HomeMy WebLinkAboutAgreement A-16-221-1 with Exodus Recovery Inc..pdf Agreement No. 16-221-1
1 AMENDMENT ITO AGREEMENT
2 THIS AMENDMENT, hereinafter referred to as "Amendment I", is made and entered into this
3 18th day of June 2019, by and between the COUNTY OF FRESNO, a Political Subdivision of the
4 State of California, hereinafter referred to as "COUNTY", and EXODUS RECOVERY, INC, a for-profit
5 California corporation, whose address is 9808 Venice Blvd, Suite 700, Culver City, CA 90232,
6 hereinafter referred to as "CONTRACTOR" (collectively as the "parties").
7 WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement
8 No. 16-221, effective July 1, 2016, whereby CONTRACTOR agreed to operate an Adult Crisis
9 Stabilization Center(Adult CSC) to provide crisis stabilization services to adults, age eighteen (18) and
10 older, and a Youth Crisis Stabilization Center (Youth CSC) to provide crisis stabilization services to
11 children and youth up to age eighteen (18), who may be admitted on a voluntary or involuntary basis
12 regardless of the source of payment, and who are referred by the COUNTY's Department of
13 Behavioral Health (DBH), a contract provider with DBH, law enforcement, hospital emergency rooms,
14 and Emergency Medical Services transports; and
15 WHEREAS, under COUNTY Agreement No. 16-221, CONTRACTOR also agreed to operate a
16 State-mandated toll-free answering service (Access Line) in accordance with state and federal
17 regulations; and
18 WHEREAS, CONTRACTOR has requested greater access to the COUNTY's DBH electronic
19 health record system (Avatar); and
20 WHEREAS, COUNTY, through DBH, is willing to provide CONTRACTOR with greater access to
21 its electronic health record system; and
22 WHEREAS, the parties desire to amend COUNTY Agreement No. 16-221, regarding changes
23 as stated below and restate the Agreement in its entirety.
24 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which is
25 hereby acknowledged, the parties agree to amend the Agreement as follows:
26 1. That the existing COUNTY Agreement No. 16-221, all text in reference to "Exhibit A-3"
27 shall be replaced with text "Revised Exhibit A-3". Revised Exhibit A-3 is attached hereto and
28 incorporated herein by this reference.
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1 2. That the following section shall be inserted into COUNTY Agreement No. 16-221, at
2 Page Three (3), Paragraph One (1), Line Twenty-Six (26):
3 "K. CONTRACTOR shall align programs, services, and practices with the vision,
4 mission, and guiding principles of the DBH, as further described in Exhibit O, "Fresno County
5 Department of Behavioral Health Guiding Principles of Care Delivery", attached hereto and by this
6 reference incorporated herein and made part of this Agreement.
7 L. CONTRACTOR shall send to County's DBH upon execution of this Agreement, a
8 detailed plan ensuring clinically appropriate leadership and supervision of their clinical program.
9 Recruitment and retaining clinical leadership with the clinical competencies to oversee services based
10 on the level of care and program design presented herein shall be included in this plan. A description
11 and monitoring of this plan shall be provided.
12 M. CONTRACTOR shall participate in utilizing and integrating the Reaching
13 Recovery and other clinical tools and measures as directed by the DBH.
14 N. It is the expectation of the COUNTY that CONTRACTOR provide timely access
15 to services that meet the State of California standards for care. CONTRACTOR shall track timeliness
16 of services to clients and provide a monthly report showing the monitoring or tracking tool that
17 captures this data. COUNTY and CONTRACTOR shall meet to go over this monitoring tool on a
18 monthly basis as needed. COUNTY shall take corrective action if there is a failure to comply by
19 CONTRACTOR with the above timely access standards. CONTRACTOR shall also provide tracking
20 tools and measurements for effectiveness, efficiency, and client satisfaction indicators as required by
21 Commission on Accreditation of Rehabilitation Facilities (CARF) standards and as further detailed in
22 Exhibit A-1, Exhibit A-2 and Revised Exhibit A-3.
23 O. CONTRACTOR may maintain its records in COUNTY's electronic health record
24 (EHR) system (currently Avatar, the preferred EHR system by DBH) in accordance with Exhibit D,
25 "Documentation Standards for Client Records", as licenses become available. The client record shall
26 begin with registration and intake, and include client authorizations, assessments, plans of care, and
27 progress notes, as well as other documents as approved by COUNTY's DBH. COUNTY shall be
28 allowed to review records of services provided, including the goals and objectives of the treatment
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1 plan, and how the therapy provided is achieving the goals and objectives. If CONTRACTOR
2 determines to maintain its records in Avatar, it shall provide COUNTY's DBH Director, or his or her
3 designee, with a thirty (30) day notice. If at any time CONTRACTOR chooses not to maintain its
4 records in Avatar, it shall provide COUNTY's DBH Director, or his or her designee, with a thirty (30)
5 days advance written notice and CONTRACTOR will be responsible for obtaining its own system, at its
6 own cost, for electronic health records management.
7 Disclaimer
8 COUNTY makes no warranty or representation that information entered into the
9 COUNTY's DBH EHR system by CONTRACTOR will be accurate, adequate or satisfactory for
10 CONTRACTOR's own purposes or that any information in CONTRACTOR's possession or control, or
11 transmitted or received by CONTRACTOR, is or will be secure from unauthorized access, viewing,
12 use, disclosure, or breach. CONTRACTOR is solely responsible for client information entered by
13 CONTRACTOR into the COUNTY's DBH EHR system. CONTRACTOR agrees that all Private Health
14 Information (PHI) maintained by CONTRACTOR in COUNTY's DBH EHR system will be maintained in
15 conformance with all HIPAA laws, as stated in Section Nineteen (19), "Health Insurance Portability and
16 Accountability Act."
17 3. That the existing COUNTY Agreement No. 16-221, all text in reference to "Exhibit B-1"
18 shall be replaced with text "Revised Exhibit B-1". Revised Exhibit B-1 is attached hereto and
19 incorporated herein by this reference.
20 4. That the existing COUNTY Agreement No. 16-221, all text in reference to "Exhibit B-2"
21 shall be replaced with text "Revised Exhibit B-2". Revised Exhibit B-2 is attached hereto and
22 incorporated herein by this reference.
23 5. That the existing COUNTY Agreement No. 16-221, Page Six (6), beginning with
24 Paragraph Four (4), Line Two (2), with the word "The" and ending on Page Seven (7), Line Nine (8)
25 with the word, "Agreement" be deleted and the following inserted in its place:
26 "The maximum amount for the period July 1, 2018 through June 30, 2019 shall not
27 exceed Seven Million Five Hundred Thirty Six Thousand Fifty One and No/100 Dollars
28 ($7,536,051.00).
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1 For the period July 1, 2018 through June 30, 2019, it is understood by CONTRACTOR
2 and COUNTY that CONTRACTOR estimates to generate Three Million Two Hundred Two Thousand
3 Eight Hundred Twenty Two and No/100 Dollars ($3,202,822.00) in Medi-Cal Federal Financial
4 Participation (FFP) with Four Million Three Hundred Thirty Three Thousand Two Hundred Twenty Nine
5 and No/100 Dollars ($4,333,229.00) in other revenue/funding sources to offset CONTRACTOR's
6 program costs, as set forth in Revised Exhibit B-1.
7 The maximum amount for the period July 1, 2019 through June 30, 2020 shall not
8 exceed Eight Million Twenty-Six Thousand Nine Hundred Seventy One and No/100 Dollars
9 ($8,026,971.00).
10 For the period July 1, 2019 through June 30, 2020, it is understood by CONTRACTOR
11 and COUNTY that CONTRACTOR estimates to generate Three Million Four Hundred Eleven
12 Thousand Four Hundred Sixty Three and No/100 Dollars ($3,411,463.00) in Medi-Cal Federal
13 Financial Participation (FFP) with Four Million Six Hundred Fifteen Thousand Five Hundred Eight and
14 No/100 Dollars ($4,615,508.00) in other revenue/funding sources to offset CONTRACTOR's program
15 costs, as set forth in Revised Exhibit B-1.
16 The maximum amount for the period July 1, 2020 through June 30, 2021 shall not
17 exceed Eight Million Two Hundred Seventeen Thousand Seven Hundred Fifty Nine and No/100
18 Dollars ($8,217,759.00).
19 For the period July 1, 2020 through June 30, 2021, it is understood by CONTRACTOR
20 and COUNTY that CONTRACTOR estimates to generate Three Million Four Hundred Ninety Two
21 Thousand Five Hundred Forty Eight and No/100 Dollars ($3,492,548.00) in Medi-Cal Federal Financial
22 Participation (FFP) with Four Million Seven Hundred Twenty Five Thousand Two Hundred Eleven and
23 No/100 Dollars ($4,725,211.00) in other revenue/funding sources to offset CONTRACTOR's program
24 costs, as set forth in Revised Exhibit B-1.
25 In no event shall the total maximum compensation for actual adult crisis stabilization
26 services performed at the Adult CSC under the terms and conditions of this Agreement be in excess of
27 Thirty Seven Million Thirty Two Thousand One Hundred Sixty Nine and No/100 Dollars
28 ($37,032,169.00) during the total five (5) year terms of this Agreement."
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1 6. That the existing COUNTY Agreement No. 16-221, Page Eight (8), beginning with
2 Paragraph Four (4), Line Six (6), with the word "The" and ending on Page Nine (9), Line Eleven (11)
3 with the word, "Agreement" be deleted and the following inserted in its place:
4 "The maximum amount for the period July 1, 2018 through June 30, 2019 shall not
5 exceed Three Million Seventy Eight Thousand One Hundred Five and No/100 Dollars ($3,078,105.00).
6 For the period July 1, 2018 through June 30, 2019, it is understood by CONTRACTOR
7 and COUNTY that CONTRACTOR estimates to generate One Million Three Hundred Twenty Three
8 Thousand Five Hundred Eighty Five and No/100 Dollars ($1,323,585.00) in Medi-Cal Federal
9 Financial Participation (FFP) with One Million Seven Hundred Fifty Four Thousand Five Hundred
10 Twenty and No/100 Dollars ($1,754,520.00) in other revenue/funding sources to offset
11 CONTRACTOR's program costs, as set forth in Revised Exhibit B-2.
12 The maximum amount for the period July 1, 2019 through June 30, 2020 shall not
13 exceed Three Million Two Hundred Seventy Eight Thousand Six Hundred Eighty-Five and No/100
14 Dollars ($3,278,685.00).
15 For the period July 1, 2019 through June 30, 2020, it is understood by CONTRACTOR
16 and COUNTY that CONTRACTOR estimates to generate One Million Four Hundred Nine Thousand
17 Eight Hundred Thirty Five and No/100 Dollars ($1,409,835.00) in Medi-Cal Federal Financial
18 Participation (FFP) with One Million Eight Hundred Sixty Eight Thousand Eight Hundred Fifty and
19 No/100 Dollars ($1,868,850.00) in other revenue/funding sources to offset CONTRACTOR's program
20 costs, as set forth in Revised Exhibit B-2.
21 The maximum amount for the period July 1, 2020 through June 30, 2021 shall not
22 exceed Three Million Three Hundred Fifty-Nine Thousand Two Hundred Seventy Five and No/100
23 Dollars ($3,359,275.00).
24 For the period July 1, 2020 through June 30, 2021, it is understood by CONTRACTOR
25 and COUNTY that CONTRACTOR estimates to generate One Million Four Hundred Forty Four
26 Thousand Four Hundred Eighty Eight and No/100 Dollars ($1,444,488.00) in Medi-Cal Federal
27 Financial Participation (FFP) with One Million Nine Hundred Fourteen Thousand Seven Hundred
28
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1 Eighty Seven and No/100 Dollars ($1,914,787.00) in other revenue/funding sources to offset
2 CONTRACTOR's program costs, as set forth in Revised Exhibit B-2.
3 In no event shall the total maximum compensation for actual youth crisis stabilization
4 services performed at the Youth CSC under the terms and conditions of this Agreement be in excess
5 of Fifteen Million Seventy Six Thousand One Hundred Sixteen and No/100 Dollars ($15,076,116.00)
6 during the total five (5) year terms of this Agreement."
7 7. That the existing COUNTY Agreement No. 16-221, Page Ten (10), beginning with
8 Paragraph Four (4), Line Six (6), with the word "In" and ending on Page Ten (10), Line Nine (9) with
9 the word, "Agreement" be deleted and the following inserted in its place:
10 "In no event shall the total maximum compensation for actual Access Line services
11 performed under the terms and conditions of this Agreement be in excess of One Million Five Hundred
12 Eighteen Thousand Seven Hundred Ten and No/100 Dollars ($1,518,710.00) during the total five (5)
13 year term of this Agreement."
14 8. That the following section shall be inserted into COUNTY Agreement No. 16-221 at
15 Page Twelve (12), Paragraph Five (5), Line Twenty-Three (23):
16 "B. COUNTY's DBH shall invoice CONTRACTOR in arrears by the fifth (5th) day of
17 each month for the prior month's fees for hosting, maintenance and applicable licenses for access to
18 Avatar in accordance with the fee schedule provided by COUNTY's DBH. CONTRACTOR shall
19 provide payment for these expenditures to COUNTY's Fresno County Department of Behavioral
20 Health, Accounts Receivable, P.O. Box 712, Fresno, CA 93717-0712, Attention: Business Office,
21 within forty-five (45) days after the date of receipt by CONTRACTOR of the invoicing provided by
22 COUNTY. Should an EHR system not be implemented, CONTRACTOR will not be able to make any
23 modifications to budget line items that reference costs for Avatar or an EHR."
24 9. That the existing COUNTY Agreement No. 16-221 Paragraph 5.13 through Paragraph
25 5.P be renumbered as Paragraph 5.0 through Paragraph 5.Q.
26 10. That the following shall be inserted into COUNTY Agreement No. 16-221 at Page
27 Sixteen (16), Paragraph Five (5), Line Nine (9):
28 "If CONTRACTOR elects to use their own EHR system, the EHR must have Certification
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1 Commission for Healthcare Information Technology (CCHIT) certification for Security Access Control,
2 Audit and Authentication. CONTRACTOR'S billers in the EHR system will need to sign an Electronic
3 Signature Certification (ESR)."
4 11. That the existing COUNTY Agreement No. 16-221, Page Seventeen (17), beginning with
5 Paragraph Seven (7), Line Twenty-Eight (28), with the word "Notwithstanding" and ending on Page
6 Eighteen (18), Line Eight (8) with the word, "Office" be deleted and the following inserted in its place:
7 "Notwithstanding the above, changes to expense category (i.e., Personnel Expenses,
8 Operating Expenses, Financial Services Expenses, etc.) subtotals in the individual program budgets,
9 as set forth in Exhibits B-1 through B-3, that do not exceed ten percent (10%) of the maximum
10 compensation payable to the CONTRACTOR and movement of funds between the Adult CSC and
11 Youth CSC budgets that does not exceed ten percent (10%) of the combined maximum compensation
12 of the referenced budgets payable to the CONTRACTOR, may be made with the signed written
13 approval of COUNTY's DBH Director, or his or her designee, and CONTRACTOR. Changes to the
14 expense category subtotals items in the individual program budgets that exceed ten percent (10%) of
15 the maximum compensation payable to the CONTRACTOR and movement of funds between the
16 Adult CSC and Youth CSC budgets that exceed ten percent (10%) of the combined maximum
17 compensation of the referenced budgets payable to the CONTRACTOR, may be made with the signed
18 written approval of COUNTY's DBH Director, or his or her designee, and CONTRACTOR through an
19 amendment approved by COUNTY's Counsel and COUNTY's Auditor-Controller/Treasurer-Tax
20 Collector's Office. Said expense category subtotal changes shall not result in any change to the
21 annual maximum compensation amount payable to CONTRACTOR, as stated in this Agreement.
22 Changes to the volume of units of services/types of service units and changes to the service rate to be
23 provided as set forth in Revised Exhibits B-1 through B-3, may be made with the written approval of
24 COUNTY's DBH Director, or his or her designee."
25 12. That the existing COUNTY Agreement No. 16-221, all text in reference to "Exhibit D"
26 shall be replaced with text "Revised Exhibit D". Revised Exhibit D is attached hereto and incorporated
27 herein by this reference.
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1 13. That the existing COUNTY Agreement No. 16-221, all text in reference to "Exhibit E"
2 shall be replaced with text "Revised Exhibit E". Revised Exhibit E is attached hereto and incorporated
3 herein by this reference.
4 14. That the following shall be inserted into COUNTY Agreement No. 16-221 at Page
5 Twenty-Two (22), Paragraph Twelve (12), Line One (1):
6 "All medical records shall be maintained for a minimum of ten (10) years from the date of
7 the end of the Agreement."
8 15. That the existing COUNTY Agreement No. 16-221, all text in reference to "Exhibit H"
9 shall be replaced with text "Revised Exhibit H". Revised Exhibit H is attached hereto and incorporated
10 herein by this reference.
11 16. That the existing COUNTY Agreement No. 16-221, Page Thirty (30), beginning with
12 Paragraph Twenty-Two (22), Line Twenty-Five (25), with the word "During" and ending on Page Thirty-
13 One (31), Line Two (2) with the word, "regulation" be deleted and the following inserted in its place:
14 "During the performance of this Agreement, CONTRACTOR and its subcontractors shall
15 not deny the contract's benefits to any person on the basis of race, religious creed, color, national
16 origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital
17 status, sex, gender, gender identity, gender expression, age, sexual orientation, or military and
18 veteran status, nor shall they discriminate unlawfully against any employee or applicant for
19 employment because of race, religious creed, color, national origin, ancestry, physical disability,
20 mental disability, medical condition, genetic information, marital status, sex, gender, gender identity,
21 gender expression, age, sexual orientation, or military and veteran status. CONTRACTOR shall
22 insure that the evaluation and treatment of employees and applicants for employment are free of such
23 discrimination. CONTRACTOR and subcontractors shall comply with the provisions of the Fair
24 Employment and Housing Act (Gov. Code §12900 et seq.), the regulations promulgated thereunder
25 (Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter 1, Part 1, Division 3,
26 Title 2 of the Government Code (Gov. Code §§11135-11139.5), and the regulations or standards
27 adopted by the awarding state agency to implement such article. Contractor shall permit access by
28 representatives of the Department of Fair Employment and Housing and the awarding state agency
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1 upon reasonable notice at any time during the normal business hours, but in no case less than twenty
2 (24) hours' notice, to such of its books, records, accounts, and all other sources of information and its
3 facilities as said Department or Agency shall require to ascertain compliance with this clause.
4 CONTRACTOR and its subcontractors shall give written notice of their obligations under this clause to
5 labor organizations with which they have a collective bargaining or other agreement. (See Cal. Code
6 Regs., tit. 2, §11105.) CONTRACTOR shall include the Non-Discrimination and compliance provisions
7 of this clause in all subcontracts to perform work under the Agreement."
8 17. That the following section shall be inserted into COUNTY Agreement No. 16-221 at
9 Page Thirty-Two (32), Paragraph Twenty-Three (23), Line Ten (10):
10 "F. CONTRACTOR shall be responsible for conducting an annual cultural
11 competency self-assessment and provide the results of said self-assessment to the COUNTY"S DBH.
12 The annual cultural competency self-assessment instruments shall be reviewed by the COUNTY and
13 revised as necessary to meet the approval of the COUNTY.
14 G. Cultural competency training for CONTRACTOR staff should be substantively
15 integrated into health professions education and training at all levels, both academic and functional,
16 including core curriculum, professional licensure, and continuing professional development programs.
17 On an annual basis, CONTRACTOR's direct service providers shall complete eight (8) hours of
18 cultural competency training. CONTRACTOR on a monthly basis shall provide COUNTY DBH a
19 monthly monitoring tool/report that shows cultural competency trainings completed.
20 H. CONTRACTOR shall attend the COUNTY's Cultural Competency Committee
21 monthly meetings, maintain its own cultural competence oversight committee, and develop a cultural
22 competency plan to address and evaluate cultural competency issues."
23 "24. AMERICANS WITH DISABILITIES ACT
24 CONTRACTOR agrees to ensure that deliverables developed and produced,
25 pursuant to this Agreement shall comply with the accessibility requirements of Section 508 of the
26 Rehabilitation Act and the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)),
27 and regulations implementing that Act as set forth in Part 1194 of Title 36 of the Code of Federal
28 Regulations. In 1998, Congress amended the Rehabilitation Act of 1973 to require Federal agencies
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1 to make their electronic and information technology (EIT) accessible to people with disabilities.
2 California Government Code section 11135 codifies section 508 of the Act requiring accessibility of
3 electronic and information technology."
4 18. That the existing COUNTY Agreement No. 16-221 Paragraph Twenty-Four (24) through
5 Paragraph Thirty-Six (36) be renumbered as Paragraph Twenty-Five (25) through Paragraph Thirty-
6 Seven (37).
7 19. That the existing COUNTY Agreement No. 16-221, Page Thirty-Three (33), beginning
8 with Paragraph Twenty-Five (25), Line Two (2), with the word "If" and ending on Line Five (5) with the
9 word "A-133", be deleted and the following inserted in its place:
10 "If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00) or
11 more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual audit
12 in accordance with the requirements of the Single Audit Standards as set forth in Office of
13 Management and Budget (OMB) 2 CFR 200."
14 20. That the existing COUNTY Agreement No. 16-221, Page Thirty-Eight (38), beginning
15 with Paragraph Thirty (30), Line Twenty (20), with the word "Submissions" and ending on Line Twenty-
16 One (21) with the word "Administration", be deleted and the following inserted in its place:
17 "CONTRACTOR is required to submit a set of fingerprints for any person with a five (5)
18 percent or greater direct or indirect ownership interest in CONTRACTOR. COUNTY may terminate
19 this Agreement where any person with a five (5) percent or greater direct or indirect ownership interest
20 in the CONTRACTOR and did not submit timely and accurate information and cooperate with any
21 screening method required in CFR, title 42, section 455.416. Submissions shall be scanned pdf
22 copies and are to be sent via email to DBHAdministration@co.fresno.ca.us, Attention: Contracts
23 Administration. COUNTY may deny enrollment or terminate this Agreement where any person with a
24 five (5) percent or greater direct or indirect ownership interest in CONTRACTOR has been convicted
25 of a criminal offense related to that person's involvement with the Medicare, Medicaid, or title XXI
26 program in the last (ten) 10 years."
27 21. COUNTY and CONTRACTOR agree that this Amendment I is sufficient to amend the
28 Agreement; and that upon execution of this Amendment I, the Agreement and Amendment I together
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1 shall be considered the Agreement.
2 The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
3 covenants, conditions and promises contained in the Agreement, and not amended herein, shall
4 remain in full force and effect. This Amendment I shall become effective upon execution by all parties.
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I EXECUTED AND EFFECTIVE as of the date first above set forth.
2
3 CONTRACTOR ) COUNTY OF FRESNO
4
5 (Authorized Signatur ) Nathan Magsig, Chairman of the Board of
Supervisors of the County of Fresno
Luana Murphy
6 Print Name
7 PRESIDENT/CEO
8 Title (Chairman of Board, or President, ATTEST:
or CEO) Bernice E. Seidel
9 Clerk to the Board of Supervisors
10 - County of Fresno, State of California
(Authorized Signature)
11 LeeAnn Skorohod
12 Print Name By:
13 Secretary/CFO/COO Deputy
Title (Secretary of Corporation, or Chief
14 Financial Officer/Treasurer, or any
Assistant Secretary or Treasurer
15
16
MAILING ADDRESS:
17 Exodus Recovery, Inc.
9808 Venice Boulevard, Suite 700
18 Culver City, CA 90232
Contact: Luana Murphy, President/CEO
19 Phone No.: (310) 945-3350
20
FOR ACCOUNTING USE ONLY:
21 Fund/Subclass: 0001/10000
Org No.: 56302110 (Adult CSC), 56302111 (Youth CSC), 56302011 (Access Line)
22 Account No.: 7295
23
Fiscal Year Adult CSC Youth CSC Access Line Total
24 FY 2016-17 $ 6,527,765 $ 2,640,397 $ 266,285 $ 9,434,447
FY 2017-18 $ 6,723,623 $ 2,719,657 $ 296,883 $ 9,740,163
25 FY 2018-19 $ 7,536,051 $ 3,078,105 $ 307,445 $10,921,601
FY 2019-20 $ 8,026,971 $ 3,278,685 $ 318,384 $11,624,040
26 FY 2020-21 $ 8,217,759 $ 3,359,275 $ 329,713 $11,906,747
Total: $37,032,169 $15,076,119 $1,518,710 $53,626,998
27
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REVISED EXHIBIT A-3
Page 1 of 6
ACCESS LINE
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA 93702 (Bldg. 319)
SERVICES: Access Line Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: July 1, 2016—August 31, 2016 (Ramp Up Period)
September 1, 2016 — June 30, 2019, with two (2) twelve (12) month renewal
options
CONTRACT AMOUNT: Contract Maximum Fiscal Year
$23,678 07/1/2016 through 08/31/2016 (Ramp Up Period)
$242,607 09/01/2016 through 06/30/2017 (Initial Operating Period)
$296,883 FY 2017-18
$307,445 FY 2018-19
$318,384 FY 2019-20
$329,713 FY 2020-21
SCHEDULE OF SERVICES:
CONTRACTOR shall operate a State-mandated toll-free answering service (Access Line) twenty-four (24)
hours per day, seven (7) days per week. The Access Line 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.
PROJECT DESCRIPTION:
CONTRACTOR shall provide answering services for the Department of Behavioral Health in accordance with
State and Federal Regulations and utilize the Access Line Database to log all calls. Access line services are
not to be subcontracted out. The 1 (800) 654-3937 access line will be a separate phone line from the Adult
and Youth Crisis Stabilization (CSC) main lines. Calls received on the access line will be monitored and
recorded separately.
1. The Department of Behavioral Health (DBH) is mandated by the State of California to maintain a written
log of all requests for specialty mental health services. The log must include specific information about
each call.'
2. State regulations require that the toll-free, 24/7, Access Line established by DBH also provides
information to Medi-Cal beneficiaries about how to access specialty mental health services, including
information about the grievance and appeals processes and the State's fair hearing system.2
California Code of Regulations(CCR):Title 9,Chapter 11,Section 1810.405(f)& State Department of Health Care Services Program Oversight and
Compliance-Annual Review Protocol for Consolidated Specialty Mental Health Services and Other Funded Services"Section A—Access.
2 California Code of Regulations(CCR):Title 9,Section 1850.205,and Code of Federal Regulations(CFR):Title 42, Part 438,Subpart F.
REVISED EXHIBIT A-3
Page 2 of 6
3. The Access Line database ("Database") is developed with intuitive, decision-tree type functionality, and
incorporates the requirements stated within the state regulations referenced above. The Database
shall be the mechanism used for collection of caller/client information received by phone and to provide
callers with information as required by the State.
4. Outcomes and expectations for the Access Line may evolve over time, based on changes to State and
Federal Regulations as well as departmental needs and goals. Any changes to Access Line will be
made at the discretion of the Department of Behavioral Health.
5. The Access line shall assess and screen the needs of the caller. The Access line shall triage the call to
meet the needs of each client. Triage shall be provided by staff appropriate to the needs of the client
(nursing staff, clinical staff, etc. as needed). Direct linkage with an appropriate plan for each client shall
be provided. When available, scheduling to make client appointments would also be provided.
6. Access line screening shall be provided for mental health and substance use disorder services. For
substance use disorder only calls, CONTRACTOR will transfer or warm hand off to the substance use
disorder-specific Access Line. The access line services shall be flexible to meet the growing and
changing needs of the Department's program and client needs. CONTRACTOR Access Line staffing
pattern will be based on call volume. The Department and CONTRACTOR shall work jointly on future
changing needs of the Department, as needed.
CONTRACTOR'S RESPONSIBILITIES:
CONTRACTOR will utilize the Access Line to triage all calls received and provide linkage, as appropriate.
Calls requiring Emergency Services or Crisis Stabilization Services will be transferred to the appropriate
agency for follow up. Calls not requiring Emergency Services or Crisis Stabilization services will be evaluated
for mental health and/or substance use linkage. Access Line operators will utilize resources including but not
limited to client information within COUNTY's Avatar Electronic Health Record system (Avatar), knowledge of
Department of Behavioral Health programs, and community programs to evaluate the caller's need and form
an action plan with the caller. Callers will be provided with clear instruction regarding next steps. All calls
received, including those transferred to Emergency Services or Crisis Stabilization Services, will be
documented in the Access Line Database, identifying, at minimum, callers Name, Date of Call, and Disposition.
1. Access Line Database: The Database is located at https://www.FCMHPAccessline.com and will be
made available to designated staff. Effective January 1, 2019, the Database will be available via
COUNTY's Avatar. The Database is designed to assist answering service operators handle calls of the
following nature. Each call type requires specific information to be gathered as indicated by the
corresponding call screen. All calls logged within the Access Log will be identified as an Emergency
Call or Non-Emergency call, as listed below in subsection "a" and "b."
a. Emergency Calls. These calls may require a warm hand-off to emergency medical services
dispatchers. When a call is received and the caller reports self or other to be in crisis or you
cannot be sure of their safety, the following five-step suicide assessment, evaluation, and triage
should be conducted:
1) Identify Risk Factors. Note those that can be modified to reduce risk. Determine if the caller
is alone.
2) Identify Protective Factors. Not those that can be enhanced. If caller is with someone, ask
caller if they are feeling unsafe (harm to self or others, risk of harm by others). If no risk of
harm by others, ask permission to speak to the person to obtain their input and information
about the present situation and history. Ask the caller if they have a therapist and if so, when
is their next appointment.
REVISED EXHIBIT A-3
Page 3 of 6
3) Conduct Suicide Inquiry. Suicidal thoughts, behavior, intent, plan and means, and lethality of
means. Ask about previous suicide attempts and by what means.
4) Determine Risk Level/Intervention. Determine risk. Choose appropriate intervention to
address and reduce risk.
5) Document. Document your assessment of risk, rationale, intervention, and follow up. Inform
treating provider of the call and interventions.
i. If it is determined that the caller is in danger, you may offer to call 9-1-1 for them
to do a safety check and determine if a 5150 hold should be written.
ii. If the caller is with someone who is safe and feels they can transport the caller to
the CSU, recommend that they bring the caller in for an immediate evaluation.
b. Non-Emergency Calls
1) The caller is requesting only information about mental health services and does not wish
to access services at the time nor receive a call back.
2) The caller is requesting mental health services.
3) The caller wishes to leave a message for his/her current care provider.
4) The caller is requesting a Medi-Cal Mental Health Booklet or Provider List.
5) The caller wishes to file or obtain information about how to file a complaint, grievance, or
appeal with the Fresno County Mental Health Plan.
6) The caller is calling for information about services from the Fresno County Mental Health
Plan (DBH) or about something other than what is mentioned above.
c. User Accounts: Access to the Database for designated CONTRACTOR staff shall be restricted
to inputting call data only.
1) New User Account: CONTRACTOR must submit the following for each designated staff
member requiring access to the Database to set up a user account:
i. First and last name,
ii. Hire date (mm/dd/yyyy), and
iii. Unique identification number (employee ID, clock-in ID, etc.) as assigned by
CONTRACTOR.
2) Account: CONTRACTOR shall notify DBH within 24 hours of any change to user status
or when a user is no longer employed by CONTRACTOR.
d. Password Resets:
1) During Normal Business Hours: A user can request his/her password to be reset by
personally calling DBH's Information Systems Division Services (ISDS) during normal
business hours. User must verify his/her identity by providing ISDS their full name, hire
date and unique Identification. A new temporary password will be provided upon
satisfactory self-identification.
2) After Normal Business Hours: User will not be able to have his/her password reset after
normal business hours as ISDS will be closed. It is expected that CONTRACTOR staff
assigned to operate the Access Line will set their user accounts during DBH business
hours.
REVISED EXHIBIT A-3
Page 4 of 6
2. Log All Calls:
a. All calls received on the Access Line phone number and by any DBH program utilizing the
phone service shall be logged into the Database, including calls patched to 911 as well as non-
mental health related requests.
b. Information about programs and services requested by callers shall be provided in accordance
to instructions in the Database decision tree.
c. If a user is unable to access the Database temporarily for any reason to log calls (including staff
without an appropriate user account), the user shall document the call by gathering the following
information about the call/caller/client. This information will then be transmitted to DBH via a
facsimile machine to a designated confidential electronic fax number provided by DBH: For
adults, FAX will be transmitted to (559) 600-7615. For children (less than 18 years of age) FAX
will be transmitted to (559) 600-7701.
1) Call Type
2) Interpreter Needed? (No/Yes)
3) Language (Specify)
4) Info is for Caller/Client (Identify)
5) First Name
6) Last Name
7) Call Back Phone #
8) Date of Birth (of person seeking services)
9) Estimated Age (Ask for this information only after DOB has been requested and cannot
be provided)
10)Comments (Specify the reason for call: caller wants to file an appeal, hearing voices
and wants to talk to a therapist, connected to 911, etc.)
If the frequency of such occurrences (inability to access the database) reaches a level, as
determined by DBH and regardless of cause that warrants more detailed information to be
logged, CONTRACTOR may be requested to provide up to the level of detail as is collected by
the Database. It is the responsibility of CONTRACTOR to notify DBH, ISDS staff, or designated
staff if the Database Access Log is not accessible.
3. Language Interpreter Services: CONTRACTOR shall utilize the account set up through Fresno
County's contracted language line provider, currently Linguistica International, to provide interpreter
services to callers when necessary or appropriate. A Language Line Quick Reference Guide is
embedded in the Database as part of the decision tree to assist operators with accessing this service.
a. Instances considered necessary or appropriate include, but are not limited to, when such
services is being requested or is accepted by the caller; the operator does not speak the caller's
language; or the operator feels such services are necessary for effective communication with
the caller.
b. All costs related to the use of language line services through this account will be paid for by
Fresno County directly to the contracted language line provider and shall not be a part of this
Agreement.
c. DBH is not responsible for costs related to interpreter services provided to callers by any other
party or agency.
REVISED EXHIBIT A-3
Page 5 of 6
4. TDD/Relay Service: CONTRACTOR shall utilize either a Telecommunication Device for the Deaf
(TDD) service or Telecommunication Relay Services (TRS) when handling calls from clients who are
Deaf, Hard of Hearing, Speech-Disabled or Deaf and Blind. CONTRACTOR may utilize the TRS if
unable to secure TDD equipment, to communicate with a caller whom the operator determines may be
deaf, hearing-impaired or speech-disabled.
5. Evaluation of Protocols: CONTRACTOR and DBH will collaborate in the ongoing evaluation of
protocols for the design and flow of Access Line services. Changes to the Access Line will be mutually
agreed upon by CONTRACTOR and DBH and be in accordance with mandates by the State of
California.
PERFORMANCE MEASUREMENTS AND MONITORING
As mandated by the State, CONTRACTOR shall meet all performance goals on a monthly basis as detailed
below in Table A. The Database is designed to enable telephone operators to appropriately handle calls
received on the Access Line and to collect the required information within the Access Log.
1. Performance Measures:
Table A: Performance Measures
# Performance Measure Goal
1. Call was logged in Access Line Database 100%
2. Operator asked if the caller's/client's situation is an emergency 100%
3. Operator asked for caller's/client's name 100%
4. Operator logged caller's/client's name accurately in Database. Calls where 100%
caller does not provide a name will be recorded as such, "No Name Provided."
5. Operator asked for caller's/client's call back phone number 100%
6. Operator logged caller's/client's call back phone number accurately in Database 100%
7. Operator asked for the reason for call 100%
8. Operator logged the reason for call accurately in Database 100%
9. Operator utilized language line service when applicable 100%
a. Caller requests/accepts interpreter services
b. Operator does not speak the caller's language
c. Operator feels interpreter services are necessary
10. Operator provided appropriate linkages to mental health services 100%
a. To the adult services program(s) as indicated in the Access Line
Database
b. To the children's services program(s) as indicated in the Access Line
Database
11. Operator provided information on the grievances/appeals/State fair hearing 100%
process
2. Performance Monitoring: DBH will conduct test calls of the Access Line on a monthly basis to monitor
the performance measures described in Table A.
a. Test calls may be made in English and/or non-English languages as deemed appropriated by
DBH.
REVISED EXHIBIT A-3
Page 6 of 6
b. The number of test calls performed by DBH to the Access Line each month shall, at minimum,
match the number of test calls conducted by the State during their review of the Access Line as
stated in the most recent version of the State Medi-Cal Protocol. For Fiscal Year 2016-17, the
number of test calls will be, at minimum, seven (7) per month.
c. Test Call Outcomes Feedback: DBH will provide feedback on test call outcomes to
CONTRACTOR designated staff overseeing the Access Line as follows:
1) The results of test calls shall be provided to CONTRACTOR designated staff as soon as
possible after all calls are performed and the "Access Line Test Call Feedback Form"
(Revised Exhibit M) is completed. Form is to be completed by Test Caller. The form may
be updated to reflect new reporting needs as appropriate.
2) The results of individual test calls shall be provided to CONTRACTOR designated staff
within 24 hours or as soon as possible, if needed, if immediate concerns arises as the
result of the call.
3) A monthly Test Call Outcomes Summary Report of all test calls performed during the
preceding month shall be provided to CONTRACTOR within 14 days after month end.
3. Corrective Action Plan: An "Access Line Statement of Deficiencies and Plan of Correction" (Revised
Exhibit N) shall accompany the monthly Test Call Outcomes Summary Report if any goal was unmet
(outcome falls below 100%) or issues related to test calls were not resolved satisfactorily. The form
may be updated to reflect new reporting needs as appropriate.
a. The "Category" and "Summary Statement of Deficiencies" will be completed by DBH based
upon findings from the monthly report.
b. CONTRACTOR shall complete the "Provider's Plan of Correction" and "Completion Date"
sections, sign and date the form and return it to the department within 14 calendar days from
the date of receipt.
c. The completed form shall be returned to the designated DBH staff, in compliance with HIPAA
regulations regarding safeguarding client information when applicable.
E-MAILING PROTECTED HEALTH INFORMATION (PHI)
Any e-mail communication with/to DBH staff containing client Protected Health Information (PHI) shall be done
so in compliance with HIPAA regulations on PHI as follows:
1. Include the Confidentiality Statement below at the beginning of all a-mails containing PHI and at the
beginning of each e-mail in a string of emails that contain PHI.
2. Confidentiality Statement:
Confidentiality Statement: This e-mail message, including any attachments, is for the
sole use of the intended recipient(s) and may contain confidential and privileged
information. Any unauthorized review, use, disclosure or distribution is prohibited. If you
are not the intended recipient, please contact the sender without using reply e-mail and
destroy all copies of the original message.
3. Examples of PHI: Client Name, Address, Phone Number, Date of Birth, Social Security Number
4. Do not include the client's name in the "Subject" line of the e-mail.
5. All phone calls and messages emailed to DBH staff containing PHI shall be sent as an encrypted
attachment. A standard password will be provided by DBH. Do not list the password within the body of
the e-mail.
Note: when appropriate, DBH ISDS staff is available to provide technical support.
REVISED EXHIBIT B-1
Page 1 of 20
Adult Crisis Stabilization Center =
Exodus Recovery, Inc.
July 1, 2016 to June 30, 2017
Budget Categories- Total Proposed Budget
Line Item Description (Must be itemized) FTE % Admin. Direct Total
PERSONNEL SALARIES:
0001 VP Northern Region 0.25 $35,750 $35,750
0002 Program Director(RN) 0.75 $134,536 $1,359 $135,895
0003 Program Nurses 16.80 $1,178,174 $1,178,174
0004 Social Service Coordinators 2.50 $143,714 $143,714
0005 Mental Health Worker 12.60 $459,480 $459,480
0006 Data Specialist 1.00 $32,500 $32,500
0007 Benefits/PAP Coordinator 1.00 $37,596 $37,596
0008 Program Assistant 1.00 $68,455 $68,455
0009 Driver 1.00 $31,200 $31,200
0010 Peer Counselor 2.00 $41,600 $41,600
0011 Intake Coordinator 0.50 $24,960 $24,960
0012 Billing Supervisor 0.20 $13,728 $13,728
SALARY TOTAL 39.60 $420,325 $1,782,727 $2,203,052
PAYROLL TAXES:
0030 OASDI $3,909 $16,579 $20,488
0031 FICA/MEDICARE $33,122 $140,479 $173,601
0032 SUI $7,763 $32,462 $40,225
PAYROLL TAX TOTAL $44,794 $189,520 $234,314
EMPLOYEE BENEFITS:
0040 Retirement $16,813 $71,309 $88,122
0041 Workers Compensation $27,321 $115,877 $143,198
0042 Health Insurance (medical vision, life, dental) 1 $54,642 $231,755 $286,397
EMPLOYEE BENEFITS TOTAL 1 $98,776 $418,941 $517,717
SALARY& BENEFITS GRAND TOTAL $2,955,083
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $33,503
1012 Utilities $73,796
1013 Janitorial $67,131
1014 Maintenance (facility) $26,041
1015 Security Personnel $901,085
1016 Maintenance (durable medical equipment) $0
1017 Other- Business Taxes/Licenses-Permits $8,520
1018 Other-One Time Start-Up Costs $0
FACILITY/EQUIPMENT TOTAL $1,110,076
OPERATING EXPENSES:
1060 Telephone $30,511
1061 Answering Service $0
1062 Postage $710
1063 Printing/Reproduction $12,158
1064 Publications $1,065
1065 Legal Notices/Advertising $1,775
1066 Office Supplies & Equipment $63,790
REVISED EXHIBIT B-1
Page 2 of 20
risis Sta ation Center
Exodus Recovery, Inc.
July 1, 2016 to June 30, 2017
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies -Therapeutic $0
1070 Program Supplies - Medical $32,577
1071 Transportation of Clients $3,880
1072 Staff Mileage/Vehicle Maintenance $2,982
1073 Staff Travel (Out of Office) $1,065
1074 Staff Training/Registration $40,578
1075 Lodging $0
1076 Other- Personnel Related Exp/Contracted PR Exp/Parking $1,149,267
1077 Other- Flex Funds $25,229
OPERATING EXPENSES TOTAL $1,365,587
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $26,775
1081 External Audit $4,500
1082 Liability Insurance $20,600
1083 Other-Administrative Overhead $851,447
1084 Other- (identify) $0
1085 Other- (identify) $0
FINANCIAL SERVICES TOTAL $903,322
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant (network & data management) $22,602
1088 Translation Services $1,420
1089 Medication Supports (Pharmaceuticals) $46,860
1090 Food Service $79,062
1091 Laundry Service $37,420
1092 Medical Waste Disposal $4,333
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultants $2,000
1096 Medical Services $0
1097 Access Line $0
1098 Other- (identify) $0
SPECIAL EXPENSES TOTAL $193,697
FIXED ASSETS:
2000 Computers & Software $0
2001 Furniture & Fixtures $0
2002 Other- (identify) $0
2003 Other- (identify) $0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $6,527,765
REVISED EXHIBIT B-1
Page 3 of 20
risis Stall0ation Center
Exodus Recovery, Inc.
July 1, 2016 to June 30, 2017
Vol/Units of
DIRECT SERVICE REVENUE: Service Rate $Amt.
3000 Mental Health Services (Individual/Family/Group Therapy) 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Crisis Stabilization - Urgent Care 69,048 $94.54 $6,527,765
3500 Other- (Identify) 0 $0.00 $0
3600 Other- (Identify) 0 $0.00 $0
3700 Other- (Identify) 0 $0.00 $0
DIRECT SERVICE REVENUE TOTAL 69,048 $6,527,765
Medi-cal Revenue $3,263,882
Cost Per Unit $94.54
FUNDING STREAM REIMBURSEMENT Population Served Percentage
4000 Private Insurance 7 $456,944
4100 Uninsured 15 $979,165
4200 Medi-Cal FFP 39 $2,545,828
4300 Realignment 39 $2,545,828
OTHER REVENUE/SOCIAL SERVICES TOTAL $6,527,765
TOTAL PROGRAM REVENUEJ $6,527,765
REVISED EXHIBIT B-1
Page 4 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2017 to June 30,2018
Budget Categories- Total Proposed Budget
Line Item Description Must be itemized FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 VP Northern Region 0.25 $36,823 $36,823
0002 Program Director(RN) 0.75 $138,533 $1,399 $139,932
0003 Program Nurses 16.80 $1,213,519 $1,213,519
0004 Social Service Coordinators 2.50 $148,025 $148,025
0005 Mental Health Worker 12.60 $473,264 $473,264
0006 Data Specialist 1.00 $33,475 $33,475
0007 Benefits/PAP Coordinator 1.00 $38,724 $38,724
0008 Program Assistant 1.00 $70,509 $70,509
0009 Driver 1.00 $32,136 $32,136
0010 Peer Counselor 2.00 $42,848 $42,848
0011 Intake Coordinator 0.50 $25,709 $25,709
0012 Billing Supervisor 0.20 $14,140 $14,140
SALARY TOTAL 39.60 $432,897 $1,836,207 $2,269,104
PAYROLL TAXES:
0030 OASDI $4,026 $17,077 $21,103
0031 FICA/MEDICARE $34,112 $144,693 $178,805
0032 SUI $8,011 $33,497 $41,508
PAYROLL TAX TOTAL $46,149 $195,267 $241,416
EMPLOYEE BENEFITS:
0040 Retirement $17,316 $73,448 $90,764
0041 Workers Compensation $28,138 $119,354 $147,492
0042 Health Insurance(medical vision,life,dental) $56,276 $238,707 $294,983
EMPLOYEE BENEFITS TOTAL $101,7301 $431,509 $533,239
SALARY&BENEFITS GRAND TOTAL $3,043,759
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $34,508
1012 Utilities $76,010
1013 Janitorial $69,145
1014 Maintenance(facility) $26,822
1015 Security Personnel $928,118
1016 Maintenance durable medical equipment) $0
1017 Other-Business Taxes/Licenses-Permits $8,776
1018 Other-One Time Start-Up Costs $0
FACILITY/EQUIPMENT TOTAL $1,143,379
OPERATING EXPENSES:
1060 Telephone $31,426
1061 Answering Service $0
1062 Postage $731
1063 Printing/Reproduction $12,523
1064 Publications $1,097
1065 Legal Notices/Advertising $1,828
1066 Office Supplies&Equipment $65,704
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies-Medical $33,554
1071 Transportation of Clients $3,996
1072 Staff Mileage/Vehicle Maintenance $3,071
1073 Staff Travel Out of Office $1,097
1074 Staff Train in /Reg istration $41,795
1075 Lodging $0
1076 Other-Personnel Related Ex /Contracted PR Ex /Parking Exp/Parking $1,183,743
1077 Other-Flex Funds $25,986
OPERATING EXPENSES TOTALI $1,406,551
FINANCIAL SERVICES EXPENSES:
REVISED EXHIBIT B-1
Page 5 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2017 to June 30,2018
1080 Accounting/Bookkeeping $27,578
1081 External Audit $4,635
1082 Liability Insurance $21,218
1083 Other-Administrative Overhead $876,994
1084 Other-(identify) $0
1085 Other-(identify) $0
FINANCIAL SERVICES TOTAL $930,425
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant(network&data management) $23,280
1088 Translation Services $1,463
1089 Medication Supports(Pharmaceuticals) $48,266
1090 Food Service $81,434
1091 Laundry Service $38,543
1092 Medical Waste Disposal $4,463
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultants $2,060
1096 Medical Services $0
1097 Access Line $0
1098 Other-(identify) $0
SPECIAL EXPENSES TOTAL $199,509
FIXED ASSETS:
2000 Computers&Software $0
2001 Furniture&Fixtures $0
2002 Other-(identify) $0
2003 Other-(identify) $0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $6,723,623
Vol/Units of
DIRECT SERVICE REVENUE: Service Rate $Amt.
3000 Mental Health Services(IndividuaWamily/Group Therapy) 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Crisis Stabilization-Urgent Care 71,119 $94.54 $6,723,624
3500 Other-(Identify) 0 $0.00 $0
3600 Other-(Identify) 0 $0.00 $0
3700 Other-(identify) 0 $0.00 $0
DIRECT SERVICE REVENUE TOTAL 71,119 6,723,624
Medi-cal Revenue 3,361,812
Cost Per Unit $94.54
FUNDING STREAM REIMBURSEMENT Population Served Percentage
4000 Private Insurance 7 $470,654
4100 Uninsured 15 $1,008,544
4200 Medi-Cal FFP 39 $2,622,213
4300 Realignment 39 $2,622,213
OTHER REVENUE/SOCIAL SERVICES TOTAL $6,723,624
TOTAL PROGRAM REVENUE $6,723,624
REVISED EXHIBIT B-1
Page 6 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2018 to June 30,2019
Budget Categories- Total Proposed Budget
Line Item Description Must be itemized FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Director of Education and Quality 0.71 $96,195 $96,195
0002 Program Director(RN) 0.53 $74,160 $74,160
0003 Program Nurses RN 7.65 $636,635 $636,635
0003 Program Nurses(LVN) 14.09 $849,529 $849,529
0003 Program Nurses LPTN 2.51 $109,617 $109,617
0004 Social Service Coordinators 3.37 $236,463 $236,463
0005 Mental Health Worker 16.26 $747,696 $747,696
0006 Data Specialist 0.71 $25,275 $25,275
0007 Benefits/PAP Coordinator 0.71 $33,218 $33,218
0008 Program Assistant 0.71 $34,824 $34,824
0009 Driver 0.71 $29,534 $29,534
0010 Peer Counselor 1.92 $85,248 $85,248
0011 Intake Coordinator 0.36 $18,253 $18,253
0012 Billing Supervisor 0.14 $9,033 $9,033
SALARY TOTAL 50.37 $331,580 $2,654,099 $2,985,679
PAYROLL TAXES:
0030 OASDI $28,507 $28,507
0031 FICA/MEDICARE $202,137 $202,137
0032 SUI $28,507 $28,507
PAYROLL TAX TOTAL $259,150 $259,150
EMPLOYEE BENEFITS:
0040 Retirement $129,007 $129,007
0041 Workers Compensation $185,097 $185,097
0042 Health Insurance(medical vision,life,dental) $246,796 $246,796
EMPLOYEE BENEFITS TOTAL $560,9001 $560,900
SALARY&BENEFITS GRAND TOTALI $3,805,729
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $36,336
1012 Utilities $84,540
1013 Janitorial $54,937
1014 Maintenance(facility) $26,822
1015 Security Personnel $904,178
1016 Maintenance durable medical equipment) $0
1017 Other-Business Taxes/Licenses-Permits $8,776
1018 Other-One Time Start-Up Costs $0
FACILITY/EQUIPMENT TOTAL $1,115,589
OPERATING EXPENSES:
1060 Telephone $31,618
1061 Answering Service $0
1062 Postage $1,256
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $1,380
1066 Office Supplies&Equipment $94,951
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies-Medical $53,266
1071 Transportation of Clients $6,151
1072 Staff Mileage/Vehicle Maintenance $3,071
1073 Staff Travel Out of Office $1,097
1074 Staff Train in /Re istration $23,942
1075 Lodging $0
1076 Other-Personnel Related Ex /Contracted PR Ex /Parking Exp/Parking $1,146,266
1077 Other-Flex Funds $32,090
OPERATING EXPENSES TOTAL $1,395,090
REVISED EXHIBIT B-1
Page 7 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2018 to June 30,2019
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $1,029
1081 External Audit $1,420
1082 Liability Insurance $21,219
1083 Other-Administrative Overhead $986,187
1084 Other-(identify) $0
1085 Other-(identify) $0
FINANCIAL SERVICES TOTAL $1,009,855
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant(network&data management) $38,535
1088 Translation Services $1,463
1089 Medication Supports(Pharmaceuticals) $17,528
1090 Food Service $76,894
1091 Laundry Service $28,843
1092 Medical Waste Disposal $0
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultants $1,463
1096 Medical Services $0
1097 Access Line $0
1098 Other-(identify) $0
SPECIAL EXPENSES TOTAL $164,727
FIXED ASSETS:
2000 Computers&Software $7,100
2001 Furniture&Fixtures $5,834
2002 Other-EHR Avatar Cost $32,126
2003 Other-(identify) $0
FIXED ASSETS TOTAL $45,060
TOTAL PROGRAM EXPENSES $7,536,051
$610,722
Vol/Units of
DIRECT SERVICE REVENUE: Service Rate $Amt.
3000 Mental Health Services(Individual/Family/Group Therapy) 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Crisis Stabilization-Urgent Care 61,214 $123.11 $7,536,051
3500 Other-(Identify) 0 $0.00 $0
3600 Other-(Identify) 0 $0.00 $0
3700 Other-(identify) 0 $0.00 $0
DIRECT SERVICE REVENUE TOTAL 61,214 7,536,051
Medi-cal Revenue 3,202,822
Cost Per Unit $123.11
FUNDING STREAM REIMBURSEMENT Population Served Percentage Po
4000 Private Insurance 2.0% $150,720
4100 Uninsured 13.0% $979,687
4200 Medi-Cal FFP 42.5% $3,202,822
4300 Realignment 42.5% $3,202,822
OTHER REVENUE/SOCIAL SERVICES TOTALI $7,536,051
TOTAL PROGRAM REVENUEJ $7,536,051
REVISED EXHIBIT B-1
Page 8 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
2018-2019
BUDGET NARRATIVE - EXPENSES
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes& Employee Benefits- Line Items 0001-0042
These amounts reflect FTE positions,part-time positions and whether the positions are administrative or direct service. Employee benefits should
be limited to a maximum of 20%of total salaries.
$3,805,729
All SWB and Operational expenses budget line items are split between Adult and Youth CSU as follows: 71%
adult and 29%youth.
Director of Education and Quality replaced VP position 0.71 FTE, Administrative Services- proposed annual
salary$135,486,total annual budget$96,195. 71%of annual salary allocated to CSC Adult.
Program Director(RN) 0.53 FTE,Administrative Services- proposed annual salary$104,451, split between Adult
71%and Youth 29%total annual budget$74,160
Program Nurses (RN) 7.65 FTE, Direct Services-total annual budget$636,635
Program Nurses (LVN) 14.09 FTE, Direct Services-total annual budget$849,529
Program Nurses (LPTN) 2.51 FTE, Direct Services-total annual budget$109,617
Social Services Coordinators 3.37 FTE, Direct Services- proposed annual salary$70,115,total annual budget
$236,463. 71% of annual salary allocated to CSC Adult.
Mental Health Workers 16.26 FTE Direct Services-average annual salary$45,987, proposed annual budget
$747,696. 71% of annual salary allocated to CSC Adult.
Data Specialist 0.71 FTE,Administrative Services-average annual salary$35,598, proposed annual budget
$25,275. 71%of annual salary allocated to CSC Adult.
Benefits/PAP Coordinator 0.71 FTE,Administrative Services-average annual salary$46,786, proposed annual
budget$33,218. 71%of annual salary allocated to CSC Adult.
Program Assistant 0.71 FTE, Administrative Services-average annual salary$49,048, proposed annual budget
$34,824. 71%of annual salary allocated to CSC Adult.
Driver 0.71 FTE,Administrative Services-average annual salary$41,597, proposed annual budget$29,534. 71%
of annual salary allocated to CSC Adult.
Peer Counselor 1.92 FTE, Direct Services-average annual salary$44,469, proposed annual budget $85,248.
71%of annual salary allocated to CSC Adult.
Intake Coordinator 0.36 FTE, Administrative Services-average annual salary$25,709, proposed annual budget
$18,253. 71%of annual salary allocated to CSC Adult.
Billing Supervisor 0.14, Administrative Services-average annual salary$12,723, proposed annual budget
$9,033. 71%of annual salary allocated to CSC Adult.
Salary Total $2,985,679
Payroll Taxes
OASDI $28,507
FICA/MEDICARE $202,137
SUI $28,507
Payroll Taxes Total $259,150
Employee Benefits
Retirement$129,007
Workers Compensation $185,097
REVISED EXHIBIT B-1
Page 9 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
2018-2019
BUDGET NARRATIVE - EXPENSES
Health Insurance (medical vision, life, dental) $246,796
Employee Benefits$560,900
Facilities/Equipment Expenses—Line Items 1010-1014
$1,115,589
Identify building lease/rent expenses, equipment(office equipment, vehicles, etc.). Attach copy of lease
Rent/Equipment Leases- Lease cost for computers, printers, copier, and faxes for the program $36,336
Utilities-Cost for program utilities $84,540
Janitorial -Cost for janitorial Service for the program $54,937
Maintenance -Cost for maintenance and repairs for the facility$26,822
Security-Cost for security personnel for the program $904,178
Business Taxes-Cost of related to business tax expense for the program $8,776
Operating Expenses-Line Items 1060-1077
$1,395,090
Telephone-Cost of phone usage expense for the program $31,618
Postage- Program related postage cost$1,256
Legal Notices/Advertising- Cost for advertising for staff recruitment and other program related advertising or
legal notices$1380
Office Supplies& Equipment- Cost for office supplies and equipment for the program $94,951
Program Supplies- Medical -Cost for medical supplies for the program $53,266
Transportation of Clients-Cost for lease of vehicle, gas, and maintenance for client transportation $6,151
Staff Mileage/Vehicle Maintenance- Cost for mileage, parking,travel expense for program staff$3,071
Staff Travel -Cost for Employee Travel $1,097
Staff Training/Registration - Cost of ongoing training for staff$23,942
Other Personnel Related Exp/Contracted PR Exp/Parking- Personnel related expenses including registry nurses
as needed, parking, relocation costs, etc. $1,146,266
Cost of client supportive services including toiletries,food, bus tokens, etc. $32,090
Financial Services Expenses—Line Items 1080-1085
$1,009,855
Accounting/Bookkeeping-Cost of financial auditing and monthly financial reviews $1,029
External Audit-Cost of External Audit Services $1,420
Liability Insurance-Cost of insurance expense for liability, business property and vehicle policy$21,219
Other Administrative Overhead -Administrative overhead expense related to the program $986,187
Special Expenses—Line Items 1090-1092
164 727
Consultant (network& data mgmt) Cost for consultant IT firm support, network monitoring, and off-site back-
up for program IT System $38,535
Translation Services- Cost for translation services for the program $1,463
REVISED EXHIBIT B-1
Page 10 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
2018-2019
BUDGET NARRATIVE - EXPENSES
Medication Supports (Pharmaceuticals) Medication costs for clients$17,528
Food Service-Cost for food services for program clients $76,894
Laundry Service - Cost for linen service for the program $28,843
Pharmaceutical Consultants-Cost medical and office related waste for the program $1,463
Fixed Assets—Line Items 1190-1193
Include all purchases over Five Thousand Dollars($5,000)including sales tax,and certain purchases under said amount such as camera,televisions,
VCRs/DVDs and other sensitive items,made during the life of the Agreement resulting from this Request for Proposal,with funds paid pursuant to
this Agreement and that will outlive the life of this Agreement.
45 060
Furniture & Fixtures $5,834
Computers &Software $7,100
Other- EHR Avatar$32,126
TOTAL PROGRAM EXPENSE: $7,536,051
REVISED EXHIBIT B-1
Page 11 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2019 to June 30,2020
Budget Categories- Total Proposed Budget
Line Item Description Must be itemized FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Director of Education and Quality 0.71 $99,081 $99,081
0002 Program Director(RN) 0.53 $76,384 $76,384
0003 Program Nurses RN 7.65 $655,734 $655,734
0003 Program Nurses(LVN) 14.09 $875,014 $875,014
0003 Program Nurses LPTN 2.51 $112,906 $112,906
0004 Social Service Coordinators 3.37 $243,557 $243,557
0005 Mental Health Worker 16.26 $770,127 $770,127
0006 Data Specialist 0.71 $26,033 $26,033
0007 Benefits/PAP Coordinator 0.71 $34,215 $34,215
0008 Program Assistant 0.71 $35,869 $35,869
0009 Driver 0.71 $30,420 $30,420
0010 Peer Counselor 1.92 $87,805 $87,805
0011 Intake Coordinator 0.36 $18,801 $18,801
0012 Billing Supervisor 0.14 $9,304 $9,304
SALARY TOTAL 50.37 $341,527 $2,733,722 $3,075,249
PAYROLL TAXES:
0030 OASDI $29,362 $29,362
0031 FICA/MEDICARE $208,201 $208,201
0032 SUI $29,362 $29,362
PAYROLL TAX TOTAL $266,926 $266,926
EMPLOYEE BENEFITS:
0040 Retirement $132,877 $132,877
0041 Workers Compensation $190,650 $190,650
0042 Health Insurance(medical vision,life,dental) $254,2001 $254,200
EMPLOYEE BENEFITS TOTAL $577,7271 $577,727
SALARY&BENEFITS GRAND TOTAL $3,919,902
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $37,426
1012 Utilities $87,076
1013 Janitorial $56,585
1014 Maintenance(facility) $27,627
1015 Security Personnel $931,303
1016 Maintenance durable medical equipment) $0
1017 Other-Business Taxes/Licenses-Permits $9,039
1018 Other-One Time Start-Up Costs $0
FACILITY/EQUIPMENT TOTAL $1,149,057
OPERATING EXPENSES:
1060 Telephone $32,567
1061 Answering Service $0
1062 Postage $1,294
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $1,421
1066 Office Supplies&Equipment $97,800
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies-Medical $54,864
1071 Transportation of Clients $6,336
1072 Staff Mileage/Vehicle Maintenance $3,163
1073 Staff Travel Out of Office $1,130
1074 Staff Train in /Reg istration $24,660
1075 Lodging $0
1076 Other-Personnel Related Ex /Contracted PR Ex /Parking Exp/Parking $1,410,824
1077 Other-Flex Funds $33,053
OPERATING EXPENSES TOTALr $1,667,111
REVISED EXHIBIT B-1
Page 12 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2019 to June 30,2020
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $1,060
1081 External Audit $1,463
1082 Liability Insurance $21,856
1083 Other-Administrative Overhead $1,050,317
1084 Other-(identify) $0
1085 Other-(identify) $0
FINANCIAL SERVICES TOTAL $1,074,695
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant(network&data management) $39,691
1088 Translation Services $1,507
1089 Medication Supports(Pharmaceuticals) $18,054
1090 Food Service $79,201
1091 Laundry Service $29,708
1092 Medical Waste Disposal $0
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultants $1,507
1096 Medical Services $0
1097 Access Line $0
1098 Other-(identify) $0
SPECIAL EXPENSES TOTAL $169,668
FIXED ASSETS:
2000 Computers&Software $7,100
2001 Furniture&Fixtures $7,312
2002 Other- EHR Avatar Cost $32,126
2003 Other-(identify) $0
FIXED ASSETS TOTAL $46,538
TOTAL PROGRAM EXPENSES $8,026,971
Vol/Units of
DIRECT SERVICE REVENUE: Service Rate $Amt.
3000 Mental Health Services(Individual/Family/Group Therapy) 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Crisis Stabilization-Urgent Care 63,417 $126.57 $8,026,971
3500 Other-(Identify) 0 $0.00 $0
3600 Other-(Identify) 0 $0.00 $0
3700 Other-(identify) 0 $0.00 $0
DIRECT SERVICE REVENUE TOTAL 63,417 8,026,971
Medi-cal Revenue 4,013,486
Cost Per Unit $126.57
FUNDING STREAM REIMBURSEMENT Population Served Percentage
4000 Private Insurance 2.0% $160,539
4100 Uninsured 13.0% $1,043,506
4200 Medi-Cal FFP 42.5% $3,411,463
4300 Realignment 42.5% $3,411,463
OTHER REVENUE/SOCIAL SERVICES TOTALI $8,026,971
TOTAL PROGRAM REVENUE1 $8,026,971
REVISED EXHIBIT B-1
Page 13 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
2019-2020
BUDGET NARRATIVE - EXPENSES
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes& Employee Benefits- Line Items 0001-0042
These amounts reflect FTE positions,part-time positions and whether the positions are administrative or direct service. Employee benefits should
be limited to a maximum of 20%of total salaries.
3 919 902
All SWB and Operational expenses budget line items are split between Adult and Youth CSU as follows: 71%
adult and 29%youth.
Director of Education and Quality replaced VP position 0.71 FTE, Administrative Services- proposed annual
salary$139,550,total annual budget$99,081. 71%of annual salary allocated to CSC Adult.
Program Director(RN) 0.53 FTE,Administrative Services- proposed annual salary$107,584,total annual budget
$76,384. 71%of annual salary allocated to CSC Adult
Program Nurses (RN) 7.65 FTE, Direct Services-total annual budget$655,734
Program Nurses (LVN) 14.09 FTE, Direct Services-total annual budget$875,014
Program Nurses (LPTN) 2.51 FTE, Direct Services-total annual budget$112,906
Social Services Coordinators 3.75 FTE, Direct Services- proposed annual salary$72,218,total annual budget
$243,557.
Mental Health Workers 16.26 FTE Direct Services-average annual salary$47,366, proposed annual budget
$770,127. 71% of annual salary allocated to CSC Adult.
Data Specialist 0.71 FTE,Administrative Services-average annual salary$36,665, proposed annual budget
$26,033. 71%of annual salary allocated to CSC Adult.
Benefits/PAP Coordinator 0.71 FTE,Administrative Services-average annual salary$48,189, proposed annual
budget$34,215. 71%of annual salary allocated to CSC Adult.
Program Assistant 0.71 FTE, Administrative Services-average annual salary$50,519, proposed annual budget
$35,689. 71%of annual salary allocated to CSC Adult.
Driver 0.71 FTE,Administrative Services-average annual salary$42,844, proposed annual budget$30,420. 71%
of annual salary allocated to CSC Adult.
Peer Counselor 1.92 FTE, Direct Services-average annual salary$45,803, proposed annual budget $87,805.
71%of annual salary allocated to CSC Adult.
Intake Coordinator 0.36 FTE, Administrative Services-average annual salary$26,480, proposed annual budget
$18,801. 71%of annual salary allocated to CSC Adult.
Billing Supervisor 0.14, Administrative Services-average annual salary$13,104, proposed annual budget
$9,304. 71%of annual salary allocated to CSC Adult.
Salary Total $3,075,249
Payroll Taxes
OASDI $29,362
FICA/MEDICARE $208,201
SUI $29,362
Payroll Taxes Total $266,926
Employee Benefits
Retirement$132,877
Workers Compensation $190,650
REVISED EXHIBIT B-1
Page 14 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
2019-2020
BUDGET NARRATIVE - EXPENSES
Health Insurance (medical vision, life, dental) $254,200
Employee Benefits$577,727
Facilities/Equipment Expenses—Line Items 1010-1014
$1,149,057
Identify building lease/rent expenses, equipment(office equipment, vehicles, etc.). Attach copy of lease
agreements if available.
Rent/Equipment Leases - Lease cost for computers, printers, copier, and faxes for the program $37,426
Utilities-Cost for program utilities $87,076
Janitorial -Cost for janitorial Service for the program $56,585
Maintenance - Cost for maintenance and repairs for the facility$27,627
Security-Cost for security personnel for the program $931,303
Business Taxes-Cost of related to business tax expense for the program $9,039
Operating Expenses-Line Items 1060-1077
1 667 111
Telephone-Cost of phone usage expense for the program $32,567
Postage- Program related postage cost$1,294
Legal Notices/Advertising- Cost for advertising for staff recruitment and other program related advertising or
legal notices$1,421
Office Supplies& Equipment- Cost for office supplies and equipment for the program $97,800
Program Supplies- Medical -Cost for medical supplies for the program $54,864
Transportation of Clients-Cost for lease of vehicle, gas, and maintenance for client transportation $6,336
Staff Mileage/Vehicle Maintenance- Cost for mileage, parking,travel expense for program staff$3,163
Staff Travel -Cost for Employee Travel $1,130
Staff Training/Registration - Cost of ongoing training for staff$24,660
Other Personnel Related Exp/Contracted PR Exp/Parking- Personnel related expenses including registry nurses
as needed, parking, relocation costs, etc. Filled open MD position (0.75 FTE at$240/HR)totlaing additional
$374,400 (71% charged to Adult CSC) annually. $1,410,824 annual budget
Cost of client supportive services including toiletries,food, bus tokens, etc. $33,053
Financial Services Expenses—Line Items 1080-1085
1 074 695
Accounting/Bookkeeping-Cost of financial auditing and monthly financial reviews $1,060
External Audit-Cost of External Audit Services$1,463
Liability Insurance-Cost of insurance expense for liability, business property and vehicle policy$21,856
Other Administrative Overhead -Administrative overhead expense related to the program $1,050,317
Special Expenses—Line Items 1090-1092
169 668
REVISED EXHIBIT B-1
Page 15 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
2019-2020
BUDGET NARRATIVE - EXPENSES
Consultant (network& data mgmt) Cost for consultant IT firm support, network monitoring, and off-site back-
up for program IT System $39,691
Translation Services- Cost for translation services for the program $1,507
Medication Supports (Pharmaceuticals) Medication costs for clients $18,054
Food Service-Cost for food services for program clients $79,201
Laundry Service -Cost for linen service for the program $29,708
Pharmaceutical Consultants-Cost medical and office related waste for the program $1,507
Fixed Assets—Line Items 1190-1193
Include all purchases over Five Thousand Dollars($5,000)including sales tax,and certain purchases under said amount such as camera,televisions,
VCRs/DVDs and other sensitive items,made during the life of the Agreement resulting from this Request for Proposal,with funds paid pursuant to
this Agreement and that will outlive the life of this Agreement.
46 538
Furniture & Fixtures $7,313
Computers &Software $7,100
Other- EHR Avatar$32,126
TOTAL PROGRAM EXPENSE: $8,026,971
REVISED EXHIBIT B-1
Page 16 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2020 to June 30,2021
Budget Categories- Total Proposed Budget
Line Item Description Must be itemized FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Director of Education and Quality 0.71 $102,053 $102,053
0002 Program Director(RN) 0.53 $78,676 $78,676
0003 Program Nurses RN 7.65 $675,406 $675,406
0003 Program Nurses(LVN) 14.09 $901,265 $901,265
0003 Program Nurses LPTN 2.51 $116,293 $116,293
0004 Social Service Coordinators 3.37 $250,864 $250,864
0005 Mental Health Worker 16.26 $793,231 $793,231
0006 Data Specialist 0.71 $26,814 $26,814
0007 Benefits/PAP Coordinator 0.71 $35,241 $35,241
0008 Program Assistant 0.71 $36,945 $36,945
0009 Driver 0.71 $31,333 $31,333
0010 Peer Counselor 1.92 $90,439 $90,439
0011 Intake Coordinator 0.36 $19,365 $19,365
0012 Billing Supervisor 0.14 $9,583 $9,583
SALARY TOTAL 50.37 $351,774 $2,815,733 $3,167,507
PAYROLL TAXES:
0030 OASDI $30,243 $30,243
0031 FICA/MEDICARE $214,447 $214,447
0032 SUI $30,243 $30,243
PAYROLL TAX TOTAL $274,933 $274,933
EMPLOYEE BENEFITS:
0040 Retirement $136,863 $136,863
0041 Workers Compensation $196,370 $196,370
0042 Health Insurance(medical vision,life,dental) $261,8261 $261,826
EMPLOYEE BENEFITS TOTAL $595,0591 $595,059
SALARY&BENEFITS GRAND TOTAL $4,037,499
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $38,549
1012 Utilities $89,688
1013 Janitorial $58,283
1014 Maintenance(facility) $28,456
1015 Security Personnel $959,242
1016 Maintenance durable medical equipment) $0
1017 Other-Business Taxes/Licenses-Permits $9,310
1018 Other-One Time Start-Up Costs $0
FACILITY/EQUIPMENT TOTAL $1,183,528
OPERATING EXPENSES:
1060 Telephone $33,544
1061 Answering Service $0
1062 Postage $1,333
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $1,464
1066 Office Supplies&Equipment $100,734
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies-Medical $56,510
1071 Transportation of Clients $6,526
1072 Staff Mileage/Vehicle Maintenance $3,258
1073 Staff Travel Out of Office $1,164
1074 Staff Train in /Reg istration $25,400
1075 Lodging $0
1076 Other-Personnel Related Ex /Contracted PR Ex /Parking Exp/Parking $1,410,824
1077 Other-Flex Funds $34,045
OPERATING EXPENSES TOTALr $1,674,800
REVISED EXHIBIT B-1
Page 17 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2020 to June 30,2021
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $1,092
1081 External Audit $1,507
1082 Liability Insurance $22,512
1083 Other-Administrative Overhead $1,075,302
1084 Other-(identify) $0
1085 Other-(identify) $0
FINANCIAL SERVICES TOTAL $1,100,413
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant(network&data management) $40,885
1088 Translation Services $1,552
1089 Medication Supports(Pharmaceuticals) $18,596
1090 Food Service $81,577
1091 Laundry Service $30,599
1092 Medical Waste Disposal $0
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultants $1,552
1096 Medical Services $0
1097 Access Line $0
1098 Other- EHR Avatar Cost $0
SPECIAL EXPENSES TOTAL $174,761
FIXED ASSETS:
2000 Computers&Software $7,100
2001 Furniture&Fixtures $7,532
2002 Other- EHR Avatar Cost $32,126
2003 Other-(identify) $0
FIXED ASSETS TOTAL $46,758
TOTAL PROGRAM EXPENSES $8,217,759
Vol/Units of
DIRECT SERVICE REVENUE: Service Rate $Amt.
3000 Mental Health Services(Individual/Family/Group Therapy) 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Crisis Stabilization-Urgent Care 63,147 130.14 8,217,759.00
3500 Other-(Identify) 0 $0.00 $0
3600 Other-(Identify) 0 $0.00 $0
3700 Other-(Identify) 0 $0.00 $0
DIRECT SERVICE REVENUE TOTAL 63,147 8,217,759
Medi-cal Revenue 3,492,548
Cost Per Unit $130.14
FUNDING STREAM REIMBURSEMENT Population Served Percentage
4000 Private Insurance 2.0% $164,355
4100 Uninsured 13.0% $1,068,309
4200 Medi-Cal FFP 42.5% $3,492,548
4300 Realignment 42.5% $3,492,548
OTHER REVENUE/SOCIAL SERVICES TOTALI $8,217,759
TOTAL PROGRAM REVENUIE1 $8,217,759
REVISED EXHIBIT B-1
Page 18 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
2020-2021
BUDGET NARRATIVE - EXPENSES
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes& Employee Benefits- Line Items 0001-0042
These amounts reflect FTE positions,part-time positions and whether the positions are administrative or direct service. Employee benefits should
be limited to a maximum of 20%of total salaries.
4 037 499
All SWB and Operational expenses budget line items are split between Adult and Youth CSU as follows: 71%
adult and 29%youth.
Director of Education and Quality replaced VP position 0.71 FTE, Administrative Services- proposed annual
salary$143,736,total annual budget$102,053. 71%of annual salary allocated to CSC Adult.
Program Director(RN) 0.53 FTE,Administrative Services- proposed annual salary$110,811,total annual budget
$78,677. 71%of annual salary allocated to CSC Adult
Program Nurses (RN) 7.65 FTE, Direct Services-total annual budget$675,406
Program Nurses (LVN) 14.09 FTE, Direct Services-total annual budget$901,265
Program Nurses (LPTN) 2.51 FTE, Direct Services-total annual budget$116,293
Social Services Coordinators 3.37 FTE, Direct Services- proposed annual salary$74,385,total annual budget
$250,864. 71% of annual salary allocated to CSC Adult.
Mental Health Workers 16.26 FTE Direct Services-average annual salary$48,787, proposed annual budget
$793,231. 71% of annual salary allocated to CSC Adult.
Data Specialist 0.71 FTE,Administrative Services-average annual salary$37,766, proposed annual budget
$26,814. 71%of annual salary allocated to CSC Adult.
Benefits/PAP Coordinator 0.71 FTE,Administrative Services-average annual salary$49,635, proposed annual
budget$35,241. 71%of annual salary allocated to CSC Adult.
Program Assistant 0.71 FTE, Administrative Services-average annual salary$52,035, proposed annual budget
$36,945. 71%of annual salary allocated to CSC Adult.
Driver 0.71 FTE,Administrative Services-average annual salary$44,130, proposed annual budget$31,333. 71%
of annual salary allocated to CSC Adult.
Peer Counselor 1.92 FTE, Direct Services-average annual salary$47,177, proposed annual budget $90,439.
71%of annual salary allocated to CSC Adult.
Intake Coordinator 0.36 FTE, Administrative Services-average annual salary$27,274, proposed annual budget
$19,365. 71%of annual salary allocated to CSC Adult.
Billing Supervisor 0.14, Administrative Services-average annual salary$13,497, proposed annual budget
$9,583. 71%of annual salary allocated to CSC Adult.
Salary Total $3,167,507
Payroll Taxes
OASDI $30,243
FICA/MEDICARE $214,447
SUI $30,243
Payroll Taxes Total $274,933
Employee Benefits
Retirement$136,863
REVISED EXHIBIT B-1
Page 19 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
2020-2021
BUDGET NARRATIVE - EXPENSES
Workers Compensation $196,370
Health Insurance (medical vision, life, dental) $261,826
Employee Benefits$595,059
Facilities/Equipment Expenses—Line Items 1010-1014
1 183 528
Identify building lease/rent expenses, equipment (office equipment,vehicles, etc.). Attach copy of lease
agreements if available.
Rent/Equipment Leases- Lease cost for computers, printers, copier, and faxes for the program $38,549
Utilities-Cost for program utilities $89,688
Janitorial -Cost for janitorial Service for the program $58,283
Maintenance -Cost for maintenance and repairs for the facility$28,456
Security-Cost for security personnel for the program $959,242
Business Taxes-Cost of related to business tax expense for the program $9,310
Operating Expenses- Line Items 1060-1077
$1,674,800
Telephone-Cost of phone usage expense for the program $33,544
Postage- Program related postage cost$1,333
Legal Notices/Advertising- Cost for advertising for staff recruitment and other program related advertising or
legal notices$1,464
Office Supplies& Equipment- Cost for office supplies and equipment for the program $100,734
Program Supplies- Medical -Cost for medical supplies for the program $56,510
Transportation of Clients-Cost for lease of vehicle, gas, and maintenance for client transportation $6,526
Staff Mileage/Vehicle Maintenance- Cost for mileage, parking,travel expense for program staff$3,258
Staff Travel - Cost for Employee Travel $1,164
Staff Training/Registration - Cost of ongoing training for staff$25,400
Other Personnel Related Exp/Contracted PR Exp/Parking- Personnel related expenses including registry nurses
as needed, parking, relocation costs, etc. Filled open MD position (0.75 FTE at$240/HR)totlaing additional
$374,400 (71% charged to Adult CSC) annually. $1,410,824 annual budget
Cost of client supportive services including toiletries,food, bus tokens, etc. $34,045
Financial Services Expenses—Line Items 1080-1085
$1,100,413
Accounting/Bookkeeping-Cost of financial auditing and monthly financial reviews $1,092
External Audit-Cost of External Audit Services $1,507
Liability Insurance-Cost of insurance expense for liability, business property and vehicle policy$22,512
Other Administrative Overhead -Administrative overhead expense related to the program $1,075,302
Special Expenses—Line Items 1090-1092
REVISED EXHIBIT B-1
Page 20 of 20
Adult Crisis Stabilization Center
Exodus Recovery, Inc.
2020-2021
BUDGET NARRATIVE - EXPENSES
174 761
Consultant (network& data mgmt) Cost for consultant IT firm support, network monitoring, and off-site back-
up for program IT System $40,885
Translation Services - Cost for translation services for the program $1,552
Medication Supports (Pharmaceuticals) Medication costs for clients$18,596
Food Service-Cost for food services for program clients $81,577
Laundry Service - Cost for linen service for the program $30,599
Pharmaceutical Consultants-Cost medical and office related waste for the program $1,552
Fixed Assets—Line Items 1190-1193
Include all purchases over Five Thousand Dollars($5,000)including sales tax,and certain purchases under said amount such as camera,televisions,
VCRs/DVDs and other sensitive items,made during the life of the Agreement resulting from this Request for Proposal,with funds paid pursuant to
this Agreement and that will outlive the life of this Agreement.
46 758
Furniture & Fixtures $7,532
Computers &Software $7,100
Other- EHR Avatar$32,126
TOTAL PROGRAM EXPENSE: $8,217,759
REVISED EXHIBIT B-2
Page 1 of 17
risis Stab iIization&enter =
Exodus Recovery, Inc.
July 1, 2016 to June 30, 2017
Budget Categories- Total Proposed Budget
Line Item Description (Must be itemized) FTE % Admin. Direct Total
PERSONNEL SALARIES:
0001 VP Northern Region 0.25 $35,750 $35,750
0002 Program Director(RN) 0.00 $0
0003 Program Nurses 8.40 $575,266 $575,266
0004 Social Service Coordinators 1.40 $94,108 $94,108
0005 Mental Health Worker 8.40 $284,357 $284,357
0006 Data Specialist 0.00 $0
0007 Benefits/PAP Coordinator 0.00 $0
0008 Program Assistant 0.00 $0
0009 Driver 0.00 $0
0010 Peer Counselor 0.00 $0
0011 Intake Coordinator 0.50 $24,960 $24,960
0012 Billing Supervisor 0.20 $14,414 $14,414
SALARY TOTAL 19.15 $75,124 $953,731 $1,028,855
PAYROLL TAXES:
0030 OASDI $699 $8,870 $9,569
0031 FICA/MEDICARE $5,920 $75,154 $81,074
0032 SUI $1,411 $17,919 $19,330
PAYROLL TAX TOTAL $8,030 $101,943 $109,973
EMPLOYEE BENEFITS:
0040 Retirement $3,005 $38,149 $41,154
0041 Workers Compensation $4,883 $61,992 $66,875
0042 Health Insurance (medical vision, life, dental) 1 $9,766 $123,985 $133,751
EMPLOYEE BENEFITS TOTAL 1 $17,654 $224,126 $241,780
SALARY& BENEFITS GRAND TOTAL $1,380,608
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $16,184
1012 Utilities $30,142
1013 Janitorial $27,420
1014 Maintenance (facility) $10,637
1015 Security Personnel $388,471
1016 Maintenance (durable medical equipment) $0
1017 Other- Business Taxes/Licenses-Permits $3,480
1018 Other-One Time Start-Up Costs $0
FACILITY/EQUIPMENT TOTAL $476,334
OPERATING EXPENSES:
1060 Telephone $19,749
1061 Answering Service $0
1062 Postage $290
1063 Printing/Reproduction $4,966
1064 Publications $435
1065 Legal Notices/Advertising $725
1066 Office Supplies & Equipment $30,598
REVISED EXHIBIT B-2
Page 2 of 17
risis Stab iIization&enter
Exodus Recovery, Inc.
July 1, 2016 to June 30, 2017
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies -Therapeutic $0
1070 Program Supplies - Medical $13,306
1071 Transportation of Clients $1,585
1072 Staff Mileage/Vehicle Maintenance $1,218
1073 Staff Travel (Out of Office) $435
1074 Staff Training/Registration $14,896
1075 Lodging $0
1076 Other- Personnel Related Exp/Contracted PR Exp/Parking $265,935
1077 Other- Flex Funds $10,305
OPERATING EXPENSES TOTAL $364,443
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $2,975
1081 External Audit $500
1082 Liability Insurance $8,414
1083 Other-Administrative Overhead $344,400
1084 Other- (identify) $0
1085 Other- (identify) $0
FINANCIAL SERVICES TOTAL $356,289
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant (network & data management) $5,651
1088 Translation Services $580
1089 Medication Supports (Pharmaceuticals) $19,140
1090 Food Service $24,984
1091 Laundry Service $11,603
1092 Medical Waste Disposal $765
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultants $0
1096 Medical Services $0
1097 Access Line $0
1098 Other- (identify) $0
SPECIAL EXPENSES TOTAL $62,723
FIXED ASSETS:
2000 Computers & Software $0
2001 Furniture & Fixtures $0
2002 Other- (identify) $0
2003 Other- (identify) $0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $2,640,397
REVISED EXHIBIT B-2
Page 3 of 17
risis Stab iIization&enter
Exodus Recovery, Inc.
July 1, 2016 to June 30, 2017
Vol/Units of
DIRECT SERVICE REVENUE: Service Rate $Amt.
3000 Mental Health Services (Individual/Family/Group Therapy) 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Crisis Stabilization - Urgent Care 27,929 $94.54 $2,640,397
3500 Other- (Identify) 0 $0.00 $0
3600 Other- (Identify) 0 $0.00 $0
3700 Other- (Identify) 0 $0.00 $0
DIRECT SERVICE REVENUE TOTAL 27,929 $2,640,397
Medi-cal Revenue $1,320,199
Cost Per Unit $94.54
FUNDING STREAM REIMBURSEMENT Population Served Percentage
4000 Private Insurance 7 $184,828
4100 Uninsured 15 $396,060
4200 Medi-Cal FFP 39 $1,029,755
4300 Realignment 39 $1,029,755
OTHER REVENUE/SOCIAL SERVICES TOTAL $2,640,397
TOTAL PROGRAM REVENUE $2,640,397
REVISED EXHIBIT B-2
Page 4 of 17
Youth Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2017 to June 30,2018
Budget Categories- Total Proposed Bud et
Line Item Description(Must be itemized) FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 VP Northern Region 0.25 $36,823 $36,823
0002 Program Director RN 0.00 $0
0003 Program Nurses 8.40 $592,524 $592,524
0004 Social Service Coordinators 1.40 $96,932 $96,932
0005 Mental Health Worker 8.40 $292,888 $292,888
0006 Data Specialist 0.00 $0
0007 Benefits/PAP Coordinator 0.00 $0
0008 Program Assistant 0.00 $0
0009 Driver 0.00 $0
0010 Peer Counselor 0.00 $0
0011 Intake Coordinator 0.50 $25,709 $25,709
0012 Billing Supervisor 0.20 $14,847 $14,847
SALARY TOTAL 19.15 $77,379 $982,344 $1,059,723
PAYROLL TAXES:
0030 OASDI $720 $9,136 $9,856
0031 FICA/MEDICARE $6,097 $77,409 $83,506
0032 SUI $1,456 $18,491 $19,947
PAYROLL TAX TOTAL $8,273 $105,036 $113,309
EMPLOYEE BENEFITS:
0040 Retirement $3,095 $39,294 $42,389
0041 Workers Compensation $5,030 $63,852 $68,882
0042 Health Insurance medical vision,life,dental $10,0591 $127,705 $137,764
EMPLOYEE BENEFITS TOTAL $18,1841 $230,8511 $249,035
SALARY&BENEFITS GRAND TOTALI $1,422,067
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $16,670
1012 Utilities $31,046
1013 Janitorial $28,243
1014 Maintenance(facility) $10,956
1015 Security Personnel $400,125
1016 Maintenance(durable medical equipment) $0
1017 Other-Business Taxes/Licenses-Permits $3,584
1018 Other-One Time Start-Up Costs $0
FACILITY/EQUIPMENT TOTAL $490,624
OPERATING EXPENSES:
1060 Telephone $20,341
1061 Answering Service $0
1062 Postage $299
1063 Printing/Reproduction $5,115
1064 Publications $448
1065 Legal Notices/Advertising $747
1066 Office Supplies&Equipment $31,516
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies-Medical $13,705
1071 Transportation of Clients $1,633
1072 Staff Mileage/Vehicle Maintenance $1,255
1073 Staff Travel Out of Office $448
1074 Staff Training/Registration $15,343
1075 Lodging $0
1076 Other-Personnel Related Exp/Contracted PR Exp/Parking $273,913
1077 Other-Flex Funds $10,614
OPERATING EXPENSES TOTAL $375,377
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkee in $3,064
REVISED EXHIBIT B-2
Page 5 of 17
Youth Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2017 to June 30,2018
1081 External Audit $515
1082 Liability Insurance $8,667
1083 Other-Administrative Overhead $354,738
1084 Other-(identify) $0
1085 Other-(identify) $0
FINANCIAL SERVICES TOTAL $366,984
SPECIAL EXPENSES(Consultant/Etc.):
1087 Consultant network&data management) $5,821
1088 Translation Services $597
1089 Medication Supports Pharmaceuticals $19,714
1090 Food Service $25,734
1091 Laundry Service $11,951
1092 Medical Waste Disposal $788
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultants $0
1096 Medical Services $0
1097 Access Line $0
1098 Other-(identify) $0
SPECIAL EXPENSES TOTAL $64,605
FIXED ASSETS:
2000 Computers&Software $0
2001 Furniture&Fixtures $0
2002 Other-(identify) $0
2003 Other- identi $0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $2,719,657
Vol/Units of
DIRECT SERVICE REVENUE: Service Rate $Amt.
3000 Mental Health Services(Individual/Family/Group Therapy) 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Crisis Stabilization-Urgent Care 28,767 $94.54 $2,719,656
3500 Other-(Identify) 0 $0.00 $0
3600 Other-(Identify) 0 $0.00 $0
3700 Other-(Identify) 0 $0.00 $0
DIRECT SERVICE REVENUE TOTAL 28,767 $2,719,656
Medi-cal Revenue $1,359,828
Cost Per Unit $94.54
FUNDING STREAM REIMBURSEMENT Population Served Percentage
4000 Private Insurance 7 $190,376
4100 Uninsured 15 $407,948
4200 Medi-Cal FFP 39 $1,060,666
4300 Realignment 39 $1,060,666
OTHER REVENUE/SOCIAL SERVICES TOTAL $2,719,656
TOTAL PROGRAM REVENUE $2,719,656
REVISED EXHIBIT B-2
Page 6 of 17
Youth Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2018 to June 30,2019
Budget Categories- Total Proposed Budget
Line Item Description Must be itemized FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Director of Education and Quality 0.29 $39,291 $39,291
0002 Program Director(RN) 0.22 $30,291 $30,291
0003 Program Nurses RN 3.12 $260,034 $260,034
0003 Program Nurses(LVN) 5.75 $346,991 $346,991
0003 Program Nurses LPTN 1.03 $44,773 $44,773
0004 Social Service Coordinators 1.38 $96,583 $96,583
0005 Mental Health Worker 6.64 $305,397 $305,397
0006 Data Specialist 0.29 $10,323 $10,323
0007 Benefits/PAP Coordinator 0.29 $13,568 $13,568
0008 Program Assistant 0.29 $14,224 $14,224
0009 Driver 0.29 $12,063 $12,063
0010 Peer Counselor 0.78 $34,819 $34,819
0011 Intake Coordinator 0.15 $7,456 $7,456
0012 Billing Supervisor 0.06 $3,690 $3,690
SALARY TOTAL 20.57 $135,434 $1,084,069 $1,219,503
PAYROLL TAXES:
0030 OASDI $11,644 $11,644
0031 FICA/MEDICARE $82,563 $82,563
0032 SUI $11,644 $11,644
PAYROLL TAX TOTAL $105,850 $105,850
EMPLOYEE BENEFITS:
0040 Retirement $52,693 $52,693
0041 Workers Compensation $75,603 $75,603
0042 Health Insurance(medical vision,life,dental) $100,8041 $100,804
EMPLOYEE BENEFITS TOTAL $229,1001 $229,100
SALARY&BENEFITS GRAND TOTAL $1,554,453
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $14,842
1012 Utilities $34,530
1013 Janitorial $22,439
1014 Maintenance(facility) $10,956
1015 Security Personnel $369,312
1016 Maintenance durable medical equipment) $0
1017 Other-Business Taxes/Licenses-Permits $3,585
1018 Other-One Time Start-Up Costs $0
FACILITY/EQUIPMENT TOTAL $455,663
OPERATING EXPENSES:
1060 Telephone $12,915
1061 Answering Service $0
1062 Postage $513
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $564
1066 Office Supplies&Equipment $38,783
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies-Medical $21,756
1071 Transportation of Clients $2,513
1072 Staff Mileage/Vehicle Maintenance $1,255
1073 Staff Travel Out of Office $448
1074 Staff Train in /Re istration $9,779
1075 Lodging $0
1076 Other-Personnel Related Ex /Contracted PR Ex /Parking Exp/Parking $468,193
1077 Other-Flex Funds $13,107
OPERATING EXPENSES TOTALr $569,826
REVISED EXHIBIT B-2
Page 7 of 17
Youth Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2018 to June 30,2019
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $420
1081 External Audit $580
1082 Liability Insurance $8,667
1083 Other-Administrative Overhead $402,809
1084 Other-(identify)
1085 Other-(identify) $0
FINANCIAL SERVICES TOTAL $412,476
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant(network&data management) $15,740
1088 Translation Services $597
1089 Medication Supports(Pharmaceuticals) $7,160
1090 Food Service $31,408
1091 Laundry Service $11,781
1092 Medical Waste Disposal $597
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultants $0
1096 Medical Services $0
1097 Access Line $0
1098 Other-(identify) $0
SPECIAL EXPENSES TOTAL $67,282
FIXED ASSETS:
2000 Computers&Software $2,900
2001 Furniture&Fixtures $2,383
2002 Other- EHR Avatar Cost) $13,122
2003 Other-(identify) $0
FIXED ASSETS TOTAL $18,405
TOTAL PROGRAM EXPENSES $3,078,105
Vol/Units of
DIRECT SERVICE REVENUE: Service Rate $Amt.
3000 Mental Health Services(Individual/Family/Group Therapy) 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Crisis Stabilization-Urgent Care 25,003 $123.11 $3,078,105
3500 Other-(Identify) 0 $0.00 $0
3600 Other-(Identify) 0 $0.00 $0
3700 Other-(identify) 0 $0.00 $0
DIRECT SERVICE REVENUE TOTAL 25,003 3,078,105
Medi-cal Revenue 1,323,585
Cost Per Unit $123.11
FUNDING STREAM REIMBURSEMENT Population Served Percentage Popul
4000 Private Insurance 11% $ 338,592
4100 Uninsured 3% $ 92,343
4200 Medi-Cal FFP 43% $ 1,323,585
4300 Realignment 43% $ 1,323,585
OTHER REVENUE/SOCIAL SERVICES TOTALI $3,078,105
TOTAL PROGRAM REVENUE1 $3,078,105
REVISED EXHIBIT B-2
Page 8 of 17
Youth Crisis Stabilization Center
Exodus Recovery,Inc.
2018-2019
BUDGET NARRATIVE-EXPENSES
PROGRAM EXPENSES
Personnel Salaries,Payroll Taxes&Employee Benefits-Line Items 0001-0042
These amounts reflect FTE positions,part-time positions and whether the positions are administrative or direct service.Employee benefits should
be limited to a maximum of 20%of total salaries.
1 554 453
All SWB and Operational expenses budget line items are split between Adult and Youth CSU as follows:71%
adult and 29%youth.
Director of Education and Quality replaced VP position 0.29 FTE,Administrative Services-proposed annual
salary$135,486,total annual budget$39,291.29%of annual salary allocated to CSC Youth.
Program Director(RN)0.22 FTE,Administrative Services-proposed annual salary$104,451,total annual budget
$30,291.29%of total annual budget allocated to CSC Youth
Program Nurses(RN)3.12 FTE,Direct Services-total annual budget$260,034
Program Nurses(LVN)5.75 FTE,Direct Services-total annual budget$346,991
Program Nurses(LPTN)1.03 FTE,Direct Services-total annual budget$44,773
Social Services Coordinators 1.38 FTE,Direct Services-proposed annual salary$70,115,total annual budget
$96,583.29%of annual salary allocated to CSC Youth.
Mental Health Workers 6.64 FTE Direct Services-average annual salary$45,987,proposed annual budget
$305,397.29%of annual salary allocated to CSC Youth.
Data Specialist 0.29 FTE,Administrative Services-average annual salary$35,598,proposed annual budget
$10,323.29%of annual salary allocated to CSC Youth.
Benefits/PAP Coordinator 0.29 FTE,Administrative Services-average annual salary$46,786,proposed annual
budget$13,568.29%of annual salary allocated to CSC youth.
Program Assistant 0.29 FTE,Administrative Services-average annual salary$49,048,proposed annual budget
$14,224. 29%of annual salary allocated to CSC Youth.
Driver 0.29FTE,Administrative Services-average annual salary$41,597,proposed annual budget$12,063. 29%
of annual salary allocated to CSC Youth.
Peer Counselor 0.78 FTE,Direct Services-average annual salary$44,469,proposed annual budget$34,819.
29%of annual salary allocated to CSC Youth.
Intake Coordinator 0.15 FTE,Administrative Services-average annual salary$25,709,proposed annual budget
$7,456.29%of annual salary allocated to CSC Youth.
Billing Supervisor 0.06 FTE,Administrative Services-average annual salary$12,723,proposed annual budget
$3,690. 29%of annual salary allocated to CSC Youth.
Salary Total$1,219,503
Payroll Taxes
OASDI$11,644
FICA/MEDICARE$82,563
SUI$11,644
Payroll Taxes Total$105,850
Employee Benefits
Retirement$52,693
Workers Compensation$75,603
Health Insurance(medical vision,life,dental)$100,804
Employee Benefits$229,100
Facilities/Equipment Expenses—Line Items 1010-1014
455 663
Identify building lease/rent expenses,equipment(office equipment,vehicles,etc.). Attach copy of lease
agreements if available.
Rent/Equipment Leases-Lease cost for computers,printers,copier,and faxes for the program$14,842
Utilities-Cost for program utilities$34,530
Janitorial-Cost forjanitorial Service for the program$22,439
Maintenance-Cost for maintenance and repairs for the facility$10,956
Security-Cost for security personnel for the program$369,312
Business Taxes-Cost of related to business tax expense for the program$3,585
Operating Expenses-Line Items 1060-1077
569 826
Telephone-Cost of phone usage expense for the program$12,915
Postage-Program related postage cost$513
REVISED EXHIBIT B-2
Page 9 of 17
Youth Crisis Stabilization Center
Exodus Recovery,Inc.
2018-2019
BUDGET NARRATIVE-EXPENSES
Legal Notices/Advertising-Cost for advertising for staff recruitment and other program related advertising or
legal notices$564
Office Supplies&Equipment-Cost for office supplies and equipment for the program$38,783
Program Supplies-Medical-Cost for medical supplies for the program$21,756
Transportation of Clients-Cost for lease of vehicle,gas,and maintenance for client transportation$2,513
Staff Mileage/Vehicle Maintenance-Cost for mileage,parking,travel expense for program staff$1,255
Staff Travel-Cost for Employee Travel$448
Staff Training/Registration-Cost of ongoing training for staff$9,779
Other Personnel Related Exp/Contracted PR Exp/Parking-Personnel related expenses including registry nurses
as needed,parking,relocation costs,etc.$468,193
Cost of client supportive services including toiletries,food,bus tokens,etc.$13,107
Financial Services Expenses—Line Items 1080-1085
412 476
Accounting/Bookkeeping-Cost of financial auditing and monthly financial reviews$420
External Audit-Cost of External Audit Services$580
Liability Insurance-Cost of insurance expense for liability,business property and vehicle policy$8667
Other Administrative Overhead-Administrative overhead expense related to the program$402,809
Special Expenses—Line Items 1090-1092
67 282
Consultant(network&data mgmt)Cost for consultant IT firm support,network monitoring,and off-site back-
up for program IT System$15,740
Translation Services-Cost for translation services for the program$597
Medication Supports(Pharmaceuticals)Medication costs for clients$7,160
Food Service-Cost for food services for program clients$31,408
Laundry Service-Cost for linen service for the program$11,781
Medical Waste Disposal-Cost medical and office related waste for the program$597
Fixed Assets—Line Items 1190-1193
Include all purchases over Five Thousand Dollars($5,000)including sales tax,and certain purchases under said amount such as camera,
televisions,VCRs/DVDs and other sensitive items,made during the life of the Agreement resulting from this Request for Proposal,with funds paid
pursuant to this Agreement and that will outlive the life of this Agreement.
18 405
Furniture&Fixtures$2,383
Computers&Software$2,900
Other-EHR Services$13,122
TOTAL PROGRAM EXPENSE: 53.078.105
REVISED EXHIBIT B-2
Page 10 of 17
Youth Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2019 to June 30,2020
Budget Categories- Total Proposed Budget
Line Item Description Must be itemized FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Director of Education and Quality 0.29 $40,470 $40,470
0002 Program Director(RN) 0.22 $31,199 $31,199
0003 Program Nurses RN 3.12 $267,836 $267,836
0003 Program Nurses(LVN) 5.75 $357,400 $357,400
0003 Program Nurses LPTN 1.03 $46,116 $46,116
0004 Social Service Coordinators 1.38 $99,480 $99,480
0005 Mental Health Worker 6.64 $314,559 $314,559
0006 Data Specialist 0.29 $10,633 $10,633
0007 Benefits/PAP Coordinator 0.29 $13,975 $13,975
0008 Program Assistant 0.29 $14,651 $14,651
0009 Driver 0.29 $12,425 $12,425
0010 Peer Counselor 0.78 $35,864 $35,864
0011 Intake Coordinator 0.15 $7,680 $7,680
0012 Billing Supervisor 0.06 $3,801 $3,801
SALARY TOTAL 20.57 $139,497 $1,116,591 $1,256,088
PAYROLL TAXES:
0030 OASDI $11,993 $11,993
0031 FICA/MEDICARE $85,040 $85,040
0032 SUI $11,993 $11,993
PAYROLL TAX TOTAL $109,027 $109,027
EMPLOYEE BENEFITS:
0040 Retirement $54,274 $54,274
0041 Workers Compensation $77,871 $77,871
0042 Health Insurance(medical vision,life,dental) $103,8281 $103,828
EMPLOYEE BENEFITS TOTAL $235,9731 $235,973
SALARY&BENEFITS GRAND TOTAL $1,601,088
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $15,287
1012 Utilities $35,566
1013 Janitorial $23,112
1014 Maintenance(facility) $11,285
1015 Security Personnel $380,391
1016 Maintenance durable medical equipment) $0
1017 Other-Business Taxes/Licenses-Permits $3,693
1018 Other-One Time Start-Up Costs $0
FACILITY/EQUIPMENT TOTAL $469,334
OPERATING EXPENSES:
1060 Telephone $13,302
1061 Answering Service $0
1062 Postage $528
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $581
1066 Office Supplies&Equipment $39,946
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies-Medical $22,409
1071 Transportation of Clients $2,588
1072 Staff Mileage/Vehicle Maintenance $1,293
1073 Staff Travel Out of Office $461
1074 Staff Train in /Re istration $10,072
1075 Lodging $0
1076 Other-Personnel Related Ex /Contracted PR Ex /Parking Exp/Parking $576,252
1077 Other-Flex Funds $13,500
OPERATING EXPENSES TOTALr $680,934
REVISED EXHIBIT B-2
Page 11 of 17
Youth Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2019 to June 30,2020
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $433
1081 External Audit $597
1082 Liability Insurance $8,927
1083 Other-Administrative Overhead $429,062
1084 Other-(identify)
1085 Other-(identify) $0
FINANCIAL SERVICES TOTAL $439,019
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant(network&data management) $16,212
1088 Translation Services $615
1089 Medication Supports(Pharmaceuticals) $7,375
1090 Food Service $32,350
1091 Laundry Service $12,134
1092 Medical Waste Disposal $615
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultants $0
1096 Medical Services $0
1097 Access Line $0
1098 Other-(identify) $0
SPECIAL EXPENSES TOTAL $69,301
FIXED ASSETS:
2000 Computers&Software $2,900
2001 Furniture&Fixtures $2,986
2002 Other- EHR Avatar Cost) $13,122
2003 Other-(identify) $0
FIXED ASSETS TOTAL $19,008
TOTAL PROGRAM EXPENSES $3,278,685
Vol/Units of
DIRECT SERVICE REVENUE: Service Rate $Amt.
3000 Mental Health Services(Individual/Family/Group Therapy) 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Crisis Stabilization-Urgent Care 25,903 $126.57 $3,278,685
3500 Other-(Identify) 0 $0.00 $0
3600 Other-(Identify) 0 $0.00 $0
3700 Other-(identify) 0 $0.00 $0
DIRECT SERVICE REVENUE TOTAL 25,903 3,278,685
Medi-cal Revenue 1,409,835
Cost Per Unit $126.58
FUNDING STREAM REIMBURSEMENT Population Served Percentage
4000 Private Insurance 11% $360,655
4100 Uninsured 3% $98,360
4200 Medi-Cal FFP 43% $1,409,835
4300 Realignment 43% $1,409,835
OTHER REVENUE/SOCIAL SERVICES TOTALI $3,278,685
TOTAL PROGRAM REVENUE1 $3,278,685
REVISED EXHIBIT B-2
Page 12 of 17
Youth Crisis Stabilization Center
Exodus Recovery,Inc.
2018-2019
BUDGET NARRATIVE-EXPENSES
PROGRAM EXPENSES
Personnel Salaries,Payroll Taxes&Employee Benefits-Line Items 0001-0042
These amounts reflect FTE positions,part-time positions and whether the positions are administrative or direct service.Employee benefits
should be limited to a maximum of 20%of total salaries.
1 601088
All SWB and Operational expenses budget line items are split between Adult and Youth CSU as follows:71%
adult and 29%youth.
Director of Education and Quality replaced VP position 0.29 FTE,Administrative Services-proposed annual
salary$139,550,total annual budget$40,470.29%of annual salary allocated to CSC Youth.
Program Director(RN)0.53 FTE,Administrative Services-proposed annual salary$107,584,total annual
budget$76,384.71%of annual salary allocated to CSC Youth
Program Nurses(RN)3.12 FTE,Direct Services-total annual budget$267,836
Program Nurses(LVN)5.75 FTE,Direct Services-total annual budget$357,400
Program Nurses(LPTN)1.03 FTE,Direct Services-total annual budget$46,116
Social Services Coordinators 1.38 FTE,Direct Services-proposed annual salary$72,218 total annual budget
$99,480.29%of annual salary allocated to CSC Youth.
Mental Health Workers 6.64 FTE Direct Services-average annual salary$47,366,proposed annual budget
$314,559.29%of annual salary allocated to CSC Youth.
Data Specialist 0.29 FTE,Administrative Services-average annual salary$36,665,proposed annual budget
$10,633.29%of annual salary allocated to CSC Youth.
Benefits/PAP Coordinator 0.29 FTE,Administrative Services-average annual salary$48,189,proposed annual
budget$13,975.29%of annual salary allocated to CSC Youth.
Program Assistant 0.29 FTE,Administrative Services-average annual salary$50,519,proposed annual budget
$14,651. 29%of annual salary allocated to CSC Youth.
Driver 0.29 FTE,Administrative Services-average annual salary$42,844,proposed annual budget$12,425.
29%of annual salary allocated to CSC Youth.
Peer Counselor 0.78 FTE,Direct Services-average annual salary$45,803,proposed annual budget$35,864.
29%of annual salary allocated to CSC Youth.
Intake Coordinator 0.15 FTE,Administrative Services-average annual salary$26,480,proposed annual budget
$7,680.29%of annual salary allocated to CSC Youth.
Billing Supervisor 0.06,Administrative Services-average annual salary$13,104,proposed annual budget
$3,801. 29%of annual salary allocated to CSC Youth.
Salary Total$1,256,088
Payroll Taxes
OASDI$11,993
FICA/MEDICARE$85,040
SUI$11,993
Payroll Taxes Total$109,027
Employee Benefits
Retirement$54,274
Workers Compensation$77,871
Health Insurance(medical vision,life,dental)$103,828
Employee Benefits$235,973
Facilities/Equipment Expenses—Line Items 1010-1014
469 334
Identify building lease/rent expenses,equipment(office equipment,vehicles,etc.). Attach copy of lease
agreements if available.
Rent/Equipment Leases-Lease cost for computers,printers,copier,and faxes for the program$15,287
Utilities-Cost for program utilities$35,566
Janitorial-Cost forjanitorial Service for the program$23,112
Maintenance-Cost for maintenance and repairs for the facility$11,285
Security-Cost for security personnel for the program$380,391
Business Taxes-Cost of related to business tax expense for the program$3,693
Operating Expenses-Line Items 1060-1077
680 934
Telephone-Cost of phone usage expense for the program$13,302
Postage-Program related postage cost$528
REVISED EXHIBIT B-2
Page 13 of 17
Youth Crisis Stabilization Center
Exodus Recovery,Inc.
2018-2019
BUDGET NARRATIVE-EXPENSES
Legal Notices/Advertising-Cost for advertising for staff recruitment and other program related advertising or
legal notices$581
Office Supplies&Equipment-Cost for office supplies and equipment for the program$39,946
Program Supplies-Medical-Cost for medical supplies for the program$22,409
Transportation of Clients-Cost for lease of vehicle,gas,and maintenance for client transportation$2,588
Staff Mileage/Vehicle Maintenance-Cost for mileage,parking,travel expense for program staff$1,293
Staff Travel-Cost for Employee Travel$461
Staff Training/Registration-Cost of ongoing training for staff$10,072
Other Personnel Related Exp/Contracted PR Exp/Parking-Personnel related expenses including registry
nurses as needed,parking,relocation costs,etc.Filled open MD position(0.75 FTE at$240/1-111)totlaing
additional$374,400(29%charged to Youth CSC)annually.$annual budget$576,252
Cost of client supportive services including toiletries,food,bus tokens,etc.$13,500
Financial Services Expenses—Line Items 1080-1085
439 019
Accounting/Bookkeeping-Cost of financial auditing and monthly financial reviews$433
External Audit-Cost of External Audit Services$597
Liability Insurance-Cost of insurance expense for liability,business property and vehicle policy$8927
Other Administrative Overhead-Administrative overhead expense related to the program$429,062
Special Expenses—Line Items 1090-1092
69 301
Consultant(network&data mgmt)Cost for consultant IT firm support,network monitoring,and off-site back-
up for program IT System$16,212
Translation Services-Cost for translation services for the program$615
Medication Supports(Pharmaceuticals)Medication costs for clients$7,375
Food Service-Cost for food services for program clients$32,350
Laundry Service-Cost for linen service for the program$12,134
Medical Waste Disposal-Cost medical and office related waste for the program$615
Fixed Assets—Line Items 1190-1193
Include all purchases over Five Thousand Dollars($5,000)including sales tax,and certain purchases
under said amount such as camera,televisions,VCRs/DVDs and other sensitive items,made during the
life of the Agreement resulting from this Request for Proposal,with funds paid pursuant to this
19 008
Furniture&Fixtures$2,987
Computers&Software$2900
Other-EHR Services$13,122
TOTAL PROGRAM EXPENSE: $3.278.685
REVISED EXHIBIT B-2
Page 14 of 17
Youth Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2020 to June 30,2021
Budget Categories- Total Proposed Budget
Line Item Description Must be itemized FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Director of Education and Quality 0.29 $41,684 $41,684
0002 Program Director(RN) 0.22 $32,135 $32,135
0003 Program Nurses RN 3.12 $275,871 $275,871
0003 Program Nurses(LVN) 5.75 $368,122 $368,122
0003 Program Nurses LPTN 1.03 $47,500 $47,500
0004 Social Service Coordinators 1.38 $102,464 $102,464
0005 Mental Health Worker 6.64 $323,996 $323,996
0006 Data Specialist 0.29 $10,952 $10,952
0007 Benefits/PAP Coordinator 0.29 $14,394 $14,394
0008 Program Assistant 0.29 $15,091 $15,091
0009 Driver 0.29 $12,798 $12,798
0010 Peer Counselor 0.78 $36,940 $36,940
0011 Intake Coordinator 0.15 $7,910 $7,910
0012 Billing Supervisor 0.06 $3,915 $3,915
SALARY TOTAL 20.57 $143,684 $1,150,088 $1,293,772
PAYROLL TAXES:
0030 OASDI $12,353 $12,353
0031 FICA/MEDICARE $87,591 $87,591
0032 SUI $12,353 $12,353
PAYROLL TAX TOTAL $112,297 $112,297
EMPLOYEE BENEFITS:
0040 Retirement $55,902 $55,902
0041 Workers Compensation $80,207 $80,207
0042 Health Insurance(medical vision,life,dental) $106,9431 $106,943
EMPLOYEE BENEFITS TOTAL $243,0521 $243,052
SALARY&BENEFITS GRAND TOTAL $1,649,121
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $0
1011 Rent/Lease Equipment $15,746
1012 Utilities $36,633
1013 Janitorial $23,805
1014 Maintenance(facility) $11,624
1015 Security Personnel $391,803
1016 Maintenance durable medical equipment) $0
1017 Other-Business Taxes/Licenses-Permits $3,804
1018 Other-One Time Start-Up Costs $0
FACILITY/EQUIPMENT TOTAL $483,414
OPERATING EXPENSES:
1060 Telephone $13,701
1061 Answering Service $0
1062 Postage $544
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $598
1066 Office Supplies&Equipment $41,144
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies-Therapeutic $0
1070 Program Supplies-Medical $23,081
1071 Transportation of Clients $2,666
1072 Staff Mileage/Vehicle Maintenance $1,332
1073 Staff Travel Out of Office $475
1074 Staff Train in /Re istration $10,374
1075 Lodging $0
1076 Other-Personnel Related Ex /Contracted PR Ex /Parking Exp/Parking $576,252
1077 Other-Flex Funds $13,905
OPERATING EXPENSES TOTALr $684,072
REVISED EXHIBIT B-2
Page 15 of 17
Youth Crisis Stabilization Center
Exodus Recovery, Inc.
July 1,2020 to June 30,2021
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $446
1081 External Audit $615
1082 Liability Insurance $9,195
1083 Other-Administrative Overhead $441,934
1084 Other-(identify)
1085 Other-(identify) $0
FINANCIAL SERVICES TOTAL $452,190
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant(network&data management) $16,698
1088 Translation Services $633
1089 Medication Supports(Pharmaceuticals) $7,596
1090 Food Service $33,321
1091 Laundry Service $12,498
1092 Medical Waste Disposal $633
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultants $0
1096 Medical Services $0
1097 Access Line $0
1098 Other-(identify) $0
SPECIAL EXPENSES TOTAL $71,380
FIXED ASSETS:
2000 Computers&Software $2,900
2001 Furniture&Fixtures $3,076
2002 Other- EHR Avatar Cost) $13,122
2003 Other-(identify) $0
FIXED ASSETS TOTAL $19,098
TOTAL PROGRAM EXPENSES $3,359,275
Vol/Units of
DIRECT SERVICE REVENUE: Service Rate $Amt.
3000 Mental Health Services(Individual/Family/Group Therapy) 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Crisis Stabilization-Urgent Care 25,813 $130.14 $3,359,275
3500 Other-(Identify) 0 $0.00 $0
3600 Other-(Identify) 0 $0.00 $0
3700 Other-(identify) 0 $0.00 $0
DIRECT SERVICE REVENUE TOTAL 25,813 3,359,275
Medi-cal Revenue 1,444,488
Cost Per Unit $130.14
FUNDING STREAM REIMBURSEMENT Population Served Percentage
4000 Private Insurance 11% $369,521
4100 Uninsured 3% $100,778
4200 Medi-Cal FFP 43% $1,444,488
4300 Realignment 43% $1,444,488
OTHER REVENUE/SOCIAL SERVICES TOTALI $3,359,275
TOTAL PROGRAM REVENUE1 $3,359,275
REVISED EXHIBIT B-2
Page 16 of 17
Youth Crisis Stabilization Center
Exodus Recovery,Inc.
2020-2021
BUDGET NARRATIVE-EXPENSES
PROGRAM EXPENSES
Personnel Salaries,Payroll Taxes&Employee Benefits-Line Items 0001-0042
These amounts reflect FTE positions,part-time positions and whether the positions are administrative or direct service.Employee benefits
should be limited to a maximum of 20%of total salaries.
1 649 121
All SWB and Operational expenses budget line items are split between Adult and Youth CSU as follows:71%
adult and 29%youth.
Director of Education and Quality replaced VP position 0.29 FTE,Administrative Services-proposed annual
salary$143,736,total annual budget$41,684.29%of annual salary allocated to CSC Youth
Program Director(RN)0.22 FTE,Administrative Services-proposed annual salary$110,811,total annual
budget$32,135.29%of annual salary allocated to CSC Youth
Program Nurses(RN)3.12 FTE,Direct Services-total annual budget$275,871
Program Nurses(LVN)5.75 FTE,Direct Services-total annual budget$368,122
Program Nurses(LPTN)1.03 FTE,Direct Services-total annual budget$47,500
Social Services Coordinators 1.38 FTE,Direct Services-proposed annual salary$74,385,total annual budget
$102,464.29%of annual salary allocated to CSC Youth.
Mental Health Workers 6.64 FTE Direct Services-average annual salary$48,787,proposed annual budget
$323,996.29%of annual salary allocated to CSC Youth.
Data Specialist 0.29 FTE,Administrative Services-average annual salary$37,766,proposed annual budget
$10,952.29%of annual salary allocated to CSC Youth.
Benefits/PAP Coordinator 0.29 FTE,Administrative Services-average annual salary$49,635,proposed annual
budget$14,394.29%of annual salary allocated to CSC Youth.
Program Assistant 0.29 FTE,Administrative Services-average annual salary$52,035,proposed annual budget
$15,091. 29%of annual salary allocated to CSC Youth.
Driver 0.29 FTE,Administrative Services-average annual salary$44,130,proposed annual budget$12,798.
29%of annual salary allocated to CSC Youth.
Peer Counselor 0.78 FTE,Direct Services-average annual salary$47,177,proposed annual budget$36,940.
29%of annual salary allocated to CSC Youth.
Intake Coordinator 0.15 FTE,Administrative Services-average annual salary$27,274,proposed annual budget
$7,910.29%of annual salary allocated to CSC Youth.
Billing Supervisor 0.06,Administrative Services-average annual salary$13,497,proposed annual budget
$3,915. 29%of annual salary allocated to CSC Youth.
Salary Total$1,293,772
Payroll Taxes
OASDI$12,353
FICA/MEDICARE$87,591
SUI$12,353
Payroll Taxes Total$112,297
Employee Benefits
Retirement$55,902
Workers Compensation$80,207
Health Insurance(medical vision,life,dental)$106,943
Employee Benefits$243,052
Facilities/Equipment Expenses—Line Items 1010-1014
483 414
Identify building lease/rent expenses,equipment(office equipment,vehicles,etc.). Attach copy of lease
agreements if available.
Rent/Equipment Leases-Lease cost for computers,printers,copier,and faxes for the program$15,746
Utilities-Cost for program utilities$36,633
Janitorial-Cost forjanitorial Service for the program$23,805
Maintenance-Cost for maintenance and repairs for the facility$11,624
Security-Cost for security personnel for the program$391,803
Business Taxes-Cost of related to business tax expense for the program$3,804
Operating Expenses-Line Items 1060-1077
684 072
Telephone-Cost of phone usage expense for the program$13,701
Postage-Program related postage cost$544
REVISED EXHIBIT B-2
Page 17 of 17
Youth Crisis Stabilization Center
Exodus Recovery,Inc.
2020-2021
BUDGET NARRATIVE-EXPENSES
Legal Notices/Advertising-Cost for advertising for staff recruitment and other program related advertising or
legal notices$598
Office Supplies&Equipment-Cost for office supplies and equipment for the program$41,144
Program Supplies-Medical-Cost for medical supplies for the program$23,081
Transportation of Clients-Cost for lease of vehicle,gas,and maintenance for client transportation$2,666
Staff Mileage/Vehicle Maintenance-Cost for mileage,parking,travel expense for program staff$1,332
Staff Travel-Cost for Employee Travel$475
Staff Training/Registration-Cost of ongoing training for staff$10,374
Other Personnel Related Exp/Contracted PR Exp/Parking-Personnel related expenses including registry
nurses as needed,parking,relocation costs,etc.Filled open MD position(0.75 FTE at$240/1-111)totlaing
additional$374,400(29%charged to Youth CSC)annually.$576,252 annual budget
Cost of client supportive services including toiletries,food,bus tokens,etc.$13,905
Financial Services Expenses—Line Items 1080-1085
452 190
Accounting/Bookkeeping-Cost of financial auditing and monthly financial reviews$446
External Audit-Cost of External Audit Services$615
Liability Insurance-Cost of insurance expense for liability,business property and vehicle policy$9195
Other Administrative Overhead-Administrative overhead expense related to the program$441,934
Special Expenses—Line Items 1090-1092
71 380
Consultant(network&data mgmt)Cost for consultant IT firm support,network monitoring,and off-site back-
up for program IT System$16,698
Translation Services-Cost for translation services for the program$633
Medication Supports(Pharmaceuticals)Medication costs for clients$7,596
Food Service-Cost for food services for program clients$33,321
Laundry Service-Cost for linen service for the program$12,498
Pharmaceutical Consultants-Cost medical and office related waste for the program$633
Fixed Assets—Line Items 1190-1193
Include all purchases over Five Thousand Dollars($5,000)including sales tax,and certain purchases under said amount such as camera,
televisions,VCRs/DVDs and other sensitive items,made during the life of the Agreement resulting from this Request for Proposal,with funds
paid pursuant to this Agreement and that will outlive the life of this Agreement.
19 098
Furniture&Fixtures$3,077
Computers&Software$2,900
Other-EHR Services$13,122
TOTAL PROGRAM EXPENSE: 53.359.275
REVISED EXHIBIT D
Page 1 of 3
Documentation Standards for Client Records
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the
record have a specific document or section addressing these topics. All medical records shall be
maintained for a minimum of ten (10) years from the date of the end of the Agreement.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client
record.
• Relevant physical health conditions reported by the client will be prominently
identified and updated as appropriate.
• Presenting problems and relevant conditions affecting the client's physical health and
mental health status will be documented, for example: living situation, daily activities,
and social support.
• Documentation will describe client's strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently
documented and updated as appropriate.
• Documentations will include medications that have been described by mental health
plan physicians, dosage of each medication, dates of initial prescriptions and refills,
and documentations of informed consent for medications.
• Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
• A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data, relevant
family information and relevant results of relevant lab tests and consultations reports.
• For children and adolescents, pre-natal and perinatal events and complete
developmental history will be documented.
• Documentations will include past and present use of tobacco, alcohol, and caffeine,
as well as illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A DSM-5 diagnosis, or a diagnosis from the most current ICD, will be documented,
consistent with the presenting problems, history mental status evaluation and/or
other assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document
changes in the client's condition.
• Client conditions will be assessed at least annually and, in most cases, at more
frequent intervals.
B. Client Plans
1. Client plans will:
0 have specific observable and/or specific quantifiable goals
REVISED EXHIBIT D
Page 2of3
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent) by:
➢ the person providing the service(s), or
➢ a person representing a team or program providing services, or
➢ a person representing the MHP providing services
➢ when the client plan is used to establish that the services are provided under
the direction of an approved category of staff, and if the below staff are not
the approved category,
➢ a physician
➢ a licensed/"waivered" psychologist
➢ a licensed/"associate" social worker
➢ a licensed/ registered/marriage and family therapist or
➢ a registered nurse
• In addition,
➢ client plans will be consistent with the diagnosis, and the focus of intervention
will be consistent with the client plan goals, and there will be documentation
of the client's participation in and agreement with the plan. Examples of the
documentation include, but are not limited to, reference to the client's
participation and agreement in the body of the plan, client signature on the
plan, or a description of the client's participation and agreement in progress
notes.
➢ client signature on the plan will be used as the means by which the
CONTRACTOR(S) documents the participation of the client
➢ when the client's signature is required on the client plan and the client refuses
or is unavailable for signature, the client plan will include a written explanation
of the refusal or unavailability.
• The CONTRACTOR(S) will give a copy of the client plan to the client on request.
2. Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for the
individual elements of the client plan described in Item 1.
C. Progress Notes
1. Items that must be contained in the client record related to the client's progress in
treatment include:
• The client record will provide timely documentation of relevant aspects of client care
• Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
• All entries in the client record will include the signature of the person providing the
service (or electronic equivalent); the person's professional degree, licensure or job
title; and the relevant identification number, if applicable
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge
summary
REVISED EXHIBIT D
Page 3of3
2. Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated below:
A. Every Service Contact
• Mental Health Services
• Medication Support Services
• Crisis Intervention
REVISED EXHIBIT E
Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business
and Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates
of pay or other forms of compensation, use of facilities, and other terms
and conditions of employment.
REVISED EXHIBIT E
Page 2 of 6
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY's Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f)
and CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply
with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-
free workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is prohibited and
specifying actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
C. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
Failure to comply with these requirements may result in suspension of payments under
this Agreement or termination of this Agreement or both and CONTRACTOR may be
REVISED EXHIBIT E
Page 3 of 6
ineligible for award of any future State agreements if the department determines that any
of the following has occurred: the CONTRACTOR has made false certification, or
violated the certification by failing to carry out the requirements as noted above. (Gov.
Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1)final unappealable finding of contempt of court by a
Federal court has been issued against CONTRACTOR within the immediately preceding
two (2) year period because of CONTRACTOR's failure to comply with an order of a
Federal court, which orders CONTRACTOR to comply with an order of the National
Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will comply with
the requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the lessor of
30 multiplied by the number of full time attorneys in the firm's offices in the State, with
the number of hours prorated on an actual day basis for any contract period of less than
a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the
State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of equipment,
materials, or supplies, other than procurement related to a public works contract, declare
under penalty of perjury that no apparel, garments or corresponding accessories,
equipment, materials, or supplies furnished to the state pursuant to the contract have
been laundered or produced in whole or in part by sweatshop labor, forced labor, convict
labor, indentured labor under penal sanction, abusive forms of child labor or exploitation
of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor,
convict labor, indentured labor under penal sanction, abusive forms of child labor or
exploitation of children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the
California Department of Industrial Relations website located at www.dir.ca.gov, and
Public Contract Code Section 6108.
b. CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR's records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the Department of
REVISED EXHIBIT E
Page 4 of 6
Industrial Relations, or the Department of Justice to determine the contractor's
compliance with the requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or has a financial
interest and which is sponsored or funded by any state agency, unless the employment,
activity or enterprise is required as a condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he or she
engaged in any of the negotiations, transactions, planning, arrangements or any part of
the decision-making process relevant to the contract while employed in any capacity by
any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a contract with any state
agency if he or she was employed by that state agency in a policy-making position in the
same general subject area as the proposed contract within the twelve (12) month period
prior to his or her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
REVISED EXHIBIT E
Page 5 of 6
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance with the
provisions, and CONTRACTOR affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR's name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment. Payment of
invoices presented with a new name cannot be paid prior to approval of said
amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently qualified to do
business in California in order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit. Although there
are some statutory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
C. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do business in California.
Agencies will determine whether a corporation is in good standing by calling the Office of
the Secretary of State.
6. RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local governing
body, which by law has authority to enter into an agreement, authorizing execution of the
agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not subject to
review promulgated by the State Air Resources Board or an air pollution control district;
(2) subject to cease and desist order not subject to review issued pursuant to Section
13301 of the Water Code for violation of waste discharge requirements or discharge
prohibitions; or (3)finally determined to be in violation of provisions of federal law
relating to air or water pollution.
REVISED EXHIBIT E
Page 6 of 6
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General, and their
designees may, at any time, inspect and audit any records or documents of
CONTRACTOR or its subcontractors, and may, at any time, inspect the premises,
physical facilities, and equipment where Medicaid-related activities or work is conducted.
The right to audit under this section exists for ten (10) years from the final date of the
contract period or from the date of completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must confirm the
identity and determine the exclusion status of CONTRACTOR, any subcontractor, as
well as any person with an ownership or control interest, or who is an agent or managing
employee of CONTRACTOR through routine checks of Federal databases. This
includes the Social Security Administration's Death Master File, the National Plan and
Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE),
the System for Award Management (SAM), and any other databases as the State or
Secretary may prescribe. These databases must be consulted upon contracting and no
less frequently than monthly thereafter. If the State finds a party that is excluded, it must
promptly notify the CONTRACTOR and take action consistent with § 438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or financial
institution located outside of the U.S. are considered in the development of actuarially
sound capitation rates.
REVISED EXHIBIT H
Page 1 of 2
FRESNO COUNTY MENTAL HEALTH PLAN
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes the form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed for
each client.
Where the forms should be sent—within 24 hours from the time of the incident or first
knowledge of the incident:
• Incident Report should be sent to:
DBHlncidentreporting(a)fresnocountyca.gov and designated Contract Analyst
REVISED EXHIBIT H
Page 2 of 2
Fresno County Department of Behavioral Health-Incident Report
Send completed forms to dbhincidentreporting@fresnocountyca.gov and designated contract analyst within 24 hours of an
incident or knowledge of an incident. DO NOT COPY OR REPRODUCE/NOT part of the medical record.
Client Information
Last Name: Click or tap here to enter text. First Name: Click or tap here to enter text. Middle Initial:Click or tap here to enter text.
Date of Birth:Click or tap here to enter text.Client ID#:Click or tap here to enter text. Gender: ❑ Male ❑ Female
County of Origin:Click or tap here to enter text.
Name of Reporting Party:Click or tap here to enter text. Name of Facility:Click or tap here to enter text.
Facility Address:Click or tap here to enter text. Facility Phone Number:Click or tap here to enter text.
Incident(check all that apply)
❑ Homicide/Homicide Attempt ❑ Attempted Suicide(resulting in serious injury) ❑ Death of Client ❑ Medical Emergency
❑ Injury(self-inflicted or by accident) ❑ Violence/Abuse/Assault(toward others, client and/or property)
❑ Other-Specify(i.e. medication errors, client escaping from locked facility,fire, poisoning,epidemic outbreaks, other
catastrophes/events that jeopardize the welfare and safety of clients,staff and/or members of the community):Click or tap here to
enter text.
Date of Incident: Click or tap here to enter text. Time of Incident: Click or tap here to enter text.❑am ❑pm
Location of Incident:Click or tap here to enter text.
Description of the Incident(Attach additional sheet if needed):Click or tap here to enter text.
Key People Directly Involved in Incident(witnesses,staff): Click or tap here to enter text.
Action Taken (check all that apply)
❑ Consulted with Physician ❑ Called 911/EMS ❑ First Aid/CPR Administered ❑ Law Enforcement Contacted
❑ Client removed from building ❑ Parent/Legal Guardian Contacted ❑Other(Specify): Click or tap here to enter text.
Description of Action Taken: Click or tap here to enter text.
Outcome of Incident(If Known): Click or tap here to enter text.
Form Completed by:
Printed Name Signature Date
Reviewed by Supervisor/Program Manager:
Printed Name Signature Date
For Internal Use only:
❑ Report to Administration ❑ Report to Intensive Analysis Committee for additional review ❑Request Additional Information
❑ No Action ❑ Unusual Occurrence ❑ Other: Click or tap here to enter text.
Revised 08/18
REVISED EXHIBIT M
Page 1 of 1
CUGti
Fresno County Mental Health Plan
o� FRES�� 1-800-654-3937 Access Line Test Call Feedback Form
The toll-free Access Line is available 24 hours a day, seven days a week,to provide information on how
to access specialty mental health services, including services needed to treat a beneficiary's urgent
condition. The toll-free line also provides information on how to use the beneficiary problem resolution
and fair hearing processes. This line also has language capabilities in all languages spoken by the
beneficiaries of Fresno County
TEST CALLER INFORMATION
Name of Staff Testing Line: Date of Call:
Fictitious Name of Caller: Time of Call: ❑AM ❑ PM
Client is a(n): ❑ Minor(under 18 years)
Fictitious Name of Client (if different): ❑ Adult (18 years and over)
Language of Caller/Client: ❑ English ❑ Spanish ❑ Hmong ❑ Other(Specify):
Caller's/Client's Phone#Provided to Operator: ( ) - ❑ None Given ❑ N/A
Reason for the call:
RESULTS OF TEST CALL
1. Did the person who took your call tell you his/her
name? ❑ Yes ❑ No If Yes,what was it:
2. Did the person who took your call ask if your situation is a crisis/emergency? ❑ Yes ❑ No
3. Did the person who took your call ask for your name? ❑ Yes ❑ No
4. Did the person who took your call ask for your phone number? ❑ Yes ❑ No
5. Foreign Ian,-ua,-e test callers only: Did the person who took your call speak ❑ N/A ❑ Yes ❑ No
your language or provide help with free language assistance services?
6. Did the person give appropriate information on how to access services? ❑ N/A ❑ Yes ❑ No
7. Did the person give appropriate phone#'s (i.e. UCWC/Exodus) to contact DBH? ❑ N/A ❑ Yes ❑ No
8. Did the person give appropriate information on how to receive literature upon ❑ N/A ❑ Yes ❑ No
your request?
9. Did the person give appropriate information on how to file a complaint upon ❑ N/A ❑ Yes ❑ No
your request?
ADDITIONAL COMMENTS
REVISED EXHIBIT N
Page 1 of 1
sti CO
Fresno County Mental Health Plan
1 (800) 654-3937 Access Line - Statement of Deficiencies and Plan of Correction
pRgS
Provider Name
Address
City Zip Code
Phone ( ) - Ext.
Category Summary Statement of Provider's Plan of Completion Date
Deficiencies Correction
Provider's Signature Title Date
EXHIBIT O
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH MISSION:
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,
families and communities in Fresno County who are affected by, or are at risk of, mental illness
and/or substance use disorders through cultivation of strengths toward promoting recovery in
the least restrictive environment.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
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EXHIBIT O
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and client values and preferences
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
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EXHIBIT O
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
6. Principle six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the client's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
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EXHIBIT O
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
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