HomeMy WebLinkAboutAgreement A-12-232-2 with Westcare.pdf
COUNTY OF FRESNO
Fresno, CA
- 1 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
AMENDMENT II TO AGREEMENT
THIS AMENDMENT, hereinafter referred to as Amendment II, is made and entered into this
______ day of ________________, 2017, by and between COUNTY OF FRESNO, a Political
Subdivision of the State of California, hereinafter referred to as “COUNTY”, and WESTCARE
CALIFORNIA, INC., a California Non-profit Corporation, whose business address is PO Box 12107,
Fresno, CA 93776, hereinafter referred to as “CONTRACTOR” (collectively the “parties”).
WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement
No. 12-232, effective May 22, 2012, and COUNTY Amendment No. 12-232-1, effective November 4,
2014, herein collectively referred to as COUNTY Agreement 12-232, whereby, CONTRACTOR
agreed to provide overnight stay facility services for eligible clients discharged from hospital
emergency departments (ED)/designated 5150 facilities, as specified in agreement 12-232 to help
reduce consumer ED stays as well as reduce recidivism rates for hospital stays; and
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, COUNTY and CONTRACTOR agree as follows:
1. That, effective July 1, 2017, all references in existing COUNTY Agreement No.
12-232 to “Exhibit A,” shall be changed to read “Revised Exhibit A,” attached hereto and incorporated
herein by reference.
2. That, effective July 1, 2017, all references in existing COUNTY Agreement No.
12-232 to “Exhibit B,” shall be changed to read “Revised Exhibit B,” attached hereto and incorporated
herein by reference.
3. That the existing COUNTY Agreement No. 12-232, Section two (2) “TERM”,
shall be revised by adding the following at Page Two (2), Line Eleven (11) after the word “term”.
“This Agreement shall be extended for an additional Twelve (12) month period
beginning July 1, 2017 through June 30, 2018.”
4. That the existing COUNTY Agreement No. 12-232, beginning on Page Four (4),
Line Nine (9) with the word “The” and ending on Page Four (4), Line Eighteen (18) with the word
COUNTY OF FRESNO
Fresno, CA
- 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
“Agreement” be deleted and the following inserted in its place:
“The maximum amounts to be paid to CONTRACTOR identified in this
Agreement are stated in Exhibit B, attached hereto and incorporated herein to this Agreement. For the
period May 22, 2012 through June 30, 2013, the maximum amount of compensation for services
rendered under this Agreement shall not exceed Eight Hundred Twenty-Eight Thousand Nine Hundred
Fifty-Four and No/100 Dollars ($828,954.00).
The maximum compensation under this Agreement for the period of July 1, 2013
through June 30, 2014, shall not exceed Six Hundred Eighty One Thousand Seven Hundred Thirty-Five
and No/100 Dollars ($681,735.00).
The maximum compensation under this Agreement for the period of July 1, 2014
through June 30, 2015 shall not exceed Seven Hundred Seventy-Eight Thousand Five Hundred Fifty
and No/100 Dollars ($778,550.00).
The maximum compensation under this Agreement for the period of July 1,
2015 through June 30, 2016 shall not exceed Eight Hundred Nineteen Thousand Ninety and No/100
Dollars ($819,090.00).
The maximum compensation under this Agreement for the period of July 1,
2016 through June 30, 2017 shall not exceed Eight Hundred Nineteen Thousand Ninety and No/100
Dollars ($819,090.00).
The maximum compensation under this Agreement for the period of July 1,
2017 through June 30, 2018 shall not exceed Eight Hundred Nineteen Thousand Ninety and No/100
Dollars ($819,090.00).
The total maximum compensation to be paid by COUNTY to CONTRACTOR
upon execution through June 30, 2018 should not exceed Four Million, Seven Hundred Forty-Six
Thousand, Five Hundred Nine and No/100 Dollars. ($4,746,509.00).”
5. That the existing COUNTY Agreement No. 12-232, beginning on Page Seven
(7), Section Seven (7), Line Four (4), with the word “Notwithstanding”, and ending on Page Seven (7),
Line Fifteen (15) with the word “herein”, be deleted and the following inserted in its place:
COUNTY OF FRESNO
Fresno, CA
- 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
“Notwithstanding the above, changes to services as needed to accommodate
changes in the law relating to the services 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’s County Counsel and Auditor-Controller/Treasurer-Tax Collector. Changes to
line items in the budget, as set forth in Exhibit C, 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. Changes to the line items in the budget that
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 her designee
through an amendment approved by COUNTY’s County Counsel and Auditor-Controller/Treasurer-
Tax Collector. 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.”
6. That the existing COUNTY Agreement No. 12-232, beginning on Page Thirteen
(13), Section Thirteen (13), Line Two (2), with the word “The,” and ending on Page Nineteen (19),
Line Twenty-Two (22), with the word “occasion” be deleted and the following inserted in its place:
“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
COUNTY OF FRESNO
Fresno, CA
- 4 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
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).”
7. That the existing COUNTY Agreement No. 12-232, beginning on Page Twenty-
Two (22), Section Twenty-One (21), , Line Twenty (20) with the word “If” and ending on page
Twenty-Three (23), line Twenty-Three (23) with the word “later” be deleted and the following inserted
in its place:
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 Department of Behavioral Health, 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 no 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 to COUNTY as a minimum requirement to attest to
CONTRACTOR’s solvency. Said audit report shall be delivered to COUNTY’s Department of
COUNTY OF FRESNO
Fresno, CA
- 5 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Behavioral Health, 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 section shall
be billed to the CONTRACTOR at COUNTY’s 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.”
8. COUNTY and CONTRACTOR agree that this Amendment II is sufficient to
amend the Agreement; and that upon execution of this Amendment II, the Agreement, Amendment I
and Amendment II 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 II shall become effective upon execution by all parties.
///
///
///
///
///
///
///
///
///
1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment II to Agreement as of the
2 day and year flrst hereinabove written.
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
WESTCARE CALIFORNIA, INC.
Print Name: SJA! t)C)
Title: -----'=~=-----...2~~)!? ____ _
Chahman of the Board, or
President, or any Vice President
A.+h.ht -1u ~· v? ~ 1-'ho'f', ~
~\AJ\bv-s::.R:\-k:, ~tJ\_u__hc:.::>-n
v,::,c.....c__A c9-0 I~ -0 I
C'l,. I C!l I ~2()1 + r 1
Print Name: --:S:' d H (>.. N N A
Title: Ccrfo('c ... :\-~. & r Cf ;h, ~ J G. C...
Secre ;n·y (of Corporation), ~~
any Assistant Secretary, or
ChiefFinancial Officer, or
any Assistant Treasurer
Mailing Address:
PO Box 12107
Fresno, CA 93776
Phone No .: (559}251-4800
COUNTY OF FRESNO
ll~~ By ______ ~--~-----------
Chairman, Board of Supervisors
Date : _ _!:Lo~-~g__~o::__-__,I_,)L--___
BERNICE E. SEIDEL, Clerk
Board of Supervisors
Date : _ ___:l9Do.l!:._~--LL.::.f&~0..__-___,\'_J_2 __ _
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
-6 -COUNTY OF FRESNO
F£esuo, CA
Revised Exhibit A
Page 1 of 5
Mental Health Services Act (MHSA)
Overnight Stay Facility
Scope of Work
ORGANIZATION:
ADDRESS:
SITE ADDRESS:
SERVICES:
CONTRACT PERIOD:
CONTRACT AMOUNT:
WestCare California, Inc.
1505 N. Chestnut, Fresno, CA 93776
2772 S. Martin Luther King Blvd, Fresno, CA 93706
Overnight stay services, clinical response services, peer support services,
discharge services, transportation and linkage to appropriate mental health
programs.
Upon Execution through June 30, 2018,
FY 2017-18 $819,090
SCHEDULE OF SERVICES:
CONTRACTOR'S staff shall be available to provide Overnight Stay Facility services to consumers seven days a
week, 24 hours a day
Contractor(s) shall provide services on eleven (11) County observed holidays in each calendar
year as follows:
New Year's Day
Martin Luther King, Jr. Holiday
President's Day
Cesar Chavez Day
Memorial Day
Independence Day
Labor Day
Veterans Day Thanksgiving Day
Day after Thanksgiving Day
Christmas Day
TARGET POPULATION:
Adult and older adult consumers receiving services from Fresno County emergency departments (ED)/designated
5150 facilities who are discharged to the Overnight Stay Facility upon the ED/designated 5150 facility determination
that a higher level of care is not necessary and linkage to outpatient and related services are required. Some
consumers may be referred for post hospitalization case management from acute care psychiatric facilities
when there is no identified plan for linkage.
PROJECT DESCRIPTION:
The Overnight Stay Facility program will provide24 hour-7 days per week overnight stay services, clinical
response services, peer support services, discharge services, transportation and linkage to appropriate mental
health programs to adults and older adults who are deemed appropriate for the Overnight Stay Facility pursuant
to discharge from designated hospital emergency departments' designated 5150 facilities and/or psychiatric
facilities.
Revised Exhibit A
Page 2 of 5
The CONTRACTOR'S Overnight Stay Facility will provide the services described below. CONTRACTOR will
provide services to approximately 1,200 consumers annually during the term of the contract. Extended
consumer stays will be allowed for homeless consumers that utilize the overnight stay program on nights when
linkages to services are not available. Contractors case management staff will follow-up the following morning
with extended stay/homeless consumers to provide the necessary linkages to services.
CONTRACTOR'S RESPONSIBILITIES:
CONTRACTOR shall:
1. Provide services to consumers discharged from local hospital Emergency Department's
(ED)/designated 5150 facilities as requested by the County. The CONTRACTOR may expand
to provide services to other agencies in the County of Fresno as needed or if requested to do
so by COUNTY, Department of Behavioral Health (DB-I).
2. Provide transportation of consumers from ED to Overnight Stay Facility. CONTRACTOR shall
arrive at ED/designated 5150 facility on average within thirty minutes of ED/designated 5150
facility request. CONTRACTOR shall then meet with appropriate ED/ designated 5150 facility or
Crisis Psychiatric Response Services (CPRS) staff and greet consumer. CONTRACTOR shall
learn the consumers discharge plan from the ED staff at the designated 5150 facility and
assist the consumer in the appropriate linkage to services the following morning.
3. Provide supervision of consumers who are being discharged from the emergency department
/designated 5150 facility. Provide for the basic care of consumers i.e.: food, bedding,
shower/bath, medication supervision, etc.
4. Provide direct assistance with needed linkages including transportation or follow up care as
prescribed by the discharging ED's designated 5150 facility. Linkages will occur as close
as possible to the next business day.
5. Maintain staffing including, but not be limited to: program supervisor, clinician for emergency
consultations, facility staffing ratio as State and Federal regulations require that will provide the
needed supervision of consumers in the overnight sleeping arrangement. Staffing must
include peer/family support and linkage specialists for the purpose of assisting the consumer
to treatment/intervention during business hours.
6. Ensure that the safety of the community, consumer and staff are a priority.
7. Have a process in place for each consumer who utilizes the overnight-stay facility to ensure
consumer is actively participating in services. CONTRACTOR will make telephone contacts
with each participant's service provider once a week for up to 45 days. Consumers who are
not keeping appointments or following through on referrals will be contacted directly, twice
weekly at a minimum. Consumers who drop out will be located and motivational interviewing
techniques will be used to encourage their return to their treatment program. CONTRACTOR
will contact participants at least once a month until the individual has consistently participated in
an outpatient program for 3 months and is functioning at a lower level of care
8. Ensure service delivery is culturally sensitive and appropriate for consumer and
consumer's family.
9. Provide family support services through Peer Support Specialists and Linkage Specialists to
aid in the recovery of the consumer as well as to educate and engage the whole family.
10. Maintain the procedures needed to handle overflow consumers. Maintain adequate space to
handle any overflow of consumers into the facility. If the number of consumers exceeds the 1:6
staff to consumer ratio, an on-call Peer Support Specialist will be notified to report to work.
Revised Exhibit A
Page 3 of 5
11. Extended consumer stays will be allowed for homeless consumers that utilize the overnight stay
program on nights when linkages to services are not available. CONTRACTOR'S case
management staff will follow-up the following morning with extended stay/homeless consumers
to provide the necessary linkages to services.
12. The Overnight Stay facility program will provide 24-hour, 7-days-per-week overnight
services, clinical response services, peer support services, discharge services,
transportation and linkage to appropriate mental health programs to adults and older adults
who are deemed appropriate for the Overnight Stay Facility pursuant to discharge from
designated hospital emergency departments/designated 5150 facilities.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Provide program and budget oversight through the County Department of Behavioral Health (DBH),
Contracted Services Division to the CONTRACTOR'S Overnight Stay Facility. In addition to contract
monitoring of the program, oversight includes, but not limited to, coordination with the State Department of
Mental Health, Mental Health Services Act in regard to program administration and outcomes.
2. Participate in evaluating the progress of the overall program and the efficiency of collaboration with the
CONTRACTOR staff and be available to the CONTRACTOR for ongoing consultation.
3. 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 may also include, as
appropriate, consumer and staff interviews, chart reviews, and other methods of obtaining required
information.
4. Recognize that cultural competency 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 CONTRACTOR):
A. Technical assistance and mandatory cultural competency training including sexual orientation and
sensitivity training for vendor personnel, at minimum once per year. County will provide mandatory
training regarding the special needs of this diverse population. 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.
B. 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.
Revised Exhibit A
Page 4 of 5
PROGRAM OUTCOMES
The following items listed below represent program outcomes to be tracked by the vendor during the term of
the Agreement:
• CONTRACTOR shall track response time to emergency departments/ designated 5150 facility
by Overnight Stay Facility team members.
• CONTRACTOR shall track the amount of time it takes to place consumers from the
emergency departments/designated 5150 facility to the Overnight Stay Facility.
• CONTRACTOR shall track referral source.
• CONTRACTOR shall track consumers with behavioral health disorders who are frequent users
of hospital emergency departments/designated 5150 facility and monitor the recidivism rate of
those consumers.
• CONTRACTOR shall monitor, report and track appropriate linkage successes and challenges
• CONTRACTOR shall track, report, and monitor follow up contacts with consumers.
• CONTRACTOR shall track clinical outcomes by discharge placement.
• CONTRACTOR shall track total discharges and discharge reasons
• CONTRACTOR will develop a satisfaction survey, approved by DBH that complies with the
mandated State performance outcome and quality improvement reports/outcomes. At a
minimum, eighty percent (80%) of consumers will report satisfaction with the program
services.
• CONTRACTOR will identify services provided to each consumer on a monthly basis.
CULTURAL & LINGUISTIC COMPETENCE:
As related to Cultural and Linguistic Competence, the CONTRACTOR:
A. Shall be required to ensure compliance with 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. Shall develop and implement 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 it language assistance program. CONTRACTOR'S procedures must
include ensuring compliance of any sub-contracted providers with these requirements.
C. Agree that minors shall not be used as interpreters.
D. Shall be required to conduct and submit to County an annual cultural and linguistic needs
assessment to promote the provision and utilization of appropriate services for its diverse consumer
population. The needs assessment report shall include findings and a plan outlining the proposed
Revised Exhibit A
Page 5 of 5
services to be improved or implemented as a result of the assessment findings, with special
attention to addressing cultural and linguistic barriers and reducing racial, ethnic, language,
abilities, and gender and age disparities.
E. Shall develop internal systems to meet the cultural and linguistic needs of the vendor's
consumer census including the incorporation cultural competency in the vendor's mission;
establishing and maintaining a process to evaluate and determine the need for special-
administrative, clinical, welcoming, billing, etc. - initiatives related to cultural
competency
F. Shall develop recruitment and retention initiatives to establish contracted program staffing
that is reflective and responsive to the needs of the program and target population.
CONTRACTOR shall establish designated staff person to coordinate and facilitate the integration of
cultural competency. The designated person will provide an array of communication tools to
distribute information to staff relating to cultural competency issues
G. Shall keep abreast of evidence-based and best practices in cultural competency in mental health care
and treatment to ensure that the vendor (s) maintains current information and an external
perspective in its policies. The CONTRACTOR will evaluate the effectiveness of strategies and
programs in improving the health status of cultural-defined populations. CONTRACTOR shall
communicate their policies to COUNTY for review of adherence with said evidenced-based
practices and best practices in cultural competency in mental health care and treatment.
CONTRACTOR shall provide translation services for program services in accordance with the
requirements noted in Paragraph 30 of this Agreement.
H. CONTRACTOR'S staff will assume that the population served may not be in
heterosexual relationships. Gender sensitivity and sexual orientation must be covered in
annual training.
I. Will utilize existing community supports, referrals to transgender support groups, etc.,
when appropriate.
J. Shall deliver services in the consumer's home community, drawing on formal and informal
resources to promote the consumer's successful participation in the community. Community
resources include not only mental health and co-occurring disorders professionals and provider
agencies, but also social, religious and cultural organizations and other natural community
support networks.
K. Shall be required to annually attend the Cultural Competence as well as the Compliance training
provided by DBH.
L. Will report its efforts to evaluate cultural and linguistic activities as part of the vendor's ongoing
quality improvement efforts in the monthly activities report. Reported information may include
consumers' complaints and grievances, results from consumer satisfaction surveys, and utilization
and other clinical data that may reveal health disparities as a result of cultural and linguistic barriers.
M. Shall recruit and hire staff that have demonstrated experience working with culturally and
linguistically underserved minority populations and have knowledge about the culture and
languages of these intended groups as well as other diverse communities.
***
Revised Exhibit B
1 of 3
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Program Supervisor 1.00 $55,000 $55,000
0002 Case Manager 3.00 $120,000 $120,000
0003 Peer Support Specialists/Driver 5.00 $111,800 $111,800
0004 Personal Service Coordinators 4.00 $120,640 $120,640
0005 Data/Program Assistant 1.00 $29,120 $29,120
0006 Medical Director 0.17 $33,270 $33,270
0007 LCSW 1.00 $55,000 $55,000
0008 Temp Help/Overtime $2,500 $2,500
0009 Title 0.00 $0
0010 Title 0.00 $0
0011 Title 0.00 $0
0012 Title 0.00 $0
SALARY TOTAL 15.17 $0 $527,330 $527,330
PAYROLL TAXES:
0030 OASDI $0
0031 FICA/MEDICARE 0.0654 $0 $34,487 $34,487
0032 SUI 0.017 $0 $8,965 $8,965
PAYROLL TAX TOTAL $0 $43,452 $43,452
EMPLOYEE BENEFITS:
0040 Retirement 0.03 0 $15,820 $15,820
0041 Workers Compensation 0.0206 0 $10,863 $10,863
0042
Health Insurance (medical, vision,
life, dental)0.067 $0 $35,331 $35,331
EMPLOYEE BENEFITS TOTAL $0 $62,014 $62,014
Line Item Description (Must be itemized)
Overnight Stay Program
WestCare California, Inc.
FY2017-2018
Budget Categories - Total Proposed Budget
Revised Exhibit B
2 of 3
SALARY & BENEFITS GRAND TOTAL $632,796
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $16,900
1011 Rent/Lease Equipment $16,464
1012 Utilities $11,000
1013 Building Maintenance $2,100
1014 Equipment purchase $0
FACILITY/EQUIPMENT TOTAL $46,464
OPERATING EXPENSES:
1060 Telephone $6,500
1061 Answering Service $0
1062 Postage $100
1063 Printing/Reproduction $150
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $4,800
1067 Household Supplies $3,000
1068 Food $250
1069 Program Supplies - Therapeutic $0
1070 Program Supplies - Medical $750
1071 Transportation of Clients $250
1072 Staff Mileage/vehicle maintenance $4,000
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $750
1075 Lodging $0
1076 Other - (Identify)$0
1077 Other - (Identify)$0
OPERATING EXPENSES TOTAL $20,550
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $0
1082 Liability Insurance $0
1083 Administrative Overhead $99,430
1084 Payroll Services $0
1085 Professional Liability Insurance $2,400
FINANCIAL SERVICES TOTAL $101,830
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$0
1091 Translation Services $1,000
1092 Medication Supports $0
SPECIAL EXPENSES TOTAL $1,000
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $500
1192 Other - (Identify)$0
1193 Other - (Identify)$0
Revised Exhibit B
3 of 3
FIXED ASSETS TOTAL $500
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)$0
2001 Client Housing Operating Expenditures (SFC 71)$0
2002.1 Clothing, Food & Hygiene (SFC 72)$12,500
2002.2 Client Transportation & Support (SFC 72)$2,500
2002.3 Education Support (SFC 72)$0
2002.4 Employment Support (SFC 72)$0
2002.5 Respite Care (SFC 72)$0
2002.6 Household Items $950
2002.7 Utility Vouchers (SFC 72)$0
2002.8 Child Care (SFC 72)$0
NON MEDI-CAL CLIENT SUPPORT TOTAL $15,950
TOTAL PROGRAM EXPENSES $819,090
MEDI-CAL REVENUE:
Units of
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Gro 0 $0.00 $0
3100 Case Management 0 $0.00 $0
3200 Crisis Services 0 $0.00 $0
3300 Medication Support 0 $0.00 $0
3400 Collateral 0 $0.00 $0
3500 Plan Development 0 $0.00 $0
3600 Assessment 0 $0.00 $0
3700 Rehabilitation 0 $0.00 $0
Estimated Medi-Cal Billing Totals 0 $0
Estimated % of Federal Financial Participation Reimbursement 0.00%$0
Early and Periodic Screening, Diagnostic, and Treatment Reimbursement 0.00%$0
MEDI-CAL REVENUE TOTAL $0
OTHER REVENUE:
4000 Other - (Identify)$0
4100 Other - (Identify)$0
4200 Other - (Identify)$0
4300 Other - (Identify)$0
OTHER REVENUE TOTAL $0
MHSA FUNDS:
5000 Prevention & Early Intervention Funds $0
5100 Community Services & Supports Funds $0
5200 Innovation Funds $0
5300 Workforce Education & Training Funds $0
MHSA FUNDS TOTAL $819,090
TOTAL PROGRAM REVENUE $819,090