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HomeMy WebLinkAboutAgreement A-23-287 Master Agreement for AFSP.pdf Agreement No. 23-287 1 SERVICE AGREEMENT 2 This Service Agreement ("Agreement") is dated June 20, 2023 and is between 3 Contractor(s) listed in Exhibit A"List of Contractors" ("Contractor(s)"), and the County of Fresno, 4 a political subdivision of the State of California ("County"). 5 Recitals 6 A. County, through its Department of Behavioral Health (DBH), is in need of qualified 7 agencies to operate Full-Service Partnership (FSP) program sites that provide comprehensive 8 mental health, housing, employment support and community supports to adults and older adults 9 with a serious mental illness (SMI); and 10 B. County, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of the 11 California Code of Regulations (C.C.R.), Section 1810.226; and 12 C. County entered into Agreement No. 20-216, effective June 9, 2020. 13 D. Changes to the agreement are necessary due the Department of Health Care Services' 14 implementation of California Advancing and Innovating Medi-Cal (CalAIM), which includes a 15 new billing structure that Contractors must utilize; 16 E. This Agreement shall replace, restate, and supersede Agreement No. 20-216 in its 17 entirely. 18 The parties therefore agree as follows: 19 Article 1 20 Contractor's Services 21 1.1 Scope of Services. The Contractor(s) shall perform all of the services provided in 22 Exhibit B, to this Agreement, titled "Scope of Services." 23 (A) Contractor(s) shall also perform all services and fulfill all responsibilities as set 24 forth in their individual "Scope of Work" documents approved by the COUNTY's DBH 25 Director, or designee, and attached as Exhibit B1, et seq. 26 1.2 Representation. The Contractor(s) represents that it is qualified, ready, willing, and 27 able to perform all of the services provided in this Agreement. 28 1 1 1.3 Compliance with Laws. The Contractor(s) shall, at its own cost, comply with all 2 applicable federal, state, and local laws and regulations in the performance of its obligations 3 under this Agreement, including but not limited to workers compensation, labor, and 4 confidentiality laws and regulations. 5 Contractor(s) shall provide services in conformance with all applicable State and Federal 6 statutes, regulations and subregulatory guidance, as from time to time amended, including but 7 not limited to: 8 (A) California Code of Regulations, Title 9; 9 (B) California Code of Regulations, Title 22; 10 (C) California Welfare and Institutions Code, Division 5; 11 (D) United States Code of Federal Regulations, Title 42, including but not limited to 12 Parts 438 and 455; 13 (E) United States Code of Federal Regulations, Title 45; 14 (F) United States Code, Title 42 (The Public Health and Welfare), as applicable; 15 (G)Balanced Budget Act of 1997; 16 (H) Health Insurance Portability and Accountability Act (HIPAA); and 17 (1) Applicable Medi-Cal laws and regulations, including applicable sub-regulatory 18 guidance, such as Behavioral Health Information Notices (BHINs), Mental Health and 19 Substance Use Disorder Services Information Notices (MHSUDS INs), and provisions of 20 County's, state or federal contracts governing services for persons served. 21 In the event any law, regulation, or guidance referred to in this section 1.3 is amended 22 during the term of this Agreement, the parties agree to comply with the amended authority as of 23 the effective date of such amendment without amending this Agreement. 24 Contractor(s) recognizes that County operates its mental health programs under an 25 agreement with DHCS, and that under said agreement the State imposes certain requirements 26 on County and its subcontractors. Contractor(s) shall adhere to all State requirements, including 27 those identified in Exhibit C, "Behavioral Health Requirements". 28 2 1 1.4 Meetings. Contractor(s) shall participate in monthly, or as needed, workgroup 2 meetings consisting of staff from County's DBH to discuss service requirements, data reporting, 3 training, policies and procedures, overall program operations and any problems or foreseeable 4 problems that may arise. Contractor(s) shall also participate in other County meetings, such as 5 but not limited to quality improvement meetings, provider meetings, Behavioral Health Board 6 meetings, bi-monthly contractor meetings, etc. Schedule for these meetings may change based 7 on the needs of the County. 8 1.5 Organizational Provider. Contractor(s) shall maintain requirements as a Mental 9 Health Plan (MHP) organizational provider throughout the term of this Agreement, as described 10 in Article 17 of this Agreement. If for any reason, this status is not maintained, County may 11 terminate this Agreement pursuant to Article 7 of this Agreement. 12 1.6 Staffing. Contractor(s) agrees that prior to providing services under the terms and 13 conditions of this Agreement, Contractor(s) shall have staff hired and in place for program 14 services and operations or County may, in addition to other remedies it may have, suspend 15 referrals or terminate this Agreement, in accordance with Article 7 of this Agreement. 16 1.7 Credentialing and Recredentialing. Contractor(s) and their respective staff must 17 follow the uniform process for credentialing and recredentialing of service providers established 18 by County, including disciplinary actions such as reducing, suspending, or terminating provider's 19 privileges. Failure to comply with specified requirements can result in suspension or termination 20 of an individual or provider. 21 Upon request, the Contractor(s) must demonstrate to the County that each of its 22 providers are qualified in accordance with current legal, professional, and technical standards, 23 and that they are appropriately licensed, registered, waivered, and/or certified. 24 Contractor(s) must not employ or subcontract with providers debarred, suspended or 25 otherwise excluded (individually, and collectively referred to as "Excluded") from participation in 26 Federal Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set 27 forth in 42 C.F.R. §438.610. See Article 12 below. 28 3 1 Contractor(s) is required to verify and document at a minimum every three years that 2 each network provider that delivers covered services continues to possess valid credentials, 3 including verification of each of the credentialing requirements as per the County's uniform 4 process for credentialing and recredentialing. If any of the requirements are not up-to-date, 5 updated information should be obtained from network providers to complete the re-credentialing 6 process. 7 1.8 Criminal Background Check. Contractor(s) shall ensure that all providers and/or 8 subcontracted providers consent to a criminal background check, including fingerprinting to the 9 extent required under state law and 42 C.F.R. § 455.434(a). Contractor(s) shall provide 10 evidence of completed consents when requested by the County, DHCS or the US Department 11 of Health & Human Services (US DHHS). 12 1.9 Guiding Principles. Contractor(s) shall align programs, services, and practices with 13 the vision, mission, and guiding principles of the DBH, as further described in Exhibit D, "Fresno 14 County Department of Behavioral Health Guiding Principles of Care Delivery". 15 1.10 Clinical Leadership. Contractor(s) shall send to County upon execution of this 16 Agreement, a detailed plan ensuring clinically appropriate leadership and supervision of their 17 clinical program. Recruitment and retaining clinical leadership with the clinical competencies to 18 oversee services based on the level of care and program design presented herein shall be 19 included in this plan. A description and monitoring of this plan shall be provided. 20 1.11 Timely Access. It is the expectation of the County that Contractor(s) provide timely 21 access to services that meet the State of California standards for care. Contractor(s) shall track 22 timeliness of services to persons served and provide a monthly report showing the monitoring or 23 tracking tool that captures this data. County and Contractor(s) shall meet to go over this 24 monitoring tool, as needed but at least on a monthly basis. County shall take corrective action if 25 there is a failure to comply by Contractor(s)with timely access standards. Contractor(s) shall 26 also provide tracking tools and measurements for effectiveness, efficiency, and persons served 27 satisfaction as further detailed in Exhibit F. 28 4 1 1.12 Electronic Health Record. Contractor(s) may maintain its records in County's 2 electronic health record (EHR) system in accordance with Exhibit E, "Documentation Standards 3 for Persons Served Records", as licenses become available. The person served record shall 4 begin with registration and intake, and include person served authorizations, assessments, 5 plans of care, and progress notes, as well as other documents as approved by County. County 6 shall be allowed to review records of all and any services provided. If Contractor(s) determines 7 to maintain its records in the County's EHR, it shall provide County's DBH Director, or his or her 8 designee, with a thirty (30) day notice. If at any time Contractor(s) chooses not to maintain its 9 records in the County's EHR, it shall provide County's DBH Director, or designee, with thirty (30) 10 days advance written notice and Contractor(s)will be responsible for obtaining its own system, 11 at its own cost, for electronic health records management. 12 Disclaimer 13 County makes no warranty or representation that information entered into the County's 14 DBH EHR system by Contractor(s) will be accurate, adequate, or satisfactory for Contractor's 15 own purposes or that any information in Contractor's possession or control, or transmitted or 16 received by Contractor(s), is or will be secure from unauthorized access, viewing, use, 17 disclosure, or breach. Contractor(s) is solely responsible for person served information entered 18 by Contractor(s) into the County's DBH EHR system. Contractor(s) agrees that all Private 19 Health Information (PHI) maintained by Contractor(s) in County's DBH EHR system will be 20 maintained in conformance with all HIPAA laws, as stated in section 18.1, "Health Insurance 21 Portability and Accountability Act." 22 1.13 Records. Contractor(s) shall maintain records in accordance with Exhibit E, 23 "Documentation Standards for Client Records". All person's served records shall be maintained 24 for a minimum of ten (10) years from the date of the end of this Agreement. 25 1.14 Access to Records. Contractor(s) shall provide County with access to all 26 documentation of services provided under this Agreement for County's use in administering this 27 Agreement. Contractor(s) shall allow County, CMS, the Office of the Inspector General, the 28 Controller General of the United States, and any other authorized Federal and State agencies to 5 1 evaluate performance under this Agreement, and to inspect, evaluate, and audit any and all 2 records, documents, and the premises, equipment and facilities maintained by the Contractor(s) 3 pertaining to such services at any time and as otherwise required under this Agreement. 4 1.15 Quality Improvement Activities and Participation. Contractor(s) shall comply with 5 the County's ongoing comprehensive Quality Assessment and Performance Improvement 6 (QAPI) Program (42 C.F.R. § 438.330(a)) and work with the County to improve established 7 outcomes by following structural and operational processes and activities that are consistent 8 with current practice standards. 9 Contractor(s) shall participate in quality improvement (QI) activities, including clinical and 10 non-clinical performance improvement projects (PIPs), as requested by the County in relation to 11 State and Federal requirements and responsibilities, to improve health outcomes and 12 individuals' satisfaction over time. Other QI activities include quality assurance, collection and 13 submission of performance measures specified by the County, mechanisms to detect both 14 underutilization and overutilization of services, individual and system outcomes, utilization 15 management, utilization review, provider appeals, provider credentialing and re-credentialing, 16 and person served grievances. Contractor(s) shall measure, monitor, and annually report to the 17 County its performance. 18 1.16 Rights of Persons Served. Rights of Persons Served. Contractor shall take all 19 appropriate steps to fully protect individual's rights, as specified in Welfare and Institutions Code 20 Sections 5325 et seq; Title 9 California Code of Regulations (CCR), Sections 861, 862, 883, 21 884; Title 22 CCR, Sections 72453 and 72527; and 42 C.F.R. § 438.100. The Contractor shall 22 ensure that its subcontractors comply with all applicable patients' rights laws and regulations. 23 Article 2 24 Reporting 25 2.1 Reports. The Contractor(s) shall submit the following reports: 26 (A) Outcome Reports 27 Contractor(s) shall submit to County clinical program performance outcome 28 reports, as requested. 6 1 Outcome reports and outcome requirements are subject to change at County's 2 discretion. Contractor(s) shall provide outcomes as stated in Exhibit B, Exhibit B1 et. seq 3 and Exhibit F. 4 (B) Staffing Report 5 Contractor(s) shall submit monthly staffing reports due by the tenth (10t") of each 6 month that identify all direct service and support staff by first and last name, applicable 7 licensure/certifications, and full-time hours worked to be used as a tracking tool to 8 determine if Contractor's program is staffed according to the requirements of this 9 Agreement. 10 (C) Mental Health Services Act (MHSA) Reporting 11 Contractor(s) shall adhere to MHSA reporting including but not limited to fiscal, 12 outcomes, and demographics as described in Exhibit B and Exhibit B1 et. seq. 13 (D) FSP Data Collection and Reporting to DHCS 14 Contractor(s) shall report client/partner information and outcomes of FSP 15 program directly into the FSP Data Collection and Reporting (DCR) system. Data shall 16 be submitted through an online interface using forms set forth in Exhibit G. 17 Contractors(s) shall submit to COUNTY's DBH by the fifteenth (15th) of each 18 month all monthly activity, outcome, and budget reports for the preceding month. 19 Contractor(s) shall also provide records of rents collected from each individual 20 and include the is individual's name, date of birth and social security number. All data 21 transmitted must be in strict conformance with Article 17 and Article 18 of this 22 Agreement. 23 (E) Additional Reports 24 Contractor(s) shall also furnish to County such statements, records, reports, 25 data, and other information as County may request pertaining to matters covered by this 26 Agreement. In the event that Contractor(s) fails to provide such reports or other 27 information required hereunder, it shall be deemed sufficient cause for County to 28 withhold monthly payments until there is compliance. In addition, Contractor(s) shall 7 1 provide written notification and explanation to County within five (5) days of any funds 2 received from another source to conduct the same services covered by this Agreement. 3 2.2 Monitoring. Contractor(s) agrees to extend to County's staff, County's DBH and the 4 California Department of Health Care Services (DHCS), or their designees, the right to review 5 and monitor records, programs, or procedures, at any time, in regard to persons served, as well 6 as the overall operation of Contractor's programs, in order to ensure compliance with the terms 7 and conditions of this Agreement. 8 Article 3 9 County's Responsibilities 10 3.1 The County shall provide oversight and collaborate with Contractor(s), other County 11 Departments and community agencies to help achieve program goals and outcomes. In addition 12 to contractor monitoring of program, oversight includes, but not limited to, coordination with 13 Department of Health Care Services (DHCS) in regard to program administration and outcomes. 14 County shall receive and analyze statistical outcome data from Contractor(s) throughout 15 the term of contract on a monthly basis. County shall notify the Contractor(s) when additional 16 participation is required. The performance outcome measurement process will not be limited to 17 survey instruments but will also include, as appropriate, persons served and staff surveys, chart 18 reviews, and other methods of obtaining required information. 19 Article 4 20 Compensation, Invoices, and Payments 21 4.1 The County agrees to pay, and the Contractor(s) agrees to receive, compensation 22 for the performance of its services under this Agreement as described in Exhibit H and Exhibit 23 H1 et seq. to this Agreement, titled "Compensation." 24 4.2 Specialty Mental Health Services Maximum Compensation. The maximum 25 compensation payable for Specialty Mental Health Services to the Contractor(s) under this 26 Agreement for the period of July 1, 2023 through June 30, 2024 is Twelve Million, Six Hundred 27 Thirteen Thousand, Two Hundred Sixty-Eight and No/100 Dollars ($12,613,268.00), which is not 28 a guaranteed sum but shall be paid only for services rendered and received. The maximum 8 1 compensation payable for Specialty Mental Health Services to the Contractor(s) under this 2 Agreement for the period of July 1, 2024 through June 30, 2025 is Twelve Million, Six Hundred 3 Thirty-Four Thousand, Thirty-Eight and No/100 Dollars ($12,634,038.00), which is not a 4 guaranteed sum but shall be paid only for services rendered and received. 5 4.3 Non-Medi-Cal Supports Maximum Compensation. The maximum compensation 6 payable to the Contractor(s) under this Agreement for Non Medi-Cal Supports including Mental 7 Health Services Act (MHSA) funds or American Rescue Plan Act (ARPA) funds for the period of 8 July 1, 2023 through June 30, 2024 for Non-Medi-Cal Supports is Two Million, Seven Hundred 9 Thirty-Nine Thousand, Two Hundred Ninety-Three and No/100 Dollars ($2,739,293.00). The 10 maximum compensation payable to the Contractor(s) under this Agreement for Non Medi-Cal 11 Supports including Mental Health Services Act (MHSA) funds or American Rescue Plan Act 12 (ARPA) funds for the period of July 1, 2024 through June 30, 2025 for Non-Medi-Cal Supports is 13 Two Million, Seven Hundred Seventy-Six Thousand, Three Hundred Seventy-Three and No/100 14 Dollars ($2,776,373.00). 15 4.4 Transition Optimization Funds. If Contractor opts to apply for transition 16 optimization funds, the maximum amount payable for transition optimization for the period of 17 July 1, 2023 through June 30, 2024 shall not exceed Two-Hundred Fifty Thousand and No/100 18 Dollars ($250,000.00) split among all current agreements between the Contractor and the 19 County for Medi-Cal billable specialty mental health and substance use disorder services as 20 further described in the Scope of Work/Services. All final invoices for transition optimization 21 funds shall be submitted by July 15, 2024. Invoices submitted thereafter, shall not be eligible for 22 payment. 23 4.5 Total Maximum Compensation. In no event shall the maximum contract amount for 24 all the services provided by the Contractor(s) to County under the terms and conditions of this 25 Agreement be in excess of Forty Million, Five Hundred Thirty-One Thousand, Four Hundred 26 Ninety-Two and No/100 Dollars ($40,531,492.00) during the entire term of this Agreement. 27 The Contractor(s) acknowledges that the County is a local government entity and does 28 so with notice that the County's powers are limited by the California Constitution and by State 9 1 law, and with notice that the Contractor(s) may receive compensation under this Agreement 2 only for services performed according to the terms of this Agreement and while this Agreement 3 is in effect, and subject to the maximum amount payable under this section. The Contractor(s) 4 further acknowledges that County employees have no authority to pay the Contractor(s) except 5 as expressly provided in this Agreement. 6 The Contractor will be compensated for performance of its services under this 7 Agreement as provided in this Article. The Contractor is not entitled to any compensation except 8 as expressly provided in this Agreement. 9 4.6 Rate Categories. The program service components for the Contractor shall be 10 categorized under one or more of the following rate categories and as indicated on Exhibit H: 11 (A) Clinic-Site Based: Clinic-Site Based programs shall be defined as programs who 12 provide less than fifty percent (50%) of services in the field. In the field services are 13 those services that do not occur through telehealth and do not occur in designated sites 14 in which the Contractor is afforded regular access. Designated sites shall be identified by 15 the Contractor and approved by County's DBH Director, or designee, in writing. 16 (B) Field Based: Field based programs shall be defined as programs that provide 17 more than fifty percent (50%) of services in the field. 18 (C) Full-Service Partnership/Assisted Outpatient Therapy/Therapeutic Behavioral 19 Health Services (FSP/AOT/TBS): FSP/AOT/TBS programs shall provide services in 20 accordance with level of care standards and general requirements as described in the 21 Scopes of Work, Exhibit B and B1 et seq. 22 DBH shall continuously monitor the programs and analyze data to review accuracy of 23 rate categories assigned and may only reassign rate categories with the written agreement of 24 both parties pursuant to Article 25. 25 4.7 Specialty Mental Health Services Claiming. Contractor(s) shall enter claims data 26 into the County's billing and transactional database system by the fifteenth (151") of every month 27 for actual services rendered in the previous month. Contractor(s) shall use Current Procedural 28 Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, as 10 1 provided in the DHCS Billing Manual available at 2 https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx, as from time to time 3 amended. 4 Claims shall be complete and accurate and must include all required information 5 regarding the claimed services. Claims data entry into the County's electronic health record 6 system shall be the responsibility of Contractor(s). County shall monitor the volume of services, 7 billing amounts and service types entered into County's electronic health record/information 8 system. Any and all audit exceptions resulting from the provision and reporting of specialty 9 mental health services by Contractor(s) shall be the sole responsibility of Contractor(s). 10 Contractor(s)will comply with all applicable policies, procedures, directives, and guidelines 11 regarding the use of County's electronic health record/information system. 12 Contractor(s) must provide all necessary data to allow County to bill Medi-Cal, and any 13 other third-party source, for services and meet State and Federal reporting requirements. The 14 necessary data can be provided by a variety of means, including but not limited to: 1) direct data 15 entry into County's electronic health record/information system; 2) providing an electronic file 16 compatible with County's electronic health record/information system; or 3) integration between 17 County's electronic health record/information system and Contractor's information system(s). 18 Contractor(s) shall maximize the Federal Financial Participation (FFP) reimbursement by 19 claiming all possible Medi-Cal services and correcting denied services for resubmission as 20 needed. 21 4.8 Applicable Fees. Contractor(s) shall not charge any persons served or third-party 22 payers any fee for service unless directed to do so by the County's DBH Director, or designee, 23 at the time the individual is referred for services. When directed to charge for services, 24 Contractor(s) shall use the uniform billing and collection guidelines prescribed by DHCS. 25 Contractor(s) will perform eligibility and financial determinations, in accordance with 26 DHCS' Uniform Method of Determining Ability to Pay (UMDAP), for all individuals unless 27 directed otherwise by the County's DBH Director or designee. 28 11 1 Contractor(s) shall not submit a claim to, or demand or otherwise collect reimbursement 2 from, the person served or persons acting on behalf of the person served for any specialty 3 mental health or related administrative services provided under this Contract, except to collect 4 other health insurance coverage, share of cost, and co-payments (Cal. Code Regs., tit. 9, 5 §1810.365(c). 6 The Contractor(s) must not bill persons served, for covered services, any amount 7 greater than would be owed if the County provided the services directly as per and otherwise 8 not bill persons served as set forth in 42 C.F.R. § 438.106. 9 If a person served has dual coverage, such as other health coverage (OHC) or Federal 10 Medicare, Contractor(s)will be responsible for billing the carrier and obtaining a payment/denial 11 or have validation of claiming with no response for ninety (90) days after the claim was mailed 12 before the service can be entered into the County's electronic health record/information system. 13 Contractor(s) must report all third-party collections for Medicare, third-party or client-pay or 14 private-pay in each month. A copy of explanation of benefits or CMS 1500 form is required as 15 documentation. Contractor(s) must comply with all laws and regulations governing the Federal 16 Medicare program, including, but not limited to: 1) the requirement of the Medicare Act, 42 17 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the Federal Centers 18 for Medicare and Medicaid Services as they relate to participation, coverage and claiming 19 reimbursement. Contractor(s) will be responsible for compliance as of the effective date of each 20 Federal, State or local law or regulation specified. 21 4.9 Invoices. The Contractor(s) shall submit monthly invoices, in arrears by the fifteenth 22 (15th) day of each month, in the format directed by the County. The Contractor(s) shall submit 23 invoices electronically to: 1) dbhinvoicereview@fresnocountyca.gov, 2) dbh- 24 invoices@fresnocountyca.gov; and 3) dbhcontractedservicesdivision@fresnocountyca.gov with 25 a copy to the assigned County's DBH Staff Analyst. At the discretion of County's DBH Director 26 or designee, if an invoice is incorrect or is otherwise not in proper form or substance, County's 27 DBH Director, or designee, shall have the right to withhold payment as to only the portion of the 28 invoice that is incorrect or improper after five (5) days prior notice to Contractor(s). Contractor(s) 12 1 agrees to continue to provide services for a period of ninety (90) days after notification of an 2 incorrect or improper invoice. If after the ninety (90) day period, the invoice is still not corrected 3 to County satisfaction, County's DBH Director, or designee, may elect to terminate this 4 Agreement, pursuant to the termination provisions stated in Article 7 of this Agreement. 5 Specialty Mental Health Services Claimable Services. For claimable services, 6 invoices shall be based on claims entered into the County's billing and transactional database 7 system for the prior month. 8 Monthly payments for claimed services shall only be based on the units of time assigned 9 to each CPT or HCPCS code entered in the County's billing and transactional database 10 multiplied by the practitioner service rates in Exhibit H. 11 County's payments to Contractor(s)for performance of claimed services are provisional 12 and subject to adjustment until the completion of all settlement activities. County's adjustments 13 to provisional payments for claimed services shall be based on the terms, conditions, and 14 limitations of this Agreement or the reasons for recoupment set forth in Article 4 and 13. 15 Cost Reimbursement Based Invoices. Invoices for cost reimbursement services shall 16 be based on actual expenses incurred in the month of service for Non Medi-Cal MHSA Direct 17 Client Supports and/or American Rescue Plan Act (ARPA) grant funds. Contractor(s) shall 18 submit monthly invoices and general ledgers to County that itemize the line item charges for 19 monthly program costs. The invoices and general ledgers will serve as tracking tools to 20 determine if Contractor's costs are in accordance with its budgeted cost. Failure to submit 21 reports and other supporting documentation shall be deemed sufficient cause for County to 22 withhold payments until there is compliance. 23 Contractor(s) must report all revenue collected from a third-party, client-pay or private- 24 pay in each monthly invoice. In addition, Contractor(s) shall submit monthly invoices for 25 reimbursement that equal the amount due less any revenue collected and/or unallowable cost 26 such as lobbying or political donations from the monthly invoice reimbursements. 27 28 13 1 Travel shall be reimbursed based on actual expenditures and reimbursement shall be at 2 Contractor's adopted rate, not to exceed the Federal Internal Revenue Services (IRS) published 3 rate. 4 Corrective Action Plans. Contractors shall enter services into the County's billing and 5 transactional database and submit invoices in accordance with the deadlines listed above and 6 information shall be accurate. Failure to meet the requirements set forth above will result in a 7 corrective action plan at the discretion of the County's DBH Director, or designee, and may 8 result in financial penalties or termination of agreement per Article 7. 9 4.10 Payment. Payments shall be made by County to Contractor(s) in arrears, for 10 services provided during the preceding month, within forty-five (45) days after the date of 11 receipt, verification, and approval by County. All final invoices and/or any final budget 12 modification requests shall be submitted by Contractor(s) within sixty (60) days following the 13 final month of service for which payment is claimed. No action shall be taken by County on 14 claims submitted beyond the sixty (60) day closeout period. Any compensation which is not 15 expended by Contractor(s) pursuant to the terms and conditions of this Agreement shall 16 automatically revert to County. 17 4.11 Specialty Mental Health Services Payments. Payment shall be made upon 18 certification and other proof satisfactory to County that services have actually been performed 19 by Contractor(s) as specified in this Agreement and/or after receipt and verification of actual 20 services provided. 21 4.12 Cost Reimbursement Payments. Payment shall be made upon certification or other 22 proof satisfactory to County that services have actually been performed by Contractor as 23 specified in this Agreement and/or after receipt and verification of actual expenditures incurred 24 by Contractor for monthly program costs for Non Medi-Cal MHSA Direct Client Supports and/or 25 ARPA grant funds, as identified in the budget narratives and budgets identified in Exhibit H1 et 26 seq., in the performance of this Agreement. County shall not be obligated to make any 27 payments under this Agreement if the request for payment is received by County more than 28 sixty (60) days after this Agreement has terminated or expired. 14 1 4.13 Recoupments and Audits. County shall recapture from Contractor(s) the value of 2 any services or other expenditures determined to be ineligible based on the County or State 3 monitoring results. The County reserves the right to enter into a repayment agreement with 4 Contractor(s), with total monthly payments not to exceed twelve (12) months from the date of 5 the repayment agreement, to recover the amount of funds to be recouped. The County has the 6 discretion to extend the repayment plan up to a total of twenty-four (24) months from the date of 7 the repayment agreement. The repayment agreement may be made with the signed written 8 approval of County's DBH Director, or designee, and respective Contractor(s) through a 9 repayment agreement. The monthly repayment amounts may be netted against the Contractor's 10 monthly billing for services rendered during the month, or the County may, in its sole discretion, 11 forego a repayment agreement and recoup all funds immediately. This remedy is not exclusive, 12 and County may seek requital from any other means, including, but not limited to, a separate 13 contract or agreement with Contractor(s). 14 Contractor(s) shall be held financially liable for any and all future disallowances/audit 15 exceptions due to Contractor's deficiency discovered through the State audit process and 16 County utilization review for services provided during the course of this Agreement. At County's 17 election, the disallowed amount will be remitted within forty-five (45) days to County upon 18 notification or shall be withheld from subsequent payments to Contractor(s). Contractor(s) shall 19 not receive reimbursement for any units of services rendered that are disallowed or denied by 20 the Fresno County Mental Health Plan (Mental Health Plan) utilization review process or 21 through the State of California DHCS audit and review process, cost report audit settlement if 22 applicable, for Medi-Cal eligible beneficiaries. 23 4.14 Incidental Expenses. The Contractor(s) is solely responsible for all of its costs and 24 expenses that are not specified as payable by the County under this Agreement. If Contractor(s) 25 fails to comply with any provision of this Agreement, County shall be relieved of its obligation for 26 further compensation. 27 4.15 Restrictions and Limitations. This Agreement shall be subject to any restrictions, 28 limitations, and/or conditions imposed by County or state or federal funding sources that may in 15 1 any way affect the fiscal provisions of, or funding for this Agreement. This Agreement is also 2 contingent upon sufficient funds being made available by County, state, or federal funding 3 sources for the term of the Agreement. If the federal or state governments reduce financial 4 participation in the Medi-Cal program, County agrees to meet with Contractor(s) to discuss 5 renegotiating the services required by this Agreement. 6 Funding is provided by fiscal year. Any unspent fiscal year appropriation does not roll 7 over and is not available for services provided in subsequent years. 8 In the event that funding for these services is delayed by the State Controller, County 9 may defer payments to Contractor(s). The amount of the deferred payment shall not exceed the 10 amount of funding delayed by the State Controller to the County. The period of time of the 11 deferral by County shall not exceed the period of time of the State Controller's delay of payment 12 to County plus forty-five (45) days. 13 4.16 Additional Financial Requirements. County has the right to monitor the 14 performance of this Agreement to ensure the accuracy of claims for reimbursement and 15 compliance with all applicable laws and regulations. 16 Contractor(s) must comply with the False Claims Act employee training and policy 17 requirements set forth in 42 U.S.C. 1396a(a)(68) and as the Secretary of the United States 18 Department of Health and Human Services may specify. 19 Contractor(s) agrees that no part of any federal funds provided under this Agreement 20 shall be used to pay the salary of an individual per fiscal year at a rate in excess of Level 1 of 21 the Executive Schedule at https://www.opm.gov/ (U.S. Office of Personnel Management), as 22 from time to time amended. 23 Federal Financial Participation is not available for any amount furnished to an Excluded 24 individual or entity, or at the direction of a physician during the period of exclusion when the 25 person providing the service knew or had reason to know of the exclusion, or to an individual or 26 entity when the County failed to suspend payments during an investigation of a credible 27 allegation of fraud [42 U.S.C. section 1396b(i)(2)]. 28 16 1 Contractor(s) must maintain financial records for a minimum period of ten (10) years or 2 until any dispute, audit or inspection is resolved, whichever is later. Contractor(s) will be 3 responsible for any disallowances related to inadequate documentation. 4 4.17 Contractor(s) Prohibited from Redirection of Contracted Funds. Contractor(s) 5 may not redirect or transfer funds from one funded program to another funded program under 6 which Contractor(s) provides services pursuant to this Agreement except through a duly 7 executed amendment to this Agreement. 8 Contractor(s) may not charge services delivered to an eligible person served under one 9 funded program to another funded program unless the person served is also eligible for services 10 under the second funded program. 11 4.18 Financial Audit Report Requirements for Pass-Through Entities. If County 12 determines that Contractor(s) is a "subrecipient" (also known as a "pass-through entity") as 13 defined in 2 C.F.R. § 200 et seq., Contractor(s) represents that it will comply with the applicable 14 cost principles and administrative requirements including claims for payment or reimbursement 15 by County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time to time. 16 Contractor(s) shall observe and comply with all applicable financial audit report requirements 17 and standards. 18 Financial audit reports must contain a separate schedule that identifies all funds included 19 in the audit that are received from or passed through the County. County programs must be 20 identified by Agreement number, Agreement amount, Agreement period, and the amount 21 expended during the fiscal year by funding source. 22 Contractor(s)will provide a financial audit report including all attachments to the report 23 and the management letter and corresponding response within six months of the end of the 24 audit year to the County's DBH Director, or designee. The County's Director, or designee, is 25 responsible for providing the audit report to the County Auditor. 26 Contractor(s) must submit any required corrective action plan to the County 27 simultaneously with the audit report or as soon thereafter as it is available. The County shall 28 17 1 monitor implementation of the corrective action plan as it pertains to services provided pursuant 2 to this Agreement. 3 Article 5 4 Term of Agreement 5 5.1 Term. This Agreement is effective on July 1, 2023, and terminates on June 30, 2024 6 except as provided in section 5.2, "Extension," or Article 7, "Termination and Suspension," 7 below. 8 5.2 Extension. The term of this Agreement may be extended for no more than a one- 9 year period only upon written approval of both parties at least thirty (30) days before the first day 10 of the one-year extension period. The County's DBH Director, or designee, is authorized to sign 11 the written approval on behalf of the County based on the Contractor's satisfactory 12 performance. The extension of this Agreement by the County is not a waiver or compromise of 13 any default or breach of this Agreement by the Contractor(s) existing at the time of the 14 extension whether or not known to the County. 15 Article 6 16 Notices 17 6.1 Contact Information. The persons and their addresses having authority to give and 18 receive notices provided for or permitted under this Agreement include the following: 19 For the County: 20 Director, Department of Behavioral Health County of Fresno 21 1925 E. Dakota Avenue Fresno, CA 93726 22 For the Contractor(s): 23 See Exhibit A, "List of Contractors" 24 6.2 Change of Contact Information. Either party may change the information in section 25 6.1 by giving notice as provided in section 6.3. 26 6.3 Method of Delivery. Each notice between the County and the Contractor(s) 27 provided for or permitted under this Agreement must be in writing, state that it is a notice 28 provided under this Agreement, and be delivered either by personal service, by first-class 18 1 United States mail, by an overnight commercial courier service, by telephonic facsimile 2 transmission, or by Portable Document Format (PDF) document attached to an email. 3 (A) A notice delivered by personal service is effective upon service to the recipient. 4 (B) A notice delivered by first-class United States mail is effective three (3) County 5 business days after deposit in the United States mail, postage prepaid, addressed to the 6 recipient. 7 (C)A notice delivered by an overnight commercial courier service is effective one (1) 8 County business day after deposit with the overnight commercial courier service, 9 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to 10 the recipient. 11 6.4 Claims Presentation. For all claims arising from or related to this Agreement, 12 nothing in this Agreement establishes, waives, or modifies any claims presentation 13 requirements or procedures provided by law, including the Government Claims Act (Division 3.6 14 of Title 1 of the Government Code, beginning with section 810). 15 6.5 Notification of Changes. Contractor(s) shall notify County in writing of any change 16 in organizational name, Head of Service or principal business at least fifteen (15) business days 17 in advance of the change. Contractor(s) shall notify County of a change of service location at 18 least six (6) months in advance to allow County sufficient time to comply with site certification 19 requirements. Said notice shall become part of this Agreement upon acknowledgment in writing 20 by the County, and no further amendment of the Agreement shall be necessary provided that 21 such change of address does not conflict with any other provisions of this Agreement. 22 Contractor(s) must immediately notify County of a change in ownership, organizational 23 status, licensure, or ability of Contractor(s) to provide the quantity or quality of the contracted 24 services in a and in no event more than fifteen (15) days of the change. 25 Article 7 26 Termination and Suspension 27 7.1 Termination for Non-Allocation of Funds. The terms of this Agreement are 28 contingent on the approval of funds by the appropriating government agency. If sufficient funds 19 1 are not allocated, then the County, upon at least thirty (30) days' advance written notice to the 2 Contractor(s), may: 3 (A) Modify the services provided by the Contractor(s) under this Agreement; or 4 (B) Terminate this Agreement. 5 7.2 Termination for Breach. 6 (A) Upon determining that a breach (as defined in paragraph (C) below) has 7 occurred, the County may give written notice of the breach to the Contractor(s). The 8 written notice may suspend performance under this Agreement and must provide at 9 least thirty (30) days for the Contractor(s) to cure the breach. 10 (B) If the Contractor(s) fails to cure the breach to the County's satisfaction within the 11 time stated in the written notice, the County may terminate this Agreement immediately. 12 (C) For purposes of this section, a breach occurs when, in the determination of the 13 County, the Contractor(s) has: 14 (1) Obtained or used funds illegally or improperly; 15 (2) Failed to comply with any part of this Agreement; 16 (3) Submitted a substantially incorrect or incomplete report to the County; or 17 (4) Improperly performed any of its obligations under this Agreement. 18 7.3 Termination without Cause. In circumstances other than those set forth above, the 19 County may terminate this Agreement by giving at least thirty (30) days advance written notice 20 to the Contractor(s). 21 7.4 No Penalty or Further Obligation. Any termination of this Agreement by the County 22 under this Article 7 is without penalty to or further obligation of the County. 23 7.5 County's Rights upon Termination. Upon termination for breach under this Article 24 7, the County may demand repayment by the Contractor(s) of any monies disbursed to the 25 Contractor(s) under this Agreement that, in the County's sole judgment, were not expended in 26 compliance with this Agreement. The Contractor(s) shall promptly refund all such monies upon 27 demand. This section survives the termination of this Agreement. 28 20 1 In the event this Agreement is terminated, Contractor(s) shall be entitled to 2 compensation for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant 3 to the terms and conditions of this Agreement through and including the effective date of 4 termination. This provision shall not limit or reduce any damages owed to the County due to a 5 breach of this Agreement by Contractor(s). 6 Article 8 7 Informing Materials for Persons Served 8 8.1 Basic Information Requirements. Contractor(s) shall provide information in a 9 manner and format that is easily understood and readily accessible to the persons served (42 10 C.F.R. § 438.10(c)(1)). Contractor(s) shall provide all written materials for persons served in 11 easily understood language, format, and alternative formats that take into consideration the 12 special needs of individuals in compliance with 42 C.F.R. § 438.10(d)(6). Contractor(s) shall 13 inform the persons served that information is available in alternate formats and how to access 14 those formats in compliance with 42 C.F.R. § 438.10. 15 Contractor(s) shall provide the required information in this section to each individual 16 receiving SMHS under this Agreement and upon request (1915(b) Medi-Cal Specialty Mental 17 Health Services Waiver, § (2), subd. (d), at p. 26., attachments 3, 4; Cal. Code Regs., tit. 9, § 18 1810.360(e)). 19 Contractor(s) shall utilize the County's website that provides the content required in this 20 section and 42 C.F.R. § 438.10 and complies with all requirements regarding the same set forth 21 in 42 C.F.R. § 438.10. 22 Contractor(s) shall use the DHCS/County-d eve loped beneficiary handbook and persons 23 served notices.(42 C.F.R. §§ 438.10(c)(4)(ii), 438.62(b)(3)). 24 8.2 Electronic Submission. Persons served information required in this section may 25 only be provided electronically by the Contractor(s) if all of the following conditions are met: 26 (A) The format is readily accessible; 27 (B) The information is placed in a location on the Contractor's website that is 28 prominent and readily accessible; 21 1 (C) The information is provided in an electronic form which can be electronically 2 retained and printed; 3 (D) The information is consistent with the content and language requirements of this 4 Agreement; 5 (E) The individual is informed that the information is available in paper form without 6 charge upon request and the Contractor(s) shall provide it upon request within five (5) 7 business days (42 C.F.R. § 438.10(c)(6)). 8 8.3 Language and Format. Contractor(s) shall provide all written materials, including 9 taglines, for persons served or potential persons served in a font size no smaller than twelve 10 (12) point (42 C.F.R. 438.10(d)(6)(ii)). 11 Contractor(s) shall ensure its written materials that are critical to obtaining services are 12 available in alternative formats, upon request of the person served or potential person served at 13 no cost. 14 Contractor(s) shall make its written materials that are critical to obtaining services, 15 including, at a minimum, provider directories, beneficiary handbook, appeal and grievance 16 notices, denial and termination notices, and the Contractor's mental health education materials, 17 available in the prevalent non-English languages in the County (42 C.F.R. § 438.10(d)(3)). 18 (A) Contractor(s) shall notify persons served, prospective persons served, and 19 members of the public that written translation is available in prevalent languages free of 20 cost and how to access those materials (42 C.F.R. § 438.10(d)(5)(i), (iii); Welfare & Inst. 21 Code § 14727(a)(1); Cal. Code Regs. tit. 9 § 1810.410, subd. (e), para. (4)). 22 Contractor(s) shall make auxiliary aids and services available upon request and free of 23 charge to each person served (42 C.F.R. § 438.10(d)(3)-(4)). 24 Contractor(s) shall make oral interpretation and auxiliary aids, such as Teletypewriter 25 Telephone/Text Telephone (TTY/TDY) and American Sign Language (ASL), available and free 26 of charge for any language in compliance with 42 C.F.R. § 438.10(d)(2), (4)-(5). 27 Taglines for written materials critical to obtaining services must be printed in a conspicuously 28 visible font size, no smaller than twelve (12) point font. 22 1 8.4 Beneficiary Informing Materials. Each person served must receive and have 2 access to the beneficiary informing materials upon request by the individual and when first 3 receiving SMHS from Contractor(s). Beneficiary informing materials include but are not limited 4 to: 5 (A) Consumer Handbook 6 (B) Provider Directory 7 (C) Grievance form 8 (D)Appeal/Expedited Appeal form 9 (E) Advance Directives brochure 10 (F) Change of Provider form 11 (G)Suggestions brochure 12 (H) Notice of Privacy Practices 13 (1) Notices of Adverse Benefit Determination (NOABDs — Including Denial and 14 Termination notices) 15 (J) Early & Periodic Screening, Diagnostic and Treatment (EPSDT) poster (if serving 16 individuals under the age of 21) 17 (K) Contractor shall ensure beneficiary informing material are displayed in the 18 threshold languages of Fresno County at all service sites, including but not limited to the 19 following: 20 (1) Consumer Handbook 21 (2) Provider Directory 22 (3) Grievance form 23 (4) Appeal/Expedited Appeal form 24 (5) Advance Directives brochure 25 (6) Change of Provider form 26 (7) Suggestions brochure 27 All beneficiary informing written materials will use easily understood language and 28 format (i.e., material written and formatted at a 6th grade reading level) and will use a font size 23 1 no smaller than 12 point. All beneficiary informing written materials shall inform beneficiaries of 2 the availability of information in alternative formats and how to make a request for an alternative 3 format. Inventory and maintenance of all beneficiary informing materials will be maintained by 4 the County's DBH Managed Care Division. Contractor will ensure that its written materials 5 include taglines or that an additional taglines document is available. 6 8.5 Beneficiary Handbook. Contractor(s) shall provide each persons served with a 7 beneficiary handbook at the time the individual first accesses services and thereafter upon 8 request. The beneficiary handbook shall be provided to beneficiaries within fourteen (14) 9 business days after receiving notice of enrollment. 10 Contractor(s) shall give each individual notice of any significant change to the 11 information contained in the beneficiary handbook at least thirty (30) days before the intended 12 effective date of change as per BHIN 22-060. 13 8.6 Accessibility. Required informing materials must be electronically available on 14 Contractor's website and must be physically available at the Contractor's facility lobby for 15 individuals' access. 16 Informing materials must be made available upon request, at no cost, in alternate 17 formats (i.e., Braille or audio) and auxiliary aids (i.e., California Relay Service (CRS) 711 and 18 American Sign Language) and must be provided to persons served within five (5) business 19 days. Large print materials shall be in a minimum of eighteen (18) point font size. 20 Informing materials will be considered provided to the individual if Contractor(s) does 21 one or more of the following: 22 (A) Mails a printed copy of the information to the persons served's mailing address 23 before the individual receives their first specialty mental health service; 24 (B) Mails a printed copy of the information upon the individual's request to their 25 mailing address; 26 (C) Provides the information by email after obtaining the persons served's agreement 27 to receive the information by email; 28 24 1 (D) Posts the information on the Contractor's website and advises the person served 2 in paper or electronic form that the information is available on the internet and includes 3 applicable internet addresses, provided that individuals with disabilities who cannot 4 access this information online are provided auxiliary aids and services upon request and 5 at no cost; or, 6 (E) Provides the information by any other method that can reasonably be expected 7 to result in the person served receiving that information. If Contractor(s) provides 8 informing materials in person, when the individual first receives specialty mental health 9 services, the date and method of delivery shall be documented in the persons served's 10 file. 11 8.7 Provider Directory. Contractor(s) must follow the County's provider directory policy, 12 in compliance with MHSUDS IN 18-020. 13 Contractor(s) must make available to persons served, in paper form upon request and 14 electronic form, specified information about the County provider network as per 42 C.F.R. § 15 438.10(h). The most current provider directory is electronically available on the County website 16 and is updated by the County no later than thirty (30) calendar days after information is received 17 to update provider information. A paper provider directory must be updated at least monthly as 18 set forth in 42 C.F.R. § 438.10(h)(3)(i). 19 Any changes to information published in the provider directory must be reported to the 20 County within two (2) weeks of the change. 21 Contractor(s) will only need to report changes/updates to the provider directory for 22 licensed, waivered, or registered mental health providers. 23 Article 9 24 Independent Contractor 25 9.1 Status. In performing under this Agreement, the Contractor(s), including its officers, 26 agents, employees, and volunteers, is at all times acting and performing as an independent 27 contractor, in an independent capacity, and not as an officer, agent, servant, employee, joint 28 venturer, partner, or associate of the County. 25 1 9.2 Verifying Performance. The County has no right to control, supervise, or direct the 2 manner or method of the Contractor's performance under this Agreement, but the County may 3 verify that the Contractor(s) is performing according to the terms of this Agreement. 4 9.3 Benefits. Because of its status as an independent contractor, the Contractor(s) has 5 no right to employment rights or benefits available to County employees. The Contractor(s) is 6 solely responsible for providing to its own employees all employee benefits required by law. The 7 Contractor(s) shall save the County harmless from all matters relating to the payment of 8 Contractor's employees, including compliance with Social Security withholding and all related 9 regulations. 10 9.4 Services to Others. The parties acknowledge that, during the term of this 11 Agreement, the Contractor(s) may provide services to others unrelated to the County. 12 9.5 Operating Costs. Contractor(s) shall provide all personnel, supplies, and operating 13 expenses of any kind required for the performance of this Agreement. 14 9.6 Additional Responsibilities. The parties acknowledge that, during the term of this 15 Agreement, the Contractor(s) will be performing hiring, training, and credentialing of staff, and 16 County will be performing additional staff credentialing to ensure compliance with State and 17 Federal regulations. 18 9.7 Subcontracts. Contractor(s) shall obtain written approval from County's DBH 19 Director, or designee, before subcontracting any of the services delivered under this Agreement. 20 County's DBH Director, or designee, retains the right to approve or reject any request for 21 subcontracting services. Any transferee, assignee, or subcontractor will be subject to all 22 applicable provisions of this Agreement, and all applicable State and Federal regulations. 23 Contractor(s) shall be held primarily responsible by County for the performance of any 24 transferee, assignee, or subcontractor unless otherwise expressly agreed to in writing by 25 County's DBH Director, or designee. The use of subcontractors by Contractor(s) shall not entitle 26 Contractor(s) to any additional compensation that is provided for under this Agreement. 27 28 26 1 Contractor(s) shall remain legally responsible for the performance of all terms and 2 conditions of this Agreement, including, without limitation, all SMHS provided by third parties 3 under subcontracts, whether approved by the County or not. 4 Article 10 5 Indemnity and Defense 6 10.1 Indemnity. The Contractor(s) shall indemnify and hold harmless and defend the 7 County (including its officers, agents, employees, and volunteers) against all claims, demands, 8 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and 9 liabilities of any kind to the County, the Contractor(s), or any third party that arise from or relate 10 to the performance or failure to perform by the Contractor(s) (or any of its officers, agents, 11 subcontractors, or employees) under this Agreement. The County may conduct or participate in 12 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or 13 defend the County. 14 10.2 Survival. This Article 10 survives the termination of this Agreement. 15 Article 11 16 Insurance 17 11.1 The Contractor(s) shall comply with all the insurance requirements in Exhibit I to this 18 Agreement. 19 Article 12 20 Assurances 21 12.1 Certification of Non-exclusion or Suspension from Participation in a Federal 22 Health Care Program. 23 (A) In entering into this Agreement, Contractor(s) certifies that it is not excluded from 24 participation in Federal Health Care Programs under either Section 1128 or 1128A of the 25 Social Security Act. Failure to so certify will render all provisions of this Agreement null 26 and void and may result in the immediate termination of this Agreement. 27 (B) In entering into this Agreement, Contractor(s) certifies, that the Contractor(s) 28 does not employ or subcontract with providers or have other relationships with providers 27 1 excluded from participation in Federal Health Care Programs, including Medi- 2 Cal/Medicaid or procurement activities, as set forth in 42 C.F.R. §438.610. Contractor(s) 3 shall conduct initial and monthly exclusion and suspension searches of the following 4 databases and provide evidence of these completed searches when requested by 5 County, DHCS or the US Department of Health and Human Services (DHHS): 6 (1) www.oig.hhs.gov/exclusions - Office of Inspector General's List of Excluded 7 Individuals/Entities (LEIE) Federal Exclusions 8 (2) www.sam.gov/content/exclusions - General Service Administration (GSA) 9 Exclusions Extractwww.Medi-Cal.ca.gov - Suspended & Ineligible Provider List 10 (3) https://nppes.cros.hhs.gov/#/- National Plan and Provider Enumeration 11 System (NPPES) 12 (4) any other database required by DHCS or US DHHS. 13 (C) In entering into this Agreement, Contractor(s) certifies, that Contractor(s) does 14 not employ staff or individual contractors/vendors that are on the Social Security 15 Administration's Death Master File. Contractor(s) shall check the database prior to 16 employing staff or individual contractors/vendors and provide evidence of these 17 completed searches when requested by the County, DHCS or the US DHHS. 18 (D) Contractor(s) is required to notify County immediately if Contractor(s) becomes 19 aware of any information that may indicate their (including employees/staff and individual 20 contractors/vendors) potential placement on an exclusions list. 21 (E) Contractor(s) shall screen and periodically revalidate all network providers in 22 accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E. 23 (F) Contractor(s) must confirm the identity and determine the exclusion status of all 24 its providers, as well as any person with an ownership or control interest, or who is an 25 agent or managing employee of the contracted agency through routine checks of federal 26 and state databases. This includes the Social Security Administration's Death Master 27 File, NPPES, the Office of Inspector General's LEIE, the Medi-Cal Suspended and 28 28 1 Ineligible Provider List (SM List) as consistent with the requirements of 42 C.F.R. § 2 455.436. 3 (G) If Contractor(s)finds a provider that is excluded, it must promptly notify the 4 County as per 42 C.F.R. § 438.608(a)(2), (4). The Contractor(s) shall not certify or pay 5 any Excluded provider with Medi-Cal funds, must treat any payments made to an 6 excluded provider as an overpayment, and any such inappropriate payments may be 7 subject to recovery. 8 Article 13 9 Inspections, Audits, and Public Records 10 13.1 Inspection of Documents. The Contractor(s) shall make available to the County, 11 and the County may examine at any time during business hours and as often as the County 12 deems necessary, all of the Contractor's records and data with respect to the matters covered 13 by this Agreement, excluding attorney-client privileged communications. The Contractor(s) shall, 14 upon request by the County, permit the County to audit and inspect all such records and data to 15 ensure the Contractor's compliance with the terms of this Agreement. 16 13.2 State Audit Requirements. If the compensation to be paid by the County under this 17 Agreement exceeds $10,000, the Contractor(s) is subject to the examination and audit of the 18 California State Auditor, as provided in Government Code section 8546.7, for a period of three 19 years after final payment under this Agreement. This section survives the termination of this 20 Agreement. 21 13.3 Internal Auditing. Contractor(s) of sufficient size as determined by County shall 22 institute and conduct a Quality Assurance Process for all services provided hereunder. Said 23 process shall include at a minimum a system for verifying that all services provided and claimed 24 for reimbursement shall meet SMHS definitions and be documented accurately. 25 In addition, Contractor(s)with medication prescribing authority shall adhere to County's 26 medication monitoring review practices. Contractor(s) shall provide County with notification and 27 a summary of any internal audit exceptions and the specific corrective actions taken to 28 29 1 sufficiently reduce the errors that are discovered through Contractor's internal audit process. 2 Contractor(s) shall provide this notification and summary to County as requested by the County. 3 13.4 Confidentiality in Audit Process. Contractor(s) and County mutually agree to 4 maintain the confidentiality of Contractor's records and information of persons served, in 5 compliance with all applicable State and Federal statutes and regulations, including but not 6 limited to HIPAA and California Welfare and Institutions Code, Section 5328. Contractor(s) shall 7 inform all of its officers, employees, and agents of the confidentiality provisions of all applicable 8 statutes. 9 Contractor's fiscal records shall contain sufficient data to enable auditors to perform a 10 complete audit and shall be maintained in conformance with standard procedures and 11 accounting principles. 12 Contractor's records shall be maintained as required by DBH and DHCS on forms 13 furnished by DHCS or the County. All statistical data or information requested by the County's 14 DBH Director, or designee, shall be provided by the Contractor(s) in a complete and timely 15 manner. 16 13.5 Reasons for Recoupment. County will conduct periodic audits of Contractor(s) files 17 to ensure appropriate clinical documentation, high quality service provision and compliance with 18 applicable federal, state and county regulations. 19 Such audits may result in requirements for Contractor(s) to reimburse County for 20 services previously paid in the following circumstances: 21 (A) Identification of Fraud, Waste or Abuse as defined in federal regulation 22 (1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code, 23 section 14107.11, subdivision (d). 24 (2) Definitions for "fraud," "waste," and "abuse" can also be found in the Medicare 25 Managed Care Manual available at https://www.cros.gov/Regulations-and- 26 Guidance/Guidance/Manuals 27 (B) Overpayment of Contractor(s) by County due to errors in claiming or 28 documentation. 30 1 (C) Other reasons specified in the SMHS Reasons for Recoupment document 2 released annually by DHCS and posted on the DHCS BHIN website. 3 Contractor(s) shall reimburse County for all overpayments identified by Contractor(s), 4 County, and/or state or federal oversight agencies as an audit exception within the timeframes 5 required by law or Country or state or federal agency. Funds owed to County will be due within 6 forty-five (45) days of notification by County, or County shall withhold future payments until all 7 excess funds have been recouped by means of an offset against any payments then or 8 thereafter owing to County under this or any other Agreement between the County and 9 Contractor(s). 10 13.6 Cooperation with Audits. Contractor(s) shall cooperate with County in any review 11 and/or audit initiated by County, DHCS, or any other applicable regulatory body. This 12 cooperation may include such activities as onsite program, fiscal, or chart reviews and/or audits. 13 In addition, Contractor(s) shall comply with all requests for any documentation or files 14 including, but not limited to, files for persons served. 15 Contractor(s) shall notify the County of any scheduled or unscheduled external 16 evaluation or site visits when it becomes aware of such visit. County shall reserve the right to 17 attend any or all parts of external review processes. 18 Contractor(s) shall allow inspection, evaluation and audit of its records, documents and 19 facilities for ten (10) years from the term end date of this Agreement or in the event 20 Contractor(s) has been notified that an audit or investigation of this Agreement has been 21 commenced, until such time as the matter under audit or investigation has been resolved, 22 including the exhaustion of all legal remedies, whichever is later pursuant to 42 C.F.R.§§ 23 438.3(h) and 438.2301(3)(i-iii). 24 13.7 Single Audit Clause. If Contractor(s) expends Seven Hundred Fifty Thousand and 25 No/100 Dollars ($750,000.00) or more in Federal and Federal flow-through monies, 26 Contractor(s) agrees to conduct an annual audit in accordance with the requirements of the 27 Single Audit Standards as set forth in Office of Management and Budget (OMB) 2 CFR 200. 28 Contractor(s) shall submit said audit and management letter to County. The audit must include a 31 1 statement of findings or a statement that there were no findings. If there were negative findings, 2 Contractor(s) must include a corrective action plan signed by an authorized individual. 3 Contractor(s) agrees to take action to correct any material non-compliance or weakness found 4 as a result of such audit. Such audit shall be delivered to County's DBH Finance Division for 5 review within nine (9) months of the end of any fiscal year in which funds were expended and/or 6 received for the program. Failure to perform the requisite audit functions as required by this 7 Agreement may result in County performing the necessary audit tasks, or at County's option, 8 contracting with a public accountant to perform said audit, or may result in the inability of County 9 to enter into future agreements with Contractor(s). All audit costs related to this Agreement are 10 the sole responsibility of Contractor(s). 11 A single audit report is not applicable if Contractor's Federal contracts do not exceed the 12 Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or Contractor's 13 only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a program audit 14 must be performed and a program audit report with management letter shall be submitted by 15 Contractor(s) to County as a minimum requirement to attest to Contractor(s) solvency. Said 16 audit report shall be delivered to County's DBH Finance Division for review no later than nine (9) 17 months after the close of the fiscal year in which the funds supplied through this Agreement are 18 expended. Failure to comply with this Act may result in County performing the necessary audit 19 tasks or contracting with a qualified accountant to perform said audit. All audit costs related to 20 this Agreement are the sole responsibility of Contractor(s) who agrees to take corrective action 21 to eliminate any material noncompliance or weakness found as a result of such audit. Audit 22 work performed by County under this paragraph shall be billed to Contractor(s) at County cost, 23 as determined by County's Auditor-Controller/Treasurer-Tax Collector. 24 Contractor(s) shall make available all records and accounts for inspection by County, the 25 State of California, if applicable, the Controller General of the United States, the Federal Grantor 26 Agency, or any of their duly authorized representatives, at all reasonable times for a period of at 27 least three (3) years following final payment under this Agreement or the closure of all other 28 pending matters, whichever is later. 32 1 13.8 Public Records. The County is not limited in any manner with respect to its public 2 disclosure of this Agreement or any record or data that the Contractor(s) may provide to the 3 County. The County's public disclosure of this Agreement or any record or data that the 4 Contractor(s) may provide to the County may include but is not limited to the following: 5 (A) The County may voluntarily, or upon request by any member of the public or 6 governmental agency, disclose this Agreement to the public or such governmental 7 agency. 8 (B) The County may voluntarily, or upon request by any member of the public or 9 governmental agency, disclose to the public or such governmental agency any record or 10 data that the Contractor(s) may provide to the County, unless such disclosure is 11 prohibited by court order. 12 (C)This Agreement, and any record or data that the Contractor(s) may provide to the 13 County, is subject to public disclosure under the Ralph M. Brown Act (California 14 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950). 15 (D) This Agreement, and any record or data that the Contractor(s) may provide to the 16 County, is subject to public disclosure as a public record under the California Public 17 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning 18 with section 6250) ("CPRA"). 19 (E) This Agreement, and any record or data that the Contractor(s) may provide to the 20 County, is subject to public disclosure as information concerning the conduct of the 21 people's business of the State of California under California Constitution, Article 1, 22 section 3, subdivision (b). 23 (F) Any marking of confidentiality or restricted access upon or otherwise made with 24 respect to any record or data that the Contractor(s) may provide to the County shall be 25 disregarded and have no effect on the County's right or duty to disclose to the public or 26 governmental agency any such record or data. 27 13.9 Public Records Act Requests. If the County receives a written or oral request 28 under the CPRA to publicly disclose any record that is in the Contractor's possession or control, 33 1 and which the County has a right, under any provision of this Agreement or applicable law, to 2 possess or control, then the County may demand, in writing, that the Contractor(s) deliver to the 3 County, for purposes of public disclosure, the requested records that may be in the possession 4 or control of the Contractor(s). Within five business days after the County's demand, the 5 Contractor(s) shall (a) deliver to the County all of the requested records that are in the 6 Contractor's possession or control, together with a written statement that the Contractor(s), after 7 conducting a diligent search, has produced all requested records that are in the Contractor's 8 possession or control, or (b) provide to the County a written statement that the Contractor(s), 9 after conducting a diligent search, does not possess or control any of the requested records. 10 The Contractor(s) shall cooperate with the County with respect to any County demand for such 11 records. If the Contractor(s)wishes to assert that any specific record or data is exempt from 12 disclosure under the CPRA or other applicable law, it must deliver the record or data to the 13 County and assert the exemption by citation to specific legal authority within the written 14 statement that it provides to the County under this section. The Contractor's assertion of any 15 exemption from disclosure is not binding on the County, but the County will give at least 10 16 days' advance written notice to the Contractor(s) before disclosing any record subject to the 17 Contractor's assertion of exemption from disclosure. The Contractor(s) shall indemnify the 18 County for any court-ordered award of costs or attorney's fees under the CPRA that results from 19 the Contractor's delay, claim of exemption, failure to produce any such records, or failure to 20 cooperate with the County with respect to any County demand for any such records. 21 Article 14 22 Right to Monitor 23 14.1 Right to Monitor. County or any subdivision or appointee thereof, and the State of 24 California or any subdivision or appointee thereof, including the Auditor General, shall have 25 absolute right to review and audit all records, books, papers, documents, corporate minutes, 26 financial records, staff information, records of persons served, other pertinent items as 27 requested, and shall have absolute right to monitor the performance of Contractor(s) in the 28 34 1 delivery of services provided under this Agreement. Full cooperation shall be given by the 2 Contractor(s) in any auditing or monitoring conducted, according to this agreement. 3 14.2 Accessibility. Contractor(s) shall make all of its premises, physical facilities, 4 equipment, books, records, documents, agreements, computers, or other electronic systems 5 pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities furnished 6 under the terms of this Agreement, or determinations of amounts payable available at any time 7 for inspection, examination, or copying by County, the State of California or any subdivision or 8 appointee thereof, CMS, U.S. Department of Health and Human Services (HHS) Office of 9 Inspector General, the United States Controller General or their designees, and other 10 authorized federal and state agencies. This audit right will exist for at least ten years from the 11 final date of the Agreement period or in the event the Contractor(s) has been notified that an 12 audit or investigation of this Agreement has commenced, until such time as the matter under 13 audit or investigation has been resolved, including the exhaustion of all legal remedies, 14 whichever is later (42 CFR §438.230(c)(3)(I)-(ii)). 15 The County, DHCS, CMS, or the HHS Office of Inspector General may inspect, 16 evaluate, and audit the Contractor(s) at any time if there is a reasonable possibility of fraud or 17 similar risk. The Department's inspection shall occur at the Contractor's place of business, 18 premises, or physical facilities (42 CFR §438.230(c)(3)(iv)). 19 14.3 Cooperation. Contractor(s) shall cooperate with County in the implementation, 20 monitoring and evaluation of this Agreement and comply with any and all reporting requirements 21 established by County. Should County identify an issue or receive notification of a complaint or 22 potential/actual/suspected violation of requirements, County may audit, monitor, and/or request 23 information from Contractor(s) to ensure compliance with laws, regulations, and requirements, 24 as applicable. 25 14.4 Probationary Status. County reserves the right to place Contractor(s) on 26 probationary status, as referenced in the Probationary Status Article, should Contractor(s)fail to 27 meet performance requirements; including, but not limited to violations such as high 28 disallowance rates, failure to report incidents and changes as contractually required, failure to 35 1 correct issues, inappropriate invoicing, untimely and inaccurate data entry, not meeting 2 performance outcomes expectations, and violations issued directly from the State. Additionally, 3 Contractor(s) may be subject to Probationary Status or termination if agreement monitoring and 4 auditing corrective actions are not resolved within specified timeframes. 5 14.5 Record Retention. Contractor(s) shall retain all records and documents originated 6 or prepared pursuant to Contractor's performance under this Agreement, including grievance 7 and appeal records, and the data, information and documentation specified in 42 C.F.R. parts 8 438.604, 438.606, 438.608, and 438.610 for a period of no less than ten years from the term 9 end date of this Agreement or until such time as the matter under audit or investigation has 10 been resolved. Records and documents include but are not limited to all physical and electronic 11 records and documents originated or prepared pursuant to Contractor's or subcontractor's 12 performance under this Agreement including working papers, reports, financial records and 13 documents of account, records of persons served, prescription files, subcontracts, and any 14 other documentation pertaining to covered services and other related services for persons 15 served. 16 14.6 Record Maintenance. Contractor(s) shall maintain all records and management 17 books pertaining to service delivery and demonstrate accountability for agreement performance 18 and maintain all fiscal, statistical, and management books and records pertaining to the 19 program. Records should include, but not be limited to, monthly summary sheets, sign-in 20 sheets, and other primary source documents. Fiscal records shall be kept in accordance with 21 Generally Accepted Accounting Principles and must account for all funds, tangible assets, 22 revenue and expenditures. Fiscal records must also comply with the Code of Federal 23 Regulations (CFR), Title II, Subtitle A, Chapter 11, Part 200, Uniform Administrative 24 Requirements, Cost Principles, and Audit Requirements for Federal Awards. 25 All records shall be complete and current and comply with all Agreement requirements. 26 Failure to maintain acceptable records per the preceding requirements shall be considered 27 grounds for withholding of payments for billings submitted and for termination of Agreement. 28 36 1 Contractor(s) shall maintain records of persons served and community service in 2 compliance with all regulations set forth by local, state, and federal requirements, laws, and 3 regulations, and provide access to clinical records by County staff. 4 Contractor(s) shall comply with the Article 18 and Article 1 regarding relinquishing or 5 maintaining medical records. 6 Contractor(s) shall agree to maintain and retain all appropriate service and financial 7 records for a period of at least ten (10) years from the date of final payment, the final date of the 8 contract period, final settlement, or until audit findings are resolved, whichever is later. 9 14.7 Financial Reports. Contractor(s) shall submit audited financial reports on an annual 10 basis to the County. The audit shall be conducted in accordance with Generally Accepted 11 Accounting Principles and generally accepted auditing standards. 12 14.8 Agreement Termination. In the event the Agreement is terminated, ends its 13 designated term or Contractor(s) ceases operation of its business, Contractor(s) shall deliver or 14 make available to County all financial records that may have been accumulated by Contractor(s) 15 or subcontractor under this Agreement, whether completed, partially completed or in progress 16 within seven (7) calendar days of said termination/end date. 17 14.9 Facilities and Assistance. Contractor(s) shall provide all reasonable facilities and 18 assistance for the safety and convenience of the County's representatives in the performance of 19 their duties. All inspections and evaluations shall be performed in such a manner that will not 20 unduly delay the work of Contractor(s). 21 14.10 County Discretion to Revoke. County has the discretion to revoke full or partial 22 provisions of the Agreement, delegated activities or obligations, or application of other remedies 23 permitted by state or federal law when the County or DHCS determines Contractor(s) has not 24 performed satisfactorily. 25 14.11 Site Inspection. Without limiting any other provision related to inspections or audits 26 otherwise set forth in this Agreement, Contractor(s) shall permit authorized County, state, and/or 27 federal agency(ies), through any authorized representative, the right to inspect or otherwise 28 evaluate the work performed or being performed hereunder including subcontract support 37 1 activities and the premises which it is being performed. Contractor(s) shall provide all 2 reasonable assistance for the safety and convenience of the authorized representative in the 3 performance of their duties. All inspections and evaluations shall be made in a manner that will 4 not unduly delay the work of the Contractor(s). 5 Article 15 6 Complaints Logs and Grievances 7 15.1 Documentation. Contractor(s) shall log complaints and the disposition of all 8 complaints from a person served or their family. Contractor(s) shall provide a copy of the 9 detailed complaint log entries concerning County-sponsored persons served to County at 10 monthly intervals by the tenth (10th) day of the following month, in a format that is mutually 11 agreed upon. Contractor shall allow beneficiaries or their representative to file a grievance either 12 orally, or in writing at any time with the Mental Health Plan. In the event Contractor is notified by 13 a beneficiary or their representative of a discrimination grievance, Contractor shall report 14 discrimination grievances to the Mental Health Plan within 24 hours. The Contractor shall not 15 require a beneficiary or their representative to file a Discrimination Grievance with the Mental 16 Health Plan before filing the complaint directly with the DHCS Office of Civil Rights and the U.S. 17 Health and Human Services Office for Civil Rights. 18 15.2 Rights of Persons Served. Contractor(s) shall post signs informing persons served 19 of their right to file a complaint or grievance, appeals, and expedited appeals. In addition, 20 Contractor(s) shall inform every person served of their rights as set forth in Exhibit J. 21 15.3 Incident Reporting. Contractor(s) shall file an incident report for all incidents 22 involving persons served, following the protocol identified in Exhibit K. 23 Article 16 24 Compliance 25 16.1 Compliance. Contractor(s) agrees to comply with County's Contractor(s) Code of 26 Conduct and Ethics and the County's Compliance Program in accordance with Exhibit L. Within 27 thirty (30) days of entering into this Agreement with County, Contractor(s) shall ensure all of 28 Contractor's employees, agents, and subcontractors providing services under this Agreement 38 1 certify in writing, that he or she has received, read, understood, and shall abide by the 2 Contractor(s) Code of Conduct and Ethics. Contractor(s) shall ensure that within thirty (30) days 3 of hire, all new employees, agents, and subcontractors providing services under this Agreement 4 shall certify in writing that he or she has received, read, understood, and shall abide by the 5 Contractor(s) Code of Conduct and Ethics. Contractor(s) understands that the promotion of and 6 adherence to the Contractor(s) Code of Conduct is an element in evaluating the performance of 7 Contractor(s) and its employees, agents, and subcontractors. 8 Within thirty (30) days of entering into this Agreement, and annually thereafter, all 9 employees, agents, and subcontractors providing services under this Agreement shall complete 10 general compliance training, and appropriate employees, agents, and subcontractors shall 11 complete documentation and billing or billing/reimbursement training. All new employees, 12 agents, and subcontractors shall attend the appropriate training within thirty (30) days of hire. 13 Each individual who is required to attend training shall certify in writing that he or she has 14 received the required training. The certification shall specify the type of training received and the 15 date received. The certification shall be provided to County's DBH Compliance Officer at 1925 16 E. Dakota Ave, Fresno, California 93726. Contractor(s) agrees to reimburse County for the 17 entire cost of any penalty imposed upon County by the Federal Government as a result of 18 Contractor's violation of the terms of this Agreement. 19 16.2 Compliance with State Medi-Cal Requirements. Contractor(s) shall be required to 20 maintain Mental Health Plan organizational provider certification by Fresno County. 21 Contractor(s) must meet Medi-Cal organization provider standards as listed in Exhibit M, "Medi- 22 Cal Organizational Provider Standards". It is acknowledged that all references to Organizational 23 Provider and/or Provider in Exhibit M shall refer to Contractor(s). 24 16.3 Medi-Cal Certification and Mental Health Plan Compliance. Contractor(s) will 25 establish and maintain Medi-Cal certification or become certified within ninety (90) days of the 26 effective date of this Agreement through County to provide reimbursable services to Medi-Cal 27 eligible persons served. In addition, Contractor(s) shall work with the County's DBH to execute 28 the process if not currently certified by County for credentialing of staff. During this process, the 39 1 Contractor(s) will obtain a legal entity number established by the DHCS, a requirement for 2 maintaining Mental Health Plan organizational provider status throughout the term of this 3 Agreement. Contractor(s) will be required to become Medi-Cal certified prior to providing 4 services to Medi-Cal eligible persons served and seeking reimbursement from the County. 5 Contractor(s) will not be reimbursed by County for any services rendered prior to certification. 6 Contractor(s) shall provide direct specialty mental health services in accordance with the 7 Mental Health Plan. Contractor(s) must comply with the "Fresno County Mental Health Plan 8 Compliance Program and Code of Conduct" set forth in Exhibit L. 9 Contractor(s) may provide direct specialty mental health services using unlicensed staff 10 as long as the individual is approved as a provider by the Mental Health Plan, is supervised by 11 licensed staff, works within his/her scope and only delivers allowable direct specialty mental 12 health services. It is understood that each service is subject to audit for compliance with Federal 13 and State regulations, and that County may be making payments in advance of said review. In 14 the event that a service is disapproved, County may, at its sole discretion, withhold 15 compensation or set off from other payments due the amount of said disapproved services. 16 Contractor(s) shall be responsible for audit exceptions to ineligible dates of services or incorrect 17 application of utilization review requirements. 18 16.4 Network Adequacy. The Contractor(s) shall ensure that all services covered under 19 this Agreement are available and accessible to persons served in a timely manner and in 20 accordance with the network adequacy standards required by regulation. (42 C.F.R. §438.206 21 (a), (c)). 22 Contractor(s) shall submit, when requested by County and in a manner and format 23 determined by the County, network adequacy certification information to the County, utilizing a 24 provided template or other designated format. 25 Contractor(s) shall submit updated network adequacy information to the County any time 26 there has been a significant change that would affect the adequacy and capacity of services. 27 28 40 1 To the extent possible and appropriately consistent with CCR, Title 9, §1830.225 and 42 2 C.F.R. §438.3 (1), the Contractor(s) shall provide a person served the ability to choose the 3 person providing services to them. 4 16.5 Compliance Program, Including Fraud Prevention and Overpayments. 5 Contractor(s) shall have in place a compliance program designed to detect and prevent fraud, 6 waste and abuse, as per42 C.F.R. § 438.608(a)(1), that must include: 7 (A) Written policies, procedures, and standards of conduct that articulate the 8 organization's commitment to comply with all applicable requirements and standards 9 under the Agreement, and all applicable federal and state requirements. 10 (B) A Compliance Office (CO)who is responsible for developing and implementing 11 policies, procedures, and practices designed to ensure compliance with the 12 requirements of this Agreement and who reports directly to the CEO and the Board of 13 Directors. 14 (C)A Regulatory Compliance Committee on the Board of Directors and at the senior 15 management level charged with overseeing the organization's compliance program and 16 its compliance with the requirements under the Agreement. 17 (D)A system for training and education for the Compliance Officer, the organization's 18 senior management, and the organization's employees for the federal and state 19 standards and requirements under the Agreement. 20 (E) Effective lines of communication between the Compliance Officer and the 21 organization's employees. 22 (F) Enforcement of standards through well-publicized disciplinary guidelines. 23 (G)The establishment and implementation of procedures and a system with 24 dedicated staff for routine internal monitoring and auditing of compliance risks, prompt 25 response to compliance issues as they are raised, investigation of potential compliance 26 problems as identified in the course of self-evaluation and audits, corrections of such 27 problems promptly and thoroughly to reduce the potential for recurrence and ongoing 28 compliance with the requirements under the Agreement. 41 1 (H) The requirement for prompt reporting and repayment of any overpayments 2 identified. 3 16.6 Reporting. Contractor(s) must have administrative and management arrangements 4 or procedures designed to detect and prevent fraud, waste and abuse of federal or state health 5 care funding. Contractor(s) must report fraud and abuse information to the County including but 6 not limited to: 7 (A) Any potential fraud, waste, or abuse as per 42 C.F.R. § 438.608(a), (a)(7), 8 (B) All overpayments identified or recovered, specifying the overpayment due to 9 potential fraud as per 42 C.F.R. § 438.608(a), (a)(2), 10 (C) Information about changes in a persons served's circumstances that may affect 11 the person served's eligibility including changes in their residence or the death of the 12 person served as per 42 C.F.R. § 438.608(a)(3). 13 (D) Information about a change in the Contractor's circumstances that may affect the 14 network provider's eligibility to participate in the managed care program, including the 15 termination of this Agreement with the Contractor(s) as per 42 C.F.R. § 438.608(a)(6). 16 Contractor(s) shall implement written policies that provide detailed information about the 17 False Claims Act ("Act") and other federal and state laws described in section 1902(a)(68) of the 18 Act, including information about rights of employees to be protected as whistleblowers. 19 Contractor(s) shall make prompt referral of any potential fraud, waste or abuse to County 20 or potential fraud directly to the State Medicaid Fraud Control Unit. 21 16.7 Overpayments. County may suspend payments to Contractor(s) if DHCS or County 22 determine that there is a credible allegation of fraud in accordance with 42 C.F.R. §455.23. (42 23 C.F.R. §438.608 (a)(8)). 24 Contractor(s) shall report to County all identified overpayments and reason for the 25 overpayment, including overpayments due to potential fraud. Contractor(s) shall return any 26 overpayments to the County within 60 calendar days after the date on which the overpayment 27 was identified. (42 C.F.R. § 438.608 (a)(2), (c)(3)). 28 42 1 Article 17 2 Federal and State Laws 3 17.1 Health Insurance Portability and Accountability Act. County and Contractor(s) 4 each consider and represent themselves as covered entities as defined by the U.S. Health 5 Insurance Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and agree to 6 use and disclose Protected Health Information (PHI) as required by law. 7 County and Contractor(s) acknowledge that the exchange of PHI between them is only 8 for treatment, payment, and health care operations. 9 County and Contractor(s) intend to protect the privacy and provide for the security of PHI 10 pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for 11 Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated 12 thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations) and 13 other applicable laws. 14 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require 15 Contractor(s) to enter into a agreement containing specific requirements prior to the disclosure 16 of PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 17 164.504(e) of the Code of Federal Regulations. 18 17.2 Physical Accessibility. In accordance with the accessibility requirements of section 19 508 of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor(s) must 20 provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal 21 beneficiaries with physical or mental disabilities. 22 Article 18 23 Data Security 24 18.1 Data Security Requirements. Contractor(s) shall comply with data security 25 requirements in Exhibit N to this Agreement. 26 27 28 43 1 Article 19 2 Publicity Prohibition 3 19.1 Self-Promotion. None of the funds, materials, property, or services provided directly 4 or indirectly under this Agreement shall be used for Contractor's advertising, fundraising, or 5 publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self- 6 promotion. 7 19.2 Public Awareness. Notwithstanding the above, publicity of the services described in 8 Article 1 of this Agreement shall be allowed as necessary to raise public awareness about the 9 availability of such specific services when approved in advance by County's DBH Director, or 10 designee, for such items as written/printed materials, the use of media (i.e., radio, television, 11 newspapers), and any other related expense(s). Communication products must follow DBH 12 graphic standards, including typefaces and colors, to communicate our authority and project a 13 unified brand. This includes all media types and channels and all materials on and offline that 14 are created as part of DBH's efforts to provide information to the public. 15 Article 20 16 Disclosure of Self-Dealing Transactions 17 20.1 Applicability. This Article 20 applies if the Contractor(s) is operating as a 18 corporation, or changes its status to operate as a corporation. 19 20.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a 20 self-dealing transaction, he or she shall disclose the transaction by completing and signing a 21 "Self-Dealing Transaction Disclosure Form" (Exhibit O) and submitting it to the County before 22 commencing the transaction or immediately after. 23 20.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor(s) 24 is a party and in which one or more of its directors, as an individual, has a material financial 25 interest. 26 27 28 44 1 Article 21 2 Disclosure of Ownership and/or Control Interest Information 3 21.1 Applicability. This provision is only applicable if Contractor(s) is disclosing entities, 4 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.), 5 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2). 6 21.2 Duty to Disclose. Contractor(s) must disclose the following information as 7 requested in the Provider Disclosure Statement, Disclosure of Ownership and Control Interest 8 Statement, Exhibit P: 9 (A) Disclosure of five percent (5%) or More Ownership Interest: 10 (1) In the case of corporate entities with an ownership or control interest in the 11 disclosing entity, the primary business address as well as every business location 12 and P.O. Box address must be disclosed. In the case of an individual, the date of 13 birth and Social Security number must be disclosed. 14 (2) In the case of a corporation with ownership or control interest in the 15 disclosing entity or in any subcontractor in which the disclosing entity has a five 16 percent (5%) or more interest, the corporation tax identification number must be 17 disclosed. 18 (3) For individuals or corporations with ownership or control interest in any 19 subcontractor in which the disclosing entity has a five percent (5%) or more interest, 20 the disclosure of familial relationship is required. 21 (4) For individuals with five percent (5%) or more direct or indirect ownership 22 interest of a disclosing entity, the individual shall provide evidence of completion of a 23 criminal background check, including fingerprinting, if required by law, prior to 24 execution of Contract. (42 C.F.R. § 455.434) 25 (B) Disclosures Related to Business Transactions: 26 (1) The ownership of any subcontractor with whom Contractor(s) has had 27 business transactions totaling more than $25,000 during the 12-month period ending 28 on the date of the request. 45 1 (2) Any significant business transactions between Contractor(s) and any wholly 2 owned supplier, or between Contractor(s) and any subcontractor, during the 5-year 3 period ending on the date of the request. (42 C.F.R. § 455.105(b).) 4 (C) Disclosures Related to Persons Convicted of Crimes: 5 (1) The identity of any person who has an ownership or control interest in the 6 provider or is an agent or managing employee of the provider who has been 7 convicted of a criminal offense related to that person's involvement in any program 8 under the Medicare, Medicaid, or the Title XXI services program since the inception 9 of those programs. (42 C.F.R. § 455.106.) 10 (2) County shall terminate the enrollment of Contractor(s) if any person with five 11 percent (5%) or greater direct or indirect ownership interest in the disclosing entity 12 has been convicted of a criminal offense related to the person's involvement with 13 Medicare, Medicaid, or Title XXI program in the last ten (10) years. 14 21.3 Contractor(s) must provide disclosure upon execution of Contract, extension for 15 renewal, and within 35 days after any change in Contractor(s) ownership or upon request of 16 County. County may refuse to enter into an agreement or terminate an existing agreement with 17 Contractor(s) if Contractor(s) fails to disclose ownership and control interest information, 18 information related to business transactions and information on persons convicted of crimes, or 19 if Contractor(s) did not fully and accurately make the disclosure as required. 20 21.4 Contractor(s) must provide the County with written disclosure of any prohibited 21 affiliations under 42 C.F.R. § 438.610. Contractor(s) must not employ or subcontract with 22 providers or have other relationships with providers Excluded from participation in Federal 23 Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42 24 C.F.R. §438.610. 25 21.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to 26 DBHContractedServices@fresnocountyca.gov. County may deny enrollment or terminate this 27 Agreement where any person with five percent (5%) or greater direct or indirect ownership 28 interest in Contractor(s) has been convicted of a criminal offense related to that person's 46 1 involvement with the Medicare, Medicaid, or Title XXI program in the last ten (10) years. County 2 may terminate this Agreement where any person with five percent (5%) or greater direct or 3 indirect ownership interest in the Contractor(s) did not submit timely and accurate information 4 and cooperate with any screening method required in CFR, Title 42, Section 455.416 5 Article 22 6 Disclosure of Criminal History and Civil Actions 7 22.1 Applicability. Contractor(s) is required to disclose if any of the following conditions 8 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively 9 referred to as "Contractor(s)"): 10 (A) Within the three (3) year period preceding the Agreement award, they have been 11 convicted of, or had a civil judgment tendered against them for: 12 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain, 13 or performing a public (federal, state, or local) transaction or contract under a public 14 transaction; 15 (2) Violation of a federal or state antitrust statute; 16 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records; 17 or 18 (4) False statements or receipt of stolen property. 19 (B) Within a three (3) year period preceding their Agreement award, they have had a 20 public transaction (federal, state, or local) terminated for cause or default. 21 22.2 Duty to Disclose. Disclosure of the above information will not automatically 22 eliminate Contractor(s) from further business consideration. The information will be considered 23 as part of the determination of whether to continue and/or renew this Agreement and any 24 additional information or explanation that Contractor(s) elects to submit with the disclosed 25 information will be considered. If it is later determined that the Contractor(s) failed to disclose 26 required information, any contract awarded to such Contractor(s) may be immediately voided 27 and terminated for material failure to comply with the terms and conditions of the award. 28 47 1 Contractor(s) must sign a "Certification Regarding Debarment, Suspension, and Other 2 Responsible Matters — Primary Covered Transactions" in the form set forth in Exhibit Q. 3 Additionally, Contractor(s) must immediately advise the County in writing if, during the term of 4 the Agreement: (1) Contractor(s) becomes suspended, debarred, excluded or ineligible for 5 participation in Federal or State funded programs or from receiving federal funds as listed in the 6 excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions 7 become applicable to Contractor(s). Contractor(s) shall indemnify, defend, and hold County 8 harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility, 9 or other matter listed in the signed Certification Regarding Debarment, Suspension, and Other 10 Responsibility Matters. 11 Article 23 12 Cultural and Linguistic Competency 13 23.1 General.All services, policies and procedures must be culturally and linguistically 14 appropriate. Contractor(s) must participate in the implementation of the most recent Cultural 15 Competency Plan for the County and shall adhere to all cultural competency standards and 16 requirements. Contractor(s) shall participate in the County's efforts to promote the delivery of 17 services in a culturally competent and equitable manner to all individuals, including those with 18 limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and 19 regardless of gender, sexual orientation, or gender identity including active participation in the 20 County's Diversity, Equity and Inclusion Committee. 21 23.2 Policies and Procedures. Contractor(s) shall comply with requirements of policies 22 and procedures for ensuring access and appropriate use of trained interpreters and material 23 translation services for all limited and/or no English proficient beneficiaries, including, but not 24 limited to, assessing the cultural and linguistic needs of the beneficiaries, training of staff on the 25 policies and procedures, and monitoring its language assistance program. Contractor's policies 26 and procedures shall ensure compliance of any subcontracted providers with these 27 requirements. 28 48 1 23.3 Interpreter Services. Contractor(s) shall notify its beneficiaries that oral 2 interpretation is available for any language and written translation is available in prevalent 3 languages and that auxiliary aids and services are available upon request, at no cost and in a 4 timely manner for limited and/or no English proficient beneficiaries and/or beneficiaries with 5 disabilities. Contractor(s) shall avoid relying on an adult or minor child accompanying the 6 beneficiary to interpret or facilitate communication; however, if the beneficiary refuses language 7 assistance services, the Contractor(s) must document the offer, refusal, and justification in the 8 beneficiary's file. 9 23.4 Interpreter Qualifications. Contractor(s) shall ensure that employees, agents, 10 subcontractors, and/or partners who interpret or translate for a beneficiary or who directly 11 communicate with a beneficiary in a language other than English (1) have completed annual 12 training provided by County at no cost to Contractor(s); (2) have demonstrated proficiency in the 13 beneficiary's language; (3) can effectively communicate any specialized terms and concepts 14 specific to Contractor's services; and (4) adheres to generally accepted interpreter ethic 15 principles. As requested by County, Contractor(s) shall identify all who interpret for or provide 16 direct communication to any program beneficiary in a language other than English and identify 17 when the Contractor(s) last monitored the interpreter for language competence. 18 23.5 CLAS Standards. Contractor(s) shall submit to County for approval, within ninety 19 (90) days from date of contract execution, Contractor's plan to address all fifteen (15) National 20 Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by the 21 Office of Minority Health and as set forth in Exhibit R "National Standards on Culturally and 22 Linguistically Appropriate Services", attached hereto and incorporated herein by reference and 23 made part of this Agreement. As the CLAS standards are updated, Contractor's plan must be 24 updated accordingly. As requested by County, Contractor(s) shall be responsible for conducting 25 an annual CLAS self-assessment and providing the results of the self-assessment to the 26 County. The annual CLAS self-assessment instruments shall be reviewed by the County and 27 revised as necessary to meet the approval of the County. 28 49 1 23.6 Training Requirements. Cultural competency training for Contractor(s) staff should 2 be substantively integrated into health professions education and training at all levels, both 3 academically and functionally, including core curriculum, professional licensure, and continuing 4 professional development programs. As requested by County, Contractor(s) shall report on the 5 completion of cultural competency trainings to ensure direct service providers are completing a 6 minimum of twelve (12) hours of annual cultural competency training. 7 23.7 Continuing Cultural Competence. Contractor(s) shall create and sustain a forum 8 that includes staff at all agency levels to discuss cultural competence. Contractor(s) shall 9 designate a representative from Contractor's team to attend County's Diversity, Equity and 10 Inclusion Committee. 11 Article 24 12 General Terms 13 24.1 Modification. Except as provided in Article 7, "Termination and Suspension," this 14 Agreement may not be modified, and no waiver is effective, except by written agreement signed 15 by both parties. The Contractor(s) acknowledges that County employees have no authority to 16 modify this Agreement except as expressly provided in this Agreement. 17 (A) Notwithstanding the above, non-material changes to services, staffing, and 18 responsibilities of the Contractor, as needed, to accommodate changes in the laws 19 relating to service requirements and specialty mental health treatment, may be made 20 with the signed written approval of County's DBH Director, or designee, and Contractor 21 through an amendment approved by County's County Counsel and the County's Auditor- 22 Controller/Treasurer-Tax Collector's Office. Said modifications shall not result in any 23 change to the maximum compensation amount payable to Contractor, as stated herein. 24 (B) In addition, changes to line items and expense category subtotals, as set forth in 25 Exhibit H1 et seq., that when added together during the term of the agreement do not 26 exceed ten percent (10%) of the total maximum compensation payable to Contractor, 27 may be made with the written approval of Contractor and County's DBH Director or 28 designee. Changes to service rates on Exhibit H that do not exceed 3% of the approved 50 1 rate, or that are needed to accommodate state-mandated rate increases, may be made 2 with the written approval of the DBH Director or designee. These rate changes may not 3 add or alter any other terms or conditions of the Agreement. Said modifications shall not 4 result in any change to the maximum compensation amount payable to Contractor, as 5 stated herein. 6 24.2 Separate Agreement. It is mutually understood by the parties that this Agreement 7 does not, in any way, create a joint venture among Contractors. By execution of this Agreement, 8 Contractors understand that a separate Agreement is formed between each individual 9 Contractor and County. 10 24.3 Addition/Deletion of Providers. The County reserves the right at any time during 11 the term of this Agreement to add Contractors to and remove Contractors from the list contained 12 on Exhibit A. It is understood that any such additions and removals will not affect compensation 13 paid to the other Contractors, and therefore such additions and removals may be made by 14 County without notice or approval of other Contractors under this Agreement. The County's 15 DBH Director, or designee, may remove a Contractor from the agreement where there is mutual 16 written consent between the DBH Director and Contractor. 17 24.4 Non-Assignment. Neither party may assign its rights or delegate its obligations 18 under this Agreement without the prior written consent of the other party. 19 24.5 Governing Law. The laws of the State of California govern all matters arising from 20 or related to this Agreement. 21 24.6 Jurisdiction and Venue. This Agreement is signed and performed in Fresno 22 County, California. Contractor(s) consents to California jurisdiction for actions arising from or 23 related to this Agreement, and, subject to the Government Claims Act, all such actions must be 24 brought and maintained in Fresno County. 25 24.7 Construction. The final form of this Agreement is the result of the parties' combined 26 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be 27 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement 28 against either party. 51 1 24.8 Days. Unless otherwise specified, "days" means calendar days. 2 24.9 Headings. The headings and section titles in this Agreement are for convenience 3 only and are not part of this Agreement. 4 24.10 Severability. If anything in this Agreement is found by a court of competent 5 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in 6 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of 7 this Agreement with lawful and enforceable terms intended to accomplish the parties' original 8 intent. 9 24.11 Nondiscrimination. During the performance of this Agreement, the Contractor(s) 10 shall not unlawfully discriminate against any employee or applicant for employment, or recipient 11 of services, because of race, religious creed, color, national origin, ancestry, physical disability, 12 mental disability, medical condition, genetic information, marital status, sex, gender, gender 13 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to 14 all applicable State of California and federal statutes and regulation. 15 Contractor(s) shall take affirmative action to ensure that services to intended Medi-Cal 16 beneficiaries are provided without use of any policy or practice that has the effect of 17 discriminating on the basis of race, color, religion, ancestry, marital status, national origin, ethnic 18 group identification, sex, sexual orientation, gender, gender identity, age, medical condition, 19 genetic information, health status or need for health care services, or mental or physical 20 disability. 21 24.12 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation 22 of the Contractor(s) under this Agreement on any one or more occasions is not a waiver of 23 performance of any continuing or other obligation of the Contractor(s) and does not prohibit 24 enforcement by the County of any obligation on any other occasion. 25 24.13 Entire Agreement. This Agreement, including its exhibits, is the entire agreement 26 between the Contractor(s) and the County with respect to the subject matter of this Agreement, 27 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements, 28 publications, and understandings of any nature unless those things are expressly included in 52 1 this Agreement. If there is any inconsistency between the terms of this Agreement without its 2 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving 3 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the 4 exhibits. 5 24.14 No Third-Party Beneficiaries. This Agreement does not and is not intended to 6 create any rights or obligations for any person or entity except for the parties. 7 24.15 Authorized Signature. The Contractor(s) represents and warrants to the County 8 that: 9 (A) The Contractor(s) is duly authorized and empowered to sign and perform its 10 obligations under this Agreement. 11 (B) The individual signing this Agreement on behalf of the Contractor(s) is duly 12 authorized to do so and his or her signature on this Agreement legally binds the 13 Contractor(s) to the terms of this Agreement. 14 24.16 Electronic Signatures. The parties agree that this Agreement may be executed by 15 electronic signature as provided in this section. 16 (A) An "electronic signature" means any symbol or process intended by an individual 17 signing this Agreement to represent their signature, including but not limited to (1) a 18 digital signature; (2) a faxed version of an original handwritten signature; or (3) an 19 electronically scanned and transmitted (for example by PDF document) version of an 20 original handwritten signature. 21 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed 22 equivalent to a valid original handwritten signature of the person signing this Agreement 23 for all purposes, including but not limited to evidentiary proof in any administrative or 24 judicial proceeding, and (2) has the same force and effect as the valid original 25 handwritten signature of that person. 26 (C)The provisions of this section satisfy the requirements of Civil Code section 27 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, 28 Part 2, Title 2.5, beginning with section 1633.1). 53 1 (D) Each party using a digital signature represents that it has undertaken and 2 satisfied the requirements of Government Code section 16.5, subdivision (a), 3 paragraphs (1) through (5), and agrees that each other party may rely upon that 4 representation. 5 (E) This Agreement is not conditioned upon the parties conducting the transactions 6 under it by electronic means and either party may sign this Agreement with an original 7 handwritten signature. 8 24.17 Counterparts. This Agreement may be signed in counterparts, each of which is an 9 original, and all of which together constitute this Agreement. 10 [SIGNATURE PAGE FOLLOWS] 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 54 1 The parties are signing this Agreement on the date stated in the introductory clause. 2 CONTRACTOR(S) COUNTY OF FRESNO 3 See Exhibit A"List of Contractors" 4 Subsequent signature pages are attached. _ 5 Sal Quint No, hairman of the Board of Supervisors of the County of Fresno 6 Attest: 7 Bernice E. Seidel Clerk of the Board of Supervisors 8 County of Fresno, State of California 9 By: 10 Deputy 11 For accounting use only: 12 Org No.: 56302007 Account No.: 7295 13 Fund No.: 0001 Subclass No.: 10000 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ft 55 1 CONTRACTOR: 2 TURNING POIN OF CENTRAL CALIFORNIA, INC. 3 4 Raymond . Banks, Chie Executive Officer 5 6 7 8 Willia oodall, i f Fi ancial fficer J 9 10 11 615 S Atwood St. Visalia, Ca 93277 12 Attention: Raymond Banks, CEO Phone: 559-732-8086 ext.7101 13 Phone: 559-999-8983 mobile 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 56 1 CONTRACTOR: 2 MENTAL HEALTH SYSTEMS, INC. dba TURN BEHAVIORAL HEALTH SERVICES �7awte,r C C U44an,7Y� 3 j 9CCallaghan Jr(May 30, 02313� 50 PDT) 4 James C Callaghan Jr CEO/President [Name], [Title] 5 6 trc .iott(May30,20231359 PDT) 7 tracey mcdermott CFO 8 [Name], [Title] 9 10 11 9456 Farnham St. San Diego, Ca 92123 12 Attention: James C. Callaghan, CEO Phone: 858-573-2600 ext.1101 13 Phone: 858-254-4338 mobile 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 57 Exhibit A ADULT FULL-SERVICE PARTNERSHIP PROGRAM LIST OF CONTRACTOR(S) 1. Turning Point of Central California, Inc. Business Type: Private, non-profit, 501 (c)(3) corporation Business Address: P.O. Box 7447 Visalia, CA 93290 Contact: Raymond Banks, CEO raymondbanks(a)tpocc.org Service Addresses: Site #1 —Vista 258 N Blackstone Ave Fresno, CA 93701 Site #2 - Sunrise 3855 N. West Ave Suite 110 Fresno, CA 93705 Site #4 —Vista AOT 258 N Blackstone Ave Fresno, CA 93701 Target Population: Adult and Older Adult with Serious Mental Illness (SMI) Level of Care: Outpatient/intensive Case Management and Full-Service Partnership Provider Exhibits: Vista: Exhibit B1 — SOW, Exhibit H1 — Compensation Sunrise: Exhibit B1 — SOW, Exhibit H2 — Compensation Vista AOT: Exhibit B2 — SOW, Exhibit H3 — Compensation 2. Mental Health Systems, Inc. dba TURN Behavioral Health Services Business Type: Private, non-profit, 501 (c)(3) corporation Business Address: 9465 Farnham Street San Diego, California 92123 Contact: James C. Callaghan, President & CEO Icallaghan(a)turnbhs.org Service Addresses: Site #3— D.A.R.T. West 2550 W Clinton Ave Bldg. W Fresno, CA 93705 Target Population: Adult and Older Adult with Serious Mental Illness (SMI) Level of Care: Outpatient/intensive Case Management and Full-Service Partnership Provider Exhibits: D.A.R.T. West: Exhibit B3 — SOW, Exhibit H4 — Compensation Exhibit B-Scope of Services Page 1 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model CONTRACT SERVICES: Full Service Partnership (FSP) programs providing comprehensive mental health, housing, employment support and community supports for adults with serious mental illness (SMI) CONTRACT TERM: July 1, 2023 -June 30, 2024 July 1, 2024 -June 30, 2025 (possible 12-month extension based on satisfactory performance) CONTRACTOR(s): Refer to Exhibit A BACKGROUND: COUNTY, on behalf of the Department of Behavioral Health (DBH) is providing FSP Services to adults with SMI by contracting for a maximum of four (4) adult FSP program sites, providing comprehensive mental health, housing, employment support and community supports with a continuous service capacity for up to 720 individuals. Each of the four (4) program sites will maintain a combined caseload per site of 180 individuals at any given time throughout the contract term. The FSP program(s) will encompass a unified team approach, in which the provider commits to do "whatever-it-takes" and "meet the individual where they are" to assist the person served to reach their personal recovery, resiliency and wellness goals and aim to reduce the number of days of hospitalization, incarceration and/or homelessness. Services are provided on a voluntary basis, 24 hours per day, seven days per week (24/7), with a case manager to individual ratio of no more than 1:15. Each FSP program site can implement elements of the Assertive Community Treatment (ACT) model within the context of creating a team structure for comprehensive and coordinated services that support and promote recovery. Adoption of select ACT program elements will help FSP teams achieve the team structure required by Mental Health Services Act (MHSA) funding regulations. Each FSP program site will not need to implement full-on ACT program services. CONTRACTOR(s) must be thoroughly familiar with the provisions of MHSA, including but not limited to State MHSA regulations, policy interpretations, and definitions. CONTRACTOR(s) must also be thoroughly familiar and have knowledge and understanding of Fresno County's diverse and unique populations. CONTRACTOR(s) will use MHSA funds to reach the unserved and underserved, new and existing persons served and their family members who receive services through Fresno County DBH and other contracted services. CONTRACTOR(s) programs, services, and practices must align with DBH's vision, mission, and "Guiding Principles of Care Delivery", attached as Exhibit C. DBH's 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. SCHEDULE OF SERVICES: CONTRACTOR(s) staff shall be available to provide services to individuals twenty-four (24) hours per day, seven (7) days per week. Exhibit B-Scope of Services Page 2 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model TARGET POPULATION: The individual's participation in CONTRACTOR(s)'s FSP program is on a voluntary basis. The target population to be served under this Agreement includes individuals 18 years of age and older from Fresno County who meet the requirements for an SMI diagnosis. All adults referred for FSP services must meet the following criteria: 1. Their mental disorder results in substantial functional impairments or symptoms, or they have a psychiatric history that shows that, without treatment, there is an imminent risk of decompensation with substantial impairments or symptoms. 2. Due to mental functional impairment and circumstances, they are likely to become so disabled as to require public assistance, services, or entitlements; AND 3. They are in one of the following situations: a. They are unserved and one of the following: i. Homeless or at risk of becoming homeless ii. Involved in the criminal justice system iii. Frequent users of hospital or emergency room services as the primary resource for mental health treatment b. They are underserved and at risk of one of the following: i. Homelessness ii. Involvement in the criminal justice system iii. Institutionalization PROJECT DESCRIPTION: CONTRACTOR(s)' FSP programs shall be a "whatever-it-takes" program working toward ending homelessness, frequent hospitalizations, and/or incarcerations for adults with SMI. This program will provide comprehensive mental health, housing, employment support and community supports to a maximum of 720 adult with the goal of supporting them in recovery and self-sufficiency. Services must be strength-based, individual-directed, co-occurring capable, and employ psychosocial rehabilitation and recovery model principles. The FSP program shall be a partnership between the CONTRACTOR(s) and COUNTY DBH, with the CONTRACTOR(s) providing multi-level services directed toward the individual needs of the enrollees. Services and supports provided by the CONTRACTOR(s) shall include, but shall not be limited to: assessments, therapy, medication support, personal service coordination, crisis management, rehabilitation services, employment and education, advocacy and linkage to community resources. Additional support includes any direct assistance necessary to ensure that individuals obtain the basic necessities of daily life, such as food, clothing, transportation, housing, personal hygiene, medical services, and other financial support. It is expected that each person served approved to enter the program will be offered the full array of services and supports, including a minimum of three (3) face-to-face contacts per week, or as clinically appropriate. COUNTY staff shall oversee program outcomes, reporting, referrals and contract monitoring. Referrals: All referrals for services will be approved by the DBH Director, or designee. While referrals can be made from various sources, approval of an individual's entry into the Adult FSP program will be made by DBH. Exhibit B -Scope of Services Page 3 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model Staffing: FSP programs seek to engage individuals with SMI into intensive, wraparound services with a low case manager to individual ratio between (1:10) to (1:15), and provide a "whatever it takes" and "meeting the individual where they are" approach to wellness and recovery, including but not limited to: • Promoting recovery and increasing quality of life; • Decreasing negative outcomes such as hospitalization, incarceration, and homelessness; and • Increasing positive outcomes such as increased life skills, access to benefits and income, involvement with meaningful activities such as education and employment, and socialization and psychosocial supports (e.g., psychosocial outcomes). CONTRACTOR(s) staffing shall include a minimum of a 1.00 FTE Psychiatrist to meet with individuals on a monthly basis, or as needed, per respective FSP program site. PROGRAM OBJECTIVES AND DELIVERABLES - FSP: The following items listed below represent FSP program goals to be achieved by CONTRACTOR(s). Each FSP program site's success will be based on the number of goals it can achieve, resulting from performance outcomes. The CONTRACTOR(s) will utilize a computerized tracking system with which outcome measures and other relevant client data, such as demographics, will be maintained. 1. Reduce frequency of hospitalizations for each individual. CONTRACTOR(s) will provide, through self- reporting, most recent 12-month history which will be used as baseline data. Each individual will show a 70% reduction in hospitalization after one year of receiving services or upon discharge. Reports and data will be submitted on a monthly basis. 2. Reduce frequency of homelessness for each individual. CONTRACTOR(s) will provide most recent 12- month history which will be used as baseline data. Each individual will show an 80% reduction in days spent homeless after one year of receiving services or upon discharge. Each individual will obtain and maintain stable housing after one year of receiving services or upon discharge. Reports and data will be submitted on a monthly basis. 3. Reduce frequency of incarceration for each individual. CONTRACTOR(s) will provide, through self- reporting, most recent 12-month history which will be used as baseline data. Each individual will show an 80% reduction in days spent incarcerated after one year of receiving services. Each additional year will show an additional 5% reduction. Reports and data will be submitted on a monthly basis. 4. CONTRACTOR(s) will provide each individual with the appropriate level of housing support, reflective of the individual's needs. Each individual in need of housing will receive assistance in housing placement and support- including emergency housing - contingent upon level of need and independent functioning. Each individual will have stable housing upon discharge. Reports and data will be submitted on a monthly basis. 5. CONTRACTOR(s) will provide services to the satisfaction of the persons served and will address any reported complaints. Satisfaction surveys will be made available and reviewed regularly; a bi-annual Performance Outcome Quality Improvement survey will be provided to persons served; and complaint forms and grievance forms will be made easily available. Reports and data will be submitted on a monthly or annual basis, respectively. 6. CONTRACTOR(s) will provide a level of service and support that reflect each individual's needs. Each individual will increase their level of functioning and, within one year of treatment (or as clinically Exhibit B-Scope of Services Page 4 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model appropriate), will transition to a lower level of service within the program. Reports and data will be submitted on a monthly basis. 7. CONTRACTOR(s) will provide services helping each individual to achieve a level of recovery, stability, and independence that will allow transition to the least restrictive level of care possible. Written reports will be submitted on a quarterly basis. 8. CONTRACTOR(s) shall work with individuals to assist them in setting their goals and generating a Plan of Care which includes personalized wellness goals for each individual. These goals will be evaluated, monitored, and adjusted regularly. Written reports will be submitted on a quarterly basis. 9. CONTRACTOR(s) shall establish and maintain collaborative relationships with agencies and individuals who have frequent contact with hospitalized, homeless, or incarcerated adults. Examples of collaborative relationships include local law enforcement agencies, Veterans Administration, Marjorie Mason Center, Fresno County Human Services Departments, churches, acute psychiatric facilities, schools, community centers, etc. Letters of introduction, including description of services and how to contact the FSP program shall be distributed to potential partners. 10. CONTRACTOR(s) will complete quarterly reports, as mandated by the State for FSPs. Reports shall be made directly into the FSP Data Collection and Reporting (DCR) system. 11. The Direct Services productivity rate is expected to be at a minimum of sixty-five percent (65%) and reported in writing at regularly scheduled meetings with COUNTY staff. 12. CONTRACTOR(s) will identify services provided to each person served on a monthly basis, as needed by the Department, including recreational and social activities and linkages provided to individuals such as the County's Job Option Program. This information will be provided to the designated Division Manager in a monthly report. CONTRACTOR(s)'S RESPONSIBILITIES: CONTRACTOR(s) may operate the FSP program by utilizing the Assertive Community Treatment (ACT) model of care to provide services to adults with SMI who are frequent users of hospital and crisis services and therefore, are at risk of hospitalization, incarceration, and homelessness. CONTRACTOR(s) shall: A. Coordinate with law enforcement and courts services, as needed. B. Be available to provide the following services, including but not limited to: • Personal service coordination and supportive counseling; • Ongoing assessment of the individual's mental illness symptoms and response to treatment; • Education of the individual regarding his/her mental illness and the effects (including side effects) of prescribed medications; • Symptom management efforts directed to helping the individual identify the symptoms and their occurrence patterns, and development of methods (internal, behavioral, adaptive) to lessen their effects; • Provision, both on planned and on an "as needed" basis, of such psychological support as is necessary to help individuals accomplish their personal goals and cope with the stresses of day- to-day living. Exhibit B-Scope of Services Page 5 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model C. Be available to provide crisis assessment and intervention twenty-four (24) hours per day, seven (7) days per week throughout the year, including telephone and face-to-face contact as needed. The following crisis response measures shall also be followed: • Response to crisis shall be rapid and flexible; • When crisis housing is necessary for short-term care and inpatient treatment (either voluntary or involuntary), the staff shall collaborate with the treatment staff in such facilities. Support shall be provided to the maximum extent possible, including accompanying the individual to the facility, remaining with the individual during assessment, and beginning the process of planning with the individual for discharge to the community as soon as possible; D. Provide services in the areas of medication prescription, administration, monitoring, and documentation. • The psychiatrist shall assess each individual's mental illness symptoms and behavior and prescribe appropriate medication, regularly review and document symptoms as well as the individual's response to the prescribed medications, educate the individual and family members, and monitor, treat and document any medication side effects. • The nurse shall establish medication policies and procedures which identify processes to administer medications, train other team members, and assess regularly other team members' competency in this area. • All FSP team staff shall assess and document individual's mental illness symptoms and behavior in response to medication and shall monitor for medication side-effects during the provision of observed self-administration and during ongoing face-to-face contacts. • Regarding residents of residential care facilities, the team shall collaborate with staff at these facilities to ensure individuals at these locations are taking prescribed medications and the staff is monitoring their response to the medication(s). Furthermore, the staff shall review the facility records (after receiving written consent from the person served) and shall regularly collaborate with facility staff about treatment plans, goals, objectives and interventions. E. Provide whatever direct assistance is necessary and reasonable to ensure that the individual obtains the basic necessities of daily life, such as food, housing, clothing, medical services, and other financial support. F. Ensure that each FSP Team member shall have, in their possession, during regular working hours (and appropriate on-call hours) an adequate amount of financial resources to make emergency purchases of food, shelter, clothing, prescriptions, transportation, or other items for individuals, as needed. The team shall have access to larger flexible funding accounts for assistance with housing deposits, furniture purchases, and other items, with sound accounting practices for recording and monitoring the use of these funds. G. Assist the individual with establishing a payee or payee service. The FSP team may utilize assistance funds to assist individuals with short-term loans or grants, as necessary. The team shall link individuals to appropriate social services, provide transportation as necessary, and link the individual to appropriate legal advocacy representation. H. Provide training, instruction, support and assistance to the individual in developing personal skills, including but not limited to, the ability to: 0 Carry out personal hygiene tasks; Exhibit B-Scope of Services Page 6 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model • Perform household chores, including housekeeping, cooking, laundry and shopping; • Develop or improve money management skills; • Use community transportation; and • Locate, finance and maintain safe, clean and affordable housing. I. Develop and support the individual's participation in recreation, social activities, and relationships. Priority shall be given to supporting the persons served in establishing positive social relationships in normative community settings. Staff shall assist individuals in establishing positive social relationships and participating in social/recreational activities in the community. Such services shall include, but not be limited to, assisting individuals with: • Developing social skills and the skills and other skills needed to develop meaningful personal relationships; • Planning appropriate and productive use of leisure time including familiarizing persons served with available social and recreational opportunities; • Interacting with landlords, neighbors and others effectively and appropriately; • Developing assertiveness and self-esteem; and • Using existing self-help centers, groups, spiritual, and recreational groups to combat isolation and withdrawal experienced by many persons coping with severe mental illness. J. Provide alcohol, tobacco and drug use disorder services for individuals with co-occurring disorders, as clinically appropriate and in accordance with harm reduction principles. This will include, but is not limited to individual and group interventions to assist individuals in: • Identifying alcohol, tobacco, and drug abuse effects and patterns; • Recognizing interactive effects of alcohol, tobacco, and drug use, psychiatric symptoms and psychotropic medications; • Developing coping skills and alternatives to minimize alcohol, tobacco and drug use; • Achieving periods of abstinence and/or decreased risk behaviors and increased stability; • Attending appropriate recovery or self-help meetings: and • Achieving an alcohol and drug free lifestyle, as desired. K. Act to minimize the individual's involvement in the criminal justice system, with services to include, but not be limited to; • Helping the individual identify precipitants to the individual's criminal involvement; • Providing necessary treatment, support and education to help eliminate unlawful activities or criminal involvement that may be a consequence of the individual's mental illness; and • Collaborating with police, court personnel, and jail/prison officials to ensure appropriate collaboration and clinical support through the legal processes. Exhibit B-Scope of Services Page 7 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model L. Assist the individual, family and other members of their social network to relate in a positive and supportive manner through such means as: • Education about the individual's SMI and their role in the therapeutic process and treatment services and supports; • Supportive counseling; • Intervention to resolve conflict; • Referral, as appropriate, of the family to therapy, self-help and other family support services; and M. Coordinate with other community mental health and non-mental health providers, as well as other medical professionals. Staff shall provide the following functions for all individuals served: • Development of formal and informal affiliations with other human service providers including, mental health, physical health care, addiction treatment providers, and inpatient units; • Involvement of other pertinent agencies, the individual's family, and members of their social network in the coordination of the assessment, and in the development, implementation and revision of service plans; • Advocacy and assistance to individuals to obtain needed benefits and services, such as supplemental security income, general relief, housing subsidies, food stamps, medical assistance, and legal services; • Coordination of meetings of the individual's other service providers in the community; • Maintenance of ongoing communication with all other agencies serving the individual, including hospitals, primary care physicians, rehabilitation services and housing providers as required; • Maintenance of working relationships with other community services, such as education, law enforcement and social services; • Maintenance of the clinical treatment relationship with the individual on a continuing basis whether the individual is in the hospital, in the community, involved with other agencies or the criminal justice system; and • Methods for service coordination and communication between the team and other service providers serving the same individuals shall be developed and implemented consistent with Fresno County confidentiality rules. N. Monitor service outcomes to determine if the person served has meaningful use of their time, stays in school or maintains employment, has reduced numbers of hospitalizations, incarcerations, and periods of homelessness. DBH will use State identified criteria for measuring these outcomes. The treatment team will be monitored to ensure appropriate service delivery and adherence to MHSA philosophies. O. Provide comprehensive services, including intensive mental health treatment, rehabilitation, and case management with the goal of increasing adaptive functioning in the community and preventing unnecessary re-admissions to Institutes of Mental Disease (IMD), acute inpatient facilities, or other higher levels of care. P. Meet with DBH on a monthly basis, or more often as agreed upon, for contract and performance monitoring. Exhibit B-Scope of Services Page 8 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model Employment and Education FSP program sites will assist the individual in accessing and participating in the employment and education programs offered in the community, as appropriate. In order to facilitate individual participation in community education and employment programs FSP shall include, but is not limited to: • Collaboration with and education of community providers as it relates to individual's mental illness, abilities, levels of functioning, educational and employment interest, and potential effects of the client's mental health symptoms on participation, in education and work; • Encouragement and individual rehabilitation related to the integration, practicing, follow through and problem solving as it relates to continued education and employment • Individual supportive counseling and education to assist the individual, family, and support system in identifying, managing, and coping with the symptoms of mental illness that may interfere with his/her work or education experience; • On-the-job or work-related crisis intervention; • Crisis intervention in the educational setting; • Work/education-related supportive services, such as assistance with grooming and personal hygiene, securing appropriate clothing, wake-up calls, and transportation; and • The team staff shall also link with the supportive services offered for additional and ongoing support related to education and employment. Housing The FSP team will empower individuals to take an active role in the recovery process. The FSP team will provide housing options and support individuals in maintaining a stable residence by providing needed services, accessing resources, and encouraging individuals to be independent, productive and responsible. 