HomeMy WebLinkAboutAgreement A-22-304 with Exodus CSCs.pdf Agreement No. 22-304
1 AGREEMENT
2 THIS AGREEMENT is made and entered into this 12t" day of July , 2022, by
3 and between the COUNTY OF FRESNO, a political subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and EXODUS RECOVERY, INC., a for profit corporation, whose address is
5 9808 Venice Blvd, Suite 700, Culver City, CA 90232, hereinafter referred to as "CONTRACTOR"
6 (collectively the "parties").
7 WITNESSETH:
8 WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), is in need of a
9 qualified agency to operate an Adult Crisis Stabilization Center (Adult CSC) to provide crisis
10 stabilization services to adults, age 18 and older;
11 WHEREAS, COUNTY, through DBH, is in need of a qualified agency to operate a Youth Crisis
12 Stabilization Center (Youth CSC) to provide crisis stabilization services to youth, age up to 18;
13 WHEREAS, all individuals in need of crisis stabilization services may be admitted on a voluntary
14 or involuntary basis referred by DBH, a DBH-subcontracted provider, law enforcement, hospital
15 emergency departments, and Emergency Medical Services transports, regardless of the source of
16 payment;
17 WHEREAS, COUNTY, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of
18 the California Code of Regulations, section 1810.226; and
19 WHEREAS, CONTRACTOR is qualified and willing to operate said Adult CSC and Youth CSC
20 pursuant to the terms and conditions of this Agreement.
21 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
22 hereto agree as follows:
23 1. OBLIGATIONS OF THE CONTRACTOR
24 A. CONTRACTOR shall perform all services and fulfill all responsibilities as set forth
25 in Exhibit A-1, "Adult Crisis Stabilization Center Scope of Work" and Exhibit A-2, "Youth Crisis
26 Stabilization Center Scope of Work", both attached hereto and incorporated herein by reference.
27 B. CONTRACTOR shall align programs, services, and practices with the vision,
28 mission, and guiding principles of the COUNTY's DBH, as further described in Exhibit B, "Guiding
1 - COUNTY OF FRESNO
Fresno, CA
I Principles of Care Delivery", attached hereto and by this reference incorporated herein and made part of
2 this Agreement.
3 C. CONTRACTOR shall send to County's DBH upon execution of this Agreement, a
4 detailed plan ensuring clinically appropriate leadership and supervision of their clinical program.
5 Recruitment and retention of clinical leadership with the clinical competencies to oversee services based
6 on the level of care and program design presented herein shall be included in this plan. A description and
7 monitoring of this plan shall be provided.
8 D. During the term of this Agreement, it is expected that there will be a change in
9 location of the service site(s) to the Heritage Centre located at the corner of Shields Avenue and
10 Millbrook Avenue in Fresno, California 93703. COUNTY's DBH Director, or designee, will give verbal
11 notification of the timeframe expected regarding the relocation. CONTRACTOR shall work
12 collaboratively with COUNTY to ensure an efficient transition and transport of all individuals currently
13 receiving services.
14 E. CONTRACTOR shall maintain requirements as an organizational provider
15 throughout the term of this Agreement, as described in Section Seventeen (17) of this Agreement. If for
16 any reason, this status is not maintained, the COUNTY may terminate this Agreement pursuant to
17 Section Three (3) of this Agreement.
18 F. CONTRACTOR agrees that prior to providing services under the terms and
19 conditions of this Agreement, it shall have appropriate staff hired and in place for program services and
20 operations or COUNTY may, in addition to other remedies it may have, suspend referrals or terminate
21 this Agreement in accordance with Section Three (3) of this Agreement. The parties acknowledge that
22 CONTRACTOR will be performing hiring, training, and credentialing of staff, and COUNTY will be
23 performing additional staff credentialing to ensure compliance with State and Federal regulations.
24 G. CONTRACTOR shall collect, maintain and report all data and the individual's
25 information for the service categories independent of one another, including but not limited to: Medi-Cal
26 billing, other insurance or revenue billing and reports; staff schedules and reports; performance measures;
27 monthly invoices and general ledgers; and other data as required.
28 H. It is acknowledged by all parties hereto that COUNTY's DBH shall monitor the
- 2 - COUNTY OF FRESNO
Fresno, CA
1 services provided by CONTRACTOR, in accordance with Section Fourteen (14) of this Agreement.
2 I. CONTRACTOR shall participate in periodic workgroup meetings consisting of staff
3 from COUNTY's DBH to discuss service requirements, data reporting, outcomes measurement, training,
4 policies and procedures, overall program operations, and any problems or foreseeable problems that may
5 arise.
6 J. 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 COUNTY's DBH Director, or designee. All print or media materials, including program
9 branding and program references shall be reviewed and approved by the COUNTY'S DBH Director, or
10 designee. The program funded under this Agreement shall be identified as a "County of Fresno,
11 Department of Behavioral Health funded program", and operated by the CONTRACTOR under the
12 terms and conditions of this Agreement.
13 2. TERM
14 The term of this Agreement shall be for a period of three (3) years, commencing
15 retoractive to July 1, 2022 through and including June 30, 2025. This Agreement may be extended for
16 two (2) additional consecutive twelve (12) month periods upon written approval of both parties no later
17 than thirty (30) days prior to the first day of the next twelve (12) month extension period. The DBH
18 Director, or designee, is authorized to execute such written approval on behalf of COUNTY based on
19 CONTRACTOR'S satisfactory performance.
20 3. TERMINATION
21 A. Non-Allocation of Funds—The terms of this Agreement, and the services to be
22 provided thereunder, are contingent on the approval of funds by the appropriating government agency.
23 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
24 terminated at any time by giving CONTRACTOR sixty (60) days advance written notice.
25 B. Breach of Contract—COUNTY may immediately suspend or terminate this
26 Agreement in whole or in part, where in the determination of COUNTY there is:
27 1) An illegal or improper use of funds;
28 2) A failure to comply with any term of this Agreement;
- 3 - COUNTY OF FRESNO
Fresno, CA
1 3) A substantially incorrect or incomplete report submitted to COUNTY;
2 4) Improperly performed service.
3 In no event shall any payment by COUNTY constitute a waiver by the COUNTY of any
4 breach of this Agreement or any default which may then exist on the part of the CONTRACTOR. Neither
5 shall such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or
6 default. The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the
7 COUNTY of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of the
8 COUNTY were not expended in accordance with the terms of this Agreement. CONTRACTOR shall
9 promptly refund any such funds upon demand or, at COUNTY's option, such repayment shall be deducted
10 from future payments owing to CONTRACTOR under this Agreement.
11 C. Without Cause - Under circumstances other than those set forth above, this
12 Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written notice of an
13 intention to terminate to CONTRACTOR.
14 4. COMPENSATION
15 COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
16 compensation for actual expenditures incurred in accordance with Exhibit C-1, "Adult Crisis
17 Stabilization Center Budget and Narrative", and Exhibit C-2, "Youth Crisis Stabilization Center Budget
18 and Narrative", as approved by the COUNTY's DBH Director, or designee, both attached hereto and
19 incorporated herein by this reference.
20 Maximum Annual Compensation
21 A. Adult CSC
22 In no event shall compensation paid for actual services performed at the Adult
23 CSC under this Agreement during the period of July 1, 2022 through June 30, 2023 be in excess of
24 Fourteen Million, Four Hundred Thirty-Eight Thousand, Eight Hundred Fifteen and No/100 Dollars
25 ($14,438,815.00).
26 In no event shall compensation paid for actual services performed at the Adult
27 CSC under this Agreement during the period of July 1, 2023 through June 30, 2024 be in excess of
28 Fourteen Million, Seven Hundred Eleven Thousand, One Hundred Sixty-Two and No/100 Dollars
- 4 - COUNTY OF FRESNO
Fresno, CA
1 ($14,711,162.00).
2 In no event shall compensation paid for actual services performed at the Adult
3 CSC under this Agreement during the period of July 1, 2024 through June 30, 2025 be in excess of
4 Fourteen Million, Nine Hundred Ninety-One Thousand, Six Hundred Forty-One and No/100 Dollars
5 ($14,991,641.00).
6 If this Agreement is extended for the first optional 12-month extension period, in
7 no event shall compensation paid for actual services performed at the Adult CSC under this Agreement
8 during the period of July 1, 2025 through June 30, 2026 be in excess of Fifteen Million, Two Hundred
9 Seventy-Two, One Hundred Two and No/100 Dollars ($15,272,102.00).
10 If this Agreement is extended for the second optional 12-month extension period,
11 in no event shall compensation paid for actual services performed at the Adult CSC under this
12 Agreement during the period of July 1, 2026 through June 30, 2027 be in excess of Fifteen Million, Five
13 Hundred Seventy-Eight Thousand, One Hundred Forty-Six and No/100 Dollars ($15,578,146.00).
14 B. Youth CSC
15 In no event shall compensation paid for actual services performed at the Youth
16 CSC under this Agreement during the period of July 1, 2022 through June 30, 2023 be in excess of
17 Five Million, Nine Hundred Sixty Thousand, Ninety-Three and No/100 Dollars ($5,960,093.00).
18 In no event shall compensation paid for actual services performed at the Youth
19 CSC under this Agreement during the period of July 1, 2023 through June 30, 2024 be in excess of Six
20 Million, Seventy-Three Thousand, Two Hundred Three and No/100 Dollars ($6,073,203.00).
21 In no event shall compensation paid for actual services performed at the Youth
22 CSC under this Agreement during the period of July 1, 2024 through June 30, 2025 be in excess of Six
23 Million, One Hundred Eighty-Nine Thousand, Seven Hundred and No/100 Dollars ($6,189,700.00).
24 If this Agreement is extended for the first optional 12-month extension period, in
25 no event shall compensation paid for actual services performed at the Youth CSC under this
26 Agreement during the period of July 1, 2025 through June 30, 2026 be in excess of Six Million, Three
27 Hundred Nine Thousand, Six Hundred Ninety-Nine and No/100 Dollars ($6,309,699.00).
28 If this Agreement is extended for the second optional 12-month extension period,
5 - COUNTY OF FRESNO
Fresno, CA
1 in no event shall compensation paid for actual services performed at the Youth CSC under this
2 Agreement during the period of July 1, 2026 through June 30, 2027 be in excess of Six Million, Four
3 Hundred Thirty-One Thousand, Three Hundred Fifty-Nine and No/100 Dollars ($6,431,359.00).
4 Total Compensation
5 A. Adult CSC
6 In no event shall the total maximum compensation amount under this Agreement
7 for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25) combined for services provided at the
8 Adult CSC exceed Forty-Four Million, One Hundred Forty-One Thousand, Six Hundred Eighteen and
9 No/100 Dollars ($44,141,618.00).
10 In no event shall the total maximum compensation amount under this Agreement
11 for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus one (1) 12-month extension period
12 (FY 2025-26) combined for services provided at the Adult CSC exceed Fifty-Nine Million, Four Hundred
13 Thirteen Thousand, Seven Hundred Twenty and No/100 Dollars ($59,413,720.00).
14 In no event shall the total maximum compensation amount under this Agreement
15 for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus two (2) 12-month extension periods
16 (FY 2025-26 & FY 2026-27) combined for services provided at the Adult CSC exceed Seventy-Four
17 Million, Nine Hundred Ninety-One Thousand, Eight Hundred Sixty-Six and No/100 Dollars
18 ($74,991,866.00).
19 B. Youth CSC
20 In no event shall the total maximum compensation amount under this Agreement
21 for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25) combined for services provided at the
22 Youth CSC exceed Eighteen Million, Two Hundred Twenty-Two Thousand, Nine Hundred Ninety-Six
23 and No/100 Dollars ($18,222,996.00).
24 In no event shall the total maximum compensation amount under this Agreement
25 for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus the first 12-month extension period
26 (FY 2025-26) combined for services provided at the Youth CSC exceed Twenty-Four Million, Five
27 Hundred Thirty-Two Thousand, Six Hundred Ninety-Five and No/100 Dollars ($24,532,695.00).
28 In no event shall the total maximum compensation amount under this Agreement
- 6 - COUNTY OF FRESNO
Fresno, CA
1 for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus both 12-month extension periods
2 (FY 2025-26 & FY 2026-27) combined for services provided at the Youth CSC exceed Thirty Million,
3 Nine Hundred Sixty-Four Thousand, Fifty-Four and No/100 Dollars ($30,964,054.00).
4 C. Total Maximum Compensation
5 In no event shall the total maximum compensation amount under this Agreement
6 for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25) combined for services provided at the
7 Adult and Youth CSC exceed Sixty-Two Million, Three Hundred Sixty-Four Thousand, Six Hundred
8 Fourteen and No/100 Dollars ($62,364,614.00).
9 In no event shall the total maximum compensation amount under this Agreement
10 for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus one (1) 12-month extension period
11 (FY 2025-26) combined for services provided at the Adult and Youth CSC exceed Eighty-Three Million,
12 Nine Hundred Forty-Six Thousand, Four Hundred Fifteen and No/100 Dollars ($83,946,415.00).
13 In no event shall the total maximum compensation amount under this Agreement
14 for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus two (2) 12-month extension periods
15 (FY 2025-26 & FY 2026-27) combined for services provided at the Adult and Youth CSC exceed One
16 Hundred Five Million, Nine Hundred Fifty-Five Thousand, Nine Hundred Twenty and No/100 Dollars
17 ($105,955,920.00).
18 D. Additional Requirements
19 1. If CONTRACTOR fails to generate the Medi-Cal revenue and/or private pay
20 reimbursement amounts set forth in Exhibits C-1 and C-2, COUNTY shall not be obligated to pay the
21 difference between these estimated amounts and the actual amounts generated.
22 2. Travel shall be reimbursed based on actual expenditures and mileage
23 reimbursement shall be at CONTRACTOR's adopted rate per mile, not to exceed the Federal Internal
24 Revenue Services (IRS) published rate.
25 3. It is understood that all expenses incidental to CONTRACTOR's
26 performance of services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails
27 to comply with any provision of this Agreement, COUNTY shall be relieved of its obligation for further
28 compensation.
- 7 - COUNTY OF FRESNO
Fresno, CA
1 4. Payments shall be made by COUNTY to CONTRACTOR in arrears for
2 services provided during the preceding month, within forty-five (45) days after the date of receipt and
3 approval by COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments shall be
4 made after receipt and verification of actual expenditures incurred by CONTRACTOR for monthly program
5 costs, as identified in Exhibits C-1 and C-2, in the performance of this Agreement and shall be documented
6 to COUNTY on a monthly basis by the tenth (10th) of the month following the month of said expenditures.
7 5. COUNTY shall not be obligated to make any payments under this
8 Agreement if the request for payment is received by COUNTY more than sixty (60) days after this
9 Agreement has terminated or expired.
10 6. All final invoices and/or any final budget modification requests shall be
11 submitted by CONTRACTOR within sixty (60) days following the final month of service for which payment
12 is claimed. No action shall be taken by COUNTY on invoices submitted beyond the sixty (60) day closeout
13 period. Any compensation which is not expended by CONTRACTOR pursuant to the terms and
14 conditions of this Agreement shall automatically revert to COUNTY.
15 7. The services provided by CONTRACTOR under this Agreement are funded
16 in whole or in part by the State of California. In the event that funding for these services is delayed by the
17 State Controller, COUNTY may defer payments to CONTRACTOR. The amount of the deferred payment
18 shall not exceed the amount of funding delayed by the State Controller to the COUNTY. The period of
19 time of the deferral by COUNTY shall not exceed the period of time of the State Controller's delay of
20 payment to COUNTY plus forty-five (45) days.
21 8. CONTRACTOR shall be held financially liable for any and all future
22 disallowances/audit exceptions due to CONTRACTOR deficiency discovered through the State audit
23 process and COUNTY utilization review during the course of this Agreement. At COUNTY's election, the
24 disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall be
25 withheld from subsequent payments to CONTRACTOR. CONTRACTOR shall not receive reimbursement
26 for any units of services rendered that are disallowed or denied by the COUNTY's DBH utilization review
2 7 process or through the State Department of Health Care Services (DHCS) cost report audit settlement
28 process for Medi-Cal eligible persons served. Notwithstanding the above, COUNTY must notify
- 8 - COUNTY OF FRESNO
Fresno, CA
I CONTRACTOR prior to any State audit process and/or COUNTY utilization review. To the extent
2 allowable by law, CONTRACTOR shall have the right to be present during each phase of any State audit
3 process and/or COUNTY utilization review and shall be provided all documentation related to each phase
4 of any State audit process and/or COUNTY utilization review. Additionally, prior to any disallowances/audit
5 exceptions becoming final, CONTRACTOR shall be given at least ten (10) business days to respond to
6 such proposed disallowances/audit exceptions.
7 5. INVOICING
8 A. CONTRACTOR shall invoice COUNTY in arrears by the tenth (10t") day of each
9 month for actual expenses incurred during the prior month electronically to: 1)
10 dbhinvoicereview(a�fresnocountyca.gov, 2) dbh-invoices(a)-fresnocountyca.gov; and 3)
11 dbhcontractedservicesdivision(aD_fresnocountyca.gov with a copy to the assigned COUNTY's DBH Staff
12 Analyst. After CONTRACTOR renders service to referred persons served, CONTRACTOR shall invoice
13 COUNTY for payment, certify the expenditure, and submit electronic claiming data into COUNTY's
14 electronic information system for all persons served, including those eligible for Medi-Cal as well as those
15 that are not eligible for Medi-Cal, including contracted cost per unit and actual cost per unit. Invoices and
16 reports shall be in such detail as acceptable to COUNTY's DBH, as described herein. Billing information
17 must include the persons served's name, individual ID number, date of service, type of mental health
18 service provided, duration of service, International Classification of Diseases (ICD) diagnosis, service
19 provider name, units of service provided, rate of service provided, and actual amount of service. No
20 reimbursement for costs incurred by CONTRACTOR for services delivered under this Agreement shall be
21 made until the invoice and supporting documentation is received, verified, and approved by COUNTY's
22 DBH. COUNTY must pay CONTRACTOR before submitting a claim to DHCS for Federal reimbursement
23 for Medi-Cal eligible persons served.
24 B. At the discretion of COUNTY's DBH Director, or designee, if an invoice is incorrect
25 or is otherwise not in proper form or substance, COUNTY's DBH Director, or designee, shall have the right
26 to withhold payment as to only that portion of the invoice that is incorrect or improper after five (5) days
27 prior notice to CONTRACTOR. CONTRACTOR agrees to continue to provide services for a period of
28 ninety(90) days after notification of an incorrect or improper invoice. If after the ninety(90) day period, the
- 9 - COUNTY OF FRESNO
Fresno, CA
1 invoice is still not corrected to COUNTY DBH's satisfaction, COUNTY's DBH Director, or designee, may
2 elect to terminate this Agreement, pursuant to the termination provisions stated in Section Three (3) of this
3 Agreement. In addition, for invoices received ninety (90) days after the expiration of each term of this
4 Agreement or termination of this Agreement, at the discretion of COUNTY's DBH Director, or designee,
5 COUNTY's DBH shall have the right to deny payment of any additional invoices received.
6 C. CONTRACTOR shall submit monthly invoices and general ledgers to COUNTY's
7 DBH that itemize the line item charges for monthly program costs. Unallowable costs such as lobbying or
8 political donations must be deducted from the monthly invoice reimbursements. The invoices and general
9 ledgers will serve as tracking tools to determine if CONTRACTOR's program costs are in accordance with
10 its budgeted cost. Failure to submit reports and other supporting documentation shall be deemed
11 sufficient cause for COUNTY to withhold payments until there is compliance, as further described in
12 Section Five (5) herein.
13 D. CONTRACTOR must report all third-party collections from other funding sources for
14 Medicare, private insurance, private pay or any other third party. Monthly invoices for reimbursement must
15 equal the amount due CONTRACTOR less any funding sources not eligible for Federal reimbursement
16 and any other revenues generated by CONTRACTOR (i.e., private insurance, etc.).
17 E. CONTRACTOR shall submit monthly staffing reports that identify all direct service
18 and support staff, applicable Iicensure/certifications, and full-time hours worked to be used as a tracking
19 tool to determine if CONTRACTOR's program is staffed according to the services provided under this
20 Agreement.
21 F. CONTRACTOR must maintain financial records for a period of seven (7)years or
22 until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible for
23 any disallowances related to inadequate documentation.
24 G. CONTRACTOR is responsible for collecting and managing of data in a manner to
25 be determined by DHCS and COUNTY's DBH in accordance with applicable rules and regulations.
26 COUNTY's electronic information system is a critical source of information for purposes of monitoring
27 service volume and obtaining reimbursement. CONTRACTOR must attend the COUNTY's DBH training
28 on equipment reporting for assets, intangible and sensitive minor assets, COUNTY's electronic information
- 10 - COUNTY OF FRESNO
Fresno, CA
I system, and related cost reporting.
2 H. CONTRACTOR shall submit service data into COUNTY's electronic information
3 system within thirty (30) calendar days from the date of services were rendered.
4 G. CONTRACTOR must provide all necessary data to allow COUNTY to bill Medi-Cal,
5 and any other third-party source, for services and meet State and Federal reporting requirements. The
6 necessary data can be provided by a variety of means, including but not limited to: 1) direct data entry into
7 COUNTY's electronic information system; 2) providing an electronic file compatible with COUNTY's
8 electronic information system; or 3) integration between COUNTY's electronic information system and
9 CONTRACTOR's information system(s).
10 H. If a person served has dual coverage, such as other health coverage (OHC) or
11 Federal Medicare, CONTRACTOR will be responsible for billing the carrier and obtaining a payment/denial
12 or have validation of claiming with no response ninety (90) days after the claim was mailed before the
13 service can be entered into COUNTY's electronic information system. CONTRACTOR must report all
14 third-party collections or revenue for Medicare, third party, or private pay in each monthly invoice and in the
15 annual cost report that is required to be submitted. A copy of explanation of benefits or CMS 1500 form is
16 required as documentation. CONTRACTOR shall submit monthly invoices for reimbursement that equal
17 the amount due CONTRACTOR less any funding sources not eligible for Federal and State
18 reimbursement. CONTRACTOR must comply with all laws and regulations governing the Federal
19 Medicare program, including, but not limited to: 1)the requirement of the Medicare Act, 42 U.S.C. section
20 1395 et seq; and 2)the regulation and rules promulgated by the Federal Centers for Medicare and
21 Medicaid Services as they relate to participation, coverage and claiming reimbursement. CONTRACTOR
22 will be responsible for compliance as of the effective date of each Federal, State or local law or regulation
23 specified.
24 I. Data entry into the COUNTY's electronic information system shall be the
25 responsibility of CONTRACTOR. COUNTY shall monitor the volume of services and cost of services
26 entered into COUNTY's electronic information system. Any and all audit exceptions resulting from the
2 7 provision and reporting of specialty mental health services by CONTRACTOR shall be the sole
28 responsibility of CONTRACTOR. CONTRACTOR will comply with all applicable policies, procedures,
11 - COUNTY OF FRESNO
Fresno, CA
I directives and guidelines regarding the use of COUNTY's electronic information system.
2 J. Medi-Cal Certification and Mental Health Plan Compliance
3 CONTRACTOR shall establish and maintain Medi-Cal certification or become certified
4 within ninety (90) days of the execution of this Agreement through COUNTY's DBH. In addition,
5 CONTRACTOR shall work with COUNTY's DBH to execute the process if not currently certified by
6 COUNTY for credentialing of staff. Service location must be approved by COUNTY's DBH during the
7 Medi-Cal certification process. During this process, the CONTRACTOR shall obtain a legal entity number
8 established by DHCS as this is a requirement for maintaining COUNTY's MHP Organizational Provider
9 status throughout the term of this Agreement. CONTRACTOR shall become Medi-Cal certified prior to
10 providing services to Medi-Cal eligible persons served and seeking reimbursement from the COUNTY.
11 CONTRACTOR will not be reimbursed by COUNTY for any services rendered prior to Medi-Cal
12 certification. CONTRACTOR shall comply with any and all requests and directives associated with
13 COUNTY maintaining State Medi-Cal site certification.
14 CONTRACTOR shall provide specialty mental health services in accordance with
15 COUNTY's MHP. CONTRACTOR must comply with the "Fresno County Mental Health Plan Compliance
16 Program and Code of Conduct" set forth in Exhibit D, attached hereto and incorporated herein by
17 reference and made part of this Agreement.
18 CONTRACTOR may provide direct specialty mental health services using unlicensed staff
19 as long as the CONTRACTOR is approved as an Organizational Provider by the COUNTY's MHP and the
20 individual is supervised by licensed staff who meet the Board of Behavioral Sciences requirements for
21 supervision, works within his/her scope, and only delivers allowable direct specialty mental health services.
22 Unlicensed staff must also be credentialed by COUNTY's MHP.
23 It is understood that each service is subject to audit for compliance with Federal and State
24 regulations, and that COUNTY may be making payments in advance of said review. In the event that a
25 service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set off from other
26 payments due the amount of said disapproved services. This remedy is not exclusive, and COUNTY may
2 7 seek requital from any other means, including but not limited to, a separate contract or agreement with
28 CONTRACTOR. CONTRACTOR shall be responsible for audit exceptions to ineligible dates of services
- 12 - COUNTY OF FRESNO
Fresno, CA
1 or incorrect application of utilization review requirements. CONTRACTOR shall comply with any and all
2 requests associated with any State and/or Federal reviews or audits.
3 6. INDEPENDENT CONTRACTOR
4 In performance of the work, duties, and obligations assumed by CONTRACTOR under this
5 Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
6 CONTRACTOR's officers, agents, and employees will at all times be acting and performing as an
7 independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
8 employee,joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have no right to
9 control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and
10 function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
11 CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
12 CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
13 rules and regulations, if any, of governmental authorities having jurisdiction over matters, which are directly
14 or indirectly the subject of this Agreement.
15 Because of its status as an independent contractor, CONTRACTOR shall have absolutely
16 no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
17 solely liable and responsible for providing to, or on behalf of, its employees all legally-required employee
18 benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all
19 matters relating to payment of CONTRACTOR's employees, including compliance with Social Security,
20 withholding, and all other regulations governing such matters. It is acknowledged that during the term of
21 this Agreement, CONTRACTOR may be providing services to others unrelated to COUNTY or to this
22 Agreement.
23 7. MODIFICATION
24 Any matters of this Agreement may be modified from time to time by the written consent of
25 all the parties without, in any way, affecting the remainder.
26 In addition, changes to expense category (i.e., Salary & Benefits, Facilities/Equipment,
27 Operating, Financial Services, Special Expenses, Fixed Assets, etc.) subtotals in the individual program
28 budgets, as set forth in Exhibits C-1 and C-2, that do not exceed ten percent (10%) of the maximum
- 13 - COUNTY OF FRESNO
Fresno, CA
I compensation payable to CONTRACTOR, and movement of funds between the individual program
2 budgets that does not exceed ten percent (10%) of the maximum compensation payable to the
3 CONTRACTOR, may be made with the written approval of COUNTY's DBH Director, or designee.
4 Modifications shall not result in any change to the maximum compensation amounts payable to
5 CONTRACTOR, as stated in this Agreement.
6 8. NON-ASSIGNMENT
7 No party shall assign, transfer or subcontract this Agreement nor their rights or duties under
8 this Agreement without the prior written consent of COUNTY.
9 9. HOLD-HARMLESS
10 CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
11 defend COUNTY, its officers, agents, and employees from any and all costs and expenses, including
12 attorney fees and court costs, damages, liabilities, claims, and losses occurring or resulting to COUNTY
13 in connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents, or
14 employees under this Agreement, and from any and all costs and expenses, including attorney fees
15 and court costs, damages, liabilities, claims and losses occurring or resulting to any person, firm or
16 corporation who may be injured or damaged by the performance, or failure to perform, of
17 CONTRACTOR, its officers, agents, or employees under this Agreement. CONTRACTOR agrees to
18 indemnify COUNTY for Federal, State of California and/or local audit exceptions resulting from
19 noncompliance herein on the part of CONTRACTOR.
20 The provisions of this Section 9 shall survive termination of this Agreement.
21 10. INSURANCE
22 Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any
23 third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following
24 insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
25 arrangement or Joint Powers Agreement (JPA)throughout the term of the Agreement:
26 A. Commercial General Liability
27 Commercial General Liability Insurance with limits of not less than Two Million
28 Dollars ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00).
- 14 - COUNTY OF FRESNO
Fresno, CA
I This policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
2 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
3 liability or any other liability insurance deemed necessary because of the nature of this contract.
4 B. Automobile Liability
5 Comprehensive Automobile Liability Insurance with limits of not less than One
6 Million Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
7 include any auto used in connection with this Agreement.
8 C. Professional Liability
9 If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W.,
10 M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One Million
11 Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
12 CONTRACTOR agrees that it shall maintain, at its sole expense, in full force and effect for a period of
13 three (3)years following the termination of this Agreement, one or more policies of professional liability
14 insurance with limits of coverage as specified herein.
15 D. Worker's Compensation
16 A policy of Worker's Compensation insurance as may be required by the California
17 Labor Code.
18 E. Cyber liability
19 Cyber Liability Insurance, with limits not less than $2,000,000.00 per occurrence or
20 claim, $2,000,000.00 aggregate. Coverage shall be sufficiently broad to respond to the duties and
21 obligations as is undertaken by CONTRACTOR in this Agreement and shall include, but not be limited to,
22 claims involving infringement of intellectual property, including but not limited to infringement of copyright,
23 trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of
24 electronic information, release of private information, alteration of electronic information, extortion and
25 network security. The policy shall provide coverage for breach response costs as well as regulatory fines
26 and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations.
27 F. Technology Professional Liability (Errors and Omissions)
28 Technology professional liability (errors and omissions) insurance with limits of not
- 15 - COUNTY OF FRESNO
Fresno, CA
I less than Two Million Dollars ($2,000,000.00) per occurrence. Coverage must encompass all of the
2 Contractor's obligations under this Agreement, including but not limited to claims involving Cyber Risks.
3 Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
4 Breaches, which may include Disclosure of Personal Information to an Unauthorized Third Party; (ii)
5 breach of any of the Contractor's obligations under Section # of this Agreement; (iii) infringement of
6 intellectual property, including but not limited to infringement of copyright, trademark, and trade dress;
7 (iv) invasion of privacy, including release of private information; (v) information theft; (vi) damage to or
8 destruction or alteration of electronic information; (vii) extortion related to the Contractor's obligations
9 under this Agreement regarding electronic information, including Personal Information; (viii) network
10 security; (ix) data breach response costs, including Security Breach response costs; (x) regulatory fines
11 and penalties related to the Contractor's obligations under this Agreement regarding electronic
12 information, including Personal Information; and (xi) credit monitoring expenses.
13 G. Molestation
14 Sexual abuse/molestation liability insurance with limits of not less than One Million
15 Dollars ($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This policy
16 shall be issued on a per occurrence basis.
17 Additional Requirements Relating to Insurance
18 CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
19 naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
20 additional insured, but only insofar as the operations under this Agreement are concerned. Such coverage
21 for additional insured shall apply as primary insurance and any other insurance, or self-insurance,
22 maintained by COUNTY, its officers, agents and employees shall be excess only and not contributing with
23 insurance provided under CONTRACTOR's policies herein. This insurance shall not be cancelled or
24 changed without a minimum of thirty (30) days advance written notice given to COUNTY.
25 CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
26 employees any amounts paid by the policy of worker's compensation insurance required by this
27 Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
28 necessary to accomplish such waiver of subrogation, but CONTRACTOR's waiver of subrogation under
- 16 - COUNTY OF FRESNO
Fresno, CA
I this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
2 Within thirty (30) days from the date CONTRACTOR signs and executes this Agreement,
3 CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the
4 foregoing policies, as required herein, with a hard copy to the County of Fresno, Department of Behavioral
5 Heath, Contracted Services, Attn: Staff Analyst, and an emailed copy to
6 dbhcontractedservicesdivisionCo)fresnocountyca.gov and the assigned DBH Contracts Staff Analyst stating
7 that such insurance coverage have been obtained and are in full force; that the County of Fresno, its
8 officers, agents and employees will not be responsible for any premiums on the policies; that such
9 Commercial General Liability insurance names the County of Fresno, its officers, agents and employees,
10 individually and collectively, as additional insured, but only insofar as the operations under this Agreement
11 are concerned; that such coverage for additional insured shall apply as primary insurance and any other
12 insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees, shall be excess
13 only and not contributing with insurance provided under CONTRACTOR's policies herein; and that this
14 insurance shall not be cancelled or changed without a minimum of thirty(30) days advance, written notice
15 given to COUNTY.
