HomeMy WebLinkAboutAgreement A-23-627 BHBH Agreement with RH Community Builders LP.pdf Agreement No. 23-627
1 SERVICE AGREEMENT
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This Service Agreement ("Agreement") is dated November 28, 2023 and is between
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RH Community Builders LP, a California limited partnership ("Contractor"), and the County of
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Fresno, a political subdivision of the State of California ("County").
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Recitals
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A. The Fresno County Department of Behavioral Health (DBH) received Behavioral Health
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Board Housing (BHBH) grant funding from the State of California (State) Department of Health
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Care Services (DHCS) to provide immediate and sustainable bridge housing and treatment
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needs of the people experiencing homelessness who have a serious mental illness (SMI)
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and/or substance use disorders (SUD).
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B. The County is in need of a qualified agency to operate the County's BHBH program.
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C. The purpose of this Agreement is for the Contractor to make available supportive
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services and Specialty Mental Health Services (SMHS) to support people who have a serious
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behavioral health condition that prevent them from accessing help and moving out of
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homelessness, which Contractor's services shall be funded in large part by the grant from
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DHCS.
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D. Contractor is qualified and willing to operate the BHBH program.
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The parties therefore agree as follows:
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Article 1
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Contractor's Services
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1.1 Scope of Services. The Contractor shall perform all of the services provided in
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Exhibit A to this Agreement, titled "Scope of Services."
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1.2 Representation. The Contractor represents that it is qualified, ready, willing, and
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able to perform all of the services provided in this Agreement.
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1.3 Compliance with Laws. The Contractor shall, at its own cost, comply with all
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applicable federal, state, and local laws and regulations in the performance of its obligations
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1 under this Agreement, including but not limited to workers compensation, labor, and
2 confidentiality laws and regulations.
3 Contractor shall provide services in conformance with all applicable State and Federal
4 statutes regulations and subregulatory guidance, as from time to time amended, including but
5 not limited to:
6 (A) California Code of Regulations, Title 9;
7 (B) California Code of Regulations, Title 22;
8 (C) California Welfare and Institutions Code, Division 5;
9 (D) United States Code of Federal Regulations, Title 42, including but not limited to
10 Parts 438 and 455;
11 (E) United States Code of Federal Regulations, Title 45;
12 (F) United States Code, Title 42 (The Public Health and Welfare), as applicable;
13 (G)Balanced Budget Act of 1997;
14 (H) Health Insurance Portability and Accountability Act (HIPAA); and
15 (1) Applicable Medi-Cal laws and regulations, including applicable sub-regulatory
16 guidance, such as Behavioral Health Information Notices (BHINs), Mental Health and
17 Substance Use Disorder Services Information Notices (MHSUDS INs), and provisions of
18 County's, state or federal contracts governing services for persons served.
19 In the event any law, regulation, or guidance referred to in this section 1.3 is
20 amended during the term of this Agreement, the parties agree to comply with the amended
21 authority as of the effective date of such amendment without amending this Agreement.
22 Contractor recognizes that County operates its mental health programs under an
23 agreement with DHCS, and that under said agreement the State imposes certain requirements
24 on County and its subcontractors. Contractor shall adhere to all State requirements, including
25 those identified in Exhibit B to this Agreement titled, "Behavioral Health Requirements."
26 1.4 Meetings. Contractor shall participate in monthly, or as needed, workgroup
27 meetings consisting of staff from County's DBH to discuss service requirements, data reporting,
28 training, policies and procedures, overall
1 program operations and any problems or foreseeable problems that may arise. Contractor shall
2 also participate in other County meetings, such as but not limited to quality improvement
3 meetings, provider meetings, Behavioral Health Board meetings, bi-monthly contractor
4 meetings, etc. Scheduling for these meetings may change based on the needs of the County.
5 1.5 Organizational Provider. Contractor shall maintain requirements as a Mental
6 Health Plan (MHP) organizational provider throughout the term of this Agreement, as described
7 in Article 17 of this Agreement. If for any reason, this status is not maintained, and such failure
8 to maintain is not cured by Contractor, County may terminate this Agreement pursuant to Article
9 7 of this Agreement.
10 1.6 Staffing. Contractor agrees that prior to providing services under the terms and
11 conditions of this Agreement, Contractor shall have staff hired and in place for program
12 services and operations or County may, in addition to other remedies it may have, suspend
13 referrals or terminate this Agreement, in accordance with Article 7 of this Agreement.
14 1.7 Credentialing and Recredentialing. Contractor and their respective staff must
15 follow the uniform process for credentialing and recredentialing of service providers established
16 by County, including disciplinary actions such as reducing, suspending, or terminating
17 provider's privileges. Failure to comply with specified requirements can result in suspension or
18 termination of an individual or provider.
19 Upon-request, the Contractor must provide copies of documentation held by
20 Contractor to-demonstrate to the County that each of its providers are qualified in accordance
21 with current legal, professional, and technical standards, and that they are appropriately
22 licensed, registered, waivered, and/or certified.
23 Contractor must not employ or subcontract with providers debarred, suspended or
24 otherwise excluded (individually, and collectively referred to as "Excluded") from participation in
25 Federal Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set
26 forth in 42 C.F.R. §438.610. See Article 12 below.
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1 Contractor is required to verify and document at a minimum every three years that
2 each network provider that delivers covered services continues to possess valid credentials,
3 including verification of each of the credentialing requirements as per the County's uniform
4 process for credentialing and recredentialing. If any of the requirements are not up-to-date,
5 updated information should be obtained from network providers to complete the re-credentialing
6 process.
7 1.8 Criminal Background Check. Contractor shall ensure that all providers and/or
8 subcontracted providers consent to a criminal background check, including fingerprinting to the
9 extent required under state law and 42 C.F.R. § 455.434(a). Contractor shall provide evidence
10 of completed consents when requested by the County, DHCS or the US Department of Health
11 & Human Services (US DHHS).
12 1.9 Guiding Principles. Contractor shall align programs, services, and practices with
13 the vision, mission, and guiding principles of the DBH, as further described in Exhibit C to this
14 Agreement titled, "Fresno County Department of Behavioral Health Guiding Principles of Care
15 Delivery."
16 1.10 Clinical Leadership. Contractor shall send to County upon execution of this
17 Agreement, a detailed plan ensuring clinically appropriate leadership and supervision of their
18 clinical program. Recruitment and retaining clinical leadership with the clinical competencies to
19 oversee services based on the level of care and program design presented herein shall be
20 included in this plan. A description and monitoring of this plan shall be provided.
21 1.11 Timely Access. It is the expectation of the County that Contractor provide timely
22 access to services that meet the State of California standards for care. Contractor shall track
23 timeliness of services to persons served and provide a monthly report showing the monitoring
24 or tracking tool that captures this data. County and Contractor shall meet to go over this
25 monitoring tool, as needed but at least on a monthly basis, County shall take corrective action if
26 there is a failure to comply by Contractor with timely access standards. Contractor shall also
27 provide tracking tools and measurements for effectiveness, efficiency, and persons served
28 satisfaction as further detailed in Exhibit A.
1 1.12 Electronic Health Record. Contractor may maintain its records in County's
2 electronic health record (EHR) system in accordance with Exhibit D to this Agreement titled,
3 "Documentation Standards for Persons Served Records," as licenses become available. The
4 person served record shall begin with registration and intake, and include person served
5 authorizations, assessments, plans of care, and progress notes, as well as other documents as
6 approved by County. County shall be allowed to review records of all and any services
7 provided. If Contractor determines to maintain its records in the County's EHR, it shall provide
8 County's DBH Director, or his or her designee, with a thirty (30) day notice. If at any time
9 Contractor chooses not to maintain its records in the County's EHR, it shall provide County's
10 DBH Director, or designee, with thirty (30) days advance written notice and Contractor will be
11 responsible for obtaining its own system, at its own cost, for electronic health records
12 management.
13 Disclaimer
14 County makes no warranty or representation that information entered into the
15 County's DBH EHR system by Contractor will be accurate, adequate, or satisfactory for
16 Contractor's own purposes or that any information in Contractor's possession or control, or
17 transmitted or received by Contractor, is or will be secure from unauthorized access, viewing,
18 use, disclosure, or breach. Contractor is solely responsible for person served information
19 entered by Contractor into the County's DBH EHR system. Contractor agrees that all Private
20 Health Information (PHI) maintained by Contractor in County's DBH EHR system will be
21 maintained in conformance with all HIPAA laws, as stated in section 18.1, "Health Insurance
22 Portability and Accountability Act."
23 1.13 Records. Contractor shall maintain records in accordance with Exhibit D to this
24 Agreement titled, "Documentation Standards for Client Records." The records of all persons
25 served shall be maintained for a minimum of 10 years from the date of the end of this
26 Agreement.
27 1.14 Access to Records. Contractor shall provide County with access to all
28 documentation of services provided under this Agreement for County's use in administering this
1 Agreement. Contractor shall allow County, CMS, the Office of the Inspector General, the
2 Controller General of the United States, and any other authorized Federal and State agencies
3 to evaluate performance under this Agreement, and to inspect, evaluate, and audit any and all
4 records, documents, and the premises, equipment and facilities maintained by the Contractor
5 pertaining to such services at any time and as otherwise required under this Agreement.
6 1.15 Quality Improvement Activities and Participation. Contractor shall comply with
7 the County's ongoing comprehensive Quality Assessment and Performance Improvement
8 (QAPI) Program (42 C.F.R. § 438.330(a)) and work with the County to improve established
9 outcomes by following structural and operational processes and activities that are consistent
10 with current practice standards.
11 Contractor shall participate in quality improvement (QI) activities, including clinical
12 and non-clinical performance improvement projects (PIPs), as requested by the County in
13 relation to State and Federal requirements and responsibilities, to improve health outcomes and
14 individuals' satisfaction with services over time. Other QI activities include quality assurance,
15 collection and submission of performance measures specified by the County, mechanisms to
16 detect both underutilization and overutilization of services, individual and system outcomes,
17 utilization management, utilization review, provider appeals, provider credentialing and
18 re-credentialing, and person served grievances. Contractor shall measure, monitor, and
19 annually report to the County on its performance.
20 1.16 Rights of Persons Served. Contractor shall comply with applicable laws and
21 regulations relating to patients' rights, including but not limited to Wel. & Inst. Code 5325, Cal.
22 Code Regs., tit. 9, sections 862 through 868, and 42 C. F. R. § 438.100. The Contractor shall
23 ensure that its subcontractors comply with all applicable patients' rights laws and regulations.
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25 Article 2
26 Reporting
27 2.1 Reports. The Contractor shall submit the following reports provided in attached
28 Exhibits of this Agreement.
1 (A) Outcome Reports
2 Contractor shall submit to County clinical program performance outcome reports,
3 as requested. Outcomes reports are provided in Exhibit K
4 Outcome reports and outcome requirements are subject to change at County's
5 discretion. Contractor shall provide outcomes as stated in Exhibit A and E.
6 (B) Staffing Report
7 Contractor shall submit monthly staffing reports due by the 10th of each month
8 that identify all direct service and support staff by first and last name, applicable
9 licensure/certifications, and full-time hours worked to be used as a tracking tool to
10 determine if Contractor's program is staffed according to the requirements of this
11 Agreement.
12 (C) Mental Health Services Act (MHSA) Reporting
13 Contractor shall adhere to MHSA reporting including but not limited to fiscal,
14 outcomes, and demographics as described in Exhibit A.
15 (D)Additional Reports
16 Contractor shall also furnish to County such statements, records, reports, data,
17 and other information as County may request pertaining to matters covered by this
18 Agreement. In the event that Contractor fails to provide such reports or other
19 information required hereunder, it shall be deemed sufficient cause for County to
20 withhold monthly payments until there is compliance. In addition, Contractor shall
21 provide written notification and explanation to County within five (5) days of any funds
22 received from another source to conduct the same services covered by this Agreement.
23 2.2 Monitoring. Contractor agrees to extend to County's staff, County's DBH and the
24 California Department of Health Care Services (DHCS), or their designees, the right to review
25 and monitor records, programs, or procedures, at any time, in regard to persons served, as well
26 as the overall operation of Contractor's programs, in order to ensure compliance with the terms
27 and conditions of this Agreement.
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1 Article 3
2 County's Responsibilities
3 3.1 The County shall provide oversight and collaborate with Contractor, other County
4 Departments and community agencies to help achieve program goals and outcomes. In
5 addition to contractor monitoring of program, oversight includes, but not limited to, coordination
6 with Department of Health Care Services (DHCS) in regard to program administration and
7 outcomes.
8 County shall receive and analyze statistical outcome data from Contractor
9 throughout the term of contract on a monthly basis. County shall notify the Contractor when
10 additional participation is required. The performance outcome measurement process will not be
11 limited to survey instruments but will also include, as appropriate, persons served and staff
12 surveys, chart reviews, and other methods of obtaining required information under this
13 Agreement as described in Exhibit K.
14 Article 4
15 Compensation, Invoices, and Payments
16 4.1 The County agrees to pay, and the Contractor agrees to receive, compensation for
17 the performance of its services under this Agreement as described in Exhibit E to this
18 Agreement, titled "Compensation."
19 4.2 Specialty Mental Health Services Maximum Compensation. The maximum
20 compensation payable to the Contractor under this Agreement for the period of July 1, 2023
21 through June 30, 2024 for Specialty Mental Health Services is Three Million, Two Hundred
22 Thousand Dollars and zero Cents ($3,200,000.00), which is not a guaranteed sum but shall be
23 paid only for services rendered and received. The maximum compensation payable to the
24 Contractor under this Agreement for the period of July 1, 2024 through June 30, 2025 for
25 Specialty Mental Health Services is Five Million Two Hundred Thousand Dollars and zero
26 Cents ($5,200,000.00), which is not a guaranteed sum but shall be paid only for services
27 rendered and received. The maximum compensation payable to the Contractor under this
28 Agreement for the period of July 1, 2025, through June 30, 2026 for Specialty Mental Health
1 Services is Five Million Three-Hundred Thousand Dollars and zero Cents ($5,300,000.00),
2 which is not a guaranteed sum but shall be paid only for services rendered and received. The
3 maximum compensation payable to the Contractor under this Agreement for the period of July
4 1, 2026, through June 30, 2027 for Specialty Mental Health Services is Five Million
5 Four-Hundred Thousand Dollars and zero Cents ($5,400,000.00), which is not a guaranteed
6 sum but shall be paid only for services rendered and received.
7 4.3 Behavioral Health Bridge Grant Maximum Compensation. The maximum
8 compensation payable to the Contractor under this Agreement for the period of July 1, 2023,
9 through June 30, 2024, from the Behavioral Health Bridge Grant is Eight Million Seven Hundred
10 Ninety-Two Thousand One Hundred Five Dollars and zero Cents ($8,792,105.00) The
11 maximum compensation payable to the Contractor under this Agreement for the period of July
12 1, 2024, through June 30, 2025 from the Behavioral Health Bridge Grant is Three Million Nine
13 Hundred Ten Thousand One Hundred Forty Dollars and zero Cents ($3,910,140.00). The
14 maximum compensation payable to the Contractor under this Agreement for the period of July
15 1, 2025, through June 30, 2026, from the Behavioral Health Bridge Grant is Three Million
16 Seven Hundred Sixty-Seven Thousand One Hundred Ninety Dollars and zero Cents
17 ($3,767,190.00). The maximum compensation payable to the Contractor under this Agreement
18 for the period of July 1, 2026, through June 30, 2027, from the Behavioral Health Bridge Grant
19 is Three Million Nine Hundred Twenty-Eight Thousand Nine Hundred Thirty-Five Dollars and
20 zero Cents ($3,928,935.00).
21 4.4 Total Maximum Compensation. In no event shall the maximum contract amount
22 for all the services provided by the Contractor to County under the terms and conditions of this
23 Agreement be in excess of Thirty-Nine Million, Four Hundred Ninety-Eight Thousand, Three
24 Hundred Seventy and zero Cents ($39,498,370.00) the entire term of this Agreement.
25 The Contractor acknowledges that the County is a local government entity and does
26 so with notice that the County's powers are limited by the California Constitution and by State
27 law, and with notice that the Contractor may receive compensation under this Agreement only
28 for services performed according to the terms of this Agreement and while this Agreement is in
1 effect, and subject to the maximum amount payable under this section. The Contractor further
2 acknowledges that County employees have no authority to pay the Contractor except as
3 expressly provided in this Agreement.
4 The Contractor will be compensated for performance of its services under this
5 Agreement as provided in this Article. The Contractor is not entitled to any compensation
6 except as expressly provided in this Agreement.
7 4.5 Rate Categories. The program service components for the Contractor(s) shall be
8 categorized under one or more of the following rate categories and as indicated on Exhibit F1
9 and Exhibit F2:
10 (A) Clinic-Site Based: Clinic-Site Based programs shall be defined as programs who
11 provide less than fifty percent (50%) of services in the field. In the field services are
12 those services that do not occur through telehealth and do not occur in designated sites
13 in which the Contractor is afforded regular access. Designated sites shall be identified
14 by the Contractor and approved by County's DBH Director or designee in writing.
15 (B) Field Based: Field based programs shall be defined as programs that provide
16 more than fifty percent (50%) of services in the field.
17 (C) Full-Service Partnership/Assisted Outpatient Therapy/Therapeutic Behavioral
18 Health Services (FSP/AOT/TBS): FSP/AOT/TBS programs shall provide services in
19 accordance with level of care standards and general requirements as described in the
20 Scope of Work/Services, if applicable.
21 DBH shall continuously monitor the programs and analyze data to review accuracy
22 of rate categories assigned and may only reassign rate categories with the written agreement of
23 both parties pursuant to Article 25.
24 4.6 Specialty Mental Health Services Claiming. Contractor shall enter claims data into
25 the County's billing and transactional database system by the fifteenth (15t") of every month for
26 actual services rendered in the previous month. Contractor shall use Current Procedural
27 Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, as
28 provided in the DHCS Billing Manual available at
1 https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx, as from time to time
2 amended.
3 Claims shall be complete and materially accurate and must include all required
4 information regarding the claimed services. Claims data entry into the County's electronic
5 health record system shall be the responsibility of Contractor. County shall monitor the volume
6 of services, billing amounts and service types entered into County's electronic health
7 record/information system. Any and all audit exceptions resulting from the provision and
8 reporting of specialty mental health services by Contractor shall be the sole responsibility of
9 Contractor. Contractor will comply with all applicable policies, procedures, directives, and
10 guidelines regarding the use of County's electronic health record/information system.
11 Contractor must provide all necessary data to allow County to bill Medi-Cal, and any
12 other third-party source, for services and meet State and Federal reporting requirements. The
13 necessary data can be provided by a variety of means, including but not limited to: 1) direct
14 data entry into County's electronic health record/information system; 2) providing an electronic
15 file compatible with County's electronic health record/information system; or 3) integration
16 between County's electronic health record/information system and Contractor's information
17 system(s). Contractor shall maximize the Federal Financial Participation (FFP) reimbursement
18 by claiming all possible Medi-Cal services and correcting denied services for resubmission as
19 needed.
20 4.7 Applicable Fees. Contractor shall not charge any persons served or third-party
21 payers any fee for service unless directed to do so by the County's DBH Director or designee at
22 the time the individual is referred for services. When directed to charge for services, Contractor
23 shall use the uniform billing and collection guidelines prescribed by DHCS.
24 Contractor will perform eligibility and financial determinations, in accordance with
25 DHCS' Uniform Method of Determining Ability to Pay (UMDAP), for all individuals unless
26 directed otherwise by the County's DBH Director or designee.
27 Contractor shall not submit a claim to, or demand or otherwise collect
28 reimbursement from, the person served or persons acting on behalf of the person served for
1 any specialty mental health or related administrative services provided under this Contract,
2 except to collect other health insurance coverage, share of cost, and co-payments (Cal. Code
3 Regs., tit. 9, §1810.365(c).
4 The Contractor must not bill persons served, for covered services, any amount
5 greater than would be owed if the County provided the services directly as per and otherwise
6 not bill persons served as set forth in 42 C.F.R. § 438.106.
7 If a person served has dual coverage, such as other health coverage (OHC) or
8 Federal Medicare, Contractor will be responsible for billing the carrier and obtaining a
9 payment/denial or have validation of claiming with no response for ninety (90) days after the
10 claim was mailed before the service can be entered into the County's electronic health
11 record/information system. Contractor must report all third-party collections for Medicare,
12 third-party or client-pay or private-pay in each month. A copy of explanation of benefits or CMS
13 1500 form is required as documentation. Contractor must comply with all laws and regulations
14 governing the Federal Medicare program, including, but not limited to: 1) the requirement of the
15 Medicare Act, 42 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by
16 the Federal Centers for Medicare and Medicaid Services as they relate to participation,
17 coverage and claiming reimbursement. Contractor will be responsible for compliance as of the
18 effective date of each Federal, State or local law or regulation specified.
19 4.8 Invoices. The Contractor shall submit monthly invoices, in arrears by the fifteenth
20 (15t") day of each month, in the format directed by the County. The Contractor shall submit
21 invoices electronically to: 1)dbhinvoicereview@fresnocountyca.gov, 2)
22 dbh-invoices@fresnocountyca.gov; and 3)dbhcontractedservicesdivision@fresnocountyca.gov
23 with a copy to the assigned County's DBH Staff Analyst. At the discretion of County's DBH
24 Director or designee, if an invoice is incorrect or is otherwise not in proper form or substance,
25 County's DBH Director, or designee, shall have the right to withhold payment as to only the
26 portion of the invoice that is incorrect or improper after five (5) days prior notice to Contractor.
27 Contractor agrees to continue to provide services for a period of ninety (90) days after
28 notification of an incorrect or improper invoice. If after the ninety (90) day period, the invoice is
1 still not corrected to County satisfaction, County's DBH Director, or designee, may elect to
2 terminate this Agreement, pursuant to the termination provisions stated in Article 7 of this
3 Agreement.
4 Specialty Mental Health Services Claimable Services. For claimable services,
5 invoices shall be based on claims entered into the County's billing and transactional database
6 system for the prior month.
7 Monthly payments for claimed services shall only be based on the units of time
8 assigned to each CPT or HCPCS code entered in the County's billing and transactional
9 database multiplied by the practitioner service rates in Exhibit F1 and Exhibit F2.
10 County's payments to Contractor for performance of claimed services are provisional
11 and subject to adjustment until the completion of all settlement activities. County's adjustments
12 to provisional payments for claimed services shall be based on the terms, conditions, and
13 limitations of this Agreement or the reasons for recoupment set forth in Article 4 and 13.
14 Any claimable services submitted beyond six (6) months from the month of service
15 may be ineligible for payment.
16 Cost Reimbursement Based Invoices. Invoices for cost reimbursement services
17 shall be based on actual expenses incurred in the month of service. Contractor shall submit
18 monthly invoices and general ledgers to County that itemize the line-item charges for monthly
19 program costs are in accordance with its budgeted cost as defined in Exhibit F1and F2. The
20 invoices and general ledgers will serve as tracking tools to determine if Contractor's costs are in
21 accordance with its budgeted cost. Failure to submit reports and other supporting
22 documentation shall be deemed sufficient cause for County to withhold payments until there is
23 compliance.
24 Contractor must report all revenue collected from a third-party, client-pay or
25 private-pay in each monthly invoice. In addition, Contractor shall submit monthly invoices for
26 reimbursement that equal the amount due less any revenue collected and/or unallowable cost
27 such as lobbying or political donations from the monthly invoice reimbursements.
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1 Travel shall be reimbursed based on actual expenditures and reimbursement shall
2 be at Contractor's adopted rate, not to exceed the Federal Internal Revenue Services (IRS)
3 published rate.
4 Corrective Action Plans. Contractors shall enter services into the County's billing
5 and transactional database and submit invoices in accordance with the deadlines listed above
6 and information shall be materially accurate. Failure to meet the requirements set forth above
7 will result in a corrective action plan at the discretion of the County's DBH Director, or designee,
8 and may result in financial penalties or termination of agreement per Article 7.
9 4.9 Payment. Payments shall be made by County to Contractor in arrears, for services
10 provided during the preceding month, within forty-five (45) days after the date of receipt,
11 verification, and approval by County. All final invoices and/or any final budget modification
12 requests shall be submitted by Contractor within sixty (60) days following the final month of
13 service for which payment is claimed. No action shall be taken by County on claims submitted
14 beyond the sixty (60) day closeout period. Any compensation which is not expended by
15 Contractor pursuant to the terms and conditions of this Agreement shall automatically revert to
16 County.
17 4.10 Specialty Mental Health Services Payments. Payment shall be made upon
18 certification and other proof satisfactory to County that services have actually been performed
19 by Contractor as specified in this Agreement and/or after receipt and verification of actual
20 services provided.
21 4.11 Cost Reimbursement Payments. Payment shall be made upon certification or
22 other proof satisfactory to County that services have actually been performed by Contractor as
23 specified in this Agreement and/or after receipt and verification of actual expenditures incurred
24 by Contractor for monthly program costs, as identified in the budget narratives and budgets
25 identified in Exhibit E, in the performance of this Agreement. County shall not be obligated to
26 make any payments under this Agreement if the request for payment is received by County
27 more than sixty (60) days after this Agreement has terminated or expired.
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1 4.12 Recoupments and Audits. County shall recapture from Contractor the value of any
2 services or other expenditures determined to be ineligible based on the County or State
3 monitoring results. The County reserves the right to enter into a repayment agreement with
4 Contractor, with total monthly payments not to exceed twelve (12) months from the date of the
5 repayment agreement, to recover the amount of funds to be recouped. The County has the
6 discretion to extend the repayment plan up to a total of twenty-four (24) months from the date of
7 the repayment agreement. The repayment agreement may be made with the signed written
8 approval of County's DBH Director, or designee, and respective Contractor through a
9 repayment agreement. The monthly repayment amounts may be netted against the
10 Contractor's monthly billing for services rendered during the month, or the County may, in its
11 sole discretion, forego a repayment agreement and recoup all funds immediately. This remedy
12 is not exclusive, and County may seek requital from any other means, including, but not limited
13 to, a separate contract or agreement with Contractor.
14 Contractor shall be held financially liable for any and all future disallowances/audit
15 exceptions due to Contractor's deficiency discovered through the State audit process and
16 County utilization review for services provided during the course of this Agreement. At County's
17 election, the disallowed amount will be remitted within forty-five (45) days to County upon
18 notification or shall be withheld from subsequent payments to Contractor. Contractor shall not
19 receive reimbursement for any units of services rendered that are disallowed or denied by the
20 Fresno County Mental Health Plan (Mental Health Plan) utilization review process or through
21 the State of California DHCS audit and review process, cost report audit settlement if
22 applicable, for Medi-Cal eligible beneficiaries.
23 4.13 Incidental Expenses. The Contractor is solely responsible for all of its costs and
24 expenses that are not specified as payable by the County under this Agreement. If Contractor
25 fails to comply with any provision of this Agreement, County shall be relieved of its obligation for
26 further compensation.
27 4.14 Restrictions and Limitations. This Agreement shall be subject to any restrictions,
28 limitations, and/or conditions imposed by County or state or federal funding sources that may in
1 any way affect the fiscal provisions of, or funding for this Agreement. This Agreement is also
2 contingent upon sufficient funds being made available by County, state, or federal funding
3 sources for the term of the Agreement. If the federal or state governments reduce financial
4 participation in the Medi-Cal program, County agrees to meet with Contractor to discuss
5 renegotiating the services required by this Agreement. In the event this Agreement is
6 terminated, Contractor shall be entitled to compensation for all services satisfactorily provided
7 pursuant to the terms and conditions of this Agreement through and including the effective date
8 of termination.
9 Funding is provided by fiscal year. Any unspent fiscal year appropriation does not
10 roll over and is not available for services provided in subsequent years.
11 In the event that funding for these services is delayed by the State Controller,
12 County may defer payments to Contractor. The amount of the deferred payment shall not
13 exceed the amount of funding delayed by the State Controller to the County. The period of time
14 of the deferral by County shall not exceed the period of time of the State Controller's delay of
15 payment to County plus forty-five (45) days.
16 4.15 Additional Financial Requirements. County has the right to monitor the
17 performance of this Agreement to ensure the accuracy of claims for reimbursement and
18 compliance with all applicable laws and regulations.
19 Contractor must comply with the False Claims Act employee training and policy
20 requirements set forth in 42 U.S.C. 1396a(a)(68) and as the Secretary of the United States
21 Department of Health and Human Services may specify.
22 Contractor agrees that no part of any federal funds provided under this Agreement
23 shall be used to pay the salary of an individual per fiscal year at a rate in excess of Level 1 of
24 the Executive Schedule at https://www.opm.gov/ (U.S. Office of Personnel Management), as
25 from time to time amended.
26 Federal Financial Participation is not available for any amount furnished to an
27 Excluded individual or entity, or at the direction of a physician during the period of exclusion
28 when the person providing the service knew or had reason to know of the exclusion, or to an
1 individual or entity when the County failed to suspend payments during an investigation of a
2 credible allegation of fraud [42 U.S.C. section 1396b(i)(2)].
3 Contractor must maintain financial records for a minimum period of ten (10) years or
4 until any dispute, audit or inspection is resolved, whichever is later. Contractor will be
5 responsible for any disallowances related to inadequate documentation.
6 4.16 Contractor Prohibited from Redirection of Contracted Funds. Contractor may
7 not redirect or transfer funds from one funded program to another funded program under which
8 Contractor provides services pursuant to this Agreement except through a duly executed
9 amendment to this Agreement.
10 Contractor may not charge services delivered to an eligible person served under one
11 funded program to another funded program unless the person served is also eligible for
12 services under the second funded program.
13 4.17 Financial Audit Report Requirements for Pass-Through Entities. If County
14 determines that Contractor is a "subrecipient" (also known as a "pass-through entity") as
15 defined in 2 C.F.R. § 200 et seq., Contractor represents that it will comply with the applicable
16 cost principles and administrative requirements including claims for payment or reimbursement
17 by County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time to time.
18 Contractor shall observe and comply with all applicable financial audit report requirements and
19 standards.
20 Financial audit reports must contain a separate schedule that identifies all funds
21 included in the audit that are received from or passed through the County. County programs
22 must be identified by Agreement number, Agreement amount, Agreement period, and the
23 amount expended during the fiscal year by funding source.
24 Contractor will provide a financial audit report including all attachments to the report
25 and the management letter and corresponding response within six months of the end of the
26 audit year to the County's DBH Director or designee. The County's Director or designee is
27 responsible for providing the audit report to the County Auditor.
28
1 Contractor must submit any required corrective action plan to the County
2 simultaneously with the audit report or as soon thereafter as it is available. The County shall
3 monitor implementation of the corrective action plan as it pertains to services provided pursuant
4 to this Agreement.
5 Article 5
6 Term of Agreement
7 5.1 Term. This Agreement is effective on July 1, 2023, and terminates on June 30, 2027
8 Article 6
9 Notices
10 6.1 Contact Information. The persons and their addresses having authority to give and
11 receive notices provided for or permitted under this Agreement include the following:
12
For the County:
13 Director
14 County of Fresno
1925 E. Dakota Avenue Fresno,
15 CA 93726
16 For the Contractor: Katie Wilbur
RH Community Builders, LP
17 3040 N. Fresno Street Fresno,
CA 93705
18
19 6.2 Change of Contact Information. Either party may change the information in section
20 6.1 by giving notice as provided in section 6.3.
21 6.3 Method of Delivery. Each notice between the County and the Contractor provided
22 for or permitted under this Agreement must be in writing, state that it is a notice provided under
23 this Agreement, and be delivered either by personal service, by first-class United States mail,
24 by an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
25 Document Format (PDF) document attached to an email.
26 (A) A notice delivered by personal service is effective upon service to the recipient.
27
28
1 (B) A notice delivered by first-class United States mail is effective three (3) County
2 business days after deposit in the United States mail, postage prepaid, addressed to the
3 recipient.
4 (C)A notice delivered by an overnight commercial courier service is effective one (1)
5 County business day after deposit with the overnight commercial courier service,
6 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
7 the recipient.
8 6.4 Claims Presentation. For all claims arising from or related to this Agreement,
9 nothing in this Agreement establishes, waives, or modifies any claims presentation
10 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
11 of Title 1 of the Government Code, beginning with section 810).
12 6.5 Notification of Changes. Contractor shall notify County in writing of any change in
13 organizational name, Head of Service or principal business at least fifteen (15) business days in
14 advance of the change. Contractor shall notify County of a change of service location at least
15 six (6) months in advance to allow County sufficient time to comply with site certification
16 requirements. Said notice shall become part of this Agreement upon acknowledgment in writing
17 by the County, and no further amendment of the Agreement shall be necessary provided that
18 such change of address does not conflict with any other provisions of this Agreement.
19 Contractor must immediately notify County of a change in ownership, organizational
20 status, licensure, or ability of Contractor to provide the quantity or quality of the contracted
21 services in this Agreement and in no event more than 15 days of the change.
22 Article 7
23 Termination and Suspension
24 7.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
25 contingent on the approval of funds by the appropriating government agency. If sufficient funds
26 are not allocated, then the County, upon at least thirty (30) days' advance written notice to the
27 Contractor, may:
28 (A) Modify the services provided by the Contractor under this Agreement; or
1 (B) Terminate this Agreement.
2 7.2 Termination for Breach.
3 (A) Upon determining that a breach (as defined in paragraph (C) below) has
4 occurred, the County may give written notice of the breach to the Contractor. The written
5 notice may suspend performance under this Agreement and must provide at least thirty
6 (30) days for the Contractor to cure the breach.
7 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
8 time stated in the written notice, the County may terminate this Agreement immediately.
9 (C) For purposes of this section, a breach occurs when, in the determination of the
10 County, the Contractor has:
11 (1) Obtained or used funds illegally or improperly;
12 (2) Failed to comply with any part of this Agreement;
13 (3) Submitted a substantially incorrect or incomplete report to
14 the County; or
15 (4) Improperly performed any of its obligations under this Agreement.
16 7.3 Termination without Cause. In circumstances other than those set forth above, the
17 County may terminate this Agreement by giving at least thirty (30) days advance written notice
18 to the Contractor.
19 7.4 No Penalty or Further Obligation. Any termination of this Agreement by the
20 County under this Article 7 is without penalty to or further obligation of the County.
21 7.5 County's Rights upon Termination. Upon termination for breach under this Article
22 7, the County may demand repayment by the Contractor of any monies disbursed to the
23 Contractor under this Agreement that, in the County's sole judgment, were not expended in
24 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
25 demand. This section survives the termination of this Agreement.
26 In the event this Agreement is terminated, Contractor shall be entitled to
27 compensation for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant
28 to the terms and conditions of this Agreement through and including the effective date of
1 termination. This provision shall not limit or reduce any damages owed to the County due to a
2 breach of this Agreement by Contractor.