1. The team shall provide whatever direct assistance is necessary to ensure that the individual obtains the basic necessities of daily life, including but not limited to: • Safe, clean, affordable housing; • Food and clothing; • Medical and dental services; and • Securing appropriate financial support, which may include Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), General Relief (GR), and money management or payee services. 2. CONTRACTOR(s) shall ensure that team members have rapid access to flexible spending funds for items such as security deposits, furniture, and/or other items required for independent living. 3. CONTRACTOR(s) will provide housing services, as needed, to ensure that individuals maintain their housing. CONTRACTOR(s) shall provide: • Training and assistance to individual in locating, securing and inhabiting housing which is appropriate to their level of functioning; Exhibit B-Scope of Services Page 9 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model • Training and instruction, including individual support, problem solving, skill development, modeling and supervision, in the home and in community settings, to teach the person served to manage finances and maintain safe, clean, affordable housing; • Supportive and independent housing for the person served with the goal to have every individual in secure housing that is appropriate for their level of ability and need that is sustainable, as soon as reasonably possible; 4. CONTRACTOR(s) will establish a program to provide rent subsidies for independent housing needed while developing a plan for sustainable housing based on individual need and ability. Levels of Care FSP services are designed in a framework which allows the individual to move fluidly through different levels of care as the client's individual recovery and wellness dictates. Each CONTRACTOR(s)' specific levels of services are identified and detailed in Exhibit B-1 et. seq. Hours of Operation CONTRACTOR(s)' specific hours of operation are identified and detailed in Exhibit B-1 et. seq. Program Outcomes/Performance Outcome Measures Services and Performance Measures - Under the provision of the MHSA Community Services and Supports (CSS) component, COUNTY's DBH receives funding to expand, develop and create successful CSS programs for children, transitional aged youth, adults, and older adults in a culturally, ethically, and linguistically competent approach for underserved and unserved populations. CONTRACTOR(s)' specific approaches to these services, and their performance measures and outcome goals are detailed in Exhibits B-1 et. seq. CONTRACTOR(s) shall comply with all project monitoring and compliance protocols, procedures, data collection methods, and reporting requirements requested by the COUNTY. CONTRACTOR(s) shall use performance outcome measures for evaluating program and system effectiveness to ensure services and service delivery strategies are positively impacting the service population. In addition, these measures shall be used to ensure FSP services are in alignment with MHSA guiding principles which are inclusive of: an integrated service experience; community collaboration; cultural competence; individual/family driven service; and wellness, resilience, and recovery focused services. Goals of the FSP programs include less utilization of more costly crisis services, and minimization or avoidance of more severe outcomes such as substance use disorder, hospitalization or incarceration. Performance outcome measures shall be tracked on an ongoing basis. Performance outcome measures are reported to the COUNTY annually in accumulative reports for overall program and contract evaluation. Forms and tools used to gather and report data reflecting services provided, populations served, and impact of those services are to be developed by the COUNTY and CONTRACTOR(s). CONTRACTOR(s) will work closely with the COUNTY to analyze the data and make necessary adjustments to service delivery and reporting requirements before the start of each new fiscal year. CONTRACTOR(s)' specific performance measures and outcome goals are identified and detailed in Exhibit B-1 et. seq. Measurable outcomes may be reviewed for input and approval by a designated DBH work group upon contract execution and adjusted as needed each new fiscal year. The purpose of this review process is to ensure a comprehensive system wide approach to the evaluation of programs through an effective outcome reporting process. Exhibit B-Scope of Services Page 10 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model DBH collects data about the characteristics of the persons served and measures service delivery performance indicators in each of the following domains. At minimum, one (1) performance indicator will be identified for each of the four (4) domains listed below. 1. Effectiveness: A performance dimension that assesses the degree to which an intervention or services have achieved the desired outcome/result/quality of care through measuring change over time. The results achieved and outcomes observed are for persons served. Examples of indicators include: Persons get a job with benefits, or receive supports needed to live in the community, increased function, activities, or participation, and improvement of health, employment/earnings, or plan of care goal attainment. 2. Efficiency: Relationship between results and resources used, such as time, money, and staff. The demonstration of the relationship between results and the resources used to achieve them. A performance dimension addressing the relationship between the outputs/results and the resources used to deliver the service. Examples of indicators include: Direct staff cost per person served, amount of time it takes to achieve an outcome, gain in scores per days of service, service hours per person achieving some positive outcome, total budget (actual cost) per person served, length of stay and direct service hours of clinical and medical staff. 3. Access: Organizations' capacity to provide services of those who desire or need services. Barriers or lack thereof for persons obtaining services. The ability of persons served to receive the right service at the right time. A performance dimension addressing the degree to which a person needing services is able to access those services. Examples of indicators include: Timeliness of program entry (from first request for service to first service), ongoing wait times/wait lists, minimizing barriers to getting services, and no-show/cancellation rates. 4. Satisfaction: Satisfaction Measures are usually orientated towards persons served, family, staff, and stakeholders. The degree to which persons served, COUNTY and other stakeholders are satisfied with services. A performance dimension that describes reports or ratings from persons served about services received from an organization. Examples of indicators include: opinion of persons served or other key stakeholders in regards to access, process, or outcome of services received, Consumer and/or Treatment Perception Survey. CONTRACTOR(s) will address each of the categories referenced above in CONTRACTOR(s)' specific performance measures and outcome goals as identified and detailed in Exhibit B-1 et. seq. and may propose/provide other performance and outcome measures that are deemed best to evaluate the services provided to persons served and/or to evaluate overall program performance. Separate performance and outcomes measures are expected for specialty mental health services and clinical training services. DBH may adjust the performance and outcome measures periodically throughout the duration of this Agreement, as needed, to best measure the program as determined by COUNTY. CONTRACTOR(s) shall utilize and integrate clinical tools as directed by DBH. CONTRACTOR(s) must utilize a computerized tracking system with which performance and outcome measures and other relevant individual data, such as demographics, will be maintained. The data tracking system may be incorporated into the CONTRACTOR(s)' EHR or be a stand-alone database. DBH must be afforded read-only access to the CONTRATOR(S)' data tracking system, if applicable. DBH prefers that the Exhibit B -Scope of Services Page 11 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model CONTRACTOR(s) utilize its EHR with full access being provided by DBH. However, if the CONTRACTOR(s) is unable or unwilling to utilize DBH's current EHR, arrangements must be made to ensure that an interface to transfer all necessary reporting and outcome information is developed to meet the needs of DBH. Additional Reporting Requirements per FSP Site CONTRACTOR(s) will be responsible for meeting with DBH on a monthly basis, or more often as agreed upon between DBH and CONTRACTOR(s), for contract and performance monitoring. CONTRACTOR(s) will be required to submit monthly reports to the COUNTY that will include, but not be limited to: dollars billed for Medi-Cal and MHSA (non-Medi-Cal) persons served; actual expenses; the number of persons served served/anticipated to be served; utilization of services by persons served; and staff composition. These reports will be due within thirty (30) days after the last day of the previous month or payments may be delayed. Additional reporting is required for FSPs by DHCS. DHCS uses the FSP Data Collection and Reporting (DCR) system to ensure adequate research and evaluation, regarding the effectiveness of services being provided and the achievement of the outcome measures. CONTRACTOR(s) will need to report individual/partner information and outcomes of the FSP program directly into the DCR system. Data will be submitted through an online interface using specific forms. The Partnership Assessment Form gathers baseline information about the partner and is completed once the partnership is established. Key Event Tracking provides a snapshot of changes in key quality of life areas and is tracked on a continuous basis throughout the course of the FSP. The Quarterly Assessment collects updated information about changes in quality of life areas and is completed every three (3) months from the date the partnership is established. "Continuous improvement is a core tenant of the Department and MHSA. Over the past few years, County DBH participated in a statewide FSP evaluation project. The result of the project required that DBH and CONTRACTOR(S) should add another question to the State required DCR data as follows: New question added to the DCR effective July 1, 2023: Question: "How often do you get the social and emotional support that you need?" Answer: Response options will be; always, usually, sometimes, rarely, or never. In addition to the requirements set above, the following items listed below represent program goals to be achieved by CONTRACTOR(s). The CONTRACTOR(s) programs' success will be based on the number of goals it can achieve, resulting from performance outcomes. CONTRACTOR(s) will utilize a computerized tracking system with which outcome measures and other relevant client data, such as demographics, will be maintained. Regarding Crisis Interventions and Recidivism: Each enrollee will have no more than six (6) key events (specifically incarceration, homelessness, and crisis or inpatient hospitalization admission) during the first six (6) months in the adult FSP programs. There will be a reduction of key events for enrollees tracked as: • No more than three (3) key events (incarceration, homelessness, and crisis or inpatient hospitalization admission) during months six to twelve (6-12) of enrollment in program. • No more than one (1) key event (incarceration, homelessness, and crisis or inpatient hospitalization admission) during months thirteen to eighteen (13-18) of enrollment in program. A. FSP program sites will show zero percent (0%) days of homelessness after being enrolled in the program unless individual declined housing assistance. CONTRACTOR(s) shall notify DBH of Exhibit B-Scope of Services Page 12 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model individual's decline and document accordingly. CONTRACTOR(s) must have clear documentation of efforts to house individuals in appropriate setting. B. FSP program sites will show a ninety percent (90%) reduction in individual's days in inpatient psychiatric hospitalizations after being enrolled in FSP compared to the year before being enrolled in the FSP. C. FSP program sites will show a ninety percent (90%) reduction in individual's days incarcerated after being enrolled in FSP compared to the year before being enrolled in the FSP. Regarding Linkages and Referrals: A. Within ninety (90) days of being enrolled in the FSP, one hundred percent (100%) of individuals who did not have SSI will have made applications completed to receive SSI. CONTRACTOR(s) will provide this data as requested. B. Within six (6) months of being enrolled in the FSP, one hundred percent (100%) of individuals will have linkages to and documentation of a Primary Care Physician. C. Within thirty (30) days of enrollment, one hundred percent (100%) of individuals will have participated in forming their Individualized Service Plan. D. Within one hundred twenty (120) days of enrollment, one hundred percent (100%) of individuals will be provided/linked to job coaching activities. E. Where appropriate, within ninety (90) days of enrollment, at least seventy-five percent (75%) of applicable individuals will have been offered the opportunity to participate in Supportive Education and Employment Services. Within one hundred twenty (120) days of enrollment, at least ninety-five percent (95%) of applicable individuals will have been offered the opportunity to participate in Supportive Education and Employment Services. Outcomes will be monitored to see if the individual has meaningful use of their time, maintains employment, and hospitalizations and incarcerations are reduced as well as homelessness. COUNTY's DBH will use State criteria for measuring these outcomes. CONTRACTOR(s) FSP program sites will be monitored regarding services delivered and if they meet the goals of MHSA. The FSP program sites will use an effective method likely to bring about intended outcomes, based on one of the following standards, or a combination of the following standards (as defined by current MHSA regulations): • Evidence-based practice standard • Promising practice standard • Community and or practice-based evidence standard MHSA CONTRACTOR(s) will collect all data and fulfill all reporting requirements as specified in the applicable MHSA regulations related to the program type, strategies, and standards indicated above or as indicated in MHSA regulations. CONTRACTOR(s) will work with COUNTY to ensure data, outcomes, and reports are included in all required MHSA reports, plans, and updates. Exhibit B-Scope of Services Page 13 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model Current MHSA Regulations can be found at the following website: http://mhsoac.ca.gov/laws-and-regulations CONTRACTOR should understand all MHSA regulations to ensure they have the organizational capacity to record, track, and report all required elements. COUNTY RESPONSIBILITIES: COUNTY shall: 1. Provide oversight of the CONTRACTOR(s) FSP program sites through the County Department of Behavioral Health (DBH) and the DBH Contracted Services Division Manager, or designee. In addition to contract monitoring of the FSP program sites, oversight includes, but is not limited to, coordination with DHCS and MHSA in regard to program administration and outcomes. 2. Assist the CONTRACTOR(s) in making linkages with the entire behavioral health system. This will be accomplished through regularly scheduled meetings as well as formal and informal consultation. 3. Participate in evaluating the progress of the overall program and the efficiency of collaboration with the CONTRACTOR(s) staff and will be available to the CONTRACTOR(s) for ongoing consultation. 4. Receive and analyze statistical data outcome information from CONTRACTOR(s) throughout the term of this Agreement on a monthly basis. DBH will notify the CONTRACTOR(s) when additional participation is required. The performance outcome measurement process will not be limited to survey instruments but will also include, as appropriate, person served and staff interviews, chart reviews, and other methods of obtaining required information. 5. Recognize that cultural competence is a goal toward which professionals, agencies, and systems should strive. Becoming culturally competent is a developmental process and incorporates at all levels the importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally unique needs. Offering those services in a manner that fails to achieve its intended result due to cultural and linguistic barriers is not cost effective. To assist the CONTRACTOR(s) efforts towards cultural and linguistic competency, DBH shall provide the following at no cost to CONTRACTOR(s): A. Technical assistance to CONTRACTOR(s) regarding cultural competency requirements and sexual orientation training. B. Mandatory cultural competency training including sexual orientation and sensitivity training for DBH and CONTRACTOR(s) personnel, at minimum once per year. COUNTY will provide mandatory training regarding the special needs of this diverse population and will be included in the cultural competence training(s). Sexual orientation and sensitivity to gender differences is a basic cultural competence principle and shall be included in the cultural competency training. Literature suggests that the mental health needs of lesbian, gay, bisexual, transgender, questioning and other (LGBTQ+) individuals may be at increased risk for mental disorders and behavioral health problems due to exposure to societal stressors such as stigmatization, prejudice and anti-gay violence. Social support may be critical for this population. Access to care may be limited due to concerns about providers' sensitivity to differences in sexual orientation. C. Technical assistance for CONTRACTOR(s) in translating behavioral health and substance use disorder services information into DBH's threshold languages (Spanish, Laotian, Cambodian and Hmong). Translation services and costs associated will be the responsibility of the CONTRACTOR(s). Exhibit B-Scope of Services Page 14 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model Transition Optimization Opportunities One-time Transition Optimization Funds will be available to specialty mental health providers and Drug Medi- Cal providers within FY 2023-24 to encourage Contractors to identify and implement organization changes during the first year of CalAIM Payment Reform to improve outcomes for persons served and create operational efficiencies. Contractor is expected to utilize the strategies, tools and knowledge learned to their programming and continue to improve services for the population served. Drug Medi-Cal Transition Optimization funds will be provided through County Realignment. a. Fundinq Allocation Methodology i. Each participating contractor is eligible to apply for an allocation of Transition Optimization Funds up to the maximum amounts stated in Article 4 of the Agreement and further described below. Transition optimization funds will only be available from July 1, 2023 through June 30, 2024 and payments shall be on a quarterly basis. ii. Payments will be disbursed upon review and approval by DBH of each deliverable described below. Quarterly progress reports shall be submitted to DBH in order to show progress as outlined in the submitted plans and deliverables. iii. Payments will be dependent on Contractor demonstrating progress toward meeting deliverables described in this exhibit. Contractors who fail to submit progress reports by stated deadlines, or who do not demonstrate adequate progress made, may be determined ineligible for that quarter's payment at the sole discretion of the County. iv. All invoices will be submitted on a quarterly basis within fifteen (15) days following the end of the quarter. Invoices submitted thereafter may not be eligible for payment. b. Responsibilities i. Letter of Intent Contractor shall submit a letter of intent to DBH by July 31, 2023, identifying the selected Transition Optimization Activity(ies) and commitment to meet the deliverable deadlines as described below. The letter shall include all current Medi-Cal billable specialty mental health and substance use disorder services agreements the Contractor has with the County. The County shall respond to the Contractor's letter of intent within 30 days. The County's response shall include a breakdown of anticipated payments, as determined by the County, depending on the Transition Optimization Activity(ies) chosen and depending on the number of current Medi-Cal billable specialty mental health and substance use disorder services agreements the Contractor has with the County. ii. Quarterly Reports Contractor shall submit quarterly progress reports and invoices. Reports shall be submitted on the dates indicated in the Schedule of Deliverables below. Invoices are due 15 days after the end of each quarter. All activities shall be completed by June 30, 2024. The report shall include updated plans/tools and progress Contractor has made toward the Transition Optimization Activity(ies) described in each Contractors' letter of intent. iii. Schedule of Deliverables: Equity Gap Analysis, Fiscal Monitoring Tool, and Electronic Health Record 1. Q1 Reports: July-Sept: a. Letter of Intent: Due July 31, 2023 b. Fiscal Monitoring Tool, Equity Gap Analysis, and Electronic Health Record Implementation Plans (if applicable): Due September 30, 2023 Exhibit B-Scope of Services Page 15 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model c. Fiscal Monitoring Tool Identified Practices and Strategies (if applicable): Due September 30, 2023 2. Q2 Report: Oct-Dec: Due January 15, 2024 3. Q3 Report: Jan-Mar: Due April 15, 2024 4. Q4 Report: Apr-June: Due July 15, 2024 iv. All deliverables will be reviewed and approved by DBH prior to payment. c. Eligible Transition Optimization Activities i. Fiscal Monitoring Tools: Contractor shall submit to DBH a draft of their fiscal monitoring tool that shall be used monthly on an ongoing basis to evaluate fiscal health of the organization. Tools shall, at a minimum, monitor costs, productivity targets and identify one or more practice pattern(s) the organization is employing to increase direct care time to the Medi-Cal population. 1. Fiscal Monitoring Tools and Implementation Plan: Contractor shall develop fiscal monitoring tools that will be used monthly to ensure their organizational fiscal health and implementation plan. Fiscal monitoring tools drafts and implementation plan shall be submitted to DBH by September 30, 2023. a. Identified Practice: Identify at least one process improvement that shall be modified by September 30, 2023. b. Quarterly Progress Reports: Quarterly progress reports shall be submitted including but not limited to a narrative of progress, obstacles, alternative solutions and outcomes. c. Funding for this activity shall be available up to $25,000 for the initial agreement with Contractor and up to another$10,000 for each additional agreement. County shall provide further details on deliverables and payment schedule in County's response to the Contractor's letter of intent. ii. Equity Gap Analysis: Contractor shall produce a report identifying the race/ethnicity of population served in fiscal year 2022-23 compared to the County's population as provided by the County. Contractor shall identify key disparities in both persons served and amount of services and frequency of transitions to other levels of care received. Contractor shall identify three (3) strategies they shall employ during FY 2023-24 to reduce the disparities among underserved population. 1. Report on Underserved Population: Contractor shall submit an Equity Gap Report to the Department containing including, but not limited to, the following: a. Identify if it serves specific population within its program(s) and identify whom the program(s) currently served based on data. b. Staffing/workforce information and demographics. Report the staffing/workforce supporting the different programs and populations served by the provider in Fresno County. This data is to evaluate how the staffing reflects the populations it is serving. c. Comparison of the county penetration rates to the demographics of persons served by the Contractor and program(s) under agreement with DBH. d. Data on retention of persons served by demographics. Total persons served and the average length of stay by demographics of the persons served in programs. i. Which populations are remaining in the programs by demographics, which ones are having the shortest stays. ii. How long is the average length of stay by the demographics. Exhibit B-Scope of Services Page 16 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model e. Identify what data points the Contractor is missing at this time that challenges its ability to thoroughly assess its equity gap analysis. Examples: Data is not collected, Data that is missing or under reported, data not captured in its processes, etc. 2. Equity Improvement Implementation Plan: Contractor shall submit an Equity Improvement Implementation Plan related to improving health equity by September 30, 2023. The plan shall include the following items at a minimum: a. Contractor shall select three strategies from below: i. Plan shall include specific efforts including, but not limited to, the following and timelines to increase access to underserved groups. 1. Outreach/Engagement with underserved communities 2. Active attendance/participation in DBH's Diversity Equity and Inclusion (DEI) workgroup 3. Plan for retention of persons served in programs who are underrepresented 4. Improvement of demographic data collection including Sexual Orientation Gender Identity (SOGI)/LGBTQ data. ii. Plan shall address workforce capacity to render services to more underserved populations, through: 1. Development of bilingual personnel 2. Recruitment plan for more diverse workforce to reflect populations served. 3. Training for workforce to increase capacity to be culturally responsive 4. Development workforce pool for the future that can be bilingual and bicultural b. Timeline for each effort shall be included in the plan. c. Contractor shall identify the measurement to be used to demonstrate successful implementation of plan. Measure may be identified by the Contractor to best support their plan and goals. d. Contractor shall develop and submit policies and procedures to formally support equity effort. 3. Quarterly Progress Reports: Use available data including but not limited to, External Quality Review Organization (EQRO) and EHR data to evaluate the strategies deployed. Quarterly progress reports shall be submitted including but not limited to a narrative of the progress, obstacles, alternative solutions and outcomes. The final quarter shall include a comprehensive final report on the outcomes. 4. Funding for this activity shall be available up to $25,000 for the initial agreement with Contractor and up to another$10,000 for each additional agreement. County shall provide further details on deliverables and payment schedule in County's response to the Contractor's letter of intent. iii. Electronic Health Record (EHR): The implementation and expansion of the SmartCare EHR is an essential component of improving oversight with the implementation of payment reform. Furthermore, a standardized EHR will improve continuity of care, create transparency across the system, remove obstacles for individuals accessing services and improve the overall outcomes for persons served. For Contractors who plan to opt in to use SmartCare or have previously opted into Exhibit B-Scope of Services Page 17 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model DBH's former EHR and intend to transition to SmartCare, user fees and costs shall be waived during FY 2023-2024 and FY 2024-2025. 1. Option One: Current EHR Users a. Strategic Plan: Contractors utilizing DBH's EHR as their current EHR, and who will continue to utilize SmartCare beginning July 1, 2023, shall provide a plan, including, but not limited to, how they will optimize Medi-Cal billing, illustrate how they will utilize the information in the EHR to improve care for persons served, and a training plan for their organization by September 30, 2023. b. Quarterly Progress Reports: Quarterly progress reports shall be submitted, including, but not limited to, a narrative on the progress, obstacles, alternative solutions and outcomes. c. Total compensation for this Electronic Health Record activity, Option 1, shall not exceed $50,000.00 split among all current agreements between the Contractor and the County for Medi-Cal billable specialty mental health and substance use disorder services. County shall provide further details on deliverables and payment schedule in County's response to the Contractor's letter of intent. 2. Option Two: Non-EHR Users a. Contractor shall submit an implementation plan by September 30, 2023 regarding how they will transition to utilizing the SmartCare EHR by June 30, 2024. The plan shall include, at a minimum, an identified Go Live Date, plan on how the current record system will be maintained and utilized, training plan including number of individuals, and additional supports. The Go Live Date must occur by June 30, 2024 to receive final payment. Contractor shall work closely with DBH to identify needs, assignments, collaboration opportunities to transition. b. For Option 2, the Contractor shall not be reimbursed more than $200,000 split among all current agreements between the Contractor and the County for Medi-Cal billable specialty mental health and substance use disorder services. The total maximum compensation available for this option, shall include costs for maintaining current electronic health record/record system and additional supports and training costs per user. Contractor shall transition both specialty mental health and Drug Medi-Cal programming to the County's EHR and shall be required to use the County's EHR for future eligibility agreements with DBH. County shall provide further details on deliverables and payment schedule in County's response to the Contractor's letter of intent. Exhibit B-Scope of Services Page 18 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model FSP Service Delivery Model Full Service Partnerships (FSP) are designed as a partnership between enrollees and the service provider. The FSP service delivery ethic incorporates recovery and cultural competence into the services and supports offered to consumers. In this partnership, the service provider commits to do "whatever it takes" and to "meet the person served where they are" in order to assist the enrollee achieve their personal recovery/resiliency and wellness goals. 1. The Target Population is consistent with the population identified in the Fresno County MHSA Community Planning Process The target population must meet requirements for SMI/SED diagnosis; and must address reduction of specific ethnic disparities, as indicated in the MHSA Community Services and Supports proposal on which the RFP is based. The target population will include individuals who are not currently served and meet one or more of the following criteria: ■ Homeless ■ At risk of homelessness- such as youth aging out of foster care or ■ persons coming out of jail ■ Involved in the criminal justice system (including adults with child ■ protection issues) ■ Frequent users of hospital and emergency room services or are so underserved that they are at risk of: ■ Homelessness -such as persons living in institutions or nursing homes ■ Criminal justice involvement ■ Institutionalization Diagnoses that serve as criteria for inclusion in the target population will be based on definitions found in 5600.3 California Welfare and Institutions code defining serious emotionally disturbed mental disorder or serious mental disorder. The operational definition of"diagnosis" for programs serving the chronically homeless may also include co-occurring disorders, personality disorders, general anxiety/mood disorders, and Post Traumatic Stress Disorder). 2. FSP Program Components: All MHSA FSP Programs must include the following in their program descriptions • Providers who are part of the multidisciplinary, community based "treatment" teams serve as an ally to the consumer's recovery process. The partnership allows persons served and family members opportunities for informed choice o The team description must demonstrate commitment and capacity to do "whatever it takes" to assist the enrolled member, specifically: ■ Low staff to person served ratio (approximately 1:12; or the ratio that has been specified in the contract statement of work) ■ 24/7 availability of the multidisciplinary team. ■ Team culture is created where each member of the team knows each person served and the persons served are familiar with each member of the team. ■ Members of the team speak the persons served language, are familiar with community resources that reflect the healing beliefs of the persons served culture and are positioned to assist the person served make meaningful connection with those Exhibit B-Scope of Services Page 19 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model resources. ■ Crisis response comes from a person known to the person served. ■ Staff is given the administrative flexibility and flex-funding to connect consumers with non-mental health services and same day needs. Examples include Housing; Primary Care; Dual Disorder Services, Education Services and Supports; Vocational services and supports; Payee services/benefits advocacy; Community recreational activities (YMCA classes, libraries, movie theaters); Social Services, Food, Transportation, and Clothing. ■ Availability of Integrated Dual Diagnosis Treatment or other dual recovery intervention that will provide effective treatment for the target population. • Outreach and engagement. The team's outreach and engagement strategy must be voluntary and driven by the values of persons served culture. This means that consumers will be engaged "where they are" in terms of their community location, their need for clinical and non-clinical services/supports and their phase of recovery. Outreach workers will have culturally competent language skills and will function as an ally to the consumer's decision to receive services. Peer Support will be included in the outreach and engagement of new persons served. • Procedures for enrollment and dis-enrollment will be easily understood, clearly communicated and non-coercive. Enrollment is voluntary. A condition of enrollment is that the person served indicates that they want services from the assertive-community treatment model team. • Each adult, older adult, and transition age youth enrollee must have a Personal Service Coordinator (PSC). The PSC is an ally to the enrollee and acts as a "single point of responsibility" within the multidisciplinary team for coordinating services and supports. "Personal Service Coordinators (PSCs) for adults- case managers for children and youth- must have a caseload that is low enough so that. (1) their availability to the individual and family is appropriate to their service needs, (2) they are able to provide intensive services and supports when needed, and(3) they can give the individual served and/or family member considerable personal attention... PSCs/case managers must be culturally competent, and know the community resources of the persons served racial ethnic community." (Source: DMH Planning Requirements, Section III Identifying Populations for Full Service Partnerships, Aug 2005) • Each enrollee must have an Integrated Services and Supports Plan that is developed with their Personal Services Coordinator. This ISSP is a planning tool that builds on the consumer's strengths. It includes goals and provides a map of the steps that the enrollee identifies as necessary to move along his/her recovery path. "Integrated Services and Supports Plans must operationalize the five fundamental concepts (identified listed in section three of this Exhibit) and should reflect community collaboration, be culturally competent, be person served/family driven with a wellness/recovery/resiliency focus and they must provide an integrated service experience for the person served/family. In addition, the ISSP will be person/child-centered, and give individuals and their families'sufficient information to allow them to make informed choices about the services in which they participate. Services should also include linkage to, or provision of, all needed services or benefits as defined by the person served and or family in consultation with the PSC/case manager. This includes the capability of increasing or decreasing service intensity as needed." (Source: DMH Planning Requirements, Section III Identifying Populations for Full Service Partnerships, Aug 2005) • Peer support services will be made available to the person served. At least two staff(a minimum of 1 FTE) who acts in peer support roles will be employed in each MHSA program. o The enrollee is given significant access to peer recovery and self-help services. Tools such as Advanced Directives are made available to adult and older adult persons served, and Wellness Exhibit B-Scope of Services Page 20 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model Recovery Action Plans (WRAP) are made available to adult, transition age youth and older adult persons served. o Peer Counselors are included as equal partners in the multidisciplinary team and play a critical role in developing the recovery culture and person served orientation of the team. 3. The Five (5) Core MHSA Concepts are embedded in each program Concept 1: Recovery/resiliency orientation: FSPs will embody the values of recovery and resiliency (i.e., hope, personal responsibility, self- advocacy, choice, respect) and the program principles of recovery and resiliency, including: • Person served-driven goal setting and Individualized Services and Supports Plans • Providers are allies to the persons served recovery process. • A harm-reduction approach to substance abuse that encourages recovery and abstinence but does not penalize consumers or withdraw help from them if they are using. • A built-in understanding and expectation of setbacks as part of recovery. • Links to a range of services that are part of the consumers "pathway to wellness" (i.e., employment, health care, peer support, housing, medications, food and clothing) FSPs will collaborate with the MHSA Family Education Center which makes support services available to family members and the MHSA Wellness Recovery Resource Hub which makes wellness recovery training and technical assistance available to FSP staff. Concept 2: Cultural Competence Orientation: The program's structure, staffing and service delivery values will reflect the cultural values and orientation of the program's target populations. The FSP program will embody principals of cultural competence including: ■ Diverse staff, representative of the primary ethnic groups to be reached through the program ■ Staff trained regarding common access barriers for racial and ethnic groups targeted (including the impact of housing discrimination) ■ Links to community-based organizations that share the healing beliefs and practices of ethnic communities served by the FSP. The FSP program must also be able to deal with gender and sexual orientation diversity. Training in sensitivity to gender and sexuality issues is a key component for staff on the Team. Concept 3: Community Collaboration: FSP Collaborations ensure that community resources are made available to enrollees. These collaborations include subcontracts between the vendor and other agencies, memoranda of understanding with community non-profits and businesses regarding providing services to persons served, and informal relationships built between FSP staff and community stakeholders that result in improved access and decreased discrimination. Concept 4: Person Served/Family Driven program: In FSPs, the Integrated Services and Supports Plan (ISSP) is used by adult persons served and families of children and youth to identify their needs and preferences which lead to the services and supports that will be most effective for them. Providers work in full partnership with persons served to develop these ISSPs. Their needs and preferences drive the policy and financing decisions that affect them. Concept 5: Integrated Service Experience: FSP programs were incorporated into the MHSA to ensure that these dollars funded "integrated service experiences." This means that services are "seamless" to persons served and that persons served do not have to negotiate multiple agencies and funding sources to get critical needs met and to move towards recovery and develop resiliency. Services are delivered, or at a minimum, coordinated through a single agency or a system of care. The integrated service experience centers on the individual/family, uses a strength-based approach, and includes multi-agency programs and joint planning to best address the individual/family's needs using the full range of community-based treatment, case Exhibit B-Scope of Services Page 21 of 21 Full Service Partnership (FSP) Program Overview, Transition Optimization Opportunity and FSP Service Delivery Model management, and interagency system components required by children/transition age youth/adults/older adults. EXHIBIT B1 — Scope of Work Page 1 of 23 Full-Service Partnership (FSP) Program Scope of Work CONTRACTOR: Turning Point of Central California, Inc. CONTACT: Ryan Banks, CEO Elect rya n ba n ks(a)tpocc.org Elizabeth Escoto, Regional Director eescoto(a)tpocc.org SITE ADDRESS: Program Site#1: Vista —258 N. Blackstone Avenue, Fresno, CA 93701 Program Site#2: Sunrise— 3855 N. West Ave. Suite 110 Fresno, CA 93705 CONTRACT TERM: July 1, 2023 —June 30, 2024 July 1, 2024 —June 30, 2025, possible twelve-month extension PROGRAM DESCRIPTION CONTRACTOR's FSP programs are designed for adults who have been diagnosed with serious mental illness (SMI) and would benefit from an intensive service program. The foundation of FSPs is doing "whatever it takes" to help individuals on their path to recovery and wellness. CONTRACTOR's FSP program embraces individual-driven services and supports with each individual choosing services based on individual needs. CONTRACTOR's FSP program will feature a low case manager to person served ratio (1:15), 24/7 crisis availability, and a team approach that is a partnership between behavioral health program staff and individuals. CONTRACTOR's FSP programs will continue to assist with housing, employment, and education in addition to providing behavioral health services and integrated treatment for individuals who have a co-occurring mental health and substance use disorder. Services shall be provided to individuals in their homes, the community, and other locations when clinically indicated. Peer and caregiver support groups are available to each individual served by the program. Embedded in CONTRACTOR's FSP programs is a commitment to deliver services in ways that are culturally and linguistically competent and appropriate. CONTRACTOR shall deliver, coordinate, supervise, and administer their FSP programs while clearly demonstrating principles of wellness and recovery, as well as Fresno County Department of Behavioral Health (DBH)'s Vision, Mission, and Guiding Principles. A strengths-based, individual-directed care plan will be developed with every individual to "meet individuals where they are," and provide tailored treatment that focuses on engagement and is effective. In addition to management of primary and negative symptoms of individuals' mental illness, measurable attainable self-set goals in key areas such as financial management, education and employment shall be made available to each individual served by the program. While some symptoms may never be fully eliminated, the ability to manage and overcome them may ultimately be more empowering and essential for long-term recovery. CONTRACTOR believes individuals' self-achievements for control of their life to be the most important factor for overall life satisfaction and an essential component to the motivation to achieve ongoing recovery and growth. CONTRACTOR will operate two (2) FSP program sites upon execution of this Agreement. One of the two sites will be the "Vista" FSP program. The second "Sunrise" site will provide for an EXHIBIT B1 — Scope of Work Page 2 of 23 additional 180 individuals served. Both program sites will enable people who are diagnosed with a mental illness to be able to live, work, learn, and participate fully in community life. Recovery often means recovering aspects of life and fulfillment despite a disability. It can also mean reduction or elimination of symptoms. Resilience describes aspects of personal qualities, such as, optimism and traits of problem-solving skills, that lead to mastery and independence. Even negative experiences can build resilience as problems are overcome and learning leads to hope and self-reliance. Services that enable recovery and resilience are easy to access, integrated, seamless, individual- centered, multi-disciplinary, culturally competent, and chosen. All services described herein shall be recovery and resilience oriented. CONTRACTOR seeks to increase opportunities for individuals and families to have greater choice in service type and service providers as well as treatment strategies for service delivery. CONTRACTOR shall empower individuals served by the program autonomy in treatment, services, and support by emphasizing individuals' choice. Choices encourage personal responsibility, incentivize insight, self-monitoring, and accountability, while creating interest and benefit for sustaining recovery. Choices restore dignity and encourage quality of life. LOCATION OF SERVICES All sites listed below have been selected based on close proximity to the public bus stops to assist individuals with having geographic access to services both in the clinic and in the community. Every treatment plan will be geared with the intent of gradually decreasing each individual's dependence on the program while increasing their independence and ability to access a network of supports, services, and providers in the community. CONTRACTOR has worked with many FSP programs and understands that flexibility in services is extremely valuable in ensuring engagement and allowing each individual to direct services. Locations of services shall be provided in the field, meeting the individuals where they are, as we utilize the "whatever it takes" approach to service delivery at every practical and clinically appropriate instance. Such locations would be individuals' home, shelters, business, (e.g., coffee shops, library, grocery store, etc.) school, work, and doctor's office, while taking measures to ensure privacy and attend to confidentiality. CONTRACTOR shall provide services in the most appropriate location for the individual and allowing the individual to decide what is best for them as opposed to the traditional outpatient delivery of services being office-based. For many individuals living with severe mental illness, transportation is often a significant barrier to accessing treatment services, completing daily activities, and gaining independence. CONTRACTOR will assist all individuals with developing a means for stable transportation and transport individual as needed regardless of functional ability level. CONTRACTOR's staff shall be available to provide individuals served with transportation in agency vehicles with the intention of assisting each individual in becoming more self-sufficient over time. CONTRACTOR's staff shall provide education around the public transportation options and financial assistance to access transportation. CONTRACTOR shall abide by all Final Rule mandates, or any other federal, state, or county regulatory requirements regarding timely appointment standards, and shall provide the following: • Urgent care appointment for services that do not require prior authorization —within 48 hours of a request • Urgent appointment for services that do require prior authorization —within 96 hours of a request EXHIBIT B1 — Scope of Work Page 3 of 23 • Non-urgent appointment with a non-physician mental health care provider—within ten (10) business days of request • Non-urgent appointment with a psychiatrist—within fifteen (15) business days of request • Opioid treatment program —within three (3) business days of request • Individuals who access outpatient specialty mental health services shall receive an appointment within ten (10) business days from request to appointment. HOURS OF OPERATION CONTRACTOR's FSP program sites shall have office hours of operation Monday through Friday from 8:00 am to 5:00 pm. In addition, the FSP program sites will be adequately staffed and will provide services in the field (program hours) until 7:00 pm Monday through Friday. The FSP program sites shall also have services available on Saturdays and Sundays from 8:00 am to 5:00 pm. This level of accessibility for the individual and/or family will help to reduce and prevent negative outcomes for individuals including unnecessary hospitalizations, incarcerations, or evictions. DESCRIPTION OF SERVICES Crisis Assessment and Intervention CONTRACTOR's treatment teams shall be available to respond to individuals' served crises 24/7 including the ability to respond in the community and in person when appropriate. These services shall be delivered by the treatment teams, as needed. Services shall be delivered directly to the individual through direct assistance in the clinic or community when clinically appropriate. These services shall be provided in a culturally and linguistically appropriate manner with assistance from other treatment team staff or interpreter services as needed. Program staff members are certified in CPR and First Aid, as well as Pro-Act training (which focus on verbal crisis intervention and de-escalation), Adverse Childhood Experiences (ACES) and the Columbia Suicide Severity Rating Scale. CONTRACTOR's clinicians are also trained in Recognizing and Responding to Suicide Risk (RRSR). CONTRACTOR's clinical and medical staff will seek certification by DBH Managed Care for the ability to write 5150's for individual. Other crisis services CONTRACTOR's 24/7 rapid response will be available for a number of crises including, but not limited to: • Being stranded without transportation • Experiencing a physical health emergency • Experiencing exacerbated behavioral health symptoms • Running out of needed medications • Unexpected immediate/urgent housing need • Roommate/family conflicts requiring support • Experiencing heightened anxiety or fears surrounding safety • Experiencing physical threats to safety Medication Services EXHIBIT B1 — Scope of Work Page 4 of 23 CONTRACTOR shall provide the following regarding medication services: • Medication prescriptions/licensed psychiatrist • Injectable medication services • Medication education (provided by both psychiatrist and nursing staff) • Monitoring medication delivery (nursing staff will deliver medications face-to-face) • Labs (as ordered by the psychiatrist) Hygiene CONTRACTOR understands that for an individual to begin or continue working on their mental health symptoms, basic necessities must be taken care of first. The FSP program sites shall provide all those needs to assist the individual in stabilizing and providing support. Some of these items include hygiene packages, such as shampoo, soap, toothpaste/toothbrush, and deodorant. Other items in stock at the clinics are basic clothing items, such as socks, underwear, shirts and pants. CONTRACTOR shall maintain a stock of some basic necessity supplies at each of their FSP program sites at all times. If the program does not have immediate access, the staff shall purchase those items the same day the individual is identified in need. Other basic necessities, such as food and water, will be provided both in the office setting and at placement or their current housing as needed. Housing CONTRACTOR shall ensure that each individual has appropriate housing. CONTRACTOR has many valued relationships with independent living home operators allowing for quick response from housing vendors to get individual placed in housing the same day they are enrolled in services or in need of housing. CONTRACTOR shall maintain positive communication and relationships with agencies supportive of housing needs. Group Rehabilitation The FSP program sites shall have access to daily groups, as many as four (4) a day, to encourage and teach new skills related to personal growth. Other opportunities for building personal growth shall be provided for in the community. These services shall be individualized and assisted by their Personal Service Coordinator and include, cooking classes, knitting, yoga, Zumba, gardening, etc. Examples of group topics include: • WRAP - Wellness and Recovery Action Plan • Identifying and using strengths • Education on socialization skills • Positive self-care • Communication skills and boundaries/assertiveness skills • Healthy self-esteem/positive thinking • Conflict resolution education and skills building • Language/stigma of mental health • Setting behavioral health goals • Anger education and coping skills • Creating healthy relationships EXHIBIT B1 — Scope of Work Page 5 of 23 • Coping with stress/anxiety in public setting • Coping with grief and loss • Stages of change • Craft and activities group • Money management group For many people living with a severe mental illness, the associated symptoms significantly interfere with social development, forming relationships, making friends, and relating with family members, employers, and landlords. Providing group rehabilitation services to assist individual to meet interpersonal goals and to increase social skills needed for effective interpersonal performance will be one of the most important responsibilities for the treatment team. Social and Interpersonal Support CONTRACTOR shall provide assistance with a wide range of social activities. The treatment teams will help each individual to develop, restore, and maintain social and interpersonal relationships, to engage in social and leisure-time activities, and to increase their social network by providing social and interpersonal support to individuals. CONTRACTOR shall create opportunities for social networking by providing support groups, hosting program sponsored social activities, linking individuals to other community recreational programs, cultural ceremonies, or spiritual celebrations. Monthly social activities will be offered to further promote social development including movie and pizza days, local plays, trips to the zoo, trips to the County Fair, farmers markets, local art museums/events, barbeques at the park, and holiday events. In addition, individuals shall be linked to other community resources including, Blue Sky Wellness Center, Heritage Day Center, cultural and/or religious centers, and community centers where individuals can use learned social skills to further expand opportunities for social development. CONTRACTOR shall ensure that individualized feedback/intervention is available and provided in a clinically meaningful way during these opportunities. Co-Occurring Services CONTRACTOR shall provide a welcoming, safe environment for individuals with co- occurring diagnoses. Treatment shall be made available continuously to all individual regardless of their"readiness" for abstinence or ability to participate. Supportive and cognitive-behavioral treatment will be provided individually and in groups. The team will use directive methods to help individuals lessen substance use, to change associated attitudes and behaviors, and to develop new ways of coping and living. A Dual Diagnosis Specialist Case Manager along with the treatment teams will work towards developing a trusting relationship with the individual so that they are more willing to discuss substance use and its effects on behavioral health, physical health, and daily functioning. A Dual Diagnosis Specialist Case Manager will keep individuals engaged by providing counseling and supportive services in the office and in community settings. Further, a Dual Diagnosis Specialist Case Manager shall frequently combine this work with other treatment goals. Courts and the Justice System CONTRACTOR has experience in working with the Behavioral Health Court, the Public Defender's Office, the District Attorney, Jail Psychiatric Services, Police Department, Sheriff's Office, as well as County Probation Department. CONTRACTOR shall continue to work cooperatively with law enforcement, the Courts, and Probation Departments to assist individual to follow the law, comply with all of their legal requirements, and promote the best interests and recovery of the individual. Staff, particularly a Criminal Justice Case Manager, will work directly EXHIBIT B1 — Scope of Work Page 6 of 23 with the individual to assist in resolving all criminal justice involvement. These services shall be delivered directly by a Criminal Justice Case Manager and other treatment team staff as appropriate. A Criminal Justice Specialist shall work to minimize each individuals' involvement in the Criminal Justice System by: 1) helping the individual to identify precipitants to each individuals' criminal involvement, 2) providing necessary treatment, support, and education to help eliminate unlawful activities or criminal involvement that may be a consequence of individuals behavioral health symptoms, 3) collaborate with police, court, and jail officials to ensure appropriate use of legal and behavioral health services. A cognitive behavioral approach shall be used in examining how thoughts lead to behavior and will examine how erroneous thinking leads to criminal behavior. Staff will work cooperatively with probation, parole, court, and law enforcement agencies to meet supervision requirements. Cognitive behavioral approaches/interventions assist the individual to change thinking that leads to criminal activities and lifestyles. Staff will also assist the individual to understand how the effects/symptoms of their behavioral health can lead to commission of crime, and to develop a plan of crime prevention for their own lifestyle/behaviors. Staff will help the individual to develop alternatives to the functions or individual perceived "benefits" that the criminal behavioral has provided the individual. CONTRACTOR's Criminal Justice Case Managers shall apply for Fresno County jail passes that will enable them to have the ability to contact individuals while incarcerated inside the jail. It is beneficial to develop a relationship with the jail's clinical assessment team and detention facility personnel. Obtaining access to the jail assists in discharge planning for the individuals served. A Criminal Justice Case Manager shall work directly with any individual who becomes involved in the criminal justice system. Services shall include assistance in the following: • Maintaining contact with individuals while incarcerated • Supporting individual throughout any criminal justice involvement • Advocating with jail medical services for any medical needs the individual may have (this task will be done in collaboration with the nursing staff who will ensure that all pertinent medical information is made available to jail medical staff including current medication regimen) • Advocacy with the courts • Linking individual to legal aid • Assisting individuals with arranging payment of fines as needed • Providing an overview of Behavioral Health Court if this is an option for the individual Behavioral Health Court (BHC)/Other Collaborative Mental Health Courts Support Collaborative Court support services delivered to individuals shall include: • Conducting regular case conferences in conjunction with the Collaborative Court team to determine progress and to problem solve barriers • Supporting the individual during case conferences • Assistance/support during court appearances • Specialized treatment planning which includes input from the Collaborative Court team • Assistance in meeting all court participation requirements • Assistance/support during meetings with probation officers and ongoing • communication with probation officers EXHIBIT B1 — Scope of Work Page 7 of 23 • Linkage to and financial assistance (as needed)for mandatory drug testing as appropriate/ordered by the court • Referral/linkage to residential substance use disorder treatment as needed/ordered by the court • Court advocacy in conjunction with Collaborative Court team LEVELS OF CARE CONTRACTOR's services are designed in a framework which allows the individual to move fluidly through different levels of care as the individual's recovery and wellness dictates. In addition to the four (4) levels of care, all individuals will be able to receive targeted support services as needed. Each individual served by the program shall be continuously assessed and evaluated for appropriate level of care placement and transitioned when clinically indicated. The four (4) levels of care starting with the level of highest intensity are: • Level 1 - Engagement and Stabilization • Level 2 - Recovery and Discovery • Level 3 - Empowerment and Strength • Level 4 - Forward Bound CONTRACTOR shall implement principles and practices of the assertive community treatment (ACT) model of care within the FSP program sites and will continue to use this model in delivery of services. The FSP services are collaborative and shall be integrated with community services. Linkage to family therapy and education on community supports such as NAMI, and Fresno County Family Support Group, will be made available to families and individual support partners as individuals move through all phases of service delivery. Twenty-four (24) hour on-call services and crisis services shall be made available to all individuals throughout their enrollment in the CONTRACTOR's program. The following are service descriptions that shall be provided by CONTRACTOR in each level of care: Level 1 - Engagement and Stabilization Engagement and Stabilization (Level 1) is the highest level of support and most intensive level of services for an individual. During this time, an individual will be offered services according to individualized needs and the intensity of the services can be adjusted to meet each individuals' changing needs during this period. It is very important that the services be hands-on and frequent during this initial level. During each individuals' engagement and stabilization period the individual is making many adjustments and changes which may require flexibility in frequency of services. As such, the services in Level 1, while intense, will have an ebb and flow based upon individual individualized acceptance and need—there may be some periods where an individual needs services daily, followed by periods of lesser need. Individuals often enter the program and are experiencing distress and need support across multiple domains. The intention of this level of care is to provide support for the individual's needs and increase the individual's stabilization. A "whatever it takes" approach will be the focus for delivery of these services. Level 2 - Recovery and Discovery EXHIBIT B1 — Scope of Work Page 8 of 23 Recovery and Discovery (Level 2) continues with a focus on recovery and wellness goals and will begin to address stabilization across multiple domains. Some of the areas of focus are self- discovery/increased awareness and insight into mental health, sustained management of mental health symptoms, exploring education and employment goals, increased socialization skills, permanent housing, and increased engagement in individual recovery. This is the level where the majority of the stabilization work will be addressed and there are many tasks to be completed. This is a level where an individual can experience both recovery and discovery of self and their own strengths. This is expected to be the longest level of care due to the nature of the tasks to be completed. Each individuals' participation in this level shall be reviewed at a minimum every six (6) months and informed by Reaching Recovery outcomes. Services at this level remain frequent and the expectation is that there will be increased individual engagement and participation in a variety of services. Level 3 - Empowerment and Strength Empowerment and Strength (Level 3) maximizes focus on recovery and wellness goals. In this level, an individual will have experienced sustained stability and will be well on their way to independent living. This level will provide fewer intensive services as it allows an individual to "test the water" of independence and experience life with their own strengths. The program recognizes that this is an important area of growth and will remain available to the individual as needed while continuing to support the individual as needed. An additional focus in this level will be educating the individual on how to meet their needs through community resources and to independently access help when needed. Individuals in Level 3 are now being prepared for the final level of services. There is now a decrease in the number of case management, physician, therapist, and nursing contacts based upon the individualized functioning of the individual. It is anticipated that housing is stable, the individual has not required crisis services, monthly income has become stable, and the individual has made progress in the management of mental health symptoms (with or without medication support). The individual is now encouraged to move closer to independence utilizing the individual own strengths. Level 4 - Forward Bound Forward Bound (Level 4) is intended to be a safety net and monitoring level of services. When an individual has successfully transitioned to Level 4 it is assumed that the individual has reached baseline and is stable across multiple domains. The individual has learned recovery and wellness goals and has achieved some success at mastering independent living goals. CONTRACTOR shall ensure that individuals' housing is stable prior to discharge from Forward Bound. Times of transition can produce anxiety which can exacerbate an individual's symptoms. Support at Level 4 will allow the individual a safety net of services while they are attempting to assert their independence and receive services in the community. CONTRACTOR has experienced that sometimes when an individual is linked to a lower level of care, individuals experience significant anxiety, which results in decompensation. Level 4 will mirror the less intensive services that the individual will be transitioned to and will allow the individual to adjust to less program contact, while becoming engaged in other community services. This is a hands-on level of care as the individual will be supported throughout the transition to another provider. The expected time frame for this level is three (3) months; however as long as the transition is not complete the individual will remain in this level. In addition to these four levels of care we will have four special "in addition" categories. Regardless of the level of care, an individual will be given an additional level of supported services as appropriate. 