HomeMy WebLinkAboutAgreement A-22-422 Amendment with Kings View Rural CIT.pdf ii
DocuSign Envelope ID:52471 E7A-61 133-4540-13C76-0106CCAF9C4A Agreement No. 22-422
1 AMENDMENT I TO AGREEMENT
2
3 THIS AMENDMENT, hereinafter referred to as"Amendment I", is made and entered into this
4 20th day of September , 2022, by and between the COUNTY OF FRESNO, a Political Subdivision
5 of the State of California, hereinafter referred to as "COUNTY", and KINGS VIEW, a private non-profit
6 501(c)(3) California organization, whose address is 7170 N. Financial Drive, Suite 110, Fresno, CA 93720,
7 hereinafter referred to as "CONTRACTOR" (collectively the "parties").
8 WITNESSETH:
9 WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), the Mental Health
10 Services Act (MHSA) Prevention and Early Intervention (PEI) component and input from the MHSA
11 community stakeholder process, recognizes the need to provide crisis intervention team (CIT) services to
12 individuals experiencing a behavioral health crisis in the rural areas of Fresno County; and
13 WHEREAS, COUNTY, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of
14 the California Code of Regulations (C.C.R.), Section 1810.226; and
15 WHEREAS, CONTRACTOR is qualified and willing to provide said services pursuant to the
16 terms and conditions of this Agreement; and
17 WHEREAS, the COUNTY, through its DBH, has received additional grant funds for, and wishes
18 CONTRACTOR to employ additional case management staff to provide post-crisis follow-up services in
19 conjunction with other services provided pursuant to Agreement No. 22-266.
20 NOW, THEREFORE, in consideration of the mutual covenants, terms and conditions herein
21 contained, the parties hereto agree as follows:
22 1. That in existing County Agreement No. 22-266, all references to "Exhibit C" shall be
23 replaced with the text "Exhibit C and Exhibit C-2". Exhibit C-2 is attached hereto and incorporated
24 herein by this reference.
25 2. That in existing County Agreement No. 22-266, all references to "Exhibit A" shall be
26 replaced with the text "Exhibit A and Exhibit A-2". Exhibit A-2 is attached hereto and incorporated herein
27 by this reference.
28 3. That COUNTY Agreement No. 22-266, Section One (1) "SERVICES", Subsection D, Page
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1 Two (2) beginning on Line Nine (9) with the word "This" and ending on Page Two (2), Line Thirteen (13)
2 after the word "requested" be deleted and the following inserted in its place:
3 "D. This Agreement provides for CIT services in the rural areas of Fresno County.
4 CONTRACTOR shall collect, maintain and report all data for Rural CIT services by the East and West
5 regions of Fresno County, independent of one another, including but not limited to: Medi-Cal billing,
6 other insurance billing, and reports; staff schedules and reports; performance measures; monthly
7 invoices and general ledgers; Crisis Care Mobile Units (CCMU) grant reports; and other data as
8 requested."
9 4. That COUNTY Agreement No. 22-266, Section Four (4) "COMPENSATION",
10 Subsection A, Page Five (5) beginning on Line Eleven (11) with the word "COUNTY" and ending on
11 Page Six (6), Line One (1) after the word "compensation" be deleted and the following inserted in its
12 place:
13 "A. COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
14 compensation for actual expenditures incurred in accordance with the CONTRACTOR's "budget"
15 documents approved by the COUNTY's DBH Director or designee and attached hereto as Exhibit C "Cost
16 Proposal and Narrative" and Exhibit C-2 "Crisis Care Mobile Units Grant Budget" and incorporated herein
17 by this reference.
18 The maximum amount payable to CONTRACTOR for the period of July 1, 2022
19 through June 30, 2023 shall not exceed Two Million, Nine Hundred and Fifteen Thousand, Seven Hundred
20 and Sixty-Nine, and No/100 Dollars ($2,915,769.00).
21 The maximum amount payable to CONTRACTOR for the period of July 1, 2023
22 through June 30, 2024 shall not exceed Two Million, Eight Hundred and Sixty Thousand, Seven Hundred
23 and Twelve, and No/100 Dollars ($2,860,712.00).
24 The maximum amount payable to CONTRACTOR for the period of July 1, 2024
25 through June 30, 2025 shall not exceed Two Million, Eight Hundred and Sixty-Two Thousand, Seven
26 Hundred and Fifty-Seven, and No/100 Dollars ($2,862,757.00).
27 In no event shall compensation paid for services performed under this Agreement be
28 in excess of Eight Million, Six Hundred and Thirty-Nine Thousand, Two Hundred and Thirty-Eight, and
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DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
1 No/100 Dollars ($8,639,238.00) during the term of this Agreement.
2 It is understood that all expenses incidental to CONTRACTOR'S performance of
3 services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails to comply with
4 any provision of this Agreement, COUNTY shall be relieved of its obligation for further compensation."
5 5. COUNTY and CONTRACTOR agree that this Amendment I is sufficient to amend the
6 Agreement; and that upon execution of this Amendment I, the Agreement and Amendment I shall be
7 considered the Agreement.
8 6. The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
9 covenants, condition and promises contained in the Agreement, and not amended herein, shall remain in
10 full force and effective. This Amendment I shall be effective upon execution.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year
2 first hereinabove written.