16 In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
17 provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
18 Agreement upon the occurrence of such event.
19 All policies shall be issued by admitted insurers licensed to do business in the State of
20 California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc.
21 rating of A FSC VI or better.
22 11. LICENSES/CERTIFICATES
23 Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR's staff shall
24 maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for the
25 provision of the services hereunder and required by the laws and regulations of the United States of
26 America, State of California, the County of Fresno, and any other applicable governmental agencies.
27 CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
28 licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
- 17 - COUNTY OF FRESNO
Fresno, CA
I appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR's staff shall comply with all
2 applicable laws, rules or regulations, as may now exist or be hereafter changed.
3 12. RECORDS
4 CONTRACTOR shall maintain its records in COUNTY's EHR system (currently Avatar)
5 in accordance with Exhibit E, "Documentation Standards for Individual Medical Records," attached
6 hereto and incorporated herein by reference and made part of this Agreement. The individual's health
7 record shall begin with registration and intake and include authorizations, assessments, plans of care,
8 and progress notes, as well as other documents as approved by the COUNTY's DBH. COUNTY shall
9 be allowed to review records of services provided, including the goals and objectives of the treatment
10 plan, and how the therapy provided is achieving the goals and objectives. If CONTRACTOR
11 determines to maintain its records in COUNTY's EHR system, it shall provide COUNTY's DBH Director,
12 or designee, with a thirty (30) day notice. If at any time CONTRACTOR chooses not to maintain its
13 records in COUNTY's EHR system, it shall provide COUNTY'S DBH Director, or designee, with a thirty
14 (30) day notice and CONTRACTOR will be responsible for obtaining its own system, at its own cost, for
15 Electronic Health Record management. Disclaimer— COUNTY makes no warranty or representation
16 that information entered into the COUNTY's EHR system by CONTRACTOR will be accurate, adequate
17 or satisfactory for CONTRACTOR's own purposes or that any information in CONTRACTOR's
18 possession or control, or transmitted or received by CONTRACTOR, is or will be secure from
19 unauthorized access, viewing, use, disclosure, or breach. CONTRACTOR is solely responsible for the
20 individual's information entered by CONTRACTOR into the COUNTY's EHR system. CONTRACTOR
21 agrees that all Private Health Information (PHI) maintained by CONTRACTOR in COUNTY's EHR
22 system will be maintained in conformance with all Health Insurance Portability and Accountability Act
23 (HIPAA) laws, as stated in Section Nineteen (19), "Health Insurance Portability and Accountability Act".
24 COUNTY shall be allowed to review all records of services provided, including the goals
25 and objectives of the treatment plan, and how the therapy provided is achieving the goals and objectives.
26 All mental health records shall be considered the property of the COUNTY and shall be retained by the
2 7 COUNTY upon termination or expiration of this Agreement.
28 13. REPORTS
- 18 - COUNTY OF FRESNO
Fresno, CA
I A. Outcome Reports
2 CONTRACTOR shall submit to COUNTY's DBH service outcome reports as
3 requested by COUNTY's DBH. Outcome reports and outcome requirements are subject to change at
4 COUNTY's DBH discretion.
5 B. Additional Reports
6 CONTRACTOR shall also furnish to COUNTY such statements, records, reports,
7 data, and other information as COUNTY's DBH may request pertaining to matters covered by this
8 Agreement. In the event that CONTRACTOR fails to provide such reports or other information required
9 hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments until there is
10 compliance. In addition, CONTRACTOR shall provide written notification and explanation to COUNTY
11 within five (5) days of any funds received from another source to conduct the same services covered by
12 this Agreement.
13 C. Cost Report
14 CONTRACTOR agrees to submit a complete and accurate detailed cost report on
15 an annual basis for each fiscal year ending June 30th in the format prescribed by the DHCS for the
16 purposes of Short Doyle Medi-Cal reimbursements and total costs for programs. The cost report will be
17 the source document for several phases of settlement with the DHCS for the purposes of Short Doyle
18 Medi-Cal reimbursement. CONTRACTOR shall report costs under their approved legal entity number
19 established during the Medi-Cal certification process. The information provided applies to CONTRACTOR
20 for program related costs for services rendered to Medi-Cal and non-Medi-Cal persons served.
21 CONTRACTOR will remit a schedule to provide the required information on published charges (PC)for all
22 authorized services. The report will serve as a source document to determine their usual and customary
23 charge prevalent in the public mental health sector that is used to bill the general public, insurers, or other
24 non-Medi-Cal third party payers during the course of business operations. CONTRACTOR must report all
25 collections for Medi-Cal/Medicare services and collections. The CONTRACTOR shall also submit with the
26 cost report a copy of the CONTRACTOR's general ledger that supports revenues and expenditures and
27 reconciled detailed report of reported total units of services rendered under this Agreement to the units of
28 services reported by CONTRACTOR to COUNTY's electronic information system.
- 19 - COUNTY OF FRESNO
Fresno, CA
I Cost Reports must be submitted to the COUNTY as a hard copy with a signed
2 cover letter and electronic copy of completed DHCS cost report form along with requested support
3 documents following each fiscal year ending June 30th. During the month of September of each year this
4 Agreement is effective, COUNTY will issue instructions of the annual cost report which indicates the
5 training session, DHCS cost report template worksheets, and deadlines to submit, as determined by State
6 DHCS annually. CONTRACTOR shall remit a hard copy of cost report to County of Fresno, Attention:
7 Cost Report Team, PO BOX 45003, Fresno CA 93718. CONTRACTOR shall remit the electronic copy or
8 any inquiries to DBHcostreportteam@fresnocountyca.gov.
9 All Cost Reports must be prepared in accordance with General Accepted
10 Accounting Principles (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3) and
11 5718(c). Unallowable costs such as lobby or political donations must be deducted on the cost report and
12 invoice reimbursement.
13 If the CONTRACTOR does not submit the cost report by the deadline, including any
14 extension period granted by the COUNTY, the COUNTY may withhold payments of pending invoicing
15 under compensation until the cost report has been submitted and clears COUNTY desk audit for
16 completeness.
17 D. Settlements with State Department of Health Care Services (DHCS)
18 During the term of this Agreement and thereafter, COUNTY and CONTRACTOR
19 agree to settle dollar amounts disallowed or settled in accordance with DHCS audit settlement findings
20 related to the reimbursement provided under this Agreement. CONTRACTOR will participate in the
21 several phases of settlements between COUNTY/CONTRACTOR and DHCS. The phases of initial cost
22 reporting for settlement according to State reconciliation of records for paid Medi-Cal services and audit
23 settlement are: State DHCS audit 1) initial cost reporting —after an internal review by COUNTY, the
24 COUNTY files the cost report with State DHCS on behalf of CONTRACTOR's legal entity for the fiscal
25 year; 2) Settlement—State reconciliation of records for paid Medi-Cal services, approximately 18 to 36
26 months following the State close of the fiscal year, DHCS will send notice for any settlement under this
27 provision to COUNTY; and 3)Audit Settlement-State DHCS audit. After final reconciliation and settlement
28 DHCS may conduct a review of medical records, cost report along with support documents submitted to
- 20 - COUNTY OF FRESNO
Fresno, CA
I COUNTY in initial submission to determine accuracy and may disallow costs and/or units of services.
2 COUNTY may choose to appeal and therefore reserves the right to defer payback settlement with
3 CONTRACTOR until resolution of the appeal. DHCS Audits will follow Federal Medicaid procedures for
4 managing overpayments.
5 If at the end of the Audit Settlement, COUNTY determines that it overpaid
6 CONTRACTOR, it will require CONTRACTOR to repay the Medi-Cal related overpayment back to
7 COUNTY. Funds owed to COUNTY will be due within forty-five (45) days of notification by COUNTY, or
8 COUNTY shall withhold future payments until all excess funds have been recouped by means of an offset
9 against any payments then or thereafter owing to COUNTY under this or any other Agreement between
10 the COUNTY and CONTRACTOR.
11 14. MONITORING
12 CONTRACTOR agrees to extend to COUNTY's staff, COUNTY's DBH Director, and
13 DHCS, or their designees, the right to review and monitor records, services, or procedures, at any time, in
14 regard to COUNTY persons served, as well as the overall operation of CONTRACTOR's performance, in
15 order to ensure compliance with the terms and conditions of this Agreement.
16 15. REFERENCES TO LAWS AND RULES
17 In the event any law, regulation, or policy referred to in this Agreement is amended during
18 the term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
19 such amendment.
20 16. COMPLIANCE WITH STATE REQUIREMENTS
21 CONTRACTOR recognizes that COUNTY operates its mental health programs under an
22 agreement with DHCS, and that under said agreement the State imposes certain requirements on
23 COUNTY and its subcontractors. CONTRACTOR shall adhere to all State requirements, including those
24 identified in Exhibit F, "State Mental Health Requirements", attached hereto and by this reference
25 incorporated herein and made part of this Agreement.
26 17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
27 CONTRACTOR shall be required to maintain organizational provider certification by
28 COUNTY. CONTRACTOR must meet Medi-Cal organizational provider standards as listed in Exhibit G,
- 21 - COUNTY OF FRESNO
Fresno, CA
I "Medi-Cal Organizational Provider Standards", attached hereto and by this reference incorporated herein
2 and made part of this Agreement. It is acknowledged that all references to Organizational Provider and/or
3 Provider in Exhibit G shall refer to CONTRACTOR.
4 CONTRACTOR shall inform every person served of their rights under the COUNTY's
5 Mental Health Plan as described in Exhibit H, "Mental Health Plan Grievances and Appeals Process",
6 attached hereto and by this reference incorporated herein and made part of this Agreement.
7 CONTRACTOR shall also file an incident report for all incidents involving persons served,
8 following the COUNTY's DBH "Incident Reporting and Intensive Analysis" policy and procedure guide and
9 using the "Incident Report" protocol and user guide identified in Exhibit I, attached hereto and by this
10 reference incorporated herein and made part of this Agreement.
11 18. CONFIDENTIALITY
12 All services performed by CONTRACTOR under this Agreement shall be in strict
13 conformance with all applicable Federal, State of California and/or local laws and regulations relating to
14 confidentiality.
15 19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
16 COUNTY and CONTRACTOR each consider and represent themselves as covered
17 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-
18 191 (HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by law.
19 COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is
20 only for treatment, payment, and health care operations.
21 COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of
22 PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for
23 Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated thereunder
24 by the U.S. Department of Health and Human Services (HIPAA Regulations) and other applicable laws.
25 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require CONTRACTOR to enter
26 into a contract containing specific requirements prior to the disclosure of PHI, as set forth in, but not limited
2 7 to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal Regulations.
28 20. DATA SECURITY
- 22 - COUNTY OF FRESNO
Fresno, CA
I For the purpose of preventing the potential loss, misappropriation or inadvertent access,
2 viewing, use or disclosure of COUNTY data including sensitive or personal information; abuse of COUNTY
3 resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into a
4 contractual relationship with COUNTY for the purpose of providing services under this Agreement must
5 employ adequate data security measures to protect the confidential information provided to
6 CONTRACTOR by COUNTY, including but not limited to the following:
7 A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
8 CONTRACTOR may not connect to COUNTY networks via personally-owned
9 mobile, wireless or handheld devices, unless the following conditions are met:
10 1) CONTRACTOR has received authorization by COUNTY for telecommuting
11 purposes;
12 2) Current virus protection software is in place;
13 3) Mobile device has the remote wipe feature enabled; and
14 4) A secure connection is used.
15 B. CONTRACTOR-Owned Computers or Computer Peripherals
16 CONTRACTOR may not bring contractor-owned computers or computer
17 peripherals into COUNTY for use without prior authorization from COUNTY's Chief Information Officer
18 and/or designee(s), including but not limited to mobile storage devices. If data is approved to be
19 transferred, data must be encrypted and stored on a secure server approved by COUNTY and transferred
20 by means of a Virtual Private Network (VPN) connection, or another type of secure connection.
21 C. COUNTY-Owned Computer Equipment
22 CONTRACTOR may not use COUNTY computers or computer peripherals on non-
23 County premises without prior authorization from COUNTY's Chief Information Officer and/or designee(s).
24 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive data on
25 any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
26 E. CONTRACTOR shall be responsible to employ strict controls to ensure the integrity
27 and security of COUNTY's confidential information and prevent unauthorized access, viewing, use, or
28 disclosure of data maintained in computer files, program documentation, data processing systems, data
- 23 - COUNTY OF FRESNO
Fresno, CA
1 files, and data processing equipment which stores or processes COUNTY data internally and externally.
2 F. Confidential persons served information transmitted to one party by the other by
3 means of electronic transmissions must be encrypted according to Advanced Encryption Standards (AES)
4 of 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
5 G. CONTRACTOR is responsible to immediately notify COUNTY of any violations,
6 breaches or potential breaches of security related to COUNTY's confidential information, data maintained
7 in computer files, program documentation, data processing systems, data files and data processing
8 equipment which stores or processes COUNTY data internally or externally.
9 H. COUNTY shall provide oversight to CONTRACTOR's response to all incidents
10 arising from a possible breach of security related to COUNTY's persons served confidential information
11 provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected
12 individuals as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR
13 will be responsible for all costs incurred as a result of providing the required notification.
14 21. PROPERTY OF COUNTY
15 A. COUNTY and CONTRACTOR recognize that fixed assets are tangible and
16 intangible property obtained or controlled under COUNTY for use in operational capacity and will benefit
17 COUNTY for a period more than one year. Depreciation of the qualified items will be on a straight-line
18 basis.
19 For COUNTY purposes, fixed assets must fulfill three (3) qualifications:
20 1) Have life span of over one year;
21 2) Is not a repair part; and
22 3) Must be valued at or greater than the capitalization thresholds for the asset
23 type.
24 Asset Type Threshold
25 Land $0
• Buildings and Improvements $100,000
26 0 Infrastructure $100,000
• Tangible $5,000
27 o Equipment
o Vehicles
28 0 Intangible $100,000
- 24 - COUNTY OF FRESNO
Fresno, CA
1 o Internally Generated Software
o Purchased Software
2 o Easements
o Patents
3 • And Capital Lease $5,000
4
Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
5
approved and identified as an asset, it will be tagged with a COUNTY program number. A Fixed Asset
6
Log (and related instructions), attached hereto as Exhibit J and Exhibit J-1 and by this reference
7
incorporated herein and made part of this Agreement, will be maintained by COUNTY's Asset
8
Management System and annually inventoried until the asset is fully depreciated. During the terms of this
9
Agreement, CONTRACTOR's fixed assets may be inventoried in comparison to COUNTY's DBH Asset
10
Inventory System.
11
B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
12
more than One Thousand and No/100 Dollars ($1,000.00), with over one year life span, and/or are mobile
13
and high risk of theft or loss are sensitive assets. Such sensitive items are not limited to computers,
14
copiers, televisions, cameras and other sensitive items as determined by COUNTY's DBH Director, or
15
designee. CONTRACTOR will maintain a tracking system on the items utilizing Exhibits J and J-1. Items
16
are not required to be capitalized or depreciated and are subject to annual inventory for compliance.
17
C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
18
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in an
19
annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this
20
Agreement, CONTRACTOR shall be physically present when fixed and inventoried assets are returned to
21
COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all COUNTY-owned
22
undepreciated fixed and inventoried assets, or the monetary value of said assets if unable to produce the
23
assets at the expiration or termination of this Agreement.
24
CONTRACTOR further agrees to the following:
25
1) Maintain all items of equipment in good working order and condition, normal
26
wear and tear is expected;
27
2) Label all items of equipment with COUNTY assigned program number,
28
perform periodic inventories as required by COUNTY, and maintain an inventory list showing where and
- 25 - COUNTY OF FRESNO
Fresno, CA
1 how the equipment is being used, in accordance with procedures developed by COUNTY. All such lists
2 shall be submitted to COUNTY within ten (10) days of any request therefore; and
3 3) Report in writing to COUNTY immediately after discovery, the loss or theft of
4 any items of equipment. For stolen items, the local law enforcement agency must be contacted and a
5 copy of the police report submitted to COUNTY.
6 D. The purchase of any equipment by CONTRACTOR with funds provided hereunder
7 shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions of this Agreement as
8 appropriate, and must be directly related to CONTRACTORS services or activities under the terms of this
9 Agreement. COUNTY's DBH may refuse reimbursement for any costs resulting from equipment
10 purchased, which are incurred by CONTRACTOR, if prior written approval has not been obtained from
11 COUNTY.
12 E. CONTRACTOR must obtain prior written approval from COUNTY's DBH whenever
13 there is any modification or change in the use of any property acquired or improved, in whole or in part,
14 using funds under this Agreement. If any real or personal property acquired or improved with said funds
15 identified herein is sold and/or is utilized by CONTRACTOR for a use which does not qualify under this
16 Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal to the current fair market value
17 of the property, less any portion thereof attributable to expenditures of funds not provided under this
18 Agreement. These requirements shall continue in effect for the life of the property. In the event this
19 Agreement expires, or terminates, the requirements for this Section shall remain in effect for activities or
20 property funded with said funds, unless action is taken by the State government to relieve COUNTY of
21 these obligations.
22 22. NON-DISCRIMINATION
23 During the performance of this Agreement, CONTRACTOR and its subcontractors shall not
24 deny the contract's benefits to any person on the basis of race, religious creed, color, national origin,
25 ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex,
26 gender, gender identity, gender expression, age, sexual orientation, or military and veteran status, nor
27 shall they discriminate unlawfully against any employee or applicant for employment because of race,
28 religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition,
- 26 - COUNTY OF FRESNO
Fresno, CA
1 genetic information, marital status, sex, gender identity, gender expression, age, sexual orientation, or
2 military and veteran status.
3 CONTRACTOR shall ensure that the evaluation and treatment of employees and
4 applicants for employment are free of such discrimination. CONTRACTOR and subcontractors shall
5 comply with the provisions of the Fair Employment and Housing Act(Gov. Code §12800 et seq.), the
6 regulations promulgated thereunder(Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5,
7 Chapter 1, Part 1, Division 3, Title 2 of the Government Code (Gov. Code §11135-11139.5), and the
8 regulations or standards adopted by the awarding state agency to implement such article. CONTRACTOR
9 shall permit access by representatives of the Department of Fair Employment and Housing and the
10 awarding state agency upon reasonable notice at any time during the normal business hours, but in no
11 case less than twenty-four(24) hours notice, to such of its books, records, accounts, and all other sources
12 of information and its facilities as said department or agency shall require to ascertain compliance with this
13 clause. CONTRACTOR and its subcontractors shall give written notice of their obligations under this
14 clause to labor organizations with which they have a collective bargaining or other agreement. (See Cal.
15 Code Regs., tit. 2, §11105.) CONTRACTOR shall include the non-discrimination and compliance
16 provisions of this clause in all subcontracts to perform work under this Agreement.
17 23. CULTURAL COMPETENCY
18 As related to Cultural and Linguistic Competence:
19 A. CONTRACTOR shall not discriminate against beneficiaries based on race, color,
20 national origin, sex, disability, or religion. CONTRACTOR shall ensure that a limited and/or no English
21 proficient beneficiary is entitled to equal access and participation in federally funded programs through
22 the provision of comprehensive and quality bilingual services pursuant to Title 6 of the Civil Rights Act
23 of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R. Part 80) and Executive Order 12250 of 1979.
24 B. CONTRACTOR shall comply with requirements of policies and procedures for
25 ensuring access and appropriate use of trained interpreters and material translation services for all
26 limited and/or no English proficient beneficiaries, including, but not limited to, assessing the cultural and
27 linguistic needs of the beneficiaries, training of staff on the policies and procedures, and monitoring its
28 language assistance program. CONTRACTOR's policies and procedures shall ensure compliance of any
- 27 - COUNTY OF FRESNO
Fresno, CA
I subcontracted providers with these requirements.
2 C. CONTRACTOR shall notify its beneficiaries that oral interpretation is available for
3 any language and written translation is available in prevalent languages and that auxiliary aids and
4 services are available upon request, at no cost and in a timely manner for limited and/or no English
5 proficient beneficiaries and/or beneficiaries with disabilities. CONTRACTOR shall avoid relying on an adult
6 or minor child accompanying the beneficiary to interpret or facilitate communication; however, if the
7 beneficiary refuses language assistance services, the CONTRACTOR must document the offer, refusal
8 and justification in the beneficiary's file.
9 D. CONTRACTOR shall ensure that employees, agents, subcontractors, and/or
10 partners who interpret or translate for a beneficiary or who directly communicate with a beneficiary in a
11 language other than English (1) have completed annual training provided by COUNTY at no cost to
12 CONTRACTOR; (2) have demonstrated proficiency in the beneficiary's language; (3) can effectively
13 communicate any specialized terms and concepts specific to CONTRACTOR's services; and (4) adheres
14 to generally accepted interpreter ethic principles. As requested by COUNTY, CONTRACTOR shall identify
15 all who interpret for or provide direct communication to any program beneficiary in a language other than
16 English and identify when the CONTRACTOR last monitored the interpreter for language competence.
17 E. CONTRACTOR shall submit to COUNTY for approval, within ninety (90) days from
18 date of contract execution, CONTRACTOR's plan to address all fifteen (15) National Standards for
19 Culturally and Linguistically Appropriate Service (CLAS), as published by the Office of Minority Health and
20 as set forth in Exhibit K, "National Standards on Culturally and Linguistically Appropriate Services",
21 attached hereto and incorporated herein by reference and made part of this Agreement. As the CLAS
22 standards are updated, CONTRACTOR's plan must be updated accordingly. As requested by COUNTY,
23 CONTRACTOR shall be responsible for conducting an annual CLAS self-assessment and providing the
24 results of the self-assessment to the COUNTY. The annual CLAS self-assessment instruments shall be
25 reviewed by the COUNTY and revised as necessary to meet the approval of the COUNTY.
26 F. Cultural competency training for CONTRACTOR staff should be substantively
27 integrated into health professions education and training at all levels, both academically and functionally,
28 including core curriculum, professional licensure, and continuing professional development programs. As
- 28 - COUNTY OF FRESNO
Fresno, CA
I requested by COUNTY, CONTRACTOR shall report on the completion of cultural competency trainings to
2 ensure direct service providers are completing a minimum of one (1) cultural competency training annually.
3 G. CONTRACTOR shall create and sustain a forum that includes staff at all agency
4 levels to discuss cultural competence. COUNTY encourages a representative from CONTRACTOR's
5 forum to attend COUNTY's Cultural Humility Committee.
6 24. AMERICANS WITH DISABILITIES ACT
7 CONTRACTOR agrees to ensure that deliverables developed and produced, pursuant to
8 this Agreement, shall comply with the accessibility requirements of Section 508 of the Rehabilitation Act
9 and the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)), and regulations
10 implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal Regulations. In 1998,
11 Congress amended the Rehabilitation Act of 1973 to require Federal agencies to make their electronic and
12 information technology (EIT) accessible to people with disabilities. California Government Code section
13 11135 codifies section 508 of the Act requiring accessibility of electronic and information technology.
14 25. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
15 To the extent necessary to prevent disallowance of reimbursement under section
16 1861(v)(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four(4)
17 years after the furnishing of services under this Agreement, CONTRACTOR shall make available, upon
18 written request to the Secretary of the United States Department of Health and Human Services, or upon
19 request to the Comptroller General of the United States General Accounting Office, or any of their duly
20 authorized representatives, a copy of this Agreement and such books, documents, and records as are
21 necessary to certify the nature and extent of the costs of these services provided by CONTRACTOR under
22 this Agreement. CONTRACTOR further agrees that in the event CONTRACTOR carries out any of its
23 duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and No/100
24 Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such Agreement
25 shall contain a clause to the effect that until the expiration of four(4)years after the furnishing of such
26 services pursuant to such subcontract, the related organizations shall make available, upon written request
27 to the Secretary of the United States Department of Health and Human Services, or upon request to the
28 Comptroller General of the United States General Accounting Office, or any of their duly authorized
- 29 - COUNTY OF FRESNO
Fresno, CA
I representatives, a copy of such subcontract and such books, documents, and records of such organization
2 as are necessary to verify the nature and extent of such costs.
3 26. SINGLE AUDIT CLAUSE
4 A. If CONTRACTOR expends Seven Hundred Fifty Thousand and No/100 Dollars
5 ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an
6 annual audit in accordance with the requirements of the Single Audit Standards as set forth in Office of
7 Management and Budget (OMB) 2 CFR 200. CONTRACTOR shall submit said audit and management
8 letter to COUNTY. The audit must include a statement of findings or a statement that there were no
9 findings. If there were negative findings, CONTRACTOR must include a corrective action plan signed by
10 an authorized individual. CONTRACTOR agrees to take action to correct any material non-compliance or
11 weakness found as a result of such audit. Such audit shall be delivered to COUNTY's DBH Finance
12 Division for review within nine (9) months of the end of any fiscal year in which funds were expended
13 and/or received for the program. Failure to perform the requisite audit functions as required by this
14 Agreement may result in COUNTY performing the necessary audit tasks, or at COUNTY's option,
15 contracting with a public accountant to perform said audit, or may result in the inability of COUNTY to enter
16 into future agreements with CONTRACTOR. All audit costs related to this Agreement are the sole
17 responsibility of CONTRACTOR.
18 B. A single audit report is not applicable if CONTRACTOR's Federal contracts do not
19 exceed the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
20 CONTRACTOR's only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a
21 program audit must be performed and a program audit report with management letter shall be submitted
22 by CONTRACTOR to COUNTY as a minimum requirement to attest to CONTRACTOR solvency. Said
23 audit report shall be delivered to COUNTY's DBH Finance Division for review no later than nine (9) months
24 after the close of the fiscal year in which the funds supplied through this Agreement are expended. Failure
25 to comply with this Act may result in COUNTY performing the necessary audit tasks or contracting with a
26 qualified accountant to perform said audit. All audit costs related to this Agreement are the sole
2 7 responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
28 noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under this
- 30 - COUNTY OF FRESNO
Fresno, CA
I paragraph shall be billed to CONTRACTOR at COUNTY cost, as determined by COUNTY's Auditor-
2 Controller/Treasurer-Tax Collector.
3 C. CONTRACTOR shall make available all records and accounts for inspection by
4 COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
5 Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
6 least three (3) years following final payment under this Agreement or the closure of all other pending
7 matters, whichever is later.
8 27. COMPLIANCE
9 CONTRACTOR agrees to comply with COUNTY's Contractor Code of Conduct and Ethics
10 and the COUNTY's Compliance Program in accordance with Exhibit D. Within thirty (30) days of entering
11 into this Agreement with COUNTY, CONTRACTOR shall have all of CONTRACTOR's employees, agents,
12 and subcontractors providing services under this Agreement certify in writing, that he or she has received,
13 read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR shall
14 ensure that within thirty (30) days of hire, all new employees, agents, and subcontractors providing
15 services under this Agreement shall certify in writing that he or she has received, read, understood, and
16 shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR understands that the
17 promotion of and adherence to the Contractor Code of Conduct is an element in evaluating the
18 performance of CONTRACTOR and its employees, agents and subcontractors.
19 ///
20 Within thirty(30)days of entering into this Agreement, and annually thereafter, all
21 employees, agents, and subcontractors providing services under this Agreement shall complete general
22 compliance training, and appropriate employees, agents, and subcontractors shall complete
23 documentation and billing or billing/reimbursement training. All new employees, agents, and
24 subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual who is
25 required to attend training shall certify in writing that he or she has received the required training. The
26 certification shall specify the type of training received and the date received. The certification shall be
27 provided to COUNTY's DBH Compliance Officer at 1925 E. Dakota Ave, Fresno, California 93726.
28 CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed upon COUNTY
- 31 - COUNTY OF FRESNO
Fresno, CA
I by the Federal Government as a result of CONTRACTOR's violation of the terms of this Agreement.
2 28. ASSURANCES
3 In entering into this Agreement, CONTRACTOR certifies that neither they, nor any of their
4 officers, are currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
5 Health Care Programs; that neither they, nor any of their officers, have been convicted of a criminal
6 offense related to the provision of health care items or services; nor have they, nor any of their officers,
7 been reinstated to participate in the Federal Health Care Programs after a period of exclusion, suspension,
8 debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that CONTRACTOR
9 is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility for, or involvement
10 with, COUNTY's business operations related to the Federal Health Care Programs and shall remove such
11 CONTRACTOR from any position in which CONTRACTOR's compensation, or the items or services
12 rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, directly or indirectly, by
13 Federal Health Care Programs or otherwise with Federal Funds at least until such time as CONTRACTOR
14 is reinstated into participation in the Federal Health Care Programs.
15 A. If COUNTY has notice that either CONTRACTOR, or its officers, have been
16 charged with a criminal offense related to any Federal Health Care Program, or are proposed for exclusion
17 during the term of any contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure
18 the accuracy of any claims submitted to any Federal Health Care Program. At its discretion, given such
19 circumstances, COUNTY may request that CONTRACTOR cease providing services until resolution of the
20 charges or the proposed exclusion.
21 B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
22 subcontractors of CONTRACTOR who, in each case, are expected to perform professional services under
23 this Agreement, will be queried as to whether: (1)they are now or ever have been excluded, suspended,
24 debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)they have been
25 convicted of a criminal offense related to the provision of health care items or services; and (3)they have
26 been reinstated to participate in the Federal Health Care Programs after a period of exclusion, suspension,
27 debarment, or ineligibility.
28 1) In the event the potential employee or subcontractor informs
- 32 - COUNTY OF FRESNO
Fresno, CA
I CONTRACTOR that he or she is excluded, suspended, debarred, or otherwise ineligible, or has been
2 convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR hires
3 or engages such potential employee or subcontractor, CONTRACTOR will ensure that said employee or
4 subcontractor does no work, either directly or indirectly relating to services provided to COUNTY.
5 2) Notwithstanding the above, COUNTY, at its discretion, may terminate this
6 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
7 defined by COUNTY)that no excluded, suspended, or otherwise ineligible employee or subcontractor of
8 CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
9 Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
10 to protect the interests of COUNTY consumers.
11 C. CONTRACTOR shall verify(by asking the applicable employees and
12 subcontractors)that all current employees and existing subcontractors who, in each case, are expected to
13 perform professional services under this Agreement: (1) are not currently excluded, suspended, debarred,
14 or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted of a
15 criminal offense related to the provision of health care items or services; and (3) have not been reinstated
16 to participate in the Federal Health Care Program after a period of exclusion, suspension, debarment, or
17 ineligibility. In the event any existing employee or subcontractor informs CONTRACTOR that he or she is
18 excluded, suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs,
19 or has been convicted of a criminal offense relating to the provision of health care services,
20 CONTRACTOR will ensure that said employee or subcontractor does no work, either direct or indirect,
21 relating to services provided to COUNTY.
22 1) CONTRACTOR agrees to notify COUNTY immediately during the term of
23 this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case, is
24 providing professional services under this Agreement is excluded, suspended, debarred, or otherwise
25 ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating
26 to the provision of health care services.
27 2) Notwithstanding the above, COUNTY, at its discretion, may terminate this
28 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
- 33 - COUNTY OF FRESNO
Fresno, CA
I defined by COUNTY)that no excluded, suspended, or otherwise ineligible employee or subcontractor of
2 CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
3 Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
4 to protect the interests of COUNTY's persons served.
5 D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
6 information from COUNTY which may be necessary to complete any internal or external audits relating to
7 CONTRACTOR's compliance with the provisions of this Section.
8 E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
9 imposed upon COUNTY by the Federal Government as a result of CONTRACTOR's violation of
10 CONTRACTOR's obligations as described in this Section.
11 29. PUBLICITY PROHIBITION
12 None of the funds, materials, property or services provided directly or indirectly under this
13 Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e., purchasing of
14 tickets/tables, silent auction donations, etc.)for the purpose of self-promotion. Notwithstanding the above,
15 publicity of the services described in Section One (1) of this Agreement shall be allowed as necessary to
16 raise public awareness about the availability of such specific services when approved in advance by
17 COUNTY's DBH Director or designee and at a cost to be provided in Exhibits C-1 and C-2 for such items
18 as written/printed materials, the use of media (i.e., radio, television, newspapers), and any other related
19 expense(s).