0 Hospitalization/Post Hospitalization Support Level EXHIBIT B1 — Scope of Work Page 9 of 23 • Incarceration/Post Incarceration Support Level • Homelessness Support Level • Dual Diagnosis Support Level HOSPITALIZATION/POST HOSPITALIZATION SUPPORT LEVEL Being hospitalized is often a very traumatic experience. CONTRACTOR understands that extra support during this time has proven to have a positive influence on individuals' recovery. This level of care is not a stand-alone level. This level shall be added as an additional level of support whenever an individual is placed in an inpatient psychiatric setting or evaluated and discharged without admission. These services shall be delivered directly by members of the treatment team and will be coordinated by the individual's primary case manager. Services shall be delivered to the individual and to the individual's support persons (per individual preference). The services delivered in this supplementary support level are: • When an individual's application for up to 72-Hour Assessment, Evaluation, and Crisis Inter vention or Placement for Evaluation and Treatment (a.k.a., DHCS 1801 Application, or"515 0 hold") is being written by CONTRACTOR's staff, before initial placement in the hospital th e individual will receive explanation from their trusted Treatment Team regarding what is oc curring and why. CONTRACTOR shall maintain compliance with any regulation specified or referenced on the most current version of said form. • CONTRACTOR shall always contact the inpatient hospital to provide collateral information e.g., current medications, allergies if applicable and medication history, circumstance of the initiation of the hold). • The individual's case manager shall maintain contact with the inpatient hospital, psychiatric health facility, or crisis stabilization unit as applicable throughout the individual's stay. CON TRACTOR shall begin discharge planning immediately following the detainment advisemen t. • If the individual has given permission for family/support person involvement, collateral servi ces shall be offered to the family/support person during this time. • A case staffing shall take place to determine the options of placement and treatment for the individual upon discharge; if appropriate the involved family/support person will be invited to this case staffing. • During the time the individual is placed in the inpatient hospital, psychiatric health facility, or crisis stabilization unit, a member of the treatment team will maintain contact with the individ ual, letting the individual's level of functioning dictate the frequency of these contacts. • Upon discharge from the hospital, a Treatment Team member will ensure the individual is transported to the appropriate destination and that housing arrangements have been made. • After discharge, a psychiatrist appointment will be made immediately for the medication regi men to be evaluated with the individual. If the individual is not taking medications, the optio n of taking medications will be discussed at this time. • After discharge from the hospital, a case staffing with the individual's team will take place. T he purpose of the staffing will be to identify triggers that resulted in the hospitalization and t o determine ways to provide more support for the individual. This will be an opportunity to e xplore what is working or not working in the treatment plan and what needs to be increased or added to the plan. The individual's current level of care will also be evaluated. • The individual will be invited to be included in this staffing and the individual's input will be s olicited. If the individual chooses not to attend this staffing the results of staffing will be disc ussed with the individual and the individual's input sought at that time. • If the individual has support persons or family who are involved in treatment, the support pe EXHIBIT B1 — Scope of Work Page 10 of 23 rsons/family will be invited (with the individual's permission) to attend the case staffing team meeting. Family/support person involvement is highly valued and every opportunity to empo wer the family and include the individual's support persons in treatment will be utilized. • Service contact and delivery increases to five (5) contacts a week for a minimum of three (3 ) weeks. This will be all face-to-face contact, whenever possible. The goal is to give extra s upport to the individual and to assist the individual in handling stressors immediately. This i ncreased contact has proven to be one of the most valued and effective of post-hospitalizati on services. • During this time, the individual's placement will be re-evaluated. Steps are taken to ensure t hat the individual is in the least restrictive most appropriate housing available. It may be det ermined that a higher or lower level of housing supervision is appropriate. It may be determi ned that the same level of housing in a different location would be appropriate. • After three (3) weeks there will be another staffing which the individual and family an d support persons are invited to attend. At this meeting, it will be decided if the curre nt level of care is appropriate or if there are changes needed to be made. It will also be an opportunity to discuss what has been working and what hasn't been working. Any adjustments needed will be made to the Individual Service and Support Plan (IS SP) at this time. Throughout these first three (3) post hospitalization weeks, the individual will remain within the same level of care. During the case staffing following this three (3) week period, an evaluation of the appropriateness of the level of services can be made. Hospitalization will not be the only factor in determining the need for change in the level of care. Sometimes individuals have circumstances which create a temporary crisis or have a relapse which triggers the hospitalization. Many aspects of the individual's life and level of functioning will be explored to determine the individual's service needs. Review of the individual's current functioning and can help determine appropriate level of care. INCARCERATION/POST INCARCERATION SUPPORT Being incarcerated is often a very traumatic experience. CONTRACTOR knows that extra support during this time has proven to have a positive influence on the individual's recovery. This level of care is not a stand-alone level. This level will be added as an additional level of support whenever an individual is incarcerated or arrested and released without incarceration. These services will be delivered directly by a Criminal Justice Specialist and coordinated by the individual's primary case manager while the individual is incarcerated. Upon discharge from the Jail, all appropriate team members will deliver services. Services will be delivered to the individual and to individual family and partners (per individual preference). The services delivered at this supplementary support level are: • If an individual becomes incarcerated, the individual will be added to a Criminal Justice Cas e Manager case load as well as remaining with their current primary case manager. • The Criminal Justice/Case Manager will visit the individual in jail as soon as possible (this p osition will have obtained the necessary jail clearance.) • The Criminal Justice/Case Manager will also act as a court liaison to assist and support the individual. • If the individual is incarcerated for an extended period (seven days or more), the Mental Health Specialist Criminal Justice/Case Manager will work collaboratively with the individual I primary case manager so that the individual will have weekly contact, engagement, and support while incarcerated. • After release from jail, a psychiatrist appointment will be made immediately for the EXHIBIT B1 — Scope of Work Page 11 of 23 medication regimen to be evaluated with the individual. If the individual is not taking medications, the option of taking medications will be discussed at this time. • When an individual is released from incarceration, a case staffing with the individual's Treat ment Team will take place. The purpose of the staffing will be to identify triggers that resulte d in the incarceration and to determine ways to provide more support for the individual. This will be an opportunity to explore what is working or not working in the treatment plan and what needs to be increased or added to the plan. • The individual will be invited to be included in this staffing and the individual's input will be solicited. If the individual chooses not to attend this staffing, the results of staffing will be discussed with the individual and the individual's input sought at that time. • If the individual has support persons or family who are involved in treatment, the support pe rsons/family will be invited to attend this staffing. Family/support person involvement is highl y valued and every opportunity to empower the family and include the support persons in tr eatment will be utilized. If the individual has a probation officer, the probation officer will als o be invited to the staffing with the individual's permission. • Housing services will be adjusted, as necessary, to the individual's need. • Depending upon the triggers that resulted in the charges, the individual will be encouraged t o attend the appropriate groups and seek counseling services at the program. • Staff will work closely with the courts and probation to ensure that the individual is cooperating to the best of individual's ability. HOMELESSNESS SUPPORT LEVEL CONTRACTOR understands that housing is one of the most important needs for all persons and holds the belief that persons living with a SMI diagnosis can successfully live in and maintain normal housing with frequent and consistent team contact and support. Sometimes even with these supports an individual may have difficulty maintaining housing and will become homeless. This is a traumatic experience for the persons served and can exacerbate the individual's behavioral health symptoms. CONTRACTOR knows that extra support during this time has proven to have a positive influence on the individual's recovery. This level of care is not a stand-alone level. This level will be added as an additional level of support whenever an individual becomes homeless. These services will be delivered directly by members of the Treatment Team and will be coordinated by the individual's primary case manager in collaboration with the Housing Coordinator. Services will be delivered to the individual and to individual family and partners (per individual request). The services delivered at this level are: • Emergency case staffing with the individual (and individual family if appropriate), Case Manager, and Housing Coordinator to explore housing options available for individual. • The individual will be offered Emergency or Temporary housing and linked to this housing. • The individual's contact information will be changed on the caseload. • A Key Event Tracking (KET) form will be completed, as appropriate, and the informatio n entered into the tracking system. • The circumstances which resulted in the individual becoming homeless will be explored and the individual will be supported and educated on how to maintain housing, as needed. • If the individual has given permission for family/support person involvement collateral servic es will be offered to the family/support person during this time. • A psychiatrist appointment will be made for the medication regime to be evaluated with the i ndividual. If the individual is not taking medications, the option of taking medications will be discussed at this time. EXHIBIT B1 — Scope of Work Page 12 of 23 • A case staffing with the individual's team will take place. The purpose of the staffing will be t o identify triggers that resulted in the homelessness and to determine ways to provide more support for the individual. This will be an opportunity to explore what is working or not worki ng in the treatment plan and what needs to be increased or added to the plan. The individu al's current level of care will also be evaluated. • The individual will be invited to be included in this staffing and the individual's input will be s olicited. If the individual chooses not to attend this staffing, the results of staffing will be disc ussed with the individual and the individuals input sought at that time. If the individual has support or family who are involved in treatment, the support/family will b e invited with the individual's permission to attend this staffing. Family/support and involvem ent is highly valued and every opportunity to empower the family and include the family in tr eatment will be utilized. • Service contact and delivery may be increased to three (3) contacts per week for a minimu m of three (3) weeks. This will be all face-to-face contacts when possible. The goal is to giv e extra support to the individual and to assist the individual in handling stressors immediatel Y• • During this time the individual's placement is re-evaluated. Steps are taken to ensure that th e individual is in the least restrictive most appropriate housing available. It may be determin ed that a higher or lower level of housing supervision is appropriate. It may be determined t hat the same level of housing in a different location would be appropriate. • After approximately three (3) weeks there will be another staffing where the individual and family/support are invited to attend. At this meeting, it will be decided if the current level of care is appropriate or if there are changes needed to be made. It will also be an opportun ity to discuss what has been working and what has not been working. Any adjustments will be made to the ISSP at this time. Throughout these first three (3) post homelessness weeks the individual will remain in the same level of care and during the case staffing an evaluation of the appropriateness of the level of services can be made. Homelessness will not be the only factor in determining the need for change in the level of care. Sometimes individuals have circumstances which create a temporary crisis or have a relapse which triggers the homelessness. Many aspects of the individual's life and level of functioning will be explored to determine individual's service need. Review of the individual's current functioning and can help determine appropriate level of care. DUAL DIAGNOSIS SUPPORT LEVEL Delivery of services and approaches for individuals with SMI diagnoses and co-existing substance use disorders will be a vital part of the recovery and wellness process. Treatment is made available continuously to all individuals regardless of their"readiness" for abstinence or ability to participate. The Dual Diagnosis Specialist will combine the use of harm reduction practices with motivational interventions to transition individuals through stages of change. The five stages of change include pre-contemplation, contemplation, preparation, action, and maintenance. The five stages of change follow the individual from the initial stage in which the individual sees no need to change, to the final stages where the individual makes the change and then maintains it. In the preparation and action phases the Dual Diagnosis Specialist will assist the individual in developing a plan to become and stay clean and sober. The plan may include detoxification, inpatient treatment, outpatient treatment, ANNA groups, sober living residences, and positive social supports for sobriety. It is during this stage that individuals will often reach out for assistance. Whenever an individual requests help to maintain sobriety, it will be made available to the individual. Relapse is expected as part of the change process. When relapse occurs, the Dual Diagnosis Specialist and Case Manager will assist the individual in not catastrophizing the relapse in order to limit the length and damage, including returning to treatment if needed. The Treatment Team will selectively use EXHIBIT B1 — Scope of Work Page 13 of 23 outside treatment services as appropriate. Outside providers will be enlisted when inpatient services are needed for individual detoxification, induce remission of heavy substance use, or to establish linkage to outpatient treatment. This is a traumatic experience and can exacerbate the individual's behavioral health symptoms. CONTRACTOR knows that extra support during this time has proven to have a positive influence on the individual's recovery. This level of care is not a stand-alone level. This level will be added as an additional level of support whenever an individual agrees to dual diagnosis services. These services will be delivered directly by a number of members of the Treatment Team and will be coordinated by the individual's primary Case Manager in collaboration with the Dual Diagnosis Specialist. The services delivered at this level are: • Emergency case staffing with the individual (and individual family if appropriate), Case Manager, and Dual Diagnosis Specialist to explore treatment options available for the indivi dual. • The individual will be offered and linked to substance use disorder treatment based upon individual's acceptance of these services. • The individual's housing options will be explored, and a change made as appropriate (sober living, residential treatment care, detoxification). • After the treatment options has been determined, a case staffing with the individual' s Treatment Team will take place. The purpose of the staffing will be to identify trigg ers and to determine ways to provide more support for the individual. This will be an opportunity to explore what is working or not working in the treatment plan and what needs to be increased or added to the plan. The individual's current level of care will also be evaluated. The individual will be invited to be included in this staffing and the individual's input will be solicited. If the individual chooses not to attend this staffing t he results of staffing will be discussed with the individual and the individuals input so ught at that time. If the individual has support or family who are involved in treatment the support/family will be invited with the individual's permission to attend this staffin g. Family/support and involvement is highly valued and every opportunity to empow er the family and include the family in treatment will be utilized. • If the individual has given permission for family/support person involvement collateral servic es will be offered to the family/support person during this time. • A psychiatrist appointment will be made for the medication regime to be evaluated with the i ndividual. If the individual is not taking medications, the option of taking medications will be discussed at this time. • Service contact and delivery is maintained while individual is in residential treatment . This will be all face-to-face contact when possible. The goal is to give extra support to the individual and to assist the individual in handling stressors immediately. • During this time the individual's placement will be re-evaluated. Steps will be taken t o ensure that the individual is in the least restrictive most appropriate housing availa ble. It may be determined that a higher or lower level of housing supervision is appr opriate. It may be determined that the same level of housing in a different location w ould be appropriate. • After approximately three (3) weeks, there will be another staffing where the individu al and family/support are invited to attend (as appropriate). At this meeting, it will be decided if the current level of care is appropriate or if there are changes needed to b e made. It will also be an opportunity to discuss what has been working and what ha sn't been working. Any adjustments needed will be made to the ISSP at this time. EXHIBIT B1 — Scope of Work Page 14 of 23 Throughout these first three (3) post dual diagnosis weeks the individual will remain in the same level of care and during the case staffing an evaluation of the appropriateness of the level of services can be made. Substance use or relapse will not be the only factor in determining the need for change in the level of care. Many aspects of the individual's life and level of functioning will be explored to determine individual's service need. Review of the individual's current functioning and can help determine appropriate level of care. LEVEL 1: Engagement & Stabilization Min. 4-5 contacts per week LEVEL 2: Recovery & Discovery Min. 3-4 contacts per week LEVEL 3: Empowerment & Strength Min. 2-3 contacts per week LEVEL 4: Forward Bound 1-2 contacts per *The contact frequency is approximate and may be adjusted according to individual need. "For details regarding service intensity,see the previous section. LEVEL ELIGIBILITYITRANSITION CRITERIA Individuals and Case Managers will together assess "Recovery and Wellness" goals as written into the ISSP every six (6) months and will be updated as needed. Level 1 - Engagement and Stabilization Engagement and Stabilization begins with focus on recovery and wellness goals. All individuals will enter the program at this level. An individual will be objectively stable in the following domains for at least six (6) months before transitioning to Level 2 - Recovery and Discovery. 1. Individual has begun to show engagement in the program. (The individual will have successfully attended all scheduled psychiatric, nursing and therapy appointments (or cancelled appropriately) for at least three (3) months. Individual will have participated in case management contact in the community at an appropriate level for at least three (3) months. Individual will have several instances of initiating contact with the treatment team.) EXHIBIT B1 — Scope of Work Page 15 of 23 2. Individual crisis or crisis visits will have decreased during the last six (6) months. (It is anticipated that individuals will have crisis of many types during the enrollment in the program therefore the goal is to see a decrease in crisis rather than an elimination of crisis.) 3. Individual has been hospitalized less than once in the last six (6) months. (During this initial period of program enrollment frequent hospitalizations are sometimes experienced however as the individual becomes engaged and stable in a variety of domains these hospitalizations are anticipated to decrease as enrollment in the program continues.) 4. Individual has not been incarcerated in the last six (6) months. (If an individual becomes incarcerated and access to the program is restricted it will take a longer period of time for individual to accomplish the tasks of this level.) 5. Housing in the community has remained stable for a minimum of three (3) months (It is anticipated that there is housing movement when an individual first enters a program and housing can be considered stable for this level when it is maintained for three (3) months.) 6. Individual has been able to consistently access food and clothing resources with or without the assistance of the case manager. (It is anticipated that as an individual's finances stabilize and management of symptoms improves, they will become more independent in this area.) 7. Medication concerns have been addressed and individual adheres to medication regime in accordance with individual level of functioning. (Some individuals will choose not to take medication and not taking medications alone will not prevent transition.) 8. Individual has applied to all appropriate entitlements and finances have begun to stabilize. (Individual has applied for benefits upon enrollment however obtaining these can take a longer period of time.) 9. Individual will have been referred to a Primary Care Physician and any medical concerns have been addressed. 10. Evaluation indicates lower level of care. Level 2 - Recovery and Discovery Recovery and Discovery continues with focus on recovery and wellness goals and begins to focus on stabilization across multiple domains. Some of the areas of focus are: (1) self-discovery, increased awareness and insight into mental health, (2) sustained management of mental health symptoms, (3) exploring education and employment goals, increased socialization skills, (4) permanent housing, and (5) increased engagement in individual recovery. This is the level where the majority of the stabilization work will be addressed and there are many tasks to be completed. This is the level where an individual can experience both recovery and discovery of self and their own strengths. This is expected to be the longest level of care due to the nature of the tasks to be completed. An individual's participation in this level will be reviewed at a minimum every six (6) months. An individual will be objectively stable in the following domains for at least six (6) months before transitioning to Level 3 - Empowerment and Strength. 1. Individual has shown engagement and progress in the program. (Individual is regularly accessing Case Management services, Rehabilitation services, and attending Groups and/or Individual Therapy through the program. The individual successfully attends all scheduled psychiatric, nursing and therapy appointments (or cancelled appropriately) for at least six (6) months.) EXHIBIT B1 — Scope of Work Page 16 of 23 2. Individual crisis or crisis visits will have decreased to less than once in the last six (6) months. (It is anticipated that individuals will have crisis of many types during the enrollment in the program therefore the goal is to see a decrease in crisis vs. an elimination of crisis. At this level there should be a major decrease in crisis instances.) 3. Individual has not been hospitalized in the last six (6) months. (The expectation is that during this level the individual will have learned coping skills to handle crisis and will utilize the treatment team services to assist in times of crisis.) 4. Individual has not been incarcerated in the last six (6) months. (If an individual becomes incarcerated and access to the program is restricted it will take a longer period of time for individual to accomplish the tasks of this level.) 5. Housing in the community remained stable for a minimum of six (6) months and is becoming or has become self-sustaining. 6. Individual has been able to consistently access food and clothing resources and is self- sustaining. 7. Medications are stable and self-administered/monitored and the individual adheres to appropriate medication regimen. (Some individuals will choose not to take medication and not taking medications alone will not prevent transition.) 8. Monthly income is stable and self-sustaining (Medi-Cal/SSI) or stable financial arrangement in place. 9. Individual has been successfully linked to community resources and/or has an understanding of how to access these resources. 10. Individual has been given the opportunity to become involved in education or employment and works towards those goals and is accessing these services. 11. Individual is able to attend pertinent appointments without assistance. 12. Individual has begun to learn to advocate for themselves in the community. 13. Evaluation indicates lower level of care. Level 3 - Empowerment and Strength Empowerment and Strength maximizes focus on recovery and wellness goals. In this level an individual will have experienced sustained stability and will be well on the way to independent living. This level will provide less intensive services as it allows an individual to "test the water" of independence and experience life with their own strengths. The program recognizes that this is an important area of growth and will remain available to the individual as needed and will continue to support the individual as needed. An additional focus in this level will be ensuring the individual understands how to have their needs met through community resources and is aware of where to find help when needed. An individual will be objectively stable in the following domains for at least six (6) months before transitioning to Level 4 - Forward Bound. 1. Individual has shown engagement and progress in the program and community. 2. No crisis or crisis visits in the last three (3) months. 3. Individual has not been hospitalized in the last six (6) months. 4. Individual has not been incarcerated in the last six (6) months. 5. Housing in the community remained stable for a minimum of six (6) months and is self- sustaining. 6. Individual has been able to consistently access food and clothing resources and self- sustaining. EXHIBIT B1 — Scope of Work Page 17 of 23 7. Medications are stable and self-administered/monitored and the individual adheres to appropriate medication regimen. (Some individuals will choose not to take medication and not taking medications alone will not prevent transition.) 8. Monthly income is stable and self-sustaining (Medi-Cal/SSI) and individual is able to budget or stable financial arrangements are in place. 9. Individual has been successfully linked to community resources and/or has an understanding of how to access these resources. 10. Individual has been given the opportunity to become involved in education or employment and is working towards those goals and is accessing these services. 11. Individual is able to attend pertinent appointments without assistance. 12. Individual is able to advocate for themselves in the community when appropriate. 13. Individual no longer requires services beyond medication monitoring, therapy and groups. 14. Evaluation indicates a lower level of care. Level 4 - Forward Bound Forward Bound is intended to be a safety net and a monitoring level of service. When an individual has successfully transitioned to this level it is assumed that the individual has reached baseline and is stable across multiple domains. The individual has learned recovery and wellness goals and has achieved some success at mastering independent living goals. However, transition is often an anxiety producing time and often exacerbates individual's symptoms. Providing this level will allow the individual a safety net of services while they are attempting to assert their independence and receive services in the community. CONTRACTOR has experienced that sometimes when an individual is linked to a lower level of care, the individual experiences great anxiety which results in decomposition. This level of care will mirror the less intensive services that the individual will be transitioned to and will allow the individual to adjust to less program contact, while becoming engaged in other community services. This is a hands-on level of care as the individual will be supported throughout the transition to another provider. The expected time frame for this level is three (3) months; however, as long as the transition is not complete the individual will remain in this level. 1. Individual has been stabilized across multiple domains and has been referred to another provider. 2. There are no hospitalizations, no incarcerations, no homelessness, and no individual crisis. 3. Housing in the community has remained stable. 4. There are no medication concerns. 5. Evaluation indicates a lower level of care. The individual's level of care will be formally reviewed at a minimum of every six (6) months from the last level review and may be reviewed at any time as treatment dictates. This review will be a case staffing with the Treatment Team and the individual and individual/family/support persons will be invited to attend (dependent upon individual preference). During this staffing, the individual's input will be sought as well as the input from the other treatment team staff to determine what is working and what needs to be improved. This staffing will be done in conjunction with the ISSP, which will allow adjustments to be made to the plan as well if appropriate. The criteria for each level will be reviewed so an objective decision based upon individual's readiness for transition can be made. The criteria will be discussed with the individual upon entrance to the level and will be provided in written format for the individual as well as support persons to review. EXHIBIT B1 — Scope of Work Page 18 of 23 In addition to this regularly scheduled six (6) month review, an individual's level of care will be reviewed when any of the following occur: 1. The therapist, psychiatrist, case manager or other treatment team members express concern that the level of care may need to be adjusted. 2. The individual experiences one of the following triggering events: hospitalization, crisis services, incarceration, homelessness or significant substance use concerns. (These individual experiences will trigger a review to assess the individual's ongoing needs to determine if the individual needs to have a level change. In addition, for any these triggering events the individuals will automatically have an increase in supportive services as described under program services. These supportive services temporarily increase the intensity and frequencies of individual services to support the individual through these events. After these supportive services have been in place for three weeks a case staffing will take place to determine the appropriate level of care for the individual.) The individual's level of care will be tracked on the master caseload spreadsheet (a HIPAA compliant encrypted document for use internally in the program). This spreadsheet is accessible to appropriate staff and contains information important to individual care. Some of the types of information in addition to individual demographic information are program enrollment date, assessment date, Plan of Care due date, diagnosis, last psychiatrist appointment, insurance information, financial information, Primary Care Physician appointments, last hospitalization, last incarceration, housing status and primary case manager and primary therapist. CONTRACTOR has found that having this information in a spreadsheet has been a benefit to individual care. CONTRACTOR propose to add another domain on this master caseload which will list individual levels of care and enrollment into that level, the caseload will also show the next review date to adjust the level if needed. It will also track hospitalization, crisis services, incarceration, homelessness and instances of significant substance use concerns. There will be an additional tracking sheet created that will track every level case staffing the individual has had to allow the treatment team an overall understanding of the individual's progress through the program. This additional spreadsheet will also track hospitalization, crisis services, incarceration, homelessness and instances of significant substance use concerns. PROGRAM OBJECTIVES, DELIVERABLES AND OUTCOMES CONTRACTOR will utilize a computer tracking system with which outcome measures and other relevant data will be maintained. Program objectives will include: 1. A 70% reduction in hospitalization frequency for each individual after one year of receiving services or upon discharge. 2. An 80% reduction in days spent homeless after one year of receiving services or upon discharge. 3. An 80% reduction in days spent incarcerated after one year of receiving services. Program deliverables will include: 1. All individuals receiving the appropriate level of housing support. 2. Individual satisfaction with services and timely, efficient resolution of complaints. EXHIBIT B1 — Scope of Work Page 19 of 23 3. All individuals receiving the level of service and support that addresses their unique needs. 4. All individuals receive services that help them achieve a level of recovery, stability and independence that will allow transition to the least restrictive level of care possible as appropriate for their individual needs. 5. The collaborative development and achievement of meaningful treatment and wellness goals for all individuals. 6. Collaborative relationships will be established and maintained between CONTRACTOR and community partners who have frequent contact with hospitalized, homeless or incarcerated adults. 7. Timely submission of all required reports through the DCR system. 8. Minimum of 65% productivity for direct service staff. 9. CONTRACTOR will identify services provided to each individual on a monthly basis. TARGET CATEGORIES: The following outcome measures will be collected during the implementation of this program: (1) Effectiveness, (2) Efficiency, (3) Access, (4) Satisfaction and Feedback of Persons Served as well as Stakeholders. These outcomes are evidenced by a reduction in hospitalizations, incarcerations, homelessness and medical hospitalizations as well as increased participation in education, employment or volunteerism. 1. Effectiveness- A. Psychiatric Hospitalization Hospitalization refers to any hospital admission captured in COUNTY's electronic health record. Data may be entered by any hospital that utilizes the COUNTY's EHR including COUNTY's PHF, Community Behavioral Health Center (CBHC), and Kaweah Delta Psychiatric Hospital. The goal of this measure is to assess the degree of effectiveness for FSP level services. CONTRACTOR will track decreases in the number of days hospitalized post enrollment and compare to the total number of days spent in a psychiatric setting 12 months prior to program enrollment. i. Objective: To prevent and reduce the total number of individuals and days spent in a psychiatric hospital setting compared to the total number of individuals and days spent hospitalized 12 months prior to program enrollment. ii. Indicator: Percentage of individuals that experienced no psychiatric hospitalizations, and total number of individuals and days spent in a hospital setting compared to pre-enrollment. iii. Eligible Individuals: FSP individuals served by the program for a minimum of one year. iv. Time of Measure: One fiscal year V. Data Source: DCR/ITWS State database. vi. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP services will experience no episodes of psychiatric hospitalization. The number of individuals and days spent in a psychiatric hospital setting will be reduced when compared to the number of days hospitalized prior to program enrollment. vii. Outcome: Will be measured annually. B. Incarcerations EXHIBIT B1 — Scope of Work Page 20 of 23 Incarceration refers to individuals confined in a jail or prison setting. The goal is to reduce the number of days spent confined in a jail or prison setting compared to the number of days spent incarcerated 12 months prior to program enrollment. i. Objective: To prevent and reduce the total number of individuals and days spent incarcerated compared to the total number of days spent incarcerated 12 months prior to program enrollment. ii. Indicator: Percentage of individuals that experienced no incarcerations and the total number of individuals and days spent incarcerated compared to pre-enrollment. iii. Eligible Individuals: FSP individuals served by the program a minimum of one year. iv. Time of Measure: one fiscal year V. Data Source: DCR/ITWS State database. vi. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP services will experience no episodes of incarceration. The total number of individuals and days incarcerated will be reduced when compared to 12 months prior to enrollment. vii. Outcome: Will be measured annually. C. Homelessness Homelessness refers to individuals without a place to live, who are living is a place not meant for human habitation, or who are living in an emergency shelter. The goal is to reduce the total number of days spent homeless compared to the total number of days spent homeless 12 months prior to program enrollment. i. Objective: To prevent and reduce the total number of individuals and days spent homeless compared to the total number of individuals and days spent homeless 12 months prior to program enrollment. ii. Indicator: Percentage of individuals that experienced no episodes of homelessness and the total number of individuals and days spent homeless compared to pre- enrollment. iii. Eligible Individuals: FSP individuals served by the program a minimum of one year. iv. Time of Measure: one fiscal year V. Data Source: DCR/ITWS State database. vi. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP services will experience no episodes of homelessness. The total number of individuals and days spent homeless will be reduced when compared to 12 months prior to program enrollment. vii. Outcome: Will be measured annually. D. Medical Hospitalizations Medical hospitalization refers to individuals who frequently require hospitalization at a local hospital or emergency department as a result of chronic or untreated physical health related conditions. The goal is to reduce the total number of days spent in a hospital or emergency department setting compared to the total number of days spent hospitalized 12 months prior to program enrollment. i. Objective: To prevent and reduce the total number of individuals and days spent in a hospital or emergency department (ED) setting compared to 12 months prior to program enrollment. ii. Indicator: Percentage of individuals that experienced no episodes of medical hospitalizations or ED admissions, and the total number of individuals and days admitted in a medical hospital or ED compared to pre-enrollment. iii. Eligible Individuals: FSP individuals served by the program for a minimum of one year. iv. Time of Measure: one fiscal year V. Data Source: DCR/ITWS State database. EXHIBIT B1 — Scope of Work Page 21 of 23 vi. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP services will experience no episodes of medical hospitalizations or ED admissions. The total number of individuals and days admitted in a medical hospital or ED will be reduced when compared to 12 months prior to program enrollment. vii. Outcome: Will be measured annually. E. Participation in Educational Settings Educational setting refers to any learning environment or institution that offers educational services and curriculum according to specific objectives. Examples may include adult schools, vocational schools, community colleges, on-line coursework and universities. The goal is to increase the annual percentage of participants enrolled in educational settings. i. Objective: To increase the annual percentage of FSP participants enrolled in educational settings. ii. Indicator: Annual percentage of FSP individuals enrolled in educational settings. iii. Eligible Individuals: FSP individuals served by the program enrolled in educational settings. iv. Time of Measure: one fiscal year V. Data Source: DCR/ITWS State database. vi. Target Goal Expectancy: 15% of FSP individuals will be enrolled in educational settings. vii. Outcome: To be measured annually. F. Participation in Employment or Volunteerism Employment refers to work environments where individuals are paid competitive wages in exchange for job related activities performed. Volunteerism refers to environments where individuals willingly provide services or complete tasks without any expectation of financial compensation but may gain work experience and job-related skills. The goal is to increase the annual percentage of participants engaged in employment or volunteer activities. i. Objective: To increase the annual percentage of FSP individuals engaged in employment or volunteer activities. ii. Indicator: Annual percentage of FSP individuals engaged in employment or volunteer activities. iii. Eligible Individuals: FSP individuals served by the program engaged in employment or volunteer activities. iv. Time of Measure: one fiscal year V. Data Source: DCR/ITWS State database. vi. Target Goal Expectancy: To have a minimum of 15% of FSP individuals engaged in employment or volunteer activities annually. vii. Outcome: To be measured annually. 2. Efficiency- A. Cost per Individual Costs include all staffing and overhead costs associated with the operation of each FSP Program Site. The goal is to efficiently use resources and maintain or minimize costs per individual. i. Objective: To efficiently use resources and maintain or minimize cost per individual. ii. Indicator: Total program costs compared to number of unique individuals served. iii. Eligible Individuals: FSP individuals served by the program. iv. Time of Measure: one fiscal year V. Data Source: Avatar and Financial Records vi. Target Goal Expectancy: To keep within budgeted costs for the program. vii. Outcome: To be measured annually. EXHIBIT B1 — Scope of Work Page 22 of 23 3. Access- A. Length of time from referral to first contact Each FSP program site will receive referrals from multiple community entities for individuals seeking treatment for co-occurring disorders. The goal of the programs is to act promptly for each referral and to provide timely service for individuals requesting services. The target wait time from referral to first contact is within two (2) business days. i. Objective: To provide timely service for individuals requesting mental health care. ii. Indicator: Percentage of individuals that received first contact attempts within seven (7) business days of the referral date. iii. Eligible Individuals: Individuals referred to the program. iv. Time of Measure: one fiscal year V. Data Source: Avatar vi. Target Goal Expectancy: 70% of individuals will attempt to be contacted within seven (7) business days of the referral date. vii. Outcome: To be measured annually. B. Length of time from first contact to first assessment appointment offered Each FSP program site will receive assessment referrals from multiple community entities. The goal of the programs is to act promptly for each referral and the goal wait time from referral to first intake/assessment appointment is within ten (10) business days. i. Objective: To provide timely service for individuals requesting mental health care. ii. Indicator: Percentage of individuals offered their first assessment appointment within ten (10) business days of the first contact date. iii. Eligible Individuals: Individuals referred to the program and offered an assessment appointment. iv. Time of Measure: one fiscal year V. Data Source: Avatar vi. Target Goal Expectancy: 70% of individuals will be offered their first assessment appointment within ten (10) business days of the first contact date. vii. Outcome: To be measured annually. C. Length of time from assessment to the first psychiatry appointment offered Each FSP program site will receive referrals from multiple community entities for psychiatry appointments. The goal of the programs is to act promptly for each referral. The goal wait time from referral to first scheduled psychiatry appointment is within fifteen (15) business days. i. Objective: To provide timely service for individuals requesting psychiatric care and medications. ii. Indicator: Percentage of individuals offered their first psychiatry appointment within fifteen (15) business days of their assessment appointment. iii. Eligible Individuals: Individuals assessed and enrolled into program services. iv. Time of Measure: one fiscal year V. Data Source: EHR vi. Target Goal Expectancy: 70% of individuals will be offered their first psychiatry appointment within fifteen (15) business days of their assessment date. vii. Outcome: To be measured annually. 4. Satisfaction & Feedback of Persons Served & Stakeholders- Consumer Perception Survey EXHIBIT B1 — Scope of Work Page 23 of 23 Consumer Perception Surveys (CPS) are conducted every six (6) months. FSP individuals and their family members will be encouraged to complete the CPS surveys made available to them at County and contracted provider organizations. i. Objective: To gauge satisfaction of individuals and collect data for service planning and quality improvement. ii. Indicator: Average percent of individuals who complete the survey and response was 'Agree' or'Strongly Agree' for the following domains: General Satisfaction, Perception of Access, Perception of Quality and Appropriateness, Perception of Treatment Participation, Perception of Outcomes of Services, Perception of Functioning, and Perception of Social Connectedness. iii. Eligible Individuals: Individuals who agree to complete the survey. iv. Time of Measure: The survey will be conducted in May of each year. V. Data Source: Consumer Perception Survey data vi. Target Goal Expectancy: The program would like to see a majority of individuals satisfied for each domain. vii. Outcome: To be measured annually. EXHIBIT B2 — Scope of Work Page 1 of 13 Assisted Outpatient Treatment (AOT) Scope of Work CONTRACTOR: Turning Point of Central California, Inc. CONTACT: Ryan Banks, CEO Elect ryanbanks(a)_tpocc.org Elizabeth Escoto, Regional Director eescoto _tpocc.org SITE ADDRESS: Program Site#4: Vista AOT Program 258 N. Blackstone Avenue, Fresno, CA 93701 SERVICES: Assisted Outpatient Treatment Services CONTRACT TERM: July 1, 2023 —June 30, 2024 July 1, 2024 —June 30, 2025, possible twelve-month extension PROGRAM DESCRIPTION On September 28, 2002, Assembly Bill (AB) 1421 established the Assisted Outpatient Treatment (AOT) Demonstration Project Act of 2002, known as Laura's Law, which provides court-ordered community treatment for individuals with a history of violence or repeated hospitalizations. AOT permits California Counties to utilize courts, probation, and mental health systems to address the needs of individuals unable to participate in community mental health treatment programs without supervision. On September 25, 2020, AB 1976 was chaptered into law amending the current legislation associated with AOT to require all California Counties to begin AOT implementation effective July 1, 2021. On September 30, 2021, Senate Bill (SB) 507 amended the current legislation to expand criteria for individuals who are qualified to be petitioned to receive court ordered AOT services. This law also repealed the sunset date of Laura's Law extending it indefinitely. The California Department of Health Care Services (DHCS) required all counties to begin implementation of AOT services to begin July 1, 2021, with actual services to begin July 1, 2022. Fresno County Department of Behavioral Health (DBH) began the implementation process for AOT services during FY 2021-22, as required by the State. DBH made the determination that AOT services shall be provided at the Full Service Partnership (FSP) level. DBH's intention is to be able to serve individuals who historically have refused voluntary treatment services and whose safety in the community continues to deteriorate as a result of their mental illness. The primary goal of AOT is to encourage the development of an ongoing positive relationship between the treatment team and the participant so that, in time, the person served engages in voluntary treatment. CONTRACTOR shall provide the following services, further described herein: EXHIBIT B2 — Scope of Work Page 2 of 13 • Training and education regarding AOT Services to all of the stakeholders in the community • Assertive outreach and engagement • AOT petition processing o Including investigations • Court processes • Care coordination meetings • FSP treatment services • AOT program objectives and deliverables • Data collection and tracking for DHCS annual reporting requirements AOT involves a process of determining whether an individual meets specific criteria [Welfare & Institutions Code (W&IC) 53461 for court ordered outpatient treatment and monitoring specifically for those with severe and persistent mental illness. AOT is a tool which utilizes a community-based service delivery model designed for individuals most at risk for the negative consequences of untreated mental illness. AOT is a civil (not criminal) legal procedure. The goal is to help participants engage in treatment, not to punish them when they do not. The first step of the AOT process shall begin with an Assertive Outreach and Engagement (AOE) level of service to help engage individuals. Immediately upon receipt of the referral, the provider will work to support the individual served in accepting voluntary services. If voluntary services continue to be refused, the individual may be approved for an AOT petition for treatment. CONTRACTOR shall be responsible to file the AOT petition with Superior Court. They will also be responsible to walk the individual who is the subject of the petition through the court process and attend all court hearings with them. If AOT is implemented by the judge, the CONTRACTOR will begin to provide FSP treatment services. The CONTRACTOR will be responsible for all treatment components related to the individual's care and will assist with oversight in the court process for hearings and evaluations. TARGET POPULATION: The target population for AOT services includes any adult (18 years and older) within Fresno County who has been historically unwilling to engage in treatment services voluntarily. The individual must also meet all nine (9) of the criteria (W&IC 5346) required before an AOT petition can be considered. The typical characteristics of the target population include the following: • Having an untreated severe and persistent mental Illness that severely affects the individual's ability to function in the community including, but not limited to mental health disorders such as bipolar disorder, schizophrenia, schizoaffective disorder • Among common symptoms: paranoia, delusions, hallucinations, mania, depressive mood • Unable to participate in treatment voluntarily due to severe symptoms and severe lack of awareness of one's own illness (anosognosia) • Frequent emergency contacts • Homeless, or at risk of homelessness • Increased risk of victimization EXHIBIT B2 — Scope of Work Page 3 of 13 • Decompensating (grave disability) • Possible extensive history of psychiatric hospitalizations • Likelihood of co-occurring substance use disorder • Recent or past history of criminal justice involvement due to symptoms and substance use disorder • Unmet 5150 threshold, despite significant distress • LPS conserved individuals may be considered, as appropriate, as part of transitional plan to a lower level of restrictive treatment and support LOCATION OF SERVICES Services shall be provided wherever the individual is at (e.g., home, community-based location, or court). Telehealth, mobile services, and co-location in natural supports and gathering places for the intended population are additional options to increase the frequency of individuals obtaining needed services. HOURS OF OPERATION The hours of operation for the AOT services will coincide with the FSP contract's existing office hours. The proposed hours of operation must ensure availability to individuals and families, as needed. A minimum of eight (8) hours, five (5) days per week is required. Should individuals/family members require services during non-traditional office hours, CONTRACTOR will work to accommodate them in the most appropriate manner. CONTRACTOR shall provide details of business hours made available outside of traditional business hours. The hours of operation for the AOE services shall be made available at all times of the day. The intention for AOE services is to engage those typically unwilling to be engaged; therefore, the providers need to be available any time of the day, whenever the individual may be ready to engage. This falls in line with FSP programs' regulatory requirement for 24 hours/day and 7 days/week (24/7) access to services. CONTRACTOR must provide a plan to detail 24/7 coverage and support, as appropriate for the individuals served. CONTRACTOR shall provide clinic hours for the highest need for this target population. On-call hours staffed with program staff shall be proposed; hotlines will not suffice. For after-hours needs, services will be continuously available to individuals with the first point of access being a phone call to the program. Exempt staff will rotate through an on-call schedule on a regular basis so that the persons served are able to reach program staff directly, 24 hours per day, 7 days per week. Phone-calls to the program after-hours will connect with these exempt staff who will determine the type of service required by the person served or family member and ensure that those services are provided with minimal wait time. Because cases are discussed in the context of High-Risk Resource Team meetings, and because persons served enjoy the welcoming environment of the clinic setting and choose to engage in social activities there, the individuals are known to all case managers, nursing staff, clinicians and supervisors. On-call shifts after hours are staffed with these same people, therefore the persons served will be able to reach someone who knows them, any time of day. SERVICES START DATE: EXHIBIT B2 — Scope of Work Page 4 of 13 The AOT services, as identified herein, shall begin October 1, 2022. The CONTRACTOR's ramp-up period will be from May 1, 2022 to September 30, 2022 during which CONTRACTOR will be reimbursed for ramp-up expenditures such as recruiting and hiring additional staff, procuring office space and equipment, establishing any additional business/clinical operations required of the new service lines, developing the AOT-specific training and education, as well as beginning to meet with all necessary stakeholders. DBH requires that CONTRACTOR begin attending meetings with stakeholders immediately. Implementation for training and education (as further defined herein) regarding AOT services to the community stakeholders shall begin May 1, 2022. Trainings and/or flyers shall be made available to the stakeholders prior to the official start of services on October 1, 2022. DESCRIPTION OF SERVICES CONTRACTOR shall provide the following services as described herein in an individual centered, recovery oriented, trauma informed manner. Individuals shall be served with cultural humility and shall support the individual systematically (family support, physical health, housing, vocational services, etc.). TRAINING AND EDUCATION PLAN According to DHCS requirements and W&I Code 5349.1(a), all counties implementing AOT must have a training and education development plan established prior to implementation of AOT services. CONTRACTOR will be required to develop a training and education plan as one of the first services performed in preparation for providing AOT services. The training and education plan shall be developed in collaboration with DHCS, persons served and family advocacy agencies, County Counsel, and other stakeholders regarding appropriateness of the training/curriculum. The plan shall highlight the potential partners in AOT services, type of trainings needed for AOT, potential resources, and means to inform stakeholders and making information on AOT services available. The training and education plan must describe how training will be provided to mental health treatment providers and to other stakeholders in the community, including, but not limited to, law enforcement officials and certification hearing officers involved in making treatment and involuntary commitment decisions. The training will inform not just the program design, but process, eligibility, legal considerations, as well as public and system education, and service evaluation. The plan shall inform stakeholders what AOT is and is not, the eligibility criteria for AOT in Fresno County, the referral process in Fresno County, and alternative resources (info on substance use treatment services, housing services, crisis, and other supports). General public information will be available as collateral materials (such as brochures, flyers, and other specific materials in the COUNTY's threshold languages). DHCS requires that the training must include the following: • Information relative to legal requirements for detaining a person for involuntary inpatient and outpatient treatment, including criteria to be considered with respect to determining if a person is considered to be gravely disabled. EXHIBIT B2 — Scope of Work Page 5 of 13 • Methods for ensuring that decisions regarding involuntary treatment as provided in AOT, directs individuals toward the most effective treatment. Training shall include an emphasis on each individual's rights to provide informed consent for assistance. Community Stakeholders CONTRACTOR shall work with an array of community partners including, but not limited to the following: Legal and Justice Partners • County Counsel • District Attorney's Office • Superior Court • Office of the Public Defender • Central California Legal Services • Fresno and Metro CIT teams • Sheriffs (Corrections) • Probation Community Partners • NAMI-Fresno • Patients' Rights Advocate • Family Advocacy • FSP Providers • Crisis Providers • Board of Supervisors Public Partners • Family Members • Peers and Peer Support • Persons Served • Behavioral Health Board ASSERTIVE OUTREACH AND ENGAGEMENT CONTRACTOR shall provide Assertive Outreach and Engagement (AOE) to all individuals for whom a referral for AOT has been received. The goal is to motivate the individuals to engage into voluntary services before any legal proceedings need to be implemented. DBH's definition of Assertive Outreach and Engagement is the following: "Outreach attempts that are persistent, thorough, and are sensitive to readiness and present stage of change and acknowledges that individuals might not be ready to engage with the system of care. Attempts are specific and tailored to the individual and may include attempts to visit the individual's residence, or other places the individual is known to frequent such as places of work, leisure, or worship. Outreach may include consulting with wellness centers, crisis centers/programs, local inpatient units, previous providers, homeless shelters, and other agencies to determine if the individual has been seen at those locations or in the community. All efforts and types of attempts are specific to the individual, are clinically based (not protocol-based), are person centered EXHIBIT B2 — Scope of Work Page 6 of 13 and are clearly documented in the chart. The individuals should be encouraged to accept services and supports that they perceive as beneficial and will be the driving force in planning in their recovery process respecting the stages of change." AOE services shall be initiated immediately upon receiving a referral from DBH that has been triaged and vetted to be an appropriate referral for possible AOT services. Every effort at fostering engagement should occur prior to the initiation of the AOT petition process. Parties acknowledge that CONTRACTOR has up to thirty (30) days to provide AOE services prior to initiating the AOT Petition Processing steps. On a case-by-case basis, CONTRACTOR may opt to provide an additional thirty (30) days of AOE services if in their clinical judgment the person served may be considering the possibility for voluntary services. CONTRACTOR may opt up to provide two (2) additional thirty (30) days extensions of AOE services, for a total of no more than ninety (90) days of AOE services. Engagement is the foundation of continued program involvement and continued program involvement is a key aspect to success. This service will be provided directly by different members of the CONTRACTOR's treatment team, through direct contact with the person served. Services will be delivered in a culturally and linguistically appropriate manner. The services will be provided through direct face-to-face contact with the individual and their family/support person when appropriate. Due to the importance of engagement, it is a prominent part of all levels of service. The importance of engagement is increasingly vital before an individual has accepted services and during the initial stages of service. Individuals who may be referred for AOT services will likely be ambivalent to accept services or to be involved with the program, so it is the task of the program to work to engage these individuals. This may be accomplished by, and not limited to, allowing the referred individual the opportunity to visit the program, to meet with various members of the team, learn about the services, understand the program benefits, and to move at their own pace while being provided culturally appropriate outreach as needed. The AOT program is voluntary and as such it becomes the task of the program to engage the individual as well as to assist the individual in discovering the value of participating in services. CONTRACTOR shall follow the "whatever it takes" model in engaging persons served. This may often require multiple contacts with an individual at a variety of community settings to create a level of trust with the individual. The goal of engagement is to assist the individual in exploring the benefits of participating in the program. Some may be initially hesitant to accept services, but after a period of attempted engagement an individual may agree to partial services. An individual's agreement to partial services is acceptable and additional services will continue to be offered. This agreement to partial services is viewed as an opportunity to continue to engage the individual. CONTRACTOR understands that some are hesitant, due to a number of factors, to readily embrace the program and often require additional engagement time and/or attempts before fully accepting all offers of support. The choice of service acceptance is always the individual's prerogative, and the responsibility of the program is to assist them in understanding the values of the variety of services. CONTRACTOR shall meet the individual where they are with a culturally sensitive approach and with full understanding that an individual's willingness to participate in a program can change. AOT PETITION PROCESSING EXHIBIT B2 — Scope of Work Page 7 of 13 The AOT petition process is initiated when it is determined that the individual subject to the referral received by a qualified requestor continues to refuse engagement and it is the determination of CONTRACTOR that no further AOE services will likely result in the individual engaging voluntarily. An AOT referral can be requested by concerned family members, caregivers, or other qualified referral sources for people who may be too ill to recognize the need for services. Requestors of an AOT Petition Per W&I Code 5346(b)(2), only the following are considered a "qualified party" to be able to submit a referral for possible AOT petition: • A person 18 years of age or older • A person who is the parent, spouse, or sibling or child 18 years of age or older • The director of a public or private agency, treatment facility, charitable organization, or licensed residential care facility providing mental health services • The director of a hospital where the person is hospitalized. • A licensed mental health treatment provider • A peace officer, parole officer, or probation officer • A judge of a superior court before whom the person who is the subject of the petition appears. With the passage of SB 317, community-based programs working with incarcerated individuals who are deemed Misdemeanor Incompetent to Stand Trial (MIST) are considered an appropriate referral source for an AOT petition. Courts reviewing MIST individual cases can also make referrals to AOT if the court has determined that they are ineligible for mental health diversion. Investigation While AOE services are provided, CONTRACTOR will simultaneously conduct an investigation to determine if the individual in question meets the criteria for an AOT petition. If the individual meets criteria, the CONTRACTOR will generate the AOT petition, which must be signed by the DBH Director (or designee) and then be submitted to the court. It should be noted the DBH Director (or designee) can only file an AOT petition if there is a reasonable likelihood that the elements can be proven by clear and convincing evidence. Once evidence is confirmed, the provider will notify the DBH Director (or designee) that a petition can be filed. Petition The petition will be signed and submitted by the DBH Director (or designee) to the Fresno County Superior Court shall be accompanied by an affidavit of a licensed mental health treatment provider designated by the local mental health director who shall state, if applicable, either of the following: 1. That the licensed mental health treatment provider has personally examined the person who is the subject of the petition no more than ten (10) days prior to the submission of the petition, the facts and reasons why the person who is the subject of the petition meets the criteria in subdivision (a), that the licensed mental health treatment provider recommends assisted outpatient treatment for the person who is the subject of the petition, and that the licensed mental health treatment provider is willing and able to testify at the hearing on the petition. EXHIBIT B2 — Scope of Work Page 8 of 13 2. That no more than ten (10) days prior to the filing of the petition, the licensed mental health treatment provider, or designee, has made appropriate attempts to elicit the cooperation of the person who is the subject of the petition, but has not been successful in persuading that person to submit to an examination, that the licensed mental health treatment provider has reason to believe that the person who is the subject of the petition meets the criteria for assisted outpatient treatment, and that the licensed mental health treatment provider is willing and able to examine the person who is the subject of the petition and testify at the hearing on the petition. The individual who is the subject of the petition shall have the right to be represented by counsel at all stages of an AOT proceeding commenced. If the person so elects, the court shall immediately appoint the public defender or other attorney to assist the person in all stages of the proceedings. The individual shall pay the cost of the legal services, if able. Petition is Reviewed The court will review the submitted AOT petition to determine if there is sufficient evidence to proceed to a hearing. If necessary, the Court may order that the respondent (person described in the petition) be evaluated. COURT PROCESSES There are three (3) stages to the court processes for AOT. CONTRACTOR will be responsible to walk the individual through each stage. Pre-Hearing If the AOT petition is deemed valid and the Court decides to proceed with the case, the Court will set a date for the hearing. If petition is not contested, the hearing will be set within five (5) court days of receiving the petition. Court Hearing and Due Process Requirements The individual subject to the AOT petition is entitled to full due process protections. It is the responsibility of the petitioner to convince the judge (or person representing the court) that the respondent meets the AOT commitment criteria. In other words, the "the burden of proof' is on the petitioner. Experts, including psychiatrists and/or other licensed mental health professionals, shall provide testimony in support or opposition to the petition. If the evidence is "clear and convincing," the judge may order the person to receive involuntary treatment for a period of time called "commitment" of which FSP treatment services will be provided to the individual. Court Settlement Process: If an individual elects to voluntarily engage in services after an AOT petition is officially filed, a Settlement Agreement will need to be written. It is still considered a legal court order, but identifies the individual is willingly agreeing to services. Court reports are still required every 60 days as long as the Settlement Agreement is valid. Court Progress Reports The CONTRACTOR's treatment team will present regular progress reports or status summaries, to the court at a timeline to be determined by the judge, but no less than every sixty (60) days. Prior to the expiration of the period of court ordered AOT services (commitment), the EXHIBIT B2 — Scope of Work Page 9 of 13 treatment team will decide whether to ask the court to extend the period of court-ordered services. The court must find clear and convincing evidence that the person meets criteria before it can order the person to continue receiving court ordered AOT services. The length of time a person is required to participate in AOT services will vary from person to person. CONTRACTOR's FSP treatment team may recommend dismissal of the individual's case at any time prior to the expiration of the court order if it is determined that the person will voluntarily consent to treatment. The FSP treatment team may let the commitment period expire without requesting a continuation or they can also request a period of an additional 180 days. DISCHARGE PLANNING Once an individual has successfully completed their court ordered AOT services, CONTRACTOR will work with the individual to assist them with either continuing FSP services with CONTRACTOR or connecting via warm handoff to other outpatient services, as their identified level of care requires. FSP TREATMENT SERVICES If AOT services are court-ordered, the individual will be assigned to CONTRACTOR's Vista FSP Program, described herein in Exhibit B-1. Beginning August 15, 2022, CONTRACTOR will be assigned a maximum capacity of twenty (20) slots for AOT-court ordered specific individuals. FSP Services: CONTRACTOR shall provide comprehensive mental health services, including housing and community supports, to their AOT-specific individuals. The FSP treatment services will encompass a unified team approach, in which the provider shall commit to do "whatever-it- takes" and "meet the individual where they are" to assist them to reach their personal recovery, resiliency and wellness goals and aim to reduce the number of days of hospitalization, incarceration and/or homelessness. The individual will be encouraged to actively participate in the establishment of goals and objectives, with specific criteria for evaluating progress toward meeting those goals and objection. All FSP services shall follow all terms and conditions provided for within this Agreement. Staffing: The staffing pattern for the provision of AOT services shall meet all State licensing and regulatory requirements for an FSP provider. All licensed or certified staff must be licensed or certified within the State of California. Staff should be reflective of and responsive to the needs of the target population and shall be comprised of a community-based, multidisciplinary, highly trained mental health team. Staffing for AOT-court ordered specific individuals must be provided treatment by a staff-to- individual ratio must be no more than ten (10) individuals served per team member (W&IC 5348). CONTRACTOR must staff a licensed mental health professional assigned to the caseload who will be responsible for all of the court appearances on behalf of the AOT- petitioned individuals. Medications EXHIBIT B2 — Scope of Work Page 10 of 13 Most individuals who will be engaged in AOT services will require medications while receiving FSP treatment services; however, the provider cannot force medications on any individual receiving court ordered AOT services. AOT PROGRAM OBJECTIVES AND DELIVERABLES CONTRACTOR shall meet the following objectives and deliverables as defined in W&IC 5348: A. Provision for services to meet the needs of persons who are physically disabled. B. Provision for services to meet the special needs of older adults. C. Provision for family support and consultation services, parenting support and consultation services, and peer support or self-help group support, if appropriate. D. Provision for services to be individual-directed and that employ psychosocial rehabilitation and recovery principles. E. Provision for psychiatric and psychological services that are integrated with other services and for psychiatric and psychological collaboration in overall service planning. F. Provision for services specifically directed to young adults with serious mental illness (18 to 25 years of age) who are homeless or at significant risk of becoming homeless. These provisions may include continuation of services that still would be received through other funds had eligibility not been terminated as a result of age. G. Services reflecting special needs of women from diverse cultural backgrounds, including supportive housing that accepts children, personal services coordinator therapeutic treatment, and substance treatment programs that address gender-specific trauma and abuse in the lives of persons with mental illness, and vocational rehabilitation programs that offer job training programs free of gender bias and sensitive to the needs of women. H. Provision for housing for individuals that is immediate, transitional, permanent, or all of these. I. Provision for individuals who have been suffering from an untreated severe mental illness for less than one year, and who do not require the full range of services, but who are at risk of becoming homeless unless a comprehensive individual and family support services plan is implemented. These individuals shall be served in a manner that is designed to meet their needs. J. Each individual shall have a clearly designated mental health personal services coordinator who may be part of a multidisciplinary treatment team that is responsible for providing or ensuring needed services. Responsibilities include complete assessment of the individual's needs, development of the personal services plan, linkage with all appropriate community services, monitoring of the quality and follow through of services, and necessary advocacy to ensure each individual receives those services that are agreed to in the personal services plan. Each individual shall participate in the development of their personal services plan, and responsible staff shall consult with the designated conservator, if one has been appointed, and, with the consent of the individual, shall consult with the family and other significant persons as appropriate. K. The individual personal services plan shall ensure that persons subject to assisted outpatient treatment programs receive age-appropriate, gender-appropriate, and EXHIBIT B2 — Scope of Work Page 11 of 13 culturally appropriate services, to the extent feasible, that are designed to enable recipients to: a. Live in the most independent, least restrictive housing feasible in the local community, and, for those with children, to live in a supportive housing environment that strives for reunification with their children or assists persons served in maintaining custody of their children, as is appropriate. b. Engage in the highest level of work or productive activity appropriate to their abilities and experience. c. Create and maintain a support system consisting of friends, family, and participation in community activities. d. Access an appropriate level of academic education or vocational training. e. Obtain an adequate income. f. Self-manage their illnesses and exert as much control as possible over both the day-to-day and long-term decisions that affect their lives. g. Access necessary physical health care and maintain the best possible physical health. h. Reduce or eliminate serious antisocial or criminal behavior, and thereby reduce or eliminate their contact with the criminal justice system. i. Reduce or eliminate the distress caused by the symptoms of mental illness. j. Have freedom from dangerous addictive substances. ADMINISTRATIVE REQUIREMENTS 1. CONTRACTOR shall meet with COUNTY staff monthly, or as often as needed, for monitoring of program services, capacity trends, staffing levels and to exchange pertinent operational information, resolve problems, and coordinate services. 