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Home My WebLink AboutAgreement A-23-016 Amendment I to DMC Master Agreement.pdf Agreement No. 23-016 AMENDMENT I TO AGREEMENT THIS AMENDMENT I (hereinafter "Amendment") is dated January 3, 2023, by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California, Fresno, California (hereinafter "COUNTY'), and each Contractor listed in Revised Exhibit A, "Drug Medi-Cal Services Vendor List," attached hereto and by this reference incorporated herein (hereinafter collectively referred to as "CONTRACTOR"), and such additional CONTRACTORS as may, from time to time during the term of this Agreement, be added by COUNTY. Reference in this Agreement to "party" or "parties" shall be understood to refer to COUNTY and each CONTRACTOR, unless otherwise specified. WITNESSETH: WHEREAS, COUNTY and CONTRACTOR(S) entered into Agreement number 22-176, effective July 1, 2022 (hereinafter"Agreement"), wherein CONTRACTOR(S) agreed to provide Drug Medi-Cal (DMC) Substance Use Disorder (SUD) treatment services; and WHEREAS, COUNTY and certain CONTRACTOR(S) have opted into participation in a pilot project for a new DMC service known as Contingency Management— Recovery Incentives; and WHEREAS, the California Department of Health Care Services (DHCS) has issued new insurance requirements; and WHEREAS, COUNTY and CONTRACTORS now desire to amend the Agreement regarding changes as stated below and restate the Agreement in its entirety. NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which is hereby acknowledged, COUNTY and CONTRACTOR agree as follows: 1. That Section Three (3) of the Agreement, beginning on Page Four (4), Line One (1) through Page Four (4), Line Seven (7), is deleted in its entirety and replaced with the following: "3. TERM A. DMC Services - The term of this Agreement shall be for a period of three (3) years, commencing on July 1, 2022 through and including June 30, 2025. This Agreement may be extended for two (2) additional consecutive twelve (12) month periods upon written approval of both parties no later than thirty (30) days prior to the first day of the next twelve (12) month extension period. The DBH Director, or his or her designee, is authorized to execute such written approval on - 1 - DMC Master Agreement behalf of COUNTY based on CONTRACTOR's satisfactory performance. B. Contingency Management Pilot—The term of the Contingency Management pilot shall be January 3, 2023 through March 31, 2024 for CONTRACTOR(S) that opt into participation as indicated by the inclusion of Contingency Management rates on Amended Exhibit E1. Following the pilot period, should DHCS exercise the option of adding contingency management as a permanent DMC eligible service then contingency management services will be aligned with the terms of this Agreement stated above under 3.A, DMC Services." 2. That Section Five (5) of the Agreement, beginning on Page Five (5), Line Six (6) through Page Seven (7), Line Thirteen (13), is deleted in its entirety and replaced with the following: "5. COMPENSATION For claims submitted for services rendered under this Agreement, COUNTY agrees to pay CONTRACTOR(S) and CONTRACTOR(S) agree to receive compensation as follows: A. DMC SERVICES - In no event shall services performed under this Agreement be in excess of annually negotiated reimbursement rates agreed upon by COUNTY and CONTRACTOR during the term of this Agreement and approved by DHCS, incorporated herein as Amended Exhibit E1, "Fresno County Drug Medi-Cal Rates" as updated annually. In no event will the negotiated reimbursement rates be in excess of the COUNTY's maximum rate approved by DHCS. It is understood that all expenses incidental to CONTRACTOR's performance of services under this Agreement shall be borne by CONTRACTOR. 1) COUNTY shall reimburse non-NTP CONTRACTOR(S) the negotiated contractor-specific rates. Contractor rates cannot exceed the DHCS-approved county maximum rates established in the annual fiscal plan. 2) COUNTY shall reimburse NTP CONTRACTOR(S) the lesser of the uniform statewide daily reimbursement rate, as published annually by DHCS and incorporated in to Exhibit E1, or the CONTRACTOR's usual or customary charge to the public. 3) Payments by COUNTY shall be in arrears, based on CONTRACTOR's monthly invoices submitted for services provided during the preceding month, within forty-five (45) days after receipt, verification and approval of CONTRACTOR's monthly invoices by COUNTY's DBH. - 2 - DMC Master Agreement If payment for services is denied or disallowed by State, and subsequently resubmitted to COUNTY by CONTRACTOR, disallowed portion will be withheld from the next reimbursement to CONTRACTOR until COUNTY has received reimbursement from State for said services. If CONTRACTOR is not in compliance with periodic reporting requirements as described in Exhibit F, Provider Reporting Requirements, then payments shall be held until compliance is achieved. 4) CONTRACTOR must accept, as payment in full, the amounts paid by DHCS in accordance with the Intergovernmental Agreement. CONTRACTOR may not demand any additional payments from DHCS, person served, or other third-party payers. 5) CONTRACTOR shall comply with 45 CFR 162.410(a)(1) for any subpart that would be a covered health care provider if it were a separate legal entity. For purposes of this paragraph, a covered health care provider shall have the same definition as set forth in 45 CFR 160.103. DHCS shall make payments for covered services only if CONTRACTOR is in compliance with federal regulations. B. CONTINGENCY MANAGEMENT STARTUP FUNDS 1) For claims submitted for contingency management startup funds, COUNTY agrees to pay CONTRACTOR(S) and CONTRACTOR(S) agree to receive compensation based on actual expenses in accordance with CONTRACTORS' approved budgets, attached here as Exhibit E2 and incorporated by reference, from Contingency Management Pilot Program Startup Funds Request For Application (RFA) response. The COUNTY will make the Contingency Management Pilot Program Startup Funds RFA response available upon request for the term of the Agreement. 2) Contingency Management Startup Funds will be funded by Substance Abuse Block Grant (SABG) and Behavioral Health Quality Improvement Plan (BHQIP) funds in an amount not to exceed One Hundred Forty-Eight Thousand Seven Hundred Forty-Eight and No/100 Dollars ($148,748) for costs incurred between November 1, 2022 through March 31, 2023. 3) Startup funds must be returned to COUNTY if CONTRACTOR should fail to meet contingency management implementation requirements, including completion of required trainings and readiness review within four (4) months of program launch or if CONTRACTOR withdraws from the program. - 3 - DMC Master Agreement C. COMPLIANCE — If CONTRACTOR should fail to comply with any provision of this Agreement, COUNTY shall be relieved of its obligation for further compensation. CONTRACTOR's and COUNTY's obligations under this section shall survive the termination of this Agreement with respect to services provided during the term of this Agreement without regard to the cause of termination of this Agreement. D. QUALITY ASSURANCE — For services rendered herein, CONTRACTOR shall assure that an on-going quality assurance component is in place and is occurring. CONTRACTOR shall assure that clinical records for each participant are of such detail and length that a review of said record will verify that appropriate services were provided. If the record is unclear, incomplete, and/or indicates that appropriate services were not provided, COUNTY reserves the right to withhold payment for the applicable unit(s) of service. E. PUBLIC INFORMATION — CONTRACTOR shall disclose its funding source in all public information. Communication products must follow DBH graphic standards, including typefaces and colors, to communicate our authority and project a unified brand. This includes all media types and channels and all materials on and offline that are created as part of DBH's efforts to provide information to the public. Communication products must include a funding acknowledgement determined by the level of funding provided by DBH as follows: 1) A Program of Fresno County Department of Behavioral Health (100% funded); 2) Funding provided by Fresno County Department of Behavioral Health (50% or more funded); 3) Funded, in part, by County of Fresno Department of Behavioral Health (less than 50% funded); and 4) A partnership, with funding by Fresno County department of Behavioral Health (any funding amount). F. LOBBYING ACTIVITY— CONTRACTOR shall not directly or indirectly use any of the funds provided under this Agreement for publicity, lobbying, or propaganda purposes designed to - 4 - DMC Master Agreement support or defeat legislation pending before the Congress of the United States or the Legislature of the State of California. G. POLITICAL ACTIVITY—CONTRACTOR shall not directly or indirectly use any of the funds under this Agreement for any political activity or to further the election or defeat of any candidate for public office." 3. All references to "Exhibit E1" in the Agreement shall be deemed references to "Amended Exhibit E1". Amended Exhibit E1 is attached hereto and incorporated herein by this reference. 4. That Section Six (6) of the Agreement, beginning on Page Seven (7), Line Fourteen (14) through Page Eight (8), Line Eleven (11), is deleted in its entirety and replaced with the following: "6. INVOICING A. DMC SERVICES - COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive compensation at negotiated DMC rates for DMC covered services described in Amended Exhibit B, Modality of Service Descriptions. CONTRACTOR shall enter billing information into the COUNTY's designated information system by the fifteenth (15th) of every month. Billing process shall be in accordance with the DHCS DMC Billing Manual, and by this reference incorporated herein, available at the DBH website at https://www.co.fresno.ca.us/departments/behavioral-health/home/for-providers/contract- providers/substance-use-disorder-providers. In addition to billing, non-NTP CONTRACTOR(S) shall submit on a monthly basis by the twenty-fifth (25th), an Operational Expense Report, per modality of service, along with a general ledger, payroll register and supporting documentation for any line items selected. For the purposes of verifying that costs are allowable and equitable, CONTRACTOR shall submit any additional documentation as deemed necessary by DBH. Non-NTP CONTRACTORs are all CONTRACTORs that are not DEA licensed Narcotic Treatment Programs. B. CONTINGENCY MANAGEMENT STARTUP FUNDS - COUNTY agrees to pay CONTRACTOR(S) and CONTRACTOR(S) agrees to accept reimbursement for expenses approved under the Contingency Management Startup Funds Request for Applications (RFA) in amounts not to exceed provider budgets in Exhibit E2 for costs incurred between November 1, 2022 through March - 5 - DMC Master Agreement 31, 2023. The County will make the Contingency Management Pilot Program Startup Funds RFA available upon request for the term of the Agreement. Costs not approved through the RFA will be withheld from CONTRACTOR reimbursement. C. CONTRACTORs that elect to use the COUNTY's electronic health records system (EHR) shall be invoiced in arrears by the fifth (5'h) day of the month for the prior month's hosting fee for access to COUNTY's EHR in accordance with the fee schedule set forth in Exhibit G, "Electronic Health Records Software Charges," attached hereto and incorporated herein by this reference and made part of this Agreement. COUNTY shall invoice CONTRACTOR(S) annually for the annual maintenance and licensing fee for access to COUNTY's electronic information system in accordance with the fee schedule as set forth in Exhibit G. CONTRACTOR shall provide payment for these expenditures to COUNTY's Department of Behavioral Health, Accounts Receivable, P.O. Box 712, Fresno, CA 93717-0712, Attention: Business Office, within forty-five (45) days after the date of receipt by CONTRACTOR of the invoicing provided by COUNTY. D. COUNTY's DBH shall invoice CONTRACTOR on an annual basis the amount of $75 per clinical position to access The Change Companies ASAM training modules which are required to be completed upon hire and prior to delivering clinical services then annually thereafter." 4. That Section Eighteen (18) of the Agreement, beginning on Page Sixteen (16), Line Ten (10) through Page Eighteen (18), Line Twenty-One (21), is deleted in its entirety and replaced with the following: 18. INSURANCE Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following insurance policies or a program of self-insurance, including but not limited to, an insurance pooling arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement: A. Commercial General Liability Commercial General Liability Insurance with limits of not less than Two Million Dollars ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00). This policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including - 6 - DMC Master Agreement completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal liability or any other liability insurance deemed necessary because of the nature of this contract. B. Automobile Liability Comprehensive Automobile Liability Insurance with limits of not less than One Million Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should include any auto used in connection with this Agreement. C. Professional Liability If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One Million Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate. D. Employer's Liability (Residential only) A policy of Employer's Liability Insurance, with minimum coverage amounts for bodily injury or disease of not less than One Million Dollars ($1,000,000) per occurrence. E. Worker's Compensation A policy of Worker's Compensation insurance as may be required by the California Labor Code. F. Molestation Sexual abuse/ molestation liability insurance with limits of not less than Two Million Dollars ($2,000,000.00) per occurrence, with an annual aggregate of Four Million Dollars ($4,000,000.00). This policy shall be issued on a per occurrence basis. G. Cyber Liability Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by CONTRACTOR in this Agreement and shall include, but not be limited to, claims involving infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of electronic information, release of private information, alteration of electronic information, extortion and network security. The policy shall provide coverage for breach response costs as well as regulatory - 7 - DMC Master Agreement fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations. CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance naming the County of Fresno, its officers, agents, and employees, individually and collectively, as additional insured, but only insofar as the operations under this Agreement are concerned. Such coverage for additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees shall be excess only and not contributing with insurance provided under CONTRACTOR's policies herein. This insurance shall not be cancelled or changed without a minimum of thirty (30) days advance written notice given to COUNTY. CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and employees any amounts paid by the policy of worker's compensation insurance required by this Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be necessary to accomplish such waiver of subrogation, but CONTRACTOR's waiver of subrogation under this paragraph is effective whether or not CONTRACTOR obtains such an endorsement. Within thirty (30) days from the date CONTRACTOR signs and executes this Agreement, CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the foregoing policies, as required herein, to the assigned analyst at the County of Fresno, Department of Behavioral Health, Contracts Division — SUD Services at 3133 N Millbrook Avenue, Fresno, California, 93703, stating that such insurance coverages have been obtained and are in full force; that the County of Fresno, its officers, agents and employees will not be responsible for any premiums on the policies; that for such worker's compensation insurance the CONTRACTOR has waived its right to recover from the COUNTY, its officers, agents, and employees any amounts paid under the insurance policy and that waiver does not invalidate the insurance policy; that such Commercial General Liability insurance names the County of Fresno, its officers, agents and employees, individually and collectively, as additional insured, but only insofar as the operations under this Agreement are concerned; that such coverage for additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents and - 8 - DMC Master Agreement employees, shall be excess only and not contributing with insurance provided under CONTRACTOR's policies herein; and that this insurance shall not be cancelled or changed without a minimum of thirty (30) days advance, written notice given to COUNTY. In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this Agreement upon the occurrence of such event. All policies shall be issued by admitted insurers licensed to do business in the State of California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc. rating of A FSC VII or better." 5. That Section Two (2) of the Agreement, beginning on Page Three (3), Line Eighteen (18) through Line Twenty-Seven (27), is deleted in its entirety and replaced with the following: "2. ADDITIONS/DELETIONS OF CONTRACTOR(S) The COUNTY reserves the right at any time during the term of this Agreement to add new CONTRACTOR(S) to those listed in Exhibit A, "DMC Services Vendor List." It is understood that any such additions will not affect compensation paid to the other CONTRACTOR(S), and therefore such additions may be made with COUNTY without notice to or approval from other CONTRACTOR(S) under this Agreement. These same provisions shall apply to the deletion of any CONTRACTOR listed in Exhibit A, "DMC Services Vendor List," except that deletions shall be made by written mutual agreement between the COUNTY and the particular CONTRACTOR to be deleted or shall be in accordance with the provisions of Section Four (4), TERMINATION, of this Agreement." 6. That Section Twenty-Two (22) of the Agreement, beginning on Page Twenty-One (21), Line Twenty-Six (26) with the word "COUNTY" and ending on Page Twenty-Two (22), Line Four (4) with the word "immediately" be deleted in its entirety and replaced with the following: "COUNTY shall recapture from CONTRACTOR the value of any services or other expenditures determined to be ineligible based on the COUNTY or State monitoring results. The COUNTY reserves the right to enter into a repayment agreement with CONTRACTOR, with total monthly payments not to exceed twelve (12) months from the date of the repayment agreement, to recover the amount of funds to be recouped. The COUNTY has the discretion to extend the repayment plan up to a total of twenty- - 9 - DMC Master Agreement four (24) months from the date of the repayment agreement. The repayment agreement may be made with the signed written approval of COUNTY's DBH Director, or his or her designee, and respective CONTRACTOR through a repayment agreement. The monthly repayment amounts may be netted against the CONTRACTOR's monthly billing for services rendered during the month, or the COUNTY may, in its sole discretion, forego a repayment agreement and recoup all funds immediately. This remedy is not exclusive, and COUNTY may seek requital from any other means, including, but not limited to, a separate contract or agreement with CONTRACTOR." 7. The parties agree that this Amendment may be executed by electronic signature as provided in this section. An "electronic signature" means any symbol or process intended by an individual signing this Amendment to represent their signature, including but not limited to (1) a digital signature; (2) a faxed version of an original handwritten signature; or (3) an electronically scanned and transmitted (for example by PDF document) of a handwritten signature. Each electronic signature affixed or attached to this Amendment (1) is deemed equivalent to a valid original handwritten signature of the person signing this Amendment for all purposes, including but not limited to evidentiary proof in any administrative or judicial proceeding, and (2) has the same force and effect as the valid original handwritten signature of that person. The provisions of this section satisfy the requirements of Civil Code section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5, beginning with section 1633.1). Each party using a digital signature represents that it has undertaken and satisfied the requirements of Government Code section 16.5, subdivision (a), paragraphs (1) through (5), and agrees that each other party may rely upon that representation. This Amendment is not conditioned upon the parties conducting the transactions under it by electronic means and either party may sign this Amendment with an original handwritten signature. 8. COUNTY and CONTRACTOR agree that this Amendment is sufficient to amend the Agreement and, that upon execution of this Amendment, the Agreement and this Amendment together shall be considered the Agreement. - 10 - DMC Master Agreement 9. The Agreement, as hereby amended, is ratified and continued. All provisions, terms, covenants, conditions and promises contained in the Agreement and not amended herein shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment I as of the day and year first hereinabove written. CONTRACTOR COUNTY OF FRESNO SEE EXHIBIT A wounntyvrofl e Board of Supervisors of Fresno ATTEST: Bernice E. Seidel Clerk of the Board of Supervisors County of Fresno, State of California t By: Deputy FOR ACCOUNTING USE ONLY: Drug Medi-Cal ORG No.: 56302081 Account No.: 7295/0 Fund/Subclass: 0001/10000 - 11 - DMC Master Agreement Requisition No.: N/A Provider: AEGIS TREATMENT CENTERS,LLC. By �� t,� Tom. Print Name: Susan D. Hoeflich Title: Vice President,Managed Care Chairman of the Board, President, or Vice President Date: 11/21/2022 - 12 - DMC Master Agreement Provider: BAKERSFIELD RECOVERY SERVICE,INC. By Print Name6e Al 1 1,�61� Title: TA"�4- 1 tr�,yl Chairman of the Board, President,or Vice President Date: �Z- BY r Print Name: 1 -70 c- C�-t--X>cg-�' Title: �X�c�"� ivy �i r--cF'� Secretary (of Corporation), Assistant Secretary, Chief Financial Officer,or Assistant Treasurer Date: - 13- DMC Master Agreement Provider: BAYMARK HEALTH SERVICES, INC. dba ADDICTION RESEARCH AND TREATMENT,INC. dba MEDMARK TREATMENT CENTERS—WEST SHAW,INC. B Print Name: Frank Baumann Title: Vice President Chairman,of the Board, President, or Vice President Date: B .2Q 4 J41 Print Name: Genco Gilberto D'Andria Title: VP Treasurer Secretary(of Corporation),Assistant Secretary, Chief Financial Officer, or Assistant Treasurer Date: ��z z z - 14 - DMC Master Agreement I' 1 } 7Y k Provider: CENTRAL CALIFORNIA RECOVERY,INC. By, r Print Name: % Title: hairman of YBoar�, Presi ent, or Vice President Date: By fJ et G( Print Name/. �'�2 Title: D Secretary (of Corporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer Date: i 1 x 1 1 C J DMC Master Agreement Provider: COMPREHENSIVE ADDICTION PROGRAMS INC, - B Y Prize Zame. Title: c-e 5 Ycjx- Chairman of the Board,President, or Vice President Date: By Mi— �f — V r Print Name: `/e W�Y'� � T Y�ao � Title: _ Secretary(of Corporation), Assi tant Secretary, Chief Financial Officer,or Assistant Treasurer Date: � 7iZ - 16- DMC Master Agreement Provider: DELTA CARE, INC. By Print Name: F Er-,J u, Chairman of the Board, President, or Vice President Date: BY11`Act ensue. Print Name: A-C-ij y Title: GC C--C V C"'"`A Secretary (of Corporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer Date: - 17 - DMC Master Agreement Provider: FRESNO COUNTY HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE SERVICES,INC. B P Print Name: Alfredo C. Vasq C3 Title: CHAIRMAN Chairman of the Board, President,or Vice President Date: Novement 17, 2022 By L�� Print Name: / b y Title: 1C.PCG! Secretary(of Corporation),Assistant Secretary, Chief Financial Officer, or Assistant Treasurer Date: LZ Z - 18 - DMC Master Agreement Provider: MSNO NEW CONNECTIONS,INC. BY�2ea4��&�— Print Name: "Gifts: � ,�)ia__._��_,��t�l` Cihairman/of the Board„President,or Vice President Date:J � 1 zoo Z- By�:-4 1/l 62 Print Namc:-De�yj&,l A LtSIF. Title: p�Q _-"�L- Secretary(of corporation,Assistant Sccretary, Chief Financial Officer„or Assistant Treasurer Date: �-- -19- t)MC Master Agreement DocuSign Envelope ID:91B84C6F-41CC-42DE-AOEB-3C2137A3CC96 Provider: KINGS VIEW DocuSigned by: B � � Na&anx �w:+•c y— A04F817F73914D5... Print Name: Amanda Nugent Divine Title: CEO Chairman of the Board, President, or Vice President Date: 12/1/2022 DocuSigned by: By- 79925D1G4CSC40B... Print Name: Michael Kosareff Title: CFO Secretary (of Corporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer Date: 12/2/2022 - 20 - DMC Master Agreement Provider: MENTAL HEALTH SYSTEMS,INC. 7ff 12J '(" By .lames CCaRaghan J[(Nov 2H, 022 1059 PST) Print Name: James C Callaghan Jr Title: Ce0/President Chairman of the Board, President, or Vice President Date: Nov 28,2022 By Print Name: tracey mcdermott Title: CFO Secretary(of Corporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer Date: Nov 28,2022 - 21 - DMC Master Agreement Provider: PRODIGY HEALTHCARE,INC. By Print Name: Jagdip Dhanda Title: CEO Chairman of the Board, President, or Vice President Date: 12/01/2022 By Print Name: Jagdip Dhanda Title: Secretary Secretary (of Corporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer Date: 12/01/2022 - 22 - DMC Master Agreement THIS PAGE INTENTIONALLY LEFT BLANK - 23 - DMC Master Agreement Provider: PROMESA BEHAVIORAL HEALTH, INC. ' 1444:�hl/-,en By Print Name: M 1 C H 1L X � Title: elajw�� Chairman of the Board, President, or Vice President Date: 1,2-A 2 �,7,0 Z Z By �— Print Name: Title: Secretary(of Corporation),Assistant Secretary, Chief Financial Officer, or Assistant Treasurer Date: - 24 - DMC Master Agreement Provider: TURNING POINT OF CENTRAL CALIFORNIA, INC. By Print Name: Raymond R. Banks Title: Chief Executive Officer Chairman of the Board, President, or Vice President Date: 11/30/22 By "&LYe6" Print Name: William Goodall Title: Chief Financial Officer Secretary (of Corporation), Assistant Secretary, Chief Financial Officer, or Assistant Treasurer Date: 11/30/2022 - 25 - DMC Master Agreement Provider: WESTCARE CALIFORNIA,INC. ByNZ 406 L 19, Print Name: Title: CCDC) Chairman of the Board,President,or Vice President Date: //" J obi WC_CA' Z UZ2-VZ B Title: CC-,r DC'6(--k 4 Secretary(of Corporation),Assistant-Sedetaiy, Chief Financial Officer,or Assistant Treasurer Date: -26- DMC Master Agreement THIS PAGE INTENTIONALLY LEFT BLANK - 27 - DMC Master Agreement THIS PAGE INTENTIONALLY LEFT BLANK - 28 - DMC Master Agreement Fresno County Department of Behavioral Health Exhibit A Drug Medi-Cal Services Vendor List VENDOR CONTACT PHONE NUMBER TYPE OF BUSINESS BayMark Health Services,Inc. Addiction Research and Treatment,Inc. Regional Vice President (707)290-0670 For Profit Corporation MeclMark Treatment Centers—Fresno West,Inc. Dawn Groendyke Remit to: 1720 Lakepointe Drive#117 Lewisville,Tx 75057 Aegis Treatment Centers,U.C. Regional Director (818)206-0360 Limited Liability Company Remitto: Sarah Khawaja-Laljiani 7246 Remmet Ave. Canoga Park,Ca 91303 Bakersfield Recovery Services Inc. Executive Director (661)325-1817 501(c)3 Non-Profit Corporation Remit to: Eric Sanders PO Box 3218 Bakersfield,CA 93385 Central California Recovery,Inc. President (559)273-2942 501(c)3 Non-Profit Corporation Remitto: Dale White (559)681-1947 1204 W.Shaw Ave.#102 Fresno,CA 93711 Comprehensive Addiction Programs,Inc. Executive Director (559)492-1373 501(c)3 Non-Profit Corporation Remit to: 2445 W.Whitesbridge Ave. Fresno,CA 93706 Delta Care,Inc. Executive Director (559)276-7558 501(c)3 Non-Profit Corporation Remitto: 4705 N.Sonora Ave#113 Fresno,Ca 93722 Fresno County Hispanic Commission on Alcohol and Drug Abuse Services,Inc. Executive Director (559)268-6480 501(c)3 Non-Profit Corporation Remit to: Domingo Zapata 1803 Broadway St. Fresno,Ca 93721 Fresno New Connections,Inc. Executive Director (559)248-1548 501(c)3 Non-profit Corporation Remit to: Carrie Christensen 4411 N.Cedar Ave.#108 Fresno,CA 93726 Kings View Chief Financial Officer (559)251-0100 x3011 501(c)3 Non-profit Corporation Remitto: 7170 N.Financial Drive,#110 Fresno,CA 93720 Mental Health Systems,Inc. CEO (858)573-2600 501(c)3 Non-profit Corporation Remit to: James Callaghan 9465 Farnham St. CFO San Diego,CA 92123 Joelle Verbestel Prodigy Healthcare,Inc. President (559)892-9452 For Profit Corporation Remit to: J.D.Dhanda P.O.Box 820 Fowler,Ca 93625 Promesa Behavioral Health CEO (559)439-5437 501(c)3 Non-profit Corporation Remitto: Lisa Weigant 7120 N.Marks Ave,#110 Fresno,Ca 93711 Turning Point of Central California,Inc. Chief Executive Officer (559)732-8086 501(c)3 Non-profit Corporation Remitto: PO Box 7447 Visalia,CA 93290 WestCare California,Inc. Chief Operating Officer (559)251-4800 501(c)3 Non-profit Corporation Remit to: Shawn A.Jenkins 1900 N.Gateway Blvd,100 Fresno,CA 93727 **A list of current provider sites can be found at: https://www.co.fresno.ca.us/departments/behaviora I-hea lth/substa nce-use-disorder-services DMC Master Agreement Revised 8/05/2022 1 of 1 Amended Exhibit B Fresno County,Department of Behavioral Health Drug Medi-Cal Organized Delivery System Modality of Service Descriptions Covered services under the Drug Medi-Cal Organized Delivery System(DMC-ODS) shall be furnished in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to persons served under fee-for-service Medicaid, as set forth in 42 CFR 440.230. Contractors shall ensure that the services are sufficient in amount, duration, or scope to reasonably be expected to achieve the purpose for which the services are furnished. Contractors may not arbitrarily deny or reduce the amount duration, or scope of a required service solely because of diagnosis, type of illness, or condition of the person served. Contractors are required to ensure services are provided timely as further described in the Fresno County Substance Use Disorder Provider Manual. In all levels of care, contractors are required to either offer medications for addiction treatment (MAT) directly or demonstrate effective referral mechanisms in place to the most clinically appropriate MAT services. Providing a person served the contact information for a MAT program is insufficient. Placement in an appropriate level of care must be determined through an assessment based on the American Society of Addiction Medicine (ASAM) criteria and prescribed by the contractor's medical director. DRUG MEDI-CAL SERVICES: EARLY INTERVENTION SERVICES (ASAM LEVEL 0.5) Early intervention services (EIS) are available to persons served under 21 who are screened and determined to be at risk of developing an SUD. At risk persons served may receive any service component covered under the outpatient level of care (ASAM 1.0) as early intervention services. An SUD diagnosis is not required for early intervention services. A full assessment utilizing the ASAM criteria is not required for a person served under the age of 21 to receive EIS. An abbreviated ASAM screening tool may be used. If the person served under 21 meets diagnostic criteria for SUD, a full ASAM assessment shall be performed and the person served shall receive a referral to the appropriate level of care indicated by the assessment. EIS services may be delivered in a wide variety of settings and can be provided in person, by telehealth, or by telephone. EIS services do not limit or modify the Early Periodic Screening, Diagnostic and Treatment (EPSDT)mandate. Revised 11/01/2022 1 Amended Exhibit B OUTPATIENT SERVICES (ASAM LEVEL 1.0) Outpatient services consist of up to nine (9)hours per week of medically necessary services for adults and up to six (6) hours per week of services for adolescents. Services may exceed the maximum hours based on individual medical necessity. Services can be provided by an LPHA or registered/certified counselor in-person, by telephone, or telehealth in any appropriate setting in the community, in accordance with HIPAA and 42 CFR Part 2. Group size is limited to no less than two (2) and no more than twelve (12)persons served. Outpatient services include the following service components: • Assessment • Care Coordination • Counseling (individual/group) • Family Therapy • Medication Services • MAT for opioid use disorders • MAT for alcohol use disorders and non-opioid SUDS • Patient Education • Recovery Services • SUD Crisis Intervention Services INTENSIVE OUTPATIENT SERVICES (ASAM LEVEL 2.1) Intensive outpatient involves structured programming provided to persons served as medically necessary for a minimum of nine (9)hours and a maximum of nineteen(19) hours for adults and a minimum of six(6)hours and a maximum of nineteen(19) for adolescents. Providers may exceed maximum treatment hours when determined to be medically necessary. Intensive outpatient treatment services include the same service components listed under Outpatient 1.0. Services can be provided by an LPHA or registered/certified counselor in-person, by telephone, or telehealth in any appropriate setting in the community, in accordance with HIPAA and 42 CFR Part 2. Group size is limited to no less than two (2) and no more than twelve (12)persons served. OPIOID (NARCOTIC) TREATMENT PROGRAMS (ASAM LEVEL 1.0) Narcotic treatment program services shall be provided in accordance with Title 9, Chapter 4, Division 4 and CFR 42. Narcotic Treatment Programs (NTP), also known as Opioid Treatment Programs (OTP), are outpatient programs that provide Food and Drug Administration(FDA)-approved medications and biological products to treat SUDs when ordered by a physician as medically necessary. Revised 11/01/2022 2 Amended Exhibit B NTPs are required to administer, dispense, or prescribe medications to persons served covered under the DMC-ODS formulary including methadone, buprenorphine (transmucosal and long- acting injectable), naltrexone (oral and long-acting injectable), disulfiram, and naloxone. NTPs may also prescribe the medication for dispensing at a pharmacy. The medical evaluation for methadone treatment must be conducted in-person. Persons served in OTP/NTP settings shall receive no less than fifty(50)minutes of treatment services per calendar month although additional services may be provided based on medical necessity. Counseling services provided in the NTP modality can be provided in person, by telehealth or by telephone. NTP services include the following service components: • Assessment • Care Coordination • Counseling (individual/group) • Family Therapy • Medical Psychotherapy • Medication Services • MAT for opioid use disorders • MAT for alcohol use disorders and non-opioid SUDS • Patient Education • Recovery Services • SUD Crisis Intervention Services PERINATAL/NON-PERINATAL RESIDENTIAL SUBSTANCE USE DISORDER TREATMENT SERVICES (EXCLUDING ROOM AND BOARD) (ASAM LEVELS 3.1, 3.3 and 3.5) Residential treatment services are provided in facilities licensed by the California Department of Health Care Services (DHCS) or the California Department of Social Services for adolescents that also have DMC certification and a DHCS Level of Care Designation or an ASAM LOC Certification demonstrating ability to delivery care consistent with ASAM treatment criteria. There is no bed capacity limit for residential facilities.The Contactor must provide 24-hour care with trained personnel, including awake staff on the overnight shift to address persons served needs. Adults (21 and over): The length of stay in a short-term residential setting shall be determined by individualized clinical need. Services must include preparation for a step down to a less intensive level of care, when clinically appropriate. The statewide goal for the average length of stay for residential treatment services is 30 days. Adolescents (under the age of 21): The length of stay in a short-term residential setting shall be determined by individualized clinical need. Services must include preparation for step down to a less intensive level of care as soon as clinically appropriate. Adolescent beneficiaries receiving residential treatment shall be stabilized as soon as possible and moved down to a less intensive Revised 11/01/2022 3 Amended Exhibit B level of treatment. Nothing in the DMC-ODS or in this paragraph overrides any EPSDT requirements. Residential contractor(s) must seek prior authorization for residential treatment services upon admission and prior to the expiration of each authorized treatment period. Treatment authorization request processes can be found in the Fresno County SUD Provider Manual. Residential services include the following service components: • Assessment • Care Coordination • Counseling (individual/group) • Family Therapy • Medication Services • MAT for opioid use disorders • MAT for alcohol use disorders and non-opioid SUDS • Patient Education • Recovery Services • SUD Crisis Intervention Services WITHDRAWAL MANAGEMENT (Level I-WM,Level 2-WM and Level 3.2-WM) Withdrawal management (WM) services are prescribed based on an individual assessment using the ASAM criteria. Contractor(s) shall ensure persons served receiving both residential and outpatient WM services are monitored during the detoxification process. Withdrawal Management Services may be provided in an outpatient or residential setting. Withdrawal management services are urgent and provided on a short-term basis. When provided as part of withdrawal management services, service activities such as the assessment, focus on the stabilization and management of psychological and physiological symptoms associated with withdrawal, engagement in care and effective transitions to a level of care where comprehensive treatment services are provided. A full ASAM assessment shall not be required as a condition of admission to a withdrawal management program. ASAM 3.7-WM and 4-WM services are part of the DMC-ODS continuum of care but are offered through the Medi-Cal Managed Care Plans, Anthem Blue Cross and CalViva Health. If a person served is determined to be in need of this level of care, the provider should provide care coordination to the Managed Care Plans for treatment. Withdrawal Management services include the following service components: • Assessment • Care Coordination • Medication Services • MAT for opioid use disorders • MAT for alcohol use disorders and non-opioid SUDS Revised 11/01/2022 4 Amended Exhibit B • Observation • Recovery Services MEDICATION ASSISTED TREATMENT (MAT) Medication for addiction treatment includes all FDA-approved medications and biological products to treat Alcohol Use Disorders (AUD), Opioid Use Disorders (OUD) and any SUD. MAT may be provided in clinical or non-clinical settings and can be delivered as a standalone service or as a service delivered as part of another level of care. Persons served who decline counseling services shall not be denied access to MAT or administratively discharged. Additional MAT involves the ordering, prescribing, administering, and monitoring of medications for substance use disorders. All DMC-ODS providers, at all levels of care, must demonstrate that they either directly offer or have an effective referral mechanism/process to MAT for persons served with SUD diagnoses. MAT services may be provided in conjunction with the following service components: • Assessment • Care Coordination • Counseling (individual/group) • Family Therapy • Medication Services • Patient Education • Recovery Services • SUD Crisis Intervention Services • Withdrawal Management Services CONTINGENCY MANAGEMENT (RECOVERY INCENTIVES) Contingency Management(CM) is an evidence-based behavioral treatment that provides motivational incentive to reduce the use of stimulants. CM is the only treatment that has demonstrated robust outcomes for persons served with stimulant use disorder, including reduction or cessation of drug use and longer retention in treatment. CM is a structured 24-week program, followed by six or more months of additional recovery support services. Persons served will be able to earn motivational incentives in the form of low- denomination gift cards, with a total retail value determined per treatment episode. In the Fall of 2022, CM will be piloted in select DMC-ODS counties, including Fresno County, as an optional DMC benefit. CM will initially be available through DMC certified outpatient providers that opted into participation during the pilot. Following the conclusion of the CM pilot on March 31, 2024, opting in will become available to all outpatient programs so long as DHCS adds CM as a permanent Medi-Cal benefit. Revised 11/01/2022 5 Amended Exhibit B CARE COORDINATION SERVICE (formerly Case Management) Care Coordination services are defined as a service that assists persons served to access needed medical, educational, social, prevocational, vocational, rehabilitative, or other community services. Care coordination consists of activities to provide coordination of SUD care, mental health care, and medical care, and to support the person served with linkages to services and supports designed to restore the person served to their best possible functional level. Care Coordination services are provided to a person served in conjunction with all levels of treatment and may also be claimed as a standalone service. Care Coordination services may be provided by an LPHA or certified counselor. Contractors shall use care coordination services to coordinate with physical and/or mental health systems of care. Care coordination can be provided in clinical or nonclinical settings (including the community) and can be provided face-to-face,by telehealth, or by telephone. Care Coordination shall include one or more of the following components: • Coordination with medical and mental health providers to monitor and support comorbid health conditions. • Discharge planning, including coordinating with SUD treatment providers to support transitions between levels of care and to recovery resources, referrals to mental health providers, and referrals to primary or specialty medical providers. • Coordinating with ancillary services, including individualized connection, referral, and linkages to community-based services and supports including but not limited to educational, social, prevocational, vocational, housing, nutritional, criminal justice, transportation, childcare, child development, family/marriage education, cultural sources, and mutual aid support groups. Care Coordination shall be consistent with and shall not violate confidentiality of persons served as set forth in 42 CFR Part 2, and California law. PEER SUPPORT SERVICES (Available following completion of Fresno County opt-in) Peer support services promote recovery, resiliency, engagement, socialization, self-sufficiency, self-advocacy, development of natural supports, and identification of strengths through structured activities such as group and individual coaching to set recovery goals and identify steps to reach the goals. Peer support services may be provided with the person served or significant support person(s) and may be provided in a clinical or non-clinical setting. Peer support services can include contact with family members or other people (collaterals) supporting the person served if the purpose of the collateral's participation is to focus on the treatment needs of the person served. Revised 11/01/2022 6 Amended Exhibit B Peer support services are delivered and claimed as a standalone service. Peer support services can be provided in conjunction with other services or levels of care, including inpatient and residential services, but shall be billed separately. There may be times when,based on clinical judgment, the person served is not present during the delivery of the service, but remains the focus of the service. Peer Support Services are based on a plan of care that includes specific individualized goals and is approved by a Behavioral Health Specialist or a Peer Support Supervisor. Peer support services consist of Education Skill Building Groups, Engagement services and Therapeutic Activity services. Peer Support Specialists are individuals in recovery with a current State-approved Medi-Cal Peer Support Specialist Certification Program certification and working under the direction of a Behavioral Health Professional. Behavioral Health Professionals must be licensed, waivered, or registered in accordance with applicable State of California licensure requirements and listed in the California Medicaid State Plan as a qualified DMC provider. RECOVERY SERVICES Recovery Services are designed to support recovery and prevent relapse with the objective of restoring the person served to their best possible functional level. Recovery services can be utilized when the person served is triggered, when the person served has relapsed or simply as a measure to prevent relapse. Persons served do not need to be diagnosed as being in remission to access Recovery Services. Persons served may receive Recovery Services while receiving MAT services, including NTP services. Persons served may receive Recovery Services immediately after incarceration with a prior diagnosis of SUD. Services may be provided in person, by telehealth, or by telephone. Recovery Services can be delivered and claimed as a standalone service, concurrently with the other levels of care or as a service delivered as part of other levels of care. Contractors that do not opt to make recovery services available must refer persons served to a contractor that provides recovery services. Recovery Services shall include the following service components: • Assessment • Care Coordination • Counseling (individual and group) • Family Therapy Recovery Monitoring, which includes recovery coaching and monitoring designed for the maximum reduction of the person served's SUD • Relapse Prevention which includes interventions designed to teach persons served with SUD how to anticipate and cope with the potential for relapse for the maximum reduction of the person served's SUD. Revised 11/01/2022 7 Amended Exhibit B CLINICIAN CONSULTATION (formerly Physician Consultation) Clinician Consultation consists of LPHAs consulting with LPHAs, such as addiction medicine physicians, addiction psychiatrists, licensed clinicians, or clinical pharmacists, to support the provision of care. Clinician Consultation is designed to support licensed clinicians with complex cases and may address medication selection, dosing, side effect management, adherence, drug-drug interactions, or level of care considerations. It includes consultations between clinicians designed to assist clinicians with seeking expert advice on treatment needs for specific persons served. These consultations can occur in person,by telehealth, by telephone, or by asynchronous telecommunication systems. NON-DMC FUNDED SERVICES: Non-DMC eligible persons served will have access to the same services as DMC-eligible persons served with costs reimbursed through other sources. These services, available to all perinatal and non-perinatal adults and adolescents, include: • Early Intervention Services • Outpatient • Intensive Outpatient • Medication Assisted Treatment • Residential treatment, including Withdrawal Management • Care Coordination • Peer Support Services • Recovery Services • Clinician Consultation Room and Board for Residential Treatment and Withdrawal Management services is not eligible for reimbursement through DMC. These costs will be covered with other non-DMC funding sources. Revised 11/01/2022 8 Amended Exhibit E1 Fresno County Department of Behavioral Health Drug Medi-Cal Treatment Services Approved Rates by Provider Fiscal Year 2022-23 15-Minute Unit Day Rate OPT IOT Care Recovery Clinician MAT Contingency Withdrawal Residential Residential Coordination Services Consultation Management Management 3.1 3.5 APPROVED MAXIMUM UOS RATE 51.00 53.85 51.45 52.05 153.60 153.60 39.42 164.24 185.13 188.52 COUNTY APPROVED PROVIDER RATES: Bakersfield Recovery,Inc.-Jason's Retreat 164.24 Bakersfield Recovery,Inc.-Capistrano 164.24 Central California Recovery 45.00 46.35 153.60 153.60 35.85 Comprehensive Addiction Programs,Inc. 43.95 153.60 153.60 145.17 138.61 151.66 Delta Care 40.50 51.45 33.00 153.60 153.60 Fresno County Hispanic Commission 43.05 153.60 153.60 111.05 Fresno New Connections 32.70 53.85 51.45 27.00 153.60 153.60 Kings View-Fresno 44.55 44.55 153.60 153.60 Mental Health Systems-FYA 39.00 38.55 37.20 153.60 153.60 Mental Health Systems-IMPACT 48.45 50.10 49.35 48.60 153.60 153.60 Mental Health Systems-Fresno First(Womens) 43.05 153.60 153.60 127.27 172.38 172.38 Mental Health Systems-Fresno First(Perinatal) 43.05 153.60 153.60 127.27 172.38 172.38 Prodigy 50.55 50.10 52.05 153.60 153.60 Promesa 48.90 46.80 49.50 153.60 153.60 Turning Point-First Street Center 36.60 35.55 153.60 153.60 Turning Point-Quest House 43.05 153.60 153.60 177.92 188.52 WestCare Outpatient-Belmont 51.00 50.70 49.65 42.75 153.60 153.60 37.20 WestCare Bakersfield Residential 40.50 153.60 153.60 163.41 120.63 WestCare Fresno Residential Mens 35.25 153.60 153.60 164.24 156.84 163.66 Perinatal 35.25 153.60 153.60 164.24 170.78 175.84 Womens 35.25 153.60 153.601 164.24 158.83 173.87 DMC Master Agreement Revised 11/01/2022 1 of 15 Amended Exhibit E1 Department of Health Care Services Local Governmental Financing Division Drug Medi-Cal (DMC) Rates for Fiscal Year 2022-23 Non Perinatal DMC Description Unit of Service (UOS) FY 2022-23 UOS Rate' Narcotic Treatment Program (NTP) - Daily $16.20 Methadone NTP - Individual Counseling One 10-minute Increment $19.01 NTP - Group Counseling One 10-minute Increment $4.49 Intensive Outpatient Treatment Face-to-Face Visit $87.24 Naltrexonel Face-to-Face Visit $19.06 Residential - for EPSDT Beneficiaries Daily $128.47 Outpatient Drug Free (ODF) Individual Face-to-Face Visit (Per $95.07 Counseling Person ODF Group Counseling Face-to-Face Visit (Per $40.40 Person Perinatal DMC Description Unit of Service (UOS) FY 22-23 UOS Rate** NTP - Methadone Daily $17.45 NTP - Individual Counseling' One 10-minute Increment $27.21 NTP - Group Counseling' One 10-minute Increment $9.09 Intensive Outpatient Treatment Face-to-Face Visit $104.37 Perinatal Residential Daily $128.47 ODF Individual Counseling Face-to-Face Visit (Per $136.08 Person ODF Group Counseling Face-to-Face Visit (Per $81 82 Person 1 -From FY 2002-03 through FY 2008-09,Naltrexone was frozen at the$21.19(FY 1 999 2000)approved rate.Counties and service providers have not provided,submitted claims,nor reported cost for this service since FY 1997-98.For FY 2009-10,the$21.19 frozen rate was reduced by 10 percent to$19.07.The rate was reduced to$19.06 when county administration was excluded from the rates. Drug Medi-Cal used$19.06 as the FY 22-23 developed rate. 2-FY 2009-2010 rates were adjusted by the cumulative growth of the change in the Implicit Price Deflator(IDP), in accordance with Welfare&Institutions Code Section 14021.9(b).The 15.6 percent is a year-to-year summation of the change in IDP's which are as follows:0%for FY 2009-10,3.2%for FY 2010-11 2.7%for FY 2011-12,2.8%for FY 2012-13,3.0%for FY 2013-14, 1.10%for FY 2014-15,-0.30%for FY 2015-16, 1.3%for FY 2016-17,3.5%for FY 2017-18,3.2%for FY 2018-19, 1.4%for FY 2019-20,2.6%for FY 20-21,7.1%for FY 21-22,and 4.8%for FY 22-23. DMC Master Agreement Exhibit E1 Department of Health Care Services Local Governmental Financing Division Drug Medi-Cal (DMC) Rates for Fiscal Year 2022-23 Additional Medication Assisted Treatments Available in Waiver Opt-In Counties Narcotic Treatment Programs Non Perinatal DMC Additional Medication Addiction Treatment (MAT) Rates Description Unit of Service (UOS) FY 2022-23UOS Rate** Narcotic Treatment Program (NTP) — Buprenorphine- Mono Daily $31.32 NTP — Buprenorphine-Naloxone: Daily $31.80 Tablets NTP - Buprenorphine-Naloxone: Film Daily $28.31 NTP - Buprenorphine Injectable Monthly $1,970.17 NTP - Naltrexone Injectable Monthly $2,151.97 NTP - Disulfiram Daily $11.30 NTP-Naloxone Dispensed according to $144.96 need Perinatal DMC Additional Medication Addiction Treatment (MAT) Rates Description Unit of Service (UOS) FY 22-23 UOS Rate** NTP - Buprenorphine-Mono Daily $42.38 NTP - Buprenorphine-Naloxone: Daily $42.85 Tablets NTP - Buprenorphine-Naloxone: Film Daily $39.37 NTP - Buprenorphine Injectable Monthly $1,970.17 NTP - Naltrexone Injectable Monthly $2,151.97 NTP - Disulfiram Daily $11.47 NTP-Naloxone Dispensed according to $144.96 need DMC Master Agreement Amended Exhibit E1 Fresno County Department of Behavioral Health Drug Medi-Cal Treatment Services Approved Rates by Provider Fiscal Year 2023-24 15-Minute Unit Day Rate OPT IOT Care Recovery Clinician MAT Contingency Withdrawal Residential Residential Coordination Services Consultation Management Management 3.1 3.5 APPROVED MAXIMUM UOS RATE COUNTY APPROVED PROVIDER RATES: Bakersfield Recovery, Inc.-Jason's Retreat Bakersfield Recovery, Inc.-Capistrano Central California Recovery Comprehensive Addiction Programs, Inc. Delta Care Fresno County Hispanic Commission Fresno New Connections Kings View-Fresno Mental Health Systems-FYA Mental Health Systems-IMPACT Mental Health Systems-Fresno First(Womens) Mental Health Systems-Fresno First(Perinatal) Prodigy Promesa Turning Point-First Street Center Turning Point-Quest House WestCare Outpatient-Belmont WestCare Bakersfield Residential WestCare Fresno Residential Mens Perinatal Womens DMC Master Agreement Revised 11/01/2022 4 of 15 Amended Exhibit E1 [This page intentionally left blank] DMC Master Agreement Revised 11/01/2022 5 of 15 Amended Exhibit E1 [This page intentionally left blank] DMC Master Agreement Revised 11/01/2022 6 of 15 Amended Exhibit E1 Fresno County Department of Behavioral Health Drug Medi-Cal Treatment Services Approved Rates by Provider Fiscal Year 2024-25 15-Minute Unit Day Rate OPT IOT Care Recovery Clinician MAT Contingency Withdrawal Residential Residential Coordination Services Consultation Management Management 3.1 3.5 APPROVED MAXIMUM UOS RATE COUNTY APPROVED PROVIDER RATES: Bakersfield Recovery, Inc.-Jason's Retreat Bakersfield Recovery, Inc.-Capistrano Central California Recovery Comprehensive Addiction Programs, Inc. Delta Care Fresno County Hispanic Commission Fresno New Connections Kings View-Fresno Mental Health Systems-FYA Mental Health Systems-IMPACT Mental Health Systems-Fresno First(Womens) Mental Health Systems-Fresno First(Perinatal) Prodigy Promesa Turning Point-First Street Center Turning Point-Quest House WestCare Outpatient-Belmont WestCare Bakersfield Residential WestCare Fresno Residential Mens Perinatal Womens DMC Master Agreement Revised 11/01/2022 7 of 15 Amended Exhibit E1 [This page intentionally left blank] DMC Master Agreement Revised 11/01/2022 8 of 15 Amended Exhibit E1 [This page intentionally left blank] DMC Master Agreement Revised 11/01/2022 9 of 15 Amended Exhibit E1 Fresno County Department of Behavioral Health Drug Medi-Cal Treatment Services Approved Rates by Provider Fiscal Year 2025-26 15-Minute Unit Day Rate OPT IOT Care Recovery Clinician MAT Contingency Withdrawal Residential Residential Coordination Services Consultation Management Management 3.1 3.5 APPROVED MAXIMUM UOS RATE COUNTY APPROVED PROVIDER RATES: Bakersfield Recovery, Inc.-Jason's Retreat Bakersfield Recovery, Inc.-Capistrano Central California Recovery Comprehensive Addiction Programs, Inc. Delta Care Fresno County Hispanic Commission Fresno New Connections Kings View-Fresno Mental Health Systems-FYA Mental Health Systems-IMPACT Mental Health Systems-Fresno First(Womens) Mental Health Systems-Fresno First(Perinatal) Prodigy Promesa Turning Point-First Street Center Turning Point-Quest House WestCare Outpatient-Belmont WestCare Bakersfield Residential WestCare Fresno Residential Mens Perinatal Womens DMC Master Agreement Revised 11/01/2022 10 of 15 Amended Exhibit E1 [This page intentionally left blank] DMC Master Agreement Revised 11/01/2022 11 of 15 Amended Exhibit E1 [This page intentionally left blank] DMC Master Agreement Revised 11/01/2022 12 of 15 Amended Exhibit E1 Fresno County Department of Behavioral Health Drug Medi-Cal Treatment Services Approved Rates by Provider Fiscal Year 2026-27 15-Minute Unit Day Rate OPT IOT Care Recovery Clinician MAT Contingency Withdrawal Residential Residential Coordination Services Consultation Management Management 3.1 3.5 APPROVED MAXIMUM UOS RATE COUNTY APPROVED PROVIDER RATES: Bakersfield Recovery, Inc.-Jason's Retreat Bakersfield Recovery, Inc.-Capistrano Central California Recovery Comprehensive Addiction Programs, Inc. Delta Care Fresno County Hispanic Commission Fresno New Connections Kings View-Fresno Mental Health Systems-FYA Mental Health Systems-IMPACT Mental Health Systems-Fresno First(Womens) Mental Health Systems-Fresno First(Perinatal) Prodigy Promesa Turning Point-First Street Center Turning Point-Quest House WestCare Outpatient-Belmont WestCare Bakersfield Residential WestCare Fresno Residential Mens Perinatal Womens DMC Master Agreement Revised 11/01/2022 13 of 15 Amended Exhibit E1 [This page intentionally left blank] DMC Master Agreement Revised 11/01/2022 14 of 15 Amended Exhibit E1 [This page intentionally left blank] DMC Master Agreement Revised 11/01/2022 15 of 15 Exhibit E2 Central California Recovery Central California Recovery CM Start Up Funding Fiscal Year(FY)2022-2023 PROGRAM EXPENSES 1000:DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct# Administrative Position FTE Admin Program Total 1101 $ $ 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 1115 Direct Personnel Admin Salaries Subtotal 0.00 $ - $ - 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 0.00 1 $ - $ - $ - Direct Employee Benefits Acct# Description Admin Program Total 1201 Retirement $ 1202 Worker's Compensation 1203 Health Insurance 1204 Other(specify) 1205 Other(specify) 1206 1 Other(specify) Direct Employee Benefits Subtotal: $ $ $ Direct Payroll Taxes&Expenses: Acct# Description Admin Program Total 1301 OASDI $ - $ - $ - 1302 FICA/MEDICARE - - - 1303 SUI - - - 1304 Other(specify) 1305 Other(specify) 1306 1 Other(specify) Direct Payroll Taxes&Expenses Subtotal: $ - $ - $ - DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program #DIV/0! #DIV/01 Fresno County partmentofBe avrrn'al alt�GDt Contract Budget Narrative Rcviscd2/7/2020 Exhibit E2 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(specify) 2012 Other(specify) 2013 Other(specify) 2014 Other(specify) 2015 Other(specify) 2016 Other(specify) DIRECT CLIENT CARE TOTAL $ 3000:DIRECT OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ 3002 Printing/Postage - 3003 Office,Household&Program Supplies 11,664 3004 Advertising - 3005 Staff Development&Training 180 3006 1 Staff Mileage - 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) - DIRECT OPERATING EXPENSES TOTAL: $ 11,844 4000:DIRECT FACILITIES&EQUIPMENT 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 4008 Other 4009 Other 4010 Other(specify) DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 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) 963 5004 Translation Services - 5005 Other(specify) 5006 1 Other(specify) 5007 Other(specify) 5008 Other(specify) DIRECT SPECIAL EXPENSES TOTAL: $ 963 Fresno CountyRYPUntof" .NIHeakhent Contract Budget Mnative Revised2/7/2020 Exhibit E2 6000:INDIRECT EXPENSES Acd# 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(Provider0—d Equipment to be UsedforProgram Purposes) - 6008 Personnel(indirect Salaries&Benefits) 6009 Other(specify) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 Other(specify) INDIRECT EXPENSES TOTAL $ INDIRECT COST RATE 0.00% 7000:DIRECT FIXED ASSETS Acct# Line Item Description Amount 7001 Computer Equipment&Software $ 600 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data - 7003 Furniture&Fixtures 600 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 l Assets over$5,000/unit(Specify) 7007 Other(specify) 7008 Other(specify) FIXED ASSETS EXPENSES TOTAL $ 1,200 TOTAL PROGRAM EXPENSES $ 14,007 PROGRAM FUNDING SOURCES 8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION) Acd# 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)%1 0% MEDI-CAL FFP TOTAL $ - 8100-SUBSTANCE USE DISORDER FUNDS Acd# Line Item Description Amount 8101 Drug Medi-Cal $ 8102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acd# Line Item Description Amount 8201 lRealignment $ REALIGNMENT TOTAL $ 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acd# MHSA Component MHSA Program Name Amount 8301 CSS-CommunityServices&Supports $ 8302 PEI-Prevention&Early Intervention 8303 INN-Innovations 8304 WET-Workforce Education&Training 8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ Fresno County Lkp^a�nt of"Bet.NMI Heakhent Contract Budget Mnative Revised 2/7/2020 Exhibit E2 8400-OTHER REVENUE Acct p Line Item Description Amount 8401 Client Fees $ - 8402 Client Insurance - 8403 Grants(Specify) - 8404 Other(Specify)BHQIP 14,007 8405 Other(Specify) OTHER REVENUE TOTAL $ 14,007 TOTAL PROGRAM FUNDING SOURCES: $ 14,007 NET PROGRAM COST: $ Fresno County Ikpantneent ofBehavrrn3l tiealthent Contract Budget Narrative Revised 2/7/2020 Exhibit E2 Central California Recovery CM Startup Funding Central California 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 n/Name/Department/County FTE LEI Total 0.00 Position Contract n/Name/Department/County FTE Total 0.00 Position Contract n/Name/Department/County FTE Total 0.00 Position Contract n/Name/Department/County FTE Total 0.00 Position Contract n/Name/Department/County FTE Total 0.00 Position Contract n/Name/Department/County FTE Total 0.00 Position Contract n/Name/Department/County FTE Fresno County parunentofBe avrrn'al alth�Dt Contract Budget Narrative Rcviscd2/7/2020 Exhibit E2 Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE% Fresno County Lkp^a nt. e,r.NlHeakhent Contract Budget Mnative Revised2/7/2020 Exhibit E2 Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Fresno County Lkpa�eni of"BettavKMal Heakhent Contract Budget Mnative Revised 2/7/2020 Exhibit E2 Central California Recovery Central California Recovery CM Start Up Funding Fiscal Year(FY)2022-2023 Budget Narrative PROGRAM EXPENSE ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:DIRECT SALARIES&BENEFITS Administrative Positions - 1101 0 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 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 0 Direct Employee Benefits 1201 Retirement 1202 Worker's Compensation 1203 Health Insurance 1204 Other(specify) 1205 Other(specify) 1206 Other(specify) Direct Payroll Taxes&Expenses: 1301 OASDI 1302 FICA/MEDICARE 1303 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(specify) 2012 Other(specify) 2013 Other(specify) 2014 Other(specify) 20115 Other(specify)egrp Fresno County PIMA of'BehavKMalHeakhent Contract Budget Mnative Revised2/7/2020 Exhibit E2 PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2016 Other(specify) - 3000:DIRECT OPERATING EXPENSES 11,844 3001 Telecommunications - 3002 Printing/Postage - 3003 Office,Household&Program Supplies 11,664 Urine drug tests for 60 clients-36 tests per person at$5.40 per test 3004 Advertising - 3005 Staff Development&Training 180 Fees for required new SLID counselor trainings 3006 Staff Mileage - 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) 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 963 5001 Consultant(Network&Data Management) - 5002 HMIS(Health Management Information System) - 5003 Contractual/Consulting Services (Specify) 963 Contracted staff at$25 per hour for 38.5 hours for training 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(specify) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 116-6 6013 Other(specify) 7000:DIRECT FIXED ASSETS 1,200 7001 Computer Equipment&Software 600 New laptop for contingency management coordinator 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA - 7003 Furniture&Fixtures 600 New desk and chair for contingency management coordinator 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) 7007 Other(specify) 7008 1 Other(specify) PROGRAM FUNDING SOURCES 8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION) PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED BY THE RFP 8001 Mental Health Services 8002 Case Management 8003 Crisis Services 8004 1 Medica�a}}tiio��nQQSuu�pr[pporttp Fresno County Lk�paeMnt o£BehavxMal HeaHhent Contract Budget Narrative Revised 2/7 2020 Exhibit E2 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 8005 Collateral 8006 Plan Development 8007 Assessment 8008 Rehabilitation 8009 Other(Specify) 8010 1 Other(Specify) TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 14,007 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 14,007 BUDGET CHECK: - Fresno CountyLkp^ ntof" .NIHeakhent Contract Budget Mutative Revised2/7/2020 Exhibit E2 WestCare California,Inc. Contingency Management Pilot Program Start Up Funds Fiscal Year(FY)2022-23 PROGRAM EXPENSES 1000:DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct p Administrative Position FTE Admin Program Total 1101 $ 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 1115 Direct Personnel Admin Salaries Subtotal 0.00 $ - $ - Acct p Program Position FTE Admin Program Total 1116 Program Coordinator 1.00 16,250 $ 16,250 1117 - 1118 1119 - 1120 1121 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 Direct Personnel Program Salaries Subtotal 1.00 $ 16,250 $ 16,250 Admin Program Total Direct Personnel Salaries Subtotal 1.00 $ - $ 16,250 $ 16,250 Direct Employee Benefits Acct# Description Admin Program Total 1201 Retirement $ 163 $ 163 1202 Worker's Compensation 666 666 1203 Health Insurance 1,219 1,219 1204 Vacation Payouts 46 46 1205 Dental Insurance 73 73 1206 1 Life Insurance 1 11 1 11 Direct Employee Benefits Subtotal: $ $ 2,178 $ 2,178 Direct Payroll Taxes&Expenses: Acct p Description Admin Program Total 1301 OASDI $ - $ - 1302 FICA/MEDICARE 1,219 1,219 1303 SUI - 1304 Unemployment Taxes 162 162 1305 Other(specify) - 1306 Other(specify) Direct Payroll Taxes&Expenses Subtotal: $ - $ 1,381 $ 1,381 DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ - $ 19,809 $ 19,809 DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program 0%1 100% Fresno County parunentofBe avrrn'aI oulln Dt Contract Budget Narrative Rcviscd2/7/2020 Exhibit E2 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(specify) 2012 Other(specify) 2013 Other(specify) 2014 Other(specify) 2015 Other(specify) 2016 Other(specify) DIRECT CLIENT CARE TOTAL $ 3000:DIRECT OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications 3002 Printing/Postage 3003 Office,Household&Program Supplies 9,720 3004 Advertising 100 3005 Staff Development&Training 3006 1 Staff Mileage - 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) - DIRECT OPERATING EXPENSES TOTAL: $ 10,220 4000:DIRECT FACILITIES&EQUIPMENT 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 Other(specify) DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 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 1 Other(specify) 5007 Other(specify) 5008 Other(specify) DIRECT SPECIAL EXPENSES TOTAL: $ Fresno CountyLkpa Aofkhavi !iIHeakhent Contract Budget Mnative Revised2/7/2020 Exhibit E2 6000:INDIRECT EXPENSES Acd# Line Item Description Amount Administrative Overhead 6001 Use this line and only this line for approved indirect cost rate $ 8,399 Administrative Overhead 6002 Professional Liability Insurance - 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation(Provider0—d Equipment to be UsedforProgram Purposes) - 6008 Personnel(indirect Salaries&Benefits) 6009 Other(specify) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) - 6013 Other(specify) INDIRECT EXPENSES TOTAL $ 8,399 INDIRECT COST RATE 26.00% 7000:DIRECT FIXED ASSETS Acct# Line Item Description Amount 7001 Computer Equipment&Software $ 1,550 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data 7003 Furniture&Fixtures 725 7004 Leasehold/Tenant/Building Improvements 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 l Assets over$5,000/unit(Specify) 7007 10ther 7008 10ther FIXED ASSETS EXPENSES TOTAL $ 2,275 TOTAL PROGRAM EXPENSES $ 40,703 PROGRAM FUNDING SOURCES 8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION) Acd# 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)%1 0% MEDI-CAL FFP TOTAL $ - 8100-SUBSTANCE USE DISORDER FUNDS Acd# Line Item Description Amount 8101 Drug Medi-Cal $ 8102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acd# Line Item Description Amount 8201 lRealignment $ REALIGNMENT TOTAL $ 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acd# MHSA Component MHSA Program Name Amount 8301 CSS-CommunityServices&Supports $ 8302 PEI-Prevention&Early Intervention 8303 INN-Innovations 8304 WET-Workforce Education&Training 8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ Fresno CountyLkpa Aofkhavi !ilHeakhent Contract Budget Mnative Revised2/7/2020 Exhibit E2 8400-OTHER REVENUE Acct p Line Item Description Amount 8401 Client Fees $ - 8402 Client Insurance - 8403 Grants(Specify) - 8404 Other(Specify)BHQIP 40,703 8405 Other(Specify) - OTHER REVENUE TOTAL $ 40,703 TOTAL PROGRAM FUNDING SOURCES: $ 40,703 NET PROGRAM COST: $ Fresno County Ikpantneent ofBehavrrn3l tiealthent Contract Budget Narrative Revised 2/7/2020 Exhibit E2 Contingency Management Pilot Program Startup Funds WestCare California,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 n/Name/Department/County FTE LEI Total 0.00 Position Contract n/Name/Department/County FTE Total 0.00 Position Contract n/Name/Department/County FTE Total 0.00 Position Contract n/Name/Department/County FTE Total 0.00 Position Contract n/Name/Department/County FTE Total 0.00 Position Contract n/Name/Department/County FTE Total 0.00 Position Contract n/Name/Department/County FTE Fresno County parunentofBe avrrn'al alth�Dt Contract Budget Narrative Rcviscd2/7/2020 Exhibit E2 Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE% Fresno County Lkp^a nt. e,r.NlHeakhent Contract Budget Mnative Revised2/7/2020 Exhibit E2 Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Fresno County Lkpa�eni of"BettavKMal Heakhent Contract Budget Mnative Revised 2/7/2020 Exhibit E2 WestCare California,Inc. Contingency Management Pilot Program Start Up Funds 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 19,809 Administrative Positions - 1101 0 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 16,250 1116 Program Coordinator 16,250 The CM Coordinator will lead the tracking and delivery of all CM services,including administering and interpreting UDT results.The projected amount is allocated for 3 months worth of salary. 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 0 Direct Employee Benefits 1201 Retirement 163 allocated 1%of the total personnel costs 1202 Worker's Compensation 666 allocated 4.1%of the total personnel costs 1203 Health Insurance 1,219 allocated 7.5%of the total personnel costs 1204 Vacation Payouts 46 allocated.28%of the total personnel costs 1205 Dental Insurance 73 allocated.45%of the total personnel costs 1206 Life Insurance 11 allocated.07%of the total personnel costs Direct Payroll Taxes&Expenses: 1,381 1301 OASDI - 1302 FICA/MEDICARE 1,219 allocated 7.5%of the total personnel costs 1303 SUI - 1304 Unemployment Taxes 162 allocated 1%of the total personnel costs 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(specify) 2012 Other(specify) 20113 Other(specify)egrp Fresno County PIMA ofkhavi !il akhent Contract Budget Mnative Revised2/7/2020 Exhibit E2 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2014 Other(specify) 2015 Other(specify) 2016 Other(specify) 3000:DIRECT OPERATING EXPENSES 10,220 3001 Telecommunications - 3002 Printing/Postage - 3003 Office,Household&Program Supplies 9,720 Urine Drug Tests for 50 clients using 36 cups(3 weeks)at$5.40/cup 3004 Advertising 500 Cost of staff recruitment/Advertisement and hiring cost that includes background check. 3005 Staff Development&Training - 3006 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 1 Other(specify) 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 1 Other(specify) 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 8,399 6001 Administrative Overhead 8,399 Comprised of personnel and other costs associated with supporting the program like 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(specify) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 116-6 6013 Other(specify) 7000:DIRECT FIXED ASSETS 2,275 7001 Computer Equipment&Software 1,550 Compute equipment for the CM Coordinator 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA - 7003 Furniture&Fixtures 725 Includes office table,chairs and cabinets for the CM Coordinator 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) 7007 Other 7008 1 Other 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 }}HH�e��alltQthh�SSeerviicces Fresno County Lk�pa eMntoPBet�avxMalHeaAent Contract Budget Murative Revised2/7/2020 Exhibit E2 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 8002 Case Management 8003 Crisis Services 8004 Medication Support 8005 Collateral 8006 Plan Development 8007 Assessment 8008 Rehabilitation 8009 Other(Specify) 8010 Other(Specify) TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 40,703 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 40,703 BUDGETCHECK: - Fresno County Lkp^ nt of"BettavKMal Heakhent Contract Budget Mutative Revised 2/7/2020 Report Purpose Submit to Notes weekly Monthly Annual As Needed ASAM Level of Care Tracks level of care determined at sas@ Submit reports by Monday for the (LOC) screening,assessment,and reassessment fresnocountyca.gov previous week; ensure that reports are Monday and actual LOC referred to. password protected or encrypted. Provides capacity and utilization 5th of DATAR information on publicly funded SUD DHCS Webpage following programs. month Template provided by DBH. • Provider shall enter information per modality. If provider offers multiple Managed care requirement. Used to levelsof care within a modality, provider is to use the program ID with 15th of Monthly Status Report monitor network adequacy standards. sas@ followin (MSR) Provides status on DMC programs and is fresnocountyca.gov the lowest LOC(e.g.,for residential, monthg used to update provider directory. enter info under 3.1 instead of 3.5). • Providers are asked to report departing counselors via MSR as soon asthey become aware of the upcoming change. Provides information on length of waittime 15th of Wait List* for admission into a residential sas@ Applicable to residential providers only following program. fresnocountyca.gov month Checks for clinicians'eligibility to provide 15th of Ineligible Persons services based on sanctions or exclusion sas@ Template provided by DBH current Screening status. fresnocountyca.gov month 15t"of Missed Appointments Collects missed appointment data. Avatar following month 15th of Grievance Log DHCS requirement.Collects grievances at mcare@ Template provided by DBH following SUD programs. fresnocountyca.gov month 25th of Operational Expense Tracks provider expenses and monitors sas@ Template provided by DBH following Review(OER)* whether reported costs are allowable. fresnocountyca.gov month DMC Master Agreement Report Purpose Submit to Notes weekly Monthly Annual As Needed Network Adequacy sas@ Certification Tool Used to monitor network adequacy Template provided by DBH Feb 1 (NACT) standards. fresnocountyca.gov Culturally and Used to monitor adherence to the Linguistically National CLAS Standards which are sas@ Appropriate Services intended to advance health equity, Template provided b DBH TBD fresnocountyca.gov p p Y (CLAS)self-assessment improve quality,and help eliminate and CLAS plan health care disparities. Americans with Used to monitor compliance with sas@ Disabilities Act(ADA) legislation that prohibits discrimination fresnocountyca.gov Template provided by DBH TBD self-assessment against people with disabilities. Identifies costs and charges related to sas@ Cost Report* program. fresnocountyca.gov Due annually; date set by DHCS and DBH TBD Electronic copy: sas@ fresnocountyca.gov Hard copy: Mandated questionnaire used to determine Department of Risk Assessment a provider's risk categoryclassification. Behavioral Health Due annually; date set by DBH TBD Substance Use Disorder Services Attn: Fiscal Analyst 3133 N Millbrook Ave Fresno, CA 93703 DMC Master Agreement Additional Reports Report Purpose Submit to Notes weekly Monthly Annual As Needed • Providers are required to complete an online report of any incidents that compromise the health and Logic Manager Incident reporting system Logic Manager safety of clients, employees or X community members. • Reports must be submitted within 48 hours of an incident • Complete form at the time that an individual requests Access Form Collects timeliness data. Avatar SUD treatment X • Instructions are posted at our SUD Services Provider Page • Timeframes vary. Refer to MHSUDS IN #18-010E: https://www.dhcs.ca.gov/forms andpubs/Pages/Behavioral Heal Managed care requirement. NOABD letters th Information Notice.aspx Notice of Adverse Benefit provide information to Medi-Cal persons mcare@ • Templates provided by DBH, Determination (NOABD) served about their appeal rights and other fresnocountyca.gov available at the Provider page: X rights under the Medi-Cal program. https://www.co.fresno.ca.us/depar tments/behavioral- health/home/for- providers/contract- providers/substance-use-disorder- providers *Excluding NTP-only Providers DMC Master Agreement Exhibit G Page 1 of 1 ELECTRONIC HEALTH RECORD SOFTWARE CHARGES CONTRACTOR(S) understand that COUNTY utilizes NetSmart's Avatar for its Electronic Health Records Management. CONTRACTOR(S) agree to reimburse COUNTY for all user license fees for accessing NetSmart's Avatar, as set forth below. Description FY 2018-19 FY 2019-20 FY 2020-21 FY 2021-22 FY 2022-23 General Users Avatar Named User Hosting (per active user per month; every Avatar"active" log on $37.00 $37.00 $37.00 $37.00 $37.00 ID is a named user) Avatar Named User Maintenance* $14.00 $14.00 $14.00 $14.00 (per active user per month) $14.00 Cloud Hosting- Perceptive Disaster Recovery (per active user per month) $4.66 $4.66 $4.66 $4.66 $4.66 eRx Users Full Suite Prescriber $104.00 $104.00 $104.00 $104.00 (per active user per month; applicable to an active $104.00 Prescriber user ePrescribing Controlled Substances Tokens $8.00 $8.00 $8.00 $8.00 (per active user per month; applicable to an active $8.00 Prescriber user of Controlled Substances Non-Prescribing User $13.00 $13.00 $13.00 $13.00 (per active user per month; applicable to an active Non- $13.00 Prescriber user Reaching Recovery Users Reaching Recovery (per adult client/person served per year; applicable to $10.00 $10.00 $10.00 $10.00 $10.00 adult treatment programs except contracted triage/CI, CSU or PHF ProviderConnect Users Individual Subscription' (per user per month; applicable to provider-user whose $41.25 $41.25 $41.25 $41.25 $41.25 claims are reviewed and posted by Managed Care) Should CONTRACTOR(S) choose not to utilize NetSmart's Avatar for its Electronic Health Records management, CONTRACTOR(S) will be responsible for obtaining its own system for Electronic Health Records management. *Annual Maintenance increases by 3%each FY on July 111 aI AA faxed pages peF MORth A R additiGRal fee of$0.20 peF faxed page will apply theFeafteF. DMC Master Agreement