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HomeMy WebLinkAboutAgreement A-12-184-3 with Turning Point of Central California Inc..pdf Agreement No. 12-184-3 1 AMENDMENT III TO AGREEMENT 2 THIS AMENDMENT, hereinafter referred to as Amendment III, is made and entered into 3 this 16th day of June , 2015,by and between the COUNTY OF FRESNO, a 4 political subdivision of the State of California, hereinafter referred to as "COUNTY", and TURNING 5 POINT OF CENTRAL CALIFORNIA,Inc., a California Non-Profit Corporation, whose remit to 6 address is P. 0. Box 7447,Visalia, CA 93290, and whose service address is FIRST STREET CENTER, 7 3636 N First Street Suites 135 and 154, Fresno, CA 93726, hereinafter referred to as 8 "CONTRACTOR". 9 WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement 10 No. 12-184, effective April 24, 2012, Amendment I,No. 12-184-1, effective September 11, 2012, and 11 Amendment 11,No. 12-184-2, effective April 22, 2014 (hereinafter referred to as the "Agreement"); and 12 WHEREAS, CONTRACTOR agreed to provide outpatient mental health, outpatient substance 13 use disorder treatment services, and Full-Service Partnership (FSP)treatment services to AB109 Public 14 Safety Realignment and the Post-release Community Supervision Act of 2011; and 15 WHEREAS, the parties desire to amend the Agreement regarding changes as stated below and 16 restate the Agreement in its entirety. 17 NOW,THEREFORE, in consideration of their mutual promises, covenants and conditions, 18 hereinafter set forth,the sufficiency of which is acknowledged, the parties agree as follows: 19 1. That the following text in Agreement#12-184, Page Six (6), beginning with Paragraph 20 Four(4), Section E, Line Seventeen (17)with the line, "For the period July 1, 2015 through June 30, 21 2016"and ending on page Seven (7), Line Four (4)with the word "costs" be deleted and the following 22 inserted in its place: 23 "E. For the period July 1, 2015 through June 30, 2016 24 1) In no event shall the maximum compensation under this Agreement for 25 Substance Use Disorder Services, Outpatient Mental Health Services, and FSP-Services combined 26 exceed Three Million Nine Hundred Ninety-Six Thousand Three Hundred Sixty-Seven and No/l00 27 Dollars ($3,996,367.00). 28 2) Substance Use Disorders and Outpatient Mental Health-The maximum 1 - COUNTY 01:MIESNO Vre.no,CA 1 compensation under this Agreement for Substance Use Disorder Services and Outpatient Mental Health 2 Services shall not exceed Two Million Four Hundred Forty Thousand Four Hundred Sixty-Four and 3 No/100 Dollars ($2,440,464.00). CONTRACTOR is expected to invoice Medi-Cal for those clients 4 that are eligible, prior to invoicing the COUNTY. 5 3) Full Service Partnership - The maximum compensation under this 6 Agreement for FSP Services shall not exceed One Million Five Hundred Fifty-Five Thousand Nine 7 Hundred Three and No/ 100 Dollars ($1,555,903.00). It is further understood by CONTRACTOR and 8 COUNTY that CONTRACTOR estimates to generate Eight Hundred Fifty Thousand Nine Hundred 9 Three and No/100 Dollars ($850,903.00) in Medi-Cal Federal Financial Participation (FFP) and Five 10 Thousand and No/100 Dollars ($5,000.00) from the collection of consumer rents to offset 11 CONTRACTOR's program costs. 12 2. That the following text in Agreement#12-184, Page Twenty-Six (26), beginning with 13 Paragraph Twenty-Eight (28), Section G, Line Twenty (20) with the line, "A single audit report is not 14 applicable if all of CONTRACTOR's federal contracts do not exceed $500,000" and ending on page 15 Twenty-Six (26), Line Twenty-One (21) with the word "Medi-Cal." be deleted and the following 16 inserted in its place: 17 "A single audit report is not applicable if all of CONTRACTOR's federal contracts do 18 not exceed $750,000 or CONTRACTOR's only funding is through Drug related Medi-Cal." 19 3. That all references in existing COUNTY Agreement No. 12-184 to "Exhibit A" shall be 20 changed to read "Revised Exhibit A—Amendment 11I" where appropriate, attached hereto and 21 incorporated herein by reference. 22 4. That all references in existing COUNTY Agreement No. 12-184 to "Exhibit C" and 23 "Revised Exhibit C" shall be changed to read "Revised Exhibit C— Amendment III" where appropriate, 24 attached hereto and incorporated herein by reference. 25 5. That all references in existing COUNTY Agreement No. 12-184 to "Exhibit I" shall be 26 changed to read "Revised Exhibit I — Single Audit Requirement" where appropriate, attached hereto 27 and incorporated herein by reference. 28 — 2 — COUN Y U1'FR1:SNO I resnu,CA 1 6. COUNTY and CONTRACTOR agree that this Amendment III is sufficient to amend 2 Agreement No. 12-184, Amendment I No. 12-184-l and Amendment II No. 12-l 84-2 and that upon 3 execution of this Amendment III, the Agreement, Amendment I, Amendment II, and Amendment III 4 together shall be considered the Agreement. 5 7. The Agreement, as hereby amended, is ratified and continued. All provisions, terms, 6 covenants, conditions and promises contained in the Agreement, and not amended herein, shall remain 7 in full force and effect. This Amendment III shall become effective upon execution by all parties. 8 10 12 13 HI 14 /// 15 HI 16 17 18 19 20 21 22 23 24 2 5 26 27 28 3 — COUNTY OF FRkSM) 14cs11o,CA 1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment III to the Agreement 12- 2 184 as of the day and year first hereinabove written. 3 ATTEST: 4 5 CONTRACTOR: TURNING POINT OF CENTRAL 6 CALIFORNIA, INC. 7 8 By: / 9 Print Name: 10 11 Title: _ Chairman of Board, or President, 12 or any Vice President 13 14 15 By: lc 16 Print Name: 17 Title: 6 D 18 Secretary (of Corporation), or any Assistant Secretary, or 19 Chief Financial Officer, or 20 any Assistant Treasurer 21 22 Mailing Address: 23 P. O. Box 7447 24 Visalia, CA 93290 Contact: Executive Director 25 26 27 PLEASE SEE ADDITIONAL SIGNATURE PAGE ATTACHED 28 — 4 — COUNTY 0I FRI!SNO Fresno,CA 1 APPROVED AS TO ACCOUNTING FORM: COUNTY OF FRESNO 2 VICKI CROW, C.P.A., AUDITOR-CONTROLLER/ TREASURER-TAX COLLECTOR 3 � 5 By: By. DEBORAH A. POOCHIGIAN, Clh6kman 6 Board of Supervisors 7 8 APPROVED AS TO LEGAL FORM: BERNICE E. SEIDEL, Clerk DANIEL C. CEDERBORG, COUNTY COUNSEL Board of Supervisors 9 10 11 By: By: CW 12 13 REVIEWED AND RECOMMENDED FOR 14 APPROVAL: '15 '16 By' 17 DA AN U ECHT, Dir ctor Department of Behavioral Health 18 19 The following is for COUNTY's use: 20 Fund/Subclass: 0001/10000 21 22 Organization: 56302070 56304525 Total Contract 23 FY 2011-12 $ 300,000.00 $ 87,500.00 $ 387,500.00 FY 2012-13 $1,988,246.00 $ 460,007.00 $2,448,253.00 24 FY 2013-14 $2,038,246.00 $ 599,262.00 $2,637,508.00 25 FY 2014-15 $2,038,246.00 $ 744,696.00 $2,782,942.00 FY 2015-16 $2,440,464.00 $1,555,903.00 $3,996,367.00 26 Account/Program: 7294/0 27 28 bb — 5 — COUNTY OF FRESNO Fresno,CA REVISED EXHIBIT A AMENDMENT III Page 1 of 13 AB 109 SCOPE OF WORK Section 1: Outpatient Mental Health and Substance Use Disorders Services Section 2: Full Service Partnership Services ORGANIZATION: Turning Point of Central California MAILING ADDRESS: P.O. Box 7447, Visalia CA 93290 