HomeMy WebLinkAboutAgreement A-23-184 MOU with County of Madera.pdf Agreement No. 23-184
1 MEMORANDUM OF UNDERSTANDING
2 This Memorandum of Understanding ("MOU") is dated April 25, 2023 and is
3 between the COUNTY OF MADERA, a political subdivision of the State of California ("Madera
4 County"), and the COUNTY OF FRESNO, a political subdivision of the State of California
5 ("Fresno County").
6 Recitals
7 A. On December 29, 2022 at 9:00 am, the Madera Community Hospital closed their
8 emergency department (ED) to all ambulances, leaving no location within Madera County to
9 transport individuals who have been placed on a Welfare & Institutions (W&I) 5150 hold.
10 B. On July 12, 2022, Fresno County entered into agreement #22-304 with Exodus
11 Recovery, Inc. (Exodus) to operate a 24-7 Crisis Stabilization Center (CSC) for adults and youth
12 who are exhibiting acute psychiatric symptoms and are admitted on a voluntary or involuntary
13 basis and/or have been placed on a 5150 hold. The Exodus CSC is currently located at 4411 E.
14 Kings Canyon Road, Fresno, California 93702. CSC services are performed pursuant to W&IC
15 sections 5704.5(b), 5704.6(c), and 5614(b)(3).
16 C. On November 14, 2017, Fresno County entered into agreement #17-580 (and
17 subsequent amendment 1 #17-580-1 on April 28, 2020; and amendment 11 #22-540 on
18 November 29, 2022) with Central Star Behavioral Health, Inc. (Central Stars) to operate a 16-
19 bed Crisis Residential Treatment (CRT) 24-7 facility located at 496 S. Barton, Fresno, California
20 93702, for adults who are referred from the CSC, hospitals EDs, and other inpatient psychiatric
21 facilities and are in need of continuing services in a residential setting. CRT services are defined
22 in California Code of Regulations (CCR), Title 9 Section 1810.208.
23 D. Fresno County, through its Department of Behavioral Health (DBH), and Madera
24 County, through its Behavioral Health Services (BHS) Department, sharing the same interest,
25 agree to coordinate for Madera residents to obtain services from the Exodus CSC and Central
26 Stars CRT (collectively Fresno County's CSC and CRT) to address the needs of the community.
27 This partnership will increase accessibility to services for Madera County residents who no
28 longer have access within their own county of residence.
1
1 The parties therefore agree as follows:
2 Article 1
3 Fresno County's Services
4 1.1 Scope of Services.
5 (A) Responsibilities of Fresno County:
6 (1) Fresno County shall allow Madera County's adult residents to utilize beds at
7 Fresno County's CSC and CRT, based upon availability. Neither facility will expand
8 capacity to accommodate Madera County residents. Fresno County residents shall
9 retain priority placement if beds are limited. Referral sources and admissions policies
10 shall remain the same as currently designated for Fresno County's CSC and CRT.
11 (2) Madera County residents may seek services from Fresno County's CSC and
12 CRT with all required and related psychiatric health services as stated in the
13 respective agreements for each program, both attached hereto as Exhibit A—
14 Exodus Recovery, Inc. Crisis Stabilization Center Services and Exhibit B —Central
15 Star Behavioral Health Crisis Residential Treatment Services and are incorporated
16 herein by this reference.
17 (3) The decision to admit Madera County residents to either facility for treatment
18 is at the sole discretion of Fresno County and/or Fresno County's CSC and CRT .
19 (4) The decision to discharge Madera County residents from either facility shall
20 be at the sole discretion of Fresno County and/or Fresno County's CSC and CRT.
21 Madera County's representative may participate in discharge planning at their
22 discretion.
23 (5) Invoicing Madera County on a monthly basis for bed days utilized by Madera
24 County residents in the previous month as described herein in Article 2.
25 (6) Data tracking of the number of bed days utilized by Madera County residents
26 at Fresno County's CSC and CRT during each month of services during the term of
27 this MOU.
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1 (7) Fresno County's Utilization Review Specialist (URS) staff may monitor
2 Madera County's residents at Fresno County's CSC and CRT as part of the annual
3 audit performed by Fresno County's Managed Care Division on an ongoing basis to
4 confirm medical necessity.
5 (8) Patients' Rights Advocate services and Certification Review Hearing Officer
6 services will be provided by Fresno County's existing contracted providers of each
7 said service.
8 (9) Fresno County shall provide copies of Madera County's residents charts to
9 Madera County, upon request. Madera County shall be allowed to review records of
10 services provided to its residents, including the goals and objectives of the treatment
11 plan, and how the therapy provided is achieving the goals and objectives.
12 (10) Fresno County shall make available to Madera County, and Madera
13 County may examine at any time during business hours and as often as Madera
14 County deems necessary, all of Fresno County's records and data with respect to
15 the matters covered by this MOU, excluding attorney-client privileged
16 communications.
17 (11) Notification shall be given to Madera County if residents are transferred
18 out of either facility or are the subject of or have caused any unusual incidents.
19 (12) Will allow for reciprocity of Medi-Cal credentialing of providers at each of
20 the facilities mentioned within this MOU for purposes of Medi-Cal billing, claims,
21 reviews, or audits.
22 (B) Responsibilities of Madera County:
23 (1) Madera County shall provide reimbursement to Fresno County for all services
24 incurred at Fresno County's CSC and CRT on behalf of the residents of their county.
25 (2) Madera County shall use its best efforts to provide Fresno County and
26 Fresno County's CSC and CRT with such individual information as is reasonably
27 necessary to aid Fresno County in providing treatment to Madera County residents.
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1 (3) Madera County will be responsible for any writ or Riese hearings via the
2 Madera Superior Court. Madera County will be responsible for all procedures related
3 to the initialization of LPS Conservatorship for a Madera County resident.
4 (4) Payment shall be made to Fresno County based off the invoices sent to
5 Madera County after each month of service as defined herein in Article 2
6 (5) Madera County, or its designees, shall provide required transportation for the
7 person served to and from Fresno County's CSC or CRT for all Madera County
8 residents.
9 1.1.13.5.1. For CRT services provided that require transportation back to
10 Madera County for other services, Madera County shall provide
11 necessary transportation to the City of Madera and the return to the
12 CRT, as applicable.
13 1.1.13.5.2. For CRT or CSC services, Fresno County's CSC and CRT may
14 contact the Madera County resident's family/significant other to arrange
15 for transportation upon discharge.
16 (6) Case Management services necessary for individual cases admitted to either
17 the CSC or CRT shall be provided by Madera County Department of Behavioral
18 Health Services (BHS) as appropriate.
19 (7) Data tracking for all Madera County residents admitted to either the adult or
20 youth CSC or the CRT to validate numbers tracked by Fresno County.
21 (8) For referrals for CRT services, application packets should be sent to Madera
22 County's existing subcontracted provider, the County of Merced Crisis Residential
23 Unit (CRU), first. If Merced CRU is at capacity, then an application packet may be
24 submitted for review to the Fresno County CRT facility.
25 1.2 Representation. Fresno County represents that it and Fresno County's CSC and
26 CRT are qualified, ready, willing, and able to perform all of the services provided for in this
27 MOU.
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1 1.3 Compliance with Laws. Fresno County and Madera County shall each, at its own
2 cost, comply with all applicable federal, state, and local laws and regulations in the performance
3 of its obligations under this MOU, including but not limited to workers compensation, labor, and
4 confidentiality laws and regulations.
5 All services performed by Fresno County under this MOU shall be in strict
6 conformance with all applicable Federal, State of California and/or local laws and
7 regulations relating to confidentiality.
8 1.4 Monitoring. Fresno County agrees to extend to Madera County's staff the right to
9 review and monitor records, programs, or procedures, at any time, in regard to Madera
10 residents.
11 1.5 Organizational Provider. Fresno County shall require that Fresno County's CSC
12 and CRT identified herein to maintain requirements as a Fresno County Mental Health Plan
13 (FCMHP) organizational provider throughout the term of their associated MOUs.
14 1.6 Timely Access. It is the expectation that Fresno County will continue to provide
15 timely access to services that meet the State of California standards for care. Fresno County
16 shall track timeliness of services and provide a monthly report showing the monitoring or
17 tracking tool that captures this data. Madera County and Fresno County shall meet to go over
18 this monitoring tool, as needed, but at least on a monthly basis.
19 Disclaimer
20 Fresno County agrees that all Protected Health Information (PHI) maintained by Fresno
21 County in County's DBH EHR system will be maintained in conformance with all HIPAA laws, as
22 stated in section 13.1, "Health Insurance Portability and Accountability Act", including all
23 responsibilities within the Business Associate Agreement attached hereto as Exhibit C and
24 incorporated herein by reference.
25 Article 2
26 Compensation, Invoices, and Payments
27 2.1 Madera County agrees to pay, and Fresno County agrees to receive, compensation
28 for the performance of its services under this MOU as described in this section.
5
1 2.2 Maximum Compensation.
2 (A) Fresno County's CSC and CRT, are currently paid for services via operational
3 cost-based reimbursement. Beginning July 1, 2023, Fresno County's CSC and CRT will
4 be paid for services via fee-for-service reimbursement.
5 (B) For the period of December 29, 2022 through December 31, 2023, Fresno
6 County shall bill Madera County for all actual services provided at a percentage of the
7 monthly invoice (Fresno County's costs) equivalent to the number of Madera County
8 residents divided by the total number of individuals who received services in that given
9 month for the adult or youth CSC and the adult CRT.
10 (C) Maximum Compensation:
11 For the period of December 29, 2022 to December 31, 2023, the Maximum
12 Compensation amount for actual services provided shall not exceed Nine
13 Hundred Thousand and No/100 Dollars ($900,000.00).
14 2.3 Invoices.
15 (A) Fresno County shall invoice Madera County for the utilization of bed days within
16 ten (10) business days of payment approval for Fresno County's CSC and CRT monthly
17 invoices. Invoices will be submitted to the following Madera County mailbox addressed
18 to the County of Madera, Behavioral Health Services:
19 BHS.accounts.payable@maderacounty.com.
20 (B) Payment by Madera County shall be within forty-five (45) days of receipt of
21 Fresno County's invoices.
22 2.4 Medi-Cal Certification and Mental Health Plan Compliance. Fresno County will
23 ensure Fresno County's CSC and CRT are Medi-Cal certified by the Fresno County Mental
24 Health Plan (FCMHP). Fresno County's CSC and CRTwill provide direct specialty mental health
25 services in accordance with the FCMHP.
26 2.5 Payment. Madera County shall pay each correctly completed and timely submitted
27 invoice within forty-five (45) days after receipt. Madera County shall remit any payment to
28 Fresno County's address specified in the invoice.
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1 Payments shall be made by Madera County to Fresno County in arrears, for services
2 provided during the preceding month, within forty-five (45) days after the date of receipt and
3 approval by Madera County of the monthly invoicing as described in this Article. Payments shall
4 be made after receipt and verification of actual expenditures incurred by Fresno County for its
5 Fresno County's CSC and CRT's monthly program costs in accordance with Exhibit A and
6 Exhibit B and shall be submitted to Madera County on a monthly basis.
7 The services provided by Fresno County under this MOU are funded in whole or in
8 part by the State of California. In the event that funding for these services is delayed by the
9 State Controller, Madera County may defer payments to Fresno County. The amount of the
10 deferred payment shall not exceed the amount of funding delayed by the State Controller to
11 Madera County. The period of time of the deferral by Madera County shall not exceed the
12 period of time of the State Controller's delay of payment to Madera County plus forty-five (45)
13 days.
14 2.6 Incidental Expenses. Fresno County and Madera County are solely responsible for
15 all of its costs and expenses that are not specified as payable by Madera County to Fresno
16 County under this MOU.
17 Article 3
18 Term of MOU
19 3.1 Term. This MOU is effective retroactive to December 29, 2022 and terminates on
20 December 31, 2023, except as provided in section 3.2, "Extension," or Article 5, "Termination
21 and Suspension," below.
22 Article 4
23 Notices
24 4.1 Contact Information. The persons and their addresses having authority to give and
25 receive notices provided for or permitted under this MOU include the following:
26
For Fresno County:
27 Department of Behavioral Health Director
County of Fresno
28 1925 E. Dakota Ave.
Fresno, CA 93726
7
1
For Madera County:
2 Behavioral Health Services Director
County of Madera
3 P.O. Box 1288
Madera, CA 93639
4
5 4.2 Change of Contact Information. Either party may change the information in section
6 4.1 by giving notice as provided in section 4.3.
7 4.3 Method of Delivery. Each notice between Madera County and Fresno County
8 provided for or permitted under this MOU must be in writing, state that it is a notice provided
9 under this MOU, and be delivered either by personal service, by first-class United States mail,
10 by an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
11 Document Format (PDF) document attached to an email.
12 (A) A notice delivered by personal service is effective upon service to the recipient.
13 (B) A notice delivered by first-class United States mail is effective three (3) County
14 business days after deposit in the United States mail, postage prepaid, addressed to the
15 recipient.
16 (C)A notice delivered by an overnight commercial courier service is effective one (1)
17 County business day after deposit with the overnight commercial courier service,
18 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
19 the recipient.
20 (D)A notice delivered by telephonic facsimile transmission or by PDF document
21 attached to an email is effective when transmission to the recipient is completed (but, if
22 such transmission is completed outside of County business hours, then such delivery is
23 deemed to be effective at the next beginning of a County business day), provided that
24 the sender maintains a machine record of the completed transmission.
25 4.4 Claims Presentation. For all claims arising from or related to this MOU, nothing in
26 this MOU establishes, waives, or modifies any claims presentation requirements or procedures
27 provided by law, including the Government Claims Act (Division 3.6 of Title 1 of the Government
28 Code, beginning with section 810).
8
1 Article 5
2 Termination and Suspension
3 5.1 Termination for Non-Allocation of Funds. The terms of this MOU are contingent
4 on the approval of funds by the appropriating government agency. If sufficient funds are not
5 allocated, then either party, upon at least thirty (30) days' advance written notice to the other
6 party, may:
7 (A) Modify the services provided by Fresno County under this MOU; or
8 (B) Terminate this MOU.
9 5.2 Termination for Breach.
10 (A) Upon determining that a breach (as defined in paragraph (C) below) has
11 occurred, either party may give written notice of the breach to the other party. The
12 written notice may suspend performance under this MOU and must provide at least thirty
13 (30) days for the other party to cure the breach.
14 (B) If either party fails to cure the breach to the other party's satisfaction within the
15 time stated in the written notice, either party may terminate this MOU immediately.
16 (C) For purposes of this section, a breach occurs when, in the determination of either
17 party, the other party has:
18 (1) Obtained or used funds illegally or improperly;
19 (2) Failed to comply with any part of this MOU;
20 (3) Submitted a substantially incorrect or incomplete report to the other party; or
21 (4) Improperly performed any of its obligations under this MOU.
22 5.3 Termination without Cause. In circumstances other than those set forth above,
23 either party may terminate this MOU by giving at least thirty (30) days advance written notice of
24 intention to terminate.
25 5.4 No Penalty or Further Obligation. Any termination of this MOU by either party
26 under this Article 5 is without penalty to or further obligation of either party.
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1 Article 6
2 Indemnity and Defense
3 6.1 Indemnity.
4 (A) Madera County shall indemnify and hold harmless and defend Fresno County
5 (including its officers, agents, employees, and volunteers) against all claims, demands,
6 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties,
7 and liabilities of any kind to Fresno County, Madera County, or any third party that arise
8 from or relate to the performance or failure to perform by Madera County (or any of its
9 officers, agents, subcontractors, or employees) under this MOU. Fresno County may
10 conduct or participate in its own defense without affecting Madera County's obligation to
11 indemnify and hold harmless or defend Fresno County. Madera County agrees to
12 indemnify Fresno County for Federal and/or State of California audit exceptions resulting
13 from noncompliance herein on the part of Madera County.
14 6.2 Survival. This Article 6 survives the termination of this MOU.
15 Article 7
16 Insurance, Assurances, and Licenses/Certificates
17 7.1 Insurance. Fresno County shall comply with all the insurance requirements in
18 Exhibit D to this MOU.
19 7.2 Licenses/Certificates. Throughout each term of this MOU, Fresno County's
20 subcontractors shall maintain all necessary licenses, permits, approvals, certificates, waivers,
21 and exemptions necessary for the provision of the services hereunder and required by the laws
22 and regulations of the United States of America, State of California, the County of Fresno, and
23 any other applicable governmental agencies. Fresno County shall notify Madera County
24 immediately in writing of its inability to obtain or maintain such licenses, permits, approvals,
25 certificates, waivers, and exemptions irrespective of the pendency of any appeal related thereto.
26 Additionally, Fresno County staff shall comply with all applicable laws, rules, or regulations, as
27 may now exist or be hereafter changed.
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1 Article 8
2 Confidentiality
3 Confidentiality. All services performed by either party under this MOU shall be in
4 strict conformance with all applicable Federal, State of California and/or local laws and
5 regulations relating to confidentiality.
6 Article 9
7 General Terms
8 9.1 Modification. Any matters of this MOU may be modified from time to time by the
9 written consent of all the parties without, in any way, affecting the remainder.
10 9.2 Non-Assignment. Neither party may assign its rights or delegate its obligations
11 under this MOU without the prior written consent of the other party.
12 9.3 Governing Law. The laws of the State of California govern all matters arising from
13 or related to this MOU.
14 9.4 Jurisdiction and Venue. This MOU is signed and performed in Fresno County,
15 California. Fresno County and Madera County consent to California jurisdiction for actions
16 arising from or related to this MOU, and, subject to the Government Claims Act, all such actions
17 must be brought and maintained in Fresno County.
18 9.5 Construction. The final form of this MOU is the result of the parties' combined
19 efforts. If anything in this MOU is found by a court of competent jurisdiction to be ambiguous,
20 that ambiguity shall not be resolved by construing the terms of this MOU against either party.
21 9.6 Days. Unless otherwise specified, "days" means calendar days.
22 9.7 Headings. The headings and section titles in this MOU are for convenience only and
23 are not part of this MOU.
24 9.8 References to Laws and Rules. In the event any law, regulation, or policy referred
25 to in this MOU is amended during the term thereof, the parties hereto agree to comply with the
26 amended provision as of the effective date of such amendment.
27 9.9 Severability. If anything in this MOU is found by a court of competent jurisdiction to
28 be unlawful or otherwise unenforceable, the balance of this MOU remains in effect, and the
11
1 parties shall make best efforts to replace the unlawful or unenforceable part of this MOU with
2 lawful and enforceable terms intended to accomplish the parties' original intent.
3 9.10 Nondiscrimination. During the performance of this MOU, Fresno County and
4 Madera County shall not unlawfully discriminate against any employee or applicant for
5 employment, or recipient of services, because of race, religious creed, color, national origin,
6 ancestry, physical disability, mental disability, medical condition, genetic information, marital
7 status, sex, gender, gender identity, gender expression, age, sexual orientation, military status
8 or veteran status pursuant to all applicable State of California and federal statutes and
9 regulation.
10 9.11 No Waiver. Payment, waiver, or discharge by Madera County of any liability or
11 obligation of Fresno County under this MOU on any one or more occasions is not a waiver of
12 performance of any continuing or other obligation of Fresno County and does not prohibit
13 enforcement by Madera County of any obligation on any other occasion.
14 9.12 Entire MOU. This MOU, including its exhibits, is the entire MOU between Fresno
15 County and Madera County with respect to the subject matter of this MOU, and it supersedes all
16 previous negotiations, proposals, commitments, writings, advertisements, publications, and
17 understandings of any nature unless those things are expressly included in this MOU. If there is
18 any inconsistency between the terms of this MOU without its exhibits and the terms of the
19 exhibits, then the inconsistency will be resolved by giving precedence first to the terms of this
20 MOU without its exhibits, and then to the terms of the exhibits.
21 9.13 No Third-Party Beneficiaries. This MOU does not and is not intended to create any
22 rights or obligations for any person or entity except for the parties.
23 9.14 Authorized Signature. Fresno County and Madera County represent and warrant
24 that:
25 (A) Fresno County and Madera County are each duly authorized and empowered to
26 sign and perform its respective obligations under this MOU.
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1 (B) The individuals signing this MOU on behalf of Fresno County and Madera County
2 are duly authorized to do so and their respective signatures on this MOU legally binds
3 Fresno County and Madera County to the terms of this MOU.
4 9.15 Electronic Signatures. The parties agree that this MOU may be executed by
5 electronic signature as provided in this section.
6 (A) An "electronic signature" means any symbol or process intended by an individual
7 signing this MOU to represent their signature, including but not limited to (1) a digital
8 signature; (2) a faxed version of an original handwritten signature; or (3) an electronically
9 scanned and transmitted (for example by PDF document) version of an original
10 handwritten signature.
11 (B) Each electronic signature affixed or attached to this MOU (1) is deemed
12 equivalent to a valid original handwritten signature of the person signing this MOU for all
13 purposes, including but not limited to evidentiary proof in any administrative or judicial
14 proceeding, and (2) has the same force and effect as the valid original handwritten
15 signature of that person.
16 (C)The provisions of this section satisfy the requirements of Civil Code section
17 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
18 Part 2, Title 2.5, beginning with section 1633.1).
19 (D) Each party using a digital signature represents that it has undertaken and
20 satisfied the requirements of Government Code section 16.5, subdivision (a),
21 paragraphs (1) through (5), and agrees that each other party may rely upon that
22 representation.
23 (E) This MOU is not conditioned upon the parties conducting the transactions under
24 it by electronic means and either party may sign this MOU with an original handwritten
25 signature.
26 9.16 Counterparts. This MOU may be signed in counterparts, each of which is an
27 original, and all of which together constitute this MOU.
28 [SIGNATURE PAGES FOLLOW]
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1 The parties are signing this MOU on the date stated in the introductory clause.
2
COUNTY OF MADERA
3 Vk A
4 Nr
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5
Chairman, Board of Supervisors „r
6 = �°
Lp\o
7 ATTEST.
C o v
8 Bv: �"Z
erk, Board of ,Supervisors
9
10 Approved as to Legal Form:
COUNTY COUNSEL
11 Digitally signed by Dale E.
Dale E. DW.�N'galupl
CN=Dale E.Bacigalupi
email=dbadgalupi@l—rmamith.
12 �—d C=US O=Lozano Smith
D'j
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14 ACCOUNT NUMBERS:
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[ADDITIONAL SIGNATURE PAGE
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1
COUNTY OF FRESNO
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3 _
4 S?fQJ) ro,7Chairman of the Board of
S e sqrs of the County of Fresno
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Attest:
6 Bernice E. Seidel
Clerk of the Board of Supervisors
7 County of Fresno, State of California
8
By: _l ne
9 Deputy
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11 For County of Fresno accounting use only:
12 Org No.: 5630
Account No.: 7295
13 Fund No.: 0001
Subclass No.: 10000
14
Organization/Cost Centers:
15
Exodus Recovery, Inc. CSC 56302110 (Adult) 56302111 (Youth)
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Central Stars CRT 56302117
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Agreement No. 22-304
Exhibit A
Page 1 of 217
AGREEMENT
THIS AGREEMENT is made and entered into this 12th day of July , 2022, by
and between the COUNTY OF FRESNO, a political subdivision of the State of California, hereinafter
referred to as "COUNTY", and EXODUS RECOVERY, INC., a for profit corporation, whose address is
9808 Venice Blvd, Suite 700, Culver City, CA 90232, hereinafter referred to as "CONTRACTOR"
(collectively the "parties").
WITNESSETH:
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), is in need of a
qualified agency to operate an Adult Crisis Stabilization Center (Adult CSC) to provide crisis
stabilization services to adults, age 18 and older;
WHEREAS, COUNTY, through DBH, is in need of a qualified agency to operate a Youth Crisis
Stabilization Center (Youth CSC) to provide crisis stabilization services to youth, age up to 18;
WHEREAS, all individuals in need of crisis stabilization services may be admitted on a voluntary
or involuntary basis referred by DBH, a DBH-subcontracted provider, law enforcement, hospital
emergency departments, and Emergency Medical Services transports, regardless of the source of
payment;
WHEREAS, COUNTY, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of
the California Code of Regulations, section 1810.226; and
WHEREAS, CONTRACTOR is qualified and willing to operate said Adult CSC and Youth CSC
pursuant to the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
hereto agree as follows:
1. OBLIGATIONS OF THE CONTRACTOR
A. CONTRACTOR shall perform all services and fulfill all responsibilities as set forth
in Exhibit A-1, "Adult Crisis Stabilization Center Scope of Work" and Exhibit A-2, "Youth Crisis
Stabilization Center Scope of Work", both attached hereto and incorporated herein by reference.
B. CONTRACTOR shall align programs, services, and practices with the vision,
mission, and guiding principles of the COUNTY's DBH, as further described in Exhibit B, "Guiding
Exhibit A
Page 2 of 217
Principles of Care Delivery", attached hereto and by this reference incorporated herein and made part of
this Agreement.
C. CONTRACTOR shall send to County's DBH upon execution of this Agreement, a
detailed plan ensuring clinically appropriate leadership and supervision of their clinical program.
Recruitment and retention of clinical leadership with the clinical competencies to oversee services based
on the level of care and program design presented herein shall be included in this plan. A description and
monitoring of this plan shall be provided.
D. During the term of this Agreement, it is expected that there will be a change in
location of the service site(s) to the Heritage Centre located at the corner of Shields Avenue and
Millbrook Avenue in Fresno, California 93703. COUNTY's DBH Director, or designee, will give verbal
notification of the timeframe expected regarding the relocation. CONTRACTOR shall work
collaboratively with COUNTY to ensure an efficient transition and transport of all individuals currently
receiving services.
E. CONTRACTOR shall maintain requirements as an organizational provider
throughout the term of this Agreement, as described in Section Seventeen (17) of this Agreement. If for
any reason, this status is not maintained, the COUNTY may terminate this Agreement pursuant to
Section Three (3) of this Agreement.
F. CONTRACTOR agrees that prior to providing services under the terms and
conditions of this Agreement, it shall have appropriate staff hired and in place for program services and
operations or COUNTY may, in addition to other remedies it may have, suspend referrals or terminate
this Agreement in accordance with Section Three (3) of this Agreement. The parties acknowledge that
CONTRACTOR will be performing hiring, training, and credentialing of staff, and COUNTY will be
performing additional staff credentialing to ensure compliance with State and Federal regulations.
G. CONTRACTOR shall collect, maintain and report all data and the individual's
information for the service categories independent of one another, including but not limited to: Medi-Cal
billing, other insurance or revenue billing and reports; staff schedules and reports; performance measures;
monthly invoices and general ledgers; and other data as required.
H. It is acknowledged by all parties hereto that COUNTY's DBH shall monitor the
Exhibit A
Page 3of217
services provided by CONTRACTOR, in accordance with Section Fourteen (14) of this Agreement.
I. CONTRACTOR shall participate in periodic workgroup meetings consisting of staff
from COUNTY's DBH to discuss service requirements, data reporting, outcomes measurement, training,
policies and procedures, overall program operations, and any problems or foreseeable problems that may
arise.
J. It is mutually agreed by all parties to this Agreement, that the program funded
under this Agreement shall be identified and subsequently named/branded through the review and
approval of COUNTY's DBH Director, or designee. All print or media materials, including program
branding and program references shall be reviewed and approved by the COUNTY'S DBH Director, or
designee. The program funded under this Agreement shall be identified as a "County of Fresno,
Department of Behavioral Health funded program", and operated by the CONTRACTOR under the
terms and conditions of this Agreement.
2. TERM
The term of this Agreement shall be for a period of three (3) years, commencing
retoractive to 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 designee, is authorized to execute such written approval on behalf of COUNTY based on
CONTRACTOR'S satisfactory performance.
3. TERMINATION
A. Non-Allocation of Funds—The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR sixty (60) days advance written notice.
B. Breach of Contract—COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
Exhibit A
Page 4 of 217
3) A substantially incorrect or incomplete report submitted to COUNTY;
4) Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by the COUNTY of any
breach of this Agreement or any default which may then exist on the part of the CONTRACTOR. Neither
shall such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or
default. The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the
COUNTY of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of the
COUNTY were not expended in accordance with the terms of this Agreement. CONTRACTOR shall
promptly refund any such funds upon demand or, at COUNTY's option, such repayment shall be deducted
from future payments owing to CONTRACTOR under this Agreement.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written notice of an
intention to terminate to CONTRACTOR.
4. COMPENSATION
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation for actual expenditures incurred in accordance with Exhibit C-1, "Adult Crisis
Stabilization Center Budget and Narrative", and Exhibit C-2, "Youth Crisis Stabilization Center Budget
and Narrative", as approved by the COUNTY's DBH Director, or designee, both attached hereto and
incorporated herein by this reference.
Maximum Annual Compensation
A. Adult CSC
In no event shall compensation paid for actual services performed at the Adult
CSC under this Agreement during the period of July 1, 2022 through June 30, 2023 be in excess of
Fourteen Million, Four Hundred Thirty-Eight Thousand, Eight Hundred Fifteen and No/100 Dollars
($14,438,815.00).
In no event shall compensation paid for actual services performed at the Adult
CSC under this Agreement during the period of July 1, 2023 through June 30, 2024 be in excess of
Fourteen Million, Seven Hundred Eleven Thousand, One Hundred Sixty-Two and No/100 Dollars
Exhibit A
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($14,711,162.00).
In no event shall compensation paid for actual services performed at the Adult
CSC under this Agreement during the period of July 1, 2024 through June 30, 2025 be in excess of
Fourteen Million, Nine Hundred Ninety-One Thousand, Six Hundred Forty-One and No/100 Dollars
($14,991,641.00).
If this Agreement is extended for the first optional 12-month extension period, in
no event shall compensation paid for actual services performed at the Adult CSC under this Agreement
during the period of July 1, 2025 through June 30, 2026 be in excess of Fifteen Million, Two Hundred
Seventy-Two, One Hundred Two and No/100 Dollars ($15,272,102.00).
If this Agreement is extended for the second optional 12-month extension period,
in no event shall compensation paid for actual services performed at the Adult CSC under this
Agreement during the period of July 1, 2026 through June 30, 2027 be in excess of Fifteen Million, Five
Hundred Seventy-Eight Thousand, One Hundred Forty-Six and No/100 Dollars ($15,578,146.00).
B. Youth CSC
In no event shall compensation paid for actual services performed at the Youth
CSC under this Agreement during the period of July 1, 2022 through June 30, 2023 be in excess of
Five Million, Nine Hundred Sixty Thousand, Ninety-Three and No/100 Dollars ($5,960,093.00).
In no event shall compensation paid for actual services performed at the Youth
CSC under this Agreement during the period of July 1, 2023 through June 30, 2024 be in excess of Six
Million, Seventy-Three Thousand, Two Hundred Three and No/100 Dollars ($6,073,203.00).
In no event shall compensation paid for actual services performed at the Youth
CSC under this Agreement during the period of July 1, 2024 through June 30, 2025 be in excess of Six
Million, One Hundred Eighty-Nine Thousand, Seven Hundred and No/100 Dollars ($6,189,700.00).
If this Agreement is extended for the first optional 12-month extension period, in
no event shall compensation paid for actual services performed at the Youth CSC under this
Agreement during the period of July 1, 2025 through June 30, 2026 be in excess of Six Million, Three
Hundred Nine Thousand, Six Hundred Ninety-Nine and No/100 Dollars ($6,309,699.00).
If this Agreement is extended for the second optional 12-month extension period,
Exhibit A
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in no event shall compensation paid for actual services performed at the Youth CSC under this
Agreement during the period of July 1, 2026 through June 30, 2027 be in excess of Six Million, Four
Hundred Thirty-One Thousand, Three Hundred Fifty-Nine and No/100 Dollars ($6,431,359.00).
Total Compensation
A. Adult CSC
In no event shall the total maximum compensation amount under this Agreement
for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25) combined for services provided at the
Adult CSC exceed Forty-Four Million, One Hundred Forty-One Thousand, Six Hundred Eighteen and
No/100 Dollars ($44,141,618.00).
In no event shall the total maximum compensation amount under this Agreement
for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus one (1) 12-month extension period
(FY 2025-26) combined for services provided at the Adult CSC exceed Fifty-Nine Million, Four Hundred
Thirteen Thousand, Seven Hundred Twenty and No/100 Dollars ($59,413,720.00).
In no event shall the total maximum compensation amount under this Agreement
for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus two (2) 12-month extension periods
(FY 2025-26 & FY 2026-27) combined for services provided at the Adult CSC exceed Seventy-Four
Million, Nine Hundred Ninety-One Thousand, Eight Hundred Sixty-Six and No/100 Dollars
($74,991,866.00).
B. Youth CSC
In no event shall the total maximum compensation amount under this Agreement
for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25) combined for services provided at the
Youth CSC exceed Eighteen Million, Two Hundred Twenty-Two Thousand, Nine Hundred Ninety-Six
and No/100 Dollars ($18,222,996.00).
In no event shall the total maximum compensation amount under this Agreement
for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus the first 12-month extension period
(FY 2025-26) combined for services provided at the Youth CSC exceed Twenty-Four Million, Five
Hundred Thirty-Two Thousand, Six Hundred Ninety-Five and No/100 Dollars ($24,532,695.00).
In no event shall the total maximum compensation amount under this Agreement
Exhibit A
Page 7 of 217
for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus both 12-month extension periods
(FY 2025-26 & FY 2026-27) combined for services provided at the Youth CSC exceed Thirty Million,
Nine Hundred Sixty-Four Thousand, Fifty-Four and No/100 Dollars ($30,964,054.00).
C. Total Maximum Compensation
In no event shall the total maximum compensation amount under this Agreement
for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25) combined for services provided at the
Adult and Youth CSC exceed Sixty-Two Million, Three Hundred Sixty-Four Thousand, Six Hundred
Fourteen and No/100 Dollars ($62,364,614.00).
In no event shall the total maximum compensation amount under this Agreement
for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus one (1) 12-month extension period
(FY 2025-26) combined for services provided at the Adult and Youth CSC exceed Eighty-Three Million,
Nine Hundred Forty-Six Thousand, Four Hundred Fifteen and No/100 Dollars ($83,946,415.00).
In no event shall the total maximum compensation amount under this Agreement
for the initial term (FY 2022-23, FY 2023-24, and FY 2024-25), plus two (2) 12-month extension periods
(FY 2025-26 & FY 2026-27) combined for services provided at the Adult and Youth CSC exceed One
Hundred Five Million, Nine Hundred Fifty-Five Thousand, Nine Hundred Twenty and No/100 Dollars
($105,955,920.00).
D. Additional Requirements
1. If CONTRACTOR fails to generate the Medi-Cal revenue and/or private pay
reimbursement amounts set forth in Exhibits C-1 and C-2, COUNTY shall not be obligated to pay the
difference between these estimated amounts and the actual amounts generated.
2. Travel shall be reimbursed based on actual expenditures and mileage
reimbursement shall be at CONTRACTOR's adopted rate per mile, not to exceed the Federal Internal
Revenue Services (IRS) published rate.
3. It is understood that all expenses incidental to CONTRACTOR's
performance of services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails
to comply with any provision of this Agreement, COUNTY shall be relieved of its obligation for further
compensation.
Exhibit A
Page 8 of 217
4. Payments shall be made by COUNTY to CONTRACTOR in arrears for
services provided during the preceding month, within forty-five (45) days after the date of receipt and
approval by COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments shall be
made after receipt and verification of actual expenditures incurred by CONTRACTOR for monthly program
costs, as identified in Exhibits C-1 and C-2, in the performance of this Agreement and shall be documented
to COUNTY on a monthly basis by the tenth (10th) of the month following the month of said expenditures.
5. COUNTY shall not be obligated to make any payments under this
Agreement if the request for payment is received by COUNTY more than sixty (60) days after this
Agreement has terminated or expired.
6. All final invoices and/or any final budget modification requests shall be
submitted by CONTRACTOR within sixty (60) days following the final month of service for which payment
is claimed. No action shall be taken by COUNTY on invoices submitted beyond the sixty (60) day closeout
period. Any compensation which is not expended by CONTRACTOR pursuant to the terms and
conditions of this Agreement shall automatically revert to COUNTY.
7. The services provided by CONTRACTOR under this Agreement are funded
in whole or in part by the State of California. In the event that funding for these services is delayed by the
State Controller, COUNTY may defer payments to CONTRACTOR. The amount of the deferred payment
shall not exceed the amount of funding delayed by the State Controller to the COUNTY. The period of
time of the deferral by COUNTY shall not exceed the period of time of the State Controller's delay of
payment to COUNTY plus forty-five (45) days.
8. CONTRACTOR shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR deficiency discovered through the State audit
process and COUNTY utilization review during the course of this Agreement. At COUNTY's election, the
disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall be
withheld from subsequent payments to CONTRACTOR. CONTRACTOR shall not receive reimbursement
for any units of services rendered that are disallowed or denied by the COUNTY's DBH utilization review
process or through the State Department of Health Care Services (DHCS) cost report audit settlement
process for Medi-Cal eligible persons served. Notwithstanding the above, COUNTY must notify
Exhibit A
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CONTRACTOR prior to any State audit process and/or COUNTY utilization review. To the extent
allowable by law, CONTRACTOR shall have the right to be present during each phase of any State audit
process and/or COUNTY utilization review and shall be provided all documentation related to each phase
of any State audit process and/or COUNTY utilization review. Additionally, prior to any disallowances/audit
exceptions becoming final, CONTRACTOR shall be given at least ten (10) business days to respond to
such proposed disallowances/audit exceptions.
5. INVOICING
A. CONTRACTOR shall invoice COUNTY in arrears by the tenth (10'") day of each
month for actual expenses incurred during the prior month electronically to: 1)
dbhinvoicereview(a),fresnocountyca.gov, 2) dbh-invoices(a),fresnocountyca.gov; and 3)
dbhcontractedservicesdivis ion(a)fresnocountyca.gov with a copy to the assigned COUNTY's DBH Staff
Analyst. After CONTRACTOR renders service to referred persons served, CONTRACTOR shall invoice
COUNTY for payment, certify the expenditure, and submit electronic claiming data into COUNTY's
electronic information system for all persons served, including those eligible for Medi-Cal as well as those
that are not eligible for Medi-Cal, including contracted cost per unit and actual cost per unit. Invoices and
reports shall be in such detail as acceptable to COUNTY's DBH, as described herein. Billing information
must include the persons served's name, individual ID number, date of service, type of mental health
service provided, duration of service, International Classification of Diseases (ICD) diagnosis, service
provider name, units of service provided, rate of service provided, and actual amount of service. No
reimbursement for costs incurred by CONTRACTOR for services delivered under this Agreement shall be
made until the invoice and supporting documentation is received, verified, and approved by COUNTY's
DBH. COUNTY must pay CONTRACTOR before submitting a claim to DHCS for Federal reimbursement
for Medi-Cal eligible persons served.
B. At the discretion of COUNTY's DBH Director, or designee, if an invoice is incorrect
or is otherwise not in proper form or substance, COUNTY's DBH Director, or designee, shall have the right
to withhold payment as to only that portion of the invoice that is incorrect or improper after five (5) days
prior notice to CONTRACTOR. CONTRACTOR agrees to continue to provide services for a period of
ninety (90) days after notification of an incorrect or improper invoice. If after the ninety (90) day period, the
Exhibit A
Page 10 of 217
invoice is still not corrected to COUNTY DBH's satisfaction, COUNTY's DBH Director, or designee, may
elect to terminate this Agreement, pursuant to the termination provisions stated in Section Three (3) of this
Agreement. In addition, for invoices received ninety (90) days after the expiration of each term of this
Agreement or termination of this Agreement, at the discretion of COUNTY's DBH Director, or designee,
COUNTY's DBH shall have the right to deny payment of any additional invoices received.
C. CONTRACTOR shall submit monthly invoices and general ledgers to COUNTY's
DBH that itemize the line item charges for monthly program costs. Unallowable costs such as lobbying or
political donations must be deducted from the monthly invoice reimbursements. The invoices and general
ledgers will serve as tracking tools to determine if CONTRACTOR's program costs are in accordance with
its budgeted cost. Failure to submit reports and other supporting documentation shall be deemed
sufficient cause for COUNTY to withhold payments until there is compliance, as further described in
Section Five (5) herein.
D. CONTRACTOR must report all third-party collections from other funding sources for
Medicare, private insurance, private pay or any other third party. Monthly invoices for reimbursement must
equal the amount due CONTRACTOR less any funding sources not eligible for Federal reimbursement
and any other revenues generated by CONTRACTOR (i.e., private insurance, etc.).
E. CONTRACTOR shall submit monthly staffing reports that identify all direct service
and support staff, applicable Iicensure/certifications, and full-time hours worked to be used as a tracking
tool to determine if CONTRACTOR's program is staffed according to the services provided under this
Agreement.
F. CONTRACTOR must maintain financial records for a period of seven (7)years or
until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible for
any disallowances related to inadequate documentation.
G. CONTRACTOR is responsible for collecting and managing of data in a manner to
be determined by DHCS and COUNTY's DBH in accordance with applicable rules and regulations.
COUNTY's electronic information system is a critical source of information for purposes of monitoring
service volume and obtaining reimbursement. CONTRACTOR must attend the COUNTY's DBH training
on equipment reporting for assets, intangible and sensitive minor assets, COUNTY's electronic information
Exhibit A
Page 11 of 217
system, and related cost reporting.
H. CONTRACTOR shall submit service data into COUNTY's electronic information
system within thirty (30) calendar days from the date of services were rendered.
G. CONTRACTOR must provide all necessary data to allow COUNTY to bill Medi-Cal,
and any other third-party source, for services and meet State and Federal reporting requirements. The
necessary data can be provided by a variety of means, including but not limited to: 1) direct data entry into
COUNTY's electronic information system; 2) providing an electronic file compatible with COUNTY's
electronic information system; or 3) integration between COUNTY's electronic information system and
CONTRACTOR's information system(s).
H. If a person served has dual coverage, such as other health coverage (OHC) or
Federal Medicare, CONTRACTOR will be responsible for billing the carrier and obtaining a payment/denial
or have validation of claiming with no response ninety (90) days after the claim was mailed before the
service can be entered into COUNTY's electronic information system. CONTRACTOR must report all
third-party collections or revenue for Medicare, third party, or private pay in each monthly invoice and in the
annual cost report that is required to be submitted. A copy of explanation of benefits or CMS 1500 form is
required as documentation. CONTRACTOR shall submit monthly invoices for reimbursement that equal
the amount due CONTRACTOR less any funding sources not eligible for Federal and State
reimbursement. CONTRACTOR must comply with all laws and regulations governing the Federal
Medicare program, including, but not limited to: 1)the requirement of the Medicare Act, 42 U.S.C. section
1395 et seq; and 2)the regulation and rules promulgated by the Federal Centers for Medicare and
Medicaid Services as they relate to participation, coverage and claiming reimbursement. CONTRACTOR
will be responsible for compliance as of the effective date of each Federal, State or local law or regulation
specified.
I. Data entry into the COUNTY's electronic information system shall be the
responsibility of CONTRACTOR. COUNTY shall monitor the volume of services and cost of services
entered into COUNTY's electronic information system. Any and all audit exceptions resulting from the
provision and reporting of specialty mental health services by CONTRACTOR shall be the sole
responsibility of CONTRACTOR. CONTRACTOR will comply with all applicable policies, procedures,
Exhibit A
Page 12 of 217
directives and guidelines regarding the use of COUNTY's electronic information system.
J. Medi-Cal Certification and Mental Health Plan Compliance
CONTRACTOR shall establish and maintain Medi-Cal certification or become certified
within ninety (90) days of the execution of this Agreement through COUNTY's DBH. In addition,
CONTRACTOR shall work with COUNTY's DBH to execute the process if not currently certified by
COUNTY for credentialing of staff. Service location must be approved by COUNTY's DBH during the
Medi-Cal certification process. During this process, the CONTRACTOR shall obtain a legal entity number
established by DHCS as this is a requirement for maintaining COUNTY's MHP Organizational Provider
status throughout the term of this Agreement. CONTRACTOR shall become Medi-Cal certified prior to
providing services to Medi-Cal eligible persons served and seeking reimbursement from the COUNTY.
CONTRACTOR will not be reimbursed by COUNTY for any services rendered prior to Medi-Cal
certification. CONTRACTOR shall comply with any and all requests and directives associated with
COUNTY maintaining State Medi-Cal site certification.
CONTRACTOR shall provide specialty mental health services in accordance with
COUNTY's MHP. CONTRACTOR must comply with the "Fresno County Mental Health Plan Compliance
Program and Code of Conduct" set forth in Exhibit D, attached hereto and incorporated herein by
reference and made part of this Agreement.
CONTRACTOR may provide direct specialty mental health services using unlicensed staff
as long as the CONTRACTOR is approved as an Organizational Provider by the COUNTY's MHP and the
individual is supervised by licensed staff who meet the Board of Behavioral Sciences requirements for
supervision, works within his/her scope, and only delivers allowable direct specialty mental health services.
Unlicensed staff must also be credentialed by COUNTY's MHP.
It is understood that each service is subject to audit for compliance with Federal and State
regulations, and that COUNTY may be making payments in advance of said review. In the event that a
service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set off from other
payments due the amount of said disapproved services. 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. CONTRACTOR shall be responsible for audit exceptions to ineligible dates of services
Exhibit A
Page 13 of 217
or incorrect application of utilization review requirements. CONTRACTOR shall comply with any and all
requests associated with any State and/or Federal reviews or audits.
6. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under this
Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
CONTRACTOR's officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee,joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have no right to
control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and
function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
rules and regulations, if any, of governmental authorities having jurisdiction over matters, which are directly
or indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely
no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
solely liable and responsible for providing to, or on behalf of, its employees all legally-required employee
benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all
matters relating to payment of CONTRACTOR's employees, including compliance with Social Security,
withholding, and all other regulations governing such matters. It is acknowledged that during the term of
this Agreement, CONTRACTOR may be providing services to others unrelated to COUNTY or to this
Agreement.
7. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent of
all the parties without, in any way, affecting the remainder.
In addition, changes to expense category (i.e., Salary & Benefits, Facilities/Equipment,
Operating, Financial Services, Special Expenses, Fixed Assets, etc.) subtotals in the individual program
budgets, as set forth in Exhibits C-1 and C-2, that do not exceed ten percent (10%) of the maximum
Exhibit A
Page 14 of 217
compensation payable to CONTRACTOR, and movement of funds between the individual program
budgets that does not exceed ten percent (10%) of the maximum compensation payable to the
CONTRACTOR, may be made with the written approval of COUNTY's DBH Director, or designee.
Modifications shall not result in any change to the maximum compensation amounts payable to
CONTRACTOR, as stated in this Agreement.
8. NON-ASSIGNMENT
No party shall assign, transfer or subcontract this Agreement nor their rights or duties under
this Agreement without the prior written consent of COUNTY.
9. HOLD-HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
defend COUNTY, its officers, agents, and employees from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims, and losses occurring or resulting to COUNTY
in connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents, or
employees under this Agreement, and from any and all costs and expenses, including attorney fees
and court costs, damages, liabilities, claims and losses occurring or resulting to any person, firm or
corporation who may be injured or damaged by the performance, or failure to perform, of
CONTRACTOR, its officers, agents, or employees under this Agreement. CONTRACTOR agrees to
indemnify COUNTY for Federal, State of California and/or local audit exceptions resulting from
noncompliance herein on the part of CONTRACTOR.
The provisions of this Section 9 shall survive termination of this Agreement.
10. 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).
Exhibit A
Page 15 of 217
This policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
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.
CONTRACTOR agrees that it shall maintain, at its sole expense, in full force and effect for a period of
three (3)years following the termination of this Agreement, one or more policies of professional liability
insurance with limits of coverage as specified herein.
D. Worker's Compensation
A policy of Worker's Compensation insurance as may be required by the California
Labor Code.
E. Cyber liability
Cyber Liability Insurance, with limits not less than $2,000,000.00 per occurrence or
claim, $2,000,000.00 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 fines
and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations.
F. Technology Professional Liability (Errors and Omissions)
Technology professional liability (errors and omissions) insurance with limits of not
Exhibit A
Page 16 of 217
less than Two Million Dollars ($2,000,000.00) per occurrence. Coverage must encompass all of the
Contractor's obligations under this Agreement, including but not limited to claims involving Cyber Risks.
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breaches, which may include Disclosure of Personal Information to an Unauthorized Third Party; (ii)
breach of any of the Contractor's obligations under Section # of this Agreement; (iii) infringement of
intellectual property, including but not limited to infringement of copyright, trademark, and trade dress;
(iv) invasion of privacy, including release of private information; (v) information theft; (vi) damage to or
destruction or alteration of electronic information; (vii) extortion related to the Contractor's obligations
under this Agreement regarding electronic information, including Personal Information; (viii) network
security; (ix) data breach response costs, including Security Breach response costs; (x) regulatory fines
and penalties related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; and (xi) credit monitoring expenses.
G. Molestation
Sexual abuse/molestation liability insurance with limits of not less than One Million
Dollars ($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate. This policy
shall be issued on a per occurrence basis.
Additional Requirements Relating to Insurance
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
Exhibit A
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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, with a hard copy to the County of Fresno, Department of Behavioral
Heath, Contracted Services, Attn: Staff Analyst, and an emailed copy to
dbhcontractedservicesdivisionCo)fresnocountyca.gov and the assigned DBH Contracts Staff Analyst stating
that such insurance coverage 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 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 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 VI or better.
11. LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR's staff shall
maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for the
provision of the services hereunder and required by the laws and regulations of the United States of
America, State of California, the County of Fresno, and any other applicable governmental agencies.
CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
Exhibit A
Page 18 of 217
appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR's staff shall comply with all
applicable laws, rules or regulations, as may now exist or be hereafter changed.
12. RECORDS
CONTRACTOR shall maintain its records in COUNTY's EHR system (currently Avatar)
in accordance with Exhibit E, "Documentation Standards for Individual Medical Records," attached
hereto and incorporated herein by reference and made part of this Agreement. The individual's health
record shall begin with registration and intake and include authorizations, assessments, plans of care,
and progress notes, as well as other documents as approved by the COUNTY's DBH. COUNTY shall
be allowed to review records of services provided, including the goals and objectives of the treatment
plan, and how the therapy provided is achieving the goals and objectives. If CONTRACTOR
determines to maintain its records in COUNTY's EHR system, it shall provide COUNTY's DBH Director,
or designee, with a thirty (30) day notice. If at any time CONTRACTOR chooses not to maintain its
records in COUNTY's EHR system, it shall provide COUNTY'S DBH Director, or designee, with a thirty
(30) day notice and CONTRACTOR will be responsible for obtaining its own system, at its own cost, for
Electronic Health Record management. Disclaimer— COUNTY makes no warranty or representation
that information entered into the COUNTY's EHR system by CONTRACTOR will be accurate, adequate
or satisfactory for CONTRACTOR's own purposes or that any information in CONTRACTOR's
possession or control, or transmitted or received by CONTRACTOR, is or will be secure from
unauthorized access, viewing, use, disclosure, or breach. CONTRACTOR is solely responsible for the
individual's information entered by CONTRACTOR into the COUNTY's EHR system. CONTRACTOR
agrees that all Private Health Information (PHI) maintained by CONTRACTOR in COUNTY's EHR
system will be maintained in conformance with all Health Insurance Portability and Accountability Act
(HIPAA) laws, as stated in Section Nineteen (19), "Health Insurance Portability and Accountability Act".
COUNTY shall be allowed to review all records of services provided, including the goals
and objectives of the treatment plan, and how the therapy provided is achieving the goals and objectives.
All mental health records shall be considered the property of the COUNTY and shall be retained by the
COUNTY upon termination or expiration of this Agreement.
13. REPORTS
Exhibit A
Page 19 of 217
A. Outcome Reports
CONTRACTOR shall submit to COUNTY's DBH service outcome reports as
requested by COUNTY's DBH. Outcome reports and outcome requirements are subject to change at
COUNTY's DBH discretion.
B. Additional Reports
CONTRACTOR shall also furnish to COUNTY such statements, records, reports,
data, and other information as COUNTY's DBH may request pertaining to matters covered by this
Agreement. In the event that CONTRACTOR fails to provide such reports or other information required
hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments until there is
compliance. In addition, CONTRACTOR shall provide written notification and explanation to COUNTY
within five (5) days of any funds received from another source to conduct the same services covered by
this Agreement.
C. Cost Report
CONTRACTOR agrees to submit a complete and accurate detailed cost report on
an annual basis for each fiscal year ending June 30th in the format prescribed by the DHCS for the
purposes of Short Doyle Medi-Cal reimbursements and total costs for programs. The cost report will be
the source document for several phases of settlement with the DHCS for the purposes of Short Doyle
Medi-Cal reimbursement. CONTRACTOR shall report costs under their approved legal entity number
established during the Medi-Cal certification process. The information provided applies to CONTRACTOR
for program related costs for services rendered to Medi-Cal and non-Medi-Cal persons served.
CONTRACTOR will remit a schedule to provide the required information on published charges (PC)for all
authorized services. The report will serve as a source document to determine their usual and customary
charge prevalent in the public mental health sector that is used to bill the general public, insurers, or other
non-Medi-Cal third party payers during the course of business operations. CONTRACTOR must report all
collections for Medi-Cal/Medicare services and collections. The CONTRACTOR shall also submit with the
cost report a copy of the CONTRACTOR's general ledger that supports revenues and expenditures and
reconciled detailed report of reported total units of services rendered under this Agreement to the units of
services reported by CONTRACTOR to COUNTY's electronic information system.
Exhibit A
Page 20 of 217
Cost Reports must be submitted to the COUNTY as a hard copy with a signed
cover letter and electronic copy of completed DHCS cost report form along with requested support
documents following each fiscal year ending June 30th. During the month of September of each year this
Agreement is effective, COUNTY will issue instructions of the annual cost report which indicates the
training session, DHCS cost report template worksheets, and deadlines to submit, as determined by State
DHCS annually. CONTRACTOR shall remit a hard copy of cost report to County of Fresno, Attention:
Cost Report Team, PO BOX 45003, Fresno CA 93718. CONTRACTOR shall remit the electronic copy or
any inquiries to DBHcostreportteam@fresnocountyca.gov.
All Cost Reports must be prepared in accordance with General Accepted
Accounting Principles (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3) and
5718(c). Unallowable costs such as lobby or political donations must be deducted on the cost report and
invoice reimbursement.
If the CONTRACTOR does not submit the cost report by the deadline, including any
extension period granted by the COUNTY, the COUNTY may withhold payments of pending invoicing
under compensation until the cost report has been submitted and clears COUNTY desk audit for
completeness.
D. Settlements with State Department of Health Care Services (DHCS)
During the term of this Agreement and thereafter, COUNTY and CONTRACTOR
agree to settle dollar amounts disallowed or settled in accordance with DHCS audit settlement findings
related to the reimbursement provided under this Agreement. CONTRACTOR will participate in the
several phases of settlements between COUNTY/CONTRACTOR and DHCS. The phases of initial cost
reporting for settlement according to State reconciliation of records for paid Medi-Cal services and audit
settlement are: State DHCS audit 1) initial cost reporting —after an internal review by COUNTY, the
COUNTY files the cost report with State DHCS on behalf of CONTRACTOR's legal entity for the fiscal
year; 2) Settlement—State reconciliation of records for paid Medi-Cal services, approximately 18 to 36
months following the State close of the fiscal year, DHCS will send notice for any settlement under this
provision to COUNTY; and 3)Audit Settlement-State DHCS audit. After final reconciliation and settlement
DHCS may conduct a review of medical records, cost report along with support documents submitted to
Exhibit A
Page 21 of 217
COUNTY in initial submission to determine accuracy and may disallow costs and/or units of services.
COUNTY may choose to appeal and therefore reserves the right to defer payback settlement with
CONTRACTOR until resolution of the appeal. DHCS Audits will follow Federal Medicaid procedures for
managing overpayments.
If at the end of the Audit Settlement, COUNTY determines that it overpaid
CONTRACTOR, it will require CONTRACTOR to repay the Medi-Cal related overpayment back to
COUNTY. Funds owed to COUNTY will be due within forty-five (45) days of notification by COUNTY, or
COUNTY shall withhold future payments until all excess funds have been recouped by means of an offset
against any payments then or thereafter owing to COUNTY under this or any other Agreement between
the COUNTY and CONTRACTOR.
14. MONITORING
CONTRACTOR agrees to extend to COUNTY's staff, COUNTY's DBH Director, and
DHCS, or their designees, the right to review and monitor records, services, or procedures, at any time, in
regard to COUNTY persons served, as well as the overall operation of CONTRACTOR's performance, in
order to ensure compliance with the terms and conditions of this Agreement.
15. REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended during
the term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
such amendment.
16. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates its mental health programs under an
agreement with DHCS, and that under said agreement the State imposes certain requirements on
COUNTY and its subcontractors. CONTRACTOR shall adhere to all State requirements, including those
identified in Exhibit F, "State Mental Health Requirements", attached hereto and by this reference
incorporated herein and made part of this Agreement.
17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall be required to maintain organizational provider certification by
COUNTY. CONTRACTOR must meet Medi-Cal organizational provider standards as listed in Exhibit G,
Exhibit A
Page 22 of 217
"Medi-Cal Organizational Provider Standards", attached hereto and by this reference incorporated herein
and made part of this Agreement. It is acknowledged that all references to Organizational Provider and/or
Provider in Exhibit G shall refer to CONTRACTOR.
CONTRACTOR shall inform every person served of their rights under the COUNTY's
Mental Health Plan as described in Exhibit H, "Mental Health Plan Grievances and Appeals Process",
attached hereto and by this reference incorporated herein and made part of this Agreement.
CONTRACTOR shall also file an incident report for all incidents involving persons served,
following the COUNTY's DBH "Incident Reporting and Intensive Analysis" policy and procedure guide and
using the "Incident Report" protocol and user guide identified in Exhibit I, attached hereto and by this
reference incorporated herein and made part of this Agreement.
18. CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating to
confidentiality.
19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-
191 (HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is
only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of
PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for
Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated thereunder
by the U.S. Department of Health and Human Services (HIPAA Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require CONTRACTOR to enter
into a contract containing specific requirements prior to the disclosure of PHI, as set forth in, but not limited
to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal Regulations.
20. DATA SECURITY
Exhibit A
Page 23 of 217
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal information; abuse of COUNTY
resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into a
contractual relationship with COUNTY for the purpose of providing services under this Agreement must
employ adequate data security measures to protect the confidential information provided to
CONTRACTOR by COUNTY, including but not limited to the following:
A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR has received authorization by COUNTY for telecommuting
purposes;
2) Current virus protection software is in place;
3) Mobile device has the remote wipe feature enabled; and
4) A secure connection is used.
B. CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR may not bring contractor-owned computers or computer
peripherals into COUNTY for use without prior authorization from COUNTY's Chief Information Officer
and/or designee(s), including but not limited to mobile storage devices. If data is approved to be
transferred, data must be encrypted and stored on a secure server approved by COUNTY and transferred
by means of a Virtual Private Network (VPN) connection, or another type of secure connection.
C. COUNTY-Owned Computer Equipment
CONTRACTOR may not use COUNTY computers or computer peripherals on non-
County premises without prior authorization from COUNTY's Chief Information Officer and/or designee(s).
D. CONTRACTOR may not store COUNTY's private, confidential or sensitive data on
any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E. CONTRACTOR shall be responsible to employ strict controls to ensure the integrity
and security of COUNTY's confidential information and prevent unauthorized access, viewing, use, or
disclosure of data maintained in computer files, program documentation, data processing systems, data
Exhibit A
Page 24 of 217
files, and data processing equipment which stores or processes COUNTY data internally and externally.
F. Confidential persons served information transmitted to one party by the other by
means of electronic transmissions must be encrypted according to Advanced Encryption Standards (AES)
of 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
G. CONTRACTOR is responsible to immediately notify COUNTY of any violations,
breaches or potential breaches of security related to COUNTY's confidential information, data maintained
in computer files, program documentation, data processing systems, data files and data processing
equipment which stores or processes COUNTY data internally or externally.
H. COUNTY shall provide oversight to CONTRACTOR's response to all incidents
arising from a possible breach of security related to COUNTY's persons served confidential information
provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected
individuals as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR
will be responsible for all costs incurred as a result of providing the required notification.
21. PROPERTY OF COUNTY
A. COUNTY and CONTRACTOR recognize that fixed assets are tangible and
intangible property obtained or controlled under COUNTY for use in operational capacity and will benefit
COUNTY for a period more than one year. Depreciation of the qualified items will be on a straight-line
basis.
For COUNTY purposes, fixed assets must fulfill three (3) qualifications:
1) Have life span of over one year;
2) Is not a repair part; and
3) Must be valued at or greater than the capitalization thresholds for the asset
type.
Asset Type Threshold
• Land $0
• Buildings and Improvements $100,000
• Infrastructure $100,000
• Tangible $5,000
o Equipment
o Vehicles
• Intangible $100,000
Exhibit A
Page 25 of 217
o Internally Generated Software
o Purchased Software
o Easements
o Patents
• And Capital Lease $5,000
Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
approved and identified as an asset, it will be tagged with a COUNTY program number. A Fixed Asset
Log (and related instructions), attached hereto as Exhibit J and Exhibit J-1 and by this reference
incorporated herein and made part of this Agreement, will be maintained by COUNTY's Asset
Management System and annually inventoried until the asset is fully depreciated. During the terms of this
Agreement, CONTRACTOR's fixed assets may be inventoried in comparison to COUNTY's DBH Asset
Inventory System.
B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
more than One Thousand and No/100 Dollars ($1,000.00), with over one year life span, and/or are mobile
and high risk of theft or loss are sensitive assets. Such sensitive items are not limited to computers,
copiers, televisions, cameras and other sensitive items as determined by COUNTY's DBH Director, or
designee. CONTRACTOR will maintain a tracking system on the items utilizing Exhibits J and J-1. Items
are not required to be capitalized or depreciated and are subject to annual inventory for compliance.
C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in an
annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of this
Agreement, CONTRACTOR shall be physically present when fixed and inventoried assets are returned to
COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all COUNTY-owned
undepreciated fixed and inventoried assets, or the monetary value of said assets if unable to produce the
assets at the expiration or termination of this Agreement.
CONTRACTOR further agrees to the following:
1) Maintain all items of equipment in good working order and condition, normal
wear and tear is expected;
2) Label all items of equipment with COUNTY assigned program number,
perform periodic inventories as required by COUNTY, and maintain an inventory list showing where and
Exhibit A
Page 26 of 217
how the equipment is being used, in accordance with procedures developed by COUNTY. All such lists
shall be submitted to COUNTY within ten (10) days of any request therefore; and
3) Report in writing to COUNTY immediately after discovery, the loss or theft of
any items of equipment. For stolen items, the local law enforcement agency must be contacted and a
copy of the police report submitted to COUNTY.
D. The purchase of any equipment by CONTRACTOR with funds provided hereunder
shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions of this Agreement as
appropriate, and must be directly related to CONTRACTORS services or activities under the terms of this
Agreement. COUNTY's DBH may refuse reimbursement for any costs resulting from equipment
purchased, which are incurred by CONTRACTOR, if prior written approval has not been obtained from
COUNTY.
E. CONTRACTOR must obtain prior written approval from COUNTY's DBH whenever
there is any modification or change in the use of any property acquired or improved, in whole or in part,
using funds under this Agreement. If any real or personal property acquired or improved with said funds
identified herein is sold and/or is utilized by CONTRACTOR for a use which does not qualify under this
Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal to the current fair market value
of the property, less any portion thereof attributable to expenditures of funds not provided under this
Agreement. These requirements shall continue in effect for the life of the property. In the event this
Agreement expires, or terminates, the requirements for this Section shall remain in effect for activities or
property funded with said funds, unless action is taken by the State government to relieve COUNTY of
these obligations.
22. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR and its subcontractors shall not
deny the contract's benefits to any person on the basis of race, religious creed, color, national origin,
ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex,
gender, gender identity, gender expression, age, sexual orientation, or military and veteran status, nor
shall they discriminate unlawfully against any employee or applicant for employment because of race,
religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition,
Exhibit A
Page 27 of 217
genetic information, marital status, sex, gender identity, gender expression, age, sexual orientation, or
military and veteran status.
CONTRACTOR shall ensure that the evaluation and treatment of employees and
applicants for employment are free of such discrimination. CONTRACTOR and subcontractors shall
comply with the provisions of the Fair Employment and Housing Act(Gov. Code §12800 et seq.), the
regulations promulgated thereunder(Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5,
Chapter 1, Part 1, Division 3, Title 2 of the Government Code (Gov. Code §11135-11139.5), and the
regulations or standards adopted by the awarding state agency to implement such article. CONTRACTOR
shall permit access by representatives of the Department of Fair Employment and Housing and the
awarding state agency upon reasonable notice at any time during the normal business hours, but in no
case less than twenty-four(24) hours notice, to such of its books, records, accounts, and all other sources
of information and its facilities as said department or agency shall require to ascertain compliance with this
clause. CONTRACTOR and its subcontractors shall give written notice of their obligations under this
clause to labor organizations with which they have a collective bargaining or other agreement. (See Cal.
Code Regs., tit. 2, §11105.) CONTRACTOR shall include the non-discrimination and compliance
provisions of this clause in all subcontracts to perform work under this Agreement.
23. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence:
A. CONTRACTOR shall not discriminate against beneficiaries based on race, color,
national origin, sex, disability, or religion. CONTRACTOR shall ensure that a limited and/or no English
proficient beneficiary is entitled to equal access and participation in federally funded programs through
the provision of comprehensive and quality bilingual services pursuant to Title 6 of the Civil Rights Act
of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R. Part 80) and Executive Order 12250 of 1979.
B. CONTRACTOR shall comply with requirements of policies and procedures for
ensuring access and appropriate use of trained interpreters and material translation services for all
limited and/or no English proficient beneficiaries, including, but not limited to, assessing the cultural and
linguistic needs of the beneficiaries, training of staff on the policies and procedures, and monitoring its
language assistance program. CONTRACTOR's policies and procedures shall ensure compliance of any
Exhibit A
Page 28 of 217
subcontracted providers with these requirements.
C. CONTRACTOR shall notify its beneficiaries that oral interpretation is available for
any language and written translation is available in prevalent languages and that auxiliary aids and
services are available upon request, at no cost and in a timely manner for limited and/or no English
proficient beneficiaries and/or beneficiaries with disabilities. CONTRACTOR shall avoid relying on an adult
or minor child accompanying the beneficiary to interpret or facilitate communication; however, if the
beneficiary refuses language assistance services, the CONTRACTOR must document the offer, refusal
and justification in the beneficiary's file.
D. CONTRACTOR shall ensure that employees, agents, subcontractors, and/or
partners who interpret or translate for a beneficiary or who directly communicate with a beneficiary in a
language other than English (1) have completed annual training provided by COUNTY at no cost to
CONTRACTOR; (2) have demonstrated proficiency in the beneficiary's language; (3) can effectively
communicate any specialized terms and concepts specific to CONTRACTOR's services; and (4) adheres
to generally accepted interpreter ethic principles. As requested by COUNTY, CONTRACTOR shall identify
all who interpret for or provide direct communication to any program beneficiary in a language other than
English and identify when the CONTRACTOR last monitored the interpreter for language competence.
E. CONTRACTOR shall submit to COUNTY for approval, within ninety (90) days from
date of contract execution, CONTRACTOR's plan to address all fifteen (15) National Standards for
Culturally and Linguistically Appropriate Service (CLAS), as published by the Office of Minority Health and
as set forth in Exhibit K, "National Standards on Culturally and Linguistically Appropriate Services",
attached hereto and incorporated herein by reference and made part of this Agreement. As the CLAS
standards are updated, CONTRACTOR's plan must be updated accordingly. As requested by COUNTY,
CONTRACTOR shall be responsible for conducting an annual CLAS self-assessment and providing the
results of the self-assessment to the COUNTY. The annual CLAS self-assessment instruments shall be
reviewed by the COUNTY and revised as necessary to meet the approval of the COUNTY.
F. Cultural competency training for CONTRACTOR staff should be substantively
integrated into health professions education and training at all levels, both academically and functionally,
including core curriculum, professional licensure, and continuing professional development programs. As
Exhibit A
Page 29 of 217
requested by COUNTY, CONTRACTOR shall report on the completion of cultural competency trainings to
ensure direct service providers are completing a minimum of one (1) cultural competency training annually.
G. CONTRACTOR shall create and sustain a forum that includes staff at all agency
levels to discuss cultural competence. COUNTY encourages a representative from CONTRACTOR's
forum to attend COUNTY's Cultural Humility Committee.
24. AMERICANS WITH DISABILITIES ACT
CONTRACTOR agrees to ensure that deliverables developed and produced, pursuant to
this Agreement, shall comply with the accessibility requirements of Section 508 of the Rehabilitation Act
and the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)), and regulations
implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal Regulations. In 1998,
Congress amended the Rehabilitation Act of 1973 to require Federal agencies to make their electronic and
information technology (EIT) accessible to people with disabilities. California Government Code section
11135 codifies section 508 of the Act requiring accessibility of electronic and information technology.
25. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section
1861(v)(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[1]), until the expiration of four(4)
years after the furnishing of services under this Agreement, CONTRACTOR shall make available, upon
written request to the Secretary of the United States Department of Health and Human Services, or upon
request to the Comptroller General of the United States General Accounting Office, or any of their duly
authorized representatives, a copy of this Agreement and such books, documents, and records as are
necessary to certify the nature and extent of the costs of these services provided by CONTRACTOR under
this Agreement. CONTRACTOR further agrees that in the event CONTRACTOR carries out any of its
duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and No/100
Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such Agreement
shall contain a clause to the effect that until the expiration of four (4) years after the furnishing of such
services pursuant to such subcontract, the related organizations shall make available, upon written request
to the Secretary of the United States Department of Health and Human Services, or upon request to the
Comptroller General of the United States General Accounting Office, or any of their duly authorized
Exhibit A
Page 30 of 217
representatives, a copy of such subcontract and such books, documents, and records of such organization
as are necessary to verify the nature and extent of such costs.
26. SINGLE AUDIT CLAUSE
A. If CONTRACTOR expends Seven Hundred Fifty Thousand and No/100 Dollars
($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an
annual audit in accordance with the requirements of the Single Audit Standards as set forth in Office of
Management and Budget (OMB) 2 CFR 200. CONTRACTOR shall submit said audit and management
letter to COUNTY. The audit must include a statement of findings or a statement that there were no
findings. If there were negative findings, CONTRACTOR must include a corrective action plan signed by
an authorized individual. CONTRACTOR agrees to take action to correct any material non-compliance or
weakness found as a result of such audit. Such audit shall be delivered to COUNTY's DBH Finance
Division for review within nine (9) months of the end of any fiscal year in which funds were expended
and/or received for the program. Failure to perform the requisite audit functions as required by this
Agreement may result in COUNTY performing the necessary audit tasks, or at COUNTY's option,
contracting with a public accountant to perform said audit, or may result in the inability of COUNTY to enter
into future agreements with CONTRACTOR. All audit costs related to this Agreement are the sole
responsibility of CONTRACTOR.
B. A single audit report is not applicable if CONTRACTOR's Federal contracts do not
exceed the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
CONTRACTOR's only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a
program audit must be performed and a program audit report with management letter shall be submitted
by CONTRACTOR to COUNTY as a minimum requirement to attest to CONTRACTOR solvency. Said
audit report shall be delivered to COUNTY's DBH Finance Division for review no later than nine (9) months
after the close of the fiscal year in which the funds supplied through this Agreement are expended. Failure
to comply with this Act may result in COUNTY performing the necessary audit tasks or contracting with a
qualified accountant to perform said audit. All audit costs related to this Agreement are the sole
responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under this
Exhibit A
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paragraph shall be billed to CONTRACTOR at COUNTY cost, as determined by COUNTY's Auditor-
Controller/Treasurer-Tax Collector.
C. CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other pending
matters, whichever is later.
27. COMPLIANCE
CONTRACTOR agrees to comply with COUNTY's Contractor Code of Conduct and Ethics
and the COUNTY's Compliance Program in accordance with Exhibit D. Within thirty (30) days of entering
into this Agreement with COUNTY, CONTRACTOR shall have all of CONTRACTOR's employees, agents,
and subcontractors providing services under this Agreement certify in writing, that he or she has received,
read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR shall
ensure that within thirty (30) days of hire, all new employees, agents, and subcontractors providing
services under this Agreement shall certify in writing that he or she has received, read, understood, and
shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR understands that the
promotion of and adherence to the Contractor Code of Conduct is an element in evaluating the
performance of CONTRACTOR and its employees, agents and subcontractors.
///
Within thirty(30)days of entering into this Agreement, and annually thereafter, all
employees, agents, and subcontractors providing services under this Agreement shall complete general
compliance training, and appropriate employees, agents, and subcontractors shall complete
documentation and billing or billing/reimbursement training. All new employees, agents, and
subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual who is
required to attend training shall certify in writing that he or she has received the required training. The
certification shall specify the type of training received and the date received. The certification shall be
provided to COUNTY's DBH Compliance Officer at 1925 E. Dakota Ave, Fresno, California 93726.
CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed upon COUNTY
Exhibit A
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by the Federal Government as a result of CONTRACTOR's violation of the terms of this Agreement.
28. ASSURANCES
In entering into this Agreement, CONTRACTOR certifies that neither they, nor any of their
officers, are currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
Health Care Programs; that neither they, nor any of their officers, have been convicted of a criminal
offense related to the provision of health care items or services; nor have they, nor any of their officers,
been reinstated to participate in the Federal Health Care Programs after a period of exclusion, suspension,
debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that CONTRACTOR
is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility for, or involvement
with, COUNTY's business operations related to the Federal Health Care Programs and shall remove such
CONTRACTOR from any position in which CONTRACTOR's compensation, or the items or services
rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, directly or indirectly, by
Federal Health Care Programs or otherwise with Federal Funds at least until such time as CONTRACTOR
is reinstated into participation in the Federal Health Care Programs.
A. If COUNTY has notice that either CONTRACTOR, or its officers, have been
charged with a criminal offense related to any Federal Health Care Program, or are proposed for exclusion
during the term of any contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure
the accuracy of any claims submitted to any Federal Health Care Program. At its discretion, given such
circumstances, COUNTY may request that CONTRACTOR cease providing services until resolution of the
charges or the proposed exclusion.
B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional services under
this Agreement, will be queried as to whether: (1)they are now or ever have been excluded, suspended,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)they have been
convicted of a criminal offense related to the provision of health care items or services; and (3)they have
been reinstated to participate in the Federal Health Care Programs after a period of exclusion, suspension,
debarment, or ineligibility.
1) In the event the potential employee or subcontractor informs
Exhibit A
Page 33 of 217
CONTRACTOR that he or she is excluded, suspended, debarred, or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR hires
or engages such potential employee or subcontractor, CONTRACTOR will ensure that said employee or
subcontractor does no work, either directly or indirectly relating to services provided to COUNTY.
2) Notwithstanding the above, COUNTY, at its discretion, may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
defined by COUNTY)that no excluded, suspended, or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
to protect the interests of COUNTY consumers.
C. CONTRACTOR shall verify (by asking the applicable employees and
subcontractors)that all current employees and existing subcontractors who, in each case, are expected to
perform professional services under this Agreement: (1) are not currently excluded, suspended, debarred,
or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted of a
criminal offense related to the provision of health care items or services; and (3) have not been reinstated
to participate in the Federal Health Care Program after a period of exclusion, suspension, debarment, or
ineligibility. In the event any existing employee or subcontractor informs CONTRACTOR that he or she is
excluded, suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs,
or has been convicted of a criminal offense relating to the provision of health care services,
CONTRACTOR will ensure that said employee or subcontractor does no work, either direct or indirect,
relating to services provided to COUNTY.
1) CONTRACTOR agrees to notify COUNTY immediately during the term of
this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case, is
providing professional services under this Agreement is excluded, suspended, debarred, or otherwise
ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating
to the provision of health care services.
2) Notwithstanding the above, COUNTY, at its discretion, may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
Exhibit A
Page 34 of 217
defined by COUNTY)that no excluded, suspended, or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY
to protect the interests of COUNTY's persons served.
D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY which may be necessary to complete any internal or external audits relating to
CONTRACTOR's compliance with the provisions of this Section.
E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR's violation of
CONTRACTOR's obligations as described in this Section.
29. PUBLICITY PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under this
Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e., purchasing of
tickets/tables, silent auction donations, etc.)for the purpose of self-promotion. Notwithstanding the above,
publicity of the services described in Section One (1) of this Agreement shall be allowed as necessary to
raise public awareness about the availability of such specific services when approved in advance by
COUNTY's DBH Director or designee and at a cost to be provided in Exhibits C-1 and C-2 for such items
as written/printed materials, the use of media (i.e., radio, television, newspapers), and any other related
expense(s).
30. COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a person
served or their family. CONTRACTOR shall provide a copy of the detailed complaint log entries
concerning COUNTY-sponsored persons served to COUNTY at monthly intervals by the tenth (10t") day of
the following month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide
details and attach documentation of each complaint with the log. CONTRACTOR shall post signs
informing persons served of their right to file a complaint or grievance. CONTRACTOR shall notify
COUNTY of all incidents reportable to State licensing bodies that affect COUNTY persons served within
twenty-four (24) hours of receipt of a complaint.
Exhibit A
Page 35 of 217
Within ten (10) days after each incident or complaint affecting COUNTY persons served,
CONTRACTOR shall provide COUNTY with information relevant to the complaint, investigative details of
the complaint, the complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the
complaint. In addition, CONTRACTOR shall inform every person served of their rights as set forth in
Exhibit H. CONTRACTOR shall file an incident report for all incidents involving persons served, following
the protocol and user guide identified in Exhibit I.
31. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is disclosing entities, fiscal agents, or
managed care entities, as defined in Code of Federal Regulations (C.F.R.), Title 42 §§455.101, 455.104
and 455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit L, "Disclosure of
Ownership and Control Interest Statement", attached hereto and by this reference incorporated herein and
made part of this Agreement. CONTRACTOR shall submit this form to the COUNTY's DBH within thirty
(30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall report any changes to
this information within thirty-five (35) days of occurrence by completing Exhibit L. Submissions shall be
scanned portable document format (pdf) copies and are to be sent via email to COUNTY's DBH assigned
Staff Analyst.
///
CONTRACTOR is required to submit a set of fingerprints for any person with a five
percent (5%) or greater direct or indirect ownership interest in CONTRACTOR. COUNTY may
terminate this Agreement where any person with a five percent (5%) or greater direct or indirect
ownership interest in the CONTRACTOR did not submit timely and accurate information and cooperate
with any screening method required in CFR, Title 42, Section 455.416. Submissions shall be scanned
pdf copies and are to be sent via email to DBHContractedServicesDivision(a)_fresnocountyca.gov.
COUNTY may deny enrollment or terminate this Agreement where any person with a five percent (5%)
or greater direct or indirect ownership interest in CONTRACTOR has been convicted of a criminal
offense related to that person's involvement with the Medicare, Medicaid, or Title XXI program in the
Exhibit A
Page 36 of 217
last ten (10) years.
32. DISCLOSURE— CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR is required to disclose if any of the following conditions apply to them, their
owners, officers, corporate managers, and partners (hereinafter collectively referred to in this Section as
"CONTRACTOR"):
A. Within the three (3) year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1) Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local)transaction or contract under a public transaction;
2) Violation of a federal or state antitrust statute;
3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
or
4) False statements or receipt of stolen property.
B. Within the three (3) year period preceding the Agreement award, they have had a
public transaction (federal, state, or local)terminated for cause or default.
Disclosure of the above information will not automatically eliminate CONTRACTOR from
further business consideration. The information will be considered as part of the determination of whether
to continue and/or renew this Agreement and any additional information or explanation that
CONTRACTOR elects to submit with the disclosed information will be considered. If it is later determined
that CONTRACTOR failed to disclose required information, any contract awarded to such CONTRACTOR
may be immediately voided and terminated for material failure to comply with the terms and conditions of
the award.
CONTRACTOR must sign a "Certification Regarding Debarment, Suspension, and Other
Responsibility Matters- Primary Covered Transactions" in the form set forth in Exhibit M, attached hereto
and by this reference incorporated herein and made part of this Agreement. Additionally, CONTRACTOR
must immediately advise COUNTY's DBH in writing if, during the term of this Agreement: (1)
CONTRACTOR becomes suspended, debarred, excluded, or ineligible for participation in Federal or State
funded programs or from receiving federal funds as listed in the excluded parties' list system
Exhibit A
Page 37 of 217
(http://www.epls.clov); or(2) any of the above listed conditions become applicable to CONTRACTOR.
CONTRACTOR shall indemnify, defend, and hold COUNTY harmless for any loss or damage resulting
from a conviction, debarment, exclusion, ineligibility, or other matter listed in the signed Certification
Regarding Debarment, Suspension, and Other Responsibility Matters.
33. AUDITS AND INSPECTIONS
The CONTRACTOR shall at any time during business hours, and as often as the COUNTY
may deem necessary, make available to the COUNTY for examination all of its records and data with
respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request by the
COUNTY, permit the COUNTY to audit and inspect all of such records and data necessary to ensure
CONTRACTOR'S compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 ($10,000.00), CONTRACTOR shall
be subject to the examination and audit of the California State Auditor for a period of three (3) years after
final payment under contract(Government Code Section 8546.7).
34. NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY CONTRACTOR
Director, Fresno County President/Chief Executive Officer
Department of Behavioral Health Exodus Recovery, Inc.
1925 E. Dakota Ave 9808 Venice Blvd, Suite 700
Fresno, CA 93726 Culver City, CA 90232
All notices between COUNTY and CONTRACTOR provided for or permitted under this
Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
personal service is effective upon service to the recipient. A notice delivered by first-class United States
mail is effective three (3) COUNTY business days after deposit in the United States mail, postage prepaid,
addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
(1) COUNTY business day after deposit with the overnight commercial courier service, delivery fees
prepaid, with delivery instructions given for next day delivery, addressed to the recipient. A notice
delivered by telephonic facsimile is effective when transmission to the recipient is completed (but, if such
Exhibit A
Page 38 of 217
transmission is completed outside of COUNTY business hours, then such delivery shall be deemed to be
effective at the next beginning of a COUNTY business day), provided that the sender maintains a machine
record of the completed transmission. For all claims arising out of or related to this Agreement, nothing in
this section establishes, waives, or modifies any claims presentation requirements or procedures provided
by law, including but not limited to the Government Claims Act(Division 3.6 of Title 1 of the Government
Code, beginning with Section 810).
35. GOVERNING LAW
Venue for any action arising out of or related to the Agreement shall only be in Fresno
County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
36. DISCLOSURE OF SELF-DEALING TRANSACTIONS
Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
is a party and in which one or more of its directors has a material financial interest. Members of the
Board of Directors shall disclose any self-dealing transactions that they are a party to by completing
and signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit N and incorporated
herein by reference, and submitting it to the COUNTY prior to commencing with the self-dealing
transaction or immediately thereafter.
37. ELECTRONIC SIGNATURE
The parties agree that this Agreement 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 Agreement 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
Agreement (1) is deemed equivalent to a valid original handwritten signature of the person signing this
Agreement for all purposes, including but not limited to evidentiary proof in any administrative or judicial
Exhibit A
Page 39 of 217
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 Agreement is not conditioned upon the
parties conducting the transactions under it by electronic means and either party may sign this Agreement
with an original handwritten signature.
38. ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire agreement between the
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understanding of any nature whatsoever unless expressly included in this Agreement.
Exhibit A-1 Adult Crisis Stabilization Center Scope of Work
Exhibit A-2 Youth Crisis Stabilization Center Scope of Work
Exhibit B DBH Guiding Principles of Care Delivery
Exhibit C-1 Adult CSC Budgets and Budget Narratives
Exhibit C-2 Youth CSC Budgets and Budget Narratives
Exhibit D FCMHP Compliance Plan and Code of Conduct
Exhibit E Documentation Standards for Individual Medical Records
Exhibit F State Mental Health Requirements
Exhibit G Medi-Cal Organizational Provider Standards
Exhibit H Fresno County MHP Grievances and Appeals Process
Exhibit I Protocol for Completion of Incident Report
Exhibit J &J-1 Fixed Asset and Sensitive Item Log
Exhibit K National CLAS Standards
Exhibit L Disclosure of Ownership and Control Interest Statement
Exhibit M Certification Regarding Debarment
Exhibit N Self-Dealing Transaction Disclosure Form
Exhibi A
Page 40 of 217
1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
2 year first hereinabove written.
3
4 CONTRACTOR: COUNTY OF FRESNO
EXODUS RECOVERY, INC.
5 6 By:
Brian Pacheco, Chairman of the Board of
Supervisors of the County of Fresno
8 Print Name: Luana Murphy
9
10 Title: President/CEO
Chairman of Board, or President
11 or any Vice President ATTEST:
12 BERNICE E. SEIDEL
Clerk of the Board of Supervisors
13 County of Fresno, State of California
14 By.
15
16 Print Name: LeeAnn Skorohod By `�f7
Deputy
17 Title: Corporate Secretary/COO
18 Secretary of Corporation, or
any Assistant Secretary, or
19 Chief Financial Officer, or
20 any Assistant Treasurer
21
22 Mailing Address:
9808 Venice Blvd, Suite 700
23 Culver City, CA 90232
Phone No.: (310)945-3350
24 Contact: Luana Murphy, President/CEO
25 FOR ACCOUNTING USE ONLY:
26 Fund/Subclass: 0001/10000
27 Organization: 56302110(Youth CSC), 56302111 (Adult CSC)
Account No.: 7295
28
- 40 - COUNTY OF FRESNO
Fresno, CA
Exhibit A
Page 41 of 217
ADULT CRISIS STABILIZATION CENTER
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA 93702 (Bldg 319)
SERVICES: Adult Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: July 1, 2022 — June 30, 2025, with two (2) twelve (12) month
renewal options
SCHEDULE/LOCATION OF SERVICES:
CONTRACTOR shall operate the Adult Crisis Stabilization Center (Adult CSC) twenty-
four (24) hours per day, seven (7) days per week. The Adult CSC shall be located at the
Kings Canyon Campus at 4411 E. Kings Canyon Road, Fresno, California 93702
(Building 319), a COUNTY-owned building, pursuant to a separate lease agreement (and
any related amendments) between COUNTY and Exodus Foundation, Inc., an affiliate of
CONTRACTOR. At some point during the contract term when construction is complete,
the Adult CSC will be relocated to the COUNTY's Heritage Campus at the intersection of
Shields Avenue and Millbrook Avenue.
TARGET POPULATION:
The target population will include individuals 18 years of age and older from Fresno
County, who are exhibiting acute psychiatric symptoms and have either been placed on
a Welfare and Institution Code (W&IC) 5150 designation or who request admittance to
the Adult CSC on a voluntary status.
CONTRACTOR will provide crisis stabilization services to adults with a maximum
capacity of forty-four (44) beds at any given time. CONTRACTOR may also be in the
process of assessing or evaluating additional individuals, as necessary. At times
throughout the contract term, COUNTY DBH may request the increase of beds for
capacity needs (e.g., with increase in acuity and census due to the Covid-19 pandemic).
The maximum capacity will also potentially be modified due to the unknown capacity of
the new 24-7 facility at the Heritage Centre. The updated maximum capacity will be
made upon written agreement between COUNTY and CONTRACTOR.
Exhibit A
Page 42 of 217
CONTRACTOR will accept voluntary or involuntarily admitted adults regardless of
source of payment; individuals may include Medi-Cal beneficiaries, Medicare and
Medicare/Medi-Cal beneficiaries, privately insured and indigent/uninsured who are
referred by the Department of Behavioral Health (DBH), a contracted provider with
COUNTY DBH, a hospital emergency department, law enforcement, or Emergency
Medical Services (EMS). Individuals may be referred by family or be self-referred.
These services shall be performed pursuant to W&IC, sections 5704.5(b), 5704.6(c),
and 5614(b)(3) and program principles and the array of treatment options required
under W&IC, sections 5600.2 to 5600.9 inclusive.
PROJECT DESCRIPTION:
CONTRACTOR shall be responsible to comply with the requirements of the Fresno
County Mental Health Plan (FCMHP) and must complete and submit supporting clinical
and any other such documentation as may be required by the COUNTY for every person
served in the Adult CSC. The FCMHP will perform a utilization review of all admissions
to determine that the documentation demonstrates that medical necessity criteria as
defined by the California Department of Health Care Services (DHCS) was met for each
duration of the hospitalization, except for the episode of discharge.
CONTRACTOR shall be responsible to enter all Individual Service Information, admission
data and billing information into the COUNTY data system (AVATAR) and will be
responsible for any and all audit exceptions pertaining to the delivery of services.
CONTRACTOR'S RESPONSIBILITIES:
A. CONTRACTOR shall ensure that the Adult CSC provides the following services:
1 . Management and alleviation of the individual's acute psychiatric symptoms
through effective therapeutic interventions and supportive services to avoid
the need for a higher level of psychiatric care when clinically appropriate.
2. A recovery/strength based clinical program which has appropriate
professional staffing on a twenty-four (24) hour, seven (7) day a week
basis.
3. A safe, secure environment for persons served that encourages wellness
and recovery.
4. A comprehensive multi-disciplinary evaluation and individual-centered
treatment plan.
5. Dietary services through the availability of nourishment or snacks in
accordance with Title 22, Division 5, Chapter 9, Article 3, Section 77077.
Exhibit A
Page 43 of 217
6. Admission procedures for individuals, who are not on involuntary holds in
accordance with W&IC 5150 and also individuals placed on W&IC 5150
involuntary holds.
7. Crisis consultation services to rural service providers (e.g., emergency
departments, etc.) that may not have timely access to the centrally located
crisis stabilization facilities and may require consultation to support
individual care planning and/or mitigate unnecessary long transports of
persons served to the Adult CSC from remote areas. Crisis consultation
may occur via teleconference, tele-behavioral health (i.e., utilization of
video and computer equipment), and/or other method presented by
CONTRACTOR and deemed acceptable by the department.
8. Treatment Planning — Under the clinical direction of the mental health
clinician, the multi-disciplinary treatment team formed by the Crisis
Stabilization staff shall provide the following services:
a. Mental Status Examination
b. Medical Evaluation
c. Full Clinical Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Individual Centered Treatment Planning
g. Aftercare Planning and Wellness Recovery Action Plan (WRAP)
9. Staffing
a. The staffing pattern for the crisis stabilization program shall meet all
current State licensing and regulatory requirements including medical
staff standards, nursing staff standards, social work and rehabilitation
staff requirements pursuant to Title 9, Division 1 , Chapter 11 , Article
3, Section 1840.348 of the California Code of Regulations (CCR) for
Crisis Stabilization services. All staff requiring federal/state licensure
or certification will be required to be licensed or certified in the State
of California and be in good standing with the state licensing or
certification board. CONTRACTOR shall remain up-to-date with all
current regulatory changes and adhere to all new and/or modified
requirements.
b. All facility staff who provide direct individual care or perform
coding/billing functions must meet the requirements of the FCMHP
Compliance Program. This includes the screening for excluded
persons and entities by accessing or querying the applicable licensing
board(s), the National Practitioner Data Bank (NPDB), Office of
Inspector General's List of Excluded Individuals/Entities (LEIE),
Exhibit A
Page 44 of 217
Excluded Parties List System (EPLS) and Medi-Cal Suspended and
Ineligible List prior to hire and annually thereafter. In addition, all
licensed/registered/waivered staff must complete a FCMHP Provider
Application and be credentialed by the FCMHP's Credentialing
Committee. All of CONTRACTOR's staff who have direct contact
with the persons served, shall have Department of Justice (DOJ),
Federal Bureau of Investigation (FBI), and Sheriff fingerprinting
(Livescan) executed.
c. Peer and/or family support staff will be an active and key member of
the multi-disciplinary team to assist with treatment planning,
mentoring, support and advocate with individuals/families during their
time at the Adult CSC facility and will assist with discharge planning
and facilitate the individual's transition to the appropriate lower level
of care.
d. The staffing requirements defined by CCR, Title 9, Section 1840.348
for the Adult CSC is as follows:
(a) A physician shall be on call at all times for the provision of those
Crisis Stabilization Services that may only be provided by a physician.
(b) There shall be a minimum of one Registered Nurse, Psychiatric
Technician, or Licensed Vocational Nurse on site at all times
beneficiaries are present.
(c) At a minimum there shall be a ratio of at least one (1) licensed
mental health or waivered/registered professional on site for each
four (4) beneficiaries or other individuals receiving crisis stabilization
services at any given time.
(d) If the person served is evaluated as needing service activities that
can only be provided by a specific type of licensed professional, such
persons shall be available.
(e) Other persons may be utilized by the program, according to need.
(f) If Crisis Stabilization services are co-located with other specialty
mental health services, persons providing Crisis Stabilization must be
separate and distinct from persons providing other services.
(g) Persons included in required Crisis Stabilization ratios and
minimums may not be counted toward meeting ratios and minimums
for other services.
e. CONTRACTOR shall submit daily staffing reports that identify all
direct service and support staff by first and last name, applicable
Iicensure/certifications, full time hours worked, and the
Exhibit A
Page 45 of 217
licensed/waivered/registered mental health professionals to person
served ratio.
10. Medical Records
a. CONTRACTOR shall maintain records in accordance with Exhibit E,
"Documentation Standards for Individual Medical Records." During
site visits, COUNTY shall be allowed to review records of services
provided, including the goals and objectives of the treatment plan,
and how the therapy provided is achieving the goals and objectives.
b. CONTRACTOR will be responsible for "release of information"
requests for the Adult CSC facility and shall adhere to applicable
federal and state regulations.
c. CONTRACTOR can develop and implement a medical records
system which meets all State and Federal requirement and clearly
documents medical necessity for both treatment and billing services.
Medical records shall be kept in such a manner as to comply with the
Fresno County Quality Improvement standards and Federal and State
quality standards. COUNTY has an electronic medical record system.
CONTRACTOR may elect to utilize and participate with the
COUNTY's electronic health record system if they do not have their
own system in place. It is anticipated that CONTRACTOR shall be
utilizing an electronic medical records system by the end of this
contract term.
11. Clinical Staff - The clinical staff of CONTRACTOR shall be composed of all
licensed mental health or waivered/registered professionals as included in
CCR, Title 9, Division 1, Chapter 11, Article 3, Section 1840.348 (Crisis
Stabilization Staffing Requirements).
12. Medical Staff— The medical staff shall include a physician and a registered
nurse, psychiatric technician or licensed vocational nurse and any other
type of licensed professional needed to address individual's needs,
pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 (Crisis Stabilization Staffing Requirements).
13. Pharmaceutical Services — CONTRACTOR shall provide for medication
services on an as needed basis and the staffing must reflect this
availability, pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3,
Section 1840.338 (Crisis Stabilization Contact and Site Requirements) and
all other applicable federal/state regulations.
14. Assessment of Physical Health and Medical Backup Services — Pursuant to
CCR, Title 9, Division 1, Chapter 11, Article 3, Section 1840.338 (Crisis
Stabilization Contact and Site Requirements), CONTRACTOR shall provide
admission history and physical examination, and maintain a written
Exhibit A
Page 46 of 217
agreement for medical services with one or more general acute care
hospitals.
15. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify the COUNTY of any admission of
COUNTY's person served within twenty-four (24) hours or the next
business day in a manner approved by the COUNTY. The
notification method shall be approved by the COUNTY.
b. CONTRACTOR shall be responsible to ensure that documentation in
the individual's medical record meets medical necessity criteria for
the hours of service submitted to COUNTY for reimbursement by
federal intermediaries, third-party payers and other responsible
parties.
c. CONTRACTOR shall enter all mental health data and billing
information into the COUNTY's electronic information system and will
be responsible for any and all audit exceptions pertaining to the
delivery of services.
d. CONTRACTOR shall submit a complete and accurate DHCS
Short/Doyle Medi-Cal Cost Report for each fiscal year ending June
30t" affected by the proposed agreement within 120 days following
the end of each fiscal year.
e. CONTRACTOR shall insure that cost reports are prepared in
accordance with General Accepted Accounting Principles (GAAP)
and the standards set forth by the DHCS and the COUNTY.
16. Patients' Rights and Certification Review Hearings:
a. CONTRACTOR shall adopt and post in a conspicuous place a written
policy on individual's rights in accordance with section 70707 of Title
22 of the CCR and section 5325.1 of the W&IC and Title 42 Code of
Federal Regulations section 438.100.
b. CONTRACTOR shall allow access to COUNTY's persons served by
the Patients' Rights Advocate designated by the COUNTY.
17. Family Advocate - CONTRACTOR shall promote and allow the persons
served access to the Family Advocacy Services representative (Family
Advocate) who is contracted by the COUNTY to advocate and assist
individuals, families and support systems who are seeking or receiving
mental health services.
18. Grievances and Incident Reports
CONTRACTOR shall have all grievance forms readily available at the Adult
CSC facility.
Exhibit A
Page 47 of 217
CONTRACTOR shall log all grievances and the disposition of all grievances
received from a person served or their family in accordance with FCMHP
policies and procedures as indicated herein. CONTRACTOR shall provide
a summary of the grievance log entries concerning COUNTY-sponsored
individuals to the DBH Director, or designee, at monthly intervals, by the
fifteenth (15th) day of the following month, in a format that is mutually
agreed upon. CONTRACTOR shall post signs, provided by the COUNTY,
informing individuals of their right to file a grievance and appeal.
CONTRACTOR shall notify COUNTY of all incidents or unusual
occurrences reportable to state licensing bodies that affect COUNTY's
persons served within twenty-four (24) hours. CONTRACTOR shall use the
Incident Reporting process as indicated within Exhibit I for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-
sponsored individuals, CONTRACTOR shall provide County with the
complaint and CONTRACTOR's disposition of, or corrective action taken to
resolve the complaint or incident.
Within fifteen (15) days after CONTRACTOR submits a corrective action
plan to a California State licensing and/or accrediting body concerning any
sentinel event, as the term is defined by the licensing or accrediting agency,
and within fifteen (15) days after CONTRACTOR receives a corrective
action order from a California State licensing and/or accrediting body to
address a sentinel event, CONTRACTOR shall provide a summary of such
plans and orders to COUNTY.
19. Provide a safe and secure environment to provide for clinical and medical
assessment, diagnostic formulation, crisis intervention, medication
management, and clinical treatment for adults with acute psychiatric
symptoms. This includes the manner in which seclusion and restraint will
be administered when necessary for the safety of the persons served, other
persons served in the program, and staff.
20. Provide the appropriate type and level of staffing to provide for a clinically
effective program design that adheres to State staffing requirements.
21. Provide staff training in the areas of non-violent crisis intervention,
evidence-based practice, best practice, or promising practices to ensure
staff are competent and proficient in the therapeutic interventions and
practices in serving adult individuals accessing the Adult CSC.
22. CONTRACTOR shall utilize cost containment strategies for the provision of
stock and prescription medications to individuals (i.e., by contracting with a
pharmaceutical benefits management company) and provide the COUNTY
with the type of formulary utilized by the program as well as information
regarding co-pays and/or generic substitutions.
Exhibit A
Page 48 of 217
23. Provide an intensive treatment program which has individualized treatment
plans.
24. Stabilize the individuals' acute psychiatric symptoms in the most expedient
manner possible while adhering to appropriate clinical care standards. This
may include initiating a Treatment Authorization Request (TAR) to the
pharmacy and providing justification when psychotropic medications are
needed on an emergency basis.
25. Effectively partner with other programs in the COUNTY and community
system (i.e., law enforcement, local emergency departments, etc.) in
accepting COUNTY's persons served for admission for crisis stabilization
services.
26. Effectively partner with rural services providers (i.e., emergency
departments, etc.) to provide crisis stabilization services via teleconference,
tele-behavioral health (i.e., utilization of video and computer equipment),
and/or other method deemed acceptable by COUNTY.
27. Work collaboratively with the COUNTY and community resources in
discharge planning to ensure appropriate referral and direct linkage to
ongoing outpatient specialty mental health treatment services, substance
use disorder treatment services, etc. are provided. Discharge planning
would also include working collaboratively with out-of-county mental health
plans to ensure individuals in foster care who reside within Fresno County
are linked to appropriate ongoing specialty mental health services,
substance use disorder treatment services, etc. as appropriate.
28. Identify individuals with frequent admissions during the fiscal year and
develop strategies with other COUNTY and community agencies to reduce
readmissions and improve individuals' overall well-being through
coordination of care.
29. Effectively interact with community agencies, other mental health programs
and providers, natural support systems, and families to assist individuals to
be discharged to the appropriate level of care.
30. Work effectively with the DBH Conservatorship Team as appropriate for
individuals presenting to the Adult CSC as gravely disabled who may
require consideration for a temporary conservatorship.
31. Integrate mental health and substance use disorder services. The
CONTRACTOR shall perform the following:
a. Develop a formal written Continuous Quality Improvement CQI action
plan to identify measurable objectives toward the achievement of co-
occurring disorders (COD) treatment capability that will be addressed by
the program during the contract period. These objectives should be
Exhibit A
Page 49 of 217
achievable and realistic for the program, based on a self-assessment
and the program priorities, but need to include attention to making
progress on the following issues, at minimum:
1 . Welcoming policies, practices, and procedures related to the
engagement of individuals with co-occurring issues and disorders;
2. Removal or reduction of access barriers to admission based on
co-occurring diagnosis or medication;
3. Improvement in routine integrated screening, and identification in
the data system of how many persons served have co-occurring
issues;
4. Developing the goal of basic co-occurring competency for all
treatment and support staff, regardless of licensure or certification;
and
5. Documentation of coordination of care with collaborative mental
health and/or substance use disorder providers for each person
served.
B. Regarding cultural and linguistic competence requirements, CONTRACTOR
shall:
1 . Ensure compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C.
Section 2000d, and 45 C.F.R. Part 80) and Executive Order 12250 of 1979
which prohibits recipients of federal financial assistance from discriminating
against persons based on race, color, national origin, sex, disability or
religion. This is interpreted to mean that a limited English proficient (LEP)
individual is entitled to equal access and participation in federally funded
programs through the provision of comprehensive and quality bilingual
services.
2. Create and maintain policies and procedures for ensuring access and
appropriate use of trained interpreters and material translation services for
all LEP persons served, including, but not limited to, assessing the cultural
and linguistic needs of its persons served, training of staff on the policies
and procedures, and monitoring its language assistance program. The
CONTRACTOR's procedures must include ensuring compliance of any
subcontracted providers with these requirements.
3. Ensure that minors shall not be used as interpreters.
4. Conduct and submit to COUNTY an annual cultural and linguistic needs
assessment to promote the provision and utilization of appropriate services
for its diverse population. The needs assessment report shall include
findings and a plan outlining the proposed services to be improved or
implemented as a result of the assessment findings, with special attention to
Exhibit A
Page 50 of 217
addressing cultural and linguistic barriers and reducing racial, ethnic,
language, abilities, gender, and age disparities.
5. Develop internal systems to meet the cultural and linguistic needs of the
CONTRACTOR's persons served census including the incorporation of
cultural competency in the CONTRACTOR's mission; establishing and
maintaining a process to evaluate and determine the need for special -
administrative, clinical, welcoming, billing, etc. - initiatives related to cultural
competency.
6. Develop recruitment and retention initiatives to establish contracted program
staffing that is reflective and responsive to the needs of the program and
target population.
7. Establish designated staff person to coordinate and facilitate the integration
of cultural competency guidelines and attend COUNTY's DBH Cultural
Diversity Committee scheduled meetings. The designated person will
provide an array of communication tools to distribute information to staff
relating to cultural competency issues.
8. Keep abreast of evidence-based and best practices in cultural competency
in mental health care and treatment to ensure that the CONTRACTOR
maintains current information and an external perspective in its policies.
The CONTRACTOR shall evaluate the effectiveness of strategies and
programs in improving the health status of cultural-defined populations.
9. Ensure that an assessment of an individual's sexual orientation is included
in the bio-psychosocial intake process. CONTRACTOR's staff shall assume
that the population served may not be in heterosexual relationships.
Sensitivity to gender and sexual orientation must be covered in annual
training.
10. Utilize existing community supports, referrals to transgender support groups,
etc., when appropriate.
11. Attend annual Cultural Competence, Compliance, Health Insurance
Portability and Accountability Act (HIPAA), Billing, and Documentation
training provided by COUNTY's DBH.
12. Report its efforts to evaluate cultural and linguistic activities as part of the
CONTRACTOR's ongoing quality improvement efforts in the monthly
activities report. Reported information may include individuals' complaints
and grievances, any resulting actions regarding complaints and grievances,
results from persons served satisfaction surveys, and utilization and other
clinical data that may reveal health disparities as a result of cultural and
linguistic barriers.
C. Regarding Conservatees, CONTRACTOR agrees to the following:
Exhibit A
Page 51 of 217
CONTRACTOR shall work with COUNTY's DBH Persons Served Placement
Team to find placement for COUNTY conservatees that are discharged from the
CONTRACTOR-operated Adult CSC.
D. Regarding direct admissions to the Adult CSC from COUNTY's DBH programs
or its contracted providers, CONTRACTOR agrees to the following:
1 . To allow direct admits from COUNTY's DBH programs or its contracted
providers when the Adult CSC has the capacity to accept individuals for
services.
2. Said direct admits shall not require medical clearance, if persons served
would otherwise meet the Central California Emergency Medical Services
Agency 5150 Destination Policy requirements as mentioned hereinbelow in
Subsection G. However, in the event a referred individual is known to
possess a contagious medical condition, said individual shall be medically
cleared by a local hospital prior to admission to the Adult CSC operated by
CONTRACTOR.
E. Regarding the placement of an individual at another designated facility:
1 . CONTRACTOR shall notify COUNTY DBH when an individual will remain at
the CSC for a period in excess of 24 hours, while awaiting placement and/or
transportation. COUNTY's Patients' Rights Advocate will be included in this
notification
2. CONTRACTOR shall provide the following services to individuals who
remain at the Adult CSC for a period in excess of 24 hours and who are
awaiting placement and/or transportation:
a. Three meal periods and three snack times per 24 hours
b. Daily encouragement and support with activities of daily living i.e.,
showering, washing of clothes, teeth brushing, hair combing, etc.
c. Daily psychiatric evaluation by both the provider and licensed nursing
staff to evaluate/determine the individuals most appropriate level of care
d. Daily medication evaluation, administration and education
e. Daily group activities (e.g., 12-Step Meetings, WRAP, Goals Group, etc.)
f. Daily one-on-one peer support provided by designated Peer Advocate
g. Daily activities such as meditation, art, entertainment and outdoor
activities provided in the outside courtyard
h. Daily education in relation to mental health diagnosis, treatments, and
community resources
F. Regarding the provision of court testimony related to Adult CSC individuals,
CONTRACTOR agrees to the following:
Exhibit A
Page 52 of 217
CONTRACTOR's staff shall provide court testimony relevant to Adult CSC
individuals, when required.
G. Regarding the Central California Emergency Medical Services Agency
(CCEMSA) 5150 Destination Policy, CONTRACTOR agrees to the following:
CONTRACTOR agrees to follow the then-current Central California
Emergency Medical Services Agency 5150 Destination Policy #547 as
identified in Attachment A, attached hereto and incorporated herein. Said
policy may be updated periodically throughout the term of this Agreement;
CONTRACTOR must adhere to the most recent policies designated by the
CCEMSA 5150 Destination Policy.
H. CONTRACTOR shall participate in the following meetings:
1 . CONTRACTOR shall participate in periodic workgroup meetings scheduled
by staff from COUNTY's DBH Mental Health Contracted Services Division.
The meetings shall be held monthly, or as needed, to discuss contract
requirements, data reporting, outcomes measurement, training, policies and
procedures, and overall program operations.
2. CONTRACTOR's administrative level agency representative, who is duly
authorized to act on behalf of CONTRACTOR, shall attend regularly
scheduled monthly Behavioral Health Board meetings.
3. CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider
Meetings, as scheduled by staff from COUNTY's Mental Health Contracted
Services Division, when deemed necessary by the DBH Director, or
designee.
4. CONTRACTOR may also be asked to make presentations in the community
about the program and services that are available.
I. Regarding the development of policies and protocols:
CONTRACTOR and COUNTY's DBH shall collaborate on the development
of specific policies and protocols related to the daily operation of the Adult
CSC. Such policies will include, but not be limited to, the following:
placement of adults in psychiatric health facilities or other inpatient
programs either locally or outside the county, facility limitations, and special
persons served populations. Such policies and protocols shall be mutually
agreed upon between CONTRACTOR and COUNTY's DBH Director, or
designee. Any changes to such policies and protocols shall be mutually
agreed upon between CONTRACTOR and COUNTY's DBH Director, or
designee.
Exhibit A
Page 53 of 217
PROGRAM OUTCOMES
The Department of Behavioral Health is dedicated to supporting the wellness of
individuals, families and communities in Fresno County who are affected by, or at the
risk of, mental illness and/or substance use disorders through cultivation of strengths
toward promoting recovery in the least restrictive environment.
Five (5) Work Plans will be utilized to support DBH's mission statement. The work
plans were developed as a concept of a Transformation Plan that would encompass
system planning, implementation and oversight to be reflective of a comprehensive
system of care. These work plans are provided below and represent program goals
to be achieved by CONTRACTOR in addition to CONTRACTOR-developed
outcomes. DBH may adjust the outcome measurements needed under this program
periodically, so as to best measure the success of individuals and program as
determined by the COUNTY.
CONTRACTOR will utilize a computerized tracking system with which outcome
measures and other relevant persons served data, such as demographics, will be
maintained.
1. Behavioral Health Integrated Access — timeliness between persons served
referral to admission, admission to treatment, and treatment to discharge;
penetration rate; effectiveness of discharge planning as demonstrated by
referral and linkage to other DBH programs, community providers, and other
community resources; and services that provide screening and access to
ensure persons served are linked to the services they need, including mental
health substance use disorders and physical health services.
2. Wellness, Recovery, and Resiliency Supports — collaborative approach to
treatment strategies to reduce readmission of persons served with frequent
admissions to the facility; effectiveness of services as demonstrated by the
number of persons served who are able to be discharged to the community
and avoid inpatient hospitalization; measurement of recidivism rates, including
measuring percentage of recidivism within 30 days. State the Evidence Based
Practices (EBP) that shall be used.
3. Cultural/Community Defined Practices — services or philosophical practices
which support the unique cultural-specific needs of individuals receiving care.
Focus on behavioral health practices which reflect the unique needs of various
cultures and communities who reside within Fresno County.
4. Behavioral Health Clinical Care — services where direct therapeutic treatment
is provided. Include the framework of "Levels of Care" where individual's
needs, as identified through assessment/screening, are matched with a
complexity and intensity of services meets those needs.
Exhibit A
Page 54 of 217
5. Infrastructure Supports — includes all personnel, equipment, programs, and
facilities which exist to support the delivery of care to the individuals served.
Includes safety, quality improvement and regulatory compliance functions,
along with outcome assessment/program evaluation, training, and technology.
6. Denial rate for Crisis Stabilization billing will be decreased by five percent (5%)
within the first six (6) months, based on previous program denial rates. Rates
will be determined by the utilization review performed by FCMHP.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Perform a utilization review, annually at a minimum, (through its FCMHP) of ten
percent (10%) of all admissions to determine that the documentation
demonstrates that medical necessity criteria as defined by the DHCS were met
throughout the duration of the crisis stabilization episode. The FCMHP will
maintain discretion regarding possible subsequent utilization review beyond ten
percent (10%), as necessary.
2. Provide oversight of the CONTRACTOR's Adult CSC program. In addition to
contract monitoring of program(s), oversight includes, but is not limited to,
coordination with the DHCS in regard to program administration and outcomes.
3. Assist the CONTRACTOR in making linkages to the appropriate level of care
within the behavioral health system of care to ensure continuity of care. This will
be accomplished through regularly scheduled meetings as well as formal and
informal consultation.
4. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the CONTRACTOR staff and will be available to the contractor
for ongoing consultation.
5. Receive and analyze statistical outcome data from CONTRACTOR throughout the
term of contract on a monthly basis. DBH will notify the CONTRACTOR when
additional participation is required. The performance outcome measurement
process will not be limited to survey instruments but will also include, as
appropriate, individual and staff interviews, chart reviews, and other methods of
obtaining required information.
6. Recognize that cultural competence is a goal toward which professionals,
agencies, and systems should strive. Becoming culturally competent is a
developmental process and incorporates at all levels the importance of culture, the
assessment of cross-cultural relations, vigilance towards the dynamics that result
from cultural differences, the expansion of cultural knowledge, and the adaptation
of services to meet culturally unique needs. Offering those services in a manner
that fails to achieve its intended result due to cultural and linguistic barriers is not
cost effective. To assist the CONTRACTOR's efforts towards cultural and
Exhibit A
Page 55 of 217
linguistic competency, DBH shall provide the following at no cost to
CONTRACTOR:
A. Mandatory cultural competency training including sexual orientation and
sensitivity training for CONTRACTOR personnel, at minimum once per year.
COUNTY will provide mandatory training regarding the special needs of this
diverse population and will be included in the cultural competence training(s).
Sexual orientation and sensitivity to gender differences is a basic cultural
competence principle and shall be included in the cultural competency
training. Literature suggests that the mental health needs of lesbian, gay,
bisexual, transgender, and queer (LGBTQ+) individuals may be at increased
risk for mental disorders and mental health problems due to exposure to
societal stressors such as stigmatization, prejudice and anti-gay violence.
Social support may be critical for this population. Access to care may be
limited due to concerns about providers' sensitivity to differences in sexual
orientation.
B. Assistance to CONTRACTOR in locating appropriate providers who can
translate behavioral health and substance abuse services information into
COUNTY's threshold languages (English, Spanish, and Hmong). Translation
services and costs associated will be the responsibility of the CONTRACTOR.
CENTRAL CALIFORNIA EMERGENCY Exhibit A
Page 56 of 217
MEDICAL SERVICES
A Division of the Fresno County Department of Public Health
Manual Policy
Emergency Medical Services Number 547
Administrative Policies and Procedures
Page 1 of 9
Subject Patient Destination
References Title 13, Section 1106 of the California Code of Regulations Effective:
Title 22, Division 9, Chapter 7 of the California Code of Regulations 04/18/83
I. POLICY
Patients of the Prehospital EMS System shall be transported to an appropriately staffed and equipped hospital.
II. MEDICAL PATIENT DESTINATION
A. Medical Patients shall be transported to the appropriate destination in accordance with the following chart:
Fresno County Kings County Madera County Tulare County
Medical—Adult
Non-emergent Patient's Choice Patient's Choice Patient's Choice Patient's Choice
Life-threatening Closest Appropriate Closest Appropriate Closest Appropriate Closest Appropriate
Regional Medical Kaweah Health Medical Regional Medical Kaweah Health Medical
Acute current of injury Center or St.Agnes Center or Regional Center or St.Agnes Center or Regional
(acute MI) Medical Center Medical Center Medical Center Medical Center
(Quickest travel time) (Quickest travel time) (Quickest travel time) (Quickest travel time)
Medical—Pediatric(14 years or younger)
Stable Patient/Family Choice Patient/Family Choice Patient/Family Choice Patient/Family Choice
Kaweah Health Medical
RMC or VCH*** RMC or VCH * * RMC or VCH *** Center or
Unstable (Quickest travel time) (Quickest travel time) (Quickest travel time) Sierra View District
Hospital
(Quickest travel time)
5150 patients
CSC or Patient's Choice
5150-Adult within Fresno County Patient's Choice within Patient's Choice within Patient's Choice within
(See criteria on page 4) Kings County Madera County Tulare County
YCSU or Patient/Family
5150—Children (<18 Choice within Fresno Patient/Family Choice Patient/Family Choice Patient/Family Choice
yrs) County within Kings County within Madera County within Tulare County
(See criteria on page 4)
Kaiser Kaiser N/A N/A N/A
Veteran's Administration Veteran's Administration N/A N/A N/A
*** If transport time is greater than 60 minutes, base hospital contact shall be made to determine appropriate destination.
Approved By Daniel J. Lynch Revision
EMS Division Manager (Signature on File at EMS Agency 3/14/2022
Jim Andrews, M.D.
EMS Medical Director (Signature on File at EMS Agency)
Exhibit A
Page 57 of 217
B. Medical Patient Destination —Considerations
1. In a non-emergent situation (as determined by the EMT or Paramedic at the scene and/or the
Base Hospital Physician/MICN giving medical direction), the patient will be taken to the receiving
hospital of his/her choice. If the patient is unable to determine this, the hospital designated by the
private physician and/or patient's family member will be utilized. Paramedics and EMTs should
determine where the patient normally receives their medical care and encourage the patient to
return to that hospital for medical care as long as the patient's medical condition allows for such
transport.
2. The Paramedic/EMT/MICN/BHP should only provide the patient with alternatives for destination
of patient choice. It is inappropriate for the Paramedic/EMT/MICN/BHP to endorse specific
facilities or provide personal opinion on the quality of local facilities.
3. Health Plans - If the patient is a member of a health plan with a preferred hospital, an attempt
should be made to transport the patient to a participating facility.
4. Closest Appropriate Hospital
a. The closest appropriate hospital is defined as the closest emergency department
"equipped, staffed, and prepared to administer care appropriate to the needs of the
patient" (California Code of Regulations, Title 13, Section 1106 (b) 2).
b. Closest is defined as the shortest travel time not necessarily the closest by distance.
C. The Base Hospital Physician will have the ultimate authority for patient destination.
d. The closest appropriate hospital does not mean that critically ill patients always go to the
closest"receiving" hospital. They go to the closest"appropriate" hospital. The following
guidelines will help to define "appropriate":
1) Due to short transport times, the appropriate receiving facility for a life-
threatening medical situation would be a hospital with a basic emergency service
(holds a special services permit from the California State Department of Health
Services). Hospitals with basic emergency services are:
a) Adventist Health Hanford (AH-H)
b) Adventist Health Tulare (AH-T)
c) Clovis Community Medical Center(CCMC)
d) Kaiser Permanente Hospital (KPH)
e) Kaweah Health Medical Center(KHMC)
f) Madera Community Hospital (MCH)
g) Regional Medical Center(RMC)
h) Saint Agnes Medical Center(SAMC)
i) Sierra View District Hospital (SVDH)
j) Valley Children's Hospital (VCH)
2) Rural Areas - Due to prolonged travel times to the urban area, the appropriate
receiving hospital for a life-threatening medical situation would be a hospital with
a standby emergency service (holds a special services permit from the California
State Department of Health Services). Hospitals with stand-by emergency
services that are approved to receive ambulances are:
a) Adventist Health Reedley (AH-R)
b) Adventist Health Selma (AH-S)
c) Coalinga Regional Medical Center(CRMC)
Exhibit A
Page 58 of 217
5. Acute Cardiac Emergency
In the event of an acute current of injury, transport should be to a designated cardiac center,
which has 24/7 interventional heart catheterization capabilities. The following is a list of readings
from various cardiac monitors that would require transport to a designated cardiac center:
• ***ACUTE MI *** (Zoll Monitor E Series)
• ***STEMI*** (Zoll Monitor X Series))
• ***ACUTE MI SUSPECTED*** (Physio-Control Monitor LifePak 12)
• ***MEETS ST ELEVATION MI CRITERIA*** (Physio-Control Monitor LifePak 15)
The designated cardiac centers in the CCEMSA region are:
• Regional Medical Center
• Kaweah Health Medical Center
• Saint Agnes Medical Center
Transport shall be to the cardiac center that has the quickest transport time if transport time is
less than 60 minutes. If transport time is greater than 60 minutes, then transport to the closest
appropriate facility or consider helicopter rendezvous. Destination is determined by:
a. Interpretation of 12-lead ECG; or
b. Base Hospital consultation if required.
6. Patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an advanced airway or
OPA, this is not an unstable airway.
b. Any patient with CPR in progress.
C. Any critically ill or unstable patient when Base Hospital contact is not possible (i.e.,
Paramedic or EMT must make the ultimate destination decision).
7. Patients who go to a non-receiving hospital:
Patients may be transported to a non-receiving hospital only when the Base Hospital has
contacted the receiving doctor and received assurance of immediate acceptance of the patient.
Such assurance should then be documented on the Base Hospital run form.
8. Patients who go to a receiving hospital, which is not closest:
Unstable patients who request this hospital and, in the opinion of the Base Hospital Physician,
the extra travel time is not dangerous to the patient
Exhibit A
Page 59 of 217
C. Fresno County 5150 Holds—Considerations
1. Fresno County 5150 patient criteria for transport Crisis Stabilization Center(CSC)Youth Crisis
Stabilization Unit(YCSU):
a. If the patient meets the following criteria, he/she shall be transported directly to Crisis
Stabilization Center(CSC) if age 18 or greater; or the Youth Crisis Stabilization Unit
(YCSU) if under 18 years of age:
• No urgent medical complaint or evidence of acute medical/surgical/trauma problem
requiring urgent treatment prior to psychotic admission.
• No alteration in mental status due to dementia or delirium.
• Glasgow Coma Score 14 or 15.
• Complete vital signs within limits (HR, RR, BP and GCS).
• Not febrile to palpation/measurement.
• Under the influence of alcohol or drugs, patient can walk without assistance and is
able to follow verbal commands (does not apply to YCSU).
1) Adults:
a) Pulse: 50-120 bpm
b) Systolic Blood Pressure: 100-180 mm Hg
c) Diastolic Blood Pressure: less than 120 mm Hg
d) Respiratory Rate: 12-30
2) Pediatrics:
a) Vital signs appropriate for children (policy 530.32).
NOTE: Refer to the Criteria for Transporting a Fresno County 5150 Patient Directly to
Crisis Stabilization Center(CSC)or Youth Crisis Stabilization Unit(YCSU)
Screening Form attached to this policy.
Patients that Crisis Stabilization Center(CSC) and Youth Crisis Stabilization Unit (YCSU)
cannot accept:
• Patients with dementia or delirium.
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use,
catheters, wired devices, etc.).
• Patients in wheelchairs that cannot move independently.
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires
anything more that once daily dry gauze and tape dressing.
b. All other patients on a 5150 hold in Fresno County not meeting the above criteria will be
transported to Patient/Family Choice within Fresno County.
C. Patients placed on a 5150 hold are to be transported to facilities within the county where
the 5150 hold was initiated.
d. The 5150 destination policy does not apply to psychiatric patients who are voluntarily
requesting evaluation (not on a 5150 hold). If the patient is not on a 5150 hold, then
transport will be to a receiving facility of their choice, which includes CSC or YCSU
(Fresno County only) if patient meets criteria within this policy.
e. Kaiser Permanente patients on a 5150 hold are to be transported to that facility.
f. Veteran's Administration patients on a 5150 hold are to be transported to that facility.
Exhibit A
Page 60 of 217
D. Veteran's Administration
1. The Veteran's Administration emergency department will accept all patients with a Veterans
Administration (VA) Identification Card or active-duty Department of Defense (DOD) Card (Patient
Name Only, no dependent(s). Name of patient on card must be the patient requesting transport).
No prior approval or Base Hospital contact is necessary. If the patient requests transport to
Veterans Administration emergency department and does not have the identification noted
above, contact the VA Emergency Department directly for prior approval before the patient is
transported. The complete name and the full social security number will be required. Contact the
Veteran's Administration on Med 6 or 241-3600.
2. Patients that cannot be transported directly to the Veteran's Administration are:
• Cardiac arrest due to trauma
• Pediatric cardiac arrest
• Trauma Center Triage Criteria
• OB patient in active labor
• Gynecological complaints and known obvious pregnancy with vaginal bleeding
• ST-segment elevation myocardial infarction (STEMI)
NOTE: INTERFACILITY TRANSPORTS ARE NOT MANAGED THROUGH THIS PROCEDURE.
III. TRAUMA PATIENT DESTINATION
A. Trauma patients shall be transported to the appropriate closet facility in accordance with the following chart:
0 F-5,
ss Physiological Criteria
ystolic Blood Pressure:
o Adults: <90 mm Hg
o Pediatrics: <80 mm Hg with signs
and symptoms of shock(Refer to EMS
Policy 530.32 for estimated weight
formulas or use Broselow Tape)
• Respiratory Rate:
o Adults: <10 or>30 RMC or KHMC
o Children: <20 if under age 1 _P1 VCH(14 years or age or less)
•Glasgow Coma Score<13(or,in patients whose L (Consider air transport)
normal GCS is less than 15,or a decrease of two
or more of the patients GCS score)
• Penetrating injury to the head
• Paraplegia
• Quadriplegia
Assess Anatomy of Injury
• Penetrating injuries to neck or torso RMC or KHMC
• Flail chest VCH(14 years or age or less)
• Two or more proximal long-bone fractures (Consider air transport)
• Amputation proximal to wrist or ankle 00
TRAUMA DESTINATION CHART
Exhibit A
Page 61 of 217
FAssess Burns
STABLE TRAUMA PATIENTS WITH:
• Partial/Full thickness burns>10%TBSA
• Partial/Full thickness circumferential burns RMC
• Partial/Full thickness burns to face,hands,feet, IRWIN 1 11 (Consider air transport)
major joints,perineum,or genitals
• Electrical burns with voltage>120 volts
• Chemical burns>10%TBSA
Assess Mechanism of Injury
• Falls
o Adults: >20 ft.(one story=10 ft.) RMC or KHMC
o Children: >10 ft.or 3 times height of the VCH(14 years of age or less)
child (Consider air transport)
Assess Special Considerations
WITH A SIGNIFICANT COMPLAINT:
• Age greater than 55 years
• Anticoagulation or bleeding disorders Consider transport to
• Pregnancy greater than 20 weeks RMC or KHMC
• Auto vs.Pedestrian>20 mph VCH(14 years of age or less)
• Motorcycle crash>20 mph
Paramedic/Flight Nurse Judgment
Consider RMC or KHMC
WITH A SIGNIFICANT COMPLAINT VCH(14 years of age or less)
Base Hospital Consultation
SIGNIFICANT COMPLAINT
Transport According to Policy
Perseveration
Deteriorating mental status
Severe chest pain
Severe shortness of breath
Severe abdominal pain
Sustained,overwhelming"Feeling of Doom"
Exhibit A
Page 62 of 217
NOTE: If transport time is greater than 60 minutes for patients meeting trauma triage criteria, base
hospital contact shall be made to determine appropriate destination.
NOTE: If transport time is greater than 2 hours for patients meeting burn triage criteria, base hospital
contact shall be made to determine appropriate destination.
B. Triage Criteria
Triage criteria will determine if the patient will be transported to a trauma center or closest receiving
hospital.
C. Trauma Patient Destination —Considerations
1. If the patient is in cardiac arrest from penetrating trauma in the greater Fresno or Visalia
metropolitan area, the patient should be transported to Regional Medical Center, Kaweah Health
Medical Center or Valley Children's Hospital, bypassing a closer receiving facility. However, if the
transport time to Regional Medical Center, Kaweah Health Medical Center, or Valley Children's
Hospital is greater than ten (10) minutes, then transport should be to the closest receiving facility
within ten minutes transport time (Refer to EMS Policy#550).
2. Trauma patients, meeting trauma center criteria, who have a transport time greater than 60
minutes to the trauma center, will require base hospital contact for destination decision.
3. The following types of incidents should be consideration for transport to the designated Trauma
Center, based upon paramedic judgment:
a. Motorcycle Crash - Non-ambulatory with potential of significant injuries
b. Auto versus Pedestrian - Non-ambulatory with potential of significant injuries
NOTE:Paramedic judgment is based upon the paramedic's own knowledge and experience to determine
if the patient's condition would require transport to a designated Trauma Center due the mechanism of
injury and potential underlying injuries. The Paramedic may contact a Base Hospital for advice on
destination.
4. Transport of Trauma Patients by Helicopter
A trauma patient should not be transported by helicopter unless they meet trauma triage criteria
to be transported to a trauma center or the patient is inaccessible by ambulance (i.e., wilderness
transports). EXCEPTION: When the paramedic feels helicopter transport of the patient would be
beneficial to the outcome of the patient.
5. Burn Patients
The following patients should be transported directly to the Regional Burn Center(Regional
Medical Center) bypassing other hospitals if ETA to Regional Medical Center is within two hours.
a. Patients with 20(partial thickness) or 30(full thickness) burns that are more than 10%
total body surface area
b. Patients with 20(partial thickness) or 31, (full thickness) circumferential burns of any body
part
C. Patients with 20(partial thickness) or 30(full thickness) burns to face, hands, feet, major
joints, perineum, or genitals
d. Electrical burns with voltage greater than 120 volts
e. Patients with chemical burns greater than 10% total body surface area.
Exhibit A
Page 63 of 217
6. Carbon Monoxide Poisoning - Early call-ins to Regional Medical Center should be made for
patients that appear to have significant exposure to carbon monoxide poisoning (altered mental
status, vomiting, and headaches).
7. Trauma patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an ET Tube or OPA,
this is not an unstable airway.
b. Any patient with CPR in progress (refer to EMS Policy#550).
C. Any critically injured or unstable patient when Base Hospital contact is not possible
(i.e., Paramedic or EMT must make the ultimate destination decision).
IV. PATIENTS WHO REFUSE TRANSPORT TO THE APPROPRIATE HOSPITAL
A Base Hospital shall be contacted for the purpose of physician consultation on patients who meet one or more of
the triage criteria and refuse transport to the appropriate hospital. This will usually not be a problem with the
acutely ill patient. However, some patients with normal mental status may wish to be transported to a different
hospital than the one selected via the triage criteria. These situations should be treated as "Refusal of Medical
Care and/or Transportation" situation (refer to EMS Policy#546). The Base Hospital Physician, after radio
contact, may allow the patient to go to the destination of their choice, have a "Refusal of Medical Care and/or
Transportation " signed or insist on transport to the designated hospital.
V. SPECIAL CONSIDERATION FOR FRESNO HEART & SURGICAL HOSPITAL DESTINATION
While the Fresno Heart& Surgical Hospital is a hospital within Central California EMS Region, it does not have
an emergency department and is not an approved facility for patient transports within EMS Policy and
Procedures. Patients who are requesting transport to the Fresno Heart& Surgical Hospital from the prehospital
setting will require Base Hospital contact to confirm acceptance. Since the Fresno Heart & Surgical Hospital is
under the Community Medical Center organization, EMS personnel should contact Regional Medical Center
when requesting transport to the Fresno Heart & Surgical Hospital. If attempts to contact Regional Medical
Center are unsuccessful, EMS personnel should contact another Base Hospital. Interfacility transfers involving
the Fresno Heart& Surgical Hospital shall be in accordance with EMS Policy#553, "ALS Interfacility
Transports".
Exhibit A
Page 64 of 217
Central California EMS Agency
Criteria for Transporting a Fresno County 5150/Psychiatric Patient
Directly to CSC or YCSU Screening Form
Patient's Name: EMS#:
Patient has urgent medical complaint or evidence of acute medical/surgical problem.
[] True—transport Patient/Family Choice [] False
Patient has alteration in mental status due to dementia or delirium.
[] True—transport Patient/Family Choice [] False
Patient has a Glasgow Coma Score 13 or less.
[] True—transport Patient/Family Choice [] False
There are lacerations with a gap of greater than 2 mm or fat/muscle visible in the wound (excludes any
type of stab wound).
[] True—transport Patient/Family Choice [] False
There are lacerations or wounds inflicted by others.
[] True—transport Patient/Family Choice [] False
Complete vital signs are within limits:
Adults:
Pulse outside range of 50-120. [] True—transport Patient/Family Choice [] False
Systolic Blood Pressure outside range of 100-180. [] True—transport Patient/Family Choice [] False
Diastolic Blood Pressure greater than 120. [] True—transport Patient/Family Choice [] False
Respiratory Rate outside range of 12-30. [] True—transport Patient/Family Choice [] False
Pediatrics:
Vital signs inappropriate for children
(Policy 530.32) [] True—transport Patient/Family Choice [] False
Patient is febrile to palpation/measurement.
[] True—transport Patient/Family Choice [] False
Is patient under the influence of alcohol or drugs?
[] Yes No
If yes, to under the influence of alcohol or drugs, does patient require assistance to walk?
[] True—transport Patient/Family Choice [] False
If all of the above answers are False, patient may be transported to CSC/YCSU; otherwise, transport is
Patient/ Family Choice.
Patients that Crisis Stabilization Center(CSC) or Youth Crisis Stabilization Unit (YCSU) cannot accept:
• Patients with dementia or delirium
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use, catheters,
wired devices, etc.)
• Patients in wheelchairs that cannot move independently
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires anything more
than once daily dry gauze and tape dressing
Exhibit A
Page 65 of 217
YOUTH CRISIS STABILIZATION CENTER
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA, 93702 (Bldg 319)
SERVICES: Youth Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: July 1, 2022 — June 30, 2025, with two (2) twelve (12) month
renewal options
SCHEDULE/LOCATION OF SERVICES:
CONTRACTOR shall operate the Youth Crisis Stabilization Center (Youth CSC) twenty-
four (24) hours per day, seven (7) days per week. The Youth CSC shall be located at
the Kings Canyon Campus at 4411 E. Kings Canyon Road, Fresno, California 93702
(Building 319), a COUNTY-owned building, pursuant to a separate lease agreement
(and any related amendments) between COUNTY and Exodus Foundation, Inc., an
affiliate of CONTRACTOR. At some point during the contract term when construction is
complete, the Adult CSC will be relocated to the COUNTY's Heritage Campus at the
intersection of Shields Avenue and Millbrook Avenue.
TARGET POPULATION:
The target population will include children and youth, up to 18 years of age, from Fresno
County, who are exhibiting acute psychiatric symptoms and have either been placed on
a Welfare and Institutions Code (W&IC) 5150 designation or who request admittance to
the Youth CSC on a voluntary status.
CONTRACTOR will provide crisis stabilization services to children and youth with a
maximum capacity of sixteen (16) beds at any given time. CONTRACTOR may also be
in the process of assessing or evaluating additional youth, as necessary. At times
throughout the contract term, COUNTY DBH may request the increase of beds for
capacity needs (e.g., with increase in acuity and census due to the Covid-19 pandemic).
The maximum capacity will also potentially be modified due to the unknown capacity of
the new 24-7 facility at the Heritage Centre. The updated maximum capacity will be
made upon written agreement between COUNTY and CONTRACTOR.
Exhibit A
Page 66 of 217
CONTRACTOR will accept voluntary or involuntarily admitted individuals regardless of
source of payment; youth may include Medi-Cal beneficiaries, or privately insured and
indigent/uninsured who are referred by the COUNTY's Department of Behavioral Health
(DBH), a contracted provider with COUNTY DBH, a hospital emergency department,
law enforcement, or Emergency Medical Services (EMS). Youth may also be referred
by family or self-referred. The Youth CSC will also serve foster children and youth who
reside in Fresno County and remain under the original jurisdiction of another county.
These services shall be performed pursuant to W&IC, sections 5704.5(b), 5704.6(c),
and 5614(b)(3) and program principles and the array of treatment options required
under W&IC, sections 5600.2 to 5600.9 inclusive.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health
component of Medicaid. Federal statutes and regulations state that children under
age 21 who are enrolled in Medicaid are entitled to EPSDT benefits and that States
must cover a broad array of preventive and treatment services to include crisis
stabilization. The requirement is to maintain its funding for children's services at a
level equal to or more than the proportion expended for children's program services in
FY 83-84.
PROJECT DESCRIPTION:
CONTRACTOR shall be responsible to comply with the requirements of the Fresno
County Mental Health Plan (FCMHP) and must complete and submit supporting clinical
and any other such documentation as may be required by the COUNTY for every youth
served in the Youth CSC. The FCMHP will perform a utilization review of all admissions
to determine that the documentation demonstrates that medical necessity criteria as
defined by the California Department of Health Care Services (DHCS) was met for each
duration of the crisis stabilization services claimed for reimbursement.
CONTRACTOR shall be responsible to enter all Individual Service Information,
admission data and billing information into the COUNTY data system (AVATAR) and
will be responsible for any and all audit exceptions pertaining to the delivery of services.
CONTRACTOR'S RESPONSIBILITIES:
A. CONTRACTOR shall ensure that the Youth CSC provides the following services:
1 . Management and alleviation of a youth's acute psychiatric symptoms
through effective therapeutic interventions and supportive services to avoid
the need for a higher level of psychiatric care when clinically appropriate.
2. A recovery/strength based clinical program which has appropriate
professional staffing on a twenty-four (24) hour, seven (7) day a week
basis.
Exhibit A
Page 67 of 217
3. A safe, secure environment for youth that encourages wellness and
recovery.
4. A comprehensive multi-disciplinary evaluation and individual-centered
treatment plan.
5. Dietary services through the availability of nourishment or snacks in
accordance with Title 22, Division 5, Chapter 9, Article 3, Section 77077.
6. Admission procedures for youth, who are not on involuntary holds in
accordance with W&IC 5150 and also individuals placed on W&IC 5150
involuntary holds.
7. Crisis consultation services to rural service providers (e.g., emergency
departments, etc.) that may not have timely access to the centrally located
crisis stabilization facilities and may require consultation to support an
individual's care planning and/or mitigate unnecessary long transports of
youth to the Youth CSC from remote areas. Crisis consultation may occur
via teleconference, tele-behavioral health (i.e., utilization of video and
computer equipment), and/or other method presented by CONTRACTOR
and deemed acceptable by the COUNTY.
8. Treatment Planning — Under the clinical direction of the mental health
clinician, the multi-disciplinary treatment team formed by the Youth Crisis
Stabilization staff shall provide the following services:
a. Mental Status Examination
b. Medical Evaluation
c. Full Clinical Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Youth Centered Treatment Planning
g. Aftercare Planning and Wellness Recovery Action Plan (WRAP)
9. Staffing
a. The staffing pattern for the crisis stabilization program shall meet all
current State licensing and regulatory requirements including medical
staff standards, nursing staff standards, social work and rehabilitation
staff requirements pursuant to Title 9, Division 1, Chapter 11, Article
3, Section 1840.348 of the California Code of Regulations (CCR) for
Crisis Stabilization services. All staff requiring federal/state licensure
or certification will be required to be licensed or certified in the State
of California and be in good standing with the state licensing or
certification board. CONTRACTOR shall remain up-to-date with all
Exhibit A
Page 68 of 217
current regulatory changes and adhere to all new and/or modified
requirements.
b. All facility staff who provide direct care or perform coding/billing
functions must meet the requirements of the FCMHP Compliance
Program. This includes the screening for excluded persons and
entities by accessing or querying the applicable licensing board(s),
the National Practitioner Data Bank (NPDB), Office of Inspector
General's List of Excluded Individuals/Entities (LEIE), Excluded
Parties List System (EPLS) and Medi-Cal Suspended and Ineligible
List prior to hire and annually thereafter. In addition, all licensed,
registered, waivered staff must complete a FCMHP Provider
Application and be credentialed by the FCMHP's Credentialing
Committee. All of CONTRACTOR's staff who will have direct contact
with the youth, shall have Department of Justice (DOJ), Federal
Bureau of Investigation (FBI), and Sheriff fingerprinting (Livescan)
executed.
c. Peer and/or family support staff will be an active and key member of
the multi-disciplinary team to assist with treatment planning,
mentoring, support and advocate with youth/families during their time
at the Youth CSC facility and will assist with discharge planning and
facilitate the individual's transition to the appropriate lower level of
care.
d. At the time of execution of this Agreement, the staffing requirements
defined by the CCR, Title 9, Section 1840.348 for the Youth CSC are
as follows:
(a) A physician shall be on call at all times for the provision of those
Crisis Stabilization Services that may only be provided by a physician.
(b) There shall be a minimum of one Registered Nurse, Psychiatric
Technician, or Licensed Vocational Nurse on site at all times
beneficiaries are present.
(c) At a minimum there shall be a ratio of at least one (1) licensed
mental health or waivered/registered professional on site for each
four (4) beneficiaries or other individuals receiving Crisis Stabilization
at any given time.
(d) If the youth is evaluated as needing service activities that can only
be provided by a specific type of licensed professional, such persons
shall be available.
(e) Other persons may be utilized by the program, according to need.
Exhibit A
Page 69 of 217
(f) If Crisis Stabilization services are co-located with other specialty
mental health services, persons providing Crisis Stabilization must be
separate and distinct from persons providing other services.
(g) Persons included in required Crisis Stabilization ratios and
minimums may not be counted toward meeting ratios and minimums
for other services.
e. CONTRACTOR shall submit daily staffing reports that identify all
direct service and support staff by first and last name, applicable
licensure/certifications, full time hours worked, and the
licensed/waivered/registered mental health professionals to youth
ratio.
10. Medical Records
a. CONTRACTOR shall maintain records in accordance with Exhibit E,
"Documentation Standards for Individual Medical Records." During
site visits, COUNTY shall be allowed to review records of services
provided, including the goals and objectives of the treatment plan,
and how the therapy provided is achieving the goals and objectives.
b. CONTRACTOR will be responsible for "release of information"
requests for the Youth CSC facility and shall adhere to applicable
federal and state regulations.
c. CONTRACTOR can develop and implement a medical records
system which meets all State and Federal requirement and clearly
documents medical necessity for both treatment and billing services.
Medical records shall be kept in such a manner as to comply with the
Fresno County Quality Improvement standards and Federal and State
quality standards. COUNTY has an electronic medical record system.
CONTRACTOR may elect to utilize and participate with the
COUNTY's electronic health record system if they do not have their
own system in place. It is anticipated that CONTRACTOR shall be
utilizing an electronic medical records system by the end of this
contract term.
11. Clinical Staff— CONTRACTOR's clinical staff shall be composed of all
licensed mental health or waivered/registered professionals as included in
CCR, Title 9, Division 1, Chapter 11, Article 3, Section 1840.348 (Crisis
Stabilization Staffing Requirements).
12. Medical Staff— The medical staff shall include a physician and a registered
nurse, psychiatric technician or licensed vocational nurse and any other
type of licensed professional needed to address youth needs pursuant to
CCR, Title 9, Division 1, Chapter 11, Article 3, Section 1840.348 (Crisis
Stabilization Staffing Requirements).
Exhibit A
Page 70 of 217
13. Pharmaceutical Services — CONTRACTOR shall provide for medication
services on an as needed basis and the staffing must reflect this availability
pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.338 (Crisis Stabilization Contact and Site Requirements) and all other
applicable federal/state regulations. The administration of a psychotropic
medication(s) to children and youth in the Foster Care System will adhere
to federal/state regulations, the requirements of pharmaceutical vendors
and the coordination with the Department of Social Services-Child Welfare
as it relates to the completion of forms, provision of information, etc.
14. Assessment of Physical Health and Medical Backup Services — Pursuant to
CCR, Title 9, Division 1, Chapter 11, Article 3, Section 1840.338 (Crisis
Stabilization Contact and Site Requirements), CONTRACTOR shall provide
admission history and physical examination, and maintain a written
agreement for medical services with one or more general acute care
hospitals.
15. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify the COUNTY of any admission of a
COUNTY youth within twenty-four (24) hours or the next business
day in a manner approved by the COUNTY. The notification method
shall be approved by the COUNTY.
b. CONTRACTOR shall be responsible to ensure that documentation in
the individual's medical record meets medical necessity criteria for
the hours of service submitted to COUNTY for reimbursement by
federal intermediaries, third-party payers and other responsible
parties.
c. CONTRACTOR shall enter all mental health data and billing
information into the COUNTY's electronic information system and will
be responsible for any and all audit exceptions pertaining to the
delivery of services.
d. CONTRACTOR shall submit a complete and accurate DHCS
Short/Doyle Medi-Cal Cost Report for each fiscal year ending June
30t" affected by the proposed agreement within 120 days following
the end of each fiscal year.
e. CONTRACTOR shall ensure that cost reports are prepared in
accordance with General Accepted Accounting Principles (GAAP)
and the standards set forth by the DHCS and the COUNTY.
16. Patients' Rights and Certification Review Hearings:
a. CONTRACTOR shall adopt and post in a conspicuous place a written
policy on individual's rights in accordance with section 70707 of Title
22 of the CCR and section 5325.1 of the W&IC and Title 42 Code of
Federal Regulations section 438.100.
Exhibit A
Page 71 of 217
b. CONTRACTOR shall allow access to COUNTY youth by the Patients'
Rights Advocate designated by the COUNTY.
17. Family Advocate - CONTRACTOR shall promote and allow individual
access to the Family Advocacy Services representative (Family Advocate)
who is contracted by the COUNTY to advocate and assist individuals,
families and support systems who are seeking or receiving mental health
services.
18. Grievances and Incident Reports
CONTRACTOR shall have all grievance forms readily available at the
Youth CSC facility.
CONTRACTOR shall log all grievances and the disposition of all grievances
received from a youth or their family in accordance with FCMHP policies
and procedures as indicated herein. CONTRACTOR shall provide a
summary of the grievance log entries concerning COUNTY-sponsored
individuals to the DBH Director, or designee, at monthly intervals, by the
fifteenth (15th) day of the following month, in a format that is mutually
agreed upon. CONTRACTOR shall post signs, provided by the COUNTY,
informing youth of their right to file a grievance and appeal.
CONTRACTOR shall notify COUNTY of all incidents or unusual
occurrences reportable to state licensing bodies that affect COUNTY
individuals within twenty-four (24) hours. CONTRACTOR shall use the
Incident Reporting system as indicated herein within Exhibit I for such
reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-
sponsored youth, CONTRACTOR shall provide County with the complaint
and CONTRACTOR's disposition of, or corrective action taken to resolve
the complaint or incident.
Within fifteen (15) days after CONTRACTOR submits a corrective action
plan to a California State licensing and/or accrediting body concerning any
sentinel event, as the term is defined by the licensing or accrediting agency,
and within fifteen (15) days after CONTRACTOR receives a corrective
action order from a California State licensing and/or accrediting body to
address a sentinel event, CONTRACTOR shall provide a summary of such
plans and orders to COUNTY.
19. Provide a safe and secure environment to provide for clinical and medical
assessment, diagnostic formulation, crisis intervention, medication
management, and clinical treatment for individuals with acute psychiatric
symptoms. This includes the manner in which seclusion and restraint will
be administered when necessary for the safety of the youth, other youth in
the program, and staff.
Exhibit A
Page 72 of 217
20. Provide the appropriate type and level of staffing to provide for a clinically
effective program design that adheres to State staffing requirements.
21. Provide staff training in the areas of non-violent crisis intervention,
evidence-based practice, best practice, or promising practices to ensure
staff are competent and proficient in the therapeutic interventions and
practices in serving youth accessing the Youth CSC.
22. CONTRACTOR shall utilize cost containment strategies for the provision of
stock and prescription medications to individuals(i.e., by contracting with a
pharmaceutical benefits management company) and provide the COUNTY
with the type of formulary utilized by the program as well as information
regarding co-pays and/or generic substitutions.
23. Provide an intensive treatment program which has individualized treatment
plans.
24. Stabilize the youth's acute psychiatric symptoms in the most expedient
manner possible while adhering to appropriate clinical care standards. This
may include initiating a Treatment Authorization Request (TAR) to the
pharmacy and providing justification when psychotropic medications are
needed on an emergency basis.
25. Effectively partner with other programs in the COUNTY and community
system (i.e., law enforcement, local emergency departments, etc.) in
accepting COUNTY youth for admission for crisis stabilization services.
26. Effectively partner with rural services providers (i.e., emergency
departments, etc.) to provide crisis stabilization services via teleconference,
tele-behavioral health (i.e., utilization of video and computer equipment),
and/or other method deemed acceptable by COUNTY.
27. Work collaboratively with the COUNTY and community resources in
discharge planning to ensure appropriate referral and direct linkage to
ongoing outpatient specialty mental health treatment services, substance
use disorder treatment services, etc. are provided. Discharge planning
would also include working collaboratively with out-of-county Mental Health
Plans to ensure youth in foster care who reside within Fresno County are
linked to appropriate ongoing specialty mental health services, substance
use disorder treatment services, etc. as appropriate.
28. Identify youth with frequent admissions during the fiscal year and develop
strategies with other COUNTY and community agencies to reduce
readmissions and improve an individual's overall well-being through
coordination of care.
Exhibit A
Page 73 of 217
29. Effectively interact with community agencies, other mental health programs
and providers, natural support systems, and families to assist clients to be
discharged to the appropriate level of care.
30. Integrate mental health and substance use disorder services. The
CONTRACTOR shall perform the following:
a. Develop a formal written Continuous Quality Improvement CQI action
plan to identify measurable objectives toward the achievement of co-
occurring disorders (COD) treatment capability that will be addressed by
the program during the contract period. These objectives should be
achievable and realistic for the program, based on a self-assessment
and the program priorities, but need to include attention to making
progress on the following issues, at minimum:
1 . Welcoming policies, practices, and procedures related to the
engagement of individuals with co-occurring issues and disorders;
2. Removal or reduction of access barriers to admission based on
co-occurring diagnosis or medication;
3. Improvement in routine integrated screening, and identification in
the data system of how many individuals served have co-occurring
issues;
4. Developing the goal of basic co-occurring competency for all
treatment and support staff, regardless of licensure or certification;
and
5. Documentation of coordination of care with collaborative mental
health and/or substance use disorder providers for each youth.
B. Regarding cultural and linguistic competence requirements, CONTRACTOR
shall:
1 . Ensure compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C.
Section 2000d, and 45 C.F.R. Part 80) and Executive Order 12250 of 1979
which prohibits recipients of federal financial assistance from discriminating
against persons based on race, color, national origin, sex, disability or
religion. This is interpreted to mean that a limited English proficient (LEP)
individual is entitled to equal access and participation in federally funded
programs through the provision of comprehensive and quality bilingual
services.
2. Create and maintain policies and procedures for ensuring access and
appropriate use of trained interpreters and material translation services for
all LEP youth, including, but not limited to, assessing the cultural and
linguistic needs of its youth, training of staff on the policies and procedures,
and monitoring its language assistance program. CONTRACTOR's
Exhibit A
Page 74 of 217
procedures must include ensuring compliance of any subcontracted
providers with these requirements.
3. Ensure that minors shall not be used as interpreters.
4. Conduct and submit to COUNTY an annual cultural and linguistic needs
assessment to promote the provision and utilization of appropriate services
for its diverse population. The needs assessment report shall include
findings and a plan outlining the proposed services to be improved or
implemented as a result of the assessment findings, with special attention
to addressing cultural and linguistic barriers and reducing racial, ethnic,
language, abilities, gender, and age disparities.
5. Develop internal systems to meet the cultural and linguistic needs of the
CONTRACTOR's census including the incorporation of cultural competency
in the CONTRACTOR's mission; establishing and maintaining a process to
evaluate and determine the need for special - administrative, clinical,
welcoming, billing, etc. - initiatives related to cultural competency.
6. Develop recruitment and retention initiatives to establish contracted
program staffing that is reflective and responsive to the needs of the
program and target population.
7. Establish designated staff person to coordinate and facilitate the integration
of cultural competency guidelines and attend COUNTY's DBH Cultural
Diversity Committee scheduled meetings. The designated person will
provide an array of communication tools to distribute information to staff
relating to cultural competency issues.
8. Keep abreast of evidence-based and best practices in cultural competency
in mental health care and treatment to ensure that the CONTRACTOR
maintains current information and an external perspective in its policies.
CONTRACTOR shall evaluate the effectiveness of strategies and programs
in improving the health status of cultural-defined populations.
9. Ensure that an assessment of a youth's sexual orientation is included in the
bio-psychosocial intake process. CONTRACTOR's staff shall assume that
the population served may not be in heterosexual relationships. Sensitivity
to gender and sexual orientation must be covered in annual training.
10. Utilize existing community supports, referrals to transgender support
groups, etc., when appropriate.
11. Attend annual Cultural Competence, Compliance, Health Insurance
Portability and Accountability Act (HIPAA), Billing, and Documentation
training provided by COUNTY's DBH.
Exhibit A
Page 75 of 217
12. Report its efforts to evaluation cultural and linguistic activities as part of the
CONTRACTOR's ongoing quality improvement efforts in the monthly
activities report. Reported information may include an individual's
complaints and grievances, any resulting actions regarding complaints and
grievances, results from persons served satisfaction surveys, and utilization
and other clinical data that may reveal health disparities as a result of
cultural and linguistic barriers.
C. Regarding direct admissions to the YOUTH CSC from COUNTY's DBH
programs or its contracted providers, CONTRACTOR agrees to the following:
1 . To allow direct admits from COUNTY's DBH programs or its contracted
providers when Youth CSC has the capacity to accept youth for services.
2. Said direct admits shall not require medical clearance, if youth would
otherwise meet the Central California Emergency Medical Services Agency
5150 Destination Policy requirements as mentioned herein below in
Subsection G. However, in the event a referred youth is known to possess
a contagious medical condition, said youth shall be medically cleared by a
local hospital prior to admission to the Youth CSC operated by
CONTRACTOR.
D. Regarding the provision of court testimony related to Youth CSC persons
served, CONTRACTOR agrees to the following:
CONTRACTOR's staff shall provide court testimony relevant to Youth CSC
persons served, when required.
E. Regarding placements of Youth in a Psychiatric Health Facility or other
inpatient level of care:
CONTRACTOR's staff shall locate and coordinate transfer for any youth
being treated at the Youth CSC who is in need of further services and
placement into a psychiatric health facility (PHF) or other appropriate acute
psychiatric inpatient facility. This includes working collaboratively with the
staff of the Youth PHF Subcontracted Provider to coordinate the transfer of
youth ages 12 to 17 to their Youth Psychiatric Health Facility.
CONTRACTOR acknowledges that transfer of youth may occur at all hours
of the day and agrees to attend promptly to the needs of the youth and will
conduct the transfer as soon as feasibly possible.
F. Regarding the placement of a youth at another designated facility:
1 . CONTRACTOR shall notify COUNTY DBH when a youth will remain at the
CSC for a period in excess of 24 hours, while awaiting placement and/or
Exhibit A
Page 76 of 217
transportation. COUNTY's Patients' Rights Advocate will be included in this
notification
2. CONTRACTOR shall provide the following services to youth who remain at
the CSC for a period in excess of 24 hours and who are awaiting placement
and/or transportation:
a. Three meal periods and three snack times per 24 hours
b. Daily encouragement and support with activities of daily living i.e.
showering, washing of clothes, teeth brushing, hair combing etc.
c. Daily psychiatric evaluation by both the provider and licensed nursing
staff to evaluate/determine the youth's most appropriate level of care
d. Daily medication evaluation, administration and education
e. Daily group activities (e.g., 12-Step Meetings, WRAP, Goals Group, etc.)
f. Daily one-on-one peer support provided by designated Peer Advocate
g. Daily activities such as meditation, art, entertainment and outdoor
activities provided in the outside courtyard
h. Daily education in relation to mental health diagnosis, treatments, and
community resources
G. Regarding the Central California Emergency Medical Services Agency
(CCEMSA) 5150 Destination Policy, CONTRACTOR agrees to the following:
CONTRACTOR agrees to follow the then-current Central California
Emergency Medical Services Agency 5150 Destination Policy #547 as
identified in Attachment A, attached hereto and incorporated herein. Said
policy may be updated periodically throughout the term of this Agreement;
CONTRACTOR must adhere to the most recent policies designated by the
CCEMSA 5150 Destination Policy.
H. CONTRACTOR shall participate in the following meetings:
1 . CONTRACTOR shall participate in periodic workgroup meetings
scheduled by staff from COUNTY's DBH Mental Health Contracted
Services Division. The meetings shall be held monthly, or as needed, to
discuss contract requirements, data reporting, outcomes measurement,
training, policies and procedures, and overall program operations.
2. CONTRACTOR's administrative level agency representative, who is duly
authorized to act on behalf of CONTRACTOR, shall attend regularly
scheduled monthly Behavioral Health Board meetings and its Children's
Services Committee.
3. CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider
Meetings, as scheduled by staff from COUNTY's Mental Health Contracted
Exhibit A
Page 77 of 217
Services Division, when deemed necessary by the DBH Director, or
designee.
4. CONTRACTOR may also be asked to make presentations in the
community about the program and services that are available
I. Regarding the development of policies and protocols:
CONTRACTOR and COUNTY's DBH shall collaborate on the development
of specific policies and protocols related to the daily operation of the Youth
CSC. Such policies will include, but not be limited to, the following:
placement of youth in psychiatric health facilities or other inpatient
programs either locally or outside the county, facility limitations, and
special populations. Such policies and protocols shall be mutually agreed
upon between CONTRACTOR and COUNTY's DBH Director, or designee.
Any changes to such policies and protocols shall be mutually agreed upon
between CONTRACTOR and COUNTY's DBH Director, or designee.
PROGRAM OUTCOMES
The Department of Behavioral Health is dedicated to supporting the wellness of
individuals, families and communities in Fresno County who are affected by, or at the
risk of, mental illness and/or substance use disorders through cultivation of strengths
toward promoting recovery in the least restrictive environment.
Five (5) Work Plans will be utilized to support DBH's mission statement. The work
plans were developed as a concept of a Transformation Plan that would encompass
system planning, implementation and oversight to be reflective of a comprehensive
system of care. These work plans are provided below and represent program goals
to be achieved by CONTRACTOR in addition to CONTRACTOR-developed
outcomes. DBH may adjust the outcome measurements needed under this program
periodically, so as to best measure the success of the youth and the program as
determined by the County.
CONTRACTOR will utilize a computerized tracking system with which outcome
measures and other relevant consumer data, such as demographics, will be
maintained.
1 . Behavioral Health Integrated Access — timeliness between referral to
admission, admission to treatment, and treatment to discharge; penetration
rate; effectiveness of discharge planning as demonstrated by referral and
linkage to other DBH programs, community providers, and other community
resources; and services that provide screening and access to ensure youth are
linked to the services they need, including mental health substance use
disorders and physical health services.
Exhibit A
Page 78 of 217
2. Wellness, Recovery, and Resiliency Supports — collaborative approach to
treatment strategies to reduce readmission of consumers with frequent
admissions to the facility; effectiveness of services as demonstrated by the
number of consumers who are able to be discharged to the community and
avoid inpatient hospitalization; measurement of recidivism rates, including
measuring percentage of recidivism within thirty (30) days. State the Evidence
Based Practices (EBP) that shall be used.
3. Cultural/Community Defined Practices — services or philosophical practices
which support the unique cultural-specific needs of individuals receiving care.
Focus on behavioral health practices which reflect the unique needs of various
cultures and communities who reside within Fresno County.
4. Behavioral Health Clinical Care — services where direct therapeutic treatment
is provided. Include the framework of "Levels of Care" where the youth's
needs, as identified through assessment/screening, are matched with a
complexity and intensity of services meets those needs.
5. Infrastructure Supports — includes all personnel, equipment, programs, and
facilities which exist to support the delivery of care to the youth served.
Includes safety, quality improvement and regulatory compliance functions,
along with outcome assessment/program evaluation, training, and technology.
6. Denial rate for Crisis Stabilization billing will be decreased by five percent (5%)
within the first six (6) months, based on previous program denial rates. Rates
will be determined by the utilization review performed by FCMHP.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Perform a utilization review, annually at a minimum, (through its FCMHP) of ten
percent (10%) of all admissions to determine that the documentation
demonstrates that medical necessity criteria as defined by the DHCS were met
throughout the duration of the crisis stabilization episode. The FCMHP will
maintain discretion regarding possible subsequent utilization review beyond ten
percent (10%), as necessary.
2. Provide oversight of the CONTRACTOR's Youth CSC program. In addition to
contract monitoring of program(s), oversight includes, but is not limited to,
coordination with the DHCS in regard to program administration and outcomes.
3. Assist the CONTRACTOR in making linkages to the appropriate level of care
within the behavioral health system of care to ensure continuity of care. This will
be accomplished through regularly scheduled meetings as well as formal and
informal consultation.
Exhibit A
Page 79 of 217
4. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the CONTRACTOR staff and will be available to the
CONTRACTOR for ongoing consultation.
5. Receive and analyze statistical outcome data from CONTRACTOR throughout the
term of contract on a monthly basis. DBH will notify the CONTRACTOR when
additional participation is required. The performance outcome measurement
process will not be limited to survey instruments but will also include, as
appropriate, youth and staff interviews, chart reviews, and other methods of
obtaining required information.
6. Recognize that cultural competence is a goal toward which professionals,
agencies, and systems should strive. Becoming culturally competent is a
developmental process and incorporates at all levels the importance of culture, the
assessment of cross-cultural relations, vigilance towards the dynamics that result
from cultural differences, the expansion of cultural knowledge, and the adaptation
of services to meet culturally-unique needs. Offering those services in a manner
that fails to achieve its intended result due to cultural and linguistic barriers is not
cost effective. To assist the CONTRACTOR's efforts towards cultural and
linguistic competency, DBH shall provide the following at no cost to
CONTRACTOR:
A. Mandatory cultural competency training including sexual orientation and
sensitivity training for CONTRACTOR personnel, at minimum once per year.
COUNTY will provide mandatory training regarding the special needs of this
diverse population and will be included in the cultural competence training(s).
Sexual orientation and sensitivity to gender differences is a basic cultural
competence principle and shall be included in the cultural competency
training. Literature suggests that the mental health needs of lesbian, gay,
bisexual, transgender, and queer (LGBTQ+) individuals may be at increased
risk for mental disorders and mental health problems due to exposure to
societal stressors such as stigmatization, prejudice and anti-gay violence.
Social support may be critical for this population. Access to care may be
limited due to concerns about providers' sensitivity to differences in sexual
orientation.
B. Assistance to CONTRACTOR in locating appropriate providers who can
translate behavioral health and substance abuse services information into
COUNTY's threshold languages (English, Spanish, and Hmong). Translation
services and costs associated will be the responsibility of the CONTRACTOR.
CENTRAL CALIFORNIA EMERGENCY Exhibit A
Page 80 of 217
MEDICAL SERVICES
A Division of the Fresno County Department of Public Health
Manual Policy
Emergency Medical Services Number 547
Administrative Policies and Procedures
Page 1 of 9
Subject Patient Destination
References Title 13, Section 1106 of the California Code of Regulations Effective:
Title 22, Division 9, Chapter 7 of the California Code of Regulations 04/18/83
I. POLICY
Patients of the Prehospital EMS System shall be transported to an appropriately staffed and equipped hospital.
II. MEDICAL PATIENT DESTINATION
A. Medical Patients shall be transported to the appropriate destination in accordance with the following chart:
Fresno County Kings County Madera County Tulare County
Medical—Adult
Non-emergent Patient's Choice Patient's Choice Patient's Choice Patient's Choice
Life-threatening Closest Appropriate Closest Appropriate Closest Appropriate Closest Appropriate
Regional Medical Kaweah Health Medical Regional Medical Kaweah Health Medical
Acute current of injury Center or St.Agnes Center or Regional Center or St.Agnes Center or Regional
(acute MI) Medical Center Medical Center Medical Center Medical Center
(Quickest travel time) (Quickest travel time) (Quickest travel time) (Quickest travel time)
Medical—Pediatric(14 years or younger)
Stable Patient/Family Choice Patient/Family Choice Patient/Family Choice Patient/Family Choice
Kaweah Health Medical
RMC or VCH*** RMC or VCH * * RMC or VCH *** Center or
Unstable (Quickest travel time) (Quickest travel time) (Quickest travel time) Sierra View District
Hospital
(Quickest travel time)
5150 patients
CSC or Patient's Choice
5150-Adult within Fresno County Patient's Choice within Patient's Choice within Patient's Choice within
(See criteria on page 4) Kings County Madera County Tulare County
YCSU or Patient/Family
5150—Children (<18 Choice within Fresno Patient/Family Choice Patient/Family Choice Patient/Family Choice
yrs) County within Kings County within Madera County within Tulare County
(See criteria on page 4)
Kaiser Kaiser N/A N/A N/A
Veteran's Administration Veteran's Administration N/A N/A N/A
*** If transport time is greater than 60 minutes, base hospital contact shall be made to determine appropriate destination.
Approved By Daniel J. Lynch Revision
EMS Division Manager (Signature on File at EMS Agency 3/14/2022
Jim Andrews, M.D.
EMS Medical Director (Signature on File at EMS Agency)
Exhibit A
Page 81 of 217
B. Medical Patient Destination —Considerations
1. In a non-emergent situation (as determined by the EMT or Paramedic at the scene and/or the
Base Hospital Physician/MICN giving medical direction), the patient will be taken to the receiving
hospital of his/her choice. If the patient is unable to determine this, the hospital designated by the
private physician and/or patient's family member will be utilized. Paramedics and EMTs should
determine where the patient normally receives their medical care and encourage the patient to
return to that hospital for medical care as long as the patient's medical condition allows for such
transport.
2. The Paramedic/EMT/MICN/BHP should only provide the patient with alternatives for destination
of patient choice. It is inappropriate for the Paramedic/EMT/MICN/BHP to endorse specific
facilities or provide personal opinion on the quality of local facilities.
3. Health Plans - If the patient is a member of a health plan with a preferred hospital, an attempt
should be made to transport the patient to a participating facility.
4. Closest Appropriate Hospital
a. The closest appropriate hospital is defined as the closest emergency department
"equipped, staffed, and prepared to administer care appropriate to the needs of the
patient" (California Code of Regulations, Title 13, Section 1106 (b) 2).
b. Closest is defined as the shortest travel time not necessarily the closest by distance.
C. The Base Hospital Physician will have the ultimate authority for patient destination.
d. The closest appropriate hospital does not mean that critically ill patients always go to the
closest"receiving" hospital. They go to the closest"appropriate" hospital. The following
guidelines will help to define "appropriate":
1) Due to short transport times, the appropriate receiving facility for a life-
threatening medical situation would be a hospital with a basic emergency service
(holds a special services permit from the California State Department of Health
Services). Hospitals with basic emergency services are:
a) Adventist Health Hanford (AH-H)
b) Adventist Health Tulare (AH-T)
c) Clovis Community Medical Center(CCMC)
d) Kaiser Permanente Hospital (KPH)
e) Kaweah Health Medical Center(KHMC)
f) Madera Community Hospital (MCH)
g) Regional Medical Center(RMC)
h) Saint Agnes Medical Center(SAMC)
i) Sierra View District Hospital (SVDH)
j) Valley Children's Hospital (VCH)
2) Rural Areas - Due to prolonged travel times to the urban area, the appropriate
receiving hospital for a life-threatening medical situation would be a hospital with
a standby emergency service (holds a special services permit from the California
State Department of Health Services). Hospitals with stand-by emergency
services that are approved to receive ambulances are:
a) Adventist Health Reedley (AH-R)
b) Adventist Health Selma (AH-S)
c) Coalinga Regional Medical Center(CRMC)
Exhibit A
Page 82 of 217
5. Acute Cardiac Emergency
In the event of an acute current of injury, transport should be to a designated cardiac center,
which has 24/7 interventional heart catheterization capabilities. The following is a list of readings
from various cardiac monitors that would require transport to a designated cardiac center:
• ***ACUTE MI *** (Zoll Monitor E Series)
• ***STEMI*** (Zoll Monitor X Series))
• ***ACUTE MI SUSPECTED*** (Physio-Control Monitor LifePak 12)
• ***MEETS ST ELEVATION MI CRITERIA*** (Physio-Control Monitor LifePak 15)
The designated cardiac centers in the CCEMSA region are:
• Regional Medical Center
• Kaweah Health Medical Center
• Saint Agnes Medical Center
Transport shall be to the cardiac center that has the quickest transport time if transport time is
less than 60 minutes. If transport time is greater than 60 minutes, then transport to the closest
appropriate facility or consider helicopter rendezvous. Destination is determined by:
a. Interpretation of 12-lead ECG; or
b. Base Hospital consultation if required.
6. Patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an advanced airway or
OPA, this is not an unstable airway.
b. Any patient with CPR in progress.
C. Any critically ill or unstable patient when Base Hospital contact is not possible (i.e.,
Paramedic or EMT must make the ultimate destination decision).
7. Patients who go to a non-receiving hospital:
Patients may be transported to a non-receiving hospital only when the Base Hospital has
contacted the receiving doctor and received assurance of immediate acceptance of the patient.
Such assurance should then be documented on the Base Hospital run form.
8. Patients who go to a receiving hospital, which is not closest:
Unstable patients who request this hospital and, in the opinion of the Base Hospital Physician,
the extra travel time is not dangerous to the patient
Exhibit A
Page 83 of 217
C. Fresno County 5150 Holds—Considerations
1. Fresno County 5150 patient criteria for transport Crisis Stabilization Center(CSC)Youth Crisis
Stabilization Unit(YCSU):
a. If the patient meets the following criteria, he/she shall be transported directly to Crisis
Stabilization Center(CSC) if age 18 or greater; or the Youth Crisis Stabilization Unit
(YCSU) if under 18 years of age:
• No urgent medical complaint or evidence of acute medical/surgical/trauma problem
requiring urgent treatment prior to psychotic admission.
• No alteration in mental status due to dementia or delirium.
• Glasgow Coma Score 14 or 15.
• Complete vital signs within limits (HR, RR, BP and GCS).
• Not febrile to palpation/measurement.
• Under the influence of alcohol or drugs, patient can walk without assistance and is
able to follow verbal commands (does not apply to YCSU).
1) Adults:
a) Pulse: 50-120 bpm
b) Systolic Blood Pressure: 100-180 mm Hg
c) Diastolic Blood Pressure: less than 120 mm Hg
d) Respiratory Rate: 12-30
2) Pediatrics:
a) Vital signs appropriate for children (policy 530.32).
NOTE: Refer to the Criteria for Transporting a Fresno County 5150 Patient Directly to
Crisis Stabilization Center(CSC)or Youth Crisis Stabilization Unit(YCSU)
Screening Form attached to this policy.
Patients that Crisis Stabilization Center(CSC) and Youth Crisis Stabilization Unit (YCSU)
cannot accept:
• Patients with dementia or delirium.
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use,
catheters, wired devices, etc.).
• Patients in wheelchairs that cannot move independently.
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires
anything more that once daily dry gauze and tape dressing.
b. All other patients on a 5150 hold in Fresno County not meeting the above criteria will be
transported to Patient/Family Choice within Fresno County.
C. Patients placed on a 5150 hold are to be transported to facilities within the county where
the 5150 hold was initiated.
d. The 5150 destination policy does not apply to psychiatric patients who are voluntarily
requesting evaluation (not on a 5150 hold). If the patient is not on a 5150 hold, then
transport will be to a receiving facility of their choice, which includes CSC or YCSU
(Fresno County only) if patient meets criteria within this policy.
e. Kaiser Permanente patients on a 5150 hold are to be transported to that facility.
f. Veteran's Administration patients on a 5150 hold are to be transported to that facility.
Exhibit A
Page 84 of 217
D. Veteran's Administration
1. The Veteran's Administration emergency department will accept all patients with a Veterans
Administration (VA) Identification Card or active-duty Department of Defense (DOD) Card (Patient
Name Only, no dependent(s). Name of patient on card must be the patient requesting transport).
No prior approval or Base Hospital contact is necessary. If the patient requests transport to
Veterans Administration emergency department and does not have the identification noted
above, contact the VA Emergency Department directly for prior approval before the patient is
transported. The complete name and the full social security number will be required. Contact the
Veteran's Administration on Med 6 or 241-3600.
2. Patients that cannot be transported directly to the Veteran's Administration are:
• Cardiac arrest due to trauma
• Pediatric cardiac arrest
• Trauma Center Triage Criteria
• OB patient in active labor
• Gynecological complaints and known obvious pregnancy with vaginal bleeding
• ST-segment elevation myocardial infarction (STEMI)
NOTE: INTERFACILITY TRANSPORTS ARE NOT MANAGED THROUGH THIS PROCEDURE.
III. TRAUMA PATIENT DESTINATION
A. Trauma patients shall be transported to the appropriate closet facility in accordance with the following chart:
0 F-5,
ss Physiological Criteria
ystolic Blood Pressure:
o Adults: <90 mm Hg
o Pediatrics: <80 mm Hg with signs
and symptoms of shock(Refer to EMS
Policy 530.32 for estimated weight
formulas or use Broselow Tape)
• Respiratory Rate:
o Adults: <10 or>30 RMC or KHMC
o Children: <20 if under age 1 _P1 VCH(14 years or age or less)
•Glasgow Coma Score<13(or,in patients whose L (Consider air transport)
normal GCS is less than 15,or a decrease of two
or more of the patients GCS score)
• Penetrating injury to the head
• Paraplegia
• Quadriplegia
Assess Anatomy of Injury
• Penetrating injuries to neck or torso RMC or KHMC
• Flail chest VCH(14 years or age or less)
• Two or more proximal long-bone fractures (Consider air transport)
• Amputation proximal to wrist or ankle 00
TRAUMA DESTINATION CHART
Exhibit A
Page 85 of 217
FAssess Burns
STABLE TRAUMA PATIENTS WITH:
• Partial/Full thickness burns>10%TBSA
• Partial/Full thickness circumferential burns RMC
• Partial/Full thickness burns to face,hands,feet, IRWIN 1 11 (Consider air transport)
major joints,perineum,or genitals
• Electrical burns with voltage>120 volts
• Chemical burns>10%TBSA
Assess Mechanism of Injury
• Falls
o Adults: >20 ft.(one story=10 ft.) RMC or KHMC
o Children: >10 ft.or 3 times height of the VCH(14 years of age or less)
child (Consider air transport)
Assess Special Considerations
WITH A SIGNIFICANT COMPLAINT:
• Age greater than 55 years
• Anticoagulation or bleeding disorders Consider transport to
• Pregnancy greater than 20 weeks RMC or KHMC
• Auto vs.Pedestrian>20 mph VCH(14 years of age or less)
• Motorcycle crash>20 mph
Paramedic/Flight Nurse Judgment
Consider RMC or KHMC
WITH A SIGNIFICANT COMPLAINT VCH(14 years of age or less)
Base Hospital Consultation
SIGNIFICANT COMPLAINT
Transport According to Policy
Perseveration
Deteriorating mental status
Severe chest pain
Severe shortness of breath
Severe abdominal pain
Sustained,overwhelming"Feeling of Doom"
Exhibit A
Page 86 of 217
NOTE: If transport time is greater than 60 minutes for patients meeting trauma triage criteria, base
hospital contact shall be made to determine appropriate destination.
NOTE: If transport time is greater than 2 hours for patients meeting burn triage criteria, base hospital
contact shall be made to determine appropriate destination.
B. Triage Criteria
Triage criteria will determine if the patient will be transported to a trauma center or closest receiving
hospital.
C. Trauma Patient Destination —Considerations
1. If the patient is in cardiac arrest from penetrating trauma in the greater Fresno or Visalia
metropolitan area, the patient should be transported to Regional Medical Center, Kaweah Health
Medical Center or Valley Children's Hospital, bypassing a closer receiving facility. However, if the
transport time to Regional Medical Center, Kaweah Health Medical Center, or Valley Children's
Hospital is greater than ten (10) minutes, then transport should be to the closest receiving facility
within ten minutes transport time (Refer to EMS Policy#550).
2. Trauma patients, meeting trauma center criteria, who have a transport time greater than 60
minutes to the trauma center, will require base hospital contact for destination decision.
3. The following types of incidents should be consideration for transport to the designated Trauma
Center, based upon paramedic judgment:
a. Motorcycle Crash - Non-ambulatory with potential of significant injuries
b. Auto versus Pedestrian - Non-ambulatory with potential of significant injuries
NOTE:Paramedic judgment is based upon the paramedic's own knowledge and experience to determine
if the patient's condition would require transport to a designated Trauma Center due the mechanism of
injury and potential underlying injuries. The Paramedic may contact a Base Hospital for advice on
destination.
4. Transport of Trauma Patients by Helicopter
A trauma patient should not be transported by helicopter unless they meet trauma triage criteria
to be transported to a trauma center or the patient is inaccessible by ambulance (i.e., wilderness
transports). EXCEPTION: When the paramedic feels helicopter transport of the patient would be
beneficial to the outcome of the patient.
5. Burn Patients
The following patients should be transported directly to the Regional Burn Center(Regional
Medical Center) bypassing other hospitals if ETA to Regional Medical Center is within two hours.
a. Patients with 20(partial thickness) or 30(full thickness) burns that are more than 10%
total body surface area
b. Patients with 20(partial thickness) or 31, (full thickness) circumferential burns of any body
part
C. Patients with 20(partial thickness) or 30(full thickness) burns to face, hands, feet, major
joints, perineum, or genitals
d. Electrical burns with voltage greater than 120 volts
e. Patients with chemical burns greater than 10% total body surface area.
Exhibit A
Page 87 of 217
6. Carbon Monoxide Poisoning - Early call-ins to Regional Medical Center should be made for
patients that appear to have significant exposure to carbon monoxide poisoning (altered mental
status, vomiting, and headaches).
7. Trauma patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an ET Tube or OPA,
this is not an unstable airway.
b. Any patient with CPR in progress (refer to EMS Policy#550).
C. Any critically injured or unstable patient when Base Hospital contact is not possible
(i.e., Paramedic or EMT must make the ultimate destination decision).
IV. PATIENTS WHO REFUSE TRANSPORT TO THE APPROPRIATE HOSPITAL
A Base Hospital shall be contacted for the purpose of physician consultation on patients who meet one or more of
the triage criteria and refuse transport to the appropriate hospital. This will usually not be a problem with the
acutely ill patient. However, some patients with normal mental status may wish to be transported to a different
hospital than the one selected via the triage criteria. These situations should be treated as "Refusal of Medical
Care and/or Transportation" situation (refer to EMS Policy#546). The Base Hospital Physician, after radio
contact, may allow the patient to go to the destination of their choice, have a "Refusal of Medical Care and/or
Transportation " signed or insist on transport to the designated hospital.
V. SPECIAL CONSIDERATION FOR FRESNO HEART & SURGICAL HOSPITAL DESTINATION
While the Fresno Heart& Surgical Hospital is a hospital within Central California EMS Region, it does not have
an emergency department and is not an approved facility for patient transports within EMS Policy and
Procedures. Patients who are requesting transport to the Fresno Heart& Surgical Hospital from the prehospital
setting will require Base Hospital contact to confirm acceptance. Since the Fresno Heart & Surgical Hospital is
under the Community Medical Center organization, EMS personnel should contact Regional Medical Center
when requesting transport to the Fresno Heart & Surgical Hospital. If attempts to contact Regional Medical
Center are unsuccessful, EMS personnel should contact another Base Hospital. Interfacility transfers involving
the Fresno Heart& Surgical Hospital shall be in accordance with EMS Policy#553, "ALS Interfacility
Transports".
Exhibit A
Page 88 of 217
Central California EMS Agency
Criteria for Transporting a Fresno County 5150/Psychiatric Patient
Directly to CSC or YCSU Screening Form
Patient's Name: EMS#:
Patient has urgent medical complaint or evidence of acute medical/surgical problem.
[] True—transport Patient/Family Choice [] False
Patient has alteration in mental status due to dementia or delirium.
[] True—transport Patient/Family Choice [] False
Patient has a Glasgow Coma Score 13 or less.
[] True—transport Patient/Family Choice [] False
There are lacerations with a gap of greater than 2 mm or fat/muscle visible in the wound (excludes any
type of stab wound).
[] True—transport Patient/Family Choice [] False
There are lacerations or wounds inflicted by others.
[] True—transport Patient/Family Choice [] False
Complete vital signs are within limits:
Adults:
Pulse outside range of 50-120. [] True—transport Patient/Family Choice [] False
Systolic Blood Pressure outside range of 100-180. [] True—transport Patient/Family Choice [] False
Diastolic Blood Pressure greater than 120. [] True—transport Patient/Family Choice [] False
Respiratory Rate outside range of 12-30. [] True—transport Patient/Family Choice [] False
Pediatrics:
Vital signs inappropriate for children
(Policy 530.32) [] True—transport Patient/Family Choice [] False
Patient is febrile to palpation/measurement.
[] True—transport Patient/Family Choice [] False
Is patient under the influence of alcohol or drugs?
[] Yes No
If yes, to under the influence of alcohol or drugs, does patient require assistance to walk?
[] True—transport Patient/Family Choice [] False
If all of the above answers are False, patient may be transported to CSC/YCSU; otherwise, transport is
Patient/ Family Choice.
Patients that Crisis Stabilization Center(CSC) or Youth Crisis Stabilization Unit (YCSU) cannot accept:
• Patients with dementia or delirium
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use, catheters,
wired devices, etc.)
• Patients in wheelchairs that cannot move independently
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires anything more
than once daily dry gauze and tape dressing
Exhibit A
Page 89 of 217
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
Exhibit A
Page 90 of 217
2. Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
Exhibit A
Page 91 of 217
6. Principle Six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
Exhibit A
Page 92 of 217
10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 93 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.71 $ 109,687 $ 109,687
1102 Assistant Program Director 0.71 91,418 91,418
1103 Admin Clerk 0.14 6,084 6,084
1104 Health Information Specialist 2.13 104,956 104,956
1105 Health Information Specialist(Supervisor) 0.36 21,295 21,295
1106 Program Support Assistant 0.78 33,464 33,464
1107 Quality Improvement Director 0.71 74,534 74,534
1108 Senior Data Specialist 0.71 27,380 27,380
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 6.25 $ 468,818 $ 468,818
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 1.19 $ 38,104 $ 38,104
1117 Discharge Planner 0.14 8,214 8,214
1118 Social Services Coordinator 2.70 219,024 219,024
1119 Program Nurse(LVN/LPTN) 15.98 1,842,209 1,842,209
1120 Program Nurse(RN) 11.93 2,031,587 2,031,587
1121 Mental Health Worker 19.88 1,433,184 1,433,184
1122 Clinical Services Supervisor 0.71 63,900 63,900
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 52.53 $ 5,636,222 $ 5,636,222
Admin Program Total
Direct Personnel Salaries Subtotal 58.78 $ 468,818 $ 5,636,222 $ 6,105,040
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 61,778 $ 61,778
1202 Worker's Compensation 247,114 247,114
1203 Health Insurance 444,805 444,805
1204 Admin Fee 61,778 - 61,778
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 815,475 $ - $ 815,475
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 383,026 $ $ 383,026
1302 FICA/MEDICARE 383,026 383,026
1303 SUI 210,046 210,046
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 976,098 $ $ 976,098
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,260,391 $ 5,636,222 $ 7,896,613
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
29% 71%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Flealth Cont-act Budget Nairetive Revised 2/7/2020
Exhibit A
Acct# Line Item Description Amount
2001 Child Care $ Page 94 of 217
2002 Client Housing Support -
2003 Client Transportation&Support 4,851
2004 Clothing,Food,&Hygiene 128,513
2005 Education Support
2006 1 Employment Support
2007 Household Items for Clients
2008 Medication Supports 15,946
2009 Program Supplies-Medical 94,656
2010 Utility Vouchers -
2011 Laundry Service 40,401
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 284,367
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 44,242
3002 Printing/Postage 1,807
3003 Office,Household&Program Supplies 109,346
3004 Advertising -
3005 Staff Development&Training 24,884
3006 Staff Mileage 5,301
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 2,428
3010 Personnel/Contracted Parking/Parking 2,397,688
3011 Flex Funds 72,418
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 2,658,114
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 36,021
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067
4004 Rent/Lease Vehicles -
4005 Security 1,406,528
4006 Utilities 40,968
4007 Janitorial 124,130
4008 Business Taxes/License Permits 10,510
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 1,671,224
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788
5005 Other(specify) -
5006 1 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 2,788
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(indirect salanes&Benefits) -
6009 Indirect Costs $ 1,880,263
6010 Other(specify)
6011 Other(specify) -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
6012 Other(specify)
Page 95 of 217
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 1,909,403
INDIRECT COST RATE 15.24%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 9,206
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 16,306
TOTAL PROGRAM EXPENSES $ 14,438,815
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 104,785 170.00 17,813,416
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 104,7851 $ 17,813,416
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 14,250,733
Federal Financial Participation(FFP)%1 53% 7,567,139
MEDI-CAL FFP TOTAL $ 7,567,139
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment 1$ 6,742,659
REALIGNMENT TOTAL $ 6,742,659
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 129,017
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 129,0171
TOTAL PROGRAM FUNDING SOURCES: $ 14,438,815
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 96 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2022-23
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
LEI
Total 300.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
Page 97 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 98 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 99 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2022-23 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 7,896,613
Administrative Positions 468,818
1101 Program Director 109,687 Administrative Services 0.71 FTE
1102 Assistant Program Director 91,418 Administrative Services 0.71 FTE
1103 Admin Clerk 6,084 Administrative Services 0.14 FTE
1104 Health Information Specialist 104,956 Administrative Services 2.13 FTE
1105 Health Information Specialist(Supervisor) 21,295 Administrative Services 0.36 FTE
1106 Program Support Assistant 33,464 Administrative Services 0.78 FTE
1107 Quality Improvement Director 74,534 lAdministrative Services 0.71 FTE
1108 Senior Data Specialist 27,380 Administrative Services 0.71 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 5,636,222
1116 Peer Advocate 38,104 Direct Services 1.19 FTE
1117 Discharge Planner 8,214 Direct Services 0.14 FTE
1118 Social Services Coordinator 219,024 Direct Services 2.70 FTE
1119 Program Nurse(LVN/LPTN) 1,842,209 Direct Services 15.98 FTE
1120 Program Nurse(RN) 2,031,587 Direct Services 11.93 FTE
1121 Mental Health Worker 1,433,184 Direct Services 19.88 FTE
1122 Clinical Services Supervisor 63,900 Direct Services 0.71 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits
1201 Retirement 61,778
1202 Worker's Compensation 247,114
1203 Health Insurance 444,805
1204 Admin Fee 61,778
1205 Other(specify) -
1206 Other(specify)
Direct Payroll Taxes&Expenses: 976,098
1301 OASDI 383,026
1302 FICA/MEDICARE 383,026
1303 SUI 210,046
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 284,367
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 4,851 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 128,513 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946 Client Medication
2009 Program Supplies-Medical 94,656 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 40,401 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 2,658,114
3001 Telecommunications 44,242 Program Telephone and Internet
3002 Printing/Postage 1,807 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 109,346 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 24,884 Staff Training Cost
3006 Staff Mileage 5,301 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 2,428 Legal Fees
3010 Personnel/Contracted Parking/Parking 2,397,688 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 72,418 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 1,671,224
4001 Building Maintenance 36,021 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 1,406,528 Security Personnel
4006 Utilities 40,968 Facility Utility
4007 Janitorial 124,130 Facility Janitorial
4008 Business Taxes/License Permits 10,510 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 2,788
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 1,909,403
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 1,880,263 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 16,306
7001 Computer Equipment&Software 9,206 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,100 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehaviorel Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 14,438,815
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 14,438,815
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 102 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.71 $ 112,977 $ 112,977
1102 Assistant Program Director 0.71 94,161 94,161
1103 Admin Clerk 0.14 6,267 6,267
1104 Health Information Specialist 2.13 108,105 108,105
1105 Health Information Specialist(Supervisor) 0.36 21,934 21,934
1106 Program Support Assistant 0.78 34,468 34,468
1107 Quality Improvement Director 0.71 76,770 76,770
1108 Senior Data Specialist 0.71 28,201 28,201
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 6.25 $ 482,883 $ 482,883
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 1.19 $ 39,247 $ 39,247
1117 Discharge Planner 0.14 8,460 8,460
1118 Social Services Coordinator 2.70 225,595 225,595
1119 Program Nurse(LVN/LPTN) 15.98 1,897,475 1,897,475
1120 Program Nurse(RN) 11.93 2,092,534 2,092,534
1121 Mental Health Worker 19.88 1,476,180 1,476,180
1122 Clinical Services Supervisor 0.71 65,817 65,817
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 52.53 $ 5,805,308 $ 5,805,308
Admin Program Total
Direct Personnel Salaries Subtotal 58.78 $ 482,883 $ 5,805,308 $ 6,288,191
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 63,632 $ $ 63,632
1202 Worker's Compensation 254,527 254,527
1203 Health Insurance 458,149 458,149
1204 Admin Fee 63,632 63,632
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 839,940 $ - $ 839,940
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 394,516 $ $ 394,516
1302 FICA/MEDICARE 394,516 394,516
1303 SUI 216,348 216,348
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 1,005,380 $ $ 1,005,380
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,328,203 $ 5,805,308 $ 8,133,511
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
29% 71%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Flealth Cont-act Budget Narnuive Revised 2/7/2020
Exhibit A
Acct# Line Item Description Amount
2001 Child Care $ Page 103 of 217
2002 Client Housing Support -
2003 Client Transportation&Support 4,851
2004 Clothing,Food,&Hygiene 128,513
2005 Education Support
2006 1 Employment Support
2007 Household Items for Clients
2008 Medication Supports 15,946
2009 Program Supplies-Medical 94,656
2010 Utility Vouchers -
2011 Laundry Service 40,401
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 284,367
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 44,242
3002 Printing/Postage 1,807
3003 Office,Household&Program Supplies 109,346
3004 Advertising -
3005 Staff Development&Training 24,884
3006 1 Staff Mileage 5,301
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 2,428
3010 Personnel/Contracted Parking/Parking 2,397,688
3011 Flex Funds 72,418
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 2,658,114
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 36,021
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067
4004 Rent/Lease Vehicles
4005 Security 1,406,528
4006 Utilities 40,968
4007 Janitorial 124,130
4008 Business Taxes/License Permits 10,510
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 1,671,224
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 2,788
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 2,788
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Costs $ 1,915,712
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
6012 Other(specify)
Page 104 of 217
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 1,944,852
INDIRECT COST RATE 15.23%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 9,206
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 16,306
TOTAL PROGRAM EXPENSES $ 14,711,162
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 101,676 170.00 17,285,003
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 1 101,6761 $ 17,285,003
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 13,828,002
Federal Financial Participation(FFP)%1 53% 7,342,669
MEDI-CAL FFP TOTAL $ 7,342,669
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment 1$ 7,237,043
REALIGNMENT TOTAL 1$ 7,237,043
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 131,450
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 131,450)
TOTAL PROGRAM FUNDING SOURCES: $ 14,711,162
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 105 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2023-24
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno
Adult Crisis Stabilization Center/Fresno
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 106 of 217
Tota 1 0.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno
Adult Crisis Stabilization Center/Fresno
Total 0.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 107 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 108 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 8,133,511
Administrative Positions 482,883
1101 Program Director 112,977 Administrative Services 0.71 FTE
1102 Assistant Program Director 94,161 Administrative Services 0.71 FTE
1103 Admin Clerk 6,267 Administrative Services 0.14 FTE
1104 Health Information Specialist 108,105 Administrative Services 2.13 FTE
1105 Health Information Specialist(Supervisor) 21,934 Administrative Services 0.36 FTE
1106 Program Support Assistant 34,468 Administrative Services 0.78 FTE
1107 Quality Improvement Director 76,770 lAdministrative Services 0.71 FTE
1108 Senior Data Specialist 28,201 Administrative Services 0.71 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 5,805,308
1116 Peer Advocate 39,247 Direct Services 1.19 FTE
1117 Discharge Planner 8,460 Direct Services 0.14 FTE
1118 Social Services Coordinator 225,595 Direct Services 2.70 FTE
1119 Program Nurse(LVN/LPTN) 1,897,475 Direct Services 15.98 FTE
1120 Program Nurse(RN) 2,092,534 Direct Services 11.93 FTE
1121 Mental Health Worker 1,476,180 Direct Services 19.88 FTE
1122 Clinical Services Supervisor 65,817 Direct Services 0.71 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 839,940
1201 Retirement 63,632
1202 Worker's Compensation 254,527
1203 Health Insurance 458,149
1204 Admin Fee 63,632
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 1,005,380
1301 OASDI 394,516
1302 FICA/MEDICARE 394,516
1303 SUI 216,348
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 284,367
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 4,851 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 128,513 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946 Client Medication
2009 Program Supplies-Medical 94,656 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 40,401 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 2,658,114
3001 Telecommunications 44,242 Program Telephone and Internet
3002 Printing/Postage 1,807 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 109,346 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 24,884 Staff Training Cost
3006 Staff Mileage 5,301 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 2,428 Legal Fees
3010 Personnel/Contracted Parking/Parking 2,397,688 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 72,418 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 1,671,224
4001 Building Maintenance 36,021 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 1,406,528 Security Personnel
4006 Utilities 40,968 Facility Utility
4007 Janitorial 124,130 Facility Janitorial
4008 Business Taxes/License Permits 10,510 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 2,788
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 1,944,852
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 1,915,712 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 16,306
7001 Computer Equipment&Software 9,206 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,100 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehaviorel Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 14,711,162
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 14,711,162
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 111 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.71 $ 116,367 $ 116,367
1102 Assistant Program Director 0.71 96,986 96,986
1103 Admin Clerk 0.14 6,455 6,455
1104 Health Information Specialist 2.13 111,348 111,348
1105 Health Information Specialist(Supervisor) 0.36 22,592 22,592
1106 Program Support Assistant 0.78 35,502 35,502
1107 Quality Improvement Director 0.71 79,073 79,073
1108 Senior Data Specialist 0.71 29,047 29,047
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 6.25 $ 497,370 $ 497,370
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 1.19 $ 40,424 $ 40,424
1117 Discharge Planner 0.14 8,714 8,714
1118 Social Services Coordinator 2.70 232,363 232,363
1119 Program Nurse(LVN/LPTN) 15.98 1,954,400 1,954,400
1120 Program Nurse(RN) 11.93 2,155,310 2,155,310
1121 Mental Health Worker 19.88 1,520,465 1,520,465
1122 Clinical Services Supervisor 0.71 67,792 67,792
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 52.53 $ 5,979,468 $ 5,979,468
Admin Program Total
Direct Personnel Salaries Subtotal 58.78 $ 497,370 $ 5,979,468 $ 6,476,838
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 65,541 $ $ 65,541
1202 Worker's Compensation 262,163 262,163
1203 Health Insurance 471,893 471,893
1204 Admin Fee 65,541 65,541
1205 Other(specify) -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 865,138 $ - $ 865,138
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 406,352 $ $ 406,352
1302 FICA/MEDICARE 406,352 406,352
1303 SUI 222,838 222,838
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 1,035,542 $ $ 1,035,542
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,398,050 $ 5,979,468 $ 8,377,518
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
29% 71%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Flealth Cont-act Budget Narnuive Revised 2/7/2020
Exhibit A
Acct# Line Item Description Amount
2001 Child Care $ Page 112 of 217
2002 Client Housing Support -
2003 Client Transportation&Support 4,851
2004 Clothing,Food,&Hygiene 128,513
2005 Education Support
2006 1 Employment Support
2007 Household Items for Clients
2008 Medication Supports 15,946
2009 Program Supplies-Medical 94,656
2010 Utility Vouchers -
2011 Laundry Service 40,401
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 284,367
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 44,242
3002 Printing/Postage 1,807
3003 Office,Household&Program Supplies 109,346
3004 Advertising -
3005 Staff Development&Training 24,884
3006 1 Staff Mileage 5,301
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 2,428
3010 Personnel/Contracted Parking/Parking 2,397,688
3011 Flex Funds 72,418
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 2,658,114
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 36,021
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067
4004 Rent/Lease Vehicles
4005 Security 1,406,528
4006 Utilities 40,968
4007 Janitorial 124,130
4008 Business Taxes/License Permits 10,510
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 1,671,224
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 2,788
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 2,788
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Cost $ 1,952,184
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
6012 Other(specify)
Page 113 of 217
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 1,981,324
INDIRECT COST RATE 15.23%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 9,206
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 16,306
TOTAL PROGRAM EXPENSES $ 14,991,641
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 98,678 170.00 16,775,321
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 198,6781 $ 16,775,321
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 13,420,257
Federal Financial Participation(FFP)%1 53% 7,126,156
MEDI-CAL FFP TOTAL $ 7,126,156
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 7,731,533
REALIGNMENT TOTAL $ 7,731,533
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 133,952
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 133,9520
TOTAL PROGRAM FUNDING SOURCES: $ 14,991,641
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 114 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2024-25
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
Page 115 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 116 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 117 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 8,377,518
Administrative Positions 497,370
1101 Program Director 116,367 Administrative Services 0.71 FTE
1102 Assistant Program Director 96,986 Administrative Services 0.71 FTE
1103 Admin Clerk 6,455 Administrative Services 0.14 FTE
1104 Health Information Specialist 111,348 Administrative Services 2.13 FTE
1105 Health Information Specialist(Supervisor) 22,592 Administrative Services 0.36 FTE
1106 Program Support Assistant 35,502 Administrative Services 0.78 FTE
1107 Quality Improvement Director 79,073 Administrative Services 0.71 FTE
1108 Senior Data Specialist 29,047 Administrative Services 0.71 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 5,979,468
1116 Peer Advocate 40,424 Direct Services 1.19 FTE
1117 Discharge Planner 8,714 Direct Services 0.14 FTE
1118 Social Services Coordinator 232,363 Direct Services 2.70 FTE
1119 Program Nurse(LVN/LPTN) 1,954,400 Direct Services 15.98 FTE
1120 Program Nurse(RN) 2,155,310 Direct Services 11.93 FTE
1121 Mental Health Worker 1,520,465 Direct Services 19.88 FTE
1122 Clinical Services Supervisor 67,792 Direct Services 0.71 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 865,138
1201 Retirement 65,541
1202 Worker's Compensation 262,163
1203 Health Insurance 471,893
1204 Admin Fee 65,541
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 1,035,542
1301 OASDI 406,352
1302 FICA/MEDICARE 406,352
1303 SUI 222,838
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 284,367
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 4,851 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 128,513 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946 Client Medication
2009 Program Supplies-Medical 94,656 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 40,401 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE Of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 2,658,114
3001 Telecommunications 44,242 Program Telephone and Internet
3002 Printing/Postage 1,807 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 109,346 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 24,884 Staff Training Cost
3006 Staff Mileage 5,301 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 2,428 Legal Fees
3010 Personnel/Contracted Parking/Parking 2,397,688 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 72,418 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 1,671,224
4001 Building Maintenance 36,021 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 1,406,528 Security Personnel
4006 Utilities 40,968 Facility Utility
4007 Janitorial 124,130 Facility Janitorial
4008 Business Taxes/License Permits 10,510 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify) -
5000:DIRECT SPECIAL EXPENSES 2,788
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 1,981,324
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 1,952,184 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 16,306
7001 Computer Equipment&Software 9,206 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,100 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
='Budget FYTIB176
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehavioral Health Contract BudgetMnative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 14,991,641
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 14,991,641 0
BUDGETCHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 120 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.71 $ 119,858 $ 119,858
1102 Assistant Program Director 0.71 99,895 99,895
1103 Admin Clerk 0.14 6,649 6,649
1104 Health Information Specialist 2.13 114,688 114,688
1105 Health Information Specialist(Supervisor) 0.36 23,270 23,270
1106 Program Support Assistant 0.78 36,567 36,567
1107 Quality Improvement Director 0.71 81,445 81,445
1108 Senior Data Specialist 0.71 29,919 29,919
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 6.25 $ 512,291 $ 512,291
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 1.19 $ 41,637 $ 41,637
1117 Discharge Planner 0.14 8,976 8,976
1118 Social Services Coordinator 2.70 239,333 239,333
1119 Program Nurse(LVN/LPTN) 15.98 2,013,032 2,013,032
1120 Program Nurse(RN) 11.93 2,219,969 2,219,969
1121 Mental Health Worker 19.88 1,566,079 1,566,079
1122 Clinical Services Supervisor 0.71 69,825 69,825
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 52.53 $ 6,158,851 $ 6,158,851
Admin Program Total
Direct Personnel Salaries Subtotal 58.78 $ 512,291 $ 6,158,851 $ 6,671,142
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 67,507 $ $ 67,507
1202 Worker's Compensation 270,028 270,028
1203 Health Insurance 486,050 486,050
1204 Admin Fee 67,507 - 67,507
1205 Other(specify) - -
1206 1 Other(specify) - I -
Direct Employee Benefits Subtotal: $ 891,092 $ - $ 891,092
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 418,542 $ $ 418,542
1302 FICA/MEDICARE 418,542 418,542
1303 SUI 229,523 229,523
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 1,066,607 $ $ 1,066,607
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,469,990 $ 6,158,851 $ 8,628,841
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
29% 71%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Flealth Cont-act Budget Narnuive Revised 2/7/2020
Exhibit A
Acct# Line Item Description Amount
2001 Child Care $ Page 121 of 217
2002 Client Housing Support -
2003 Client Transportation&Support 4,851
2004 Clothing,Food,&Hygiene 128,513
2005 Education Support
2006 1 Employment Support
2007 Household Items for Clients
2008 Medication Supports 15,946
2009 Program Supplies-Medical 94,656
2010 Utility Vouchers -
2011 Other(specify) 40,401
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 284,367
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 44,242
3002 Printing/Postage 1,807
3003 Office,Household&Program Supplies 109,346
3004 Advertising -
3005 Staff Development&Training 24,884
3006 Staff Mileage 5,301
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 2,428
3010 Personnel/Contracted Parking/Parking 2,397,688
3011 Flex Funds 72,418
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 2,658,114
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 36,021
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067
4004 Rent/Lease Vehicles -
4005 Security 1,406,528
4006 Utilities 40,968
4007 Janitorial 124,130
4008 Business Taxes/License Permits 10,510
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 1,671,224
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788
5005 Other(specify) -
5006 1 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 2,788
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(indirect salaries&Benefits) -
6009 Indirect Cost $ 1,981,322
6010 Other(specify)
6011 Other(specify) -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
6012 Other(specify)
Page 122 of 217
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 2,010,462
INDIRECT COST RATE 15.16%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 9,206
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 16,306
TOTAL PROGRAM EXPENSES $ 15,272,102
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 95,382 170.00 16,214,953
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 195,3821 $ 16,214,953
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 12,971,963
Federal Financial Participation(FFP)%1 53% 6,888,112
MEDI-CAL FFP TOTAL $ 6,888,112
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment 1$ 8,248,038
REALIGNMENT TOTAL $ 8,248,038
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 135,952
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 135,9520
TOTAL PROGRAM FUNDING SOURCES: $ 15,272,102
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 123 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
Page 124 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 125 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 126 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 8,628,841
Administrative Positions 512,291
1101 Program Director 119,858 Administrative Services 0.71 FTE
1102 Assistant Program Director 99,895 Administrative Services 0.71 FTE
1103 Admin Clerk 6,649 Administrative Services 0.14 FTE
1104 Health Information Specialist 114,688 Administrative Services 2.13 FTE
1105 Health Information Specialist(Supervisor) 23,270 Administrative Services 0.36 FTE
1106 Program Support Assistant 36,567 Administrative Services 0.78 FTE
1107 Quality Improvement Director 81,445 lAdministrative Services 0.71 FTE
1108 Senior Data Specialist 29,919 Administrative Services 0.71 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 6,158,851
1116 Peer Advocate 41,637 Direct Services 1.19 FTE
1117 Discharge Planner 8,976 Direct Services 0.14 FTE
1118 Social Services Coordinator 239,333 Direct Services 2.70 FTE
1119 Program Nurse(LVN/LPTN) 2,013,032 Direct Services 15.98 FTE
1120 Program Nurse(RN) 2,219,969 Direct Services 11.93 FTE
1121 Mental Health Worker 1,566,079 Direct Services 19.88 FTE
1122 Clinical Services Supervisor 69,825 Direct Services 0.71 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 891,092
1201 Retirement 67,507
1202 Worker's Compensation 270,028
1203 Health Insurance 486,050
1204 Admin Fee 67,507
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 1,066,607
1301 OASDI 418,542
1302 FICA/MEDICARE 418,542
1303 SUI 229,523
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 284,367
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 4,851 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 128,513 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946 Client Medication
2009 Program Supplies-Medical 94,656 Program Medical Supplies
2010 Utility Vouchers -
2011 Other(specify) 40,401 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 2,658,114
3001 Telecommunications 44,242 Program Telephone and Internet
3002 Printing/Postage 1,807 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 109,346 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 24,884 Staff Training Cost
3006 Staff Mileage 5,301 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 2,428 Legal Fees
3010 Personnel/Contracted Parking/Parking 2,397,688 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 72,418 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 1,671,224
4001 Building Maintenance 36,021 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 1,406,528 Security Personnel
4006 Utilities 40,968 Facility Utility
4007 Janitorial 124,130 Facility Janitorial
4008 Business Taxes/License Permits 10,510 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 2,788
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 2,010,462
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Cost 1,981,322 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 16,306
7001 Computer Equipment&Software 9,206 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,100 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehaviorel Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 15,272,102
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 15,272,102
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 129 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.71 $ 123,453 $ 123,453
1102 Assistant Program Director 0.71 102,892 102,892
1103 Admin Clerk 0.14 6,848 6,848
1104 Health Information Specialist 2.13 118,129 118,129
1105 Health Information Specialist(Supervisor) 0.36 23,968 23,968
1106 Program Support Assistant 0.78 37,664 37,664
1107 Quality Improvement Director 0.71 83,889 83,889
1108 Senior Data Specialist 0.71 30,816 30,816
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 6.25 $ 527,659 $ 527,659
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 1.19 $ 42,886 $ 42,886
1117 Discharge Planner 0.14 9,245 9,245
1118 Social Services Coordinator 2.70 246,513 246,513
1119 Program Nurse(LVN/LPTN) 15.98 2,073,423 2,073,423
1120 Program Nurse(RN) 11.93 2,286,569 2,286,569
1121 Mental Health Worker 19.88 1,613,061 1,613,061
1122 Clinical Services Supervisor 0.71 71,920 71,920
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 52.53 $ 6,343,617 $ 6,343,617
Admin Program Total
Direct Personnel Salaries Subtotal 58.78 $ 527,659 $ 6,343,617 $ 6,871,276
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 69,532 $ - $ 69,532
1202 Worker's Compensation 278,129 278,129
1203 Health Insurance 500,632 500,632
1204 Admin Fee 69,532 - 69,532
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 917,825 $ - $ 917,825
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 431,099 $ $ 431,099
1302 FICA/MEDICARE 431,099 431,099
1303 SUI 236,409 236,409
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 1,098,607 $ $ 1,098,607
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,544,091 $ 6,343,617 $ 8,887,708
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
29% 71%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Flealth Cont-act Budget Narnuive Revised 2/7/2020
Exhibit A
Acct# Line Item Description Amount
2001 Child Care $ Page 130 of 217
2002 Client Housing Support -
2003 Client Transportation&Support 4,851
2004 Clothing,Food,&Hygiene 128,513
2005 Education Support
2006 1 Employment Support
2007 Household Items for Clients
2008 Medication Supports 15,946
2009 Program Supplies-Medical 94,656
2010 Utility Vouchers -
2011 Laundry Service 40,401
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 284,367
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 44,242
3002 Printing/Postage 1,807
3003 Office,Household&Program Supplies 109,346
3004 Advertising -
3005 Staff Development&Training 24,884
3006 1 Staff Mileage 5,301
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 2,428
3010 Personnel/Contracted Parking/Parking 2,397,688
3011 Flex Funds 72,418
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 2,658,114
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 36,021
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067
4004 Rent/Lease Vehicles
4005 Security 1,406,528
4006 Utilities 40,968
4007 Janitorial 124,130
4008 Business Taxes/License Permits 10,510
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 1,671,224
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 2,788
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 2,788
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Costs $ 2,028,499
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
6012 Other(specify)
Page 131 of 217
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 2,057,639
INDIRECT COST RATE 15.22%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 9,206
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 16,306
TOTAL PROGRAM EXPENSES $ 15,578,146
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 - -
8009 Other(Specify):Crisis Stabilization UC 93,003 170.00 15,810,431
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 193,0031 $ 15,810,431
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 12,648,345
Federal Financial Participation(FFP)%1 53% 6,716,271
MEDI-CAL FFP TOTAL $ 6,716,271
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 8,722,687
REALIGNMENT TOTAL $ 8,722,687
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 139,188
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 139,188
TOTAL PROGRAM FUNDING SOURCES: $ 15,578,146
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 132 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2026-27
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
Page 133 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 134 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
ADULT CRISIS STABILIZATION CENTER(CSC) Page 135 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 8,887,708
Administrative Positions 527,659
1101 Program Director 123,453 Administrative Services 0.71 FTE
1102 Assistant Program Director 102,892 Administrative Services 0.71 FTE
1103 Admin Clerk 6,848 Administrative Services 0.14 FTE
1104 Health Information Specialist 118,129 Administrative Services 2.13 FTE
1105 Health Information Specialist(Supervisor) 23,968 Administrative Services 0.36 FTE
1106 Program Support Assistant 37,664 Administrative Services 0.78 FTE
1107 Quality Improvement Director 83,889 1 Administrative Services 0.71 FTE
1108 Senior Data Specialist 30,816 Administrative Services 0.71 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 6,343,617
1116 Peer Advocate 42,886 Direct Services 1.19 FTE
1117 Discharge Planner 9,245 Direct Services 0.14 FTE
1118 Social Services Coordinator 246,513 Direct Services 2.70 FTE
1119 Program Nurse(LVN/LPTN) 2,073,423 Direct Services 15.98 FTE
1120 Program Nurse(RN) 2,286,569 Direct Services 11.93 FTE
1121 Mental Health Worker 1,613,061 Direct Services 19.88 FTE
1122 Clinical Services Supervisor 71,920 Direct Services 0.71 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 917,825
1201 Retirement 69,532
1202 Worker's Compensation 278,129
1203 Health Insurance 500,632
1204 Admin Fee 69,532
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 1,098,607
1301 OASDI 431,099
1302 FICA/MEDICARE 431,099
1303 SUI 236,409
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 284,367
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 4,851 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 128,513 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 15,946 Client Medication
2009 Program Supplies-Medical 94,656 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 40,401 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 2,658,114
3001 Telecommunications 44,242 Program Telephone and Internet
3002 Printing/Postage 1,807 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 109,346 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 24,884 Staff Training Cost
3006 Staff Mileage 5,301 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 2,428 Legal Fees
3010 Personnel/Contracted Parking/Parking 2,397,688 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 72,418 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 1,671,224
4001 Building Maintenance 36,021 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 53,067 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 1,406,528 Security Personnel
4006 Utilities 40,968 Facility Utility
4007 Janitorial 124,130 Facility Janitorial
4008 Business Taxes/License Permits 10,510 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 2,788
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 2,788 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 2,057,639
6001 Administrative Overhead -
6002 Professional Liability Insurance 28,430
6003 Accounting/Bookkeeping 710 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 2,028,499 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 16,306
7001 Computer Equipment&Software 9,206 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,100 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehaviorel Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 15,578,146
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 15,578,146
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 138 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Program Director 0.29 $ 44,802 $ 44,802
1102 Assistant Program Director 0.29 37,340 37,340
1103 Admin Clerk 0.06 2,485 2,485
1104 Health Information Specialist 0.87 42,869 42,869
1105 Health Information Specialist(Supervisor) 0.15 8,698 8,698
1106 Program Support Assistant 0.32 13,669 13,669
1107 Quality Improvement Director 0.29 30,444 30,444
1108 Senior Data Specialist 0.29 11,183 11,183
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.56 $ 191,490 $ 191,490
Acct# Program Position FTE Admin Program Total
1116 Peer Advocate 0.48 $ 15,563 $ 15,563
1117 Discharge Planner 0.06 3,355 3,355
1118 Social Services Coordinator 1.91 154,939 154,939
1119 Program Nurse(LVN/LPTN) 11.40 752,452 752,452
1120 Program Nurse(RN) 7.31 829,803 829,803
1121 Mental Health Worker 11.77 585,385 585,385
1122 Clinical Services Supervisor 0.29 26,100 26,100
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotall 33.22 1 $ 2,367,597 1 $ 2,367,597
Admin Program Total
Direct Personnel Salaries Subtotal 35.78 $ 191,490 $ 2,367,597 $ 2,559,087
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 25,133 $ 25,133
1202 Worker's Compensation 100,530 100,530
1203 Health lnsurance 180,953 180,953
1204 Admin Fee 25,133 25,133
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 331,749 $ - $ 331,749
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 155,821 $ $ 155,821
1302 FICA/MEDICARE 155,821 155,821
1303 SUI 85,450 85,450
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 397,092 $ $ 397,092
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 920,331 $ 2,367,597 $ 3,287,928
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
28%1 72%
2000:DIRECT CLIENT SUPPORT
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Acct# Line Item Description Amount
2001 Child Care $ Page 139 of 217
2002 Client Housing Support -
2003 Client Transportation&Support 1,981
2004 Clothing,Food,&Hygiene 52,491
2005 Education Support
2006 1 Employment Support
2007 Household Items for Clients
2008 Medication Supports 6,513
2009 Program Supplies-Medical 38,662
2010 Utility Vouchers -
2011 Laundry Service 16,502
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 116,149
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 18,071
3002 Printing/Postage 738
3003 Office,Household&Program Supplies 44,662
3004 Advertising
3005 Staff Development&Training 10,164
3006 Staff Mileage 2,165
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 992
3010 Personnel/Contracted Parking/Parking 979,337
3011 Flex Funds 29,579
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 1,085,708
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 14,713
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675
4004 Rent/Lease Vehicles -
4005 Security 574,497
4006 Utilities 16,733
4007 Janitorial 50,701
4008 Business Taxes/License Permits 4,293
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j 682,612
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139
5005 Other(specify) -
5006 1 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 1,139
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(indirect Salanes&Benefits) -
6009 Indirect Cost 767,995
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
6012 Other(specify)
Page 140 of 217
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 779,897
INDIRECT COST RATE 15.06%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,760
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,900
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES $ 5,960,093
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 42,799 170.00 7,275,904
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 142,7991 $ 7,275,904
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 5,820,723
Federal Financial Participation(FFP)%1 53% 3,090,804
MEDI-CAL FFP TOTAL $ 3,090,804
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment $ 2,816,592
REALIGNMENT TOTAL $ 2,816,592
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 52,697
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 52,697
TOTAL PROGRAM FUNDING SOURCES: $ 5,960,093
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 141 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2022-23
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
LEI
Total 300.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
Page 142 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 143 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 144 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2022-23 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 3,287,928
Administrative Positions 191,490
1101 Program Director 44,802 Administrative Services 0.29 FTE
1102 Assistant Program Director 37,340 Administrative Services 0.29 FTE
1103 Admin Clerk 2,485 Administrative Services 0.06 FTE
1104 Health Information Specialist 42,869 Administrative Services 0.87 FTE
1105 Health Information Specialist(Supervisor) 8,698 Administrative Services 0.15 FTE
1106 Program Support Assistant 13,669 Administrative Services 0.32 FTE
1107 Quality Improvement Director 30,444 Administrative Services 0.29 FTE
1108 Senior Data Specialist 11,183 Administrative Services 0.29 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 2,367,597
1116 Peer Advocate 15,563 Direct Services 0.48 FTE
1117 Discharge Planner 3,355 Direct Services 0.06 FTE
1118 Social Services Coordinator 154,939 Direct Services 1.91 FTE
1119 Program Nurse(LVN/LPTN) 752,452 Direct Services 11.40 FTE
1120 Program Nurse(RN) 829,803 Direct Services 7.11 FTE
1121 Mental Health Worker 585,385 Direct Services 11.77 FTE
1122 Clinical Services Supervisor 26,100 Direct Services 0.29 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits
1201 Retirement 25,133
1202 Worker's Compensation 100,530
1203 Health Insurance 180,953
1204 Admin Fee 25,133
1205 Other(specify) -
1206 Other(specify)
Direct Payroll Taxes&Expenses: 397,092
1301 OASDI 155,821
1302 FICA/MEDICARE 155,821
1303 SUI 85,450
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 116,149
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,981 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 52,491 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513 Client Medication
2009 Program Supplies-Medical 38,662 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 16,502 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 1,085,708
3001 Telecommunications 18,071 Program Telephone and Internet
3002 Printing/Postage 738 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 44,662 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 10,164 Staff Training Cost
3006 Staff Mileage 2,165 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 992 Legal Fees
3010 Personnel/Contracted Parking/Parking 979,337 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 29,579 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 682,612
4001 Building Maintenance 14,713 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 574,497 Security Personnel
4006 Utilities 16,733 Facility Utility
4007 Janitorial 50,701 Facility Janitorial
4008 Business Taxes/License Permits 4,293 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 1,139
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 779,897
6001 Administrative Overhead -
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Cost 767,995 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 6,660
7001 Computer Equipment&Software 3,760 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 2,900 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehaviorel Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 5,960,093
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 5,960,093
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 147 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.29 $ 46,146 $ 46,146
1102 Assistant Program Director 0.29 38,460 38,460
1103 Admin Clerk 0.06 2,560 2,560
1104 Health Information Specialist 0.87 44,156 44,156
1105 Health Information Specialist(Supervisor) 0.15 8,959 8,959
1106 Program Support Assistant 0.32 14,079 14,079
1107 Quality Improvement Director 0.29 31,357 31,357
1108 Senior Data Specialist 0.29 11,519 11,519
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.56 $ 197,236 $ 197,236
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 0.48 $ 16,030 $ 16,030
1117 Discharge Planner 0.06 3,456 3,456
1118 Social Services Coordinator 1.91 159,587 159,587
1119 Program Nurse(LVN/LPTN) 11.40 775,025 775,025
1120 Program Nurse(RN) 7.31 854,697 854,697
1121 Mental Health Worker 11.77 602,947 602,947
1122 Clinical Services Supervisor 0.29 26,883 26,883
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 33.22 $ 2,438,625 $ 2,438,625
Admin Program Total
Direct Personnel Salaries Subtotal 35.78 $ 197,236 $ 2,438,625 $ 2,635,861
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 25,887 $ $ 25,887
1202 Worker's Compensation 103,546 103,546
1203 Health Insurance 186,381 186,381
1204 Admin Fee 25,887 - 25,887
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 341,701 $ - $ 341,701
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 160,496 $ $ 160,496
1302 FICA/MEDICARE 160,496 160,496
1303 SUI 88,013 88,013
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 409,005 $ $ 409,005
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 947,942 $ 2,438,625 $ 3,386,567
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
28% 72%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Health Cont-act Budget Narnuive Revised 2/7/2020
Exhibit A
Acct# Line Item Description Amount
2001 Child Care $ Page 148 of 217
2002 Client Housing Support -
2003 Client Transportation&Support 1,981
2004 Clothing,Food,&Hygiene 52,491
2005 Education Support
2006 1 Employment Support
2007 Household Items for Clients
2008 Medication Supports 6,513
2009 Program Supplies-Medical 38,662
2010 Utility Vouchers -
2011 Laundry Service 16,502
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 116,149
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 18,071
3002 Printing/Postage 738
3003 Office,Household&Program Supplies 44,662
3004 Advertising -
3005 Staff Development&Training 10,164
3006 1 Staff Mileage 2,165
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 992
3010 Personnel/Contracted Parking/Parking 979,337
3011 Flex Funds 29,579
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 1,085,708
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 14,713
4002 Rent/Lease Building
4003 Rent/Lease Equipment 21,675
4004 Rent/Lease Vehicles
4005 Security 574,497
4006 Utilities 16,733
4007 Janitorial 50,701
4008 Business Taxes/License Permits 4,293
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 682,612
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 1,139
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 1,139
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Costs 782,466
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
6012 Other(specify)
Page 149 of 217
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 794,368
INDIRECT COST RATE 15.05%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,760
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,900
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES $ 6,073,203
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 - -
8009 Other(Specify):Crisis Stabilization UC 41,529 170.00 7,060,001
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 141,5291 $ 7,060,001
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 5,648,001
Federal Financial Participation(FFP)%1 53% 2,999,089
MEDI-CAL FFP TOTAL $ 2,999,089
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment 1$ 3,020,424
REALIGNMENT TOTAL $ 3,020,424
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 53,690
8405 Other(Specify) -
OTHER REVENUE TOTALI$ 53,690
TOTAL PROGRAM FUNDING SOURCES: $ 6,073,203
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 150 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2023-24
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno
Adult Crisis Stabilization Center/Fresno
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 151 of 217
Tota 1 0.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno
Adult Crisis Stabilization Center/Fresno
Total 0.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 152 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 153 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 3,386,567
Administrative Positions 197,236
1101 Program Director 46,146 Administrative Services 0.29 FTE
1102 Assistant Program Director 38,460 Administrative Services 0.29 FTE
1103 Admin Clerk 2,560 Administrative Services 0.06 FTE
1104 Health Information Specialist 44,156 Administrative Services 0.87 FTE
1105 Health Information Specialist(Supervisor) 8,959 Administrative Services 0.15 FTE
1106 Program Support Assistant 14,079 Administrative Services 0.32 FTE
1107 Quality Improvement Director 31,357 Administrative Services 0.29 FTE
1108 Senior Data Specialist 11,519 Administrative Services 0.29 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 2,438,625
1116 Peer Advocate 16,030 Direct Services 0.48 FTE
1117 Discharge Planner 3,456 Direct Services 0.06 FTE
1118 Social Services Coordinator 159,587 Direct Services 1.91 FTE
1119 Program Nurse(LVN/LPTN) 775,025 Direct Services 11.40 FTE
1120 Program Nurse(RN) 854,697 Direct Services 7.11 FTE
1121 Mental Health Worker 602,947 Direct Services 11.77 FTE
1122 Clinical Services Supervisor 26,883 Direct Services 0.29 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 341,701
1201 Retirement 25,887
1202 Worker's Compensation 103,546
1203 Health Insurance 186,381
1204 Admin Fee 25,887
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 409,005
1301 OASDI 160,496
1302 FICA/MEDICARE 160,496
1303 SUI 88,013
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 116,149
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,981 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 52,491 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513 Client Medication
2009 Program Supplies-Medical 38,662 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 16,502 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 1,085,708
3001 Telecommunications 18,071 Program Telephone and Internet
3002 Printing/Postage 738 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 44,662 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 10,164 Staff Training Cost
3006 Staff Mileage 2,165 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 992 Legal Fees
3010 Personnel/Contracted Parking/Parking 979,337 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 29,579 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 682,612
4001 Building Maintenance 14,713 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 574,497 Security Personnel
4006 Utilities 16,733 Facility Utility
4007 Janitorial 50,701 Facility Janitorial
4008 Business Taxes/License Permits 4,293 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 1,139
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 794,368
6001 Administrative Overhead -
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 782,466 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 6,660
7001 Computer Equipment&Software 3,760 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 2,900 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehaviorel Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 6,073,203
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 6,073,203
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 156 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.29 $ 47,530 $ 47,530
1102 Assistant Program Director 0.29 39,614 39,614
1103 Admin Clerk 0.06 2,637 2,637
1104 Health Information Specialist 0.87 45,480 45,480
1105 Health Information Specialist(Supervisor) 0.15 9,228 9,228
1106 Program Support Assistant 0.32 14,501 14,501
1107 Quality Improvement Director 0.29 32,298 32,298
1108 Senior Data Specialist 0.29 11,864 11,864
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.56 $ 203,152 $ 203,152
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 0.48 $ 16,511 $ 16,511
1117 Discharge Planner 0.06 3,559 3,559
1118 Social Services Coordinator 1.91 164,375 164,375
1119 Program Nurse(LVN/LPTN) 11.40 798,276 798,276
1120 Program Nurse(RN) 7.31 880,338 880,338
1121 Mental Health Worker 11.77 621,035 621,035
1122 Clinical Services Supervisor 0.29 27,689 27,689
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 33.22 $ 2,511,783 $ 2,511,783
Admin Program Total
Direct Personnel Salaries Subtotal 35.78 $ 203,152 $ 2,511,783 $ 2,714,935
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 26,663 $ $ 26,663
1202 Worker's Compensation 106,652 106,652
1203 Health Insurance 191,973 191,973
1204 Admin Fee 26,663 26,663
1205 Other(specify)
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 351,951 $ - $ 351,951
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 165,310 $ $ 165,310
1302 FICA/MEDICARE 165,310 165,310
1303 SUI 90,653 90,653
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 421,273 $ $ 421,273
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 976,376 $ 2,511,783 $ 3,488,159
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
28% 72%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Health Cont-act Budget Narnuive Revised 2/7/2020
Exhibit A
Acct# Line Item Description Amount
2001 Child Care $ Page 157 of 217
2002 Client Housing Support -
2003 Client Transportation&Support 1,981
2004 Clothing,Food,&Hygiene 52,491
2005 Education Support
2006 1 Employment Support
2007 Household Items for Clients
2008 Medication Supports 6,513
2009 Program Supplies-Medical 38,662
2010 Utility Vouchers -
2011 Laundry Service 16,502
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 116,149
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 18,071
3002 Printing/Postage 738
3003 Office,Household&Program Supplies 44,662
3004 Advertising -
3005 Staff Development&Training 10,164
3006 1 Staff Mileage 2,165
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 992
3010 Personnel/Contracted Parking/Parking 979,337
3011 Flex Funds 29,579
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 1,085,708
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 14,713
4002 Rent/Lease Building
4003 Rent/Lease Equipment 21,675
4004 Rent/Lease Vehicles
4005 Security 574,497
4006 Utilities 16,733
4007 Janitorial 50,701
4008 Business Taxes/License Permits 4,293
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 682,612
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 1,139
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 1,139
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Cost 797,371
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
6012 Other(specify)
Page 158 of 217
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 809,273
INDIRECT COST RATE 15.04%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,760
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,900
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES $ 6,189,700
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 40,305 170.00 6,851,890
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 140,3051 $ 6,851,890
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 5,481,512
Federal Financial Participation(FFP)%1 53% 2,910,683
MEDI-CAL FFP TOTAL $ 2,910,683
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment 1$ 3,224,304
REALIGNMENT TOTAL $ 3,224,304
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 54,713
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 54,713
TOTAL PROGRAM FUNDING SOURCES: $ 6,189,700
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 159 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2024-25
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
Page 160 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 161 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 162 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 3,488,159
Administrative Positions 203,152
1101 Program Director 47,530 Administrative Services 0.29 FTE
1102 Assistant Program Director 39,614 Administrative Services 0.29 FTE
1103 Admin Clerk 2,637 Administrative Services 0.06 FTE
1104 Health Information Specialist 45,480 Administrative Services 0.87 FTE
1105 Health Information Specialist(Supervisor) 9,228 Administrative Services 0.15 FTE
1106 Program Support Assistant 14,501 Administrative Services 0.32 FTE
1107 Quality Improvement Director 32,298 Administrative Services 0.29 FTE
1108 Senior Data Specialist 11,864 Administrative Services 0.29 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 2,511,783
1116 Peer Advocate 16,511 Direct Services 0.48 FTE
1117 Discharge Planner 3,559 Direct Services 0.06 FTE
1118 Social Services Coordinator 164,375 Direct Services 1.91 FTE
1119 Program Nurse(LVN/LPTN) 798,276 Direct Services 11.40 FTE
1120 Program Nurse(RN) 880,338 Direct Services 7.11 FTE
1121 Mental Health Worker 621,035 Direct Services 11.77 FTE
1122 Clinical Services Supervisor 27,689 Direct Services 0.29 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 351,951
1201 Retirement 26,663
1202 Worker's Compensation 106,652
1203 Health Insurance 191,973
1204 Admin Fee 26,663
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 421,273
1301 OASDI 165,310
1302 FICA/MEDICARE 165,310
1303 SUI 90,653
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 116,149
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,981 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 52,491 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513 Client Medication
2009 Program Supplies-Medical 38,662 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 16,502 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE Of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 1,085,708
3001 Telecommunications 18,071 Program Telephone and Internet
3002 Printing/Postage 738 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 44,662 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 10,164 Staff Training Cost
3006 Staff Mileage 2,165 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 992 Legal Fees
3010 Personnel/Contracted Parking/Parking 979,337 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 29,579 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 682,612
4001 Building Maintenance 14,713 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 574,497 Security Personnel
4006 Utilities 16,733 Facility Utility
4007 Janitorial 50,701 Facility Janitorial
4008 Business Taxes/License Permits 4,293 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify) -
5000:DIRECT SPECIAL EXPENSES 1,139
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 809,273
6001 Administrative Overhead -
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 797,371 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 6,660
7001 Computer Equipment&Software 3,760 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 2,900 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
='Budget FY3'1B176
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department of Behavioral Health Contract BudgetMnative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 6,189,700
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 6,189,700 0
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 165 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.29 $ 48,956 $ 48,956
1102 Assistant Program Director 0.29 40,802 40,802
1103 Admin Clerk 0.06 2,716 2,716
1104 Health Information Specialist 0.87 46,845 46,845
1105 Health Information Specialist(Supervisor) 0.15 9,505 9,505
1106 Program Support Assistant 0.32 14,936 14,936
1107 Quality Improvement Director 0.29 33,266 33,266
1108 Senior Data Specialist 0.29 12,220 12,220
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.56 $ 209,246 $ 209,246
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 0.48 $ 17,007 $ 17,007
1117 Discharge Planner 0.06 3,666 3,666
1118 Social Services Coordinator 1.91 169,306 169,306
1119 Program Nurse(LVN/LPTN) 11.40 822,224 822,224
1120 Program Nurse(RN) 7.31 906,748 906,748
1121 Mental Health Worker 11.77 639,666 639,666
1122 Clinical Services Supervisor 0.29 28,520 28,520
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 33.22 $ 2,587,137 $ 2,587,137
Admin Program Total
Direct Personnel Salaries Subtotal 35.78 $ 209,246 $ 2,587,137 $ 2,796,383
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 27,463 $ $ 27,463
1202 Worker's Compensation 109,852 109,852
1203 Health Insurance 197,732 197,732
1204 Admin Fee 27,463 - 27,463
1205 Other(specify) - -
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ 362,510 $ - $ 362,510
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 170,270 $ $ 170,270
1302 FICA/MEDICARE 170,270 170,270
1303 SUI 93,373 93,373
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 433,913 $ $ 433,913
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 1,005,669 $ 2,587,137 $ 3,592,806
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
28% 72%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Health Cont-act Budget Narnuive Revised 2/7/2020
Exhibit A
Acct# Line Item Description Amount
2001 Child Care $ Page 166 of 217
2002 Client Housing Support -
2003 Client Transportation&Support 1,981
2004 Clothing,Food,&Hygiene 52,491
2005 Education Support
2006 1 Employment Support
2007 Household Items for Clients
2008 Medication Supports 6,513
2009 Program Supplies-Medical 38,662
2010 Utility Vouchers -
2011 Other(specify) 16,502
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 116,149
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 18,071
3002 Printing/Postage 738
3003 Office,Household&Program Supplies 44,662
3004 Advertising
3005 Staff Development&Training 10,164
3006 Staff Mileage 2,165
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 992
3010 Personnel/Contracted Parking/Parking 979,337
3011 Flex Funds 29,579
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 1,085,708
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 14,713
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675
4004 Rent/Lease Vehicles -
4005 Security 574,497
4006 Utilities 16,733
4007 Janitorial 50,701
4008 Business Taxes/License Permits 4,293
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j 682,612
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139
5005 Other(specify) -
5006 1 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 1,139
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforProgrom Purposes) -
6008 Personnel(indirect Salanes&Benefits) -
6009 Indirect Cost 812,723
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
6012 Other(specify)
Page 167 of 217
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 824,625
INDIRECT COST RATE 15.03%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,760
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,900
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES $ 6,309,699
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 39,125 170.00 6,651,251
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 139,1251 $ 6,651,251
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 5,321,000
Federal Financial Participation(FFP)%1 53% 2,825,451
MEDI-CAL FFP TOTAL $ 2,825,451
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment 1$ 3,428,482
REALIGNMENT TOTAL 1$ 3,428,482
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 55,766
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 55,766
TOTAL PROGRAM FUNDING SOURCES: $ 6,309,699
NET PROGRAM COST: $
Fresno County Depamnent ofBehavioral Flealth Cont-act Budget Narrative Revised 2/7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 168 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
Page 169 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 170 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 171 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 3,592,806
Administrative Positions 209,246
1101 Program Director 48,956 Administrative Services 0.29 FTE
1102 Assistant Program Director 40,802 Administrative Services 0.29 FTE
1103 Admin Clerk 2,716 Administrative Services 0.06 FTE
1104 Health Information Specialist 46,845 Administrative Services 0.87 FTE
1105 Health Information Specialist(Supervisor) 9,505 Administrative Services 0.15 FTE
1106 Program Support Assistant 14,936 Administrative Services 0.32 FTE
1107 Quality Improvement Director 33,266 Administrative Services 0.29 FTE
1108 Senior Data Specialist 12,220 Administrative Services 0.29 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 2,587,137
1116 Peer Advocate 17,007 Direct Services 0.48 FTE
1117 Discharge Planner 3,666 Direct Services 0.06 FTE
1118 Social Services Coordinator 169,306 Direct Services 1.91 FTE
1119 Program Nurse(LVN/LPTN) 822,224 Direct Services 11.40 FTE
1120 Program Nurse(RN) 906,748 Direct Services 7.11 FTE
1121 Mental Health Worker 639,666 Direct Services 11.77 FTE
1122 Clinical Services Supervisor 28,520 Direct Services 0.29 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 362,510
1201 Retirement 27,463
1202 Worker's Compensation 109,852
1203 Health Insurance 197,732
1204 Admin Fee 27,463
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 433,913
1301 OASDI 170,270
1302 FICA/MEDICARE 170,270
1303 SUI 93,373
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 116,149
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,981 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 52,491 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513 Client Medication
2009 Program Supplies-Medical 38,662 Program Medical Supplies
2010 Utility Vouchers -
2011 Other(specify) 16,502 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 1,085,708
3001 Telecommunications 18,071 Program Telephone and Internet
3002 Printing/Postage 738 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 44,662 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 10,164 Staff Training Cost
3006 Staff Mileage 2,165 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 992 Legal Fees
3010 Personnel/Contracted Parking/Parking 979,337 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 29,579 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 682,612
4001 Building Maintenance 14,713 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 574,497 Security Personnel
4006 Utilities 16,733 Facility Utility
4007 Janitorial 50,701 Facility Janitorial
4008 Business Taxes/License Permits 4,293 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 1,139
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 824,625
6001 Administrative Overhead -
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Cost 812,723 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 6,660
7001 Computer Equipment&Software 3,760 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 2,900 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehaviorel Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 6,309,699
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 6,309,699
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 174 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct p Administrative Position FTE Admin Program Total
1101 Program Director 0.29 $ 50,425 $ 50,425
1102 Assistant Program Director 0.29 42,026 42,026
1103 Admin Clerk 0.06 2,797 2,797
1104 Health Information Specialist 0.87 48,250 48,250
1105 Health Information Specialist(Supervisor) 0.15 9,790 9,790
1106 Program Support Assistant 0.32 15,384 15,384
1107 Quality Improvement Director 0.29 34,264 34,264
1108 Senior Data Specialist 0.29 12,587 12,587
1109 - -
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.56 $ 215,523 $ 215,523
Acct p Program Position FTE Admin Program Total
1116 Peer Advocate 0.48 $ 17,517 $ 17,517
1117 Discharge Planner 0.06 3,777 3,777
1118 Social Services Coordinator 1.91 174,385 174,385
1119 Program Nurse(LVN/LPTN) 11.40 846,890 846,890
1120 Program Nurse(RN) 7.31 933,951 933,951
1121 Mental Health Worker 11.77 658,856 658,856
1122 Clinical Services Supervisor 0.29 29,376 29,376
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 33.22 $ 2,664,752 $ 2,664,752
Admin Program Total
Direct Personnel Salaries Subtotal 35.78 $ 215,523 $ 2,664,752 $ 2,880,275
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 28,287 $ $ 28,287
1202 Worker's Compensation 113,147 113,147
1203 Health Insurance 203,664 203,664
1204 Admin Fee 28,287 28,287
1205 Other(specify) - -
1206 1 Other(specify) - I -
Direct Employee Benefits Subtotal: $ 373,385 $ - $ 373,385
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 175,378 $ $ 175,378
1302 FICA/MEDICARE 175,378 175,378
1303 SUI 96,174 96,174
1304 Other(specify) -
1305 Other(specify) -
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 446,930 $ $ 446,930
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 1,035,838 $ 2,664,752 $ 3,700,590
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
28% 72%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Health Cont-act Budget Narnuive Revised 2/7/2020
Exhibit A
Acct# Line Item Description Amount
2001 Child Care $ Page 175 of 217
2002 Client Housing Support -
2003 Client Transportation&Support 1,981
2004 Clothing,Food,&Hygiene 52,491
2005 Education Support
2006 1 Employment Support
2007 Household Items for Clients
2008 Medication Supports 6,513
2009 Program Supplies-Medical 38,662
2010 Utility Vouchers -
2011 Laundry Service 16,502
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 116,149
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 18,071
3002 Printing/Postage 738
3003 Office,Household&Program Supplies 44,662
3004 Advertising -
3005 Staff Development&Training 10,164
3006 1 Staff Mileage 2,165
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance -
3009 Legal Notices/Advertising 992
3010 Personnel/Contracted Parking/Parking 979,337
3011 Flex Funds 29,579
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 1,085,708
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 14,713
4002 Rent/Lease Building
4003 Rent/Lease Equipment 21,675
4004 Rent/Lease Vehicles
4005 Security 574,497
4006 Utilities 16,733
4007 Janitorial 50,701
4008 Business Taxes/License Permits 4,293
4009 Other(specify) -
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 682,612
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 1,139
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL:j 1,139
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be UsedforPmgmm Purposes) -
6008 Personnel(lndl—tSahries&Benefits) -
6009 Indirect Costs $ 826,599
6010 Other(specify) -
6011 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
6012 Other(specify)
Page 176 of 217
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 838,501
INDIRECT COST RATE 14.99%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 3,760
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 2,900
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES $ 6,431,359
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct p Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0 -
8009 Other(Specify):Crisis Stabilization UC 37,898 170.00 6,442,678
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 137,8981 $ 6,442,678
Estimated%of Clients who are Medi-Cal Beneficiaries 80%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 5,154,142
Federal Financial Participation(FFP)%1 53% 2,736,850
MEDI-CAL FFP TOTAL $ 2,736,850
8100-SUBSTANCE USE DISORDER FUNDS
Acct p Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 ISABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct p Line Item Description Amount
8201 lRealignment 1$ 3,637,791
REALIGNMENT TOTAL 1$ 3,637,791
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct p MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ -
8400-OTHER REVENUE
Acct p Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify)
8404 Private Insurance Income 56,718
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 56,718
TOTAL PROGRAM FUNDING SOURCES: $ 6,431,359
NET PROGRAM COST: $
Fresno County Department of Behavioral Fleahh Cont-act Budget Narrative Revised 2/7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 177 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2026-27
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Admin Clerk Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Health Information Specialist(Supervisor) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Support Assistant Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position lContract#/Name/Department/County FTE%
Quality Improvement Director Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
Page 178 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Senior Data Specialist Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Peer Advocate Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Discharge Planner Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Social Services Coordinator Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(LVN/LPTN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Program Nurse(RN) Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Position Contract#/Name/Department/County FTE%
Mental Health Worker Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 179 of 217
Total 100.00
Position Contract#/Name/Department/County FTE%
Clinical Services Supervisor Youth Crisis Stabilization Center/Fresno 29.00
Adult Crisis Stabilization Center/Fresno 71.00
Total 100.00
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
YOUTH CRISIS STABILIZATION CENTER(CSC) Page 180 of 217
Exodus Recovery,Inc.
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 3,700,590
Administrative Positions 215,523
1101 Program Director 50,425 Administrative Services 0.29 FTE
1102 Assistant Program Director 42,026 Administrative Services 0.29 FTE
1103 Admin Clerk 2,797 Administrative Services 0.06 FTE
1104 Health Information Specialist 48,250 Administrative Services 0.87 FTE
1105 Health Information Specialist(Supervisor) 9,790 Administrative Services 0.15 FTE
1106 Program Support Assistant 15,384 Administrative Services 0.32 FTE
1107 Quality Improvement Director 34,264 Administrative Services 0.29 FTE
1108 Senior Data Specialist 12,587 Administrative Services 0.29 FTE
1109 -
1110
1111
1112
1113
1114
1115
Program Positions 2,664,752
1116 Peer Advocate 17,517 Direct Services 0.48 FTE
1117 Discharge Planner 3,777 Direct Services 0.06 FTE
1118 Social Services Coordinator 174,385 Direct Services 1.91 FTE
1119 Program Nurse(LVN/LPTN) 846,890 Direct Services 11.40 FTE
1120 Program Nurse(RN) 933,951 Direct Services 7.11 FTE
1121 Mental Health Worker 658,856 Direct Services 11.77 FTE
1122 Clinical Services Supervisor 29,376 Direct Services 0.29 FTE
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 373,385
1201 Retirement 28,287
1202 Worker's Compensation 113,147
1203 Health Insurance 203,664
1204 Admin Fee 28,287
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 446,930
1301 OASDI 175,378
1302 FICA/MEDICARE 175,378
1303 SUI 96,174
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 116,149
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,981 Vehicle lease,Fuel and Maintenance for Clients
2004 Clothing,Food,&Hygiene 52,491 Food Service
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 6,513 Client Medication
2009 Program Supplies-Medical 38,662 Program Medical Supplies
2010 Utility Vouchers -
2011 Laundry Service 16,502 Client Laundry Service
2012 Other(specify) -
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 1,085,708
3001 Telecommunications 18,071 Program Telephone and Internet
3002 Printing/Postage 738 Program Postage&Delivery Cost
3003 Office,Household&Program Supplies 44,662 Office Supply and Equipment Cost
3004 Advertising -
3005 Staff Development&Training 10,164 Staff Training Cost
3006 Staff Mileage 2,165 Staff Mileage&Vehicle Maintenance Cost
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 Legal Notices/Advertising 992 Legal Fees
3010 Personnel/Contracted Parking/Parking 979,337 Personnel related expenses including registry nurses as needed,parking and relocation
3011 Flex Funds 29,579 Client Flex Funds
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 682,612
4001 Building Maintenance 14,713 Building maintenance&repairs
4002 Rent/Lease Building -
4003 Rent/Lease Equipment 21,675 Leased computer cost
4004 Rent/Lease Vehicles
4005 Security 574,497 Security Personnel
4006 Utilities 16,733 Facility Utility
4007 Janitorial 50,701 Facility Janitorial
4008 Business Taxes/License Permits 4,293 Business License,Permits fees
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 1,139
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,139 Client translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 838,501
6001 Administrative Overhead -
6002 Professional Liability Insurance 11,612
6003 Accounting/Bookkeeping 290 External Accounting Services
6004 External Audit -
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 Indirect Costs 826,599 Expense provides corporate management,fiscal services,payroll,human resources,
accounts payable and other administrative functions.
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 6,660
7001 Computer Equipment&Software 3,760 Staff Computer replacement
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 2,900 Staff&Client Furniture replacement
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
Fresno County Department ofBehaviorel Heakh Contract BudgetMnadve Revised 2/7/2020
Exhibit A
PROGRAM EXPENSE of 217
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify):Crisis Stabilization UC
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 6,431,359
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 6,431,359
BUDGET CHECK: -
Fresno County Department ofBehavioral Health Contract Budget Narrative Revised 2t7/2020
Exhibit A
Page 183 of 217
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health
services. Mental health contractors and the manner in which they conduct themselves are a
vital part of this commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with
which contractor and its employees and subcontractors shall comply. Contractor shall
require its employees and subcontractors to attend a compliance training that will be
provided by Fresno County. After completion of this training, each contractor, contractor's
employee and subcontractor must sign the Contractor Acknowledgment and Agreement
form and return this form to the Compliance officer or designee.
Contractor and its employees and subcontractor shall:
1 . Comply with all applicable laws, regulations, rules or guidelines when providing and
billing for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in
their professional dealing related to their contract with the County and avoid any
conduct that could reasonably be expected to reflect adversely upon the integrity of
the County.
3. Treat County employees, consumers, and other mental health contractors fairly and
with respect.
4. NOT engage in any activity in violation of the County's Compliance Program, nor
engage in any other conduct which violates any applicable law, regulation, rule or
guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely
and are consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or
reimbursement of any kind are submitted.
Exhibit A
Page 184 of 217
7. Bill only for eligible services actually rendered and fully documented. Use billing
codes that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by County employees or other mental health contractors, or report
any activity that they believe may violate the standards of the Compliance Program, or
any other applicable law, regulation, rule or guideline. Fresno County prohibits
retaliation against any person making a report. Any person engaging in any form of
retaliation will be subject to disciplinary or other appropriate action by the County.
Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or
guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible
person and therefore excluded from participation in the Federal Health Care
Programs.
Exhibit A
Page 185 of 217
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
Signature : Date
For Group or Organizational Providers
Group/Org. Name (print):
Employee Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
❑ Other:
Job Title (if different from Discipline):
Signature: Date: / /
Exhibit A
Page 186 of 217
Documentation Standards for Client Records
The documentation standards are described below under key topics related to client
care. All standards must be addressed in the client record; however, there is no
requirement that the record have a specific document or section addressing these
topics.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive
client record.
• Relevant physical health conditions reported by the client will be prominently
identified and updated as appropriate.
• Presenting problems and relevant conditions affecting the client's physical health
and mental health status will be documented, for example: living situation, daily
activities, and social support.
• Documentation will describe client's strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently
documented and updated as appropriate.
• Documentations will include medications that have been described by mental
health plan physicians, dosage of each medication, dates of initial prescriptions
and refills, and documentations of informed consent for medications.
• Client self report of allergies and adverse reactions to medications, or lack of
known allergies/sensitivities will be clearly documented.
• A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data,
relevant family information and relevant results of relevant lab tests and
consultations reports.
• For children and adolescents, pre-natal and perinatal events and complete
developmental history will be documented.
• Documentations will include past and present use of tobacco, alcohol, and
caffeine, as well as illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A five axis diagnosis from the most current DSM, or a diagnosis from the most
current ICD, will be documented, consistent with the presenting problems, history
mental status evaluation and/or other assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document
changes in the client's condition.
• Client conditions will be assessed at least annually and, in most cases, at more
frequent intervals.
Exhibit A
Page 187 of 217
B. Client Plans
1. Client plans will:
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent) by:
■ the person providing the service(s), or
■ a person representing a team or program providing services, or
■ a person representing the MHP providing services
■ when the client plan is used to establish that the services are provided under
the direction of an approved category of staff, and if the below staff are not
the approved category,
■ a physician
■ a licensed/ "waivered" psychologist
■ a licensed/ "associate" social worker
■ a licensed/ registered/marriage and family therapist or
■ a registered nurse
• In addition,
■ client plans will be consistent with the diagnosis, and the focus of intervention
will be consistent with the client plan goals, and there will be documentation
of the client's participation in and agreement with the plan. Examples of the
documentation include, but are not limited to, reference to the client's
participation and agreement in the body of the plan, client signature on the
plan, or a description of the client's participation and agreement in progress
notes.
■ client signature on the plan will be used as the means by which the
CONTRACTOR(S) documents the participation of the client
■ when the client's signature is required on the client plan and the client refuses
or is unavailable for signature, the client plan will include a written explanation
of the refusal or unavailability.
■ The CONTRACTOR(S) will give a copy of the client plan to the client on
request.
2. Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for
the individual elements of the client plan described in item 1.
C. Progress Notes
Exhibit A
Page 188 of 217
1. Items that must be contained in the client record related to the client's progress in
treatment include:
• The client record will provide timely documentation of relevant aspects of client
care
• Mental health staff/practitioners will use client records to document client
encounters, including relevant clinical decisions and interventions
• All entries in the client record will include the signature of the person providing
the service (or electronic equivalent); the person's professional degree, licensure
or job title; and the relevant identification number, if applicable
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge
summary
2. Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated
below:
A. Every Service Contact
■ Mental Health Services
■ Medication Support Services
■ Crisis Intervention
Exhibit A
Page 189 of 217
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance
with all applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal
services have met applicable professional licensure requirements
pursuant to Business and Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance
with all State of California and Federal statutes and regulations regarding
confidentiality, including but not limited to confidentiality of information
requirements at 42, Code of Federal Regulations sections 2.1 et seq;
California Welfare and Institutions Code, sections 14100.2, 11977, 11812,
5328; Division 10.5 and 10.6 of the California Health and Safety Code;
Title 22, California Code of Regulations, section 51009; and Division 1,
Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and
to the public all eligibility requirements to participate in the program
plan set forth in the Agreement. No person shall, because of ethnic
group identification, age, gender, color, disability, medical condition,
national origin, race, ancestry, marital status, religion, religious
creed, political belief or sexual preference be excluded from
participation, be denied benefits of, or be subject to discrimination
under any program or activity receiving Federal or State of
California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color,
national origin, sex, religion, age, disability status, or sexual
preference in employment practices. Such practices include
retirement, recruitment advertising, hiring, layoff, termination,
Exhibit A
Page 190 of 217
upgrading, demotion, transfer, rates of pay or other forms of
compensation, use of facilities, and other terms and conditions of
employment.
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all
further funds, until CONTRACTOR can show clear and convincing
evidence to the satisfaction of COUNTY that funds provided under
this Agreement were not used in connection with the alleged
discrimination.
D. Nepotism
Except by consent of COUNTY's Department of Behavioral Health
Director, or designee, no person shall be employed by
CONTRACTOR who is related by blood or marriage to, or who is a
member of the Board of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations,
including but not limited to, laws, regulations, and State policies relating to
patients'rights
Exhibit A
Page 191 of 217
Medi-Cal Organizational Provider Standards
1. The organizational provider possesses the necessary license to operate, if
applicable, and any required certification.
2. The space owned, leased or operated by the provider and used for services or staff
meets local fire codes.
3. The physical plant of any site owned, leased, or operated by the provider and used
for services or staff is clean, sanitary and in good repair.
4. The organizational provider establishes and implements maintenance policies for
any site owned, leased, or operated by the provider and used for services or staff to
ensure the safety and well being of beneficiaries and staff.
5. The organizational provider has a current administrative manual which includes:
personnel policies and procedures, general operating procedures, service delivery
policies, and procedures for reporting unusual occurrences relating to health and
safety issues.
6. The organizational provider maintains client records in a manner that meets
applicable state and federal standards.
7. The organization provider has staffing adequate to allow the County to claim federal
financial participation for the services the Provider delivers to beneficiaries, as
described in Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8. The organizational provider has written procedures for referring individuals to a
psychiatrist when necessary, or to a physician, if a psychiatrist is not available.
9. The organizational provider has as head of service a licensed mental health
professional of other appropriate individual as described in Title 9, CCR, Sections
622 through 630.
10. For organizational providers that provide or store medications, the provider stores
and dispenses medications in compliance with all pertinent state and federal
standards. In particular:
A. All drugs obtained by prescription are labeled in compliance with federal and
state laws. Prescription labels are altered only by persons legally authorized to
do so.
B. Drugs intended for external use only or food stuffs are stored separately from
drugs for internal use.
Exhibit A
Page 192 of 217
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86
degrees F and refrigerated drugs at 36-46 degrees F.
D. Drugs are stored in a locked area with access limited to those medical
personnel authorized to prescribe, dispense or administer medication.
E. Drugs are not retained after the expiration date. IM multi-dose vials are dated
and initialed when opened.
F. A drug log is maintained to ensure the provider disposes of expired,
contaminated, deteriorated and abandoned drugs in a manner consistent with
state and federal laws.
G. Policies and procedures are in place for dispensing, administering and storing
medications.
11. For organizational providers that provide day treatment intensive or day
rehabilitation, the provider must have a written description of the day treatment
intensive and/or day treatment rehabilitation program that complies with State
Department of Health Care Service's day treatment requirements. The COUNTY
shall review the provider's written program description for compliance with the State
Department of Health Care Service's day treatment requirements.
12. The COUNTY may accept the host county's site certification and reserves the right
to conduct an on-site certification review at least every three (3) years. The
COUNTY may also conduct additional certification reviews when:
• The provider makes major staffing changes.
• The provider makes organizational and/or corporate structure changes
(example: conversion from a non-profit status).
• The provider adds day treatment or medication support services when
medications shall be administered or dispensed from the provider site.
• There are significant changes in the physical plant of the provider site (some
physical plant changes could require a new fire clearance).
• There is change of ownership or location.
• There are complaints against the provider.
• There are unusual events, accidents, or injuries requiring medical treatment
for clients, staff or members of the community.
Exhibit A
Page 193 of 217
Fresno County Mental Health Plan
Grievances and Appeals Process
Grievances
The Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance
and appeal process and an expedited appeal process to resolve grievances and
disputes at the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-for-
service providers to give verbal and written information to Medi-Cal beneficiaries
regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
their clients copies of all current beneficiary information annually at the time their
treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self-addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Exhibit A
Page 194 of 217
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process— the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process— the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for MHP
payment authorization, or the process or payment of a provider's claim to the MHP.
Payment authorization issues— the provider may appeal a denied or modified request
for payment authorization or a dispute with the MHP regarding the processing or
payment of a provider's claim to the MHP. The written appeal must be submitted to the
MHP within ninety (90) calendar days of the date of the receipt of the non-approval of
payment.
The MHP shall have sixty (60) calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the decision
that addresses each issue raised by the provider, and any action required by the
provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request, the
MHP utilizes Managed Care staff who were not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within thirty (30) calendar days of receipt of the
decision
Other complaints— if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the MHP. The provider will receive a written response from the MHP within sixty (60)
calendar days of receipt of the complaint. The decision rendered buy the MHP is final.
Exhibit A
Page 195 of 217
FRESNO COUNTY MENTAL HEALTH PLAN
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit A
Page 196 of 217
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) Where did this happen?
Name/DMH#
1. Background information of the incident:
2. Method of investigation: (chart review,face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses,visitors, physicians,employees)
3. Preliminary findings: How did it happen?Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent �❑ inconsequential El consequential death not applicable �❑ unknown El
4. Response: a)corrective action, b)Plan of Action, c)other
Completed by(print name)
Completed by(signature) Date completed
Reviewed by Supervisor(print name)
Supervisor Signature Date
Exhibit A
Page 17
Vendor: Contract# Contact Person Contact#
a e a e Fresno
Item Make/Brand ' Mod Serial# k y y m Requested Approved( Purchase Location Condition County Cost
c (If Fixed If Fixed Date Inventory
v) I I Number
a�
n
m Copier Canon 27CRT 9YHJY65R x 3/27/2008 4/1/2008 4/10/2008 Heritage New $6,500.00
x
w
m
Q
E DVD Player Sony DV2230 PXC4356A n/a 4/1/2008 Heritage New $ 0
x
w
Date Prepared:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Exhibit A
PageqWf�17
23
24
25
Date Received:
Exhibit J-1
FIXED ASSET AND SENSI TI VE ITEM TMCM NG E)hibit A
f 217
Fi el d Nurrber Fi el d Description I nst r uct i on or Commnt s Requi red or Condi t i onal
Header Vendor I ndi cat e t he I egal narre of t he agency cont r act ed t o Requi red
pr ovi de ser vi ces.
Header Pr ogr am I ndi cat e the title of the project as described in the Requi red
cont r act wi t h t he Count y.
Header Cont r act # I ndi cat e t he assi gned Count y cont r act nurrber. I f not Requi red
known, County st of f can pr ovi de.
Header Contact Person I ndi cat a the first and last narre of the pr i nar y agency Required
contact for the contract .
Header Cont act # I ndi cat e t he rrnst appr opr i at e t el ephone nurrber of t he Requi red
pr i rrar y agency cont act f or t he cont r act .
Header Date Prepared I ndi cat e t he rrost cur r ent dat e t hat t he t r acki ng form Requi red
was corrpl et ed by the vendor .
a Item I dent i f y t he i t em by pr ovi di ng a comronl y recognized Requi red
descr i pt i on of the item
b IVbke/ Brand I dent i f y t he company t hat rranuf act ur ed t he i t em Requi red
c IVbdel I dent i f y t he rrodel number f or t he i t ern i f appl i cable. Condi t i onal
d Ser i al # I dent i f y t he ser i al nurrber f or t he i t ern i f appl i cabl e. Condi t i onal
IVbr k t he box wi t h an "X' i f t he cost of t he i t em i s
e Fi xed Asset $5, 000 or rnor e to i ndi cat e that the i t em i s a fixed Condi t i onal
asset .
IVI�r k the box with an "X' if the item rreet s the cr i t er i a
f Sensitive Item of a sensi t i ve i t em as def i ned by t he Count y. Conditional
g Dat a Request ed I ndi cat e t he dat e t hat t he agency subrri t t ed a request Requi red
to the County to purchase the item
h Date Approved I ndi cat e t he dat e t hat t he Count y approved t he request Required
to purchase t he i t em
i Purchase Date I ndi cat a the dat e t he agency purchased t he i t em Requi red
j Locat i on I ndi cat e the physi cal I ocat i on of t he i t em Required
k Condi t i on I ndi cat e the general condi t i on of t he i t em ( New, Good, Requi red
Mr n, Bad) .
Fresno County
I Inventory I ndi cat e t he FR # provided by the County for the item Condi t i onal
Nurrber
m Cost I ndi cat e t he t of al pur chase pr i ce of t he i t em i ncl udi ng Requi red
sales tax and other costs, such as shi ppi ng.
Exhibit K
Paghlib°f 4
National Standards for Culturally and Linguistically Page 200 of 217
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse
cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,
practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are
responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and
practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at
no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,
verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals
and/or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the
populations in the service area.
Engagement, Continuous Improvement, and Accountability:
9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them
throughout the organization's planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into
measurement and continuous quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health
equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement
services that respond to the cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural
and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent,
and resolve conflicts or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and
the general public.
Exhibit B
Page F-Wibit A
The Case for the Enhanced National CLAS Standards Page 201 of 217
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
—Dr. Martin Luther King, Jr.
Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human
Services [HHS] Office of Minority Health, 2011). Currently, individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of
health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease Prevention
and Health Promotion, 2010). Though health inequities are directly related to the existence of historical and current
discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate
services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of
all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely
affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but
also a public health concern. In the United States, it has been estimated that the combined cost of health disparities and
subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin, & Richard, 2009).
Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care
and services (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CLAS Standards will improve an organization's ability to address
health care disparities.
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities
(HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to
End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide
collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the
enhanced National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and
linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the
United States.
Bibliography:
Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ
Publication No.04-E008-02).Retrieved from the Agency of Healthcare Research and Quality website:
http://www.a h rq.gov/down loads/pub/evidence/pdf/m i nq ua l/m i nq ua I.pdf
Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).
Retrieved from The Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
LaVeist,T.A.,Gaskin,D.J.,&Richard,P.(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic
Studies website: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and
Human Services,Office of Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.
Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved
from http://www.healthypeople.gov/2020/topicsobjectives2O2O/overview.aspx?topicid=39
U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from
http://minorityhealth.hhs.gov/npa
World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
Exhibit A
Page 202 of 217
CULTURAL COMPETENCE FORM
Agency Name:
Program Category:
Identify the Agency's ability to apply language, gender, and culturally specific competencies to the services
provided by checking all that apply and/or provide the name of Agency that you have an arrangement with to
respond to these referrals.
A B C
Language, Gender, and/or Have staff Name of Agency that you have an
Cultural Competence 1 2 arrangement with to respond to
Included in Not included these referrals
staffing in staffing
work plan work plan.
Explain
below
Spanish (Language
Vietnamese (Language
Other Language:
LGBT Staff
African American Staff
Latino Staff
Native American Staff
Asian American Staff
Pacific Islander Staff
Others:
Exhibit A
Page 203 of 217
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) City State ZIP code
CLIA number Taxpayer ID number(EIN) /Telephone number
l )
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVIII, XIX, or XX? ......................................................................................................................... o 0
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVI 11, XIX, or XX?...................................................................................... n n
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 71
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under"Remarks."
NAME ADDRESS EIN
B. Type of entity: n Sole proprietorship n Partnership o Corporation
71 Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... >
71
NAME ADDRESS PROVIDER NUMBER
Exhibit A
Page 204 of 217
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... n n
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... n n
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ n n
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
Exhibit A
Page 205 of 217
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit A
Page 206 of 217
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) (d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)
Exhibit A
Page 207 of 217
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County'),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit A
Page 208 of 217
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3) Disclosure(Please describe the nature of the self-dealing transaction you are a party to)
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a)
(5)Authorized Signature
Signature: Date:
CENTRAL CALIFORNIA EMERGENCY Exhibit A
Page 209 of 217
MEDICAL SERVICES
A Division of the Fresno County Department of Public Health
Manual Policy
Emergency Medical Services Number 547
Administrative Policies and Procedures
Page 1 of 9
Subject Patient Destination
References Title 13, Section 1106 of the California Code of Regulations Effective:
Title 22, Division 9, Chapter 7 of the California Code of Regulations 04/18/83
I. POLICY
Patients of the Prehospital EMS System shall be transported to an appropriately staffed and equipped hospital.
II. MEDICAL PATIENT DESTINATION
A. Medical Patients shall be transported to the appropriate destination in accordance with the following chart:
Fresno County Kings County Madera County Tulare County
Medical—Adult
Non-emergent Patient's Choice Patient's Choice Patient's Choice Patient's Choice
Life-threatening Closest Appropriate Closest Appropriate Closest Appropriate Closest Appropriate
Regional Medical Kaweah Health Medical Regional Medical Kaweah Health Medical
Acute current of injury Center or St.Agnes Center or Regional Center or St.Agnes Center or Regional
(acute MI) Medical Center Medical Center Medical Center Medical Center
(Quickest travel time) (Quickest travel time) (Quickest travel time) (Quickest travel time)
Medical—Pediatric(14 years or younger)
Stable Patient/Family Choice Patient/Family Choice Patient/Family Choice Patient/Family Choice
Kaweah Health Medical
RMC or VCH*** RMC or VCH * * RMC or VCH *** Center or
Unstable (Quickest travel time) (Quickest travel time) (Quickest travel time) Sierra View District
Hospital
(Quickest travel time)
5150 patients
CSC or Patient's Choice
5150-Adult within Fresno County Patient's Choice within Patient's Choice within Patient's Choice within
(See criteria on page 4) Kings County Madera County Tulare County
YCSU or Patient/Family
5150—Children (<18 Choice within Fresno Patient/Family Choice Patient/Family Choice Patient/Family Choice
yrs) County within Kings County within Madera County within Tulare County
(See criteria on page 4)
Kaiser Kaiser N/A N/A N/A
Veteran's Administration Veteran's Administration N/A N/A N/A
*** If transport time is greater than 60 minutes, base hospital contact shall be made to determine appropriate destination.
Approved By Daniel J. Lynch Revision
EMS Division Manager (Signature on File at EMS Agency 3/14/2022
Jim Andrews, M.D.
EMS Medical Director (Signature on File at EMS Agency)
Exhibit A
Page 210 of 217
Page 2 of 9
Subject: Policy
Patient Destination Number: 547
B. Medical Patient Destination —Considerations
1. In a non-emergent situation (as determined by the EMT or Paramedic at the scene and/or the
Base Hospital Physician/MICN giving medical direction), the patient will be taken to the receiving
hospital of his/her choice. If the patient is unable to determine this, the hospital designated by the
private physician and/or patient's family member will be utilized. Paramedics and EMTs should
determine where the patient normally receives their medical care and encourage the patient to
return to that hospital for medical care as long as the patient's medical condition allows for such
transport.
2. The Paramedic/EMT/MICN/BHP should only provide the patient with alternatives for destination
of patient choice. It is inappropriate for the Paramedic/EMT/MICN/BHP to endorse specific
facilities or provide personal opinion on the quality of local facilities.
3. Health Plans - If the patient is a member of a health plan with a preferred hospital, an attempt
should be made to transport the patient to a participating facility.
4. Closest Appropriate Hospital
a. The closest appropriate hospital is defined as the closest emergency department
"equipped, staffed, and prepared to administer care appropriate to the needs of the
patient" (California Code of Regulations, Title 13, Section 1106 (b) 2).
b. Closest is defined as the shortest travel time not necessarily the closest by distance.
C. The Base Hospital Physician will have the ultimate authority for patient destination.
d. The closest appropriate hospital does not mean that critically ill patients always go to the
closest"receiving" hospital. They go to the closest"appropriate" hospital. The following
guidelines will help to define "appropriate":
1) Due to short transport times, the appropriate receiving facility for a life-
threatening medical situation would be a hospital with a basic emergency service
(holds a special services permit from the California State Department of Health
Services). Hospitals with basic emergency services are:
a) Adventist Health Hanford (AH-H)
b) Adventist Health Tulare (AH-T)
c) Clovis Community Medical Center(CCMC)
d) Kaiser Permanente Hospital (KPH)
e) Kaweah Health Medical Center(KHMC)
f) Madera Community Hospital (MCH)
g) Regional Medical Center(RMC)
h) Saint Agnes Medical Center(SAMC)
i) Sierra View District Hospital (SVDH)
j) Valley Children's Hospital (VCH)
2) Rural Areas - Due to prolonged travel times to the urban area, the appropriate
receiving hospital for a life-threatening medical situation would be a hospital with
a standby emergency service (holds a special services permit from the California
State Department of Health Services). Hospitals with stand-by emergency
services that are approved to receive ambulances are:
a) Adventist Health Reedley (AH-R)
b) Adventist Health Selma (AH-S)
c) Coalinga Regional Medical Center(CRMC)
Exhibit A
Page 211 of 217
Page 3 of 9
Subject: Policy
Patient Destination Number: 547
5. Acute Cardiac Emergency
In the event of an acute current of injury, transport should be to a designated cardiac center,
which has 24/7 interventional heart catheterization capabilities. The following is a list of readings
from various cardiac monitors that would require transport to a designated cardiac center:
• ***ACUTE MI *** (Zoll Monitor E Series)
• ***STEMI*** (Zoll Monitor X Series))
• ***ACUTE MI SUSPECTED*** (Physio-Control Monitor LifePak 12)
• ***MEETS ST ELEVATION MI CRITERIA*** (Physio-Control Monitor LifePak 15)
The designated cardiac centers in the CCEMSA region are:
• Regional Medical Center
• Kaweah Health Medical Center
• Saint Agnes Medical Center
Transport shall be to the cardiac center that has the quickest transport time if transport time is
less than 60 minutes. If transport time is greater than 60 minutes, then transport to the closest
appropriate facility or consider helicopter rendezvous. Destination is determined by:
a. Interpretation of 12-lead ECG; or
b. Base Hospital consultation if required.
6. Patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an advanced airway or
OPA, this is not an unstable airway.
b. Any patient with CPR in progress.
C. Any critically ill or unstable patient when Base Hospital contact is not possible (i.e.,
Paramedic or EMT must make the ultimate destination decision).
7. Patients who go to a non-receiving hospital:
Patients may be transported to a non-receiving hospital only when the Base Hospital has
contacted the receiving doctor and received assurance of immediate acceptance of the patient.
Such assurance should then be documented on the Base Hospital run form.
8. Patients who go to a receiving hospital, which is not closest:
Unstable patients who request this hospital and, in the opinion of the Base Hospital Physician,
the extra travel time is not dangerous to the patient
Exhibit A
Page 212 of 217
Page 4 of 9
Subject: Policy
Patient Destination Number: 547
C. Fresno County 5150 Holds—Considerations
1. Fresno County 5150 patient criteria for transport Crisis Stabilization Center(CSC)Youth Crisis
Stabilization Unit(YCSU):
a. If the patient meets the following criteria, he/she shall be transported directly to Crisis
Stabilization Center(CSC) if age 18 or greater; or the Youth Crisis Stabilization Unit
(YCSU) if under 18 years of age:
• No urgent medical complaint or evidence of acute medical/surgical/trauma problem
requiring urgent treatment prior to psychotic admission.
• No alteration in mental status due to dementia or delirium.
• Glasgow Coma Score 14 or 15.
• Complete vital signs within limits (HR, RR, BP and GCS).
• Not febrile to palpation/measurement.
• Under the influence of alcohol or drugs, patient can walk without assistance and is
able to follow verbal commands (does not apply to YCSU).
1) Adults:
a) Pulse: 50-120 bpm
b) Systolic Blood Pressure: 100-180 mm Hg
c) Diastolic Blood Pressure: less than 120 mm Hg
d) Respiratory Rate: 12-30
2) Pediatrics:
a) Vital signs appropriate for children (policy 530.32).
NOTE: Refer to the Criteria for Transporting a Fresno County 5150 Patient Directly to
Crisis Stabilization Center(CSC)or Youth Crisis Stabilization Unit(YCSU)
Screening Form attached to this policy.
Patients that Crisis Stabilization Center(CSC) and Youth Crisis Stabilization Unit (YCSU)
cannot accept:
• Patients with dementia or delirium.
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use,
catheters, wired devices, etc.).
• Patients in wheelchairs that cannot move independently.
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires
anything more that once daily dry gauze and tape dressing.
b. All other patients on a 5150 hold in Fresno County not meeting the above criteria will be
transported to Patient/Family Choice within Fresno County.
C. Patients placed on a 5150 hold are to be transported to facilities within the county where
the 5150 hold was initiated.
d. The 5150 destination policy does not apply to psychiatric patients who are voluntarily
requesting evaluation (not on a 5150 hold). If the patient is not on a 5150 hold, then
transport will be to a receiving facility of their choice, which includes CSC or YCSU
(Fresno County only) if patient meets criteria within this policy.
e. Kaiser Permanente patients on a 5150 hold are to be transported to that facility.
f. Veteran's Administration patients on a 5150 hold are to be transported to that facility.
Exhibit A
Page 213 of 217
Page 5 of 9
Subject: Policy
Patient Destination Number: 547
D. Veteran's Administration
1. The Veteran's Administration emergency department will accept all patients with a Veterans
Administration (VA) Identification Card or active-duty Department of Defense (DOD) Card (Patient
Name Only, no dependent(s). Name of patient on card must be the patient requesting transport).
No prior approval or Base Hospital contact is necessary. If the patient requests transport to
Veterans Administration emergency department and does not have the identification noted
above, contact the VA Emergency Department directly for prior approval before the patient is
transported. The complete name and the full social security number will be required. Contact the
Veteran's Administration on Med 6 or 241-3600.
2. Patients that cannot be transported directly to the Veteran's Administration are:
• Cardiac arrest due to trauma
• Pediatric cardiac arrest
• Trauma Center Triage Criteria
• OB patient in active labor
• Gynecological complaints and known obvious pregnancy with vaginal bleeding
• ST-segment elevation myocardial infarction (STEMI)
NOTE: INTERFACILITY TRANSPORTS ARE NOT MANAGED THROUGH THIS PROCEDURE.
III. TRAUMA PATIENT DESTINATION
A. Trauma patients shall be transported to the appropriate closet facility in accordance with the following chart:
0 F-5,
ss Physiological Criteria
ystolic Blood Pressure:
o Adults: <90 mm Hg
o Pediatrics: <80 mm Hg with signs
and symptoms of shock(Refer to EMS
Policy 530.32 for estimated weight
formulas or use Broselow Tape)
• Respiratory Rate:
o Adults: <10 or>30 RMC or KHMC
o Children: <20 if under age 1 VCH(14 years or age or less)
•Glasgow Coma Score<13(or,in patients whose (Consider air transport)
normal GCS is less than 15,or a decrease of two
or more of the patients GCS score)
• Penetrating injury to the head
• Paraplegia
• Quadriplegia
Assess Anatomy of Injury
• Penetrating injuries to neck or torso RMC or KHMC
• Flail chest VCH(14 years or age or less)
• Two or more proximal long-bone fractures (Consider air transport)
• Amputation proximal to wrist or ankle 00
TRAUMA DESTINATION CHART
Exhibit A
Page 214 of 217
Page 6 of 9
Subject: Policy
Patient Destination Number: 547
Assess Burns
STABLE TRAUMA PATIENTS WITH:
• Partial/Full thickness burns>10%TBSA
• Partial/Full thickness circumferential burns RMC
• Partial/Full thickness burns to face,hands,feet, IRWIN 1 11 (Consider air transport)
major joints,perineum,or genitals
• Electrical burns with voltage>120 volts
• Chemical burns>10%TBSA
Assess Mechanism of Injury
• Falls
o Adults: >20 ft.(one story=10 ft.) RMC or KHMC
o Children: >10 ft.or 3 times height of the VCH(14 years of age or less)
child (Consider air transport)
Assess Special Considerations
WITH A SIGNIFICANT COMPLAINT:
• Age greater than 55 years
• Anticoagulation or bleeding disorders Consider transport to
• Pregnancy greater than 20 weeks RMC or KHMC
• Auto vs.Pedestrian>20 mph VCH(14 years of age or less)
• Motorcycle crash>20 mph
Paramedic/Flight Nurse Judgment
Consider RMC or KHMC
WITH A SIGNIFICANT COMPLAINT VCH(14 years of age or less)
Base Hospital Consultation
SIGNIFICANT COMPLAINT
Transport According to Policy
Perseveration
Deteriorating mental status
Severe chest pain
Severe shortness of breath
Severe abdominal pain
Sustained,overwhelming"Feeling of Doom"
Exhibit A
Page 215 of 217
Page 7 of 9
Subject: Policy
Patient Destination Number: 547
NOTE: If transport time is greater than 60 minutes for patients meeting trauma triage criteria, base
hospital contact shall be made to determine appropriate destination.
NOTE: If transport time is greater than 2 hours for patients meeting burn triage criteria, base hospital
contact shall be made to determine appropriate destination.
B. Triage Criteria
Triage criteria will determine if the patient will be transported to a trauma center or closest receiving
hospital.
C. Trauma Patient Destination —Considerations
1. If the patient is in cardiac arrest from penetrating trauma in the greater Fresno or Visalia
metropolitan area, the patient should be transported to Regional Medical Center, Kaweah Health
Medical Center or Valley Children's Hospital, bypassing a closer receiving facility. However, if the
transport time to Regional Medical Center, Kaweah Health Medical Center, or Valley Children's
Hospital is greater than ten (10) minutes, then transport should be to the closest receiving facility
within ten minutes transport time (Refer to EMS Policy#550).
2. Trauma patients, meeting trauma center criteria, who have a transport time greater than 60
minutes to the trauma center, will require base hospital contact for destination decision.
3. The following types of incidents should be consideration for transport to the designated Trauma
Center, based upon paramedic judgment:
a. Motorcycle Crash - Non-ambulatory with potential of significant injuries
b. Auto versus Pedestrian - Non-ambulatory with potential of significant injuries
NOTE:Paramedic judgment is based upon the paramedic's own knowledge and experience to determine
if the patient's condition would require transport to a designated Trauma Center due the mechanism of
injury and potential underlying injuries. The Paramedic may contact a Base Hospital for advice on
destination.
4. Transport of Trauma Patients by Helicopter
A trauma patient should not be transported by helicopter unless they meet trauma triage criteria
to be transported to a trauma center or the patient is inaccessible by ambulance (i.e., wilderness
transports). EXCEPTION: When the paramedic feels helicopter transport of the patient would be
beneficial to the outcome of the patient.
5. Burn Patients
The following patients should be transported directly to the Regional Burn Center(Regional
Medical Center) bypassing other hospitals if ETA to Regional Medical Center is within two hours.
a. Patients with 20(partial thickness) or 30(full thickness) burns that are more than 10%
total body surface area
b. Patients with 20(partial thickness) or 31, (full thickness) circumferential burns of any body
part
C. Patients with 20(partial thickness) or 30(full thickness) burns to face, hands, feet, major
joints, perineum, or genitals
d. Electrical burns with voltage greater than 120 volts
e. Patients with chemical burns greater than 10% total body surface area.
Exhibit A
Page 216 of 217
Page 8 of 9
Subject: Policy
Patient Destination Number: 547
6. Carbon Monoxide Poisoning - Early call-ins to Regional Medical Center should be made for
patients that appear to have significant exposure to carbon monoxide poisoning (altered mental
status, vomiting, and headaches).
7. Trauma patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS
airway). Example: If the patient can be bagged via a BVM without an ET Tube or OPA,
this is not an unstable airway.
b. Any patient with CPR in progress (refer to EMS Policy#550).
C. Any critically injured or unstable patient when Base Hospital contact is not possible
(i.e., Paramedic or EMT must make the ultimate destination decision).
IV. PATIENTS WHO REFUSE TRANSPORT TO THE APPROPRIATE HOSPITAL
A Base Hospital shall be contacted for the purpose of physician consultation on patients who meet one or more of
the triage criteria and refuse transport to the appropriate hospital. This will usually not be a problem with the
acutely ill patient. However, some patients with normal mental status may wish to be transported to a different
hospital than the one selected via the triage criteria. These situations should be treated as "Refusal of Medical
Care and/or Transportation" situation (refer to EMS Policy#546). The Base Hospital Physician, after radio
contact, may allow the patient to go to the destination of their choice, have a "Refusal of Medical Care and/or
Transportation " signed or insist on transport to the designated hospital.
V. SPECIAL CONSIDERATION FOR FRESNO HEART & SURGICAL HOSPITAL DESTINATION
While the Fresno Heart& Surgical Hospital is a hospital within Central California EMS Region, it does not have
an emergency department and is not an approved facility for patient transports within EMS Policy and
Procedures. Patients who are requesting transport to the Fresno Heart& Surgical Hospital from the prehospital
setting will require Base Hospital contact to confirm acceptance. Since the Fresno Heart & Surgical Hospital is
under the Community Medical Center organization, EMS personnel should contact Regional Medical Center
when requesting transport to the Fresno Heart & Surgical Hospital. If attempts to contact Regional Medical
Center are unsuccessful, EMS personnel should contact another Base Hospital. Interfacility transfers involving
the Fresno Heart& Surgical Hospital shall be in accordance with EMS Policy#553, "ALS Interfacility
Transports".
Exhibit A
Page 217 of 217
Central California EMS Agency
Criteria for Transporting a Fresno County 5150/Psychiatric Patient
Directly to CSC or YCSU Screening Form
Patient's Name: EMS#:
Patient has urgent medical complaint or evidence of acute medical/surgical problem.
[] True—transport Patient/Family Choice [] False
Patient has alteration in mental status due to dementia or delirium.
[] True—transport Patient/Family Choice [] False
Patient has a Glasgow Coma Score 13 or less.
[] True—transport Patient/Family Choice [] False
There are lacerations with a gap of greater than 2 mm or fat/muscle visible in the wound (excludes any
type of stab wound).
[] True—transport Patient/Family Choice [] False
There are lacerations or wounds inflicted by others.
[] True—transport Patient/Family Choice [] False
Complete vital signs are within limits:
Adults:
Pulse outside range of 50-120. [] True—transport Patient/Family Choice [] False
Systolic Blood Pressure outside range of 100-180. [] True—transport Patient/Family Choice [] False
Diastolic Blood Pressure greater than 120. [] True—transport Patient/Family Choice [] False
Respiratory Rate outside range of 12-30. [] True—transport Patient/Family Choice [] False
Pediatrics:
Vital signs inappropriate for children
(Policy 530.32) [] True—transport Patient/Family Choice [] False
Patient is febrile to palpation/measurement.
[] True—transport Patient/Family Choice [] False
Is patient under the influence of alcohol or drugs?
[] Yes No
If yes, to under the influence of alcohol or drugs, does patient require assistance to walk?
[] True—transport Patient/Family Choice [] False
If all of the above answers are False, patient may be transported to CSC/YCSU; otherwise, transport is
Patient/ Family Choice.
Patients that Crisis Stabilization Center(CSC) or Youth Crisis Stabilization Unit (YCSU) cannot accept:
• Patients with dementia or delirium
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use, catheters,
wired devices, etc.)
• Patients in wheelchairs that cannot move independently
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires anything more
than once daily dry gauze and tape dressing
Exhibit B
Agreement No. 17-580 Pac e 1 of 105
1 AGREEMENT
2 THIS AGREEMENT is made and entered into this fourteenth day of November 2017, by and
3 between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and CENTRAL STAR BEHAVIORAL HEALTH,INC., a for-profit
5 corporation, whose business address is 1501 Hughes Way, Suite 150, Long Beach, CA, 90810,
6 hereinafter referred to as "CONTRACTOR".
7 WITNESSETH:
8 WHEREAS, COUNTY,through its Department of Behavioral Health (DBH), is in need of a
9 qualified agency to operate its fifteen (15)bed crisis residential treatment(CRT)facility to provide
10 psychiatric services to adult clients who may be admitted on a voluntary basis and may include Medi-
11 Cal beneficiaries,Medicare and Medicare/Medi-Cal beneficiaries, and indigent/uninsured clients who
12 are referred by DBH,DBH contract providers, Institutes of Mental Disease (IMD's), emergency
13 psychiatric services, hospital emergency rooms, and other COUNTY departments and other agencies.
14 WHEREAS, COUNTY,through its DBH, is a Mental Health Plan(MHP), as defined in Title 9
15 of the California Code of Regulations (C.C.R.), Section 1810.226; and
16 WHEREAS, CONTRACTOR is qualified and willing to provide services required by COUNTY,
17 pursuant to the terms and conditions of this Agreement.
18 NOW, THEREFORE, in consideration of their mutual covenants and conditions,the parties
19 hereto agree as follows:
20 1. SERVICES
21 A. CONTRACTOR shall perform all services and fulfill all responsibilities as set forth
22 in Exhibit A,"Crisis Residential Treatment Service Program Scope of Work,"attached hereto and by this
23 reference incorporated herein and made part of this Agreement.
24 B. CONTRACTOR shall also perform all services and fulfill all responsibilities as
25 specified in COUNTY's Request for Proposal (RFP)No. 18-005 dated August 16, 2017, and Addendum
26 No. One (1)to COUNTY's RFP No. 18-005 dated August 30, 2017, herein collectively referred to as
27 COUNTY's Revised RFP No. 18-005, and CONTRACTOR's response to said Revised RFP dated
28 September 19, 2017, all incorporated herein by reference and made part of this Agreement. In the event
- 1 - COUNTY OF FRESNO
Fresno, CA
Exhibit B
Page 2 of 105
of any inconsistency among these documents, the inconsistency shall be resolved by giving precedence
in the following order of priority: 1)to this Agreement, including all Exhibits; 2) to the Revised RFP;
and 3)to the Response to the Revised RFP. A copy of COUNTY's Revised RFP No. 18-005 and
CONTRACTOR's response thereto shall be retained and made available during the term of this
Agreement by COUNTY's DBH Contracts Division.
C. It is acknowledged by all parties hereto that COUNTY's DBH Contracts Division
unit shall monitor the CRT Program operated by CONTRACTOR, in accordance with Section Fourteen
(14) of this Agreement.
D. CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
consisting of staff from COUNTY's DBH to discuss service requirements, data reporting, training,
policies and procedures, overall program operations and any problems or foreseeable problems that may
arise.
E. CONTRACTOR's affiliate Star View Children and Family Services, Inc., a non-
profit Internal Revenue Code section 501 (c)(3) corporation, shall execute a mutually agreeable lease
agreement with COUNTY for the lease of COUNTY-owned property located at 496 S. Barton, Fresno,
CA 93702, as the site for CONTRACTOR's provision of CRT services under this Agreement. If
CONTRACTOR or CONTRACTOR's affiliate fails to accomplish these tasks prior to providing
services under this Agreement, COUNTY may, in addition to other remedies it may have, suspend
referrals or terminate this Agreement, in accordance with Section Three (3) of this Agreement.
F. CONTRACTOR shall maintain requirements as an organizational provider
throughout the term of this Agreement, as described in Section Seventeen(17) of this Agreement. If for
any reason, this status is not maintained, COUNTY may terminate this Agreement pursuant to Section
Three (3) of this Agreement.
G. CONTRACTOR agrees that prior to, and while providing services under the
terms and conditions of this Agreement, CONTRACTOR shall have staff hired and in place for program
services and operations or COUNTY may, in addition to other remedies it may have, suspend referrals
or terminate this Agreement, in accordance with Section Three (3) of this Agreement.
H. It is acknowledged by all parties hereto that COUNTY's DBH shall be
Exhibit B
Page 3 of 105
responsible for construction of the CRT. Payments for COUNTY DBH approved improvements to the
CRT facility during the term of this Agreement shall be at the discretion of the COUNTY's DBH
Director or designee. Improvements stated herein shall mean those improvements to the CRT
designated to assist with the operation of the CRT. The parties agree that the anticipated start date for
the CONTRACTOR's CRT to commence serving clients will be May 1, 2018.
I. It is acknowledged by all parties hereto that the ramp up period shall commence
on December 1, 2017, which is 60 days prior to the forecasted issuance of the facility's occupancy
notice and fire clearance. Due to ongoing construction with the CRT facility, the dates of the ramp up
period and initial operational period may be adjusted with the written approval of COUNTY's DBH
Director, or designee.
J. It is acknowledged by all parties hereto that landscaping,building maintenance,
and utilities for the CRT will be provided by COUNTY and COUNTY will invoice CONTRACTOR
for said services as further described in section five (5) of this Agreement.
2. TERM
This Agreement shall become effective on the 1 st day of December, 2017 and shall
terminate on the 30th day of June, 2018.
Effective July 1, 2018, this Agreement, subject to satisfactory outcomes performance and
subject to State funding each year, shall continue for an additional three (3) year term with an option for
two (2) additional twelve (12) month periods upon the same terms and conditions herein set forth, unless
written notice of non-renewal is given by COUNTY, CONTRACTOR or COUNTY's DBH Director or
designee, not later than sixty(60) days prior to the close of the then current Agreement term.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR thirty(30) days advance written notice.
B. Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
Exhibit B
Page 4 of 105
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to COUNTY;
4) Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of
any breach of this Agreement or any default which may then exist on the part of CONTRACTOR.
Neither shall such payment impair or prejudice any remedy available to COUNTY with respect to the
breach or default. COUNTY shall have the right to demand of CONTRACTOR the repayment to
COUNTY of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of
COUNTY were not expended in accordance with the terms of this Agreement. CONTRACTOR shall
promptly refund any such funds upon demand, or at COUNTY's option, such repayment shall be
deducted from future payments owing to CONTRACTOR under this Agreement.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY's DBH Director or
designee upon the giving of thirty(30) days advance written notice prior to close of the current
Agreement term.
4. COMPENSATION
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation in accordance with the Budget set forth in Exhibit B, attached hereto and by this reference
incorporated herein and made part of this Agreement.
A. Maximum Contract Amount
The maximum amount for the ramp up period (December 1, 2017 through April 30,
2018) shall not exceed Four Hundred Thirty-Five Thousand Nine Hundred Fourteen and No/100 Dollars
($435,914).
The maximum amount for the initial operational period of May 1, 2018 through June 30,
2018 shall not exceed Three Hundred Thirty-Nine Thousand Two Hundred Eighty-Two and No/100
Dollars ($339,282.00).
The maximum amount for the period of July 1, 2018 through June 30, 2019 shall not
Exhibit B
Page 5 of 105
exceed Two Million Sixty-Five Thousand Six Hundred Eight and No/100 Dollars ($2,065,608.00).
The maximum amount for the period of July 1, 2019 through June 30, 2020 shall not
exceed Two Million One Hundred Twenty-One Thousand Four Hundred Fifty-Three and No/100
Dollars ($2,121,453.00).
The maximum amount for the period of July 1, 2020 through June 30, 2021 shall not
exceed Two Million One Hundred Seventy-Four Thousand Eight Hundred Eighty-Nine and No/100
Dollars ($2,174,889.00).
The maximum amount for the period of July 1, 2021 through June 30, 2022 shall not
exceed Two Million Two Hundred Thirty-Four Thousand Eight Hundred Ninety-Five and No/100
Dollars ($2,234,895.00).
The maximum amount for the period of July 1, 2022 through June 30, 2023 shall not
exceed Two Million Two Hundred Ninety-Five Thousand Three Hundred Thirty-Nine and No/100
Dollars ($2,295,339.00).
In no event shall the maximum contract amount for all the services provided by the
CONTRACTOR to COUNTY under the terms and conditions of this Agreement be in excess of Eleven
Million Six Hundred Sixty-Seven Thousand Three Hundred Eighty and No/100 Dollars
($11,667,380.00) during the total term of this Agreement.
B. If CONTRACTOR fails to generate the Medi-Cal revenue and/or client fee
reimbursement amounts set forth in Exhibit B, the COUNTY shall not be obligated to pay the difference
between these estimated amounts and the actual amounts generated.
It is further understood by COUNTY and CONTRACTOR that any Medi-Cal revenue
and/or client fee reimbursements above the amounts stated herein will be used to directly offset the
COUNTY's contribution of COUNTY funds identified in Exhibit B. The offset of funds will also be
clearly identified in monthly invoices received from CONTRACTOR as further described in Section Five
(5) of this Agreement.
Travel shall be reimbursed based on actual expenditures and mileage reimbursement shall
be at CONTRACTOR's adopted rate per mile, not to exceed the Federal Internal Revenue Services (IRS)
published rate.
Exhibit B
Page 6 of 105
Payment shall be made upon certification or other proof satisfactory to COUNTY's DBH
that services have actually been performed by CONTRACTOR as specified in this Agreement.
C. It is understood that all expenses incidental to CONTRACTOR's performance of
services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails to comply
with any provision of this Agreement, COUNTY shall be relieved of its obligation for further
compensation.
D. Payments shall be made by COUNTY to CONTRACTOR in arrears, for services
provided during the preceding month, within forty-five (45) days after the date of receipt and approval by
COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments shall be made
after receipt and verification of actual expenditures incurred by CONTRACTOR for monthly program
costs, as identified in Exhibit B, in the performance of this Agreement and shall be documented to
COUNTY on a monthly basis by the tenth (10t') of the month following the month of said expenditures.
The parties acknowledge that the CONTRACTOR will be performing hiring, training, and credentialing
of staff, configuring the facility and office space, and obtaining site certification from the COUNTY
Mental Health Plan(Mental Health Plan).
E. COUNTY shall not be obligated to make any payments under this Agreement if
the request for payment is received by COUNTY more than sixty(60) days after this Agreement has
terminated or expired.
All final invoices and/or any final budget modification requests shall be submitted by
CONTRACTOR within sixty(60) days following the final month of service for which payment is
claimed. No action shall be taken by COUNTY on claims submitted beyond the sixty(60) day closeout
period. Any compensation which is not expended by CONTRACTOR pursuant to the terms and
conditions of this Agreement shall automatically revert to COUNTY.
F. The services provided by CONTRACTOR under this Agreement are funded in
whole or in part by the State of California. In the event that funding for these services is delayed by the
State Controller, COUNTY may defer payments to CONTRACTOR. The amount of the deferred
payment shall not exceed the amount of funding delayed by the State Controller to the COUNTY. The
period of time of the deferral by COUNTY shall not exceed the period of time of the State Controller's
Exhibit B
Page 7 of 105
delay of payment to COUNTY plus forty-five (45) days.
G. CONTRACTOR shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR's deficiency discovered through the State audit
process and COUNTY utilization review during the course of this Agreement. At COUNTY's election,
the disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall
be withheld from subsequent payments to CONTRACTOR. CONTRACTOR shall not receive
reimbursement for any units of services rendered that are disallowed or denied by the Fresno County
Mental Health Plan(Mental Health Plan)utilization review process or through the DHCS cost report
audit settlement process for Medi-Cal eligible clients.
H. It is understood by CONTRACTOR and COUNTY that this Agreement is funded
with mental health funds to serve individuals with SMI, many of whom have co-occurring disorders. It is
further understood by CONTRACTOR and COUNTY that funds shall be used to support appropriately
integrated services for co-occurring disorders in the target population, and that integrated services can be
documented in crisis assessments, interventions, and progress notes documenting linkages.
5. INVOICING
A. CONTRACTOR shall invoice COUNTY in arrears by the tenth (10"') day of each
month for the prior month's actual services rendered to DBHInvoices@co.fresno.ca.us. After
CONTRACTOR renders service to referred clients, CONTRACTOR will invoice COUNTY for
payment, certify the expenditure, and submit electronic claiming data into COUNTY's electronic
information system for all clients, including those eligible for Medi-Cal as well as those that are not
eligible for Medi-Cal, including contracted cost per unit and actual cost per unit. COUNTY must pay
CONTRACTOR before submitting a claim to DHCS for Federal reimbursement for Medi-Cal eligible
clients.
B. CONTRACTOR shall submit to the COUNTY by the tenth (loth) of each month
a detailed general ledger(GL), itemizing costs incurred in the previous month. Failure to submit GL
reports and supporting documentation shall be deemed sufficient cause for COUNTY to withhold
payments until there is compliance, as further described in Section Five (5) herein.
C. If CONTRACTOR chooses to utilize the COUNTY's electronic health record
Exhibit B
Page 8 of 105
system as their own full electronic health records system, COUNTY's DBH shall invoice
CONTRACTOR in arrears by the fifth(51h day of each month for the prior month's hosting fee for
access to the COUNTY's electronic information system in accordance with the fee schedule as set
forth in Exhibit C, `Electronic Health Records Software Charges" attached hereto and incorporated
herein by reference. COUNTY shall invoice CONTRACTOR annually for the annual maintenance
and licensing fee for access to the COUNTY's electronic information system in accordance with the
fee schedule as set forth in Exhibit C. COUNTY shall invoice CONTRACTOR annually for the
Reaching Recovery fee for access to the COUNTY's electronic information system in accordance with
the fee schedule as set forth in Exhibit C. CONTRACTOR shall provide payment for these
expenditures to COUNTY's Fresno County 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. At the discretion of COUNTY's DBH Director, or designee, if an invoice is
incorrect or is otherwise not in proper form or substance, COUNTY's DBH Director, or designee, shall
have the right to withhold payment as to only that portion of the invoice that is incorrect or improper
after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to provide
services for a period of ninety(90) days after notification of an incorrect or improper invoice. If after
the ninety(90) day period, the invoice(s) is still not corrected to COUNTY DBH's satisfaction,
COUNTY's DBH Director, or designee, may elect to terminate this Agreement,pursuant to the
termination provisions stated in Section Three (3) of this Agreement. In addition, for invoices received
sixty(60) days after the expiration of each term of this Agreement or termination of this Agreement, at
the discretion of COUNTY's DBH Director, or designee, COUNTY's DBH shall have the right to deny
payment of any additional invoices received.
E. Monthly invoices shall include a client roster, identifying volume reported by
payer group clients served(including third party payer of services)by month and year-to-date, including
percentages.
F. CONTRACTOR shall submit monthly invoices and general ledgers that itemize
the line item charges for monthly program costs (per applicable budget, as identified in Exhibit B),
Exhibit B
Page 9 of 105
including the cost per unit calculation based on clients served within that month, and excluding
unallowable costs. Unallowable costs such as lobbying or political donations must be deducted from the
monthly invoice reimbursements. The invoices and general ledgers will serve as tracking tools to
determine if CONTRACTOR's program costs are in accordance with its budgeted cost, and cost per unit
negotiated by service modes compared to actual cost per unit, as set forth in Exhibit B. The actual cost
per unit will be based upon total costs and total units of service. It will also serve for the COUNTY to
certify the public funds expended for purposes of claiming Federal and State reimbursement for the cost
of Medi-Cal services and activities.
G. CONTRACTOR will remit annually within ninety(90) days from June 30, a
schedule to provide the required information on published charges for all authorized direct specialty
mental health services. The published charge listing will serve as a source document to determine the
CONTRACTOR's usual and customary charge prevalent in the public mental health sector that is used
to bill the general public, insurers or other non-Medi-Cal third party payers during the course of business
operations.
H. CONTRACTOR shall submit monthly staffing reports that identify all direct
service and support staff, applicable licensure/certifications, and full time hours worked to be used as a
tracking tool to determine if CONTRACTOR's program is staffed according to the services provided
under this Agreement.
I. CONTRACTOR must maintain such financial records for a period of seven(7)
years or until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be
responsible for any disallowances related to inadequate documentation.
J. CONTRACTOR is responsible for collection and managing data in a manner to
be determined by DHCS and the Mental Health Plan in accordance with applicable rules and
regulations. COUNTY's electronic billing system is a critical source of information for purposes of
monitoring service volume and obtaining reimbursement. CONTRACTOR must attend COUNTY's
DBH's Business Office training on equipment reporting for assets, intangible and sensitive minor assets;
COUNTY's electronic information system; and related cost reporting.
K. CONTRACTOR shall submit service data into COUNTY's electronic information
Exhibit B
Page 10 of 105
system within ten(10) calendar days from the date services were rendered. Federal and State
reimbursement for Medi-Cal specialty mental health services is based on public expenditures certified
by the CONTRACTOR.
L. CONTRACTOR must provide all necessary data to allow the COUNTY to bill
Medi-Cal, and any other third-party source, for services and meet State and Federal reporting
requirements. The necessary data can be provided by a variety of means, including but not limited to: 1)
direct data entry into COUNTY's electronic information system; 2)providing an electronic file
compatible with COUNTY's electronic information system; or 3) integration between COUNTY's
electronic information system and CONTRACTOR's information system(s).
M. If a client has dual coverage, such as other health coverage (OHC) or Federal
Medicare, the CONTRACTOR will be responsible for billing the carrier and obtaining a
payment/denial or have validation of claiming with no response ninety(90) days after the claim was
mailed before the service can be entered into the COUNTY's electronic information system.
CONTRACTOR must report all third party collections for Medicare, third party or client pay or
private pay in each monthly invoice and in the annual cost report that is required to be submitted. A
copy of explanation of benefits or CMS 1500 form is required as documentation. CONTRACTOR
must report all revenue collected from OHC, third-party, client-pay or private-pay in each monthly
invoice and in the cost report that is required to be submitted. CONTRACTOR shall submit monthly
invoices for reimbursement that equal the amount due CONTRACTOR less any funding sources not
eligible for Federal and State reimbursement. CONTRACTOR must comply with all laws and
regulations governing the Federal Medicare program, including, but not limited to: 1) the requirement
of the Medicare Act, 42 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the
Federal Centers for Medicare and Medicaid Services as they relate to participation, coverage and
claiming reimbursement. CONTRACTOR will be responsible for compliance as of the effective date
of each Federal, State or local law or regulation specified.
N. Data entry shall be the responsibility of the CONTRACTOR. The direct specialty
mental health services data must be reconciled by the CONTRACTOR to the monthly invoices
submitted for payment. COUNTY shall monitor the volume of services and cost of services entered into
Exhibit B
Page 11 of 105
the COUNTY's electronic information system. Any and all audit exceptions resulting from the
provision and reporting of specialty mental health services by CONTRACTOR shall be the sole
responsibility of the CONTRACTOR. CONTRACTOR will comply with all applicable policies,
procedures, directives and guidelines regarding the use of COUNTY's electronic information system.
O. Medi-Cal Certification and Mental Health Plan Compliance
CONTRACTOR will establish and maintain Medi-Cal certification or become
certified within ninety(90) days of the issuance of the facility's occupancy notice and fire clearance for
services to be delivered under this Agreement through COUNTY to provide reimbursable services to
Medi-Cal eligible clients. In addition, CONTRACTOR shall work with the COUNTY's DBH to
execute the process if not currently certified by COUNTY for credentialing of staff. During this
process, the CONTRACTOR will obtain a legal entity number established by the DHCS, as this is a
requirement for maintaining Mental Health Plan organizational provider status throughout the term of
this Agreement. CONTRACTOR will be required to become Medi-Cal certified prior to providing
direct specialty mental health services to Medi-Cal eligible clients and seeking reimbursement from the
COUNTY for costs associated with direct specialty mental health services. CONTRACTOR will not be
reimbursed by COUNTY for any direct specialty mental health services rendered prior to certification.
CONTRACTOR shall provide specialty mental health services in accordance with
the COUNTY's Mental Health Plan. CONTRACTOR must comply with the "Fresno County Mental
Health Plan Compliance Program and Code of Conduct" set forth in Exhibit D, attached hereto and
incorporated herein by reference and made part of this Agreement.
CONTRACTOR may provide direct specialty mental health services using
unlicensed staff as long as the individual is approved as a provider by the Mental Health Plan, is
supervised by licensed staff, works within his/her scope and only delivers allowable direct specialty
mental health services. It is understood that each service is subject to audit for compliance with Federal
and State regulations, and that COUNTY may be making payments in advance of said review. In the
event that a service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set
off from other payments due the amount of said disapproved services. CONTRACTOR shall be
responsible for audit exceptions to ineligible dates of services or incorrect application of utilization
Exhibit B
Page 12 of 105
review requirements.
6. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under
this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
CONTRACTOR's officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee,joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have no right
to control or supervise or direct the manner or method by which CONTRACTOR shall perform its work
and function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules and
regulations, if any, of governmental authorities having jurisdiction over matters which are directly or
indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely
no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
solely liable and responsible for providing to, or on behalf of, its employees all legally-required
employee benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY
harmless from all matters relating to payment of CONTRACTOR's employees, including compliance
with Social Security, withholding, and all other regulations governing such matters. It is acknowledged
that during the term of this Agreement, CONTRACTOR may be providing services to others unrelated
to COUNTY or to this Agreement.
7. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent
of all the parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to services, staffing, and responsibilities of the
CONTRACTOR , as needed, to accommodate changes in the laws relating to mental health treatment, as
set forth in Exhibit A, may be made with the signed written approval of COUNTY's DBH Director or
designee and CONTRACTOR through an amendment approved by COUNTY's Counsel and the
Exhibit B
Page 13 of 105
COUNTY's Auditor-Controller's Office.
In addition, changes to line items in the budgets, as set forth in Exhibit B, that do not
exceed 10% of the maximum compensation payable to the CONTRACTOR, and changes to the volume
of units of services/types of service units, and changes to the service rates to be provided, as set forth in
Exhibit B, may be made with the written approval of COUNTY's DBH Director, or designee. Changes
to the line items in the budget that exceed ten percent(10%) of the maximum compensation payable to
the CONTRACTOR, may be made with the signed written approval of COUNTY's DBH Director, or
designee through an amendment approved by COUNTY's Counsel and COUNTY's Auditor-
Controller's Office..
Said modifications shall not result in any change to the annual maximum compensation
amount payable to CONTRACTOR, as stated in this Agreement.
8. NON-ASSIGNMENT
No party shall assign, transfer or subcontract this Agreement nor their rights or duties
under this Agreement without the prior written consent of COUNTY.
9. HOLD-HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
defend COUNTY, its officers, agents and employees from any and all costs and expenses including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to COUNTY
in connection with the performance, or failure to perform,by CONTRACTOR, its officers, agents or
employees under this Agreement, and from any and all costs and expenses, including attorney fees and
court costs, damages, liabilities, claims and losses occurring or resulting to any person, firm or
corporation who may be injured or damaged by the performance, or failure to perform, of
CONTRACTOR, their officers, agents or employees under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal and/or State of California
audit exceptions resulting from noncompliance herein on the part of CONTRACTOR.
10. INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or
any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and affect the
Exhibit B
Page 14 of 105
following insurance policies throughout the term of this Agreement:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million
Dollars ($2,000,000)per occurrence and an annual aggregate of Five Million
Dollars ($5,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverage including completed operations,product
liability, contractual liability, Explosion, Collapse, and Underground(XCU), fire
legal liability or any other liability insurance deemed necessary because of the
nature of the Agreement.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits for bodily injury of
not less than Two Hundred Fifty Thousand Dollars ($250,000)per person, Five
Hundred Thousand Dollars ($500,000)per accident and for property damages of
not less than Fifty Thousand Dollars ($50,000), or such coverage with a combined
single limit of One Million Dollars ($1,000,000). Coverage should include owned
and non-owned vehicles used in connection with this Agreement.
C. Real and Property Insurance
CONTRACTOR shall maintain a policy of insurance for all risk personal property
coverage which shall be endorsed naming the County of Fresno as an additional
loss payee. The personal property coverage shall be in an amount that will cover
the total of the COUNTY purchase and owned property, at a minimum, as
discussed in Section Twenty(21) of this Agreement.
All Risk Property Insurance
CONTRACTOR will provide property coverage for the full replacement value of
the COUNTY'S personal property in possession of CONTRACTOR and/or used
in the execution of this Agreement. COUNTY will be identified on an appropriate
certificate of insurance as the certificate holder and will be named as an
Additional Loss Payee on the Property Insurance Policy.
D. Professional Liability
If CONTRACTOR employs licensed professional staff(e.g. Ph.D., R.N.,
L.C.S.W., M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000)per occurrence, Three
Million Dollars ($3,000,000) annual aggregate. CONTRACTOR agrees that it
shall maintain, at its sole expense, in full force and effect for a period of three (3)
years following the termination of this Agreement, one or more policies of
professional liability insurance with limits of coverage as specified herein.
Exhibit B
Page 15 of 105
E. Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
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.
Within thirty(30) days from the date CONTRACTOR signs this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 3133
N. Millbrook Ave, Fresno, California, 93703, Attention: Contracts Division, 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 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 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, COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
Exhibit B
Page 16 of 105
All policies shall be with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of
A FSC VII or better.
11. LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR's staff
shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary
for the provision of the services hereunder and required by the laws and regulations of the United States
of America, State of California, the County of Fresno, and any other applicable governmental agencies.
CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
licenses,permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR's staff shall comply with all
applicable laws, rules or regulations, as may now exist or be hereafter changed.
12. RECORDS
CONTRACTOR shall maintain records in accordance with Exhibit E, "Documentation
Standards for Client Records", attached hereto and by this reference incorporated herein and made part
of this Agreement. During site visits, COUNTY shall be allowed to review records of services provided,
including the goals and objectives of the treatment plan, and how the therapy provided is achieving the
goals and objectives.
13. REPORTS
A. Outcome Reports
CONTRACTOR shall submit to COUNTY's DBH service outcome reports as
requested by COUNTY's DBH. Outcome reports and outcome requirements are subject to change at
COUNTY's DBH discretion.
B. Additional Reports
CONTRACTOR shall also furnish to COUNTY such statements, records, reports,
data, and other information as COUNTY's DBH may request pertaining to matters covered by this
Agreement. In the event that CONTRACTOR fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments
Exhibit B
Page 17 of 105
until there is compliance. In addition, CONTRACTOR shall provide written notification and
explanation to COUNTY within five (5) days of any funds received from another source to conduct the
same services covered by this Agreement.
C. Cost Report
CONTRACTOR agrees to submit a complete and accurate detailed cost report to
the COUNTY's DBH on an annual basis for each fiscal year ending June 30th in the format prescribed
by the State DHCS for the purposes of Short Doyle Medi-Cal reimbursements and total costs for
programs. The cost report will be the source document for several phases of settlement with the DHCS
for the purposes of Short Doyle Medi-Cal reimbursement. CONTRACTOR shall report costs under their
approved legal entity number established during the Medi-Cal certification process. The information
provided applies to CONTRACTOR for program related costs for services rendered to Medi-Cal and
non Medi-Cal clients. The CONTRACTOR will remit a schedule to provide the required information on
published charges for all authorized services. The report will serve as a source document to determine
the CONTRACTOR's usual and customary charge prevalent in the public mental health sector that is
used to bill the general public, insurers or other non-Medi-Cal third party payors during the course of
business operations. CONTRACTOR must report all collections for Medi-Cal/Medicare services and
collections. The CONTRACTOR shall also submit with the cost report a copy of the CONTRACTOR's
general ledger that supports revenues and expenditures and reconciled detailed report of reported total
units of services rendered under this Agreement to the units of services reported by CONTRACTOR to
COUNTY'S electronic information system.
Each fiscal year ending June 30, CONTRACTOR shall remit a hard copy of their
annual cost report with a signed cover letter and requested support documents to County of Fresno,
Attention: DBH Cost Report Team, PO BOX 45003, Fresno CA 93718. In addition, CONTRACTOR
shall remit an electronic copy or any inquiries to DBHcostreportteam@co.fresno.ca.us. COUNTY shall
provide instructions of the cost report, cost report training, State DHCS cost report template worksheets,
and deadlines to submit the cost reports as determined by the State each fiscal year.
All Cost Reports must be prepared in accordance with General Accepted
Accounting Principles (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3)
Exhibit B
Page 18 of 105
and 5718(c). Unallowable costs such as lobbying or political donations must be deducted on the cost
report and monthly invoice reimbursements.
If the CONTRACTOR does not submit the cost report by the deadline, including
any extension period granted by the COUNTY, the COUNTY may withhold payments of pending
invoicing under compensation until the cost report has been submitted and clears COUNTY desk audit
for completeness.
D. Settlements with State Department of Health Care Services (DHCS)
During the term of this Agreement and thereafter, COUNTY and
CONTRACTOR agree to settle dollar amounts disallowed or settled in accordance with DHCS audit
settlement findings related to the reimbursement provided under this Agreement. CONTRACTOR will
participate in the several phases of settlements between COUNTY/CONTRACTOR and DHCS. The
phases of initial cost reporting for settlement according to State reconciliation of records for paid Medi-
Cal services and audit settlement are: State DHCS audit 1) initial cost reporting - after an internal review
by COUNTY, the COUNTY files the cost report with State DHCS on behalf of the CONTRACTOR's
legal entity for the fiscal year; 2) Settlement—State reconciliation of records for paid Medi-Cal services,
approximately 18 to 36 months following the State close of the fiscal year, DHCS will send notice for
any settlement under this provision to the COUNTY; 3)Audit Settlement-State DHCS audit. After final
reconciliation and settlement DHCS may conduct a review of medical records, cost report along with
support documents submitted to COUNTY in initial submission to determine accuracy and may disallow
costs and/or units of services reported on the CONTRACTOR's legal entity cost report. COUNTY may
choose to appeal and therefore reserves the right to defer payback settlement with CONTRACTOR until
resolution of the appeal. DHCS Audits will follow Federal Medicaid procedures for managing
overpayments. If at the end of the Audit Settlement, the COUNTY determines that it overpaid the
CONTRACTOR, it will require the CONTRACTOR to repay the Medi-Cal related overpayment back to
the COUNTY.
Funds owed to COUNTY will be due within forty-five (45) days of notification
by the COUNTY, or COUNTY shall withhold future payments until all excess funds have been
recouped by means of an offset against any payments then or thereafter owing to COUNTY under this
Exhibit B
Page 19 of 105
or any other Agreement between the COUNTY and CONTRACTOR.
14. MONITORING
CONTRACTOR agrees to extend to COUNTY's staff, COUNTY's DBH Director and
the State Department of Health Care Services, or their designees, the right to review and monitor
records, programs or procedures, at any time, in regard to clients, as well as the overall operation of
CONTRACTOR's programs, in order to ensure compliance with the terms and conditions of this
Agreement.
15. REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended
during the term thereof, the parties hereto agree to comply with the amended provision as of the
effective date of such amendment.
16. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates its mental health programs under an
agreement with the State of California Department Health Care Services, and that under said agreement
the State imposes certain requirements on COUNTY and its subcontractors. CONTRACTOR shall
adhere to all State requirements, including those identified in Exhibit F "State Mental Health
Requirements", attached hereto and by this reference incorporated herein and made part of this
Agreement. CONTRACTOR shall also file an incident report for all incidents involving consumers,
following the Protocol and using the Worksheet identified in Exhibit G, attached hereto and by this
reference incorporated herein and made part of this Agreement.
17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall be required to maintain organizational provider certification by
Fresno County. CONTRACTOR must meet Medi-Cal organization provider standards as listed in
Exhibit H, Medi-Cal Organizational Provider Standards, attached hereto and incorporated herein and
made part of this Agreement. It is acknowledged that all references to Organizational Provider and/or
Provider in Exhibit H shall refer to CONTRACTOR. In addition, CONTRACTOR shall inform every
client of their rights under the COUNTY's Mental Health Plan as described in Exhibit I, attached hereto
and by this reference incorporated herein and made part of this Agreement. CONTRACTOR shall also
Exhibit B
Page 20 of 105
file an incident report for all incidents involving clients, following the Protocol and using the Worksheet
identified in Exhibit G, attached hereto and by this reference incorporated herein and made part of this
Agreement, or a protocol and worksheet presented by CONTRACTOR that is accepted by COUNTY's
DBH Director or designee.
18. CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating to
confidentiality.
19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
104-191 (HIPAA) and agree to use and disclose Protected Health Information(PHI) as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is
only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the security
of PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for
Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated
thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations) and other
applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI,
as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504€ of the Code of
Federal Regulations.
20. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter
into a contractual relationship with the COUNTY for the purpose of providing services under this
Exhibit B
Page 21 of 105
Agreement must employ adequate data security measures to protect the confidential information
provided to CONTRACTOR by the COUNTY, including but not limited to the following:
A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR has received authorization by COUNTY for telecommuting
purposes;
2) Current virus protection software is in place;
3) Mobile device has the remote wipe feature enabled/and
4) A secure connection is used.
B. CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY's Chief
Information Officer, and/or designee(s), including but not limited to mobile storage devices. If data is
approved to be transferred, data must be stored on a secure server approved by the COUNTY and
transferred by means of a Virtual Private Network(VPN) connection, or another type of secure
connection. Said data must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR may not use COUNTY computers or computer peripherals on
non-COUNTY premises without prior authorization from the COUNTY's Chief Information Officer,
and/or designee(s).
D. CONTRACTOR may not store COUNTY's private, confidential or sensitive data
on any hard-disk drive,portable storage device, or remote storage installation unless encrypted.
E. CONTRACTOR shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY's confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files,program documentation, data processing
systems, data files and data processing equipment which stores or processes COUNTY data internally
and externally.
Exhibit B
Page 22 of 105
F. Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128
BIT or higher. Additionally, a password or pass phrase must be utilized.
G. CONTRACTOR is responsible to immediately notify COUNTY of any
violations, breaches or potential breaches of security related to COUNTY's confidential information,
data maintained in computer files,program documentation, data processing systems, data files and data
processing equipment which stores or processes COUNTY data internally or externally.
H. COUNTY shall provide oversight to CONTRACTOR's response to all incidents
arising from a possible breach of security related to COUNTY's confidential client information provided
to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected individuals
as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will be
responsible for all costs incurred as a result of providing the required notification.
21. PROPERTY OF COUNTY
A. COUNTY and CONTRACTOR recognizes that fixed assets are tangible and
intangible property obtained or controlled under COUNTY's Mental Health Plan for use in operational
capacity and will benefit COUNTY for a period more than one year. Depreciation of the qualified items
will be on a straight-line basis.
For COUNTY purposes, fixed assets must fulfill three qualifications:
1. Asset must have life span of over one year.
2. The asset is not a repair part
3. The asset must be valued at or greater than the capitalization thresholds for the
asset type
Asset type Threshold
• land $0
• buildings and improvements $100,000
• infrastructure $100,000
• be tangible $5,000
o equipment
o vehicles
• or intangible asset $100,000
0 Internally generated software
Exhibit B
Page 23 of 105
o Purchased software
o Easements
o Patents
• and capital lease $5,000
Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
approved and identified as an asset it will be tagged with a COUNTY program number. A Fixed asset
log will be maintained by COUNTY's Asset Management System and annual inventoried until the asset
is fully depreciated. During the terms of this Agreement, CONTRACTOR's fixed assets may be
inventoried in comparison to COUNTY's DBH Asset Inventory System.
B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
more than$1,000, with over one year life span, and are mobile and high risk of theft or loss are sensitive
assets. Such sensitive items are not limited to computers, copiers, televisions, cameras and other
sensitive items as determined by COUNTY's DBH Director or designee. CONTRACTOR maintains a
tracking system on the items and are not required to be capitalize or depreciated. The items are subject
to annual inventory for compliance.
C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in
an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of
this Agreement CONTRACTOR shall be physically present when fixed and inventoried assets are
returned to COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all
COUNTY owned undepreciated fixed and inventoried assets, or the monetary value of said assets if
unable to produce the assets at the expiration or termination of this Agreement.
CONTRACTOR further agrees to the following:
1. To maintain all items of equipment in good working order and condition,
normal wear and tear is expected;
2. To label all items of equipment with COUNTY assigned program number,
to perform periodic inventories as required by COUNTY and to maintain an inventory list showing
where and how the equipment is being used, in accordance with procedures developed by COUNTY.
All such lists shall be submitted to COUNTY within ten(10) days of any request therefore; and
Exhibit B
Page 24 of 105
3. To report in writing to COUNTY immediately after discovery, the lost or
theft of any items of equipment. For stolen items, the local law enforcement agency must be contacted
and a copy of the police report submitted to COUNTY.
D. The purchase of any equipment by CONTRACTOR with funds provided
hereunder shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions of this
Agreement as appropriate, and must be directly related to CONTRACTOR's services or activity under
the terms of this Agreement. COUNTY's DBH may refuse reimbursement for any costs resulting from
equipment purchased, which are incurred by CONTRACTOR, if prior written approval has not been
obtained from COUNTY.
E. CONTRACTOR must obtain prior written approval from COUNTY's DBH
whenever there is any modification or change in the use of any property acquired or improved, in whole
or in part,using funds under this Agreement. If any real or personal property acquired or improved with
said funds identified herein is sold and/or is utilized by CONTRACTOR for a use which does not
qualify under this Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal to the
current fair market value of the property, less any portion thereof attributable to expenditures of funds
not provided under this Agreement. These requirements shall continue in effect for the life of the
property. In the event this Agreement expires, or terminates, the requirements for this Section shall
remain in effect for activities or property funded with said funds,unless action is taken by the State
government to relieve COUNTY of these obligations
22. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of
race, religion, color, national origin, ancestry, physical handicap, medical condition, marital status, age
or gender, pursuant to all applicable State and Federal statutes and regulations.
23. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R.
Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
Exhibit B
Page 25 of 105
from discriminating against persons based on race, color, national origin, sex, disability or religion. This
is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access and
participation in federally funded programs through the provision of comprehensive and quality bilingual
services.
B. Policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP consumers, including, but not limited to,
assessing the cultural and linguistic needs of its consumers, training of staff on the policies and
procedures, and monitoring its language assistance program. The CONTRACTOR's procedures must
include ensuring compliance of any sub-contracted providers with these requirements.
C. CONTRACTOR shall not use minors as interpreters.
D. CONTRACTOR shall provide and pay for interpreting and translation services to
persons participating in CONTRACTOR's services who have limited or no English language
proficiency, including services to persons who are deaf or blind. Interpreter and translation services
shall be provided as necessary to allow such participants meaningful access to the programs, services
and benefits provided by CONTRACTOR. Interpreter and translation services, including translation of
CONTRACTOR's "vital documents" (those documents that contain information that is critical for
accessing CONTRACTOR's services or are required by law) shall be provided to participants at no cost
to the participant. CONTRACTOR shall ensure that any employees, agents, subcontractors, or partners
who interpret or translate for a program participant, or who directly communicate with a program
participant in a language other than English, demonstrate proficiency in the participant's language and
can effectively communicate any specialized terms and concepts peculiar to CONTRACTOR's services.
E. In compliance with the State mandated Culturally and Linguistically Appropriate
Services standards as published by the Office of Minority Health, CONTRACTOR must submit to
COUNTY for approval, within 60 days from date of contract execution, CONTRACTOR's plan to
address all fifteen national cultural competency standards as set forth in the"National Standards on
Culturally and Linguistically Appropriate Services (CLAS)"
(http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf). COUNTY's annual on-site review of
CONTRACTOR shall include collection of documentation to ensure all national standards are
Exhibit B
Page 26 of 105
implemented. As the national competency standards are updated, CONTRACTOR's plan must be
updated accordingly.
24. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section
1861(v)(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of
four(4) years after the furnishing of services under this Agreement, CONTRACTOR shall make
available,upon written request to the Secretary of the United States Department of Health and Human
Services, or upon request to the Comptroller General of the United States General Accounting Office, or
any of their duly authorized representatives, a copy of this Agreement and such books, documents, and
records as are necessary to certify the nature and extent of the costs of these services provided by
CONTRACTOR under this Agreement. CONTRACTOR further agrees that in the event
CONTRACTOR carries out any of its duties under this Agreement through a subcontract, with a value
or cost of Ten Thousand and No/I00 Dollars ($10,000.00) or more over a twelve (12) month period,
with a related organization, such Agreement shall contain a clause to the effect that until the expiration
of four(4) years after the furnishing of such services pursuant to such subcontract, the related
organizations shall make available, upon written request to the Secretary of the United States
Department of Health and Human Services, or upon request to the Comptroller General of the United
States General Accounting Office, or any of their duly authorized representatives, a copy of such
subcontract and such books, documents, and records of such organization as are necessary to verify the
nature and extent of such costs.
25. SINGLE AUDIT CLAUSE
A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00)
or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual audit
in accordance with the requirements of the Single Audit Standards as set forth in Office of Management
and Budget(OMB) Circular A-133. CONTRACTOR shall submit said audit and management letter to
COUNTY. The audit must include a statement of findings or a statement that there were no findings. If
there were negative findings, CONTRACTOR must include a corrective action plan signed by an
authorized individual. CONTRACTOR agrees to take action to correct any material non-compliance or
Exhibit B
Page 27 of 105
weakness found as a result of such audit. Such audit shall be delivered to COUNTY's DBH Business
Office, for review within nine (9) months of the end of any fiscal year in which funds were expended
and/or received for the program. Failure to perform the requisite audit functions as required by this
Agreement may result in COUNTY performing the necessary audit tasks, or at COUNTY's option,
contracting with a public accountant to perform said audit, or, may result in the inability of COUNTY to
enter into future agreements with CONTRACTOR. All audit costs related to this Agreement are the
sole responsibility of CONTRACTOR.
B. A single audit report is not applicable if CONTRACTOR's Federal contracts do
not exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR's
only funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must
be performed and a program audit report with management letter shall be submitted by CONTRACTOR
to COUNTY as a minimum requirement to attest to CONTRACTOR's solvency. Said audit report shall
be delivered to COUNTY's DBH Business Office, for review no later than nine (9) months after the
close of the fiscal year in which the funds supplied through this Agreement are expended. Failure to
comply with this Act may result in COUNTY performing the necessary audit tasks or contracting with a
qualified accountant to perform said audit. All audit costs related to this Agreement are the sole
responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under
this paragraph shall be billed to the CONTRACTOR at COUNTY cost, as determined by COUNTY's
Auditor-Controller/Treasurer-Tax Collector.
C. CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
period of at least three (3) years following final payment under this Agreement or the closure of all other
pending matters, whichever is later.
26. COMPLIANCE
CONTRACTOR agrees to comply with the COUNTY's Contractor Code of Conduct and
Ethics and the COUNTY's Compliance Program in accordance with Exhibit D attached hereto and
Exhibit B
Page 28 of 105
incorporated herein by reference and made part of this Agreement. Within thirty(30) days of entering
into this Agreement with the COUNTY, CONTRACTOR shall have all of CONTRACTOR's
employees, agents and subcontractors providing services under this Agreement certify in writing, that he
or she has received, read, understood, and shall abide by the Contractor Code of Conduct and Ethics.
CONTRACTOR shall ensure that within thirty(30) days of hire, all new employees, agents and
subcontractors providing services under this Agreement shall certify in writing that he or she has
received, read,understood, and shall abide by the Contractor Code of Conduct and Ethics.
CONTRACTOR understands that the promotion of and adherence to the Code of Conduct is an element
in evaluating the performance of CONTRACTOR and its employees, agents and subcontractors.
Within thirty(30) days of entering into this Agreement, and annually thereafter, all
employees, agents and subcontractors providing services under this Agreement shall complete general
compliance training and appropriate employees, agents and subcontractors shall complete
documentation and billing or billing/reimbursement training. All new employees, agents and
subcontractors shall attend the appropriate training within 30 days of hire. Each individual who is
required to attend training shall certify in writing that he or she has received the required training. The
certification shall specify the type of training received and the date received. The certification shall be
provided to the COUNTY's Compliance Officer at 3133 N. Millbrook, Fresno, California 93703.
CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed upon
COUNTY by the Federal Government as a result of CONTRACTOR's violation of the terms of this
Agreement.
27. ASSURANCES
In entering into this Agreement, CONTRACTOR certifies that it, nor any of its officers,
are not currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
Health Care Programs: that it, nor any of its officers, have not been convicted of a criminal offense
related to the provision of health care items or services; nor has it, or any of its officers, been reinstated
to participate in the Federal Health Care Programs after a period of exclusion, suspension, debarment, or
ineligibility. If COUNTY learns, subsequent to entering into a contract, that CONTRACTOR is
ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility for, or
Exhibit B
Page 29 of 105
involvement with, COUNTY's business operations related to the Federal Health Care Programs and
shall remove such CONTRACTOR from any position in which CONTRACTOR's compensation, or the
items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part,
directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until
such time as CONTRACTOR is reinstated into participation in the Federal Health Care Programs.
A. If COUNTY has notice that CONTRACTOR, or its officers, has been charged
with a criminal offense related to any Federal Health Care Program, or is proposed for exclusion during
the term of any contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the
accuracy of any claims submitted to any Federal Health Care Program. At its discretion given such
circumstances, COUNTY may request that CONTRACTOR cease providing services until resolution of
the charges or the proposed exclusion.
B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
under this Agreement, will be queried as to whether(1)they are now or ever have been excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) they
have been convicted of a criminal offense related to the provision of health care items or services; and or
(3)they have been reinstated to participate in the Federal Health Care Programs after a period of
exclusion, suspension, debarment, or ineligibility.
1. In the event the potential employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR
hires or engages such potential employee or subcontractor, CONTRACTOR will ensure that said
employee or subcontractor does no work, either directly or indirectly relating to services provided to
COUNTY.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to
Exhibit B
Page 30 of 105
COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be determined
by COUNTY to protect the interests of COUNTY consumers.
C. CONTRACTOR shall verify(by asking the applicable employees and
subcontractors)that all current employees and existing subcontractors who, in each case, are expected to
perform professional services under this Agreement(1) are not currently excluded, suspended, debarred,
or otherwise ineligible to participate in the Federal Health Care Programs; (2)have not been convicted
of a criminal offense related to the provision of health care items or services; and(3) have not been
reinstated to participation in the Federal Health Care Program after a period of exclusion, suspension,
debarment, or ineligibility. In the event any existing employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible to participate in
the Federal Health Care Programs, or has been convicted of a criminal offense relating to the provision
of health care services, CONTRACTOR will ensure that said employee or subcontractor does no work,
either direct or indirect, relating to services provided to COUNTY.
1. CONTRACTOR agrees to notify COUNTY immediately during the term
of this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each
case, is providing professional services under this Agreement is excluded, suspended, debarred or
otherwise ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal
offense relating to the provision of health care services.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section 3 of this Agreement, or require adequate assurance (as defined by
COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to
COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be determined
by COUNTY to protect the interests of COUNTY consumers.
D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY which may be necessary to complete any internal or external audits relating
to CONTRACTOR's compliance with the provisions of this Section.
E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
Exhibit B
Page 31 of 105
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR'S violation of
CONTRACTOR'S obligations as described in this Section.
28. PUBLICITY PROHIBITION
None of the funds, materials,property or services provided directly or indirectly under
this Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity(i.e.,
purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
Notwithstanding the above, publicity of the services described in Section One (1) of this Agreement
shall be allowed as necessary to raise public awareness about the availability of such specific services
when approved in advance by COUNTY's DBH Director or designee and at a cost to be provided in
Exhibit B for such items as written/printed materials, the use of media(i.e., radio, television,
newspapers) and any other related expense(s).
29. COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a client
or a client's family. CONTRACTOR shall provide a copy of the detailed complaint log entries
concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (101h) day of the
following month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide
details and attach documentation of each complaint with the log. CONTRACTOR shall post signs
informing clients of their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY
of all incidents reportable to State licensing bodies that affect COUNTY clients within twenty-four(24)
hours of receipt of a complaint.
Within ten(10) days after each incident or complaint affecting COUNTY-sponsored
clients, CONTRACTOR shall provide COUNTY with information relevant to the complaint,
investigative details of the complaint, the complaint and CONTRACTOR's disposition of, or corrective
action taken to resolve the complaint. In addition, CONTRACTOR shall inform every client of their
rights as set forth in Exhibit I. CONTRACTOR shall file an incident report for all incidents involving
clients, following the protocol and using the worksheet identified in Exhibit G and incorporated herein
by reference and made part of this Agreement.
30. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
Exhibit B
Page 32 of 105
INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104,
and 455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit J, "Disclosure
of Ownership and Control Interest Statement", attached hereto and by this reference incorporated herein
and made part of this Agreement. CONTRACTOR shall submit this form to the COUNTY's DBH
within thirty(30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall
report any changes to this information within thirty-five (35) days of occurrence by completing Exhibit
J, "Disclosure of Ownership and Control Interest Statement." Submissions shall be scanned pdf copies
and are to be sent via email to DBHAdministrationnco.fresno.ca.us attention: Contracts Administration.
31. DISCLOSURE—CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR is required to disclose if any of the following conditions apply to them,
their owners, officers, corporate managers and partners (hereinafter collectively referred to as
"CONTRACTOR"):
A. Within the three-year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1. Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or contract
under a public transaction;
2. Violation of a federal or state antitrust statute;
3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
records; or
4. False statements or receipt of stolen property.
B. Within a three-year period preceding their Agreement award, they have had a
public transaction (federal, state, or local) terminated for cause or default.
Exhibit B
Page 33 of 105
Disclosure of the above information will not automatically eliminate
CONTRACTOR from further business consideration. The information will be considered as part of
the determination of whether to continue and/or renew this Agreement and any additional information
or explanation that a CONTRACTOR elects to submit with the disclosed information will be
considered. If it is later determined that the CONTRACTOR failed to disclose required information,
any contract awarded to such CONTRACTOR may be immediately voided and terminated for
material failure to comply with the terms and conditions of the award.
CONTRACTOR must sign a "Certification Regarding Debarment, Suspension,
and Other Responsibility Matters-Primary Covered Transactions"in the form set forth in Exhibit K,
attached hereto and by this reference incorporated herein and made part of this Agreement.
Additionally, CONTRACTOR must immediately advise the COUNTY's DBH in writing if, during the
term of this Agreement: (1) CONTRACTOR becomes suspended, debarred, excluded or ineligible for
participation in federal or state funded programs or from receiving federal funds as listed in the excluded
parties' list system(http://www.ols.gov); or(2) any of the above listed conditions become applicable to
CONTRACTOR. CONTRACTOR shall indemnify, defend and hold the COUNTY harmless for any
loss or damage resulting from a conviction, debarment, exclusion, ineligibility or other matter listed in
the signed Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
32. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation(a
for-profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR
changes its status to operate as a corporation.
Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this Agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
is a party and in which one or more of its directors has a material financial interest. Members of the
Board of Directors shall disclose any self-dealing transactions that they are a party to by completing and
signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit L and incorporated
herein by reference and made part of this Agreement, and submitting it to the COUNTY prior to
Exhibit B
Page 34 of 105
commencing with the self-dealing transaction or immediately thereafter.
33. AUDITS AND INSPECTIONS
The CONTRACTOR shall at any time during business hours, and as often as the
COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
data with respect to the matters covered by this Agreement. The CONTRACTOR shall,upon request by
the COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to ensure
CONTRACTOR's compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR shall be subject to the examination and audit of the State Auditor General for a period
of three (3) years after final payment under contract(California Government Code section 8546.7).
34. NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY CONTRACTOR
Director, Fresno County President and CEO
Department of Behavioral Health Central Star Behavioral Health, Inc.
3133 N. Millbrook Ave 1501 Hughes Way, Suite 150
Fresno, CA 93702 Long Beach, CA 90810
Any and all notices between COUNTY and CONTRACTOR provided for or permitted
under this Agreement or by law shall be in writing and shall be deemed duly served when personally
delivered to one of the parties, or in lieu of such personal service, when deposited in the United States
Mail, postage prepaid, addressed to such party.
35. GOVERNING LAW
Venue for any action arising out of or related to the Agreement shall only be in Fresno
County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
36. ENTIRE AGREEMENT
This Agreement, including all Exhibits, COUNTY's Revised RFP No. 18-005 and
Exhibit B
Page 35 of 105
CONTRACTOR's Response to RFP No. 18-005 constitutes the entire agreement between
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
agreement negotiations,proposals, commitments, writings, advertisements,publications, and
understandings of any nature whatsoever unless expressly included in this Agreement.
Exhibit B
P ge 36 of 105
1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
2 year first hereinabove written.
3
4 CONTRACTOR:
5 CENTRAL STAR BEHAVIORAL COUNTY OF FRESNO
6 HEALTH, INC.
7
B 8
Brian Pacheco,
8 Chairman of the Board of Supervisors of the
9 / County of Fresno
Print Name: , �/:.1¢ C'/
10 Title: �1 C'9�1c5��or► S Date: / I — I ILI- 11
11 Chief Executive Officer,or
12 President,or any Vice President
13
14 ATTEST:
15 Bernice E. Seidel,
Clerk to the Board of Supervisors
16 By: - -- =�-"�'- -- - �-� �- County of Fresno, State of California
17 print Name:
18 Title: l L G By:- � SIhD.(J
19 Secretary (of Corporation), or Deputy
any Assistant Secretary, or
20 Chief Financial Officer, or Date:-
21 any Assistant Treasurer
22
23
PLEASE SEE ADDITIONAL SIGNATURE
24 Mailing Address: PAGE ATTACHED
25 Central Star Behavioral Health, Inc.
1501 Hughes Way, Suite 150
26 Long Beach, CA 90810
27 Contact: Kent Dunlap,Senior, Vice President
28 Phone: (310) 221-6336 ext. 125
a6 COUNTY OF FRESNO
Fresno, CA
Exhibit B
Page 37 of 105
FOR FRESNO COUNTY ACCOUNTING USE ONLY:
Fund/Subclass: 0001/10000
Org No.: 5630
Account No.: 7295
Exhibit B
Page 38 of 105
CRISIS RESIDENTIAL TREATMENT
SCOPE OF WORK
ORGANIZATION: Central Star Behavioral Health, Inc.
MAILING ADDRESS: 1501 Hughes Way, Suite 150, Long Beach, CA 90810
SERVICE ADDRESS: 496 S. Barton, Fresno, CA 93702
SERVICES: Crisis Residential Treatment Services
CONTRACT PERIOD: December 1, 2017 through June 30, 2021, with an option for two (2)
twelve (12) month renewal terms
BACKGROUND
CONTRACTOR shall provide crisis residential treatment (CRT) services as defined in California
Code of Regulations (CCR), Title 9, §1810.208. Crisis Residential Treatment Services. "Crisis
Residential Treatment Service" means therapeutic or rehabilitative services provided in a non-
institutional residential setting which provides a structured program as an alternative to
hospitalization for beneficiaries experiencing an acute psychiatric episode or crisis who do not have
medical complications requiring nursing care. The therapeutic and rehabilitative services shall be
provided as defined in California Code of Regulations (CRR), Title 22, §1810.208, consistent with a
Social Rehabilitation Program, which will be provided in a non-institutional residential setting.
CONTRACTOR shall be responsible for the CRT staffing, programming service operations, and
quality assurance. The CRT facility provides a residential setting that creates a safe base from
which clients can collaborate with staff, friends and family to assess their needs and assist in
framing their own recovery plan.
Culturally-attuned services will include crisis intervention and stabilization strategies, screening for
medical complications, diagnosis formulation, medication education, medication monitoring, clinical
assessment, individual treatment/rehabilitation plans, and discharge planning that actively links
clients with resources, such as permanent housing, pre-vocational and vocational programs,
substance abuse treatment services and other supports based on the clients' individual strengths
and needs.
TARGET POPULATION:
The target population will include male and female individuals, who are 18 to 59 years of age, who
are experiencing acute psychiatric episodes or crisis. The CRT is projected to serve 194 unique
clients annually.
The focus shall be individuals in a pre-contemplative/contemplative stage of change that are seeking
structure to achieve recovery. Individuals presenting for psychiatric care typically have existing co-
occurring physical health concerns and/or trauma-related experiences, and occasionally have
undiagnosed physical disorders that are not the cause of their mental symptoms but nonetheless will
require evaluation and treatment. However, these clients must not have serious medical
complications that require nursing management. Medical clearance will be required for referred
clients where there are indicators of an acute medical condition as determined by a medical
screening, which must occur within 30 calendar days prior to clients' admission to the CRT. In the
Exhibit B
Page 39 of 105
event a referred client is known to possess a contagious medical condition, said client shall be
medically cleared by a local hospital prior to admission to the CRT.
All clients shall have a primary diagnosis of mental health disorder. The psychiatric diagnosis must
reflect a severe, persistent mental illness or a maladaptive reaction to a mental health crisis. The
primary diagnosis cannot be dementia, mental retardation, or substance abuse/dependence.
Individuals will be referred to the CRT by the following, including but not limited to: the COUNTY's
Department of Behavioral Health (DBH), DBH contract providers, Institutes of Mental Disease (IMDs),
Emergency Psychiatric Services (EPS), or emergency rooms (aka hospital emergency departments).
When the CRT program is nearing full capacity, clients who have accessed emergency services such
as EMS, or law enforcement, multiple times will be prioritized for the purpose of admission to the
CRT.
LOCATION OF SERVICES:
CONTRACTOR shall provide CRT services within the COUNTY-owned facility located at 496 S.
Barton, Fresno, CA 93702.
DESCRIPTION OF SERVICES:
I. The CRT shall be a positive level of care and a temporary alternative for adults experiencing
an acute psychiatric episode or intense emotional distress who might otherwise face voluntary
or involuntary commitment in a higher level of care.
II. Clients shall be engaged in recovery activities throughout each day. Most programming shall
be group-focused with individual sessions to help reinforce learning. The majority of services
shall be delivered at the certified CRT site and will be face-to-face encounters between clients
and staff. However, some services, not available at the CRT, may be provided by reputable
and known programs in the community via referrals and linkage from the CRT staff.
Group sessions and activities provided by CONTRACTOR shall:
A. Introduce daily structure and supportive motivation moving toward self-discipline and self-
management, which is helpful to persons used to living in a disorganized and chaotic way;
B. Provide norms that reinforce healthy ways of interacting and a safe and supportive
therapeutic milieu that is crucial for recovery, including fitness-oriented and
creative/expressive outlets;
C. Develop clients' communication and socialization skills. This is helpful to all and particularly
useful for individuals whose socializing, historically, revolved around using substances;
D. Advance individual recovery and facilitate those further along in their recovery to support
other members through a positive peer wellness and recovery culture;
E. Provide a venue for group facilitators to transmit new information, teach new wellness and
life skills, and guide clients as they practice new behaviors.
III. The CRT staff shall conduct individual client evaluations to help determine the need for the
type and intensity of additional services to be provided within a framework of peer support and
trauma informed approaches to recovery.
IV. CONTRACTOR's staff will be trained in the use of the following EBPs, when appropriate for
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clients' assessed individual needs and service plan.
A. Wellness Recovery Action Planning (WRAP) — a self-management tool that clients can
use to monitor uncomfortable, distressing feelings and behaviors and identify planned
responses that will reduce, modify, or eliminate them.
B. Motivational Interviewing — a widely used practice in recovery as it integrates well into
short-term crisis stabilization services, offers sound engagement strategies addressing
any/all conditions, and works in a respectful manner to help consumers take ownership
of their recovery.
C. Aggression Replacement Training — a research-based, multi-component cognitive-
behavioral treatment to promote pro-social behavior by addressing factors that contribute
to aggression.
D. Seeking Safety— an evidence-based counseling model to help people, including clients
with dual diagnoses, to attain safety from trauma and/or substance abuse.
V. CONTRACTOR shall prescribe prescription drugs when needed. The majority of CRT clients
will have already been prescribed prescription drugs that will need to be monitored by the
CONTRACTOR. At the time of admission, CONTRACTOR shall obtain a complete medication
history from clients, gather information about the appropriateness of medications for the
clients, taking into account the clients' ages, weight, pathophysiology, allergies, vital signs, and
clients' knowledge/beliefs about drugs. The CONTRACTOR shall update the medication
information periodically as well as conduct education with the clients to ascertain that the
medication is being taken correctly and continues to be advantageous.
CONTRACTOR shall maintain a list of all prescribed and non-prescribed medications for all
CRT clients. Medication support will be led by a Psychiatric Nurse Practitioner. Support will
also be provided by licensed nursing personnel (Mental Health Registered Nurse and
LVN/LPT's). All medication shall be stored in a locked central location with a control system
so that unauthorized individuals cannot access the medication. Refrigerated medications will
be stored in a locked refrigerator separate from food supplies. In addition when it is a part of
client's individual treatment/rehabilitation plan, CONTRACTOR shall encourage clients to be
personally responsible for holding, managing, and safeguarding all of their medications.
VI. CONTRACTOR staff and client shall work together to develop a written treatment/rehabilitation
plan specifying goals and objectives as well as identifying the staff and client responsibilities
for their achievement. Clients shall be involved in an ongoing review of progress towards
reaching established goals and be involved in the planning and evaluation of their treatment
goals. The plan shall contain at least the following elements:
A. Statement of specific treatment needs and goals
B. Description of specific services to address identified treatment needs
C. Documentation of reviews by staff and client of the plan at least weekly
D. Anticipated length of stay needed to accomplish identified goals, and methods to
evaluate the achievement of these goals.
VI I. If an individual treatment/rehabilitation plan requires services to be provided by another
program or agency, there shall be documented evidence in the clients' case record of
communication between all persons responsible for the treatment/rehabilitation plan.
Following the referral of a client to an outside agency, the client's primary assigned CRT staff
Exhibit B
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member will follow up with the client and the service provider to whom the client was referred
to ensure that services were accessed. It is the CRT team members' role to assist the client
with mediating any barriers to accessing services (e.g. travel, scheduling, etc.) as well as any
perceived stigma in seeking assistance from the service providers e.g. substance abuse,
victimization, etc.
VIII. CONTRACTOR shall prepare a written discharge summary prepared by CRT staff and client,
which includes an outline of services provided, goals accomplished, reason and plan for
discharge, and referral follow-up plans. Discharge summaries will be the reports that provide a
link between the CRT and the clients' next level of care and/or their primary medical care
services. They also serve an internal reference for future care at the CRT, if necessary.
IX. Clients shall be involved, depending on capability, in the operation of the CRT household.
This shall include participation in the formulation and monitoring of house rules, as well as in
the daily operation of the facility, including but not limited to cooking, cleaning, menu planning
and activity planning. Clients shall be active in all aspects of running the CRT household,
gaining skills in the activities of daily living, such as shopping, cooking, laundry and budgeting.
Purposeful group activities shall also be scheduled, such as joining in on grocery shopping
trips.
X. Structured day and evening services shall consist of, at a minimum, an average of fourteen
(14) specific rehabilitation service hours and seven (7) activity program hours per week for
each client, and shall be available seven (7) days a week. Services shall include, but not be
limited to:
• Individual and Group Counseling or Therapy
• Crisis Intervention
• Pre-vocational or Vocational Counseling
• Education Services and Remediation
• Client Advocacy, (including assisting client to develop their own advocacy skills)
• Independent Living Skills
• Money Management
• Self-control and Symptom Management
• Sexual Health Education
• Education on Self Administration of Medication
• Personal Grooming and Hygiene and Other Activities for Daily Living
• In general, an activity program that encourages socialization within the program and
general community, and that assists linking the clients to resources which are available
after leaving the program
V. CONTRACTOR shall provide at least three (3) balanced and complete meals each day. A kitchen
shall be made available for client use. CONTRACTOR shall encourage clients to participate in
meal preparation and menu planning depending on capability. Any reasonable special dietary
needs shall be provided for clients (e.g., vegetarian meals, vegan meals, etc.).
STAFFING:
CONTRACTOR employs a blend of licensed behavioral health practitioners, health professionals,
and para-professional staff with lived experiences reflective of the experiences of those with
Exhibit B
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behavioral health problems. CRT staff includes the Contractor Administrator; Program Director,
Clinical Supervisor; Psychiatric Nurse Practitioner, Clinical Psychologist/Psychiatrist; LVNs/LPT;
Mental Health Specialist, Recovery Counselors, Safety Specialist/Recovery Counselor, Household
Coaches/Cooks, Resource Specialist and EMR/Clerk. CONTRACTOR staff who provide
management and administrative services regionally for the CRT in Fresno County include: the
UR/QA/Medical Records, Human Resources, Training, Billing Clerk, and Maintenance Technician.
CONTRACTOR'S staff meets (or exceeds) all State licensing and regulatory requirements including
medical staff standards, nursing staff standards, and rehabilitation staff requirements. All staff
achieves LiveScan and DOJ clearance. Licensed and registered clinicians clear OIG/HHS eligibility
screening. Continuing supervision of medical services are provided by a Nurse Practitioner who
evaluates clients as needed and is available on-call for the provision of non-emergency physical
health care. The Clinical Supervisor provides clinical oversight for behavioral health staff, including
the Mental Health Specialist, Recovery Counselors, and Resource Specialist. All staff that require
state licensure and/or certification shall remain in good standing with their respective state licensing
or certification boards.
CRT staff shall be employed by the CONTRACTOR except for psychiatrists, primary care
physician(s) and a dietician who are independent contractors. CONTRACTOR shall contract with a
Psychiatrist for 5-8 hours/week to work collaboratively with a Nurse Practitioner. Subject to approval
by the County, some Psychiatry services may be provided via telemedicine.
CONTRACTOR'S Administrator will inform the COUNTY's DBH within 24 hours of any staff
changes that may affect the CRT program.
HOURS OF OPERATION:
CONTRACTOR staff shall be available to provide services to clients twenty-four (24) hours per day,
seven (7) days per week.
ANTICIPATED AVERAGE CLIENT LENGTH OF STAY:
The anticipated average client length of stay in the CRT shall be in accordance with each client's
assessed needs, but not to exceed thirty (30) days unless circumstances documented in the client's
record require a longer length of stay beyond thirty (30) days. Under no circumstances may the
length of stay exceed 89 days.
GOALS/OUTCOMES:
CONTRACTOR shall utilize a computerized tracking system with which performance and outcome
measures and other relevant client data, such as demographics, will be maintained. The data
tracking system may be incorporated into CONTRACTOR'S electronic health records (EHR) system
or be a stand-alone database. DBH must be afforded read only access to the data tracking system.
CONTRACTOR uses standardized assessment/outcome tools, performance measures, and
satisfaction surveys for quality improvement and to evaluate progress towards the CRT program
goals.
CONTRACTOR staff shall use Electronic Health Records (EHR) and other tools to track and report
member data, utilization and treatment outcomes across multiple domains, aided by dedicated
Quality Assurance and Research and Program Practices (RPP) Department staff within
CONTRACTOR'S Total Quality Management System (TQM). CONTRACTOR shall maintain an
Electronic Medical Record (EMR), enabling them to keep and easily transmit data from a
comprehensive client record consistent with the requirements of CCL Title 22, section 6.
Exhibit B
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CONTRACTOR shall partner with the COUNTY to implement an evaluation protocol that addresses
the desired results of the program — stabilizing individuals during a difficult period and connecting
them into needed community-based services and supports, while reducing their future risk of crisis
and need for hospitalizations and other high-end services. CONTRACTOR shall assess their past,
current and future status in the overall system of care (i.e., use of crisis services, psychiatric
hospital, arrests/detainments, etc.) and their stability and prospects in the community (housing, use
of peer supports, mental health treatment enrollments, educational/vocational endeavors,
employment, etc.), taken at the time of enrollment and tracked through referral and linkages
provided at discharge.
CONTRACTOR shall work with the COUNTY in analyzing post-discharges statuses on similar
indicators, to the extent these data are available on clients in COUNTY databases. CONTRACTOR
shall adapt and apply similar metrics for the above indicator areas as appear on the Mental Health
Services Act (MHSA) form sets used in Full Service Partnership (FSP) programs (PAF, KETs, 3Ms)
and/or from Client Outcome Report (COR).
Assessments of statuses shall be complemented using standardized functional assessments such
as the Milestones of Recovery (MORS), the Recovery Assessment Scale (RAS) and/or the Behavior
and Symptom Identification Scale (BASIS), the latter two are completed by the client themselves
regarding the time before admission compared to the time preceding discharge. Other important
areas of measurement for program evaluation include fidelity protocols (e.g., development of a
WRAP by discharge, pre-post group services assessments, focus groups with clients, etc.);
client/family's experience and satisfaction with services; and, gathering feedback from agency
partners. All data from outcome measurements shall be routinely reviewed and applied to the
continuous quality improvement of programs, with stakeholder input, in the context of
CONTRACTOR's comprehensive Total Quality Management (TQM) program.
The following examples provide preliminary information about tracking methods:
a. Access to care: The ability of clients to receive the right service at the right time.
CONTRACTOR'S business analytics system uptakes data from the EHR on referral dates,
admission/intake dates, and service dates by service types. This allows for graphically presenting
and monitoring aggregate Key Performance Indicators (KPIs) on dashboards by agency/program
regarding the time between referral to admission/intake to first service; and to inspect the array of
services (mix/match and intensity/volume) provided. The BA application also allows drill down to
client/staff levels, beyond the aggregation, to examine outliers that may require review and case-
level problem-solving. These dashboards are the primary way program managers and QA
personnel actively monitor access in real time; they also pay attention to periodic, cross-sectional
feedback from consumer and agency partner surveys which include inquiries about service access
and staff's responsiveness.
1) Timeliness of bridging prescriptions
All prescriptions are dated in the EHR, so the time between the end/beginning of prescriptions can
be calculated. If the client is being transferred from or to another facility, the nursing team compiles
a record of all discharge prescriptions for the client and the next-on provider so they have full
information to work with in carrying on with needed services. CONTRACTOR shall include inquiry
about Rx continuity during warm-hand offs and at a one month post discharge follow-up phone call.
2) Timeliness of identifying clients with a serious mental illness
Symptoms and risk, such as depression, poor judgment, affect regulation, trauma adjustment, and
suicide risk, as well as pertinent clinical diagnoses are established through comprehensive
Exhibit B
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assessments at intake, and are also tracked using standardized tools, e.g., the MORS, (clinician
rating), BASIS and/or RAS (client rating) over time in the program to discharge. Specific types of
assessments, such as for suicide risk (CSSRS), psychiatric traumas (ACES), and substance abuse
(SBIRT) are prompted based on screening responses of clients, administered at admission, and
may also be re-administered by staff at any point during treatment in which there is new/heightened
concern.
3) Timeliness between client referral for assessment and completion of assessment;
assessment to first treatment service; and, first treatment service to next follow-up.
Assessment and Individual Service Planning will both take place within 24 hours of admission.
Assessments findings will be entered and tracked in the EMIR and will determine each person's
current status, safety, and support needs, including: (1) a comprehensive bio-psycho-social
evaluation summarizing psychiatric history and treatment, developmental milestones, medical
history, relationships and mental health status; (2) screening for high risk behaviors using the
Columbia Suicide Severity and Risk Scale (CSSRS), and Screening, Brief Intervention, and Referral
to Treatment (SBIRT) to assess for substance use, along with other assessments for other varied
health and safety risks and needs identification.
4) Timeliness of subsequent follow-up visits
For services provided while in the program, per comprehensive assessments and the plan of care,
service entries in the EHR permit tabulations of time frames between the assessment/plan of care
determination of need and service provision. For services to be provided once the client discharges,
as part of their aftercare plan, CONTRACTOR shall conduct linkages using warm hand-offs
(personal contact) with the next-on provider, and at least one follow-up phone call within the first
month of discharge. CONTRACTOR shall document dates, times and notes regarding such
transition support contacts and will also work with the county, as desired, to evaluate county
datasets on post discharge connections into subsequent services. Based on prior experiences
operating and evaluating residentially-based treatment settings, very quick connections at discharge
are essential to retaining clients in ongoing needed services—the goal is to effect uptake within two
weeks or less from CRT exit.
5) Timeliness of response to sick call/health service requests
Any health issue that arises while a client is in the CRT, which cannot be handled by the nursing
staff in the facility (e.g., beyond first aid, simple pain management, etc.) is addressed as an urgency
(to be addressed on the shift and/or very next shift). Staff arranges access and transportation, and
otherwise supports the client to obtain medical care, based on the nature of the issue — immediately
from a hospital ER if an emergency, or at the scheduled appointment for less acute needs.
b. Effectiveness: Objective results achieved through health care services.
Examples include:
1) Effectiveness of crisis interventions
2) Effectiveness of treatment interventions (medical and behavioral health indicators)
CONTRACTOR shall track the percent of individuals who receive a crisis service who, within 15
days and within 30 days, return for crisis services at a hospital emergency department, psychiatric
hospital or jail. CONTRACTOR shall initially aim for <20% within 30 days, and will collaborate in the
pursuit of data and analyses that involve logging in EHR and through datasets accessible to the
county from these entities. Importantly, CONTRACTOR shall actively participate in quality
Exhibit B
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improvement initiatives the COUNTY sponsors to address system of care (community provider)
uptakes necessary to avoid crises, re-hospitalizations, and re-admissions to the CRT.
Improving member experience in achieving wellness and recovery will be tracked by: a) Recording
progress on individualized goals generated through collaboration with members and families -- at
least 85% will achieve progress on most/all their treatment goals (these are measured on the
CONTRACTOR's COR); b) Pre-post MORS (clinician rated), RAS and/or BASIS (client self-rated)
tools —there will be statistically significant desirable shifts (non-random effects) and strong effect
sizes (when latter can be determined, requires statistical norms) demonstrating reduced symptoms
and improved psycho-social functioning on standardized ratings; and, c) Completion of a WRAP by
discharge — at least 85% will create or refine an existing written WRAP (also measured on the
CONTRACTOR's COR).
3) Effectiveness of discharge planning (such as percentage of clients successfully linked to
COUNTY programs, community providers, and/or other community resources after release)
The goal is for a large majority, 90% or more, of all clients to be connected into community based
services and supports by discharge, meaning they are not discharged to a hospital, IMD,
incarcerative setting, or homeless/shelter. CONTRACTOR shall apply the methods described above
(data gathered during warm hand-offs, follow-up phone calls, and/or through analyses of COUNTY
datasets).
4) Timely continuity of verified community prescriptions for medication(s), upon client's
release
The goal is for a large majority, 85% or more, to experience prescription continuity. CONTRACTOR
shall apply the methods described above (data gathered during warm hand-offs, follow-up phone
calls, and/or through analyses of COUNTY datasets) to assess this.
5) Effectiveness of transportation coordination, upon release
The goal is for a large majority, 85% or more, to gain the transportation they need to participate in
aftercare services. CONTRACTOR shall provide discharging clients with bus passes, taxi vouchers,
and other means of assuring they can start aftercare programs and discussions shall take place for
how such supports can be continued with the next-on provider. CONTRACTOR shall apply the
methods described above (data gathered during warm hand-offs, follow-up phone calls, and/or
through analyses of county datasets) to assess this.
c. Efficiency: The demonstration of the relationship between results and the resources used to
achieve them.
Cost efficiency is best handled through data partnerships. CONTRACTOR shall participate in
COUNTY workgroups and/or partner with COUNTY evaluators to shape meaningful cost reduction
studies that demonstrate the positive impact of CRTs to a community's bottom line, as well as to
those served.
d. Satisfaction and Compliance: The degree to which clients, COUNTY, and other stakeholders
are satisfied with the services.
An overall resident satisfaction rating (and family satisfaction rating, where appropriate) of at least
90% on service aspects related to quality of care, accessibility, and timeliness of services, cultural
and linguistic attunement based on results from a resident satisfaction questionnaire, approved by
the COUNTY, and administered at discharge.
Exhibit B
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CONTRACTOR shall reach out to clients and families, hold focus groups, and conduct Satisfaction
Surveys to get direct feedback regarding satisfaction or dissatisfaction, suggestions for program
improvement, and input for interpreting outcome data. CONTRACTOR shall annually survey Agency
Partners to gather feedback about the program for improvement.
Examples include:
1) Audits and other performance and utilization reviews of health care services and
compliance with agreement terms and conditions.
CONTRACTOR's TQM program provides a wide array of quality/fidelity protocols which can be
tapped for this program (e.g., over 100 QA probes or checklists). Quality Assurance audits will be
conducted of daily progress notes (including psychiatrist, social work, nursing progress notes) to
ensure medical necessity is present and documented; and, regular periodic utilization reviews are
structured either internally and/or in conjunction with county personnel. In all circumstances, the
local QA team, supported by regional QA Managers, summarize the findings to provide the CRT
Team with timely feedback.
2) Surveys of persons served, family members, other health care providers, and other
stakeholders
All of CONTRACTOR'S programs participate in state/county driven MHSIP twice annual (usually,
Nov, May) survey cycles and put concerted effort at achieving good response rates, and at applying
the data to QI. Residentially-based programs also run exit interviews/surveys with discharging
clients and their family members, either on random sample or full sample bases, of any/all willing to
participate. CONTRACTOR shall survey agency partners at least annually, and be available to
others' constructive feedback and input at any time.
Overall, CONTRACTOR shall complete COUNTY mandated reporting, quarterly and annually.
Desired components, formats, cycles and timelines will all be observed. Reports will highlight both
successes and areas for improvement with related plans tracked through subsequent reporting
cycles as needed until a QA/QI project is complete. This information is shared with staff, members,
and other key stakeholders and shall be used to implement timely quality improvements
Exhibit B
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Crisis Residential Treatment Program
Central Stars Behavioral Health
Start Up/Ramp Up Budget- December 1, 2017 through April 30, 2018 (FY 2017-18)
Budget Categories- Total Proposed Budget
Line Item Description (Must be itemized) FTE % Admin. Direct Total
PERSONNEL SALARIES:
0001 Administrator 0.25 $14,514 $14,514
0002 Clinical Supervisor 1.00 $18,750 $18,750
0003 Nurse Practitioner 1.00 $9,013 $9,013
0004 LVN/LPN 4.60 $15,517 $15,517
0005 Program Director 1.00 $38,578 $38,578
0006 Recovery Counselor 6.00 $13,184 $13,184
0007 Household Counselor 3.00 $6,309 $6,309
0008 MHS Therapist 1.50 $6,116 $6,116
0009 Clerk 1.00 $9,360 $9,360
0010 Peer Counselor 1.50 $2,860 $2,860
0011 Resource Specialist 1.00 $2,678 $2,678
0012 HRManager 0.25 $1,517 $1,517
0013 QA Manager 0.25 $1,387 $1,387
0014 Training Coordinator 0.25 $1,040 $1,040
0015 Billing Clerk 0.25 $1,560 $1,560
0.00 $0
SALARY TOTAL 22.85 $29,378 $113,005 $142,383
PAYROLL TAXES:
0030 OASDI $1,821 $7,006 $8,828
0031 FICA/MEDICARE $426 $1,639 $2,065
0032 SUI $397 $1,526 $1,922
PAYROLL TAX TOTAL $2,644 $10,170 $12,814
EMPLOYEE BENEFITS:
0040 Retirement $734 $2,825 $3,560
0041 Workers Compensation $881 $3,390 $4,271
0042 Health Insurance (medical, vision, life, dental) $3,5251 $13,561 $17,086
EMPLOYEE BENEFITS TOTAL $5,1411 $19,7761 $24,917
SALARY& BENEFITS GRAND TOTAL $180,114
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $0
1012 Utilities $0
1013 Building Maintenance $3,500
1014 Equipment purchase $0
FACILITY/EQUIPMENT TOTAL $3,500
Exhibit B
Page 48 of 105
OPERATING EXPENSES:
1060 Telephone $4,160
1061 Answering Service $0
1062 Postage $100
1063 Printing/Reproduction $880
1064 Publications $200
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $4,944
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies- Medical $3,350
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $0
1073 Staff Travel (Out of County) $1,500
1074 Staff Training/Registration $7,000
1075 Lodging $6,000
1076 Centralized Services-Program $10,611
OPERATING EXPENSES TOTAL $38,745
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $0
1082 Liability Insurance $0
1083 Administrative Overhead $35,371
1084 Payroll Services $2,100
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $37,471
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management) $0
1091 Translation Services $0
1092 Medication Supports $0
1093 Recruitment $3,900
1094 Nutrionist $2,500
1095 Linens $9,600
SPECIAL EXPENSES TOTAL $16,000
Exhibit B
Page 49 of 105
FIXED ASSETS:
1190 Computers & Software $74,784
1191 Furniture & Fixtures $50,000
1192 Other- (Identify) $30,000
1193 Other- (Identify) $5,000
FIXED ASSETS TOTAL $159,784
NON MEDI-CAL BOARD & CARE EXPENSES:(Do not include in M/Cal rate calculations)
2000 Household supplies $300
2001 Other- (Identify) $0
2002 Other- (Identify) $0
2003 Other- (Identify) $0
2004 Other- (Identify) $0
2005 Other- (Identify) $0
2006 Other- (Identify) $0
2007 Other- (Identify) $0
2008 Other- (Identify) $0
2009 Other- (Identify) $0
NON MEDI-CAL BOARD & CARE TOTAL $300
TOTAL PROGRAM EXPENSES $435,914
MEDI-CAL REVENUE: Units of Service Rate $Amount
3000 Adult Crisis Residential (Mode 05/SFC 40-49) 0 $0.00 $0
3100 Medication Support (Mode 15/SFC 60-69) 0 $0.00 $0
3200 Other(identify) 0 $0.00 $0
Estimated Medi-Cal Billing Totals 0 $0
Estimated % of Federal Financial Participation Reimbursement 0.00% $0
Estimated % of State Behavioral Health Realignment Reimbursement 0.00% $0
MEDI-CAL REVENUE TOTAL $0
OTHER REVENUE:
4000 Mental Health Realignment $435,914
4100 Other- (Identify) $0
4200 Other- (Identify) $0
4300 Other- (Identify) $0
OTHER REVENUE TOTAL $435,914
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $0
5200 Innovation Funds $0
5300 Workforce Education &Training Funds $0
MHSA FUNDS TOTAL $0
TOTAL PROGRAM REVENUE $435,914
Exhibit B
Page 50 of 105
Crisis Residential Treatment Program
Central Stars Behavioral Health
Operational Budget- May 1, 2018 through June 30, 2018 (FY 2017-18)
Budget Categories- Total Proposed Budget
Line Item Description (Must be itemized) FTE % Admin. Direct Total
PERSONNEL SALARIES:
0001 Administrator 0.25 $5,330 $5,330
0002 Clinical Supervisor 1.00 $12,500 $12,500
0003 Nurse Practitioner 1.00 $18,027 $18,027
0004 LVN/LPN 4.60 $31,034 $31,034
0005 Program Director 1.00 $14,167 $14,167
0006 Recovery Counselor 6.00 $26,368 $26,368
0007 Household Counselor 3.00 $12,618 $12,618
0008 MHS Therapist 1.50 $12,231 $12,231
0009 Clerk 1.00 $6,240 $6,240
0010 Peer Counselor 1.50 $5,720 $5,720
0011 Resource Specialist 1.00 $5,356 $5,356
0012 HR Manager 0.25 $3,033 $3,033
0013 QA Manager 0.25 $2,773 $2,773
0014 Training Coordinator 0.25 $2,080 $2,080
0015 Billing Clerk 0.25 $3,120 $3,120
SALARY TOTAL 22.10 $22,576 $138,021 $160,597
PAYROLL TAXES:
0030 OASDI $1,400 $8,557 $9,957
0031 FICA/MEDICARE $327 $2,001 $2,329
0032 SUI $531 $3,243 $3,774
PAYROLL TAX TOTAL $2,258 $13,802 $16,060
EMPLOYEE BENEFITS:
0040 Retirement $564 $3,451 $4,015
0041 Workers Compensation $677 $4,141 $4,818
0042 Health Insurance (medical, vision, life, dental) $2,709 $16,563 $19,272
EMPLOYEE BENEFITS TOTAL $3,951 $24,154 $28,104
SALARY& BENEFITS GRAND TOTAL $204,761
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $0
1012 Utilities $9,667
1013 Building Maintenance $4,167
1014 Equipment purchase $0
Exhibit B
Page 51 of 105
1015 Janitorial $4,000
1016 Property taxes $200
FACILITY/EQUIPMENT TOTAL $18,034
OPERATING EXPENSES:
1060 Telephone $7,018
1061 Answering Service $0
1062 Postage $200
1063 Printing/Reproduction $880
1064 Publications $200
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $2,410
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies- Medical $6,700
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $2,000
1073 Staff Travel (Out of County) $0
1074 Staff Training/Registration $2,000
1075 Lodging $500
1076 Centralized services Program $8,472
1077 Minor equipment $3,487
OPERATING EXPENSES TOTAL $33,867
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $1,200
1082 Liability Insurance $1,650
1083 Administrative Overhead $42,355
1084 Payroll Services $2,800
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $48,005
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant(network &data management) $0
1091 Translation Services $200
1092 Medication Supports $0
1093 Purched Professional fees $2,195
1094 Psychiatrist $15,253
SPECIAL EXPENSES TOTAL $17,648
FIXED ASSETS:
1190 Computers & Software $0
Exhibit B
Page 52 of 105
1191 Furniture & Fixtures $0
1192 Other- (Identify) $0
1193 Other- (Identify) $0
FIXED ASSETS TOTAL $0
NON MEDI-CAL BOARD & CARE EXPENSES:(Do not include in M/Cal rate calculations)
2000 Household Supplies $400
2001 Food $9,667
2002 Program Supplies-Therapeutic $900
2003 Client Support $6,000
2004 Other- (Identify) $0
2005 Other- (Identify) $0
2006 Other- (Identify) $0
2007 Other- (Identify) $0
2008 Other- (Identify) $0
2009 Other- (Identify) $0
NON MEDI-CAL BOARD & CARE TOTAL $16,967
TOTAL PROGRAM EXPENSES $339,282
MEDI-CAL REVENUE: Units of Service Rate $Amount
3000 Adult Crisis Residential (Mode 05/SFC 40-49) 915 $352.44 $322,483
3100 Medication Support (Mode 15/SFC 60-69) 3,200 $5.25 $16,800
3200 Other(identify) 0 $0.00 $0
Estimated Medi-Cal Billing Totalsi 4,115 $339,283
Estimated % of Federal Financial Participation Reimbursement 50.00% $169,641
Estimated % of State Behavioral Health Realignment Reimbursement 40.00% $135,713
MEDI-CAL REVENUE TOTAL $305,354
OTHER REVENUE:
4000 Out of county $16,964
4100 Private insurance $16,964
4200 Other- (Identify) $0
4300 Other- (Identify) $0
OTHER REVENUE TOTAL $33,928
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $0
5200 Innovation Funds $0
5300 Workforce Education &Training Funds $0
MHSA FUNDS TOTAL $0
TOTAL PROGRAM REVENUE $339,282
Exhibit B
Page 53 of 105
Crisis Residential Treatment Program
Central Stars Behavioral Health
Budget- July 1, 2018 through June 30, 2019 (12 months)
Budget Categories- Total Proposed Budget
Line Item Description (Must be itemized) FTE % Admin. Direct Total
PERSONNEL SALARIES:
0001 Administrator 0.25 $32,460 $32,460
0002 Clinical Supervisor 1.00 $76,125 $76,125
0003 Nurse Practitioner 1.00 $109,782 $109,782
0004 LVN/LPN 4.60 $188,996 $188,996
0005 Program Director 1.00 $86,275 $86,275
0006 Recovery Counselor 6.00 $160,581 $160,581
0007 Household Counselor 3.00 $76,841 $76,841
0008 MHS Therapist 1.50 $74,488 $74,488
0009 Clerk 1.00 $38,002 $38,002
0010 Peer Counselor 1.50 $34,835 $34,835
0011 Resource Specialist 1.00 $32,618 $32,618
0012 HR Manager 0.25 $18,473 $18,473
0013 QA Manager 0.25 $16,890 $16,890
0014 Training Coordinator 0.25 $12,667 $12,667
0015 Billing Clerk 0.25 $19,001 $19,001
SALARY TOTAL 22.85 $137,493 $840,541 $978,034
PAYROLL TAXES:
0030 OASDI $8,525 $52,114 $60,638
0031 FICA/MEDICARE $1,994 $12,188 $14,181
0032 SUI $3,231 $19,753 $22,984
PAYROLL TAX TOTAL $13,749 $84,054 $97,803
EMPLOYEE BENEFITS:
0040 Retirement 3,437 21,014 $24,451
0041 Workers Compensation 4,125 25,216 $29,341
0042 Health Insurance (medical, vision, life, dental) 16,499 100,865 $117,364
EMPLOYEE BENEFITS TOTAL 1 $24,061 $147,095 $171,156
SALARY& BENEFITS GRAND TOTAL $1,246,993
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $0
1012 Utilities $58,000
1013 Building Maintenance $25,000
1014 Equipment purchase $0
Exhibit B
Page 54 of 105
1015 Janitorial $24,000
1016 Property taxes $1,200
FACILITY/EQUIPMENT TOTAL $108,200
OPERATING EXPENSES:
1060 Telephone $28,328
1061 Answering Service $0
1062 Postage $1,200
1063 Printing/Reproduction $5,280
1064 Publications $1,200
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $14,460
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies- Medical $40,200
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $12,232
1073 Staff Travel (Out of County) $0
1074 Staff Training/Registration $12,000
1075 Lodging $0
1076 Licenses $2,084
1077 Computers and software $39,545
1078 Minor equipment $3,000
OPERATING EXPENSES TOTAL $159,529
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $7,200
1082 Liability Insurance $9,900
1083 Administrative Overhead $171,987
1084 Payroll Services $16,800
1085 Professional Liability Insurance $0
1086 Centralized fiscal services .05 $85,994
FINANCIAL SERVICES TOTAL $291,881
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant(network &data management) $0
1091 Translation Services $1,200
1092 Laundry service $360
1093 Medical Waste Disposal $7,200
1094 Nutritionist Services $3,840
1095 Recruitment $1,770
Exhibit B
Page 55 of 105
1096 Psychiatrist $91,520
1097 Centralized services- Program $51,596
SPECIAL EXPENSES TOTAL $157,486
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other- (Identify) $0
1193 Other- (Identify) $0
FIXED ASSETS TOTAL $0
NON MEDI-CAL BOARD & CARE EXPENSES:(Do not include in M/Cal rate calculations)
2000 Household Supplies $2,400
2001 Food $57,719
2002 Program Supplies -Therapeutic $5,400
2003 Client Support $36,000
2004 Other- (Identify) $0
NON MEDI-CAL BOARD & CARE TOTAL $101,519
TOTAL PROGRAM EXPENSES $2,065,608
MEDI-CAL REVENUE: Units of Service Rate $Amount
3000 Adult Crisis Residential (Mode 05/SFC 40-49) 5,475 $358.87 $1,964,813
3100 Medication Support (Mode 15/SFC 60-69) 19,200 $5.25 $100,800
3200 Other(identify) 0 $0.00 $0
Estimated Medi-Cal Billing Totalsl 24,675 $2,065,613
Estimated % of Federal Financial Participation Reimbursement 50.00% $1,032,807
Estimated % of State Behavioral Health Realignment Reimbursement 40.00% $826,245
MEDI-CAL REVENUE TOTAL $1,859,052
OTHER REVENUE:
4000 Out of county revenue $103,278
4100 Private insurance revenue $103,278
4200 Other- (Identify) $0
4300 Other- (Identify) $0
OTHER REVENUE TOTAL $206,556
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $0
5200 Innovation Funds $0
5300 Workforce Education &Training Funds $0
MHSA FUNDS TOTAL $0
TOTAL PROGRAM REVENUE $2,065,608
Exhibit B
Page 56 of 105
Crisis Residential Treatment Program
Central Stars Behavioral Health
Budget- July 1, 2019 through June 30, 2020 (12 months)
Budget Categories- Total Proposed Budget
Line Item Description (Must be itemized) FTE % Admin. Direct Total
PERSONNEL SALARIES:
0001 Administrator 0.25 $33,433 $33,433
0002 Clinical Supervisor 1.00 $78,409 $78,409
0003 Nurse Practitioner 1.00 $113,076 $113,076
0004 LVN/LPN 4.60 $194,666 $194,666
0005 Program Director 1.00 $88,863 $88,863
0006 Recovery Counselor 6.00 $165,399 $165,399
0007 Household Counselor 3.00 $79,146 $79,146
0008 MHS Therapist 1.50 $76,723 $76,723
0009 Clerk 1.00 $39,142 $0 $39,142
0010 Peer Counselor 1.50 $35,880 $35,880
0011 Resource Specialist 1.00 $33,597 $33,597
0012 HR Manager 0.25 $19,027 $19,027
0013 QA Manager 0.25 $17,396 $17,396
0014 Training Coordinator 0.25 $13,047 $13,047
0015 Billing Clerk 0.50 $19,571 $19,571
SALARY TOTAL 23.10 $141,616 $865,759 $1,007,375
PAYROLL TAXES:
0030 OASDI $8,780 $53,677 $62,457
0031 FICA/MEDICARE $2,053 $12,554 $14,607
0032 SUI $3,328 $20,345 $23,673
PAYROLL TAX TOTAL $14,162 $86,576 $100,738
EMPLOYEE BENEFITS:
0040 Retirement 3,540 21,644 $25,184
0041 Workers Compensation 4,248 25,973 $30,221
0042 Health Insurance (medical, vision, life, dental) 16,994 103,891 $120,885
EMPLOYEE BENEFITS TOTAL $24,783 $151,508 $176,291
SALARY& BENEFITS GRAND TOTAL $1,284,403
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $0
1012 Utilities $58,000
1013 Building Maintenance $25,000
1014 Equipment purchase
Exhibit B
Page 57 of 105
1015 Janitorial $24,480
1016 Property taxes $1,200
FACILITY/EQUIPMENT TOTAL $108,680
OPERATING EXPENSES:
1060 Telephone $28,894
1061 Answering Service $0
1062 Postage $1,236
1063 Printing/Reproduction $5,386
1064 Publications $1,200
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $14,749
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies- Medical $41,004
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $12,599
1073 Staff Travel (Out of County) $0
1074 Staff Training/Registration $12,000
1075 Lodging $0
1076 Licenses $2,147
1077 Computer&software $40,276
1078 Minor equipment $3,000
OPERATING EXPENSES TOTAL $162,491
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $7,200
1082 Liability Insurance $10,296
1083 Administrative Overhead $176,644
1084 Payroll Services $17,136
1085 Professional Liability Insurance $0
1086 Centralized fiscal services .05 $88,322
FINANCIAL SERVICES TOTAL $299,598
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant(network &data management) $0
1091 Translation Services $1,236
1092 Laundry service $370
1093 Medical Waste Disposal $7,416
1094 Nutritionist Services $3,840
1095 Recruitment $1,770
Exhibit B
Page 58 of 105
1096 Psychiatrist $93,600
1097 Centralized services- Program $52,992
SPECIAL EXPENSES TOTAL $161,224
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other- (Identify) $0
1193 Other- (Identify) $0
FIXED ASSETS TOTAL $0
NON MEDI-CAL BOARD & CARE EXPENSES:(Do not include in M/Cal rate calculations)
2000 Household Supplies $2,448
2001 Food $59,450
2002 Program Supplies -Therapeutic $5,508
2003 Client Support $37,651
2004 Other- (Identify) $0
NON MEDI-CAL BOARD & CARE TOTAL $105,057
TOTAL PROGRAM EXPENSES $2,121,453
MEDI-CAL REVENUE: Units of Service Rate $Amount
3000 Adult Crisis Residential (Mode 05/SFC 40-49) 5,475 $368.49 $2,017,482
3100 Medication Support (Mode 15/SFC 60-69) 19,200 $5.42 $104,064
3200 Other(identify) 0 $0.00 $0
Estimated Medi-Cal Billing Totalsl 24,675 $2,121,546
Estimated % of Federal Financial Participation Reimbursement 50.00% $1,060,773
Estimated % of State Behavioral Health Realignment Reimbursement 40.00% $848,618
MEDI-CAL REVENUE TOTAL $1,909,391
OTHER REVENUE:
4000 Other- (Identify) $106,031
4100 Other- (Identify) $106,031
4200 Other- (Identify) $0
4300 Other- (Identify) $0
OTHER REVENUE TOTAL $212,062
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $0
5200 Innovation Funds $0
5300 Workforce Education &Training Funds $0
MHSA FUNDS TOTAL $0
TOTAL PROGRAM REVENUE $2,121,453
Exhibit B
Page 59 of 105
Crisis Residential Treatment Program
Central Stars Behavioral Health
Budget- July 1, 2020 through June 30, 2021 (12 months)
Budget Categories- Total Proposed Budget
Line Item Description (Must be itemized) FTE % Admin. Direct Total
PERSONNEL SALARIES:
0001 Administrator 0.25 $34,436 $34,436
0002 Clinical Supervisor 1.00 $80,761 $80,761
0003 Nurse Practitioner 1.00 $116,468 $116,468
0004 LVN/LPN 4.60 $200,506 $200,506
0005 Program Director 1.00 $91,529 $91,529
0006 Recovery Counselor 6.00 $170,361 $170,361
0007 Household Counselor 3.00 $81,520 $81,520
0008 MHS Therapist 1.50 $79,025 $79,025
0009 Clerk 1.00 $40,316 $40,316
0010 Peer Counselor 1.50 $36,956 $36,956
0011 Resource Specialist 1.00 $34,604 $34,604
0012 HR Manager 0.25 $19,598 $19,598
0013 QA Manager 0.25 $17,918 $17,918
0014 Training Coordinator 0.25 $13,439 $13,439
0015 Billing Clerk 0.50 $20,158 $20,158
SALARY TOTAL 23.10 $145,865 $891,730 $1,037,595
PAYROLL TAXES:
0030 OASDI $9,044 $55,287 $64,331
0031 FICA/MEDICARE $2,115 $12,930 $15,045
0032 SUI $3,428 $20,956 $24,383
PAYROLL TAX TOTAL $14,587 $89,173 $103,760
EMPLOYEE BENEFITS:
0040 Retirement 3,647 22,293 $25,940
0041 Workers Compensation 4,376 26,752 $31,128
0042 Health Insurance (medical, vision, life, dental) 117,504 1 107,008 $124,511
EMPLOYEE BENEFITS TOTAL $25,5261 $156,053 $181,579
SALARY& BENEFITS GRAND TOTAL $1,322,934
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $0
1012 Utilities $58,000
1013 Building Maintenance $25,000
1014 Equipment purchase
1015 Janitorial $24,970
Exhibit B
Page 60 of 105
1016 Property taxes $1,236
FACILITY/EQUIPMENT TOTAL $109,206
OPERATING EXPENSES:
1060 Telephone $29,446
1061 Answering Service $0
1062 Postage $1,260
1063 Printing/Reproduction $5,494
1064 Publications $1,224
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $15,044
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies- Medical $42,234
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $12,600
1073 Staff Travel (Out of County) $0
1074 Staff Training/Registration $12,240
1075 Lodging $0
1076 Licenses $2,189
1077 Computer& software $41,135
1078 Minor equipment $3,060
OPERATING EXPENSES TOTAL $165,926
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $7,344
1082 Liability Insurance $10,604
1083 Administrative Overhead $181,094
1084 Payroll Services $17,136
1085 Professional Liability Insurance $0
1086 Centralized fiscal services .05 $90,547
FINANCIAL SERVICES TOTAL $306,725
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network &data management) $0
1091 Translation Services $1,260
1092 Laundry service $378
1093 Medical Waste Disposal $7,564
1094 Nutritionist Services $3,918
1095 Recruitment $1,824
1096 Psychiatrist $93,600
1097 Centralized services - Program $54,328
Exhibit B
Page 61 of 105
SPECIAL EXPENSES TOTAL 1 $162,872
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other- (Identify) $0
1193 Other- (Identify) $0
FIXED ASSETS TOTAL $0
NON MEDI-CAL BOARD & CARE EXPENSES:(Do not include in M/Cal rate calculations)
2000 Household Supplies $2,496
2001 Food $61,234
2002 Program Supplies - Therapeutic $5,674
2003 Client Support $37,822
2004 Other- (Identify) $0
NON MEDI-CAL BOARD & CARE TOTAL $107,226
TOTAL PROGRAM EXPENSES $2,174,889
MEDI-CAL REVENUE: Units of Service Rate $ Amount
3000 Adult Crisis Residential (Mode 05/SFC 40-49) 5,475 $377.95 $2,069,276
3100 Medication Support (Mode 15/SFC 60-69) 19,200 $5.50 $105,600
3200 Other(identify) 0 $0.00 $0
Estimated Medi-Cal Billing Totalsl 24,675 $2,174,876
Estimated % of Federal Financial Participation Reimbursement 50.00% $1,087,438
Estimated % of State Behavioral Health Realignment Reimbursement 40.00% $869,951
MEDI-CAL REVENUE TOTAL $1,957,389
OTHER REVENUE:
4000 Other- (Identify) $108,750
4100 Other- (Identify) $108,750
4200 Other- (Identify) $0
4300 Other- (Identify) $0
OTHER REVENUE TOTAL $217,500
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $0
5200 Innovation Funds $0
5300 Workforce Education &Training Funds $0
MHSA FUNDS TOTAL $0
TOTAL PROGRAM REVENUEJ 2,174,889
Exhibit B
Page 62 of 105
Crisis Residential Treatment Program
Central Stars Behavioral Health
Budget-July 1, 2021 through June 30, 2022
Budget Categories - Total Proposed Budget
Line Item Description (Must be itemized) FTE % Admin. Direct Total
PERSONNEL SALARIES:
0001 Administrator 0.25 $35,470 $35,470
0002 Clinical Supervisor 1.00 $83,184 $83,184
0003 Nurse Practitioner 1.00 $119,962 $119,962
0004 LVN/LPN 4.60 $206,522 $206,522
0005 Program Director 1.00 $94,275 $94,275
0006 Recovery Counselor 6.00 $175,471 $175,471
0007 Household Counselor 3.00 $83,966 $83,966
0008 MHS Therapist 1.50 $81,395 $81,395
0009 Clerk 1.00 $41,525 $41,525
0010 Peer Counselor 1.50 $38,065 $38,065
0011 Resource Specialist 1.00 $35,643 $35,643
0012 HR Manager 0.25 $20,185 $20,185
0013 QA Manager 0.25 $18,456 $18,456
0014 Training Coordinator 0.25 $13,842 $13,842
0015 Billing Clerk 0.50 $20,763 $20,763
SALARY TOTAL 23.10 $150,241 $918,483 $1,068,724
PAYROLL TAXES:
0030 OASDI $9,315 $56,946 $66,261
0031 FICA/MEDICARE $2,178 $13,318 $15,496
0032 SUI $3,531 $21,584 $25,115
PAYROLL TAX TOTAL $15,024 $91,848 $106,872
EMPLOYEE BENEFITS:
0040 Retirement 3,756 22,962 $26,718
0041 Workers Compensation 4,507 27,554 $32,062
0042 Health Insurance (medical, vision, life, dental) 18,029 110,218 $128,247
EMPLOYEE BENEFITS TOTAL $26,2921 $160,735 $187,027
SALARY& BENEFITS GRAND TOTAL $1,362,623
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $0
1012 Utilities $58,000
1013 Building Maintenance $25,000
1014 Equipment purchase
1015 Janitorial $25,469
Exhibit B
Page 63 of 105
1016 Property taxes $1,261
FACILITY/EQUIPMENT TOTAL $109,730
OPERATING EXPENSES:
1060 Telephone $30,035
1061 Answering Service $0
1062 Postage $1,286
1063 Printing/Reproduction $5,603
1064 Publications $1,248
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $15,345
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies -Therapeutic $0
1070 Program Supplies - Medical $43,501
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $12,851
1073 Staff Travel (Out of County) $0
1074 Staff Training/Registration $12,607
1075 Lodging $0
1076 Licenses $2,233
1077 Computer&software $42,226
1078 Minor equipment $3,152
OPERATING EXPENSES TOTAL $170,087
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $7,491
1082 Liability Insurance $11,029
1083 Administrative Overhead $186,095
1084 Payroll Services $17,479
1085 Professional Liability Insurance $0
1086 Centralized fiscal services .05 $93,047
FINANCIAL SERVICES TOTAL $315,141
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant(network &data management) $0
1091 Translation Services $1,299
1092 Laundry service $386
1093 Medical Waste Disposal $7,791
1094 Nutritionist Services $4,034
1095 Recruitment $1,878
1096 Psychiatrist $95,680
1097 Centralized services- Program $55,818
Exhibit B
Page 64 of 105
SPECIAL EXPENSES TOTAL $166,886
FIXED ASSETS:
1190 Computers &Software $0
1191 Furniture & Fixtures $0
1192 Other- (Identify) $0
1193 Other- (Identify) $0
FIXED ASSETS TOTAL $0
NON MEDI-CAL BOARD &CARE EXPENSES:(Do not include in M/Cal rate calculations)
2000 Household Supplies $2,547
2001 Food $63,071
2002 Program Supplies -Therapeutic $5,843
2003 Client Support $38,967
2004 Other- (Identify) $0
NON MEDI-CAL BOARD & CARE TOTAL $110,428
TOTAL PROGRAM EXPENSES $2,234,895
MEDI-CAL REVENUE: Units of Service Rate $Amount
3000 Adult Crisis Residential (Mode 05/SFC 40-49) 5,475 $388.91 $2,129,283
3100 Medication Support (Mode 15/SFC 60-69) 19,200 $5.50 $105,600
3200 Other(identify) 0 $0.00 $0
Estimated Medi-Cal Billing Totalsl 24,675 $2,234,883
Estimated % of Federal Financial Participation Reimbursement 50.00% $1,117,442
Estimated % of State Behavioral Health Realignment Reimbursement 40.00% $893,953
MEDI-CAL REVENUE TOTAL $2,011,395
OTHER REVENUE:
4000 Other- (Identify) $111,750
4100 Other- (Identify) $111,750
4200 Other- (Identify) $0
4300 Other- (Identify) $0
OTHER REVENUE TOTAL $223,500
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $0
5200 Innovation Funds $0
5300 Workforce Education &Training Funds $0
MHSA FUNDS TOTAL $0
TOTAL PROGRAM REVENUEJ $2,234,895
Exhibit B
Page 65 of 105
Crisis Residential Treatment Program
Central Stars Behavioral Health
Budget-July 1, 2022 through June 30, 2023
Budget Categories- Total Proposed Budget
Line Item Description (Must be itemized) FTE % Admin. Direct Total
PERSONNEL SALARIES:
0001 Administrator 0.25 $36,534 $36,534
0002 Clinical Supervisor 1.00 $85,679 $85,679
0003 Nurse Practitioner 1.00 $123,561 $123,561
0004 LVN/LPN 4.60 $212,717 $212,717
0005 Program Director 1.00 $97,103 $97,103
0006 Recovery Counselor 6.00 $180,735 $180,735
0007 Household Counselor 3.00 $86,485 $86,485
0008 MHS Therapist 1.50 $83,837 $83,837
0009 Clerk 1.00 $42,771 $42,771
0010 Peer Counselor 1.50 $39,207 $39,207
0011 Resource Specialist 1.00 $36,712 $36,712
0012 HR Manager 0.25 $20,792 $20,792
0013 QA Manager 0.25 $19,009 $19,009
0014 Training Coordinator 0.25 $14,257 $14,257
0015 Billing Clerk 0.50 $21,386 $21,386
SALARY TOTAL 23.10 $154,749 $946,036 $1,100,785
PAYROLL TAXES:
0030 OASDI $9,594 $58,654 $68,249
0031 FICA/MEDICARE $2,244 $13,718 $15,961
0032 SUI $3,637 $22,232 $25,868
PAYROLL TAX TOTAL $15,475 $94,604 $110,079
EMPLOYEE BENEFITS:
0040 Retirement 3,869 23,651 $27,520
0041 Workers Compensation 4,642 28,381 $33,024
0042 Health Insurance (medical, vision, life, dental) 18,570 113,524 $132,094
EMPLOYEE BENEFITS TOTAL $27,0811 $165,5561 $192,637
SALARY& BENEFITS GRAND TOTAL $1,403,501
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $0
1012 Utilities $58,000
1013 Building Maintenance $25,000
1014 Equipment purchase
1015 Janitorial $26,233
Exhibit B
Page 66 of 105
1016 Property taxes $1,299
FACILITY/EQUIPMENT TOTAL $110,532
OPERATING EXPENSES:
1060 Telephone $30,649
1061 Answering Service $0
1062 Postage $1,286
1063 Printing/Reproduction $5,715
1064 Publications $1,273
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $15,652
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies- Medical $44,371
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $13,238
1073 Staff Travel (Out of County) $0
1074 Staff Training/Registration $12,859
1075 Lodging $0
1076 Licenses $2,278
1077 Computer&software $43,046
1078 Minor equipment $3,215
OPERATING EXPENSES TOTAL $173,582
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $7,641
1082 Liability Insurance $11,360
1083 Administrative Overhead $191,153
1084 Payroll Services $17,828
1085 Professional Liability Insurance $0
1086 Centralized fiscal services .05 $95,577
FINANCIAL SERVICES TOTAL 1 $323,559
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant(network &data management) $0
1091 Translation Services $1,337
1092 Laundry service $393
1093 Medical Waste Disposal $8,025
1094 Nutritionist Services $4,115
1095 Recruitment $1,935
1096 Psychiatrist $97,760
Exhibit B
Page 67 of 105
1097 Centralized services- Program $57,344
SPECIAL EXPENSES TOTAL $170,909
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other- (Identify) $0
1193 Other- (Identify) $0
FIXED ASSETS TOTAL $0
NON MEDI-CAL BOARD & CARE EXPENSES:(Do not include in M/Cal rate calculations)
2000 Household Supplies $2,598
2001 Food $64,963
2002 Program Supplies-Therapeutic $5,960
2003 Client Support $39,735
2004 Other- (Identify) $0
NON MEDI-CAL BOARD & CARE TOTAL $113,256
TOTAL PROGRAM EXPENSES $2,295,339
MEDI-CAL REVENUE: Units of Service Rate $Amount
3000 Adult Crisis Residential (Mode 05/SFC 40-49) 5,475 $399.43 $2,186,879
3100 Medication Support (Mode 15/SFC 60-69) 19,200 $5.65 $108,480
3200 Other(identify) 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Collateral 0 $0.00 $0
3500 Plan Development 0 $0.00 $0
3600 Assessment 0 $0.00 $0
3700 Rehabilitation 0 $0.00 $0
Estimated Medi-Cal Billing Totalsl 24,675 $2,295,359
Estimated % of Federal Financial Participation Reimbursement 50.00% $1,147,680
Estimated % of State Behavioral Health Realignment Reimbursement 40.00% $918,144
MEDI-CAL REVENUE TOTAL $2,065,823
OTHER REVENUE:
4000 Other- (Identify) $114,758
4100 Other- (Identify) $114,758
4200 Other- (Identify) $0
4300 Other- (Identify) $0
OTHER REVENUE TOTAL $229,516
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $0
5200 Innovation Funds $0
5300 Workforce Education &Training Funds $0
MHSA FUNDS TOTAL $0
TOTAL PROGRAM REVENUEJ $2,295,339
Exhibit B
Page 68 of 105
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
Fee Per User/License
NetSmart Avatar Monthly $ 37.00 $ 37.00 $ 37.00 $ 37.00 $ 37.00
Hosting Service
(per named user per month)
NetSmart Avatar Annual $ 168.00 $ 173.04 $ 178.23 $ 183.58 $ 189.09
Maintenance/License*
(per named license per year)
OrderConnect License' $ 1,278.00 $ 1,278.00 $ 1,278.00 $ 1,278.00 $ 1,278.00
(per named license per year)
Reaching Recovery $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00
(per named user per year)
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 1St
'Includes 100 faxed pages per month. An additional fee of$0.20 per faxed page will apply thereafter.
Exhibit B
Page 69 of 105
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health services.
Mental health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its employees
and subcontractors to attend a compliance training that will be provided by Fresno County. After
completion of this training, each contractor, contractor's employee and subcontractor must sign the
Contractor Acknowledgment and Agreement form and return this form to the Compliance officer or
designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and billing
for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their
professional dealing related to their contract with the County and avoid any conduct that could
reasonably be expected to reflect adversely upon the integrity of the County.
3. Treat County employees, consumers, and other mental health contractors fairly and with
respect.
4. NOT engage in any activity in violation of the County's Compliance Program, nor engage in
any other conduct which violates any applicable law, regulation, rule or guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely and are
consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement
of any kind are submitted.
7. Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
Exhibit B
Page 70 of 105
8. Act promptly to investigate and correct problems if errors in claims or billing are discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of Conduct
and Ethics by County employees or other mental health contractors, or report any activity that
they believe may violate the standards of the Compliance Program, or any other applicable
law, regulation, rule or guideline. Fresno County prohibits retaliation against any person
making a report. Any person engaging in any form of retaliation will be subject to disciplinary
or other appropriate action by the County. Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible person
and therefore excluded from participation in the Federal Health Care Programs.
Exhibit B
Page 71 of 105
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
Signature : Date
For Group or Organizational Providers
Group/Org. Name (print):
Employee Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
❑ Other:
Job Title (if different from Discipline):
Signature: Date: / /
Exhibit B
Page 72 of 105
Documentation Standards For Client Records
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the record
have a specific document or section addressing these topics.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client record.
• Relevant physical health conditions reported by the client will be prominently identified
and updated as appropriate.
• Presenting problems and relevant conditions affecting the client's physical health and
mental health status will be documented, for example: living situation, daily activities,
and social support.
• Documentation will describe client's strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently
documented and updated as appropriate.
• Documentations will include medications that have been described by mental health plan
physicians, dosage of each medication, dates of initial prescriptions and refills, and
documentations of informed consent for medications.
• Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
• A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data, relevant
family information and relevant results of relevant lab tests and consultations reports.
• For children and adolescents, pre-natal and perinatal events and complete developmental
history will be documented.
• Documentations will include past and present use of tobacco, alcohol, and caffeine, as
well as illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A five axis diagnosis from the most current DSM, or a diagnosis from the most current
ICD, will be documented, consistent with the presenting problems, history mental status
evaluation and/or other assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document changes in
the client's condition.
• Client conditions will be assessed at least annually and, in most cases, at more frequent
intervals.
B. Client Plans
1.Client plans will:
Exhibit B
Page 73 of 105
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent)by:
➢ the person providing the service(s), or
➢ a person representing a team or program providing services, or
➢ a person representing the MHP providing services
➢ when the client plan is used to establish that the services are provided under the
direction of an approved category of staff, and if the below staff are not the approved
category,
➢ a physician
➢ a licensed/"waivered"psychologist
➢ a licensed/"associate" social worker
➢ a licensed/registered/marriage and family therapist or
➢ a registered nurse
• In addition,
➢ client plans will be consistent with the diagnosis, and the focus of intervention will be
consistent with the client plan goals, and there will be documentation of the client's
participation in and agreement with the plan. Examples of the documentation include,
but are not limited to, reference to the client's participation and agreement in the body
of the plan, client signature on the plan, or a description of the client's participation
and agreement in progress notes.
➢ client signature on the plan will be used as the means by which the
CONTRACTOR(S) documents the participation of the client
➢ when the client's signature is required on the client plan and the client refuses or is
unavailable for signature, the client plan will include a written explanation of the
refusal or unavailability.
• The CONTRACTOR(S) will give a copy of the client plan to the client on request.
2.Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for the
individual elements of the client plan described in item 1.
C. Progress Notes
1.Items that must be contained in the client record related to the client's progress in treatment
include:
• The client record will provide timely documentation of relevant aspects of client care
• Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
• All entries in the client record will include the signature of the person providing the
service (or electronic equivalent); the person's professional degree, licensure or job title;
and the relevant identification number, if applicable
Exhibit B
Page 74 of 105
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge summary
2.Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated below:
A.Every Service Contact
• Mental Health Services
• Medication Support Services
• Crisis Intervention
Exhibit B
Page 75 of 105
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level)persons employed by the COUNTY Mental Health
Program (directly or through contract)providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with
all State of California and Federal statutes and regulations regarding
confidentiality, including but not limited to confidentiality of information
requirements at 42, Code of Federal Regulations sections 2.1 et seq; California
Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division
10.5 and 10.6 of the California Health and Safety Code; Title 22, California Code
of Regulations, section 51009; and Division 1, Part 2.6, Chapters 1-7 of the
California Civil Code.
4. NON-DISCRIMINATION
A. Eli ig bility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed,political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer,
Exhibit B
Page 76 of 105
rates of pay or other forms of compensation,use of facilities, and other
terms and conditions of employment.
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all
further funds,until CONTRACTOR can show clear and convincing
evidence to the satisfaction of COUNTY that funds provided under this
Agreement were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY's Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights
Exhibit B
Page 77 of 105
FRESNO COUNiyNENTAL HEALTH PLAN
GmEvANCES AND INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit B
Page 78 of 105
INCIDENT REPORT WORKSHEET
Wien did this happen? (date/time) Where did this happen?
Narne/DMH#
1. Background information of the incident:
2. Method of investigation: (chart review,face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses,visitors, physicians, employees)
3. Preliminary findings: How did it happen? Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome seventy: Nonexistent �❑ inconsequential �❑ consequential death not applicable [Ell unknown �❑
4. Response: a)corrective action, b) Plan of Action, c)other
Completed by(print name)
Completed by(signature) Date completed
Reviewed by Supervisor(print name)
Supervisor Signature Date
Exhibit B
Page 79 of 105
Medi-Cal Organizational Provider Standards
1. The organizational provider possesses the necessary license to operate, if applicable, and any
required certification.
2. The space owned, leased or operated by the provider and used for services or staff meets
local fire codes.
3. The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4. The organizational provider establishes and implements maintenance policies for any site
owned, leased, or operated by the provider and used for services or staff to ensure the safety
and well being of beneficiaries and staff.
5. The organizational provider has a current administrative manual which includes: personnel
policies and procedures, general operating procedures, service delivery policies, and
procedures for reporting unusual occurrences relating to health and safety issues.
6. The organizational provider maintains client records in a manner that meets applicable state
and federal standards.
7. The organization provider has staffing adequate to allow the County to claim federal
financial participation for the services the Provider delivers to beneficiaries, as described in
Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8. The organizational provider has written procedures for referring individuals to a psychiatrist
when necessary, or to a physician, if a psychiatrist is not available.
9. The organizational provider has as head of service a licensed mental health professional of
other appropriate individual as described in Title 9, CCR, Sections 622 through 630.
10. For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A. All drugs obtained by prescription are labeled in compliance with federal and state laws.
Prescription labels are altered only by persons legally authorized to do so.
B. Drugs intended for external use only or food stuffs are stored separately from drugs for
internal use.
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86 degrees F
and refrigerated drugs at 36-46 degrees F.
Exhibit B
Page 80 of 105
D. Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F. A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal laws.
G. Policies and procedures are in place for dispensing, administering and storing
medications.
11. For organizational providers that provide day treatment intensive or day rehabilitation,
the provider must have a written description of the day treatment intensive and/or day
treatment rehabilitation program that complies with State Department of Health Care
Service's day treatment requirements. The COUNTY shall review the provider's written
program description for compliance with the State Department of Health Care Service's
day treatment requirements.
12. The COUNTY may accept the host county's site certification and reserves the right to
conduct an on-site certification review at least every three years. The COUNTY may also
conduct additional certification reviews when:
• The provider makes major staffing changes.
• The provider makes organizational and/or corporate structure changes (example:
conversion from a non-profit status).
• The provider adds day treatment or medication support services when medications
shall be administered or dispensed from the provider site.
• There are significant changes in the physical plant of the provider site (some physical
plant changes could require a new fire clearance).
• There is change of ownership or location.
• There are complaints against the provider.
• There are unusual events, accidents, or injuries requiring medical treatment for
clients, staff or members of the community.
Exhibit B
Page 81 of 105
Fresno County Mental Health Plan
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance
and appeal process and an expedited appeal process to resolve grievances and
disputes at the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-
for-service providers give verbal and written information to Medi-Cal beneficiaries
regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a
grievance form, an appeal form, and Request for Change of Provider Form. All
of these beneficiary materials must be posted in prominent locations where Medi-
Cal beneficiaries receive outpatient specialty mental health services, including
the waiting rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required
to give their clients copies of all current beneficiary information annually at the
time their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without
any penalty, change in mental health services, or any form of retaliation. All
Medi-Cal beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available
for beneficiaries to pick up at all provider sites without having to make a verbal or
written request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other
complaints and concerns.
Exhibit B
Page 82 of 105
Informal provider problem resolution process— the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the
attempt is unsuccessful and the provider chooses to forego the informal
grievance process, the provider will be advised to file a written complaint to the
MHP address (listed above).
Formal provider appeal process— the provider has the right to access the
provider appeal process at any time before, during, or after the provider problem
resolution process has begun, when the complaint concerns a denied or modified
request for MHP payment authorization, or the process or payment of a
provider's claim to the MHP.
Payment authorization issues— the provider may appeal a denied or modified
request for payment authorization or a dispute with the MHP regarding the
processing or payment of a provider's claim to the MHP. The written appeal
must be submitted to the MHP within 90 calendar days of the date of the receipt
of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the
decision that addresses each issue raised by the provider, and any action
required by the provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request,
the MHP utilizes a Managed Care staff who was not involved in the initial denial
or modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be
asked to submit a revised request for payment within 30 calendar days of receipt
of the decision
Other complaints— if there are other issues or complaints, which are not related
to payment authorization issues, providers are encouraged to send a letter of
complaint to the MHP. The provider will receive a written response from the
MHP within 60 calendar days of receipt of the complaint. The decision rendered
buy the MHP is final.
Exhibit B
Page 83 of 105
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) City State ZIP code
CLIA number Taxpayer ID number(EIN) /Telephone number
)
Il. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
byTitles XVIII, XIX, or XX?......................................................................................................................... o 0
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX?...................................................................................... o 0
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVII I providers only)........... o 0
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under"Remarks."
NAME ADDRESS EIN
B. Type of entity: o Sole proprietorship o Partnership o Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... o 0
NAME ADDRESS PROVIDER NUMBER
Exhibit B
Page 84 of 105
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... o 0
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... o 0
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
Exhibit B
Page 85 of 105
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit B
Page 86 of 105
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) (d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)
Exhibit B
Page 87 of 105
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County"), members
of a contractor's board of directors (hereinafter referred to as "County Contractor"), must disclose any
self-dealing transactions that they are a party to while providing goods, performing services, or both
for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit B
Page 88 of 105
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3) Disclosure(Please describe the nature of the self-dealing transaction you are a party to)
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a)
(5)Authorized Signature
Signature: Date:
xhibit B
Agreement No. 17-580-Rage 8 of 105
1 AMENDMENT I TO AGREEMENT
2 THIS AMENDMENT, hereinafter referred to as "Amendment I", is made and entered into this
3 28th day of April 2020, by and between the COUNTY OF FRESNO, a Political
4 Subdivision of the State of California, hereinafter referred to as "COUNTY", and CENTRAL STAR
5 BEHAVIORAL HEALTH, INC., a for-profit corporation, whose address is 1501 Hughes Way, Suite
6 150, Long Beach, CA 90810, hereinafter referred to as "CONTRACTOR" (collectively the "parties").
7 WHEREAS the parties entered into that certain Agreement, identified as COUNTY Agreement
8 No. A-17-580, effective December 1, 2017, hereinafter referred to as "Agreement", whereby
9 CONTRACTOR agreed to provide certain crisis residential treatment services to COUNTY's
10 Department of Behavioral Health (DBH); and
11 WHEREAS the parties now desire to amend the Agreement regarding changes as stated
12 below and restate the Agreement in its entirety.
13 NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
14 hereinafter set forth, the sufficiency of which is hereby acknowledged, the parties agree as follows:
15 1. That the existing COUNTY Agreement No. A-17-580, Page Twelve (12), beginning with
16 Paragraph Three (3), Line Twenty-Two (22) with the word 7. MODIFICATION" and ending on Page
17 Thirteen (13), Line Eleven (11) with the word "Agreement" be deleted and the following inserted in its
18 place:
19 67. MODIFICATION
20 Any matters of this Agreement may be modified from time to time by the written
21 consent of all the parties without, in any way, affecting the remainder.
22 Notwithstanding the above, minor changes to services, staffing, and
23 responsibilities of the CONTRACTOR , as needed, and changes to accommodate changes in the laws
24 relating to mental health treatment, may be made with the signed written approval of COUNTY's DBH
25 Director, or designee, and CONTRACTOR through an amendment approved by COUNTY's Counsel
26 and the COUNTY's Auditor-Controller's Office.
27 In addition, changes to expense category (i.e., Salary & Benefits,
28 Facilities/Equipment, Operating, Financial Services, Special Expenses, Fixed Assets, etc.) subtotals in the
- 1 - COUNTY OF FRESNO
Fresno, CA
xhibit B
Page 9 of 105
1 budgets, and changes to the volume of units of services/types of service units to be provided as set forth
2 in Exhibit B, that do not exceed ten percent (10%)of the maximum compensation payable to the
3 CONTRACTOR may be made with the written approval of COUNTY's DBH Director, or designee.
4 Changes to the expense categories in the budget that exceed ten percent (10%) of the maximum
5 compensation payable to the CONTRACTOR, may be made with the signed written approval of
6 COUNTY's DBH Director, designee through an amendment approved by COUNTY's Counsel and
7 COUNTY's Auditor-Controller's Office.
8 For the period of March 1, 2020 to June 30, 2020, changes to expense category
9 (i.e., Salary & Benefits, Facilities/Equipment, Operating, Financial Services, Special Expenses, Fixed
10 Assets, etc.) subtotals in the budgets, and changes to the volume of units of services/types of service
11 units to be provided as set forth in Exhibit B, that do not exceed twenty percent (20%) of the maximum
12 compensation payable to the CONTRACTOR may be made with the written approval of COUNTY's DBH
13 Director, or designee.
14 Said modifications shall not result in any change to the annual maximum
15 compensation amount payable to CONTRACTOR, as stated in this Agreement."
16 2. Except as otherwise provided in this Amendment I, all other provisions of the
17 Agreement remain unchanged and in full force and effect. This Amendment I shall become effective
18 retroactive to March 1, 2020.
19
20
21
22
23
24
25
26
27
28
- 2 - COUNTY OF FRESNO
Fresno, CA
Exhibit B
Page 91 of 105
1
i, IN WITNESS Wi-IEREOF, the parties hereto have executed this Amendment I to Agreement as
{� of the day and year first hereinabove written.
CONTRACTOR: COUNTY OF FRESNO:
CENTRAL STAR BEHAVIORAL
I, HEALTH, INC.
r�
By ` B
/ Ernest Buddy Men s,
11 Chairman of the Board of Supervisors
/ of the County of Fresno l
Print Name: l\ ,-7 : e I
e (� 11f
11 Title:
Chairman of the Board, or
President, or any Vice President
` Date: �ll L—' BERNICE E. SEIDEL, !
I Clerk of the Board of Supervisors
County of Fresno. State of California
By By U Ak'
1 11" Deputy
Print Name. i\ i%A
1
' Title: J? l .-
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
- Date: q l r
Mailing Address:
1501 Hughes Way, Sufte 150
Long Beach, CA 90810
Phone#: (310) 221-6336 j
Contact: Kent Dunlap
Fund/Subclass: 0001/10000
Organization: 56302117
Account#: 7295
R. JCM
I
Agreement No. 22-540
xhibit B
Page 9 2 of 105
1 AMENDMENT II TO AGREEMENT
2 THIS AMENDMENT, hereinafter referred to as "Amendment II", is made and entered into this
3 29'h day of November 2022, by and between the COUNTY OF FRESNO, a Political
4 Subdivision of the State of California, hereinafter referred to as "COUNTY", and CENTRAL STAR
5 BEHAVIORAL HEALTH, INC., a for-profit corporation, whose address is 1501 Hughes Way, Suite
6 150, Long Beach, CA 90810, hereinafter referred to as "CONTRACTOR" (collectively the "parties").
7 WHEREAS the parties entered into that certain Agreement, identified as COUNTY Agreement
8 No. A-17-580, effective December 1, 2017, and the Amendment I to said Agreement No. A-17-580-1,
9 effective April 28, 2020, hereinafter collectively referred to as "Agreement", whereby CONTRACTOR
10 agreed to provide certain crisis residential treatment (CRT) services to COUNTY's Department of
11 Behavioral Health (DBH); and
12 WHEREAS, CONTRACTOR is in need of additional funding for an additional 3.54 full time
13 equivalent (FTE) direct care staff (therapists, licensed vocational nurses, and recovery counselors) as
14 well as an overall additional 0.68 FTE position for administrative staff (human resources, training,
15 quality assurance) to manage the complex CRT services within a 24/7 facility (including related
16 benefits and payroll taxes for said staff); and
17 WHEREAS, CONTRACTOR determined an increase in salary for direct care positions was
18 necessary for staff retention; and
19 WHEREAS the parties now desire to amend the Agreement regarding changes as stated
20 below and restate the Agreement in its entirety.
21 NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
22 hereinafter set forth, the sufficiency of which is hereby acknowledged, the parties agree as follows:
23 1. That the existing COUNTY Agreement, as set forth in the original Agreement No. A-17-
24 580, Page Four (4), beginning with Paragraph Four (4), Line Seventeen (17) with the heading 'A.
25 COMPENSATION" and ending on Page Five (5), Line Seventeen (17) with the word "Agreement" be
26 deleted and the following inserted in its place:
27 'A. COMPENSATION
28 COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
1 - COUNTY OF FRESNO
Fresno, CA
xhibit B
Page 9 3 of 105
1 compensation in accordance with the Budget set forth in Revised Exhibit B, attached hereto and by
2 this reference incorporated herein and made part of this Agreement.
3 A. Maximum Contract Amount
4 The maximum amount for the ramp-up period (December 1, 2017
5 through April 30, 2018) shall not exceed Four Hundred Thirty-Five Thousand, Nine Hundred Fourteen
6 and No/100 Dollars ($435,914).
7 The maximum amount for the initial operational period of May 1, 2018
8 through June 30, 2018 shall not exceed Three Hundred Thirty-Nine Thousand, Two Hundred Eighty-
9 Two and No/100 Dollars ($339,282.00).
10 The maximum amount for the period of July 1, 2018 through June 30,
11 2019 shall not exceed Two Million, Sixty-Five Thousand, Six Hundred Eight and No/100 Dollars
12 ($2,065,608.00).
13 The maximum amount for the period of July 1, 2019 through June 30,
14 2020 shall not exceed Two Million, One Hundred Twenty-One Thousand, Four Hundred Fifty-Three
15 and No/100 Dollars ($2,121,453.00).
16 The maximum amount for the period of July 1, 2020 through June 30,
17 2021 shall not exceed Two Million, One Hundred Seventy-Four Thousand, Eight Hundred Eighty-Nine
18 and No/100 Dollars ($2,174,889.00).
19 The maximum amount for the period of July 1, 2021 through June 30,
20 2022 shall not exceed Two Million, Two Hundred Thirty-Four Thousand, Eight Hundred Ninety-Five
21 and No/100 Dollars ($2,234,895.00).
22 The maximum amount for the period of July 1, 2022 through June 30,
23 2023 shall not exceed Two Million, Four Hundred Seventy-Two Thousand, Nine Hundred Fifty-Seven
24 and No/100 Dollars ($2,472,957.00).
25 In no event shall the maximum contract amount for all the services
26 provided by the CONTRACTOR to COUNTY under the terms and conditions of this Agreement be in
27 excess of Eleven Million, Eight Hundred Forty-Four Thousand, Nine Hundred Ninety-Eight and No/100
28 Dollars ($11,844,998.00) during the total term of this Agreement."
- 2 - COUNTY OF FRESNO
Fresno, CA
xhibit B
Page 9 of 105
1 2. Except as otherwise provided in this Amendment II, all other provisions of the
2 Agreement remain unchanged and in full force and effect. This Amendment II shall become effective
3 upon execution.
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18 ///
19
20
21
22
23
24
25
26
27
28
- 3 - COUNTY OF FRESNO
Fresno, CA
Exhibit B
Page 95 of 105
1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment II to Agreement
2 as of the day and year first hereinabove written.
3
CONTRACTOR: COUNTY OF FRESNO:
4 CENTRAL STAR BEHAVIORAL
5 HEALTH, INC.
By By
7 Brian Pacheco,
Chairman of the Board of Supervisors
8 o
Print Name: Kent Dunlap f the County of Fresno
9
Title: President and Chief Executive Officer
10 Chairman of the Board, or
11 President, or any Vice President ATTEST:
12 Date: 11/4/2022 BERNICE E. SEIDEL,
Clerk of the Board of Supervisors
13 County of Fresno, State of California
14
15 By By_
Deputy
16 Print Name:
17 Title:
Secretary (of Corporation), or
18 any Assistant Secretary, or
Chief Financial Officer, or
19 any Assistant Treasurer
20 Date:
21
22 Mailing Address:
1501 Hughes Way, Suite 150
23 Long Beach, CA 90810
Phone#: (310) 221-6336
24 Contact: Kent Dunlap
25 Fund/Subclass: 0001/10000
26 Organization: 56302117
Account#: 7295
27
28
- 4 - COUNTY OF FRESNO
Fresno, CA
Exhibit B
CRISIS RESIDENTIAL TREATMENT(CRT) Page 96 of 105
Central Stars Behavioral Health,Inc.
Fiscal Year(FY)2022-23(12/1/2022 to 6/30/2023)
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
r
Administrator 0.37 $ 60,000 $ 60,000
HR Manager 0.13 20,792 20,792
HRCoordinator/Assistant/TalentAcquisition 0.13 24,000 24,000
Administrative Service Coordinator 0.13 9,500 9,500
Training Manager 0.13 12,000 12,000
Training Coordinator 0.13 14,257 14,257
1107 QA Manager 0.29 19,009 19,009
1108 QA Coordinator/Assistant 0.37 10,500 10,500
1109 Clerk/Clerk Unit/EMR 1.00 42,771 42,771
1110 - -
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.68 $ 212,829 $ 212,829
Acct# Program Position FTE Admin Program Total
1116 Program Director/Manager 1.00 $ 97,103 $ 97,103
1117 Program Coordinator 1.00 80,000 80,000
1118 Resource Specialist 1.00 36,712 36,712
1119 MHS Thera pist/Special ist 2.50 83,837 83,837
1120 Household Counselor/Coach 3.00 86,485 86,485
1121 Peer Counselor/Peer Mentor 1.50 39,207 39,207
1122 1 Recovery Counselor 6.00 180,735 180,735
1123 LVN/LPT 4.60 283,877 283,877
1124 -
1125 -
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 20.60 $ 887,956 $ 887,956
Admin Program Total
Direct Personnel Salaries Subtotal 23.28 $ 212,829 $ 887,956 $ 1,100,785
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 2,477 $ 19,860 $ 22,337
1202 Worker's Compensation 3,716 29,789 33,505
1203 Health Insurance 14,863 119,156 134,019
1204 401K Match 258 1,986 2,244
1205 Life AD&D 37 496 533
1206 1 Other(specify) - -
Direct Employee Benefits Subtotal: $ 21,351 $ 171,287 $ 192,638
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 1,355 $ 64,458 $ 65,813
1302 FICA/MEDICARE 1,816 15,074 16,890
1303 SUI 2,944 24,431 27,375
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ 6,115 $ 103,963 $ 110,078
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 240,295 $ 1,163,206 $ 1,403,501
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
17.12%1 82.88%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B
Acct# Line Item Description Amount Page 97 of 105
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 3,500
2004 Client Support,Clothing,Food,&Hygiene 115,812
2005 Education Support -
2006 1 Employment Support
2007 Household Items for Clients 1,349
2008 Medication Supports -
2009 Program Supplies-Medical 50,331
2010 Utility Vouchers -
2011 Translation services -
2012 Laundry services 2,500
2013 Nutritionist Services 4,115
2014 Medical Waste Disposal 4,146
2015 Client Activities 7,200
2016
DIRECT CLIENT CARE TOTAL $ 188,953
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 57,035
3002 Printing/Postage 14,903
3003 Office,Household&Program Supplies 48,478
3004 Advertising -
3005 Staff Development&Training 6,770
3006 Staff Mileage 2,500
3007 Subscriptions&Memberships 1,273
3008 Vehicle Maintenance 10,738
3009 Recruiting 7,000
3010 Business License 3,699
3011 Liability Insurance 20,029
3012
DIRECT OPERATING EXPENSES TOTAL: $ 172,425
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 25,000
4002 Rent/Lease Building 4,392
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 58,000
4007 Depreciation 5,752
4008 Other(Janitorial)
4009 Other(Property Taxes)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL: $ 93,144
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Psychiatric) 103,800
5004 Translation Services 1,337
5005 Centralized Serivices Program 96,432
5006 1 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 201,569
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit 7,641
6005 Insurance(Specify):
6006 Payroll Services -
6007 Depreciation(Provider0-d!Equipment to be Usedfor Program Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 Other(specify)
6010 Centralized Fiscal services(5%) 105,000
6011 Centralized Services Administration 263,453
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B
6012 Other(specify) Page 98 of 105
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 376,104
INDIRECT COST RATE 17.94%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 30,000
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 7,261
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssetsover$5,000/unit(Specify)
7007 Other(Minor Equipment)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 37,261
TOTAL PROGRAM EXPENSES $ 2,472,957
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 lAssessment 0
8008 Rehabilitation 0 -
8009 Adult Crisis Residential(Mode 05/SFC 40-49) 4,513 399.43 1,802,628
8010 Medication Support(Mode 15/SFC 60-69) 1 118,642 5.65 1 670,329
Estimated Specialty Mental Health Services Billing Totals: 1 123,1551 $ 2,472,957
Estimated%of Clients who are Medi-Cal Beneficiaries 90%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries 2,225,661
Federal Financial Participation(FFP)% 1 50% 1,112,830
MEDI-CAL FFP TOTAL $ 1,112,830
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 ISABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 Realignment $ 1,052,165
REALIGNMENT TOTAL $ 1,052,165
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSAComponent 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
MHSATOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance
8403 Grants(Specify)ARPA Funding 78,446
8404 Other(Non-insured) 114,758
8405 Other(Private Insurance) 114,758
OTHER REVENUE TOTAL $ 307,9621
TOTAL PROGRAM FUNDING SOURCES: $ 2,472,957
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B
Page 99 of 105
CRISIS RESIDENTIAL TREATMENT(CRT)
Central Stars Behavioral Health,Inc.
Fiscal Year(FY)2022-23(12/1/2022 to 6/30/2023)
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Administrator A-17-580/Solane Ruiz,LCSW,CRT/Fresno 0.37
A-20-238/Solane Ruiz,LCSW,PHF/Fresno 0.73
Total 1.10
Position Contract#/Name/Department/County FTE%
HR Manager A-17-580/Jacqueline Foster/CRT/Fresno 0.13
A-20-238/Jacqueline Foster/PHF/Fresno 0.18
A-19-277/Jacqueline Foster/CWMHS/Fresno 0.19
A-18-576/Jacqueline Foster/TAY/Fresno 0.08
A-18-233/Jacqueline Foster/WRAP/Fresno 0.19
Jacqueline Foster/CRU/Merced 0.13
Jacqueline Foster/CSU/Merced
Jacqueline Foster/CBHST/Stanislaus 0.10
Total 1.00
Position Contract#/Name/Department/County FTE%
HR Coordinator/Assistant/Talent Acquisition A-17-580/Heather Stefanelli Vilahuer/CRT/Fresno 0.13
A-20-238/HeatherStefanelli Vila huer/PHF/Fresno 0.18
19-277/HeatherStefanelli Vila huer/CWMHS/Fres 0.19
A-18-576/Heather Stefanelli Vilahuer/TAY/Fresno 0.08
-18-2330/Heather Stefanelli Vilahuer/WRAP/Fresr 0.19
Heather Stefanelli Vila huer/CRU/Merced 0.13
Heather Stefanelli Vilahuer/CSU/Merced
Heather Stefanelli Vila huerr/CBHST/Stanislaus 0.10
Total 1.00
Position Contract#/Name/Department/County FTE%
Administrative Service Coordinator A-17-580/Alex Vargas/CRT/Fresno 0.13
A-17-580/Alex Vargas/PHF/Fresno 0.18
A-17-580/Alex Vargas/CWMHS/Fresno 0.19
A-17-580/Alex Vargas/TAY/Fresno 0.08
A-17-580/Alex Vargas/WRAP/Fresno 0.19
Alex Vargas/CRU/Merced 0.13
Alex Vargas/CSU/Merced
Alex Vargas/CBHST/Stanislaus 0.10
Total 1.00
Position Contract#/Name/Department/County FTE%
Training Manager A-17-580/Wendy Davis/CRT/Fresno 0.13
A-17-580/Wendy Davis/PHF/Fresno 0.18
A-17-580/Wendy Davis/CWMHS/Fresno 0.19
A-17-580/Wendy Davis/TAY/Fresno 0.08
A-17-580/Wendy Davis/WRAP/Fresno 0.19
Wendy Davis/CRU/Merced 0.13
Wendy Davis/CSU/Merced
Wendy Davis/CBHST/Stanislaus 0.10
Total 1.00
Position Contract#/Name/Department/County FTE%
Training Coordinator A-17-580/Rebecca Rosario/CRT/Fresno 0.13
A-17-580/Rebecca Rosa rio/PHF/Fresno 0.18
A-17-580/Rebecca Rosario/CWMHS/Fresno 0.19
A-17-580/Rebecca Rosario/TAY/Fresno 0.08
A-17-580/Rebecca Rosario/WRAP/Fresno 0.19
Rebecca Rosario/CRU/Merced 0.13
Rebecca Rosario/CSU/Merced
Rebecca Rosa rio/CB HST/Sta n isla us 0.10
Total 1.00
Position Contract#/Name/Department/County FTE%
CIA Manager A-17-580/Samantha Perryman,LPT/CRT/Fresno 0.29
A-20-238/Samantha Perryman/PHF/Fresno 0.49
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B
Samantha Perryman/CRU/Merced 0.22 Page 100 of 105
Samantha Perryman/CSU/Merced
Total 1.00
Position Contract#/Name/Department/County FTE
QA Coordinator/Assistant A-17-580/Vacant/CRT/Fresno 0.37
A-20-238/Vacant/PHF/Fresno 0.63
Total 1.00
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 Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B
Page 101 of 105
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B
CRISIS RESIDENTIAL TREATMENT(CRT) Page 102 of 105
Central Stars Behavioral Health,Inc.
Fiscal Year(FY)2022-23(12/1/2022 to 6/30/2023) Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,403,501
Administrative Positions 212,829
1101 Administrator 60,000 These positions form part of the program operations support staff.The cost is shared
by all programs and is allocated to each program based on each program's wages.
Without this support from an affiliated organization,the program would need to have
dedicated staff for these functions.Additionally,any costs shared with this program
will result in savings to the County through lower costs for the other Central Star
Merced County programs.
1102 HR Manager 20,792 These positions form part of the program operations support staff.The cost is shared
by all programs and is allocated to each program based on each program's wages.
Without this support from an affiliated organization,the program would need to have
dedicated staff for these functions.Additionally,any costs shared with this program
will result in savings to the County through lower costs for the other Central Star
Merced County programs.
1103 HR Coordinator/Assistant/Talent Acquisition 24,000 These positions form part of the program operations support staff.The cost is shared
by all programs and is allocated to each program based on each program's wages.
Without this support from an affiliated organization,the program would need to have
dedicated staff for these functions.Additionally,any costs shared with this program
will result in savings to the County through lower costs for the other Central Star
Merced County programs.
1104 Administrative Service Coordinator 9,500 These positions form part of the program operations support staff.The cost is shared
by all programs and is allocated to each program based on each program's wages.
Without this support from an affiliated organization,the program would need to have
dedicated staff for these functions.Additionally,any costs shared with this program
will result in savings to the County through lower costs for the other Central Star
Merced County programs.
1105 Training Manager 12,000 These positions form part of the program operations support staff.The cost is shared
by all programs and is allocated to each program based on each program's wages.
Without this support from an affiliated organization,the program would need to have
dedicated staff for these functions.Additionally,any costs shared with this program
will result in savings to the County through lower costs for the other Central Star
Merced County programs.
1106 Training Coordinator 14,257 These positions form part of the program operations support staff.The cost is shared
by all programs and is allocated to each program based on each program's wages.
Without this support from an affiliated organization,the program would need to have
dedicated staff for these functions.Additionally,any costs shared with this program
will result in savings to the County through lower costs for the other Central Star
Merced County programs.
1107 CA Manager 19,009 These positions form part of the program operations support staff.The cost is shared
by all programs and is allocated to each program based on each program's wages.
Without this support from an affiliated organization,the program would need to have
dedicated staff for these functions.Additionally,any costs shared with this program
will result in savings to the County through lower costs for the other Central Star
Merced County programs.
1108 CA Coordinator/Assistant 10,500 These positions form part of the program operations support staff.The cost is shared
by all programs and is allocated to each program based on each program's wages.
Without this support from an affiliated organization,the program would need to have
dedicated staff for these functions.Additionally,any costs shared with this program
will result in savings to the County through lower costs for the other Central Star
Merced County programs.
1109 Clerk/Clerk Unit/EMR 42,771 The Clerk will be a receptionist,order supplies,perform clerical tasks for the director,
managers and supervisors and maintain medical record for audits.
1110 0 -
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions 887,956
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B
Page 103 of 105
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1116 Program Director/Manager 97,103 Program director provides supervision of mental health and other support staff and has
responsibility for planning and oversight of CRT program services delivery.Acts as a
resource for therapists on issues related to treatment on specific cases or types of
cases,review treatment plans and therapeutic techniques utilized,ensure that
therapists provide treatment within the scope of licensure.
1117 Program Coordinator 80,000 The CRT Program Coordinator assists the CRT Program Manager in directing the
activities of assigned non-licensed personnel who provide direct client care services to
residents of the Central Star Crisis Resident Treatment Facility on a 24-hour 7 day a
week basis.
1118 Resource Specialist 36,712 Resource Specialists helps coordinate and develop community resources for all
participants,including housing,vocational,educational services,transportation and
other social support services.
1119 MHS Therapist/Specialist 83,837 The MH Specialists has primary responsibility as clinical therapist and serves as the
primary point of contact for case management.Will assess residents at start of
treatment;develop and maintain CRT;and lead residents towards the fulfillment of
CRT.Will coordinate the care and lead treatment based on each resident's choice;
collect all documentation needed to develop CRTs with residents and support people;
provide treatment using EBPs,e.g.,individual/group services,crisis intervention,family
therapy,case management,and family support.
1120 Household Counselor/Coach 86,485 The Household coaches act as a"single point of responsibility"for residents for skill
development such as cooking,cleaning or other home related tasks.The Household
Coaches are available as appropriate to resident needs,providing residents with
individualized attention,and offering intensive services and support when needed.
Household coaches does not supervise staff,but will work directly with residents based
on their care plan or needs.
1121 Peer Counselor/Peer Mentor 39,207 The Peer Counselors help consumers explore options given their available resources
and formulate problem-solving plans.They also serve as informal counselors,offering
consumers the opportunity to discuss issues surrounding relationships,feelings,
attitudes,personal goals and individual rights.Sometimes Peer Counselors help people
learn independent living skills such as money management or various household skills.
1122 Recovery Counselor 180,735 The Recovery Counselors are para-professional treatment team members who are
responsible for providing direct care to meet the physical and psychosocial needs of
the clients through direct and indirect physical and verbal interaction.Duties are
performed under direct supervision of the Program Manager,or designee in most
cases,but some tasks are accomplished independently.Recovery Counselors are peers
and individuals with lived experiences.Are also responsible for working with families to
provide support and education,and advocacy.Attends team meetings and participates
in development of CRT.
1123 LVN/LPT 283,877 The Clinical Supervisor has primary responsibility for supervising,managing and
coordinating the oversight of programs.The Clinical Supervisor has oversight
responsibility for the LVN,Mental Health Specialist,and Peer Counselor. He/she acts
as liaison with external agencies and functions on teams with other clinical&support
staff.Functions as a key management team member in all administrative and program
duties.
1124 0 The LVN's will maintain professional standards for medical management,including
providing nursing assessments,dispensing of medication,and monitoring of side
effects.Provide direct care including medications and assessments,and manage
confidential health information.Essential responsibilities include completing resident
medication intake/preparation for psychiatric care/evaluations and coordinating with
psychiatric provider;evaluating residents for potential medication side effects and
reporting to psychiatric provider;coordinating resident care by maintaining direct
contact with psychiatric provider;and ensuring medication administration protocols
are met.
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10
Direct Employee Benefits 192,638
1201 IRetirement 1 22,337 JEmployee Benefit
1202 Worker's Compensation 33,505 Employee Benefit
1203 Health Insurance 134,019 Employee Benefit
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B
Page 104 of 105
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1204 401K Match 2,244 Employee Benefit
1205 Life AD&D 533 Employee Benefit
1206 Other(specify)
Direct Payroll Taxes&Expenses: 110,078
1301 OASDI 65,813 1 Payroll Taxes
1302 FICA/MEDICARE 16,890 Payroll Taxes
1303 SUI 27,375 Payroll Taxes
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 188,953
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 3,500 Transportation for clients to various community social resources and support.
2004 Client Support,Clothing,Food,&Hygiene 115,812 Annual cost of food,water,clothing,toiletries,and hygiene products for clients.
Birthcertificate,DMV IDs,and different County and State documents as needed.
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients 1,349 Cleaning supplies for client rooms,bathrooms,kitchen and office
2008 Medication Supports -
2009 Program Supplies-Medical 50,331 Annual cost for RX meds w/o medical reimbursement and medical supplies(OTC meds,
first aid supplies)
2010 Utility Vouchers -
2011 Translation services -
2012 Laundry services 2,500 Laundry services for large items that cannot be done in on-site laundry
2013 Nutritionist Services 4,115 Consultant services to maintain healthy dietary requirements of clients
2014 Medical Waste Disposal 4,146 Stericyle services
2015 Client Activities 7,200 Client therapeutic supplies
2016 0 -
3000:DIRECT OPERATING EXPENSES 172,425
3001 Telecommunications 57,035 This is the cost of telephone,cable,internet services,budgeted at an average of
$860/mo.based on our experience.Included is$700 reimbursement of$60/month for
employee phone/internet reimbursement.
3002 Printing/Postage 14,903 This category includes copier lease cost,overages,and toner,the cost has been
budgeted based on our current lease which works out to be$1,122/month.
3003 Office,Household&Program Supplies 48,478 Office and Kitchen supplies
3004 Advertising -
3005 Staff Development&Training 6,770 This cost comprises the on-going program-required education,training,and materials
for the new staff.
3006 Staff Mileage 2,500 Staff travel mileage reimbursement,vehicle gas reimbursement
3007 Subscriptions&Memberships 1,273 Cable/Netflix
3008 Vehicle Maintenance 10,738 Vehicle maintenance
3009 Recruiting 7,000 This is the cost of recruitment and hiring to cover for staff turnover over the course of
the program.
3010 Business License 3,699 Includes business license,Bulletin Board System,The Joint Commission,and property
taxes.
3011 Liability Insurance 20,029 Practice and property liability insurance per employee per year
3012 10
4000:DIRECT FACILITIES&EQUIPMENT 93,144
4001 Building Maintenance 25,000 County's building allocated maintenance cost per County Contract
4002 Rent/Lease Building 4,392 Shared Admnistration staff building lease allocation
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 58,000 County's building allocated utilities cost per County Contract
4007 Depreciation 5,752 Vehicle depreciation
4008 Other(Janitorial) -
4009 Other(Property Taxes)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 201,569
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Psychiatric) 103,800 Two months of medication and behavioral support in conjunction with Nurse
Practitioner
5004 Translation Services 1,337 Client translation fees as needed.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit B
Page 105 of 105
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5005 Centralized Serivices Program 96,432 This cost is comprised of the SBHG corporate and regional support in areas including
Program Development and Evaluation,Quality&Compliance,and Training.The cost of
this support is allocated to all programs utilizing standard accounting practices and is
budgeted at 6.32%of total program salaries.
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 376,104
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping -
6004 External Audit 7,641 Required external CPA firm audit
6005 Insurance(Specify): -
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify) -
6010 Centralized Fiscal services(5%) 105,000 As a profit provider,Central Star has no ability to do fund raising to offset unallowable
costs such as income taxes as well as denials and other unreimbursed services.This line
item provides a cushion to mitigate this exposure.Calculated at 5%of total program
expenses less Client support expenses and Centralized services-Administrative
6011 Centralized Services Administration 263,463 Allocation from Stars Behavioral Health Group.It covers operations administration,
information technology,human resources,communications,finance,and associated
fringe benefits and expenses.SBHG oversight ensures consistency with our quality
standards and policies and procedures.The cost is developed from allocating the SBHG
costs among all the programs within all the SBHG companies based on standard
accounting practices.This economy of scale results in a significant savings for all SBHG
programs.Rather than staffing each program for all necessary services above,the
services are performed by fewer employees and then shared among all SBHG
programs.$121,032 or 5%of the total expenses is budgeted as SBHG operating
income.5%of the total expenses is budgeted as net income.These net income funds
support a prudent reserve,ability to offset unreimbursed costs,and adds value to
SBHG's employee benefit of its Employee Stock Ownership Program(ESOP).
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 37,261
7001 Computer Equipment&Software 30,000 Replacement cost for hardware,annual software licenses,cost of maintenance of
current equipment
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 7,261 Cost of minor equipment an other appliances as needed
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(Minor Equipment)
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Adult Crisis Residential(Mode 05/SFC 40-49)
8010 Medication Support(Mode 15/SFC 60-69)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 2,472,957
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 2,472,957
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C
Health Insurance Portability and Accountability Act (HIPAA)
1. Fresno County is a "Covered Entity," and Madera County is a "Business
Associate," as these terms are defined by 45 CFR 160.103. In connection with providing
services under the MOU, the parties anticipate that Madera County will create and/or receive
Protected Health Information ("PHI") from or on behalf of Fresno County. The parties enter into
this Business Associate MOU (BAA) to comply with the Business Associate requirements of
HIPAA, to govern the use and disclosures of PHI under this MOU. "HIPAA Rules" shall mean
the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Parts 160 and
164.
The parties to this MOU shall be in strict conformance with all applicable federal and
State of California laws and regulations, including, but not limited to California Welfare and
Institutions Code sections 5328, 10850, and 14100.2 et seq.; 42 CFR 2; 42 CFR 431; California
Civil Code section 56 et seq.; the Health Insurance Portability and Accountability Act of 1996, as
amended ("HIPAA"), including, but not limited to, 45 CFR Parts160, 45 CFR 162, and 45 CFR
164; the Health Information Technology for Economic and Clinical Health Act ("HITECH")
regarding the confidentiality and security of patient information, including, but not limited to 42
USC 17901 et seq.; and the Genetic Information Nondiscrimination Act ("GINA") of 2008
regarding the confidentiality of genetic information.
Except as otherwise provided in this MOU, Madera County, as a business associate of
Fresno County, may use or disclose Protected Health Information ("PHI") to perform functions,
activities or services for or on behalf of Fresno County, as specified in this MOU, provided that
such use or disclosure shall not violate HIPAA Rules. The uses and disclosures of PHI may not
be more expansive than those applicable to Fresno County, as the "Covered Entity" under the
HIPAA Rules, except as authorized for management, administrative or legal responsibilities of
Madera County.
2. Madera County, including its subcontractors and employees, shall protect from
unauthorized access, use, or disclosure of names and other identifying information, including
genetic information, concerning persons receiving services pursuant to this MOU, except where
permitted in order to carry out data aggregation purposes for health care operations [45 CFR §§
C-1
Exhibit C
Health Insurance Portability and Accountability Act (HIPAA)
164.504(e)(2)(i), 164.504(e)(2)(ii)(A), and 164.504(e)(4)(i)]. This pertains to any and all persons
receiving services pursuant to a Fresno County-funded program. This requirement applies to
electronic PHI. Madera County shall not use such identifying information or genetic information
for any purpose other than carrying out Madera County's obligations under this MOU.
3. Madera County, including its subcontractors and employees, shall not disclose
any such identifying information or genetic information to any person or entity, except as
otherwise specifically permitted by this MOU, authorized by Subpart E of 45 CFR Part 164 or
other law, required by the Secretary of the United States Department of Health and Human
Services ("Secretary"), or authorized by the client/patient in writing. In using or disclosing PHI
that is permitted by this MOU or authorized by law, Madera County shall make reasonable
efforts to limit PHI to the minimum necessary to accomplish intended purpose of use, disclosure
or request.
4. For purposes of the above sections, identifying information shall include, but not
be limited to, name, identifying number, symbol, or other identifying particular assigned to the
individual, such as fingerprint or voiceprint, or photograph.
5. For purposes of the above sections, genetic information shall include genetic
tests of family members of an individual or individual(s), manifestation of disease or disorder of
family members of an individual, or any request for or receipt of genetic services by individual or
family members. Family member means a dependent or any person who is first, second, third,
or fourth degree relative.
6. Madera County shall provide access, at the request of Fresno County, and in the
time and manner designated by Fresno County, to PHI in a designated record set (as defined in
45 CFR § 164.501), to an individual or to Fresno County in order to meet the requirements of 45
CFR § 164.524 regarding access by individuals to their PHI. With respect to individual
requests, access shall be provided within thirty (30) days from request. Access may be
extended if Madera County cannot provide access and provides the individual with the reasons
for the delay and the date when access may be granted. PHI shall be provided in the form and
format requested by the individual or the Fresno County.
C-2
Exhibit C
Health Insurance Portability and Accountability Act (HIPAA)
Madera County shall make any amendment(s) to PHI in a designated record set at the
request of Fresno County or individual, and in the time and manner designated by Fresno
County in accordance with 45 CFR § 164.526.
Madera County shall provide to Fresno County or to an individual, in a time and manner
designated by Fresno County, information collected in accordance with 45 CFR § 164.528, to
permit Fresno County to respond to a request by the individual for an accounting of disclosures
of PHI in accordance with 45 CFR § 164.528.
7. Madera County shall report to Fresno County, in writing, any knowledge or
reasonable belief that there has been unauthorized access, viewing, use, disclosure, security
incident, or breach of unsecured PHI not permitted by this MOU of which Madera County
becomes aware, immediately and without reasonable delay and in no case later than two (2)
business days of discovery. Immediate notification shall be made to Fresno County's
Information Security Officer and Privacy Officer and Fresno County's Department of Public
Health ("DPH") HIPAA Representative, within two (2) business days of discovery. The
notification shall include, to the extent possible, the identification of each individual whose
unsecured PHI has been, or is reasonably believed to have been, accessed, acquired, used,
disclosed, or breached. Madera County shall take prompt corrective action to cure any
deficiencies and any action pertaining to such unauthorized disclosure required by applicable
federal and State laws and regulations. Madera County shall investigate such breach and is
responsible for all notifications required by law and regulation or deemed necessary by Fresno
County and shall provide a written report of the investigation and reporting required to Fresno
County's Information Security Officer and Privacy Officer and Fresno County's DPH HIPAA
Representative.
This written investigation and description of any reporting necessary shall be
postmarked within the thirty (30) working days of the discovery of the breach to the addresses
below:
C-3
Exhibit C
Health Insurance Portability and Accountability Act (HIPAA)
County of Fresno County of Fresno County of Fresno
Dept. of Behavioral Health Department of Public Health Department of Internal
HIPAA Representative Privacy Officer Services
(559) 600-6798 (559) 600-6405 Information Security Officer
1925 E. Dakota (559) 600-6439 (559) 600-5800
Fresno, California 93726 1221 Fulton Mall 333 W. Pontiac Way
Fresno, California 93721 Clovis, California 93612
8. Madera County shall make its internal practices, books, and records relating to
the use and disclosure of PHI received from Fresno County or created or received by Madera
County on behalf of Fresno County, in compliance in compliance with HIPAA's Privacy Rule,
including, but not limited to the requirements set forth in Title 45, CFR, Sections 160 and 164.
Madera County shall make its internal practices, books, and records relating to the use and
disclosure of PHI received from Fresno County or created or received by Madera County on
behalf of Fresno County, available to the Secretary upon demand.
Madera County shall cooperate with the compliance and investigation reviews
conducted by the Secretary. PHI access to the Secretary must be provided during Madera
County's normal business hours; however, upon exigent circumstances access at any time must
be granted. Upon the Secretary's compliance or investigation review, if PHI is unavailable to
Madera County and in possession of a subcontractors of Madera County, Madera County must
certify to the Secretary its efforts to obtain the information from the subcontractors.
9. Safeguards
Madera County shall implement administrative, physical, and technical safeguards as
required by the HIPAA Security Rule, Subpart C of 45 CFR Part 164, that reasonably and
appropriately protect the confidentiality, integrity, and availability of PHI, including electronic
PHI, that it creates, receives, maintains or transmits on behalf of Fresno County and to prevent
unauthorized access, viewing, use, disclosure, or breach of PHI other than as provided for by
this MOU. Madera County shall conduct an accurate and thorough assessment of the potential
risks and vulnerabilities to the confidentiality, integrity and availability of electronic PHI. Madera
County shall develop and maintain a written information privacy and security program that
includes administrative, technical and physical safeguards appropriate to the size and
complexity of Madera County's operations and the nature and scope of its activities. Upon
C-4
Exhibit C
Health Insurance Portability and Accountability Act (HIPAA)
Fresno County's request, Madera County shall provide Fresno County with information
concerning such safeguards.
Madera County shall implement strong access controls and other security safeguards
and precautions in order to restrict logical and physical access to confidential, personal (e.g.,
PHI) or sensitive data to authorized users only. Said safeguards and precautions shall include
the following administrative and technical password controls for all systems used to process or
store confidential, personal, or sensitive data:
A. Passwords must not be:
(1) Shared or written down where they are accessible or recognizable by anyone
else; such as taped to computer screens, stored under keyboards, or visible
in a work area;
(2) A dictionary word; or
(3) Stored in clear text
B. Passwords must be:
(1) Eight (8) characters or more in length;
(2) Changed every ninety (90) days;
(3) Changed immediately if revealed or compromised; and
(4) Composed of characters from at least three (3) of the following four (4)
groups from the standard keyboard:
a) Upper case letters (A-Z);
b) Lowercase letters (a-z);
c) Arabic numerals (0 through 9); and
d) Non-alphanumeric characters (punctuation symbols).
Madera County shall implement the following security controls on each workstation or
portable computing device (e.g., laptop computer) containing confidential, personal, or sensitive
data:
1. Network-based firewall and/or personal firewall;
2. Continuously updated anti-virus software; and
C-5
Exhibit C
Health Insurance Portability and Accountability Act (HIPAA)
3. Patch management process including installation of all operating system/software
vendor security patches.
Madera County shall utilize a commercial encryption solution that has received FIPS
140-2 validation to encrypt all confidential, personal, or sensitive data stored on portable
electronic media (including, but not limited to, compact disks and thumb drives) and on portable
computing devices (including, but not limited to, laptop and notebook computers).
Madera County shall not transmit confidential, personal, or sensitive data via e-mail or
other internet transport protocol unless the data is encrypted by a solution that has been
validated by the National Institute of Standards and Technology (NIST) as conforming to the
Advanced Encryption Standard (AES) Algorithm. Madera County must apply appropriate
sanctions against its employees who fail to comply with these safeguards. Madera County must
adopt procedures for terminating access to PHI when employment of employee ends.
10. Mitigation of Harmful Effects
Madera County shall mitigate, to the extent practicable, any harmful effect that is
suspected or known to Madera County of an unauthorized access, viewing, use, disclosure, or
breach of PHI by Madera County or its subcontractors in violation of the requirements of these
provisions. Madera County must document suspected or known harmful effects and the
outcome.
11. Madera County's Subcontractors
Madera County shall ensure that any of its subcontractors, including subcontractors, if
applicable, to whom Madera County provides PHI received from or created or received by
Madera County on behalf of Fresno County, agree to the same restrictions, safeguards, and
conditions that apply to Madera County with respect to such PHI and to incorporate, when
applicable, the relevant provisions of these provisions into each subcontract or sub-award to
such agents or subcontractors.
Nothing in this section 11 or this Exhibit C authorizes the Madera County to perform
services under this MOU using subcontractors.
C-6
Exhibit C
Health Insurance Portability and Accountability Act (HIPAA)
12. Employee Training and Discipline
Madera County shall train and use reasonable measures to ensure compliance with the
requirements of these provisions by employees who assist in the performance of functions or
activities on behalf of Fresno County under this MOU and use or disclose PHI, and discipline
such employees who intentionally violate any provisions of these provisions, which may include
termination of employment.
13. Termination for Cause
Upon Fresno County's knowledge of a material breach of these provisions by Madera
County, Fresno County will either:
A. Provide an opportunity for Madera County to cure the breach or end the
violation, and Fresno County may terminate this MOU if Madera County does not cure the
breach or end the violation within the time specified by Fresno County; or
B. Immediately terminate this MOU if the Madera County has breached a
material term of this Exhibit C and cure is not possible, as determined by the Fresno County.
C. If neither cure nor termination is feasible, Fresno County's Privacy Officer
will report the violation to the Secretary of the U.S. Department of Health and Human Services.
14. Judicial or Administrative Proceedings
Fresno County may terminate this MOU if: (1) Madera County is found guilty in a
criminal proceeding for a violation of the HIPAA Privacy or Security Laws or the HITECH Act; or
(2) there is a finding or stipulation in an administrative or civil proceeding in which Madera
County is a party that Madera County has violated a privacy or security standard or requirement
of the HITECH Act, HIPAA or other security or privacy laws.
15. Effect of Termination
Upon termination or expiration of this MOU for any reason, Madera County shall return
or destroy all PHI received from Fresno County (or created or received by Madera County on
behalf of Fresno County) that Madera County still maintains in any form and shall retain no
copies of such PHI. If return or destruction of PHI is not feasible, Madera County shall continue
to extend the protections of these provisions to such information, and limit further use of such
C-7
Exhibit C
Health Insurance Portability and Accountability Act (HIPAA)
PHI to those purposes that make the return or destruction of such PHI infeasible. This provision
applies to PHI that is in the possession of subcontractors or agents, if applicable, of Madera
County. If Madera County destroys the PHI data, a certification of date and time of destruction
shall be provided to Fresno County by Madera County.
16. Compliance with Other Laws
To the extent that other state and/or federal laws provide additional, stricter and/or more
protective privacy and/or security protections to PHI or other confidential information covered
under this BAA, Madera County agrees to comply with the more protective of the privacy and
security standards set forth in the applicable state or federal laws to the extent such standards
provide a greater degree of protection and security than HIPAA Rules or are otherwise more
favorable to the individual.
17. Disclaimer
Fresno County makes no warranty or representation that compliance by Madera County
with these provisions, the HITECH Act, or the HIPAA Rules, will be adequate or satisfactory for
Madera County's own purposes or that any information in Madera County's possession or
control, or transmitted or received by Madera County, is or will be secure from unauthorized
access, viewing, use, disclosure, or breach. Madera County is solely responsible for all
decisions made by Madera County regarding the safeguarding of PHI.
18. Amendment
The parties acknowledge that Federal and State laws relating to electronic data security
and privacy are rapidly evolving and that amendment of this Exhibit C may be required to
provide for procedures to ensure compliance with such developments. The parties specifically
agree to take such action as is necessary to amend this MOU in order to implement the
standards and requirements of the HIPAA Rules, the HITECH Act and other applicable laws
relating to the security or privacy of PHI. Fresno County may terminate this MOU upon thirty
(30) days written notice in the event that Madera County does not enter into an amendment
providing assurances regarding the safeguarding of PHI that Fresno County in its sole
discretion, deems sufficient to satisfy the standards and requirements of the HIPAA Rules, and
c-8
Exhibit C
Health Insurance Portability and Accountability Act (HIPAA)
the HITECH Act.
19. No Third-Party Beneficiaries
Nothing expressed or implied in the provisions of this Exhibit C is intended to confer, and
nothing in this Exhibit C does confer, upon any person other than Fresno County or Madera
County and their respective successors or assignees, any rights, remedies, obligations or
liabilities whatsoever.
20. Interpretation
The provisions of this Exhibit C shall be interpreted as broadly as necessary to
implement and comply with the HIPAA Rules, and applicable State laws. The parties agree that
any ambiguity in the terms and conditions of these provisions shall be resolved in favor of a
meaning that complies and is consistent with the HIPAA Rules.
21. Regulatory References
A reference in the terms and conditions of these provisions to a section in the HIPAA
Rules means the section as in effect or as amended.
22. Survival
The respective rights and obligations of Madera County as stated in this Exhibit C
survive the termination or expiration of this MOU.
23. No Waiver of Obligation
Change, waiver or discharge by Fresno County of any liability or obligation of Madera
County under this Exhibit C on any one or more occasions is not a waiver of performance of any
continuing or other obligation of Madera County and does not prohibit enforcement by Fresno
County of any obligation on any other occasion.
C-9
Exhibit D
Insurance Requirements
1. Required Policies
Without limiting Madera County's right to obtain indemnification from Fresno County or any third
parties, Fresno County, 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 this MOU.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. Fresno County shall obtain an endorsement to
this policy naming Madera, its officers, agents, employees, and volunteers, individually
and collectively, as additional insureds, but only insofar as the operations under this
MOU are concerned. Such coverage for additional insureds will apply as primary
insurance and any other insurance, or self-insurance, maintained by Madera County is
excess only and not contributing with insurance provided under Fresno County's policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this MOU.
(C) Property Liability. All risk personal property insurance which shall be endorsed naming
Madera County as an additional loss payee. The personal property coverage shall be in
an amount that will cover the total of Madera County purchased and owned property, at
a minimum, as discussed in Article 11 of this MOU. As applicable, Fresno County will
provide property coverage for the full replacement value of Madera County's personal
property in possession of Fresno County and/or used in the execution of this MOU.
Madera County will be identified on an appropriate certificate of insurance as the
certificate holder and will be named as an Additional Loss Payee on the Property
Insurance Policy.
(D)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(E) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(F) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1)the retroactive date must
be prior to the date on which services began under this MOU; (2) Fresno County shall
maintain the policy and provide to Madera County annual evidence of insurance for not
less than five years after completion of services under this MOU; and (3) if the policy is
canceled or not renewed, and not replaced with another claims-made policy with a
retroactive date prior to the date on which services begin under this MOU, then Fresno
County shall purchase extended reporting coverage on its claims-made policy for a
minimum of five years after completion of services under this MOU.
D-1
Exhibit D
(G)Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(H) Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of Fresno County.
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of Fresno County's obligations under Article 15
of this MOU; (iv) system failure; (v) data recovery; (vi) failure to timely disclose data
breach or Security Breach; (vii) failure to comply with privacy policy; (viii) payment card
liabilities and costs; (ix) infringement of intellectual property, including but not limited to
infringement of copyright, trademark, and trade dress; (x) invasion of privacy, including
release of private information; (xi) information theft; (xii) damage to or destruction or
alteration of electronic information; (xiii) cyber extortion; (xiv) extortion related to Fresno
County's obligations under this MOU regarding electronic information, including Personal
Information; (xv) fraudulent instruction; (xvi)funds transfer fraud; (xvii) telephone fraud;
(xviii) network security; (xix) data breach response costs, including Security Breach
response costs; (xx) regulatory fines and penalties related to Fresno County's
obligations under this MOU regarding electronic information, including Personal
Information; and (xxi) credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after Fresno County signs this MOU, and at
any time during the term of this MOU as requested by the Madera County's Risk
Manager or the County Administrative Office, Fresno County shall deliver, or cause its
broker or producer to deliver, to the County of Fresno, Department of Behavioral Health,
3676 E. Shields Avenue, Fresno, California, 93726, Attention: Contracted Services
Division or electronically to dbhcontractedservicesdivision@fresnocountyca.gov with a
copy to the assigned County's DBH Staff Analyst.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) Madera County, its officers, agents, employees,
and volunteers are not responsible for any premiums on the policy; and (3)
Fresno County has waived its right to recover from Madera County, its officers,
agents, employees, and volunteers any amounts paid under any insurance policy
required by this MOU and that waiver does not invalidate the insurance policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this MOU are concerned. The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by Madera
D-2
Exhibit D
County shall be excess only and not contributing with insurance provided under
Fresno County's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this MOU.
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this MOU.
(v) The cyber liability insurance certificate must also state that it is endorsed, and
include an endorsement, to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited
to information or data) that is in the care, custody, or control of Fresno County.
(B) Acceptability of Insurers. All insurance policies required under this MOU must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this MOU an A.M. Best, Inc. rating of no less
than A: VII. Coverage provided by a risk sharing pool shall be acceptable subject to
approval by Madera County.
(C) Notice of Cancellation or Change. For each insurance policy required under this MOU,
Fresno County shall provide to Madera County or ensure that the policy requires the
insurer to provide to Madera County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, Fresno County shall, or shall cause the insurer to, provide written notice to
Madera County not less than 10 days in advance of cancellation. For cancellation of the
policy for any other reason, and for any other change to the policy, Fresno County shall,
or shall cause the insurer to, provide written notice to Madera County not less than 30
days in advance of cancellation or change. Madera County in its sole discretion may
determine that the failure of Fresno County or its insurer to timely provide a written
notice required by this paragraph is a breach of this MOU.
(D) Madera County's Entitlement to Greater Coverage. If Fresno County has or obtains
insurance with broader coverage, higher limits, or both, than what is required under this
MOU, then Madera County requires and is entitled to the broader coverage, higher
limits, or both. To that end, Fresno County shall deliver, or cause its broker or producer
to deliver, to Madera County's Risk Manager certificates of insurance and endorsements
for all of the coverages that have such broader coverage, higher limits, or both, as
required under this MOU.
(E) Waiver of Subrogation. Fresno County waives any right to recover from Madera
County, its officers, agents, employees, and volunteers any amounts paid under the
policy of worker's compensation insurance required by this MOU. Fresno County is
solely responsible to obtain any policy endorsement that may be necessary to
accomplish that waiver, but Fresno County's waiver of subrogation under this paragraph
is effective whether or not Fresno County obtains such an endorsement.
(F) Madera County's Remedy for Fresno County's Failure to Maintain. If Fresno County
fails to keep in effect at all times any insurance coverage required under this MOU,
D-3
Exhibit D
Madera County may, in addition to any other remedies it may have, suspend or
terminate this MOU upon the occurrence of that failure, or purchase such insurance
coverage, and charge the cost of that coverage to Fresno County. Madera County may
offset such charges against any amounts owed by Madera County to Fresno County
under this MOU.
(G)Subcontractors. Fresno County shall require and verify that all subcontractors used by
Fresno County to provide services under this MOU maintain insurance meeting all
insurance requirements provided in this MOU. This paragraph does not authorize Fresno
County to provide services under this MOU using subcontractors.
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