2. CONTRACTOR shall participate in a joint meeting with COUNTY staff and other providers of FSP services on a quarterly basis, or as often as needed, to discuss program trends and resolution of concerns and problems across all providers. 3. CONTRACTOR shall attend bi-monthly Mental Health Contracted Provider Meetings held by DBH. 4. CONTRACTOR will complete and submit monthly activity reports in a manner determined by DBH. 5. CONTRACTOR will complete and submit annual outcome reports, as determined by DBH and as indicated by this Agreement. PERFORMANCE OUTCOMES AND MEASURES EXHIBIT B2 — Scope of Work Page 12 of 13 CONTRACTOR is required to submit measurable outcomes on a semi-annual basis, as identified in the DBH's Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes Measures. Performance outcome measures must be approved by DBH and satisfy all State and local mandates. DBH will provide technical assistance and support in defining measurable outcomes. All performance indicators will reflect the following four (4) domains: Effectiveness - A performance dimension that assesses the degree to which an intervention or series have achieved the desired outcome/result/quality of care through measuring change over time. The results achieved and outcomes observed are for persons served. Efficiency - Relationship between results and resources used, such as time, money, and staff. The demonstration of the relationship between results and the resources used to achieve them. A performance dimension addressing the relationship between the outputs/results of the resources used to deliver the service. Access - Organizations' capacity to provide services to those who desire or need services. Barriers or lack thereof for persons obtaining services. The ability of individuals to receive the right service at the right time. A performance dimension addressing the degree to which a person needing services is able to access those services. Satisfaction - Satisfaction measures are usually oriented towards individuals, family, staff, and stakeholders. The degree to which the individuals, the COUNTY, and other stakeholders are satisfied with services. A performance dimension that describes reports or ratings from persons served about services received from an organization. DBH may adjust the performance and outcome measures periodically throughout the duration of this Agreement, as needed, to best measure the program as determined by COUNTY. CONTRACTOR must utilize a computerized tracking system with which performance and outcome measures and other relevant data, such as demographics, will be maintained. DATA COLLECTION &TRACKING FOR DHCS ANNUAL REPORTING Data Collection & Tracking It is required by DHCS that all counties providing AOT services provide specific data requirements to be collected and tracked. CONTRACTOR shall track data outcomes for the following required elements, based on information that is available: • Number of persons served by the program, and of those, the number who are able to maintain housing and the number who maintain contact with the treatment system • Contacts with local law enforcement, and the extent to which local and state • incarceration of persons in the program has been reduced or avoided • Number of persons in the program participating in employment services programs, including competitive employment • Days of hospitalization of persons in the program that have been reduced or avoided • Adherence to prescribed treatment by persons in the program • Other indicators of successful engagement, if any, by persons in the program EXHIBIT B2 — Scope of Work Page 13 of 13 • Victimization of persons in the program • Violent behavior of persons in the program • Substance use by persons in the program • Type, intensity, and frequency of treatment of persons in the program • Extent to which enforcement mechanisms are used by the program, when applicable • Social functioning of persons in the program • Skills in independent living of persons in the program • Satisfaction with program services both by those receiving them, and by their families, when relevant DHCS Annual Reporting: AOT Survey Tool CONTRACTOR shall assist DBH with the DHCS required annual submittal of an "AOT Survey Tool" containing requested data tracked and outcomes reported in a comprehensive evaluation report. The annual report is due to DHCS by October 1 of each year. EXHIBIT B3 — Scope of Work Page 1 of 11 Full-Service Partnership (FSP) Program Scope of Work CONTRACTOR: Mental Health Systems, Inc., dba TURN Behavioral Health Services CONTACT: James C. Callaghan, President & CEO icallaghan(a)turnbhs.org SITE ADDRESS: Program Site#3: DART West FSP 2550 West Clinton Avenue, Bldg. W Fresno, CA 93705 CONTRACT TERM: July 1, 2023 —June 30, 2024 July 1, 2024 —June 30, 2025, possible twelve-month extension PROJECT DESCRIPTION CONTRACTOR's Daring to Achieve Recovery Together (DART) West program site will be recovery oriented, co-occurring disorder capable FSP programs consisting of three (3) levels of care: FSP, Heightened FSP, and Intensive FSP so that individuals have the support they require to remain engaged in services with the flexibility of moving from one level to another seamlessly. The program will provide comprehensive, dual diagnosis services staffed by teams which will be composed of qualified, culturally diverse professionals who mirror the cultures of the individuals to be served and who bring a variety of education, experience levels, lived experience, and expertise in the field of mental illness, substance use disorder recovery, supportive services and housing to the program. The program design will provide community-based and culturally competent outpatient mental health treatment and substance use disorder treatment which increases the likelihood of individuals becoming productive members of society. DART West will provide the full spectrum of FSP services 24 hours per day, seven days per week (24/7). With recovery as the primary goal, services will include a strong focus on skills building. DART West staff will meet individuals "where they are" and do "whatever it takes" to move the individuals served through the stages of change to empower each individual to achieve their goals. The program's philosophy and values include the belief that every person has the potential for growth, regardless of disability; each Individual Services and Support Plan (ISSP) will be strength- based focusing on individual and family strengths with the firm belief that all persons served can achieve recovery goals, gain increased independence, self-sufficiency and achieve community integration with the necessary individualized supports. The DART West FSP Program will incorporate a comprehensive array of evidence-based practices and models including the Housing First model, combined with a harm reduction model that ensures individuals face the fewest barriers to service as possible. The program will provide a wide variety of housing services to support the mantra: "it's not if the person served is ready for housing but is the housing ready for our individual" to ensure the ability to wrap the appropriate amount of care around each individual thus allowing them to successfully live in housing of their choice. EXHIBIT B3 — Scope of Work Page 2 of 11 The DART West FSP Program will ensure that all services are: • Recovery oriented; • Individual-centered and built upon collaborations between each team, individual and family that emphasize individual ownership of the recovery process; • Designed to incorporate strengths-based solutions to improve the individual's quality of life utilizing a broad array of integrated services; • Linking individuals to supportive services in the community; • Inclusive of the participation of family members and community support systems; • Supportive of peer recovery networks; and • Focused on reducing hospitalizations, incarcerations, homelessness and crisis episodes. LOCATION OF SERVICES To increase the frequency of individuals obtaining needed services within the community, CONTRACTOR will: 1) Utilize program vehicles to travel to outreach locations in order to provide services to individuals wherever they are residing or most comfortable; 2) Provide transportation to services, if needed; 3) Provide bus passes or access to Uber Health for those without their own transportation; 4) Provide care packages to meet immediate needs of individuals and to help with their engagement in services; 5) Each FSP team will provide services in a specific geographic area, with outreach taking place throughout Fresno in areas where individuals who may be in need of services are known to congregate; 6) Provide services in the field, including medical/psychiatric, at least 80% of the time; 7) Collaborate with other community agencies in order to connect and engage with potential individuals; 8) Include peers with lived experience or the experience of having lived with an individual who has struggled with homelessness, mental health, and/or substance use; 9) Include team members who reflect the demographics of the population; 10) Establish rapport by building relationships—the key to a successful program that effectively links individuals to needed services and to address common barriers. EXHIBIT B3 — Scope of Work Page 3 of 11 DESCRIPTION OF SERVICES Outreach and Engagement: CONTRACTOR will have Peer Support Specialists on each of the Treatment Teams. All staff will be trained in and will use Motivational Interviewing (MI) to meet individuals where they are, establish rapport, and help individuals establish baseline goals for improving their circumstances. All services will be voluntary and individualized based on each individual's unique needs, challenges and level of functioning; "individual voice and choice" will always be respected. Outreach and engagement activities will respect the individual as the expert in their own life and will focus on strengths rather than deficits throughout the process of initial contact, engagement, and linkage with other providers. The Treatment Teams will work with individuals to establish what they want and will point them in the direction to achieve their objectives while honoring their preferences, including how often they wish to be contacted. In addition, CONTRACTOR will provide education on the choices or services available in the community which will help the individual and family to attain their goals. Crisis Intervention: FSP teams will be trained in crisis de-escalation and will incorporate crisis planning into each individual's ISSP. In order to best support FSP individuals when they are in crisis, CONTRACTOR will build upon and keep a strong network of resources available. The Program Manager (PM) for the DART West site will meet with entities such as the Kingsview Crisis Intervention Team (CIT), and the WestCare Supportive Overnight Stay Program, hospitals and emergency departments, crisis responders, faith-based and culturally-affiliated organizations serving specific religious or ethnic populations, as well as the LGBTQ+ community so that CONTRACTOR is able to coordinate warm handoffs when our individuals are in crisis. In addition, CONTRACTOR will operate a 24/7 crisis line to ensure that our individuals may always reach an understanding team member in times of duress. Needs Assessment: All individuals enrolled in CONTRACTOR's DART West FSP program will undergo continuous assessment of needs and strengths through the use of formal assessment tools, self- report and staff and family/support observations. The Personal Services Coordinator (PSC) conducts the initial intake and assessment at a location convenient to the individual in order to meet them where they are in terms of both geography and in terms of defining what they perceive as their most pressing issues. Coordination of Services: One of the primary tasks of the PSC is to coordinate services in order to optimize the overall health of FSP individuals. CONTRACTOR values such coordination of care, as well as the linkage of individuals to medical homes, per their service plans. Through strong relationships with physical healthcare providers CONTRACTOR assures quality coordinated care, integrated treatment, and bidirectional communication and referrals. Communication is critical for FSP individuals to receive the most comprehensive care possible. CONTRACTOR's FSP Program will request mandatory person served/guardian authorization to exchange information with primary care providers (PCPs) prior to releasing any information; then upon authorization, the program will communicate with primary care providers as required. Contact, at minimum, is made annually with each PCP per the individual's needs and contact is documented. Many times, due to the individual's changing needs, hospitalizations, lab results, or high-risk situations, contact is made EXHIBIT B3 — Scope of Work Page 4 of 11 more frequently in the best interest of the individual. CONTRACTOR uses a Care Coordination form to track referrals to PCPs and the form is kept in the individual's chart. All contacts are documented, and ongoing evidence of collaboration is maintained in our clinical charts. Collateral and Family/Peer Support and Education Services: CONTRACTOR's FSP Treatment Teams will work to integrate family and peers supports into each individual's recovery to help support ongoing efforts and to assist with reintegration to the community. Collateral support begins with the assessment process when the PSC works to elicit information from the individual's natural supports. Throughout the individual's participation in the FSP program, Treatment Team members engage and teach family through psychoeducational groups, individual meetings, and by promoting the message of recovery and hope in all interactions utilizing language that represents their shared experiences rather than labels, diagnoses, and clinical terminology. This message of hope includes the vision that recovery is a process with no limitations, including going to school, volunteering, and employment. Through honest and open communication and sharing, team members assist individuals and family members in understanding that no matter how challenging the situation, "There is always hope." The presence of peers on each FSP team helps to reinforce this message, as well as to give individuals and family a relatable individual who can truly understand their journey. Individual and Group Therapeutic Services: CONTRACTOR's DART West FSP program will offer each individual treatment that is specific to their needs and goals. Individuals may engage in individual therapy sessions with a licensed or license-eligible clinician. CONTRACTOR will typically use Cognitive Behavioral Therapy (CBT) as a baseline treatment modality; however, CONTRACTOR's clinicians will use the most appropriate modalities based on the needs of the individual such as CBT for Psychosis (CBTp), Trauma-Focused CBT (TF-CBT), and Dialectical Behavior Therapy (DBT) as well as reinforcing skills learned in groups such as Cognitive Behavioral Social Skills group, DBT group, Seeking Safety, etc. A variety of group therapy options are offered at each program to include those focusing on specific therapeutic modalities, trauma, co-occurring disorders, wellness, life skills, etc. The FSP Program will have its own unique group schedule based on the individual population's needs and goals. Treatment and Support for Co-Occurring Disorders: All CONTRACTOR team members will be trained in co-occurring disorders including providing a welcoming environment for those with co-occurring disorders so that all individuals can feel comfortable discussing their substance use with staff. All staff will also be trained to provide co-occurring disorders services and will be able to provide both individual and group services to those individuals with co-occurring disorders. Including a Dual Recovery Case Manager and Peer Support Specialist is an additional strategy to ensure that individuals are comfortable with disclosing their substance use and feel that staff are empathetic with their experiences both with the positive and negative effects of substance use. While the goal of services will be to help individuals achieve an alcohol and drug free lifestyle if that is their choice, the program will also use harm reduction strategies as individuals move through the stages of change from denial, unless abstinence is mandated by the Court. Rehabilitation/Activities of Daily Living: CONTRACTOR's program rehabilitation services will support individuals in the improvement, maintenance, or restoration of functional skills, daily living skills, social and leisure EXHIBIT B3 — Scope of Work Page 5 of 11 skills, grooming and personal hygiene skills, obtaining support resources, and medication education. Services to family members will provide support for those individuals and address the goals of the ISSP and their role and needed skills or skill development in supporting their family member. Many skills will be taught by CONTRACTOR team members as they work with individuals directly "in vivo," in community-based workshops or groups. Rehabilitation services may take place individually or in groups, and in the home or other community location. Whether in individual meetings or small groups, team members will work with the individual to develop and use appropriate skills such as personal hygiene, house cleaning and household chores including housekeeping and laundry, using community and public transportation, shopping for and preparing/cooking healthy meals, money management skills, and care of physical health. Medication Support Services: CONTRACTOR has a great deal of experience providing comprehensive medication management and support services and working with Patient Assistance Programs. FSP program services will include medication evaluation, prescribing, Medication Assisted Treatment (MAT) for co-occurring disorders, medication education, consultation, prescription delivery, monitoring, linkage, and support provided at the program site or in the community based on the individual's wishes. Personal Service Care Coordination: Each person served in the CONTRACTOR's FSP program will have an identified single point of responsibility, the Personal Service Coordinator (PSC) who functions as the Case Manager to ensure that services are provided as appropriate, available in a timely manner and individualized. The PSC does initial outreach, engagement, and intake, ensuring that the individual's basic needs are addressed including food, clothing, and shelter and serves as the individual's main point of contact for service provision throughout their enrollment in the program. Linkage and Consultation: CONTRACTOR works in each community to establish a roadmap of referrals and linkages necessary to assist individuals in meeting their goals across all life domains both during and after program participation. Based on individual and family choice, team members will provide active linkage to community resources (e.g., faith-based, Legal Aid, etc.); other service providers including those providing primary care, mental health services, and substance use disorder services; self-help communities; Wellness Recovery Action Plan (WRAP) groups; ethnic organizations; peer-run programs, including NAMI and Recovery International and Clubhouses; recreational resources; and health and wellness providers. CONTRACTOR's DART West program will provide "active linkage" which typically involves a Peer and Family Advocate or other identified team member going with the individual until the individual feels connected to the resource. Referrals and linkages are made with a "warm handoff' to ensure that the individual and provider have made a genuine connection. Non-Behavioral Health Services and Supports: Transportation, housing, flexible funds, and representative payee services are all addressed in each individual's ISSP, coordinated by their PSC. EXHIBIT B3 — Scope of Work Page 6 of 11 HOURS OF OPERATION CONTRACTOR's FSP program site will be open from 7:00 am to 5:00 pm seven (7) days per week with after-hours services provided as necessary. When individual intervention is required between 5:00 pm and 7:00 am, the on-call team member will notify the Supervisor on Call and the team will respond in person, if necessary. The team members identified as most appropriate to respond will meet at the individual's location to address the crisis and do "whatever it takes" to ensure safety and to stabilize the situation. The Consultant Psychiatrist will also be available to assist, as needed. The team may also respond in the community, if it is determined to be safe, to transport the individual to another housing location such as the master leased unit set aside for respite care and late in the day referrals; for example, if the landlord is threatening to evict the individual that night. Typically, staff will then work with the landlord the next day to resolve the crisis and try to maintain the individual's housing. LEVELS OF CARE CONTRACTOR's FSP Program will utilize a multiple tiered model with three (3) levels of care to ensure maximum flexibility for individuals to move seamlessly between levels, as clinically indicated. Provision of these three (3) different levels of service within the FSP model allows for more individualized treatment and for better engagement and retention. The level system allows for individuals to move along at a pace that makes sense for them and their specific needs, incorporating successes in their recovery journey as they step down from one level to another. It also provides individuals and FSP staff with clear parameters for goal achievement to ensure that individuals are moving along in treatment at an appropriate pace. The tiers/levels of care are: • FSP • Heightened FSP • Intensive FSP Intensive FSP services will be designed to meet FSP fidelity standards, including staffing levels and frequency/intensity of services. Individuals at the Intensive FSP level of care will have at least four (4) contacts per week, with group participation as determined by the ISSP. Each Intensive FSP level individual will receive at least 120 minutes of face-to-face services per week. Since individuals will typically be working on different areas of the ISSP such as symptom management, education, etc., each individual will typically be working with more than one team member in any given week (e.g., the nurse for ongoing medication monitoring, PSC for linkages, etc.) The Treatment Team will meet with individuals in person and/or on the phone as often as necessary to maintain them in the community and to avoid hospitalizations or a higher level of care. The team will work with individuals who are progressing toward the achievement of the goals in their ISSP to decrease the intensity of services. However, the team will consistently maintain contact with individuals and each individual will be discussed at the morning meeting. Therefore, the team will always be able to step in quickly to avoid symptoms worsening and to prevent minor problems from escalating into crises. Heightened FSP will be similar to the Intensive FSP level in terms of intensity of services. Individuals at this level will receive services based on their individual needs with a minimum of three (3) weekly contacts, at least one of which will be face-to-face for a minimum of 90 minutes of face-to-face service per week. The frequency of individual services and individual clinical counseling will thus be less than at the Intensive FSP level of care. Services provided will begin to lay the groundwork for participation in more and varied types of groups to assist in addressing EXHIBIT B3 — Scope of Work Page 7 of 11 individual-identified issues. For example, an individual may participate in individual counseling at the Heightened FSP level using Trauma Focused CBT to build a foundation for participation in Seeking Safety once they have transitioned down to FSP. FSP individuals will have at least three (3) individual contacts per week, one of which will be face-to-face for a minimum of 60 minutes per week. Although services will be less frequent than at the Heightened FSP or Intensive FSP level, intensity and frequency will continue to be individualized to meet each individual's needs, including identifying the services that the individual will participate in at the FSP level, and responding promptly to any individual who has a crisis or event that necessitates immediate response, including increasing services or moving up a level of care until such time as the individual is re-stabilized and moving forward toward the individual's ISSP goal attainment. The primary difference between services provided at the Intensive FSP level of care and those provided at the Heightened FSP and FSP level of care will be the frequency/intensity of services which will be decreasing as the individual moves towards the FSP level. The frequency of individual services and individual clinical counseling will be less intense and there will be more wraparound services as individuals step down through the levels of services. For example, individuals in the FSP level will have demonstrated improved capacity toward identifying strengths and barriers. Intensive FSP criteria: individuals must meet criteria for a Serious Mental Illness (SMI). They must meet medical necessity and have significant impairment (e.g., paranoid and hearing voices, cannot leave the house, etc.) that impair their functioning. The individual must be a consistent utilizer of emergency or crisis services due to assessed impairments in one (1) of five (5) domains: • living arrangement (without permanent safe living situation), • employment (without regular, sustainable income), • daily activities (life is organized around survival needs), • social relationships (estrangement from family/healthy supports), and/or • health (co-occurring untreated, unmanaged medical conditions). Heightened FSP criteria: individuals will have a persistent SMI, who are unstable or in crisis but with less impairment than those at the Intensive FSP level of DART West. They may have limited social skills, serious impairments across all life domains (including physical health problems), and histories of trauma. Many will face imminent risk of hospitalization, incarceration, and homelessness, and/or are frequent utilizers of emergency psychiatric services many of whom have acute and long-term institutionalization backgrounds who are often difficult to engage in services, yet can succeed in the community with sufficient linkage, structure, and support. FSP criteria: Individuals with an SMI who, by moving through the Intensive FSP and Heightened FSP levels of care, are beginning to explore their needs across all life domains who are open to exploring the resolution of barriers to a healthier lifestyle such as permanent, safe and stable housing, education/vocation, daily activities, lack of support system, and less than optimum health. Transitions Among Levels of Care: Individuals in the CONTRACTOR's DART West FSP program will experience seamless transitions from one level of care to another within the program. It is CONTRACTOR's primary goal to ensure that individuals remain engaged and on track with pursuit of the individual's ISSP objectives toward a healthier, more satisfying life. Each individual will be assisted to achieve a level EXHIBIT B3 — Scope of Work Page 8 of 11 of recovery, stability, and independence that will allow them to transition to the least restrictive level of care possible. Some individuals may remain at the highest level of service for an extended period, others may demonstrate improvements in functioning that allow them to work with staff to titrate services down, moving to a lower level of care within the program. Other individuals may be assigned to a lower level of care within the program based on their initial assessment and continued evaluation. All services will be tailored to the individual's needs, wishes, and preferences. CONTRACTOR's DART West program will re-evaluate every 90 days to determine the appropriate level of care for all individuals. In addition, staff will monitor individuals during their regular interactions, at all levels of care, to identify any potential crises or occurrences that may indicate that the individual needs a higher level of care or conversely is ready for a lower level of care as they demonstrate increased competency and higher skills levels in living successfully in the community, managing symptoms, etc. As individuals move through the levels of care, staff will update the Plan of Care to reflect the services needed and the frequency and intensity of services with individuals. However, individuals may not be aware that they are being served in different levels of care; therefore, transitions should not impact the individual's perspective of where they are in their treatment trajectory. Individuals will experience working with staff on different services they need as they increase their competencies and work with staff to titrate down the frequency of services in preparation for stepping down to a lower level of care. Transitions will thus be seamless throughout all levels of care with individuals feeling no disruption or anxiety as they transition. Should individuals need to move to a higher level of service because of an increase in acuity of symptoms or circumstances, they will experience this as an increase in intensity of services and the addition of services as needed, rather than a formal transition. PROGRAM OBJECTIVES AND OUTCOMES CONTRACTOR will utilize its electronic health systems, including the County's EHR, to collect data to track metrics which inform individual outcomes. 1. 80% of individuals will demonstrate improved adult stability and decreased incarceration and psychiatric hospitalization as evidenced by information from Key Event Tracking (KET) and 3Ms; 2. 95% of individuals will demonstrate a positive individual services experience as evidenced by annual individual survey data reflecting scores of satisfied and very satisfied with services received. 4. All participants will have demonstrated decreased criminogenic risks/needs as evidenced by the Level of Service Inventory-Revised (LSI-R). For the Intensive FSP tier within the DART West program, CONTRACTOR will meet outcomes in each of the following domains and has included more than one performance indicator for each of the domains. Effectiveness: 1. Individuals served will experience a reduction in recidivism events (incarcerations, homelessness, crisis or inpatient hospitalization admissions) to no more than six (6) events within the first six (6) months after admission compared to events prior to admission as EXHIBIT B3 — Scope of Work Page 9 of 11 evidenced by reports of the KETs completed for each individual whenever a key event takes place. 2. There will be a reduction of key events for recidivism tracked as: a. A reduction in engagement in three (3) or less key recidivism events (incarcerations, homelessness, crisis or inpatient hospitalization admissions) during 6-12 months in the program compared to events prior to admission, as evidenced by reports of the KETs completed for each individual whenever a key event takes place. b. A reduction in engagement in no more than one (1) key recidivism event (incarcerations, homelessness, crisis or inpatient hospitalization admissions) during 13-18 months in the program compared to events prior to admission, as evidenced by reports of the KETs completed for each individual whenever a key event takes place. 3. The program will demonstrate at least 75% reduction in inpatient psychiatric hospitalizations after being admitted to program services compared to inpatient days utilized the year prior to program admissions, as evidenced by the end of year Data Collection and Reporting (DCR) system report. 4. The program will demonstrate at least 75% reduction in incarceration days after being admitted to program services compared to inpatient days utilized the years prior to program admissions, as evidenced by the end of year DCR report. 5. The program will demonstrate at least 75% reduction in days of homelessness compared to events prior to admission, unless housing assistance is declined, as evidenced by the end of year DCR report. 6. The program will show at least 75% reduction in crisis episodes compared to episodes prior to program admission as evidenced by the end of year DCR report. 7. The program will demonstrate a significant increase in individual functioning, as evidenced by the above outcomes#3-6. CONTRACTOR's DART West Program Manager will ensure that reports are run monthly from the DCR system and will review these reports to ensure that the program is on track to meet overall outcomes. Efficiency: 1. The DART West Program direct services productivity rate is expected by CONTRACTOR to be at a minimum of 65% and will be reported in writing by the Program Manager at regularly scheduled meetings with DBH. Productivity shall be reviewed during the monthly meeting between the Program Manager and Program Supervisors/Team Leads. 2. Individuals in independent supportive housing and lower levels of housing such as Independent Living Homes will develop a plan to provide for their own housing costs. The team will work with individuals on payment issues. Individuals will assume responsibility for housing cost, when ready and as appropriate. A report regarding individual plans for housing costs will be submitted annually. EXHIBIT B3— Scope of Work Page 10 of 11 3. The program will conduct an assessment within 24 hours of initial appointment to assess for appropriate level of care and will conduct the ASAM within 72 hours of initial appointment to assess for the appropriate level of care for individuals with substance use disorder. Access: 1. Within 24 hours of referral receipt, CONTRACTOR will make contact to schedule intake and enrollment. Initial appointments will be scheduled within 24 -72 hours from initial contact. If individual declines contact, CONTRACTOR will document accordingly and notify referral source, as evidenced by access logs delivered each month to DBH Managed Care. 2. Within 90 days of admission to DART West, at least 95% of individuals who do not have Supplemental Security Income (SSI) will have completed an SSI application, as evidenced by progress notes, a receipt in the individual's file, and the tracking log. 3. Within 60 days of admission to DART West, at least 95% of individuals will be linked to General Relief to establish supplemental income, as evidenced by progress notes, a receipt in the individual's file, and the tracking log. 4. Within six (6) months of being admitted to DART West, at least 95% of individuals served will have linkage to and documentation of a Primary Care Physician, as evidenced by the tracking log. 5. Within 30 days of enrollment, at least 95% of individuals will have participated in forming their individualized personal service care plan, as evidenced by the personal service care plan in the individual's file. 6. Within 120 days of enrollment, at least 95% of individuals will be provided/linked to supported employment activities, if desired, as evidenced by a referral placed in the team meeting binder and a progress note. Satisfaction: 1. The program will develop a satisfaction survey that is approved by DBH's MHSA Coordinator, or designee, and will comply with mandated State performance outcomes and quality improvement reports/outcomes. At a minimum, 75% percent of individuals will report their satisfaction with program services provided by the DART West FSP Program twice annually. The program will regularly implement Program Satisfaction - Consumer (PS-C) tools designed to track, measure, and evaluate individual, family, and community-partner satisfaction. The PS-C will be provided to the individual and family separately every six (6) months and during the discharge process. The PS-C is a 20-item scaled questionnaire that asks the individual and family about their experience with the CONTRACTOR's service, specific providers, ease of use, flexibility and satisfaction of results. The California Brief Multi-Cultural Competency Scale (CBMCS) will be e-mailed annually to all staff to complete anonymously and submit to the Program Manager. Results are used to identify areas of training need, and to update the program's Cultural Competency Plan. The Program Satisfaction — Community Partner (PS-CP) tool will be provided to partners who collaborate with the program. The Program Manager regularly reviews these tools, EXHIBIT B3— Scope of Work Page 11 of 11 recording them no less than quarterly into the Program Satisfaction Report regularly submitted to CONTRACTOR's Vice President of Clinical Services who collaborates with the Program Manager to build on identified strengths and mitigate identified concerns. Outcome Tracking for the FSP levels of care: Effectiveness 1. Psychiatric Hospitalizations: Frequency of hospitalizations will be reduced for each individual. Through an individual self-report tool, persons served will show a 70% reduction in hospitalization after one year of receiving services or upon discharge. 2. Homelessness: Frequency of homelessness will be reduced for each individual. Persons served will show an 80% reduction in days spent homeless after one year of receiving services or upon discharge. Each individual will obtain and maintain stable housing after one year or receiving services or upon discharge. 3. Housing: Each individual will be linked to the appropriate level of housing support, reflective of their individual needs. Persons served will receive assistance in housing placement and support, including emergency housing, contingent upon level of need and independent functioning. Each individual shall have stable and sustained housing upon discharge. 2. Each individual will be assisted to achieve a level of recovery, stability, and independence that will allow them to transition to the least restrictive level of care possible. 3. Personal wellness goals will be included in each individual's ISSP. Goals will be evaluated, monitored, and adjusted regularly and written reports will be submitted quarterly. 4. Direct Services Productivity Rate: The DART WEST Program services productivity rate will be at a minimum of 65%. 5. Supplemental Security Income: Within six (6) months of enrollment, 99% of individuals without SSI will have made SSI applications and a written report regarding these goals will be submitted semi-annually. Efficiency Cost per person served: The program will efficiently use resources and maintain or minimize the cost per person served. Access Persons served will begin receiving services within 24 hours of being transitioned to or from any level of care. Satisfaction Consumer Perception Survey: The DART West program will gauge satisfaction of individuals and collect data for service planning and quality improvement. The Consumer Perception Survey is conducted by DBH every six (6) months over a 1-week period. The program staff will encourage individuals to participate in completing the survey with the goal of a 75% satisfaction rate for each domain. Exhibit C BEHAVIORAL 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 Plan (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. C-1 Exhibit C 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. C-2 Exhibit C 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 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 C-3 Exhibit C 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 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 M 0410): 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. C-4 Exhibit C 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) 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. C-5 Exhibit C 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. 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. C-6 Exhibit C CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM) REQUIREMENTS 1. SERVICES AND ACCESS PROVISIONS a. CERTIFICATION OF ELIGIBILITY i. Contractor will, in cooperation with County, comply with Section 14705.5 of California Welfare and Institutions Code to obtain a certification of an individual's eligibility for Specialty Mental Health Services (SMHS) under Medi-Cal. b. ACCESS TO SPECIALTY MENTAL HEALTH SERVICES i. In collaboration with the County, Contractor will work to ensure that individuals to whom the Contractor provides SMHS meet access criteria, as per Department of Health Care Services (DHCS) guidance specified in BHIN 21-073. Specifically, the Contractor will ensure that the clinical record for each individual includes information as a whole indicating that individual's presentation and needs are aligned with the criteria applicable to their age at the time of service provision as specified below. ii. For enrolled individuals under 21 years of age, Contractor shall provide all medically necessary SMHS required pursuant to Section 1396d(r) of Title 42 of the United States Code. Covered SMHS shall be provided to enrolled individuals who meet either of the following criteria, (1) or (11) below. If an individual under age 21 meets the criteria as described in (1) below, the beneficiary meets criteria to access SMHS; it is not necessary to establish that the beneficiary also meets the criteria in (b) below. 1. The individual has a condition placing them at high risk for a mental health disorder due to experience of trauma evidenced by any of the following: scoring in the high-risk range under a trauma screening tool approved by DHCS, involvement in the child welfare system, juvenile justice involvement, or experiencing homelessness. OR 2. The individual has at least one of the following: a. A significant impairment b. A reasonable probability of significant deterioration in an important area of life functioning c. A reasonable probability of not progressing developmentally as appropriate. d. A need for SMHS, regardless of presence of impairment, that are not included within the mental health benefits that a Medi-Cal Managed Care Plan (MCP) is required to provide. AND the individual's condition as described in subparagraph (11 a-d) above is due to one of the following: C-7 Exhibit C a. A diagnosed mental health disorder, according to the criteria in the current editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases and Related Health Problems (ICD). b. A suspected mental health disorder that has not yet been diagnosed. c. Significant trauma placing the individual at risk of a future mental health condition, based on the assessment of a licensed mental health professional. iii. For individuals 21 years of age or older, Contractor shall provide covered SMHS for clients who meet both of the following criteria, (a) and (b) below: 1. The individual has one or both of the following: a. Significant impairment, where impairment is defined as distress, disability, or dysfunction in social, occupational, or other important activities. b. A reasonable probability of significant deterioration in an important area of life functioning. 2. The individual's condition as described in paragraph (a) is due to either of the following: a. A diagnosed mental health disorder, according to the criteria in the current editions of the DSM and ICD. b. A suspected mental disorder that has not yet been diagnosed. c. ADDITIONAL CLARIFICATIONS i. Criteria 1. A clinically appropriate and covered mental health prevention, screening, assessment, treatment, or recovery service listed within Exhibit A of this Agreement can be provided and submitted to the County for reimbursement under any of the following circumstances: a. The services were provided prior to determining a diagnosis, including clinically appropriate and covered services provided during the assessment process; b. The service was not included in an individual treatment plan; or c. The individual had a co-occurring substance use disorder. ii. Diagnosis Not a Prerequisite 1. Per BHIN 21-073, a mental health diagnosis is not a prerequisite for access to covered SMHS. This does not eliminate the requirement that all Medi-Cal claims, including SMHS claims, include a current Centers for C-8 Exhibit C Medicare & Medicaid Services (CMS) approved ICD diagnosis code d. MEDICAL NECESSITY i. Contractor will ensure that services provided are medically necessary in compliance with BHIN 21-073 and pursuant to Welfare and Institutions Code section 14184.402(a). Services provided to a client must be medically necessary and clinically appropriate to address the individual's presenting condition. Documentation in each individual's chart as a whole will demonstrate medical necessity as defined below, based on the client's age at the time of service provision. ii. For individuals 21 years of age or older, a service is "medically necessary" or a "medical necessity" when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain as set forth in Welfare and Institutions Code section 14059.5. iii. For individuals under 21 years of age, a service is "medically necessary" or a "medical necessity" if the service meets the standards set forth in Section 1396d(r)(5) of Title 42 of the United States Code. e. COORDINATION OF CARE i. Contractor shall ensure that all care, treatment and services provided pursuant to this Agreement are coordinated among all providers who are serving the individual, including all other SMHS providers, as well as providers of Non-Specialty Mental Health Services (NSMHS), substance use disorder treatment services, physical health services, dental services, regional center services and all other services as applicable to ensure a client-centered and whole-person approach to services. ii. Contractor shall ensure that care coordination activities support the monitoring and treatment of comorbid substance use disorder and/or health conditions. iii. Contractor shall include in care coordination activities efforts to connect, refer and link individual s to community-based services and supports, including but not limited to educational, social, prevocational, vocational, housing, nutritional, criminal justice, transportation, childcare, child development, family/marriage education, cultural sources, and mutual aid support groups. iv. Contractor shall engage in care coordination activities beginning at intake and throughout the treatment and discharge planning processes. v. To facilitate care coordination, Contractor will request a HIPAA and California law compliant client authorization to share the individual's information with and among all other providers involved in the individual's care, in satisfaction of state and federal privacy laws and regulations. f. CO-OCCURRING TREATMENT AND NO WRONG DOOR C-9 Exhibit C i. Per BHIN 22-011, Specialty and Non-Specialty Mental Health Services can be provided concurrently, if those services are clinically appropriate, coordinated, and not duplicative. When a client meets criteria for both NSMHS and SMHS, the individual should receive services based on individual clinical need and established therapeutic relationships. Clinically appropriate and covered SMHS can also be provided when the individual has a co- occurring mental health condition and substance use disorder. ii. Under this Agreement, Contractor will ensure that individual s receive timely mental health services without delay. Services are reimbursable to Contractor by County even when: 1. Services are provided prior to determination of a diagnosis, during the assessment or prior to determination of whether SMHS access criteria are met, even if the assessment ultimately indicates the individual does not meet criteria for SMHS. 2. If Contractor is serving a individual receiving both SMHS and NSMHS, Contractor holds responsibility for documenting coordination of care and ensuring that services are non-duplicative. 2. AUTHORIZATION AND DOCUMENTATION PROVISIONS a. SERVICE AUTHORIZATION i. Contractor will collaborate with County to complete authorization requests in line with County and DHCS policy. ii. Contractor shall have in place, and follow, written policies and procedures for completing requests for initial and continuing authorizations of services, as required by County guidance. iii. Contractor shall respond to County in a timely manner when consultation is necessary for County to make appropriate authorization determinations. iv. County shall provide Contractor with written notice of authorization determinations within the timeframes set forth in BHINs 22-016 and 22-017, or any subsequent DHCS notices. v. Contractor shall alert County when an expedited authorization decision (no later than 72 hours) is necessary due to an individual's specific needs and circumstances that could seriously jeopardize the individual s life or health, or ability to attain, maintain, or regain maximum function. b. DOCUMENTATION REQUIREMENTS i. Contractor will follow all documentation requirements as specified in Article 4.2-4.8 inclusive in compliance with federal, state and County requirements. ii. All Contractor documentation shall be accurate, complete, and legible, shall list each date of service, and include the face-to-face time for each service. Contractor shall document travel and documentation time for each service separately from face-to-face time and provide this information to County upon request. C-10 Exhibit C Services must be identified as provided in-person, by telephone, or by telehealth. iii. All services shall be documented utilizing County-approved templates and contain all required elements. Contractor agrees to satisfy the chart documentation requirements set forth in BHIN 22- 019 and the contract between County and DHCS. Failure to comply with documentation standards specified in this Article require corrective action plans. c. ASSESSMENT i. Contractor shall ensure that all individuals' medical records include an assessment of each individual's need for mental health services. ii. Contractor will utilize the seven uniform assessment domains and include other required elements as identified in BHIN 22-019 and document the assessment in the individual's medical record. iii. For individuals aged 6 through 21, the Child and Adolescent Needs and Strengths (CANS), and for individual s aged 3 through 18, the Pediatric Symptom Checklist-35 (PSC-35) tools are required at intake, every six months during treatment, and at discharge, as specified in DHCS MHSUDS INs 17-052 and 18- 048. iv. The time period for providers to complete an initial assessment and subsequent assessments for SMHS are up to clinical discretion of County; however, Contractor's providers shall complete assessments within a reasonable time and in accordance with generally accepted standards of practice. d. ICD-10 i. Contractor shall use the criteria set forth in the current edition of the DSM as the clinical tool to make diagnostic determinations. ii. Once a DSM diagnosis is determined, the Contractor shall determine the corresponding mental health diagnosis in the current edition of ICD. Contractor shall use the ICD diagnosis code(s) to submit a claim for SMHS to receive reimbursement from County. iii. The ICD Tabular List of Diseases and Injuries is maintained by CMS and may be updated during the term of this Agreement. Changes to the lists of ICD diagnoses do not require an amendment to this Agreement, and County may implement these changes as provided by CMS e. PROBLEM LIST i. Contractor will create and maintain a Problem List for each individual served under this Agreement. The problem list is a list of symptoms, conditions, diagnoses, and/or risk factors identified through assessment, psychiatric diagnostic evaluation, crisis encounters, or other types of service encounters. ii. Contractor must document a problem list that adheres to industry standards utilizing at minimum current SNOMED International, C-11 Exhibit C Systematized Nomenclature of Medicine Clinical Terms (SNOMED CTO) U.S. Edition, September 2022 Release, and ICD- 10-CM 2023. iii. A problem identified during a service encounter may be addressed by the service provider during that service encounter and subsequently added to the problem list. iv. The problem list shall include, but is not limited to, all elements specified in BHIN 22-019. v. County does not require the problem list to be updated within a specific timeframe or have a requirement about how frequently the problem list should be updated after a problem has initially been added. However, Contractor shall update the problem list within a reasonable time such that the problem list reflects the current issues facing the client, in accordance with generally accepted standards of practice and in specific circumstances specified in BHIN 22-019. f. TREATMENT AND CARE PLANS i. Contractor is not required to complete treatment or care plans for clients under this Agreement, except in the circumstances specified in BHIN 22-019 and additional guidance from DHCS that may follow after execution of this Agreement. g. PROGRESS NOTES i. Contractor shall create progress notes for the provision of all SMHS services provided under this Agreement. ii. Each progress note shall provide sufficient detail to support the service code selected for the service type as indicated by the service code description. iii. Progress notes shall include all elements specified in BHIN 22- 019, whether the note be for an individual or a group service. iv. Contractor shall complete progress notes within three business days of providing a service, with the exception of notes for crisis services, which shall be completed within 24 hours. v. Providers shall complete a daily progress note for services that are billed on a daily basis, such as residential and day treatment services, if applicable. h. TRANSITION OF CARE TOOL i. Contractor shall use a Transition of Care Tool for any individual whose existing services will be transferred from Contractor to an Medi-Cal Managed Care Plan (MCP) provider or when NSMHS will be added to the existing mental health treatment provided by Contractor, as specified in BHIN 22-065, in order to ensure continuity of care. ii. Determinations to transition care or add services from an MCP shall be made in alignment with County policies and via a person- centered, shared decision-making process. iii. Contractor may directly use the DHCS-provided Transition of Care Tool, found at https://www.dhcs.ca.gov/Pages/Screening-and- C-12 Exhibit C Transition-of-Care-Tools-for-Medi-Cal-Mental-Health- Services.aspx, or obtain a copy of that tool provided by the County. Contractor may create the Transition of Care Tool in its Electronic Health Record (EHR). However, the contents of the Transition of Care Tool, including the specific wording and order of fields, shall remain identical to the DHCS provided form. The only exception to this requirement is when the tool is translated into languages other than English. i. TELEHEALTH i. Contractor may use telehealth, when it deems clinically appropriate, as a mode of delivering behavioral health services in accordance with all applicable County, state, and federal requirements, including those related to privacy/security, efficiency, and standards of care. Such services will conform to the definitions and meet the requirements included in the Medi-Cal Provider Manual: Telehealth, available in the DHCS Telehealth Resources page at: https://www.dhcs.ca.gov/provqovpart/Pages/TelehealthResources .aspx. ii. All telehealth equipment and service locations must ensure that client confidentiality is maintained. iii. Licensed providers and staff may provide services via telephone and telehealth as long as the service is within their scope of practice. iv. Medical records for individuals served by Contractor under this Agreement must include documentation of written or verbal consent for telehealth or telephone services if such services are provided by Contractor. Such consent must be obtained at least once prior to initiating applicable health care services and consent must include all elements as specified in BHIN 22-019. v. County may at any time audit Contractor's telehealth practices, and Contractor must allow access to all materials needed to adequately monitor Contractor's adherence to telehealth standards and requirements. 3. CLIENT PROTECTIONS a. GRIEVANCES, APPEALS AND NOTICES OF ADVERSE BENEFIT DETERMINATION i. All grievances (as defined by 42 C.F.R. § 438.400) and complaints received by Contractor must be immediately forwarded to the County's Managed Care Department or other designated persons via a secure method (e.g., encrypted email or by fax) to allow ample time for the Managed Care staff to acknowledge receipt of the grievance and complaints and issue appropriate responses. ii. Contractor shall not discourage the filing of grievances and individual s do not need to use the term "grievance" for a complaint to be captured as an expression of dissatisfaction and, therefore, a grievance. C-13 Exhibit C iii. Aligned with MHSUDS IN 18-010E and 42 C.F.R. §438.404, the appropriate and delegated Notice of Adverse Benefit Determination (NOABD) must be issued by Contractor within the specified timeframes using the template provided by the County. iv. NOABDs must be issued to individuals anytime the Contractor has made or intends to make an adverse benefit determination that includes the reduction, suspension, or termination of a previously authorized service and/or the failure to provide services in a timely manner. The notice must have a clear and concise explanation of the reason(s) for the decision as established by DHCS and the County. The Contractor must inform the County immediately after issuing a NOABD. v. Procedures and timeframes for responding to grievances, issuing and responding to adverse benefit determinations, appeals, and state hearings must be followed as per 42 C.F.R., Part 438, Subpart F (42 C.F.R. §§ 438.400 —438.424). vi. Contractor must provide individuals any reasonable assistance in completing forms and taking other procedural steps related to a grievance or appeal such as auxiliary aids and interpreter services. vii. Contractor must maintain records of grievances and appeals and must review the information as part of its ongoing monitoring procedures. The record must be accurately maintained in a manner accessible to the County and available upon request to DHCS. b. Advanced Directives i. Contractor must comply with all County policies and procedures regarding Advanced Directives in compliance with the requirements of 42 C.F.R. §§ 422.128 and 438.6(i) (1), (3) and (4). c. Continuity of Care i. Contractor shall follow the County's continuity of care policy that is in accordance with applicable state and federal regulations, MHSUDS IN 18-059 and any BHINs issued by DHCS for parity in mental health and substance use disorder benefits subsequent to the effective date of this Agreement (42 C.F.R. § 438.62(b)(1)-(2).) 4. QUALITY IMPROVEMENT PROGRAM a. QUALITY IMPROVEMENT ACTIVITIES AND PARTICIPATION i. Contractor shall implement mechanisms to assess person served/family satisfaction based on County's guidance. The Contractor shall assess individual/family satisfaction by: 1. Surveying person served/family satisfaction with the Contractor's services at least annually. 2. Evaluating person served's grievances, appeals and State Hearings at least annually. 3. Evaluating requests to change persons providing services at least annually. C-14 Exhibit C 4. Informing the County and individuals of the results of client/family satisfaction activities. ii. Contractor, if applicable, shall implement mechanisms to monitor the safety and effectiveness of medication practices. This mechanism shall be under the supervision of a person licensed to prescribe or dispense prescription drugs, at least annually and as required by DBH. iii. Contractor shall implement mechanisms to monitor appropriate and timely intervention of occurrences that raise quality of care concerns. The Contractor shall take appropriate follow-up action when such an occurrence is identified. The results of the intervention shall be evaluated by the Contractor at least annually and shared with the County. iv. Contractor shall assist County, as needed, with the development and implementation of Corrective Action Plans. v. Contractor shall collaborate with County to create a County's QI Work Plan with documented annual evaluations and documented revisions as needed. The Ql Work Plan shall evaluate the impact and effectiveness of its quality assessment and performance improvement program. vi. Contractor shall attend and participate in the County's Quality Improvement Committee (QIC) to recommend policy decisions, review and evaluate results of QI activities, including PIPs, institute needed Ql actions, and ensure follow-up of Ql processes. Contractor shall ensure that there is active participation by the Contractor's practitioners and providers in the QIC. vii. Contractor shall participate, as required, in annual, independent external quality reviews (EQR) of the quality, timeliness, and access to the services covered under this Contract, which are conducted pursuant to Subpart E of Part 438 of the Code of Federal Regulations. (42 C.F.R. §§ 438.350(a) and 438.320) b. TIMELY ACCESS i. Timely access standards include: 1. Contractor must have hours of operation during which services are provided to Medi-Cal individuals that are no less than the hours of operation during which the provider offers services to non-Medi-Cal individual s. If the Contractor's provider only serves Medi-Cal clients, the provider must provide hours of operation comparable to the hours the provider makes available for Medi-Cal services that are not covered by the Agreement or another County. 2. Appointments data, including wait times for requested services, must be recorded and tracked by Contractor, and submitted to the County on a monthly basis in a format specified by the County. Appointments' data should be submitted to the County's Quality Management Department or other designated persons. C-15 Exhibit C 3. Urgent care appointments for services that do not require prior authorization must be provided to individual s within 48 hours of a request. Urgent appointments for services that do require prior authorization must be provided to clients within 96 hours of request. 4. Non-urgent non-psychiatry mental health services, including, but not limited to Assessment, Targeted Case Management, and Individual and Group Therapy appointments (for both adult and children/youth) must be made available to Medi-Cal individuals within 10 business days from the date the individual or a provider acting on behalf of the individual, requests an appointment for a medically necessary service. Non-urgent psychiatry appointments (for both adult and children/youth) must be made available to Medi-Cal individual s within 15 business days from the date the client or a provider acting on behalf of the individual, requests an appointment for a medically necessary service. 5. Applicable appointment time standards may be extended if the referring or treating provider has determined and noted in the individual's record that a longer waiting period will not have a detrimental impact on the health of the individual. 