SERVICE ADDRESS: 3636 N. First Street, Suites 135 and 154, Fresno, CA 93726 SERVICES: Mental health outpatient (OP) services, substance use disorders (SUD) treatment services, and full service partnership (FSP) services as required by AB109 Public Safety Realignment and the Post-release Community Supervision Act of 2011. SUBSTANCE USE DISORDERS AND OUTPATIENT SERVICES SU/OP Director: Ryan Banks, (559) 906-8673 Regional Director: Dennis Reid, (559) 269-4087 County Division: Department of Behavioral Health, Contracts Division County Contact: Baldomero Berber, Staff Analyst, (559) 600-0609 FULL SERVICE PARTERNERSHIP SERVICES FSP Director: Ryan Banks, (559) 906-8673 Regional Director: Sharon Ross, (559) 226-01678983 County Division: Department of Behavioral Health, Contracts Division County Contact: Baldomero Berber, Staff Analyst, (559) 600-0609 CONTRACT PERIOD: April 24, 2012 through June 30, 2013, with an option for three (3) twelve (12) month renewal terms CONTRACT AMOUNT: Total Substance Use Full Service Term Budget and Outpatient Partnership FY 11-12 $387,500 $300,000 $87,500 FY 12-13 $2,448,253 $1,988,246 $460,007 FY 13-14 $2,637,508 $2,038,246 $599,262 FY 14-15 $2,782,942 $2,038,246 $744,696 FY 15-16 $3,996,367 $2,440,464 $1,555,903 REVISED EXHIBIT A AMENDMENT III Page 2 of 13 SECTION 1 Outpatient Mental Health and Substance Use Disorders Services OUTPATIENT SERVICES: In anticipation of a large percentage of the Fresno County's AB-109 population requiring outpatient substance use treatment and mental health services, First Street Center (FSC) Outpatient Program aims to assist. FSC Outpatient Program will provide services that have been personalized to the client's needs. The First Street Center Outpatient program will emphasize a broad and cohesive substance abuse and co-occurring treatment approach for all clients with the following essential components being established: • The FSC Outpatient Program will be open for morning, early afternoon, late afternoon, and evening classes for its clients. The FSC Outpatient Program will be available for individual Substance Use Disorder Counseling sessions and/or Case Management sessions primarily between the hours of 8am and 5pm, Monday through Friday and at various scheduled times that have been scheduled by the Case Manager/Substance Use Disorder Counselor and the client. • When a client presents to the FSC Outpatient Program with a substance use disorder as well as a mental health need, each disorder will be considered primary thus allowing the client to embrace an integrated plan for their individual treatment. • The FSC Outpatient Program understand the need for psychiatric services with the co- occurring population thus the FSC Outpatient Program will work on a direct treatment approach that emphasizes the need of the client while focusing on the integrated care of the client. • The FSC will focus on a "treatment on demand" approach that utilizes a "whatever it takes" component. The FSC Outpatient Program will also focus on cultural/linguistic awareness while taking on an empathic, non-judgmental, evidenced based, person-centered approach that is not only built for substance use disorders but one that is also built around the needs of the co-occurring and mental health client. • The team at the FSC Outpatient Program will use an approach that focuses on the client's strengths and current skills with the belief that all clients should participate in their own treatment plans. • The FSC Outpatient Program will strive to become Medi-Cal compliant. Further, the FSC Outpatient Program will provide treatment services to adults aged 18-years old and up and their families. The FSC Outpatient Program will work under the "treatment on demand" approach where no client is given priority over the next. The FSC Outpatient Program will work directly with the AB-109 probationary department for all referrals and complete the screening process for all clients directly at the A13-109 probationary department. The FSC Outpatient Program is available from 8am to 5pm regularly with evening classes and Case Management/Substance Use Disorder Counseling/Mental Health sessions as scheduled. The FSC Outpatient Program will also have telephone contact with their clients as needed and crisis management as needed. The following crisis response measures shall also be followed by the staff at the FSC Outpatient Program: 1. The FSC Outpatient Program will follow the direct lead of the Program Director and/or Supervisor during the crisis. REVISED EXHIBIT A AMENDMENT III Page 3 of 13 2. The FSC Outpatient Program will respond to all crises in a rapid and flexible manner. 3. The FSC Outpatient Program understands that there are several types of crisis situations that can occur with the clients who are involved in the outpatient program, which may include: housing crisis, suicidal ideation, homicidal ideation, relapse, decompensation, and others. 4. Due to the FSC Outpatient Program understanding that there will undoubtedly be different types of crises, the FSC Outpatient Program will be fully aware of all crisis situations that occur within the Outpatient Program through a staffing that will immediately follow the crisis situations. 5. When a housing crisis occurs at the FSC Outpatient Program, the Program Director, the FSC Supervisor, and the FSC Case Manager will be notified immediately of said housing crisis. a. The FSC Outpatient Program will take every measure to ensure that the FSC clients have housing, whether in a sober living environment or in inpatient treatment (either voluntary or involuntary). b. When such a need for housing has been acknowledged, the FSC Outpatient Program staff shall collaborate with the treatment staff in such facilities. 6. The FSC Outpatient Program believes that all crisis services shall be monitored to ensure that all interventions have begun appropriately and that will be commenced with a discharge plan that will take place in collaboration with staff at the appropriate agency. All staff at the FSC Outpatient Program will be trained on the housing situations in Fresno County as a way to assist clients in locating, securing, and inhabiting appropriate housing that has been deemed appropriate for their exact level of care. Further, the FSC Outpatient Program will provide housing options to all clients in need as well as maintain clients in independent living by providing needed services to all clients, accessing appropriate resources for each client, and encouraging all clients to live responsible and productive lives in an independent setting. The FSC Outpatient Program will provide a variety of services in the area of psychotropic medication management, which will include: tele-psychiatry, the prescribing of psychotropic medications, the administration of psychotropic medications by way of injectable medications, monitoring the client after they have begun psychotropic medications, and the documentation of all avenues leading to the course of medication management and further by completing the following: 1. The tele-psychiatrist working with through the FSC Outpatient Program shall assess each client's mental illness thereby prescribing any appropriate medication that the client is in need of; regularly review and documents that client's symptoms and response to their mediation; educate the client on how their medications work; treat and documents any adverse reactions that come from the client's medication. 2. The FSC Program Nurse shall establish medication policies and procedures which will train the client in the knowledge of their own medication as well as all staff. The FSC Program Nurse will provide necessary training to all FSC staff that is required for their overall learning. 3. All FSC staff will document their client's mental illness symptoms and how the client responds to their medication. All FSC staff will observe the side effects of their client's medication and discuss any concerns that they have with the Lead Mental Health Clinician as well as the FSC Program Nurse. The FSC Outpatient Program will provide substance use disorder treatment that is not only intensive and comprehensive but also level appropriate for the client. The FSC Outpatient Program will work under the lens of"treatment on demand" where clients are served according to their need and not upon the timeline of the treatment program. The FSC Outpatient Program will work under the needs of the clients whether the client is being seen for their substance use disorder, co-occurring disorder, or mental health disorder. REVISED EXHIBIT A AMENDMENT III Page 4of13 The FSC Outpatient Program team will have access to several resources for their clients, including the ability to make emergency purchases of food, clothing, prescriptions, and other basic needs for their clients. The FSC Outpatient Program will have sound practices for tracking these purchases. The FSC Outpatient Program shall provide training and instruction to support and assist all clients in learning the skills of personal hygiene, job-readiness skills, resume writing, mock-interview sessions, "how to dress to impress", provide suits and ties to male clients and dresses to females after courses, linkage services that apply to general relief, SSI, and others. The FSC Outpatient Case Managers assist clients with scheduling doctor appointments and the follow-through with appointments as well as court services. FSC Case Managers also provide linkage services between clients and the FSC Mental Health team for additional support. The FSC Outpatient Program shall provide initial support of all clients with scheduling activities that are built around the client's level of care. FSC Substance Use Disorder Counselors will facilitate group processes and the educational building in the client through the delivery of all SUD Educational Classes that are focus-driven and psychoeducational in manner. The FSC Substance Use Disorder (SUD) Counselors will provide a key focus to all AB-109 clients that aim at the Criminal and Addictive Thinking process of the client and how to overcome past barriers. The FSC SUD Counselors will teach socialization skills to clients that are in need, while also focusing on the relapse prevention model. FSC SUD Counselors will also emphasize the importance of Familial systems in the client's recovery by assigning the client on a needs basis to family group or familial therapy with a Mental Health Clinician through First Street Center. FSC SUD Counselors will provide UA testing (both on 5- panel and 10-panel, as needed) of all clients. The FSC SUD Counselors will test clients at time of DISCHARGE and during the discharge planning. Referrals will be made to clients in the level of care 3 and 4 to Aftercare treatment. FSC Substance Use Disorder Counselors will be available 24/7 for crisis management at an on-call basis. The FSC Outpatient Program will provide an integrated approach for all co-occurring clients. The FSC Outpatient Program will work with a "treatment on demand" principle that is empathic, nonjudgmental, unique, and having a positive regard that focuses on the client's individual needs. The FSC Outpatient Program will work to minimize the client's involvement in the criminal justice system, whether it is in the Fresno County Jail or elsewhere within the California Department of Corrections and Rehabilitation by means of classes, groups, or individual sessions between the client and their assigned SUD Counselor, Case Manager, or Mental Health Clinician. STAFFING REQUIREMENTS: One of the most critical features of the FSC Outpatient Program is the team delivery method, which shall be the unified team approach with the client and their families at its focus. With this client/family approach, the FSC Outpatient Program will unify their team in an effort to build a unified focus that strengthens each FSC staff member's diverse skills. Due to the FSC Outpatient Program working under a "treatment on demand" lens, the FSC Outpatient Program will have no exact staff to client ratio. Designated staff shall be on-call during the off-hour periods, on a rotating basis in order to respond to the exact needs of the clients. The AB-109 psychiatrist (or Licensed Psychiatric Nurse Practitioner) will be available during regular business hours. GRIEVANCES AND INCIDENT REPORTS: The FSC Outpatient Program understands that there will be times of grievances and incident reports. The FSC Outpatient Program will notify Fresno County of all incidents or unusual occurrences reportable to state licensing bodies that affect Fresno County clients within (24) twenty-four hours of the incident. The FSC Outpatient Program will within (15) fifteen days after each grievance or incident REVISED EXHIBIT A AMENDMENT III Page 5 of 13 affecting the Fresno County sponsored clients inform provide the Fresno County with the corrective action that will be taken to resolve the complaint or incident. REPORTING REQUIREMENTS: The FSC Outpatient Program will maintain an up-to-date caseload record of all clients who are participants in the FSC Outpatient Program. The FSC Outpatient Program will provide Fresno County with client, programmatic, and other demographic information upon request. PROGRAM OUTCOMES The following items listed below represent program outcomes to be tracked by the vendor during the term of the contract: A. Engagement: 1. 95 percent of all referrals will receive intake/assessment within one week of referral. Average number of days can be calculated with a goal of reducing the average. 2. 25 percent of cases will engage the families of the offender in the offender's treatment. B. Retention: 1. The number and percentage of offenders who complete each of the five levels of treatment will be calculated with the following percentage as goals for each level: Level 1 — 70 percent; Level 2 — 65 percent; Level 3 — 60 percent; Level 4 — 55 percent; Level 5 — 65 percent, and voluntary aftercare — 30 percent. 2. The average length of treatment episode for offenders participating per level. C. Abstinence/Sobriety: 1. A goal of 90 percent of all urine tests for drug alcohol use (random, scheduled and for cause) will be negative. 2. 70 percent of discharges completing treatment with no alcohol or drug use detected by urine testing. 3. 95 percent of discharges completing treatment with no alcohol or drug use detected during the month prior to discharge. 4. 70 percent achieving progress as determined by Addiction Severity Index drug and alcohol use subscales. D. Treatment Objectives/Achievements: 1. Number and percentage of offenders achieving 75 percent of their individual treatment goals. 2. Number and percentage of offenders attaining essential treatment/recovery information and skills as determined by post-activity written test (goal of 80 percent). 3. 75 percent of all participants will develop ongoing recovery support network of family, friends, and sobriety communities, or mainstream resources. REVISED EXHIBIT A AMENDMENT III Page 6 of 13 E. Mental Health: 1. Number and percentage of mentally ill offenders who substitute illicit drugs with authorized medications. 2. Number and percentage (goal — 85 percent) of mentally ill or dually diagnosed who evidence no hospitalization, incarceration, or use of County Crisis services (include hospital emergency departments) as result of their mental illness during their program participation. 3. Number and percentage who develop a wellness/recovery plan (goal — 85 percent). 4. Number and percentage of mentally ill participants who have adequate ongoing housing, income, medication, social supports, mental health treatment services, and ongoing mainstream resources at the time of program discharge. 5. Percent of participant and families that self-report wellness and recovery at the time of program discharge. F. Consumer Satisfaction: 1. Client perception of care is rated as satisfactory or better in pre- and post-discharge survey (goal of 75 percent). G. Law-Abiding Lifestyle: 1. Post-discharge recidivism for new crimes, and violation of terms of community supervision. REVISED EXHIBIT A AMENDMENT III Page 7 of 13 SECTION 2 AB109 Full Service Partnership FULL SERVICE PARTNERSHIP PROGRAM DESCRIPTION The AB 109 Full Service Partnership (FSP) program shall provide innovative and evidence-based mental health services specifically tailored to meet the unique needs of the seriously mentally ill (SMI) population identified among the AB109 post-release adult male and female offenders. This project shall include the use of innovative approaches resulting in increased access to services for the underserved criminal justice clients thereby encouraging and assisting this population in transition towards growth, stability, wellness, and recovery. Services shall be delivered with a focus of"meeting the clients where they are" utilizing a "whatever it takes" approach. Services shall be culturally and linguistically competent, values-driven, evidence-based and co-occurring capable. An important element of this project will be close and constant communication and collaboration between CONTRACTOR, the criminal justice system, Fresno County Probation Department, and Fresno County Department of Behavioral Health, Mental Health Services Act. SCHEDULE OF SERVICES CONTRACTOR staff shall be available to provide FSP services to a minimum of forty-five (45) consumers 24 hours per day, 7 days per week including telephone and face-to-face contact as needed; and spend at least 75% of their time on billable activities on behalf of the consumers. TARGET POPULATION The target population is comprised of AB109 post-release adult male and female offenders, age 18 and older and their families, who have a serious mental illness (SMI) such as schizophrenia major depression with psychotic features or bi-polar disorders. This program will serve a minimum of 45 AB109 transfer consumers referred by the Probation Department at any given point in time. STAFFING REQUIREMENTS 1. CONTRACTOR shall implement and support the use of a team delivery method, which shall be the unified team approach with a consumer/family centered focus. With this approach, the multiple staff members that make up the team shall "unify" their diverse skills in order to address each consumer's mental health and substance abuse needs. Staffing responses and program design should show evidence of consumer/family support as provided through consumer/family specialists 2. The FSP AB 109 Team staff to consumer ratio shall be set at or between 1:10 to 1:15, or one staff serving no more than ten to fifteen consumers. All treatment staff will be included in the ratio. The FSP AB 109 Team must meet the ratio requirements. 3. The FSP AB 109 Team shall be available twenty-four (24) hours per day, seven (7) days per week. The staff shall have hours that allow them to work evenings and weekends. Staff shall be on-call during off-hour periods, on a rotating basis in order to respond immediately to consumers by telephone or in person, as dictated by consumer needs. The Psychiatrist, or Psychiatric Nurse Practitioner, shall be available during normal business hours and on- call during off-hours periods. CONTRACTOR'S RESPONSIBILITIES CONTRACTOR shall ensure that: REVISED EXHIBIT A AMENDMENT III Page 8 of 13 1. Staff be available to provide intensive case management and crisis outreach services 24 hours a day, 7 days a week; 2. Staff spend a minimum of 75% of their time on billable activities on behalf of FSP program consumers; 3. When substance disorder and psychiatric disorder co-exist, each disorder should be considered primary; an integrated dual treatment approach is recommended, where each disorder receives appropriately intensive diagnosis-specific treatment; 4. Services are delivered with a focus of"meeting the client where they are" utilizing a "whatever it takes" approach; 5. Services shall be culturally/linguistically competent, values-driven, evidence-based and co- occurring capable; 6. A strength-based approach is implemented which will help consumers build on their current skills and the consumer will actively participate in their individual treatment planning; the goal being to help the consumer towards growth, stability, wellness, and recovery; 7. Highest priority for FSP services is given to individuals in a complex crisis; 8. FSP services offer an array of integrated mental health and substance abuse services that are need driven, not appointment driven, and that involve case management and recovery based peer support as well as community and family support; 9. FSP AB 109 Team and services adhere to the following crisis response measures: a. Response to crisis shall be rapid and flexible; b. When crisis housing is necessary for short-term care and inpatient treatment (either voluntary or involuntary), the staff shall collaborate with the treatment staff in such facilities. Support shall be provided, including accompanying the consumer to the facility, remaining with the consumer during assessment, and beginning the process of planning with the consumer for discharge to the community as soon as possible; c. Usage of crisis services and hospitalizations shall be monitored to ensure that interventions were initiated and that discharge planning took place in collaboration with the admitting facility. Monitoring can include and lead into costs to the service provider for inpatient days in the event discharge is delayed due to lack of response or discharge options for enrollees. 10. FSP AB 109 Team make available/coordinate housing services for each consumer as follows: a. Training and assistance to consumers in locating, securing and inhabiting housing which is appropriate to their level of functioning; b. Providing housing options and maintain clients in independent living by providing needed services, accessing resources and encouraging consumers to be independent, productive and responsible; c. Assisting consumers in securing supported independent and permanent housing as appropriate for consumers in their community throughout the metropolitan, and rural (western and eastern areas) of Fresno County where consumers prefer to reside; REVISED EXHIBIT A AMENDMENT III Page 9of13 d. Assisting consumers in securing emergency housing voucher. 11. The FSP AB 109 Team provide services in the areas of medication prescription, administration, monitoring, and documentation as indicated below. a. The team psychiatrist shall assess each consumer's mental illness and prescribe appropriate medication, regularly review and document symptoms as well as the consumer's response to the prescribed medications, educate the consumer and family members, and monitor, treat and document any medication side effects. b. The nurse shall establish medication policies and procedures which identify processes to administer medications, train other team members, and assess regularly other team members' competency in this area. c. All team staff shall document consumer's mental illness symptoms and behavior in response to medication and shall monitor for medication side-effects during the provision of observed self-administration and during ongoing face-to-face contacts. d. Medication provision and psychiatric services are the full responsibility of the selected provider. 12. The FSP AB 109 Team provide whatever direct assistance is necessary and reasonable to ensure that the consumer obtains the basic necessities of daily life, such as food, housing, clothing, medical/mental health/substance abuse services, and other financial support. 13. The FSP AB 109 Team provide intensive and comprehensive alcohol, tobacco and drug abuse treatment services in accordance with harm reduction principles. The provision of integrated dual recovery substance abuse/mental health services is a key ingredient in the FSP service delivery model. 14. The FSP AB 109 Team members have access to resources in order to make emergency purchases of food, shelter, clothing, prescriptions, transportation, or other items for consumers, as needed. The team shall also have access to larger sums of client assistance funds for deposits, furniture purchases, and other items. The FSP will utilize sound accounting practices for recording and monitoring the use of these funds. 15. The FSP AB 109 Team may serve as "representative payee" or work with an organization which provides such services, for some consumers. The FSP will utilize sound accounting practices to monitor these situations. The team may utilize client assistance funds to assist consumers with short-term loans or grants, as necessary. The team shall link consumers to appropriate social services, provide transportation as necessary, and link the client to appropriate legal advocacy representation. 16. The FSP AB 109 Team provide training and instruction to support and assist the client in developing personal skills and assist in the identification of and participation in community based recreational and social activities. 17. The FSP AB 109 Team provide integrated, co-occurring capable alcohol, tobacco and drug abuse services as needed, in accordance with harm reduction principles. The provision of substance abuse/mental health services is a key ingredient in FSP services. 18. The FSP AB 109 Team work to minimize the consumer's involvement in the criminal justice system and will service as program representative during any contact with local law enforcement agencies. REVISED EXHIBIT A AMENDMENT III Page 10 of 13 19. CONTRACTOR shall develop a satisfaction survey, approved by DBH that complies with the mandated State performance outcome and quality improvement reports/outcomes. At a minimum, seventy-five percent (75%) of consumers will report satisfaction with the program services. PROGRAM REPORTS AND OUTCOMES 1. FSP Requirements - As required by the Mental Health Services Act, CONTRACTOR shall be responsible for correctly completing the following Full Service Partnership Forms into the State web-based database on a monthly basis: a. Partnership Assessment Forms (PAF) - completed once, when partnership is established with a client (baseline). b. Key Event Tracking Form (KET) - completed when change occurs in key areas. c. Quarterly Assessment Form (3M) - completed every 3 (three) months. These forms can be viewed at http://www.dmh.ca.gov/POQI, then select "Forms" under the "MHSA Full Service Partnership Evaluation". CONTRACTOR shall complete all Full Services Partnership Reporting according to DMH regulations. 2. Grievances a. CONTRACTOR shall log all grievances and the disposition of all grievances received from a consumer or a consumer's family in accordance with Fresno County Mental Health Plan policies and procedures (Exhibit 1). b. CONTRACTOR shall provide a summary of the grievance log entries concerning County-sponsored consumers to the Department of Behavioral Health Director or designee at monthly intervals, by the tenth (20th) day of the following month, in a County approved format. c. CONTRACTOR shall post signs, provided by the County, informing consumers of their right to file a grievance and appeal. d. Within fifteen (15) days after each grievance or incident affecting County-sponsored consumers, CONTRACTOR shall provide County with the complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the complaint or incident. e. 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. 3. Incident Reports a. CONTRACTOR will notify County of all incidents or unusual occurrences reportable to state licensing bodies that affect County consumers within twenty-four (24) hours. CONTRACTOR shall use the CONTRACTOR specific form for such reporting. REVISED EXHIBIT A AMENDMENT III Page 11 of 13 b. Within fifteen (15) days after each grievance or incident affecting County-sponsored consumers, CONTRACTOR shall provide County with the complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the complaint or incident. c. 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. 4. Report Delivery and Content Requirements CONTRACTOR shall deliver all MHSA required reporting in data collection format that reflects MHSA and Data Infrastructure Grant (DIG) requirements in a timely and accurate manner. Reporting information should include demographics and attendance, as well as track unduplicated and duplicated consumer counts as required by DMH reporting standards. 5. Billable Services CONTRACTOR shall ensure billable Mental Health Specialty Services meet any/all County, State, Federal regulations including any utilization review and quality assurance standards, and provide all pertinent and appropriate information in a timely manner to County to bill Medi-Cal for services rendered. 6. Utilization of Services CONTRACTOR may be required to closely monitor and report monthly the utilization of services by consumers to ensure the dollars available during each term of this Agreement provide the level of program services as identified this Agreement. CONTRACTOR shall submit a monthly report to the COUNTY of the units of service provided by service function code and dollars billed, actual expenses, revenues generated from non Medi-Cal billed services (such as collecting consumer rents), the number of consumers served and waiting list for the purpose of contract monitoring within 30 days after the last day of the previous month. CONTRACTOR may be required to submit Quality Improvement reports within the timeframe as specified by the Fresno County Mental Health Plan. 7. Short/Doyle Medi-Cal Cost Report CONTRACTOR shall submit a complete and accurate State of California Department of Mental Health (DMH) Short/Doyle Medi-Cal Cost Report for each fiscal year ending June 30th affected by this Agreement. The cost report must be submitted to the County's DBH Business Office within 90 days following the end of each fiscal year. All cost reports must be prepared in accordance with general accounting principles and the standards set forth by the DMH and the County. 8. Caseload Records CONTRACTOR shall maintain an up to date caseload record of all clients receiving services from the AB 109 FSP program, and provide consumer, programmatic, and other demographic information to the COUNTY. Reports are to be submitted to the DBH MHSA REVISED EXHIBIT A AMENDMENT III Page 12 of 13 Administrative Staff Analyst or the DBH Director or designee by the 20th of each month unless otherwise directed by DBH Director or designee. 9. Outcome Measurements and Reporting Outcomes are to be reported annually on the Outcomes Template included in Invoices and Reports (Exhibit D). Outcomes to be tracked include, but may not be limited to, increases/decreases in: LOCUS scores, hospitalization/crisis, homelessness, and incarceration. In addition, consumer progress with education, employment, socialization and other life skills may be used to determine Program success and effectiveness. Annual recommendations to the County Board of Supervisors for Agreement renewals will be based upon CONTRACTOR's successful delivery, maintenance, tracking, and reporting of program services and outcomes. Outcome reporting will be requested by DBH annually (typically in January for the previous calendar year). 10. Consumer Satisfaction Survey Consumer Satisfaction Survey shall be tracked and reported on at a minimum annually and shall be submitted with Outcome Measures when requested by DBH (typically in January for previous calendar year). At a minimum, seventy-five percent (75%) of consumers will report satisfaction with the program services. COUNTY'S RESPONSIBILITIES COUNTY shall: 1. Provide oversight (through the County Department of Behavioral Health (DBH), Adult System of Care, and the Mental Health Services Act, Division Managers or designees) of the CONTRACTOR's FSP program. In addition to contract monitoring of program, oversight includes, but not limited to, coordination with the State Department of Mental Health, Mental Health Services Act in regard to program administration and outcomes. 2. Assist CONTRACTOR in making linkages with the total mental health system. This will be accomplished through regularly scheduled meetings as well as formal and informal consultation 3. 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. 4. Receive and analyze statistical data outcome information 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. 5. 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 efforts towards REVISED EXHIBIT A AMENDMENT III Page 13 of 13 cultural and linguistic competency, DBH shall provide the following at no cost to CONTRACTOR: a. Technical assistance to CONTRACTOR regarding cultural competency requirements and sexual orientation training. b. Mandatory cultural competency training including sexual orientation and sensitivity training for DBH and CONTRACTOR or 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, questioning (LGBTQ) individuals may be at increased risk for mental disorders and mental health problems due to exposure to societal stressors such as stigmatization, prejudice and anti-gay violence. Social support may be critical for this population. Access to care may be limited due to concerns about providers' sensitivity to differences in sexual orientation. c. Technical assistance for CONTRACTOR in translating behavioral health and substance abuse services information into DBH's threshold languages (Spanish, Laotian, Cambodian, and Hmong). Translation services and costs associated will be the responsibility of CONTRACTOR. PROGRAM OBJECTIVES (FSP Program) The items listed below represent program objectives to be tracked and achieved by CONTRACTOR during the contract terms. 1. Reduce frequency of hospitalization for each consumer served. 2. Reduce frequency of homelessness for each consumer served. 3. Reduce frequency of access to crisis services provided by the DBH Intensive Services Division. 4. Reduce frequency of incarceration for each consumer served. 5. Improve LOCUS scores for each consumer served; 6. Improve socialization and life skill for each consumer served 7. 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A w w Oo 0 f O OD 00Co -C, rA m 3 m AAA ° A m m m o 3 x 3 cn v+ fA a fA yt S -D w w w w (n (T in N V D N 0000 . A O O O O N T 0 0 0 0 0 C ooOoo :3 ci W (D 3 m m d N Ch W O O N V D 0 W W V O _ O A Qf o w T N V T '11 CD df to j D W N _ N D O O tli 0046 t° W 00 O 0 0 m D 7 n !A M 41 N1 W (n w w fA m 0 twit o 0 o A 0 0 0 0 H (n pVp tD 4 � � y N (n p t0 O v 2 x N N O (n Ci d 3 O ° a) N -4 W cn al (' m D < wNNNd+ 3 �m to -4 (n AA co D x m m NW( W -4d ° o m m P 0 (Nn $ d c m m= -( N CO w 3 Z W z n REVISED EXHIBIT C AMENDMENT III Substance Use Disorder Services(AB109)-Outpatient Portion Turning Point Of Central CA,Inc. July 2015-June 2016 Budget Categories- Total Proposed Budget Line Item Description (Must be itemized) FTE% Admin. Direct Total PERSONNEL SALARIES: 1 Program Director 0.65 $ 42,857 $ 42,857 2 Mental Health Professional/Team Leader 0 $ - 3 Supervising Personal Service Coordinator 1 $ 44,302 $ 44,302 4 Intake Specialist 0.75 $ 31,621 $ 31,621 5 Substance Abuse Counsler 5 $ 193,390 $ 193,390 6 Driver 1 $ 26,369 $ 26,369 7 Nurse 0 $ - $ - 8 Case Manager 1 $ 36,298 $ 36,298 9 Secretary 1 $ 31,907 $ 31,907 10 Billing Clerk 0.5 $ 15,954 $ 15,954 SALARY TOTAL 10.9 $0 $ 422,698 $ 422,698 PAYROLL TAXES: 30 OASDI $0 31 FICA/MEDICARE $ 33,557 $ 33,557 32 SUI $ 9,663 $ 9,663 PAYROLL TAX TOTAL $0 $ 43,220 $ 43,220 EMPLOYEE BENEFITS: 40 Retirement $ 6,652 $ 6,652 41 Workers Compensation $ 4,641 $ 4,641 Health Insurance (medical,vision, life, 42 dental) $ 77,888 $ 77,888 EMPLOYEE BENEFITS TOTAL $0 $ 89,181 $ 89,181 SALARY&BENEFITS GRAND TOTAL $ 555,099 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building $35,250 1011 Rent/Lease Equipment $0 1012 Utilities $8,434 1013 Building Maintenance $3,500 1014 Equipment Maintenance $1,510 1015 Equipment Purchase $0 FACILITY/EQUIPMENT TOTAL $48,694 OPERATING EXPENSES: 1060 Telephone $2,575 1061 Answering Service $0 1062 Postage $6 1063 Printing/Reproduction $850 1064 Publications $535 1065 Legal Notices/Advertising $0 1066 Office Supplies&Equipment $5,368 1067 Household Supplies $755 1068 Food $0 1069 Program Supplies-Therapeutic $755 1070 Program Supplies-Medical $0 1071 Transportation of Clients $3,986 1072 Staff Mileage/vehicle maintenance $9,900 1073 Staff Travel(Out of County) $0 1074 Staff Training/Registration $1,006 1075 Lodging $236 1076 Other-(Vehicle Insurance) $2,330 1077 Other-(Client Activities) $1,761 1078 Other-(Depreciation) $0 1079 Other-(Recruitment) $346 1080 ADP Licensing $6,408 1080 O/S Labor Clinical-Psychiatrist $11,592 OPERATING EXPENSES TOTAL $48,409 REVISED EXHIBIT C AMENDMENT III FINANCIAL SERVICES EXPENSES: 1080 Accounting/Bookkeeping $0 1081 External Audit $1,510 1082 Liability Insurance $1,006 1083 Administrative Overhead $106,825 1084 Payroll Services $0 1085 Professional Liability Insurance $0 FINANCIAL SERVICES TOTAL $109,341 SPECIAL EXPENSES(Consultant/Etc.): 1090 Consultant(network&data management) $0 1091 Translation Services $0 1092 Medication Supports $0 SPECIAL EXPENSES TOTAL $0 FIXED ASSETS: 1190 Computers&Software $0 1191 Furniture&Fixtures $0 1192 Other—(Identify) $0 1193 Other—(Identify) $0 FIXED ASSETS TOTAL $0 NON MEDI-CAL CLIENT SUPPORT EXPENSES: 2000 Intensive Substance Use Disorder Services(SFC 70) $200,000 2001 Residential Services(SFC 71) $848,625 2002.1 Clothing,Food&Hygiene(SFC 72) $1,500 2002.2 Client Transportation&Support(SFC 72) $0 2002.3 Education Support(SFC 72) $0 2002.4 Employment Support(SFC 72) $0 2002.5 Respite Care(SFC 72) $0 2002.6 Household Items $0 2002.7 Utility Vouchers(SFC 72) $0 2002.8 Child Care(SFC 72) $0 NON MEDI-CAL CLIENT SUPPORT TOTAL $1,050,125 TOTAL PROGRAM EXPENSES $1,811,668 MEDI-CAL REVENUE: Units of Service Rate $Amount 3000 Group Contacts 2234 $26.23 $58,598 3100 Individual Contacts 220 $67.38 $14,824 3200 0 $0.00 $0 3300 0 $0.00 $0 3400 0 $0.00 $0 3500 0 $0.00 $0 3600 0 $0.00 $0 3700 0 $0.00 $0 Estimated Medi-Cal Billing Totals 2454 $73,422 Estimated%of Federal Financial Participation Reimbursement 100.00% $73,422 Estimated%of Clients Served that will be Medi-Cal Eligible 0.00% MEDI-CAL REVENUE TOTAL $73,422 OTHER REVENUE: 4000 Other—(AB 109 Funds) $1,538,246 4100 Other—(SAPT Funds) $200,000 4200 Other—(Identify) $0 4300 Other—(Identify) $0 OTHER REVENUE TOTAL $1,738,246 MHSA FUNDS: 5000 Prevention&Early Intervention Funds $0 5100 Community Services&Supports Funds $0 MHSA FUNDS TOTAL $0 TOTAL PROGRAM REVENUE $1,811,668 REVISED EXHIBIT C AMENDMENT III Mental Health Services(AB109)-Outpatient Portion Turning Point Of Central CA,Inc. July 2015-June 2016 Budget Categories- Total Proposed Budget Line Item Description (Must be itemized) FTE % Admin. Direct Total PERSONNEL SALARIES: 1 Program Director 0.35 $ 23,077 $ 23,077 2 Mental Health Professional/Team Leader 1.00 $ 65,934 $ 65,934 3 Supervising Personal Service Coordinator 0.00 $ - $ - 4 Intake Specialist 0.25 $ 10,540 $ 10,540 5 Eligibility Worker 050 $ 24,660 $ 24,660 6 Substance Abuse Counsler 0.00 $ - $ - 7 Driver 0.00 $ - $ - 8 Nurse 0.50 $ 25,135 $ 25,135 9 Case Manager 2.00 $ 82,425 $ 82,425 10 Secretary 0.00 $ - $ - 11 Billing Clerk 0.50 $ 15,954 $ 15,954 12 Personal Service Coordinator/CM 0.00 $ - $ - 13 Records Technician 0.50 $ 20,421 $ 20,421 SALARY TOTAL 5.6 $0 $ 268,146 $ 268,146 PAYROLL TAXES: 30 OASDI 0 $0 31 FICA/MEDICARE $ 20,513 $ 20,513 32 SUI $ 6,442 $ 6,442 PAYROLL TAX TOTAL $0 $ 26.955 $ 26,955 EMPLOYEE BENEFITS: 40 Retirement $ 3,783 $ 3,783 41 Workers Compensation $ 2,669 $ 2,669 Health Insurance (medical,vision, life, 42 dental) $ 49,846 1 $ 49,846 EMPLOYEE BENEFITS TOTAL $0 I $ 56,298 $ 56,298 SALARY& BENEFITS GRAND TOTAL $ 351,399 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building $39,200 1011 Rent/Lease Equipment $0 1012 Utilities $8,220 1013 Building Maintenance $2,700 1014 Equipment Maintenance $890 1015 Equipment Purchase $0 FACILITY/EQUIPMENT TOTAL $51,010 OPERATING EXPENSES: 1060 Telephone $1,818 1061 Answering Service $0 1062 Postage $4 1063 Printing/Reproduction $723 1064 Publications $315 1065 Legal Notices/Advertising $0 1066 Office Supplies&Equipment $3,107 1067 Household Supplies $445 1068 Food $0 1069 Program Supplies-Therapeutic $445 1070 Program Supplies-Medical $0 1071 Transportation of Clients $74 1072 Staff Mileage/vehicle maintenance $0 1073 Staff Travel(Out of County) $0 1074 Staff Training/Registration $594 1075 Lodging $139 REVISED EXHIBIT C AMENDMENT III 1076 Other—(Vehicle Insurance) $0 1076 Other—(Client Activities) $1,039 1076 Other—(Depreciation) $0 1076 Other—(Recruitment) $202 1077 ADP Licensing $0 1078 EMIR Licensing $6,000 1080 O/S Labor Clinical-Therapast $20,800 1080 O/S Labor Clerical $0 1080 O/S Labor Clinical-Psychiatrist $74,880 OPERATING EXPENSES TOTAL $110,585 FINANCIAL SERVICES EXPENSES: 1080 Accounting/Bookkeeping $0 1081 External Audit $890 1082 Liability Insurance $594 1083 Administrative Overhead $94,319 1084 Payroll Services $0 1085 Professional Liability Insurance $0 FINANCIAL SERVICES TOTAL $95,803 SPECIAL EXPENSES(Consultant/Etc): 1090 Consultant(network&data management) $0 1091 Translation Services $0 1092 Medication Supports $20,000 SPECIAL EXPENSES TOTAL $20,000 FIXED ASSETS: 1190 Computers&Software $0 1191 Furniture& Fixtures $0 1192 Other—(Identify) $0 1193 Other—(Identify) $0 FIXED ASSETS TOTAL $0 NON MEDI-CAL CLIENT SUPPORT EXPENSES: 2000 Intensive Substance Use Disorder Services(SFC 70) $0 2001 Residential Services(SFC 71) $0 2002.1 Clothing, Food& Hygiene(SFC 72) $0 2002.2 Client Transportation&Support(SFC 72) $0 2002.3 Education Support(SFC 72) $0 2002.4 Employment Support(SFC 72) $0 2002.5 Respite Care(SFC 72) $0 2002.6 Household Items $0 2002.7 Utility Vouchers(SFC 72) $0 2002.8 Child Care(SFC 72) $0 NON MEDI-CAL CLIENT SUPPORT TOTAL $0 TOTAL PROGRAM EXPENSES $628,797 MEDI-CAL REVENUE: Units of Service Rate $Amount 3000 Mental Health Services(Individual/Family/Group 57,330 $2.20 $126,126.0 3100 Case Management 35,000 $1.80 $63,000.0 3200 Crisis Services 19,965 $2.95 $58,896.8 3300 Medication Support 24,976 $3.75 $93,660.0 3400 Collateral 8,100 $2.20 $17,820.0 3500 Plan Development 32,400 $2.20 $71,280.0 3600 Assessment 5,400 $2.20 $11,880.0 3700 Rehabilitation 28,718 $2.20 $63,180.0 Estimated Medi-Cal Billing Totalsi 211,889 $505,843 Estimated%of Federal Financial Participation Reimbursement 50.00% $177,044.00 Estimated%of Clients Served that will be Medi-Cal Eligible-SD 70.00% Estimated%of MAGI Federal Financial Participation Reimbursement 100.00% $151,752 83 Estimated%of Clients Served that will be Medi-Cal Eligible-ACA 30.00% MEDI-CAL REVENUE TOTAL $328,796.83 REVISED EXHIBIT C AMENDMENT III OTHER REVENUE: 4000 Other—Client Fees $0 4100 Other—Client Insurance $0 4200 Other—(Identify) $0 4300 Other—(Identify) $0 OTHER REVENUE TOTAL $0 MHSA FUNDS: 5000 AB 109 Funds $0 5100 Community Services&Supports Funds $300,000 MHSA FUNDS TOTAL $300,000 TOTAL PROGRAM REVENUE $628,797 REVISED EXHIBIT C AMENDMENT III Mental Health &Substance Use Disorder Services (AB109) -FSP Portion Turning Point Of Central CA, Inc. July 2015-June 2016 Budget Categories- Total Proposed Budget Line Item Description (Must be itemized) FTE % Admin. Direct Total PERSONNEL SALARIES: 1 PSC B 6 $230,000 $230,000 2 Peer Support-PSC 0.5 $11,926 $11,926 3 MH Professional 1 $66,339 $66,339 4 Program Director 1 $80,979 $80,979 5 Nurse 1 $43,321 $43,321 6 Billing Clerk 0.5 $20,175 $20,175 7 Secretary 1 $30,519 $30,519 8 Psychiatrist 0.4 $144,390 $144,390 9 PSC C 1 $43,321.00 $43,321 10 Substance Abuse 1 $34,473.00 $34,473 11 Title 0 $0 12 Title 0 $0 SALARY TOTAL 13.4 $0 $705,443 $705,443 PAYROLL TAXES: 30 OASDI $4,900 $4,900 31 FICA/MEDICARE $42,000 $42,000 32 SUI $11,275 $11,275 PAYROLL TAX TOTAL $0 $58,175 $58,175 EMPLOYEE BENEFITS: 40 Retirement $14,390 $14,390 41 Workers Compensation $5,300 $5,300 Health Insurance (medical, vision, 42 life, dental) $126,000 $126,000 EMPLOYEE BENEFITS TOTAL $0 $145,690 $145,690 SALARY& BENEFITS GRAND TOTAL $909,308 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building $34,000 1011 Rent/Lease Equipment $1,500 1012 Utilities $8,000 1013 Building Maintenance $5,000 1014 Equipment purchase $0 FACILITY/EQUIPMENT TOTAL $48,500 REVISED EXHIBIT C AMENDMENT III OPERATING EXPENSES: 1060 Telephone $7,000 1061 Answering Service $0 1062 Postage $500 1063 Printing/Reproduction $1,000 1064 Publications $250 1065 Legal Notices/Advertising $0 1066 Office Supplies& Equipment $11,500 1067 Household Supplies $1,000 1068 Food $0 1069 Program Supplies-Therapeutic $500 1070 Program Supplies-Medical $0 1071 Transportation of Clients $0 1072 Staff Mileage/Vehicle maintenance $25,500 1073 Staff Travel (Out of County) $0 1074 Staff Training/Registration $1,000 1075 Lodging $1,000 1076 Other-Vehicle Insurance $4,200 1076 Other-Client Activities $4,000 1076 Other-Depreciation $600 1076 Other-Recruitment $580 $0 OPERATING EXPENSES TOTAL $58,630 FINANCIAL SERVICES EXPENSES: 1080 Accounting/Bookkeeping $0 1081 External Audit $0 1082 Liability Insurance $1,800 1083 Administrative Overhead $202,214 1084 Payroll Services $0 1085 Professional Liability Insurance $0 FINANCIAL SERVICES TOTAL $204,014 SPECIAL EXPENSES (Consultant/Etc.): 1090 Consultant(network&data management) $0 1091 Translation Services $0 1092 Medication Supports $45,000 SPECIAL EXPENSES TOTAL $45,000 FIXED ASSETS: 1190 Computers&Software $1,000 1191 Furniture& Fixtures $0 1192 Other—(Identify) $0 1193 Other—(Identify) $0 FIXED ASSETS TOTAL $1,000 REVISED EXHIBIT C AMENDMENT III NON MEDI-CAL CLIENT SUPPORT EXPENSES: 2000 Client Housing Support Expenses (SFC 70) $270,000 2001 Client Housing Operating Expenses (SFC 71) $3,351 2002.1 Clothing, Food& Hygiene (SFC 72) $10,000 2002.2 Client Transportation& Support(SFC 72) $5,000 2002.3 Education Support(SFC 72) $500 2002.4 Employment Support(SFC 72) $500 2002.5 Respite Care (SFC 72) $0 2002.6 Household Items $0 2002.7 Utility Vouchers (SFC 72) $0 2002.8 Child Care (SFC 72) $100 NON MEDI-CAL CLIENT SUPPORT TOTAL $289,451 TOTAL PROGRAM EXPENSES1 $1,555,903 MEDI-CAL REVENUE: Units of Service Rate $Amount Mental Health Services (Individual/Family/Group 3000 Therapy) 61031 $2.61 $159,291 3100 Case Management 100044 $2.02 $202,089 3200 Crisis Services 2741 $3.88 $10,635 3300 Medication Support 11034 $4.82 $53,184 3400 Collateral 1675 $2.61 $4,372 3500 Plan Development 2997 $2.61 $7,822 3600 Assessment 5127 $2.61 $13,381 3700 Rehabilitation 234810 $2.61 $612,854 Estimated Medi-Cal Billing Totalsi 0 $1,063,628 Estimated % of Federal Financial Participation Reimbursement 50.00% $212,726 Estimated % of Clients Served that will be Medi-Cal Eligible-SD 40.00% Estimated %of Federal Financial Participation Reimbursement 100.00% $638,176.94 Estimated % of Clients Served that will be Medi-Cal Eligible-ACA 60.00% MEDI-CAL REVENUE TOTAL $850,903 OTHER REVENUE: 4000 Other—(Client Rents) $5,000 4100 Other—(Identify) $0 4200 Other—(Identify) $0 4300 Other—(Identify) $0 OTHER REVENUE TOTAL $5,000 MHSA FUNDS: 5000 Prevention& Early Intervention Funds $0 5100 Mental Health Services Act Innovations Funds $350,000 5100 AB109 Realignment Funds $350,000 MHSA FUNDS TOTAL $700,000 TOTAL PROGRAM REVENUE $1,555,903 REVISED EXHIBIT I—SINGLE AUDIT REQUIREMENT SINGLE AUDIT REQUIREMENT A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual audit in accordance with the requirements of the Single Audit Standards as set forth in Office of Management and Budget (OMB) Circular A-133. CONTRACTOR shall submit said audit and management letter to COUNTY. The audit must include a statement of findings or a statement that there were no findings. If there were negative findings, CONTRACTOR must include a corrective action plan signed by an authorized individual. CONTRACTOR agrees to take action to correct any material non-compliance or weakness found as a result of such audit. Such audit shall be delivered to COUNTY's Department of Behavioral Health, Business Office for review within nine (9) months of the end of any fiscal year in which funds were expended and/or received for the program. Failure to perform the requisite audit functions as required by this Agreement may result in COUNTY performing the necessary audit tasks, or at COUNTY's option, contracting with a public accountant to perform said audit, or, may result in the inability of COUNTY to enter into future agreements with CONTRACTOR. All audit costs related to this Agreement are the sole responsibility of CONTRACTOR. B. A single audit report is not applicable if CONTRACTOR's Federal contracts do not exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR'S only funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must be performed and a program audit report with management letter shall be submitted by CONTRACTOR to COUNTY as a minimum requirement to attest to CONTRACTOR's solvency. Said audit report shall be delivered to COUNTY's Department of Behavioral Health, Business Office for review, no later than nine (9) months after the close of the fiscal year in which the funds supplied through this Agreement are expended. Failure to comply with this Act may result in COUNTY performing the necessary audit tasks or Page 1 of 2 contracting with a qualified accountant to perform said audit. All audit costs related to this Agreement are the sole responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under this section shall be billed to the CONTRACTOR at COUNTY's cost, as determined by COUNTY's Auditor-Controller/Treasurer-Tax Collector. C. CONTRACTOR shall make available all records and accounts for inspection by COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at least three (3) years following final payment under this Agreement or the closure of all other pending matters, whichever is later. Page 2 of 2