HomeMy WebLinkAboutAgreement A-12-119-3 with Recovery Inc..pdf AGREEMENT NO. 12-119-3
1 AMENDMENT III TO AGREEMENT
2 THIS AMENDMENT, hereinafter referred to as Amendment III, is made and entered into this
3 10th day of March , 2015, by and between the COUNTY OF FRESNO, a Political
4 Subdivision of the State of California, hereafter referred to as "COUNTY", and EXODUS
5 RECOVERY, INC., a for-profit California Corporation, whose address is 9808 Venice Boulevard,
6 Suite 700, Culver City, California 90232, hereinafter referred to as "CONTRACTOR" (collectively
7 the "parties").
8 WHEREAS, the parties entered into that certain Agreement identified as COUNTY Agreement
9 No. 12-119, effective March 7, 2012, COUNTY Amendment No. 12-119-1 effective May 21, 2013,
10 and COUNTY Amendment No. 12-119-2 effective June 17, 2014 hereinafter collectively referred to
11 as COUNTY Agreement No. 12-119 whereby CONTRACTOR agreed to operate an Adult Crisis
12 Stabilization Center(Adult CSC) to provide crisis stabilization services to adult clients age 18 and
13 older who may be admitted on a voluntary or involuntary basis regardless of the source of payment
14 who are referred by the COUNTY's Department of Behavioral Health (DBH), law enforcement,
15 hospital emergency departments, and Emergency Medical Services transports; and
16 WHEREAS, COUNTY, through DBH, is also in need of a qualified agency to operate a Youth
17 Crisis Stabilization Center(Youth CSC) to provide crisis stabilization services to children and youth
18 client up to age 18 who may be admitted on a voluntary or involuntary basis regardless of the source
19 of payment, who are referred by the same said agencies mentioned hereinabove; and
20 WHEREAS, CONTRACTOR is qualified and willing to expand current services to operate said
21 Youth CSC pursuant to the terms and conditions of this Agreement; and
22 WHEREAS, the parties desire to amend COUNTY Agreement No. 12-119 effective March 10,
23 2015, regarding changes as stated below and restate the Agreement in its entirety.
24 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
25 is hereby acknowledged, the parties agree as follows:
26 1. That the following text of Agreement No. 12-119, Paragraph One (1), Page One (1),
27 beginning with Line Twenty (20), with the word"SERVICES" and ending on Page Two (2), Line
28 Seven(7), with the word "Division" be deleted and the following inserted in its place:
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1 "1. SERVICES
2 A. CONTRACTOR shall perform all services and fulfill all responsibilities
3 as set forth in its Revised Exhibit Al, "Adult Crisis Stabilization Center, Scope of Work," attached
4 hereto and by this reference incorporated herein and made part of this Agreement. In providing adult
5 crisis stabilization services, CONTRACTOR shall perform all services and fulfill all responsibilities
6 as specified in COUNTY's Request for Proposal (RFP)No. 952-4944 dated May 2, 2011 and
7 Addendum No. One (1) to COUNTY's RFP No. 952-4944 dated June 1, 2011, herein collectively
8 referred to as COUNTY's Revised RFP, and CONTRACTOR's Response to said Revised RFP dated
9 June 24, 2011, as well as CONTRACTOR's Response to Follow-Up Questions dated July 28, 2011,
10 all incorporated herein by reference and made part of this Agreement. In the event of any
11 inconsistency among these documents, the inconsistency shall be resolved by giving precedence in
12 the following order of priority to: (1)this Agreement, including all Exhibits, (2) the Revised RFP, (3)
13 CONTRACTOR's Response to Follow-Up Questions; and (4) CONTRACTOR's Response to the
14 Revised RFP. A copy of COUNTY's Revised RFP No. 952-4944 and CONTRACTOR's response
15 thereto and CONTRACTOR's Response to Follow-Up Questions shall be retained and made
16 available during the term of this Agreement by COUNTY's DBH Contracts Division.
17 B. CONTRACTOR shall also perform all services and fulfill all
18 responsibilities as set forth in its Revised Exhibit A2 "Youth Crisis Stabilization Center, Scope of
19 Work,"attached hereto and by this reference incorporated herein and made part of this Agreement."
20 2. That the following text of Agreement No. 12-119, Paragraph One (1), Page Two (2),
21 beginning with Line Nineteen(19), Subsection F, with the word"CONTRACTOR" and ending on
22 Line Twenty-Five (25), with the word"Agreement" be deleted and the following inserted in its
23 place:
24 "F. CONTRACTOR agrees that prior to providing services under the terms
25 and conditions of this Agreement, CONTRACTOR shall have, and for the term of this Agreement
26 shall maintain, staff hired and in place for program services and operations. CONTRACTOR further
27 agrees that CONTRACTOR's affiliate EXODUS FOUNDATION, INC., a non-profit Internal
28 Revenue Code section 501(c)(3) corporation, shall execute, and for the term of this Agreement shall
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1 maintain, a mutually agreeable lease agreement(s) (and any related amendments) for the lease of
2 COUNTY-owned property located at 4411 E. Kings Canyon, Fresno, California 93702 (Building
3 319) as the site for CONTRACTOR's provision of Adult CSC and Youth CSC services under this
4 Agreement. If CONTRACTOR or CONTRACTOR's affiliate fails to accomplish these tasks prior to
5 providing services under this Agreement, COUNTY may, in addition to other remedies it may have,
6 suspend referrals or terminate this Agreement, in accordance with Section Three (3) of this
7 Agreement."
8 3. That the following text shall be inserted into Agreement No. 12-119, at Page Three (3),
9 Paragraph One (1), Line Eight (8):
10 "I. The period beginning March 13, 2012 through June 30, 2012 shall be
11 considered the Ramp Up Period for the Adult CSC. The period of May 4, 2012 through June 30,
12 2012 shall be considered the Initial Operational Period for the Adult CSC. Each twelve (12)month
13 period thereafter, up to the maximum of four(4) years, will collectively be referred to as the
14 Operational Period for the Adult CSC. The period of March 10, 2015 through March 31, 2015 shall
15 be considered the Second Ramp Up Period for the expansion of additional bed capacity available at
16 the Adult CSC and the expansion to incorporate bed capacity for minors at the Youth CSC. The
17 period of April 1, 2015 through June 30, 2015 shall be considered the Initial Operational Period for
18 the Youth CSC. The period of July 1, 2015 through June 30, 2016 shall be considered the
19 Operational Period for the Youth CSC.
20 J. The parties agree that the CONTRACTOR shall have the Adult CSC
21 facility operational commencing May 4, 2012 and shall have the expansion to the Adult CSC facility
22 operational commencing April 1, 2015. The parties also agree that the anticipated start date for the
23 CONTRACTOR to commence serving clients at the Youth CSC will be April 1, 2015."
24 4. That the following text of Agreement No. 12-119, Page Three (3), beginning with
25 Paragraph Two (2), Line Eight (8), with the word "TERM" and ending on Page Four (4), Line Eight
26 (8), with the word "terminate"be deleted and the following inserted in its place:
27 662. TERM
28 This Agreement shall become effective on the 7th day of March, 2012 and shall
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I terminate on the 30th day of June, 2012.
2 Effective July 1, 2012,this Agreement, subject to satisfactory outcomes
3 performance and subject to State funding each year, shall continue for four(4) additional twelve (12)
4 month extension periods upon the same terms and conditions herein set forth, unless written notice of
5 non-renewal is given by COUNTY or CONTRACTOR or COUNTY's DBH Director, or designee, not
6 later than thirty (30) days prior to the close of the current Agreement term."
7 3. TERMINATION
8 A. Non-Allocation of Funds - The terms of this Agreement, and the services
9 to be provided thereunder, are contingent on the approval of funds by the appropriating government
10 agency. Should sufficient funds not be allocated,the services provided may be modified, or this
11 Agreement terminated at any time by giving CONTRACTOR thirty (30) days advance written notice.
12 B. Breach of Contract- COUNTY may immediately suspend or terminate
13 this Agreement in whole or in part, where in the determination of COUNTY there is:
14 1) An illegal or improper use of funds;
15 2) A failure to comply with any term of this Agreement;
16 3) A substantially incorrect or incomplete report submitted to
17 COUNTY;
18 4) Improperly performed service.
19 In no event shall any payment by COUNTY constitute a waiver by
20 COUNTY of any breach of this Agreement or any default which may then exist on the part of
21 CONTRACTOR. Neither shall such payment impair or prejudice any remedy available to COUNTY
22 with respect to the breach or default. The COUNTY shall have the right to demand of the
23 CONTRACTOR the repayment to the COUNTY of any funds disbursed to CONTRACTOR under
24 this Agreement, which in the judgment of COUNTY were not expended in accordance with the terms
25 of this Agreement. The CONTRACTOR shall promptly refund any such funds upon demand or at
26 COUNTY's option, such repayment shall be deducted from future payments owing to
27 CONTRACTOR under this Agreement.
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1 C. Without Cause - Under circumstances other than those set forth above,
2 this Agreement may be terminated by COUNTY or CONTRACTOR upon the giving of thirty (30)
3 days advance written notice of an intention to terminate."
4 5. That the following text of Agreement No. 12-119, Page Four(4), beginning with
5 Paragraph Four(4), Line Nine (9), with the word "COMPENSATION" and ending on Page Seven
6 (7), Line Twenty-Three (23), with the word"Rates" be deleted and the following inserted in its place:
7 "4. COMPENSATION
8 A. Maximum Compensation
9 (1) ADULT CSC:
10 COUNTY agrees to pay CONTRACTOR and CONTRACTOR
11 agrees to receive compensation based on actual cost for adult crisis stabilization services at the Adult
12 CSC in accordance with Revised Exhibit B-3 "Adult CSC Budget", attached hereto and by this
13 reference incorporated herein.
14 a. Ramp Up Period:
15 The maximum contract amount under this Agreement for
16 the Ramp Up Period (March 7, 2012 through May 31, 2012) shall not exceed Five Hundred Eighty-
1 7 Three Thousand, Forty Five and No/100 Dollars ($583,045.00), as identified in Revised Exhibit B-3.
18 b. Initial Operational Period:
19 The maximum contract amount for the Initial Operational
20 Period (May 4, 2012 through June 30, 2012) shall not exceed Six Hundred Fifty-Six Thousand, Four
21 Hundred Thirty-Four and No/100 Dollars ($656,434.00), as identified in Revised Exhibit B-3.
22 For the Initial Operational Period (May 4, 2012 through
23 June 30, 2012), it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to
24 generate One Hundred Twenty-One Thousand, Four Hundred Forty and No/100 Dollars
25 ($121,440.00) in Medi-Cal Federal Financial Participation(FFP); Five Hundred Twenty-Eight
26 Thousand, Four Hundred Thirty and No/100 Dollars ($528,430.00) in Behavioral Health
27 Realignment; and other revenue sources to offset CONTRACTOR's program costs, as set forth in
28 Revised Exhibit B-3.
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1 C. First 12-month Operational Period:
2 The maximum contract amount for the first twelve (12)
3 month Operational Period(July 1, 2012 through June 30, 2013) shall not exceed Three Million, Eight
4 Hundred Fifty-Five Thousand, Two Hundred Forty-Nine and No/100 Dollars ($3,855,249.00), as
5 identified in Revised Exhibit B-3.
6 For the first twelve (12) month Operational Period (July 1,
7 2012 through June 30, 2013), it is understood by CONTRACTOR and COUNTY that
8 CONTRACTOR estimates to generate Seven Hundred Thirteen Thousand, Two Hundred Twenty-
9 One and No/100 Dollars ($713,221.00) in Medi-Cal FFP; Three Million, One Hundred Three
10 Thousand, Four Hundred Seventy-Five and No/100 Dollars ($3,103,475.00) in Behavioral Health
11 Realignment; and other revenue sources to offset CONTRACTOR's program costs, as set forth in
12 Revised Exhibit B-3.
13 d. Second 12-month Operational Period:
14 The maximum contract amount for the second twelve (12)
15 month Operational Period (July 1, 2013 through June 30, 2014) shall not exceed Three Million, Nine
16 Hundred Sixty-Seven Thousand, Seven Hundred Forty-One and No/100 Dollars ($3,967,741.00), as
17 identified in Revised Exhibit B-3.
18 For the second twelve (12) month Operational Period (July
19 1, 2013 through June 30, 2014), it is understood by CONTRACTOR and COUNTY that
20 CONTRACTOR estimates to generate Seven Hundred Thirty-Four Thousand, Thirty-Two and
21 No/100 Dollars ($734,032.00) in Medi-Cal FFP; Three Million, One Hundred Ninety-Four Thousand,
22 Thirty-Two and No/100 Dollars ($3,194,032.00) in Behavioral Health Realignment; and other
23 revenue sources to offset CONTRACTOR's program costs, as set forth in Revised Exhibit B-3.
24 e. Second Ramp Up Period Adult CSC Expansion):
25 The maximum contract amount under this Agreement for
26 the second ramp up period for the expansion of the Adult CSC (March 10, 2015 through March 31,
27 2015) shall not exceed Forty-Eight Thousand Four Hundred Forty-Eight and No/100 Dollars
28 ($48,448.00), as identified in Revised Exhibit B-3.
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1 f. Third 12-month Operational Period:
2 The maximum contract amount for the third twelve (12)
3 month Operational Period (July 1, 2014 through June 30, 2015) shall not exceed Four Million, Five
4 Hundred Thirty-Two Thousand, Nine Hundred Thirty-Three and No/100 Dollars ($4,532,933.00), as
5 identified in Revised Exhibit B-3.
6 For the third twelve(12) month Operational Period (July
7 1, 2014 through June 30, 2015), it is understood by CONTRACTOR and COUNTY that
8 CONTRACTOR estimates to generate Eight Hundred Thirty-Eight Thousand, Five Hundred Ninety-
9 Three and No/100 Dollars ($838,593.00) in Medi-Cal FFP; Three Million, Six Hundred Forty-Nine
10 Thousand, Eleven and No/100 Dollars ($3,649,011.00) in Behavioral Health Realignment; and other
11 revenue sources to offset CONTRACTOR's program costs, as set forth in Revised Budget B-3.
12 g. Fourth 12-month Operational Period:
13 The maximum contract amount for the fourth twelve (12)
14 month Operational Period (July 1, 2015 through June 30, 2016) shall not exceed Six Million, Four
15 Hundred Eighteen Thousand, Eight Hundred Ninety-Three and No/100 Dollars ($6,418,893.00), as
16 identified in Revised Exhibit B-3.
17 For the fourth twelve (12) month Operational Period (July
18 1, 2015 through June 30, 2016), it is understood by CONTRACTOR and COUNTY that
19 CONTRACTOR estimates to generate Two Million, Four Hundred Seven Thousand, Eighty-Five and
20 No/100 Dollars ($2,407,085.00) in Medi-Cal FFP; Three Million, Six Hundred Ninety Thousand,
21 Eight Hundred Sixty-Three and No/100 Dollars ($3,690,863.00) in Behavioral Health Realignment;
22 and other revenue sources to offset CONTRACTOR's program costs, as set forth in Revised Budget
23 B-3.
24 h. Adult CSC Maximum Compensation:
25 In no event shall the total maximum compensation for
26 actual adult crisis stabilization services performed at the Adult CSC under this Agreement, be in
27 excess of Twenty Million, Sixty-Two Thousand, Seven Hundred Forty-Three and No/100 Dollars
28 ($20,062,743.00).
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1 (2) YOUTH CSC:
2 COUNTY agrees to pay CONTRACTOR and CONTRACTOR
3 agrees to receive compensation based on actual cost for youth crisis stabilization services at the
4 Youth CSC in accordance with Revised Exhibit C, "Youth CSC Budget", attached hereto and by this
5 reference incorporated herein.
6 a. Ramp Up Period:
7 The maximum contract amount under this Agreement for
8 the Ramp Up Period (March 10, 2015 through March 31, 2015) shall not exceed Two Hundred Eight
9 Thousand, Five Hundred Thirty and No/100 Dollars ($208,530.00), as identified in the "Youth CSC
10 Budget" in Revised Exhibit C.
11 b. Initial Operational Period:
12 The maximum contract amount for the Initial Operational
13 Period (April 1, 2015 through June 30, 2015) shall not exceed Six Hundred Ninety-Four Thousand,
14 Five Hundred Fifty-Eight and No/100 Dollars ($694,558.00), as identified in Revised Exhibit C.
15 For the Initial Operational Period (April 1, 2015 through
16 June 30, 2015), it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to
17 generate Three Hundred Twenty-Nine Thousand, Nine Hundred Fifteen and No/100 Dollars
18 ($329,915.00) in Medi-Cal FFP; Three Hundred Forty-Three Thousand, Eight Hundred Six and
19 No/100 Dollars($343,806.00) in Behavioral Health Realignment; and other revenue sources to offset
20 CONTRACTOR's program costs, as set forth in Revised Exhibit C.
21 C. 12-month Operational Period:
22 The maximum contract amount for the twelve (12) month
23 Operational Period (July 1, 2015 through June 30, 2016) shall not exceed Two Million, Six Hundred
24 Forty-Nine Thousand, Two Hundred Sixty-Nine and No/100 Dollars ($2,649,269.00), as identified in
25 Revised Exhibit C.
26 For the first twelve (12) month Operational Period (July 1,
27 2015 through June 30, 2016), it is understood by CONTRACTOR and COUNTY that
28 CONTRACTOR estimates to generate One Million, One Hundred Ninety-Two Thousand, One
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1 Hundred Seventy-One and No/100 Dollars ($1,192,171.00) in Medi-Cal FFP; One Million, Two
2 Hundred Seventy-One Thousand, Six Hundred Forty-Nine and No/100 Dollars ($1,271,649.00) in
3 Behavioral Health Realignment; and other revenue sources to offset CONTRACTOR's program
4 costs, as set forth in Revised Exhibit C.
5 d. Youth CSC Maximum Compensation:
6 In no event shall the total maximum compensation for
7 actual youth crisis stabilization services performed at the Youth CSC under this Agreement, be in
8 excess of Three Million, Five Hundred Fifty-Two Thousand, Three Hundred Fifty-Seven and No/100
9 Dollars ($3,552,357.00).
10 (3) TOTAL CONTRACT MAXIMUM:
11 In no event shall the total maximum compensation for all actual
12 crisis stabilization services performed by CONTRACTOR under this Agreement, be in excess of
13 Twenty-Three Million, Six Hundred Fifteen Thousand, One Hundred and No/100 Dollars
14 ($23,615,100.00).
15 (4) ADDITIONAL PROVISIONS:
16 If CONTRACTOR fails to generate the Medi-Cal FFP and/or
17 Behavioral Health Realignment amounts set forth hereinabove, the COUNTY shall not be obligated
18 to pay the difference between these estimated amounts and the actual amounts generated.
19 It is further understood by COUNTY and CONTRACTOR that
20 any Medi-Cal FFP, Behavioral Health Realignment, and/or other guarantor reimbursement above the
21 amounts stated herein will be used to directly offset the COUNTY's contribution of Mental Health
22 Realignment funds identified in Revised Exhibit B-3 and Revised Exhibit C. The offset of funds will
23 also be clearly identified in monthly invoices received from CONTRACTOR as further described in
24 Section Five (5) of this Agreement.
25 Travel shall be reimbursed based on actual expenditures and
26 mileage reimbursement shall be at CONTRACTOR's adopted rate per mile, not to exceed the IRS
27 published rate. CONTRACTOR agrees to limit administrative cost to a maximum of fifteen percent
28 (15%) of the total program budget and to limit employee benefits to a maximum of twenty percent
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1 (20%) of total salaries for those employees working under this Agreement during the term of this
2 Agreement. Payment shall be made upon certification or other proof satisfactory to COUNTY's
3 DBH that services have actually been performed by CONTRACTOR as specified in this Agreement.
4 B. It is understood that all expenses incidental to CONTRACTOR's
5 performance of services under this Agreement shall be borne by CONTRACTOR. If
6 CONTRACTOR fails to comply with any provision of this Agreement, COUNTY shall be relieved of
7 its obligation for further compensation.
8 C. For the Adult CSC Ramp Up Period (March 7, 2012 through May 31,
9 2012), the Adult CSC Second Ramp Up Period(March 10, 2015 through March 31, 2015), and the
10 Youth CSC Ramp Up Period (March 10, 2015 through March 31, 2015), payments shall be made by
11 COUNTY to CONTRACTOR in arrears, for services provided during the preceding month, within
12 forty-five (45) days after the date of receipt and approval by COUNTY of the monthly invoicing as
13 described in Section Five (5) herein. Payments shall be made after receipt and verification of actual
14 expenditures incurred by CONTRACTOR for monthly program costs, as identified in Revised
15 Exhibit B-3 and Revised Exhibit C, and shall be documented to COUNTY on a monthly basis by the
16 tenth (loth) of the month following the month of said expenditures. The parties acknowledge that the
17 CONTRACTOR will be developing the Adult CSC during the time period of March 7, 2012 through
18 May 31, 2012 and the Youth CSC during the time period of March 10, 2015 through March 31, 2015,
19 and will be performing hiring, training, and credentialing of staff, configuring the facility and office
20 space, and obtaining site certification from the California Department of Health Care Services
21 (DHCS) and/or the COUNTY Mental Health Plan(Mental Health Plan), as determined appropriate by
22 the applicable licensing and certification agency,to serve Medi-Cal beneficiaries and seeking
23 payment for services rendered and other administrative tasks associated with launching the Adult and
24 Youth CSCs.
25 D. For the Initial and 12-month extension Operational Periods (May 4, 2012
26 through June 30, 2012 and each subsequent twelve (12) month period of said Agreement), payments
27 shall be made by COUNTY to CONTRACTOR in equal installments. COUNTY will pay to
28 CONTRACTOR on the twentieth (201h) of each month for the services to be provided the following
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1 month. CONTRACTOR shall submit to COUNTY by the tenth (10`h) of each month a detailed
2 general ledger(GL), one for each CSC, itemizing costs incurred in the previous month. Each
3 payment will be reconciled to CONTRACTOR's GLs, and any amounts identified as owed to
4 COUNTY will be reduced from COUNTY's next payment to CONTRACTOR. The first
5 reconciliation shall be performed after the third month of the facility's operation with subsequent
6 reconciliation performed every month thereafter. Failure to submit GL reports and supporting
7 documentation shall be deemed sufficient cause for COUNTY to withhold payments until there is
8 compliance, as further described in Section Five (5)herein.
9 E. COUNTY shall not be obligated to make any payments under this
10 Agreement if the request for payment is received by COUNTY more than sixty (60) days after this
11 Agreement has terminated or expired.
12 All final claims, including actual cost per unit, and/or any final budget
13 modification requests shall be submitted by CONTRACTOR within sixty (60) days following the
14 final month of service for which payment is claimed. No action shall be taken by COUNTY on
15 claims submitted beyond the sixty (60) day closeout period. Any compensation which is not
16 expended by CONTRACTOR pursuant to the terms and conditions of this Agreement shall
17 automatically revert to COUNTY.
18 F. The services provided by CONTRACTOR under this Agreement are
19 funded in whole or in part by the State of California. In the event that funding for these services is
20 delayed by the State Controller, COUNTY may defer payments to CONTRACTOR. The amount of
21 the deferred payment shall not exceed the amount of funding delayed by the State Controller to
22 COUNTY. The period of time of the deferral by COUNTY shall not exceed the period of time of the
23 State Controller's delay of payment to COUNTY plus forty-five (45) days.
24 G. CONTRACTOR shall be held financially liable for any and all future
25 disallowances/audit exceptions due to CONTRACTOR's deficiency discovered through the State
26 audit process and COUNTY utilization review during the course of this Agreement. At COUNTY's
27 election,the disallowed amount will be remitted within forty-five (45) days to COUNTY upon
28 notification or shall be withheld from subsequent payments to CONTRACTOR. CONTRACTOR
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1 shall not receive reimbursement for any units of services rendered that are disallowed or denied by
2 the Fresno County Mental Health Plan(Mental Health Plan) utilization review process or through
3 DHCS cost report audit settlement process for Medi-Cal eligible clients.
4 H. It is understood by CONTRACTOR and COUNTY that this Agreement
5 is funded with mental health funds to serve individuals with serious emotional disturbances(SED),
6 many of whom have co-occurring substance use disorders. It is further understood by
7 CONTRACTOR and COUNTY that Mental Health Realignment funds shall be used to support
8 appropriately integrated services for co-occurring substance use disorders in the target population,
9 and that integrated services can be documented in crisis assessments, interventions and progress notes
10 documenting linkages."
11 6. That the following text of Agreement No. 12-119, Page Seven (7), beginning with
12 Paragraph Five (5), Line Twenty-Four(24), with the word"INVOICING" and ending on Page Nine
13 (9), Line Five (5), with the word "requirements" be deleted and the following inserted in its place:
14 665. INVOICING
15 A. COUNTY's DBH shall invoice CONTRACTOR by the fifth(51h) day of
16 each month for the prior month's expenditures for landscaping, building maintenance and utilities for
17 the Adult CSC and for the Youth CSC, separately. CONTRACTOR shall provide payment for these
18 expenditures to COUNTY's Fresno County Department of Behavioral Health, Accounts Receivable,
19 P.O. Box 712, Fresno, CA 93717-0712, Attention: Business Office, within forty-five (45) days after
20 the date of receipt by CONTRACTOR of the monthly invoicing provided by COUNTY.
21 B. CONTRACTOR shall invoice COUNTY in arrears by the tenth(10`h) day
22 of each month for the prior month's actual services rendered to DBHlnvoices@co.fresno.ca.us.
23 CONTRACTOR shall submit one invoice for the actual services provided at the Adult CSC and one
24 invoice for the actual services provided at the Youth CSC. After CONTRACTOR renders service to
25 referred clients, CONTRACTOR will invoice COUNTY for payment, certify the expenditure, and
26 submit electronic claiming billing directly into COUNTY's billing system (AVATAR) for the DHCS
27 reimbursements for all clients, including those eligible for Medi-Cal as well as those that are not
28 eligible for Medi-Cal, including contracted cost per unit and actual cost per unit. COUNTY must pay
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1 CONTRACTOR before submitting a claim to DHCS for Federal reimbursement for Medi-Cal eligible
2 clients.
3 C. At the discretion of COUNTY's DBH Director, or designee, if an invoice
4 is incorrect or is otherwise not in proper form or substance, COUNTY's DBH Director, or designee,
5 shall have the right to withhold payment as to only that portion of the invoice that is incorrect or
6 improper after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to
7 provide services for a period of ninety (90) days after notification of an incorrect or improper invoice.
8 If after the ninety (90) day period, the invoice(s) is still not corrected to COUNTY DBH's
9 satisfaction, COUNTY's DBH Director, or designee,may elect to terminate this Agreement,pursuant
10 to the termination provisions stated in Section Three (3) of this Agreement. In addition, for invoices
11 received ninety (90) days after the expiration of each term of this Agreement or termination of this
12 Agreement, at the discretion of COUNTY's DBH Director, or designee, COUNTY's DBH shall have
13 the right to deny payment of any additional invoices received.
14 D. The initial invoices for the Ramp Up Periods will not contain roster
15 reporting. For the Initial and Operational periods thereafter, as identified herein, monthly invoices
16 shall include a client roster for the Adult CSC and a client roster for the Youth CSC, identifying
17 volume reported by payer group clients served(including third party payer of services) by month and
18 year-to-date, including percentages.
19 E. CONTRACTOR shall submit monthly invoices and general ledgers that
20 itemize the line item charges for monthly program costs (per applicable budget, as identified in
21 Revised Exhibit B-3 and Revised Exhibit C), including the cost per unit calculation based on clients
22 served within that month, and excluding lobbying costs. The invoices and general ledgers will serve
23 as tracking tools to determine if CONTRACTOR's program costs are in accordance with its budgeted
24 cost, and cost per unit negotiated by service modes compared to actual cost per unit, as set forth in
25 Revised Exhibit B-3 and Revised Exhibit C. The actual cost per unit will be based upon total costs
26 and total units of service. It will also serve for the COUNTY to certify the public funds expended for
27 purposes of claiming federal reimbursement for the cost of Medicaid services and activities.
28 CONTRACTOR shall remit to COUNTY on a quarterly basis, separated by Adult CSC services and
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1 Youth CSC services, a summary report of total operational costs and volume of service unit to report
2 the actual costs per unit compared to the negotiated rate, as identified in Revised Exhibit B-3 and
3 Revised Exhibit C, to report interim cost per unit. The quarterly reports will be used by COUNTY to
4 ensure compliance with federal reimbursements certified public expenditures.
5 F. CONTRACTOR must report all third party collections from other
6 funding sources such as Medicare, private insurance, client private pay or any other third party.
7 COUNTY expects the invoice for reimbursement to equal the amount due CONTRACTOR less any
8 funding sources not eligible for federal reimbursement.
9 G. CONTRACTOR will remit annually within ninety (90) days from June
10 30, a schedule to provide the required information on published charges (PC) for all authorized
11 services, as applicable to the Adult CSC, Youth CSC, or both. The published charge listing will serve
12 as a source document to determine the CONTRACTOR's usual and customary charge prevalent in
13 the public mental health sector that is used to bill the general public, insurers or other non-Medi-Cal
14 third party payers during the course of business operations.
15 H. CONTRACTOR shall submit monthly staffing reports (one for the Adult
16 CSC and one for the Youth CSC) that identify all direct service and support staff, applicable
17 licensure/certifications, and full time hours worked to be used as a tracking tool to determine if
18 CONTRACTOR's program is staffed according to the Agreement requirements.
19 I. CONTRACTOR must maintain such financial records for a period of
20 seven(7) years or until any dispute, audit or inspection is resolved, whichever is later.
21 CONTRACTOR will be responsible for any disallowances related to inadequate documentation.
22 J. CONTRACTOR is responsible for collection and managing data in a
23 manner to be determined by DHCS and the Mental Health Plan in accordance with applicable rules
24 and regulations. COUNTY electronic billing system is a critical source of information for purposes
25 of monitoring and obtaining reimbursement. CONTRACTOR must attend COUNTY's Business
26 Office training on equipment reporting for assets, intangible and sensitive minor assets, Avatar
27 claiming module and related cost reporting.
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1 K. CONTRACTOR shall submit electronic billing for services directly into
2 COUNTY's billing module (AVATAR) within ten (10) calendar days from the date services were
3 rendered. DHCS' FFP reimbursement for Medi-Cal specialty mental health services is based on
4 public expenditures certified by the CONTRACTOR. CONTRACTOR must submit a signed
5 certified public expenditure report, one for the Adult CSC and one for the Youth CSC, with each
6 respective monthly invoice. DHCS expects the claim for reimbursement to equal the amount the
7 COUNTY paid the CONTRACTOR for the service rendered less any funding sources not eligible for
8 Federal reimbursement.
9 L. CONTRACTOR must provide all necessary data to allow the COUNTY
10 to bill Medi-Cal, and any other third-party source, for services and meet State and Federal reporting
11 requirements. The necessary data can be provided by a variety of means, including but not limited to:
12 1) direct data entry into COUNTY's information system; 2)providing an electronic file compatible
13 with COUNTY's information system; or 3) integration between COUNTY's information system and
14 CONTRACTOR's information system(s).
15 M. If a Medi-Cal client has dual coverage, such as other health coverage
16 (OHC) or Medicare, the CONTRACTOR will be responsible for billing the carrier and obtaining a
17 payment/denial or have validation of claiming with no response ninety (90) days after the claim
18 was mailed before the service can be entered into AVATAR. CONTRACTOR must report all third
19 party collections for Medicare, third party or client pay or private pay in each monthly invoice and
20 in the cost report that is required to be submitted. A copy of explanation of benefits or CSM 1500
21 is required as documentation. CONTRACTOR must comply with all laws and regulations
22 governing Medicare program, including, but not limited to: 1) the requirement of the Medicare
23 Act, 42 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the Centers for
24 Medicare and Medicaid Services as they relate to participation, coverage and claiming
25 reimbursement. CONTRACTOR will be responsible for compliance as of the effective date of each
26 federal, state or local law or regulation specified.
27 N. Data entry shall be the responsibility of the CONTRACTOR. The data
28 for billing must be reconciled by the CONTRACTOR to the monthly invoices submitted for payment.
- 15 - COUNTY OF FRESNO
Fresno, CA
1 COUNTY shall monitor the number and dollar amount of services entered into AVATAR. Any and
2 all audit exceptions resulting from the provision and billing of Medi-Cal services by CONTRACTOR
3 shall be the sole responsibility of the CONTRACTOR. CONTRACTOR will comply with all
4 applicable policies, procedures, directives and guidelines regarding the use of COUNTY's billing
5 system.
6 O. Medi-Cal Certification and Mental Health Plan Compliance
7 CONTRACTOR will establish and maintain Medi-Cal certification or
8 become certified within ninety (90) days of the effective date of this Agreement for the Adult CSC
9 through COUNTY to provide reimbursable services to Medi-Cal eligible adult clients.
10 CONTRACTOR will establish and maintain Medi-Cal certification or become certified within ninety
11 (90) days of March 10, 2015 for the Youth CSC through COUNTY to provide reimbursable services
12 to Medi-Cal eligible youth clients. In addition, CONTRACTOR shall work with the COUNTY's
13 DBH Managed Care and Business Office to execute the process if not currently certified by
14 COUNTY for credentialing of staff. During this process, the CONTRACTOR will obtain a legal
15 entity number established by the DHCS, a requirement for maintaining organizational provider status
16 throughout the term of this Agreement. CONTRACTOR will be required to become Medi-Cal
17 certified prior to providing services to Medi-Cal eligible clients and seeking reimbursement in
18 COUNTY's billing system. CONTRACTOR will not be reimbursed by COUNTY for any Medi-Cal
19 services rendered prior to certification.
20 Medi-Cal billing shall be in accordance with the Mental Health Plan.
21 CONTRACTOR must comply with the "Fresno County Mental Health Plan Compliance Program and
22 Code of Conduct" set forth in Revised Exhibit J, attached hereto and incorporated herein by reference
23 and made part of this Agreement.
24 Medi-Cal can be billed for direct specialty mental health services of
25 unlicensed staff as long as the individual is approved as an organizational provider by the Mental
26 Health Plan, is supervised by licensed staff, works within his/her scope and only bills Medi-Cal for
27 allowable specialty mental health services.
28
16 - COUNTY OF FRESNO
Fresno, CA
I It is understood that each claim is subject to audit for compliance with
2 Federal and State regulations, and that COUNTY may be making payments in advance of said
3 review. In the event that a Medi-Cal billable service is disapproved, COUNTY may, at its sole
4 discretion, withhold compensation or set off from other payments due the amount of said disapproved
5 services. CONTRACTOR shall be responsible for audit exceptions to ineligible dates of services or
6 incorrect application of utilization review requirements."
7 7. That the following text of Agreement No. 12-119, Page Nine (9), beginning with
8 Paragraph Seven (7), Line Twenty-Six (26), with the word "MODIFICATION"and ending on Page
9 Ten(10), Line Five (5), with the word "herein" be deleted and the following inserted in its place:
10 667. MODIFICATION
11 Any matters of this Agreement may be modified from time to time by the written
12 consent of all the parties without, in any way, affecting the remainder.
13 Notwithstanding the above, changes to line items in the budget, as set forth in
14 Revised Exhibit B-3 and Revised Exhibit C, that do not exceed ten percent (10%) of the maximum
15 compensation payable to the CONTRACTOR, and changes to the volume of units of services/types
16 of service units to be provided as set forth in Revised Exhibit B-3 and Revised Exhibit C, may be
17 made with the written approval of COUNTY's DBH Director, or designee. Said budget line item and
18 service volume/types of service units changes shall not result in any change to the maximum
19 compensation amount payable to CONTRACTOR, as stated herein."
20 8. That the following text of Agreement No. 12-119, Page Ten (10), beginning with
21 Paragraph Ten(10), Line Twenty (20), with the word "INSURANCE" and ending on Page Twelve
22 (12), Line Twenty-Five (25), with the word"better" be deleted and the following inserted in its
23 place:
24 "10. INSURANCE
25 Without limiting COUNTY's right to obtain indemnification from
26 CONTRACTOR or any third parties, CONTRACTOR, at its sole expense, shall maintain in full force
27 and effect the following insurance policies throughout the term of this Agreement:
28
17 - COUNTY OF FRESNO
Fresno, CA
1 A. Commercial General Liability
2 Commercial General Liability Insurance with limits of not less than Two Million
3 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.
4 COUNTY may require specific coverage including completed operations,
product liability, contractual liability, Explosion, Collapse, and Underground
5 (XCU), fire legal liability or any other liability insurance deemed necessary
6 because of the nature of the Agreement.
7 B. Automobile Liability
8 Comprehensive Automobile Liability Insurance with limits for bodily injury of
9 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
10 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
11 include owned and non-owned vehicles used in connection with this Agreement.
12
C. Real and Personal Property
13
CONTRACTOR shall maintain a policy of insurance for all risk personal
14 property coverage which shall be endorsed naming the County of Fresno as an
15 additional loss payee. The personal property coverage shall be in an amount that
will cover the total of the County purchased and owned property, at a minimum,
16 as discussed in Section Twenty-One (21) of this Agreement.
17 All Risk Property Insurance
18
CONTRACTOR will provide property coverage for the full replacement value of
19 the County's Personal Property in the possession of Contractor and/or used in the
20 execution of this agreement. County will be identified on an appropriate
certificate of insurance as the certificate holder and will be named as an
21 Additional Loss Payee on the Property Insurance Policy.
22 D. Professional Liability
23 If CONTRACTOR employs licensed professional staff(e.g. Ph.D., R.N.,
24 L.C.S.W., L.M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000) per occurrence, Three
25 Million Dollars ($3,000,000) annual aggregate. CONTRACTOR agrees that it
26 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
27 professional liability insurance with limits of coverage as specified herein.
28 1H
- 18 - COUNTY OF FRESNO
Fresno, CA
1 E. Worker's Compensation
2 A policy of Worker's Compensation Insurance as may be required by the
3 California Labor Code.
4 F. Child Abuse/Molestation and Social Services Coveraae
5 CONTRACTOR shall have either separate policies or umbrella policy with
6 endorsements covering Child Abuse/Molestation and Social Services Liability
coverage or have a specific endorsement on their General Commercial liability
7 policy covering Child Abuse/Molestation and Social Services Liability. The
8 policy limits for these policies shall be $1,000,000 per occurrence with
$2,000,000 annual aggregate. The policies are to be on a per occurrence basis.
9
10 CONTRACTOR shall obtain endorsements to the Commercial General Liability
11 insurance naming the County of Fresno, its officers, agents, and employees, individually and
12 collectively, as additional insured, but only insofar as the operations under this Agreement are
13 concerned. Such coverage for additional insured shall apply as primary insurance and any other
14 insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees shall be
15 excess only and not contributing with insurance provided under CONTRACTOR'S policies herein.
16 This insurance shall not be cancelled or changed without a minimum of thirty (30) days advance
17 written notice given to COUNTY.
18 Within thirty (30) days from the date CONTRACTOR signs this Agreement,
19 CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of
20 the foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health,
21 3133 N. Millbrook Ave, Fresno, California, 93703, Attention: Mental Health Contracts Section,
22 stating that such insurance coverages have been obtained and are in full force; that the County of
23 Fresno, its officers, agents and employees will not be responsible for any premiums on the policies;
24 that such Commercial General Liability insurance names the County of Fresno, its officers, agents
25 and employees, individually and collectively, as additional insured, but only insofar as the operations
26 under this Agreement are concerned; that such coverage for additional insured shall apply as primary
27 insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents
28 and employees, shall be excess only and not contributing with insurance provided under
- 19 - COUNTY OF FRESNO
Fresno, CA
I CONTRACTOR's policies herein; and that this insurance shall not be cancelled or changed without a
2 minimum of thirty (30) days advance, written notice given to COUNTY.
3 In the event CONTRACTOR fails to keep in effect at all times insurance
4 coverage as herein provided, COUNTY may, in addition to other remedies it may have, suspend or
5 terminate this Agreement upon the occurrence of such event.
6 All policies shall be with admitted insurers licensed to do business in the State of
7 California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating
8 of A FSC VII or better."
9 9. That the following text of Agreement No. 12-119, Page Thirteen(13), beginning with
10 Paragraph Thirteen (13), Line Twelve (12), with the word"REPORTS" and ending on Page Fourteen
11 (14), Line Twenty-Eight (28), with the word"Agreement" be deleted and the following inserted in its
12 place:
13 "13. REPORTS
14 A. Cost Report—CONTRACTOR agrees to submit a complete and accurate
15 detailed cost report on an annual basis for each fiscal year ending June 301h in the format prescribed
16 by the DHCS for the purposes of Short Doyle Medi-Cal reimbursements and total costs for programs.
17 CONTRACTOR shall submit one cost report for the Adult CSC services and one cost report for the
18 Youth CSC services. Each cost report will be the source document for several phases of settlement
19 with the DHCS for the purposes of Short Doyle Medi-Cal reimbursement. CONTRACTOR shall
20 report costs under their approved legal entity number established during the Medi-Cal certification
21 process. The information provided applies to CONTRACTOR for program related costs for services
22 rendered to Medi-Cal and non Medi-Cal. The CONTRACTOR will remit a schedule to provide the
23 required information on published charges (PC) for all authorized services. The report will serve as a
24 source document to determine their usual and customary charge prevalent in the public mental health
25 sector that is used to bill the general public, insurers or other non-Medi-Cal third party payers during
26 the course of business operations. CONTRACTOR must report all collections for Medi-
2 7 Cal/Medicare services and collections. The CONTRACTOR shall also submit with each cost report a
28 copy of the CONTRACTOR's general ledger that supports revenues and expenditures for the
- 20 - COUNTY OF FRESNO
Fresno, CA
1 specified Adult or Youth CSC. CONTRACTOR must also include a reconciled detailed report of the
2 total units of services rendered under this Agreement compared to the units of services entered by
3 CONTRACTOR into COUNTY'S data system.
4 Cost Reports must be submitted to the COUNTY as a hard copy with a signed
5 cover letter and electronic copy of the completed DHCS cost report form along with requested
6 support documents following each fiscal year ending June 301". During the month of September of
7 each year this Agreement is effective, COUNTY will issue instructions of the annual cost report
8 which indicates the training session, DHCS cost report template worksheets, and deadlines to submit
9 as determined by the State annually. Remit the hard copies of the cost reports to County of Fresno,
10 Attention: Cost Report Team, P.O. Box 45003, Fresno, CA 93718. Remit the electronic copy or any
11 inquiries to DBHcostreportteam@co.fresno.ca.us.
12 All Cost Reports must be prepared in accordance with General Accepted
13 Accounting Principles (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3)
14 and 5718(c). Unallowable costs such as lobby or political donations must be deducted on the cost
15 report and invoice reimbursements.
16 If the CONTRACTOR does not submit the cost report(s) by the deadline,
17 including any extension period granted by the COUNTY,the COUNTY may withhold payments of
18 pending invoicing under compensation until the cost report(s) has been submitted and clears
19 COUNTY desk audit for completeness.
20 B. Settlements with State Department of Health Care Services (DHCS)
21 During the term of this Agreement and thereafter, COUNTY and
22 CONTRACTOR agree to settle dollar amounts disallowed or settled in accordance with DHCS and
23 COUNTY audit settlement findings related to the Medi-Cal and realignment reimbursements.
24 CONTRACTOR will participate in the several phases of settlements between
25 COUNTY/CONTRACTOR and DHCS. The phases of initial cost reporting for settlement according
26 to State reconciliation of records for paid Medi-Cal services and audit settlement-State DHCS audit:
27 1) initial cost reporting - after an internal review by COUNTY, the COUNTY files cost report with
28 State DHCS on behalf of the CONTRACTOR's legal entity for the fiscal year; 2) Settlement—State
- 21 - COUNTY OF FRESNO
Fresno, CA
1 reconciliation of records for paid Medi-Cal services, approximately eighteen (18)to thirty-six (36)
2 months following the State close of the fiscal year, DHCS will send notice for any settlement under
3 this provision will be sent to the COUNTY; and 3) Audit Settlement-State DHCS audit. After final
4 reconciliation and settlement, COUNTY and/or DHCS may conduct a review of medical records, cost
5 report along with support documents submitted to COUNTY in initial submission to determine
6 accuracy and may disallow cost and/or unit of service reported on the CONTRACTOR's legal entity
7 cost report. COUNTY may choose to appeal and therefore reserves the right to defer payback
8 settlement with CONTRACTOR until resolution of the appeal. DHCS Audits will follow federal
9 Medicaid procedures for managing overpayments.
10 If at the end of the Audit Settlement, the COUNTY determines that it
11 overpaid the CONTRACTOR, it will require the CONTRACTOR to repay the Medi-Cal related
12 overpayment back to the COUNTY.
13 Funds owed to COUNTY will be due within forty-five (45) days of
14 notification by the COUNTY, or COUNTY shall withhold future payments until all excess funds
15 have been recouped by means of an offset against any payments then or thereafter owing to
16 CONTRACTOR under this or any other Agreement.
17 C. Outcome Reports—CONTRACTOR shall submit to COUNTY's DBH
18 service outcome reports as requested by DBH. Outcome reports and outcome requirements are
19 subject to change at COUNTY DBH's discretion.
20 D. Additional Reports—CONTRACTOR shall also furnish to COUNTY
21 such statements, records, reports, data, and other information as COUNTY's DBH may request
22 pertaining to matters covered by this Agreement. In the event that CONTRACTOR fails to provide
23 such reports or other information required hereunder, it shall be deemed sufficient cause for
24 COUNTY to withhold monthly payments until there is compliance. In addition, CONTRACTOR
25 shall provide written notification and explanation to COUNTY within five (5) days of any funds
26 received from another source to conduct the same services covered by this Agreement.
27 E. Quarterly Report Progress_ Updates—CONTRACTOR shall complete
28 Quarterly Progress Report updates according to DHCS regulations, in the form set forth in Exhibit E,
- 22 - COUNTY OF FRESNO
Fresno, CA
I attached hereto and by this reference incorporated herein and made part of this Agreement.
2 CONTRACTOR shall utilize the Quarterly Report Progress Update Report as shown in Exhibit E, to
3 submit the required Quarterly Report Progress updates: one for the Adult CSC and one for the Youth
4 CSC. Quarterly reports shall be submitted to COUNTY's DBH Mental Health Contracts Division for
5 review within thirty (30) days of the end of each quarter.
6 F. Daily Census Reports—CONTRACTOR will submit a copy of admitted
7 clients on a daily basis (i.e., a daily census report)to COUNTY's DBH Director, and/or designee,
8 separated by the Adult CSC daily census information and the Youth CSC daily census information.
9 Said daily census report shall identify clients by DHCS number, Social Security number, date of
10 birth, age, length of stay, Axis I Diagnosis, housing status, and financial status such as Medi-Cal
11 and/or general relief, identify clients primary physician status, and identify discharged clients in a
12 format acceptable to COUNTY'S DBH Director, or designee. Said daily census reports shall
13 accompany each monthly invoice submitted by CONTRACTOR."
14 10. That the following text of Agreement No. 12-119, Page Twenty-Three (23),beginning
15 with Paragraph Twenty (20), Line One (1), with the word"DATA SECURITY" and ending on Page
16 Twenty-Four (24), Line Eighteen (18), with the word"notification" be deleted and the following
17 inserted in its place:
18 "20. DATA SECURITY
19 For the purpose of preventing the potential loss, misappropriation or inadvertent
20 access, viewing, use or disclosure of COUNTY data including sensitive or personal client
21 information; abuse of COUNTY resources; and/or disruption to COUNTY operations, individuals
22 and/or agencies that enter into a contractual relationship with the COUNTY for the purpose of
23 providing services under this Agreement must employ adequate data security measures to protect the
24 confidential information provided to CONTRACTOR by the COUNTY, including but not limited to
25 the following:
26 A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
27 CONTRACTOR may not connect to COUNTY networks via personally-
2 8 owned mobile, wireless or handheld devices, unless the following conditions are met:
- 23 - COUNTY OF FRESNO
Fresno, CA
1 1) CONTRACTOR has received authorization by COUNTY
2 for telecommuting purposes;
3 2) Current virus protection software is in place;
4 3) Mobile device has the remote wipe feature enabled; and
5 4) A secure connection is used.
6 B. CONTRACTOR-Owned Computers or Computer Peripherals
7 CONTRACTOR may not bring CONTRACTOR-owned computers or
8 computer peripherals into the COUNTY for use without prior authorization from the COUNTY's
9 Chief Information Officer, and/or designee(s), including but not limited to mobile storage devices. If
10 data is approved to be transferred, data must be stored on a secure server approved by the COUNTY
11 and transferred by means of a Virtual Private Network(VPN) connection, or another type of secure
12 connection. Said data must be encrypted.
13 C. COUNTY-Owned Computer Equipment
14 CONTRACTOR, including its subcontractors and employees, may not
15 use COUNTY computers or computer peripherals on non-COUNTY premises without prior
16 authorization from the COUNTY's Chief Information Officer, and/or designee(s).
17 D. CONTRACTOR may not store COUNTY's private, confidential or
18 sensitive data on any hard-disk drive, portable storage device, or remote storage installation unless
19 encrypted.
20 E. CONTRACTOR shall be responsible to employ strict controls to ensure
21 the integrity and security of COUNTY's confidential information and to prevent unauthorized access,
22 viewing, use or disclosure of data maintained in computer files, program documentation, data
23 processing systems, data files and data processing equipment which stores or processes COUNTY
24 data internally and externally.
25 F. Confidential client information transmitted to one party by the other by
26 means of electronic transmissions must be encrypted according to Advanced Encryption Standards
27 (AES) of 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
28
24 - COUNTY OF FRESNO
Fresno, CA
1 G. CONTRACTOR is responsible to immediately notify COUNTY of any
2 violations, breaches or potential breaches of security related to COUNTY's confidential information,
3 data maintained in computer files, program documentation, data processing systems, data files and
4 data processing equipment which stores or processes COUNTY data internally or externally.
5 H. COUNTY shall provide oversight to CONTRACTOR's response to all
6 incidents arising from a possible breach of security related to COUNTY's confidential client
7 information provided to CONTRACTOR. CONTRACTOR will be responsible to issue any
8 notification to affected individuals as required by law or as deemed necessary by COUNTY in its sole
9 discretion. CONTRACTOR will be responsible for all costs incurred as a result of providing the
10 required notification."
11 11. That the following text of Agreement No. 12-119, Page Twenty-Four(24), beginning
12 with Paragraph Twenty-One (21), Line Nineteen (19), with the word "EQUIPMENT" and ending on
13 Page Twenty-Six (26), Line One (1), with the word"obligations" be deleted and the following
14 inserted in its place:
15 1121. PROPERTY OF COUNTY
16 A. COUNTY and CONTRACTOR recognizes that fixed assets are tangible
17 and intangible property obtained or controlled under COUNTY's Mental Health Plan for use in
18 operational capacity and will benefit COUNTY for a period more than one year. Depreciation of the
19 qualified items will be on a straight-line basis.
20 For COUNTY purposes, fixed assets must fulfill three qualifications:
21 1. Asset must have life span of over one year.
22 2. The asset is not a repair part.
23 3. The asset must be valued at or greater than the capitalization thresholds
24 for the asset type:
25 Asset type Threshold
26 • land $0
27 • buildings and improvements $100,000
• infrastructure $100,000
28
- 25 - COUNTY OF FRESNO
Fresno, CA
1 . be tangible $5,000
2 o equipment
o vehicles
3 • or intangible asset $100,000
o Internally generated software
4 o Purchased software
5 o Easements
o Patents
6 • and capital lease $5,000
7 Qualified fixed asset equipment is to be reported and approved by COUNTY. If
8 it is approved and identified as an asset it will be tagged with a COUNTY program number. A Fixed
9 asset log will be maintained by COUNTY's Asset Management System and annual inventoried until
10 the asset is fully depreciated. During the terms of this Agreement, CONTRACTOR's fixed assets
11 may be inventoried in comparison to COUNTY's DBH Asset Inventory System.
12 B. Certain purchases less than Five Thousand and No/100 Dollars
13
($5,000.00)but more than One Thousand and No/100 Dollars ($1,000.00), with over one year life
14 span, and are mobile and high risk of theft or loss are sensitive assets. Such sensitive items are not
15 limited to computers, copiers, televisions, cameras and other sensitive items as determined by
16 COUNTY's DBH Director or designee. CONTRACTOR maintains a tracking system on the items
17 and are not required to be capitalize or depreciated. The items are subject to annual inventory for
18
compliance.
19 C. Assets shall be retained by COUNTY, as COUNTY property, in the event
20 this Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to
21 participate in an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or
22 expiration of this Agreement CONTRACTOR shall be physically present when fixed and inventoried
23 assets are returned to COUNTY possession. CONTRACTOR is responsible for returning to
24 COUNTY all COUNTY owned undepreciated fixed and inventoried assets, or the monetary value of
25 said assets if unable to produce the assets at the expiration or termination of this Agreement.
26 CONTRACTOR further agrees to the following:
27 1. To maintain all items of equipment in good working order and
28 condition, normal wear and tear is expected;
26 - COUNTY OF FRESNO
Fresno, CA
1 2. To label all items of equipment with COUNTY assigned program
2 number, to perform periodic inventories as required by COUNTY and to maintain an inventory list
3 showing where and how the equipment is being used, in accordance with procedures developed by
4 COUNTY. All such lists shall be submitted to COUNTY within ten(10) days of any request
5 therefore; and
6 3. To report in writing to COUNTY immediately after discovery,the
7 lost or theft of any items of equipment. For stolen items, the local law enforcement agency must be
8 contacted and a copy of the police report submitted to COUNTY.
9 D. The purchase of any equipment by CONTRACTOR with funds provided
10 hereunder shall require the prior written approval of COUNTY's DBH, shall fulfill the provisions of
11 this Agreement as appropriate, and must be directly related to CONTRACTOR's services or activity
12 under the terms of this Agreement. COUNTY's DBH may refuse reimbursement for any costs
13 resulting from equipment purchased, which are incurred by CONTRACTOR, if prior written approval
14 has not been obtained from COUNTY.
15 E. CONTRACTOR must obtain prior written approval from COUNTY's
16 DBH whenever there is any modification or change in the use of any property acquired or improved,
17 in whole or in part, using funds under this agreement. If any real or personal property acquired or
18 improved with said funds identified herein is sold and/or is utilized by CONTRACTOR for a use
19 which does not qualify under this program, CONTRACTOR shall reimburse COUNTY in an amount
20 equal to the current fair market value of the property, less any portion thereof attributable to
21 expenditures of non-program funds. These requirements shall continue in effect for the life of the
22 property. In the event the program is closed out, the requirements for this Section Twenty-One (21)
23 shall remain in effect for activities or property funded with said funds,unless action is taken by the
24 State government to relieve COUNTY of these obligations."
25 12. That the following text of Agreement No. 12-119, Page Twenty-Six (26), beginning with
26 Paragraph Twenty-Three (23), Line Seven (7), with the word"ENGLISH PROFICIENCY" and
27 ending on Page Twenty-Six (26), Line Nineteen (19), with the word "services" be deleted and the
28 following inserted in its place:
- 27 - COUNTY OF FRESNO
Fresno, CA
1 "23. CULTURAL COMPETENCY
2 As related to Cultural and Linguistic Competence, CONTRACTOR shall comply
3 with:
4 A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. section 2000d, and 45
5 C.F.R. Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial
6 assistance from discriminating against persons based on race, color, national origin, sex, disability or
7 religion. This is interpreted to mean that a limited English proficient (LEP) individual is entitled to
8 equal access and participation in federally funded programs through the provision of comprehensive
9 and quality bilingual services.
10 B. Policies and procedures for ensuring access and appropriate use of trained
11 interpreters and material translation services for all LEP clients, including, but not limited to,
12 assessing the cultural and linguistic needs of its clients,training of staff on the policies and
13 procedures, and monitoring its language assistance program. The CONTRACTOR's procedures must
14 include ensuring compliance of any sub-contracted providers with these requirements.
15 C. CONTRACTOR shall not use minors as interpreters.
16 D. CONTRACTOR shall provide and pay for interpreting and translation
17 services to persons participating in CONTRACTOR's services who have limited or no English
18 language proficiency, including services to persons who are deaf or blind. Interpreter and translation
19 services shall be provided as necessary to allow such participants meaningful access to the programs,
20 services and benefits provided by CONTRACTOR. Interpreter and translation services, including
21 translation of CONTRACTOR's"vital documents" (those documents that contain information that is
22 critical for accessing CONTRACTOR's services or are required by law) shall be provided to
23 participants at no cost to the participant. CONTRACTOR shall ensure that any employees, agents,
24 subcontractors, or partners who interpret or translate for a program participant, or who directly
25 communicate with a program participant in a language other than English, demonstrate proficiency in
26 the participant's language and can effectively communicate any specialized terms and concepts
27 peculiar to CONTRACTOR's services.
28
28 - COUNTY OF FRESNO
Fresno, CA
1 E. In compliance with the State mandated Culturally and Linguistically
2 Appropriate Services standards as published by the Office of Minority Health, CONTRACTOR must
3 submit to COUNTY for approval, within sixty(60) days from date of contract execution,
4 CONTRACTOR's plan to address all fifteen national cultural competency standards as set forth in the
5 "National Standards on Culturally and Linguistically Appropriate Services (CLAS)"
6 http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf. COUNTY's annual on-site review
7 of CONTRACTOR shall include collection of documentation to ensure all national standards are
8 implemented. As the national competency standards are updated, CONTRACTOR's plan must be
9 updated accordingly."
10 13. That the following text of Agreement No. 12-119, Page Twenty-Eight(28), beginning
11 with Paragraph Twenty-Six (26), Line Fifteen(15), with the word"COMPLIANCE" and ending on
12 Page Twenty-Nine (29), Line Eight (8), with the word"Agreement" be deleted and the following
13 inserted in its place:
14 "26. COMPLIANCE
15 CONTRACTOR shall comply with all requirements of the"Fresno County
16 Mental Health Compliance Program and Contractor Code of Conduct and Ethics" as set forth in
17 Revised Exhibit J. Within thirty (30) days of entering into this Agreement with the COUNTY,
18 CONTRACTOR shall have all of CONTRACTOR's employees, agents and subcontractors providing
19 services under this Agreement certify in writing, that they have received, read, understood, and shall
20 abide by the requirements set forth in Revised Exhibit J. CONTRACTOR shall ensure that within
21 thirty (30)days of hire, all new employees, agents and subcontractors providing services under this
22 Agreement certify in writing that they have received, read, understood, and shall abide by the
23 requirements set forth in Revised Exhibit J. CONTRACTOR understands that the promotion of and
24 adherence to such requirements is an element in evaluating the performance of CONTRACTOR and
25 its employees, agents and subcontractors.
26 Within thirty (30) days of entering into this Agreement, and annually thereafter,
27 all employees, agents and subcontractors providing services under this Agreement shall complete
28 general compliance training and appropriate employees, agents and subcontractors shall complete
- 29 - COUNTY OF FRESNO
Fresno, CA
1 documentation and billing or billing/reimbursement training. All new employees, agents and
2 subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual
3 who is required to attend training shall certify in writing that he or she has received the required
4 training. The certification shall specify the type of training received and the date received. The
5 certification shall be provided to the COUNTY's Compliance Officer at 3133 N. Millbrook, Room
6 171, Fresno, CA 93703. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any
7 penalty imposed upon COUNTY by the Federal Government as a result of CONTRACTOR's
8 violation of the terms of this Agreement."
9 14. That Paragraph Thirty-One (31) (DISCLOSURE OF OWNERSHIP AND/OR
10 CONTROL INTEREST INFORMATION) added to Agreement No. 12-119 by Amendment II be
11 deleted and the following inserted in its place:
12 "31. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
13 INFORMATION
14 This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal
15 agent, or managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101
16 455.104, and 455.106(a)(1),(2).
17 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and
18 455.106(a)(1),(2), the following information must be disclosed by CONTRACTOR by completing
19 Exhibit M, "Disclosure of Ownership and Control Interest Statement", attached hereto and by this
20 reference incorporated herein and made part of this Agreement. CONTRACTOR shall submit this
21 form to COUNTY's DBH within thirty (30) days of the effective date of this Agreement.
22 Additionally, CONTRACTOR shall report any changes to this information within thirty-five (35)
23 days of occurrence by completing Exhibit M, "Disclosure of Ownership and Control Interest
24 Statement." Submissions shall be scanned pdf copies and are to be sent via email to
25 DBHAdministration&co.fresno.ca.us attention: Contracts Administration."
26 15. That the following be inserted as Paragraph Thirty-Two (32) immediately after
27 Paragraph Thirty-One (31) (DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
28 INFORMATION):
- 30 - COUNTY OF FRESNO
Fresno, CA
1 "32. DISCLOSURE —CRIMINAL HISTORY AND CIVIL ACTIONS
2 CONTRACTOR is required to disclose if any of the following conditions apply
3 to them,their owners, officers, corporate managers and partners (hereinafter collectively referred to
4 as "CONTRACTOR"):
5 A. Within the three-year period preceding the Agreement award,they have
6 been convicted of, or had a civil judgment rendered against them for:
7 1. Fraud or a criminal offense in connection with obtaining,
8 attempting to obtain, or performing a public (federal, state, or
9 local) transaction or contract under a public transaction;
10 2. Violation of a federal or state antitrust statute;
11 3. Embezzlement,theft, forgery, bribery, falsification, or
12 destruction of records; or
13 4. False statements or receipt of stolen property.
14 B. Within a three-year period preceding their Agreement award, they have
15 had a public transaction(federal, state, or local) terminated for cause or default.
16 Disclosure of the above information will not automatically eliminate
17 CONTRACTOR from further business consideration. The information will be considered as part of
18 the determination of whether to continue and/or renew the Contract and any additional information
19 or explanation that a CONTRACTOR elects to submit with the disclosed information will be
20 considered. If it is later determined that the CONTRACTOR failed to disclose required
21 information, any contract awarded to such CONTRACTOR may be immediately voided and
22 terminated for material failure to comply with the terms and conditions of the award.
23 CONTRACTOR must sign a "Certification Regarding Debarment,
24 Suspension, and Other Responsibility Matters- Primary Covered Transactions" in the form set forth
25 in Revised Exhibit N, attached hereto and by this reference incorporated herein. Additionally,
26 CONTRACTOR must immediately advise the County in writing if, during the term of this
27 Agreement: (1) CONTRACTOR becomes suspended, debarred, excluded or ineligible for
28 participation in federal or state funded programs or from receiving federal funds as listed in the
- 31 - COUNTY OF FRESNO
Fresno, CA
1 excluded parties' list system (http://www.sam.gov); or(2) any of the above listed conditions become
2 applicable to CONTRACTOR. CONTRACTOR shall indemnify, defend and hold the COUNTY
3 harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility or
4 other matter listed in the signed Certification Regarding Debarment, Suspension, and Other
5 Responsibility Matters."
6 16. That the existing Agreement No. 12-119, Paragraph Thirty-Two (32), (COMPLAINTS)
7 be deleted and the following inserted in its place:
8 "33. COMPLAINTS
9 CONTRACTOR shall log complaints and the disposition of all complaints from
10 a client or a client's family. CONTRACTOR shall provide a copy of the detailed complaint log
11 entries concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (1 oth)
12 day of the following month, in a format that is mutually agreed upon. Besides the detailed complaint
13 log, CONTRACTOR shall provide details and attach documentation of each complaint with the log.
14 CONTRACTOR shall post signs informing clients of their right to file a complaint or grievance.
15 CONTRACTOR shall notify COUNTY of all incidents reportable to state licensing bodies that affect
16 COUNTY clients within twenty-four(24)hours of receipt of a complaint.
17 Within ten(10) days after each incident or complaint affecting COUNTY-
18 sponsored clients, CONTRACTOR shall provide COUNTY with information relevant to the
19 complaint, investigative details of the complaint,the complaint and CONTRACTOR's disposition of,
20 or corrective action taken to resolve the complaint. In addition, CONTRACTOR shall inform every
21 client of their rights as set forth in Exhibit H. CONTRACTOR shall file an incident report for all
22 incidents involving clients, following the Protocol and using the Worksheet identified in Exhibit I."
23 17. That the existing COUNTY Agreement No. 12-119 Paragraphs Thirty-Three (33)
24 (`°NOTICES") through Thirty-Five (35) ("ENTIRE AGREEMENT") be renumbered to read
25 Paragraphs Thirty-Four(34)through Thirty-Six (36).
26 18. That all references in existing County Agreement No. 12-119, within Paragraph One (1)
27 to "CSC", shall be changed to read "Adult and Youth CSCs".
28
32 - COUNTY OF FRESNO
Fresno, CA
1 19. That all references in existing County Agreement No. 12-119 to"Exhibit A", shall be
2 changed to read "Revised Exhibit A". A copy of Revised Exhibit A is attached hereto and
3 incorporated herein by reference.
4 20. That all references in existing County Agreement No. 12-119 to "Revised Exhibit B-2,
5 shall be changed to read "Revised Exhibit B-3". A copy of Revised Exhibit B-3 is attached hereto
6 and incorporated herein by reference.
7 21. That all references in existing County Agreement No. 12-119 to "Exhibit C"be deleted.
8 22. That all references in existing County Agreement No. 12-119 to "Exhibit J, shall be
9 changed to read "Revised Exhibit F. A copy of Revised Exhibit J is attached hereto and incorporated
10 herein by reference.
11 23. That all references in existing County Agreement No. 12-119 to "Exhibit L, shall be
12 changed to read"Revised Exhibit L". A copy of Revised Exhibit L is attached hereto and
13 incorporated herein by reference.
14 24. Exhibit M is attached hereto and incorporated herein by reference.
15 25. That all references in existing County Agreement No. 12-119 to "Exhibit N, shall be
16 changed to read "Revised Exhibit N". A copy of Revised Exhibit N is attached hereto and
17 incorporated herein by reference.
18 26. That all references in existing County Agreement No. 12-119 to the word"consumer"
19 shall be changed to read "client".
20 27. COUNTY and CONTRACTOR agree that this Amendment III is sufficient to amend the
21 Agreement; and that upon execution of this Amendment I11, the Agreement, Amendment 1,
22 Amendment 11, and Amendment III together shall be considered the Agreement.
23 The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
24 covenants, conditions and promises contained in the Agreement and not amended herein, shall remain
25 in full force and effect. This Amendment III shall become effective March 10, 2015.
26
27
28
- 33 - COUNTY OF FRESNO
Fresno, CA
1 IN WITNESS WHEREOF,the parties hereto have executed this Amendment III to Agreement
2 No. 12-119 as of the day and year first hereinabove written.
3
4 EXODUS RECOVERY, INC. COUNTY OF FRESNO
5
6 By: / By
7 Chairman, Board of Supervis
8 Print Name: Luana M h
9
10 Title: President/CEO
11 Chairman of Board, or President
Or any Vice President
12 BERNICE E. SEIDEL, Clerk
13 Board of Supervisors
By
14
15 Print Name: LeeAnn Skorohod By
16
17 Title: Secretary of Corporation/Sr VP Operations
18 Secretary of Corporation, or
19 Any Assistant Secretary, or
Chief Financial Officer, or
20 Any Assistant Treasurer
21
22 Mailing Address:
23 Exodus Recovery, Inc.
9808 Venice Boulevard, Suite 700
24 Culver City, CA 90232
25 PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
26 Contact: Luana Murphy, President/CEO
27 Phone: (310) 945-3350
28
=-34_ COUNTY OF FRESNO
Fresno, CA
1 APPROVED AS TO LEGAL FORM:
2 DANIEL C. CEDERBORG, COUNTY COUNSEL
3By
4
r
5 APPROVED AS TO ACCOUNTING FORM:
6 VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
7
1
8 By
9
10 REVIEWED AND RECOMMENDED FOR APPROVAL:
11 By V�_
12 Dawan Utec , Director
13 Department of Behavioral Health
14
Fund/Subclass: 0001/10000
15 Account/Program: 7294/0
16 Organization: 56302110
17
INITIAL CONTRACT AMOUNTS(12 beds):
18 Fiscal Year Program Cost
FY 2012-12 $ 583,045 (Ramp Up Period: March 7,2012—May 31, 2012)
19 FY 2012-12 $ 656,434 (Initial Operational Period: May 4, 2012—June 30, 2012)
FY 2012-13 $3,855,249 (Operational Period)
20 FY 2013-14 $3,967,741 (Operational Period)
21 ADULT EXPANSION(additional 8 beds—total of 20 beds, effective April 1, 2015):
22 Fiscal Year Program Cost
FY 2014-15 $ 48,448 (Second Ramp Up Period: March 10, 2015 —April 1, 2015)
23 FY 2014-15 $4,532,933 (Operational Period: 9 months for 12 beds; 3 months for 20 beds)
FY 2015-16 $6,418,893 (Operational Period)
24
25 Organization: 56302111
26 YOUTH EXPANSION(8 beds,effective April 1, 2015):
Fiscal Year Program Cost
27 FY 2014-15 $ 208,530 (Second Ramp Up Period: March 10, 2015 —March 31,2015)
FY 2014-15 $ 694,558 (Initial Operational Period: April 1, 2015 —June 30, 2015)
28 FY 2015-16 $2,649,269 (Operational Period)
finelkl
- 35 - COUNTY OF FRESNO
Fresno, CA
Revised Exhibit Al
Page 1 of 9
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
SERVICES: Adult Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: March 7, 2012 — May 31, 2012 (Ramp Up Period)
May 4, 2012 —June 30, 2012 (Initial Operational Period)
Effective July 1, 2012, shall continue with an option for four (4) twelve (12) month
renewals (Operational Periods)
INITIAL CONTRACT AMOUNT: $ 583,045 3/7/2012 through 5/31/2012 (Ramp Up Period)
(12 beds maximum) $ 656,434 5/4/2012 through 6/30/2012 (Initial Operational Period)
$3,855,249 FY 2012-13 (Operational Periods)
$3,967,741 FY 2013-14
EXPANSION AMOUNT: $ 48,448 3/10/2015 through 3/31/2015 (Second Ramp Up Period)
(additional 8 beds, for a $4,532,933 FY 2014-15 (Operational Periods)
total of 20 beds maximum) $6,418,893 FY 2015-16
SCHEDULE 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.
TARGET POPULATION:
The target population will include clients 18 years of age and older from Fresno County, who are exhibiting
acute psychiatric symptoms that have 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 adult clients with a twenty (20) bed maximum at any given time. However,
CONTRACTOR may be in the process of assessing or evaluating additional clients, as necessary.
CONTRACTOR will accept voluntary or involuntarily admitted clients regardless of source of payment;
clients will include Medi-Cal beneficiaries, Medicare and Medicare/Medi-Cal beneficiaries, privately insured
and indigent/uninsured clients who are referred by the Department of Behavioral Health (DBH), a contract
provider with the DBH, a hospital emergency room (aka emergency department), law enforcement, or
Emergency Medical Services (EMS). Clients may also be family or 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:
Revised Exhibit Al
Page 2 of 9
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid.
Federal statutes and regulations state that youth 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. These requirements shall
apply to clients between the ages of 18 to 21 regarding services under this Agreement.
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 client 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 Client 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 client'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 clients that encourages wellness and recovery.
4. A comprehensive multi-disciplinary evaluation and client-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 clients, who are not on involuntary holds in accordance with Welfare
and Institutions Code 5150 and also individuals placed on W&I 5150 involuntary holds.
7. 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. Psycho-Social Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Client Centered Treatment Planning
g. Aftercare Planning and Wellness Recovery Action Plan (WRAP)
Revised Exhibit Al
Page 3 of 9
8. 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 that require 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 client 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
lice nsed/registered/waivered staff must complete a FCMHP Provider Application and be
credehtialed by the FCMHP's Credentialing Committee. All of CONTRACTOR's staff who
have direct contact with the clients, 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
clients/families during their time at the Adult CSC facility and will assist with discharge
planning and facilitate the client'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 licensed mental health or
waive red/registered professional on site for each four beneficiaries or other patients
receiving Crisis Stabilization at any given time.
(d) If the beneficiary 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."
Revised Exhibit Al
Page 4 of 9
9. Medical Records
a. The CONTRACTOR shall be responsible to enter all Client 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.
b. The CONTRACTOR will be responsible for "release of information" requests for the Adult
CSC facility and shall adhere to applicable federal and state regulations.
10. 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).
11. 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 client needs, pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 (Crisis Stabilization Staffing Requirements).
12. 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.
13. 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.
14. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify the COUNTY of any admission of a COUNTY client within
twenty-four (24) hours or the next business day in a manner approved by the COUNTY.
The notification method shall be mutually acceptable by both COUNTY and
CONTRACTOR.
b. CONTRACTOR shall be responsible to insure that documentation in the client'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
data 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 30th affected by the proposed agreement within
ninety (90) days following the end of each fiscal year.
e. CONTRACTOR shall insure that cost reports are prepared in accordance with Generally
Accepted Accounting Principles and the standards set forth by the DHCS and the
COUNTY.
15. Patients' Rights and Certification Review Hearings:
a. CONTRACTOR shall adopt and post in a conspicuous place a written policy on patient
rights in accordance with section 70707 of Title 22 of the California Code of Regulations
and section 5325.1 of the California Welfare and Institutions Code and Title 42 Code of
Federal Regulations section 438.100.
Revised Exhibit Al
Page 5 of 9
b. CONTRACTOR shall allow access to COUNTY clients by the Patients' Rights Advocate
designated by the COUNTY.
16. Grievances and Incident Reports - CONTRACTOR shall log all grievances and the disposition of
all grievances received from a client or a client's family in accordance with FCMHP policies and
procedures as indicated within Exhibit H. CONTRACTOR shall provide a summary of the
grievance log entries concerning COUNTY-sponsored clients 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 clients 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 clients within twenty-four (24) hours. The CONTRACTOR
shall use the Incident Report form as indicated within Exhibit I for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-sponsored clients,
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.
17. Provide a safe and secure environment to provide for clinical and medical assessment,
diagnostic formulation, crisis intervention, medication management and clinical treatment for
mental health clients with acute psychiatric symptoms. This includes the manner in
which seclusion and restraint will be administered when necessary for the safety of the
clients, other clients in the program and staff.
18. CONTRACTOR shall utilize cost containment strategies for the provision of stock and
prescription medications to clients by contracting with a pharmaceutical benefits management
company, and provide the COUNTY with the type of formulary utilized by the program, and
provide the COUNTY with information regarding co-pays and/or generic substitutions.
19. Provide the appropriate type and level of staffing to provide for a clinical effective program
design that adheres to State staffing requirements.
20. Provide an intensive treatment program which has individualized treatment plans.
21. Stabilize the clients' 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.
22. Effectively partner with other programs in the COUNTY and community system (i.e. law
enforcement, local emergency departments, etc.) in accepting COUNTY clients for admission for
Crisis Stabilization services and also to work collaboratively in discharge planning to ensure
appropriate ongoing outpatient specialty mental health treatment services (COUNTY mental
health programs, community based organizations, etc.) are provided.
23. Identify COUNTY clients with frequent admissions during the fiscal year and develop
strategies with other COUNTY and community agencies to reduce readmissions and improve
clients' overall well-being through coordination of care.
Revised Exhibit Al
Page 6 of 9
24. 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.
25. Work effectively with the DBH Conservatorship Team as appropriate for clients
presenting to the Adult CSC as gravely disabled who may require consideration for a temporary
conservatorship.
26. 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 clients 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 client.
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 clients, including, but not limited to,
assessing the cultural and linguistic needs of its clients, 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 client 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.
Revised Exhibit Al
Page 7 of 9
5. Develop internal systems to meet the cultural and linguistic needs of the CONTRACTOR's client
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 the COUNTY's DBH Cultural Competency Committee monthly
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 a client'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 clients' complaints and grievances, results from client 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:
CONTRACTOR shall work with COUNTY's DBH Client 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, the 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 clients for services.
2. Said direct admits shall not require medical clearance, if client would otherwise meet the
Emergency Medical Services 5150 Destination Policy requirements as mentioned hereinbelow in
Subsection F. However, in the event a referred client is known to possess a contagious medical
condition, said patient shall be medically cleared by a local hospital prior to admission to the Adult
CSC operated by CONTRACTOR.
E. Regarding the provision of court testimony related to Adult CSC clients CONTRACTOR agrees to
the following:
CONTRACTOR's staff shall provide court testimony relevant to Adult CSC clients, when required.
Revised Exhibit Al
Page 8 of 9
F. Regarding the Emergency Medical Services (EMS) 5150 Destination Policy, CONTRACTOR
agrees to the following:
CONTRACTOR agrees to follow the then-current Emergency Medical Services 5150 Destination
Policy as identified in Revised Exhibit L, 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 EMS 5150 Destination Policy. References to the
Children's Crisis Assessment Intervention Resolution (CCAIR) Unit in Revised Exhibit L reflect
services to be performed by CONTRACTOR at the COUNTY's Youth CSC, beginning April 1,
2015. Upon commencement of services, the EMS 5150 Destination Policy will be updated
accordingly.
G. 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 Unit. 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 (upon commencement of the newly-enacted Board).
3. CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider Meetings, as
scheduled by staff from COUNTY's Mental Health Contracted Services Unit, when deemed
necessary by the DBH Director, or designee.
H. 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 client 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.
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 insure continuity of care. This will be accomplished through regularly
scheduled meetings as well as formal and informal consultation.
Revised Exhibit Al
Page 9 of 9
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, client 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 (LGBT) 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.
Revised Exhibit A2
Page 1 of 9
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
SERVICES: Youth Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: March 10, 2015 — March 31, 2015 (Ramp Up Period)
April 1, 2015— June 30, 2015 (Initial Operational Period)
Effective July 1, 2015, shall continue one-year (Operational Period)
CONTRACT AMOUNT: $ 208,530 3/10/2015 through 3/31/2015 (Ramp Up Period)
$ 694,558 4/1/2015 through 6/30/2015 (Initial Operational Period)
$2,649,269 FY 2015-16 (Operational Period)
SCHEDULE 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.
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 that have 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 clients with an eight (8) bed maximum at any given
time. However, CONTRACTOR may be in the process of assessing or evaluating additional clients, as
necessary. CONTRACTOR will accept voluntary or involuntarily admitted clients regardless of source of
payment; clients may include Medi-Cal beneficiaries, Medicare and Medicare/Medi-Cal beneficiaries,
privately insured and indigent/uninsured clients who are referred by the Department of Behavioral Health
(DBH), a contract provider with the DBH, a hospital emergency department, law enforcement, or Emergency
Medical Services (EMS). Clients may also be family or 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:
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.
Revised Exhibit A2
Page 2 of 9
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 client 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
hospitalization, except for the episode of discharge.
CONTRACTOR shall be responsible to enter all Client 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 client'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 clients that encourages wellness and recovery.
4. A comprehensive multi-disciplinary evaluation and client-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 clients, who are not on involuntary holds in accordance with Welfare
and Institutions Code 5150 and also individuals placed on W&I 5150 involuntary holds.
7. 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. Psycho-Social Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Client Centered Treatment Planning
g. Aftercare Planning and Wellness Recovery Action Plan (WRAP)
8. 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 that require federal/state licensure or certification will
Revised Exhibit A2
Page 3 of 9
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 client 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
I ice nsed/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 clients, 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
clients/families during their time at the YOUTH CSC facility and will assist with discharge
planning and facilitate the client's transition to the appropriate lower level of care.
d. At the time of execution of this Agreement, the staffing requirements defined by the
California Code of Regulations, 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 licensed mental health or
waivered/registered professional on site for each four beneficiaries or other patients
receiving Crisis Stabilization at any given time.
(d) If the beneficiary 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."
9. Medical Records
a. The CONTRACTOR shall be responsible to enter all Client 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.
b. The CONTRACTOR will be responsible for "release of information" requests for the Youth
CSC facility and shall adhere to applicable federal and state regulations.
Revised Exhibit A2
Page 4 of 9
10. 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).
11. 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 client needs pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 (Crisis Stabilization Staffing Requirements).
12. 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.
13. 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.
14. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify the COUNTY of any admission of a COUNTY client within
twenty-four (24) hours or the next business day in a manner approved by the COUNTY.
The notification method shall be mutually acceptable by both COUNTY and
CONTRACTOR.
b. CONTRACTOR shall be responsible to insure that documentation in the client'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
data 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 30th affected by the proposed agreement within
ninety (90) days following the end of each fiscal year.
e. CONTRACTOR shall insure that cost reports are prepared in accordance with the
Generally Accepted Accounting Principles and the standards set forth by the DHCS and
the COUNTY.
15. Patients' Rights and Certification Review Hearings:
a. CONTRACTOR shall adopt and post in a conspicuous place a written policy on patient
rights in accordance with section 70707 of Title 22 of the California Code of Regulations
and section 5325.1 of the California W&IC and Title 42 Code of Federal Regulations
section 438.100.
b. CONTRACTOR shall allow access to COUNTY clients by the Patients' Rights Advocate
designated by the COUNTY.
16. Grievances and Incident Reports - CONTRACTOR shall log all grievances and the disposition of
all grievances received from a client or a client's family in accordance with FCMHP policies and
procedures as indicated within Exhibit H. CONTRACTOR shall provide a summary of the
grievance log entries concerning COUNTY-sponsored clients 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 clients of
their right to file a grievance and appeal.
Revised Exhibit A2
Page 5 of 9
CONTRACTOR shall notify COUNTY of all incidents or unusual occurrences reportable to state
licensing bodies that affect COUNTY clients within twenty-four (24) hours. The CONTRACTOR
shall use the Incident Report form as indicated within Exhibit I for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-sponsored clients,
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.
17. Provide a safe and secure environment to provide for clinical and medical assessment,
diagnostic formulation, crisis intervention, medication management and clinical treatment for
mental health clients with acute psychiatric symptoms. This includes the manner in
which seclusion and restraint will be administered when necessary for the safety of the
clients, other clients in the program and staff.
18. CONTRACTOR shall utilize cost containment strategies for the provision of stock and
prescription medications to clients by contracting with a pharmaceutical benefits management
company, and provide the COUNTY with the type of formulary utilized by the program, and
provide the COUNTY with information regarding co-pays and/or generic substitutions.
19. Provide the appropriate type and level of staffing to provide for a clinical effective program
design that adheres to State staffing requirements.
20. Provide an intensive treatment program which has individualized treatment plans.
21. Stabilize the clients' 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.
22. Effectively partner with other programs in the COUNTY and community system (i.e. law
enforcement, local emergency departments, etc.) in accepting COUNTY clients for admission
for crisis stabilization services and also to work collaboratively in discharge planning to ensure
appropriate ongoing outpatient specialty mental health treatment services (COUNTY mental
health programs, community based organizations, etc.) are provided.
23. Identify COUNTY clients with frequent admissions during the fiscal year and develop
strategies with other COUNTY and community agencies to reduce readmissions and improve
clients' overall well-being through coordination of care.
24. 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.
25. 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
Revised Exhibit A2
Page 6 of 9
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 clients 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 client.
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 clients, including, but not limited to,
assessing the cultural and linguistic needs of its clients, 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 client 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 client
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 the COUNTY's DBH Cultural Competency Committee monthly
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.
Revised Exhibit A2
Page 7 of 9
9. Ensure that an assessment of a client'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 clients' complaints and grievances, results from client 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, the 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 clients for services.
2. Said direct admits shall not require medical clearance, if client would otherwise meet the
Emergency Medical Services 5150 Destination Policy requirements as mentioned hereinbelow in
Subsection F. However, in the 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 Youth
CSC operated by CONTRACTOR.
D. Regarding the provision of court testimony related to Youth CSC clients, CONTRACTOR agrees to
the following:
CONTRACTOR's staff shall provide court testimony relevant to Youth CSC clients, 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 inpatient level of care. CONTRACTOR acknowledges that COUNTY
will be establishing a new Youth PHF adjacent to the Youth CSC facility in April 2015; however,
this provision applies to youth whose age or complex clinical or other co-occurring health needs
require placement at a non-County acute care 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 Emergency Medical Services (EMS) 5150 Destination Policy. CONTRACTOR
agrees to the following:
CONTRACTOR agrees to follow the then-current Emergency Medical Services 5150 Destination
Policy as identified in Revised Exhibit L, 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 EMS 5150 Destination Policy. References
to the Children's Crisis Assessment Intervention Resolution (CCAIR) in Revised Exhibit L, reflect
services to be performed at COUNTY's Youth CSC, beginning April 1, 2015. Upon
commencement of services, the EMS 5150 Destination Policy will be updated accordingly.
Revised Exhibit A2
Page 8 of 9
G. 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 Unit. 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 (upon commencement of the newly-enacted Board).
3. CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider Meetings, as
scheduled by staff from COUNTY's Mental Health Contracted Services Unit, when deemed
necessary by the DBH Director, or designee.
H. 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 client 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.
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.
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, client 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
Revised Exhibit A2
Page 9 of 9
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 (LGBT) 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.
Revised Exhibit B-3
Summary of Crisis Stabilization-Adult
Funding Streams Reimbursement
County Behavioral
Operational #of days/ Published Contract Medical FFP Health Operational Funding Other Contract
Period: months Rate Rate/Bed volume Expenditure" Realignment 3rd party Maximum
Hour Realignment
3/7/12-6/30/12* <4 months 583,045 583,045 583,045
5/4/12-6/30/12 <2 months $94.54 $94.54 6,943 656,434 6,564 121,440 528,430 656,434
FY 2012-13 12 months $94.54 $94.54 40,779 3,855,249 38,553 713,221 3,103,475 3,855,249
FY 2013-14 12 months $94.54 $94.54 41,969 3,967,741 39,677 734,032 3,194,032 3,967,741
3/10/15-3/31/15* 22 days 48,448 48,448 48,448
FY 2014-W 12 months $94.54 $94.54 47,947 4,532,933 45,329 838,593 3,649,011 4,532,933
***FY 2015-16 1 12 months $94.54 1 $94.541 67,896 6,418,893 320,945 2,407,085 1 3,690,863 1 6,418,893
*Start-up Periods
9 months of 12-beds;3 months of 20-beds $ 20,062,743 $ 631,493 $ 451,068 $ 4,814,370 $ 14,165,811 $ 20,062,743
**Based on Budget Exhibits
***2015-16 Leap year
Note: The first two operational periods intentionally overlap.
RFP 952-4944 Revised Exhibit B-3
Crisis Stabilization Center(20 bed)
Exodus Recovery,Inc.
March 10,2015 through March 31,2015(8 bed expansion)
i Page 1 of 3
(Crisis Stabilization Center-Adults @ County site)
Budget Categories- Total Proposed Budget
Line Item Description(Must be itemized) FTE Admin. Direct Total
PERSONNEL SALARIES:
0001 Title Psychiatrist $0
0002 Title Nurse Practitioner $0
0003 Title Program Director $0
0004 Title Program Nurses $0
0005 Title Social Services Coordinators $0
0006 Title Mental Health Worker $0
0007 Title Data Specialist $0
0008 Title iBenefds/PAP Coordinators $0
0009 Title Program Assistant $0
0010 Title I Driver $0
0011 Title Peer Counselor $0
0012 Title Administrative Support Staff 0.4 $5,148 $5,148
0013 Title $0
0014 Title $0
SALARY TOTAL 0.4 $5,148 $0 $5,148
PAYROLL TAXES:
0030 OASDI (Employee Responsibilty) - $0
0031 FICA/MEDICARE $394 $394
0032 U.I. $543 $543
PAYROLL TAX TOTAL $937 $0 $937
EMPLOYEE BENEFITS:
0040 ;Retirement(Voluntary Plan) $0
0041 Workers Compensation $288 $288
0042 Health Insurance(medical,vision, life,dental) $395 $395
EMPLOYEE BENEFITS TOTAL $683 $0 $683
SALARY&BENEFITS GRAND TOTAL $6,768
RFP 952-4944 Revised Exhibit B-3
Crisis Stabilization Center(20 bed)
Exodus Recovery, Inc.
March 10,2015 through March 31,2015(8 bed expansion)
FACILITIES/EQUIPMENT EXPENSES: i Page 2 of 3
1010 Rent/Lease Building
1011 Rent/Lease Equipment
1012 Utilities
1013 Janitorial
1014 Maintenance(facility)
1015 Security Personnel
1016 Maintenance(durable medical equipment)
1017 Other-Business Taxes/License-Permits
1018 Other-One-Time Start-Up Costs $34,800
FACILITY/EQUIPMENT TOTAL $34,800
OPERATING EXPENSES:
1060 Telephone
1061 Answering Service
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/Advertising
1066 Office Supplies&Equipment
1067 Household Supplies
1068 Food _
1069 Program Supplies-Therapeutic
1070 Program Supplies-Medical
1071 (Transportation of Clients
1072 'Staff Mileage/vehicle maintenance
1073 Staff Travel(Out of County)(Orn. at LA Prog Site)
1074 Staff Training/Registration
1075 Lodging -
1076 Other-Personnel Related Expenses/Contracted Payroll Exps/Parking
1077 Other-Staff Orientation $5,840
i
1077 Other-Flex Funds
OPERATING EXPENSES TOTAL $5,840
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance Yi
1083 Other-Administrative Overhead $1,040
FINANCIAL SERVICES TOTAL $1,040
RFP 952-4944 Revised Exhibit B-3
Crisis Stabilization Center(20 bed)
Exodus Recovery,Inca
March 10,2015 through March 31,2015(8 bed expansion)
SPECIAL EXPENSES Consultant/Etc.): Page 3 of 3
1087 Consultant(network&data management)
1088 Translation Services
1089 Medication Supports(Pharmaceuticals)
1090 Food Service -
1091 Laundry_service
1092 Medical Waste Disposal
1093 Nutritionist Services
1094 X-ray and EKG services
1095 Pharmaceutical Consultant
1096 Medical Services
1097 ,Other-Laboratory , -
1098 Other
SPECIAL EXPENSES TOTAL $0
FIXED ASSETS:
2000 Computers&Software
2001 'Furniture&Fixtures
2002 Other
2003 Other
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $48,448
vol/Units o
DIRECT SERVICE REVENUE: Svc Rate $Amt.
Mental Health Services
3000 (Individual/Family/Group Therapy) $0
3100 Case Management $0
3200 Crisis Services $0
3300 Medication Support $0
3400 ;Crisis Stabilization-Urgent Care $0
3500 other $0
3600 other $0
3700 - - other - - $0
DIRECT SERVICE REVENUE TOTAL 0 0
Medi-cal Revenue _ 4 $0
Cost Per Unit
Funding Streams Reimbursement
4000 Private Insurance $0
4100 Uninsured
- - $0
- - - -
4200 Me_di-Cal FFP $0
- - - --
4300 Behavioral Health Realignment $0
OTHER REVENUE TOTAL $0
TOTAL PROGRAM REVENUE 0
RFP 952-4944 Revised Exhibit B-3
Crisis Stabilization Center(20 bed)
Exodus Recovery,Inc.
July 1,2014-June 30,2015(8 bed expansion:April 1,2015-June 30,2015)
_ _ Pa�elof3_
Crisis Stabilization Center-Adults @County site)
(
Budget Categories- Current Budget Total Proposed Budget
Line Item Description Must be itemized FTE Admin. Direct Total FTE Admin. Direct Total
PERSONNEL SALARIES:
0001 Title Psychiatrist 1.60 $262,900 $.262,900 2.38 $262,900 $262,900
0002 Title Nurse Practitioner 1.50 $111,780 $111,780 - 1.75 $111,780 $111,780
0003 Title Program Director 1.00 $128,700 $1,300 $130,000 1.00 $128,700 $1,300 $130,000
0004 Title Program Nurses 9.60 $658,694 $658,694 16,80 $798,554 $798,554
0005_ Title Social Services Coordinators 2.00 $1,176 $116,469 $117,645 2.88 $1,325 $131,162 $132,487
0006 Title Mental Health Worker 8.40 $272,214 $272,214 12.60 $312,870 $312,870
0007 Title Data Specialist 1.00 $35,360 $35,360 1.00 $35,360 $35,360
0008 Title Benefits/PAP Coordinators 1.00 $31,200 $31,200 1.00 $31,200 $31,200
0009 Title Program Assistant 1.00 $41,600 $41,600 1.00 - $41,600 $41,600
0010 Title Driver 1.00 $31,200 $31,200 1.00 $31,200 $31,200
0011 Title 'Peer Counselor 1.00 $20,800 $20,800 2.00 $41,600 $41,600
0012 'Title Administrative Support Staff 0.20 $28,852 $28,852 0.30 $31,734 $31,734
0013 Title 'Billing Supervisor $0 0.20 $3,696 $3,696
0014 Title Intake Coordinator $0 0.88 $6,720 $6,720
0015 Title vP Northern Region $0 0.25 $8,562 $8,562
-Expense moved to line 1076 as of 10/O1/14
SALARY TOTAL 29.30 $318,888 $1.423,357 $1,742,245 45.04 $361,697 $1,618,566 $1,980,263
PAYROLL TAXES:
0030 OASDI I(Employee Responsibility) $0 $0
0031 FICA/MEDICARE $106,861 $106,861 $25,793 $89,145 $114,938
0032 U.I. $26,204 $26,204 $2,026 $33,288 $35,314
PAYROLL TAX TOTAL $133,065 $0 $133,065 $27,819 $122,433 $150,252
EMPLOYEE BENEFITS:
0040 Retirement(Voluntary Plan) $0 $0
0041 Workers Compensation 130,779 $130,779 $28,574 $115,123 $143,697
0042 Health Insurance medical,vision,life,dental $140,591 $140,591 $38,340 $120,062 $158,402
EMPLOYEE BENEFITS TOTAL $271,370 $0 $271,370 $66,9141 $235,185 $302,099
SALARY&BENEFITS GRAND TOTAL $2,146,680 $2,432,614
RFP 952-4944 Revised Exhibit B-3
Crisis Stabilization Center(20 bed)
Exodus Recovery,Inc.
July 1,2014-June 30,2015(8 bed expansion:April 1,2015-June 30,2015)
FACILITIES/EQUIPMENT EXPENSES: Page 2 of 3
1010 Rent/Lease Building $p
1011 Rent/Lease Equipment $19,627 $22,717
1012 Utilities $54,106 $59,446
1013 Janitorial $54,636 $66,378
1014 Maintenance(facility) $15,914 $18,052
1015 .Security Personnel $428,927 - $464,747
1016 -Maintenance Cdurable medical equipment) $0 $0
1017 Other-Business Taxes/License-Permits $7,692 $8,192
1018 Other-One-Time Start-Up Costs 1 $0 $0
FACILITY/EQUIPMENT TOTAL $580,902 $639,532
OPERATING EXPENSES:
1060 Telephone $47,741 $51,217
1061 Answering Service $0 ! $0
1062 Postage $1,957 $2,107
1063 Printing/Reproduction $1,335 $1,335
1064 Publications $1,125 $1,175
1065 Legal Notices/Advertising $2,814 $2,844
1066 Office Supplies&Equipment $26,226 $29,626
1067 Household Supplies $0 _ - $0
1068 ;Food - $0 _ $0
1069 Program Supplies-Therapeutic $0 $0
1070 Program Supplies-Medical $6.480 $7,948
1071 Transportation of Clients $12,348 $12,348
1072 Staff Mileage/vehicle maintenance $7,426 $7,551
1073 Staff Travel Out of County) Orn.at LA Prog Site). $1,034 $1,034
1074 Staff Training/Registration $2,186 $2,256
1075 !Lodging $0 $0
1076 Other-Personnel Related
Expenses/Contracted Payroll Exps/Parking $313,663 $433,866
-
1077 Other-Flex Funds $50.000 $53,000
'OPERATING EXPENSES TOTAL $474,3351 $606,307
FINANCIAL SERVICES EXPENSES:
1080 (Accounting/Bookkeeping $2,652 $2,732
1081 External Audit $0 $0
1082 Liability Insurance $10,609 $11,859
1083 Other-Administrative Overhead $514,492 $590,392
FINANCIAL SERVICES TOTAL 1 $527,7531 1 $604,983
RFP 952-49" Revised Exhibit B-3
_ Crisis Stabilization Center(20 bed)
Exodus Recovery,Inc.
July 1,2014-June 30,2016(8 bed expansion:April 1,2015-June 30,2016)
SPECIAL EXPENSES Consultant/Etc. : Pa e 3 of 3
1087 Consultant(network 8 data management) $26,226 $28,226
1088 Translation Services $3,278 r $3,528
1089 ..Medication Supports(Pharmaceuticals) $115,638 1 $124,908
1090 !Food Service $26,698 $31,798
1091 Laundry service $23,606 $26,156
1092 Medical Waste Disposal $8,442 $8,717
1093 Nutritionist Services $0 $0
1094 iX-ray and EKG services $0 $0
1095 Pharmaceutical Consultant $1,093 $0
1096 Medical Services $0 $0
1097 _!Other-Laboratory $21,950 $23,150
1098 i Other-Storage/Shredding Storage/Shredding $2,814 $3,014
SPECIAL EXPENSES TOTAL $229,7451 $249,497
FIXED ASSETS:
2000 Computers 8 Software $0 $0
2001 Furniture&Fixtures $0 $0
2002 Other $0 $0
2003 Other 1 $0 $0
FIXED ASSETS TOTAL $0 $0
TOTAL PROGRAM EXPENSES $3,959,415 TOTAL PROGRAM EXPENSES $4,532,933
t
I
Vol/Units o
DIRECT SERVICE REVENUE: Svc Rate $Amt.
Mental eat ervices
3000 (Individual/Family/GroupTh_erapy) _$0
3106 Case Management $0
3200 Crisis Services $0
3306 Medication Support $0
3400 Crisis_Stabilization-Urgent Care 47,947 $94.54 $4532,933
3500 other $0
3600 other $0
- - -- - -
3700 -rother - $0
DIRECT SERVICE REVENUE TOTAL 47,947 $4,532,933
Medi-cal Revenue $1677185
!Cost Per Unit $94.54
Funding Streams Reimbursement Population Served Percentage
40.0.0 Private Insurance 1% 45,329
4100 Uninsured 62a
43 0 Behavioral Health Realignment Qa
_ 2,810,_41.8
4200 Medi-Cal FFP 37/0
- - - -838,593
838,593
OTHER REVENUE TOTAL 1 $4,532,933
TOTAL PROGRAM REVENIJEJ $4,532,933
RFP 952-4944 Revised Exhibit B-3
Crisis Stabilization Center(20 bed)
Exodus Recovery,Inc.
Operational Period: July 1,2015-June 30,2016
Crisis Stabilization C Page 1 of 3
( enter-Adults�County site)
- - - - g -
Budget Categories- Current Budget _ Total Proposed Budget_
Line Item Description Must be itemized FTE Admin. Direct Total FTE Admin. Direct Total
PERSONNEL SALARIES:
0001 Title iPsychiatrist 1.50 $0 $0 2.83 $0 $0
0002 Title Nurse Practitioner 1.60 $0 $0 1.75 $0 $0
0003 Title Program Director 1.00 $128,700 $1,300 $130,000 1.00 $128,700 $1,300 $130,000
0004 Title Program Nurses 9.60 $658,694 $658,694 16,80 $1,178,174 $1,178,174
0005 Title Social Services Coordinators 2.00 $1,176 $116,469 $117,645 2.88 $1,728 $171,045 $172,773
0006 Title Mental Health Worker 8.40 $272,214 $272,214 12.60 $423,222 -- $423,222
0007 Title Data Specialist 1.00 $35,360 $35,360 1.00 $35,360 $35060
0008 Title Benefiis/PAPCoordinators 1.00 $31,200 $31,200 1.00 $31,200 $31,200
0009 Title Program Assistant 1.00 $41,600 $41,600 1.00 $41,600 $41,600
0010 'Title iDriver 1.00 $31,200 $31,200 1.00 $31,200 $31,200
0011 Title Peer Counselor 1.00 $20,800 $20,800 2.00 $41,600 $41,600
0012 Title Administrative Support Staff 0.20 $28,852 $28,852 0.30 $39,559 $39,559
0013 _'.Title Billing Supervisor $0 0.20 $13,728 $13,728
0014 Title Intake Coordinator $0 0.50 $24,960 $24,960
0015 Title VP Northern Region $0 0.25 $34,250 $34,250
•Expense moved to line 1076 as of 10/01/14
SALARY TOTAL 29.30 $318,888 $1,048,677 $1,367,565 45.11 $423,885 $1,773,741 $2,197,626
PAYROLL TAXES:
0030 OASDI (Employee Responsibilty) $0 $0
00311FICA/MEDICARE $20,874 $88,987 $109,861 $24,313 $147,366 $171,679
0032 U.I. $5,003 $21,329 $26,332 1 $6,011 $29,043 $35,054
PAYROLL TAX TOTAL $25,877 $110,316 $136,193 $30,324 $176,409 $206,733
EMPLOYEE BENEFITS:
- - -
0040 Retirement(Voluntary Plan) $0 $0
0041 !Workers Compensation $15,498 $66,072 $81,570 $18,052 $138,527 $156,579
0042 Health Insurance medical,vision,life,dental $18,509 $78,908 $97,417 $22,038 $138,9061 $160,944
EMPLOYEE BENEFITS TOTAL $34,007 $144,980 $178,987 $40,090 $277,4331 $317,523
'SALARY&BENEFITS GRAND TOTAL $1,682,745 i 1 $2,721,882
RFP 952-4944
Revised Exhibit B-3
Crisis Stabilization Center(20 bed)
Exodus Recovery,Inc.
Operational Period: July 1,2015-June 30,2016
FACILITIES/EQUIPMENT EXPENSES: Pa e 2 of 3
1010 Rent/Lease Building $0 $0
1011 Rent/Lease Equipment $20,216
1012 Utilities $55,729 $77,359
1013 Janitorial $56,275 $103,243
1014 Maintenance(facility) $16,391 $25,661
1015 Security Personnel $441,795 $725,929
1016 Maintenance(durable medical equipment) $0 $0
1017 Other-Business Taxes/License-Permits $7,923 $11,013
1018 Other-One-Time Start-Up Costs $0 $0
FACILITYIEQUIPMENT TOTAL $598,329 $975,781
OPERATING EXPENSES:
1060 Telephone $49,173 $63,078
1061 Answering Service $0 $0
1062 Postage $2,016 4 -__ $2,943
1063 !Printing/Reproduction $1,375 $1,375
1064 Publications $1,159 $1,468
1065 Legal Notices/Advertising $2,814 $2,999
1066 Office Supplies&Equipment $27,013 $40,609
1067 Household-Supplies $0 $0
1068 Food $0 _ _$0
1069 .Program Supplies-Therapeutic $0 $0
1070 Program Supplies-Medical $6,674 $12,545
1071 Transportation of Clients $20,259 $20,259
1072 Staff Mileage/vehicle maintenance $10,732 j $11,350
1073 Staff Travel�Outof-County) $1,034
I - _
1074 Staff Training/Registration $3,317 $3,750
1075 Lodging $0 - $0
1076 :Other-Personnel Related Expenses/Contracted Payroll Exps/Parking $850,436 i $1,310,129
- -
1077 Other-Flex Funds $50,000 $62,000
!OPERATING EXPENSES TOTAL $1,024,968 $1,533,539
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $2,732 $3,226
1081 External Audit $0 $0
1082 Liability Insurance $10,927 $18,652
1083 Other-Administrative Overhead $530,089 $837,247
FINANCIAL ERVICES TOTAL $543,748 $859,125
RFP 952-4944
Revised Exhibit B-3
Crisis Stabilization Center(20 bed)
Exodus Recovery,Inc.
Operational Period: July 1,2015-June 30,2016
SPECIAL EXPENSES Consultant/Etc. : Pa e 3 of 3
1087 (Consultant(network&data management) $27,013 $39,373
1088 Translation Services $3,376 $4,941
1089 Medication Supports(Pharmaceuticals) $119,107 $156,187
1090 Food Service $27,499 $47,893
1091 Laundry service_ $24,315 $34,512
1092 .Medical Waste Disposal $8,695 $10,395
1093 ,Nutritionist Services $0 $0
1094 X-ray and EKG services $0 $0
1095 Pharmaceutical Consultant $1,126
— $1 126
1096 Medical Services $0 $0
1097 Other-Laboratory $22,609 $30,025
1098 Other-Store a/Shredin $2,898 $4,134
!SPECIAL EXPENSES TOTAL $236,638 $328,566
FIXED ASSETS:
2000 Computers&Software $0 $0
2001 Furniture&Fixtures $0 $0
2002 (Other $0 $0
2003 Other $0 $0
FIXED ASSETS TOTAL $0 $0
TOTAL PROGRAM EXPENSES $4,086,428 TOTAL PROGRAM EXPENSES $6,418,893
- _ Vol/units o
DIRECT SERVICE REVENUE: Svc Rate $Amt.
Mental eat ervices
3000 (Individual/Family/Group Therapy) $0
3100 Case Management $0
3200 i Crisis Services $0
3306 Medication Support $0
- - -- - -
3400 Crisis Stabilization-Urgent Care 67,896 $94.54 $6,418,893
3506 other _ - -- $0
3600 - other - -- $0
3700 other $0
DIRECT SERVICE REVENUE TOTAL 67,896 $6,418,893
IMedi-cal Revenue
- -ue $4,814,169
Cost Per Unit + _ $94.54
Funding Streams Reim bursaPopulation Served Percent
age
e
4000 Private Insurance 5% 320,945
4100 Uninsured 20% 1,283,779
— - - --
4200 Medi-Cal FFP 75% 2,407,085
4300 Behavioral Health Realignment 2,407,085
OTHER REVENUE TOTAL $6,418,893
TOTAL PROGRAM REVENUE1 $6,418,893
Revised Exhibit C
Summary of Crisis Stabilization-Youth
Funding Streams Reimbursement
County Behavioral
Published Contract volume Operational Funding Other MediCal FFP Health Contract
Rate Rate/Bed Expenditure" Realignment 3rd party Realignment Maximum
Hour
3/10/15-3/31/15* 30 days $ 208,530 208,530 $ 208,530
4/1/15-6/30/15*` 13 months 1 $94.541 $94.541 7,347 1 $ 694,558 20,837 1 329,915 343,806 $ 694,558
***FY 2015-16 112 monthsl $94.541 $94.541 28,023 1 $ 2,649,269 1 185,449 1 1,192,171 1 1,271,649 1 $ 2,649,269
`Start-up Period
**Initial Operational Period $ 3,552,357 $ 3,552,357
***2015-16 Leap year
Revised Exhibit C
Youth Crisis Stabilization Center(8 bed)
Exodus Recovery,Inc.
Start-up Period: March 10,2015 through March 31,2015
'- +Page 1 of 3
(Crisis Stabilization Center-Youth @ County site)
Budget Categories- Total Proposed Budget
Line Item Description Must be itemized) FTE Admin. Direct Total
PERSONNEL SALARIES:
0001 Title Psychiatrist $0
0002 Title Nurse Practitioner $0
0003 Title Program Director(Shared with Adult Unit) $0
0004 Title Program Nurses $0
0005 Title Social Services Coordinators $0
0006 Title Mental Health Worker $0
0007 i Title Data Specialist(Shared with Adult Unit) _ $0
0008 Title }Benefits/PAP Coordinators(Shared with Adult Unit) $0
0009 Title Program Assistant(Shared with Adult Unit) $0
0010 Title Intake Coordinator $0
0011 Title Billing Supervisor $0
0012 Title VP Northern Region $0
0013 Title Administrative Support Staff 0.4 $5,148 $5,148
0014 Title $0
SALARY TOTAL 0.4 $5,148 $0 $5,148
PAYROLL TAXES:
0030 IOASDI .(Employee Responsibilty) $0
0031 FICA/MEDICARE $394 $394
0032 U.I. $543 $543
PAYROLL TAX TOTAL $937 $0 $937
EMPLOYEE BENEFITS:
0040 Retirement(Voluntary Plan) $0
0041 Workers Compensation $288 $288
0042 Health Insurance medical,vision,life,dental) $395 $395
EMPLOYEE BENEFITS TOTAL $683 $0 $683
SALARY&BENEFITS GRAND TOTAL 1 $6,768
Revised Exhibit C
Youth Crisis Stabilization Center(8 bed)
Exodus Recovery,Inc.
Start-up Period: March 10,2015 through March 31,2015
FACILITIES/EQUIPMENT EXPENSES: Page 2 of 3
1010 Rent/Lease Building
1011 Rent/Lease Equipment
1012 Utilities
1013 Janitorial
1014 Maintenance(facility)
1015 ;Security Personnel -
1016 'Maintenance(durable medical equipment) - -_
1017 Other-Business Taxes/License-Permits
1018 Other-One-Time Start-Up Costs $185,130
FACILITY/EQUIPMENT TOTAL $185,130
OPERATING EXPENSES:
1060 Telephone
1061 Answering Service
1062 Postage_
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/Advertising
- r-
1066 Office Supplies&Equipment -
i
1067 Household Supplies
1068 Food
1069 Program Supplies-Therapeutic
1070 Program Supplies-Medical
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance
1073 Staff Travel(Out of County) -
1074 Staff Training/Registration
1075 Lodging
1076 Other-Personnel Related Expenses/Contracted Payroll Exps/Parking
1077 Other-Staff Orientation $12,000
1077 Other-Flex Funds
OPERATING EXPENSES TOTAL $12,000
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance
1083 Other-Administrative Overhead $4,632
FINANCIAL SERVICES TOTAL $4,6321
Revised Exhibit C
Youth Crisis Stabilization Center(8 bed)
Exodus Recovery, Inc.
Start-up Period: March 10,2015 through March 31,2015
SPECIAL EXPENSES(Consultant/Etc.): Page 3 of 3
1087 Consultant(network&data management)
1088 Translation Services
1089 Medication Supports(Pharmaceuticals)
1090 Food Service
1091 Laundry service
1092 Medical Waste Disposal
1093 Nutritionist Services
1094 X-ray and EKG services
1095 Pharmaceutical Consultant
1096 Medical Services
1097 ,Other-Laboratory
1098 Other-Storage/Shredding
SPECIAL EXPENSES TOTAL $0
FIXED ASSETS: -
2000 'Computers&Software
2001 Furniture&Fixtures
2002 Other
2003 Other
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $208,530
Vol/Units o
DIRECT SERVICE REVENUE: Svc Rate $Amt.
Mental Health Services
3000 ;(Individual/Family/Group Therapy) $0
3100 Case Management $0
3200 Crisis Services $0
- - -
3300 t Medication Support $0
3400 1 Crisis Stabilization-Urgent Care $0
3500 other- _ _ - - $0
3600 - 'other - $0
3700 _ ,other - - - $0
DIRECT SERVICE REVENUE TOTAL 0 0
-.
Medi-cal Revenue $0
Cost Per Unit
Funding Streams- -t - — -
Reimbursement
4000 Private Insurance $0
4100 Uninsured
4200 Medi-Cal FFP $0
4300 Behavioral Health Realignment $0
OTHER REVENUE TOTAL 0
TOTAL PROGRAM REVENUE 0
Revised Exhibit C
Youth Crisis Stabilization Center(8 bed)
Exodus Recovery,Inc.
Initial Operational Period: April 1,2015 to June 30,2015
Page 1 of 3
(Crisis Stabilization Center-Youth @ County site)
Budget Categories- Total Proposed Budget
Line Item Description(Must be itemized) FTE Admin. Direct Total
PERSONNEL SALARIES:
0001 Title Psychiatrist* 0.75 $0 $0
0002 Title iNurse,Practitioner* 1.00 $0 $0
0003 Title Program Director(Shared with Adult Unit) $0
0004 iTitle Program Nurses 8.40 $147,504 $147504
0005 ;Title Social Services Coordinators 1.40 $24,130 $24,130
0006 Title Mental Health Worker 8.40 $72,912 $72,912
0007 Title Data Specialist(Shared with Adult Unit) $0
0008 Title Benefits/PAP Coordinators(Shared with Adult Unit) $0
0009 Title Program Assistant(Shared with Adult Unit) $0
0010 ;Title Intake Coordinator 0.50 $6,720 $6,720
0011 Title Billing Supervisor 0.20 $3,696 $3,696
0012 Title VP Northern Region 0.25 $8,562 $8,562
0013 Title Administrative Support Staff 0.10 $2,882 $2,882
'Expense in Line 1076 as this is a contracted
0014 service $0
SALARY TOTAL 21.00 $21,860 $244,546 $266,406
PAYROLL TAXES:
0030 IOASDI :KEmployee Responsibilty) $0
0031 FICA/MEDICARE $931 $19,505 $20,436
0032 U.1. $966 $9,262 $10,228
PAYROLL TAX TOTAL $1,897 $28,767 $30,664
EMPLOYEE BENEFITS:
0040 'Retirement(Voluntary Plan) $0
0041 'Workers Compensation $684 $14,329 $15,013
0042 Health Insurance medical,vision,life,dental) $941 $19,338 $20,279
EMPLOYEE BENEFITS TOTAL $1,625 $33,667 $35,292
'SALARY&BENEFITS GRAND TOTAL $332,362
Revised Exhibit C
Youth Crisis Stabilization Center(8 bed)
Exodus Recovery,Inc.
Initial Operational Period: April 1,2015 to June 30,2015
FACILITIES/EQUIPMENT EXPENSES: Page 2 of 3
1010 Rent/Lease Building
1011 Rent/Lease Equipment $3,090
1012 Utilities $5,340
1013 ,Janitorial $11,742
1014 1 Maintenance(facility) $2,138
1015 .Security Personnel $77,730
1016 Maintenance(durable medical equipment)
1017 Other-Business Taxes/License-Permits $500
1018 !Other-One-Time Start-Up Costs
FACILITY/EQUIPMENT TOTAL $100,540
OPERATING EXPENSES:
1060 Telephone $6,953
1061 ;Answering Service
1062 Postage $150
1063 Printing/Reproduction
1064 Publications $50
1065 Legal Notices/Advertising $30
1066 Office Supplies&Equipment $3,400
1067 Household Supplies
1068 Food
1069 Program Supplies-Therapeutic
1070 Program Supplies-Medical $1,468
1071 Transportation of Clients _
r
1072 Staff Mileage/vehicle maintenance $125
1073 _ Staff Travel(Out of County)
1074 Staff Training/Registration $70
1075 Lodging
1076 Other-Personnel Related Expenses/Contracted Payroll Exps/Parking $133,640
1077 Other-Staff Orientation
1077 Other-Flex Funds $3,000
OPERATING EXPENSES TOTAL $148,886
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $80
1081 External Audit
1082 !Liability Insurance $1,250
1083 Other-Administrative Overhead $90,595
FINANCIAL SERVICE TOTAL $91,925
Revised Exhibit C
Youth Crisis Stabilization Center(8 bed)
Exodus Recovery,Inc.
Initial Operational Period: April 1,2015 to June 30,2015
SPECIAL EXPENSES(Consultant/Etc.): Page 3 of 3
1087 Consultant(network&data management) $2,000
1088 Translation Services $250
1089 Medication Supports(Pharmaceuticals) $9,270
1090 Food Service $5,100
1091 Laundry service $2,550
1092 Medical Waste Disposal $275
1093 Nutritionist Services
1094 X-ray and EKG services
1095 Pharmaceutical Consultant
1096 Medical Services
1097 Other-Laboratory $1,200
1098 !Other-Storage/Shredding $200
SPECIAL EXPENSES TOTAL $20,845
FIXED ASSETS:
2000 Computers&Software
2001 Furniture&Fixtures
2002 Other
2003 Other
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $694,568
I
Volni s o
DIRECT SERVICE REVENUE: Svc Rate $Amt.
Mental Health Services
3000 (Individual/Family/Group Therapy) _ _ __$0
3100 Case Management _ $0
3200 Crisis Services — $0
- -
3300 Medication Support $0
3400 Crisis Stabilization-Urgent Care 7,347 $94.54 $694,558
3500 other $0
3600 other $0
3700 other - - $0
DIRECT SERVICE REVENUE TOTAL 7,347 $6 4,558
:Medi-cal Revenue $659,830
Cost Per Unit $94.54
Funding Streams Reimbursement Population Served Percent -age
4000 Private Insurance 3% $20,837
4100 Uninsured 2% $13,891
4200 Medi-Cal FFP 95%' $329,915
4300 Behavioral Health Realignment $329,915
OTHER REVENUE TOTAL $694,558
TOTAL PROGRAM REVENUE $694,558
Revised Exhibit C
Youth Crisis Stabilization Center(8 bed)
Exodus Recovery,Inc.
Operational Period: July 1,2015 to June 30,2016
- Page 1 of 3
(Crisis Stabilization Center-Youth @ County site)
Budget Categories _ Total Proposed Budget
Line Item Description(Must be itemized) FTE Admin. Direct Total
PERSONNEL SALARIES:
0001 Title Psychiatrist 0.75 $0 $0
0002 Title Nurse Practitioner 1.00 $0 $0
0003 ;Title iProgram Director(Shared with Adult Unit) $0
0004 Title_ -Program Nurses 8.40 $547,872 $547,872
0005 ;Title Social Services Coordinators 1.40 $89,627 $89,627
0006 Title Mental Health Worker 8.40 $270,816 $270,816
0007 Title Data Specialist(Shared with Adult Unit) $0
0008 Title i Benefits/PAP Coordinators(Shared with Adult Unit) $0
0009 Title Program Assistant(Shared with Adult Unit) $0
0010 -_Title Intake Coordinator 0.50 $24,960 $24,960
0011 (Title Billing Supervisor 0.20 $13,728 $13,728
0012 ,Title 'vP Northern Region 0.25 $34,250 $34,250
0013 Title Administrative Support Staff 0.10 $10,705 $10,705
0014 Title $0
SALARY TOTAL 21.0 $83,643 $908,315 $991,958
PAYROLL TAXES: -
0030 _OASDI _(Employee Responsibilty) $0
0031 FICA/MEDICARE $3,458 $72,446 $75,904
0032 U.I. $987 $9,057 $10,044
PAYROLL TAX TOTAL $4,445 $81,503 $85,948
EMPLOYEE BENEFITS:
0040 Retirement(Voluntary Plan) _ __$0
0041 Workers Compensation $2,554 $53,506 $56,060
0042 Health Insurance(medical,vision,life,dental) $3,522 $73,771 $77,293
EMPLOYEE BENEFITS TOTAL $6,076 $127,277 $133,353
SALARY&BENEFITS GRAND TOTAL $1,211,259
Revised Exhibit C
Youth Crisis Stabilization Center(8 bed)
Exodus Recovery,Inc.
Operational Period: July 1,2015 to June 30,2016
FACILITIES/EQUIPMENT EXPENSES: Page 2 of 3
1010 'Rent/Lease Building
1011 }Rent/Lease Equipment $12,360
1012 Utilities $21,630
1013 Janitorial $46,968
1014 Maintenance(facility) _ $9,270
1015 Security Personnel $310,920
1016 Maintenance(durable medical equipment)
1017 Other-Business Taxes/License-Permits $3,090
1018 Other-One-Time Start-Up Costs
FACILITY/EQUIPMENT TOTAL $404,238
OPERATING EXPENSES:
1060 Telephone - $27,810
1061 Answering_Service
1062 Postage __ $927
1063 Printing/Reproduction
1064 Publications $309
1065 Legal Notices/Advertising _ ! $185
1066 Office Supplies&Equipment $13,596
1067 Household Supplies
1068 Food
1069 !Program Supplies-Therapeutic
1070 Program Supplies-Medical $5,871
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance _ $618
1073 Staff Travel(Out of County)
1074 Staff Training/Registration $433
1075 Lodging
1076 Other-Personnel Related Expenses/Contracted Payroll Exps/Parking $526,319
1077 -'Other-Staff Orientation
1077 Other-Flex Funds $12,000
OPERATING EXPENSES TOTAL $588,068
FINANCIAL SERVICES EXPENSES:
1080 'Accountin_g/Bookkeeping $494
1081 External Audit
1082 Liability Insurance
1083 Other-Administrative Overhead $345,557
FINANCIAL SERVICES TOTAL $353,776
Revised Exhibit C
Youth Crisis Stabilization Center(8 bed)
Exodus Recovery,Inc.
Operational Period: July 1,2015 to June 30,2016
SPECIAL EXPENSES Consultant/Etc.): 'Page 3 of 3
1087 Consultant(network&data management) $12,360
1088 Translation Services t $1545
1089 Medication Supports(Pharmaceuticals) $37,080
1090 ,Food Service $20,394
1091 'Laundry service $10,197
1092 Medical Waste Disposal $1,700
1093 Nutritionist Services
1094 X-ray and EKG services
1095 Pharmaceutical Consultant
1096 'Medical Services
1097 Other-Laboratory $7,416
1098 Other-Storage/Shredding Storage/Shredding $1,236
SPECIAL EXPENSES TOTAL $91,928
FIXED ASSETS:
2000 'Computers&Software
2001 Furniture&Fixtures
2002 'Other
2003 'Other
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $2,649,269
Vol/units o
DIRECT SERVICE REVENUE: Svc Rate $Amt.
Mental Health Services
3000 (Individual/Family/Group Therapy) $0
3100 Case Management $0
3206 Crisis Services $0
3300 Medication Support $0
3400 Crisis Stabilization-Urgent Care 28,023 $94,54 $2,649,269
3500 other - -
$0
3600 other $0
3700 ;other
$0
DIRECT SERVICE REVENUE TOTAL 28,023 92,649,269
Medi-cal Revenue $2,384,342
Cost Per Unit $94.54
Funding Streams Reimbursement Population Served Percentage
4000 Private Insurance 7%, $185,449
4100 Uninsured 30/6 $79,478
4206 _ Medi-Cal FFP 90% $1 192,171
4300 Behavioral Health Realignment $1,192,171
OTHER REVENUE TOTAL $2,649,269
TOTAL PROGRAM REVENUE1 $2,649,269
Revised Exhibit J
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health services.
Mental health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its employees
and subcontractors to attend a compliance training that will be provided by Fresno County. After
completion of this training, each contractor, contractor's employee and subcontractor must sign the
Contractor Acknowledgment and Agreement form and return this form to the Compliance officer or
designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and billing
for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their
professional dealing related to their contract with the County and avoid any conduct that could
reasonably be expected to reflect adversely upon the integrity of the County.
3. Treat County employees, consumers, and other mental health contractors fairly and with
respect.
4. NOT engage in any activity in violation of the County's Compliance Program, nor engage in
any other conduct which violates any applicable law, regulation, rule or guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely and are
consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement
of any kind are submitted.
7. Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
Revised Exhibit J
Page 2of3
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.
Revised Exhibit J
Page 3 of 3
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: / /
Revised Exhibit L
CENTRAL CALIFORNIA
EMERGENCY MEDICAL SERVICES
A Division of the Fresno County Department of Public Health
Manual Policy
Emergency Medical Services Number 547
Administrative Policies and Procedures
Page 1 of 10
Subject Patient Destination
References Title 13, Section 1 106 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 Count
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 Delta Medical Regional Medical Kaweah Delta 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
uickest travel time uickest travel time Quickest travel time (Quickest travel time
Medical--Pedish*(14 yem or younger)
Stable Patient/Family Choice Patient/Family Choice Patient/Family Choice Patient/Family Choice
Kaweah Delta Medical
RMC or Children's *** RMC or Children's *** RMC or Children's *** Center or
Unstable (Quickest travel time) (Quickest travel time) (Quickest travel time) Sierra View District
Hospital ***
Quickest travel time
51*padeltu
5150-Adult CSC or Patient's Choice Patient's Choice within Patient's Choice within Patient's Choice within
within Fresno County Kings County Madera County Tulare Count
CCAIR or Patient/Family Choice Patient/Family Choice Patient/Family Choice
5150—Children(<18 yrs) Patient/Family Choice within Kings County within Madera County within Tulare County
See criteria below
Kaiser(within Kaiser Kaiser designated N/A N/A N/A
Facility) facility
Veteran's Veteran's N/A N/A N/A
Administration Administration
*** If transport time is greater than 60 minutes, base hospital contact shall be made to determine appropriate destination.
Approved By Revision
EMS Division Manager Signatures on File at EMS Agency 01/01/2015
EMS Medical Director Signatures on File at EMS Agency
Page 2 of 10
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 concerning 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"qpnroprriate"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 Medical Center Hanford(AMC-H)
b) Children's Hospital Central California(Children's Hospital)
c) Clovis Community Medical Center(CCMC)
d) Kaiser Permanente Hospital(KPH)
e) Kaweah Delta Medical Center(KDMC)
0 Madera Community Hospital (MCH)
g) Saint Agnes Medical Center(SAMC)
h) Sierra View District Hospital (SVDH)
i) Tulare Regional Medical Center(TRMC)
j) Regional Medical Center(RMC)
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 Medical Center Reedley(AMC-R)
b) Adventist Medical Center Selma(AMC-S)
Page 3 of 10
Subject: Policy
Patient Destination Number: 547
c) Coalinga Regional Medical Center(CRMC)
5. Acute Cardiac Emergency
In the event of an acute current of injury transport should be to a facility with interventional heart
catheterization capabilities. The following is a list of readings from various cardiac monitors:
• *** 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)
Transport should be either to:
• Regional Medical Center
• Kaweah Delta Medical Center
• Saint Agnes Medical Center;
whichever 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 ET Tube 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 hospitals:
Patients may be transported to a non-receiving hospital only when the Base Hospital has contacted the
receiving doctor and received assurance of immediate acceptance of the patient. Such assurance should
then be documented on the Base Hospital run form.
8. Patients who go to a receiving hospital,which is not closest:
Unstable patients who request this hospital and,in the opinion of the Base Hospital Physician,the extra
travel time is not dangerous to the patient
Page 4 of 10
Subject: Policy
Patient Destination Number: 547
C. Fresno County 5 150 Holds—Considerations
1. Fresno County 5150 patient criteria for transport Crisis Stabilization Center(CSC)and Children's Crisis
Assessment Intervention Resolution(CCAIR):
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 Children's Crisis Assessment Intervention Resolution
(CCAIR) 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 CCAIR).
1) Adults:
a) Pulse: 50-120.
b) Systolic Blood Pressure: 100-180.
c) Diastolic Blood Pressure: less than 120.
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 CCAIR Screening Form attached to this policy.
Patients that Crisis Stabilization Center(CSC)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(Fresno County only)if patient meets
criteria within this policy.
e. Veteran's Administration
Page 5 of 10
Subject: Policy
Patient Destination Number: 547
2. 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 dependant(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.
3. 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 destination in accordance with the following chart:
TRAUMA DESTINATION CHART
OFO
ess Physiological Criteria
stolic Blood Pressure:
Adults: <90 mm Hg
o Pediatrics: <80 mm Hg with signs and
symptoms of shock(Refer to EMS Policy RMC or KDMC
530.32 for estimated weight formulas or ' (Consider air transport)
use BroselowTape)
• Respiratory Rate:
o Adults: <10 or>30
o Children: <20 if under age 1
Fno
Assess Local Criteria
asgow Coma Score<13(or,in patients whose
rmal GCS is less than 15,or a decrease of two
or more of the patients GCS score)
• Penetrating injury to the head RMC
• Paraplegia (Consider air transport)
• Quadriplegia
• Any Burn(Air only)
Assess Anatomy of Injury
• Penetrating injuries to neck or torso
• Flail chest RMC or KDMC
• Two or more proximal long-bone fractures (Consider air transport)
• Amputation proximal to wrist or ankle
Page 6 of 10
Subject: Policy
Patient Destination Number: 547
0 Assess Burns
F
STABLE TRAUMA PATIENTS WITH:
• Partial/Full thickness burns>10%TBSA
• Partial/Full thickness circumferential burns RMC
• Partial/Full thickness burns to face,hands,feet, (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 KDMC
o Children: >10 ft.or 3 times height of the (Consider air transport)
child
. 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 KDMC
• Auto vs.Pedestrian>20 mph
• Motorcycle crash>20 mph
Paramedic/Flight Nurse Judgment
Consider RMC or KDMC
WITH A SIGNIFICANT COMPLAINT Base Hospital Consultation
SIGNIFICANT COMPLAINT
Transport According to Policy Perseveration
Deteriorating mental status
Severe chest pain
Severe shortness of breath
Severe abdominal pain
Sustained, overwhelming"Feeling of Doom"
Page 7 of 10
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 or Kaweah Delta Medical Center,bypassing a
closer receiving facility. However, if the transport time to Regional Medical Center or Kaweah Delta
Medical Center 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 the Regional 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
a. 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.
I) Patients with 2°(partial thickness) or 30(full thickness) burns that are more than 10% total
body surface area
2) Patients with 2'(partial thickness)or 3° (full thickness)circumferential burns of any body part
3) Patients with 2°(partial thickness)or 3°(full thickness)burns to face,hands, feet,major joints,
perineum,or genitals
4) Electrical burns with voltage greater than 120 volts
5) Patients with chemical burns greater than 10%total body surface area.
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).
Page 8 of 10
Subject: Policy
Patient Destination Number: 547
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. PATIENTS WHO CAN GO DIRECTLY TO AN EMERGENCY DEPARTMENT WAITING ROOM
Prehospital personnel shall utilize the emergency department patient entrance at all receiving hospitals for non-emergent
patients. Delivery of patients to the appropriate area of the emergency department is based on severity of illness.
Patients who meet the following criteria can be taken directly to the emergency department walk-in waiting room,bypassing
the ambulance entrance used for serious or critically ill patients.
• Patients 18 years old or older or minors accompanied by a responsible adult.
• Patient has normal, age appropriate vital signs(t 5%).
• Patient can sit unassisted and has reasonable mobility.
• Patient does not meet criteria for ETA call-in.
• Patient does not have IV access started by EMS.
• Patient is not on a 5150 hold or in custody.
EMS personnel must give report to a hospital employee authorized to triage,or take possession of the patient,and obtain a
signature for transfer of patient care. If there is a difference of opinion as to the appropriate waiting area,or location of the
patient,the hospital representative will make the final decision as to the disposition of the patient and provide the turnover
signature.
Pa e9of10
Subject: Policy
Patient Destination Number: 547
VI. SPECIAL CONSIDERATION FOR OBSTETRICS OR PREGNANT PATIENTS REQUESTING ADVENTIST MEDICAL
CENTER—HANFORD
While Central Valley General Hospital will not have an emergency department,the hospital will still be open as an in-patient
/out-patient facility for OB/GYN services. Ambulance patients may be taken directly to Central Valley General Hospital
under the following circumstances:
• Transfers from a physician's office when the physician requests that the patient be taken directly to Central Valley
General Hospital
• An interfacility transfer from another hospital(i.e., direct admit)
• Obstetrics or pregnancy related calls when directed by the Base Hospital(Adventist Medical Center—Hanford)to
transport directly to Central Valley General Hospital. A full standard call-in must be made to the Base Hospital on
all OB/GYN patients.
VII. SPECIAL CONSIDERATION FOR HEART HOSPTAL DESTINATION
While the Heart 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 Heart Hospital from the prehospital setting will require Base Hospital contact to confirm
acceptance. Since the Heart Hospital is under the Community Medical Center organization, EMS personnel should contact
Regional Medical Center when requesting transport to the Heart Hospital. If attempts to contact Regional Medical Center
are unsuccessful, EMS personnel should contact another Base Hospital. Interfacility transfers involving the Heart Hospital
shall be in accordance with EMS Policy#553,"ALS Interfacility Transports".
Revised Exhibit L
Central California EMS Agency
Criteria for Transporting a Fresno County 5150/Psychiatric Patient
Directly to CSC or CCAIR 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/CCAIR. Otherwise transport is
Patient/Family Choice.
Patients that Crisis Stabilization Center(CSC)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
Exhibit M
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) city State ZIP code
CLIA number Taxpayer ID number(EIN) Telephone number
( )
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
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 XVIII 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: in Sole proprietorship o Partnership o Corporation
in Unincorporated Associations 0 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
M
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... 0 0
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... 0 0
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ 0 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... 0 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?......... 0 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... 0 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
Revised Exhibit N
1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Revised Exhibit N
2of2
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)