3
4 CONTRACTOR: COUNTY OF FRESNO
5 Kings V' ocusigned by.
6 BY: 4— 0j,
7 Brian Pacheco, Chairman of the Board of
g Print Name:
Amanda Nugent Divine Supervisors of the County of Fresno
9
10 Title: CEO
11 Chair of the Board, or President
or any Vice President ATTEST:
12 Bernice E. Seidel
o�,sbd.d by: Clerk of the Board of Supervisors
13 1w ..d County of Fresno, State of California
14 By.
15
Mich
16
Print Name: Michael Kosareff By
17 Title: CFO
Deputy
18 Secretary of Corporation, or
19 any Assistant Secretary, or
Chief Financial Officer, or
20 any Assistant Treasurer
21
FOR ACCOUNTING USE ONLY:
22 Fund: 0001
Subclass: 10000
23 Org: 56304766
Account: 7295
24
Program Budget CCMU Grant Budget Total
25 FY 2022-23: $2,833,225.00 $82,544.00 $2,915,769.00
FY 2023-24: $2,850,944.00 $9,768.00 $2,860,712.00
26 FY 2024-25: $2,862,757.00 $0.00 $2,862,757.00
27 Total: $8,546,926.00 $92,312.00 $8,639,238.00
28
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Exhibit A-2
Page 1 of 5
Crisis Care Mobile Units (CCMU) Grant
SCOPE OF WORK
CONTRACTOR: Kings View
PROGRAMS: Rural Crisis Intervention Team (Metro CIT)
SITE ADDRESS: 4910 E. Ashlan Ave. Ste. 118, Fresno, CA 93726
PROJECT TERM: September 20, 2022 — June 30, 2024
I. PROJECT DESCRIPTION
DHCS utilized $150 million in funding received from the Behavioral Health Continuum
Infrastructure Program and $55 million in funding received from the Substance Abuse and
Mental Health Services Administration through the Coronavirus Response and Relief
Appropriations Act to solicit applications from county or city behavioral health agencies to
support and expand behavioral health mobile crisis and non-crisis services. The County of
Fresno Department of Behavioral Health (DBH) included $92,312 in grant funding to add case
management staff to the Rural CIT program.
The goal of the CCMU grant project is to expand crisis intervention team (CIT) services to youth
twenty-five (25) years of age and younger by adding dedicated case management staff to follow
up on every CIT encounter with this population. Services are provided by interagency
coordination between behavioral health clinicians, case managers and community-based
organizations to link these individuals to behavioral health services and other supports identified
by the behavioral health clinician during the CIT encounter(s).
II. SERVICES START DATE
Contractor shall begin recruiting for case management staff effective September 20, 2022.
III. TARGET POPULATION
The target population to be served by the case managers funded through the CCMU grant
project shall be every youth twenty-five (25) years of age or younger after a CIT encounter
with contractor's CIT clinician. Although this population must be prioritized, the case
management staff may conduct post-crisis follow-up with other individuals if time permits.
Based on CIT services provided in FY 2021-22, the added case management staff will provide
an estimated 2,400 services per fiscal year to 1,350 youth. Youth twenty-five (25) years old
and younger make up approximately 50% of individuals served by the CIT programs and
accounts for about 50% of CIT services provided.
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Exhibit A-2
Page 2 of 5
Contractor shall provide culturally and linguistically appropriate services that will meet the needs
of the youth population of Fresno County.
IV. LOCATION OF SERVICES
Post-crisis follow-up services are to be provided face-to-face, over the phone, using video or via
United States mail as appropriate and in accordance with DBH's Guiding Principles of Care
Delivery.
V. DESCRIPTION OF SERVICES
Services are provided by interagency coordination between behavioral health clinicians, case
managers and community-based organizations to link these individuals to behavioral health
services and other supports identified by the behavioral health clinician during the CIT
encounter(s). A case manager must be assigned to each individual within twenty-four (24) hours
of the crisis encounter.
Case management services will be culturally responsive, strengths-based, trauma-informed and
recovery-oriented. These services will be continuously evaluated by the County and Contractor.
The Contractor must adapt to meet the geographically dispersed needs of those living in rural and
metropolitan Fresno County, the communities' needs as crisis services and demands fluctuate,
and as Fresno County identifies more appropriate CIT models that improve service delivery.
Case management services must be community-based; incorporate stigma reduction and suicide
prevention; and comprehensive of recovery practices and community engagement during the
course of service delivery.
A. Documentation and Billing
1 . Contractor will use Fresno County DBH's electronic health record (EHR) and billing
system (currently Avatar), and business management platform (currently Domo) to
conduct data analysis.
2. Contractor must complete all documentation within 24 hours of service delivery,
including but not limited to: access forms, client referral forms and progress notes.
In addition, all related documents need to be uploaded within the same timeframe.
3. Contractor must adhere to the documentation standards established in DBH's
Clinical Documentation and Billing Manual for Specialty Mental Health Services,
DBH Policy and Procedure Guides (PPG) 2.1.9 "Assessments" and DBH PPG 4.4.6
"Documentation Standards for Progress Notes" as well as any future amendments
to these documents.
4. Contractor shall utilize collaborative documentation with the person served
whenever it is clinically indicated. Staff must adhere to DBH's collaborative
documentation standards, which may include training courses offered by DBH.
B. Care Coordination and Community Collaboration
1 . Contractor shall participate in care coordination activities with DBH, law enforcement
and other community agencies.
2. Contractor agrees to coordinate with the Family Urgent Response System in Fresno
County and utilize this program as a resource for qualified individuals.
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Exhibit A-2
Page 3 of 5
3. Comprehensive knowledge of community resources is essential for case management
staff to refer persons served to appropriate services. Contractor must make all
attempts to ensure program staff are aware of applicable community resources and
how to refer to these programs.
4. If the person served is linked to a DBH program, Contractor will notify the service
provider as soon as practicable.
This Scope of Work provides an outline of desired services and should not be considered all-
inclusive.
VI. STAFFING LEVELS
The Rural CIT program will employ one (1) case manager.
DBH is working to establish a standard productivity rate for contracted providers. Once
determined, the awarded vendor must be prepared to capture, evaluate, report staff productivity,
and make necessary program adjustments to meet the requirements.
VII. HOURS OF OPERATION
Case management services shall be provided from 8:00am - 5:00pm, Monday through Friday.
VIIII. PERFORMANCE AND OUTCOME MEASUREMENTS
Contractor shall comply with all project monitoring and compliance protocols, procedures, data
collection methods, and reporting requirements requested by the County. Additionally, the
Contractor is required to complete CCMU grant reports as requested (see Attachment 1 for data
metrics). County and Contractor shall use performance outcome measures for evaluating
program and system effectiveness to ensure services and service delivery strategies are
positively impacting the service population.
In addition, these measures shall be used to ensure the program is in alignment with MHSA
guiding principles which are inclusive of: an integrated service experience; community
collaboration; cultural competence; individual/family driven service; and wellness, resilience, and
recovery-focused services.
Performance outcome measures shall be tracked on an ongoing basis and used to update the
County as requested. In addition, performance outcome measures are reported to the County
annually in accumulative reports for overall program and contract evaluation. Forms and tools
used to gather, and report data reflecting services provided, populations served, and impact of
those services are to be developed by the County and Contractor. Contractor will work closely
with the County to analyze the data and make necessary adjustments to service delivery and
reporting requirements before the start of each new fiscal year and at appropriate intervals during
the fiscal year.
Measurable outcomes may be reviewed for input and approval by a designated DBH work
group upon contract execution and adjusted as needed each new fiscal year. The purpose of
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Exhibit A-2
Page 4 of 5
this review process is to ensure a comprehensive system-wide approach to the evaluation of
programs through an effective outcome reporting process.
The following items listed below represent program goals to be achieved by Contractor. The
program's success will be based on the number of goals it can achieve, resulting from
performance outcomes. Contractor will utilize a computerized tracking system with which
outcome measures and other relevant individual data, such as demographics, will be maintained.
Contractor will collect data about the characteristics of the individuals served and measure
service delivery performance indicators in the four Commission on Accreditation of Rehabilitation
Facilities (CARF) domains listed below, with at least one performance indicator for each of the
four domains. Contractor shall submit annual outcomes on a report template to be provided by
the County for each level of care provided.
1. Effectiveness
2. Efficiency
3. Access
4. Satisfaction & Feedback of Persons Served & Stakeholders
Additional Reporting Requirements
Contractor will be responsible for meeting with DBH on a monthly basis, or more often as
agreed upon between DBH and Contractor, for contract and performance monitoring.
Contractor will be required to submit monthly reports to the County that will include, but not be
limited to: dollars billed for Medi-Cal, DSH, CCMU and MHSA (non-Medi-Cal or non-Medi-Cal
services) persons served; actual expenses; the number of persons served/anticipated to be
served; wait lists; utilization of services by persons served; and staff composition. These
reports will be due within 30 days after the last day of the previous month or payments may be
delayed.
DBH requires the following data reporting, which must be submitted to the Department by the loth
of each month, unless otherwise indicated. The reporting period is typically the prior month in
which services were provided. The following funding, staffing, services and data must be collected,
maintained and reported by the established deadlines. Reporting templates and requirements are
subject to change based on State and Federal regulations, funding guidelines and efforts to
improve service delivery.
A. Invoices must be submitted each month and shall include expenses and revenues from the
prior month.
B. The Monthly Staffing Report shall be submitted each month and must include each program
staff member, their title, full-time equivalent, salary and other information as deemed
appropriate by DBH.
C. CCMU grant reports must be submitted at least quarterly, but more frequently as needed.
D. Annual Performance Outcome Measures reports shall be completed at least annually and
submitted to DBH as requested. County staff will notify the awarded vendor when its agency's
participation is required. The performance outcome measurement report process will include
survey instruments, person served and staff interviews, chart reviews, and other methods of
obtaining necessary information as appropriate.
E. The awarded vendor will be required to provide culturally and linguistically appropriate services
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Exhibit A-2
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that align with the National Standards for Culturally and Linguistically Appropriate Services and
DBH PPG 1.5.1 Culturally and Linguistically Appropriate Services as well as any updates to
these standards. The program will be required to report staff training related to cultural
competency as requested by DBH.
VIII. COUNTY RESPONSIBILITIES:
A. The County will make available the expertise of County identified Peer Support and Family
Advocate(s) as informational resources for the awarded vendor. These resources may have
designated hours of contact for each rural community or clinician for the purpose of training,
material development and ongoing support.
B. Provide oversight, support, technical assistance and ongoing monitoring of the CCMU grant
project through an assigned Contract Analyst and Utilization Review Specialist.
C. Provide consultation on a regular basis by facilitating monthly provider meetings between
DBH and the awarded vendor.
D. Assist the Contractor in analyzing program-generated data to identify system barriers,
memorialize program strengths and improve outcomes.
E. Provide support in establishing and maintaining working relationships between the
Contractor and community-based organizations.
F. Offer training opportunities as funding allows.
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Attachment 1
DHCS
CRISIS CARE MOBILE UNITS PROGRAM
CCMU Implementation Grantees
Quarterly Report Narrative Summary
QUARTER BEGIN DATE:
QUARTER END DATE:
GRANTEE ID:
PROGRAM NAME:
NAME OF PERSON SUBMITTING FORM:
EMAIL OF PERSON SUBMITTING FORM:
DATE SUBMITTED:
Narrative Questions:
1. Provide a brief(up to 50 words) executive summary of your project and accomplishments this
quarter.
2. For each area of activity in your statement of work for this quarter, provide a description of
major activities or accomplishments that occurred during the reporting period.
a. Activities/Deliverables
i. Equipment/Property
ii. Activities/Deliverables That Build the CCMU Infrastructure
1. Vehicle-related Costs for the CCMU
2. Field Communications for CCMU
3. Dispatch of CCMU Teams
4. Trainings
5. Coordination and Planning Activities with Local and Regional
Organizations and/or to Manage Multiple CCMUs
6. Developing Peer Supports within Crisis Services
7. Marketing for CCMU Services
8. Data Collection, Analysis, and Quarterly Reporting for CCMU
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Attachment 1
iii. Direct Services
3. What challenges or barriers are you encountering and, if applicable, possible resolutions in
implementing your plan?
4. Are there any staffing or program changes this quarter? ❑Yes ❑ No—If yes, please explain your
answer.
5. Have you purchased any equipment/property this quarter? ❑Yes ❑ No—If yes, what is status?
6. Do you have any pending or new TA requests? (Check one) ❑ Yes, request in process ❑Yes, new
request❑ No—If a new request, please describe here:
Quarterly Report Data Questions
CCMU PROGRAM STATUS:
1. How many total CCMU teams do you currently have?
1a. Have new teams started this quarter? ❑Yes ❑ No
1b. If yes, how many new teams started this quarter?
2. Do CCMU teams serve all zip codes in your jurisdiction? ❑Yes ❑ No
2a. If no, what zip codes are served?
2b. If no, what zip codes are not served?
2c. Are there zip codes where new services began this quarter? ❑ Yes ❑ No
3. Are CCMU services available 24/7? ❑ Yes ❑ No
3a. If no, what are the hours of operation?
3b. If no, how many hours a week are CCMU services available?
4. How many total hours of CCMU services were available this quarter? (all hours for all teams)
5. What is the makeup of your CCMU teams? Please indicate how many of each type of team in
the table below.
Staffing Number of teams
One clinician and one peer
One clinician and one para-professional (e.g., bachelor level)
Two clinicians
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Attachment 1
One clinician and one case manager
One clinician and one EMT or other health provider
Other:
If other, please describe:
ABOUT CCMU INQUIRIES RESULTING IN DISPATCH
1. For each zip code in your jurisdiction, provide,for the reporting quarter,the number of
calls/requests received, resulting in dispatch, and resulting in CCMU services.
Zip Code Number of calls/ Number of calls/ Number of dispatches
requests to CCMU requests resulting in resulting in CCMU
dispatch services
Zip code
not
known
TOTAL
2. For each referral source, indicate how many calls were received, resulted in dispatch, and
resulted in CCMU services,for the reporting quarter.
Referral source initiating Number of calls/ Number of calls/ Number of
call/request to CCMU requests to CCMU requests resulting dispatches resulting
in dispatch in CCMU services
Crisis line/suicide
hotline/988
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911
211
FURS
Law enforcement
Medical/health provider
Criminal justice referral
Business
Homeless service provider
Community member
Family/friend
Self-referral
Other
Source not available
Total
3. Reasons for dispatch and behavioral health conditions.
3.a. For each listed primary reason for dispatch, indicate how many calls were received, resulted in
dispatch, and resulted in CCMU services,for the reporting quarter.
Primary reason for dispatch Number of calls/ Number of calls/ Number of
requests to CCMU requests resulting in dispatches resulting
dispatch in CCMU services
Possible risk of harm to self
or suicide risk
Possible risk of harm to
others
Significant decompensation
or inability to care for self
Possible substance use,
intoxication, or overdose
risk
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Attachment 1
Welfare check(individual
receiving BH Services)
Welfare check-other
Significant agitation or
bizarre behavior
Otherreason
Unknown reason
Total
3.b. For each listed behavioral health condition, indicate how many calls were received, resulted in
dispatch, and resulted in CCMU services,for the reporting quarter.
3b. Which best describes Number of calls/ Number of calls/ Number of
the behavioral health requests to CCMU requests resulting in dispatches resulting
condition? dispatch in CCMU services
Substance misuse/SUD
MH/SMI or SED
COD
Unknown
Total
4.Please indicate the number of calls, by response time,that did not result in dispatch, that resulted
in dispatch but no CCMU services,that resulted in dispatch and CCMU services, and that resulted in
dispatch,total, for the reporting quarter.
Response Time
Mean Response Time in
Minutes (all calls over
quarter)
Median Response Time
in Minutes (all calls over
quarter)
Dispatch status Number of Calls and Response Time Windows
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< 1 > 1 hours >2 hours >4 hours > 24 hours unknown
hour < 2 hours <4 hours < 24 hours
Dispatch, no CCMU
services
Dispatch, CCMU services
Total calls resulting in
dispatch
5. For the dispatches that did not result in CCMU services, how many were due to each of the
following reasons,for the specified quarter?
Reason Number of Calls
Individual not found
Individual refused services
Situation resolved in community prior to CCMU arrival
Law enforcement responded first and declined CCMU participation
Emergency health responded first and declined CCMU participation
Another reason (please describe and provide number)
Unknown
If another reason, please describe and provide number(s):
NON-DISPATCHED CCMU CALLS
6a. Does your CCMU team provide crisis services in the community without a dispatch (e.g.,through
mobile outreach or walk-in)? ❑ Yes ❑ No
If yes, complete the following tables.
6b. If yes, please indicate the number of unduplicated individuals seen,for the specified quarter,
without a dispatch (include services with CCMU metrics).
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6b. Reason for CCMU services Number of unduplicated individuals
seen without dispatch
Possible risk of harm to self or suicide risk
Possible risk of harm to others
Significant decompensation or inability to care for
self
Significant agitation or bizarre behavior
Substance use: intoxication or overdose risk
School referral
Welfare check(individual receiving BH services)
Welfare check(other)
Otherreason
Unknown
Total (may not add up exactly)
6c. Which of the following best describes the Number of unduplicated individuals
behavioral health reason for crisis services seen without dispatch
Substance misuse/Substance Use Disorder(SUD)
Mental health (MH)/Serious Mental Illness (SMI) or
Serious Emotional Disturbance (SED)
Co-occurring(COD)
Unknown
Total
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Attachment 1
CCMU SERVICES AND RESOLUTION
1. What CCMU services were delivered during the reporting quarter?
Type of CCMU service Number of individuals Percent of individuals
receiving this service receiving this service this
quarter.
Total number of CCMU service 100%
recipients
Triage/screening onsite
Clinical assessment by MH
professional
De-escalation
Support for family/friends
Coordination with medical
services
Coordination with behavioral
health services
Crisis and safety planning
5150/5185
Administered Naloxone
Other(please describe and
indicate number and percent)
If other, please describe and list the number and percentage of each other service:
2. How were CCMU services resolved during the reporting quarter?
Resolution of CCMU services Number of individuals with Percentage of individuals
CCMU resolved in this way resolved in this way
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Total number of CCMU service N/A
recipients
De-escalated onsite (no
resources/referrals)
De-escalated onsite with referrals/
warm handoff
Transported to community
behavioral health
Transported to medical care
Detained 5150 or 5185 hold
(involuntarily taken to hospital)
Detained by law enforcement
Unresolved
Other(please describe)
If other, please describe and list the number and percentage of each other service:
3. Complete tables below for more information on the types of agencies referred or transported to
as described in question 2 above.
3a. Referrals and Warm Handoffs
Name of agency Type of agency Zip Code Number of warm
handoffs/referrals
3b. When individuals are transported to agencies (medical or behavioral health)
Name of agency Type of agency Zip Code Number of warm
handoffs/referrals
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4. Follow Up Services
Services received Number of individuals Percent of individuals
receiving CCMU services
who received each of the
following:
Any CCMU services
Any follow-up care
Follow-up care within 48 hours
Engaged in at least one service at
the time of follow-up
Other(please describe and
indicate number and percent)
If other, please describe and list the number and percentage of each other service:
CCMU SERVICES— DIAGNOSES AND DEMOGRAPHICS
1. Please indicate the primary diagnosis of individuals receiving CCMU services,for the specified
quarter, by count and as a percentage of individuals receiving CCMU services.
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Attachment 1
Primary diagnosis Total number of individuals Percentage of individuals
receiving CCMU services who served receiving CCMU
have this diagnosis services who have this
diagnosis
Psychosis
Substance use disorder
Adjustment disorder
Bipolar disorder
Depressive disorder
(including MDD)
Anxiety disorder
(including PTSD)
Schizoaffective disorder
Schizophrenia
Neurodevelopmental
disorder
Severely Emotionally
Disturbed (SED)
Unspecified mental
disorder
No diagnosis
Other
Unknown
Total
2. Enter the number and percentage of individuals served,for the reporting quarter, by
race/ethnicity.
Race/Ethnicity Number receiving services As a percent of individuals
receiving services
American Indian/Alaska
Native
Asian or Asian American
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Black/African American
Native Hawaiian/Pacific
Islander
Latinx/Chicanx/Hispanic
More than one race
White
Other (please describe)
Unknown
Tota I
If"something else (not listed here)," please describe and list number:
3. Enter the number and percentage of individuals served,for the reporting quarter, by
primary language.
Primary language Number receiving services Percent of individuals
served who speak:
English
Spanish
Mandarin
Cantonese
Tagalog(including Filipino)
Vietnamese
Korean
Armenian
Farsi
Arabic
Other(please identify and
provide numbers)
Unknown
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Attachment 1
Total
If"something else (not listed here)," please describe and list number:
4. Enter the number and percentage of individuals receiving CCMU services,for the reporting
quarter, by gender.
Gender Number As a percentage of
receiving individuals receiving
services services
Male
Female
Non-binary/other
Unknown
Total
5. How many individuals served during the reporting quarter were pregnant?
6. Enter the number and percent of all individuals receiving CCMU services, for the reporting
quarter, by age group.
Age Number receiving services As a percentage of
individuals receiving
services
< 12
12-17
18-24
25-44
45-64
65+
Unknown
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Attachment 1
Total
6a. Provide the living arrangements for individuals under 18 receiving CCMU services, for the reporting
quarter, by number and as a percentage of individuals under 18 receiving services.
Living situation Number receiving services Percent of individuals aged
<18 served who:
Lives with a
parent/guardian
Does not live with a
parent/guardian
Unknown
Total
7. Enter the number and percentage of individuals receiving CCMU services, for the reporting
quarter, by sexual orientation.
Sexual orientation Number receiving Percent of individuals served
services who are:
Asexual
Bisexual/pansexual
Gay
Heterosexual/straight
Lesbian
Queer
Two-Spirit
Something else (not listed
here; please describe and
provide number and
percentage)
Unknown
Total
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Attachment 1
If"Something else (not listed here)," please describe and list number:
8. Enter the number and percentage of individuals receiving CCMU services, for the reporting
quarter, by military status.
Military status Number receiving Percent of individuals served who are:
services
Active military
Military family
Non-military
Veteran
Unknown
Total
9. Enter the number and percentage of individuals receiving CCMU services, by insurance status.
Insurance status Number receiving Percent of individual
services served who have:
Medi-Cal enrolled
Medi-Cal expired or in-
process
Medicare
Other health insurance
No health insurance
Unknown
Total
10. Enter the number and percentage of individuals receiving CCMU services, for the reporting
quarter, by housing status:
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Attachment 1
Housing status Number receiving "Percent of individuals
services served who are:
Unhoused, unsheltered
Unhoused, sheltered
At risk of homeless
Stably housed
Other
Unknown
Total
11. Enter the number and percentage of individuals receiving CCMU services,for the reporting
quarter, by previous experience with behavioral health care.
Previous behavioral health experience Number Percent of
receiving individuals
services served who:
Never received behavioral health services
before
Receive or have received SMI/SED
services (Full-Service Partnerships or
other SMI services)
Receive or have received SUD services
Have received some counseling or
health/community based mental health
services in the past
Other(please describe)
Unknown
Total
If"Other" please describe and list number:
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Attachment 1
OTHER ORGANIZATIONAL AND INFRASTRUCTURE RELATED ITEMS
1. Staffing
Please provide the following information about the staffing of your CCMU program.
Position FTEs working on FTEs currently Unduplicated count of Vacant positions
CCMU paid by CCMU staff working on CCMU in CCMU
(regardless of program (regardless of hours or program (by
funding source) funding source) FTE)
Clinicians
Peer staff
Other direct service
staff
Management and
administrative staff
Other
If"Other" please describe:
2. Outreach
Enter the total number of outreach materials developed and distributed by your organization
during the reporting quarter. Outreach materials are any materials developed to reach
providers,the community or other project stakeholders.This could include flyers, newsletters,
social media posts, billboard, email blasts, podcasts, PSAs, advertisements etc.
3a. Number of outreach materials developed this quarter:
3b. Number of outreach materials distributed this quarter:
3c. Enter the number of unique outreach materials developed, during the reporting quarter,
in each of the languages below. If a material is in more than one language, include it
under each relevant language.
Language Number of products developed
English
Spanish
DocuSign Envelope ID:52471 E7A-61 133-4540-13C76-0106CCAF9C4A
Attachment 1
Mandarin
Cantonese
Tagalog (including Filipino)
Vietnamese
Korean
Armenian
Farsi
Arabic
Other (please list)
If"Other" please list:
3d. Enter the number of visitors to the CCMU website (if applicable) during the reporting
quarter:
3e. Enter the total number of in-person or virtual community events held by or attended by your
organization for purpose of awareness/outreach, during the reporting quarter, and the total
number of attendees across all events of each type:
Outreach Event Type Number of events Total number of attendees
Community events held
Community events
attended
3f. Who was the audience for your outreach activities during the reporting quarter? (Check
all that apply.)
❑ People who use drugs
❑ People with mental health conditions
DocuSign Envelope ID:52471 E7A-61 133-4540-13C76-0106CCAF9C4A
Attachment 1
❑ People who have never accessed behavioral health care before
❑ Family members of individuals with SUD/SMI
❑ Native American/Tribal/Urban Indian populations
❑ Black/African American populations
❑ Latino/a/x specific populations
❑ Southeast Asian populations
❑ LGBTQ2SIA+
❑ Individuals experiencing homelessness
❑ Youth (under 18)
❑ TAY(18-24)
❑ Veterans
❑ Immigrants without documentation
❑ People involved with the justice system
❑ Pregnant and post-partum persons
❑ Other(please list)
3. Collaboration
3a. Enter the total number of each of the following types of agencies with whom your CCMU
program currently collaborates with:
Organization type Total number of current Total number of current
referral relationships MOUs
Peer-run organizations
SUD treatment centers
Mental health treatment centers
Hospitals
Law enforcement agencies
Schools/educational institutions
Homeless service providers
DocuSign Envelope ID:52471 E7A-61 133-4540-13C76-0106CCAF9C4A
Attachment 1
Other (please list and indicate
numbers)
If"Other" please describe and list number of relationships:
3b. How are you collaborating with each of the stakeholder groups in the development and
implementation of CCMU?
Stakeholder group Brief description of involvement in planning and implementation of
CCMU this quarter
Individuals with
lived experience
of MH/SUD
Family members
Crisis and suicide
hotlines
911 dispatch
First responders
Law enforcement
Tribal
representatives
DocuSign Envelope ID:52471 E7A-61 133-4540-13C76-0106CCAF9C4A
Attachment 1
College/university
Schools (k-12)
Housing/homeless
services
Health care
SUD services
MH services
Business
community
Other city/county
govt
Other community
agencies
DocuSign Envelope ID:52471 E7A-61 133-4540-13C76-0106CCAF9C4A
Attachment 1
Other
4. Trainings
4a. Enter the total number of trainings made available to staff of the CCMU and community
partners, for the reporting quarter, by training type.
Training type/topic Number of in- Total number Number of Total number
person attended virtual attended
trainings trainings
POST-approved Crisis
Intervention Training
Other crisis intervention
training
De-escalation techniques
(e.g., management of
agitation and verbal de-
escalation)
Understanding SMI and MH
crisis response
Understanding SUD and
crisis response (including
Naloxone training)
Suicide risk assessment and
intervention (and MH First
Aid)
Cultural humility and
culturally responsive
services
Trauma-informed care
Working with youth/TAY
and SED
DocuSign Envelope ID:52471 E7A-61 133-4540-13C76-0106CCAF9C4A
Attachment 1
Safety and self-care for field
workers
Other evidence-based
practices(e.g., harm
reduction, structured brief
interventions)
Collaboration or
administrative excellence
Accessing mobile crisis
services
Other(please list)
4b. Enter the total number of individuals trained (in 5a), by job category, during the reporting
quarter:
Job category Total number of individuals trained
Clinician
Peer
Other behavioral health provider
Administrator/manager
Administrative support
Law enforcement
Other system partner
Other(please list)
Unknown
Total
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Crisis Care Mobile Units(CCMU)Grant Funds
Kings View Rural CIT
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 QI Data Analyst 0.11 $ 7,550 $ 7,550
1102 - -
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.11 $ 7,550 $ 7,550
Acct# Program Position FTE Admin Program Total
1116 Case Manager 1.00 $ 42,545 $ 42,545
1117 - -
1118
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotall 1.00 1 $ 42,545 1 $ 42,545
Admin Program Total
Direct Personnel Salaries Subtotall 1.11 1 $ 7,550 1 $ 42,545 1 $ 50,095
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 93 $ 523 $ 616
1202 Worker's Compensation 140 791 931
1203 Health Insurance 896 5,047 5,943
1204 Other(specify) -
1205 10ther(specify) -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
1206 10ther(specify) -
Direct Employee Benefits Subtotal: $ 1,129 $ 6,361 $ 7,490
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 578 3,255 3,833
1303 SUI 30 170 200
1304 Other(specify) -
1305 10ther(specify) -
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 608 $ 3,425 $ 4,033
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 9,287 $ 52,331 $ 61,618
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
15%1 85%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support
2003 Client Transportation&Support -
2004 Clothing, Food,&Hygiene 1,500
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers -
2011 Other(Program Supplies) 500
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 10ther(specify)
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $ 2,000
3000: DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 780
3002 Printing/Postage
3003 Office, Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 5,049
3009 Other(specify) -
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:1 $ 5,829
4000: DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles 3,428
4005 Security -
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 10ther(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 3,428
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
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000: INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(Administrative Overhead) 7,569
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify)
INDIRECT EXPENSES TOTAL $ 7,569
INDIRECT COST RATE 10.10%
7000: DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 2,100
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures
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) I
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
DocuSign Envelope ID: 52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
70pg Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 2,100
TOTAL PROGRAM EXPENSES $ 82,544
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0 -
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
8009 Other(Specify) 0
8010 Other(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: 0 $
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN -Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance -
8403 Grants(Crisis Care Mobile Units) 82,544
8404 Other(Specify) -
8405 Other(Specify)
OTHER REVENUE TOTAL $ 82 544
TOTAL PROGRAM FUNDING SOURCES: $ 82,544
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
DocuSign Envelope ID:52471 E7A-61 133-4540-13C76-0106CCAF9C4A
Crisis Care Mobile Units (CCMU) Grant Funds
Kings View Rural CIT
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
QI Data Analyst PATH SMHS/Fresno 0.02
PATH/OEL Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural CIT/Fresno 0.14
Rural CIT-CCMU/Fresno 0.11
Metro CIT/Fresno 0.01
Metro CIT-CCMU/Fresno 0.11
Map Point/Fresno 0.07
FURS/Fresno 0.03
Shasta 0.04
Kings 0.24
Quality& Performance Improvement Depart. 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Crisis Care Mobile Units(CCMU)Grant Funds
Kings View Rural CIT
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 61,618
Administrative Positions 7,550
1101 Cll Data Analyst 7,550 This position will perform a wide range of duties to support data collection,
management,and reporting needs required for CCMU grant.
1102 0 -
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 42,545
1116 Case Manager 42,545 Provides post-crisis case management and care coordination activites.
1117 0 -
1118 0
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 -
Direct Employee Benefits 7,490
1201 Retirement 616 Cost of 401K
1202 Worker's Compensation 931 Workers'compensation insurance
1203 Health Insurance 5,943 Cost of medical,vision,dental,life and long-term disability insurance.
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 4,033
1301 OASDI -
1302 FICA/MEDICARE 3,833 Cost of FICA/Medicare
1303 SUI 200 Cost of SUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 2,000
2001 Child Care -
2002 Client Housing Support
2003 Client Transportation&Support -
2004 Clothing,Food,&Hygiene 1,500 Includes program supplies that support clients with items such as,clothing,snacks,
drinks,blankets,and hygiene supplies.Clothing items consist of the following:Shirts,
pants,shorts,shoes,underwear,outerwear(jackets,beanies,gloves,socks,etc.)and
any other wearable items to protect clients from the weather elements.
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
DocuSign Envelope ID: 52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2011 Other(Program Supplies) 500 Includes therapeutic supplies that can be used to assist in focus enhancement and
emotional regulation.Additional benefits include distraction,anxiety reduction,
soothing of sensitive sensory nerves,reducing agitation,and restoring an individual's
sense of control.These items include stress relief sensory items such as pop-its,stress
balls,fidget spinners,coloring books/crayons,etc.
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 1 Others ecif
3000:DIRECT OPERATING EXPENSES 5,829
3001 Telecommunications 780 Cost of a cell phone,cell phones service,data connectivity.
3002 Printing/Postage -
3003 Office Household&Program Supplies
3004 Advertising
3005 Staff Develo ment&Training
3006 Staff Mileage
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 5,049 Minor auto repairs&maintenance required to maintain 1 leased vehicle for client
transportation and program needs.Includes expenses such as oil changes,car washes,
vehicle tracking service,auto fuel,and DMV fees.
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 1 Others ecif
4000:DIRECT FACILITIES&EQUIPMENT 3,428
4001 Building Maintenance -
4002 Rent Lease Building
4003 Rent Lease Equipment -
4004 Rent/Lease Vehicles 3,428 Cost of 1 leased vehicles to allow case management staff to conduct post-crisis follow-
up services in person and transport persons served,as appropriate.
4005 Security -
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Others ecif
5000:DIRECT SPECIAL EXPENSES -
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 7,569
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(Administrative Overhead) 7,569 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 2,100
7001 Computer Equipment&Software 2,100 Purchase of 1 computer for case management staff and estimated software needs to
support staff.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2I7I2020
DocuSign Envelope ID:52471 E7A-61 133-4540-13C76-0106CCAF9C4A
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
7008 Other(specify) -
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 1 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 82,544
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 82,544
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Crisis Care Mobile Units(CCMU)Grant Funds
Kings View Rural CIT
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 QI Data Analyst 0.11 $ 7,928 $ 7,928
1102 - -
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.11 $ 7,928 $ 7,928
Acct# Program Position FTE Admin Program Total
1116 $
1117
1118
1119
1120
1121
1122
1123
1124
1125 -
1126
1127
1128
1129 -
1130
1131
1132 -
1133
1134
Direct Personnel Program Salaries Subtotall 0.00 1 $ $
Admin Program Total
Direct Personnel Salaries Subtotall 0.11 1 $ 7,928 1 $ - $ 7,928
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 96 $ 96
1202 Worker's Compensation 151 151
1203 Health Insurance 955 955
1204 Other(specify)
1205 10ther(specify) -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
1206 10ther(specify) -
Direct Employee Benefits Subtotal: $ 1,202 $ - $ 1,202
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $
1302 FICA/MEDICARE 606 606
1303 SUI 32 32
1304 Other(specify) -
1305 10ther(specify) -
1306 10ther(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 638 $ - $ 638
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 9,768 $ - $ 9,768
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
100%1 0.
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(Program Supplies)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 10ther(specify)
2016 10ther(specify)
DIRECT CLIENT CARE TOTAL $
3000: DIRECT OPERATING EXPENSES
Acct# Line Item Description
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ -
4000: DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 10ther(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL: $
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
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000: INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(Administrative Overhead)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 10ther(specify)
INDIRECT EXPENSES TOTAL $
INDIRECT COST RATE 0.00%
7000: DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
DocuSign Envelope ID: 52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $
TOTAL PROGRAM EXPENSES $ 9,768
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation p
8009 Other(Specify) 0
8010 Other(Specify) 0
Estimated Specialty Mental Health Services Billing Totals: p $
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance -
8403 Grants(Crisis Care Mobile Units) 9,768
8404 Other(Specify) -
8405 Other(Specify)
OTHER REVENUE TOTAL $ g 768
TOTAL PROGRAM FUNDING SOURCES: $ 9,768
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
DocuSign Envelope ID:52471 E7A-61 133-4540-13C76-0106CCAF9C4A
Crisis Care Mobile Units (CCMU) Grant Funds
Kings View Rural CIT
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
QI Data Analyst PATH SMHS/Fresno 0.02
PATH/OEL Fresno 0.05
PATH MOP/Fresno 0.05
Blue Sky/Fresno 0.12
Rural CIT/Fresno 0.14
Rural CIT-CCMU/Fresno 0.11
Metro CIT/Fresno 0.01
Metro CIT-CCMU/Fresno 0.11
Map Point/Fresno 0.07
FURS/Fresno 0.03
Shasta 0.04
Kings 0.24
Quality& Performance Improvement Depart. 0.01
Total 1.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
DocuSign Envelope ID: 52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
Crisis Care Mobile Units(CCMU)Grant Funds
Kings View Rural CIT
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 9,768
Administrative Positions 7,928
1101 CII Data Analyst 7,928 This position will perform a wide range of duties to support data collection,
management,and reporting needs required for CCMU grant.
1102 0 -
1103 0
1104 0
1105 0
1106 0
1107 p
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions
1116 0
1117 0
1118 0
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10
Direct Employee Benefits 1,202
1201 Retirement 96 Cost of 401K
1202 Worker's Compensation 151 Workers'compensation insurance
1203 Health Insurance 955 Cost of medical,vision,dental,life and long-term disability insurance.
1204 Other(specify)
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 638
1301 OASDI -
1302 FICA/MEDICARE 606 Cost of FICA/Medicare
1303 SUI 32 Cost of SUI
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation&Support
2004 Clothing,Food,&Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(Program Supplies)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2I7I2020
DocuSign Envelope ID: 52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2015 Others ecif
2016 1 Others ecif
3000:DIRECT OPERATING EXPENSES -
3001 Telecommunications
3002 Printing/Postage
3003 Office Household&Program Supplies
3004 Advertising
3005 Staff Develo ment&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 1 (sDecifvl
ecif
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES -
5001 1 Consultant Network&Data Management)
5002 HMIS Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES
6001 Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(Administrative Overhead)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2I7I2020
DocuSign Envelope ID:52471 E7A-61 B3-4540-BC76-0106CCAF9C4A
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 9,768
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 9,768
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020