3 Article 8
4 Informing Materials for Persons Served
5 8.1 Basic Information Requirements. Contractor shall-provide information in a manner
6 and format that is easily understood and readily accessible to the persons served (42 C.F.R. §
7 438.10(c)(1)). Contractor shall provide all written materials for persons served in easily
8 understood language, format, and alternative formats that take into consideration the special
9 needs of individuals in compliance with 42 C.F.R. § 438.10(d)(6). Contractor shall inform the
10 persons served that information is available in alternate formats and how to access those
11 formats in compliance with 42 C.F.R. § 438.10.
12 Contractor shall provide the required information in this section to each individual
13 receiving SMHS under this Agreement and upon request (1915(b) Medi-Cal Specialty Mental
14 Health Services Waiver, § (2), subd. (d), at p. 26., attachments 3, 4; Cal. Code Regs., tit. 9, §
15 1810.360(e)).
16 Contractor shall utilize the County's website that provides the content required in this
17 section and 42 C.F.R. § 438.10 and complies with all requirements regarding the same set forth
18 in 42 C.F.R. § 438.10.
19 Contractor shall use the DHCS/County-developed beneficiary handbook and
20 persons served notices.(42 C.F.R. §§ 438.10(c)(4)(ii), 438.62(b)(3)).
21 8.2 Electronic Submission. Persons served information required in this section may
22 only be provided electronically by the Contractor if all of the following conditions are met:
23 (A) The format is readily accessible;
24 (B) The information is placed in a location on the Contractor's website that is
25 prominent and readily accessible;
26 (C)The information is provided in an electronic form which can be electronically
27 retained and printed;
28
1 (D)The information is consistent with the content and language requirements of this
2 Agreement;
3 (E) The individual is informed that the information is available in paper form without
4 charge upon request and the Contractor shall provide it upon request within five (5)
5 business days (42 C.F.R. § 438.10(c)(6)).
6 8.3 Language and Format. Contractor shall provide all written materials, including
7 taglines, for persons served or potential persons served in a font size no smaller than twelve
8 (12) point (42 C.F.R. 438.10(d)(6)(ii)).
9 Contractor shall ensure its written materials that are critical to obtaining services are
10 available in alternative formats, upon request of the person served or potential person served at
11 no cost.
12 Contractor shall make its written materials that are critical to obtaining services,
13 including, at a minimum, provider directories, beneficiary handbook, appeal and grievance
14 notices, denial and termination notices, and the Contractor's mental health education materials,
15 available in the prevalent non-English languages in the County (42 C.F.R. § 438.10(d)(3)).
16 (A) Contractor shall notify persons served, prospective persons served, and
17 members of the public that written translation is available in prevalent languages free of
18 cost and how to access those materials (42 C.F.R. § 438.10(d)(5)(i), (iii); Welfare & Inst.
19 Code § 14727(a)(1); Cal. Code Regs. tit. 9 § 1810.410, subd. (e), para. (4)).
20 Contractor shall make auxiliary aids and services available upon request and free of
21 charge to each person served (42 C.F.R. § 438.10(d)(3)-(4)).
22 Contractor shall make oral interpretation and auxiliary aids, such as Teletypewriter
23 Telephone/Text Telephone (TTY/TDY) and American Sign Language (ASL), available and free
24 of charge for any language in compliance with 42 C.F.R. § 438.10(d)(2), (4)-(5).
25 Taglines for written materials critical to obtaining services must be printed in a
26 conspicuously visible font size, no smaller than twelve (12) point font.
27
28
1 8.4 Beneficiary Informing Materials. Each person served must receive and have
2 access to the beneficiary informing materials upon request by the individual and when first
3 receiving SMHS from Contractor. Beneficiary informing materials include but are not limited to:
4 (A) Consumer Handbook
5 (B) Provider Directory
6 (C) Grievance form
7 (D)Appeal/Expedited Appeal form
8 (E) Advance Directives brochure
9 (F) Change of Provider form
10 (G)Suggestions brochure
11 (H) Notice of Privacy Practices
12 (1) Notices of Adverse Benefit Determination (NOABDs— Including Denial and
13 Termination notices)
14 (J) Early & Periodic Screening, Diagnostic and Treatment (EPSDT) poster (if
15 serving individuals under the age of 21)
16 (K) Contractor shall ensure beneficiary informing material are displayed in the
17 threshold languages of Fresno County at all service sites, including but not limited to the
18 following:
19 (1) Consumer Handbook
20 (2) Provider Directory
21 (3) Grievance form
22 (4) Appeal/Expedited Appeal form
23 (5) Advance Directives brochure
24 (6) Change of Provider form
25 (7) Suggestions brochure
26 All beneficiary informing written materials will use easily understood language and
27 format (i.e. material written and formatted at a 6th grade reading level), and will use a font size
28 no smaller than 12 point. All beneficiary informing written materials shall inform beneficiaries of
1 the availability of information in alternative formats and how to make a request for an alternative
2 format. Inventory and maintenance of all beneficiary informing materials will be maintained by
3 the County's DBH Managed Care Division. Contractor will ensure that its written materials
4 include taglines or that an additional taglines document is available.
5 8.5 Beneficiary Handbook. Contractor shall provide each persons served with a
6 beneficiary handbook at the time the individual first accesses services and thereafter upon
7 request. The beneficiary handbook shall be provided to beneficiaries within fourteen (14)
8 business days after receiving notice of enrollment.
9 Contractor shall give each individual notice of any significant change to the
10 information contained in the beneficiary handbook at least thirty (30) days before the intended
11 effective date of change as per BHIN 22-060.
12 8.6 Accessibility. Required informing materials must be electronically available on
13 Contractor's website and must be physically available at the Contractor's facility lobby for
14 individuals' access.
15 Informing materials must be made available upon request, at no cost, in alternate
16 formats (i.e., Braille or audio) and auxiliary aids (i.e., California Relay Service (CRS) 711 and
17 American Sign Language) and must be provided to persons served within five (5) business
18 days. Large print materials shall be in a minimum of eighteen (18) point font size.
19 Informing materials will be considered provided to the individual if Contractor does
20 one or more of the following:
21 (A) Mails a printed copy of the information to the persons served's mailing address
22 before the individual receives their first specialty mental health service;
23 (B) Mails a printed copy of the information upon the individual's request to their
24 mailing address;
25 (C) Provides the information by email after obtaining the persons served's
26 agreement to receive the information by email;
27 (D) Posts the information on the Contractor's website and advises the person served
28 in paper or electronic form that the information is available on the internet and includes
1 applicable internet addresses, provided that individuals with disabilities who cannot
2 access this information online are provided auxiliary aids and services upon request and
3 at no cost; or,
4 (E) Provides the information by any other method that can reasonably be expected
5 to result in the person served receiving that information. If Contractor provides informing
6 materials in person, when the individual first receives specialty mental health services,
7 the date and method of delivery shall be documented in the persons served's file.
8 8.7 Provider Directory. Contractor must follow the County's provider directory policy, in
9 compliance with MHSUDS IN 18-020.
10 Contractor must make available to persons served, in paper form upon request and
11 electronic form, specified information about the County provider network as per 42 C.F.R. §
12 438.10(h). The most current provider directory is electronically available on the County website
13 and is updated by the County no later than thirty (30) calendar days after information is
14 received to update provider information. A paper provider directory must be updated at least
15 monthly as set forth in 42 C.F.R. § 438.10(h)(3)(i).
16 Any changes to information published in the provider directory must be reported to
17 the County within two (2) weeks of the change.
18 Contractor will only need to report changes/updates to the provider directory for
19 licensed, waivered, or registered mental health providers.
20 Article 9
21 Independent Contractor
22 9.1 Status. In performing under this Agreement, the Contractor, including its officers,
23 agents, employees, and volunteers, is at all times acting and performing as an independent
24 contractor, in an independent capacity, and not as an officer, agent, servant, employee, joint
25 venturer, partner, or associate of the County.
26 9.2 Verifying Performance. The County has no right to control, supervise, or direct the
27 manner or method of the Contractor's performance under this Agreement, but the County may
28 verify that the Contractor is performing according to the terms of this Agreement.
1 9.3 Benefits. Because of its status as an independent contractor, the Contractor has no
2 right to employment rights or benefits available to County employees. The Contractor is solely
3 responsible for providing to its own employees all employee benefits required by law. The
4 Contractor shall save the County harmless from all matters relating to the payment of
5 Contractor's employees, including compliance with Social Security withholding and all related
6 regulations.
7 9.4 Services to Others. The parties acknowledge that, during the term of this
8 Agreement, the Contractor may provide services to others unrelated to the County.
9 9.5 Operating Costs. Contractor shall provide all personnel, supplies, and operating
10 expenses of any kind required.
11 9.6 Additional Responsibilities. The parties acknowledge that, during the term of this
12 Agreement, the Contractor will be performing hiring, training, and credentialing of staff, and
13 County will be performing additional staff credentialing to ensure compliance with State and
14 Federal regulations.
15 9.7 Subcontracts. Contractor shall obtain written approval from County's Department of
16 Behavioral Health Director, or designee before subcontracting any of the services delivered
17 under this Agreement. County's Department of Behavioral Health Director, or designee retains
18 the right to approve or reject any request for subcontracting services. Any transferee, assignee,
19 or subcontractor will be subject to all applicable provisions of this Agreement, and all applicable
20 State and Federal regulations. Contractor shall be held primarily responsible by County for the
21 performance of any transferee, assignee, or subcontractor unless otherwise expressly agreed
22 to in writing by County's Department of Behavioral Health Director, or designee. The use of
23 subcontractors by Contractor shall not entitle Contractor to any additional compensation that is
24 provided for under this Agreement.
25 Contractor shall remain legally responsible for the performance of all terms and
26 conditions of this Agreement, including, without limitation, all SMHS provided by third parties
27 under subcontracts, whether approved by the County or not.
28
1 Article 10
2 Indemnity and Defense
3 10.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
4 County (including its officers, agents, employees, and volunteers) against all claims, demands,
5 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
6 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
7 the performance or failure to perform by the Contractor (or any of its officers, agents,
8 subcontractors, or employees) under this Agreement. The County may conduct or participate in
9 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
10 defend the County.
11 10.2 Survival. This Article 10 survives the termination of this Agreement.
12 Article 11
13 Insurance
14 11.1 The Contractor shall comply with all the insurance requirements in Exhibit G to this
15 Agreement.
16 Article 12
17 Assurances
18 12.1 Certification of Non-exclusion or Suspension from Participation in a Federal
19 Health Care Program.
20 (A) In entering into this Agreement, Contractor certifies that it is not excluded from
21 participation in Federal Health Care Programs under either Section 1128 or 1128A of
22 the Social Security Act. Failure to so certify will render all provisions of this Agreement
23 null and void and may result in the immediate termination of this Agreement.
24 (B) In entering into this Agreement, Contractor certifies, that the Contractor does not
25 employ or subcontract with providers or have other relationships with providers excluded
26 from participation in Federal Health Care Programs, including Medi-Cal/Medicaid or
27 procurement activities, as set forth in 42 C.F.R. §438.610. Contractor shall conduct
28 initial and monthly exclusion and suspension searches of the following databases and
1 provide evidence of these completed searches when requested by County, DHCS or the
2 US Department of Health and Human Services (DHHS):
3 (1) www.oig.hhs.gov/exclusions - Office of Inspector General's List of Excluded
4 Individuals/Entities (LEIE) Federal Exclusions
5 (2) www.sam.gov/content/exclusions - General Service Administration (GSA)
6 Exclusions Extractwww.Medi-Cal.ca.gov- Suspended & Ineligible Provider List
7 (3) https://nppes.cros.hhs.gov/#/ - National Plan and Provider Enumeration
8 System (NPPES)
9 (4) any other database required by DHCS or US DHHS.
10 (C) In entering into this Agreement, Contractor certifies, that Contractor does not
11 employ staff or individual contractors/vendors that are on the Social Security
12 Administration's Death Master File. Contractor shall check the database prior to
13 employing staff or individual contractors/vendors and provide evidence of these
14 completed searches when requested by the County, DHCS or the US DHHS.
15 (D) Contractor is required to notify County immediately if Contractor becomes aware
16 of any information that may indicate their (including employees/staff and individual
17 contractors/vendors) potential placement on an exclusions list.
18 (E) Contractor shall screen and periodically revalidate all network providers in
19 accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E.
20 (F) Contractor must confirm the identity and determine the exclusion status of all its
21 providers, as well as any person with an ownership or control interest, or who is an
22 agent or managing employee of the contracted agency through routine checks of
23 federal and state databases. This includes the Social Security Administration's Death
24 Master File, NPPES, the Office of Inspector General's LEIE, the Medi-Cal Suspended
25 and Ineligible Provider List (S&I List) as consistent with the requirements of 42 C.F.R. §
26 455.436.
27 (G)If Contractor finds a provider that is excluded, it must promptly notify the County
28 as per 42 C.F.R. § 438.608(a)(2), (4). The Contractor shall not certify or pay any
1 Excluded provider with Medi-Cal funds, must treat any payments made to an excluded
2 provider as an overpayment, and any such inappropriate payments may be subject to
3 recovery.
4 Article 13
5 Inspections, Audits, and Public Records
6 13.1 Inspection of Documents. The Contractor shall make available to the County, and
7 the County may examine at any time during business hours and as often as the County deems
8 necessary, all of the Contractor's records and data with respect to the matters covered by this
9 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
10 request by the County, permit the County to audit and inspect all of such records and data to
11 ensure the Contractor's compliance with the terms of this Agreement.
12 13.2 State Audit Requirements. If the compensation to be paid by the County under this
13 Agreement exceeds $10,000, the Contractor is subject to the examination and audit of the
14 California State Auditor, as provided in Government Code section 8546.7, for a period of three
15 years after final payment under this Agreement. This section survives the termination of this
16 Agreement.
17 13.3 Internal Auditing. Contractors of sufficient size as determined by County shall
18 institute and conduct a Quality Assurance Process for all services provided hereunder. Said
19 process shall include at a minimum a system for verifying that all services provided and claimed
20 for reimbursement shall meet SMHS definitions and be documented accurately.
21 In addition, Contractors with medication prescribing authority shall adhere to County's
22 medication monitoring review practices. Contractor shall provide County with notification and a
23 summary of any internal audit exceptions and the specific corrective actions taken to sufficiently
24 reduce the errors that are discovered through Contractor's internal audit process. Contractor
25 shall provide this notification and summary to County as requested by the County.
26 13.4 Confidentiality in Audit Process. Contractor and County mutually agree to
27 maintain the confidentiality of Contractor's records and information of persons served, in
28 compliance with all applicable State and Federal statutes and regulations, including but not
1 limited to HIPAA and California Welfare and Institutions Code, Section 5328. Contractor shall
2 inform all of its officers, employees, and agents of the confidentiality provisions of all applicable
3 statutes.
4 Contractor's fiscal records shall contain sufficient data to enable auditors to perform
5 a complete audit and shall be maintained in conformance with standard procedures and
6 accounting principles.
7 Contractor's records shall be maintained as required by DBH and DHCS on forms
8 furnished by DHCS or the County. All statistical data or information requested by the County's
9 DBH Director or designee shall be provided by the Contractor in a complete and timely manner.
10 13.5 Reasons for Recoupment. County will conduct periodic audits of Contractor files to
11 ensure appropriate clinical documentation, high quality service provision and compliance with
12 applicable federal, state and county regulations.
13 Such audits may result in requirements for Contractor to reimburse County for
14 services previously paid in the following circumstances:
15 (A) Identification of Fraud, Waste or Abuse as defined in federal regulation
16 (1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code,
17 section 14107.11, subdivision (d).
18 (2) Definitions for"fraud," "waste," and "abuse" can also be found in the
19 Medicare Managed Care Manual available at
20 https://www.cros.gov/Regulations-and-Guidance/Guidance/Manuals
21 (B) Overpayment of Contractor by County due to errors in claiming or
22 documentation.
23 (C) Other reasons specified in the SMHS Reasons for Recoupment document
24 released annually by DHCS and posted on the DHCS BHIN website.
25 Contractor shall reimburse County for all overpayments identified by Contractor,
26 County, and/or state or federal oversight agencies as an audit exception within the timeframes
27 required by law or Country or state or federal agency. Funds owed to County will be due within
28 forty-five (45) days of notification by County, or County shall withhold future payments until all
1 excess funds have been recouped by means of an offset against any payments then or
2 thereafter owing to County under this or any other Agreement between the County and
3 Contractor.
4 13.6 Cooperation with Audits. Contractor shall cooperate with County in any review
5 and/or audit initiated by County, DHCS, or any other applicable regulatory body. This
6 cooperation may include such activities as onsite program, fiscal, or chart reviews and/or
7 audits.
8 In addition, Contractor shall comply with all requests for any documentation or files
9 including, but not limited to, files for persons served.
10 Contractor shall notify the County of any scheduled or unscheduled external
11 evaluation or site visits when it becomes aware of such visit. County shall reserve the right to
12 attend any or all parts of external review processes.
13 Contractor shall allow inspection, evaluation and audit of its records, documents and
14 facilities for ten (10) years from the term end date of this Agreement or in the event Contractor
15 has been notified that an audit or investigation of this Agreement has been commenced, until
16 such time as the matter under audit or investigation has been resolved, including the
17 exhaustion of all legal remedies, whichever is later pursuant to 42 C.F.R.§§ 438.3(h) and
18 438.230I(3)(i-iii).
19 13.7 Single Audit Clause. If Contractor expends Seven Hundred Fifty Thousand and
20 No/100 Dollars ($750,000.00) or more in Federal and Federal flow-through monies, Contractor
21 agrees to conduct an annual audit in accordance with the requirements of the Single Audit
22 Standards as set forth in Office of Management and Budget (OMB) 2 CFR 200. Contractor shall
23 submit said audit and management letter to County. The audit must include a statement of
24 findings or a statement that there were no findings. If there were negative findings, Contractor
25 must include a corrective action plan signed by an authorized individual. Contractor agrees to
26 take action to correct any material non-compliance or weakness found as a result of such audit.
27 Such audit shall be delivered to County's DBH Finance Division for review within nine (9)
28 months of the end of any fiscal year in which funds were expended and/or received for the
1 program. Failure to perform the requisite audit functions as required by this Agreement may
2 result in County performing the necessary audit tasks, or at County's option, contracting with a
3 public accountant to perform said audit, or may result in the inability of County to enter into
4 future agreements with Contractor. All audit costs related to this Agreement are the sole
5 responsibility of Contractor.
6 A single audit report is not applicable if Contractor's Federal contracts do not exceed
7 the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
8 Contractor's only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a
9 program audit must be performed and a program audit report with management letter shall be
10 submitted by Contractor to County as a minimum requirement to attest to Contractor solvency.
11 Said audit report shall be delivered to County's DBH Finance Division for review no later than
12 nine (9) months after the close of the fiscal year in which the funds supplied through this
13 Agreement are expended. Failure to comply with this Act may result in County performing the
14 necessary audit tasks or contracting with a qualified accountant to perform said audit. All audit
15 costs related to this Agreement are the sole responsibility of Contractor who agrees to take
16 corrective action to eliminate any material noncompliance or weakness found as a result of
17 such audit. Audit work performed by County under this paragraph shall be billed to Contractor
18 at County cost, as determined by County's Auditor-Controller/Treasurer-Tax Collector.
19 Contractor shall make available all records and accounts for inspection by County,
20 the State of California, if applicable, the Controller General of the United States, the Federal
21 Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
22 period of at least three (3) years following final payment under this Agreement or the closure of
23 all other pending matters, whichever is later.
24 13.8 Public Records. The County is not limited in any manner with respect to its public
25 disclosure of this Agreement or any record or data that the Contractor may provide to the
26 County. The County's public disclosure of this Agreement or any record or data that the
27 Contractor may provide to the County may include but is not limited to the following:
28
1 (A) The County may voluntarily, or upon request by any member of the public or
2 governmental agency, disclose this Agreement to the public or such governmental
3 agency.
4 (B) The County may voluntarily, or upon request by any member of the public or
5 governmental agency, disclose to the public or such governmental agency any record or
6 data that the Contractor may provide to the County, unless such disclosure is prohibited
7 by court order.
8 (C)This Agreement, and any record or data that the Contractor may provide to the
9 County, is subject to public disclosure under the Ralph M. Brown Act (California
10 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
11 (D)This Agreement, and any record or data that the Contractor may provide to the
12 County, is subject to public disclosure as a public record under the California Public
13 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
14 with section 6250) ("CPRA").
15 (E) This Agreement, and any record or data that the Contractor may provide to the
16 County, is subject to public disclosure as information concerning the conduct of the
17 people's business of the State of California under California Constitution, Article 1,
18 section 3, subdivision (b).
19 (F) Any marking of confidentiality or restricted access upon or otherwise made with
20 respect to any record or data that the Contractor may provide to the County shall be
21 disregarded and have no effect on the County's right or duty to disclose to the public or
22 governmental agency any such record or data.
23 13.9 Public Records Act Requests. If the County receives a written or oral request
24 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
25 and which the County has a right, under any provision of this Agreement or applicable law, to
26 possess or control, then the County may demand, in writing, that the Contractor deliver to the
27 County, for purposes of public disclosure, the requested records that may be in the possession
28 or control of the Contractor. Within five business days after the County's demand, the
1 Contractor shall (a) deliver to the County all of the requested records that are in the
2 Contractor's possession or control, together with a written statement that the Contractor, after
3 conducting a diligent search, has produced all requested records that are in the Contractor's
4 possession or control, or (b) provide to the County a written statement that the Contractor, after
5 conducting a diligent search, does not possess or control any of the requested records. The
6 Contractor shall cooperate with the County with respect to any County demand for such
7 records. If the Contractor wishes to assert that any specific record or data is exempt from
8 disclosure under the CPRA or other applicable law, it must deliver the record or data to the
9 County and assert the exemption by citation to specific legal authority within the written
10 statement that it provides to the County under this section. The Contractor's assertion of any
11 exemption from disclosure is not binding on the County, but the County will give at least 10
12 days' advance written notice to the Contractor before disclosing any record subject to the
13 Contractor's assertion of exemption from disclosure. The Contractor shall indemnify the County
14 for any court-ordered award of costs or attorney's fees under the CPRA that results from the
15 Contractor's delay, claim of exemption, failure to produce any such records, or failure to
16 cooperate with the County with respect to any County demand for any such records.
17 Article 14
18 Right to Monitor
19 14.1 Right to Monitor. County or any subdivision or appointee thereof, and the State of
20 California or any subdivision or appointee thereof, including the Auditor General, shall have
21 absolute right to review and audit all records, books, papers, documents, corporate minutes,
22 financial records, staff information, records of persons served, other pertinent items as
23 requested, and shall have absolute right to monitor the performance of Contractor in the
24 delivery of services provided under this Agreement. Full cooperation shall be given by the
25 Contractor in any auditing or monitoring conducted, according to this agreement.
26 14.2 Accessibility. Contractor shall make all of its premises, physical facilities,
27 equipment, books, records, documents, agreements, computers, or other electronic systems
28 pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities furnished
1 under the terms of this Agreement, or determinations of amounts payable available at any time
2 for inspection, examination, or copying by County, the State of California or any subdivision or
3 appointee thereof, CMS, U.S. Department of Health and Human Services (HHS) Office of
4 Inspector General, the United States Controller General or their designees, and other
5 authorized federal and state agencies. This audit right will exist for at least ten years from the
6 final date of the Agreement period or in the event the Contractor has been notified that an audit
7 or investigation of this Agreement has commenced, until such time as the matter under audit or
8 investigation has been resolved, including the exhaustion of all legal remedies, whichever is
9 later (42 CFR §438.230(c)(3)(I)-(ii)).
10 The County, DHCS, CMS, or the HHS Office of Inspector General may inspect,
11 evaluate, and audit the Contractor at any time if there is a reasonable possibility of fraud or
12 similar risk. The Department's inspection shall occur at the Contractor's place of business,
13 premises, or physical facilities (42 CFR §438.230(c)(3)(iv)).
14 14.3 Cooperation. Contractor shall cooperate with County in the implementation,
15 monitoring and evaluation of this Agreement and comply with any and all reporting
16 requirements established by County. Should County identify an issue or receive notification of a
17 complaint or potential/actual/suspected violation of requirements, County may audit, monitor,
18 and/or request information from Contractor to ensure compliance with laws, regulations, and
19 requirements, as applicable.
20 14.4 Probationary Status. County reserves the right to place Contractor on probationary
21 status, as referenced in the Probationary Status Article, should Contractor fail to meet
22 performance requirements; including, but not limited to violations such as high disallowance
23 rates, failure to report incidents and changes as contractually required, failure to correct issues,
24 inappropriate invoicing, untimely and inaccurate data entry, not meeting performance outcomes
25 expectations, and violations issued directly from the State. Additionally, Contractor may be
26 subject to Probationary Status or termination if agreement monitoring and auditing corrective
27 actions are not resolved within specified timeframes.
28
1 14.5 Record Retention. Contractor shall retain all records and documents originated or
2 prepared pursuant to Contractor's performance under this Agreement, including grievance and
3 appeal records, and the data, information and documentation specified in 42 C.F.R. parts
4 438.604, 438.606, 438.608, and 438.610 for a period of no less than ten years from the term
5 end date of this Agreement or until such time as the matter under audit or investigation has
6 been resolved. Records and documents include but are not limited to all physical and electronic
7 records and documents originated or prepared pursuant to Contractor's or subcontractor's
8 performance under this Agreement including working papers, reports, financial records and
9 documents of account, records of persons served, prescription files, subcontracts, and any
10 other documentation pertaining to covered services and other related services for persons
11 served.
12 14.6 Record Maintenance. Contractor shall maintain all records and management books
13 pertaining to service delivery and demonstrate accountability for agreement performance and
14 maintain all fiscal, statistical, and management books and records pertaining to the program.
15 Records should include, but not be limited to, monthly summary sheets, sign-in sheets, and
16 other primary source documents. Fiscal records shall be kept in accordance with Generally
17 Accepted Accounting Principles and must account for all funds, tangible assets, revenue and
18 expenditures. Fiscal records must also comply with the Code of Federal Regulations (CFR),
19 Title II, Subtitle A, Chapter 11, Part 200, Uniform Administrative Requirements, Cost Principles,
20 and Audit Requirements for Federal Awards.
21 All records shall be complete and current and comply with all Agreement
22 requirements. Failure to maintain acceptable records per the preceding requirements shall be
23 considered grounds for withholding of payments for billings submitted and for termination of
24 Agreement.
25 Contractor shall maintain records of persons served and community service in
26 compliance with all regulations set forth by local, state, and federal requirements, laws, and
27 regulations, and provide access to clinical records by County staff.
28
1 Contractor shall comply with the Article 18 and Article 1 regarding relinquishing or
2 maintaining medical records.
3 Contractor shall agree to maintain and retain all appropriate service and financial
4 records for a period of at least ten (10) years from the date of final payment, the final date of
5 the contract period, final settlement, or until audit findings are resolved, whichever is later.
6 14.7 Financial Reports. Contractor shall submit audited financial reports on an annual
7 basis to the County. The audit shall be conducted in accordance with Generally Accepted
8 Accounting Principles and generally accepted auditing standards.
9 14.8 Agreement Termination. In the event the Agreement is terminated, ends its
10 designated term or Contractor ceases operation of its business, Contractor shall deliver or
11 make available to County all financial records that may have been accumulated by Contractor
12 or subcontractor under this Agreement, whether completed, partially completed or in progress
13 within seven (7) calendar days of said termination/end date.
14 14.9 Facilities and Assistance. Contractor shall provide all reasonable facilities and
15 assistance for the safety and convenience of the County's representatives in the performance
16 of their duties. All inspections and evaluations shall be performed in such a manner that will not
17 unduly delay the work of Contractor.
18 14.10 County Discretion to Revoke. County has the discretion to revoke full or partial
19 provisions of the Agreement, delegated activities or obligations, or application of other remedies
20 permitted by state or federal law when the County or DHCS determines Contractor has not
21 performed satisfactorily.
22 14.11 Site Inspection. Without limiting any other provision related to inspections or audits
23 otherwise set forth in this Agreement, Contractor shall permit authorized County, state, and/or
24 federal agency(ies), through any authorized representative, the right to inspect or otherwise
25 evaluate the work performed or being performed hereunder including subcontract support
26 activities and the premises which it is being performed. Contractor shall provide all reasonable
27 assistance for the safety and convenience of the authorized representative in the performance
28
1 of their duties. All inspections and evaluations shall be made in a manner that will not unduly
2 delay the work of the Contractor.
3 Article 15
4 Complaints Logs and Grievances
5 15.1 Documentation. Contractor shall log complaints and the disposition of all
6 complaints from a person served or their family. Contractor shall provide a copy of the detailed
7 complaint log entries concerning County-sponsored persons served to County at monthly
8 intervals by the tenth (10th) day of the following month, in a format that is mutually agreed
9 upon. Contractor shall allow beneficiaries or their representative to file a grievance either orally,
10 or in writing at any time with the Mental health Plan. In the event Contractor is notified by a
11 beneficiary or their representative of a discrimination grievance, subcontractor shall report
12 discrimination grievances to the Mental Health Plan within 24 hours. The Contractor shall not
13 require a beneficiary or their representative to file a Discrimination Grievance with the Mental
14 Health Plan before filing the complaint directly with the DHCS Office of Civil Rights and the U.S.
15 Health and Human Services Office for Civil Rights.
16 15.2 Rights of Persons Served. Contractor shall post signs informing persons served of
17 their right to file a complaint or grievance, appeals, and expedited appeals. In addition,
18 Contractor shall inform every person served of their rights as set forth in Exhibit H.
19 15.3 Incident Reporting. Contractor shall file an incident report for all incidents involving
20 persons served, following the protocol identified in Exhibit I.
21 Article 16
22 Property of County
23 16.1 Applicability. Article 16 shall only apply to the program components and services
24 provided under operational costs.
25 16.2 Fixed Assets. County and Contractor recognize that fixed assets are tangible and
26 intangible property obtained or controlled under County for use in operational capacity and will
27 benefit County for a period more than one (1) year. The parties agree that the Phoenix site
28 located at 4141 N. Blackstone Avenue is not considered a fixed asset under this Agreement.
1 16.3 Agreement Assets. Assets shall be tracked on an agreement by agreement basis.
2 All of these assets shall fall into the "Equipment" category unless funding source allows for
3 additional types of assets. At a minimum, the following types of items are considered to be
4 assets:
5 (A) Computers (desktops and laptops)*
6 (B) Copiers, cell phones, tablets, and other devices with any HIPAA data
7 (C) Modular furniture
8 (D)Any items over $500 or more with a lifespan of at least two (2) years:
9 (1) Televisions
10 (2) Washers/Dryers
11 (3) Printers
12 (4) Digital Cameras
13 (5) Other equipment/furniture
14 (6) Items in total when purchased or used as a group fall into one or more of the
15 above categories
16 (E) Items of sensitive nature shall be purchased and allocated to a single
17 agreement. All items containing HIPAA data are considered sensitive.
18 Contractor shall ensure proper tracking for contact assets that include the following
19 asset attributes at a minimum:
20 (A) Description of the asset;
21 (B) The unique identifier of the asset if applicable, i.e., serial number;
22 (C)The acquisition date;
23 (D)The quantity of the asset;
24 (E) The location of the asset or to whom the asset is assigned;
25 (F) The cost of the asset at the time of acquisition;
26 (G)The source of grant funding if applicable;
27 (H)The disposition date, and
28 (1) The method of disposition (surplus, transferred, destroyed, lost)
1 All Contract assets shall be returned to the Department at the end of the agreement
2 period.
3 16.4 Retention and Maintenance. Assets shall be retained by County, as County
4 property, in the event this Agreement is terminated or upon expiration of this Agreement.
5 Contractor agrees to participate in an annual inventory of all County fixed and inventoried
6 assets. Upon termination or expiration of this Agreement, Contractor shall be physically
7 present when fixed and inventoried assets are returned to County possession. Contractor is
8 responsible for returning to County all County owned undepreciated fixed and inventoried
9 assets, or the monetary value of said assets if unable to produce the assets at the expiration or
10 termination of this Agreement. Contractor further agrees to the following:
11 Maintain all items of equipment in good working order and condition, normal wear
12 and tear excepted;
13 Label all items of equipment with County assigned program number, to perform
14 periodic inventories as required by County and to maintain an inventory list showing where and
15 how the equipment is being used in accordance with procedures developed by County. All
16 such lists shall be submitted to County within ten (10) days of any request therefore; and
17 Report in writing to County immediately after discovery, the loss or theft of any items
18 of equipment. For stolen items, the local law enforcement agency must be contacted, and a
19 copy of the police report submitted to County.
20 16.5 Equipment Purchase. The purchase of any equipment by Contractor with funds
21 provided hereunder shall require the prior written approval of County's DBH Director or
22 designee, shall fulfill the provisions of this Agreement as appropriate, and must be directly
23 related to Contractor's services or activity under the terms of this Agreement. County may
24 refuse reimbursement for any costs resulting from equipment purchased, which are incurred by
25 Contractor, if prior written approval has not been obtained from County.
26 16.6 Modification. Contractor must obtain prior written approval from County's DBH
27 whenever there is any modification or change in the use of any property acquired or improved,
28 in whole or in part, using funds under this Agreement. If any real or personal property acquired
1 or improved with said funds identified herein is sold and/or is utilized by Contractor for a use
2 which does not qualify under this Agreement, Contractor shall reimburse County in an amount
3 equal to the current fair market value of the property, less any portion thereof attributable to
4 expenditures of funds not provided under this Agreement. These requirements shall continue
5 in effect for the life of the property. In the event this Agreement expires, the requirements for
6 this Article shall remain in effect for activities or property funded with said funds, unless action
7 is taken by the State government to relieve County of these obligations.
8 Article 17
9 Compliance
10 17.1 Compliance. Contractor agrees to comply with County's Contractor Code of
11 Conduct and Ethics and the County's Compliance Program in accordance with Exhibit J. Within
12 thirty (30) days of entering into this Agreement with County, Contractor shall ensure all of
13 Contractor's employees, agents, and subcontractors providing services under this Agreement
14 certify in writing, that he or she has received, read, understood, and shall abide by the
15 Contractor Code of Conduct and Ethics. Contractor shall ensure that within thirty (30) days of
16 hire, all new employees, agents, and subcontractors providing services under this Agreement
17 shall certify in writing that he or she has received, read, understood, and shall abide by the
18 Contractor Code of Conduct and Ethics. Contractor understands that the promotion of and
19 adherence to the Contractor Code of Conduct is an element in evaluating the performance of
20 Contractor and its employees, agents, and subcontractors.
21 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
22 employees, agents, and subcontractors providing services under this Agreement shall complete
23 general compliance training, and appropriate employees, agents, and subcontractors shall
24 complete documentation and billing or billing/reimbursement training. All new employees,
25 agents, and subcontractors shall attend the appropriate training within thirty (30) days of hire.
