HomeMy WebLinkAboutAgreement A-13-311-1 with CYS.pdf
COUNTY OF FRESNO
Fresno, CA
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AMENDMENT I TO AGREEMENT
THIS AMENDMENT, hereinafter referred to as Amendment I, 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”, COMPREHENSIVE
YOUTH SERVICES OF FRESNO, INC., a California, Non-profit 501(c)(3) Corporation, whose
address is 4545 N. West Avenue, Fresno, CA 93705, hereinafter referred to as “CONTRACTOR”.
Reference in this Amendment to “parties” shall be understood to refer to COUNTY and
CONTRACTOR, unless otherwise specified.
WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement
No. 13-311, effective July 1, 2013, (hereinafter referred to as the Agreement) whereby
CONTRACTOR agreed to provide a Mental Health Services Act (MHSA) funded Functional Family
Therapy (FFT) Program to deliver Prevention and Early Intervention (PEI) mental health and
community services to underserved or unserved high risk youth ages primarily 11–18 with Serious
Emotional Disturbance (SED) who although not incarcerated, are involved with the juvenile justice
system.
WHEREAS, the parties desire to amend the Agreement regarding changes as stated below and
restate the Agreement in its entirety.
NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
is hereby acknowledged, the parties agree as follows:
1. All references in the Agreement to “Exhibit A” shall be replaced by “Revised Exhibit
A.” Revised Exhibit A is attached hereto and incorporated herein by this reference.
2. All references in the Agreement to “Exhibit B”, shall be replaced by Revised Exhibit B.”
Revised Exhibit B is attached hereto and incorporated herein by this reference.
3. That Paragraph Four (4) – Compensation – of the Agreement, on Page Three (3),
beginning on Line Twenty-Two (22), and ending on Page Three (3), Line Twenty-Six (26) shall be
deleted in its entirety and the following inserted in its place:
“4. COMPENSATION
“Contingent upon confirmation of funding by the California Department of Health Care
COUNTY OF FRESNO
Fresno, CA
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Services, COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation for actual expenditures incurred in accordance with the budget projections specified
Revised Exhibit B: Budget, attached hereto and incorporated herein by reference.
The maximum compensation under this Agreement for each twelve month period from
July 1, 2013 through June 30, 2017 shall not exceed One Million Five Hundred Seventy-One
Thousand Three Hundred Fifty-Three and No/100 Dollars ($1,571,353.00). The maximum
compensation under this Agreement for the period of July 1, 2017 through June 30, 2018 shall not
exceed One Million Nine Hundred Seventy-Four Thousand Nine Hundred Seventeen and No/100
Dollars ($1,974,917.00). The total contract maximum of for the entire Term of this Agreement shall
not exceed Eight Million Two Hundred Sixty Thousand Three Hundred Twenty-Ninety and No/100
Dollars ($8,260,329.00).”
4. That Paragraph Seven (7) – Modification – of the Agreement, on Page Eight (8),
beginning on Line Eleven (11), and ending on Page Eight (8), Line Eighteen (18) be deleted in its
entirety and the following inserted in its place:
“7. MODIFICATION
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 Revised 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 Revised Exhibit B, that do not exceed 10% of the maximum
compensation payable to the CONTRACTOR, may be made with the written approval of COUNTY’s
Department of Behavioral Health Director, or her designee, and CONTRACTOR. Changes to the line
items in the budget that exceed ten percent (10%) of the maximum compensation payable to
CONTRACTOR, may be made with the signed written approval of COUNTY’s Department of
Behavioral Health Director, or designee, and CONTRACTOR, through an amendment approved by
County Counsel and Auditor. Said budget line item changes shall not result in any change to the
annual maximum compensation amount payable to CONTRACTOR, as stated in this Agreement.”
5. That Paragraph Nineteen (19) – Health Insurance Portability and Accountability Act – of
COUNTY OF FRESNO
Fresno, CA
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the Agreement, on Page Fourteen (14), beginning on Line Twenty-Seven (27), and ending on Page
Twenty-One (21), Line Twenty-One (21) be deleted in its entirety and the following inserted in its
place:
“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 104-191(HIPAA) and agree to use and disclose protected health information as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of protected health
information 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 Protected Health Information (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(e) of the
Code of Federal Regulations (CFR).”
6. That Paragraph Thirty-Three (33) – Notices- of the Agreement, on Page Thirty-Three
(33), beginning on Line Two (2), and ending on Page Thirty-Three (33), Line Thirteen (13) be
deleted in its entirety and the following inserted in its place:
“33. NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY CONTRACTOR
Director, Fresno County Executive Director
Department of Behavioral Health Comprehensive Youth Services
3133 N. Millbrook Avenue of Fresno, Inc.
Fresno, CA 93703 4545 N. West Avenue
Fresno, CA 93705
COUNTY OF FRESNO
Fresno, CA
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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.”
7. COUNTY and CONTRACTOR agree that this Amendment I is sufficient to amend the
Agreement No. 13-311; and that upon execution of this Amendment I, the Agreement and
Amendment I together shall be considered the Agreement.
The Agreement, as hereby amended, is ratified and continued. All provisions, terms, covenants,
conditions and promises contained in the Agreement , and not amended herein, shall remain in full
force and effect. This Amendment I shall become effective upon execution by all parties.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment I to Agreement
2 No. 13-311 as ofthe day and year first hereinabove written.
3
4 ATTEST:
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CONTRACTOR:
COMPREHENSIVE YOUTH SERVICES
OF FRESNO, INC.
By:~-----
Print Name: 8~ h 4 r-d_ Ql' 12 1.19 r\..
Title:~~
Chairman of Board, or President
Or any Vice President
Title: -Ju_,~ ~ ~
Secretary o or at1 n or
Any Assistant Secretary, or
Chief Financial Officer, or
Any Assistant Treasurer
Mailing Address:
4545 N. West Avenue
Fresno, CA 93705
(559) 229-3561
Contact: Becky Kramer, Executive Director
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COUNTY OF FRESNO
By: _Vt_~, ~~.l_:....____
Chairman, Board of Supervisors
Date: '/ -ll -\ J
BERNICE E. SEIDEL, Clerk
Board of Supervisors
By: ~SOJ-r\ & 3}.6fl ;Do pu-tw
Date: _'1....:_-_:1....!....\ -_\~):...._ ___ _
COUNTY OF FRESNO
Fresno, CA
12345678910111213141516171819202122232425262728APPROVEDASTOLEGALFORM:DANIELC.CEDERBORG,COUNTYCOUNSELBy_LAPPROVEDASTOACCOUNTINGFORM:OSCARJ.GARCIA,C.P.A.,AUDITOR-CONTROLLER/TREASURER-TAXCOLLECTORByjj,REVIEWEDANDRECOMMENDEDFORAPPROVAL:DawanUtecht,DirectorDepartmentofBehavioralHealthFund/Subclass:0001/10000Organization:56304321Account/Program:7295/06COUNTYOFFRESNOFresno,CA
Revised Exhibit A
Page 1 of 7
Functional Family Therapy Services to Children/Youth
Scope of Work
ORGANIZATION: Comprehensive Youth Services of Fresno, Inc.
ADDRESS: 4545 N. West Avenue, Fresno, CA 93705
SERVICES: Functional Family Therapy (FFT) Services to Children & Families
CONTRACT TERM: July 1, 2013 – June 30, 2018
CONTRACT AMOUNT: FY 2013-14 $1,571,353
FY 2014-15 $1,571,353
FY 2015-16 $1,571,353
FY 2016-17 $1,571,353
FY 2017-18 $1,974,917
I. SCHEDULE OF SERVICES:
CONTRACTOR’s staff shall be available to provide services to consumers 12 hours per day (8:00 am
to 8:00 pm), five (5) days per week (Monday – Friday).
II. TARGET POPULATION:
CONTRACTOR shall provide Mental Health Services Act (MHSA) Prevention and Early Intervention
(PEI) services, consisting of mental health and client support, to youth, ages 11 – 18, with serious
emotional disturbance (SED) and their families. The target population shall include youth who are at-
risk of involvement, or are currently involved in the juvenile justice system, and have significant family
conflict. Additionally, services shall be provided to clients/families in rural/metro areas;
clients/families that have no or limited means of payment for services; clients/families who have been
reluctant to seek services from traditional mental health settings; and clients/families who are in
danger of homelessness, hospitalizations, out of home placements, and emergency room visits.
A minimum of 200 clients, which includes the referred youth, their sibling(s), significant relatives, and/or
other youth and adult(s) (parents, caregivers, significant support persons), shall be enrolled in this
program at any given time throughout each twelve (12) month period of this Agreement. A minimum of
450 unduplicated clients shall be served each twelve (12) month period.
III. PROJECT DESCRIPTION:
Functional Family Therapy (FFT) is a short-term, high quality intervention program with an average of
15 sessions, once a week for 15 weeks. It employs three phases of intervention: 1) engagement and
motivation; 2) behavior change; and 3) generalizations. Services are conducted in both clinic and
home settings, and can also be provided in a variety of settings including schools, child welfare
facilities, probation and parole offices/aftercare systems, and mental health facilities.
FFT is a strength-based evidence-based mental health PEI model. At its core is a focus and
assessment of those risk and protective factors that impact the adolescent and his or her
environment, with specific attention paid to both intrafamilial and extrafamilial factors, and how they
present within and influence the therapeutic process.
Revised Exhibit A
Page 2 of 7
The determination of which services and supports are to be provided to each client/family shall be
made on the basis of the individual services and supports plan (Plan of Care) which is created by the
client/family and the Community Mental Health Specialists (CMHS).
The Plan of Care is developed with the CMHS and used to identify the client’s goals and describe the
array of services and supports necessary to achieve these goals, based on the client’s needs and
preferences and, when appropriate, the needs and preferences of the client’s family.
The concepts of wellness and recovery shall be embedded in this program through all interventions
that will focus on the strengths of the family and work toward the goal of enhancing those strengths
and self-sufficiency.
CONTRACTOR shall provide services that will encourage clients and families to achieve wellness
and recovery. As clients and families advance in the program they will be able to reach a level of
wellness and recovery that should allow them to successfully discharge from the program or move to
a lower level of service. CONTRACTOR shall make appropriate decisions that allow it to efficiently
serve enrolled clients and families, as well as clients awaiting enrollment.
IV. CONTRACTOR RESPONSIBILITIES:
CONTRACTOR shall:
A. Provide the following staffing components:
1. Employ one Clinical Director to provide oversight and management of the FFT program.
2. Employ fourteen (14) full time equivalent (FTE) CMHS who possess a Master’s degree.
3. Employ four (4) FTE Parent Partners/Care Managers who possess a Bachelor’s degree
(preferably in psychology, counseling, etc.).
a. Care Managers shall assist in service coordination and ensure that families receive
peer support, education, and advocacy services as needed.
b. Parent Partners shall work with staff and families to assist in the planning and
provision of treatment to youth and families.
B. Provide the following specific services as it relates to the FFT evidence-based PEI model:
1. Adhere to the principles of FFT model and procedures.
2. Provide competent service delivery of the FFT model.
3. Participate in continuous training and technical assistance with a certified agency that
provides clinical oversight of the delivery of the FFT model.
C. Provide the following as it relates to cultural competence:
1. Recruit and hire staff that have demonstrated experience working with the Latino, African
American, Southeast Asian, Native American, and other minority populations, and have
knowledge about the culture of these targeted groups as well as other diverse
communities.
2. Ensure staff attend annual trainings on cultural competency, awareness, and diversity as
provided by selected bidder(s), or online via COUNTY’s eLearning system.
CONTRACTOR’s staff shall be appropriately trained in providing services in a culturally
sensitive manner.
Revised Exhibit A
Page 3 of 7
3. Ensure staff attend civil rights training as provided by CONTRACTOR, or online via
COUNTY’s eLearning system.
4. Recruit and hire bilingual staff. At a minimum, CONTRACTOR shall hire staff who are
competent in Spanish and Hmong, the threshold languages of Fresno County.
5. Secure trained translation and interpretation services in the threshold languages as well
as Cambodian, Russian, Arabic, Armenian, Punjabi, and other languages commonly used
in Fresno County. Translators and interpreters shall be appropriately trained to provide
services in a culturally sensitive manner.
6. Provide services by seeking to understand and placing importance on the traditional
values, beliefs, and family histories of clients, as cultural values and traditions offer special
strengths in treating and helping to guide clients toward wellness and recovery.
7. Provide services within the most relevant and meaningful cultural, gender-sensitive, and
age-appropriate context for the target population.
8. Develop plans to continually engage targeted populations.
9. Recruit and hire former client/family members as a significant portion of their staffing in
consultation with COUNTY, as needed.
10. Demonstrate knowledge and experience in working with Latino, Southeast Asian, African
American, Native American communities, and other diverse communities.
11. Develop and expand partnerships with the following unserved and underserved
populations by engaging community leaders and members to identify and document their
specific needs: Latino (migrant workers, immigrants, etc), African-American (within
targeted zip codes), Southeast Asian (refugees, etc.), and Native American (specific
targeted tribes). Engagement will include visiting rancheros, reservations, and other
targeted population areas.
12. Ensure a streamlined approach is used to provide target populations with access to
appropriate services at convenient times.
13. Distribute literature or informational brochures in threshold languages to clients and
request feedback in regard to engaging and improving access to care for culturally diverse
communities within the service area.
14. Conduct an annual cultural competency self-assessment and provide the results to
COUNTY. COUNTY shall review and revise the self-assessment tool as necessary to
meet COUNTY’s approval.
15. Provide services in communities throughout Fresno County, as opposed to traditional
mental health offices, to increase the frequency of client access of needed services and
decrease reluctance to seek and obtain services due to fear or negative stigma.
16. Promote system of care accountability for performance outcomes, which enable children
and their families to live independently, work, maintain community supports, stay in good
health, and avoid substance abuse and incarceration.
17. Develop individual services and supports plans that are flexible and open to meet the
unique needs of the targeted populations.
Revised Exhibit A
Page 4 of 7
18. Collaborate with agencies that are recognized and accepted by the targeted populations.
19. Provide family support and help create family partnerships utilizing peer support for
families and parenting support.
20. Establish culturally specific multidisciplinary treatment teams to provide services.
21. Provide supportive housing vouchers and referrals for safe, adequate, and affordable
housing.
22. Provide parenting groups that are conducted in the client and family’s preferred language.
23. Provide gender sensitive services with consideration to gender-specific psychologies and
needs, including the identity and role of the primary care giver, domestic violence, and
women’s health issues.
24. Ensure staff are trained to keep an open mind and maintain non-judgmental interaction
with clients/families.
25. Seek to hire and train staff and community stakeholders that provide services to the target
populations in the development of age specific and gender appropriate program services
and service delivery methods.
26. Ensure hiring and contracting practices are based on local data and reflect the needs of
the population to be served.
27. Attend COUNTY’s Cultural Diversity Committee monthly meetings, maintain its own
cultural competence oversight committee, and develop a cultural competency plan to
address and evaluate cultural competency issues. COUNTY shall provide technical
assistance and demographic data to CONTRACTOR in relation to cultural competency
planning.
28. Train staff regarding best practice for utilizing interpreters to ensure effective
communication with monolingual clients and families to assist in the delivery of culturally
and linguistically appropriate services.
V. COUNTY RESPONSIBILITIES:
COUNTY shall:
A. Provide oversight, through its MHSA Coordinator or designee, and collaborate with
CONTACTOR and other COUNTY Departments and community agencies to help achieve
State program goals and outcomes. Oversight includes, but is not limited to, contract
monitoring and coordination with the State Department of Health Care Services in regard to
program administration and outcomes.
B. Assist CONTRACTOR in making linkages with the total mental health system of care. This
will be accomplished through regularly scheduled meetings as well as formal and informal
consultation.
C. Participate in evaluating overall program progress and efficiency, and be available to
CONTRACTOR for ongoing consultation.
D. Gather outcome information from target client groups and CONTRACTOR throughout each
term of this Agreement. COUNTY shall notify CONTRACTOR when its participation is
Revised Exhibit A
Page 5 of 7
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.
E. Assist CONTRACTOR’s efforts toward cultural and linguistic competency by providing the
following to CONTRACTOR:
1. Technical assistance and training regarding cultural competency requirements at no cost
to CONTRACTOR.
2. Mandatory cultural competency training for CONTRACTOR personnel, on an annual basis,
at minimum.
3. Technical assistance for translating information into COUNTY’s threshold languages
(Spanish and Hmong). Translation services and costs associated will be the responsibility
of the CONTRACTOR.
VI. PERFORMANCE MEASUREMENT:
A. Data Collection:
1. Data collection and evaluation methods may include, but are not limited to, staff,
participant, and family interviews; and case file reviews.
2. CONTRACTOR shall conduct consumer satisfaction surveys to identify service efficacy
and opportunities for program development, as well as gaps in meeting cultural needs of
the clients and/or families.
3. CONTRACTOR shall ensure all active program clients and families participate in the semi-
annual State Performance Outcomes Quality Improvement (POQI) survey. CONTRACTOR
will distribute POQI surveys to and collect completed surveys from all active clients/families.
4. CONTRACTOR(S) shall collect data regarding the ethnic and language demographics of
clients and/or families receiving services, as well as survey clients and families in regard
to improvements to programs to ensure culturally relevant service provision.
5. CONTRACTOR(S) shall maintain all client data in permanent electronic case records, and
establish policies and procedures for data collection and client confidentiality.
B. Performance Outcomes
CONTRACTOR’s performance will also be evaluated by COUNTY DBH utilizing the following
performance outcomes:
Goal/Objective 1: Increase the delivery of mental health treatment services to
unserved and underserved clients and families with limited or no
means of payment.
Outcome 1A: FFT PEI program services shall be provided to clients and families
with limited or no means of payment.
Outcome Indicator 1A: More than 50% of clients/families receiving FFT PEI program
services shall have limited or no means of payment for mental health
services as indicated by the payer sources identified for the clients
Revised Exhibit A
Page 6 of 7
on monthly client rosters and program reports.
Outcome 1B: FFT PEI program services shall be provided to clients/families in
rural Fresno County areas.
Outcome Indicator 1B: More than 50% of the clients/families receiving FFT PEI program
services shall reside in rural Fresno County areas as indicated by
the zip codes identified for clients on monthly client rosters and
program reports. Client rosters should include client demographic
data (e.g., age, gender, residence, etc.) and client utilization data
(e.g., quantity/quality of services delivered).
Goal/Objective 2: Identify and build upon individual and family strengths and assets to
help parents and children develop new skills to enhance family
cohesion.
Outcome 2: Clients will gain skills to reduce family conflict and the ability to
identify familial strengths.
Outcome Indicator 2: 75% of clients/families completing the FFT program will report an
increase in family cohesion as measured by Client Outcome
Measurement tools and Outcome Questionnaires.
Goal/Objective 3: Improve functioning of clients completing the FFT PEI program.
Outcome 3: Clients will gain self confidence, increased ability to handle anger
and manage difficult situations, and experience improved individual
functioning.
Outcome Indicator 3A: 85% of the clients that participate in the FFT PEI program will report
functional improvement measured by CANS (Child/Adolescent
Needs and Strengths) scores.
Outcome Indicator 3B: 50% of the clients that complete the FFT PEI program will report a
decrease in school problems between the start and end of the
program.
Outcome Indicator 3C: 50% of the clients that complete the FFT PEI program will report a
decrease in inpatient mental health crisis visits between the start
and end of the program.
Outcome Indicator 3D: 50% of the clients that complete the FFT PEI program will report a
decrease in recidivism into the Juvenile Justice System between the
start and end of the program.
Outcome Indicator 3E: 85% of the clients participating in the FFT PEI program diagnosed
with mental health disorders (e.g., conduct disorder, oppositional
defiant disorder, disruptive behavior disorder, etc.) when they begin
the FFT PEI program will report improvement upon successful
program completion.
Revised Exhibit A
Page 7 of 7
Goal/Objective 4: Ensure clients/families are actively engaged in the FFT PEI
program.
Outcome 4: Clients/families will indicate satisfaction with FFT PEI program
services they receive.
Outcome Indicator 4: At a minimum, 80% percent of clients/families will report their
satisfaction with program services on CONTRACTOR’s consumer
satisfaction surveys and the semi-annual State POQI survey.
C. Reports
1. CONTRACTOR shall prepare an evaluation report annually, which will be submitted to the
COUNTY’s DBH and made available to partnering and interested local agencies and
organizations (e.g., project collaborators, other community agencies, and mental health
treatment providers). Annual evaluation reports will include the following information:
demographics of the target population served, services provided to each participant, number
of hospitalizations, enrollment in school, results of data analysis compared to planned
process, output and outcome measures, barriers to program implementation and measures
taken to overcome those barriers, accomplishments of program participants, lessons
learned, and the final result of any and all satisfactory survey(s).
2. CONTRACTOR shall be expected to comply with all contract monitoring and compliance
protocols, procedures, data collection methods, and reporting requirements conducted by
COUNTY.
3. Additional reports and outcome information may be requested by COUNTY at a later date,
as needed.
Functional Family Therapy Services to Children and Families
Comprehensive Youth Services
Year 5: July 1, 2017 - June 30, 2018
Revised Exhibit B
Page 1 of 2
Admin.Direct Total
0001 1.65 -$ 133,818$ 133,818$
0002 0.25 -$ 33,816$ 33,816$
0003 1.12 -$ 86,207$ 86,207$
0004 14.00 -$ 638,928$ 638,928$
0005 4.00 -$ 141,236$ 141,236$
0006 Varies 54,910$ 54,910$ 109,820$
21.02 54,910$ 1,088,915$ 1,143,825$
0030 -$ -$ -$
0031 8,402$ 79,101$ 87,503$
0032 763$ 9,125$ 9,888$
9,165$ 88,226$ 97,391$
0040 4,122$ 38,785$ 42,907$
0041 1,112$ 12,854$ 13,966$
0042 12,507$ 159,170$ 171,677$
17,741$ 210,809$ 228,550$
1,469,766$
1010 123,100$
1011 29,426$
1012 27,423$
1013 12,968$
192,917$
1060 25,228$
1061 -$
1062 -$
1063 -$
1064 -$
1065 2,114$
1066 17,907$
1067 -$
1068 3,000$
1069 Program Supplies - Therapeutic 7,471$
1070 -$
1071 -$
1072 50,742$
1073 25,290$
1074 49,615$
1075 31,800$
213,167$
1080 -$
1081 8,425$
1082 -$
1083 5,055$
1084 4,536$
1085 9,031$
27,047$
Budget Categories -
Line Item Description (Must be itemized)
PERSONNEL SALARIES:
Program Manager
Clinical Director
Staff Training/Registration
Lodging
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES:
Accounting/Bookkeeping
External Audit
Household Supplies
Food
Program Supplies - Medical
Transportation of Clients
Staff Mileage/Vehicle Maintenance
Staff Travel (Out of County)
Liability Insurance
Administrative Overhead
Payroll Services
Professional Liability Insurance
FINANCIAL SERVICES TOTAL
Asnwering Service
Postage
Printing/Reproduction
Publications
Informational Publications
Office Supplies & Equipment
Rent/Lease Equipment
Utilities
Building Maintenance
FACILITY/EQUIPMENT TOTAL
OPERATING EXPENSES:
Telephone
SALARY & BENEFITS GRAND TOTAL
FACILITIES/EQUIPMENT EXPENSES:
Rent/Lease Building
EMPLOYEE BENEFITS TOTAL
OASDI
FICA/MEDICARE
SUI
FTE %
Total Proposed Budget
PAYROLL TAXES:
Peer Review/Lead Therapist/Clinical Supervisor
Community Mental Health Specialist
Care Manager/Parent Partner
Exec Dir/Finance Mgr/Bookkeeping/Clerical
SALARY TOTAL
PAYROLL TAX TOTAL
EMPLOYEE BENEFITS:
Retirement
Workers Compensation
Health Insurance (medical vision, life, dental)
Revised Exhibit B
Page 2 of 2
1090 43,670$
1091 500$
1092 750$
44,920$
FIXED ASSETS:
1190 -$
1191 -$
1192 6,600$
1193 -$
6,600$
2000 -$
2001 -$
2001.1 14,500$
2001.2 4,250$
2001.3 1,000$
2001.4 750$
2001.5 -$
2001.6 -$
2001.7 -$
2001.8 -$
20,500$
Vol/Units of Svc Rate $ Amt.
3000 334,547 2.61$ 873,168$
3100 68,188 2.02$ 137,740$
3200 444 3.88$ 1,723$
3300 - 4.82$ -$
3400 15,525 2.61$ 40,520$
3500 5,303 2.61$ 13,841$
3600 83,945 2.61$ 219,096$
3700 6,063 2.61$ 15,824$
514,015 1,301,912$
50%
50%
1,301,912$
4000 -$
4100 -$
-$
5000 673,005$
5100 -$
673,005$
Other
MHSA FUNDS TOTAL
TOTAL
PROGRAM
REVENUE
Untility Vouchers (SFC 72)
Child Care (SFC 72)
NON MEDI-CAL CLIENT SUPPORT EXPENSE TOTAL:
TOTAL
PROGRAM
EXPENSES
Consultant (network & data management)
Translation Services
Medication Supports
SPECIAL EXPENSES TOTAL
Computers & Software - Telephone System & Computer Network
Furniture & Fixtures
1,974,917$
OTHER REVENUE:
Client Rents
Other
OTHER REVENUE TOTAL
MHSA FUNDS:
Prevention & Early Intervention Funds
Assessment
Rehabilitation
Estimated Medi-Cal Billing Totals
Estimated % of Federal Financial Participation
Estimated % of Clients Served that will be Medi-Cal Eligible
MEDI-CAL REVENUE TOTAL
Mental Health Services (Individual/Family/Group Therapy)
Case Management
Crisis Services
Medication Support
Collateral
Plan Development
1,974,917$
MENTAL HEALTH REVENUE:
Clothing, Food & Hygiene (SFC 72)
Client Transportation & Support (SFC 72)
Education Support (SFC 72)
Employment Support (SFC 72)
Respite Care (SFC 72)
Household Items
Other - Leased Automobile
Other - (Identify)
FIXED ASSETS TOTAL
NON MEDI-CAL CLIENT SUPPORT EXPENSE:
Client Housing Support Expenditures (SFC 70)
Client Housing Operating Expenditures (SFC 71)
SPECIAL EXPENSES: