 50% of individuals that participated
in services realize positive RMI recovery growth trends.
Consumer Recovery Measure (CRM)
Indicator: Consumer Recovery Measure (CRM) A quarterly rating of an
individual's perception of recovery across 5 dimensions: hope, symptom
management, personal sense of safety, active growth orientation, satisfaction
with social networks. Increased scores indicate positive recovery growth from
the individual's perspective.
ii. Who Applied: FSP individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Electronic Health Record
v_. Target Goal Expectancy: To have a minimum of 50% of individuals that participated
in services perceive positive recovery growth trends.
2. Efficiency-
a. Cost per Individual Served
Costs include all staffing and overhead costs associated with operation of the program.
i. Indicator: Total program costs compared to number of unique AB 109 individuals
served.
ii. Who Applied: FSP individuals served by the program in Fiscal Year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar and Financial Records
v. Target Goal Expectancy To keep within departmental budgeted costs for the program.
3.Access-
a. Length of time from referral to first contact
vii. Indicator: Percentage of individuals that received first contact attempts within 7
business days of the referral date.
viii. Who Applied: Individuals referred to the program.
ix. Time of Measure: Fiscal Year
x. Data Source: Avatar
A Target Goal Expectancy: 70% of individuals will attempt to be contacted within 7
business days of the referral date.
xii. Outcome: The average wait time from referral to first contact was 1 day. 98% of
individuals were contacted within 7 days of the referral date.
Exhibit A
Page 23 of 26
b. Length of time from first contact to first assessment appointment offered
�i. Indicator: Percentage of individuals offered their first assessment appointment within
10 business days of the first contact date.
vii. Who Applied: Individuals referred to the program and offered an assessment
appointment.
viii Time of Measure: Fiscal Year
ix. Data Source: Avatar Access Form
x. Target Goal Expectancy: 70% of individuals will be offered their first assessment
appointment within 10 business days of the first contact date.
C. Length of time from assessment to first psychiatry appointment offered
vi. Indicator: Percentage of individuals offered their first psychiatry appointment within
15 business days of their assessment date.
vii Who Applied: Individuals assessed and enrolled into program services
vii Time of Measure: Fiscal Year
ix. Data Source: Avatar Referral Form
x. Target Goal Expectancy 70% of individuals will be offered their first psychiatry
appointment date within 15 business days of their assessment date.
4. Satisfaction & Feedback of Persons Served & Stakeholders-
a. Consumer Perception Survey
Consumer Perception Surveys (CPS) are conducted every six months over a one week
period. Beneficiaries of the MHP are encouraged to participate in filling out the CPS surveys
which are available to individuals served and family members at County and contracted
provider organizations.
Indicator: Average percent of individuals served who complete the survey and
response was 'Agree' or 'Strongly Agree' for the following domains: General
Satisfaction, Perception of Access, Perception of Quality and Appropriateness,
Perception of Treatment Participation, Perception of Outcomes of Services,
Perception of Functioning, and Perception of Social Connectedness.
ii. Who Applied: Persons served who completed the survey in November of 2019
for the program.
iii. Time of Measure: The survey was conducted in November of 2019.
iv. Data Source: Consumer Perception Survey data
v_. Target Goal Expectancy: The program would like to see a majority of persons served
satisfied for each domain.
Outpatient
1 . Effectiveness-
a. Treatment Objectives/Achievements
i_ Indicator: Percentage of individuals that completed treatment and completed 75%
or more of their treatment plan goals.
ii. Who Applied: A sample of OP individuals served by the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar/Accucare EHR
v. Target Goal Expectancy: A minimum of 95% of individuals who complete treatment
will complete at least 75% of treatment plan goals.
Exhibit A
Page 24 of 26
b. Successful Completion
Indicator: Percentage of individuals that complete treatment or leave with
satisfactory progress.
Who Applied: OP individuals that participated in outpatient substance use disorder
services provided by the program.
Time of Measure: Fiscal Year
iv. Data Source: Accucare EHR/Discharge Summaries and Post treatment surveys
v_. Target Goal Expectancy: A minimum of 70% of individuals served will successfully
complete treatment or leave before completion with satisfactory progress.
c. Psychiatric Hospitalizations/Incarcerations
Indicator: Percentage of individuals that experience zero psychiatric
hospitalizations or incarcerations.
ii. Who Applied: OP individuals that received mental health treatment services.
Time of Measure: Fiscal Year
iv. Data Source: Avatar EHR/Accucare EHR
v_. Target Goal Expectancy: 95% of individuals receiving mental health and co-
occurring treatment will experience zero psychiatric hospitalizations or
incarcerations.
d. Reaching Recovery: Consumer Recovery Measure and Recovery Marker Inventory
The program implemented the use of Reaching and Recovery tools in October of 2017.
Reaching Recovery is a tool that was developed by the Mental Health Center of Denver;
its major focus is tracking change across multiple domains of wellness. With Reaching
Recovery in place, the program began to utilize several tools designed to measure
recovery individuals receiving mental health services: the Recovery Needs Level Marker,
Consumer Recovery Measure, and Recovery Marker Inventory.
Recovery Needs Level (RNL)
Indicator: Recovery Needs Level (RNL) records the status of observed needs
across 17 domains. RNL scores are compared at 6 month intervals to show
trends of recovery through time. Reduced scores indicate positive recovery
growth and movement towards reduced levels of service.
Who Applied: A sample of OP individuals that received mental health services for
a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Electronic Health Record
v_. Target Goal Expectancy: To have a minimum of 50% of individuals that participated
in services achieve positive recovery growth and a minimum of 25% transition to
lower levels of service.
Recovery Marker Inventory (RMI)
Indicator: Recovery Marker Inventory (RMI) A practitioner's rating of the
individual's recovery on 8 objective factors associated with recovery:
employment, education, active growth, level of symptom management,
participation in services, housing. RMI scores are compared at quarterly
intervals to show trends of recovery through time. Increased scores indicate
positive recovery growth.
Who Applied: A sample of OP individuals that received mental health services for
a minimum of one year.
Time of Measure: Fiscal Year
Exhibit A
Page 25 of 26
iv. Data Source: Avatar Electronic Health Record
v_. Target Goal Expectancy: To have a minimum of 50% of individuals that participated
in services achieve positive RMI recovery growth trends.
Consumer Recovery Measure (CRM)
Indicator: Consumer Recovery Measure (CRM) A quarterly rating of an
individual's perception of recovery across 5 dimensions: hope, symptom
management, personal sense of safety, active growth orientation, satisfaction
with social networks. Increased scores indicate positive recovery growth from
the individual's perspective.
ii. Who Applied: A sample of OP individuals that received mental health services for
a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Electronic Health Record
v_. Target Goal Expectances To have a minimum of 50% of the individuals participating
in services perceive positive recovery growth trends.
2. Efficiency-
a. Cost per Individual
Costs include all staffing and overhead costs associated with operation of the program.
Indicator: Total program costs compared to the number of unique OP individuals
served.
ii. Who Applied: OP individuals served by the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar and Financial Records
v. Target Goal Expectancy:To keep within departmental budgeted costs for the program.
3.Access-
b. Length of time from SUD Screening to First Assessment Appointment Offered
Indicator: Percentage of individuals offered an SUD assessment appointment within 10
business days of their SUD screening.
ii. Who Applied: A sample of individuals referred to the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar/Accucare EHR
v. Target Goal Expectancy: 70% of referred individuals will be offered their first SUD
assessment appointment within 10 business days of their SUD screening.
c. Length of time from mental health screening to the first offered mental health
assessment appointment
Indicator: Percentage of individuals offered their first mental health assessment
appointment within 10 business days of initial screening.
Who Applied: A sample of individuals referred to the program.
Time of Measure: Fiscal Year
Data Source: Avatar EHR
Target Goal Expectancy: 70% of individuals will be offered an appointment for their first
mental health assessment within 10 business days of initial screening.
d. Length of time from SUD Assessment to first treatment appointment offered
Exhibit A
Page 26 of 26
Indicator: Percentage of individuals offered their first SLID treatment appointment within
10 business days of their assessment date.
Who Applied: A sample of individuals referred to the program.
Time of Measure: Fiscal Year
Data Source: Accucare EHR
Target Goal Expectancy A minimum of 70% of individuals will be offered their first
SUD treatment appointment within 10 business days of their assessment date.
e. Length of time from mental health assessment to first treatment appointment offered
Indicator: Percentage of individuals offered their first mental health treatment
appointment within 10 business days of their assessment date.
Who Applied: A sample of individuals referred to the program.
Time of Measure: Fiscal Year
Data Source: Avatar EHR
Target Goal Expectancy: A minimum of 70% of individuals will be offered their first
treatment appointment within 10 business days of their assessment.
f. Length of time from mental health assessment to the first psychiatry appointment date
offered
Indicator: Percentage of individuals offered their first psychiatry appointment within 15
business days of their assessment date.
Who Applied: A sample of individuals referred to the program.
Time of Measure: Fiscal Year
Data Source: Avatar EHR
Target Goal Expectancy: A minimum of 70% of individuals will be offered their first
psychiatry appointment within 15 business days of their assessment date.
4.Satisfaction: (1) Indicator; (2) Who Applied; (3) Time
4. Satisfaction & Feedback of Persons Served & Stakeholders-
Consumer Perception Surveys (CPS) are conducted every six months over a one week
period. Beneficiaries of the MHP are encouraged to participate in filling out the CPS
surveys which are available to consumers and family members at County and contracted
provider organizations.
Objective: To gauge satisfaction of individuals and collect data for service planning
and quality improvement.
Indicator: Average percent of individuals who complete the survey and response was
'Agree' or'Strongly Agree' for the following domains: General Satisfaction, Perception
of Access, Perception of Quality and Appropriateness, Perception of Treatment
Participation, Perception of Outcomes of Services, Perception of Functioning, and
Perception of Social Connectedness.
iii. Who Applied: Individuals who completed the survey in June of 2021.
iv. Time of Measure: Surveys were completed in June of 2021.
V. Data Source: Consumer Perception Survey data
vi. Target Goal Expectancy: The program would like to see a majority of individuals
satisfied for each domain.
Exhibit B
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
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
1
rev 01-02-2020
Exhibit B
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two -Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
2
rev 01-02-2020
Exhibit B
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
6. Principle Six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
3
rev 01-02-2020
Exhibit B
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
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 22
DRUG MEDI-CAL INTERGOVERNMENTAL AGREEMENT REQUIREMENTS
Fresno County, through the Department of Behavioral Health, makes substance use disorder
treatment services available throughout the county to Medi-Cal eligible persons served through funds
provided under an Intergovernmental Agreement with the California Department of Health Care
Services. The County, and all contracted providers, must comply with the terms of the
Intergovernmental Agreement, and any amendments thereto, including but not limited to the
following:
1. STATE ALCOHOL AND DRUG REQUIREMENTS
A. INDEMNIFICATION
The CONTRACTOR agrees to indemnify, defend and save harmless the
State, its officers, agents and employees from any and all claims and losses accruing or resulting to
any and all contractors, subcontractors, materialmen, laborers and any other person, firm or
corporation furnishing or supplying work, services, materials or supplies in connection with the
performance of this Agreement and from any and all claims and losses accruing or resulting to any
person, firm or corporation who may be injured or damaged by the CONTRACTOR in the
performance of this Agreement.
B. INDEPENDENT CONTRACTOR
The CONTRACTOR and the agents and employees of CONTRACTOR, in the
performance of this Agreement, shall act in an independent capacity and not as officers or
employees or agents of State of California.
C. CONTROL REQUIREMENTS
This Agreement is subject to all applicable Federal and State laws, regulations
and standards. CONTRACTOR(S) shall establish written procedures consistent with State-County
Contract requirements. The provisions of this Agreement are not intended to abrogate any
provisions of law or regulation existing or enacted during the term of this Agreement.
D. 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 Part 2, Title 42, Code of Federal Regulations;
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.
E. REVENUE COLLECTION POLICY
CONTRACTOR shall conform to all policies and procedures regarding
revenue collection issued by the State under the provisions of the Health and Safety Code, Division
10.5.
F. EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
CONTRACTOR agrees that all funds paid out by the State shall be used
exclusively for providing alcohol and/or drug program services, administrative costs, and allowable
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Exhibit C
Page 2 of 22
overhead.
G. ACCESS TO SERVICES
CONTRACTOR shall provide accessible and appropriate services in
accordance with Federal and State statutes and regulations to all eligible persons.
H. REPORTS
CONTRACTOR agrees to participate in surveys related to the performance of
this Agreement and expenditure of funds and agrees to provide any such information in a mutually
agreed upon format.
I. AUDITS
All State and Federal funds furnished to the CONTRACTOR(S) pursuant to this
Agreement along with related patient fees, third party payments, or other related revenues and funds
commingled with the foregoing funds are subject to audit by the State. The State may audit all
alcohol and drug program revenue and expenditures contained in this Agreement for the purpose of
establishing the basis for the subsequent year's negotiation.
J. RECORDS MAINTENANCE
1) CONTRACTOR shall maintain books, records, documents, and other
evidence necessary to monitor and audit this Agreement.
2) CONTRACTOR shall maintain adequate program and fiscal records
relating to individuals served under the terms of this Agreement, as required, to meet the needs of
the State in monitoring quality, quantity, fiscal accountability, and accessibility of services.
Information on each individual shall include, but not be limited to, admission records, patient and
participant interviews and progress notes, and records of service provided by various service
locations, in sufficient detail to make possible an evaluation of services provided and compliance with
this Agreement.
2. FEDERAL CERTIFICATIONS
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY
EXCLUSION LOWER TIER COVERED TRANSACTIONS
A. DBH and CONTRACTOR recognize that Federal assistance funds will be used
under the terms of this Agreement. For purposes of this section, DBH will be referred to as the
"prospective recipient".
B. This certification is required by the regulations implementing Executive Order
12549, Debarment and Suspension, 29 CFR Part 98, section 98.510, Participants' responsibilities.
The regulations were published as Part VII of the May 26, 1988 Federal Register(pages 19160-
19211).
1) The prospective recipient of Federal assistance funds certifies by
entering this Agreement, that neither it nor its principals are presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any Federal department or agency.
2) The prospective recipient of funds agrees by entering into this
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Exhibit C
Page 3 of 22
Agreement, that it shall not knowingly enter into any lower tier covered transaction with a person who
is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered
transaction, unless authorized by the Federal department or agency with which this transaction
originated.
3) Where the prospective recipient of Federal assistance funds is unable
to certify to any of the statements in this certification, such prospective participant shall attach an
explanation to this Agreement.
4) The CONTRACTOR shall provide immediate written notice to DBH if at
any time CONTRACTOR learns that its certification in this clause of this Agreement was erroneous
when submitted or has become erroneous by reason of changed circumstances.
5) The prospective recipient further agrees that by entering into this
Agreement, it will include a clause identical to this clause of this Agreement, and titled "Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered
Transactions", in all lower tier covered transactions and in all solicitations for lower tier covered
transactions.
6) The certification in this clause of this Agreement is a material
representation of fact upon which reliance was placed by COUNTY when this transaction was
entered into.
3. SMOKING PROHIBITION REQUIREMENTS
CONTRACTOR shall comply with Public Law 103-227, also known as the Pro-
Children Act of 1994 (20 USC Section 6081, et seq.), and with California Labor Code Section 6404.5,
the California Smoke-Free Workplace Law.
4. TRAFFICKING IN PERSONS PROVISIONS — PRIVATE ENTITY
CONTRACTOR shall conform to all Federal statutes and regulations prohibiting
trafficking in persons, as well as trafficking-related activities, including, but not limited to the
trafficking of persons provisions in Section 106(g) of the Trafficking Victims Protection Act of 2000
(TVPA) as amended by Section 1702.
CONTRACTOR, CONTRACTOR's employees, subrecipients, and subrecipients'
employees may not:
A) Engage in severe forms of trafficking in persons during the period of time
that the award is in effect;
B) Procure a commercial sex act during the period of time that the award is in
effect; or
C) Use forced labor in the performance of the award or subawards under the
award.
This agreement may be unilaterally terminated, without penalty, if CONTRACTOR
or a subrecipient that is a private entity is determined to have violated a prohibition of the TVPA or
has an employee who is determined by the DBH Director or her designee to have violated a
prohibition of the TVPA through conduct that is either associated with performance under the
award or imputed to the CONTRACTOR or their subrecipient using the standards and due
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Exhibit C
Page 4 of 22
process for imputing the conduct of an individual to an organization that are provided in 2 C.F.R.
Part 180, "OMB Guidelines to Agencies on Government-wide Debarment and Suspension
(Nonprocurement).
CONTRACTOR must inform the DBH Director or her designee immediately of any
information received from any source alleging a violation of a prohibition of the TVPA.
CONTRACTOR must sign a certification annually acknowledging the Trafficking
Victims Protection Act of 2000 requirements (TVPA Certification), attached hereto as Attachment
A, incorporated herein by reference and made part of this Agreement and must require all
employees to complete annual TVPA training.
5. UNLAWFUL USE OF DRUGS AND ALCOHOL OR UNLAWFUL USE MESSAGES
CONTRACTOR shall ensure that information produced with Federal funds pertaining
to drug and alcohol related programs contains a clearly written statement that there shall be no
unlawful use of drugs or alcohol associated with the program. Additionally, CONTRACTOR shall
ensure that no aspect of the program includes any message in materials, curricula, teachings, or
promotion of the responsible use, if the use is unlawful, of drugs or alcohol pursuant to Health and
Safety Code (HSC) 11999-11999.3.
CONTRACTOR must sign the Unlawful Use of Drugs and Alcohol Certification,
attached hereto as Attachment B, incorporated herein by reference and made part of this Agreement
agreeing to uphold the obligations of HSC 11999— 11999.3.
This agreement may be unilaterally terminated, without penalty, if CONTRACTOR or a
subcontractor that is a private entity is determined to have violated a prohibition of the Unlawful Use
of Drugs and Alcohol message or has an employee who is determined by the DBH Director or her
designee to have violated a prohibition of the Unlawful Use of Drugs and Alcohol message.
6. CONFIDENTIALITY OATH
CONTRACTOR shall ensure that all of its employees sign a written confidentiality
oath, attached hereto as Attachment C, before they begin employment with CONTRACTOR and
shall renew said document annually thereafter. CONTRACTOR shall retain each employee's
written confidentiality oath for COUNTY and DHCS inspection for a period of six (6) years
following the termination of this agreement.
7. CONTROL REQUIREMENTS
Performance under this Agreement is subject to all applicable Federal and State
laws, regulations and standards. CONTRACTOR shall establish written accounting procedures
consistent with applicable Federal and State laws, regulations and standards, and shall be held
accountable for audit exceptions taken by the State or COUNTY for failure to comply with these
requirements.
These requirements include, but may not be limited to, those set forth in this
Agreement, and:
A. HSC, Division 10.5, commencing with Section 11760;
B. California Code of Regulations (CCR), Title 9, Division 4, Chapter 8,
commencing with Section 13000;
4
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Exhibit C
Page 5 of 22
C. Government Code Section 16367.8
D. 42, CFR, Sections 8.1 through 8.6.
E. Title 21, CFR, Sections 1301.01 through 1301.93, Department of Justice,
Controlled Substances.
F. State Administrative Manual (SAM), Chapter 7200 (General Outline of
Procedures).
G. 31 U.S.C. sections 7501-7507 (Single Audit Act of 1984; Single Audit Act
Amendments of 1996);
H. 2CFR Part 200 (Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards); and
CONTRACTOR shall be familiar with the above requirements and must incorporate
these requirements into written policies and procedures, as applicable.
8. CULTURALLY COMPETENT SERVICES
CONTRACTOR shall ensure equal access to quality care by diverse populations by
adopting the federal Office of Minority Health Culturally and Linguistically Appropriate Service
(CLAS) national standards and complying with 42 CFR 438.206(c)(2). CONTRACTOR's policies,
procedures, and practices must be consistent with the principles outlined and are embedded in
the organizational structure, as well as being upheld in day-to-day operations. CONTRACTOR
shall promote the delivery of services in a culturally competent manner to all persons served,
including those with limited English proficiency and diverse cultural and ethnic backgrounds,
disabilities, and regardless of gender, sexual orientation or gender identity.
9. ADA CONSIDERATIONS
CONTRACTOR shall ensure that physical access, reasonable accommodations,
and accessible equipment are available for Medicaid persons served with physical or mental
disabilities in accordance with CFR Title 45, Part 84 and the Americans with Disabilities Act.
10. ADDITIONAL INTERGOVERNMENTAL AGREEMENT RESTRICTIONS
This Agreement is subject to any additional restrictions, limitations, conditions, or
statutes enacted or amended by the federal or state governments, which may affect the
provisions, terms, or funding of this Agreement in any manner.
11. NULLIFICATION OF DMC-ODS SERVICES
The parties agree that failure of COUNTY, or CONTRACTOR, to comply with W&I
section 14124.24, the Special Terms and Conditions, and this Agreement, shall be deemed a
breach that results in the termination of the State-County Intergovernmental Agreement for cause.
In the event of a breach, the DMC-ODS services shall terminate. The COUNTY shall immediately
begin providing DMC services to the person served in accordance with the State Plan.
12. HATCH ACT
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Exhibit C
Page 6 of 22
CONTRACTOR shall comply with the provisions of the Hatch Act (Title 5 USC,
Sections 1501-1508), which limit the political activities of employees whose principal employment
activities are funded in whole or in part with federal funds.
13. LIMITATION ON USE OF FUNDS FOR PROMOTION OF LEGALIZATION OF
CONTROLLED SUBSTANCES
CONTRACTOR is prohibited from using funds made available through this
Agreement for any activity that promotes the legalization of any drug or other substance included
in Schedule I of Section 202 of the Controlled Substances Act (21 USC 812).
14. NONDISCRIMINATION IN EMPLOYMENT AND SERVICES
CONTRACTOR certifies that under the laws of the United States and the State of
California, incorporated into this Agreement by reference and made a part hereof as if set forth in
full, CONTRACTOR shall not unlawfully discriminate against any person.
15. FEDERAL LAW REQUIREMENTS
CONTRACTOR shall comply with the following Federal law requirements:
A. Title VI of the Civil Rights Act of 1964, Section 2000d, as amended,
prohibiting discrimination based on race, color, or national origin in federally
funded programs.
B. Title IX of the Education Amendments of 1972 (regarding education and
programs and activities), if applicable.
C. Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.) prohibiting
discrimination on the basis of race, color, religion, sex, handicap, familial
status or national origin in the sale or rental of housing.
D. Age Discrimination Act of 1975 (45 CFR Part 90), as amended (42 USC
Sections 6101 — 6107), which prohibits discrimination on the basis of age.
E. Age Discrimination in Employment Act (29 CFR Part 1625).
F. Title I of the Americans with Disabilities Act (29 CFR Part 1630) prohibiting
discrimination against the disabled in employment.
G. Americans with Disabilities Act (28 CFR Part 35) prohibiting discrimination
against the disabled by public entities.
H. Title III of the Americans with Disabilities Act (28 CFR Part 36) regarding
access.
I. Rehabilitation Act of 1973, as amended (29 USC Section 794), prohibiting
discrimination on the basis of individuals with disabilities.
J. Executive Order 11246 (42 USC 2000(e) et seq. and 41 CFR Part 60)
regarding nondiscrimination in employment under federal contracts and
construction contracts greater than $10,000 funded by federal financial
assistance.
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Exhibit C
Page 7 of 22
K. Executive Order 13166 (67 FR 41455) to improve access to federal services
for those with limited English proficiency.
L. The Drug Abuse Office and Treatment Act of 1972, as amended, relating to
nondiscrimination on the basis of drug abuse.
M. The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment
and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism.
16. STATE LAW REQUIREMENTS
CONTRACTOR shall comply with the following State law requirements:
A. Fair Employment and Housing Act (Government Code Section 12900 et
seq.) and the applicable regulations promulgated thereunder (California
Administrative Code, Title 2, Section 7285.0 et seq.).
B. Title 2, Division 3, Article 9.5 of the Government Code, commencing with
Section 11135.
C. Title 9, Division 4, Chapter 8, commencing with Section 10800.
D. No state or Federal funds shall be used by COUNTY, or CONTRACTOR, for
sectarian worship, instruction, and/or proselytization. No state funds shall be
used by CONTRACTOR, or CONTRACTOR, to provide direct, immediate, or
substantial support to any religious activity.
E. Noncompliance with the requirements of nondiscrimination in services shall
constitute grounds for state to withhold payments under this Agreement or
terminate all, or any type, of funding provided hereunder.
17. INVESTIGATIONS AND CONFIDENTIALITY OF ADMINISTRATIVE ACTIONS
COUNTY acknowledges that if a DMC provider is under investigation by DHCS or
any other state, local or federal law enforcement agency for fraud or abuse, DHCS may
temporarily suspend CONTRACTOR from the DMC program, pursuant to W&I Code, Section
14043.36(a). Information about CONTRACTOR's administrative sanction status is confidential
until such time as the action is either completed or resolved. The DHCS may also issue a
Payment Suspension to a provider pursuant to W&I Code, Section 14107.11 and Code of Federal
Regulations, Title 42, section 455.23. The COUNTY is to withhold payments from a DMC
provider during the time a Payment Suspension is in effect. COUNTY has executed a
Confidentiality Agreement that permits DHCS to communicate with COUNTY concerning
CONTRACTOR(S) that are subject to administrative sanctions.
18. COUNSELOR CERTIFICATION
CONTRACTOR shall ensure that any counselor or registrant providing intake,
assessment of need for services, treatment or recovery planning, individual or group counseling to
participants, patients, or residents in a DHCS licensed or certified program is required to be
certified as defined in CCR Title 9, Division 4, Chapter 8.
19. ADMISSION DISCRIMINATION
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Exhibit C
Page 8 of 22
CONTRACTOR shall accept individuals eligible for admission in the order in which
they apply without restriction, up to the limits set under the State-County Intergovernmental
Agreement. CONTRACTOR shall not, based on health status or need for health care services,
discriminate against individuals eligible for admission. CONTRACTOR shall follow all Federal and
State civil rights laws. CONTRACTOR shall not unlawfully discriminate, exclude people, or treat
them differently, on any ground protected under Federal or State law, including sex, race, color,
religion, ancestry, national origin, ethnic group identification, age, mental disability, physical
disability, medical condition, genetic information, marital status„ gender, gender identity, or sexual
orientation and will not use any policy or practice that has the effect of discriminating on the basis
of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental
disability, physical disability, medical condition, genetic information, marital status, gender, gender
identity, or sexual orientation. CONTRACTOR shall ensure that persons served that meet
medical necessity for Medication Assisted Treatment (MAT) receive the same access to care as
non-MAT persons served.
CONTRACTOR shall provide information on how to file a Discrimination Grievance
with COUNTY or DHCS if there is a concern of discrimination based on sex, race, color, religion,
ancestry, national origin, ethnic group identification, age, mental disability, physical disability,
medical condition, genetic information, marital status, gender, gender identity, or sexual
orientation. CONTRACTOR shall also provide information on how to file a Discrimination
Grievance with the United States Department of Health and Human Services Office of Civil Rights
if there is a concern of discrimination based on race, color, national origin, sex, age, or disability.
20. SUBCONTRACTUAL REQUIREMENTS
CONTRACTOR shall fulfill contractual requirements of delegated services or
activities in accordance with 42 CFR §438.230 and shall perform the delegated activities and
reporting responsibilities in compliance with COUNTYs State-County Intergovernmental
Agreement obligations. CONTRACTOR shall comply with all applicable Medicaid laws and
regulations, including applicable sub-regulatory guidance and contract provisions.
CONTRACTOR shall not bill persons served for covered services under this
agreement in excess of the amount that would be owed by the individual if the COUNTY had
directly provided the services (42 U.S.C. 1396u-2(b)(6)(C)).
21. INSPECTION AND AUDIT OF RECORDS AND ACCESS TO FACILITIES
CONTRACTOR agrees that COUNTY, DHCS, CMS, the HHS Inspector General,
the Comptroller General, or their designees have the right to audit, evaluate, and inspect any
books, records, contracts, computer or other electronic systems of CONTRACTOR, or of the
CONTRACTOR's sub-contractor, that pertain to any aspect of services and activities performed,
or determination of amounts payable under COUNTY's contract with DHCS. CONTRACTOR shall
make available, at any time, for purposes of an audit, evaluation, or inspection, its premises,
physical facilities, equipment, books, records, contracts, computer or other electronic systems
relating to its Medicaid enrollees. The right to audit will exist through 10 years from the final date
of the contract period or from the date of completion of any audit, whichever is later.