26 Each individual who is required to attend training shall certify in writing that he or she has
27 received the required training. The certification shall specify the type of training received and
28 the date received. The certification shall be provided to County's DBH Compliance Officer at
1 1925 E. Dakota Ave, Fresno, California 93726. Contractor agrees to reimburse County for the
2 entire cost of any penalty imposed upon County by the Federal Government as a result of
3 Contractor's violation of the terms of this Agreement.
4 17.2 Compliance with State Medi-Cal Requirements. Contractor shall be required to
5 maintain Mental Health Plan organizational provider certification by Fresno County. Contractor
6 must meet Medi-Cal organization provider standards as listed in Exhibit L to this Agreement
7 tiled, "Medi-Cal Organizational Provider Standards." It is acknowledged that all references to
8 Organizational Provider and/or Provider in Exhibit L shall refer to Contractor.
9 17.3 Medi-Cal Certification and Mental Health Plan Compliance. Contractor will
10 establish and maintain Medi-Cal certification or become certified within ninety (90) days of the
11 effective date of this Agreement through County to provide reimbursable services to Medi-Cal
12 eligible persons served. In addition, Contractor shall work with the County's DBH to execute
13 the process if not currently certified by County for credentialing of staff. During this process,
14 the Contractor will obtain a legal entity number established by the DHCS, a requirement for
15 maintaining Mental Health Plan organizational provider status throughout the term of this
16 Agreement. Contractor will be required to become Medi-Cal certified prior to providing services
17 to Medi-Cal eligible persons served and seeking reimbursement from the County. Contractor
18 will not be reimbursed by County for any services rendered prior to certification.
19 Contractor shall provide direct specialty mental health services in accordance with
20 the Mental Health Plan. Contractor must comply with the "Fresno County Mental Health Plan
21 Compliance Program and Code of Conduct" set forth in Exhibit J to this Agreement.
22 Contractor may provide direct specialty mental health services using unlicensed staff
23 as long as the individual is approved as a provider by the Mental Health Plan, is supervised by
24 licensed staff, works within his/her scope and only delivers allowable direct specialty mental
25 health services. It is understood that each service is subject to audit for compliance with
26 Federal and State regulations, and that County may be making payments in advance of said
27 review. In the event that a service is disapproved, County may, at its sole discretion, withhold
28 compensation or set off from other payments due the amount of said disapproved services.
1 Contractor shall be responsible for audit exceptions to ineligible dates of services or incorrect
2 application of utilization review requirements.
3 17.4 Network Adequacy. The Contractor shall ensure that all services covered under
4 this Agreement are available and accessible to persons served in a timely manner and in
5 accordance with the network adequacy standards required by regulation. (42 C.F.R. §438.206
6 (a), (c)).
7 Contractor shall submit, when requested by County and in a manner and format
8 determined by the County, network adequacy certification information to the County, utilizing a
9 provided template or other designated format.
10 Contractor shall submit updated network adequacy information to the County any
11 time there has been a significant change that would affect the adequacy and capacity of
12 services.
13 To the extent possible and appropriately consistent with CCR, Title 9, §1830.225
14 and 42 C.F.R. §438.3 (1), the Contractor shall provide a person served the ability to choose the
15 person providing services to them.
16 17.5 Compliance Program, Including Fraud Prevention and Overpayments.
17 Contractor shall have in place a compliance program designed to detect and prevent fraud,
18 waste and abuse, as per 42 C.F.R. § 438.608(a)(1), that must include:
19 (A) Written policies, procedures, and standards of conduct that articulate the
20 organization's commitment to comply with all applicable requirements and standards
21 under the Agreement, and all applicable federal and state requirements.
22 (B) A Compliance Office (CO)who is responsible for developing and implementing
23 policies, procedures, and practices designed to ensure compliance with the
24 requirements of this Agreement and who reports directly to the CEO and the Board of
25 Directors.
26 (C)A Regulatory Compliance Committee on the Board of Directors and at the senior
27 management level charged with overseeing the organization's compliance program and
28 its compliance with the requirements under the Agreement.
1 (D)A system for training and education for the Compliance Officer, the
2 organization's senior management, and the organization's employees for the federal
3 and state standards and requirements under the Agreement.
4 (E) Effective lines of communication between the Compliance Officer and the
5 organization's employees.
6 (F) Enforcement of standards through well-publicized disciplinary guidelines.
7 (G)The establishment and implementation of procedures and a system with
8 dedicated staff for routine internal monitoring and auditing of compliance risks, prompt
9 response to compliance issues as they are raised, investigation of potential compliance
10 problems as identified in the course of self-evaluation and audits, corrections of such
11 problems promptly and thoroughly to reduce the potential for recurrence and ongoing
12 compliance with the requirements under the Agreement.
13 (H)The requirement for prompt reporting and repayment of any overpayments
14 identified.
15 17.6 Reporting. Contractor must have administrative and management arrangements or
16 procedures designed to detect and prevent fraud, waste and abuse of federal or state health
17 care funding. Contractor must report fraud and abuse information to the County including but
18 not limited to:
19 (A) Any potential fraud, waste, or abuse as per 42 C.F.R. § 438.608(a), (a)(7),
20 (B) All overpayments identified or recovered, specifying the overpayment due to
21 potential fraud as per 42 C.F.R. § 438.608(a), (a)(2),
22 (C) Information about changes in a persons served's circumstances that may affect
23 the person served's eligibility including changes in their residence or the death of the
24 person served as per 42 C.F.R. § 438.608(a)(3).
25 (D) Information about a change in the Contractor's circumstances that may affect the
26 network provider's eligibility to participate in the managed care program, including the
27 termination of this Agreement with the Contractor as per 42 C.F.R. § 438.608(a)(6).
28
1 Contractor shall implement written policies that provide detailed information about
2 the False Claims Act ("Act") and other federal and state laws described in section 1902(a)(68)
3 of the Act, including information about rights of employees to be protected as whistleblowers.
4 Contractor shall make prompt referral of any potential fraud, waste or abuse to
5 County or potential fraud directly to the State Medicaid Fraud Control Unit.
6 17.7 Overpayments. County may suspend payments to Contractor if DHCS or County
7 determine that there is a credible allegation of fraud in accordance with 42 C.F.R. §455.23. (42
8 C.F.R. §438.608 (a)(8)).
9 Contractor shall report to County all identified overpayments and reason for the
10 overpayment, including overpayments due to potential fraud. Contractor shall return any
11 overpayments to the County within 60 calendar days after the date on which the overpayment
12 was identified. (42 C.F.R. § 438.608 (a)(2), (c)(3)).
13 Article 18
14 Federal and State Laws
15 18.1 Health Insurance Portability and Accountability Act. County and Contractor each
16 consider and represent themselves as covered entities as defined by the U.S. Health Insurance
17 Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and agree to use and
18 disclose Protected Health Information (PHI) as required by law.
19 County and Contractor acknowledge that the exchange of PHI between them is only
20 for treatment, payment, and health care operations.
21 County and Contractor intend to protect the privacy and provide for the security of
22 PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology
23 for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
24 promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
25 Regulations) and other applicable laws.
26 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
27 Contractor and County to enter into a Business Associate Agreement before PHI is disclosed,
28 as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of
1 the Code of Federal Regulations. The parties agree to the requirements in Exhibit R to this
2 Agreement.
3 18.2 Physical Accessibility. In accordance with the accessibility requirements of section
4 508 of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor must
5 provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal
6 beneficiaries with physical or mental disabilities.
7 Article 19
8 Data Security
9 19.1 Data Security Requirements. Contractor shall comply with data security
10 requirements in Exhibit M to this Agreement.
11
12 Article 20
13 Publicity Prohibition
14 20.1 Self-Promotion. None of the funds, materials, property, or services provided directly
15 or indirectly under this Agreement shall be used for Contractor's advertising, fundraising, or
16 publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.) for the purpose of
17 self-promotion.
18 20.2 Public Awareness. Notwithstanding the above, publicity of the services described in
19 Article 1 of this Agreement shall be allowed as necessary to raise public awareness about the
20 availability of such specific services when approved in advance by County's DBH Director or
21 designee and at a cost to be provided in Exhibit F1 for such items as written/printed materials,
22 the use of media (i.e., radio, television, newspapers), and any other related expense(s).
23 Communication products must follow DBH graphic standards, including typefaces and colors, to
24 communicate our authority and project a unified brand. This includes all media types and
25 channels and all materials on and offline that are created as part of DBH's efforts to provide
26 information to the public.
27
28
1 Article 21
2 Disclosure of Self-Dealing Transactions
3 21.1 Applicability. This Article 21 applies if the Contractor is operating as a corporation,
4 or changes its status to operate as a corporation.
5 21.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
6 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
7 "Self-Dealing Transaction Disclosure Form" (Exhibit N to this Agreement) and submitting it to
8 the County before commencing the transaction or immediately after.
9 21.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
10 a party and in which one or more of its directors, as an individual, has a material financial
11 interest.
12 Article 22
13 Disclosure of Ownership and/or Control Interest Information
14 22.1 Applicability. This provision is only applicable if Contractor is disclosing entities,
15 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
16 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
17 22.2 Duty to Disclose. Contractor must disclose the following information as requested
18 in the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement,
19 Exhibit O:
20 (A) Disclosure of 5% or More Ownership Interest:
21 (1) In the case of corporate entities with an ownership or control interest in the
22 disclosing entity, the primary business address as well as every business location
23 and P.O. Box address must be disclosed. In the case of an individual, the date of
24 birth and Social Security number must be disclosed.
25 (2) In the case of a corporation with ownership or control interest in the
26 disclosing entity or in any subcontractor in which the disclosing entity has a five
27 percent (5%) or more interest, the corporation tax identification number must be
28 disclosed.
1 (3) For individuals or corporations with ownership or control interest in any
2 subcontractor in which the disclosing entity has a five percent (5%) or more interest,
3 the disclosure of familial relationship is required.
4 (4) For individuals with five percent (5%) or more direct or indirect ownership
5 interest of a disclosing entity, the individual shall provide evidence of completion of a
6 criminal background check, including fingerprinting, if required by law, prior to
7 execution of Contract. (42 C.F.R. § 455.434)
8 (B) Disclosures Related to Business Transactions:
9 (1) The ownership of any subcontractor with whom Contractor has had business
10 transactions totaling more than $25,000 during the 12-month period ending on the
11 date of the request.
12 (2) Any significant business transactions between Contractor and any wholly
13 owned supplier, or between Contractor and any subcontractor, during the 5-year
14 period ending on the date of the request. (42 C.F.R. § 455.105(b).)
15 (C) Disclosures Related to Persons Convicted of Crimes:
16 (1) The identity of any person who has an ownership or control interest in the
17 provider or is an agent or managing employee of the provider who has been
18 convicted of a criminal offense related to that person's involvement in any program
19 under the Medicare, Medicaid, or the Title XXI services program since the inception
20 of those programs. (42 C.F.R. § 455.106.)
21 (2) County shall terminate the enrollment of Contractor if any person with five
22 percent (5%) or greater direct or indirect ownership interest in the disclosing entity
23 has been convicted of a criminal offense related to the person's involvement with
24 Medicare, Medicaid, or Title XXI program in the last 10 years.
25 22.3 Contractor must provide disclosure upon execution of Contract, extension for
26 renewal, and within 35 days after any change in Contractor ownership or upon request of
27 County. County may refuse to enter into an agreement or terminate an existing agreement with
28 Contractor if Contractor fails to disclose ownership and control interest information, information
1 related to business transactions and information on persons convicted of crimes, or if
2 Contractor did not fully and accurately make the disclosure as required.
3 22.4 Contractor must provide the County with written disclosure of any prohibited
4 affiliations under 42 C.F.R. § 438.610. Contractor must not employ or subcontract with
5 providers or have other relationships with providers Excluded from participation in Federal
6 Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42
7 C.F.R. §438.610.
8 22.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
9 DBHContractedServices@fresnocountyca.gov. County may deny enrollment or terminate this
10 Agreement where any person with five (5) percent or greater direct or indirect ownership
11 interest in Contractor has been convicted of a criminal offense related to that person's
12 involvement with the Medicare, Medicaid, or Title XXI program in the last ten (10) years. County
13 may terminate this Agreement where any person with five (5) percent or greater direct or
14 indirect ownership interest in the Contractor did not submit timely and accurate information and
15 cooperate with any screening method required in CFR, Title 42, Section 455.416.
16 Article 23
17 Disclosure of Criminal History and Civil Actions
18 23.1 Applicability. Contractor is required to disclose if any of the following conditions
19 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
20 referred to as "Contractor"):
21 (A) Within the three (3) year period preceding the Agreement award, they have been
22 convicted of, or had a civil judgment tendered against them for:
23 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
24 or performing a public (federal, state, or local) transaction or contract under a public
25 transaction;
26 (2) Violation of a federal or state antitrust statute;
27 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
28 or
1 (4) False statements or receipt of stolen property.
2 (B) Within a three (3) year period preceding their Agreement award, they have had a
3 public transaction (federal, state, or local) terminated for cause or default.
4 23.2 Duty to Disclose. Disclosure of the above information will not automatically
5 eliminate Contractor from further business consideration. The information will be considered as
6 part of the determination of whether to continue and/or renew this Agreement and any
7 additional information or explanation that Contractor elects to submit with the disclosed
8 information will be considered. If it is later determined that the Contractor failed to disclose
9 required information, any contract awarded to such Contractor may be immediately voided and
10 terminated for material failure to comply with the terms and conditions of the award.
11 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
12 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit P to this
13 Agreement. Additionally, Contractor must immediately advise the County in writing if, during
14 the term of the Agreement: (1) Contractor becomes suspended, debarred, excluded or ineligible
15 for participation in Federal or State funded programs or from receiving federal funds as listed in
16 the excluded parties list system (http://www.epls.gov); or(2) any of the above listed conditions
17 become applicable to Contractor. Contractor shall indemnify, defend, and hold County
18 harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility,
19 or other matter listed in the signed Certification Regarding Debarment, Suspension, and Other
20 Responsibility Matters.
21 Article 24
22 Cultural and Linguistic Competency
23 24.1 General.All services, policies and procedures must be culturally and linguistically
24 appropriate. Contractor must participate in the implementation of the most recent Cultural
25 Competency Plan for the County and shall adhere to all cultural competency standards and
26 requirements. Contractor shall participate in the County's efforts to promote the delivery of
27 services in a culturally competent and equitable manner to all individuals, including those with
28 limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and
1 regardless of gender, sexual orientation, or gender identity including active participation in the
2 County's Diversity, Equity and Inclusion Committee.
3 24.2 Policies and Procedures. Contractor shall comply with requirements of policies and
4 procedures for ensuring access and appropriate use of trained interpreters and material
5 translation services for all limited and/or no English proficient beneficiaries, including, but not
6 limited to, assessing the cultural and linguistic needs of the beneficiaries, training of staff on the
7 policies and procedures, and monitoring its language assistance program. Contractor's policies
8 and procedures shall ensure compliance of any subcontracted providers with these
9 requirements.
10 24.3 Interpreter Services. Contractor shall notify its beneficiaries that oral interpretation
11 is available for any language and written translation is available in prevalent languages and that
12 auxiliary aids and services are available upon request, at no cost and in a timely manner for
13 limited and/or no English proficient beneficiaries and/or beneficiaries with disabilities.
14 Contractor shall avoid relying on an adult or minor child accompanying the beneficiary to
15 interpret or facilitate communication; however, if the beneficiary refuses language assistance
16 services, the Contractor must document the offer, refusal, and justification in the beneficiary's
17 file.
18 24.4 Interpreter Qualifications. Contractor shall ensure that employees, agents,
19 subcontractors, and/or partners who interpret or translate for a beneficiary or who directly
20 communicate with a beneficiary in a language other than English (1) have completed annual
21 training provided by County at no cost to Contractor; (2) have demonstrated proficiency in the
22 beneficiary's language; (3) can effectively communicate any specialized terms and concepts
23 specific to Contractor's services; and (4) adheres to generally accepted interpreter ethic
24 principles. As requested by County, Contractor shall identify all who interpret for or provide
25 direct communication to any program beneficiary in a language other than English and identify
26 when the Contractor last monitored the interpreter for language competence.
27 24.5 CLAS Standards. Contractor shall submit to County for approval, within ninety (90)
28 days from date of contract execution, Contractor's plan to address all fifteen (15) National
1 Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by the
2 Office of Minority Health and as set forth in Exhibit Q to this Agreement titled, "National
3 Standards on Culturally and Linguistically Appropriate Services." As the CLAS standards are
4 updated, Contractor's plan must be updated accordingly. As requested by County, Contractor
5 shall be responsible for conducting an annual CLAS self-assessment and providing the results
6 of the self-assessment to the County. The annual CLAS self-assessment instruments shall be
7 reviewed by the County and revised as necessary to meet the approval of the County.
8 24.6 Training Requirements. Cultural competency training for Contractor staff should be
9 substantively integrated into health professions education and training at all levels, both
10 academically and functionally, including core curriculum, professional licensure, and continuing
11 professional development programs. As requested by County, Contractor shall report on the
12 completion of cultural competency trainings to ensure direct service providers are completing a
13 minimum of twelve (12) hours of annual cultural competency training.
14 24.7 Continuing Cultural Competence. Contractor shall create and sustain a forum that
15 includes staff at all agency levels to discuss cultural competence. Contractor shall designate a
16 representative from Contractor's team to attend County's Diversity, Equity and Inclusion
17 Committee.
18 Article 25
19 General Terms
20 25.1 Modification. Except as provided in Article 7, "Termination and Suspension," this
21 Agreement may not be modified, and no waiver is effective, except by written agreement signed
22 by both parties. The Contractor acknowledges that County employees have no authority to
23 modify this Agreement except as expressly provided in this Agreement.
24 (A) Notwithstanding the above, non-material changes to services, staffing, and
25 responsibilities of the Contractor, as needed, to accommodate changes in the laws
26 relating to service requirements and specialty mental health treatment, may be made
27 with the signed written approval of County's DBH Director, or designee, and Contractor
28 through an amendment approved by County's County Counsel and the County's
1 Auditor-Controller/Treasurer-Tax Collector's Office. Said modifications shall not result in
2 any change to the maximum compensation amount payable to Contractor, as stated
3 herein.
4 (B) In addition, changes to line items and expense category subtotals, as set forth in
5 Exhibit F1, that when added together during the term of the agreement do not exceed
6 ten percent (10%) of the total maximum compensation payable to Contractor, may be
7 made with the written approval of Contractor and County's DBH Director or designee.
8 Changes to service rates on Exhibit E that do not exceed 3% of the approved rate, or
9 that are needed to accommodate state-mandated rate increases, may be made with the
10 written approval of the DBH Director or designee. These rate changes may not add or
11 alter any other terms or conditions of the Agreement. Said modifications shall not result
12 in any change to the maximum compensation amount payable to Contractor, as stated
13 herein.
14 25.2 Non-Assignment. Neither party may assign its rights or delegate its obligations
15 under this Agreement without the prior written consent of the other party.
16 25.3 Governing Law. The laws of the State of California govern all matters arising from
17 or related to this Agreement.
18 25.4 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
19 County, California. Contractor consents to California jurisdiction for actions arising from or
20 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
21 brought and maintained in Fresno County.
22 25.5 Construction. The final form of this Agreement is the result of the parties' combined
23 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
24 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
25 against either party.
26 25.6 Days. Unless otherwise specified, "days" means calendar days.
27 25.7 Headings. The headings and section titles in this Agreement are for convenience
28 only and are not part of this Agreement.
1 25.8 Severability. If anything in this Agreement is found by a court of competent
2 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
3 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
4 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
5 intent.
6 25.9 Nondiscrimination. During the performance of this Agreement, the Contractor shall
7 not unlawfully discriminate against any employee or applicant for employment, or recipient of
8 services, because of race, religious creed, color, national origin, ancestry, physical disability,
9 mental disability, medical condition, genetic information, marital status, sex, gender, gender
10 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
11 all applicable State of California and federal statutes and regulation.
12 Contractor shall take affirmative action to ensure that services to intended Medi-Cal
13 beneficiaries are provided without use of any policy or practice that has the effect of
14 discriminating on the basis of race, color, religion, ancestry, marital status, national origin,
15 ethnic group identification, sex, sexual orientation, gender, gender identity, age, medical
16 condition, genetic information, health status or need for health care services, or mental or
17 physical disability.
18 25.10 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
19 of the Contractor under this Agreement on any one or more occasions is not a waiver of
20 performance of any continuing or other obligation of the Contractor and does not prohibit
21 enforcement by the County of any obligation on any other occasion.
22 25.11 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
23 between the Contractor and the County with respect to the subject matter of this Agreement,
24 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
25 publications, and understandings of any nature unless those things are expressly included in
26 this Agreement. If there is any inconsistency between the terms of this Agreement without its
27 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
28
1 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
2 exhibits.
3 25.12 No Third-Party Beneficiaries. This Agreement does not and is not intended to
4 create any rights or obligations for any person or entity except for the parties.
5 25.13 Authorized Signature. The Contractor represents and warrants to the County that:
6 (A) The Contractor is duly authorized and empowered to sign and perform its
7 obligations under this Agreement.
8 (B) The individual signing this Agreement on behalf of the Contractor is duly
9 authorized to do so and his or her signature on this Agreement legally binds the
10 Contractor to the terms of this Agreement.
11 25.14 Electronic Signatures. The parties agree that this Agreement may be executed by
12 electronic signature as provided in this section.
13 (A)An "electronic signature" means any symbol or process intended by an individual
14 signing this Agreement to represent their signature, including but not limited to (1) a
15 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
16 electronically scanned and transmitted (for example by PDF document) version of an
17 original handwritten signature.
18 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
19 equivalent to a valid original handwritten signature of the person signing this Agreement
20 for all purposes, including but not limited to evidentiary proof in any administrative or
21 judicial proceeding, and (2) has the same force and effect as the valid original
22 handwritten signature of that person.
23 (C)The provisions of this section satisfy the requirements of Civil Code section
24 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
25 Part 2, Title 2.5, beginning with section 1633.1).
26 (D) Each party using a digital signature represents that it has undertaken and
27 satisfied the requirements of Government Code section 16.5, subdivision (a),
28
1 paragraphs (1) through (5), and agrees that each other party may rely upon that
2 representation.
3 (E) This Agreement is not conditioned upon the parties conducting the transactions
4 under it by electronic means and either party may sign this Agreement with an original
5 handwritten signature.
6 25.15 Counterparts. This Agreement may be signed in counterparts, each of which is an
7 original, and all of which together constitute this Agreement.
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2 The parties are signing this Agreement on the date stated in the introductory clause.
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RH Community Builders, LP County of Fresno
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6 �L /.
Wayne Rutledge, C of Executive Officer Sqf Q ro, hairman of the Board of
7 Supe s orthts County of Fresno
8 Attest:
Bernice E. Seidel
9 Clerk of the Board of Supervisors
10 County of Fresno, State of California
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By:
12 Deputy
13 For accounting use only:
14 Org No.: 5630/5002
15 Account No.: 7295
Fund No.: 0001
16 Subclass No.: 10000
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Exhibit A
Page 1 of 9
BEHAVORIAL HEALTH BRIDGE HOUSING SCOPE OF WORK
ORGANIZATION: RH Community Builders, LP
ADDRESS: 3040 N Fresno Street Fresno, CA 93703
\SIERRA SUNRISE SITE ADDRESS: 949 N Parkway Drive Fresno, CA 93728
PHONIEX LANDING SITE ADDRESS: 4141 N Blackstone Ave Fresno, CA 93726
ROJECT DIRECTOR: Katie Wilbur, Executive Director PHONE
NUMBER: (559) 981-1034
CONTRACT PERIOD: July 1, 2023 —June 30, 2027
FY 2023-24 Specialty Mental Health Services: $3,200,000.00
FY 2023-24 BHBH Grant Funds: $8,792,105.00
FY 2024-25 Specialty Mental Health Service: $5,200,000.00
FY 2024-25 BHBH Grant Funds: $3,910,140.00
FY 2025-26 Specialty Mental Health Service: $5,300,000.00
FY 2025-26 BHBH Grant Funds: $3,767,190.00
FY 2026-27 Specialty Mental Health Service: $5,400,000.00
FY 2027-27 BHBH Grant Funds: $3,928,935.00
Total Maximum Compensation: $39,498,370.00
Introduction
RH Community Builders (RHCB)will provide low-barrier, emergency shelter and rental
assistance services to individuals who are experiencing homelessness and documented or
suspected severe mental illness. The intent of these services is to provide a stable shelter service
to provide wraparound services and support identification and transitions into permanent
housing.
TARGET POPULATION
Bridge Housing must serve individuals with serious behavioral health conditions, including SMI
and/or SUD, who are experiencing homelessness and have a history of being unable to sustain in
a lower level of shelter or housing. The passage of Senate Bill (SB) 1335 which establishes the
Community Assistance, Recovery, and Empowerment (CARE) Program stipulate that the CARE
Program participants be prioritized for any appropriate bridge housing funded by the BHBH
program. Additionally, BHBH must prioritize addressing the needs of populations
disproportionately impacted by homelessness.
Individuals must also meet a criteria level for shelter:
1. Experiencing literal homelessness
2. Ability to care for self:
a. Facilities are ADA accessible,but individuals must be able to self-transfer
b. CNA level staff available for mild Assisted Living Device (ALD) assistance-
wound care
c. Must be able to use the restroom independently and control bowels
3. Phoenix Landing will screen for 290 statuses due to proximity of schools
DESCRIPTION OF SERVICES
RHCB will provide low-barrier shelter to individuals in Fresno County who are experiencing
literal homelessness and has a documented or suspected severe mental illness. The program will
provide 180 beds at two service locations: 949 N Parkway Drive Fresno, CA 93728 and 4141 N
Blackstone Ave Fresno, CA 93726.
The program will provide wraparound services aimed at stabilizing the individual and identifying
permanent housing solutions. Each individual will be assigned to a Care Team consisting of 1
Lead Care manager, 1 Clinician, 1 Housing Navigator, 1 CNA, and 2 Peer Support Specialists.
Referrals will come from:
1. CARE Court (effective 12/24)
2. Full-Service Partnership Programs contracted with Fresno County DBH
3. Literally homeless individuals engaged with Fresno County DBH
4. Crisis Residential and PHF
5. Hospitals and other Emergency Facilities
a. Has a Mental Health Principal Diagnosis
b. Housing instability
c. Demonstrated inability to maintain at a lower-level community shelter
6. DBH Housing Services—recent history of 5150, documented mental health, and
demonstrated inability to maintain current housing
Upon referral to the program, the individual will complete the following:
1. Initial intake to gather basic identifying information
2. Universal Data Elements (UDE) required for entry into HMIS (all individuals will be
entered into HMIS and the program will comply with all AB 977 reporting requirements.)
The program will offer a mixture of individual occupancy and double occupancy rooms. Double
occupancy rooms will be utilized whenever possible to maximize the amount of services
delivered, however individual occupancy rooms will be available for individuals whose mental
health or other needs indicate that an individual room will be beneficial to their ability to remain
sheltered. The program will operate under low-barrier, housing first principles, meaning
individuals may still be active in their addiction.
PROGRAM OBJECTIVES AND OUTCOMES
RHCB shall:
Utilize a tracking system with which performance and outcome measures and other relevant
person served data, such as demographics, will be maintained. The data tracking system may be
incorporated into RHCB's electronic health records (EHR) system or be a stand-alone database.
County must be afforded read-only access to the data tracking system. The following items listed
below represent program goals to be tracked and achieved by the RHCB during the contract
terms.
1. Effectiveness:
a. Hospitalizations—To assess the degree of effectiveness, RHCB will track
decreases in the number of days hospitalized post-enrollment and compare to the
total number of days spent in the psychiatric setting 12 months prior to program
enrollment.
b. Incarcerations—To reduce the total number of days spent confined in a jail or
prison setting, RHCB will track decreases and compare to the total number of
days spent incarcerated 12 months prior to program enrollment.
c. Homelessness—To reduce the total number of days spent homeless, RHCB will
track decreases and compare to the total number of days spent homeless 12
months prior to program enrollment.
d. Medical Hospitalizations—To reduce the total number of days spent in a hospital
or emergency department setting, RHCB will track decreases and compare to the
total number of days hospitalized 12 months prior to program enrollment.
e. Housing—Individuals in shelter will develop a plan for permanent housing.
f. Supplemental Security Income—Within six(3) months of enrollment, seventy
percent (70%) of Individuals without SSI will have made SSI applications. RHCB
shall provide a written report regarding these goals on a quarterly-annual basis.
g. Productivity—Direct service productivity rate shall be a minimum of sixty-five
percent (65%).
h. Primary Care- Within thirty days (30) of enrollment fifty percent(50%) of
individuals will be referred to a primary care doctor.
i. Substance Abuse- Within thirty days (30) of enrollment ninety percent (90%) of
co-occurring individuals will be referred to a SUD outpatient service.
2. Efficiency
a. Cost Per Person served—RHCB will efficiently use resources and maintain or
minimize costs per person served. Costs include all staffing and overhead costs
associated with program operations.
3. Access
a. Length of Time from Referral to First Contact—RHCB will provide timely
service for persons served requesting services. The goal wait time from referral to
first contact is within three (3)business days.
b. Length of Time from Referral to First Intake/Assessment Appointment—The goal
wait time from referral to first intake/assessment appointment is within three (3)
business days.
c. Length of Time from Referral to First Mental Health and/or SUD Appointment—
The goal wait time from referral to first mental health and/or SUD appointment is
within fifteen(15)business days.
4. Satisfaction
a. Consumer Perception Survey—RHCB will gauge satisfaction of individuals and
collect data for service planning and quality improvement. The surveys are
conducted every three (3) months over a week period. Program beneficiaries are
encouraged to participate in completing the survey. The goal is for 75% of
persons served to be satisfied for each domain.
REPORTING, MONITORING, AND COMMUNICATION REQUIREMENTS
RHCB shall:
1. Enter data on the individuals and families served into local Homeless Management
information system(HMIS), as required by AB 977
2. Submit quarterly narrative and data reports that document progress toward improved
outcomes as requested by County
3. Participate in monthly calls, learning collaboratives, and other TTA activities
4. Participate in monthly meetings with County
5. Meet the funding requirements,participate in financial review auditing and fraud
prevention, and ensure appropriate uses of funds with County as requested
6. Provide required program updates and participate in monitoring reimbursement reviews
with County, DHCS and/or Advocates for Human Potential (AHP) as requested
7. Reporting
RHCB shall:
Participate in data collection and submission of quarterly narrative, data, and financial reports.
Reports will be submitted as directed by County. These reports will summarize progress in
implementing the BHBH Program Plan; expending funds, including, without limitation,
equipment purchases; subcontracting; and providing bridge housing for individuals experiencing
homelessness and serious behavioral health conditions; and must include accomplishments and
any barriers to goals of the BHBH Program. The reports must cover the following time frames
and observe the following due dates:
Reporting—Year 1
• Quarter 1: September 5—September 30, 2023, due by November 8, 2023
• Quarter 2: October 1—December 31,2023, due by February 8, 2024
• Quarter 3: January 1—March 31, 2024, due by May 8, 2024
• Quarter 4: April 1—June 30, 2024, due by August 9, 2024
➢ Meet state requirements for submission of data
into the HMIS system as required by AB 977
when and in the manner required.
Reporting—Year 2
• Quarter 1: July 1—September 30, 2024, due by November 8, 2024
• Quarter 2: October 1—December 31,2024, due by February 7, 2025
• Quarter 3: January 1—March 31, 2025, due by May 9, 2025
• Quarter 4: April 1—June 30, 2025, due by August 8, 2025
➢ Meet state requirements for submission of data into
the HMIS system as required by AB 977 when and in
the manner required.
Reporting—Year 3
• Quarter 1: July 1—September 30, 2025, due by November 7, 2025
-Quarter 2: October 1—December 31, 2025, due by February 6, 2026
• Quarter 3: January 1—March 31, 2026, due by May 11, 2026
• Quarter 4: April 1—June 30, 2026, due by August 7, 2026
➢ Meet state requirements for submission of data into
the HMIS system as required by AB 977 when and in
the manner required.
Reporting—Year 4
• Quarter 1: July 1—September 30, 2026, due by November 6, 2026
• Quarter 2: October 1—December 31, 2026, due by February 10, 2027
• Quarter 3: January 1—March 31, 2027, due by May 11, 2027
• Quarter 4: April 1—June 30, 2027, due June 28, 2027
➢ Meet state requirements for submission of data into
the HMIS system as required by AB 977 when and in
the manner required.
Submit a final report by June 28, 2027.
RHCB'S RESPONSIBILITIES
RHCB shall:
Key supportive services will utilize the Critical Time Intervention(CTI) Model to make
available support to individuals with serious mental illness. Available supportive services will
include,but may not be limited to the following:
1. Provide services based on the community needs and principles and will include voluntary
supportive services for individuals experiencing both homelessness and serious mental
health conditions.
2. Support access to medication assisted treatment (MAT) and psychotropic medications for
the treatment of mental disorders.
3. Prioritize and ensure that eligible CARE program participants receive BHBH Program
services.
4. Provide outreach and progressive engagement strategies to offer and encourage
individuals and/or families to enter.
5. Provide housing navigation and other supports to participants in accessing sustainable,
affordable,permanent housing resources.
6. Conduct all services in a manner that allows for choice, enables people to stay in their
"home" communities to the best extent possible, and provide community integration in
accordance with all applicable federal and state laws.
7. Clinical support services including assistance with accessing, understanding, and utilizing
all aspects of an individualized treatment plan, including but not limited to case
management, therapy, and peer support.
8. Behavioral health management efforts directed to assist people to manage their wellness,
create plans of action, and to identify personal patterns in order to decrease episodes of
house instability and recidivism.
9. Provide housing navigation services including utilization of the Fresno Madera
Continuum of Care (FMCoQ Coordinated Entry System (CES) for identification of
housing options if appropriate, support individual with identification of appropriate
housing options, and facilitate transition into permanent housing.
10. Life-skills development services and support to include personal care and hygiene,
conflict-management, money-management, and how to transition into permanent
housing.
11. Provide benefits development counseling and advocacy to assist with accessing and
securing any eligible benefits, including Medi-Cal and Social Security benefits.
12. Coordination of services, including linkages to primary health care, mental health care,
substance abuse services, and medication referrals.
13. Provide direct specialty mental health services in accordance with the Mental Health
Plan. RHCB will ensure the individual to whom the specialty mental health services meet
the criteria and will ensure clinical record for each individual includes information and
needs aligned with the criteria applicable at the time of service.
14. Transport individual to and from services as needed.
15. Provide services for co-occurring substance use disorders:
a. Identify alcohol, tabaco and drug abuse effects and patterns.
b. Education regarding the interaction of alcohol, tobacco, and drug use with
psychiatric symptoms and medication.
c. Use of clinical interventions and peer support recovery groups and activities.
d. Education on relapse prevention
CULTURAL AND LINGUISTIC COMPETENCE REQUIREMENTS:
TRAINING REQUIREMENTS
RHCB shall:
Be trained in the purpose, mission, and philosophy, of the BHBH Program during their new hire
orientation and annually throughout the course of their employment. Ongoing training shall
include topics such as clinical, administrative, operational, human resource, cultural, and
information technology areas. Additionally, cultural competency, Criminogenic Risk Factors,
and specialized clinical training shall also be utilized.
Specific BHBH service delivery training shall include:
1. Cultural Awareness and Responsiveness
2. Compliance, Billing, and Documentation training
3. Self Care and Burn Out Prevention Training
4. ProACT training
5. Harm Reduction training
6. Housing First training
7. Trauma Informed and Trauma Responsive Methods and Processes
8. Motivational Interviewing
9. Strength based, Individual Driven Plan Development and Natural Support Inclusion
10. Attend other required trainings provided by the County
HOURS OF OPERATION:
RHCB shall:
1. Be available to provide services to individuals 24 hours per day, seven (7) days per week.
AVERAGE INDIVIDUAL LENGTH OF STAY:
1. The average length of stay for individual shall be approximately 90-180 days.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Assist RHCB in making linkages with the total mental health system. This will be
accomplished through regularly scheduled meetings as well as formal and informal
consultation.
2. Participate in evaluating the progress of the overall program and the efficiency of
collaboration with RHCB staff and will be available to RHCB for ongoing consultation.
3. Receive and analyze statistical data outcome information from RHCB throughout the
term of contract on a monthly basis. DBH will notify RHCB 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.
4. 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.
Exhibit B
BEHAVIORAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The County and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the County Mental Health Plan
(directly or through contract) providing Short-Doyle/Medi-Cal services have met
applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
Contractor shall conform to and County shall monitor compliance with all State of
California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
Contractor shall prepare and make available to County and to the public
all eligibility requirements to participate in the program plan set forth in the
Agreement. No person shall, because of ethnic group identification, age,
gender, color, disability, medical condition, national origin, race, ancestry,
marital status, religion, religious creed, political belief or sexual
preference be excluded from participation, be denied benefits of, or be
subject to discrimination under any program or activity receiving Federal
or State of California assistance.
B. Employment Opportunity
Contractor shall comply with County policy, and the Equal Employment
Opportunity Commission guidelines, which forbids discrimination against
any person on the grounds of race, color, national origin, sex, religion,
age, disability status, or sexual preference in employment practices.
Such practices include retirement, recruitment advertising, hiring, layoff,
termination, upgrading, demotion, transfer, rates of pay or other forms of
compensation, use of facilities, and other terms and conditions of
employment.
B-1
Exhibit B
C. Suspension of Compensation
If an allegation of discrimination occurs, County may withhold all further
funds, until Contractor can show clear and convincing evidence to the
satisfaction of County that funds provided under this Agreement were not
used in connection with the alleged discrimination.
D. Nepotism
Except by consent of County's Department of Behavioral Health Director,
or designee, no person shall be employed by Contractor who is related by
blood or marriage to, or who is a member of the Board of Directors or an
officer of Contractor.
5. PATIENTS' RIGHTS
Contractor shall comply with applicable laws and regulations, including but not
limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied
with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f) and
CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-
free workplace by taking the following actions:
A. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is
prohibited and specifying actions to be taken against employees for
violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
C. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
B-2
Exhibit B
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and Contractor
may be ineligible for award of any future State agreements if the department
determines that any of the following has occurred: the Contractor has made
false certification, or violated the certification by failing to carry out the
requirements as noted above. (Gov. Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor
certifies that no more than one (1)final unappealable finding of contempt of court
by a Federal court has been issued against Contractor within the immediately
preceding two (2) year period because of Contractor's failure to comply with an
order of a Federal court, which orders Contractor to comply with an order of the
National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to
public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
Contractor agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the
lessor of 30 multiplied by the number of full time attorneys in the firm's offices in
the State, with the number of hours prorated on an actual day basis for any
contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the
meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to
contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel,
garments or corresponding accessories, or the procurement of
equipment, materials, or supplies, other than procurement related to a
public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been
laundered or produced in whole or in part by sweatshop labor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, or with the
benefit of sweatshop labor, forced labor, convict labor, indentured labor
under penal sanction, abusive forms of child labor or exploitation of
children in sweatshop labor. Contractor further declares under penalty of
perjury that they adhere to the Sweatfree Code of Conduct as set forth on
B-3
Exhibit B
the California Department of Industrial Relations website located at
www.dir.ca.gov, and Public Contract Code Section 6108.
b. Contractor agrees to cooperate fully in providing reasonable access to the
Contractor's records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the
Department of Industrial Relations, or the Department of Justice to
determine the Contractor's compliance with the requirements under
paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractor
certifies that Contractor is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, Contractor certifies
that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: Contractor needs to be aware of the following
provisions regarding current or former state employees. If Contractor has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code§10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent Contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code �10411):
a). For the two (2)year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he
or she engaged in any of the negotiations, transactions, planning,
arrangements or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency.
B-4
Exhibit B
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a
contract with any state agency if he or she was employed by that state
agency in a policy-making position in the same general subject area as
the proposed contract within the twelve (12) month period prior to his or
her leaving state service.
If Contractor violates any provisions of above paragraphs, such action by
Contractor shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not
receive payment other than payment of each meeting of the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware
of the provisions which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance with the
provisions, and CONTRACTOR affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it
complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval
of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently
qualified to do business in California in order to ensure that all obligations
due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit.
Although there are some statutory exceptions to taxation, rarely will a
corporate Contractor performing within the state not be subject to the
franchise tax.
C. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do
business in California. Agencies will determine whether a corporation is
in good standing by calling the Office of the Secretary of State.
B-5
Exhibit B
6. RESOLUTION: A County, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local
governing body, which by law has authority to enter into an agreement,
authorizing execution of the agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
Contractor shall not be: (1) in violation of any order or resolution not subject to
review promulgated by the State Air Resources Board or an air pollution control
district; (2) subject to cease and desist order not subject to review issued
pursuant to Section 13301 of the Water Code for violation of waste discharge
requirements or discharge prohibitions; or (3) finally determined to be in violation
of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
Contractors that are not another state agency or other governmental entity.
9. INSPECTION AND AUDIT OF RECORDS AND ACCESS TO FACILITIES:
The State, CMS, the Office of the Inspector General, the Comptroller General,
and their designees may, at any time, inspect and audit any records or
documents of Contractor or its subcontractors, and may, at any time, inspect the
premises, physical facilities, and equipment where Medicaid-related activities or
work is conducted. The right to audit under this section exists for ten (10) years
from the final date of the contract period or from the date of completion of any
audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must
confirm the identity and determine the exclusion status of Contractor, any
subcontractor, as well as any person with an ownership or control interest, or
who is an agent or managing employee of Contractor through routine checks of
Federal databases. This includes the Social Security Administration's Death
Master File, the National Plan and Provider Enumeration System (NPPES), the
List of Excluded Individuals/Entities (LEIE), the System for Award Management
(SAM), and any other databases as the State or Secretary may prescribe. These
databases must be consulted upon contracting and no less frequently than
monthly thereafter. If the State finds a party that is excluded, it must promptly
notify the Contractor and take action consistent with § 438.610(c).
The State must ensure that Contractor with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
Contractor to a network provider, out-of-network provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
B-6
Exhibit B
CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM)
REQUIREMENTS
1. SERVICES AND ACCESS PROVISIONS
a. CERTIFICATION OF ELIGIBILITY
i. Contractor will, in cooperation with County, comply with Section
14705.5 of California Welfare and Institutions Code to obtain a
certification of an individual's eligibility for Specialty Mental Health
Services (SMHS) under Medi-Cal.
b. ACCESS TO SPECIALTY MENTAL HEALTH SERVICES
i. In collaboration with the County, Contractor will work to ensure
that individuals to whom the Contractor provides SMHS meet
access criteria, as per Department of Health Care Services
(DHCS) guidance specified in BHIN 21-073. Specifically, the
Contractor will ensure that the clinical record for each individual
includes information as a whole indicating that individual's
presentation and needs are aligned with the criteria applicable to
their age at the time of service provision as specified below.
ii. For enrolled individuals under 21 years of age, Contractor shall
provide all medically necessary SMHS required pursuant to
Section 1396d(r) of Title 42 of the United States Code. Covered
SMHS shall be provided to enrolled individuals who meet either of
the following criteria, (1) or (II) below. If an individual under age 21
meets the criteria as described in (1) below, the beneficiary meets
criteria to access SMHS; it is not necessary to establish that the
beneficiary also meets the criteria in (b) below.
1. The individual has a condition placing them at high risk for
a mental health disorder due to experience of trauma
evidenced by any of the following: scoring in the high-risk
range under a trauma screening tool approved by DHCS,
involvement in the child welfare system, juvenile justice
involvement, or experiencing homelessness.
OR
2. The individual has at least one of the following:
a. A significant impairment
b. A reasonable probability of significant deterioration
in an important area of life functioning
c. A reasonable probability of not progressing
developmentally as appropriate.
d. A need for SMHS, regardless of presence of
impairment, that are not included within the mental
health benefits that a Medi-Cal Managed Care Plan
(MCP) is required to provide.
AND the individual's condition as described in subparagraph
(11 a-d) above is due to one of the following:
B-7
Exhibit B
a. A diagnosed mental health disorder, according to
the criteria in the current editions of the Diagnostic
and Statistical Manual of Mental Disorders (DSM)
and the International Classification of Diseases and
Related Health Problems (ICD).
b. A suspected mental health disorder that has not yet
been diagnosed.
c. Significant trauma placing the individual at risk of a
future mental health condition, based on the
assessment of a licensed mental health
professional.
iii. For individuals 21 years of age or older, Contractor shall provide
covered SMHS for clients who meet both of the following criteria,
(a) and (b) below:
1. The individual has one or both of the following:
a. Significant impairment, where impairment is defined
as distress, disability, or dysfunction in social,
occupational, or other important activities.
b. A reasonable probability of significant deterioration
in an important area of life functioning.
2. The individual's condition as described in paragraph (a) is
due to either of the following:
a. A diagnosed mental health disorder, according to
the criteria in the current editions of the DSM and
ICD.
b. A suspected mental disorder that has not yet been
diagnosed.
c. ADDITIONAL CLARIFICATIONS
i. Criteria
1. A clinically appropriate and covered mental health
prevention, screening, assessment, treatment, or recovery
service listed within Exhibit A of this Agreement can be
provided and submitted to the County for reimbursement
under any of the following circumstances:
a. The services were provided prior to determining a
diagnosis, including clinically appropriate and
covered services provided during the assessment
process;
b. The service was not included in an individual
treatment plan; or
c. The individual had a co-occurring substance use
disorder.
ii. Diagnosis Not a Prerequisite
1. Per BHIN 21-073, a mental health diagnosis is not a
prerequisite for access to covered SMHS. This does not
eliminate the requirement that all Medi-Cal claims,
including SMHS claims, include a current Centers for
B-8
Exhibit B
Medicare & Medicaid Services (CMS) approved ICD
diagnosis code
d. MEDICAL NECESSITY
i. Contractor will ensure that services provided are medically
necessary in compliance with BHIN 21-073 and pursuant to
Welfare and Institutions Code section 14184.402(a). Services
provided to a client must be medically necessary and clinically
appropriate to address the individual's presenting condition.
Documentation in each individual's chart as a whole will
demonstrate medical necessity as defined below, based on the
client's age at the time of service provision.
ii. For individuals 21 years of age or older, a service is "medically
necessary" or a "medical necessity" when it is reasonable and
necessary to protect life, to prevent significant illness or significant
disability, or to alleviate severe pain as set forth in Welfare and
Institutions Code section 14059.5.
iii. For individuals under 21 years of age, a service is "medically
necessary" or a "medical necessity" if the service meets the
standards set forth in Section 1396d(r)(5) of Title 42 of the United
States Code.
e. COORDINATION OF CARE
i. Contractor shall ensure that all care, treatment and services
provided pursuant to this Agreement are coordinated among all
providers who are serving the individual, including all other SMHS
providers, as well as providers of Non-Specialty Mental Health
Services (NSMHS), substance use disorder treatment services,
physical health services, dental services, regional center services
and all other services as applicable to ensure a client-centered
and whole-person approach to services.
ii. Contractor shall ensure that care coordination activities support
the monitoring and treatment of comorbid substance use disorder
and/or health conditions.
iii. Contractor shall include in care coordination activities efforts to
connect, refer and link individual s to community-based services
and supports, including but not limited to educational, social,
prevocational, vocational, housing, nutritional, criminal justice,
transportation, childcare, child development, family/marriage
education, cultural sources, and mutual aid support groups.
iv. Contractor shall engage in care coordination activities beginning
at intake and throughout the treatment and discharge planning
processes.
v. To facilitate care coordination, Contractor will request a HIPAA
and California law compliant client authorization to share the
individual's information with and among all other providers
involved in the individual's care, in satisfaction of state and federal
privacy laws and regulations.
f. CO-OCCURRING TREATMENT AND NO WRONG DOOR
B-9
Exhibit B
i. Per BHIN 22-011, Specialty and Non-Specialty Mental Health
Services can be provided concurrently, if those services are
clinically appropriate, coordinated, and not duplicative. When a
client meets criteria for both NSMHS and SMHS, the individual
should receive services based on individual clinical need and
established therapeutic relationships. Clinically appropriate and
covered SMHS can also be provided when the individual has a co-
occurring mental health condition and substance use disorder.
ii. Under this Agreement, Contractor will ensure that individual s
receive timely mental health services without delay. Services are
reimbursable to Contractor by County even when:
1. Services are provided prior to determination of a diagnosis,
during the assessment or prior to determination of whether
SMHS access criteria are met, even if the assessment
ultimately indicates the individual does not meet criteria for
SMHS.
2. If Contractor is serving a individual receiving both SMHS
and NSMHS, Contractor holds responsibility for
documenting coordination of care and ensuring that
services are non-duplicative.
2. AUTHORIZATION AND DOCUMENTATION PROVISIONS
a. SERVICE AUTHORIZATION
i. Contractor will collaborate with County to complete authorization
requests in line with County and DHCS policy.
ii. Contractor shall have in place, and follow, written policies and
procedures for completing requests for initial and continuing
authorizations of services, as required by County guidance.
iii. Contractor shall respond to County in a timely manner when
consultation is necessary for County to make appropriate
authorization determinations.
iv. County shall provide Contractor with written notice of authorization
determinations within the timeframes set forth in BHINs 22-016
and 22-017, or any subsequent DHCS notices.
v. Contractor shall alert County when an expedited authorization
decision (no later than 72 hours) is necessary due to an
individual's specific needs and circumstances that could seriously
jeopardize the individual s life or health, or ability to attain,
maintain, or regain maximum function.
b. DOCUMENTATION REQUIREMENTS
i. Contractor will follow all documentation requirements as specified
in Article 4.2-4.8 inclusive in compliance with federal, state and
County requirements.
ii. All Contractor documentation shall be accurate, complete, and
legible, shall list each date of service, and include the face-to-face
time for each service. Contractor shall document travel and
documentation time for each service separately from face-to-face
time and provide this information to County upon request.
B-10
Exhibit B
Services must be identified as provided in-person, by telephone,
or by telehealth.
iii. All services shall be documented utilizing County-approved
templates and contain all required elements. Contractor agrees to
satisfy the chart documentation requirements set forth in BHIN 22-
019 and the contract between County and DHCS. Failure to
comply with documentation standards specified in this Article
require corrective action plans.
c. ASSESSMENT
i. Contractor shall ensure that all individuals' medical records
include an assessment of each individual's need for mental health
services.
ii. Contractor will utilize the seven uniform assessment domains and
include other required elements as identified in BHIN 22-019 and
document the assessment in the individual's medical record.
iii. For individual s aged 6 through 20, the Child and Adolescent
Needs and Strengths (CANS), and for individual s aged 3 through
18, the Pediatric Symptom Checklist-35 (PSC-35) tools are
required at intake, every six months during treatment, and at
discharge, as specified in DHCS MHSUDS INs 17-052 and 18-
048.
iv. The time period for providers to complete an initial assessment
and subsequent assessments for SMHS are up to clinical
discretion of County; however, Contractor's providers shall
complete assessments within a reasonable time and in
accordance with generally accepted standards of practice.
d. ICD-10
i. Contractor shall use the criteria set forth in the current edition of
the DSM as the clinical tool to make diagnostic determinations.
ii. Once a DSM diagnosis is determined, the Contractor shall
determine the corresponding mental health diagnosis in the
current edition of ICD. Contractor shall use the ICD diagnosis
code(s)to submit a claim for SMHS to receive reimbursement
from County.
iii. The ICD Tabular List of Diseases and Injuries is maintained by
CMS and may be updated during the term of this Agreement.
Changes to the lists of ICD diagnoses do not require an
amendment to this Agreement, and County may implement these
changes as provided by CMS
e. PROBLEM LIST
i. Contractor will create and maintain a Problem List for each
individual served under this Agreement. The problem list is a list of
symptoms, conditions, diagnoses, and/or risk factors identified
through assessment, psychiatric diagnostic evaluation, crisis
encounters, or other types of service encounters.
ii. Contractor must document a problem list that adheres to industry
standards utilizing at minimum current SNOMED International,
B-11
Exhibit B
Systematized Nomenclature of Medicine Clinical Terms
(SNOMED CT®) U.S. Edition, September 2022 Release, and ICD-
10-CM 2023.
iii. A problem identified during a service encounter may be addressed
by the service provider during that service encounter and
subsequently added to the problem list.
iv. The problem list shall include, but is not limited to, all elements
specified in BHIN 22-019.
v. County does not require the problem list to be updated within a
specific timeframe or have a requirement about how frequently the
problem list should be updated after a problem has initially been
added. However, Contractor shall update the problem list within a
reasonable time such that the problem list reflects the current
issues facing the client, in accordance with generally accepted
standards of practice and in specific circumstances specified in
BHIN 22-019.
f. TREATMENT AND CARE PLANS
i. Contractor is not required to complete treatment or care plans for
clients under this Agreement, except in the circumstances
specified in BHIN 22-019 and additional guidance from DHCS that
may follow after execution of this Agreement.
g. PROGRESS NOTES
i. Contractor shall create progress notes for the provision of all
SMHS services provided under this Agreement.
ii. Each progress note shall provide sufficient detail to support the
service code selected for the service type as indicated by the
service code description.
iii. Progress notes shall include all elements specified in BHIN 22-
019, whether the note be for an individual or a group service.
iv. Contractor shall complete progress notes within three business
days of providing a service, with the exception of notes for crisis
services, which shall be completed within 24 hours.
v. Providers shall complete a daily progress note for services that
are billed on a daily basis, such as residential and day treatment
services, if applicable.
h. TRANSITION OF CARE TOOL
i. Contractor shall use a Transition of Care Tool for any individual
whose existing services will be transferred from Contractor to an
Medi-Cal Managed Care Plan (MCP) provider or when NSMHS
will be added to the existing mental health treatment provided by
Contractor, as specified in BHIN 22-065, in order to ensure
continuity of care.
ii. Determinations to transition care or add services from an MCP
shall be made in alignment with County policies and via a person-
centered, shared decision-making process.
iii. Contractor may directly use the DHCS-provided Transition of Care
Tool, found at https://www.dhcs.ca.gov/Pages/Screening-and-
B-12
Exhibit B
Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-
Services.aspx, or obtain a copy of that tool provided by the
County. Contractor may create the Transition of Care Tool in its
Electronic Health Record (EHR). However, the contents of the
Transition of Care Tool, including the specific wording and order of
fields, shall remain identical to the DHCS provided form. The only
exception to this requirement is when the tool is translated into
languages other than English.
i. TELEHEALTH
i. Contractor may use telehealth, when it deems clinically
appropriate, as a mode of delivering behavioral health services in
accordance with all applicable County, state, and federal
requirements, including those related to privacy/security,
efficiency, and standards of care. Such services will conform to
the definitions and meet the requirements included in the Medi-Cal
Provider Manual: Telehealth, available in the DHCS Telehealth
Resources page at:
httos://www.dhcs.ca.gov/i)rovgovparUPages/Telehealth Resources
.aspx.
ii. All telehealth equipment and service locations must ensure that
client confidentiality is maintained.
iii. Licensed providers and staff may provide services via telephone
and telehealth as long as the service is within their scope of
practice.
iv. Medical records for individuals served by Contractor under this
Agreement must include documentation of written or verbal
consent for telehealth or telephone services if such services are
provided by Contractor. Such consent must be obtained at least
once prior to initiating applicable health care services and consent
must include all elements as specified in BHIN 22-019.
v. County may at any time audit Contractor's telehealth practices,
and Contractor must allow access to all materials needed to
adequately monitor Contractor's adherence to telehealth
standards and requirements.
3. CLIENT PROTECTIONS
a. GRIEVANCES, APPEALS AND NOTICES OF ADVERSE BENEFIT
DETERMINATION
i. All grievances (as defined by 42 C.F.R. § 438.400) and complaints
received by Contractor must be immediately forwarded to the
County's Managed Care Department or other designated persons
via a secure method (e.g., encrypted email or by fax) to allow
ample time for the Managed Care staff to acknowledge receipt of
the grievance and complaints and issue appropriate responses.
ii. Contractor shall not discourage the filing of grievances and
individual s do not need to use the term "grievance" for a
complaint to be captured as an expression of dissatisfaction and,
therefore, a grievance.
B-13
Exhibit B
iii. Aligned with MHSUDS IN 18-010E and 42 C.F.R. §438.404, the
appropriate and delegated Notice of Adverse Benefit
Determination (NOABD) must be issued by Contractor within the
specified timeframes using the template provided by the County.
iv. NOABDs must be issued to individuals anytime the Contractor has
made or intends to make an adverse benefit determination that
includes the reduction, suspension, or termination of a previously
authorized service and/or the failure to provide services in a timely
manner. The notice must have a clear and concise explanation of
the reason(s) for the decision as established by DHCS and the
County. The Contractor must inform the County immediately after
issuing a NOABD.
v. Procedures and timeframes for responding to grievances, issuing
and responding to adverse benefit determinations, appeals, and
state hearings must be followed as per 42 C.F.R., Part 438,
Subpart F (42 C.F.R. §§ 438.400 —438.424).
vi. Contractor must provide individuals any reasonable assistance in
completing forms and taking other procedural steps related to a
grievance or appeal such as auxiliary aids and interpreter
services.
vii. Contractor must maintain records of grievances and appeals and
must review the information as part of its ongoing monitoring
procedures. The record must be accurately maintained in a
manner accessible to the County and available upon request to
DHCS.
b. Advanced Directives
i. Contractor must comply with all County policies and procedures
regarding Advanced Directives in compliance with the
requirements of 42 C.F.R. §§422.128 and 438.6(i) (1), (3) and (4).
c. Continuity of Care
i. Contractor shall follow the County's continuity of care policy that is
in accordance with applicable state and federal regulations,
MHSUDS IN 18-059 and any BHINs issued by DHCS for parity in
mental health and substance use disorder benefits subsequent to
the effective date of this Agreement (42 C.F.R. §438.62(b)(1)-(2).)
4. QUALITY IMPROVEMENT PROGRAM
a. QUALITY IMPROVEMENT ACTIVITIES AND PARTICIPATION
i. Contractor shall implement mechanisms to assess person
served/family satisfaction based on County's guidance. The
Contractor shall assess individual/family satisfaction by:
1. Surveying person served/family satisfaction with the
Contractor's services at least annually.
2. Evaluating person served's grievances, appeals and State
Hearings at least annually.
3. Evaluating requests to change persons providing services
at least annually.
B-14
Exhibit B
4. Informing the County and individuals of the results of
client/family satisfaction activities.
ii. Contractor, if applicable, shall implement mechanisms to monitor
the safety and effectiveness of medication practices. This
mechanism shall be under the supervision of a person licensed to
prescribe or dispense prescription drugs, at least annually and as
required by DBH.
iii. Contractor shall implement mechanisms to monitor appropriate
and timely intervention of occurrences that raise quality of care
concerns. The Contractor shall take appropriate follow-up action
when such an occurrence is identified. The results of the
intervention shall be evaluated by the Contractor at least annually
and shared with the County.
iv. Contractor shall assist County, as needed, with the development
and implementation of Corrective Action Plans.
v. Contractor shall collaborate with County to create a QI Work Plan
with documented annual evaluations and documented revisions
as needed. The QI Work Plan shall evaluate the impact and
effectiveness of its quality assessment and performance
improvement program.
vi. Contractor shall attend and participate in the County's Quality
Improvement Committee (QIC) to recommend policy decisions,
review and evaluate results of QI activities, including PIPs,
institute needed QI actions, and ensure follow-up of QI processes.
Contractor shall ensure that there is active participation by the
Contractor's practitioners and providers in the QIC.
vii. Contractor shall participate, as required, in annual, independent
external quality reviews (EQR) of the quality, timeliness, and
access to the services covered under this Contract, which are
conducted pursuant to Subpart E of Part 438 of the Code of
Federal Regulations. (42 C.F.R. §§ 438.350(a) and 438.320)
b. TIMELY ACCESS
i. Timely access standards include:
1. Contractor must have hours of operation during which
services are provided to Medi-Cal individuals that are no
less than the hours of operation during which the provider
offers services to non-Medi-Cal individual s. If the
Contractor's provider only serves Medi-Cal clients, the
provider must provide hours of operation comparable to
the hours the provider makes available for Medi-Cal
services that are not covered by the Agreement or another
County.
2. Appointments data, including wait times for requested
services, must be recorded and tracked by Contractor, and
submitted to the County on a monthly basis in a format
specified by the County. Appointments' data should be
submitted to the County's Quality Management
Department or other designated persons.
B-15
Exhibit B
3. Urgent care appointments for services that do not require
prior authorization must be provided to individual s within
48 hours of a request. Urgent appointments for services
that do require prior authorization must be provided to
clients within 96 hours of request.
4. Non-urgent non-psychiatry mental health services,
including, but not limited to Assessment, Targeted Case
Management, and Individual and Group Therapy
appointments (for both adult and children/youth) must be
made available to Medi-Cal individuals within 10 business
days from the date the individual or a provider acting on
behalf of the individual, requests an appointment for a
medically necessary service. Non-urgent psychiatry
appointments (for both adult and children/youth) must be
made available to Medi-Cal individual s within 15 business
days from the date the client or a provider acting on behalf
of the individual, requests an appointment for a medically
necessary service.
5. Applicable appointment time standards may be extended if
the referring or treating provider has determined and noted
in the individual's record that a longer waiting period will
not have a detrimental impact on the health of the
individual.
6. Periodic office visits to monitor and treat mental health
conditions may be scheduled in advance consistent with
professionally recognized standards of practice as
determined by the treating licensed mental health provider
acting within the scope of their practice.
c. PROVIDER APPLICATION AND VALIDATION FOR ENROLLMENT
(PAVE)
i. Contractor shall ensure that all of its required clinical staff, who
are rendering SMHS to Medi-Cal individuals on behalf of
Contractor, are registered through DHCS' Provider Application
and Validation for Enrollment (PAVE) portal, pursuant to BHIN 20-
071 requirements, the 21st Century Cures Act and the CMS
Medicaid and Children's Health Insurance Program (CHIP)
Managed Care Final Rule.
ii. SMHS licensed individuals required to enroll via the "Ordering,
Referring and Prescribing" (ORP) PAVE enrollment pathway (i.e.
PAVE application package) available through the DHCS PIED
Pave Portal, include: Licensed Clinical Social Worker (LCSW),
Licensed Marriage and Family Therapist (LMFT), Licensed
Professional Clinical Counselor (LPCC), Psychologist, Licensed
Educational Psychologist, Physician (MD and DO), Physician
Assistant, Registered Pharmacist/Pharmacist, Certified
Pediatric/Family Nurse Practitioner, Nurse Practitioner,
Occupational Therapist, and Speech-Language Pathologist.
Interns, trainees, and associates are not eligible for enrollment.
B-16
Exhibit B
d. PHYSICIAN INCENTIVE PLAN
i. If Contractor wants to institute a Physician Incentive Plan,
Contractor shall submit the proposed plan to the County which will
in turn submit the Plan to the State for approval, in accordance
with the provisions of 42 C.F.R. § 438.6(c).
5. DATA, PRIVACY AND SECURITY REQUIREMENTS
a. ELECTRONIC PRIVACY AND SECURITY
i. Contractor shall have a secure email system and send any email
containing PII or PHI in a secure and encrypted manner.
Contractor's email transmissions shall display a warning banner
stating that data is confidential, systems activities are monitored
and logged for administrative and security purposes, systems use
is for authorized users only, and that users are directed to log off
the system if they do not agree with these requirements.
ii. Contractor shall institute compliant password management
policies and procedures, which shall include but not be limited to
procedures for creating, changing, and safeguarding passwords.
Contractor shall establish guidelines for creating passwords and
ensuring that passwords expire and are changed at least once
every 90 days.
iii. Any Electronic Health Records (EHRs) maintained by Contractor
that contain PHI or PII for individuals served through this
Agreement shall contain a warning banner regarding the PHI or
PII contained within the EHR. Contractors that utilize an EHR shall
maintain all parts of the clinical record that are not stored in the
EHR, including but not limited to the following examples of client
signed documents: discharge plans, informing materials, and
health questionnaire.
iv. Contractor entering data into any County electronic systems shall
ensure that staff are trained to enter and maintain data within this
system.
6. PROGRAM INTEGRITY
a. Credentialing and Re-credentialing of Providers
i. Contractor shall ensure that all of their network providers
delivering covered services, sign and date an attestation
statement on a form provided by County, in which each provider
attests to the following:
1. Any limitations or inabilities that affect the provider's ability
to perform any of the position's essential functions, with or
without accommodation;
2. A history of loss of license or felony convictions;
3. A history of loss or limitation of privileges or disciplinary
activity;
4. A lack of present illegal drug use; and
5. The application's accuracy and completeness
B-17
Exhibit B
ii. Contractor must file and keep track of attestation statements,
credentialing applications and credentialing status for all of their
providers and must make those available to the County upon
request at any time.
iii. Contractor is required to sign an annual attestation statement at
the time of Agreement renewal in which they will attest that they
will follow County's Credentialing Policy and MHSUDS IN 18-019
and ensure that all of their rendering providers are credentialed as
per established guidelines.
B-18
Fresno County Department of Behavioral Health Exhibit C
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
1
rev 01-02-2020
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two-Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness;these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
2
rev 01-02-2020
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
6. Principle Six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight-Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine -Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
3
rev 01-02-2020
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
10. Principle Ten -Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals,families, and community
members
4
rev 01-02-2020
Exhibit D
DOCUMENTATION STANDARDS FOR PERSON SERVED RECORDS
The documentation standards are described below under key topics related to care for persons
served. All standards must be addressed in the person served's record; however, there is no
requirement that the record have a specific document or section addressing these topics. All
medical records shall be maintained for a minimum of 10 years from the date of the end of the
Agreement.
A. Assessments
1. The following areas will be included as a part of a comprehensive person served's
record:
• Presenting problems, including impairments in function, and current mental
status exam.
• Traumatic incidents which include trauma exposures, trauma reactions, trauma
screenings, and systems involvement if relevant
• Behavioral health history including mental health history, substance use/abuse,
and previous services
• Medical history including physical health conditions, medications, and
developmental history
• Psychosocial factors including family, social and life circumstances, cultural
considerations
• Strengths, risks, and protective factors, including safety planning
• Clinical summary, treatment recommendations, and level of care determination
including diagnostic and clinical impression with a diagnosis
• The assessment shall include a typed or legibly printed name, signature of the
service provider and date of signature.
2. Timeliness/Frequency Standard for Assessment
• The time period to complete an initial assessment and subsequent assessments
for SMHS is up to clinical discretion.
• Assessments shall be completed within a reasonable time and in accordance
with generally accepted standards of practice.
B. Problem list
The use of a Problem List has largely replaced the use of treatment plans and is
therefore required to be part of the person served's record. The problem list shall be
updated on an ongoing basis to reflect the current presentation of the person in care.
The problem list shall include, but is not limited to, the following:
• Diagnoses identified by a provider acting within their scope of practice
• Problems identified by a provider acting within their scope of practice
• Problems or illnesses identified by the person in care and/or significant support
person if any
• The name and title of the provider that identified, added, or removed the problem,
and the date the problem was identified, added, or removed
Rev 04/2023 D-1
Exhibit D
C. Treatment and Care Plan Requirements
1. Targeted Case Management
• Specifies the goals, treatment, service activities, and assistance to address the
negotiated objectives of the plan and the medical, social, educational, and other
services needed by the person in care
• Identifies a course of action to respond to the assessed needs of the person in
care
• Includes development of a transition plan when the person in care has achieved
the goals of the care plan
• Peer support services must be based on an approved care plan
• Must be provided in a narrative format in the person's progress notes
• Updated at least annually
2. Services requiring Treatments Plans
• Intensive Home-Based Services (IHBS)
• Intensive Care Coordination (ICC)
• Therapeutic Behavioral Services (TBS)
• Must have specific observable and/or specific quantifiable goals
• Must identify the proposed type(s) of intervention
• Must be signed (or electronic equivalent) by:
➢ the person providing the service(s), or
➢ a person representing a team or program providing services, or
➢ a person representing the MHP providing services
➢ when the person served's plan is used to establish that the services are
provided under the direction of an approved category of staff, and if the below
staff are not the approved category,
➢ a physician
➢ a licensed/"waivered" psychologist
➢ a licensed/"associate" social worker
➢ a licensed/registered/marriage and family therapist or
➢ a registered nurse
• In addition,
➢ Person served's plans will be consistent with the diagnosis, and the focus of
intervention will be consistent with the person served's plan goals, and there will
be documentation of the person served's participation in and agreement with
the plan. Examples of the documentation include, but are not limited to,
reference to the person served's participation and agreement in the body of the
plan, person served's signature on the plan, or a description of the person
served's participation and agreement in progress notes.
➢ Person served's signature on the plan will be used as the means by which the
Contractor documents the participation of the person served. When the person
served's signature is required on the person served's plan and the person
Rev 04/2023 D-2
Exhibit D
served refuses or is unavailable for signature, the person served's plan will
include a written explanation of the refusal or unavailability.
➢ The Contractor will give a copy of the person served's plan to the person served
on request.
D. Progress Notes
1. Providers shall create progress notes for the provision of all SMHS. Each progress
note shall provide sufficient detail to support the service code selected for the service
type as indicated by the service code description. Progress notes shall include:
• The type of service rendered.
• A narrative describing the service, including how the service addressed the
beneficiary's behavioral health need (e.g., symptom, condition, diagnosis, and/or
risk factors).
• The date that the service was provided to the beneficiary.
• Duration of the service, including travel and documentation time.
• Location of the beneficiary at the time of receiving the service.
• A typed or legibly printed name, signature of the service provider and date of
signature.
• ICD 10 code
• Current Procedural Terminology (CPT) or Healthcare Common Procedure
Coding System (HCPCS) code.
• Next steps including, but not limited to, planned action steps by the provider or by
the beneficiary, collaboration with the beneficiary, collaboration with other
provider(s) and any update to the problem list as appropriate.
2. Timeliness/Frequency of Progress Notes
• Progress notes shall be completed within 3 business days of providing a service,
except for notes for crisis services, which shall be completed within 24 hours.
• A note must be completed for every service contact
Exhibit E
Behavioral Health Bridge Housing-Pheniox Landing
RH Community Builders
Fiscal Year(FY) 2023-2024
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Director 0.15 $ 11,700 $ 11,700
1102 Program Manager 0.50 26,001 26,001
1103 Fiscal Analyst 0.25 8,736 8,736
1104 -
1105
1106
1107
1108
1109 -
1110 -
1111 -
1112 -
1113 -
1114 -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.90 $ 46,437 $ 46,437
Acct# Program Position FTE Admin Program Total
1116 Certified Nursing Assistant 3.00 $ 78,003 $ 78,003
1117 Driver 2.00 41,602 41,602
1118 Maintenance Tech 2.00 63,789 63,789
1119 Food Service 1.00 20,801 20,801
1120 Overnight Monitor 1.00 124,805 124,805
1121 Janitor 2.00 34,668 34,668
1122 - -
1123 - -
1124 - -
1125 - -
1126 - -
1127 - -
1128 - -
1129 - -
1130 - -
1131 - -
1132 - -
1133 - -
1134 - -
Direct Personnel Program Salaries Subtotal 11.00 $ 363,668 $ 363,668
Admin Program Total
Direct Personnel Salaries Subtotal 11.90 $ 46,437 $ 363,668 $ 410,195
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 720 $ 11,200 $ 11,920
1202 Worker's Compensation 4,149 29,093 33,242
1203 Health Insurance 3,800 64,000 67,800
1204 Other(specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
1205 10ther(specify) -
1206 10ther(specify) - -
Direct Employee Benefits Subtotal:l $ 8,669 1 $ 104,293 1 $ 112,962
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 2,879 $ 22,547 $ 25,426
1302 FICA/MEDICARE 673 5,273 5,946
1303 SUI 1,532 12,001 13,533
1304 Employer Training Tax 46 365 411
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 5,130 $ 40,186 $ 45,316
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 60,236 $ 508,147 $ 568,383
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
11%1 89.
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 20,000
2003 Client Transportation&Support
2004 Clothing, Food,&Hygiene 175,000
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other: Recreational Activities
2012 Other: Landlord Engagement Funds
2013 Other(specify)
2014 Other(specify)
2015 Other(specify) -
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 195,000
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 8,000
3002 Printing/Postage 630
3003 Office, Household&Program Supplies 21,000
3004 Advertising
3005 Staff Development&Training 11,520
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance 1,260
3009 Vehicle Insurance 3,780
3010 Othe Required Insurance Coverage 17,700
3011
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 63,890
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 9,900
4002 Rent/Lease Building 200,000
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles 11,170
4005 Security 120,000
4006 Utilities 41,491
4007 Other(specify)
4008 Other(specify) -
4009 Other(specify) -
4010 10ther(specify) -
DIRECTFACILITIES/EQUIPMENT TOTAL: $ 382,561
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 25,860
5002 HMIS(Health Management Information System) 865
5003 Contractual/Consulting Services: Emp Background Checks&CPR Cert Cards 8,420
5004 Translation Services 3,000
5005 Other:SmartCare Fees
5006 Other: Reaching Recovery Fees
5007 Other:Contracted Services(MD/NP)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 38,145
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 161,100
Administrative Overhead
6002 113rofessional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits)
6009 Other: Indirect Cost
6010 Other:Contracted Services
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 161,100
INDIRECT COST RATE 2.27%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 95,000
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 15,000
7003 Furniture&Fixtures 68,000
7004 Leasehold/Tenant/Building Improvements 205,543
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Acqusition of 4141 N Blackstone Ave 5,458,333
7008 Other(specify) -
FIXED ASSETS EXPENSES TOTAL $ 5,841,876
TOTAL PROGRAM EXPENSES $ 7,250,955
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 59%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 1 53%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports
8302 PEI -Prevention&Early Intervention
8303 INN- Innovations
8304 WET-Workforce Education &Training
8305 jCFTN -Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants Operations 1,772,622
8404 BHBH Infastructure 5,478,J
8405 Other(Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
I OTHER REVENUE TOTALI $ 7,250,955
TOTAL PROGRAM FUNDING SOURCES: $ 7,250,955
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing- Pheniox Landing
RH Community Builders
Fiscal Year (FY) 2023-2024
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Director BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.20
CalAIM/Sierra BHBH/Fresno County 0.15
BHBH/Rodeway BHBH/Fresno County DBH 0.15
Medi-Cal/Rodeway BHBH/Fresno County 0.25
CalAIM/Rodeway BHBH/Fresno County 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager BHBH/Rodeway BHBH/Fresno County DBH 0.50
Medi-Cal/Rodeway BHBH/Fresno County 0.50
Total 1.00
Position Contract#/Name/Department/County FTE
Fiscal Analyst BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
The Lodge/Fresno County DBH 0.25
CalAIM Fresno/Anthem Blue Cross/Fresno 0.05
Total 1.00
Position Contract#/Name/Department/County FTE
Certified Nursing Assistant BHBH/Rodeway BHBH/Fresno County DBH 3.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 3.00
Position Contract#/Name/Department/County FTE
Driver BHBH/Rodeway BHBH/Fresno County DBH 2.00
Total 2.00
Position Contract#/Name/Department/County FTE
Maintenance Tech BHBH/Rodeway BHBH/Fresno County DBH 2.00
Total 2.00
Position Contract#/Name/Department/County FTE
Food Service BHBH/Rodeway BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Overnight Monitor BHBH/Rodeway BHBH/Fresno County DBH 6.00
Total 6.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Position Contract#/Name/Department/County FTE
Janitor BHBH/Rodeway BHBH/Fresno County DBH 2.00
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Pheniox Landing
RH Community Builders
Fiscal Year(FY)2023-2024 Budget Narrative
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 568,383
Administrative Positions 46,437
1101 Director $ 10,920 Responsible for contract compliance and daily support of Program Manager
1102 Program Manager 36,401 Responsible for day to day management of program including staff support
1103 Fiscal Analyst 12,740 Responsible for fiscal management of the program including complaince with funding
1104 -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Program Positions 363,668
1116 Certified Nursing Assistant 78,003 Responsible for teaching daily living skills to clients including bathing and wound care.
1117 Driver 41,602 Responsible for transporting clients to appointments including medical,housing,and
1118 Maintenance Tech 63,789 Responsibel for repairs to facility for client caused damage.
1119 Food Service 20,801 Responsible for ensuring food is stored properly and clients receive daily meals
1120 Overnight Monitor 124,805 Resposnible for oversight of facility and client needs,ensuring safety and operations.
1121 Janitor 34,668 Responsible for keeping client rooms and common space clean.
1122 -
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits
1201 Retirement Match up to 3%of employee contribuitons
1202 Worker's Compensation Required worker's compensation coverage
1203 Health Insurance 80%employer paid coverage
1204 Other(specify)
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 45,316
1301 OASDI 25,426 Required OASDI taxes
1302 FICA/MEDICARE 5,946 Required FICA/MEDICARE taxes
1303 SUI 13,533 Required SUI taxes
1304 Employer Training Tax 411 Required ETT
1305 Other(specify) -
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 195,000
2001 Child Care -
2002 Client Housing Support 20,000 Short/Medium Term Rental Assistance and Deposits for Clients.
2003 Client Transportation&Support -
2004 Clothing,Food,&Hygiene 175,000 3 meals daily,snacks,basic clothing,and hygiene for clients
2005 Education Support
2006 Employment Support -
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other:Recreational Activities
2012 Other:Landlord Engagement Funds
2013 Other(specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 63,890
3001 Telecommunications 8,000 Cellphones,emails,etc.for program
3002 Printing/Postage 630 Business cards,monthly copier expense
3003 Office,Household&Program Supplies 21,000 Supplies for program operations including office supplies,cleaning supplies,and other
household items
3004 Advertising - Advertising for hiring,program promotion
3005 Staff Development&Training 11,520 Training for staff including MH First Aid,conferences related to work,and ProACT
3006 Staff Mileage -
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 1,260 Maintenance of program vehicles
3009 Vehicle Insurance 3,780 Required insurance for driver coverage
3010 Othe Required Insurance Coverage 17,700 Required insurances per contract requirements
3011 0 -
3012 Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 382,561
4001 Building Maintenance 9,900 Upkeep of facility for client caused damage
4002 Rent/Lease Building 200,000 Monthly rent for entire facility
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles 11,170 Monthly rent of vehicle for transporation fo clients
4005 Security 120,000 Standing security guard at site 24/7
4006 Utilities 41,491 Monthly expenses including internet,gas,water,electric and garbage.
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 38,145
5001 Consultant(Network&Data Management) 25,860 IT consulting
5002 HMIS(Health Management Information System) 865 HMIS access
5003 Contractual/Consulting Services:Emp Background 8,420 Backgrounds,drug testing staff management software,and timekeeping,
5004 Translation Services 3,000 Language line fees
5005 Other:SmartCare Fees -
5006 Other:Reaching Recovery Fees
5007 Other:Contracted Services(MD/NP)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 161,100
6001 Administrative Overhead 161,100 10%De Minimus Rate
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other:Indirect Cost
6010 Other:Contracted Services
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 5,841,876
7001 Computer Equipment&Software 95,000 Replacement devices as needed
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 15,000 Replacement devices as needed
7003 Furniture&Fixtures 68,000 Replacement client beds or room furniture
7004 Leasehold/Tenant/Building Improvements 205,543 Improvements to initial facility including safety and security improvements,
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Acqusition of 4141 N Blackstone Ave 5,458,333
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
F-
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 1 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 7,250,955
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 7,250,955
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Pheniox Landing
RH Community Builders
Fiscal Year(FY) 2024-2025
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Director 0.20 $ 26,209 $ 26,209
1102 Program Manager 0.50 43,682 43,682
1103 Fiscal Analyst 0.25 18,097 18,097
1104 -
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111 -
1112 -
1113 -
1114 -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.95 $ 87,988 $ 87,988
Acct# Program Position FTE Admin Program Total
1116 Certified Nursing Assistant 4.00 $ 216,328 $ 216,328
1117 Driver 1.00 95,684 95,684
1118 Maintenance Tech 1.00 99,844 99,844
1119 Food Service 1.00 43,682 43,682
1120 Overnight Monitor 1.00 43,682 43,682
1121 Janitor 2.00 87,363 87,363
1122 -
1123 -
1124 -
1125 -
1126 -
1127 -
1128 -
1129 -
1130 -
1131 -
1132 -
1133 -
1134 - -
Direct Personnel Program Salaries Subtotal 10.00 $ 586,583 $ 586,583
Admin Program Total
Direct Personnel Salaries Subtotal 10.95 $ 87,988 $ 586,583 $ 674,571
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,020 $ 14,400 $ 15,420
1202 Worker's Compensation 7,039 46,927 53,966
1203 Health Insurance 4,560 67,200 71,760
1204 Other(specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
1205 10ther(specify) I -
1206 10ther(specify) I - -
Direct Employee Benefits Subtotal:j $ 12,619 1 $ 128,527 1 $ 141,146
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 5,455 $ 36,368 $ 41,823
1302 FICA/MEDICARE 1,276 8,505 9,781
1303 SUI 2,904 19,357 22,261
1304 Employer Training Tax 88 587 675
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 9,723 $ 64,817 $ 74,540
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 110,330 $ 779,927 $ 890,257
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
12%1 88.
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 25,000
2003 Client Transportation&Support 2,700
2004 Clothing, Food,&Hygiene 100,000
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical 5,000
2010 Utility Vouchers
2011 Other: Recreational Activities
2012 Other: Landlord Engagement 30,000
2013 Other(specify)
2014 Other(specify) -
2015 Other(specify) j
2016 Other(specify) DIRECT CLIENT CARE TOTAL $ 162,7
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 6,264
3002 Printing/Postage 270
3003 Office, Household&Program Supplies 10,380
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions& Memberships
3008 Vehicle Maintenance 540
3009 Other Vehicle Insurance 1,620
3010 Other Required Insurance Coverage
3011 Other(specify) -
3012 10ther(specify) -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
DIRECT OPERATING EXPENSES TOTAL: $ 19,0741
4000:DIRECT FACILITIES&EQUIPMENT
Acct# line Item Description Amount
4001 Building Maintenance $ 19,800
4002 Rent/Lease Building 400,000
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles 22,340
4005 Security 270,000
4006 Utilities 82,980
4007 Other(specify)
4008 Other(specify)
4009 10ther(specify) -
4010 10ther(specify) -
DIRECTFACILITIES/EQUIPMENTTOTAL: $ 795,120
5000:DIRECT SPECIAL EXPENSES
Acct# line Item Description Amount
5001 Consultant(Network&Data Management) $ 15,000
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services: Emp Background Checks&CPR Cert Cards 3,600
5004 Translation Services 1,500
5005 Other:SmartCare Fees
5006 Other: Reaching Recovery Fees
5007 Other:Contracted Services(MD/NP)
5008 Other(specify) j
DIRECT SPECIAL EXPENSES TOTAL: $ 20,1
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 186,785
Administrative Overhead
6002 113rofessional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits)
6009 Other: Indirect Cost
6010 Other:Contracted Services
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 186,785
INDIRECT COST RATE 9.87%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 1,000
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 1,000
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
7003 Furniture&Fixtures 3,600
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,600
TOTAL PROGRAM EXPENSES $ 2,079,636
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 59%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 1 53%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports
8302 PEI -Prevention & Early Intervention
8303 INN- Innovations
8304 WET-Workforce Education&Training
8305 jCFTN-Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify) -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
8404 JBHBH Operations 1 2,054,636
8405 JBHBH Infastructure 1 25,000
OTHER REVENUE TOTALI $ 2,079,636
TOTAL PROGRAM FUNDING SOURCES: 1 $ 2,079,636
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing- Pheonix Landing
RH Community Builders
Fiscal Year (FY) 2024-25
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Director BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
CalAIM/Sierra BHBH/Fresno County 0.15
BHBH/Rodeway BHBH/Fresno County DBH 0.20
Medi-Cal/Rodeway BHBH/Fresno County 0.15
CalAIM/Rodeway BHBH/Fresno County 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager BHBH/Rodeway BHBH/Fresno County DBH 0.50
Medi-Cal/Rodeway BHBH/Fresno County 0.50
Total 1.00
Position Contract#/Name/Department/County FTE
Fiscal Analyst BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
The Lodge/Fresno County DBH 0.25
CalAIM Fresno/Anthem Blue Cross/Fresno 0.05
Total 1.00
Position Contract#/Name/Department/County FTE
Certified Nursing Assistant BHBH/Rodeway BHBH/Fresno County DBH 4.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 4.00
Position Contract#/Name/Department/County FTE
Driver BHBH/Rodeway BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Maintenance Tech BHBH/Rodeway BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Food Service BHBH/Rodeway BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Overnight Monitor BHBH/Rodeway BHBH/Fresno County DBH 6.00
Total 6.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Position Contract#/Name/Department/County FTE
Janitor BHBH/Rodeway BHBH/Fresno County DBH 2.00
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Pheniox Landing
RH Community Builders
Fiscal Year(FY)2024-2025 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 890,257
Administrative Positions 87,988
1101 26,209 Responsible for contract compliance and daily support of Program Manager
1102 43,682 Responsible for day to day management of program including staff support
1103 18,097 Responsible for fiscal management of the program including complaince with funding
1104 -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115 -
Program Positions 586,583
1116 216,328 Responsible for teaching daily living skills to clients including bathing and wound care.
1117 95,684 Responsible for transporting clients to appointments including medical,housing,and
1118 99,844 Responsibel for repairs to facility for client caused damage.
1119 43,682 Responsible for ensuring food is stored properly and clients receive daily meals
1120 43,682 Responnible for oversight of facility and client needs,ensuring safety and operations.
1121 87,363 Responsible for keeping client rooms and common space clean.
1122 -
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134 -
Direct Employee Benefits 141,146
1201 Retirement 15,420 Match up to 3%of employee contribuitons
1202 Worker's Compensation 53,966 Required worker's compensation coverage
1203 Health Insurance 71,760 80%employer paid coverage
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 74,540
1301 OASDI 41,823 Required OASDI taxes
1302 FICA/MEDICARE 9,781 Required FICA/MEDICARE taxes
1303 SUI 22,261 Required SUI taxes
1304 Employer Training Tax 675 Required ETT
1305 Other(specify) -
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 262,700
2001 Child Care -
2002 Client Housing Support 25,000 Short/Medium Term Rental Assistance and Deposits for Clients.
2003 Client Transportation&Support 2,700 Gas for client transports and bus passes
2004 Clothing,Food,&Hygiene 100,000 3 meals daily,snacks,basic clothing,and hygiene for clients
2005 Education Support
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical 5,000 Wound care and medical supplies including RX co-pays for for clients
2010 Utility Vouchers -
2011 Other:Recreational Activities -
2012 Other:Landlord Engagement 30,000 Funds to assist in engaging landlords to assist in locating housing for clients exiting
program.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 19,074
3001 Telecommunications 6,264 Cellphones,emails,etc.for program
3002 Printing/Postage 270 Business cards,monthly copier expense
3003 Office,Household&Program Supplies 10,380 Supplies for program operations including office supplies,cleaning supplies,and other
household items
3004 Advertising -
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 540 Maintenance of program vehicles
3009 Other Vehicle Insurance 1,620 Required insurance for driver coverage
3010 Other Required Insurance Coverage - Required insurances per contract requirements
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 795,120
4001 Building Maintenance 19,800 Upkeep of facility for client caused damage
4002 Rent/Lease Building 400,000 Monthly rent for entire facility
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles 22,340 Monthly rent of vehicle for transporation fo clients
4005 Security 270,000 Standing security guard at site 24/7
4006 Utilities 82,980 Monthly expenses including internet,gas,water,electric and garbage.
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 20,100
5001 Consultant(Network&Data Management) 15,000 IT consulting
5002 HMIS(Health Management Information System) - HMIS access
5003 Contractual/Consulting Services:Emp Background 3,600 Backgrounds,drug testing staff management software,and timekeeping,
5004 Translation Services 1,500 Language line fees
5005 Other:SmartCare Fees
5006 Other:Reaching Recovery Fees -
5007 Other:Contracted Services(MD/NP)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 186,795
6001 Administrative Overhead 186,785 10%De Minimus Rate
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other:Indirect Cost
6010 Other:Contracted Services
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 5,600
7001 Computer Equipment&Software 1,000 Replacement devices as needed
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 1,000 Replacement devices as needed
7003 Furniture&Fixtures 3,600 Replacement client beds or room furniture
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001
8002
8003
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 1 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 2,079,636
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 2,079,636
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Pheniox Landing
RH Community Builders
Fiscal Year(FY) 2025-2026
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Director 0.15 $ 20,281 $ 20,281
1102 Program Manager 0.50 44,722 44,722
1103 Fiscal Analyst 0.25 18,721 18,721
1104 -
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111 -
1112 -
1113 -
1114 -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.90 $ 83,724 $ 83,724
Acct# Program Position FTE Admin Program Total
1116 Certified Nursing Assistant 4.00 $ 224,649 $ 224,649
1117 Driver 1.00 49,922 49,922
1118 Maintenance Tech 2.00 104,004 104,004
1119 Food Service 1.00 45,762 45,762
1120 - -
1121 -
1122 -
1123 -
1124 -
1125 -
1126 -
1127 -
1128 -
1129 -
1130 -
1131 -
1132 -
1133 -
1134 - -
Direct Personnel Program Salaries Subtotal 8.00 $ 424,337 $ 424,337
Admin Program Total
Direct Personnel Salaries Subtotal 8.90 $ 83,724 $ 424,337 $ 508,061
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,140 $ 9,600 $ 10,740
1202 Worker's Compensation 7,954 40,312 48,266
1203 Health Insurance 4,560 62,400 66,960
1204 Other(specify) - - -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
1205 10ther(specify) I - -
1206 10ther(specify) I - -
Direct Employee Benefits Subtotal:j $ 13,654 1 $ 112,312 1 $ 125,966
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 5,191 $ 26,309 $ 31,500
1302 FICA/MEDICARE 1,214 6,153 7,367
1303 SUI 2,763 14,003 16,766
1304 Employer Training Tax 48 424 472
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 9,216 $ 46,889 $ 56,105
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 106,594 $ 583,538 $ 690,132
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
15%1 85.
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 35,000
2003 Client Transportation&Support 2,750
2004 Clothing, Food,&Hygiene 103,000
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical 5,150
2010 Utility Vouchers
2011 Other: Recreational Activities
2012 Other: Landlord Engagment 30,000
2013 Other(specify)
2014 Other(specify)
2015 Other(specify) -
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 175,900
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 6,400
3002 Printing/Postage 270
3003 Office, Household&Program Supplies 10,650
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance 540
3009 Other Vehicle Insurance 1,650
3010 Other Required Insurance Coverage
3011 Other(specify) -
3012 10ther(specify) I -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
DIRECT OPERATING EXPENSES TOTAL: $ 19,5101
4000:DIRECT FACILITIES&EQUIPMENT
Acct# line Item Description Amount
4001 Building Maintenance $ 20,000
4002 Rent/Lease Building 412,000
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles 23,001
4005 Security 278,100
4006 Utilities 85,470
4007 Other(specify) -
4008 Other(specify) -
4009 10ther(specify) -
4010 10ther(specify) -
DIRECTFACILITIES/EQUIPMENTTOTAL: $ 818,571
5000:DIRECT SPECIAL EXPENSES
Acct# line Item Description Amount
5001 Consultant(Network&Data Management) $ 15,450
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services: Emp Background Checks&CPR Cert Cards 3,717
5004 Translation Services 1,500
5005 Other:SmartCare Fees
5006 Other: Reaching Recovery Fees
5007 Other:Contracted Services(MD/NP)
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 20,667
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 169,548
Administrative Overhead
6002 113rofessional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits)
6009 Other: Indirect Cost
6010 Other:Contracted Services
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 169,548
INDIRECT COST RATE 9.80%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 1,000
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 1,000
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
7003 Furniture&Fixtures 3,700
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,700
TOTAL PROGRAM EXPENSES $ 1,900,028
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 59%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 1 53%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports
8302 PEI -Prevention & Early Intervention
8303 INN- Innovations
8304 WET-Workforce Education&Training
8305 jCFTN-Capital Facilities&Technology
MHSA TOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify) -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
8404 JBHBH Operations 1 1,865,028
8405 JBHBH Infastructure 1 35,000
OTHER REVENUE TOTALI $ 1,900,028
TOTAL PROGRAM FUNDING SOURCES: 1 $ 1,900,028
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing- Pheniox Landing
RH Community Builders
Fiscal Year (FY) 2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Director BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
CalAIM/Sierra BHBH/Fresno County 0.15
BHBH/Rodeway BHBH/Fresno County DBH 0.15
Medi-Cal/Rodeway BHBH/Fresno County 0.20
CalAIM/Rodeway BHBH/Fresno County 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager BHBH/Rodeway BHBH/Fresno County DBH 0.50
Medi-Cal/Rodeway BHBH/Fresno County 0.50
Total 1.00
Position Contract#/Name/Department/County FTE
Fiscal Analyst BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
The Lodge/Fresno County DBH 0.25
CalAIM Fresno/Anthem Blue Cross/Fresno 0.05
Total 1.00
Position Contract#/Name/Department/County FTE
Certified Nusing Assistant BHBH/Rodeway BHBH/Fresno County DBH
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 0.00
Position Contract#/Name/Department/County FTE
Driver BHBH/Rodeway BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Maintenance Tech BHBH/Rodeway BHBH/Fresno County DBH 2.00
Total 2.00
Position Contract#/Name/Department/County FTE
Food Service 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Sierra
RH Community Builders
Fiscal Year(FY)2025-2026 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
#### #REFI
Administrative Positions #REF!
#REFI 20,281 Responsible for contract compliance and daily support of Program Manager
#REFI 44,722 Responsible for day to day management of program including staff support
#REFI 18,721 Responsible for fiscal management of the program including complaince with funding
#REFI -
#REF!
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REF! -
Program Positions 424,337
#REF! 224,649 Responsible for teaching daily living skills to clients including bathing and wound care.
#REFI 49,922 Responsible for transporting clients to appointments including medical,housing,and
#REFI 104,004 Responsibel for repairs to facility for client caused damage.
#REFI 45,762 Responsible for ensuring food is stored properly and clients receive daily meals
#REFI -
#REF!
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REF! 125,966
#REFI #REF! 10,740 Match up to 3%of employee contributors
#REFI #REF! 48,266 Required worker's compensation coverage
#REFI #REF! 66,960 80%employer paid coverage
#REFI #REF! -
#REF! #REF!
#REFI #REF! -
#REFI 56,105
#REF! #REF! 31,500 Required OASDI taxes
#REFI #REF! 7,367 Required FICA/MEDICARE taxes
#REFI #REF! 16,766 Required SUI taxes
#REFI #REF! 472 Required ETT
#REFI #REF! -
#REFI #REF! -
#REFI 175,900
#REFI #REF! -
#REF! #REF! 35,000 Short/Medium Term Rental Assistance and Deposits for Clients.
#REFI #REF! 2,750 Gas for client transports and bus passes
#REFI #REF! 103,000 3 meals daily,snacks,basic clothing,and hygiene for clients
#REFI #REF! -
#REF! #REF!
#REFI #REF!
#REFI #REF! -
#REFI #REF! 5,150 Wound care and medical supplies including RX co-pays for for clients
#REFI #REF! -
#REFI Other:Recreational Activities -
#REF! #REF! 30,000 Funds to assist in engaging landlords to assist in locating housing for clients exiting
program.
#REFI #REF! -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! 19,510
#REF! #REF! 6,400 Cellphones,emails,etc.for program
#REF! #REF! 270 Business cards,monthly copier expense
#REF! #REF! 10,650 Supplies for program operations including office supplies,cleaning supplies,and other
household items
#REF! #REF! - Advertising for hiring,program promotion
#REF! #REF! Training for staff including MH First Aid,conferences related to work,and ProACT
#REF! #REF! Mileage reimbursement for staff driving personal vechiles for program business
#REF! #REF!
#REF! #REF! 540 Maintenance of program vehicles
#REF! #REF! 1,650 Required insurance for driver coverage
#REF! #REF! - Required insurances per contract requirements
#REF! #REF!
#REF! #REF!
#REF! 818,571
#REF! #REF! 20,000 Upkeep of facility for client caused damage
#REF! #REF! 412,000 Monthly rent for entire facility
#REF! #REF! -
#REF! #REF! 23,001 Monthly rent of vehicle for transporation fo clients
#REF! #REF! 278,100 Standing security guard at site 24/7
#REF! #REF! 85,470 Monthly expenses including internet,gas,water,electric and garbage.
#REF! #REF! -
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! 20,667
#REF! #REF! 15,450 IT consulting
#REF! #REF! - HMIS access
#REF! Contractual/Consulting Services:Emp Background 3,717 Backgrounds,drug testing staff management software,and timekeeping,
#REF! #REF! 1,500 Language line fees
#REF! Other:SmartCare Fees
#REF! Other:Reaching Recovery Fees -
#REF! Other:Contracted Services(MD/NP)
#REF! #REF! I -
#REF! 169,548
#REF! #REF! 169,548 10%De Minimus Rate
#REF! #REF! -
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF! -
#REF! 5,700
#REF! #REF! 1,000 Replacement devices as needed
#REF! #REF! 1,000 Replacement devices as needed
#REF! #REF! 3,700 Replacement client beds or room furniture
#REF! #REF! -
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
PROGRAM FUNDING SOURCES
#REF!
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
F-
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: #REF!
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,900,028 0
BUDGET CHECK: #REF!
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Pheniox Landing
RH Community Builders
Fiscal Year(FY) 2026-2027
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Director 0.15 $ 20,905 $ 20,905
1102 Program Manager 0.50 45,762 45,762
1103 Fiscal Analyst 0.25 19,345 19,345
1104 - -
1105 -
1106 -
1107 -
1108 -
1109 -
1110 -
1111 -
1112 -
1113 -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.90 $ 86,012 $ 86,012
Acct# Program Position FTE Admin Program Total
1116 Certified Nursing Assistant 4.00 $ 232,969 $ 232,969
1117 Driver 1.00 52,002 52,002
1118 Maintenance Tech 2.00 112,324 112,324
1119 Food Service 1.00 45,762 45,762
1120 -
1121
1122 -
1123 -
1124 -
1125 -
1126 -
1127 -
1128 -
1129 -
1130 -
1131 -
1132 -
1133 -
1134 - -
Direct Personnel Program Salaries Subtotal 8.00 $ 443,057 $ 443,057
Admin Program Total
Direct Personnel Salaries Subtotal 8.90 $ 86,012 $ 443,057 $ 529,069
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,710 $ 14,400 $ 16,110
1202 Worker's Compensation 6,881 35,445 42,326
1203 Health Insurance 5,700 63,840 69,540
1204 Other(specify) - -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
1205 10ther(specify) I - -
1206 10ther(specify) I - -
Direct Employee Benefits Subtotal:j $ 14,291 1 $ 113,685 1 $ 127,976
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 533 $ 27,470 $ 28,003
1302 FICA/MEDICARE 1,247 6,424 7,671
1303 SUI 2,838 14,621 17,459
1304 Other(specify) 86 443 529
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 4,704 $ 48,958 $ 53,662
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 105,007 $ 605,700 $ 710,707
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
15%1 85.
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 50,538
2003 Client Transportation&Support 2,500
2004 Clothing, Food,&Hygiene 106,000
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical 5,300
2010 Utility Vouchers
2011 Other: Recreational Activities
2012 Other: Landlord Engagement Funds 30,000
2013 Other(specify) -
2014 Other(specify) -
2015 Other(specify) -
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 194,338
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 6,645
3002 Printing/Postage 270
3003 Office, Household&Program Supplies 11,000
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions& Memberships
3008 Vehicle Maintenance 570
3009 Other Vehicle Insurance 1,700
3010 Other Required Insurance Coverage
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 20,185
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 20,000
4002 Rent/Lease Building 424,360
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles 23,000
4005 Security 286,443
4006 Utilities 88,035
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 841,838
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 15,500
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services: Emp Background Checks&CPR Cert Cards 3,828
5004 Translation Services 1,500
5005 Other:SmartCare Fees -
5006 Other: Reaching Recovery Fees -
5007 Other:Contracted Services(MD/NP) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 20,828
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 174,285
Administrative Overhead
6002 113rofessional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other: Indirect Cost -
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 174,285
INDIRECT COST RATE 9.72%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 1,000
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 1,000
7003 Furniture&Fixtures 3,500
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 5,500
TOTAL PROGRAM EXPENSES $ 1,967,681
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI -Prevention & Early Intervention
8303 INN- Innovations
8304 WET-Workforce Education&Training
8305 jCFTN-Capital Facilities&Technology
MHSATOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)
8404 BHBH Operations
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
8405 BHBH Infastructure 1,967,681
OTHER REVENUE TOTALI $ 1,967,681
TOTAL PROGRAM FUNDING SOURCES: $ 1,967,681
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing- Pheniox Landing
RH Community Builders
Fiscal Year (FY) 2026-2027
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Director BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
CalAIM/Sierra BHBH/Fresno County 0.15
BHBH/Rodeway BHBH/Fresno County DBH 0.15
Medi-Cal/Rodeway BHBH/Fresno County 0.20
CalAIM/Rodeway BHBH/Fresno County 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager BHBH/Rodeway BHBH/Fresno County DBH 0.50
Medi-Cal/Rodeway BHBH/Fresno County 0.50
Total 1.00
Position Contract#/Name/Department/County FTE
Fiscal Analyst BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
The Lodge/Fresno County DBH 0.25
CalAIM Fresno/Anthem Blue Cross/Fresno 0.05
Total 1.00
Position Contract#/Name/Department/County FTE
Certified Nusing Assistant BHBH/Rodeway BHBH/Fresno County DBH 4.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 4.00
Position Contract#/Name/Department/County FTE
Driver BHBH/Rodeway BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Maintenance Tech BHBH/Rodeway BHBH/Fresno County DBH 2.00
Total 2.00
Position Contract#/Name/Department/County FTE
Food Service BHBH/Rodeway BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Pheniox Landing
RH Community Builders
Fiscal Year(FY)2026-2027 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 710,707
Administrative Positions 86,012
1101 20,905 Responsible for contract compliance and daily support of Program Manager
1102 45,762 Responsible for day to day management of program including staff support
1103 19,345 Responsible for fiscal management of the program including complaince with funding
requirements
1104 -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Program Positions 443,057
1116 232,969 Responsible for teaching daily living skills to clients including bathing and wound care.
1117 52,002 Responsible for transporting clients to appointments including medical,housing,and
court.
1118 112,324 Responsibel for repairs to facility for client caused damage.
1119 45,762 Responsible for ensuring food is stored properly and clients receive daily meals
1120 -
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134 -
Direct Employee Benefits 127,976
1201 Retirement 16,110 Match up to 3%of employee contribuitons
1202 Worker's Compensation 42,326 Required worker's compensation coverage
1203 Health Insurance 69,540 80%employer paid coverage
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 53,662
1301 OASDI 28,003 Required OASDI taxes
1302 FICA/MEDICARE 7,671 Required FICA/MEDICARE taxes
1303 SUI 17,459 Required SUI taxes
1304 Other(specify) 529 Required ETT
1305 Other(specify) -
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 294,338
2001 Child Care -
2002 Client Housing Support 50,538 Short/Medium Term Rental Assistance and Deposits for Clients.
2003 Client Transportation&Support 2,500 Gas for client transports and bus passes
2004 Clothing,Food,&Hygiene 106,000 3 meals daily,snacks,basic clothing,and hygiene for clients
2005 Education Support
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical 5,300 Wound care and medical supplies including RX co-pays for for clients
2010 Utility Vouchers -
2011 Other:Recreational Activities
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012 Other:Landlord Engagement Funds 30,000 Funds to assist in engaging landlords to assist in locating housing for clients exiting
program.
2013 Other(specify) -
2014 Other(specify)
2015 Other(specify)
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 20,185
3001 Telecommunications 6,645 Cellphones,emails,etc.for program
3002 Printing/Postage 270 Business cards,monthly copier expense
3003 Office,Household&Program Supplies 11,000 Supplies for program operations including office supplies,cleaning supplies,and other
household items
3004 Advertising - Advertising for hiring,program promotion
3005 Staff Development&Training Training for staff including MH First Aid,conferences related to work,and ProACT
3006 Staff Mileage Mileage reimbursement for staff driving personal vechiles for program business
3007 Subscriptions&Memberships
3008 Vehicle Maintenance 570 Maintenance of program vehicles
3009 Other Vehicle Insurance 1,700 Required insurance for driver coverage
3010 Other Required Insurance Coverage - Required insurances per contract requirements
3011 Other(specify)
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 841,838
4001 Building Maintenance 20,000 Upkeep of facility for client caused damage
4002 Rent/Lease Building 424,360 Monthly rent for entire facility
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles 23,000 Monthly rent of vehicle for transporation fo clients
4005 Security 286,443 Standing security guard at site 24/7
4006 Utilities 88,035 Monthly expenses including internet,gas,water,electric and garbage.
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 20,828
5001 Consultant(Network&Data Management) 15,500 IT consulting
5002 HMIS(Health Management Information System) - HMIS access
5003 Contractual/Consulting Services:Emp Background 3,828 Backgrounds,drug testing staff management software,and timekeeping,
5004 Translation Services 1,500 Language line fees
5005 Other:SmartCare Fees
5006 Other:Reaching Recovery Fees -
5007 Other:Contracted Services(MD/NP)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 174,295
6001 Administrative Overhead 174,285 10%De Minimus Rate
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other:Indirect Cost
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 5,500
7001 Computer Equipment&Software 1,000 Replacement devices as needed
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 1,000 Replacement devices as needed
7003 Furniture&Fixtures 3,500 Replacement client beds or room furniture
7004 Leasehold/Tenant/Building Improvements - Improvements to initial facility including safety and security improvements,
7005 Other Assets over$500 with Lifespan of 2 Years+ Initial computers,servers,and networking of facility
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,967,681
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,967,681
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Sierra
RH Community Builders
Fiscal Year(FY) 2023-2024
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Director 0.20 $ 16,641 $ 16,641
1102 Program Manager 0.50 27,734 27,734
1103 Fiscal Analyst 0.25 9,707 9,707
1104 -
1105
1106
1107
1108
1109 -
1110 -
1111 -
1112 -
1113 -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.95 $ 54,082 $ 54,082
Acct# Program Position FTE Admin Program Total
1116 Certified Nursing Assistant 2.00 $ 60,669 $ 60,669
1117 Driver 1.00 30,508 30,508
1118 Maintenance Tech 1.00 33,281 33,281
1119 Food Service 1.00 30,508 30,508
1120 Overnight Monitor 6.00 158,086 158,086
1121 Janitor 1.50 31,201 31,201
1122 - -
1123 -
1124 -
1125 -
1126 -
1127 -
1128 -
1129 -
1130 -
1131 -
1132 -
1133 -
1134 -
Direct Personnel Program Salaries Subtotal 12.50 $ 344,253 $ 344,253
Admin Program Total
Direct Personnel Salaries Subtotal 13.45 $ 54,082 $ 344,253 $ 398,335
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 850 $ 3,550 $ 4,400
1202 Worker's Compensation 5,138 32,704 37,842
1203 Health Insurance 2,840 31,600 34,440
1204 Other(specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
1205 10ther(specify) -
1206 10ther(specify) - -
Direct Employee Benefits Subtotal:l $ 8,828 1 $ 67,854 1 $ 76,682
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 3,353 $ 21,344 $ 24,697
1302 FICA/MEDICARE 784 4,992 5,776
1303 SUI 1,785 11,360 13,145
1304 Employer Training Tax 54 344 398
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 5,976 $ 38,040 $ 44,016
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 68,886 $ 450,147 $ 519,033
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
13% 87%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 12,000
2003 Client Transportation&Support 3,000
2004 Clothing, Food,&Hygiene 148,667
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical 6,000
2010 Utility Vouchers
2011 Other: Recreational Activities
2012 Other: Landlord Engagement Funds 15,000
2013 Other(specify)
2014 Other(specify) -
2015 Other(specify) -
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 184,667
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 6,667
3002 Printing/Postage 300
3003 Office, Household&Program Supplies 10,000
3004 Advertising
3005 Staff Development&Training 7,833
3006 Staff Mileage
3007 Subscriptions& Memberships
3008 Vehicle Maintenance 534
3009 Vehicle Insurance 1,200
3010 Othe Required Insurance Coverage 4,333
3011
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 30,867
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
4000:DIRECT FACILITIES&EQUIPMENT
Acct# line Item Description Amount
4001 Building Maintenance
4002 Rent/Lease Building 166,667
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles 4,000
4005 Security 100,000
4006 Utilities
4007 Other(specify)
4008 Other(specify) -
4009 Other(specify) -
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 270,667
5000:DIRECT SPECIAL EXPENSES
Acct# line Item Description Amount
5001 Consultant(Network&Data Management) $ 9,334
5002 HMIS(Health Management Information System) 865
5003 Contractual/Consulting Services: Emp Background Checks&CPR Cert Cards 8,253
5004 Translation Services 1,000
5005 Other:SmartCare Fees
5006 Other: Reaching Recovery Fees
5007 Other:Contracted Services(MD/NP)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 19,452
6000:INDIRECT EXPENSES
Acct# line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 139,013
Administrative Overhead
6002 113rofessional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits)
6009 Other: Indirect Cost
6010 Other:Contracted Services
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 139,013
INDIRECT COST RATE 9.91%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 75,000
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 9,200
7003 Furniture&Fixtures 18,000
7004 Leasehold/Tenant/Building Improvements 180,000
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
7005 Other Assets over$500 with Lifespan of 2 Years+ 95,251
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify)
7008 Other(specify) -
FIXED ASSETS EXPENSES TOTAL $ 377,451
TOTAL PROGRAM EXPENSES $ 1,541,150
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 59%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 1 53%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports
8302 PEI -Prevention & Early Intervention
8303 INN- Innovations
8304 WET-Workforce Education&Training
8305 jCFTN-Capital Facilities&Technology
MHSATOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance -
8403 BHBH Operations 1,529,150
8404 BHBH Infastructure 12,000
8405 Other(Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
I OTHER REVENUE TOTALI $ 1,541,150
TOTAL PROGRAM FUNDING SOURCES: 1 $ 1,541,150
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing- Sierra
RH Community Builders
Fiscal Year (FY) 2023-2024
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Director BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
CalAIM/Sierra BHBH/Fresno County 0.15
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
CalAIM/Rodeway BHBH/Fresno County 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager BHBH/Sierra BHBH/Fresno County DBH 0.50
Medi-Cal/Sierra BHBH/Fresno County 0.50
Total 1.00
Position Contract#/Name/Department/County FTE
Fiscal Analyst BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
The Lodge/Fresno County DBH 0.25
CalAIM Fresno/Anthem Blue Cross/Fresno 0.05
Total 1.00
Position Contract#/Name/Department/County FTE
Certified Nursing Assistant BHBH/Sierra BHBH/Fresno County DBH 2.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 2.00
Position Contract#/Name/Department/County FTE
Driver BHBH/Sierra BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Maintenance Tech BHBH/Sierra BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Food Service BHBH/Sierra BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Overnight Monitor BHBH/Sierra BHBH/Fresno County DBH 6.00
Total 6.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Position Contract#/Name/Department/County FTE
Janitor BHBH/Sierra BHBH/Fresno County DBH 1.50
Total 1.50
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Sierra
RH Community Builders
Fiscal Year(FY)2023-2024 Budget Narrative
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 519,033
Administrative Positions 54,082
1101 Director $ 10,920 Responsible for contract compliance and daily support of Program Manager
1102 Program Manager 36,401 Responsible for day to day management of program including staff support
1103 Fiscal Analyst 12,740 Responsible for fiscal management of the program including complaince with funding
1104 -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Program Positions 344,253
1116 Certified Nursing Assistant 60,669 Responsible for teaching daily living skills to clients including bathing and wound care.
1117 Driver 30,508 Responsible for transporting clients to appointments including medical,housing,and
1118 Maintenance Tech 33,281 Responsibel for repairs to facility for client caused damage.
1119 Food Service 30,508 Responsible for ensuring food is stored properly and clients receive daily meals
1120 Overnight Monitor 158,086 Resposnible for oversight of facility and client needs,ensuring safety and operations.
1121 Janitor 31,201 Responsible for keeping client rooms and common space clean.
1122 -
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits
1201 Retirement Match up to 3%of employee contribuitons
1202 Worker's Compensation Required worker's compensation coverage
1203 Health Insurance 80%employer paid coverage
1204 Other(specify)
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 44,016
1301 OASDI 24,697 Required OASDI taxes
1302 FICA/MEDICARE 5,776 Required FICA/MEDICARE taxes
1303 SUI 13,145 Required SUI taxes
1304 Employer Training Tax 398 Required ETT
1305 Other(specify) -
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 184,667
2001 Child Care -
2002 Client Housing Support 12,000 Short/Medium Term DFA for client rent&deposits upon program completion.
2003 Client Transportation&Support 3,000 Gas for client transports and bus passes
2004 Clothing,Food,&Hygiene 148,667 3 meals daily,snacks,basic clothing,and hygiene for clients
2005 Education Support
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical 6,000 Wound care and medical supplies including RX co-pays for for clients
2010 Utility Vouchers -
2011 Other:Recreational Activities -
2012 Other:Landlord Engagement Funds 15,000 Funds to assist in engaging landlords to assist in locating housing for clients exiting
program.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
3000:DIRECT OPERATING EXPENSES 30,867
3001 Telecommunications 6,667 Cellphones,emails,etc.for program
3002 Printing/Postage 300 Business cards,monthly copier expense
3003 Office,Household&Program Supplies 10,000 Supplies for program operations including office supplies,cleaning supplies,and other
household items
3004 Advertising - Advertising for hiring,program promotion
3005 Staff Development&Training 7,833 Training for staff including MH First Aid,conferences related to work,and ProACT
3006 Staff Mileage - Mileage reimbursement for staff driving personal vechiles for program business
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 534 Maintenance of program vehicles
3009 Vehicle Insurance 1,200 Required insurance for driver coverage
3010 Othe Required Insurance Coverage 4,333 Required insurances per contract requirements
3011 0 -
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 270,667
4001 Building Maintenance - Upkeep of facility for client caused damage
4002 Rent/Lease Building 166,667 Monthly rent for entire facility
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles 4,000 Monthly rent of vehicle for transporation fo clients
4005 Security 100,000 Standing security guard at site 24/7
4006 Utilities - Monthly expenses including internet,gas,water,electric and garbage.
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 19,452
5001 Consultant(Network&Data Management) 9,334 IT consulting
5002 HMIS(Health Management Information System) 865 HMIS access
5003 Contractual/Consulting Services:Emp Background 8,253 Backgrounds,drug testing staff management software,and timekeeping,
5004 Translation Services 1,000 Language line fees
5005 Other:SmartCare Fees
5006 Other:Reaching Recovery Fees -
5007 Other:Contracted Services(MD/NP)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 139,013
6001 Administrative Overhead 139,013 10%De Minimus Rate
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other:Indirect Cost
6010 Other:Contracted Services
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 377,451
7001 Computer Equipment&Software 75,000 Replacement devices as needed
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 9,200 Replacement devices as needed
7003 Furniture&Fixtures 18,000 Replacement client beds or room furniture
7004 Leasehold/Tenant/Building Improvements 180,000 Improvements to initial facility including safety and security improvements,
7005 Other Assets over$500 with Lifespan of 2 Years+ 95,251 Initial computers,servers,and networking of facility
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify)
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,541,150
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,541,150
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Sierra
RH Community Builders
Fiscal Year(FY) 2024-2025
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Director 0.10 $ 29,414 $ 29,414
1102 Program Manager 0.50 43,682 43,682
1103 Fiscal Analyst 0.25 15,081 15,081
1104 -
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111 -
1112 -
1113 -
1114 -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.85 $ 88,177 $ 88,177
Acct# Program Position FTE Admin Program Total
1116 Certified Nursing Assistant 2.00 $ 108,164 $ 108,164
1117 Driver 1.00 45,762 45,762
1118 Maintenance Tech 1.00 49,922 49,922
1119 Food Service 1.00 45,762 45,762
1120 Overnight Monitor 6.00 262,090 262,090
1121 Janitor 2.00 95,684 95,684
1122 -
1123 -
1124 -
1125 -
1126 -
1127 -
1128 -
1129 -
1130 -
1131 -
1132 -
1133 -
1134 - -
Direct Personnel Program Salaries Subtotal 13.00 $ 607,384 $ 607,384
Admin Program Total
Direct Personnel Salaries Subtotal 13.85 $ 88,177 $ 607,384 $ 695,561
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,020 $ 15,600 $ 16,620
1202 Worker's Compensation 6,827 48,923 55,750
1203 Health Insurance 4,080 62,400 66,480
1204 Other(specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
1205 10ther(specify) I -
1206 10ther(specify) I - -
Direct Employee Benefits Subtotal:j $ 11,927 1 $ 126,923 1 $ 138,850
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 4,456 $ 37,916 $ 42,372
1302 FICA/MEDICARE 1,042 8,867 9,909
1303 SUI 2,372 20,181 22,553
1304 Employer Training Tax 612 72 684
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 8,482 $ 67,036 $ 75,518
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 108,586 $ 801,343 $ 909,929
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
12%1 88.
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 15,000
2003 Client Transportation&Support 4,500
2004 Clothing, Food,&Hygiene 223,000
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical 9,000
2010 Utility Vouchers
2011 Other: Recreational Activities
2012 Other: Landlord Engagement 35,000
2013 Other(specify)
2014 Other(specify) -
2015 Other(specify) j
2016 Other(specify) DIRECT CLIENT CARE TOTAL $ 286,5
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 10,000
3002 Printing/Postage 450
3003 Office, Household&Program Supplies 15,000
3004 Advertising
3005 Staff Development&Training 3,500
3006 Staff Mileage
3007 Subscriptions& Memberships
3008 Vehicle Maintenance 800
3009 Other Vehicle Insurance 1,800
3010 Other Required Insurance Coverage 61500
3011 Other(specify) -
3012 Other(specify) -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
DIRECT OPERATING EXPENSES TOTAL: $ 38,0501
4000:DIRECT FACILITIES&EQUIPMENT
Acct# line Item Description Amount
4001 Building Maintenance
4002 Rent/Lease Building 250,000
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles 6,000
4005 Security 150,000
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify) -
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j $ 406,000
5000:DIRECT SPECIAL EXPENSES
Acct# line Item Description Amount
5001 Consultant(Network&Data Management) $ 14,000
5002 HMIS(Health Management Information System) 1,800
5003 Contractual/Consulting Services: Emp Background Checks&CPR Cert Cards 5,630
5004 Translation Services 1,500
5005 Other:SmartCare Fees
5006 Other: Reaching Recovery Fees
5007 Other:Contracted Services(MD/NP)
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 22,930
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 165,045
Administrative Overhead
6002 113rofessional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits)
6009 Other: Indirect Cost
6010 Other:Contracted Services
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 165,045
INDIRECT COST RATE 9.91%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 500
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 500
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
7003 Furniture&Fixtures 1,050
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
7008 Other(specify) -
FIXED ASSETS EXPENSES TOTAL $ 2,050
TOTAL PROGRAM EXPENSES $ 1,830,504
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 10ther(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 59%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 1 53%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 jCFTN-Capital Facilities&Technology -
MHSA TOTAL $ -
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
8404 JBHBH Operations
8405 JBHBH Infastructure 1 1,830,504
OTHER REVENUE TOTALI $ 1,830,504
TOTAL PROGRAM FUNDING SOURCES: 1 $ 1,830,504
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing- Sierra
RH Community Builders
Fiscal Year (FY) 2024-25
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Director BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
CalAIM/Sierra BHBH/Fresno County 0.15
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
CalAIM/Rodeway BHBH/Fresno County 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager BHBH/Sierra BHBH/Fresno County DBH 0.50
Medi-Cal/Sierra BHBH/Fresno County 0.50
Total 1.00
Position Contract#/Name/Department/County FTE
Fiscal Analyst BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
The Lodge/Fresno County DBH 0.25
CalAIM Fresno/Anthem Blue Cross/Fresno 0.05
Total 1.00
Position Contract#/Name/Department/County FTE
Certified Nursing Assistant BHBH/Sierra BHBH/Fresno County DBH 2.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 2.00
Position Contract#/Name/Department/County FTE
Driver BHBH/Sierra BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Maintenance Tech BHBH/Sierra BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Food Service BHBH/Sierra BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Overnight Monitor BHBH/Sierra BHBH/Fresno County DBH 6.00
Total 6.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Position Contract#/Name/Department/County FTE
Janitor BHBH/Sierra BHBH/Fresno County DBH 2.00
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Sierra
RH Community Builders
Fiscal Year(FY)2024-2025 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 909,929
Administrative Positions 88,177
1101 29,414 Responsible for contract compliance and daily support of Program Manager
1102 43,682 Responsible for day to day management of program including staff support
1103 15,081 Responsible for fiscal management of the program including complaince with funding
1104 -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115 -
Program Positions 607,384
1116 108,164 Responsible for teaching daily living skills to clients including bathing and wound care.
1117 45,762 Responsible for transporting clients to appointments including medical,housing,and
1118 49,922 Responsibel for repairs to facility for client caused damage.
1119 45,762 Responsible for ensuring food is stored properly and clients receive daily meals
1120 262,090 Responnible for oversight of facility and client needs,ensuring safety and operations.
1121 95,684 Responsible for keeping client rooms and common space clean.
1122 -
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134 -
Direct Employee Benefits 138,850
1201 Retirement 16,620 Match up to 3%of employee contribuitons
1202 Worker's Compensation 55,750 Required worker's compensation coverage
1203 Health Insurance 66,480 80%employer paid coverage
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 75,518
1301 OASDI 42,372 Required OASDI taxes
1302 FICA/MEDICARE 9,909 Required FICA/MEDICARE taxes
1303 SUI 22,553 Required SUI taxes
1304 Employer Training Tax 684 Required ETT
1305 Other(specify) -
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 286,500
2001 Child Care -
2002 Client Housing Support 15,000 Short/Medium Term DFA for Client Rent/Despoits.
2003 Client Transportation&Support 4,500 Gas for client transports and bus passes
2004 Clothing,Food,&Hygiene 223,000 3 meals daily,snacks,basic clothing,and hygiene for clients
2005 Education Support
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical 9,000 Wound care and medical supplies including RX co-pays for for clients
2010 Utility Vouchers -
2011 Other:Recreational Activities -
2012 Other:Landlord Engagement 35,000 Funds to assist in engaging landlords to assist in locating housing for clients exiting
program.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 38,050
3001 Telecommunications 10,000 Cellphones,emails,etc.for program
3002 Printing/Postage 450 Business cards,monthly copier expense
3003 Office,Household&Program Supplies 15,000 Supplies for program operations including office supplies,cleaning supplies,and other
household items
3004 Advertising - Advertising for hiring,program promotion
3005 Staff Development&Training 3,500 Training for staff including MH First Aid,conferences related to work,and ProACT
3006 Staff Mileage - Mileage reimbursement for staff driving personal vechiles for program business
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 800 Maintenance of program vehicles
3009 Other Vehicle Insurance 1,800 Required insurance for driver coverage
3010 Other Required Insurance Coverage 6,500 Required insurances per contract requirements
3011 Other(specify) -
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 406,000
4001 Building Maintenance - Upkeep of facility for client caused damage
4002 Rent/Lease Building 250,000 Monthly rent for entire facility
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles 6,000 Monthly rent of vehicle for transporation fo clients
4005 Security 150,000 Standing security guard at site 24/7
4006 Utilities - Monthly expenses including internet,gas,water,electric and garbage.
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 22,930
5001 Consultant(Network&Data Management) 14,000 IT consulting
5002 HMIS(Health Management Information System) 1,800 HMIS access
5003 Contractual/Consulting Services:Emp Background 5,630 Backgrounds,drug testing staff management software,and timekeeping,
5004 Translation Services 1,500 Language line fees
5005 Other:SmartCare Fees
5006 Other:Reaching Recovery Fees -
5007 Other:Contracted Services(MD/NP)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 165,045
6001 Administrative Overhead 165,045 10%De Minimus Rate
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other:Indirect Cost
6010 Other:Contracted Services
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 2,050
7001 Computer Equipment&Software 500 Replacement devices as needed
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 500 Replacement devices as needed
7003 Furniture&Fixtures 1,050 Replacement client beds or room furniture
7004 Leasehold/Tenant/Building Improvements - Improvements to initial facility including safety and security improvements,
7005 Other Assets over$500 with Lifespan of 2 Years+ Initial computers,servers,and networking of facility
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001
8002
8003
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 1 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,830,504
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,830,504
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Sierra
RH Community Builders
Fiscal Year(FY) 2025-2026
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Director 0.10 $ 27,041 $ 27,041
1102 Program Manager 0.50 58,138 58,138
1103 Fiscal Analyst 0.25 15,601 15,601
1104 -
1105
1106 -
1107 -
1108 -
1109 -
1110 -
1111 -
1112 -
1113 -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.85 $ 100,780 $ 100,780
Acct# Program Position FTE Admin Program Total
1116 Certified Nursing Assistant 2.00 $ 112,324 $ 112,324
1117 Driver 1.00 49,922 49,922
1118 Maintenance Tech 1.00 52,002 52,002
1119 Food Service 1.00 45,762 45,762
1120 Overnight Monitor 6.00 274,571 274,571
1121 Janitor 2.00 91,524 91,524
1122 - -
1123 -
1124 -
1125 -
1126 -
1127 -
1128 -
1129 -
1130 -
1131 -
1132 -
1133 -
1134 - -
Direct Personnel Program Salaries Subtotal 13.00 $ 626,105 $ 626,105
Admin Program Total
Direct Personnel Salaries Subtotal 13.85 $ 100,780 $ 626,105 $ 726,875
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,020 $ 3,600 $ 4,620
1202 Worker's Compensation 9,574 49,759 59,333
1203 Health Insurance 4,080 62,400 66,480
1204 Other(specify) - -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
1205 10ther(specify) I - -
1206 10ther(specify) I - -
Direct Employee Benefits Subtotal:j $ 14,674 1 $ 115,759 1 $ 130,433
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 6,248 $ 38,561 $ 44,809
1302 FICA/MEDICARE 1,461 901 2,362
1303 SUI 3,326 20,524 23,850
1304 Employer Training Tax 101 639 740
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 11,136 $ 60,625 $ 71,761
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 126,590 $ 802,489 $ 929,079
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
14%1 86.
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 20,000
2003 Client Transportation&Support 4,635
2004 Clothing, Food,&Hygiene 229,600
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical 9,270
2010 Utility Vouchers
2011 Other: Recreational Activities
2012 Other: Landlord Engagment 35,000
2013 Other(specify) -
2014 Other(specify) -
2015 Other(specify) -
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 298,505
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 10,300
3002 Printing/Postage 460
3003 Office, Household&Program Supplies 15,400
3004 Advertising
3005 Staff Development&Training 3,605
3006 Staff Mileage
3007 Subscriptions& Memberships -
3008 Vehicle Maintenance 820
3009 Other Vehicle Insurance 1,850
3010 Other Required Insurance Coverage 6,695
3011 Other(specify) -
IL 3012 Other(specify) -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
DIRECT OPERATING EXPENSES TOTAL: $ 39,1301
4000:DIRECT FACILITIES&EQUIPMENT
Acct# line Item Description Amount
4001 Building Maintenance $ -
4002 Rent/Lease Building 247,200
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles 6,180
4005 Security 154,500
4006 Utilities -
4007 Other(specify) -
4008 Other(specify) -
4009 10ther(specify) -
4010 10ther(specify) -
DIRECTFACILITIES/EQUIPMENTTOTAL: $ 407,880
5000:DIRECT SPECIAL EXPENSES
Acct# line Item Description Amount
5001 Consultant(Network&Data Management) $ 14,420
5002 HMIS(Health Management Information System) 865
5003 Contractual/Consulting Services: Emp Background Checks&CPR Cert Cards 5,750
5004 Translation Services 1,500
5005 Other:SmartCare Fees
5006 Other: Reaching Recovery Fees
5007 Other:Contracted Services(MD/NP)
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 22,535
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 167,923
Administrative Overhead
6002 113rofessional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits)
6009 Other: Indirect Cost
6010 Other:Contracted Services
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 167,923
INDIRECT COST RATE 9.88%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 515
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 515
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
7003 Furniture&Fixtures 1,080
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) j
7008 Other(specify) FIXED ASSETS EXPENSES TOTAL $ 2,1
TOTAL PROGRAM EXPENSES $ 1,867,162
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 10ther(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 59%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 1 53%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 jCFTN-Capital Facilities&Technology -
MHSA TOTAL $ -
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
8404 JBHBH Operations
8405 JBHBH Infastructure 1 1,867,162
OTHER REVENUE TOTALI $ 1,867,162
TOTAL PROGRAM FUNDING SOURCES: 1 $ 1,867,162
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing- Sierra
RH Community Builders
Fiscal Year (FY) 2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Director BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
CalAIM/Sierra BHBH/Fresno County 0.15
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
CalAIM/Rodeway BHBH/Fresno County 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager BHBH/Sierra BHBH/Fresno County DBH 0.50
Medi-Cal/Sierra BHBH/Fresno County 0.50
Total 1.00
Position Contract#/Name/Department/County FTE
Fiscal Analyst BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
The Lodge/Fresno County DBH 0.25
CalAIM Fresno/Anthem Blue Cross/Fresno 0.05
Total 1.00
Position Contract#/Name/Department/County FTE
Certified Nursing Assistant BHBH/Sierra BHBH/Fresno County DBH 2.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 2.00
Position Contract#/Name/Department/County FTE
Driver BHBH/Sierra BHBH/Fresno County DBH
Total 0.00
Position Contract#/Name/Department/County FTE
Maintenance Tech BHBH/Sierra BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Food Service BHBH/Sierra BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Overnight Monitor BHBH/Sierra BHBH/Fresno County DBH 6.00
Total 6.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Position Contract#/Name/Department/County FTE
Janitor BHBH/Sierra BHBH/Fresno County DBH 2.00
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Sierra
RH Community Builders
Fiscal Year(FY)2025-2026 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
#### #REFI
Administrative Positions #REF!
#REFI 27,041 Responsible for contract compliance and daily support of Program Manager
#REFI 58,138 Responsible for day to day management of program including staff support
#REFI 15,601 Responsible for fiscal management of the program including complaince with funding
#REFI -
#REF!
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REF! -
Program Positions 626,105
#REF! 112,324 Responsible for teaching daily living skills to clients including bathing and wound care.
#REFI 49,922 Responsible for transporting clients to appointments including medical,housing,and
#REFI 52,002 Responsibel for repairs to facility for client caused damage.
#REFI 45,762 Responsible for ensuring food is stored properly and clients receive daily meals
#REFI 274,571 Responnible for oversight of facility and client needs,ensuring safety and operations.
#REFI 91,524 Responsible for keeping client rooms and common space clean.
#REFI -
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI
#REFI -
#REFI 130,433
#REFI #REF! 4,620 Match up to 3%of employee contribuitons
#REFI #REF! 59,333 Required worker's compensation coverage
#REFI #REF! 66,480 80%employer paid coverage
#REFI #REF! -
#REFI #REF!
#REFI #REF! -
#REFI 71,761
#REFI #REF! 44,809 Required OASDI taxes
#REFI #REF! 2,362 Required FICA/MEDICARE taxes
#REFI #REF! 23,850 Required SUI taxes
#REFI #REF! 740 Required ETT
#REFI #REF! -
#REF! #REF! -
#REFI 298,505
#REFI #REF! -
#REFI #REF! 20,000 Short/Medium Term DFA for Client Rent/Despoits.
#REFI #REF! 4,635 Gas for client transports and bus passes
#REFI #REF! 229,600 3 meals daily,snacks,basic clothing,and hygiene for clients
#REFI #REF! -
#REFI #REF!
#REFI #REF!
#REFI #REF! -
#REF! #REF! 9,270 Wound care and medical supplies including RX co-pays for for clients
#REFI #REF! -
#REF! Other:Recreational Activities -
#REFI #REF! 35,000 Funds to assist in engaging landlords to assist in locating housing for clients exiting
program.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
#REFI #REF!
#REFI #REFI
#REFI #REF!
#REFI #REF! -
#REFI 39,130
#REFI #REF! 10,300 Cellphones,emails,etc.for program
#REFI #REF! 460 Business cards,monthly copier expense
#REFI #REF! 15,400 Supplies for program operations including office supplies,cleaning supplies,and other
household items
#REFI #REF! - Advertising for hiring,program promotion
#REFI #REF! 3,605 Training for staff including MH First Aid,conferences related to work,and ProACT
#REFI #REF! - Mileage reimbursement for staff driving personal vechiles for program business
#REFI #REF! -
#REF! #REF! 820 Maintenance of program vehicles
#REFI #REF! 1,850 Required insurance for driver coverage
#REFI #REF! 6,695 Required insurances per contract requirements
#REFI #REF! -
#REF! #REF!
#REFI 407,880
#REFI #REF! - Upkeep of facility for client caused damage
#REFI #REF! 247,200 Monthly rent for entire facility
#REFI #REF! -
#REF! #REF! 6,180 Monthly rent of vehicle for transporation fo clients
#REFI #REF! 154,500 Standing security guard at site 24/7
#REFI #REF! - Monthly expenses including internet,gas,water,electric and garbage.
#REFI #REF!
#REFI #REF!
#REFI #REF! -
#REF! #REF!
#REFI 22,535
#REFI #REF! 14,420 IT consulting
#REFI #REF! 865 HMIS access
#REFI Contractual/Consulting Services:Emp Background 5,750 Backgrounds,drug testing staff management software,and timekeeping,
#REFI #REF! 1,500 Language line fees
#REFI Other:SmartCare Fees -
#REF! Other:Reaching Recovery Fees
#REFI Other:Contracted Services(MD/NP)
#REFI #REF!
#REFI 167,923
#REFI #REF! 167,923 10%De Minimus Rate
#REFI #REF! -
#REF! #REF!
#REFI #REF!
#REFI #REF!
#REFI #REF!
#REFI #REF!
#REFI #REF!
#REFI #REF!
#REFI #REF!
#REFI #REF!
#REFI #REF!
#REF! #REF! I -
#REFI 2,110
#REFI #REF! 515 Replacement devices as needed
#REFI #REF! 515 Replacement devices as needed
#REFI #REF! 1,080 Replacement client beds or room furniture
#REFI #REF! - Improvements to initial facility including safety and security improvements,
#REFI #REF! Initial computers,servers,and networking of facility
#REFI #REF!
#REFI #REF!
#REFI #REF!
PROGRAM FUNDING SOURCES
#REF!
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
#REF! #REF!
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: #REF!
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,867,162 0
BUDGET CHECK: #REF!
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Sierra
RH Community Builders
Fiscal Year(FY) 2026-2027
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Director 0.20 $ 27,873 $ 27,873
1102 Program Manager 0.65 59,490 59,490
1103 Fiscal Analyst 0.25 16,121 16,121
1104 - -
1105 -
1106 -
1107 -
1108 -
1109 -
1110 -
1111 -
1112 -
1113 -
1114 - -
1115 - -
Direct Personnel Admin Salaries Subtotal 1.10 $ 103,484 $ 103,484
Acct# Program Position FTE Admin Program Total
1116 Certified Nursing Assistant 2.00 $ 116,484 $ 116,484
1117 Driver 1.00 52,002 52,002
1118 Maintenance Tech 1.00 56,162 56,162
1119 Food Service 1.00 47,842 47,842
1120 Overnight Monitor 6.00 274,571 274,571
1121 Janitor 2.00 95,684 95,684
1122 - -
1123 -
1124 -
1125 -
1126 -
1127 -
1128 -
1129 -
1130 -
1131 -
1132 -
1133 -
1134 - -
Direct Personnel Program Salaries Subtotal 13.00 $ 642,745 $ 642,745
Admin Program Total
Direct Personnel Salaries Subtotal 14.10 $ 103,484 $ 642,745 $ 746,229
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 1,530 $ 23,400 $ 24,930
1202 Worker's Compensation 7,203 51,420 58,623
1203 Health Insurance 6,500 75,000 81,500
1204 Other(specify) - -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
1205 10ther(specify) I - -
1206 10ther(specify) I - -
Direct Employee Benefits Subtotal:j $ 15,233 1 $ 149,820 1 $ 165,053
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 6,416 $ 39,850 $ 46,266
1302 FICA/MEDICARE 1,501 9,320 10,821
1303 SUI 3,415 21,211 24,626
1304 Other(specify) 103 643 746
1305 Other(specify) - - -
1306 Other(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 11,435 $ 71,024 $ 82,459
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 130,152 $ 863,589 $ 993,741
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
13%1 87.
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support 25,000
2003 Client Transportation&Support 4,775
2004 Clothing, Food,&Hygiene 236,580
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical 9,500
2010 Utility Vouchers -
2011 Other: Recreational Activities -
2012 Other: Landlord Engagement Funds 30,000
2013 Other(specify) -
2014 Other(specify) -
2015 Other(specify) -
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 305,855
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 10,609
3002 Printing/Postage 450
3003 Office, Household&Program Supplies 15,900
3004 Advertising
3005 Staff Development&Training 3,700
3006 Staff Mileage -
3007 Subscriptions& Memberships -
3008 Vehicle Maintenance 850
3009 Other Vehicle Insurance 1,900
3010 Other Required Insurance Coverage 6,895
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 40,304
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ -
4002 Rent/Lease Building 254,616
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles 6,365
4005 Security 159,135
4006 Utilities -
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 420,116
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 14,850
5002 HMIS(Health Management Information System) 865
5003 Contractual/Consulting Services: Emp Background Checks&CPR Cert Cards 5,900
5004 Translation Services 1,500
5005 Other:SmartCare Fees -
5006 Other: Reaching Recovery Fees -
5007 Other:Contracted Services(MD/NP) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 23,115
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 176,023
Administrative Overhead
6002 113rofessional Liability Insurance -
6003 Accounting/Bookkeeping -
6004 External Audit -
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other: Indirect Cost -
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 176,023
INDIRECT COST RATE 9.86%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 500
7002 Copiers,Cell Phones,Tablets, Devices to Contain HIPAA Data 500
7003 Furniture&Fixtures 1,100
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 2,100
TOTAL PROGRAM EXPENSES $ 1,961,254
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $
Estimated%of Clients who are Medi-Cal Beneficiaries 0%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation (FFP)% 0%
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI -Prevention & Early Intervention
8303 INN- Innovations
8304 WET-Workforce Education&Training
8305 jCFTN-Capital Facilities&Technology
MHSATOTAL $
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(Specify)
8404 BHBH Operations 1,936,254
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
8405 BHBH Infastructure 25,000
OTHER REVENUE TOTALI $ 1,961,254
TOTAL PROGRAM FUNDING SOURCES: $ 1,961,254
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing- Sierra
RH Community Builders
Fiscal Year (FY) 2026-2027
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Director BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
CalAIM/Sierra BHBH/Fresno County 0.15
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
CalAIM/Rodeway BHBH/Fresno County 0.15
Total 1.00
Position Contract#/Name/Department/County FTE
Program Manager BHBH/Sierra BHBH/Fresno County DBH 0.50
Medi-Cal/Sierra BHBH/Fresno County 0.50
Total 1.00
Position Contract#/Name/Department/County FTE
Fiscal Analyst BHBH/Sierra BHBH/Fresno County DBH 0.10
Medi-Cal/Sierra BHBH/Fresno County 0.25
BHBH/Rodeway BHBH/Fresno County DBH 0.10
Medi-Cal/Rodeway BHBH/Fresno County 0.25
The Lodge/Fresno County DBH 0.25
CalAIM Fresno/Anthem Blue Cross/Fresno 0.05
Total 1.00
Position Contract#/Name/Department/County FTE
Certified Nursing Assistant BHBH/Sierra BHBH/Fresno County DBH 2.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 2.00
Position Contract#/Name/Department/County FTE
Driver BHBH/Sierra BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Maintenance Tech BHBH/Sierra BHBH/Fresno County DBH 1.00
Total 1.00
Position Contract#/Name/Department/County FTE
Food Service BHBH/Sierra BHBH/Fresno County DBH
Total 0.00
Position Contract#/Name/Department/County FTE
Overnight Monitor BHBH/Sierra BHBH/Fresno County DBH 6.00
Total 6.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Position Contract#/Name/Department/County FTE
Janitor BHBH/Sierra BHBH/Fresno County DBH 2.00
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Behavioral Health Bridge Housing-Sierra
RH Community Builders
Fiscal Year(FY)2026-2027 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 993,741
Administrative Positions 103,484
1101 27,873 Responsible for contract compliance and daily support of Program Manager
1102 59,490 Responsible for day to day management of program including staff support
1103 16,121 Responsible for fiscal management of the program including complaince with funding
requirements
1104 -
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Program Positions 642,745
1116 116,484 Responsible for teaching daily living skills to clients including bathing and wound care.
1117 52,002 Responsible for transporting clients to appointments including medical,housing,and
court.
1118 56,162 Responsibel for repairs to facility for client caused damage.
1119 47,842 Responsible for ensuring food is stored properly and clients receive daily meals
1120 274,571 Resposnible for oversight of facility and client needs,ensuring safety and operations.
1121 95,684 Responsible for keeping client rooms and common space clean.
1122 -
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Employee Benefits 165,053
1201 Retirement 24,930 Match up to 3%of employee contribuitons
1202 Worker's Compensation 58,623 Required worker's compensation coverage
1203 Health Insurance 81,500 80%employer paid coverage
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 82,459
1301 OASDI 46,266 Required OASDI taxes
1302 FICA/MEDICARE 10,821 Required FICA/MEDICARE taxes
1303 SUI 24,626 Required SUI taxes
1304 Other(specify) 746 Required ETT
1305 Other(specify) -
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 305,855
2001 Child Care -
2002 Client Housing Support 25,000 Short/Medium Term DFA for Client Rent/Despoits.
2003 Client Transportation&Support 4,775 Gas for client transports and bus passes
2004 Clothing,Food,&Hygiene 236,580 3 meals daily,snacks,basic clothing,and hygiene for clients
2005 Education Support
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical 9,500 Wound care and medical supplies including RX co-pays for for clients
2010 Utility Vouchers -
2011 Other:Recreational Activities
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012 Other:Landlord Engagement Funds 30,000 Funds to assist in engaging landlords to assist in locating housing for clients exiting
program.
2013 Other(specify) -
2014 Other(specify)
2015 Other(specify)
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 40,304
3001 Telecommunications 10,609 Cellphones,emails,etc.for program
3002 Printing/Postage 450 Business cards,monthly copier expense
3003 Office,Household&Program Supplies 15,900 Supplies for program operations including office supplies,cleaning supplies,and other
household items
3004 Advertising - Advertising for hiring,program promotion
3005 Staff Development&Training 3,700 Training for staff including MH First Aid,conferences related to work,and ProACT
3006 Staff Mileage - Mileage reimbursement for staff driving personal vechiles for program business
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 850 Maintenance of program vehicles
3009 Other Vehicle Insurance 1,900 Required insurance for driver coverage
3010 Other Required Insurance Coverage 6,895 Required insurances per contract requirements
3011 Other(specify) -
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 420,116
4001 Building Maintenance - Upkeep of facility for client caused damage
4002 Rent/Lease Building 254,616 Monthly rent for entire facility
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles 6,365 Monthly rent of vehicle for transporation fo clients
4005 Security 159,135 Standing security guard at site 24/7
4006 Utilities - Monthly expenses including internet,gas,water,electric and garbage.
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 23,115
5001 Consultant(Network&Data Management) 14,850 IT consulting
5002 HMIS(Health Management Information System) 865 HMIS access
5003 Contractual/Consulting Services:Emp Background 5,900 Backgrounds,drug testing staff management software,and timekeeping,
5004 Translation Services 1,500 Language line fees
5005 Other:SmartCare Fees
5006 Other:Reaching Recovery Fees -
5007 Other:Contracted Services(MD/NP)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 176,023
6001 Administrative Overhead 176,023 10%De Minimus Rate
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other:Indirect Cost
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 2,100
7001 Computer Equipment&Software 500 Replacement devices as needed
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 500 Replacement devices as needed
7003 Furniture&Fixtures 1,100 Replacement client beds or room furniture
7004 Leasehold/Tenant/Building Improvements - Improvements to initial facility including safety and security improvements,
7005 Other Assets over$500 with Lifespan of 2 Years+ Initial computers,servers,and networking of facility
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,961,254
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,961,254
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Compensation Exhibit F-1
Fresno County Department of Behavioral Health
Specialty Mental Health Services Outpatient Rates
Clinic/Site Based
(less than 50%of services are provided in the field)
Provider Rate
Provider Type Per Hour
Psychiatrist/ Contracted Psychiatrist $912.79
Physicians Assistant $409.38
Nurse Practitioner $453.91
RN $370.76
Certified Nurse Specialist $453.91
LV N $194.77
Pharmacist $436.93
Licensed Psychiatric Technician $166.97
Psychologist/Pre-licensed Psychologist $367.09
LPHA (MFT LCSW LPCC)/ Intern or Waivered LPHA (MFT LCSW LPCC) $237.56
Occupational Therapist $316.22
Mental Health Rehab Specialist $178.73
Peer Recovery Specialist $187.66
Other Qualified Providers - Other Designated MH staff that bill
medical $178.73
Exhibit F-2
Add-on/Supplemental codes
Service Unit Maximum Units that Rate per Unit
Can be Billed
Interactive 15 mins per unit 1 per allowed $16.50
Complexity procedure per
provider per
beneficiary
Sign Language or 15 mins per unit Variable $30.00
Oral Interpretive
Services
Exhibit G
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third parties, Contractor, at its
sole expense, shall maintain in full force and effect the following insurance policies throughout the term of this
Agreement.
(A) Commercial General Liability. Commercial general liability insurance with limits of not less than Two Million
Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000). This policy
must be issued on a per occurrence basis. Coverage must include products, completed operations, property
damage, bodily injury, personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers, individually and
collectively, as additional insureds, but only insofar as the operations under this Agreement are concerned.
Such coverage for additional insureds will apply as primary insurance and any other insurance, or self-
insurance, maintained by the County is excess only and not contributing with insurance provided under the
Contractor's policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One Million Dollars
($1,000,000) per occurrence for bodily injury and for property damages. Coverage must include any auto used
in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of the State of California
with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One Million Dollars
($1,000,000) per occurrence for bodily injury and for disease.
(E) Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not less than Two Million
Dollars ($2,000,000) per occurrence, with an annual aggregate of Four Million Dollars ($4,000,000). This policy
must be issued on a per occurrence basis.
(F) Professional Liability. Professional liability insurance with limits of not less than One Million Dollars
($1,000,000) per occurrence and an annual aggregate of Three Million Dollars ($3,000,000). If this is a claims-
made policy, then (1) the retroactive date must be prior to the date on which services began under this
Agreement; (2) the Contractor shall maintain the policy and provide to the County annual evidence of
insurance for not less than five years after completion of services under this Agreement; and (3) if the policy is
canceled or not renewed, and not replaced with another claims-made policy with a retroactive date prior to the
date on which services begin under this Agreement, then the Contractor shall purchase extended reporting
coverage on its claims-made policy for a minimum of five years after completion of services under this
Agreement.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars ($2,000,000) per
occurrence. Coverage must include claims involving Cyber Risks. The cyber liability policy must be endorsed
to cover the full replacement value of damage to, alteration of, loss of, or destruction of intangible property
(including but not limited to information or data) that is in the care, custody, or control of the Contractor.
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security Breach, which may include
Disclosure of Personal Information to an Unauthorized Third Party; (ii) data breach; (iii) breach of any of the
Contractor's obligations under [identify the Article, section, or exhibit containing data security obligations] of
this Agreement; (iv) system failure; (v) data recovery; (vi) failure to timely disclose data breach or Security
Breach; (vii)failure to comply with privacy policy; (viii) payment card liabilities and costs; (ix) infringement of
intellectual property, including but not limited to infringement of copyright, trademark, and trade dress; (x)
invasion of privacy, including release of private information; (xi) information theft; (xii) damage to or destruction
G-99
Exhibit G
or alteration of electronic information; (xiii) cyber extortion; (xiv) extortion related to the Contractor's obligations
under this Agreement regarding electronic information, including Personal Information; (xv)fraudulent
instruction; (xvi) funds transfer fraud; (xvii) telephone fraud; (xviii) network security; (xix) data breach response
costs, including Security Breach response costs; (xx) regulatory fines and penalties related to the Contractor's
obligations under this Agreement regarding electronic information, including Personal Information; and (xxi)
credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement, and at any time during
the term of this Agreement as requested by the County's Risk Manager or the County Administrative Office,
the Contractor shall deliver, or cause its broker or producer to deliver, to the County Risk Manager, at 2220
Tulare Street, 16th Floor, Fresno, California 93721, or HRRiskManagement@fresnocountyca.gov, and by mail
or email to the person identified to receive notices under this Agreement, certificates of insurance and
endorsements for all of the coverages required under this Agreement.
(i) Each insurance certificate must state that: (1) the insurance coverage has been obtained and is in full
force; (2) the County, its officers, agents, employees, and volunteers are not responsible for any
premiums on the policy; and (3) the Contractor has waived its right to recover from the County, its
officers, agents, employees, and volunteers any amounts paid under any insurance policy required by
this Agreement and that waiver does not invalidate the insurance policy.
(ii) The commercial general liability insurance certificate must also state, and include an endorsement, that
the County of Fresno, its officers, agents, employees, and volunteers, individually and collectively, are
additional insureds insofar as the operations under this Agreement are concerned. The commercial
general liability insurance certificate must also state that the coverage shall apply as primary insurance
and any other insurance, or self-insurance, maintained by the County shall be excess only and not
contributing with insurance provided under the Contractor's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any auto used in
connection with this Agreement.
(iv) The professional liability insurance certificate, if it is a claims-made policy, must also state the
retroactive date of the policy, which must be prior to the date on which services began under this
Agreement.
(v) The technology professional liability insurance certificate must also state that coverage encompasses
all of the Contractor's obligations under this Agreement, including but not limited to claims involving
Cyber Risks, as that term is defined in this Agreement.
(vi) The cyber liability insurance certificate must also state that it is endorsed, and include an endorsement,
to cover the full replacement value of damage to, alteration of, loss of, or destruction of intangible
property (including but not limited to information or data) that is in the care, custody, or control of the
Contractor.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be issued by admitted
insurers licensed to do business in the State of California and possessing at all times during the term of this
Agreement an A.M. Best, Inc. rating of no less than A: VII.
(C) Notice of Cancellation or Change. For each insurance policy required under this Agreement, the Contractor
shall provide to the County, or ensure that the policy requires the insurer to provide to the County, written
notice of any cancellation or change in the policy as required in this paragraph. For cancellation of the policy
for nonpayment of premium, the Contractor shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy for any other reason,
and for any other change to the policy, the Contractor shall, or shall cause the insurer to, provide written notice
G-23
Exhibit G
to the County not less than 30 days in advance of cancellation or change. The County in its sole discretion may
determine that the failure of the Contractor or its insurer to timely provide a written notice required by this
paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance with broader
coverage, higher limits, or both, than what is required under this Agreement, then the County requires and is
entitled to the broader coverage, higher limits, or both. To that end, the Contractor shall deliver, or cause its
broker or producer to deliver, to the County's Risk Manager certificates of insurance and endorsements for all
of the coverages that have such broader coverage, higher limits, or both, as required under this Agreement.
(E) Waiver of Subrogation. The Contractor waives any right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under the policy of worker's compensation insurance required by
this Agreement. The Contractor is solely responsible to obtain any policy endorsement that may be necessary
to accomplish that waiver, but the Contractor's waiver of subrogation under this paragraph is effective whether
or not the Contractor obtains such an endorsement.
(F) County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep in effect at all times
any insurance coverage required under this Agreement, the County may, in addition to any other remedies it
may have, suspend or terminate this Agreement upon the occurrence of that failure, or purchase such
insurance coverage, and charge the cost of that coverage to the Contractor. The County may offset such
charges against any amounts owed by the County to the Contractor under this Agreement.
(G)Subcontractors. The Contractor shall require and verify that all subcontractors used by the Contractor to
provide services under this Agreement maintain insurance meeting all insurance requirements provided in this
Agreement. This paragraph does not authorize the Contractor to provide services under this Agreement using
subcontractors.
G-24
Exhibit H
FRESNO COUNTY MENTAL HEALTH PLAN
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance and
appeal process and an expedited appeal process to resolve grievances and disputes at
the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-for-service
providers give verbal and written information to Medi-Cal beneficiaries regarding the
following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
the individuals served copies of all current beneficiary information 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.
Informal provider problem resolution process—the provider may first speak to a Provider
Relations Specialist (PRS) regarding his or her complaint or concern.
H-1
Exhibit H
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.
H-2
Exhibit I
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
The Incident Report must be completed for all incidents involving individuals served through
DBH's current incident reporting portal, Logic Manager, at
https:Hfresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182beOc5cdcd5072bb1864cdee
4d3d6e
• The reporting portal is available 24 hours a day, every day.
• Any employee of the Contractor can submit an incident using the reporting portal at
any time. No login is required.
• The designated administrator of the Contractor can add information to the follow up
section of the report after submission.
• When an employee submits an incident within 24 hours from the time of the incident
or first knowledge of the incident, the Contractor's designated administrator, the
assigned contract analyst and the Incident Reporting email inbox will be notified
immediately via email from the Logic Manager system that there is a new incident to
review.
• Meeting the 24 hour incident reporting requirements will be easier as there are no
signatures to collect.
• The user guide attached identifies the reporting process and the reviewer process,
and is subject to updates based on DBH's selected incident reporting portal system.
• Employees involved in a crisis incident should be offered appropriate Employee
Assistance Program (EAP) or similar related wellness and recovery assistance. In
conjunction with the DBH's Guiding Principles of Care Delivery and wellness of the
workforce, Contractor shall align their practices around this vision and ensure
needed debriefing services are offered to all employees involved in a crisis incident.
Employees shall be afforded all services to strengthen their recovery and wellness
related to the crisis incident. Appropriate follow-up with the employee shall be carried
out and a plan for workforce wellness shall be submitted to DBH.
Questions about incident reporting, how to use the incident reporting portal, or
designating/changing the name of the administrator who will review incidents for the Contractor
should be emailed to DBHlncidentReporting@fresnocountyca.gov and the assigned contract
analyst.
I-1
Exhibit I
cot, Mental Health Plan (MHP) and Substance Use Disorder(SUD) services
1 Incident Reporting System
°ems ° INCIDENT REVIEWER ROLE — User Guide
Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted
providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete
a written report of any incidents compromising the health and safety of persons served, employees, or
community members.
Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's
an easier way for any employee to report an incident at any time. A few highlights:
• No supervisor signature is immediately required.
• Additional information can be added to the report by the program supervisor/manager without
having to resubmit the incident.
• When an incident is submitted, the assigned contract analyst, program supervisor/manager,
clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email
notification of a new incident and can log in any time to review the incident. Everything that
was on the original paper/electronic form matches the online form.
• Do away with submitting a paper version with a signature.
• This online submission allows for timely action for the health and safety of the persons-served,
as well as compliance with state reporting timelines when necessary.
As an Incident Reviewer, the responsibility is to:
• Log in to Logic Manager and review incident submitted within 48 hours of notification of incident.
• Review incident for clarity, missing information and add in additional information deemed
appropriate.
• Notify DBHlncidentReporting@fresnocountyca.gov if there is additional information to be report
after initial submission
• Contact.DBHlncidentReporting@fresnocountVca.gov if there are any concerns, questions or
comments with Logic Manager or incident reporting.
Below is the link to report incidents
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bbl864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
1-2
Exhibit I
F C 4 6 fmsnodbh.logicmanageccom/incidents/?t=9&p=1&k=182be0c5cdcd5072bb1864cdee4d3d6e
••
Incident Report
Please complete this form
' Client Information
Name of Facility'
Name of Reporting Party'
i
Facility Address'
Facility Phone Number'
Mental Health or Substance Use Disorder Program?'
sdcctodor
Client First Name'
i
Client Last Name'
i
Client Date of Birth
-/-/yryy
Client Address
i
Client ID
Gender'
County of Origin'
Summary
Subject o
Incident(check all that apply)'
select optionlsi
If Other-specify(i.e.fire,poisoning,epidemic outbreaks,other catastrophes/events that jeopardize the welfare and safety of clients,staff and/or members of the community):
Entertert
Description of the incident'
Enter taut
1-3
Exhibit I
Similar to the paper version, multiple incident categories can be selected
Incident(check all that apply)`
Medical Emergency x Death of Client -
Homicide/Homicide Attempt
AWOL/Elopement from locked facility
Vlolence/Abuse/Assault(toward others,client and/or property
Attempted Suicide(resulting in serious injury)
Injury(self-inflicted or by accident)
Medication Error
F C Q O fresnodbh.logicmaoeger.com/incidents/?t=9&p=l&k=182be0cScdcdSG72bbl864cdee4d3d6e
Date of Incident'
Time of Incident'
Enter tex.
Location of Incident*
Key People Directly Involved in Incident(witnesses,staff)'
Did the Injured Party seek Medical Attention?
Attach any additional details
B Add File or Drop File Here
Reported By Name'
Entcrtcx_
Reported By Email'
Reported On
10/30/2019
1-4
Exhibit I
As another bonus feature, either drag files(such as a copy of a UOR, additional statements/document) or click on
Add File to upl ad a file.
E C fl i fresnodbh.logicmanagecco me sRt=9&0=1&k=182be0c5cdcd5072bb1864cdee4d3d6e
B Add File or Drop File Here
Reported By Name'
Reported By Email'
cntnr tcn
Reported On
10/30/2019
Follow Up
Action Taken(check all that apply)-
Please specify if other
Description of Action Taken'
LnM te:a
Outcome'
Similar to the paper version, multiple Action Taken categories can be selected.
Follow Up
Action Taken(check all that apply)
Law Enforcement Contacted x Called 911/EMS x -
Consulted with Physician
First Ald/CPR Administered
Client removed from building
Parent/Legal Guardian Contacted
Other
When done entering all the information,simply click submit.
Any fields that have a red asterisk, require information an will prevent submission of the form if left blank.
1-5
Exhibit I
A"Thank you for your submission"statement will pop up if an incident is successfully submitted. Click"Reload the
Form"to submit another incident.
LogicManager
Thank you for your submission[
RELOAD THE FORM
A Notification email will be received when a new incident is reported, or a new comment has been made regarding
an incident. Click on "Open this incident in Logic Manager" and the Logic Manager login screen will show.
Wed 10/30/2019 10:40 AM
SL SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@ log icmanager.com>
tJ Notification-
To DBH Incident Reporting
0 K there are problems with how this message is displayed,click here to view it in a web o
Click here to download pictures.To help protect your privacy,outlook prevented autom c download of some pictures in this message.
CAUTION H-EXTERNAL EMAIL-THINK BEFORE YOU CLICK
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Hi Mila Arevalo,
You have received a notification through LogicManager_Please see the details
below.
Type:Incident Report
Subject:102:
Notifiratlon To:Mila Arevalo
open this incident in LogicManager
If using Internet Explorer,dick here to open the notification.
This email was generated by LogicManager.If you have any technical issues,
please email sucoorticb1ceicmanacter.com.
1-6
Exhibit I
Enter in email address and password. First time users will be prompted to set up a password.
C Q O fresnodbh.my.logicmanager.com/Iogi,T
LogicManager
Forgot your password?
Once logged in,the main screen will show reviewer task (incidents to review). Click on analyst/supervisor follow up
to view the incident.
LogicManager puns
Your Task List
TASK NAME SOURCE >TATUS 41511,VED TO
1-7
Exhibit I
This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and
facility information. No edits can be made to this section.
Analyst Follow Up
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ExilkyaM�xs
Mental warm o�suCiuna Ix an�ax vmEr,m!'
[Dent MiOakrmdar
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The next tab is Sum ary: No edits can be made to this section.
Analyst Follow Up
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O�Ix MLYxx Y
rr Mnee-wxMDt.rnE pasonnq,m�eemrt ouIDreaai,xnb wlaxropncs;eveMs iEx AOwrei[e[M1e-1—ane.1tt ur 1u1aM/ormem0xso11necommnmlYl-
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1-8
Exhibit I
The next tab is Follow up: This section can be edited. Add to the areas below or make corrections to these fields. Be
sure to click SAVE w en edits are made.Then Cancel to Exi ut of the incident.
Analyst Follow Up
"ID"-, oreut i summary Follow Up Documents
Acton Taken(dWk aft that app'W
Law Eniprcwnenscontactee lc -
Please specify if otlxr
Des<npnon of Action TaNen'
f
,eaea mrormaleon
copse of e<mn-t,n«r v<rc«prwr 3o-31a�
Task ID:3135oprt<LD3:null u < I O
The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding
documents.Then Cancel to Exit out of the incident.
Analyst Follow Up x
Task Details Client Information Summary Follow Up Documents
- Q Add Document "
Name Type Source Upload Date Uploaded By
l%
dia.
No documents yet.
Drop files here or click on the Add Document dropdown.
« < > » CANCEL SAVE
Task ID:313 Source:103:null
If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once
submitted,the incident will be removed from the task list and no further edits can be made. Notice the SUBMIT
button is on every tab. If further information needs to be included, email
DBHlncidentReporting@fresnocountyca.gov
1-9
Exhibit I
To get back to the home view, click on the LID is Manager icon at any time. Any incidents that still need review will
show on this screen, click o x incident and start the review process again.
Your Task Lis[
TASK NAME souFcE STAiuS ASS IGVEDTO ..lf'L.f ?'
1-10
Exhibit J
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws, regulations,
rules and guidelines that apply to the provision and payment of mental health services. Mental
health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its
employees and subcontractors to attend a compliance training that will be provided by Fresno
County. After completion of this training, Contractor, Contractor' employees and subcontractors must
sign the Contractor Acknowledgment and Agreement form and return this form to the Compliance
Officer or designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and
billing for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in
their professional dealing related to their contract with the County and avoid any
conduct that could reasonably be expected to reflect adversely upon the integrity of the
County.
3. Treat County employees, persons served, and other mental health contractors fairly
and with respect.
4. NOT engage in any activity in violation of the County's Compliance Program, nor
engage in any other conduct which violates any applicable law, regulation, rule or
guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely
and are consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or
reimbursement of any kind are submitted.
J-1
Exhibit J
7. Bill only for eligible services actually rendered and fully documented. Use billing codes
that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by County employees or other mental health contractors, or report
any activity that they believe may violate the standards of the Compliance Program, or
any other applicable law, regulation, rule or guideline. Fresno County prohibits
retaliation against any person making a report. Any person engaging in any form of
retaliation will be subject to disciplinary or other appropriate action by the County.
Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or
guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible
person and therefore excluded from participation in the Federal Health Care Programs.
J-2
Exhibit J
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 guideline s. 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:
J-3
Exhibit K
coU Department of Behavioral Health
s Policy and Procedure Guide
O 1856 O
FREE) PPG 1.2.7
Section: Mental Health
Effective Date: 05/30/2017 Revised Date: 05/30/2017
Policy Title: Performance Outcome Measures
Approved by: Dawan Utecht (Director of Behavioral Health), Francisco Escobedo (Sr. Staff Analyst- QA), Kannika
Toonnachat (Division Manager -Technology and Quality Management)
POLICY8 It is the policy of Fresno County Department of Behavioral Health and the
Fresno County Mental Health Plan (FCMHP)to ensure procedures for
developing performance measures which accurately reflect vital areas of
performance and provide for systematic, ongoing collection and analysis
of valid and reliable data. Data collection is not intended to be an
additional task for FCMHP programs/providers but rather embedded within
the various non-treatment, treatment and clinical documentation.
PURPOSE: To determine the effectiveness and efficiency of services provided by
measuring performance outcomes/results achieved by the persons served
during service delivery or following service completion, delivery of service,
and of the individuals' satisfaction. This is a vital management tool used to
clarify goals, document the efforts toward achieving those goals, and thus
measure the benefit the service delivery to the persons served.
Performance measurement selection is part of the planning and
developing process design of the program. Performance measurement is
the ongoing monitoring and reporting of progress towards pre-established
objectives/goals.
REFERENCE: California Code of Regulations, Title 9, Chapter 11, Section
1810.380(a)(1): State Oversight
DHCS Service, Administrative and Operational Requirements
Mental Health Services Act(MHSA), California Code of Regulations, Title
9, Section 3320, 3200.050, and 3200.120
Commission on Accreditation of Rehabilitation Facilities (CARF)
DEFINITIONS:
1. Indicator: Qualitative or quantitative measure(s)that tell if the outcomes have been
accomplished. Indicators evaluate key performance in relation to objectives. It indicates
what the program is accomplishing and if the anticipated results are being achieved.
MISSION STATEMENT
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,families and communities in Fresno County who are affected by,or are at risk
of,mental illness and/or substance use disorders through cultivation of strengths toward promoting recovery in the least restrictive environment.
Template Review Date 3128116
1 �
K-1
Exhibit K
c0U Department of Behavioral Health
It Policy and Procedure Guide
0 185O
F17 Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7
[Policy Title: Performance Outcome Measures
2. Intervention: A systematic plan of action consciously adapted in an attempt to address
and reduce the causes of failure or need to improve upon system.
3. Fresno County Mental Health Plan (FCMHP): Fresno County's contract with the State
Department of Health and Human Services that allows for the provision of specialty
mental health services. Services may be delivered by county-operated programs,
contracted organizational, or group providers.
4. Objective (Goal): Intended results or the impact of learning, programs, or activities.
5. Outcomes: Specific results or changes achieved as a consequence of the program or
intervention. Outcomes are connected to the objectives/goals identified by the program
or intervention.
PROCEDURE:
I. Each FCMHP program/provider shall engage in measurement of outcomes in order
to generate reliable and valid data on the effectiveness and efficiency of programs or
interventions. Programs/providers will establish/select objectives (goals), decide on
a methodology and timeline for the collection of data, and use an appropriate data
collection tool. This occurs during the program planning and development process.
Outcomes should be in alignment with the program/provider goals.
11. Outcomes should be measureable, obtainable, clear, accurately reflect the expected
result, and include specific time frames. Once the measures have been selected, it
is necessary to design a way to gather the information. For each service delivery
performance indicator, FCMHP program/provider shall determine: to whom the
indicator will be applied; who is responsible for collecting the data; the tool from
which data will be collected; and a performance target based on an industry
benchmark, or a benchmark set by the program/provider.
Ill. Performance measures are subject to review and approval by FCMHP
Administration.
IV. Performance measurement is the ongoing monitoring and reporting of progress
towards pre-established objectives/goals. Annually, each FCMHP program/provider
must measure service delivery performance in each of the areas/domains listed
below. Dependent on the program/provider service deliverables, exceptions must be
approved by the FCMHP Administration.
2 1 P a g e
K-2
Exhibit K
c0U Department of Behavioral Health
It Policy and Procedure Guide
0 185O
F17 Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7
[Policy Title: Performance Outcome Measures
a. Effectiveness of services— How well programs performed and the results
achieved. Effectiveness measures address the quality of care through
measuring change over time. Examples include but are not limited to: reduction
of hospitalization, reduction of symptoms, employment and housing status, and
reduction of recidivism rate and incidence of relapse.
b. Efficiency of services — The relationship between the outcomes and the
resources used. Examples include but are not limited to: service delivery cost per
service unit, length of stay, and direct service hours of clinical and medical staff.
c. Services access—Changes or improvements in the program/provider's capacity
and timeliness to provide services to those who request them. Examples include
but are not limited to: wait/length of time from first request/referral to first service
or subsequent appointment, convenience of service hours and locations, number
of clients served by program capacity, and no-show and cancellation rates.
d. Satisfaction and feedback from persons served and stakeholders—Changes or
increased positive/negative feedback regarding the experiences of the persons
served and others (families, referral sources, payors/guarantors, etc.).
Satisfaction measures are usually oriented toward clients, family members,
personnel, the community, and funding sources. Examples include but are not
limited to: did the organization/program focus on the recovery of the person
served, were grievances or concerns addressed, overall feelings of satisfaction,
and satisfaction with physical facilities, fees, access, service effectiveness, and
efficiency.
V. Each FCMHP program/provider shall use the following templates to document the
defined goals, intervention(s), specific indicators, and outcomes.
1. FCMHP Outcome Report template (see Attachment A)
2. FCMHP Outcome Analysis template (see Attachment C)
3 1 P a g e
K-3
Exhibit L
COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
Contractor shall be required to maintain organizational provider certification by the host county.
A copy of this renewal certificate must be furnished to County within thirty (30) days of receipt of
certificate from host county. The Contractor must meet Medi-Cal organization provider
standards as stated below. It is acknowledged that all references to Organizational Provider
and/or Provider below shall refer to the Contractor.
Medi-Cal Organizational Provider Standards
1. The organizational provider possesses the necessary license to operate, if applicable,
and any required certification.
2. The space owned, leased or operated by the provider and used for services or staff
meets local fire codes.
3. The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4. The organizational provider establishes and implements maintenance policies for any
site owned, leased, or operated by the provider and used for services or staff to ensure
the safety and well-being of beneficiaries and staff.
5. The organizational provider has a current administrative manual which includes:
personnel policies and procedures, general operating procedures, service delivery
policies, and procedures for reporting unusual occurrences relating to health and
safety issues.
6. The organizational provider maintains client records in a manner that meets applicable
state and federal standards.
7. The organization provider has staffing adequate to allow the COUNTY to claim federal
financial participation for the services the Provider delivers to beneficiaries, as
described in Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8. The organizational provider has as head of service a licensed mental health
professional or other appropriate individual as described in Title 9, CCR, Sections 622
through 630.
9. For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A. All drugs obtained by prescription are labeled in compliance with federal and state
laws. Prescription labels are altered only by persons legally authorized to do so.
B. Drugs intended for external use only or food stuffs are stored separately from drugs
for internal use.
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86
degrees F and refrigerated drugs at 36-46 degrees F.
L-1
Exhibit L
D. Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F. A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal
laws.
G. Policies and procedures are in place for dispensing, administering and storing
medications.
10. The County may accept the host county's site certification and reserves the right to
conduct an on-site certification review at least every three years. The County may also
conduct additional certification reviews when:
• The provider makes major staffing changes.
• The provider makes organizational and/or corporate structure changes
(example: conversion from a non-profit status).
• The provider adds day treatment or medication support services when
medications shall be administered or dispensed from the provider site.
• There are significant changes in the physical plant of the provider site (some
physical plant changes could require a new fire clearance).
• There is change of ownership or location.
• There are complaints against the provider.
• There are unusual events, accidents, or injuries requiring medical treatment for
clients, staff or members of the community.
L-2
Exhibit M
Data Security
1. Definitions
Capitalized terms used in this Exhibit have the meanings set forth in this section 1.
(A) "Authorized Employees" means the Contractor's employees who have access to
Personal Information.
(B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii)any and all
of the Contractor's subcontractors, representatives, agents, outsourcers, and
consultants, and providers of professional services to the Contractor, who have access
to Personal Information and are bound by law or in writing by confidentiality obligations
sufficient to protect Personal Information in accordance with the terms of this Exhibit L.
(C) "Director" means the County's Director of the Department of Behavioral Health or his or
her designee.
(D) "Disclose" or any derivative of that word means to disclose, release, transfer,
disseminate, or otherwise provide access to or communicate all or any part of any
Personal Information orally, in writing, or by electronic or any other means to any person.
(E) "Person" means any natural person, corporation, partnership, limited liability company,
firm, or association.
(F) "Personal Information" means any and all information, including any data, provided, or
to which access is provided, to the Contractor by or upon the authorization of the
County, under this Agreement, including but not limited to vital records, that: (i) identifies,
describes, or relates to, or is associated with, or is capable of being used to identify,
describe, or relate to, or associate with, a person (including, without limitation, names,
physical descriptions, signatures, addresses, telephone numbers, e-mail addresses,
education, financial matters, employment history, and other unique identifiers, as well as
statements made by or attributable to the person); (ii) is used or is capable of being used
to authenticate a person (including, without limitation, employee identification numbers,
government-issued identification numbers, passwords or personal identification numbers
(PINs), financial account numbers, credit report information, answers to security
questions, and other personal identifiers); or (iii) is personal information within the
meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision
(e). Personal Information does not include publicly available information that is lawfully
made available to the general public from federal, state, or local government records.