6. Periodic office visits to monitor and treat mental health conditions may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed mental health provider acting within the scope of their practice. c. PROVIDER APPLICATION AND VALIDATION FOR ENROLLMENT (PAVE) i. Contractor shall ensure that all of its required clinical staff, who are rendering SMHS to Medi-Cal individuals on behalf of Contractor, are registered through DHCS' Provider Application and Validation for Enrollment (PAVE) portal, pursuant to BHIN 20- 071 requirements, the 21st Century Cures Act and the CMS Medicaid and Children's Health Insurance Program (CHIP) Managed Care Final Rule. ii. SMHS licensed individuals required to enroll via the "Ordering, Referring and Prescribing" (ORP) PAVE enrollment pathway (i.e. PAVE application package) available through the DHCS PED Pave Portal, include: Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), Psychologist, Licensed Educational Psychologist, Physician (MD and DO), Physician Assistant, Registered Pharmacist/Pharmacist, Certified Pediatric/Family Nurse Practitioner, Nurse Practitioner, Occupational Therapist, and Speech-Language Pathologist. Interns, trainees, and associates are not eligible for enrollment. C-16 Exhibit C d. PHYSICIAN INCENTIVE PLAN i. If Contractor wants to institute a Physician Incentive Plan, Contractor shall submit the proposed plan to the County which will in turn submit the Plan to the State for approval, in accordance with the provisions of 42 C.F.R. § 438.6(c). 5. DATA, PRIVACY AND SECURITY REQUIREMENTS a. ELECTRONIC PRIVACY AND SECURITY i. Contractor shall have a secure email system and send any email containing PII or PHI in a secure and encrypted manner. Contractor's email transmissions shall display a warning banner stating that data is confidential, systems activities are monitored and logged for administrative and security purposes, systems use is for authorized users only, and that users are directed to log off the system if they do not agree with these requirements. ii. Contractor shall institute compliant password management policies and procedures, which shall include but not be limited to procedures for creating, changing, and safeguarding passwords. Contractor shall establish guidelines for creating passwords and ensuring that passwords expire and are changed at least once every 90 days. iii. Any Electronic Health Records (EHRs) maintained by Contractor that contain PHI or PII for individuals served through this Agreement shall contain a warning banner regarding the PHI or PII contained within the EHR. Contractors that utilize an EHR shall maintain all parts of the clinical record that are not stored in the EHR, including but not limited to the following examples of client signed documents: discharge plans, informing materials, and health questionnaire. iv. Contractor entering data into any County electronic systems shall ensure that staff are trained to enter and maintain data within this system. 6. PROGRAM INTEGRITY a. Credentialing and Re-credentialing of Providers i. Contractor shall ensure that all of their network providers delivering covered services, sign and date an attestation statement on a form provided by County, in which each provider attests to the following: 1. Any limitations or inabilities that affect the provider's ability to perform any of the position's essential functions, with or without accommodation; 2. A history of loss of license or felony convictions; 3. A history of loss or limitation of privileges or disciplinary activity; 4. A lack of present illegal drug use; and 5. The application's accuracy and completeness C-17 Exhibit C ii. Contractor must file and keep track of attestation statements, credentialing applications and credentialing status for all of their providers and must make those available to the County upon request at any time. iii. Contractor is required to sign an annual attestation statement at the time of Agreement renewal in which they will attest that they will follow County's Credentialing Policy and MHSUDS IN 18-019 and ensure that all of their rendering providers are credentialed as per established guidelines. C-18 Exhibit D Page 1 of 4 Fresno County Department of Behavioral Health Guiding Principles of Care Delivery DBH VISION: Health and well-being for our community. DBH MISSION: DBH, in partnership with our diverse community, is dedicated to providing quality, culturally responsive, behavioral health services to promote wellness, recovery, and resiliency for individuals and families in our community. DBH GOALS: Quadruple Aim • Deliver quality care • Maximize resources while focusing on efficiency • Provide an excellent care experience • Promote workforce well-being GUIDING PRINCIPLES OF CARE DELIVERY: The DBH 11 principles of care delivery define and guide a system that strives for excellence in the provision of behavioral health services where the values of wellness, resiliency, and recovery are central to the development of programs, services, and workforce. The principles provide the clinical framework that influences decision-making on all aspects of care delivery including program design and implementation, service delivery, training of the workforce, allocation of resources, and measurement of outcomes. 1. Principle One -Timely Access & Integrated Services o Individuals and families are connected with services in a manner that is streamlined, effective, and seamless o Collaborative care coordination occurs across agencies, plans for care are integrated, and whole person care considers all life domains such as health, education, employment, housing, and spirituality o Barriers to access and treatment are identified and addressed o Excellent customer service ensures individuals and families are transitioned from one point of care to another without disruption of care 1 rev 01-02-2020 Exhibit D Page 2 of 4 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 values and preferences of those we serve o Other clinically significant interventions such as innovative, promising, and emerging practices are embraced 2 rev 01-02-2020 Exhibit D Page 3 of 4 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 person's stage of change o Progression though stages of change are supported through positive working relationships and alliances that are motivating o Providers support individuals and families to develop strategies aimed at reducing negative outcomes of substance misuse though a harm reduction approach o Each individual defines their own recovery and recovers at their own pace when provided with sufficient time and support 3 rev 01-02-2020 Exhibit D Page 4 of 4 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 4 rev 01-02-2020 Exhibit E-Documentation Standards for Client Records 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 10 years from the date of the end of the Agreement. A. Assessments 1. The following areas will be included as a part of a comprehensive client record: • Presenting problems, including impairments in function, and current mental status exam. • Traumatic incidents which include trauma exposures, trauma reactions, trauma screenings, and systems involvement if relevant • Behavioral health history including mental health history, substance use/abuse, and previous services • Medical history including physical health conditions, medications, and developmental history • Psychosocial factors including family, social and life circumstances, cultural considerations • Strengths, risks, and protective factors, including safety planning • Clinical summary, treatment recommendations, and level of care determination including diagnostic and clinical impression with a diagnosis • The assessment shall include a typed or legibly printed name, signature of the service provider and date of signature. 2. Timeliness/Frequency Standard for Assessment • The time period to complete an initial assessment and subsequent assessments for SMHS is up to clinical discretion. • Assessments shall be completed within a reasonable time and in accordance with generally accepted standards of practice. B. Problem list The use of a Problem List has largely replaced the use of treatment plans and is therefore required to be part of the client record. The problem list shall be updated on an ongoing basis to reflect the current presentation of the person in care. The problem list shall include, but is not limited to, the following: • Diagnoses identified by a provider acting within their scope of practice • Problems identified by a provider acting within their scope of practice • Problems or illnesses identified by the person in care and/or significant support person if any • The name and title of the provider that identified, added, or removed the problem, and the date the problem was identified, added, or removed C. Treatment and Care Plan Requirements 1. Targeted Case Management Exhibit E-Documentation Standards for Client Records Page 2 of 3 • Specifies the goals, treatment, service activities, and assistance to address the negotiated objectives of the plan and the medical, social, educational, and other services needed by the person in care • Identifies a course of action to respond to the assessed needs of the person in care • Includes development of a transition plan when the person in care has achieved the goals of the care plan • Peer support services must be based on an approved care plan • Must be provided in a narrative format in the person's progress notes • Updated at least annually 2. Services requiring Treatments Plans • Intensive Home-Based Services (IHBS) • Intensive Care Coordination (ICC) • Therapeutic Behavioral Services (TBS) • Must have specific observable and/or specific quantifiable goals • Must identify the proposed type(s) of intervention • Must 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 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 will give a copy of the client plan to the client on request. D. Progress Notes Exhibit E-Documentation Standards for Client Records Page 3 of 3 1. Providers shall create progress notes for the provision of all SMHS. Each progress note shall provide sufficient detail to support the service code selected for the service type as indicated by the service code description. Progress notes shall include: • The type of service rendered. • A narrative describing the service, including how the service addressed the beneficiary's behavioral health need (e.g., symptom, condition, diagnosis, and/or risk factors). • The date that the service was provided to the beneficiary. • Duration of the service, including travel and documentation time. • Location of the beneficiary at the time of receiving the service. • A typed or legibly printed name, signature of the service provider and date of signature. • ICD 10 code • Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code. • Next steps including, but not limited to, planned action steps by the provider or by the beneficiary, collaboration with the beneficiary, collaboration with other provider(s) and any update to the problem list as appropriate. 2. Timeliness/Frequency of Progress Notes • Progress notes shall be completed within 3 business days of providing a service, except for notes for crisis services, which shall be completed within 24 hours. • A note must be completed for every service contact Exhibit F - Performance Outcome Measures Page 1 of 3 coU Department of Behavioral Health Policy and Procedure Guide FRES PPG 1.2.7 Section: Mental Health Effective Date: 05/30/2017 Revised Date: 05/30/2017 Policy Title: Performance Outcome Measures Approved by: Dawan Utecht (Director of Behavioral Health), Francisco Escobedo (Sr. Staff Analyst-QA), Kannika Toonnachat (Division Manager-Technology and Quality Management) POLICY: It is the policy of Fresno County Department of Behavioral Health and the Fresno County Mental Health Plan (FCMHP) to ensure procedures for developing performance measures which accurately reflect vital areas of performance and provide for systematic, ongoing collection and analysis of valid and reliable data. Data collection is not intended to be an additional task for FCMHP programs/providers but rather embedded within the various non-treatment, treatment and clinical documentation. PURPOSE: To determine the effectiveness and efficiency of services provided by measuring performance outcomes/results achieved by the persons served during service delivery or following service completion, delivery of service, and of the individuals' satisfaction. This is a vital management tool used to clarify goals, document the efforts toward achieving those goals, and thus measure the benefit the service delivery to the persons served. Performance measurement selection is part of the planning and developing process design of the program. Performance measurement is the ongoing monitoring and reporting of progress towards pre-established objectives/goals. REFERENCE: California Code of Regulations, Title 9, Chapter 11, Section 1810.380(a)(1): State Oversight DHCS Service, Administrative and Operational Requirements Mental Health Services Act (MHSA), California Code of Regulations, Title 9, Section 3320, 3200.050, and 3200.120 Commission on Accreditation of Rehabilitation Facilities (CARF) DEFINITIONS: 1. Indicator: Qualitative or quantitative measure(s) that tell if the outcomes have been accomplished. Indicators evaluate key performance in relation to objectives. It indicates what the program is accomplishing and if the anticipated results are being achieved. MISSION STATEMENT 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. Template Review Date 3128116 11 Exhibit F - Performance Outcome Measures Page 2 of 3 coU Department of Behavioral Health Policy and Procedure Guide O 1856 O FRES) Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7 Policy Title: Performance Outcome Measures 2. Intervention: A systematic plan of action consciously adapted in an attempt to address and reduce the causes of failure or need to improve upon system. 3. Fresno County Mental Health Plan (FCMHP): Fresno County's contract with the State Department of Health and Human Services that allows for the provision of specialty mental health services. Services may be delivered by county-operated programs, contracted organizational, or group providers. 4. Objective (Goal): Intended results or the impact of learning, programs, or activities. 5. Outcomes: Specific results or changes achieved as a consequence of the program or intervention. Outcomes are connected to the objectives/goals identified by the program or intervention. PROCEDURE: I. Each FCMHP program/provider shall engage in measurement of outcomes in order to generate reliable and valid data on the effectiveness and efficiency of programs or interventions. Programs/providers will establish/select objectives (goals), decide on a methodology and timeline for the collection of data, and use an appropriate data collection tool. This occurs during the program planning and development process. Outcomes should be in alignment with the program/provider goals. II. Outcomes should be measureable, obtainable, clear, accurately reflect the expected result, and include specific time frames. Once the measures have been selected, it is necessary to design a way to gather the information. For each service delivery performance indicator, FCMHP program/provider shall determine: to whom the indicator will be applied; who is responsible for collecting the data; the tool from which data will be collected; and a performance target based on an industry benchmark, or a benchmark set by the program/provider. III. Performance measures are subject to review and approval by FCMHP Administration. IV. Performance measurement is the ongoing monitoring and reporting of progress towards pre-established objectives/goals. Annually, each FCMHP program/provider must measure service delivery performance in each of the areas/domains listed below. Dependent on the program/provider service deliverables, exceptions must be approved by the FCMHP Administration. 2 1 P a g e Exhibit F - Performance Outcome Measures Page 3 of 3 coU Department of Behavioral Health Policy and Procedure Guide O 1856 O FRES) Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7 Policy Title: Performance Outcome Measures a. Effectiveness of services — How well programs performed and the results achieved. Effectiveness measures address the quality of care through measuring change over time. Examples include but are not limited to: reduction of hospitalization, reduction of symptoms, employment and housing status, and reduction of recidivism rate and incidence of relapse. b. Efficiency of services — The relationship between the outcomes and the resources used. Examples include but are not limited to: service delivery cost per service unit, length of stay, and direct service hours of clinical and medical staff. c. Services access — Changes or improvements in the program/provider's capacity and timeliness to provide services to those who request them. Examples include but are not limited to: wait/length of time from first request/referral to first service or subsequent appointment, convenience of service hours and locations, number of clients served by program capacity, and no-show and cancellation rates. d. Satisfaction and feedback from persons served and stakeholders— Changes or increased positive/negative feedback regarding the experiences of the persons served and others (families, referral sources, payors/guarantors, etc.). Satisfaction measures are usually oriented toward clients, family members, personnel, the community, and funding sources. Examples include but are not limited to: did the organization/program focus on the recovery of the person served, were grievances or concerns addressed, overall feelings of satisfaction, and satisfaction with physical facilities, fees, access, service effectiveness, and efficiency. V. Each FCMHP program/provider shall use the following templates to document the defined goals, intervention(s), specific indicators, and outcomes. 1. FCMHP Outcome Report template (see Attachment A) 2. FCMHP Outcome Analysis template (see Attachment C) 3 1 P a g e Exhibit G DCR - PAF, KET & 3M Forms Paae 1 of 22 ADULT PAF FULL SERVICE PARTNERSHIP 5/1/07 Adult Partnership Assessment Form FOR AGES 26-59 YEARS PARTNERSHIP INFORMATION County CSI County Client Number (CCN) County Partner ID (optional) Partner's First Name Partner's Last Name Partnership Date (mm/dd/yyyy) Partner's Date of Birth (mm/dd/yyyy) Who referred the partner? (mark one) Self Emergency Room Homeless Shelter Family Member(e.g., parent, guardian, sibling. aunt. Mental Health Facility/ Street Outreach uncle. grandparent, child) Community Agency C Significant Other(e.g., boyfriend /girlfriend. spouse) C Social Services Agency Jail / Prison Friend/ Neighbor(i.e., unrelated other) Substance Abuse Treatment Acute Psychiatric / State Facility/Agency Hospital School Faith-based Organization Other Primary Care/ Medical Office Other County/ Community Agency ADMINISTRATIVE INFORMATION PARTNERSHIP STATUS Provider Number / NPI (Optional) Full Service Partnership Program ID Partnership Service Coordinator ID PROGRAM INFORMATION In which additional program(s) is the partner CURRENTLY involved? (mark all that apply) AB2034 Governor's Homeless Initiative (GHI) MHSA Housing Program 1 Exhibit G I DCR - PAF, KET & 3M Forms Page 2 of 22 RESIDENTIAL INFORMATION - includes hospitalization and incarceration DURING DURING THE THE PAST YESTERDAY PAST 12 12 PRIOR TO MONTHS MONTHS THE LAST SETTING TONIGHT (as of 11-59 INDICATE THE INDICATE 12 p.m the day TOTAL THE MONTHS BEFORE # TOTAL (mark all partnership) # DAYS that apply) OCCURRENCES (must= 365 days) GENERAL LIVING ARRANGEMENT In an apartment or house alone/with spouse/partner/ minor children / other dependents/ roommate —must hold F lease or share in rent/mortgage With one or both biological /adoptive parents With adult family member(s)other than parents Single Room Occupancy(must hold lease) SHELTER/HOMELESS Emergency Shelter/ Temporary Housing (includes people living with friends but paying no rent) Homeless (includes people living in their cars) C' C SUPERVISED PLACEMENT Unlicensed but supervised individual placement (includes paid caretakers, personal care attendants) Assisted Living Facility �' I Unlicensed but supervised congregate placement (includes C. group living homes, sober living homes) Licensed Community Care Facility (Board and Care) HOSPITAL Acute Medical Hospital C' C Acute Psychiatric Hospital / Psychiatric Health Facility (PHF) State Psychiatric Hospital RESIDENTIAL PROGRAM Licensed Residential Treatment (includes crisis, short-term, long-term, substance abuse, dual diagnosis residential C' C programs) Skilled Nursing Facility (physical) C C Skilled Nursing Facility(psychiatric) C Long-Term Institutional Care [Institution for Mental Disease C. _. (IMD), Mental Health Rehabilitation Center (MHRC)] 2 Exhibit G I DCR - PAF, KET & 3M Forms Page 3 of 22 RESIDENTIAL INFORMATION -includes hospitalization and incarceration (Continued) JUSTICE PLACEMENT Jail �' C F- Prison f OTHER Other Unknown C EDUCATION Highest level of education completed: C, No High School Diploma/No GED Associate's Degree (e.g., A.A.,A.S.)/Technical or Vocational Degree GED Coursework Bachelor's Degree (e.g., B.A., B.S.) High School Diploma/GED Master's Degree(e.g., M.A., M.S.) Some College/Some Technical or Vocational Doctoral Degree(e.g., M.D., Ph.D.) Training For the educational settings below, indicate where the was DURING THE PAST 12 is CURRENTLY MONTHS partner..... #of weeks (mark all that apply) Not in school of any kind F- High School/Adult Education F- Technical/Vocational School F Community College/4 year College r Graduate School r Other Does one of the partner's current recovery goals include any kind of education at this time? Yes No 3 Exhibit G I DCR - PAF, KET & 3M Forms Page 4 of 22 EMPLOYMENT EMPLOYMENT DURING THE PAST 12 MONTHS #OF AVERAGE AVERAGE Indicate the partner's employment status... HOURS per HOURLY WEEKS WEEK WAGE Competitive Employment: Paid employment in the community in a position that is also open to individuals $� without a disability. Supported Employment: Competitive Employment(see above)with ongoing on-site or off-site job-related $� support services provided. Transitional Employment/Enclave: Paid jobs in the community that are 1) open only to individuals with a disability AND 2)are either time-limited for the purpose of moving to a more permanent job OR are $� part of a group of disabled individuals who are working as a team in the midst of teams of non-disabled individuals who are performing the same work. Paid In-House Work(Sheltered Workshop/Work Experience/Agency-Owned Business): Paid jobs open only to program participants with a disability. A Sheltered Workshop usually offers sub-minimum wage work in a simulated environment.A Work Experience (Adjustment) Program within an agency provides exposure to the standard expectations and advantages of employment.An Agency-Owned Business $� serves customers outside the agency and provides realistic work experiences and can be located at the program site or in the community. Non-paid(Volunteer)Work Experience: Non-paid (volunteer)jobs in an agency or volunteer work in the community that provides exposure to the standard expectations of employment. Other Gainful/Employment Activity: Any informal employment activity that increases the partner's income (e.g., recycling, gardening, babysitting) OR participation in formal structured classes and/or workshops providing instruction on issues pertinent to getting a job. (Does NOT $� include such activities as panhandling or illegal activities such as prostitution.) Unemployed 4 Exhibit G I DCR - PAF, KET & 3M Forms Page 5 of 22 CURRENT EMPLOYMENT AVERAGE AVERAGE Indicate the partner's employment status... HOURS per HOURLY WAGE WEEK Competitive Employment: Paid employment in the community in a position that is also open to individuals without a $� disability. Supported Employment: Competitive Employment(see above)with ongoing on-site or off-site job-related support $� services provided. Transitional Employment/Enclave: Paid jobs in the community that are 1)open only to individuals with a disability AND 2) are either time-limited for the purpose of moving to a more permanent job OR are part of a group of disabled individuals who are working as a team in the midst of teams of non- $� disabled individuals who are performing the same work. Paid In-House Work(Sheltered Workshop/Work Experience/Agency-Owned Business): Paid jobs open only to program participants with a disability.A Sheltered Workshop usually offers sub-minimum wage work in a simulated environment. A Work Experience (Adjustment) Program within an agency provides exposure to the standard expectations and advantages of employment. An Agency-Owned Business serves customers outside $� the agency and provides realistic work experiences and can be located at the program site or in the community. Non-paid(Volunteer)Work Experience: Non-paid (volunteer)jobs in an agency or volunteer work in the community that provides exposure to the standard expectations of employment. Other Gainful/ Employment Activity: Any informal employment activity that increases the partner's income(e.g., recycling, gardening, babysitting)OR participation in formal structured classes and/or workshops providing instruction on issues pertinent to getting a job. (Does NOT include such $0 activities as panhandling or illegal activities such as prostitution.) The partner is not employed at this time. F Does one of the partner's current recovery goals include any kind of ( Yes No employment at this time? 5 Exhibit G I DCR - PAF, KET & 3M Forms Page 6 of 22 SOURCES OF FINANCIAL SUPPORT DURING THE PAST 12 MONTHS CURRENTLY Indicate all the sources of financial support used to meet the needs of the partner: (mark all that (mark all that apply) apply) Partner's Wages F F Partner's Spouse/Significant Other's Wages F F Savings F F Other Family Member/ Friend F F Retirement/Social Security Income F- r Veteran's Assistance Benefits r F- Loan/Credit r F- Housing Subsidy r r General Relief/General Assistance F r Food Stamps F F- Temporary Assistance for Needy Families (TANF) F F- Supplemental Security Income/State Supplementary Payment(SSI /SSP) Program F r Social Security Disability Insurance (SSDI) F F- State Disability Insurance (SDI) F T- American Indian Tribal Benefits (e.g., per capita, revenue sharing, trust disbursements) F F Other F F No Financial Support F F 6 Exhibit G I DCR - PAF, KET & 3M Forms Page 7 of 22 LEGAL ISSUES/ DESIGNATIONS JUSTICE SYSTEM INVOLVEMENT ARREST INFORMATION Indicate the number of times the partner was arrested DURING THE PAST 12 MONTHS: Was the partner arrested anytime PRIOR TO THE LAST 12 MONTHS? Yes {' No PROBATION INFORMATION Is the partner CURRENTLY on probation? � Yes r No Was the partner on probation DURING THE PAST 12 MONTHS? . Yes t` No Was the partner on probation anytime PRIOR TO THE LAST 12 MONTHS? Yes r No PAROLE INFORMATION Was the partner on any kind of parole DURING THE PAST 12 MONTHS? _ Yes r No Was the partner on any kind of parole anytime PRIOR TO THE LAST 12 MONTHS? (" Yes r No CONSERVATORSHIP 1 PAYEE INFORMATION CONSERVATORSHIP INFORMATION Is the partner CURRENTLY on conservatorship? Yes r No Was the partner on conservatorship DURING THE PAST 12 MONTHS? r` Yes +r No Was the partner on conservatorship anytime PRIOR TO THE LAST 12 MONTHS? r Yes r No PAYEE INFORMATION Does the partner CURRENTLY have a payee? � Yes C' No Did the partner have a payee DURING THE PAST 12 MONTHS? r Yes r No Did the partner have a payee anytime PRIOR TO THE LAST 12 MONTHS? "- Yes +r No CUSTODY INFORMATION Indicate the total number of children the partner has who are CURRENTLY: Placed on W& I Code 300 Status: (Dependent of the court) Placed in Foster Care: Legally Reunified with partner: Adopted out: 7 Exhibit G I DCR - PAF, KET & 3M Forms Page 8 of 22 EMERGENCY INTERVENTION Please indicate the number of emergency interventions(e.g.,emergency room visit, crisis stabilization unit)the partner had DURING THE PAST 12 MONTHS that were: Physical Health Related Mental Health/Substance Abuse Related HEALTH STATUS Does the partner have a primary care physician CURRENTLY? Yes No Did the partner have a primary care physician DURING THE PAST 12 MONTHS? Yes No SUBSTANCE ABUSE In the opinion of the partnership service coordinator, has the partner ever had a co- occurring mental illness and substance use problem? Yes No In the opinion of the partnership service coordinator, does the partner CURRENTLY have �- Yes C No an active co-occurring mental illness and substance use problem? Is the partner CURRENTLY receiving substance abuse services? Yes No COUNTY USE QUESTIONS COUNTY USE QUESTIONS VALUES To be tracked on the KEY EVENT TRACKING form: County Use Field# 1 County Use Field# 2 County Use Field# 3 To be tracked on the QUARTERLY ASSESSMENT form: County Use Field# 1 County Use Field# 2 County Use Field# 3 8 Exhibit G DCR - PAF, KET & 3M Forms ADULT of 2 FULL SERVICE PARTNERSHIP 5/1/07 Adult Key Event Tracking Form FOR AGES 26-59 YEARS PARTNERSHIP INFORMATION County CSI County Client Number (CCN) County Partner ID (optional) Partner's First Name Partner's Last Name Date Completed (mm/dd/yyyy) Partner's Date of Birth (mm/dd/yyyy) CHANGE IN ADMINISTRATIVE INFORMATION (Skip this section if there are no changes) PARTNERSHIP STATUS Date of Provider Number Change (mm/dd/yyyy): / NPI NEW Provider Number: / NPI Date of Full Service Partnership Program ID Change (mm/dd/yyyy): NEW Full Service Partnership Program ID: Date of Partnership Service Coordinator ID Change (mm/dd/yyyy): NEW Partnership Service Coordinator ID: 1 Exhibit G I DCR - PAF, KET & 3M Forms Page 10 of 22 CHANGE IN ADMINISTRATIVE INFORMATION (Skip this section 0there are no changes) (Continued) Date of Partnership Status Change (mm/dd/yyyy): Indicate NEW partnership status: r Discontinuation /Interruption of Full Service Partnership and/or community services/program (indicate reason below) Reestablishment of Full Service Partnership and /or community services/ program If there is a DISCONTINUATION/ INTERRUPTION of Full Service Partnership and /or community services/program, indicate the reason (mark one): Target population criteria are not met. !^ Partner decided to discontinue Full Service Partnership participation after partnership established. Partner moved to another county/service area. After repeated attempts to contact partner, s/he cannot be located. Community services/program interrupted —Partner's circumstances reflect a need for residential/institutional mental health services at this time [such as an Institution for Mental Disease (IMD), Mental Health Rehabilitation Center(MHRC), State Hospital]. Community services/program interrupted —Partner will be serving JAIL sentence. C Community services/program interrupted —Partner will be serving PRISON sentence. r Partner has successfully met his/ her goals such that discontinuation of Full Service Partnership is appropriate. r Partner is deceased. PROGRAM INFORMATION Date of Program Change Program Name Currently Involved? (mm/dd/yyyy) A62034 Now enrolled in the AB2034 Program No longer participating in the AB2034 Program r Now enrolled in the GHI Program Governor's Homeless Initiative (GHI) No longer participating in the GHI Program Now enrolled in the MHSA Housing Program MHSA Housing Program C' No longer participating in the MHSA Housing Program 2 Exhibit G I DCR - PAF, KET & 3M Forms Page 11 of 22 RESIDENTIAL INFORMATION - includes hospitalization and incarceration(skip this section if there are no changes) Date of Residential Status Change (mm/dd/yyyy): SETTING Indicate the new residential status (mark one): GENERAL LIVING ARRANGEMENT In an apartment or house alone /with spouse/ partner/ minor children / `, other dependents/ roommate—must hold lease or share in rent/mortgage With one or both biological /adoptive parents C' With adult family member(s) other than parents C' Single Room Occupancy (must hold lease) C' SHELTER/ HOMELESS Emergency Shelter/ Temporary Housing (includes people living with friends C, but paying no rent) Homeless (includes people living in their cars) C' SUPERVISED PLACEMENT Unlicensed but supervised individual placement (includes paid caretakers. C, personal care attendants) Assisted Living Facility C' Unlicensed but supervised congregate placement (includes group living C homes. sober living homes) Licensed Community Care Facility (Board and Care) C HOSPITAL Acute Medical Hospital C' Acute Psychiatric Hospital / Psychiatric Health Facility (PHF) C' State Psychiatric Hospital C' RESIDENTIAL PROGRAM Licensed Residential Treatment (includes crisis, short-term, long-term, C' substance abuse, dual diagnosis residential programs) Skilled Nursing Facility (physical) C' Skilled Nursing Facility (psychiatric) C' Long-Term Institutional Care [Institution for Mental Disease (IMD), Mental r Health Rehabilitation Center (MHRC)] JUSTICE PLACEMENT Jail C' OTHER Other C' Unknown C' 3 Exhibit G I DCR - PAF, KET & 3M Forms Page 12 of 22 EDUCATION (Skip this section if there are no changes) GRADE LEVEL INFORMATION Date of Grade Level Completion (mm/dd/yyyy): Level of education completed: No High School Diploma/No GED Associate's Degree (e.g.,A.A.,A.S.)/Technical or Vocational Degree GED Coursework Bachelor's Degree (e.g., B.A., B.S.) High School Diploma/GED Master's Degree (e.g., M.A., M.S.) C Some College/Some Technical or Vocational C Doctoral Degree (e.g., M.D., Ph.D.) Training EDUCATIONAL SETTING INFORMATION Date of Educational Setting Change (mm/dd/yyyy): If there are any educational setting changes, indicate ALL new and ongoing statuses including those previously reported. Setting Not in school of any kind F- High School/Adult Education F- Technical/Vocational School F- Community College/4 year College F- Graduate School F- Other F- If stopping school, did the partner complete a class and/or program? Yes No Does one of the partner's current recovery goals include any C' Yes No kind of education at this time? 4 Exhibit G I DCR - PAF, KET & 3M Forms EMPLOYMENT (Skip this section if there are no changes) Page 13 of 22 Date of Employment Change (mm/dd/yyyy): CURRENT EMPLOYMENT If there are any changes to the partner's employment, indicate ALL new and ongoing AVERAGE AVERAGE statuses including those previously reported. HOURS perWEEK HOURLY WAGE Competitive Employment: Paid employment in the community in a position that is also open to individuals without a $� disability. Supported Employment: Competitive Employment(see above)with ongoing on-site or off-site job-related support $� services provided. Transitional Employment/Enclave: Paid jobs in the community that are 1)open only to individuals with a disability AND 2) are either time-limited for the purpose of moving to a more permanent job OR are part of a group of disabled individuals who are working as a team in the midst of teams of non- $0 disabled individuals who are performing the same work. Paid In-House Work(Sheltered Workshop/Work Experience/Agency-Owned Business): Paid jobs open only to program participants with a disability.A Sheltered Workshop usually offers sub-minimum wage work in a simulated environment.A Work Experience (Adjustment) Program within an agency provides exposure to the standard expectations and advantages of employment. An Agency-Owned Business serves customers outside $0 the agency and provides realistic work experiences and can be located at the program site or in the community. Non-paid(Volunteer)Work Experience: Non-paid (volunteer)jobs in an agency or volunteer work in the community that provides exposure to the standard expectations of employment. Other Gainful/Employment Activity: Any informal employment activity that increases the partner's income (e.g., recycling, gardening, babysitting)OR participation in formal structured classes and/or workshops providing instruction on issues pertinent to getting a job. (Does NOT include such $� activities as panhandling or illegal activities such as prostitution.) The partner is not employed at this time. F Does one of the partner's current recovery goals include any C Yes C No kind of employment at this time? 5 Exhibit G I DCR - PAF, KET & 3M Forms LEGAL ISSUES/DESIGNATIONS (Skip this section if there are no changes) Page 14 of 22 ARREST INFORMATION Date Partner Arrested (mm/dd/yyyy): PROBATION INFORMATION Date of Probation Status Change (mm/dd/yyyy): Indicate new probation status: C Removed from Probation Placed on Probation CONSERVATORSHIP INFORMATION Date of Conservatorship Status Change (mm/dd/yyyy): Indicate new conservatorship status: �' Removed from conservatorship Placed on conservatorship PAYEE INFORMATION Date of Payee Status Change(mm/dd/yyyy): Indicate new payee status: �' Removed from payee status Placed on payee status EMERGENCY INTERVENTION (Skip this section if there are no chap es Date of Emergency Intervention (mm/dd/yyyy): Indicate the type of emergency intervention: (e.g., emergency room visit, crisis stabilization unit) C Physical Health Related Mental Health/Substance Abuse Related COUNTY USE QUESTIONS (Skip this section if there are no changes) DATE of CHANGE COUNTY USE QUESTIONS NEW VALUE (mmldd/yyyy) County Use Field# 1 County Use Field#2 County Use Field# 3 6 Exhibit G DCR - PAF KET & 3M Forms FULL SERVICE PARTNERSHIP OLDER Aftterlllket2 5/1/07 Older Adult Key Event Tracking Form FOR AGES 60+ YEARS PARTNERSHIP INFORMATION County CSI County Client Number (CCN) County Partner ID (optional) Partner's First Name Partner's Last Name Date Completed (mm/dd/yyyy) Partner's Date of Birth (mm/dd/yyyy) 1 Exhibit G DCR - PAF, KET & 3M Forms CHANGE IN ADMINISTRATIVE INFORMATION (Skip this section if there are no changes) Page 16 of 22 PARTNERSHIP STATUS Date of Provider Number Change (mm/dd/yyyy): / NPI NEW Provider Number: / NPI Date of Full Service Partnership Program ID Change (m m/dd/yyyy): NEW Full Service Partnership Program ID: Date of Partnership Service Coordinator ID Change (mm/dd/yyyy): NEW Partnership Service Coordinator ID: Date of Partnership Status Change (mm/dd/yyyy): Indicate NEW partnership status: Discontinuation / Interruption of Full Service Partnership and /or community services / program (indicate reason below) Reestablishment of Full Service Partnership and /or community services/program If there is a DISCONTINUATION / INTERRUPTION of Full Service Partnership and /or community services/ program, indicate the reason (mark one): Target population criteria are not met. Partner decided to discontinue Full Service Partnership participation after partnership established. Partner moved to another county/service area. After repeated attempts to contact partner, s/he cannot be located. Community services /program interrupted — Partner's circumstances reflect a need for residential / institutional mental health services at this time [such as an Institution for Mental Disease (IMD). Mental Health Rehabilitation Center(MHRC), State Hospital]. l Community services /program interrupted — Partnerwill be serving JAIL sentence. Community services /program interrupted — Partner will be serving PRISON sentence. Partner has successfully met his/ her goals such that discontinuation of Full Service Partnership is appropriate. Partner is deceased. PROGRAM INFORMATION Date of Program Change Program Name Currently Involved? (mmldd/yyyy) AB2034 Now enrolled in the AB2034 Program No longer participating in the AB2034 Program Now enrolled in the GHI Program Governor's Homeless Initiative (GHI) No longer participating in the GHI Program Now enrolled in the MHSA Housing Program MHSA Housing Program No longer participating in the MHSA Housing Program 2 Exhibit G I DCR - PAF, KET & 3M Forms RESIDENTIAL INFORMATION - includes hospitalization and incarceration (skip this section it there are no changes) Page 17 of 22 Date of Residential Status Change (mm/dd/yyyy): SETTING Indicate the new residential status(mark one): GENERAL LIVING ARRANGEMENT In an apartment or house alone/with spouse/partner/minor children other dependents/roommate—must hold lease or share in rent/mortgage With one or both biological/adoptive parents With adult family member(s)other than parents Single Room Occupancy(must hold lease) SHELTER/HOMELESS Emergency Shelter/Temporary Housing (includes people living with friends but paying no rent) Homeless (includes people living in their cars) SUPERVISED PLACEMENT Unlicensed but supervised individual placement(includes paid caretakers, _ personal care attendants) Assisted Living Facility Unlicensed but supervised congregate placement(includes group living C' homes, sober living homes) Licensed Community Care Facility(Board and Care) <' HOSPITAL Acute Medical Hospital <' Acute Psychiatric Hospital/Psychiatric Health Facility(PHF) C State Psychiatric Hospital C' RESIDENTIAL PROGRAM Licensed Residential Treatment(includes crisis, short-term, long-term, `, substance abuse, dual diagnosis residential programs) Skilled Nursing Facility (physical) l' Skilled Nursing Facility (psychiatric) <' Long-Term Institutional Care [Institution for Mental Disease (IMD), Mental C Health Rehabilitation Center(MHRC)] JUSTICE PLACEMENT Jail OTHER Other C Unknown 3 Exhibit G I DCR - PAF, KET & 3M Forms EDUCATION (Skip this section if there are no changes) Page 18 of 22 GRADE LEVEL INFORMATION Date of Grade Level Completion (mm/dd/yyyy): Level of education completed: No High School Diploma/No GED Associate's Degree (e.g., A.A., A.S.)/Technical or Vocational Degree GED Coursework Bachelor's Degree (e.g., B.A., B.S.) High School Diploma/GED Master's Degree(e.g., M.A., M.S.) Some College/Some Technical or Vocational r Doctoral Degree (e.g., M.D., Ph.D.) Training EDUCATIONAL SETTING INFORMATION Date of Educational Setting Change (mm/dd/yyyy): If there are any educational setting changes, indicate ALL new and ongoing statuses including those previously reported. Setting Not in school of any kind F- High School/Adult Education F Technical/Vocational School F Community College/4 year College r Graduate School Other r If stopping school, did the partner complete a class and/or program? Yes No Does one of the partner's current recovery goals include any C Yes No kind of education at this time? 4 Exhibit G I DCR - PAF, KET & 3M Forms EMPLOYMENT (Skip this section if there are no changes) Page 19 of 22 Date of Employment Change (mm/dd/yyyy): CURRENT EMPLOYMENT If there are any changes to the partner's employment, indicate ALL new and ongoing AVERAGE AVERAGE HOURS per statuses including those previously reported. WEEK HOURLY WAGE Competitive Employment: Paid employment in the community in a position that is also open to individuals without a $� disability. Supported Employment: Competitive Employment(see above)with ongoing on-site or off-site job-related support $� services provided. Transitional Employment/Enclave: Paid jobs in the community that are 1) open only to individuals with a disability AND 2) are either time-limited for the purpose of moving to a more permanent job OR are part of a group of disabled individuals who are working as a team in the midst of teams of non- $0 disabled individuals who are performing the same work. Paid In-House Work(Sheltered Workshop/Work Experience/Agency-Owned Business): Paid jobs open only to program participants with a disability. A Sheltered Workshop usually offers sub-minimum wage work in a simulated environment. A Work Experience (Adjustment) Program within an agency provides exposure to the standard expectations and advantages of employment. An Agency-Owned Business serves customers outside $� the agency and provides realistic work experiences and can be located at the program site or in the community. Non-paid (Volunteer)Work Experience: Non-paid (volunteer)jobs in an agency or volunteer work in the community that provides exposure to the standard expectations of employment. Other Gainful/Employment Activity: Any informal employment activity that increases the partner's income (e.g., recycling, gardening, babysitting) OR participation in formal structured classes and/or workshops providing instruction on issues pertinent to getting a job. (Does NOT include such $� activities as panhandling or illegal activities such as prostitution.) The partner is not employed at this time. Does one of the partner's current recovery goals include any kind of employment at this time? < Yes C No 5 Exhibit G I DCR - PAF, KET & 3M Forms LEGAL ISSUES/ DESIGNATIONS (Skip this section if there are no changes) Page 20 of 22 ARREST INFORMATION Date Partner Arrested (mm/dd/yyyy): PROBATION INFORMATION Date of Probation Status Change (mm/dd/yyyy): Indicate new probation status: C Removed from Probation C Placed on Probation CONSERVATORSHIP INFORMATION Date of Conservatorship Status Change (mm/dd/yyyy): Indicate new conservatorship status: � Removed from conservatorship Placed on conservatorship PAYEE INFORMATION Date of Payee Status Change (mm/dd/yyyy): Indicate new payee status: Removed from payee status Placed on payee status EMERGENCY INTERVENTION tSkip this section if there are nc chan es' Date of Emergency Intervention (mm/dd/yyyy): Indicate the type of emergency intervention: (e.g., emergency room visit, crisis stabilization unit) Physical Health Related Mental Health / Substance Abuse Related COUNTY USE QUESTIONS (Skip this section if there are no changes) DATE of CHANGE (mm/ddlyyyy) COUNTY USE QUESTIONS NEW VALUE County Use Field # 1 7771 County Use Field # 2 County Use Field# 3 7771 6 Exhibit G DCR - PAF KET & 3M Forms FULL SERVICE PARTNERSHIP ADBEeMIof 2 5/1/07 Adult Quarterly Assessment Form FOR AGES 26-59 YEARS PARTNERSHIP INFORMATION County CSI County Client Number (CCN) County Partner ID (optional) Partner's First Name Partner's Last Name Date Completed (mm/dd/yyyy) Partner's Date of Birth (mm/dd/yyyy) SOURCES OF FINANCIAL SUPPORT CURRENTLY Indicate all the sources of financial support used to meet the needs of the partner: (mark all that apply) Partner's Wages Partner's Spouse/ Significant Other's Wages Savings Other Family Member/ Friend r Retirement/ Social Security Income r Veteran's Assistance Benefits r Loan /Credit F Housing Subsidy r General Relief/General Assistance r Food Stamps r Temporary Assistance for Needy Families (TANF) F Supplemental Security Income/ State Supplementary Payment (SSI / SSP) Program r Social Security Disability Insurance (SSDI) r State Disability Insurance(SDI) r American Indian Tribal Benefits (e.g., per capita, revenue sharing, trust disbursements) F Other F No Financial Support r 1 Exhibit G DCR - PAF, KET & 3M Forms Page 22 of 22 LEGAL ISSUES/ DESIGNATIONS CUSTODY INFORMATION Indicate the total number of children the partner has who are CURRENTLY: Placed on W& I Code 300 Status: (Dependent of the court) Placed in Foster Care: Legally Reunified with partner: Adopted out: HEALTH STATUS Does the partner have a primary care physician CURRENTLY? �' Yes �' No SUBSTANCE ABUSE In the opinion of the partnership service coordinator, does the partner CURRENTLY have �- Yes r No an active co-occurring mental illness and substance use problem? Is the partner CURRENTLY receiving substance abuse services? � Yes No COUNTY USE QUESTIONS COUNTY USE QUESTIONS NEW VALUE County Use Field# 1 County Use Field#2 County Use Field#3 2 Exhibit H FSP-AOT Rates Fresno County Department of Behavioral Health Specialty Mental Health Services Outpatient Rates FSP and AOT Provider Rate Provider Type Per Hour Psychiatrist/Contracted Psychiatrist $1,140.98 Physicians Assistant $511.73 Nurse Practitioner $567.38 RN $463.45 Certified Nurse Specialist $567.38 LVN $243.47 Pharmacist $546.16 Licensed Psychiatric Technician $208.72 Psychologist/Pre-licensed Psychologist $458.87 LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA(MFT LCSW LPCC) $296.95 Occupational Therapist $395.28 Mental Health Rehab Specialist $223.41 Peer Recovery Specialist $234.58 Other Qualified Providers-Other Designated MH staff that bill medical $223.41 Exhibit H1 - Compensation Page 1 of 12 Adult FSP Master Agreement-Vista Turning Point of Central California,Inc. Fiscal Year(FY)2023-24 PROGRAM EXPENSES 1000:DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct# Administrative Position FTE Admin Program Total 1101 $ 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 1115 Direct Personnel Admin Salaries Subtotal 0.00 - Acct# Program Position FTE Admin Program Total 1116 $ 1117 1118 1119 1120 1121 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 Direct Personnel Program Salaries Subtotall 0.00 1 $ $ Admin Program Total Direct Personnel Salaries Subtotall 0.00 1 $ - $ Direct Employee Benefits Acct# Description Admin Program Total 1201 Retirement $ 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) - - 1205 Other(specify) - - - 1206 Other(specify) - - - Direct Employee Benefits Subtotal: $ - $ - $ - Direct Payroll Taxes&Expenses: Acct# Description Admin Program Total 1301 OASDI $ $ $ 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) Direct Payroll Taxes&Expenses Subtotal: $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program #DIV/0! #DIV/01 Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H1 - Compensation Pa e2of12 2000:DIRECT CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care $ 2002 Client Housing Support 547,998 2003 Client Transportation&Support 3,000 2004 Clothing,Food,&Hygiene 2,800 2005 Education Support 2006 Employment Support 2007 Household Items for Clients 2008 Medication Supports 39,750 2009 Program Supplies-Medical 4,300 2010 Utility Vouchers 12,000 2011 Client Building Maintenance 2012 Client Therapy 2013 Client Activities/Recreation 6,500 2014 Client Personal Needs 2015 Client Food 1,500 2016 Other(specify) - DIRECT CLIENT CARE TOTAL $ 617,848 3000:DIRECT OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ - 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 1 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) DIRECT OPERATING EXPENSES TOTAL: $ - 4000:DIRECT FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) DIRECT FACILITIES/EQUIPMENTTOTAL: $ 5000:DIRECT SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network&Data Management) $ 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 1 Other(specify) 5007 Other(specify) 5008 Other(specify) DIRECT SPECIAL EXPENSES TOTAL: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H1 - Compensation Pa e3of12 6000:INDIRECT EXPENSES Acct# Line Item Description Amount Administrative Overhead 6001 Use this line and only this line for approved indirect cost rate $ Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation wrovide,-0—dit Equipment tobeUsedfor Program vo.Poses/ 6008 Personnel(indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 Other(specify) INDIRECT EXPENSES TOTAL $ INDIRECT COST RATE 0.00% 7000:DIRECT FIXED ASSETS Acct# Line Item Description Amount 7001 Computer Equipment&Software $ - 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data - 7003 Furniture&Fixtures - 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ - 7006 Assets over$5,000/unit(Specify) - 7007 Other(specify) - 7008 Other(specify) - FIXED ASSETS EXPENSES TOTAL $ - TOTAL PROGRAM EXPENSES $ 617,848 PROGRAM FUNDING SOURCES 8100-SUBSTANCE USE DISORDER FUNDS Acct# Line Item Description Amount 8101 Drug Medi-Cal $ 8102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acct# Line Item Description Amount 8201 lRealignment $ REALIGNMENT TOTAL $ - 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports Turning Point Vista Adult FSP $ 617,848 8302 PEI-Prevention&Early Intervention - 8303 INN-Innovations 8304 WET-Workforce Education&Training 8305 CFTN-Capital Facilities&Technology - MHSA TOTAL $ 617,848 8400-OTHER REVENUE Acct# Line Item Description Amount 8401 Client Fees $ 8402 Client Insurance 8403 Grants(ARPA) 8404 Other(Specify) 8405 Other(Specify) OTHER REVENUE TOTAL $ TOTAL PROGRAM FUNDING SOURCES: $ 617,848 NET PROGRAM COST: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H1 - Compensation Page 4 of 12 Adult FSP Master Agreement-Vista Turning Point of Central California,Inc. Fiscal Year(FY)2023-24 Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:DIRECT SALARIES&BENEFITS Administrative Positions 1101 0 1102 0 1103 0 1104 0 1105 0 1106 0 1107 0 1108 0 1109 0 1110 0 1111 0 1112 0 1113 0 1114 0 1115 0 Program Positions 1116 0 1117 0 1118 0 1119 0 1120 0 1121 0 1122 0 1123 0 1124 0 1125 0 1126 0 1127 0 1128 0 1129 0 1130 0 1131 0 1132 0 1133 0 1134 0 Direct Employee Benefits 1201 Retirement 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) 1205 Other(specify) 1206 Other(specify) Direct Payroll Taxes&Expenses: 1301 OASDI 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) - 2000:DIRECT CLIENT SUPPORT 617,848 2001 Child Care - 2002 Client Housing Support 547,998 10-7060 Client Housing Assistance:Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&care,etc.) 2003 Client Transportation&Support 3,000 10-7015 Client Transportation:Cost for client transportation.(Examples:bus tokens/passes,taxi,other public transportation,bicycles,etc.) 2004 Clothing,Food,&Hygiene 2,800 10-7021 Client Clothing&Hygiene:Cost of client hygiene supplies and non-work related clothing.(Examples:clothes,shoes,hats,beanies,scarves,soap,toothpaste,deodorant, grooming supplies,hair accessories,diapers,etc.) 2005 Education Support - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H1 - Compensation Page 5 of 12 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2006 Employment Support - 2007 Household Items for Clients 2008 Medication Supports 39,750 10-7030 Client Medical Expense:Cost of medical supplies or treatment/medical expense for a specific client.(Examples:co-pays*,prescription/lab work not covered by insurance,over-the-counter medications*,first aid kit/supplies for client's use at home, etc.)*if allowable per contract 2009 Program Supplies-Medical 4,300 10-6122 Program Supplies-Medical:Cost of medical supplies to be used by staff or clients at the program location to meet program objective.Such items are to remain at the program location and not sent home with the client.Such items include,but are not limited to first aid kits,blood pressure monitor,latex gloves,syringes,hazard disposal service,sunblock,insect repellent,*over-the-counter medication/vitamins-if allowable per contract*,etc. 2010 Utility Vouchers 12,000 10-7023 Client Utility/Rental Security Deposits:Cost of client utility bills and/or security deposits. 2011 Client Building Maintenance - 2012 Client Therapy - 2013 Client Activities/Recreation 6,500 7010 Client Activities/Recreation:Cost for client activities&recreation events. (Examples:cable bill,food/drinks/utensils/decorations needed for a specific client event,incentive rewards,cash reinforcer,admission fees to events,etc.) 2014 Client Personal Needs - 2015 Client Food 1,500 7025 Client Food Non-Resident:Cost of food for a particular client to be consumed while off site of program location.(Examples:groceries for client's home,prepared meal,restaurant gift card*w/clients initials/#,etc.) 2016 Other(specify) 3000:DIRECT OPERATING EXPENSES 3001 Telecommunications 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 1 Other(specify) 4000:DIRECT FACILITIES&EQUIPMENT 4001 Building Maintenance 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) 5000:DIRECT SPECIAL EXPENSES 5001 Consultant(Network&Data Management) 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 Other(specify) 5007 Other(specify) 5008 1 Other(specify) 6000:INDIRECT EXPENSES 6001 Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H1 - Compensation Page 6 of 12 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 6005 1 Insurance(Specify): 6006 Payroll Services 6007 Depreciation(Provider-Owned Equipment to be Used 6008 Personnel(Indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 Other(specify) 7000:DIRECT FIXED ASSETS 7001 Computer Equipment&Software 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 7003 Furniture&Fixtures 7004 Leasehold/Tenant/Building Improvements 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) 7007 Other(specify) 7008 1 Other(specify) TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 617,848 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 617,848 BUDGET CHECK: - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H1 - Compensation Page 7 of 12 Adult FSP Master Agreement-Vista Turning Point of Central California,Inc. Fiscal Year(FY)2024-25 PROGRAM EXPENSES 1000:DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct# Administrative Position FTE Admin Program Total 1101 $ 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 1115 Direct Personnel Admin Salaries Subtotal 0.00 - Acct# Program Position FTE Admin Program Total 1116 $ 1117 1118 1119 1120 1121 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 Direct Personnel Program Salaries Subtotall 0.00 1 $ $ Admin Program Total Direct Personnel Salaries Subtotall 0.00 1 $ - $ Direct Employee Benefits Acct# Description Admin Program Total 1201 Retirement $ 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) 1205 Other(specify) 1206 Other(specify) Direct Employee Benefits Subtotal: $ $ $ Direct Payroll Taxes&Expenses: Acct# Description Admin Program Total 1301 OASDI $ - 1302 FICA/MEDICARE - - - 1303 SUI - - - 1304 Other(specify) - - - 1305 Other(specify) - - - 1306 Other(specify) - - - Direct Payroll Taxes&Expenses Subtotal: $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program #DIV/01 #DIV/0! Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H1 - Compensation Pa e8of12 2000:DIRECT CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care $ 2002 Client Housing Support 566,538 2003 Client Transportation&Support 3,000 2004 Clothing,Food,&Hygiene 2,800 2005 Education Support - 2006 Employment Support 2007 Household Items for Clients - 2008 Medication Supports 39,750 2009 Program Supplies-Medical 4,300 2010 Utility Vouchers 12,000 2011 Other(specify) 2012 Other(specify) - 2013 Other(specify) 6,500 2014 Other(specify) - 2015 Other(specify) 1,500 2016 Other(specify) - DIRECT CLIENT CARE TOTAL $ 636,388 3000:DIRECT OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ - 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 1 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) DIRECT OPERATING EXPENSES TOTAL: $ - 4000:DIRECT FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) DIRECT FACILITIES/EQUIPMENTTOTAL: $ 5000:DIRECT SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network&Data Management) $ 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 1 Other(specify) 5007 Other(specify) 5008 Other(specify) DIRECT SPECIAL EXPENSES TOTAL: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H1 - Compensation Pa e9of12 6000:INDIRECT EXPENSES Acct# Line Item Description Amount Administrative Overhead 6001 Use this line and only this line for approved indirect cost rate $ Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation wrovide,-0—dit Equipment tobeUsedfor Program vo.Poses/ 6008 Personnel(indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 Other(specify) INDIRECT EXPENSES TOTAL $ INDIRECT COST RATE 0.00% 7000:DIRECT FIXED ASSETS Acct# Line Item Description Amount 7001 Computer Equipment&Software $ - 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data - 7003 Furniture&Fixtures - 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ - 7006 Assets over$5,000/unit(Specify) - 7007 Other(specify) - 7008 Other(specify) - FIXED ASSETS EXPENSES TOTAL $ - TOTAL PROGRAM EXPENSES $ 636,388 PROGRAM FUNDING SOURCES 8100-SUBSTANCE USE DISORDER FUNDS Acct# Line Item Description Amount 8101 Drug Medi-Cal $ 8102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acct# Line Item Description Amount 8201 lRealignment $ REALIGNMENT TOTAL $ - 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports Turning Point Vista Adult FSP $ 636,388 8302 PEI-Prevention&Early Intervention - 8303 INN-Innovations 8304 WET-Workforce Education&Training 8305 CFTN-Capital Facilities&Technology - MHSA TOTAL $ 636,388 8400-OTHER REVENUE Acct# Line Item Description Amount 8401 Client Fees $ 8402 Client Insurance 8403 Grants(ARPA) 8404 Other(Specify) 8405 Other(Specify) OTHER REVENUE TOTAL $ TOTAL PROGRAM FUNDING SOURCES: $ 636,388 NET PROGRAM COST: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H1 - Compensation Page 10 of 12 Adult FSP Master Agreement-Vista Turning Point of Central California,Inc. Fiscal Year(FY)2024-25 Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:DIRECT SALARIES&BENEFITS Administrative Positions 1101 0 1102 0 1103 0 1104 0 1105 0 1106 0 1107 0 1108 0 1109 0 1110 0 1111 0 1112 0 1113 0 1114 0 1115 0 Program Positions 1116 0 1117 0 1118 0 1119 0 1120 0 1121 0 1122 0 1123 0 1124 0 1125 0 1126 0 1127 0 1128 0 1129 0 1130 0 1131 0 1132 0 1133 0 1134 0 Direct Employee Benefits 1201 Retirement 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) 1205 Other(specify) 1206 Other(specify) Direct Payroll Taxes&Expenses: 1301 OASDI 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) - 2000:DIRECT CLIENT SUPPORT 636,388 2001 Child Care - 2002 Client Housing Support 566,538 10-7060 Client Housing Assistance:Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&care,etc.) 2003 Client Transportation&Support 3,000 10-7015 Client Transportation:Cost for client transportation.(Examples:bus tokens/passes,taxi,other public transportation,bicycles,etc.) 2004 Clothing,Food,&Hygiene 2,800 10-7021 Client Clothing&Hygiene:Cost of client hygiene supplies and non-work related clothing.(Examples:clothes,shoes,hats,beanies,scarves,soap,toothpaste,deodorant, grooming supplies,hair accessories,diapers,etc.) 2005 Education Support - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H1 - Compensation Page 11 of 12 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2006 Employment Support - 2007 Household Items for Clients 2008 Medication Supports 39,750 10-7030 Client Medical Expense:Cost of medical supplies or treatment/medical expense for a specific client.(Examples:co-pays*,prescription/lab work not covered by insurance,over-the-counter medications*,first aid kit/supplies for client's use at home, etc.)*if allowable per contract 2009 Program Supplies-Medical 4,300 10-6122 Program Supplies-Medical:Cost of medical supplies to be used by staff or clients at the program location to meet program objective.Such items are to remain at the program location and not sent home with the client.Such items include,but are not limited to first aid kits,blood pressure monitor,latex gloves,syringes,hazard disposal service,sunblock,insect repellent,*over-the-counter medication/vitamins-if allowable per contract*,etc. 2010 Utility Vouchers 12,000 10-7023 Client Utility/Rental Security Deposits:Cost of client utility bills and/or security deposits. 2011 Client Building Maintenance - 2012 Client Therapy - 2013 Client Activities/Recreation 6,500 7010 Client Activities/Recreation:Cost for client activities&recreation events. (Examples:cable bill,food/drinks/utensils/decorations needed for a specific client event,incentive rewards,cash reinforcer,admission fees to events,etc.) 2014 Client Personal Needs - 2015 Client Food 1,500 7025 Client Food Non-Resident:Cost of food for a particular client to be consumed while off site of program location.(Examples:groceries for client's home,prepared meal,restaurant gift card*w/clients initials/#,etc.) 2016 Other(specify) 3000:DIRECT OPERATING EXPENSES 3001 Telecommunications 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 1 Other(specify) 4000:DIRECT FACILITIES&EQUIPMENT 4001 Building Maintenance 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) 5000:DIRECT SPECIAL EXPENSES 5001 Consultant(Network&Data Management) 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 Other(specify) 5007 Other(specify) 5008 1 Other(specify) 6000:INDIRECT EXPENSES 6001 Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H1 - Compensation Page 12 of 12 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 6005 1 Insurance(Specify): 6006 Payroll Services 6007 Depreciation(Provider-Owned Equipment to be Used 6008 Personnel(Indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 Other(specify) 7000:DIRECT FIXED ASSETS 7001 Computer Equipment&Software 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 7003 Furniture&Fixtures 7004 Leasehold/Tenant/Building Improvements 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) 7007 Other(specify) 7008 1 Other(specify) TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 636,388 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 636,388 BUDGET CHECK: - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H2 - Compensation Page 1 of 12 Adult FSP Master Agreement-Sunrise Turning Point of Central California,Inc. Fiscal Year(FY)2023-24 PROGRAM EXPENSES 1000:DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct# Administrative Position FTE Admin Program Total 1101 $ 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 1115 Direct Personnel Admin Salaries Subtotal 0.00 - Acct# Program Position FTE Admin Program Total 1116 $ 1117 1118 1119 1120 1121 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 Direct Personnel Program Salaries Subtotall 0.00 1 $ $ Admin Program Total Direct Personnel Salaries Subtotall 0.00 1 $ - $ Direct Employee Benefits Acct# Description Admin Program Total 1201 Retirement $ 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) - - 1205 Other(specify) - - - 1206 Other(specify) - - - Direct Employee Benefits Subtotal: $ - $ - $ - Direct Payroll Taxes&Expenses: Acct# Description Admin Program Total 1301 OASDI $ $ $ 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) Direct Payroll Taxes&Expenses Subtotal: $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program #DIV/0! #DIV/0! Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H2 - Compensation Pa e2of12 2000:DIRECT CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care $ 2002 Client Housing Support 538,898 2003 Client Transportation&Support 1,600 2004 Clothing,Food,&Hygiene 9,000 2005 Education Support 150 2006 Employment Support 100 2007 Household Items for Clients 2008 Medication Supports 38,200 2009 Program Supplies-Medical 6,500 2010 Utility Vouchers 8,000 2011 Client Building Maintenance 1,000 2012 Client Therapy 200 2013 Client Activities/Recreation 10,000 2014 Client Personal Needs 1,000 2015 Client Food 2,000 2016 Client Furnishings 1,200 DIRECT CLIENT CARE TOTAL $ 617,848 3000:DIRECT OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ - 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 1 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) DIRECT OPERATING EXPENSES TOTAL: $ - 4000:DIRECT FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) DIRECT FACILITIES/EQUIPMENTTOTAL: $ 5000:DIRECT SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network&Data Management) $ 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 1 Other(specify) 5007 Other(specify) 5008 Other(specify) DIRECT SPECIAL EXPENSES TOTAL: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H2 - Compensation Pa e3of12 6000:INDIRECT EXPENSES Acct# Line Item Description Amount Administrative Overhead 6001 Use this line and only this line for approved indirect cost rate $ Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation wrovide,-0—dit Equipment tobeUsedfor Program vo.Poses/ 6008 Personnel(indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 Other(specify) INDIRECT EXPENSES TOTAL $ INDIRECT COST RATE 0.00% 7000:DIRECT FIXED ASSETS Acct p Line Item Description Amount 7001 s $ 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data - 7003 Furniture&Fixtures - 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ - 7006 Assets over$5,000/unit(Specify) - 7007 Other(specify) - 7008 Other(specify) - FIXED ASSETS EXPENSES TOTAL $ - TOTAL PROGRAM EXPENSES $ 617,848 PROGRAM FUNDING SOURCES 8100-SUBSTANCE USE DISORDER FUNDS Acct# Line Item Description Amount 8101 Drug Medi-Cal $ 8102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acct# Line Item Description Amount 8201 lRealignment $ REALIGNMENT TOTAL $ - 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports Turnign Point Sunrise Adult FSP $ 617,848 8302 PEI-Prevention&Early Intervention - 8303 INN-Innovations 8304 WET-Workforce Education&Training 8305 CFTN-Capital Facilities&Technology - MHSA TOTAL $ 617,848 8400-OTHER REVENUE Acct# Line Item Description Amount 8401 Client Fees $ 8402 Client Insurance 8403 Grants(ARPA) 8404 Other(Specify) 8405 Other(Specify) OTHER REVENUE TOTAL $ TOTAL PROGRAM FUNDING SOURCES: $ 617,848 NET PROGRAM COST: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H2 - Compensation Page 4 of 12 Adult FSP Master Agreement-Sunrise Turning Point of Central California,Inc. Fiscal Year(FY)2023-24 Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:DIRECT SALARIES&BENEFITS Administrative Positions 1101 0 1102 0 1103 0 1104 0 1105 0 1106 0 1107 0 1108 0 1109 0 1110 0 1111 0 1112 0 1113 0 1114 0 1115 0 Program Positions 1116 0 1117 0 1118 0 1119 0 1120 0 1121 0 1122 0 1123 0 1124 0 1125 0 1126 0 1127 0 1128 0 1129 0 1130 0 1131 0 1132 0 1133 0 1134 0 Direct Employee Benefits 1201 Retirement 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) 1205 Other(specify) 1206 Other(specify) Direct Payroll Taxes&Expenses: 1301 OASDI 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) - 2000:DIRECT CLIENT SUPPORT 617,848 2001 Child Care - 2002 Client Housing Support 538,898 10-7060 Client Housing Assistance:Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&care,etc.) 2003 Client Transportation&Support 1,600 10-7015 Client Transportation:Cost for client transportation.(Examples:bus tokens/passes,taxi,other public transportation,bicycles,etc.) 2004 Clothing,Food,&Hygiene 9,000 10-7021 Client Clothing&Hygiene:Cost of client hygiene supplies and non-work related clothing.(Examples:clothes,shoes,hats,beanies,scarves,soap,toothpaste,deodorant, grooming supplies,hair accessories,diapers,etc.) Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H2 - Compensation Page 5 of 12 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2005 Education Support 150 10-7150 Client Educational Material:Cost of course fees and educational materials distributed to clients and prospective clients.Including court ordered educational class 2006 Employment Support 100 10-7022 Client Employment Support:Cost of client pre-employment preparation and employment retention.(Examples:job search and interview attire,work boots and tools required for employment,etc.) 2007 Household Items for Clients - 2008 Medication Supports 38,200 10-7030 Client Medical Expense:Cost of medical supplies or treatment/medical expense for a specific client.(Examples:co-pays*,prescription/lab work not covered by insurance,over-the-counter medications*,first aid kit/supplies for client's use at home, etc.)*if allowable per contract 2009 Program Supplies-Medical 6,500 10-6122 Program Supplies-Medical:Cost of medical supplies to be used by staff or clients at the program location to meet program objective.Such items are to remain at the program location and not sent home with the client.Such items include,but are not limited to first aid kits,blood pressure monitor,latex gloves,syringes,hazard disposal service,sunblock,insect repellent,*over-the-counter medication/vitamins-if allowable per contract*,etc. 2010 Utility Vouchers 8,000 10-7023 Client Utility/Rental Security Deposits:Cost of client utility bills and/or security deposits. 2011 Client Building Maintenance 1,000 10-7190 Client Building Maintenance:Cost of building repair or maintenance paid for on client's behalf.(Examples:handyman work,plumbing,drywall,roofing,carpet cleaning, air/furnace filters,keys,key tags,padlocks,etc. 2012 Client Therapy 200 10-7050 Client Therapy:Cost of therapy services not covered by insurance and therapeutic supplies for clients to use outside of the program.(Examples:exercise videos/equipment,relaxation audio/visual recordings,artistic expression supplies,etc.) 2013 Client Activities/Recreation 10,000 7010 Client Activities/Recreation:Cost for client activities&recreation events. (Examples:cable bill,food/drinks/utensils/decorations needed for a specific client event,incentive rewards,cash reinforcer,admission fees to events,etc.) 2014 Client Personal Needs 1,000 7020 Client Personal Needs:Cost of supplying clients with necessary personal items not detailed in other accounts.(Examples:birth certificate,DMV fee for ID or license,clients household cleaning products/house supplies/kitchen supplies for their own home, pots/pans/dishes,linens,locker lock,paper towels and child related expenses such as car seat/stroller/play pin/toys,special food for allergies,reinforcers from P&I funds, laptop,tablet,etc.) 2015 Client Food 2,000 7025 Client Food Non-Resident:Cost of food for a particular client to be consumed while off site of program location.(Examples:groceries for client's home,prepared meal,restaurant gift card*w/clients initials/#,etc.) 2016 Client Furnishings 1,200 10-7024 Client Furnishings:Cost of purchasing furniture for client's home.(Examples: couch,bed,mattress,television,entertainment stand,dinette set,telephone,radio, etc.) 3000:DIRECT OPERATING EXPENSES 3001 Telecommunications 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) 4000:DIRECT FACILITIES&EQUIPMENT 4001 Building Maintenance 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H2 - Compensation Page 6 of 12 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 4009 Other(specify) 4010 Other(specify) 5000:DIRECT SPECIAL EXPENSES 5001 Consultant(Network&Data Management) 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 Other(specify) 5007 Other(specify) 5008 Other(specify) 6000:INDIRECT EXPENSES 6001 Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation(Provider-Owned Equipment to be Used 6008 Personnel(Indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 1 Other(specify) 7000:DIRECT FIXED ASSETS 7001 Computer Equipment&Software 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 7003 Furniture&Fixtures 7004 Leasehold/Tenant/Building Improvements 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) 7007 Other(specify) 7008 Other(specify) TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 617,848 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 617,848 BUDGET CHECK: - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H2 - Compensation Page 7 of 12 Adult FSP Master Agreement-Sunrise Turning Point of Central California,Inc. Fiscal Year(FY)2024-25 PROGRAM EXPENSES 1000:DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct# Administrative Position FTE Admin Program Total 1101 $ 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 1115 Direct Personnel Admin Salaries Subtotal 0.00 - Acct# Program Position FTE Admin Program Total 1116 $ 1117 1118 1119 1120 1121 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 Direct Personnel Program Salaries Subtotall 0.00 1 $ $ Admin Program Total Direct Personnel Salaries Subtotall 0.00 1 $ - $ Direct Employee Benefits Acct# Description Admin Program Total 1201 Retirement $ 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) 1205 Other(specify) 1206 Other(specify) Direct Employee Benefits Subtotal: $ $ $ Direct Payroll Taxes&Expenses: Acct# Description Admin Program Total 1301 OASDI $ - 1302 FICA/MEDICARE - - - 1303 SUI - - - 1304 Other(specify) - - - 1305 Other(specify) - - - 1306 Other(specify) - - - Direct Payroll Taxes&Expenses Subtotal: $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program #DIV/01 #DIV/0! Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H2 - Compensation Pa e8of12 2000:DIRECT CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care $ 2002 Client Housing Support 557,438 2003 Client Transportation&Support 1,600 2004 Clothing,Food,&Hygiene 9,000 2005 Education Support 150 2006 Employment Support 100 2007 Household Items for Clients - 2008 Medication Supports 38,200 2009 Program Supplies-Medical 6,500 2010 Utility Vouchers 8,000 2011 Client Building Maintenance 1,000 2012 Client Therapy 200 2013 Client Activities/Recreation 10,000 2014 Client Personal Needs 1,000 2015 Client Food 2,000 2016 Client Furnishings 1,200 DIRECT CLIENT CARE TOTAL $ 636,388 3000:DIRECT OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ - 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 1 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) DIRECT OPERATING EXPENSES TOTAL: $ - 4000:DIRECT FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) DIRECT FACILITIES/EQUIPMENTTOTAL: $ 5000:DIRECT SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network&Data Management) $ 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 1 Other(specify) 5007 Other(specify) 5008 Other(specify) DIRECT SPECIAL EXPENSES TOTAL: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H2 - Compensation Pa e9of12 6000:INDIRECT EXPENSES Acct# Line Item Description Amount Administrative Overhead 6001 Use this line and only this line for approved indirect cost rate $ Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation wrovide,-0—dit Equipment tobeUsedfor Program vo.Poses/ 6008 Personnel(indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 Other(specify) INDIRECT EXPENSES TOTAL $ INDIRECT COST RATE 0.00% 7000:DIRECT FIXED ASSETS Acct# Line Item Description Amount 7001 Computer Equipment&Software $ - 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data - 7003 Furniture&Fixtures - 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ - 7006 Assets over$5,000/unit(Specify) - 7007 Other(specify) - 7008 Other(specify) - FIXED ASSETS EXPENSES TOTAL $ - TOTAL PROGRAM EXPENSES $ 636,388 PROGRAM FUNDING SOURCES 8100-SUBSTANCE USE DISORDER FUNDS Acct# Line Item Description Amount 8101 Drug Medi-Cal $ 8102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acct# Line Item Description Amount 8201 lRealignment $ REALIGNMENT TOTAL $ - 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports Turnign Point Sunrise Adult FSP $ 636,388 8302 PEI-Prevention&Early Intervention - 8303 INN-Innovations 8304 WET-Workforce Education&Training 8305 CFTN-Capital Facilities&Technology - MHSA TOTAL $ 636,388 8400-OTHER REVENUE Acct# Line Item Description Amount 8401 Client Fees $ 8402 Client Insurance 8403 Grants(ARPA) 8404 Other(Specify) 8405 Other(Specify) OTHER REVENUE TOTAL $ TOTAL PROGRAM FUNDING SOURCES: $ 636,388 NET PROGRAM COST: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H2 - Compensation Page 10 of 12 Adult FSP Master Agreement-Sunrise Turning Point of Central California,Inc. Fiscal Year(FY)2024-25 Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:DIRECT SALARIES&BENEFITS Administrative Positions 1101 0 1102 0 1103 0 1104 0 1105 0 1106 0 1107 0 1108 0 1109 0 1110 0 1111 0 1112 0 1113 0 1114 0 1115 0 Program Positions 1116 0 1117 0 1118 0 1119 0 1120 0 1121 0 1122 0 1123 0 1124 0 1125 0 1126 0 1127 0 1128 0 1129 0 1130 0 1131 0 1132 0 1133 0 1134 0 Direct Employee Benefits 1201 Retirement 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) 1205 Other(specify) 1206 Other(specify) Direct Payroll Taxes&Expenses: 1301 OASDI 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) - 2000:DIRECT CLIENT SUPPORT 636,388 2001 Child Care - 2002 Client Housing Support 557,438 10-7060 Client Housing Assistance:Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&care,etc.) 2003 Client Transportation&Support 1,600 10-7015 Client Transportation:Cost for client transportation.(Examples:bus tokens/passes,taxi,other public transportation,bicycles,etc.) 2004 Clothing,Food,&Hygiene 9,000 10-7021 Client Clothing&Hygiene:Cost of client hygiene supplies and non-work related clothing.(Examples:clothes,shoes,hats,beanies,scarves,soap,toothpaste,deodorant, grooming supplies,hair accessories,diapers,etc.) Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H2 - Compensation Page 11 of 12 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2005 Education Support 150 10-7150 Client Educational Material:Cost of course fees and educational materials distributed to clients and prospective clients.Including court ordered educational class 2006 Employment Support 100 10-7022 Client Employment Support:Cost of client pre-employment preparation and employment retention.(Examples:job search and interview attire,work boots and tools required for employment,etc.) 2007 Household Items for Clients - 2008 Medication Supports 38,200 10-7030 Client Medical Expense:Cost of medical supplies or treatment/medical expense for a specific client.(Examples:co-pays*,prescription/lab work not covered by insurance,over-the-counter medications*,first aid kit/supplies for client's use at home, etc.)*if allowable per contract 2009 Program Supplies-Medical 6,500 10-6122 Program Supplies-Medical:Cost of medical supplies to be used by staff or clients at the program location to meet program objective.Such items are to remain at the program location and not sent home with the client.Such items include,but are not limited to first aid kits,blood pressure monitor,latex gloves,syringes,hazard disposal service,sunblock,insect repellent,*over-the-counter medication/vitamins-if allowable per contract*,etc. 2010 Utility Vouchers 8,000 10-7023 Client Utility/Rental Security Deposits:Cost of client utility bills and/or security deposits. 2011 Client Building Maintenance 1,000 10-7190 Client Building Maintenance:Cost of building repair or maintenance paid for on client's behalf.(Examples:handyman work,plumbing,drywall,roofing,carpet cleaning, air/furnace filters,keys,key tags,padlocks,etc. 2012 Client Therapy 200 10-7050 Client Therapy:Cost of therapy services not covered by insurance and therapeutic supplies for clients to use outside of the program.(Examples:exercise videos/equipment,relaxation audio/visual recordings,artistic expression supplies,etc.) 2013 Client Activities/Recreation 10,000 7010 Client Activities/Recreation:Cost for client activities&recreation events. (Examples:cable bill,food/drinks/utensils/decorations needed for a specific client event,incentive rewards,cash reinforcer,admission fees to events,etc.) 2014 Client Personal Needs 1,000 7020 Client Personal Needs:Cost of supplying clients with necessary personal items not detailed in other accounts.(Examples:birth certificate,DMV fee for ID or license,clients household cleaning products/house supplies/kitchen supplies for their own home, pots/pans/dishes,linens,locker lock,paper towels and child related expenses such as car seat/stroller/play pin/toys,special food for allergies,reinforcers from P&I funds, laptop,tablet,etc.) 2015 Client Food 2,000 7025 Client Food Non-Resident:Cost of food for a particular client to be consumed while off site of program location.(Examples:groceries for client's home,prepared meal,restaurant gift card*w/clients initials/#,etc.) 2016 Client Furnishings 1,200 10-7024 Client Furnishings:Cost of purchasing furniture for client's home.(Examples: couch,bed,mattress,television,entertainment stand,dinette set,telephone,radio, etc.) 3000:DIRECT OPERATING EXPENSES 3001 Telecommunications 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) 4000:DIRECT FACILITIES&EQUIPMENT 4001 Building Maintenance 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H2 - Compensation Page 12 of 12 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 4009 Other(specify) 4010 Other(specify) 5000:DIRECT SPECIAL EXPENSES 5001 Consultant(Network&Data Management) 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 Other(specify) 5007 Other(specify) 5008 Other(specify) 6000:INDIRECT EXPENSES 6001 Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation(Provider-Owned Equipment to be Used 6008 Personnel(Indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 1 Other(specify) 7000:DIRECT FIXED ASSETS 7001 Computer Equipment&Software 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 7003 Furniture&Fixtures 7004 Leasehold/Tenant/Building Improvements 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) 7007 Other(specify) 7008 Other(specify) TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 636,388 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 636,388 BUDGET CHECK: - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 1 of 20 ASSISTED OUTPATIENT TREATMENT(ACT) Turning Point of Central California,Inc. Fiscal Year(FY)2023-24 PROGRAM EXPENSES 1000:DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct p Administrative Position FTE Admin Program Total 1101 Records Technician 0.14 5,403 $ 5,403 1102 Administrative Assistant 0.14 6,206 6,206 1103 Bookkeeper 0.14 6,523 6,523 1104 Secretary 0.27 10,324 10,324 1105 Intake Specialist 0.14 7,206 7,206 1106 - - 1107 1108 1109 1110 1111 1112 1113 1114 1115 Direct Personnel Admin Salaries Subtotal 0.83 $ 35,663 $ 35,663 Acct p Program Position FTE Admin Program Total 1116 Assistant Program Director 0.15 $ 14,025 $ 14,025 1117 Program Director 0.25 29,978 29,978 1118 Mental Health Specialist/Case Manager 2.00 106,657 106,657 1119 Mental Health Professional 1.00 77,587 77,587 1120 Nurse 0.14 9,477 9,477 1121 - - 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 Direct Personnel Program Salaries Subtotall 3.54 1 $ 237,725 1 $ 237,725 Admin Program I Total Direct Personnel Salaries Subtotall 4.37 1 $ 35,663 1 $ 237,725 1 $ 273,388 Direct Employee Benefits Acct# Description Admin Program Total 1201 Retirement $ 1,231 $ 7,881 $ 9,113 1202 Worker's Compensation 438 2,804 3,242 1203 Health Insurance 5,182 33,165 38,347 1204 Other(Dental) 407 2,602 3,009 1205 Other(ACI) 12 79 91 1206 1 Other(Accrued Paid Leave) 1 4,105 1 26,272 1 30,376 Direct Employee Benefits Subtotal: $ 11,375 $ 72,803 $ 84,179 Direct Payroll Taxes&Expenses: Acct# Description Admin Program Total 1301 OASDI $ 595 $ 3,809 $ 4,405 1302 FICA/MEDICARE 2,566 16,420 18,985 1303 SUI 599 3,836 4,435 1304 Other(specify) 1305 Other(specify) 1306 1 Other(specify) Direct Payroll Taxes&Expenses Subtotal: $ 3,760 $ 24,065 $ 27,825 DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ 50,798 $ 334,593 $ 385,391 DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program 13% 87% Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Pa e 2 of 20 2000:DIRECT CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care $ - 2002 Client Housing Support 150,000 2003 Client Transportation&Support 500 2004 Clothing&Hygiene 500 2005 Education Support - 2006 Employment Support 2007 Household Items for Clients - 2008 Medication Supports 4,300 2009 Program Supplies-Medical - 2010 Utility Vouchers 1,000 2011 Client Activities 1,500 2012 Client Personal Needs 200 2013 Client Food 200 2014 Client Physical Exams - 2015 Client Testing Materials - 2016 Client Furnishings 500 DIRECT CLIENT CARE TOTAL $ 158,700 3000:DIRECT OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ 2,435 3002 Printing/Postage 951 3003 Office,Household&Program Supplies 4,871 3004 Advertising - 3005 Staff Development&Training 1,948 3006 1 Staff Mileage 1,484 3007 Subscriptions&Memberships 425 3008 Vehicle Maintenance/Fuel/Insurance 5,188 3009 Recruitment 1,747 3010 Other(specify) - 3011 Other(specify) 3012 Other(specify) DIRECT OPERATING EXPENSES TOTAL: $ 19,050 4000:DIRECT FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ 773 4002 Rent/Lease Building 10,360 4003 Rent/Lease Equipment 302 4004 Rent/Lease Vehicles 5,667 4005 Security 255 4006 Utilities 6,958 4007 Equipment Maintenance 201 4008 Other(specify) - 4009 Other(specify) 4010 Other(specify) - DIRECT FACILITIES/EQUIPMENT TOTAL]$ 24,516 5000:DIRECT SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network&Data Management) $ 93 5002 HMIS(Health Management Information System) - 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 200 5005 O/S Labor Phychiatrist 20,000 5006 0/S Labor Counselor 1,175 5007 Other(specify) 5008 Other(specify) DIRECT SPECIAL EXPENSES TOTAL: $ 21,468 Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H3 - Compensation Pa e 3 of 20 6000:INDIRECT EXPENSES Acct# Line Item Description Amount Administrative Overhead 6001 Use this line and only this line for approved indirect cost rate $ - Administrative Overhead 6002 Professional Liability Insurance 1,832 6003 Accounting/Bookkeeping - 6004 External Audit 410 6005 Insurance(Specify): - 6006 Payroll Services 1,294 6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) - 6008 Personnel(Indirect Salaries&Benefits) - 6009 Licenses 379 6010 Indirect 92,709 6011 Other(specify) - 6012 Other(specify) 6013 Other(specify) INDIRECT EXPENSES TOTAL $ 96,624 INDIRECT COST RATE 15.73% 7000:DIRECT FIXED ASSETS Acct# Line Item Description Amount 7001 Computer Equipment&Software $ - 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data - 7003 Furniture&Fixtures 178 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ - 7006 Assets over$5,000/unit(Specify) - 7007 Expendable Equipment 4,840 7008 Other(specify) - FIXED ASSETS EXPENSES TOTAL $ 5,018 TOTAL PROGRAM EXPENSES $ 710,766 PROGRAM FUNDING SOURCES 8100-SUBSTANCE USE DISORDER FUNDS Acct# Line Item Description Amount 8101 Drug Medi-Cal $ 8102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acct# Line Item Description Amount 8201 lRealignment $ 382,158 REALIGNMENT TOTAL $ 382,158 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports $ - 8302 PEI-Prevention&Early Intervention 8303 INN-Innovations 8304 WET-Workforce Education&Training 8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ 8400-OTHER REVENUE Acct# Line Item Description Amount 8401 Client Fees $ 8402 Client Insurance 8403 Grants(ARPA) 328,608 8404 Other(Specify) - 8405 Other(Specify) OTHER REVENUE TOTAL $ 328,608 TOTAL PROGRAM FUNDING SOURCES: $ 710,766 NET PROGRAM COST: $ 0 Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 4 of 20 ASSISTED OUTPATIENT TREATMENT(ACT) Turning Point of Central California,Inc. Fiscal Year(FY)2023-24 PARTIAL FTE DETAIL For all positions with FTE's split among multiple programs/contracts the below must be filled out Position Contract p/Name/Department/County FTE Records Technician ACT 0.14 x Vista 0.36 x Sunrise 0.50 x Total 1.00 Position Contract p/Name/Department/County FTE Administrative Assistant ACT 0.14 x Vista 0.86 x Total 1.00 Position Contract p/Name/Department/County FTE Bookkeeper ACT 0.14 x Vista 0.36 x Sunrise 0.50 x Total 1.00 Position Contract p/Name/Department/County FTE Secretary ACT 0.27 x Vista 0.73 x Total 1.00 Position Contract p/Name/Department/County FTE Intake Specialist ACT 0.14 x Vista 0.36 x Sunrise 0.50 x Total 1.00 Position Contract p/Name/Department/County FTE Assistant Program Director ACT 0.15 x Vista 0.85 x Total 1.00 Position Contract p/Name/Department/County FTE Program Director ACT 0.25 x Vista 0.75 x Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 5 of 20 Total 1.00 Position Contract#/Name/Department/County FTE% Nurse ACT 0.14 x Vista 0.86 x Total 1.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE% Total 0.00 Position Contract#/Name/Department/County FTE% Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H3 - Compensation Page 6 of 20 Total 0.00 Position Contract N/Name/Department/County FTE Total 0.00 Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H3 - Compensation Page 7 of 20 ASSISTED OUTPATIENT TREATMENT(AOT) Turning Point of Central California,Inc. Fiscal Year(FY)2023-24 Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:DIRECT SALARIES&BENEFITS 385,391 Administrative Positions 35,663 1101 Records Technician 5,403 The Records Technician will keep track of the Medical Records and will do the billing for the program. 1102 Administrative Assistant 6,206 The Administrative Assistant will oversee the support staff and will help with all support staff duties. 1103 Bookkeeper 6,523 The Program Bookkeeper will be assisting the clients with their client fees for their portion of rent if necessary and keeping track of all the incoming and outgoing of petty cash as needed. 1104 Secretary 10,324 Provides direct services to the program by data entry,phone calls,checking in clients, etc. 1105 Intake Specialist 7,206 Reviews all referrals,contacting referral source and coordinating intake services to enroll in FSP program. The specialist also assists client in applying for additional benefits,such as General Relief,Social Security Benefits,Medi-cal,etc. 1106 0 - 1107 0 1108 0 1109 0 1110 0 1111 0 1112 0 1113 0 1114 0 1115 0 Program Positions 237,725 1116 Assistant Program Director 14,025 The Asssitant Program Director will supervise staff and assist the Program Director. Any additional funds outside of Medi-Cal are used for this/these positions for non-treatment and/or non-billable related costs to be able to continue to provide continuity of care. 1117 Program Director 29,978 The Program Director oversees the program and the hiring,training and supervising of staff.When a staff takes leave,the program is not changed since it's already been accrued.Our Positions are based on class/step,some might be less and some might be more,all according to the person's experience and education when they come to work for Turning Point. 1118 Mental Health Specialist/Case Manager 106,657 Mental Health Specialist will carry a caseload while also specializing in linking and providing services to those interested in engagement in employment and education services. 1119 Mental Health Professional 77,587 Provides mental health assessment,assessing for Medical Necessity,assists client in identifying treatment plan goals according to diagnosis. MHP also provides individual and group therapy as client requests,while also providing program support to assist clients in crisis. 1120 Nurse 9,477 Nurses work with the doctors for client care,maintaining compliance with Turning Point policies and procedures,providing training and ensuring accurate charting in accordance with Medi-cal. 1121 0 - 1122 0 1123 0 1124 0 1125 0 1126 0 1127 0 1128 0 1129 0 1130 0 1131 0 1132 0 1133 0 1134 0 Direct Employee Benefits 84,179 1201 Retirement 9,113 10-5940 Retirement:Cost of Agency contribution to employee retirement plans. 1202 Worker's Compensation 3,242 10-5930 Workers Compensation Insurance:Cost of workers compensation insurance. 1203 Health Insurance 38,347 10-5950 Health Insurance:Agency cost for health insurance including Vision Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 8 of 20 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1204 Other(Dental) 3,009 10-5960 Dental Insurance:Agency cost for dental insurance. 1205 Other(ACI) 91 10-5990 Other Benefits:Agency cost for other wage related employee benefits. 1206 Other(Accrued Paid Leave) 30,376 10-5980 Accrued Paid Leave:The monetary value of staff Paid Leave hours as they accrue on a monthly basis. Direct Payroll Taxes&Expenses: 27,825 1301 OASDI 4,405 10-5910 F.I.C.A.(Federal Insurance Contributions Act):Employer portion of F.I.C.A.taxes charged to the Agency by the Internal Revenue Service.F.I.C.A.is comprised of"Old- Age,Survivors,and Disability Insurance"(OASDI),plus"Hospital Insurance"(Medicare). 1302 FICA/MEDICARE 18,985 10-5910 F.I.C.A.(Federal Insurance Contributions Act):Employer portion of F.I.C.A.taxes charged to the Agency by the Internal Revenue Service.F.I.C.A.is comprised of"Old- Age,Survivors,and Disability Insurance"(OASDI),plus"Hospital Insurance"(Medicare). 1303 SUI 4,435 10-5920 S.U.I.(State Unemployment Insurance):Employer portion of S.U.I.taxes charged to the Agency by the various states in which wages are paid. 1304 Other(specify) - 1305 Other(specify) 1306 Other(specify) 2000:DIRECT CLIENT SUPPORT 158,700 2001 Child Care - 2002 Client Housing Support 150,000 10-7060 Client Housing Assistance:Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&care,etc.) 2003 Client Transportation&Support 500 10-7015 Client Transportation:Cost for client transportation.(Examples:bus tokens/passes,taxi,other public transportation,bicycles,etc.) 2004 Clothing&Hygiene 500 10-7021 Client Clothing&Hygiene:Cost of client hygiene supplies and non-work related clothing.(Examples:clothes,shoes,hats,beanies,scarves,soap,toothpaste,deodorant, grooming supplies,hair accessories,diapers,etc.) 2005 Education Support - 2006 Employment Support 2007 Household Items for Clients - 2008 Medication Supports 4,300 10-6122 Program Supplies-Medical:Cost of medical supplies to be used by staff or clients at the program location to meet program objective.Such items are to remain at the program location and not sent home with the client.Such items include,but are not limited to first aid kits,blood pressure monitor,latex gloves,syringes,hazard disposal service,sunblock,insect repellent,*over-the-counter medication/vitamins-if allowable per contract*,etc. 2009 Program Supplies-Medical - 2010 Utility Vouchers 1,000 10-7023 Client Utility/Rental Security Deposits:Cost of client utility bills and/or security deposits. 2011 Client Activities 1,500 10-7010 Client Activities/Recreation:Cost for client activities&recreation events. (Examples:cable bill,food/drinks/utensils/decorations needed for a specific client event,incentive rewards,cash reinforcer,admission fees to events,etc.) 2012 Client Personal Needs 200 10-7020 Client Personal Needs:Cost of supplying clients with necessary personal items not detailed in other accounts.(Examples:birth certificate,DMV fee for ID or license, clients household cleaning products/house supplies/kitchen supplies for their own home,pots/pans/dishes,linens,locker lock,paper towels and child related expenses such as car seat/stroller/play pin/toys,special food for allergies,reinforcers from P&I funds,laptop,tablet,etc.) 2013 Client Food 200 10-7025 Client Food Non-Resident:Cost of food for a particular client to be consumed while off site of program location.(Examples:groceries for client's home,prepared meal,restaurant gift card*w/clients initials/#,etc.) 2014 Client Physical Exams 2015 Client Testing Materials - 2016 Client Furnishings 500 10-7024 Client Furnishings:Cost of purchasing furniture for client's home.(Examples: couch,bed,mattress,television,entertainment stand,dinette set,telephone,radio, etc.) 3000:DIRECT OPERATING EXPENSES 19,050 3001 Telecommunications 2,435 10-6340 Communications:Cost of electronic communications. (Examples:internet, phone,fax,cell phones,etc.) Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 9 of 20 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 3002 Printing/Postage 951 10-6400 Postage:Cost of Agency postage and delivery.Including delivery by the U.S. Post Office,U.P.S.,FedEx or other courier services. 3003 Office,Household&Program Supplies 4,871 10-6110 Office Supplies:Cost of items normally used in an office setting.10-6130 House Supplies:Cost of supplies used by staff during their scheduled work hours.These items are normally used to operate the building at the program location.These items are to remain at program location and not sent home with client.10-6120 Program Supplies: Cost of any items normally used by clients or to directly benefit the clients to meet program objectives while receiving services.These items are to remain at the program location and not sent home with the client.10-6243 General Supplies:Cost of items generally used by all at program's location.10-6244 Janitorial Supplies&Services:Cost of items or services to maintain the esthetics of the premises. 3004 Advertising - 3005 Staff Development&Training 1,948 10-6440 Staff Educational Expense:Cost of employee training courses and materials. (Examples:certification,training,books,etc.)*May include cost of room rental 3006 Staff Mileage 1,484 10-6060 Staff Mileage:Cost of employee mileage reimbursement paid in accordance with FPM section 1005. 3007 Subscriptions&Memberships 425 10-6360 Dues&Subscriptions:Cost of membership dues and subscriptions.(Examples: magazine,newspaper,memberships,etc.) 3008 Vehicle Maintenance/Fuel/Insurance 5,188 10-6030 Vehicle Insurance:Cost for vehicle insurance.10-6040 Vehicle Fuel:Cost of gas in vehicles.10-6050 Vehicle Maintenance:Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with maintenance and repair of vehicles used by Agency programs.(Examples:repairs,battery,carwash*Includes:impounds) 3009 Recruitment 1,747 10-6470 Recruitment:Cost of advertising and other employee recruitment expenses. (Examples:newspaper ad,urine screening,background check,etc.) 3010 Other(specify) - 3011 Other(specify) 3012 Other(specify) 4000:DIRECT FACILITIES&EQUIPMENT 24,516 4001 Building Maintenance 773 10-6330 Building Maintenance:Cost of Agency building repairs and maintenance. (Examples:electrical work,A/C and heating,hood cleaning,plumbing,deadbolt,door knob/lock,keys,key tags,air/furnace filters,smoke alarm,cot alarm,exit sign,blinds, etc.)This account should not be used if a specific outside labor contractor is doing an identifiable project,in this case use 6603,or projects over$2,000.00 that will require the procurement process and a WIP to be completed. 4002 Rent/Lease Building 10,360 10-6320 Building Rent(Other):Cost of rent/lease payments made for building leases from outside sources. 4003 Rent/Lease Equipment 302 10-6220 Furniture&Equipment Rent/Lease(Other):Cost of rent/lease payments made for furniture and equipment leases from outside sources.(Examples:high capacity copier/printer/scanner,washer/dryer,vending machine,furniture,water cooler, postage meter,etc.) 4004 Rent/Lease Vehicles 5,667 10-6020 Vehicle Rent/Lease(Other):Rental cost of non-Agency vehicles and lease of agency vehicles. 4005 Security 255 10-6390 Security:Cast of installation,maintenance and monthly service fees for building alarms and other security measures.(Examples:security/surveillance equipment,service and installation,safes,locks,padlocks,etc.) 4006 Utilities 6,958 10-6350 Utilities:Cost of service for power,gas,water,sewer,garbage,etc. 4007 Equipment Maintenance 201 10-6230 Equipment Maintenance:Cost of repair or maintenance of office/house equipment and furniture.(Examples:high capacity copier/printer/scanner,replacement parts such as hard drive,video card,adapter,laptop battery,monitor/printer/phone cord,cord covers,power strip,surge protector,extension cord,cable ties,drum,hose, filter,drawer slide set/rollers,keys for filing cabinet,etc.) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) 5000:DIRECT SPECIAL EXPENSES 21,468 Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 10 of 20 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 5001 Consultant(Network&Data Management) 93 10-6115 Software&Computer Support:Cost of computer software and computer support.(Examples:Microsoft Office,QuickBooks,PDF converter,Avatar,Vipre anti- virus,LogMeln,web filter,etc.)This account should not be used for the purchase of computers and related accessories.Computer accessories such as a mouse,keyboard and speakers must be coded to 6190 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) - 5004 Translation Services 200 Paid to outside vendors for translation/interpreter services. 5005 O/5 Labor Phychiatrist 20,000 These accounts are assigned to record various professional services provided by contracted Psychiatrist working as independent agents. 5006 O/S Labor Counselor 1,175 These accounts are assigned to record various professional services provided by contracted Consultant working as independent agents. 5007 Other(specify) - 5008 1 Other(specify) 6000:INDIRECT EXPENSES 96,624 6001 Administrative Overhead 6002 Professional Liability Insurance 1,832 10-6370Insurance:Cost of Agency liability and property insurance. 6003 Accounting/Bookkeeping - 6004 External Audit 410 10-6460 Audit Expense:Cost of outside audit fees. 6005 Insurance(Specify): - 6006 Payroll Services 1,294 10-6482 Payroll Software&Support 6007 Depreciation(Provider-Owned Equipment to be Used - 6008 Personnel(Indirect Salaries&Benefits) - 6009 Licenses 379 10-6380 Licenses:Cost in obtaining and renewing licenses and permits.(Examples: Electronic Medical Records(EMR)database,kitchen/restaurant permit,fire clearance, facility inspections,vehicle registration,etc.) 6010 Indirect 92,709 10-9000's Indirect Allocated Costs 6011 Other(specify) - 6012 Other(specify) 6013 Other(specify) 7000:DIRECT FIXED ASSETS 5,018 7001 Computer Equipment&Software - 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA - 7003 Furniture&Fixtures 178 10-6240 Expendable Furniture:Cost of small,inexpensive Agency property with a normal useful life generally less than one year or a value that is minor or insignificant, typically items with a total cost of less than$5000 per item.(Examples:small desk, portable desk,chair,filing cabinet,mail slots,shelving unit,table,foldable tables/chairs, bed,mattress,nightstand,room divider,etc.*Includes assembly fee)(For additional information,see procedures section 0900) 7004 Leasehold/Tenant/Building Improvements 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) - 7007 Expendable Equipment 4,840 10-6190 Expendable Equipment:Cost of purchasing office/house equipment that has a cost less than$5000 per item.(Examples:electronic stapler/calculator/hole puncher, computer,monitor,keyboard,mouse,speakers and other computer accessories including mousepad and wrist pad,desk printer,tablet,tablet cover,lamp,desk lamp, fan,radio,television,phone,coffee machine,popcorn maker,toaster,refrigerator, dishwasher,washer,dryer,portable a/c unit,hand soap/hand towel dispenser,fire extinguisher,dolly,canopy,shed,barbecue,drill,etc.) 7008 Other(specify) I - TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 710,766 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 710,766 BUDGET CHECK: - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 11 of 20 ASSISTED OUTPATIENT TREATMENT(ACT) Turning Point of Central California,Inc. Fiscal Year(FY)2024-25 PROGRAM EXPENSES 1000:DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct# Administrative Position FTE Admin Program Total 1101 Records Technician 0.14 5,619 $ 5,619 1102 Administrative Assistant 0.14 6,454 6,454 1103 Bookkeeper 0.14 6,784 6,784 1104 Secretary 0.27 10,737 10,737 1105 Intake Specialist 0.14 7,495 7,495 1106 - - 1107 1108 1109 1110 1111 1112 1113 1114 1115 Direct Personnel Admin Salaries Subtotal 0.83 $ 37,089 $ 37,089 Acct# Program Position FTE Admin Program Total 1116 Assistant Program Director 0.15 $ 14,586 $ 14,586 1117 Program Director 0.25 31,177 31,177 1118 Mental Health Specialist/Case Manager 2.00 110,923 110,923 1119 Mental Health Professional 1.00 80,690 80,690 1120 Nurse 0.14 9,856 9,856 1121 - - 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 Direct Personnel Program Salaries Subtotall 3.54 1 $ 247,232 1 $ 247,232 Admin Program I Total Direct Personnel Salaries Subtotall 4.37 1 $ 37,089 1 $ 247,232 1 $ 284,321 Direct Employee Benefits Acct# Description Admin Program Total 1201 Retirement $ 1,236 $ 8,241 $ 9,477 1202 Worker's Compensation 440 2,932 3,372 1203 Health Insurance 5,202 34,679 39,881 1204 Other(Dental) 408 2,721 3,129 1205 Other(ACI) 12 82 94 1206 1 Other(Accrued Paid Leave) 1 4,121 1 27,470 1 31,591 Direct Employee Benefits Subtotal: $ 11,419 $ 76,125 $ 87,544 Direct Payroll Taxes&Expenses: Acct# Description Admin Program Total 1301 OASDI $ 598 $ 3,983 $ 4,581 1302 FICA/MEDICARE 2,576 17,169 19,745 1303 SUI 602 4,011 4,613 1304 Other(specify) - - - 1305 Other(specify) - - - 1306 1 Other(specify) - - - Direct Payroll Taxes&Expenses Subtotal: $ 3,776 $ 25,163 $ 28,939 DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ 52,284 $ 348,520 $ 400,804 DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program 13% 87% Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 12 of 20 2000:DIRECT CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care $ - 2002 Client Housing Support 150,000 2003 Client Transportation&Support 500 2004 Clothing&Hygiene 500 2005 Education Support - 2006 Employment Support 2007 Household Items for Clients - 2008 Medication Supports 4,312 2009 Program Supplies-Medical - 2010 Utility Vouchers 1,000 2011 Client Activities 1,500 2012 Client Personal Needs 200 2013 Client Food 200 2014 Client Physical Exams - 2015 Client Testing Materials - 2016 Client Furnishings 500 DIRECT CLIENT CARE TOTAL $ 158,712 3000:DIRECT OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ 2,533 3002 Printing/Postage 989 3003 Office,Household&Program Supplies 5,066 3004 Advertising - 3005 Staff Development&Training 2,026 3006 1 Staff Mileage 1,544 3007 Subscriptions&Memberships 442 3008 Vehicle Maintenance/Fuel/Insurance 5,312 3009 Recruitment 1,817 3010 Other(specify) - 3011 Other(specify) 3012 Other(specify) DIRECT OPERATING EXPENSES TOTAL: $ 19,729 4000:DIRECT FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ 804 4002 Rent/Lease Building 10,774 4003 Rent/Lease Equipment 302 4004 Rent/Lease Vehicles 5,667 4005 Security 265 4006 Utilities 7,236 4007 Equipment Maintenance 209 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) DIRECT FACILITIES/EQUIPMENTTOTAL: $ 25,257 5000:DIRECT SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network&Data Management) $ 96 5002 HMIS(Health Management Information System) - 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 208 5005 O/S Labor Phychiatrist 20,800 5006 0/S Labor Counselor 1,222 5007 Other(specify) 5008 Other(specify) DIRECT SPECIAL EXPENSES TOTAL: $ 22,326 Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H3 - Compensation Page 13 of 20 6000:INDIRECT EXPENSES Acct# Line Item Description Amount Administrative Overhead 6001 Use this line and only this line for approved indirect cost rate $ - Administrative Overhead 6002 Professional Liability Insurance 1,906 6003 Accounting/Bookkeeping - 6004 External Audit 426 6005 Insurance(Specify): - 6006 Payroll Services 1,346 6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) - 6008 Personnel(Indirect Salaries&Benefits) - 6009 Licenses 394 6010 Indirect 95,418 6011 Other(specify) - 6012 Other(specify) 6013 Other(specify) - INDIRECT EXPENSES TOTAL $ 99,490 INDIRECT COST RATE 15.74% 7000:DIRECT FIXED ASSETS Acct# Line Item Description Amount 7001 Computer Equipment&Software $ - 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data - 7003 Furniture&Fixtures 185 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ - 7006 Assets over$5,000/unit(Specify) - 7007 Expendable Equipment 5,033 7008 Other(specify) - FIXED ASSETS EXPENSES TOTAL $ 5,218 TOTAL PROGRAM EXPENSES $ 731,536 PROGRAM FUNDING SOURCES 8100-SUBSTANCE USE DISORDER FUNDS Acct# Line Item Description Amount 8101 Drug Medi-Cal $ 8102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acct# Line Item Description Amount 8201 lRealignment $ 402,928 REALIGNMENT TOTAL $ 402,928 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports $ - 8302 PEI-Prevention&Early Intervention 8303 INN-Innovations 8304 WET-Workforce Education&Training 8305 CFTN-Capital Facilities&Technology MHSA TOTAL $ 8400-OTHER REVENUE Acct# Line Item Description Amount 8401 Client Fees $ 8402 Client Insurance 8403 Grants(ARPA) 328,608 8404 Other(Specify) - 8405 Other(Specify) OTHER REVENUE TOTAL $ 328,608 TOTAL PROGRAM FUNDING SOURCES: $ 731,536 NET PROGRAM COST: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 14 of 20 ASSISTED OUTPATIENT TREATMENT(AOT) Turning Point of Central California,Inc. Fiscal Year(FY)2024-25 PARTIAL FTE DETAIL For all positions with FTE's split among multiple programs/contracts the below must be filled out Position Contract#/Name/Department/County FTE% Records Technician AOT 0.14 Vista 0.36 Sunrise 0.50 Total 1.00 Position Contract#/Name/Department/County FTE% Administrative Assistant AOT 0.14 Vista 0.86 Total 1.00 Position Contract#/Name/Department/County FTE% Bookkeeper AOT 0.14 Vista 0.36 Sunrise 0.50 Total 1.00 Position Contract#/Name/Department/County FTE% Secretary AOT 0.27 Vista 0.73 Total 1.00 Position Contract#/Name/Department/County FTE% Intake Specialist AOT 0.14 Vista 0.36 Sunrise 0.50 Total 1.00 Position Contract#/Name/Department/County FTE% Assistant Program Director AOT OAS Vista 0.85 Total 1.00 Position Contract#/Name/Department/County FTE% Program Director AOT 0.25 Vista 0.75 Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H3 - Compensation Page 15 of 20 Total 1.00 Position Contract#/Name/Department/County FTE Nurse AOT 0.14 Vista 0.86 Total 1.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Position Contract#/Name/Department/County FTE Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 16 of 20 Total 0.00 Position Contract#/Name/Department/County FTE Total 0.00 Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H3 - Compensation Page 17 of 20 ASSISTED OUTPATIENT TREATMENT(AOT) Turning Point of Central California,Inc. Fiscal Year(FY)2024-25 Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:DIRECT SALARIES&BENEFITS 400,804 Administrative Positions 37,089 1101 Administrative Assistant 5,619 The Records Technician will keep track of the Medical Records and will do the billing for the program. 1102 Administrative Assistant 6,454 The Administrative Assistant will oversee the support staff and will help with all support staff duties. 1103 Bookkeeper 6,784 The Program Bookkeeper will be assisting the clients with their client fees for their portion of rent if necessary and keeping track of all the incoming and outgoing of petty cash as needed. 1104 Secretary 10,737 Provides direct services to the program by data entry,phone calls,checking in clients, etc. 1105 Intake Specialist 7,495 Reviews all referrals,contacting referral source and coordinating intake services to enroll in FSP program. The specialist also assists client in applying for additional benefits,such as General Relief,Social Security Benefits,Medi-cal,etc. 1106 0 - 1107 0 1108 0 1109 0 1110 0 1111 0 1112 0 1113 0 1114 0 1115 0 Program Positions 247,232 1116 Assistant Program Director 14,586 The Asssitant Program Director will supervise staff and assist the Program Director. Any additional funds outside of Medi-Cal are used for this/these positions for non-treatment and/or non-billable related costs to be able to continue to provide continuity of care. 1117 Program Director 31,177 The Program Director oversees the program and the hiring,training and supervising of staff.When a staff takes leave,the program is not changed since it's already been accrued.Our Positions are based on class/step,some might be less and some might be more,all according to the person's experience and education when they come to work for Turning Point. 1118 Mental Health Specialist/Case Manager 110,923 Mental Health Specialist will carry a caseload while also specializing in linking and providing services to those interested in engagement in employment and education services. 1119 Mental Health Professional 80,690 Provides mental health assessment,assessing for Medical Necessity,assists client in identifying treatment plan goals according to diagnosis. MHP also provides individual and group therapy as client requests,while also providing program support to assist clients in crisis. 1120 Nurse 9,856 Nurses work with the doctors for client care,maintaining compliance with Turning Point policies and procedures,providing training and ensuring accurate charting in accordance with Medi-cal. 1121 0 - 1122 0 1123 0 1124 0 1125 0 1126 0 1127 0 1128 0 1129 0 1130 0 1131 0 1132 0 1133 0 1134 0 Direct Employee Benefits 87,544 1201 Retirement 9,477 10-5940 Retirement:Cost of Agency contribution to employee retirement plans. 1202 Worker's Compensation 3,372 10-5930 Workers Compensation Insurance:Cost of workers compensation insurance. 1203 Health Insurance 39,881 10-5950 Health Insurance:Agency cost for health insurance including Vision Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 18 of 20 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1204 Other(Dental) 3,129 10-5960 Dental Insurance:Agency cost for dental insurance. 1205 Other(ACI) 94 10-5990 Other Benefits:Agency cost for other wage related employee benefits. 1206 Other(Accrued Paid Leave) 31,591 10-5980 Accrued Paid Leave:The monetary value of staff Paid Leave hours as they accrue on a monthly basis. Direct Payroll Taxes&Expenses: 28,939 1301 OASDI 4,581 10-5910 F.I.C.A.(Federal Insurance Contributions Act):Employer portion of F.I.C.A.taxes charged to the Agency by the Internal Revenue Service.F.I.C.A.is comprised of"Old- Age,Survivors,and Disability Insurance"(OASDI),plus"Hospital Insurance"(Medicare). 1302 FICA/MEDICARE 19,745 10-5910 F.I.C.A.(Federal Insurance Contributions Act):Employer portion of F.I.C.A.taxes charged to the Agency by the Internal Revenue Service.F.I.C.A.is comprised of"Old- Age,Survivors,and Disability Insurance"(OASDI),plus"Hospital Insurance"(Medicare). 1303 SUI 4,613 10-5920 S.U.I.(State Unemployment Insurance):Employer portion of S.U.I.taxes charged to the Agency by the various states in which wages are paid. 1304 Other(specify) - 1305 Other(specify) 1306 Other(specify) 2000:DIRECT CLIENT SUPPORT 158,712 2001 Child Care - 2002 Client Housing Support 150,000 10-7060 Client Housing Assistance:Cost of rent,housing assistance and deposit paid on behalf of client.(Examples:first/last month deposit,late fees,monthly rent,hotel charges,room&board,board&care,etc.) 2003 Client Transportation&Support 500 10-7015 Client Transportation:Cost for client transportation.(Examples:bus tokens/passes,taxi,other public transportation,bicycles,etc.) 2004 Clothing&Hygiene 500 10-7021 Client Clothing&Hygiene:Cost of client hygiene supplies and non-work related clothing.(Examples:clothes,shoes,hats,beanies,scarves,soap,toothpaste,deodorant, grooming supplies,hair accessories,diapers,etc.) 2005 Education Support - 2006 Employment Support 2007 Household Items for Clients - 2008 Medication Supports 4,312 10-6122 Program Supplies-Medical:Cost of medical supplies to be used by staff or clients at the program location to meet program objective.Such items are to remain at the program location and not sent home with the client.Such items include,but are not limited to first aid kits,blood pressure monitor,latex gloves,syringes,hazard disposal service,sunblock,insect repellent,*over-the-counter medication/vitamins-if allowable per contract*,etc. 2009 Program Supplies-Medical - 2010 Utility Vouchers 1,000 10-7023 Client Utility/Rental Security Deposits:Cost of client utility bills and/or security deposits. 2011 Client Activities 1,500 10-7010 Client Activities/Recreation:Cost for client activities&recreation events. (Examples:cable bill,food/drinks/utensils/decorations needed for a specific client event,incentive rewards,cash reinforcer,admission fees to events,etc.) 2012 Client Personal Needs 200 10-7020 Client Personal Needs:Cost of supplying clients with necessary personal items not detailed in other accounts.(Examples:birth certificate,DMV fee for ID or license, clients household cleaning products/house supplies/kitchen supplies for their own home,pots/pans/dishes,linens,locker lock,paper towels and child related expenses such as car seat/stroller/play pin/toys,special food for allergies,reinforcers from P&I funds,laptop,tablet,etc.) 2013 Client Food 200 10-7025 Client Food Non-Resident:Cost of food for a particular client to be consumed while off site of program location.(Examples:groceries for client's home,prepared meal,restaurant gift card*w/clients initials/#,etc.) 2014 Client Physical Exams 2015 Client Testing Materials - 2016 Client Furnishings 500 10-7024 Client Furnishings:Cost of purchasing furniture for client's home.(Examples: couch,bed,mattress,television,entertainment stand,dinette set,telephone,radio, etc.) 3000:DIRECT OPERATING EXPENSES 19,729 3001 Telecommunications 2,533 10-6340 Communications:Cost of electronic communications. (Examples:internet, phone,fax,cell phones,etc.) Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 19 of 20 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 3002 Printing/Postage 989 10-6400 Postage:Cost of Agency postage and delivery.Including delivery by the U.S. Post Office,U.P.S.,FedEx or other courier services. 3003 Office,Household&Program Supplies 5,066 10-6110 Office Supplies:Cost of items normally used in an office setting.10-6130 House Supplies:Cost of supplies used by staff during their scheduled work hours.These items are normally used to operate the building at the program location.These items are to remain at program location and not sent home with client.10-6120 Program Supplies: Cost of any items normally used by clients or to directly benefit the clients to meet program objectives while receiving services.These items are to remain at the program location and not sent home with the client.10-6243 General Supplies:Cost of items generally used by all at program's location.10-6244 Janitorial Supplies&Services:Cost of items or services to maintain the esthetics of the premises. 3004 Advertising - 3005 Staff Development&Training 2,026 10-6440 Staff Educational Expense:Cost of employee training courses and materials. (Examples:certification,training,books,etc.)*May include cost of room rental 3006 Staff Mileage 1,544 10-6060 Staff Mileage:Cost of employee mileage reimbursement paid in accordance with FPM section 1005. 3007 Subscriptions&Memberships 442 10-6360 Dues&Subscriptions:Cost of membership dues and subscriptions.(Examples: magazine,newspaper,memberships,etc.) 3008 Vehicle Maintenance/Fuel/Insurance 5,312 10-6030 Vehicle Insurance:Cost for vehicle insurance.10-6040 Vehicle Fuel:Cost of gas in vehicles.10-6050 Vehicle Maintenance:Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with maintenance and repair of vehicles used by Agency programs.(Examples:repairs,battery,carwash*Includes:impounds) 3009 Recruitment 1,817 10-6470 Recruitment:Cost of advertising and other employee recruitment expenses. (Examples:newspaper ad,urine screening,background check,etc.) 3010 Other(specify) - 3011 Other(specify) 3012 Other(specify) 4000:DIRECT FACILITIES&EQUIPMENT 25,257 4001 Building Maintenance 804 10-6330 Building Maintenance:Cost of Agency building repairs and maintenance. (Examples:electrical work,A/C and heating,hood cleaning,plumbing,deadbolt,door knob/lock,keys,key tags,air/furnace filters,smoke alarm,cot alarm,exit sign,blinds, etc.)This account should not be used if a specific outside labor contractor is doing an identifiable project,in this case use 6603,or projects over$2,000.00 that will require the procurement process and a WIP to be completed. 4002 Rent/Lease Building 10,774 10-6320 Building Rent(Other):Cost of rent/lease payments made for building leases from outside sources. 4003 Rent/Lease Equipment 302 10-6220 Furniture&Equipment Rent/Lease(Other):Cost of rent/lease payments made for furniture and equipment leases from outside sources.(Examples:high capacity copier/printer/scanner,washer/dryer,vending machine,furniture,water cooler, postage meter,etc.) 4004 Rent/Lease Vehicles 5,667 10-6020 Vehicle Rent/Lease(Other):Rental cost of non-Agency vehicles and lease of agency vehicles. 4005 Security 265 10-6390 Security:Cast of installation,maintenance and monthly service fees for building alarms and other security measures.(Examples:security/surveillance equipment,service and installation,safes,locks,padlocks,etc.) 4006 Utilities 7,236 10-6350 Utilities:Cost of service for power,gas,water,sewer,garbage,etc. 4007 Equipment Maintenance 209 10-6230 Equipment Maintenance:Cost of repair or maintenance of office/house equipment and furniture.(Examples:high capacity copier/printer/scanner,replacement parts such as hard drive,video card,adapter,laptop battery,monitor/printer/phone cord,cord covers,power strip,surge protector,extension cord,cable ties,drum,hose, filter,drawer slide set/rollers,keys for filing cabinet,etc.) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) 5000:DIRECT SPECIAL EXPENSES 22,326 Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H3 - Compensation Page 20 of 20 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 5001 Consultant(Network&Data Management) 96 10-6115 Software&Computer Support:Cost of computer software and computer support.(Examples:Microsoft Office,QuickBooks,PDF converter,Avatar,Vipre anti- virus,LogMeln,web filter,etc.)This account should not be used for the purchase of computers and related accessories.Computer accessories such as a mouse,keyboard and speakers must be coded to 6190 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) - 5004 Translation Services 208 Paid to outside vendors for translation/interpreter services. 5005 O/5 Labor Phychiatrist 20,800 These accounts are assigned to record various professional services provided by contracted Psychiatrist working as independent agents. 5006 O/S Labor Counselor 1,222 These accounts are assigned to record various professional services provided by contracted Consultant working as independent agents. 5007 Other(specify) - 5008 1 Other(specify) 6000:INDIRECT EXPENSES 99,490 6001 Administrative Overhead 6002 Professional Liability Insurance 1,906 10-6370Insurance:Cost of Agency liability and property insurance. 6003 Accounting/Bookkeeping - 6004 External Audit 426 10-6460 Audit Expense:Cost of outside audit fees. 6005 Insurance(Specify): - 6006 Payroll Services 1,346 10-6482 Payroll Software&Support 6007 Depreciation(Provider-Owned Equipment to be Used - 6008 Personnel(Indirect Salaries&Benefits) - 6009 Licenses 394 10-6380 Licenses:Cost in obtaining and renewing licenses and permits.(Examples: Electronic Medical Records(EMR)database,kitchen/restaurant permit,fire clearance, facility inspections,vehicle registration,etc.) 6010 Indirect 95,418 10-9000's Indirect Allocated Costs 6011 Other(specify) - 6012 Other(specify) 6013 Other(specify) 7000:DIRECT FIXED ASSETS 5,218 7001 Computer Equipment&Software - 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA - 7003 Furniture&Fixtures 185 10-6240 Expendable Furniture:Cost of small,inexpensive Agency property with a normal useful life generally less than one year or a value that is minor or insignificant, typically items with a total cost of less than$5000 per item.(Examples:small desk, portable desk,chair,filing cabinet,mail slots,shelving unit,table,foldable tables/chairs, bed,mattress,nightstand,room divider,etc.*Includes assembly fee)(For additional information,see procedures section 0900) 7004 Leasehold/Tenant/Building Improvements 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) - 7007 Expendable Equipment 5,033 10-6190 Expendable Equipment:Cost of purchasing office/house equipment that has a cost less than$5000 per item.(Examples:electronic stapler/calculator/hole puncher, computer,monitor,keyboard,mouse,speakers and other computer accessories including mousepad and wrist pad,desk printer,tablet,tablet cover,lamp,desk lamp, fan,radio,television,phone,coffee machine,popcorn maker,toaster,refrigerator, dishwasher,washer,dryer,portable a/c unit,hand soap/hand towel dispenser,fire extinguisher,dolly,canopy,shed,barbecue,drill,etc.) 7008 Other(specify) I - TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 731,536 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 731,536 BUDGET CHECK: - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H4 - Compensation Page 1 of 12 Adult FSP Master Agreement-D.A.R.T.West Mental Health Systems,Inc. Fiscal Year(FY)2023-24 PROGRAM EXPENSES 1000:DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct# Administrative Position FTE Admin Program Total 1101 $ 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 1115 Direct Personnel Admin Salaries Subtotal 0.00 - Acct# Program Position FTE Admin Program Total 1116 $ 1117 1118 1119 1120 1121 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 Direct Personnel Program Salaries Subtotall 0.00 1 $ $ Admin Program Total Direct Personnel Salaries Subtotall 0.00 1 $ - $ Direct Employee Benefits Acct# Description Admin Program Total 1201 Retirement $ 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) - - 1205 Other(specify) - - - 1206 Other(specify) - - - Direct Employee Benefits Subtotal: $ - $ - $ - Direct Payroll Taxes&Expenses: Acct# Description Admin Program Total 1301 OASDI $ $ $ 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) Direct Payroll Taxes&Expenses Subtotal: $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program #DIV/0! #DIV/0! Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H4 - Compensation Pa e2of12 2000:DIRECT CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care 2,571 2002 Client Housing Support 601,800 2003 Client Transportation&Support 34,731 2004 Clothing,Food,&Hygiene 13,886 2005 Education Support 2,571 2006 Employment Support 2,571 2007 Household Items for Clients 20,429 2008 Medication Supports 487,386 2009 Program Supplies-Medical 8,400 2010 Utility Vouchers 643 2011 Other(specify) 2012 Other(specify) 2013 Other(specify) 2014 Other(specify) 2015 Other(specify) 2016 Other(specify) - DIRECT CLIENT CARE TOTAL $ 1,174,988 3000:DIRECT OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ - 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 1 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) DIRECT OPERATING EXPENSES TOTAL: $ - 4000:DIRECT FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 5000:DIRECT SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network&Data Management) $ 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 1 Other(specify) 5007 Other(specify) 5008 Other(specify) DIRECT SPECIAL EXPENSES TOTAL: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H4 - Compensation Pa e3of12 6000:INDIRECT EXPENSES Acct# Line Item Description Amount Administrative Overhead 6001 Use this line and only this line for approved indirect cost rate $ Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation wrovide,-0—dit Equipment tobeUsedfor Program vo.Poses/ 6008 Personnel(indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 Other(specify) INDIRECT EXPENSES TOTAL $ INDIRECT COST RATE 0.00% 7000:DIRECT FIXED ASSETS Acct# Line Item Description Amount 7001 Computer Equipment&Software $ - 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data - 7003 Furniture&Fixtures - 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ - 7006 Assets over$5,000/unit(Specify) - 7007 Other(specify) - 7008 Other(specify) - FIXED ASSETS EXPENSES TOTAL $ - TOTAL PROGRAM EXPENSES $ 1,174,988 PROGRAM FUNDING SOURCES 8100-SUBSTANCE USE DISORDER FUNDS Acct# Line Item Description Amount 8101 Drug Medi-Cal $ 8102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acct# Line Item Description Amount 8201 lRealignment $ REALIGNMENT TOTAL $ - 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports Turn BHS/MHS D.A.R.T.West Adult FSP $ 1,174,988 8302 PEI-Prevention&Early Intervention - 8303 INN-Innovations 8304 WET-Workforce Education&Training 8305 CFTN-Capital Facilities&Technology - MHSA TOTAL $ 1,174,988 8400-OTHER REVENUE Acct# Line Item Description Amount 8401 Client Fees $ 8402 Client Insurance 8403 Grants(ARPA) 8404 Other(Specify) 8405 Other(Specify) OTHER REVENUE TOTAL $ TOTAL PROGRAM FUNDING SOURCES: $ 1,174,988 NET PROGRAM COST: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H4 - Compensation Page 4 of 12 Adult FSP Master Agreement-D.A.R.T.West Mental Health Systems,Inc. Fiscal Year(FY)2023-24 Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:DIRECT SALARIES&BENEFITS Administrative Positions 1101 0 1102 0 1103 0 1104 0 1105 0 1106 0 1107 0 1108 0 1109 0 1110 0 1111 0 1112 0 1113 0 1114 0 1115 0 Program Positions 1116 0 1117 0 1118 0 1119 0 1120 0 1121 0 1122 0 1123 0 1124 0 1125 0 1126 0 1127 0 1128 0 1129 0 1130 0 1131 0 1132 0 1133 0 1134 0 Direct Employee Benefits 1201 Retirement 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) 1205 Other(specify) 1206 Other(specify) Direct Payroll Taxes&Expenses: 1301 OASDI 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) - 2000:DIRECT CLIENT SUPPORT 1,174,988 2001 Child Care 2,571 Estimated wrap expenses related to child care for clients 2002 Client Housing Support 601,800 Estimated expenses for housing support for clients 2003 Client Transportation&Support 34,731 Cost of transporting clients by staff(mileage reimbursement or gas for vehicles)and bus passes/cards for client transportation needs. 2004 Clothing,Food,&Hygiene 13,886 Estimated expenses for food&for clothing 2005 Education Support 2,571 Estimated wrap expenses related to education support for clients 2006 Employment Support 2,571 Estimated wrap expenses related to employment support for clients 2007 Household Items for Clients 20,429 Estimated wrap expenses related to household items for clients 2008 Medication Supports 487,386 Estimated wrap expenses related to medication supports(psychiatrist)for clients- Psychiatrist service expense outside of the MHS,Inc.staff. Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H4 - Compensation Page 5 of 12 PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2009 Program Supplies-Medical 8,400 Medical supplies that consist of miscellaneous items such as latex gloves,cotton, alcohol swipes,etc.,in addition to charges for laboratory tests for clients(i.e.blood tests). 2010 Utility Vouchers 643 Estimated wrap expenses related to utility vouchers for clients 2011 Other(specify) - 2012 Other(specify) 2013 Other(specify) 2014 Other(specify) 2015 Other(specify) 2016 1 Other(specify) 3000:DIRECT OPERATING EXPENSES 3001 Telecommunications 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 1 Other(specify) 4000:DIRECT FACILITIES&EQUIPMENT 4001 Building Maintenance 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) 5000:DIRECT SPECIAL EXPENSES 5001 Consultant(Network&Data Management) 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 Other(specify) 5007 Other(specify) 5008 Other(specify) 6000:INDIRECT EXPENSES 6001 Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation(Provider-Owned Equipment to be Used 6008 Personnel(Indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) Insurance,timekeeping,audit fees,corporate costs for processing invoices 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 1 Other(specify) 7000:DIRECT FIXED ASSETS 7001 Computer Equipment&Software 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 7003 Furniture&Fixtures 7004 Leasehold/Tenant/Building Improvements 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H4 - Compensation Page 6 of 12 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 7007 Other(specify) 7008 Other(specify) - TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,174,988 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,174,988 BUDGET CHECK: - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2I7I2020 Exhibit H4 - Compensation Page 7 of 12 Adult FSP Master Agreement-D.A.R.T.West Mental Health Systems,Inc. Fiscal Year(FY)2024-25 PROGRAM EXPENSES 1000:DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct# Administrative Position FTE Admin Program Total 1101 $ 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 1115 Direct Personnel Admin Salaries Subtotal 0.00 - Acct# Program Position FTE Admin Program Total 1116 $ 1117 1118 1119 1120 1121 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 Direct Personnel Program Salaries Subtotall 0.00 1 $ $ Admin Program Total Direct Personnel Salaries Subtotall 0.00 1 $ - $ Direct Employee Benefits Acct# Description Admin Program Total 1201 Retirement $ 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) 1205 Other(specify) 1206 Other(specify) Direct Employee Benefits Subtotal: $ $ $ Direct Payroll Taxes&Expenses: Acct# Description Admin Program Total 1301 OASDI $ - 1302 FICA/MEDICARE - - - 1303 SUI - - - 1304 Other(specify) - - - 1305 Other(specify) - - - 1306 Other(specify) - - - Direct Payroll Taxes&Expenses Subtotal: $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program #DIV/01 #DIV/0! Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H4 - Compensation Pa e8of12 2000:DIRECT CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care 2,571 2002 Client Housing Support 601,800 2003 Client Transportation&Support 34,731 2004 Clothing,Food,&Hygiene 13,886 2005 Education Support 2,571 2006 Employment Support 2,571 2007 Household Items for Clients 20,429 2008 Medication Supports 487,386 2009 Program Supplies-Medical 8,400 2010 Utility Vouchers 643 2011 Other(specify) 2012 Other(specify) - 2013 Other(specify) 2014 Other(specify) 2015 Other(specify) 2016 Other(specify) - DIRECT CLIENT CARE TOTAL $ 1,174,988 3000:DIRECT OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ - 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 1 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) DIRECT OPERATING EXPENSES TOTAL: $ - 4000:DIRECT FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) DIRECT FACILITIES/EQUIPMENT TOTAL:j$ 5000:DIRECT SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network&Data Management) $ 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 1 Other(specify) 5007 Other(specify) 5008 Other(specify) DIRECT SPECIAL EXPENSES TOTAL: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020 Exhibit H4 - Compensation Pa e9of12 6000:INDIRECT EXPENSES Acct# Line Item Description Amount Administrative Overhead 6001 Use this line and only this line for approved indirect cost rate $ Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation wrovide,-0—dit Equipment tobeUsedfor Program vo.Poses/ 6008 Personnel(indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 Other(specify) INDIRECT EXPENSES TOTAL $ INDIRECT COST RATE 0.00% 7000:DIRECT FIXED ASSETS Acct# Line Item Description Amount 7001 Computer Equipment&Software $ - 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data - 7003 Furniture&Fixtures - 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 Years+ - 7006 Assets over$5,000/unit(Specify) - 7007 Other(specify) - 7008 Other(specify) - FIXED ASSETS EXPENSES TOTAL $ - TOTAL PROGRAM EXPENSES $ 1,174,988 PROGRAM FUNDING SOURCES 8100-SUBSTANCE USE DISORDER FUNDS Acct# Line Item Description Amount 8101 Drug Medi-Cal $ 8102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acct# Line Item Description Amount 8201 lRealignment $ REALIGNMENT TOTAL $ - 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports Turn BHS/MHS D.A.R.T.West Adult FSP $ 1,174,988 8302 PEI-Prevention&Early Intervention - 8303 INN-Innovations 8304 WET-Workforce Education&Training 8305 CFTN-Capital Facilities&Technology - MHSA TOTAL $ 1,174,988 8400-OTHER REVENUE Acct# Line Item Description Amount 8401 Client Fees $ 8402 Client Insurance 8403 Grants(ARPA) 8404 Other(Specify) 8405 Other(Specify) OTHER REVENUE TOTAL $ TOTAL PROGRAM FUNDING SOURCES: $ 1,174,988 NET PROGRAM COST: $ Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H4 - Compensation Page 10 of 12 Adult FSP Master Agreement-D.A.R.T.West Mental Health Systems,Inc. Fiscal Year(FY)2024-25 Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:DIRECT SALARIES&BENEFITS Administrative Positions 1101 0 1102 0 1103 0 1104 0 1105 0 1106 0 1107 0 1108 0 1109 0 1110 0 1111 0 1112 0 1113 0 1114 0 1115 0 Program Positions 1116 0 1117 0 1118 0 1119 0 1120 0 1121 0 1122 0 1123 0 1124 0 1125 0 1126 0 1127 0 1128 0 1129 0 1130 0 1131 0 1132 0 1133 0 1134 0 Direct Employee Benefits 1201 Retirement 1202 Worker's Compensation 1203 Health Insurance 1204 Other(Benefits listed under ARPA Grant) 1205 Other(specify) 1206 Other(specify) Direct Payroll Taxes&Expenses: 1301 OASDI 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) - 2000:DIRECT CLIENT SUPPORT 1,174,988 2001 Child Care 2,571 Estimated wrap expenses related to child care for clients 2002 Client Housing Support 601,800 Estimated expenses for housing support for clients 2003 Client Transportation&Support 34,731 Cost of transporting clients by staff(mileage reimbursement or gas for vehicles)and bus passes/cards for client transportation needs. 2004 Clothing,Food,&Hygiene 13,886 Estimated expenses for food&for clothing 2005 Education Support 2,571 Estimated wrap expenses related to education support for clients 2006 Employment Support 2,571 Estimated wrap expenses related to employment support for clients 2007 Household Items for Clients 20,429 Estimated wrap expenses related to household items for clients 2008 Medication Supports 487,386 Estimated wrap expenses related to medication supports(psychiatrist)for clients- Psychiatrist service expense outside of the MHS,Inc.staff. Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H4 - Compensation Page 11 of 12 PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2009 Program Supplies-Medical 8,400 Medical supplies that consist of miscellaneous items such as latex gloves,cotton, alcohol swipes,etc.,in addition to charges for laboratory tests for clients(i.e.blood tests). 2010 Utility Vouchers 643 Estimated wrap expenses related to utility vouchers for clients 2011 Other(specify) - 2012 Other(specify) 2013 Other(specify) 2014 Other(specify) 2015 Other(specify) 2016 1 Other(specify) 3000:DIRECT OPERATING EXPENSES 3001 Telecommunications 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 1 Other(specify) 4000:DIRECT FACILITIES&EQUIPMENT 4001 Building Maintenance 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) 5000:DIRECT SPECIAL EXPENSES 5001 Consultant(Network&Data Management) 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services 5005 Other(specify) 5006 Other(specify) 5007 Other(specify) 5008 Other(specify) 6000:INDIRECT EXPENSES 6001 Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation(Provider-Owned Equipment to be Used 6008 Personnel(Indirect Salaries&Benefits) 6009 Other(Indirect Cost under ARPA Grant) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 1 Other(specify) 7000:DIRECT FIXED ASSETS 7001 Computer Equipment&Software 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 7003 Furniture&Fixtures 7004 Leasehold/Tenant/Building Improvements 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 Exhibit H4 - Compensation Page 12 of 12 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 7007 Other(specify) 7008 Other(specify) - TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,174,988 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,174,988 BUDGET CHECK: - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2I7I2020 Exhibit I Insurance Requirements 1. Required Policies Without limiting the County's right to obtain indemnification from the Contractor or any third parties, Contractor, at its sole expense, shall maintain in full force and effect the following insurance policies throughout the term of this Agreement. (A) Commercial General Liability. Commercial general liability insurance with limits of not less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis. Coverage must include products, completed operations, property damage, bodily injury, personal injury, and advertising injury. The Contractor shall obtain an endorsement to this policy naming the County of Fresno, its officers, agents, employees, and volunteers, individually and collectively, as additional insureds, but only insofar as the operations under this Agreement are concerned. Such coverage for additional insureds will apply as primary insurance and any other insurance, or self-insurance, maintained by the County is excess only and not contributing with insurance provided under the Contractor's policy. (B) Automobile Liability. Automobile liability insurance with limits of not less than One Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages. Coverage must include any auto used in connection with this Agreement. (C)Workers Compensation. Workers compensation insurance as required by the laws of the State of California with statutory limits. (D) Employer's Liability. Employer's liability insurance with limits of not less than One Million Dollars ($1,000,000) per occurrence for bodily injury and for disease. (E) Professional Liability. Professional liability insurance with limits of not less than One Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million Dollars ($3,000,000). If this is a claims-made policy, then (1)the retroactive date must be prior to the date on which services began under this Agreement; (2)the Contractor shall maintain the policy and provide to the County annual evidence of insurance for not less than five years after completion of services under this Agreement; and (3) if the policy is canceled or not renewed, and not replaced with another claims-made policy with a retroactive date prior to the date on which services begin under this Agreement, then the Contractor shall purchase extended reporting coverage on its claims-made policy for a minimum of five years after completion of services under this Agreement. (F) Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis. (G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars ($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The cyber liability policy must be endorsed to cover the full replacement value of damage to, alteration of, loss of, or destruction of intangible property (including but not limited to information or data) that is in the care, custody, or control of the Contractor. I-1 Exhibit I Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security Breach, which may include Disclosure of Personal Information to an Unauthorized Third Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under Article 18 of this Agreement; (iv) system failure; (v) data recovery; (vi) failure to timely disclose data breach or Security Breach; (vii) failure to comply with privacy policy; (viii) payment card liabilities and costs; (ix) infringement of intellectual property, including but not limited to infringement of copyright, trademark, and trade dress; (x) invasion of privacy, including release of private information; (xi) information theft; (xii) damage to or destruction or alteration of electronic information; (xiii) cyber extortion; (xiv) extortion related to the Contractor's obligations under this Agreement regarding electronic information, including Personal Information; (xv)fraudulent instruction; (xvi) funds transfer fraud; (xvii) telephone fraud; (xviii) network security; (xix) data breach response costs, including Security Breach response costs; (xx) regulatory fines and penalties related to the Contractor's obligations under this Agreement regarding electronic information, including Personal Information; and (xxi) credit monitoring expenses. If the Contractor is a governmental entity, it may satisfy the policy requirements above through a program of self-insurance, including an insurance pooling arrangement or joint exercise of powers agreement. 2. Additional Requirements (A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement, and at any time during the term of this Agreement as requested by the County's Risk Manager or the County Administrative Office, the Contractor shall deliver, or cause its broker or producer to deliver, to the County Risk Manager, at 2220 Tulare Street, 16th Floor, Fresno, California 93721, or HRRiskManagement@fresnocountyca.gov, and by mail or email to the person identified to receive notices under this Agreement, certificates of insurance and endorsements for all of the coverages required under this Agreement. (i) Each insurance certificate must state that: (1) the insurance coverage has been obtained and is in full force; (2) the County, its officers, agents, employees, and volunteers are not responsible for any premiums on the policy; and (3) the Contractor has waived its right to recover from the County, its officers, agents, employees, and volunteers any amounts paid under any insurance policy required by this Agreement and that waiver does not invalidate the insurance policy. (ii) The commercial general liability insurance certificate must also state, and include an endorsement, that the County of Fresno, its officers, agents, employees, and volunteers, individually and collectively, are additional insureds insofar as the operations under this Agreement are concerned. The commercial general liability insurance certificate must also state that the coverage shall apply as primary insurance and any other insurance, or self-insurance, maintained by the County shall be excess only and not contributing with insurance provided under the Contractor's policy. 1-2 Exhibit I (iii) The automobile liability insurance certificate must state that the policy covers any auto used in connection with this Agreement. (iv) The professional liability insurance certificate, if it is a claims-made policy, must also state the retroactive date of the policy, which must be prior to the date on which services began under this Agreement. (v) The cyber liability insurance certificate must also state that it is endorsed, and include an endorsement, to cover the full replacement value of damage to, alteration of, loss of, or destruction of intangible property (including but not limited to information or data) that is in the care, custody, or control of the Contractor. (B) Acceptability of Insurers. All insurance policies required under this Agreement must be issued by admitted insurers licensed to do business in the State of California and possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no less than A: VI I. (C) Notice of Cancellation or Change. For each insurance policy required under this Agreement, the Contractor shall provide to the County, or ensure that the policy requires the insurer to provide to the County, written notice of any cancellation or change in the policy as required in this paragraph. For cancellation of the policy for nonpayment of premium, the Contractor shall, or shall cause the insurer to, provide written notice to the County not less than 10 days in advance of cancellation. For cancellation of the policy for any other reason, and for any other change to the policy, the Contractor shall, or shall cause the insurer to, provide written notice to the County not less than 30 days in advance of cancellation or change. The County in its sole discretion may determine that the failure of the Contractor or its insurer to timely provide a written notice required by this paragraph is a breach of this Agreement. (D) County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance with broader coverage, higher limits, or both, than what is required under this Agreement, then the County requires and is entitled to the broader coverage, higher limits, or both. To that end, the Contractor shall deliver, or cause its broker or producer to deliver, to the County's Risk Manager certificates of insurance and endorsements for all of the coverages that have such broader coverage, higher limits, or both, as required under this Agreement. (E) Waiver of Subrogation. The Contractor waives any right to recover from the County, its officers, agents, employees, and volunteers any amounts paid under the policy of worker's compensation insurance required by this Agreement. The Contractor is solely responsible to obtain any policy endorsement that may be necessary to accomplish that waiver, but the Contractor's waiver of subrogation under this paragraph is effective whether or not the Contractor obtains such an endorsement. (F) County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep in effect at all times any insurance coverage required under this Agreement, the County may, in addition to any other remedies it may have, suspend or terminate this Agreement upon the occurrence of that failure, or purchase such insurance coverage, and charge the cost of that coverage to the Contractor. The County may offset such 1-3 Exhibit I charges against any amounts owed by the County to the Contractor under this Agreement. (G)Subcontractors. The Contractor shall require and verify that all subcontractors used by the Contractor to provide services under this Agreement maintain insurance meeting all insurance requirements provided in this Agreement. This paragraph does not authorize the Contractor to provide services under this Agreement using subcontractors. 1-4 Exhibit J FRESNO COUNTY MENTAL HEALTH PLAN Grievances Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance and appeal process and an expedited appeal process to resolve grievances and disputes at the earliest and the lowest possible level. Title 9 of the California Code of Regulations requires that the MHP and its fee-for-service providers give verbal and written information to Medi-Cal beneficiaries regarding the following: • How to access specialty mental health services • How to file a grievance about services • How to file for a State Fair Hearing The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance form, an appeal form, and Request for Change of Provider Form. All of these beneficiary materials must be posted in prominent locations where Medi-Cal beneficiaries receive outpatient specialty mental health services, including the waiting rooms of providers' offices of service. Please note that all fee-for-service providers and contract agencies are required to give the individuals served copies of all current beneficiary information at intake and annually thereafter. Beneficiaries have the right to use the grievance and/or appeal process without any penalty, change in mental health services, or any form of retaliation. All Medi-Cal beneficiaries can file an appeal or state hearing. Grievances and appeals forms and self addressed envelopes must be available for beneficiaries to pick up at all provider sites without having to make a verbal or written request. Forms can be sent to the following address: Fresno County Mental Health Plan P.O. Box 45003 Fresno, CA 93718-9886 (800) 654-3937 (for more information) (559) 488-3055 (TTY) Provider Problem Resolution and Appeals Process The MHP uses a simple, informal procedure in identifying and resolving provider concerns and problems regarding payment authorization issues, other complaints and concerns. Informal provider problem resolution process—the provider may first speak to a Provider Relations Specialist (PRS) regarding his or her complaint or concern. J-1 Exhibit J The PRS will attempt to settle the complaint or concern with the provider. If the attempt is unsuccessful and the provider chooses to forego the informal grievance process, the provider will be advised to file a written complaint to the MHP address (listed above). Formal provider appeal process—the provider has the right to access the provider appeal process at any time before, during, or after the provider problem resolution process has begun, when the complaint concerns a denied or modified request for MHP payment authorization, or the process or payment of a provider's claim to the MHP. Payment authorization issues—the provider may appeal a denied or modified request for payment authorization or a dispute with the MHP regarding the processing or payment of a provider's claim to the MHP. The written appeal must be submitted to the MHP within 90 calendar days of the date of the receipt of the non-approval of payment. The MHP shall have 60 calendar days from its receipt of the appeal to inform the provider in writing of the decision, including a statement of the reasons for the decision that addresses each issue raised by the provider, and any action required by the provider to implement the decision. If the appeal concerns a denial or modification of payment authorization request, the MHP utilizes a Managed Care staff who was not involved in the initial denial or modification decision to determine the appeal decision. If the Managed Care staff reverses the appealed decision, the provider will be asked to submit a revised request for payment within 30 calendar days of receipt of the decision Other complaints— if there are other issues or complaints, which are not related to payment authorization issues, providers are encouraged to send a letter of complaint to the MHP. The provider will receive a written response from the MHP within 60 calendar days of receipt of the complaint. The decision rendered buy the MHP is final. J-2 Exhibit K-Incident Reporting Page 1 of 9 INCIDENT REPORTING PROTOCOL FOR COMPLETION OF INCIDENT REPORT The Incident Report must be completed for all incidents involving individuals served through DBH's current incident reporting portal, Logic Manager, at https:Hfresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182beOc5cdcd5072bb1864cdee 4d3d6e • The reporting portal is available 24 hours a day, every day. • Any employee of the CONTRACTOR can submit an incident using the reporting portal at any time. No login is required. • The designated administrator of the CONTRACTOR can add information to the follow up section of the report after submission. • When an employee submits an incident within 24 hours from the time of the incident or first knowledge of the incident, the CONTRACTOR's designated administrator, the assigned contract analyst and the Incident Reporting email inbox will be notified immediately via email from the Logic Manager system that there is a new incident to review. • Meeting the 24 hour incident reporting requirements will be easier as there are no signatures to collect. • The user guide attached identifies the reporting process and the reviewer process, and is subject to updates based on DBH's selected incident reporting portal system. Questions about incident reporting, how to use the incident reporting portal, or designating/changing the name of the administrator who will review incidents for the CONTRACTOR should be emailed to DBHlncidentReporting@fresnocountyca.gov and the assigned contract analyst. Exhibit K-Incident Reporting Page 2 of 9 Mental Health Plan (MHP) and Substance Use Disorder(SUD) services Co�,� Incident Reporting System 19 INCIDENT REVIEWER ROLE — User Guide Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete a written report of any incidents compromising the health and safety of persons served, employees, or community members. Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's an easier way for any employee to report an incident at any time. A few highlights: • No supervisor signature is immediately required. • Additional information can be added to the report by the program supervisor/manager without having to resubmit the incident. • When an incident is submitted, the assigned contract analyst, program supervisor/manager, clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email notification of a new incident and can log in any time to review the incident. Everything that was on the original paper/electronic form matches the online form. • Do away with submitting a paper version with a signature. • This online submission allows for timely action for the health and safety of the persons-served, as well as compliance with state reporting timelines when necessary. As an Incident Reviewer,the responsibility is to: • Log in to Logic Manager and review incident submitted within 48 hours of notification of incident. • Review incident for clarity, missing information and add in additional information deemed appropriate. • Notify DBHlncidentReporting@fresnocountyca.gov if there is additional information to be report after initial submission • Contact.DBHlncidentReporting@fresnocountVca.gov if there are any concerns, questions or comments with Logic Manager or incident reporting. Below is the link to report incidents https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcdSO72bbl864cdee4d3d6e The link will take employees to the reporting screen to begin incident submission: Exhibit K-Incident Reporting Page 3 of 9 E C O Y Iresrtotfohlragicnunagcr.com _. - - ... - - LogicManager Incident Report Please complete this form • client information Nam.of Fadllty' Name of Reporting Party Fadllty AddreW Facility Phone Number- N.nul Hwlth or Subztanc.Uso Dlsarder Program?' Client Fust Name' Cllont last Nam. F C O r Client Data.1 Mirth Client Address cLmuD tsender county of origin' • Summary Subject u Incident icheck all that apply) If oiher•sp-fy ll...fife,polsomng.epldemic outbreaks,other catastrophesi'eeents that jeopardize the walfam and safety of diants,staff and for members of the commumtyj: Descrfpllon of the Incident' Exhibit K-Incident Reporting Page 4 of 9 Similar to the paper version, multiple incident categories can be selected Incident tcheck MIIha I applyI Medr,MEmergency , Deatho(Client�. Homicide/Homicide Attempt AWOL)Eiopement from locked facility, Oct.—Abirw Assault(toward others,client and-propeny Attempted Sulr,de irendting in serious injury) Injury(sel6lnlllrled or by accident) Medication Error E C O i bes wl6h.luyfcmanager.cwnlluiJenls(ft-�b0, 1&k-t02tndr5cda1507T.Dbi06Act1eeAdJd6r Date of Incident* Time of Incident' Location of Incident' Key Poople Directly Inadeed in Incident witnesses.zt.M Did the Injured Pany seek Medical AtWnllon' Attach any addmonaI details ®P�dEilc or Drop Rio Here Reported by Name' Reported By Email' Reported On W30/2019 Exhibit K-Incident Reporting Page 5 of 9 As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on Add File to r ur ptre sdmlie.ig. . 4 rr,rom Reported By Name' Reported By Email Ruponod On 10/30/2019 • follow Up kini.Taken(check all that apply) Please sp—fy it other Dvw 1ptlon of Action Takon- Outcome' Similar to the paper version, multiple Action Taken categories can be selected. . T•ttnw U, action Taken(check all that apply, Law Enforcement Contacted• Called 9ll/EMS Conwlted with Physician fir:)Aid;C PR Ad--stered Chant nmev.M from bund�ng Parentr'Legal Goardlan Contacted Other When done entering all the information, simply click submit. Any fields that have a red asterisk, require information an will prevent submission of the form if left blank. A "Thank you for your submission" statement will pop up if an incident is successfully submitted. Click"Reload the Form"to submit another incident. LogicManager Thank you for your submission) RELOAD THE FORM Exhibit K-Incident Reporting Page 6 of 9 A Notification email will be received when a new incident is reported, or a new comment has been made regarding an incident. Click on "Open this incident in Logic Manager" and the Logic Manager login screen will show. Wed 10/30/2019 10:40 AM SL SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@logicmanager.com> Notification- To DBH Incident Reporting ©f there are problems with haw this message is displayed,click here to view it in a web Click here to download pictures.To help protect your privacy,Outlook prevented autom ocdownload of some pictures in this message. CAUTION!!I-EXTERNAL EMAIL-THINK BEFORE YOU CLICK 0"hlchhd W re hdd hve m dwnkm pn,res.TP h*W,,te car Wtlmk Prrmdd wmnvEc dwmbd dMu PCWre Fontlx lv,rNan9r,IM. Ri Mila Arevalo, You have received a notficafion through LogicManager.Please see the details below. Type:Incident Report Subject:102 Notification To:Mila Arevalo 01xn this incident in LogicManager If using Internet Explorer,click here to open the notification. This email was generated by LogicManager If you have any technical issues. please email supportC@Iogicmanager.com. Enter in email address and password. First time users will be prompted to set up a password. C Q Q fresnodbh.my.logicmanager.com/login LogicManager F61 dI FuasI,"ICJ Exhibit K-Incident Reporting Page 7 of 9 Once logged in,the main screen will show reviewer task (incidents to review). Click on analyst/supervisor follow up to view the incident. Your Task List TASK NAM[ SV�((l! ,1:.1�iY .�,.,.1�., �..,,I. P• _i_..t. This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and facility information. No edits can be made to this section. Analyst Follow Up -.uMarm. The next tab is Sum ary: No edits can be made to this section. Analyst Follow Up wr�.�ra.r r .an u+.�r..nn.w��..w�i..a.....e�.�«w...a..r.«u.w.+.-�e.wi«va.m.r•....e..rreo..�.,ue,.•e m.....b...erw.<.mW��nr B I V S 11 bmwrma«n• w,nrw. I r Exhibit K-Incident Reporting Page 8 of 9 The next tab is Follow up: This section can be edited. Add to th areas below or make corrections to these fields. Be E w en edits are made.Then Cancel to Exi ut of the incident. Analyst Follow Up Actwn r,ken to«a.0 tM+OMri' uw FA,.e.m.nt[wrau.e r - «.aysp.ce.•r:r. p�,.phond,ncr:»en ,edn M«m.ao. gut.ordwm.,nt«p«tdon«ta nab r.fkia nx lnwnr tot nm • ., .. The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding documents.Then Cancel to Exit out of the incident. Analyst Follow Up in;k Uctal: fli.M iMnrmttlnn ;ur^.r•nv tol•,w t'c bo[umrnr• ® Add Darament v !lame Tra Source piead p,te upt.—dnv �i !b OocumrnF yel Drop fi z here or tuck—he Add DOcum«A drop.— Ia.k ID:]t)Sourtr to-1. « < ! [ANCfi C)( If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once submitted,the incident will be removed from the task list and no further edits can be made. Notice the SUBMIT button is on every tab. If further information needs to be included, email DBHlncidentReportine@fresnocountyca.gov Exhibit K-Incident Reporting Page 9 of 9 To get back to the home view, cli�thheis Manager icon at any time. Any incidents that still need review will show on this screen, click o and start the review process again. Your Task List TASK NAMf SOU— fi:l�.s .��li�ti r.Ci�.� ,..S�I'._`:r:b'• _�_;>. Exhibit L-Compliance Page 1 of 3 FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM CONTRACTOR CODE OF CONDUCT AND ETHICS Fresno County is firmly committed to full compliance with all applicable laws, regulations, rules and guidelines that apply to the provision and payment of mental health services. Mental health contractors and the manner in which they conduct themselves are a vital part of this commitment. Fresno County has established this Contractor Code of Conduct and Ethics with which contractor and its employees and subcontractors shall comply. CONTRACTOR(S) shall require its employees and subcontractors to attend a compliance training that will be provided by Fresno County. After completion of this training, CONTRACTOR(S), CONTRACTOR(S)' employees and subcontractors must sign the Contractor Acknowledgment and Agreement form and return this form to the Compliance Officer or designee. Contractor and its employees and subcontractor shall: 1. Comply with all applicable laws, regulations, rules or guidelines when providing and billing for mental health services. 2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their professional dealing related to their contract with the COUNTY and avoid any conduct that could reasonably be expected to reflect adversely upon the integrity of the COUNTY. 3. Treat COUNTY employees, consumers, and other mental health contractors fairly and with respect. 4. NOT engage in any activity in violation of the COUNTY's Compliance Program, nor engage in any other conduct which violates any applicable law, regulation, rule or guideline 5. Take precautions to ensure that claims are prepared and submitted accurately, timely and are consistent with all applicable laws, regulations, rules or guidelines. 6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement of any kind are submitted. Exhibit L-Compliance Page 2 of 3 7. Bill only for eligible services actually rendered and fully documented. Use billing codes that accurately describe the services provided. 8. Act promptly to investigate and correct problems if errors in claims or billing are discovered. 9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of Conduct and Ethics by COUNTY employees or other mental health contractors, or report any activity that they believe may violate the standards of the Compliance Program, or any other applicable law, regulation, rule or guideline. Fresno County prohibits retaliation against any person making a report. Any person engaging in any form of retaliation will be subject to disciplinary or other appropriate action by the COUNTY. CONTRACTOR(S) may report anonymously. 10. Consult with the Compliance Officer if you have any questions or are uncertain of any Compliance Program standard or any other applicable law, regulation, rule or guideline. 11. Immediately notify the Compliance Officer if they become or may become an Ineligible person and therefore excluded from participation in the Federal Health Care Programs. Exhibit L-Compliance Page 3 of 3 Fresno County Mental Health Compliance Program Contractor Acknowledgment and Agreement I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental Health Compliance Program and understand the contents thereof. I further agree to abide by the Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my responsibilities as a mental health contractor for Fresno County. I understand and accept my responsibilities under this Agreement. I further understand that any violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program may result in termination of my agreement with Fresno County. I further understand that Fresno County will report me to the appropriate Federal or State agency. For Individual Providers Name (print): Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT Signature: Date: For Group or Organizational Providers Group/Org. Name (print): Employee Name (print): Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT ❑ Other: Job Title (if different from Discipline): Signature: Date: / / Exhibit M-Compliance with State Medi-Cal Requirements Page 1 of 2 COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS CONTRACTOR shall be required to maintain organizational provider certification by the host county. A copy of this renewal certificate must be furnished to COUNTY within thirty (30) days of receipt of certificate from host county. The CONTRACTOR must meet Medi-Cal organization provider standards as stated below. It is acknowledged that all references to Organizational Provider and/or Provider below shall refer to the CONTRACTOR. Medi-Cal Organizational Provider Standards 1. The organizational provider possesses the necessary license to operate, if applicable, and any required certification. 2. The space owned, leased or operated by the provider and used for services or staff meets local fire codes. 3. The physical plant of any site owned, leased, or operated by the provider and used for services or staff is clean, sanitary and in good repair. 4. The organizational provider establishes and implements maintenance policies for any site owned, leased, or operated by the provider and used for services or staff to ensure the safety and well-being of beneficiaries and staff. 5. The organizational provider has a current administrative manual which includes: personnel policies and procedures, general operating procedures, service delivery policies, and procedures for reporting unusual occurrences relating to health and safety issues. 6. The organizational provider maintains client records in a manner that meets applicable state and federal standards. 7. The organization provider has staffing adequate to allow the COUNTY to claim federal financial participation for the services the Provider delivers to beneficiaries, as described in Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable. 8. The organizational provider has as head of service a licensed mental health professional or other appropriate individual as described in Title 9, CCR, Sections 622 through 630. 9. For organizational providers that provide or store medications, the provider stores and dispenses medications in compliance with all pertinent state and federal standards. In particular: A. All drugs obtained by prescription are labeled in compliance with federal and state laws. Prescription labels are altered only by persons legally authorized to do so. B. Drugs intended for external use only or food stuffs are stored separately from drugs for internal use. C. All drugs are stored at proper temperatures, room temperature drugs at 59-86 degrees F and refrigerated drugs at 36-46 degrees F. Exhibit M-Compliance with State Medi-Cal Requirements Page 2 of 2 D. Drugs are stored in a locked area with access limited to those medical personnel authorized to prescribe, dispense or administer medication. E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and initialed when opened. F. A drug log is maintained to ensure the provider disposes of expired, contaminated, deteriorated and abandoned drugs in a manner consistent with state and federal laws. G. Policies and procedures are in place for dispensing, administering and storing medications. 10. The COUNTY may accept the host county's site certification and reserves the right to conduct an on-site certification review at least every three years. The COUNTY may also conduct additional certification reviews when: • The provider makes major staffing changes. • The provider makes organizational and/or corporate structure changes (example: conversion from a non-profit status). • The provider adds day treatment or medication support services when medications shall be administered or dispensed from the provider site. • There are significant changes in the physical plant of the provider site (some physical plant changes could require a new fire clearance). • There is change of ownership or location. • There are complaints against the provider. • There are unusual events, accidents, or injuries requiring medical treatment for clients, staff or members of the community. Exhibit N-Data Security Page 1 of 8 Exhibit N Data Security 1. Definitions Capitalized terms used in this Exhibit M have the meanings set forth in this section 1. (A) "Authorized Employees" means the Contractor's employees who have access to Personal Information. (B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all of the Contractor's subcontractors, representatives, agents, outsourcers, and consultants, and providers of professional services to the Contractor, who have access to Personal Information and are bound by law or in writing by confidentiality obligations sufficient to protect Personal Information in accordance with the terms of this Exhibit M. (C) "Director" means the County's Director of the Department of Behavioral Health or designee. (D) "Disclose" or any derivative of that word means to disclose, release, transfer, disseminate, or otherwise provide access to or communicate all or any part of any Personal Information orally, in writing, or by electronic or any other means to any person. (E) "Person" means any natural person, corporation, partnership, limited liability company, firm, or association. (F) "Personal Information" means any and all information, including any data, provided, or to which access is provided, to the Contractor by or upon the authorization of the County, under this Agreement, including but not limited to vital records, that: (i) identifies, describes, or relates to, or is associated with, or is capable of being used to identify, describe, or relate to, or associate with, a person (including, without limitation, names, physical descriptions, signatures, addresses, telephone numbers, e-mail addresses, education, financial matters, employment history, and other unique identifiers, as well as statements made by or attributable to the person); (ii) is used or is capable of being used to authenticate a person (including, without limitation, employee identification numbers, government-issued identification numbers, passwords or personal identification numbers (PINS), financial account numbers, credit report information, answers to security questions, and other personal identifiers); or (iii) is personal information within the meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision (e). Personal Information does not include publicly available information that is lawfully made available to the general public from federal, state, or local government records. (G) "Privacy Practices Complaint" means a complaint received by the County relating to the Contractor's (or any Authorized Person's) privacy practices, or alleging a Security Breach. Such complaint shall have sufficient detail to enable the Contractor to promptly investigate and take remedial action under this Exhibit M. (H) "Security Safeguards" means physical, technical, administrative or organizational security procedures and practices put in place by the Contractor (or any Authorized Persons) that relate to the protection of the security, confidentiality, value, or integrity of Personal Information. Security Safeguards shall satisfy the minimal requirements set forth in section 3(C) of this Exhibit M. N-1 Exhibit N-Data Security Page 2 of 8 Exhibit N Data Security (1) "Security Breach" means (i) any act or omission that compromises either the security, confidentiality, value, or integrity of any Personal Information or the Security Safeguards, or (ii) any unauthorized Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage to, any Personal Information. (J) "Use" or any derivative of that word means to receive, acquire, collect, apply, manipulate, employ, process, transmit, disseminate, access, store, disclose, or dispose of Personal Information. 2. Standard of Care (A) The Contractor acknowledges that, in the course of its engagement by the County under this Agreement, the Contractor, or any Authorized Persons, may Use Personal Information only as permitted in this Agreement. (B) The Contractor acknowledges that Personal Information is deemed to be confidential information of, or owned by, the County (or persons from whom the County receives or has received Personal Information) and is not confidential information of, or owned or by, the Contractor, or any Authorized Persons. The Contractor further acknowledges that all right, title, and interest in or to the Personal Information remains in the County (or persons from whom the County receives or has received Personal Information) regardless of the Contractor's, or any Authorized Person's, Use of that Personal Information. (C) The Contractor agrees and covenants in favor of the Country that the Contractor shall: (i) keep and maintain all Personal Information in strict confidence, using such degree of care under this section 2 as is reasonable and appropriate to avoid a Security Breach; (ii) Use Personal Information exclusively for the purposes for which the Personal Information is made accessible to the Contractor pursuant to the terms of this Exhibit M; (iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal Information for the Contractor's own purposes or for the benefit of anyone other than the County, without the County's express prior written consent, which the County may give or withhold in its sole and absolute discretion; and (iv) not, directly or indirectly, Disclose Personal Information to any person (an "Unauthorized Third Party") other than Authorized Persons pursuant to this Agreement, without the Director's express prior written consent. (D) Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it, or any Authorized Person, is required to disclose Personal Information to government regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be required by applicable law, Contractor shall (i) immediately notify the County of the specific demand for, and legal authority for the disclosure, including providing County with a copy of any notice, discovery demand, subpoena, or order, as applicable, received by the Contractor, or any Authorized Person, from any government regulatory authorities, or in relation to any legal proceeding, and (ii) promptly notify the County N-2 Exhibit N-Data Security Page 3 of 8 Exhibit N Data Security before such Personal Information is offered by the Contractor for such disclosure so that the County may have sufficient time to obtain a court order or take any other action the County may deem necessary to protect the Personal Information from such disclosure, and the Contractor shall cooperate with the County to minimize the scope of such disclosure of such Personal Information. (E) The Contractor shall remain liable to the County for the actions and omissions of any Unauthorized Third Party concerning its Use of such Personal Information as if they were the Contractor's own actions and omissions. 3. Information Security (A) The Contractor covenants, represents and warrants to the County that the Contractor's Use of Personal Information under this Agreement does and will at all times comply with all applicable federal, state, and local, privacy and data protection laws, as well as all other applicable regulations and directives, including but not limited to California Civil Code, Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song- Beverly Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3, beginning with section 1747). If the Contractor Uses credit, debit or other payment cardholder information, the Contractor shall at all times remain in compliance with the Payment Card Industry Data Security Standard ("PCI DSS") requirements, including remaining aware at all times of changes to the PCI DSS and promptly implementing and maintaining all procedures and practices as may be necessary to remain in compliance with the PCI DSS, in each case, at the Contractor's sole cost and expense. (B) The Contractor covenants, represents and warrants to the County that, as of the effective date of this Agreement, the Contractor has not received notice of any violation of any privacy or data protection laws, as well as any other applicable regulations or directives, and is not the subject of any pending legal action or investigation by, any government regulatory authority regarding same. (C) Without limiting the Contractor's obligations under section 3(A) of this Exhibit M, the Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than accepted industry practices and, at a minimum, include the following: (i) limiting Use of Personal Information strictly to the Contractor's and Authorized Persons' technical and administrative personnel who are necessary for the Contractor's, or Authorized Persons', Use of the Personal Information pursuant to this Agreement; (ii) ensuring that all of the Contractor's connectivity to County computing systems will only be through the County's security gateways and firewalls, and only through security procedures approved upon the express prior written consent of the Director; (iii) to the extent that they contain or provide access to Personal Information, (a) securing business facilities, data centers, paper files, servers, back-up systems and computing equipment, operating systems, and software applications, including, but not limited to, all mobile devices and other equipment, operating systems, and software applications with information storage capability; (b) N-3 Exhibit N-Data Security Page 4 of 8 Exhibit N Data Security employing adequate controls and data security measures, both internally and externally, to protect (1) the Personal Information from potential loss or misappropriation, or unauthorized Use, and (2) the County's operations from disruption and abuse; (c) having and maintaining network, device application, database and platform security; (d) maintaining authentication and access controls within media, computing equipment, operating systems, and software applications; and (e) installing and maintaining in all mobile, wireless, or handheld devices a secure internet connection, having continuously updated anti-virus software protection and a remote wipe feature always enabled, all of which is subject to express prior written consent of the Director; (iv) encrypting all Personal Information at advance encryption standards of Advanced Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile devices, including but not limited to hard disks, portable storage devices, or remote installation, or (b) transmitted over public or wireless networks (the encrypted Personal Information must be subject to password or pass phrase, and be stored on a secure server and transferred by means of a Virtual Private Network (VPN) connection, or another type of secure connection, all of which is subject to express prior written consent of the Director); (v) strictly segregating Personal Information from all other information of the Contractor, including any Authorized Person, or anyone with whom the Contractor or any Authorized Person deals so that Personal Information is not commingled with any other types of information; (vi) having a patch management process including installation of all operating system and software vendor security patches; (vii) maintaining appropriate personnel security and integrity procedures and practices, including, but not limited to, conducting background checks of Authorized Employees consistent with applicable law; and (viii) providing appropriate privacy and information security training to Authorized Employees. (D) During the term of each Authorized Employee's employment by the Contractor, the Contractor shall cause such Authorized Employees to abide strictly by the Contractor's obligations under this Exhibit M. The Contractor shall maintain a disciplinary process to address any unauthorized Use of Personal Information by any Authorized Employees. (E)The Contractor shall, in a secure manner, backup daily, or more frequently if it is the Contractor's practice to do so more frequently, Personal Information received from the County, and the County shall have immediate, real time access, at all times, to such backups via a secure, remote access connection provided by the Contractor, through the Internet. (F)The Contractor shall provide the County with the name and contact information for each Authorized Employee (including such Authorized Employee's work shift, and at least one alternate Authorized Employee for each Authorized Employee during such work shift) who shall serve as the County's primary security contact with the Contractor and shall be N-4 Exhibit N-Data Security Page 5 of 8 Exhibit N Data Security available to assist the County twenty-four (24) hours per day, seven (7) days per week as a contact in resolving the Contractor's and any Authorized Persons' obligations associated with a Security Breach or a Privacy Practices Complaint. (G)The Contractor shall not knowingly include or authorize any Trojan Horse, back door, time bomb, drop dead device, worm, virus, or other code of any kind that may disable, erase, display any unauthorized message within, or otherwise impair any County computing system, with or without the intent to cause harm. 4. Security Breach Procedures (A) Immediately upon the Contractor's awareness or reasonable belief of a Security Breach, the Contractor shall (i) notify the Director of the Security Breach, such notice to be given first by telephone at the following telephone number, followed promptly by email at the following email address: incidents@fresnocountyca.gov, phone number 559-600-5900 (which telephone number and email address the County may update by providing notice to the Contractor), and (ii) preserve all relevant evidence (and cause any affected Authorized Person to preserve all relevant evidence) relating to the Security Breach. The notification shall include, to the extent reasonably possible, the identification of each type and the extent of Personal Information that has been, or is reasonably believed to have been, breached, including but not limited to, compromised, or subjected to unauthorized Use, Disclosure, or modification, or any loss or destruction, corruption, or damage. (B) Immediately following the Contractor's notification to the County of a Security Breach, as provided pursuant to section 4(A) of this Exhibit M, the Parties shall coordinate with each other to investigate the Security Breach. The Contractor agrees to fully cooperate with the County, including, without limitation: (i) assisting the County in conducting any investigation; (ii) providing the County with physical access to the facilities and operations affected; (iii) facilitating interviews with Authorized Persons and any of the Contractor's other employees knowledgeable of the matter; and (iv) making available all relevant records, logs, files, data reporting and other materials required to comply with applicable law, regulation, industry standards, or as otherwise reasonably required by the County. To that end, the Contractor shall, with respect to a Security Breach, be solely responsible, at its cost, for all notifications required by law and regulation, or deemed reasonably necessary by the County, and the Contractor shall provide a written report of the investigation and reporting required to the Director within 30 days after the Contractor's discovery of the Security Breach. (C) County shall promptly notify the Contractor of the Director's knowledge, or reasonable belief, of any Privacy Practices Complaint, and upon the Contractor's receipt of that notification, the Contractor shall promptly address such Privacy Practices Complaint, including taking any corrective action under this Exhibit M, all at the Contractor's sole expense, in accordance with applicable privacy rights, laws, regulations and standards. N-5 Exhibit N-Data Security Page 6 of 8 Exhibit N Data Security In the event the Contractor discovers a Security Breach, the Contractor shall treat the Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractor's receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the County whether the matter is a Security Breach, or otherwise has been corrected and the manner of correction, or determined not to require corrective action and the reason for that determination. (D)The Contractor shall take prompt corrective action to respond to and remedy any Security Breach and take mitigating actions, including but not limiting to, preventing any reoccurrence of the Security Breach and correcting any deficiency in Security Safeguards as a result of such incident, all at the Contractor's sole expense, in accordance with applicable privacy rights, laws, regulations and standards. The Contractor shall reimburse the County for all reasonable costs incurred by the County in responding to, and mitigating damages caused by, any Security Breach, including all costs of the County incurred relation to any litigation or other action described section 4(E) of this Exhibit M. (E)The Contractor agrees to cooperate, at its sole expense, with the County in any litigation or other action to protect the County's rights relating to Personal Information, including the rights of persons from whom the County receives Personal Information. S. Oversight of Security Compliance (A) The Contractor shall have and maintain a written information security policy that specifies Security Safeguards appropriate to the size and complexity of the Contractor's operations and the nature and scope of its activities. (B) Upon the County's written request, to confirm the Contractor's compliance with this Exhibit M, as well as any applicable laws, regulations and industry standards, the Contractor grants the County or, upon the County's election, a third party on the County's behalf, permission to perform an assessment, audit, examination or review of all controls in the Contractor's physical and technical environment in relation to all Personal Information that is Used by the Contractor pursuant to this Agreement. The Contractor shall fully cooperate with such assessment, audit or examination, as applicable, by providing the County or the third party on the County's behalf, access to all Authorized Employees and other knowledgeable personnel, physical premises, documentation, infrastructure and application software that is Used by the Contractor for Personal Information pursuant to this Agreement. In addition, the Contractor shall provide the County with the results of any audit by or on behalf of the Contractor that assesses the effectiveness of the Contractor's information security program as relevant to the security and confidentiality of Personal Information Used by the Contractor or Authorized Persons during the course of this Agreement under this Exhibit M. (C) The Contractor shall ensure that all Authorized Persons who Use Personal Information agree to the same restrictions and conditions in this Exhibit M. that apply to the Contractor with respect to such Personal Information by incorporating the relevant provisions of these provisions into a valid and binding written agreement between the Contractor and such Authorized Persons, or amending any written agreements to provide same. N-6 Exhibit N-Data Security Page 7 of 8 Exhibit N Data Security 6. Return or Destruction of Personal Information. Upon the termination of this Agreement, the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the County all Personal Information, whether in written, electronic or other form or media, in its possession or the possession of such Authorized Persons, in a machine readable form used by the County at the time of such return, or upon the express prior written consent of the Director, securely destroy all such Personal Information, and certify in writing to the County that such Personal Information have been returned to the County or disposed of securely, as applicable. If the Contractor is authorized to dispose of any such Personal Information, as provided in this Exhibit M, such certification shall state the date, time, and manner (including standard) of disposal and by whom, specifying the title of the individual. The Contractor shall comply with all reasonable directions provided by the Director with respect to the return or disposal of Personal Information and copies of Personal Information. If return or disposal of such Personal Information or copies of Personal Information is not feasible, the Contractor shall notify the County according, specifying the reason, and continue to extend the protections of this Exhibit M to all such Personal Information and copies of Personal Information. The Contractor shall not retain any copy of any Personal Information after returning or disposing of Personal Information as required by this section 6. The Contractor's obligations under this section 6 survive the termination of this Agreement and apply to all Personal Information that the Contractor retains if return or disposal is not feasible and to all Personal Information that the Contractor may later discover. 7. Equitable Relief. The Contractor acknowledges that any breach of its covenants or obligations set forth in this Exhibit M may cause the County irreparable harm for which monetary damages would not be adequate compensation and agrees that, in the event of such breach or threatened breach, the County is entitled to seek equitable relief, including a restraining order, injunctive relief, specific performance and any other relief that may be available from any court, in addition to any other remedy to which the County may be entitled at law or in equity. Such remedies shall not be deemed to be exclusive but shall be in addition to all other remedies available to the County at law or in equity or under this Agreement. 8. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its officers, employees, and agents, (each, a "County Indemnitee") from and against any and all infringement of intellectual property including, but not limited to infringement of copyright, trademark, and trade dress, invasion of privacy, information theft, and extortion, unauthorized Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage to, Personal Information, Security Breach response and remedy costs, credit monitoring expenses, forfeitures, losses, damages, liabilities, deficiencies, actions,judgments, interest, awards, fines and penalties (including regulatory fines and penalties), costs or expenses of whatever kind, including attorneys' fees and costs, the cost of enforcing any right to indemnification or defense under this Exhibit M and the cost of pursuing any insurance providers, arising out of or resulting from any third party claim or action against any County Indemnitee in relation to the Contractor's, its officers, employees, or agents, or any Authorized Employee's or Authorized Person's, performance or failure to perform under this Exhibit M or arising out of or resulting from the Contractor's failure to comply with any of its obligations under this section 8. The provisions of this section 8 do not apply to the acts or omissions of the County. The provisions of this section 8 are cumulative to any other obligation of the Contractor to, defend, indemnify, or hold harmless any County Indemnitee under this Agreement. The provisions of this section 8 shall survive the termination of this Agreement. N-7 Exhibit N-Data Security Page 8 of 8 Exhibit N Data Security 9. Survival. The respective rights and obligations of the Contractor and the County as stated in this Exhibit M shall survive the termination of this Agreement. 10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit M is intended to confer, nor shall anything in this Exhibit M confer, upon any person other than the County or the Contractor and their respective successors or assignees, any rights, remedies, obligations or liabilities whatsoever. 11. No County Warranty. The County does not make any warranty or representation whether any Personal Information in the Contractor's (or any Authorized Person's) possession or control, or Use by the Contractor (or any Authorized Person), pursuant to the terms of this Agreement is or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint. N-8 Exhibit O - Self-Dealing Transaction Disclosure Form Page 1 of 2 SELF-DEALING TRANSACTION DISCLOSURE FORM In order to conduct business with the County of Fresno (hereinafter referred to as "County"), members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must disclose any self-dealing transactions that they are a party to while providing goods, performing services, or both for the County. A self-dealing transaction is defined below: "A self-dealing transaction means a transaction to which the corporation is a party and in which one or more of its directors has a material financial interest" The definition above will be utilized for purposes of completing this disclosure form. INSTRUCTIONS (1) Enter board member's name,job title (if applicable), and date this disclosure is being made. (2) Enter the board member's company/agency name and address. (3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the County. At a minimum, include a description of the following: a. The name of the agency/company with which the corporation has the transaction; and b. The nature of the material financial interest in the Corporation's transaction that the board member has. (4) Describe in detail why the self-dealing transaction is appropriate based on applicable provisions of the Corporations Code. (5) Form must be signed by the board member that is involved in the self-dealing transaction described in Sections (3) and (4). Exhibit O - Self-Dealing Transaction Disclosure Form Page 2 of 2 (1)Company Board Member Information: Name: Date: Job Title: (2)Company/Agency Name and Address: (3)Disclosure(Please describe the nature of the self-dealing transaction you are a party to) (4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a) (5)Authorized Signature Signature: Date: Exhibit P-Disclosure of Ownership and Control Interest Statement Page 1 of 2 DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT I. Identifying Information Name of entity D/B/A Address(number,street) City State ZIP code CLIA number Taxpayer ID number(EIN) Telephone number ( ) II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued. YES NO A. Are there any individuals or organizations having a direct or indirect ownership or control interest of five percent or more in the institution, organizations, or agency that have been convicted of a criminal offense related to the involvement of such persons or organizations in any of the programs established by Titles XVIII, XIX, or XX? ......................................................................................................................... o 0 B. Are there any directors, officers, agents, or managing employees of the institution, agency, or organization who have ever been convicted of a criminal offense related to their involvement in such programs established by Titles XVI Il, XIX, or XX?...................................................................................... o 71 C. Are there any individuals currently employed by the institution, agency, or organization in a managerial, accounting, auditing, or similar capacity who were employed by the institution's, organization's, or agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 71 III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are related to each other, this must be reported under"Remarks." NAME ADDRESS EIN B. Type of entity: o Sole proprietorship o Partnership o Corporation n Unincorporated Associations o Other(specify) C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations under"Remarks." D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities? (Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses ofindividuals, and provider numbers........................................................................................................... 71 o NAME ADDRESS PROVIDER NUMBER Exhibit P-Disclosure of Ownership and Control Interest Statement Page 2 of 2 YES NO IV. A. Has there been a change in ownership or control within the last year? ....................................................... o 0 If yes, give date. B. Do you anticipate any change of ownership or control within the year?....................................................... o 0 If yes, when? C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0 If yes, when? V. Is the facility operated by a management company or leased in whole or part by another organization?.......... n n If yes, give date of change in operations. VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... n n VII. A. Is this facility chain affiliated? ...................................................................................................................... n n If yes, list name, address of corporation, and EIN. Name EIN Address(number,name) City State ZIP code B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain? (If yes, list name, address of corporation, and EIN.) Name EIN Address(number,name) City State ZIP code Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the information requested may result in denial of a request to participate or where the entity already participates, a termination of its agreement or contract with the agency, as appropriate. Name of authorized representative(typed) Title Signature Date Remarks Exhibit P-Disclosure of Ownership and Control Interest Statement Page 1 of 2 DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT I. Identifying Information Name of entity D/B/A Turning Point of Central California, Inc. N/A Address(number,street) city State ZIP code P.O. Box 7447 Visalia CA 93290-7447 CLIA number Taxpayer to number(EIN) Telephone number 94-1719862 ( 559 ) 732-8086 II. Answer the following questions by checking "Yes" or"No." If any of the questions are answered "Yes," list names and addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued. YES NO A. Are there any individuals or organizations having a direct or indirect ownership or control interest of five percent or more in the institution, organizations, or agency that have been convicted of a criminal offense related to the involvement of such persons or organizations in any of the programs established byTitles XVI11,XIX,or XX?......................................................................................................................... n B. Are there any directors, officers, agents, or managing employees of the institution, agency, or organization who have ever been convicted of a criminal offense related to their involvement in such programs established by Titles XVIII,XIX,or XX?.....................................................................................1 n 0 C. Are there any individuals currently employed by the institution, agency, or organization in a managerial, accounting, auditing, or similar capacity who were employed by the institution's, organization's, or agency's fiscal intermediary or carrier within the previous 12 months? (Title XVI II providers only)........... n 91 III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are related to each other, this must be reported under"Remarks." NAME ADDRESS EIN None B. Type of entity: n Sole proprietorship n Partnership n Corporation n Unincorporated Associations n Other(specify) C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations under"Remarks." D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities? (Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses of individuals,and provider numbers........................................................................................................... n CK NAME ADDRESS PROVIDER NUMBER NIA Exhibit P-Disclosure of Ownership and Control Interest Statement Page 2 of 2 YES NO IV. A. Has there been a change in ownership or control within the last year?....................................................... o09 If yes, give date. B. Do you anticipate any change of ownership or control within the year?....................................................... o If yes,when? C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0 If yes, when? V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o N If yes, give date of change in operations. VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o VI I. A. Is this facility chain affiliated? ...................................................................................................................... o CR If yes, list name, address of corporation, and EIN. Name EIN NIA Address(number,name) city State ZIP code B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain? No (If yes, list name, address of corporation,and EIN.) Name NIA EIN Address(number,name) City State ZIP code Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the information requested may result in denial of a request to participate or where the entity already participates, a termination of its agreement or contract with the agency, as appropriate. Name of authorized representative(typed) Title Raymond R. s Chief Executive Officer Signature Date Remarks Exhibit Q-Certification Regarding Debarment ect. Page 1 of 2 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS INSTRUCTIONS FOR CERTIFICATION 1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 5. The terms covered transaction, debarred, suspended, ineligible, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations. 6. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. CERTIFICATION (1) The prospective primary participant certifies to the best of its knowledge and belief, that it, its owners, officers, corporate managers and partners: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency; (b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; Exhibit Q-Certification Regarding Debarment ect. Page 2 of 2 (c) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Signature: Date: (Printed Name & Title) (Name of Agency or Company) Exhibit Q-Certification Regarding Debarment ect. Page 2 of 2 (c) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Signature: Date:�4 Of Raymond R. Banks,CEO Turning Point of Central California, Inc. (Printed Name & Title) (Name of Agency or Company) Exhibit R Page 1 of 2 1 National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations to: Principal Standard: 1. Provide effective,equitable,understandable,and respectful quality care and services that are responsive to diverse cultural health beliefs and practices,preferred languages,health literacy,and other communication needs. Governance,Leadership,and Workforce: 2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,practices,and allocated resources. 3. Recruit,promote,and support a culturally and linguistically diverse governance,leadership,and workforce that are responsive to the population in the service area. 4. Educate and train governance,leadership,and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis. Communication and Language Assistance: 5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs,at no cost to them,to facilitate timely access to all health care and services. 6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,verbally and in writing. 7. Ensure the competence of individuals providing language assistance,recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. 8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. Engagement,Continuous Improvement,and Accountability: 9. Establish culturally and linguistically appropriate goals,policies,and management accountability,and infuse them throughout the organization's planning and operations. 10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities. 11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery. 12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area. 13. Partner with the community to design,implement,and evaluate policies,practices,and services to ensure cultural and linguistic appropriateness. 14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify,prevent,and resolve conflicts or complaints. 15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders,constituents,and the general public. ��� 1 Think Cultural Health F S(_ U.S.Deporfinentof https://www.thinkculturalhealth.hhs.gov/ �O M H Health and Human Services Office of Minority Health contact@thinkculturalhealth.hhs.gov o�� Exhibit R Page 2 of 2 2 The Case for the National CLAS Standards Health equity is the attainment of the highest level of health for all people.'Currently,individuals across the United States from various cultural backgrounds are unable to attain their highest level of health for several reasons,including the social determinants of health,or those conditions in which individuals are born,grow,live,work,and age,2 such as socioeconomic status,education level,and the availability of health services.3 Though health inequities are directly related to the existence of historical and current discrimination and social injustice,one of the most modifiable factors is the lack of culturally and linguistically appropriate services,broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals. Of all the forms of Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely affect neighborhoods,communities,and the broader society,thus making inequality, injustice in the issue not only an individual concern but also a public health concern. In the United States,it health care is the most has been estimated that the combined cost of health disparities and subsequent deaths due to shocking and inhumane. inadequate and/or inequitable care is$1.24 trillion.4 Culturally and linguistically appropriate services are increasingly recognized as effective in improving —Dr. Martin Luther King,Jr. the quality of care and services.5,6 By providing a structure to implement culturally and linguistically appropriate services,the National CLAS Standards will improve an organization's ability to address health care disparities. The National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities'and the National Stakeholder Strategy for Achieving Health Equity,8 which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives,the National CLAS Standards are intended to advance health equity,improve quality,and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.Adoption of these Standards will help advance better health and health care in the United States. Bibliography 1. U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from http://minorityhealth.hhs.gov/npa 2.World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/ 3. U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved from http://www. hea lthypeopl e.gov/2020/to picsobjectives2O20/overvi ew.as px?topicid=39 4. LaVeist,T A.,Gaskin,D.J.,&Richard,P(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic Studies website:http://www. jointeenter.org/sites/default/files/upload/research/files/The%20Economic%2 OBurden%20of%2OHealth%201nequalities%20in%20the%2OUnited%2OStates.pdf 5. Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ Publication No.04-EO08-02).Retrieved from the Agency of Healthcare Research and Quality website:http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minquai.pdf 6.Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).Retrieved from The Commonwealth Fund website:http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultiinguisticcomp_962.pdf 7. U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.Retrieved from http:// minorityhealth.hhs.gov/npa/f les/Plans/HHS/H HS_Plan_complete.pdf 8. National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and Human Services,Office of Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286 ��� 1 Think Cultural Health F S(_ U.S.Deporfinentof https://www.thinkculturalhealth.hhs.gov/ 1O M H Health and Human Services Office of Minority Health contact@thinkculturalhealth.hhs.gov o��