22. GRIEVANCE
CONTRACTOR shall comply with Grievance procedures set forth in the State-
County Intergovernmental Agreement, the Provider Manual and the Member Handbook.
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Exhibit C
Page 9 of 22
CONTRACTOR shall make the following grievance information available to all
persons served:
A. Perons Served's right to a State Fair Hearing and how to obtain a hearing as
well as representation rules.
B. Person Served's right to file grievances and appeals, including the
requirements and timeframes for filing.
C. Person Served's right to give written consent to allow CONTRACTOR or
legal representative, acting on behalf of the person served, to file an appeal.
D. Person Served may file a grievance orally or in writing to DHCS or COUNTY.
E. The availability of assistance with filing grievances and appeals.
F. The toll-free number to file oral grievances and appeals.
G. Person Served's right to request continuation of benefits during an appeal or
state fair hearing filing although the person served may be liable for the cost of any continued
benefits if the action is upheld.
H. Any state determined contractor's appeal rights to challenge the failure of the
COUNTY to cover a service.
23. GREIVANCE AND APPEALS RECORDKEEPING REQUIREMENTS
CONTRACTOR shall retain person served grievance and appeal records as
referenced in 42 CFR §438.416, for a period of no less than ten (10) years. Person served
grievance and appeal data shall include a general description of the reason for the grievance or
appeal, the date the grievance or appeal was received, the date of each review or, if applicable,
review meeting, the resolution and date of resolution at each level of the grievance or appeal and
the name of the covered person for whom the grievance or appeal was filed. The record must be
accurately maintained in a manner accessible to DHCS and available upon request to CMS.
24. PERSON SERVED INFORMING AND TRANSLATION SERVICES
CONTRACTOR shall make written and verbal information available to persons
served in their language of choice.
Written material: CONTRACTOR shall use COUNTY's written/translated materials
that are critical to obtaining services, including the provider directory, member handbook, appeal
and grievance notices, and denial and termination notices, available in the prevalent non—English
languages. All other CONTRACTOR specific written materials must be made available in the
prevalent non-English languages. CONTRACTOR shall ensure that written materials use easily
understood language and format, use a font size no smaller than 12-point, and are made available
in alternative formats upon request of the potential person served or person served at no cost.
Written materials shall include taglines in the prevalent non-English languages in the state, as well
as large print, explaining the availability of written translation or oral interpretation to understand
the information provided and the toll-free and TTY/TDY telephone number of COUNTY's
member/customer service unit. Written materials for potential and current persons served shall
include language taglines in at least the top sixteen (16) non-English languages spoken by
individuals with limited English proficiency of the State, as well as large print, explaining the
9
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Exhibit C
Page 10 of 22
availability of written translation or oral interpretation to understand the information provided.
Large print means in a font size no smaller than 18 point.
Auxiliary aids: CONTRACTOR shall ensure auxiliary aids and services in an
appropriate manner that takes into consideration the special needs of persons served or potential
persons served with disabilities or limited English proficiency shall be made available upon
request of the potential person served or person served at no cost.
Interpretation services: CONTRACTOR shall make interpretation services available
free of charge and in a timely manner to each person served. This includes oral interpretation and
the use of auxiliary aids (such as TTY/TDY and American Sign Language) and services including
qualified interpreters for individuals with disabilities. Oral interpretation requirements apply to all
non—English languages, not just those that DHCS identifies as prevalent. Pursuant to WIC
14029.91(a)(1)(B), Oral interpretation services shall be provided by an interpreter that, at a
minimum, meets all the following qualifications:
A. Demonstrated proficiency in speaking and understanding both spoken
English and the language spoken by the limited-English-proficient person served;
B. The ability to interpret effectively, accurately, and impartially, both receptively
and expressly, to and from the language spoken by the limited-English-proficient person served
and English, using any necessary specialized vocabulary, terminology, and phraseology; and
C. Adherence to generally accepted interpreter ethics principles, including client
confidentiality.
CONTRACTOR shall notify its persons served and prospective persons served that
oral interpretation is available for any language and written translation is available in prevalent
languages to individuals whose primary language is not English free of cost and how to access
those materials. This may include, but is not limited to qualified interpreters and information
written in other languages. CONTRACTOR shall notify persons served that auxiliary aids and
services are available upon request, at no cost and in a timely manner for non-English
speaking/reading/writing persons served and persons served with disabilities. Free aides and
services to people with disabilities to help them communicate better may include, but are not
limited to, qualified sign language interpreters and written information in other formats (e.g. large
print, audio, accessible electronic formats, and other formats). CONTRACTOR shall notify
persons served how to access these services.
Pursuant to 14029.91(a)(1)(C), CONTRACTOR shall not require a person served
with limited English proficiency to provide his or her own interpreter or rely on a staff member who
does not meet the qualifications described above.
CONTRACTOR shall not rely on an adult or minor child accompanying the limited-
English-proficient person served to interpret or facilitate communication except under the
circumstances described in WIC Section 14029.91(a)(1)(D) for emergencies and upon request
that the accompanying adult provide assistance.
Pursuant to 45 CFR 92.201, CONTRACTOR shall not require a person served with
limited English proficiency to accept language assistance services.
CONTRACTOR shall post a DHCS-approved nondiscrimination notice and
language taglines in at least the top sixteen (16) non-English languages in the State (as
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Exhibit C
Page 11 of 22
determined by DHCS) as well as large print, explaining the availability of free language assistance
services, including written translation and oral interpretation to understand the information
provided, and the toll-free and TTY/TDY telephone number of CONTRACTOR's
member/customer service unit, as follows:
A. In all conspicuous physical locations where CONTRACTOR interacts with
the public;
B. In a conspicuous location on CONTRACTOR's website that is accessible on
CONTRACTOR's home page, and in a manner that allows persons served and prospective
persons served to easily locate the information; and
C. In all significant communications and significant publications targeted to
persons served, enrollees, applicants, and members of the public, except for significant
publications and significant communications that are small-sized, such as postcards and tri-fold
brochures.
CONTRACTOR shall post a DHCS-approved nondiscrimination statement and
language taglines in a least the top two non-English languages in the State (as determined by
DHCS), explaining the availability of free language assistance services, and the toll-free and
TTY/TDY telephone number of CONTRACTOR's member/customer service unit, as follows:
A. In all significant publications and significant communications that are small-
sized, such as postcards and tri-fold brochures; and
B. CONTRACTOR's nondiscrimination notice, nondiscrimination statement,
and language taglines must be in a conspicuously visible font size no smaller than 12-point. Any
large print tagline required must be in a font size no smaller than 18-point and must include
information on how to request auxiliary aides and services, including the provision of the materials
in alternative formats.
25. MEMBER HANDBOOK
CONTRACTOR shall utilize COUNTY developed member handbook and issue to
persons served at intake. Member handbooks can also be made available by mailing a printed
copy of the information to the person served's mailing address, emailing after obtaining the person
served's agreement to receive information by email, providing direction in paper or electronic form
to the COUNTY website or any other method that can reasonably be expected to result in the
person served receiving that information.
26. TIMELY ACCESS REQUIREMENTS
CONTRACTOR shall meet DHCS and COUNTY standards for timely access to care
and services, taking into account the urgency of the need for services. CONTRACTORs must
offer hours of operation that are no less than the hours of operation offered to commercial persons
served or comparable to Medicaid FFS, if CONTRACTOR services only Medicaid persons served.
Timeliness standards include, but are not limited to:
A. Initial contact to first face-to-face appointment— 10 business days
B. Initial contact to first dose of NTP — 3 business days
C. Timeliness of services for Urgent Conditions — 1 business day
11
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Exhibit C
Page 12 of 22
CONTRACTOR shall ensure that medical attention for emergency and crisis
medical conditions are provided immediately.
12
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Exhibit C
Page 13 of 22
27. CARE COORDINATION
CONTRACTOR and COUNTY shall comply with the care and coordination
requirements of the State-County Intergovernmental Agreement, Exhibit A, Attachment I, II.E.3.
CONTRACTOR shall ensure that each person served has an ongoing source of care appropriate
to his or her needs and shall ensure a person or entity within their organization is formally
designated as primarily responsible for coordinating the services accessed by the person served.
The person served shall be provided information on how to contact their case manager.
CONTRACTOR shall coordinate services between levels of care, with services the person served
receives from any other managed care organization and the services the person served receives
from community and social support providers. Care coordination efforts shall be accurately
documented in person served's chart to be verified during COUNTY chart audits conducted at
least annually.
CONTRACTOR shall make a best effort to conduct an initial screening of each
person served's ancillary needs, within thirty (30) calendar days of the effective date of admission
for all new persons served, including subsequent attempts if the initial attempt to contact the
person served is unsuccessful.
CONTRACTOR shall ensure that it maintains and shares, as appropriate, a person
served health record in accordance with professional standards.
CONTRACTOR shall ensure that in the process of coordinating care, each person
served's privacy is protected in accordance with the privacy requirements in 45 CFR parts 160
and 164 subparts A and E and 42 CFR Part 2, to the extent that they are applicable.
CONTRACTOR shall ensure that persons served are aware of and are referred to,
when appropriate, recovery supports and services immediately after discharge or upon completion
of an acute care stay.
28. AUTHORIZATION OF SERVICES
CONTRACTOR shall adhere to COUNTY's written policies and procedures, outlined
in the Provider Manual, for authorization of services.
29. PERFORMANCE IMPROVEMENT PROJECTS
CONTRACTOR shall assist, when requested by COUNTY, in developing and
reviewing annual Performance Improvement Projects including but not limited to identifying a
clinical and a non-clinical problem, brainstorming causes and barriers, implementation of
interventions for the identified problems, and analysis of interventions. CONTRACTOR shall
assist in planning and initiation of activities for increasing or sustaining improvement.
30. CONTRACTOR DMC CERTIFICATION
DMC certified contractors must revalidate DMC certification with DHCS every five
(5) years. Failure to revalidate DMC certification within 120 days following the expiration of every
five (5) year period will result in contract termination. COUNTY shall terminate CONTRACTOR
immediately upon notification from DHCS that the CONTRACTOR cannot be enrolled, or the
expiration of one 120-day period without enrollment of CONTRACTOR and shall notify affected
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Exhibit C
Page 14 of 22
person served. CONTRACTOR shall ensure enrollment with DHCS as a Medicaid provider
consistent with the provider disclosure, screening and enrollment requirements.
DMC certified CONTRACTORs shall be subject to continuing certification
requirements at least once every five years. DHCS may allow the CONTRACTOR to continue
delivering covered services to person served at a site subject to on-site review by DHCS as part
of the recertification process prior to the date of the on-site review, provided the site is operational,
the certification remains valid, and has all required fire clearances. DHCS shall conduct
unannounced certification and recertification site visits at clinics pursuant to W&I Code, Section
14043.7.
31. PROGRAM INTEGRITY REQUIREMENTS
CONTRACTOR shall implement and maintain arrangements or procedures that are
designed to detect and prevent fraud, waste, and abuse. CONTRACTOR shall maintain written
policies, procedures, and standards of conduct that articulate CONTRACTORs commitment to
comply with all applicable requirements and standards under the State-County Intergovernmental
Agreement, and all applicable Federal and State requirements. CONTRACTOR shall establish
and implement procedures and a system with dedicated staff for routine internal monitoring and
auditing of compliance risks, prompt response to compliance issues as they are raised,
investigation of potential compliance problems as identified in the course of self-evaluation and
audits, correction of such problems promptly and thoroughly (or coordination of suspected criminal
acts with law enforcement agencies) to reduce the potential for recurrence, and ongoing
compliance.
CONTRACTOR shall provide reports to COUNTY within 60 calendar days when it
has identified an overpayment. COUNTY shall provide a mechanism for reporting and collecting
overpayment.
CONTRACTOR shall retain information regarding data, information, and
documentation for person served encounter data specified in 42 CFR §§438.604, 438.606,
438.608, and 438.610 for a period of no less than 10 years.
CONTRACTOR shall ensure sites keep a record of persons served being treated at
that location.
CONTRACTOR shall not knowingly have a relationship with a director, officer or
partner of CONTRACTOR, a subcontractor of CONTRACTOR, a person with beneficial ownership
of five (5) percent or more of CONTRACTOR's equity or a network provider or person with an
employment, consulting or other arrangement with the CONTRACTOR for the provision of items
and services that are significant and material to the CONTRACTOR's obligations under this
Agreement with the following:
A. An individual or entity that is debarred, suspended, or otherwise excluded
from participating in procurement activities under the Federal Acquisition Regulation or from
participating in non-procurement activities under regulations issued under Executive Order No.
12549 or under guidelines implementing Executive Order No. 12549.
B. An individual or entity who is an affiliate, as defined in the Federal
Acquisition Regulation at 48 CFR 2, Section 101, of a person described above.
14
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Exhibit C
Page 15 of 22
CONTRACTOR shall not have a relationship with an individual or entity that is
excluded from participation in any Federal Health Care Program under section 1128 or 1128A of
the Act.
32. CONTRACTOR SPECIFICATIONS
CONTRACTOR shall ensure that professional staff shall be licensed, registered,
certified or recognized under California scope of practice statutes. Professional staff shall provide
services within their individual scope of practice and receive supervision required under their
scope of practice laws. CONTRACTOR shall ensure that professional staff(LPHAs) receive a
minimum of five (5) hours of continuing education related to addiction medicine each year.
Copies of these certifications and licenses shall be maintained in staff's personnel files and
records shall be made available to COUNTY upon request.
CONTRACTOR shall ensure that non-professional staff receive appropriate onsite
orientation and training prior to performing assigned duties. A professional and/or administrative
staff shall supervise non-professional staff. Professional and non-professional staff are required to
have appropriate experience and any necessary training at the time of hiring. Documentation of
trainings, certifications and licensure shall be contained in personnel files. Registered and
certified SLID counselors shall adhere to all requirements in Title 9, Chapter 8.
33. CREDENTIALING/RECREDENTIALING
CONTRACTOR shall follow the COUNTY's established credentialing and re-
credentialing process for all licensed and/or certified staff. Initial credentialing must be completed
prior to providing treatment services. Re-credentialing must be completed every three (3) years.
34. MEDICAL DIRECTOR REQUIREMENTS
CONTRACTOR's Medical Director must, prior to the delivery of services under this
Contract, be enrolled with DHCS under applicable state regulations, screened in accordance with
42 CFR 455.450(a) as a "limited" categorical risk within a year prior to serving as a Medical
Director under this Agreement, and have a signed Medicaid provider agreement with DHCS as
required by 42 CFR 431.107.
Medical Directors shall receive a minimum of five (5) hours of continuing medical
education related to addiction medicine annually.
35. ASAM REQUIREMENTS
CONTRACTOR shall use COUNTY's American Society of Addiction Medicine
(ASAM) criteria assessment and re-assessment tools to determine the person served's level of
care. CONTRACTOR shall ensure that assessment of services for adolescents will follow the
ASAM adolescent treatment criteria.
CONTRACTOR and CONTRACTOR's staff shall comply with obtaining ASAM
Criteria training prior to providing services. CONTRACTOR shall ensure that, at minimum, staff
conducting assessments complete the two e-Training modules entitled "ASAM Multidimensional
Assessment", "From Assessment to Service Planning and Level of Care" and "Introduction to the
ASAM Criteria". CONTRACTOR shall maintain records of ASAM trainings in personnel files and
will make these records available to COUNTY upon request.
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Exhibit C
Page 16 of 22
Residential care CONTRACTORs must meet the established ASAM criteria for each
level of residential care provided and receive an ASAM Designation prior to providing DMC-ODS
services.
36. MEDICAL NECESSITY
CONTRACTOR shall ensure that an initial medical necessity determination, for an
individual to receive a DMC-ODS benefit, is performed through a face-to-face review or telehealth
by a Medical Director or a LPHA. If a person served's assessment and intake information are
completed by a counselor through a face-to-face review or telehealth, the Medical Director or
LPHA shall evaluate each person served's assessment and intake information with the counselor
to establish whether that person served meets medical necessity criteria. The ASAM Criteria shall
be applied to determine placement into the level of assessed services.
CONTRACTOR shall ensure that all ADULT persons served receive at least one
diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth Edition for
Substance-Related and Addictive Disorders. After establishing a diagnosis and documenting the
basis for diagnosis, the American Society of Addiction Medicine (ASAM) Placement Criteria shall
be applied by the diagnosing individual to for placement into the correct level of care.
CONTRACTOR shall periodically as directed by COUNTY, and at a minimum of
every six (6) months, reassess for continued medical necessity of an ongoing treatment. The
reassessment determination must be documented by the Medical Director, licensed physician or
LPHA as clinically appropriate.
OTP/NTP CONTRACTOR shall periodically as directed by COUNTY, and at a
minimum within two (2) years from admission and annually thereafter, reassess for continued
medical necessity of an ongoing treatment and determine that those services are still clinically
appropriate for that individual.
For Medical Necessity definition and Assessment and Reassessment timeframes
CONTRACTOR shall refer to the Provider Manual.
Individuals under age 21 are eligible to receive Medicaid services pursuant to the
Early Periodic Screening, Diagnostic and Treatment (EPSDT) mandate. Under the EPSDT
mandate, perons served under the age 21 are eligible to receive all appropriate and medically
necessary services needed to correct and ameliorate health conditions that are coverable under
section 1905(a) Medicaid authority. Nothing in the DMC-ODS shall override any EPSDT
requirements. Medical necessity for an adolescent individual (an individual under the age of 21) is
determined using the following criteria:
A. The adolescent individual may be assessed to be at-risk for developing a
SUD based on the following criteria:
1) Substance use does NOT meet the minimum diagnosis criteria per
the DSM 5; and
2) Reports of experimental or early-phase substance use, associated
biopsychosocial risk factors, and information gathered from the full
ASAM assessment and the At-Risk Determination Tool indicate risk
of developing an SUD.
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Exhibit C
Page 17 of 22
B. The adolescent individual must meet the ASAM adolescent treatment
criteria.
37. MEDI-CAL ELIGIBILITY VERIFICATION
CONTRACTOR shall be responsible for verifying the Medi-Cal eligibility of each
person served for each month of service prior to billing for DMC services for that month. Medi-Cal
eligibility verification should be performed prior to rendering service, in accordance with and as
described in the DHCS DMC Provider Billing Manual. Options for verifying the eligibility of a Medi-
Cal person served are described in the DHCS DMC Provider Billing Manual at the following web
address and by this reference incorporated herein.
https://www.dhcs.ca.gov/services/Documents/SUD%20-
%20DMC%20Billing%20Manual/DMC Billing Manual 2019%20Final.pdf
38. OTHER HEALTH COVERAGE BILLING REQUIREMENTS
In the event that a person served has Other Health Coverage (OHC),
CONTRACTOR shall bill the OHC prior to billing DMC to receive either payment from the OHC, or
a notice of denial from the OHC indicating that either the recipient's OHC coverage has been
exhausted or that the specific service is not a benefit of the OHC.
39. DMC REIMBURSEMENT RATE SETTING
CONTRACTOR shall submit financial and service data to COUNTY on an annual
basis in a format provide by, and by a deadline set by, COUNTY for reimbursement rate setting
purposes. COUNTY shall approve contractor-specific reimbursement rates for each modality
except NTPs. CONTRACTORs that do not comply with the requirements of the rate setting
process will be considered out of compliance with contractual requirements and will not receive
annual reimbursement rates CONTRACTORs that are non-compliant are subject to contract
termination.
Annual reimbursement rates for NTP services shall be set by DHCS pursuant to the
process set forth in W&I Code, Section 14021.51. NTP CONTRACTOR shall submit cost reports
to DHCS.
40. DMC CERTIFICATION AND ENROLLMENT
Prior to delivering SUD services CONTRACTOR shall obtain any licenses,
registrations, DMC certifications or approval to operate a SUD program or provide a covered
service in accordance with applicable laws and regulations. CONTRACTOR shall continuously
maintain any licenses, registrations, DMC certifications or approval to operate a SUD program or
provide a covered service in accordance with applicable laws and regulations for the duration of
this Contract. CONTRACTOR and any subcontractors shall comply with the following regulations
and guidelines:
A. Title 21, CFR Part 1300, et seq., Title 42, CFR, Part 8;
B. Title 22, Sections 51490.1(a);
C. Exhibit A, Attachment I, Article III.PP — Requirements for Services;
D. Title 9, Division 4, Chapter 4, Subchapter 1, Sections 10000, et seq.; and
17
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Exhibit C
Page 18 of 22
E. Title 22, Division 3, Chapter 3, sections 51000 et. seq.
41. PERINATAL CERTIFICATION REQUIREMENTS
CONTRACTORs of perinatal DMC services shall be properly certified to provide
these services and comply with the applicable requirements below:
A. Perinatal services shall address treatment and recovery issues specific to
pregnant and postpartum women, such as relationships, sexual and physical
abuse, and development of parenting skills.
B. Perinatal services shall include:
1) Mother/child habilitative and rehabilitative services (i.e., development
of parenting skills, training in child development, which may include
the provision of cooperative child care pursuant to Health and Safety
Code Section 1596.792);
2) Service access (i.e., provision of or arrangement for transportation to
and from medically necessary treatment);
3) Education to reduce harmful effects of alcohol and drugs on the
mother and fetus or the mother and infant; and
4) Coordination of ancillary services (i.e., assistance in accessing and
completing dental services, social services, community services,
educational/vocational training and other services which are
medically necessary to prevent risk to fetus or infant).
C. Medical documentation that substantiates the person served's pregnancy
and the last day of pregnancy shall be maintained in the person served file.
42. YOUTH TREATMENT GUIDELINES
CONTRACTOR shall follow the "Youth Treatment Guidelines," available at the
DHCS web address at: http://www.dhcs.ca.gov/individuals/Pages/youthSUDservices.aspx and by
this reference incorporated herein, in developing and implementing youth treatment programs
funded under this Agreement until such time new Youth Treatment Guidelines are established and
adopted. No formal amendment of this contract is required for new guidelines to apply.
43. CONTRACTOR CHANGE IN SERVICE OR LOCATION
CONTRACTOR shall ensure that any reduction of covered services or relocations
are not implemented until approval is issued by DHCS. CONTRACTOR must submit a new DMC
certification application to the DHCS Provider Enrollment Division (PED). The DMC certification
application shall be submitted to PED 60 days prior to the desired effective date of the reduction
of covered services or relocation.
CONTRACTOR shall notify COUNTY when its license, registration, certification, or
approval to operate a SUD program or provide a covered service is revoked, suspended,
modified, or not renewed by entities other than DHCS.
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Exhibit C
Page 19 of 22
44. MEDICATION ASSISTED TREATMENT
CONTRACTORs that do not provide medication assisted treatment shall have
procedures for linkage/integration for persons served requiring medication assisted treatment.
CONTRACTOR staff will regularly communicate with physicians of person served who are
prescribed these medications unless the person served refuses to consent to sign 42 CFR part 2
Compliant Releases of Information for this purpose.
45. EVIDENCE BASED PRACTICES (EBP)
CONTRACTOR shall implement Motivational Interviewing and at least two EBPs
prescribed by DHCS based on the timeline established by COUNTY as outlined in the Provider
Manual. The two additional required EBPs may be selected from the following: Cognitive-
Behavioral Therapy, Relapse Prevention, Trauma-Informed Treatment and Psycho-Education.
Three EBPs shall be utilized per service modality. COUNTY and DHCS will monitor the
implementation and regular training of EBPs to staff during reviews. CONTRACTOR shall ensure
that staff are internally monitored for training, quality of delivery and fidelity of Evidence Based
Practices.
46. COORDINATION AND CONTINUITY OF CARE WITH MANAGED CARE PLANS
CONTRACTOR shall coordinate with the Managed Care Plans, Anthem and
CaIVIVA Health, when appropriate, for comprehensive physical and behavioral health screening
and collaborative treatment planning. COUNTY shall maintain MOUs with the managed care
plans to facility person served care coordination and will monitor CONTRACTORs with regard to
the effectiveness of physical health care coordination.
47. POSTSERVICE POSTPAYMENT AND POSTSERVICE PREPAYMENT (PSPP)
DHCS shall conduct Postservice Postpayment and Postservice Prepayment (PSPP)
Utilization Reviews of contracted DMC providers to determine whether the DMC services were
provided. DHCS shall issue the PSPP report to the COUNTY with a copy to CONTRACTOR.
CONTRACTOR shall ensure any deficiencies are remediated and COUNTY shall attest the
deficiencies have been remediated.
All CONTRACTOR shall submit a COUNTY-approved corrective action plan (CAP)
to DHCS within 60 days of the date of the PSPP report. CONTRACTOR(S) that do not comply with
the CAP submittal requirements or fail to implement the approved CAP provisions within the
designated timeline are subject to payment withholding until compliance is determined.
48. DRUG SCREENING
Where drug screening by urinalysis is deemed medically appropriate,
CONTRACTOR shall establish procedures which protect against the falsification and/or
contamination of any urine sample and document urinalysis results in the person served's file.
49. TREATMENT RECORDING REQUIREMENTS
CONTRACTOR shall comply with the requirements outlined in the
Intergovernmental Agreement, Exhibit A, Attachment I, Section PP, regarding admission,
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Exhibit C
Page 20 of 22
assessment, person served record, medical necessity and diagnosis, physical examination,
treatment plan, sign-in sheets, progress notes, continuing services, and discharge.
50. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF
1996
If any of the work performed under this Agreement is subject to the HIPAA,
CONTRACTOR shall perform the work in compliance with all applicable provisions of HIPAA. As
identified in Exhibit F of the State County Intergovernmental Agreement, DHCS, COUNTY and
CONTRACTOR shall cooperate to ensure mutual agreement as to those transactions between
them, to which this Provision applies. Refer to Exhibit F for additional information.
A. Trading Partner Requirements
1) No Changes: CONTRACTOR hereby agrees that for the personal
health information (PHI), it shall not change any definition, data condition or use of a data element
or segment as proscribed in the federal Health and Human Services Transaction Standard
Regulation [45 CFR Part 162915(a)].
2) No Additions: CONTRACTOR hereby agrees that for PHI, it shall not
add any data elements or segments to the maximum data set as proscribed in the HHS
Transaction Standard Regulation [45CFR Part 162.915 (b)].
3) No Unauthorized Uses: CONTRACTOR hereby agrees that for PHI, it
shall not use any code or data elements that are marked `not used" in the in the HHS
Transactions Implementation specification or are not in the HHS Transaction Standard's
implementation specification [45CFR Part 162.915 (c)].
4) No Changes to Meaning or Intent: CONTRACTOR hereby agrees
that for PHI, it shall not change the meaning or intent of the HHS Transaction Standard's
implementation specification [45CFR Part 162.915 (d)].
B. Concurrence for Test Modifications to HHS Transaction Standards
CONTRACTOR agrees and understands that there exists the possibility that DHCS
or others may request an extension from the uses of a standard in the HHS Transaction
Standards. If this occurs, CONTRACTOR agrees that it shall participate in such test modifications.
C. Adequate Testing
CONTRACTOR is responsible to adequately test all business rules appropriate to
their types and specialties. If the CONTRACTOR is acting as a clearinghouse for enrolled
providers, CONTRACTOR has obligations to adequately test all business rules appropriate to
each and every provider type and specialty for which they provide clearinghouse services.
D. Deficiencies
The CONTRACTOR agrees to cure transactions errors or deficiencies identified by
DHCS, and transactions errors or deficiencies identified by an enrolled CONTRACTOR if the
COUNTY is acting as a clearinghouse for that CONTRACTOR. If the CONTRACTOR is a
clearinghouse, the CONTRACTOR agrees to properly communicate deficiencies and other
pertinent information regarding electronic transactions to enrolled CONTRACTORS for which they
provide clearinghouse services.
Revised 01/31/2022
Exhibit C
Page 21 of 22
E. Code Set Retention
Both COUNTY and CONTRACTOR understand and agree to keep open code sets
being processed or used in this Agreement for a least the current billing period or any appeal
period, whichever is longer.
F. Data Transmission Log
Both COUNTY and CONTRACTOR shall establish and maintain a Data
Transmission Log, which shall record any and all data transmissions taking place between the
Parties during the term of this Agreement. Each Party shall take necessary and reasonable steps
to ensure that such Data Transmission Logs constitute a current, accurate, complete and
unaltered record of any and all Data Transmissions between the Parties, and shall be retained by
each Party for no less than twenty-four (24) months following the date of the Data Transmission.
The Data Transmission Log may be maintained on computer media or other suitable means
provided that, if necessary to do so, the information contained in the Data Transmission Log may
be retrieved in a timely manner and presented in readable form.
51. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS
A. General Parity Requirement
CONTRACTOR shall not impose any financial requirements, Quantitative
Treatment Limitations, or Non-Quantitative Treatment Limitations in any classification of benefit
(inpatient, outpatient, emergency care, or prescription drugs) other than those limitations permitted
and outlined in the State-County Contract.
CONTRACTOR shall not apply any financial requirement or treatment
limitation to substance use disorder services in any classification of benefit that is more restrictive
than the predominant financial requirement or treatment limitation of that type applied to
substantially all medical/surgical benefits in the same classification of benefit furnished to person
served (whether or not the benefits are furnished by the CONTRACTOR). (42 CFR 438.910(b)(1))
CONTRACTOR shall provide substance use disorder services to person
served in every classification in which medical/surgical benefits are provided. (42 CFR
438.910(b)(2))
B. Quantitative Limitations
CONTRACTOR shall not apply any cumulative financial requirement for
substance use disorder services in a classification that accumulates separately from any
established for medical/surgical services in the same classification. (42 CFR 438.910(c)(3))
C. Non-Quantitative Limitations
CONTRACTOR shall not impose a non-quantitative treatment limitation for
substance use disorder benefits in any classification unless, under the policies and procedures of
CONTRACTOR as written and in operation, any processes, strategies, evidentiary standards, or
other factors used in applying the non-quantitative treatment limitation to substance use disorder
benefits in the classification are comparable to, and are applied no more stringently than, the
processes, strategies, evidentiary standards, or other factors used in applying the limitation for
medical/surgical benefits in the classification. (42 CFR §438.910(d))
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Exhibit C
Page 22 of 22
52. CONTRACTOR shall use processes, strategies, evidentiary standards, or other
factors in determining access to out-of-network providers for substance use disorder services that
are comparable to, and applied no more stringently than, the processes, strategies, evidentiary
standards, or other factors in determining access to out-of-network providers for medical/surgical
benefits. (42 CFR §438.910(d)(3)).
53. ACCESSIBILITY CONSIDERATIONS
CONTRACTOR shall ensure that their health programs or activities provided
through electronic and information technology are accessible to person served with disabilities,
unless doing so would result in undue financial and administrative burdens or a fundamental
alteration in the nature of the health programs or activities. When undue financial and
administrative burdens or a fundamental alteration exist, CONTRACTOR shall provide information
in a format other than an electronic format that would not result in such undue financial and
administrative burdens or a fundamental alteration but would ensure, to the maximum extent
possible, that person served with disabilities receive the benefits or services of the health program
or activity that are provided through electronic and information technology.
CONTRACTOR shall make reasonable modifications to policies, practices, or
procedures when such modifications are necessary to avoid discrimination on the basis of
disability, unless CONTRACTOR can demonstrate that making the modifications would
fundamentally alter the nature of the health program or activity. For the purposes of this section,
the term "reasonable modifications" shall be interpreted in a manner consistent with the term as
set forth in the ADA Title II regulation at 28 CFR 35.130(b)(7).
54. STATE PLAN COUNTIES OTP/NTP PERSONS SERVED
OTP CONTRACTORs shall ensure that a person served that resides in a county
that does not participate in DMC-ODS does not experience a disruption of OTP/NTP services. OTP
CONTRACTORs shall provide any medically necessary NTP services covered by the California
Medi-Cal State Plan to persons served that reside in a county that does not participate in DMC-
ODS. OTP CONTRACTORs who provide services to an out-of-county person served shall submit
claims for those services to the county in which the person served resides (according to MEDS).
PERSON SERVED RIGHTS
CONTRACTOR shall comply with any applicable Federal and state laws that pertain
to person served rights and shall ensure that its employees observe and protect those rights.
CONTRACTOR shall have written policies guaranteeing the person served's rights specified in 42
CFR 438.100.
RECORD RETENTION
CONTRACTORS shall maintain records for each service rendered, to whom it was
rendered, and the date of service, pursuant to WIC 14124.1 and 42 CFR 438.3(h) and 438.3(u).
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Exhibit D
Page 1 of 120
Forensic Behavioral Health-Continuum of Care OP MH SUD
Turning Point of Central California
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Records Technician 0.45 $ 19,948 $ 19,948
1102 Program Bookkeeper 0.45 19,948 19,948
1103 Secretary 1.00 43,304 43,304
1104
1105
1106 -
1107 -
1108 -
1109
1110
1111
1112
1113
1114
1115 -
Direct Personnel Admin Salaries Subtotal 1.90 $ 83,200 $ 83,200
Acct# Program Position FTE Admin Program Total
1116 Program Director 1.00 $ 75,265 $ 75,265
1117 Mental Health Professional 3.00 237,932 237,932
1118 Supervising PSC 1.00 62,804 62,804
1119 Substance Abuse Counselor 6.00 323,407 323,407
1120 Case Manager 2.00 95,834 95,834
1121 Intake Assistant 2.00 97,579 97,579
1122 Nurse 0.50 35,509 35,509
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 15.50 $ 928,330 $ 928,330
Admin Program Total
Direct Personnel Salaries Subtotal 17.40 $ 83,200 $ 928,330 $ 1,011,530
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,977 $ 31,622 $ 33,599
1202 Worker's Compensation 705 11,279 11,984
1203 Health Insurance 7,954 127,249 135,203
1204 Other Dental Insurance 624 9,989 10,613
1205 10therAccrued Paid Leave 6,380 1 102,067 108,447
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 2 of 120
1206 10ther ACI 1 20 316 336
Direct Employee Benefits Subtotal: $ 17,659 $ 282,523 $ 300,182
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 928 $ 14,854 $ 15,782
1302 FICA/MEDICARE 4,145 66,311 70,456
1303 SUI 962 15,390 16,352
1304 Other(specify) - -
1305 10ther(specify) -
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 6,035 $ 96,555 $ 102,590
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 106,894 $ 1,307,408 $ 1,414,302
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
8% 92%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 60,056
2003 Client Transportation&Support 6,000
2004 Clothing, Food,&Hygiene 1,500
2005 jEclucation Support 6,000
2006 Employment Support 2,500
2007 Household Items for Clients 2,000
2008 Medication Supports 3,000
2009 Program Supplies-Medical 1,000
2010 Utility Vouchers 4,000
2011 Other Client Activities 2,600
2012 Other Personal Needs 400
2013 Other Client Testing Material 10,000
2014 Other(specify) -
2015 Other(specify)
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 99,056
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 8,000
3002 Printing/Postage 3,400
3003 Office,Household&Program Supplies 12,000
3004 Advertising -
3005 Staff Development&Training 20,000
3006 Staff Mileage 1,000
3007 Subscriptions&Memberships 500
3008 Vehicle Maintenance 1,000
3009 Other Vehicle Insurance/Fuel 6,000
3010 Other Staff Meetings/Employee Relations 1,350
3011 Other Recruitment 5,000
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 58,250
4000:DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 3 of 120
Acct# Line Item Description Amount
4001 Building Maintenance $ 8,000
4002 Rent/Lease Building 90,000
4003 Rent/Lease Equipment 2,200
4004 Rent/Lease Vehicles -
4005 Security 1,200
4006 Utilities 20,000
4007 Other Equipment Maintenance 2,000
4008 Otherinsurance 5,000
4009 Other Depreciation Expense for Office 7,152
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 135,552
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) 35,500
5003 Contractual/Consulting Services (Specify) 18,457
5004 Translation Services 5,000
5005 Other Psychiatrist 75,000
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 133,957
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 1,500
6005 Insurance(Specify):
6006 Payroll Services 5,000
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT, Executive, Regional Supports 275,519
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify) -
6013 10ther(specify)
INDIRECT EXPENSES TOTAL $ 282,019
INDIRECT COST RATE 15.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 20,450
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 18,000
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)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 4 of 120
FIXED ASSETS EXPENSES TOTAL $ 38,450
TOTAL PROGRAM EXPENSES $ 2,161,586
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 59,260 4.70 $ 278,522
8002 Case Management 0 -
8003 Crisis Services 123 3.40 419
8004 Medication Support 14,900 8.46 126,054
8005 Collateral 59 4.70 277
8006 Plan Development 5,065 4.70 23,806
8007 Assessment 23,200 4.70 109,040
8008 Rehabilitation 0 - -
8009 Other(Specify) 0
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 1 102,6071 $ 538,117
Estimated%of Clients who are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 538,117
Federal Financial Participation(FFP)% 1 79% 425,113
MEDI-CAL FFP TOTAL $ 425,113
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ 578,993
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ 578,993
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 $ 300,000
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 JCFTN-Capital Facilities&Technology
MHSA TOTAL $ 300,000
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance -
8403 CCP AB109 857,481
8404 Other(Specify)
8405 10ther(Specify)
OTHER REVENUE TOTAL $ 857,481
TOTAL PROGRAM FUNDING SOURCES: $ 2,161,587
NET PROGRAM COST: $ (0)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 5 of 120
Forensic Behavioral Health - Continuum of Care
Provider Name
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
Records Technician FSC-FSP/Fresno 55%
Total 0.55
Position Contract#/Name/Department/County FTE
Program Bookkeeper FSC-FSP/Fresno 55%
Total 0.55
Position Contract#/Name/Department/County FTE
Nurse FSC-FSP/Fresno 50%
Total 0.50
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 6 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 7 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 8 of 120
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 9 of 120
Forensic Behavioral Health-Continuum of Care OP MH SUD
Turning Point of Central California
Fiscal Year(FY)2022-23 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,414,302
Administrative Positions 83,200
0.45 1101 Records Technician 19,948 The Records Technician will keep track of the Medical Records and will do the billing for
the program
0.45 1102 Program Bookkeeper 19,948 The Program Bookkeeperwill be assistingthe clients with their client fees fortheir
portion of rent if necessary and keeping track of all the incoming and outgoing of petty
cash as needed.
1.00 1103 Secretary 43,304 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions 928,330
1.00 1116 Program Director 75,265 The Program Director oversees the program and the hiring,training and supervising of
staff. There is an 8%reduction in salaries for accrued paid leave.When a staff takes
leave,the program is not changed since it's already been accrued.Our Positions are
based on class/step,some might be less and some might be more,all according to the
person's experience and education when they come to work for Turning Point.This
program requires a Bachelor Degree and SUD certification.
3.00 1117 Mental Health Professional 237,932 Provides mental health assessment,assessing for Medical Necessity,assists client in
identifying treatment plan goals according to diagnosis. MHP also provides individual
and group therapy as client requests,while also providing program support to assist
clients in crisis. One of the Mental Health Professionals will also be BBS
1.00 1118 Supervising PSC 62,804 Provides supervision to all Substance Abuse Conselors,Case Managers and Intake
Assistant to ensure client care,maintain compliance with Turning Point policies and
procedures. Supervisor also assisting in training new staff and reporting to the Program
Director.
6.00 1119 Substance Abuse Counselor 323,407 The Substance Abuse Counslor is responsible for the Substance Abuse Treatment
services in accordance with program requirements and ADP licensing.
2.00 1120 Case Manager 95,834 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC.
2.00 1121 Intake Assistant 97,579 The Intake Assistant processes all referrals related to this program.These services
include completeing all new admissions in a timely manner with the goal of opening the
client.
0.50 1122 Nurse 35,509 Nurses work with the doctors for Client care,maintaining compliance with Turning
Point policies and procedures,providing training and ensuring accurate charting in
accordance with Medi-cal.
1123 0 -
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 300,182
1201 Retirement 33,599 Cost of Agency contribution to employee retirement plans.This is based on 3%of the
whole salary.
1202 Worker's Compensation 11,984 Cost of workers compensation insurance
1203 Health Insurance 135,203 Agency cost for health insurance,our health plans vary on what the employee chooses.
This is the range Pere ployer cost from$399.15 per month to$1299.24 per month.
We used an average of$8000 per year.
1204 Other Dental Insurance 10,613 Agency cost for dental Insurance
1205 OtherAccrued Paid Leave 108,447 The monetary value of staff Paid Leave hours as the accrue on a monthly basis
1206 Other ACI 336 Employee assistance program
Fresno County Department ofBehavioral Fkahb Contract Budget Template Revised 4/10/2020
Exhibit D
Page 10 of 120
PROGRAM EXPENSE
ACCT#J LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
Direct Payroll Taxes&Expenses: 102,590
1301 OASDI 15,782 Disability Insurance
1302 FICA/MEDICARE 70,456 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and"Hospital Insurance"
(Medicare).
1303 SUI 16,352 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
wages are paid.
1304 Other(specify) -
1305 Other(specify) -
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 99,056
2001 Child Care -
2002 Client Housing Support 60,056 Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:
first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&
care,etc.)
2003 Client Transportation&Support 6,000 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 1,500 Cost of Client hygiene supplies and non-work related clothing.(examples:clothes,
shoes,soap,toothpaste,deodorant,grooming supplies,diapers,etc.)
2005 Education Support 6,000 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational classes.
2006 Employment Support 2,500 Cost of client pre-employment preparation and employement retention.(Examples:job
search and interview attire,work boots and tools required for employment,etc.)
2007 Household Items for Clients 2,000 Cost of purchasing items for clients home.(Examples:pots,pans,dishes,silverware,
telephone,radio,etc.)
2008 Medication Supports 3,000 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
co-pays,prescriptions,lab work not covered by insurance,over the counter
medications,first aid kits/supplies for clients use at home.
2009 Program Supplies-Medical 1,000 Cost of medical supplies to be used by staff or clients at the program location to meet
program objective.Such items are to remain at the program location and not sent
home with the client.Such items include,but are not limited to first aid kits,blood
pressure monitor,latex gloves,syringes,hazard disposal service,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility Vouchers 4,000 Cost of utility vouchers for a specific client.
2011 Other Client Activities 2,600 Cost for client activities&recreation events.(Examples:cable bill,
food/drinks/utensils/decorations needed for a specific client event,incentive rewards,
admission fees to events,etc.)
2012 Other Personal Needs 400 Cost of supplying clients with necessary personal items(Examples:birth certificate,
DMV Fee for ID or license,clients household cleaning products/house supplies,etc.)
2013 Other Client Testing Material 10,000 Testing materials as needed and required
2014 Other(specify) -
2015 Other(specify) -
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 58,250
3001 Telecommunications 8,000 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 3,400 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including delivery
by the USPS,UPS,FEDEX and other courier services
3003 Office,Household&Program Supplies 12,000 Cost of items normally used in an office setting.(Examples:pens,pencils,paper tablets,
paper clips,notepads,staples,non-electric staplers/hole punchers/calculators,and
other items normally used in an office setting.)House Supplies,Cost of supplies used by
staff during their scheduled work hours.These items are normally used to operate the
building at the program location.These items are to remain at program location and
not sent home with client.(Examples:pots,pans,pot holders,kitchen towels,curtains,
detergent,Clorox for clothes,can opener,dishes,furnace filter,decorations,linens,
etc.),Program Supplies,Cost of any items normally used by clients to meet program
objectives while receiving services.These items are to remain at the program location
and not sent home with the client.Such items include,but are not limited to video
tapes,printed handouts,desk reference books,research material,curriculum,puzzles,
board games,therapeutic/meditative supplies and other items that are specifically
designed and used to accomplish program goals.
3004 Advertising -
3005 Staff Development&Training 20,000 Cost of employee training courses and materials.
3006 Staff Mileage 1,000 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 500 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
Fresno County Depautrnent ofBehavioral Fleakb Contract Budget Template Revised 4/10/2020
Exhibit D
Page 11 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3008 Vehicle Maintenance 1,000 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
maintenance and repair of vehicles used by Agency programs.
3009 Other Vehicle Insurance/Fuel 6,000 Cost of gas in vehicles and insurance.
3010 Other Staff Meetings/Employee Relations 1,350 Staff Meetings:Cost of room and supplies necessary for staff meetings.Employee
Relations:Cost relating to improvement of working conditions(Examples:
Company picnic items,etc.)$10 per FTE per year budgeted for Employee Relations,
all other expenses are related to Staff Meetings.
3011 Other Recruitment 5,000 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3012 Other s eci
4000:DIRECT FACILITIES&EQUIPMENT 135,552
4001 Building Maintenance 8,000 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 90,000 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 2,200 Cost of rent/lease payments made for furniture and equipment leases.
4004 Rent/Lease Vehicles - Rental cost of vehicles and lease of agency vehicles.
4005 Security 1,200 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 20,000 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other Equipment Maintenance 2,000 Cost of equipment and furniture repair and maintenance.(Examples:high capacity
copier/printer/scanner,replacement parts such as hard drive,laptop battery,
monitor/printer/phone cord,drum,power strip,surge protector,video card,etc.)
4008 Other Insurance 5,000 Cost of liability and property insurance
4009 Other Depreciation Expense for Office 7,152 Cost of items depreciated at the progra,no pre owned by the agency.
4030 Other(specify)
5000:DIRECT SPECIAL EXPENSES 133,957
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 35,500 Avatar costs
5003 Contractual/Consulting Services(Specify) 18,457 These accounts are assigned to record various professional services provided by
contracted Consultant working as independent agents.Built in YOY escalator.
Professional services include vendors such as Credible Wireless Data Access and Valley
Expetec IT related expenses as well as clinical supervision.
5004 Translation Services 5,000 Paid to outside vendors for translation/interpreter services
5005 Other Psychiatrist 75,000 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify)
6000:INDIRECT EXPENSES 282,019
6001 Administrative Overhead -
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit 1,500 Cost of outside audit fees
6005 Insurance(Specify): -
6006 Payroll Services 5,000 This is our UKG timekeeping/HR system
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT,Executive,Regional 275,519 Support of corporate and regional offices such as processing invoices,payroll,cost
Supports reports,etc.
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify)
7000:DIRECT FIXED ASSETS 38,450
7001 Computer Equipment&Software 20,450 Computer and software as needed for the program.Obsolete Equip replacement as
well as initial purchase of equipment for newly budgeted/additional staff.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 18,000 Chairs or other furniture as needed for the program,replacement of damaged/worn
furniture as well as initial purchase of furniture for newly budgeted/additional staff.
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)
Fresno County Department ofBehavioral Heakb Contract Budget Template Revised 4/10/2020
Exhibit D
Page 12 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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 Based on Trends in our current contracts and the cost per unit currently
8002 Case Management Based on Trends in our current contracts and the cost per unit currently
8003 Crisis Services Based on Trends in our current contracts and the cost per unit currently
8004 Medication Support Based on Trends in our current contracts and the cost per unit currently
8005 Collateral Based on Trends in our current contracts and the cost per unit currently
8006 Plan Development Based on Trends in our current contracts and the cost per unit currently
8007 Assessment Based on Trends in our current contracts and the cost per unit currently
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 2,161,586
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 2,161,586
BUDGET CHECK: -
Fresno County Deparawnt ofBehavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 13 of 120
Forensic Behavioral Health-Continuum of Care OP MH SUD
Turning Point of Central California
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Records Technician 0.45 $ 20,347 $ 20,347
1102 Program Bookkeeper 0.45 20,347 20,347
1103 Secretary 1.00 44,170 44,170
1104
1105
1106 -
1107 -
1108 -
1109
1110
1111
1112
1113
1114
1115 -
Direct Personnel Admin Salaries Subtotal 1.90 $ 84,865 $ 84,865
Acct# Program Position FTE Admin Program Total
1116 Program Director 1.00 $ 76,771 $ 76,771
1117 Mental Health Professional 3.00 242,690 242,690
1118 Supervising PSC 1.00 64,060 64,060
1119 Substance Abuse Counselor 6.00 329,876 329,876
1120 Case Manager 2.00 97,750 97,750
1121 Intake Assistant 2.00 99,531 99,531
1122 Nurse 0.50 36,220 36,220
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 15.50 $ 946,897 $ 946,897
Admin Program Total
Direct Personnel Salaries Subtotal 17.40 $ 84,865 $ 946,897 $ 1,031,761
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 2,017 $ 32,254 $ 34,271
1202 Worker's Compensation 719 11,504 12,223
1203 Health Insurance 8,116 129,791 137,907
1204 Other Dental Insurance 637 10,188 10,825
1205 10therAccrued Paid Leave 6,510 104,106 110,616
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 14 of 120
1206 10ther ACI 1 20 1 323 1 343
Direct Employee Benefits Subtotal:1 $ 18,019 $ 288,166 $ 306,185
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 947 $ 15,150 $ 16,098
1302 FICA/MEDICARE 4,229 67,636 71,865
1303 SUI 982 15,697 16,679
1304 Other(specify) -
1305 10ther(specify)
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 6,158 $ 98,483 $ 104,642
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 109,042 $ 1,333,546 $ 1,442,589
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
8% 92%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 59,200
2003 Client Transportation&Support 6,120
2004 Clothing, Food,&Hygiene 1,530
2005 jEclucation Support 6,120
2006 Employment Support 2,550
2007 Household Items for Clients 2,040
2008 Medication Supports 3,060
2009 Program Supplies-Medical 1,020
2010 Utility Vouchers 4,080
2011 Other Client Activities 2,652
2012 Other Personal Needs 408
2013 Other Client Testing Material 10,200
2014 Other(specify) -
2015 Other(specify)
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $ 98,980
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 8,160
3002 Printing/Postage 3,468
3003 Office,Household&Program Supplies 12,240
3004 Advertising -
3005 Staff Development&Training 10,000
3006 Staff Mileage 1,020
3007 Subscriptions&Memberships 510
3008 Vehicle Maintenance 1,020
3009 Other Vehicle Insurance/Fuel 6,120
3010 Other Staff Meetings/Employee, Employer Relations 1,377
3011 Other Recruitment 5,100
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 49,015
4000:DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 15 of 120
Acct# Line Item Description Amount
4001 Building Maintenance $ 8,160
4002 Rent/Lease Building 91,800
4003 Rent/Lease Equipment 2,244
4004 Rent/Lease Vehicles -
4005 Security 1,224
4006 Utilities 20,400
4007 Other Equipment Maintenance 2,040
4008 Otherinsurance 5,100
4009 Other Depreciation Expense for Office 7,295
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 138,263
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) 36,210
5003 Contractual/Consulting Services (Specify) 18,826
5004 Translation Services 5,100
5005 Other Psychiatrist 76,500
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 136,636
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 1,530
6005 Insurance(Specify):
6006 Payroll Services 5,100
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT, Executive, Regional Supports 274,174
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify) -
6013 10ther(specify)
INDIRECT EXPENSES TOTAL $ 280,804
INDIRECT COST RATE 15.00%
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 3,000
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)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 16 of 120
FIXED ASSETS EXPENSES TOTAL $ 6,000
TOTAL PROGRAM EXPENSES $ 2,152,287
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 59,260 4.70 $ 278,522
8002 Case Management 0 -
8003 Crisis Services 123 3.40 419
8004 Medication Support 14,900 8.46 126,054
8005 Collateral 59 4.70 277
8006 Plan Development 5,065 4.70 23,806
8007 Assessment 23,200 4.70 109,040
8008 Rehabilitation 0 - -
8009 Other(Specify) 0
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 1 102,6071 $ 538,117
Estimated%of Clients who are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 538,117
Federal Financial Participation(FFP)% 1 79% 425,113
MEDI-CAL FFP TOTAL $ 425,113
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ 569,693
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ 569,693
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 $ 300,000
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 JCFTN-Capital Facilities&Technology
MHSA TOTAL $ 300,000
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance -
8403 CCP AB109 857,481
8404 Other(Specify)
8405 10ther(Specify)
OTHER REVENUE TOTAL $ 857,481
TOTAL PROGRAM FUNDING SOURCES: $ 2,152,287
NET PROGRAM COST: $ 0
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 17 of 120
Forensic Behavioral Health - Continuum of Care
Turning Point of Central California
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 %
Records Technician FSC-FSP/Fresno 55%
Total 0.55
Position Contract#/Name/Department/County FTE %
Program Bookkeeper FSC-FSP/Fresno 55%
Total 0.55
Position Contract#/Name/Department/County FTE %
Nurse FSC-FSP/Fresno so%
Total 0.50
Position Contract#/Name/Department/County FTE %
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 18 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Pa e 19 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 20 of 120
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 21 of 120
Forensic Behavioral Health-Continuum of Care OP MH SUD
Turning Point of Central California
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 1,442,589
Administrative Positions 84,865
1101 Records Technician 20,347 The Records Technician will keep track of the Medical Records and will do the billing
for the program
1102 Program Bookkeeper 20,347 The Program Bookkeeper will be assisting the clients with their client fees for their
portion of rent if necessary and keeping track of all the incoming and outgoing of
petty cash as needed.
1103 Secretary 44,170 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.
1104 0 -
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0 -
Program Positions 946,897
1116 Program Director 76,771 The Program Director oversees the program and the hiring,training and supervising of
staff. There is an 8%reduction in salaries for accrued paid leave.When a staff takes
leave,the program is not changed since it's already been accrued.Our Positions are
based on class/step,some might be less and some might be more,all according to the
person's experience and education when they come to work for Turning Point.This
program requires a Bachelor Degree and SLID certification.There is a slight increase in
salaries from previous year for COLA.
1117 Mental Health Professional 242,690 Provides mental health assessment,assessing for Medical Necessity,assists client in
identifying treatment plan goals according to diagnosis. MHP also provides individual
and group therapy as client requests,while also providing program support to assist
clients in crisis.
1118 Supervising PSC 64,060 Provides supervision to all Substance Abuse Conselors,Case Managers and Intake
Assistant to ensure client care,maintain compliance with Turning Point policies and
procedures. Supervisor also assisting in training new staff and reporting to the
Program Director.
1119 Substance Abuse Counselor 329,876 The Substance Abuse Counslor is responsible for the Substance Abuse Treatment
services in accordance with program requirements and ADP licensing.
1120 Case Manager 97,750 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC.
1121 Intake Assistant 99,531 The Intake Assistant processes all referrals related to this program.These services
include completeing all new admissions in a timely manner with the goal of opening
the client.
1122 Nurse 36,220 Nurses work with the doctors for Client care,maintaining compliance with Turning
Point policies and procedures,providing training and ensuring accurate charting in
accordance with Medi-cal.
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 306,185
1201 Retirement 34,271 Cost of Agency contribution to employee retirement plans.This is based on 3%of the
whole salary.
1202 Worker's Compensation 12,223 Cost of workers compensation insurance.
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/102020
Exhibit D
Page 22 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1203 Health Insurance 137,907 Agency cost for health insurance,our health plans vary on what the employee
chooses.This is the range per employer cost from$399.15 per month to$1299.24 per
month.We used an average of$8000 per year.
1204 Other Dental Insurance 10,825 Agency cost for dental Insurance
1205 Other Accrued Paid Leave 110,616 The monetary value of staff Paid Leave hours as the accrue on a monthly basis
1206 Other ACI 1 343 1 Employee assistance program
Direct Payroll Taxes&Expenses: 104,642
1301 OASDI 16,098 Disability Insurance
1302 FICA/MEDICARE 71,865 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and"Hospital Insurance"
(Medicare).
1303 SUI 16,679 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
wages are paid.
1304 Other(specify) -
1305 Other(specify)
1306 1 Other(specify)
2000:DIRECT CLIENT SUPPORT 98,980
2001 Child Care
2002 Client Housing Support 59,200 Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:
first/last month deposit,late fees,monthly rent,hotel charges,room&board,board
&care,etc.)
2003 Client Transportation&Support 6,120 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 1,530 Cost of Client hygiene supplies and non-work related clothing.(examples:clothes,
shoes,soap,toothpaste,deodorant,grooming supplies,diapers,etc.)
2005 Education Support 6,120 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational classes.
2006 Employment Support 2,550 Cost of client pre-employment preparation and employement retention.(Examples:
job search and interview attire,work boots and tools required for employment,etc.)
2007 Household Items for Clients 2,040 Cost of purchasing items for clients home.(Examples:pots,pans,dishes,silverware,
telephone,radio,etc.)
2008 Medication Supports 3,060 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
co-pays,prescriptions,lab work not covered by insurance,over the counter
medications,first aid kits/supplies for clients use at home.
2009 Program Supplies-Medical 1,020 Cost of medical supplies to be used by staff or clients at the program location to meet
program objective.Such items are to remain at the program location and not sent
home with the client.Such items include,but are not limited to first aid kits,blood
pressure monitor,latex gloves,syringes,hazard disposal service,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility Vouchers 4,080 Cost of utility vouchers for a specific client.
2011 Other Client Activities 2,652 Cost for client activities&recreation events.(Examples:cable bill,
food/drinks/utensils/decorations needed for a specific client event,incentive rewards,
admission fees to events,etc.)
2012 Other Personal Needs 408 Cost of supplying clients with necessary personal items(Examples:birth certificate,
DMV Fee for ID or license,clients household cleaning products/house supplies,etc.)
2013 Other Client Testing Material 10,200 Testing materials as needed and required
2014 Other(specify) -
2015 Other(specify)
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 49,015
3001 Telecommunications 8,160 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 3,468 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including
delivery by the USPS,UPS,FEDEX and other courier services
Fresno County Department ofBehavioml Health Contract Budget Template Revised 4/102020
Exhibit D
Page 23 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3003 Office,Household&Program Supplies 12,240 Cost of items normally used in an office setting.(Examples:pens,pencils,paper
tablets,paper clips,notepads,staples,non-electric staplers/hole
punchers/calculators,and other items normally used in an office setting.)House
Supplies,Cost of supplies used by staff during their scheduled work hours.These
items are normally used to operate the building at the program location.These items
are to remain at program location and not sent home with client.(Examples:pots,
pans,pot holders,kitchen towels,curtains,detergent,Clorox for clothes,can opener,
dishes,furnace filter,decorations,linens,etc.),Program Supplies,Cost of any items
normally used by clients to meet program objectives while receiving services.These
items are to remain at the program location and not sent home with the client.Such
items include,but are not limited to video tapes,printed handouts,desk reference
books,research material,curriculum,puzzles,board games,therapeutic/meditative
supplies and other items that are specifically designed and used to accomplish
program goals.
3004 Advertising -
3005 Staff Development&Training 10,000 Cost of employee training courses and materials.
3006 Staff Mileage 1,020 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 510 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
3008 Vehicle Maintenance 1,020 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated
with maintenance and repair of vehicles used by Agency programs.
3009 Other Vehicle insurance/Fuel 6,120 Cost of gas in vehicles and insurance.
3010 Other Staff Meetings/Employee,Employer Relations 1,377 Staff Meetings:Cost of room and supplies necessary for staff meetings.Employee
Relations:Cost relating to improvement of working conditions(Examples:
Company picnic items,etc.)$10 per FTE per year budgeted for Employee Relations,
all other expenses are related to Staff Meetings.
3011 Other Recruitment 5,100 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 138,263
4001 Building Maintenance 8,160 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 91,800 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 2,244 Cost of rent/lease payments made for furniture and equipment leases.
4004 Rent/Lease Vehicles - Rental cost of vehicles and lease of agency vehicles.
4005 Security 1,224 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 20,400 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other Equipment Maintenance 2,040 Cost of equipment and furniture repair and maintenance.(Examples:high capacity
copier/printer/scanner,replacement parts such as hard drive,laptop battery,
monitor/printer/phone cord,drum,power strip,surge protector,video card,etc.)
4008 Other Insurance 5,100 Cost of liability and property insurance
4009 Other Depreciation Expense for Office 7,295 Cost of items depreciated at the progra,no pre owned by the agency.
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 136,636
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 36,210 Avatar costs
5003 Contractual/Consulting Services (Specify) 18,826 These accounts are assigned to record various professional services provided by
contracted Consultant working as independent agents.Built in YOY escalator.
Professional services include vendors such as Credible Wireless Data Access and Valley
Expetec IT related expenses as well as clinical supervision.
5004 Translation Services 5,100 Paid to outside vendors for translation/interpreter services
5005 Other Psychiatrist 76,500 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 280,804
6001 Administrative Overhead
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/102020
Exhibit D
Page 24 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit 1,530 Cost of outside audit fees
6005 Insurance(Specify): -
6006 Payroll Services 5,100 This is our UKG timekeeping/HR system
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT,Executive,Regional 274,174 Support of corporate and regional offices such as processing invoices,payroll,cost
Supports reports,etc.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 6,000
7001 Computer Equipment&Software 3,000 Computer and software as needed for the program
7002 Copiers,Cell Phones,Tablets,Devices to Contain -
7003 Furniture&Fixtures 3,000 Chairs or other furniture as needed for the program
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 Based on Trends in our current contracts and the cost per unit currently
8002 Case Management Based on Trends in our current contracts and the cost per unit currently
8003 Crisis Services Based on Trends in our current contracts and the cost per unit currently
8004 Medication Support Based on Trends in our current contracts and the cost per unit currently
8005 Collateral Based on Trends in our current contracts and the cost per unit currently
8006 Plan Development Based on Trends in our current contracts and the cost per unit currently
8007 Assessment Based on Trends in our current contracts and the cost per unit currently
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 2,152,287
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 2,152,287
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/102020
Exhibit D
Page 25 of 120
Forensic Behavioral Health-Continuum of Care OP MH SUD
Turning Point of Central California
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Records Technician 0.45 $ 20,754 $ 20,754
1102 Program Bookkeeper 0.45 20,754 20,754
1103 Secretary 1.00 45,053 45,053
1104 -
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111
1112
1113
1114
1115 -
Direct Personnel Admin Salaries Subtotal 1.90 $ 86,562 $ 86,562
Acct# Program Position FTE Admin Program Total
1116 Program Director 1.00 $ 78,306 $ 78,306
1117 Mental Health Professional 3.00 247,544 247,544
1118 Supervising PSC 1.00 65,341 65,341
1119 Substance Abuse Counselor 6.00 336,473 336,473
1120 Case Manager 2.00 99,705 99,705
1121 Intake Assistant 2.00 101,521 101,521
1122 Nurse 0.50 36,944 36,944
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 15.50 $ 965,835 $ 965,835
Admin Program Total
Direct Personnel Salaries Subtotal 17.40 $ 86,562 $ 965,835 $ 1,052,397
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 2,057 $ 32,900 $ 34,957
1202 Worker's Compensation 734 11,734 12,468
1203 Health Insurance 8,278 132,387 140,665
1204 Other Dental Insurance 650 10,392 11,042
1205 10therAccrued Paid Leave 6,640 106,188 112,828
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 26 of 120
1206 10ther ACI 1 211 329 350
Direct Employee Benefits Subtotal: $ 18,380 $ 293,929 $ 312,309
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 966 $ 15,453 $ 16,420
1302 FICA/MEDICARE 4,314 68,989 73,303
1303 SUI 1,001 16,011 17,012
1304 Other(specify) -
1305 10ther(specify)
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 6,281 $ 100,453 $ 106,735
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 111,223 $ 1,360,217 $ 1,471,440
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
8% 92%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 60,384
2003 Client Transportation&Support 6,242
2004 Clothing, Food,&Hygiene 1,561
2005 jEclucation Support 6,242
2006 Employment Support 2,601
2007 Household Items for Clients 2,081
2008 Medication Supports 3,121
2009 Program Supplies-Medical 1,040
2010 Utility Vouchers 4,162
2011 Other Client Activities 2,705
2012 Other Personal Needs 416
2013 Other Client Testing Material 10,404
2014 Other(specify) -
2015 Other(specify)
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $ 100,960
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 8,323
3002 Printing/Postage 3,537
3003 Office,Household&Program Supplies 12,485
3004 Advertising -
3005 Staff Development&Training 10,200
3006 Staff Mileage 1,040
3007 Subscriptions&Memberships 520
3008 Vehicle Maintenance 1,040
3009 Other Vehicle Insurance/Fuel 6,242
3010 Other Staff Meetings/Employee, Employer Relations 1,405
3011 Other Recruitment 5,202
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 49,995
4000:DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 27 of 120
Acct# Line Item Description Amount
4001 Building Maintenance $ 8,323
4002 Rent/Lease Building 93,636
4003 Rent/Lease Equipment 2,289
4004 Rent/Lease Vehicles -
4005 Security 1,248
4006 Utilities 20,808
4007 Other Equipment Maintenance 2,081
4008 Otherinsurance 5,202
4009 Other Depreciation Expense for Office 7,441
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 141,028
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) 36,934
5003 Contractual/Consulting Services (Specify) 19,203
5004 Translation Services 5,202
5005 Other Psychiatrist 78,030
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 139,369
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 1,561
6005 Insurance(Specify):
6006 Payroll Services 5,202
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT, Executive, Regional Supports 279,651
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify) -
6013 10ther(specify)
INDIRECT EXPENSES TOTAL $ 286,414
INDIRECT COST RATE 15.00%
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 3,000
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)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 28 of 120
FIXED ASSETS EXPENSES TOTAL $ 6,000
TOTAL PROGRAM EXPENSES $ 2,195,207
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 61,589 4.70 $ 289,468
8002 Case Management 0 -
8003 Crisis Services 128 3.40 435
8004 Medication Support 15,486 8.46 131,008
8005 Collateral 61 4.70 288
8006 Plan Development 5,264 4.70 24,741
8007 Assessment 24,112 4.70 113,325
8008 Rehabilitation 0 - -
8009 Other(Specify) 0
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 1 106,6391 $ 559,265
Estimated%of Clients who are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 559,265
Federal Financial Participation(FFP)% 1 79% 441,820
MEDI-CAL FFP TOTAL $ 441,820
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ 595,906
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ 595,906
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 $ 300,000
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 JCFTN-Capital Facilities&Technology
MHSA TOTAL $ 300,000
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance -
8403 CCP AB109 857,481
8404 Other(Specify)
8405 10ther(Specify)
OTHER REVENUE TOTAL $ 857,481
TOTAL PROGRAM FUNDING SOURCES: $ 2,195,207
NET PROGRAM COST: $ (0)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 29 of 120
Forensic Behavioral Health - Continuum of Care
Turning Point of Central California
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 %
Records Technician FSC-FSP/Fresno 55%
Total 0.55
Position Contract#/Name/Department/County FTE %
Program Bookkeeper FSC-FSP/Fresno 55%
Total 0.55
Position Contract#/Name/Department/County FTE %
Nurse FSC-FSP/Fresno so%
Total 0.50
Position Contract#/Name/Department/County FTE %
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 30 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Pa e 31 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 32 of 120
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 33 of 120
Forensic Behavioral Health-Continuum of Care OP MH SUD
Turning Point of Central California
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,471,440
Administrative Positions 86,562
1101 Records Technician 20,754 The Records Technician will keep track of the Medical Records and will do the billing
for the program
1102 Program Bookkeeper 20,754 The Program Bookkeeper will be assisting the clients with their client fees for their
portion of rent if necessary and keeping track of all the incoming and outgoing of petty
cash as needed.
1103 Secretary 45,053 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.
1104 0 -
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 965,835
1116 Program Director 78,306 The Program Director oversees the program and the hiring,training and supervising of
staff. There is an 8%reduction in salaries for accrued paid leave.When a staff takes
leave,the program is not changed since it's already been accrued.Our Positions are
based on class/step,some might be less and some might be more,all according to the
person's experience and education when they come to work for Turning Point.This
program requires a Bachelor Degree and SLID certification.There is a slight increase in
salaries from previous year for COLA.
1117 Mental Health Professional 247,544 Provides mental health assessment,assessing for Medical Necessity,assists client in
identifying treatment plan goals according to diagnosis. MHP also provides individual
and group therapy as client requests,while also providing program support to assist
clients in crisis. One of the Mental Health Professionals will also be BBS
1118 Supervising PSC 65,341 Provides supervision to all Substance Abuse Conselors,Case Managers and Intake
Assistant to ensure client care,maintain compliance with Turning Point policies and
procedures. Supervisor also assisting in training new staff and reporting to the
Program Director.
1119 Substance Abuse Counselor 336,473 The Substance Abuse Counslor is responsible for the Substance Abuse Treatment
services in accordance with program requirements and ADP licensing.
1120 Case Manager 99,705 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC.
1121 Intake Assistant 101,521 The Intake Assistant processes all referrals related to this program.These services
include completeing all new admissions in a timely manner with the goal of opening
the client.
1122 Nurse 36,944 Nurses work with the doctors for Client care,maintaining compliance with Turning
Paint policies and procedures,providing training and ensuring accurate charting in
accordance with Medi-cal.
1123 0 -
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 312,309
1201 Retirement 34,957 Cost of Agency contribution to employee retirement plans.This is based on 3%of the
whole salary.
1202 Worker's Compensation 12,468 Cost of workers compensation insurance.
1203 Health Insurance 140,665 Agency cost for health insurance,our health plans vary on what the employee chooses.
This is the range per employer cost from$399.15 per month to$1299.24 per month.
We used an average of$8000 per year.
1204 Other Dental Insurance 11,042 Agency cost for dental Insurance
Fresno County Deparanent of Behavioral Fcakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 34 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1205 Other Accrued Paid Leave 112,828 The monetary value of staff Paid Leave hours as the accrue on a monthly basis
1206 Other ACI 350 Employee assistance program
Direct Payroll Taxes&Expenses: 106,735
1301 OASDI 16,420 Disability Insurance
1302 FICA/MEDICARE 73,303 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and"Hospital Insurance"
(Medicare).
1303 SUI 17,012 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
wages are paid.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 100,960
2001 Child Care
2002 Client Housing Support 60,384 Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:
first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&
care,etc.)
2003 Client Transportation&Support 6,242 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 1,561 Cost of Client hygiene supplies and non-work related clothing.(examples:clothes,
shoes,soap,toothpaste,deodorant,grooming supplies,diapers,etc.)
2005 Education Support 6,242 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational classes.
2006 Employment Support 2,601 Cost of client pre-employment preparation and employement retention.(Examples:
job search and interview attire,work boots and tools required for employment,etc.)
2007 Household Items for Clients 2,081 Cost of purchasing items for clients home.(Examples:pots,pans,dishes,silverware,
telephone,radio,etc.)
2008 Medication Supports 3,121 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
co-pays,prescriptions,lab work not covered by insurance,over the counter
medications,first aid kits/supplies for clients use at home.
2009 Program Supplies-Medical 1,040 Cost of medical supplies to be used by staff or clients at the program location to meet
program objective.Such items are to remain at the program location and not sent
home with the client.Such items include,but are not limited to first aid kits,blood
pressure monitor,latex gloves,syringes,hazard disposal service,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility Vouchers 4,162 Cost of utility vouchers for a specific client.
2011 Other Client Activities 2,705 Cost for client activities&recreation events.(Examples:cable bill,
food/drinks/utensils/decorations needed for a specific client event,incentive rewards,
admission fees to events,etc.)
2012 Other Personal Needs 416 Cost of supplying clients with necessary personal items(Examples:birth certificate,
DMV Fee for ID or license,clients household cleaning products/house supplies,etc.)
2013 Other Client Testing Material 10,404 Testing materials as needed and required
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 49,995
3001 Telecommunications 8,323 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 3,537 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including delivery
by the LISPS,UPS,FEDEX and other courier services
3003 Office,Household&Program Supplies 12,485 Cost of items normally used in an office setting.(Examples:pens,pencils,paper
tablets,paper clips,notepads,staples,non-electric staplers/hole punchers/calculators,
and other items normally used in an office setting.)House Supplies,Cost of supplies
used by staff during their scheduled work hours.These items are normally used to
operate the building at the program location.These items are to remain at program
location and not sent home with client.(Examples:pots,pans,pot holders,kitchen
towels,curtains,detergent,Clorox for clothes,can opener,dishes,furnace filter,
decorations,linens,etc.),Program Supplies,Cost of any items normally used by clients
to meet program objectives while receiving services.These items are to remain at the
program location and not sent home with the client.Such items include,but are not
limited to video tapes,printed handouts,desk reference books,research material,
curriculum,puzzles,board games,therapeutic/meditative supplies and other items
that are specifically designed and used to accomplish program goals.
3004 Advertising -
3005 Staff Development&Training 10,200 Cost of employee training courses and materials.
Fresno County apartment of Behavioral Beakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 35 of 120
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3006 Staff Mileage 1,040 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 520 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
3008 Vehicle Maintenance 1,040 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
maintenance and repair of vehicles used by Agency programs.
3009 Other Vehicle Insurance/Fuel 6,242 Cost of gas in vehicles and insurance.
3010 Other Staff Meetings/Employee,Employer Relations 1,405 Staff Meetings:Cost of room and supplies necessary for staff meetings.Employee
Relations:Cost relating to improvement of working conditions(Examples:
Company picnic items,etc.)$10 per FTE per year budgeted for Employee Relations,
all other expenses are related to Staff Meetings.
3011 Other Recruitment 5,202 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 141,028
4001 Building Maintenance 8,323 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 93,636 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 2,289 Cost of rent/lease payments made for furniture and equipment leases.
4004 Rent/Lease Vehicles - Rental cost of vehicles and lease of agency vehicles.
4005 Security 1,248 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 20,808 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other Equipment Maintenance 2,081 Cost of equipment and furniture repair and maintenance.(Examples:high capacity
copier/printer/scanner,replacement parts such as hard drive,laptop battery,
monitor/printer/phone cord,drum,power strip,surge protector,video card,etc.)
4008 Other Insurance 5,202 Cost of liability and property insurance
4009 Other Depreciation Expense for Office 7,441 Cost of items depreciated at the progra,no pre owned by the agency.
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 139,369
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 36,934 Avatar casts
5003 Contractual/Consulting Services (Specify) 19,203 These accounts are assigned to record various professional services provided by
contracted Consultant working as independent agents.Built in YOY escalator.
Professional services include vendors such as Credible Wireless Data Access and Valley
Expetec IT related expenses as well as clinical supervision.
5004 Translation Services 5,202 Paid to outside vendors for translation/interpreter services
5005 Other Psychiatrist 78,030 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 286,414
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit 1,561 Cost of outside audit fees
6005 Insurance(Specify): -
6006 Payroll Services 5,202 This is our UKG timekeeping/HR system
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT,Executive,Regional 279,651 Support of corporate and regional offices such as processing invoices,payroll,cast
Supports reports,etc.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 6,000
7001 Computer Equipment&Software 3,000 Computer and software as needed for the program
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 3,000 Chairs or other furniture as needed for the program
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)
Fresno County Depamnent of Behavioral Beakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 36 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORTIDOYLE 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 Based on Trends in our current contracts and the cost per unit currently
8002 Case Management Based on Trends in our current contracts and the cost per unit currently
8003 Crisis Services Based on Trends in our current contracts and the cost per unit currently
8004 Medication Support Based on Trends in our current contracts and the cost per unit currently
8005 Collateral Based on Trends in our current contracts and the cost per unit currently
8006 Plan Development Based on Trends in our current contracts and the cost per unit currently
8007 Assessment Based on Trends in our current contracts and the cost per unit currently
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 2,195,206
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 2,195,207
BUDGET CHECK: 1
Fresno County Deparanent of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 37 of 120
Forensic Behavioral Health-Continuum of Care OP MH SUD
Turning Point of Central California
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Records Technician 0.45 $ 21,169 $ 21,169
1102 Program Bookkeeper 0.45 21,169 21,169
1103 Secretary 1.00 45,954 45,954
1104
1105
1106 -
1107 -
1108 -
1109
1110
1111
1112
1113
1114
1115 -
Direct Personnel Admin Salaries Subtotal 1.90 $ 88,292 $ 88,292
Acct# Program Position FTE Admin Program Total
1116 Program Director 1.00 $ 79,872 $ 79,872
1117 Mental Health Professional 3.00 252,495 252,495
1118 Supervising PSC 1.00 66,648 66,648
1119 Substance Abuse Counselor 6.00 343,203 343,203
1120 Case Manager 2.00 101,699 101,699
1121 Intake Assistant 2.00 103,552 103,552
1122 Nurse 0.45 37,683 37,683
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 15.45 $ 985,151 $ 985,151
Admin Program Total
Direct Personnel Salaries Subtotal 17.35 $ 88,292 $ 985,151 $ 1,073,444
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 2,098 $ 33,557 $ 35,656
1202 Worker's Compensation 748 11,969 12,717
1203 Health Insurance 8,444 135,034 143,478
1204 Other Dental Insurance 663 10,600 11,263
1205 10therAccrued Paid Leave 6,773 108,312 115,085
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 38 of 120
1206 10ther ACI 1 211 336 357
Direct Employee Benefits Subtotal: $ 18,747 $ 299,808 $ 318,555
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 986 $ 15,763 $ 16,748
1302 FICA/MEDICARE 4,400 70,368 74,769
1303 SUI 1,021 16,331 17,353
1304 Other(specify) -
1305 10ther(specify)
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 6,407 $ 102,462 $ 108,869
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 113,447 $ 1,387,422 $ 1,500,868
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
8% 92%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 60,384
2003 Client Transportation&Support 6,242
2004 Clothing, Food,&Hygiene 1,561
2005 jEclucation Support 6,242
2006 Employment Support 2,601
2007 Household Items for Clients 2,081
2008 Medication Supports 3,121
2009 Program Supplies-Medical 1,040
2010 Utility Vouchers 4,162
2011 Other Client Activities 2,705
2012 Other Personal Needs 416
2013 Other Client Testing Material 10,404
2014 Other(specify) -
2015 Other(specify)
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $ 100,960
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 8,323
3002 Printing/Postage 3,537
3003 Office,Household&Program Supplies 12,485
3004 Advertising -
3005 Staff Development&Training 10,200
3006 Staff Mileage 1,040
3007 Subscriptions&Memberships 520
3008 Vehicle Maintenance 1,040
3009 Other Vehicle Insurance/Fuel 6,242
3010 Other Staff Meetings/Employee, Employer Relations 1,405
3011 Other Recruitment 5,202
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 49,995
4000:DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 39 of 120
Acct# Line Item Description Amount
4001 Building Maintenance $ 8,323
4002 Rent/Lease Building 93,636
4003 Rent/Lease Equipment 2,289
4004 Rent/Lease Vehicles -
4005 Security 1,248
4006 Utilities 20,808
4007 Other Equipment Maintenance 2,081
4008 Otherinsurance 5,202
4009 Other Depreciation Expense for Office 7,441
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 141,028
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) 36,934
5003 Contractual/Consulting Services (Specify) 19,203
5004 Translation Services 5,202
5005 Other Psychiatrist 78,030
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 139,369
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 1,561
6005 Insurance(Specify):
6006 Payroll Services 5,202
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT, Executive, Regional Supports 284,003
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify) -
6013 10ther(specify)
INDIRECT EXPENSES TOTAL $ 290,766
INDIRECT COST RATE 15.00%
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 3,000
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)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 40 of 120
FIXED ASSETS EXPENSES TOTAL $ 6,000
TOTAL PROGRAM EXPENSES $ 2,228,986
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 64,770 4.70 $ 304,419
8002 Case Management 0 -
8003 Crisis Services 134 3.40 457
8004 Medication Support 16,285 8.46 137,774
8005 Collateral 64 4.70 303
8006 Plan Development 5,536 4.70 26,019
8007 Assessment 25,357 4.70 119,179
8008 Rehabilitation 0 - -
8009 Other(Specify) 0
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 112,1471 $ 588,151
Estimated%of Clients who are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 588,151
Federal Financial Participation(FFP)% 1 79% 464,640
MEDI-CAL FFP TOTAL $ 464,640
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ 606,865
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ 606,865
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 $ 300,000
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 JCFTN-Capital Facilities&Technology
MHSA TOTAL $ 300,000
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance -
8403 CCP AB109 857,481
8404 Other(Specify)
8405 10ther(Specify)
OTHER REVENUE TOTAL $ 857,481
TOTAL PROGRAM FUNDING SOURCES: $ 2,228,986
NET PROGRAM COST: $ 0
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 41 of 120
Forensic Behavioral Health - Continuum of Care
Turning Point of Central California
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 %
Records Technician FSC-FSP/Fresno 55%
Total 0.55
Position Contract#/Name/Department/County FTE %
Program Bookkeeper FSC-FSP/Fresno 55%
Total 0.55
Position Contract#/Name/Department/County FTE %
Nurse FSC-FSP/Fresno so%
Total 0.50
Position Contract#/Name/Department/County FTE %
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 42 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Pa e 43 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 44 of 120
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 45 of 120
Forensic Behavioral Health-Continuum of Care OP MH SUD
Turning Point of Central California
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,500,868
Administrative Positions 88,292
1101 Records Technician 21,169 The Records Technician will keep track of the Medical Records and will do the billing
for the program
1102 Program Bookkeeper 21,169 The Program Bookkeeper will be assisting the clients with their client fees for their
portion of rent if necessary and keeping track of all the incoming and outgoing of petty
cash as needed.
1103 Secretary 45,954 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.
1104 0 -
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 985,151
1116 Program Director 79,872 The Program Director oversees the program and the hiring,training and supervising of
staff. There is an 8%reduction in salaries for accrued paid leave.When a staff takes
leave,the program is not changed since it's already been accrued.Our Positions are
based on class/step,some might be less and some might be more,all according to the
person's experience and education when they come to work for Turning Point.This
program requires a Bachelor Degree and SLID certification.There is a slight increase in
salaries from previous year for COLA.
1117 Mental Health Professional 252,495 Provides mental health assessment,assessing for Medical Necessity,assists client in
identifying treatment plan goals according to diagnosis. MHP also provides individual
and group therapy as client requests,while also providing program support to assist
clients in crisis. One of the Mental Health Professionals will also be BBS
1118 Supervising PSC 66,648 Provides supervision to all Substance Abuse Conselors,Case Managers and Intake
Assistant to ensure client care,maintain compliance with Turning Point policies and
procedures. Supervisor also assisting in training new staff and reporting to the
Program Director.
1119 Substance Abuse Counselor 343,203 The Substance Abuse Counslor is responsible for the Substance Abuse Treatment
services in accordance with program requirements and ADP licensing.
1120 Case Manager 101,699 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC.
1121 Intake Assistant 103,552 The Intake Assistant processes all referrals related to this program.These services
include completeing all new admissions in a timely manner with the goal of opening
the client.
1122 Nurse 37,683 Nurses work with the doctors for Client care,maintaining compliance with Turning
Point policies and procedures,providing training and ensuring accurate charting in
accordance with Medi-cal.
1123 0 -
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 318,555
1201 Retirement 35,656 Cost of Agency contribution to employee retirement plans.This is based on 3%of the
whale salary.
1202 Worker's Compensation 12,717 Cost of workers compensation insurance.
1203 Health Insurance 143,478 Agency cast for health insurance,our health plans vary on what the employee chooses.
This is the range per employer cost from$399.15 per month to$1299.24 per month.
We used an average of$8000 per year.
1204 Other Dental Insurance 11,263 Agency cost for dental Insurance
Fresno County Deparanent of Behavioral Heakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 46 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1205 Other Accrued Paid Leave 115,085 The monetary value of staff Paid Leave hours as the accrue on a monthly basis
1206 Other ACI 357 Employee assistance program
Direct Payroll Taxes&Expenses: 108,869
1301 OASDI 16,748 Disability Insurance
1302 FICA/MEDICARE 74,769 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and"Hospital Insurance"
(Medicare).
1303 SUI 17,353 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
wages are paid.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 100,960
2001 Child Care
2002 Client Housing Support 60,384 Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:
first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&
care,etc.)
2003 Client Transportation&Support 6,242 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 1,561 Cost of Client hygiene supplies and non-work related clothing.(examples:clothes,
shoes,soap,toothpaste,deodorant,grooming supplies,diapers,etc.)
2005 Education Support 6,242 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational classes.
2006 Employment Support 2,601 Cost of client pre-employment preparation and employement retention.(Examples:
job search and interview attire,work boots and tools required for employment,etc.)
2007 Household Items for Clients 2,081 Cost of purchasing items for clients home.(Examples:pots,pans,dishes,silverware,
telephone,radio,etc.)
2008 Medication Supports 3,121 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
co-pays,prescriptions,lab work not covered by insurance,over the counter
medications,first aid kits/supplies for clients use at home.
