HomeMy WebLinkAboutAgreement A-23-296 with TPCC.pdf Agreement No. 23-296
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated June 20, 2023 and is between
3 Turning Point of Central California, Inc., a California non-profit corporation, ("Contractor"), and
4 the County of Fresno, a political subdivision of the State of California ("County").
5 Recitals
6 A. County, through its Department of Behavioral Health (DBH), determined a need for a
7 qualified provider to operate a Forensic Behavioral Health Continuum of Care for certain Fresno
8 County residents to receive substance use disorder and co-occurring mental health outpatient
9 (SUD/MH OP), full service partnership (FSP), and assertive community treatment (ACT)
10 services under California Assembly Bill (AB) 109 Public Safety Realignment and the Post-
11 Release Community Supervision Act of 2011, and mental health diversion under AB1810,
12 California Senate Bill (SB) 317 and Penal Code section 1001.36; and
13 B. County is authorized through its Intergovernmental Agreement with the California State
14 Department of Health Care Services (DHCS), hereinafter referred to as State or DHCS, to
15 subcontract for Drug Medi-Cal services (DMC) in Fresno County; and
16 C. County is authorized to contract with privately operated agencies for the provision of
17 alcohol and other drug treatment services, pursuant to Title 9, Division 4 of the California Code
18 of Regulations and Division 10.5 (commencing with Section 11750) of the California Health and
19 Safety Code; and
20 D. County, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of the
21 California Code of Regulations, Section 1810.226; and
22 E. Contractor is certified by the State to provide services required by County, pursuant to
23 the terms and conditions of this Agreement; and
24 F. County received grant funds for Whole Person Care Like (WPCL) Pilot navigation and
25 linkage services; and
26 G. County entered into Agreement No. 22-264 with Contractor on June 21, 2022, amended
27 by Agreement No. 23-036 on January 24, 2023, collectively Agreement No. 23-036;
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1 H. Changes to the agreement are necessary due the DHCS implementation of California
2 Advancing and Innovating Medi-Cal (CaIAIM), which includes a new billing structure that
3 Contractor must utilize; and
4 I. County has received funds for, and wishes Contractor to provide Department of State
5 Hospital (DSH) Jail Diversion services in conjunction with other services provided pursuant to
6 Agreement No. 23-036; and
7 J. This Agreement shall replace, restate, and supersede Agreement No. 23-036 in its
8 entirety.
9 The parties therefore agree as follows:
10 Article 1
11 Contractor's Services
12 1.1 Scope of Services. The Contractor shall perform all of the services provided in
13 Exhibit A, titled "Scope of Services;" Exhibit A-1, titled "WPCL Scope of Services;" and Exhibit
14 A-2, titled "DSH Diversion Scope of Services" to this Agreement.
15 1.2 Representation. The Contractor represents that it is qualified, ready, willing, and
16 able to perform all of the services provided in this Agreement.
17 1.3 Compliance with Laws. The Contractor shall, at its own cost, comply with all
18 applicable federal, state, and local laws and regulations in the performance of its obligations
19 under this Agreement, including but not limited to workers compensation, labor, and
20 confidentiality laws and regulations.
21 Contractor shall provide services in conformance with all applicable State and Federal
22 statutes, regulations and subregulatory guidance, as from time to time amended, including but
23 not limited to:
24 (A) California Code of Regulations, Title 9;
25 (B) California Code of Regulations, Title 22;
26 (C) California Welfare and Institutions Code, Division 5;
27 (D) United States Code of Federal Regulations, Title 42, including but not limited to
28 Parts 438 and 455;
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1 (E) United States Code of Federal Regulations, Title 45;
2 (F) United States Code, Title 42 (The Public Health and Welfare), as applicable;
3 (G)Balanced Budget Act of 1997;
4 (H) Health Insurance Portability and Accountability Act (HIPAA); and
5 (1) Applicable Medi-Cal laws and regulations, including applicable sub-regulatory
6 guidance, such as Behavioral Health Information Notices (BHINs), Mental Health and
7 Substance Use Disorder Services Information Notices (MHSUDS INs), and provisions of
8 County's, state or federal contracts governing services for persons served.
9 In the event any law, regulation, or guidance referred to in this section 1.3 is amended
10 during the term of this Agreement, the parties agree to comply with the amended authority as of
11 the effective date of such amendment without amending this Agreement.
12 Contractor shall comply with requirements stated within the Intergovernmental
13 Agreement as listed in Exhibit B, Drug Medi-Cal Specific Requirements; and with all other
14 provisions set forth in the Intergovernmental Agreement, made available by the COUNTY's DBH
15 at the following web address: https://www.co.fresno.ca.us/departments/behavioral-
16 health/home/for-providers/contract-providers/substance-use-disorder-providers. Contractor is
17 referred to therein as "Subcontractor" and County is referred to therein as "Contractor."
18 Contractor recognizes that County operates its mental health programs under an
19 agreement with DHCS, and that under said agreement the State imposes certain requirements
20 on County and its subcontractors. Contractor shall adhere to all State requirements, including
21 those identified in Exhibit C, "Behavioral Health Requirements".
22 1.4 DSH Jail Diversion Funding. Contractor acknowledges that County's DBH receives
23 funding under DSH Jail Diversion for eligible individuals with serious mental disorders who have
24 committed certain felony crimes and found by a Court to qualify for diversion services pursuant
25 to Penal Code section 1001.36. Contractor shall comply with all terms and conditions of the
26 DSH Diversion funding agreement between DSH and the County in Exhibit D, including any and
27 all applicable modifications or amendments to such funding agreement.
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1 1.5 Meetings. Contractor shall participate in monthly, or as needed, workgroup meetings
2 consisting of staff from County's DBH to discuss service requirements, data reporting, training,
3 policies and procedures, overall program operations and any problems or foreseeable problems
4 that may arise. Contractor shall also participate in other County meetings, such as but not
5 limited to quality improvement meetings, provider meetings, Behavioral Health Board meetings,
6 bi-monthly contractor meetings, etc. Schedule for these meetings may change based on the
7 needs of the County.
8 1.6 Organizational Provider. Contractor shall maintain requirements as a Mental Health
9 Plan (MHP) organizational provider throughout the term of this Agreement, as described in
10 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 1.7 Staffing. Contractor agrees that prior to providing services under the terms and
13 conditions of this Agreement, Contractor shall have staff hired and in place for program services
14 and operations or County may, in addition to other remedies it may have, suspend referrals or
15 terminate this Agreement, in accordance with Article 7 of this Agreement.
16 1.8 Credentialing and Recredentialing. Contractor 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 must demonstrate to the County that each of its providers
22 are qualified in accordance with current legal, professional, and technical standards, and that
23 they are appropriately licensed, registered, waivered, and/or certified.
24 Contractor 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.
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1 Contractor is required to verify and document at a minimum every three years that each
2 network provider that delivers covered services continues to possess valid credentials, including
3 verification of each of the credentialing requirements as per the County's uniform process for
4 credentialing and recredentialing. If any of the requirements are not up-to-date, updated
5 information should be obtained from network providers to complete the re-credentialing process.
6 1.9 Criminal Background Check. Contractor shall ensure that all providers and/or
7 subcontracted providers consent to a criminal background check, including fingerprinting to the
8 extent required under state law and 42 C.F.R. § 455.434(a). Contractor shall provide evidence
9 of completed consents when requested by the County, DHCS or the US Department of Health &
10 Human Services (US DHHS).
11 1.10 Guiding Principles. Contractor shall align programs, services, and practices with
12 the vision, mission, and guiding principles of the DBH, as further described in Exhibit E, "Fresno
13 County Department of Behavioral Health Guiding Principles of Care Delivery".
14 1.11 Clinical Leadership. Contractor shall send to County upon execution of this
15 Agreement, a detailed plan ensuring clinically appropriate leadership and supervision of their
16 clinical program. Recruitment and retaining clinical leadership with the clinical competencies to
17 oversee services based on the level of care and program design presented herein shall be
18 included in this plan. A description and monitoring of this plan shall be provided.
19 1.12 Timely Access. It is the expectation of the County that Contractor provide timely
20 access to services that meet the State of California standards for care. Contractor must
21 complete intake for all persons served (including persons served referred by Court or Probation)
22 within timeframes specified below from initial contact.
23 (A) Contractor shall provide non-urgent services within ten (10) business days from
24 request/referral to first appointment;
25 (B) Contractor shall provide psychiatry services within fifteen (15) business days
26 from request/referral to first appointment;
27 (C) Contractor shall provide urgent services as soon as needed based on each
28 person's needs; and
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1 (D) Contractor shall comply with reporting requirements of Superior Court of Fresno
2 and Fresno County Probation Department relating to beneficiary status change and
3 treatment progress if an appropriate Release of Information (ROI) is in place within two
4 (2) business days from next court appearance or upon request.
5 Contractor shall track timeliness of services to persons served and provide a monthly
6 report showing the monitoring or tracking tool that captures this data. County and Contractor
7 shall meet to go over this monitoring tool, as needed but at least on a monthly basis. County
8 shall take corrective action if there is a failure to comply by Contractor with timely access
9 standards. Contractor shall also provide tracking tools and measurements for effectiveness,
10 efficiency, and persons served satisfaction as further detailed in Exhibit A, Exhibit A-1 and
11 Exhibit A-2.
12 1.13 Electronic Health Record. Contractor may maintain its records in County's
13 electronic health record (EHR) system in accordance with Exhibit F, "Documentation Standards
14 for Person Served Records", as licenses become available. The person served record shall
15 begin with registration and intake, and include person served authorizations, assessments,
16 plans of care, and progress notes, as well as other documents as approved by County. County
17 shall be allowed to review records of all and any services provided. If Contractor determines to
18 maintain its records in the County's EHR, it shall provide County's DBH Director, or his or her
19 designee, with a thirty (30) day notice. If at any time Contractor chooses not to maintain its
20 records in the County's EHR, it shall provide County's DBH Director, or designee, with thirty (30)
21 days advance written notice and Contractor will be responsible for obtaining its own system, at
22 its own cost, for electronic health records management.
23 Disclaimer
24 County makes no warranty or representation that information entered into the County's
25 DBH EHR system by Contractor will be accurate, adequate, or satisfactory for Contractor's own
26 purposes or that any information in Contractor's possession or control, or transmitted or
27 received by Contractor, is or will be secure from unauthorized access, viewing, use, disclosure,
28 or breach. Contractor is solely responsible for person served information entered by Contractor
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1 into the County's DBH EHR system. Contractor agrees that all Private Health Information (PHI)
2 maintained by Contractor in County's DBH EHR system will be maintained in conformance with
3 all HIPAA laws, as stated in section 18.1, "Health Insurance Portability and Accountability Act."
4 1.14 Records. Contractor shall maintain records in accordance with Exhibit F,
5 "Documentation Standards for Person Served Records". All person served records shall be
6 maintained for a minimum of ten (10) years from the date of the end of this Agreement.
7 1.15 Access to Records. Contractor shall provide County with access to all
8 documentation of services provided under this Agreement for County's use in administering this
9 Agreement. Contractor shall allow County, CMS, the Office of the Inspector General, the
10 Controller General of the United States, and any other authorized Federal and State agencies to
11 evaluate performance under this Agreement, and to inspect, evaluate, and audit any and all
12 records, documents, and the premises, equipment and facilities maintained by the Contractor
13 pertaining to such services at any time and as otherwise required under this Agreement.
14 1.16 Quality Improvement Activities and Participation. Contractor shall comply with
15 the County's ongoing comprehensive Quality Assessment and Performance Improvement
16 (QAPI) Program (42 C.F.R. § 438.330(a)) and work with the County to improve established
17 outcomes by following structural and operational processes and activities that are consistent
18 with current practice standards.
19 Contractor shall participate in quality improvement (QI) activities, including clinical and
20 non-clinical performance improvement projects (PIPs), as requested by the County in relation to
21 State and Federal requirements and responsibilities, to improve health outcomes and
22 individuals' satisfaction over time. Other QI activities include quality assurance, collection and
23 submission of performance measures specified by the County, mechanisms to detect both
24 underutilization and overutilization of services, individual and system outcomes, utilization
25 management, utilization review, provider appeals, provider credentialing and re-credentialing,
26 and person served grievances. Contractor shall measure, monitor, and annually report to the
27 County its performance.
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1 1.17 Rights of Persons Served. Contractor shall comply with applicable laws and
2 regulations relating to patients' rights, including but not limited to Wel. & Inst. Code 5325, Cal.
3 Code Regs., tit. 9, sections 862 through 868, and 42 C. F. R. § 438.100. The Contractor shall
4 ensure that its subcontractors comply with all applicable patients' rights laws and regulations.
5 Article 2
6 Reporting
7 2.1 Reports. The Contractor shall submit the following reports:
8 (A) Outcome Reports
9 Contractor shall submit to County clinical program performance outcome reports,
10 as requested.
11 Outcome reports and outcome requirements are subject to change at County's
12 discretion. Contractor shall provide outcomes as stated in Exhibit A, Exhibit A-1, Exhibit
13 A-2 and Exhibit G.
14 (B) Staffing Report
15 Contractor shall submit monthly staffing reports due by the tenth of each month
16 that identify all direct service and support staff by first and last name, applicable
17 licensure/certifications, and full-time hours worked to be used as a tracking tool to
18 determine if Contractor's program is staffed according to the requirements of this
19 Agreement.
20 (C) Mental Health Services Act (MHSA) Reporting
21 Contractor shall adhere to MHSA reporting including but not limited to fiscal,
22 outcomes, and demographics as described in Exhibit A, Exhibit A-1 and Exhibit A-2.
23 (D)AB109 Public Safety Realignment Reporting
24 County's Community Corrections Partnership Council (CCP) is responsible for
25 providing a report to the State which will describe and evaluate the Public Safety
26 Realignment Act, A13109 Implementation Plan funding for essential planning purposes,
27 maintain program accountability and program monitoring. Contractor is required to
28 submit quarterly and annually to County's CCP, with a copy to County's DBH, such
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1 statutory outcome data reporting. Outcome and data requirements are subject to change
2 at State and County's discretion.
3 (E) DSH Diversion Reporting
4 County's DBH is responsible for providing a report to the State which will
5 describe and evaluate the DSH diversion funding for essential planning purposes,
6 maintaining program accountability and program monitoring. Contractor is required to
7 submit quarterly to the County's DBH such statutory outcome data reporting in
8 accordance to Exhibit H. Outcome data and report requirements are subject to change
9 at State and County's DBH discretion.
10 (F) FSP Data Collection and Reporting to DHCS
11 Contractor shall report person served/partner information and outcomes of
12 FSP/ACT program directly into the FSP Data Collection and Reporting (DCR) system.
13 Data shall be submitted through an online interface using forms set forth in Exhibit I.
14 (G)Additional Reports
15 Contractor shall also furnish to County such statements, records, reports, data,
16 and other information as County may request pertaining to matters covered by this
17 Agreement. In the event that Contractor fails to provide such reports or other
18 information required hereunder, it shall be deemed sufficient cause for County to
19 withhold monthly payments until there is compliance. In addition, Contractor shall
20 provide written notification and explanation to County within five (5) days of any funds
21 received from another source to conduct the same services covered by this Agreement.
22 2.2 Monitoring. Contractor agrees to extend to County's staff, County's DBH and
23 DHCS, or their designees, the right to review and monitor records, programs, or procedures, at
24 any time, in regard to persons served, as well as the overall operation of Contractor's programs,
25 in order to ensure compliance with the terms and conditions of this Agreement.
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1 Article 3
2 County's Responsibilities
3 3.1 The County shall provide oversight and collaborate with Contractor, other County
4 Departments and community agencies to help achieve program goals and outcomes. In addition
5 to contractor monitoring of program, oversight includes, but not limited to, coordination with
6 DHCS in regard to program administration and outcomes. County shall participate in evaluating
7 the progress of the overall program, levels of care components, and the efficiency of
8 collaboration with the Contractor staff and will be available to Contractor for ongoing
9 consultation.
10 County shall receive and analyze statistical outcome data from Contractor throughout
11 the term of contract on a monthly basis. County shall notify the Contractor when additional
12 participation is required. The performance outcome measurement process will not be limited to
13 survey instruments but will also include, as appropriate, persons served and staff surveys, chart
14 reviews, and other methods of obtaining required information.
15 Article 4
16 Compensation, Invoices, and Payments
17 4.1 The County agrees to pay, and the Contractor agrees to receive, compensation for
18 the performance of its services under this Agreement as described in Exhibit J to this
19 Agreement titled "Compensation", and Exhibit J-1 and Exhibit J-2 to this Agreement, titled
20 "Program Expenses".
21 4.2 Specialty Mental Health Services Maximum Compensation. The maximum
22 compensation payable to the Contractor under this Agreement for SUD/MH OP Specialty
23 Mental Health Services for the period of July 1, 2023 through June 30, 2024 is One Million,
24 Seven Hundred Twenty-Eight Thousand, Eight Hundred Thirty-Eight and No/100 Dollars
25 ($1,728,838.00), which is not a guaranteed sum but shall be paid only for services rendered and
26 received. The maximum compensation payable to the Contractor under this Agreement for
27 SUD/MH OP Specialty Mental Health Services for the period of July 1, 2024 through June 30,
28 2025 is One Million, Seven Hundred Twenty-Eight Thousand, Eight Hundred Thirty-Eight and
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1 No/100 Dollars ($1,728,838.00), which is not a guaranteed sum but shall be paid only for
2 services rendered and received. If performance standards are met and this Agreement is
3 extended for additional twelve (12) month terms pursuant to Article 5.2, the maximum
4 compensation payable to the Contractor under this Agreement for SUD/MH OP Specialty
5 Mental Health Services for each subsequent twelve (12) month period is One Million, Seven
6 Hundred Twenty-Eight Thousand, Eight Hundred Thirty-Eight and No/100 Dollars
7 ($1,728,838.00), which is not a guaranteed sum but shall be paid only for services rendered and
8 received.
9 The maximum compensation payable to the Contractor under this Agreement for
10 FSP/ACT Specialty Mental Health Services for the period of July 1, 2023 through June 30, 2024
11 is Two Million, Three Hundred Ninety-Eight Thousand, Three Hundred Ten and No/100 Dollars
12 ($2,398,310.00), which is not a guaranteed sum but shall be paid only for services rendered and
13 received. The maximum compensation payable to the Contractor under this Agreement for
14 FSP/ACT Specialty Mental Health Services for the period of July 1, 2024 through June 30, 2025
15 is Two Million, Three Hundred Ninety-Eight Thousand, Three Hundred Ten and No/100 Dollars
16 ($2,398,310.00, which is not a guaranteed sum but shall be paid only for services rendered and
17 received. If performance standards are met and this Agreement is extended for additional
18 twelve (12) month terms pursuant to Article 5.2, the maximum compensation payable to the
19 Contractor under this Agreement for FSP/ACT Specialty Mental Health Services for each
20 subsequent twelve (12) month period is Two Million, Three Hundred Ninety-Eight Thousand,
21 Three Hundred Ten and No/100 Dollars ($2,398,310.00), which is not a guaranteed sum but
22 shall be paid only for services rendered and received.
23 4.3 Non-Medi-Cal Supports Maximum Compensation. The maximum compensation
24 payable to the Contractor under this Agreement for SUD/MH OP Non-Medi-Cal Support
25 Services for the period of July 1, 2023 through June 30, 2024 is Six Hundred, Fifty-Eight
26 Thousand, Two Hundred Fifty and No/100 Dollars ($658,250.00), which is not a guaranteed
27 sum but shall be paid only for services rendered and received. The maximum compensation
28 payable to the Contractor under this Agreement for SUD/MH OP Non-Medi-Cal Support
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1 Services for the period of July 1, 2024 through June 30, 2025 is Six Hundred, Fifty-Eight
2 Thousand, Two Hundred Fifty and No/100 Dollars ($658,250.00), which is not a guaranteed
3 sum but shall be paid only for services rendered and received. If performance standards are
4 met and this Agreement is extended for additional twelve (12) month terms pursuant to Article
5 5.2, the maximum compensation payable to the Contractor under this Agreement for SUD/MH
6 OP Non-Medi-Cal Support Services for each subsequent twelve (12) month period is Six
7 Hundred, Fifty-Eight Thousand, Two Hundred Fifty and No/100 Dollars ($658,250.00), which is
8 not a guaranteed sum but shall be paid only for services rendered and received.
9 The maximum compensation payable to the Contractor under this Agreement for
10 FSP/ACT Non-Medi-Cal Support Services for the period of July 1, 2023 through June 30, 2024
11 is One Million, Seven Hundred Forty-Seven Thousand, Four Hundred Eighty-Three and No/100
12 Dollars ($1,747,483.00). The maximum compensation payable to the Contractor under this
13 Agreement for FSP/ACT services for the period of July 1, 2024 through June 30, 2025 is One
14 Million, Seven Hundred Forty-Seven Thousand, Four Hundred Eighty Three and No/100 Dollars
15 ($1,747,483.00). If performance standards are met and this Agreement is extended for
16 additional twelve (12) month terms pursuant to Article 5.2, the maximum compensation payable
17 to the Contractor under this Agreement for FSP/ACT services for each subsequent twelve (12)
18 month period is One Million, Seven Hundred Forty-Seven Thousand, Four Hundred Eighty
19 Three and No/100 Dollars ($1,747,483.00), which is not a guaranteed sum but shall be paid
20 only for services rendered and received.
21 4.4 Whole Person Care Like Pilot Maximum Compensation. The maximum
22 compensation payable to the Contractor under this Agreement for Whole Person Care Like Pilot
23 Services the period of July 1, 2023 through June 30, 2024 is Three Hundred Fifty-Seven
24 Thousand, Seven Hundred Fifty-One and No/100 Dollars ($357,751.00). The maximum
25 compensation payable to the Contractor under this Agreement for Whole Person Care Like Pilot
26 Services for the period of July 1, 2023 through June 30, 2024 is Three Hundred Fifty-Seven
27 Thousand, Seven Hundred Fifty-One and No/100 Dollars ($357,751.00).
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1 4.5 Transition Optimization Funds. If Contractor opts to apply for transition
2 optimization funds, the maximum amount payable for transition optimization for the period of
3 July 1, 2023 through June 30, 2024 shall not exceed Two Hundred Thousand and No/100
4 dollars ($250,000.00) split among all current agreements between the Contractor and the
5 County for Medi-Cal billable specialty mental health and substance use disorder services as
6 further described in the Scope of Work/Services. All final invoices for transition optimization
7 funds shall be submitted by June 15, 2024. Invoices submitted thereafter, shall not be eligible
8 for payment.
9 4.6 Total Maximum Compensation. In no event shall the maximum contract amount for
10 all the services provided by the Contractor to County under the terms and conditions of this
11 Agreement be in excess of Twenty Seven Million, Ninety-Seven Thousand, Twenty-Four and
12 No/100 Dollars ($27,097,024.00) during the entire term of this Agreement.
13 The Contractor acknowledges that the County is a local government entity and does so
14 with notice that the County's powers are limited by the California Constitution and by State law,
15 and with notice that the Contractor may receive compensation under this Agreement only for
16 services performed according to the terms of this Agreement and while this Agreement is in
17 effect, and subject to the maximum amount payable under this section. The Contractor further
18 acknowledges that County employees have no authority to pay the Contractor except as
19 expressly provided in this Agreement.
20 The Contractor will be compensated for performance of its services under this
21 Agreement as provided in this Article. The Contractor is not entitled to any compensation except
22 as expressly provided in this Agreement.
23 4.7 Rate Categories. The program service components for the Contractor shall be
24 categorized under one or more of the following rate categories and as indicated on Exhibit J.
25 (A) Clinic-Site Based: Clinic-Site Based programs shall be defined as programs who
26 provide less than fifty percent (50%) of services in the field. In the field services are
27 those services that do not occur through telehealth and do not occur in designated sites
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1 in which the Contractor is afforded regular access. Designated sites shall be identified by
2 the Contractor and approved by County's DBH Director or designee in writing.
3 (B) Field Based: Field based programs shall be defined as programs that provide
4 more than fifty percent (50%) of services in the field.
5 (C) Full Service Partnership/Assisted Outpatient Therapy/Therapeutic Behavioral
6 Health Services (FSP/AOT/TBS): FSP/AOT/TBS programs shall provide services in
7 accordance with level of care standards and general requirements as described in the
8 Scope of Work/Services, if applicable.
9 County's DBH shall continuously monitor the programs and analyze data to review
10 accuracy of rate categories assigned and may be reassigned by the County's DBH Director or
11 designee, as described in Article 25.
12 4.8 Specialty Mental Health Services Claiming. Contractor shall enter claims data into
13 the County's billing and transactional database system by the fifteenth (15th) of every month for
14 actual services rendered in the previous month. Contractor shall use Current Procedural
15 Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, as
16 provided in the DHCS Billing Manual available at
17 https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx, as from time to time
18 amended.
19 Claims shall be complete and accurate and must include all required information
20 regarding the claimed services. Claims data entry into the County's electronic health record
21 system shall be the responsibility of Contractor. County shall monitor the volume of services,
22 billing amounts and service types entered into County's electronic health record/information
23 system. Any and all audit exceptions resulting from the provision and reporting of specialty
24 mental health services by Contractor shall be the sole responsibility of Contractor. Contractor
25 will comply with all applicable policies, procedures, directives, and guidelines regarding the use
26 of County's electronic health record/information system.
27 Contractor must provide all necessary data to allow County to bill Medi-Cal, and any
28 other third-party source, for services and meet State and Federal reporting requirements. The
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1 necessary data can be provided by a variety of means, including but not limited to: 1) direct data
2 entry into County's electronic health record/information system; 2) providing an electronic file
3 compatible with County's electronic health record/information system; or 3) integration between
4 County's electronic health record/information system and Contractor's information system(s).
5 Contractor shall maximize the Federal Financial Participation (FFP) reimbursement by claiming
6 all possible Medi-Cal services and correcting denied services for resubmission as needed.
7 4.9 Applicable Fees. Contractor shall not charge any persons served or third-party
8 payers any fee for service unless directed to do so by the County's DBH Director or designee at
9 the time the individual is referred for services. When directed to charge for services, Contractor
10 shall use the uniform billing and collection guidelines prescribed by DHCS.
11 Contractor will perform eligibility and financial determinations, in accordance with DHCS'
12 Uniform Method of Determining Ability to Pay (UMDAP), for all individuals unless directed
13 otherwise by the County's DBH Director or designee.
14 Contractor shall not submit a claim to, or demand or otherwise collect reimbursement
15 from, the person served or persons acting on behalf of the person served for any specialty
16 mental health or related administrative services provided under this Contract, except to collect
17 other health insurance coverage, share of cost, and co-payments (Cal. Code Regs., tit. 9,
18 §1810.365(c).
19 The Contractor must not bill persons served, for covered services, any amount greater
20 than would be owed if the County provided the services directly as per and otherwise not bill
21 persons served as set forth in 42 C.F.R. § 438.106.
22 If a person served has dual coverage, such as other health coverage (OHC) or Federal
23 Medicare, Contractor will be responsible for billing the carrier and obtaining a payment/denial or
24 have validation of claiming with no response for ninety (90) days after the claim was mailed
25 before the service can be entered into the County's electronic health record/information system.
26 Contractor must report all third-party collections for Medicare, third-party or client-pay or private-
27 pay in each month. A copy of explanation of benefits or CMS 1500 form is required as
28 documentation. Contractor must comply with all laws and regulations governing the Federal
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1 Medicare program, including, but not limited to: 1) the requirement of the Medicare Act, 42
2 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the Federal Centers
3 for Medicare and Medicaid Services as they relate to participation, coverage and claiming
4 reimbursement. Contractor will be responsible for compliance as of the effective date of each
5 Federal, State or local law or regulation specified.
6 4.10 Invoices. The Contractor shall submit monthly invoices, in arrears by the fifteenth
7 (15t") day of each month, in the format directed by the County. The Contractor shall submit
8 invoices electronically to: 1) dbhinvoicereview@fresnocountyca.gov, 2) dbh-
9 invoices@fresnocountyca.gov; and 3) dbhcontractedservicesdivision@fresnocountyca.gov with
10 a copy to the assigned County's DBH Staff Analyst. At the discretion of County's DBH Director
11 or designee, if an invoice is incorrect or is otherwise not in proper form or substance, County's
12 DBH Director, or designee, shall have the right to withhold payment as to only the portion of the
13 invoice that is incorrect or improper after five (5) days prior notice to Contractor. Contractor
14 agrees to continue to provide services for a period of ninety (90) days after notification of an
15 incorrect or improper invoice. If after the ninety (90) day period, the invoice is still not corrected
16 to County satisfaction, County's DBH Director, or designee, may elect to terminate this
17 Agreement, pursuant to the termination provisions stated in Article 7 of this Agreement.
18 Specialty Mental Health Services Claimable Services. For claimable services,
19 invoices shall be based on claims entered into the County's billing and transactional database
20 system for the prior month.
21 Monthly payments for claimed services shall only be based on the units of time assigned
22 to each CPT or HCPCS code entered in the County's billing and transactional database
23 multiplied by the practitioner service rates in Exhibit J.
24 County's payments to Contractor for performance of claimed services are provisional
25 and subject to adjustment until the completion of all settlement activities. County's adjustments
26 to provisional payments for claimed services shall be based on the terms, conditions, and
27 limitations of this Agreement or the reasons for recoupment set forth in Article 4 and 13.
28
16
1 Any claimable services submitted beyond six (6) months from the month of service may
2 be ineligible for payment.
3 Cost Reimbursement Based Invoices. Invoices for cost reimbursement services shall
4 be based on actual expenses incurred in the month of service. Contractor shall submit monthly
5 invoices and general ledgers to County that itemize the line item charges for monthly program
6 costs. The invoices and general ledgers will serve as tracking tools to determine if Contractor's
7 costs are in accordance with its budgeted cost. Failure to submit reports and other supporting
8 documentation shall be deemed sufficient cause for County to withhold payments until there is
9 compliance.
10 Contractor must report all revenue collected from a third-party, client-pay or private-pay
11 in each monthly invoice. In addition, Contractor shall submit monthly invoices for reimbursement
12 that equal the amount due less any revenue collected and/or unallowable cost such as lobbying
13 or political donations from the monthly invoice reimbursements.
14 Travel shall be reimbursed based on actual expenditures and reimbursement shall be at
15 Contractor's adopted rate, not to exceed the Federal Internal Revenue Services (IRS) published
16 rate.
17 Corrective Action Plans. Contractors shall enter services into the County's billing and
18 transactional database and submit invoices in accordance with the deadlines listed above and
19 information shall be accurate. Failure to meet the requirements set forth above will result in a
20 corrective action plan at the discretion of the County's DBH Director, or designee, and may
21 result in financial penalties or termination of agreement per Article 7.
22 4.11 Payment. Payments shall be made by County to Contractor in arrears, for services
23 provided during the preceding month, within forty-five (45) days after the date of receipt,
24 verification, and approval by County. All final invoices and/or any final budget modification
25 requests shall be submitted by Contractor within sixty (60) days following the final month of
26 service for which payment is claimed. No action shall be taken by County on claims submitted
27 beyond the sixty (60) day closeout period. Any compensation which is not expended by
28
17
1 Contractor pursuant to the terms and conditions of this Agreement shall automatically revert to
2 County.
3 4.12 Specialty Mental Health Services Payments. Payment shall be made upon
4 certification and other proof satisfactory to County that services have actually been performed
5 by Contractor as specified in this Agreement and/or after receipt and verification of actual
6 services provided.
7 4.13 Cost Reimbursement Payments. Payment shall be made upon certification or other
8 proof satisfactory to County that services have actually been performed by Contractor as
9 specified in this Agreement and/or after receipt and verification of actual expenditures incurred
10 by Contractor for monthly program costs, as identified in the budget narratives and budgets
11 identified in Exhibit J-1 and J-2, in the performance of this Agreement. County shall not be
12 obligated to make any payments under this Agreement if the request for payment is received by
13 County more than sixty (60) days after this Agreement has terminated or expired.
14 4.14 Recoupments and Audits. County shall recapture from Contractor the value of any
15 services or other expenditures determined to be ineligible based on the County or State
16 monitoring results. The County reserves the right to enter into a repayment agreement with
17 Contractor, with total monthly payments not to exceed twelve (12) months from the date of the
18 repayment agreement, to recover the amount of funds to be recouped. The County has the
19 discretion to extend the repayment plan up to a total of twenty-four (24) months from the date of
20 the repayment agreement. The repayment agreement may be made with the signed written
21 approval of County's DBH Director, or designee, and respective Contractor through a
22 repayment agreement. The monthly repayment amounts may be netted against the Contractor's
23 monthly billing for services rendered during the month, or the County may, in its sole discretion,
24 forego a repayment agreement and recoup all funds immediately. This remedy is not exclusive,
25 and County may seek requital from any other means, including, but not limited to, a separate
26 contract or agreement with Contractor.
27 Contractor shall be held financially liable for any and all future disallowances/audit
28 exceptions due to Contractor's deficiency discovered through the State audit process and
18
1 County utilization review for services provided during the course of this Agreement. At County's
2 election, the disallowed amount will be remitted within forty-five (45) days to County upon
3 notification or shall be withheld from subsequent payments to Contractor. Contractor shall not
4 receive reimbursement for any units of services rendered that are disallowed or denied by the
5 Fresno County Mental Health Plan (Mental Health Plan) utilization review process or through
6 the State of California DHCS audit and review process, cost report audit settlement if applicable,
7 for Medi-Cal eligible beneficiaries.
8 4.15 Incidental Expenses. The Contractor is solely responsible for all of its costs and
9 expenses that are not specified as payable by the County under this Agreement. If Contractor
10 fails to comply with any provision of this Agreement, County shall be relieved of its obligation for
11 further compensation.
12 4.16 Restrictions and Limitations. This Agreement shall be subject to any restrictions,
13 limitations, and/or conditions imposed by County or state or federal funding sources that may in
14 any way affect the fiscal provisions of, or funding for this Agreement. This Agreement is also
15 contingent upon sufficient funds being made available by County, state, or federal funding
16 sources for the term of the Agreement. If the federal or state governments reduce financial
17 participation in the Medi-Cal program, County agrees to meet with Contractor to discuss
18 renegotiating the services required by this Agreement.
19 Funding is provided by fiscal year. Any unspent fiscal year appropriation does not roll
20 over and is not available for services provided in subsequent years.
21 In the event that funding for these services is delayed by the State Controller, County
22 may defer payments to Contractor. The amount of the deferred payment shall not exceed the
23 amount of funding delayed by the State Controller to the County. The period of time of the
24 deferral by County shall not exceed the period of time of the State Controller's delay of payment
25 to County plus forty-five (45) days.
26 4.17 Additional Financial Requirements. County has the right to monitor the
27 performance of this Agreement to ensure the accuracy of claims for reimbursement and
28 compliance with all applicable laws and regulations.
19
1 Contractor must comply with the False Claims Act employee training and policy
2 requirements set forth in 42 U.S.C. 1396a(a)(68) and as the Secretary of the United States
3 Department of Health and Human Services may specify.
4 Contractor agrees that no part of any federal funds provided under this Agreement shall
5 be used to pay the salary of an individual per fiscal year at a rate in excess of Level 1 of the
6 Executive Schedule at https://www.opm.gov/ (U.S. Office of Personnel Management), as from
7 time to time amended.
8 Federal Financial Participation is not available for any amount furnished to an Excluded
9 individual or entity, or at the direction of a physician during the period of exclusion when the
10 person providing the service knew or had reason to know of the exclusion, or to an individual or
11 entity when the County failed to suspend payments during an investigation of a credible
12 allegation of fraud [42 U.S.C. section 1396b(i)(2)].
13 Contractor must maintain financial records for a minimum period of ten (10) years or until
14 any dispute, audit or inspection is resolved, whichever is later. Contractor will be responsible for
15 any disallowances related to inadequate documentation.
16 4.18 Contractor Prohibited from Redirection of Contracted Funds. Contractor may
17 not redirect or transfer funds from one funded program to another funded program under which
18 Contractor provides services pursuant to this Agreement except through a duly executed
19 amendment to this Agreement.
20 Contractor may not charge services delivered to an eligible person served under one
21 funded program to another funded program unless the person served is also eligible for services
22 under the second funded program.
23 4.19 Financial Audit Report Requirements for Pass-Through Entities. If County
24 determines that Contractor is a "subrecipient" (also known as a "pass-through entity") as defined
25 in 2 C.F.R. § 200 et seq., Contractor represents that it will comply with the applicable cost
26 principles and administrative requirements including claims for payment or reimbursement by
27 County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time to time. Contractor
28 shall observe and comply with all applicable financial audit report requirements and standards.
20
1 Financial audit reports must contain a separate schedule that identifies all funds included
2 in the audit that are received from or passed through the County. County programs must be
3 identified by Agreement number, Agreement amount, Agreement period, and the amount
4 expended during the fiscal year by funding source.
5 Contractor will provide a financial audit report including all attachments to the report and
6 the management letter and corresponding response within six months of the end of the audit
7 year to the County's DBH Director or designee. The County's DBH Director or designee is
8 responsible for providing the audit report to the County Auditor.
9 Contractor must submit any required corrective action plan to the County simultaneously
10 with the audit report or as soon thereafter as it is available. The County shall monitor
11 implementation of the corrective action plan as it pertains to services provided pursuant to this
12 Agreement.
13 Article 5
14 Term of Agreement
15 5.1 Term. This Agreement is effective on July 1, 2023, and terminates on June 30, 2025
16 except as provided in section 5.2, "Extension," or Article 7, "Termination and Suspension,"
17 below.
18 5.2 Extension. The term of this Agreement may be extended for two (2) additional
19 consecutive one-year periods only upon written approval of both parties at least thirty (30) days
20 before the first day of next one-year extension period. The County's DBH Director or designee is
21 authorized to sign the written approval on behalf of the County based on the Contractor's
22 satisfactory performance. The extension of this Agreement by the County is not a waiver or
23 compromise of any default or breach of this Agreement by the Contractor existing at the time of
24 the extension whether or not known to the County.
25 Article 6
26 Notices
27 6.1 Contact Information. The persons and their addresses having authority to give and
28 receive notices provided for or permitted under this Agreement include the following:
21
1
For the County:
2 Director
County of Fresno
3 1925 E. Dakota Avenue
Fresno, CA 93726
4
For the Contractor:
5 Chief Executive Officer
Turning Point of Central California, Inc.
6 P.O. Box 7447
Visalia, CA 93290-7447
7
6.2 Change of Contact Information. Either party may change the information in section
8
6.1 by giving notice as provided in section 6.3.
9
6.3 Method of Delivery. Each notice between the County and the Contractor provided
10
for or permitted under this Agreement must be in writing, state that it is a notice provided under
11
this Agreement, and be delivered either by personal service, by first-class United States mail, by
12
an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
13
Document Format (PDF) document attached to an email.
14
(A) A notice delivered by personal service is effective upon service to the recipient.
15
(B) A notice delivered by first-class United States mail is effective three (3) County
16
business days after deposit in the United States mail, postage prepaid, addressed to the
17
recipient.
18
(C)A notice delivered by an overnight commercial courier service is effective one (1)
19
County business day after deposit with the overnight commercial courier service,
20
delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
21
the recipient.
22
6.4 Claims Presentation. For all claims arising from or related to this Agreement,
23
nothing in this Agreement establishes, waives, or modifies any claims presentation
24
requirements or procedures provided by law, including the Government Claims Act (Division 3.6
25
of Title 1 of the Government Code, beginning with section 810).
26
6.5 Notification of Changes. Contractor shall notify County in writing of any change in
27
organizational name, Head of Service or principal business at least fifteen (15) business days in
28
advance of the change. Contractor shall notify County of a change of service location at least
22
1 six (6) months in advance to allow County sufficient time to comply with site certification
2 requirements. Said notice shall become part of this Agreement upon acknowledgment in writing
3 by the County, and no further amendment of the Agreement shall be necessary provided that
4 such change of address does not conflict with any other provisions of this Agreement.
5 Contractor must immediately notify County of a change in ownership, organizational
6 status, licensure, or ability of Contractor to provide the quantity or quality of the contracted
7 services in a and in no event more than fifteen (15) days of the change.
8 Article 7
9 Termination and Suspension
10 7.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
11 contingent on the approval of funds by the appropriating government agency. If sufficient funds
12 are not allocated, then the County, upon at least thirty (30) days' advance written notice to the
13 Contractor, may:
14 (A) Modify the services provided by the Contractor under this Agreement; or
15 (B) Terminate this Agreement.
16 7.2 Termination for Breach.
17 (A) Upon determining that a breach (as defined in paragraph (C) below) has
18 occurred, the County may give written notice of the breach to the Contractor. The written
19 notice may suspend performance under this Agreement and must provide at least thirty
20 (30) days for the Contractor to cure the breach.
21 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
22 time stated in the written notice, the County may terminate this Agreement immediately.
23 (C) For purposes of this section, a breach occurs when, in the determination of the
24 County, the Contractor has:
25 (1) Obtained or used funds illegally or improperly;
26 (2) Failed to comply with any part of this Agreement;
27 (3) Submitted a substantially incorrect or incomplete report to the County; or
28 (4) Improperly performed any of its obligations under this Agreement.
23
1 7.3 Termination without Cause. In circumstances other than those set forth above, the
2 County may terminate this Agreement by giving at least thirty (30) days advance written notice
3 to the Contractor.
4 7.4 No Penalty or Further Obligation. Any termination of this Agreement by the County
5 under this Article 7 is without penalty to or further obligation of the County.
6 7.5 County's Rights upon Termination. Upon termination for breach under this Article
7 7, the County may demand repayment by the Contractor of any monies disbursed to the
8 Contractor under this Agreement that, in the County's sole judgment, were not expended in
9 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
10 demand. This section survives the termination of this Agreement.
11 In the event this Agreement is terminated, Contractor shall be entitled to compensation
12 for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant to the terms
13 and conditions of this Agreement through and including the effective date of termination. This
14 provision shall not limit or reduce any damages owed to the County due to a breach of this
15 Agreement by Contractor.
16 Article 8
17 Informing Materials for Persons Served
18 8.1 Basic Information Requirements. Contractor shall provide information in a manner
19 and format that is easily understood and readily accessible to the persons served (42 C.F.R. §
20 438.10(c)(1)). Contractor shall provide all written materials for persons served in easily
21 understood language, format, and alternative formats that take into consideration the special
22 needs of individuals in compliance with 42 C.F.R. § 438.10(d)(6). Contractor shall inform the
23 persons served that information is available in alternate formats and how to access those
24 formats in compliance with 42 C.F.R. § 438.10.
25 Contractor shall provide the required information in this section to each individual
26 receiving SMHS under this Agreement and upon request (1915(b) Medi-Cal Specialty Mental
27 Health Services Waiver, § (2), subd.(d), at p. 26., attachments 3, 4; Cal. Code Regs., tit. 9, §
28 1810.360(e)).
24
1 Contractor shall utilize the County's website that provides the content required in this
2 section and 42 C.F.R. § 438.10 and complies with all requirements regarding the same set forth
3 in 42 C.F.R. § 438.10.
4 Contractor shall use the DHCS/County-developed beneficiary handbook and persons
5 served notices. (42 C.F.R. §§ 438.10(c)(4)(ii), 438.62(b)(3)).
6 8.2 Electronic Submission. Persons served information required in this section may
7 only be provided electronically by the Contractor if all of the following conditions are met:
8 (A) The format is readily accessible;
9 (B) The information is placed in a location on the Contractor's website that is
10 prominent and readily accessible;
11 (C)The information is provided in an electronic form which can be electronically
12 retained and printed;
13 (D)The information is consistent with the content and language requirements of this
14 Agreement;
15 (E) The individual is informed that the information is available in paper form without
16 charge upon request and the Contractor shall provide it upon request within five (5)
17 business days (42 C.F.R. § 438.10(c)(6)).
18 8.3 Language and Format. Contractor shall provide all written materials, including
19 taglines, for persons served or potential persons served in a font size no smaller than twelve
20 (12) point (42 C.F.R. 438.10(d)(6)(ii)).
21 Contractor shall ensure its written materials that are critical to obtaining services are
22 available in alternative formats, upon request of the person served or potential person served at
23 no cost.
24 Contractor shall make its written materials that are critical to obtaining services,
25 including, at a minimum, provider directories, beneficiary handbook, appeal and grievance
26 notices, denial and termination notices, and the Contractor's mental health education materials,
27 available in the prevalent non-English languages in the County (42 C.F.R. § 438.10(d)(3)).
28
25
1 (A) Contractor shall notify persons served, prospective persons served, and
2 members of the public that written translation is available in prevalent languages free of
3 cost and how to access those materials (42 C.F.R. § 438.10(d)(5)(i), (iii); Welfare & Inst.
4 Code § 14727(a)(1); Cal. Code Regs. tit. 9 § 1810.410, subd.(e), para. (4)).
5 Contractor shall make auxiliary aids and services available upon request and free of
6 charge to each person served (42 C.F.R. § 438.10(d)(3)-(4)).
7 Contractor shall make oral interpretation and auxiliary aids, such as Teletypewriter
8 Telephone/Text Telephone (TTY/TDY) and American Sign Language (ASL), available and free
9 of charge for any language in compliance with 42 C.F.R. § 438.10(d)(2), (4)-(5).
10 Taglines for written materials critical to obtaining services must be printed in a conspicuously
11 visible font size, no smaller than twelve (12) point font.
12 8.4 Beneficiary Informing Materials. Each person served must receive and have
13 access to the beneficiary informing materials upon request by the individual and when first
14 receiving SMHS from Contractor. Beneficiary informing materials include but are not limited to:
15 (A) Consumer Handbook
16 (B) Provider Directory
17 (C) Grievance form
18 (D)Appeal/Expedited Appeal form
19 (E) Advance Directives brochure
20 (F) Change of Provider form
21 (G)Suggestions brochure
22 (H) Notice of Privacy Practices
23 (1) Notices of Adverse Benefit Determination (NOABDs — Including Denial and
24 Termination notices)
25 (J) Early & Periodic Screening, Diagnostic and Treatment (EPSDT) poster (if serving
26 individuals under the age of twenty-one (21))
27
28
26
1 (K) Contractor shall ensure beneficiary informing material are displayed in the
2 threshold languages of Fresno County at all service sites, including but not limited to the
3 following:
4 (1) Consumer Handbook
5 (2) Provider Directory
6 (3) Grievance form
7 (4) Appeal/Expedited Appeal form
8 (5) Advance Directives brochure
9 (6) Change of Provider form
10 (7) Suggestions brochure
11 All beneficiary informing written materials will use easily understood language and
12 format (i.e. material written and formatted at a sixth grade reading level), and will use a font size
13 no smaller than twelve (12) point. All beneficiary informing written materials shall inform
14 beneficiaries of the availability of information in alternative formats and how to make a request
15 for an alternative format. Inventory and maintenance of all beneficiary informing materials will be
16 maintained by the County's DBH Managed Care Division. Contractor will ensure that its written
17 materials include taglines or that an additional taglines document is available.
18 8.5 Beneficiary Handbook. Contractor shall provide each person served with a
19 beneficiary handbook at the time the individual first accesses services and thereafter upon
20 request. The beneficiary handbook shall be provided to beneficiaries within fourteen (14)
21 business days after receiving notice of enrollment.
22 Contractor shall give each individual notice of any significant change to the information
23 contained in the beneficiary handbook at least thirty (30) days before the intended effective date
24 of change as per BHIN 22-060.
25 8.6 Accessibility. Required informing materials must be electronically available on
26 Contractor's website and must be physically available at the Contractor's facility lobby for
27 individuals' access.
28
27
1 Informing materials must be made available upon request, at no cost, in alternate
2 formats (i.e., Braille or audio) and auxiliary aids (i.e., California Relay Service (CRS) 711 and
3 American Sign Language) and must be provided to persons served within five (5) business
4 days. Large print materials shall be in a minimum of eighteen (18) point font size.
5 Informing materials will be considered provided to the individual if Contractor does one
6 or more of the following:
7 (A) Mails a printed copy of the information to the person served's mailing address
8 before the individual receives their first specialty mental health service;
9 (B) Mails a printed copy of the information upon the individual's request to their
10 mailing address;
11 (C) Provides the information by email after obtaining the person served's agreement
12 to receive the information by email;
13 (D) Posts the information on the Contractor's website and advises the person served
14 in paper or electronic form that the information is available on the internet and includes
15 applicable internet addresses, provided that individuals with disabilities who cannot
16 access this information online are provided auxiliary aids and services upon request and
17 at no cost; or,
18 (E) Provides the information by any other method that can reasonably be expected
19 to result in the person served receiving that information. If Contractor provides informing
20 materials in person, when the individual first receives specialty mental health services,
21 the date and method of delivery shall be documented in the person served's file.
22 8.7 Provider Directory. Contractor must follow the County's provider directory policy, in
23 compliance with MHSUDS IN 18-020.
24 Contractor must make available to persons served, in paper form upon request and
25 electronic form, specified information about the County provider network as per 42 C.F.R. §
26 438.10(h). The most current provider directory is electronically available on the County website
27 and is updated by the County no later than thirty (30) calendar days after information is received
28
28
1 to update provider information. A paper provider directory must be updated at least monthly as
2 set forth in 42 C.F.R. § 438.10(h)(3)(i).
3 Any changes to information published in the provider directory must be reported to the
4 County within two (2) weeks of the change.
5 Contractor will only need to report changes/updates to the provider directory for
6 licensed, waivered, or registered mental health providers.
7 Article 9
8 Independent Contractor
9 9.1 Status. In performing under this Agreement, the Contractor, including its officers,
10 agents, employees, and volunteers, is at all times acting and performing as an independent
11 contractor, in an independent capacity, and not as an officer, agent, servant, employee,joint
12 venturer, partner, or associate of the County.
13 9.2 Verifying Performance. The County has no right to control, supervise, or direct the
14 manner or method of the Contractor's performance under this Agreement, but the County may
15 verify that the Contractor is performing according to the terms of this Agreement.
16 9.3 Benefits. Because of its status as an independent contractor, the Contractor has no
17 right to employment rights or benefits available to County employees. The Contractor is solely
18 responsible for providing to its own employees all employee benefits required by law. The
19 Contractor shall save the County harmless from all matters relating to the payment of
20 Contractor's employees, including compliance with Social Security withholding and all related
21 regulations.
22 9.4 Services to Others. The parties acknowledge that, during the term of this
23 Agreement, the Contractor may provide services to others unrelated to the County.
24 9.5 Operating Costs. Contractor shall provide all personnel, supplies, and operating
25 expenses of any kind required for the performance of this Agreement.
26 9.6 Additional Responsibilities. The parties acknowledge that, during the term of this
27 Agreement, the Contractor will be performing hiring, training, and credentialing of staff, and
28
29
1 County will be performing additional staff credentialing to ensure compliance with State and
2 Federal regulations.
3 9.7 Subcontracts. Contractor shall obtain written approval from County's DBH Director,
4 or designee before subcontracting any of the services delivered under this Agreement. County's
5 DBH Director, or designee retains the right to approve or reject any request for subcontracting
6 services. Any transferee, assignee, or subcontractor will be subject to all applicable provisions
7 of this Agreement, and all applicable State and Federal regulations. Contractor shall be held
8 primarily responsible by County for the performance of any transferee, assignee, or
9 subcontractor unless otherwise expressly agreed to in writing by County's DBH Director, or
10 designee. The use of subcontractors by Contractor shall not entitle Contractor to any additional
11 compensation that is provided for under this Agreement.
12 Contractor shall remain legally responsible for the performance of all terms and
13 conditions of this Agreement, including, without limitation, all SMHS provided by third parties
14 under subcontracts, whether approved by the County or not.
15
16 Article 10
17 Indemnity and Defense
18 10.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
19 County (including its officers, agents, employees, and volunteers) against all claims, demands,
20 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
21 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
22 the performance or failure to perform by the Contractor (or any of its officers, agents,
23 subcontractors, or employees) under this Agreement. The County may conduct or participate in
24 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
25 defend the County.
26 10.2 Survival. This Article 10 survives the termination of this Agreement.
27
28
30
1 Article 11
2 Insurance
3 11.1 The Contractor shall comply with all the insurance requirements in Exhibit K to this
4 Agreement.
5 Article 12
6 Assurances
7 12.1 Certification of Non-exclusion or Suspension from Participation in a Federal
8 Health Care Program.
9 (A) In entering into this Agreement, Contractor certifies that it is not excluded from
10 participation in Federal Health Care Programs under either Section 1128 or 1128A of the
11 Social Security Act. Failure to so certify will render all provisions of this Agreement null
12 and void and may result in the immediate termination of this Agreement.
13 (B) In entering into this Agreement, Contractor certifies, that the Contractor does not
14 employ or subcontract with providers or have other relationships with providers excluded
15 from participation in Federal Health Care Programs, including Medi-Cal/Medicaid or
16 procurement activities, as set forth in 42 C.F.R. §438.610. Contractor shall conduct initial
17 and monthly exclusion and suspension searches of the following databases and provide
18 evidence of these completed searches when requested by County, DHCS or the US
19 Department of Health and Human Services (DHHS):
20 (1) www.oig.hhs.gov/exclusions - Office of Inspector General's List of Excluded
21 Individuals/Entities (LEIE) Federal Exclusions
22 (2) www.sam.gov/content/exclusions - General Service Administration (GSA)
23 Exclusions Extractwww.Medi-Cal.ca.gov- Suspended & Ineligible Provider List
24 (3) https:Hnppes.cros.hhs.gov/#/- National Plan and Provider Enumeration
25 System (NPPES)
26 (4) any other database required by DHCS or US DHHS.
27 (C) In entering into this Agreement, Contractor certifies, that Contractor does not
28 employ staff or individual contractors/vendors that are on the Social Security
31
1 Administration's Death Master File. Contractor shall check the database prior to
2 employing staff or individual contractors/vendors and provide evidence of these
3 completed searches when requested by the County, DHCS or the US DHHS.