(G)"Privacy Practices Complaint" means a complaint received by the County relating to
the Contractor's (or any Authorized Person's) privacy practices, or alleging a Security
Breach. Such complaint shall have sufficient detail to enable the Contractor to promptly
investigate and take remedial action under this Exhibit L.
(H) "Security Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by the Contractor (or any Authorized
Persons)that relate to the protection of the security, confidentiality, value, or integrity of
Personal Information. Security Safeguards shall satisfy the minimal requirements set
forth in section 3(C) of this Exhibit L.
M-1
Exhibit M
(1) "Security Breach" means (i) any act or omission that compromises either the security,
confidentiality, value, or integrity of any Personal Information or the Security Safeguards,
or (ii) any unauthorized Use, Disclosure, or modification of, or any loss or destruction of,
or any corruption of or damage to, any Personal Information.
(J) "Use" or any derivative of that word means to receive, acquire, collect, apply,
manipulate, employ, process, transmit, disseminate, access, store, disclose, or dispose
of Personal Information.
2. Standard of Care
(A) The Contractor acknowledges that, in the course of its engagement by the County under
this Agreement, the Contractor, or any Authorized Persons, may Use Personal
Information only as permitted in this Agreement.
(B) The Contractor acknowledges that Personal Information is deemed to be confidential
information of, or owned by, the County (or persons from whom the County receives or
has received Personal Information) and is not confidential information of, or owned or by,
the Contractor, or any Authorized Persons. The Contractor further acknowledges that all
right, title, and interest in or to the Personal Information remains in the County (or
persons from whom the County receives or has received Personal Information)
regardless of the Contractor's, or any Authorized Person's, Use of that Personal
Information.
(C) The Contractor agrees and covenants in favor of the Country that the Contractor shall:
(i) keep and maintain all Personal Information in strict confidence, using such
degree of care under this section 2 as is reasonable and appropriate to avoid a
Security Breach;
(ii) Use Personal Information exclusively for the purposes for which the Personal
Information is made accessible to the Contractor pursuant to the terms of this
Exhibit L;
(iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal
Information for the Contractor's own purposes or for the benefit of anyone other
than the County, without the County's express prior written consent, which the
County may give or withhold in its sole and absolute discretion; and
(iv) not, directly or indirectly, Disclose Personal Information to any person (an
"Unauthorized Third Party") other than Authorized Persons pursuant to this
Agreement, without the Director's express prior written consent.
(D) Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it,
or any Authorized Person, is required to disclose Personal Information to government
regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be
required by applicable law, Contractor shall (i) immediately notify the County of the
specific demand for, and legal authority for the disclosure, including providing County
with a copy of any notice, discovery demand, subpoena, or order, as applicable,
received by the Contractor, or any Authorized Person, from any government regulatory
authorities, or in relation to any legal proceeding, and (ii) promptly notify the County
M-2
Exhibit M
before such Personal Information is offered by the Contractor for such disclosure so that
the County may have sufficient time to obtain a court order or take any other action the
County may deem necessary to protect the Personal Information from such disclosure,
and the Contractor shall cooperate with the County to minimize the scope of such
disclosure of such Personal Information.
(E) The Contractor shall remain liable to the County for the actions and omissions of any
Unauthorized Third Party concerning its Use of such Personal Information as if they
were the Contractor's own actions and omissions.
3. Information Security
(A) The Contractor covenants, represents and warrants to the County that the Contractor's
Use of Personal Information under this Agreement does and will at all times comply with
all applicable federal, state, and local, privacy and data protection laws, as well as all
other applicable regulations and directives, including but not limited to California Civil
Code, Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song-
Beverly Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3,
beginning with section 1747). If the Contractor Uses credit, debit or other payment
cardholder information, the Contractor shall at all times remain in compliance with the
Payment Card Industry Data Security Standard ("PCI DSS") requirements, including
remaining aware at all times of changes to the PCI DSS and promptly implementing and
maintaining all procedures and practices as may be necessary to remain in compliance
with the PCI DSS, in each case, at the Contractor's sole cost and expense.
(B) The Contractor covenants, represents and warrants to the County that, as of the
effective date of this Agreement, the Contractor has not received notice of any violation
of any privacy or data protection laws, as well as any other applicable regulations or
directives, and is not the subject of any pending legal action or investigation by, any
government regulatory authority regarding same.
(C) Without limiting the Contractor's obligations under section 3(A) of this Exhibit L, the
Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than
accepted industry practices and, at a minimum, include the following:
(i) limiting Use of Personal Information strictly to the Contractor's and Authorized
Persons' technical and administrative personnel who are necessary for the
Contractor's, or Authorized Persons', Use of the Personal Information pursuant to
this Agreement;
(ii) ensuring that all of the Contractor's connectivity to County computing systems
will only be through the County's security gateways and firewalls, and only
through security procedures approved upon the express prior written consent of
the Director;
(iii) to the extent that they contain or provide access to Personal Information, (a)
securing business facilities, data centers, paper files, servers, back-up systems
and computing equipment, operating systems, and software applications,
including, but not limited to, all mobile devices and other equipment, operating
systems, and software applications with information storage capability; (b)
M-3
Exhibit M
employing adequate controls and data security measures, both internally and
externally, to protect (1) the Personal Information from potential loss or
misappropriation, or unauthorized Use, and (2) the County's operations from
disruption and abuse; (c) having and maintaining network, device application,
database and platform security; (d) maintaining authentication and access
controls within media, computing equipment, operating systems, and software
applications; and (e) installing and maintaining in all mobile, wireless, or
handheld devices a secure internet connection, having continuously updated
anti-virus software protection and a remote wipe feature always enabled, all of
which is subject to express prior written consent of the Director;
(iv) encrypting all Personal Information at advance encryption standards of Advanced
Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile
devices, including but not limited to hard disks, portable storage devices, or
remote installation, or (b) transmitted over public or wireless networks (the
encrypted Personal Information must be subject to password or pass phrase, and
be stored on a secure server and transferred by means of a Virtual Private
Network (VPN) connection, or another type of secure connection, all of which is
subject to express prior written consent of the Director);
(v) strictly segregating Personal Information from all other information of the
Contractor, including any Authorized Person, or anyone with whom the
Contractor or any Authorized Person deals so that Personal Information is not
commingled with any other types of information;
(vi) having a patch management process including installation of all operating system
and software vendor security patches;
(vii) maintaining appropriate personnel security and integrity procedures and
practices, including, but not limited to, conducting background checks of
Authorized Employees consistent with applicable law; and
(viii) providing appropriate privacy and information security training to Authorized
Employees.
(D) During the term of each Authorized Employee's employment by the Contractor, the
Contractor shall cause such Authorized Employees to abide strictly by the Contractor's
obligations under this Exhibit L. The Contractor shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
(E) The Contractor shall, in a secure manner, backup daily, or more frequently if it is the
Contractor's practice to do so more frequently, Personal Information received from the
County, and the County shall have immediate, real time access, at all times, to such
backups via a secure, remote access connection provided by the Contractor, through the
Internet.
(F) The Contractor shall provide the County with the name and contact information for each
Authorized Employee (including such Authorized Employee's work shift, and at least one
alternate Authorized Employee for each Authorized Employee during such work shift)
who shall serve as the County's primary security contact with the Contractor and shall be
M-4
Exhibit M
available to assist the County twenty-four (24) hours per day, seven (7) days per week
as a contact in resolving the Contractor's and any Authorized Persons' obligations
associated with a Security Breach or a Privacy Practices Complaint.
(G)The Contractor shall not knowingly include or authorize any Trojan Horse, back door,
time bomb, drop dead device, worm, virus, or other code of any kind that may disable,
erase, display any unauthorized message within, or otherwise impair any County
computing system, with or without the intent to cause harm.
4. Security Breach Procedures
(A) Immediately upon the Contractor's awareness or reasonable belief of a Security Breach,
the Contractor shall (i) notify the Director of the Security Breach, such notice to be given
first by telephone at the following telephone number, followed promptly by email at the
following email addresses: incidents(a�-fresnocountyca.gov, 559-600-5900, (559) 600-
4645, dbhcontractedservices(a)fresnocountyca.gov,
dbhforensicservices(a-)_fresnocountyca.gov (which telephone number and email address
the County may update by providing notice to the Contractor), and (ii) preserve all
relevant evidence (and cause any affected Authorized Person to preserve all relevant
evidence) relating to the Security Breach. The notification shall include, to the extent
reasonably possible, the identification of each type and the extent of Personal
Information that has been, or is reasonably believed to have been, breached, including
but not limited to, compromised, or subjected to unauthorized Use, Disclosure, or
modification, or any loss or destruction, corruption, or damage.
(B) Immediately following the Contractor's notification to the County of a Security Breach, as
provided pursuant to section 4(A) of this Exhibit L, the Parties shall coordinate with each
other to investigate the Security Breach. The Contractor agrees to fully cooperate with
the County, including, without limitation:
(i) assisting the County in conducting any investigation;
(ii) providing the County with physical access to the facilities and operations
affected;
(iii) facilitating interviews with Authorized Persons and any of the Contractor's other
employees knowledgeable of the matter; and
(iv) making available all relevant records, logs, files, data reporting and other
materials required to comply with applicable law, regulation, industry standards,
or as otherwise reasonably required by the County.
To that end, the Contractor shall, with respect to a Security Breach, be solely
responsible, at its cost, for all notifications required by law and regulation, or deemed
reasonably necessary by the County, and the Contractor shall provide a written report of
the investigation and reporting required to the Director within 30 days after the
Contractor's discovery of the Security Breach.
(C) County shall promptly notify the Contractor of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint, and upon the Contractor's receipt of that
notification, the Contractor shall promptly address such Privacy Practices Complaint,
M-5
Exhibit M
including taking any corrective action under this Exhibit L, all at the Contractor's sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
In the event the Contractor discovers a Security Breach, the Contractor shall treat the
Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractor's
receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the
County whether the matter is a Security Breach, or otherwise has been corrected and
the manner of correction, or determined not to require corrective action and the reason
for that determination.
(D) The Contractor shall take prompt corrective action to respond to and remedy any
Security Breach and take mitigating actions, including but not limiting to, preventing any
reoccurrence of the Security Breach and correcting any deficiency in Security
Safeguards as a result of such incident, all at the Contractor's sole expense, in
accordance with applicable privacy rights, laws, regulations and standards. The
Contractor shall reimburse the County for all reasonable costs incurred by the County in
responding to, and mitigating damages caused by, any Security Breach, including all
costs of the County incurred relation to any litigation or other action described section
4(E) of this Exhibit L.
(E) The Contractor agrees to cooperate, at its sole expense, with the County in any litigation
or other action to protect the County's rights relating to Personal Information, including
the rights of persons from whom the County receives Personal Information.
5. Oversight of Security Compliance
(A) The Contractor shall have and maintain a written information security policy that
specifies Security Safeguards appropriate to the size and complexity of the Contractor's
operations and the nature and scope of its activities.
(B) Upon the County's written request, to confirm the Contractor's compliance with this
Exhibit L, as well as any applicable laws, regulations and industry standards, the
Contractor grants the County or, upon the County's election, a third party on the
County's behalf, permission to perform an assessment, audit, examination or review of
all controls in the Contractor's physical and technical environment in relation to all
Personal Information that is Used by the Contractor pursuant to this Agreement. The
Contractor shall fully cooperate with such assessment, audit or examination, as
applicable, by providing the County or the third party on the County's behalf, access to
all Authorized Employees and other knowledgeable personnel, physical premises,
documentation, infrastructure and application software that is Used by the Contractor for
Personal Information pursuant to this Agreement. In addition, the Contractor shall
provide the County with the results of any audit by or on behalf of the Contractor that
assesses the effectiveness of the Contractor's information security program as relevant
to the security and confidentiality of Personal Information Used by the Contractor or
Authorized Persons during the course of this Agreement under this Exhibit L.
(C) The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit L. that apply to the
Contractor with respect to such Personal Information by incorporating the relevant
provisions of these provisions into a valid and binding written agreement between the
M-6
Exhibit M
Contractor and such Authorized Persons, or amending any written agreements to
provide same.
6. Return or Destruction of Personal Information. Upon the termination of this Agreement,
the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the County
all Personal Information, whether in written, electronic or other form or media, in its possession
or the possession of such Authorized Persons, in a machine readable form used by the County
at the time of such return, or upon the express prior written consent of the Director, securely
destroy all such Personal Information, and certify in writing to the County that such Personal
Information have been returned to the County or disposed of securely, as applicable. If the
Contractor is authorized to dispose of any such Personal Information, as provided in this Exhibit
L, such certification shall state the date, time, and manner (including standard) of disposal and
by whom, specifying the title of the individual. The Contractor shall comply with all reasonable
directions provided by the Director with respect to the return or disposal of Personal Information
and copies of Personal Information. If return or disposal of such Personal Information or copies
of Personal Information is not feasible, the Contractor shall notify the County according,
specifying the reason, and continue to extend the protections of this Exhibit L to all such
Personal Information and copies of Personal Information. The Contractor shall not retain any
copy of any Personal Information after returning or disposing of Personal Information as
required by this section 6. The Contractor's obligations under this section 6 survive the
termination of this Agreement and apply to all Personal Information that the Contractor retains if
return or disposal is not feasible and to all Personal Information that the Contractor may later
discover.
7. Equitable Relief. The Contractor acknowledges that any breach of its covenants or
obligations set forth in this Exhibit L may cause the County irreparable harm for which monetary
damages would not be adequate compensation and agrees that, in the event of such breach or
threatened breach, the County is entitled to seek equitable relief, including a restraining order,
injunctive relief, specific performance and any other relief that may be available from any court,
in addition to any other remedy to which the County may be entitled at law or in equity. Such
remedies shall not be deemed to be exclusive but shall be in addition to all other remedies
available to the County at law or in equity or under this Agreement.
8. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its
officers, employees, and agents, (each, a "County Indemnitee") from and against any and all
infringement of intellectual property including, but not limited to infringement of copyright,
trademark, and trade dress, invasion of privacy, information theft, and extortion, unauthorized
Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage
to, Personal Information, Security Breach response and remedy costs, credit monitoring
expenses, forfeitures, losses, damages, liabilities, deficiencies, actions, judgments, interest,
awards, fines and penalties (including regulatory fines and penalties), costs or expenses of
whatever kind, including attorneys' fees and costs, the cost of enforcing any right to
indemnification or defense under this Exhibit L and the cost of pursuing any insurance
providers, arising out of or resulting from any third party claim or action against any County
Indemnitee in relation to the Contractor's, its officers, employees, or agents, or any Authorized
Employee's or Authorized Person's, performance or failure to perform under this Exhibit L or
arising out of or resulting from the Contractor's failure to comply with any of its obligations under
this section 8. The provisions of this section 8 do not apply to the acts or omissions of the
M-7
Exhibit M
County. The provisions of this section 8 are cumulative to any other obligation of the Contractor
to, defend, indemnify, or hold harmless any County Indemnitee under this Agreement. The
provisions of this section 8 shall survive the termination of this Agreement.
9. Survival. The respective rights and obligations of the Contractor and the County as stated
in this Exhibit L shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit L
is intended to confer, nor shall anything in this Exhibit L confer, upon any person other than the
County or the Contractor and their respective successors or assignees, any rights, remedies,
obligations or liabilities whatsoever.
11. No County Warranty. The County does not make any warranty or representation whether
any Personal Information in the Contractor's (or any Authorized Person's) possession or control,
or Use by the Contractor (or any Authorized Person), pursuant to the terms of this Agreement is
or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint.
M-8
Exhibit N
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno ("County"), members of a
contractor's board of directors ("County Contractor"), must disclose any self-dealing transactions
that they are a party to while providing goods, performing services, or both for the County. A
self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest."
The definition above will be used for purposes of completing this disclosure form.
Instructions
(1) Enter board member's name, job title (if applicable), and date this disclosure is being
made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction;
and
b. The nature of the material financial interest in the Corporation's transaction that
the board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
The form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
N-1
Exhibit N
(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:
N-2
Exhibit O
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) City State ZIP code
CILIA 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.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVI II,XIX,or XX? ......................................................................................................................... n n
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 XVI II,XIX,or XX?...................................................................................... o 0
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVII I providers only)........... o 0
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under"Remarks."
NAME ADDRESS EIN
B. Type of entity: o Sole proprietorship o Partnership o Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors,and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership,or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... o n
NAME ADDRESS PROVIDER NUMBER
O-1
Exhibit O
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... o 0
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... o 0
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... n n
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
O-2
Exhibit P
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
P-1
Exhibit P
(c) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
P-2
Exhibit Q
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help
eliminate health care disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
l. Provide effective,equitable,understandable,and respectful quality care and services that are responsive to diverse cultural health beliefs and
practices, preferred languages,health literacy,and other communication needs.
Governance,Leadership,and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,practices,and
allocated resources.
3. Recruit,promote,and support a culturally and linguistically diverse governance,leadership,and workforce that are responsive to the population in
the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.
Communication and Language Assistance:
S. Offer language assistance to individuals who have limited English proficiency and/or other communication needs,at no cost to them,to facilitate
timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,verbally and in writing.
7. Ensure the competence of individuals providing language assistance,recognizing that the use of untrained individuals and/or minors as interpreters
should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
Engagement,Continuous Improvement,and Accountability:
9. Establish culturally and linguistically appropriate goals,policies,and management accountability,and infuse them throughout the organization's
planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous
quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to
inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the
cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design,implement,and evaluate policies,practices,and services to ensure cultural and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify,prevent,and resolve conflicts
or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders,constituents,and the general public.
\,L Think Cultural Health
�1 US.Department of https://www.thinkculturalhealth.hhs.gov/
{� //�� Health and Human Services
O1 Y 1 H Office of MinorityHeanh contact@thinkculturalhealth.hhs.gov
Q-1
Exhibit Q
2
The Case for the National CLAS Standards
Health equity is the attainment of the highest level of health for all people.' Currently,individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons,including the social determinants of health,or those conditions in which
individuals are born,grow,live,work,and age,' such as socioeconomic status,education level,and the availability of health services.3
Though health inequities are directly related to the existence of historical and current discrimination
and social injustice,one of the most modifiable factors is the lack of culturally and linguistically
appropriate services,broadly defined as care and services that are respectful of and responsive to
the cultural and linguistic needs of all individuals.
Of all the forms of
Health inequities result in disparities that directly affect the quality of life for all individuals.Health
disparities adversely affect neighborhoods,communities,and the broader society,thus making inequality, injustice in
the issue not only an individual concern but also a public health concern. In the United States,it health care is the most
has been estimated that the combined cost of health disparities and subsequent deaths due to shocking and inhumane.
inadequate and/or inequitable care is$1.24 trillion.4
Culturally and linguistically appropriate services are increasingly recognized as effective in improving —Dr.Martin Luther King,Jr.
the quality of care and services.s,6 By providing a structure to implement culturally and linguistically
appropriate services,the National CLAS Standards will improve an organization's ability to address
health care disparities.
The National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities'and the National Stakeholder Strategy for
Achieving Health Equity,'which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial
and ethnic health disparities across the country.
Similar to these initiatives,the National CLAS Standards are intended to advance health equity,improve quality,and help eliminate health care disparities
by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. Adoption of
these Standards will help advance better health and health care in the United States.
Bibliography
1.U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from http://minorityhealth.hhs.gov/npa
2.World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
3. U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved from http://www.
h ealthypeopl e.gov/2020/topics objectives2O2O/overview.as px.7topicid=3 9
4. LaVeist,T.A.,Gaskin,D.J.,&Richard,P.(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic Studies website:http://www.
jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2 OBurden%20of%2OHealth%201nequalities%20in%20the%2OUnited%20States.pdf
5. Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ Publication No.04-EO08-02).Retrieved
from the Agency of Healthcare Research and Quality website:http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minqual.pdf
6.Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).Retrieved from The
Commonwealth Fund website:http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultiinguisticcomp_962.pdf
7. U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.Retrieved from http://
minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan complete.pdf
8. National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and Human Services,Office of
Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
Think Cultural Health
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Q-2
Exhibit R
Health Insurance Portability and Accountability Act (HIPAA)
Business Associate Agreement
1. The County is a "Covered Entity," and the Contractor is a "Business Associate,"
as these terms are defined by 45 CFR 160.103. In connection with providing services under the
Agreement, the parties anticipate that the Contractor will create and/or receive Protected Health
Information ("PHI") from or on behalf of the County. The parties enter into this Business
Associate Agreement (BAA) to comply with the Business Associate requirements of HIPAA, to
govern the use and disclosures of PHI under this Agreement. "HIPAA Rules" shall mean the
Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Parts 160 and 164.
The parties to this Agreement shall be in strict conformance with all applicable federal
and State of California laws and regulations, including, but not limited to California Welfare and
Institutions Code sections 5328, 10850, and 14100.2 et seq.; 42 CFR 2; 42 CFR 431; California
Civil Code section 56 et seq.; the Health Insurance Portability and Accountability Act of 1996, as
amended ("HIPAA"), including, but not limited to, 45 CFR Parts160, 45 CFR 162, and 45 CFR
164; the Health Information Technology for Economic and Clinical Health Act ("HITECH")
regarding the confidentiality and security of patient information, including, but not limited to 42
USC 17901 et seq.; and the Genetic Information Nondiscrimination Act ("GINA") of 2008
regarding the confidentiality of genetic information.
Except as otherwise provided in this Agreement, the Contractor, as a business associate
of the County, may use or disclose Protected Health Information ("PHI") to perform functions,
activities or services for or on behalf of the County, as specified in this Agreement, provided that
such use or disclosure shall not violate HIPAA Rules. The uses and disclosures of PHI may not
be more expansive than those applicable to the County, as the "Covered Entity" under the
HIPAA Rules, except as authorized for management, administrative or legal responsibilities of
the Contractor.
2. The Contractor, including its subcontractors and employees, shall protect from
unauthorized access, use, or disclosure of names and other identifying information, including
genetic information, concerning persons receiving services pursuant to this Agreement, except
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Exhibit R
where permitted in order to carry out data aggregation purposes for health care operations [45
CFR §§ 164.504(e)(2)(i), 164.504(e)(2)(ii)(A), and 164.504(e)(4)(i)]. This pertains to any and all
persons receiving services pursuant to a County-funded program. This requirement applies to
electronic PHI. The Contractor shall not use such identifying information or genetic information
for any purpose other than carrying out the Contractor's obligations under this Agreement.
3. The Contractor, including its subcontractors and employees, shall not disclose
any such identifying information or genetic information to any person or entity, except as
otherwise specifically permitted by this Agreement, authorized by Subpart E of 45 CFR Part 164
or other law, required by the Secretary of the United States Department of Health and Human
Services ("Secretary"), or authorized by the client/patient in writing. In using or disclosing PHI
that is permitted by this Agreement or authorized by law, the Contractor shall make reasonable
efforts to limit PHI to the minimum necessary to accomplish intended purpose of use, disclosure
or request.
4. For purposes of the above sections, identifying information shall include, but not
be limited to, name, identifying number, symbol, or other identifying particular assigned to the
individual, such as fingerprint or voiceprint, or photograph.
5. For purposes of the above sections, genetic information shall include genetic
tests of family members of an individual or individual(s), manifestation of disease or disorder of
family members of an individual, or any request for or receipt of genetic services by individual or
family members. Family member means a dependent or any person who is first, second, third,
or fourth degree relative.
6. The Contractor shall provide access, at the request of the County, and in the time
and manner designated by the County, to PHI in a designated record set (as defined in 45 CFR
§ 164.501), to an individual or to COUNTY in order to meet the requirements of 45 CFR §
164.524 regarding access by individuals to their PHI. With respect to individual requests,
access shall be provided within thirty (30) days from request. Access may be extended if the
Contractor cannot provide access and provides the individual with the reasons for the delay and
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Exhibit R
the date when access may be granted. PHI shall be provided in the form and format requested
by the individual or the County.
The Contractor shall make any amendment(s) to PHI in a designated record set at the
request of the County or individual, and in the time and manner designated by the County in
accordance with 45 CFR § 164.526.
The Contractor shall provide to the County or to an individual, in a time and manner
designated by the County, information collected in accordance with 45 CFR § 164.528, to permit
the County to respond to a request by the individual for an accounting of disclosures of PHI in
accordance with 45 CFR § 164.528.
7. The Contractor shall report to the County, in writing, any knowledge or
reasonable belief that there has been unauthorized access, viewing, use, disclosure, security
incident, or breach of unsecured PHI not permitted by this Agreement of which the Contractor
becomes aware, immediately and without reasonable delay and in no case later than two (2)
business days of discovery. Immediate notification shall be made to the County's Information
Security Officer and Privacy Officer and the County's Department of Public Health ("DPH")
HIPAA Representative, within two (2) business days of discovery. The notification shall include,
to the extent possible, the identification of each individual whose unsecured PHI has been, or is
reasonably believed to have been, accessed, acquired, used, disclosed, or breached. The
Contractor shall take prompt corrective action to cure any deficiencies and any action pertaining
to such unauthorized disclosure required by applicable federal and State laws and regulations.
The Contractor shall investigate such breach and is responsible for all notifications required by
law and regulation or deemed necessary by the County and shall provide a written report of the
investigation and reporting required to the County's Information Security Officer and Privacy
Officer and the County's DPH HIPAA Representative.
This written investigation and description of any reporting necessary shall be
postmarked within the thirty (30) working days of the discovery of the breach to the addresses
below:
County of Fresno County of Fresno County of Fresno
Department of Public Health Department of Public Health Department of Internal
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Exhibit R
HIPAA Representative Privacy Officer Services
(559) 600-6439 (559) 600-6405 Information Security Officer
P.O. Box 11867 P.O. Box 11867 (559) 600-5800
Fresno, California 93775 Fresno, California 93775 2048 North Fine Street
Fresno, California 93727
8. The Contractor shall make its internal practices, books, and records relating to
the use and disclosure of PHI received from the county, or created or received by the Contractor
on behalf of the County, in compliance with Parts the HIPAA Rules. The Contractor shall make
its internal practices, books, and records relating to the use and disclosure of PHI received from
the County, or created or received by the Contractor on behalf of the County, available to the
Secretary upon demand.
The Contractor shall cooperate with the compliance and investigation reviews conducted
by the Secretary. PHI access to the Secretary must be provided during the Contractor's normal
business hours; however, upon exigent circumstances access at any time must be granted.
Upon the Secretary's compliance or investigation review, if PHI is unavailable to the Contractor
and in possession of a subcontractor of the Contractor, the Contractor must certify to the
Secretary its efforts to obtain the information from the subcontractor.
9. Safeguards
The Contractor shall implement administrative, physical, and technical safeguards as
required by the HIPAA Security Rule, Subpart C of 45 CFR Part 164, that reasonably and
appropriately protect the confidentiality, integrity, and availability of PHI, including electronic
PHI, that it creates, receives, maintains or transmits on behalf of the County and to prevent
unauthorized access, viewing, use, disclosure, or breach of PHI other than as provided for by
this Agreement. The Contractor shall conduct an accurate and thorough assessment of the
potential risks and vulnerabilities to the confidentiality, integrity and availability of electronic PHI.
The Contractor shall develop and maintain a written information privacy and security program
that includes administrative, technical and physical safeguards appropriate to the size and
complexity of the Contractor's operations and the nature and scope of its activities. Upon the
County's request, the Contractor shall provide the County with information concerning such
safeguards.
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Exhibit R
The Contractor shall implement strong access controls and other security safeguards
and precautions in order to restrict logical and physical access to confidential, personal (e.g.,
PHI) or sensitive data to authorized users only. Said safeguards and precautions shall include
the following administrative and technical password controls for all systems used to process or
store confidential, personal, or sensitive data:
A. Passwords must not be:
(1) Shared or written down where they are accessible or recognizable by anyone
else; such as taped to computer screens, stored under keyboards, or visible
in a work area;
(2) A dictionary word; or
(3) Stored in clear text
B. Passwords must be:
(1) Eight (8) characters or more in length;
(2) Changed every ninety (90) days;
(3) Changed immediately if revealed or compromised; and
(4) Composed of characters from at least three (3) of the following four (4)
groups from the standard keyboard:
a) Upper case letters (A-Z);
b) Lowercase letters (a-z);
c) Arabic numerals (0 through 9); and
d) Non-alphanumeric characters (punctuation symbols).
The Contractor shall implement the following security controls on each workstation or
portable computing device (e.g., laptop computer) containing confidential, personal, or sensitive
data:
1. Network-based firewall and/or personal firewall;
2. Continuously updated anti-virus software; and
3. Patch management process including installation of all operating system/software
vendor security patches.
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Exhibit R
The Contractor shall utilize a commercial encryption solution that has received FIPS
140-2 validation to encrypt all confidential, personal, or sensitive data stored on portable
electronic media (including, but not limited to, compact disks and thumb drives) and on portable
computing devices (including, but not limited to, laptop and notebook computers).
The Contractor shall not transmit confidential, personal, or sensitive data via e-mail or
other internet transport protocol unless the data is encrypted by a solution that has been
validated by the National Institute of Standards and Technology (NIST) as conforming to the
Advanced Encryption Standard (AES)Algorithm. The Contractor must apply appropriate
sanctions against its employees who fail to comply with these safeguards. The Contractor must
adopt procedures for terminating access to PHI when employment of employee ends.
10. Mitigation of Harmful Effects
The Contractor shall mitigate, to the extent practicable, any harmful effect that is
suspected or known to the Contractor of an unauthorized access, viewing, use, disclosure, or
breach of PHI by the Contractor or its subcontractors in violation of the requirements of these
provisions. The Contractor must document suspected or known harmful effects and the
outcome.
11. The Contractor's Subcontractors
The Contractor shall ensure that any of its contractors, including subcontractors, if
applicable, to whom the Contractor provides PHI received from or created or received by the
Contractor on behalf of the County, agree to the same restrictions, safeguards, and conditions
that apply to the Contractor with respect to such PHI and to incorporate, when applicable, the
relevant provisions of these provisions into each subcontract or sub-award to such agents or
subcontractors.
Nothing in this section 11 or this exhibit authorizes the Contractor to perform services
under this Agreement using subcontractors.
12. Employee Training and Discipline
The Contractor shall train and use reasonable measures to ensure compliance with the
requirements of these provisions by employees who assist in the performance of functions or
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Exhibit R
activities on behalf of the County under this Agreement and use or disclose PHI, and discipline
such employees who intentionally violate any provisions of these provisions, which may include
termination of employment.
13. Termination for Cause
Upon the County's knowledge of a material breach of these provisions by the Contractor,
the County will either:
A. Provide an opportunity for the Contractor to cure the breach or end the
violation, and the County may terminate this Agreement if the Contractor does not cure the
breach or end the violation within the time specified by the County; or
B. Immediately terminate this Agreement if the Contractor has breached a
material term of this exhibit and cure is not possible, as determined by the County.
C. If neither cure nor termination is feasible, the County's Privacy Officer will
report the violation to the Secretary of the U.S. Department of Health and Human Services.
14. Judicial or Administrative Proceedings
The County may terminate this Agreement if: (1) the Contractor is found guilty in a
criminal proceeding for a violation of the HIPAA Privacy or Security Laws or the HITECH Act; or
(2) there is a finding or stipulation in an administrative or civil proceeding in which the Contractor
is a party that the Contractor has violated a privacy or security standard or requirement of the
HITECH Act, HIPAA or other security or privacy laws.
15. Effect of Termination
Upon termination or expiration of this Agreement for any reason, the Contractor shall
return or destroy all PHI received from the County (or created or received by the Contractor on
behalf of the County) that the Contractor still maintains in any form, and shall retain no copies of
such PHI. If return or destruction of PHI is not feasible, the Contractor shall continue to extend
the protections of these provisions to such information, and limit further use of such PHI to those
purposes that make the return or destruction of such PHI infeasible. This provision applies to
PHI that is in the possession of subcontractors or agents, if applicable, of the Contractor. If the
Contractor destroys the PHI data, a certification of date and time of destruction shall be
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Exhibit R
provided to the County by the Contractor.
16. Compliance with Other Laws
To the extent that other state and/or federal laws provide additional, stricter and/or more
protective privacy and/or security protections to PHI or other confidential information covered
under this BAA, the Contractor agrees to comply with the more protective of the privacy and
security standards set forth in the applicable state or federal laws to the extent such standards
provide a greater degree of protection and security than HIPAA Rules or are otherwise more
favorable to the individual.
17. Disclaimer
The County makes no warranty or representation that compliance by the Contractor with
these provisions, the HITECH Act, or the HIPAA Rules, will be adequate or satisfactory for the
Contractor's own purposes or that any information in the Contractor's possession or control, or
transmitted or received by the Contractor, is or will be secure from unauthorized access,
viewing, use, disclosure, or breach. The Contractor is solely responsible for all decisions made
by the Contractor regarding the safeguarding of PHI.
18. Amendment
The parties acknowledge that Federal and State laws relating to electronic data security
and privacy are rapidly evolving and that amendment of this exhibit may be required to provide
for procedures to ensure compliance with such developments. The parties specifically agree to
take such action as is necessary to amend this agreement in order to implement the standards
and requirements of the HIPAA Rules, the HITECH Act and other applicable laws relating to the
security or privacy of PHI. The County may terminate this Agreement upon thirty (30) days
written notice in the event that the Contractor does not enter into an amendment providing
assurances regarding the safeguarding of PHI that the County in its sole discretion, deems
sufficient to satisfy the standards and requirements of the HIPAA Rules, and the HITECH Act.
19. No Third-Party Beneficiaries
Nothing expressed or implied in the provisions of this exhibit is intended to confer, and
nothing in this exhibit does confer, upon any person other than the County or the Contractor and
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Exhibit R
their respective successors or assignees, any rights, remedies, obligations or liabilities
whatsoever.
20. Interpretation
The provisions of this exhibit shall be interpreted as broadly as necessary to implement
and comply with the HIPAA Rules, and applicable State laws. The parties agree that any
ambiguity in the terms and conditions of these provisions shall be resolved in favor of a meaning
that complies and is consistent with the HIPAA Rules.
21. Regulatory References
A reference in the terms and conditions of these provisions to a section in the HIPAA
Rules means the section as in effect or as amended.
22. Survival
The respective rights and obligations of the Contractor as stated in this exhibit survive
the termination or expiration of this Agreement.
23. No Waiver of Obligation
Change, waiver or discharge by the County of any liability or obligation of the Contractor
under this exhibit on any one or more occasions is not a waiver of performance of any
continuing or other obligation of the Contractor and does not prohibit enforcement by the County
of any obligation on any other occasion.
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