20 30. COMPLAINTS
21 CONTRACTOR shall log complaints and the disposition of all complaints from a person
22 served or their family. CONTRACTOR shall provide a copy of the detailed complaint log entries
23 concerning COUNTY-sponsored persons served to COUNTY at monthly intervals by the tenth (10t") day of
24 the following month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide
25 details and attach documentation of each complaint with the log. CONTRACTOR shall post signs
26 informing persons served of their right to file a complaint or grievance. CONTRACTOR shall notify
2 7 COUNTY of all incidents reportable to State licensing bodies that affect COUNTY persons served within
28 twenty-four (24) hours of receipt of a complaint.
34 - COUNTY OF FRESNO
Fresno, CA
I Within ten (10) days after each incident or complaint affecting COUNTY persons served,
2 CONTRACTOR shall provide COUNTY with information relevant to the complaint, investigative details of
3 the complaint, the complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the
4 complaint. In addition, CONTRACTOR shall inform every person served of their rights as set forth in
5 Exhibit H. CONTRACTOR shall file an incident report for all incidents involving persons served, following
6 the protocol and user guide identified in Exhibit I.
7 31. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
8 This provision is only applicable if CONTRACTOR is disclosing entities, fiscal agents, or
9 managed care entities, as defined in Code of Federal Regulations (C.F.R.), Title 42 §§455.101, 455.104
10 and 455.106(a)(1),(2).
11 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
12 the following information must be disclosed by CONTRACTOR by completing Exhibit L, "Disclosure of
13 Ownership and Control Interest Statement", attached hereto and by this reference incorporated herein and
14 made part of this Agreement. CONTRACTOR shall submit this form to the COUNTY's DBH within thirty
15 (30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall report any changes to
16 this information within thirty-five (35) days of occurrence by completing Exhibit L. Submissions shall be
17 scanned portable document format (pdf) copies and are to be sent via email to COUNTY's DBH assigned
18 Staff Analyst.
19 ///
20 CONTRACTOR is required to submit a set of fingerprints for any person with a five
21 percent (5%) or greater direct or indirect ownership interest in CONTRACTOR. COUNTY may
22 terminate this Agreement where any person with a five percent (5%) or greater direct or indirect
23 ownership interest in the CONTRACTOR did not submit timely and accurate information and cooperate
24 with any screening method required in CFR, Title 42, Section 455.416. Submissions shall be scanned
25 pdf copies and are to be sent via email to DBHContractedServicesDivision(a)_fresnocountyca.gov.
26 COUNTY may deny enrollment or terminate this Agreement where any person with a five percent (5%)
2 7 or greater direct or indirect ownership interest in CONTRACTOR has been convicted of a criminal
28 offense related to that person's involvement with the Medicare, Medicaid, or Title XXI program in the
- 35 - COUNTY OF FRESNO
Fresno, CA
I last ten (10) years.
2 32. DISCLOSURE—CRIMINAL HISTORY AND CIVIL ACTIONS
3 CONTRACTOR is required to disclose if any of the following conditions apply to them, their
4 owners, officers, corporate managers, and partners (hereinafter collectively referred to in this Section as
5 "CONTRACTOR"):
6 A. Within the three (3)year period preceding the Agreement award, they have been
7 convicted of, or had a civil judgment rendered against them for:
8 1) Fraud or a criminal offense in connection with obtaining, attempting to
9 obtain, or performing a public (federal, state, or local)transaction or contract under a public transaction;
10 2) Violation of a federal or state antitrust statute;
11 3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
12 or
13 4) False statements or receipt of stolen property.
14 B. Within the three (3)year period preceding the Agreement award, they have had a
15 public transaction (federal, state, or local)terminated for cause or default.
16 Disclosure of the above information will not automatically eliminate CONTRACTOR from
17 further business consideration. The information will be considered as part of the determination of whether
18 to continue and/or renew this Agreement and any additional information or explanation that
19 CONTRACTOR elects to submit with the disclosed information will be considered. If it is later determined
20 that CONTRACTOR failed to disclose required information, any contract awarded to such CONTRACTOR
21 may be immediately voided and terminated for material failure to comply with the terms and conditions of
22 the award.
23 CONTRACTOR must sign a "Certification Regarding Debarment, Suspension, and Other
24 Responsibility Matters- Primary Covered Transactions" in the form set forth in Exhibit M, attached hereto
25 and by this reference incorporated herein and made part of this Agreement. Additionally, CONTRACTOR
26 must immediately advise COUNTY's DBH in writing if, during the term of this Agreement: (1)
27 CONTRACTOR becomes suspended, debarred, excluded, or ineligible for participation in Federal or State
28 funded programs or from receiving federal funds as listed in the excluded parties' list system
- 36 - COUNTY OF FRESNO
Fresno, CA
1 (http://www.epls.gov); or(2) any of the above listed conditions become applicable to CONTRACTOR.
2 CONTRACTOR shall indemnify, defend, and hold COUNTY harmless for any loss or damage resulting
3 from a conviction, debarment, exclusion, ineligibility, or other matter listed in the signed Certification
4 Regarding Debarment, Suspension, and Other Responsibility Matters.
5 33. AUDITS AND INSPECTIONS
6 The CONTRACTOR shall at any time during business hours, and as often as the COUNTY
7 may deem necessary, make available to the COUNTY for examination all of its records and data with
8 respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request by the
9 COUNTY, permit the COUNTY to audit and inspect all of such records and data necessary to ensure
10 CONTRACTOR'S compliance with the terms of this Agreement.
11 If this Agreement exceeds Ten Thousand and No/100 ($10,000.00), CONTRACTOR shall
12 be subject to the examination and audit of the California State Auditor for a period of three (3) years after
13 final payment under contract(Government Code Section 8546.7).
14 34. NOTICES
15 The persons having authority to give and receive notices under this Agreement and their
16 addresses include the following:
17 COUNTY CONTRACTOR
Director, Fresno County President/Chief Executive Officer
18 Department of Behavioral Health Exodus Recovery, Inc.
1925 E. Dakota Ave 9808 Venice Blvd, Suite 700
19 Fresno, CA 93726 Culver City, CA 90232
20 All notices between COUNTY and CONTRACTOR provided for or permitted under this
21 Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
22 an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
23 personal service is effective upon service to the recipient. A notice delivered by first-class United States
24 mail is effective three (3) COUNTY business days after deposit in the United States mail, postage prepaid,
25 addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
26 (1) COUNTY business day after deposit with the overnight commercial courier service, delivery fees
27 prepaid, with delivery instructions given for next day delivery, addressed to the recipient. A notice
28 delivered by telephonic facsimile is effective when transmission to the recipient is completed (but, if such
- 37 - COUNTY OF FRESNO
Fresno, CA
1 transmission is completed outside of COUNTY business hours, then such delivery shall be deemed to be
2 effective at the next beginning of a COUNTY business day), provided that the sender maintains a machine
3 record of the completed transmission. For all claims arising out of or related to this Agreement, nothing in
4 this section establishes, waives, or modifies any claims presentation requirements or procedures provided
5 by law, including but not limited to the Government Claims Act(Division 3.6 of Title 1 of the Government
6 Code, beginning with Section 810).
7 35. GOVERNING LAW
8 Venue for any action arising out of or related to the Agreement shall only be in Fresno
9 County, California.
10 The rights and obligations of the parties and all interpretation and performance of this
11 Agreement shall be governed in all respects by the laws of the State of California.
12 36. DISCLOSURE OF SELF-DEALING TRANSACTIONS
13 Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing
14 transactions that they are a party to while CONTRACTOR is providing goods or performing services
15 under this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
16 is a party and in which one or more of its directors has a material financial interest. Members of the
17 Board of Directors shall disclose any self-dealing transactions that they are a party to by completing
18 and signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit N and incorporated
19 herein by reference, and submitting it to the COUNTY prior to commencing with the self-dealing
20 transaction or immediately thereafter.
21 37. ELECTRONIC SIGNATURE
22 The parties agree that this Agreement may be executed by electronic signature as provided
23 in this section. An "electronic signature" means any symbol or process intended by an individual signing
24 this Agreement to represent their signature, including but not limited to: (1) a digital signature; (2) a faxed
25 version of an original handwritten signature; or(3) an electronically scanned and transmitted (for example
26 by PDF document) of a handwritten signature. Each electronic signature affixed or attached to this
27 Agreement (1) is deemed equivalent to a valid original handwritten signature of the person signing this
28 Agreement for all purposes, including but not limited to evidentiary proof in any administrative or judicial
- 38 - COUNTY OF FRESNO
Fresno, CA
1 proceeding, and (2) has the same force and effect as the valid original handwritten signature of that
2 person. The provisions of this section satisfy the requirements of Civil Code section 1633.5, subdivision
3 (b), in the Uniform Electronic Transaction Act(Civil Code, Division 3, Part 2, Title 2.5, beginning with
4 section 1633.1). Each party using a digital signature represents that it has undertaken and satisfied the
5 requirements of Government Code Section 16.5, subdivision (a), paragraphs (1) through (5), and agrees
6 that each other party may rely upon that representation. This Agreement is not conditioned upon the
7 parties conducting the transactions under it by electronic means and either party may sign this Agreement
8 with an original handwritten signature.
9 38. ENTIRE AGREEMENT
10 This Agreement, including all Exhibits, constitutes the entire agreement between the
11 CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
12 Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
13 understanding of any nature whatsoever unless expressly included in this Agreement.
14
Exhibit A-1 Adult Crisis Stabilization Center Scope of Work
15 Exhibit A-2 Youth Crisis Stabilization Center Scope of Work
16 Exhibit B DBH Guiding Principles of Care Delivery
Exhibit C-1 Adult CSC Budgets and Budget Narratives
17 Exhibit C-2 Youth CSC Budgets and Budget Narratives
Exhibit D FCMHP Compliance Plan and Code of Conduct
18 Exhibit E Documentation Standards for Individual Medical Records
Exhibit F State Mental Health Requirements
19 Exhibit G Medi-Cal Organizational Provider Standards
20 Exhibit H Fresno County MHP Grievances and Appeals Process
Exhibit I Protocol for Completion of Incident Report
21 Exhibit J &J-1 Fixed Asset and Sensitive Item Log
Exhibit K National CLAS Standards
22 Exhibit L Disclosure of Ownership and Control Interest Statement
Exhibit M Certification Regarding Debarment
23 Exhibit N Self-Dealing Transaction Disclosure Form
24
25
26
27
28
39 - COUNTY OF FRESNO
Fresno, CA
1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
2 year first hereinabove written.
3
4 CONTRACTOR: COUNTY OF FRESNO
EXODUS RECOVERY, INC.
5 6 By:
Brian Pacheco, Chairman of the Board of
Supervisors of the County of Fresno
8 Print Name: Luana Murphy
9
10 Title: President/CEO
Chairman of Board, or President
11 or any Vice President ATTEST:
12 BERNICE E. SEIDEL
Clerk of the Board of Supervisors
13 County of Fresno, State of California
14 By.
15
16 Print Name: LeeAnn Skorohod By `�f7
Deputy
17 Title: Corporate Secretary/COO
18 Secretary of Corporation, or
any Assistant Secretary, or
19 Chief Financial Officer, or
20 any Assistant Treasurer
21
22 Mailing Address:
9808 Venice Blvd, Suite 700
23 Culver City, CA 90232
Phone No.: (310)945-3350
24 Contact: Luana Murphy, President/CEO
25 FOR ACCOUNTING USE ONLY:
26 Fund/Subclass: 0001/10000
27 Organization: 56302110(Youth CSC), 56302111 (Adult CSC)
Account No.: 7295
28
- 40 - COUNTY OF FRESNO
Fresno, CA
Exhibit A-1
Page 1 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
ADULT CRISIS STABILIZATION CENTER
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA 93702 (Bldg 319)
SERVICES: Adult Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: July 1, 2022 — June 30, 2025, with two (2) twelve (12) month
renewal options
SCHEDULE/LOCATION OF SERVICES:
CONTRACTOR shall operate the Adult Crisis Stabilization Center (Adult CSC) twenty-
four (24) hours per day, seven (7) days per week. The Adult CSC shall be located at the
Kings Canyon Campus at 4411 E. Kings Canyon Road, Fresno, California 93702
(Building 319), a COUNTY-owned building, pursuant to a separate lease agreement (and
any related amendments) between COUNTY and Exodus Foundation, Inc., an affiliate of
CONTRACTOR. At some point during the contract term when construction is complete,
the Adult CSC will be relocated to the COUNTY's Heritage Campus at the intersection of
Shields Avenue and Millbrook Avenue.
TARGET POPULATION:
The target population will include individuals 18 years of age and older from Fresno
County, who are exhibiting acute psychiatric symptoms and have either been placed on
a Welfare and Institution Code (W&IC) 5150 designation or who request admittance to
the Adult CSC on a voluntary status.
CONTRACTOR will provide crisis stabilization services to adults with a maximum
capacity of forty-four (44) beds at any given time. CONTRACTOR may also be in the
process of assessing or evaluating additional individuals, as necessary. At times
throughout the contract term, COUNTY DBH may request the increase of beds for
capacity needs (e.g., with increase in acuity and census due to the Covid-19 pandemic).
The maximum capacity will also potentially be modified due to the unknown capacity of
the new 24-7 facility at the Heritage Centre. The updated maximum capacity will be
made upon written agreement between COUNTY and CONTRACTOR.
Exodus Recovery, Inc. Pagel
Exhibit A-1
Page 2 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
CONTRACTOR will accept voluntary or involuntarily admitted adults regardless of
source of payment; individuals may include Medi-Cal beneficiaries, Medicare and
Medicare/Medi-Cal beneficiaries, privately insured and indigent/uninsured who are
referred by the Department of Behavioral Health (DBH), a contracted provider with
COUNTY DBH, a hospital emergency department, law enforcement, or Emergency
Medical Services (EMS). Individuals may be referred by family or be self-referred.
These services shall be performed pursuant to W&IC, sections 5704.5(b), 5704.6(c),
and 5614(b)(3) and program principles and the array of treatment options required
under W&IC, sections 5600.2 to 5600.9 inclusive.
PROJECT DESCRIPTION:
CONTRACTOR shall be responsible to comply with the requirements of the Fresno
County Mental Health Plan (FCMHP) and must complete and submit supporting clinical
and any other such documentation as may be required by the COUNTY for every person
served in the Adult CSC. The FCMHP will perform a utilization review of all admissions
to determine that the documentation demonstrates that medical necessity criteria as
defined by the California Department of Health Care Services (DHCS) was met for each
duration of the hospitalization, except for the episode of discharge.
CONTRACTOR shall be responsible to enter all Individual Service Information, admission
data and billing information into the COUNTY data system (AVATAR) and will be
responsible for any and all audit exceptions pertaining to the delivery of services.
CONTRACTOR'S RESPONSIBILITIES:
A. CONTRACTOR shall ensure that the Adult CSC provides the following services:
1 . Management and alleviation of the individual's acute psychiatric symptoms
through effective therapeutic interventions and supportive services to avoid
the need for a higher level of psychiatric care when clinically appropriate.
2. A recovery/strength based clinical program which has appropriate
professional staffing on a twenty-four (24) hour, seven (7) day a week
basis.
3. A safe, secure environment for persons served that encourages wellness
and recovery.
4. A comprehensive multi-disciplinary evaluation and individual-centered
treatment plan.
5. Dietary services through the availability of nourishment or snacks in
accordance with Title 22, Division 5, Chapter 9, Article 3, Section 77077.
Exodus Recovery, Inc. Page 2
Exhibit A-1
Page 3 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
6. Admission procedures for individuals, who are not on involuntary holds in
accordance with W&IC 5150 and also individuals placed on W&IC 5150
involuntary holds.
7. Crisis consultation services to rural service providers (e.g., emergency
departments, etc.) that may not have timely access to the centrally located
crisis stabilization facilities and may require consultation to support
individual care planning and/or mitigate unnecessary long transports of
persons served to the Adult CSC from remote areas. Crisis consultation
may occur via teleconference, tele-behavioral health (i.e., utilization of
video and computer equipment), and/or other method presented by
CONTRACTOR and deemed acceptable by the department.
8. Treatment Planning — Under the clinical direction of the mental health
clinician, the multi-disciplinary treatment team formed by the Crisis
Stabilization staff shall provide the following services:
a. Mental Status Examination
b. Medical Evaluation
c. Full Clinical Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Individual Centered Treatment Planning
g. Aftercare Planning and Wellness Recovery Action Plan (WRAP)
9. Staffing
a. The staffing pattern for the crisis stabilization program shall meet all
current State licensing and regulatory requirements including medical
staff standards, nursing staff standards, social work and rehabilitation
staff requirements pursuant to Title 9, Division 1 , Chapter 11 , Article
3, Section 1840.348 of the California Code of Regulations (CCR) for
Crisis Stabilization services. All staff requiring federal/state licensure
or certification will be required to be licensed or certified in the State
of California and be in good standing with the state licensing or
certification board. CONTRACTOR shall remain up-to-date with all
current regulatory changes and adhere to all new and/or modified
requirements.
b. All facility staff who provide direct individual care or perform
coding/billing functions must meet the requirements of the FCMHP
Compliance Program. This includes the screening for excluded
persons and entities by accessing or querying the applicable licensing
board(s), the National Practitioner Data Bank (NPDB), Office of
Inspector General's List of Excluded Individuals/Entities (LEIE),
Exodus Recovery, Inc. Page 3
Exhibit A-1
Page 4 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
Excluded Parties List System (EPLS) and Medi-Cal Suspended and
Ineligible List prior to hire and annually thereafter. In addition, all
licensed/registered/waivered staff must complete a FCMHP Provider
Application and be credentialed by the FCMHP's Credentialing
Committee. All of CONTRACTOR's staff who have direct contact
with the persons served, shall have Department of Justice (DOJ),
Federal Bureau of Investigation (FBI), and Sheriff fingerprinting
(Livescan) executed.
c. Peer and/or family support staff will be an active and key member of
the multi-disciplinary team to assist with treatment planning,
mentoring, support and advocate with individuals/families during their
time at the Adult CSC facility and will assist with discharge planning
and facilitate the individual's transition to the appropriate lower level
of care.
d. The staffing requirements defined by CCR, Title 9, Section 1840.348
for the Adult CSC is as follows:
(a) A physician shall be on call at all times for the provision of those
Crisis Stabilization Services that may only be provided by a physician.
(b) There shall be a minimum of one Registered Nurse, Psychiatric
Technician, or Licensed Vocational Nurse on site at all times
beneficiaries are present.
(c) At a minimum there shall be a ratio of at least one (1) licensed
mental health or waivered/registered professional on site for each
four (4) beneficiaries or other individuals receiving crisis stabilization
services at any given time.
(d) If the person served is evaluated as needing service activities that
can only be provided by a specific type of licensed professional, such
persons shall be available.
(e) Other persons may be utilized by the program, according to need.
(f) If Crisis Stabilization services are co-located with other specialty
mental health services, persons providing Crisis Stabilization must be
separate and distinct from persons providing other services.
(g) Persons included in required Crisis Stabilization ratios and
minimums may not be counted toward meeting ratios and minimums
for other services.
e. CONTRACTOR shall submit daily staffing reports that identify all
direct service and support staff by first and last name, applicable
Iicensure/certifications, full time hours worked, and the
Exodus Recovery, Inc. Page 4
Exhibit A-1
Page 5 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
licensed/waivered/registered mental health professionals to person
served ratio.
10. Medical Records
a. CONTRACTOR shall maintain records in accordance with Exhibit E,
"Documentation Standards for Individual Medical Records." During
site visits, COUNTY shall be allowed to review records of services
provided, including the goals and objectives of the treatment plan,
and how the therapy provided is achieving the goals and objectives.
b. CONTRACTOR will be responsible for "release of information"
requests for the Adult CSC facility and shall adhere to applicable
federal and state regulations.
c. CONTRACTOR can develop and implement a medical records
system which meets all State and Federal requirement and clearly
documents medical necessity for both treatment and billing services.
Medical records shall be kept in such a manner as to comply with the
Fresno County Quality Improvement standards and Federal and State
quality standards. COUNTY has an electronic medical record system.
CONTRACTOR may elect to utilize and participate with the
COUNTY's electronic health record system if they do not have their
own system in place. It is anticipated that CONTRACTOR shall be
utilizing an electronic medical records system by the end of this
contract term.
11. Clinical Staff - The clinical staff of CONTRACTOR shall be composed of all
licensed mental health or waivered/registered professionals as included in
CCR, Title 9, Division 1, Chapter 11, Article 3, Section 1840.348 (Crisis
Stabilization Staffing Requirements).
12. Medical Staff— The medical staff shall include a physician and a registered
nurse, psychiatric technician or licensed vocational nurse and any other
type of licensed professional needed to address individual's needs,
pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 (Crisis Stabilization Staffing Requirements).
13. Pharmaceutical Services — CONTRACTOR shall provide for medication
services on an as needed basis and the staffing must reflect this
availability, pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3,
Section 1840.338 (Crisis Stabilization Contact and Site Requirements) and
all other applicable federal/state regulations.
14. Assessment of Physical Health and Medical Backup Services — Pursuant to
CCR, Title 9, Division 1, Chapter 11, Article 3, Section 1840.338 (Crisis
Stabilization Contact and Site Requirements), CONTRACTOR shall provide
admission history and physical examination, and maintain a written
Exodus Recovery, Inc. Page 5
Exhibit A-1
Page 6 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
agreement for medical services with one or more general acute care
hospitals.
15. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify the COUNTY of any admission of
COUNTY's person served within twenty-four (24) hours or the next
business day in a manner approved by the COUNTY. The
notification method shall be approved by the COUNTY.
b. CONTRACTOR shall be responsible to ensure that documentation in
the individual's medical record meets medical necessity criteria for
the hours of service submitted to COUNTY for reimbursement by
federal intermediaries, third-party payers and other responsible
parties.
c. CONTRACTOR shall enter all mental health data and billing
information into the COUNTY's electronic information system and will
be responsible for any and all audit exceptions pertaining to the
delivery of services.
d. CONTRACTOR shall submit a complete and accurate DHCS
Short/Doyle Medi-Cal Cost Report for each fiscal year ending June
30t" affected by the proposed agreement within 120 days following
the end of each fiscal year.
e. CONTRACTOR shall insure that cost reports are prepared in
accordance with General Accepted Accounting Principles (GAAP)
and the standards set forth by the DHCS and the COUNTY.
16. Patients' Rights and Certification Review Hearings:
a. CONTRACTOR shall adopt and post in a conspicuous place a written
policy on individual's rights in accordance with section 70707 of Title
22 of the CCR and section 5325.1 of the W&IC and Title 42 Code of
Federal Regulations section 438.100.
b. CONTRACTOR shall allow access to COUNTY's persons served by
the Patients' Rights Advocate designated by the COUNTY.
17. Family Advocate - CONTRACTOR shall promote and allow the persons
served access to the Family Advocacy Services representative (Family
Advocate) who is contracted by the COUNTY to advocate and assist
individuals, families and support systems who are seeking or receiving
mental health services.
18. Grievances and Incident Reports
CONTRACTOR shall have all grievance forms readily available at the Adult
CSC facility.
Exodus Recovery, Inc. Page 6
Exhibit A-1
Page 7 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
CONTRACTOR shall log all grievances and the disposition of all grievances
received from a person served or their family in accordance with FCMHP
policies and procedures as indicated herein. CONTRACTOR shall provide
a summary of the grievance log entries concerning COUNTY-sponsored
individuals to the DBH Director, or designee, at monthly intervals, by the
fifteenth (15th) day of the following month, in a format that is mutually
agreed upon. CONTRACTOR shall post signs, provided by the COUNTY,
informing individuals of their right to file a grievance and appeal.
CONTRACTOR shall notify COUNTY of all incidents or unusual
occurrences reportable to state licensing bodies that affect COUNTY's
persons served within twenty-four (24) hours. CONTRACTOR shall use the
Incident Reporting process as indicated within Exhibit I for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-
sponsored individuals, CONTRACTOR shall provide County with the
complaint and CONTRACTOR's disposition of, or corrective action taken to
resolve the complaint or incident.
Within fifteen (15) days after CONTRACTOR submits a corrective action
plan to a California State licensing and/or accrediting body concerning any
sentinel event, as the term is defined by the licensing or accrediting agency,
and within fifteen (15) days after CONTRACTOR receives a corrective
action order from a California State licensing and/or accrediting body to
address a sentinel event, CONTRACTOR shall provide a summary of such
plans and orders to COUNTY.
19. Provide a safe and secure environment to provide for clinical and medical
assessment, diagnostic formulation, crisis intervention, medication
management, and clinical treatment for adults with acute psychiatric
symptoms. This includes the manner in which seclusion and restraint will
be administered when necessary for the safety of the persons served, other
persons served in the program, and staff.
20. Provide the appropriate type and level of staffing to provide for a clinically
effective program design that adheres to State staffing requirements.
21. Provide staff training in the areas of non-violent crisis intervention,
evidence-based practice, best practice, or promising practices to ensure
staff are competent and proficient in the therapeutic interventions and
practices in serving adult individuals accessing the Adult CSC.
22. CONTRACTOR shall utilize cost containment strategies for the provision of
stock and prescription medications to individuals (i.e., by contracting with a
pharmaceutical benefits management company) and provide the COUNTY
with the type of formulary utilized by the program as well as information
regarding co-pays and/or generic substitutions.
Exodus Recovery, Inc. Page 7
Exhibit A-1
Page 8 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
23. Provide an intensive treatment program which has individualized treatment
plans.
24. Stabilize the individuals' acute psychiatric symptoms in the most expedient
manner possible while adhering to appropriate clinical care standards. This
may include initiating a Treatment Authorization Request (TAR) to the
pharmacy and providing justification when psychotropic medications are
needed on an emergency basis.
25. Effectively partner with other programs in the COUNTY and community
system (i.e., law enforcement, local emergency departments, etc.) in
accepting COUNTY's persons served for admission for crisis stabilization
services.
26. Effectively partner with rural services providers (i.e., emergency
departments, etc.) to provide crisis stabilization services via teleconference,
tele-behavioral health (i.e., utilization of video and computer equipment),
and/or other method deemed acceptable by COUNTY.
27. Work collaboratively with the COUNTY and community resources in
discharge planning to ensure appropriate referral and direct linkage to
ongoing outpatient specialty mental health treatment services, substance
use disorder treatment services, etc. are provided. Discharge planning
would also include working collaboratively with out-of-county mental health
plans to ensure individuals in foster care who reside within Fresno County
are linked to appropriate ongoing specialty mental health services,
substance use disorder treatment services, etc. as appropriate.
28. Identify individuals with frequent admissions during the fiscal year and
develop strategies with other COUNTY and community agencies to reduce
readmissions and improve individuals' overall well-being through
coordination of care.
29. Effectively interact with community agencies, other mental health programs
and providers, natural support systems, and families to assist individuals to
be discharged to the appropriate level of care.
30. Work effectively with the DBH Conservatorship Team as appropriate for
individuals presenting to the Adult CSC as gravely disabled who may
require consideration for a temporary conservatorship.
31. Integrate mental health and substance use disorder services. The
CONTRACTOR shall perform the following:
a. Develop a formal written Continuous Quality Improvement CQI action
plan to identify measurable objectives toward the achievement of co-
occurring disorders (COD) treatment capability that will be addressed by
the program during the contract period. These objectives should be
Exodus Recovery, Inc. Page 8
Exhibit A-1
Page 9 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
achievable and realistic for the program, based on a self-assessment
and the program priorities, but need to include attention to making
progress on the following issues, at minimum:
1 . Welcoming policies, practices, and procedures related to the
engagement of individuals with co-occurring issues and disorders;
2. Removal or reduction of access barriers to admission based on
co-occurring diagnosis or medication;
3. Improvement in routine integrated screening, and identification in
the data system of how many persons served have co-occurring
issues;
4. Developing the goal of basic co-occurring competency for all
treatment and support staff, regardless of licensure or certification;
and
5. Documentation of coordination of care with collaborative mental
health and/or substance use disorder providers for each person
served.
B. Regarding cultural and linguistic competence requirements, CONTRACTOR
shall:
1 . Ensure compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C.
Section 2000d, and 45 C.F.R. Part 80) and Executive Order 12250 of 1979
which prohibits recipients of federal financial assistance from discriminating
against persons based on race, color, national origin, sex, disability or
religion. This is interpreted to mean that a limited English proficient (LEP)
individual is entitled to equal access and participation in federally funded
programs through the provision of comprehensive and quality bilingual
services.
2. Create and maintain policies and procedures for ensuring access and
appropriate use of trained interpreters and material translation services for
all LEP persons served, including, but not limited to, assessing the cultural
and linguistic needs of its persons served, training of staff on the policies
and procedures, and monitoring its language assistance program. The
CONTRACTOR's procedures must include ensuring compliance of any
subcontracted providers with these requirements.
3. Ensure that minors shall not be used as interpreters.
4. Conduct and submit to COUNTY an annual cultural and linguistic needs
assessment to promote the provision and utilization of appropriate services
for its diverse population. The needs assessment report shall include
findings and a plan outlining the proposed services to be improved or
implemented as a result of the assessment findings, with special attention to
Exodus Recovery, Inc. Page 9
Exhibit A-1
Page 10 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
addressing cultural and linguistic barriers and reducing racial, ethnic,
language, abilities, gender, and age disparities.
5. Develop internal systems to meet the cultural and linguistic needs of the
CONTRACTOR's persons served census including the incorporation of
cultural competency in the CONTRACTOR's mission; establishing and
maintaining a process to evaluate and determine the need for special -
administrative, clinical, welcoming, billing, etc. - initiatives related to cultural
competency.
6. Develop recruitment and retention initiatives to establish contracted program
staffing that is reflective and responsive to the needs of the program and
target population.
7. Establish designated staff person to coordinate and facilitate the integration
of cultural competency guidelines and attend COUNTY's DBH Cultural
Diversity Committee scheduled meetings. The designated person will
provide an array of communication tools to distribute information to staff
relating to cultural competency issues.
8. Keep abreast of evidence-based and best practices in cultural competency
in mental health care and treatment to ensure that the CONTRACTOR
maintains current information and an external perspective in its policies.
The CONTRACTOR shall evaluate the effectiveness of strategies and
programs in improving the health status of cultural-defined populations.
9. Ensure that an assessment of an individual's sexual orientation is included
in the bio-psychosocial intake process. CONTRACTOR's staff shall assume
that the population served may not be in heterosexual relationships.
Sensitivity to gender and sexual orientation must be covered in annual
training.
10. Utilize existing community supports, referrals to transgender support groups,
etc., when appropriate.
11. Attend annual Cultural Competence, Compliance, Health Insurance
Portability and Accountability Act (HIPAA), Billing, and Documentation
training provided by COUNTY's DBH.
12. Report its efforts to evaluate cultural and linguistic activities as part of the
CONTRACTOR's ongoing quality improvement efforts in the monthly
activities report. Reported information may include individuals' complaints
and grievances, any resulting actions regarding complaints and grievances,
results from persons served satisfaction surveys, and utilization and other
clinical data that may reveal health disparities as a result of cultural and
linguistic barriers.
C. Regarding Conservatees, CONTRACTOR agrees to the following:
Exodus Recovery, Inc. Page 10
Exhibit A-1
Page 11 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
CONTRACTOR shall work with COUNTY's DBH Persons Served Placement
Team to find placement for COUNTY conservatees that are discharged from the
CONTRACTOR-operated Adult CSC.
D. Regarding direct admissions to the Adult CSC from COUNTY's DBH programs
or its contracted providers, CONTRACTOR agrees to the following:
1 . To allow direct admits from COUNTY's DBH programs or its contracted
providers when the Adult CSC has the capacity to accept individuals for
services.
2. Said direct admits shall not require medical clearance, if persons served
would otherwise meet the Central California Emergency Medical Services
Agency 5150 Destination Policy requirements as mentioned hereinbelow in
Subsection G. However, in the event a referred individual is known to
possess a contagious medical condition, said individual shall be medically
cleared by a local hospital prior to admission to the Adult CSC operated by
CONTRACTOR.
E. Regarding the placement of an individual at another designated facility:
1 . CONTRACTOR shall notify COUNTY DBH when an individual will remain at
the CSC for a period in excess of 24 hours, while awaiting placement and/or
transportation. COUNTY's Patients' Rights Advocate will be included in this
notification
2. CONTRACTOR shall provide the following services to individuals who
remain at the Adult CSC for a period in excess of 24 hours and who are
awaiting placement and/or transportation:
a. Three meal periods and three snack times per 24 hours
b. Daily encouragement and support with activities of daily living i.e.,
showering, washing of clothes, teeth brushing, hair combing, etc.
c. Daily psychiatric evaluation by both the provider and licensed nursing
staff to evaluate/determine the individuals most appropriate level of care
d. Daily medication evaluation, administration and education
e. Daily group activities (e.g., 12-Step Meetings, WRAP, Goals Group, etc.)
f. Daily one-on-one peer support provided by designated Peer Advocate
g. Daily activities such as meditation, art, entertainment and outdoor
activities provided in the outside courtyard
h. Daily education in relation to mental health diagnosis, treatments, and
community resources
F. Regarding the provision of court testimony related to Adult CSC individuals,
CONTRACTOR agrees to the following:
Exodus Recovery, Inc. Page 11
Exhibit A-1
Page 12 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
CONTRACTOR's staff shall provide court testimony relevant to Adult CSC
individuals, when required.
G. Regarding the Central California Emergency Medical Services Agency
(CCEMSA) 5150 Destination Policy, CONTRACTOR agrees to the following:
CONTRACTOR agrees to follow the then-current Central California
Emergency Medical Services Agency 5150 Destination Policy #547 as
identified in Attachment A, attached hereto and incorporated herein. Said
policy may be updated periodically throughout the term of this Agreement;
CONTRACTOR must adhere to the most recent policies designated by the
CCEMSA 5150 Destination Policy.
H. CONTRACTOR shall participate in the following meetings:
1 . CONTRACTOR shall participate in periodic workgroup meetings scheduled
by staff from COUNTY's DBH Mental Health Contracted Services Division.
The meetings shall be held monthly, or as needed, to discuss contract
requirements, data reporting, outcomes measurement, training, policies and
procedures, and overall program operations.
2. CONTRACTOR's administrative level agency representative, who is duly
authorized to act on behalf of CONTRACTOR, shall attend regularly
scheduled monthly Behavioral Health Board meetings.
3. CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider
Meetings, as scheduled by staff from COUNTY's Mental Health Contracted
Services Division, when deemed necessary by the DBH Director, or
designee.
4. CONTRACTOR may also be asked to make presentations in the community
about the program and services that are available.
I. Regarding the development of policies and protocols:
CONTRACTOR and COUNTY's DBH shall collaborate on the development
of specific policies and protocols related to the daily operation of the Adult
CSC. Such policies will include, but not be limited to, the following:
placement of adults in psychiatric health facilities or other inpatient
programs either locally or outside the county, facility limitations, and special
persons served populations. Such policies and protocols shall be mutually
agreed upon between CONTRACTOR and COUNTY's DBH Director, or
designee. Any changes to such policies and protocols shall be mutually
agreed upon between CONTRACTOR and COUNTY's DBH Director, or
designee.
Exodus Recovery, Inc. Page 12
Exhibit A-1
Page 13 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
PROGRAM OUTCOMES
The Department of Behavioral Health is dedicated to supporting the wellness of
individuals, families and communities in Fresno County who are affected by, or at the
risk of, mental illness and/or substance use disorders through cultivation of strengths
toward promoting recovery in the least restrictive environment.
Five (5) Work Plans will be utilized to support DBH's mission statement. The work
plans were developed as a concept of a Transformation Plan that would encompass
system planning, implementation and oversight to be reflective of a comprehensive
system of care. These work plans are provided below and represent program goals
to be achieved by CONTRACTOR in addition to CONTRACTOR-developed
outcomes. DBH may adjust the outcome measurements needed under this program
periodically, so as to best measure the success of individuals and program as
determined by the COUNTY.
CONTRACTOR will utilize a computerized tracking system with which outcome
measures and other relevant persons served data, such as demographics, will be
maintained.
1. Behavioral Health Integrated Access — timeliness between persons served
referral to admission, admission to treatment, and treatment to discharge;
penetration rate; effectiveness of discharge planning as demonstrated by
referral and linkage to other DBH programs, community providers, and other
community resources; and services that provide screening and access to
ensure persons served are linked to the services they need, including mental
health substance use disorders and physical health services.
2. Wellness, Recovery, and Resiliency Supports — collaborative approach to
treatment strategies to reduce readmission of persons served with frequent
admissions to the facility; effectiveness of services as demonstrated by the
number of persons served who are able to be discharged to the community
and avoid inpatient hospitalization; measurement of recidivism rates, including
measuring percentage of recidivism within 30 days. State the Evidence Based
Practices (EBP) that shall be used.
3. Cultural/Community Defined Practices — services or philosophical practices
which support the unique cultural-specific needs of individuals receiving care.
Focus on behavioral health practices which reflect the unique needs of various
cultures and communities who reside within Fresno County.
4. Behavioral Health Clinical Care — services where direct therapeutic treatment
is provided. Include the framework of "Levels of Care" where individual's
needs, as identified through assessment/screening, are matched with a
complexity and intensity of services meets those needs.
Exodus Recovery, Inc. Page 13
Exhibit A-1
Page 14 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
5. Infrastructure Supports — includes all personnel, equipment, programs, and
facilities which exist to support the delivery of care to the individuals served.
Includes safety, quality improvement and regulatory compliance functions,
along with outcome assessment/program evaluation, training, and technology.
6. Denial rate for Crisis Stabilization billing will be decreased by five percent (5%)
within the first six (6) months, based on previous program denial rates. Rates
will be determined by the utilization review performed by FCMHP.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Perform a utilization review, annually at a minimum, (through its FCMHP) of ten
percent (10%) of all admissions to determine that the documentation
demonstrates that medical necessity criteria as defined by the DHCS were met
throughout the duration of the crisis stabilization episode. The FCMHP will
maintain discretion regarding possible subsequent utilization review beyond ten
percent (10%), as necessary.
2. Provide oversight of the CONTRACTOR's Adult CSC program. In addition to
contract monitoring of program(s), oversight includes, but is not limited to,
coordination with the DHCS in regard to program administration and outcomes.
3. Assist the 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.
4. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the CONTRACTOR staff and will be available to the contractor
for ongoing consultation.
5. 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.
6. 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
Exodus Recovery, Inc. Page 14
Exhibit A-1
Page 15 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
linguistic competency, DBH shall provide the following at no cost to
CONTRACTOR:
A. 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).
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, and queer (LGBTQ+) 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.
B. 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.
Exodus Recovery, Inc. Page 15
Attachment A
CENTRAL CALIFORNIA EMERGENCY Page 1 of 9
MEDICAL SERVICES
A Division of the Fresno County Department of Public Health
Manual Policy
Emergency Medical Services Number 547
Administrative Policies and Procedures
Page 1 of 9
Subject Patient Destination
References Title 13, Section 1106 of the California Code of Regulations Effective:
Title 22, Division 9, Chapter 7 of the California Code of Regulations 04/18/83
I. POLICY
Patients of the Prehospital EMS System shall be transported to an appropriately staffed and equipped hospital.
II. MEDICAL PATIENT DESTINATION
A. Medical Patients shall be transported to the appropriate destination in accordance with the following chart:
Fresno County Kings County Madera County Tulare County
Medical—Adult
Non-emergent Patient's Choice Patient's Choice Patient's Choice Patient's Choice
Life-threatening Closest Appropriate Closest Appropriate Closest Appropriate Closest Appropriate
Regional Medical Kaweah Health Medical Regional Medical Kaweah Health Medical
Acute current of injury Center or St.Agnes Center or Regional Center or St.Agnes Center or Regional
(acute MI) Medical Center Medical Center Medical Center Medical Center
(Quickest travel time) (Quickest travel time) (Quickest travel time) (Quickest travel time)
Medical—Pediatric(14 years or younger)
Stable Patient/Family Choice Patient/Family Choice Patient/Family Choice Patient/Family Choice
Kaweah Health Medical
RMC or VCH*** RMC or VCH * * RMC or VCH *** Center or
Unstable (Quickest travel time) (Quickest travel time) (Quickest travel time) Sierra View District
Hospital
(Quickest travel time)
5150 patients
CSC or Patient's Choice
5150-Adult within Fresno County Patient's Choice within Patient's Choice within Patient's Choice within
(See criteria on page 4) Kings County Madera County Tulare County
YCSU or Patient/Family
5150—Children (<18 Choice within Fresno Patient/Family Choice Patient/Family Choice Patient/Family Choice
yrs) County within Kings County within Madera County within Tulare County
(See criteria on page 4)
Kaiser Kaiser N/A N/A N/A
Veteran's Administration Veteran's Administration N/A N/A N/A
*** If transport time is greater than 60 minutes, base hospital contact shall be made to determine appropriate destination.
Approved By Daniel J. Lynch Revision
EMS Division Manager (Signature on File at EMS Agency 3/14/2022
Jim Andrews, M.D.
EMS Medical Director (Signature on File at EMS Agency)
Attachment A
Page 2 of 9
B. Medical Patient Destination —Considerations
1. In a non-emergent situation (as determined by the EMT or Paramedic at the scene and/or the
Base Hospital Physician/MICN giving medical direction), the patient will be taken to the receiving
hospital of his/her choice. If the patient is unable to determine this, the hospital designated by the
private physician and/or patient's family member will be utilized. Paramedics and EMTs should
determine where the patient normally receives their medical care and encourage the patient to
return to that hospital for medical care as long as the patient's medical condition allows for such
transport.
2. The Paramedic/EMT/MICN/BHP should only provide the patient with alternatives for destination
of patient choice. It is inappropriate for the Paramedic/EMT/MICN/BHP to endorse specific
facilities or provide personal opinion on the quality of local facilities.
3. Health Plans - If the patient is a member of a health plan with a preferred hospital, an attempt
should be made to transport the patient to a participating facility.
4. Closest Appropriate Hospital
a. The closest appropriate hospital is defined as the closest emergency department
"equipped, staffed, and prepared to administer care appropriate to the needs of the
patient" (California Code of Regulations, Title 13, Section 1106 (b) 2).
b. Closest is defined as the shortest travel time not necessarily the closest by distance.
C. The Base Hospital Physician will have the ultimate authority for patient destination.
d. The closest appropriate hospital does not mean that critically ill patients always go to the
closest"receiving" hospital. They go to the closest"appropriate" hospital. The following
guidelines will help to define "appropriate":
1) Due to short transport times, the appropriate receiving facility for a life-
threatening medical situation would be a hospital with a basic emergency service
(holds a special services permit from the California State Department of Health
Services). Hospitals with basic emergency services are:
a) Adventist Health Hanford (AH-H)
b) Adventist Health Tulare (AH-T)
c) Clovis Community Medical Center(CCMC)
d) Kaiser Permanente Hospital (KPH)
e) Kaweah Health Medical Center(KHMC)
f) Madera Community Hospital (MCH)
g) Regional Medical Center(RMC)
h) Saint Agnes Medical Center(SAMC)
i) Sierra View District Hospital (SVDH)
j) Valley Children's Hospital (VCH)
2) Rural Areas - Due to prolonged travel times to the urban area, the appropriate
receiving hospital for a life-threatening medical situation would be a hospital with
a standby emergency service (holds a special services permit from the California
State Department of Health Services). Hospitals with stand-by emergency
services that are approved to receive ambulances are:
a) Adventist Health Reedley (AH-R)
b) Adventist Health Selma (AH-S)
c) Coalinga Regional Medical Center(CRMC)
Attachment A
Page 3 of 9
5. Acute Cardiac Emergency
In the event of an acute current of injury, transport should be to a designated cardiac center,
which has 24/7 interventional heart catheterization capabilities. The following is a list of readings
from various cardiac monitors that would require transport to a designated cardiac center:
• ***ACUTE MI *** (Zoll Monitor E Series)
• ***STEMI*** (Zoll Monitor X Series))
• ***ACUTE MI SUSPECTED*** (Physio-Control Monitor LifePak 12)
• ***MEETS ST ELEVATION MI CRITERIA*** (Physio-Control Monitor LifePak 15)
The designated cardiac centers in the CCEMSA region are:
• Regional Medical Center
• Kaweah Health Medical Center
• Saint Agnes Medical Center
Transport shall be to the cardiac center that has the quickest transport time if transport time is
less than 60 minutes. If transport time is greater than 60 minutes, then transport to the closest
appropriate facility or consider helicopter rendezvous. Destination is determined by:
a. Interpretation of 12-lead ECG; or
b. Base Hospital consultation if required.
6. Patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an advanced airway or
OPA, this is not an unstable airway.
b. Any patient with CPR in progress.
C. Any critically ill or unstable patient when Base Hospital contact is not possible (i.e.,
Paramedic or EMT must make the ultimate destination decision).
7. Patients who go to a non-receiving hospital:
Patients may be transported to a non-receiving hospital only when the Base Hospital has
contacted the receiving doctor and received assurance of immediate acceptance of the patient.
Such assurance should then be documented on the Base Hospital run form.
8. Patients who go to a receiving hospital, which is not closest:
Unstable patients who request this hospital and, in the opinion of the Base Hospital Physician,
the extra travel time is not dangerous to the patient
Attachment A
Page 4 of 9
C. Fresno County 5150 Holds—Considerations
1. Fresno County 5150 patient criteria for transport Crisis Stabilization Center(CSC)Youth Crisis
Stabilization Unit(YCSU):
a. If the patient meets the following criteria, he/she shall be transported directly to Crisis
Stabilization Center(CSC) if age 18 or greater; or the Youth Crisis Stabilization Unit
(YCSU) if under 18 years of age:
• No urgent medical complaint or evidence of acute medical/surgical/trauma problem
requiring urgent treatment prior to psychotic admission.
• No alteration in mental status due to dementia or delirium.
• Glasgow Coma Score 14 or 15.
• Complete vital signs within limits (HR, RR, BP and GCS).
• Not febrile to palpation/measurement.
• Under the influence of alcohol or drugs, patient can walk without assistance and is
able to follow verbal commands (does not apply to YCSU).
1) Adults:
a) Pulse: 50-120 bpm
b) Systolic Blood Pressure: 100-180 mm Hg
c) Diastolic Blood Pressure: less than 120 mm Hg
d) Respiratory Rate: 12-30
2) Pediatrics:
a) Vital signs appropriate for children (policy 530.32).
NOTE: Refer to the Criteria for Transporting a Fresno County 5150 Patient Directly to
Crisis Stabilization Center(CSC)or Youth Crisis Stabilization Unit(YCSU)
Screening Form attached to this policy.
Patients that Crisis Stabilization Center(CSC) and Youth Crisis Stabilization Unit (YCSU)
cannot accept:
• Patients with dementia or delirium.
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use,
catheters, wired devices, etc.).
• Patients in wheelchairs that cannot move independently.
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires
anything more that once daily dry gauze and tape dressing.
b. All other patients on a 5150 hold in Fresno County not meeting the above criteria will be
transported to Patient/Family Choice within Fresno County.
C. Patients placed on a 5150 hold are to be transported to facilities within the county where
the 5150 hold was initiated.
d. The 5150 destination policy does not apply to psychiatric patients who are voluntarily
requesting evaluation (not on a 5150 hold). If the patient is not on a 5150 hold, then
transport will be to a receiving facility of their choice, which includes CSC or YCSU
(Fresno County only) if patient meets criteria within this policy.
e. Kaiser Permanente patients on a 5150 hold are to be transported to that facility.
f. Veteran's Administration patients on a 5150 hold are to be transported to that facility.
Attachment A
Page 5 of 9
D. Veteran's Administration
1. The Veteran's Administration emergency department will accept all patients with a Veterans
Administration (VA) Identification Card or active-duty Department of Defense (DOD) Card (Patient
Name Only, no dependent(s). Name of patient on card must be the patient requesting transport).
No prior approval or Base Hospital contact is necessary. If the patient requests transport to
Veterans Administration emergency department and does not have the identification noted
above, contact the VA Emergency Department directly for prior approval before the patient is
transported. The complete name and the full social security number will be required. Contact the
Veteran's Administration on Med 6 or 241-3600.
2. Patients that cannot be transported directly to the Veteran's Administration are:
• Cardiac arrest due to trauma
• Pediatric cardiac arrest
• Trauma Center Triage Criteria
• OB patient in active labor
• Gynecological complaints and known obvious pregnancy with vaginal bleeding
• ST-segment elevation myocardial infarction (STEMI)
NOTE: INTERFACILITY TRANSPORTS ARE NOT MANAGED THROUGH THIS PROCEDURE.
III. TRAUMA PATIENT DESTINATION
A. Trauma patients shall be transported to the appropriate closet facility in accordance with the following chart:
0 F-5,
ss Physiological Criteria
ystolic Blood Pressure:
o Adults: <90 mm Hg
o Pediatrics: <80 mm Hg with signs
and symptoms of shock(Refer to EMS
Policy 530.32 for estimated weight
formulas or use Broselow Tape)
• Respiratory Rate:
o Adults: <10 or>30 RMC or KHMC
o Children: <20 if under age 1 _P1 VCH(14 years or age or less)
•Glasgow Coma Score<13(or,in patients whose L (Consider air transport)
normal GCS is less than 15,or a decrease of two
or more of the patients GCS score)
• Penetrating injury to the head
• Paraplegia
• Quadriplegia
Assess Anatomy of Injury
• Penetrating injuries to neck or torso RMC or KHMC
• Flail chest VCH(14 years or age or less)
• Two or more proximal long-bone fractures (Consider air transport)
• Amputation proximal to wrist or ankle 00
TRAUMA DESTINATION CHART
Attachment A
Page 6 of 9
Assess Burns
F
RAUMA PATIENTS WITH:
rtial/Full thickness burns>10%TBSA
• Partial/Full thickness circumferential burns RMC
• Partial/Full thickness burns to face,hands,feet, IRWIN 1 11 (Consider air transport)
major joints,perineum,or genitals
• Electrical burns with voltage>120 volts
• Chemical burns>10%TBSA
Assess Mechanism of Injury
• Falls
o Adults: >20 ft.(one story=10 ft.) RMC or KHMC
o Children: >10 ft.or 3 times height of the VCH(14 years of age or less)
child (Consider air transport)
Assess Special Considerations
WITH A SIGNIFICANT COMPLAINT:
• Age greater than 55 years
• Anticoagulation or bleeding disorders Consider transport to
• Pregnancy greater than 20 weeks RMC or KHMC
• Auto vs.Pedestrian>20 mph VCH(14 years of age or less)
• Motorcycle crash>20 mph
Paramedic/Flight Nurse Judgment
Consider RMC or KHMC
WITH A SIGNIFICANT COMPLAINT VCH(14 years of age or less)
Base Hospital Consultation
SIGNIFICANT COMPLAINT
Transport According to Policy
Perseveration
Deteriorating mental status
Severe chest pain
Severe shortness of breath
Severe abdominal pain
Sustained,overwhelming"Feeling of Doom"
Attachment A
Page 7 of 9
NOTE: If transport time is greater than 60 minutes for patients meeting trauma triage criteria, base
hospital contact shall be made to determine appropriate destination.
NOTE: If transport time is greater than 2 hours for patients meeting burn triage criteria, base hospital
contact shall be made to determine appropriate destination.
B. Triage Criteria
Triage criteria will determine if the patient will be transported to a trauma center or closest receiving
hospital.
C. Trauma Patient Destination —Considerations
1. If the patient is in cardiac arrest from penetrating trauma in the greater Fresno or Visalia
metropolitan area, the patient should be transported to Regional Medical Center, Kaweah Health
Medical Center or Valley Children's Hospital, bypassing a closer receiving facility. However, if the
transport time to Regional Medical Center, Kaweah Health Medical Center, or Valley Children's
Hospital is greater than ten (10) minutes, then transport should be to the closest receiving facility
within ten minutes transport time (Refer to EMS Policy#550).
2. Trauma patients, meeting trauma center criteria, who have a transport time greater than 60
minutes to the trauma center, will require base hospital contact for destination decision.
3. The following types of incidents should be consideration for transport to the designated Trauma
Center, based upon paramedic judgment:
a. Motorcycle Crash - Non-ambulatory with potential of significant injuries
b. Auto versus Pedestrian - Non-ambulatory with potential of significant injuries
NOTE:Paramedic judgment is based upon the paramedic's own knowledge and experience to determine
if the patient's condition would require transport to a designated Trauma Center due the mechanism of
injury and potential underlying injuries. The Paramedic may contact a Base Hospital for advice on
destination.
4. Transport of Trauma Patients by Helicopter
A trauma patient should not be transported by helicopter unless they meet trauma triage criteria
to be transported to a trauma center or the patient is inaccessible by ambulance (i.e., wilderness
transports). EXCEPTION: When the paramedic feels helicopter transport of the patient would be
beneficial to the outcome of the patient.
5. Burn Patients
The following patients should be transported directly to the Regional Burn Center(Regional
Medical Center) bypassing other hospitals if ETA to Regional Medical Center is within two hours.
a. Patients with 20(partial thickness) or 30(full thickness) burns that are more than 10%
total body surface area
b. Patients with 20(partial thickness) or 31, (full thickness) circumferential burns of any body
part
C. Patients with 20(partial thickness) or 30(full thickness) burns to face, hands, feet, major
joints, perineum, or genitals
d. Electrical burns with voltage greater than 120 volts
e. Patients with chemical burns greater than 10% total body surface area.
Attachment A
Page 8 of 9
6. Carbon Monoxide Poisoning - Early call-ins to Regional Medical Center should be made for
patients that appear to have significant exposure to carbon monoxide poisoning (altered mental
status, vomiting, and headaches).
7. Trauma patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an ET Tube or OPA,
this is not an unstable airway.
b. Any patient with CPR in progress (refer to EMS Policy#550).
C. Any critically injured or unstable patient when Base Hospital contact is not possible
(i.e., Paramedic or EMT must make the ultimate destination decision).
IV. PATIENTS WHO REFUSE TRANSPORT TO THE APPROPRIATE HOSPITAL
A Base Hospital shall be contacted for the purpose of physician consultation on patients who meet one or more of
the triage criteria and refuse transport to the appropriate hospital. This will usually not be a problem with the
acutely ill patient. However, some patients with normal mental status may wish to be transported to a different
hospital than the one selected via the triage criteria. These situations should be treated as "Refusal of Medical
Care and/or Transportation" situation (refer to EMS Policy#546). The Base Hospital Physician, after radio
contact, may allow the patient to go to the destination of their choice, have a "Refusal of Medical Care and/or
Transportation " signed or insist on transport to the designated hospital.
V. SPECIAL CONSIDERATION FOR FRESNO HEART & SURGICAL HOSPITAL DESTINATION
While the Fresno Heart& Surgical Hospital is a hospital within Central California EMS Region, it does not have
an emergency department and is not an approved facility for patient transports within EMS Policy and
Procedures. Patients who are requesting transport to the Fresno Heart& Surgical Hospital from the prehospital
setting will require Base Hospital contact to confirm acceptance. Since the Fresno Heart & Surgical Hospital is
under the Community Medical Center organization, EMS personnel should contact Regional Medical Center
when requesting transport to the Fresno Heart & Surgical Hospital. If attempts to contact Regional Medical
Center are unsuccessful, EMS personnel should contact another Base Hospital. Interfacility transfers involving
the Fresno Heart& Surgical Hospital shall be in accordance with EMS Policy#553, "ALS Interfacility
Transports".
Attachment A
Page 9 of 9
Central California EMS Agency
Criteria for Transporting a Fresno County 5150/Psychiatric Patient
Directly to CSC or YCSU Screening Form
Patient's Name: EMS#:
Patient has urgent medical complaint or evidence of acute medical/surgical problem.
[] True—transport Patient/Family Choice [] False
Patient has alteration in mental status due to dementia or delirium.
[] True—transport Patient/Family Choice [] False
Patient has a Glasgow Coma Score 13 or less.
[] True—transport Patient/Family Choice [] False
There are lacerations with a gap of greater than 2 mm or fat/muscle visible in the wound (excludes any
type of stab wound).
[] True—transport Patient/Family Choice [] False
There are lacerations or wounds inflicted by others.
[] True—transport Patient/Family Choice [] False
Complete vital signs are within limits:
Adults:
Pulse outside range of 50-120. [] True—transport Patient/Family Choice [] False
Systolic Blood Pressure outside range of 100-180. [] True—transport Patient/Family Choice [] False
Diastolic Blood Pressure greater than 120. [] True—transport PatienVFamily Choice [] False
Respiratory Rate outside range of 12-30. [] True—transport PatienVFamily Choice [] False
Pediatrics:
Vital signs inappropriate for children
(Policy 530.32) [] True—transport PatienVFamily Choice [] False
Patient is febrile to palpation/measurement.
[] True—transport Patient/Family Choice [] False
Is patient under the influence of alcohol or drugs?
[] Yes No
If yes, to under the influence of alcohol or drugs, does patient require assistance to walk?
[] True—transport PatienVFamily Choice [] False
If all of the above answers are False, patient may be transported to CSC/YCSU; otherwise, transport is
Patient/ Family Choice.
Patients that Crisis Stabilization Center(CSC) or Youth Crisis Stabilization Unit (YCSU) cannot accept:
• Patients with dementia or delirium
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use, catheters,
wired devices, etc.)
• Patients in wheelchairs that cannot move independently
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires anything more
than once daily dry gauze and tape dressing
Exhibit A-2
Page 1 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
YOUTH CRISIS STABILIZATION CENTER
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA, 93702 (Bldg 319)
SERVICES: Youth Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: July 1, 2022 — June 30, 2025, with two (2) twelve (12) month
renewal options
SCHEDULE/LOCATION OF SERVICES:
CONTRACTOR shall operate the Youth Crisis Stabilization Center (Youth CSC) twenty-
four (24) hours per day, seven (7) days per week. The Youth CSC shall be located at
the Kings Canyon Campus at 4411 E. Kings Canyon Road, Fresno, California 93702
(Building 319), a COUNTY-owned building, pursuant to a separate lease agreement
(and any related amendments) between COUNTY and Exodus Foundation, Inc., an
affiliate of CONTRACTOR. At some point during the contract term when construction is
complete, the Adult CSC will be relocated to the COUNTY's Heritage Campus at the
intersection of Shields Avenue and Millbrook Avenue.
TARGET POPULATION:
The target population will include children and youth, up to 18 years of age, from Fresno
County, who are exhibiting acute psychiatric symptoms and have either been placed on
a Welfare and Institutions Code (W&IC) 5150 designation or who request admittance to
the Youth CSC on a voluntary status.
CONTRACTOR will provide crisis stabilization services to children and youth with a
maximum capacity of sixteen (16) beds at any given time. CONTRACTOR may also be
in the process of assessing or evaluating additional youth, as necessary. At times
throughout the contract term, COUNTY DBH may request the increase of beds for
capacity needs (e.g., with increase in acuity and census due to the Covid-19 pandemic).
The maximum capacity will also potentially be modified due to the unknown capacity of
the new 24-7 facility at the Heritage Centre. The updated maximum capacity will be
made upon written agreement between COUNTY and CONTRACTOR.
Exodus Recovery, Inc. Pagel
Exhibit A-2
Page 2 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
CONTRACTOR will accept voluntary or involuntarily admitted individuals regardless of
source of payment; youth may include Medi-Cal beneficiaries, or privately insured and
indigent/uninsured who are referred by the COUNTY's Department of Behavioral Health
(DBH), a contracted provider with COUNTY DBH, a hospital emergency department,
law enforcement, or Emergency Medical Services (EMS). Youth may also be referred
by family or self-referred. The Youth CSC will also serve foster children and youth who
reside in Fresno County and remain under the original jurisdiction of another county.
These services shall be performed pursuant to W&IC, sections 5704.5(b), 5704.6(c),
and 5614(b)(3) and program principles and the array of treatment options required
under W&IC, sections 5600.2 to 5600.9 inclusive.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health
component of Medicaid. Federal statutes and regulations state that children under
age 21 who are enrolled in Medicaid are entitled to EPSDT benefits and that States
must cover a broad array of preventive and treatment services to include crisis
stabilization. The requirement is to maintain its funding for children's services at a
level equal to or more than the proportion expended for children's program services in
FY 83-84.
PROJECT DESCRIPTION:
CONTRACTOR shall be responsible to comply with the requirements of the Fresno
County Mental Health Plan (FCMHP) and must complete and submit supporting clinical
and any other such documentation as may be required by the COUNTY for every youth
served in the Youth CSC. The FCMHP will perform a utilization review of all admissions
to determine that the documentation demonstrates that medical necessity criteria as
defined by the California Department of Health Care Services (DHCS) was met for each
duration of the crisis stabilization services claimed for reimbursement.
CONTRACTOR shall be responsible to enter all Individual Service Information,
admission data and billing information into the COUNTY data system (AVATAR) and
will be responsible for any and all audit exceptions pertaining to the delivery of services.
CONTRACTOR'S RESPONSIBILITIES:
A. CONTRACTOR shall ensure that the Youth CSC provides the following services:
1 . Management and alleviation of a youth's acute psychiatric symptoms
through effective therapeutic interventions and supportive services to avoid
the need for a higher level of psychiatric care when clinically appropriate.
2. A recovery/strength based clinical program which has appropriate
professional staffing on a twenty-four (24) hour, seven (7) day a week
basis.
Exodus Recovery, Inc. Page 2
Exhibit A-2
Page 3 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
3. A safe, secure environment for youth that encourages wellness and
recovery.
4. A comprehensive multi-disciplinary evaluation and individual-centered
treatment plan.
5. Dietary services through the availability of nourishment or snacks in
accordance with Title 22, Division 5, Chapter 9, Article 3, Section 77077.
6. Admission procedures for youth, who are not on involuntary holds in
accordance with W&IC 5150 and also individuals placed on W&IC 5150
involuntary holds.
7. Crisis consultation services to rural service providers (e.g., emergency
departments, etc.) that may not have timely access to the centrally located
crisis stabilization facilities and may require consultation to support an
individual's care planning and/or mitigate unnecessary long transports of
youth to the Youth CSC from remote areas. Crisis consultation may occur
via teleconference, tele-behavioral health (i.e., utilization of video and
computer equipment), and/or other method presented by CONTRACTOR
and deemed acceptable by the COUNTY.
8. Treatment Planning — Under the clinical direction of the mental health
clinician, the multi-disciplinary treatment team formed by the Youth Crisis
Stabilization staff shall provide the following services:
a. Mental Status Examination
b. Medical Evaluation
c. Full Clinical Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Youth Centered Treatment Planning
g. Aftercare Planning and Wellness Recovery Action Plan (WRAP)
9. Staffing
a. The staffing pattern for the crisis stabilization program shall meet all
current State licensing and regulatory requirements including medical
staff standards, nursing staff standards, social work and rehabilitation
staff requirements pursuant to Title 9, Division 1, Chapter 11, Article
3, Section 1840.348 of the California Code of Regulations (CCR) for
Crisis Stabilization services. All staff requiring federal/state licensure
or certification will be required to be licensed or certified in the State
of California and be in good standing with the state licensing or
certification board. CONTRACTOR shall remain up-to-date with all
Exodus Recovery, Inc. Page 3
Exhibit A-2
Page 4 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
current regulatory changes and adhere to all new and/or modified
requirements.
b. All facility staff who provide direct care or perform coding/billing
functions must meet the requirements of the FCMHP Compliance
Program. This includes the screening for excluded persons and
entities by accessing or querying the applicable licensing board(s),
the National Practitioner 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 annually thereafter. In addition, all licensed,
registered, waivered staff must complete a FCMHP Provider
Application and be credentialed by the FCMHP's Credentialing
Committee. All of CONTRACTOR's staff who will have direct contact
with the youth, shall have Department of Justice (DOJ), Federal
Bureau of Investigation (FBI), and Sheriff fingerprinting (Livescan)
executed.
c. Peer and/or family support staff will be an active and key member of
the multi-disciplinary team to assist with treatment planning,
mentoring, support and advocate with youth/families during their time
at the Youth CSC facility and will assist with discharge planning and
facilitate the individual's transition to the appropriate lower level of
care.
d. At the time of execution of this Agreement, the staffing requirements
defined by the CCR, Title 9, Section 1840.348 for the Youth CSC are
as follows:
(a) A physician shall be on call at all times for the provision of those
Crisis Stabilization Services that may only be provided by a physician.
(b) There shall be a minimum of one Registered Nurse, Psychiatric
Technician, or Licensed Vocational Nurse on site at all times
beneficiaries are present.
(c) At a minimum there shall be a ratio of at least one (1) licensed
mental health or waivered/registered professional on site for each
four (4) beneficiaries or other individuals receiving Crisis Stabilization
at any given time.
(d) If the youth is evaluated as needing service activities that can only
be provided by a specific type of licensed professional, such persons
shall be available.
(e) Other persons may be utilized by the program, according to need.
Exodus Recovery, Inc. Page 4
Exhibit A-2
Page 5 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
(f) If Crisis Stabilization services are co-located with other specialty
mental health services, persons providing Crisis Stabilization must be
separate and distinct from persons providing other services.
(g) Persons included in required Crisis Stabilization ratios and
minimums may not be counted toward meeting ratios and minimums
for other services.
e. CONTRACTOR shall submit daily staffing reports that identify all
direct service and support staff by first and last name, applicable
licensure/certifications, full time hours worked, and the
licensed/waivered/registered mental health professionals to youth
ratio.
10. Medical Records
a. CONTRACTOR shall maintain records in accordance with Exhibit E,
"Documentation Standards for Individual Medical Records." During
site visits, COUNTY shall be allowed to review records of services
provided, including the goals and objectives of the treatment plan,
and how the therapy provided is achieving the goals and objectives.
b. CONTRACTOR will be responsible for "release of information"
requests for the Youth CSC facility and shall adhere to applicable
federal and state regulations.
c. CONTRACTOR can develop and implement a medical records
system which meets all State and Federal requirement and clearly
documents medical necessity for both treatment and billing services.
Medical records shall be kept in such a manner as to comply with the
Fresno County Quality Improvement standards and Federal and State
quality standards. COUNTY has an electronic medical record system.
CONTRACTOR may elect to utilize and participate with the
COUNTY's electronic health record system if they do not have their
own system in place. It is anticipated that CONTRACTOR shall be
utilizing an electronic medical records system by the end of this
contract term.
11. Clinical Staff— CONTRACTOR's clinical staff shall be composed of all
licensed mental health or waivered/registered professionals as included in
CCR, Title 9, Division 1, Chapter 11, Article 3, Section 1840.348 (Crisis
Stabilization Staffing Requirements).
12. Medical Staff— The medical staff shall include a physician and a registered
nurse, psychiatric technician or licensed vocational nurse and any other
type of licensed professional needed to address youth needs pursuant to
CCR, Title 9, Division 1, Chapter 11, Article 3, Section 1840.348 (Crisis
Stabilization Staffing Requirements).
Exodus Recovery, Inc. Page 5
Exhibit A-2
Page 6 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
13. Pharmaceutical Services — CONTRACTOR shall provide for medication
services on an as needed basis and the staffing must reflect this availability
pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.338 (Crisis Stabilization Contact and Site Requirements) and all other
applicable federal/state regulations. The administration of a psychotropic
medication(s) to children and youth in the Foster Care System will adhere
to federal/state regulations, the requirements of pharmaceutical vendors
and the coordination with the Department of Social Services-Child Welfare
as it relates to the completion of forms, provision of information, etc.
14. Assessment of Physical Health and Medical Backup Services — Pursuant to
CCR, Title 9, Division 1, Chapter 11, Article 3, Section 1840.338 (Crisis
Stabilization Contact and Site Requirements), CONTRACTOR shall provide
admission history and physical examination, and maintain a written
agreement for medical services with one or more general acute care
hospitals.
15. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify the COUNTY of any admission of a
COUNTY youth within twenty-four (24) hours or the next business
day in a manner approved by the COUNTY. The notification method
shall be approved by the COUNTY.
b. CONTRACTOR shall be responsible to ensure that documentation in
the individual's medical record meets medical necessity criteria for
the hours of service submitted to COUNTY for reimbursement by
federal intermediaries, third-party payers and other responsible
parties.
c. CONTRACTOR shall enter all mental health data and billing
information into the COUNTY's electronic information system and will
be responsible for any and all audit exceptions pertaining to the
delivery of services.
d. CONTRACTOR shall submit a complete and accurate DHCS
Short/Doyle Medi-Cal Cost Report for each fiscal year ending June
30t" affected by the proposed agreement within 120 days following
the end of each fiscal year.
e. CONTRACTOR shall ensure that cost reports are prepared in
accordance with General Accepted Accounting Principles (GAAP)
and the standards set forth by the DHCS and the COUNTY.
16. Patients' Rights and Certification Review Hearings:
a. CONTRACTOR shall adopt and post in a conspicuous place a written
policy on individual's rights in accordance with section 70707 of Title
22 of the CCR and section 5325.1 of the W&IC and Title 42 Code of
Federal Regulations section 438.100.
Exodus Recovery, Inc. Page 6
Exhibit A-2
Page 7 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
b. CONTRACTOR shall allow access to COUNTY youth by the Patients'
Rights Advocate designated by the COUNTY.
17. Family Advocate - CONTRACTOR shall promote and allow individual
access to the Family Advocacy Services representative (Family Advocate)
who is contracted by the COUNTY to advocate and assist individuals,
families and support systems who are seeking or receiving mental health
services.
18. Grievances and Incident Reports
CONTRACTOR shall have all grievance forms readily available at the
Youth CSC facility.
CONTRACTOR shall log all grievances and the disposition of all grievances
received from a youth or their family in accordance with FCMHP policies
and procedures as indicated herein. CONTRACTOR shall provide a
summary of the grievance log entries concerning COUNTY-sponsored
individuals to the DBH Director, or designee, at monthly intervals, by the
fifteenth (15th) day of the following month, in a format that is mutually
agreed upon. CONTRACTOR shall post signs, provided by the COUNTY,
informing youth of their right to file a grievance and appeal.
CONTRACTOR shall notify COUNTY of all incidents or unusual
occurrences reportable to state licensing bodies that affect COUNTY
individuals within twenty-four (24) hours. CONTRACTOR shall use the
Incident Reporting system as indicated herein within Exhibit I for such
reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-
sponsored youth, CONTRACTOR shall provide County with the complaint
and CONTRACTOR's disposition of, or corrective action taken to resolve
the complaint or incident.
Within fifteen (15) days after CONTRACTOR submits a corrective action
plan to a California State licensing and/or accrediting body concerning any
sentinel event, as the term is defined by the licensing or accrediting agency,
and within fifteen (15) days after CONTRACTOR receives a corrective
action order from a California State licensing and/or accrediting body to
address a sentinel event, CONTRACTOR shall provide a summary of such
plans and orders to COUNTY.
19. Provide a safe and secure environment to provide for clinical and medical
assessment, diagnostic formulation, crisis intervention, medication
management, and clinical treatment for individuals with acute psychiatric
symptoms. This includes the manner in which seclusion and restraint will
be administered when necessary for the safety of the youth, other youth in
the program, and staff.
Exodus Recovery, Inc. Page 7
Exhibit A-2
Page 8 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
20. Provide the appropriate type and level of staffing to provide for a clinically
effective program design that adheres to State staffing requirements.
21. Provide staff training in the areas of non-violent crisis intervention,
evidence-based practice, best practice, or promising practices to ensure
staff are competent and proficient in the therapeutic interventions and
practices in serving youth accessing the Youth CSC.
22. CONTRACTOR shall utilize cost containment strategies for the provision of
stock and prescription medications to individuals(i.e., by contracting with a
pharmaceutical benefits management company) and provide the COUNTY
with the type of formulary utilized by the program as well as information
regarding co-pays and/or generic substitutions.
23. Provide an intensive treatment program which has individualized treatment
plans.
24. Stabilize the youth's acute psychiatric symptoms in the most expedient
manner possible while adhering to appropriate clinical care standards. This
may include initiating a Treatment Authorization Request (TAR) to the
pharmacy and providing justification when psychotropic medications are
needed on an emergency basis.
25. Effectively partner with other programs in the COUNTY and community
system (i.e., law enforcement, local emergency departments, etc.) in
accepting COUNTY youth for admission for crisis stabilization services.
26. Effectively partner with rural services providers (i.e., emergency
departments, etc.) to provide crisis stabilization services via teleconference,
tele-behavioral health (i.e., utilization of video and computer equipment),
and/or other method deemed acceptable by COUNTY.
27. Work collaboratively with the COUNTY and community resources in
discharge planning to ensure appropriate referral and direct linkage to
ongoing outpatient specialty mental health treatment services, substance
use disorder treatment services, etc. are provided. Discharge planning
would also include working collaboratively with out-of-county Mental Health
Plans to ensure youth in foster care who reside within Fresno County are
linked to appropriate ongoing specialty mental health services, substance
use disorder treatment services, etc. as appropriate.
28. Identify youth with frequent admissions during the fiscal year and develop
strategies with other COUNTY and community agencies to reduce
readmissions and improve an individual's overall well-being through
coordination of care.
Exodus Recovery, Inc. Page 8
Exhibit A-2
Page 9 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
29. Effectively interact with community agencies, other mental health programs
and providers, natural support systems, and families to assist clients to be
discharged to the appropriate level of care.
30. Integrate mental health and substance use disorder services. The
CONTRACTOR shall perform the following:
a. Develop a formal written Continuous Quality Improvement CQI action
plan to identify measurable objectives toward the achievement of co-
occurring disorders (COD) treatment capability that will be addressed by
the program during the contract period. These objectives should be
achievable and realistic for the program, based on a self-assessment
and the program priorities, but need to include attention to making
progress on the following issues, at minimum:
1 . Welcoming policies, practices, and procedures related to the
engagement of individuals with co-occurring issues and disorders;
2. Removal or reduction of access barriers to admission based on
co-occurring diagnosis or medication;
3. Improvement in routine integrated screening, and identification in
the data system of how many individuals served have co-occurring
issues;
4. Developing the goal of basic co-occurring competency for all
treatment and support staff, regardless of licensure or certification;
and
5. Documentation of coordination of care with collaborative mental
health and/or substance use disorder providers for each youth.
B. Regarding cultural and linguistic competence requirements, CONTRACTOR
shall:
1 . Ensure compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C.
Section 2000d, and 45 C.F.R. Part 80) and Executive Order 12250 of 1979
which prohibits recipients of federal financial assistance from discriminating
against persons based on race, color, national origin, sex, disability or
religion. This is interpreted to mean that a limited English proficient (LEP)
individual is entitled to equal access and participation in federally funded
programs through the provision of comprehensive and quality bilingual
services.
2. Create and maintain policies and procedures for ensuring access and
appropriate use of trained interpreters and material translation services for
all LEP youth, including, but not limited to, assessing the cultural and
linguistic needs of its youth, training of staff on the policies and procedures,
and monitoring its language assistance program. CONTRACTOR's
Exodus Recovery, Inc. Page 9
Exhibit A-2
Page 10 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
procedures must include ensuring compliance of any subcontracted
providers with these requirements.
3. Ensure that minors shall not be used as interpreters.
4. Conduct and submit to COUNTY an annual cultural and linguistic needs
assessment to promote the provision and utilization of appropriate services
for its diverse population. The needs assessment report shall include
findings and a plan outlining the proposed services to be improved or
implemented as a result of the assessment findings, with special attention
to addressing cultural and linguistic barriers and reducing racial, ethnic,
language, abilities, gender, and age disparities.
5. Develop internal systems to meet the cultural and linguistic needs of the
CONTRACTOR's census including the incorporation of cultural competency
in the CONTRACTOR's mission; establishing and maintaining a process to
evaluate and determine the need for special - administrative, clinical,
welcoming, billing, etc. - initiatives related to cultural competency.
6. Develop recruitment and retention initiatives to establish contracted
program staffing that is reflective and responsive to the needs of the
program and target population.
7. Establish designated staff person to coordinate and facilitate the integration
of cultural competency guidelines and attend COUNTY's DBH Cultural
Diversity Committee scheduled meetings. The designated person will
provide an array of communication tools to distribute information to staff
relating to cultural competency issues.
8. Keep abreast of evidence-based and best practices in cultural competency
in mental health care and treatment to ensure that the CONTRACTOR
maintains current information and an external perspective in its policies.
CONTRACTOR shall evaluate the effectiveness of strategies and programs
in improving the health status of cultural-defined populations.
9. Ensure that an assessment of a youth's sexual orientation is included in the
bio-psychosocial intake process. CONTRACTOR's staff shall assume that
the population served may not be in heterosexual relationships. Sensitivity
to gender and sexual orientation must be covered in annual training.
10. Utilize existing community supports, referrals to transgender support
groups, etc., when appropriate.
11. Attend annual Cultural Competence, Compliance, Health Insurance
Portability and Accountability Act (HIPAA), Billing, and Documentation
training provided by COUNTY's DBH.
Exodus Recovery, Inc. Page 10
Exhibit A-2
Page 11 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
12. Report its efforts to evaluation cultural and linguistic activities as part of the
CONTRACTOR's ongoing quality improvement efforts in the monthly
activities report. Reported information may include an individual's
complaints and grievances, any resulting actions regarding complaints and
grievances, results from persons served satisfaction surveys, and utilization
and other clinical data that may reveal health disparities as a result of
cultural and linguistic barriers.
C. Regarding direct admissions to the YOUTH CSC from COUNTY's DBH
programs or its contracted providers, CONTRACTOR agrees to the following:
1 . To allow direct admits from COUNTY's DBH programs or its contracted
providers when Youth CSC has the capacity to accept youth for services.
2. Said direct admits shall not require medical clearance, if youth would
otherwise meet the Central California Emergency Medical Services Agency
5150 Destination Policy requirements as mentioned herein below in
Subsection G. However, in the event a referred youth is known to possess
a contagious medical condition, said youth shall be medically cleared by a
local hospital prior to admission to the Youth CSC operated by
CONTRACTOR.
D. Regarding the provision of court testimony related to Youth CSC persons
served, CONTRACTOR agrees to the following:
CONTRACTOR's staff shall provide court testimony relevant to Youth CSC
persons served, when required.
E. Regarding placements of Youth in a Psychiatric Health Facility or other
inpatient level of care:
CONTRACTOR's staff shall locate and coordinate transfer for any youth
being treated at the Youth CSC who is in need of further services and
placement into a psychiatric health facility (PHF) or other appropriate acute
psychiatric inpatient facility. This includes working collaboratively with the
staff of the Youth PHF Subcontracted Provider to coordinate the transfer of
youth ages 12 to 17 to their Youth Psychiatric Health Facility.
CONTRACTOR acknowledges that transfer of youth may occur at all hours
of the day and agrees to attend promptly to the needs of the youth and will
conduct the transfer as soon as feasibly possible.
F. Regarding the placement of a youth at another designated facility:
1 . CONTRACTOR shall notify COUNTY DBH when a youth will remain at the
CSC for a period in excess of 24 hours, while awaiting placement and/or
Exodus Recovery, Inc. Page 11
Exhibit A-2
Page 12 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
transportation. COUNTY's Patients' Rights Advocate will be included in this
notification
2. CONTRACTOR shall provide the following services to youth who remain at
the CSC for a period in excess of 24 hours and who are awaiting placement
and/or transportation:
a. Three meal periods and three snack times per 24 hours
b. Daily encouragement and support with activities of daily living i.e.
showering, washing of clothes, teeth brushing, hair combing etc.
c. Daily psychiatric evaluation by both the provider and licensed nursing
staff to evaluate/determine the youth's most appropriate level of care
d. Daily medication evaluation, administration and education
e. Daily group activities (e.g., 12-Step Meetings, WRAP, Goals Group, etc.)
f. Daily one-on-one peer support provided by designated Peer Advocate
g. Daily activities such as meditation, art, entertainment and outdoor
activities provided in the outside courtyard
h. Daily education in relation to mental health diagnosis, treatments, and
community resources
G. Regarding the Central California Emergency Medical Services Agency
(CCEMSA) 5150 Destination Policy, CONTRACTOR agrees to the following:
CONTRACTOR agrees to follow the then-current Central California
Emergency Medical Services Agency 5150 Destination Policy #547 as
identified in Attachment A, attached hereto and incorporated herein. Said
policy may be updated periodically throughout the term of this Agreement;
CONTRACTOR must adhere to the most recent policies designated by the
CCEMSA 5150 Destination Policy.
H. CONTRACTOR shall participate in the following meetings:
1 . CONTRACTOR shall participate in periodic workgroup meetings
scheduled by staff from COUNTY's DBH Mental Health Contracted
Services Division. The meetings shall be held monthly, or as needed, to
discuss contract requirements, data reporting, outcomes measurement,
training, policies and procedures, and overall program operations.
2. CONTRACTOR's administrative level agency representative, who is duly
authorized to act on behalf of CONTRACTOR, shall attend regularly
scheduled monthly Behavioral Health Board meetings and its Children's
Services Committee.
3. CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider
Meetings, as scheduled by staff from COUNTY's Mental Health Contracted
Exodus Recovery, Inc. Page 12
Exhibit A-2
Page 13 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
Services Division, when deemed necessary by the DBH Director, or
designee.
4. CONTRACTOR may also be asked to make presentations in the
community about the program and services that are available
I. Regarding the development of policies and protocols:
CONTRACTOR and COUNTY's DBH shall collaborate on the development
of specific policies and protocols related to the daily operation of the Youth
CSC. Such policies will include, but not be limited to, the following:
placement of youth in psychiatric health facilities or other inpatient
programs either locally or outside the county, facility limitations, and
special populations. Such policies and protocols shall be mutually agreed
upon between CONTRACTOR and COUNTY's DBH Director, or designee.
Any changes to such policies and protocols shall be mutually agreed upon
between CONTRACTOR and COUNTY's DBH Director, or designee.
PROGRAM OUTCOMES
The Department of Behavioral Health is dedicated to supporting the wellness of
individuals, families and communities in Fresno County who are affected by, or at the
risk of, mental illness and/or substance use disorders through cultivation of strengths
toward promoting recovery in the least restrictive environment.
Five (5) Work Plans will be utilized to support DBH's mission statement. The work
plans were developed as a concept of a Transformation Plan that would encompass
system planning, implementation and oversight to be reflective of a comprehensive
system of care. These work plans are provided below and represent program goals
to be achieved by CONTRACTOR in addition to CONTRACTOR-developed
outcomes. DBH may adjust the outcome measurements needed under this program
periodically, so as to best measure the success of the youth and the program as
determined by the County.
CONTRACTOR will utilize a computerized tracking system with which outcome
measures and other relevant consumer data, such as demographics, will be
maintained.
1 . Behavioral Health Integrated Access — timeliness between referral to
admission, admission to treatment, and treatment to discharge; penetration
rate; effectiveness of discharge planning as demonstrated by referral and
linkage to other DBH programs, community providers, and other community
resources; and services that provide screening and access to ensure youth are
linked to the services they need, including mental health substance use
disorders and physical health services.
Exodus Recovery, Inc. Page 13
Exhibit A-2
Page 14 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
2. Wellness, Recovery, and Resiliency Supports — collaborative approach to
treatment strategies to reduce readmission of consumers with frequent
admissions to the facility; effectiveness of services as demonstrated by the
number of consumers who are able to be discharged to the community and
avoid inpatient hospitalization; measurement of recidivism rates, including
measuring percentage of recidivism within thirty (30) days. State the Evidence
Based Practices (EBP) that shall be used.
3. Cultural/Community Defined Practices — services or philosophical practices
which support the unique cultural-specific needs of individuals receiving care.
Focus on behavioral health practices which reflect the unique needs of various
cultures and communities who reside within Fresno County.
4. Behavioral Health Clinical Care — services where direct therapeutic treatment
is provided. Include the framework of "Levels of Care" where the youth's
needs, as identified through assessment/screening, are matched with a
complexity and intensity of services meets those needs.
5. Infrastructure Supports — includes all personnel, equipment, programs, and
facilities which exist to support the delivery of care to the youth served.
Includes safety, quality improvement and regulatory compliance functions,
along with outcome assessment/program evaluation, training, and technology.
6. Denial rate for Crisis Stabilization billing will be decreased by five percent (5%)
within the first six (6) months, based on previous program denial rates. Rates
will be determined by the utilization review performed by FCMHP.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Perform a utilization review, annually at a minimum, (through its FCMHP) of ten
percent (10%) of all admissions to determine that the documentation
demonstrates that medical necessity criteria as defined by the DHCS were met
throughout the duration of the crisis stabilization episode. The FCMHP will
maintain discretion regarding possible subsequent utilization review beyond ten
percent (10%), as necessary.
2. Provide oversight of the CONTRACTOR's Youth CSC program. In addition to
contract monitoring of program(s), oversight includes, but is not limited to,
coordination with the DHCS in regard to program administration and outcomes.
3. Assist the 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.
Exodus Recovery, Inc. Page 14
Exhibit A-2
Page 15 of 15
CRISIS STABILIZATION CENTER COUNTY OF FRESNO
4. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the CONTRACTOR staff and will be available to the
CONTRACTOR for ongoing consultation.
5. 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, youth and staff interviews, chart reviews, and other methods of
obtaining required information.
6. 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, DBH shall provide the following at no cost to
CONTRACTOR:
A. 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).
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, and queer (LGBTQ+) 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.
B. 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.
Exodus Recovery, Inc. Page 15
Attachment A
CENTRAL CALIFORNIA EMERGENCY Page 1 of 9
MEDICAL SERVICES
A Division of the Fresno County Department of Public Health
Manual Policy
Emergency Medical Services Number 547
Administrative Policies and Procedures
Page 1 of 9
Subject Patient Destination
References Title 13, Section 1106 of the California Code of Regulations Effective:
Title 22, Division 9, Chapter 7 of the California Code of Regulations 04/18/83
I. POLICY
Patients of the Prehospital EMS System shall be transported to an appropriately staffed and equipped hospital.
II. MEDICAL PATIENT DESTINATION
A. Medical Patients shall be transported to the appropriate destination in accordance with the following chart:
Fresno County Kings County Madera County Tulare County
Medical—Adult
Non-emergent Patient's Choice Patient's Choice Patient's Choice Patient's Choice
Life-threatening Closest Appropriate Closest Appropriate Closest Appropriate Closest Appropriate
Regional Medical Kaweah Health Medical Regional Medical Kaweah Health Medical
Acute current of injury Center or St.Agnes Center or Regional Center or St.Agnes Center or Regional
(acute MI) Medical Center Medical Center Medical Center Medical Center
(Quickest travel time) (Quickest travel time) (Quickest travel time) (Quickest travel time)
Medical—Pediatric(14 years or younger)
Stable Patient/Family Choice Patient/Family Choice Patient/Family Choice Patient/Family Choice
Kaweah Health Medical
RMC or VCH*** RMC or VCH * * RMC or VCH *** Center or
Unstable (Quickest travel time) (Quickest travel time) (Quickest travel time) Sierra View District
Hospital
(Quickest travel time)
5150 patients
CSC or Patient's Choice
5150-Adult within Fresno County Patient's Choice within Patient's Choice within Patient's Choice within
(See criteria on page 4) Kings County Madera County Tulare County
YCSU or Patient/Family
5150—Children (<18 Choice within Fresno Patient/Family Choice Patient/Family Choice Patient/Family Choice
yrs) County within Kings County within Madera County within Tulare County
(See criteria on page 4)
Kaiser Kaiser N/A N/A N/A
Veteran's Administration Veteran's Administration N/A N/A N/A
*** If transport time is greater than 60 minutes, base hospital contact shall be made to determine appropriate destination.
Approved By Daniel J. Lynch Revision
EMS Division Manager (Signature on File at EMS Agency 3/14/2022
Jim Andrews, M.D.
EMS Medical Director (Signature on File at EMS Agency)
Attachment A
Page 2 of 9
B. Medical Patient Destination —Considerations
1. In a non-emergent situation (as determined by the EMT or Paramedic at the scene and/or the
Base Hospital Physician/MICN giving medical direction), the patient will be taken to the receiving
hospital of his/her choice. If the patient is unable to determine this, the hospital designated by the
private physician and/or patient's family member will be utilized. Paramedics and EMTs should
determine where the patient normally receives their medical care and encourage the patient to
return to that hospital for medical care as long as the patient's medical condition allows for such
transport.
2. The Paramedic/EMT/MICN/BHP should only provide the patient with alternatives for destination
of patient choice. It is inappropriate for the Paramedic/EMT/MICN/BHP to endorse specific
facilities or provide personal opinion on the quality of local facilities.
3. Health Plans - If the patient is a member of a health plan with a preferred hospital, an attempt
should be made to transport the patient to a participating facility.
4. Closest Appropriate Hospital
a. The closest appropriate hospital is defined as the closest emergency department
"equipped, staffed, and prepared to administer care appropriate to the needs of the
patient" (California Code of Regulations, Title 13, Section 1106 (b) 2).
b. Closest is defined as the shortest travel time not necessarily the closest by distance.
C. The Base Hospital Physician will have the ultimate authority for patient destination.
d. The closest appropriate hospital does not mean that critically ill patients always go to the
closest"receiving" hospital. They go to the closest"appropriate" hospital. The following
guidelines will help to define "appropriate":
1) Due to short transport times, the appropriate receiving facility for a life-
threatening medical situation would be a hospital with a basic emergency service
(holds a special services permit from the California State Department of Health
Services). Hospitals with basic emergency services are:
a) Adventist Health Hanford (AH-H)
b) Adventist Health Tulare (AH-T)
c) Clovis Community Medical Center(CCMC)
d) Kaiser Permanente Hospital (KPH)
e) Kaweah Health Medical Center(KHMC)
f) Madera Community Hospital (MCH)
g) Regional Medical Center(RMC)
h) Saint Agnes Medical Center(SAMC)
i) Sierra View District Hospital (SVDH)
j) Valley Children's Hospital (VCH)
2) Rural Areas - Due to prolonged travel times to the urban area, the appropriate
receiving hospital for a life-threatening medical situation would be a hospital with
a standby emergency service (holds a special services permit from the California
State Department of Health Services). Hospitals with stand-by emergency
services that are approved to receive ambulances are:
a) Adventist Health Reedley (AH-R)
b) Adventist Health Selma (AH-S)
c) Coalinga Regional Medical Center(CRMC)
Attachment A
Page 3 of 9
5. Acute Cardiac Emergency
In the event of an acute current of injury, transport should be to a designated cardiac center,
which has 24/7 interventional heart catheterization capabilities. The following is a list of readings
from various cardiac monitors that would require transport to a designated cardiac center:
• ***ACUTE MI *** (Zoll Monitor E Series)
• ***STEMI*** (Zoll Monitor X Series))
• ***ACUTE MI SUSPECTED*** (Physio-Control Monitor LifePak 12)
• ***MEETS ST ELEVATION MI CRITERIA*** (Physio-Control Monitor LifePak 15)
The designated cardiac centers in the CCEMSA region are:
• Regional Medical Center
• Kaweah Health Medical Center
• Saint Agnes Medical Center
Transport shall be to the cardiac center that has the quickest transport time if transport time is
less than 60 minutes. If transport time is greater than 60 minutes, then transport to the closest
appropriate facility or consider helicopter rendezvous. Destination is determined by:
a. Interpretation of 12-lead ECG; or
b. Base Hospital consultation if required.
6. Patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an advanced airway or
OPA, this is not an unstable airway.
b. Any patient with CPR in progress.
C. Any critically ill or unstable patient when Base Hospital contact is not possible (i.e.,
Paramedic or EMT must make the ultimate destination decision).
7. Patients who go to a non-receiving hospital:
Patients may be transported to a non-receiving hospital only when the Base Hospital has
contacted the receiving doctor and received assurance of immediate acceptance of the patient.
Such assurance should then be documented on the Base Hospital run form.
8. Patients who go to a receiving hospital, which is not closest:
Unstable patients who request this hospital and, in the opinion of the Base Hospital Physician,
the extra travel time is not dangerous to the patient
Attachment A
Page 4 of 9
C. Fresno County 5150 Holds—Considerations
1. Fresno County 5150 patient criteria for transport Crisis Stabilization Center(CSC)Youth Crisis
Stabilization Unit(YCSU):
a. If the patient meets the following criteria, he/she shall be transported directly to Crisis
Stabilization Center(CSC) if age 18 or greater; or the Youth Crisis Stabilization Unit
(YCSU) if under 18 years of age:
• No urgent medical complaint or evidence of acute medical/surgical/trauma problem
requiring urgent treatment prior to psychotic admission.
• No alteration in mental status due to dementia or delirium.
• Glasgow Coma Score 14 or 15.
• Complete vital signs within limits (HR, RR, BP and GCS).
• Not febrile to palpation/measurement.
• Under the influence of alcohol or drugs, patient can walk without assistance and is
able to follow verbal commands (does not apply to YCSU).
1) Adults:
a) Pulse: 50-120 bpm
b) Systolic Blood Pressure: 100-180 mm Hg
c) Diastolic Blood Pressure: less than 120 mm Hg
d) Respiratory Rate: 12-30
2) Pediatrics:
a) Vital signs appropriate for children (policy 530.32).
NOTE: Refer to the Criteria for Transporting a Fresno County 5150 Patient Directly to
Crisis Stabilization Center(CSC)or Youth Crisis Stabilization Unit(YCSU)
Screening Form attached to this policy.
Patients that Crisis Stabilization Center(CSC) and Youth Crisis Stabilization Unit (YCSU)
cannot accept:
• Patients with dementia or delirium.
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use,
catheters, wired devices, etc.).
• Patients in wheelchairs that cannot move independently.
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires
anything more that once daily dry gauze and tape dressing.
b. All other patients on a 5150 hold in Fresno County not meeting the above criteria will be
transported to Patient/Family Choice within Fresno County.
C. Patients placed on a 5150 hold are to be transported to facilities within the county where
the 5150 hold was initiated.
d. The 5150 destination policy does not apply to psychiatric patients who are voluntarily
requesting evaluation (not on a 5150 hold). If the patient is not on a 5150 hold, then
transport will be to a receiving facility of their choice, which includes CSC or YCSU
(Fresno County only) if patient meets criteria within this policy.
e. Kaiser Permanente patients on a 5150 hold are to be transported to that facility.
f. Veteran's Administration patients on a 5150 hold are to be transported to that facility.
Attachment A
Page 5 of 9
D. Veteran's Administration
1. The Veteran's Administration emergency department will accept all patients with a Veterans
Administration (VA) Identification Card or active-duty Department of Defense (DOD) Card (Patient
Name Only, no dependent(s). Name of patient on card must be the patient requesting transport).
No prior approval or Base Hospital contact is necessary. If the patient requests transport to
Veterans Administration emergency department and does not have the identification noted
above, contact the VA Emergency Department directly for prior approval before the patient is
transported. The complete name and the full social security number will be required. Contact the
Veteran's Administration on Med 6 or 241-3600.
2. Patients that cannot be transported directly to the Veteran's Administration are:
• Cardiac arrest due to trauma
• Pediatric cardiac arrest
• Trauma Center Triage Criteria
• OB patient in active labor
• Gynecological complaints and known obvious pregnancy with vaginal bleeding
• ST-segment elevation myocardial infarction (STEMI)
NOTE: INTERFACILITY TRANSPORTS ARE NOT MANAGED THROUGH THIS PROCEDURE.
III. TRAUMA PATIENT DESTINATION
A. Trauma patients shall be transported to the appropriate closet facility in accordance with the following chart:
0 F-5,
ss Physiological Criteria
ystolic Blood Pressure:
o Adults: <90 mm Hg
o Pediatrics: <80 mm Hg with signs
and symptoms of shock(Refer to EMS
Policy 530.32 for estimated weight
formulas or use Broselow Tape)
• Respiratory Rate:
o Adults: <10 or>30 RMC or KHMC
o Children: <20 if under age 1 _P1 VCH(14 years or age or less)
•Glasgow Coma Score<13(or,in patients whose L (Consider air transport)
normal GCS is less than 15,or a decrease of two
or more of the patients GCS score)
• Penetrating injury to the head
• Paraplegia
• Quadriplegia
Assess Anatomy of Injury
• Penetrating injuries to neck or torso RMC or KHMC
• Flail chest VCH(14 years or age or less)
• Two or more proximal long-bone fractures (Consider air transport)
• Amputation proximal to wrist or ankle 00
TRAUMA DESTINATION CHART
Attachment A
Page 6 of 9
Assess Burns
F
RAUMA PATIENTS WITH:
rtial/Full thickness burns>10%TBSA
• Partial/Full thickness circumferential burns RMC
• Partial/Full thickness burns to face,hands,feet, IRWIN 1 11 (Consider air transport)
major joints,perineum,or genitals
• Electrical burns with voltage>120 volts
• Chemical burns>10%TBSA
Assess Mechanism of Injury
• Falls
o Adults: >20 ft.(one story=10 ft.) RMC or KHMC
o Children: >10 ft.or 3 times height of the VCH(14 years of age or less)
child (Consider air transport)
Assess Special Considerations
WITH A SIGNIFICANT COMPLAINT:
• Age greater than 55 years
• Anticoagulation or bleeding disorders Consider transport to
• Pregnancy greater than 20 weeks RMC or KHMC
• Auto vs.Pedestrian>20 mph VCH(14 years of age or less)
• Motorcycle crash>20 mph
Paramedic/Flight Nurse Judgment
Consider RMC or KHMC
WITH A SIGNIFICANT COMPLAINT VCH(14 years of age or less)
Base Hospital Consultation
SIGNIFICANT COMPLAINT
Transport According to Policy
Perseveration
Deteriorating mental status
Severe chest pain
Severe shortness of breath
Severe abdominal pain
Sustained,overwhelming"Feeling of Doom"
Attachment A
Page 7 of 9
NOTE: If transport time is greater than 60 minutes for patients meeting trauma triage criteria, base
hospital contact shall be made to determine appropriate destination.
NOTE: If transport time is greater than 2 hours for patients meeting burn triage criteria, base hospital
contact shall be made to determine appropriate destination.
B. Triage Criteria
Triage criteria will determine if the patient will be transported to a trauma center or closest receiving
hospital.
C. Trauma Patient Destination —Considerations
1. If the patient is in cardiac arrest from penetrating trauma in the greater Fresno or Visalia
metropolitan area, the patient should be transported to Regional Medical Center, Kaweah Health
Medical Center or Valley Children's Hospital, bypassing a closer receiving facility. However, if the
transport time to Regional Medical Center, Kaweah Health Medical Center, or Valley Children's
Hospital is greater than ten (10) minutes, then transport should be to the closest receiving facility
within ten minutes transport time (Refer to EMS Policy#550).
2. Trauma patients, meeting trauma center criteria, who have a transport time greater than 60
minutes to the trauma center, will require base hospital contact for destination decision.
3. The following types of incidents should be consideration for transport to the designated Trauma
Center, based upon paramedic judgment:
a. Motorcycle Crash - Non-ambulatory with potential of significant injuries
b. Auto versus Pedestrian - Non-ambulatory with potential of significant injuries
NOTE:Paramedic judgment is based upon the paramedic's own knowledge and experience to determine
if the patient's condition would require transport to a designated Trauma Center due the mechanism of
injury and potential underlying injuries. The Paramedic may contact a Base Hospital for advice on
destination.
4. Transport of Trauma Patients by Helicopter
A trauma patient should not be transported by helicopter unless they meet trauma triage criteria
to be transported to a trauma center or the patient is inaccessible by ambulance (i.e., wilderness
transports). EXCEPTION: When the paramedic feels helicopter transport of the patient would be
beneficial to the outcome of the patient.
5. Burn Patients
The following patients should be transported directly to the Regional Burn Center(Regional
Medical Center) bypassing other hospitals if ETA to Regional Medical Center is within two hours.
a. Patients with 20(partial thickness) or 30(full thickness) burns that are more than 10%
total body surface area
b. Patients with 20(partial thickness) or 31, (full thickness) circumferential burns of any body
part
C. Patients with 20(partial thickness) or 30(full thickness) burns to face, hands, feet, major
joints, perineum, or genitals
d. Electrical burns with voltage greater than 120 volts
e. Patients with chemical burns greater than 10% total body surface area.
Attachment A
Page 8 of 9
6. Carbon Monoxide Poisoning - Early call-ins to Regional Medical Center should be made for
patients that appear to have significant exposure to carbon monoxide poisoning (altered mental
status, vomiting, and headaches).
7. Trauma patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an ET Tube or OPA,
this is not an unstable airway.
b. Any patient with CPR in progress (refer to EMS Policy#550).
C. Any critically injured or unstable patient when Base Hospital contact is not possible
(i.e., Paramedic or EMT must make the ultimate destination decision).
IV. PATIENTS WHO REFUSE TRANSPORT TO THE APPROPRIATE HOSPITAL
A Base Hospital shall be contacted for the purpose of physician consultation on patients who meet one or more of
the triage criteria and refuse transport to the appropriate hospital. This will usually not be a problem with the
acutely ill patient. However, some patients with normal mental status may wish to be transported to a different
hospital than the one selected via the triage criteria. These situations should be treated as "Refusal of Medical
Care and/or Transportation" situation (refer to EMS Policy#546). The Base Hospital Physician, after radio
contact, may allow the patient to go to the destination of their choice, have a "Refusal of Medical Care and/or
Transportation " signed or insist on transport to the designated hospital.
V. SPECIAL CONSIDERATION FOR FRESNO HEART & SURGICAL HOSPITAL DESTINATION
While the Fresno Heart& Surgical Hospital is a hospital within Central California EMS Region, it does not have
an emergency department and is not an approved facility for patient transports within EMS Policy and
Procedures. Patients who are requesting transport to the Fresno Heart& Surgical Hospital from the prehospital
setting will require Base Hospital contact to confirm acceptance. Since the Fresno Heart & Surgical Hospital is
under the Community Medical Center organization, EMS personnel should contact Regional Medical Center
when requesting transport to the Fresno Heart & Surgical Hospital. If attempts to contact Regional Medical
Center are unsuccessful, EMS personnel should contact another Base Hospital. Interfacility transfers involving
the Fresno Heart& Surgical Hospital shall be in accordance with EMS Policy#553, "ALS Interfacility
Transports".
Attachment A
Page 9 of 9
Central California EMS Agency
Criteria for Transporting a Fresno County 5150/Psychiatric Patient
Directly to CSC or YCSU Screening Form
Patient's Name: EMS#:
Patient has urgent medical complaint or evidence of acute medical/surgical problem.
[] True—transport Patient/Family Choice [] False
Patient has alteration in mental status due to dementia or delirium.
[] True—transport Patient/Family Choice [] False
Patient has a Glasgow Coma Score 13 or less.
[] True—transport Patient/Family Choice [] False
There are lacerations with a gap of greater than 2 mm or fat/muscle visible in the wound (excludes any
type of stab wound).
[] True—transport Patient/Family Choice [] False
There are lacerations or wounds inflicted by others.
[] True—transport Patient/Family Choice [] False
Complete vital signs are within limits:
Adults:
Pulse outside range of 50-120. [] True—transport Patient/Family Choice [] False
Systolic Blood Pressure outside range of 100-180. [] True—transport Patient/Family Choice [] False
Diastolic Blood Pressure greater than 120. [] True—transport PatienVFamily Choice [] False
Respiratory Rate outside range of 12-30. [] True—transport PatienVFamily Choice [] False
Pediatrics:
Vital signs inappropriate for children
(Policy 530.32) [] True—transport PatienVFamily Choice [] False
Patient is febrile to palpation/measurement.
[] True—transport Patient/Family Choice [] False
Is patient under the influence of alcohol or drugs?
[] Yes No
If yes, to under the influence of alcohol or drugs, does patient require assistance to walk?
[] True—transport PatienVFamily Choice [] False
If all of the above answers are False, patient may be transported to CSC/YCSU; otherwise, transport is
Patient/ Family Choice.
Patients that Crisis Stabilization Center(CSC) or Youth Crisis Stabilization Unit (YCSU) cannot accept:
• Patients with dementia or delirium
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use, catheters,
wired devices, etc.)
• Patients in wheelchairs that cannot move independently
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires anything more
than once daily dry gauze and tape dressing
Exhibit B
Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
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
Page 2 of 4
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
Page 3 of 4
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
Page 4 of 4
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-1
Page 1 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.71 $ 109,687 $ 109,687
1102 Assistant Program Director 0.71 91,418 91,418
1103 Admin Clerk 0.14 6,084 6,084
1104 Health Information Specialist 2.13 104,956 104,956
1105 Health Information Specialist(Supervisor) 0.36 21,295 21,295
1106 Program Support Assistant 0.78 33,464 33,464
1107 Quality Improvement Director 0.71 74,534 74,534
1108 Senior Data Specialist 0.71 27,380 27,380
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 6.25 $ 468,818 $ 468,818
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 1.19 $ 38,104 $ 38,104
1117 Discharge Planner 0.14 8,214 8,214
1118 Social Services Coordinator 2.70 219,024 219,024
1119 Program Nurse(LVN/LPTN) 15.98 1,842,209 1,842,209
1120 Program Nurse(RN) 11.93 2,031,587 2,031,587
1121 Mental Health Worker 19.88 1,433,184 1,433,184
1122 Clinical Services Supervisor 0.71 63,900 63,900
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 52.53 $ 5,636,222 $ 5,636,222
Admin Program Total
Direct Personnel Salaries Subtotal 58.78 $ 468,818 $ 5,636,222 $ 6,105,040
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 61,778 $ 61,778
1202 Worker's Compensation 247,114 247,114
1203 Health Insurance 444,805 444,805
1204 Admin Fee 61,778 - 61,778
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 815,475 $ - $ 815,475
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 383,026 $ $ 383,026
1302 FICA/MEDICARE 383,026 383,026
1303 SUI 210,046 210,046
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 976,098 $ $ 976,098
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,260,391 $ 5,636,222 $ 7,896,613
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
29% 71%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Flealth Cont-act Budget Nairetive Revised 2/7/2020
Exhibit C-1
Page 2 of 45
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 4,851
2004 Clothing,Food,&Hygiene 128,513
2005 Education Support
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946
2009 Program Supplies-Medical 94,656
2010 Utility Vouchers -
2011 Laundry Service 40,401
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 284,367
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 44,242
3002 Printing/Postage 1,807
3003 Office,Household&Program Supplies 109,346
3004 Advertising -
3005 Staff Development&Training 24,884
3006 Staff Mileage 5,301
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 2,428
3010 Personnel/Contracted Parking/Parking 2,397,688
3011 Flex Funds 72,418
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 2,658,114
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 36,021
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067
4004 Rent/Lease Vehicles -
4005 Security 1,406,528
4006 Utilities 40,968
4007 Janitorial 124,130
4008 Business Taxes/License Permits 10,510
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 1,671,224
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788
5005 Other(specify) -
5006 1 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 2,788
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 28,430
6003 Accounting/Bookkeeping 710
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(indirect Salanes&Benefits) -
6009 Indirect Costs $ 1,880,263
6010 Other(specify)
6011 Other(specify) -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 3 of 45
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 1,909,403
INDIRECT COST RATE 15.24%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 9,206
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 16,306
TOTAL PROGRAM EXPENSES $ 14,438,815
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 104,785 170.00 17,813,416
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 104,7851 $ 17,813,416
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 14,250,733
Federal Financial Participation(FFP)%1 53% 7,567,139
MEDI-CAL FFP TOTAL $ 7,567,139
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 6,742,659
REALIGNMENT TOTAL $ 6,742,659
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 129,017
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 129,0171
TOTAL PROGRAM FUNDING SOURCES: $ 14,438,815
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 4 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
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 Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
LEI
Total 300.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 5 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 6 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 7 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2022-23 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 7,896,613
Administrative Positions 468,818
1101 Program Director 109,687 Administrative Services 0.71 FTE
1102 Assistant Program Director 91,418 Administrative Services 0.71 FTE
1103 Admin Clerk 6,084 Administrative Services 0.14 FTE
1104 Health Information Specialist 104,956 Administrative Services 2.13 FTE
1105 Health Information Specialist(Supervisor) 21,295 Administrative Services 0.36 FTE
1106 Program Support Assistant 33,464 Administrative Services 0.78 FTE
1107 Quality Improvement Director 74,534 lAdministrative Services 0.71 FTE
1108 Senior Data Specialist 27,380 Administrative Services 0.71 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 5,636,222
1116 Peer Advocate 38,104 Direct Services 1.19 FTE
1117 Discharge Planner 8,214 Direct Services 0.14 FTE
1118 Social Services Coordinator 219,024 Direct Services 2.70 FTE
1119 Program Nurse(LVN/LPTN) 1,842,209 Direct Services 15.98 FTE
1120 Program Nurse(RN) 2,031,587 Direct Services 11.93 FTE
1121 Mental Health Worker 1,433,184 Direct Services 19.88 FTE
1122 Clinical Services Supervisor 63,900 Direct Services 0.71 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits
1201 Retirement 61,778
1202 Worker's Compensation 247,114
1203 Health Insurance 444,805
1204 Admin Fee 61,778
1205 Other(specify) -
1206 Other(specify)
Direct Payroll Taxes&Expenses: 976,098
1301 OASDI 383,026
1302 FICA/MEDICARE 383,026
1303 SUI 210,046
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 284,367
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 4,851 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 128,513 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946 Client Medication
2009 Program Supplies-Medical 94,656 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 40,401 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 8 of 45
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 2,658,114
3001 Telecommunications 44,242 Program Telephone and Internet
3002 Printing/Postage 1,807 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 109,346 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 24,884 Staff Training Cost
3006 Staff Mileage 5,301 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 2,428 Legal Fees
3010 Personnel/Contracted Parking/Parking 2,397,688 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 72,418 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 1,671,224
4001 Building Maintenance 36,021 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 1,406,528 Security Personnel
4006 Utilities 40,968 Facility Utility
4007 Janitorial 124,130 Facility Janitorial
4008 Business Taxes/License Permits 10,510 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 2,788
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 1,909,403
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 1,880,263 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 16,306
7001 Computer Equipment&Software 9,206 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,100 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioral Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit C-1
Page 9 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 14,438,815
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 14,438,815
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 10 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Program Director 0.71 $ 112,977 $ 112,977
1102 Assistant Program Director 0.71 94,161 94,161
1103 Admin Clerk 0.14 6,267 6,267
1104 Health Information Specialist 2.13 108,105 108,105
1105 Health Information Specialist(Supervisor) 0.36 21,934 21,934
1106 Program Support Assistant 0.78 34,468 34,468
1107 Quality Improvement Director 0.71 76,770 76,770
1108 Senior Data Specialist 0.71 28,201 28,201
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 6.25 $ 482,883 $ 482,883
Acct# Program Position FTE Admin Program Total
1116 Peer Advocate 1.19 $ 39,247 $ 39,247
1117 Discharge Planner 0.14 8,460 8,460
1118 Social Services Coordinator 2.70 225,595 225,595
1119 Program Nurse(LVN/LPTN) 15.98 1,897,475 1,897,475
1120 Program Nurse(RN) 11.93 2,092,534 2,092,534
1121 Mental Health Worker 19.88 1,476,180 1,476,180
1122 Clinical Services Supervisor 0.71 65,817 65,817
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 52.53 1 $ 5,805,308 1 $ 5,805,308
Admin Program Total
Direct Personnel Salaries Subtotal 58.78 $ 482,883 $ 5,805,308 $ 6,288,191
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 63,632 $ $ 63,632
1202 Worker's Compensation 254,527 254,527
1203 Health Insurance 458,149 458,149
1204 Admin Fee 63,632 63,632
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 839,940 $ - $ 839,940
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 394,516 $ $ 394,516
1302 FICA/MEDICARE 394,516 394,516
1303 SUI 216,348 216,348
1304 Other(specify) -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 1,005,380 $ $ 1,005,380
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,328,203 $ 5,805,308 $ 8,133,511
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
29% 71%
2000:DIRECT CLIENT SUPPORT
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 11 of 45
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 4,851
2004 Clothing,Food,&Hygiene 128,513
2005 Education Support
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946
2009 Program Supplies-Medical 94,656
2010 Utility Vouchers -
2011 Laundry Service 40,401
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 284,367
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 44,242
3002 Printing/Postage 1,807
3003 Office,Household&Program Supplies 109,346
3004 Advertising -
3005 Staff Development&Training 24,884
3006 1 Staff Mileage 5,301
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 2,428
3010 Personnel/Contracted Parking/Parking 2,397,688
3011 Flex Funds 72,418
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 2,658,114
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 36,021
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067
4004 Rent/Lease Vehicles
4005 Security 1,406,528
4006 Utilities 40,968
4007 Janitorial 124,130
4008 Business Taxes/License Permits 10,510
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 1,671,224
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 2,788
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 2,788
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 28,430
6003 Accounting/Bookkeeping 710
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Costs $ 1,915,712
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 12 of 45
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 1,944,852
INDIRECT COST RATE 15.23%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 9,206
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 16,306
TOTAL PROGRAM EXPENSES $ 14,711,162
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 101,676 170.00 17,285,003
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 101,6761 $ 17,285,003
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 13,828,002
Federal Financial Participation(FFP)%1 53% 7,342,669
MEDI-CAL FFP TOTAL $ 7,342,669
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 7,237,043
REALIGNMENT TOTAL $ 7,237,043
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 131,450
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 131,450)
TOTAL PROGRAM FUNDING SOURCES: $ 14,711,162
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 13 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
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%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno
Adult Crisis Stabilization Center/Fresno
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 14 of 45
Tota 1 0.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno
Adult Crisis Stabilization Center/Fresno
Total 0.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 15 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 16 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 8,133,511
Administrative Positions 482,883
1101 Program Director 112,977 Administrative Services 0.71 FTE
1102 Assistant Program Director 94,161 Administrative Services 0.71 FTE
1103 Admin Clerk 6,267 Administrative Services 0.14 FTE
1104 Health Information Specialist 108,105 Administrative Services 2.13 FTE
1105 Health Information Specialist(Supervisor) 21,934 Administrative Services 0.36 FTE
1106 Program Support Assistant 34,468 Administrative Services 0.78 FTE
1107 Quality Improvement Director 76,770 lAdministrative Services 0.71 FTE
1108 Senior Data Specialist 28,201 Administrative Services 0.71 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 5,805,308
1116 Peer Advocate 39,247 Direct Services 1.19 FTE
1117 Discharge Planner 8,460 Direct Services 0.14 FTE
1118 Social Services Coordinator 225,595 Direct Services 2.70 FTE
1119 Program Nurse(LVN/LPTN) 1,897,475 Direct Services 15.98 FTE
1120 Program Nurse(RN) 2,092,534 Direct Services 11.93 FTE
1121 Mental Health Worker 1,476,180 Direct Services 19.88 FTE
1122 Clinical Services Supervisor 65,817 Direct Services 0.71 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 839,940
1201 Retirement 63,632
1202 Worker's Compensation 254,527
1203 Health Insurance 458,149
1204 Admin Fee 63,632
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 1,005,380
1301 OASDI 394,516
1302 FICA/MEDICARE 394,516
1303 SUI 216,348
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 284,367
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 4,851 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 128,513 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946 Client Medication
2009 Program Supplies-Medical 94,656 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 40,401 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 17 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 2,658,114
3001 Telecommunications 44,242 Program Telephone and Internet
3002 Printing/Postage 1,807 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 109,346 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 24,884 Staff Training Cost
3006 Staff Mileage 5,301 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 2,428 Legal Fees
3010 Personnel/Contracted Parking/Parking 2,397,688 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 72,418 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 1,671,224
4001 Building Maintenance 36,021 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 1,406,528 Security Personnel
4006 Utilities 40,968 Facility Utility
4007 Janitorial 124,130 Facility Janitorial
4008 Business Taxes/License Permits 10,510 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 2,788
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 1,944,852
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 1,915,712 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 16,306
7001 Computer Equipment&Software 9,206 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,100 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioml Health Contract BudgetMnative Revised 2/7/2020
Exhibit C-1
Page 18 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 14,711,162
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 14,711,162
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 19 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.71 $ 116,367 $ 116,367
1102 Assistant Program Director 0.71 96,986 96,986
1103 Admin Clerk 0.14 6,455 6,455
1104 Health Information Specialist 2.13 111,348 111,348
1105 Health Information Specialist(Supervisor) 0.36 22,592 22,592
1106 Program Support Assistant 0.78 35,502 35,502
1107 Quality Improvement Director 0.71 79,073 79,073
1108 Senior Data Specialist 0.71 29,047 29,047
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 6.25 $ 497,370 $ 497,370
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 1.19 $ 40,424 $ 40,424
1117 Discharge Planner 0.14 8,714 8,714
1118 Social Services Coordinator 2.70 232,363 232,363
1119 Program Nurse(LVN/LPTN) 15.98 1,954,400 1,954,400
1120 Program Nurse(RN) 11.93 2,155,310 2,155,310
1121 Mental Health Worker 19.88 1,520,465 1,520,465
1122 Clinical Services Supervisor 0.71 67,792 67,792
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 52.53 $ 5,979,468 $ 5,979,468
Admin Program Total
Direct Personnel Salaries Subtotal 58.78 $ 497,370 $ 5,979,468 $ 6,476,838
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 65,541 $ $ 65,541
1202 Worker's Compensation 262,163 262,163
1203 Health Insurance 471,893 471,893
1204 Admin Fee 65,541 65,541
1205 Other(specify) -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 865,138 $ - $ 865,138
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 406,352 $ $ 406,352
1302 FICA/MEDICARE 406,352 406,352
1303 SUI 222,838 222,838
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 1,035,542 $ $ 1,035,542
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,398,050 $ 5,979,468 $ 8,377,518
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
29% 71%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Flealth Cont-act Budget Narnuive Revised 2/7/2020
Exhibit C-1
Page 20 of 45
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 4,851
2004 Clothing,Food,&Hygiene 128,513
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports 15,946
2009 Program Supplies-Medical 94,656
2010 Utility Vouchers -
2011 Laundry Service 40,401
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 284,367
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 44,242
3002 Printing/Postage 1,807
3003 Office,Household&Program Supplies 109,346
3004 Advertising -
3005 Staff Development&Training 24,884
3006 1 Staff Mileage 5,301
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 2,428
3010 Personnel/Contracted Parking/Parking 2,397,688
3011 Flex Funds 72,418
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 2,658,114
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 36,021
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067
4004 Rent/Lease Vehicles
4005 Security 1,406,528
4006 Utilities 40,968
4007 Janitorial 124,130
4008 Business Taxes/License Permits 10,510
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 1,671,224
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 2,788
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 2,788
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 28,430
6003 Accounting/Bookkeeping 710
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Cost $ 1,952,184
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 21 of 45
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 1,981,324
INDIRECT COST RATE 15.23%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 9,206
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 16,306
TOTAL PROGRAM EXPENSES $ 14,991,641
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 98,678 170.00 16,775,321
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 98,6781 $ 16,775,321
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 13,420,257
Federal Financial Participation(FFP)%1 53% 7,126,156
MEDI-CAL FFP TOTAL $ 7,126,156
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 7,731,533
REALIGNMENT TOTAL $ 7,731,533
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 133,952
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 133,9520
TOTAL PROGRAM FUNDING SOURCES: $ 14,991,641
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 22 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
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%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 23 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 24 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 25 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 8,377,518
Administrative Positions 497,370
1101 Program Director 116,367 Administrative Services 0.71 FTE
1102 Assistant Program Director 96,986 Administrative Services 0.71 FTE
1103 Admin Clerk 6,455 Administrative Services 0.14 FTE
1104 Health Information Specialist 111,348 Administrative Services 2.13 FTE
1105 Health Information Specialist(Supervisor) 22,592 Administrative Services 0.36 FTE
1106 Program Support Assistant 35,502 Administrative Services 0.78 FTE
1107 Quality Improvement Director 79,073 lAdministrative Services 0.71 FTE
1108 Senior Data Specialist 29,047 Administrative Services 0.71 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 5,979,468
1116 Peer Advocate 40,424 Direct Services 1.19 FTE
1117 Discharge Planner 8,714 Direct Services 0.14 FTE
1118 Social Services Coordinator 232,363 Direct Services 2.70 FTE
1119 Program Nurse(LVN/LPTN) 1,954,400 Direct Services 15.98 FTE
1120 Program Nurse(RN) 2,155,310 Direct Services 11.93 FTE
1121 Mental Health Worker 1,520,465 Direct Services 19.88 FTE
1122 Clinical Services Supervisor 67,792 Direct Services 0.71 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 865,138
1201 Retirement 65,541
1202 Worker's Compensation 262,163
1203 Health Insurance 471,893
1204 Admin Fee 65,541
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 1,035,542
1301 OASDI 406,352
1302 FICA/MEDICARE 406,352
1303 SUI 222,838
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 284,367
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 4,851 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 128,513 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946 Client Medication
2009 Program Supplies-Medical 94,656 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 40,401 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 26 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 2,658,114
3001 Telecommunications 44,242 Program Telephone and Internet
3002 Printing/Postage 1,807 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 109,346 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 24,884 Staff Training Cost
3006 Staff Mileage 5,301 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 2,428 Legal Fees
3010 Personnel/Contracted Parking/Parking 2,397,688 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 72,418 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 1,671,224
4001 Building Maintenance 36,021 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 1,406,528 Security Personnel
4006 Utilities 40,968 Facility Utility
4007 Janitorial 124,130 Facility Janitorial
4008 Business Taxes/License Permits 10,510 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify) -
5000:DIRECT SPECIAL EXPENSES 2,788
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 1,981,324
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 1,952,184 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 16,306
7001 Computer Equipment&Software 9,206 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,100 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
='Budget FYTIB176
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioral Health Contract BudgetMnative Revised 2/7/2020
Exhibit C-1
Page 27 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 14,991,641
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 14,991,641 0
BUDGETCHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 28 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.71 $ 119,858 $ 119,858
1102 Assistant Program Director 0.71 99,895 99,895
1103 Admin Clerk 0.14 6,649 6,649
1104 Health Information Specialist 2.13 114,688 114,688
1105 Health Information Specialist(Supervisor) 0.36 23,270 23,270
1106 Program Support Assistant 0.78 36,567 36,567
1107 Quality Improvement Director 0.71 81,445 81,445
1108 Senior Data Specialist 0.71 29,919 29,919
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 6.25 $ 512,291 $ 512,291
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 1.19 $ 41,637 $ 41,637
1117 Discharge Planner 0.14 8,976 8,976
1118 Social Services Coordinator 2.70 239,333 239,333
1119 Program Nurse(LVN/LPTN) 15.98 2,013,032 2,013,032
1120 Program Nurse(RN) 11.93 2,219,969 2,219,969
1121 Mental Health Worker 19.88 1,566,079 1,566,079
1122 Clinical Services Supervisor 0.71 69,825 69,825
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 52.53 $ 6,158,851 $ 6,158,851
Admin Program Total
Direct Personnel Salaries Subtotal 58.78 $ 512,291 $ 6,158,851 $ 6,671,142
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 67,507 $ $ 67,507
1202 Worker's Compensation 270,028 270,028
1203 Health Insurance 486,050 486,050
1204 Admin Fee 67,507 - 67,507
1205 Other(specify) - -
1206 1 Other(specify) - I -
Direct Employee Benefits Subtotal: $ 891,092 $ - $ 891,092
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 418,542 $ $ 418,542
1302 FICA/MEDICARE 418,542 418,542
1303 SUI 229,523 229,523
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 1,066,607 $ $ 1,066,607
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,469,990 $ 6,158,851 $ 8,628,841
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
29% 71%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Flealth Cont-act Budget Narnuive Revised 2/7/2020
Exhibit C-1
Page 29 of 45
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 4,851
2004 Clothing,Food,&Hygiene 128,513
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports 15,946
2009 Program Supplies-Medical 94,656
2010 Utility Vouchers -
2011 Other(specify) 40,401
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 284,367
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 44,242
3002 Printing/Postage 1,807
3003 Office,Household&Program Supplies 109,346
3004 Advertising -
3005 Staff Development&Training 24,884
3006 Staff Mileage 5,301
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 2,428
3010 Personnel/Contracted Parking/Parking 2,397,688
3011 Flex Funds 72,418
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 2,658,114
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 36,021
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067
4004 Rent/Lease Vehicles -
4005 Security 1,406,528
4006 Utilities 40,968
4007 Janitorial 124,130
4008 Business Taxes/License Permits 10,510
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 1,671,224
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788
5005 Other(specify) -
5006 1 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 2,788
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 28,430
6003 Accounting/Bookkeeping 710
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(indirect Salanes&Benefits) -
6009 Indirect Cost $ 1,981,322
6010 Other(specify)
6011 Other(specify) -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 30 of 45
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 2,010,462
INDIRECT COST RATE 15.16%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 9,206
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 16,306
TOTAL PROGRAM EXPENSES $ 15,272,102
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 95,382 170.00 16,214,953
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 95,3821 $ 16,214,953
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 12,971,963
Federal Financial Participation(FFP)%1 53% 6,888,112
MEDI-CAL FFP TOTAL $ 6,888,112
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 8,248,038
REALIGNMENT TOTAL $ 8,248,038
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 135,952
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 135,9520
TOTAL PROGRAM FUNDING SOURCES: $ 15,272,102
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 31 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
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%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 32 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 33 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 34 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 8,628,841
Administrative Positions 512,291
1101 Program Director 119,858 Administrative Services 0.71 FTE
1102 Assistant Program Director 99,895 Administrative Services 0.71 FTE
1103 Admin Clerk 6,649 Administrative Services 0.14 FTE
1104 Health Information Specialist 114,688 Administrative Services 2.13 FTE
1105 Health Information Specialist(Supervisor) 23,270 Administrative Services 0.36 FTE
1106 Program Support Assistant 36,567 Administrative Services 0.78 FTE
1107 Quality Improvement Director 81,445 lAdministrative Services 0.71 FTE
1108 Senior Data Specialist 29,919 Administrative Services 0.71 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 6,158,851
1116 Peer Advocate 41,637 Direct Services 1.19 FTE
1117 Discharge Planner 8,976 Direct Services 0.14 FTE
1118 Social Services Coordinator 239,333 Direct Services 2.70 FTE
1119 Program Nurse(LVN/LPTN) 2,013,032 Direct Services 15.98 FTE
1120 Program Nurse(RN) 2,219,969 Direct Services 11.93 FTE
1121 Mental Health Worker 1,566,079 Direct Services 19.88 FTE
1122 Clinical Services Supervisor 69,825 Direct Services 0.71 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 891,092
1201 Retirement 67,507
1202 Worker's Compensation 270,028
1203 Health Insurance 486,050
1204 Admin Fee 67,507
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 1,066,607
1301 OASDI 418,542
1302 FICA/MEDICARE 418,542
1303 SUI 229,523
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 284,367
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 4,851 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 128,513 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946 Client Medication
2009 Program Supplies-Medical 94,656 Program Medical Supplies
2010 Utility Vouchers -
2011 Other(specify) 40,401 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 35 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 2,658,114
3001 Telecommunications 44,242 Program Telephone and Internet
3002 Printing/Postage 1,807 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 109,346 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 24,884 Staff Training Cost
3006 Staff Mileage 5,301 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 2,428 Legal Fees
3010 Personnel/Contracted Parking/Parking 2,397,688 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 72,418 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 1,671,224
4001 Building Maintenance 36,021 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 1,406,528 Security Personnel
4006 Utilities 40,968 Facility Utility
4007 Janitorial 124,130 Facility Janitorial
4008 Business Taxes/License Permits 10,510 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 2,788
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 2,010,462
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Cost 1,981,322 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 16,306
7001 Computer Equipment&Software 9,206 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,100 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioml Health Contract BudgetMnative Revised 2/7/2020
Exhibit C-1
Page 36 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 15,272,102
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 15,272,102
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 37 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.71 $ 123,453 $ 123,453
1102 Assistant Program Director 0.71 102,892 102,892
1103 Admin Clerk 0.14 6,848 6,848
1104 Health Information Specialist 2.13 118,129 118,129
1105 Health Information Specialist(Supervisor) 0.36 23,968 23,968
1106 Program Support Assistant 0.78 37,664 37,664
1107 Quality Improvement Director 0.71 83,889 83,889
1108 Senior Data Specialist 0.71 30,816 30,816
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 6.25 $ 527,659 $ 527,659
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 1.19 $ 42,886 $ 42,886
1117 Discharge Planner 0.14 9,245 9,245
1118 Social Services Coordinator 2.70 246,513 246,513
1119 Program Nurse(LVN/LPTN) 15.98 2,073,423 2,073,423
1120 Program Nurse(RN) 11.93 2,286,569 2,286,569
1121 Mental Health Worker 19.88 1,613,061 1,613,061
1122 Clinical Services Supervisor 0.71 71,920 71,920
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 52.53 $ 6,343,617 $ 6,343,617
Admin Program Total
Direct Personnel Salaries Subtotal 58.78 $ 527,659 $ 6,343,617 $ 6,871,276
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 69,532 $ - $ 69,532
1202 Worker's Compensation 278,129 278,129
1203 Health Insurance 500,632 500,632
1204 Admin Fee 69,532 - 69,532
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 917,825 $ - $ 917,825
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 431,099 $ $ 431,099
1302 FICA/MEDICARE 431,099 431,099
1303 SUI 236,409 236,409
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 1,098,607 $ $ 1,098,607
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,544,091 $ 6,343,617 $ 8,887,708
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
29% 71%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Flealth Cont-act Budget Narnuive Revised 2/7/2020
Exhibit C-1
Page 38 of 45
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 4,851
2004 Clothing,Food,&Hygiene 128,513
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports 15,946
2009 Program Supplies-Medical 94,656
2010 Utility Vouchers -
2011 Laundry Service 40,401
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 284,367
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 44,242
3002 Printing/Postage 1,807
3003 Office,Household&Program Supplies 109,346
3004 Advertising -
3005 Staff Development&Training 24,884
3006 1 Staff Mileage 5,301
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 2,428
3010 Personnel/Contracted Parking/Parking 2,397,688
3011 Flex Funds 72,418
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 2,658,114
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 36,021
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067
4004 Rent/Lease Vehicles
4005 Security 1,406,528
4006 Utilities 40,968
4007 Janitorial 124,130
4008 Business Taxes/License Permits 10,510
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 1,671,224
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 2,788
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 2,788
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 28,430
6003 Accounting/Bookkeeping 710
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Costs $ 2,028,499
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 39 of 45
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 2,057,639
INDIRECT COST RATE 15.22%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 9,206
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 16,306
TOTAL PROGRAM EXPENSES $ 15,578,146
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 93,003 170.00 15,810,431
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 93,0031 $ 15,810,431
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 12,648,345
Federal Financial Participation(FFP)%1 53% 6,716,271
MEDI-CAL FFP TOTAL $ 6,716,271
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 8,722,687
REALIGNMENT TOTAL $ 8,722,687
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 139,188
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 139,188
TOTAL PROGRAM FUNDING SOURCES: $ 15,578,146
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 40 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
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%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 41 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 42 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-1
Page 43 of 45
ADULT CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 8,887,708
Administrative Positions 527,659
1101 Program Director 123,453 Administrative Services 0.71 FTE
1102 Assistant Program Director 102,892 Administrative Services 0.71 FTE
1103 Admin Clerk 6,848 Administrative Services 0.14 FTE
1104 Health Information Specialist 118,129 Administrative Services 2.13 FTE
1105 Health Information Specialist(Supervisor) 23,968 Administrative Services 0.36 FTE
1106 Program Support Assistant 37,664 Administrative Services 0.78 FTE
1107 Quality Improvement Director 83,889 lAdministrative Services 0.71 FTE
1108 Senior Data Specialist 30,816 Administrative Services 0.71 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 6,343,617
1116 Peer Advocate 42,886 Direct Services 1.19 FTE
1117 Discharge Planner 9,245 Direct Services 0.14 FTE
1118 Social Services Coordinator 246,513 Direct Services 2.70 FTE
1119 Program Nurse(LVN/LPTN) 2,073,423 Direct Services 15.98 FTE
1120 Program Nurse(RN) 2,286,569 Direct Services 11.93 FTE
1121 Mental Health Worker 1,613,061 Direct Services 19.88 FTE
1122 Clinical Services Supervisor 71,920 Direct Services 0.71 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 917,825
1201 Retirement 69,532
1202 Worker's Compensation 278,129
1203 Health Insurance 500,632
1204 Admin Fee 69,532
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 1,098,607
1301 OASDI 431,099
1302 FICA/MEDICARE 431,099
1303 SUI 236,409
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 284,367
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 4,851 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 128,513 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946 Client Medication
2009 Program Supplies-Medical 94,656 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 40,401 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-1
Page 44 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 2,658,114
3001 Telecommunications 44,242 Program Telephone and Internet
3002 Printing/Postage 1,807 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 109,346 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 24,884 Staff Training Cost
3006 Staff Mileage 5,301 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 2,428 Legal Fees
3010 Personnel/Contracted Parking/Parking 2,397,688 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 72,418 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 1,671,224
4001 Building Maintenance 36,021 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 1,406,528 Security Personnel
4006 Utilities 40,968 Facility Utility
4007 Janitorial 124,130 Facility Janitorial
4008 Business Taxes/License Permits 10,510 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 2,788
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 2,057,639
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 2,028,499 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 16,306
7001 Computer Equipment&Software 9,206 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,100 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioml Health Contract BudgetMnative Revised 2/7/2020
Exhibit C-1
Page 45 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 15,578,146
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 15,578,146
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 1 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Program Director 0.29 $ 44,802 $ 44,802
1102 Assistant Program Director 0.29 37,340 37,340
1103 Admin Clerk 0.06 2,485 2,485
1104 Health Information Specialist 0.87 42,869 42,869
1105 Health Information Specialist(Supervisor) 0.15 8,698 8,698
1106 Program Support Assistant 0.32 13,669 13,669
1107 Quality Improvement Director 0.29 30,444 30,444
1108 Senior Data Specialist 0.29 11,183 11,183
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.56 $ 191,490 $ 191,490
Acct# Program Position FTE Admin Program Total
1116 Peer Advocate 0.48 $ 15,563 $ 15,563
1117 Discharge Planner 0.06 3,355 3,355
1118 Social Services Coordinator 1.91 154,939 154,939
1119 Program Nurse(LVN/LPTN) 11.40 752,452 752,452
1120 Program Nurse(RN) 7.31 829,803 829,803
1121 Mental Health Worker 11.77 585,385 585,385
1122 Clinical Services Supervisor 0.29 26,100 26,100
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotall 33.22 1 $ 2,367,597 1 $ 2,367,597
Admin Program Total
Direct Personnel Salaries Subtotal 35.78 $ 191,490 $ 2,367,597 $ 2,559,087
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 25,133 $ 25,133
1202 Worker's Compensation 100,530 100,530
1203 Health lnsurance 180,953 180,953
1204 Admin Fee 25,133 25,133
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 331,749 $ - $ 331,749
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 155,821 $ $ 155,821
1302 FICA/MEDICARE 155,821 155,821
1303 SUI 85,450 85,450
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 397,092 $ $ 397,092
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 920,331 $ 2,367,597 $ 3,287,928
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
28% 72%
2000:DIRECT CLIENT SUPPORT
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 2 of 45
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 1,981
2004 Clothing,Food,&Hygiene 52,491
2005 Education Support
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513
2009 Program Supplies-Medical 38,662
2010 Utility Vouchers -
2011 Laundry Service 16,502
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 116,149
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 18,071
3002 Printing/Postage 738
3003 Office,Household&Program Supplies 44,662
3004 Advertising -
3005 Staff Development&Training 10,164
3006 Staff Mileage 2,165
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 992
3010 Personnel/Contracted Parking/Parking 979,337
3011 Flex Funds 29,579
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 1,085,708
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 14,713
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675
4004 Rent/Lease Vehicles -
4005 Security 574,497
4006 Utilities 16,733
4007 Janitorial 50,701
4008 Business Taxes/License Permits 4,293
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j 682,612
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139
5005 Other(specify) -
5006 1 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 1,139
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 11,612
6003 Accounting/Bookkeeping 290
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(indirect Salanes&Benefits) -
6009 Indirect Cost 767,995
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 3 of 45
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 779,897
INDIRECT COST RATE 15.06%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,760
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,900
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES $ 5,960,093
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 42,799 170.00 7,275,904
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 42,7991 $ 7,275,904
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 5,820,723
Federal Financial Participation(FFP)%1 53% 3,090,804
MEDI-CAL FFP TOTAL $ 3,090,804
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 2,816,592
REALIGNMENT TOTAL $ 2,816,592
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 52,697
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 52,697
TOTAL PROGRAM FUNDING SOURCES: $ 5,960,093
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 4 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
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 Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
LEI
Total 300.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 5 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 6 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 7 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2022-23 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 3,287,928
Administrative Positions 191,490
1101 Program Director 44,802 Administrative Services 0.29 FTE
1102 Assistant Program Director 37,340 Administrative Services 0.29 FTE
1103 Admin Clerk 2,485 Administrative Services 0.06 FTE
1104 Health Information Specialist 42,869 Administrative Services 0.87 FTE
1105 Health Information Specialist(Supervisor) 8,698 Administrative Services 0.15 FTE
1106 Program Support Assistant 13,669 Administrative Services 0.32 FTE
1107 Quality Improvement Director 30,444 Administrative Services 0.29 FTE
1108 Senior Data Specialist 11,183 Administrative Services 0.29 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 2,367,597
1116 Peer Advocate 15,563 Direct Services 0.48 FTE
1117 Discharge Planner 3,355 Direct Services 0.06 FTE
1118 Social Services Coordinator 154,939 Direct Services 1.91 FTE
1119 Program Nurse(LVN/LPTN) 752,452 Direct Services 11.40 FTE
1120 Program Nurse(RN) 829,803 Direct Services 7.11 FTE
1121 Mental Health Worker 585,385 Direct Services 11.77 FTE
1122 Clinical Services Supervisor 26,100 Direct Services 0.29 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits
1201 Retirement 25,133
1202 Worker's Compensation 100,530
1203 Health Insurance 180,953
1204 Admin Fee 25,133
1205 Other(specify) -
1206 Other(specify)
Direct Payroll Taxes&Expenses: 397,092
1301 OASDI 155,821
1302 FICA/MEDICARE 155,821
1303 SUI 85,450
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 116,149
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,981 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 52,491 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513 Client Medication
2009 Program Supplies-Medical 38,662 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 16,502 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 8 of 45
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 1,085,708
3001 Telecommunications 18,071 Program Telephone and Internet
3002 Printing/Postage 738 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 44,662 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 10,164 Staff Training Cost
3006 Staff Mileage 2,165 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 992 Legal Fees
3010 Personnel/Contracted Parking/Parking 979,337 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 29,579 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 682,612
4001 Building Maintenance 14,713 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 574,497 Security Personnel
4006 Utilities 16,733 Facility Utility
4007 Janitorial 50,701 Facility Janitorial
4008 Business Taxes/License Permits 4,293 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 1,139
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 779,897
6001 Administrative Overhead -
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Cost 767,995 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 6,660
7001 Computer Equipment&Software 3,760 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 2,900 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioral Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit C-2
Page 9 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 5,960,093
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 5,960,093
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 10 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.29 $ 46,146 $ 46,146
1102 Assistant Program Director 0.29 38,460 38,460
1103 Admin Clerk 0.06 2,560 2,560
1104 Health Information Specialist 0.87 44,156 44,156
1105 Health Information Specialist(Supervisor) 0.15 8,959 8,959
1106 Program Support Assistant 0.32 14,079 14,079
1107 Quality Improvement Director 0.29 31,357 31,357
1108 Senior Data Specialist 0.29 11,519 11,519
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.56 $ 197,236 $ 197,236
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 0.48 $ 16,030 $ 16,030
1117 Discharge Planner 0.06 3,456 3,456
1118 Social Services Coordinator 1.91 159,587 159,587
1119 Program Nurse(LVN/LPTN) 11.40 775,025 775,025
1120 Program Nurse(RN) 7.31 854,697 854,697
1121 Mental Health Worker 11.77 602,947 602,947
1122 Clinical Services Supervisor 0.29 26,883 26,883
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 33.22 $ 2,438,625 $ 2,438,625
Admin Program Total
Direct Personnel Salaries Subtotal 35.78 $ 197,236 $ 2,438,625 $ 2,635,861
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 25,887 $ $ 25,887
1202 Worker's Compensation 103,546 103,546
1203 Health Insurance 186,381 186,381
1204 Admin Fee 25,887 - 25,887
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 341,701 $ - $ 341,701
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 160,496 $ $ 160,496
1302 FICA/MEDICARE 160,496 160,496
1303 SUI 88,013 88,013
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 409,005 $ $ 409,005
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 947,942 $ 2,438,625 $ 3,386,567
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
28% 72%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Health Cont-act Budget Narnuive Revised 2/7/2020
Exhibit C-2
Page 11 of 45
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 1,981
2004 Clothing,Food,&Hygiene 52,491
2005 Education Support
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513
2009 Program Supplies-Medical 38,662
2010 Utility Vouchers -
2011 Laundry Service 16,502
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 116,149
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 18,071
3002 Printing/Postage 738
3003 Office,Household&Program Supplies 44,662
3004 Advertising -
3005 Staff Development&Training 10,164
3006 1 Staff Mileage 2,165
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 992
3010 Personnel/Contracted Parking/Parking 979,337
3011 Flex Funds 29,579
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 1,085,708
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 14,713
4002 Rent/Lease Building
4003 Rent/Lease Equipment 21,675
4004 Rent/Lease Vehicles
4005 Security 574,497
4006 Utilities 16,733
4007 Janitorial 50,701
4008 Business Taxes/License Permits 4,293
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 682,612
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 1,139
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 1,139
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 11,612
6003 Accounting/Bookkeeping 290
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Costs 782,466
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 12 of 45
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 794,368
INDIRECT COST RATE 15.05%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,760
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,900
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES $ 6,073,203
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 41,529 170.00 7,060,001
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 41,5291 $ 7,060,001
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 5,648,001
Federal Financial Participation(FFP)%1 53% 2,999,089
MEDI-CAL FFP TOTAL $ 2,999,089
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 3,020,424
REALIGNMENT TOTAL $ 3,020,424
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 53,690
8405 Other(Specify) -
OTHER REVENUE TOTALI$ 53,690
TOTAL PROGRAM FUNDING SOURCES: $ 6,073,203
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 13 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
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%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno
Adult Crisis Stabilization Center/Fresno
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 14 of 45
Tota 1 0.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno
Adult Crisis Stabilization Center/Fresno
Total 0.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 15 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 16 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 3,386,567
Administrative Positions 197,236
1101 Program Director 46,146 Administrative Services 0.29 FTE
1102 Assistant Program Director 38,460 Administrative Services 0.29 FTE
1103 Admin Clerk 2,560 Administrative Services 0.06 FTE
1104 Health Information Specialist 44,156 Administrative Services 0.87 FTE
1105 Health Information Specialist(Supervisor) 8,959 Administrative Services 0.15 FTE
1106 Program Support Assistant 14,079 Administrative Services 0.32 FTE
1107 Quality Improvement Director 31,357 Administrative Services 0.29 FTE
1108 Senior Data Specialist 11,519 Administrative Services 0.29 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 2,438,625
1116 Peer Advocate 16,030 Direct Services 0.48 FTE
1117 Discharge Planner 3,456 Direct Services 0.06 FTE
1118 Social Services Coordinator 159,587 Direct Services 1.91 FTE
1119 Program Nurse(LVN/LPTN) 775,025 Direct Services 11.40 FTE
1120 Program Nurse(RN) 854,697 Direct Services 7.11 FTE
1121 Mental Health Worker 602,947 Direct Services 11.77 FTE
1122 Clinical Services Supervisor 26,883 Direct Services 0.29 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 341,701
1201 Retirement 25,887
1202 Worker's Compensation 103,546
1203 Health Insurance 186,381
1204 Admin Fee 25,887
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 409,005
1301 OASDI 160,496
1302 FICA/MEDICARE 160,496
1303 SUI 88,013
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 116,149
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,981 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 52,491 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513 Client Medication
2009 Program Supplies-Medical 38,662 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 16,502 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 17 of 45
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 1,085,708
3001 Telecommunications 18,071 Program Telephone and Internet
3002 Printing/Postage 738 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 44,662 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 10,164 Staff Training Cost
3006 Staff Mileage 2,165 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 992 Legal Fees
3010 Personnel/Contracted Parking/Parking 979,337 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 29,579 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 682,612
4001 Building Maintenance 14,713 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 574,497 Security Personnel
4006 Utilities 16,733 Facility Utility
4007 Janitorial 50,701 Facility Janitorial
4008 Business Taxes/License Permits 4,293 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 1,139
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 794,368
6001 Administrative Overhead -
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 782,466 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 6,660
7001 Computer Equipment&Software 3,760 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 2,900 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioral Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit C-2
Page 18 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 6,073,203
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 6,073,203
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 19 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.29 $ 47,530 $ 47,530
1102 Assistant Program Director 0.29 39,614 39,614
1103 Admin Clerk 0.06 2,637 2,637
1104 Health Information Specialist 0.87 45,480 45,480
1105 Health Information Specialist(Supervisor) 0.15 9,228 9,228
1106 Program Support Assistant 0.32 14,501 14,501
1107 Quality Improvement Director 0.29 32,298 32,298
1108 Senior Data Specialist 0.29 11,864 11,864
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.56 $ 203,152 $ 203,152
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 0.48 $ 16,511 $ 16,511
1117 Discharge Planner 0.06 3,559 3,559
1118 Social Services Coordinator 1.91 164,375 164,375
1119 Program Nurse(LVN/LPTN) 11.40 798,276 798,276
1120 Program Nurse(RN) 7.31 880,338 880,338
1121 Mental Health Worker 11.77 621,035 621,035
1122 Clinical Services Supervisor 0.29 27,689 27,689
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 33.22 $ 2,511,783 $ 2,511,783
Admin Program Total
Direct Personnel Salaries Subtotal 35.78 $ 203,152 $ 2,511,783 $ 2,714,935
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 26,663 $ $ 26,663
1202 Worker's Compensation 106,652 106,652
1203 Health Insurance 191,973 191,973
1204 Admin Fee 26,663 26,663
1205 Other(specify)
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 351,951 $ - $ 351,951
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 165,310 $ $ 165,310
1302 FICA/MEDICARE 165,310 165,310
1303 SUI 90,653 90,653
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 421,273 $ $ 421,273
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 976,376 $ 2,511,783 $ 3,488,159
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
28% 72%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Health Cont-act Budget Narnuive Revised 2/7/2020
Exhibit C-2
Page 20 of 45
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 1,981
2004 Clothing,Food,&Hygiene 52,491
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports 6,513
2009 Program Supplies-Medical 38,662
2010 Utility Vouchers -
2011 Laundry Service 16,502
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 116,149
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 18,071
3002 Printing/Postage 738
3003 Office,Household&Program Supplies 44,662
3004 Advertising -
3005 Staff Development&Training 10,164
3006 1 Staff Mileage 2,165
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 992
3010 Personnel/Contracted Parking/Parking 979,337
3011 Flex Funds 29,579
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 1,085,708
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 14,713
4002 Rent/Lease Building
4003 Rent/Lease Equipment 21,675
4004 Rent/Lease Vehicles
4005 Security 574,497
4006 Utilities 16,733
4007 Janitorial 50,701
4008 Business Taxes/License Permits 4,293
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 682,612
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 1,139
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 1,139
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 11,612
6003 Accounting/Bookkeeping 290
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Cost 797,371
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 21 of 45
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 809,273
INDIRECT COST RATE 15.04%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,760
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,900
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES $ 6,189,700
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 40,305 170.00 6,851,890
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 40,3051 $ 6,851,890
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 5,481,512
Federal Financial Participation(FFP)%1 53% 2,910,683
MEDI-CAL FFP TOTAL $ 2,910,683
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 3,224,304
REALIGNMENT TOTAL $ 3,224,304
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 54,713
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 54,713
TOTAL PROGRAM FUNDING SOURCES: $ 6,189,700
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 22 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
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%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 23 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 24 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 25 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 3,488,159
Administrative Positions 203,152
1101 Program Director 47,530 Administrative Services 0.29 FTE
1102 Assistant Program Director 39,614 Administrative Services 0.29 FTE
1103 Admin Clerk 2,637 Administrative Services 0.06 FTE
1104 Health Information Specialist 45,480 Administrative Services 0.87 FTE
1105 Health Information Specialist(Supervisor) 9,228 Administrative Services 0.15 FTE
1106 Program Support Assistant 14,501 Administrative Services 0.32 FTE
1107 Quality Improvement Director 32,298 Administrative Services 0.29 FTE
1108 Senior Data Specialist 11,864 Administrative Services 0.29 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 2,511,783
1116 Peer Advocate 16,511 Direct Services 0.48 FTE
1117 Discharge Planner 3,559 Direct Services 0.06 FTE
1118 Social Services Coordinator 164,375 Direct Services 1.91 FTE
1119 Program Nurse(LVN/LPTN) 798,276 Direct Services 11.40 FTE
1120 Program Nurse(RN) 880,338 Direct Services 7.11 FTE
1121 Mental Health Worker 621,035 Direct Services 11.77 FTE
1122 Clinical Services Supervisor 27,689 Direct Services 0.29 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 351,951
1201 Retirement 26,663
1202 Worker's Compensation 106,652
1203 Health Insurance 191,973
1204 Admin Fee 26,663
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 421,273
1301 OASDI 165,310
1302 FICA/MEDICARE 165,310
1303 SUI 90,653
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 116,149
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,981 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 52,491 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513 Client Medication
2009 Program Supplies-Medical 38,662 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 16,502 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 26 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 1,085,708
3001 Telecommunications 18,071 Program Telephone and Internet
3002 Printing/Postage 738 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 44,662 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 10,164 Staff Training Cost
3006 Staff Mileage 2,165 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 992 Legal Fees
3010 Personnel/Contracted Parking/Parking 979,337 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 29,579 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 682,612
4001 Building Maintenance 14,713 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 574,497 Security Personnel
4006 Utilities 16,733 Facility Utility
4007 Janitorial 50,701 Facility Janitorial
4008 Business Taxes/License Permits 4,293 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify) -
5000:DIRECT SPECIAL EXPENSES 1,139
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 809,273
6001 Administrative Overhead -
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 797,371 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 6,660
7001 Computer Equipment&Software 3,760 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 2,900 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
='Budget FYTIB176
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioral Health Contract BudgetMnative Revised 2/7/2020
Exhibit C-2
Page 27 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 6,189,700
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 6,189,700 0
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 28 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.29 $ 48,956 $ 48,956
1102 Assistant Program Director 0.29 40,802 40,802
1103 Admin Clerk 0.06 2,716 2,716
1104 Health Information Specialist 0.87 46,845 46,845
1105 Health Information Specialist(Supervisor) 0.15 9,505 9,505
1106 Program Support Assistant 0.32 14,936 14,936
1107 Quality Improvement Director 0.29 33,266 33,266
1108 Senior Data Specialist 0.29 12,220 12,220
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.56 $ 209,246 $ 209,246
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 0.48 $ 17,007 $ 17,007
1117 Discharge Planner 0.06 3,666 3,666
1118 Social Services Coordinator 1.91 169,306 169,306
1119 Program Nurse(LVN/LPTN) 11.40 822,224 822,224
1120 Program Nurse(RN) 7.31 906,748 906,748
1121 Mental Health Worker 11.77 639,666 639,666
1122 Clinical Services Supervisor 0.29 28,520 28,520
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 33.22 $ 2,587,137 $ 2,587,137
Admin Program Total
Direct Personnel Salaries Subtotal 35.78 $ 209,246 $ 2,587,137 $ 2,796,383
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 27,463 $ $ 27,463
1202 Worker's Compensation 109,852 109,852
1203 Health Insurance 197,732 197,732
1204 Admin Fee 27,463 - 27,463
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 362,510 $ - $ 362,510
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 170,270 $ $ 170,270
1302 FICA/MEDICARE 170,270 170,270
1303 SUI 93,373 93,373
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 433,913 $ $ 433,913
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 1,005,669 $ 2,587,137 $ 3,592,806
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
28% 72%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Health Cont-act Budget Narnuive Revised 2/7/2020
Exhibit C-2
Page 29 of 45
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 1,981
2004 Clothing,Food,&Hygiene 52,491
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports 6,513
2009 Program Supplies-Medical 38,662
2010 Utility Vouchers -
2011 Other(specify) 16,502
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 116,149
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 18,071
3002 Printing/Postage 738
3003 Office,Household&Program Supplies 44,662
3004 Advertising
3005 Staff Development&Training 10,164
3006 Staff Mileage 2,165
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 992
3010 Personnel/Contracted Parking/Parking 979,337
3011 Flex Funds 29,579
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 1,085,708
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 14,713
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675
4004 Rent/Lease Vehicles -
4005 Security 574,497
4006 Utilities 16,733
4007 Janitorial 50,701
4008 Business Taxes/License Permits 4,293
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j 682,612
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139
5005 Other(specify) -
5006 1 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 1,139
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 11,612
6003 Accounting/Bookkeeping 290
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(indirect Salanes&Benefits) -
6009 Indirect Cost 812,723
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 30 of 45
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 824,625
INDIRECT COST RATE 15.03%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,760
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,900
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES $ 6,309,699
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 39,125 170.00 6,651,251
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 39,1251 $ 6,651,251
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 5,321,000
Federal Financial Participation(FFP)%1 53% 2,825,451
MEDI-CAL FFP TOTAL $ 2,825,451
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 3,428,482
REALIGNMENT TOTAL $ 3,428,482
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 55,766
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 55,766
TOTAL PROGRAM FUNDING SOURCES: $ 6,309,699
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 31 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
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%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 32 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 33 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 34 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 3,592,806
Administrative Positions 209,246
1101 Program Director 48,956 Administrative Services 0.29 FTE
1102 Assistant Program Director 40,802 Administrative Services 0.29 FTE
1103 Admin Clerk 2,716 Administrative Services 0.06 FTE
1104 Health Information Specialist 46,845 Administrative Services 0.87 FTE
1105 Health Information Specialist(Supervisor) 9,505 Administrative Services 0.15 FTE
1106 Program Support Assistant 14,936 Administrative Services 0.32 FTE
1107 Quality Improvement Director 33,266 Administrative Services 0.29 FTE
1108 Senior Data Specialist 12,220 Administrative Services 0.29 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 2,587,137
1116 Peer Advocate 17,007 Direct Services 0.48 FTE
1117 Discharge Planner 3,666 Direct Services 0.06 FTE
1118 Social Services Coordinator 169,306 Direct Services 1.91 FTE
1119 Program Nurse(LVN/LPTN) 822,224 Direct Services 11.40 FTE
1120 Program Nurse(RN) 906,748 Direct Services 7.11 FTE
1121 Mental Health Worker 639,666 Direct Services 11.77 FTE
1122 Clinical Services Supervisor 28,520 Direct Services 0.29 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 362,510
1201 Retirement 27,463
1202 Worker's Compensation 109,852
1203 Health Insurance 197,732
1204 Admin Fee 27,463
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 433,913
1301 OASDI 170,270
1302 FICA/MEDICARE 170,270
1303 SUI 93,373
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 116,149
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,981 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 52,491 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513 Client Medication
2009 Program Supplies-Medical 38,662 Program Medical Supplies
2010 Utility Vouchers -
2011 Other(specify) 16,502 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 35 of 45
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 1,085,708
3001 Telecommunications 18,071 Program Telephone and Internet
3002 Printing/Postage 738 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 44,662 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 10,164 Staff Training Cost
3006 Staff Mileage 2,165 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 992 Legal Fees
3010 Personnel/Contracted Parking/Parking 979,337 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 29,579 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 682,612
4001 Building Maintenance 14,713 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 574,497 Security Personnel
4006 Utilities 16,733 Facility Utility
4007 Janitorial 50,701 Facility Janitorial
4008 Business Taxes/License Permits 4,293 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 1,139
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 824,625
6001 Administrative Overhead -
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Cost 812,723 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 6,660
7001 Computer Equipment&Software 3,760 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 2,900 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioral Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit C-2
Page 36 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 6,309,699
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 6,309,699
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 37 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.29 $ 50,425 $ 50,425
1102 Assistant Program Director 0.29 42,026 42,026
1103 Admin Clerk 0.06 2,797 2,797
1104 Health Information Specialist 0.87 48,250 48,250
1105 Health Information Specialist(Supervisor) 0.15 9,790 9,790
1106 Program Support Assistant 0.32 15,384 15,384
1107 Quality Improvement Director 0.29 34,264 34,264
1108 Senior Data Specialist 0.29 12,587 12,587
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.56 $ 215,523 $ 215,523
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 0.48 $ 17,517 $ 17,517
1117 Discharge Planner 0.06 3,777 3,777
1118 Social Services Coordinator 1.91 174,385 174,385
1119 Program Nurse(LVN/LPTN) 11.40 846,890 846,890
1120 Program Nurse(RN) 7.31 933,951 933,951
1121 Mental Health Worker 11.77 658,856 658,856
1122 Clinical Services Supervisor 0.29 29,376 29,376
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 33.22 $ 2,664,752 $ 2,664,752
Admin Program Total
Direct Personnel Salaries Subtotal 35.78 $ 215,523 $ 2,664,752 $ 2,880,275
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 28,287 $ $ 28,287
1202 Worker's Compensation 113,147 113,147
1203 Health Insurance 203,664 203,664
1204 Admin Fee 28,287 28,287
1205 Other(specify) - -
1206 1 Other(specify) - I -
Direct Employee Benefits Subtotal: $ 373,385 $ - $ 373,385
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 175,378 $ $ 175,378
1302 FICA/MEDICARE 175,378 175,378
1303 SUI 96,174 96,174
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 446,930 $ $ 446,930
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 1,035,838 $ 2,664,752 $ 3,700,590
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
28% 72%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Health Cont-act Budget Narnuive Revised 2/7/2020
Exhibit C-2
Page 38 of 45
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 1,981
2004 Clothing,Food,&Hygiene 52,491
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports 6,513
2009 Program Supplies-Medical 38,662
2010 Utility Vouchers -
2011 Laundry Service 16,502
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 116,149
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 18,071
3002 Printing/Postage 738
3003 Office,Household&Program Supplies 44,662
3004 Advertising -
3005 Staff Development&Training 10,164
3006 1 Staff Mileage 2,165
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 992
3010 Personnel/Contracted Parking/Parking 979,337
3011 Flex Funds 29,579
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 1,085,708
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 14,713
4002 Rent/Lease Building
4003 Rent/Lease Equipment 21,675
4004 Rent/Lease Vehicles
4005 Security 574,497
4006 Utilities 16,733
4007 Janitorial 50,701
4008 Business Taxes/License Permits 4,293
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 682,612
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 1,139
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 1,139
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 11,612
6003 Accounting/Bookkeeping 290
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Costs $ 826,599
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 39 of 45
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 838,501
INDIRECT COST RATE 14.99%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,760
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,900
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES $ 6,431,359
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 37,898 170.00 6,442,678
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 37,8981 $ 6,442,678
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 5,154,142
Federal Financial Participation(FFP)%1 53% 2,736,850
MEDI-CAL FFP TOTAL $ 2,736,850
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 3,637,791
REALIGNMENT TOTAL $ 3,637,791
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 56,718
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 56,718
TOTAL PROGRAM FUNDING SOURCES: $ 6,431,359
NET PROGRAM COST: $
Fresno County Department of Behavioral Fleahh Cont-act Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 40 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
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%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 41 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 42 of 45
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit C-2
Page 43 of 45
YOUTH CRISIS STABILIZATION CENTER(CSC)
Exodus Recovery,Inc.
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 3,700,590
Administrative Positions 215,523
1101 Program Director 50,425 Administrative Services 0.29 FTE
1102 Assistant Program Director 42,026 Administrative Services 0.29 FTE
1103 Admin Clerk 2,797 Administrative Services 0.06 FTE
1104 Health Information Specialist 48,250 Administrative Services 0.87 FTE
1105 Health Information Specialist(Supervisor) 9,790 Administrative Services 0.15 FTE
1106 Program Support Assistant 15,384 Administrative Services 0.32 FTE
1107 Quality Improvement Director 34,264 Administrative Services 0.29 FTE
1108 Senior Data Specialist 12,587 Administrative Services 0.29 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 2,664,752
1116 Peer Advocate 17,517 Direct Services 0.48 FTE
1117 Discharge Planner 3,777 Direct Services 0.06 FTE
1118 Social Services Coordinator 174,385 Direct Services 1.91 FTE
1119 Program Nurse(LVN/LPTN) 846,890 Direct Services 11.40 FTE
1120 Program Nurse(RN) 933,951 Direct Services 7.11 FTE
1121 Mental Health Worker 658,856 Direct Services 11.77 FTE
1122 Clinical Services Supervisor 29,376 Direct Services 0.29 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 373,385
1201 Retirement 28,287
1202 Worker's Compensation 113,147
1203 Health Insurance 203,664
1204 Admin Fee 28,287
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 446,930
1301 OASDI 175,378
1302 FICA/MEDICARE 175,378
1303 SUI 96,174
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 116,149
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,981 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 52,491 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513 Client Medication
2009 Program Supplies-Medical 38,662 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 16,502 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C-2
Page 44 of 45
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 1,085,708
3001 Telecommunications 18,071 Program Telephone and Internet
3002 Printing/Postage 738 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 44,662 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 10,164 Staff Training Cost
3006 Staff Mileage 2,165 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 992 Legal Fees
3010 Personnel/Contracted Parking/Parking 979,337 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 29,579 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 682,612
4001 Building Maintenance 14,713 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 574,497 Security Personnel
4006 Utilities 16,733 Facility Utility
4007 Janitorial 50,701 Facility Janitorial
4008 Business Taxes/License Permits 4,293 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 1,139
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 838,501
6001 Administrative Overhead -
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 826,599 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 6,660
7001 Computer Equipment&Software 3,760 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 2,900 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioral Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit C-2
Page 45 of 45
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 6,431,359
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 6,431,359
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit D
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health
services. Mental health contractors and the manner in which they conduct themselves are a
vital part of this commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with
which contractor and its employees and subcontractors shall comply. Contractor shall
require its employees and subcontractors to attend a compliance training that will be
provided by Fresno County. After completion of this training, each contractor, contractor's
employee and subcontractor must sign the Contractor Acknowledgment and Agreement
form and return this form to the Compliance officer or designee.
Contractor and its employees and subcontractor shall:
1 . Comply with all applicable laws, regulations, rules or guidelines when providing and
billing for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in
their professional dealing related to their contract with the County and avoid any
conduct that could reasonably be expected to reflect adversely upon the integrity of
the County.
3. Treat County employees, consumers, and other mental health contractors fairly and
with respect.
4. NOT engage in any activity in violation of the County's Compliance Program, nor
engage in any other conduct which violates any applicable law, regulation, rule or
guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely
and are consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or
reimbursement of any kind are submitted.
Exhibit D
Page 2 of 3
7. Bill only for eligible services actually rendered and fully documented. Use billing
codes that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by County employees or other mental health contractors, or report
any activity that they believe may violate the standards of the Compliance Program, or
any other applicable law, regulation, rule or guideline. Fresno County prohibits
retaliation against any person making a report. Any person engaging in any form of
retaliation will be subject to disciplinary or other appropriate action by the County.
Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or
guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible
person and therefore excluded from participation in the Federal Health Care
Programs.
Exhibit D
Page 3of3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
Signature : Date
For Group or Organizational Providers
Group/Org. Name (print):
Employee Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
❑ Other:
Job Title (if different from Discipline):
Signature: Date: / /
Exhibit E
Page 1 of 3
Documentation Standards for Client Records
The documentation standards are described below under key topics related to client
care. All standards must be addressed in the client record; however, there is no
requirement that the record have a specific document or section addressing these
topics.
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 five axis diagnosis from the most current DSM, or a diagnosis from the most
current ICD, will be documented, consistent with the presenting problems, history
mental status evaluation and/or other assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document
changes in the client's condition.
• Client conditions will be assessed at least annually and, in most cases, at more
frequent intervals.
Exhibit E
Page 2 of 3
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.
■ client signature on the plan will be used as the means by which the
CONTRACTOR(S) documents the participation of the client
■ when the client's signature is required on the client plan and the client refuses
or is unavailable for signature, the client plan will include a written explanation
of the refusal or unavailability.
■ The CONTRACTOR(S) will give a copy of the client plan to the client on
request.
2. Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for
the individual elements of the client plan described in item 1.
C. Progress Notes
Exhibit E
Page 3of3
1. Items that must be contained in the client record related to the client's progress in
treatment include:
• The client record will provide timely documentation of relevant aspects of client
care
• Mental health staff/practitioners will use client records to document client
encounters, including relevant clinical decisions and interventions
• All entries in the client record will include the signature of the person providing
the service (or electronic equivalent); the person's professional degree, licensure
or job title; and the relevant identification number, if applicable
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge
summary
2. Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated
below:
A. Every Service Contact
■ Mental Health Services
■ Medication Support Services
■ Crisis Intervention
Exhibit F
Page 1 of 2
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,
Exhibit F
Page 2 of 2
upgrading, demotion, transfer, rates of pay or other forms of
compensation, use of facilities, and other terms and conditions of
employment.
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all
further funds, until CONTRACTOR can show clear and convincing
evidence to the satisfaction of COUNTY that funds provided under
this Agreement were not used in connection with the alleged
discrimination.
D. Nepotism
Except by consent of COUNTY's Department of Behavioral Health
Director, or designee, no person shall be employed by
CONTRACTOR who is related by blood or marriage to, or who is a
member of the Board of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations,
including but not limited to, laws, regulations, and State policies relating to
patients'rights
Exhibit G
Page 1 of 2
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 written procedures for referring individuals to a
psychiatrist when necessary, or to a physician, if a psychiatrist is not available.
9. The organizational provider has as head of service a licensed mental health
professional of other appropriate individual as described in Title 9, CCR, Sections
622 through 630.
10. 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.
Exhibit G
Page 2 of 2
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86
degrees F and refrigerated drugs at 36-46 degrees F.
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.
11. For organizational providers that provide day treatment intensive or day
rehabilitation, the provider must have a written description of the day treatment
intensive and/or day treatment rehabilitation program that complies with State
Department of Health Care Service's day treatment requirements. The COUNTY
shall review the provider's written program description for compliance with the State
Department of Health Care Service's day treatment requirements.
12. 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 (3) 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 H
Page 1 of 2
Fresno County Mental Health Plan
Grievances and Appeals Process
Grievances
The 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 to give verbal and written information to Medi-Cal beneficiaries
regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
their clients copies of all current beneficiary information annually at the time their
treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self-addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Exhibit H
Page 2 of 2
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.
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 ninety (90) calendar days of the date of the receipt of the non-approval of
payment.
The MHP shall have sixty (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 Managed Care staff who were 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 thirty (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 sixty (60)
calendar days of receipt of the complaint. The decision rendered buy the MHP is final.
Exhibit I
Page 1 of 2
FRESNO COUNTY MENTAL HEALTH PLAN
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit I
Page 2 of 2
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) Where did this happen?
Name/DMH#
1. Background information of the incident:
2. Method of investigation: (chart review,face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses,visitors, physicians,employees)
3. Preliminary findings: How did it happen?Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent inconsequential �❑ consequential death not applicable �❑ unknown �❑
4. Response: a)corrective action, b)Plan of Action, c)other
Completed by(print name)
Completed by(signature) Date completed
Reviewed by Supervisor(print name)
Supervisor Signature Date
Exhibit J
Page 1 of 2
Vendor: Contract# Contact Person Contact#
a e a e Fresno
Item Make/Brand ' Mod Serial# k y y m Requested Approved( Purchase Location Condition County Cost
c (If Fixed If Fixed Date Inventory
v) I I Number
a�
n
m Copier Canon 27CRT 9YHJY65R x 3/27/2008 4/1/2008 4/10/2008 Heritage New $6,500.00
x
w
m
Q
E DVD Player Sony DV2230 PXC4356A n/a 4/1/2008 Heritage New $
x
w
Date Prepared:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Exhibit J
Page 2 of 2
23
24
25
Date Received:
Exhibit J-1
FIXED ASSET AND SENSI TI VE ITEM TRACM NG Page 1 of 1
Fi el d Nurrber Fi el d I nst r uct i on or Commnt s Requi red or Condi t i onal
Descr i pt i on
Header Vendor I ndi cat e t he I egal narre of t he agency cont r act ed t o Requi red
pr ovi de ser vi ces.
Header Pr ogr am I ndi cat e the title of the project as described in the Requi red
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 nurrber. I f not Requi red
known, County st of f can pr ovi de.
Header Contact Person I ndi cat a the first and last narre of the pr i nar y agency Required
contact for the contract .
Header Cont act # I ndi cat e t he rrnst appr opr i at e t el ephone nurrber of t he Requi red
pr i rrar y agency cont act f or t he cont r act .
Header Date Prepared I ndi cat e t he rrost cur r ent dat e t hat t he t r acki ng form Requi red
was corrpl et ed by the vendor .
a Item I dent i f y t he i t em by pr ovi di ng a comronl y recognized Requi red
descr i pt i on of the item
b IVbke/ Brand I dent i f y t he company t hat rranuf act ur ed t he i t em Requi red
c IVbdel I dent i f y t he rrodel number f or t he i t ern i f appl i cable. Condi t i onal
d Ser i al # I dent i f y t he ser i al nurrber f or t he i t ern i f appl i cabl e. Condi t i onal
IVbr 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 rnor e to i ndi cat e that the i t em i s a fixed Condi t i onal
asset .
IVI�r k the box with an "X' if the item rreet s the cr i t er i a
f Sensitive Item of a sensi t i ve i t em as def i ned by t he Count y. Conditional
g Dat a Request ed I ndi cat e t he dat e t hat t he agency subrri t t ed a request Requi red
to 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 Required
to purchase t he i t em
i Purchase Date I ndi cat a the dat e t he agency purchased t he i t em Requi red
j Locat i on I ndi cat e the physi cal I ocat i on of t he i t em Required
k Condi t i on I ndi cat e the general condi t i on of t he i t em ( New, Good, Requi red
Mr n, Bad) .
Fresno County
I Inventory I ndi cat e t he FR # provided by the County for the item Condi t i onal
Nurrber
m Cost I ndi cat e t he t of al pur chase pr i ce of t he i t em i ncl udi ng Requi red
sales tax and other costs, such as shi ppi ng.
Exhibit K
Page 1 of 2
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.
l THINK
He��Mof www.ThinkCulturalHealth.hhs.gov CULTURAL
f'O M H a�dn`a��,t, HEALTH •
Ottke Of MlnorlN HeaR11
Exhibit B
Page 2 of 2
The Case for the Enhanced National CLAS Standards
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
—Dr. Martin Luther King, Jr.
Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human
Services [HHS] Office of Minority Health, 2011). 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 (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease Prevention
and Health Promotion, 2010). Though health inequities are directly related to the existence of historical and current
discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate
services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of
all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely
affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but
also a public health concern. In the United States, it has been estimated that the combined cost of health disparities and
subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin, & Richard, 2009).
Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care
and services (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CLAS Standards will improve an organization's ability to address
health care disparities.
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities
(HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to
End Health Disparities, 2011), 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
enhanced 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:
Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ
Publication No.04-E008-02).Retrieved from the Agency of Healthcare Research and Quality website:
http://www.a h rq.gov/down loads/pub/evidence/pdf/m i nq ua l/m i nq ua I.pdf
Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).
Retrieved from The Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
LaVeist,T.A.,Gaskin,D.J.,&Richard,P.(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic
Studies website: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
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
U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.
Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved
from http://www.healthypeople.gov/2020/topicsobjectives2O2O/overview.aspx?topicid=39
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
World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
I THINK
He MandHu www.ThinkCulturalHealth.hhs.gov CULTURAL —
f'O M H a�dno��,�, HEALTH •
Ottke Of MlnorlN HeaR11
Exhibit K
Page 1 of 1
CULTURAL COMPETENCE FORM
Agency Name:
Program Category:
Identify the Agency's ability to apply language, gender, and culturally specific competencies to the services
provided by checking all that apply and/or provide the name of Agency that you have an arrangement with to
respond to these referrals.
A B C
Language, Gender, and/or Have staff Name of Agency that you have an
Cultural Competence 1 2 arrangement with to respond to
Included in Not included these referrals
staffing in staffing
work plan work plan.
Explain
below
Spanish (Language
Vietnamese (Language
Other Language:
LGBT Staff
African American Staff
Latino Staff
Native American Staff
Asian American Staff
Pacific Islander Staff
Others:
Page 1 of 1
Exhibit L
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) City State ZIP code
CLIA number Taxpayer ID number(EIN) /Telephone number
l )
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVIII, XIX, or XX? ......................................................................................................................... o 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 XVI 11, XIX, or XX?...................................................................................... n n
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 71
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: n Sole proprietorship n Partnership o Corporation
71 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........................................................................................................... >
71
NAME ADDRESS PROVIDER NUMBER
Exhibit L
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... n n
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... n n
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ n n
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 M
1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit M
2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) (d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)
Exhibit N
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 N
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:
CENTRAL CALIFORNIA EMERGENCY
MEDICAL SERVICES
A Division of the Fresno County Department of Public Health
Manual Policy
Emergency Medical Services Number 547
Administrative Policies and Procedures
Page 1 of 9
Subject Patient Destination
References Title 13, Section 1106 of the California Code of Regulations Effective:
Title 22, Division 9, Chapter 7 of the California Code of Regulations 04/18/83
I. POLICY
Patients of the Prehospital EMS System shall be transported to an appropriately staffed and equipped hospital.
II. MEDICAL PATIENT DESTINATION
A. Medical Patients shall be transported to the appropriate destination in accordance with the following chart:
Fresno County Kings County Madera County Tulare County
Medical—Adult
Non-emergent Patient's Choice Patient's Choice Patient's Choice Patient's Choice
Life-threatening Closest Appropriate Closest Appropriate Closest Appropriate Closest Appropriate
Regional Medical Kaweah Health Medical Regional Medical Kaweah Health Medical
Acute current of injury Center or St.Agnes Center or Regional Center or St.Agnes Center or Regional
(acute MI) Medical Center Medical Center Medical Center Medical Center
(Quickest travel time) (Quickest travel time) (Quickest travel time) (Quickest travel time)
Medical—Pediatric(14 years or younger)
Stable Patient/Family Choice Patient/Family Choice Patient/Family Choice Patient/Family Choice
Kaweah Health Medical
RMC or VCH*** RMC or VCH * * RMC or VCH *** Center or
Unstable (Quickest travel time) (Quickest travel time) (Quickest travel time) Sierra View District
Hospital
(Quickest travel time)
5150 patients
CSC or Patient's Choice
5150-Adult within Fresno County Patient's Choice within Patient's Choice within Patient's Choice within
(See criteria on page 4) Kings County Madera County Tulare County
YCSU or Patient/Family
5150—Children (<18 Choice within Fresno Patient/Family Choice Patient/Family Choice Patient/Family Choice
yrs) County within Kings County within Madera County within Tulare County
(See criteria on page 4)
Kaiser Kaiser N/A N/A N/A
Veteran's Administration Veteran's Administration N/A N/A N/A
*** If transport time is greater than 60 minutes, base hospital contact shall be made to determine appropriate destination.
Approved By Daniel J. Lynch Revision
EMS Division Manager (Signature on File at EMS Agency 3/14/2022
Jim Andrews, M.D.
EMS Medical Director (Signature on File at EMS Agency)
Page 2 of 9
Subject: Policy
Patient Destination Number: 547
B. Medical Patient Destination —Considerations
1. In a non-emergent situation (as determined by the EMT or Paramedic at the scene and/or the
Base Hospital Physician/MICN giving medical direction), the patient will be taken to the receiving
hospital of his/her choice. If the patient is unable to determine this, the hospital designated by the
private physician and/or patient's family member will be utilized. Paramedics and EMTs should
determine where the patient normally receives their medical care and encourage the patient to
return to that hospital for medical care as long as the patient's medical condition allows for such
transport.
2. The Paramedic/EMT/MICN/BHP should only provide the patient with alternatives for destination
of patient choice. It is inappropriate for the Paramedic/EMT/MICN/BHP to endorse specific
facilities or provide personal opinion on the quality of local facilities.
3. Health Plans - If the patient is a member of a health plan with a preferred hospital, an attempt
should be made to transport the patient to a participating facility.
4. Closest Appropriate Hospital
a. The closest appropriate hospital is defined as the closest emergency department
"equipped, staffed, and prepared to administer care appropriate to the needs of the
patient" (California Code of Regulations, Title 13, Section 1106 (b) 2).
b. Closest is defined as the shortest travel time not necessarily the closest by distance.
C. The Base Hospital Physician will have the ultimate authority for patient destination.
d. The closest appropriate hospital does not mean that critically ill patients always go to the
closest"receiving" hospital. They go to the closest"appropriate" hospital. The following
guidelines will help to define "appropriate":
1) Due to short transport times, the appropriate receiving facility for a life-
threatening medical situation would be a hospital with a basic emergency service
(holds a special services permit from the California State Department of Health
Services). Hospitals with basic emergency services are:
a) Adventist Health Hanford (AH-H)
b) Adventist Health Tulare (AH-T)
c) Clovis Community Medical Center(CCMC)
d) Kaiser Permanente Hospital (KPH)
e) Kaweah Health Medical Center(KHMC)
f) Madera Community Hospital (MCH)
g) Regional Medical Center(RMC)
h) Saint Agnes Medical Center(SAMC)
i) Sierra View District Hospital (SVDH)
j) Valley Children's Hospital (VCH)
2) Rural Areas - Due to prolonged travel times to the urban area, the appropriate
receiving hospital for a life-threatening medical situation would be a hospital with
a standby emergency service (holds a special services permit from the California
State Department of Health Services). Hospitals with stand-by emergency
services that are approved to receive ambulances are:
a) Adventist Health Reedley (AH-R)
b) Adventist Health Selma (AH-S)
c) Coalinga Regional Medical Center(CRMC)
Page 3 of 9
Subject: Policy
Patient Destination Number: 547
5. Acute Cardiac Emergency
In the event of an acute current of injury, transport should be to a designated cardiac center,
which has 24/7 interventional heart catheterization capabilities. The following is a list of readings
from various cardiac monitors that would require transport to a designated cardiac center:
• ***ACUTE MI *** (Zoll Monitor E Series)
• ***STEMI*** (Zoll Monitor X Series))
• ***ACUTE MI SUSPECTED*** (Physio-Control Monitor LifePak 12)
• ***MEETS ST ELEVATION MI CRITERIA*** (Physio-Control Monitor LifePak 15)
The designated cardiac centers in the CCEMSA region are:
• Regional Medical Center
• Kaweah Health Medical Center
• Saint Agnes Medical Center
Transport shall be to the cardiac center that has the quickest transport time if transport time is
less than 60 minutes. If transport time is greater than 60 minutes, then transport to the closest
appropriate facility or consider helicopter rendezvous. Destination is determined by:
a. Interpretation of 12-lead ECG; or
b. Base Hospital consultation if required.
6. Patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an advanced airway or
OPA, this is not an unstable airway.
b. Any patient with CPR in progress.
C. Any critically ill or unstable patient when Base Hospital contact is not possible (i.e.,
Paramedic or EMT must make the ultimate destination decision).
7. Patients who go to a non-receiving hospital:
Patients may be transported to a non-receiving hospital only when the Base Hospital has
contacted the receiving doctor and received assurance of immediate acceptance of the patient.
Such assurance should then be documented on the Base Hospital run form.
8. Patients who go to a receiving hospital, which is not closest:
Unstable patients who request this hospital and, in the opinion of the Base Hospital Physician,
the extra travel time is not dangerous to the patient
Page 4 of 9
Subject: Policy
Patient Destination Number: 547
C. Fresno County 5150 Holds—Considerations
1. Fresno County 5150 patient criteria for transport Crisis Stabilization Center(CSC)Youth Crisis
Stabilization Unit (YCSU):
a. If the patient meets the following criteria, he/she shall be transported directly to Crisis
Stabilization Center(CSC) if age 18 or greater; or the Youth Crisis Stabilization Unit
(YCSU) if under 18 years of age:
• No urgent medical complaint or evidence of acute medical/surgical/trauma problem
requiring urgent treatment prior to psychotic admission.
• No alteration in mental status due to dementia or delirium.
• Glasgow Coma Score 14 or 15.
• Complete vital signs within limits (HR, RR, BP and GCS).
• Not febrile to palpation/measurement.
• Under the influence of alcohol or drugs, patient can walk without assistance and is
able to follow verbal commands (does not apply to YCSU).
1) Adults:
a) Pulse: 50-120 bpm
b) Systolic Blood Pressure: 100-180 mm Hg
c) Diastolic Blood Pressure: less than 120 mm Hg
d) Respiratory Rate: 12-30
2) Pediatrics:
a) Vital signs appropriate for children (policy 530.32).
NOTE: Refer to the Criteria for Transporting a Fresno County 5150 Patient Directly to
Crisis Stabilization Center(CSC)or Youth Crisis Stabilization Unit (YCSU)
Screening Form attached to this policy.
Patients that Crisis Stabilization Center(CSC)and Youth Crisis Stabilization Unit(YCSU)
cannot accept:
• Patients with dementia or delirium.
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use,
catheters, wired devices, etc.).
• Patients in wheelchairs that cannot move independently.
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires
anything more that once daily dry gauze and tape dressing.
b. All other patients on a 5150 hold in Fresno County not meeting the above criteria will be
transported to Patient/Family Choice within Fresno County.
C. Patients placed on a 5150 hold are to be transported to facilities within the county where
the 5150 hold was initiated.
d. The 5150 destination policy does not apply to psychiatric patients who are voluntarily
requesting evaluation (not on a 5150 hold). If the patient is not on a 5150 hold, then
transport will be to a receiving facility of their choice, which includes CSC or YCSU
(Fresno County only) if patient meets criteria within this policy.
e. Kaiser Permanente patients on a 5150 hold are to be transported to that facility.
f. Veteran's Administration patients on a 5150 hold are to be transported to that facility.
Page 5 of 9
Subject: Policy
Patient Destination Number: 547
D. Veteran's Administration
1. The Veteran's Administration emergency department will accept all patients with a Veterans
Administration (VA) Identification Card or active-duty Department of Defense (DOD) Card (Patient
Name Only, no dependent(s). Name of patient on card must be the patient requesting transport).
No prior approval or Base Hospital contact is necessary. If the patient requests transport to
Veterans Administration emergency department and does not have the identification noted
above, contact the VA Emergency Department directly for prior approval before the patient is
transported. The complete name and the full social security number will be required. Contact the
Veteran's Administration on Med 6 or 241-3600.
2. Patients that cannot be transported directly to the Veteran's Administration are:
• Cardiac arrest due to trauma
• Pediatric cardiac arrest
• Trauma Center Triage Criteria
• OB patient in active labor
• Gynecological complaints and known obvious pregnancy with vaginal bleeding
• ST-segment elevation myocardial infarction (STEMI)
NOTE: INTERFACILITY TRANSPORTS ARE NOT MANAGED THROUGH THIS PROCEDURE.
III. TRAUMA PATIENT DESTINATION
A. Trauma patients shall be transported to the appropriate closet facility in accordance with the following chart:
0 F-5,
ss Physiological Criteria
ystolic Blood Pressure:
o Adults: <90 mm Hg
o Pediatrics: <80 mm Hg with signs
and symptoms of shock(Refer to EMS
Policy 530.32 for estimated weight
formulas or use Broselow Tape)
• Respiratory Rate:
o Adults: <10 or>30 RMC or KHMC
o Children: <20 if under age 1 VCH(14 years or age or less)
•Glasgow Coma Score<13(or,in patients whose (Consider air transport)
normal GCS is less than 15,or a decrease of two
or more of the patients GCS score)
• Penetrating injury to the head
• Paraplegia
• Quadriplegia
Assess Anatomy of Injury
• Penetrating injuries to neck or torso RMC or KHMC
• Flail chest VCH(14 years or age or less)
• Two or more proximal long-bone fractures (Consider air transport)
• Amputation proximal to wrist or ankle 00
TRAUMA DESTINATION CHART
Page 6 of 9
Subject: Policy
Patient Destination Number: 547
Assess Burns
STABLE TRAUMA PATIENTS WITH:
• Partial/Full thickness burns>10%TBSA
• Partial/Full thickness circumferential burns RMC
• Partial/Full thickness burns to face,hands,feet, IRWIN 1 11 (Consider air transport)
major joints,perineum,or genitals
• Electrical burns with voltage>120 volts
• Chemical burns>10%TBSA
Assess Mechanism of Injury
• Falls
o Adults: >20 ft.(one story=10 ft.) RMC or KHMC
o Children: >10 ft.or 3 times height of the VCH(14 years of age or less)
child (Consider air transport)
Assess Special Considerations
WITH A SIGNIFICANT COMPLAINT:
• Age greater than 55 years
• Anticoagulation or bleeding disorders Consider transport to
• Pregnancy greater than 20 weeks RMC or KHMC
• Auto vs.Pedestrian>20 mph VCH(14 years of age or less)
• Motorcycle crash>20 mph
Paramedic/Flight Nurse Judgment
Consider RMC or KHMC
WITH A SIGNIFICANT COMPLAINT VCH(14 years of age or less)
Base Hospital Consultation
SIGNIFICANT COMPLAINT
Transport According to Policy
Perseveration
Deteriorating mental status
Severe chest pain
Severe shortness of breath
Severe abdominal pain
Sustained,overwhelming"Feeling of Doom"
Page 7 of 9
Subject: Policy
Patient Destination Number: 547
NOTE: If transport time is greater than 60 minutes for patients meeting trauma triage criteria, base
hospital contact shall be made to determine appropriate destination.
NOTE: If transport time is greater than 2 hours for patients meeting burn triage criteria, base hospital
contact shall be made to determine appropriate destination.
B. Triage Criteria
Triage criteria will determine if the patient will be transported to a trauma center or closest receiving
hospital.
C. Trauma Patient Destination —Considerations
1. If the patient is in cardiac arrest from penetrating trauma in the greater Fresno or Visalia
metropolitan area, the patient should be transported to Regional Medical Center, Kaweah Health
Medical Center or Valley Children's Hospital, bypassing a closer receiving facility. However, if the
transport time to Regional Medical Center, Kaweah Health Medical Center, or Valley Children's
Hospital is greater than ten (10) minutes, then transport should be to the closest receiving facility
within ten minutes transport time (Refer to EMS Policy#550).
2. Trauma patients, meeting trauma center criteria, who have a transport time greater than 60
minutes to the trauma center, will require base hospital contact for destination decision.
3. The following types of incidents should be consideration for transport to the designated Trauma
Center, based upon paramedic judgment:
a. Motorcycle Crash - Non-ambulatory with potential of significant injuries
b. Auto versus Pedestrian - Non-ambulatory with potential of significant injuries
NOTE:Paramedic judgment is based upon the paramedic's own knowledge and experience to determine
if the patient's condition would require transport to a designated Trauma Center due the mechanism of
injury and potential underlying injuries. The Paramedic may contact a Base Hospital for advice on
destination.
4. Transport of Trauma Patients by Helicopter
A trauma patient should not be transported by helicopter unless they meet trauma triage criteria
to be transported to a trauma center or the patient is inaccessible by ambulance (i.e., wilderness
transports). EXCEPTION: When the paramedic feels helicopter transport of the patient would be
beneficial to the outcome of the patient.
5. Burn Patients
The following patients should be transported directly to the Regional Burn Center(Regional
Medical Center) bypassing other hospitals if ETA to Regional Medical Center is within two hours.
a. Patients with 20(partial thickness) or 30(full thickness) burns that are more than 10%
total body surface area
b. Patients with 20(partial thickness) or 31, (full thickness) circumferential burns of any body
part
C. Patients with 20(partial thickness) or 30(full thickness) burns to face, hands, feet, major
joints, perineum, or genitals
d. Electrical burns with voltage greater than 120 volts
e. Patients with chemical burns greater than 10% total body surface area.
Page 8 of 9
Subject: Policy
Patient Destination Number: 547
6. Carbon Monoxide Poisoning - Early call-ins to Regional Medical Center should be made for
patients that appear to have significant exposure to carbon monoxide poisoning (altered mental
status, vomiting, and headaches).
7. Trauma patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an ET Tube or OPA,
this is not an unstable airway.
b. Any patient with CPR in progress (refer to EMS Policy#550).
C. Any critically injured or unstable patient when Base Hospital contact is not possible
(i.e., Paramedic or EMT must make the ultimate destination decision).
IV. PATIENTS WHO REFUSE TRANSPORT TO THE APPROPRIATE HOSPITAL
A Base Hospital shall be contacted for the purpose of physician consultation on patients who meet one or more of
the triage criteria and refuse transport to the appropriate hospital. This will usually not be a problem with the
acutely ill patient. However, some patients with normal mental status may wish to be transported to a different
hospital than the one selected via the triage criteria. These situations should be treated as "Refusal of Medical
Care and/or Transportation" situation (refer to EMS Policy#546). The Base Hospital Physician, after radio
contact, may allow the patient to go to the destination of their choice, have a "Refusal of Medical Care and/or
Transportation " signed or insist on transport to the designated hospital.
V. SPECIAL CONSIDERATION FOR FRESNO HEART & SURGICAL HOSPITAL DESTINATION
While the Fresno Heart& Surgical Hospital is a hospital within Central California EMS Region, it does not have
an emergency department and is not an approved facility for patient transports within EMS Policy and
Procedures. Patients who are requesting transport to the Fresno Heart& Surgical Hospital from the prehospital
setting will require Base Hospital contact to confirm acceptance. Since the Fresno Heart & Surgical Hospital is
under the Community Medical Center organization, EMS personnel should contact Regional Medical Center
when requesting transport to the Fresno Heart & Surgical Hospital. If attempts to contact Regional Medical
Center are unsuccessful, EMS personnel should contact another Base Hospital. Interfacility transfers involving
the Fresno Heart& Surgical Hospital shall be in accordance with EMS Policy#553, "ALS Interfacility
Transports".
Central California EMS Agency
Criteria for Transporting a Fresno County 5150/Psychiatric Patient
Directly to CSC or YCSU Screening Form
Patient's Name: EMS#:
Patient has urgent medical complaint or evidence of acute medical/surgical problem.
[] True—transport Patient/Family Choice [] False
Patient has alteration in mental status due to dementia or delirium.
[] True—transport Patient/Family Choice [] False
Patient has a Glasgow Coma Score 13 or less.
[] True—transport Patient/Family Choice [] False
There are lacerations with a gap of greater than 2 mm or fat/muscle visible in the wound (excludes any
type of stab wound).
[] True—transport Patient/Family Choice [] False
There are lacerations or wounds inflicted by others.
[] True—transport Patient/Family Choice [] False
Complete vital signs are within limits:
Adults:
Pulse outside range of 50-120. [] True—transport Patient/Family Choice [] False
Systolic Blood Pressure outside range of 100-180. [] True—transport Patient/Family Choice [] False
Diastolic Blood Pressure greater than 120. [] True—transport PatienUFamily Choice [] False
Respiratory Rate outside range of 12-30. [] True—transport PatienUFamily Choice [] False
Pediatrics:
Vital signs inappropriate for children
(Policy 530.32) [] True—transport Patient/Family Choice [] False
Patient is febrile to palpation/measurement.
[] True—transport Patient/Family Choice [] False
Is patient under the influence of alcohol or drugs?
[] Yes No
If yes, to under the influence of alcohol or drugs, does patient require assistance to walk?
[] True—transport Patient/Family Choice [] False
If all of the above answers are False, patient may be transported to CSC/YCSU; otherwise, transport is
Patient/ Family Choice.
Patients that Crisis Stabilization Center(CSC) or Youth Crisis Stabilization Unit(YCSU) cannot accept:
• Patients with dementia or delirium
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use, catheters,
wired devices, etc.)
• Patients in wheelchairs that cannot move independently
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires anything more
than once daily dry gauze and tape dressing