4 (D) Contractor is required to notify County immediately if Contractor becomes aware
5 of any information that may indicate their (including employees/staff and individual
6 contractors/vendors) potential placement on an exclusions list.
7 (E) Contractor shall screen and periodically revalidate all network providers in
8 accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E.
9 (F) Contractor must confirm the identity and determine the exclusion status of all its
10 providers, as well as any person with an ownership or control interest, or who is an
11 agent or managing employee of the contracted agency through routine checks of federal
12 and state databases. This includes the Social Security Administration's Death Master
13 File, NPPES, the Office of Inspector General's LEIE, the Medi-Cal Suspended and
14 Ineligible Provider List (S&I List) as consistent with the requirements of 42 C.F.R. §
15 455.436.
16 (G) If Contractor finds a provider that is excluded, it must promptly notify the County
17 as per 42 C.F.R. § 438.608(a)(2), (4). The Contractor shall not certify or pay any
18 Excluded provider with Medi-Cal funds, must treat any payments made to an excluded
19 provider as an overpayment, and any such inappropriate payments may be subject to
20 recovery.
21 Article 13
22 Inspections, Audits, and Public Records
23 13.1 Inspection of Documents. The Contractor shall make available to the County, and
24 the County may examine at any time during business hours and as often as the County deems
25 necessary, all of the Contractor's records and data with respect to the matters covered by this
26 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
27 request by the County, permit the County to audit and inspect all of such records and data to
28 ensure the Contractor's compliance with the terms of this Agreement.
32
1 13.2 State Audit Requirements. If the compensation to be paid by the County under this
2 Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00), the Contractor is subject
3 to the examination and audit of the California State Auditor, as provided in Government Code
4 section 8546.7, for a period of three years after final payment under this Agreement. This
5 section survives the termination of this Agreement.
6 13.3 Internal Auditing. Contractors of sufficient size as determined by County shall
7 institute and conduct a Quality Assurance Process for all services provided hereunder. Said
8 process shall include at a minimum a system for verifying that all services provided and claimed
9 for reimbursement shall meet SMHS definitions and be documented accurately.
10 In addition, Contractors with medication prescribing authority shall adhere to County's
11 medication monitoring review practices. Contractor shall provide County with notification and a
12 summary of any internal audit exceptions and the specific corrective actions taken to sufficiently
13 reduce the errors that are discovered through Contractor's internal audit process. Contractor
14 shall provide this notification and summary to County as requested by the County.
15 13.4 Confidentiality in Audit Process. Contractor and County mutually agree to
16 maintain the confidentiality of Contractor's records and information of persons served, in
17 compliance with all applicable State and Federal statutes and regulations, including but not
18 limited to HIPAA and California Welfare and Institutions Code, Section 5328. Contractor shall
19 inform all of its officers, employees, and agents of the confidentiality provisions of all applicable
20 statutes.
21 Contractor's fiscal records shall contain sufficient data to enable auditors to perform a
22 complete audit and shall be maintained in conformance with standard procedures and
23 accounting principles.
24 Contractor's records shall be maintained as required by County's DBH and DHCS on
25 forms furnished by DHCS or the County. All statistical data or information requested by the
26 County's DBH Director or designee shall be provided by the Contractor in a complete and timely
27 manner.
28
33
1 13.5 Reasons for Recoupment. County will conduct periodic audits of Contractor files to
2 ensure appropriate clinical documentation, high quality service provision and compliance with
3 applicable federal, state and county regulations.
4 Such audits may result in requirements for Contractor to reimburse County for services
5 previously paid in the following circumstances:
6 (A) Identification of Fraud, Waste or Abuse as defined in federal regulation
7 (1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code,
8 section 14107.11, subdivision (d).
9 (2) Definitions for"fraud," "waste," and "abuse" can also be found in the Medicare
10 Managed Care Manual available at https://www.cros.gov/Regulations-and-
11 Guidance/Guidance/Manuals
12 (B) Overpayment of Contractor by County due to errors in claiming or
13 documentation.
14 (C) Other reasons specified in the SMHS Reasons for Recoupment document
15 released annually by DHCS and posted on the DHCS BHIN website.
16 Contractor shall reimburse County for all overpayments identified by Contractor, County,
17 and/or state or federal oversight agencies as an audit exception within the timeframes required
18 by law or Country or state or federal agency. Funds owed to County will be due within forty-five
19 (45) days of notification by County, or County shall withhold future payments until all excess
20 funds have been recouped by means of an offset against any payments then or thereafter owing
21 to County under this or any other Agreement between the County and Contractor.
22 13.6 Cooperation with Audits. Contractor shall cooperate with County in any review
23 and/or audit initiated by County, DHCS, or any other applicable regulatory body. This
24 cooperation may include such activities as onsite program, fiscal, or chart reviews and/or audits.
25 In addition, Contractor shall comply with all requests for any documentation or files
26 including, but not limited to, files for persons served.
27
28
34
1 Contractor shall notify the County of any scheduled or unscheduled external evaluation
2 or site visits when it becomes aware of such visit. County shall reserve the right to attend any or
3 all parts of external review processes.
4 Contractor shall allow inspection, evaluation and audit of its records, documents and
5 facilities for ten (10) years from the term end date of this Agreement or in the event Contractor
6 has been notified that an audit or investigation of this Agreement has been commenced, until
7 such time as the matter under audit or investigation has been resolved, including the exhaustion
8 of all legal remedies, whichever is later pursuant to 42 C.F.R.§§ 438.3(h) and 438.2301(3)(i-iii).
9 13.7 Single Audit Clause. If Contractor expends Seven Hundred Fifty Thousand and
10 No/100 Dollars ($750,000.00) or more in Federal and Federal flow-through monies, Contractor
11 agrees to conduct an annual audit in accordance with the requirements of the Single Audit
12 Standards as set forth in Office of Management and Budget (OMB) 2 CFR 200. Contractor shall
13 submit said audit and management letter to County. The audit must include a statement of
14 findings or a statement that there were no findings. If there were negative findings, Contractor
15 must include a corrective action plan signed by an authorized individual. Contractor agrees to
16 take action to correct any material non-compliance or weakness found as a result of such audit.
17 Such audit shall be delivered to County's DBH Finance Division for review within nine (9)
18 months of the end of any fiscal year in which funds were expended and/or received for the
19 program. Failure to perform the requisite audit functions as required by this Agreement may
20 result in County performing the necessary audit tasks, or at County's option, contracting with a
21 public accountant to perform said audit, or may result in the inability of County to enter into
22 future agreements with Contractor. All audit costs related to this Agreement are the sole
23 responsibility of Contractor.
24 A single audit report is not applicable if Contractor's Federal contracts do not exceed the
25 Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or Contractor's
26 only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a program audit
27 must be performed and a program audit report with management letter shall be submitted by
28 Contractor to County as a minimum requirement to attest to Contractor solvency. Said audit
35
1 report shall be delivered to County's DBH Finance Division for review no later than nine (9)
2 months after the close of the fiscal year in which the funds supplied through this Agreement are
3 expended. Failure to comply with this Act may result in County performing the necessary audit
4 tasks or contracting with a qualified accountant to perform said audit. All audit costs related to
5 this Agreement are the sole responsibility of Contractor who agrees to take corrective action to
6 eliminate any material noncompliance or weakness found as a result of such audit. Audit work
7 performed by County under this paragraph shall be billed to Contractor at County cost, as
8 determined by County's Auditor-Controller/Treasurer-Tax Collector.
9 Contractor shall make available all records and accounts for inspection by County, the
10 State of California, if applicable, the Controller General of the United States, the Federal Grantor
11 Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
12 least three (3) years following final payment under this Agreement or the closure of all other
13 pending matters, whichever is later.
14 13.8 Public Records. The County is not limited in any manner with respect to its public
15 disclosure of this Agreement or any record or data that the Contractor may provide to the
16 County. The County's public disclosure of this Agreement or any record or data that the
17 Contractor may provide to the County may include but is not limited to the following:
18 (A) The County may voluntarily, or upon request by any member of the public or
19 governmental agency, disclose this Agreement to the public or such governmental
20 agency.
21 (B) The County may voluntarily, or upon request by any member of the public or
22 governmental agency, disclose to the public or such governmental agency any record or
23 data that the Contractor may provide to the County, unless such disclosure is prohibited
24 by court order.
25 (C)This Agreement, and any record or data that the Contractor may provide to the
26 County, is subject to public disclosure under the Ralph M. Brown Act (California
27 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
28
36
1 (D) This Agreement, and any record or data that the Contractor may provide to the
2 County, is subject to public disclosure as a public record under the California Public
3 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
4 with section 6250) ("CPRA").
5 (E) This Agreement, and any record or data that the Contractor may provide to the
6 County, is subject to public disclosure as information concerning the conduct of the
7 people's business of the State of California under California Constitution, Article 1,
8 section 3, subdivision (b).
9 (F) Any marking of confidentiality or restricted access upon or otherwise made with
10 respect to any record or data that the Contractor may provide to the County shall be
11 disregarded and have no effect on the County's right or duty to disclose to the public or
12 governmental agency any such record or data.
13 13.9 Public Records Act Requests. If the County receives a written or oral request
14 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
15 and which the County has a right, under any provision of this Agreement or applicable law, to
16 possess or control, then the County may demand, in writing, that the Contractor deliver to the
17 County, for purposes of public disclosure, the requested records that may be in the possession
18 or control of the Contractor. Within five business days after the County's demand, the
19 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's
20 possession or control, together with a written statement that the Contractor, after conducting a
21 diligent search, has produced all requested records that are in the Contractor's possession or
22 control, or (b) provide to the County a written statement that the Contractor, after conducting a
23 diligent search, does not possess or control any of the requested records. The Contractor shall
24 cooperate with the County with respect to any County demand for such records. If the
25 Contractor wishes to assert that any specific record or data is exempt from disclosure under the
26 CPRA or other applicable law, it must deliver the record or data to the County and assert the
27 exemption by citation to specific legal authority within the written statement that it provides to
28 the County under this section. The Contractor's assertion of any exemption from disclosure is
37
1 not binding on the County, but the County will give at least 10 days' advance written notice to
2 the Contractor before disclosing any record subject to the Contractor's assertion of exemption
3 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs
4 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption,
5 failure to produce any such records, or failure to cooperate with the County with respect to any
6 County demand for any such records.
7 Article 14
8 Right to Monitor
9 14.1 Right to Monitor. County or any subdivision or appointee thereof, and the State of
10 California or any subdivision or appointee thereof, including the Auditor General, shall have
11 absolute right to review and audit all records, books, papers, documents, corporate minutes,
12 financial records, staff information, records of persons served, other pertinent items as
13 requested, and shall have absolute right to monitor the performance of Contractor in the delivery
14 of services provided under this Agreement. Full cooperation shall be given by the Contractor in
15 any auditing or monitoring conducted, according to this agreement.
16 14.2 Accessibility. Contractor shall make all of its premises, physical facilities,
17 equipment, books, records, documents, agreements, computers, or other electronic systems
18 pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities furnished
19 under the terms of this Agreement, or determinations of amounts payable available at any time
20 for inspection, examination, or copying by County, the State of California or any subdivision or
21 appointee thereof, CMS, U.S. Department of Health and Human Services (HHS) Office of
22 Inspector General, the United States Controller General or their designees, and other
23 authorized federal and state agencies. This audit right will exist for at least ten years from the
24 final date of the Agreement period or in the event the Contractor has been notified that an audit
25 or investigation of this Agreement has commenced, until such time as the matter under audit or
26 investigation has been resolved, including the exhaustion of all legal remedies, whichever is
27 later (42 CFR §438.230(c)(3)(I)-(ii)).
28
38
1 The County, DHCS, CMS, or the HHS Office of Inspector General may inspect,
2 evaluate, and audit the Contractor at any time if there is a reasonable possibility of fraud or
3 similar risk. The Department's inspection shall occur at the Contractor's place of business,
4 premises, or physical facilities (42 CFR §438.230(c)(3)(iv)).
5 14.3 Cooperation. Contractor shall cooperate with County in the implementation,
6 monitoring and evaluation of this Agreement and comply with any and all reporting requirements
7 established by County. Should County identify an issue or receive notification of a complaint or
8 potential/actual/suspected violation of requirements, County may audit, monitor, and/or request
9 information from Contractor to ensure compliance with laws, regulations, and requirements, as
10 applicable.
11 14.4 Probationary Status. County reserves the right to place Contractor on probationary
12 status, as referenced in the Probationary Status Article, should Contractor fail to meet
13 performance requirements; including, but not limited to violations such as high disallowance
14 rates, failure to report incidents and changes as contractually required, failure to correct issues,
15 inappropriate invoicing, untimely and inaccurate data entry, not meeting performance outcomes
16 expectations, and violations issued directly from the State. Additionally, Contractor may be
17 subject to Probationary Status or termination if agreement monitoring and auditing corrective
18 actions are not resolved within specified timeframes.
19 14.5 Record Retention. Contractor shall retain all records and documents originated or
20 prepared pursuant to Contractor's performance under this Agreement, including grievance and
21 appeal records, and the data, information and documentation specified in 42 C.F.R. parts
22 438.604, 438.606, 438.608, and 438.610 for a period of no less than ten (10) years from the
23 term end date of this Agreement or until such time as the matter under audit or investigation has
24 been resolved. Records and documents include but are not limited to all physical and electronic
25 records and documents originated or prepared pursuant to Contractor's or subcontractor's
26 performance under this Agreement including working papers, reports, financial records and
27 documents of account, records of persons served, prescription files, subcontracts, and any
28
39
1 other documentation pertaining to covered services and other related services for persons
2 served.
3 14.6 Record Maintenance. Contractor shall maintain all records and management books
4 pertaining to service delivery and demonstrate accountability for agreement performance and
5 maintain all fiscal, statistical, and management books and records pertaining to the program.
6 Records should include, but not be limited to, monthly summary sheets, sign-in sheets, and
7 other primary source documents. Fiscal records shall be kept in accordance with Generally
8 Accepted Accounting Principles and must account for all funds, tangible assets, revenue and
9 expenditures. Fiscal records must also comply with the Code of Federal Regulations (CFR),
10 Title ll, Subtitle A, Chapter 11, Part 200, Uniform Administrative Requirements, Cost Principles,
11 and Audit Requirements for Federal Awards.
12 All records shall be complete and current and comply with all Agreement requirements.
13 Failure to maintain acceptable records per the preceding requirements shall be considered
14 grounds for withholding of payments for billings submitted and for termination of Agreement.
15 Contractor shall maintain records of persons served and community service in
16 compliance with all regulations set forth by local, state, and federal requirements, laws, and
17 regulations, and provide access to clinical records by County staff.
18 Contractor shall comply with the Article 18 and Article 1 regarding relinquishing or
19 maintaining medical records.
20 Contractor shall agree to maintain and retain all appropriate service and financial
21 records for a period of at least ten (10) years from the date of final payment, the final date of the
22 contract period, final settlement, or until audit findings are resolved, whichever is later.
23 14.7 Financial Reports. Contractor shall submit audited financial reports on an annual
24 basis to the County. The audit shall be conducted in accordance with Generally Accepted
25 Accounting Principles and generally accepted auditing standards.
26 14.8 Agreement Termination. In the event the Agreement is terminated, ends its
27 designated term or Contractor ceases operation of its business, Contractor shall deliver or make
28 available to County all financial records that may have been accumulated by Contractor or
40
1 subcontractor under this Agreement, whether completed, partially completed or in progress
2 within seven (7) calendar days of said termination/end date.
3 14.9 Facilities and Assistance. Contractor shall provide all reasonable facilities and
4 assistance for the safety and convenience of the County's representatives in the performance of
5 their duties. All inspections and evaluations shall be performed in such a manner that will not
6 unduly delay the work of Contractor.
7 14.10 County Discretion to Revoke. County has the discretion to revoke full or partial
8 provisions of the Agreement, delegated activities or obligations, or application of other remedies
9 permitted by state or federal law when the County or DHCS determines Contractor has not
10 performed satisfactorily.
11 14.11 Site Inspection. Without limiting any other provision related to inspections or audits
12 otherwise set forth in this Agreement, Contractor shall permit authorized County, state, and/or
13 federal agency(ies), through any authorized representative, the right to inspect or otherwise
14 evaluate the work performed or being performed hereunder including subcontract support
15 activities and the premises which it is being performed. Contractor shall provide all reasonable
16 assistance for the safety and convenience of the authorized representative in the performance
17 of their duties. All inspections and evaluations shall be made in a manner that will not unduly
18 delay the work of the Contractor.
19 Article 15
20 Complaint Logs and Grievances
21 15.1 Documentation. Contractor shall log complaints and the disposition of all complaints
22 from a person served or their family. Contractor shall provide a copy of the detailed complaint
23 log entries concerning County-sponsored persons served to County at monthly intervals by the
24 tenth (10th) day of the following month, in a format that is mutually agreed upon. Contractor
25 shall allow beneficiaries or their representative to file a grievance either orally, or in writing at
26 any time with the Mental Health Plan. In the event Contractor is notified by a beneficiary or their
27 representative of a discrimination grievance, Contractor shall report discrimination grievances to
28 the Mental Health Plan within 24 hours. The Contractor shall not require a beneficiary or their
41
1 representative to file a Discrimination Grievance with the Mental Health Plan before filing the
2 complaint directly with the DHCS Office of Civil Rights and the U.S. Health and Human Services
3 Office for Civil Rights.
4 15.2 Rights of Persons Served. Contractor shall post signs informing persons served of
5 their right to file a complaint or grievance, appeals, and expedited appeals. In addition,
6 Contractor shall inform every person served of their rights as set forth in Exhibit L.
7 15.3 Incident Reporting. Contractor shall file an incident report for all incidents involving
8 persons served, following the protocol identified in Exhibit M.
9 Article 16
10 Property of County
11 16.1 Applicability. Article 16 shall only apply to the program components and services
12 provided under operational costs.
13 16.2 Fixed Assets. County and Contractor recognize that fixed assets are tangible and
14 intangible property obtained or controlled under County for use in operational capacity and will
15 benefit County for a period more than one (1) year.
16 16.3 Agreement Assets. Assets shall be tracked on an agreement by agreement basis.
17 All of these assets shall fall into the "Equipment" category unless funding source allows for
18 additional types of assets. At a minimum, the following types of items are considered to be
19 assets:
20 (A) Computers (desktops and laptops)
21 (B) Copiers, cell phones, tablets, and other devices with any HIPAA data
22 (C) Modular furniture
23 (D)Any items over $500 or more with a Iifespan of at least two (2) years:
24 (1) Televisions
25 (2) Washers/Dryers
26 (3) Printers
27 (4) Digital Cameras
28 (5) Other equipment/furniture
42
1 (6) Items in total when purchased or used as a group fall into one or more of the
2 above categories
3 (E) Items of sensitive nature shall be purchased and allocated to a single agreement.
4 All items containing HIPAA data are considered sensitive.
5 Contractor shall ensure proper tracking for contact assets that include the following
6 asset attributes at a minimum:
7 (A) Description of the asset;
8 (B) The unique identifier of the asset if applicable, i.e., serial number;
9 (C)The acquisition date;
10 (D)The quantity of the asset;
11 (E) The location of the asset or to whom the asset is assigned;
12 (F) The cost of the asset at the time of acquisition;
13 (G)The source of grant funding if applicable;
14 (H)The disposition date, and
15 (1) The method of disposition (surplus, transferred, destroyed, lost)
16 All Contract assets shall be returned to the Department at the end of the agreement
17 period.
18 16.4 Retention and Maintenance. Assets shall be retained by County, as County
19 property, in the event this Agreement is terminated or upon expiration of this Agreement.
20 Contractor agrees to participate in an annual inventory of all County fixed and inventoried
21 assets. Upon termination or expiration of this Agreement, Contractor shall be physically present
22 when fixed and inventoried assets are returned to County possession. Contractor is responsible
23 for returning to County all County owned undepreciated fixed and inventoried assets, or the
24 monetary value of said assets if unable to produce the assets at the expiration or termination of
25 this Agreement. Contractor further agrees to the following:
26 Maintain all items of equipment in good working order and condition, normal wear and
27 tear excepted;
28
43
1 Label all items of equipment with County assigned program number, to perform periodic
2 inventories as required by County and to maintain an inventory list showing where and how the
3 equipment is being used in accordance with procedures developed by County. All such lists
4 shall be submitted to County within ten (10) days of any request therefore; and
5 Report in writing to County immediately after discovery, the loss or theft of any items of
6 equipment. For stolen items, the local law enforcement agency must be contacted, and a copy
7 of the police report submitted to County.
8 16.5 Equipment Purchase. The purchase of any equipment by Contractor with funds
9 provided hereunder shall require the prior written approval of County's DBH Director or
10 designee, shall fulfill the provisions of this Agreement as appropriate, and must be directly
11 related to Contractor's services or activity under the terms of this Agreement. County may
12 refuse reimbursement for any costs resulting from equipment purchased, which are incurred by
13 Contractor, if prior written approval has not been obtained from County.
14 16.6 Modification. Contractor must obtain prior written approval from County's DBH
15 whenever there is any modification or change in the use of any property acquired or improved,
16 in whole or in part, using funds under this Agreement. If any real or personal property acquired
17 or improved with said funds identified herein is sold and/or is utilized by Contractor for a use
18 which does not qualify under this Agreement, Contractor shall reimburse County in an amount
19 equal to the current fair market value of the property, less any portion thereof attributable to
20 expenditures of funds not provided under this Agreement. These requirements shall continue in
21 effect for the life of the property. In the event this Agreement expires, the requirements for this
22 Article shall remain in effect for activities or property funded with said funds, unless action is
23 taken by the State government to relieve County of these obligations.
24 Article 17
25 Compliance
26 17.1 Compliance. Contractor agrees to comply with County's Contractor Code of
27 Conduct and Ethics and the County's Compliance Program in accordance with Exhibit N.
28 Within thirty (30) days of entering into this Agreement with County, Contractor shall ensure all of
44
1 Contractor's employees, agents, and subcontractors providing services under this Agreement
2 certify in writing, that he or she has received, read, understood, and shall abide by the
3 Contractor Code of Conduct and Ethics. Contractor shall ensure that within thirty (30) days of
4 hire, all new employees, agents, and subcontractors providing services under this Agreement
5 shall certify in writing that he or she has received, read, understood, and shall abide by the
6 Contractor Code of Conduct and Ethics. Contractor understands that the promotion of and
7 adherence to the Contractor Code of Conduct is an element in evaluating the performance of
8 Contractor and its employees, agents, and subcontractors.
9 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
10 employees, agents, and subcontractors providing services under this Agreement shall complete
11 general compliance training, and appropriate employees, agents, and subcontractors shall
12 complete documentation and billing or billing/reimbursement training. All new employees,
13 agents, and subcontractors shall attend the appropriate training within thirty (30) days of hire.
14 Each individual who is required to attend training shall certify in writing that he or she has
15 received the required training. The certification shall specify the type of training received and the
16 date received. The certification shall be provided to County's DBH Compliance Officer at 1925
17 E. Dakota Ave, Fresno, California 93726. Contractor agrees to reimburse County for the entire
18 cost of any penalty imposed upon County by the Federal Government as a result of Contractor's
19 violation of the terms of this Agreement.
20 17.2 Compliance with State Medi-Cal Requirements. Contractor shall be required to
21 maintain Mental Health Plan organizational provider certification by Fresno County. Contractor
22 must meet Medi-Cal organization provider standards as listed in Exhibit O, "Medi-Cal
23 Organizational Provider Standards", attached hereto and by this reference incorporated herein
24 and made part of this Agreement. It is acknowledged that all references to Organizational
25 Provider and/or Provider in Exhibit O shall refer to Contractor.
26 17.3 Medi-Cal Certification and Mental Health Plan Compliance. Contractor will
27 establish and maintain Medi-Cal certification or become certified within ninety (90) days of the
28 effective date of this Agreement through County to provide reimbursable services to Medi-Cal
45
1 eligible persons served. In addition, Contractor shall work with the County's DBH to execute the
2 process if not currently certified by County for credentialing of staff. During this process, the
3 Contractor will obtain a legal entity number established by the DHCS, a requirement for
4 maintaining Mental Health Plan organizational provider status throughout the term of this
5 Agreement. Contractor will be required to become Medi-Cal certified prior to providing services
6 to Medi-Cal eligible persons served and seeking reimbursement from the County. Contractor will
7 not be reimbursed by County for any services rendered prior to certification.
8 Contractor shall provide direct specialty mental health services in accordance with the
9 Mental Health Plan. Contractor must comply with the "Fresno County Mental Health Plan
10 Compliance Program and Code of Conduct" set forth in Exhibit N.
11 Contractor may provide direct specialty mental health services using unlicensed staff as
12 long as the individual is approved as a provider by the Mental Health Plan, is supervised by
13 licensed staff, works within his/her scope and only delivers allowable direct specialty mental
14 health services. It is understood that each service is subject to audit for compliance with Federal
15 and State regulations, and that County may be making payments in advance of said review. In
16 the event that a service is disapproved, County may, at its sole discretion, withhold
17 compensation or set off from other payments due the amount of said disapproved services.
18 Contractor shall be responsible for audit exceptions to ineligible dates of services or incorrect
19 application of utilization review requirements.
20 17.4 Network Adequacy. The Contractor shall ensure that all services covered under this
21 Agreement are available and accessible to persons served in a timely manner and in
22 accordance with the network adequacy standards required by regulation. (42 C.F.R. §438.206
23 (a), (c)).
24 Contractor shall submit, when requested by County and in a manner and format
25 determined by the County, network adequacy certification information to the County, utilizing a
26 provided template or other designated format.
27 Contractor shall submit updated network adequacy information to the County any time
28 there has been a significant change that would affect the adequacy and capacity of services.
46
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 shall provide a person served the ability to choose the person
3 providing services to them.
4 17.5 Compliance Program, Including Fraud Prevention and Overpayments.
5 Contractor shall have in place a compliance program designed to detect and prevent fraud,
6 waste and abuse, as per 42 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.
47
1 (H)The requirement for prompt reporting and repayment of any overpayments
2 identified.
3 17.6 Reporting. Contractor must have administrative and management arrangements or
4 procedures designed to detect and prevent fraud, waste and abuse of federal or state health
5 care funding. Contractor 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 person served's circumstances that may affect
11 the person served's eligibility including changes in the 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 as per 42 C.F.R. § 438.608(a)(6).
16 Contractor 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 shall make prompt referral of any potential fraud, waste or abuse to County or
20 potential fraud directly to the State Medicaid Fraud Control Unit.
21 17.7 Overpayments. County may suspend payments to Contractor 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 shall report to County all identified overpayments and reason for the
25 overpayment, including overpayments due to potential fraud. Contractor shall return any
26 overpayments to the County within sixty (60) calendar days after the date on which the
27 overpayment was identified. (42 C.F.R. § 438.608 (a)(2), (c)(3)).
28
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1 Article 18
2 Federal and State Laws
3 18.1 Health Insurance Portability and Accountability Act. County and Contractor each
4 consider and represent themselves as covered entities as defined by the U.S. Health Insurance
5 Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and agree to use and
6 disclose Protected Health Information (PHI) as required by law.
7 County and Contractor acknowledge that the exchange of PHI between them is only for
8 treatment, payment, and health care operations.
9 County and Contractor 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 to enter into a agreement containing specific requirements prior to the disclosure of
16 PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e)
17 of the Code of Federal Regulations.
18 18.2 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 must
20 provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal
21 beneficiaries with physical or mental disabilities.
22 Article 19
23 Data Security
24 19.1 Data Security Requirements. Contractor shall comply with data security
25 requirements in Exhibit P to this Agreement.
26
27 Article 20
28 Publicity Prohibition
49
1 20.1 Self-Promotion. None of the funds, materials, property, or services provided directly
2 or indirectly under this Agreement shall be used for Contractor's advertising, fundraising, or
3 publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-
4 promotion.
5 20.2 Public Awareness. Notwithstanding the above, publicity of the services described in
6 Article 1 of this Agreement shall be allowed as necessary to raise public awareness about the
7 availability of such specific services when approved in advance by County's DBH Director or
8 designee and at a cost to be provided in Exhibit J, Exhibit J-1 and Exhibit J-2 for such items as
9 written/printed materials, the use of media (i.e., radio, television, newspapers), and any other
10 related expense(s). Communication products must follow County's DBH graphic standards,
11 including typefaces and colors, to communicate our authority and project a unified brand. This
12 includes all media types and channels and all materials on and offline that are created as part of
13 County's DBH's efforts to provide information to the public.
14 Article 21
15 Disclosure of Self-Dealing Transactions
16 21.1 Applicability. This Article 21 applies if the Contractor is operating as a corporation,
17 or changes its status to operate as a corporation.
18 21.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
19 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
20 "Self-Dealing Transaction Disclosure Form" (Exhibit Q to this Agreement) and submitting it to
21 the County before commencing the transaction or immediately after.
22 21.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
23 a party and in which one or more of its directors, as an individual, has a material financial
24 interest.
25 Article 22
26 Disclosure of Ownership and/or Control Interest Information
27
28
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1 22.1 Applicability. This provision is only applicable if Contractor is disclosing entities,
2 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
3 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
4 22.2 Duty to Disclose. Contractor must disclose the following information as requested in
5 the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement,
6 Exhibit R:
7 (A) Disclosure of Five Percent (5%) or More Ownership Interest:
8 (1) In the case of corporate entities with an ownership or control interest in the
9 disclosing entity, the primary business address as well as every business location
and P.O. Box address must be disclosed. In the case of an individual, the date of
10
birth and Social Security number must be disclosed.
11 (2) In the case of a corporation with ownership or control interest in the
12 disclosing entity or in any subcontractor in which the disclosing entity has a five
13 percent (5%) or more interest, the corporation tax identification number must be
14 disclosed.
(3) For individuals or corporations with ownership or control interest in any
15
subcontractor in which the disclosing entity has a five percent (5%) or more interest,
16 the disclosure of familial relationship is required.
17 (4) For individuals with five percent (5%) or more direct or indirect ownership
18 interest of a disclosing entity, the individual shall provide evidence of completion of a
19 criminal background check, including fingerprinting, if required by law, prior to
execution of Contract. (42 C.F.R. § 455.434)
20
(B) Disclosures Related to Business Transactions:
21 (1) The ownership of any subcontractor with whom Contractor has had business
22 transactions totaling more than Twenty-Five Thousand and No/100 Dollars
23 ($25,000.00) during the twelve (12)-month period ending on the date of the request.
24 (2) Any significant business transactions between Contractor and any wholly
owned supplier, or between Contractor and any subcontractor, during the 5-year
25 period ending on the date of the request. (42 C.F.R. § 455.105(b).)
26 (C) Disclosures Related to Persons Convicted of Crimes:
27 (1) The identity of any person who has an ownership or control interest in the
28 provider or is an agent or managing employee of the provider who has been
convicted of a criminal offense related to that person's involvement in any program
51
1 under the Medicare, Medicaid, or the Title XXI services program since the inception
2 of those programs. (42 C.F.R. § 455.106.)
3 (2) County shall terminate the enrollment of Contractor if any person with five
percent (5%) or greater direct or indirect ownership interest in the disclosing entity
4
has been convicted of a criminal offense related to the person's involvement with
5 Medicare, Medicaid, or Title XXI program in the last ten (10) years.
6 22.3 Contractor must provide disclosure upon execution of Contract, extension for
7 renewal, and within thirty-five (35) days after any change in Contractor ownership or upon
8 request of County. County may refuse to enter into an agreement or terminate an existing
9 agreement with Contractor if Contractor fails to disclose ownership and control interest
10 information, information related to business transactions and information on persons convicted
11 of crimes, or if Contractor did not fully and accurately make the disclosure as required.
12 22.4 Contractor must provide the County with written disclosure of any prohibited
13 affiliations under 42 C.F.R. § 438.610. Contractor must not employ or subcontract with providers
14 or have other relationships with providers Excluded from participation in Federal Health Care
15 Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42 C.F.R.
16 §438.610.
17 22.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
18 DBHContractedServices@fresnocountyca.gov. County may deny enrollment or terminate this
19 Agreement where any person with five (5) percent or greater direct or indirect ownership interest
20 in Contractor has been convicted of a criminal offense related to that person's involvement with
21 the Medicare, Medicaid, or Title XXI program in the last ten (10) years. County may terminate
22 this Agreement where any person with five (5) percent or greater direct or indirect ownership
23 interest in the Contractor did not submit timely and accurate information and cooperate with any
24 screening method required in CFR, Title 42, Section 455.416
25 Article 23
26 Disclosure of Criminal History and Civil Actions
27
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1 23.1 Applicability. Contractor is required to disclose if any of the following conditions
2 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
3 referred to as "Contractor"):
4 (A) Within the three (3) year period preceding the Agreement award, they have been
5 convicted of, or had a civil judgment tendered against them for:
6 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
7 or performing a public (federal, state, or local) transaction or contract under a public
8 transaction;
9 (2) Violation of a federal or state antitrust statute;
10 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
11 or
12 (4) False statements or receipt of stolen property.
13 (B) Within a three (3) year period preceding their Agreement award, they have had a
14 public transaction (federal, state, or local) terminated for cause or default.
15 23.2 Duty to Disclose. Disclosure of the above information will not automatically
16 eliminate Contractor from further business consideration. The information will be considered as
17 part of the determination of whether to continue and/or renew this Agreement and any additional
18 information or explanation that Contractor elects to submit with the disclosed information will be
19 considered. If it is later determined that the Contractor failed to disclose required information,
20 any contract awarded to such Contractor may be immediately voided and terminated for
21 material failure to comply with the terms and conditions of the award.
22 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
23 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit S attached
24 hereto and by this reference incorporated herein. Additionally, Contractor must immediately
25 advise the County in writing if, during the term of the Agreement: (1) Contractor becomes
26 suspended, debarred, excluded or ineligible for participation in Federal or State funded
27 programs or from receiving federal funds as listed in the excluded parties list system
28 (http://www.epls.gov); or(2) any of the above listed conditions become applicable to Contractor.
53
1 Contractor shall indemnify, defend, and hold County harmless for any loss or damage resulting
2 from a conviction, debarment, exclusion, ineligibility, or other matter listed in the signed
3 Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
4 Article 24
5 Cultural and Linguistic Competency
6 24.1 General.All services, policies and procedures must be culturally and linguistically
7 appropriate. Contractor must participate in the implementation of the most recent Cultural
8 Competency Plan for the County and shall adhere to all cultural competency standards and
9 requirements. Contractor shall participate in the County's efforts to promote the delivery of
10 services in a culturally competent and equitable manner to all individuals, including those with
11 limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and
12 regardless of gender, sexual orientation, or gender identity including active participation in the
13 County's Diversity, Equity and Inclusion Committee.
14 24.2 Policies and Procedures. Contractor shall comply with requirements of policies and
15 procedures for ensuring access and appropriate use of trained interpreters and material
16 translation services for all limited and/or no English proficient beneficiaries, including, but not
17 limited to, assessing the cultural and linguistic needs of the beneficiaries, training of staff on the
18 policies and procedures, and monitoring its language assistance program. Contractor's policies
19 and procedures shall ensure compliance of any subcontracted providers with these
20 requirements.
21 24.3 Interpreter Services. Contractor shall notify its beneficiaries that oral interpretation
22 is available for any language and written translation is available in prevalent languages and that
23 auxiliary aids and services are available upon request, at no cost and in a timely manner for
24 limited and/or no English proficient beneficiaries and/or beneficiaries with disabilities.
25 Contractor shall avoid relying on an adult or minor child accompanying the beneficiary to
26 interpret or facilitate communication; however, if the beneficiary refuses language assistance
27 services, the Contractor must document the offer, refusal, and justification in the beneficiary's
28 file.
54
1 24.4 Interpreter Qualifications. Contractor shall ensure that employees, agents,
2 subcontractors, and/or partners who interpret or translate for a beneficiary or who directly
3 communicate with a beneficiary in a language other than English (1) have completed annual
4 training provided by County at no cost to Contractor; (2) have demonstrated proficiency in the
5 beneficiary's language; (3) can effectively communicate any specialized terms and concepts
6 specific to Contractor's services; and (4) adheres to generally accepted interpreter ethic
7 principles. As requested by County, Contractor shall identify all who interpret for or provide
8 direct communication to any program beneficiary in a language other than English and identify
9 when the Contractor last monitored the interpreter for language competence.
10 24.5 CLAS Standards. Contractor shall submit to County for approval, within ninety (90)
11 days from date of contract execution, Contractor's plan to address all fifteen (15) National
12 Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by the
13 Office of Minority Health and as set forth in Exhibit T "National Standards on Culturally and
14 Linguistically Appropriate Services", attached hereto and incorporated herein by reference and
15 made part of this Agreement. As the CLAS standards are updated, Contractor's plan must be
16 updated accordingly. As requested by County, Contractor shall be responsible for conducting an
17 annual CLAS self-assessment and providing the results of the self-assessment to the County.
18 The annual CLAS self-assessment instruments shall be reviewed by the County and revised as
19 necessary to meet the approval of the County.
20 24.6 Training Requirements. Cultural competency training for Contractor staff should be
21 substantively integrated into health professions education and training at all levels, both
22 academically and functionally, including core curriculum, professional licensure, and continuing
23 professional development programs. As requested by County, Contractor shall report on the
24 completion of cultural competency trainings to ensure direct service providers are completing a
25 minimum of twelve (12) hours of annual cultural competency training.
26 24.7 Continuing Cultural Competence. Contractor shall create and sustain a forum that
27 includes staff at all agency levels to discuss cultural competence. Contractor shall designate a
28
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1 representative from Contractor's team to attend County's Diversity, Equity and Inclusion
2 Committee.
3 Article 25
4 General Terms
5 25.1 Modification. Except as provided in Article 7, "Termination and Suspension," this
6 Agreement may not be modified, and no waiver is effective, except by written agreement signed
7 by both parties. The Contractor acknowledges that County employees have no authority to
8 modify this Agreement except as expressly provided in this Agreement.
9 (A) Notwithstanding the above, non-material changes to services, staffing, and
10 responsibilities of the Contractor, as needed, to accommodate changes in the laws
11 relating to service requirements and specialty mental health treatment, may be made
12 with the signed written approval of County's DBH Director, or designee, and Contractor
13 through an amendment approved by County's County Counsel and the County's Auditor-
14 Controller/Treasurer-Tax Collector's Office. Said modifications shall not result in any
15 change to the maximum compensation amount payable to Contractor, as stated herein.
16 (B) In addition, changes to line items and expense category subtotals, as set forth in
17 Exhibit J-1 and Exhibit J-2, that when added together during the term of the agreement
18 do not exceed ten percent (10%) of the maximum compensation payable to Contractor,
19 may be made with the written approval of Contractor and County's DBH Director or
20 designee. Changes to rates on Exhibit J that do not exceed three percent (3%) of the
21 approved rate, or that are needed to accommodate state-mandated rate increases, may
22 be made with the written approval of the DBH Director or designee. These rate changes
23 may not add or alter any other terms or conditions of the Agreement. Said modifications
24 shall not result in any change to the maximum compensation amount payable to
25 Contractor, as stated herein.
26 25.2 Consistent Federal Income Tax Position. Contractor acknowledges that the
27 County's adult jail facilities been acquired or improved (and is situated on land that has been
28 acquired) using net proceeds of governmental tax-exempt bonds ("Bond-Financed Facility").
56
1 Contractor agrees that, with respect to this Agreement and the Bond-Financed Facility,
2 Contractor is not entitled to take, and shall not take, any position (also known as a "tax position")
3 with the Internal Revenue Service that is inconsistent with being a "service provider" to the
4 County, as a "qualified user" with respect to the Bond-Financed Facility, as "managed property,"
5 as all of those terms are used in Internal Revenue Service Revenue Procedure 2016-44 and
6 2017-13, as applicable, and to that end, for example, and not as a limitation, Contractor agrees
7 that Contractor shall not, in connection with any federal income tax return that they file with the
8 Internal Revenue Service or any other statement or information that it provides to the Internal
9 Revenue Service, (a) claim ownership, or that it is a lessee, of any portion of the Bond-Financed
10 Facility, or (b) claim any depreciation or amortization (as referenced in Internal Revenue Service
11 Revenue Procedure 2016-44) or amortization deduction (as referenced in Internal Revenue
12 Service Revenue Procedure 2017-13), investment tax credit, or deduction for any payment as
13 rent with respect to the Bond-Financed Facility.
14 25.3 Non-Possession. This Agreement does not grant to Contractor any right to control
15 or exclusively possess all or any portion of any County facility and at any time authorized
16 County staff may enter County facilities where Contractor is providing services.
17 25.4 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 25.5 Governing Law. The laws of the State of California govern all matters arising from
20 or related to this Agreement.
21 25.6 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
22 County, California. Contractor 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 25.7 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.
57
1 25.8 Days. Unless otherwise specified, "days" means calendar days.
2 25.9 Headings. The headings and section titles in this Agreement are for convenience
3 only and are not part of this Agreement.
4 25.10 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 25.11 Nondiscrimination. During the performance of this Agreement, the Contractor shall
10 not unlawfully discriminate against any employee or applicant for employment, or recipient of
11 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 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 25.12 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
22 of the Contractor 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 and does not prohibit
24 enforcement by the County of any obligation on any other occasion.
25 25.13 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
26 between the Contractor 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
58
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 25.14 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 25.15 Authorized Signature. The Contractor represents and warrants to the County that:
8 (A) The Contractor is duly authorized and empowered to sign and perform its
9 obligations under this Agreement.
10 (B) The individual signing this Agreement on behalf of the Contractor is duly
11 authorized to do so and his or her signature on this Agreement legally binds the
12 Contractor to the terms of this Agreement.
13 25.16 Electronic Signatures. The parties agree that this Agreement may be executed by
14 electronic signature as provided in this section.
15 (A) An "electronic signature" means any symbol or process intended by an individual
16 signing this Agreement to represent their signature, including but not limited to (1) a
17 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
18 electronically scanned and transmitted (for example by PDF document) version of an
19 original handwritten signature.
20 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
21 equivalent to a valid original handwritten signature of the person signing this Agreement
22 for all purposes, including but not limited to evidentiary proof in any administrative or
23 judicial proceeding, and (2) has the same force and effect as the valid original
24 handwritten signature of that person.
25 (C)The provisions of this section satisfy the requirements of Civil Code section
26 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
27 Part 2, Title 2.5, beginning with section 1633.1).
28
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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 25.17 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]
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1 The parties are signing this Agreement on the date stated in the introductory clause.
2
TURNING POINT OF CENTRAL COUNTY OF FRESNO
3 CALIF NIA, I
4
5 ay LBanks Chief E cutive Officer Sal. ui t o, hairman of the Board of
Super. ' o he County of Fresno
6
Attest:
7 WA iam Goodafi ief Financial Officer Bernice E. Seidel
71 Clerk of the Board of Supervisors
8 County of Fresno, State of California
615 S. Atwood St.
9 Visalia, CA 93277
By:
10 Deputy
11
For accounting use only:
12
Org No.: 56302081 (DMC); 56302070 (AB109 OP/FSP/ACT); 56304784 (MHSA
13 OP);56304525 (MHSA FSP/ACT); 56302362 (WPCL); 56302361 (DSH)
Account No.: 7295/0
14 Fund No.: 0001
Subclass No.: 10000
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Exhibit A
FORENSIC BEHAVIORAL HEALTH — CONTINUUM OF CARE
SCOPE OF WORK
CONTRACTOR: Turning Point of Central California, Inc. (Turning Point)
LOCATION OF SERVICES: 3636 N. First Street, Suite 135
I. BACKGROUND
The 2011 Public Safety Realignment contained in AB 109 specifies local responsibilities for
managing certain adult offenders. The intent of realignment is to allow maximum local flexibility
within the statutory framework for the adult population transfers set forth in AB 109. The authors
of this bill have identified several community interventions to assist this population lead a
productive crime-free life. It is recognized that a number of these people would benefit from
mental health and/or substance use disorder treatment and support services.
Under Assembly Bill (AB) 1810 on June 27, 2018, pre-trial jail diversion is defined as the
"postponement of prosecution, either temporarily or permanently, at any point in the judicial
process from the point at which the accused is charged until adjudication, to allow the defendant
to undergo mental health treatment." Essentially, pre-trial jail diversion will allow mental health
services treatment in lieu of trial and sentencing by a jury or judge for those who have been
deemed to have a mental health illness, which significantly contributed to the act of the crime.
Senate Bill (SB) 317 authorized the ability for the court to suspend proceedings and grant
diversion to individuals charged with misdemeanors who have been found incompetent to stand
trial. Currently individuals that are found incompetent to stand trial are either referred to an out of
county inpatient facility for restoration services or a Full-Service Partnership (FSP) within the
DBH system of care for mental health services. With the passing of SB 317, IST individuals are
more likely to be diverted to community based supports for both mental health and restoration
services.
The Forensic Behavioral Health Continuum of Care (FBH-COC) will be comprised of an
evidence-based, 2-tiered, outpatient, mental health and co-occurring SUD treatment and support
services program specifically tailored to meet the unique needs of the target population. The
benefit to the 2-tiered system will be the flexibility to move the individuals seamlessly from one
level of care to another level of care based on clinical need — all under the same program.
The FBH-COC will include the following levels of care: Assertive Community Treatment (ACT),
Full-Service Partnership (FSP), and Outpatient (OP).
Contractor shall include, at a minimum, the following services in all levels of care:
• Mental health treatment
• Substance use disorder treatment
• Medication support
• Case management
• Crisis intervention
• Housing support
• Peer support
• Criminal justice support
A-1
Exhibit A
• Educational and vocational services
• Rehabilitative services
• Transportation services
• Assistance with child services
• Medi-Cal enrollment
• SSI or SSDI enrollment
• Anger management
• Faith-based support
• Food support
• Outreach and engagement
The FBH-COC is new program and involves many partners. Processes are being developed and
are expected to change to improve service delivery. Contractor shall be flexible and is welcomed to
propose improvements and communicate concerns to County's Department of Behavioral Health
(DBH).
II. TARGET POPULATION
The program is designed to provide services to adults and older adults with criminogenic needs,
including but not limited to individuals who qualify for AB 109 services, AB 1810 services, and
those who have been declared Incompetent to Stand Trial (IST). The target population will include
those who may have little to no criminogenic risk factors.. This proposal is intended to detail costs
and services provided to 100 FSP/ACT persons served at any given time. The program will serve,
at any given time, 20% at Tier I (ACT) and 80% at Tier II (FSP). The program will provide a range
of services that will be tailored to each individual's needs for service type, intensity and duration.
The SAMHSA Risk-Needs-Responsivity (RNR) model identifies that this target population needs
specialized treatment approaches that are dependent upon the needs/risk of each individual — both
psychiatric and criminogenic. Persons served will therefore be assigned to one of three primary
levels of care upon completion of the intake/assessment: ACT, FSP and OP. Within each level are
additional sub-levels that specifically focus treatment on the achievement of competencies and
milestones that form the building blocks to ensure that the individual gradually builds and maintains
earned progress in treatment. In this way, treatment is continually meeting the individual where
they are, and providing the necessary scaffolding to help them improve functioning and life
satisfaction. It is expected that the majority of persons served will be at the OP level of care.
III. LOCATION OF SERVICES
The program will be located in a safe, welcoming office setting, close to community resources and
public transportation. Transportation will be provided by staff through the use of agency vehicles
and individuals will be taught how to use public transportation and provided bus passes or tokens
when appropriate, to further reduce barriers while providing them with a level of assistance that
matches their functional ability. The offices are located at 3636 N. First Street, Suites 162 & 135,
Fresno, CA 93726. The Contractor has housed multiple programs at this facility for several years,
individuals have consistently affirmed that this location is easily accessible. Additionally, the
majority of services are expected to be provided in the field, literally meeting the individuals where
they are in the community.
A-2
Exhibit A
Both suites are located in the same building complex, and both are currently site certified by the
FCMHP to provide specialty mental health services to the AB109 FSP and OP populations. The
ACT/FSP services are expected to be served in suite 162, and the OP services are to be provided
in suite 135. The majority of services, however, are expected to be provided in the field, at
locations that are most convenient for individuals. Telehealth services will be offered if preferred by
the person served, or if there is a public health order to discontinue face to face services.
IV. HOURS OF OPERATION
The ACT, FSP and OP programs maintain office hours of operation Monday through Friday from
8:00 a.m. to 5:00 p.m. Each individual will have a single point of responsibility through a Mental
Health Specialist (MHS). The caseload of each MHS will be low enough to ensure their availability
to the individual and family is appropriate to their service needs; they are able to provide intensive
services and supports when needed, and they can give the individual and/or family member
considerable personal attention. Other members of the team the individual and/or family members
will have access to will include a program psychiatrist, a nurse, social workers and marriage and
family therapists, and peer supports.
The ACT/FSP and OP programs also have 24/7 crisis availability. A trained staff member is
prepared to respond to all crisis situations through rotating scheduled staff of the day (like officer of
the day) during normal work hours and on-call coverage for after-hours. All on-call staff are mental
health professionals and management staff. Updates on person served are readily updated to
these staff members and they have full access to the HER to reference Plan of Care and recent
intervention/medication support. These staff carry a cell phone and remain within 25 miles of the
city to be able to respond to situations within one hour. Telephone interventions are utilized when
sufficient to the purpose; however, staff provide face-to-face services to the extent necessary to
ensure individual safety and resolve the crisis. Emergency housing is available, and staff are
trained to access crisis services if needed. Staff are trained that use of crisis services should be
avoided if safely preventable, as the goals of the program are to reduce/eliminate use of these
services. Staff coordinate care with crisis service workers and residential program staff and seek to
return persons served to supported independence as quickly as is appropriate. Services include
the ability of the MHS, or other team members known to the individual or family to respond to
persons served and family members 24 hours a day, seven days a week. This level of
accessibility for the individual and/or family helps to reduce and prevent negative outcomes for
persons served including unnecessary hospitalizations, incarcerations, or evictions.
V. DESCRIPTION OF SERVICES
The intended benefit of creating a program such as the FBH-COC with multiple tiers and levels of
care is for maximum flexibility to move individuals seamlessly between levels, as clinically
indicated. Most of the persons served will need ongoing, long-term treatment and support. The
Contractor shall provide a level of service and support that will reflect each participant's unique
and individual needs.
1. Behavioral Health
A. Contractor shall provide "core" services to all individuals in the program. Services will
include are but are not limited to the following:
i. Engagement;
A-3
Exhibit A
ii. Transportation Services;
iii. Personal Needs (food, clothing, hygiene, etc.);
iv. Social Activities;
V. Access/linkage to Medical/doctor/Primary Care Physician (PCP);
vi. Housing;
vii. Life Skills Classes;
viii. Ancillary Services;
ix. Peer Support Services;
X. Crisis Intervention Services;
Xi. Securing Legal Documents;
xii. Entitlements/Benefits;
xiii. Legal Assistance;
xiv. Educational/Employment Support.
B. Contractor shall provide the following clinical services:
i. Treatment Plan/Plan of Care;
ii. Assessment;
iii. Reaching Recovery Tools;
iv. Pediatric Symptom Checklist (PSC) 35 and the Child and Adolescent Needs and
Strengths (CANS) assessment;
V. Individual Therapy;
vi. Group Therapy;
vii. Case Management;
viii. Consultation;
ix. Collateral;
X. Breath/Saliva Testing;
A. Individual & Group SUD services;
xii. Linkage to intensive Outpatient SUD services;
xiii. Linkage to Withdrawal Management;
xiv. Linkage to In-Patient Residential Services;
xv. Linkage to Recovery Residence;
xvi. Changing Offender Behavior (COB) Curriculum;
xvii. Hospitalization/Post Hospitalization Support,
xviii. Post Incarceration Support;
xix. Homelessness Support.
C. Contractor will ensure that all services:
i. Be values-driven, strengths based, individual-driven, and co-occurring capable;
ii. Be culturally and linguistically competent;
iii. Be age, culture, gender, and language appropriate;
iv. Include accommodations for individuals with physical disability(ies);
V. Include close and constant communication and collaboration between Contractor ,
the criminal justice system (including the Courts, Public Defender and Probation);
vi. Include evidence-based practices (EBPs) appropriate for the target population.
D. Methods for service coordination and communication between program and other
service providers shall be developed and implemented consistent with Fresno County
Mental Health Plan (MHP) confidentiality rules.
A-4
Exhibit A
E. Contractor shall maintain up to date caseload record of all individuals enrolled in
services, and provide individual, programmatic, and other demographic information to
DBH.
F. Contractor shall utilize the SAMHSA Risk-Needs-Responsivity (RNR) model to inform
and determine level of intensity of Contractor supervision and the specific interventions
that will be applied based on each individual's level of risk, criminogenic needs and
capacity to respond effectively.
G. Contractor shall ensure billable specialty mental health services meet any/all County,
State, Federal regulations including any utilization review and quality assurance
standards, and provide all pertinent and appropriate information in a timely manner to
DBH to bill Medi-Cal services rendered.
2. Levels of Treatment
A. "Tier 1" —Assertive Community Treatment (ACT)
i. Many of the individuals will be released from jail and enter the FBH-COC at this
level of care. Individuals eligible for this level of intervention may have been
provided services at the level of in-patient psychiatric hospitalization however, due
to diversion, will instead require a high-intensity, wrap-around services in the
community. The ACT Evidence-Based Practice (EBP) is an individual-focused,
community-based, time-unlimited model of delivering comprehensive and effective
services to individuals such as this, who have needs not well met by traditional
approaches to delivering services. Their needs are often complex with disorders that
are often under-managed and further complicated by varying degrees of
involvement with the criminal justice system. For the individuals with the greatest
need, who are admitted to the FBH-COC at the ACT level of care, Contractor is
committed to offering those individuals treatment that is consistent with the full
fidelity ACT model.
ii. Contractor shall ensure the following minimum staffing levels:
a. 10 individuals/clinician or fewer: The ACT team will maintain a low consumer
to staff ratio in the range of 10:1 in order to ensure adequate intensity and
individualization of services
b. 90% or more individuals have face-to-face contact with more than staff
member in 2 weeks: The entire team shares responsibility for each individual;
each clinician contributes expertise as appropriate. The team approach
ensures continuity of care for individuals, and creates a supportive
organizational environment for practitioners.
c. ACT Team will meet at least 4 days/week and reviews each individual each
time, even if only briefly: Daily team meetings allow ACT practitioners to
discuss individuals, solve problems, and plan treatment and rehabilitation
efforts, ensuring all individuals receive optimal service.
d. Supervisor provides services at least 50% of the time: Research has shown
this factor was among the five most strongly related to better outcomes. Team
leaders who also have direct clinical contact are better able to model
appropriate clinical interventions and remain in touch with the individual
served by the team.
e. Less than 20% turnover in 2 years: Whenever possible, the Contractor will
strive to maintain a consistent staffing team to enhance team cohesion;
A-5
Exhibit A
additionally, consistent staffing enhances the therapeutic relationships
between individuals and providers.
f. ACT Team will operate at 95% or more of full staffing over each 12 month
period: Whenever possible, we strive to maintain consistent, multidisciplinary
services with minimal position vacancies.
g. A psychiatric prescriber is assigned directly to the ACT Team: The
psychiatrist/psychiatric prescriber serves as medical director for the team; in
addition to medication monitoring, the psychiatrist/psychiatric prescriber
functions as a fully integrated team member, participating in treatment
planning and rehabilitation efforts.
h. Two full-time nurses or more are members for the ACT Team: The full-time
nursing staff has been found to be a critical ingredient in successful ACT
Teams. The nurses function as full members of the team, which includes
conducting home visits, treatment planning, and daily team meetings. Nurses
can help monitor needed medications and serve to educate the team about
important medication issues.
i. Staff with Substance Use Disorder (SUD) training or supervised SUD
experience: Concurrent substance use disorders are common in persons with
severe mental illness. Appropriate assessment and intervention strategies are
critical.
j. Two FTEs or more with 1 year educational/employment rehabilitation training
or supervised VR experience: ACT teams emphasize skill development and
support in natural settings. Fully integrated ACT teams include vocational
services that enable individuals to find and keep jobs in integrated work
settings.
k. ACT Team will maintain appropriate staff-to-individual ratio: The ACT team
provides an integrated approach to mental health services, through
which the range of treatment issues are addressed from a variety of
perspectives; it is critical to maintain adequate staff size and disciplinary
background in order to provide comprehensive, individualized service
and adequate access/coverage to each individual.
Contractor shall ensure that its ACT Team:
a. Actively recruits a defined population and all cases comply with explicit
admission criteria. ACT is best suited to individuals who do not effectively use
less intensive mental health services.
b. Provides 24-hour coverage: An immediate response can help minimize
distress when persons with severe mental illness are faced with crisis.
When the ACT team provides crisis intervention, continuity of care is
maintained. Non-crisis services are available after hours as appropriate.
c. Will be involved in 95% or more hospital admissions. More appropriate use of
psychiatric hospitalization occurs, and continuity of care is maintained, when
the ACT Team is involved with psychiatric hospitalizations.
d. Is jointly involved in the planning of 95% or more of hospital discharges of
individuals served. Ongoing participation of the ACT Team during an
individual's hospitalization and discharge planning allows the team to help
maintain community supports (e.g., housing), and continuity of service.
e. Serves individuals on a time-unlimited basis, with fewer than 5% graduating
annually: Individuals often regress when they are terminated from short-term
ACT Teams. Time-unlimited services encourage the development of stable,
ongoing therapeutic relationships.
A-6
Exhibit A
f. Provides 80% or more of total face-to-face contacts in the community:
Contacts in natural settings (i.e., where individuals live, work, and interact
with other people) are thought to be more effective than when they occur in
hospital or office settings, as skills may not transfer well to natural settings.
Furthermore, more accurate assessment of the person served can occur in
his or her community setting because the clinician can make direct
observations rather than relying on self-report. Medication delivery, crisis
intervention, and networking are more easily accomplished through home
visits.
g. Retains 95% or more of caseload over a 12-month period: Outreach efforts,
both initially and after an individual is enrolled on an ACT team, help build
relationships and ensure individuals receive ongoing services.
h. Will demonstrate consistently well-thought-out strategies and use street
outreach and legal mechanisms whenever appropriate: Individuals are not
immediately discharged from the ACT Team due to failure to keep
appointments. Retention of persons served is a high priority for ACT teams.
Persistent, caring attempts to engage individuals in treatment helps foster a
trusting relationship between the person served and the ACT team. Assertive
outreach is considered a critical feature of the ACT team.
i. Provides an average of 2 hours/week or more of face-to-face contact per
individual: In order to help individuals with severe and persistent symptoms
maintain and improve their function within the community, high service
intensity is often required.
j. Provides an average of 4 or more face-to-face contacts per week per
individual: ACT Teams are highly invested in their individuals, and maintain
frequent contact in order to provide ongoing, responsive support as needed.
Frequent contacts are associated with improved outcomes.
k. Provides four or more contacts per month per individual with support system in
the community: Developing and maintaining community support further
enhances individual's integration and functioning.
I. Provides individuals with substance use disorders spend, on average, 24
minutes/week or more in formal substance abuse treatment (as determined by
medical necessity): substance use disorders often occur concurrently in
persons with SMI; these co-occurring disorders require treatment that directly
addresses them.
m. Encourages 50% or more of the individuals with substance use disorders
attend at least one substance abuse treatment group meeting during a month
(as determined by medical necessity): Group treatment has been shown to
positively influence recovery for persons with dual disorders (DD).
n. Is fully based in DD treatment principles (stage-wise treatment model that is
non- confrontational, follows behavioral principles, considers interactions of
mental illness and substance abuse, and has gradual expectations of
abstinence), with treatment provided by ACT Team staff: The DD model
attends to the concerns of both SMI and substance abuse for maximum
opportunity for recovery and symptom management.
o. Has peer support staff that are employed full-time: Some research has
concluded that including persons served as staff on case management teams
improves the practice culture, making it more attuned to consumer
perspectives.
p. Provides an Integrated Approach: Individuals benefit when services are
integrated into a single team, rather than when they are referred to many
A-7
Exhibit A
different service providers. Furthermore, an integrated approach allows
services to be tailored to each individual.
B. "Tier 2" — Full Service Partnership (FSP)
i. Service Approach:
a. Contractor shall include the use of innovative approaches resulting in
increased access to services and encouraging and assisting individuals in
transition towards growth, stability, wellness, recovery and self-sufficiency.
b. Contractor shall deliver services with a focus of"meeting the individuals
where they are" utilizing a "whatever it takes" approach.
C. Contractor shall utilize a peer to peer support network that includes hiring
recovering individuals/family members of recovering individuals. Staff shall
employ harm reduction in philosophy and motivational interviewing
techniques and principles. Peer counselors shall be equal partners in the
multi-disciplinary team and play a critical role in developing the recovery
culture and person-centered focus of the team. The team will provide peer
recovery and self-help services and use resources such as Wellness
Recovery Action Plans (WRAP); the UCLA Program for Social and
Independent Living Skills; Trauma Recovery and Empowerment Model
(TREM); and a module for living cooperatively with roommates and
housemates in group residential settings.
d. Contractor shall abide by the FSP Service Delivery Model and the FSP
Objectives and Performance Measures.
ii. Contractor shall ensure the following minimum staffing levels:
a. FSP services will be provided by a multi-disciplinary team.
b. CONTRACTOR shall assign a Personal Service Coordinator (PSC) to each
individual who will act as a "single point of responsibility" within the ACT
Team for coordination services and supports. The PSC will be readily
available to the individual and family as needed and will be culturally
competent and know the community resources of the individual's
racial/ethnic community.
C. A low person served to staff ratio:
(i) 12:1
iii. Contractor shall ensure the following availability of services:
a. Contractor's PSC staff shall be available to provide crisis assessment and
intervention twenty-four hours per day, seven days per week throughout the
year, including telephone and face-to-face contact as needed. There shall be
no barrier to access crisis services based solely on active substance use.
Response to crisis shall be rapid and flexible. The vendor shall collaborate
with facilities and designated County staff to provide emergency placement
should crisis housing, short-term care and inpatient treatment (voluntary or
involuntary) be needed. CONTRACTOR's staff shall provide support to the
maximum extent possible, including accompanying the individual to the
facility, performing a face to face visit if admitted to crisis facility and
remaining with the individual during the assessment. As soon as possible
Contractor staff shall begin the process of planning for discharge and return
to the community.
b. Case management services will be available twenty-four hours per day,
seven days a week throughout the year.
A-8
Exhibit A
iv. Contractor shall ensure that its FSP Team services:
a. "Core" services referenced on page 4, section VI "Description of Services will
be provided by the multi-disciplinary team.
b. The PSC will work closely with the individual to develop an Integrated
Services and Supports Plan (ISSP). The ISSP will provide a map of steps
the individual identifies as necessity to move along their recovery path. The
ISSP will operationalize the fundamental concepts of individual/family
directedness, well resiliency focus, community collaboration,
integrated service experience, and cultural competency
C. In conjunction with the multi-disciplinary team, the PSC will coordinate
linkages to all of the services or benefits that have been defined by the
individual/family and the multi-disciplinary team, and which will be delivered
by community partners in the full-service partnership.
V. Contractor shall ensure the following frequency of services:
a. Contractor shall offer the full array of services and supports, including a
minimum of three (3) face to face contacts per week or as clinically
appropriate.
C. "Tier 3" —Outpatient (OP)
i. Service Approach:
a. Each individual will be provided integrated dual treatment for both Mild to Moderate as
well as Severe Mental Illness (SMI)and Substance Use Disorder(SUD)diagnoses
being addressed as the primary focus of clinical attention. However, to assess,
conceptualize and identify treatment strategies for an individual, assessment of
symptoms and impairments specific to an individual's SUD helps the treatment team
employ targeted interventions that are evidence-based and proven effective for those
specific issues. SUD diagnosis-specific services are also culturally/linguistically
competent, values-driven, and focused on restoring the dignity of every person.
SUD services will be based on the individual's stage of change and based in
harm reduction theory in order to help individuals reduce barriers to treatment.
The role of the Turning Point FBH-COC staff will be to help the individual
achieve measurable goals towards sobriety, stability and physical health with the
use of coping skills and peer support.
ii. Contractor shall ensure that the following OP services meet Drug Medi-Cal -
Organized Delivery System (DMC-ODS) and Mental Health Plan (MHP) provider
manual requirements:
a. Intake Services;
b. Breath/Urine testing;
c. Treatment Plan/POC/Update;
d. Individual therapy;
e. Group therapy;
f. Case Management;
g. Collateral;
h. Consultation;
i. Linkage to Recovery Residences;
j. Contingency Management(pending completion and evaluation of DHCS
contingency management pilot; and
k. Recovery Services.
A-9
Exhibit A
iii. Contractor shall ensure the following linkages to services as needed:
a. Withdrawal Management;
b. In-Patient Residential Treatment Services;
c. Recovery Homes; and
d. Medication Assisted Treatment (MAT).
iv. Availability of Services:
a. Contractor shall make available outpatient services eight (8) hours a day, five (5)
days a week.
V. Contractor shall ensure the following frequency of services:
a. Frequency of services will be provided as clinically indicated.
3. Housing
Housing services are vital to provide stability, reduce hospital/jail visits, and allow for recovery
and the building of resiliency. Individuals living with severe mental illnesses can successfully
live in and maintain housing with frequent, consistent team contact and support. With this in
mind, the Contractor shall offer linkages and financial assistance for a variety of housing options for
persons served including crisis housing, transitional or low-barrier housing, recovery residence,
residential drug treatment, board and care homes, and room and board homes. Because the FBH-
COC population is known to experience many barriers to securing and maintaining housing, the
Contractor provides specialty training to mitigate some of the barriers and to individually
support the persons served with obtaining the least restrictive housing option appropriate for
the individual.
Housing support needs to match the individual's unique needs at a particular point in time. Housing
options range based on individual's level of need with the goal of supporting the individual to
achieve the highest level of independence possible for them individually. FBH-COC persons
served who are parenting children are offered opportunities and options for appropriate housing
as well. Mental Health Service Act (MHSA) program funds are used to subsidize a variety of
housing needs for including emergency housing, rental payments, deposits, utilities, and the
purchase of household goods. The program staff may accompany the individual to meet with
landlords or housing managers to support and advocate as needed. Program staff educate
persons served about expectations of tenancy, lease/rental agreement requirements, and the
importance of remaining courteous of other tenants. Staff regularly visits the housing
environment to ensure it is appropriate to individual needs. Staff work to help persons served
eliminate any problems before an eviction or other negative consequence arises.
The ACT team initially assists persons served with obtaining assistance with rent and utilities
as a part of developing a long-term plan for sustainable independence. Persons served are
assisted with determining eligibility and completing application processes for housing subsidies.
As many individuals may initially require room and board or board and care level housing while
they stabilize, the FBH-COC program will rely on relationships that have been developed
between room and board operators and board and care operators who work solely with the
FSP population in other Turning Point programs and are willing to be patient in working with the
unique set of challenges tied to housing individuals in these difficult stages of recovery. Step up
and permanent housing options are facilitated through the use of community partners such as
Falcon Court, STASIS housing, The Californian apartments, or privately leased apartments.
A-10
Exhibit A
FSP individuals often have difficulty maintaining housing, therefore the Contractor offers and
pursues housing options to overcome barriers experienced by persons served. The goal is for
each individual to be able to maintain safe and sustainable housing at the individual's highest
level of independence.
4. Discharge Planning
Before active program participation is concluded and prior to an approved discharge from the
program; program staff will meet with the individual to develop an individualized strategy that
will assist the individual in maintaining a continued alcohol and drug free lifestyle. This meeting
with the individual must be completed in 30 days prior to the last face to face treatment session
by the counselor. The discharge planning process will include individual's recovery plan, which
the individual will need to identify their relapse triggers, explain how each trigger could cause
them to relapse, then identify their plan to avoid those relapse when confronted by each of the
trigger. Individual will also need to generate a support plan that includes a list of individuals
and/or organizations and activities that can provide support and assistance for individual to
maintain sobriety. Individual and counselor must review the discharge plan; both must sign and
date the discharge plan. After individual and counselor have signed it, then the physician must
review, sign, date, and approve the discharge plan. Once the individual, counselor, and
physician had signed and dated the discharge plan, a copy is given to the individual. Discharge
planning will no longer be dictated by the probation term, it will focus on medical necessity to
determine when appropriately necessary.
5. Collaboration with Probation
The Contractor shall collaborate with the Fresno County Probation Department (the
"Probation Department") to provide screenings on-site at the AB 109 office to individuals who
may need MH and/or SUD services. Individuals who are screened to need services are to be
referred to the appropriate level of care for services. The Contractor shall also make
arrangements to provide assessments to EOP individuals outside of regular business hours
as needed.
The Contractor shall participate with the Probation Department in Pre-Release Coordinated
Clinical Assessment Team (CCAT) teleconferences to discuss EOP incarcerated individual's
case prior to release. This is most helpful as it is often the only time that there is direct access
to California Department of Corrections and Rehabilitation (CDCR) doctors and clinicians to
ask questions related to an EOP incarcerated individual. These teleconferences are done
during regular business hours.
6. Collaboration with Court Services
All individuals who are placed in the FBH-COC will have intermittent requirements to report
back to the collaborative treatment courts regarding the individual's progress. The Contractor
shall identify an individual who will communicate and coordinate with court services and/or
law enforcement, as needed. The CONTRACTOR shall work with court partners to create
and use a standardized form for court reporting. Court reporting should be completed in a
timely fashion and be submitted to the court a minimum of 48 hours in advance of the next
scheduled court hearing.
A-11
Exhibit A
The Contractor will need to be able to provide court attendance assistance to participants by
hosting them in their office for Virtual Court sessions or helping the individual arrange
transportation to hearings as necessary.
The Contractor shall designate staff to attend specialty treatment court hearings, including
but not limited to Mental Health Diversion (MHD) Court and Mental Health Incompetent to
Stand Trial (MHIST) Court. Staff will attend hearings on a frequency to be determined by
DBH.
7. Other Collaborative Relationships
The Contractor 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 but are not limited to local law enforcement
agencies, Veterans Administration, Marjorie Mason Center, Fresno County Human Services
Departments, Faith Organization, acute psychiatric facilities, schools, community centers, etc.
Letters of introduction, including a description of services and how to contact the FBH-COC
program shall be distributed to potential community partners. There may be a need for a
Memorandum of Understanding (MOU) or Data Use Agreement between the Contractor and
one or more of the community partners if data is to be shared and collected. HIPAA
regulations must always be considered and adhered to when discussing protected health
information (PHI) with another agency.
At some point during the resulting contract, there may be an increased need for collaborative
efforts initiated with other County Departments (such as the Public Defender ["PD"], District
Attorney ["DA"], Sheriff-Coroner ["Sheriff'], Probation Department, Social Services, etc.) that
will require full cooperation by the Contractor.
The Contractor shall be willing to provide information on the program services through
trainings and infographics to our community and criminal justice partners (PD, DA, Sheriff,
Probation, Jail, Social Services, etc.)
8. County Responsibilities
A. Provide oversight and collaborate with Contractor and other County Departments and
community agencies to help achieve State program goals and outcomes. In addition to
contract monitoring of program(s), oversight includes, but not limited to, coordination
with the Department of Health Care Services (DHCS) in regard to program
administration and outcomes.
B. Assist Contractor in making linkages to the appropriate level of care within the
behavioral health system of care to ensure continuity of care. This will be accomplished
through regularly scheduled meetings as well as formal and informal consultation.
C. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the Contractor staff and will be available to Contractor for ongoing
consultation.
D. Receive and analyze statistical outcome data from Contractor throughout the term of
contract on a monthly basis. DBH will notify the Contractor when additional participation
A-12
Exhibit A
is required. The performance outcome measurement process will not be limited to
survey instruments but will also include, as appropriate, individual and staff interviews,
chart reviews, and other methods of obtaining required information.
E. 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, County shall provide the
following at no cost to Contractor:
i. Mandatory cultural competency training including sexual orientation and sensitivity
training for Contractor personnel, at minimum once per year. County will provide
mandatory training regarding the special needs of this diverse population and will be
included in the cultural competence training(s), if Contractor does not have a similar
training in place. Sexual orientation and sensitivity to gender differences is a basic
cultural competence principle and shall be included in the cultural competency
training. Literature suggests that the mental health needs of lesbian, gay, bisexual,
transgender (LGBT) individuals may be at increased risk for mental disorders and
mental health problems due to exposure to societal stressors such as stigmatization,
prejudice and anti-gay violence. Social support may be critical for this population.
Access to care may be limited due to concerns about providers' sensitivity to
differences in sexual orientation.
ii. Assistance to Contractor in locating appropriate providers who can translate
behavioral health and substance abuse services information into County's threshold
languages (English, Spanish, and Hmong). Translation services and costs
associated will be the responsibility of the Contractor.
VI. STAFFING
Contractor shall provide a staffing plan that is clear and concise and allows for full implementation
of all services described in the program. Staff shall be qualified in education, experience, clinical,
and cultural competencies according to DMC-ODS and MHP provider manual
requirements. Staffing pattern shall include Addiction Specialists, Psychiatrists and
Nurses, Housing Specialists, Employment Specialists, Personal Service Coordinators, Peer
Support Specialists and Outreach and Engagement Coordinators.
Contractor shall maintain staffing levels adequate in relation to the number of open individual cases
at any given point to ensure quality service that meets the requirements of the program.
Contractor shall provide robust, comprehensive and ongoing training and mentoring
to staff in evidence-based practices (EBP) of the program to ensure fidelity and to build
competency and expertise of their staff. In addition to EBPs, Contractor shall provide
training to on co-occurring and trauma informed practice.
A-13
Exhibit A
Contractor shall demonstrate staff proficiency (training and certification) in suicide and crisis
intervention procedures and other training subjects that would benefits the individuals in their
wellness goals.
Contractor shall ensure clinical supervisor(s) will oversee the work of the clinicians, including
approving documentation and claiming in the electronic medical records as required. The clinical
supervisor(s) shall be able to provide Board of Behavioral Sciences (BBS) supervision.
All staff, who provide direct care or perform coding/billing functions, must meet the requirements of
the Fresno County Mental Health Plan (FCMHP) Compliance Program. This includes the screening
for excluded persons and entities by accessing or querying the applicable licensing board(s), the
National Provide Data Bank (NPDB), Office of Inspector General's List of Excluded
Individuals/Entities (LEIE), Excluded Parties List System (EPLS) and Medi-Cal Suspended and
Ineligible List prior to hire and monthly thereafter. In addition, all licensed/registered/waivered staff
must complete a FCMHP Provider Application and be credentialed by the FCMHP's Credentialing
Committee. All licensed staff shall have Department of Justice (DOJ), Federal Bureau of
Investigation (FBI), and Sherriff fingerprinting (Live scan) executed.
VII. PEER SUPPORT RESOURCES
The Contractor recognizes the value of the use of individual directed peer-to-peer support
networks. As part of an individual's recovery, a variety of peer activities are made available for
persons served. FBH-COC will employ peer support staff who have lived mental health /criminal
justice involvement/substance use disorder experience and has a heart to give back as part of the
FBH-COC treatment team. Individuals often struggle in social situations and having peer-run
activities is a way to have persons served begin to interact in a social situation. Individuals are
encouraged to participate in existing peer support programs in the community and FBH-COC will
sponsor peer support activities facilitated by the Peer Support Specialist at the program site as
well. Peer support services are promoted in a manner that encourages individual responsibility and
participation in their own recovery and seeks to assist individuals in understanding and combating
stigmatization including their own self-imposed stigma. Staff will continue to assist individuals to
develop their own program-based formal and informal support groups.
This approach to treatment provides vital opportunities to engage in pro-social activities while
establishing hope, dignity, and engagement. The Turning Point FBH-COC program will cultivate an
active peer led leadership team that allows opportunity for persons served to build leadership skills
in planning and promoting monthly program events for other persons served. The leadership team
role will instill a sense of purpose for individuals as they volunteer to be greeters, introduce new
individuals to the program, and hold peers accountable to engage in respectful behavior.
VIII. AVERAGE CLIENT LENGTH OF STAY
Individuals will remain in the ACT program for as long as clinically necessary. ACT Teams will
decrease the intensity of services to individuals who are experiencing progress, but should
maintain enough contact so that if circumstances change—they can step in quickly to avoid
symptoms from worsening and prevent minor problems from decompensating into crisis.
Individuals are able to remain in the FBH-COC as long as services are clinically justified. When
services for those individuals with a length of stay longer than the maximum 24-month period under
AB 1810 pre-trial jail diversion, they will be allowed to continue receiving treatment until it is no
A-14
Exhibit A
longer clinically necessary. DBH may require treatment reauthorization every 60 days for
individuals who have completed their pre-trial probation term or AB1810 diversion term if the
program is at capacity and unable to accept new referrals from the Court or Probation.
IX. REPORTING
Contractor shall comply with the following reporting requirements:
1. AB 109 Reporting:
A. Quarterly Program Statistics;
B. Fiscal Reporting, including monthly invoicing; and
C. Contractor shall complete all reports mandated by the CCP.
2. MHSA Reporting
A. Demographics to be collected must include the following data points:
i. Age
ii. Race
iii. Ethnicity
iv. Primary Language
V. Gender Identification at Present
vi. Gender assigned at birth
vii. Sexual Orientation
viii. Veteran Status
ix. Any Disabilities
X. Note: Support services for each participant need to be documented in the
participants chart and be related to their wellness plan.
A. All expense for support services need to be documented, and included in the chart,
and be justified by the wellness plan. All providers do need to provide a cost per
individual served for support services.
3. FSP/ACT Reporting
A. Contractor shall complete quarterly reports, as mandated by the State for FSPs and
ACTs under CCR Title 9, sections 3620.10 and 3530.90. Reports shall be made directly
into the Data Collection and Reporting (DCR) system.
4. CSI Reporting
A. Contractor shall work with DBH to capture and enter all Client Service Information (CSI),
admission data, and billing information into DBH's data system for the purposes of
effective care coordination and State reporting. CONTRACTOR shall provide all
necessary data to allow DBH to capture all CSI data for services provided and to meet
all State and Federal reporting requirements. Methods of providing such information
include, but are not limited to, the following:
i. Direct data entry in DBH's electronic information system; or
ii. Provide an electronic file compatible with DBH's electronic information system.
5. Contractor shall comply with all reporting requests made by DBH. Reporting requirements
are subject to change as the program develops.
X. PERFORMANCE AND OUTCOME MEASUREMENTS
A-15
Exhibit A
Contractor shall comply with all project monitoring and compliance protocols, procedures, data
collection methods, and reporting requirements requested by the County. County and
Contractor 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 the FBHP is 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.
Performance outcome measures shall be tracked on an ongoing basis and used to update the
County monthly (by the 1011 of the month following the report period). In addition, 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. Contractor 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 and at appropriate intervals during the fiscal year.
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.
The following items listed below represent program goals to be achieved by Contractor. The
program's success will be based on the number of goals it can achieve, resulting from
performance outcomes. Contractor will utilize a computerized tracking system with which
outcome measures and other relevant individual data, such as demographics, will be
maintained.
Contractor will collect data about the characteristics of the individuals served and measure
service delivery performance indicators in the four Commission on Accreditation of
Rehabilitation Facilities (CARF) domains, with at least one performance indicator for each of
the four domains. Contractor shall submit annual outcomes on a report template to be provided
by the County for each level of care provided.
Assertive Community Treatment
1. Effectiveness
a. Psychiatric Hospitalization
Hospitalization refers to any hospital admission captured in Fresno County's electronic
health record, Avatar. Data may be entered by any hospital that utilizes Avatar including
Exodus PHF, Community Behavioral Health Center (CBHC), and Kaweah Delta Psychiatric
Hospital.
i_ Objective: To prevent and minimize the total number of individuals and days spent
in a psychiatric hospital post incarceration.
ii. Indicator: Percentage of individuals enrolled in FSP services that experienced no
psychiatric hospitalizations post incarceration, and the total number of individuals
and days hospitalized post incarceration.
A-16
Exhibit A
iii. Who Applied: ACT individuals served by the program for a minimum of one year.
iv. Time of Measure: 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 post enrollment.
b. Incarcerations
Incarceration refers to individuals confined in a jail or prison setting.
i_ Indicator: A reduction of the number of individuals experiencing arrests, the
frequency of arrests, and the numbers of days spent incarcerated compared
to pre-enrollment.
ii. Who Applied: ACT individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectancy: To reduce the total number of individuals arrested, the
frequency of arrests, and the total number of days incarcerated.
c. Homelessness
Homelessness refers to individuals without a place to live, who are living in a place
not meant for human habitation, or who are living in an emergency shelter.
i. Indicator: Percentage of individuals that experienced no episodes of
homelessness and the total number of days spent homeless compared to pre-
enrollment.
ii. Who Applied: ACT individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP
services will experience no episodes of homelessness. The total number of days
spent homeless will be reduced when compared to 12 months prior to program
enrollment.
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.
i_ Indicator: Percentage of individuals that experienced no episodes of medical
hospitalizations or ED admissions, and total number of days spent in a hospital
or ED setting compared to pre-enrollment.
ii. Who Applied: ACT individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. 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 days admitted in a medical hospital or ED will be
reduced when compared to 12 months prior to program enrollment.
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
A-17
Exhibit A
include adult schools, vocational schools, community colleges, universities, and high
schools.
i_ Indicator: Annual percentage of program individuals enrolled in educational
settings.
H. Who Applied: ACT individuals served by the program enrolled in educational
settings.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectancy: To have a minimum of 15% of ACT individuals enrolled
in educational settings 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 persons served are willingly provide services or complete tasks
without any expectation of financial compensation, but may gain work experience
and job related skills.
i. Indicator: Annual percentage of individuals engaged in employment or
volunteer activities.
ii. Who Applied: ACT individuals served by the program and that participated in
employment or volunteer activities.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectancy: To have a minimum of 15% of ACT individuals
participate in employment or volunteer activities annually.
2. Efficiency
a. Cost per Individual Served
Costs include all staffing and overhead costs associated with operation of the program.
i. Indicator: Total program costs compared to number of unique AB 109 individuals
served.
ii. Who Applied: ACT individuals served by the program in Fiscal Year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar and Financial Records
v. Target Goal Expectancy: To keep within budgeted costs for the program.
3.Access
a. Length of time from referral to first contact
i_ Indicator: Percentage of individuals that received first contact attempts within 7
business days of the referral date.
ii. Who Applied: Individuals referred to the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar
v_. Target Goal Expectancy: 70% of individuals will attempt to be contacted within 7
business days of the referral date.
A-18
Exhibit A
vi. Outcome: The average wait time from referral to first contact was 1 day. 98% of
individuals were contacted within 7 days of the referral date.
b. Length of time from first contact to first assessment appointment offered
i. Indicator: Percentage of individuals offered their first assessment appointment within
10 business days of the first contact date.
ii. Who Applied: Individuals referred to the program and offered an assessment
appointment.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Access Form
v. Target Goal Expectancy: 70% of individuals will be offered their first assessment
appointment within 10 business days of the first contact date.
C. Length of time from assessment to first psychiatry appointment offered
i_ Indicator: Percentage of individuals offered their first psychiatry appointment within
15 business days of their assessment date.
ii. Who Applied: Individuals assessed and enrolled into program services
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar Referral Form
v_. Target Goal Expectancy: 70% of individuals will be offered their first psychiatry
appointment date within 15 business days of their assessment date.
4. Satisfaction & Feedback of Persons Served & Stakeholders
a. Consumer Perception Survey
Consumer Perception Surveys (CPS) are conducted every six months over a one week
period. Beneficiaries of the MHP are encouraged to participate in filling out the CPS
surveys which are available to individuals served and family members at County and
contracted provider organizations.
i. Indicator: Average percent of individuals served 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.
ii. Who Applied: Persons served who completed the survey in November of 2019
for the program.
iii. Time of Measure: The survey was conducted in November of 2019.
iv. Data Source: Consumer Perception Survey data
v. Target Goal Expectancy: More than 50% of individuals served will respond that
they are satisfied with the services they received
Full Service Partnership
1. Effectiveness
A-19
Exhibit A
a. Psychiatric Hospitalization
Hospitalization refers to any hospital admission captured in Fresno County's electronic
health record, Avatar. Data may be entered by any hospital that utilizes Avatar including
Exodus PHF, Community Behavioral Health Center (CBHC), and Kaweah Delta Psychiatric
Hospital.
i_ Indicator: Percentage of individuals enrolled in FSP services that experienced no
psychiatric hospitalizations post incarceration, and the total number of individuals
and days hospitalized post incarceration.
ii. Who Applied: FSP individuals served by the program for a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP services
will experience no episodes of psychiatric hospitalization post enrollment.
b. Incarcerations
Incarceration refers to individuals confined in a jail or prison setting.
i_ Indicator: A reduction of the number of individuals experiencing arrests, the
frequency of arrests, and the numbers of days spent incarcerated compared to
pre-enrollment.
ii. Who Applied: FSP individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v_. Target Goal Expectancy: To reduce the total number of individuals arrested, the
frequency of arrests, and the total number of days incarcerated.
c. Homelessness
Homelessness refers to individuals without a place to live, who are living in a place
not meant for human habitation, or who are living in an emergency shelter.
i_ Indicator: Percentage of individuals that experienced no episodes of
homelessness and the total number of days spent homeless compared to pre-
enrollment.
ii. Who Applied: FSP individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectancy: A minimum of 70% of individuals enrolled in FSP
services will experience no episodes of homelessness. The total number of days
spent homeless will be reduced when compared to 12 months prior to program
enrollment.
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.
i. Indicator: Percentage of individuals that experienced no episodes of medical
hospitalizations or ED admissions, and total number of days spent in a hospital
or ED setting compared to pre-enrollment.
ii. Who Applied: FSP individuals served by the program a minimum of one year.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
A-20
Exhibit A
v. 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 days admitted in a medical hospital or ED will be
reduced when compared to 12 months prior to program enrollment.
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, universities, and high
schools.
i_ Indicator: Annual percentage of program individuals enrolled in educational
settings.
H. Who Applied: FSP individuals served by the program enrolled in educational
settings.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectancy: To have a minimum of 15% of FSP individuals enrolled
in educational settings 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 persons served are willingly provide services or complete tasks
without any expectation of financial compensation, but may gain work experience
and job related skills.
i_ Indicator: Annual percentage of individuals engaged in employment or
volunteer activities.
H. Who Applied: FSP individuals served by the program and that participated in
employment or volunteer activities.
iii. Time of Measure: Fiscal Year
iv. Data Source: DCR/ITWS State database.
v. Target Goal Expectancy: To have a minimum of 15% of FSP individuals
participate in employment or volunteer activities annually.
2. Efficiency
a. Cost per Individual Served
Costs include all staffing and overhead costs associated with operation of the program.
Indicator: Total program costs compared to number of unique AB 109 individuals
served.
ii. Who Applied: FSP individuals served by the program in Fiscal Year.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar and Financial Records
v. Target Goal Expectancy: To keep within departmental budgeted costs for the
program.
3.Access
a. Length of time from referral to first contact
A-21
Exhibit A
vii. Indicator: Percentage of individuals that received first contact attempts within 7
business days of the referral date.
viii. Who Applied: Individuals referred to the program.
ix. Time of Measure: Fiscal Year
x. Data Source: Avatar
A Target Goal Expectancy: 70% of individuals will attempt to be contacted within 7
business days of the referral date.
xii. Outcome: The average wait time from referral to first contact was 1 day. 98% of
individuals were contacted within 7 days of the referral date.
b. Length of time from first contact to first assessment appointment offered
vi. Indicator: Percentage of individuals offered their first assessment appointment within
10 business days of the first contact date.
vii. Who Applied: Individuals referred to the program and offered an assessment
appointment.
viii. Time of Measure: Fiscal Year
ix. Data Source: Avatar Access Form
x. Target Goal Expectancy: 70% of individuals will be offered their first assessment
appointment within 10 business days of the first contact date.
C. Length of time from assessment to first psychiatry appointment offered
A. Indicator: Percentage of individuals offered their first psychiatry appointment within
15 business days of their assessment date.
vii. Who Applied: Individuals assessed and enrolled into program services
viii.Time of Measure: Fiscal Year
ix. Data Source: Avatar Referral Form
x. Target Goal Expectancy: 70% of individuals will be offered their first psychiatry
appointment date within 15 business days of their assessment date.
4. Satisfaction & Feedback of Persons Served & Stakeholders
a. Consumer Perception Survey
Consumer Perception Surveys (CPS) are conducted every six months over a one week
period. Beneficiaries of the MHP are encouraged to participate in filling out the CPS
surveys which are available to individuals served and family members at County and
contracted provider organizations.
Indicator: Average percent of individuals served 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.
ii. Who Applied: Persons served who completed the survey in November of 2019
for the program.
iii. Time of Measure: The survey was conducted in November of 2019.
iv. Data Source: Consumer Perception Survey data
A-22
Exhibit A
Target Goal Expectancy: The program would like to see a majority of persons
served satisfied for each domain.
Outpatient
1. Effectiveness
a. Treatment Objectives/Achievements
i_ Indicator: Percentage of individuals that completed treatment and completed 75%
or more of their treatment plan goals.
ii. Who Applied: A sample of OP individuals served by the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar/Accucare EHR
v. Target Goal Expectancy: A minimum of 95% of individuals who complete treatment
will complete at least 75% of treatment plan goals.
b. Successful Completion
Indicator: Percentage of individuals that complete treatment or leave with
satisfactory progress.
Who Applied: OP individuals that participated in outpatient substance use disorder
services provided by the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Accucare EHR/Discharge Summaries and Post treatment surveys
v. Target Goal Expectancy: A minimum of 70% of individuals served will
successfully complete treatment or leave before completion with satisfactory
progress.
c. Psychiatric Hospitalizations/Incarcerations
i_ Indicator: Percentage of individuals that experience zero psychiatric
hospitalizations or incarcerations.
ii. Who Applied: OP individuals that received mental health treatment services.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar EHR/Accucare EHR
v_. Target Goal Expectancy: 95% of individuals receiving mental health and co-
occurring treatment will experience zero psychiatric hospitalizations or
incarcerations.
2. Efficiency
a. Cost per Individual
Costs include all staffing and overhead costs associated with operation of the program.
i. Indicator: Total program costs compared to the number of unique OP individuals
served.
ii. Who Applied: OP individuals served by the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar and Financial Records
v. Target Goal Expectancy: To keep within departmental budgeted costs for the
program.
A-23
Exhibit A
3.Access
a. Length of time from SUD Screening to First Assessment Appointment Offered
Indicator: Percentage of individuals offered an SUD assessment appointment within
10 business days of their SUD screening.
ii. Who Applied: A sample of individuals referred to the program.
in. Time of Measure: Fiscal Year
iv. Data Source: Avatar/Accucare EHR
v. Target Goal Expectancy: 70% of referred individuals will be offered their first SUD
assessment appointment within 10 business days of their SUD screening.
b. Length of time from mental health screening to the first offered mental health
assessment appointment
Indicator: Percentage of individuals offered their first mental health assessment
appointment within 10 business days of initial screening.
Who Applied: A sample of individuals referred to the program.
Time of Measure: Fiscal Year
Data Source: Avatar EHR
Target Goal Expectancy: 70% of individuals will be offered an appointment for their
first mental health assessment within 10 business days of initial screening.
c. Length of time from SUD Assessment to first treatment appointment offered
Indicator: Percentage of individuals offered their first SUD treatment appointment
within 10 business days of their assessment date.
Who Applied: A sample of individuals referred to the program.
Time of Measure: Fiscal Year
Data Source: Accucare EHR
Target Goal Expectancy: A minimum of 70% of individuals will be offered their first
SUD treatment appointment within 10 business days of their assessment date.
d. Length of time from mental health assessment to first treatment appointment offered
Indicator: Percentage of individuals offered their first mental health treatment
appointment within 10 business days of their assessment date.
Who Applied: A sample of individuals referred to the program.
Time of Measure: Fiscal Year
Data Source: Avatar EHR
Target Goal Expectancy: A minimum of 70% of individuals will be offered their first
treatment appointment within 10 business days of their assessment.
e. Length of time from mental health assessment to the first psychiatry appointment
date offered
A-24
Exhibit A
Indicator: Percentage of individuals offered their first psychiatry appointment within 15
business days of their assessment date.
Who Applied: A sample of individuals referred to the program.
Time of Measure: Fiscal Year
Data Source: Avatar EHR
Target Goal Expectancy: A minimum of 70% of individuals will be offered their first
psychiatry appointment within 15 business days of their assessment date.
4. Satisfaction & Feedback of Persons Served & Stakeholders
Consumer Perception Surveys (CPS) are conducted every six months over a one week period.
Beneficiaries of the MHP are encouraged to participate in filling out the CPS surveys which are
available to consumers and family members at County and contracted provider organizations.
Objective: To gauge satisfaction of individuals and collect data for service planning
and quality improvement.
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. Who Applied: Individuals who completed the survey in June.
iv. Time of Measure: Surveys were completed in June.
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.
XI. TRANSITIONAL OPTIMIZATION FUNDS
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.
1. Funding Allocation Methodology
A. 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.
B. 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.
A-25
Exhibit A
C. 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.
D. 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.
2. Responsibilities
A. 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.
B. 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.
C. Schedule of Deliverables: Equity Gap Analysis, Fiscal Monitoring Tool, and
Electronic Health Record
i. 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
c. Fiscal Monitoring Tool Identified Practices and Strategies (if applicable): Due
September 30, 2023
ii. Q2 Report: Oct-Dec: Due January 15, 2024
iii. Q3 Report: Jan-Mar: Due April 15, 2024
iv. Q4 Report: Apr-June: Due July 15, 2024
D. All deliverables will be reviewed and approved by DBH prior to payment.
3. Eligible Transition Optimization Activities
A. 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
A-26
Exhibit A
identify one or more practice pattern(s) the organization is employing to increase direct
care time to the Medi-Cal population.
i. 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.
B. 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.
i. 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.
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.
A-27
Exhibit A
ii. 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.
iii. 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.
iv. 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.
C. 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
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.
A-28
Exhibit A
i. 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.
ii. 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.
A-29
Exhibit A-1
WHOLE PERSON CARE-LIKE PILOT
SCOPE OF WORK
I. PROJECT DESCRIPTION
California's Whole Person Care-Like (WPCL) Pilot program coordinates physical health,
behavioral health, and social services in a person-centered manner with the goal of improved
beneficiary health and well-being. Low-income populations are more likely to experience a
multitude of physical health, behavioral health, and social needs, requiring individuals to seek
care across multiple and fragmented systems. The need for a Whole Person Care approach
arose due to unmet social, behavioral health, and physical health needs within vulnerable
populations, and from the existing fragmentation of organization and financing of current health
and human services systems.
In December 2019, the County of Fresno (County) applied for one-time funding in the amount of
$894,377.20 made possible by the 2019-20 Governor's Budget to initiate WPCL capacity with
the intention of utilizing the funds for administrative and programmatic activities specific to high-
risk populations, specifically individuals who are experiencing homelessness who have mental
illness and/or two or more chronic health conditions.
Contractor shall include, at a minimum, the following services in utilization of this funding:
• System Navigation
• Short-term care coordination
• Intensive care management
• Linkage to housing services and supports
• Homeless prevention/intervention
The Contractor shall provide system navigation to a target population of Penal Code, section
1203 probationers (PC 1203), and Mandatory Supervision (MS) defendants, or as
recommended by County, who meet the following criteria:
• Have a mental health diagnosis and chronic physical health condition;
• Are homeless, or at-risk of homelessness;
• Have a term of formal probation or MS upon release;
And have a scheduled release date within 60-90 days of referral.
The WPCL component is new to the Forensic Behavioral Health —Continuum of Care program
and involves many partners. Processes are being developed and expected to change to
improve service delivery. Contractor shall be flexible and is welcomed to propose improvements
and communicate concerns to the County.
II. SERVICES START DATE
The Contractor shall follow the Timeline summarized as follows:
Anticipated Timeline
1. JULY 2023 — FEB 2025— Services
A-1 - 1
Exhibit A-1
A. Collaborate with County and community partners to review existing information
management systems, including Homeless Management Information System
(HMIS) and Fresno Community Health Improvement Partnership (FCHIP)'s
community health worker network system. Work with CalAIM Managed Care Plan
justice-involved Enhanced Care Management (ECM) services and supports.
B. Distribute updated flyers and brochures reflecting system navigation and referral
process.
C. See "Description of Services" section in following sections
2. MAR 2025—JUN 2025— Evaluation and Report Writing
A. See "Outcomes" section in following sections
Contractor and Department of Behavioral Health (DBH) shall remain in constant communication
with regards to capacity based on funding streams, as well as the need to modify the start-up
period earlier or later than anticipated..
III. TARGET POPULATION
The target population shall include adults 18 years or older being released from Fresno County
Jail (Jail) on PC 1203 probation and MS defendants who meet the following criteria:
• Have a mental health diagnosis and chronic physical health condition;
• Are homeless, or at-risk of homelessness;
• Have a term of formal probation or MS upon release; and,
• Have a scheduled release date within 60-90 days of referral.
Individuals shall be referred for the WPCL navigation program through screening and review by
the Probation Department, the Jail health service provider, DBH, and the Contractor.
IV. LOCATION OF SERVICES
WPCL services shall be provided in the community setting where the individual is located. This
shall include delivering services while the individual is incarcerated at the Jail. Services are
expected to be provided at locations that are most convenient for individuals. Telehealth
services shall be available, if preferred by the person served, or if there is a public health order
to discontinue face-to-face services.
V. HOURS OF OPERATION
Hours of operation should meet the needs of the population to be served and take into
consideration the 24/7 nature of the Jail facility services. At minimum, services shall be available
eight (8) hours a day, five (5) days a week.
VI. DESCRIPTION OF SERVICES
The intended benefit of creating the WPCL Pilot program is to establish a navigation system to
meet the physical health, behavioral health, social, and housing needs of individuals reentering
the community after incarceration.
A-1 - 2
Exhibit A-1
1. Behavioral Health
A. Contractor shall ensure that all services are:
• Values-driven, strengths based, individual-driven, and co-occurring capable;
• Culturally and linguistically competent;
• Age, culture, gender, and language appropriate;
• Include accommodations for individuals with physical disability(ies);
• Include close and constant communication and collaboration between
Contractor, the criminal justice system (including the Courts, Public Defender and
Probation Department); and,
• Include evidence-based practices (EBPs) appropriate for the target population.
B. Methods for service coordination and communication between program and other
service providers shall be developed and implemented consistent with FCMHP
confidentiality rules.
C. Contractor shall maintain up to date caseload record of all individuals enrolled in
services, and provide individual, programmatic, and other demographic information
to DBH.
D. Contractor shall utilize the Substance Abuse and Mental Health Services
Administration (SAMHSA) Risk-Needs-Responsivity (RNR) model to inform and
determine level of services to correctly link individuals to services based on their
level of needs and risk factors.
2. System Navigation Services
Contractor shall initiate and facilitate outreach and engagement to WPCL-eligible individuals
after the Probation Department, DBH, Jail service provider, and Contractor reviews their case
for appropriate services. Individual may be in custody or subject to early/unplanned release at
time of referral.
A. Contractor shall apply for a Jail Pass for access to the Jail
B. Services shall include and are not limited to the following:
• Jail visits to build first-hand familiarity and coordination with the corresponding
Jail personnel and understand Jail procedures around visitation;
• Face-to-face interviews with the suitable candidates for WPCL;
• Building rapport and therapeutic alliance with individuals;
• Screening assessments of the primary and priority needs of the individual, as
well as strengths and potential natural sources including established family and
social supports;
• Sharing information and collaboration between the WPCL team so that
preparations can be made in advance to assist in planning and arranging the
preliminary release arrangement. This would include, at a minimum, basic
assessment data about the individual's symptoms, needs, medications, housing
status, etc.;
• Engagement— Maintaining contact with the individual while waiting for release.
Warm handoff to appropriate mental health and physical health providers;
A-1 - 3
Exhibit A-1
• System Navigation
a. Coordinate post release transportation. Individual shall first be transported to
the program for a face-to-face meeting where they shall review screening and
linkage plan with the navigation team if one has been completed, or complete
one if needed;
b. Education regarding behavioral health rights; and,
c. Linkage to mental health, physical health, and housing needs.
3. Housing
Housing services are vital to provide stability, reduce hospital/Jail returns, and allow for
recovery and the building of resiliency. The Contractor shall offer linkages for a variety of
housing options for persons served including crisis housing, transitional or low-barrier
housing, recovery residence, residential drug treatment, board and care homes, and room
and board homes.
4. Other Collaborative Relationships
The Contractor shall establish and maintain collaborative relationships with agencies and
individuals who have frequent contact with adult that are hospitalized, experiencing
homelessness, or incarcerated. Examples of collaborative relationships include but are not
limited to local law enforcement agencies, Veterans Administration, Marjorie Mason Center,
Fresno County Human Services Departments, Faith-Based Organizations, acute psychiatric
facilities, schools, community centers, etc. There may be a need for a Memorandum of
Understanding (MOU) or Data Use Agreement between the Contractor and one or more of
the community partners if data is to be shared and collected. Health Insurance Portability
and Accountability Act (HIPAA) regulations must always be considered and adhered to
when discussing protected health information (PHI) with another agency.
5. County Responsibilities
A. Provide oversight and collaborate with Contractor and other County Departments
and community agencies to help achieve program goals and outcomes. In addition to
contract monitoring of program(s), oversight includes, but is not limited to,
coordination with the State Department of Health Care Services (DHCS) in regard to
program administration and outcomes.
B. Assist Contractor in making linkages to the appropriate level of care within the
behavioral health system of care to ensure continuity of care. This shall be
accomplished through regularly scheduled meetings as well as formal and informal
consultation.
C. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with the Contractor staff and shall be available to Contractor for
ongoing consultation.
D. Receive and analyze statistical outcome data from Contractor throughout the term of
contract monthly. DBH shall notify the Contractor when additional participation is
required. The performance outcome measurement process shall not be limited to
survey instruments but shall also include, as appropriate, individual and staff
interviews, chart reviews, and other methods of obtaining required information.
A-1 - 4
Exhibit A-1
E. 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, County
shall provide the following at no cost to Contractor:
• Mandatory cultural competency training including sexual orientation and
sensitivity training for Contractor personnel, at minimum once per year. County
shall provide mandatory training regarding the special needs of this diverse
population and shall be included in the cultural competence training(s) if
Contractor does not have a similar training in place. Sexual orientation and
sensitivity to gender differences is a basic cultural competence principle and shall
be included in the cultural competency training. Literature suggests that the
mental health needs of lesbian, gay, bisexual, transgender (LGBT) individuals
may be at increased risk for mental disorders and mental health problems due to
exposure to societal stressors such as stigmatization, prejudice, and anti-gay
violence. Social support may be critical for this population. Access to care may
be limited due to concerns about providers' sensitivity to differences in sexual
orientation.
• Assistance to Contractor in locating appropriate providers who can translate
behavioral health and substance use disorder services information into County's
threshold languages (English, Spanish, and Hmong). Translation services and
costs associated shall be the responsibility of the Contractor.
VII. STAFFING
The staffing plan should be clear and concise and allow for full implementation of all items
described in the program. It is expected that the WPCL team shall complete the services and
linkages as identified above. Contractor shall be knowledgeable of cultural
sensitivity/competency and well versed in community resources.
Staff work schedules shall be responsive to person served needs and shall permit staff to be
available at times/locations that are convenient for the person served and/or respond to family
members' concerns.
There is no mental health treatment currently offered or anticipated at this program. The staffing
plan should include Case Managers, supervision of Case Managers, and additional positions as
needed to ensure full implementation of the program. The staffing ratio shall be 1:30 for Case
Managers hired for the WPCL team, with a capacity of 60 individuals at any given time.
Vill. PEER SUPPORT RESOURCES
The Contractor recognizes the value of the use of individual directed peer-to-peer support
networks. As part of an individual's recovery, a variety of peer activities are made available for
persons served. WPCL team shall employ peer support staff who have lived mental health
/criminal justice involvement/substance use disorder experience and has a heart to give back as
A-1 - 5
Exhibit A-1
part of the WPCL team.
IX. AVERAGE CLIENT LENGTH OF STAY
The services to be provided by the WPCL system navigation program are to be short term-
lasting less than 90 days- and focused on providing persons served with access to health and
social services that promote health, financial, and social well-being in the community. The
Contractor is expected to provide case management services for individuals until they have
been successfully linked to appropriate services and have begun attending appointments.
X. REPORTING
Contractor shall comply with the following reporting requirements:
1. WPCL Reporting
A. Contractor provide all necessary data to allow DBH to capture all WPCL data for
services provided and to meet all DHCS reporting requirements. Data to be collected
shall include, but not be limited to, the following:
• General:
a. Service refusal rates for all linkage areas: physical health, mental health,
substance use disorder and housing;
b. Number of needs assessments/screenings administered;
c. Number of persons released with health insurance coverage (reactivated
Medicaid, private insurance, etc.);
d. Rate of linkage to services;
• Physical Health:
a. What is the primary chronic physical health condition (diabetes, hypertension,
heart condition, etc.);
b. Number of linkages to primary care;
c. Average number of days between release from incarceration and contact with
primary care physician; and,
d. Number of individuals who were referred to doctor appointments and didn't
go.
• Mental Health and Substance Use Disorder:
a. What is the primary mental health diagnosis;
b. Number and percentage of persons with substance use disorders;
c. Number and percentage of persons who kept their first appointments; and,
d. Number and percentage of persons released with psychotropic medications.
• Housing:
a. Number of persons discharged to homelessness, a shelter, or unknown
address;
b. Number of persons enrolled in the Homeless Management Information
System (HMIS) program;
c. Number of individuals linked to temporary or permanent housing;
d. Number of individuals linked to housing in the Metro area; and
e. Number of individuals linked to housing in the Rural area.
A-1 - 6
Exhibit A-1
2. Contractor shall comply with all reporting requests made by DBH. Reporting
requirements are subject to change as the program develops.
3. The COUNTY will submit an evaluation and summary within 90 days after the full
expenditure of WPCL funding. The report will demonstrate the disposition of funds, types
of services provided, and number of individuals who received services related to this
one-time funding. Contractor shall assist in the writing of this report by providing data
and review on the pilot program.
XI. PERFORMANCE AND OUTCOME MEASUREMENTS
Contractor shall comply with all project monitoring and compliance protocols, procedures,
data collection methods, and reporting requirements requested by the County. County and
Contractor shall use performance outcome measures for evaluating program and system
effectiveness to ensure services and service delivery strategies are positively impacting the
service population.
Performance outcome measures shall be tracked on an ongoing basis and used to update
the County monthly (by the 101" of the month following the report period). In addition,
performance outcome measures are reported to the County annually in accumulative
reports for overall program and contract evaluation. Contractor shall 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 and at appropriate intervals
during the fiscal year.
The following items listed below represent program goals to be achieved by Contractor. The
program's success shall be based on the number of goals it can achieve, resulting from
performance outcomes. Contractor shall utilize a computerized tracking system with which
outcome measures and other relevant individual data, such as demographics, shall be
maintained.
Contractor shall collect data about the characteristics of the individuals served and measure
service delivery performance indicators in the four Commission on Accreditation of
Rehabilitation Facilities (CARF) domains, with at least one performance indicator for each of
the four domains. Contractor shall submit annual outcomes on a report template to be
provided by the County for each level of care provided.
1. Effectiveness
a. Linkage Objectives/Achievements
i_ Indicator: Percentage of individuals that were linked to each part of their case
plan and attended 75% or more of their first appointments.
ii. Who Applied: A sample of individuals served by the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Provider
v. Target Goal Expectancy: A minimum of 95% of individuals who complete a
screening shall complete at least 75% of treatment plan goals.
b. Successful Completion
i. Indicator: Percentage of individuals that complete a screening or leave with
satisfactory progress.
A-1 - 7
Exhibit A-1
ii. Who Applied: Individuals that participated in system navigation services
provided by the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Discharge Summaries and Post treatment surveys
v. Target Goal Expectancy: A minimum of 70% of individuals served shall
successfully complete a screening or leave before completion with satisfactory
progress.
2. Efficiency
a. Cost per Individual
Costs include all staffing and overhead costs associated with operation of the program.
i. Indicator: Total program costs compared to the number of unique individuals
served.
ii. Who Applied: Individuals served by the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Provider Data Tool and Financial Records
v. Target Goal Expectancy: To keep within departmental budgeted costs for the
program.
3. Access
a. Length of time from referral to first outreach session offered
i_ Indicator: Percentage of individuals offered an outreach session within 10 business
days of their referral.
H. Who Applied: A sample of individuals referred to the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Provider
v. Target Goal Expectancy: 70% of referred individuals shall be offered their first
outreach session within 10 business days of their referral.
b. Length of time from Jail release to first mental health referral offered
vi. Indicator: Percentage of individuals offered a mental health referral within 10
business days of their Jail release.
vii. Who Applied: A sample of individuals referred to the program.
viii. Time of Measure: Fiscal Year
ix. Data Source: Provider
x. Target Goal Expectancy: 70% of referred individuals shall be offered their first
mental health referral within 10 business days of their Jail release.
c. Length of time from Jail release to first substance use disorder referral offered
A Indicator: Percentage of individuals offered a substance use disorder referral within
10 business days of their Jail release.
xii. Who Applied: A sample of individuals referred to the program.
xiii. Time of Measure: Fiscal Year
Av. Data Source: Provider
xv. Target Goal Expectancy: 70% of referred individuals shall be offered their first
substance use disorder referral within 10 business days of their Jail release.
d. Length of time from Jail release to first physical health appointment offered
i. Indicator: Percentage of individuals offered their first physical health appointment
within 10 business days of Jail release.
ii. Who Applied: A sample of individuals referred to the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Provider
A-1 - 8
Exhibit A-1
v. Target Goal Expectancy: 70% of individuals shall be offered a physical health
appointment within 10 business days of Jail release.
e. Length of time from Jail release to the first housing linkage offered
i. Indicator: Percentage of individuals offered their first housing linkage within 10
business days of their Jail release.
ii. Who Applied: A sample of individuals referred to the program.
iii. Time of Measure: Fiscal Year
iv. Data Source: Avatar EHR
v. Target Goal Expectancy: A minimum of 70% of individuals shall be offered their
first housing linkage within 10 business days of their Jail release.
f. Psychiatric Hospitalizations/Incarcerations
i. Indicator: Percentage of individuals that experience zero psychiatric
hospitalizations or incarcerations.
ii. Who Applied: Individuals that received system navigation services.
iii. Time of Measure: Fiscal Year
iv. Data Source: Provider
v_. Target Goal Expectancy: 95% of individuals receiving system navigation
services shall experience zero psychiatric hospitalizations or incarcerations.
g. Physical Hospitalizations
vi. Indicator: Percentage of individuals that experience zero physical hospitalizations.
vii. Who Applied: Individuals that received system navigation services.
viii. Time of Measure: Fiscal Year
ix. Data Source: Provider
x. Target Goal Expectancy: 95% of individuals receiving system navigation
services shall experience zero physical hospitalizations.
4. Satisfaction & Feedback of Persons Served & Stakeholders
Satisfaction Measures are usually orientated towards persons served, family, staff, and
stakeholders. The degree to which persons served, the County and other stakeholders are
satisfied with services. A performance dimension that describes reports of ratings from
persons served about services received from an organization
i_ Objective: To gauge satisfaction of stakeholders and collect data for service
planning and quality improvement.
ii. Indicator: Average percent of stakeholders 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. Who Applied: Individuals who completed the survey in June.
iv. Time of Measure: Surveys were completed in June.
v_. Data Source: Provider Stakeholder Survey data
vi. Target Goal Expectancy: The program would like to see a majority of stakeholders
satisfied for each domain.
A-1 - 9
Exhibit A-2
FORENSIC BEHAVIORAL HEALTH — CONTINUUM OF CARE
SCOPE OF WORK— Department of State Hospital Diversion Services
CONTRACTOR: Turning Point of Central California, Inc. (Turning Point)
SCOPE OF WORK TERM: July 1, 2023 — June 30, 2024
I. BACKGROUND
Under Assembly Bill (AB) 1810 and Senate Bill (SB) 215, pre-trial diversion allows for
community-based mental health services treatment in lieu of trial and sentencing by a jury or
judge for those individuals diagnosed with a mental health disorder, which played a significant
role in the charged offense. The increasing number of incompetent to stand trial (IST) individuals
has also created long wait lists for restoration services at Department of State Hospitals (DSH)
placements, and many of these individuals remain incarcerated and decompensate. For counties
who have transferred large number of individuals with felony crimes from county jails to a state
hospital for IST services, DSH released one-time funding to implement AB 1810 pre-trial
diversion program services and connect these individuals to local mental health treatments and
supportive services.
From September 22, 2020 — June 30, 2022, the contracted provider Turning Point operated the
Forensic Behavioral Health Diversion Program (Diversion Program) to provide services to AB
1810 DSH participants. The County has decided to combine these services into the Forensic
Behavioral Health Continuum of Care (FBH-COC).
DSH has contracted with the Department of Behavioral Health (DBH) to extend the available
funding into Fiscal Year 2023-24.
Contractor shall provide all services in accordance with the rules and regulations of AB 1810, SB
215, Penal Code (PC) Sections 1001.35 and 1001.36, Welfare and Institutions Code (W&IC)
Section 4361, and Title 9 of California Code of Regulations, Sections 1810.226 and 3615.
The FBH-COC DSH funding will continue to include the following levels of care: Assertive
Community Treatment (ACT) and Full-Service Partnership (FSP).
Contract shall include, at a minimum, the following services in all levels of care to DSH funding
eligible persons:
• Mental health treatment
• Substance use disorder treatment
• Medication support
• Case management
• Crisis intervention
• Housing support
• Peer support
• Criminal justice support
• Educational and vocational services
• Rehabilitative services
• Transportation services
• Assistance with child services
• Medi-Cal enrollment
A-2-1
Exhibit A-2
• SSI or SSDI enrollment
• Anger management
• Faith-based support
• Food support
• Outreach and engagement
II. SERVICES START DATE
Services shall begin on July 1, 2023. There is not a ramp-up period for this program due to persons
served transitioning to a program run by the same provider.
III. TARGET POPULATION
The population for the FBH-COC expansion will be partially funded by DSH AB1810 diversion
funds, Mental Health Services Act (MHSA), Medi-Cal Federal Financial Participation. Individuals
will be referred for mental health diversion and evaluated for eligibility and suitability by the Mental
Health Diversion Court team. Only individuals that are found eligible and suitable for FBH-COC by
the court judicial process will be enrolled.
Individuals that can be funded by DSH AB1810 funds must meet the criteria identified in statutory
regulations of W&IC 4361, sub. (c)(1)(A)-(C) which includes the following:
• Adult (age 18 and older);
• Felony offense;
• Must have a primary diagnosis of one of the following:
o Schizophrenia
o Schizoaffective Disorder
o Bipolar Disorder
• The crime that qualifies the individual for diversion must be connected to the primary
diagnosis; and
• Symptoms of their mental illness must have contributed significantly to their commitment of
the offense.
The individuals who meet criteria under the DSH funding must be tracked separately in order to
meet DSH reporting requirements for fiscal, data and outcomes collection. An individual must
remain in the program for a minimum of 30 days or successfully complete the program to be
reportable under the DSH funding.
This proposal is intended to detail costs and services provided to 30 FSP/ACT persons served at
any given time. The program will serve, at any given time, 20% at Tier I (ACT) and 80% at Tier II
(FSP). The program will provide a range of services that will be tailored to each individual's needs
for service type, intensity and duration.
The SAMHSA Risk-Needs-Responsivity (RNR) model identifies that this target population needs
specialized treatment approaches that are dependent upon the needs/risk of each individual — both
psychiatric and criminogenic. Persons served will therefore be assigned to one of two primary
levels of care upon completion of the intake/assessment: ACT and FSP. Within each level are
additional sub-levels that specifically focus treatment on the achievement of competencies and
milestones that form the building blocks to ensure that the individual gradually builds and maintains
earned progress in treatment. In this way, treatment is continually meeting the individual where
A-2-2
Exhibit A-2
they are, and providing the necessary scaffolding to help them improve functioning and life
satisfaction.
IV. LOCATION OF SERVICES
Contractor shall provide location of services detailed in Exhibit A.
V. HOURS OF OPERATION
Contractor shall abide by "HOURS OF OPERATION" section in Exhibit A.
Services are available at all levels of care outside of regular working hours as needed.
VI. DESCRIPTION OF SERVICES
Contractor shall provide all of the services detailed in Exhibit A
VII. STAFFING
Contractor shall provide all of the staffing as detailed in Exhibit A
VIII. PEER SUPPORT RESOURCES
Contractor shall provide all of the resources as detailed in Exhibit A
IX. REPORTING
Contractor shall comply with reporting requirements stated in Exhibit A and the following reporting
requirements:
1. DSH Reporting
A. DSH has outlined specific reporting requirements. Contractor shall provide the following
reporting for all individuals meeting criteria to be funded by DSH.
i. Contractor shall assist County's DBH in submission of a compilation of DSH Grant
pre-trial diversion expenditures on a bi-annual basis, 60 days after the end of July
and December of each fiscal year.
ii. Contractor shall complete and submit the following required data to the assigned
Staff Analyst via email and DBHContractedServicesDivision@fresnocountyca.gov
monthly by the 20th. Contractor shall identify any data in the data set subject to the
rules of 42 Code of Federal Regulations part 2 upon submission to DBH. The data
collection process shall capture, but is not limited to, the following data elements:
a. The number of individuals that the Court ordered to post-booking diversion and
the length of time for which the defendant has been ordered to Felony Mental
Health Diversion (Diversion).
b. The number of individuals originally declared IST on felony charges that the
Court ultimately ordered to Diversion.
c. The number of individuals participating in Diversion.
d. The name, social security number, date of birth, and demographics of each
individual participating in Diversion.
A-2-3
Exhibit A-2
e. The length of time in Diversion for each participating individual.
f. The types of services and supports provided to each individual participating in
Diversion.
g. The number of days each individual was in jail prior to placement in Diversion.
h. The number of days that each individual spent in each level of care facility.
i. The diagnoses of each individual participating in Diversion.
j. The nature of the charges for each individual participating in Diversion.
k. The number of individuals who completed Diversion.
I. The name, social security number and birthdate of each individual who did not
complete Diversion and the reasons for not completing Diversion.
iii. Contractor shall report of any absent without leave (AWOL) individuals from
program to DBH as well as any Special Incident that occurs within 48 hours of the
incident. Reports will be submitted by emailing the assigned Staff Analyst with a cc
to DBH Contracted Services. A"Special Incident' is a significant patient occurrence
or any event which has the potential of adversely affecting the operation of the
program. The following occurrences qualify as Special Incidents:
a. Suicide or attempt;
b. Death or serious injury of, or by, patient;
c. Criminal behavior (including arrests, with or without conviction);
d. Any incident which may result in public or media attention to the program.
2. Contractor shall comply with all reporting requests made by DBH. Reporting requirements
are subject to change as the program develops.
X. PERFORMANCE AND OUTCOME MEASUREMENTS
Contractor shall provide all of the performance and outcome measurements as detailed in Exhibit
A.
A-2-4
Exhibit B
DRUG MEDI-CAL INTERGOVERNMENTAL AGREEMENT REQUIREMENTS
Fresno County, through the Department of Behavioral Health, makes substance use disorder
treatment services available throughout the county to Medi-Cal eligible persons served through funds
provided under an Intergovernmental Agreement with the California Department of Health Care
Services. The County, and all contracted providers, must comply with the terms of the
Intergovernmental Agreement, and any amendments thereto, including but not limited to the
following:
1. STATE ALCOHOL AND DRUG REQUIREMENTS
A. INDEMNIFICATION
The CONTRACTOR agrees to indemnify, defend and save harmless the
State, its officers, agents and employees from any and all claims and losses accruing or resulting to
any and all contractors, subcontractors, materialmen, laborers and any other person, firm or
corporation furnishing or supplying work, services, materials or supplies in connection with the
performance of this Agreement and from any and all claims and losses accruing or resulting to any
person, firm or corporation who may be injured or damaged by the CONTRACTOR in the
performance of this Agreement.
B. INDEPENDENT CONTRACTOR
The CONTRACTOR and the agents and employees of CONTRACTOR, in the
performance of this Agreement, shall act in an independent capacity and not as officers or
employees or agents of State of California.
C. CONTROL REQUIREMENTS
This Agreement is subject to all applicable Federal and State laws, regulations
and standards. CONTRACTOR(S) shall establish written procedures consistent with State-County
Contract requirements. The provisions of this Agreement are not intended to abrogate any
provisions of law or regulation existing or enacted during the term of this Agreement.
D. 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 Part 2, Title 42, Code of Federal Regulations;
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.
E. REVENUE COLLECTION POLICY
CONTRACTOR shall conform to all policies and procedures regarding
revenue collection issued by the State under the provisions of the Health and Safety Code, Division
10.5.
F. EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
CONTRACTOR agrees that all funds paid out by the State shall be used
exclusively for providing alcohol and/or drug program services, administrative costs, and allowable
overhead.
B-1
Exhibit B
G. ACCESS TO SERVICES
CONTRACTOR shall provide accessible and appropriate services in
accordance with Federal and State statutes and regulations to all eligible persons.
H. REPORTS
CONTRACTOR agrees to participate in surveys related to the performance of
this Agreement and expenditure of funds and agrees to provide any such information in a mutually
agreed upon format.
I. AUDITS
All State and Federal funds furnished to the CONTRACTOR(S) pursuant to this
Agreement along with related patient fees, third party payments, or other related revenues and funds
commingled with the foregoing funds are subject to audit by the State. The State may audit all
alcohol and drug program revenue and expenditures contained in this Agreement for the purpose of
establishing the basis for the subsequent year's negotiation.
J. RECORDS MAINTENANCE
1) CONTRACTOR shall maintain books, records, documents, and other
evidence necessary to monitor and audit this Agreement.
2) CONTRACTOR shall maintain adequate program and fiscal records
relating to individuals served under the terms of this Agreement, as required, to meet the needs of
the State in monitoring quality, quantity, fiscal accountability, and accessibility of services.
Information on each individual shall include, but not be limited to, admission records, patient and
participant interviews and progress notes, and records of service provided by various service
locations, in sufficient detail to make possible an evaluation of services provided and compliance with
this Agreement.
2. FEDERAL CERTIFICATIONS
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY
EXCLUSION LOWER TIER COVERED TRANSACTIONS
A. DBH and CONTRACTOR recognize that Federal assistance funds will be used
under the terms of this Agreement. For purposes of this section, DBH will be referred to as the
"prospective recipient".
B. This certification is required by the regulations implementing Executive Order
12549, Debarment and Suspension, 29 CFR Part 98, section 98.510, Participants' responsibilities.
The regulations were published as Part VII of the May 26, 1988 Federal Register(pages 19160-
19211).
1) The prospective recipient of Federal assistance funds certifies by
entering this Agreement, that neither it nor its principals are presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any Federal department or agency.
2) The prospective recipient of funds agrees by entering into this
Agreement, that it shall not knowingly enter into any lower tier covered transaction with a person who
is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered
B-2
Exhibit B
transaction, unless authorized by the Federal department or agency with which this transaction
originated.
3) Where the prospective recipient of Federal assistance funds is unable
to certify to any of the statements in this certification, such prospective participant shall attach an
explanation to this Agreement.
4) The CONTRACTOR shall provide immediate written notice to DBH if at
any time CONTRACTOR learns that its certification in this clause of this Agreement was erroneous
when submitted or has become erroneous by reason of changed circumstances.
5) The prospective recipient further agrees that by entering into this
Agreement, it will include a clause identical to this clause of this Agreement, and titled "Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered
Transactions", in all lower tier covered transactions and in all solicitations for lower tier covered
transactions.
6) The certification in this clause of this Agreement is a material
representation of fact upon which reliance was placed by COUNTY when this transaction was
entered into.
3. SMOKING PROHIBITION REQUIREMENTS
CONTRACTOR shall comply with Public Law 103-227, also known as the Pro-
Children Act of 1994 (20 USC Section 6081, et seq.), and with California Labor Code Section 6404.5,
the California Smoke-Free Workplace Law.
4. TRAFFICKING IN PERSONS PROVISIONS — PRIVATE ENTITY
CONTRACTOR shall conform to all Federal statutes and regulations prohibiting
trafficking in persons, as well as trafficking-related activities, including, but not limited to the
trafficking of persons provisions in Section 106(g) of the Trafficking Victims Protection Act of 2000
(TVPA) as amended by Section 1702.
CONTRACTOR, CONTRACTOR's employees, subrecipients, and subrecipients'
employees may not:
A) Engage in severe forms of trafficking in persons during the period of time
that the award is in effect;
B) Procure a commercial sex act during the period of time that the award is in
effect; or
C) Use forced labor in the performance of the award or subawards under the
award.
This agreement may be unilaterally terminated, without penalty, if CONTRACTOR
or a subrecipient that is a private entity is determined to have violated a prohibition of the TVPA or
has an employee who is determined by the DBH Director or her designee to have violated a
prohibition of the TVPA through conduct that is either associated with performance under the
award or imputed to the CONTRACTOR or their subrecipient using the standards and due
process for imputing the conduct of an individual to an organization that are provided in 2 C.F.R.
B-3
Exhibit B
Part 180, "OMB Guidelines to Agencies on Government-wide Debarment and Suspension
(Nonprocurement).
CONTRACTOR must inform the DBH Director or her designee immediately of any
information received from any source alleging a violation of a prohibition of the TVPA.
CONTRACTOR must sign a certification annually acknowledging the Trafficking
Victims Protection Act of 2000 requirements (TVPA Certification), attached hereto as Attachment
A, incorporated herein by reference and made part of this Agreement and must require all
employees to complete annual TVPA training.
5. UNLAWFUL USE OF DRUGS AND ALCOHOL OR UNLAWFUL USE MESSAGES
CONTRACTOR shall ensure that information produced with Federal funds pertaining
to drug and alcohol related programs contains a clearly written statement that there shall be no
unlawful use of drugs or alcohol associated with the program. Additionally, CONTRACTOR shall
ensure that no aspect of the program includes any message in materials, curricula, teachings, or
promotion of the responsible use, if the use is unlawful, of drugs or alcohol pursuant to Health and
Safety Code (HSC) 11999-11999.3.
CONTRACTOR must sign the Unlawful Use of Drugs and Alcohol Certification,
attached hereto as Attachment B, incorporated herein by reference and made part of this Agreement
agreeing to uphold the obligations of HSC 11999— 11999.3.
This agreement may be unilaterally terminated, without penalty, if CONTRACTOR or a
subcontractor that is a private entity is determined to have violated a prohibition of the Unlawful Use
of Drugs and Alcohol message or has an employee who is determined by the DBH Director or her
designee to have violated a prohibition of the Unlawful Use of Drugs and Alcohol message.
6. CONFIDENTIALITY OATH
CONTRACTOR shall ensure that all of its employees sign a written confidentiality
oath, attached hereto as Attachment C, before they begin employment with CONTRACTOR and
shall renew said document annually thereafter. CONTRACTOR shall retain each employee's
written confidentiality oath for COUNTY and DHCS inspection for a period of six (6) years
following the termination of this agreement.
7. CONTROL REQUIREMENTS
Performance under this Agreement is subject to all applicable Federal and State
laws, regulations and standards. CONTRACTOR shall establish written accounting procedures
consistent with applicable Federal and State laws, regulations and standards, and shall be held
accountable for audit exceptions taken by the State or COUNTY for failure to comply with these
requirements.
These requirements include, but may not be limited to, those set forth in this
Agreement, and:
A. HSC, Division 10.5, commencing with Section 11760;
B. California Code of Regulations (CCR), Title 9, Division 4, Chapter 8,
commencing with Section 13000;
C. Government Code Section 16367.8
B-4
Exhibit B
D. 42, CFR, Sections 8.1 through 8.6.
E. Title 21, CFR, Sections 1301.01 through 1301.93, Department of Justice,
Controlled Substances.
F. State Administrative Manual (SAM), Chapter 7200 (General Outline of
Procedures).
G. 31 U.S.C. sections 7501-7507 (Single Audit Act of 1984; Single Audit Act
Amendments of 1996);
H. 2CFR Part 200 (Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards); and
CONTRACTOR shall be familiar with the above requirements and must incorporate
these requirements into written policies and procedures, as applicable.
8. CULTURALLY COMPETENT SERVICES
CONTRACTOR shall ensure equal access to quality care by diverse populations by
adopting the federal Office of Minority Health Culturally and Linguistically Appropriate Service
(CLAS) national standards and complying with 42 CFR 438.206(c)(2). CONTRACTOR's policies,
procedures, and practices must be consistent with the principles outlined and are embedded in
the organizational structure, as well as being upheld in day-to-day operations. CONTRACTOR
shall promote the delivery of services in a culturally competent manner to all persons served,
including those with limited English proficiency and diverse cultural and ethnic backgrounds,
disabilities, and regardless of gender, sexual orientation or gender identity.
9. ADA CONSIDERATIONS
CONTRACTOR shall ensure that physical access, reasonable accommodations,
and accessible equipment are available for Medicaid persons served with physical or mental
disabilities in accordance with CFR Title 45, Part 84 and the Americans with Disabilities Act.
10. ADDITIONAL INTERGOVERNMENTAL AGREEMENT RESTRICTIONS
This Agreement is subject to any additional restrictions, limitations, conditions, or
statutes enacted or amended by the federal or state governments, which may affect the
provisions, terms, or funding of this Agreement in any manner.
11. NULLIFICATION OF DMC-ODS SERVICES
The parties agree that failure of COUNTY, or CONTRACTOR, to comply with W&I
section 14124.24, the Special Terms and Conditions, and this Agreement, shall be deemed a
breach that results in the termination of the State-County Intergovernmental Agreement for cause.
In the event of a breach, the DMC-ODS services shall terminate. The COUNTY shall immediately
begin providing DMC services to the person served in accordance with the State Plan.
12. HATCH ACT
CONTRACTOR shall comply with the provisions of the Hatch Act (Title 5 USC,
Sections 1501-1508), which limit the political activities of employees whose principal employment
activities are funded in whole or in part with federal funds.
B-5
Exhibit B
13. LIMITATION ON USE OF FUNDS FOR PROMOTION OF LEGALIZATION OF
CONTROLLED SUBSTANCES
CONTRACTOR is prohibited from using funds made available through this
Agreement for any activity that promotes the legalization of any drug or other substance included
in Schedule I of Section 202 of the Controlled Substances Act (21 USC 812).
14. NONDISCRIMINATION IN EMPLOYMENT AND SERVICES
CONTRACTOR certifies that under the laws of the United States and the State of
California, incorporated into this Agreement by reference and made a part hereof as if set forth in
full, CONTRACTOR shall not unlawfully discriminate against any person.
15. FEDERAL LAW REQUIREMENTS
CONTRACTOR shall comply with the following Federal law requirements:
A. Title VI of the Civil Rights Act of 1964, Section 2000d, as amended,
prohibiting discrimination based on race, color, or national origin in federally
funded programs.
B. Title IX of the Education Amendments of 1972 (regarding education and
programs and activities), if applicable.
C. Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.) prohibiting
discrimination on the basis of race, color, religion, sex, handicap, familial
status or national origin in the sale or rental of housing.
D. Age Discrimination Act of 1975 (45 CFR Part 90), as amended (42 USC
Sections 6101 —6107), which prohibits discrimination on the basis of age.
E. Age Discrimination in Employment Act (29 CFR Part 1625).
F. Title I of the Americans with Disabilities Act (29 CFR Part 1630) prohibiting
discrimination against the disabled in employment.
G. Americans with Disabilities Act (28 CFR Part 35) prohibiting discrimination
against the disabled by public entities.
H. Title III of the Americans with Disabilities Act (28 CFR Part 36) regarding
access.
I. Rehabilitation Act of 1973, as amended (29 USC Section 794), prohibiting
discrimination on the basis of individuals with disabilities.
J. Executive Order 11246 (42 USC 2000(e) et seq. and 41 CFR Part 60)
regarding nondiscrimination in employment under federal contracts and
construction contracts greater than $10,000 funded by federal financial
assistance.
K. Executive Order 13166 (67 FR 41455) to improve access to federal services
for those with limited English proficiency.
L. The Drug Abuse Office and Treatment Act of 1972, as amended, relating to
nondiscrimination on the basis of drug abuse.
B-6
Exhibit B
M. The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment
and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism.
16. STATE LAW REQUIREMENTS
CONTRACTOR shall comply with the following State law requirements:
A. Fair Employment and Housing Act (Government Code Section 12900 et
seq.) and the applicable regulations promulgated thereunder (California
Administrative Code, Title 2, Section 7285.0 et seq.).
B. Title 2, Division 3, Article 9.5 of the Government Code, commencing with
Section 11135.
C. Title 9, Division 4, Chapter 8, commencing with Section 10800.
D. No state or Federal funds shall be used by COUNTY, or CONTRACTOR, for
sectarian worship, instruction, and/or proselytization. No state funds shall be
used by CONTRACTOR, or CONTRACTOR, to provide direct, immediate, or
substantial support to any religious activity.
E. Noncompliance with the requirements of nondiscrimination in services shall
constitute grounds for state to withhold payments under this Agreement or
terminate all, or any type, of funding provided hereunder.
17. INVESTIGATIONS AND CONFIDENTIALITY OF ADMINISTRATIVE ACTIONS
COUNTY acknowledges that if a DMC provider is under investigation by DHCS or
any other state, local or federal law enforcement agency for fraud or abuse, DHCS may
temporarily suspend CONTRACTOR from the DMC program, pursuant to W&I Code, Section
14043.36(a). Information about CONTRACTOR's administrative sanction status is confidential
until such time as the action is either completed or resolved. The DHCS may also issue a
Payment Suspension to a provider pursuant to W&I Code, Section 14107.11 and Code of Federal
Regulations, Title 42, section 455.23. The COUNTY is to withhold payments from a DMC
provider during the time a Payment Suspension is in effect. COUNTY has executed a
Confidentiality Agreement that permits DHCS to communicate with COUNTY concerning
CONTRACTOR(S) that are subject to administrative sanctions.
18. COUNSELOR CERTIFICATION
CONTRACTOR shall ensure that any counselor or registrant providing intake,
assessment of need for services, treatment or recovery planning, individual or group counseling to
participants, patients, or residents in a DHCS licensed or certified program is required to be
certified as defined in CCR Title 9, Division 4, Chapter 8.
19. ADMISSION DISCRIMINATION
CONTRACTOR shall accept individuals eligible for admission in the order in which
they apply without restriction, up to the limits set under the State-County Intergovernmental
Agreement. CONTRACTOR shall not, based on health status or need for health care services,
discriminate against individuals eligible for admission. CONTRACTOR shall follow all Federal and
State civil rights laws. CONTRACTOR shall not unlawfully discriminate, exclude people, or treat
B-7
Exhibit B
them differently, on any ground protected under Federal or State law, including sex, race, color,
religion, ancestry, national origin, ethnic group identification, age, mental disability, physical
disability, medical condition, genetic information, marital status„ gender, gender identity, or sexual
orientation and will not use any policy or practice that has the effect of discriminating on the basis
of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental
disability, physical disability, medical condition, genetic information, marital status, gender, gender
identity, or sexual orientation. CONTRACTOR shall ensure that persons served that meet
medical necessity for Medication Assisted Treatment (MAT) receive the same access to care as
non-MAT persons served.
CONTRACTOR shall provide information on how to file a Discrimination Grievance
with COUNTY or DHCS if there is a concern of discrimination based on sex, race, color, religion,
ancestry, national origin, ethnic group identification, age, mental disability, physical disability,
medical condition, genetic information, marital status, gender, gender identity, or sexual
orientation. CONTRACTOR shall also provide information on how to file a Discrimination
Grievance with the United States Department of Health and Human Services Office of Civil Rights
if there is a concern of discrimination based on race, color, national origin, sex, age, or disability.
20. SUBCONTRACTUAL REQUIREMENTS
CONTRACTOR shall fulfill contractual requirements of delegated services or
activities in accordance with 42 CFR §438.230 and shall perform the delegated activities and
reporting responsibilities in compliance with COUNTYs State-County Intergovernmental
Agreement obligations. CONTRACTOR shall comply with all applicable Medicaid laws and
regulations, including applicable sub-regulatory guidance and contract provisions.
CONTRACTOR shall not bill persons served for covered services under this
agreement in excess of the amount that would be owed by the individual if the COUNTY had
directly provided the services (42 U.S.C. 1396u-2(b)(6)(C)).
21. INSPECTION AND AUDIT OF RECORDS AND ACCESS TO FACILITIES
CONTRACTOR agrees that COUNTY, DHCS, CMS, the HHS Inspector General,
the Comptroller General, or their designees have the right to audit, evaluate, and inspect any
books, records, contracts, computer or other electronic systems of CONTRACTOR, or of the
CONTRACTOR's sub-contractor, that pertain to any aspect of services and activities performed,
or determination of amounts payable under COUNTY's contract with DHCS. CONTRACTOR shall
make available, at any time, for purposes of an audit, evaluation, or inspection, its premises,
physical facilities, equipment, books, records, contracts, computer or other electronic systems
relating to its Medicaid enrollees. The right to audit will exist through 10 years from the final date
of the contract period or from the date of completion of any audit, whichever is later.
22. GRIEVANCE
CONTRACTOR shall comply with Grievance procedures set forth in the State-
County Intergovernmental Agreement, the Provider Manual and the Member Handbook.
CONTRACTOR shall make the following grievance information available to all
persons served:
A. Perons Served's right to a State Fair Hearing and how to obtain a hearing as
well as representation rules.
B-8
Exhibit B
B. Person Served's right to file grievances and appeals, including the
requirements and timeframes for filing.
C. Person Served's right to give written consent to allow CONTRACTOR or
legal representative, acting on behalf of the person served, to file an appeal.
D. Person Served may file a grievance orally or in writing to DHCS or COUNTY.
E. The availability of assistance with filing grievances and appeals.
F. The toll-free number to file oral grievances and appeals.
G. Person Served's right to request continuation of benefits during an appeal or
state fair hearing filing although the person served may be liable for the cost of any continued
benefits if the action is upheld.
H. Any state determined contractor's appeal rights to challenge the failure of the
COUNTY to cover a service.
23. GREIVANCE AND APPEALS RECORDKEEPING REQUIREMENTS
CONTRACTOR shall retain person served grievance and appeal records as
referenced in 42 CFR §438.416, for a period of no less than ten (10) years. Person served
grievance and appeal data shall include a general description of the reason for the grievance or
appeal, the date the grievance or appeal was received, the date of each review or, if applicable,
review meeting, the resolution and date of resolution at each level of the grievance or appeal and
the name of the covered person for whom the grievance or appeal was filed. The record must be
accurately maintained in a manner accessible to DHCS and available upon request to CMS.
24. PERSON SERVED INFORMING AND TRANSLATION SERVICES
CONTRACTOR shall make written and verbal information available to persons
served in their language of choice.
Written material: CONTRACTOR shall use COUNTY's written/translated materials
that are critical to obtaining services, including the provider directory, member handbook, appeal
and grievance notices, and denial and termination notices, available in the prevalent non—English
languages. All other CONTRACTOR specific written materials must be made available in the
prevalent non-English languages. CONTRACTOR shall ensure that written materials use easily
understood language and format, use a font size no smaller than 12-point, and are made available
in alternative formats upon request of the potential person served or person served at no cost.
Written materials shall include taglines in the prevalent non-English languages in the state, as well
as large print, explaining the availability of written translation or oral interpretation to understand
the information provided and the toll-free and TTY/TDY telephone number of COUNTY's
member/customer service unit. Written materials for potential and current persons served shall
include language taglines in at least the top sixteen (16) non-English languages spoken by
individuals with limited English proficiency of the State, as well as large print, explaining the
availability of written translation or oral interpretation to understand the information provided.
Large print means in a font size no smaller than 18 point.
Auxiliary aids: CONTRACTOR shall ensure auxiliary aids and services in an
appropriate manner that takes into consideration the special needs of persons served or potential
B-9
Exhibit B
persons served with disabilities or limited English proficiency shall be made available upon
request of the potential person served or person served at no cost.
Interpretation services: CONTRACTOR shall make interpretation services available
free of charge and in a timely manner to each person served. This includes oral interpretation and
the use of auxiliary aids (such as TTY/TDY and American Sign Language) and services including
qualified interpreters for individuals with disabilities. Oral interpretation requirements apply to all
non—English languages, not just those that DHCS identifies as prevalent. Pursuant to WIC
14029.91(a)(1)(B), Oral interpretation services shall be provided by an interpreter that, at a
minimum, meets all the following qualifications:
A. Demonstrated proficiency in speaking and understanding both spoken
English and the language spoken by the limited-English-proficient person served;
B. The ability to interpret effectively, accurately, and impartially, both receptively
and expressly, to and from the language spoken by the limited-English-proficient person served
and English, using any necessary specialized vocabulary, terminology, and phraseology; and
C. Adherence to generally accepted interpreter ethics principles, including client
confidentiality.
CONTRACTOR shall notify its persons served and prospective persons served that
oral interpretation is available for any language and written translation is available in prevalent
languages to individuals whose primary language is not English free of cost and how to access
those materials. This may include, but is not limited to qualified interpreters and information
written in other languages. CONTRACTOR shall notify persons served that auxiliary aids and
services are available upon request, at no cost and in a timely manner for non-English
speaking/reading/writing persons served and persons served with disabilities. Free aides and
services to people with disabilities to help them communicate better may include, but are not
limited to, qualified sign language interpreters and written information in other formats (e.g. large
print, audio, accessible electronic formats, and other formats). CONTRACTOR shall notify
persons served how to access these services.
Pursuant to 14029.91(a)(1)(C), CONTRACTOR shall not require a person served
with limited English proficiency to provide his or her own interpreter or rely on a staff member who
does not meet the qualifications described above.
CONTRACTOR shall not rely on an adult or minor child accompanying the limited-
English-proficient person served to interpret or facilitate communication except under the
circumstances described in WIC Section 14029.91(a)(1)(D) for emergencies and upon request
that the accompanying adult provide assistance.
Pursuant to 45 CFR 92.201, CONTRACTOR shall not require a person served with
limited English proficiency to accept language assistance services.
CONTRACTOR shall post a DHCS-approved nondiscrimination notice and
language taglines in at least the top sixteen (16) non-English languages in the State (as
determined by DHCS) as well as large print, explaining the availability of free language assistance
services, including written translation and oral interpretation to understand the information
provided, and the toll-free and TTY/TDY telephone number of CONTRACTOR's
member/customer service unit, as follows:
B-10
Exhibit B
A. In all conspicuous physical locations where CONTRACTOR interacts with
the public;
B. In a conspicuous location on CONTRACTOR's website that is accessible on
CONTRACTOR's home page, and in a manner that allows persons served and prospective
persons served to easily locate the information; and
C. In all significant communications and significant publications targeted to
persons served, enrollees, applicants, and members of the public, except for significant
publications and significant communications that are small-sized, such as postcards and tri-fold
brochures.
CONTRACTOR shall post a DHCS-approved nondiscrimination statement and
language taglines in a least the top two non-English languages in the State (as determined by
DHCS), explaining the availability of free language assistance services, and the toll-free and
TTY/TDY telephone number of CONTRACTOR's member/customer service unit, as follows:
A. In all significant publications and significant communications that are small-
sized, such as postcards and tri-fold brochures; and
B. CONTRACTOR's nondiscrimination notice, nondiscrimination statement,
and language taglines must be in a conspicuously visible font size no smaller than 12-point. Any
large print tagline required must be in a font size no smaller than 18-point and must include
information on how to request auxiliary aides and services, including the provision of the materials
in alternative formats.
25. MEMBER HANDBOOK
CONTRACTOR shall utilize COUNTY developed member handbook and issue to
persons served at intake. Member handbooks can also be made available by mailing a printed
copy of the information to the person served's mailing address, emailing after obtaining the person
served's agreement to receive information by email, providing direction in paper or electronic form
to the COUNTY website or any other method that can reasonably be expected to result in the
person served receiving that information.
26. TIMELY ACCESS REQUIREMENTS
CONTRACTOR shall meet DHCS and COUNTY standards for timely access to care
and services, taking into account the urgency of the need for services. CONTRACTORs must
offer hours of operation that are no less than the hours of operation offered to commercial persons
served or comparable to Medicaid FFS, if CONTRACTOR services only Medicaid persons served.
Timeliness standards include, but are not limited to:
A. Initial contact to first face-to-face appointment— 10 business days
B. Initial contact to first dose of NTP — 3 business days
C. Timeliness of services for Urgent Conditions — 1 business day
CONTRACTOR shall ensure that medical attention for emergency and crisis
medical conditions are provided immediately.
B-11
Exhibit B
27. CARE COORDINATION
CONTRACTOR and COUNTY shall comply with the care and coordination
requirements of the State-County Intergovernmental Agreement, Exhibit A, Attachment I, II.E.3.
CONTRACTOR shall ensure that each person served has an ongoing source of care appropriate
to his or her needs and shall ensure a person or entity within their organization is formally
designated as primarily responsible for coordinating the services accessed by the person served.
The person served shall be provided information on how to contact their case manager.
CONTRACTOR shall coordinate services between levels of care, with services the person served
receives from any other managed care organization and the services the person served receives
from community and social support providers. Care coordination efforts shall be accurately
documented in person served's chart to be verified during COUNTY chart audits conducted at
least annually.
CONTRACTOR shall make a best effort to conduct an initial screening of each
person served's ancillary needs, within thirty (30) calendar days of the effective date of admission
for all new persons served, including subsequent attempts if the initial attempt to contact the
person served is unsuccessful.
CONTRACTOR shall ensure that it maintains and shares, as appropriate, a person
served health record in accordance with professional standards.
CONTRACTOR shall ensure that in the process of coordinating care, each person
served's privacy is protected in accordance with the privacy requirements in 45 CFR parts 160
and 164 subparts A and E and 42 CFR Part 2, to the extent that they are applicable.
CONTRACTOR shall ensure that persons served are aware of and are referred to,
when appropriate, recovery supports and services immediately after discharge or upon completion
of an acute care stay.
28. AUTHORIZATION OF SERVICES
CONTRACTOR shall adhere to COUNTY's written policies and procedures, outlined
in the Provider Manual, for authorization of services.
29. PERFORMANCE IMPROVEMENT PROJECTS
CONTRACTOR shall assist, when requested by COUNTY, in developing and
reviewing annual Performance Improvement Projects including but not limited to identifying a
clinical and a non-clinical problem, brainstorming causes and barriers, implementation of
interventions for the identified problems, and analysis of interventions. CONTRACTOR shall
assist in planning and initiation of activities for increasing or sustaining improvement.
30. CONTRACTOR DMC CERTIFICATION
DMC certified contractors must revalidate DMC certification with DHCS every five
(5) years. Failure to revalidate DMC certification within 120 days following the expiration of every
five (5) year period will result in contract termination. COUNTY shall terminate CONTRACTOR
immediately upon notification from DHCS that the CONTRACTOR cannot be enrolled, or the
expiration of one 120-day period without enrollment of CONTRACTOR and shall notify affected
B-12
Exhibit B
person served. CONTRACTOR shall ensure enrollment with DHCS as a Medicaid provider
consistent with the provider disclosure, screening and enrollment requirements.
DMC certified CONTRACTORs shall be subject to continuing certification
requirements at least once every five years. DHCS may allow the CONTRACTOR to continue
delivering covered services to person served at a site subject to on-site review by DHCS as part
of the recertification process prior to the date of the on-site review, provided the site is operational,
the certification remains valid, and has all required fire clearances. DHCS shall conduct
unannounced certification and recertification site visits at clinics pursuant to W&I Code, Section
14043.7.
31. PROGRAM INTEGRITY REQUIREMENTS
CONTRACTOR shall implement and maintain arrangements or procedures that are
designed to detect and prevent fraud, waste, and abuse. CONTRACTOR shall maintain written
policies, procedures, and standards of conduct that articulate CONTRACTORs commitment to
comply with all applicable requirements and standards under the State-County Intergovernmental
Agreement, and all applicable Federal and State requirements. CONTRACTOR shall establish
and implement procedures and a system with dedicated staff for routine internal monitoring and
auditing of compliance risks, prompt response to compliance issues as they are raised,
investigation of potential compliance problems as identified in the course of self-evaluation and
audits, correction of such problems promptly and thoroughly (or coordination of suspected criminal
acts with law enforcement agencies) to reduce the potential for recurrence, and ongoing
compliance.
CONTRACTOR shall provide reports to COUNTY within 60 calendar days when it
has identified an overpayment. COUNTY shall provide a mechanism for reporting and collecting
overpayment.
CONTRACTOR shall retain information regarding data, information, and
documentation for person served encounter data specified in 42 CFR §§438.604, 438.606,
438.608, and 438.610 for a period of no less than 10 years.
CONTRACTOR shall ensure sites keep a record of persons served being treated at
that location.
CONTRACTOR shall not knowingly have a relationship with a director, officer or
partner of CONTRACTOR, a subcontractor of CONTRACTOR, a person with beneficial ownership
of five (5) percent or more of CONTRACTOR's equity or a network provider or person with an
employment, consulting or other arrangement with the CONTRACTOR for the provision of items
and services that are significant and material to the CONTRACTOR's obligations under this
Agreement with the following:
A. An individual or entity that is debarred, suspended, or otherwise excluded
from participating in procurement activities under the Federal Acquisition Regulation or from
participating in non-procurement activities under regulations issued under Executive Order No.
12549 or under guidelines implementing Executive Order No. 12549.
B. An individual or entity who is an affiliate, as defined in the Federal
Acquisition Regulation at 48 CFR 2, Section 101, of a person described above.
B-13
Exhibit B
CONTRACTOR shall not have a relationship with an individual or entity that is
excluded from participation in any Federal Health Care Program under section 1128 or 1128A of
the Act.
32. CONTRACTOR SPECIFICATIONS
CONTRACTOR shall ensure that professional staff shall be licensed, registered,
certified or recognized under California scope of practice statutes. Professional staff shall provide
services within their individual scope of practice and receive supervision required under their
scope of practice laws. CONTRACTOR shall ensure that professional staff(LPHAs) receive a
minimum of five (5) hours of continuing education related to addiction medicine each year.
Copies of these certifications and licenses shall be maintained in staff's personnel files and
records shall be made available to COUNTY upon request.
CONTRACTOR shall ensure that non-professional staff receive appropriate onsite
orientation and training prior to performing assigned duties. A professional and/or administrative
staff shall supervise non-professional staff. Professional and non-professional staff are required to
have appropriate experience and any necessary training at the time of hiring. Documentation of
trainings, certifications and licensure shall be contained in personnel files. Registered and
certified SLID counselors shall adhere to all requirements in Title 9, Chapter 8.
33. CREDENTIALING/RECREDENTIALING
CONTRACTOR shall follow the COUNTY's established credentialing and re-
credentialing process for all licensed and/or certified staff. Initial credentialing must be completed
prior to providing treatment services. Re-credentialing must be completed every three (3) years.
34. MEDICAL DIRECTOR REQUIREMENTS
CONTRACTOR's Medical Director must, prior to the delivery of services under this
Contract, be enrolled with DHCS under applicable state regulations, screened in accordance with
42 CFR 455.450(a) as a "limited" categorical risk within a year prior to serving as a Medical
Director under this Agreement, and have a signed Medicaid provider agreement with DHCS as
required by 42 CFR 431.107.
Medical Directors shall receive a minimum of five (5) hours of continuing medical
education related to addiction medicine annually.
35. ASAM REQUIREMENTS
CONTRACTOR shall use COUNTY's American Society of Addiction Medicine
(ASAM) criteria assessment and re-assessment tools to determine the person served's level of
care. CONTRACTOR shall ensure that assessment of services for adolescents will follow the
ASAM adolescent treatment criteria.
CONTRACTOR and CONTRACTOR's staff shall comply with obtaining ASAM
Criteria training prior to providing services. CONTRACTOR shall ensure that, at minimum, staff
conducting assessments complete the two e-Training modules entitled "ASAM Multidimensional
Assessment", "From Assessment to Service Planning and Level of Care" and "Introduction to the
ASAM Criteria". CONTRACTOR shall maintain records of ASAM trainings in personnel files and
will make these records available to COUNTY upon request.
B-14
Exhibit B
Residential care CONTRACTORs must meet the established ASAM criteria for each
level of residential care provided and receive an ASAM Designation prior to providing DMC-ODS
services.
36. MEDICAL NECESSITY
CONTRACTOR shall ensure that an initial medical necessity determination, for an
individual to receive a DMC-ODS benefit, is performed through a face-to-face review or telehealth
by a Medical Director or a LPHA. If a person served's assessment and intake information are
completed by a counselor through a face-to-face review or telehealth, the Medical Director or
LPHA shall evaluate each person served's assessment and intake information with the counselor
to establish whether that person served meets medical necessity criteria. The ASAM Criteria shall
be applied to determine placement into the level of assessed services.
CONTRACTOR shall ensure that all ADULT persons served receive at least one
diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth Edition for
Substance-Related and Addictive Disorders. After establishing a diagnosis and documenting the
basis for diagnosis, the American Society of Addiction Medicine (ASAM) Placement Criteria shall
be applied by the diagnosing individual to for placement into the correct level of care.
CONTRACTOR shall periodically as directed by COUNTY, and at a minimum of
every six (6) months, reassess for continued medical necessity of an ongoing treatment. The
reassessment determination must be documented by the Medical Director, licensed physician or
LPHA as clinically appropriate.
OTP/NTP CONTRACTOR shall periodically as directed by COUNTY, and at a
minimum within two (2) years from admission and annually thereafter, reassess for continued
medical necessity of an ongoing treatment and determine that those services are still clinically
appropriate for that individual.
For Medical Necessity definition and Assessment and Reassessment timeframes
CONTRACTOR shall refer to the Provider Manual.
Individuals under age 21 are eligible to receive Medicaid services pursuant to the
Early Periodic Screening, Diagnostic and Treatment (EPSDT) mandate. Under the EPSDT
mandate, perons served under the age 21 are eligible to receive all appropriate and medically
necessary services needed to correct and ameliorate health conditions that are coverable under
section 1905(a) Medicaid authority. Nothing in the DMC-ODS shall override any EPSDT
requirements. Medical necessity for an adolescent individual (an individual under the age of 21) is
determined using the following criteria:
A. The adolescent individual may be assessed to be at-risk for developing a
SUD based on the following criteria:
1) Substance use does NOT meet the minimum diagnosis criteria per
the DSM 5; and
2) Reports of experimental or early-phase substance use, associated
biopsychosocial risk factors, and information gathered from the full
ASAM assessment and the At-Risk Determination Tool indicate risk
of developing an SUD.
B-15
Exhibit B
B. The adolescent individual must meet the ASAM adolescent treatment
criteria.
37. MEDI-CAL ELIGIBILITY VERIFICATION
CONTRACTOR shall be responsible for verifying the Medi-Cal eligibility of each
person served for each month of service prior to billing for DMC services for that month. Medi-Cal
eligibility verification should be performed prior to rendering service, in accordance with and as
described in the DHCS DMC Provider Billing Manual. Options for verifying the eligibility of a Medi-
Cal person served are described in the DHCS DMC Provider Billing Manual at the following web
address and by this reference incorporated herein.
https://www.dhcs.ca.gov/services/Documents/SUD°/o20-
%20DMC%20Billinq%20Manual/DMC Billing Manual 2019%20Final.pdf
38. OTHER HEALTH COVERAGE BILLING REQUIREMENTS
In the event that a person served has Other Health Coverage (OHC),
CONTRACTOR shall bill the OHC prior to billing DMC to receive either payment from the OHC, or
a notice of denial from the OHC indicating that either the recipient's OHC coverage has been
exhausted or that the specific service is not a benefit of the OHC.
39. DMC REIMBURSEMENT RATE SETTING
CONTRACTOR shall submit financial and service data to COUNTY on an annual
basis in a format provide by, and by a deadline set by, COUNTY for reimbursement rate setting
purposes. COUNTY shall approve contractor-specific reimbursement rates for each modality
except NTPs. CONTRACTORs that do not comply with the requirements of the rate setting
process will be considered out of compliance with contractual requirements and will not receive
annual reimbursement rates CONTRACTORs that are non-compliant are subject to contract
termination.
Annual reimbursement rates for NTP services shall be set by DHCS pursuant to the
process set forth in W&I Code, Section 14021.51. NTP CONTRACTOR shall submit cost reports
to DHCS.
40. DMC CERTIFICATION AND ENROLLMENT
Prior to delivering SUD services CONTRACTOR shall obtain any licenses,
registrations, DMC certifications or approval to operate a SUD program or provide a covered
service in accordance with applicable laws and regulations. CONTRACTOR shall continuously
maintain any licenses, registrations, DMC certifications or approval to operate a SUD program or
provide a covered service in accordance with applicable laws and regulations for the duration of
this Contract. CONTRACTOR and any subcontractors shall comply with the following regulations
and guidelines:
A. Title 21, CFR Part 1300, et seq., Title 42, CFR, Part 8;
B. Title 22, Sections 51490.1(a);
C. Exhibit A, Attachment I, Article III.PP — Requirements for Services;
D. Title 9, Division 4, Chapter 4, Subchapter 1, Sections 10000, et seq.; and
B-16
Exhibit B
E. Title 22, Division 3, Chapter 3, sections 51000 et. seq.
41. PERINATAL CERTIFICATION REQUIREMENTS
CONTRACTORs of perinatal DMC services shall be properly certified to provide
these services and comply with the applicable requirements below:
A. Perinatal services shall address treatment and recovery issues specific to
pregnant and postpartum women, such as relationships, sexual and physical
abuse, and development of parenting skills.
B. Perinatal services shall include:
1) Mother/child habilitative and rehabilitative services (i.e., development
of parenting skills, training in child development, which may include
the provision of cooperative child care pursuant to Health and Safety
Code Section 1596.792);
2) Service access (i.e., provision of or arrangement for transportation to
and from medically necessary treatment);
3) Education to reduce harmful effects of alcohol and drugs on the
mother and fetus or the mother and infant; and
4) Coordination of ancillary services (i.e., assistance in accessing and
completing dental services, social services, community services,
educational/vocational training and other services which are
medically necessary to prevent risk to fetus or infant).
C. Medical documentation that substantiates the person served's pregnancy
and the last day of pregnancy shall be maintained in the person served file.
42. YOUTH TREATMENT GUIDELINES
CONTRACTOR shall follow the "Youth Treatment Guidelines," available at the
DHCS web address at: http://www.dhcs.ca.gov/individuals/Pages/youthSUDservices.aspx and by
this reference incorporated herein, in developing and implementing youth treatment programs
funded under this Agreement until such time new Youth Treatment Guidelines are established and
adopted. No formal amendment of this contract is required for new guidelines to apply.
43. CONTRACTOR CHANGE IN SERVICE OR LOCATION
CONTRACTOR shall ensure that any reduction of covered services or relocations
are not implemented until approval is issued by DHCS. CONTRACTOR must submit a new DMC
certification application to the DHCS Provider Enrollment Division (PED). The DMC certification
application shall be submitted to PED 60 days prior to the desired effective date of the reduction
of covered services or relocation.
CONTRACTOR shall notify COUNTY when its license, registration, certification, or
approval to operate a SUD program or provide a covered service is revoked, suspended,
modified, or not renewed by entities other than DHCS.
B-17
Exhibit B
44. MEDICATION ASSISTED TREATMENT
CONTRACTORs that do not provide medication assisted treatment shall have
procedures for linkage/integration for persons served requiring medication assisted treatment.
CONTRACTOR staff will regularly communicate with physicians of person served who are
prescribed these medications unless the person served refuses to consent to sign 42 CFR part 2
Compliant Releases of Information for this purpose.
45. EVIDENCE BASED PRACTICES (EBP)
CONTRACTOR shall implement Motivational Interviewing and at least two EBPs
prescribed by DHCS based on the timeline established by COUNTY as outlined in the Provider
Manual. The two additional required EBPs may be selected from the following: Cognitive-
Behavioral Therapy, Relapse Prevention, Trauma-Informed Treatment and Psycho-Education.
Three EBPs shall be utilized per service modality. COUNTY and DHCS will monitor the
implementation and regular training of EBPs to staff during reviews. CONTRACTOR shall ensure
that staff are internally monitored for training, quality of delivery and fidelity of Evidence Based
Practices.
46. COORDINATION AND CONTINUITY OF CARE WITH MANAGED CARE PLANS
CONTRACTOR shall coordinate with the Managed Care Plans, Anthem and
CaIVIVA Health, when appropriate, for comprehensive physical and behavioral health screening
and collaborative treatment planning. COUNTY shall maintain MOUs with the managed care
plans to facility person served care coordination and will monitor CONTRACTORs with regard to
the effectiveness of physical health care coordination.
47. POSTSERVICE POSTPAYMENT AND POSTSERVICE PREPAYMENT (PSPP)
DHCS shall conduct Postservice Postpayment and Postservice Prepayment (PSPP)
Utilization Reviews of contracted DMC providers to determine whether the DMC services were
provided. DHCS shall issue the PSPP report to the COUNTY with a copy to CONTRACTOR.
CONTRACTOR shall ensure any deficiencies are remediated and COUNTY shall attest the
deficiencies have been remediated.
All CONTRACTOR shall submit a COUNTY-approved corrective action plan (CAP)
to DHCS within 60 days of the date of the PSPP report. CONTRACTOR(S) that do not comply with
the CAP submittal requirements or fail to implement the approved CAP provisions within the
designated timeline are subject to payment withholding until compliance is determined.
48. DRUG SCREENING
Where drug screening by urinalysis is deemed medically appropriate,
CONTRACTOR shall establish procedures which protect against the falsification and/or
contamination of any urine sample and document urinalysis results in the person served's file.
49. TREATMENT RECORDING REQUIREMENTS
CONTRACTOR shall comply with the requirements outlined in the
Intergovernmental Agreement, Exhibit A, Attachment I, Section PP, regarding admission,
B-18
Exhibit B
assessment, person served record, medical necessity and diagnosis, physical examination,
treatment plan, sign-in sheets, progress notes, continuing services, and discharge.
50. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF
1996
If any of the work performed under this Agreement is subject to the HIPAA,
CONTRACTOR shall perform the work in compliance with all applicable provisions of HIPAA. As
identified in Exhibit F of the State County Intergovernmental Agreement, DHCS, COUNTY and
CONTRACTOR shall cooperate to ensure mutual agreement as to those transactions between
them, to which this Provision applies. Refer to Exhibit F for additional information.
A. Trading Partner Requirements
1) No Changes: CONTRACTOR hereby agrees that for the personal
health information (PHI), it shall not change any definition, data condition or use of a data element
or segment as proscribed in the federal Health and Human Services Transaction Standard
Regulation [45 CFR Part 162915(a)].
2) No Additions: CONTRACTOR hereby agrees that for PHI, it shall not
add any data elements or segments to the maximum data set as proscribed in the HHS
Transaction Standard Regulation [45CFR Part 162.915 (b)].
3) No Unauthorized Uses: CONTRACTOR hereby agrees that for PHI, it
shall not use any code or data elements that are marked `not used" in the in the HHS
Transactions Implementation specification or are not in the HHS Transaction Standard's
implementation specification [45CFR Part 162.915 (c)].
4) No Changes to Meaning or Intent: CONTRACTOR hereby agrees
that for PHI, it shall not change the meaning or intent of the HHS Transaction Standard's
implementation specification [45CFR Part 162.915 (d)].
B. Concurrence for Test Modifications to HHS Transaction Standards
CONTRACTOR agrees and understands that there exists the possibility that DHCS
or others may request an extension from the uses of a standard in the HHS Transaction
Standards. If this occurs, CONTRACTOR agrees that it shall participate in such test modifications.
C. Adequate Testing
CONTRACTOR is responsible to adequately test all business rules appropriate to
their types and specialties. If the CONTRACTOR is acting as a clearinghouse for enrolled
providers, CONTRACTOR has obligations to adequately test all business rules appropriate to
each and every provider type and specialty for which they provide clearinghouse services.
D. Deficiencies
The CONTRACTOR agrees to cure transactions errors or deficiencies identified by
DHCS, and transactions errors or deficiencies identified by an enrolled CONTRACTOR if the
COUNTY is acting as a clearinghouse for that CONTRACTOR. If the CONTRACTOR is a
clearinghouse, the CONTRACTOR agrees to properly communicate deficiencies and other
pertinent information regarding electronic transactions to enrolled CONTRACTORS for which they
provide clearinghouse services.
B-19
Exhibit B
E. Code Set Retention
Both COUNTY and CONTRACTOR understand and agree to keep open code sets
being processed or used in this Agreement for a least the current billing period or any appeal
period, whichever is longer.
F. Data Transmission Log
Both COUNTY and CONTRACTOR shall establish and maintain a Data
Transmission Log, which shall record any and all data transmissions taking place between the
Parties during the term of this Agreement. Each Party shall take necessary and reasonable steps
to ensure that such Data Transmission Logs constitute a current, accurate, complete and
unaltered record of any and all Data Transmissions between the Parties, and shall be retained by
each Party for no less than twenty-four (24) months following the date of the Data Transmission.
The Data Transmission Log may be maintained on computer media or other suitable means
provided that, if necessary to do so, the information contained in the Data Transmission Log may
be retrieved in a timely manner and presented in readable form.
51. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS
A. General Parity Requirement
CONTRACTOR shall not impose any financial requirements, Quantitative
Treatment Limitations, or Non-Quantitative Treatment Limitations in any classification of benefit
(inpatient, outpatient, emergency care, or prescription drugs) other than those limitations permitted
and outlined in the State-County Contract.
CONTRACTOR shall not apply any financial requirement or treatment
limitation to substance use disorder services in any classification of benefit that is more restrictive
than the predominant financial requirement or treatment limitation of that type applied to
substantially all medical/surgical benefits in the same classification of benefit furnished to person
served (whether or not the benefits are furnished by the CONTRACTOR). (42 CFR 438.910(b)(1))
CONTRACTOR shall provide substance use disorder services to person
served in every classification in which medical/surgical benefits are provided. (42 CFR
438.910(b)(2))
B. Quantitative Limitations
CONTRACTOR shall not apply any cumulative financial requirement for
substance use disorder services in a classification that accumulates separately from any
established for medical/surgical services in the same classification. (42 CFR 438.910(c)(3))
C. Non-Quantitative Limitations
CONTRACTOR shall not impose a non-quantitative treatment limitation for
substance use disorder benefits in any classification unless, under the policies and procedures of
CONTRACTOR as written and in operation, any processes, strategies, evidentiary standards, or
other factors used in applying the non-quantitative treatment limitation to substance use disorder
benefits in the classification are comparable to, and are applied no more stringently than, the
processes, strategies, evidentiary standards, or other factors used in applying the limitation for
medical/surgical benefits in the classification. (42 CFR §438.910(d))
B-20
Exhibit B
52. CONTRACTOR shall use processes, strategies, evidentiary standards, or other
factors in determining access to out-of-network providers for substance use disorder services that
are comparable to, and applied no more stringently than, the processes, strategies, evidentiary
standards, or other factors in determining access to out-of-network providers for medical/surgical
benefits. (42 CFR §438.910(d)(3)).
53. ACCESSIBILITY CONSIDERATIONS
CONTRACTOR shall ensure that their health programs or activities provided
through electronic and information technology are accessible to person served with disabilities,
unless doing so would result in undue financial and administrative burdens or a fundamental
alteration in the nature of the health programs or activities. When undue financial and
administrative burdens or a fundamental alteration exist, CONTRACTOR shall provide information
in a format other than an electronic format that would not result in such undue financial and
administrative burdens or a fundamental alteration but would ensure, to the maximum extent
possible, that person served with disabilities receive the benefits or services of the health program
or activity that are provided through electronic and information technology.
CONTRACTOR shall make reasonable modifications to policies, practices, or
procedures when such modifications are necessary to avoid discrimination on the basis of
disability, unless CONTRACTOR can demonstrate that making the modifications would
fundamentally alter the nature of the health program or activity. For the purposes of this section,
the term "reasonable modifications" shall be interpreted in a manner consistent with the term as
set forth in the ADA Title II regulation at 28 CFR 35.130(b)(7).
54. STATE PLAN COUNTIES OTP/NTP PERSONS SERVED
OTP CONTRACTORs shall ensure that a person served that resides in a county
that does not participate in DMC-ODS does not experience a disruption of OTP/NTP services. OTP
CONTRACTORs shall provide any medically necessary NTP services covered by the California
Medi-Cal State Plan to persons served that reside in a county that does not participate in DMC-
ODS. OTP CONTRACTORs who provide services to an out-of-county person served shall submit
claims for those services to the county in which the person served resides (according to MEDS).
PERSON SERVED RIGHTS
CONTRACTOR shall comply with any applicable Federal and state laws that pertain
to person served rights and shall ensure that its employees observe and protect those rights.
CONTRACTOR shall have written policies guaranteeing the person served's rights specified in 42
CFR 438.100.
RECORD RETENTION
CONTRACTORS shall maintain records for each service rendered, to whom it was
rendered, and the date of service, pursuant to WIC 14124.1 and 42 CFR 438.3(h) and 438.3(u).
B-21
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
EXHIBIT A
SCOPE OF WORK
1. CONTRACTED PARTIES:
A. The County of Fresno and/or their authorized designee, hereafter referred to as "Contractor,"
agrees to provide services (as defined in Section 4) pursuant to the terms and conditions of this
Agreement.
2. PROJECT REPRESENTATIVES:
A. The project representatives during the term of this Agreement shall be:
DSH Contract Manager: DSH Administrative Contact:
Section/Unit: Section/Unit:
Forensic Services Division Forensic Services Division
Attention: Ashley Breth Attention: Ashley Breth
Staff Services Manager I, Staff Services Manager I,
Specialist Specialist
Address: 1600 9th Street, Room 410 Address: 1600 9th Street, Room 410
Sacramento, CA 95814 Sacramento, CA 95814
Phone: Fax: Phone: TFax-:(916) 654-4187 (916) 651-1168 (916) 654-4187 ) 651-1168
Email: Email:
Ashley.Breth dsh.ca. ov Ashley.Breth dsh.ca. ov
County Contract Manager:
Section/Unit:
Department of Behavioral Health
Attention: Dawan Utecht
Director
Address: 1925 E. Dakota
Fresno, CA 93726
Phone: Fax:
(559) 600-9192
Email:
dutecht@fresnocountyca.gov
Either party may make changes to the contact names or information above by giving written notice to
the other party. Said changes shall not require an amendment to this Agreement.
D - 1
Exhibit D
3. PROJECT SUMMARY:
A. Contractor shall administer a pre-trial jail felony mental health diversion program for individuals
charged with felony offenses in Fresno County. Program participants are individuals with serious
mental disorders who have committed certain felony crimes and found by a Court of competent
jurisdiction, to qualify for diversion services pursuant to Penal Code section 1001.36 hereafter
referred to as "Felony Mental Health Diversion Clients." Contractor shall provide clinically
appropriate or evidence-based mental health treatment and wraparound services across a
continuum of care, as appropriate, to meet the individual needs of Felony Mental Health Diversion
Clients. For purposes of this section, "wraparound services" means services provided in addition to
the mental health treatment necessary to meet the individual's needs for successfully managing his
or her mental health symptoms and to successfully live in the community.
4. PROGRAM IMPLEMENTATION FUNDS:
A. The DSH shall distribute up to 25% of total funds to Contractor for initial program implementation
costs incurred under this Agreement. Contractor shall submit to the DSH a written program plan
including an outline of the use of the program implementation funding as a deliverable prior to
payment of funds. Program implementation costs shall include, but are not limited to:
a. Initial procurement and set up of diversion client housing
b. Initial administrative operating expenses and equipment
c. Initial training and technical assistance activities
d. Development of operational guidelines, policies and procedures
e. Recruitment, hiring, and orientation activities supporting new staff
5. CONTRACTOR RESPONSIBILITIES:
A. The estimated total number of unduplicated Felony Mental Health Diversion Clients to be served by
Contractor during the term of this agreement is 42. Felony Mental Health Diversion Clients must
maintain participation in the Diversion program for a minimum of 30 days to be counted towards the
Contractor's target population goals required for distribution of funds as outlined in Exhibit B,
Budget Detail. If a participating Felony Mental Health Diversion Client successfully completes the
program in less than 30 days, the Contractor may account for the Felony Mental Health Diversion
Client in the total reported to DSH for purposes of meeting target population goals required for
distribution of funds.
B. Contractor shall collaborate with community stakeholders and other partner agencies in the
planning and implementation of the diversion program as outlined in the required program plan
document. Collaborative partners include but are not limited to the following county-specific groups:
behavioral health, community-based treatment providers, housing providers, courts, Public
Defender, District Attorney, probation and Sheriff/jail administrator.
C. Contractor shall thoroughly assess and identify which Felony Mental Health Diversion Clients are
clinically appropriate for admission into the community-based jail diversion program based upon
statutory criteria (Welf. & Inst. Code, § 4361, subd. (c)(1)(A)-(C)). Additionally, Contractor shall
initiate and maintain treatment while the Felony Mental Health Diversion Clients are incarcerated
and awaiting release from jail and placement in the community.
D. To the extent not prohibited by Federal law, Contractor shall provide DSH with data no less than
quarterly including but not limited to statutory requirements detailed in AB1810 (2018) and Welfare
and Institutions Code section 4361 (Section 4361)for individual Felony Mental Health Diversion
D - 2
Exhibit D
Clients. DSH shall have the right to modify, reduce, or add data elements or outcome measures at
any time in its discretion consistent with Section 4361, subdivision (g). Exhibit A Attachment 1
details the statutory data elements that are required. Data shall be submitted in the method and
format set forth by the DSH. Contractor shall identify any data in the dataset subject to the rules of
42 Code of Federal Regulations part 2 upon submission to DSH. DSH shall use this data and
outcome measures to perform program evaluation to assess the efficacy and resource allocation of
the program, for monitoring of the program to ensure that services outlined in law and the proposal
were provided, to provide reports to the Legislature and other stakeholders, and to perform
research related to provision of improved services to the target population.
E. Felony Mental Health Diversion Clients housed in community-based diversion programs shall
remain under the legal and physical supervision of Contractor. Contractor is responsible for full
range of services and supports including but not limited to medical care, transportation, and
patients-rights services.
F. Contractor retains the right to exclude specific individual Felony Mental Health Diversion Clients
from the community-based diversion program based on the terms and conditions set forth in the
Client's Diversion plan or based on the criteria agreed upon by collaborative partner agencies at
any point during participation in the program.
G. Contractor shall submit a written document outlining the program plan developed and agreed to by
all county collaborative partners. Said document shall identify roles and responsibilities, describe
the program from initial identification of potential Felony Mental Health Diversion Clients to program
completion, and list all services to be provided in the program. Plan shall also include a detailed
program flowchart depicting all stages of the program; an itemized budget plan identifying
personnel and operation and equipment costs, county match, and other fund sources; and an
outline of program implementation costs as detailed in section 4 of this exhibit. The final county
plan must be approved by DSH prior to program implementation. Any changes to this plan must be
agreed to in writing by both parties.
H. Contractor shall connect individuals to services in the community after they have completed
diversion as defined in this agreement. Contractor shall be responsible for coordinating with
behavioral health programs for continued mental health care, crisis intervention, ongoing counseling
and care, and psychotropic medication compliance for the Felony Mental Health Diversion Clients.
I. Contractor will track Diversion expenditures and shall provide a report itemizing Diversion
expenditures and required match contributions, by funding source, to DSH within sixty days after
the close of the months of December and June on a bi-annual basis during the term of this
agreement. A final report itemizing Diversion expenditures and required match contributions, by
funding source, shall be due within sixty days after the termination of the agreement.
J. Contractor shall report in writing via email to the DSH Contract Manager or designee if a current
Felony Mental Health Diversion Client is absent without leave (AWOL) or is involved in a Special
Incident. Such reporting to DSH will take place within forty-eight (48) hours of such an incident.
A "Special Incident" is a significant patient occurrence or any event which has the potential of
adversely affecting the operation of the program. The following occurrences qualify as Special
Incidents:
i. Suicide or attempt;
ii. Death or serious injury of, or by, patient;
D - 3
Exhibit D
iii. Criminal behavior (including arrests, with or without conviction);
iv. Any incident which may result in public or media attention to the program.
K. If Contractor is unable to serve the total number of unduplicated Felony Mental Health Diversion
Clients stated in provision 5.A. due to actual client costs exceeding the level of funds available,
Contractor shall notify the DSH Contract Manager or designee in writing no less than 180 days prior
to the expiration of this Agreement; and shall provide an updated plan to include: 1) an explanation
of the reasons for the cost increases; 2) the revised number of Felony Mental Health Diversion
Clients to be served by the community-based diversion program; and 3) the revised budget, not to
exceed the maximum amount set forth in this Agreement. Upon approval of the revised plan by the
DSH, an amendment to this Agreement shall be initiated.
L. Contractor and its subcontractors shall procure and keep in full force and effect during the term of
this Agreement all permits, registrations, and licenses necessary to accomplish the work specified
in this Agreement and shall give all notices necessary and incident to the lawful prosecution of the
work. Contractor shall provide proof of any such Iicense(s), permits(s), and certificate(s) upon
request by the DSH. Contractor agrees that failure by itself or its subcontractors to provide evidence
of licensing, permits, or certifications shall constitute a material breach for which the DSH may
terminate this Agreement with cause.
M. Contractor shall provide services as outlined in this Agreement. Contractor shall be responsible to
fulfill the requirements of this Agreement and shall incur expenses at its own risk and invest
sufficient amount of time and capital to fulfill the obligations as contained herein.
N. Contractor and its subcontractors shall keep informed of, observe, comply with, and cause all its
agents and employees to observe and to comply with all prevailing Federal, State, and local laws,
rules, and regulations made pursuant to pertinent Federal, State, and local laws. If any conflict
arises between provisions of the plans and specifications and any such law above referred to, then
Contractor shall immediately notify the DSH in writing.
O. Unless otherwise specified, this Agreement may be canceled at any time by Contractor, in writing,
with 50 days advance notice. The DSH may terminate the Agreement pursuant to section 7 of
Exhibit C if Contractor or its subcontractors fails to comply with a federal, state, or local law and the
noncompliance, based on the facts and circumstances, would constitute a material breach of this
Agreement under California law.
6. DSH RESPONSIBILITIES:
A. DSH shall distribute funds to Contractor in accordance with the schedule outlined in Exhibit B,
Budget Detail.
B. The DSH shall provide a data collection process to Contractor. Contractor shall submit data to the
DSH no less than quarterly per statutory requirements. The Contractor shall collect the data
elements listed in Exhibit A Attachment 1. Additional elements may be added by DSH in
accordance with Section 4361.
C. Upon receipt of the statutory data requirements (Exhibit A Attachment 1)from Contractor, DSH will
analyze data for the purpose of program evaluation, monitoring, reporting, and research.
D - 4
Exhibit D
D. DSH will provide a quarterly report to Contractor summarizing the statutory data requirements and
outcome measures.
7. PERFORMANCE MEASURES:
A. Complete and Timely Provision of Services
i. Expectations: Contractor is expected to provide all services, including any and all required
reports, in a timely manner—in accordance with timelines established in this Scope of Work.
ii. Penalties: Should Contractor not provide all services, including any and all required reports in a
timely manner, the DSH may choose to terminate this Agreement. Additionally, the DSH may
find Contractor to be not responsible in provision of services and evaluate this in future
contracting opportunities.
8. AMENDMENTS:
A. The parties reserve the right to amend this Agreement for two additional terms of up to
one year each, and to add funding sufficient for these periods. This right to amend is in
addition to the right to amend for other reasons contained in this Agreement or noted in
the solicitation that resulted in this Agreement, if applicable. Any amendment shall be in
writing and signed by both parties.
D - 5
Exhibit D
EXHIBIT A, ATTACHMENT 1
STATUTORY OUTCOME DATA REQUIREMENTS
The DSH shall provide a data collection process to the Contractor. Contractor shall complete and submit the
required data to the DSH no less than quarterly. Contractor shall identify any data in the dataset subject to the
rules of 42 Code of Federal Regulations part 2 upon submission to DSH. The data collection process shall
capture, but is not limited to, the following data elements:
1. The number of individuals that the Court ordered to post-booking diversion and the length of time for
which the defendant has been ordered to Felony Mental Health Diversion (Diversion).
2. The number of individuals originally declared IST on felony charges that the Court ultimately ordered to
Diversion.
3. The number of individuals participating in Diversion.
4. The name, social security number, date of birth, and demographics of each individual participating in
Diversion.
5. The length of time in Diversion for each participating individual.
6. The types of services and supports provided to each individual participating in Diversion.
7. The number of days each individual was in jail prior to placement in Diversion.
8. The number of days that each individual spent in each level of care facility.
9. The diagnoses of each individual participating in Diversion.
10. The nature of the charges for each individual participating in Diversion.
11. The number of individuals who completed Diversion.
12. The name, social security number and birthdate of each individual who did not complete Diversion and
the reasons for not completing Diversion.
D - 6
Exhibit D
EXHIBIT B
BUDGET DETAIL AND PAYMENT PROVISIONS
1. INVOICING AND PAYMENT
A. For services satisfactorily rendered, upon implementation of the pre-trial Felony Mental Health
Diversion program and upon receipt and approval of invoices submitted as described herein, the
DSH agrees to compensate Contractor in accordance with the schedule of payments specified in
section 5, Budget Detail.
B. Contractor shall submit a single invoice for all initial program implementation costs associated with
and pertaining to the written plan submitted to DSH in accordance with Exhibit A, Scope of Work,
section 4, "Program Implementation Funds."
C. Contractor shall submit supporting documentation for each invoice to validate outcomes achieved
by the Contractor as specified in Exhibit B, Provision 5.
D. The DSH shall not be responsible for services performed by Contractor outside of this agreement,
or for services performed other than as outlined in Exhibit A, Scope of Work.
2. INSTRUCTIONS TO CONTRACTOR:
A. To expedite the processing of invoices submitted to the DSH for distribution of funds, all invoice(s)
shall be submitted to the DSH for review and approval at either:
Department of State Hospitals
Attention: Accounting Office
1600 Ninth Street, Room 141
Sacramento, CA 95814
OR
DSHSAC.AccountsPayable@dsh.ca.gov
B. Contractor shall submit one original and three copies of each invoice, unless emailed.
C. Contractor shall type, not handwrite, each invoice on company letterhead. The DSH may provide an
invoice template, if requested, which may be used in lieu of company letterhead.
D. Contractor shall clearly note Contractor's name and address on each invoice. The name on the
invoice must match the Payee Data Record (Std. 204) and the name listed on this Agreement.
E. Contractor shall list and itemize in accordance with the Budget Detail, all services or deliverables
provided on each invoice.
F. Contractor shall include the following on each submitted invoice:
i. Date(s) during which the services or deliverables were provided and the date in which the
invoice was generated.
ii. Agreement number, which can be found on the Standard Agreement Form (Std. 213).
iii. Small Business certification number, if applicable
iv. Professional license number, if applicable
D - 7
Exhibit D
v. Invoice total
3. BUDGET CONTINGENCY CLAUSE:
A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered
under this Agreement does not appropriate sufficient funds for the program, this Agreement shall no
longer be in full force and effect. In this event, the State shall have no liability to pay any funds
whatsoever to Contractor or to furnish any other considerations under this Agreement and
Contractor shall not be obligated to perform any provisions of this Agreement.
B. If funding for any Fiscal Year is reduced or deleted by the Budget Act for purposes of this program,
the State shall have the option to either cancel this Agreement with no liability occurring to the
State, or offer an Agreement amendment to Contractor to reflect the reduced amount.
C. If this Agreement overlaps Federal and State fiscal years, should funds not be appropriated by
Congress or approved by the Legislature for the Fiscal Year(s) following that during which this
Agreement was executed, the State may exercise its option to cancel this Agreement.
D. In addition, this Agreement is subject to any additional restrictions, limitations, or conditions enacted
by Congress or the Legislature which may affect the provisions or terms of funding of this
Agreement in any manner.
4. PROMPT PAYMENT CLAUSE:
A. Payment shall be made in accordance with, and within the time specified in, Government Code §
927 et seq.
5. BUDGET DETAIL:
A. The maximum amount of this Agreement shall not exceed $5,843,700.00.
B. Funds awarded to the County pursuant to this contract shall be distributed in a total of six (6)
installments as outlined below.
C. Upon contract execution, as well as receipt and approval of the single submitted invoice, the DSH
shall disburse one-time program implementation funds to Contractor not exceed $ 1,460,925 (up to
25% of total awarded).
D. Upon successful admission of 4 total unduplicated Felony Mental Health Diversion Clients with a
minimum length of stay of 30 days (10% of Contractor's target population goal), the DSH shall
disburse program funds to Contractor not to exceed $ 584,370.00 (10% of total awarded).
Supporting documentation required for distribution of funds shall be an itemized list of clients served
by the program including admission date and if applicable, discharge date.
E. Upon successful admission of 11 total unduplicated Felony Mental Health Diversion Clients with a
minimum length of stay of 30 days (25% of Contractor's target population goal), DSH shall disburse
program funds to Contractor not to exceed $ 876,555.00 (15% of total awarded). Supporting
documentation required for distribution of funds is an itemized list of clients served by the program
including admission date and if applicable, discharge date.
D - 8
Exhibit D
F. Upon admission of 21 total unduplicated Felony Mental Health Diversion Clients with a minimum
length of stay of 30 days (50% of Contractor's target population goal), DSH shall disburse the
remaining funds to Contractor not to exceed $ 1,168,740.00 (20% of total awarded). Supporting
documentation required for distribution of funds is an itemized list of clients served by the program
including admission date and if applicable, discharge date.
G. Upon admission of 32 total unduplicated Felony Mental Health Diversion Clients with a minimum
length of stay of 30 days (75% of Contractor's target population goal), DSH shall disburse the
remaining funds to Contractor not to exceed $ 876,555.00 (15% of total awarded). Supporting
documentation required for distribution of funds is an itemized list of clients served by the program
including admission date and if applicable, discharge date.
H. Upon admission of 42 total unduplicated Felony Mental Health Diversion Clients with a minimum
length of stay of 30 days (100% of Contractor's target population goal), DSH shall disburse the
remaining funds to Contractor not to exceed $ 876,555.00 (15% of total awarded). Supporting
documentation required for distribution of funds is an itemized list of clients served by the program
including admission date and if applicable, discharge date.
I. At the sole discretion of the DSH and for the purposes of accounting, the DSH may adjust the total
proposed expenditure for each fiscal year as needed. In no event will this change the contract price
for the services actually rendered.
J. Contractor shall submit all invoices within a reasonable time but, no later than 12 months from the
date that services were provided. If Contractor fails to provide invoices within 12 months of the date
services are rendered, the DSH may elect to reject the invoices for payment as untimely and
Contractor will be deemed to have waived any right to payment of the late invoices.
K. Contractor shall contribute a 20% or $ 1,168,740.00 match in local county funds. The county match
may be cash, in-kind, or a combination thereof. Local county funds allowable include but are not
limited to 1991 Realignment, 2011 Realignment, and county general fund. Funding from other state
or federal sources, including Medi-Cal federal financial participation, shall not be counted towards
the required county match.
L. Contractor shall utilize Peoplesoft Financial System to track Diversion expenditures and shall
provide a report itemizing Diversion expenditures and required match contributions to DSH within
sixty days after the close of the months of December and June on a bi-annual basis during the term
of this Agreement. A final report itemizing Diversion expenditures and required match contributions
shall be due within sixty days after the termination of the agreement.
D - 9
Exhibit D
EXHIBIT B, ATTACHMENT 1
SAMPLE INVOICE
THIS IS A SAMPLE.
[Insert Contractor's Department company logo/address]
INVOICE
DATE INVOICE#
Department of State Hospitals
Attn: Accounting Office
1600 9t" Street, Room 141
Sacramento, CA 95814
AGREEMENT#
DSH Diversion Funding Disbursement Request
Disbursement Program Benchmark Total Disbursement Requested
Program
El One Implementation $
Admission of 10% of
❑ Two clients $
Admission of 25% of
El Three clients
Admission of 50% of
El Four clients $
❑ Five Admission of 75% of $
clients
Admission of 100% of
El Six clients
PLEASE MAKE REMITTANCE PAYABLE TO:
[Insert Contractor's Department billing contact/address]
Prepared By: [Signature here]
[Insert name/title here]
D - 10
Exhibit D
EXHIBIT C
GENERAL TERMS AND CONDITIONS
1. APPROVAL: This Agreement is of no force or effect until signed by both parties and approved by the
Department of General Services, if required. Contractor may not commence performance until such
approval has been obtained.
2. AMENDMENT: No amendment or variation of the terms of this Agreement shall be valid unless made in
writing, signed by the parties and approved as required. No oral understanding or Agreement not
incorporated in the Agreement is binding on any of the parties.
3. ASSIGNMENT: This Agreement is not assignable by the Contractor, either in whole or in part, without the
consent of the State in the form of a formal written amendment.
6. AUDIT: Contractor agrees that the awarding department, the Department of General Services, the Bureau
of State Audits, or their designated representative shall have the right to review and to copy any records
and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to
maintain such records for possible audit for a minimum of three (3) years after final payment, unless a
longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such
records during normal business hours and to allow interviews of any employees who might reasonably
have information related to such records. Further, Contractor agrees to include a similar right of the State
to audit records and interview staff in any subcontract related to performance of this Agreement. (Gov.
Code §8546.7, Pub. Contract Code §10115 et seq., CCR Title 2, Section 1896)
7. DISPUTES: Contractor shall continue with the responsibilities under this Agreement during any dispute.
8. TERMINATION FOR CAUSE: The State may terminate this Agreement and be relieved of any payments
should the Contractor fail to perform the requirements of this Agreement at the time and in the manner
herein provided. In the event of such termination the State may proceed with the work in any manner
deemed proper by the State. All costs to the State shall be deducted from any sum due the Contractor
under this Agreement and the balance, if any, shall be paid to the Contractor upon demand.
9. INDEPENDENT CONTRACTOR: Contractor, and the agents and employees of Contractor, in the
performance of this Agreement, shall act in an independent capacity and not as officers or employees or
agents of the State.
10. RECYCLING CERTIFICATION: The Contractor shall certify in writing under penalty of perjury, the
minimum, if not exact, percentage of post-consumer material as defined in the Public Contract Code
Section 12200, in products, materials, goods, or supplies offered or sold to the State regardless of whether
the product meets the requirements of Public Contract Code Section 12209. With respect to printer or
duplication cartridges that comply with the requirements of Section 12156(e), the certification required by
this subdivision shall specify that the cartridges so comply (Pub. Contract Code §12205).
11. NON-DISCRIMINATION CLAUSE: During the performance of this Agreement, Contractor and its
subcontractors shall not deny the contract's benefits to any person on the basis of race, religious creed,
color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information,
marital status, sex, gender, gender identity, gender expression, age, sexual orientation, or military and
veteran status, nor shall they discriminate unlawfully against any employee or applicant for employment
because of race, religious creed, color, national origin, ancestry, physical disability, mental disability,
medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
D - 11
Exhibit D
sexual orientation, or military and veteran status. Contractor shall insure that the evaluation and treatment
of employees and applicants for employment are free of such discrimination. Contractor and
subcontractors shall comply with the provisions of the Fair Employment and Housing Act (Gov. Code
§12900 et seq.), the regulations promulgated thereunder (Cal. Code Regs., tit. 2, §11000 et seq.), the
provisions of Article 9.5, Chapter 1, Part 1, Division 3, Title 2 of the Government Code (Gov. Code
§§11135-11139.5), and the regulations or standards adopted by the awarding state agency to implement
such article. Contractor shall permit access by representatives of the Department of Fair Employment and
Housing and the awarding state agency upon reasonable notice at any time during the normal business
hours, but in no case less than 24 hours' notice, to such of its books, records, accounts, and all other
sources of information and its facilities as said Department or Agency shall require to ascertain compliance
with this clause. Contractor and its subcontractors shall give written notice of their obligations under this
clause to labor organizations with which they have a collective bargaining or other agreement. (See Cal.
Code Regs., tit. 2, §11105.)
Contractor shall include the nondiscrimination and compliance provisions of this clause in all subcontracts
to perform work under the Agreement.
12. CERTIFICATION CLAUSES: The CONTRACTOR CERTIFICATION CLAUSES contained in the document
CCC 04/2017 are hereby incorporated by reference and made a part of this Agreement by this reference
as if attached hereto.
13. TIMELINESS: Time is of the essence in this Agreement.
14. COMPENSATION: The consideration to be paid Contractor, as provided herein, shall be in compensation
for all of Contractor's expenses incurred in the performance hereof, including travel, per diem, and taxes,
unless otherwise expressly so provided.
15. GOVERNING LAW: This contract is governed by and shall be interpreted in accordance with the laws of
the State of California.
16. ANTITRUST CLAIMS: The Contractor by signing this agreement hereby certifies that if these services or
goods are obtained by means of a competitive bid, the Contractor shall comply with the requirements of the
Government Codes Sections set out below.
a. The Government Code Chapter on Antitrust claims contains the following definitions:
1) "Public purchase" means a purchase by means of competitive bids of goods, services, or materials
by the State or any of its political subdivisions or public agencies on whose behalf the Attorney
General may bring an action pursuant to subdivision (c) of Section 16750 of the Business and
Professions Code.
2) "Public purchasing body" means the State or the subdivision or agency making a public purchase.
Government Code Section 4550.
b. In submitting a bid to a public purchasing body, the bidder offers and agrees that if the bid is accepted,
it will assign to the purchasing body all rights, title, and interest in and to all causes of action it may
have under Section 4 of the Clayton Act (15 U.S.C. Sec. 15) or under the Cartwright Act (Chapter 2
(commencing with Section 16700) of Part 2 of Division 7 of the Business and Professions Code),
arising from purchases of goods, materials, or services by the bidder for sale to the purchasing body
pursuant to the bid. Such assignment shall be made and become effective at the time the purchasing
body tenders final payment to the bidder. Government Code Section 4552.
D - 12
Exhibit D
c. If an awarding body or public purchasing body receives, either through judgment or settlement, a
monetary recovery for a cause of action assigned under this chapter, the assignor shall be entitled to
receive reimbursement for actual legal costs incurred and may, upon demand, recover from the public
body any portion of the recovery, including treble damages, attributable to overcharges that were paid
by the assignor but were not paid by the public body as part of the bid price, less the expenses incurred
in obtaining that portion of the recovery. Government Code Section 4553.
d. Upon demand in writing by the assignor, the assignee shall, within one year from such demand,
reassign the cause of action assigned under this part if the assignor has been or may have been
injured by the violation of law for which the cause of action arose and (a) the assignee has not been
injured thereby, or (b) the assignee declines to file a court action for the cause of action. See
Government Code Section 4554.
16. CHILD SUPPORT COMPLIANCE ACT: For any Agreement in excess of$100,000, the contractor
acknowledges in accordance with Public Contract Code 7110, that:
a. The contractor recognizes the importance of child and family support obligations and shall fully comply
with all applicable state and federal laws relating to child and family support enforcement, including, but
not limited to, disclosure of information and compliance with earnings assignment orders, as provided in
Chapter 8 (commencing with section 5200) of Part 5 of Division 9 of the Family Code; and
b. The contractor, to the best of its knowledge is fully complying with the earnings assignment orders of all
employees and is providing the names of all new employees to the New Hire Registry maintained by
the California Employment Development Department.
17. UNENFORCEABLE PROVISION: In the event that any provision of this Agreement is unenforceable or
held to be unenforceable, then the parties agree that all other provisions of this Agreement have force and
effect and shall not be affected thereby.
18. PRIORITY HIRING CONSIDERATIONS: If this Contract includes services in excess of$200,000, the
Contractor shall give priority consideration in filling vacancies in positions funded by the Contract to
qualified recipients of aid under Welfare and Institutions Code Section 11200 in accordance with Pub.
Contract Code §10353.
19. SMALL BUSINESS PARTICIPATION AND DVBE PARTICIPATION REPORTING REQUIREMENTS:
a. If for this Contract Contractor made a commitment to achieve small business participation, then
Contractor must within 60 days of receiving final payment under this Contract (or within such other time
period as may be specified elsewhere in this Contract) report to the awarding department the actual
percentage of small business participation that was achieved. (Govt. Code § 14841.)
b. If for this Contract Contractor made a commitment to achieve disabled veteran business enterprise
(DVBE) participation, then Contractor must within 60 days of receiving final payment under this
Contract (or within such other time period as may be specified elsewhere in this Contract) certify in a
report to the awarding department: (1) the total amount the prime Contractor received under the
Contract; (2) the name and address of the DVBE(s) that participated in the performance of the
Contract; (3) the amount each DVBE received from the prime Contractor; (4) that all payments under
the Contract have been made to the DVBE; and (5) the actual percentage of DVBE participation that
was achieved. A person or entity that knowingly provides false information shall be subject to a civil
penalty for each violation. (Mil. & Vets. Code § 999.5(d); Govt. Code § 14841.)
D - 13
Exhibit D
20. LOSS LEADER: If this contract involves the furnishing of equipment, materials, or supplies then the
following statement is incorporated: It is unlawful for any person engaged in business within this state to
sell or use any article or product as a "loss leader" as defined in Section 17030 of the Business and
Professions Code. (PCC 10344(e).)
D - 14
Exhibit D
EXHIBIT D
SPECIAL TERMS AND CONDITIONS
1. SUBCONTRACTS:
A. Except for subcontracts identified in accordance with the solicitation, Contractor shall submit any
subcontracts in connection with this Agreement to the DSH for its prior written approval. No work
shall be subcontracted without the prior written approval of the DSH. Upon the termination of any
subcontract, the DSH shall be notified immediately. Any subcontract shall include all the terms
and conditions of this Agreement and its attachments.
B. Nothing contained in this Agreement shall create any contractual relationship between the DSH
and any subcontractors, and Contractor is solely responsible for payment of any and all fees,
expenses, salaries and benefits of subcontractor. No subcontract shall relieve Contractor of its
responsibilities and obligations hereunder. Contractor is fully responsible to the DSH for the acts
and omissions of its subcontractors and of persons either directly or indirectly employed or acting
as an agent by any of them. Contractor agrees to indemnify and hold the DSH harmless for any
costs, losses or claims, including reasonable attorney fees, resulting from its subcontractors.
2. PUBLICATIONS AND REPORTS:
A. The DSH reserves the right to use and reproduce all publications, reports, and data produced or
delivered pursuant to this Agreement. The DSH further reserves the right to authorize others to
use or reproduce such materials, provided the author of the report is acknowledged in any such
use or reproduction.
B. If the publication and/or report are prepared by non-employees of the DSH, and the total cost for
such preparation exceeds $5,000, the publication and/or report shall contain the numbers and
dollar amounts of all agreements and subcontracts relating to the preparation of the publication
and report in a separate section of the report (Gov. Code, §7550).
3. PROGRESS REPORTS:
A. If progress reports are required by the Agreement, Contractor shall provide a progress report in
writing, or orally if approved by the DSH Contract Manager, at least once a month to the DSH
Contract Manager. This progress report shall include, but not be limited to, a statement that the
Contractor is or is not on schedule, any pertinent reports, and any interim findings if applicable.
Contractor shall cooperate with and shall be available to meet with the DSH to discuss any
difficulties or special problems, so that solutions or remedies can be developed as soon as
possible.
4. PRESENTATION:
A. Upon request, Contractor shall meet with the DSH to present any findings, conclusions, and
recommendations required by the Agreement for approval. If set forth in the Agreement,
Contractor shall submit a comprehensive final report for approval. Both the final meeting and the
final report shall be completed on or before the date indicated in this Agreement.
5. DEPARTMENT OF STATE HOSPITALS STAFF:
A. The DSH's staff shall be permitted to work side-by-side with Contractor's staff to the extent and
under conditions as directed by the DSH Contract Manager. In this connection, the DSH's staff
shall be given access to all data, working papers, etc., which Contractor seeks to utilize.
D - 15
Exhibit D
6. CONFIDENTIALITY OF DATA AND DOCUMENTS:
A. Contractor shall not disclose data or documents or disseminate the contents of the final or any
preliminary report without written permission of the DSH Contract Manager. However, all public
entities shall comply with California Public Records Act (Gov. Code, §6250 et seq.).
B. Permission to disclose information or documents on one occasion shall not authorize Contractor
to further disclose such information or documents on any other occasion except as otherwise
provided in the Agreement or required by law.
C. Contractor shall not comment publicly to the press, or any other media, regarding the data or
documents generated, collected, or produced in connection with this Agreement, or the DSH's
actions on the same, except to the DSH's staff, Contractor's own personnel involved in the
performance of this Agreement, or as required by law.
D. If requested by the DSH, Contractor shall require each of its employees or officers who will be
involved in the performance of this Agreement to agree to the above terms in a form to be
approved by the DSH and shall supply the DSH with evidence thereof.
E. After any data or documents submitted has become a part of the public records of the DSH,
Contractor may at its own expense and upon written approval by the DSH Contract Manager,
publish or utilize the same data or documents but shall include the following Notice:
LEGAL NOTICE
This report was prepared as an account of work sponsored by the Department of State Hospitals
(Department), but does not necessarily represent the views of the Department or any of its employees
except to the extent, if any, that it has formally been approved by the Department. For information
regarding any such action, communicate directly with the Department at P.O. Box 952050,
Sacramento, California, 94252-2050. Neither said Department nor the State of California, nor any
officer or employee thereof, or any of its contractors or subcontractors makes any warranty, express or
implied, or assumes any legal liability whatsoever for the contents of this document. Nor does any
party represent that use of the data contained herein, would not infringe upon privately owned rights
without obtaining permission or authorization from any party who has any rights in connection with the
data.
7. PROVISIONS RELATING TO DATA:
A. "Data" as used in this Agreement means recorded information, regardless of form or
characteristics, of a scientific or technical nature. It may, for example, document research,
experimental, developmental or engineering work; or be usable or be used to define a design or
process; or support a premise or conclusion asserted in any deliverable document called for by
this Agreement. The data may be graphic or pictorial delineations in media, such as drawings or
photographs, charts, tables, mathematical modes, collections or extrapolations of data or
information, etc. It may be in machine form, as punched cards, magnetic tape, computer
printouts, or may be retained in computer memory.
D - 16
Exhibit D
B. "Generated data" is that data, which Contractor has collected, collated, recorded, deduced, read
out, or postulated for utilization in the performance of this Agreement. Any electronic data
processing program, model or software system developed or substantially modified by Contractor
in the performance of this Agreement at the expense of the DSH, together with complete
documentation thereof, shall be treated in the same manner as generated data.
C. "Deliverable data" is that data which under terms of this Agreement is required to be delivered to
the DSH. Such data shall be property of the State of California and the DSH.
D. Prior to the expiration of any legally required retention period and before destroying any data,
Contractor shall notify the DSH of any such contemplated action; and the DSH may within
30 days of said notification determine whether or not this data shall be further preserved. The
DSH shall pay the expense of further preserving this data. The DSH shall have unrestricted
reasonable access to the data that is preserved in accordance with this Agreement.
E. Contractor shall use best efforts to furnish competent witnesses to testify in any court of law
regarding data used in or generated under the performance of this Agreement.
F. All financial, statistical, personal, technical and other data and information relating to the DSH's
operation, which are designated confidential by the State or the DSH and made available to carry
out the Agreement, or which become available to Contractor in order to carry out this Agreement,
shall be protected by Contractor from unauthorized use and disclosure.
G. If the DSH determines that the data and information are inadequately protected by Contractor or
its subcontractors, the DSH shall provide notice of its determination and Contractor and/or its
subcontractors shall improve the protections to the DSH's satisfaction which shall be evidenced
by written approval of the protections implemented.
8. APPROVAL OF PRODUCT:
A. Each product to be approved under this Agreement shall be approved by the Contract Manager.
The DSH's determination as to satisfactory work shall be final, absent fraud or mistake.
9. SUBSTITUTIONS:
A. Contractor's key personnel as indicated in its proposal may not be substituted without the
Contract Manager's prior written approval.
10. NOTICE:
A. Notice to either party shall be given by first class mail, by Federal Express, United Parcel Service
or similar carrier, properly addressed, postage fully prepaid, to the address beneath the name of
each respective party. Alternatively, notice may be given by personal delivery by any means
whatsoever to the party and such notice shall be deemed effective when delivered.
11. WAIVER:
A. All remedies afforded in this Agreement are cumulative; that is, in addition to every other remedy
provided therein or by law. The failure of the DSH to enforce any provision of this Agreement,
shall not waive its right to enforce the provision or any other provision of the Agreement.
D - 17
Exhibit D
12. GRATUITIES AND CONTINGENCY FEES:
A. Contractor shall not provide gratuities to any officer or employee of the DSH or the State to secure
an agreement or favorable treatment with respect to an agreement, the occurrence of which shall
constitute a material breach of this Agreement. The DSH, by written notice to Contractor, may
terminate this Agreement with cause if it is found that gratuities were offered or given by
Contractor or any agent or representative of the Contractor to any officer or employee of the State
or the DSH with a view toward securing an agreement or securing favorable treatment with
respect to the awarding, amending, or performance of such agreement.
B. In the event this Agreement is terminated as provided in the paragraph above, the DSH shall be
entitled (a) to pursue the same remedies against Contractor as it could pursue in the event of the
breach of the Agreement by Contractor, and (b) as a predetermined amount of liquidated
damages, Contractor shall pay an amount which shall not be less than three times the cost
incurred by Contractor in providing any such gratuities to any such officer or employee.
C. The rights and remedies of the DSH provided in this clause shall not be exclusive and are in
addition to any other rights and remedies provided by law or under this Agreement.
D. Contractor warrants by execution of this Agreement that no person or selling agency has been
employed or retained to solicit or secure this Agreement for a commission, percentage, brokerage
or contingent fee, excepting bona fide employees of Contractor, for the purpose of securing
business. For breach or violation of this warranty, the DSH shall, among other rights, have the
right to rescind this Agreement without liability, paying only for the values of the work actually
returned, or in its discretion to deduct from the Agreement price or consideration, or otherwise
recover, the full amount of such commission, percentage, brokerage, or contingent fee.
13. INTEGRATION CLAUSE:
A. The parties agree that this Agreement, including only the State standard form 213 and all exhibits,
constitute the entire agreement of the parties and no other understanding or communication,
whether written or oral, shall be construed to be a part of this Agreement.
14. CAPTIONS:
A. The clause headings appearing in this Agreement have been inserted for the purpose of
convenience and ready reference. They do not purport to and shall not be deemed to define, limit
or extend the scope or intent of the clauses to which they pertain.
15. PUBLIC HEARINGS:
A. If public hearings on the subject matter dealt with in this Agreement are held within one year from
the Agreement expiration date, Contractor shall make available to testify the personnel assigned
to this Agreement at the hourly rates specified in Contractor's proposed budget. The DSH shall
reimburse Contractor for travel of said personnel at the Agreement, or if none, at State rates for
such testimony as may be requested by the DSH.
D - 18
Exhibit D
16. FORCE MAJEURE:
A. Neither the DSH nor Contractor shall be deemed to be in default in the performance of the terms
of this Agreement if either party is prevented from performing the terms of this Agreement by
causes beyond its control, which shall include without being limited to: acts of God; interference,
rulings or decision by municipal, Federal, State, or other governmental agencies, boards or
commissions; any laws and/or regulations of such municipal, State, Federal, or other
governmental bodies; or any catastrophe resulting from flood, fire, explosion, earthquakes, or
other similar environmental causes beyond the control of the defaulting party. If any of the stated
contingencies occur, the party delayed by force majeure shall immediately give the other party
written notice of the cause of delay. The party delayed by force majeure shall use reasonable
diligence to correct the cause of the delay, if correctable.
17. LITIGATION:
A. The DSH, promptly after receiving notice thereof, shall notify Contractor in writing of the
commencement of any claim, suit, or action against the DSH or its officers or employees.
Contractor shall immediately notify the DSH of any claim or action against it which affects, or may
affect, this Agreement, the terms or conditions hereunder, the DSH, and shall take such action
with respect to said claim or action which is consistent with the terms of this Agreement and the
interest of the DSH.
B. Contractor shall be in default of this Agreement (i) upon the institution by or against Contractor of
insolvency, receivership or bankruptcy proceedings or any other proceedings for the settlement of
Contractor's debts, (ii) upon Contractor making an assignment for the benefit of creditors, (iii)
upon either party's dissolution or ceasing to do business or (iv) when the facts and circumstances
indicate that Contractor is insolvent. For purposes of this Agreement, Contractor shall be deemed
insolvent if: (i) Contractor has failed to pay salaries, overtime or benefits required by law of
agreement, (ii) Contractor has failed to pay a subcontractor amounts owed pursuant to its
agreements with a subcontractor, or (iii) Contractor has failed to pay a vendor amounts Contractor
owes the vendor for more than 90 days the past due date for payment.
18. DISPUTES:
A. Contractor shall first discuss and attempt to resolve any dispute arising under or relating to the
performance of this Agreement, which is not disposed of by the Agreement, informally with the
DSH Contract Manager. If the dispute cannot be disposed of at this level, then the dispute shall
be decided by the DSH Deputy Director of Administration. All issues pertaining to this dispute
shall be submitted in written statements and addressed to the Deputy Director of Administration,
Department of State Hospitals, 1600 9th Street, Room 101, Sacramento, California 95814. Such
written notice must contain the Agreement Number. Within ten days of receipt of the written
grievance report from Contractor, the Deputy Director of Administration, or his/her designee, shall
meet with Contractor and the Project Manager for the purposes of resolving the dispute. The
decision of the Deputy Director shall be final. During the dispute process, Contractor shall
proceed diligently with the performance of the Agreement. Neither the pendency of a dispute, nor
its consideration by the Deputy Director of Administration, shall excuse Contractor from full and
timely performance of the services required in accordance with the terms of this Agreement.
D - 19
Exhibit D
19. EVALUATION OF CONTRACTOR'S PERFORMANCE:
A. The DSH shall evaluate Contractor's performance under this Agreement using standardized
evaluation forms which shall be made available to every state agency pursuant to Public Contract
Code §10367.
20. AUDITS, INSPECTION AND ENFORCEMENT:
A. Contractor agrees to allow the DSH to inspect its facilities and systems, and make available for
review its books and records to enable the DSH to monitor compliance with the terms of this
Agreement and audit invoices submitted to the DSH.
B. Contractor shall promptly remedy any violation of any provision of this Agreement to the
satisfaction of the DSH.
C. The fact that the DSH inspects, or fails to inspect, or has the right to inspect Contractor's facilities,
systems, books and records does not relieve Contractor of its responsibility to independently
monitor its compliance with this Agreement.
D. The DSH's failure to detect or the DSH's detection of any unsatisfactory practices, but failure to
notify Contractor or require Contractor's remediation of the unsatisfactory practices does not
constitute acceptance of such practice or a waiver of the DSH's enforcement rights under the
Agreement.
21. USE OF STATE FUNDS:
A. Contractor, including its officers and members, shall not use funds received from the DSH
pursuant to this Agreement to support or pay for costs or expenses related to the following:
i. Campaigning or other partisan activities to advocate for either the election or defeat of any
candidate for elective office, or for or against the passage of any proposition or ballot
measure; or,
ii. Lobbying for either the passage or defeat of any legislation.
B. This provision is not intended and shall not be construed to limit any expression of a view,
opinion, or position of any member of Contractor as an individual or private citizens, as long as
State funds are not used; nor does this provision limit Contractor from merely reporting the results
of a poll or survey of its membership.
22. CANCELLATION PROVISIONS:
A. Unless otherwise specified, this Agreement may be canceled at any time by the DSH, in writing,
with thirty (30) days advance notice. If canceled, payment shall be made only for the provision of
services expressly authorized by this Agreement until the date of cancellation and only at the
rates set forth in Exhibit B, Budget Detail. In the case of early termination, a final payment will be
made to Contractor upon receipt of an invoice covering all authorized costs, at the rates set forth
in Exhibit B, incurred prior to the date of cancellation or termination. The DSH shall not be
responsible for unamortized costs, overhead or capital costs or any other related costs, including
but, not limited to costs incurred in connection with the cancellation of leases or contracts
pertaining to facilities, equipment or supplies, labor and employee benefits costs, and
expenditures incurred after the date of notice of cancellation.
D - 20
Exhibit D
B. If the DSH determines that Contractor has breached a material term of the Agreement and has
not cured the breach or ended the violation within the time specified by the DSH, the DSH may
terminate the contract by providing notice to Contractor. The DSH Information Security Officer
shall report as required HIPAA violations to the Secretary of the U.S. Department of Health and
Human Services.
C. Failure to comply with section 1 or 6 of this Exhibit, or a violation of section 12 of this Exhibit, shall
be deemed a material breach of this Agreement.
23. EMPLOYMENT PROVISIONS:
A. Contractor acknowledges and agrees that neither Contractor, their personnel, subcontractors, nor
other service providers through this Agreement are employees of the DSH. Contractor and its
independent contractors shall be solely responsible for:
i. Paying any and all payroll taxes, including, but not limited to Social Security and Medicare
taxes,
ii. Federal or state income tax withholding,
iii. Providing unemployment insurance and workers compensation insurance, and
iv. Paying compensation to its employees in accordance with federal and state labor laws,
including overtime pay unless otherwise specified in this Agreement, as well as penalties that
may be imposed for failure to comply with these laws. Contractor agrees to indemnify and
hold harmless the DSH for any damages, losses, expenses, including reasonable attorney
fees, in connection with its failure to pay salary or overtime, or provide benefits, including, but
not limited to health care benefits or retirement benefits, to its employees, or its failure to
provide to comply with federal or state labor laws.
24. LIABILITY FOR LOSS AND DAMAGES:
A. Any damages by Contractor, their personnel, subcontractors, and other service providers through
this Agreement to the DSH's facility, including equipment, furniture, materials, or other State or
DSH property, shall be repaired or replaced by Contractor to the satisfaction of the DSH at
Contractor's expense. The DSH, at its option, may repair any such damage and deduct the cost
thereof from any sum due Contractor under this Agreement.
25. SECURITY CLEARANCE/FINGERPRINTING/TUBERCULIN SKIN TESTING:
A. The DSH reserves the right to conduct fingerprinting, drug testing, and/or security clearance
through the Department of Justice, Bureau of Criminal Identification and Information (BCII), prior
to award and at any time during the term of the Agreement, in order to permit Contractor, their
personnel, subcontractors, and other service providers through this Agreement access to State
premises. The DSH further reserves the right to terminate this Agreement should a threat to
security, by Contractor, their personnel, subcontractors, and other service providers through this
Agreement, be determined.
D - 21
Exhibit D
B. At the sole discretion of the DSH, and in accordance with each facility's Infection Control Policy,
the Contractor, their personnel, subcontractors, and anyone else affiliated with this Agreement
providing services may be required to provide the DSH with Tuberculin (TB) test results. These
test results shall indicate completion of the two-step TB testing process using the Mantoux
method. The first step is a tuberculin skin test (TST) completed within the last 12 months prior to
the date the tested person is to provide services to a DSH facility. The second step is a TST
which must be completed within the 30 days prior to the date the tested person is to provide
services to a DSH facility, unless otherwise specified.
C. If both of the documented results of the TST provided <_ 0-9/mm of induration, then the tested
person may be cleared to provide services. However, if the documented result of the TST is >_
10/mm of induration, then they shall be subject to additional testing and/or clearances before he
or she is allowed to work at a DSH facility.
D. The DSH reserves the right, in its sole and absolute discretion, to take measures to minimize the
transmission of influenza. Contractor, their personnel, subcontractors, and other service providers
through this Agreement may be required to either a) show written proof that they have received an
influenza vaccine, or b) complete an Influenza Declination Form, which will be provided upon
request. In addition, all non-vaccinated providers may be required to wear a mask. In its sole and
absolute discretion, DSH may elect to provide free influenza vaccines to Contractor, their
personnel, subcontractors, and other service providers through this Agreement.
26. PHYSICIAN OWNERSHIP AND REFERRAL ACT OF 1993:
A. For applicable medical services contracts, and in accordance with the Physician Ownership and
Referral Act of 1993, Contractor shall not refer any patient to any health care provider or health-
related facility if the Contractor has a financial interest with that health care provider or health-
related facility.
B. Contractor may make a referral to or request consultation from a sole source health care provider
or health-related facility in which financial interest is held if Contractor is located where there is no
alternative provider of service within either twenty-five (25) miles or forty (40) minutes travel time,
subject to the prior approval of the DSH. Contractor shall disclose, in writing, as well as on a
continuous basis, to the DSH, its financial interest at the time of referral or request for
consultation. In no event, will this prohibit patients from receiving emergency health care
services.
D - 22
Exhibit D
DEPARTMENT OF STATE HOSPITALS
EXHIBIT F
(For Non-HIPAA/HITECH Act Contracts)
Information Privacy and Security Requirements
This Information Privacy and Security Requirements Exhibit (For Non-HIPAA/HITECH Act Contracts)
(hereinafter referred to as "this Exhibit") sets forth the information privacy and security requirements Contractor
is obligated to follow with respect to all personal and confidential information (as defined herein) disclosed to
Contractor, or collected, created, maintained, stored, transmitted or used by Contractor for or on behalf of the
California Department of State Hospitals (hereinafter "DSH"), pursuant to Contractor's agreement with DSH.
(Such personal and confidential information is referred to herein collectively as"DSH PCI".) DSH and Contractor
desire to protect the privacy and provide for the security of DSH PCI pursuant to this Exhibit and in compliance
with state and federal laws applicable to the DSH PCI.
I. Order of Precedence: With respect to information privacy and security requirements for all DSH PCI, the
terms and conditions of this Exhibit shall take precedence over any conflicting terms or conditions set
forth in any other part of the agreement between Contractor and DSH, including Exhibit A (Scope of
Work), all other exhibits and any other attachments, and shall prevail over any such conflicting terms or
conditions.
11. Effect on lower tier transactions: The terms of this Exhibit shall apply to all contracts, subcontracts, and
subawards, and the information privacy and security requirements Contractor is obligated to follow with
respect to DSH PCI disclosed to Contractor, or collected, created, maintained, stored, transmitted or
used by Contractor for or on behalf of DSH, pursuant to Contractor's agreement with DSH. When
applicable the Contractor shall incorporate the relevant provisions of this Exhibit into each subcontract or
subaward to its agents, subcontractors, or independent consultants.
111. Definitions: For purposes of the agreement between Contractor and DSH, including this Exhibit, the
following definitions shall apply:
A. Breach: "Breach" means:
1. the unauthorized acquisition, access, use, or disclosure of DSH PCI in a manner which
compromises the security, confidentiality or integrity of the information; or
2. the same as the definition of "breach of the security of the system" set forth in California Civil
Code section 1798.29(f).
B. Confidential Information: "Confidential information" means information that:
1. does not meet the definition of"public records" set forth in California Government Code section
6252(e), or is exempt from disclosure under any of the provisions of Section 6250, et seq of the
California Government Code or any other applicable state or federal laws; or
2. is contained in documents, files, folders, books or records that are clearly labeled, marked or
designated with the word "confidential" by DSH.
D - 23
Exhibit D
C. Disclosure: "Disclosure" means the release, transfer, provision of, access to, or divulging in any
manner of information outside the entity holding the information.
D. PCI: "PCI" means "personal information" and "confidential information" collectively (as these terms
are defined herein).
E. Personal Information: "Personal information" means information, in any medium (paper, electronic,
oral) that:
1. directly or indirectly collectively identifies or uniquely describes an individual; or
2. could be used in combination with other information to indirectly identify or uniquely describe an
individual, or link an individual to the other information; or
3. meets the definition of "personal information" set forth in California Civil Code section 1798.3,
subdivision (a); or
4. is one of the data elements set forth in California Civil Code section 1798.29, subdivision (g)(1)
or (g)(2); or
5. meets the definition of "medical information" set forth in either California Civil Code section
1798.29, subdivision (h)(2), or California Civil Code section 56.05, subdivision 0); or
6. meets the definition of "health insurance information" set forth in California Civil Code section
1798.29, subdivision (h)(3); or
7. is protected from disclosure under applicable state or federal law.
F. Security Incident: "Security Incident" means:
1. an attempted breach; or
2. the attempted or successful unauthorized access or disclosure, modification or destruction of
DSH PCI, in violation of any state or federal law or in a manner not permitted under the
agreement between Contractor and DSH, including this Exhibit; or
3. the attempted or successful modification or destruction of, or interference with, Contractor's
system operations in an information technology system, that negatively impacts the
confidentiality, availability or integrity of DSH PCI; or
4. any event that is reasonably believed to have compromised the confidentiality, integrity, or
availability of an information asset, system, process, data storage, or transmission.
Furthermore, an information security incident may also include an event that constitutes a
violation or imminent threat of violation of information security policies or procedures, including
acceptable use policies.
G. Use: "Use" means the sharing, employment, application, utilization, examination, or analysis of
information.
IV. Disclosure Restrictions: The Contractor and its employees, agents, and subcontractors shall protect from
unauthorized disclosure any DSH PCI. The Contractor shall not disclose, except as otherwise specifically
permitted by the agreement between Contractor and DSH (including this Exhibit), any DSH PCI to anyone
D - 24
Exhibit D
other than DSH personnel or programs without prior written authorization from the DSH Program Contract
Manager, except if disclosure is required by State or Federal law.
V. 42 C.F.R. Part 2 compliance: DSH shall receive patient identifying substance use disorder treatment
information for program evaluation and auditing purposes. In accordance with 42 C.F.R. part 2.53, DSH
agrees to:
(i) Maintain and destroy patient identifying information and records covered by 42 C.F.R. Part 2 in
a manner consistent with the policies and procedures established under 42 C.F.R. part 2.16;
(ii) Retain records in compliance with applicable federal, state, and local record retention laws;
and
(iii) Comply with the limitations on disclosure and use in 42 C.F.R. part 2.53(d).
VI. Use Restrictions: The Contractor and its employees, agents, and subcontractors shall not use any DSH
PCI for any purpose other than performing the Contractor's obligations under its agreement with DSH.
DSH and its employees, agents, and subcontractors shall not use any data received from contractor for
any purpose other than noted in this agreement, Welfare and Institutions Code section 4361, or Assembly
Bill 1810.
VI I. Research compliance: DSH is a covered entity under the Health Insurance Portability and Accountability
Act of 1996 (HIPAA). DSH shall receive protected health information and patient identifying substance
use disorder treatment information for research purposes. In accordance with 42 C.F.R. part 2.52(a) and
45 C.F.R. part 164.512(i), DSH shall only use the data received from contractor for research purposes
after obtaining approval from the State of California's Institutional Review Board, the California Health
and Human Services' Committee for the Protection of Human Subjects. DSH shall follow all of its internal
policies and procedures for obtaining approval for research using data reported by contractor. DSH
agrees to comply with HIPAA and 42 C.F.R. Part 2 regarding all requirements including retention and
destruction.
VIII. Safeguards: The Contractor shall implement administrative, physical, and technical safeguards that
reasonably and appropriately protect the privacy, confidentiality, security, integrity, and availability of DSH
PCI, including electronic or computerized DSH PCI. At each location where DSH PCI exists under
Contractor's control, the Contractor shall develop and maintain a written information privacy and security
program that includes administrative, technical and physical safeguards appropriate to the size and
complexity of the Contractor's operations and the nature and scope of its activities in performing its
agreement with DSH, including this Exhibit, and which incorporates the requirements of Section VII,
Security, below. Contractor shall provide DSH with Contractor's current and updated policies within five
(5) business days of a request by DSH for the policies.
IX. Security: The Contractor shall take any and all steps reasonably necessary to ensure the continuous
security of all computerized data systems containing DSH PCI. These steps shall include, at a minimum,
complying with all of the data system security precautions listed in the Contractor Data Security Standards
set forth in Attachment 1 to this Exhibit.
X. Security Officer: At each place where DSH PCI is located, the Contractor shall designate a Security
Officer to oversee its compliance with this Exhibit and to communicate with DSH on matters concerning
this Exhibit.
XI. Training: The Contractor shall provide training on its obligations under this Exhibit, at its own expense, to
all of its employees who assist in the performance of Contractor's obligations under Contractor's
agreement with DSH, including this Exhibit, or otherwise use or disclose DSH PCI.
D - 25
Exhibit D
A. The Contractor shall require each employee who receives training to certify, either in hard copy or
electronic form, the date on which the training was completed.
B. The Contractor shall retain each employee's certifications for DSH inspection for a period of three
years following contract termination or completion.
C. Contractor shall provide DSH with its employee's certifications within five (5) business days of a
request by DSH for the employee's certifications.
XII. Employee Discipline: Contractor shall impose discipline that it deems appropriate (in its sole discretion)
on such employees and other Contractor workforce members under Contractor's direct control who
intentionally or negligently violate any provisions of this Exhibit.
XIII. Breach and Security Incident Responsibilities:
A. Notification to DSH of Breach or Security Incident: The Contractor shall notify DSH immediately
by telephone call plus email or fax upon the discovery of a breach (as defined in this Exhibit),
and within twenty-four (24) hours by email or fax of the discovery of any security incident (as
defined in this Exhibit), unless a law enforcement agency determines that the notification will impede
a criminal investigation, in which case the notification required by this section shall be made to DSH
immediately after the law enforcement agency determines that such notification will not compromise
the investigation. Notification shall be provided to the DSH Program Contract Manager, the DSH
Privacy Officer and the DSH Chief Information Security Officer, using the contact information listed
in Section XI(F), below. If the breach or security incident is discovered after business hours or on
a weekend or holiday and involves DSH PCI in electronic or computerized form, notification to DSH
shall be provided by calling the DSH Information Security Office at the telephone numbers listed in
Section XI(F), below. For purposes of this Section, breaches and security incidents shall be treated
as discovered by Contractor as of the first day on which such breach or security incident is known
to the Contractor, or, by exercising reasonable diligence would have been known to the Contractor.
Contractor shall be deemed to have knowledge of a breach if such breach is known, or by exercising
reasonable diligence would have been known, to any person, other than the person committing the
breach, who is an employee or agent of the Contractor.
Contractor shall take:
1. prompt corrective action to mitigate any risks or damages involved with the breach or security
incident and to protect the operating environment; and
2. any action pertaining to a breach required by applicable federal and state laws, including,
specifically, California Civil Code section 1798.29 and 1798.82.
B. Investigation of Breach and Security Incidents: The Contractor shall immediately investigate such
breach or security incident. As soon as the information is known and subject to the legitimate needs
of law enforcement, Contractor shall inform the DSH Program Contract Manager, the DSH Privacy
Officer, and the DSH Chief Information Security Officer of:
1. what data elements were involved, and the extent of the data disclosure or access involved in
the breach, including, specifically, the number of individuals whose personal information was
breached; and
2. a description of the unauthorized persons known or reasonably believed to have improperly
used the DSH PCI and/or a description of the unauthorized persons known or reasonably
D - 26
Exhibit D
believed to have improperly accessed or acquired the DSH PCI, or to whom it is known or
reasonably believed to have had the DSH PCI improperly disclosed to them; and
3. a description of where the DSH PCI is believed to have been improperly used or disclosed; and
4. a description of the probable and proximate causes of the breach or security incident; and
5. whether Civil Code section 1798.29 and 1798.82 or any other federal or state laws requiring
individual notifications of breaches have been triggered.
C. Written Report: The Contractor shall provide a written report of the investigation to the DSH
Program Contract Manager, the DSH Privacy Officer, and the DSH Chief Information Security
Officer as soon as practicable after the discovery of the breach or security incident. The report shall
include, but not be limited to, the information specified above, as well as a complete, detailed
corrective action plan, including information on measures that were taken to halt and/or contain the
breach or security incident, and measures to be taken to prevent the recurrence or further disclosure
of data regarding such breach or security incident.
D. Notification to Individuals: If notification to individuals whose information was breached is required
under state or federal law, and regardless of whether Contractor is considered only a custodian
and/or non-owner of the DSH PCI, Contractor shall, at its sole expense, and at the sole election of
DSH, either:
1. make notification to the individuals affected by the breach (including substitute notification),
pursuant to the content and timeliness provisions of such applicable state or federal breach
notice laws. Contractor shall inform the DSH Privacy Officer of the time, manner and content
of any such notifications, prior to the transmission of such notifications to the individuals; or
2. cooperate with and assist DSH in its notification (including substitute notification) to the
individuals affected by the breach.
E. Submission of Sample Notification to Attorney General: If notification to more than 500 individuals
is required pursuant to California Civil Code section 1798.29 or 1798.82, and regardless of whether
Contractor is considered only a custodian and/or non-owner of the DSH PCI, Contractor shall, at its
sole expense, and at the sole election of DSH, either:
1. electronically submit a single sample copy of the security breach notification, excluding any
personally identifiable information, to the Attorney General pursuant to the format. content and
timeliness provisions of Section 1798.29, subdivision (e), or 1798.82, subdivision (f). Contractor
shall inform the DSH Privacy Officer of the time, manner and content of any such submissions,
prior to the transmission of such submissions to the Attorney General; or
2. cooperate with and assist DSH in its submission of a sample copy of the notification to the
Attorney General.
F. DSH Contact Information: To direct communications to the above referenced DSH staff, the
Contractor shall initiate contact as indicated herein. DSH reserves the right to make changes to
the contact information below by verbal or written notice to the Contractor. Said changes shall not
require an amendment to this Exhibit or the agreement to which it is incorporated.
D - 27
Exhibit D
DSH Program Contract DSH Privacy Officer DSH Chief Information
Manager Security Officer
See the Scope of Work Chief Privacy Officer (A) Chief Information Security Officer
exhibit for Program Office of Legal Services Information Security Office
Contract Manager California Dept. State Hospitals 1600 9th Street, Suite 250
1600 91" Street, Room 433 Sacramento, CA 95814
Sacramento, CA 95814
Email:iso(@dsh.ca.gov and
Email: security(a dsh.ca.gov
yamin.scardigli(aD-dsh.ca.gov Telephone: 916-654-4218
Telephone: (916) 562-3721
XIV. Documentation of Disclosures for Requests for Accounting: Contractor shall document and make
available to DSH or (at the direction of DSH) to an Individual such disclosures of DSH PCI, and
information related to such disclosures, necessary to respond to a proper request by the subject Individual
for an accounting of disclosures of personal information as required by Civil Code section 1798.25, or
any applicable state or federal law.
XV. Requests for DSH PCI by Third Parties: The Contractor and its employees, agents, or subcontractors
shall promptly transmit to the DSH Program Contract Manager all requests for disclosure of any DSH
PCI requested by third parties to the agreement between Contractor and DSH (except from an Individual
for an accounting of disclosures of the individual's personal information pursuant to applicable state or
federal law), unless prohibited from doing so by applicable state or federal law.
XVI. Audits, Inspection and Enforcement: DSH may inspect the facilities, systems, books and records of
Contractor to monitor compliance with this Exhibit. Contractor shall promptly remedy any violation of any
provision of this Exhibit and shall certify the same to the DSH Program Contract Manager in writing.
XVII. Return or Destruction of DSH PCI on Expiration or Termination: Upon expiration or termination of the
agreement between Contractor and DSH for any reason, Contractor shall securely return or destroy the
DSH PCI. If return or destruction is not feasible, Contractor shall provide a written explanation to the DSH
Program Contract Manager, the DSH Privacy Officer and the DSH Chief Information Security Officer,
using the contact information listed in Section XI(F), above.
A. Retention Required by Law: If required by state or federal law, Contractor may retain, after
expiration or termination, DSH PCI for the time specified as necessary to comply with the law.
B. Obligations Continue Until Return or Destruction: Contractor's obligations under this Exhibit shall
continue until Contractor destroys the DSH PCI or returns the DSH PCI to DSH; provided however,
that on expiration or termination of the agreement between Contractor and DSH, Contractor shall
not further use or disclose the DSH PCI except as required by state or federal law.
C. Notification of Election to Destroy DSH PCI: If Contractor elects to destroy the DSH PCI, Contractor
shall certify in writing within 30 days of the expiration or termination of the agreement to the DSH
Program Contract Manager, the DSH Privacy Officer and the DSH Chief Information Security
Officer, using the contact information listed in Section XI(F), above, that the DSH PCI has been
securely destroyed. The notice shall include the date and type of destruction method used.
D - 28
Exhibit D
XVIII. Amendment: The parties acknowledge that federal and state laws regarding information security
and privacy rapidly evolves and that amendment of this Exhibit may be required to provide for
procedures to ensure compliance with such laws. The parties specifically agree to take such action
as is necessary to implement new standards and requirements imposed by regulations and other
applicable laws relating to the security or privacy of DSH PCI. The parties agree to promptly enter
into negotiations concerning an amendment to this Exhibit consistent with new standards and
requirements imposed by applicable laws and regulations.
XIX. Assistance in Litigation or Administrative Proceedings: Contractor shall make itself and any
subcontractors, workforce employees or agents assisting Contractor in the performance of its
obligations under the agreement between Contractor and DSH, available to DSH at no cost to DSH
to testify as witnesses, in the event of litigation or administrative proceedings being commenced
against DSH, its director, officers or employees based upon claimed violation of laws relating to
security and privacy, which involves inactions or actions by the Contractor, except where Contractor
or its subcontractor, workforce employee or agent is a named adverse party.
XX. No Third-Party Beneficiaries: Nothing express or implied in the terms and conditions of this Exhibit
is intended to confer, nor shall anything herein confer, upon any person other than DSH or
Contractor and their respective successors or assignees, any rights, remedies, obligations or
liabilities whatsoever.
XXI. Interpretation: The terms and conditions in this Exhibit shall be interpreted as broadly as necessary
to implement and comply with regulations and applicable State laws. The parties agree that any
ambiguity in the terms and conditions of this Exhibit shall be resolved in favor of a meaning that
complies and is consistent with federal and state laws and regulations.
XXII. Survival: If Contractor does not return or destroy the DSH PCI upon the expiration or termination
of the Agreement, the respective rights and obligations of Contractor under Sections VI, VI and XI
of this Exhibit shall survive the completion or termination of the agreement between Contractor and
DSH.
D - 29
Exhibit D
Attachment 1
Contractor Data Security Standards
1. General Security Controls
A. Confidentiality Statement. All persons that will be working with DSH PCI must sign a
confidentiality statement. The statement must include at a minimum, General Use, Security and
Privacy safeguards, Unacceptable Use, and Enforcement Policies. The statement must be signed
by the workforce member prior to access to DSH PCI. The statement must be renewed annually.
The Contractor shall retain each person's written confidentiality statement for DSH inspection for a
period of three (3) years following contract termination.
B. Background check. Before a member of the Contractor's workforce may access DSH PCI,
Contractor must conduct a thorough background check of that worker and evaluate the results to
assure that there is no indication that the worker may present a risk for theft of confidential data.
The Contractor shall retain each workforce member's background check documentation for a period
of three (3) years following contract termination.
C. Workstation/Laptop encryption. All workstations and laptops that process and/or store DSH PCI
must be encrypted using a FIPS 140-2 certified algorithm, such as Advanced Encryption Standard
(AES), with a 128bit key or higher. The encryption solution must be full disk unless approved by
the DSH Information Security Office.
D. Server Security. Servers containing unencrypted DSH PCI must have sufficient administrative,
physical, and technical controls in place to protect that data, based upon a risk assess ment/system
security review.
E. Minimum Necessary. Only the minimum necessary amount of DSH PCI required to perform
necessary business functions may be copied, downloaded, or exported.
F. Removable media devices. All electronic files that contain DSH PCI data must be encrypted when
stored on any removable media or portable device (i.e. USB thumb drives, floppies, CD/DVD, smart
devices tapes etc.). PCI must be encrypted using a FIPS 140-2 certified algorithm, such as
Advanced Encryption Standard (AES), with a 128bit key or higher
G. Antivirus software. All workstations, laptops and other systems that process and/or store DSH
PCI must install and actively use a comprehensive anti-virus software solution with automatic
updates scheduled at least daily.
H. Patch Management. All workstations, laptops and other systems that process and/or store DSH
PCI must have operating system and application security patches applied, with system reboot if
necessary. There must be a documented patch management process which determines installation
timeframe based on risk assessment and vendor recommendations. At a maximum, all applicable
patches must be installed within 30 days of vendor release.
I. User IDs and Password Controls. All users must be issued a unique user name for accessing
DSH PCI. Username must be promptly disabled, deleted, or the password changed upon the
transfer or termination of an employee with knowledge of the password. Passwords are not to be
shared. Must be at least eight characters. Must be a non-dictionary word. Must not be stored in
readable format on the computer. Must be changed every 60 days. Must be changed if revealed
D - 30
Exhibit D
or compromised. Must be composed of characters from at least three of the following four groups
from the standard keyboard:
• Upper case letters (A-Z)
• Lower case letters (a-z)
• Arabic numerals (0-9)
• Non-alphanumeric characters (punctuation symbols)
J. Data Sanitization. All DSH PCI must be sanitized using NIST Special Publication 800-88 standard
methods for data sanitization when the DSH PCI is no longer needed.
2. System Security Controls
A. System Timeout. The system must provide an automatic timeout, requiring reauthentication of the
user session after no more than 20 minutes of inactivity.
B. Warning Banners. All systems containing DSH PCI must display a warning banner each time a
user attempts access, stating that data is confidential, systems are logged, and system use is for
business purposes only. User must be directed to log off the system if they do not agree with these
requirements.
C. System Logging. The system must maintain an automated audit trail which can identify the user
or system process which initiates a request for DSH PCI, or which alters DSH PCI. The audit trail
must be date and time stamped, must log both successful and failed accesses, must be read only,
and must be restricted to authorized users This logging must be included for all user privilege levels
including, but not limited to, systems administrators. If DSH PCI is stored in a database, database
logging functionality must be enabled. Audit trail data must be archived for at least 3 years after
occurrence.
D. Access Controls. The system must use role based access controls for all user authentications,
enforcing the principle of least privilege.
E. Transmission encryption. All data transmissions of DSH PCI outside the contractor's secure
internal network must be encrypted using a FIPS 140-2 certified algorithm, such as Advanced
Encryption Standard (AES), with a 128bit key or higher. Encryption can be end to end at the
network level, or the data files containing DSH PCI can be encrypted. This requirement pertains to
any type of DSH PCI in motion such as website access, file transfer, and E-Mail.
F. Intrusion Detection. All systems involved in accessing, holding, transporting, and protecting DSH
PCI that are accessible via the Internet must be protected by a comprehensive intrusion detection
and prevention solution.
3. Audit Controls
A. System Security Review. All systems processing and/or storing DSH PCI must have at least an
annual system risk assessment/security review which provides assurance that administrative,
physical, and technical controls are functioning effectively and providing adequate levels of
protection. Reviews shall include vulnerability scanning tools.
B. Log Reviews. All systems processing and/or storing DSH PCI must have a routine procedure in
place to review system logs for unauthorized access.
D - 31
Exhibit D
C. Change Control. All systems processing and/or storing DSH PCI must have a documented change
control procedure that ensures separation of duties and protects the confidentiality, integrity and
availability of data.
4. Business Continuity/ Disaster Recovery Controls
A. Disaster Recovery. Contractor must establish a documented plan to enable continuation of critical
business processes and protection of the security of electronic DSH PCI in the event of an
emergency. Emergency means any circumstance or situation that causes normal computer
operations to become unavailable for use in performing the work required under this agreement for
more than 24 hours.
B. Data Backup Plan. Contractor must have established documented procedures to securely backup
DSH PCI to maintain retrievable exact copies of DSH PCI. The backups shall be encrypted. The
plan must include a regular schedule for making backups, storing backups offsite, an inventory of
backup media, and the amount of time to restore DSH PCI should it be lost. At a minimum, the
schedule must be a weekly full backup and monthly offsite storage of DSH data.
5. Paper Document Controls
A. Supervision of Data. DSH PCI in paper form shall not be left unattended at any time, unless it is
locked in a file cabinet, file room, desk or office. Unattended means that information is not being
observed by an employee authorized to access the information. DSH PCI in paper form shall not
be left unattended at any time in vehicles or planes and shall not be checked in baggage on
commercial airplanes.
B. Escorting Visitors. Visitors to areas where DSH PCI is contained shall be escorted and DSH PHI
shall be kept out of sight while visitors are in the area.
C. Confidential Destruction. DSH PCI must be disposed of through confidential means, using NIST
Special Publication 800-88 standard methods for data sanitization when the DSH PSCI is no longer
needed.
D. Removal of Data. DSH PCI must not be removed from the premises of the Contractor except with
express written permission of DSH.
E. Faxing. Faxes containing DSH PCI shall not be left unattended and fax machines shall be in secure
areas. Faxes shall contain a confidentiality statement notifying persons receiving faxes in error to
destroy them. Fax numbers shall be verified with the intended recipient before sending.
F. Mailing. DSH PCI shall only be mailed using secure methods. Large volume mailings of DSH PHI
shall be by a secure, bonded courier with signature required on receipt. Disks and other
transportable media sent through the mail must be encrypted with a DSH approved solution, such
as a solution using a vendor product specified on the CALIFORNIA STRATEGIC SOURCING
INITIATIVE.
D - 32
Exhibit E
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
E-1
Exhibit E
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
E-2
Exhibit E
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
E-3
Exhibit E
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
E-4
Exhibit F
DOCUMENTATION STANDARDS FOR PERSON SERVED RECORDS
The documentation standards are described below under key topics related to care for persons
served. All standards must be addressed in the person served's 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 person served's
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 person served's 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
Rev 04/2023 F-1
Exhibit F
C. Treatment and Care Plan Requirements
1. Targeted Case Management
• 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 person served's 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,
➢ Person served's plans will be consistent with the diagnosis, and the focus of
intervention will be consistent with the person served's plan goals, and there will
be documentation of the person served's participation in and agreement with
the plan. Examples of the documentation include, but are not limited to,
reference to the person served's participation and agreement in the body of the
plan, person served's signature on the plan, or a description of the person
served's participation and agreement in progress notes.
➢ Person served's signature on the plan will be used as the means by which the
Contractor documents the participation of the person served. When the person
served's signature is required on the person served's plan and the person
Rev 04/2023 F-2
Exhibit F
served refuses or is unavailable for signature, the person served's plan will
include a written explanation of the refusal or unavailability.
➢ The Contractor will give a copy of the person served's plan to the person served
on request.
D. Progress Notes
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
Rev 04/2023 F-3
Exhibit G
coU Department of Behavioral Health
PF16* Policy and Procedure Guide
O 1 56 O
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
1 �
G-1
Exhibit G
COU��� Department of Behavioral Health
Policy and Procedure Guide
0 185 0
FRES FSection: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
G-2
Exhibit G
COU��� Department of Behavioral Health
Policy and Procedure Guide
O 1s56 O
FRESH FSection: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)
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G-3
Exhibit H
DSH — Pre-trial Felony Mental Health Diversion
DSH Diversion Outcomes Data Dictionary— Services - Fresno
SSN Social security number— 9-digit social security number (no dashes)
YEAR Year— Current calendar year
FYQTR Fiscal year quarter— Select one:
• Q1: July 1 — September 30
• Q2: October 1 — December 31
• Q3: January 1 — March 30
• Q4: April 1 — June 30
REPDAT Date report/data was prepared MM/DD/YYYY
INDIV Is the participant still in diversion?
• No
• Yes
DATEDEND Date diversion ended MM/DD/YYYY
REASDEND Reason diversion ended
• Successful completion
• Termination due to re-arrest
• Termination because of mental illness
• Termination because of risk of danger
• Termination due to AWOL
• Termination due to patient refusing medications
• Termination for other reason
OREASEND If other, what is the reason
DATREARR If arrested, date of re-arrest MM/DD/YYYY
SECTION FOR SERVICES PROVIDED IN REPORTING PERIOD
CASEM Case management intervention
• Forensic Assertive Community Treatment (FACT)
• Full service partnership
• Legal/criminal justice support
• Other case management for mental health
NUMCASEM Number of case management services provided in reporting period for
each service type
H-1
Exhibit H
HOSP Psychiatric inpatient hospitalization (includes Psychiatric Health
Facility or PHF)?
• No
• Yes
DOAHOSP Date of admission to hospital MM/DD/YYYY
DODCHOSP Date of discharge from hospital MM/DD/YYYY
RESTX Residential treatment
• Crisis residential facility
• Adult residential treatment facility
DOARES Date of admission to residential treatment MM/DD/YYYY
DODCRES Date of discharge from residential treatment MM/DD/YYYY
HOUSE Supportive housing
• Board and care
• Room and board
• Sober Living Environment
• Supportive Family Housing
• Other Supportive Housing
DOAHOUSE Date of entry into supportive housing MM/DD/YYYY
DODCHOUSE Date of exit from supportive housing MM/DD/YYYY
OPTMHTX Outpatient mental health services
• Medication support
• Group therapy
• Individual therapy
NOPTMHTX Number of outpatient mental health services provided in current reporting
period for each service type
MEDTX Was participant prescribed an antipsychotic?
• No
• Yes
MEDINJ Is the antipsychotic medication a long-acting injectable?
• No
• Yes
MEDNAME Name of antipsychotic
H-2
Exhibit H
OTHMEDTX Was participant prescribed either/both of the following medications?
• Mood stabilizer
• Antidepressant
• Both
• Neither (or leave blank)
SUBSTTX Substance use disorder treatment
• Inpatient/detox
• Residential SA treatment
• Outpatient SA treatment
DOASATX Date of admission to inpatient/residential SA treatment MM/DD/YYYY
DODCSATX Date of discharge from inpatient/residential SA treatment M/DD/YYYY
NSATX If not residential, number of contacts in reporting period for each type SA
treatment
MEDSA Was participant prescribed medication for substance abuse?
(e.g. Naltrexone)
• No
• Yes
MEDSANAME Name of substance abuse medication
OTHERTX Other types of treatment provided
• Faith based
• Family support/psychoeducational
• Peer support
• Vocational support
NOTHTX Number of contacts in reporting period for other treatment for each service
type (if known)
CRISIS Any crisis services provided
• Crisis call center/Access line
• Mobile crisis team/CIT team
• Crisis Stabilization
NCRISIS Number of crisis contacts in reporting period
OCRISIS Describe other crisis services
OSERVICE Describe other treatment services not provided in this list
H-3
Exhibit H
DSH — Pre-trial Felony Mental Health Diversion
DSH Diversion Outcomes Data Dictionary - Behavioral Health - Fresno
YEAR Year— Current calendar years
FYQTR Fiscal year quarter— Select one
• Q1: July 1 — September 30
• Q2: October 1 — December 31
• Q3: January 1 — March 30
• Q4: April 1 — June 30
LNAME Last name — Last name of DSH Diversion participant
FNAME First name — First name of DSH Diversion participant
SSN Social security number— 9-digit social security number (no dashes)
DOB Date of birth of participant— MM/DD/YYYY
SEX Gender— Select one
• Male
• Female
• Transgender M-F
• Transgender F-M
• Non-binary
• Other
ETHNIC Race/Ethnicity — Select one
• White Non - Hispanic
• Black Non - Hispanic
• Hispanic
• Asian
• American Indian or Alaska Native
• Native Hawaiian/Other Pacific Islander/Filipino
• Other
MCAL Medi-Cal status — was the participant enrolled in Medi-Cal at time of arrest
• No
• Yes
• Not eligible
MCALE If not eligible, reason why if known
H-4
Exhibit H
LIVSIT Living situation — What was the participant's living status at the time they were
arrested (see following definitions)
• Not homeless: Permanent housing/Housed in treatment facilities/board and
care/group home for more than 90 days
• Homeless sheltered: Housed in treatment facilities/board and care/group
home for more than 90 days OR hotel/motel/couch surfing
- *key: must have access to running water & electricity
• Homeless unsheltered: Living in car/encampment/other unsheltered situation
BEHAVIORAL HEALTH VARIABLES
DEVAL Was there a diversion eligibility evaluation?
• No
• Yes
HOWELIG If No, how was eligibility determined
DOE Diversion eligibility evaluation date MM/DD/YYYY
MOTIV Based on eligibility evaluation, was the crime related to the individual's (select
primary motive)
• Psychosis
• Homelessness
PDIAG Primary diagnoses determined from diversion evaluation (select one)
• Schizophrenia (F20.9)
• Schizoaffective disorder (F25.0, F25.1)
• Bipolar disorder (F31.xx, excluding F31.81)
SUBSTDX Does the individual have a co-morbid substance abuse diagnosis?
• No
• Yes
SUBST If yes, please enter individual's drug of choice:
• Alcohol
• Cannabis
• Cocaine
• Hallucinogen
• Amphetamine or other stimulant
• Opioid
• Other
• 3 or more of above
H-5
Exhibit H
PERSD Does the individual have a co-morbid Personality Disorder diagnosis?
• No
• Yes
PDDX If yes, which Personality Disorder?
• Antisocial Personality Disorder
• Borderline Personality Disorder
• Other Personality Disorder
COGD Does the individual have a co-morbid Cognitive Disorder diagnosis? This
includes Neurocognitive Disorders (Alzheimer's, vascular dementia, TBI) or
intellectual disability
• No
• Yes
RISKASS Was structured risk assessment performed?
• No
• Yes
If Yes, which one?
RANAME - Short-Term Assessment of Risk & Treatability (START)
- Historical Clinical Risk Management— 20 (HCR-20)
- Level of Services Inventory (LSI)
OTHERRA - Other
MATCHS How were services matched to participant?
• Risk-Needs-Responsivity (RNR) Assessment
• Provided standard mental health services
• Other
RNRASS List Risk-Needs-Responsivity (RNR) Assessment
OTHERM List other service matching method
JDIVS Diversion services provided prior to release from jail
• No
• Yes
If Yes:
DBJDIVS Date jail diversion services began MM/DD/YYYY
DEJDIVS Date jail diversion services ended MM/DD/YYYY
JAILMED Name of antipsychotic medication prescribed in jail
H-6
Exhibit
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 x
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
Significant Other(e.g., boyfriend /girlfriend. spouse) C Social Services Agency Jail / Prison
r` 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
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) f �'
SUPERVISED PLACEMENT
Unlicensed but supervised individual placement (includes
paid caretakers, personal care attendants)
Assisted Living Facility �' I
Unlicensed but supervised congregate placement (includes
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) C' C' r
State Psychiatric Hospital C' C r
RESIDENTIAL PROGRAM
Licensed Residential Treatment (includes crisis, short-term,
long-term, substance abuse, dual diagnosis residential ('
programs)
Skilled Nursing Facility (physical) C C
Skilled Nursing Facility(psychiatric) C
Long-Term Institutional Care [Institution for Mental Disease C C
(IMD), Mental Health Rehabilitation Center (MHRC)]
1 -2
Exhibit
RESIDENTIAL INFORMATION - includes hospitalization and incarceration (Continued)
JUSTICE PLACEMENT
Jail �' C r
Prison
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
1 -3
Exhibit
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
1 -4
Exhibit I
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?
1 -5
Exhibit
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
1 -6
Exhibit
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:
1 -7
Exhibit
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 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
1 -8
Exhibit I ADULT KET
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 -9
Exhibit I
CHANGE IN ADMINISTRATIVE INFORMATION (Skip this section rfthere 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 F No longer participating in the MHSA Housing
Program
1 -10
Exhibit
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'
-11
Exhibit
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?
1 -12
EMPLOYMENT (Skip this section if there are no changes)
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?
1 -13
LEGAL ISSUES/DESIGNATIONS (Skip this section if there arFooMNLek
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
1 -14
FULL SEM96040TNERSHIP OLDER ADULT KET
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 -15
CHANGE IN ADMINISTRATIVE INFORMATION (Skip this secjpqj4jMAeno changes)
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
RESIDENTIAL INFORMATION - includes hospitalization and ' ti n (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
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 <'
Unknown
1 -17
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.)
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?
1 -18
EMPLOYMENT (Skip this section if there are no changes)
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 $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.
Does one of the partner's current recovery goals include any
kind of employment at this time? <' Yes C No
1 -19
LEGAL ISSUES/ DESIGNATIONS (Skip this section if there arExhb")
ARREST INFORMATION
Date Partner Arrested (mm/dd/yyyy):
PROBATION INFORMATION
Date of Probation Status Change (mm/dd/yyyy):
Indicate new probation status:
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 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
1 -20
FULL SER\96 %IhTNERSHIP ADULT 3M
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 -21
LEGAL ISSUES/ DESIGNATIONS Exhibit
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 C No
COUNTY USE QUESTIONS
COUNTY USE QUESTIONS NEW VALUE
County Use Field# 1
County Use Field#2
County Use Field#3
1 -22
Exhibit J
1 Compensation
2 The Contractor will be compensated for performance of its services under this
3 Agreement as provided in this Exhibit J, and Exhibit J-1 and Exhibit J-2. The Contractor is not
4 entitled to any compensation except as expressly provided in this Exhibit J, and Exhibit J-1 and
5 Exhibit J-2.
6 1. Specialty Mental Health Service Rates
7 In no event shall compensation for the specialty mental health services for SUD/MH
8 OP and FSP/ACT performed under this Agreement be in excess of reimbursement
9 rates set by County during the term of this Agreement. County and Contractor has
10 identified SUD/MH OP to be in the clinic/site based category, and FSP/ACT to be in
11 the FSP/AOT category. In no event will the reimbursement rates to Contractor be in
12 excess of the reimbursement rates in County's fee schedule as set by DHCS in BHIN
13 No. 23.017, including any and all of its modifications or amendments.
14 Fresno County Department of Behavioral Health
15 Specialty Mental Health Services Outpatient Rates
Clinic/Site Based less than 50% of services are provided in the field
16 Provider Rate Per
17 Provider Type Hour
Psychiatrist/ Contracted Psychiatrist $912.79
18 Physicians Assistant $409.38
19 Nurse Practitioner $453.91
RN $370.76
20 Certified Nurse Specialist $453.91
21 LVN $194.77
22 Pharmacist $436.93
Licensed Psychiatric Technician $166.97
23 Psychologist/Pre-licensed Psychologist $367.09
24 LPHA (MFT, LCSW, LPCC)/ Intern or Waivered LPHA
(MFT, LCSW, LPCC) $237.56
25 Occupational Therapist $316.22
26 Mental Health Rehab Specialist $178.73
Peer Recovery Specialist 1 $187.66
27 Other Qualified Providers - Other Designated MH staff that
28 bill medical $178.73
J-1
Exhibit J
1 Fresno County Department of Behavioral Health
Specialty Mental Health Services Outpatient Rates
2 FSP and AOT
3 Provider Rate Per
Provider Type Hour
4 Psychiatrist/ Contracted Psychiatrist $1,140.98
5 Physicians Assistant $511.73
6 Nurse Practitioner $567.38
RN $463.45
7 Certified Nurse Specialist $567.38
8 LVN $243.47
Pharmacist $546.16
9 Licensed Psychiatric Technician $208.72
10 Psychologist/Pre-licensed Psychologist $458.87
11 LPHA (MFT LCSW LPCC)/ Intern or Waivered LPHA (MFT
LCSW LPCC) $296.95
12 Occupational Therapist $395.28
13 Mental Health Rehab Specialist $223.41
Peer Recovery Specialist $234.58
14 Other Qualified Providers - Other Designated MH staff that
15 bill medical $223.41
16 2. Non-Medi-Cal Supports
17 County agrees to pay Contractor and Contractor agrees to receive compensation for
18 actual expenditures incurred in accordance with the Contractor's cost reimbursement
19 "budget" documents for non-Medi-Cal support services for SUD/MH OP and
20 FSP/ACT as approved by the County's DBH director or designee in Exhibit J-1.
21 3. Whole Person Care Like Pilot Services
22 County agrees to pay Contractor and Contractor agrees to receive compensation for
23 actual expenditures incurred in accordance with the Contractor's cost reimbursement
24 "budget" documents approved by the County's DBH director or designee in Exhibit J-
25 2
26
27
28
J-2
Exhibit J-1
Forensic Continuum of Care FSP/ACT
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 Records Technician 0.69 $ 7,582 $ 7,582
1102 Administrative Assistant 0.60 13,320 13,320
1103 Program Bookkeeper 0.60 13,320 13,320
1104 Secretary 0.60 10,673 10,673
1105 - -
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.49 $ 44,895 $ 44,895
Acct# Program Position FTE Admin Program Total
1116 Assistant Program Director 0.60 $ 29,531 $ 29,531
1117 Program Director 0.60 36,030 36,030
1118 Mental Health Specialist 0.69 171,351 171,351
1119 Supervising Personal Services Coordinator 0.60 20,844 20,844
1120 Peer Support 0.69 33,763 33,763
1121 Mental Health Professional 0.69 73,911 73,911
1122 Nurse 0.69 30,831 30,831
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 4.55 $ 396,261 $ 396,261
Admin Program Total
Direct Personnel Salaries Subtotal 7.04 $ 44,895 $ 396,261 $ 441,156
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,496 $ 13,209 $ 14,705
1202 Worker's Compensation 532 4,700 5,232
1203 Health Insurance 6,650 58,701 65,351
1204 Other(Dental) 522 4,605 5,127
1205 Other(ACI) 15 132 147
1206 1 Other(Accrued Paid Leave) 4,988 44,029 49,017
Direct Employee Benefits Subtotal: $ 14,203 $ 125,376 $ 139,579
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 723 $ 6,384 $ 7,107
1302 FICA/MEDICARE 3,118 27,518 30,636
1303 SUI 728 6,428 7,156
1304 Other(specify) - - -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 4,569 $ 40,330 $ 44,899
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 63,667 $ 561,967 $ 625,634
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin I Program
10% 90%
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-1
Exhibit J-1
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support 593,075
2003 Client Transportation&Support 7,000
2004 Clothing&Hygiene 5,000
2005 Education Support 10,000
2006 Employment Support 3,200
2007 Household Items for Clients -
2008 Medication Supports 86,000
2009 Program Supplies-Medical 2,199
2010 Utility Vouchers 19,200
2011 Client Activities 10,000
2012 Client Personal Needs 2,200
2013 Client Food 5,259
2014 Client Physical Exams 9,750
2015 Client Testing Materials 1,600
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 754,483
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 3,194
3002 Printing/Postage 332
3003 Office,Household&Program Supplies 3,065
3004 Advertising -
3005 Staff Development&Training 2,763
3006 1 Staff Mileage 362
3007 Subscriptions&Memberships 272
3008 Vehicle Maintenance/Fuel/Insurance 9,330
3009 Recruitment 2,235
3010 Other(specify) -
3011 Other(specify)
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 21,553
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 287
4002 Rent/Lease Building 47,534
4003 Rent/Lease Equipment 302
4004 Rent/Lease Vehicles 8,774
4005 Security 498
4006 Utilities 10,113
4007 Equipment Maintenance 362
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 67,870
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 179
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 1,374
5005 O/S Labor Phychiatrist 42,649
5006 1 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 44,202
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-2
Exhibit J-1
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 1,857
6003 Accounting/Bookkeeping
6004 External Audit 377
6005 Insurance(Specify):
6006 Payroll Services 2,117
6007 Depreciation(Provider-owned Egwpment to be Usedfor Program Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 Licenses 876
6010 Indirect 222,716
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 227,943
INDIRECT COST RATE 15.00%
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 604
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 1 Assets over$5,000/unit(Specify)
7007 Expendable Equipment 5,194
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,798
TOTAL PROGRAM EXPENSES $ 1,747,483
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 rensic Behavioral Health Continuum of Care-F $ 754,483
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 754,483
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees
8402 Client Insurance
8403 Grants(Specify)-CCP AB109 797,621
8404 Other(Specify)-DSH Diversion 195,379
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 993,000
TOTAL PROGRAM FUNDING SOURCES: $ 1,747,483
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-3
Exhibit J-1
Forensic Continuum of Care FSP/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#/Name/Department/County FTE%
Records Technician Allocation to CCP&DSH 0.38
Allocation to FSC FSP UP 0.17
OP 0.45
Total 1.00
Position Contract#/Name/Department/County FTE%
Administrative Assistant Allocation to CCP&DSH 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Bookkeeper Allocation to CCP&DSH 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Secretary Allocation to CCP&DSH 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Allocation to CCP&DSH 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Director Allocation to CCP&DSH 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager Allocation to CCP&DSH 0.69
Allocation to FSC FSP UP 0.31
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-4
Exhibit J-1
Total 1.00
Position Contract#/Name/Department/County FTE
Supervising Personal Services Coordinator Allocation to CCP&DSH 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE
Peer Support Allocation to CCP&DSH 0.69
Allocation to FSC FSP UP 0.31
Total 1.00
Position Contract#/Name/Department/County FTE%
Mental Health Professional Allocation to CCP&DSH 0.69
Allocation to FSC FSP UP 0.31
Total 1.00
Position Contract#/Name/Department/County FTE%
Nurse Allocation to CCP&DSH 0.52
Allocation to FSC FSP UP 0.23
OP 0.25
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-5
Exhibit J-1
El
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-6
Exhibit J-1
Forensic Continuum of Care FSP/ACT
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 625,634
Administrative Positions 44,895
1101 Records Technician 7,582 The Records Technician will keep track of the Medical Records and will do the billing for
the program.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.
1102 Administrative Assistant 13,320 The Administrative Assistant will oversee the support staff and will help with all support
staff duties.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.
1103 Program Bookkeeper 13,320 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.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.
1104 Secretary 10,673 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.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.
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 396,261
1116 Assistant Program Director 29,531 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 36,030 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.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.
1118 Mental Health Specialist 171,351 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. 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.
1119 Supervising Personal Services Coordinator 20,844 Provides supervision to all Mental Health Specialists to ensure client care,maintain
compliance with Turning Point policies and procedures. Supervisor also assisting in
training new staff and reporting to the Assistant 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.
1120 Peer Support 33,763 Serves as a client advocate and provides information and peer support to clients
throughout their recovery process. 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.
1121 Mental Health Professional 73,911 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. 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.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-7
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1122 Nurse 30,831 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. 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.
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 14,705 10-5940 Retirement:Cost of Agency contribution to employee retirement plans.These
are non-treatment related costs.
1202 Worker's Compensation 5,232 10-5930 Workers Compensation Insurance:Cost of workers compensation insurance.
These are non-treatment related costs.
1203 Health Insurance 65,351 10-5950 Health Insurance:Agency cost for health insurance including Vision These are
non-treatment related costs.
1204 Other(Dental) 5,127 10-5960 Dental Insurance:Agency cost for dental insurance.These are non-treatment
related costs.
1205 Other(ACI) 147 10-5990 Other Benefits:Agency cost for other wage related employee benefits.These
are non-treatment related costs.
1206 Other(Accrued Paid Leave) 49,017 10-5980 Accrued Paid Leave:The monetary value of staff Paid Leave hours as they
accrue on a monthly basis.These are non-treatment related costs.
Direct Payroll Taxes&Expenses: 44,899
1301 OASDI 7,107 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).
These are non-treatment related costs.
1302 FICA/MEDICARE 30,636 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).
These are non-treatment related costs.
1303 SUI 7,156 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.These are non-
treatment related costs.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 754,483
2001 Child Care -
2002 Client Housing Support 593,075 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 7,000 10-7015 Client Transportation:Cost for client transportation.(Examples:bus
tokens/passes,taxi,other public transportation,bicycles,etc.)
2004 Clothing&Hygiene 5,000 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.)
2005 Education Support 10,000 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 3,200 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 -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-8
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2008 Medication Supports 86,000 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 2,199 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 19,200 10-7023 Client Utility/Rental Security Deposits:Cast of client utility bills and/or security
deposits.
2011 Client Activities 10,000 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 2,200 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 5,259 10-6150 Food:Cost of food and drink to be consumed by the residents/clients.
(Examples:Groceries to prepare onsite,outside food brought onsite,food/drinks for
clients)
2014 Client Physical Exams 9,750 10-7080 Client Physical Exams:Cost of client admission physical examinations and TB
testing.
2015 Client Testing Materials 1,600 10-7140 Client Testing Material:Cast of U/A testing supplies,including breathalyzer,
used to determine treatment required for clients.
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 21,553
3001 Telecommunications 3,194 10-6340 Communications:Cost of electronic communications. (Examples:internet,
phone,fax,cell phones,etc.)These are non-treatment related costs.
3002 Printing/Postage 332 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.These are non-treatment related
costs.
3003 Office,Household&Program Supplies 3,065 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.These are non-treatment
related costs.
3004 Advertising -
3005 Staff Development&Training 2,763 10-6440 Staff Educational Expense:Cost of employee training courses and materials.
(Examples:certification,training,books,etc.)*May include cost of room rental.These
are non-treatment related costs.
3006 Staff Mileage 362 10-6060 Staff Mileage:Cost of employee mileage reimbursement paid in accordance
with FPM section 1005.These are non-treatment related costs.
3007 Subscriptions&Memberships 272 10-6360 Dues&Subscriptions:Cost of membership dues and subscriptions.(Examples:
magazine,newspaper,memberships,etc.)These are non-treatment related costs.
3008 Vehicle Maintenance/Fuel/Insurance 9,330 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)These are
non-treatment related costs.
3009 Recruitment 2,235 10-6470 Recruitment:Cost of advertising and other employee recruitment expenses.
(Examples:newspaper ad,urine screening,background check,etc.)These are non-
treatment related costs.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-9
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 67,870
4001 Building Maintenance 287 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.These are non-treatment related
costs.These are non-treatment related costs.
4002 Rent/Lease Building 47,534 10-6320 Building Rent(Other):Cost of rent/lease payments made for building leases
from outside sources.These are non-treatment related costs.
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.)These are non-treatment related costs.
4004 Rent/Lease Vehicles 8,774 10-6020 Vehicle Rent/Lease(Other):Rental cost of non-Agency vehicles and lease of
agency vehicles.
4005 Security 498 10-6390 Security:Cost 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.)These are non-
treatment related costs.
4006 Utilities 10,113 10-6350 Utilities:Cost of service for power,gas,water,sewer,garbage,etc.These are
non-treatment related costs.
4007 Equipment Maintenance 362 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.) These are non-treatment
related costs.
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 44,202
5001 Consultant(Network&Data Management) 179 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.These are non-treatment related costs.
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,374 Paid to outside vendors for translation/interpreter services.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.
5005 O/S Labor Phychiatrist 42,649 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.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.
5006 Other(specify)
5007 Other(specify) -
5008 Other(specify)
6000:INDIRECT EXPENSES 227,943
6001 Administrative Overhead
6002 Professional Liability Insurance 1,857 10-6370 Insurance:Cost of Agency liability and property insurance.These are non-
treatment related costs.
6003 Accounting/Bookkeeping -
6004 External Audit 377 10-6460 Audit Expense:Cost of outside audit fees.These are non-treatment related
costs.
6005 Insurance(Specify): -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-10
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6006 Payroll Services 2,117 10-6482 Payroll Software&Support.These are non-treatment related costs.
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 876 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.)These are non-treatment related costs.
6010 Indirect 222,716 10-9000's Indirect Allocated Costs.These are non-treatment related costs.
6011 Other(specify) -
6012 Other(specify)
6013 Other 1snprifvl
7000:DIRECT FIXED ASSETS 5,798
7001 Computer Equipment&Software -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 604 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)These are non-treatment related costs.
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 5,194 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.)These are non-treatment related
costs.
