HomeMy WebLinkAboutAgreement A-17-266 with Turning Point for FSP Services.pdfCOUNTY OF FRESNO
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AGREEMENT
THIS AGREEMENT is made and entered into this __________ day of ______________ 2017,
by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,
hereinafter referred to as "COUNTY", and TURNING POINT OF CENTRAL CALIFORNIA, INC.,
a California Private Non-Profit Corporation, whose service address is 3636 N. First Street, Suites 162
and 164, Fresno, CA 93726, and remit to, address is P.O. Box 7447, Visalia, CA 93290, hereinafter
referred to as "CONTRACTOR".
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), has determined
there is a need for certain Fresno County residents to receive mental health Full Service Partnership
(FSP) services as required by AB109 Public Safety Realignment and the Postrelease Community
Supervision Act of 2011; and
WHEREAS, COUNTY, through its DBH, is a Mental Health Plan (MHP), as defined in Title 9
of the California Code of Regulations (C.C.R.), Section 1810.226; and
WHEREAS, CONTRACTOR is qualified and willing to provide services required by COUNTY,
pursuant to the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
hereto agree as follows:
1.SERVICES
A. CONTRACTOR shall perform all services and fulfill all responsibilities as set forth
in Exhibit A, “MHSA Full Service Partnership Services Program Scope of Work,” attached hereto and by
this reference incorporated herein and made part of this Agreement. In addition, all services shall be
performed in accordance with Exhibit B, “Full Service Partnership Service Delivery Model,” attached
hereto and by this reference incorporated herein.
B.CONTRACTOR shall also perform all services and fulfill all responsibilities as
specified in COUNTY’s Request for Proposal (RFP) No. 17-064 dated March 9, 2017, and Addendum
No. One (1) to COUNTY’s RFP No. 17-064 dated April 4, 2017, herein collectively referred to as
COUNTY’s Revised RFP No. 17-064, and CONTRACTOR’s response to said Revised RFP dated April
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20, 2017, all incorporated herein by reference and made part of this Agreement. In the event of any
inconsistency among these documents, the inconsistency shall be resolved by giving precedence in the
following order of priority: 1) to this Agreement, including all Exhibits; 2) to the Revised RFP; and 3)
to the Response to the Revised RFP. A copy of COUNTY’s Revised RFP No. 17-064 and
CONTRACTOR’s response thereto shall be retained and made available during the term of this
Agreement by COUNTY’s DBH Contracts Division.
C.It is acknowledged by all parties hereto that COUNTY’s DBH Contracts Division
unit shall monitor the FSP Program operated by CONTRACTOR, in accordance with Section Fourteen
(14) of this Agreement.
D. CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
consisting of staff from COUNTY’s DBH to discuss service requirements, data reporting, training,
policies and procedures, overall program operations and any problems or foreseeable problems that may
arise.
E. It is acknowledged that upon execution of this Agreement, CONTRACTOR will
provide FSP services, as identified and incorporated herein, at the following location: 3636 N 1st St
#162 & #164, Fresno, CA 93726. Any change to CONTRACTOR’s location of the service site must be
made with thirty (30) days advance written notice to COUNTY’s DBH Director or designee and only
upon written approval from COUNTY’s DBH Director or designee.
F. CONTRACTOR shall maintain requirements as an organizational provider
throughout the term of this Agreement, as described in Section Seventeen (17) of this Agreement. If for
any reason, this status is not maintained, COUNTY may terminate this Agreement pursuant to Section
Three (3) of this Agreement.
G. CONTRACTOR agrees that prior to, and while providing services under the
terms and conditions of this Agreement, CONTRACTOR shall have staff hired and in place for program
services and operations or COUNTY may, in addition to other remedies it may have, suspend referrals
or terminate this Agreement, in accordance with Section Three (3) of this Agreement.
2.TERM
The term of this Agreement shall be for the period of three (3) years, commencing on
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July 1, 2017 through and including June 30, 2020. This Agreement may be extended for two (2)
additional consecutive twelve (12) month periods upon written approval of both parties no later than
thirty (30) days prior to the first day of the next twelve (12) month extension period. The County’s
DBH Director or his or her designee is authorized to execute such written approval on behalf of
COUNTY based on CONTRACTOR’S satisfactory performance.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR thirty (30) days advance written notice.
B. Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to COUNTY;
4) Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of
any breach of this Agreement or any default which may then exist on the part of CONTRACTOR.
Neither shall such payment impair or prejudice any remedy available to COUNTY with respect to the
breach or default. COUNTY shall have the right to demand of CONTRACTOR the repayment to
COUNTY of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of
COUNTY were not expended in accordance with the terms of this Agreement. CONTRACTOR shall
promptly refund any such funds upon demand, or at COUNTY’s option, such repayment shall be
deducted from future payments owing to CONTRACTOR under this Agreement.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY’s DBH Director or
designee upon the giving of thirty (30) days advance written notice prior to close of the current
Agreement term.
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4. COMPENSATION
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation in accordance with the Budget set forth in Exhibit B, attached hereto and by this reference
incorporated herein and made part of this Agreement.
A. Maximum Contract Amount
The maximum amount for the period of July 1, 2017 through June 30, 2018 shall not
exceed One Million Five Hundred Fifty-Five Thousand Nine Hundred Three and No/100 Dollars
($1,555,903.00).
The maximum amount for the period of July 1, 2018 through June 30, 2019 shall not
exceed One Million Five Hundred Fifty-Five Thousand Nine Hundred Three and No/100 Dollars
($1,555,903.00).
The maximum amount for the period of July 1, 2019 through June 30, 2020 shall not
exceed One Million Five Hundred Fifty-Five Thousand Nine Hundred Three and No/100 Dollars
($1,555,903.00).
The maximum amount for the period of July 1, 2020 through June 30, 2021 shall not
exceed One Million Five Hundred Fifty-Five Thousand Nine Hundred Three and No/100 Dollars
($1,555,903.00).
The maximum amount for the period of July 1, 2021 through June 30, 2022 shall not
exceed One Million Five Hundred Fifty-Five Thousand Nine Hundred Three and No/100 Dollars
($1,555,903.00).
In no event shall the maximum contract amount for the services provided by the
CONTRACTOR to COUNTY under the terms and conditions of this Agreement be in excess of Seven
Million Seven Hundred Seventy-Nine Thousand Five Hundred Fifteen and No/100 Dollars
($7,779,515.00) during the total five (5) year term of the Agreement.
B. Prior to March 1st of each twelve (12) month period of this Agreement,
CONTRACTOR shall provide to COUNTY’s DBH an updated budget in the format identified in
Exhibit B, for the upcoming twelve month period. Each such budget shall require the approval of
COUNTY’s DBH Director or his/her designee prior to April 1st for the upcoming twelve (12) month
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period covered by said budget. If said budget is not received by the March 1st due date, the budget for
the upcoming twelve (12) month period will remain at the prior year’s funding level. The maximum
amount of said approved budget shall not exceed the maximum compensation for the current Agreement
period.
If CONTRACTOR fails to generate the Medi-Cal revenue and/or client fee
reimbursement amounts set forth in Exhibit B, the COUNTY shall not be obligated to pay the difference
between these estimated amounts and the actual amounts generated.
It is further understood by COUNTY and CONTRACTOR that any Medi-Cal revenue
and/or client fee reimbursements above the amounts stated herein will be used to directly offset the
COUNTY’s contribution of COUNTY funds identified in Exhibit B. The offset of funds will also be
clearly identified in monthly invoices received from CONTRACTOR as further described in Section Five
(5) of this Agreement.
Travel shall be reimbursed based on actual expenditures and mileage reimbursement shall
be at CONTRACTOR’s adopted rate per mile, not to exceed the Federal Internal Revenue Services (IRS)
published rate.
Payment shall be made upon certification or other proof satisfactory to COUNTY’s DBH
that services have actually been performed by CONTRACTOR as specified in this Agreement.
C. It is understood that all expenses incidental to CONTRACTOR’s performance of
services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails to comply
with any provision of this Agreement, COUNTY shall be relieved of its obligation for further
compensation.
D. Payments shall be made by COUNTY to CONTRACTOR in arrears, for services
provided during the preceding month, within forty-five (45) days after the date of receipt and approval by
COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments shall be made
after receipt and verification of actual expenditures incurred by CONTRACTOR for monthly program
costs, as identified in Exhibit B, in the performance of this Agreement and shall be documented to
COUNTY on a monthly basis by the fifteenth (15th) of the month following the month of said
expenditures. The parties acknowledge that the CONTRACTOR will be performing hiring, training, and
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credentialing of staff, configuring the facility and office space, and obtaining site certification from the
COUNTY Mental Health Plan (Mental Health Plan).
E. COUNTY shall not be obligated to make any payments under this Agreement if
the request for payment is received by COUNTY more than sixty (60) days after this Agreement has
terminated or expired.
All final claims, including actual cost per unit, and/or any final budget
modification requests shall be submitted by CONTRACTOR within sixty (60) days following the final
month of service for which payment is claimed. No action shall be taken by COUNTY on claims
submitted beyond the sixty (60) day closeout period. Any compensation which is not expended by
CONTRACTOR pursuant to the terms and conditions of this Agreement shall automatically revert to
COUNTY.
F. The services provided by CONTRACTOR under this Agreement are funded in
whole or in part by the State of California. In the event that funding for these services is delayed by the
State Controller, COUNTY may defer payments to CONTRACTOR. The amount of the deferred
payment shall not exceed the amount of funding delayed by the State Controller to the COUNTY. The
period of time of the deferral by COUNTY shall not exceed the period of time of the State Controller’s
delay of payment to COUNTY plus forty-five (45) days.
G. CONTRACTOR shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR’s deficiency discovered through the State audit
process and COUNTY utilization review during the course of this Agreement. At COUNTY’s election,
the disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall
be withheld from subsequent payments to CONTRACTOR. CONTRACTOR shall not receive
reimbursement for any units of services rendered that are disallowed or denied by the Fresno County
Mental Health Plan (Mental Health Plan) utilization review process or through the DHCS cost report
audit settlement process for Medi-Cal eligible clients.
H. It is understood by CONTRACTOR and COUNTY that this Agreement is funded
with mental health funds to serve individuals with SMI, many of whom have co-occurring substance use
disorders. It is further understood by CONTRACTOR and COUNTY that funds shall be used to support
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appropriately integrated services for co-occurring substance use disorders in the target population, and
that integrated services can be documented in crisis assessments, interventions, and progress notes
documenting linkages.
5. INVOICING
A. CONTRACTOR shall invoice COUNTY in arrears by the fifteenth (15th) day of
each month for the prior month’s actual services rendered to DBHInvoices@co.fresno.ca.us. After
CONTRACTOR renders service to referred clients, CONTRACTOR will invoice COUNTY for
payment, certify the expenditure, and submit electronic claiming data into COUNTY’s electronic
information system for all clients, including those eligible for Medi-Cal as well as those that are not
eligible for Medi-Cal, including contracted cost per unit and actual cost per unit. COUNTY must pay
CONTRACTOR before submitting a claim to DHCS for Federal reimbursement for Medi-Cal eligible
clients.
B. CONTRACTOR shall submit to the COUNTY by the tenth (10th) of each month
a detailed general ledger (GL), itemizing costs incurred in the previous month. Failure to submit GL
reports and supporting documentation shall be deemed sufficient cause for COUNTY to withhold
payments until there is compliance, as further described in Section Five (5) herein.
C. COUNTY’s DBH shall invoice CONTRACTOR in arrears by the fifth (5th day of
each month for the prior month’s hosting fee for access to the COUNTY’s electronic information
system in accordance with the fee schedule as set forth in Exhibit C, “Electronic Health Records
Software Charges” attached hereto and incorporated herein by reference. COUNTY shall invoice
CONTRACTOR annually for the annual maintenance and licensing fee for access to the COUNTY’s
electronic information system in accordance with the fee schedule as set forth in Exhibit C. COUNTY
shall invoice CONTRACTOR annually for the Reaching Recovery fee for access to the COUNTY’s
electronic information system in accordance with the fee schedule as set forth in Exhibit C.
CONTRACTOR shall provide payment for these expenditures to COUNTY’s Fresno County
Department of Behavioral Health, Accounts Receivable, P.O. Box 712, Fresno, CA 93717-0712,
Attention: Business Office, within forty-five (45) days after the date of receipt by CONTRACTOR of
the invoicing provided by COUNTY.
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D. At the discretion of COUNTY’s DBH Director, or designee, if an invoice is
incorrect or is otherwise not in proper form or substance, COUNTY’s DBH Director, or designee, shall
have the right to withhold payment as to only that portion of the invoice that is incorrect or improper
after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to provide
services for a period of ninety (90) days after notification of an incorrect or improper invoice. If after
the ninety (90) day period, the invoice(s) is still not corrected to COUNTY DBH’s satisfaction,
COUNTY’s DBH Director, or designee, may elect to terminate this Agreement, pursuant to the
termination provisions stated in Section Three (3) of this Agreement. In addition, for invoices received
sixty (60) days after the expiration of each term of this Agreement or termination of this Agreement, at
the discretion of COUNTY’s DBH Director, or designee, COUNTY’s DBH shall have the right to deny
payment of any additional invoices received.
E. Monthly invoices shall include a client roster, identifying volume reported by
payer group clients served (including third party payer of services) by month and year-to-date, including
percentages.
F. CONTRACTOR shall submit monthly invoices and general ledgers that itemize
the line item charges for monthly program costs (per applicable budget, as identified in Exhibit B),
including the cost per unit calculation based on clients served within that month, and excluding lobbying
costs. The invoices and general ledgers will serve as tracking tools to determine if CONTRACTOR’s
program costs are in accordance with its budgeted cost, and cost per unit negotiated by service modes
compared to actual cost per unit, as set forth in Exhibit B. The actual cost per unit will be based upon
total costs and total units of service. It will also serve for the COUNTY to certify the public funds
expended for purposes of claiming Federal and State reimbursement for the cost of Medicaid services
and activities.
G. CONTRACTOR will remit annually within ninety (90) days from June 30, a
schedule to provide the required information on published charges for all authorized direct specialty
mental health services. The published charge listing will serve as a source document to determine the
CONTRACTOR’s usual and customary charge prevalent in the public mental health sector that is used
to bill the general public, insurers or other non-Medi-Cal third party payers during the course of business
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operations.
H. CONTRACTOR shall submit monthly staffing reports that identify all direct
service and support staff, applicable licensure/certifications, and full time hours worked to be used as a
tracking tool to determine if CONTRACTOR’s program is staffed according to the services provided
under this Agreement.
I. CONTRACTOR must maintain such financial records for a period of seven (7) years or
until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be
responsible for any disallowances related to inadequate documentation.
J. CONTRACTOR is responsible for collection and managing data in a manner to
be determined by DHCS and the Mental Health Plan in accordance with applicable rules and
regulations. COUNTY’s electronic billing system is a critical source of information for purposes of
monitoring service volume and obtaining reimbursement. CONTRACTOR must attend COUNTY’s
DBH’s Business Office training on equipment reporting for assets, intangible and sensitive minor assets;
COUNTY’s electronic information system; and related cost reporting.
K. CONTRACTOR shall submit service data into COUNTY’s electronic
information system within ten (10) calendar days from the date services were rendered. Federal and
State reimbursement for Medi-Cal specialty mental health services is based on public expenditures
certified by the CONTRACTOR.
L. CONTRACTOR must provide all necessary data to allow the COUNTY to bill
Medi-Cal, and any other third-party source, for services and meet State and Federal reporting
requirements. The necessary data can be provided by a variety of means, including but not limited to: 1)
direct data entry into COUNTY’s electronic information system; 2) providing an electronic file
compatible with COUNTY’s electronic information system; or 3) integration between COUNTY’s
electronic information system and CONTRACTOR’s information system(s).
M. If a client has dual coverage, such as other health coverage (OHC) or Federal
Medicare, the CONTRACTOR will be responsible for billing the carrier and obtaining a
payment/denial or have validation of claiming with no response ninety (90) days after the claim was
mailed before the service can be entered into the COUNTY’s electronic information system.
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CONTRACTOR must report all third party collections for Medicare, third party or client pay or
private pay in each monthly invoice and in the cost report that is required to be submitted. A copy of
explanation of benefits or CSM 1500 is required as documentation. CONTRACTOR must report all
revenue collected from OHC, third-party, client-pay or private-pay in each monthly invoice and in the
cost report that is required to be submitted. CONTRACTOR shall submit monthly invoices for
reimbursement that equal the amount due CONTRACTOR less any funding sources not eligible for
Federal and State reimbursement. CONTRACTOR must comply with all laws and regulations
governing the Federal Medicare program, including, but not limited to: 1) the requirement of the
Medicare Act, 42 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the
Federal Centers for Medicare and Medicaid Services as they relate to participation, coverage and
claiming reimbursement. CONTRACTOR will be responsible for compliance as of the effective date
of each Federal, State or local law or regulation specified.
N. Data entry shall be the responsibility of the CONTRACTOR. The direct specialty
mental health services data must be reconciled by the CONTRACTOR to the monthly invoices
submitted for payment. COUNTY shall monitor the volume of services and cost of services entered into
the COUNTY’s electronic information system. Any and all audit exceptions resulting from the
provision and reporting of specialty mental health services by CONTRACTOR shall be the sole
responsibility of the CONTRACTOR. CONTRACTOR will comply with all applicable policies,
procedures, directives and guidelines regarding the use of COUNTY’s electronic information system.
O. Medi-Cal Certification and Mental Health Plan Compliance
CONTRACTOR will establish and maintain Medi-Cal certification or become
certified within ninety (90) days of the effective date of this Agreement through COUNTY to provide
reimbursable services to Medi-Cal eligible clients. In addition, CONTRACTOR shall work with the
COUNTY’s DBH to execute the process if not currently certified by COUNTY for credentialing of
staff. During this process, the CONTRACTOR will obtain a legal entity number established by the
DHCS, as this is a requirement for maintaining Mental Health Plan organizational provider status
throughout the term of this Agreement. CONTRACTOR will be required to become Medi-Cal certified
prior to providing services to Medi-Cal eligible clients and seeking reimbursement from the COUNTY.
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CONTRACTOR will not be reimbursed by COUNTY for any services rendered prior to certification.
CONTRACTOR shall provide specialty mental health services in accordance with
the COUNTY’s Mental Health Plan. CONTRACTOR must comply with the “Fresno County Mental
Health Plan Compliance Program and Code of Conduct” set forth in Exhibit D, attached hereto and
incorporated herein by reference and made part of this Agreement.
CONTRACTOR may provide direct specialty mental health services using
unlicensed staff as long as the individual is approved as a provider by the Mental Health Plan, is
supervised by licensed staff, works within his/her scope and only delivers allowable direct specialty
mental health services. It is understood that each service is subject to audit for compliance with Federal
and State regulations, and that COUNTY may be making payments in advance of said review. In the
event that a service is disapproved, COUNTY may, at its sole discretion, withhold compensation or set
off from other payments due the amount of said disapproved services. CONTRACTOR shall be
responsible for audit exceptions to ineligible dates of services or incorrect application of utilization
review requirements.
6. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under
this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
CONTRACTOR's officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have no right
to control or supervise or direct the manner or method by which CONTRACTOR shall perform its work
and function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules and
regulations, if any, of governmental authorities having jurisdiction over matters which are directly or
indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely
no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
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solely liable and responsible for providing to, or on behalf of, its employees all legally-required
employee benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY
harmless from all matters relating to payment of CONTRACTOR’s employees, including compliance
with Social Security, withholding, and all other regulations governing such matters. It is acknowledged
that during the term of this Agreement, CONTRACTOR may be providing services to others unrelated
to COUNTY or to this Agreement.
///
7. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent
of all the parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to services as needed to accommodate changes in the
law relating to mental health and substance use disorder treatment, as set forth in Exhibit A, may be
made with the signed written approval of COUNTY’s DBH Director or designee and CONTRACTOR
through an amendment approved by County Counsel and Auditor.
Changes to line items in the budget, as set forth in Exhibit B, that do not exceed 10% of
the maximum compensation payable to the CONTRACTOR, and changes to the volume of units of
services/types of service units to be provided as set forth in Exhibit B, may be made with the written
approval of COUNTY’s Department of Behavioral Health Director, or designee. Changes to the line
items in the budget that do exceed 10% of the maximum compensation payable to the CONTRACTOR,
may be made with the signed written approval of COUNTY’s Department of Behavioral Health
Director, or designee through an amendment approved by County Counsel and Auditor. In addition,
changes to the fee schedule identified in Exhibit C, “Electronic Health Records Software Charges,” may
be made with the written approval of COUNTY’s Department of Behavioral Health Director, or
designee. Said budget line item, service volume/types of service unit, and fee schedule changes shall not
result in any change to the annual maximum compensation amount payable to CONTRACTOR, as
stated in this Agreement.
8. NON-ASSIGNMENT
No party shall assign, transfer or subcontract this Agreement nor their rights or duties
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under this Agreement without the prior written consent of COUNTY.
9. HOLD-HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
defend COUNTY, its officers, agents and employees from any and all costs and expenses including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to COUNTY
in connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents or
employees under this Agreement, and from any and all costs and expenses, including attorney fees and
court costs, damages, liabilities, claims and losses occurring or resulting to any person, firm or
corporation who may be injured or damaged by the performance, or failure to perform, of
CONTRACTOR, their officers, agents or employees under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal and/or State of California
audit exceptions resulting from noncompliance herein on the part of CONTRACTOR.
10. INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or
any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and affect 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 Five Million
Dollars ($5,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverage including completed operations, product
liability, contractual liability, Explosion, Collapse, and Underground (XCU), fire
legal liability or any other liability insurance deemed necessary because of the
nature of the Agreement.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits for bodily injury of
not less than Two Hundred Fifty Thousand Dollars ($250,000) per person, Five
Hundred Thousand Dollars ($500,000) per accident and for property damages of
not less than Fifty Thousand Dollars ($50,000), or such coverage with a combined
single limit of One Million Dollars ($1,000,000). Coverage should include owned
and non-owned vehicles used in connection with this Agreement.
C. Real and Property Insurance
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CONTRACTOR shall maintain a policy of insurance for all risk personal property
coverage which shall be endorsed naming the County of Fresno as an additional
loss payee. The personal property coverage shall be in an amount that will cover
the total of the COUNTY purchase and owned property, at a minimum, as
discussed in Section Twenty (21) of this Agreement.
All Risk Property Insurance
CONTRACTOR will provide property coverage for the full replacement value of
the COUNTY’S personal property in possession of CONTRACTOR and/or used
in the execution of this Agreement. COUNTY will be identified on an appropriate
certificate of insurance as the certificate holder and will be named as an
Additional Loss Payee on the Property Insurance Policy.
D. Professional Liability
If CONTRACTOR employs licensed professional staff (e.g. Ph.D., R.N.,
L.C.S.W., M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000) per occurrence, Three
Million Dollars ($3,000,000) annual aggregate. CONTRACTOR agrees that it
shall maintain, at its sole expense, in full force and effect for a period of three (3)
years following the termination of this Agreement, one or more policies of
professional liability insurance with limits of coverage as specified herein.
E. Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
CONTRACTOR shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees shall be excess
only and not contributing with insurance provided under CONTRACTOR’s policies herein. This
insurance shall not be cancelled or changed without a minimum of thirty (30) days advance written
notice given to COUNTY.
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Within thirty (30) days from the date CONTRACTOR signs this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 3133
N. Millbrook Ave, Fresno, California, 93703, Attention: Contracts Division, stating that such insurance
coverages have been obtained and are in full force; that the County of Fresno, its officers, agents and
employees will not be responsible for any premiums on the policies; that such Commercial General
Liability insurance names the County of Fresno, its officers, agents and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned; that such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees, shall be
excess only and not contributing with insurance provided under CONTRACTOR’s policies herein; and
that this insurance shall not be cancelled or changed without a minimum of thirty (30) days advance,
written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
herein provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of
A FSC VII or better.
11. LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR’s staff
shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary
for the provision of the services hereunder and required by the laws and regulations of the United States
of America, State of California, the County of Fresno, and any other applicable governmental agencies.
CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain such
licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of any
appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR’s staff shall comply with all
applicable laws, rules or regulations, as may now exist or be hereafter changed.
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12. RECORDS
CONTRACTOR shall maintain records in accordance with Exhibit E, "Documentation
Standards for Client Records", attached hereto and by this reference incorporated herein and made part
of this Agreement. During site visits, COUNTY shall be allowed to review records of services provided,
including the goals and objectives of the treatment plan, and how the therapy provided is achieving the
goals and objectives.
13. REPORTS
A. Outcome Reports
CONTRACTOR shall submit to COUNTY’s DBH service outcome reports as
requested by COUNTY’s DBH. Outcome reports and outcome requirements are subject to change at
COUNTY’s DBH discretion.
B. Additional Reports
CONTRACTOR shall also furnish to COUNTY such statements, records, reports,
data, and other information as COUNTY’s DBH may request pertaining to matters covered by this
Agreement. In the event that CONTRACTOR fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments
until there is compliance. In addition, CONTRACTOR shall provide written notification and
explanation to COUNTY within five (5) days of any funds received from another source to conduct the
same services covered by this Agreement.
C. Cost Report
CONTRACTOR agrees to submit a complete and accurate detailed cost report to
the COUNTY’s DBH on an annual basis for each fiscal year ending June 30th in the format prescribed
by the State DHCS for the purposes of Short Doyle Medi-Cal reimbursements and total costs for
programs. The cost report will be the source document for several phases of settlement with the DHCS
for the purposes of Short Doyle Medi-Cal reimbursement. CONTRACTOR shall report costs under their
approved legal entity number established during the Medi-Cal certification process. The information
provided applies to CONTRACTOR for program related costs for services rendered to Medi-Cal and
non Medi-Cal clients. The CONTRACTOR will remit a schedule to provide the required information on
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published charges for all authorized services. The report will serve as a source document to determine
the CONTRACTOR’s usual and customary charge prevalent in the public mental health sector that is
used to bill the general public, insurers or other non-Medi-Cal third party payors during the course of
business operations. CONTRACTOR must report all collections for Medi-Cal/Medicare services and
collections. The CONTRACTOR shall also submit with the cost report a copy of the CONTRACTOR’s
general ledger that supports revenues and expenditures and reconciled detailed report of reported total
units of services rendered under this Agreement to the units of services reported by CONTRACTOR to
COUNTY’S electronic information system.
Each fiscal year ending June 30, CONTRACTOR shall remit a hard copy of their
annual cost report with a signed cover letter and requested support documents to County of Fresno,
Attention: DBH Cost Report Team, PO BOX 45003, Fresno CA 93718. In addition, CONTRACTOR
shall remit an electronic copy or any inquiries to DBHcostreportteam@co.fresno.ca.us. COUNTY shall
provide instructions of the cost report, cost report training, State DHCS cost report template worksheets,
and deadlines to submit the cost reports as determined by the State each fiscal year.
All Cost Reports must be prepared in accordance with General Accepted
Accounting Principles (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3)
and 5718(c). Unallowable costs such as lobbying or political donations must be deducted on the cost
report and monthly invoice reimbursements.
If the CONTRACTOR does not submit the cost report by the deadline, including
any extension period granted by the COUNTY, the COUNTY may withhold payments of pending
invoicing under compensation until the cost report has been submitted and clears COUNTY desk audit
for completeness.
D. Settlements with State Department of Health Care Services (DHCS)
During the term of this Agreement and thereafter, COUNTY and
CONTRACTOR agree to settle dollar amounts disallowed or settled in accordance with DHCS audit
settlement findings related to the reimbursement provided under this Agreement. CONTRACTOR will
participate in the several phases of settlements between COUNTY/CONTRACTOR and DHCS. The
phases of initial cost reporting for settlement according to State reconciliation of records for paid Medi-
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Cal services and audit settlement are: State DHCS audit 1) initial cost reporting - after an internal review
by COUNTY, the COUNTY files the cost report with State DHCS on behalf of the CONTRACTOR’s
legal entity for the fiscal year; 2) Settlement –State reconciliation of records for paid Medi-Cal services,
approximately 18 to 36 months following the State close of the fiscal year, DHCS will send notice for
any settlement under this provision to the COUNTY; 3) Audit Settlement-State DHCS audit. After final
reconciliation and settlement DHCS may conduct a review of medical records, cost report along with
support documents submitted to COUNTY in initial submission to determine accuracy and may disallow
costs and/or units of services reported on the CONTRACTOR’s legal entity cost report. COUNTY may
choose to appeal and therefore reserves the right to defer payback settlement with CONTRACTOR until
resolution of the appeal. DHCS Audits will follow Federal Medicaid procedures for managing
overpayments. If at the end of the Audit Settlement, the COUNTY determines that it overpaid the
CONTRACTOR, it will require the CONTRACTOR to repay the Medi-Cal related overpayment back to
the COUNTY.
Funds owed to COUNTY will be due within forty-five (45) days of notification
by the COUNTY, or COUNTY shall withhold future payments until all excess funds have been
recouped by means of an offset against any payments then or thereafter owing to COUNTY under this
or any other Agreement between the COUNTY and CONTRACTOR.
14. MONITORING
CONTRACTOR agrees to extend to COUNTY’s staff, COUNTY’s DBH Director and
the State Department of Health Care Services, or their designees, the right to review and monitor
records, programs or procedures, at any time, in regard to clients, as well as the overall operation of
CONTRACTOR’s programs, in order to ensure compliance with the terms and conditions of this
Agreement.
15. REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended
during the term thereof, the parties hereto agree to comply with the amended provision as of the
effective date of such amendment.
///
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16. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates its mental health programs under an
agreement with the State of California Department Health Care Services, and that under said agreement
the State imposes certain requirements on COUNTY and its subcontractors. CONTRACTOR shall
adhere to all State requirements, including those identified in Exhibit F “State Mental Health
Requirements”, attached hereto and by this reference incorporated herein and made part of this
Agreement. CONTRACTOR shall also file an incident report for all incidents involving consumers,
following the Protocol and using the Worksheet identified in Exhibit G, attached hereto and by this
reference incorporated herein and made part of this Agreement.
17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall be required to maintain organizational provider certification by
Fresno County. CONTRACTOR must meet Medi-Cal organization provider standards as listed in
Exhibit H, Medi-Cal Organizational Provider Standards, attached hereto and incorporated herein and
made part of this Agreement. It is acknowledged that all references to Organizational Provider and/or
Provider in Exhibit H shall refer to CONTRACTOR. In addition, CONTRACTOR shall inform every
client of their rights under the COUNTY's Mental Health Plan as described in Exhibit I, attached hereto
and by this reference incorporated herein and made part of this Agreement. CONTRACTOR shall also
file an incident report for all incidents involving clients, following the Protocol and using the Worksheet
identified in Exhibit G, attached hereto and by this reference incorporated herein and made part of this
Agreement, or a protocol and worksheet presented by CONTRACTOR that is accepted by COUNTY’s
DBH Director or designee.
18. CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating to
confidentiality.
19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
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104-191 (HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is
only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR intend to protect the privacy and provide for the security
of PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for
Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated
thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations) and other
applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI,
as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504€ of the Code of
Federal Regulations.
20. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter
into a contractual relationship with the COUNTY for the purpose of providing services under this
Agreement must employ adequate data security measures to protect the confidential information
provided to CONTRACTOR by the COUNTY, including but not limited to the following:
A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR has received authorization by COUNTY for telecommuting
purposes;
2) Current virus protection software is in place;
3) Mobile device has the remote wipe feature enabled/ and
4) A secure connection is used.
B. CONTRACTOR-Owned Computers or Computer Peripherals
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CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief
Information Officer, and/or designee(s), including but not limited to mobile storage devices. If data is
approved to be transferred, data must be stored on a secure server approved by the COUNTY and
transferred by means of a Virtual Private Network (VPN) connection, or another type of secure
connection. Said data must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR may not use COUNTY computers or computer peripherals on
non-COUNTY premises without prior authorization from the COUNTY’s Chief Information Officer,
and/or designee(s).
D. CONTRACTOR may not store COUNTY’s private, confidential or sensitive data
on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E. CONTRACTOR shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data processing
systems, data files and data processing equipment which stores or processes COUNTY data internally
and externally.
F. Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128
BIT or higher. Additionally, a password or pass phrase must be utilized.
G. CONTRACTOR is responsible to immediately notify COUNTY of any
violations, breaches or potential breaches of security related to COUNTY’s confidential information,
data maintained in computer files, program documentation, data processing systems, data files and data
processing equipment which stores or processes COUNTY data internally or externally.
H. COUNTY shall provide oversight to CONTRACTOR’s response to all incidents
arising from a possible breach of security related to COUNTY’s confidential client information provided
to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected individuals
as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will be
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responsible for all costs incurred as a result of providing the required notification.
21. PROPERTY OF COUNTY
A. COUNTY and CONTRACTOR recognizes that fixed assets are tangible and
intangible property obtained or controlled under COUNTY’s Mental Health Plan for use in operational
capacity and will benefit COUNTY for a period more than one year. Depreciation of the qualified items
will be on a straight-line basis.
For COUNTY purposes, fixed assets must fulfill three qualifications:
1. Asset must have life span of over one year.
2. The asset is not a repair part
3. The asset must be valued at or greater than the capitalization thresholds for the
asset type
Asset type Threshold
• land $0
• buildings and improvements $100,000
• infrastructure $100,000
• be tangible $5,000
o equipment
o vehicles
• or intangible asset $100,000
o Internally generated software
o Purchased software
o Easements
o Patents
• and capital lease $5,000
Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
approved and identified as an asset it will be tagged with a COUNTY program number. A Fixed asset
log will be maintained by COUNTY’s Asset Management System and annual inventoried until the asset
is fully depreciated. During the terms of this Agreement, CONTRACTOR’s fixed assets may be
inventoried in comparison to COUNTY’s DBH Asset Inventory System.
B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
more than $1,000, with over one year life span, and are mobile and high risk of theft or loss are sensitive
assets. Such sensitive items are not limited to computers, copiers, televisions, cameras and other
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sensitive items as determined by COUNTY’s DBH Director or designee. CONTRACTOR maintains a
tracking system on the items and are not required to be capitalize or depreciated. The items are subject
to annual inventory for compliance.
C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate in
an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of
this Agreement CONTRACTOR shall be physically present when fixed and inventoried assets are
returned to COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all
COUNTY owned undepreciated fixed and inventoried assets, or the monetary value of said assets if
unable to produce the assets at the expiration or termination of this Agreement.
CONTRACTOR further agrees to the following:
1. To maintain all items of equipment in good working order and condition,
normal wear and tear is expected;
2. To label all items of equipment with COUNTY assigned program number,
to perform periodic inventories as required by COUNTY and to maintain an inventory list showing
where and how the equipment is being used, in accordance with procedures developed by COUNTY.
All such lists shall be submitted to COUNTY within ten (10) days of any request therefore; and
3. To report in writing to COUNTY immediately after discovery, the lost or
theft of any items of equipment. For stolen items, the local law enforcement agency must be contacted
and a copy of the police report submitted to COUNTY.
D. The purchase of any equipment by CONTRACTOR with funds provided
hereunder shall require the prior written approval of COUNTY’s DBH, shall fulfill the provisions of this
Agreement as appropriate, and must be directly related to CONTRACTOR’s services or activity under
the terms of this Agreement. COUNTY’s DBH may refuse reimbursement for any costs resulting from
equipment purchased, which are incurred by CONTRACTOR, if prior written approval has not been
obtained from COUNTY.
E. CONTRACTOR must obtain prior written approval from COUNTY’s DBH
whenever there is any modification or change in the use of any property acquired or improved, in whole
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or in part, using funds under this Agreement. If any real or personal property acquired or improved with
said funds identified herein is sold and/or is utilized by CONTRACTOR for a use which does not
qualify under this Agreement, CONTRACTOR shall reimburse COUNTY in an amount equal to the
current fair market value of the property, less any portion thereof attributable to expenditures of funds
not provided under this Agreement. These requirements shall continue in effect for the life of the
property. In the event this Agreement expires, or terminates, the requirements for this Section shall
remain in effect for activities or property funded with said funds, unless action is taken by the State
government to relieve COUNTY of these obligations
22. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of
race, religion, color, national origin, ancestry, physical handicap, medical condition, marital status, age
or gender, pursuant to all applicable State and Federal statutes and regulations.
23. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R.
Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
from discriminating against persons based on race, color, national origin, sex, disability or religion. This
is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access and
participation in federally funded programs through the provision of comprehensive and quality bilingual
services.
B. Policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP consumers, including, but not limited to,
assessing the cultural and linguistic needs of its consumers, training of staff on the policies and
procedures, and monitoring its language assistance program. The CONTRACTOR’s procedures must
include ensuring compliance of any sub-contracted providers with these requirements.
C. CONTRACTOR shall not use minors as interpreters.
D. CONTRACTOR shall provide and pay for interpreting and translation services to
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persons participating in CONTRACTOR’s services who have limited or no English language
proficiency, including services to persons who are deaf or blind. Interpreter and translation services
shall be provided as necessary to allow such participants meaningful access to the programs, services
and benefits provided by CONTRACTOR. Interpreter and translation services, including translation of
CONTRACTOR’s “vital documents” (those documents that contain information that is critical for
accessing CONTRACTOR’s services or are required by law) shall be provided to participants at no cost
to the participant. CONTRACTOR shall ensure that any employees, agents, subcontractors, or partners
who interpret or translate for a program participant, or who directly communicate with a program
participant in a language other than English, demonstrate proficiency in the participant's language and
can effectively communicate any specialized terms and concepts peculiar to CONTRACTOR’s services.
E. In compliance with the State mandated Culturally and Linguistically Appropriate
Services standards as published by the Office of Minority Health, CONTRACTOR must submit to
COUNTY for approval, within 60 days from date of contract execution, CONTRACTOR’s plan to
address all fifteen national cultural competency standards as set forth in the “National Standards on
Culturally and Linguistically Appropriate Services (CLAS)”
(http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf). COUNTY’s annual on-site review of
CONTRACTOR shall include collection of documentation to ensure all national standards are
implemented. As the national competency standards are updated, CONTRACTOR’s plan must be
updated accordingly.
24. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section
1861(v)(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of
four (4) years after the furnishing of services under this Agreement, CONTRACTOR shall make
available, upon written request to the Secretary of the United States Department of Health and Human
Services, or upon request to the Comptroller General of the United States General Accounting Office, or
any of their duly authorized representatives, a copy of this Agreement and such books, documents, and
records as are necessary to certify the nature and extent of the costs of these services provided by
CONTRACTOR under this Agreement. CONTRACTOR further agrees that in the event
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CONTRACTOR carries out any of its duties under this Agreement through a subcontract, with a value
or cost of Ten Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month period,
with a related organization, such Agreement shall contain a clause to the effect that until the expiration
of four (4) years after the furnishing of such services pursuant to such subcontract, the related
organizations shall make available, upon written request to the Secretary of the United States
Department of Health and Human Services, or upon request to the Comptroller General of the United
States General Accounting Office, or any of their duly authorized representatives, a copy of such
subcontract and such books, documents, and records of such organization as are necessary to verify the
nature and extent of such costs.
25. SINGLE AUDIT CLAUSE
A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000.00)
or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual audit
in accordance with the requirements of the Single Audit Standards as set forth in Office of Management
and Budget (OMB) Circular A-133. CONTRACTOR shall submit said audit and management letter to
COUNTY. The audit must include a statement of findings or a statement that there were no findings. If
there were negative findings, CONTRACTOR must include a corrective action plan signed by an
authorized individual. CONTRACTOR agrees to take action to correct any material non-compliance or
weakness found as a result of such audit. Such audit shall be delivered to COUNTY’s DBH Business
Office, for review within nine (9) months of the end of any fiscal year in which funds were expended
and/or received for the program. Failure to perform the requisite audit functions as required by this
Agreement may result in COUNTY performing the necessary audit tasks, or at COUNTY’s option,
contracting with a public accountant to perform said audit, or, may result in the inability of COUNTY to
enter into future agreements with CONTRACTOR. All audit costs related to this Agreement are the
sole responsibility of CONTRACTOR.
B. A single audit report is not applicable if CONTRACTOR’s Federal contracts do
not exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR’s
only funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must
be performed and a program audit report with management letter shall be submitted by CONTRACTOR
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to COUNTY as a minimum requirement to attest to CONTRACTOR’s solvency. Said audit report shall
be delivered to COUNTY’s DBH Business Office, for review no later than nine (9) months after the
close of the fiscal year in which the funds supplied through this Agreement are expended. Failure to
comply with this Act may result in COUNTY performing the necessary audit tasks or contracting with a
qualified accountant to perform said audit. All audit costs related to this Agreement are the sole
responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under
this paragraph shall be billed to the CONTRACTOR at COUNTY cost, as determined by COUNTY’s
Auditor-Controller/Treasurer-Tax Collector.
C. CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
period of at least three (3) years following final payment under this Agreement or the closure of all other
pending matters, whichever is later.
26. COMPLIANCE
CONTRACTOR agrees to comply with the COUNTY’s Contractor Code of Conduct and
Ethics and the COUNTY’s Compliance Program in accordance with Exhibit D attached hereto and
incorporated herein by reference and made part of this Agreement. Within thirty (30) days of entering
into this Agreement with the COUNTY, CONTRACTOR shall have all of CONTRACTOR’s
employees, agents and subcontractors providing services under this Agreement certify in writing, that he
or she has received, read, understood, and shall abide by the Contractor Code of Conduct and Ethics.
CONTRACTOR shall ensure that within thirty (30) days of hire, all new employees, agents and
subcontractors providing services under this Agreement shall certify in writing that he or she has
received, read, understood, and shall abide by the Contractor Code of Conduct and Ethics.
CONTRACTOR understands that the promotion of and adherence to the Code of Conduct is an element
in evaluating the performance of CONTRACTOR and its employees, agents and subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agents and subcontractors providing services under this Agreement shall complete general
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compliance training and appropriate employees, agents and subcontractors shall complete
documentation and billing or billing/reimbursement training. All new employees, agents and
subcontractors shall attend the appropriate training within 30 days of hire. Each individual who is
required to attend training shall certify in writing that he or she has received the required training. The
certification shall specify the type of training received and the date received. The certification shall be
provided to the COUNTY’s Compliance Officer at 3133 N. Millbrook, Fresno, California 93703.
CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed upon
COUNTY by the Federal Government as a result of CONTRACTOR’s violation of the terms of this
Agreement.
27. ASSURANCES
In entering into this Agreement, CONTRACTOR certifies that it, nor any of its officers,
are not currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
Health Care Programs: that it, nor any of its officers, have not been convicted of a criminal offense
related to the provision of health care items or services; nor has it, or any of its officers, been reinstated
to participate in the Federal Health Care Programs after a period of exclusion, suspension, debarment, or
ineligibility. If COUNTY learns, subsequent to entering into a contract, that CONTRACTOR is
ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility for, or
involvement with, COUNTY’s business operations related to the Federal Health Care Programs and
shall remove such CONTRACTOR from any position in which CONTRACTOR’s compensation, or the
items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part,
directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until
such time as CONTRACTOR is reinstated into participation in the Federal Health Care Programs.
A. If COUNTY has notice that CONTRACTOR, or its officers, has been charged
with a criminal offense related to any Federal Health Care Program, or is proposed for exclusion during
the term of any contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the
accuracy of any claims submitted to any Federal Health Care Program. At its discretion given such
circumstances, COUNTY may request that CONTRACTOR cease providing services until resolution of
the charges or the proposed exclusion.
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B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
under this Agreement, will be queried as to whether (1) they are now or ever have been excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) they
have been convicted of a criminal offense related to the provision of health care items or services; and or
(3) they have been reinstated to participate in the Federal Health Care Programs after a period of
exclusion, suspension, debarment, or ineligibility.
1. In the event the potential employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR
hires or engages such potential employee or subcontractor, CONTRACTOR will ensure that said
employee or subcontractor does no work, either directly or indirectly relating to services provided to
COUNTY.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to
COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be determined
by COUNTY to protect the interests of COUNTY consumers.
C. CONTRACTOR shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are expected to
perform professional services under this Agreement (1) are not currently excluded, suspended, debarred,
or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been convicted
of a criminal offense related to the provision of health care items or services; and (3) have not been
reinstated to participation in the Federal Health Care Program after a period of exclusion, suspension,
debarment, or ineligibility. In the event any existing employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible to participate in
the Federal Health Care Programs, or has been convicted of a criminal offense relating to the provision
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of health care services, CONTRACTOR will ensure that said employee or subcontractor does no work,
either direct or indirect, relating to services provided to COUNTY.
1. CONTRACTOR agrees to notify COUNTY immediately during the term
of this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each
case, is providing professional services under this Agreement is excluded, suspended, debarred or
otherwise ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal
offense relating to the provision of health care services.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section 3 of this Agreement, or require adequate assurance (as defined by
COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to
COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be determined
by COUNTY to protect the interests of COUNTY consumers.
D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY which may be necessary to complete any internal or external audits relating
to CONTRACTOR’s compliance with the provisions of this Section.
E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR’S violation of
CONTRACTOR’S obligations as described in this Section.
28. PUBLICITY PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under
this Agreement shall be used for CONTRACTOR’s advertising, fundraising, or publicity (i.e.,
purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
Notwithstanding the above, publicity of the services described in Section One (1) of this Agreement
shall be allowed as necessary to raise public awareness about the availability of such specific services
when approved in advance by COUNTY’s DBH Director or designee and at a cost to be provided in
Exhibit B for such items as written/printed materials, the use of media (i.e., radio, television,
newspapers) and any other related expense(s).
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29. COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a client
or a client's family. CONTRACTOR shall provide a copy of the detailed complaint log entries
concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (l 0th) day of the
following month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide
details and attach documentation of each complaint with the log. CONTRACTOR shall post signs
informing clients of their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY
of all incidents reportable to State licensing bodies that affect COUNTY clients within twenty-four (24)
hours of receipt of a complaint.
Within ten (10) days after each incident or complaint affecting COUNTY-sponsored
clients, CONTRACTOR shall provide COUNTY with information relevant to the complaint,
investigative details of the complaint, the complaint and CONTRACTOR's disposition of, or corrective
action taken to resolve the complaint. In addition, CONTRACTOR shall inform every client of their
rights as set forth in Exhibit H. CONTRACTOR shall file an incident report for all incidents involving
clients, following the protocol and using the worksheet identified in Exhibit F and incorporated herein
by reference and made part of this Agreement.
30. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104,
and 455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit J, “Disclosure
of Ownership and Control Interest Statement”, attached hereto and by this reference incorporated herein
and made part of this Agreement. CONTRACTOR shall submit this form to the COUNTY’s DBH
within thirty (30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall
report any changes to this information within thirty-five (35) days of occurrence by completing Exhibit
J, “Disclosure of Ownership and Control Interest Statement.” Submissions shall be scanned pdf copies
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and are to be sent via email to DBHAdministration@co.fresno.ca.us attention: Contracts Administration.
31. DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR is required to disclose if any of the following conditions apply to them,
their owners, officers, corporate managers and partners (hereinafter collectively referred to as
“CONTRACTOR”):
A. Within the three-year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1. 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;
2. Violation of a federal or state antitrust statute;
3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
records; or
4. False statements or receipt of stolen property.
B. Within a three-year period preceding their Agreement award, they have had a
public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate
CONTRACTOR from further business consideration. The information will be considered as part of
the determination of whether to continue and/or renew this Agreement and any additional information
or explanation that a CONTRACTOR elects to submit with the disclosed information will be
considered. If it is later determined that the CONTRACTOR failed to disclose required information,
any contract awarded to such CONTRACTOR may be immediately voided and terminated for
material failure to comply with the terms and conditions of the award.
CONTRACTOR must sign a “Certification Regarding Debarment, Suspension,
and Other Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit K,
attached hereto and by this reference incorporated herein and made part of this Agreement.
Additionally, CONTRACTOR must immediately advise the COUNTY’s DBH in writing if, during the
term of this Agreement: (1) CONTRACTOR becomes suspended, debarred, excluded or ineligible for
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participation in federal or state funded programs or from receiving federal funds as listed in the excluded
parties’ list system (http://www.epls.gov); or (2) any of the above listed conditions become applicable to
CONTRACTOR. CONTRACTOR shall indemnify, defend and hold the COUNTY harmless for any
loss or damage resulting from a conviction, debarment, exclusion, ineligibility or other matter listed in
the signed Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
32. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a
for-profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR
changes its status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this Agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
is a party and in which one or more of its directors has a material financial interest. Members of the
Board of Directors shall disclose any self-dealing transactions that they are a party to by completing and
signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit L and incorporated
herein by reference and made part of this Agreement, and submitting it to the COUNTY prior to
commencing with the self-dealing transaction or immediately thereafter.
33. AUDITS AND INSPECTIONS
The CONTRACTOR shall at any time during business hours, and as often as the
COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
data with respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request by
the COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to ensure
CONTRACTOR’s compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR shall be subject to the examination and audit of the State Auditor General for a period
of three (3) years after final payment under contract (California Government Code section 8546.7).
34. NOTICES
The persons having authority to give and receive notices under this Agreement and their
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addresses include the following:
COUNTY CONTRACTOR
Director, Fresno County Chief Executive Officer
Department of Behavioral Health Turning Point of Central California
3133 N. Millbrook Ave 2625 East Divisadero Street
Fresno, CA 93702 Fresno, CA 93721
Any and all notices between COUNTY and CONTRACTOR provided for or permitted
under this Agreement or by law shall be in writing and shall be deemed duly served when personally
delivered to one of the parties, or in lieu of such personal service, when deposited in the United States
Mail, postage prepaid, addressed to such party.
35. GOVERNING LAW
Venue for any action arising out of or related to the Agreement shall only be in Fresno
County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
36. ENTIRE AGREEMENT
This Agreement, including all Exhibits, COUNTY’s Revised RFP No. 17-064 and
CONTRACTOR’s Response to RFP No. 17-064 constitutes the entire agreement between
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understandings of any nature whatsoever unless expressly included in this Agreement.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year first
2 hereinabove written.
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1 4
CONTRACTOR:
TURNJNG POINT OF COUNTY OF FRESNO
CEN~O~: By:~
PrintName: AA-Y'7DJ()p ~):::.,>
By:_il_· ~--
Chairman , Board of Supervisors
Title: c)/;~ b kcr..JT;~. OF,&J~ate: __ 6_b'--=I:.......~~J_._7_
ChiefExecutive Officer, or 7 I
President, or any Vice President
BERNICE E . SEIDEL, Clerk
Board of Supervisors
1 5 By: __ &_·~--·--~-----
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R Ut:...f!... '!;;/..,-Print Name: __ /_cn-___ ..LL __ -, __ _
Title: ___ C!._h ___ ~--
Secretary (of Corporation), or
any Assistant Secretary, or
ChiefFinancial Officer, or
any Ass istant Treasurer
Mailing Address:
P. 0. Box 7447
Visalia, CA 93290-7447
Phone No.: (559) 732-8086 Ext. 140
Contact: ChiefExecutive Officer
By :~ bAsb op ,~~~
Date: Lo -';}..D -\ 1
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
-35 -COU NTY OF FRES NO
Fresno , CA
EXHIBIT A—SCOPE OF WORK
Page 1 of 17
AB 109
SCOPE OF WORK
Full Service Partnership Services
ORGANIZATION: Turning Point of Central California
MAILING ADDRESS: P.O. Box 7447, Visalia CA 93290
SERVICE ADDRESS: 3636 N. First Street, Suites 162 and 164, Fresno, CA 93726
SERVICES: Full service partnership (FSP) services as required by AB109 Public
Safety Realignment and the Post-release Community Supervision Act
of 2011.
PROJECT DIRECTOR: Sharon Ross
Phone Number: (559) 221-5191
CONTRACT PERIOD: July 1, 2017 through June 30, 2020, with an option for two (2) twelve
(12) month renewal terms
CONTRACT AMOUNT:
Term Budget
FY17-18 $1,555,903
FY18-19 $1,555,903
FY19-20 $1,555,903
FY20-21 $1,555,903
FY21-22 $1,555,903
EXHIBIT A—SCOPE OF WORK
Page 2 of 17
AB109 Full Service Partnership
FULL SERVICE PARTNERSHIP PROGRAM DESCRIPTION
The AB 109 Full Service Partnership (FSP) program shall provide innovative and evidence-based
mental health services specifically tailored to meet the unique needs of the seriously mentally ill (SMI)
population identified among the AB109 post-release adult male and female offenders. This project
shall include the use of innovative approaches resulting in increased access to services for the
underserved criminal justice clients thereby encouraging and assisting this population in transition
towards growth, stability, wellness, and recovery. Services shall be delivered with a focus of “meeting
the clients where they are” utilizing a “whatever it takes” approach. Services shall be culturally and
linguistically competent, values-driven, evidence-based and co-occurring capable. An important
element of this project will be close and constant communication and collaboration between
CONTRACTOR, the criminal justice system, Fresno County Probation Department, and Fresno
County Department of Behavioral Health, Mental Health Services Act.
SCHEDULE OF SERVICES:
CONTRACTOR staff shall be available to provide services to clients twenty-four (24) hours per day,
seven (7) days per week.
TARGET POPULATION:
The target population is comprised of AB109 post-release adult male and female offenders, age 18
and older and their families, who have a serious mental illness (SMI) such as schizophrenia major
depression with psychotic features or bi-polar disorders. This program will serve a minimum of 105
AB109 transfer consumers referred by the Probation Department at any given point in time.
PROJECT DESCRIPTION:
The County’s FSP Program is a “whatever-it-takes” program working toward ending homelessness,
frequent hospitalizations, and/or incarcerations for adults with Serious Mental Illness (SMI). This
program will provide comprehensive mental health, housing, and community supports to 105 adults and
older adults with an SMI with the goal of supporting the client in recovery and self-sufficiency. Services
shall be provided utilizing the Assertive Community Treatment (ACT) model and be strength-based,
client-directed, co-occurring capable, and employ psychosocial rehabilitation and recovery model
principles.
The FSP program shall be a partnership between the CONTRACTOR and the Department of
Behavioral Health (DBH), with the CONTRACTOR providing multi-level services directed toward the
individual needs of the enrollees. Services and supports provided by the CONTRACTOR shall
include, but shall not be limited to: assessments, therapy, medication support, personal service
coordination, crisis management, rehabilitation services, employment and education, advocacy and
linkage to community resources. Additional support includes any direct assistance necessary to
ensure that clients obtain the basic necessities of daily life, such as food, clothing, transportation,
housing, personal hygiene, medical services, and other financial support. It is expected that each
client approved to enter the program will be offered the full array of services and supports, including
three (3) face-to-face contacts per week, or as clinically appropriate. County staff shall oversee
program outcomes, reporting, client referrals and contract monitoring. All client referrals will be
approved by the Fresno County Mental Health Director or designee.
EXHIBIT A—SCOPE OF WORK
Page 3 of 17
Staff to client ratio shall not fall below 1:10 or exceed 1:15. CONTRACTOR shall provide 12.75 Full
Time Equivalent (FTE) staff, further described in Exhibit B, “Budget Summary”, dedicated to the
FSP program. CONTRACTOR staffing shall include a contract with the equivalent of .25 FTE
Psychiatrist to meet with clients on a monthly basis (at minimum) or as needed.
PROGRAM OBJECTIVES AND DELIVERABLES - FSP:
The following items listed below represent FSP program goals to be achieved by CONTRACTOR.
The programs success will be based on the number of goals it can achieve, resulting from
performance outcomes. The CONTRACTOR will utilize a computerized tracking system with which
outcome measures and other relevant client data, such as demographics, will be maintained.
1. Reduce frequency of hospitalizations for each client. CONTRACTOR will provide, through client
self-reporting, most recent 12 month history for each client which will be used as baseline data.
Each client will show a 70% reduction in hospitalization after one year of receiving services or
upon discharge. Reports and data will be submitted on a monthly basis.
2. Reduce frequency of homelessness for each client. CONTRACTOR will provide most recent 12
month history for each client which will be used as baseline data. Each client will show an 80%
reduction in days spent homeless after one year of receiving services or upon discharge. Each
client will obtain and maintain stable housing after one year of receiving services or upon
discharge. Reports and data will be submitted on a monthly basis.
3. Reduce frequency of incarceration for each client. CONTRACTOR will provide, through client
self-reporting, most recent 12 month history for each client which will be used as baseline data.
Each client will show an 80% reduction in days spent incarcerated after one year of receiving
services. Each additional year will show an additional 5% reduction. Reports and data will be
submitted on a monthly basis.
4. CONTRACTOR will provide each client with the appropriate level of housing support, reflective
of client’s needs. Each client in need of housing will receive assistance in housing placement
and support – including emergency housing – contingent upon level of need and independent
functioning. Each client will have stable housing upon discharge. Reports and data will be
submitted on a monthly basis.
5. CONTRACTOR will provide services to the satisfaction of clients and will address any reported
complaints. Satisfaction surveys will be made available and reviewed regularly; a bi-annual
Performance Outcome Improvement survey will be provided to clients; and complaint forms and
grievance forms will be made easily available to clients. Reports and data will be submitted on a
monthly or annual basis, respectively.
6. CONTRACTOR will provide a level of service and support that reflect each client’s needs. Each
client will increase their level of functioning and, within one year of treatment (or as clinically
appropriate), will transition to a lower level of service within the program. Reports and data will
be submitted on a monthly basis.
7. CONTRACTOR will provide services helping each client to achieve a level of recovery, stability,
and independence that will allow transition to the least restrictive level of care possible. Written
reports will be submitted on a quarterly basis.
8. CONTRACTOR shall work with clients to assist them in setting their goals and generating a Plan
of Care which includes personalized wellness goals for each client. These goals will be
evaluated, monitored, and adjusted regularly. Written reports will be submitted on a quarterly
basis.
EXHIBIT A—SCOPE OF WORK
Page 4 of 17
9.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 local law enforcement agencies, Veterans
Administration, Marjorie Mason Center, Fresno County Human Services Departments, churches,
acute psychiatric facilities, schools, community centers, etc. Letters of introduction, including
description of services and how to contact the FSP program shall be distributed to potential
partners.
10.CONTRACTOR will complete quarterly reports, as mandated by the State for FSPs. Reports
shall be made directly into the FSP Data Collection and Reporting (DCR) system.
11.Direct Services productivity rate is expected to be at a minimum of seventy-five percent (75%)
and reported in writing at regularly scheduled meetings with the Department.
12.CONTRACTOR will identify services provided to each client on a monthly basis, as needed by
the Department, including recreational and social activities and linkages provided to clients such
as the County’s Job Option Program. This information will be provided to the designated
Division Manager in a monthly report.
CONTRACTOR’S RESPONSIBILITIES:
CONTRACTOR shall operate the FSP program by utilizing the Assertive Community Treatment
(ACT) model of care to provide services to adult clients with SMI who are frequent users of
hospital/crisis services and therefore, are at risk of hospitalization, incarceration, and
homelessness. CONTRACTOR shall:
A.Coordinate with law enforcement and courts services, as needed.
B. Be available to provide the following services, including but not limited to:
•Personal service coordination and supportive counseling;
•Ongoing assessment of the client’s mental illness symptoms and response to treatment;
•Education of the client regarding his/her mental illness and the effects (including side
effects) of prescribed medications;
•Symptom management efforts directed to helping the client identify the symptoms and
their occurrence patterns, and development of methods (internal, behavioral, adaptive) to
lessen their effects;
•Provision, both on planned and on an “as needed” basis, of such psychological support
as is necessary to help clients accomplish their personal goals and cope with the
stresses of day-to-day living.
C.Be available to provide crisis assessment and intervention twenty-four (24) hours per day,
seven (7) days per week throughout the year, including telephone and face-to-face contact
as needed. The following crisis response measures shall also be followed:
•Response to crisis shall be rapid and flexible;
EXHIBIT A—SCOPE OF WORK
Page 5 of 17
• When crisis housing is necessary for short-term care and inpatient treatment (either
voluntary or involuntary), the staff shall collaborate with the treatment staff in such
facilities. Support shall be provided to the maximum extent possible, including
accompanying the client to the facility, remaining with the client during assessment, and
beginning the process of planning with the client for discharge to the community as soon
as possible;
D. Provide services in the areas of medication prescription, administration, monitoring, and
documentation.
• The Psychiatrist shall assess each client’s mental illness symptoms and behavior and
prescribe appropriate medication, regularly review and document symptoms as well as
the client’s response to the prescribed medications, educate the client and family
members, and monitor, treat and document any medication side effects.
• The nurse shall establish medication policies and procedures which identify processes to
administer medications, train other team members, and assess regularly other team
members’ competency in this area.
• All FSP team staff shall assess and document client’s mental illness symptoms and
behavior in response to medication and shall monitor for medication side-effects during
the provision of observed self-administration and during ongoing face-to-face contacts.
• Regarding residents of Residential Care Facilities, the team shall collaborate with staff at
these facilities to ensure clients at these locations are taking prescribed medications and
the staff is monitoring their response to the medication(s). Furthermore the staff shall
review the facility records (after receiving written consent from the client) and shall
regularly collaborate with facility staff about treatment plans, goals, objectives and
interventions.
E. Provide whatever direct assistance is necessary and reasonable to ensure that the client
obtains the basic necessities of daily life, such as food, housing, clothing, medical services,
and other financial support.
F. Ensure that each FSP Team member shall have, in their possession, during regular working
hours (and appropriate on-call hours) an adequate amount of financial resources to make
emergency purchases of food, shelter, clothing, prescriptions, transportation, or other items
for consumers, as needed. The team shall have access to larger flexible funding accounts
for assistance with housing deposits, furniture purchases, and other items, with sound
accounting practices for recording and monitoring the use of these funds.
G. Assist the client with establishing a payee or payee service. The FSP team may utilize client
assistance funds to assist clients with short-term loans or grants, as necessary. The team
shall link clients to appropriate social services, provide transportation as necessary, and link
the client to appropriate legal advocacy representation.
H. Provide training, instruction, support and assistance to the client in developing personal
skills, including but not limited to, the ability to:
• Carry out personal hygiene tasks;
• Perform household chores, including housekeeping, cooking, laundry and shopping;
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• Develop or improve money management skills;
• Use community transportation; and
• Locate, finance and maintain safe, clean and affordable housing.
I. Develop and support the client’s participation in recreation, social activities, and
relationships. Priority shall be given to supporting clients in establishing positive social
relationships in normative community settings. Staff shall assist clients in establishing
positive social relationships and participating in social/recreational activities in the
community. Such services shall include, but not be limited to, assisting clients in:
• Developing social skills and the skills and other skills needed to develop meaningful
personal relationships;
• Planning appropriate and productive use of leisure time including familiarizing clients with
available social and recreational opportunities;
• Interacting with landlords, neighbors and others effectively and appropriately;
• Developing assertiveness and self-esteem; and
• Using existing self-help centers, groups, spiritual, and recreational groups to combat
isolation and withdrawal experienced by many persons coping with severe mental illness.
J. Provide alcohol, tobacco and drug abuse services for co-occurring clients, as clinically
appropriate and in accordance with harm reduction principles. This will include, but is not
limited to individual and group interventions to assist clients in:
• Identifying alcohol, tobacco, and drug abuse effects and patterns;
• Recognizing interactive effects of alcohol, tobacco, and drug use, psychiatric symptoms
and psychotropic medications;
• Developing coping skills and alternatives to minimize alcohol, tobacco and drug use;
• Achieving periods of abstinence and/or decreased risk behaviors and increased stability;
• Attending appropriate recovery or self-help meetings: and
• Achieving an alcohol and drug free lifestyle, as desired.
K. Act to minimize the client’s involvement in the criminal justice system, with services to
include, but not be limited to;
• Helping the client identify precipitants to client’s criminal involvement;
• Providing necessary treatment, support and education to help eliminate unlawful
activities or criminal involvement that may be a consequence of the client’s mental
illness; and
• Collaborating with police, court personnel, and jail/prison officials to ensure appropriate
collaboration and clinical support through the legal processes.
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L. Assist the client, family and other members of the client’s social network to relate in a
positive and supportive manner through such means as:
• Education about the client’s severe mental illness and their role in the therapeutic
process and treatment services and supports;
• Supportive counseling;
• Intervention to resolve conflict;
• Referral, as appropriate, of the family to therapy, self-help and other family support
services; and
M. Coordinate with other community mental health and non-mental health providers, as well as
other medical professionals. Staff shall provide the following functions for all clients served:
• Development of formal and informal affiliations with other human service providers
including, mental health, physical health care, addiction treatment providers, and
inpatient units;
• Involvement of other pertinent agencies, the client’s family, and members of the client’s
social network in the coordination of the assessment, and in the development,
implementation and revision of service plans;
• Advocacy and assistance to clients to obtain needed benefits and services, such as
supplemental security income, general relief, housing subsidies, food stamps, medical
assistance, and legal services;
• Coordination of meetings of the client’s service providers in the community;
• Maintenance of ongoing communication with all other agencies serving the client,
including hospitals, primary care physicians, rehabilitation services and housing
providers as required;
• Maintenance of working relationships with other community services, such as education,
law enforcement and social services;
• Maintenance of the clinical treatment relationship with the client on a continuing basis
whether the client is in the hospital, in the community, involved with other agencies or the
criminal justice system; and
• Methods for service coordination and communication between the team and other
service providers serving the same clients shall be developed and implemented
consistent with Fresno County confidentiality rules.
N. Monitor service outcomes to determine if the client has meaningful use of their time, stays in
school or maintains employment, has reduced numbers of hospitalizations, incarcerations,
and periods of homelessness. The DBH will use State identified criteria for measuring these
outcomes. The treatment team will be monitored to ensure appropriate service delivery and
adherence to MHSA philosophies.
O. Provide comprehensive services, including intensive mental health treatment, rehabilitation,
and case management with the goal of increasing adaptive functioning in the community and
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preventing unnecessary re-admissions to Institutes of Mental Disease (IMD), acute inpatient
facilities, or other higher levels of care.
P.Meet with DBH on a monthly basis, or more often as agreed upon, for contract and
performance monitoring.
Employment and Education
FSP program will assist the client in accessing and participating in the employment and education
programs offered in the community, as appropriate.
In order to facilitate client participation in community education and employment programs FSP
shall include, but is not limited to:
•Collaboration with and education of community providers as it relates to client’s mental
illness, abilities, levels of functioning, educational and employment interest, and potential
effects of the client’s mental health symptoms on participation, in education and work;
•Encouragement and individual rehabilitation related to the integration, practicing, follow
through and problem solving as it relates to continued education and employment
•Individual supportive counseling and education to assist the client, his/her family, and
support system in identifying, managing, and coping with the symptoms of mental illness
that may interfere with his/her work or education experience;
•On-the-job or work-related crisis intervention;
•Crisis intervention in the educational setting;
•Work/education-related supportive services, such as assistance with grooming and
personal hygiene, securing appropriate clothing, wake-up calls, and transportation; and
•The team staff shall also link with the supportive services offered through “The Center”
for additional and ongoing support related to education and employment.
Housing
The FSP team will empower clients to take an active role in the recovery process. The FSP team
will provide housing options and maintain clients in maintaining a stable residence by providing
needed services, accessing resources, and encouraging clients to be independent, productive and
responsible.
1.The team shall provide whatever direct assistance is necessary to ensure that the client
obtains the basic necessities of daily life, including but not limited to:
•Safe, clean, affordable housing;
•Food and clothing;
•Medical and dental services; and
•Securing appropriate financial support, which may include Supplemental Security Income
(SSI), Social Security Disability Insurance (SSDI), General Relief (GR), and money
management or payee services.
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2.The CONTRACTOR shall ensure that team members have rapid access to flexible spending
funds for items such as security deposits, furniture, and/or other items required for
independent living.
3.The CONTRACTOR will provide housing services, as needed, to ensure that clients maintain
their housing. The vendor shall provide:
•Training and assistance to client in locating, securing and inhabiting housing which is
appropriate to their level of functioning;
•Training and instruction, including individual support, problem solving, skill development,
modeling and supervision, in the home and in community settings, to teach the client to
manage finances and maintain safe, clean, affordable housing;
•Supportive and independent housing for the client with the goal to have every client in
secure housing that is appropriate for his/her level of ability and need that is sustainable,
as soon as reasonable possible;
4.The CONTRACTOR will establish a program to provide rent subsidies for independent
housing needed while developing a plan for sustainable housing based on client need and
ability.
SERVICES PROVIDED:
•GENERAL PROGRAM SERVICES - All of the following services are provided by different
team members dependent on the appropriate staff scope of knowledge, work, and expertise.
Services are generally provided through direct face-to-face contact. Some crisis support or
case management can be provided by telephone as needed. All services are provided in a
culturally and linguistically appropriate manner. We have some bi-lingual staff and utilize
interpreting services whenever necessary. Services are provided to the client and to the
client's family/support person, based on client preferences for family/support person
involvement. Services are provided directly by FSC staff unless otherwise stated.
•REFERRAL PROCESS - The FSC FSP program has created an easy access point to
treatment by co-locating an FSC intake specialist at Probation. The co-location of staff
makes the consultation, referral, and intake process quick, easy, and effective for the
Probation Officers and clients. At the request of the Probation Officer, an individual can be
scheduled for a screening appointment or walk-in appointment. Having an FSC staff member
stationed at Probation has also assisted in the development of a positive relationship and
collaboration with Probation, allowing for open communication, consultation, and planning.
The FSC program has also been successful with coordinating direct referrals from CDCR
state penitentiaries, state psychiatric hospitals, Fresno County Jail, Exodus, and DBH.
Coordinated efforts between these agencies, Probation, and FSC staff have ensured quality
access to treatment services and supports. Once a brief screening assessment is
completed, the individual will be placed in the appropriate level of care within FSC services
(outpatient SUD services, outpatient Mental Health services, Co-occurring services, or FSP
services within our FSC-FSP program).
•ENGAGMENT SERVICES - Our job is to work to engage all clients through activities such
as allowing the client the opportunity to visit the program, meet with various members of the
team, learn about the services, understand the program benefits, and to move at their own
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pace. Turning Point follows the "whatever it takes" model in helping clients discover the
value of engaging in services. This may often require multiple contacts with a client at a
variety of community settings to create a level of trust. The goal of engagement is to assist
the client in exploring the benefits of participating in the program.
•INTAKE SERVICES - The intake process involves welcoming the client and orienting them
to the program location, services and program rules. At intake, the client is offered
family/support person services and involvement as they deem appropriate and releases of
information are obtained. Rights such as the right to be respected, to privacy, to choose a
provider, to have services delivered in the client's preferred language, and to have a choice
in the type of services delivered are discussed with the client as integral to program
services. A Partner Assessment of Functioning (PAF) is completed to assist in creating a
baseline for outcomes and is entered into the California State Data Tracking System
(ITWS/DCR). Appointment times for both a Mental Health Assessment and Psychiatric
appointments are also determined during intake to occur within 7 days of the client's
admission (emergency psychiatric appointment can be made sooner if needed). A primary
PSC is assigned to the client to coordinate services {as described in more detail below under
Case Management) and a primary clinician is assigned to deliver therapy services.
•MENTAL HEALTH ASSESSMENT - The Mental Health Assessment is provided by the
Mental Health Professional who is a registered clinician in current good standing with the
California BBS and is credentialed by Fresno County to provide such services. The Mental
Health assessment gathers mental health information, develops client goals, and identifies
the client's strengths in order to help the client reach their desired goals. The assessment
will identify the presenting problem and the symptoms the client is experiencing, with
attention to duration, frequency, and effect on daily living activities. A history regarding
present illness, past medical and psychological history, personal and family
histories/structure, developmental history, employment, social development/functioning,
education, financial, housing, and substance use history. During the assessment, the
clinician will also complete the initial Reaching and Recovery inventory tool called the
Recovery Needs Level (RNL) assessment to develop a baseline of recovery that is
measured across time during the course of treatment.
•PLAN OF CARE -After the initial mental health assessment, a plan of care is developed in
collaboration with the client and the Mental Health Professional. The plan of care assesses
the client's needs, strengths, and preferences in order to formulate a plan of care. The plan
of care: 1) Identifies individual issues and presenting problems, 2) sets specific measurable
and quantifiable goals for each issue/problem, 3} develops specific approaches and
interventions necessary for the client to meet their goals, 4) improves capacity to function as
independently as possible within the community, and 5) achieves the maximum level of
recovery possible. The following key areas shall be addressed in the plan of care: psychiatric
illness, symptom reduction, activities of daily living, social relationships, and substance use.
•INDIVIDUAL SERVICE AND SUPPORT PLAN (ISSP) - Over the course of several weeks
an ISSP is created through collaboration with the client and PSC. This is a strengths-based
tool that assists in development of short term and long term goals of clients. The ISSP is re-
visited throughout the client's enrollment in the program. Examples of some the services
provided and incorporated into the ISSP are: crisis intervention plan, WRAP plan, culturally
preferred treatment and linkage to treatment centers, strengths assessment, employment
and education supports, housing supports, independent living supports, psycho-education
groups and individual counseling. The service plan assists clients in setting goals, identifying
barriers to success, design the specific objectives {with time frames}, develop the
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interventions, and use feedback mechanisms to gauge success. Goals aim to improve
quality of life and are ideally recorded in the clients' own words.
•PSYCHOTHERAPY SERVICES - Psychotherapy allows clients to engage with a warm and
welcoming Mental Health Professional trained in a variety of evidenced-based practices in
an effort to improve their quality of life. The therapist works to create a calming,
nonjudgmental, confidential atmosphere to facilitate a therapeutic alliance. The therapist
works with clients regarding current struggles, exploring barriers, and validating the client's
experience. Psychotherapy services recognize the importance of providing genuineness
(openness and self-disclosure), acceptance (being seen with unconditional positive regard),
and empathy (being listened to and understood). Working in this framework provides the
opportunity for clients to work towards understanding of self, behavioral changes, symptom
reduction, and improving healthy relationships. The therapeutic environment can support the
client in working towards a reduction in problematic behavioral health symptoms and an
increase in positive life changes. Therapists use evidenced-based practices such as
Cognitive Behavioral Therapy (CBT), Motivational Interviewing (Ml), Psychoeducational
Family Therapy-Systems Approach (Family Systems Therapy), the Wellness and Recovery
Action Plan (WRAP), among others. The therapist partners with the client to identify
therapeutic goals as well as client's strengths, improve the client's self-awareness, teach
techniques to change problematic ways of thinking or feeling, develop healthy relationships,
motivate the client to change, establish ways to maintain gains once they are made, and
plan for future obstacles.
•PSYCHIATRIC ASSESSMENT/EVALUATION - Psychiatric Assessment/Evaluation
performed by the subcontracted licensed Psychiatrist determines the need for medication
services to assist in the reduction of symptoms of behavioral health. Major activities include:
medication evaluation (identifying accurate diagnosis and specifying target symptoms and
initial severity), medication prescription (prescribing the type and dose of medication(s)
designed to alleviate the symptoms identified above), medication monitoring (monitoring
changes in symptoms, occurrence and tolerability to side-effects, as well as reviewing data
used in making medication decisions), and individual client education (increasing client
knowledge and understanding of the symptoms being treated, medications being prescribed,
the expected benefits, impact on symptoms, identification of side-effects, and how to
effectively manage side-effects).
•MEDICATION MANAGEMENT/PSYCHIATRIST- Medication prescription administration
and monitoring is accomplished by the program psychiatrist through symptoms assessment,
diagnosis, education regarding the disorder, education regarding medication benefits and
risks, obtaining informed consent, documenting ongoing symptoms, and documenting
medication response. All treatment team members document symptoms and behaviors in
response to medication and inform the psychiatrist of such changes. Program policy and
procedure address physician orders, order of medication, organization of medication per
schedule and dosage, and provide security for medication.
•PSYCHIATRIC CONSULTATIONS -As one of the leads in the treatment team, Psychiatric
consultations are ongoing with the client's treatment team members, including client's
therapist, assigned PSC, and program LVN. There is regularly scheduled time weekly to
case staff clients and emergency consultation is available as needed. The Psychiatrist is
available to consult with client's family/support person (based on client's preference and
release of information) when requested.
•INJECTABLE MEDICATION SERVICES - If the client and Psychiatrist have determined
that injectable medications would be an acceptable medication regimen, the client is
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assisted in this by the LVN. The LVN dispenses injectable medications as ordered by the
Psychiatrist for the client and monitors the ongoing use, effectiveness, and any side-effects.
Both the psychiatrist and nurse train all staff to identify and monitor the symptoms of
behavioral health, the positive effects of medications, and unintended side-effects. All
program staff monitor program clients to track medication adherence and effectiveness.
•MEDICATION EDUCATION - Medication Education is provided by the psychiatrist and
LVN. The client is given information in both written and verbal delivery methods to allow well-
informed choices. Client ownership of choices often promotes improved medication
adherence thereby enhancing the effectiveness of prescribed medications. Participants
receive comprehendible information on the effects and side-effects of prescribed
medications on their daily lives as well as information regarding interactions with co-
occurring disorders. Attention to respect of the client's cultural and personal preferences is
given in this area.
•MONITORING MEDICATION DELIVERY AND LABS - The program LVN monitors the
delivery of medication services to the clients. The psychiatrist frequently orders labs to
monitor for a variety of items such as kidney and liver function, cholesterol levels, and sugar
levels, as some medications can affect these ranges. The use of labs in monitoring
medications helps to ensure therapeutic levels of medications are maintained in order to
avoid toxicity and monitor compliance.
•INTEGRATION WITH PRIMARY CARE PHYSICIAN - At Turning Point the importance of
being mindful of treating the whole person in both behavioral and physical health is
imperative in the services we provide. Linkage to and integration with a PCP is provided by
FSC within 30 days of program enrollment, regardless of insurance or ability to pay. The
client may be transported and supported at these PCP appointments by FSC staff. Follow up
support is provided as needed. The program goal is to have 100% of clients linked to PCP
services. Staff also support the client with dental or vision linkage as needed.
•NURSING SUPPORT LVN/LPT - In house nursing staff is available for support and
education at our client's convenience through scheduled and walk in appointments taken at
the office as well as in the field as needed. The program LVN provides client focused
treatment tailored to our client's specific level of care and is able to consult with all treatment
team members as needed to ensure highest client care. The LVN can assist with
understanding the role of psychotropic medications, dispensing/tracking prescribed
medications, evaluating medication effectiveness, providing psychiatric and physical health
education, monitoring medication side effects, and providing community health resources to
support wellness.
•CASE MANAGEMENT -The primary assigned PSC is the main person to coordinate,
monitor, offer, advocate, and educate the client and client services. The PSC is able to
provide crisis support, and assist the client's family as needed. Case Management services
may be provided to the client individually, in group settings, and over the phone. The client
receives services which assist them in gaining access to Medi-Cal eligibility, medical care,
social, housing, and educational resources. The PSC assists clients in the office setting and
the community to accomplish daily living tasks to enable the client to continue to live in the
community while increasing independence. The PSC communicates with the client's
assigned probation officer frequently to remain informed of participation status, updates, and
concerns. Transportation and assistance in accessing other resources (i.e., applications,
food banks, medical care, parenting classes, housing options, etc.) is facilitated by the PSC.
The assigned PSC maintains the ISSP, progress notes, probation reports, and followup
reports to ensure each remain accurate and up to date.
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• WELLNESS AND RECOVERY SERVICES - Clients receive training and support across
multiple domains, as wellness and recovery is global in nature, with the goal of allowing the
client to improve and practice wellness tools. Staff provide instruction, modeling, and one-
on-one support in the course of natural setting/daily events to manage day-to-day life and
promote increased self-efficacy. This "hands on" approach is augmented by supportive
peers, scheduled life skills classes, and group activities. A teaching/coaching approach is
used that empowers the client to gain mastery and take responsibility as wellness and
recovery strives for the client to guide their own recovery journey.
• TRANSPORTATION SERVICES - Transportation is often a significant barrier to accessing
treatment services, completing daily activities, and gaining independence. We utilize a
variety of transportation resources including program vehicles, staff vehicles, public
transportation, bus tokens, bus passes, taxi services, and Medi-Cal/Medicare sponsored
transportation services to support clients in maintaining stable transportation. Clients are
taught how to access public transportation routes, riding, and transfers side-byside with their
PSC as needed. Clients are assisted with applying for Special Rider passes and Handi-Ride
passes for clients that have qualifying disabilities.
• SECURING LEGAL DOCUMENTS - Many clients come into the program without the basic
legal documents that they need to move forward in their recovery. Our program assists the
client in acquiring these documents which may include: applying for California Identification
Card, obtaining copies of Birth Certificates, applying for or obtaining a Social Security Card,
and assistance with application for immigration/naturalization documents.
• ENTITLEMENTS/BENEFITS -A client's level of stability is often related to the ability to
provide for their own physical needs. FSC has developed positive relationships with many of
the entitlement providers and has a track record of successfully obtaining benefits for clients.
Clients are assisted in applying for all appropriate entitlements which may include: General
Relief, CalFresh, Medi-Cal, SSI/SSDI benefits, Section 8, and CalWORKs. Staff supports
clients throughout this process, including assisting clients in filing benefits application and
assisting clients in filing appeals as necessary. Clients are educated regarding entitlements
that they may apply for and will be assisted in applying for all appropriate entitlements.
• ADVOCACY SERVICES - Clients often benefit from advocacy services of PSCs. Without
this type of help, these apparently routine activities often pose insurmountable hurdles for
the client hindering their wellness. Areas which PSCs may assist the client through advocacy
may include: eligible benefits, development of support person involvement, education or
employment settings, payee services, court settings, obtaining an apartment, as well other
areas to support clients with their daily function and goals.
• CRIMINAL JUSTICE SERVICES - The PSCs work directly with the client to assist the client
in resolving all criminal justice involvement and successfully completing their probation term.
Turning Point's FSC FSP will continue to work collaboratively with Probation, Law
Enforcement, and the Courts to assist clients to follow the law, comply with all of their legal
requirements, and promote the best interests and recovery of the client. FSC has experience
in working with the Behavioral Health Court, Jail Psychiatric Services, Police Department,
and Sheriff's Office, as well as Probation. Staff will work to minimize the client's involvement
in the Criminal Justice System by helping the client identify precipitants to criminal
involvement, providing necessary treatment to help eliminate unlawful activities, and
collaborating with Probation Officers. A cognitive behavioral approach is used in helping
clients examine how thoughts lead to behavior. This can include examination of social
involvements, financial management practices, substance use, selfdefeating behaviors, and
avoidance of detrimental people/places/things. Staff assists clients in developing a plan of
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crime prevention for their own lifestyle/behaviors. Specific program staff possess and
maintain a jail pass that enables them to have the ability to contact and support clients while
incarcerated inside the jail.
• HOUSING SERVICES - Housing services provide stability, reduce hospital/jail visits, and
allow for recovery and the building of resiliency. Housing options range based on client's
level of need with the goal of supporting the client to achieve the highest level of
independence. FSC program funding is used to subsidize a variety of housing needs
including rental payments, deposits, utilities, and the purchase of household goods. FSC
staff may accompany clients to meet with landlords or housing managers to support or
advocate as needed. FSC staff educate clients about expectations of tenancy, lease/rental
agreement requirements, and remaining courteous of other tenants. FSC staff regularly visit
the housing environment to ensure housing is appropriate to client needs. Staff work to help
clients eliminate any problems before eviction or other negative consequences arise. The
FSC team assists clients with obtaining economic and rent assistance. Clients are assisted
with determining eligibility and completing application processes for HUD housing, Section 8,
Shelter Plus Care, MHSA housing, MAP Point, and other housing subsidies.
• EDUCATION - Education plays a critical role in enhancing recovery and community
integration. FSC works directly with the SEES (Supported Employment Educational
Services), Economic Opportunities Commission, and Workforce Connections for both
educational and employment services. Staff support clients to encourage career
development and overcome barriers. The PSC can support the client in entrance
application process, financial assistance application process, field trips to school settings,
coping skills to assist client in engaging in educational setting, and assistance with supplies
as needed (clothing, back packs, and school supplies). They also provide support through
teaching study habits and reinforcing achievement. Community colleges offer students with
psychological disabilities a variety of supports through a number of programs such as
Disability Students Programs and Services (DSP&S) and Extended Opportunities Programs
and Services (EOPS). Through DSP&S students may ask for support services and/or special
class instruction through development of a student educational contract which specifies the
service. Full time students may be eligible for Board of Governor's Grant fee waiver through
EOPS. Students eligible for EOPS develop an education plan and mutual responsibilities
contract. Self Sufficiency Programs at the Social Security Administration and the Ticket to
Work program through local certified employment networks (EN) are accessed when
beneficial.
• EMPLOYMENT - Clients are assessed for their ability and desire to seek and maintain
employment. The PSC provides assistance with the client's individual needs for job
development, job seeking skills, job retention skills, on-the-job coaching or crisis intervention
when client is starting out. Clients are encouraged and guided to acquire and maintain
appropriate job skills and social skills necessary to obtain and keep employment. The client
is encouraged to pursue their hopes and dreams for an ideal career. This may involve
educational and/or vocational training programs to learn job skills, a career certification, and
practical experience. Program staff may counsel to assist clients to identify and cope with
symptoms of behavioral health. Staff may provide support in areas such as grooming and
hygiene, transportation, wakeup calls, obtaining work clothes/tools, resumes, understanding
tax or insurance forms, and linkage to job fairs. Participants are also taught to use peers as
a natural and extended support system for work situations and give each other honest
feedback, praise, and helpful advice regarding work problems. These include community
resources through the Department of Behavioral Health, Workforce Connection, and SEES
program, which offers services specifically for the program's population. Department of
Vocational Rehabilitation, and Social Security Administration's Ticket to Work programs, and
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the Employment Development Department (EDD) will also be utilized. EDD provides the
Intensive Services program, job search workshops, Jobs for All, Road to Self Sufficiency
workshops, and the Employment Opportunity. Volunteer opportunities are also sought for
client's wishing to gain work experience.
• WELLNESS AND RECOVERY GROUPS - Participation in Wellness and Recovery groups
allows the clients to receive education and to socialize with peers. Groups create a dynamic
where clients can engage with peers in seeing that they are not alone in their challenges
with anxiety, depression, PTSD, or other behavioral health symptoms. Group provides a
setting where peers can give and receive a wide range of perspectives on their situation, and
can gain feedback to better deal with their problems. Groups allow for education regarding
ability to identify mental health symptoms, management of symptoms, and self-directed
coping methods. The groups help clients in a classroom type of setting to learn social skills,
comradery, support for each other, and a safe environment for them to share their
experience with one another. Group can also help clients to identify their ability to take
control of their thoughts, behavior, and decision making as well as improving their
awareness of symptoms, cues, and using these skills to better assist them cope with their
behavioral health, support persons, peers, others, and daily stressors. Examples of topics
included:
WRAP Wellness and Recovery Plan
Positive self-care • Identifying and using strengths
Communication skills • Education on socialization skills
Healthy self-esteem/positive thinking
Conflict resolution skills building
Coping with grief and loss
The language/stigma of mental health
Stages of change
Setting behavioral health goals
Craft and activities group
Anger education and coping skills
Money Management Group
Creating healthy relationships
Education and Employment Groups
Coping with public stress/anxiety
AOD Rehabilitation Groups
• DUAL DIAGNOSIS SERVICES - Delivery of services and approaches for clients with SMI
and coexisting substance use disorders are a vital part of the recovery and wellness
process. Treatment is made available continuously to all clients regardless of their
"readiness" for abstinence or ability to participate. Supportive and cognitive-behavioral
treatment is provided individually and in groups. The team uses directive methods to help
clients lessen substance use, to change associated attitudes and behaviors, and to develop
new ways of coping and living. The PSCs combine the use of harm reduction practices with
motivational interventions to transition clients through stages of change. In the preparation
and action phases the PSC assist the client in developing a plan to become and stay clean
and sober. Once a client has attained a period of sobriety, the staff help a client develop and
maintain a relapse prevention plan that will include identifying and preventing triggers of use,
establishing and completing positive activities of daily living, creating a positive support
network, and working towards other stated treatment goals. FSC links clients to outside
treatment services as appropriate. Community programs and resources FSC links clients to
include: detoxification, inpatient treatment, outpatient treatment, AA/NA groups, transitional
housing, sober living facilities, WestCare, Spirit of Women, Light House, Fresno New
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Connections, Comprehensive Addictions Program {CAP), King of Kings, Quest House, Lujan
Homes, Decision Home, WestCare Sober Living, and CAP Sober Living. Housing options
strive to provide a harm reduction approach to substance abuse.
• PEER ACTIVITIES - As part of a client's recovery, a variety of peer activities will be made
available for the clients. Clients often struggle in social situations and having Peer-run
activities is a way to have clients begin to interact in a social situation. These services will be
delivered by the Peer Support Specialist. Clients will be encouraged to participate in existing
peer support programs in the community and will sponsor peer support activities at its office
site. Peer support services will be promoted in a manner that encourages client responsibility
and participation in their own recovery and in a manner that helps new clients understand
and combat stigmatization against behavioral health and to reduce their own self-imposed
stigma. Staff will assist program clients to develop their own program-based formal and
informal support groups as well as access existing community groups.
• SOCIAL ACTIVITY SERVICES - Turning Point provides assistance with a wide range of
social activities. The treatment team helps clients to develop, restore, and maintain social
and interpersonal relationships. For many people living with SMI, the associated symptoms
significantly interfere with social development, and vital interactions with family members,
employers, or landlords. Staff support clients' social development through individual
supportive therapy, problem solving, role playing, and modeling. FSC seeks to create
opportunities for social networking by providing support groups, hosting program sponsored
social activities, linking clients to other community recreational programs {ex: Blue Sky,
Heritage Day Center, etc.), cultural ceremonies, or, spiritual celebrations. Turning Point
facilitates support groups that foster peer-topeer networking. Monthly social activity outings
in the community are offered to further promote social development. Many clients do not
have the opportunity to participate in holiday gatherings because of poor or non-existent
family or social relationships which can cause clients to feel lonely or isolated. FSC provides
social gatherings to celebrate holidays and other socially recognized days such as
Thanksgiving, Halloween, Valentine's Day, etc. that are inclusive to all clients and their
families.
• CRISIS INTERVENTION SERVICES - The FSC treatment team is available to respond to
crisis 24/7 by phone, including the ability to respond in the community when appropriate. The
24/7 crisis line can be utilized by clients in need of various supports, including: mental health
symptom crisis, physical health crisis, unexpected immediate housing need, interpersonal
conflicts requiring support, anxiety surrounding safety, or physical threats to safety. All
Turning Point Staff receive Professional Assault Crisis Training (Pro-ACT} so that they might
support clients with de-escalation while maintaining the respect and safety of the client, staff,
and other program participants. When clients in crisis are found to be a "danger to
themselves or others," FSC has staff that are trained by Fresno County to initiate and write
an involuntary psychiatric hold when appropriate in compliance with applicable sections of
the California Welfare and Institutions Code (5150). Staff remains in contact with clients
during any inpatient holds to provide continued support and post-hospitalization planning. All
treatment team staff is trained to support clients in identifying, reducing, and stabilizing crisis
situations. Clients are encouraged to develop individualized WRAP plans and are taught to
identify triggers (people, places, things, etc.) and utilize coping strategies (contact support
person, take a walk, listen to music, etc.) in order to avoid crisis situations that will result in
hospitalizations. Clients are provided support in identifying coping strategies that can be
used in order, to reduce the symptoms experienced and to develop stabilization in order to
avoid a higher level of care.
EXHIBIT A—SCOPE OF WORK
Page 17 of 17
COUNTY RESPONSIBILITIES:
COUNTY shall:
1.Provide oversight (through the County Department of Behavioral Health (DBH) and the DBH
Contracted Services Division Manager or designee of the CONTRACTOR’s FSP program. In
addition to contract monitoring of program, oversight includes, but not limited to, coordination
with the State Department of Health Care Services, Mental Health Services Act in regard to
program administration and outcomes.
2.Assist the CONTRACTOR in making linkages with the total mental health system. This will be
accomplished through regularly scheduled meetings as well as formal and informal consultation
3.Participate in evaluating the progress of the overall program and the efficiency of collaboration
with the vendor staff and will be available to the contractor for ongoing consultation.
4.Receive and analyze statistical data outcome information from vendor throughout the term of
contract on a monthly basis. DBH will notify the vendor when additional participation is
required. The performance outcome measurement process will not be limited to survey
instruments but will also include, as appropriate, client and staff interviews, chart reviews, and
other methods of obtaining required information.
5.Recognize that cultural competence is a goal toward which professionals, agencies, and
systems should strive. Becoming culturally competent is a developmental process and
incorporates at all levels the importance of culture, the assessment of cross-cultural relations,
vigilance towards the dynamics that result from cultural differences, the expansion of cultural
knowledge, and the adaptation of services to meet culturally-unique needs. Offering those
services in a manner that fails to achieve its intended result due to cultural and linguistic
barriers is not cost effective. To assist the vendor efforts towards cultural and linguistic
competency, DBH shall provide the following at no cost to vendor(s):
A.Technical assistance to vendor regarding cultural competency requirements and sexual
orientation training.
B.Mandatory cultural competency training including sexual orientation and sensitivity training
for DBH and vendor personnel, at minimum once per year. COUNTY will provide
mandatory training regarding the special needs of this diverse population and will be
included in the cultural competence training(s). Sexual orientation and sensitivity to gender
differences is a basic cultural competence principle and shall be included in the cultural
competency training. Literature suggests that the mental health needs of lesbian, gay,
bisexual, transgender (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.
C.Technical assistance for vendor in translating behavioral health and substance abuse
services information into DBH’s threshold languages (Spanish, Laotian, Cambodian and
Hmong). Translation services and costs associated will be the responsibility of the vendor.
Exhibit B
Page 1 of 3
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 PSC B 7.00 $267,361 $267,361
0002 Peer Support - PSC 0.50 $15,989 $15,989
0003 MH Professional 1.00 $70,816 $70,816
0004 Program Director 1.00 $87,747 $87,747
0005 Nurse 0.75 $37,758 $37,758
0006 Billing Clerk 0.25 $8,720 $8,720
0007 Secretary 1.00 $36,315 $36,315
0008 PSC C 1.00 $54,152 $54,152
0009 Bookkeeper 0.25 $17,217 $17,217
0010 Title 0.00 $0
0011 Title 0.00 $0
0012 Title 0.00 $0
SALARY TOTAL 12.75 $0 $596,075 $596,075
PAYROLL TAXES:
0030 OASDI/FICA/MEDICARE $51,675 $51,675
0032 SUI $6,500 $6,500
PAYROLL TAX TOTAL $0 $58,175 $58,175
EMPLOYEE BENEFITS:
0040 Retirement $10,565 $10,565
0041 Workers Compensation $4,946 $4,946
0042 Health Insurance (medical, vision, life, dental)$88,200 $88,200
0043 Accrued Paid Leave $55,576 $55,576
EMPLOYEE BENEFITS TOTAL $0 $159,287 $159,287
SALARY & BENEFITS GRAND TOTAL $813,537
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $47,000
1011 Rent/Lease Equipment $1,500
1012 Utilities $12,500
1013 Building Maintenance $9,500
1014 Equipment purchase $0
FACILITY/EQUIPMENT TOTAL $70,500
Line Item Description (Must be itemized)
FULL SERVICE PARTNERSHIP SERVICES (AB 109)
Turning Point of Central CA, Inc.
FY 2017-18, 2018-19, 2019-2020, 2020-21, FY 2021-22
Budget Categories -Total Proposed Budget
Exhibit B
Page 2 of 3OPERATING EXPENSES:
1060 Telephone $8,500
1061 Answering Service $0
1062 Postage $500
1063 Printing/Reproduction $1,000
1064 Publications $350
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $15,268
1067 Household Supplies $1,575
1068 Food $0
1069 Program Supplies - Therapeutic $1,800
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $12,000
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $2,400
1075 Lodging $1,500
1076 Other - Vehicle Insurance $25,500
1077 Other - Depreciation $1,650
1078 Other - Recruitment $1,580
OPERATING EXPENSES TOTAL $73,623
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $0
1082 Liability Insurance $3,800
1083 Administrative Overhead $201,000
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $204,800
SPECIAL EXPENSES (Consultant/Etc.):
1090 O/S Psychiatrist $116,879
1091 Translation Services $0
1092 Medication Supports $13,113
SPECIAL EXPENSES TOTAL $129,992
FIXED ASSETS:
1190 Computers & Software $5,000
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $5,000
Exhibit B
Page 3 of 3NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$235,000
2001 Client Housing Operating Expenditures (SFC 71)$3,351
2002.1 Clothing, Food & Hygiene (SFC 72)$10,000
2002.2 Client Transportation & Support (SFC 72)$5,000
2002.3 Education Support (SFC 72)$500
2002.4 Employment Support (SFC 72)$500
2002.5 Client Activities $4,000
2002.6 Household Items $0
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$100
NON MEDI-CAL CLIENT SUPPORT TOTAL $258,451
TOTAL PROGRAM EXPENSES $1,555,903
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)53,490 $2.25 $120,354
3100 Case Management 43,787 $1.89 $82,757
3200 Crisis Services 3,519 $2.75 $9,677
3300 Medication Support 59,087 $4.22 $249,347
3400 Collateral 7,051 $2.25 $15,865
3500 Plan Development 4,074 $2.25 $9,167
3600 Assessment 13,392 $2.25 $30,132
3700 Rehabilitation 304,914 $2.25 $686,057
Estimated Medi-Cal Billing Totals 489,314 $1,203,355
Estimated % of Federal Financial Participation Reimbursement 22.00%$132,369
Estimated % of Early and Periodic Screening, Diagnostic, and Treatment Reimbursement 51.00%$583,026
MEDI-CAL REVENUE TOTAL $715,395
OTHER REVENUE:
4000 Other - Client Fees $3,500
4100 Other - (Identify)$0
4200 Other - (Identify)$0
4300 Other - (Identify)$0
OTHER REVENUE TOTAL $3,500
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $0
5200 Innovation Funds $487,008
5300 Workforce Education & Training Funds $350,000
MHSA FUNDS TOTAL $837,008
TOTAL PROGRAM REVENUE $1,555,903
Exhibit C
Page 1 of 1
Electronic Health Records Software Charges
CONTRACTOR understands that COUNTY utilizes Netsmart’s Avatar for its Electronic Health Records management.
CONTRACTOR agrees to reimburse COUNTY for all user license fees for accessing Netsmart’s Avatar, as set forth below:
Description Effective Fee Per
User
NetSmart Avatar Monthly
Hosting Service
(per named user per month)
02/01/2016 $37.00
NetSmart Avatar Annual
Maintenance/License
(per named license per year)
02/01/2016 $249.95
OrderConnect License 1 (per
named license per year) 02/01/2016 $1,278.00
Reaching Recovery Upon first
use of tools $10.00
* Annual maintenance increases 3% each FY on July 1st
Should CONTRACTOR choose not to utilize Netsmart’s Avatar for its Electronic Health Records management, CONTRACTOR
will be responsible for obtaining its own system for Electronic Health Records management.
1 Includes 100 faxed pages per month. An additional fee of $0.20 per faxed page will apply, thereafter.
Exhibit D
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health s ervices.
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 sha ll 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, each contractor, contractor’s employee and subcontractor must sign the
Contractor Acknowledgment and Agreement form and return this form to the Compliance officer or
designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and billing
for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their
professional dealing related to their contract with the County and avoid any conduct that could
reasonably be expected to reflect adversely upon the integrity of the County.
3. Treat County employees, consumers, and other mental health contractors fairly and with
respect.
4. NOT engage in any activity in violation of the County’s Compliance Program, nor engage in
any other conduct which violates any appl icable 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 fi ctitious claims for payment or reimbursement
of any kind are submitted.
7. Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
Exhibit D
Page 2 of 3
8. Act promptly to investigate and correct probl ems 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 discipl inary
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 guidelin e.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible person
and therefore excluded from participation in the Federal Health Care Programs.
Exhibit D
Page 3 of 3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print): _____________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Signature :________________________________ Date : ___/____/___
For Group or Organizational Providers
Group/Org. Name (print): _______________________________________
Employee Name (print): ________________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Other:___________________________________________
Job Title (if different from Discipline): ___________________________
Signature: _________________________________ Date: ____/___/____
Exhibit E
Page 1 of 3
Documentation Standards For Client Records
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the record
have a specific document or section addressing these topics.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client record.
Relevant physical health conditions reported by the client will be prominently identified
and updated as appropriate.
Presenting problems and relevant conditions affecting the client’s physical health and
mental health status will be documented, for example: living situation, daily activities,
and social support.
Documentation will describe client’s strengths in achieving client plan goals.
Special status situations that present a risk to clients or others will be prominently
documented and updated as appropriate.
Documentations will include medications that have been described by mental health plan
physicians, dosage of each medication, dates of initial prescriptions and refills, and
documentations of informed consent for medications.
Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data, relevant
family information and relevant results of relevant lab tests and consultations reports.
For children and adolescents, pre-natal and perinatal events and complete developmental
history will be documented.
Documentations will include past and present use of tobacco, alcohol, and caffeine, as
well as illicit, prescribed and over-the-counter drugs.
A relevant mental status examination will be documented.
A five axis diagnosis from the most current DSM, or a diagnosis from the most current
ICD, will be documented, consistent with the presenting problems, history mental status
evaluation and/or other assessment data.
2. Timeliness/Frequency Standard for Assessment
An assessment will be completed at intake and updated as needed to document changes in
the client’s condition.
Client conditions will be assessed at least annually and, in most cases, at more frequent
intervals.
B. Client Plans
1. Client plans will:
Exhibit E
Page 2 of 3
have specific observable and/or specific quantifiable goals
identify the proposed type(s) of intervention
have a proposed duration of intervention(s)
be signed (or electronic equivalent) by:
the person providing the service(s), or
a person representing a team or program providing services, or
a person representing the MHP providing services
when the client plan is used to establish that the services are provided under the
direction of an approved category of staff, and if the below staff are not the approved
category,
a physician
a licensed/ “waivered” psychologist
a licensed/ “associate” social worker
a licensed/ registered/marriage and family therapist or
a registered nurse
In addition,
client plans will be consistent with the diagnosis, and the focus of intervention will be
consistent with the client plan goals, and there will be documentation of the client’s
participation in and agreement with the plan. Examples of the documentation include,
but are not limited to, reference to the client’s participation and agreement in the body
of the plan, client signature on the plan, or a description of the client’s participation
and agreement in progress notes.
client signature on the plan will be used as the means by which the
CONTRACTOR(S) documents the participation of the client
when the client’s signature is required on the client plan and the client refuses or is
unavailable for signature, the client plan will include a written explanation of the
refusal or unavailability.
The CONTRACTOR(S) will give a copy of the client plan to the client on request.
2. Timeliness/Frequency of Client Plan:
Will be updated at least annually
The CONTRACTOR(S) will establish standards for timeliness and frequency for the
individual elements of the client plan described in item 1.
C. Progress Notes
1. Items that must be contained in the client record related to the client’s progress in treatment
include:
The client record will provide timely documentation of relevant aspects of client care
Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
All entries in the client record will include the signature of the person providing the
service (or electronic equivalent); the person’s professional degree, licensure or job title;
and the relevant identification number, if applicable
Exhibit E
Page 3 of 3
All entries will include the date services were provided
The record will be legible
The client record will document follow-up care, or as appropriate, a discharge summary
2. Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated below:
A. Every Service Contact
Mental Health Services
Medication Support Services
Crisis Intervention
Exhibit F
Page 1 of 2
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with
all State of California and Federal statutes and regulations regarding
confidentiality, including but not limited to confidentiality of information
requirements at 42, Code of Federal Regulations sections 2.1 et seq; California
Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division
10.5 and 10.6 of the California Health and Safety Code; Title 22, California Code
of Regulations, section 51009; and Division 1, Part 2.6, Chapters 1-7 of the
California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer,
Exhibit F
Page 2 of 2
rates of pay or other forms of compensation, use of facilities, and other
terms and conditions of employment.
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
Exhibit G
Page 1 of 2
FFRREESSNNOO CCOOUUNNTTYY MMEENNTTAALL HHEEAALLTTHH PPLLAANN
GGRRIIEEVVAANNCCEESS AANNDD IINNCCIIDDEENNTT RREEPPOORRTTIINNGG
PPRROOTTOOCCOOLL FFOORR CCOOMMPPLLEETTIIOONN OOFF IINNCCIIDDEENNTT RREEPPOORRTT
The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this for m, and the supervisor co -signs it.
When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
Incident Report should be sent to:
DBH Program Supervisor
Exhibit G
Page 2 of 2
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) Where did this happen?
Name/DMH #
1. Background information of the incident:
2. Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
3. Preliminary findings: How did it happen? Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent inconsequential consequential death not applicable unknown
4. Response: a) corrective action, b) Plan of Action, c) other
Completed by (print name)
Completed by (signature) Date completed
Reviewed by Supervisor (print name)
Supervisor Signature Date
Exhibit H
Page 1 of 2
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 written procedures for referring individuals to a psychiatrist
when necessary, or to a physician, if a psychiatrist is not available.
9. The organizational provider has as head of service a licensed mental health professional of
other appropriate individual as described in Title 9, CCR, Sections 622 through 630.
10. For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A. All drugs obtained by prescription are labeled in compliance with federal and state laws.
Prescription labels are altered only by persons legally authorized to do so.
B. Drugs intended for external use only or food stuffs are stored separately from drugs for
internal use.
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86 degrees F
and refrigerated drugs at 36-46 degrees F.
Exhibit H
Page 2 of 2
D. Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F. A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal laws.
G. Policies and procedures are in place for dispensing, administering and storing
medications.
11. For organizational providers that provide day treatment intensive or day rehabilitation,
the provider must have a written description of the day treatment intensive and/or day
treatment rehabilitation program that complies with State Department of Health Care
Service’s day treatment requirements. The COUNTY shall review the provider’s written
program description for compliance with the State Department of Health Care Service’s
day treatment requirements.
12. The COUNTY may accept the host county’s site certification and reserves the right to
conduct an on-site certification review at least every three years. The COUNTY may also
conduct additional certification reviews when:
The provider makes major staffing changes.
The provider makes organizational and/or corporate structure changes (example:
conversion from a non-profit status).
The provider adds day treatment or medication support services when medications
shall be administered or dispensed from the provider site.
There are significant changes in the physical plant of the provider site (some physical
plant changes could require a new fire clearance).
There is change of ownership or location.
There are complaints against the provider.
There are unusual events, accidents, or injuries requiring medical treatment for
clients, staff or members of the community.
Exhibit I
Page 1 of 2
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 their clients copies of all current beneficiary information annually at the
time their treatment plans are updated and at intake.
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.
Exhibit I
Page 2 of 2
Informal provider problem resolution process – the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
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.
Exhibit J
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DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II. Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses of individuals or corporations under “Remarks” on page 2. Identify each item number to be continued.
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
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
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? ...................................................................................... ❒ ❒
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) ........... ❒ ❒
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: ❒ Sole proprietorship ❒ Partnership ❒ Corporation
❒ Unincorporated Associations ❒ 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. ..........................................................................................................
❒ ❒
NAME ADDRESS PROVIDER NUMBER
Exhibit J
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YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
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?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) Title
Signature Date
Remarks
Exhibit K
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CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHE R
RESPONSIBILITY MATTERS --PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set ou t 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 certific ation 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 th e 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.
Exhibit K
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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;
(c) (d) 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 explanati on
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)
Exhibit L
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SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”), members
of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must disclose any
self-dealing transactions that they are a party to while providing goods, performing services, or both
for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporat ion is a party and in which one
or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self -dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4) Describe in detail why the self -dealing transaction is appropriate based on a pplicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self -dealing transaction
described in Sections (3) and (4).
Exhibit L
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(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: