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Home My WebLink AboutAgreement A-06-134-1 with Managed Care Master Agreement (Amendment I).pdfAgreement No. 06-134-1 1 RETROACTIVE AMENDMENT I TO AGREEMENT 2 THIS AMENDMENT, hereinafter referred to as Amendment I, is made and entered into 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 this 16th day of June , 2015, by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as "COUNTY", and each PROVIDER listed in Exhibit A, "Provider(s)", attached hereto and by this reference incorporated herein, collectively hereinafter referred to as "PROVIDER(s)", and such additional PROVIDER(s) as may, from time to time during the term of this Agreement, be added by COUNTY with the Department of Behavioral Health (DBH) Director, or designee, approval. References in this Amendment I to Agreement to "party" or "parties" shall be understood to refer to COUNTY and each PROVIDER, unless otherwise specified. WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement No. 06-134, effective July I, 2006, whereby PROVIDER(s) agreed to provide specialty mental health services to certain Medi-Cal beneficiaries; and WHEREAS, the parties desire to amend COUNTY Agreement No. 06-134, regarding changes as stated below and restate the Agreement in its entirety. NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which is hereby acknowledged, the parties agree as follows: 1. That the existing COUNTY Agreement No. 06-134, Section Four ( 4 ), Page 19 Eleven (11 ), Line Twenty-Two (22), beginning with the word "In" and ending on Page Eleven 20 (11), Line Twenty-Four (24), with the word "Agreement" be deleted and the following inserted 21 in its place: 22 "In no event shall services provided by all PROVIDER(s) pursuant to the MHP 23 effective upon execution through June 30,2014 exceed a total amount ofTwo Million, Five 24 Hundred Thousand and No/100 Dollars ($2,500,000) for each twelve (12) month period ofthis 2 5 Agreement. In no event shall services provided by all PROVIDER(s) pursuant to the· MHP 26 from July 1, 2014 through June 30,2015 exceed a total amount ofThree Million, Five Hundred 2 7 Thousand and Noll 00 Dollars ($3,500,000.00)." 28 /// -1 - COUNTY OF FRESNO Fresno, CA 1 2.That the existing COUNTY Agreement No.06-134,Section Five (5),Page 2 Twelve (12),Line Twenty-Seven (27)beginning with the word "This"and ending on Page 3 Thirteen (13),Line Three (3),with the word "period"be deleted and the following inserted in 4 its place: 5 "This Agreement shall become effective on the 1st day of July,2006 and shall 6 terminate on June 30, 2015." 7 3.COUNTY and PROVIDER(s)agree that this Amendment Iis sufficient to amend the Agreement;and that upon execution of this Amendment I,the Agreement,and Amendment I together shall be considered the Agreement. The Agreement,as hereby amended,is ratified and continued.All provisions, terms,covenants,conditions and promisescontained in the Agreement,and not amendedherein, shall remain in full force and effect.This Amendment I shall become effective retroactive to 13 July 1,2014. 14 /// 15 /// 16 /// IV /// 18 /// 19 /// 2 0 /// 21 /// 22 /// 23 /// 24 /// 25 /// 2 6 /// 27 /// 28 /// 9 10 11 12 2 - COUNTY OF FRESNO Fresno,CA 1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment I to 2 Agreement No. 06-134 as ofthe day and year first hereinabove written. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PROVIDER(S): SEE ATTACHED EXHIBIT A -3 - COUNTY OF FRESNO BERNICE E. SEIDEL, Clerk Board of Supervisors Date: PLEASE SEE ADDITIONAL SIGNATURE PAGE ATTACHED COUNTY OF FRESNO Fresno, CA 1 2 3 4 5 6 7 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 APPROVED AS TO LEGAL FORM: DANIEL C.CEDERBORG,COUNTY COUNSEL APPROVED AS TO ACCOUNTING FORM: VICKI CROW,C.P.A.,AUDITOR-CONTROLLER/ TREASURER-TAX COLLECTOR UkdS C\By REVIEWED AND RECOMMENDED FOR APPROVAL: By A^^tML^UJ^cA^t Dawan Utecht,Director Department of Behavioral Health Fund/Subclass:0001/10000 Organization:56302666 Account/Program:7223/0 Fiscal Year (FY) FY 2006-07 through FY 2013-14 FY 2014-2015 Program Cost $2,500,000.00 (Each FY) $3,500,000.00 COUNTY OF FRESNO Fresno,CA Individual Providers Name Al-Saoudi,Yuleen Amling-Heiken,Jane Armer,Justin Avina,Erica Bergstrom,Virginia Broesel,Rondi Brookins,Antionette Cardoza,Julie Case,Gabriele Casillas,Jennell A. Dickey,Judith Fulton,Tracy Garvey,Catherine Glidden,Howard,Dr. Gordon-Mcintosh,Wanda Haider,Shazina,Dr. Jackson-Salcedo,Peggy, Dr. Johnson,David Lopez,Jeanette Lose,Linda Malin,Matthew Mar,Jeffrey,Dr. Pacheco,Myrna Powroznik,James Qualle,Cordie Micah Randolph,Michelle Roltgen,Teresa Romero,Jorge Slagle,Laura Steele,Ronald Trujillo,Elinda Xiong,Zoua Young,Perry Ziyar,Latif, Dr. Group Providers Name Bashful Elephant Counseling Castani Family Services DN Associates Dunamis,Inc Fresno Mental Health Generational Changes,Inc. House Psychiatric Clinic,Inc Kids Play Therapy,Inc. Address 516 Villa Suite #3 Clovis, CA 93612- 5464 N.Palm #B Fresno,CA 93704- 614 N. St Sanger,CA 93657- 614 N.Street Sanger,CA 93657- 5588 N.Palm Fresno,CA 93704- 4747 N. First,Suite 119 Fresno,CA 93726- 3723 E.Dakota Fresno,CA 93726- 2490 W.Shaw Ave Suite 101 Fresno,CA 93710 4420 N.First #121 Fresno,CA 93726- 6225 N. First Street Suite 103 Fresno,CA 93710 5707 N.Palm #103 Fresno,CA 93704 5464 N Palm Ave,Ste # B Fresno,CA 93704- 5475 N.Fresno Street Fresno,CA 93710 1660 E.Herndon #150 Fresno,CA 93720- 5588 N. Palm Ave Fresno,CA 93704- 416 W Bluff Ave Fresno,CA 93711 1586 N. Van Ness Fresno,CA 93728- 3097 Willow Ave Suite #4 Clovis, CA 93612- 2008 N. Fine #103 Fresno,CA 93727- 1305 W. Bullard #11 Fresno,CA 93704- 264 Clovis Ave Ste 212 Clovis,CA 93612- 5100 N.Sixth #135 Fresno,CA 93710 5588 N.Palm Ave Fresno,CA 93704- 5588 N. Palm Ave Suite P4 Fresno,CA 93704- 264 Clovis Ave Ste 212 Clovis, CA 93612- 5070 N.Sixth #174 Fresno,CA 93710- 2505 W.Shaw Fresno,CA 93711- 5070 N.Sixth #174 Fresno,CA 93710- 3114 Willow Ave Ste 102 Clovis, CA 93612- 7005 N Milburn Ave,Suite 202,Fresno,CA 93722 1713 Tulare St Suite 132 Fresno,CA 93721- 5588 N.Palm Avenue Fresno,CA 93704 5707 N.Palm #103 Fresno,CA 93704- 7335 N. First #109 Fresno,CA 93720- Address 3097 Willow Ave Suite #4 Clovis, CA 93612- 5100 N.6th Ste 104 Fresno,CA 93710- 3457 W Shaw Ave #101 Fresno,CA 93711 4991 E.McKinley #112 Fresno,CA 93727- 1130 E.Shaw Ste 105 Fresno,CA 93710- 2409 Merced Ste 106 Fresno,CA 93721- 1322 E.Shaw #410 Fresno,CA 93710- 5100 N.Sixth #140 Fresno,CA 93710- Page 1 of 1 Exhibit A 6 PROVIDER:Yuleen Al-Saoudi by tin(c?s?/#•/-Saa(M) P"nt Name:Yy /)f p^-Ah S(A/)IA(I) Title:L M f'T ^JitlDate:'l o /13 Mailing Address: 516 Villa Suite #3 Clovis,Ca.93612 COUNTY OF FRESNO Fresno,CA PROVIDER:Jane Amling-Heiken By^^DOOJ?i>^v\0rHe^tf\ ) Print Name;j[AA£ ••J kc Title:L.m.v •J ' 1" Date:5'^^3 Mailing Address: 5464 N.Palm #B Fresno,CA 93704 COUNTY OF FRESNO Fresno,CA PROVIDER:Justin Armer By ,W^/^yf/C^U^^i Print Name:^J jft (i/i -5./JCAiCS ™e:U7 R" =Mr/fsDate Mailing Address: 614 N.St Sanger,Ca.93657 COUNTY OF FRESNO Fresno,CA $ PROVIDER:Erica Avina Print Name:fsn'CiX-rVvflfW )\AAt-^ Title:umpr Date:^\^D\\cS • Mailing Address: 614 N.St Sanger,Ca.93657 COUNTY OF FRESNO Fresno,CA °f PROVIDER: Virginia Bejgstrom By //^A'^LXyQLWfrrn Print Name:V/rCj-./^/g (£>#_/^iC JT<7/r7 Title:Lmf1. Date:S Ii Cj //^ Mailing Address: 5588 N.Palm Fresno,CA 93704 COUNTY OF FRESNO Fresno,CA It PROVIDER:Rondi Broesel By Uirrxji f/hOQdt Print Name:\\Cn<jl QfO^St ™e:Ijr Ui, Date:^Ir^Q Mailing Address: 4747 N.First,Suite 119 Fresno,CA 93726 COUNTY OF FRESNO Fresno,CA PROVIDER:Antionette Brookins By c^-X'.x,.c<K 'v ^• Print Name:AvA'^v-1c:4-k v">••^•"*—v-^—^'d Title:L-*^V 1 Date:u'~>'^-1*9 Mailing Address: 3723 E.Dakota Fresno,CA 93726- COUNTY OF FRESNO Fresno,CA )St Julie Cardoza PrintName:\_\lAU6 ^r6c^(X kMJ Title:LMJrT Date:ty\Oj\i5^' Mailing Address: 2490 W.Shaw Ave Suite 101 Fresno,CA 93710 COUNTY OF FRESNO Fresno,CA PROVIDER:Gabriele Case By >-Mft\t($../.d><- Print Name:h&hi iC If L &^^ Title:Lf^Cc Date:5-f[-15 Mailing Address: /75"/W,5h/iw 4450 N.First #121 Fresno,CA 9372# n COUNTY OF FRESNO Fresno,CA K PROVIDER:Jennell A Casillas By *s£l£l4Wk Print Name:JlmilW (M^Wdl Title:LWVrT DtlX Date:(K /HfK Mailing Address: 6225 N.First Street,Suite 103 Fresno,CA 93710 COUNTY OF FRESNO Fresno,CA 15 PROVIDER:Judith Dickey By $46%//g///A Print Name:tf/yj,7J jff 7)/c&£, Title://////T Date:S^O-^O/S Mailing Address: 5707 N.Palm #103 Fresno,Ca.93704 COUNTY OF FRESNO Fresno,CA \(C PROVIDER:Tracy Fulton By <//Uu^-c^ Print Name:cacy^d'Htryi Title:LMFT Date:S//Z/J5 Mailing Address: 5464 N Palm Ave,Ste # B Fresno,CA 93704 COUNTY OF FRESNO Fresno,CA IT PROVIDER:Katherine Garvey By (^t Print Name:CW TV*-£/f/^X Q^iVli/f^/ Title:Cs^lX/~' Date:V/3 //S Mailing Address: 5475 N Fresno Str. Fresno,Ca.93710 :OUNTY OF FRESNO Fresno,CA /? PROVIDER:Howard Glidden By ^/^k^^^^L Print Name:fjtn>v**~$bi.^Je * Title:fJ4,L^opsy cA*/ifc+& Date:S~/n/2'»r Mailing Address: 1660 E.Herndon#150 Fresno,CA 93720 COUNTY OF FRESNO Fresno,CA II PROVIDER:Wanda Gordon-Mcintosh Print Name/k^f//)/^/£•6>x>&^M /Pfcfad&A. Date:5~-/f~A~ Mailing Address: 5588 N.Palm Ave Fresno,CA 93704 COUNTY OF FRESNO Fresno,CA £G PROVIDER:Shazina Haider By (^)•^AtJUviPL h Print Name:^7/^7 A;/?/M/AEfVPA h Title:d£ir\i ^W f^^K^xTCp^l^ Date:dT7/<§///-~m Mailing Address: 416 W.Bluff Ave. Fresno,Ca.93711-6908 COUNTY OF FRESNO Fresno,CA 3. PROVIDER:Dr. Peggy Jackson-Salcedo :\^PKD Print Name:\<£>^jS"^A G" Title:1 S~^V-~"U "V^\^S"(]'^^V Date:m n\>M^ Mailing Address: 1586N.Van Ness Fresno,CA 93728 COUNTY OF FRESNO Fresno,CA <2<? PROVIDER^Johnson,Ba^fd By ^AtA stftir Print Name:,/>fr/t'Q ^^M^ Title:L A ff Date:*/(*f5 Mailing Address: 3097 Willow Ave Suite #4 Clovis,CA 93612 COUNTY OF FRESNO Fresno,CA A3 PROVIDER:Jeanette Lopez By Oi a/yufle.,dtfrfipj. Print Name:JennpMe^,Tarn hen Lop^ Title:LCS)iJ Date:$-£&AO/A Mailing Address: 2008 N.Fine #103 Fresno,CA 93727 COUNTY OF FRESNO Fresno,CA AM PROVIDER:Linda Lose Print Name:n a &It'1 Date:SaIIaAA. Mailing Address: 1305 W.Bullard#ll Fresno,CA 93704 O^A Title:yifl'ZArfrf £-f-xw^v^C>;^4&- COUNTY OF FRESNO Fresno,CA a5 PROVIDER;Matthew Kelly Malin ^/V Print Name:lM (^\A v/V/Vc^{I Title:^VAA fT Date:4>-Yg-\$ Mailing Address: 264 Clovis Ave Ste.212 Clovis,Ca.93612 COUNTY OF FRESNO Fresno,CA, ^ PROVIDER:Jeffrey B.Mar By„A^A Print Name:Jc f-f^tr a/4^•»^,i> Title:faycCi^joy A~h Date:5~/ftf/fjA Mailing Address: 5100 North sixth Street #135 Fresno,Ca.93710 COUNTY OF FRESNO Fresno,CA 3l1 PROVIDER:Myrna Pacheco By ^^\M(\AM Print Name:\^V V'A ^\CXCVV ^C 0 Title:LUfT Date:R-A-\S Mailing Address: 5588 N.Palm Avenue Fresno.CA 93704 COUNTY OF FRESNO Fresno,CA .1 James Powroznik By. Print Name:J^Vnx^A-1 vav^rwr^Ayc^ Title:L^-AFc Date:y~l°>—IT Mailing Address: 5588 N.Palm Ave Fresno,CA 93704 COUNTY OF FRESNO Fresno,CA 5< PROVIDER:Cordie Micah Qualle By^ Print Name:[jtfviX-U U'oU C*u4U Title:^-MpT Date:S~'1*6 '1<T Mailing Address: 264 Clovis Ave #202 Clovis Ca 93612 COUNTY OF FRESNO Fresno,CA 30 PROVIDER:Michelle Randolph By i Print Name:(Y\ICW.\W IJ Cunkj\i>h Title:U C - Date:G-i'4-6 Mailing Address: 5100 N Sixth Street Fresno,Ca.93710 COUNTY OF FRESNO Fresno,CA 31 PROVIDER:Teresa Roltgen By VytJlM.. Print Name:/p r^g S>•-Krt l4ri f H Title:_JJM£71_ Date:S~/f-/*D Mailing Address: 2505 W.Shaw Avenue Fresno,CA 93711 COUNTY OF FRESNO Fresno,CA 35. PROVIDER:Jorge Romero Print Name:c Title:Pma Date:Qt/iyyjp/f Mailing Address: 5070 N Sixth Street,Suite 174 Fresno,CA 93710 COUNTY OF FRESNO Fresno,CA PROVIDER:Laura Slagle By <7)dU^&JJfr Print Name:Laura S\qo)c Title:Lm £T Date:O 5 /1 cj /Lq Mailing Address: 3114 Willow Avenue,Suite 102 Clovis,CA 93612 COUNTY OF FRESNO Fresno,CA 5H PROVIDER:Ron C Steele By Print Name:&W J^Tt^t^/d£to) Title:GW^GlC Date:«gfa/r Mailing Address: 7005 N.Milburn Avenue,Suite 202 Fresno,CA 93722 COUNTY OF FRESNO Fresno,CA 3^ PROVIDER:Erlinda Trujillo By .iLIalL ^H^jch Print Name:L(Lhwft l^tulld Title:L t S \J Date:S~A 0 -I A Mailing Address: 2848 Mariposa Street Fresno,CA 93721 COUNTY OF FRESNO Fresno,CA 3k Print Name:"76'(J<\X^MCrj Title:Ix/i^mA t^AWj-fl AaJ faujy jU\^l(A Date:5JlcljjS Mailing Address: 5588 N.Palm Ave Fresno,CA 93704 COUNTY OF FRESNO Fresno,CA 57 PROVIDER:Perry Young bv y^rr^^O(3A$Lrn^T Print Name: vA ^.p^iclTitle: /AV\ ;srjn(^c^Date Mailing Address: 5707 N.Palm Avenue,Suite 103 Fresno,CA 93704 COUNTY OF FRESNO Fresno,CA 38 PROVIDER:LatifZiyar By j^m,.^^. Print Name:LftTif 7?jj rf/2- Title:frt^,'Je-t-\^ Date:$V /j-'i Mailing Address: 7335 N.First Street,Suite 109 Fresno,CA 93720 COUNTY OF FRESNO Fresno,CA 31 PROVIDER:BASHFUL ELEPHANT COUNSELING Print Name: 3 l(xt7lbU^ Title: Date: By: Chairman of the Board,or President,or any Vice President S-l8-t£ Print Name: Title: Secretary (of Corporation), or any Assistant Secretary,or Chief Financial Officer,or any Assistant Treasurer COUNTY OF FRESNO Fresno,CA ro PROVIDER:CASTANI FAMILY SERVICES By ^/h^MUlA jQjLXP&g,^M f^f Print Name:^>|OJf\iJ>A t^\\JaU^^ Title:/^/^AP^T Chairman of the Board,or President,or any Vice President Date:f?/(g /^-OI<^~ By: Print Name: Title: Secretary (of Corporation),or any Assistant Secretary,or Chief Financial Officer,or any Assistant Treasurer COUNTY OF FRESNO Fresno,CA H' Mailing Address: 3457 W Shaw Ave #101 Fresno,CA 93711 PROVIDER:DN Associates By •L^toUt^cjA'JPrintName: •"^.^e-Title:KC Date: By: Chairman of the Board,or President,or any Vice President (|*\[i A Print Name: Title: Secretary (of Corporation), or any Assistant Secretary,or Chief Financial Officer,or any Assistant Treasurer COUNTY OF FRESNO Fresno,CA PROVIDER:DUNAMIS,INC. Print Name:CVflQfxjdC)&h{*~ Title:C € C) Date: By: Chairman of the Board,or President,or any Vice President Print Name: Title: Secretary (of Corporation),or any Assistant Secretary,or Chief Financial Officer,or any Assistant Treasurer Mailing Address: 4991 E.McKinley,Suite 112 Fresno,CA 93727 1 -COUNTY OF FRESNO Fresno,CA ri PROVIDER:FRESNO MENTAL HEALTH By ^^^r^ Print Name:Wi/?*v/Vv *~~T7S?foil H* Title:M£ Chairman of the Board,or President,or any Vice President Date:<f/^A - By: Print Name: Title: Secretary (of Corporation),or any Assistant Secretary,or Chief Financial Officer,or any Assistant Treasurer COUNTY OF FRESNO Fresno,CA HH PROVIDER:GENERATIONAL CHANGES,INC. Print Name:A*dL AJaiL^Jr/iCy^- Title:C£d Chairman of the Board,or President,or any Vice President Date:6~/f~20/£ By: Print Name:AA/J (a Jj/Lfisi laATitle:Ufa Secretary (of Corporation),or any Assistant Secretary,or Chief Financial Officer,or any Assistant Treasurer - 1 COUNTY OF FRESNO Fresno,CA t& PROVIDER:HOUSE PSYCHIATRIC CLINIC,INC. By_^ Print Name:[AAlAAAtftt*'M&^cA Title:jJpf <.g#»/A Chairman of the Board,or President,or any Vice President Date:S-I1-I5 By: Print Name: Title: Secretary (of Corporation), or any Assistant Secretary,or Chief Financial Officer,or any Assistant Treasurer 1 - COUNTY OF FRESNO Fresno,CA fU PROVIDER:KIDS PLAY THERAPY,INC. bv W)ck^&(lUrffl? Print Name:(PPjpLQ i *fc ,1k)()M^ Title:^tMjJC— Chairman of the Board,or President,or any Vice President Date:&-/8-1& By: Print Name: Title: Secretary (of Corporation), or any Assistant Secretary,or Chief Financial Officer,or any Assistant Treasurer COUNTY OF FRESNO Fresno,CA HI