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,747,483
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,747,483
BUDGET CHECK:
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-11
Exhibit J-1
Forensic Continuum of Care FSP/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 0.69 $ 7,582 $ 7,582
1102 Administrative Assistant 0.60 13,320 13,320
1103 Program Bookkeeper 0.60 13,320 13,320
1104 Secretary 0.60 10,673 10,673
1105 - -
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.49 $ 44,895 $ 44,895
Acct# Program Position FTE Admin Program Total
1116 Assistant Program Director 0.60 $ 29,531 $ 29,531
1117 Program Director 0.60 36,030 36,030
1118 Mental Health Specialist 0.69 171,351 171,351
1119 Supervising Personal Services Coordinator 0.60 20,844 20,844
1120 Peer Support 0.69 33,763 33,763
1121 Mental Health Professional 0.69 73,911 73,911
1122 Nurse 0.69 30,831 30,831
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 4.55 $ 396,261 $ 396,261
Admin Program Total
Direct Personnel Salaries Subtotal 7.04 $ 44,895 $ 396,261 $ 441,156
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,496 $ 13,209 $ 14,705
1202 Worker's Compensation 532 4,700 5,232
1203 Health Insurance 6,650 58,701 65,351
1204 Other(Dental) 522 4,605 5,127
1205 Other(ACI) 15 132 147
1206 1 Other(Accrued Paid Leave) 4,988 44,029 49,017
Direct Employee Benefits Subtotal: $ 14,203 $ 125,376 $ 139,579
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 723 $ 6,384 $ 7,107
1302 FICA/MEDICARE 3,118 27,518 30,636
1303 SUI 728 6,428 7,156
1304 Other(specify) - - -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 4,569 $ 40,330 $ 44,899
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 63,667 $ 561,967 $ 625,634
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin I Program
10% 90%
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-12
Exhibit J-1
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support 593,075
2003 Client Transportation&Support 7,000
2004 Clothing&Hygiene 5,000
2005 Education Support 10,000
2006 Employment Support 3,200
2007 Household Items for Clients -
2008 Medication Supports 86,000
2009 Program Supplies-Medical 2,199
2010 Utility Vouchers 19,200
2011 Client Activities 10,000
2012 Client Personal Needs 2,200
2013 Client Food 5,259
2014 Client Physical Exams 9,750
2015 Client Testing Materials 1,600
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 754,483
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 3,194
3002 Printing/Postage 332
3003 Office,Household&Program Supplies 3,065
3004 Advertising -
3005 Staff Development&Training 2,763
3006 1 Staff Mileage 362
3007 Subscriptions&Memberships 272
3008 Vehicle Maintenance/Fuel/Insurance 9,330
3009 Recruitment 2,235
3010 Other(specify) -
3011 Other(specify)
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 21,553
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 287
4002 Rent/Lease Building 47,534
4003 Rent/Lease Equipment 302
4004 Rent/Lease Vehicles 8,774
4005 Security 498
4006 Utilities 10,113
4007 Equipment Maintenance 362
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 67,870
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 179
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 1,374
5005 O/S Labor Phychiatrist 42,649
5006 1 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 44,202
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-13
Exhibit J-1
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 1,857
6003 Accounting/Bookkeeping
6004 External Audit 377
6005 Insurance(Specify):
6006 Payroll Services 2,117
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 876
6010 Indirect 222,716
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 227,943
INDIRECT COST RATE 15.00%
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 604
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 1 Assets over$5,000/unit(Specify)
7007 Expendable Equipment 5,194
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,798
TOTAL PROGRAM EXPENSES $ 1,747,483
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 rensic Behavioral Health Continuum of Care-F $ 754,483
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 754,483
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)-CCP AB109 993,000
8404 Other(Specify)-DSH Diversion
8405 Other(Specify)
OTHER REVENUE TOTAL $ 993,000
TOTAL PROGRAM FUNDING SOURCES: $ 1,747,483
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-14
Exhibit J-1
Forensic Continuum of Care FSP/ACT
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 Allocation to CCP 0.38
Allocation to FSC FSP UP 0.17
OP 0.45
Total 1.00
Position Contract#/Name/Department/County FTE%
Administrative Assistant Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Bookkeeper Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Secretary Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Director Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager Allocation to CCP 0.69
Allocation to FSC FSP UP 0.31
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-15
Exhibit J-1
Total 1.00
Position Contract#/Name/Department/County FTE
Supervising Personal Services Coordinator Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Peer Support Allocation to CCP 0.69
Allocation to FSC FSP UP 0.31
Total 1.00
Position Contract#/Name/Department/County FTE%
Mental Health Professional Allocation to CCP 0.69
Allocation to FSC FSP UP 0.31
Total 1.00
Position Contract#/Name/Department/County FTE
Nurse Allocation to CCP 0.52
Allocation to FSC FSP UP 0.23
OP 0.25
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-16
Exhibit J-1
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-17
Exhibit J-1
Forensic Continuum of Care FSP/ACT
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 625,634
Administrative Positions 44,895
1101 Records Technician 7,582 The Records Technician will keep track of the Medical Records and will do the billing for
the program.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.
1102 Administrative Assistant 13,320 The Administrative Assistant will oversee the support staff and will help with all support
staff duties.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.
1103 Program Bookkeeper 13,320 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.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.
1104 Secretary 10,673 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.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.
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 396,261
1116 Assistant Program Director 29,531 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 36,030 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.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.
1118 Mental Health Specialist 171,351 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. 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.
1119 Supervising Personal Services Coordinator 20,844 Provides supervision to all Mental Health Specialists to ensure client care,maintain
compliance with Turning Point policies and procedures. Supervisor also assisting in
training new staff and reporting to the Assistant 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.
1120 Peer Support 33,763 Serves as a client advocate and provides information and peer support to clients
throughout their recovery process. 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.
1121 Mental Health Professional 73,911 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. 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.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-18
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1122 Nurse 30,831 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. 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.
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 14,705 10-5940 Retirement:Cost of Agency contribution to employee retirement plans.These
are non-treatment related costs.
1202 Worker's Compensation 5,232 10-5930 Workers Compensation Insurance:Cost of workers compensation insurance.
These are non-treatment related costs.
1203 Health Insurance 65,351 10-5950 Health Insurance:Agency cost for health insurance including Vision These are
non-treatment related costs.
1204 Other(Dental) 5,127 10-5960 Dental Insurance:Agency cost for dental insurance.These are non-treatment
related costs.
1205 Other(ACI) 147 10-5990 Other Benefits:Agency cost for other wage related employee benefits.These
are non-treatment related costs.
1206 Other(Accrued Paid Leave) 49,017 10-5980 Accrued Paid Leave:The monetary value of staff Paid Leave hours as they
accrue on a monthly basis.These are non-treatment related costs.
Direct Payroll Taxes&Expenses: 44,899
1301 OASDI 7,107 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).
These are non-treatment related costs.
1302 FICA/MEDICARE 30,636 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).
These are non-treatment related costs.
1303 SUI 7,156 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.These are non-
treatment related costs.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 754,483
2001 Child Care -
2002 Client Housing Support 593,075 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 7,000 10-7015 Client Transportation:Cost for client transportation.(Examples:bus
tokens/passes,taxi,other public transportation,bicycles,etc.)
2004 Clothing&Hygiene 5,000 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.)
2005 Education Support 10,000 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 3,200 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 -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-19
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2008 Medication Supports 86,000 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 2,199 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 19,200 10-7023 Client Utility/Rental Security Deposits:Cast of client utility bills and/or security
deposits.
2011 Client Activities 10,000 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 2,200 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 5,259 10-6150 Food:Cost of food and drink to be consumed by the residents/clients.
(Examples:Groceries to prepare onsite,outside food brought onsite,food/drinks for
clients)
2014 Client Physical Exams 9,750 10-7080 Client Physical Exams:Cost of client admission physical examinations and TB
testing.
2015 Client Testing Materials 1,600 10-7140 Client Testing Material:Cast of U/A testing supplies,including breathalyzer,
used to determine treatment required for clients.
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 21,553
3001 Telecommunications 3,194 10-6340 Communications:Cost of electronic communications. (Examples:internet,
phone,fax,cell phones,etc.)These are non-treatment related costs.
3002 Printing/Postage 332 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.These are non-treatment related
costs.
3003 Office,Household&Program Supplies 3,065 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.These are non-treatment
related costs.
3004 Advertising -
3005 Staff Development&Training 2,763 10-6440 Staff Educational Expense:Cost of employee training courses and materials.
(Examples:certification,training,books,etc.)*May include cost of room rental.These
are non-treatment related costs.
3006 Staff Mileage 362 10-6060 Staff Mileage:Cost of employee mileage reimbursement paid in accordance
with FPM section 1005.These are non-treatment related costs.
3007 Subscriptions&Memberships 272 10-6360 Dues&Subscriptions:Cost of membership dues and subscriptions.(Examples:
magazine,newspaper,memberships,etc.)These are non-treatment related costs.
3008 Vehicle Maintenance/Fuel/Insurance 9,330 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)These are
non-treatment related costs.
3009 Recruitment 2,235 10-6470 Recruitment:Cost of advertising and other employee recruitment expenses.
(Examples:newspaper ad,urine screening,background check,etc.)These are non-
treatment related costs.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-20
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 67,870
4001 Building Maintenance 287 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.These are non-treatment related
costs.These are non-treatment related costs.
4002 Rent/Lease Building 47,534 10-6320 Building Rent(Other):Cost of rent/lease payments made for building leases
from outside sources.These are non-treatment related costs.
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.)These are non-treatment related costs.
4004 Rent/Lease Vehicles 8,774 10-6020 Vehicle Rent/Lease(Other):Rental cost of non-Agency vehicles and lease of
agency vehicles.
4005 Security 498 10-6390 Security:Cost 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.)These are non-
treatment related costs.
4006 Utilities 10,113 10-6350 Utilities:Cost of service for power,gas,water,sewer,garbage,etc.These are
non-treatment related costs.
4007 Equipment Maintenance 362 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.) These are non-treatment
related costs.
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 44,202
5001 Consultant(Network&Data Management) 179 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.These are non-treatment related costs.
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,374 Paid to outside vendors for translation/interpreter services.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.
5005 O/S Labor Phychiatrist 42,649 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.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.
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 227,943
6001 Administrative Overhead
6002 Professional Liability Insurance 1,857 10-6370Insurance:Cost of Agency liability and property insurance.These are non-
treatment related costs.
6003 Accounting/Bookkeeping -
6004 External Audit 377 10-6460 Audit Expense:Cost of outside audit fees.These are non-treatment related
costs.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-21
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6005 Insurance(Specify):
6006 Payroll Services 2,117 10-6482 Payroll Software&Support.These are non-treatment related costs.
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 876 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.)These are non-treatment related costs.
6010 Indirect 222,716 10-9000's Indirect Allocated Costs.These are non-treatment related costs.
6011 Other(specify) -
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 5,798
7001 Computer Equipment&Software -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 604 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)These are non-treatment related costs.
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 5,194 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.)These are non-treatment related
costs.
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,747,483
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,747,483
BUDGETCHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-22
Exhibit J-1
Forensic Continuum of Care FSP/ACT
Turning Point of Central California,Inc.
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Records Technician 0.69 $ 7,582 $ 7,582
1102 Administrative Assistant 0.60 13,320 13,320
1103 Program Bookkeeper 0.60 13,320 13,320
1104 Secretary 0.60 10,673 10,673
1105 - -
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.49 $ 44,895 $ 44,895
Acct# Program Position FTE Admin Program Total
1116 Assistant Program Director 0.60 $ 29,531 $ 29,531
1117 Program Director 0.60 36,030 36,030
1118 Mental Health Specialist 0.69 171,351 171,351
1119 Supervising Personal Services Coordinator 0.60 20,844 20,844
1120 Peer Support 0.69 33,763 33,763
1121 Mental Health Professional 0.69 73,911 73,911
1122 Nurse 0.69 30,831 30,831
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 4.55 $ 396,261 $ 396,261
Admin Program Total
Direct Personnel Salaries Subtotal 7.04 $ 44,895 $ 396,261 $ 441,156
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,496 $ 13,209 $ 14,705
1202 Worker's Compensation 532 4,700 5,232
1203 Health Insurance 6,650 58,701 65,351
1204 Other(Dental) 522 4,605 5,127
1205 Other(ACI) 15 132 147
1206 1 Other(Accrued Paid Leave) 4,988 44,029 49,017
Direct Employee Benefits Subtotal: $ 14,203 $ 125,376 $ 139,579
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 723 $ 6,384 $ 7,107
1302 FICA/MEDICARE 3,118 27,518 30,636
1303 SUI 728 6,428 7,156
1304 Other(specify) - - -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 4,569 $ 40,330 $ 44,899
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 63,667 $ 561,967 $ 625,634
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin I Program
10% 90%
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-23
Exhibit J-1
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support 593,075
2003 Client Transportation&Support 7,000
2004 Clothing&Hygiene 5,000
2005 Education Support 10,000
2006 Employment Support 3,200
2007 Household Items for Clients -
2008 Medication Supports 86,000
2009 Program Supplies-Medical 2,199
2010 Utility Vouchers 19,200
2011 Client Activities 10,000
2012 Client Personal Needs 2,200
2013 Client Food 5,259
2014 Client Physical Exams 9,750
2015 Client Testing Materials 1,600
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 754,483
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 3,194
3002 Printing/Postage 332
3003 Office,Household&Program Supplies 3,065
3004 Advertising -
3005 Staff Development&Training 2,763
3006 1 Staff Mileage 362
3007 Subscriptions&Memberships 272
3008 Vehicle Maintenance/Fuel/Insurance 9,330
3009 Recruitment 2,235
3010 Other(specify) -
3011 Other(specify)
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 21,553
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 287
4002 Rent/Lease Building 47,534
4003 Rent/Lease Equipment 302
4004 Rent/Lease Vehicles 8,774
4005 Security 498
4006 Utilities 10,113
4007 Equipment Maintenance 362
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 67,870
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 179
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 1,374
5005 O/S Labor Phychiatrist 42,649
5006 1 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 44,202
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-24
Exhibit J-1
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 1,857
6003 Accounting/Bookkeeping
6004 External Audit 377
6005 Insurance(Specify):
6006 Payroll Services 2,117
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 876
6010 Indirect 222,716
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 227,943
INDIRECT COST RATE 15.00%
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 604
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 1 Assets over$5,000/unit(Specify)
7007 Expendable Equipment 5,194
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,798
TOTAL PROGRAM EXPENSES $ 1,747,483
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 rensic Behavioral Health Continuum of Care-F $ 754,483
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 754,483
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)-CCP AB109 993,000
8404 Other(Specify)-DSH Diversion
8405 Other(Specify)
OTHER REVENUE TOTAL $ 993,000
TOTAL PROGRAM FUNDING SOURCES: $ 1,747,483
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-25
Exhibit J-1
Forensic Continuum of Care FSP/ACT
Turning Point of Central California,Inc.
Fiscal Year(FY)2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Records Technician Allocation to CCP 0.38
Allocation to FSC FSP UP 0.17
OP 0.45
Total 1.00
Position Contract#/Name/Department/County FTE%
Administrative Assistant Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Bookkeeper Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Secretary Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Director Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager Allocation to CCP 0.69
Allocation to FSC FSP UP 0.31
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-26
Exhibit J-1
Total 1.00
Position Contract#/Name/Department/County FTE
Supervising Personal Services Coordinator Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Peer Support Allocation to CCP 0.69
Allocation to FSC FSP UP 0.31
Total 1.00
Position Contract#/Name/Department/County FTE%
Mental Health Professional Allocation to CCP 0.69
Allocation to FSC FSP UP 0.31
Total 1.00
Position Contract#/Name/Department/County FTE
Nurse Allocation to CCP 0.52
Allocation to FSC FSP UP 0.23
OP 0.25
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-27
Exhibit J-1
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-28
Exhibit J-1
Forensic Continuum of Care FSP/ACT
Turning Point of Central California,Inc.
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 625,634
Administrative Positions 44,895
1101 Records Technician 7,582 The Records Technician will keep track of the Medical Records and will do the billing for
the program.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.
1102 Administrative Assistant 13,320 The Administrative Assistant will oversee the support staff and will help with all support
staff duties.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.
1103 Program Bookkeeper 13,320 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.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.
1104 Secretary 10,673 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.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.
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 396,261
1116 Assistant Program Director 29,531 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 36,030 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.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.
1118 Mental Health Specialist 171,351 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. 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.
1119 Supervising Personal Services Coordinator 20,844 Provides supervision to all Mental Health Specialists to ensure client care,maintain
compliance with Turning Point policies and procedures. Supervisor also assisting in
training new staff and reporting to the Assistant 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.
1120 Peer Support 33,763 Serves as a client advocate and provides information and peer support to clients
throughout their recovery process. 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.
1121 Mental Health Professional 73,911 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. 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.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-29
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1122 Nurse 30,831 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. 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.
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 14,705 10-5940 Retirement:Cost of Agency contribution to employee retirement plans.These
are non-treatment related costs.
1202 Worker's Compensation 5,232 10-5930 Workers Compensation Insurance:Cost of workers compensation insurance.
These are non-treatment related costs.
1203 Health Insurance 65,351 10-5950 Health Insurance:Agency cost for health insurance including Vision These are
non-treatment related costs.
1204 Other(Dental) 5,127 10-5960 Dental Insurance:Agency cost for dental insurance.These are non-treatment
related costs.
1205 Other(ACI) 147 10-5990 Other Benefits:Agency cost for other wage related employee benefits.These
are non-treatment related costs.
1206 Other(Accrued Paid Leave) 49,017 10-5980 Accrued Paid Leave:The monetary value of staff Paid Leave hours as they
accrue on a monthly basis.These are non-treatment related costs.
Direct Payroll Taxes&Expenses: 44,899
1301 OASDI 7,107 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).
These are non-treatment related costs.
1302 FICA/MEDICARE 30,636 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).
These are non-treatment related costs.
1303 SUI 7,156 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.These are non-
treatment related costs.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 754,483
2001 Child Care -
2002 Client Housing Support 593,075 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 7,000 10-7015 Client Transportation:Cost for client transportation.(Examples:bus
tokens/passes,taxi,other public transportation,bicycles,etc.)
2004 Clothing&Hygiene 5,000 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.)
2005 Education Support 10,000 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 3,200 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 -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-30
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2008 Medication Supports 86,000 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 2,199 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 19,200 10-7023 Client Utility/Rental Security Deposits:Cast of client utility bills and/or security
deposits.
2011 Client Activities 10,000 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 2,200 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 5,259 10-6150 Food:Cost of food and drink to be consumed by the residents/clients.
(Examples:Groceries to prepare onsite,outside food brought onsite,food/drinks for
clients)
2014 Client Physical Exams 9,750 10-7080 Client Physical Exams:Cost of client admission physical examinations and TB
testing.
2015 Client Testing Materials 1,600 10-7140 Client Testing Material:Cast of U/A testing supplies,including breathalyzer,
used to determine treatment required for clients.
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 21,553
3001 Telecommunications 3,194 10-6340 Communications:Cost of electronic communications. (Examples:internet,
phone,fax,cell phones,etc.)These are non-treatment related costs.
3002 Printing/Postage 332 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.These are non-treatment related
costs.
3003 Office,Household&Program Supplies 3,065 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.These are non-treatment
related costs.
3004 Advertising -
3005 Staff Development&Training 2,763 10-6440 Staff Educational Expense:Cost of employee training courses and materials.
(Examples:certification,training,books,etc.)*May include cost of room rental.These
are non-treatment related costs.
3006 Staff Mileage 362 10-6060 Staff Mileage:Cost of employee mileage reimbursement paid in accordance
with FPM section 1005.These are non-treatment related costs.
3007 Subscriptions&Memberships 272 10-6360 Dues&Subscriptions:Cost of membership dues and subscriptions.(Examples:
magazine,newspaper,memberships,etc.)These are non-treatment related costs.
3008 Vehicle Maintenance/Fuel/Insurance 9,330 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)These are
non-treatment related costs.
3009 Recruitment 2,235 10-6470 Recruitment:Cost of advertising and other employee recruitment expenses.
(Examples:newspaper ad,urine screening,background check,etc.)These are non-
treatment related costs.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-31
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 67,870
4001 Building Maintenance 287 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.These are non-treatment related
costs.These are non-treatment related costs.
4002 Rent/Lease Building 47,534 10-6320 Building Rent(Other):Cost of rent/lease payments made for building leases
from outside sources.These are non-treatment related costs.
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.)These are non-treatment related costs.
4004 Rent/Lease Vehicles 8,774 10-6020 Vehicle Rent/Lease(Other):Rental cost of non-Agency vehicles and lease of
agency vehicles.
4005 Security 498 10-6390 Security:Cost 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.)These are non-
treatment related costs.
4006 Utilities 10,113 10-6350 Utilities:Cost of service for power,gas,water,sewer,garbage,etc.These are
non-treatment related costs.
4007 Equipment Maintenance 362 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.) These are non-treatment
related costs.
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 44,202
5001 Consultant(Network&Data Management) 179 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.These are non-treatment related costs.
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,374 Paid to outside vendors for translation/interpreter services.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.
5005 O/S Labor Phychiatrist 42,649 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.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.
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 227,943
6001 Administrative Overhead
6002 Professional Liability Insurance 1,857 10-6370Insurance:Cost of Agency liability and property insurance.These are non-
treatment related costs.
6003 Accounting/Bookkeeping -
6004 External Audit 377 10-6460 Audit Expense:Cost of outside audit fees.These are non-treatment related
costs.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-32
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6005 Insurance(Specify):
6006 Payroll Services 2,117 10-6482 Payroll Software&Support.These are non-treatment related costs.
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 876 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.)These are non-treatment related costs.
6010 Indirect 222,716 10-9000's Indirect Allocated Costs.These are non-treatment related costs.
6011 Other(specify) -
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 5,798
7001 Computer Equipment&Software -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 604 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)These are non-treatment related costs.
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 5,194 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.)These are non-treatment related
costs.
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,747,483
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,747,483
BUDGETCHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-33
Exhibit J-1
Forensic Continuum of Care FSP/ACT
Turning Point of Central California,Inc.
Fiscal Year(FY)2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Records Technician 0.69 $ 7,582 $ 7,582
1102 Administrative Assistant 0.60 13,320 13,320
1103 Program Bookkeeper 0.60 13,320 13,320
1104 Secretary 0.60 10,673 10,673
1105 - -
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 2.49 $ 44,895 $ 44,895
Acct# Program Position FTE Admin Program Total
1116 Assistant Program Director 0.60 $ 29,531 $ 29,531
1117 Program Director 0.60 36,030 36,030
1118 Mental Health Specialist 0.69 171,351 171,351
1119 Supervising Personal Services Coordinator 0.60 20,844 20,844
1120 Peer Support 0.69 33,763 33,763
1121 Mental Health Professional 0.69 73,911 73,911
1122 Nurse 0.69 30,831 30,831
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 4.55 $ 396,261 $ 396,261
Admin Program Total
Direct Personnel Salaries Subtotal 7.04 $ 44,895 $ 396,261 $ 441,156
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,496 $ 13,209 $ 14,705
1202 Worker's Compensation 532 4,700 5,232
1203 Health Insurance 6,650 58,701 65,351
1204 Other(Dental) 522 4,605 5,127
1205 Other(ACI) 15 132 147
1206 1 Other(Accrued Paid Leave) 4,988 44,029 49,017
Direct Employee Benefits Subtotal: $ 14,203 $ 125,376 $ 139,579
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 723 $ 6,384 $ 7,107
1302 FICA/MEDICARE 3,118 27,518 30,636
1303 SUI 728 6,428 7,156
1304 Other(specify) - - -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 4,569 $ 40,330 $ 44,899
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 63,667 $ 561,967 $ 625,634
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin I Program
10% 90%
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-34
Exhibit J-1
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support 593,075
2003 Client Transportation&Support 7,000
2004 Clothing&Hygiene 5,000
2005 Education Support 10,000
2006 Employment Support 3,200
2007 Household Items for Clients -
2008 Medication Supports 86,000
2009 Program Supplies-Medical 2,199
2010 Utility Vouchers 19,200
2011 Client Activities 10,000
2012 Client Personal Needs 2,200
2013 Client Food 5,259
2014 Client Physical Exams 9,750
2015 Client Testing Materials 1,600
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 754,483
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 3,194
3002 Printing/Postage 332
3003 Office,Household&Program Supplies 3,065
3004 Advertising -
3005 Staff Development&Training 2,763
3006 1 Staff Mileage 362
3007 Subscriptions&Memberships 272
3008 Vehicle Maintenance/Fuel/Insurance 9,330
3009 Recruitment 2,235
3010 Other(specify) -
3011 Other(specify)
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 21,553
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 287
4002 Rent/Lease Building 47,534
4003 Rent/Lease Equipment 302
4004 Rent/Lease Vehicles 8,774
4005 Security 498
4006 Utilities 10,113
4007 Equipment Maintenance 362
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 67,870
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 179
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 1,374
5005 O/S Labor Phychiatrist 42,649
5006 1 Other(specify) -
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 44,202
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-35
Exhibit J-1
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 1,857
6003 Accounting/Bookkeeping
6004 External Audit 377
6005 Insurance(Specify):
6006 Payroll Services 2,117
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 876
6010 Indirect 222,716
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 227,943
INDIRECT COST RATE 15.00%
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 604
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 1 Assets over$5,000/unit(Specify)
7007 Expendable Equipment 5,194
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,798
TOTAL PROGRAM EXPENSES $ 1,747,483
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 rensic Behavioral Health Continuum of Care-F $ 754,483
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 754,483
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)-CCP AB109 993,000
8404 Other(Specify)-DSH Diversion
8405 Other(Specify)
OTHER REVENUE TOTAL $ 993,000
TOTAL PROGRAM FUNDING SOURCES: $ 1,747,483
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-36
Exhibit J-1
Forensic Continuum of Care FSP/ACT
Turning Point of Central California,Inc.
Fiscal Year(FY)2026-27
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Records Technician Allocation to CCP 0.38
Allocation to FSC FSP UP 0.17
OP 0.45
Total 1.00
Position Contract#/Name/Department/County FTE%
Administrative Assistant Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Bookkeeper Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Secretary Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Assistant Program Director Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Director Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager Allocation to CCP 0.69
Allocation to FSC FSP UP 0.31
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-37
Exhibit J-1
Total 1.00
Position Contract#/Name/Department/County FTE
Supervising Personal Services Coordinator Allocation to CCP 0.60
Allocation to FSC FSP UP 0.27
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE%
Peer Support Allocation to CCP 0.69
Allocation to FSC FSP UP 0.31
Total 1.00
Position Contract#/Name/Department/County FTE%
Mental Health Professional Allocation to CCP 0.69
Allocation to FSC FSP UP 0.31
Total 1.00
Position Contract#/Name/Department/County FTE
Nurse Allocation to CCP 0.52
Allocation to FSC FSP UP 0.23
OP 0.25
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-38
Exhibit J-1
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-39
Exhibit J-1
Forensic Continuum of Care FSP/ACT
Turning Point of Central California,Inc.
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 625,634
Administrative Positions 44,895
1101 Records Technician 7,582 The Records Technician will keep track of the Medical Records and will do the billing for
the program.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.
1102 Administrative Assistant 13,320 The Administrative Assistant will oversee the support staff and will help with all support
staff duties.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.
1103 Program Bookkeeper 13,320 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.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.
1104 Secretary 10,673 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.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.
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 396,261
1116 Assistant Program Director 29,531 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 36,030 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.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.
1118 Mental Health Specialist 171,351 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. 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.
1119 Supervising Personal Services Coordinator 20,844 Provides supervision to all Mental Health Specialists to ensure client care,maintain
compliance with Turning Point policies and procedures. Supervisor also assisting in
training new staff and reporting to the Assistant 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.
1120 Peer Support 33,763 Serves as a client advocate and provides information and peer support to clients
throughout their recovery process. 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.
1121 Mental Health Professional 73,911 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. 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.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-40
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1122 Nurse 30,831 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. 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.
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 14,705 10-5940 Retirement:Cost of Agency contribution to employee retirement plans.These
are non-treatment related costs.
1202 Worker's Compensation 5,232 10-5930 Workers Compensation Insurance:Cost of workers compensation insurance.
These are non-treatment related costs.
1203 Health Insurance 65,351 10-5950 Health Insurance:Agency cost for health insurance including Vision These are
non-treatment related costs.
1204 Other(Dental) 5,127 10-5960 Dental Insurance:Agency cost for dental insurance.These are non-treatment
related costs.
1205 Other(ACI) 147 10-5990 Other Benefits:Agency cost for other wage related employee benefits.These
are non-treatment related costs.
1206 Other(Accrued Paid Leave) 49,017 10-5980 Accrued Paid Leave:The monetary value of staff Paid Leave hours as they
accrue on a monthly basis.These are non-treatment related costs.
Direct Payroll Taxes&Expenses: 44,899
1301 OASDI 7,107 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).
These are non-treatment related costs.
1302 FICA/MEDICARE 30,636 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).
These are non-treatment related costs.
1303 SUI 7,156 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.These are non-
treatment related costs.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 754,483
2001 Child Care -
2002 Client Housing Support 593,075 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 7,000 10-7015 Client Transportation:Cost for client transportation.(Examples:bus
tokens/passes,taxi,other public transportation,bicycles,etc.)
2004 Clothing&Hygiene 5,000 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.)
2005 Education Support 10,000 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 3,200 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 -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-41
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2008 Medication Supports 86,000 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 2,199 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 19,200 10-7023 Client Utility/Rental Security Deposits:Cast of client utility bills and/or security
deposits.
2011 Client Activities 10,000 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 2,200 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 5,259 10-6150 Food:Cost of food and drink to be consumed by the residents/clients.
(Examples:Groceries to prepare onsite,outside food brought onsite,food/drinks for
clients)
2014 Client Physical Exams 9,750 10-7080 Client Physical Exams:Cost of client admission physical examinations and TB
testing.
2015 Client Testing Materials 1,600 10-7140 Client Testing Material:Cast of U/A testing supplies,including breathalyzer,
used to determine treatment required for clients.
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 21,553
3001 Telecommunications 3,194 10-6340 Communications:Cost of electronic communications. (Examples:internet,
phone,fax,cell phones,etc.)These are non-treatment related costs.
3002 Printing/Postage 332 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.These are non-treatment related
costs.
3003 Office,Household&Program Supplies 3,065 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.These are non-treatment
related costs.
3004 Advertising -
3005 Staff Development&Training 2,763 10-6440 Staff Educational Expense:Cost of employee training courses and materials.
(Examples:certification,training,books,etc.)*May include cost of room rental.These
are non-treatment related costs.
3006 Staff Mileage 362 10-6060 Staff Mileage:Cost of employee mileage reimbursement paid in accordance
with FPM section 1005.These are non-treatment related costs.
3007 Subscriptions&Memberships 272 10-6360 Dues&Subscriptions:Cost of membership dues and subscriptions.(Examples:
magazine,newspaper,memberships,etc.)These are non-treatment related costs.
3008 Vehicle Maintenance/Fuel/Insurance 9,330 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)These are
non-treatment related costs.
3009 Recruitment 2,235 10-6470 Recruitment:Cost of advertising and other employee recruitment expenses.
(Examples:newspaper ad,urine screening,background check,etc.)These are non-
treatment related costs.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-42
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 67,870
4001 Building Maintenance 287 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.These are non-treatment related
costs.These are non-treatment related costs.
4002 Rent/Lease Building 47,534 10-6320 Building Rent(Other):Cost of rent/lease payments made for building leases
from outside sources.These are non-treatment related costs.
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.)These are non-treatment related costs.
4004 Rent/Lease Vehicles 8,774 10-6020 Vehicle Rent/Lease(Other):Rental cost of non-Agency vehicles and lease of
agency vehicles.
4005 Security 498 10-6390 Security:Cost 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.)These are non-
treatment related costs.
4006 Utilities 10,113 10-6350 Utilities:Cost of service for power,gas,water,sewer,garbage,etc.These are
non-treatment related costs.
4007 Equipment Maintenance 362 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.) These are non-treatment
related costs.
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 44,202
5001 Consultant(Network&Data Management) 179 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.These are non-treatment related costs.
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 1,374 Paid to outside vendors for translation/interpreter services.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.
5005 O/S Labor Phychiatrist 42,649 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.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.
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 227,943
6001 Administrative Overhead
6002 Professional Liability Insurance 1,857 10-6370Insurance:Cost of Agency liability and property insurance.These are non-
treatment related costs.
6003 Accounting/Bookkeeping -
6004 External Audit 377 10-6460 Audit Expense:Cost of outside audit fees.These are non-treatment related
costs.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-43
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6005 Insurance(Specify):
6006 Payroll Services 2,117 10-6482 Payroll Software&Support.These are non-treatment related costs.
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 876 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.)These are non-treatment related costs.
6010 Indirect 222,716 10-9000's Indirect Allocated Costs.These are non-treatment related costs.
6011 Other(specify) -
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 5,798
7001 Computer Equipment&Software -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 604 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)These are non-treatment related costs.
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 5,194 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.)These are non-treatment related
costs.
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,747,483
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,747,483
BUDGETCHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-44
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
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 Records Technician 0.12 $ 4,810 $ 4,810
1102 Secretary 0.26 10,182 10,182
1103 Bookkeeper 0.26 11,804 11,804
1104 - -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.64 $ 26,796 $ 26,796
Acct# Program Position FTE Admin Program Total
1116 Intake Assistant 0.26 $ 26,082 $ 26,082
1117 Program Director 0.26 23,695 23,695
1118 Case Manager 0.28 26,972 26,972
1119 Supervising Personal Services Coordinator 0.28 18,180 18,180
1120 Substance Abuse Counselor 0.28 67,080 67,080
1121 Mental Health Professional 0.27 67,041 67,041
1122 Nurse 0.06 7,025 7,025
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 1.69 $ 236,075 $ 236,075
Admin Program Total
Direct Personnel Salaries Subtotal 2.33 $ 26,796 $ 236,075 $ 262,871
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,164 $ 7,507 $ 8,671
1202 Worker's Compensation 414 2,671 3,085
1203 Health Insurance 4,846 31,264 36,110
1204 Dental Insurance 380 2,453 2,833
1205 ACI 12 75 87
1206 Accrued Paid Leave 3,879 25,023 28,902
Direct Employee Benefits Subtotal: $ 10,695 $ 68,993 $ 79,688
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 562 $ 3,628 $ 4,190
1302 FICA/MEDICARE 2,424 15,640 18,064
1303 SUI 566 3,653 4,219
1304 Other(specify) - - -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 3,552 $ 22,921 $ 26,473
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 41,043 $ 327,989 $ 369,032
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin I Program
11% 89%
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-45
Exhibit J-1
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support 120,000
2003 Client Transportation&Support 500
2004 Clothing,Food,&Hygiene 1,000
2005 Education Support
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 4,300
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Clothing&Hygiene 1,000
2012 Client Testing Material 9,850
2013 Client Food 300
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 136,950
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 2,204
3002 Printing/Postage 706
3003 Office,Household&Program Supplies 3,888
3004 Advertising -
3005 Staff Development&Training 1,957
3006 1 Staff Mileage 372
3007 Subscriptions&Memberships 106
3008 Vehicle Maintenance 936
3009 Recruitment 692
3010 Outreach&Engagement 147
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 11,008
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 80
4002 Rent/Lease Building 20,846
4003 Rent/Lease Equipment 519
4004 Rent/Lease Vehicles -
4005 Security 453
4006 Utilities 5,819
4007 Equipment Maintenance 626
4008 Depreciation 159
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 28,502
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 26
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services -
5005 OS Labor Psychiatrist 17,604
5006 1 OS Labor Physician 3,304
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 20,934
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-46
Exhibit J-1
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 2,277
6003 Accounting/Bookkeeping
6004 External Audit 346
6005 Insurance(Specify): -
6006 Payroll Services 1,928
6007 Depreciation(Provider-owned Equipment to be Usedfor Program Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 Licenses 5,384
6010 Indirect 75,924
6011 Other(specify)
6012 Other(specify) -
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 85,859
INDIRECT COST RATE 15.00%
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 2,583
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 1 Assets over$5,000/unit(Specify)
7007 Expendable Equipment 3,382
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,965
TOTAL PROGRAM EXPENSES $ 658,250
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-CommunityServices&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(Specify)-CCP AB109 658,250
8404 Other(Specify)
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 658,250
TOTAL PROGRAM FUNDING SOURCES: $ 658,250
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-47
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
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#/Name/Department/County FTE%
Records Technician Allocation to FSC OP MH FFP 0.08
Allocation to FSC OP MH CCP 0.02
Allocation to FSC OP SUD FFP 0.25
Allocation to FSC OP SUD CCP 0.10
Allocation to FSC FSP CCP&DSH 0.38
Allocation to FSC FSP FFP 0.17
Total 1.00
Position Contract#/Name/Department/County FTE%
Secretary Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP 0.05
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Bookkeeper Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP 0.05
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Intake Assistant Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP 0.05
Allocation to FSC OP SUD FFP 0.57
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Director Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP 0.05
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Total 1.00
Position Contract#/Name/Department/County FTE%
Supervising Personal Services Coordinator Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-48
Exhibit J-1
Total 1.00
Position Contract#/Name/Department/County FTE
Substance Abuse Counselor Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Total 1.00
Position Contract#/Name/Department/County FTE%
Mental Health Professional Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP 0.05
Allocation to FSC OP SUD FFP O.S6
Allocation to FSC OP SUD CCP 0.22
Total 1.00
Position Contract#/Name/Department/County FTE%
Nurse Allocation to FSC OP MH FFP 0.04
Allocation to FSC OP MH CCP 0.01
Allocation to FSC OP SUD FFP 0.14
Allocation to FSC OP SUD CCP 0.05
Allocation to FSC FSP CCP&DSH 0.52
Allocation to FSC FSP FFP 0.23
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-49
Exhibit J-1
El
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-50
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
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 369,032
Administrative Positions 26,796
1101 Records Technician 4,810 The Records Technician will keep track of the Medical Records and will do the billing for
the program.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.
1102 Secretary 10,182 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.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.
1103 Bookkeeper 11,804 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.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.
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 236,075
1116 Intake Assistant 26,082 The Intake Assistant processes all referrals related to this program.These services
include completeing all new admissions in a timely manner with the goal of opening the
client.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 23,695 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.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.
1118 Case Manager 26,972 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC.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.
1119 Supervising Personal Services Coordinator 18,180 Provides supervision to all Substance Abuse Conselors,Case Managers and Intake
Assistant to ensure client care,maintain compliance with Turning Point policies and
procedures. Supervisor also assisting in training new staff and reporting to 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.
1120 Substance Abuse Counselor 67,080 The Substance Abuse Counslor is responsible for the Substance Abuse Treatment
services in accordance with program requirements and ADP licensing.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.
1121 Mental Health Professional 67,041 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. 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.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-51
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1122 Nurse 7,025 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. 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.
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 8,671 10-5940 Retirement:Cost of Agency contribution to employee retirement plans.These
are non-treatment related costs.
1202 Worker's Compensation 3,085 10-5930 Workers Compensation Insurance:Cost of workers compensation insurance.
These are non-treatment related costs.
1203 Health Insurance 36,110 10-5950 Health Insurance:Agency cost for health insurance including Vision.These are
non-treatment related costs.
1204 Dental Insurance 2,833 10-5960 Dental Insurance:Agency cost for dental insurance.
1205 ACI 87 10-5990 Other Benefits:Agency cost for other wage related employee benefits.These
are non-treatment related costs.
1206 Accrued Paid Leave 28,902 10-5980 Accrued Paid Leave:The monetary value of staff Paid Leave hours as they
accrue on a monthly basis.These are non-treatment related costs.
Direct Payroll Taxes&Expenses: 26,473
1301 OASDI 4,190 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).
These are non-treatment related costs.
1302 FICA/MEDICARE 18,064 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).
These are non-treatment related costs.
1303 SUI 4,219 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.These are non-
treatment related costs.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 136,950
2001 Child Care -
2002 Client Housing Support 120,000 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,Food,&Hygiene 1,000 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.)
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-52
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2011 Clothing&Hygiene 1,000 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 Testing Material 9,850 10-7140 Client Testing Material:Cost of U/A testing supplies,including breathalyzer,
used to determine treatment required for clients.
2013 Client Food 300 10-6150 Food:Cost of food and drink to be consumed by the residents/clients.
(Examples:Groceries to prepare onsite,outside food brought onsite,food/drinks for
clients)
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 11,008
3001 Telecommunications 2,204 10-6340 Communications:Cost of electronic communications. (Examples:internet,
phone,fax,cell phones,etc.)These are non-treatment related costs.
3002 Printing/Postage 706 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.These are non-treatment related
costs.
3003 Office,Household&Program Supplies 3,888 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.These are non-treatment
related costs.
3004 Advertising -
3005 Staff Development&Training 1,957 10-6440 Staff Educational Expense:Cost of employee training courses and materials.
(Examples:certification,training,books,etc.)*May include cost of room rental.These
are non-treatment related costs.
3006 Staff Mileage 372 10-6060 Staff Mileage:Cost of employee mileage reimbursement paid in accordance
with FPM section 1005.These are non-treatment related costs.
3007 Subscriptions&Memberships 106 10-6360 Dues&Subscriptions:Cost of membership dues and subscriptions.(Examples:
magazine,newspaper,memberships,etc.)These are non-treatment related costs.
3008 Vehicle Maintenance 936 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)These are
non-treatment related costs.
3009 Recruitment 692 10-6470 Recruitment:Cost of advertising and other employee recruitment expenses.
(Examples:newspaper ad,urine screening,background check,etc.)
3010 Outreach&Engagement 147 10-6693 0&E Client Needs:Cost related to services and supplies used during outreach
and engagement events/activities.These are non-treatment related costs.
3011 Other(specify) -
3012 1 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 28,502
4001 Building Maintenance 80 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.These are non-treatment related
costs.
4002 Rent/Lease Building 20,846 10-6320 Building Rent(Other):Cost of rent/lease payments made for building leases
from outside sources.These are non-treatment related costs.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-53
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4003 Rent/Lease Equipment 519 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.)These are non-treatment related costs.
4004 Rent/Lease Vehicles
4005 Security 453 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.)These are non-
treatment related costs.
4006 Utilities 5,819 10-6350 Utilities:Cost of service for power,gas,water,sewer,garbage,etc.These are
non-treatment related costs.
4007 Equipment Maintenance 626 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.) These are non-treatment
related costs.
4008 Depreciation 159 10-8050 Depreciation:This account should be charged for the depreciation expense of
the Agency's tangible assets.These are non-treatment related costs.
4009 Other(specify) -
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 20,934
5001 Consultant(Network&Data Management) 26 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.These are non-treatment related costs.
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services -
5005 OS Labor Psychiatrist 17,604 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.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.
5006 OS Labor Physician 3,304 These accounts are assigned to record various professional services provided by
contracted Physician working as independent agents.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.
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 85,859
6001 Administrative Overhead
6002 Professional Liability Insurance 2,277 10-6370Insurance:Cost of Agency liability and property insurance.These are non-
treatment related costs.
6003 Accounting/Bookkeeping -
6004 External Audit 346 10-6460 Audit Expense:Cost of outside audit fees.These are non-treatment related
costs.
6005 Insurance(Specify): -
6006 Payroll Services 1,928 10-6482 Payroll Software&Support These are non-treatment related costs.
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 5,384 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.)These are non-treatment related costs.
6010 Indirect 75,924 10-9000's Indirect Allocated Costs.These are non-treatment related costs.
6011 Other(specify) -
6012 Other(specify)
6013 Other(specifO
7000:DIRECT FIXED ASSETS 5,965
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-54
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures 2,583 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)These are non-treatment related costs.
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 3,382 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.)These are non-treatment related
costs.
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 658,250
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 658,250
BUDGETCHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-55
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
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 0.12 $ 4,810 $ 4,810
1102 Secretary 0.26 10,182 10,182
1103 Bookkeeper 0.26 11,804 11,804
1104 - -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.64 $ 26,796 $ 26,796
Acct# Program Position FTE Admin Program Total
1116 Intake Assistant 0.26 $ 26,082 $ 26,082
1117 Program Director 0.26 23,695 23,695
1118 Case Manager 0.28 26,972 26,972
1119 Supervising Personal Services Coordinator 0.28 18,180 18,180
1120 Substance Abuse Counselor 0.28 67,080 67,080
1121 Mental Health Professional 0.27 67,041 67,041
1122 Nurse 0.06 7,025 7,025
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 1.69 $ 236,075 $ 236,075
Admin Program Total
Direct Personnel Salaries Subtotal 2.33 $ 26,796 $ 236,075 $ 262,871
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,164 $ 7,507 $ 8,671
1202 Worker's Compensation 414 2,671 3,085
1203 Health Insurance 4,846 31,264 36,110
1204 Dental Insurance 380 2,453 2,833
1205 ACI 12 75 87
1206 Accrued Paid Leave 3,879 25,023 28,902
Direct Employee Benefits Subtotal: $ 10,695 $ 68,993 $ 79,688
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 562 $ 3,628 $ 4,190
1302 FICA/MEDICARE 2,424 15,640 18,064
1303 SUI 566 3,653 4,219
1304 Other(specify) - - -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 3,552 $ 22,921 $ 26,473
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 41,043 $ 327,989 $ 369,032
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin I Program
11% 89%
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-56
Exhibit J-1
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support 120,000
2003 Client Transportation&Support 500
2004 Clothing,Food,&Hygiene 1,000
2005 Education Support
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 4,300
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Clothing&Hygiene 1,000
2012 Client Testing Material 9,850
2013 Client Food 300
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 136,950
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 2,204
3002 Printing/Postage 706
3003 Office,Household&Program Supplies 3,888
3004 Advertising -
3005 Staff Development&Training 1,957
3006 1 Staff Mileage 372
3007 Subscriptions&Memberships 106
3008 Vehicle Maintenance 936
3009 Recruitment 692
3010 Outreach&Engagement 147
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 11,008
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 80
4002 Rent/Lease Building 20,846
4003 Rent/Lease Equipment 519
4004 Rent/Lease Vehicles -
4005 Security 453
4006 Utilities 5,819
4007 Equipment Maintenance 626
4008 Depreciation 159
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 28,502
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 26
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services -
5005 OS Labor Psychiatrist 17,604
5006 1 OS Labor Physician 3,304
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 20,934
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-57
Exhibit J-1
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 2,277
6003 Accounting/Bookkeeping
6004 External Audit 346
6005 Insurance(Specify): -
6006 Payroll Services 1,928
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 5,384
6010 Indirect 75,924
6011 Other(specify)
6012 Other(specify) -
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 85,859
INDIRECT COST RATE 15.00%
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 2,583
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 1 Assets over$5,000/unit(Specify)
7007 Expendable Equipment 3,382
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,965
TOTAL PROGRAM EXPENSES $ 658,250
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-CommunityServices&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(Specify)-CCP AB109 658,250
8404 Other(Specify) -
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 658,250
TOTAL PROGRAM FUNDING SOURCES: $ 658,250
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-58
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
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 Allocation to FSC OP MH FFP 0.08
Allocation to FSC OP MH CCP 0.02
Allocation to FSC OP SUD FFP 0.25
Allocation to FSC OP SUD CCP 0.10
Allocation to FSC FSP CCP&DSH 0.38
Allocation to FSC FSP FFP 0.17
Total 1.00
Position Contract#/Name/Department/County FTE%
Secretary Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Bookkeeper Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP O.OS
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Intake Assistant Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.57
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Director Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Total 1.00
Position Contract#/Name/Department/County FTE%
Supervising Personal Services Coordinator Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-59
Exhibit J-1
Total 1.00
Position Contract#/Name/Department/County FTE
Substance Abuse Counselor Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Total 1.00
Position Contract#/Name/Department/County FTE%
Mental Health Professional Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.22
Total 1.00
Position Contract#/Name/Department/County FTE%
Nurse Allocation to FSC OP MH FFP 0.04
Allocation to FSC OP MH CCP 0.01
Allocation to FSC OP SUD FFP 0.14
Allocation to FSC OP SUD CCP 0.05
Allocation to FSC FSP CCP&DSH 0.52
Allocation to FSC FSP FFP 0.23
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-60
Exhibit J-1
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-61
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
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 369,032
Administrative Positions 26,796
1101 Records Technician 4,810 The Records Technician will keep track of the Medical Records and will do the billing for
the program.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.
1102 Secretary 10,182 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.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.
1103 Bookkeeper 11,804 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.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.
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 236,075
1116 Intake Assistant 26,082 The Intake Assistant processes all referrals related to this program.These services
include completeing all new admissions in a timely manner with the goal of opening the
client.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 23,695 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.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.
1118 Case Manager 26,972 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC.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.
1119 Supervising Personal Services Coordinator 18,180 Provides supervision to all Substance Abuse Conselors,Case Managers and Intake
Assistant to ensure client care,maintain compliance with Turning Point policies and
procedures. Supervisor also assisting in training new staff and reporting to 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.
1120 Substance Abuse Counselor 67,080 The Substance Abuse Counslor is responsible for the Substance Abuse Treatment
services in accordance with program requirements and ADP licensing.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.
1121 Mental Health Professional 67,041 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. 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.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-62
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1122 Nurse 7,025 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. 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.
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 8,671 10-5940 Retirement:Cost of Agency contribution to employee retirement plans.These
are non-treatment related costs.
1202 Worker's Compensation 3,085 10-5930 Workers Compensation Insurance:Cost of workers compensation insurance.
These are non-treatment related costs.
1203 Health Insurance 36,110 10-5950 Health Insurance:Agency cost for health insurance including Vision.These are
non-treatment related costs.
1204 Dental Insurance 2,833 10-5960 Dental Insurance:Agency cost for dental insurance.
1205 ACI 87 10-5990 Other Benefits:Agency cost for other wage related employee benefits.These
are non-treatment related costs.
1206 Accrued Paid Leave 28,902 10-5980 Accrued Paid Leave:The monetary value of staff Paid Leave hours as they
accrue on a monthly basis.These are non-treatment related costs.
Direct Payroll Taxes&Expenses: 26,473
1301 OASDI 4,190 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).
These are non-treatment related costs.
1302 FICA/MEDICARE 18,064 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).
These are non-treatment related costs.
1303 SUI 4,219 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.These are non-
treatment related costs.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 136,9S0
2001 Child Care -
2002 Client Housing Support 120,000 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,Food,&Hygiene 1,000 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.)
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.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-63
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Clothing&Hygiene 1,000 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 Testing Material 9,850 10-7140 Client Testing Material:Cast of U/A testing supplies,including breathalyzer,
used to determine treatment required for clients.
2013 Client Food 300 10-6150 Food:Cost of food and drink to be consumed by the residents/clients.
(Examples:Groceries to prepare onsite,outside food brought onsite,food/drinks for
clients)
2014 Other(specify) -
2015 Other(specify)
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 11,008
3001 Telecommunications 2,204 10-6340 Communications:Cost of electronic communications. (Examples:internet,
phone,fax,cell phones,etc.)These are non-treatment related costs.
3002 Printing/Postage 706 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.These are non-treatment related
costs.
3003 Office,Household&Program Supplies 3,888 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.These are non-treatment
related costs.
3004 Advertising -
3005 Staff Development&Training 1,957 10-6440 Staff Educational Expense:Cost of employee training courses and materials.
(Examples:certification,training,books,etc.)*May include cost of room rental.These
are non-treatment related costs.
3006 Staff Mileage 372 10-6060 Staff Mileage:Cast of employee mileage reimbursement paid in accordance
with FPM section 1005.These are non-treatment related costs.
3007 Subscriptions&Memberships 106 10-6360 Dues&Subscriptions:Cost of membership dues and subscriptions.(Examples:
magazine,newspaper,memberships,etc.)These are non-treatment related costs.
3008 Vehicle Maintenance 936 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)These are
non-treatment related costs.
3009 Recruitment 692 10-6470 Recruitment:Cost of advertising and other employee recruitment expenses.
(Examples:newspaper ad,urine screening,background check,etc.)
3010 Outreach&Engagement 147 10-6693 O&E Client Needs:Cost related to services and supplies used during outreach
and engagement events/activities.These are non-treatment related costs.
3011 Other(specify) -
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 28,502
4001 Building Maintenance 80 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,co2 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.These are non-treatment related
costs.
4002 Rent/Lease Building 20,846 10-6320 Building Rent(Other):Cost of rent/lease payments made for building leases
from outside sources.These are non-treatment related costs.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-64
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4003 Rent/Lease Equipment 519 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.)These are non-treatment related costs.
4004 Rent/Lease Vehicles
4005 Security 453 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.)These are non-
treatment related costs.
4006 Utilities 5,819 10-6350 Utilities:Cost of service for power,gas,water,sewer,garbage,etc.These are
non-treatment related costs.
4007 Equipment Maintenance 626 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.) These are non-treatment
related costs.
4008 Depreciation 159 10-8050 Depreciation:This account should be charged for the depreciation expense of
the Agency's tangible assets.These are non-treatment related costs.
4009 Other(specify) -
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 20,934
5001 Consultant(Network&Data Management) 26 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.These are non-treatment related costs.
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services -
5005 OS Labor Psychiatrist 17,604 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.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.
5006 OS Labor Physician 3,304 These accounts are assigned to record various professional services provided by
contracted Physician working as independent agents.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.
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 85,859
6001 Administrative Overhead
6002 Professional Liability Insurance 2,277 10-6370Insurance:Cost of Agency liability and property insurance.These are non-
treatment related costs.
6003 Accounting/Bookkeeping -
6004 External Audit 346 10-6460 Audit Expense:Cost of outside audit fees.These are non-treatment related
costs.
6005 Insurance(Specify): -
6006 Payroll Services 1,928 10-6482 Payroll Software&Support These are non-treatment related costs.
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 5,384 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.)These are non-treatment related costs.
6010 Indirect 75,924 10-9000's Indirect Allocated Costs.These are non-treatment related costs.
6011 Other(specify) -
6012 Other(specify)
6013 Other(specifO
7000:DIRECT FIXED ASSETS 5,965
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-65
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures 2,583 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)These are non-treatment related costs.
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 3,382 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.)These are non-treatment related
costs.
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 658,250
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 658,250
BUDGETCHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-66
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
Turning Point of Central California,Inc.
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Records Technician 0.12 $ 4,810 $ 4,810
1102 Secretary 0.26 10,182 10,182
1103 Bookkeeper 0.26 11,804 11,804
1104 - -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.64 $ 26,796 $ 26,796
Acct# Program Position FTE Admin Program Total
1116 Intake Assistant 0.26 $ 26,082 $ 26,082
1117 Program Director 0.26 23,695 23,695
1118 Case Manager 0.28 26,972 26,972
1119 Supervising Personal Services Coordinator 0.28 18,180 18,180
1120 Substance Abuse Counselor 0.28 67,080 67,080
1121 Mental Health Professional 0.27 67,041 67,041
1122 Nurse 0.06 7,025 7,025
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 1.69 $ 236,075 $ 236,075
Admin Program Total
Direct Personnel Salaries Subtotal 2.33 $ 26,796 $ 236,075 $ 262,871
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,164 $ 7,507 $ 8,671
1202 Worker's Compensation 414 2,671 3,085
1203 Health Insurance 4,846 31,264 36,110
1204 Dental Insurance 380 2,453 2,833
1205 ACI 12 75 87
1206 Accrued Paid Leave 3,879 25,023 28,902
Direct Employee Benefits Subtotal: $ 10,695 $ 68,993 $ 79,688
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 562 $ 3,628 $ 4,190
1302 FICA/MEDICARE 2,424 15,640 18,064
1303 SUI 566 3,653 4,219
1304 Other(specify) - - -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 3,552 $ 22,921 $ 26,473
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 41,043 $ 327,989 $ 369,032
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin I Program
11% 89%
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-67
Exhibit J-1
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support 120,000
2003 Client Transportation&Support 500
2004 Clothing,Food,&Hygiene 1,000
2005 Education Support
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 4,300
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Clothing&Hygiene 1,000
2012 Client Testing Material 9,850
2013 Client Food 300
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 136,950
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 2,204
3002 Printing/Postage 706
3003 Office,Household&Program Supplies 3,888
3004 Advertising -
3005 Staff Development&Training 1,957
3006 1 Staff Mileage 372
3007 Subscriptions&Memberships 106
3008 Vehicle Maintenance 936
3009 Recruitment 692
3010 Outreach&Engagement 147
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 11,008
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 80
4002 Rent/Lease Building 20,846
4003 Rent/Lease Equipment 519
4004 Rent/Lease Vehicles -
4005 Security 453
4006 Utilities 5,819
4007 Equipment Maintenance 626
4008 Depreciation 159
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 28,502
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 26
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services -
5005 OS Labor Psychiatrist 17,604
5006 1 OS Labor Physician 3,304
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 20,934
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-68
Exhibit J-1
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 2,277
6003 Accounting/Bookkeeping
6004 External Audit 346
6005 Insurance(Specify): -
6006 Payroll Services 1,928
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 5,384
6010 Indirect 75,924
6011 Other(specify)
6012 Other(specify) -
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 85,859
INDIRECT COST RATE 15.00%
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 2,583
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 1 Assets over$5,000/unit(Specify)
7007 Expendable Equipment 3,382
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,965
TOTAL PROGRAM EXPENSES $ 658,250
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-CommunityServices&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(Specify)-CCP AB109 658,250
8404 Other(Specify) -
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 658,250
TOTAL PROGRAM FUNDING SOURCES: $ 658,250
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-69
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
Turning Point of Central California,Inc.
Fiscal Year(FY)2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Records Technician Allocation to FSC OP MH FFP 0.08
Allocation to FSC OP MH CCP 0.02
Allocation to FSC OP SUD FFP 0.2S
Allocation to FSC OP SUD CCP 0.10
Allocation to FSC FSP CCP&DSH 0.38
Allocation to FSC FSP FFP 0.17
Total 1.00
Position Contract#/Name/Department/County FTE%
Secretary Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Bookkeeper Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP 0.0S
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Intake Assistant Allocation to F5C OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.57
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Director Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Total 1.00
Position Contract#/Name/Department/County FTE%
Supervising Personal Services Coordinator Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-70
Exhibit J-1
Total 1.00
Position Contract#/Name/Department/County FTE
Substance Abuse Counselor Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Total 1.00
Position Contract#/Name/Department/County FTE%
Mental Health Professional Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.22
Total 1.00
Position Contract#/Name/Department/County FTE%
Nurse Allocation to FSC OP MH FFP 0.04
Allocation to FSC OP MH CCP 0.01
Allocation to FSC OP SUD FFP 0.14
Allocation to FSC OP SUD CCP 0.05
Allocation to FSC FSP CCP&DSH 0.52
Allocation to FSC FSP FFP 0.23
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-71
Exhibit J-1
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-72
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
Turning Point of Central California,Inc.
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 369,032
Administrative Positions 26,796
1101 Records Technician 4,810 The Records Technician will keep track of the Medical Records and will do the billing for
the program.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.
1102 Secretary 10,182 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.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.
1103 Bookkeeper 11,804 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.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.
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 236,075
1116 Intake Assistant 26,082 The Intake Assistant processes all referrals related to this program.These services
include completeing all new admissions in a timely manner with the goal of opening the
client.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 23,695
1118 Case Manager 26,972 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC.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.
1119 Supervising Personal Services Coordinator 18,180 Provides supervision to all Substance Abuse Conselors,Case Managers and Intake
Assistant to ensure client care,maintain compliance with Turning Point policies and
procedures. Supervisor also assisting in training new staff and reporting to 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.
1120 Substance Abuse Counselor 67,080 The Substance Abuse Counslor is responsible for the Substance Abuse Treatment
services in accordance with program requirements and ADP licensing.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.
1121 Mental Health Professional 67,041 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. 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.
1122 Nurse 7,025 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. 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.
1123 0
1124 0
1125 0
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-73
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits
1201 Retirement 8,671 10-5940 Retirement:Cost of Agency contribution to employee retirement plans.These
are non-treatment related costs.
1202 Worker's Compensation 3,085 10-5930 Workers Compensation Insurance:Cost of workers compensation insurance.
These are non-treatment related costs.
1203 Health Insurance 36,110 10-5950 Health Insurance:Agency cost for health insurance including Vision.These are
non-treatment related costs.
1204 Dental Insurance 2,833 10-5960 Dental Insurance:Agency cost for dental insurance.
1205 ACI 87 10-5990 Other Benefits:Agency cost for other wage related employee benefits.These
are non-treatment related costs.
1206 Accrued Paid Leave 28,902 10-5980 Accrued Paid Leave:The monetary value of staff Paid Leave hours as they
accrue on a monthly basis.These are non-treatment related costs.
Direct Payroll Taxes&Expenses: 26,473
1301 OASDI 4,190 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).
These are non-treatment related costs.
1302 FICA/MEDICARE 18,064 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).
These are non-treatment related costs.
1303 SUI 4,219 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.These are non-
treatment related costs.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 136,950
2001 Child Care -
2002 Client Housing Support 120,000 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,Food,&Hygiene 1,000 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.)
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 -
2011 Clothing&Hygiene 1,000 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 Testing Material 9,850 10-7140 Client Testing Material:Cost of U/A testing supplies,including breathalyzer,
used to determine treatment required for clients.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-74
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2013 Client Food 300 10-6150 Food:Cost of food and drink to be consumed by the residents/clients.
(Examples:Groceries to prepare onsite,outside food brought onsite,food/drinks for
clients)
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 11,008
3001 Telecommunications 2,204 10-6340 Communications:Cost of electronic communications. (Examples:internet,
phone,fax,cell phones,etc.)These are non-treatment related costs.
3002 Printing/Postage 706 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.These are non-treatment related
costs.
3003 Office,Household&Program Supplies 3,888 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.These are non-treatment
related costs.
3004 Advertising -
3005 Staff Development&Training 1,957 10-6440 Staff Educational Expense:Cost of employee training courses and materials.
(Examples:certification,training,books,etc.)*May include cost of room rental.These
are non-treatment related costs.
3006 Staff Mileage 372 10-6060 Staff Mileage:Cast of employee mileage reimbursement paid in accordance
with FPM section 1005.These are non-treatment related costs.
3007 Subscriptions&Memberships 106 10-6360 Dues&Subscriptions:Cost of membership dues and subscriptions.(Examples:
magazine,newspaper,memberships,etc.)These are non-treatment related costs.
3008 Vehicle Maintenance 936 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)These are
non-treatment related costs.
3009 Recruitment 692 10-6470 Recruitment:Cost of advertising and other employee recruitment expenses.
(Examples:newspaper ad,urine screening,background check,etc.)
3010 Outreach&Engagement 147 10-6693 0&E Client Needs:Cost related to services and supplies used during outreach
and engagement events/activities.These are non-treatment related costs.
3011 Other(specify) -
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 28,502
4001 Building Maintenance 80 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,co2 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.These are non-treatment related
costs.
4002 Rent/Lease Building 20,846 10-6320 Building Rent(Other):Cost of rent/lease payments made for building leases
from outside sources.These are non-treatment related costs.
4003 Rent/Lease Equipment 519 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.)These are non-treatment related costs.
4004 Rent/Lease Vehicles
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-75
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4005 Security 453 10-6390 Security:Cost 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.)These are non-
treatment related costs.
4006 Utilities 5,819 10-6350 Utilities:Cost of service for power,gas,water,sewer,garbage,etc.These are
non-treatment related costs.
4007 Equipment Maintenance 626 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.) These are non-treatment
related costs.
4008 Depreciation 159 10-8050 Depreciation:This account should be charged for the depreciation expense of
the Agency's tangible assets.These are non-treatment related costs.
4009 Other(specify) -
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 20,934
5001 Consultant(Network&Data Management) 26 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.These are non-treatment related costs.
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services -
5005 OS Labor Psychiatrist 17,604 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.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.
5006 OS Labor Physician 3,304 These accounts are assigned to record various professional services provided by
contracted Physician working as independent agents.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.
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 85,859
6001 Administrative Overhead
6002 Professional Liability Insurance 2,277 10-6370 Insurance:Cost of Agency liability and property insurance.These are non-
treatment related costs.
6003 Accounting/Bookkeeping -
6004 External Audit 346 10-6460 Audit Expense:Cost of outside audit fees.These are non-treatment related
costs.
6005 Insurance(Specify): -
6006 Payroll Services 1,928 10-6482 Payroll Software&Support These are non-treatment related costs.
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 5,384 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.)These are non-treatment related costs.
6010 Indirect 75,924 10-9000's Indirect Allocated Costs.These are non-treatment related costs.
6011 Other(specify) -
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 5,965
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-76
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7003 Furniture&Fixtures 2,583 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)These are non-treatment related costs.
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 3,382 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.)These are non-treatment related
costs.
7008 Other(specify) -
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 658,250
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 658,250
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-77
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
Turning Point of Central California,Inc.
Fiscal Year(FY)2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Records Technician 0.12 $ 4,810 $ 4,810
1102 Secretary 0.26 10,182 10,182
1103 Bookkeeper 0.26 11,804 11,804
1104 - -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.64 $ 26,796 $ 26,796
Acct# Program Position FTE Admin Program Total
1116 Intake Assistant 0.26 $ 26,082 $ 26,082
1117 Program Director 0.26 23,695 23,695
1118 Case Manager 0.28 26,972 26,972
1119 Supervising Personal Services Coordinator 0.28 18,180 18,180
1120 Substance Abuse Counselor 0.28 67,080 67,080
1121 Mental Health Professional 0.27 67,041 67,041
1122 Nurse 0.06 7,025 7,025
1123 - -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 1.69 $ 236,075 $ 236,075
Admin Program Total
Direct Personnel Salaries Subtotal 2.33 $ 26,796 $ 236,075 $ 262,871
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,164 $ 7,507 $ 8,671
1202 Worker's Compensation 414 2,671 3,085
1203 Health Insurance 4,846 31,264 36,110
1204 Dental Insurance 380 2,453 2,833
1205 ACI 12 75 87
1206 Accrued Paid Leave 3,879 25,023 28,902
Direct Employee Benefits Subtotal: $ 10,695 $ 68,993 $ 79,688
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 562 $ 3,628 $ 4,190
1302 FICA/MEDICARE 2,424 15,640 18,064
1303 SUI 566 3,653 4,219
1304 Other(specify) - - -
1305 Other(specify)
1306 1 Other(specify) -
Direct Payroll Taxes&Expenses Subtotal: $ 3,552 $ 22,921 $ 26,473
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 41,043 $ 327,989 $ 369,032
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin I Program
11% 89%
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-78
Exhibit J-1
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support 120,000
2003 Client Transportation&Support 500
2004 Clothing,Food,&Hygiene 1,000
2005 Education Support
2006 Employment Support
2007 Household Items for Clients -
2008 Medication Supports 4,300
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Clothing&Hygiene 1,000
2012 Client Testing Material 9,850
2013 Client Food 300
2014 Other(specify) -
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 136,950
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 2,204
3002 Printing/Postage 706
3003 Office,Household&Program Supplies 3,888
3004 Advertising -
3005 Staff Development&Training 1,957
3006 1 Staff Mileage 372
3007 Subscriptions&Memberships 106
3008 Vehicle Maintenance 936
3009 Recruitment 692
3010 Outreach&Engagement 147
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 11,008
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 80
4002 Rent/Lease Building 20,846
4003 Rent/Lease Equipment 519
4004 Rent/Lease Vehicles -
4005 Security 453
4006 Utilities 5,819
4007 Equipment Maintenance 626
4008 Depreciation 159
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 28,502
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 26
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services -
5005 OS Labor Psychiatrist 17,604
5006 1 OS Labor Physician 3,304
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 20,934
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-79
Exhibit J-1
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 2,277
6003 Accounting/Bookkeeping
6004 External Audit 346
6005 Insurance(Specify): -
6006 Payroll Services 1,928
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 5,384
6010 Indirect 75,924
6011 Other(specify)
6012 Other(specify) -
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 85,859
INDIRECT COST RATE 15.00%
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 2,583
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 1 Assets over$5,000/unit(Specify)
7007 Expendable Equipment 3,382
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,965
TOTAL PROGRAM EXPENSES $ 658,250
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-CommunityServices&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(Specify)-CCP AB109 658,250
8404 Other(Specify) -
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 658,250
TOTAL PROGRAM FUNDING SOURCES: $ 658,250
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-80
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
Turning Point of Central California,Inc.
Fiscal Year(FY)2026-27
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Records Technician Allocation to FSC OP MH FFP 0.08
Allocation to FSC OP MH CCP 0.02
Allocation to FSC OP SUD FFP 0.25
Allocation to FSC OP SUD CCP 0.10
Allocation to FSC FSP CCP&DSH 0.38
Allocation to FSC FSP FFP 0.17
Total 1.00
Position Contract#/Name/Department/County FTE%
Secretary Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Bookkeeper Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP O.OS
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Intake Assistant Allocation to F5C OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.57
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Director Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.21
Total 1.00
Position Contract#/Name/Department/County FTE%
Case Manager Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Total 1.00
Position Contract#/Name/Department/County FTE%
Supervising Personal Services Coordinator Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-81
Exhibit J-1
Total 1.00
Position Contract#/Name/Department/County FTE
Substance Abuse Counselor Allocation to FSC OP SUD FFP 0.72
Allocation to FSC OP SUD CCP 0.28
Total 1.00
Position Contract#/Name/Department/County FTE%
Mental Health Professional Allocation to FSC OP MH FFP 0.17
Allocation to FSC OP MH CCP US
Allocation to FSC OP SUD FFP 0.56
Allocation to FSC OP SUD CCP 0.22
Total 1.00
Position Contract#/Name/Department/County FTE%
Nurse Allocation to FSC OP MH FFP 0.04
Allocation to FSC OP MH CCP 0.01
Allocation to FSC OP SUD FFP 0.14
Allocation to FSC OP SUD CCP 0.05
Allocation to FSC FSP CCP&DSH 0.52
Allocation to FSC FSP FFP 0.23
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-82
Exhibit J-1
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-1-83
Exhibit J-1
Forensic Continuum of Care SUD/MH OP
Turning Point of Central California,Inc.
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 369,032
Administrative Positions 26,796
1101 Records Technician 4,810 The Records Technician will keep track of the Medical Records and will do the billing for
the program.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.
1102 Secretary 10,182 Provides direct services to the program by data entry,phone calls,checking in clients,
etc.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.
1103 Bookkeeper 11,804 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.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.
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 236,075
1116 Intake Assistant 26,082 The Intake Assistant processes all referrals related to this program.These services
include completeing all new admissions in a timely manner with the goal of opening the
client.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 23,695 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.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.
1118 Case Manager 26,972 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC.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.
1119 Supervising Personal Services Coordinator 18,180 Provides supervision to all Substance Abuse Conselors,Case Managers and Intake
Assistant to ensure client care,maintain compliance with Turning Point policies and
procedures. Supervisor also assisting in training new staff and reporting to 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.
1120 Substance Abuse Counselor 67,080 The Substance Abuse Counslor is responsible for the Substance Abuse Treatment
services in accordance with program requirements and ADP licensing.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.
1121 Mental Health Professional 67,041 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. 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.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-84
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1122 Nurse 7,025 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. 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.
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 8,671 10-5940 Retirement:Cost of Agency contribution to employee retirement plans.These
are non-treatment related costs.
1202 Worker's Compensation 3,085 10-5930 Workers Compensation Insurance:Cost of workers compensation insurance.
These are non-treatment related costs.
1203 Health Insurance 36,110 10-5950 Health Insurance:Agency cost for health insurance including Vision.These are
non-treatment related costs.
1204 Dental Insurance 2,833 10-5960 Dental Insurance:Agency cost for dental insurance.
1205 ACI 87 10-5990 Other Benefits:Agency cost for other wage related employee benefits.These
are non-treatment related costs.
1206 Accrued Paid Leave 28,902 10-5980 Accrued Paid Leave:The monetary value of staff Paid Leave hours as they
accrue on a monthly basis.These are non-treatment related costs.
Direct Payroll Taxes&Expenses: 26,473
1301 OASDI 4,190 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).
These are non-treatment related costs.
1302 FICA/MEDICARE 18,064 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).
These are non-treatment related costs.
1303 SUI 4,219 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.These are non-
treatment related costs.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 136,9S0
2001 Child Care -
2002 Client Housing Support 120,000 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,Food,&Hygiene 1,000 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.)
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.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-85
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Clothing&Hygiene 1,000 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 Testing Material 9,850 10-7140 Client Testing Material:Cast of U/A testing supplies,including breathalyzer,
used to determine treatment required for clients.
2013 Client Food 300 10-6150 Food:Cost of food and drink to be consumed by the residents/clients.
(Examples:Groceries to prepare onsite,outside food brought onsite,food/drinks for
clients)
2014 Other(specify) -
2015 Other(specify)
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 11,008
3001 Telecommunications 2,204 10-6340 Communications:Cost of electronic communications. (Examples:internet,
phone,fax,cell phones,etc.)These are non-treatment related costs.
3002 Printing/Postage 706 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.These are non-treatment related
costs.
3003 Office,Household&Program Supplies 3,888 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.These are non-treatment
related costs.
3004 Advertising -
3005 Staff Development&Training 1,957 10-6440 Staff Educational Expense:Cost of employee training courses and materials.
(Examples:certification,training,books,etc.)*May include cost of room rental.These
are non-treatment related costs.
3006 Staff Mileage 372 10-6060 Staff Mileage:Cast of employee mileage reimbursement paid in accordance
with FPM section 1005.These are non-treatment related costs.
3007 Subscriptions&Memberships 106 10-6360 Dues&Subscriptions:Cost of membership dues and subscriptions.(Examples:
magazine,newspaper,memberships,etc.)These are non-treatment related costs.
3008 Vehicle Maintenance 936 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)These are
non-treatment related costs.
3009 Recruitment 692 10-6470 Recruitment:Cost of advertising and other employee recruitment expenses.
(Examples:newspaper ad,urine screening,background check,etc.)
3010 Outreach&Engagement 147 10-6693 O&E Client Needs:Cost related to services and supplies used during outreach
and engagement events/activities.These are non-treatment related costs.
3011 Other(specify) -
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 28,502
4001 Building Maintenance 80 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,co2 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.These are non-treatment related
costs.
4002 Rent/Lease Building 20,846 10-6320 Building Rent(Other):Cost of rent/lease payments made for building leases
from outside sources.These are non-treatment related costs.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-86
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4003 Rent/Lease Equipment 519 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.)These are non-treatment related costs.
4004 Rent/Lease Vehicles
4005 Security 453 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.)These are non-
treatment related costs.
4006 Utilities 5,819 10-6350 Utilities:Cost of service for power,gas,water,sewer,garbage,etc.These are
non-treatment related costs.
4007 Equipment Maintenance 626 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.) These are non-treatment
related costs.
4008 Depreciation 159 10-8050 Depreciation:This account should be charged for the depreciation expense of
the Agency's tangible assets.These are non-treatment related costs.
4009 Other(specify) -
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 20,934
5001 Consultant(Network&Data Management) 26 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.These are non-treatment related costs.
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services -
5005 OS Labor Psychiatrist 17,604 These accounts are assigned to record various professional services provided by
contracted Psychiatrist working as independent agents.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.
5006 OS Labor Physician 3,304 These accounts are assigned to record various professional services provided by
contracted Physician working as independent agents.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.
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 85,859
6001 Administrative Overhead
6002 Professional Liability Insurance 2,277 10-6370Insurance:Cost of Agency liability and property insurance.These are non-
treatment related costs.
6003 Accounting/Bookkeeping -
6004 External Audit 346 10-6460 Audit Expense:Cost of outside audit fees.These are non-treatment related
costs.
6005 Insurance(Specify): -
6006 Payroll Services 1,928 10-6482 Payroll Software&Support These are non-treatment related costs.
6007 Depreciation(Provider-Owned Equipment to be Used -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Licenses 5,384 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.)These are non-treatment related costs.
6010 Indirect 75,924 10-9000's Indirect Allocated Costs.These are non-treatment related costs.
6011 Other(specify) -
6012 Other(specify)
6013 Other(specifO
7000:DIRECT FIXED ASSETS 5,965
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-87
Exhibit J-1
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures 2,583 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)These are non-treatment related costs.
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 3,382 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.)These are non-treatment related
costs.
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 658,250
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 658,250
BUDGETCHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-1-88
Exhibit J-2
Turining Point of Central California,Inc.
Whole Person Care Like
July 1,2023-June 30,2024
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ - $
1102 Secretary 0.25 10,447 10,447
1103 Program Bookkeeper 0.05 2,330 2,330
1104 - -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.30 $ 12,777 $ 12,777
Acct# Program Position FTE Admin Program Total
1116 Case Manager 2.00 $ 100,446 $ 100,446
1117 Supervising Personal Services Coordinator 0.25 18,231 18,231
1118 Peer Support 1.00 39,349 39,349
1119 Program Director 0.13 14,989 14,989
1120 - -
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 3.38 $ 173,015 $ 173,015
Admin Program Total
Direct Personnel Salaries Subtotal 3.68 $ 12,777 $ 173,015 $ 185,792
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 426 $ 5,800 $ 6,226
1202 Worker's Compensation 224 3,044 3,268
1203 Health/Dental/Other Insurance 2,593 29,177 31,770
1204 Other(Accrued Paid Leave) 1,420 19,332 20,752
1205 Other(specify) - -
1206 1 Other(specify) -
Direct Employee Benefits Subtotal: $ 4,663 $ 57,353 $ 62,016
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 206 $ 2,803 $ 3,009
1302 FICA/MEDICARE 887 12,082 12,969
1303 SUI 207 2,822 3,029
1304 Other(specify) - - -
1305 Other(specify)
1306 1 Other(specify) - -
Direct Payroll Taxes&Expenses Subtotal: $ 1,300 $ 17,707 $ 19,007
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 18,740 $ 248,075 $ 266,815
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin I Program
7%1 93%
2000:DIRECT CLIENT SUPPORT
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-1
Exhibit J-2
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support
2003 Client Transportation&Support 1,000
2004 Clothing,Food,&Hygiene 1,900
2005 Education Support 1,000
2006 Employment Support 800
2007 Household Items for Clients -
2008 Medication Supports 2,000
2009 Program Supplies-Medical 275
2010 Utility&Rental Security Deposits 800
2011 Other(Client Personal Needs) 800
2012 Other(0&E Client Needs) 1,000
2013 Other(Client Physical Exams) 250
2014 Other(Client Activities) -
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 9,825
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 750
3002 Printing/Postage 150
3003 Office,Household&Program Supplies 650
3004 Advertising -
3005 Staff Development&Training 500
3006 Staff Mileage 413
3007 Subscriptions&Memberships 100
3008 Vehicle Maintenance 1,250
3009 Other(Vehicle Insurance/Fuel) 9,200
3010 Other(Recruitment) 350
3011 Other(Staff Meetings/Employee Relations) 350
3012 Other(Miscellaneous Expense-COVID Supplies) 534
DIRECT OPERATING EXPENSES TOTAL: $ 14,247
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 750
4002 Rent/Lease Building 5,200
4003 Rent/Lease Equipment 150
4004 Rent/Lease Vehicles 9,600
4005 Security 100
4006 lUtilities 2,500
4007 Other(Insurance) 500
4008 Other(Equipment Maintenance) 150
4009 Other(specify) -
4010 Other(specify) -
DIRECTFACILITIES/EQUIPMENTTOTAL: $ 18,950
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 500
5005 Other(HRIS&PR Processing) 300
5006 10ther(Audit) 150
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 950
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(Provider-Owned Equipment to be UsedforProgmnn Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 Other(Admin,HR,Fiscal,IT,Executive,Regional Supports) 46,664
6010 Other(specify) -
6011 Other(specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-2
Exhibit J-2
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 46,664
INDIRECT COST RATE 15.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 100
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(Expendable Equipment) 100
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 300
TOTAL PROGRAM EXPENSES $ 357,751
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0 - -
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0 - -
8006 1 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
8009 Other(Specify) 0
8010 Other(Specify) 0 - -
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)%1 0% -
MEDI-CAL FFP TOTAL $ -
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 $ -
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology -
MHSATOTAL $ -
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
8404 Other(WPCL) 357,751
8405 Other(Specify) -
OTHER REVENUE TOTAL $ 357,751
TOTAL PROGRAM FUNDING SOURCES: $ 357,751
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-2-3
Exhibit J-2
Turining Point of Central California,Inc.
Whole Person Care Like
July 1,2023-June 30,2024
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director 22-264/FSC FSP/Fresno 0.88
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE
Supervising Personal Services Coordinator 22-264/FSC FSP/Fresno 0.75
WPCL 0.25
Total 1.00
Position Contract#/Name/Department/County FTE%
Secretary 22-264/FSC FSP/Fresno 0.75
WPCL US
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Bookkeeper WPCL 0.05
22-264/FSC FSP/Fresno 0.50
FSC OP 0.45
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-4
Exhibit J-2
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%
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 217/2020
J-2-5
Exhibit J-2
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-6
Exhibit J-2
Turining Point of Central California,Inc.
Whole Person Care Like
July 1,2023-June 30,2024 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 266,815
Administrative Positions 12,777
1101 0 -
1102 Secretary 10,447 General secretarial and front desk receptionist duties including: Answering the
telephone,greeting clients/guests,notifying staff when clients arrive for scheduled
appointments,preparing forms to be sent to the administrative office,and performing
general office duties.Assumed increase for FY 22-23&23-24.
1103 Program Bookkeeper 2,330 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.Assumed increase for FY 22-23&23-24.
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 173,015
1116 Case Manager 100,446 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC. The case manager will carry a caseload
assisting in linking those who recently were released from jail for any and all services
needed in the community.This position does not provide funding source
documentation,nor is providing rehab services,only linkages.
1117 Supervising Personal Services Coordinator 18,231 Provides supervision to all Case Managers to ensure client care,maintain compliance
with Turning Point policies and procedures. Supervisor also assisting in training new
staff and reporting to the Program Director. Assumed increase for FY 22-23&23-24.
1118 Peer Support 39,349 Serves as a client advocate and provides information and peer support to clients
throughout their recovery process.
1119 Program Director 14,989 The Program Director currently oversees the program,hiring,training and supervising
staff. Assumed increase for FY 22-23&23-24. Based on internal salary analysis,this
position is in need of a salary increase due to clinical supervision of the program and
requirement of BIBS licensure.
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 62,016
1201 Retirement 6,226 Cost of Agency contribution to employee retirement plans.
1202 Worker's Compensation 3,268 Cost of workers compensation insurance.
1203 Health/Dental/Other Insurance 31,770 Agency cost for health,dental,and other insurance
1204 Other(Accrued Paid Leave) 20,752 The monetary valueof staff Paid Leave hours as they accrue on a monthly basis.
1205 Other(specify) -
1206 1 Other(specify) -
Direct Payroll Taxes&Expenses: 19,007
1301 OASDI 3,009 Employer pays 1.40%of employee's full salary.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-7
Exhibit J-2
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1302 FICA/MEDICARE 12,969 Employer portion of F.I.C.A.taxes charged to the Agency by the InternalRevenue
Service.F.I.C.A.is comprised of"Old-Age,Survivors,and Disability Insurance"(OASDI),
plus"Hospital Insurance"(Medicare).
1303 SUI 3,029 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 1 Other(specify)
2000:DIRECT CLIENT SUPPORT 9,825
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,000 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
transportation,bicycles,etc.)
2004 Clothing,Food,&Hygiene 1,900 Cost of client hygiene supplies and non-work related clothing.Cost of food for a
particular client to be consumed while off site of program location.Cost of food and
drink to be consumed by the residents/clients at the program location.This includes
the food items stored at outpatient facilities that are not purchased for any particular
client,may be used for outpatient programs while on site.
2005 Education Support 1,000 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational class.
2006 Employment Support 800 Cost of course fees and educational materials distributed to clients and prospective
clients.Including court ordered educational class.
2007 Household Items for Clients -
2008 Medication Supports 2,000 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 275 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,over-the-counter
medication*,etc.*if allowable per contract.
2010 Utility&Rental Security Deposits 800 Cost of client utility bills and/or security deposits.
2011 Other(Client Personal Needs) 800 Cost of supplying clients with necessary personal items not detailed in other other
accounts.
2012 Other(O&E Client Needs) 1,000 Cost related to services and supplies used during outreach and engagement
events/activities.
2013 Other(Client Physical Exams) 250 Cost of client admission physical examinations and TB testing.
2014 Other(Client Activities) -
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 14,247
3001 Telecommunications 750 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 150 Cost of custom copying/printing charges(Examples:letterhead,business forms,
business cards,flyers,brochures,signs,etc.)and Postage and elivery,including delivery
by the USPS,UPS,FEDEX and other courier services
3003 Office,Household&Program Supplies 650 Cost of items normally used in an office setting.Cost of any items normally used by
clients to meet program objectives while receiving services.These items are to remain
at the program location and not sent home with the client.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.Cost of items generally used by all at program's location.
3004 Advertising -
3005 Staff Development&Training 500 Cost of employee training courses and materials.
3006 Staff Mileage 413 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 100 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
memberships,etc.)
3008 Vehicle Maintenance 1,250 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
maintenance and repair of vehicles used by Agency programs.Cost in obtaining and
renewing licenses and permits.
3009 Other(Vehicle Insurance/Fuel) 9,200 Cost for vehicle insurance and gas.
3010 Other(Recruitment) 350 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
happen for the purposes of employment
3011 Other(Staff Meetings/Employee Relations) 350 Cost relating to improvement of working conditions,employer/employee relations and
employee morale.Cost of room rental and supplies necessary for staff mettings.
3012 Other(Miscellaneous Expense-COVID Supplies) 534 Cost not more appropriately assigned to another account.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-8
Exhibit J-2
PROGRAM EXPENSE
ACCT#J LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4000:DIRECT FACILITIES&EQUIPMENT 18,950
4001 Building Maintenance 750 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
heating,hood cleaning,plumbing,etc.)This account should not be used if a specific
outside labor contractor is doing an identifiable project.
4002 Rent/Lease Building 5,200 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment ISO
4004 Rent/Lease Vehicles 9,600 Rental cost of vehicles and lease of agency vehicles.
4005 Security 100 Cost of installation,maintenance and monthly service fees for building alarms and
other security measures.(Examples:security/surveillance equipment,service and
installation,safes,etc.)
4006 Utilities 2,500 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other(Insurance) 500 Cost of insurance for general liability.
4008 Other(Equipment Maintenance) 150 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.)
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 950
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 500 Paid to an outside vendor for translation/interpreter services
5005 Other(HRIS&PR Processing) 300 HRIS costs.
5006 Other(Audit) 150 Cost of outside audit fees.
5007 Other(specify) -
116-6 5008 Other(specify)
6000:INDIRECT EXPENSES 46,664
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(Admin,HR,Fiscal,IT,Executive,Regional 46,664
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 300
7001 Computer Equipment&Software 100 Cost of computer software and computer support
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 100 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$2000 per item.
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify) -
7007 Other(Expendable Equipment) 100 Cost of purchasing office equipment that has a cost less than$2000 per item.
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-9
Exhibit J-2
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 357,751
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 357,751
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 21712020
J-2-10
Exhibit J-2
Turining Point of Central California, Inc.
Whole Person Care Like
July 1, 2024-June 30,2025
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ - $ -
1102 Secretary 0.25 10,447 10,447
1103 Program Bookkeeper 0.05 2,330 2,330
1104 - -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.300 $ 12,777 $ 12,777
Acct# Program Position I FTE I Admin I Program Total
1116 Case Manager 2.00 $ 100,446 $ 100,446
1117 Supervising Personal Services Coordinator 0.25 18,231 18,231
1118 Peer Support 1.00 39,349 39,349
1119 Prorgram Director 0.13 14,989 14,989
1120 - -
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 3.38 $ 173,015 $ 173,015
Admin Program Total
Direct Personnel Salaries Subtotal 3.68 $ 12,777 $ 173,015 $ 185,792
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-2-11
Exhibit J-2
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 426 $ 5,800 $ 6,226
1202 Worker's Compensation 224 3,044 3,268
1203 Health/Dental/Other Insurance 2,593 29,177 31,770
1204 Other(Accrued Paid Leave) 1 1,420 19,332 20,752
1205 Other(specify) -
1206 Other(specify) -
Direct Employee Benefits Subtotal: $ 4,663 $ 57,353 $ 62,016
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 206 $ 2,803 $ 3,009
1302 FICA/MEDICARE 887 12,082 12,969
1303 SUI 207 2,822 3,029
1304 Other(specify) - - -
1305 Other(specify) - - -
1306 Other(specify) - -
Direct Payroll Taxes&Expenses Subtotal: $ 1,300 $ 17,707 $ 19,007
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 18,740 $ 248,075 $ 266,815
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
7%1 9 3%]
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support -
2003 Client Transportation&Support 1,000
2004 Clothing, Food,&Hygiene 1,900
2005 Education Support 11000
2006 Employment Support 800
2007 Household Items for Clients -
2008 Medication Supports 2,000
2009 Program Supplies-Medical 275
2010 Utility&Rental Security Deposits 800
2011 Other(Client Personal Needs) 800
2012 Other(O&E Client Needs) 1,000
2013 Other(Client Physical Exams) 250
2014 Other(Client Activities) -
2015 Other(specify) -
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 9,825
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-2-12
Exhibit J-2
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 750
3002 Printing/Postage 150
3003 Office, Household&Program Supplies 650
3004 Advertising -
3005 Staff Development&Training 500
3006 Staff Mileage 413
3007 Subscriptions&Memberships 100
3008 Vehicle Maintenance 1,250
3009 Other(Vehicle Insurance/Fuel) 9,200
3010 Other(Recruitment) 350
3011 Other(Staff Meetings/Employee Relations) 350
3012 Other(Miscellaneous Expense-COVID Supplies) 534
DIRECT OPERATING EXPENSES TOTAL: $ 14,247
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 750
4002 Rent/Lease Building 5,200
4003 Rent/Lease Equipment 150
4004 1 Rent/Lease Vehicles 9,600
4005 Security 100
4006 Utilities 21500
4007 Other(Insurance) 500
4008 Other(Equipment Maintenance) 150
4009 Other(specify) -
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j 18,950
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 500
5005 Other(HRIS&PR Processing) 300
5006 Other(Audit) 150
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 950
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-2-13
Exhibit J-2
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(Provider-Owned Equipment to be Usedfor Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(Admin, HR, Fiscal,IT, Executive, Regional Supports) 46,664
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 46,664
INDIRECT COST RATE 15.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 100
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 100
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(Expendable Equipment) 100
7008 Other(specify) -
FIXED ASSETS EXPENSES TOTAL $ 300
TOTAL PROGRAM EXPENSES $ 357,751
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 - -
8007 Assessment 0 - -
8008 Rehabilitation 0 - -
8009 Other(Specify) 0 - -
8010 Other(Specify) 0 - I -
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0% -
MEDI-CAL FFP TOTAL $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-2-14
Exhibit J-2
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
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 $
8302 PEI- Prevention &Early Intervention
8303 INN- Innovations
8304 WET-Workforce Education &Training
8305 jCFTN-Capital Facilities&Technology
MHSATOTAL $ -
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)
8404 Other(WPCL) $ 357,751
8405 1 Other(Specify)
OTHER REVENUE TOTAL $ 357,751
TOTAL PROGRAM FUNDING SOURCES: $ 357,751
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
J-2-15
Exhibit J-2
Turining Point of Central California,Inc.
Whole Person Care Like
July 1,2024-June 30,2025
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE%
Program Director 22-264/FSC FSP/Fresno 0.88
WPCL 0.13
Total 1.00
Position Contract#/Name/Department/County FTE
Supervising Personal Services Coordinator 22-264/FSC FSP/Fresno 0.75
WPCL 0.25
Total 1.00
Position Contract#/Name/Department/County FTE%
Secretary 22-264/FSC FSP/Fresno 0.75
WPCL US
Total 1.00
Position Contract#/Name/Department/County FTE%
Program Bookkeeper WPCL 0.05
22-264/FSC FSP/Fresno 0.50
FSC OP 0.45
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
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-16
Exhibit J-2
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%
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 217/2020
J-2-17
Exhibit J-2
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-18
Exhibit J-2
Turining Point of Central California,Inc.
Whole Person Care Like
July 1,2024-June 30,2025 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 266,815
Administrative Positions 12,777
1101 0 -
1102 Secretary 10,447 General secretarial and front desk receptionist duties including: Answering the
telephone,greeting clients/guests,notifying staff when clients arrive for scheduled
appointments,preparing forms to be sent to the administrative office,and performing
general office duties.Assumed increase for FY 22-23&23-24.
1103 Program Bookkeeper 2,330 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.Assumed increase for FY 22-23&23-24.
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 173,015
1116 Case Manager 100,446 The Case Managers provide services which will assist individuals in gaining access to
needed medical,social,housing,economic,educational and other services as directed
by the Program Director and Supervising PSC. The case manager will carry a caseload
assisting in linking those who recently were released from jail for any and all services
needed in the community.This position does not provide funding source
documentation,nor is providing rehab services,only linkages.
1117 Supervising Personal Services Coordinator 18,231 Provides supervision to all Case Managers to ensure client care,maintain compliance
with Turning Point policies and procedures. Supervisor also assisting in training new
staff and reporting to the Program Director. Assumed increase for FY 22-23&23-24.
Based on internal salary analysis,this position is in need of a salary increase due to
clinical supervision of the program and requirement of BBS licensure.
1118 Peer Support 39,349 Serves as a client advocate and provides information and peer support to clients
throughout their recovery process.
1119 Prorgram Director 14,989 The Program Director currently oversees the program,hiring,training and supervising
staff. Assumed increase for FY 22-23&23-24.
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 62,016
1201 Retirement 6,226 Cost of Agency contribution to employee retirement plans.
1202 Worker's Compensation 3,268 Cost of workers compensation insurance.
1203 Health/Dental/Other Insurance 31,770 Agency cost for health,dental,and other insurance
1204 Other(Accrued Paid Leave) 20,752 The monetary valueof staff Paid Leave hours as they accrue on a monthly basis.
1205 Other(specify) -
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 19,007
1301 OAS DI 3,009 Employer pays 1.40%of employee's full salary.
1302 FICA/MEDICARE 12,969 Employer portion of F.I.C.A.taxes charged to the Agency by the I nterna I Revenue
1303 SUI 3,029 Employer portion of S.U.I.taxes charged to the Agency by the various states in which
1304 Other(specify) - 0
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-19
Exhibit J-2
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 9,825
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 1,000 Cost for client transportation.(Examples:bus tokens/passes,taxi,other public
2004 Clothing,Food,&Hygiene 1,900 Cost of client hygiene supplies and non-work related clothing.Cost of food for a
2005 Education Support 1,000 Cost of course fees and educational materials distributed to clients and prospective
2006 Employment Support 800 Cost of course fees and educational materials distributed to clients and prospective
2007 Household Items for Clients - 0
2008 Medication Supports 2,000 Cost of medical supplies or treatment/medical expense for a specific client.(Examples:
2009 Program Supplies-Medical 275 Cost of medical supplies to be used by staff or clients at the program location to meet
2010 Utility&Rental Security Deposits 800 Cost of client utility bills and/or security deposits.
2011 Other(Client Personal Needs) 800 Cost of supplying clients with necessary personal items not detailed in other other
2012 Other(0&E Client Needs) 1,000 Cost related to services and supplies used during outreach and engagement
2013 Other(Client Physical Exams) 250 Cost of client admission physical examinations and TB testing.
2014 Other(Client Activities) -
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 14,247
3001 Telecommunications 750 Cost of electronic communications.(Examples:internet,phone,fax,cell phones,etc.)
3002 Printing/Postage 150 Cost of custom copying/printing charges(Examples:letterhead,business forms,
3003 Office,Household&Program Supplies 650 Cost of items normally used in an office setting.Cost of any items normally used by
3004 Advertising - 0
3005 Staff Development&Training 500 Cost of employee training courses and materials.
3006 Staff Mileage 413 Cost of employee mileage reimbursement paid in accordance with FPM section 1005.
3007 Subscriptions&Memberships 100 Cost of membership dues and subscriptions.(Examples:magazine,newspaper,
3008 Vehicle Maintenance 1,250 Cost of vehicle maintenance.Including cost of parts,supplies and labor associated with
3009 Other(Vehicle Insurance/Fuel) 9,200 Cost for vehicle insurance and gas.
3010 Other(Recruitment) 350 Costs of Live Scans,DMV printouts,ads for recruiting staff and other tests that might
3011 Other(Staff Meetings/Employee Relations) 350 Cost relating to improvement of working conditions,employer/employee relations and
3012 Other Miscellaneous Expense-COVID Supplies) 534 Cost not more appropriately assigned to another account.
4000:DIRECT FACILITIES&EQUIPMENT 18,950
4001 Building Maintenance 750 Cost of Agency building repairs and maintenance.(Examples:electrical work,A/C and
4002 Rent/Lease Building 5,200 Cost of rent/lease payments made for building leases from outside sources.
4003 Rent/Lease Equipment 150 0
4004 Rent/Lease Vehicles 9,600 Rental cost of vehicles and lease of agency vehicles.
4005 Security 100 Cost of installation,maintenance and monthly service fees for building alarms and
4006 Utilities 2,500 Cost of service for power,gas,water,sewer,garbage,etc.
4007 Other(Insurance) 500 Cost of insurance for general liability.
4008 Other(Equipment Maintenance) 150 Cost of rent/leasepayments made for furniture and equipment leases from outside
4009 Other(specify) -
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 950
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify) -
5004 Translation Services 500 Paid to an outside vendor for translation/interpreter services
5005 Other(HRIS&PR Processing) 300 HRIS costs.
5006 Other(Audit) 150 Cost of outside audit fees.
5007 Other(specify) -
5008 Other(specify)
6000:INDIRECT EXPENSES 46,664
6001 Use this line and only this line for approved indirect -
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(Admin,HR,Fiscal,IT,Executive,Regional 46,664
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 300
7001 Computer Equipment&Software 100 Cost of computer software and computer support
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA - 0
7003 Furniture&Fixtures 100 Cost of small,inexpensive Agency property with a normal useful life generally less than
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020
J-2-20
Exhibit J-2
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7004 Leasehold/Tenant/Building Improvements 0
7005 Other Assets over$500 with Lifespan of 2 Years+ 0
7006 Assets over$5,000/unit(Specify) 0
7007 Other(Expendable Equipment) 100 Cost of purchasing office equipment that has a cost less than$2000 per item.
7008 Other(specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-21
Exhibit J-2
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 357,751
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 357,751 0
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
J-2-22
Exhibit K
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.
K-1
Exhibit K
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 19
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.
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.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
K-2
Exhibit K
(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 3F0 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
charges against any amounts owed by the County to the Contractor under this
Agreement.
K-3
Exhibit K
(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.
K-4
Exhibit L
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.
L-1
Exhibit L
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.
L-2
Exhibit M
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://fresnodbh.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.
• Employees involved in a crisis incident should be offered appropriate Employee
Assistance Program (EAP) or similar related wellness and recovery assistance. In
conjunction with the DBH's Guiding Principles of Care Delivery and wellness of the
workforce, Contractor shall align their practices around this vision and ensure
needed debriefing services are offered to all employees involved in a crisis incident.
Employees shall be afforded all services to strengthen their recovery and wellness
related to the crisis incident. Appropriate follow-up with the employee shall be carried
out and a plan for workforce wellness shall be submitted to DBH.
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.
M-1
Exhibit M
oo",i
Mental Health Plan (MHP) and Substance Use Disorder(SUD) services
Incident Reporting System
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=182be0c5cdcd5072bbl864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
M-2
Exhibit M
E 0 Q Y fresnodbh.IogicmanagecmmAncidents/?t=9&p=l&k=182be0c5cdcd5072bbl8Wdee4d3cl,,LogicManager
Incident Report
Please complete this form
Client Information
Name of Facility'
Name of Reporting Party'
Facility Address'
Facility Phone Number'
i
Mental Health or Substance Use Disorder Program?'
Client First Name'
Client Last Name-
F4 C 4 .,, .. t I .. :.. ..... ...
i
Client Date of Bi rth
Client Address
Client I
Gender'
County of Origin'
Summary
Subject O
Incident(check all that apply)'
If Other-specify(i.e.fire,poisoning,epidemic outbreaks,other catastrophes/events that jeopardize the welfare and safety of clients,staff and/or members of the community):
Description of the incident'
Similar to the paper version, multiple incident categories can be selected
M-3
Exhibit M
Lmt,t-L
Incident(check all that apply)'
Medical Emergency x Death of Client x
Homicide/Homicide Attempt
AWOL/Elopement from locked facility
Violence/Abuse/Assault(toward others,client and/or property
Attempted Suicide(resulting in serious injury)
Injury(self-inflicted or by accident)
Medication Error
E C 4 Y fmsnodbh.logicmamger.mmfincidents/?t=9&p=1&k=182be0c5cdcd5072bb1864cdee4d3d6e
Date of Incident'
Time of Incident'
Location of Incident'
Enter,-Y,
Key People Directly Involved in Incident(witnesses,staff)'
Enter
Did the Injured Party seek Medical Attention?
Attach any additional details
B Add File or Drop File Here
Reported By Name'
Reported By Email'
Enter text
i
Reported On
10/30/2019
M-4
Exhibit M
As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on
Add File to upl ad a file.
E G' 0 0 fresmdbh.logicmanager.com ma - -1&k-182beOc5cdcd5072bb1864cdee4d3d6e
B Add File or Drop File Here
Reported By Name'
Reported By Email'
Reported On
10/30/2019
Follow Up
Action Taken(check all that apply)'
Please specify if other
Description of Action Taken'
msr te:,,
Outcome
Ent,.
Similar to the paper version, multiple Action Taken categories can be selected.
Follow Up
Action Taken(check all that apply)'
Law Enforcement Contacted% Called 911/EMS%
Consulted with Physician
First Aid/CPR Administered
Client removed from building
Parent/Legal Guardian 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.
M-5
Exhibit M
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
r
RELOAD THE FORM
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 10/3(12n1911 og
SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@logicmanager.com>
QNotification-
To O DBH Incident Reporting
0If there are problems with how 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 rdownload of some pictures in this message.
CAUTIONM-EXTERNAL EMAIL-THINK BEFORE YOU CLICK
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Lv,eH ,Inc.
Hi Mila Arevalo,
You have received a notification through LogicManager.Please see the details
below.
Type:Incident Report
Subject:102:
Notiriwtion To:Mila Arevalo
r7]:=
If using Internet Explorer,click here to open the notification
This email was generated by LogicManager.If you have any technical issues,
please email su000rtliffioaicmanauercom.
M-6
Exhibit M
Enter in email address and password. First time users will be prompted to set up a password.
C Q O fresnodbh.my.logicmanager.com/login
LogicManager
Forgot your password?
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
a
TASK NAME SOURCE STATUS ASSIGNEDTO ASSIGNED BY DUE DATE-
Analyst Follow Up In Progress —dhi[ SYSTEM-,V,M—g,,
M-7
Exhibit M
This screen below will then pop up. There are S tabs to navigate through. Client information will show the client and
facility information. No edits can be made to this section.
Analyst Follow Up
Task Detailz Client lnkrmoxon S
AA TEST FACI III
nameof facility'
xame WaeportinBpaxy'
sacillry AEErcas'
sacniry vhone xumx.'
The next tab is Sum ary: No edits can be made to this section.
Analyst Follow Up
Task Deta ils Client Information Summ ry Follow up Doan
bj t 0
Inclbenl(check all that apply)•
Oeath of ctimt lc
If Other specify(Ia fire,po�sonm6.epbemx outbreaks,oVIk,—Urtropkes/ewntslhalleopardlk,the xrclhrcan0 safety olcllenb,uAff,.E/or membefsoflhe c —ly)
De criptlon aflhe ind—t'
B I / u $ ❑ — — — le E B Q
D.A.lnclEent'
10130121013
Time onneiaent'
I /
k«auon ormBlaenr
1
Task ID:3135ource:103:null « B 3 CANCEL
M-8
Exhibit M
The next tab is Follow up: This section can be edited. Add to th areas below or make corrections to these fields. Be
sure to click E w en edits are made. Then Cancel to Exi cat of the incident.
Analyst Follow Up
Task Details CI—tlnformatmn Summary Follow Up Documents
Action Taken(check all that apply)'
Law Enforcement Contacted X
pleasespecifyifother
D—moon of Action Taken'
f
Outcome'
f
added inrormadon
cause of deem-cancer per caroner 10-31-19�
Task ID:313 Source:—null cc c tr CANC
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
Task Details Client Information Summary Follow Up Documents
Add Document "
Name Type Source Upload Date Uploaded By
No documents yet.
Drop files here or click on the Add Document dmpdown.
1< < 5 > » CANCEL
Task ID:313 Source:103:null
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
DBHlncidentReporting@fresnocountycagov
M-9
Exhibit M
To get back to the home view�IK n the Lo is Manager icon at any time. Any incidents that still need review will
show on this screen, click o incident and start the review process again.
Lr
A
Your Task List
4
TASK NAME SOURCE STATUS ASSIGNEDTO ASSIGNED BY DUE DATE
Analyst F,11—Up MProgress meE hzf SYSTEM Lo®cManager
M-10
Exhibit N
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws, regulations,
rules and guidelines that apply to the provision and payment of mental health services. Mental
health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its
employees and subcontractors to attend a compliance training that will be provided by Fresno
County. After completion of this training, Contractor, Contractor' 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, persons served, 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.
N-1
Exhibit N
7. Bill only for eligible services actually rendered and fully documented. Use billing codes
that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by County employees or other mental health contractors, or report
any activity that they believe may violate the standards of the Compliance Program, or
any other applicable law, regulation, rule or guideline. Fresno County prohibits
retaliation against any person making a report. Any person engaging in any form of
retaliation will be subject to disciplinary or other appropriate action by the County.
Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or
guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible
person and therefore excluded from participation in the Federal Health Care Programs.
N-2
Exhibit N
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:
N-3
Exhibit O
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.
O-1
Exhibit O
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.
O-2
Exhibit P
Data Security
1. Definitions
Capitalized terms used in this Exhibit 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 L.
(C) "Director" means the County's Director of the Department of Behavioral Health or his or
her 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 L.
(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 L.
P-1
Exhibit P
(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 L;
(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
P-2
Exhibit P
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 L, 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)
P-3
Exhibit P
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 L. 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
P-4
Exhibit P
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 addresses: incidents(a)fresnocountyca.gov, 559-600-5900, (559) 600-
4645, dbhcontractedservices(a)fresnocountyca.gov,
dbhforensicservices(a)fresnocountyca.gov (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 L, 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,
P-5
Exhibit P
including taking any corrective action under this Exhibit L, all at the Contractor's sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
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 L.
(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.
5. 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 L, 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 L.
(C)The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit L. 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
P-6
Exhibit P
Contractor and such Authorized Persons, or amending any written agreements to
provide same.
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
L, 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 L 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 L 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 L 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 L 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
P-7
Exhibit P
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.
9. Survival. The respective rights and obligations of the Contractor and the County as stated
in this Exhibit L shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit L
is intended to confer, nor shall anything in this Exhibit L 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.
P-8
Exhibit Q
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno ("County"), members of a
contractor's board of directors ("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 used 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.
The form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
Q-1
Exhibit Q
(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:
Q-2
Exhibit R
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) City State ZIP code
CLIA number Taxpayer ID number(EIN) /Telephone number
l )
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVII I, XIX, or XX? ......................................................................................................................... o 0
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX?...................................................................................... o 0
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 0
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under"Remarks."
NAME ADDRESS EIN
B. Type of entity: o Sole proprietorship o Partnership o Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... o 0
NAME ADDRESS PROVIDER NUMBER
R-1
Exhibit R
R-2
Exhibit R
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... o n
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... n n
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
R-3
Exhibit S
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;
S-1
Exhibit S
(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)
S-2
Exhibit T
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.
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T-1
Exhibit T
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
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S(_ U.S.Deportment of https://www.thinkculturalhealth.hhs.gov/
1O M H Health and Human Services
Office of Minority Health contact@thinkculturalhealth.hhs.gov
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T-2