2009 Program Supplies-Medical 1,040 Cost of medical supplies to be used by staff or clients at the program location to meet
program objective.Such items are to remain at the program location and not sent
home with the client.Such items include,but are not limited to first aid kits,blood
pressure monitor,latex gloves,syringes,hazard disposal service,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility Vouchers 4,162 Cost of utility vouchers for a specific client.
2011 Other Client Activities 2,705 Cost for client activities&recreation events.(Examples:cable bill,
food/drinks/utensils/decorations needed for a specific client event,incentive rewards,
admission fees to events,etc.)
2012 Other Personal Needs 416 Cost of supplying clients with necessary personal items(Examples:birth certificate,
DMV Fee for ID or license,clients household cleaning products/house supplies,etc.)
2013 Other Client Testing Material 10,404 Testing materials as needed and required
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 49,995
3001 Telecommunications 8,323 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 3,537 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including delivery
by the LISPS,UPS,FEDEX and other courier services
3003 Office,Household&Program Supplies 12,485 Cost of items normally used in an office setting.(Examples:pens,pencils,paper
tablets,paper clips,notepads,staples,non-electric staplers/hole punchers/calculators,
and other items normally used in an office setting.)House Supplies,Cost of supplies
used by staff during their scheduled work hours.These items are normally used to
operate the building at the program location.These items are to remain at program
location and not sent home with client.(Examples:pots,pans,pot holders,kitchen
towels,curtains,detergent,Clorox for clothes,can opener,dishes,furnace filter,
decorations,linens,etc.),Program Supplies,Cost of any items normally used by clients
to meet program objectives while receiving services.These items are to remain at the
program location and not sent home with the client.Such items include,but are not
limited to video tapes,printed handouts,desk reference books,research material,
curriculum,puzzles,board games,therapeutic/meditative supplies and other items
that are specifically designed and used to accomplish program goals.
3004 Advertising -
3005 Staff Development&Training 10,200 Cost of employee training courses and materials.
Fresno County apartment of Behavioral Beakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 47 of 120
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3006 Staff Mileage 1,040 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 520 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
3008 Vehicle Maintenance 1,040 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
maintenance and repair of vehicles used by Agency programs.
3009 Other Vehicle Insurance/Fuel 6,242 Cost of gas in vehicles and insurance.
3010 Other Staff Meetings/Employee,Employer Relations 1,405 Staff Meetings:Cost of room and supplies necessary for staff meetings.Employee
Relations:Cost relating to improvement of working conditions(Examples:
Company picnic items,etc.)$10 per FTE per year budgeted for Employee Relations,
all other expenses are related to Staff Meetings.
3011 Other Recruitment 5,202 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 141,028
4001 Building Maintenance 8,323 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 93,636 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 2,289 Cost of rent/lease payments made for furniture and equipment leases.
4004 Rent/Lease Vehicles - Rental cost of vehicles and lease of agency vehicles.
4005 Security 1,248 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 20,808 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other Equipment Maintenance 2,081 Cost of equipment and furniture repair and maintenance.(Examples:high capacity
copier/printer/scanner,replacement parts such as hard drive,laptop battery,
monitor/printer/phone cord,drum,power strip,surge protector,video card,etc.)
4008 Other Insurance 5,202 Cost of liability and property insurance
4009 Other Depreciation Expense for Office 7,441 Cost of items depreciated at the progra,no pre owned by the agency.
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 139,369
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 36,934 Avatar casts
5003 Contractual/Consulting Services (Specify) 19,203 These accounts are assigned to record various professional services provided by
contracted Consultant working as independent agents.Built in YOY escalator.
Professional services include vendors such as Credible Wireless Data Access and Valley
Expetec IT related expenses as well as clinical supervision.
5004 Translation Services 5,202 Paid to outside vendors for translation/interpreter services
5005 Other Psychiatrist 78,030 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 290,766
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit 1,561 Cost of outside audit fees
6005 Insurance(Specify): -
6006 Payroll Services 5,202 This is our UKG timekeeping/HR system
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT,Executive,Regional 284,003 Support of corporate and regional offices such as processing invoices,payroll,cast
Supports reports,etc.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 6,000
7001 Computer Equipment&Software 3,000 Computer and software as needed for the program
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 3,000 Chairs or other furniture as needed for the program
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)
Fresno County Depamnent of Behavioral Beakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 48 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORTIDOYLE 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 Based on Trends in our current contracts and the cost per unit currently
8002 Case Management Based on Trends in our current contracts and the cost per unit currently
8003 Crisis Services Based on Trends in our current contracts and the cost per unit currently
8004 Medication Support Based on Trends in our current contracts and the cost per unit currently
8005 Collateral Based on Trends in our current contracts and the cost per unit currently
8006 Plan Development Based on Trends in our current contracts and the cost per unit currently
8007 Assessment Based on Trends in our current contracts and the cost per unit currently
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 2,228,986
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 2,228,986
BUDGET CHECK: -
Fresno County Deparanent of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 49 of 120
Forensic Behavioral Health-Continuum of Care OP MH SUD
Turning Point of Central California
Fiscal Year(FY)2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Records Technician 0.45 $ 21,593 $ 21,593
1102 Program Bookkeeper 0.45 21,593 21,593
1103 Secretary 1.00 46,873 46,873
1104 -
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111
1112
1113
1114
1115 -
Direct Personnel Admin Salaries Subtotal 1.90 $ 90,059 $ 90,059
Acct# Program Position FTE Admin Program Total
1116 Program Director 1.00 $ 81,470 $ 81,470
1117 Mental Health Professional 3.00 257,545 257,545
1118 Supervising PSC 1.00 67,981 67,981
1119 Substance Abuse Counselor 6.00 350,067 350,067
1120 Case Manager 2.00 103,733 103,733
1121 Intake Assistant 2.00 105,623 105,623
1122 Nurse 0.45 38,436 38,436
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133 -
1134
Direct Personnel Program Salaries Subtotal 15.45 $ 1,004,854 $ 1,004,854
Admin Program Total
Direct Personnel Salaries Subtotal 17.35 $ 90,059 $ 1,004,854 $ 1,094,913
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 2,140 $ 34,229 $ 36,369
1202 Worker's Compensation 763 12,208 12,972
1203 Health Insurance 8,613 137,735 146,348
1204 Other Dental Insurance 676 10,812 11,488
1205 10therAccrued Paid Leave 6,908 110,478 117,386
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 50 of 120
1206 10ther ACI 1 211 342 364
Direct Employee Benefits Subtotal: $ 19,122 $ 305,804 $ 324,926
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 1,005 $ 16,078 $ 17,083
1302 FICA/MEDICARE 4,488 71,776 76,264
1303 SUI 1,042 16,658 17,700
1304 Other(specify) -
1305 10ther(specify) -
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 6,535 $ 104,511 $ 111,047
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 115,716 $ 1,415,170 $ 1,530,886
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
8% 92%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 60,384
2003 Client Transportation&Support 6,242
2004 Clothing, Food,&Hygiene 1,561
2005 jEclucation Support 6,242
2006 Employment Support 2,601
2007 Household Items for Clients 2,081
2008 Medication Supports 3,121
2009 Program Supplies-Medical 1,040
2010 Utility Vouchers 4,162
2011 Other Client Activities 2,705
2012 Other Personal Needs 416
2013 Other Client Testing Material 10,404
2014 Other(specify) -
2015 Other(specify)
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $ 100,960
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 8,323
3002 Printing/Postage 3,537
3003 Office,Household&Program Supplies 12,485
3004 Advertising -
3005 Staff Development&Training 10,200
3006 Staff Mileage 1,040
3007 Subscriptions&Memberships 520
3008 Vehicle Maintenance 1,040
3009 Other Vehicle Insurance/Fuel 6,242
3010 Other Staff Meetings/Employee, Employer Relations 1,405
3011 Other Recruitment 5,202
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 49,995
4000:DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 51 of 120
Acct# Line Item Description Amount
4001 Building Maintenance $ 8,323
4002 Rent/Lease Building 93,636
4003 Rent/Lease Equipment 2,289
4004 Rent/Lease Vehicles -
4005 Security 1,248
4006 Utilities 20,808
4007 Other Equipment Maintenance 2,081
4008 Otherinsurance 5,202
4009 Other Depreciation Expense for Office 7,441
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 141,028
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) 36,934
5003 Contractual/Consulting Services (Specify) 19,203
5004 Translation Services 5,202
5005 Other Psychiatrist 78,030
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 139,369
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 1,561
6005 Insurance(Specify):
6006 Payroll Services 5,202
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT, Executive, Regional Supports 288,492
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify) -
6013 10ther(specify)
INDIRECT EXPENSES TOTAL $ 295,255
INDIRECT COST RATE 15.00%
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 3,000
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)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 52 of 120
FIXED ASSETS EXPENSES TOTAL $ 6,000
TOTAL PROGRAM EXPENSES $ 2,263,493
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 67,100 4.70 $ 315,370
8002 Case Management 0 -
8003 Crisis Services 139 3.40 474
8004 Medication Support 16,871 8.46 142,731
8005 Collateral 67 4.70 314
8006 Plan Development 5,735 4.70 26,955
8007 Assessment 26,269 4.70 123,466
8008 Rehabilitation 0 - -
8009 Other(Specify) 0
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 1 116,1821 $ 609,308
Estimated%of Clients who are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 609,308
Federal Financial Participation(FFP)% 1 79% 481,354
MEDI-CAL FFP TOTAL $ 481,354
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ 624,658
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ 624,658
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 $ 300,000
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 JCFTN-Capital Facilities&Technology
MHSA TOTAL $ 300,000
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance -
8403 CCP AB109 857,481
8404 Other(Specify)
8405 10ther(Specify)
OTHER REVENUE TOTAL $ 857,481
TOTAL PROGRAM FUNDING SOURCES: $ 2,263,493
NET PROGRAM COST: $ 0
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 53 of 120
Forensic Behavioral Health - Continuum of Care
Turning Point of Central California
Fiscal Year (FY) 2026-27
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 %
Records Technician FSC-FSP/Fresno 55%
Total 0.55
Position Contract#/Name/Department/County FTE %
Program Bookkeeper FSC-FSP/Fresno 55%
Total 0.55
Position Contract#/Name/Department/County FTE %
Nurse FSC-FSP/Fresno so%
Total 0.50
Position Contract#/Name/Department/County FTE %
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 54 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Pa e 55 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 56 of 120
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 57 of 120
Forensic Behavioral Health-Continuum of Care OP MH SUD
Turning Point of Central California
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,530,886
Administrative Positions 90,059
1101 Records Technician 21,593 The Records Technician will keep track of the Medical Records and will do the billing
for the program
1102 Program Bookkeeper 21,593 The Program Bookkeeper will be assisting the clients with their client fees for their
portion of rent if necessary and keeping track of all the incoming and outgoing of petty
cash as needed.
1103 Secretary 46,873 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.
1104 0 -
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 1,004,854
1116 Program Director 81,470 The Program Director oversees the program and the hiring,training and supervising of
staff. There is an 8%reduction in salaries for accrued paid leave.When a staff takes
leave,the program is not changed since it's already been accrued.Our Positions are
based on class/step,some might be less and some might be more,all according to the
person's experience and education when they come to work for Turning Point.This
program requires a Bachelor Degree and SLID certification.There is a slight increase in
salaries from previous year for COLA.
1117 Mental Health Professional 257,545 Provides mental health assessment,assessing for Medical Necessity,assists client in
identifying treatment plan goals according to diagnosis. MHP also provides individual
and group therapy as client requests,while also providing program support to assist
clients in crisis. One of the Mental Health Professionals will also be BBS
1118 Supervising PSC 67,981 Provides supervision to all Substance Abuse Conselors,Case Managers and Intake
Assistant to ensure client care,maintain compliance with Turning Point policies and
procedures. Supervisor also assisting in training new staff and reporting to the
Program Director.
1119 Substance Abuse Counselor 350,067 The Substance Abuse Counslor is responsible for the Substance Abuse Treatment
services in accordance with program requirements and ADP licensing.
1120 Case Manager 103,733 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC.
1121 Intake Assistant 105,623 The Intake Assistant processes all referrals related to this program.These services
include completeing all new admissions in a timely manner with the goal of opening
the client.
1122 Nurse 38,436 Nurses work with the doctors for Client care,maintaining compliance with Turning
Point policies and procedures,providing training and ensuring accurate charting in
accordance with Medi-cal.
1123 0 -
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 324,926
1201 Retirement 36,369 Cost of Agency contribution to employee retirement plans.This is based on 3%of the
whale salary.
1202 Worker's Compensation 12,972 Cost of workers compensation insurance.
1203 Health Insurance 146,348 Agency cast for health insurance,our health plans vary on what the employee chooses.
This is the range per employer cost from$399.15 per month to$1299.24 per month.
We used an average of$8000 per year.
1204 Other Dental Insurance 11,488 Agency cost for dental Insurance
Fresno County Deparanent of Behavioral Heakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 58 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1205 Other Accrued Paid Leave 117,386 The monetary value of staff Paid Leave hours as the accrue on a monthly basis
1206 Other ACI 364 Employee assistance program
Direct Payroll Taxes&Expenses: 111,047
1301 OASDI 17,083 Disability Insurance
1302 FICA/MEDICARE 76,264 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and"Hospital Insurance"
(Medicare).
1303 SUI 17,700 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
wages are paid.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 100,960
2001 Child Care
2002 Client Housing Support 60,384 Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:
first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&
care,etc.)
2003 Client Transportation&Support 6,242 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 1,561 Cost of Client hygiene supplies and non-work related clothing.(examples:clothes,
shoes,soap,toothpaste,deodorant,grooming supplies,diapers,etc.)
2005 Education Support 6,242 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational classes.
2006 Employment Support 2,601 Cost of client pre-employment preparation and employement retention.(Examples:
job search and interview attire,work boots and tools required for employment,etc.)
2007 Household Items for Clients 2,081 Cost of purchasing items for clients home.(Examples:pots,pans,dishes,silverware,
telephone,radio,etc.)
2008 Medication Supports 3,121 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
co-pays,prescriptions,lab work not covered by insurance,over the counter
medications,first aid kits/supplies for clients use at home.
2009 Program Supplies-Medical 1,040 Cost of medical supplies to be used by staff or clients at the program location to meet
program objective.Such items are to remain at the program location and not sent
home with the client.Such items include,but are not limited to first aid kits,blood
pressure monitor,latex gloves,syringes,hazard disposal service,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility Vouchers 4,162 Cost of utility vouchers for a specific client.
2011 Other Client Activities 2,705 Cost for client activities&recreation events.(Examples:cable bill,
food/drinks/utensils/decorations needed for a specific client event,incentive rewards,
admission fees to events,etc.)
2012 Other Personal Needs 416 Cost of supplying clients with necessary personal items(Examples:birth certificate,
DMV Fee for ID or license,clients household cleaning products/house supplies,etc.)
2013 Other Client Testing Material 10,404 Testing materials as needed and required
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 49,995
3001 Telecommunications 8,323 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 3,537 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including delivery
by the LISPS,UPS,FEDEX and other courier services
3003 Office,Household&Program Supplies 12,485 Cost of items normally used in an office setting.(Examples:pens,pencils,paper
tablets,paper clips,notepads,staples,non-electric staplers/hole punchers/calculators,
and other items normally used in an office setting.)House Supplies,Cost of supplies
used by staff during their scheduled work hours.These items are normally used to
operate the building at the program location.These items are to remain at program
location and not sent home with client.(Examples:pots,pans,pot holders,kitchen
towels,curtains,detergent,Clorox for clothes,can opener,dishes,furnace filter,
decorations,linens,etc.),Program Supplies,Cost of any items normally used by clients
to meet program objectives while receiving services.These items are to remain at the
program location and not sent home with the client.Such items include,but are not
limited to video tapes,printed handouts,desk reference books,research material,
curriculum,puzzles,board games,therapeutic/meditative supplies and other items
that are specifically designed and used to accomplish program goals.
3004 Advertising -
3005 Staff Development&Training 10,200 Cost of employee training courses and materials.
Fresno County apartment of Behavioral Beakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 59 of 120
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3006 Staff Mileage 1,040 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 520 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
3008 Vehicle Maintenance 1,040 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
maintenance and repair of vehicles used by Agency programs.
3009 Other Vehicle Insurance/Fuel 6,242 Cost of gas in vehicles and insurance.
3010 Other Staff Meetings/Employee,Employer Relations 1,405 Staff Meetings:Cost of room and supplies necessary for staff meetings.Employee
Relations:Cost relating to improvement of working conditions(Examples:
Company picnic items,etc.)$10 per FTE per year budgeted for Employee Relations,
all other expenses are related to Staff Meetings.
3011 Other Recruitment 5,202 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 141,028
4001 Building Maintenance 8,323 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 93,636 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 2,289 Cost of rent/lease payments made for furniture and equipment leases.
4004 Rent/Lease Vehicles - Rental cost of vehicles and lease of agency vehicles.
4005 Security 1,248 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 20,808 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other Equipment Maintenance 2,081 Cost of equipment and furniture repair and maintenance.(Examples:high capacity
copier/printer/scanner,replacement parts such as hard drive,laptop battery,
monitor/printer/phone cord,drum,power strip,surge protector,video card,etc.)
4008 Other Insurance 5,202 Cost of liability and property insurance
4009 Other Depreciation Expense for Office 7,441 Cost of items depreciated at the progra,no pre owned by the agency.
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 139,369
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 36,934 Avatar casts
5003 Contractual/Consulting Services (Specify) 19,203 These accounts are assigned to record various professional services provided by
contracted Consultant working as independent agents.Built in YOY escalator.
Professional services include vendors such as Credible Wireless Data Access and Valley
Expetec IT related expenses as well as clinical supervision.
5004 Translation Services 5,202 Paid to outside vendors for translation/interpreter services
5005 Other Psychiatrist 78,030 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 295,255
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit 1,561 Cost of outside audit fees
6005 Insurance(Specify): -
6006 Payroll Services 5,202 This is our UKG timekeeping/HR system
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT,Executive,Regional 288,492 Support of corporate and regional offices such as processing invoices,payroll,cast
Supports reports,etc.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 6,000
7001 Computer Equipment&Software 3,000 Computer and software as needed for the program
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 3,000 Chairs or other furniture as needed for the program
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)
Fresno County Depamnent of Behavioral Beakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 60 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORTIDOYLE 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 Based on Trends in our current contracts and the cost per unit currently
8002 Case Management Based on Trends in our current contracts and the cost per unit currently
8003 Crisis Services Based on Trends in our current contracts and the cost per unit currently
8004 Medication Support Based on Trends in our current contracts and the cost per unit currently
8005 Collateral Based on Trends in our current contracts and the cost per unit currently
8006 Plan Development Based on Trends in our current contracts and the cost per unit currently
8007 Assessment Based on Trends in our current contracts and the cost per unit currently
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 2,263,493
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 2,263,493
BUDGET CHECK: -
Fresno County Deparanent of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 61 of 120
Forensic Behavioral Health-Continuum of Care FSC FSP
Turning Point of Central California
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Administrative Assistant 1.00 $ 43,080 $ 43,080
1102 Records Technician 0.55 24,381 24,381
1103 Program Bookkeeper 0.55 24,381 24,381
1104 Secretary 1.00 36,769 36,769
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111
1112
1113
1114
1115 -
Direct Personnel Admin Salaries Subtotal 3.10 $ 128,612 $ 128,612
Acct# Program Position FTE Admin Program Total
1116 Program Director 0.70 $ 68,798 $ 68,798
1117 Assistant Program Director 1.00 93,501 93,501
1118 Mental Health Professionals 3.00 238,610 238,610
1119 Supervising PSC 1.00 65,766 65,766
1120 Nurse 1.50 94,436 94,436
1121 Mental Health Specialist 9.00 437,437 437,437
1122 Peer Support 2.00 64,689 64,689
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 18.20 $ 1,063,238 $ 1,063,238
Admin Program Total
Direct Personnel Salaries Subtotal 21.30 $ 128,612 $ 1,063,238 $ 1,191,849
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 4,287 $ 35,441 $ 39,728
1202 Worker's Compensation 1,529 12,641 14,170
1203 Health Insurance 24,800 145,603 170,403
1204 Other Dental Insurance 1,947 11,430 13,376
1205 10therAccrued Paid Leave 14,290 118,138 132,428
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 62 of 120
1206 10ther ACI 1 43 1 354 1 397
Direct Employee Benefits Subtotal:1 $ 46,896 1 $ 323,606 1 $ 370,503
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 2,014 $ 16,647 $ 18,661
1302 FICA/MEDICARE 8,990 74,319 83,308
1303 SUI 2,086 17,248 19,334
1304 Other(specify) - -
1305 10ther(specify)
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 13,090 $ 108,214 $ 121,304
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 188,598 $ 1,495,058 $ 1,683,656
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 325,500
2003 Client Transportation&Support 8,000
2004 Clothing, Food,&Hygiene 8,000
2005 jEclucation Support 6,000
2006 Employment Support 1,000
2007 Household Items for Clients 5,000
2008 Medication Supports 25,000
2009 Program Supplies-Medical 3,000
2010 Utility Vouchers 2,000
2011 Other Client Activities 8,000
2012 Other Personal Needs 2,000
2013 Other Client Building Maintenance 500
2014 Other Client Testing Material 850
2015 Other(specify) -
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $ 394,852
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 14,000
3002 Printing/Postage 1,500
3003 Office,Household&Program Supplies 11,400
3004 Advertising -
3005 Staff Development&Training 20,000
3006 Staff Mileage 12,000
3007 Subscriptions&Memberships 900
3008 Vehicle Maintenance 3,500
3009 Other Vehicle Insurance/Fuel 13,000
3010 Other Staff Meetings/Employee Relations 3,300
3011 Other Recruitment 8,000
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 87,600
4000:DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 63 of 120
Acct# Line Item Description Amount
4001 Building Maintenance $ 11,627
4002 Rent/Lease Building 100,000
4003 Rent/Lease Equipment 2,000
4004 Rent/Lease Vehicles 20,000
4005 Security 1,000
4006 Utilities 18,000
4007 Other Equipment Maintenance 800
4008 Otherinsurance 5,000
4009 Other Depreciation Expense for Office 6,504
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT T0TAL:j $ 164,931
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) 24,000
5003 Contractual/Consulting Services (Specify) 6,000
5004 Translation Services 4,000
5005 Other Psychiatrist $196,800
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES T0TAL:j $ 230,800
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 1,500
6005 Insurance(Specify):
6006 Payroll Services 4,000
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT, Executive, Regional Supports 391,909
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 397,409
INDIRECT COST RATE 15.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 48,800
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 37,966
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)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 64 of 120
FIXED ASSETS EXPENSES TOTAL $ 86,766
TOTAL PROGRAM EXPENSES $ 3,046,012
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 28,888 3.79 $ 109,608
8002 Case Management 136,342 2.67 363,779
8003 Crisis Services 7,820 5.13 40,142
8004 Medication Support 45,032 6.59 296,726
8005 Collateral 2,918 3.79 11,073
8006 Plan Development 3,412 3.79 12,944
8007 Assessment 10,899 3.79 41,353
8008 Rehabilitation 317,936 3.79 1,206,323
8009 Other(Specify) 0 -
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 1 553,2481 $ 2,081,950
Estimated%of Clients who are Medi-Cal Beneficiaries 95%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 1,977,853
Federal Financial Participation(FFP)% 1 79% 1,562,504
MEDI-CAL FFP TOTAL $ 1,562,504
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 $ 487,008
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 JCFTN-Capital Facilities&Technology
MHSA TOTAL $ 487,008
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ 3,500
8402 Client Insurance -
8403 CCP AB109 Funds 993,000
8404 Other(Specify)
8405 10ther(Specify)
OTHER REVENUE TOTAL $ 996,500
TOTAL PROGRAM FUNDING SOURCES: $ 3,046,012
NET PROGRAM COST: $ 0
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
RFP 2Fg04 '0IBIT L
Forensic Behavioral Health - Continuum of Care
Provider Name
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 %
Program Director Jail Diversion 30.00
Total 30.00
Position Contract#/Name/Department/County FTE %
Records Technician FSC-OP/Fresno 45%
Total 0.45
Position Contract#/Name/Department/County FTE %
Program Bookkeeper FSC-OP/Fresno 45%
Total 0.45
Position Contract#/Name/Department/County FTE %
Nurse FSC-OP/ Fresno 50%
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
RFP 2� e MIBIT L
Total 0.50
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
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
RFP 2Fage or" L
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
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
RFP 2� e MIBIT L
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 69 of 120
Forensic Behavioral Health-Continuum of Care FSC FSP
Turning Point of Central California
Fiscal Year(FY)2022-23 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,683,656
Administrative Positions 128,612
1.00 1101 Administrative Assistant 43,080 The administrative assistant will oversee the support staff and will help with all support
staff duties.
0.55 1102 Records Technician 24,381 The Records Technician will keep track of the Medical Records and will do the billing for
the program
0.55 1103 Program Bookkeeper 24,381 The Program Bookkeeperwill be assistingthe clients with their client fees fortheir
portion of rent if necessary and keeping track of all the incoming and outgoing of petty
cash as needed.
1.00 1104 Secretary 36,769 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.
1105 0 -
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions 1,063,238
0.70 1116 Program Director 68,798 The Program Director oversees the program and the hiring,training and supervising of
staff. First year budget is based on 28 hours a week since the PD will be allocated
between FSC FSP&Jail Diversion in the first year.There is an 8%reduction in salaries
for accrued paid leave.When a staff takes leave,the program is not changed since it's
already been accrued.Our Positions are based on class/step,some might be less and
some might be more,all according to the person's experience and education when they
come to work for Turning Point.This program requires a Master Degree and BBS
Licensure for appropriate clinical oversight.
1.00 1117 Assistant Program Director 93,501 The Asssitant Program Director will supervise staff and assist the Program Director.
3.00 1118 Mental Health Professionals 238,610 Provides mental health assessment,assessing for Medical Necessity,assists client in
identifying treatment plan goals according to diagnosis. MHP also provides individual
and group therapy as client requests,while also providing program support to assist
clients in crisis. One of the Mental Health Professionals will also be BBS
1.00 1119 Supervising PSC 65,766 Provides supervision to all Mental Health Specialists to ensure client care,maintain
compliance with Turning Point policies and procedures.Supervisor also assisting in
training new staff and reporting to the Assistant Program Director.
1.50 1120 Nurse 94,436 Nurses work with the doctors for Client care,maintaining compliance with Turning
Point policies and procedures,providing training and ensuring accurate charting in
accordance with Medi-cal.
9.00 1121 Mental Health Specialist 437,437 Mental Health Specialist will carry a caseload while also specializing in linking and
providing services to those interested in engagement in employment and education
services.
2.00 1122 Peer Support 64,689 Serves as a client advocate and provides information and peer support to clients
1123 0 -
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 370,503
1201 Retirement 39,728 Cost of Agency contribution to employee retirement plans.This is based on 3%of the
whole salary.
1202 Worker's Compensation 14,170
1203 Health Insurance 170,403 Agency cost for health insurance,our health plans vary on what the employee chooses.
This is the range per employer cost from$399.15 per month to 1299.24 per month.We
used an average of$8000.00 Per year.
1204 Other Dental Insurance 13,376 Agency cost for dental insurance
1205 OtherAccrued Paid Leave 132,428 The monetary value of staff Paid Leave hours as they accrue on a monthly basis
1206 Other ACI 397 Employee assistance program
Fresno County Department ofBehavioral Aeahb Contract Budget Template Revised 4/10/2020
Exhibit D
Page 70 of 120
PROGRAM EXPENSE
ACCT#J LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
Direct Payroll Taxes&Expenses: 121,304
1301 OASDI 18,661 Disability Insurance
1302 FICA/MEDICARE 83,308 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and"Hospital Insurance"
(Medicare).
1303 SUI 19,334 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
wages are paid.
1304 Other(specify) -
1305 Other(specify) -
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 394,850
2001 Child Care -
2002 Client Housing Support 325,500 Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:
first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&
care,etc.)
2003 Client Transportation&Support 8,000 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 8,000 Cost of Client hygiene supplies and non-work related clothing.(examples:clothes,
shoes,soap,toothpaste,deodorant,grooming supplies,diapers,etc.)
2005 Education Support 6,000 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational classes.
2006 Employment Support 1,000 Cost of client pre-employment preparation and employement retention.(Examples:job
search and interview attire,work boots and tools required for employment,etc.)
2007 Household Items for Clients 5,000 Cost of purchasing items for clients home.(Examples:pots,pans,dishes,silverware,
telephone,radio,etc.)
2008 Medication Supports 25,000 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
co-pays,prescriptions,lab work not covered by insurance,over the counter
medications,first aid kits/supplies for clients use at home.
2009 Program Supplies-Medical 3,000 Cost of medical supplies to be used by staff or clients at the program location to meet
program objective.Such items are to remain at the program location and not sent
home with the client.Such items include,but are not limited to first aid kits,blood
pressure monitor,latex gloves,syringes,hazard disposal service,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility Vouchers 2,000 Cost of utility vouchers for a specific client.
2011 Other Client Activities 8,000 Cost for client activities&recreation events.(Examples:cable bill,
food/drinks/utensils/decorations needed for a specific client event,incentive rewards,
admission fees to events,etc.)
2012 Other Personal Needs 2,000 Cost of supplying clients with necessary personal items(Examples:birth certificate,
DMV Fee for ID or license,clients household cleaning products/house supplies,etc.)
2013 Other Client Building Maintenance 500
2014 Other Client Testing Material 850
2015 Other(specify) -
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 87,600
3001 Telecommunications 14,000 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 1,500 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including delivery
by the USPS,UPS,FEDEX and other courier services
3003 Office,Household&Program Supplies 11,400 Cost of items normally used in an office setting.(Examples:pens,pencils,paper tablets,
paper clips,notepads,staples,non-electric staplers/hole punchers/calculators,and
other items normally used in an office setting.)House Supplies,Cost of supplies used by
staff during their scheduled work hours.These items are normally used to operate the
building at the program location.These items are to remain at program location and
not sent home with client.(Examples:pots,pans,pot holders,kitchen towels,curtains,
detergent,Clorox for clothes,can opener,dishes,furnace filter,decorations,linens,
etc.),Program Supplies,Cost of any items normally used by clients to meet program
objectives while receiving services.These items are to remain at the program location
and not sent home with the client.Such items include,but are not limited to video
tapes,printed handouts,desk reference books,research material,curriculum,puzzles,
board games,therapeutic/meditative supplies and other items that are specifically
designed and used to accomplish program goals.
3004 Advertising -
3005 Staff Development&Training 20,000 Cost of employee training courses and materials.
3006 Staff Mileage 12,000 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 900 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
Fresno County Depaazanent ofBehavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 71 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3008 Vehicle Maintenance 3,500 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
maintenance and repair of vehicles used by Agency programs.
3009 Other Vehicle Insurance/Fuel 13,000 Cost of gas in vehicles and insurance.
3010 Other Staff Meetings/Employee Relations 3,300 Staff Meetings:Cost of room and supplies necessary for staff meetings.Employee
Relations:Cost relating to improvement of working conditions(Examples:
Company picnic items,etc.)$10 per FTE per year budgeted for Employee Relations,
all other expenses are related to Staff Meetings.
3011 Other Recruitment 8,000 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3012 Other s eci
4000:DIRECT FACILITIES&EQUIPMENT 164,931
4001 Building Maintenance 11,627 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 100,000 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 2,000 Cost of rent/lease payments made for furniture and equipment leases.
4004 Rent/Lease Vehicles 20,000 Rental cost of vehicles and lease of agency vehicles.
4005 Security 1,000 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 18,000 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other Equipment Maintenance 800 Cost of equipment and furniture repair and maintenance.(Examples:high capacity
copier/printer/scanner,replacement parts such as hard drive,laptop battery,
monitor/printer/phone cord,drum,power strip,surge protector,video card,etc.)
4008 Other Insurance 5,000 Cost of liability and property insurance
4009 Other Depreciation Expense for Office 6,504 Cost of items depreciated at the progra,no pre owned by the agency.
4010 Others eci
5000:DIRECT SPECIAL EXPENSES 230,800
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 24,000 Avatar costs
5003 Contractual/Consulting Services(Specify) 6,000 These accounts are assigned to record various professional services provided by
contracted Consultant working as independent agents.Built in YOY escalator.
Professional services include vendors such as Credible Wireless Data Access and Valley
Expetec IT related expenses as well as clinical supervision.
5004 Translation Services 4,000 Paid to outside vendors for translation/interpreter services
5005 Other Psychiatrist 196,800 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify)
6000:INDIRECT EXPENSES 397,409
6001 Administrative Overhead -
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit 1,500 Cost of outside audit fees
6005 Insurance(Specify): -
6006 Payroll Services 4,000 This is our UKG timekeeping/HR system
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT,Executive,Regional 391,909 Support of corporate and regional offices such as processing invoices,payroll,cost
Supports reports,etc.
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 1 Other(specify) -
7000:DIRECT FIXED ASSETS 86,766
7001 Computer Equipment&Software 48,800 Computer and software as needed for the program.Obsolete Equip replacement as
well as initial purchase of equipment for newly budgeted/additional staff.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 37,966 Chairs or other furniture as needed for the program,replacement of damaged/worn
furniture as well as initial purchase of furniture for newly budgeted/additional staff.
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)
Fresno County Department ofBehavioral Fleahb Contract Budget Template Revised 4/10/2020
Exhibit D
Page 72 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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 Based on Trends in our current contracts and the cost per unit currently
8002 Case Management Based on Trends in our current contracts and the cost per unit currently
8003 Crisis Services Based on Trends in our current contracts and the cost per unit currently
8004 Medication Support Based on Trends in our current contracts and the cost per unit currently
8005 Collateral Based on Trends in our current contracts and the cost per unit currently
8006 Plan Development Based on Trends in our current contracts and the cost per unit currently
8007 Assessment Based on Trends in our current contracts and the cost per unit currently
8008 Rehabilitation Based on Trends in our current contracts and the cost per unit currently
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 3,046,012
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 3,046,012
BUDGET CHECK: -
Fresno County Deparawnt ofBehavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 73 of 120
Forensic Behavioral Health-Continuum of Care FSC FSP
Turning Point of Central California
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Administrative Assistant 1.00 $ 43,941 $ 43,941
1102 Records Technician 0.55 24,869 24,869
1103 Program Bookkeeper 0.55 24,869 24,869
1104 Secretary 1.00 37,505 37,505
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111
1112
1113
1114
1115 -
Direct Personnel Admin Salaries Subtotal 3.10 $ 131,184 $ 131,184
Acct# Program Position FTE Admin Program Total
1116 Program Director 1.00 $ 100,249 $ 100,249
1117 Assistant Program Director 1.00 95,371 95,371
1118 Mental Health Professionals 3.00 243,383 243,383
1119 Supervising PSC 1.00 67,081 67,081
1120 Nurse 1.50 96,324 96,324
1121 Mental Health Specialist 9.00 446,186 446,186
1122 Peer Support 2.00 65,983 65,983
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 18.50 $ 1,114,577 $ 1,114,577
Admin Program Total
Direct Personnel Salaries Subtotal 21.60 $ 131,184 $ 1,114,577 $ 1,245,761
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 4,373 $ 37,153 $ 41,525
1202 Worker's Compensation 1,560 13,251 14,811
1203 Health Insurance 25,297 150,963 176,260
1204 Other Dental Insurance 1,986 11,850 13,836
1205 10therAccrued Paid Leave 14,576 123,842 138,418
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 74 of 120
1206 10ther ACI 1 44 1 372 1 415
Direct Employee Benefits Subtotal: $ 47,834 $ 337,430 $ 385,265
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 2,054 $ 17,451 $ 19,505
1302 FICA/MEDICARE 9,170 77,907 87,077
1303 SUI 2,128 18,081 20,209
1304 Other(specify) -
1305 10ther(specify)
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 13,352 $ 113,439 $ 126,791
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 192,370 $ 1,565,447 $ 1,757,817
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
11%1 89%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 347,000
2003 Client Transportation&Support $8,000
2004 Clothing, Food,&Hygiene $8,255
2005 jEclucation Support 6,000
2006 Employment Support 1,000
2007 Household Items for Clients 5,000
2008 Medication Supports 25,000
2009 Program Supplies-Medical 3,000
2010 Utility Vouchers 2,000
2011 Other Client Activities $8,000
2012 Other Personal Needs $2,000
2013 Other Client Building Maintenance 500
2014 Other Client Testing Material 867
2015 Other(specify) -
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $ 416,622
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 12,240
3002 Printing/Postage 918
3003 Office,Household&Program Supplies 11,400
3004 Advertising -
3005 Staff Development&Training 13,498
3006 Staff Mileage 12,000
3007 Subscriptions&Memberships 900
3008 Vehicle Maintenance 3,570
3009 Other Vehicle Insurance/Fuel 13,260
3010 Other Staff Meetings/Employee Relations 3,300
3011 Other Recruitment 4,000
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 75,086
4000:DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 75 of 120
Acct# Line Item Description Amount
4001 Building Maintenance $ 9,180
4002 Rent/Lease Building 100,000
4003 Rent/Lease Equipment 2,000
4004 Rent/Lease Vehicles 20,000
4005 Security 1,000
4006 Utilities 18,000
4007 Other Equipment Maintenance 816
4008 Otherinsurance 5,000
4009 Other Depreciation Expense for Office 6,504
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT T0TAL:j $ 162,500
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) 24,000
5003 Contractual/Consulting Services (Specify) $4,062
5004 Translation Services $4,000
5005 Other O/S Psychiatrist $215,000
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES T0TAL:j $ 247,062
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 1,500
6005 Insurance(Specify):
6006 Payroll Services 6,000
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT, Executive, Regional Supports 392,910
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 400,410
INDIRECT COST RATE 15.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 5,000
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 5,000
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)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 76 of 120
FIXED ASSETS EXPENSES TOTAL $ 10,000
TOTAL PROGRAM EXPENSES $ 3,069,497
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 28,888 3.91 $ 112,928
8002 Case Management 124,520 2.75 342,297
8003 Crisis Services 7,820 5.29 41,357
8004 Medication Support 45,032 6.79 305,712
8005 Collateral 2,918 3.91 11,408
8006 Plan Development 3,412 3.91 13,336
8007 Assessment 10,899 3.91 42,606
8008 Rehabilitation 317,936 3.91 1,243,598
8009 Other(Specify) 0 -
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 1 541,4261 $ 2,113,242
Estimated%of Clients who are Medi-Cal Beneficiaries 95%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 2,007,580
Federal Financial Participation(FFP)% 1 79% 1,585,988
MEDI-CAL FFP TOTAL $ 1,585,988
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 $ 487,008
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 JCFTN-Capital Facilities&Technology
MHSA TOTAL $ 487,008
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ 3,500
8402 Client Insurance -
8403 CCP AB109 Funds 993,000
8404 Other(Specify)
8405 10ther(Specify)
OTHER REVENUE TOTAL $ 996,500
TOTAL PROGRAM FUNDING SOURCES: $ 3,069,496
NET PROGRAM COST: $ 0
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 77 of 120
Forensic Behavioral Health - Continuum of Care
Turning Point of Central California
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 %
Records Technician FSC-OP/Fresno 45%
Total 0.45
Position Contract#/Name/Department/County FTE %
Program Bookkeeper FSC-OP/Fresno 45%
Total 0.45
Position Contract#/Name/Department/County FTE %
Nurse FSC-OP/ Fresno so%
Total 0.50
Position Contract#/Name/Department/County FTE %
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 78 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Pa e 79 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 80 of 120
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 81 of 120
Forensic Behavioral Health-Continuum of Care FSC FSP
Turning Point of Central California
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 1,757,817
Administrative Positions 131,184
1.00 1101 Administrative Assistant 43,941 The administrative assistant will oversee the support staff and will help with all
support staff duties.
0.55 1102 Records Technician 24,869 The Records Technician will keep track of the Medical Records and will do the billing
for the program
0.55 1103 Program Bookkeeper 24,869 The Program Bookkeeper will be assisting the clients with their client fees for their
portion of rent if necessary and keeping track of all the incoming and outgoing of petty
cash as needed.
1.00 1104 Secretary 37,505 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.
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 1,114,577
1.00 1116 Program Director 100,249 The Program Director oversees the program and the hiring,training and supervising of
staff. FY 2-5 the PD is allocated 100%to FSC FSP,40 hours a week.There is an 8%
reduction in salaries for accrued paid leave.When a staff takes leave,the program is
not changed since it's already been accrued.Our Positions are based on class/step,
some might be less and some might be more,all according to the person's experience
and education when they come to work for Turning Point.This program requires a
Master Degree and BBS Licensure for appropriate clinical oversight.There is a slight
increase in salaries from previous year for COLA.
1.00 1117 Assistant Program Director 95,371 The Assiitant Program Director will supervise staff and assist the Program Director.
3.00 1118 Mental Health Professionals 243,383 Provides mental health assessment,assessing for Medical Necessity,assists client in
identifying treatment plan goals according to diagnosis. MHP also provides individual
and group therapy as client requests,while also providing program support to assist
clients in crisis. One of the Mental Health Professionals will also be BBS
1.00 1119 Supervising PSC 67,081 Provides supervision to all Mental Health Specialists to ensure client care,maintain
compliance with Turning Point policies and procedures. Supervisor also assisting in
training new staff and reporting to the Assistant Program Director.
1.50 1120 Nurse 96,324 Nurses work with the doctors for Client care,maintaining compliance with Turning
Point policies and procedures,providing training and ensuring accurate charting in
accordance with Medi-cal.
9.00 1121 Mental Health Specialist 446,186 Mental Health Specialist will carry a caseload while also specializing in linking and
providing services to those interested in engagement in employment and education
services.
2.00 1122 Peer Support 65,983 Serves as a client advocate and provides information and peer support to clients
throughout their recovery process.
1123 0 -
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 385,265
1201 Retirement 41,525 Cost of Agency contribution to employee retirement plans.This is based on 3%of the
whole salary.
1202 Worker's Compensation 14,811 Cost of workers compensation insurance.
1203 Health Insurance 176,260 Agency cost for health insurance,our health plans vary on what the employee chooses.
This is the range per employer cost from$399.15 per month to 1299.24 per month.
We used an average of$8000.00 Per year.
Fresno County Depatmrent of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 82 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1204 Other Dental Insurance 13,836 Agency cost for dental insurance
1205 OtherAccrued Paid Leave 138,418 The monetary value of staff Paid Leave hours as they accrue on a monthly basis
1206 Other ACI 415 Employee assistance program
Direct Payroll Taxes&Expenses: 126,791
1301 OASDI 19,505 Disability Insurance
1302 FICA/MEDICARE 87,077 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and"Hospital Insurance"
(Medicare).
1303 SUI 20,209 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
wages are paid.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 416,622
2001 Child Care -
2002 Client Housing Support 347,000 Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:
first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&
care,etc.)
2003 Client Transportation&Support 8,000 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 8,255 Cost of Client hygiene supplies and non-work related clothing.(examples:clothes,
shoes,soap,toothpaste,deodorant,grooming supplies,diapers,etc.)
2005 Education Support 6,000 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational classes.
2006 Employment Support 1,000 Cost of client pre-employment preparation and employement retention.(Examples:
job search and interview attire,work boots and tools required for employment,etc.)
2007 Household Items for Clients 5,000 Cost of purchasing items for clients home.(Examples:pots,pans,dishes,silverware,
telephone,radio,etc.)
2008 Medication Supports 25,000 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
co-pays,prescriptions,lab work not covered by insurance,over the counter
medications,first aid kits/supplies for clients use at home.
2009 Program Supplies-Medical 3,000 Cost of medical supplies to be used by staff or clients at the program location to meet
program objective.Such items are to remain at the program location and not sent
home with the client.Such items include,but are not limited to first aid kits,blood
pressure monitor,latex gloves,syringes,hazard disposal service,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility Vouchers 2,000 Cost of utility vouchers for a specific client.
2011 Other Client Activities 8,000 Cost for client activities&recreation events.(Examples:cable bill,
food/drinks/utensils/decorations needed for a specific client event,incentive rewards,
admission fees to events,etc.)
2012 Other Personal Needs 2,000 Cost of supplying clients with necessary personal items(Examples:birth certificate,
DMV Fee for ID or license,clients household cleaning products/house supplies,etc.)
2013 Other Client Building Maintenance 500
2014 Other Client Testing Material 867
2015 Other(specify) -
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 75,086
3001 Telecommunications 12,240 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 918 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including delivery
by the USPS,UPS,FEDEX and other courier services
3003 Office,Household&Program Supplies 11,400 Cost of items normally used in an office setting.(Examples:pens,pencils,paper
tablets,paper clips,notepads,staples,non-electric staplers/hole punchers/calculators,
and other items normally used in an office setting.)House Supplies,Cost of supplies
used by staff during their scheduled work hours.These items are normally used to
operate the building at the program location.These items are to remain at program
location and not sent home with client.(Examples:pots,pans,pot holders,kitchen
towels,curtains,detergent,Clorox for clothes,can opener,dishes,furnace filter,
decorations,linens,etc.),Program Supplies,Cost of any items normally used by clients
to meet program objectives while receiving services.These items are to remain at the
program location and not sent home with the client.Such items include,but are not
limited to video tapes,printed handouts,desk reference books,research material,
curriculum,puzzles,board games,therapeutic/meditative supplies and other items
that are specifically designed and used to accomplish program goals.
3004 Advertising -
3005 Staff Development&Training 13,498 Cost of employee training courses and materials.
Fresno County Department of Behavioral Mahh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 83 of 120
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3006 Staff Mileage 12,000 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 900 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
3008 Vehicle Maintenance 3,570 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
maintenance and repair of vehicles used by Agency programs.
3009 Other Vehicle Insurance/Fuel 13,260 Cost of gas in vehicles and insurance.
3010 Other Staff Meetings/Employee Relations 3,300 Staff Meetings:Cost of room and supplies necessary for staff meetings.Employee
Relations:Cost relating to improvement of working conditions(Examples:
Company picnic items,etc.)$10 per FTE per year budgeted for Employee Relations,
all other expenses are related to Staff Meetings.
3011 Other Recruitment 4,000 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 162,500
4001 Building Maintenance 9,180 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 100,000 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 2,000 Cost of rent/lease payments made for furniture and equipment leases.
4004 Rent/Lease Vehicles 20,000 Rental cost of vehicles and lease of agency vehicles.
4005 Security 1,000 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 18,000 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other Equipment Maintenance 816 Cost of equipment and furniture repair and maintenance.(Examples:high capacity
copier/printer/scanner,replacement parts such as hard drive,laptop battery,
monitor/printer/phone cord,drum,power strip,surge protector,video card,etc.)
4008 Other Insurance 5,000 Cost of liability and property insurance
4009 Other Depreciation Expense for Office 6,504 Cost of items depreciated at the progra,no pre owned by the agency.
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 247,062
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 24,000 Avatar casts
5003 Contractual/Consulting Services (Specify) 4,062 These accounts are assigned to record various professional services provided by
contracted Consultant working as independent agents.Built in YOY escalator.
Professional services include vendors such as Credible Wireless Data Access and Valley
Expetec IT related expenses as well as clinical supervision.
5004 Translation Services 4,000 Paid to outside vendors for translation/interpreter services
5005 Other O/S Psychiatrist 215,000 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 400,410
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit 1,500 Cost of outside audit fees
6005 Insurance(Specify): -
6006 Payroll Services 6,000 This is our UKG timekeeping/HR system
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT,Executive,Regional 392,910 Support of corporate and regional offices such as processing invoices,payroll,cast
Supports reports,etc.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 10,000
7001 Computer Equipment&Software 5,000 Computer and software as needed for the program
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 5,000 Chairs or other furniture as needed for the program
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)
Fresno County Departr:ent of Behavioral Makh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 84 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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 Based on Trends in our current contracts and the cost per unit currently
8002 Case Management Based on Trends in our current contracts and the cost per unit currently
8003 Crisis Services Based on Trends in our current contracts and the cost per unit currently
8004 Medication Support Based on Trends in our current contracts and the cost per unit currently
8005 Collateral Based on Trends in our current contracts and the cost per unit currently
8006 Plan Development Based on Trends in our current contracts and the cost per unit currently
8007 Assessment Based on Trends in our current contracts and the cost per unit currently
8008 Rehabilitation Based on Trends in our current contracts and the cost per unit currently
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 3,069,497
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 3,069,497
BUDGET CHECK: -
Fresno County Deparanent of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 85 of 120
Forensic Behavioral Health-Continuum of Care FSC FSP
Turning Point of Central California
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Administrative Assistant 1.00 $ 44,820 $ 44,820
1102 Records Technician 0.55 25,366 25,366
1103 Program Bookkeeper 0.55 25,366 25,366
1104 Secretary 1.00 38,255 38,255
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111
1112
1113
1114
1115 -
Direct Personnel Admin Salaries Subtotal 3.10 $ 133,808 $ 133,808
Acct# Program Position FTE Admin Program Total
1116 Program Director 1.00 $ 102,254 $ 102,254
1117 Assistant Program Director 1.00 97,279 97,279
1118 Mental Health Professionals 3.00 248,250 248,250
1119 Supervising PSC 1.00 68,423 68,423
1120 Nurse 1.50 98,251 98,251
1121 Mental Health Specialist 9.00 455,109 455,109
1122 Peer Support 2.00 67,302 67,302
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 18.50 $ 1,136,869 $ 1,136,869
Admin Program Total
Direct Personnel Salaries Subtotal 21.60 $ 133,808 $ 1,136,869 $ 1,270,676
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 4,460 $ 37,896 $ 42,356
1202 Worker's Compensation 1,591 13,516 15,107
1203 Health Insurance 25,802 153,982 179,785
1204 Other Dental Insurance 2,025 12,087 14,113
1205 10therAccrued Paid Leave 14,868 126,319 141,186
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 86 of 120
1206 10ther ACI 1 45 1 379 1 424
Direct Employee Benefits Subtotal:1 $ 48,791 $ 344,179 $ 392,970
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 2,095 $ 17,800 $ 19,895
1302 FICA/MEDICARE 9,353 79,465 88,818
1303 SUI 2,171 18,443 20,613
1304 Other(specify) -
1305 10ther(specify) -
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 13,619 $ 115,708 $ 129,327
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 196,217 $ 1,596,756 $ 1,792,973
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
11%1 89%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 353,940
2003 Client Transportation&Support $8,160
2004 Clothing, Food,&Hygiene $8,420
2005 jEclucation Support 6,120
2006 Employment Support 1,020
2007 Household Items for Clients 5,100
2008 Medication Supports 25,500
2009 Program Supplies-Medical 3,060
2010 Utility Vouchers 2,040
2011 Other Client Activities $8,160
2012 Other Personal Needs $2,040
2013 Other Client Building Maintenance 510
2014 Other Client Testing Material 884
2015 Other(specify) -
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $ 424,954
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 12,485
3002 Printing/Postage 936
3003 Office,Household&Program Supplies 11,628
3004 Advertising -
3005 Staff Development&Training 13,768
3006 Staff Mileage 12,240
3007 Subscriptions&Memberships 918
3008 Vehicle Maintenance 3,641
3009 Other Vehicle Insurance/Fuel 13,525
3010 Other Staff Meetings/Employee Relations 3,366
3011 Other Recruitment 4,080
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 76,588
4000:DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 87 of 120
Acct# Line Item Description Amount
4001 Building Maintenance $ 9,364
4002 Rent/Lease Building 102,000
4003 Rent/Lease Equipment 2,040
4004 Rent/Lease Vehicles 20,400
4005 Security 1,020
4006 Utilities 18,360
4007 Other Equipment Maintenance 832
4008 Otherinsurance 5,100
4009 Other Depreciation Expense for Office 6,634
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT T0TAL:j $ 165,750
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) 24,480
5003 Contractual/Consulting Services (Specify) $4,143
5004 Translation Services $4,080
5005 Other O/S Psychiatrist $219,300
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES T0TAL:j $ 252,003
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 1,530
6005 Insurance(Specify):
6006 Payroll Services 6,120
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT, Executive, Regional Supports 400,760
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 408,410
INDIRECT COST RATE 15.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 5,100
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 5,100
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)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 88 of 120
FIXED ASSETS EXPENSES TOTAL $ 10,200
TOTAL PROGRAM EXPENSES $ 3,130,878
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 28,888 4.06 $ 117,340
8002 Case Management 124,520 2.86 355,671
8003 Crisis Services 7,820 5.50 42,973
8004 Medication Support 45,032 7.05 317,656
8005 Collateral 2,918 4.06 11,854
8006 Plan Development 3,412 4.06 13,857
8007 Assessment 10,899 4.06 44,270
8008 Rehabilitation 317,936 4.06 1,291,410
8009 Other(Specify) 0 -
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 1 541,4261 $ 2,195,031
Estimated%of Clients who are Medi-Cal Beneficiaries 95%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 2,085,279
Federal Financial Participation(FFP)% 1 79% 1,647,370
MEDI-CAL FFP TOTAL $ 1,647,370
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 $ 487,008
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 JCFTN-Capital Facilities&Technology
MHSA TOTAL $ 487,008
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ 3,500
8402 Client Insurance -
8403 CCP AB109 Funds 993,000
8404 Other(Specify)
8405 10ther(Specify)
OTHER REVENUE TOTAL $ 996,500
TOTAL PROGRAM FUNDING SOURCES: $ 3,130,878
NET PROGRAM COST: $ (0)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 89 of 120
Forensic Behavioral Health - Continuum of Care
Turning Point of Central California
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 %
Records Technician FSC-OP/Fresno 45%
Total 0.45
Position Contract#/Name/Department/County FTE %
Program Bookkeeper FSC-OP/Fresno 45%
Total 0.45
Position Contract#/Name/Department/County FTE %
Nurse FSC-OP/Fresno 50%
Total 0.50
Position Contract#/Name/Department/County FTE %
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 90 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Pa e 91 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 92 of 120
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 93 of 120
Forensic Behavioral Health-Continuum of Care FSC FSP
Turning Point of Central California
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,792,973
Administrative Positions 133,808
1101 Administrative Assistant 44,820 The administrative assistant will oversee the support staff and will help with all
support staff duties.
1102 Records Technician 25,366 The Records Technician will keep track of the Medical Records and will do the billing
for the program
1103 Program Bookkeeper 25,366 The Program Bookkeeper will be assisting the clients with their client fees for their
portion of rent if necessary and keeping track of all the incoming and outgoing of petty
cash as needed.
1104 Secretary 38,255 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.
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 1,136,869
1116 Program Director 102,254 The Program Director oversees the program and the hiring,training and supervising of
staff. FY 2-5 the PD is allocated 100%to FSC FSP,40 hours a week.There is an 8%
reduction in salaries for accrued paid leave.When a staff takes leave,the program is
not changed since it's already been accrued.Our Positions are based on class/step,
some might be less and some might be more,all according to the person's experience
and education when they come to work for Turning Point.This program requires a
Master Degree and BBS Licensure for appropriate clinical oversight.There is a slight
increase in salaries from previous year for COLA.
1117 Assistant Program Director 97,279 The Assiitant Program Director will supervise staff and assist the Program Director.
1118 Mental Health Professionals 248,250 Provides mental health assessment,assessing for Medical Necessity,assists client in
identifying treatment plan goals according to diagnosis. MHP also provides individual
and group therapy as client requests,while also providing program support to assist
clients in crisis. One of the Mental Health Professionals will also be BBS
1119 Supervising PSC 68,423 Provides supervision to all Mental Health Specialists to ensure client care,maintain
compliance with Turning Point policies and procedures. Supervisor also assisting in
training new staff and reporting to the Assistant Program Director.
1120 Nurse 98,251 Nurses work with the doctors for Client care,maintaining compliance with Turning
Paint policies and procedures,providing training and ensuring accurate charting in
accordance with Medi-cal.
1121 Mental Health Specialist 455,109 Mental Health Specialist will carry a caseload while also specializing in linking and
providing services to those interested in engagement in employment and education
services.
1122 Peer Support 67,302 Serves as a client advocate and provides information and peer support to clients
throughout their recovery process.
1123 0 -
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 392,970
1201 Retirement 42,356 Cost of Agency contribution to employee retirement plans.This is based on 3%of the
whole salary.
1202 Worker's Compensation 15,107 Cost of workers compensation insurance.
1203 Health Insurance 179,785 Agency cast for health insurance,our health plans vary on what the employee chooses.
This is the range per employer cost from$399.15 per month to 1299.24 per month.
We used an average of$8000.00 Per year.
Fresno County Depatmnent of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 94 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1204 Other Dental Insurance 14,113 Agency cost for dental insurance
1205 Other Accrued Paid Leave 141,186 The monetary value of staff Paid Leave hours as they accrue on a monthly basis
1206 Other ACI 424 Employee assistance program
Direct Payroll Taxes&Expenses: 129,327
1301 OASDI 19,895 Disability Insurance
1302 FICA/MEDICARE 88,818 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and"Hospital Insurance"
(Medicare).
1303 SUI 20,613 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
wages are paid.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 424,954
2001 Child Care -
2002 Client Housing Support 353,940 Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:
first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&
care,etc.)
2003 Client Transportation&Support 8,160 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 8,420 Cost of Client hygiene supplies and non-work related clothing.(examples:clothes,
shoes,soap,toothpaste,deodorant,grooming supplies,diapers,etc.)
2005 Education Support 6,120 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational classes.
2006 Employment Support 1,020 Cost of client pre-employment preparation and employement retention.(Examples:
job search and interview attire,work boots and tools required for employment,etc.)
2007 Household Items for Clients 5,100 Cost of purchasing items for clients home.(Examples:pots,pans,dishes,silverware,
telephone,radio,etc.)
2008 Medication Supports 25,500 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
co-pays,prescriptions,lab work not covered by insurance,over the counter
medications,first aid kits/supplies for clients use at home.
2009 Program Supplies-Medical 3,060 Cost of medical supplies to be used by staff or clients at the program location to meet
program objective.Such items are to remain at the program location and not sent
home with the client.Such items include,but are not limited to first aid kits,blood
pressure monitor,latex gloves,syringes,hazard disposal service,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility Vouchers 2,040 Cost of utility vouchers for a specific client.
2011 Other Client Activities 8,160 Cost for client activities&recreation events.(Examples:cable bill,
food/drinks/utensils/decorations needed for a specific client event,incentive rewards,
admission fees to events,etc.)
2012 Other Personal Needs 2,040 Cost of supplying clients with necessary personal items(Examples:birth certificate,
DMV Fee for ID or license,clients household cleaning products/house supplies,etc.)
2013 Other Client Building Maintenance 510
2014 Other Client Testing Material 884
2015 Other(specify) -
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 76,588
3001 Telecommunications 12,485 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 936 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including delivery
by the USPS,UPS,FEDEX and other courier services
3003 Office,Household&Program Supplies 11,628 Cost of items normally used in an office setting.(Examples:pens,pencils,paper
tablets,paper clips,notepads,staples,non-electric staplers/hole punchers/calculators,
and other items normally used in an office setting.)House Supplies,Cost of supplies
used by staff during their scheduled work hours.These items are normally used to
operate the building at the program location.These items are to remain at program
location and not sent home with client.(Examples:pots,pans,pot holders,kitchen
towels,curtains,detergent,Clorox for clothes,can opener,dishes,furnace filter,
decorations,linens,etc.),Program Supplies,Cost of any items normally used by clients
to meet program objectives while receiving services.These items are to remain at the
program location and not sent home with the client.Such items include,but are not
limited to video tapes,printed handouts,desk reference books,research material,
curriculum,puzzles,board games,therapeutic/meditative supplies and other items
that are specifically designed and used to accomplish program goals.
3004 Advertising -
3005 Staff Development&Training 13,768 Cost of employee training courses and materials.
Fresno County Department of Behavioral Makh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 95 of 120
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3006 Staff Mileage 12,240 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 918 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
3008 Vehicle Maintenance 3,641 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
maintenance and repair of vehicles used by Agency programs.
3009 Other Vehicle Insurance/Fuel 13,525 Cost of gas in vehicles and insurance.
3010 Other Staff Meetings/Employee Relations 3,366 Staff Meetings:Cost of room and supplies necessary for staff meetings.Employee
Relations:Cost relating to improvement of working conditions(Examples:
Company picnic items,etc.)$10 per FTE per year budgeted for Employee Relations,
all other expenses are related to Staff Meetings.
3011 Other Recruitment 4,080 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 165,750
4001 Building Maintenance 9,364 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 102,000 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 2,040 Cost of rent/lease payments made for furniture and equipment leases.
4004 Rent/Lease Vehicles 20,400 Rental cost of vehicles and lease of agency vehicles.
4005 Security 1,020 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 18,360 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other Equipment Maintenance 832 Cost of equipment and furniture repair and maintenance.(Examples:high capacity
copier/printer/scanner,replacement parts such as hard drive,laptop battery,
monitor/printer/phone cord,drum,power strip,surge protector,video card,etc.)
4008 Other Insurance 5,100 Cost of liability and property insurance
4009 Other Depreciation Expense for Office 6,634 Cost of items depreciated at the progra,no pre owned by the agency.
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 252,003
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 24,480 Avatar casts
5003 Contractual/Consulting Services (Specify) 4,143 These accounts are assigned to record various professional services provided by
contracted Consultant working as independent agents.Built in YOY escalator.
Professional services include vendors such as Credible Wireless Data Access and Valley
Expetec IT related expenses as well as clinical supervision.
5004 Translation Services 4,080 Paid to outside vendors for translation/interpreter services
5005 Other O/S Psychiatrist 219,300 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 408,410
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit 1,530 Cost of outside audit fees
6005 Insurance(Specify): -
6006 Payroll Services 6,120 This is our Ultipro timekeeping/HR system
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT,Executive,Regional 400,760 Support of corporate and regional offices such as processing invoices,payroll,cast
Supports reports,etc.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 10,200
7001 Computer Equipment&Software 5,100 Computer and software as needed for the program
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 5,100 Chairs or other furniture as needed for the program
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)
Fresno County Departr:ent of Behavioral Makh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 96 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORTIDOYLE 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 Based on Trends in our current contracts and the cost per unit currently
8002 Case Management Based on Trends in our current contracts and the cost per unit currently
8003 Crisis Services Based on Trends in our current contracts and the cost per unit currently
8004 Medication Support Based on Trends in our current contracts and the cost per unit currently
8005 Collateral Based on Trends in our current contracts and the cost per unit currently
8006 Plan Development Based on Trends in our current contracts and the cost per unit currently
8007 Assessment Based on Trends in our current contracts and the cost per unit currently
8008 Rehabilitation Based on Trends in our current contracts and the cost per unit currently
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 3,130,878
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 3,130,878
BUDGET CHECK: -
Fresno County Deparanent of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 97 of 120
Forensic Behavioral Health-Continuum of Care FSC FSP
Turning Point of Central California
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Administrative Assistant 1.00 $ 45,716 $ 45,716
1102 Records Technician 0.55 25,874 25,874
1103 Program Bookkeeper 0.55 25,874 25,874
1104 Secretary 1.00 39,020 39,020
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111
1112
1113
1114
1115 -
Direct Personnel Admin Salaries Subtotal 3.10 $ 136,484 $ 136,484
Acct# Program Position FTE Admin Program Total
1116 Program Director 1.00 $ 104,299 $ 104,299
1117 Assistant Program Director 1.00 99,224 99,224
1118 Mental Health Professionals 3.00 253,215 253,215
1119 Supervising PSC 1.00 69,792 69,792
1120 Nurse 1.50 100,216 100,216
1121 Mental Health Specialist 9.00 464,212 464,212
1122 Peer Support 2.00 68,648 68,648
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 18.50 $ 1,159,606 $ 1,159,606
Admin Program Total
Direct Personnel Salaries Subtotal 21.60 $ 136,484 $ 1,159,606 $ 1,296,090
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 4,549 $ 38,654 $ 43,203
1202 Worker's Compensation 1,623 13,786 15,409
1203 Health Insurance 26,318 157,062 183,380
1204 Other Dental Insurance 2,066 12,329 14,395
1205 10therAccrued Paid Leave 15,165 128,845 144,010
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 98 of 120
1206 10ther ACI 1 45 1 387 1 432
Direct Employee Benefits Subtotal:1 $ 49,767 1 $ 351,063 $ 400,830
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 2,137 $ 18,156 $ 20,293
1302 FICA/MEDICARE 9,540 81,055 90,595
1303 SUI 2,214 18,811 21,025
1304 Other(specify) -
1305 10ther(specify)
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 13,891 $ 118,022 $ 131,913
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 200,142 $ 1,628,691 $ 1,828,832
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
11%1 89%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 361,019
2003 Client Transportation&Support $8,323
2004 Clothing, Food,&Hygiene $8,589
2005 jEclucation Support 6,242
2006 Employment Support 1,040
2007 Household Items for Clients 5,202
2008 Medication Supports 26,010
2009 Program Supplies-Medical 3,121
2010 Utility Vouchers 2,081
2011 Other Client Activities $8,323
2012 Other Personal Needs $2,081
2013 Other Client Building Maintenance 520
2014 Other Client Testing Material 902
2015 Other(specify) -
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $ 433,454
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 12,734
3002 Printing/Postage 955
3003 Office,Household&Program Supplies 11,861
3004 Advertising -
3005 Staff Development&Training 14,043
3006 Staff Mileage 12,485
3007 Subscriptions&Memberships 936
3008 Vehicle Maintenance 3,714
3009 Other Vehicle Insurance/Fuel 13,796
3010 Other Staff Meetings/Employee Relations 3,433
3011 Other Recruitment 4,162
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 78,119
4000:DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 99 of 120
Acct# Line Item Description Amount
4001 Building Maintenance $ 9,551
4002 Rent/Lease Building 104,040
4003 Rent/Lease Equipment 2,081
4004 Rent/Lease Vehicles 20,808
4005 Security 1,040
4006 Utilities 18,727
4007 Other Equipment Maintenance 849
4008 Otherinsurance 5,202
4009 Other Depreciation Expense for Office
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 162,298
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) 24,970
5003 Contractual/Consulting Services (Specify) $4,226
5004 Translation Services $4,162
5005 Other O/S Psychiatrist $223,686
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES T0TAL:j $ 257,043
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 1,561
6005 Insurance(Specify):
6006 Payroll Services 6,242
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT, Executive, Regional Supports 407,742
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 415,545
INDIRECT COST RATE 15.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 5,202
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data
7003 Furniture&Fixtures 5,202
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)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 100 of 120
FIXED ASSETS EXPENSES TOTAL $ 10,404
TOTAL PROGRAM EXPENSES $ 3,185,696
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 28,888 4.20 $ 121,244
8002 Case Management 124,520 2.95 367,506
8003 Crisis Services 7,820 5.68 44,403
8004 Medication Support 45,032 7.29 328,226
8005 Collateral 2,918 4.20 12,249
8006 Plan Development 3,412 4.20 14,319
8007 Assessment 10,899 4.20 45,743
8008 Rehabilitation 317,936 4.20 1,334,383
8009 Other(Specify) 0 -
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 1 541,4261 $ 2,268,072
Estimated%of Clients who are Medi-Cal Beneficiaries 95%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 2,154,669
Federal Financial Participation(FFP)% 1 79% 1,702,188
MEDI-CAL FFP TOTAL $ 1,702,188
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 $ 487,008
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 JCFTN-Capital Facilities&Technology
MHSA TOTAL $ 487,008
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ 3,500
8402 Client Insurance -
8403 CCP AB109 Funds 993,000
8404 Other(Specify)
8405 10ther(Specify)
OTHER REVENUE TOTAL $ 996,500
TOTAL PROGRAM FUNDING SOURCES: $ 3,185,696
NET PROGRAM COST: $ (0)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 101 of 120
Forensic Behavioral Health - Continuum of Care
Turning Point of Central California
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 %
Records Technician FSC-OP/Fresno 45%
Total 0.45
Position Contract#/Name/Department/County FTE %
Program Bookkeeper FSC-OP/Fresno 45%
Total 0.45
Position Contract#/Name/Department/County FTE %
Nurse FSC-OP/Fresno 50%
Total 0.50
Position Contract#/Name/Department/County FTE %
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 102 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Pa e 103 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 104 of 120
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 105 of 120
Forensic Behavioral Health-Continuum of Care FSC FSP
Turning Point of Central California
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,828,832
Administrative Positions 136,484
1101 Administrative Assistant 45,716 The administrative assistant will oversee the support staff and will help with all
support staff duties.
1102 Records Technician 25,874 The Records Technician will keep track of the Medical Records and will do the billing
for the program
1103 Program Bookkeeper 25,874 The Program Bookkeeper will be assisting the clients with their client fees for their
portion of rent if necessary and keeping track of all the incoming and outgoing of petty
cash as needed.
1104 Secretary 39,020 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.
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 1,159,606
1116 Program Director 104,299 The Program Director oversees the program and the hiring,training and supervising of
staff. FY 2-5 the PD is allocated 100%to FSC FSP,40 hours a week.There is an 8%
reduction in salaries for accrued paid leave.When a staff takes leave,the program is
not changed since it's already been accrued.Our Positions are based on class/step,
some might be less and some might be more,all according to the person's experience
and education when they come to work for Turning Point.This program requires a
Master Degree and BBS Licensure for appropriate clinical oversight.There is a slight
increase in salaries from previous year for COLA.
1117 Assistant Program Director 99,224 The Asssitant Program Director will supervise staff and assist the Program Director.
1118 Mental Health Professionals 253,215 Provides mental health assessment,assessing for Medical Necessity,assists client in
identifying treatment plan goals according to diagnosis. MHP also provides individual
and group therapy as client requests,while also providing program support to assist
clients in crisis. One of the Mental Health Professionals will also be BBS
1119 Supervising PSC 69,792 Provides supervision to all Mental Health Specialists to ensure client care,maintain
compliance with Turning Point policies and procedures. Supervisor also assisting in
training new staff and reporting to the Assistant Program Director.
1120 Nurse 100,216 Nurses work with the doctors for Client care,maintaining compliance with Turning
Point policies and procedures,providing training and ensuring accurate charting in
accordance with Medi-cal.
1121 Mental Health Specialist 464,212 Mental Health Specialist will carry a caseload while also specializing in linking and
providing services to those interested in engagement in employment and education
services.
1122 Peer Support 68,648 Serves as a client advocate and provides information and peer support to clients
throughout their recovery process.
1123 0 -
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 400,830
1201 Retirement 43,203 Cost of Agency contribution to employee retirement plans.This is based on 3%of the
whole salary.
1202 Worker's Compensation 15,409 Cost of workers compensation insurance.
1203 Health Insurance 183,380 Agency cost for health insurance,our health plans vary on what the employee chooses.
This is the range per employer cost from$399.15 per month to 1299.24 per month.
We used an average of$8000.00 Per year.
1204 Other Dental Insurance 14,395 Agency cost for dental insurance
Fresno County Department of Behavioral Heakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 106 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1205 Other Accrued Paid Leave 144,010 The monetary value of staff Paid Leave hours as they accrue on a monthly basis
1206 Other ACI 432 Employee assistance program
Direct Payroll Taxes&Expenses: 131,913
1301 OASDI 20,293 Disability Insurance
1302 FICA/MEDICARE 90,595 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and"Hospital Insurance"
(Medicare).
1303 SUI 21,025 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
wages are paid.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 433,454
2001 Child Care
2002 Client Housing Support 361,019 Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:
first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&
care,etc.)
2003 Client Transportation&Support 8,323 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 8,589 Cost of Client hygiene supplies and non-work related clothing.(examples:clothes,
shoes,soap,toothpaste,deodorant,grooming supplies,diapers,etc.)
2005 Education Support 6,242 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational classes.
2006 Employment Support 1,040 Cost of client pre-employment preparation and employement retention.(Examples:
job search and interview attire,work boots and tools required for employment,etc.)
2007 Household Items for Clients 5,202 Cost of purchasing items for clients home.(Examples:pots,pans,dishes,silverware,
telephone,radio,etc.)
2008 Medication Supports 26,010 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
co-pays,prescriptions,lab work not covered by insurance,over the counter
medications,first aid kits/supplies for clients use at home.
2009 Program Supplies-Medical 3,121 Cost of medical supplies to be used by staff or clients at the program location to meet
program objective.Such items are to remain at the program location and not sent
home with the client.Such items include,but are not limited to first aid kits,blood
pressure monitor,latex gloves,syringes,hazard disposal service,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility Vouchers 2,081 Cost of utility vouchers for a specific client.
2011 Other Client Activities 8,323 Cost for client activities&recreation events.(Examples:cable bill,
food/drinks/utensils/decorations needed for a specific client event,incentive rewards,
admission fees to events,etc.)
2012 Other Personal Needs 2,081 Cost of supplying clients with necessary personal items(Examples:birth certificate,
DMV Fee for ID or license,clients household cleaning products/house supplies,etc.)
2013 Other Client Building Maintenance 520
2014 Other Client Testing Material 902
2015 Other(specify) -
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 78,119
3001 Telecommunications 12,734 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 955 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including delivery
by the LISPS,UPS,FEDEX and other courier services
3003 Office,Household&Program Supplies 11,861 Cost of items normally used in an office setting.(Examples:pens,pencils,paper
tablets,paper clips,notepads,staples,non-electric staplers/hole punchers/calculators,
and other items normally used in an office setting.)House Supplies,Cost of supplies
used by staff during their scheduled work hours.These items are normally used to
operate the building at the program location.These items are to remain at program
location and not sent home with client.(Examples:pots,pans,pot holders,kitchen
towels,curtains,detergent,Clorox for clothes,can opener,dishes,furnace filter,
decorations,linens,etc.),Program Supplies,Cost of any items normally used by clients
to meet program objectives while receiving services.These items are to remain at the
program location and not sent home with the client.Such items include,but are not
limited to video tapes,printed handouts,desk reference books,research material,
curriculum,puzzles,board games,therapeutic/meditative supplies and other items
that are specifically designed and used to accomplish program goals.
3004 Advertising -
3005 Staff Development&Training 14,043 Cost of employee training courses and materials.
Fresno County apartment of Behavioral Beakh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 107 of 120
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3006 Staff Mileage 12,485 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 936 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
3008 Vehicle Maintenance 3,714 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
maintenance and repair of vehicles used by Agency programs.
3009 Other Vehicle Insurance/Fuel 13,796 Cost of gas in vehicles and insurance.
3010 Other Staff Meetings/Employee Relations 3,433 Staff Meetings:Cost of room and supplies necessary for staff meetings.Employee
Relations:Cost relating to improvement of working conditions(Examples:
Company picnic items,etc.)$10 per FTE per year budgeted for Employee Relations,
all other expenses are related to Staff Meetings.
3011 Other Recruitment 4,162 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 162,298
4001 Building Maintenance 9,551 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 104,040 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 2,081 Cost of rent/lease payments made for furniture and equipment leases.
4004 Rent/Lease Vehicles 20,808 Rental cost of vehicles and lease of agency vehicles.
4005 Security 1,040 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 18,727 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other Equipment Maintenance 849 Cost of equipment and furniture repair and maintenance.(Examples:high capacity
copier/printer/scanner,replacement parts such as hard drive,laptop battery,
monitor/printer/phone cord,drum,power strip,surge protector,video card,etc.)
4008 Other Insurance 5,202 Cost of liability and property insurance
4009 Other Depreciation Expense for Office - Cost of items depreciated at the progra,no pre owned by the agency.
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 257,043
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 24,970 Avatar casts
5003 Contractual/Consulting Services (Specify) 4,226 These accounts are assigned to record various professional services provided by
contracted Consultant working as independent agents.Built in YOY escalator.
Professional services include vendors such as Credible Wireless Data Access and Valley
Expetec IT related expenses as well as clinical supervision.
5004 Translation Services 4,162 Paid to outside vendors for translation/interpreter services
5005 Other O/S Psychiatrist 223,686 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 415,545
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit 1,561 Cost of outside audit fees
6005 Insurance(Specify): -
6006 Payroll Services 6,242 This is our Ultipro timekeeping/HR system
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT,Executive,Regional 407,742 Support of corporate and regional offices such as processing invoices,payroll,cast
Supports reports,etc.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 10,404
7001 Computer Equipment&Software 5,202 Computer and software as needed for the program
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 5,202 Chairs or other furniture as needed for the program
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)
Fresno County Departr:ent of Behavioral Makh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 108 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORTIDOYLE 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 Based on Trends in our current contracts and the cost per unit currently
8002 Case Management Based on Trends in our current contracts and the cost per unit currently
8003 Crisis Services Based on Trends in our current contracts and the cost per unit currently
8004 Medication Support Based on Trends in our current contracts and the cost per unit currently
8005 Collateral Based on Trends in our current contracts and the cost per unit currently
8006 Plan Development Based on Trends in our current contracts and the cost per unit currently
8007 Assessment Based on Trends in our current contracts and the cost per unit currently
8008 Rehabilitation Based on Trends in our current contracts and the cost per unit currently
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 3,185,696
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 3,185,696
BUDGET CHECK: -
Fresno County Deparanent of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 109 of 120
Forensic Behavioral Health-Continuum of Care FSC FSP
Turning Point of Central California
Fiscal Year(FY)2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Administrative Assistant 1.00 $ 46,631 $ 46,631
1102 Records Technician 0.55 26,391 26,391
1103 Program Bookkeeper 0.55 26,391 26,391
1104 Secretary 1.00 39,800 39,800
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111
1112
1113
1114
1115 -
Direct Personnel Admin Salaries Subtotal 3.10 $ 139,213 $ 139,213
Acct# Program Position FTE Admin Program Total
1116 Program Director 1.00 $ 106,385 $ 106,385
1117 Assistant Program Director 1.00 101,209 101,209
1118 Mental Health Professionals 3.00 258,280 258,280
1119 Supervising PSC 1.00 71,187 71,187
1120 Nurse 1.50 102,220 102,220
1121 Mental Health Specialist 9.00 473,496 473,496
1122 Peer Support 2.00 70,021 70,021
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 18.50 $ 1,182,798 $ 1,182,798
Admin Program Total
Direct Personnel Salaries Subtotal 21.60 $ 139,213 $ 1,182,798 $ 1,322,011
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 4,640 $ 39,427 $ 44,067
1202 Worker's Compensation 1,655 14,062 15,717
1203 Health Insurance 26,845 160,203 187,048
1204 Other Dental Insurance 2,107 12,576 14,683
1205 10therAccrued Paid Leave 15,468 131,422 146,890
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Pape 110 of 120
1206 10ther ACI 1 46 1 394 1 441
Direct Employee Benefits Subtotal: $ 50,762 $ 358,084 $ 408,846
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 2,180 $ 18,519 $ 20,699
1302 FICA/MEDICARE 9,731 82,676 92,406
1303 SUI 2,258 19,188 21,446
1304 Other(specify) -
1305 10ther(specify)
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 14,169 $ 120,383 $ 134,551
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 204,145 $ 1,661,264 $ 1,865,409
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
11%1 89%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 368,239
2003 Client Transportation&Support $8,490
2004 Clothing, Food,&Hygiene $8,760
2005 jEclucation Support 6,367
2006 Employment Support 1,061
2007 Household Items for Clients 5,306
2008 Medication Supports 26,530
2009 Program Supplies-Medical 3,184
2010 Utility Vouchers 2,122
2011 Other Client Activities $8,490
2012 Other Personal Needs $2,122
2013 Other Client Building Maintenance 531
2014 Other Client Testing Material 920
2015 Other(specify) -
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $ 442,123
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 12,989
3002 Printing/Postage 974
3003 Office,Household&Program Supplies 12,098
3004 Advertising -
3005 Staff Development&Training 14,324
3006 Staff Mileage 12,734
3007 Subscriptions&Memberships 955
3008 Vehicle Maintenance 3,789
3009 Other Vehicle Insurance/Fuel 14,072
3010 Other Staff Meetings/Employee Relations 3,502
3011 Other Recruitment 4,245
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 79,682
4000:DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 111 of 120
Acct# Line Item Description Amount
4001 Building Maintenance $ 9,742
4002 Rent/Lease Building 106,121
4003 Rent/Lease Equipment 2,122
4004 Rent/Lease Vehicles 21,224
4005 Security 1,061
4006 Utilities 19,102
4007 Other Equipment Maintenance 866
4008 Otherinsurance 5,306
4009 Other Depreciation Expense for Office
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT T0TAL:j $ 165,544
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) 25,469
5003 Contractual/Consulting Services (Specify) $4,311
5004 Translation Services $4,245
5005 Other O/S Psychiatrist $228,160
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES T0TAL:j $ 262,184
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 1,592
6005 Insurance(Specify):
6006 Payroll Services 6,367
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT, Executive, Regional Supports 415,739
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 423,698
INDIRECT COST RATE 15.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 5,306
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 5,306
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)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 112 of 120
FIXED ASSETS EXPENSES TOTAL $ 10,612
TOTAL PROGRAM EXPENSES $ 3,249,252
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 28,888 4.35 $ 125,771
8002 Case Management 124,520 3.06 381,228
8003 Crisis Services 7,820 5.89 46,061
8004 Medication Support 45,032 7.56 340,481
8005 Collateral 2,918 4.35 12,706
8006 Plan Development 3,412 4.35 14,853
8007 Assessment 10,899 4.35 47,451
8008 Rehabilitation 317,936 4.35 1,384,205
8009 Other(Specify) 0 -
8010 10ther(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 1 541,4261 $ 2,352,757
Estimated%of Clients who are Medi-Cal Beneficiaries 95%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 2,235,119
Federal Financial Participation(FFP)% 1 79% 1,765,744
MEDI-CAL FFP TOTAL $ 1,765,744
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 $ 487,008
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 JCFTN-Capital Facilities&Technology
MHSA TOTAL $ 487,008
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ 3,500
8402 Client Insurance -
8403 CCP AB109 Funds 993,000
8404 Other(Specify)
8405 10ther(Specify)
OTHER REVENUE TOTAL $ 996,500
TOTAL PROGRAM FUNDING SOURCES: $ 3,249,252
NET PROGRAM COST: $ 0
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 113 of 120
Forensic Behavioral Health - Continuum of Care
Turning Point of Central California
Fiscal Year (FY) 2026-27
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 %
Records Technician FSC-OP/Fresno 45%
Total 0.45
Position Contract#/Name/Department/County FTE %
Program Bookkeeper FSC-OP/Fresno 45%
Total 0.45
Position Contract#/Name/Department/County FTE %
Nurse FSC-OP/Fresno 50%
Total 0.50
Position Contract#/Name/Department/County FTE %
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 114 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Pa e 115 of 120
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
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 116 of 120
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 117 of 120
Forensic Behavioral Health-Continuum of Care FSC FSP
Turning Point of Central California
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,865,409
Administrative Positions 139,213
1101 Administrative Assistant 46,631 The administrative assistant will oversee the support staff and will help with all
support staff duties.
1102 Records Technician 26,391 The Records Technician will keep track of the Medical Records and will do the billing
for the program
1103 Program Bookkeeper 26,391 The Program Bookkeeper will be assisting the clients with their client fees for their
portion of rent if necessary and keeping track of all the incoming and outgoing of petty
cash as needed.
1104 Secretary 39,800 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.
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 1,182,798
1116 Program Director 106,385 The Program Director oversees the program and the hiring,training and supervising of
staff. FY 2-5 the PD is allocated 100%to FSC FSP,40 hours a week.There is an 8%
reduction in salaries for accrued paid leave.When a staff takes leave,the program is
not changed since it's already been accrued.Our Positions are based on class/step,
some might be less and some might be more,all according to the person's experience
and education when they come to work for Turning Point.This program requires a
Master Degree and BBS Licensure for appropriate clinical oversight.There is a slight
increase in salaries from previous year for COLA.
1117 Assistant Program Director 101,209 The Asssitant Program Director will supervise staff and assist the Program Director.
1118 Mental Health Professionals 258,280 Provides mental health assessment,assessing for Medical Necessity,assists client in
identifying treatment plan goals according to diagnosis. MHP also provides individual
and group therapy as client requests,while also providing program support to assist
clients in crisis. One of the Mental Health Professionals will also be BBS
1119 Supervising PSC 71,187 Provides supervision to all Mental Health Specialists to ensure client care,maintain
compliance with Turning Point policies and procedures. Supervisor also assisting in
training new staff and reporting to the Assistant Program Director.
1120 Nurse 102,220 Nurses work with the doctors for Client care,maintaining compliance with Turning
Point policies and procedures,providing training and ensuring accurate charting in
accordance with Medi-cal.
1121 Mental Health Specialist 473,496 Mental Health Specialist will carry a caseload while also specializing in linking and
providing services to those interested in engagement in employment and education
services.
1122 Peer Support 70,021 Serves as a client advocate and provides information and peer support to clients
throughout their recovery process.
1123 0 -
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 408,846
1201 Retirement 44,067 Cost of Agency contribution to employee retirement plans.This is based on 3%of the
whole salary.
1202 Worker's Compensation 15,717 Cost of workers compensation insurance.
1203 Health Insurance 187,048 Agency cost for health insurance,our health plans vary on what the employee chooses.
This is the range per employer cost from$399.15 per month to 1299.24 per month.
We used an average of$8000.00 Per year.
Fresno County Depatmnent of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D
Page 118 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1204 Other Dental Insurance 14,683 Agency cost for dental insurance
1205 Other Accrued Paid Leave 146,890 The monetary value of staff Paid Leave hours as they accrue on a monthly basis
1206 Other ACI 441 Employee assistance program
Direct Payroll Taxes&Expenses: 134,551
1301 OASDI 20,699 Disability Insurance
1302 FICA/MEDICARE 92,406 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and"Hospital Insurance"
(Medicare).
1303 SUI 21,446 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
wages are paid.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 442,123
2001 Child Care -
2002 Client Housing Support 368,239 Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:
first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&
care,etc.)
2003 Client Transportation&Support 8,490 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 8,760 Cost of Client hygiene supplies and non-work related clothing.(examples:clothes,
shoes,soap,toothpaste,deodorant,grooming supplies,diapers,etc.)
2005 Education Support 6,367 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational classes.
2006 Employment Support 1,061 Cost of client pre-employment preparation and employement retention.(Examples:
job search and interview attire,work boots and tools required for employment,etc.)
2007 Household Items for Clients 5,306 Cost of purchasing items for clients home.(Examples:pots,pans,dishes,silverware,
telephone,radio,etc.)
2008 Medication Supports 26,530 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
co-pays,prescriptions,lab work not covered by insurance,over the counter
medications,first aid kits/supplies for clients use at home.
2009 Program Supplies-Medical 3,184 Cost of medical supplies to be used by staff or clients at the program location to meet
program objective.Such items are to remain at the program location and not sent
home with the client.Such items include,but are not limited to first aid kits,blood
pressure monitor,latex gloves,syringes,hazard disposal service,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility Vouchers 2,122 Cost of utility vouchers for a specific client.
2011 Other Client Activities 8,490 Cost for client activities&recreation events.(Examples:cable bill,
food/drinks/utensils/decorations needed for a specific client event,incentive rewards,
admission fees to events,etc.)
2012 Other Personal Needs 2,122 Cost of supplying clients with necessary personal items(Examples:birth certificate,
DMV Fee for ID or license,clients household cleaning products/house supplies,etc.)
2013 Other Client Building Maintenance 531
2014 Other Client Testing Material 920
2015 Other(specify) -
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 79,682
3001 Telecommunications 12,989 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 974 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including delivery
by the USPS,UPS,FEDEX and other courier services
3003 Office,Household&Program Supplies 12,098 Cost of items normally used in an office setting.(Examples:pens,pencils,paper
tablets,paper clips,notepads,staples,non-electric staplers/hole punchers/calculators,
and other items normally used in an office setting.)House Supplies,Cost of supplies
used by staff during their scheduled work hours.These items are normally used to
operate the building at the program location.These items are to remain at program
location and not sent home with client.(Examples:pots,pans,pot holders,kitchen
towels,curtains,detergent,Clorox for clothes,can opener,dishes,furnace filter,
decorations,linens,etc.),Program Supplies,Cost of any items normally used by clients
to meet program objectives while receiving services.These items are to remain at the
program location and not sent home with the client.Such items include,but are not
limited to video tapes,printed handouts,desk reference books,research material,
curriculum,puzzles,board games,therapeutic/meditative supplies and other items
that are specifically designed and used to accomplish program goals.
3004 Advertising -
3005 Staff Development&Training 14,324 Cost of employee training courses and materials.
Fresno County Department of Behavioral Makh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 119 of 120
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3006 Staff Mileage 12,734 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 955 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
3008 Vehicle Maintenance 3,789 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
maintenance and repair of vehicles used by Agency programs.
3009 Other Vehicle Insurance/Fuel 14,072 Cost of gas in vehicles and insurance.
3010 Other Staff Meetings/Employee Relations 3,502 Staff Meetings:Cost of room and supplies necessary for staff meetings.Employee
Relations:Cost relating to improvement of working conditions(Examples:
Company picnic items,etc.)$10 per FTE per year budgeted for Employee Relations,
all other expenses are related to Staff Meetings.
3011 Other Recruitment 4,245 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 165,544
4001 Building Maintenance 9,742 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 106,121 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 2,122 Cost of rent/lease payments made for furniture and equipment leases.
4004 Rent/Lease Vehicles 21,224 Rental cost of vehicles and lease of agency vehicles.
4005 Security 1,061 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 19,102 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other Equipment Maintenance 866 Cost of equipment and furniture repair and maintenance.(Examples:high capacity
copier/printer/scanner,replacement parts such as hard drive,laptop battery,
monitor/printer/phone cord,drum,power strip,surge protector,video card,etc.)
4008 Other Insurance 5,306 Cost of liability and property insurance
4009 Other Depreciation Expense for Office - Cost of items depreciated at the progra,no pre owned by the agency.
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 262,184
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 25,469 Avatar casts
5003 Contractual/Consulting Services (Specify) 4,311 These accounts are assigned to record various professional services provided by
contracted Consultant working as independent agents.Built in YOY escalator.
Professional services include vendors such as Credible Wireless Data Access and Valley
Expetec IT related expenses as well as clinical supervision.
5004 Translation Services 4,245 Paid to outside vendors for translation/interpreter services
5005 Other O/S Psychiatrist 228,160 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 423,698
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit 1,592 Cost of outside audit fees
6005 Insurance(Specify): -
6006 Payroll Services 6,367 This is our Ultipro timekeeping/HR system
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other Admin,HR,Fiscal,IT,Executive,Regional 415,739 Support of corporate and regional offices such as processing invoices,payroll,cast
Supports reports,etc.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 10,612
7001 Computer Equipment&Software 5,306 Computer and software as needed for the program
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 5,306 Chairs or other furniture as needed for the program
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)
Fresno County Departr:ent of Behavioral Makh Contract Budget Template Revised 4/10/2020
Exhibit D
Page 120 of 120
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORTIDOYLE 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 Based on Trends in our current contracts and the cost per unit currently
8002 Case Management Based on Trends in our current contracts and the cost per unit currently
8003 Crisis Services Based on Trends in our current contracts and the cost per unit currently
8004 Medication Support Based on Trends in our current contracts and the cost per unit currently
8005 Collateral Based on Trends in our current contracts and the cost per unit currently
8006 Plan Development Based on Trends in our current contracts and the cost per unit currently
8007 Assessment Based on Trends in our current contracts and the cost per unit currently
8008 Rehabilitation Based on Trends in our current contracts and the cost per unit currently
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 3,249,252
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 3,249,252
BUDGET CHECK: -
Fresno County Deparanent of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit E
Page 1 of 1
ELECTRONIC HEALTH RECORD SOFTWARE CHARGES
CONTRACTOR understands that COUNTY utilizes NetSmart's Avatar for its Electronic Health Records Management.
CONTRACTOR agrees to reimburse COUNTY for all user license fees for accessing NetSmart's Avatar, as set forth below.
Description FY 2020-21 FY 2021-22 FY 2022-23 FY 2023-24 FY 2024-25
General Users
Avatar Named User Hosting
(per active user per month; every Avatar"active" log on $37.00 $37.00 $37.00 $37.00 $37.00
ID is a named user)
Avatar Named User Maintenance*
(per active user per month) $14.85 $15.30 $15.76 $16.23 $16.72
Cloud Hosting- Perceptive Disaster Recovery
(per active user per month) $4.66 $4.66 $4.66 $4.66 $4.66
eRx Users
Full Suite Prescriber
(per active user per month; applicable to an active $104.00 $104.00 $104.00 $104.00 $104.00
Prescriber user
ePrescribing Controlled Substances Tokens
(per active user per month; applicable to an active $8.00 $8.00 $8.00 $8.00 $8.00
Prescriber user of Controlled Substances
Non-Prescribing User
(per active user per month; applicable to an active Non- $13.00 $13.00 $13.00 $13.00 $13.00
Prescriber user
Reaching Recovery Users
Reaching Recovery
(per adult client/person served per year; applicable to $10.00 $10.00 $10.00 $10.00 $10.00
adult treatment programs except contracted triage/CI,
CSU or PHF
ProviderConnect Users
Individual Subscription
(per user per month; applicable to provider-user whose $41.25 $41.25 $41.25 $41.25 $41.25
claims are reviewed and posted by Managed Care
Should CONTRACTOR choose not to utilize NetSmart's Avatar for its Electronic Health Records management, CONTRACTOR will
be responsible for obtaining its own system for Electronic Health Records management.
*Annual Maintenance increases by 3%each FY on July 1st and may be subject to change pending the COUNTY's agreement terms with NetSmart.
Exhibit F
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws, regulations,
rules and guidelines that apply to the provision and payment of mental health services. Mental
health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. CONTRACTOR(S) shall require its
employees and subcontractors to attend a compliance training that will be provided by Fresno
County. After completion of this training, CONTRACTOR(S), CONTRACTOR(S)' employees and
subcontractors must sign the Contractor Acknowledgment and Agreement form and return this form
to the Compliance Officer or designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and
billing for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in
their professional dealing related to their contract with the COUNTY and avoid any
conduct that could reasonably be expected to reflect adversely upon the integrity of the
COUNTY.
3. Treat COUNTY employees, consumers, and other mental health contractors fairly and
with respect.
4. NOT engage in any activity in violation of the COUNTY's Compliance Program, nor
engage in any other conduct which violates any applicable law, regulation, rule or
guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely
and are consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or
reimbursement of any kind are submitted.
Exhibit F
Page 2 of 3
7. Bill only for eligible services actually rendered and fully documented. Use billing codes
that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by COUNTY employees or other mental health contractors, or
report any activity that they believe may violate the standards of the Compliance
Program, or any other applicable law, regulation, rule or guideline. Fresno County
prohibits retaliation against any person making a report. Any person engaging in any
form of retaliation will be subject to disciplinary or other appropriate action by the
COUNTY. CONTRACTOR(S) may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or
guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible
person and therefore excluded from participation in the Federal Health Care Programs.
Exhibit F
Page 3 of 3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
Signature: Date:
For Group or Organizational Providers
Group/Org. Name (print):
Employee Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
❑ Other:
Job Title (if different from Discipline):
Signature: Date: / /
Exhibit G
Page 1 of 4
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1) the retroactive date must
be prior to the date on which services began under this Agreement; (2) the Contractor
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse / molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
G-1
Exhibit G
Page 2 of 4
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Contractor.
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under sSection
Twenty (20) of this Agreement; (iv) system failure; (v) data recovery; (vi)failure to timely
disclose data breach or Security Breach; (vii) failure to comply with privacy policy; (viii)
payment card liabilities and costs; (ix) infringement of intellectual property, including but
not limited to infringement of copyright, trademark, and trade dress; (x) invasion of
privacy, including release of private information; (xi) information theft; (xii) damage to or
destruction or alteration of electronic information; (xiii) cyber extortion; (xiv) extortion
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; (xv)fraudulent instruction; (xvi)funds
transfer fraud; (xvii) telephone fraud; (xviii) network security; (xix) data breach response
costs, including Security Breach response costs; (xx) regulatory fines and penalties
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; and (xxi) credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement,
and at any time during the term of this Agreement as requested by the County's Risk
Manager or the County Administrative Office, the Contractor shall deliver, or cause its
broker or producer to deliver, to the County Risk Manager, at 2220 Tulare Street, 16th
Floor, Fresno, California 93721, or HRRiskManagement@fresnocountyca.gov, and by
mail or email to the person identified to receive notices under this Agreement and
DBH Contracted Services(a-)-fresnocountyca.gov with a copy to the assigned County Staff
Analyst, certificates of insurance and endorsements for all of the coverages required
under this Agreement.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and (3) the
Contractor has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned. The commercial general liability
G-2
Exhibit G
Page 3 of 4
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
shall be excess only and not contributing with insurance provided under the
Contractor's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this Agreement.
(v) The cyber liability insurance certificate must also state that it is endorsed, and
include an endorsement, to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited
to information or data) that is in the care, custody, or control of the Contractor.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VII.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, the Contractor shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, the Contractor shall, or shall
cause the insurer to, provide written notice to the County not less than 30 days in
advance of cancellation or change. The County in its sole discretion may determine that
the failure of the Contractor or its insurer to timely provide a written notice required by
this paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance
with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Contractor shall deliver, or cause its broker or producer
to deliver, to the County's Risk Manager certificates of insurance and endorsements for
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E) Waiver of Subrogation. The Contractor waives any right to recover from the County, its
officers, agents, employees, and volunteers any amounts paid under the policy of
worker's compensation insurance required by this Agreement. The Contractor is solely
responsible to obtain any policy endorsement that may be necessary to accomplish that
G-3
Exhibit G
Page 4 of 4
waiver, but the Contractor's waiver of subrogation under this paragraph is effective
whether or not the Contractor obtains such an endorsement.
(F) County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep
in effect at all times any insurance coverage required under this Agreement, the County
may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Contractor. The County may offset such
charges against any amounts owed by the County to the Contractor under this
Agreement.
(G)Subcontractors. The Contractor shall require and verify that all subcontractors used by
the Contractor to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement. This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
G-4
Exhibit H
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 H
Page 2 of 3
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document
changes in the client's condition.
• Client conditions will be assessed at least annually and, in most cases, at more
frequent intervals.
B. Client Plans
1. Client plans will:
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent) by:
➢ the person providing the service(s), or
➢ a person representing a team or program providing services, or
➢ a person representing the MHP providing services
➢ when the client plan is used to establish that the services are provided under the
direction of an approved category of staff, and if the below staff are not the
approved category,
➢ a physician
➢ a licensed/ "waivered" psychologist
➢ a licensed/"associate" social worker
➢ a licensed/ registered/marriage and family therapist or
➢ a registered nurse
• In addition,
➢ Client plans will be consistent with the diagnosis, and the focus of intervention
will be consistent with the client plan goals, and there will be documentation of
the client's participation in and agreement with the plan. Examples of the
documentation include, but are not limited to, reference to the client's
participation and agreement in the body of the plan, client signature on the plan,
or a description of the client's participation and agreement in progress notes.
Exhibit H
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 I
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 I
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 I
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 I
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 M 0411):
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 I
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 I
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 J
Page 1 of 2
COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall be required to maintain organizational provider certification by the host
county. A copy of this renewal certificate must be furnished to COUNTY within thirty (30) days
of receipt of certificate from host county. The CONTRACTOR must meet Medi-Cal organization
provider standards as stated below. It is acknowledged that all references to Organizational
Provider and/or Provider below shall refer to the CONTRACTOR.
Medi-Cal Organizational Provider Standards
1. The organizational provider possesses the necessary license to operate, if applicable,
and any required certification.
2. The space owned, leased or operated by the provider and used for services or staff
meets local fire codes.
3. The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4. The organizational provider establishes and implements maintenance policies for any
site owned, leased, or operated by the provider and used for services or staff to ensure
the safety and well-being of beneficiaries and staff.
5. The organizational provider has a current administrative manual which includes:
personnel policies and procedures, general operating procedures, service delivery
policies, and procedures for reporting unusual occurrences relating to health and
safety issues.
6. The organizational provider maintains client records in a manner that meets applicable
state and federal standards.
7. The organization provider has staffing adequate to allow the COUNTY to claim federal
financial participation for the services the Provider delivers to beneficiaries, as
described in Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8. The organizational provider has as head of service a licensed mental health
professional or other appropriate individual as described in Title 9, CCR, Sections 622
through 630.
9. For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A. All drugs obtained by prescription are labeled in compliance with federal and state
laws. Prescription labels are altered only by persons legally authorized to do so.
B. Drugs intended for external use only or food stuffs are stored separately from drugs
for internal use.
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86
degrees F and refrigerated drugs at 36-46 degrees F.
Exhibit J
Page 2 of 2
D. Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F. A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal
laws.
G. Policies and procedures are in place for dispensing, administering and storing
medications.
10. The COUNTY may accept the host county's site certification and reserves the right to
conduct an on-site certification review at least every three years. The COUNTY may
also conduct additional certification reviews when:
• The provider makes major staffing changes.
• The provider makes organizational and/or corporate structure changes
(example: conversion from a non-profit status).
• The provider adds day treatment or medication support services when
medications shall be administered or dispensed from the provider site.
• There are significant changes in the physical plant of the provider site (some
physical plant changes could require a new fire clearance).
• There is change of ownership or location.
• There are complaints against the provider.
• There are unusual events, accidents, or injuries requiring medical treatment for
clients, staff or members of the community.
Exhibit K
Page 1 of 2
FRESNO COUNTY MENTAL HEALTH PLAN
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance and
appeal process and an expedited appeal process to resolve grievances and disputes at
the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-for-service
providers give verbal and written information to Medi-Cal beneficiaries regarding the
following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
the individuals served copies of all current beneficiary information annually at the time
their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process—the provider may first speak to a Provider
Relations Specialist (PRS) regarding his or her complaint or concern.
Exhibit K
Page 2 of 2
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process—the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for MHP
payment authorization, or the process or payment of a provider's claim to the MHP.
Payment authorization issues—the provider may appeal a denied or modified request
for payment authorization or a dispute with the MHP regarding the processing or
payment of a provider's claim to the MHP. The written appeal must be submitted to the
MHP within 90 calendar days of the date of the receipt of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the decision
that addresses each issue raised by the provider, and any action required by the
provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request, the
MHP utilizes a Managed Care staff who was not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within 30 calendar days of receipt of the decision
Other complaints— if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the MHP. The provider will receive a written response from the MHP within 60 calendar
days of receipt of the complaint. The decision rendered buy the MHP is final.
Exhibit L
Page 1 of 9
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
The Incident Report must be completed for all incidents involving individuals served through
DBH's current incident reporting portal, Logic Manager, at
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=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.
• Employees involved in a crisis incident should be offered appropriate Employee
Assistance Program (EAP) or similar related wellness and recovery assistance. In
conjunction with the DBH's Guiding Principles of Care Delivery and wellness of the
workforce, CONTRACTOR shall align their practices around this vision and ensure
needed debriefing services are offered to all employees involved in a crisis incident.
Employees shall be afforded all services to strengthen their recovery and wellness
related to the crisis incident. Appropriate follow-up with the employee shall be carried
out and a plan for workforce wellness shall be submitted to DBH.
Questions about incident reporting, how to use the incident reporting portal, or
designating/changing the name of the administrator who will review incidents for the
CONTRACTOR should be emailed to DBHlncidentReporting@fresnocountyca.gov and the
assigned contract analyst.
Exhibit L
Mental Health Plan (MHP) and Substance Use Disorder(SUD) services Page 2 of 9
Cot, Incident Reporting System
INCIDENT REVIEWER ROLE — User Guide
Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted
providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete
a written report of any incidents compromising the health and safety of persons served, employees, or
community members.
Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's
an easier way for any employee to report an incident at any time. A few highlights:
• No supervisor signature is immediately required.
• Additional information can be added to the report by the program supervisor/manager without
having to resubmit the incident.
• When an incident is submitted, the assigned contract analyst, program supervisor/manager,
clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email
notification of a new incident and can log in any time to review the incident. Everything that
was on the original paper/electronic form matches the 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@fresnocountyca.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 L
Page 3 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'
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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 L
Page 4 of 9
Similar to the paper version, multiple incident categories can be selected
widen)1c41e6 all thal apply'(
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Homicldei Homicide Alt—lil
AWOL;Elopement from locked foci lity
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Exhibit L
Page 5 of 9
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Exhibit L
Page 6 of 9
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Exhibit L
Page 7 of 9
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Page 8 of 9
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Exhibit L
Page 9 of 9
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Exhibit M
Page 1 of 2
Vendor: Contract# Contact Person Contact#
` i
..
> Date Date I Fresno
y
Q £ Requested Approved( Purchase County
Item Make/Brand Model Serial# n d Location Condition Cost
(If Fixed If Fixed Date Inventory
K Asset) Assset) Number
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Date Prepared:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Date Received:
EXHIBIT M
Page 2 of 2
FI XED ASSET AND SENSI TI VE I TEM TRACM NG
Fi el d Number Fi el d I nst r uct i on or Comment s Requi red or
Descr i pt i on Condi t i onal
Header Vendor I ndi cat e t he I egal name of t he agency cont r act ed t o Requi red
provide services.
Header Pr ogr am I ndi cat e t he title of the project as described in the Required
cont r act wi t h t he Count y.
Header Cont r act # I ndi cat e t he assi gned Count y cont r act number. I f not Required
known, Count y st of f can pr ovi de.
Header Cont act Person I ndi cat e the first and last nacre of the pr i mar y agency Required
cont act f or t he cont r act.
Header Cont act # I ndi cat e t he rrost appr opr i at e t el ephone number of t he Requi red
pr i mar y agency cont act f or t he cont r act.
Header Date Prepared I ndi cat e t he rrost cur rent dat e t hat t he t r acki ng form Requi red
was corrpl et ed by the vendor.
a I t em I dent i f y t he i t em by pr ovi di ng a comrronl y recognized Requi red
descr i pt i on of t he i t em
b Mike/Brand I dent i f y t he corrpany t hat manuf act ur ed t he i t em Requi red
c IVbdel I dent i f y t he model number f or t he i t ern i f appl i cabl e. Condit i onal
d Ser i al # I dent i f y t he ser i al number f or t he i t ems if Condit i onal
appl i cabl e.
Mir k t he box wi t h an "X" i f t he cost of t he i t em i s
e Fi xed Asset $5,000 or more to i ndi cat e that the item i s a f i xed Condit i onal
asset.
f Sensi t i ve I t em fvbr k t he box with an "X' if the item meets t he Condit i onal
cr i t er i a of a sensitive item as defined by t he Count y.
g Dat a Request ed I ndi cat e t he dat e t hat t he agency submi t t ed a request Requi red
t o the County to purchase the item
h Date Approved I ndi cat e t he dat e t hat t he Count y approved t he request Requi red
to purchase t he i t em
i Purchase Date I ndi cat e t he date t he agency purchased t he i tern Requi red
j Locat i on I ndi cat e t he physi cal I ocat i on of t he i t em Requi red
k Condi t i on I ndi cat e t he general condition of t he i t em (New, Good, Requi red
V)br n, Bad).
Fresno County
I I nvent or y I ndi cat e t he FIR # pr ovi ded by t he County for the item Condit i onal
Nurrber
m Cost I ndi cat e t he t of al purchase pr i ce of t he i t em Requi red
i ncl udi ng sal es t ax and of her cost s, such as shi ppi ng.
Exhibit N
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
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Exhibit N
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.Deporfinentof https://www.thinkculturalhealth.hhs.gov/
1O M H Health and Human Services
Office of Minority Health contact@thinkculturalhealth.hhs.gov
o��
Exhibit O
Page 1 of 3
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) City State ZIP code
CLIA number Taxpayer ID number(EIN) Telephone number
( )
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued.
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 XVII I, XIX, or XX? ......................................................................................................................... o 0
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX?...................................................................................... o 0
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 0
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under"Remarks."
NAME ADDRESS EIN
B. Type of entity: o Sole proprietorship o Partnership o Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... n n
NAME ADDRESS PROVIDER NUMBER
Exhibit O
Page 2 of 3
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... o 0
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... o 0
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
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 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
Exhibit 0
Page 3 of 3
INSTRUCTIONS FOR COMPLETING DISCLOSURE OF CONTROL AND INTEREST STATEMENT
Please answer all questions as of the current date.If the yes block for any item is checked,list requested additional information under
the Remarks Section on page 2,referencing the item number to be continued. If additional space is needed use an attached sheet.
DETAILED INSTRUCTIONS
These instructions are designed to clarify certain questions on the form.Instructions are listed in question order for easy reference.No
instructions have been given for questions considered self-explanatory.
IT IS ESSENTIAL THAT ALL APPLICABLE QUESTIONS BE ANSWERED ACCURATELY AND THAT ALL INFORMATION
BE CURRENT.
Item I-Under"Identifying Information"specify in what capacity the entity is doing business as(DBA)(e.g.name of trade or
corporation).
Item II-Self-explanatory
Item III-List the names of all individuals and organizations having direct or indirect ownership interests,or controlling interest
separately or in combination amounting to an ownership interest of 5 percent or more in the disclosing entity.
Direct ownership interest-is defined as the possession of stock,equity in capital or any interest in the profits of the disclosing entity.
A disclosing entity is defined as a Medicare provider or supplier,or other entity that furnishes services or arranges for furnishing
services under Medicaid or the Maternal and Child Health program,or health related services under the social services program.
Indirect ownership interest-is defined as ownership interest in an entity that has direct or hospital-based home health agencies,are not
indirect ownership interest in the disclosing entity.The amount of indirect ownership in the disclosing entity that is held by any other
entity is determined by multiplying the percentage of ownership interest at each level.An indirect ownership interest must beds in the
facility now and the previous be reported if it equates to an ownership interest of 5 percent or more in the disclosing entity.Example:
if A owns 10 percent of the stock in a corporation that owns 80 percent of the stock of the disclosing entity,A's interest equates to an 8
percent indirect ownership and must be reported.
Controlling interest-is defined as the operational direction or management of disclosing entity which may be maintained by any or all
of the following devices:the ability or authority,expressed or reserved,to amend or change the corporate identity(i.e.,joint venture
agreement,unincorporated business status)of the disclosing entity;the ability or authority to nominate or name members of the Board
of Directors or Trustees of the disclosing entity;the ability or authority,expressed or reserved,to amend or change the by-laws,
constitution,or other operating or management direction of the disclosing entity;the right to control any or all of the assets or other
property of the disclosing entity upon the sale or dissolution of that entity;the ability or authority,expressed or reserved,to control the
sale of any or all of the assets,to encumber such assets by way of mortgage or other indebtedness,to dissolve the entity or to arrange
for the sale or transfer of the disclosing entity to new ownership or control.
Item IV-VII-(Changes in Provider Status)For Items IV-VII,if the yes box is checked,list additional information requested under
Remarks.Clearly identify which item is being continued.
Change in provider status-is defined as any change in management control.Examples of such changes would include;a change in
Medical or Nursing Director,a new Administrator,contracting the operation of the facility to a management corporation,a change in
the composition of the owning partnership which under applicable State law is not considered a change in ownership,or the hiring or
dismissing of any employees with 5 percent or more financial interest in the facility or in an owning corporation,or any change of
ownership.
Item IV-(A&B)If there has been a change in ownership within the last year or if you anticipate a change,indicate the date in the
appropriate space.
Item V-If the answer is yes,list name of the management firm and employer identification number(EIN),or the name of the leasing
organization.A management company is defined as any organization that operates and manages a business on behalf of the owner of
that business,with the owner retaining ultimate legal responsibility for operation of the facility.
Item VI-If the answer is yes,identify which has changed(Administrator,Medical Director,or Director of Nursing)and the date the
change was made.Be sure to include name of the new Administrator,Director of Nursing or Medical Director,as appropriate.
Item VII-A chain affiliate is any free-standing health care facility that is either owned,controlled,or operated under lease or contract
by an organization consisting of two or more free-standing health care facilities organized within or across State lines which is under
the ownership or through any other device,control and direction of a common party. Chain affiliates include such facilities whether
public,private,charitable or proprietary.They also include subsidiary organizations and holding corporations.Provider-based
facilities,such as hospital-based home health agencies,are not considered to be chain affiliates.
Exhibit P
Page 1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
Exhibit P
Page 2 of 2
(c) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
Exhibit Q
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "COUNTY"),
members of a CONTRACTOR's board of directors (hereinafter referred to as "County
Contractor"), must disclose any self-dealing transactions that they are a party to while
providing goods, performing services, or both for the COUNTY. A self-dealing transaction is
defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name, job title (if applicable), and date this disclosure is being
made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to
the COUNTY. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the
transaction; and
b. The nature of the material financial interest in the corporation's transaction that
the board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
Exhibit Q
Page 2 of 2
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3)Disclosure(Please describe the nature of the self-dealing transaction you are a party to):
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a):
(5)Authorized Signature
Signature: Date: