Loading...
HomeMy WebLinkAboutAgreement A-22-500 FY 2022-23 HCPCFC Plan and Budget.pdf Agreement No. 22-500 Health Care Program for Children in Foster Care Plan and Budget Reporting Checklist Page Number 1. HCPCFC Plan and Budget Reporting Checklist 1 2. HCPCFC Certification Statement 2 3. HCPCFC Organizational Chart Retain Locally 4. HCPCFC MOU with Local Child Welfare/Social Services N/A 5. HCPCFC Probation IA N/A 6. If Applicable: a. Contractor Equipment Purchased with DHCS Funds Form (DHCS1203) N/A b. Inventory/Disposition of DHCS Funded Equipment Form (DHCS1204) N/A c. Property Survey Report Form (STD 152) N/A 7. HCPCFC Plan and Budget Reporting Spreadsheet a. Agency Information Sheet 3 b. Memorandum of Understanding and Interagency Agreement 4 List c. HCPCFC Incumbent List 5 d. HCPCFC Budgets i. Base 6 — Summary and Worksheet 7 — Budget Narrative ii. Psychotropic Medication Monitoring and Oversight 8 — Summary and Worksheet g — Budget Narrative iii. Caseload Relief 10 - 11 — Summary and Worksheet 12 — Budget Narrative iv. Optional County/City- Federal Match N/A — Summary and Worksheet N/A — Budget Narrative DHCS State of California—Health and Human Services Agency Department of Health Care Services MICHELLE BRASS GAVIN NEWSOM DIRECTOR GOVERNOR Health Care Program for Children in Foster Care Certification Statement County/City: Fresno Fiscal Year: 2022-23 1 certify that the Health Care Program for Children in Foster Care (HCPCFC) will comply with all applicable state and federal and state laws and regulations, including all federal laws and regulations governing recipients of federal funds granted to states for medical assistance pursuant to Title XIX of the Social Security Act(42 U.S.C. Section 1396 et seq.). I further certify that the HCPCFC will comply with all rules promulgated by DHCS pursuant to these authorities, including the Integrated Systems of Care Plan and Fiscal Guidelines Manual. I further agree that this HCPCFC may be subject to sanctions or other remedies if this HCPCFC violates any of the above. 44---" 9/13/22 Signature of HCPCFC Director/County Authorized Date Signed Represent a Ive _ Signature of Director o,H _alth Officer Date Signed v`" Signature and Title of Other—Optional Date Signed I certify that this plan has been approved by the local governing body. L Oa, to Signature of Local Governing Body Chairperson Date Signed ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors County of Fresno,State of California Bye`/ _ Deputy Systems of Care Division 1515 K Street, Suite 400, Sacramento, CA 95814 P.O. Box 997413,MS 8100 Sacramento,CA 95899-7413 (916)327-1400 Internet Address:www.dhcs.ca.gov DHCS State of California—Health and Human Services Agency Department of Health Care Services 4w Health Care Program for Children in Foster Care MICHELLE BAASS Agency Information GAVIN NEWSOM DIRECTOR GOVERNOR County/City: IFresno I Fiscal Year: 2022-23 Official Agency Street Address:1221 Fulton Street Health Officer: Rais Vohra, MD (interim) City: Fresno Local HCPCFC Zip Code: 93721 Central Inbox: Parent Agency Director(if applicable) Name: David Luchini, Director Street Address: 1221 Fulton Street Phone: City: Fresno Email: Zip Code: 93721 Authorized HCPCFC Program Administrative Representative Name: Ankara Lee Street Address: 380 W. Ashlan Phone: 559-600-6591 City: Clovis Email: glee@fresnocountyca.gov Zip Code: 93612 Clerk of the Board of Supervisors or City Council Name: Bernice Seidel Street Address: 2281 Tulare St, 3rd Floor Phone: 559-600-6592 City: Fresno Email: bseidel@fresnocountyca.gov Zip Code: 93721 Director of Social Services Agency Name: Sanja Bugay Street Address: 205 W Pontiac Way, Bldg 2 Phone: 559-600-2301 City: Clovis Email: sbugay@fresnocountyca.gov Zip Code: 93612 Chief Probation Officer Name: Kirk Haynes Street Address: 3333 E. American Ave, STE B Phone: 559-600-1298 City: Fresno Email: khaynes Zip Code: 93725 . .d.«�� 2 § : -1 � � �/ % n I � = � & x o CD � # § \ ƒ Cu z a $ \ m U) A \ IL 0 a 0 2 'B \ © / 2 f , � \ z ƒ ƒ 2 c e 2 2 0 § / u o ■ @ I c .� 0 LL m Cl) \ % \ Q c @ W Cu Q k 0 m — 2 m \ a 2 7 ? D § ■ 7 \ % 2 2 / to @ o 0 � CL o o U o § e 2 ( ) k m c \ j 2 \ E � � \ y � 2 � � E / \ LU (D \ E �_ f \ \ CO \ $ / % If % 2 R v z m CO MW �s - - o ` U a m # m m * o c 2 �ilkLU 3�_Pi s FW- O o 0 U � En Ro O o o O CD O CD O CD O O � a U U U U U U _ LL LL LL LL LL LL N N a d a d a 0 0 � O U U U U U U S 2 I=I 2 I= 2 U Z3 > > > > > M ;+� .0 O O) O p) O) h >, U U U O 7 7 C LL 'Op ""C =O c 0 0 p Q Q U U) c cu cn U �\ co N L. � N N M Cu C. 'p cco u U ��1 ,r a N Cuai n_ Q N W c Q) ,V N c e = O a CD (L �Y LL ++ Q U) (1 ,_ P LL fn O CB L L 4-1 U O_ IL c- N as = 102 = C E _ V cu .� cu co � Q E O m or d m � N cu U N O 0 V + z a) � � Q Cu U] _ 5- t a o `� _�) aC6i m a�i m F' cu _n 2 S 2 2 Q N co Z .0 U U_ _U N C .S� a U a C :3 C 7 O Zco ,c Q)) o a _ � a :3 r c a co) O o v) c E ILi z iu ' Q � y o 0 C� yCD U Q N CoU CD a) C4 'O O C � DO O .0 J Cu 0-.�--• N 0) W f- .� U7 CB C J E O N X ,AqwQU) -lU) U` o- _ �- N M 'ct Cfl I� 00 6) O DHCS State of California-Health and Human Services Agency +r,, INP Department of Health Care Services Health Care Program for Children in Foster Care MICHELLE BAASS Budget Worksheet GAVIN NEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: I Base County/City Name: Fresno Fiscal Year: 2022-23 Column 1A 1B 1 2A 1 2 1 3A 3 Category/Line Item Total Base FTE Enhanced FTE Enhanced Non-Enhanced Non-Enhanced % Annual Salary Total Budget % (25/75) FTE! (50/50) I.Personnel Expenses # Name 1 Supervising Public Health Nurse(Ankara Lee) 40% $129,644 $51,858 75.00% $38,893 25,00% $12,964 2 Public Health Nurse(Lupe Wade) 50% $105,019 $52,510 75,00% $39,382 25.00% $13,127 3 Public Health Nurse(Sally Lopez) 50% $109,408 $54,704 75.00% $41,028 25.00% $13,676 4 Public Health Nurse(Samantha Campbell) 100% $90,683 $90,683 75.00% $68,012 25.00% $22,671 5 Public Health Nurse(Gursimran Deol) 100% $90,683 $90,683 75.00% $68,012 25.00% $22,671 6 Office Assistant(Pa Xiong) 100% $36,620 $36,620 0.00% $0 100,00% $36,620 7 $0 $0 100% $0 8 $0 $0 100% $0 9 $0 $0 100% $0 10 $0 $0 100% $0 (insert additional rows as needed) $0 $0 100% $0 Total PHN FTE% 500% 1 375.00% 125.00% Total Direct Support Staff FTE% 100% 75.00% 25.00% Net Salaries and Wages $377,057 $255,328 $121,729 Staff Benefits(Specify% 81.814% $308,484425 $208,894 $99,591 I.Total Personnel Expenses $685, $464,222 $221,320 II.Operating Expenses 1. Travel $12,000 75.00% $9,000 25.00% $3,000 2. Training $12,000 75.00% $9,000 25.00% $3,000 II.Total Operating Expenses $24,000 $18,000 $6,000 III.Total Capital Expenses IV.Indirect Expenses 1. lInternal(Specify%) 1 18.816% 1 1 $133,507 $133,507 IV.Total Indirect Expenses $133:507 $133,507 V.Total Other Expenses Budget Grand Total $843,049 1 1 $482,222 1 $360.827 Prepared By: Sign Print Title Date Email 422 I I I I Authorized HCPCFC Sign Print Title Date Email Program Representative: Budget Summary tables can be found on the"Summary Tables"sheet of this workbook. DHCS State of California—Health and Human Services Agency4Q00 Department of Health Care Services Health Care Program for Children in Foster Care MICHELLE BAASS Budget Narrative GAVIN NEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: Base County/City Namej Fresno I Fiscal Year 2022-23 I. Personnel Expenses Identify and Explain Any Changes in Personnel/Personnel Expenses Salary and Benefits for 6 positions,total of 4.4 FTE. Benefits calculated with estimated total benefits rate for the positions. Includes retirement, health insurance, OASDI, Unemployment Insurance, and Benefits II. Operating Expenses Identify and Explain All Operating Expense Line Items Private auto mileage reimbursement at$0.625/mile for program staff to travel to Travel: complete program activities and attend State-sponsored meetings, including regional Registration costs for PHNs to attend State recommended training and workshops to Training: maintain professional competence and gain program specific skills. Also includes Ill. Capital Expenses cannot be included in this budget IV. Indirect Expenses Indirect External Expenses cannot be included in this budget Identify and Explain All Indirect Expense Line Items Fresno County Department of Public Health's indirect rate is 18.816%of personnel costs Internal: approved reviewed for metholody, accounting standards, and data used by Fresno V. Other Expenses cannot be included in this budget (,tom 0 0 0 Prepared By: Sign Print Title Date Email Authorized HCPCFC Program Representative: Sign Print Title Date Email DHCS State of California—Health and Human Services Agency Department of Health Care Services 4�00 Health Care Program for Children in Foster Care � MICHELLEBAASS Budget Worksheet GAVINNEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: I Psychotropic Medication Monitoring&Oversight County/City Name: I Fresno I Fiscal Year: 2022-23 Column 1A 1B 1 2A 2 3A 3 Category/Line Item Total PMM O Annual Sala Enhanced FTE Enhanced Non-Enhanced Non-Enhanced FTE% ry Total Budget % (25/75) FTE% (50/50) I.Personnel Expenses # Name 1 Public Health(Michael Hughes) 100% $103,782 $103,782 75.00% $77,837 25.00% $25,946 2 $0 $0 1003T $0 3 $0 $0 100% $0 4 $0 $0 100% $0 5 $0 $0 100% $0 6 $0 $0 100% $0 7 1 $0 $0 100% $0 8 $0 $0 100% $0 9 $0 $0 100% $0 10 $0 $0 100% $0 �(inseadditional lines as needed) $0 $0 100% $0 Total PHN FTE% 100% 1 75.00% 25.00% Total Direct Support Staff FTE% 100% 75.00% 25.00% Net Salaries and Wages $103,782 $77,837 $25,946 Staff Benefits Specify%) 81.814% $84,908 $63,682 $21,227 I.Total Personnel Expenses $188,690 1 $141,519 1 $47,173 II.Operating Expenses 1. Travel $3,000 75.00% $2,250 25.0010 $750 2. Training $3,000 75.00% $2,250 25.00% $750 II.Total Operating Expenses $6,000 $4.500 $1,500 III.Total Capital Expenses IV.Indirect Expenses 1. 1 Internal(Specify%) 18.816% $36,633 $36,633 IV.Total Indirect Expenses $36,633 $36,633 V.Total Other Expenses Budget Grand Total $231,323 $146,019 1 $85,306 A,)—— 0 0 0 0 Prepared By: Sign Print Title Date Email yl�.�---�-� 0 0 0 0 Authorized HCPCFC Sign Print Title Date Email Program Representative: Budget Summary tables can be found on the"Summary Tables"sheet of this workbook. DHCS State of California—Health and Human Services Agency �• Department of Health Care Services Health Care Program for Children in Foster Care '1i: MICHELLE BAASS Budget Narrative GAVIN NEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: Psychotropic Medication Monitoring & Oversight County/City Namej Fresno IFiscal Year 2022-23 I. Personnel Expenses Identify and Explain Any Changes in Personnel/Personnel Expenses Salary and Benefits for 1 FTE PHN. Includes retirement, health insurance, OASDI, Unemployment Insurance, and Benfefits Administration. Ill. Operating Expenses Identify and Explain All Operating Expense Line Items Registration costs and ancillary costs for PHN to attend State recommended training and Training: workshops to maintain professional competence and gain program specific skills. Travel: III. Capital Expenses cannot be included in this budget IV. Indirect Expenses Indirect External Expenses cannot be included in this budget Identify and Explain All Indirect Expense Line Items Fresno County Department of Public Health's indirect rate is 18.816% of personnel costs Internal: approved reviewed for metholody, accounting standards, and data used by Fresno lCounty's Auditor Controlleffreasurpr-Tax Collprtor and anproved hy CDPH_ V. Other Expenses cannot be included in this budget 0 0 0 Prepared By: Sign Print Title Date Email 0 0 0 Authorized HCPCFC Program Representative: Sign Print Title Date Email DHC.,S State of California-Health and Human Services Agency Zot- Department of Health Care Services 4;01 Health Care Program for Children in Foster Care MICHELLEBAASS Budget Worksheet GAVINNEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: Caseload Relief CountylCity Name: I Fresno IFiscal Year: 2022-23 Column 1A 1B 1 2A 1 2 1 3A 3 Total Caseload Enhanced FTE Enhanced Non- Non- Category/Line Item Relief FTE% % (25/75)Annual Salary Total Budget Enhanced FTE Enhanced (sa/so) I.Personnel Expenses # Name 1 Vacant PHN 100% $90,683 $90,683 75.00% $68,012 25.00% $22,671 2 Vacant PHN 100% $ 90,683.00 $90,683 75.00% $68,012 25.00% $22,671 3 $0 $0 100% $0 4 $0 $0 100% $0 5 $0 $0 100% $0 6 $0 $0 100% $0 7 $0 $0 100% $0 8 $0 $0 100% $0 9 $0 $0 100% $0 10 $0 $0 100% $0 (insert additional lines as needed) $0 1 $0 100% $0 Total PHN FTE% 200% 150.00% 50.00% Total Direct Support Staff FTE% 100% 75.00% 25.00% Net Salaries and Wages $181,366 $136,025 $45,342 Staff Benefits Specify% 81.184% $147,240 $110,431 $36,810 I.Total Personnel Expenses $328,606 1 1 $246,456 1 1 $82,152 II.Operating Expenses 1. Travel $6,000 75.00% $4,500 25.00% $1,500 2. Training $6,000 75.00% $4,500 25.00% $1,500 II.Total Operating Expenses $12,000 $9,000 $3,000 III.Total Capital Expenses IV.Indirect Expenses 1. 1 Internal(Specify%) 18.8160/. $64,088 1 1 $64,088 IV.Total Indirect Expenses $64,088 $64,088 V.Total Other Expenses Budget Grand Total $404,694 $255,456 $149.240 0 0 0 0 Prepared By: Sign Print Title Date Email LU 0 0 0 0 Authorized HCPCFC Sign Print Title Date Email Program Representative: Budget Summary tables can be found on the"Summary Tables"sheet of this workbook. v V U C C N L 440 cr 0 O Z Z O O 46 j,F Q LL U fV.1 0 M U c O O O c O o O N V L (sT (sT d4 U N ? W W O N `� 0 c E E N 3 W W U N c`p of v y v c r m m O O o O CD c0 N tfT d7 Cil H4 U H FI LL O O CD o N c N N L cD cD O W .0 M W n �} Z Ef3 2 � � t0 w ❑ ❑ N d cD w L p CD v r V o �A V LO O C N LO cliC co O) Ln GI V1 W E+4 (FJ Ef4 lf3 N W 64 L cQ U CO 0) N v o o co rn c m N m Q o cD o v_ c4 cD w 49 N m m m o 17 " m M co p o 0 m N _N cD O U � clj LL F V) 69 V) b�4 H b9 EA V3 d U) fn M w d co fC •� 0 C = L cc cc COM LO t c � 64 b4 v V E Z Z Y ca fC L 7 � F CO cu o D) O 61 V _ (a rL U m O C7 m m cD I C L � � � � � � .cu C m O_ W 64 64 W 64 e,4 Ef3 L E L. o V a U d co o M � co o p V m m ao o c0 LL LL O 0 m aD c0 m c+) m lD c'7 Lo eA M N O c{) bq N 6 r+ va e,4 e» f- 2 v 0N0 t V V a0 C O M O = C O O CDW CD m N W 0R m cD ++ D (y4 v3 H4 EF) O �? ER EH C C Z Z a` a` N o cD I— N G! V N O N U N cD N N D N R U L oa N U z O N C m CO W ER V W N M .�fR 69 V7 U1 O1 O ^O C O O m m " o o LL o o ID ai C C <O CAD M A O V Ol N c0 O F <-fT H4 li3 EA F �' b4 (fl N LL CO LO CO 0 ai (n y C C N +m+ -m0 x yam+ Q U a s C I- c 7 r0.. I- �. j N d C "O 7 LL 'O C U d X d C L0 � C pp LL A w C J C W W a W O O to = O C C U W 6 y O U 'G m � N d ` U LL y =, _ U LL fC a o U S O O d 7 N V R N (6 [O N m y m L O N O fl N DHCS State of California—Health and Human Services Agency q;p Department of Health Care Services ►.� Health Care Program for Children in Foster Care MICHELLE BAASS Budget Narrative GAVIN NEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: Caseload Relief County/City Namej Fresno I Fiscal Year 2022-23 I. Personnel Expenses Identify and Explain Any Changes in Personnel/Personnel Expenses Salary and Benefits for 2 FTE PHNs. Includes retirement, health insurance, OASDI, Unemployment Insurance, and Benefits Administration. II. Operating Expenses Identify and Explain All Operating Expense Line Items Private auto mileage reimbursement at$0.625/mile for program staff travel to complete Travel: program activities and attend State-sponsored meetings, including regional meetings, subcommittee meetings, and training specific to job duties. Registration costs for PHNs to attend State recommended trainings and workshops to Training: maintain professional competence and gain program specific skills. Also includes ancillary costs related to attending training and State-convened meetings. III. Capital Expenses cannot be included in this budget IV. Indirect Expenses Indirect External Expenses cannot be included in this budget Identify and Explain All Indirect Expense Line Items Fresno County Department of Public Health's indirect rate is 18.816% of personnel costs Internal: approved reviewed for metholody, accounting standards, and data used by Fresno County's Auditor Controller/Treasurer-Tax Collector and approved by CDPH. V. Other Expenses cannot be included in this budget ' 0 0 0 Prepared By: Sign Print Title Date Email ,Q,L� 0 0 0 Authorized HCPCFC Program Representative: Sign Print Title Date Email