HomeMy WebLinkAboutAgreement A-19-277 for Child Welfare Mental Health Services.pdfAgreement No . 19 -277
MASTER AGREEMENT 1
2 This Agreement is made and entered into this 18th day of _-J-uo~e~--· 2019 , by and
3 between the COUNTY OF FRESNO , a Pol itical Subdivision of the State of California , hereinafter
4 referred to as "COUNTY", and each CONTRACTOR listed in Exhib it A "List of Contractors", attached
5 hereto and by this reference incorporated herein , and collectively hereinafter referred to as
6 "CONTRACTORS", and such additional CONTRACTOR(S) as may , from time to time during the term
7 of th is Agreement , be added by COUNTY. Reference in th is Agreement to "parties " shall be
8 understood to refer to COUNTY and each individual CONTRACTOR , unless otherwise specified .
9 W I T N E S S ETH:
10 WHEREAS , COUNTY, through its Department of Behavioral Health (DBH) and Department of
11 Social Services (DSS), is in need of qualified agencies to provide outpatient specialty mental health ,
12 court-specific , and community-based support services for children and youth involved in the Chi ld
13 Welfare Services (CWS) system; and
14 WHEREAS, COUNTY through its Department of Behavioral Health (DBH) is a Mental Health
15 Plan as defined in Title 9 of the California Code of Regulations (C .C .R.), section 1810.226 ; and
16 WHEREAS , CONTRACTOR(S) are qual ified and willing to provide said services pursuant to
1 7 the terms and conditions of this Agreement.
18 NOW, THEREFORE, in consideration of their mutual covenants and conditions , the parties
19 hereto agree as follows :
1. SERVICES 20
21 A. CONTRACTOR(S) shall perform all services and fulfill all responsib ilities
2 2 identified in the Summary of Services , attached hereto as Exhibits B-1 , et seq. and incorporated
2 3 herein by reference . CONTRACTOR(S) shall align programs , services , and practices with the vision ,
2 4 mission , and guiding principles of the DBH , as further described in Exhibit C , "Fresno County
2 5 Department of Behavioral Health Guiding Principles of Care De livery ," attached hereto and by this
2 6 reference incorporated herein and made part of this Agreement.
27 B . CONTRACTOR shall also perform all services and fulfill all responsibilities
2 8 specified in COUNTY's Request for Proposal (RFP) No . 19-036, dated December 27 , 2018 ,
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Addendum No. One (1) to COUNTY’s RFP No. 19-036, dated January 18, 2019, Addendum No. Two
(2) to COUNTY’s RFP No. 19-036, dated January 28, 2019, and CONTRACTOR(S) Response(s) to
said Revised RFP No. 19-036, all incorporated by reference and herein made part of this Agreement.
C.In the event of any inconsistency among these documents, the inconsistency
shall be resolved by giving precedence in the following order: 1) to this Agreement, including all
Exhibits, 2) to the COUNTY’s Revised RFP No. 19-036, and 3) to the Response(s) to the COUNTY’s
Revised RFP No. 19-036. A copy of COUNTY’s Revised RFP No. 19-036, and CONTRACTOR(S)
Response(s) thereto, shall be retained and made available during the term of this Agreement by
COUNTY’s Purchasing Department.
D.It is the expectation of the COUNTY that CONTRACTOR(S) provide timely
access to services that meet the State of California standards for care. CONTRACTOR(S) shall
provide urgent services within three (3) business days from referral to first appointment.
CONTRACTOR(S) shall provide non-urgent services within ten (10) business days from referral to
first appointment. CONTRACTOR(S) shall provide psychiatry services within fifteen (15) business
days from referral to first appointment. CONTRACTOR(S) shall track timeliness of services to clients
and provide a monthly report of the captured data. COUNTY and CONTRACTOR(S) shall meet to go
over this data on a monthly basis. COUNTY shall take corrective action if there is a failure to comply
by CONTRACTOR(S) with the above-mentioned timely access standards.
CONTRACTOR(S) shall also provide tracking tools and measurements for
effectiveness, efficiency, access, and client satisfaction indicators as required by the Commission on
Accreditation of Rehabilitation Facilities (CARF) standards and as further detailed in Exhibits B-1, et
seq.
E.CONTRACTOR(S) shall utilize assessment tools mandated by State
Department of Health Care Services (DHCS) and the California Department of Social Services
(CDSS). Presently, DHCS and CDSS have mandated the use of the California Child and
Adolescents Needs and Strengths (CANS-50) and Pediatric Symptom Checklist – parent/caregiver
version (PSC-35) for children and youth. These tools shall be completed at the beginning of
treatment, every six (6) months following the first administration, and at the end of treatment.
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Facilitators of these tools shall be trained by a CANS-certified trainer approved by the State. Training
for the PSC-35 is not required by the State of California.
F.It is acknowledged by all parties hereto that COUNTY’s DBH and DSS
Administrative units shall monitor the services provided by CONTRACTOR(S), as specified herein.
G.CONTRACTOR(S) shall participate in periodic workgroup meetings which
include staff from COUNTY’s DBH and DSS Administrative units. The meetings shall be held
monthly, or as needed, to discuss program requirements, data reporting, outcomes measurement,
training, policies and procedures, and overall program operations.
H.It is acknowledged by all parties hereto that upon execution of this Agreement,
CONTRACTOR(S)’ service sites shall be as identified in Exhibits B-1 et seq. Any change to
CONTRACTOR(S) location of the service sites may be made only upon 30 (thirty) days advance
written notification to COUNTY’s DBH Director and upon written approval from COUNTY’s DBH
Director, or his or her designee.
I.CONTRACTOR(S) shall maintain requirements as Organizational Providers
throughout the term of this Agreement, as described in Section Nineteen (19) of this Agreement. If
for any reason, this status is not maintained, the COUNTY may terminate this Agreement pursuant to
Section Three (3) of this Agreement.
J.CONTRACTOR(S) agree that prior to providing services under the terms and
conditions of this Agreement, CONTRACTOR(S) shall have appropriate staff hired and in place for
program services and operation or COUNTY may, in addition to other remedies it may have, suspend
referrals or terminate this Agreement in accordance with Section Three (3) of this Agreement.
2.TERM
The term of this Agreement shall be for a period of three (3) years commencing July 1,
2019 through and including June 30, 2022. This Agreement may be extended for two (2) additional
consecutive twelve (12) month periods upon written approval of both parties no later than thirty (30)
days prior to the first day of the next twelve (12) month extension period. The DBH Director and DSS
Director, or their designees, are authorized to execute such written approval on behalf of COUNTY
based on CONTRACTOR’s satisfactory performance.
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CONTRACTOR(S) added to this Agreement after the execution date shall become part
of the Agreement effective upon the date the executed signature page is received and approved by
the COUNTY’s DBH Director, or his or her designee, as set forth in Section Twelve (12) of this
Agreement.
The June 30 termination date specified herein shall be the termination date for all
CONTRACTOR(S), regardless of when CONTRACTOR is added to this Agreement. Any twelve (12)
month renewal period of this Agreement for any CONTRACTOR already providing services under this
Agreement shall commence on July 1st of the then current fiscal year.
3.TERMINATION
A.Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government
agency. Should sufficient funds not be allocated, the services provided may be modified, or this
Agreement terminated at any time by giving the CONTRACTOR(S) thirty (30) days advance written
notice.
B.Breach of Contract - The COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of the COUNTY there is:
1)An illegal or improper use of funds;
2)A failure to comply with any term of this Agreement;
3)A substantially incorrect or incomplete report submitted to the COUNTY;
4)Improperly performed service.
In no event shall any payment by the COUNTY constitute a waiver by the
COUNTY of any breach of this Agreement or any default which may then exist on the part of the
CONTRACTOR(S). Neither shall such payment impair or prejudice any remedy available to the
COUNTY with respect to the breach or default. The COUNTY shall have the right to demand of each
CONTRACTOR the repayment to the COUNTY of any funds disbursed to that CONTRACTOR under
this Agreement, which in the judgment of the COUNTY were not expended in accordance with the
terms of this Agreement. Each CONTRACTOR shall promptly refund any such funds upon demand
or at COUNTY’s option; such repayment shall be deducted from future payments owed to that
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CONTRACTOR under this Agreement.
C.Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY or COUNTY’s DBH and DSS Directors, or their
designees, or one (1) or more CONTRACTOR(S) upon the giving of sixty (60) days advance written
notice of an intention to terminate.
4.COMPENSATION
COUNTY agrees to pay CONTRACTOR(S) and CONTRACTOR(S) agree to receive
compensation in accordance with the budget(s) set forth in Exhibit D-1, et seq., attached hereto and
by this reference incorporated herein and made part of this Agreement.
A.Maximum Contract Amount
For fiscal year (FY) July 1, 2019 through June 30, 2020, in no event shall the
maximum compensation amount under this Agreement exceed Sixteen Million and No/100 Dollars
($16,000,000.00) for all CONTRACTOR(S) combined.
For FY July 1, 2020 through June 30, 2021, in no event shall the maximum
compensation amount under this Agreement exceed Sixteen Million and No/100 Dollars
($16,000,000.00) for all CONTRACTOR(S) combined.
For FY July 1, 2021 through June 30, 2022, in no event shall the maximum
compensation amount under this Agreement exceed Sixteen Million and No/100 Dollars
($16,000,000.00) for all CONTRACTOR(S) combined.
If this Agreement has been extended for an additional twelve (12) month
renewal period for FY July 1, 2022 through June 30, 2023, in no event shall the maximum
compensation amount under this Agreement exceed Sixteen Million and No/100 Dollars
($16,000,000.00) for all CONTRACTOR(S) combined.
If this Agreement has been extended for an additional twelve (12) month
renewal period for FY July 1, 2023 through June 30, 2024, in no event shall the maximum
compensation amount under this Agreement exceed Sixteen Million and No/100 Dollars
($16,000,000.00) for all CONTRACTOR(S) combined.
The maximum amounts paid to each CONTRACTOR(S) identified in this
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Agreement shall be as stated in the individual CONTRACTOR(S)’s “Budget” documents approved by
the COUNTY’s DBH and DSS Directors, or their designees, and attached hereto as Exhibits D-1 et
seq. and incorporated herein by this reference.
B.Maximum Compensation Amounts
In no event shall the total maximum compensation amount under this
Agreement for FY 2019-20, FY 2020-21, and FY 2021-22 combined exceed Forty-Eight Million and
No/100 Dollars ($48,000,000.00) for all CONTRACTOR(S) combined.
If performance standards are met and this Agreement is extended for an
additional twelve (12) month term pursuant to Section Three (3) of this Agreement, then in no event
shall the total maximum compensation amount under this Agreement for FY 2019-20, FY 2020-21,
FY 2021-22, and FY 2022-23 combined exceed Sixty-Four Million and No/100 Dollars
($64,000,000.00) for all CONTRACTOR(S) combined.
If performance standards are met and this Agreement is extended for an
additional twelve (12) month term pursuant to Section Three (3) of this Agreement, then in no event
shall the total maximum compensation amount under this Agreement for FY 2019-20, FY 2020-21,
FY 2021-22, FY 2022-23, and FY 2023-24 combined exceed Eighty Million and No/100 Dollars
($80,000,000.00) for all CONTRACTOR(S) combined.
C.It is understood that all expenses incidental to CONTRACTOR(S) performance
of services under this Agreement shall be borne by CONTRACTOR(S). If CONTRACTOR(S) fails to
comply with any provision of this Agreement, COUNTY shall be relieved of its obligation for further
compensation.
D.Payments shall be made by COUNTY to CONTRACTOR(S) in arrears, for
services provided during the preceding month, within forty-five (45) days after the date of receipt and
approval by COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments
shall be made after receipt and verification of actual expenditures incurred by CONTRACTOR(S) for
monthly program costs, as identified in Exhibits D-1 et seq., in the performance of this Agreement in
accordance with Exhibits B-1 et seq. and shall be submitted to COUNTY on a monthly basis by the
tenth (10th) of the month following the month of said expenditures.
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CONTRACTOR(S) shall submit to COUNTY by the tenth (10th) of each month a
detailed general ledger (GL) itemizing costs incurred in the previous month. Failure to submit GL
reports and supporting documentation shall be deemed sufficient cause for COUNTY to withhold
payments until there is compliance, as further described in Section Five (5) herein.
E.COUNTY shall not be obligated to make any payments under this Agreement if
the request for payment is received by COUNTY more than sixty (60) days after this Agreement has
terminated or expired.
F.All final invoices and/or any final budget modification requests shall be
submitted by CONTRACTOR(S) within sixty (60) days following the final month of service for which
payment is claimed. No action shall be taken by COUNTY on invoices submitted beyond the sixty
(60)day closeout period. Any compensation which is not expended by CONTRACTOR(S) pursuant
to the terms and conditions of this Agreement shall automatically revert to COUNTY.
G.The services provided by CONTRACTOR(S) under this Agreement are funded
in whole or in part by the State of California. In the event that funding for these services is delayed by
the State Controller, COUNTY may defer payments to CONTRACTOR(S). The amount of the
deferred payment shall not exceed the amount of funding delayed by the State Controller to the
COUNTY. The period of time of the deferral by COUNTY shall not exceed the period of time of the
State Controller’s delay of payment to COUNTY plus forty-five (45) days.
H.CONTRACTOR(S) shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR(S) deficiency discovered through the State’s
audit process and COUNTY’s utilization review process during the course of this Agreement. At
COUNTY’s election, the disallowed amount will be remitted within forty-five (45) days to COUNTY
upon notification or shall be withheld from subsequent payments to CONTRACTOR(S).
CONTRACTOR(S) shall not receive reimbursement for any units of services rendered that are
disallowed or denied by the COUNTY’s Mental Health Plan utilization review process or through the
State Department of Health Care Services (DHCS) cost report audit settlement process for Medi-Cal
eligible clients.
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5.INVOICING
A.CONTRACTOR(S) shall invoice COUNTY in arrears by the tenth (10th) of each
month for actual expenses incurred during the prior month to DBHInvoices@fresnocountyca.gov,
DSSInvoices@fresnocountyca.gov and a copy to the assigned DBH Mental Health Contracts Staff
Analyst and DSS Contracts Staff Analyst. After CONTRACTOR(S) renders service to referred
clients, CONTRACTOR(S) shall invoice COUNTY for payment, certify the expenditure, and submit
electronic claiming into COUNTY’s electronic information system for all clients, including those
eligible for Medi-Cal as well as those that are not eligible for Medi-Cal, including contracted cost per
unit and actual cost per unit. Invoices and reports shall be in such detail as acceptable to COUNTY’s
DBH, as described herein and in Section Fifteen (15) of this Agreement. Additionally, invoices and
supporting documentation may be mailed to: County of Fresno, Department of Behavioral Health,
Contracted Services Division, 3133 N. Millbrook, Fresno, CA 93703, Attention: CWMH Contract
Analyst. No reimbursement for services shall be made until the invoice and report is received,
verified and approved by COUNTY’s DBH. COUNTY must pay CONTRACTOR before submitting
claims to DHCS for Federal and State reimbursement for Medi-Cal eligible clients.
B.At the discretion of COUNTY’s DBH Director, or his or her designee, if an
invoice is incorrect or is otherwise not in proper form or substance, COUNTY’s DBH Director, or his or
her designee, shall have the right to withhold payment as to only that portion of the invoice that is
incorrect or improper after five (5) days prior notice to CONTRACTOR(S). CONTRACTOR(S) agrees
to continue to provide services for a period of ninety (90) days after notification of an incorrect or
improper invoice. If after the ninety (90) day period, the invoice(s) is still not corrected to COUNTY
DBH’s satisfaction, COUNTY’s DBH Director, or his or her designee, may elect to terminate this
Agreement, pursuant to the termination provisions stated in Section Three (3) of this Agreement. In
addition, for invoices received ninety (90) days after the expiration of each term of this Agreement or
termination of this Agreement, at the discretion of COUNTY’s DBH Director, or his or her designee,
COUNTY’s DBH shall have the right to deny payment of any additional invoices received.
C.Monthly invoices shall include a client roster, identifying all clients served along
with Katie A. class and sub-class members indicated, and provide demographic information on clients
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served, including any payer of services rendered to client by CONTRACTOR(S)
D.CONTRACTOR(S) shall submit monthly invoices and general ledgers to DBH
and DSS that itemize the line item charges for monthly program costs, including the cost per unit
calculation based on the number of clients served within the month, and excluding unallowable costs.
Unallowable costs such as lobbying or political donations must be deducted from the monthly invoice
reimbursements. The invoices and general ledgers will serve as tracking tools to determine if
CONTRACTOR(S)’ program costs are in accordance with its budgeted cost, and cost per unit as
negotiated by service modes, compared to actual cost per unit, as set forth in Exhibit D-1 et seq. The
actual cost per unit will be based upon total costs and total units of service. It will also serve for the
COUNTY to certify the public funds expended for purposes of claiming Federal and State
reimbursement for the cost of Medi-Cal services and activities. CONTRACTOR(S) shall remit to
COUNTY on a quarterly basis, a summary report of total operational costs and volume of service
units to report the actual costs per unit compared to the negotiated rate, as identified in Exhibits D-1
et seq., to report interim cost per unit. The quarterly reports will be used by COUNTY to ensure
compliance with Federal and State reimbursements certified public expenditures.
E.CONTRACTOR(S) must report all third party collections from other funding
sources for Medicare, private insurance, client private pay or any other third party. COUNTY
expects the invoice for reimbursement to equal the amount due CONTRACTOR less any funding
sources not eligible for Federal reimbursement and any other revenues generated by
CONTRACTOR (i.e. private insurance, etc).
F.CONTRACTOR(S) shall provide a monthly activity report with each invoice,
further described in Section Fifteen (15). In addition, each monthly invoice will be in the format as
identified in Exhibits D-1 et seq., showing each budget line item, expenses incurred, and the balance
remaining for each budget line item for all services and items as identified in Exhibits D-1 et seq.
G.CONTRACTOR(S) shall submit monthly staffing reports that identify all direct
service and support staff, applicable licensure/certifications, and full time hours worked to be used as
a tracking tool to determine if CONTRACTOR(S)’s program is staffed according to the services
provided under this Agreement.
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H.CONTRACTOR(S) must maintain such financial records for a period of seven
(7)years, or if there a dispute, audit or inspection, until it is resolved, whichever is later.
CONTRACTOR(S) will be responsible for any disallowances related to inadequate documentation.
I.CONTRACTOR(S) is responsible for collection and managing data in a
manner to be determined by DHCS and the COUNTY Mental Health Plan in accordance with
applicable rules and regulations. COUNTY’s electronic information system is a critical source of
information for purposes of monitoring and obtaining reimbursement. CONTRACTOR(S) must attend
the COUNTY DBH’s Business Office training on equipment reporting for assets, intangible and
sensitive minor assets, COUNTY’s electronic information system; and related cost reporting.
J.CONTRACTOR shall submit service data into COUNTY’s electronic
information system within thirty (30) calendar days from the date of services were rendered. Federal
and State reimbursement for Medi-Cal specialty mental health services is based on public
expenditures certified by the CONTRACTOR(S). CONTRACTOR(S) must submit a signed certified
public expenditure report in the monthly invoice. DHCS expects the claim for Federal and State
reimbursement to equal the amount the COUNTY paid the CONTRACTOR(S) for the services
rendered less any funding sources not eligible for Federal reimbursement.
K.CONTRACTOR(S) must provide all necessary data to allow the COUNTY to
bill Medi-Cal, and any other third-party source, for services and meet State and Federal reporting
requirements. The necessary data can be provided by a variety of means, including but not limited
to: 1) direct data entry into COUNTY’s electronic information system; 2) providing an electronic file
compatible with COUNTY’s electronic information system; or 3) integration between COUNTY’s
electronic information system and CONTRACTOR(S)’ information system(s).
L.If a Medi-Cal client has dual coverage, such as other health coverage (OHC)
or Medicare, the CONTRACTOR(S) will be responsible for billing the carrier and obtaining a
payment/denial or have validation of claiming with no response ninety (90) days after the claim was
mailed before the service can be entered into COUNTY’s electronic information system.
CONTRACTOR(S) must report all revenue collected from OHC, third-party, client-pay, or private-pay
in each monthly invoice and in the cost report that is required to be submitted. A copy of explanation
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of benefits or CWM 1500 is required as documentation. CONTRACTOR(S) must comply with all laws
and regulations governing Medicare program, including, but not limited to: 1) the requirement of the
Medicare Act, 42 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the
Centers for Medicare and Medicaid Services as they related participation, coverage and claiming
reimbursement. CONTRACTOR(S) will be responsible for compliance as of the effective date of
each federal, state or local law or regulation specified.
M.Data entry into the COUNTY’s electronic information system shall be the
responsibility of the CONTRACTOR(S). The direct specialty mental health services data must be
reconciled by the CONTRACTOR(S) to the monthly invoices submitted for payment. COUNTY shall
monitor the volume of services and cost of services entered into the COUNTY’s electronic information
system. Any and all audit exceptions resulting from the provision and reporting of Medi-Cal services
by CONTRACTOR(S) shall be the sole responsibility of the CONTRACTOR(S). CONTRACTOR(S)
will comply with all applicable policies, procedures, directives and guidelines regarding the use
COUNTY’s electronic information system.
N.Medi-Cal Certification and Mental Health Plan Compliance
CONTRACTOR(S) will establish and maintain Medi-Cal certification or become
certified within ninety (90) days of the start of each CONTRACTOR’s term within this Agreement
through COUNTY’s MHP. In addition, CONTRACTOR(S) shall work with COUNTY’s DBH to execute
the process if not currently certified by COUNTY for credentialing of staff. Service location must be
approved by COUNTY’s DBH during the Medi-Cal certification process. During this process, the
CONTRACTOR(S) will obtain a legal entity number established by DHCS, a requirement for
maintaining COUNTY’s MHP organizational provider status throughout the term of this Agreement.
CONTRACTOR(S) will be required to become Medi-Cal certified prior to providing services to Medi-
Cal eligible clients and seeking reimbursement from the COUNTY. CONTRACTOR(S) will not be
reimbursed by COUNTY for any services rendered prior to certification.
CONTRACTOR(S) shall provide specialty mental health services in accordance
with the COUNTY’s MHP. CONTRACTOR(S) must comply with the “Fresno County Mental Health
Plan Compliance Program and Code of Conduct” set forth in Exhibit E, attached hereto and
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incorporated herein by reference.
CONTRACTOR(S) may provide direct specialty mental health services using
unlicensed staff as long as the individual is approved as an Organizational Provider by the
COUNTY’s MHP, is supervised by licensed staff who meet the Board of Behavioral Sciences
requirements for supervision, works within his/her scope, and only delivers allowable direct specialty
mental health services. Unlicensed staff must also be credentialed by COUNTY’S MHP.
It is understood that each service is subject to audit for compliance with Federal
and State regulations and that COUNTY may be making payments in advance of said review. In the
event that a service is disapproved, COUNTY may, at its sole discretion, withhold compensation or
offset from other payments due the amount of said disapproved services. CONTRACTOR(S) shall be
responsible for audit exceptions to ineligible dates of services or incorrect application of utilization
review requirements.
6.INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR(S)
under this Agreement, it is mutually understood and agreed that CONTRACTOR(S), including any
and all of CONTRACTOR(S)’s officers, agents, and employees will at all times be acting and
performing as independent contractors, and shall act in an independent capacity and not as an
officer, agent, servant, employee, joint venture, partner, or associate of COUNTY. Furthermore,
COUNTY shall have no right to control or supervise or direct the manner or method by which
CONTRACTOR(S) shall perform its work and function. However, COUNTY shall retain the right to
administer this Agreement so as to verify that CONTRACTOR(S) is performing their obligations in
accordance with the terms and conditions thereof. CONTRACTOR(S) and COUNTY shall comply
with all applicable provisions of law and the rules and regulations, if any, of governmental authorities
having jurisdiction over matters which are directly or indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR(S) shall have
absolutely no right to employment rights and benefits available to COUNTY employees.
CONTRACTOR(S) shall be solely liable and responsible for providing to, or on behalf of, its
employees all legally-required employee benefits. In addition, CONTRACTOR(S) shall be solely
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responsible and save COUNTY harmless from all matters relating to payment of CONTRACTOR(S’)
employees, including compliance with Social Security, withholding, and all other regulations
governing such matters. It is acknowledged that during the term of this Agreement,
CONTRACTOR(S) may be providing services to others unrelated to COUNTY or to this Agreement.
7.SUBCONTRACTS
CONTRACTOR(S) shall obtain written approval from COUNTY or COUNTY’S DBH and
DSS Directors, or their designees, before subcontracting any of the services delivered under this
Agreement. Any transferee, assignee, or subcontractor will be subject to all applicable provisions of
this Agreement, and all applicable State and Federal regulations, CONTRACTOR(S) shall be held
primarily responsible by COUNTY for the performance of any transferee, assignee, or subcontractor
unless otherwise expressly agreed to in writing by COUNTY. The use of subcontractor by
CONTRACTOR(S) shall not entitle CONTRACTOR(S) to any additional compensation than is
provided for under this Agreement.
8.MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent
of all the parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to services, staffing, and responsibilities of the
CONTRACTOR(S), as needed, to accommodate changes in the laws relating to specialty mental
health treatment, may be made with the signed written approval of COUNTY’s DBH Director, or his or
her designee, and CONTRACTOR(S) through an amendment approved by COUNTY’s County
Counsel and the COUNTY’s Auditor-Controller/Treasurer-Tax Collector’s Office.
In addition, changes to expense category subtotals (i.e. Salary & Benefits,
Facilities/Equipment, Operating, Financial Services, Special Expenses, Fixed Assets, etc.) identified
in Exhibits D-1 et seq. that do not exceed ten percent (10%) of the individual CONTRACTOR’s total
annual maximum compensation, changes to the volume of units of services/types of service units to
be provided, and changes to service rates as set forth in Exhibits D-1 et seq., may be made with the
written approval of COUNTY’s DBH Director, or his or her designee.
Changes to expense category subtotals that exceed ten percent (10%) of the
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individual CONTRACTOR’s total annual maximum compensation may be made with the signed
written approval of COUNTY’s DBH Director, or his or her designee, through an amendment
approved by COUNTY’s County Counsel and COUNTY’s Auditor-Controller/Treasurer-Tax Collector’s
Office. Maximum compensation amounts payable to each CONTRACTOR may be modified with the
written approval of COUNTY’s DBH Director, or his or her designee.
Said modifications to budget expense categories, service volume/types of service
units, summary of services, and maximum compensation amounts payable to each CONTRACTOR
shall not result in any change to the total combined maximum compensation amount payable to all
CONTRACTORS under this Master Agreement, as stated herein.
9.NON-ASSIGNMENT
COUNTY and CONTRACTOR(S) shall not assign, transfer or subcontract this
Agreement nor their rights or duties under this Agreement without the prior written consent of
COUNTY and the individual CONTRACTOR seeking to make such assignment.
10.HOLD-HARMLESS
CONTRACTOR(S) agrees to indemnify, save, hold harmless, and at COUNTY's
request, defend the COUNTY, its officers, agents and employees from any and all costs and
expenses, including attorney fees and court costs, damages, liabilities, claims and losses occurring or
resulting to COUNTY in connection with the performance, or failure to perform, by
CONTRACTOR(S), its officers, agents or employees under this Agreement, and from any and all
costs and expenses, including attorney fees and court costs, damages, liabilities, claims and losses
occurring or resulting to any person, firm or corporation who may be injured or damaged by the
performance, or failure to perform, of CONTRACTOR(S), its officers, agents or employees under this
Agreement.
CONTRACTOR(S) agrees to indemnify COUNTY for Federal, State of California and/or
local audit exceptions resulting from noncompliance herein on the part of the CONTRACTOR(S).
11.INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR(S) or
any third parties, each CONTRACTOR, at its sole expense, shall maintain in full force and effect the
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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 shall be issued on a per occurrence basis.
COUNTY may require specific coverages including completed operations,
product liability, contractual liability, Explosion-Collapse-Underground, fire legal
liability or any other liability insurance deemed necessary because of the nature
of the Agreement.
B.Automobile Liability
ISO Form Number CA 00 01 covering any auto (Code 1), or if CONTRACTOR
has no owned autos, covering hired, (Code 8) and non-owned autos (Code 9),
with limits no less than $1,000,000 per accident for bodily injury and property
damage. If CONTRACTOR(S’) employees are not covered by
CONTRACTOR(S’) automobile liability insurance policy, CONTRACTOR shall
ensure that each employee as part of this Agreement procures and maintains
their own private vehicle coverage in force during the term of this Agreement, at
the employee’s sole cost and expense.
C.Professional Liability
If CONTRACTOR(S) employs licensed professional staff (e.g. Ph.D., R.N.,
L.C.S.W., L.M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000) per occurrence, Three
Million Dollars ($3,000,000) annual aggregate. CONTRACTOR agrees that it
shall maintain, at its sole expense, in full force and effect for a period of five (5)
years following the termination of this Agreement, one or more policies of
professional liability insurance with limits of coverage as specified herein.
D.Real and Property Insurance
CONTRACTOR(S) shall maintain a policy of insurance for all risk personal
property coverage which shall be endorsed naming the County of Fresno as an
additional loss payee. The personal property coverage shall be in an amount
that will cover the total of the COUNTY purchase and owned property, at a
minimum, as discussed in Section Twenty-Three (23) of this Agreement.
All Risk Property Insurance
As applicable, CONTRACTOR(S) will provide property coverage for the full
replacement value of the COUNTY’s personal property in possession of
CONTRACTOR(S) and/or used in the execution of this Agreement. COUNTY
will be identified on an appropriate certificate of insurance as the certificate
holder and will be named as an Additional Loss Payee on the Property
Insurance Policy.
///
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E.W orker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
F.Child Abuse/Molestation and Social Services Coverage
Each CONTRACTOR shall have either separate policies or an umbrella policy
with endorsements covering Child Abuse/Molestation and Social Services
Liability coverage or have a specific endorsement on their General Commercial
liability policy covering Child Abuse/Molestation and Social Services Liability.
The policy limits for these policies shall be One Million Dollars ($1,000,000) per
occurrence with a Two Million Dollars ($2,000,000) annual aggregate. The
policies are to be on a per occurrence basis.
G.Waiver of Subrogation
CONTRACTOR(S) hereby grants to COUNTY a waiver of any right to
subrogation which any insurer of said CONTRACTOR may acquire against the
COUNTY by virtue of the payment of any loss under such insurance.
CONTRACTOR(S) agrees to obtain any endorsement that may be necessary to
affect this waiver of subrogation, but this provision applies regardless of whether
or not the COUNTY has received a waiver of subrogation endorsement from the
insurer.
H.Cyber Liability
Cyber Liability Insurance, with limits not less than Two Million Dollars
($2,000,000) per occurrence or claim, Two Million Dollars ($2,000,000)
aggregate. Coverage shall be sufficiently broad to respond to the duties and
obligations as is undertaken by CONTRACTOR in this Agreement and shall
include, but not be limited to, claims involving infringement of intellectual
property, including but not limited to infringement of copyright, trademark, trade
dress, invasion of privacy violations, information theft, damage to or destruction
of electronic information, release of private information, alteration of electronic
information, extortion and network security. The policy shall provide coverage
for breach response costs as well as regulatory fines and penalties as well as
credit monitoring expenses with limits sufficient to respond to these obligations.
CONTRACTOR(S) shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under CONTRACTOR(S’) policies herein.
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This insurance shall not be cancelled or changed without a minimum of thirty (30) days advance
written notice given to COUNTY.
Within thirty (30) days from the date each CONTRACTOR signs this Agreement,
CONTRACTOR(S) shall provide certificates of insurance and endorsements as stated above for all of
the foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health,
Contracted Services Division, 3133 N. Millbrook Ave, Fresno, California, 93703, Attention: CWMH
Contract Analyst, stating that such insurance coverages have been obtained and are in full force; that
the County of Fresno, its officers, agents and employees will not be responsible for any premiums on
the policies; that such Commercial General Liability insurance names the County of Fresno, its
officers, agents and employees, individually and collectively, as additional insured, but only insofar as
the operations under this Agreement are concerned; that such coverage for additional insured shall
apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its
officers, agents and employees, shall be excess only and not contributing with insurance provided
under CONTRACTOR(S)’s policies herein; and that this insurance shall not be cancelled or changed
without a minimum of thirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR(S) fails to keep in effect at all times insurance coverage as
herein provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating
of A FSC VII or better.
12.ADDITIONS/DELETIONS OF CONTRACTORS
COUNTY’s DBH and DSS Directors, or designees, reserve the right at any time during
the term of this Agreement to add new CONTRACTOR(S) to those listed in Exhibit A. It is
understood any such additions will not affect compensation paid to any other CONTRACTOR, and
therefore such additions may be made by COUNTY without notice to or approval of the other
CONTRACTOR(S) under this Agreement. These same provisions shall apply to the deletion of any
CONTRACTOR(S) contained in Exhibit A, except that deletions shall be by written mutual agreement
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between the COUNTY and the particular CONTRACTOR to be deleted, or shall be in accordance
with the provisions of Section Three (3) of this Agreement.
13.LICENSES/CERTIFICATES
Throughout the term of this Agreement, CONTRACTOR(S) and CONTRACTOR(S)’s
staff shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions
necessary for the provision of the services hereunder and required by the laws and regulations of the
United States of America, State of California, the County of Fresno, and any other applicable
governmental agencies. CONTRACTOR(S) shall notify COUNTY immediately in writing of its inability
to obtain or maintain such licenses, permits, approvals, certificates, waivers and exemptions
irrespective of the pendency of any appeal related thereto. Additionally, CONTRACTOR(S) and
CONTRACTOR(S)’s staff shall comply with all applicable laws, rules or regulations, as may now exist
or be hereafter changed.
14.RECORDS
CONTRACTOR(S) shall maintain records in accordance with COUNTY’s
“Documentation Standards for Client Records,” attached hereto as Exhibit F and incorporated herein
by reference. During site visits, COUNTY shall be allowed to review records of services provided,
including but not limited to the goals and objectives of the treatment plan, and how the therapy
provided is achieving the goals and objectives. All medical records shall be maintained for a
minimum of ten (10) years from the date of the end of the Agreement.
15.REPORTS
A.Activity Reports
CONTRACTOR(S) shall submit to COUNTY’s DBH and DSS by the 10th of each
month all monthly activity and budget reports for the preceding month.
B.Cost Report
CONTRACTOR(S) agrees to submit a complete and accurate detailed cost
report on an annual basis for each fiscal year ending June 30th in the format prescribed by the DHCS
for the purposes of Short Doyle Medi-Cal reimbursements and total costs for programs. The cost
report will be the source document for several phases of settlement with the DHCS for the purposes
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of Short Doyle Medi-Cal reimbursement. CONTRACTOR(S) shall report costs under their approved
legal entity number established during the Medi-Cal certification process. The information provided
applies to CONTRACTOR(S) for program related costs for services rendered to Medi-Cal and non-
Medi-Cal clients. CONTRACTOR(S) will remit a schedule to provide the required information on
published charges (PC) for all authorized services. The report will serve as a source document to
determine their usual and customary charge prevalent in the public mental health sector that is used
to bill the general public, insurers, or other non-Medi-Cal third party payers during the course of
business operations. CONTRACTOR(S) must report all collections for Medi-Cal/Medicare services
and collections. The CONTRACTOR(S) shall also submit with the cost report a copy of the
CONTRACTOR(S)’ general ledger that supports revenues and expenditures and reconciled detailed
report of reported total units of services rendered under this Agreement to the units of services
reported by CONTRACTOR(S) to COUNTY’S data system.
Cost Reports must be submitted to the COUNTY as a hard copy with a signed
cover letter and electronic copy of completed DHCS cost report form along with requested support
documents following each fiscal year ending June 30th. During the month of September of each year
this Agreement is effective, COUNTY will issue instructions of the annual cost report which indicates
the training session, DHCS cost report template worksheets, and deadlines to submit, as determined
by State annually. CONTRACTOR(S) shall remit a hard copy of cost report to County of Fresno,
Attention: Cost Report Team, PO BOX 45003, Fresno CA 93718. CONTRACTOR(S) shall remit the
electronic copy or any inquiries to DBHcostreportteam@co.fresno.ca.us.
All Cost Reports must be prepared in accordance with General Accepted
Accounting Principles (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3)
and 5718(c). Unallowable costs such as lobby or political donations must be deducted on the cost
report and invoice reimbursement.
If the CONTRACTOR(S) does not submit the cost report by the deadline,
including any extension period granted by the COUNTY, the COUNTY may withhold payments of
pending invoicing under compensation until the cost report has been submitted and clears COUNTY
desk audit for completeness.
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C.Settlements with State Department of Health Care Services (DHCS)
During the term of this Agreement and thereafter, COUNTY and
CONTRACTOR(S) agree to settle dollar amounts disallowed or settled in accordance with DHCS
audit settlement findings related to the Medi-Cal and EPSDT reimbursements. CONTRACTOR(S)
will participate in several phases of settlements between COUNTY/CONTRACTOR and DHCS. The
phases are initial cost reporting for settlement, settlement according to State reconciliation of records
for paid Medi-Cal services and audit settlement-State DHCS audit: 1) initial cost reporting - after an
internal review by COUNTY, the COUNTY files cost report with State DHCS on behalf of the
CONTRACTOR’s legal entity for the fiscal year; 2) Settlement –State reconciliation of records for paid
Medi-Cal services, approximately eighteen (18) to thirty-six (36) months following the State close of
the fiscal year, DHCS will send notice for any settlement under this provision will be sent to the
COUNTY; 3) Audit Settlement-State DHCS audit. After final reconciliation and settlement, DHCS
may conduct a review of medical records, cost reports along with support documents submitted to
COUNTY in initial submission to determine accuracy and may disallow cost and/or unit of service
reported on the CONTRACTOR(S)’ legal entity cost report. COUNTY may choose to appeal and
therefore reserves the right to defer payback settlement with CONTRACTOR(S) until resolution of the
appeal. DHCS audits will follow Federal Medicaid procedures for managing overpayments.
If at the end of the audit settlement process the COUNTY determines that it
overpaid the CONTRACTOR(S), it will require the CONTRACTOR(S) to repay the Medi-Cal related
overpayment.
Funds owed to COUNTY will be due within forty-five (45) days of notification
by the COUNTY, or COUNTY shall withhold future payments until all excess funds have been
recouped by means of an offset against any payments then or thereafter owing to
CONTRACTOR(S) under this or any other Agreement.
D.Outcome Reports
CONTRACTOR(S) shall submit to COUNTY’s DBH and DSS service outcome
reports, as requested.
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E.Additional Reports
In addition, CONTRACTOR(S) shall also furnish to COUNTY such statements,
records, reports, data, and other information as COUNTY may request pertaining to matters covered
by this Agreement. In the event that CONTRACTOR(S) fails to provide such reports or other
information required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly
payments until there is compliance. In addition, CONTRACTOR(S) shall provide written notification
and explanation to COUNTY within five (5) days of any funds received from another source to
conduct the same services covered by this Agreement.
16.MONITORING
CONTRACTOR(S) agrees to extend to COUNTY’s staff, COUNTY’s DBH and DSS
Directors and DHCS, or their designees, the right to review and monitor records, program, and
policies and procedures, at any time, in regard to clients, as well as the overall operation of
CONTRACTOR(S)’ program, in order to ensure compliance with the terms and conditions of this
Agreement.
17.REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended
during the term thereof, the parties hereto agree to comply with the amended provision as of the
effective date of such amendment.
18.COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR(S) recognizes that COUNTY operates its mental health programs
under an agreement with DHCS, and that under said agreement the State imposes certain
requirements on COUNTY and its subcontractors. CONTRACTOR(S) shall adhere to all State
requirements, including those identified in Exhibit G “State Mental Health Requirements”, attached
hereto and by this reference incorporated herein.
19.COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR(S) shall be required to maintain organizational provider certification by
Fresno County. CONTRACTOR(S) must meet Medi-Cal organizational provider standards as listed
in Exhibit H, “Medi-Cal Organizational Provider Standards,” attached hereto and by this reference
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incorporated herein and made part of this Agreement. It is acknowledged that all references to
Organizational Provider and/or Provider in Exhibit H shall refer to CONTRACTOR(S). In addition,
CONTRACTOR(S) shall inform every client of their rights under the COUNTY’S MHP as described in
Exhibit I, “Fresno County Mental Health Plan Grievances and Appeals Process,” attached hereto and
by this reference incorporated herein and made part of this Agreement. CONTRACTOR shall also
file an incident report for all incidents involving clients, following the DBH’s “Incident Reporting and
Intensive Analysis” policy and procedure guide and using the “Incident Report Worksheet” identified
in Exhibit J, attached hereto and by this reference incorporated herein and made part of this
Agreement, or a protocol and worksheet presented by CONTRACTOR(S) that is accepted by
COUNTY’s DBH Director, or his or her designee.
20.CONFIDENTIALITY
All services performed by CONTRACTOR(S) under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating
to confidentiality.
21.HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR(S) each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
104-191(HIPAA) and agree to use and disclose protected health information as required by law.
COUNTY and CONTRACTOR(S) acknowledge that the exchange of protected health
information (PHI) between them is only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR(S) intend to protect the privacy and provide for the
security of PHI pursuant to this Agreement in compliance with HIPAA, the Health Information
Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations)
and other applicable laws. As part of the HIPAA Regulations, the Privacy Rule and the Security Rule
require CONTRACTOR(S) to enter into a contract containing specific requirements prior to the
disclosure of PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and
164.504(e) of the Code of Federal Regulations (CFR).
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22.DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent
access, viewing, use or disclosure of COUNTY data including sensitive or personal client information;
abuse of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies
that enter into a contractual relationship with the COUNTY for the purpose of providing services
under this Agreement must employ adequate data security measures to protect the confidential
information provided to CONTRACTOR(S) by the COUNTY, including but not limited to the following:
A.CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR(S) may not connect to COUNTY networks via personally-
owned mobile, wireless or handheld devices, unless the following conditions are met:
1)CONTRACTOR(S) has received authorization by COUNTY for
telecommuting purposes;
2)Current virus protection software is in place;
3)Mobile device has the remote wipe feature enabled/ and
4)A secure connection is used.
B.CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR(S) may not bring CONTRACTOR-owned computers or
computer peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief
Information Officer, and/or designee(s), including but not limited to mobile storage devices. If data is
approved to be transferred, data must be stored on a secure server approved by the COUNTY and
transferred by means of a Virtual Private Network (VPN) connection, or another type of secure
connection. Said data must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR(S) may not use COUNTY computers or computer peripherals
on non-COUNTY premises without prior authorization from the COUNTY’s Chief Information Officer,
and/or designee(s).
D. CONTRACTOR(S) may not store COUNTY’s private, confidential or sensitive
data on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
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E.CONTRACTOR(S) shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data
processing systems, data files and data processing equipment which stores or processes COUNTY
data internally and externally.
F.Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
128 BIT or higher. Additionally, a password or passphrase must be utilized.
G.CONTRACTOR(S) is responsible to immediately notify COUNTY of any
violations, breaches or potential breaches of security related to COUNTY’s confidential information,
data maintained in computer files, program documentation, data processing systems, data files and
data processing equipment which stores or processes COUNTY data internally or externally.
H.COUNTY shall provide oversight to CONTRACTOR(S)’ response to all incidents
arising from a possible breach of security related to COUNTY’s confidential client information
provided to CONTRACTOR(S). CONTRACTOR(S) will be responsible to issue any notification to
affected individuals as required by law or as deemed necessary by COUNTY in its sole discretion.
CONTRACTOR(S) will be responsible for all costs incurred as a result of providing the required
notification.
23.PROPERTY OF COUNTY
A.COUNTY and CONTRACTOR(S) recognize that fixed assets are tangible and
intangible property obtained or controlled under COUNTY for use in operational capacity and will
benefit COUNTY for a period more than one (1) year. Depreciation of the qualified items will be on a
straight-line basis.
For COUNTY purposes, fixed assets must fulfill three (3) qualifications:
1)Asset must have life span of over one (1) year.
2)The asset is not a repair part.
3)The asset must be valued at or greater than the capitalization thresholds
for the asset type.
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Asset type Threshold
•land $0
•buildings and improvements $100,000
•infrastructure $100,000
•be tangible $5,000
o equipment
o vehicles
•or intangible asset $100,000
o Internally generated software
o Purchased software
o Easements
o Patents
•capital lease equipment $5,000
Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is
approved and identified as an asset it will be tagged with a COUNTY program number. A “Fixed
Asset Log”, attached hereto as Exhibit K and by this reference incorporated herein, will be maintained
by COUNTY’s Asset Management System and inventoried annually until the asset is fully
depreciated. During the terms of this Agreement, CONTRACTOR(S)’ fixed assets may be
inventoried in comparison to COUNTY’s DBH Asset Inventory System.
B.Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) with
over one (1) year life span, and are mobile and high risk of theft or loss are sensitive assets. Such
sensitive items are not limited to computers, copiers, televisions, cameras and other sensitive items
as determined by COUNTY’s DBH Director, or his or her designee. CONTRACTOR(S) maintains a
tracking system on the items that are not required to be capitalized or depreciated. The items are
subject to annual inventory for compliance.
C.Assets shall be retained by COUNTY, as COUNTY property, in the event this
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR(S) agrees to
participate in an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or
expiration of this Agreement, CONTRACTOR(S) shall be physically present when fixed and
inventoried assets are returned to COUNTY possession. CONTRACTOR(S) is responsible for
returning to COUNTY all COUNTY owned undepreciated fixed and inventoried assets, or the
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monetary value of said assets if unable to produce the assets at the expiration or termination of this
Agreement.
CONTRACTOR(S) further agrees to the following:
1)To maintain all items of equipment in good working order and condition,
normal wear and tear is expected;
2)To label all items of equipment with COUNTY assigned program
number, to perform periodic inventories as required by COUNTY and to maintain an inventory list
showing where and how the equipment is being used, in accordance with procedures developed by
COUNTY. All such lists shall be submitted to COUNTY within ten (10) days of any request therefore;
and
3)To report in writing to COUNTY immediately after discovery, the loss or
theft of any items of equipment. For stolen items, the local law enforcement agency must be
contacted and a copy of the police report submitted to COUNTY.
D.The purchase of any equipment by CONTRACTOR(S) with funds provided
hereunder shall require the prior written approval of COUNTY’s DBH, shall fulfill the provisions of this
Agreement as appropriate, and must be directly related to CONTRACTOR(S)’ services or activity
under the terms of this Agreement. COUNTY’s DBH may refuse reimbursement for any costs
resulting from equipment purchased, which are incurred by CONTRACTOR(S), if prior written
approval has not been obtained from COUNTY.
E. CONTRACTOR(S) must obtain prior written approval from COUNTY’s DBH
whenever there is any modification or change in the use of any property acquired or improved, in
whole or in part, using funds under this Agreement. If any real or personal property acquired, or
improved with said funds identified herein, is sold and/or is utilized by CONTRACTOR(S) for a use
which does not qualify under this Agreement, CONTRACTOR(S) shall reimburse COUNTY in an
amount equal to the current fair market value of the property, less any portion thereof attributable to
expenditures of funds not provided under this Agreement. These requirements shall continue in
effect for the life of the property. In the event this Agreement expires, or terminates, the requirements
for this Section shall remain in effect for activities or property funded with said funds, unless action is
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taken by the State government to relieve COUNTY of these obligations
24.NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR(S) and its subcontractors
shall not deny the contract’s benefits to any person on the basis of race, religious creed, color,
national origin, ancestry, physical disability, mental disability, medical condition, genetic information,
marital status, sex, gender, gender identity, gender expression, age, sexual orientation, or military
and veteran status, not shall they discriminate unlawfully against any employee or applicant for
employment because of race, religious creed, color, national origin, ancestry, physical disability,
mental disability, medical condition, genetic information, marital status, sex, gender identity, gender
expression, age, sexual orientation, or military and veteran status.
CONTRACTOR(S) shall insure that the evaluation and treatment of employees and
applicants for employment are free of such discrimination. CONTRACTOR(S) and subcontractors
shall comply with the provisions of the Fair Employment and Housing Act (Gov. Code §12800 et
seq.), the regulations promulgated thereunder (Cal. Code Regs., tit. 2, §11000 et seq.), the provisions
of Article 9.5, Chapter 1, Part 1, Division 3, Title 2 of the Government Code (Gov. Code §11135-
11139.5), and the regulations or standards adopted by the awarding state agency to implement such
article. CONTRACTOR(S) shall permit access by representatives of the Department of Fair
Employment and Housing and the awarding state agency upon reasonable notice at any time during
the normal business hours, but in no case less than twenty-four (24) hours notice, to such of its
books, records, accounts, and all other sources of information and its facilities as said Department or
Agency shall require to ascertain compliance with this clause. CONTRACTOR(S) and its
subcontractors shall give written notice of their obligations under this clause to labor organizations
with which they have a collective bargaining or other agreement. (See Cal. Code Regs., tit. 2,
§11105) CONTRACTOR(S) shall include the Non-Discrimination and compliance provisions of this
clause in all subcontracts to perform work under this Agreement.
25.CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence:
A.CONTRACTOR(S) shall not discriminate against beneficiaries based on race,
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color, national origin, sex, disability, or religion. CONTRACTOR(S) shall ensure that a limited and/or no
English proficient beneficiary is entitled to equal access and participation in federally funded programs
through the provision of comprehensive and quality bilingual services pursuant to Title 6 of the Civil
Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R. Part 80) and Executive Order 12250 of
1979.
B.CONTRACTOR(S) shall comply with requirements of policies and procedures for
ensuring access and appropriate use of trained interpreters and material translation services for all
limited and/or no English proficient beneficiaries, including, but not limited to, assessing the cultural and
linguistic needs of the beneficiaries, training of staff on the policies and procedures, and monitoring its
language assistance program. CONTRACTOR(S)’ policies and procedures shall ensure compliance of
any subcontracted providers with these requirements.
C. CONTRACTOR(S) shall notify its beneficiaries that oral interpretation is available
for any language and written translation is available in prevalent languages and that auxiliary aids and
services are available upon request, at no cost and in a timely manner for limited and/or no English
proficient beneficiaries and/or beneficiaries with disabilities. CONTRACTOR(S) shall avoid relying on an
adult or minor child accompanying the beneficiary to interpret or facilitate communication; however, if the
beneficiary refuses language assistance services, the CONTRACTOR(S) must document the offer,
refusal and justification in the beneficiary’s file.
D. CONTRACTOR(S) shall ensure that employees, agents, subcontractors, and/or
partners who interpret or translate for a beneficiary or who directly communicate with a beneficiary in a
language other than English (1) have completed annual training provided by COUNTY at no cost to
CONTRACTOR(S); (2) have demonstrated proficiency in the beneficiary’s language; (3) can effectively
communicate any specialized terms and concepts specific to CONTRACTOR(S)’ services; and (4)
adheres to generally accepted interpreter ethic principles. As requested by COUNTY,
CONTRACTOR(S) shall identify all who interpret for or provide direct communication to any program
beneficiary in a language other than English, and identify when the CONTRACTOR last monitored the
interpreter for language competence.
E.CONTRACTOR(S) shall submit to COUNTY for approval, within ninety (90)
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days from date of contract execution, CONTRACTOR(S)’ plan to address all fifteen (15) National
Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by the Office of
Minority Health. As the CLAS standards are updated, CONTRACTOR(S)’ plan must be updated
accordingly. As requested by COUNTY, CONTRACTOR(S) shall be responsible for conducting an
annual CLAS self-assessment, and providing the results of the self-assessment to the COUNTY. The
annual CLAS self-assessment instruments shall be reviewed by the COUNTY and revised as
necessary to meet the approval of the COUNTY.
F.Cultural competency training for CONTRACTOR(S) staff should be
substantively integrated into health professions education and training at all levels, both academically
and functionally, including core curriculum, professional licensure, and continuing professional
development programs. As requested by COUNTY, CONTRACTOR(S) shall report on the
completion of cultural competency trainings to ensure direct service providers are completing a
minimum of eight (8) hours of cultural competency training annually.
G.CONTRACTOR(S) shall create and sustain a forum that includes staff at all
agency levels to discuss cultural competence. COUNTY encourages a representative from
CONTRACTOR(S)’ forum to attend COUNTY’s Cultural Humility Committee.
26.AMERICANS WITH DISABILITIES ACT
CONTRACTOR(S) agrees to ensure that deliverables developed and produced,
pursuant to this Agreement shall comply with the accessibility requirements of Section 508 of the
Rehabilitation Act and the Americans with Disabilities Act of 19373 as amended (29 U.S.C. §794 (d)),
and regulations implementing that Act as set forth in Part 1194 of the Title 36 of the Code of Federal
Regulations. In 1998, Congress amended the Rehabilitation Act of 1973 to require Federal agencies
to make their electronic and information technology (EIT) accessible to people with disabilities.
California Government Code Section 11135 codifies Section 508 of the Act requiring accessibility of
electronic and information technology.
27.CONFLICT OF INTEREST
No officer, agent, or employee of COUNTY who exercises any function or responsibility
for planning and carrying out the services provided under this Agreement shall have any direct or
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indirect personal financial interest in this Agreement. In addition, no employee of COUNTY shall be
employed by CONTRACTOR(S) to fulfill any contractual obligations with COUNTY.
CONTRACTOR(S) shall also comply with all Federal, State of California, and local
conflict of interest laws, statutes, and regulations, which shall be applicable to all parties and
beneficiaries under this Agreement and any officer, agent, or employee of COUNTY.
28.CHARITABLE CHOICE
CONTRACTOR(S) may not discriminate in its program delivery against a client or
potential client on the basis of religion or religious belief, a refusal to hold a religious belief, or a
refusal to actively participate in a religious practice. Any specifically religious activity or service made
available to individuals by CONTRACTOR(S) must be voluntary as well as separate in time and
location from COUNTY-funded activities and services. CONTRACTOR(S) shall inform COUNTY as
to whether it is faith-based. If CONTRACTOR(S) identifies as faith-based it must submit to
COUNTY’S DBH and DSS a copy of its policy on referring individuals to an alternate treatment
provider, and include a copy of this policy in its client admission forms. The policy must inform
individuals that they may be referred to an alternative provider if they object to the religious nature of
the program, and include a notice to COUNTY’s DBH and DSS. Adherence to this policy will be
monitored during annual site reviews and reviews of client files. If CONTRACTOR(S) identifies as
faith-based, by July 1 of each year, CONTRACTOR will be required to report to COUNTY’s DBH and
DSS the number of individuals who requested referrals to alternate providers based on religious
objection.
29.TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section
1861(v) (1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of
four (4) years after the furnishing of services under this Agreement, CONTRACTOR(S) shall make
available, upon written request to the Secretary of the United States Department of Health and
Human Services, or upon request to the Comptroller General of the United States General
Accounting Office, or any of their duly authorized representatives, a copy of this Agreement and such
books, documents, and records as are necessary to certify the nature and extent of the costs of these
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services provided by CONTRACTOR(S) under this Agreement. CONTRACTOR(S) further agrees
that in the event CONTRACTOR(S) carries out any of its duties under this Agreement through a
subcontract, with a value or cost of Ten Thousand and No/100 Dollars ($10,000.00) or more over a
twelve (12) month period, with a related organization, such Agreement shall contain a clause to the
effect that until the expiration of four (4) years after the furnishing of such services pursuant to such
subcontract, the related organizations shall make available, upon written request to the Secretary of
the United States Department of Health and Human Services, or upon request to the Comptroller
General of the United States General Accounting Office, or any of their duly authorized
representatives, a copy of such subcontract and such books, documents, and records of such
organization as are necessary to verify the nature and extent of such costs.
30.SINGLE AUDIT CLAUSE
A.If CONTRACTOR(S) expends Seven Hundred Fifty Thousand and No/100
Dollars ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR(S)
agrees to conduct an annual audit in accordance with the requirements of the Single Audit Standards
as set forth in Office of Management and Budget (OMB) 2 CFR 200. CONTRACTOR(S) shall submit
said audit and management letter to COUNTY. The audit must include a statement of findings or a
statement that there were no findings. If there were negative findings, CONTRACTOR(S) must
include a corrective action plan signed by an authorized individual. CONTRACTOR(S) agrees to take
action to correct any material non-compliance or weakness found as a result of such audit. Such
audit shall be delivered to COUNTY’s DBH Business Office for review within nine (9) months of the
end of any fiscal year in which funds were expended and/or received for the program. Failure to
perform the requisite audit functions as required by this Agreement may result in COUNTY
performing the necessary audit tasks, or at COUNTY’s option, contracting with a public accountant to
perform said audit, or, may result in the inability of COUNTY to enter into future agreements with
CONTRACTOR(S). All audit costs related to this Agreement are the sole responsibility of
CONTRACTOR(S).
B.A single audit report is not applicable if CONTRACTOR(S)’s Federal contracts
do not exceed the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
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CONTRACTOR(S)’ only funding is through drug-related Medi-Cal. If a single audit is not applicable,
a program audit must be performed and a program audit report with management letter shall be
submitted by CONTRACTOR(S) to COUNTY as a minimum requirement to attest to
CONTRACTOR’s solvency. Said audit report shall be delivered to COUNTY’s DBH Business Office
for review, no later than nine (9) months after the close of the fiscal year in which the funds supplied
through this Agreement are expended. Failure to comply with this act may result in COUNTY
performing the necessary audit tasks or contracting with a qualified accountant to perform said audit.
All audit costs related to this Agreement are the sole responsibility of CONTRACTOR(S) who agrees
to take corrective action to eliminate any material noncompliance or weakness found as a result of
such audit. Audit work performed by COUNTY under this section shall be billed to the
CONTRACTOR(S) at COUNTY’s cost, as determined by COUNTY’s Auditor-Controller/Treasurer-
Tax Collector.
C. CONTRACTOR(S) shall make available all records and accounts for inspection
by COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
period of at least three (3) years following final payment under this Agreement or the closure of all
other pending matters, whichever is later.
31. COMPLIANCE
CONTRACTOR(S) agrees to comply with the COUNTY’s Contractor Code of Conduct
and Ethics and the COUNTY’s Compliance Program in accordance with Exhibit E, as described
herein and in Section Five (5) above. Within thirty (30) days of entering into this Agreement with the
COUNTY, CONTRACTOR(S) shall have all of CONTRACTOR(S)’ employees, agents and
subcontractors providing services under this Agreement certify in writing, that he or she has received,
read, understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR(S)
shall ensure that within thirty (30) days of hire, all new employees, agents and subcontractors
providing services under this Agreement shall certify in writing that he or she has received, read,
understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR(S)
understands that the promotion of and adherence to the Code of Conduct is an element in evaluating
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the performance of CONTRACTOR(S) and its employees, agents and subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agents and subcontractors providing services under this Agreement shall complete
general compliance training and appropriate employees, agents and subcontractors shall complete
documentation and billing or billing/reimbursement training. All new employees, agents and
subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual who
is required to attend training shall certify in writing that he or she has received the required training.
The certification shall specify the type of training received and the date received. The certification
shall be provided to the COUNTY’s Compliance Officer at 3133 N. Millbrook Ave, Fresno, California
93703. CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of any penalty imposed
upon COUNTY by the Federal Government as a result of CONTRACTOR(S)’ violation of the terms of
this Agreement.
32.ASSURANCES
In entering into this Agreement, CONTRACTOR(S) certifies that it is not currently
excluded, suspended, debarred, or otherwise ineligible to participate in the Federal Health Care
Programs: that it has not been convicted of a criminal offense related to the provision of health care
items or services; nor has it been reinstated to participation in the Federal Health Care Programs
after a period of exclusion, suspension, debarment, or ineligibility. If COUNTY learns, subsequent to
entering into a contract, that CONTRACTOR(S) is ineligible on these grounds, COUNTY will remove
CONTRACTOR(S) from responsibility for, or involvement with, COUNTY’s business operations
related to the Federal Health Care Programs and shall remove such CONTRACTOR(S) from any
position in which CONTRACTOR(S)’ compensation, or the items or services rendered, ordered or
prescribed by CONTRACTOR(S) may be paid in whole or part, directly or indirectly, by Federal
Health Care Programs or otherwise with Federal Funds at least until such time as CONTRACTOR(S)
is reinstated into participation in the Federal Health Care Programs.
A.If COUNTY has notice that CONTRACTOR(S) has been charged with a criminal
offense related to any Federal Health Care Program, or is proposed for exclusion during the term of
any contract, CONTRACTOR(S) and COUNTY shall take all appropriate actions to ensure the
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accuracy of any claims submitted to any Federal Health Care Program. At its discretion given such
circumstances, COUNTY may request that CONTRACTOR(S) cease providing services until
resolution of the charges or the proposed exclusion.
B.CONTRACTOR(S) agrees that all potential new employees of
CONTRACTOR(S) or subcontractors of CONTRACTOR(S) who, in each case, are expected to
perform professional services under this Agreement, will be queried as to whether: (1) they are now
or ever have been excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
Health Care Programs; (2) they have been convicted of a criminal offense related to the provision of
health care items or services; and or (3) they have been reinstated to participation in the Federal
Health Care Programs after a period of exclusion, suspension, debarment, or ineligibility.
1)In the event the potential employee or subcontractor informs
CONTRACTOR(S) that he or she is excluded, suspended, debarred or otherwise ineligible, or has
been convicted of a criminal offense relating to the provision of health care services, and
CONTRACTOR(S) hires or engages such potential employee or subcontractor, CONTRACTOR(S)
will ensure that said employee or subcontractor does no work, either directly or indirectly relating to
services provided to COUNTY.
2)Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance
(as defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or
subcontractor of CONTRACTOR(S) will perform work, either directly or indirectly, relating to services
provided to COUNTY. Such demand for adequate assurance shall be effective upon a timeframe to
be determined by COUNTY to protect the interests of COUNTY consumers.
C.CONTRACTOR(S) shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are
expected to perform professional services under this Agreement: (1) are not currently excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)
have not been convicted of a criminal offense related to the provision of health care items or services;
and (3) have not been reinstated to participation in the Federal Health Care Program after a period of
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exclusion, suspension, debarment, or ineligibility. In the event any existing employee or
subcontractor informs CONTRACTOR(S) that he or she is excluded, suspended, debarred or
otherwise ineligible to participate in the Federal Health Care Programs, or has been convicted of a
criminal offense relating to the provision of health care services, CONTRACTOR(S) will ensure that
said employee or subcontractor does no work, either direct or indirect, relating to services provided to
COUNTY.
1)CONTRACTOR(S) agrees to notify COUNTY immediately during the
term of this Agreement whenever CONTRACTOR(S) learns that an employee or subcontractor who,
in each case, is providing professional services under this Agreement is excluded, suspended,
debarred or otherwise ineligible to participate in the Federal Health Care Programs, or is convicted of
a criminal offense relating to the provision of health care services.
2)Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance
(as defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or
subcontractor of CONTRACTOR(S) will perform work, either directly or indirectly, relating to services
provided to COUNTY. Such demand for adequate assurance shall be effective upon a timeframe to
be determined by COUNTY to protect the interests of COUNTY consumers.
D. CONTRACTOR(S) agrees to cooperate fully with any reasonable requests for
information from COUNTY, which may be necessary to complete any internal or external audits
relating to CONTRACTOR(S)’s compliance with the provisions of this Section.
E.CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of any
penalty imposed upon COUNTY by the Federal Government as a result of CONTRACTOR(S)’
violation of CONTRACTOR(S)’ obligations as described in this Section.
33.PUBLICITY PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under
this Agreement shall be used for CONTRACTOR(S)’ advertising, fundraising, or publicity (i.e.,
purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
Notwithstanding the above, publicity of the services described in Section One (1) of this Agreement
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shall be allowed as necessary to raise public awareness about the availability of such specific
services when approved in advance by COUNTY’s DBH Director, or his or her designee, and at a
cost to be provided in Exhibits C-1 et seq. for such items as written/printed materials, the use of
media (i.e., radio, television, newspapers) and any other related expense(s).
34.COMPLAINTS
CONTRACTOR(S) shall log complaints and the disposition of all complaints from a
client or a client’s family. CONTRACTOR(S) shall provide a copy of the detailed complaint log entries
concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (l0th) day of the
following month, in a format that is mutually agreed upon. In addition, CONTRACTOR(S) shall
provide details and attach documentation of each complaint with the log. CONTRACTOR(S) shall
post signs informing clients of their right to file a complaint or grievance. CONTRACTOR(S) shall
notify COUNTY of all incidents reportable to State licensing bodies that affect COUNTY clients within
twenty-four (24) hours of receipt of a complaint.
Within ten (10) days after each incident or complaint affecting COUNTY-sponsored
clients, CONTRACTOR(S) shall provide COUNTY with information relevant to the complaint,
investigative details of the complaint, the complaint and CONTRACTOR(S)’ disposition of, or
corrective action taken to resolve the complaint. In addition, CONTRACTOR(S) shall inform every
client of their rights as set forth in Exhibits I and J, described herein and in Section Nineteen (19)
above.
35.CHILD ABUSE REPORTING ACT
CONTRACTOR(S) shall establish a procedure acceptable to the COUNTY’s DBH and
DSS Directors, or their designees, to ensure that all of the CONTRACTOR(S)’ employees,
consultants, subcontractors or agents described in the Child Abuse Reporting Act, section 11164, et
seq of the Penal Code, and performing services under this Agreement shall report all known or
suspected child abuse or neglect to a child protective agency as defined in Penal Code section
11165.9. This procedure shall include:
A.A requirement that all CONTRACTOR(S)’ employees, consultants,
subcontractors or agents performing services shall sign a statement that he or she knows of and will
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comply with the reporting requirements as defined in Penal Code section 11166(a).
B.Establishing procedures to ensure reporting even when employees, consultants,
subcontractors, or agents who are not required to report child abuse under Penal Code section
11166(a), gain knowledge of or reasonably suspect that a child has been a victim of abuse or neglect.
36.DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
INFORMATION
This provision is only applicable if CONTRACTOR(S) is a disclosing entity, fiscal agent,
or managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101
455.104, and 455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and
455.106(a)(1),(2), the following information must be disclosed by CONTRACTOR(S) by completing
Exhibit L “Disclosure of Ownership and Control Interest Statement”, attached hereto and by this
reference incorporated herein and made part of this Agreement. CONTRACTOR(S) shall submit this
form to COUNTY’s DBH within thirty (30) days of the effective date of this Agreement. Additionally,
CONTRACTOR(S) shall report any changes to this information within thirty-five (35) days of
occurrence by completing Exhibit L. Submissions shall be scanned pdf copies and are to be sent via
email to COUNTY’s DBH Contracted Services CWMH Staff Analyst.
37.DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR(S) is required to disclose if any of the following conditions apply to
them, their owners, officers, corporate managers and partners (hereinafter collectively referred to as
“CONTRACTOR(S)”):
A.Within the three-year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1)Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or
contract under a public transaction;
2)Violation of a federal or state antitrust statute;
3)Embezzlement, theft, forgery, bribery, falsification, or destruction of
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records; or
4)False statements or receipt of stolen property.
B.Within the three-year period preceding their Agreement award, they have had
a public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate CONTRACTOR(S)
from further business consideration. The information will be considered as part of the determination
of whether to continue and/or renew the Agreement and any additional information or explanation
that a CONTRACTOR(S) elects to submit with the disclosed information will be considered. If it is
later determined that the CONTRACTOR(S) failed to disclose required information, any contract
awarded to such CONTRACTOR(S) may be immediately voided and terminated for material failure
to comply with the terms and conditions of the award.
CONTRACTOR(S) must sign a “Certification Regarding Debarment, Suspension, and
Other Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit M,
attached hereto and by this reference incorporated herein and made part of this Agreement.
Additionally, CONTRACTOR(S) must immediately advise the COUNTY in writing if, during the term of
this Agreement: (1) CONTRACTOR(S) becomes suspended, debarred, excluded or ineligible for
participation in federal or state funded programs or from receiving Federal funds as listed in the
excluded parties’ list system (http://www.epls.gov); or (2) any of the above listed conditions become
applicable to CONTRACTOR(S). CONTRACTOR(S) shall indemnify, defend and hold the COUNTY
harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility or
other matter listed in the signed Certification Regarding Debarment, Suspension, and Other
Responsibility Matters.
38.DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR(S) is operating as a corporation
(a for-profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR(S)
changes its status to operate as a corporation.
Members of the CONTRACTOR(S)’ Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR(S) is providing goods or performing
COUNTY OF FRESNO
Fresno, CA
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services under this Agreement. A self-dealing transaction shall mean a transaction to which the
CONTRACTOR(S) is a party and in which one or more of its directors has a material financial
interest. Members of the Board of Directors shall disclose any self-dealing transactions that they are
a party to by completing and signing a Self-Dealing Transaction Disclosure Form, attached hereto as
Exhibit N and incorporated herein by reference and made part of this Agreement, and submitting it to
the COUNTY prior to commencing with the self-dealing transaction or immediately thereafter.
39.AUDITS AND INSPECTIONS
CONTRACTOR(S) shall at any time during business hours, and as often as the
COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
data with respect to the matters covered by this Agreement. CONTRACTOR(S) shall, upon request
by the COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to
ensure CONTRACTOR(S)’ compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR(S) shall be subject to the examination and audit of the State Auditor General for a
period of three (3) years after final payment under contract (California Government Code section
8546.7).
40.NOTICES
The persons having authority to give and receive notices under this Agreement and
their addresses include the following:
COUNTY CONTRACTOR(S)
Director, Fresno County SEE EXHIBIT A
Department of Behavioral Health
3133 N. Millbrook Ave.
Fresno, CA 93703
Director, County of Fresno
Department of Social Services
PO Box 1912
Fresno, CA 93718-1912
All notices between COUNTY and CONTRACTOR(S) provided for or permitted under
this Agreement or by law shall be in writing and delivered either by personal service, by first-class
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Fresno, CA
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United States mail, by an overnight commercial courier service, or by telephonic facsimile
transmission. A notice delivered by personal service is effective upon service to the recipient. A
notice delivered by first-class United States mail is effective three (3) COUNTY business days after
deposit in the United States mail, postage prepaid, addressed to the recipient. A notice delivered by
an overnight commercial courier service is effective one (1) COUNTY business day after deposit with
the overnight commercial courier service, delivery fees prepaid, with delivery instructions given for
next day delivery, addressed to the recipient. A notice delivered by telephonic facsimile is effective
when transmission to the recipient is completed (but, if such transmission is completed outside of
COUNTY business hours, then such delivery shall be deemed to be effective at the next beginning of
a COUNTY business day), provided that the sender maintains a machine record of the completed
transmission. For all claims arising out of or related to this Agreement, nothing in this Section
establishes, waives, or modifies any claims presentation requirements or procedures provided by law,
including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government
Code, beginning with Section 810).
41.SEVERABILITY
If any non-material term, provision, covenant, or condition of this Agreement is held by
a court of competent jurisdiction to be invalid, void or unenforceable, the remainder of the provisions
shall remain in full force and effect, and shall in no way be affected, impaired or invalidated.
42.SEPARATE AGREEMENT
It is mutually understood by the parties that this Agreement does not, in any way, create
a joint venture among the individual CONTRACTORS. By execution of this Agreement,
CONTRACTORS understand that a separate Agreement is formed between each individual
CONTRACTOR and COUNTY.
43.GOVERNING LAW
The parties agree that for the purpose of venue, performance under this Agreement is
in Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
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Fresno, CA
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44.ENTIRE AGREEMENT
This Agreement, including all Exhibits (listed below), COUNTY’s Revised RFP No. 19-
036, and CONTRACTOR(S) Response(s) to COUNTY’s Revised RFP No. 19-036 constitutes the
entire agreement between CONTRACTOR(S) and COUNTY with respect to the subject matter hereof
and supersedes all previous agreement negotiations, proposals, commitments, writings,
advertisements, publications, and understandings of any nature whatsoever unless expressly
included in this Agreement.
Exhibit A – List of Contractors
Exhibit B-1, et seq. -- Summary of Services
Exhibit C -- Guiding Principles of Care Delivery
Exhibit D-1, et seq. – Budgets
Exhibit E -- Fresno County Mental Health Plan Compliance
and Code of Conduct
Exhibit F -- Documentation Standards for Client Records
Exhibit G -- State Mental Health Requirements
Exhibit H -- Medi-Cal Organizational Provider Standards
Exhibit I -- Fresno County Mental Health Plan Grievances and Appeals
Process
Exhibit J -- Incident Reporting and Intensive Analysis Policy and Procedure
Guide
Exhibit K -- Fixed Asset Log
Exhibit L -- Disclosure of Ownership and Control Interest Statement
Exhibit M -- Certification Regarding Debarment, Suspension, and Other
Responsibility Matters – Primary Covered Transactions
Exhibit N -- Self-Dealing Transaction Form
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IN WITNESS WHEREOF , the parties hereto have executed this Agreement as of the day and
year first hereinabove written .
Fund/Subclass :
Organization :
AccounUProgram :
0001/10000
5630
7295/0
COUNTY OF FRESNO
Nathan Magsig , Chairman of the
Board of Supervisors of the
County of Fresno
Date :
ATTEST:
BERNICE E. SEIDEL
Clerk of the Board of Supervisors
County of Fresno , State of California
By &As.AM ~8J\D:f)
Deputy
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PLEASE SEE ADDITIONAL
SIGNATURE PAGES ATTACHED
COUNTY OF FRESNO
Fres n o, CA
Exhibit A
CHILD WELFARE MENTAL HEALTH
MASTER AGREEMENT
LIST OF CONTRACTORS
1. CALIFORNIA PSYCHOLOGICAL INSTITUTE (Exhibits B-1; C-1)
1470 W. Herndon Avenue, Suite 300
Fresno, CA 93711
Phone #: (559) 256-2000
Contact for Notices: Administrative Director
2. CENTRAL STAR BEHAVIORAL HEALTH, INC. (Exhibits B-2; C-2)
1501 Hughes Way, Suite 150
Long Beach, CA 90810
Phone #: (310) 221-6336 ext. 125
Contact for Notices: Senior Vice President
3. UPLIFT FAMILY SERVICES (Exhibits B-3; C-3)
251 Llewellyn Avenue
Campbell, CA 95008
Phone #: (408) 379-3790
Contact for Notices: Executive Director
Exhibit B-1
Page 1 of 17
CHILD WELFARE MENTAL HEALTH (CWMH)
SUMMARY OF SERVICES
ORGANIZATION: California Psychological Institute
ADDRESS: 1470 W. Herndon Avenue, Suite #300
Fresno, CA 93711
TELEPHONE: (559) 256-2000
CONTACT PERSON: Michelle Zavala, Administrative Director
CONTRACT PERIOD: July 1, 2019 – June 30, 2022
with two (2) optional twelve (12) month renewals
CONTRACT AMOUNT: $4,750,000 (July 1, 2019 – June 30, 2020);
$4,750,000 (July 1, 2020 – June 30, 2021);
$4,750,000 (July 1, 2021 – June 30, 2022);
$4,750,000 (July 1, 2022 – June 30, 2023)
$4,750,000 (July 1, 2023 – June 30, 2024)
SUMMARY OF SERVICES:
California Psychological Institute, henceforth referred to as CONTRACTOR, will be
responsible for providing medically necessary outpatient specialty mental health services
for children, youth, and their parents who meet medical necessity, as well as court-
specific services to children and families involved in Fresno County’s Child Welfare
Services (CWS) system. The majority of outpatient specialty mental health services, such
as assessments, plan development, therapy, rehabilitation services, crisis intervention,
case management, intensive home-based services and intensive care coordination are
expected to be community-based and provided in the family’s home or in the community,
whenever possible.
SCHEDULE OF SERVICES:
The CONTRACTOR’s office(s) shall be open Monday through Thursday, 7:30am to
7:00pm, and Friday to Saturday, 7:00am to 6:00pm. Clinicians will be available to see
clients and families for in-home and community-based appointments during the day,
weekend, and evening hours, up to 7:00 pm. Group services will be provided during the
day and evening hours, up to 7:00 pm, on a scheduled basis, at CONTRACTOR’s offices.
The CONTRACTOR’s office will be located at a site in the metropolitan and/or rural
community that offers public transportation in close proximity, adequate parking, and a
secure setting. In addition to the Fresno metropolitan area, CONTRACTOR shall serve
the rural areas of Fresno County as needed. Any addition or change to the location of
office-based services must be approved by the COUNTY in advance of such a change.
Exhibit B-1
Page 2 of 17
TARGET POPULATION:
CONTRACTOR shall provide specialty mental health services to all referred children,
youth, parents, guardians, and foster parents involved with a child’s CWS case. The
target population includes children and youth as referred to in the Katie A. Settlement
Agreement as members of the “class” and “subclass.”
1. Katie A. “Class” is defined as children in California who:
A. Are in foster care or are at imminent risk of foster care placement, and
B. Have a mental illness or condition that has been documented or had an
assessment already conducted, and
C. Need individualized mental health services, including but not limited to,
mental health assessments, outpatient specialty mental health services,
case management services, family support, crisis intervention, and other
medically necessary services in the home or in a home-like setting, to treat
mental illness or condition.
Imminent Risk of foster care placement means that within the last 180 days a child has
been participating in voluntary family maintenance or family reunification services and/or
has been the subject of either a telephone call to the Child Protective Services hotline or
some other documented communication made to a local Child Protective Services agency
regarding suspicions of abuse, neglect or abandonment.
Members of this class include children living with their parents, relatives, or in any variety
of placements, such as group homes, short-term residential therapeutic programs
(STRTPs), or foster homes.
2. “Katie A. Subclass” is identified as children in California who:
A. Have an open CWS case; and
B. Are full-scope Medi-Cal (Title XIX) eligible; and
C. Meet the medical necessity criteria for Medi-Cal Outpatient Specialty Mental
Health Services (SMHS) as set forth in CCR, Title 9, Section 1830.205 or
Section 1830.210; and
D. Are currently in or being considered for a W raparound program, Therapeutic
Foster Care, or specialized care rate due to behavioral health needs or
other intensive Early and Periodic Screening Diagnostic and Treatment
(EPSDT) services, including but not limited to Therapeutic Behavioral
Services or crisis stabilization/intervention; or
E. Are currently in or being considered for placement in a group home (Rate
Classification 10 or above) or STRTP, psychiatric hospital, 24-hour mental
health treatment facility (e.g., psychiatric inpatient hospital, community
Exhibit B-1
Page 3 of 17
residential treatment facility); or has experienced three (3) or more
placements within 24 months due to behavioral health needs.
I. CONTRACTOR SHALL BE RESPONSIBLE FOR THE FOLLOWING SERVICES:
A. Referrals and Engagement
1. CONTRACTOR will provide an array of outpatient specialty mental
health services to all referrals received from the Department of
Behavioral Health’s (DBH) CWMH Team. CONTRACTOR shall accept
the adequate number of referrals to meet CWMH demand and to cover
program costs. Referral priority is determined by the CWMH Team and
assessments should be completed within the following designated
timeframes:
a. Crisis Referrals – Three (3) days
b. Standard Referrals – Ten (10) days
c. Psychiatric Referrals – Fifteen (15) days
2. CONTRACTOR shall make every attempt to engage clients in service.
CONTRACTOR is expected to make at least four (4) contact attempts
(in-person or via phone), at minimum one (1) attempt each week, over
the course of thirty (30) days and then send a letter to the client if
CONTRACTOR is still unable to engage them in services.
CONTRACTOR must also maintain regular contact with DSS Social
Workers, Supervisors, and Program Managers if they are unable to
contact or engage a client. If still unable to reach client, CONTRACTOR
must submit a Notice of Action to Managed Care and the CWMH Team.
A Notice of Action is not required if the referral packet received by
CONTRACTOR is incomplete.
B. Outpatient Specialty Mental Health Services
1. CONTRACTOR shall provide the following specialty mental health
services for the appropriate duration, frequency, and intensity based
upon the needs of the individual receiving services, as determined to be
clinically appropriate by a licensed/waivered mental health clinician and
the fidelity of the therapeutic intervention provided. It is understood that
a child who meets the definition of “Katie A. Subclass” does not, in and
of itself, require a higher level or intensity of mental health treatment
absent a clinical determination by the treating mental health clinician:
a. Mental Health Assessments
Clinical analysis of the history and current status of a
beneficiary’s mental, emotional, or behavioral disorder;
relevant cultural issues and history; diagnosis; and use of
testing procedures. A comprehensive assessment shall be
Exhibit B-1
Page 4 of 17
completed by a designated licensed or registered/waivered
staff within thirty (30) days from the initial contact date. When
a person remains in continuous services, an update/re-
assessment shall be completed at least every two (2) years.
The clinician may complete a comprehensive assessment
instead of an update/re-assessment if it is determined to be
the more appropriate clinical decision for the person served.
Additionally, current State mandates require that the CANS-
50 and PSC-35 are part of the assessment at the beginning
of treatment and are administered every six (6) months and at
the end of treatment. These will be shared with the Child and
Family Team (CFT). If a current assessment has been
completed by another CFT team member, it will be accepted
in lieu of an assessment completed by the clinician.
b. Therapy
A therapeutic intervention that focuses primarily on symptom
reduction as a means to improve functional impairments.
Therapy may be delivered to an individual or group of
beneficiaries (see below) and may include family therapy at
which the beneficiary is present.
1) Individual
2) Collateral
3) Conjoint
4) Family therapy
5) Group therapy
i. Groups will be led by clinicians and supervised
by a licensed clinician. Larger groups may be
co-facilitated by two (2) unlicensed clinicians.
Licensed Clinical Supervisors will provide in-
vivo training, co-facilitation and supervision to
ensure group facilitation is high quality,
clinically effective, and appropriate.
c. Crisis Intervention
A service lasting less than 24 hours, to or on behalf of a
beneficiary, for a condition which requires more timely
response than a regularly scheduled visit. Activities may
include, but are not limited to, assessment, therapy and
service access to any significant support person in the
beneficiary’s life with the intent of improving or maintaining the
mental health status of the beneficiary.
d. Case Management
Any service that assists a beneficiary to access needed
medical, educational, social, prevocational, vocational,
rehabilitative, or other community service. Services may
Exhibit B-1
Page 5 of 17
include, but are not limited to, communication, coordination,
and referral to available resources. CONTRACTOR will be
responsible for monitoring service delivery to beneficiary by
third parties, beneficiary progress, and plan development.
e. Rehabilitation
Any activity that seeks to improve, maintain, or restore a
beneficiary’s functional, daily living, social, leisure, grooming,
personal hygiene, and meal preparation skills while also
providing access to support resources and medication
education.
f. Plan Development
The development of individual treatment plans, approval of
said treatment plans, and/or monitoring of a beneficiary’s
progress.
g. Medication Support
Any service that includes prescribing, administering,
dispensing, and monitoring psychiatric medications or
biologicals, which are necessary to alleviate the symptoms of
mental illness. Services may also include evaluation for the
need of medication, evaluation of clinical effectiveness and
side effects, obtaining informed consent, medication
education and plan development related to the delivery of the
service, and/or assessment of the beneficiary.
CONTRACTOR shall have a plan in place to ensure
medication support coverage, in the event that the
Psychiatrist is unavailable to provide services for an extended
period of time.
2. CONTRACTOR shall be responsible to provide and appropriately bill for
the following services for referred clients, including Katie A. Subclass
members, if medically necessary and provided within the California
Integrated Core Practice Model and Pathways to Mental Health Core
Practice Model, and in accordance with the “Medi-Cal Manual for
Intensive Care Coordination (ICC), Intensive Home-Based Services
(IHBS) & Therapeutic Foster Care (TFC) for Medi-Cal Beneficiaries”:
a. IHBS may include, but are not limited to:
1) Skill-based interventions for the remediation of behaviors
or improvement of symptoms;
2) Development of functional skills to improve self-care, self-
regulation, or other functional impairments by intervening
to decrease or replace non-functional behavior that
interferes with daily living tasks or the avoidance of
exploitation by others;
Exhibit B-1
Page 6 of 17
3) Development of skills or replacement behaviors that allow
the child/youth to fully participate in the teaming process
and service plans including but not limited to the treatment
plan and/or child welfare case plan;
4) Improvement in self-management of symptoms, including
self-administration of medications, as appropriate;
5) Education of the child/youth and/or their family or
caregiver(s) about how to manage the child/youth’s mental
health disorder or symptoms;
6) Support of the development, maintenance and use of
social networks, including the use of natural and
community resources;
7) Support to address behaviors that interfere with the
achievement of a stable and permanent family life;
8) Support to address behaviors that interfere with seeking
and maintaining a job, if applicable;
9) Support to address behaviors that interfere with a
child/youth’s success in achieving educational objectives.
b. IHBS can be provided by more than one (1) agency when
multiple agencies are serving a client. A minimum of 15% of
all services provided by CONTRACTOR must be IHBS. It is
expected that CONTRACTOR will provide IHBS, unless
clinical justification is provided. Clinical justification must be
documented in the client’s mental health record (this will be
reviewed and audited by the COUNTY).
c. CONTRACTOR is required to attend ICC meetings and any
teaming processes scheduled by other agencies, CWS, or by
the DBH CWMH Team to ensure coordination of all mental
health treatment services that may involve one (1) or more
provider agencies, no less than every ninety (90) days for the
child/youth.
d. ICC service components/activities include comprehensive
assessment and periodic reassessment, development and
periodic revision of the plan, referral, monitoring, follow-up
activities, and transition.
3. CONTRACTOR will be responsible for providing services in either an
office-based or community-based setting. The location of service
delivery will be determined based on the needs of the client, preference
of the client, and clinical appropriateness. Based on current data, clients
prefer or require that their services are provided in a community-based
setting. The expectation is that, at minimum, 70% of all
CONTRACTOR’s client services will be provided in the home or a
community-based setting. Location of service delivery should be
clinically justified and documented in the client record.
Exhibit B-1
Page 7 of 17
4. CONTRACTOR will be responsible to work cooperatively and
collaboratively with CWS staff, DBH staff, CWMH Team staff, and all
treatment providers, caregivers, and Foster Family Agencies to achieve
the individual and collective treatment goals. Providers are to support
the CWS case plan, communicate/resolve barriers to care, and provide
continuity and warm hand-offs whenever possible as individuals
transition from higher to lower or lower to higher levels of care within or
outside of Fresno County.
5. CONTRACTOR will be able to refer to other Fresno County Mental
Health Plan (MHP) providers, Managed Care Medi-Cal Health Plans,
and other community providers as may be appropriate and in
concurrence with the DBH CWMH Team. CONTRACTOR shall provide
case management services until client is properly linked with another
provider.
6. CONTRACTOR must use evidence-based practices (EBPs) found
effective in serving this target population. This includes the provision of
training, ongoing sustainability and fidelity to a core competency for
CONTRACTOR’s mental health clinicians. To date, CONTRACTOR
and COUNTY have agreed upon the provision of the following evidence-
based practices:
a. Infant-Family and Early Childhood Mental Health/Infant
Mental Health (IMH)
b. Child Parent Psychotherapy (CPP)
c. Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)
d. Motivational Interviewing (MI)
e. Eye Movement Desensitization and Reprocessing (EMDR)
f. Dialectical Behavioral Therapy (DBT)
Any additional evidence-based practices CONTRACTOR would like to
utilize will require review and consultation with COUNTY.
COUNTY requires CONTRACTOR to ensure their staff pursue
certification/accreditation in the agreed upon evidence-based practices,
as appropriate, during the first year term, and demonstrate to COUNTY
that they are moving toward successful completion. CONTRACTOR is
required to explain in writing their plan to require/support staff in this
regard, and their expected timeframe for completion of the
certification/accreditation process within the first year term.
C. Court-Specific Mental Health Services
1. CONTRACTOR will provide the following court-ordered mental health
services to children and families in CWS:
Exhibit B-1
Page 8 of 17
a. Court-Ordered Mental Health Assessments
Clinical analysis of the history and current status of an
individual’s mental, emotional, or behavioral disorder; relevant
cultural issues and history; diagnosis; and use of testing
procedures.
b. Psychological and Neuropsychological Evaluations
A structured, analytical interview with the individual (i.e.,
minor, parent, or guardian) which consists of a clinical
assessment, the use of testing instruments, a mental status
examination, and a clinical diagnosis (as defined/ruled out
using the ICD-10) that is performed only by a Licensed
Psychologist with at least five (5) years of postgraduate
experience. Services also include a review of CPS and
mental health services received to date and contact with
relevant others, as necessary. A second psychological or
neuropsychological evaluation may be ordered and must be
performed by a different Licensed Psychologist and
independent of the first evaluation.
c. Bonding Studies
A structured, forensic, analytic interview that includes a
mental health assessment (in order to define or rule out
clinical diagnosis using the ICD-10) for either parent(s) or
whomever has been identified by the court to participate in the
study, and the child(ren). The study includes assessment of
the interaction between the parent(s) and the child(ren) and
may include the use of testing instruments (as needed) to
more accurately gauge the strength of the bond between
parent and child. It may also include the current care
provider(s) or prospective adoptive parent(s) when ordered by
the court. These studies are to be performed only by a
Licensed Mental Health Clinician with appropriate experience
or a Waivered Psychologist working under a qualified
Licensed Psychologist. A qualified clinician will have
completed twenty (20) hours of training in Child Custody as
required by the California Board of Psychology (if the child is
0-36 months), training in the Marshak Interaction Method, and
training or experience in providing forensic evaluations for the
court.
d. Court Reports And Court Testimony
CONTRACTOR is responsible for any court reports and/or
necessary testimony.
Exhibit B-1
Page 9 of 17
1) Court Reports
Documented report of assessment and evaluation
findings, progress in treatment, recommendations for
treatment, and service plan regarding reunification,
maintenance and termination of parental rights, and
justification for recommendations. CONTRACTOR
shall provide the DBH CWMH Team with a copy of the
reports, for tracking purposes.
2) Court Testimony
On-site court testimony of assessment and evaluation
findings, treatment and service plan recommendations
regarding reunification, maintenance and termination
of parental rights, and justification for
recommendations.
D. Staffing
1. CONTRACTOR shall ensure staff are qualified in education, experience,
and clinical competencies.
2. CONTRACTOR shall maintain adequate staffing levels in relation to the
number of open client cases at any given point to ensure quality service.
CONTRACTOR shall not go over a 1:20 staffing ratio.
3. CONTRACTOR will ensure that Clinical Supervisors oversee the work
of the Clinicians, including oversight of documentation and claiming in
the electronic medical record. Clinical Supervisors who provide
mentorship to Clinicians shall be two (2) years post licensure and able
to provide Board of Behavioral Sciences (BBS) supervision.
4. CONTRACTOR’s Clinicians must be post-graduate and registered with
their local licensing board.
5. Assessments must be completed by Licensed Practitioners of the
Healing Arts (LPHA), which includes both licensed mental health
professionals and registered associates.
6. Interns, including graduate student interns, may be utilized by
CONTRACTOR to provide case management-type services, including
ICC and IHBS.
7. CONTRACTOR’s clinical staff are required to go through the
credentialing process through DBH’s Managed Care Division. Interns
are required to go through the non-credentialing application process
through DBH’s Managed Care Division.
Exhibit B-1
Page 10 of 17
8. If CONTRACTOR has other agreements with COUNTY to provide
specialty mental health treatment services, it will establish criteria and
protocols via a Child and Family Team (CFT) meeting, to ensure referral
to services are therapeutically appropriate, benefits the client and
caregiver, achieves the client’s treatment goals, supports the success of
the CWS case plan, and avoids any potential for perceived or actual
conflict of interest or self-referral.
9. CONTRACTOR shall have established clinical competency standards
when hiring direct service staff and a staff development and training
program. CONTRACTOR will provide appropriate training for all staff to
include but not limited to trauma-informed practice, EBPs utilized,
working with specialized populations such as Infant Mental Health (IMH)
and Commercially Sexually Exploited Children (CSEC), and co-
occurring competence to serve individuals with mental health and
substance use/abuse disorders.
E. Affordable Care Act and Medi-Cal Managed Care Plan requirements
1. CONTRACTOR understands that effective January 1, 2014, Medi-Cal
managed care health plans (MCHPs) are required to serve Medi-Cal
beneficiaries with mild to moderate impairment of mental, emotional,
or behavioral functioning resulting from a mental health condition
defined by the current Diagnostic and Statistical Manual. Outpatient
benefits available through MCHPs include:
a. Individual and group mental health evaluation and treatment
(psychotherapy)
b. Psychological testing, when clinically indicated to evaluate a
mental health condition;
c. Outpatient services for the purposes of monitoring drug
therapy;
d. Psychiatric consultation; and
e. Outpatient laboratory, drugs, supplies and supplements
(excluding medications as described in the forthcoming “Medi-
Cal Managed Care Plan Responsibilities for Outpatient
Mental Health Services and Coordination with County Mental
Health Plans”).
2. CONTRACTOR will comply with all requirements established by the
California Department of Health Care Services (DHCS), Fresno County
MHP, and Medi-Cal MCHPs for screening, referral, and coordination of
care for mild to moderate cases, when clinically appropriate.
F. Administrative Requirements
1. CONTRACTOR shall meet with COUNTY staff monthly, or as often as
needed, for monitoring of program services, client capacity, staffing
Exhibit B-1
Page 11 of 17
levels and to exchange pertinent operational information, resolve
problems, and coordinate services.
2. CONTRACTOR shall participate in a joint meeting with COUNTY staff
and other vendors for CWMH services on a quarterly basis, or as often
as needed, to discuss program trends and resolution of concerns and
problems across all vendors.
3. CONTRACTOR shall attend bi-monthly Mental Health Contracted
Provider Meetings held by DBH.
4. CONTRACTOR will complete and submit monthly activity reports in a
manner determined by DBH and DSS.
5. CONTRACTOR will provide annual Civil Rights training to their staff in
the first quarter of every calendar year and will provide relevant proof to
DBH and DSS by April 1, for each year of the contract.
G. Data and Reporting
1. CONTRACTOR shall maintain and provide the COUNTY with monthly
statistics on the number of individuals/families to include, but not limited
to:
a. Number of clients referred for mental health assessments;
average time between referral and contact with caregiver;
average time between referral and assessment; number of
assessments completed, number of missed/no-show
appointments, number that did not meet Medi-Cal medical
necessity criteria;
b. Number of clients referred for court-ordered services
including type of service, average time between referral
and contact with the caregiver to schedule the
appointment, average number of days between the
referral and the court-ordered service, number of
missed/no-show appointments;
c. Average wait time between assessment and first visit with
assigned therapist;
d. Average wait time between referral and provision of
medication evaluation;
e. Unique clients served; units and dollars of services billed,
average cost per client;
f. Number and reasons for discharge from care;
Exhibit B-1
Page 12 of 17
g. Number of active clients in ongoing treatment;
This information, in addition to the outcome measures to be developed,
will be provided to COUNTY on a monthly basis via an activity report
template developed by the COUNTY and due no later than the 10th of
each month.
2. Maintain case files on each individual/family, including, but not limited to
the following information:
a. Documentation of referrals to/from COUNTY, self-referrals,
and others;
b. Chronological record of individual and family services
provided including relevant contact dates, incidents, actions
taken, and results; and,
c. Case closure summary, indicating the reasons for closure and
the results of the services provided.
3. CONTRACTOR shall maintain secure case files with limited access only
to designated staff to ensure confidentiality.
4. CONTRACTOR shall submit a monthly staffing report, due no later than
the 10th of each month, detailing the total number of positions by
classification in the approved budget, number of staff hired (including
licensure, ethnicity, bilingual language capability, clinical
training/certification in EBPs), and number of vacancies.
II. COUNTY SHALL BE RESPONSIBLE FOR THE FOLLOWING:
A. Provide mental health service referrals to CONTRACTOR for children and
families involved in the CWS system.
B. Designate a contact person from DSS and DBH for CONTRACTOR to
communicate with, when necessary.
C. Meet with CONTRACTOR monthly, or as often as needed, to exchange pertinent
information, resolve problems, and work together to coordinate referrals and
services.
D. Support coordination of ICC meetings initially and no less than every ninety (90)
days for a child/youth.
E. Convene team meetings in alignment with the Continuum of Care Reform (CCR),
Child and Family Teaming, Senate Bill 163 Wraparound, and the Integrated Core
Exhibit B-1
Page 13 of 17
Practice models for which CONTRACTOR will be required to participate when
appropriate.
F. Provide education and training on CWS, practice models and Medi-Cal licensing,
documentation and billing requirements, as needed.
III. PERFORMANCE MEASUREMENTS
Overall Service Objective:
CONTRACTOR will adhere to the outcome measures developed by COUNTY and any
requirements established by the California Department of Social Services (CDSS) and
DHCS. County may adjust these outcome measurements, periodically, so as to best
measure the success of the program. These outcome measurements and indicators will
continue to be developed in conjunction with the CONTRACTOR, COUNTY, and the
State Departments.
Services provided by the CONTRACTOR will align and support the principles of Fresno
County’s child welfare practice model, the Katie A Settlement Agreement, as well as other
relevant laws, regulations, statutes, and effective operating principles required to provide
the services. Specialty mental health services will be integrated, timely, ongoing, and
uninterrupted in a family-focused, trauma-informed delivery model that supports the goals
of the client plan developed by COUNTY. Intensive home-based mental health services
are expected to provide children and families in the CWS system with effective treatment,
improve outcomes, promote wellness, aid in resiliency, and maintain family relationships
conducive to healthy emotional development.
Performance Outcomes and Measures:
Under the Katie A. Settlement Agreement and Implementation Plan, DHCS and CDSS
are collectively working to adopt statewide use of a data-informed system of
performance oversight, accountability, and communication that efficiently monitors,
measures, and evaluates access, quality, satisfaction, effectiveness, costs, and
outcomes at the individual, program, and system levels.
CONTRACTOR is required to submit measureable outcomes on a semi-annual basis,
as identified in the DBH’s Policy and Procedure Guide (PPG) 1.2.7 Performance
Outcomes Measures. Performance outcome measures must be approved by DBH and
satisfy all State and local mandates. DBH will provide technical assistance and support
in defining measureable outcomes. All performance indicators will reflect the four (4)
domains identified by the Commission Accreditation of Rehabilitation Facilities (CARF).
DBH collects data about the characteristics of the persons served and measures service
delivery performance indicators in each of the following CARF domains.
A. Effectiveness - A performance dimension that assesses the degree to which
an intervention or series have achieved the desired outcome/result/quality of
Exhibit B-1
Page 14 of 17
care through measuring change over time. The results achieved and outcomes
observed are for persons served.
B. Efficiency - Relationship between results and resources used, such as time,
money, and staff. The demonstration of the relationship between results and
the resources used to achieve them. A performance dimension addressing the
relationship between the outputs/results of the resources used to deliver the
service.
C. Access - Organizations’ capacity to provide services to those who desire or
need services. Barriers or lack thereof for persons obtaining services. The
ability of clients to receive the right service at the right time. A performance
dimension addressing the degree to which a person needing services is able
to access those services.
D. Satisfaction - Satisfaction measures are usually oriented towards clients,
family, staff, and stakeholders. The degree to which the clients, the COUNTY,
and other stakeholders are satisfied with services. A performance dimension
that describes reports or ratings from persons served about services received
from an organization.
DBH may adjust the performance and outcome measures periodically throughout the
duration of the Agreement, as needed, to best measure the program as determined by
COUNTY. CONTRACTOR must utilize a computerized tracking system with which
performance and outcome measures and other relevant client data, such as
demographics, will be maintained.
The outcome measures and indicators provided below represent COUNTY DBH and DSS
program goals to be achieved by the CONTRACTOR in addition to CONTRACTOR’s
developed outcomes.
A. Timeliness of Service – CONTRACTOR will respond to referrals within the
timeframes required by the Final Rule, in order to engage with the clients as
soon as possible.
1. Timely access to services from referral to assessment.
a. Crisis referrals: within three (3) days
b. Standard referrals: within ten (10) days
c. Psychiatric referrals: within fifteen (15) days
2. 100% of all assessments will be signed/completed within thirty (30)
days.
3. Timely access to service from assessment to ongoing treatment
4. Timely access to services from referral to medication evaluation, when
appropriate
Exhibit B-1
Page 15 of 17
B. Access and Engagement – CONTRACTOR will ensure that clients have access
to treatment, that the client is actively involved in treatment, and that every
effort is made to aid the client in successfully completing treatment.
1. CONTRACTOR will provide services in a location determined by the
needs/preference of the client and clinical appropriateness. The
expectation is that 70% of client services will be provided in the home or
a community-based setting.
2. CONTRACTOR will track the number, type, and location of services per
client.
3. CONTRACTOR will actively provide ICC and IHBS services. The
expectation is that a minimum of fifteen percent (15%) of the
CONTRACTOR’s services will be IHBS.
4. Clinician attendance at 100% of teaming meetings.
5. CONTRACTOR will track the “no-show” and cancellation (by client or
provider) rates for treatment. The expectation is that the “no-show” and
cancellation rates will be ten percent (10%) or less.
6. CONTRACTOR will track the number and reasons for discharge. The
expectation is that there will be a low number of discharges due to “no-
shows” and a low number of discharges in which the client has not
successfully completed treatment.
7. Seventy percent (70%) of individuals with an open child welfare case will
successfully complete treatment.
C. Wellness, Recovery, and Resiliency Supports – a collaborative approach to
treatment strategies to aid in the successful completion of treatment,
reunification, and reduction in recidivism.
1. Improved Child Functioning
Improvement in relationships, behavior, and academic achievements,
as demonstrated through the tracking tools, CANS 50 and PSC-35,
implemented by the CONTRACTOR and caregivers, respectively.
2. Improved Family Functioning
Improvement in ability to provide for and maintain a safe and stable
environment for the child, as demonstrated through tracking tool, CANS
50, implemented by the CONTRACTOR.
Exhibit B-1
Page 16 of 17
3. Improved Parent Functioning
Improvement in relationships, behavior, and sustaining basic needs, as
demonstrated through tracking tool, CANS 50, implemented by the
CONTRACTOR.
4. Effectiveness of discharge planning as demonstrated by referral and
linkage to other COUNTY programs, community providers, and
community resources.
5. Placement, Stability, & Permanency
a. Number of placement changes while in treatment
b. Permanency status of clients
IV. Cultural Competency
In alignment with the County’s DBH Mental Health Services Act Three-Year Plan, Mental
Health Plan, and Cultural Competency Plan, CONTRACTOR shall provide culturally
competent and culturally responsive services. CONTRACTOR’s responsibilities shall
include:
A. Mental Health and Substance Use Disorder direct service providers must
complete eight (8) hours of annual cultural competency training. Training hours
may include completing culturally competent courses through DBH Learning
Management System or attending cultural awareness events. DBH will provide
opportunities and track completion of training hours through its Learning
Management System.
B. When providing interpretation services for DBH clients, CONTRACTOR must
utilize interpreters who have received annual training and have been monitored
for language competence. By July 1st of each year, CONTRACTOR shall
provide DBH with its current list of interpreters, which includes training dates
and monitoring results. CONTRACTOR shall not utilize any interpreter who
has not received annual training and/or has not demonstrated language
competence. CONTRACTOR shall have access to DBH approved translators
via DBH’s established protocol.
C. In order for DBH to ensure a cultural, racial/ethnic, and linguistic group of direct
service providers representative of the population needing services and being
served, CONTRACTOR shall complete and email the Monthly Staffing Report,
which includes gender, ethnicity, and bilingual language capacity by the tenth
(10th) of every month.
D. CONTRACTOR shall provide a plan to address cultural competency standards
as set forth in the National Standards on Culturally and Linguistically
Appropriate Services (CLAS).
Exhibit B-1
Page 17 of 17
E. CONTRACTOR shall provide services within the most relevant and meaningful
cultural, gender-sensitive, and age-appropriate context for the target
population.
F. CONTRACTOR shall distribute literature/information brochures in appropriate
languages and request feedback as to how access to care could be improved
for culturally diverse communities. Distributed information will be approved by
DBH and/or DSS designee and translated as needed via DBH protocols.
Exhibit B-2
Page 1 of 17
CHILD WELFARE MENTAL HEALTH (CWMH)
SUMMARY OF SERVICES
ORGANIZATION: Central Star Behavioral Health, Inc.
ADDRESS: 1501 Hughes Way, Suite 150
Long Beach, CA 90810
TELEPHONE: (310) 221-6336 (x125)
CONTACT PERSON: Kent Dunlap, Senior Vice President
CONTRACT PERIOD: July 1, 2019 – June 30, 2022
with two (2) optional twelve (12) month renewals
CONTRACT AMOUNT: $4,750,000 (July 1, 2019 – June 30, 2020);
$4,750,000 (July 1, 2020 – June 30, 2021);
$4,750,000 (July 1, 2021 – June 30, 2022);
$4,750,000 (July 1, 2022 – June 30, 2023)
$4,750,000 (July 1, 2023 – June 30, 2024)
SUMMARY OF SERVICES:
Central Star Behavioral Health, Inc., henceforth referred to as CONTRACTOR, will be
responsible for providing medically necessary outpatient specialty mental health services
for children, youth, and their parents who meet medical necessity, as well as court-
specific services to children and families involved in Fresno County’s Child Welfare
Services (CWS) system. The majority of outpatient specialty mental health services, such
as assessments, plan development, therapy, rehabilitation services, crisis intervention,
case management, intensive home-based services and intensive care coordination are
expected to be community-based and provided in the family’s home or in the community,
whenever possible.
SCHEDULE OF SERVICES:
The CONTRACTOR’s office(s) shall be open Monday through Friday, 9:00am to 5:00pm.
Clinicians (Mental Health Specialists) will be available to see clients and families for in-
home and community-based appointments during the day, weekend, and evening hours,
up to 8:00 pm. Group services will be provided during the day and evening hours, up to
8:00 pm, on a scheduled basis, at CONTRACTOR’s offices. The CONTRACTOR’s office
will be located at a site in the metropolitan and/or rural community that offers public
transportation in close proximity, adequate parking, and a secure setting. In addition to
the Fresno metropolitan area, CONTRACTOR shall serve the rural areas of Fresno
County as needed. Any addition or change to the location of office-based services must
be approved by the COUNTY in advance of such a change.
Exhibit B-2
Page 2 of 17
TARGET POPULATION:
CONTRACTOR shall provide specialty mental health services to all referred children,
youth, parents, guardians, and foster parents involved with a child’s CWS case. The
target population includes children and youth as referred to in the Katie A. Settlement
Agreement as members of the “class” and “subclass.”
1. Katie A. “Class” is defined as children in California who:
A. Are in foster care or are at imminent risk of foster care placement, and
B. Have a mental illness or condition that has been documented or had an
assessment already conducted, and
C. Need individualized mental health services, including but not limited to,
mental health assessments, outpatient specialty mental health services,
case management services, family support, crisis intervention, and other
medically necessary services in the home or in a home-like setting, to treat
mental illness or condition.
Imminent Risk of foster care placement means that within the last 180 days a child has
been participating in voluntary family maintenance or family reunification services and/or
has been the subject of either a telephone call to the Child Protective Services hotline or
some other documented communication made to a local Child Protective Services agency
regarding suspicions of abuse, neglect or abandonment.
Members of this class include children living with their parents, relatives, or in any variety
of placements, such as group homes, short-term residential therapeutic programs
(STRTPs), or foster homes.
2. “Katie A. Subclass” is identified as children in California who:
A. Have an open CWS case; and
B. Are full-scope Medi-Cal (Title XIX) eligible; and
C. Meet the medical necessity criteria for Medi-Cal Outpatient Specialty Mental
Health Services (SMHS) as set forth in CCR, Title 9, Section 1830.205 or
Section 1830.210; and
D. Are currently in or being considered for a Wraparound program, Therapeutic
Foster Care, or specialized care rate due to behavioral health needs or
other intensive Early and Periodic Screening Diagnostic and Treatment
(EPSDT) services, including but not limited to Therapeutic Behavioral
Services or crisis stabilization/intervention; or
E. Are currently in or being considered for placement in a group home (Rate
Classification 10 or above) or STRTP, psychiatric hospital, 24-hour mental
health treatment facility (e.g., psychiatric inpatient hospital, community
Exhibit B-2
Page 3 of 17
residential treatment facility); or has experienced three (3) or more
placements within 24 months due to behavioral health needs.
I. CONTRACTOR SHALL BE RESPONSIBLE FOR THE FOLLOWING SERVICES:
A. Referrals and Engagement
1. CONTRACTOR will provide an array of outpatient specialty mental
health services to all referrals received from the Department of
Behavioral Health’s (DBH) CWMH Team. CONTRACTOR shall accept
the adequate number of referrals to meet CWMH demand and to cover
program costs. Referral priority is determined by the CWMH Team and
assessments should be completed within the following designated
timeframes:
a. Crisis Referrals – Three (3) days
b. Standard Referrals – Ten (10) days
c. Psychiatric Referrals – Fifteen (15) days
2. CONTRACTOR shall make every attempt to engage clients in service.
CONTRACTOR is expected to make at least four (4) contact attempts
(in-person or via phone), at minimum one (1) attempt each week, over
the course of thirty (30) days and then send a letter to the client if
CONTRACTOR is still unable to engage them in services.
CONTRACTOR must also maintain regular contact with DSS Social
Workers, Supervisors, and Program Managers if they are unable to
contact or engage a client. If still unable to reach client, CONTRACTOR
must submit a Notice of Action to Managed Care and the CWMH Team.
A Notice of Action is not required if the referral packet received by
CONTRACTOR is incomplete.
B. Outpatient Specialty Mental Health Services
1. CONTRACTOR shall provide the following specialty mental health
services for the appropriate duration, frequency, and intensity based
upon the needs of the individual receiving services, as determined to be
clinically appropriate by a licensed/waivered mental health clinician and
the fidelity of the therapeutic intervention provided. It is understood that
a child who meets the definition of “Katie A. Subclass” does not, in and
of itself, require a higher level or intensity of mental health treatment
absent a clinical determination by the treating mental health clinician:
a. Mental Health Assessments
Clinical analysis of the history and current status of a
beneficiary’s mental, emotional, or behavioral disorder;
relevant cultural issues and history; diagnosis; and use of
testing procedures. A comprehensive assessment shall be
completed by a designated licensed or registered/waivered
Exhibit B-2
Page 4 of 17
staff within thirty (30) days from the initial contact date. When
a person remains in continuous services, an update/re-
assessment shall be completed at least every two (2) years.
The clinician may complete a comprehensive assessment
instead of an update/re-assessment if it is determined to be
the more appropriate clinical decision for the person served.
Additionally, current State mandates require that the CANS-
50 and PSC-35 are part of the assessment at the beginning
of treatment and are administered every six (6) months and at
the end of treatment. These will be shared with the Child and
Family Team (CFT). If a current assessment has been
completed by another CFT team member, it will be accepted
in lieu of an assessment completed by the clinician.
b. Therapy
A therapeutic intervention that focuses primarily on symptom
reduction as a means to improve functional impairments.
Therapy may be delivered to an individual or group of
beneficiaries (see below) and may include family therapy at
which the beneficiary is present.
1) Individual
2) Collateral
3) Conjoint
4) Family therapy
5) Group therapy
i. Groups will be led by clinicians and
supervised by a licensed clinician. Larger
groups may be co-facilitated by two (2)
unlicensed clinicians. Licensed Clinical
Supervisors will provide in-vivo training, co-
facilitation and supervision to ensure group
facilitation is high quality, clinically effective,
and appropriate.
c. Crisis Intervention
A service lasting less than 24 hours, to or on behalf of a
beneficiary, for a condition which requires more timely
response than a regularly scheduled visit. Activities may
include, but are not limited to, assessment, therapy and
service access to any significant support person in the
beneficiary’s life with the intent of improving or maintaining the
mental health status of the beneficiary.
d. Case Management
Any service that assists a beneficiary to access needed
medical, educational, social, prevocational, vocational,
rehabilitative, or other community service. Services may
Exhibit B-2
Page 5 of 17
include, but are not limited to, communication, coordination,
and referral to available resources. CONTRACTOR will be
responsible for monitoring service delivery to beneficiary by
third parties, beneficiary progress, and plan development.
e. Rehabilitation
Any activity that seeks to improve, maintain, or restore a
beneficiary’s functional, daily living, social, leisure, grooming,
personal hygiene, and meal preparation skills while also
providing access to support resources and medication
education.
f. Plan Development
The development of individual treatment plans, approval of
said treatment plans, and/or monitoring of a beneficiary’s
progress.
g. Medication Support
Any service that includes prescribing, administering,
dispensing, and monitoring psychiatric medications or
biologicals, which are necessary to alleviate the symptoms of
mental illness. Services may also include evaluation for the
need of medication, evaluation of clinical effectiveness and
side effects, obtaining informed consent, medication
education and plan development related to the delivery of the
service, and/or assessment of the beneficiary.
CONTRACTOR shall have a plan in place to ensure
medication support coverage, in the event that the
Psychiatrist is unavailable to provide services for an extended
period of time.
2. CONTRACTOR shall be responsible to provide and appropriately bill for
the following services for referred clients, including Katie A. Subclass
members, if medically necessary and provided within the California
Integrated Core Practice Model and Pathways to Mental Health Core
Practice Model, and in accordance with the “Medi-Cal Manual for
Intensive Care Coordination (ICC), Intensive Home-Based Services
(IHBS) & Therapeutic Foster Care (TFC) for Medi-Cal Beneficiaries”:
a. IHBS may include, but are not limited to:
1) Skill-based interventions for the remediation of behaviors
or improvement of symptoms;
2) Development of functional skills to improve self-care, self-
regulation, or other functional impairments by intervening
to decrease or replace non-functional behavior that
interferes with daily living tasks or the avoidance of
exploitation by others;
Exhibit B-2
Page 6 of 17
3) Development of skills or replacement behaviors that allow
the child/youth to fully participate in the teaming process
and service plans including but not limited to the treatment
plan and/or child welfare case plan;
4) Improvement in self-management of symptoms, including
self-administration of medications, as appropriate;
5) Education of the child/youth and/or their family or
caregiver(s) about how to manage the child/youth’s mental
health disorder or symptoms;
6) Support of the development, maintenance and use of
social networks, including the use of natural and
community resources;
7) Support to address behaviors that interfere with the
achievement of a stable and permanent family life;
8) Support to address behaviors that interfere with seeking
and maintaining a job, if applicable;
9) Support to address behaviors that interfere with a
child/youth’s success in achieving educational objectives.
b. IHBS can be provided by more than one (1) agency when
multiple agencies are serving a client. A minimum of 15% of
all services provided by CONTRACTOR must be IHBS. It is
expected that CONTRACTOR will provide IHBS, unless
clinical justification is provided. Clinical justification must be
documented in the client’s mental health record (this will be
reviewed and audited by the COUNTY).
c. CONTRACTOR is required to attend ICC meetings and any
teaming processes scheduled by other agencies, CWS, or by
the DBH CWMH Team to ensure coordination of all mental
health treatment services that may involve one (1) or more
provider agencies, no less than every ninety (90) days for the
child/youth.
d. ICC service components/activities include comprehensive
assessment and periodic reassessment, development and
periodic revision of the plan, referral, monitoring, follow-up
activities, and transition.
3. CONTRACTOR will be responsible for providing services in either an
office-based or community-based setting. The location of service
delivery will be determined based on the needs of the client, preference
of the client, and clinical appropriateness. Based on current data, clients
prefer or require that their services are provided in a community-based
setting. The expectation is that, at minimum, 70% of all
CONTRACTOR’s client services will be provided in the home or a
community-based setting. Location of service delivery should be
clinically justified and documented in the client record.
Exhibit B-2
Page 7 of 17
4. CONTRACTOR will be responsible to work cooperatively and
collaboratively with CWS staff, DBH staff, CWMH Team staff, and all
treatment providers, caregivers, and Foster Family Agencies to achieve
the individual and collective treatment goals. Providers are to support
the CWS case plan, communicate/resolve barriers to care, and provide
continuity and warm hand-offs whenever possible as individuals
transition from higher to lower or lower to higher levels of care within or
outside of Fresno County.
5. CONTRACTOR will be able to refer to other Fresno County Mental
Health Plan (MHP) providers, Managed Care Medi-Cal Health Plans,
and other community providers as may be appropriate and in
concurrence with the DBH CWMH Team. CONTRACTOR shall provide
case management services until client is properly linked with another
provider.
6. CONTRACTOR must use evidence-based practices (EBPs) found
effective in serving this target population. This includes the provision of
training, ongoing sustainability and fidelity to a core competency for
CONTRACTOR’s mental health clinicians. To date, CONTRACTOR
and COUNTY have agreed upon the provision of the following evidence-
based practices:
a. Motivational Interviewing (MI)
b. Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)
c. Dialectical Behavioral Therapy (DBT)
d. Triple P Positive Parenting Program (Triple P)
e. Alternatives for Families Cognitive Behavioral Therapy (AF-
CBT)
f. Seeking Safety
Any additional evidence-based practices CONTRACTOR would like to
utilize will require review and consultation with COUNTY.
COUNTY requires CONTRACTOR to ensure their staff pursue
certification/accreditation in the agreed upon evidence-based practices,
as appropriate, during the first year term, and demonstrate to COUNTY
that they are moving toward successful completion. CONTRACTOR is
required to explain in writing their plan to require/support staff in this
regard, and their expected timeframe for completion of the
certification/accreditation process within the first year term.
C. Court-Specific Mental Health Services
1. CONTRACTOR will provide the following court-ordered mental health
services to children and families in CWS:
Exhibit B-2
Page 8 of 17
a. Court-Ordered Mental Health Assessments
Clinical analysis of the history and current status of an
individual’s mental, emotional, or behavioral disorder; relevant
cultural issues and history; diagnosis; and use of testing
procedures.
b. Psychological and Neuropsychological Evaluations
A structured, analytical interview with the individual (i.e.,
minor, parent, or guardian) which consists of a clinical
assessment, the use of testing instruments, a mental status
examination, and a clinical diagnosis (as defined/ruled out
using the ICD-10) that is performed only by a Licensed
Psychologist with at least five (5) years of postgraduate
experience. Services also include a review of CPS and
mental health services received to date and contact with
relevant others, as necessary. A second psychological or
neuropsychological evaluation may be ordered and must be
performed by a different Licensed Psychologist and
independent of the first evaluation.
c. Bonding Studies
A structured, forensic, analytic interview that includes a
mental health assessment (in order to define or rule out
clinical diagnosis using the ICD-10) for either parent(s) or
whomever has been identified by the court to participate in the
study, and the child(ren). The study includes assessment of
the interaction between the parent(s) and the child(ren) and
may include the use of testing instruments (as needed) to
more accurately gauge the strength of the bond between
parent and child. It may also include the current care
provider(s) or prospective adoptive parent(s) when ordered by
the court. These studies are to be performed only by a
Licensed Mental Health Clinician with appropriate experience
or a Waivered Psychologist working under a qualified
Licensed Psychologist. A qualified clinician will have
completed twenty (20) hours of training in Child Custody as
required by the California Board of Psychology (if the child is
0-36 months), training in the Marshak Interaction Method, and
training or experience in providing forensic evaluations for the
court.
d. Court Reports And Court Testimony
CONTRACTOR is responsible for any court reports and/or
necessary testimony.
Exhibit B-2
Page 9 of 17
1) Court Reports
Documented report of assessment and evaluation
findings, progress in treatment, recommendations for
treatment, and service plan regarding reunification,
maintenance and termination of parental rights, and
justification for recommendations. CONTRACTOR
shall provide the DBH CWMH Team with a copy of the
reports, for tracking purposes.
2) Court Testimony
On-site court testimony of assessment and evaluation
findings, treatment and service plan
recommendations regarding reunification,
maintenance and termination of parental rights, and
justification for recommendations.
D. Staffing
1. CONTRACTOR shall ensure staff are qualified in education, experience,
and clinical competencies.
2. CONTRACTOR shall maintain adequate staffing levels in relation to the
number of open client cases at any given point to ensure quality service.
CONTRACTOR shall not go over a 1:20 staffing ratio.
3. CONTRACTOR will ensure that Clinical Supervisors oversee the work
of the Clinicians, including oversight of documentation and claiming in
the electronic medical record. Clinical Supervisors who provide
mentorship to Clinicians shall be two (2) years post licensure and able
to provide Board of Behavioral Sciences (BBS) supervision.
4. CONTRACTOR’s Clinicians must be post-graduate and registered with
their local licensing board.
5. Assessments must be completed by Licensed Practitioners of the
Healing Arts (LPHA), which includes both licensed mental health
professionals and registered associates.
6. Interns, including graduate student interns, may be utilized by
CONTRACTOR to provide case management-type services, including
ICC and IHBS.
7. CONTRACTOR’s clinical staff are required to go through the
credentialing process through DBH’s Managed Care Division. Interns
are required to go through the non-credentialing application process
through DBH’s Managed Care Division.
Exhibit B-2
Page 10 of 17
8. If CONTRACTOR has other agreements with COUNTY to provide
specialty mental health treatment services, it will establish criteria and
protocols via a Child and Family Team (CFT) meeting, to ensure referral
to services are therapeutically appropriate, benefits the client and
caregiver, achieves the client’s treatment goals, supports the success of
the CWS case plan, and avoids any potential for perceived or actual
conflict of interest or self-referral.
9. CONTRACTOR shall have established clinical competency standards
when hiring direct service staff and a staff development and training
program. CONTRACTOR will provide appropriate training for all staff to
include but not limited to trauma-informed practice, EBPs utilized,
working with specialized populations such as Infant Mental Health (IMH)
and Commercially Sexually Exploited Children (CSEC), and co-
occurring competence to serve individuals with mental health and
substance use/abuse disorders.
E. Affordable Care Act and Medi-Cal Managed Care Plan requirements
1. CONTRACTOR understands that effective January 1, 2014, Medi-Cal
managed care health plans (MCHPs) are required to serve Medi-Cal
beneficiaries with mild to moderate impairment of mental, emotional,
or behavioral functioning resulting from a mental health condition
defined by the current Diagnostic and Statistical Manual. Outpatient
benefits available through MCHPs include:
a. Individual and group mental health evaluation and treatment
(psychotherapy)
b. Psychological testing, when clinically indicated to evaluate a
mental health condition;
c. Outpatient services for the purposes of monitoring drug
therapy;
d. Psychiatric consultation; and
e. Outpatient laboratory, drugs, supplies and supplements
(excluding medications as described in the forthcoming “Medi-
Cal Managed Care Plan Responsibilities for Outpatient
Mental Health Services and Coordination with County Mental
Health Plans”).
2. CONTRACTOR will comply with all requirements established by the
California Department of Health Care Services (DHCS), Fresno County
MHP, and Medi-Cal MCHPs for screening, referral, and coordination of
care for mild to moderate cases, when clinically appropriate.
Exhibit B-2
Page 11 of 17
F. Administrative Requirements
1. CONTRACTOR shall meet with COUNTY staff monthly, or as often as
needed, for monitoring of program services, client capacity, staffing
levels and to exchange pertinent operational information, resolve
problems, and coordinate services.
2. CONTRACTOR shall participate in a joint meeting with COUNTY staff
and other vendors for CWMH services on a quarterly basis, or as often
as needed, to discuss program trends and resolution of concerns and
problems across all vendors.
3. CONTRACTOR shall attend bi-monthly Mental Health Contracted
Provider Meetings held by DBH.
4. CONTRACTOR will provide complete and submit monthly activity
reports in a manner determined by DBH and DSS.
5. CONTRACTOR will provide annual Civil Rights training to their staff in
the first quarter of every calendar year and will provide relevant proof to
DBH and DSS by April 1, for each year of the contract.
G. Data and Reporting
1. CONTRACTOR shall maintain and provide the COUNTY with monthly
statistics on the number of individuals/families to include, but not limited
to:
a. Number of clients referred for mental health assessments;
average time between referral and contact with caregiver;
average time between referral and assessment; number of
assessments completed, number of missed/no-show
appointments, number that did not meet Medi-Cal medical
necessity criteria;
b. Number of clients referred for court-ordered services
including type of service, average time between referral
and contact with the caregiver to schedule the
appointment, average number of days between the
referral and the court-ordered service, number of
missed/no-show appointments;
c. Average wait time between assessment and first visit with
assigned therapist;
d. Average wait time between referral and provision of
medication evaluation;
Exhibit B-2
Page 12 of 17
e. Unique clients served; units and dollars of services billed,
average cost per client;
f. Number and reasons for discharge from care;
g. Number of active clients in ongoing treatment;
This information, in addition to the outcome measures to be developed,
will be provided to COUNTY on a monthly basis via an activity report
template developed by the COUNTY and due no later than the 10th of
each month.
2. Maintain case files on each individual/family, including, but not limited to
the following information:
a. Documentation of referrals to/from COUNTY, self-referrals,
and others;
b. Chronological record of individual and family services
provided including relevant contact dates, incidents, actions
taken, and results; and,
c. Case closure summary, indicating the reasons for closure and
the results of the services provided.
3. CONTRACTOR shall maintain secure case files with limited access only
to designated staff to ensure confidentiality.
4. CONTRACTOR shall submit a monthly staffing report, due no later than
the 10th of each month, detailing the total number of positions by
classification in the approved budget, number of staff hired (including
licensure, ethnicity, bilingual language capability, clinical
training/certification in EBPs), and number of vacancies.
II. COUNTY SHALL BE RESPONSIBLE FOR THE FOLLOWING:
A. Provide mental health service referrals to CONTRACTOR for children and
families involved in the CWS system.
B. Designate a contact person from DBH and DSS for CONTRACTOR to
communicate with, when necessary.
C. Meet with CONTRACTOR monthly, or as often as needed, to exchange pertinent
information, resolve problems, and work together to coordinate referrals and
services.
Exhibit B-2
Page 13 of 17
D. Support coordination of ICC meetings initially and no less than every ninety (90)
days for a child/youth.
E. Convene team meetings in alignment withthe Continuum of Care Reform (CCR),
Child and Family Teaming, Senate Bill 163 Wraparound, and the Integrated Core
Practice models for which CONTRACTOR will be required to participate when
appropriate.
F. Provide education and training on CWS, practice models and Medi-Cal licensing,
documentation and billing requirements, as needed.
III. PERFORMANCE MEASUREMENTS
Overall Service Objective:
CONTRACTOR will adhere to the outcome measures developed by COUNTY and any
requirements established by the California Department of Social Services (CDSS) and
DHCS. County may adjust these outcome measurements, periodically, so as to best
measure the success of the program. These outcome measurements and indicators will
continue to be developed in conjunction with the CONTRACTOR, COUNTY, and the
State Departments.
Services provided by the CONTRACTOR will align and support the principles of Fresno
County’s child welfare practice model, the Katie A Settlement Agreement, as well as other
relevant laws, regulations, statutes, and effective operating principles required to provide
the services. Specialty mental health services will be integrated, timely, ongoing, and
uninterrupted in a family-focused, trauma-informed delivery model that supports the goals
of the client plan developed by COUNTY. Intensive home-based mental health services
are expected to provide children and families in the CWS system with effective treatment,
improve outcomes, promote wellness, aid in resiliency, and maintain family relationships
conducive to healthy emotional development.
Performance Outcomes and Measures:
Under the Katie A. Settlement Agreement and Implementation Plan, DHCS and CDSS
are collectively working to adopt statewide use of a data-informed system of
performance oversight, accountability, and communication that efficiently monitors,
measures, and evaluates access, quality, satisfaction, effectiveness, costs, and
outcomes at the individual, program, and system levels.
CONTRACTOR is required to submit measureable outcomes on a semi-annual basis,
as identified in the DBH’s Policy and Procedure Guide (PPG) 1.2.7 Performance
Outcomes Measures. Performance outcome measures must be approved by DBH and
satisfy all State and local mandates. DBH will provide technical assistance and support
in defining measureable outcomes. All performance indicators will reflect the four (4)
domains identified by the Commission Accreditation of Rehabilitation Facilities (CARF).
Exhibit B-2
Page 14 of 17
DBH collects data about the characteristics of the persons served and measures service
delivery performance indicators in each of the following CARF domains.
A. Effectiveness - A performance dimension that assesses the degree to which
an intervention or series have achieved the desired outcome/result/quality of
care through measuring change over time. The results achieved and outcomes
observed are for persons served.
B. Efficiency - Relationship between results and resources used, such as time,
money, and staff. The demonstration of the relationship between results and
the resources used to achieve them. A performance dimension addressing the
relationship between the outputs/results of the resources used to deliver the
service.
C. Access - Organizations’ capacity to provide services to those who desire or
need services. Barriers or lack thereof for persons obtaining services. The
ability of clients to receive the right service at the right time. A performance
dimension addressing the degree to which a person needing services is able
to access those services.
D. Satisfaction - Satisfaction Measures are usually oriented towards clients,
family, staff, and stakeholders. The degree to which the clients, the COUNTY,
and other stakeholders are satisfied with services. A performance dimension
that describes reports or ratings from persons served about services received
from an organization.
DBH may adjust the performance and outcome measures periodically throughout the
duration of the Agreement, as needed, to best measure the program as determined by
the COUNTY. CONTRACTOR must utilize a computerized tracking system with which
performance and outcome measures and other relevant client data, such as
demographics, will be maintained.
The outcome measures and indicators provided below represent COUNTY DBH and DSS
program goals to be achieved by the CONTRACTOR in addition to CONTRACTOR’s
developed outcomes.
A. Timeliness of Service – CONTRACTOR will respond to referrals within the
timeframes required by the Final Rule, in order to engage with the clients as
soon as possible.
1. Timely access to services from referral to assessment.
a. Crisis referrals: within three (3) days
b. Standard referrals: within ten (10) days
c. Psychiatric referrals: within fifteen (15) days
2. 100% of all assessments will be signed/completed within thirty (30)
days.
Exhibit B-2
Page 15 of 17
3. Timely access to service from assessment to ongoing treatment
4. Timely access to services from referral to medication evaluation, when
appropriate
B. Access and Engagement – CONTRACTOR will ensure that clients have access
to treatment, that the client is actively involved in treatment, and that every
effort is made to aid the client in successfully completing treatment.
1. CONTRACTOR will provide services in a location determined by the
needs/preference of the client and clinical appropriateness. The
expectation is that 70% of client services will be provided in the home or
a community-based setting.
2. CONTRACTOR will track the number, type, and location of services per
client.
3. CONTRACTOR will actively provide ICC and IHBS services. The
expectation is that a minimum of fifteen percent (15%) of
CONTRACTOR’s services will be IHBS.
4. Clinician attendance at 100% of teaming meetings.
5. CONTRACTOR will track the “no-show” and cancellation (by client or
provider) rates for treatment. The expectation is that the “no-show” and
cancellation rates will be ten percent (10%) or less.
6. CONTRACTOR will track the number and reasons for discharge. The
expectation is that there will be a low number of discharges due to “no-
shows” and a low number of discharges in which the client has not
successfully completed treatment.
7. Seventy percent (70%) of individuals with an open child welfare case will
successfully complete treatment.
C. Wellness, Recovery, and Resiliency Supports – a collaborative approach to
treatment strategies to aid in the successful completion of treatment,
reunification, and reduction in recidivism.
1. Improved Child Functioning
Improvement in relationships, behavior, and academic achievements,
as demonstrated through the tracking tools, CANS 50 and PSC-35,
implemented by the CONTRACTOR and caregivers, respectively.
Exhibit B-2
Page 16 of 17
2. Improved Family Functioning
Improvement in ability to provide for and maintain a safe and stable
environment for the child, as demonstrated through tracking tool, CANS
50, implemented by the CONTRACTOR.
3. Improved Parent Functioning
Improvement in relationships, behavior, and sustaining basic needs, as
demonstrated through tracking tool, CANS 50, implemented by the
CONTRACTOR.
4. Effectiveness of discharge planning as demonstrated by referral and
linkage to other COUNTY programs, community providers, and
community resources.
5. Placement, Stability, & Permanency
a. Number of placement changes while in treatment
b. Permanency status of clients
IV. Cultural Competency
In alignment with the County’s DBH Mental Health Services Act Three-Year Plan, Mental
Health Plan, and Cultural Competency Plan, CONTRACTOR shall provide culturally
competent and culturally responsive services. CONTRACTOR’s responsibilities shall
include:
A. Mental Health and Substance Use Disorder direct service providers must
complete eight (8) hours of annual cultural competency training. Training hours
may include completing culturally competent courses through DBH Learning
Management System or attending cultural awareness events. DBH will provide
opportunities and track completion of training hours through its Learning
Management System.
B. When providing interpretation services for DBH clients, CONTRACTOR must
utilize interpreters who have received annual training and have been monitored
for language competence. By July 1st of each year, CONTRACTOR shall
provide DBH with its current list of interpreters, which includes training dates
and monitoring results. CONTRACTOR shall not utilize any interpreter who
has not received annual training and/or has not demonstrated language
competence. CONTRACTOR shall have access to DBH approved translators
via DBH’s established protocol.
C. In order for DBH to ensure a cultural, racial/ethnic, and linguistic group of direct
service providers representative of the population needing services and being
served, CONTRACTOR shall complete and email the Monthly Staffing Report,
which includes gender, ethnicity, and bilingual language capacity by the tenth
(10th) of every month.
Exhibit B-2
Page 17 of 17
D. CONTRACTOR shall provide a plan to address cultural competency standards
as set forth in the National Standards on Culturally and Linguistically
Appropriate Services (CLAS).
E. CONTRACTOR shall provide services within the most relevant and meaningful
cultural, gender-sensitive, and age-appropriate context for the target
population.
F. CONTRACTOR shall distribute literature/information brochures in appropriate
languages and request feedback as to how access to care could be improved
for culturally diverse communities. Distributed information will be approved by
DBH and/or DSS designee and translated as needed via DBH protocols.
Exhibit B-3
Page 1 of 17
CHILD WELFARE MENTAL HEALTH (CWMH)
SUMMARY OF SERVICES
ORGANIZATION: Uplift Family Services
ADDRESS: 251 Llewellyn Avenue
Campbell, CA 95008
TELEPHONE: (408) 379-3790
CONTACT PERSON: Marilyn Bamford, Executive Director, Central Region
CONTRACT PERIOD: July 1, 2019 – June 30, 2022
with two (2) optional twelve (12) month renewals
CONTRACT AMOUNT: $4,750,000 (July 1, 2019 – June 30, 2020);
$4,873,500 (July 1, 2020 – June 30, 2021);
$5,000,211 (July 1, 2021 – June 30, 2022);
$5,130,216 (July 1, 2022 – June 30, 2023)
$5,263,602 (July 1, 2023 – June 30, 2024)
SUMMARY OF SERVICES:
Uplift Family Services, henceforth referred to as CONTRACTOR, will be responsible for
providing medically necessary outpatient specialty mental health services for children,
youth, and their parents who meet medical necessity, as well as court-specific services
to children and families involved in Fresno County’s Child Welfare Services (CWS)
system. The majority of outpatient specialty mental health services, such as
assessments, plan development, therapy, rehabilitation services, crisis intervention, case
management, intensive home-based services and intensive care coordination are
expected to be community-based and provided in the family’s home or in the community,
whenever possible.
SCHEDULE OF SERVICES:
The CONTRACTOR’s office(s) shall be open Monday through Friday, 8:00am to 5:00pm.
Clinicians will be available to see clients and families for in-home and community-based
appointments during the day, weekend, and evening hours, up to 8:00 pm. Group
services will be provided during the day and evening hours, up to 8:00 pm, on a scheduled
basis, at CONTRACTOR’s offices. The CONTRACTOR’s office will be located at a site
in the metropolitan and/or rural community that offers public transportation in close
proximity, adequate parking, and a secure setting. In addition to the Fresno metropolitan
area, CONTRACTOR shall serve the rural areas of Fresno County as needed. Any
addition or change to the location of office-based services must be approved by the
COUNTY in advance of such a change.
Exhibit B-3
Page 2 of 17
TARGET POPULATION:
CONTRACTOR shall provide specialty mental health services to all referred children,
youth, parents, guardians, and foster parents involved with a child’s CWS case. The
target population includes children and youth as referred to in the Katie A. Settlement
Agreement as members of the “class” and “subclass.”
1. Katie A. “Class” is defined as children in California who:
A. Are in foster care or are at imminent risk of foster care placement, and
B. Have a mental illness or condition that has been documented or had an
assessment already conducted, and
C. Need individualized mental health services, including but not limited to,
mental health assessments, outpatient specialty mental health services,
case management services, family support, crisis intervention, and other
medically necessary services in the home or in a home-like setting, to treat
mental illness or condition.
Imminent Risk of foster care placement means that within the last 180 days a child has
been participating in voluntary family maintenance or family reunification services and/or
has been the subject of either a telephone call to the Child Protective Services hotline or
some other documented communication made to a local Child Protective Services agency
regarding suspicions of abuse, neglect or abandonment.
Members of this class include children living with their parents, relatives, or in any variety
of placements, such as group homes, short-term residential therapeutic programs
(STRTPs), or foster homes.
2. “Katie A. Subclass” is identified as children in California who:
A. Have an open CWS case; and
B. Are full-scope Medi-Cal (Title XIX) eligible; and
C. Meet the medical necessity criteria for Medi-Cal Outpatient Specialty Mental
Health Services (SMHS) as set forth in CCR, Title 9, Section 1830.205 or
Section 1830.210; and
D. Are currently in or being considered for a Wraparound program, Therapeutic
Foster Care, or specialized care rate due to behavioral health needs or
other intensive Early and Periodic Screening Diagnostic and Treatment
(EPSDT) services, including but not limited to Therapeutic Behavioral
Services or crisis stabilization/intervention; or
E. Are currently in or being considered for placement in a group home (Rate
Classification 10 or above) or STRTP, psychiatric hospital, 24-hour mental
health treatment facility (e.g., psychiatric inpatient hospital, community
Exhibit B-3
Page 3 of 17
residential treatment facility); or has experienced three (3) or more
placements within 24 months due to behavioral health needs.
I. CONTRACTOR SHALL BE RESPONSIBLE FOR THE FOLLOWING SERVICES:
A. Referrals and Engagement
1. CONTRACTOR will provide an array of outpatient specialty mental
health services to all referrals received from the Department of
Behavioral Health’s (DBH) CWMH Team. CONTRACTOR shall accept
the adequate number of referrals to meet CWMH demand and to cover
program costs. Referral priority is determined by the CWMH Team and
assessments should be completed within the following designated
timeframes:
a. Crisis Referrals – Three (3) days
b. Standard Referrals – Ten (10) days
c. Psychiatric Referrals – Fifteen (15) days
2. CONTRACTOR shall make every attempt to engage clients in service.
CONTRACTOR is expected to make at least four (4) contact attempts
(in-person or via phone), at minimum one (1) attempt each week, over
the course of thirty (30) days and then send a letter to the client if
CONTRACTOR is still unable to engage them in services.
CONTRACTOR must also maintain regular contact with DSS Social
Workers, Supervisors, and Program Managers if they are unable to
contact or engage a client. If still unable to reach client, CONTRACTOR
must submit a Notice of Action to Managed Care and the CWMH Team.
A Notice of Action is not required if the referral packet received by
CONTRACTOR is incomplete.
B. Outpatient Specialty Mental Health Services
1. CONTRACTOR shall provide the following specialty mental health
services for the appropriate duration, frequency, and intensity based
upon the needs of the individual receiving services, as determined to be
clinically appropriate by a licensed/waivered mental health clinician and
the fidelity of the therapeutic intervention provided. It is understood that
a child who meets the definition of “Katie A. Subclass” does not, in and
of itself, require a higher level or intensity of mental health treatment
absent a clinical determination by the treating mental health clinician:
a. Mental Health Assessments
Clinical analysis of the history and current status of a
beneficiary’s mental, emotional, or behavioral disorder;
relevant cultural issues and history; diagnosis; and use of
testing procedures. A comprehensive assessment shall be
completed by a designated licensed or registered/waivered
Exhibit B-3
Page 4 of 17
staff within thirty (30) days from the initial contact date. When
a person remains in continuous services, an update/re-
assessment shall be completed at least every two (2) years.
The clinician may complete a comprehensive assessment
instead of an update/re-assessment if it is determined to be
the more appropriate clinical decision for the person served.
Additionally, current State mandates require that the CANS-
50 and PSC-35 are part of the assessment at the beginning
of treatment and are administered every six (6) months and at
the end of treatment. These will be shared with the Child and
Family Team (CFT). If a current assessment has been
completed by another CFT team member, it will be accepted
in lieu of an assessment completed by the clinician.
b. Therapy
A therapeutic intervention that focuses primarily on symptom
reduction as a means to improve functional impairments.
Therapy may be delivered to an individual or group of
beneficiaries (see below) and may include family therapy at
which the beneficiary is present.
1) Individual
2) Collateral
3) Conjoint
4) Family therapy
5) Group therapy
i. Groups will be led by clinicians and
supervised by a licensed clinician. Larger
groups may be co-facilitated by two (2)
unlicensed clinicians. Licensed Clinical
Supervisors will provide in-vivo training, co-
facilitation and supervision to ensure group
facilitation is high quality, clinically effective,
and appropriate.
c. Crisis Intervention
A service lasting less than 24 hours, to or on behalf of a
beneficiary, for a condition which requires more timely
response than a regularly scheduled visit. Activities may
include, but are not limited to, assessment, therapy and
service access to any significant support person in the
beneficiary’s life with the intent of improving or maintaining the
mental health status of the beneficiary.
d. Case Management
Any service that assists a beneficiary to access needed
medical, educational, social, prevocational, vocational,
rehabilitative, or other community service. Services may
Exhibit B-3
Page 5 of 17
include, but are not limited to, communication, coordination,
and referral to available resources. CONTRACTOR will be
responsible for monitoring service delivery to beneficiary by
third parties, beneficiary progress, and plan development.
e. Rehabilitation
Any activity that seeks to improve, maintain, or restore a
beneficiary’s functional, daily living, social, leisure, grooming,
personal hygiene, and meal preparation skills while also
providing access to support resources and medication
education.
f. Plan Development
The development of individual treatment plans, approval of
said treatment plans, and/or monitoring of a beneficiary’s
progress.
g. Medication Support
Any service that includes prescribing, administering,
dispensing, and monitoring psychiatric medications or
biologicals, which are necessary to alleviate the symptoms of
mental illness. Services may also include evaluation for the
need of medication, evaluation of clinical effectiveness and
side effects, obtaining informed consent, medication
education and plan development related to the delivery of the
service, and/or assessment of the beneficiary.
CONTRACTOR shall have a plan in place to ensure
medication support coverage, in the event that the
Psychiatrist is unavailable to provide services for an extended
period of time.
2. CONTRACTOR shall be responsible to provide and appropriately bill for
the following services for referred clients, including Katie A. Subclass
members, if medically necessary and provided within the California
Integrated Core Practice Model and Pathways to Mental Health Core
Practice Model, and in accordance with the “Medi-Cal Manual for
Intensive Care Coordination (ICC), Intensive Home-Based Services
(IHBS) & Therapeutic Foster Care (TFC) for Medi-Cal Beneficiaries”:
a. IHBS may include, but are not limited to:
1) Skill-based interventions for the remediation of behaviors
or improvement of symptoms;
2) Development of functional skills to improve self-care, self-
regulation, or other functional impairments by intervening
to decrease or replace non-functional behavior that
interferes with daily living tasks or the avoidance of
exploitation by others;
Exhibit B-3
Page 6 of 17
3) Development of skills or replacement behaviors that allow
the child/youth to fully participate in the teaming process
and service plans including but not limited to the treatment
plan and/or child welfare case plan;
4) Improvement in self-management of symptoms, including
self-administration of medications, as appropriate;
5) Education of the child/youth and/or their family or
caregiver(s) about how to manage the child/youth’s mental
health disorder or symptoms;
6) Support of the development, maintenance and use of
social networks, including the use of natural and
community resources;
7) Support to address behaviors that interfere with the
achievement of a stable and permanent family life;
8) Support to address behaviors that interfere with seeking
and maintaining a job, if applicable;
9) Support to address behaviors that interfere with a
child/youth’s success in achieving educational objectives.
b. IHBS can be provided by more than one (1) agency when
multiple agencies are serving a client. A minimum of 15% of
all services provided by CONTRACTOR must be IHBS. It is
expected that CONTRACTOR will provide IHBS, unless
clinical justification is provided. Clinical justification must be
documented in the client’s mental health record (this will be
reviewed and audited by the COUNTY).
c. CONTRACTOR is required to attend ICC meetings and any
teaming processes scheduled by other agencies, CWS, or by
the DBH CWMH Team to ensure coordination of all mental
health treatment services that may involve one (1) or more
provider agencies, no less than every ninety (90) days for the
child/youth.
d. ICC service components/activities include comprehensive
assessment and periodic reassessment, development and
periodic revision of the plan, referral, monitoring, follow-up
activities, and transition.
3. CONTRACTOR will be responsible for providing services in either an
office-based or community-based setting. The location of service
delivery will be determined based on the needs of the client, preference
of the client, and clinical appropriateness. Based on current data, clients
prefer or require that their services are provided in a community-based
setting. The expectation is that, at minimum, 70% of all
CONTRACTOR’s client services will be provided in the home or a
Exhibit B-3
Page 7 of 17
community-based setting. Location of service delivery should be
clinically justified and documented in the client record.
4. CONTRACTOR will be responsible to work cooperatively and
collaboratively with CWS staff, DBH staff, CWMH Team staff, and all
treatment providers, caregivers, and Foster Family Agencies to achieve
the individual and collective treatment goals. Providers are to support
the CWS case plan, communicate/resolve barriers to care, and provide
continuity and warm hand-offs whenever possible as individuals
transition from higher to lower or lower to higher levels of care within or
outside of Fresno County.
CONTRACTOR will be able to refer to other Fresno County Mental
Health Plan (MHP) providers, Managed Care Medi-Cal Health Plans,
and other community providers as may be appropriate and in
concurrence with the DBH CWMH Team. CONTRACTOR shall provide
case management services until client is properly linked with another
provider.
5. CONTRACTOR must use evidence-based practices (EBPs) found
effective in serving this target population. This includes the provision of
training, ongoing sustainability and fidelity to a core competency for
CONTRACTOR’s mental health clinicians. To date, CONTRACTOR
and COUNTY have agreed upon the provision of the following evidence-
based practices:
a. Managing and Adapting Practices (MAP)
b. Motivational Interviewing (MI)
c. Dialectical Behavioral Therapy (DBT)
d. Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)
e. Child Parent Psychotherapy (CPP)
f. Infant Mental Health
Any additional evidence-based practices CONTRACTOR would like to
utilize will require review and consultation with COUNTY.
COUNTY requires CONTRACTOR to ensure their staff pursue
certification/accreditation in the agreed upon evidence-based practices,
as appropriate, during the first year term, and demonstrate to COUNTY
that they are moving toward successful completion. CONTRACTOR is
required to explain in writing their plan to require/support staff in this
regard, and their expected timeframe for completion of the
certification/accreditation process within the first year term.
C. Court-Specific Mental Health Services
1. CONTRACTOR will provide the following court-ordered mental health
services to children and families in CWS:
Exhibit B-3
Page 8 of 17
a. Court-Ordered Mental Health Assessments
Clinical analysis of the history and current status of an
individual’s mental, emotional, or behavioral disorder; relevant
cultural issues and history; diagnosis; and use of testing
procedures.
b. Psychological and Neuropsychological Evaluations
A structured, analytical interview with the individual (i.e.,
minor, parent, or guardian) which consists of a clinical
assessment, the use of testing instruments, a mental status
examination, and a clinical diagnosis (as defined/ruled out
using the ICD-10) that is performed only by a Licensed
Psychologist with at least five (5) years of postgraduate
experience. Services also include a review of CPS and
mental health services received to date and contact with
relevant others, as necessary. A second psychological or
neuropsychological evaluation may be ordered and must be
performed by a different Licensed Psychologist and
independent of the first evaluation.
c. Bonding Studies
A structured, forensic, analytic interview that includes a
mental health assessment (in order to define or rule out
clinical diagnosis using the ICD-10) for either parent(s) or
whomever has been identified by the court to participate in the
study, and the child(ren). The study includes assessment of
the interaction between the parent(s) and the child(ren) and
may include the use of testing instruments (as needed) to
more accurately gauge the strength of the bond between
parent and child. It may also include the current care
provider(s) or prospective adoptive parent(s) when ordered by
the court. These studies are to be performed only by a
Licensed Mental Health Clinician with appropriate experience
or a Waivered Psychologist working under a qualified
Licensed Psychologist. A qualified clinician will have
completed twenty (20) hours of training in Child Custody as
required by the California Board of Psychology (if the child is
0-36 months), training in the Marshak Interaction Method, and
training or experience in providing forensic evaluations for the
court.
d. Court Reports And Court Testimony
CONTRACTOR is responsible for any court reports and/or
necessary testimony.
Exhibit B-3
Page 9 of 17
1) Court Reports
Documented report of assessment and evaluation
findings, progress in treatment, recommendations for
treatment, and service plan regarding reunification,
maintenance and termination of parental rights, and
justification for recommendations. CONTRACTOR
shall provide the DBH CWMH Team with a copy of the
reports, for tracking purposes.
2) Court Testimony
On-site court testimony of assessment and evaluation
findings, treatment and service plan
recommendations regarding reunification,
maintenance and termination of parental rights, and
justification for recommendations.
D. Staffing
1. CONTRACTOR shall ensure staff are qualified in education, experience,
and clinical competencies.
2. CONTRACTOR shall maintain adequate staffing levels in relation to the
number of open client cases at any given point to ensure quality service.
CONTRACTOR shall not go over a 1:20 staffing ratio.
3. CONTRACTOR will ensure that Clinical Supervisors oversee the work
of the Clinicians, including oversight of documentation and claiming in
the electronic medical record. Clinical Supervisors who provide
mentorship to Clinicians shall be two (2) years post licensure and able
to provide Board of Behavioral Sciences (BBS) supervision.
4. CONTRACTOR’s Clinicians must be post-graduate and registered with
their local licensing board.
5. Assessments must be conducted by Licensed Practitioners of the
Healing Arts (LPHA), which includes licensed mental health
professionals and registered associates.
6. Interns, including graduate student interns, may be utilized by
CONTRACTOR to provide case management-type services, including
ICC and IHBS.
7. CONTRACTOR’s clinical staff are required to go through the
credentialing process through DBH’s Managed Care Division. Interns
are required to go through the non-credentialing application process
through DBH’s Managed Care Division.
Exhibit B-3
Page 10 of 17
8. If CONTRACTOR has other agreements with COUNTY to provide
specialty mental health treatment services, it will establish criteria and
protocols via a Child and Family Team (CFT) meeting, to ensure referral
to services are therapeutically appropriate, benefits the client and
caregiver, achieves the client’s treatment goals, supports the success of
the CWS case plan, and avoids any potential for perceived or actual
conflict of interest or self-referral.
9. CONTRACTOR shall have established clinical competency standards
when hiring direct service staff and a staff development and training
program. CONTRACTOR will provide appropriate training for all staff to
include but not limited to trauma-informed practice, EBPs utilized,
working with specialized populations such as Infant Mental Health (IMH)
and Commercially Sexually Exploited Children (CSEC), and co-
occurring competence to serve individuals with mental health and
substance use/abuse disorders.
E. Affordable Care Act and Medi-Cal Managed Care Plan requirements
1. CONTRACTOR understands that effective January 1, 2014, Medi-Cal
managed care health plans (MCHPs) are required to serve Medi-Cal
beneficiaries with mild to moderate impairment of mental, emotional,
or behavioral functioning resulting from a mental health condition
defined by the current Diagnostic and Statistical Manual. Outpatient
benefits available through MCHPs include:
a. Individual and group mental health evaluation and treatment
(psychotherapy)
b. Psychological testing, when clinically indicated to evaluate a
mental health condition;
c. Outpatient services for the purposes of monitoring drug
therapy;
d. Psychiatric consultation; and
e. Outpatient laboratory, drugs, supplies and supplements
(excluding medications as described in the forthcoming “Medi-
Cal Managed Care Plan Responsibilities for Outpatient
Mental Health Services and Coordination with County Mental
Health Plans”).
2. CONTRACTOR will comply with all requirements established by the
California Department of Health Care Services (DHCS), Fresno County
MHP, and Medi-Cal MCHPs for screening, referral, and coordination of
care for mild to moderate cases, when clinically appropriate.
Exhibit B-3
Page 11 of 17
F. Administrative Requirements
1. CONTRACTOR shall meet with COUNTY staff monthly, or as often as
needed, for monitoring of program services, client capacity, staffing
levels and to exchange pertinent operational information, resolve
problems, and coordinate services.
2. CONTRACTOR shall participate in a joint meeting with COUNTY staff
and other vendors for CWMH services on a quarterly basis, or as often
as needed, to discuss program trends and resolution of concerns and
problems across all vendors.
3. CONTRACTOR shall attend bi-monthly Mental Health Contracted
Provider Meetings held by DBH.
4. CONTRACTOR will complete and submit monthly activity reports in a
manner determined by DBH and DSS.
5. CONTRACTOR will provide annual Civil Rights training to their staff in
the first quarter of every calendar year and will provide relevant proof to
DBH and DSS by April 1, for each year of the contract.
G. Data and Reporting
1. CONTRACTOR shall maintain and provide the COUNTY with monthly
statistics on the number of individuals/families to include, but not limited
to:
a. Number of clients referred for mental health assessments;
average time between referral and contact with caregiver;
average time between referral and assessment; number of
assessments completed, number of missed/no- show
appointments, number that did not meet Medi-Cal medical
necessity criteria;
b. Number of clients referred for court-ordered services
including type of service, average time between referral
and contact with the caregiver to schedule the
appointment, average number of days between the
referral and the court-ordered service, number of
missed/no-show appointments;
c. Average wait time between assessment and first visit with
assigned therapist;
d. Average wait time between referral and provision of
medication evaluation;
Exhibit B-3
Page 12 of 17
e. Unique clients served; units and dollars of services billed,
average cost per client;
f. Number and reasons for discharge from care;
g. Number of active clients in ongoing treatment
This information, in addition to the outcome measures to be developed,
will be provided to COUNTY on a monthly basis via an activity report
template developed by the COUNTY and due no later than the 10th of
each month.
2. Maintain case files on each individual/family, including, but not limited to
the following information:
a. Documentation of referrals to/from COUNTY, self-referrals,
and others;
b. Chronological record of individual and family services
provided including relevant contact dates, incidents, actions
taken, and results; and,
c. Case closure summary, indicating the reasons for closure and
the results of the services provided.
3. CONTRACTOR shall maintain secure case files with limited access only
to designated staff to ensure confidentiality.
4. CONTRACTOR shall submit a monthly staffing report, due no later than
the 10th of each month, detailing the total number of positions by
classification in the approved budget, number of staff hired (including
licensure, ethnicity, bilingual language capability, clinical
training/certification in EBPs), and number of vacancies.
II. COUNTY SHALL BE RESPONSIBLE FOR THE FOLLOWING:
A. Provide mental health service referrals to CONTRACTOR for children and
families involved in the CWS system.
B. Designate a contact person from DSS and DBH for CONTRACTOR to
communicate with, when necessary.
C. Meet with CONTRACTOR monthly, or as often as needed, to exchange pertinent
information, resolve problems, and work together to coordinate referrals and
services.
Exhibit B-3
Page 13 of 17
D. Support coordination of ICC meetings initially and no less than every ninety (90)
days for a child/youth.
E. Convene team meetings in alignment withthe Continuum of Care Reform (CCR),
Child and Family Teaming, Senate Bill 163 Wraparound, and the Integrated Core
Practice models for which CONTRACTOR will be required to participate when
appropriate.
F. Provide education and training on CWS, practice models and Medi-Cal licensing,
documentation and billing requirements, as needed.
III. PERFORMANCE MEASUREMENTS
Overall Service Objective:
CONTRACTOR will adhere to the outcome measures developed by COUNTY and any
requirements established by the California Department of Social Services (CDSS) and
DHCS. County may adjust these outcome measurements, periodically, so as to best
measure the success of the program. These outcome measurements and indicators will
continue to be developed in conjunction with the CONTRACTOR, COUNTY, and the
State Departments.
Services provided by the CONTRACTOR will align and support the principles of Fresno
County’s child welfare practice model, the Katie A Settlement Agreement, as well as other
relevant laws, regulations, statutes, and effective operating principles required to provide
the services. Specialty mental health services will be integrated, timely, ongoing, and
uninterrupted in a family-focused, trauma-informed delivery model that supports the goals
of the client plan developed by COUNTY. Intensive home-based mental health services
are expected to provide children and families in the CWS system with effective treatment,
improve outcomes, promote wellness, aid in resiliency, and maintain family relationships
conducive to healthy emotional development.
Performance Outcomes and Measures:
Under the Katie A. Settlement Agreement and Implementation Plan, DHCS and CDSS
are collectively working to adopt statewide use of a data-informed system of
performance oversight, accountability, and communication that efficiently monitors,
measures, and evaluates access, quality, satisfaction, effectiveness, costs, and
outcomes at the individual, program, and system levels.
CONTRACTOR is required to submit measureable outcomes on a semi-annual basis,
as identified in the DBH’s Policy and Procedure Guide (PPG) 1.2.7 Performance
Outcomes Measures. Performance outcome measures must be approved by DBH and
satisfy all State and local mandates. DBH will provide technical assistance and support
in defining measureable outcomes. All performance indicators will reflect the four (4)
domains identified by the Commission Accreditation of Rehabilitation Facilities (CARF).
Exhibit B-3
Page 14 of 17
DBH collects data about the characteristics of the persons served and measures service
delivery performance indicators in each of the following CARF domains.
A. Effectiveness - A performance dimension that assesses the degree to which
an intervention or series have achieved the desired outcome/result/quality of
care through measuring change over time. The results achieved and outcomes
observed are for persons served.
B. Efficiency - Relationship between results and resources used, such as time,
money, and staff. The demonstration of the relationship between results and
the resources used to achieve them. A performance dimension addressing the
relationship between the outputs/results of the resources used to deliver the
service.
C. Access - Organizations’ capacity to provide services to those who desire or
need services. Barriers or lack thereof for persons obtaining services. The
ability of clients to receive the right service at the right time. A performance
dimension addressing the degree to which a person needing services is able
to access those services.
D. Satisfaction - Satisfaction Measures are usually oriented towards clients,
family, staff, and stakeholders. The degree to which the clients, the COUNTY,
and other stakeholders are satisfied with services. A performance dimension
that describes reports or ratings from persons served about services received
from an organization.
DBH may adjust the performance and outcome measures periodically throughout the
duration of the Agreement, as needed, to best measure the program as determined by
COUNTY. CONTRACTOR must utilize a computerized tracking system with which
performance and outcome measures and other relevant client data, such as
demographics, will be maintained.
The outcome measures and indicators provided below represent COUNTY DBH and DSS
program goals to be achieved by the CONTRACTOR in addition to CONTRACTOR’s
developed outcomes.
A. Timeliness of Service – CONTRACTOR will respond to referrals within the
timeframes required by the Final Rule, in order to engage with the clients as
soon as possible.
1. Timely access to services from referral to assessment.
a. Crisis referrals: within three (3) days
b. Standard referrals: within ten (10) days
c. Psychiatric referrals: within fifteen (15) days
2. 100% of all assessments will be signed/completed within thirty (30)
days.
Exhibit B-3
Page 15 of 17
3. Timely access to service from assessment to ongoing treatment
4. Timely access to services from referral to medication evaluation, when
appropriate
B. Access and Engagement – CONTRACTOR will ensure that clients have access
to treatment, that the client is actively involved in treatment, and that every
effort is made to aid the client in successfully completing treatment.
1. CONTRACTOR will provide services in a location determined by the
needs/preference of the client and clinical appropriateness. The
expectation is that 70% of client services will be provided in the home or
a community-based setting.
2. CONTRACTOR will track the number, type, and location of services per
client.
3. CONTRACTOR will actively provide ICC and IHBS services. The
expectation is that a minimum of fifteen percent (15%) of
CONTRACTOR’s services will be IHBS.
4. Clinician attendance at 100% of teaming meetings.
5. CONTRACTOR will track the “no-show” and cancellation (by client or
provider) rates for treatment. The expectation is that the “no-show” and
cancellation rates will be ten percent (10%) or less.
6. CONTRACTOR will track the number and reasons for discharge. The
expectation is that there will be a low number of discharges due to “no-
shows” and a low number of discharges in which the client has not
successfully completed treatment.
7. Seventy percent (70%) of individuals with an open child welfare case will
successfully complete treatment.
C. Wellness, Recovery, and Resiliency Supports – a collaborative approach to
treatment strategies to aid in the successful completion of treatment,
reunification, and reduction in recidivism.
1. Improved Child Functioning -
Improvement in relationships, behavior, and academic achievements,
as demonstrated through the tracking tools, CANS 50 and PSC-35,
implemented by the CONTRACTOR and caregivers, respectively.
2. Improved Family Functioning
Improvement in ability to provide for and maintain a safe and stable
environment for the child, as demonstrated through tracking tool, CANS
50, implemented by the CONTRACTOR.
Exhibit B-3
Page 16 of 17
3. Improved Parent Functioning
Improvement in relationships, behavior, and sustaining basic needs, as
demonstrated through tracking tool, CANS 50, implemented by the
CONTRACTOR.
4. Effectiveness of discharge planning as demonstrated by referral and
linkage to other COUNTY programs, community providers, and
community resources.
5. Placement, Stability, & Permanency
a. Number of placement changes while in treatment
b. Permanency status of clients
IV. Cultural Competency
In alignment with the County’s DBH Mental Health Services Act Three-Year Plan, Mental
Health Plan, and Cultural Competency Plan, CONTRACTOR shall provide culturally
competent and culturally responsive services. CONTRACTOR’s responsibilities shall
include:
A. Mental Health and Substance Use Disorder direct service providers must
complete eight (8) hours of annual cultural competency training. Training hours
may include completing culturally competent courses through DBH Learning
Management System or attending cultural awareness events. DBH will provide
opportunities and track completion of training hours through its Learning
Management System.
B. When providing interpretation services for DBH clients, CONTRACTOR must
utilize interpreters who have received annual training and have been monitored
for language competence. By July 1st of each year, CONTRACTOR shall
provide DBH with its current list of interpreters, which includes training dates
and monitoring results. CONTRACTOR shall not utilize any interpreter who
has not received annual training and/or has not demonstrated language
competence. CONTRACTOR shall have access to DBH approved translators
via DBH’s established protocol.
C. In order for DBH to ensure a cultural, racial/ethnic, and linguistic group of direct
service providers representative of the population needing services and being
served, CONTRACTOR shall complete and email the Monthly Staffing Report,
which includes gender, ethnicity, and bilingual language capacity by the tenth
(10th) of every month.
D. CONTRACTOR shall provide a plan to address cultural competency standards
as set forth in the National Standards on Culturally and Linguistically
Appropriate Services (CLAS).
Exhibit B-3
Page 17 of 17
E. CONTRACTOR shall provide services within the most relevant and meaningful
cultural, gender-sensitive, and age-appropriate context for the target
population.
F. CONTRACTOR shall distribute literature/information brochures in appropriate
languages and request feedback as to how access to care could be improved
for culturally diverse communities. Distributed information will be approved by
DBH and/or DSS designee and translated as needed via DBH protocols.
Exhibit C
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
1
rev 01-02-2018
DBH VISION:
Health and well-being for our community.
DBH MISSION:
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.
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
Exhibit C
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2
rev 01-02-2018
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 client values and preferences
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
Exhibit C
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
3
rev 01-02-2018
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 client’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
Exhibit C
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
4
rev 01-02-2018
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
Exhibit D-1
1 of 20
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinical Director 1.00 $145,000 $145,000
0003 Licensed Clinicians 10.50 $655,108 $655,108
0004 Unlicensed Clinicians 12.00 $710,320 $710,320
0005 Client Care Coordinators 6.00 $249,600 $249,600
0006 COO 1.00 $149,000 $149,000
0007 Program Manager 1.00 $66,560 $66,560
0008 Office Manager 1.00 $52,000 $52,000
0009 QA/Outcomes Manager 1.00 $52,180 $52,180
0010 Controller 1.00 $100,000 $100,000
0011 Medical Billing/AR/AP 2.00 $110,000 $110,000
0012 Administrative Assistants 4.00 $144,144 $144,144
0013 Patient Services Representatives 2.50 $78,000 $78,000
SALARY TOTAL 43.00 $751,884 $1,760,028 $2,511,912
PAYROLL TAXES:
0030 OASDI $47,294 $108,445 $155,739
0031 FICA/MEDICARE $10,902 $25,521 $36,423
0032 FUTA $567 $1,233 $1,800
0033 SUI $5,859 $12,803 $18,662
PAYROLL TAX TOTAL $64,622 $148,002 $212,623
EMPLOYEE BENEFITS:
0040 Retirement 62790 $137,210 $200,000
0041 Workers Compensation 3140 $6,861 $10,000
0042 Health Insurance (medical, vision, life, dental)$106,744 $233,256 $340,000
EMPLOYEE BENEFITS TOTAL $172,674 $377,327 $550,000
SALARY & BENEFITS GRAND TOTAL $3,274,535
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $276,000
1011 Rent/Lease Equipment $1,962
1012 Utilities $34,500
1013 Building Maintenance $38,000
1014 Janitorial $28,200
FACILITY/EQUIPMENT TOTAL $378,662
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
California Psychological Institute
July 1, 2019 to June 30, 2020
Budget Categories -Total Proposed Budget
Exhibit D-1
2 of 20OPERATING EXPENSES:
1060 Telephone $45,500
1061 Answering Service $0
1062 Postage $800
1063 Printing/Reproduction $3,000
1064 Publications $0
1065 Legal Notices/Advertising $3,150
1066 Office Supplies & Equipment $18,000
1067 Household Supplies $9,500
1068 Food $5,000
1069 Program Supplies - Therapeutic $26,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $98,000
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $30,000
1075 Lodging $0
1076 Licenses/Taxes $4,475
OPERATING EXPENSES TOTAL $243,425
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $15,000
1081 External Audit $14,340
1082 Liability Insurance $27,000
1083 Administrative Overhead $286,238
1084 Payroll Services $14,000
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $356,578
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$45,000
1091 Translation Services $5,000
1092 Electronic Health Record $35,000
0004 Psychologists $15,000
0002 Psychiatrists $332,800
SPECIAL EXPENSES TOTAL $432,800
FIXED ASSETS:
1190 Computers & Software $35,000
1191 Furniture & Fixtures $25,000
FIXED ASSETS TOTAL $60,000
Exhibit D-1
3 of 20NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2002.8 Child Care (SFC 72)$4,000
NON MEDI-CAL CLIENT SUPPORT TOTAL $4,000
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)846,145 $2.98 $2,521,512
3100 Case Management 165,001 $2.12 $349,802
3200 Crisis Services 2,000 $4.07 $8,140
3300 Medication Support 59,200 $5.44 $322,048
3400 Collateral 15,000 $2.98 $44,700
3500 Plan Development 15,750 $2.98 $46,935
3600 Assessment 122,500 $2.98 $365,050
3700 Rehabilitation 253,000 $2.22 $561,660
3800 ICC 44,050 $2.98 $131,269
3900 IHBS 68,550 $2.98 $204,279
Estimated Specialty Mental Health Services Billing Totals 1,591,196 $4,555,395
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,555,395
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,277,698
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,277,698
MEDI-CAL REVENUE TOTAL $4,555,395
OTHER REVENUE:
4100 Psychological Testing 8,300 $2.81 $23,323
4150 Court Documentation (per report)883 $65.00 $57,395
4200 Mental Health Services (Individual/Family/Group Therapy)20,000 $2.98 $59,600
4250 Case Management 4,000 $2.12 $8,480
4300 Crisis Services 50 $4.07 $204
4350 Medication Support 1,700 $5.44 $9,248
4400 Collateral 500 $2.98 $1,490
4450 Plan Development 225 $2.98 $671
4500 Assessment 3,500 $2.98 $10,430
4550 Rehabilitation 7,000 $2.22 $15,540
4600 ICC 1,500 $2.98 $4,470
4650 IHBS 1,260 $2.98 $3,755
OTHER REVENUE TOTAL $194,605
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-1
4 of 20
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinical Director 1.00 $145,000 $145,000
0003 Licensed Clinicians 10.50 $655,108 $655,108
0004 Unlicensed Clinicians 12.00 $710,320 $710,320
0005 Client Care Coordinators 6.00 $249,600 $249,600
0006 COO 1.00 $149,000 $149,000
0007 Program Manager 1.00 $66,560 $66,560
0008 Office Manager 1.00 $52,000 $52,000
0009 QA/Outcomes Manager 1.00 $52,180 $52,180
0010 Controller 1.00 $100,000 $100,000
0011 Medical Billing/AR/AP 2.00 $110,000 $110,000
0012 Administrative Assistants 4.00 $144,144 $144,144
0013 Patient Services Representatives 2.50 $78,000 $78,000
SALARY TOTAL 43.00 $751,884 $1,760,028 $2,511,912
PAYROLL TAXES:
0030 OASDI $47,294 $108,445 $155,739
0031 FICA/MEDICARE $10,902 $25,521 $36,423
0032 FUTA $567 $1,233 $1,800
0033 SUI $5,859 $12,803 $18,662
PAYROLL TAX TOTAL $64,622 $148,002 $212,623
EMPLOYEE BENEFITS:
0040 Retirement 62790 $137,210 $200,000
0041 Workers Compensation 3140 $6,861 $10,000
0042 Health Insurance (medical, vision, life, dental)$106,744 $233,256 $340,000
EMPLOYEE BENEFITS TOTAL $172,674 $377,327 $550,000
SALARY & BENEFITS GRAND TOTAL $3,274,535
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $276,000
1011 Rent/Lease Equipment $1,962
1012 Utilities $34,500
1013 Building Maintenance $38,000
1014 Janitorial $28,200
FACILITY/EQUIPMENT TOTAL $378,662
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
California Psychological Institute
July 1, 2020 to June 30, 2021
Budget Categories -Total Proposed Budget
Exhibit D-1
5 of 20OPERATING EXPENSES:
1060 Telephone $45,500
1061 Answering Service $0
1062 Postage $800
1063 Printing/Reproduction $3,000
1064 Publications $0
1065 Legal Notices/Advertising $3,150
1066 Office Supplies & Equipment $18,000
1067 Household Supplies $9,500
1068 Food $5,000
1069 Program Supplies - Therapeutic $26,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $98,000
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $30,000
1075 Lodging $0
1076 Licenses/Taxes $4,475
OPERATING EXPENSES TOTAL $243,425
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $15,000
1081 External Audit $14,340
1082 Liability Insurance $27,000
1083 Administrative Overhead $286,238
1084 Payroll Services $14,000
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $356,578
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$45,000
1091 Translation Services $5,000
1092 Electronic Health Record $35,000
0004 Psychologists $15,000
0002 Psychiatrists $332,800
SPECIAL EXPENSES TOTAL $432,800
FIXED ASSETS:
1190 Computers & Software $35,000
1191 Furniture & Fixtures $25,000
FIXED ASSETS TOTAL $60,000
Exhibit D-1
6 of 20NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2002.8 Child Care (SFC 72)$4,000
NON MEDI-CAL CLIENT SUPPORT TOTAL $4,000
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)846,145 $2.98 $2,521,512
3100 Case Management 165,001 $2.12 $349,802
3200 Crisis Services 2,000 $4.07 $8,140
3300 Medication Support 59,200 $5.44 $322,048
3400 Collateral 15,000 $2.98 $44,700
3500 Plan Development 15,750 $2.98 $46,935
3600 Assessment 122,500 $2.98 $365,050
3700 Rehabilitation 253,000 $2.22 $561,660
3800 ICC 44,050 $2.98 $131,269
3900 IHBS 68,550 $2.98 $204,279
Estimated Specialty Mental Health Services Billing Totals 1,591,196 $4,555,395
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,555,395
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,277,698
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,277,698
MEDI-CAL REVENUE TOTAL $4,555,395
OTHER REVENUE:
4100 Psychological Testing 8,300 $2.81 $23,323
4150 Court Documentation (per report)883 $65.00 $57,395
4200 Mental Health Services (Individual/Family/Group Therapy)20,000 $2.98 $59,600
4250 Case Management 4,000 $2.12 $8,480
4300 Crisis Services 50 $4.07 $204
4350 Medication Support 1,700 $5.44 $9,248
4400 Collateral 500 $2.98 $1,490
4450 Plan Development 225 $2.98 $671
4500 Assessment 3,500 $2.98 $10,430
4550 Rehabilitation 7,000 $2.22 $15,540
4600 ICC 1,500 $2.98 $4,470
4650 IHBS 1,260 $2.98 $3,755
OTHER REVENUE TOTAL $194,605
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-1
7 of 20
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinical Director 1.00 $145,000 $145,000
0003 Licensed Clinicians 10.50 $655,108 $655,108
0004 Unlicensed Clinicians 12.00 $710,320 $710,320
0005 Client Care Coordinators 6.00 $249,600 $249,600
0006 COO 1.00 $149,000 $149,000
0007 Program Manager 1.00 $66,560 $66,560
0008 Office Manager 1.00 $52,000 $52,000
0009 QA/Outcomes Manager 1.00 $52,180 $52,180
0010 Controller 1.00 $100,000 $100,000
0011 Medical Billing/AR/AP 2.00 $110,000 $110,000
0012 Administrative Assistants 4.00 $144,144 $144,144
0013 Patient Services Representatives 2.50 $78,000 $78,000
SALARY TOTAL 43.00 $751,884 $1,760,028 $2,511,912
PAYROLL TAXES:
0030 OASDI $47,294 $108,445 $155,739
0031 FICA/MEDICARE $10,902 $25,521 $36,423
0032 FUTA $567 $1,233 $1,800
0033 SUI $5,859 $12,803 $18,662
PAYROLL TAX TOTAL $64,622 $148,002 $212,623
EMPLOYEE BENEFITS:
0040 Retirement 62790 $137,210 $200,000
0041 Workers Compensation 3140 $6,861 $10,000
0042 Health Insurance (medical, vision, life, dental)$106,744 $233,256 $340,000
EMPLOYEE BENEFITS TOTAL $172,674 $377,327 $550,000
SALARY & BENEFITS GRAND TOTAL $3,274,535
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $276,000
1011 Rent/Lease Equipment $1,962
1012 Utilities $34,500
1013 Building Maintenance $38,000
1014 Janitorial $28,200
FACILITY/EQUIPMENT TOTAL $378,662
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
California Psychological Institute
July 1, 2021 to June 30, 2022
Budget Categories -Total Proposed Budget
Exhibit D-1
8 of 20OPERATING EXPENSES:
1060 Telephone $45,500
1061 Answering Service $0
1062 Postage $800
1063 Printing/Reproduction $3,000
1064 Publications $0
1065 Legal Notices/Advertising $3,150
1066 Office Supplies & Equipment $18,000
1067 Household Supplies $9,500
1068 Food $5,000
1069 Program Supplies - Therapeutic $26,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $98,000
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $30,000
1075 Lodging $0
1076 Licenses/Taxes $4,475
OPERATING EXPENSES TOTAL $243,425
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $15,000
1081 External Audit $14,340
1082 Liability Insurance $27,000
1083 Administrative Overhead $286,238
1084 Payroll Services $14,000
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $356,578
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$45,000
1091 Translation Services $5,000
1092 Electronic Health Record $35,000
0004 Psychologists $15,000
0002 Psychiatrists $332,800
SPECIAL EXPENSES TOTAL $432,800
FIXED ASSETS:
1190 Computers & Software $35,000
1191 Furniture & Fixtures $25,000
FIXED ASSETS TOTAL $60,000
Exhibit D-1
9 of 20NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2002.8 Child Care (SFC 72)$4,000
NON MEDI-CAL CLIENT SUPPORT TOTAL $4,000
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)846,145 $2.98 $2,521,512
3100 Case Management 165,001 $2.12 $349,802
3200 Crisis Services 2,000 $4.07 $8,140
3300 Medication Support 59,200 $5.44 $322,048
3400 Collateral 15,000 $2.98 $44,700
3500 Plan Development 15,750 $2.98 $46,935
3600 Assessment 122,500 $2.98 $365,050
3700 Rehabilitation 253,000 $2.22 $561,660
3800 ICC 44,050 $2.98 $131,269
3900 IHBS 68,550 $2.98 $204,279
Estimated Specialty Mental Health Services Billing Totals 1,591,196 $4,555,395
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,555,395
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,277,698
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,277,698
MEDI-CAL REVENUE TOTAL $4,555,395
OTHER REVENUE:
4100 Psychological Testing 8,300 $2.81 $23,323
4150 Court Documentation (per report)883 $65.00 $57,395
4200 Mental Health Services (Individual/Family/Group Therapy)20,000 $2.98 $59,600
4250 Case Management 4,000 $2.12 $8,480
4300 Crisis Services 50 $4.07 $204
4350 Medication Support 1,700 $5.44 $9,248
4400 Collateral 500 $2.98 $1,490
4450 Plan Development 225 $2.98 $671
4500 Assessment 3,500 $2.98 $10,430
4550 Rehabilitation 7,000 $2.22 $15,540
4600 ICC 1,500 $2.98 $4,470
4650 IHBS 1,260 $2.98 $3,755
OTHER REVENUE TOTAL $194,605
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-1
10 of 20
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinical Director 1.00 $145,000 $145,000
0003 Licensed Clinicians 10.50 $655,108 $655,108
0004 Unlicensed Clinicians 12.00 $710,320 $710,320
0005 Client Care Coordinators 6.00 $249,600 $249,600
0006 COO 1.00 $149,000 $149,000
0007 Program Manager 1.00 $66,560 $66,560
0008 Office Manager 1.00 $52,000 $52,000
0009 QA/Outcomes Manager 1.00 $52,180 $52,180
0010 Controller 1.00 $100,000 $100,000
0011 Medical Billing/AR/AP 2.00 $110,000 $110,000
0012 Administrative Assistants 4.00 $144,144 $144,144
0013 Patient Services Representatives 2.50 $78,000 $78,000
SALARY TOTAL 43.00 $751,884 $1,760,028 $2,511,912
PAYROLL TAXES:
0030 OASDI $47,294 $108,445 $155,739
0031 FICA/MEDICARE $10,902 $25,521 $36,423
0032 FUTA $567 $1,233 $1,800
0033 SUI $5,859 $12,803 $18,662
PAYROLL TAX TOTAL $64,622 $148,002 $212,623
EMPLOYEE BENEFITS:
0040 Retirement 62790 $137,210 $200,000
0041 Workers Compensation 3140 $6,861 $10,000
0042 Health Insurance (medical, vision, life, dental)$106,744 $233,256 $340,000
EMPLOYEE BENEFITS TOTAL $172,674 $377,327 $550,000
SALARY & BENEFITS GRAND TOTAL $3,274,535
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $276,000
1011 Rent/Lease Equipment $1,962
1012 Utilities $34,500
1013 Building Maintenance $38,000
1014 Janitorial $28,200
FACILITY/EQUIPMENT TOTAL $378,662
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
California Psychological Institute
July 1, 2022 to June 30, 2023
Budget Categories -Total Proposed Budget
Exhibit D-1
11 of 20OPERATING EXPENSES:
1060 Telephone $45,500
1061 Answering Service $0
1062 Postage $800
1063 Printing/Reproduction $3,000
1064 Publications $0
1065 Legal Notices/Advertising $3,150
1066 Office Supplies & Equipment $18,000
1067 Household Supplies $9,500
1068 Food $5,000
1069 Program Supplies - Therapeutic $26,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $98,000
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $30,000
1075 Lodging $0
1076 Licenses/Taxes $4,475
OPERATING EXPENSES TOTAL $243,425
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $15,000
1081 External Audit $14,340
1082 Liability Insurance $27,000
1083 Administrative Overhead $286,238
1084 Payroll Services $14,000
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $356,578
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$45,000
1091 Translation Services $5,000
1092 Electronic Health Record $35,000
0004 Psychologists $15,000
0002 Psychiatrists $332,800
SPECIAL EXPENSES TOTAL $432,800
FIXED ASSETS:
1190 Computers & Software $35,000
1191 Furniture & Fixtures $25,000
FIXED ASSETS TOTAL $60,000
Exhibit D-1
12 of 20NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2002.8 Child Care (SFC 72)$4,000
NON MEDI-CAL CLIENT SUPPORT TOTAL $4,000
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)846,145 $2.98 $2,521,512
3100 Case Management 165,001 $2.12 $349,802
3200 Crisis Services 2,000 $4.07 $8,140
3300 Medication Support 59,200 $5.44 $322,048
3400 Collateral 15,000 $2.98 $44,700
3500 Plan Development 15,750 $2.98 $46,935
3600 Assessment 122,500 $2.98 $365,050
3700 Rehabilitation 253,000 $2.22 $561,660
3800 ICC 44,050 $2.98 $131,269
3900 IHBS 68,550 $2.98 $204,279
Estimated Specialty Mental Health Services Billing Totals 1,591,196 $4,555,395
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,555,395
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,277,698
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,277,698
MEDI-CAL REVENUE TOTAL $4,555,395
OTHER REVENUE:
4100 Psychological Testing 8,300 $2.81 $23,323
4150 Court Documentation (per report)883 $65.00 $57,395
4200 Mental Health Services (Individual/Family/Group Therapy)20,000 $2.98 $59,600
4250 Case Management 4,000 $2.12 $8,480
4300 Crisis Services 50 $4.07 $204
4350 Medication Support 1,700 $5.44 $9,248
4400 Collateral 500 $2.98 $1,490
4450 Plan Development 225 $2.98 $671
4500 Assessment 3,500 $2.98 $10,430
4550 Rehabilitation 7,000 $2.22 $15,540
4600 ICC 1,500 $2.98 $4,470
4650 IHBS 1,260 $2.98 $3,755
OTHER REVENUE TOTAL $194,605
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-1
13 of 20
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinical Director 1.00 $145,000 $145,000
0003 Licensed Clinicians 10.50 $655,108 $655,108
0004 Unlicensed Clinicians 12.00 $710,320 $710,320
0005 Client Care Coordinators 6.00 $249,600 $249,600
0006 COO 1.00 $149,000 $149,000
0007 Program Manager 1.00 $66,560 $66,560
0008 Office Manager 1.00 $52,000 $52,000
0009 QA/Outcomes Manager 1.00 $52,180 $52,180
0010 Controller 1.00 $100,000 $100,000
0011 Medical Billing/AR/AP 2.00 $110,000 $110,000
0012 Administrative Assistants 4.00 $144,144 $144,144
0013 Patient Services Representatives 2.50 $78,000 $78,000
SALARY TOTAL 43.00 $751,884 $1,760,028 $2,511,912
PAYROLL TAXES:
0030 OASDI $47,294 $108,445 $155,739
0031 FICA/MEDICARE $10,902 $25,521 $36,423
0032 FUTA $567 $1,233 $1,800
0033 SUI $5,859 $12,803 $18,662
PAYROLL TAX TOTAL $64,622 $148,002 $212,623
EMPLOYEE BENEFITS:
0040 Retirement 62790 $137,210 $200,000
0041 Workers Compensation 3140 $6,861 $10,000
0042 Health Insurance (medical, vision, life, dental)$106,744 $233,256 $340,000
EMPLOYEE BENEFITS TOTAL $172,674 $377,327 $550,000
SALARY & BENEFITS GRAND TOTAL $3,274,535
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $276,000
1011 Rent/Lease Equipment $1,962
1012 Utilities $34,500
1013 Building Maintenance $38,000
1014 Janitorial $28,200
FACILITY/EQUIPMENT TOTAL $378,662
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
California Psychological Institute
July 1, 2023 to June 30, 2024
Budget Categories -Total Proposed Budget
Exhibit D-1
14 of 20OPERATING EXPENSES:
1060 Telephone $45,500
1061 Answering Service $0
1062 Postage $800
1063 Printing/Reproduction $3,000
1064 Publications $0
1065 Legal Notices/Advertising $3,150
1066 Office Supplies & Equipment $18,000
1067 Household Supplies $9,500
1068 Food $5,000
1069 Program Supplies - Therapeutic $26,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $98,000
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $30,000
1075 Lodging $0
1076 Licenses/Taxes $4,475
OPERATING EXPENSES TOTAL $243,425
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $15,000
1081 External Audit $14,340
1082 Liability Insurance $27,000
1083 Administrative Overhead $286,238
1084 Payroll Services $14,000
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $356,578
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$45,000
1091 Translation Services $5,000
1092 Electronic Health Record $35,000
0004 Psychologists $15,000
0002 Psychiatrists $332,800
SPECIAL EXPENSES TOTAL $432,800
FIXED ASSETS:
1190 Computers & Software $35,000
1191 Furniture & Fixtures $25,000
FIXED ASSETS TOTAL $60,000
Exhibit D-1
15 of 20NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2002.8 Child Care (SFC 72)$4,000
NON MEDI-CAL CLIENT SUPPORT TOTAL $4,000
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:Units of Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)846,145 $2.98 $2,521,512
3100 Case Management 165,001 $2.12 $349,802
3200 Crisis Services 2,000 $4.07 $8,140
3300 Medication Support 59,200 $5.44 $322,048
3400 Collateral 15,000 $2.98 $44,700
3500 Plan Development 15,750 $2.98 $46,935
3600 Assessment 122,500 $2.98 $365,050
3700 Rehabilitation 253,000 $2.22 $561,660
3800 ICC 44,050 $2.98 $131,269
3900 IHBS 68,550 $2.98 $204,279
Estimated Specialty Mental Health Services Billing Totals 1,591,196 $4,555,395
Estimated % of Clients that are Medi-Cal Beneficiaries 100%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,555,395
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,277,698
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,277,698
MEDI-CAL REVENUE TOTAL $4,555,395
OTHER REVENUE:
4100 Psychological Testing 8,300 $2.81 $23,323
4150 Court Documentation (per report)883 $65.00 $57,395
4200 Mental Health Services (Individual/Family/Group Therapy)20,000 $2.98 $59,600
4250 Case Management 4,000 $2.12 $8,480
4300 Crisis Services 50 $4.07 $204
4350 Medication Support 1,700 $5.44 $9,248
4400 Collateral 500 $2.98 $1,490
4450 Plan Development 225 $2.98 $671
4500 Assessment 3,500 $2.98 $10,430
4550 Rehabilitation 7,000 $2.22 $15,540
4600 ICC 1,500 $2.98 $4,470
4650 IHBS 1,260 $2.98 $3,755
OTHER REVENUE TOTAL $194,605
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-1
16 of 20
NARRATIVE
FY 2019 - 2024
BUDGET NARRATIVE - EXPENSES
Program Expenses
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
Personnel Salaries: California Psychological Institute has a current and proposed staff of 43
individuals.
Clinical Staff
Licensed Clinicians- 10.5 FTE- Average Salary $64,095. Provide clinical services to children and
adults under contract with Fresno County. Supervise and support unlicensed clinicians.
Unlicensed Clinicians- 12 FTE – Average salary $60,916. Provide clinical services under contract
with Fresno county to children and adults.
Client Care Coordinators- 6 FTE- Average salary $41,600. Provide support to families currently
being treated by a clinician. Provide linkage and assistance as well as education and school
support to children and families.
Billing/Finance
Controller- 1FTE- Average salary $100,000. Responsible for all general accounting duties.
Manages bank accounts, journal entries and all general accounting needs, oversees billing,
AR/AP, check reconciliation and taxes.
Medical Billing/ AR/AP- 2 FTE – Average Salary $55,500. Responsible for all medical billing and
data drop, check deposit and bill entry.
Support Staff
Administrative Assistants 4 FTE- Average Salary $36,036- Support staff, psychiatrist and
managers.
Patient Care Representative 2.50 FTE, Average Salary -$31,200. Greet clients and schedule
appointments. Do confirmation calls daily. Send all correspondence out of office.
Management Team
COO- 1 FTE Average Salary $149,000- Oversees all staff, HR, Recruitment and retention,
Contract oversight and supervises daily operations.
Exhibit D-1
17 of 20
Program Manager- 1 FTE-Average Salary- $66,560-Organizes and coordinates staff and
curriculum for groups, trainings and chart audit. Responsible for Outcomes Reporting and
monthly Activity reports
Office Manager- 1 FTE- Average Salary $52,180. Supervises administrative assistants and
patient care coordinators, coordinates schedules and time off.
QA/ Outcomes Manager- 1 FTE- Average Salary $52,180- Responsible for outcomes data input
into Avatar. Outcome collections and processing daily. Chart Review and Note review, internal
audit and coordination of peer review. Outcomes report tracking and preparation.
Payroll Taxes: Items included in this section Employer Social Security, Employer Medicare,
Employer FUTA and SUI.
Employee Benefits: California Psychological Institute is aware of the fact that Fresno County is
requiring Employee Benefits to not exceed 20% of employee wages. We recognize that in order
to maintain our status as a leading provider of quality mental health services in Fresno County,
we must be able to offer employees with a competitive benefits package consistent with
industry standards in order to incentivize and retain quality employees. Benefits offered are
full health, dental, vision, 401k, and Workers Compensation. We believe that these benefits
are a crucial part of our high staff retention rate.
Facilities/Equipment Expenses – Line Items 1010-1014
Rent/Lease Building: California Psychological Institute has an ongoing lease with Herndon
Partners, LLC for a 10,000 SQFT office space. The monthly lease agreement is $22,172.92. See
lease agreement attached in section XX.
Rent/Lease Equipment: California Psychological Institute has a monthly rental agreement with
Derrell’s for a storage space used for documentation retention, and lease agreement with
Pitney Bowes for our Postage meter and lease agreements for our photo copier.
Utilities: Expenses associated with services provided to us such as water, sewer, gas and
electric. Currently California Psychological Institute contracts with PG&E, City of Fresno and
Pinedale Public Utility for such services.
Common Area Maintenance: Expenses listed here include services provided in the following
areas - lawn maintenance, pest control, plumbing, HVAC, electrical, annual fire inspections,
trash service, and any other expenses revolving around the general maintenance, safety and
security of the common areas.
Janitorial: Cleaning cost for the interior of our building.
Exhibit D-1
18 of 20
Operating Expenses - Line Items 1060-1077
Telephone: Expenses listed here include our cost for services related to telephone, internet,
and mobile phones
Postage: Stamps, and any related cost associated with mailing items through USPS or another
courier used to mail out all intake paperwork.
Printing/Reproduction: Costs associated with document printing, business cards, scanning,
faxing, document destruction/shredding, legal pads, brochures, office stationary, promotional
items for clients such as fidget spinners, stress balls etc.
Legal/Advertising: Costs associated with promoting the business such as job postings, directory
listings, training postings, and any legal expenses incurred for business purposes.
Office Supplies: General office items required for basic office functioning such as folders, small
storage units, paper, pens, sticky notes, organizational items, highlighters, envelopes, low ticket
office décor items like office wastebaskets, clocks, calendars, name badges, door signs, low cost
computer items such as mouse pads, keyboards, mice, charging cables, printer ink, correction
fluid, iPad and cell phone cases, laminating items, tape, brochures, waiting room supplies etc.
Household Supplies: Cleaning supplies, hand soap, trash bags, water cooler, toilet paper, paper
towel, disposable cups, lids and plates, deodorizers, candles, Kleenex, stirrers, napkins, utensils,
cup sleeves etc.
Food: Food and beverage costs for the clientele such as coffee, creamer, sugar, tea, honey. We
also have snacks available in our kitchen for clients after each session. Cakes ,pizza or cupcakes
to celebrate client graduations.
Program Supplies: California Psychological Institute understands that in order to provide quality
services to its clientele, it must maintain a supply of certain items for the staff to utilize in their
interactions with their clients. Expenses in this category are items directly related to services
provided to clients, such as learning materials, books, arts and craft supplies, games, toys, RxNT
access for the Psychiatrist, any Psych Testing materials, group supplies. Other items include our
DMV and Live scan identification/verification costs related to background checks.
Staff Mileage: Employees who provide services in the field are provided mileage
reimbursements at a rate of $0.535/mile for the general upkeep and maintenance of their
vehicles. Other items included here may be expenses related to parking for meetings or court in
areas where parking garages must be used.
Staff Training/Registration: California Psychological Institute recognizes the value of providing
our staff with ongoing training and education, for the benefit of not only themselves and our
Exhibit D-1
19 of 20
business, but most importantly our clients. Therefore, one of the benefits we like to offer our
staff is a yearly stipend for approved and related trainings in our field of expertise. Employees
are provided the benefit at a rate of $200/ year, on any related training that allows them the
opportunity to better themselves so that they can offer our clients the best services, utilizing
the most current and relevant information in the field. Remaining funds are earmarked for
identified trainings useful for this work. CPP, law and ethics, DBT and cultural competency will
be scheduled within 30 days of this contract start date.
Federal/Local Taxes:
Payments made to Federal, State, City or County for various tax purposes.
Consultant Fees- Human Resource Manual, Safety and Evacuation Plan and HR consultant fees
Financial Services Expenses – Line Items 1080-1085
Accounting/Bookkeeping: Expenses associated with utilizing an outside Accounting Firm for
annual review of our bookkeeping, compliance, and yearly tax filing.
External Audit- Audited Financial Statements
Liability Insurance- General Liability and malpractice insurance costs
Payroll Processing: Costs associated with utilizing an outside Payroll company for managing
general payroll reporting and compliance, Federal and State tax payments, employee direct
deposit and payroll checks, and issuing W2s.
Administrative Overhead- Audit Cost/Expenses, Executive fees, Interest accrued on line of
credit draw, IT consulting, HIPPA compliance and clinical record audits, risk management and
program fidelity, recruiting and human resources support.
Special Expenses – Line Items 1090-1092
Translation Services: Although California Psychological Institute prides itself on having a well-
rounded, multi-lingual staff, we recognize the need to have funds available to utilize outside
translation services from time to time in order to better serve our clients and get them seen in
a more reasonable time frame when one of our in-house staff is unavailable for any reason.
Electronic Health Record: Expenses related to the maintenance of our Electronic Health Record
systems.
Computer Service Contract: Costs associated with the repairs, service, and maintenance of our
network and all company devices.
Exhibit D-1
20 of 20
Psychiatrist – Per diem. Currently scheduled 32 hours per week.
Psychologist- Per Diem.
Fixed Assets – Line Items 1190-1193
Computers/Printers/Software: Any costs associated with updates and/or replacements of our
existing equipment such as Printers, Software, Computers, Servers and server equipment,
iPads,and Cell phones, due to normal wear and use. New computers to be in HIPAA compliance
with windows 10 machines.
Furniture/Fixtures: Expenses related to the replacement of our larger ticket items in the office
due to normal wear and use such as children’s, office and waiting room furniture and
equipment, desks, chairs, storage furniture, telephone systems, etc.
Non-Medi-Cal Client Support Services- Line Items 2000-2002.8
Child Care Services- CPI will offer child care to clients seen in our office when needed to support
the family and increase access to services.
TOTAL PROGRAM EXPENSE: $4,750,000
Exhibit D-2
1 of 35
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Program Director 1.00 $99,300 $99,300
0002 Case Managers 9.00 $509,850 $509,850
0003 Mental Health Specialists 21.00 $1,448,129 $1,448,129
0004 Clinical Supervisors 3.00 $222,789 $222,789
0005 Intake Coordinator 2.00 $67,898 $67,898
0006 LVN 0.50 $26,780 $26,780
0007 Administrator 0.25 $29,175 $29,175
0008 Quality Assurance Coordinator 0.40 $21,218 $21,218
0009 Quality Assurance Manager 0.40 $27,583 $27,583
0010 Training Coordinator 0.40 $22,067 $22,067
0011 Human Resource Coordinator 0.50 $26,788 $26,788
0012 Admin Clerk 1.50 $54,631 $54,631
SALARY TOTAL 39.95 $181,462 $2,374,745 $2,556,207
PAYROLL TAXES:
0030 Payroll Taxes $18,146 $237,475 $255,621
PAYROLL TAX TOTAL $18,146 $237,475 $255,621
EMPLOYEE BENEFITS:
0040 Retirement/Workers Comp/Health Insurance $31,302 $409,644 $440,946
EMPLOYEE BENEFITS TOTAL $31,302 $409,644 $440,946
SALARY & BENEFITS GRAND TOTAL $3,252,773
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $73,080
1011 Rent/Lease Equipment $19,000
1012 Utilities $15,000
1013 Building Maintenance $22,800
1014 Equipment purchase $0
FACILITY/EQUIPMENT TOTAL $129,880
OPERATING EXPENSES:
1060 Telephone $95,468
1061 Answering Service $0
1062 Postage $0
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
Central Star Behavioral Health, Inc
FY 2019-2020
Budget Categories - Total Proposed Budget
Exhibit D-2
2 of 35
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $29,382
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies - Therapeutic $0
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $82,563
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $30,000
1075 Lodging $0
1076 Other - Purchased Services $34,860
1077 Other - Centralized services - program $125,435
$0
OPERATING EXPENSES TOTAL $397,708
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $90,000
1081 External Audit $3,600
1082 Liability Insurance $18,896
1083 Administrative Overhead $608,658
1084 Payroll Services $11,984
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $733,138
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$0
1091 Translation Services $7,200
1092 Medication Supports $186,000
SPECIAL EXPENSES TOTAL $193,200
FIXED ASSETS:
1190 Computers & Software $37,901
1191 Furniture & Fixtures $3,000
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $40,901
Exhibit D-2
3 of 35NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2002.2 Client Transportation & Support (SFC 72)$2,400
NON MEDI-CAL CLIENT SUPPORT TOTAL $2,400
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)471,977 $2.81 $1,326,255
3100 Case Management 340,015 $2.17 $737,833
3200 Crisis Intervention 2,654 $4.17 $11,067
3300 Medication Support 35,610 $5.18 $184,458
3400 Collateral 311,807 $2.81 $876,177
3500 Plan Development 32,822 $2.81 $92,229
3600 Assessment 49,233 $2.81 $138,344
3700 Rehabilitation 32,822 $2.81 $92,229
3800 ICC 212,510 $2.17 $461,146
3900 IHBS 246,163 $2.81 $691,719
Estimated Specialty Mental Health Services Billing Totals 1,735,612 $4,611,458
Estimated % of Clients that are Medi-Cal Beneficiaries 97%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,473,114
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,236,557
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,236,557
MEDI-CAL REVENUE TOTAL $4,473,114
OTHER REVENUE: Social Services Revenue
4100 Psychological Evaluations 15,866 2.81 $44,584
4200 Court Documentation, Reports 29,388 2.81 $82,581
4300 Non-MediCal Clients (Mental Health Services)39,819 2.81 $111,891
4400 Non-MediCal Clients (Case Management)14,853 2.17 $32,232
4500 Non-MediCal Clients (Crisis Intervention)85 4.17 $354
4600 Non-MediCal Clients (Medical Support)902 5.81 $5,243
OTHER REVENUE TOTAL $276,886
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-2
4 of 35
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
Program Director: $99,300 for 1.0 FTE, this position oversees program management and maintains in compliance with
contract and legal requirements.
Case Manager: $509,850 for 9.0 FTE, will provide case management activities to assist individuals at risk or indicating
symptoms of mental health problems to ensure access to needed medical, rehabilitative, and other needed services
and resources. Case Manager will work to identify and link individuals to resources and related supports, monitor
service delivery to ensure access to care. Case Manager will provide person-to-person case management support to
address barriers to treatment and will support individuals connecting with appropriate mental health resources. Case
Managers will provide individualized attention, as well as services and supports as needed.
Mental Health Specialist 1/II: $1,448,129 for 21 FTE's, provides initial and ongoing assessment; develops EPSDT plan.
Provides individual and family trauma-informed mental health services and therapy. Provides clinical support and
information to CFTs, as CFT and ICC team member. Documents and bills for services, and completes outcomes
information.
CHILD WELFARE MENTAL HEALTH SERVICES
Central Star Behavioral Health Inc.
FY 2019 - 2020
BUDGET NARRATIVE - EXPENSES
These amounts reflect FTE positions, part-time positions and whether the positions are administrative or direct service.
Employee benefits should be limited to a maximum of 20% of total salaries.
Clinical Supervisor: $222,789 for 3.0 FTE, under general direction, supervises Specialty Mental Health Services, and
the work of license-eligible therapists in accordance with BBS requirements. May also provide individual mental health
services.
Intake Coordinator: $67,898 for 2.0 FTE, processes referrals, consent packets, and paperwork, etc.
Administrator: $29,175 for .25 FTE, has a direct responsibility for the Community Service program and will report to
Regional Administrator, will ensure operational, clinical and regulatory requirements are met. He/she will directly
supervise the Program Director.
LVN: $26,780 for $0.5 FTE, provides direct client care including medications, and supervises nursing activities
performed by professional and para-professional nursing personnel on the unit.
QA Coordinator: $21,218 for .40 FTE, is responsible for utilization review and assisting in medical record management
by gathering and analyzing agency data and assisting in the agency’s quality control, quality assurance, and quality
improvement efforts.
QA Manager: $27,583 for .40 FTE, manages all Quality Assurance tasks for the program, which includes records
management, documentation and service audits for compliance to Medi-Cal and internal requirements.
Training Coordinator: $22,067 for .40 FTE, assists in the development, coordination, delivery and administration of
agency training programs.
Human Resources Coordinator: $26,788 for .50 FTE, manages all human resource clerical and administrative tasks for
the program staff. This position is responsible for supporting the development of a positive working environment to
enhance agency success and reduce legal risk, as well as management team support and consultation, employee
relations, interpretation and administration of HR policies and procedures, staff recruitment and selection,
compensation, and employee benefits etc.
Exhibit D-2
5 of 35
$2,556,207
$255,621
$440,946
Facilities/Equipment Expenses – Line Items 1010-1014
$129,880
Operating Expenses - Line Items 1060-1077
Retirement/Worker Compensation/Health Insurance: 17.25% of annual salaries
Rent/Lease Building: $73,080, is calculated at $1.40 per square foot per month for 4,350 square feet for 12 months.
Rent/Lease Equipment: $19,000 for copier lease, toner and maintenance for 12 months.
Utilities: $15,000 Electricity, Water, Gas, $1,250 per month for 12 months.
Building Maintenance: $22,800 for janitorial services, repairs and maintenance, calculated at $1,900 per month for 12
months.
Equipment purchases: $0
Telephone: $95,468 for staff cell phone reimbursement ($60 per month for 35.5 staff and the director at $100 per
month) Included is $68,708 for landline, internet & phones which includes Wi-Fi for staff tablets.
Office supplies and equipment: $29,382 based on $14,382 for office supplies for 39.95 FTE's and $15,000 for Property
Taxes, business licenses and Joint Commission fees.
Staff Mileage/Vehicle maintenance: $82,563, this is estimated staff travel reimbursement for client visits (IRS mileage
rate @ .58/miles) and for staff travel to training programs, which is based on our experience in administering similar
programs and locations. Based on our experience the 36.50 FTEs will travel approximately 75 miles/FTE per week.
Calculated @ $6,880/month.
Staff Training/Registration: $30,000, which comprise of the on-going program required education, training and materials
for staff and training for DBT/ AF-CBT/ CBT practices. Calculated at $2,500 per month.
Employee Benefits:
Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.). Attach
copy of lease agreements if available.
Identify and detail the expenses for each item utilized for program.
Other: Purchased service: $34,860 which includes start up costs for recruitment of $1,740, on-going staff recruitment,
document shredding, water and coffee service, postage meter rental, Security services and storage facility of $33,120.
Payroll Taxes.
Payroll Taxes: 10% of annual salaries
Admin Clerk: $54,631 for 1.5 FTE, is responsible for insuring the client record within EMR (Electronic Medical Record)
is maintained, physician orders are signed within the prescribed time period, clinical, consultant and discharge
documentation and appointments are scheduled, weekly summary sheets are prepared, and also acts as the
administrative support for the units.
Exhibit D-2
6 of 35
$397,708
Financial Services Expenses – Line Items 1080-1085
$733,138
Special Expenses – Line Items 1090-1092
$193,200
Fixed Assets – Line Items 1190-1193
Liability Insurance: $18,896 for general liability, property and professional liability based on $473 per FTE.
Other: Centralized Program Services: $125,435 is comprised of the SBHG corporate and regional support in the
numerous areas including support from the Senior Administrator as well as services provided for Program Development
and Evaluation (e.g., tracking and reporting outcomes, and implementation of practices), Quality & Compliance (e.g.,
internal chart audits, compliance audits, and TJC-readiness preparation), and Training (e.g., TIP and Core Practice
trainings provided company-wide). There is a significant cost advantage to all the SBHG company programs in sharing
these costs rather than building them into each program. SBHG support provides oversight of all of our programs to
ensure consistency with our standards and policies and procedures. The cost of this support is shared by all programs
and is budgeted 3% of total expenses.
Local and corporate administrative costs are limited to 15% of the total program budget.
Copies of insurance policies are required.
Detail each line item in Special Expenses.
Translation Services $7,200 for annual translation services.
Medication Supports - $186,000, includes Psychiatrist: $141,600 for 59 hours per month at $200 per hour and
Psychologist: $44,400 for 37 hours per month at $100 per hour.
Include all purchases over Five Thousand Dollars ($5,000) including sales tax, and certain purchases under said
amount such as camera, televisions, VCRs/DVDs and other sensitive items, made during the life of the Agreement
resulting from this Request for Proposal, with funds paid pursuant to this Agreement and that will outlive the life of this
Agreement.
Accounting/Bookkeeping: $90,000, this program will be supported and greatly benefit from the experienced and
established local Starlight Community Services organization. There is a large cost advantage to the program in being
supported by Starlight CS in the areas of operations, business office and billing functions. Without the support from an
affiliated organization, the program would need to have dedicated staff for these functions. Additionally any costs
shared with this program will result in savings to the county though lower costs for other Central Star County Programs.
The cost of this support is budgeted at $7,500 per month which is consistent with other programs.
Administrative overhead: Will not exceed 15% of total costs. $401,591 or 10% of total costs is an allocation from Stars
Behavioral Health Group. It covers operations administration, information technology, human resources,
communications, finance, and associated fringe benefits and expenses. SBHG oversight ensures consistency with our
quality standards and policies and procedures. The cost is developed from allocating the SBHG costs among all the
programs within all the SBHG companies based on standard accounting practices. This economy of scale results in a
significant savings for all SBHG programs. Rather than staffing each program for all necessary services above, the
services are performed by fewer employees and then shared among all SBHG programs. $207,067 or 5% of the total
expenses is budgeted as SBHG operating income. Up to 5% of the total expenses will be net income while maintaining
total Administrative/Overhead expenses under 15% of total funding.
External Audit $3,600 for annual audit fees.
Payroll services: $11,984 for payroll processing fees based on $25 per month for 39.95 employees.
Exhibit D-2
7 of 35
Fixed Assets: Includes, equipment purchases: $40,901 for furniture, IT equipment, software and support.
$40,901
Non-Medi-Cal Client Support Expenses – Line Items 2000-2002.8
$2,400
TOTAL PROGRAM EXPENSE:$4,750,000.00
Detail any anticipated expenditures for clients.
Program Supplies $2,400 for client supplies and incentives based on $200 per month - this will cover food for family
meetings and graduation celebrations.
Exhibit D-2
8 of 35
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Program Director 1.00 $101,286 $101,286
0002 Case Managers 9.00 $520,047 $520,047
0003 Mental Health Specialists 21.00 $1,477,091 $1,477,091
0004 Clinical Supervisors 3.00 $227,245 $227,245
0005 Intake Coordinator 2.00 $69,256 $69,256
0006 LVN 0.50 $27,316 $27,316
0007 Administrator 0.25 $29,758 $29,758
0008 Quality Assurance Coordinator 0.40 $21,642 $21,642
0009 Quality Assurance Manager 0.40 $28,135 $28,135
0010 Training Coordinator 0.40 $22,508 $22,508
0011 Human Resource Coordinator 0.50 $27,323 $27,323
0012 Admin Clerk 1.50 $55,724 $55,724
SALARY TOTAL 39.95 $185,091 $2,422,240 $2,607,331
PAYROLL TAXES:
0030 Payroll Taxes $18,509 $242,224 $260,733
PAYROLL TAX TOTAL $18,509 $242,224 $260,733
EMPLOYEE BENEFITS:
0040 Retirement/Workers Comp/Health Insurance $31,928 $417,836 $449,765
EMPLOYEE BENEFITS TOTAL $31,928 $417,836 $449,765
SALARY & BENEFITS GRAND TOTAL $3,317,829
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $74,542
1011 Rent/Lease Equipment $19,380
1012 Utilities $15,300
1013 Building Maintenance $23,256
1014 Equipment purchase $0
FACILITY/EQUIPMENT TOTAL $132,478
OPERATING EXPENSES:
1060 Telephone $97,377
1061 Answering Service $0
1062 Postage $0
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
Central Star Behavioral Health, Inc
FY 2020-2021
Budget Categories - Total Proposed Budget
Exhibit D-2
9 of 35
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $28,722
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies - Therapeutic $0
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $84,214
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $30,600
1075 Lodging $0
1076 Other - Purchased Services $33,782
1077 Other - Centralized services - program $121,618
OPERATING EXPENSES TOTAL $396,314
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $91,800
1081 External Audit $3,672
1082 Liability Insurance $19,274
1083 Administrative Overhead $574,449
1084 Payroll Services $12,225
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $701,420
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$0
1091 Translation Services $7,344
1092 Medication Supports $189,720
SPECIAL EXPENSES TOTAL $197,064
FIXED ASSETS:
1190 Computers & Software $2,448
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $2,448
Exhibit D-2
10 of 35NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2002.2 Client Transportation & Support (SFC 72)$2,448
NON MEDI-CAL CLIENT SUPPORT TOTAL $2,448
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)471,977 $2.81 $1,326,255
3100 Case Management 340,015 $2.17 $737,833
3200 Crisis Intervention 2,654 $4.17 $11,067
3300 Medication Support 35,610 $5.18 $184,458
3400 Collateral 311,807 $2.81 $876,177
3500 Plan Development 32,822 $2.81 $92,229
3600 Assessment 49,233 $2.81 $138,344
3700 Rehabilitation 32,822 $2.81 $92,229
3800 ICC 212,510 $2.17 $461,146
3900 IHBS 246,163 $2.81 $691,719
Estimated Specialty Mental Health Services Billing Totals 1,735,612 $4,611,458
Estimated % of Clients that are Medi-Cal Beneficiaries 97%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,473,114
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,236,557
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,236,557
MEDI-CAL REVENUE TOTAL $4,473,114
OTHER REVENUE: Social Services Revenue
4100 Psychological Evaluations 15,866 2.81 $44,584
4200 Court Documentation, Reports 29,388 2.81 $82,581
4300 Non-MediCal Clients (Mental Health Services)41,153 2.81 $115,641
4400 Non-MediCal Clients (Case Management)15,705 2.17 $34,080
4500 Non-MediCal Clients (Crisis Intervention)85 4.17 $354
4600 Non-MediCal Clients (Medical Support)902 5.81 $5,243
OTHER REVENUE TOTAL $276,886
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-2
11 of 35
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
Administrator: $29,758 for .25 FTE, has a direct responsibility for the Community Service program and will report to
Regional Administrator, will ensure operational, clinical and regulatory requirements are met. He/she will directly
supervise the Program Director.
QA Coordinator: $21,642 for .40 FTE, is responsible for utilization review and assisting in medical record
management by gathering and analyzing agency data and assisting in the agency’s quality control, quality assurance,
and quality improvement efforts.
QA Manager: $28,135 for .40 FTE, manages all Quality Assurance tasks for the program, which includes records
management, documentation and service audits for compliance to Medi-Cal and internal requirements.
Training Coordinator: $22,508 for .40 FTE, assists in the development, coordination, delivery and administration of
agency training programs.
Human Resources Coordinator: $27,323 for .50 FTE, manages all human resource clerical and administrative tasks
for the program staff. This position is responsible for supporting the development of a positive working environment to
enhance agency success and reduce legal risk, as well as management team support and consultation, employee
relations, interpretation and administration of HR policies and procedures, staff recruitment and selection,
compensation, and employee benefits etc.
LVN: $27,316 for $0.5 FTE, provides direct client care including medications, and supervises nursing activities
performed by professional and para-professional nursing personnel on the unit.
CHILD WELFARE MENTAL HEALTH SERVICES
Central Star Behavioral Health Inc.
FY 2020 - 2021
BUDGET NARRATIVE - EXPENSES
These amounts reflect FTE positions, part-time positions and whether the positions are administrative or direct
service. Employee benefits should be limited to a maximum of 20% of total salaries.
Program Director: $101,286 for 1.0 FTE, this position oversees program management and maintains in compliance
with contract and legal requirements.
Case Manager: $520,047 for 9.0 FTE, will provide case management activities to assist individuals at risk or
indicating symptoms of mental health problems to ensure access to needed medical, rehabilitative, and other needed
services and resources. Case Manager will work to identify and link individuals to resources and related supports,
monitor service delivery to ensure access to care. Case Manager will provide person-to-person case management
support to address barriers to treatment and will support individuals connecting with appropriate mental health
resources. Case Managers will provide individualized attention, as well as services and supports as needed.
Mental Health Specialist 1/II: $1,477,091 for 21 FTE's, provides initial and ongoing assessment; develops EPSDT
plan. Provides individual and family trauma-informed mental health services and therapy. Provides clinical support
and information to CFTs, as CFT and ICC team member. Documents and bills for services, and completes outcomes
information.
Clinical Supervisor: $227,245 for 3.0 FTE, under general direction, supervises Specialty Mental Health Services, and
the work of license-eligible therapists in accordance with BBS requirements. May also provide individual mental health
services.
Intake Coordinator: $69,256 for 2.0 FTE, processes referrals, consent packets, and paperwork, etc.
Exhibit D-2
12 of 35
$2,607,331
$260,733
$449,764
Facilities/Equipment Expenses – Line Items 1010-1014
$132,478
Operating Expenses - Line Items 1060-1077
Rent/Lease Equipment: $19,380 for copier lease, toner and maintenance for 12 months.
Utilities: $15,300 Electricity, Water, Gas, $1,275 per month for 12 months.
Building Maintenance: $23,256 for janitorial services, repairs and maintenance, calculated at $1,938 per month for 12
months.
Equipment purchases: $0
Identify and detail the expenses for each item utilized for program.
Telephone: $97,377 for staff cell phone reimbursement ($60 per month for 35.5 staff and the director at $100 per
month) Included is $70,617 for landline, internet & phones which includes Wi-Fi for staff tablets.
Office supplies and equipment: $28,722 based on $13,422 for office supplies for 39.95 FTE's and $15,300 for
Property Taxes, business licenses and Joint Commission fees.
Staff Mileage/Vehicle maintenance: $84,214, this is estimated staff travel reimbursement for client visits (IRS mileage
rate @ .58/miles) and for staff travel to training programs, which is based on our experience in administering similar
programs and locations. Based on our experience the 36.50 FTEs will travel approximately 75 miles/FTE per week.
Calculated @ $7,018/month.
Staff Training/Registration: $30,600, which comprise of the on-going program required education, training and
materials for staff and training for DBT/ AF-CBT/ CBT practices. Calculated at $2,550 per month.
Other: Purchased service: $33,783 which includes $2,203 on-going staff recruitment, document shredding, water
and coffee service, postage meter rental, Security services and storage facility of $31,579.
Rent/Lease Building: $74,542, is calculated at $1.43 per square foot per month for 4,350 square feet for 12 months.
Admin Clerk: $55,724 for 1.5 FTE, is responsible for insuring the client record within EMR (Electronic Medical
Record) is maintained, physician orders are signed within the prescribed time period, clinical, consultant and
discharge documentation and appointments are scheduled, weekly summary sheets are prepared, and also acts as
the administrative support for the units.
Payroll Taxes.
Payroll Taxes: 10% of annual salaries
Employee Benefits:
Retirement/Worker Compensation/Health Insurance: 17.25% of annual salaries
Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.). Attach
copy of lease agreements if available.
Exhibit D-2
13 of 35
$396,314
Financial Services Expenses – Line Items 1080-1085
$701,420
Special Expenses – Line Items 1090-1092
$197,064
Fixed Assets – Line Items 1190-1193
Fixed Assets: Includes, equipment purchases: $2,448 for IT equipment, software and support.
$2,448
Accounting/Bookkeeping: $91,800, this program will be supported and greatly benefit from the experienced and
established local Starlight Community Services organization. There is a large cost advantage to the program in being
supported by Starlight CS in the areas of operations, business office and billing functions. Without the support from
an affiliated organization, the program would need to have dedicated staff for these functions. Additionally any costs
shared with this program will result in savings to the county though lower costs for other Central Star County
Programs. The cost of this support is budgeted at $7,650 per month which is consistent with other programs.
External Audit $3,672 for annual audit fees.
Liability Insurance: $19,274 for general liability, property and professional liability based on $473 per FTE.
Administrative overhead: Will not exceed 15% of total costs. $365,671 or 9% of total costs is an allocation from Stars
Behavioral Health Group. It covers operations administration, information technology, human resources,
communications, finance, and associated fringe benefits and expenses. SBHG oversight ensures consistency with
our quality standards and policies and procedures. The cost is developed from allocating the SBHG costs among all
the programs within all the SBHG companies based on standard accounting practices. This economy of scale results
in a significant savings for all SBHG programs. Rather than staffing each program for all necessary services above,
the services are performed by fewer employees and then shared among all SBHG programs. $208,778 or 5% of the
total expenses is budgeted as SBHG operating income. Up to 5% of the total expenses will be net income while
maintaining total Administrative/Overhead expenses under 15% of total funding.
Payroll services: $12,225 for payroll processing fees based on $25.5 per month for 39.95 employees.
Detail each line item in Special Expenses.
Translation Services $7,344 for annual translation services.
Medication Supports - $189,720, includes Psychiatrist: $144,432 for 59 hours per month at $204 per hour and
Psychologist: $45,288 for 37 hours per month at $102 per hour.
Include all purchases over Five Thousand Dollars ($5,000) including sales tax, and certain purchases under said
amount such as camera, televisions, VCRs/DVDs and other sensitive items, made during the life of the Agreement
resulting from this Request for Proposal, with funds paid pursuant to this Agreement and that will outlive the life of this
Agreement.
Local and corporate administrative costs are limited to 15% of the total program budget.
Copies of insurance policies are required.
Other: Centralized Program Services: $121,618 is comprised of the SBHG corporate and regional support in the
numerous areas including support from the Senior Administrator as well as services provided for Program
Development and Evaluation (e.g., tracking and reporting outcomes, and implementation of practices), Quality &
Compliance (e.g., internal chart audits, compliance audits, and TJC-readiness preparation), and Training (e.g., TIP
and Core Practice trainings provided company-wide). There is a significant cost advantage to all the SBHG company
programs in sharing these costs rather than building them into each program. SBHG support provides oversight of all
of our programs to ensure consistency with our standards and policies and procedures. The cost of this support is
shared by all programs and is budgeted 3% of total expenses.
Exhibit D-2
14 of 35
Non-Medi-Cal Client Support Expenses – Line Items 2000-2002.8
$2,448
TOTAL PROGRAM EXPENSE:$4,750,000.00
Detail any anticipated expenditures for clients.
Program Supplies $2,448 for client supplies and incentives based on $204 per month - this will cover food for family
meetings and graduation celebrations.
Exhibit D-2
15 of 35
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Program Director 1.00 $103,312 $103,312
0002 Case Managers 8.00 $471,509 $471,509
0003 Mental Health Specialists 21.00 $1,506,633 $1,506,633
0004 Clinical Supervisors 3.00 $231,790 $231,790
0005 Intake Coordinator 2.00 $70,641 $70,641
0006 LVN 0.50 $27,862 $27,862
0007 Administrator 0.25 $30,353 $30,353
0008 Quality Assurance Coordinator 0.40 $22,075 $22,075
0009 Quality Assurance Manager 0.40 $28,698 $28,698
0010 Training Coordinator 0.40 $22,958 $22,958
0011 Human Resource Coordinator 0.50 $27,870 $27,870
0012 Admin Clerk 1.50 $56,838 $56,838
SALARY TOTAL 38.95 $188,793 $2,411,746 $2,600,539
PAYROLL TAXES:
0030 Payroll Taxes $18,879 $241,175 $260,054
PAYROLL TAX TOTAL $18,879 $241,175 $260,054
EMPLOYEE BENEFITS:
0040 Retirement/Workers Comp/Health Insurance $32,567 $416,026 $448,593
EMPLOYEE BENEFITS TOTAL $32,567 $416,026 $448,593
SALARY & BENEFITS GRAND TOTAL $3,309,186
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $76,032
1011 Rent/Lease Equipment $19,768
1012 Utilities $15,606
1013 Building Maintenance $23,721
1014 Equipment purchase $0
FACILITY/EQUIPMENT TOTAL $135,127
OPERATING EXPENSES:
1060 Telephone $99,325
1061 Answering Service $0
1062 Postage $0
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
Central Star Behavioral Health, Inc
FY 2021-2022
Budget Categories - Total Proposed Budget
Exhibit D-2
16 of 35
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $29,256
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies - Therapeutic $0
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $85,899
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $31,212
1075 Lodging $0
1076 Other - Purchased Services $34,458
1077 Other - Centralized services - program $98,079
OPERATING EXPENSES TOTAL $378,228
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $93,636
1081 External Audit $3,745
1082 Liability Insurance $19,660
1083 Administrative Overhead $591,949
1084 Payroll Services $12,469
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $721,460
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$0
1091 Translation Services $7,491
1092 Medication Supports $193,514
SPECIAL EXPENSES TOTAL $201,005
FIXED ASSETS:
1190 Computers & Software $2,497
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $2,497
Exhibit D-2
17 of 35NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2002.2 Client Transportation & Support (SFC 72)$2,497
NON MEDI-CAL CLIENT SUPPORT TOTAL $2,497
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)471,977 $2.81 $1,326,255
3100 Case Management 340,015 $2.17 $737,833
3200 Crisis Intervention 2,654 $4.17 $11,067
3300 Medication Support 35,610 $5.18 $184,458
3400 Collateral 311,807 $2.81 $876,177
3500 Plan Development 32,822 $2.81 $92,229
3600 Assessment 49,233 $2.81 $138,344
3700 Rehabilitation 32,822 $2.81 $92,229
3800 ICC 212,510 $2.17 $461,146
3900 IHBS 246,163 $2.81 $691,719
Estimated Specialty Mental Health Services Billing Totals 1,735,612 $4,611,458
Estimated % of Clients that are Medi-Cal Beneficiaries 97%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,473,114
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,236,557
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,236,557
MEDI-CAL REVENUE TOTAL $4,473,114
OTHER REVENUE: Social Services Revenue
4100 Psychological Evaluations 15,866 2.81 $44,584
4200 Court Documentation, Reports 29,388 2.81 $82,581
4300 Non-MediCal Clients (Mental Health Services)41,153 2.81 $115,641
4400 Non-MediCal Clients (Case Management)15,705 2.17 $34,080
4500 Non-MediCal Clients (Crisis Intervention)85 4.17 $354
4600 Non-MediCal Clients (Medical Support)902 5.81 $5,243
OTHER REVENUE TOTAL $276,886
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-2
18 of 35
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
Case Manager: $471,509 for 8.0 FTE, will provide case management activities to assist individuals at risk or
indicating symptoms of mental health problems to ensure access to needed medical, rehabilitative, and other needed
services and resources. Case Manager will work to identify and link individuals to resources and related supports,
monitor service delivery to ensure access to care. Case Manager will provide person-to-person case management
support to address barriers to treatment and will support individuals connecting with appropriate mental health
resources. Case Managers will provide individualized attention, as well as services and supports as needed.
Mental Health Specialist 1/II: $1,506,633 for 21 FTE's, provides initial and ongoing assessment; develops EPSDT
plan. Provides individual and family trauma-informed mental health services and therapy. Provides clinical support
and information to CFTs, as CFT and ICC team member. Documents and bills for services, and completes outcomes
information.
Clinical Supervisor: $231,790 for 3.0 FTE, under general direction, supervises Specialty Mental Health Services, and
the work of license-eligible therapists in accordance with BBS requirements. May also provide individual mental
health services.
Intake Coordinator: $70,641 for 2.0 FTE, processes referrals, consent packets, and paperwork, etc.
LVN: $27,862 for $0.5 FTE, provides direct client care including medications, and supervises nursing activities
performed by professional and para-professional nursing personnel on the unit.
Administrator: $30,353 for .25 FTE, has a direct responsibility for the Community Service program and will report to
Regional Administrator, will ensure operational, clinical and regulatory requirements are met. He/she will directly
supervise the Program Director.
QA Coordinator: $22,075 for .40 FTE, is responsible for utilization review and assisting in medical record
management by gathering and analyzing agency data and assisting in the agency’s quality control, quality
assurance, and quality improvement efforts.
QA Manager: $28,698 for .40 FTE, manages all Quality Assurance tasks for the program, which includes records
management, documentation and service audits for compliance to Medi-Cal and internal requirements.
Training Coordinator: $22,958 for .40 FTE, assists in the development, coordination, delivery and administration of
agency training programs.
Human Resources Coordinator: $27,870 for .50 FTE, manages all human resource clerical and administrative tasks
for the program staff. This position is responsible for supporting the development of a positive working environment
to enhance agency success and reduce legal risk, as well as management team support and consultation, employee
relations, interpretation and administration of HR policies and procedures, staff recruitment and selection,
compensation, and employee benefits etc.
Program Director: $103,312 for 1.0 FTE, this position oversees program management and maintains in compliance
with contract and legal requirements.
CHILD WELFARE MENTAL HEALTH SERVICES
Central Star Behavioral Health Inc.
FY 2021 - 2022
BUDGET NARRATIVE - EXPENSES
These amounts reflect FTE positions, part-time positions and whether the positions are administrative or direct
service. Employee benefits should be limited to a maximum of 20% of total salaries.
Exhibit D-2
19 of 35
$2,600,539
$260,054
$448,593
Facilities/Equipment Expenses – Line Items 1010-1014
$135,127
Operating Expenses - Line Items 1060-1077
Staff Mileage/Vehicle maintenance: $85,899, this is estimated staff travel reimbursement for client visits (IRS mileage
rate @ .58/miles) and for staff travel to training programs, which is based on our experience in administering similar
programs and locations. Based on our experience the 34.50 FTEs will travel approximately 75 miles/FTE per week.
Calculated @ $7,158/month.
Staff Training/Registration: $31,212, which comprise of the on-going program required education, training and
materials for staff and training for DBT/ AF-CBT/ CBT practices. Calculated at $2,601 per month.
Other: Purchased service: $34,458 which includes $2,247 on-going staff recruitment, document shredding, water
and coffee service, postage meter rental, Security services and storage facility of $32,211.
Office supplies and equipment: $29,256 based on $13,650 for office supplies for 38.95 FTE's and $15,606 for
Property Taxes, business licenses and Joint Commission fees.
Payroll Taxes: 10% of annual salaries
Employee Benefits:
Retirement/Worker Compensation/Health Insurance: 17.25% of annual salaries
Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.).
Attach copy of lease agreements if available.
Rent/Lease Building: $76,032, is calculated at $1.46 per square foot per month for 4,350 square feet for 12 months.
Rent/Lease Equipment: $19,768 for copier lease, toner and maintenance for 12 months.
Utilities: $15,606 Electricity, Water, Gas, $1,300 per month for 12 months.
Building Maintenance: $23,721 for janitorial services, repairs and maintenance, calculated at $1,977 per month for 12
months.
Equipment purchases: $0
Identify and detail the expenses for each item utilized for program.
Telephone: $99,325 for staff cell phone reimbursement ($60 per month for 34.5 staff and the director at $100 per
month) Included is $73,285 for landline, internet & phones which includes Wi-Fi for staff tablets.
Payroll Taxes.
Admin Clerk: $56,838 for 1.5 FTE, is responsible for insuring the client record within EMR (Electronic Medical
Record) is maintained, physician orders are signed within the prescribed time period, clinical, consultant and
discharge documentation and appointments are scheduled, weekly summary sheets are prepared, and also acts as
the administrative support for the units.
Exhibit D-2
20 of 35
$378,228
Financial Services Expenses – Line Items 1080-1085
$721,460
Special Expenses – Line Items 1090-1092
$201,005
Fixed Assets – Line Items 1190-1193
Fixed Assets: Includes, equipment purchases: $2,497 for IT equipment, software and support.
$2,497
Medication Supports - $193,514, includes Psychiatrist: $147,321 for 59 hours per month at $208 per hour and
Psychologist: $46,194 for 37 hours per month at $104 per hour.
Include all purchases over Five Thousand Dollars ($5,000) including sales tax, and certain purchases under said
amount such as camera, televisions, VCRs/DVDs and other sensitive items, made during the life of the Agreement
resulting from this Request for Proposal, with funds paid pursuant to this Agreement and that will outlive the life of
this Agreement.
Translation Services $7,491 for annual translation services.
Other: Centralized Program Services: $98,078 is comprised of the SBHG corporate and regional support in the
numerous areas including support from the Senior Administrator as well as services provided for Program
Development and Evaluation (e.g., tracking and reporting outcomes, and implementation of practices), Quality &
Compliance (e.g., internal chart audits, compliance audits, and TJC-readiness preparation), and Training (e.g., TIP
and Core Practice trainings provided company-wide). There is a significant cost advantage to all the SBHG company
programs in sharing these costs rather than building them into each program. SBHG support provides oversight of all
of our programs to ensure consistency with our standards and policies and procedures. The cost of this support is
shared by all programs and is budgeted 2.42% of total expenses.
Local and corporate administrative costs are limited to 15% of the total program budget.
Copies of insurance policies are required.
Accounting/Bookkeeping: $93,636, this program will be supported and greatly benefit from the experienced and
established local Starlight Community Services organization. There is a large cost advantage to the program in being
supported by Starlight CS in the areas of operations, business office and billing functions. Without the support from
an affiliated organization, the program would need to have dedicated staff for these functions. Additionally any costs
shared with this program will result in savings to the county though lower costs for other Central Star County
Programs. The cost of this support is budgeted at $7,803 per month which is consistent with other programs.
External Audit $3,745 for annual audit fees.
Liability Insurance: $19,660 for general liability, property and professional liability based on $473 per FTE.
Administrative overhead: Will not exceed 15% of total costs. $384,047 or 9.46% of total costs is an allocation from
Stars Behavioral Health Group. It covers operations administration, information technology, human resources,
communications, finance, and associated fringe benefits and expenses. SBHG oversight ensures consistency with
our quality standards and policies and procedures. The cost is developed from allocating the SBHG costs among all
the programs within all the SBHG companies based on standard accounting practices. This economy of scale results
in a significant savings for all SBHG programs. Rather than staffing each program for all necessary services above,
the services are performed by fewer employees and then shared among all SBHG programs. $207,903 or 5% of the
total expenses is budgeted as SBHG operating income. Up to 5% of the total expenses will be net income while
maintaining total Administrative/Overhead expenses under 15% of total funding.
Payroll services: $12,469 for payroll processing fees based on $26.7 per month for 38.95 employees.
Detail each line item in Special Expenses.
Exhibit D-2
21 of 35
Non-Medi-Cal Client Support Expenses – Line Items 2000-2002.8
$2,497
Detail any anticipated expenditures for clients.
Program Supplies $2,497 for client supplies and incentives based on $208 per month - this will cover food for family
meetings and graduation celebrations.
TOTAL PROGRAM EXPENSE:$4,750,000.00
Exhibit D-2
22 of 35
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Program Director 1.00 $105,378 $105,378
0002 Case Managers 8.00 $480,939 $480,939
0003 Mental Health Specialists 20.00 $1,463,586 $1,463,586
0004 Clinical Supervisors 3.00 $236,425 $236,425
0005 Intake Coordinator 2.00 $72,053 $72,053
0006 LVN 0.50 $28,419 $28,419
0007 Administrator 0.25 $30,960 $30,960
0008 Quality Assurance Coordinator 0.40 $22,517 $22,517
0009 Quality Assurance Manager 0.40 $29,272 $29,272
0010 Training Coordinator 0.40 $23,417 $23,417
0011 Human Resource Coordinator 0.50 $28,427 $28,427
0012 Admin Clerk 1.50 $57,975 $57,975
SALARY TOTAL 37.95 $192,569 $2,386,802 $2,579,370
PAYROLL TAXES:
0030 Payroll Taxes $19,257 $238,680 $257,937
PAYROLL TAX TOTAL $19,257 $238,680 $257,937
EMPLOYEE BENEFITS:
0040 Retirement/Workers Comp/Health Insurance $33,218 $411,723 $444,941
EMPLOYEE BENEFITS TOTAL $33,218 $411,723 $444,941
SALARY & BENEFITS GRAND TOTAL $3,282,249
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $77,553
1011 Rent/Lease Equipment $20,163
1012 Utilities $15,918
1013 Building Maintenance $24,196
1014 Equipment purchase $0
FACILITY/EQUIPMENT TOTAL $137,830
OPERATING EXPENSES:
1060 Telephone $101,311
1061 Answering Service $0
1062 Postage $0
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
Central Star Behavioral Health, Inc
FY 2022-2023
Budget Categories - Total Proposed Budget
Exhibit D-2
23 of 35
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $29,841
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies - Therapeutic $0
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $87,617
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $31,836
1075 Lodging $0
1076 Other - Purchased Services $35,147
1077 Other - Centralized services - program $101,201
OPERATING EXPENSES TOTAL $386,954
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $95,509
1081 External Audit $3,820
1082 Liability Insurance $20,053
1083 Administrative Overhead $600,747
1084 Payroll Services $12,719
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $732,848
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$0
1091 Translation Services $7,641
1092 Medication Supports $197,385
SPECIAL EXPENSES TOTAL $205,025
FIXED ASSETS:
1190 Computers & Software $2,547
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $2,547
Exhibit D-2
24 of 35NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2002.2 Client Transportation & Support (SFC 72)$2,547
NON MEDI-CAL CLIENT SUPPORT TOTAL $2,547
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)471,977 $2.81 $1,326,255
3100 Case Management 340,015 $2.17 $737,833
3200 Crisis Intervention 2,654 $4.17 $11,067
3300 Medication Support 35,610 $5.18 $184,458
3400 Collateral 311,807 $2.81 $876,177
3500 Plan Development 32,822 $2.81 $92,229
3600 Assessment 49,233 $2.81 $138,344
3700 Rehabilitation 32,822 $2.81 $92,229
3800 ICC 212,510 $2.17 $461,146
3900 IHBS 246,163 $2.81 $691,719
Estimated Specialty Mental Health Services Billing Totals 1,735,612 $4,611,458
Estimated % of Clients that are Medi-Cal Beneficiaries 97%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,473,114
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,236,557
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,236,557
MEDI-CAL REVENUE TOTAL $4,473,114
OTHER REVENUE: Social Services Revenue
4100 Psychological Evaluations 15,866 2.81 $44,584
4200 Court Documentation, Reports 29,388 2.81 $82,581
4300 Non-MediCal Clients (Mental Health Services)41,153 2.81 $115,641
4400 Non-MediCal Clients (Case Management)15,705 2.17 $34,080
4500 Non-MediCal Clients (Crisis Intervention)85 4.17 $354
4600 Non-MediCal Clients (Medical Support)902 5.81 $5,243
OTHER REVENUE TOTAL $276,886
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-2
25 of 35
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
Case Manager: $480,939 for 8.0 FTE, will provide case management activities to assist individuals at risk or indicating
symptoms of mental health problems to ensure access to needed medical, rehabilitative, and other needed services
and resources. Case Manager will work to identify and link individuals to resources and related supports, monitor
service delivery to ensure access to care. Case Manager will provide person-to-person case management support to
address barriers to treatment and will support individuals connecting with appropriate mental health resources. Case
Managers will provide individualized attention, as well as services and supports as needed.
Mental Health Specialist 1/II: $1,463,586 for 20 FTE's, provides initial and ongoing assessment; develops EPSDT plan.
Provides individual and family trauma-informed mental health services and therapy. Provides clinical support and
information to CFTs, as CFT and ICC team member. Documents and bills for services, and completes outcomes
information.
Clinical Supervisor: $236,425 for 3.0 FTE, under general direction, supervises Specialty Mental Health Services, and
the work of license-eligible therapists in accordance with BBS requirements. May also provide individual mental health
services.
Intake Coordinator: $72,054 for 2.0 FTE, processes referrals, consent packets, and paperwork, etc.
LVN: $28,419 for $0.5 FTE, provides direct client care including medications, and supervises nursing activities
performed by professional and para-professional nursing personnel on the unit.
Administrator: $30,960 for .25 FTE, has a direct responsibility for the Community Service program and will report to
Regional Administrator, will ensure operational, clinical and regulatory requirements are met. He/she will directly
supervise the Program Director.
QA Coordinator: $22,517 for .40 FTE, is responsible for utilization review and assisting in medical record management
by gathering and analyzing agency data and assisting in the agency’s quality control, quality assurance, and quality
improvement efforts.
QA Manager: $29,272 for .40 FTE, manages all Quality Assurance tasks for the program, which includes records
management, documentation and service audits for compliance to Medi-Cal and internal requirements.
Training Coordinator: $23,417 for .40 FTE, assists in the development, coordination, delivery and administration of
agency training programs.
Program Director: $105,378 for 1.0 FTE, this position oversees program management and maintains in compliance
with contract and legal requirements.
CHILD WELFARE MENTAL HEALTH SERVICES
Central Star Behavioral Health Inc.
FY 2022 - 2023
BUDGET NARRATIVE - EXPENSES
These amounts reflect FTE positions, part-time positions and whether the positions are administrative or direct service.
Employee benefits should be limited to a maximum of 20% of total salaries.
Exhibit D-2
26 of 35
$2,579,370
$257,937
$444,941
Facilities/Equipment Expenses – Line Items 1010-1014
$137,830
Operating Expenses - Line Items 1060-1077
Staff Mileage/Vehicle maintenance: $87,617, this is estimated staff travel reimbursement for client visits (IRS mileage
rate @ .58/miles) and for staff travel to training programs, which is based on our experience in administering similar
programs and locations. Based on our experience the 34.50 FTEs will travel approximately 75 miles/FTE per week.
Calculated @ $7,301/month.
Staff Training/Registration: $31,836, which comprise of the on-going program required education, training and
materials for staff and training for DBT/ AF-CBT/ CBT practices. Calculated at $2,653 per month.
Other: Purchased service: $35,147 which includes $2,292 on-going staff recruitment, document shredding, water and
coffee service, postage meter rental, Security services and storage facility of $32,855.
Office supplies and equipment: $29,841 based on $13,923 for office supplies for 37.95 FTE's and $15,918 for Property
Taxes, business licenses and Joint Commission fees.
Payroll Taxes: 10% of annual salaries
Employee Benefits:
Retirement/Worker Compensation/Health Insurance: 17.25% of annual salaries
Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.).
Attach copy of lease agreements if available.
Rent/Lease Building: $77,553, is calculated at $1.49 per square foot per month for 4,350 square feet for 12 months.
Rent/Lease Equipment: $20,163 for copier lease, toner and maintenance for 12 months.
Utilities: $15,918 Electricity, Water, Gas, $1,327 per month for 12 months.
Building Maintenance: $24,196 for janitorial services, repairs and maintenance, calculated at $2,016 per month for 12
months.
Equipment purchases: $0
Identify and detail the expenses for each item utilized for program.
Telephone: $101,311 for staff cell phone reimbursement ($60 per month for 33.5 staff and the director at $100 per
month) Included is $75,991 for landline, internet & phones which includes Wi-Fi for staff tablets.
Payroll Taxes.
Human Resources Coordinator: $28,427 for .50 FTE, manages all human resource clerical and administrative tasks for
the program staff. This position is responsible for supporting the development of a positive working environment to
enhance agency success and reduce legal risk, as well as management team support and consultation, employee
relations, interpretation and administration of HR policies and procedures, staff recruitment and selection,
compensation, and employee benefits etc.
Admin Clerk: $57,975 for 1.5 FTE, is responsible for insuring the client record within EMR (Electronic Medical Record)
is maintained, physician orders are signed within the prescribed time period, clinical, consultant and discharge
documentation and appointments are scheduled, weekly summary sheets are prepared, and also acts as the
administrative support for the units.
Exhibit D-2
27 of 35
$386,953
Financial Services Expenses – Line Items 1080-1085
$732,849
Special Expenses – Line Items 1090-1092
$205,026
Fixed Assets – Line Items 1190-1193
Fixed Assets: Includes, equipment purchases: $2,497 for IT equipment, software and support.
$2,547
Medication Supports - $197,385, includes Psychiatrist: $150,267 for 59 hours per month at $212 per hour and
Psychologist: $47,118 for 37 hours per month at $106 per hour.
Include all purchases over Five Thousand Dollars ($5,000) including sales tax, and certain purchases under said
amount such as camera, televisions, VCRs/DVDs and other sensitive items, made during the life of the Agreement
resulting from this Request for Proposal, with funds paid pursuant to this Agreement and that will outlive the life of this
Agreement.
Translation Services $7,641 for annual translation services.
Other: Centralized Program Services: $101,201 is comprised of the SBHG corporate and regional support in the
numerous areas including support from the Senior Administrator as well as services provided for Program
Development and Evaluation (e.g., tracking and reporting outcomes, and implementation of practices), Quality &
Compliance (e.g., internal chart audits, compliance audits, and TJC-readiness preparation), and Training (e.g., TIP and
Core Practice trainings provided company-wide). There is a significant cost advantage to all the SBHG company
programs in sharing these costs rather than building them into each program. SBHG support provides oversight of all
of our programs to ensure consistency with our standards and policies and procedures. The cost of this support is
shared by all programs and is budgeted 2.50% of total expenses.
Local and corporate administrative costs are limited to 15% of the total program budget.
Copies of insurance policies are required.
Accounting/Bookkeeping: $95,509, this program will be supported and greatly benefit from the experienced and
established local Starlight Community Services organization. There is a large cost advantage to the program in being
supported by Starlight CS in the areas of operations, business office and billing functions. Without the support from an
affiliated organization, the program would need to have dedicated staff for these functions. Additionally any costs
shared with this program will result in savings to the county though lower costs for other Central Star County Programs.
The cost of this support is budgeted at $7,803 per month which is consistent with other programs.
External Audit $3,820 for annual audit fees.
Liability Insurance: $20,053 for general liability, property and professional liability based on $473 per FTE.
Administrative overhead: Will not exceed 15% of total costs. $393,285 or 9.72% of total costs is an allocation from
Stars Behavioral Health Group. It covers operations administration, information technology, human resources,
communications, finance, and associated fringe benefits and expenses. SBHG oversight ensures consistency with our
quality standards and policies and procedures. The cost is developed from allocating the SBHG costs among all the
programs within all the SBHG companies based on standard accounting practices. This economy of scale results in a
significant savings for all SBHG programs. Rather than staffing each program for all necessary services above, the
services are performed by fewer employees and then shared among all SBHG programs. $207,463 or 5% of the total
expenses is budgeted as SBHG operating income. Up to 5% of the total expenses will be net income while maintaining
total Administrative/Overhead expenses under 15% of total funding.
Payroll services: $12,719 for payroll processing fees based on $30 per month for 37.95 employees.
Detail each line item in Special Expenses.
Exhibit D-2
28 of 35Non-Medi-Cal Client Support Expenses – Line Items 2000-2002.8
$2,547
Detail any anticipated expenditures for clients.
Program Supplies $2,547 for client supplies and incentives based on $212 per month - this will cover food for family
meetings and graduation celebrations.
TOTAL PROGRAM EXPENSE:$4,750,000.00
Exhibit D-2
29 of 35
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Program Director 1.00 $107,486 $107,486
0002 Case Managers 8.00 $490,558 $490,558
0003 Mental Health Specialists 20.00 $1,492,858 $1,492,858
0004 Clinical Supervisors 3.00 $241,154 $241,154
0005 Intake Coordinator 2.00 $73,495 $73,495
0006 LVN 0.50 $28,988 $28,988
0007 Administrator 0.25 $31,580 $31,580
0008 Quality Assurance Coordinator 0.40 $22,967 $22,967
0009 Quality Assurance Manager 0.40 $29,857 $29,857
0010 Training Coordinator 0.40 $23,886 $23,886
0011 Human Resource Coordinator 0.50 $28,996 $28,996
0012 Admin Clerk 1.50 $59,135 $59,135
SALARY TOTAL 37.95 $196,420 $2,434,538 $2,630,958
PAYROLL TAXES:
0030 Payroll Taxes $19,642 $243,454 $263,096
PAYROLL TAX TOTAL $19,642 $243,454 $263,096
EMPLOYEE BENEFITS:
0040 Retirement/Workers Comp/Health Insurance $33,882 $419,958 $453,840
EMPLOYEE BENEFITS TOTAL $33,882 $419,958 $453,840
SALARY & BENEFITS GRAND TOTAL $3,347,894
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $79,104
1011 Rent/Lease Equipment $20,566
1012 Utilities $16,236
1013 Building Maintenance $24,679
1014 Equipment purchase $0
FACILITY/EQUIPMENT TOTAL $140,586
OPERATING EXPENSES:
1060 Telephone $103,338
1061 Answering Service $0
1062 Postage $0
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
Central Star Behavioral Health, Inc
FY 2023-2024
Budget Categories - Total Proposed Budget
Exhibit D-2
30 of 35
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $30,438
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies - Therapeutic $0
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $89,369
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $32,473
1075 Lodging $0
1076 Other - Purchased Services $35,850
1077 Other - Centralized services - program $81,756
OPERATING EXPENSES TOTAL $373,224
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $97,419
1081 External Audit $3,897
1082 Liability Insurance $20,454
1083 Administrative Overhead $539,232
1084 Payroll Services $12,973
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $673,975
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$0
1091 Translation Services $7,794
1092 Medication Supports $201,332
SPECIAL EXPENSES TOTAL $209,126
FIXED ASSETS:
1190 Computers & Software $2,598
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $2,598
Exhibit D-2
31 of 35NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2002.2 Client Transportation & Support (SFC 72)$2,597
NON MEDI-CAL CLIENT SUPPORT TOTAL $2,597
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)471,977 $2.81 $1,326,255
3100 Case Management 340,015 $2.17 $737,833
3200 Crisis Intervention 2,654 $4.17 $11,067
3300 Medication Support 35,610 $5.18 $184,458
3400 Collateral 311,807 $2.81 $876,177
3500 Plan Development 32,822 $2.81 $92,229
3600 Assessment 49,233 $2.81 $138,344
3700 Rehabilitation 32,822 $2.81 $92,229
3800 ICC 212,510 $2.17 $461,146
3900 IHBS 246,163 $2.81 $691,719
Estimated Specialty Mental Health Services Billing Totals 1,735,612 $4,611,458
Estimated % of Clients that are Medi-Cal Beneficiaries 97%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,473,114
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,236,557
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,236,557
MEDI-CAL REVENUE TOTAL $4,473,114
OTHER REVENUE: Social Services Revenue
4100 Psychological Evaluations 15,866 2.81 $44,584
4200 Court Documentation, Reports 29,388 2.81 $82,581
4300 Non-MediCal Clients (Mental Health Services)41,153 2.81 $115,641
4400 Non-MediCal Clients (Case Management)15,705 2.17 $34,080
4500 Non-MediCal Clients (Crisis Intervention)85 4.17 $354
4600 Non-MediCal Clients (Medical Support)902 5.81 $5,243
OTHER REVENUE TOTAL $276,886
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-2
32 of 35
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
Case Manager: $490,558 for 8.0 FTE, will provide case management activities to assist individuals at risk or
indicating symptoms of mental health problems to ensure access to needed medical, rehabilitative, and other needed
services and resources. Case Manager will work to identify and link individuals to resources and related supports,
monitor service delivery to ensure access to care. Case Manager will provide person-to-person case management
support to address barriers to treatment and will support individuals connecting with appropriate mental health
resources. Case Managers will provide individualized attention, as well as services and supports as needed.
Mental Health Specialist 1/II: $1,492,858 for 20 FTE's, provides initial and ongoing assessment; develops EPSDT
plan. Provides individual and family trauma-informed mental health services and therapy. Provides clinical support
and information to CFTs, as CFT and ICC team member. Documents and bills for services, and completes outcomes
information.
Clinical Supervisor: $241,154 for 3.0 FTE, under general direction, supervises Specialty Mental Health Services, and
the work of license-eligible therapists in accordance with BBS requirements. May also provide individual mental
health services.
Intake Coordinator: $73,495 for 2.0 FTE, processes referrals, consent packets, and paperwork, etc.
LVN: $28,988 for $0.5 FTE, provides direct client care including medications, and supervises nursing activities
performed by professional and para-professional nursing personnel on the unit.
Administrator: $31,580 for .25 FTE, has a direct responsibility for the Community Service program and will report to
Regional Administrator, will ensure operational, clinical and regulatory requirements are met. He/she will directly
supervise the Program Director.
QA Coordinator: $22,967 for .40 FTE, is responsible for utilization review and assisting in medical record
management by gathering and analyzing agency data and assisting in the agency’s quality control, quality
assurance, and quality improvement efforts.
QA Manager: $29,857 for .40 FTE, manages all Quality Assurance tasks for the program, which includes records
management, documentation and service audits for compliance to Medi-Cal and internal requirements.
Training Coordinator: $23,886 for .40 FTE, assists in the development, coordination, delivery and administration of
agency training programs.
Human Resources Coordinator: $28,996 for .50 FTE, manages all human resource clerical and administrative tasks
for the program staff. This position is responsible for supporting the development of a positive working environment
to enhance agency success and reduce legal risk, as well as management team support and consultation, employee
relations, interpretation and administration of HR policies and procedures, staff recruitment and selection,
compensation, and employee benefits etc.
Program Director: $107,486 for 1.0 FTE, this position oversees program management and maintains in compliance
with contract and legal requirements.
CHILD WELFARE MENTAL HEALTH SERVICES
Central Star Behavioral Health Inc.
FY 2023 - 2024
BUDGET NARRATIVE - EXPENSES
These amounts reflect FTE positions, part-time positions and whether the positions are administrative or direct
service. Employee benefits should be limited to a maximum of 20% of total salaries.
Exhibit D-2
33 of 35
$2,630,959
$263,096
$453,840
Facilities/Equipment Expenses – Line Items 1010-1014
$140,585
Operating Expenses - Line Items 1060-1077
Staff Mileage/Vehicle maintenance: $89,369, this is estimated staff travel reimbursement for client visits (IRS mileage
rate @ .58/miles) and for staff travel to training programs, which is based on our experience in administering similar
programs and locations. Based on our experience the 34.50 FTEs will travel approximately 75 miles/FTE per week.
Calculated @ $7,447/month.
Staff Training/Registration: $32,473, which comprise of the on-going program required education, training and
materials for staff and training for DBT/ AF-CBT/ CBT practices. Calculated at $2,706 per month.
Other: Purchased service: $35,850 which includes $2,338 on-going staff recruitment, document shredding, water
and coffee service, postage meter rental, Security services and storage facility of $33,512.
Office supplies and equipment: $30,438 based on $14,202 for office supplies for 37.95 FTE's and $16,236 for
Property Taxes, business licenses and Joint Commission fees.
Payroll Taxes: 10% of annual salaries
Employee Benefits:
Retirement/Worker Compensation/Health Insurance: 17.25% of annual salaries
Identify building lease/rent expenses, equipment (office equipment, vehicles, etc.).
Attach copy of lease agreements if available.
Rent/Lease Building: $79,104, is calculated at $1.52 per square foot per month for 4,350 square feet for 12 months.
Rent/Lease Equipment: $20,566 for copier lease, toner and maintenance for 12 months.
Utilities: $16,236 Electricity, Water, Gas, $1,353 per month for 12 months.
Building Maintenance: $24,679 for janitorial services, repairs and maintenance, calculated at $2,056 per month for 12
months.
Equipment purchases: $0
Identify and detail the expenses for each item utilized for program.
Telephone: $103,338 for staff cell phone reimbursement ($60 per month for 33.5 staff and the director at $100 per
month) Included is $78,018 for landline, internet & phones which includes Wi-Fi for staff tablets.
Payroll Taxes.
Admin Clerk: $59,135 for 1.5 FTE, is responsible for insuring the client record within EMR (Electronic Medical
Record) is maintained, physician orders are signed within the prescribed time period, clinical, consultant and
discharge documentation and appointments are scheduled, weekly summary sheets are prepared, and also acts as
the administrative support for the units.
Exhibit D-2
34 of 35
$373,224
Financial Services Expenses – Line Items 1080-1085
$673,975
Special Expenses – Line Items 1090-1092
$209,126
Fixed Assets – Line Items 1190-1193
Fixed Assets: Includes, equipment purchases: $2,497 for IT equipment, software and support.
$2,598
Medication Supports - $201,332, includes Psychiatrist: $153,272 for 59 hours per month at $216 per hour and
Psychologist: $48,060 for 37 hours per month at $108 per hour.
Include all purchases over Five Thousand Dollars ($5,000) including sales tax, and certain purchases under said
amount such as camera, televisions, VCRs/DVDs and other sensitive items, made during the life of the Agreement
resulting from this Request for Proposal, with funds paid pursuant to this Agreement and that will outlive the life of
this Agreement.
Translation Services $7,794 for annual translation services.
Other: Centralized Program Services: $81,756 is comprised of the SBHG corporate and regional support in the
numerous areas including support from the Senior Administrator as well as services provided for Program
Development and Evaluation (e.g., tracking and reporting outcomes, and implementation of practices), Quality &
Compliance (e.g., internal chart audits, compliance audits, and TJC-readiness preparation), and Training (e.g., TIP
and Core Practice trainings provided company-wide). There is a significant cost advantage to all the SBHG company
programs in sharing these costs rather than building them into each program. SBHG support provides oversight of all
of our programs to ensure consistency with our standards and policies and procedures. The cost of this support is
shared by all programs and is budgeted 2% of total expenses.
Local and corporate administrative costs are limited to 15% of the total program
budget. Copies of insurance policies are required.
Accounting/Bookkeeping: $97,419, this program will be supported and greatly benefit from the experienced and
established local Starlight Community Services organization. There is a large cost advantage to the program in being
supported by Starlight CS in the areas of operations, business office and billing functions. Without the support from
an affiliated organization, the program would need to have dedicated staff for these functions. Additionally any costs
shared with this program will result in savings to the county though lower costs for other Central Star County
Programs. The cost of this support is budgeted at $8,118 per month which is consistent with other programs.
External Audit $3,897 for annual audit fees.
Liability Insurance: $20,454 for general liability, property and professional liability based on $473 per FTE.
Administrative overhead: Will not exceed 15% of total costs. $328,694 or 8% of total costs is an allocation from Stars
Behavioral Health Group. It covers operations administration, information technology, human resources,
communications, finance, and associated fringe benefits and expenses. SBHG oversight ensures consistency with
our quality standards and policies and procedures. The cost is developed from allocating the SBHG costs among all
the programs within all the SBHG companies based on standard accounting practices. This economy of scale results
in a significant savings for all SBHG programs. Rather than staffing each program for all necessary services above,
the services are performed by fewer employees and then shared among all SBHG programs. $210,538 or 5% of the
total expenses is budgeted as SBHG operating income. Up to 5% of the total expenses will be net income while
maintaining total Administrative/Overhead expenses under 15% of total funding.
Payroll services: $12,973 for payroll processing fees based on $30 per month for 37.95 employees.
Detail each line item in Special Expenses.
Exhibit D-2
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Non-Medi-Cal Client Support Expenses – Line Items 2000-2002.8
$2,597
Detail any anticipated expenditures for clients.
Program Supplies $2,597 for client supplies and incentives based on $216 per month - this will cover food for family
meetings and graduation celebrations.
TOTAL PROGRAM EXPENSE:$4,750,000.00
Exhibit D-3
1 of 60
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinician I 18.00 $958,441 $958,441
0002 Clinician II 5.00 $300,142 $300,142
0003 Family Specialist 4.00 $132,193 $132,193
0004 Clinical Program Manager 5.31 $404,020 $404,020
0005 Clinical Director 1.00 $103,461 $103,461
0006 Support Services Coordinator 2.00 $91,342 $91,342
0007 Administrative Assistant 1.68 $70,111 $70,111
0008 Regional Director 0.42 $58,170 $58,170
0009 Supervisor of Administrative Operations 0.42 $25,320 $25,320
0010 Customer Services 1.26 $62,287 $62,287
0011 Compliance - Health Information Technician 0.84 $30,842 $30,842
0012 Associate Director of Quality Support 0.42 $34,559 $34,559
0013 Health Information Manager 0.17 $18,897 $18,897
0014 Supervisor Physical Plant Operations 0.14 $12,409 $12,409
0015 Outcome - Research Specialist 0.57 $48,324 $48,324
0016 Training - Learning Partner 0.31 $21,219 $21,219
SALARY TOTAL 41.54 $382,138 $1,989,599 $2,371,737
PAYROLL TAXES:
0030 OASDI $23,693 $123,355 $147,048
0031 FICA/MEDICARE $5,541 $28,849 $34,390
0032 SUI $2,866 $14,922 $17,788
PAYROLL TAX TOTAL $32,100 $167,126 $199,226
EMPLOYEE BENEFITS:
0040 Retirement $15,286 $79,584 $94,870
0041 Workers Compensation $7,643 $39,792 $47,435
0042
( , , ,
dental)$85,980 $447,660 $533,640
EMPLOYEE BENEFITS TOTAL $108,909 $567,036 $675,945
SALARY & BENEFITS GRAND TOTAL $3,246,908
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $221,578
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
Uplift Family Services
FY 2019-2020
Budget Categories - Total Proposed Budget
Exhibit D-3
2 of 60
1011 Rent/Lease Equipment $8,358
1012 Utilities $0
1013 Building Maintenance $2,127
1014 Equipment purchase $36,710
FACILITY/EQUIPMENT TOTAL $268,773
OPERATING EXPENSES:
1060 Telephone $55,933
1061 Answering Service $0
1062 Postage $1,946
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $11,307
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies - Therapeutic $6,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Travel and Mileage/vehicle maintenance $134,949
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $99,807
1075 Lodging $0
1076 Depreciation $2,909
1077 Subscription/Membership Services $4,829
OPERATING EXPENSES TOTAL $317,680
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $4,405
1082 Liability Insurance $54,551
1083 Administrative Overhead $712,500
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $771,456
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$32,783
1091 Translation Services $30,000
1092 Contract Psychiatrist $82,400
Exhibit D-3
3 of 60
SPECIAL EXPENSES TOTAL $145,183
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $4,750,000
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy)809,717 $2.98 $2,412,957
3100 Case Management 77,859 $2.32 $180,633
3200 Crisis Services 15,571 $4.38 $68,201
3300 Medication Support 15,571 $5.44 $84,706
3400 Collateral 93,429 $2.98 $278,418
3500 Plan Development 31,143 $2.32 $72,252
3600 Assessment 124,573 $2.98 $371,228
3700 Rehabilitation 77,857 $2.98 $232,014
3800 Intensive Care Coord 77,857 $2.32 $180,628
3900 Intensive Home Based Services 233,574 $2.98 $696,051
Estimated Specialty Mental Health Services Billing Totals 1,557,151 $4,577,088
Estimated % of Clients that are Medi-Cal Beneficiaries 93%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,275,000
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,137,500
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,137,500
MEDI-CAL REVENUE TOTAL $4,275,000
OTHER REVENUE: DEPARTMENT OF SOCIAL SERVICES Rate
Court Documentation, Report, Appearance (flat rate)1,380 $74.00 $102,120
Psychological Evaluations 24,480 $2.89 $70,747
Mental Health Services (Individual/Family/Group Therapy)52,721 $2.98 $157,108
Case Management 6,512 $2.32 $15,107
Crisis Services 690 $4.38 $3,021
Medication Support 555 $5.44 $3,021
Collateral 6,083 $2.98 $18,128
Plan Development 2,605 $2.32 $6,043
Assessment 8,111 $2.98 $24,171
Rehabilitation 5,069 $2.98 $15,107
Intensive Care Coord 6,512 $2.32 $15,107
Exhibit D-3
4 of 60
Intensive Home Based Services 15,208 $2.98 $45,320
OTHER REVENUE TOTAL 129,926 $475,000
TOTAL PROGRAM REVENUE $4,750,000
Exhibit D-3
5 of 60
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
0001
0002
0003
CHILD WELFARE MENTAL HEALTH SERVICES
Uplift Family Services
FY 2019 - 2020
BUDGET NARRATIVE - EXPENSES
Clinician II
5.0 FTE at average salary $60,028 per FTE. Total Estimated Cost is $300,142.
Family Specialist
4.0 FTE at average salary $33,048 per FTE. Total Estimated Cost is $132,193.
Master's Degree (MA/MS) and at least three years of experience working with youth, young adults
and families in a therapeutic environment is required. If unlicensed must be a registered intern with
the Board of Behavioral Sciences and receiving appropriate clinical supervision. Provides
psychotherapy and psychotherapeutic support to children and families. Applies advanced use of
assessment information in development of the treatment plan and applies information and resources
to ensure quality care. Applies advanced skill in acquisition and application of clinically related
information to effectively intervene with children and families. Understands and applies multi-modal
approaches and perspectives to therapeutic direction. Provides coaching and mentoring of others in
the implementation of Evidence Based Practices (EBPs). Leads problem solving interaction and work
with external customers. Maintains audit ready charts and audits charts independently. Provides
observations and feedback to supervisor in order to monitor and/or modify programs or approaches.
Actively participates in the identification of team opportunities for improvement or identification of
deficiencies and in the development of strategies to address or bridge gaps. Leads Continuous
Quality Improvement (CQI) activities and project implementation. Required to meet applicable
productivity and documentation requirements.
18.0 FTE at average salary $53,245 per FTE. Total Estimated Cost is $958,411.
Clinician I
Master's Degree (MA/MS) and at least two years of experience working with youth, young adults and
families in a therapeutic environment is required. If unlicensed must be a registered intern with the
Board of Behavioral Sciences and receiving appropriate clinical supervision. Provides psychotherapy
and psychotherapeutic support to children and families. Up to 4 Masters level student interns will as
well be used to provide additional psychotherapy and psychotherapeutic support.
Exhibit D-3
6 of 60
0004 Clinical Program Manager
5.31 FTE at average salary $76,087 per FTE. Total Estimated Cost is $404,020.
Provides direct services to youth and families. Provides direct billable mental health services, documents in
alignment with MediCal regulations, and achieves set productivity expectations. Engages and builds alignment
and relationships with parents, youth, and others in the normal course of working with the families. Utilizes
strengths of youth, families, and others to assist in the implementation and achievement of goals and outcomes.
Works with youth and family teams to support family driven, strength based planning and interventions.
Understands and takes advantage of therapeutic opportunities in crisis situations. Conducts observations
regarding specific target behavior, track progress and modify plans with the family to support their intended
identified outcome. Assists teams in developing a hypothesis of function and underlying unmet need in an effort
to develop individualized, strength based strategies and interventions that will result in positive behavior change.
Engages caregiver, family members, and other natural supports in building youth specific parenting responses
that support positive behavior change and overall family relationships. Works in the community directly with
youth and families to develop and implement safety and skill refinement plans. Supports families in bridging to
and or building on natural resources and accessing community based program supports that will continue
support over time. Develops resources within the community to serve children and families. Assists youth and
family teams to meet specific service needs (ie: help develop strategy or resource specific to an identified need)
and monitor outcomes. Participates in family finding team activities by identifying family finding need, obtaining
authorizations, creating teams, conducting searches and setting deadlines. Completes Connectedness Maps as
needed. Documents interactions and practices and maintain administrative expectations in a timely manner.
Meets and or exceeds all direct service expectations and documentation requirements. Assists in developing
program responses to needs identified across a number of youth and families where natural community
resources are not available or appropriate. Builds on individual strengths, concerns, and needs with balanced
focus on the family as a unit. Facilitates and/or co-facilitates, supports, and model participation in healthy group
dynamics within various settings including family homes, schools, parks, and recreation centers, and treatment
facilities. Provides an open forum for expression of feelings and ideas when appropriate. Builds solid,
cooperative, culturally responsive relationships with youth and families as well as community resources to assist
with the planning, organizing, implementation and evaluation of appropriate activities to achieve family.
Exhibit D-3
7 of 60
0005
0006
1.0 FTE at average salary $103,461 per FTE. Total Estimated Cost is $103,461.
Support Services Coordinator
2.0 FTE at average salary $45,671 per FTE. Total Estimated Cost is $91,342.
Master's degree (MA/MS). Must have appropriate license to practice as a Licensed Clinical Social
Worker or Marriage Family Therapist in the State of California. Must meet the BBS requirements to
provide clinical oversight and supervision with three to ten years of experience in
healthcare/psychology/behavioral/mental health. The Clinical Director implements strategies to
accomplish the agency annual priorities at the program level. Directs and develops managers,
ensures CPMS are competent and have all tools necessary to lead teams.
Clinical Director
Ensures effective coordination of services for youth and families with other providers, both internal and external,
by supporting the development of constructive relationships and problem-solving barriers. Develops, interprets
and ensures consistent implementation of clinical program philosophy, objectives, standards, policies,
procedures and practices. Analyzes and integrates the use of outcome data to improve clinical service delivery
within assigned team. Ensures and monitors defined outcome achievement for youth and families, as well as
satisfaction levels for youth, families, and referring workers and agencies. Initiates and participates in
organizational quality improvement efforts. Lead and/or delegate work groups to respond to program
development needs. Ensures compliance with all policy and procedures including adherence to all licensing,
quality, Information Technology (IT), Human Resources (HR), compliance and regulatory standards. Leads and
manages change. Proactively identifies potential conflicts; leads parties to consensus and develops same skills
in direct reports. Manages to ensure fiscally viable programming. Ensures staff billable productivity and other
revenue related activities meet or exceed revenue forecasts. Ensures effective quality clinical services delivery
for assigned youth and families. Provides effective crisis and risk prevention and management. Partners with
county referring departments, agencies and the community to ensure comprehensive care. Participates in staff
development; hires, coaches, mentors, supervises, conducts direct field observations, trains, disciplines, and
terminates. Ensures clinical documentation and quality assurance meets both agency and payor standards,
ensuring audit ready charts and continuous quality improvement. Provides 24/7 availability as needed. Culturally
responsive to internal and external customers, and ensures family voice. Provides direct services to families and
children, as support to the direct service staff, to ensure smooth delivery of service to assigned families and
youth. Provides outreach to the community including education about agency, program and general mental
health and foster care topics. Advocates for system change in relationship to agency service delivery
philosophy. Manages day-to-day operations including utilization of all administrative electronic systems, human,
and other resources. Works collaboratively with managerial peers to develop and improve program delivery and
ensure adherence to fiscal requirements. Ensures those Child Care Licensing (CCL) regulations and policy and
procedures relating to certification of families are upheld and followed and that the youths needs are met.
Required to meet applicable productivity and documentation requirements.
Exhibit D-3
8 of 60
0007
0030
0031
0032
0040
Program Shared Staff
6.23 FTE at average salary $61,338 per FTE. Total Estimated Cost is $382,138.
Bachelor’s degree required. (with emphasis in Psychology, social Work, Sociology or
related course work) Two years of experience in Mental Health field required.Four years of
experience in Mental Health field preferred. Knowledge of excel spreadsheets; moderate computer
literacy. Clinical skills relevant to intake services including: client triage, understanding of legal/ethical
issues, and risk management.
Works within the vision, mission, and philosophy of the agency, provides customerfriendly
services to internal and external customers. With limited supervision, sets up,
coordinates and runs parenting groups, trains new staff and coaches and supports
existing staff in effectively using therapeutic interventions with children and families and
in meeting documentation quality and timeliness expectations. Analyzes outcome data
in partnership with Outcomes and Evaluation to identify quality improvement activities.
Leads quality improvement activities from start to finish, including evaluation of the
effectiveness of the activities.
Calculated at 1.45% of salaries. Annual cost is estimated at $34,390.
1.68 FTE Administrative Assistant
0.42 FTE Regional Director
0.42 FTE Supervisor of Administrative Operations
1.26 FTE Customer Services
0.84 FTE Compliance - Health Information Technician
0.42 FTE Associate Director Quality Support
0.17 FTE Health Information Management
0.14 FTE Supervisor Physical Plant Operations
0.57 FTE Outcomes - Research Specialist
0.31 FTE Training - Learning Partner
These positions are shared direct program costs that provide direct clinical, operational support,
quality, compliance and outcomes support and management and supervision support, to produce
required program outcomes to all programs in this region. Approximately 42% of cost is allocated to
this program using the basis of direct wages by program for this region’s programs.
OASDI
Calculated at 6.2% of salaries. Annual cost is estimated at $147,048.
FICA/MEDICARE
Retirement
Calculated at 4% of salaries. Annual cost is estimated at $98,870.
SUI
Calculated at 0.75% of salaries. Annual cost is estimated at $17,788.
Exhibit D-3
9 of 60
0041
0042
Facilities/Equipment Expenses – Line Items 1010-1014
1010
1011
1013
1014
Operating Expenses - Line Items 1060-1077
Workers Compensation
Calculated at 2% of salaries. Annual cost is estimated at $47,435.
This includes rental payments for equipment including leased copiers, postage machines, phone
systems, laptops or other communication, office or facility equipment. Costs are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and the
utilization of the Agency’s office in Fresno. Estimated cost is $8,358 per year.
This includes common area maintenance on leased building charges, maintenance/building repair
charges, HVAC maintenance and repair, landscaping, janitorial services, confidential paper
shredding services, in-house or outside equipment repair and labor. Costs are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and the
utilization of the Agency’s office in Fresno. Estimated cost is $2,127 per year.
This includes building rent or depreciation, storage and file storage unit rental payments and all the
costs associated with storing and retrieving of client, personnel or other files or records. Costs are
allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends and the utilization of the Agency’s new office in Fresno. Estimated cost is $221,578
per year.
Equipment purchase
Rent/Lease Building
Rent/Lease Equipment
Building Maintenance
Health Insurance (medical, vision, life, dental)
Calculated at 22.5% of salaries. Annual cost is estimated at $533,640.
3,246,908$
Equipment, parts and materials includes the purchase of non-capital assets. Sample items include,
but are not limited to, laptops, desktops, printers, calculators and fax machines, as well as system
user licenses. Costs are allocated between programs on the basis of payroll dollars and estimated.
Estimated cost is $36,710 per year.
268,773$
Exhibit D-3
10 of 60
1060
1062
1066
1069
1072
1074
Postage, printing, US mail, GSO, Federal Express, UPS, postage machine refills, outside
reproduction costs, program specific brochures and flyers when reimbursable by the program. Costs
are allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends. Estimated cost is $1,946 per year.
Telephone
Cell phones, Land Lines, DSL, fax charges, phone system; wireless cards for laptop computers
enabling UFS to maintain a fully functional mobile work force to deliver in-home/in the community
services. Costs are allocated between programs on the basis of payroll dollars and have been
estimated based on historical trends. Estimated cost is $55,933 per year.
Postage
Office Supplies & Equipment
Office supplies and equipment include, but are not limited to: paper, pens, files, staplers,
subscriptions to periodicals or newspapers, annual Agency dues and fees paid to accrediting
agencies and laptop replacement. Costs are allocated between programs on the basis of direct labor
dollars and have been estimated based on historical trends. Estimated cost is $11,307 per year.
Program Supplies - Therapeutic
Includes those supplies utilized in the direct delivery of therapeutic services to clients. Cost is
estimated to be approximately $18.50 per direct care staff per month. Materials, cash payments,
outing costs, etc. used to motivate or reinforce desired behavior in clients, as well as materials
required for use in Evidenced Based Practices. Estimated cost is $6,000 per year.
Staff Travel and Mileage/vehicle maintenance
Includes travel costs such as air fare and lodging for trainings/meetings/conferences, and mileage
reimbursement, which is paid at the prevailing federal rate (currently $0.58 per mile) to program
service staff and program administrative staff. This also includes upkeep costs for vehicles.
Estimated cost is $134,949 per year.
Staff Training/Registration
Exhibit D-3
11 of 60
1076
1077
Financial Services Expenses – Line Items 1080-1085
1081
1082
1083
Subscription/Membership Services
Includes subscriptions to periodicals, databases, software, and other subscription services, as well
as annual agency dues and fees. Costs are allocated between programs on the basis of payroll
dollars and have been estimated based on historical trends. Estimated Cost is $4,829 per year.
317,680$
Includes training in the Evidence-Based Practices of Trauma-Focused Cognitive Behavioral Therapy
(TFCBT), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), Child Parent
Psychotherapy (CPP), and Dialectical Behavior Therapy (DBT), organizational tools,
team/organizational psychology, philosophy of client based services, integration of roles/team
dynamics, assessment and individualized treatment planning, general services, organizing
admissions, individualized treatment planning associated with the EBPs, and other infant mental
health trainings. This includes train-the-trainer and any other program development training needs.
Trainings are inclusive of internal and external trainings, and all costs, except mileage associated
with training, including transportation, parking room and board, meals, refreshments cost of the
program, instructor fees and materials/manuals are included. Also includes other mandatory
trainings such as first aid and CPR. Estimated cost is $99,807 per year.
Depreciation
Depreciation includes deprecation on leasehold improvements, office furniture/fixtures and
equipment meeting amortization thresholds. Costs are allocated between programs on the basis of
payroll dollars and have been estimated based on historical trends. Estimated cost is $2,909 per
year
Administrative Overhead
Includes general business liability and property coverage along with professional liability insurance.
Costs are allocated between programs on the basis of direct labor dollars and estimated based on
historical trends. Estimated cost is $54,551 per year.
External Audit
Includes annual audit ensuring all financial records are relevant and accurate and in compliance with
state and federal laws and regulations. Audit costs are allocated between programs on the basis of
payroll dollars and have been estimated based on historical costs. Estimated cost is $4,405 per year.
Liability Insurance
Exhibit D-3
12 of 60
Special Expenses – Line Items 1090-1092
1090
1091
1092
4,750,000$ TOTAL PROGRAM EXPENSE:
Translation Services
To ensure the provision of culturally sensitive services including assurance of language access,
when there is not availability of bilingual staff interpreter/translation services are used to support a
culturally appropriate evaluation, diagnosis, treatment and referral services. Estimated Cost is
$30,000 per year.
145,183$
771,456$
Contract Psychiatrist
This includes a contract Psychiatrist position estimated to cost $195 per hour. The psychiatrist will be
required to provide at least 25 hours per month, and will provide psychiatric evaluations and
medication support services. This also includes a Nurse Practitioner, estimated to cost $125 per
hour. The nurse practitioner will be required to provide 2 hours per week and will provide additional
psychiatric evaluations and medication support services. Estimated Cost is $82,400 per year.
Represents the overhead of the Agency's general and administrative shared support services such
as finance, accounting, billing, human resources, clinical administration, information technology,
professional fees, HIPPA compliance and clinical record audits, risk management and program
fidelity, recruiting and human resources support, MIS infrastructure & QI/UM department support and
oversight as well as executive management. Costs that cannot be specifically charged to a program
are allocated to programs on the basis of direct labor program costs prior to the addition of taxes and
benefits. Administrative Overhead has been budgeted at 15% of total program expenses. Estimated
cost is $712,500 per year.
Consultant (network & data management)
The consultant will provide additional clinical supervision support for program staff. This will also be
used for a contract psychologist to provide court ordered psychological testing and reports to the
Court. Contract Psychologist estimated to cost $95 per hour. The psychologist will be required to
provide at least 20 hours per month on average. This will also cover the cost of the psychological
testing and scoring materials. Estimated cost is $32,783 per year.
Exhibit D-3
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FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinician I 18.00 $987,194 $987,194
0002 Clinician II 5.00 $309,146 $309,146
0003 Family Specialist 4.00 $136,159 $136,159
0004 Clinical Program Manager 5.31 $416,141 $416,141
0005 Clinical Director 1.00 $106,565 $106,565
0006 Support Services Coordinator 2.00 $94,082 $94,082
0007 Administrative Assistant 1.68 $72,214 $72,214
0008 Regional Director 0.42 $59,915 $59,915
0009 Supervisor of Administrative Operations 0.42 $26,080 $26,080
0010 Customer Services 1.26 $64,156 $64,156
0011 Compliance - Health Information Technician 0.84 $31,767 $31,767
0012 Associate Director of Quality Support 0.42 $35,596 $35,596
0013 Health Information Manager 0.17 $19,464 $19,464
0014 Supervisor Physical Plant Operations 0.14 $12,780 $12,780
0015 Outcome - Research Specialist 0.57 $49,774 $49,774
0016 Training - Learning Partner 0.31 $21,856 $21,856
SALARY TOTAL 41.54 $393,602 $2,049,287 $2,442,889
PAYROLL TAXES:
0030 OASDI $24,403 $127,056 $151,459
0031 FICA/MEDICARE $5,707 $29,715 $35,422
0032 SUI $2,952 $15,370 $18,322
PAYROLL TAX TOTAL $33,063 $172,140 $205,203
EMPLOYEE BENEFITS:
0040 Retirement $15,744 $81,972 $97,716
0041 Workers Compensation $7,872 $40,986 $48,858
0042 Health Insurance (medical, vision, life, dental)$88,561 $461,090 $549,650
EMPLOYEE BENEFITS TOTAL $112,177 $584,047 $696,224
SALARY & BENEFITS GRAND TOTAL $3,344,315
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $221,578
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
Uplift Family Services
FY 2020-2021
Budget Categories - Total Proposed Budget
Exhibit D-3
14 of 60
1011 Rent/Lease Equipment $8,358
1012 Utilities $0
1013 Building Maintenance $2,127
1014 Equipment purchase $36,710
FACILITY/EQUIPMENT TOTAL $268,773
OPERATING EXPENSES:
1060 Telephone $55,933
1061 Answering Service $0
1062 Postage $1,946
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $11,307
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies - Therapeutic $6,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Travel and Mileage/vehicle maintenance $134,949
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $102,648
1075 Lodging $0
1076 Depreciation $2,909
1077 Other - (Identify)$4,829
OPERATING EXPENSES TOTAL $320,521
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $4,405
1082 Liability Insurance $56,188
1083 Administrative Overhead $731,025
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $791,617
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$33,983
1091 Translation Services $30,000
1092 Contract Psychiatrist $84,290
Exhibit D-3
15 of 60
SPECIAL EXPENSES TOTAL $148,273
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $4,873,500
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy 831,572 $2.98 $2,478,085
3100 Case Management 79,959 $2.32 $185,505
3200 Crisis Services 15,992 $4.38 $70,045
3300 Medication Support 15,992 $5.44 $86,996
3400 Collateral 95,951 $2.98 $285,934
3500 Plan Development 31,983 $2.32 $74,201
3600 Assessment 127,934 $2.98 $381,243
3700 Rehabilitation 79,959 $2.98 $238,278
3800 Intensive Care Coord 79,959 $2.32 $185,505
3900 Intensive Home Based Services 239,876 $2.98 $714,830
Estimated Specialty Mental Health Services Billing Totals 1,599,177 $4,700,622
Estimated % of Clients that are Medi-Cal Beneficiaries 93%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,386,150
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,193,075
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,193,075
MEDI-CAL REVENUE TOTAL $4,386,150
OTHER REVENUE: DEPARTMENT OF SOCIAL SERVICES Rate
Court Documentation, Report, Appearance (flat rate)1,380 $74.00 $102,120
Psychological Evaluations 24,480 $2.89 $70,747
Mental Health Services (Individual/Family/Group Therapy)54,876 $2.98 $163,531
Case Management 6,778 $2.32 $15,724
Crisis Services 718 $4.38 $3,145
Medication Support 578 $5.44 $3,145
Collateral 6,332 $2.98 $18,869
Plan Development 2,711 $2.32 $6,290
Assessment 8,443 $2.98 $25,159
Rehabilitation 5,277 $2.98 $15,724
Intensive Care Coord 6,778 $2.32 $15,724
Exhibit D-3
16 of 60
Intensive Home Based Services 15,830 $2.98 $47,172
OTHER REVENUE TOTAL 134,181 $487,350
TOTAL PROGRAM REVENUE $4,873,500
Exhibit D-3
17 of 60
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
0001
0002
0003 Family Specialist
4.0 FTE at average salary $34,040 per FTE. Total Estimated Cost is $136,159.
Clinician I
18.0 FTE at average salary $54,844 per FTE. Total Estimated Cost is $987,194.Master's Degree (MA/MS) and at least two years of experience working with youth, young adults and
families in a therapeutic environment is required. If unlicensed must be a registered intern with the
Board of Behavioral Sciences and receiving appropriate clinical supervision. Provides psychotherapy
and psychotherapeutic support to children and families. Up to 4 Masters level student interns will as
well be used to provide additional psychotherapy and psychotherapeutic support.
CHILD WELFARE MENTAL HEALTH SERVICES
Uplift Family Services
FY 2020 - 2021
BUDGET NARRATIVE - EXPENSES
Clinician II
5.0 FTE at average salary $61,829 per FTE. Total Estimated Cost is $309,146.
Master's Degree (MA/MS) and at least three years of experience working with youth, young adults
and families in a therapeutic environment is required. If unlicensed must be a registered intern with
the Board of Behavioral Sciences and receiving appropriate clinical supervision. Provides
psychotherapy and psychotherapeutic support to children and families. Applies advanced use of
assessment information in development of the treatment plan and applies information and resources
to ensure quality care. Applies advanced skill in acquisition and application of clinically related
information to effectively intervene with children and families. Understands and applies multi-modal
approaches and perspectives to therapeutic direction. Provides coaching and mentoring of others in
the implementation of Evidence Based Practices (EBPs). Leads problem solving interaction and work
with external customers. Maintains audit ready charts and audits charts independently. Provides
observations and feedback to supervisor in order to monitor and/or modify programs or approaches.
Actively participates in the identification of team opportunities for improvement or identification of
deficiencies and in the development of strategies to address or bridge gaps. Leads Continuous
Quality Improvement (CQI) activities and project implementation. Required to meet applicable
productivity and documentation requirements.
Exhibit D-3
18 of 60
0004
Provides direct services to youth and families. Provides direct billable mental health services, documents in
alignment with MediCal regulations, and achieves set productivity expectations. Engages and builds alignment
and relationships with parents, youth, and others in the normal course of working with the families. Utilizes
strengths of youth, families, and others to assist in the implementation and achievement of goals and outcomes.
Works with youth and family teams to support family driven, strength based planning and interventions.
Understands and takes advantage of therapeutic opportunities in crisis situations. Conducts observations
regarding specific target behavior, track progress and modify plans with the family to support their intended
identified outcome. Assists teams in developing a hypothesis of function and underlying unmet need in an effort
to develop individualized, strength based strategies and interventions that will result in positive behavior change.
Engages caregiver, family members, and other natural supports in building youth specific parenting responses
that support positive behavior change and overall family relationships. Works in the community directly with
youth and families to develop and implement safety and skill refinement plans. Supports families in bridging to
and or building on natural resources and accessing community based program supports that will continue
support over time. Develops resources within the community to serve children and families. Assists youth and
family teams to meet specific service needs (ie: help develop strategy or resource specific to an identified need)
and monitor outcomes. Participates in family finding team activities by identifying family finding need, obtaining
authorizations, creating teams, conducting searches and setting deadlines. Completes Connectedness Maps as
needed. Documents interactions and practices and maintain administrative expectations in a timely manner.
Meets and or exceeds all direct service expectations and documentation requirements. Assists in developing
program responses to needs identified across a number of youth and families where natural community
resources are not available or appropriate. Builds on individual strengths, concerns, and needs with balanced
focus on the family as a unit. Facilitates and/or co-facilitates, supports, and model participation in healthy group
dynamics within various settings including family homes, schools, parks, and recreation centers, and treatment
facilities. Provides an open forum for expression of feelings and ideas when appropriate. Builds solid,
cooperative, culturally responsive relationships with youth and families as well as community resources to assist
with the planning, organizing, implementation and evaluation of appropriate activities to achieve family.
Clinical Program Manager
5.31 FTE at average salary $78,369 per FTE. Total Estimated Cost is $416,141.
Exhibit D-3
19 of 60
0005
0006
1.0 FTE at average salary $106,565 per FTE. Total Estimated Cost is $106,565.
Master's degree (MA/MS). Must have appropriate license to practice as a Licensed Clinical Social
Worker or Marriage Family Therapist in the State of California. Must meet the BBS requirements to
provide clinical oversight and supervision with three to ten years of experience in
healthcare/psychology/behavioral/mental health. The Clinical Director implements strategies to
accomplish the agency annual priorities at the program level. Directs and develops managers,
ensures CPMS are competent and have all tools necessary to lead teams.
Support Services Coordinator
2.0 FTE at average salary $47,041 per FTE. Total Estimated Cost is $94,082.
Ensures effective coordination of services for youth and families with other providers, both internal and external,
by supporting the development of constructive relationships and problem-solving barriers. Develops, interprets
and ensures consistent implementation of clinical program philosophy, objectives, standards, policies,
procedures and practices. Analyzes and integrates the use of outcome data to improve clinical service delivery
within assigned team. Ensures and monitors defined outcome achievement for youth and families, as well as
satisfaction levels for youth, families, and referring workers and agencies. Initiates and participates in
organizational quality improvement efforts. Lead and/or delegate work groups to respond to program
development needs. Ensures compliance with all policy and procedures including adherence to all licensing,
quality, Information Technology (IT), Human Resources (HR), compliance and regulatory standards. Leads and
manages change. Proactively identifies potential conflicts; leads parties to consensus and develops same skills
in direct reports. Manages to ensure fiscally viable programming. Ensures staff billable productivity and other
revenue related activities meet or exceed revenue forecasts. Ensures effective quality clinical services delivery
for assigned youth and families. Provides effective crisis and risk prevention and management. Partners with
county referring departments, agencies and the community to ensure comprehensive care. Participates in staff
development; hires, coaches, mentors, supervises, conducts direct field observations, trains, disciplines, and
terminates. Ensures clinical documentation and quality assurance meets both agency and payor standards,
ensuring audit ready charts and continuous quality improvement. Provides 24/7 availability as needed. Culturally
responsive to internal and external customers, and ensures family voice. Provides direct services to families and
children, as support to the direct service staff, to ensure smooth delivery of service to assigned families and
youth. Provides outreach to the community including education about agency, program and general mental
health and foster care topics. Advocates for system change in relationship to agency service delivery
philosophy. Manages day-to-day operations including utilization of all administrative electronic systems, human,
and other resources. Works collaboratively with managerial peers to develop and improve program delivery and
ensure adherence to fiscal requirements. Ensures those Child Care Licensing (CCL) regulations and policy and
procedures relating to certification of families are upheld and followed and that the youths needs are met.
Required to meet applicable productivity and documentation requirements.
Clinical Director
Exhibit D-3
20 of 60
0007
0030
0031
0032
0040
SUI
Calculated at 0.75% of salaries. Annual cost is estimated at $18,322.
Retirement
Calculated at 4% of salaries. Annual cost is estimated at $97,716.
OASDI
Calculated at 6.2% of salaries. Annual cost is estimated at $151,459.
FICA/MEDICARE
Calculated at 1.45% of salaries. Annual cost is estimated at $35,422.
Bachelor’s degree required. (with emphasis in Psychology, social Work, Sociology or
related course work) Two years of experience in Mental Health field required.Four years of
experience in Mental Health field preferred. Knowledge of excel spreadsheets; moderate computer
literacy. Clinical skills relevant to intake services including: client triage, understanding of legal/ethical
issues, and risk management.
Works within the vision, mission, and philosophy of the agency, provides customerfriendly
services to internal and external customers. With limited supervision, sets up,
coordinates and runs parenting groups, trains new staff and coaches and supports
existing staff in effectively using therapeutic interventions with children and families and
in meeting documentation quality and timeliness expectations. Analyzes outcome data
in partnership with Outcomes and Evaluation to identify quality improvement activities.
Leads quality improvement activities from start to finish, including evaluation of the
effectiveness of the activities.
Program Shared Staff
6.23 FTE at average salary $63,092 per FTE. Total Estimated Cost is $393,602.
1.68 FTE Administrative Assistant
0.42 FTE Regional Director
0.42 FTE Supervisor of Administrative Operations
1.26 FTE Customer Services
0.84 FTE Compliance - Health Information Technician
0.42 FTE Associate Director Quality Support
0.17 FTE Health Information Management
0.14 FTE Supervisor Physical Plant Operations
0.57 FTE Outcomes - Research Specialist
0.31 FTE Training - Learning Partner
These positions are shared direct program costs that provide direct clinical, operational support,
quality, compliance and outcomes support and management and supervision support, to produce
required program outcomes to all programs in this region. Approximately 42% of cost is allocated to
this program using the basis of direct wages by program for this region’s programs.
Exhibit D-3
21 of 60
0041
0042
Facilities/Equipment Expenses – Line Items 1010-1014
1010
1011
1013
1014
Operating Expenses - Line Items 1060-1077
268,773$
Building Maintenance
This includes common area maintenance on leased building charges, maintenance/building repair
charges, HVAC maintenance and repair, landscaping, janitorial services, confidential paper
shredding services, in-house or outside equipment repair and labor. Costs are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and the
utilization of the Agency’s office in Fresno. Estimated cost is $2,127 per year.
Equipment purchase
Equipment, parts and materials includes the purchase of non-capital assets. Sample items include,
but are not limited to, laptops, desktops, printers, calculators and fax machines, as well as system
user licenses. Costs are allocated between programs on the basis of payroll dollars and estimated.
Estimated cost is $36,710 per year.
Rent/Lease Building
This includes building rent or depreciation, storage and file storage unit rental payments and all the
costs associated with storing and retrieving of client, personnel or other files or records. Costs are
allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends and the utilization of the Agency’s new office in Fresno. Estimated cost is $221,578
per year.
Rent/Lease Equipment
This includes rental payments for equipment including leased copiers, postage machines, phone
systems, laptops or other communication, office or facility equipment. Costs are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and the
utilization of the Agency’s office in Fresno. Estimated cost is $8,358 per year.
3,344,315$
Workers Compensation
Calculated at 2% of salaries. Annual cost is estimated at $48,858.
Health Insurance (medical, vision, life, dental)
Calculated at 22.5% of salaries. Annual cost is estimated at $549.650.
Exhibit D-3
22 of 60
1060
1062
1066
1069
1072
1074 Staff Training/Registration
Program Supplies - Therapeutic
Includes those supplies utilized in the direct delivery of therapeutic services to clients. Cost is
estimated to be approximately $18.50 per direct care staff per month. Materials, cash payments,
outing costs, etc. used to motivate or reinforce desired behavior in clients, as well as materials
required for use in Evidenced Based Practices. Estimated cost is $6,000 per year.
Staff Travel and Mileage/vehicle maintenance
Includes travel costs such as air fare and lodging for trainings/meetings/conferences, and mileage
reimbursement, which is paid at the prevailing federal rate (currently $0.58 per mile) to program
service staff and program administrative staff. This also includes upkeep costs for vehicles.
Estimated cost is $134,949 per year.
Office supplies and equipment include, but are not limited to: paper, pens, files, staplers,
subscriptions to periodicals or newspapers, annual Agency dues and fees paid to accrediting
agencies and laptop replacement. Costs are allocated between programs on the basis of direct labor
dollars and have been estimated based on historical trends. Estimated cost is $11,307 per year.
Office Supplies & Equipment
Telephone
Cell phones, Land Lines, DSL, fax charges, phone system; wireless cards for laptop computers
enabling UFS to maintain a fully functional mobile work force to deliver in-home/in the community
services. Costs are allocated between programs on the basis of payroll dollars and have been
estimated based on historical trends. Estimated cost is $55,933 per year.
Postage
Postage, printing, US mail, GSO, Federal Express, UPS, postage machine refills, outside
reproduction costs, program specific brochures and flyers when reimbursable by the program. Costs
are allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends. Estimated cost is $1,946 per year.
Exhibit D-3
23 of 60
1076
1077
Financial Services Expenses – Line Items 1080-1085
1081
1082
1083
Includes annual audit ensuring all financial records are relevant and accurate and in compliance with
state and federal laws and regulations. Audit costs are allocated between programs on the basis of
payroll dollars and have been estimated based on historical costs. Estimated cost is $4,405 per year.
Liability Insurance
Includes general business liability and property coverage along with professional liability insurance.
Costs are allocated between programs on the basis of direct labor dollars and estimated based on
historical trends. Estimated cost is $56,188 per year.
Administrative Overhead
320,521$
External Audit
Includes training in the Evidence-Based Practices of Trauma-Focused Cognitive Behavioral Therapy
(TFCBT), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), Child Parent
Psychotherapy (CPP), and Dialectical Behavior Therapy (DBT), organizational tools,
team/organizational psychology, philosophy of client based services, integration of roles/team
dynamics, assessment and individualized treatment planning, general services, organizing
admissions, individualized treatment planning associated with the EBPs, and other infant mental
health trainings. This includes train-the-trainer and any other program development training needs.
Trainings are inclusive of internal and external trainings, and all costs, except mileage associated
with training, including transportation, parking room and board, meals, refreshments cost of the
program, instructor fees and materials/manuals are included. Also includes other mandatory
trainings such as first aid and CPR. Estimated cost is $102,648 per year.
Depreciation
Depreciation includes deprecation on leasehold improvements, office furniture/fixtures and
equipment meeting amortization thresholds. Costs are allocated between programs on the basis of
payroll dollars and have been estimated based on historical trends. Estimated cost is $2,909 per
year
Subscription/Membership Services
Includes subscriptions to periodicals, databases, software, and other subscription services, as well
as annual agency dues and fees. Costs are allocated between programs on the basis of payroll
dollars and have been estimated based on historical trends. Estimated Cost is $4,829 per year.
Exhibit D-3
24 of 60
Special Expenses – Line Items 1090-1092
1090
1091
1092
4,873,500$ TOTAL PROGRAM EXPENSE:
To ensure the provision of culturally sensitive services including assurance of language access,
when there is not availability of bilingual staff interpreter/translation services are used to support a
culturally appropriate evaluation, diagnosis, treatment and referral services. Estimated Cost is
$30,000 per year.
Contract Psychiatrist
This includes a contract Psychiatrist position estimated to cost $200 per hour. The psychiatrist will be
required to provide at least 25 hours per month, and will provide psychiatric evaluations and
medication support services. This also includes a Nurse Practitioner, estimated to cost $129 per
hour. The nurse practitioner will be required to provide 2 hours per week and will provide additional
psychiatric evaluations and medication support services. Estimated Cost is $84,290 per year.
148,273$
Consultant (network & data management)
The consultant will provide additional clinical supervision support for program staff. This will also be
used for a contract psychologist to provide court ordered psychological testing and reports to the
Court. Contract Psychologist estimated to cost $100 per hour. The psychologist will be required to
provide at least 20 hours per month on average. This will also cover the cost of the psychological
testing and scoring materials. Estimated cost is $33,983 per year.
Translation Services
Represents the overhead of the Agency's general and administrative shared support services such
as finance, accounting, billing, human resources, clinical administration, information technology,
professional fees, HIPPA compliance and clinical record audits, risk management and program
fidelity, recruiting and human resources support, MIS infrastructure & QI/UM department support and
oversight as well as executive management. Costs that cannot be specifically charged to a program
are allocated to programs on the basis of direct labor program costs prior to the addition of taxes and
benefits. Administrative Overhead has been budgeted at 15% of total program expenses. Estimated
cost is $731,025 per year.
791,617$
Exhibit D-3
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FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinician I 18.00 $1,016,810 $1,016,810
0002 Clinician II 5.00 $318,420 $318,420
0003 Family Specialist 4.00 $140,244 $140,244
0004 Clinical Program Manager 5.31 $428,625 $428,625
0005 Clinical Director 1.00 $109,762 $109,762
0006 Support Services Coordinator 2.00 $96,904 $96,904
0007 Administrative Assistant 1.68 $74,380 $74,380
0008 Regional Director 0.42 $61,712 $61,712
0009 Supervisor of Administrative Operations 0.42 $26,862 $26,862
0010 Customer Services 1.26 $66,081 $66,081
0011 Compliance - Health Information Technician 0.84 $32,720 $32,720
0012 Associate Director of Quality Support 0.42 $36,665 $36,665
0013 Health Information Manager 0.17 $20,048 $20,048
0014 Supervisor Physical Plant Operations 0.14 $13,163 $13,163
0015 Outcome - Research Specialist 0.57 $51,267 $51,267
0016 Training - Learning Partner 0.31 $22,512 $22,512
SALARY TOTAL 41.54 $405,410 $2,110,765 $2,516,175
PAYROLL TAXES:
0030 OASDI $25,135 $130,867 $156,003
0031 FICA/MEDICARE $5,878 $30,606 $36,485
0032 SUI $3,041 $15,831 $18,871
PAYROLL TAX TOTAL $34,054 $177,304 $211,359
EMPLOYEE BENEFITS:
0040 Retirement $16,216 $84,431 $100,647
0041 Workers Compensation $8,108 $42,215 $50,324
0042 Health Insurance (medical, vision, life, dental)$91,217 $474,922 $566,139
EMPLOYEE BENEFITS TOTAL $115,542 $601,568 $717,110
SALARY & BENEFITS GRAND TOTAL $3,444,644
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $221,578
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
Uplift Family Services
FY 2021-2022
Budget Categories - Total Proposed Budget
Exhibit D-3
26 of 60
1011 Rent/Lease Equipment $8,358
1012 Utilities $0
1013 Building Maintenance $2,127
1014 Equipment purchase $36,710
FACILITY/EQUIPMENT TOTAL $268,773
OPERATING EXPENSES:
1060 Telephone $55,933
1061 Answering Service $0
1062 Postage $1,946
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $11,307
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies - Therapeutic $6,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Travel and Mileage/vehicle maintenance $134,949
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $105,237
1075 Lodging $0
1076 Depreciation $2,909
1077 Subscription/Membership Services $4,829
OPERATING EXPENSES TOTAL $323,110
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $4,405
1082 Liability Insurance $57,873
1083 Administrative Overhead $750,032
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $812,310
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$35,183
1091 Translation Services $30,000
1092 Contract Psychiatrist $86,192
Exhibit D-3
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SPECIAL EXPENSES TOTAL $151,375
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $5,000,211
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy 854,018 $2.98 $2,544,974
3100 Case Management 82,117 $2.32 $190,511
3200 Crisis Services 16,423 $4.38 $71,933
3300 Medication Support 16,423 $5.44 $89,341
3400 Collateral 98,540 $2.98 $293,649
3500 Plan Development 32,848 $2.32 $76,207
3600 Assessment 131,387 $2.98 $391,533
3700 Rehabilitation 82,117 $2.98 $244,709
3800 Intensive Care Coord 82,117 $2.32 $190,511
3900 Intensive Home Based Services 246,351 $2.98 $734,126
Estimated Specialty Mental Health Services Billing Totals 1,642,341 $4,827,494
Estimated % of Clients that are Medi-Cal Beneficiaries 93%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,500,190
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,250,095
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,250,095
MEDI-CAL REVENUE TOTAL $4,500,190
OTHER REVENUE: DEPARTMENT OF SOCIAL SERVICES Rate
Court Documentation, Report, Appearance (flat rate)1,380 $74.00 $102,120
Psychological Evaluations 24,480 $2.89 $70,747
Mental Health Services (Individual/Family/Group Therapy)57,087 $2.98 $170,119
Case Management 7,051 $2.32 $16,358
Crisis Services 747 $4.38 $3,272
Medication Support 601 $5.44 $3,272
Collateral 6,587 $2.98 $19,629
Plan Development 2,820 $2.32 $6,543
Assessment 8,783 $2.98 $26,172
Rehabilitation 5,489 $2.98 $16,358
Intensive Care Coord 7,051 $2.32 $16,358
Exhibit D-3
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Intensive Home Based Services 16,467 $2.98 $49,073
OTHER REVENUE TOTAL 138,543 $500,021
TOTAL PROGRAM REVENUE $5,000,211
Exhibit D-3
29 of 60
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
0001
0002
0003 Family Specialist
4.0 FTE at average salary $35,061 per FTE. Total Estimated Cost is $140,244.
Clinician I
18.0 FTE at average salary $56,489 per FTE. Total Estimated Cost is $1,016,810.Master's Degree (MA/MS) and at least two years of experience working with youth, young adults and
families in a therapeutic environment is required. If unlicensed must be a registered intern with the
Board of Behavioral Sciences and receiving appropriate clinical supervision. Provides psychotherapy
and psychotherapeutic support to children and families. Up to 4 Masters level student interns will as
well be used to provide additional psychotherapy and psychotherapeutic support.
CHILD WELFARE MENTAL HEALTH SERVICES
Uplift Family Services
FY 2021 - 2022
BUDGET NARRATIVE - EXPENSES
Clinician II
5.0 FTE at average salary $63,684 per FTE. Total Estimated Cost is $318,420.
Master's Degree (MA/MS) and at least three years of experience working with youth, young adults
and families in a therapeutic environment is required. If unlicensed must be a registered intern with
the Board of Behavioral Sciences and receiving appropriate clinical supervision. Provides
psychotherapy and psychotherapeutic support to children and families. Applies advanced use of
assessment information in development of the treatment plan and applies information and resources
to ensure quality care. Applies advanced skill in acquisition and application of clinically related
information to effectively intervene with children and families. Understands and applies multi-modal
approaches and perspectives to therapeutic direction. Provides coaching and mentoring of others in
the implementation of Evidence Based Practices (EBPs). Leads problem solving interaction and work
with external customers. Maintains audit ready charts and audits charts independently. Provides
observations and feedback to supervisor in order to monitor and/or modify programs or approaches.
Actively participates in the identification of team opportunities for improvement or identification of
deficiencies and in the development of strategies to address or bridge gaps. Leads Continuous
Quality Improvement (CQI) activities and project implementation. Required to meet applicable
productivity and documentation requirements.
Exhibit D-3
30 of 60
0004
Provides direct services to youth and families. Provides direct billable mental health services, documents in
alignment with MediCal regulations, and achieves set productivity expectations. Engages and builds alignment
and relationships with parents, youth, and others in the normal course of working with the families. Utilizes
strengths of youth, families, and others to assist in the implementation and achievement of goals and outcomes.
Works with youth and family teams to support family driven, strength based planning and interventions.
Understands and takes advantage of therapeutic opportunities in crisis situations. Conducts observations
regarding specific target behavior, track progress and modify plans with the family to support their intended
identified outcome. Assists teams in developing a hypothesis of function and underlying unmet need in an effort
to develop individualized, strength based strategies and interventions that will result in positive behavior change.
Engages caregiver, family members, and other natural supports in building youth specific parenting responses
that support positive behavior change and overall family relationships. Works in the community directly with
youth and families to develop and implement safety and skill refinement plans. Supports families in bridging to
and or building on natural resources and accessing community based program supports that will continue
support over time. Develops resources within the community to serve children and families. Assists youth and
family teams to meet specific service needs (ie: help develop strategy or resource specific to an identified need)
and monitor outcomes. Participates in family finding team activities by identifying family finding need, obtaining
authorizations, creating teams, conducting searches and setting deadlines. Completes Connectedness Maps as
needed. Documents interactions and practices and maintain administrative expectations in a timely manner.
Meets and or exceeds all direct service expectations and documentation requirements. Assists in developing
program responses to needs identified across a number of youth and families where natural community
resources are not available or appropriate. Builds on individual strengths, concerns, and needs with balanced
focus on the family as a unit. Facilitates and/or co-facilitates, supports, and model participation in healthy group
dynamics within various settings including family homes, schools, parks, and recreation centers, and treatment
facilities. Provides an open forum for expression of feelings and ideas when appropriate. Builds solid,
cooperative, culturally responsive relationships with youth and families as well as community resources to assist
with the planning, organizing, implementation and evaluation of appropriate activities to achieve family.
Clinical Program Manager
5.31 FTE at average salary $80,720 per FTE. Total Estimated Cost is $428,625.
Exhibit D-3
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0005
0006
1.0 FTE at average salary $109,762 per FTE. Total Estimated Cost is $109,762.
Master's degree (MA/MS). Must have appropriate license to practice as a Licensed Clinical Social
Worker or Marriage Family Therapist in the State of California. Must meet the BBS requirements to
provide clinical oversight and supervision with three to ten years of experience in
healthcare/psychology/behavioral/mental health. The Clinical Director implements strategies to
accomplish the agency annual priorities at the program level. Directs and develops managers,
ensures CPMS are competent and have all tools necessary to lead teams.
Support Services Coordinator
2.0 FTE at average salary $48,452 per FTE. Total Estimated Cost is $96,904.
Ensures effective coordination of services for youth and families with other providers, both internal and external,
by supporting the development of constructive relationships and problem-solving barriers. Develops, interprets
and ensures consistent implementation of clinical program philosophy, objectives, standards, policies,
procedures and practices. Analyzes and integrates the use of outcome data to improve clinical service delivery
within assigned team. Ensures and monitors defined outcome achievement for youth and families, as well as
satisfaction levels for youth, families, and referring workers and agencies. Initiates and participates in
organizational quality improvement efforts. Lead and/or delegate work groups to respond to program
development needs. Ensures compliance with all policy and procedures including adherence to all licensing,
quality, Information Technology (IT), Human Resources (HR), compliance and regulatory standards. Leads and
manages change. Proactively identifies potential conflicts; leads parties to consensus and develops same skills
in direct reports. Manages to ensure fiscally viable programming. Ensures staff billable productivity and other
revenue related activities meet or exceed revenue forecasts. Ensures effective quality clinical services delivery
for assigned youth and families. Provides effective crisis and risk prevention and management. Partners with
county referring departments, agencies and the community to ensure comprehensive care. Participates in staff
development; hires, coaches, mentors, supervises, conducts direct field observations, trains, disciplines, and
terminates. Ensures clinical documentation and quality assurance meets both agency and payor standards,
ensuring audit ready charts and continuous quality improvement. Provides 24/7 availability as needed. Culturally
responsive to internal and external customers, and ensures family voice. Provides direct services to families and
children, as support to the direct service staff, to ensure smooth delivery of service to assigned families and
youth. Provides outreach to the community including education about agency, program and general mental
health and foster care topics. Advocates for system change in relationship to agency service delivery
philosophy. Manages day-to-day operations including utilization of all administrative electronic systems, human,
and other resources. Works collaboratively with managerial peers to develop and improve program delivery and
ensure adherence to fiscal requirements. Ensures those Child Care Licensing (CCL) regulations and policy and
procedures relating to certification of families are upheld and followed and that the youths needs are met.
Required to meet applicable productivity and documentation requirements.
Clinical Director
Exhibit D-3
32 of 60
0007
0030
0031
0032
0040
SUI
Calculated at 0.75% of salaries. Annual cost is estimated at $18,871.
Retirement
Calculated at 4% of salaries. Annual cost is estimated at $100,647.
OASDI
Calculated at 6.2% of salaries. Annual cost is estimated at $156,003.
FICA/MEDICARE
Calculated at 1.45% of salaries. Annual cost is estimated at $36,485.
Bachelor’s degree required. (with emphasis in Psychology, social Work, Sociology or
related course work) Two years of experience in Mental Health field required.Four years of
experience in Mental Health field preferred. Knowledge of excel spreadsheets; moderate computer
literacy. Clinical skills relevant to intake services including: client triage, understanding of legal/ethical
issues, and risk management.
Works within the vision, mission, and philosophy of the agency, provides customerfriendly
services to internal and external customers. With limited supervision, sets up,
coordinates and runs parenting groups, trains new staff and coaches and supports
existing staff in effectively using therapeutic interventions with children and families and
in meeting documentation quality and timeliness expectations. Analyzes outcome data
in partnership with Outcomes and Evaluation to identify quality improvement activities.
Leads quality improvement activities from start to finish, including evaluation of the
effectiveness of the activities.
Program Shared Staff
6.23 FTE at average salary $65,074 per FTE. Total Estimated Cost is $405,410.
1.68 FTE Administrative Assistant
0.42 FTE Regional Director
0.42 FTE Supervisor of Administrative Operations
1.26 FTE Customer Services
0.84 FTE Compliance - Health Information Technician
0.42 FTE Associate Director Quality Support
0.17 FTE Health Information Management
0.14 FTE Supervisor Physical Plant Operations
0.57 FTE Outcomes - Research Specialist
0.31 FTE Training - Learning Partner
These positions are shared direct program costs that provide direct clinical, operational support,
quality, compliance and outcomes support and management and supervision support, to produce
required program outcomes to all programs in this region. Approximately 42% of cost is allocated to
this program using the basis of direct wages by program for this region’s programs.
Exhibit D-3
33 of 60
0041
0042
Facilities/Equipment Expenses – Line Items 1010-1014
1010
1011
1013
1014
Operating Expenses - Line Items 1060-1077
268,773$
Building Maintenance
This includes common area maintenance on leased building charges, maintenance/building repair
charges, HVAC maintenance and repair, landscaping, janitorial services, confidential paper
shredding services, in-house or outside equipment repair and labor. Costs are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and the
utilization of the Agency’s office in Fresno. Estimated cost is $2,127 per year.
Equipment purchase
Equipment, parts and materials includes the purchase of non-capital assets. Sample items include,
but are not limited to, laptops, desktops, printers, calculators and fax machines, as well as system
user licenses. Costs are allocated between programs on the basis of payroll dollars and estimated.
Estimated cost is $36,710 per year.
Rent/Lease Building
This includes building rent or depreciation, storage and file storage unit rental payments and all the
costs associated with storing and retrieving of client, personnel or other files or records. Costs are
allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends and the utilization of the Agency’s new office in Fresno. Estimated cost is $221,578
per year.
Rent/Lease Equipment
This includes rental payments for equipment including leased copiers, postage machines, phone
systems, laptops or other communication, office or facility equipment. Costs are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and the
utilization of the Agency’s office in Fresno. Estimated cost is $8,358 per year.
3,444,644$
Workers Compensation
Calculated at 2% of salaries. Annual cost is estimated at $50,324.
Health Insurance (medical, vision, life, dental)
Calculated at 22.5% of salaries. Annual cost is estimated at $566,139.
Exhibit D-3
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1060
1062
1066
1069
1072
1074 Staff Training/Registration
Program Supplies - Therapeutic
Includes those supplies utilized in the direct delivery of therapeutic services to clients. Cost is
estimated to be approximately $18.50 per direct care staff per month. Materials, cash payments,
outing costs, etc. used to motivate or reinforce desired behavior in clients, as well as materials
required for use in Evidenced Based Practices. Estimated cost is $6,000 per year.
Staff Travel and Mileage/vehicle maintenance
Includes travel costs such as air fare and lodging for trainings/meetings/conferences, and mileage
reimbursement, which is paid at the prevailing federal rate (currently $0.58 per mile) to program
service staff and program administrative staff. This also includes upkeep costs for vehicles.
Estimated cost is $134,949 per year.
Office supplies and equipment include, but are not limited to: paper, pens, files, staplers,
subscriptions to periodicals or newspapers, annual Agency dues and fees paid to accrediting
agencies and laptop replacement. Costs are allocated between programs on the basis of direct labor
dollars and have been estimated based on historical trends. Estimated cost is $11,307 per year.
Office Supplies & Equipment
Telephone
Cell phones, Land Lines, DSL, fax charges, phone system; wireless cards for laptop computers
enabling UFS to maintain a fully functional mobile work force to deliver in-home/in the community
services. Costs are allocated between programs on the basis of payroll dollars and have been
estimated based on historical trends. Estimated cost is $55,933 per year.
Postage
Postage, printing, US mail, GSO, Federal Express, UPS, postage machine refills, outside
reproduction costs, program specific brochures and flyers when reimbursable by the program. Costs
are allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends. Estimated cost is $1,946 per year.
Exhibit D-3
35 of 60
1076
1077
Financial Services Expenses – Line Items 1080-1085
1081
1082
1083
Includes annual audit ensuring all financial records are relevant and accurate and in compliance with
state and federal laws and regulations. Audit costs are allocated between programs on the basis of
payroll dollars and have been estimated based on historical costs. Estimated cost is $4,405 per year.
Liability Insurance
Includes general business liability and property coverage along with professional liability insurance.
Costs are allocated between programs on the basis of direct labor dollars and estimated based on
historical trends. Estimated cost is $57,873 per year.
Administrative Overhead
323,110$
External Audit
Includes training in the Evidence-Based Practices of Trauma-Focused Cognitive Behavioral Therapy
(TFCBT), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), Child Parent
Psychotherapy (CPP), and Dialectical Behavior Therapy (DBT), organizational tools,
team/organizational psychology, philosophy of client based services, integration of roles/team
dynamics, assessment and individualized treatment planning, general services, organizing
admissions, individualized treatment planning associated with the EBPs, and other infant mental
health trainings. This includes train-the-trainer and any other program development training needs.
Trainings are inclusive of internal and external trainings, and all costs, except mileage associated
with training, including transportation, parking room and board, meals, refreshments cost of the
program, instructor fees and materials/manuals are included. Also includes other mandatory
trainings such as first aid and CPR. Estimated cost is $105,237 per year.
Depreciation
Depreciation includes deprecation on leasehold improvements, office furniture/fixtures and
equipment meeting amortization thresholds. Costs are allocated between programs on the basis of
payroll dollars and have been estimated based on historical trends. Estimated cost is $2,909 per
year
Subscription/Membership Services
Includes subscriptions to periodicals, databases, software, and other subscription services, as well
as annual agency dues and fees. Costs are allocated between programs on the basis of payroll
dollars and have been estimated based on historical trends. Estimated Cost is $4,829 per year.
Exhibit D-3
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Special Expenses – Line Items 1090-1092
1090
1091
1092
5,000,211$ TOTAL PROGRAM EXPENSE:
To ensure the provision of culturally sensitive services including assurance of language access,
when there is not availability of bilingual staff interpreter/translation services are used to support a
culturally appropriate evaluation, diagnosis, treatment and referral services. Estimated Cost is
$30,000 per year.
Contract Psychiatrist
This includes a contract Psychiatrist position estimated to cost $205 per hour. The psychiatrist will be
required to provide at least 25 hours per month, and will provide psychiatric evaluations and
medication support services. This also includes a Nurse Practitioner, estimated to cost $133 per
hour. The nurse practitioner will be required to provide 2 hours per week and will provide additional
psychiatric evaluations and medication support services. Estimated Cost is $86,192 per year.
151,375$
Consultant (network & data management)
The consultant will provide additional clinical supervision support for program staff. This will also be
used for a contract psychologist to provide court ordered psychological testing and reports to the
Court. Contract Psychologist estimated to cost $105 per hour. The psychologist will be required to
provide at least 20 hours per month on average. This will also cover the cost of the psychological
testing and scoring materials. Estimated cost is $35,183 per year.
Translation Services
Represents the overhead of the Agency's general and administrative shared support services such
as finance, accounting, billing, human resources, clinical administration, information technology,
professional fees, HIPPA compliance and clinical record audits, risk management and program
fidelity, recruiting and human resources support, MIS infrastructure & QI/UM department support and
oversight as well as executive management. Costs that cannot be specifically charged to a program
are allocated to programs on the basis of direct labor program costs prior to the addition of taxes and
benefits. Administrative Overhead has been budgeted at 15% of total program expenses. Estimated
cost is $750,032 per year.
812,310$
Exhibit D-3
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FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinician I 18.00 $1,047,314 $1,047,314
0002 Clinician II 5.00 $327,973 $327,973
0003 Family Specialist 4.00 $144,451 $144,451
0004 Clinical Program Manager 5.31 $441,484 $441,484
0005 Clinical Director 1.00 $113,055 $113,055
0006 Support Services Coordinator 2.00 $99,811 $99,811
0007 Administrative Assistant 1.68 $76,611 $76,611
0008 Regional Director 0.42 $63,563 $63,563
0009 Supervisor of Administrative Operations 0.42 $27,668 $27,668
0010 Customer Services 1.26 $68,063 $68,063
0011 Compliance - Health Information Technician 0.84 $33,702 $33,702
0012 Associate Director of Quality Support 0.42 $37,765 $37,765
0013 Health Information Manager 0.17 $20,650 $20,650
0014 Supervisor Physical Plant Operations 0.14 $13,558 $13,558
0015 Outcome - Research Specialist 0.57 $52,805 $52,805
0016 Training - Learning Partner 0.31 $23,187 $23,187
SALARY TOTAL 41.54 $417,572 $2,174,088 $2,591,660
PAYROLL TAXES:
0030 OASDI $25,889 $134,793 $160,683
0031 FICA/MEDICARE $6,055 $31,524 $37,579
0032 SUI $3,132 $16,306 $19,437
PAYROLL TAX TOTAL $35,076 $182,623 $217,699
EMPLOYEE BENEFITS:
0040 Retirement $16,703 $86,964 $103,667
0041 Workers Compensation $8,351 $43,482 $51,833
0042 Health Insurance (medical, vision, life, dental)$93,954 $489,170 $583,124
EMPLOYEE BENEFITS TOTAL $119,008 $619,616 $738,624
SALARY & BENEFITS GRAND TOTAL $3,547,983
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $221,578
Line Item Description (Must be itemized)
CHILD WELFARE MENTAL HEALTH SERVICES
Uplift Family Services
FY 2022-2023
Budget Categories - Total Proposed Budget
Exhibit D-3
38 of 60
1011 Rent/Lease Equipment $8,358
1012 Utilities $0
1013 Building Maintenance $2,127
1014 Equipment purchase $36,710
FACILITY/EQUIPMENT TOTAL $268,773
OPERATING EXPENSES:
1060 Telephone $55,933
1061 Answering Service $0
1062 Postage $1,946
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $11,307
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies - Therapeutic $6,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Travel and Mileage/vehicle maintenance $134,949
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $107,552
1075 Lodging $0
1076 Depreciation $2,909
1077 Subscription/Membership Services $4,829
OPERATING EXPENSES TOTAL $325,425
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $4,405
1082 Liability Insurance $59,609
1083 Administrative Overhead $769,532
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $833,546
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$36,384
1091 Translation Services $30,000
1092 Contract Psychiatrist $88,105
Exhibit D-3
39 of 60
SPECIAL EXPENSES TOTAL $154,489
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $5,130,216
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy 876,974 $2.98 $2,613,383
3100 Case Management 84,325 $2.32 $195,634
3200 Crisis Services 16,865 $4.38 $73,869
3300 Medication Support 16,865 $5.44 $91,746
3400 Collateral 101,189 $2.98 $301,543
3500 Plan Development 33,730 $2.32 $78,254
3600 Assessment 134,919 $2.98 $402,059
3700 Rehabilitation 84,324 $2.98 $251,286
3800 Intensive Care Coord 84,324 $2.32 $195,632
3900 Intensive Home Based Services 252,973 $2.98 $753,860
Estimated Specialty Mental Health Services Billing Totals 1,686,488 $4,957,263
Estimated % of Clients that are Medi-Cal Beneficiaries 93%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,617,194
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,308,597
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,308,597
MEDI-CAL REVENUE TOTAL $4,617,194
OTHER REVENUE: DEPARTMENT OF SOCIAL SERVICES Rate
Court Documentation, Report, Appearance (flat rate)1,380 $74.00 $102,120
Psychological Evaluations 24,480 $2.89 $70,747
Mental Health Services (Individual/Family/Group Therapy)59,356 $2.98 $176,880
Case Management 7,331 $2.32 $17,008
Crisis Services 777 $4.38 $3,402
Medication Support 625 $5.44 $3,402
Collateral 6,849 $2.98 $20,409
Plan Development 2,932 $2.32 $6,803
Assessment 9,132 $2.98 $27,212
Rehabilitation 5,707 $2.98 $17,008
Intensive Care Coord 7,331 $2.32 $17,008
Exhibit D-3
40 of 60
Intensive Home Based Services 17,122 $2.98 $51,023
OTHER REVENUE TOTAL 143,022 $513,022
TOTAL PROGRAM REVENUE $5,130,216
Exhibit D-3
41 of 60
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
0001
0002
0003 Family Specialist
4.0 FTE at average salary $36,113 per FTE. Total Estimated Cost is $144,451.
Clinician I
18.0 FTE at average salary $58,184 per FTE. Total Estimated Cost is $1,047,314.Master's Degree (MA/MS) and at least two years of experience working with youth, young adults and
families in a therapeutic environment is required. If unlicensed must be a registered intern with the
Board of Behavioral Sciences and receiving appropriate clinical supervision. Provides psychotherapy
and psychotherapeutic support to children and families. Up to 4 Masters level student interns will as
well be used to provide additional psychotherapy and psychotherapeutic support.
CHILD WELFARE MENTAL HEALTH SERVICES
Uplift Family Services
FY 2022 - 2023
BUDGET NARRATIVE - EXPENSES
Clinician II
5.0 FTE at average salary $65,595 per FTE. Total Estimated Cost is $327,973.
Master's Degree (MA/MS) and at least three years of experience working with youth, young adults
and families in a therapeutic environment is required. If unlicensed must be a registered intern with
the Board of Behavioral Sciences and receiving appropriate clinical supervision. Provides
psychotherapy and psychotherapeutic support to children and families. Applies advanced use of
assessment information in development of the treatment plan and applies information and resources
to ensure quality care. Applies advanced skill in acquisition and application of clinically related
information to effectively intervene with children and families. Understands and applies multi-modal
approaches and perspectives to therapeutic direction. Provides coaching and mentoring of others in
the implementation of Evidence Based Practices (EBPs). Leads problem solving interaction and work
with external customers. Maintains audit ready charts and audits charts independently. Provides
observations and feedback to supervisor in order to monitor and/or modify programs or approaches.
Actively participates in the identification of team opportunities for improvement or identification of
deficiencies and in the development of strategies to address or bridge gaps. Leads Continuous
Quality Improvement (CQI) activities and project implementation. Required to meet applicable
productivity and documentation requirements.
Exhibit D-3
42 of 60
0004
Provides direct services to youth and families. Provides direct billable mental health services, documents in
alignment with MediCal regulations, and achieves set productivity expectations. Engages and builds alignment
and relationships with parents, youth, and others in the normal course of working with the families. Utilizes
strengths of youth, families, and others to assist in the implementation and achievement of goals and outcomes.
Works with youth and family teams to support family driven, strength based planning and interventions.
Understands and takes advantage of therapeutic opportunities in crisis situations. Conducts observations
regarding specific target behavior, track progress and modify plans with the family to support their intended
identified outcome. Assists teams in developing a hypothesis of function and underlying unmet need in an effort
to develop individualized, strength based strategies and interventions that will result in positive behavior change.
Engages caregiver, family members, and other natural supports in building youth specific parenting responses
that support positive behavior change and overall family relationships. Works in the community directly with
youth and families to develop and implement safety and skill refinement plans. Supports families in bridging to
and or building on natural resources and accessing community based program supports that will continue
support over time. Develops resources within the community to serve children and families. Assists youth and
family teams to meet specific service needs (ie: help develop strategy or resource specific to an identified need)
and monitor outcomes. Participates in family finding team activities by identifying family finding need, obtaining
authorizations, creating teams, conducting searches and setting deadlines. Completes Connectedness Maps as
needed. Documents interactions and practices and maintain administrative expectations in a timely manner.
Meets and or exceeds all direct service expectations and documentation requirements. Assists in developing
program responses to needs identified across a number of youth and families where natural community
resources are not available or appropriate. Builds on individual strengths, concerns, and needs with balanced
focus on the family as a unit. Facilitates and/or co-facilitates, supports, and model participation in healthy group
dynamics within various settings including family homes, schools, parks, and recreation centers, and treatment
facilities. Provides an open forum for expression of feelings and ideas when appropriate. Builds solid,
cooperative, culturally responsive relationships with youth and families as well as community resources to assist
with the planning, organizing, implementation and evaluation of appropriate activities to achieve family.
Clinical Program Manager
5.31 FTE at average salary $83,142 per FTE. Total Estimated Cost is $441,484.
Exhibit D-3
43 of 60
0005
0006
1.0 FTE at average salary $113,055 per FTE. Total Estimated Cost is $113,055.
Master's degree (MA/MS). Must have appropriate license to practice as a Licensed Clinical Social
Worker or Marriage Family Therapist in the State of California. Must meet the BBS requirements to
provide clinical oversight and supervision with three to ten years of experience in
healthcare/psychology/behavioral/mental health. The Clinical Director implements strategies to
accomplish the agency annual priorities at the program level. Directs and develops managers,
ensures CPMS are competent and have all tools necessary to lead teams.
Support Services Coordinator
2.0 FTE at average salary $49,906 per FTE. Total Estimated Cost is $99,811.
Ensures effective coordination of services for youth and families with other providers, both internal and external,
by supporting the development of constructive relationships and problem-solving barriers. Develops, interprets
and ensures consistent implementation of clinical program philosophy, objectives, standards, policies,
procedures and practices. Analyzes and integrates the use of outcome data to improve clinical service delivery
within assigned team. Ensures and monitors defined outcome achievement for youth and families, as well as
satisfaction levels for youth, families, and referring workers and agencies. Initiates and participates in
organizational quality improvement efforts. Lead and/or delegate work groups to respond to program
development needs. Ensures compliance with all policy and procedures including adherence to all licensing,
quality, Information Technology (IT), Human Resources (HR), compliance and regulatory standards. Leads and
manages change. Proactively identifies potential conflicts; leads parties to consensus and develops same skills
in direct reports. Manages to ensure fiscally viable programming. Ensures staff billable productivity and other
revenue related activities meet or exceed revenue forecasts. Ensures effective quality clinical services delivery
for assigned youth and families. Provides effective crisis and risk prevention and management. Partners with
county referring departments, agencies and the community to ensure comprehensive care. Participates in staff
development; hires, coaches, mentors, supervises, conducts direct field observations, trains, disciplines, and
terminates. Ensures clinical documentation and quality assurance meets both agency and payor standards,
ensuring audit ready charts and continuous quality improvement. Provides 24/7 availability as needed. Culturally
responsive to internal and external customers, and ensures family voice. Provides direct services to families and
children, as support to the direct service staff, to ensure smooth delivery of service to assigned families and
youth. Provides outreach to the community including education about agency, program and general mental
health and foster care topics. Advocates for system change in relationship to agency service delivery
philosophy. Manages day-to-day operations including utilization of all administrative electronic systems, human,
and other resources. Works collaboratively with managerial peers to develop and improve program delivery and
ensure adherence to fiscal requirements. Ensures those Child Care Licensing (CCL) regulations and policy and
procedures relating to certification of families are upheld and followed and that the youths needs are met.
Required to meet applicable productivity and documentation requirements.
Clinical Director
Exhibit D-3
44 of 60
0007
0030
0031
0032
0040
SUI
Calculated at 0.75% of salaries. Annual cost is estimated at $19,437.
Retirement
Calculated at 4% of salaries. Annual cost is estimated at $103,667.
OASDI
Calculated at 6.2% of salaries. Annual cost is estimated at $160,683.
FICA/MEDICARE
Calculated at 1.45% of salaries. Annual cost is estimated at $37,579.
Bachelor’s degree required. (with emphasis in Psychology, social Work, Sociology or
related course work) Two years of experience in Mental Health field required.Four years of
experience in Mental Health field preferred. Knowledge of excel spreadsheets; moderate computer
literacy. Clinical skills relevant to intake services including: client triage, understanding of legal/ethical
issues, and risk management.
Works within the vision, mission, and philosophy of the agency, provides customerfriendly
services to internal and external customers. With limited supervision, sets up,
coordinates and runs parenting groups, trains new staff and coaches and supports
existing staff in effectively using therapeutic interventions with children and families and
in meeting documentation quality and timeliness expectations. Analyzes outcome data
in partnership with Outcomes and Evaluation to identify quality improvement activities.
Leads quality improvement activities from start to finish, including evaluation of the
effectiveness of the activities.
Program Shared Staff
6.23 FTE at average salary $67,026 per FTE. Total Estimated Cost is $417,572.
1.68 FTE Administrative Assistant
0.42 FTE Regional Director
0.42 FTE Supervisor of Administrative Operations
1.26 FTE Customer Services
0.84 FTE Compliance - Health Information Technician
0.42 FTE Associate Director Quality Support
0.17 FTE Health Information Management
0.14 FTE Supervisor Physical Plant Operations
0.57 FTE Outcomes - Research Specialist
0.31 FTE Training - Learning Partner
These positions are shared direct program costs that provide direct clinical, operational support,
quality, compliance and outcomes support and management and supervision support, to produce
required program outcomes to all programs in this region. Approximately 42% of cost is allocated to
this program using the basis of direct wages by program for this region’s programs.
Exhibit D-3
45 of 60
0041
0042
Facilities/Equipment Expenses – Line Items 1010-1014
1010
1011
1013
1014
Operating Expenses - Line Items 1060-1077
1060 Telephone
268,773$
Building Maintenance
This includes common area maintenance on leased building charges, maintenance/building repair
charges, HVAC maintenance and repair, landscaping, janitorial services, confidential paper
shredding services, in-house or outside equipment repair and labor. Costs are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and the
utilization of the Agency’s office in Fresno. Estimated cost is $2,127 per year.
Equipment purchase
Equipment, parts and materials includes the purchase of non-capital assets. Sample items include,
but are not limited to, laptops, desktops, printers, calculators and fax machines, as well as system
user licenses. Costs are allocated between programs on the basis of payroll dollars and estimated.
Estimated cost is $36,710 per year.
Rent/Lease Building
This includes building rent or depreciation, storage and file storage unit rental payments and all the
costs associated with storing and retrieving of client, personnel or other files or records. Costs are
allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends and the utilization of the Agency’s new office in Fresno. Estimated cost is $221,578
per year.
Rent/Lease Equipment
This includes rental payments for equipment including leased copiers, postage machines, phone
systems, laptops or other communication, office or facility equipment. Costs are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and the
utilization of the Agency’s office in Fresno. Estimated cost is $8,358 per year.
3,547,983$
Workers Compensation
Calculated at 2% of salaries. Annual cost is estimated at $51,833.
Health Insurance (medical, vision, life, dental)
Calculated at 22.5% of salaries. Annual cost is estimated at $583,124.
Exhibit D-3
46 of 60
1062
1066
1069
1072
1074
1076
Staff Training/Registration
Includes training in the Evidence-Based Practices of Trauma-Focused Cognitive Behavioral Therapy
(TFCBT), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), Child Parent
Psychotherapy (CPP), and Dialectical Behavior Therapy (DBT), organizational tools,
team/organizational psychology, philosophy of client based services, integration of roles/team
dynamics, assessment and individualized treatment planning, general services, organizing
admissions, individualized treatment planning associated with the EBPs, and other infant mental
health trainings. This includes train-the-trainer and any other program development training needs.
Trainings are inclusive of internal and external trainings, and all costs, except mileage associated
with training, including transportation, parking room and board, meals, refreshments cost of the
program, instructor fees and materials/manuals are included. Also includes other mandatory
trainings such as first aid and CPR. Estimated cost is $107,552 per year.
Depreciation
Program Supplies - Therapeutic
Includes those supplies utilized in the direct delivery of therapeutic services to clients. Cost is
estimated to be approximately $18.50 per direct care staff per month. Materials, cash payments,
outing costs, etc. used to motivate or reinforce desired behavior in clients, as well as materials
required for use in Evidenced Based Practices. Estimated cost is $6,000 per year.
Staff Travel and Mileage/vehicle maintenance
Includes travel costs such as air fare and lodging for trainings/meetings/conferences, and mileage
reimbursement, which is paid at the prevailing federal rate (currently $0.58 per mile) to program
service staff and program administrative staff. This also includes upkeep costs for vehicles.
Estimated cost is $134,949 per year.
Office supplies and equipment include, but are not limited to: paper, pens, files, staplers,
subscriptions to periodicals or newspapers, annual Agency dues and fees paid to accrediting
agencies and laptop replacement. Costs are allocated between programs on the basis of direct labor
dollars and have been estimated based on historical trends. Estimated cost is $11,307 per year.
Office Supplies & Equipment
Cell phones, Land Lines, DSL, fax charges, phone system; wireless cards for laptop computers
enabling UFS to maintain a fully functional mobile work force to deliver in-home/in the community
services. Costs are allocated between programs on the basis of payroll dollars and have been
estimated based on historical trends. Estimated cost is $55,933 per year.
Postage
Postage, printing, US mail, GSO, Federal Express, UPS, postage machine refills, outside
reproduction costs, program specific brochures and flyers when reimbursable by the program. Costs
are allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends. Estimated cost is $1,946 per year.
Exhibit D-3
47 of 60
1077
Financial Services Expenses – Line Items 1080-1085
1081
1082
1083
Special Expenses – Line Items 1090-1092
1090 Consultant (network & data management)
Represents the overhead of the Agency's general and administrative shared support services such
as finance, accounting, billing, human resources, clinical administration, information technology,
professional fees, HIPPA compliance and clinical record audits, risk management and program
fidelity, recruiting and human resources support, MIS infrastructure & QI/UM department support and
oversight as well as executive management. Costs that cannot be specifically charged to a program
are allocated to programs on the basis of direct labor program costs prior to the addition of taxes and
benefits. Administrative Overhead has been budgeted at 15% of total program expenses. Estimated
cost is $769,532 per year.
833,547$
Includes annual audit ensuring all financial records are relevant and accurate and in compliance with
state and federal laws and regulations. Audit costs are allocated between programs on the basis of
payroll dollars and have been estimated based on historical costs. Estimated cost is $4,405 per year.
Liability Insurance
Includes general business liability and property coverage along with professional liability insurance.
Costs are allocated between programs on the basis of direct labor dollars and estimated based on
historical trends. Estimated cost is $59,609 per year.
Administrative Overhead
325,425$
External Audit
Depreciation includes deprecation on leasehold improvements, office furniture/fixtures and
equipment meeting amortization thresholds. Costs are allocated between programs on the basis of
payroll dollars and have been estimated based on historical trends. Estimated cost is $2,909 per
year
Subscription/Membership Services
Includes subscriptions to periodicals, databases, software, and other subscription services, as well
as annual agency dues and fees. Costs are allocated between programs on the basis of payroll
dollars and have been estimated based on historical trends. Estimated Cost is $4,829 per year.
Exhibit D-3
48 of 60
1091
1092
5,130,216$ TOTAL PROGRAM EXPENSE:
To ensure the provision of culturally sensitive services including assurance of language access,
when there is not availability of bilingual staff interpreter/translation services are used to support a
culturally appropriate evaluation, diagnosis, treatment and referral services. Estimated Cost is
$30,000 per year.
Contract Psychiatrist
This includes a contract Psychiatrist position estimated to cost $210 per hour. The psychiatrist will be
required to provide at least 25 hours per month, and will provide psychiatric evaluations and
medication support services. This also includes a Nurse Practitioner, estimated to cost $137 per
hour. The nurse practitioner will be required to provide 2 hours per week and will provide additional
psychiatric evaluations and medication support services. Estimated Cost is $88,105 per year.
154,489$
The consultant will provide additional clinical supervision support for program staff. This will also be
used for a contract psychologist to provide court ordered psychological testing and reports to the
Court. Contract Psychologist estimated to cost $110 per hour. The psychologist will be required to
provide at least 20 hours per month on average. This will also cover the cost of the psychological
testing and scoring materials. Estimated cost is $36,384 per year.
Translation Services
Exhibit D-3
49 of 60
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinician I 18.00 $1,078,733 $1,078,733
0002 Clinician II 5.00 $337,812 $337,812
0003 Family Specialist 4.00 $148,785 $148,785
0004 Clinical Program Manager 5.31 $454,729 $454,729
0005 Clinical Director 1.00 $116,447 $116,447
0006 Support Services Coordinator 2.00 $102,805 $102,805
0007 Administrative Assistant 1.68 $78,909 $78,909
0008 Regional Director 0.42 $65,470 $65,470
0009 Supervisor of Administrative Operations 0.42 $28,498 $28,498
0010 Customer Services 1.26 $70,105 $70,105
0011 Compliance - Health Information Technician 0.84 $34,713 $34,713
0012 Associate Director of Quality Support 0.42 $38,897 $38,897
0013 Health Information Manager 0.17 $21,270 $21,270
0014 Supervisor Physical Plant Operations 0.14 $13,965 $13,965
0015 Outcome - Research Specialist 0.57 $54,389 $54,389
0016 Training - Learning Partner 0.31 $23,883 $23,883
SALARY TOTAL 41.54 $430,099 $2,239,311 $2,669,410
PAYROLL TAXES:
0030 OASDI $26,666 $138,837 $165,503
0031 FICA/MEDICARE $6,236 $32,470 $38,706
0032 SUI $3,226 $16,795 $20,021
PAYROLL TAX TOTAL $36,128 $188,102 $224,230
EMPLOYEE BENEFITS:
0040 Retirement $17,204 $89,572 $106,776
0041 Workers Compensation $8,602 $44,786 $53,388
0042 Health Insurance (medical, vision, life, dental)$96,772 $503,845 $600,617
EMPLOYEE BENEFITS TOTAL $122,578 $638,203 $760,782
SALARY & BENEFITS GRAND TOTAL $3,654,422
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $221,578
Line Item Description (Must be itemized)
ENTER PROGRAM NAME PER RFP/CONTRACT
Uplift Family Services
FY 2023-2024
Budget Categories - Total Proposed Budget
Exhibit D-3
50 of 60
1011 Rent/Lease Equipment $8,358
1012 Utilities $0
1013 Building Maintenance $2,127
1014 Equipment purchase $36,710
FACILITY/EQUIPMENT TOTAL $268,773
OPERATING EXPENSES:
1060 Telephone $55,933
1061 Answering Service $0
1062 Postage $1,946
1063 Printing/Reproduction $0
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $11,307
1067 Household Supplies $0
1068 Food $0
1069 Program Supplies - Therapeutic $6,000
1070 Program Supplies - Medical $0
1071 Transportation of Clients $0
1072 Staff Travel and Mileage/vehicle maintenance $134,949
1073 Staff Travel (Out of County)$0
1074 Staff Training/Registration $109,576
1075 Lodging $0
1076 Depreciation $2,909
1077 Subscription/Membership Services $4,829
OPERATING EXPENSES TOTAL $327,449
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $4,405
1082 Liability Insurance $61,398
1083 Administrative Overhead $789,540
1084 Payroll Services $0
1085 Professional Liability Insurance $0
FINANCIAL SERVICES TOTAL $855,343
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)$37,583
1091 Translation Services $30,000
1092 Contract Psychiatrist $90,032
Exhibit D-3
51 of 60
SPECIAL EXPENSES TOTAL $157,615
FIXED ASSETS:
1190 Computers & Software $0
1191 Furniture & Fixtures $0
1192 Other - (Identify)$0
1193 Other - (Identify)$0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $5,263,602
MEDI-CAL REVENUE:
Service Rate $ Amount
3000 Mental Health Services (Individual/Family/Group Therapy 900,549 $2.98 $2,683,636
3100 Case Management 86,591 $2.32 $200,891
3200 Crisis Services 17,318 $4.38 $75,853
3300 Medication Support 17,318 $5.44 $94,210
3400 Collateral 103,910 $2.98 $309,652
3500 Plan Development 34,636 $2.32 $80,356
3600 Assessment 138,546 $2.98 $412,867
3700 Rehabilitation 86,591 $2.98 $258,041
3800 Intensive Care Coord 86,591 $2.32 $200,891
3900 Intensive Home Based Services 259,774 $2.98 $774,127
Estimated Specialty Mental Health Services Billing Totals 1,731,824 $5,090,524
Estimated % of Clients that are Medi-Cal Beneficiaries 93%
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries $4,737,242
Federal M/Cal Share of Cost % (Federal Financial Participation-FFP) 50.00%$2,368,621
State M/Cal Share of Cost % (BH Realignment/EPSDT) 50.00%$2,368,621
MEDI-CAL REVENUE TOTAL $4,737,242
OTHER REVENUE: DEPARTMENT OF SOCIAL SERVICES Rate
Court Documentation, Report, Appearance (flat rate)1,380 $74.00 $102,120
Psychological Evaluations 24,480 $2.89 $70,747
Mental Health Services (Individual/Family/Group Therapy)61,683 $2.98 $183,815
Case Management 7,619 $2.32 $17,675
Crisis Services 807 $4.38 $3,535
Medication Support 650 $5.44 $3,535
Collateral 7,117 $2.98 $21,210
Plan Development 3,047 $2.32 $7,070
Assessment 9,490 $2.98 $28,279
Rehabilitation 5,931 $2.98 $17,675
Intensive Care Coord 7,619 $2.32 $17,675
Exhibit D-3
52 of 60
Intensive Home Based Services 17,793 $2.98 $53,024
OTHER REVENUE TOTAL 147,616 $526,360
TOTAL PROGRAM REVENUE $5,263,602
Exhibit D-3
53 of 60
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
0001
0002
0003 Family Specialist
4.0 FTE at average salary $37,196 per FTE. Total Estimated Cost is $148,785.
Clinician I
18.0 FTE at average salary $59,930 per FTE. Total Estimated Cost is $1,078,733.
Master's Degree (MA/MS) and at least two years of experience working with youth, young adults and
families in a therapeutic environment is required. If unlicensed must be a registered intern with the
Board of Behavioral Sciences and receiving appropriate clinical supervision. Provides psychotherapy
and psychotherapeutic support to children and families. Up to 4 Masters level student interns will as
well be used to provide additional psychotherapy and psychotherapeutic support.
CHILD WELFARE MENTAL HEALTH SERVICES
Uplift Family Services
FY 2023 - 2024
BUDGET NARRATIVE - EXPENSES
Clinician II
5.0 FTE at average salary $67,562 per FTE. Total Estimated Cost is $337,812.
Master's Degree (MA/MS) and at least three years of experience working with youth, young adults
and families in a therapeutic environment is required. If unlicensed must be a registered intern with
the Board of Behavioral Sciences and receiving appropriate clinical supervision. Provides
psychotherapy and psychotherapeutic support to children and families. Applies advanced use of
assessment information in development of the treatment plan and applies information and resources
to ensure quality care. Applies advanced skill in acquisition and application of clinically related
information to effectively intervene with children and families. Understands and applies multi-modal
approaches and perspectives to therapeutic direction. Provides coaching and mentoring of others in
the implementation of Evidence Based Practices (EBPs). Leads problem solving interaction and work
with external customers. Maintains audit ready charts and audits charts independently. Provides
observations and feedback to supervisor in order to monitor and/or modify programs or approaches.
Actively participates in the identification of team opportunities for improvement or identification of
deficiencies and in the development of strategies to address or bridge gaps. Leads Continuous
Quality Improvement (CQI) activities and project implementation. Required to meet applicable
productivity and documentation requirements.
Exhibit D-3
54 of 60
0004
Provides direct services to youth and families. Provides direct billable mental health services, documents in
alignment with MediCal regulations, and achieves set productivity expectations. Engages and builds alignment
and relationships with parents, youth, and others in the normal course of working with the families. Utilizes
strengths of youth, families, and others to assist in the implementation and achievement of goals and outcomes.
Works with youth and family teams to support family driven, strength based planning and interventions.
Understands and takes advantage of therapeutic opportunities in crisis situations. Conducts observations
regarding specific target behavior, track progress and modify plans with the family to support their intended
identified outcome. Assists teams in developing a hypothesis of function and underlying unmet need in an effort
to develop individualized, strength based strategies and interventions that will result in positive behavior change.
Engages caregiver, family members, and other natural supports in building youth specific parenting responses
that support positive behavior change and overall family relationships. Works in the community directly with
youth and families to develop and implement safety and skill refinement plans. Supports families in bridging to
and or building on natural resources and accessing community based program supports that will continue
support over time. Develops resources within the community to serve children and families. Assists youth and
family teams to meet specific service needs (ie: help develop strategy or resource specific to an identified need)
and monitor outcomes. Participates in family finding team activities by identifying family finding need, obtaining
authorizations, creating teams, conducting searches and setting deadlines. Completes Connectedness Maps as
needed. Documents interactions and practices and maintain administrative expectations in a timely manner.
Meets and or exceeds all direct service expectations and documentation requirements. Assists in developing
program responses to needs identified across a number of youth and families where natural community
resources are not available or appropriate. Builds on individual strengths, concerns, and needs with balanced
focus on the family as a unit. Facilitates and/or co-facilitates, supports, and model participation in healthy group
dynamics within various settings including family homes, schools, parks, and recreation centers, and treatment
facilities. Provides an open forum for expression of feelings and ideas when appropriate. Builds solid,
cooperative, culturally responsive relationships with youth and families as well as community resources to assist
with the planning, organizing, implementation and evaluation of appropriate activities to achieve family.
Clinical Program Manager
5.31 FTE at average salary $85,636 per FTE. Total Estimated Cost is $454,729.
Exhibit D-3
55 of 60
0005
0006
1.0 FTE at average salary $116,447 per FTE. Total Estimated Cost is $116,447.
Master's degree (MA/MS). Must have appropriate license to practice as a Licensed Clinical Social
Worker or Marriage Family Therapist in the State of California. Must meet the BBS requirements to
provide clinical oversight and supervision with three to ten years of experience in
healthcare/psychology/behavioral/mental health. The Clinical Director implements strategies to
accomplish the agency annual priorities at the program level. Directs and develops managers,
ensures CPMS are competent and have all tools necessary to lead teams.
Support Services Coordinator
2.0 FTE at average salary $51,403 per FTE. Total Estimated Cost is $102,805.
Ensures effective coordination of services for youth and families with other providers, both internal and external,
by supporting the development of constructive relationships and problem-solving barriers. Develops, interprets
and ensures consistent implementation of clinical program philosophy, objectives, standards, policies,
procedures and practices. Analyzes and integrates the use of outcome data to improve clinical service delivery
within assigned team. Ensures and monitors defined outcome achievement for youth and families, as well as
satisfaction levels for youth, families, and referring workers and agencies. Initiates and participates in
organizational quality improvement efforts. Lead and/or delegate work groups to respond to program
development needs. Ensures compliance with all policy and procedures including adherence to all licensing,
quality, Information Technology (IT), Human Resources (HR), compliance and regulatory standards. Leads and
manages change. Proactively identifies potential conflicts; leads parties to consensus and develops same skills
in direct reports. Manages to ensure fiscally viable programming. Ensures staff billable productivity and other
revenue related activities meet or exceed revenue forecasts. Ensures effective quality clinical services delivery
for assigned youth and families. Provides effective crisis and risk prevention and management. Partners with
county referring departments, agencies and the community to ensure comprehensive care. Participates in staff
development; hires, coaches, mentors, supervises, conducts direct field observations, trains, disciplines, and
terminates. Ensures clinical documentation and quality assurance meets both agency and payor standards,
ensuring audit ready charts and continuous quality improvement. Provides 24/7 availability as needed. Culturally
responsive to internal and external customers, and ensures family voice. Provides direct services to families and
children, as support to the direct service staff, to ensure smooth delivery of service to assigned families and
youth. Provides outreach to the community including education about agency, program and general mental
health and foster care topics. Advocates for system change in relationship to agency service delivery
philosophy. Manages day-to-day operations including utilization of all administrative electronic systems, human,
and other resources. Works collaboratively with managerial peers to develop and improve program delivery and
ensure adherence to fiscal requirements. Ensures those Child Care Licensing (CCL) regulations and policy and
procedures relating to certification of families are upheld and followed and that the youths needs are met.
Required to meet applicable productivity and documentation requirements.
Clinical Director
Exhibit D-3
56 of 60
0007
0030
0031
0032
0040
SUI
Calculated at 0.75% of salaries. Annual cost is estimated at $20,021.
Retirement
Calculated at 4% of salaries. Annual cost is estimated at $106,776.
OASDI
Calculated at 6.2% of salaries. Annual cost is estimated at $165,503.
FICA/MEDICARE
Calculated at 1.45% of salaries. Annual cost is estimated at $38,706.
Bachelor’s degree required. (with emphasis in Psychology, social Work, Sociology or
related course work) Two years of experience in Mental Health field required.Four years of
experience in Mental Health field preferred. Knowledge of excel spreadsheets; moderate computer
literacy. Clinical skills relevant to intake services including: client triage, understanding of legal/ethical
issues, and risk management.
Works within the vision, mission, and philosophy of the agency, provides customerfriendly
services to internal and external customers. With limited supervision, sets up,
coordinates and runs parenting groups, trains new staff and coaches and supports
existing staff in effectively using therapeutic interventions with children and families and
in meeting documentation quality and timeliness expectations. Analyzes outcome data
in partnership with Outcomes and Evaluation to identify quality improvement activities.
Leads quality improvement activities from start to finish, including evaluation of the
effectiveness of the activities.
Program Shared Staff
6.23 FTE at average salary $69,037 per FTE. Total Estimated Cost is $430,099.
1.68 FTE Administrative Assistant
0.42 FTE Regional Director
0.42 FTE Supervisor of Administrative Operations
1.26 FTE Customer Services
0.84 FTE Compliance - Health Information Technician
0.42 FTE Associate Director Quality Support
0.17 FTE Health Information Management
0.14 FTE Supervisor Physical Plant Operations
0.57 FTE Outcomes - Research Specialist
0.31 FTE Training - Learning Partner
These positions are shared direct program costs that provide direct clinical, operational support,
quality, compliance and outcomes support and management and supervision support, to produce
required program outcomes to all programs in this region. Approximately 42% of cost is allocated to
this program using the basis of direct wages by program for this region’s programs.
Exhibit D-3
57 of 60
0041
0042
Facilities/Equipment Expenses – Line Items 1010-1014
1010
1011
1013
1014
Operating Expenses - Line Items 1060-1077
1060 Telephone
268,773$
Building Maintenance
This includes common area maintenance on leased building charges, maintenance/building repair
charges, HVAC maintenance and repair, landscaping, janitorial services, confidential paper
shredding services, in-house or outside equipment repair and labor. Costs are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and the
utilization of the Agency’s office in Fresno. Estimated cost is $2,127 per year.
Equipment purchase
Equipment, parts and materials includes the purchase of non-capital assets. Sample items include,
but are not limited to, laptops, desktops, printers, calculators and fax machines, as well as system
user licenses. Costs are allocated between programs on the basis of payroll dollars and estimated.
Estimated cost is $36,710 per year.
Rent/Lease Building
This includes building rent or depreciation, storage and file storage unit rental payments and all the
costs associated with storing and retrieving of client, personnel or other files or records. Costs are
allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends and the utilization of the Agency’s new office in Fresno. Estimated cost is $221,578
per year.
Rent/Lease Equipment
This includes rental payments for equipment including leased copiers, postage machines, phone
systems, laptops or other communication, office or facility equipment. Costs are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and the
utilization of the Agency’s office in Fresno. Estimated cost is $8,358 per year.
3,654,422$
Workers Compensation
Calculated at 2% of salaries. Annual cost is estimated at $53,388.
Health Insurance (medical, vision, life, dental)
Calculated at 22.5% of salaries. Annual cost is estimated at $600,617.
Exhibit D-3
58 of 60
1062
1066
1069
1072
1074
1076
Staff Training/Registration
Includes training in the Evidence-Based Practices of Trauma-Focused Cognitive Behavioral Therapy
(TFCBT), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), Child Parent
Psychotherapy (CPP), and Dialectical Behavior Therapy (DBT), organizational tools,
team/organizational psychology, philosophy of client based services, integration of roles/team
dynamics, assessment and individualized treatment planning, general services, organizing
admissions, individualized treatment planning associated with the EBPs, and other infant mental
health trainings. This includes train-the-trainer and any other program development training needs.
Trainings are inclusive of internal and external trainings, and all costs, except mileage associated
with training, including transportation, parking room and board, meals, refreshments cost of the
program, instructor fees and materials/manuals are included. Also includes other mandatory
trainings such as first aid and CPR. Estimated cost is $109,576 per year.
Depreciation
Program Supplies - Therapeutic
Includes those supplies utilized in the direct delivery of therapeutic services to clients. Cost is
estimated to be approximately $18.50 per direct care staff per month. Materials, cash payments,
outing costs, etc. used to motivate or reinforce desired behavior in clients, as well as materials
required for use in Evidenced Based Practices. Estimated cost is $6,000 per year.
Staff Travel and Mileage/vehicle maintenance
Includes travel costs such as air fare and lodging for trainings/meetings/conferences, and mileage
reimbursement, which is paid at the prevailing federal rate (currently $0.58 per mile) to program
service staff and program administrative staff. This also includes upkeep costs for vehicles.
Estimated cost is $134,949 per year.
Office supplies and equipment include, but are not limited to: paper, pens, files, staplers,
subscriptions to periodicals or newspapers, annual Agency dues and fees paid to accrediting
agencies and laptop replacement. Costs are allocated between programs on the basis of direct labor
dollars and have been estimated based on historical trends. Estimated cost is $11,307 per year.
Office Supplies & Equipment
Cell phones, Land Lines, DSL, fax charges, phone system; wireless cards for laptop computers
enabling UFS to maintain a fully functional mobile work force to deliver in-home/in the community
services. Costs are allocated between programs on the basis of payroll dollars and have been
estimated based on historical trends. Estimated cost is $55,933 per year.
Postage
Postage, printing, US mail, GSO, Federal Express, UPS, postage machine refills, outside
reproduction costs, program specific brochures and flyers when reimbursable by the program. Costs
are allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends. Estimated cost is $1,946 per year.
Exhibit D-3
59 of 60
1077
Financial Services Expenses – Line Items 1080-1085
1081
1082
1083
Special Expenses – Line Items 1090-1092
1090 Consultant (network & data management)
Represents the overhead of the Agency's general and administrative shared support services such
as finance, accounting, billing, human resources, clinical administration, information technology,
professional fees, HIPPA compliance and clinical record audits, risk management and program
fidelity, recruiting and human resources support, MIS infrastructure & QI/UM department support and
oversight as well as executive management. Costs that cannot be specifically charged to a program
are allocated to programs on the basis of direct labor program costs prior to the addition of taxes and
benefits. Administrative Overhead has been budgeted at 15% of total program expenses. Estimated
cost is $789,540 per year.
855,343$
Includes annual audit ensuring all financial records are relevant and accurate and in compliance with
state and federal laws and regulations. Audit costs are allocated between programs on the basis of
payroll dollars and have been estimated based on historical costs. Estimated cost is $4,405 per year.
Liability Insurance
Includes general business liability and property coverage along with professional liability insurance.
Costs are allocated between programs on the basis of direct labor dollars and estimated based on
historical trends. Estimated cost is $61,398 per year.
Administrative Overhead
327,449$
External Audit
Depreciation includes deprecation on leasehold improvements, office furniture/fixtures and
equipment meeting amortization thresholds. Costs are allocated between programs on the basis of
payroll dollars and have been estimated based on historical trends. Estimated cost is $2,909 per
year
Subscription/Membership Services
Includes subscriptions to periodicals, databases, software, and other subscription services, as well
as annual agency dues and fees. Costs are allocated between programs on the basis of payroll
dollars and have been estimated based on historical trends. Estimated Cost is $4,829 per year.
Exhibit D-3
60 of 60
1091
1092
5,263,602$ TOTAL PROGRAM EXPENSE:
To ensure the provision of culturally sensitive services including assurance of language access,
when there is not availability of bilingual staff interpreter/translation services are used to support a
culturally appropriate evaluation, diagnosis, treatment and referral services. Estimated Cost is
$30,000 per year.
Contract Psychiatrist
This includes a contract Psychiatrist position estimated to cost $215 per hour. The psychiatrist will be
required to provide at least 25 hours per month, and will provide psychiatric evaluations and
medication support services. This also includes a Nurse Practitioner, estimated to cost $141 per
hour. The nurse practitioner will be required to provide 2 hours per week and will provide additional
psychiatric evaluations and medication support services. Estimated Cost is $90,032 per year.
157,615$
The consultant will provide additional clinical supervision support for program staff. This will also be
used for a contract psychologist to provide court ordered psychological testing and reports to the
Court. Contract Psychologist estimated to cost $115 per hour. The psychologist will be required to
provide at least 20 hours per month on average. This will also cover the cost of the psychological
testing and scoring materials. Estimated cost is $37,583 per year.
Translation Services
Exhibit E
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health 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 subcontractor(s) shall comply. CONTRACTOR shall require
its employees and subcontractor(s) to attend a compliance training that will be provided by Fresno
County. After completion of this training, CONTRACTOR, its employee and subcontractor(s), 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, clients, 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.
7. Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
Exhibit E
Page 2 of 3
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.
Exhibit E
Page 3 of 3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print): _____________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Signature :________________________________ Date : ___/____/___
For Group or Organizational Providers
Group/Org. Name (print): _______________________________________
Employee Name (print): ________________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Other:___________________________________________
Job Title (if different from Discipline): ___________________________
Signature: _________________________________ Date: ____/___/____
Exhibit F
Page 1 of 3
Documentation Standards For Client Records
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the
record have a specific document or section addressing these topics. 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 appropriate as a part of a comprehensive client
record.
• Relevant physical health conditions reported by the client will be prominently identified
and updated as appropriate.
• Presenting problems and relevant conditions affecting the client’s physical health and
mental health status will be documented, for example: living situation, daily activities,
and social support.
• Documentation will describe client’s strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently
documented and updated as appropriate.
• Documentations will include medications that have been described by mental health plan
physicians, dosage of each medication, dates of initial prescriptions and refills, and
documentations of informed consent for medications.
• Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
• A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data, relevant
family information and relevant results of relevant lab tests and consultations reports.
• For children and adolescents, pre-natal and perinatal events and complete
developmental history will be documented.
• Documentations will include past and present use of tobacco, alcohol, and caffeine, as
well as illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A DSM-5 diagnosis, or a diagnosis from the most current ICD, will be documented,
consistent with the presenting problems, history mental status evaluation and/or other
assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document
changes in the client’s condition.
• Client conditions will be assessed at least annually and, in most cases, at more frequent
intervals.
B. Client Plans
1. Client plans will:
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
Exhibit F
Page 2 of 3
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent) by:
the person providing the service(s), or
a person representing a team or program providing services, or
a person representing the MHP providing services
when the client plan is used to establish that the services are provided under the
direction of an approved category of staff, and if the below staff are not the approved
category,
a physician
a licensed/ “waivered” psychologist
a licensed/ “associate” social worker
a licensed/ registered/marriage and family therapist or
a registered nurse
• In addition,
client plans will be consistent with the diagnosis, and the focus of intervention will be
consistent with the client plan goals, and there will be documentation of the client’s
participation in and agreement with the plan. Examples of the documentation include,
but are not limited to, reference to the client’s participation and agreement in the
body of the plan, client signature on the plan, or a description of the client’s
participation and agreement in progress notes.
client signature on the plan will be used as the means by which the
CONTRACTOR(S) documents the participation of the client
when the client’s signature is required on the client plan and the client refuses or is
unavailable for signature, the client plan will include a written explanation of the
refusal or unavailability.
• The CONTRACTOR(S) will give a copy of the client plan to the client on request.
2. Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for the
individual elements of the client plan described in item 1.
C. Progress Notes
1. Items that must be contained in the client record related to the client’s progress in treatment
include:
• The client record will provide timely documentation of relevant aspects of client care
• Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
• All entries in the client record will include the signature of the person providing the
service (or electronic equivalent); the person’s professional degree, licensure or job title;
and the relevant identification number, if applicable
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge summary
2. Timeliness/Frequency of Progress Notes:
Exhibit F
Page 3 of 3
Progress notes shall be documented at the frequency by type of service indicated below:
A. Every Service Contact
• Mental Health Services
• Medication Support Services
• Crisis Intervention
Exhibit G
Page 1 of 7
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance
with all applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal
services have met applicable professional licensure requirements
pursuant to Business and Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance
with all State of California and Federal statutes and regulations regarding
confidentiality, including but not limited to confidentiality of information
requirements at 42, Code of Federal Regulations sections 2.1 et seq;
California Welfare and Institutions Code, sections 14100.2, 11977, 11812,
5328; Division 10.5 and 10.6 of the California Health and Safety Code;
Title 22, California Code of Regulations, section 51009; and Division 1,
Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and
to the public all eligibility requirements to participate in the program
plan set forth in the Agreement. No person shall, because of ethnic
group identification, age, gender, color, disability, medical condition,
national origin, race, ancestry, marital status, religion, religious
creed, political belief or sexual preference be excluded from
participation, be denied benefits of, or be subject to discrimination
under any program or activity receiving Federal or State of
California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color,
national origin, sex, religion, age, disability status, or sexual
preference in employment practices. Such practices include
retirement, recruitment advertising, hiring, layoff, termination,
Exhibit G
Page 2 of 7
upgrading, demotion, transfer, rates of pay or other forms of
compensation, use of facilities, and other terms and conditions of
employment.
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all
further funds, until CONTRACTOR can show clear and convincing
evidence to the satisfaction of COUNTY that funds provided under
this Agreement were not used in connection with the alleged
discrimination.
D. Nepotism
Except by consent of COUNTY’s Department of Behavioral Health
Director, or designee, no person shall be employed by
CONTRACTOR who is related by blood or marriage to, or who is a
member of the Board of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations,
including but not limited to, laws, regulations, and State policies relating to
patients' rights.
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,
Exhibit G
Page 3 of 7
4) penalties that may be imposed upon employees for drug abuse
violations.
c. Every employee who works on the proposed 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 the Agreement.
Failure to comply with these requirements may result in suspension of payments
under the Agreement or termination of the 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-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.
Exhibit G
Page 4 of 7
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. The contractor further declares under penalty of perjury
that they adhere to the Sweatfree Code of Conduct as set forth on the
California Department of Industrial Relations website located at
www.dir.ca.gov, and Public Contract Code Section 6108.
b. The 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 the
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
Exhibit G
Page 5 of 7
1) 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.
2) 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):
1) For the two-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.
2) For the twelve-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 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.)
Exhibit G
Page 6 of 7
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.
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
Exhibit G
Page 7 of 7
activities or work is conducted. The right to audit under this section exists for 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.
EXHIBIT H
Page 1 of 2
Medi-Cal Organizational Provider Standards
1. The organizational provider possesses the necessary license to operate, if applicable, and
any required certification.
2. The space owned, leased or operated by the provider and used for services or staff meets
local fire codes.
3. The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4. The organizational provider establishes and implements maintenance policies for any site
owned, leased, or operated by the provider and used for services or staff to ensure the
safety and well being of beneficiaries and staff.
5. The organizational provider has a current administrative manual which includes: personnel
policies and procedures, general operating procedures, service delivery policies, and
procedures for reporting unusual occurrences relating to health and safety issues.
6. The organizational provider maintains client records in a manner that meets applicable state
and federal standards.
7. The organization provider has staffing adequate to allow the County to claim federal
financial participation for the services the Provider delivers to beneficiaries, as described in
Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8. The organizational provider has written procedures for referring individuals to a psychiatrist
when necessary, or to a physician, if a psychiatrist is not available.
9. The organizational provider has as head of service a licensed mental health professional of
other appropriate individual as described in Title 9, CCR, Sections 622 through 630.
10. For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A. All drugs obtained by prescription are labeled in compliance with federal and state laws.
Prescription labels are altered only by persons legally authorized to do so.
B. Drugs intended for external use only or food stuffs are stored separately from drugs for
internal use.
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86 degrees
F and refrigerated drugs at 36-46 degrees F.
D. Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
EXHIBIT H
Page 2 of 2
E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F. A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal laws.
G. Policies and procedures are in place for dispensing, administering and storing
medications.
11. For organizational providers that provide day treatment intensive or day rehabilitation,
the provider must have a written description of the day treatment intensive and/or day
treatment rehabilitation program that complies with State Department of Health Care
Service’s day treatment requirements. The COUNTY shall review the provider’s written
program description for compliance with the State Department of Health Care Service’s
day treatment requirements.
12. The COUNTY may accept the host county’s site certification and reserves the right to
conduct an on-site certification review at least every three years. The COUNTY may also
conduct additional certification reviews when:
• The provider makes major staffing changes.
• The provider makes organizational and/or corporate structure changes (example:
conversion from a non-profit status).
• The provider adds day treatment or medication support services when
medications shall be administered or dispensed from the provider site.
• There are significant changes in the physical plant of the provider site (some
physical plant changes could require a new fire clearance).
• There is change of ownership or location.
• There are complaints against the provider.
• There are unusual events, accidents, or injuries requiring medical treatment for
clients, staff or members of the community.
Exhibit I
Page 1 of 2
Fresno County Mental Health Plan
Grievances and Appeals Process
Grievances
The 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 to give verbal and written information to Medi-Cal beneficiaries regarding the
following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance form, an
appeal form, and Request for Change of Provider Form. All of these beneficiary materials must
be posted in prominent locations where Medi-Cal beneficiaries receive outpatient specialty
mental health services, including the waiting rooms of providers’ offices of service.
Please note that all fee-for-service providers and contract agencies are required to give their
clients copies of all current beneficiary information annually at the time their treatment plans are
updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any penalty,
change in mental health services, or any form of retaliation. All Medi-Cal beneficiaries can file
an appeal or state hearing.
Grievances and appeals forms and self-addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written request.
Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider concerns and
problems regarding payment authorization issues, other complaints and concerns.
Exhibit I
Page 2 of 2
Informal provider problem resolution process – the provider may first speak to a Provider
Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the attempt is
unsuccessful and the provider chooses to forego the informal grievance process, the provider
will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process – the provider has the right to access the provider appeal
process at any time before, during, or after the provider problem resolution process has begun,
when the complaint concerns a denied or modified request for MHP payment authorization, or
the process or payment of a provider’s claim to the MHP.
Payment authorization issues – the provider may appeal a denied or modified request for
payment authorization or a dispute with the MHP regarding the processing or payment of a
provider’s claim to the MHP. The written appeal must be submitted to the MHP within ninety
(90) calendar days of the date of the receipt of the non-approval of payment.
The MHP shall have sixty (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 Managed Care staff who were 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 thirty (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 sixty (60) calendar days of receipt
of the complaint. The decision rendered buy the MHP is final.
Section: Administration
Effective Date: 11/01/2010 Revised Date: 03/07/2018
Policy Title: Incident Reporting and Intensive Analysis
Approved by: Dawan Utecht (Director of Behavioral Health), Elizabeth Vasquez (Compliance Officer), Kannika
Toonnachat (Division Manager - Technology and Quality Management)
Department of Behavioral Health
Policy and Procedure Guide
PPG 1.2.4
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 3/28/16
POLICY: The 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
clients, employees, or community members. The incident report must
include a thorough description of: the incident itself, client information,
type of event, location, people directly involved, action taken, and outcome
(if known). The written report must be signed and submitted to the
Department of Behavioral Health Incident Reporting email address
DBHIncidentReporting@co.fresno.ca.us within 24 hours of the incident or
knowledge of the incident. An amendment to the original incident report
may be submitted if all the required information is not readily available
within the 24 hour reporting requirement. The Intensive Analysis
Committee (IAC) will review selected incidents. Incidents that occur within
the six months following discharge must also be reported.
PURPOSE:To ensure employees identify, document and report incidents consistently
and promptly. To review incidents and recommend system, policy, and
protocol changes. To increase best practice and safety in the provision of
behavioral health care and substance use disorder services.
REFERENCE: California Evidence Code 1157, 1157.5, 1157.6 and 1157.7., Welfare and
Institutions Code on Privileged Information**, DMH Letter 1995-04, page
7-12. Fresno County Management Directive, Chapter 1700, Subject 1750,
Mental Health Plan, Policy No. RSK 100.0. MHP Contract boilerplate,
Exhibit H. Fresno County DBH Incident Report, MHRC 24-Hour Unusual
Occurrence Report-DHCS form, PSD-RM 301 Report, PHF 24-Hour
Unusual Occurrence Report-DHCS form, Unusual Occurrence Report.
**Note: California Evidence Code 1157 does not guarantee that all committee
discussions, reports and records are protected from discovery and disclosure in all
cases.
Exhibit J
Page 1 of 6
Department of Behavioral Health
Policy and Procedure Guide
PPG 1.2.4
Policy Title: Reporting Incidents and Unusual Occurrences
Section: Administration Effective Date: 11/01/2010
DEFINITIONS:
24 Hours – 24 clock hours
Department of Behavioral Health Incident Reporting email address (DBH Incident Reporting)-
DBHIncidentReporting@co.fresno.ca.us
Department of Health Care Services- DHCS
Fresno County Department of Behavioral Health- DBH
Intensive Analysis Committee – IAC
Mental Health Plan- MHP
Mental Health Rehabilitation Center- MHRC
Psychiatric Health Facility- PHF
Quality Improvement Committee- QIC
Substance Use Disorder - SUD
Unusual Occurrence Report- UOR
An Incident is any event which jeopardizes the health and/or safety of clients, employees, or
members of the community.
Incidents include, but are not limited to:
•All client deaths
•Attempted suicide (resulting in serious injury)
•Homicide or attempts at homicide
•Injury connected to services or at a service site (self-inflicted or by accident)
•Medical Emergency connected to services or at a service site
•Other (i.e. Clients escaping from a locked facility, medication errors)
•Violence, Abuse or Assault connected to services or at a service site (toward
client, others or property; resulting in serious injury)
The Fresno County DBH Incident Report, MHRC/PHF 24-hour Unusual Occurrence Report,
PSD-RM 301 and/or Unusual Occurrence Report are all confidential reports and are not to be
part of the client’s medical record.
•DO NOT file a copy of or transcribe the Fresno County DBH Incident Report,
MHRC/PHF 24-hour Unusual Occurrence Report, PSD-RM 301 and/or Unusual
Occurrence Report in to the client’s medical record.
•DO NOT document in the medical record that a Fresno County DBH Incident
Report, MHRC/PHF 24-hour Unusual Occurrence Report, PSD-RM 301 and/or
Unusual Occurrence Report was filed.
•Details of the incident that are relevant to clinical treatment may be documented
in the client’s medical record by the appropriate practitioner.
Exhibit J
Page 2 of 6
Department of Behavioral Health
Policy and Procedure Guide
PPG 1.2.4
Policy Title: Reporting Incidents and Unusual Occurrences
Section: Administration Effective Date: 11/01/2010
PROCEDURE:
I. Employees having knowledge of an incident will follow the appropriate process listed in
sections II or III below:
II. DBH County Operated Programs
A. Employees involved in or first aware of an incident shall complete and submit
encrypted Form PSD-RM 301-Incident Report: Non-Employee to a supervisor
and/or Division Manager.
1. Supervisor and/or Division Manager shall review the report for
completeness and gather any further information needed. Supervisor,
Division Manager, or designee sends the encrypted report to the DBH
Incident Reporting email address, Division Manager and DBH Human
Resources email address within 24 hours of an incident or knowledge
of an incident.
2.Intensive Analysis Chair or designated committee member will review
the PSD-RM 301-Incident Report and request further information if
needed.
III. Contracted Providers
A. All contracted providers shall complete the Fresno County DBH Incident Report.
1. The report shall be completed and signed by the employee involved in or
first aware of an incident, reviewed and signed by a supervisor and/or
Program Director and the encrypted Incident Report will be sent to the
DBH Incident Reporting email address and designated Contract Staff
Analyst within 24 hours of an incident or knowledge of an incident.
2. Intensive Analysis Chair or designated committee member will review the
DBH Incident Report. If further information is needed, designated
Contract Staff Analyst shall assist in gathering requested information and
provide the information to Intensive Analysis Chair or designated
committee member.
B. In addition to completing the Fresno County DBH Incident Report under item III-
A, Mental Health Rehabilitation Centers (MHRC) and Psychiatric Health Facilities
(PHF) must also complete the respective below report.
1. MHRC shall complete the DHCS MHRC 24-Hour Unusual Occurrence
Report.
a. Report shall be completed and signed by staff involved in or first
aware of an incident, reviewed and signed by a supervisor and/or
Exhibit J
Page 3 of 6
Department of Behavioral Health
Policy and Procedure Guide
PPG 1.2.4
Policy Title: Reporting Incidents and Unusual Occurrences
Section: Administration Effective Date: 11/01/2010
Program Director and submitted to DHCS via fax: (916) 440-5600
or encrypted email to the DHCS designated reporting contact (per
form instructions), Contract Staff Analyst and the DBH Incident
Reporting email address within 24 hours of an incident or
knowledge of an incident.
2. PHF shall complete the DHCS PHF 24-Hour Unusual Occurrence Report.
a. Report shall be completed and signed by staff involved in or first
aware of an incident, reviewed and signed by a supervisor and/or
Program Director and submitted to DHCS via fax: (916) 440-5600
or encrypted email to the DHCS designated reporting contact (per
form instructions), Contract Staff Analyst and the DBH Incident
Reporting email address within 24 hours of an incident or
knowledge of an incident.
IV. Unusual Occurrence Reporting to DHCS
A. Unusual Occurrences may include but are not limited to physical injury and
death. The MHP will report Unusual Occurrences to DHCS as determined
necessary. The Unusual Occurrence Report (UOR) shall include:
1. A written description of the incident and outcome of the incident
2. List of persons directly involved/having direct knowledge of the incident
3. Report of providers investigation and conclusion.
B. If a reported incident is determined to be an Unusual Occurrence, the UOR shall
be completed and signed by a Division Manager or a designated IAC member.
Contracted Providers (not licensed directly by the state) who have determined an
incident to be an Unusual Occurrence may elect to submit their own UORs in lieu
of a DBH Division Manager or IAC member. The UOR shall be emailed
encrypted to the DHCS designated reporting contact (per DHCS instructions),
Contract Staff Analyst (if applicable) and the DBH Incident Reporting email
address within five (5) calendar days of an incident or knowledge of an incident.
MHRC’s and PHF’s will continue to follow reporting guidelines detailed above in
Section III, B1 and B2.
C. UORs sent to DHCS may be subject to further investigation and/or information
requested by DHCS, such as: Site Reviews and Plan(s) of Correction. All
correspondence between contracted provider and DHCS regarding UORs shall
also be sent to the Contract Staff Analyst and the DBH Incident Reporting email
address for informational purposes.
D. Site visits by DBH may be conducted as needed.
Exhibit J
Page 4 of 6
Department of Behavioral Health
Policy and Procedure Guide
PPG 1.2.4
Policy Title: Reporting Incidents and Unusual Occurrences
Section: Administration Effective Date: 11/01/2010
E. DBH may request contracted providers attest that an Intensive Analysis or similar
(i.e. incident review, possible cause) has occurred. DBH may request additional
analysis or information when necessary.
V. The IAC will review incidents and recommend system, policy, and protocol changes, as
needed, based on its findings. The IAC can conduct a case review with the employees
involved to determine possible cause. The IAC shall track and trend incidents and report
to the Quality Improvement Committee (QIC). The DBH Incident Reporting email
address shall be monitored by the Intensive Analysis Chair, with supportive monitoring
by the Quality Improvement Coordinator, Division Managers and Compliance Officer.
A. The IAC will be comprised of the following:
1. Intensive Analysis Chair – Chair shall be a Licensed Marriage and Family
Therapist, Licensed Clinical Social Worker, Psychologist, or Psychiatrist
2. Deputy Director
3. Quality Improvement Coordinator
4. Division Manager from Clinical Operations
5. Compliance Officer
6. Quality Improvement Licensed Mental Health Clinician(s)
7. Medical Director
8. Other subject matter experts as deemed necessary
9. +Case specific staff
B. The IAC shall review incidents and identify those that require further review to
determine possible cause.
C. The IAC shall meet at least quarterly unless there are no incidents during the
quarter. The IAC may meet more frequently as needed.
D. The IAC shall make recommendations for changes in policy, procedure and
practice.
E. When necessary, the IAC may report personnel concerns to the appropriate HR
department; the IAC does not make or take disciplinary actions but may be
obligated to share employee concerns.
F. Copies of Incident Reporting forms received and committee notes related to
action items will be maintained by the IAC for 10 years.
G. The IAC will report aggregate data and system recommendations at QIC.
Exhibit J
Page 5 of 6
Fresno County Department of Behavioral Health-Incident Report
Send completed forms to dbhincidentreporting@co.fresno.ca.us and designated contract analyst within 24 hours of an
incident or knowledge of an incident. DO NOT COPY OR REPRODUCE/NOT part of the medical record.
Client Information
Last Name: Click or tap here to enter text. First Name: Click or tap here to enter text. Middle Initial: Click or tap here to enter text.
Date of Birth:Click or tap here to enter text. Client ID#:Click or tap here to enter text. Gender: ☐ Male ☐ Female
County of Origin: Click or tap here to enter text.
Name of Reporting Party:Click or tap here to enter text. Name of Facility:Click or tap here to enter text.
Facility Address:Click or tap here to enter text. Facility Phone Number:Click or tap here to enter text.
Incident (check all that apply)
☐Homicide/Homicide Attempt ☐ Attempted Suicide (resulting in serious injury) ☐ Death of Client ☐ Medical Emergency
☐Injury (self-inflicted or by accident)☐Violence/Abuse/Attempts to Assault (toward others, client and/or property)
☐Other- Specify (i.e. medication errors, client escaping from locked facility, fire, poisoning, epidemic outbreaks, other
catastrophes/events that jeopardize the welfare and safety of clients, staff and /or members of the community): Click or tap here to
enter text.
Date of Incident: Click or tap here to enter text. Time of Incident: Click or tap here to enter text.☐am ☐pm
Location of Incident: Click or tap here to enter text.
Description of the Incident (Attach additional sheet if needed): Click or tap here to enter text.
Key People Directly Involved in Incident (witnesses, staff): Click or tap here to enter text.
Action Taken (check all that apply) ☐Consulted with Physician ☐ Called 911/EMS ☐ First Aid/CPR Administered ☐Law Enforcement Contacted☐Client removed from building ☐ Parent/Legal Guardian Contacted ☐Other (Specify): Click or tap here to enter text.
Description of Action Taken: Click or tap here to enter text.
Outcome of Incident (If Known): Click or tap here to enter text.
Form Completed by: __________________________________ _______________________________ _____________
Printed Name Signature Date
Reviewed by Supervisor/Program Manager: _____________________________ ___________________________ ________
Printed Name Signature Date
For Internal Use only:
☐Report to Administration ☐ Report to Intensive Analysis Committee for additional review ☐Request Additional Information
☐No Action ☐ Unusual Occurrence ☐ Other: Click or tap here to enter text.
Revised 12 /2017
Exhibit J
Page 6 of 6
Exhibit K
Page 1 of 2
Vendor:Contract#Contact Person Contact#
Item Make/Brand Model Serial #Fixed AssetSensitive ItemDate
Requested
(If Fixed
Asset)
Date
Approved (
If Fixed
Assset)
Purchase
Date Location Condition
Fresno
County
Inventory
Number
Cost
ExampleCopier Canon 27CRT 9YHJY65R x 3/27/2008 4/1/2008 4/10/2008 Heritage New $6,500.00
ExampleDVD Player Sony DV2230 PXC4356A x n/a n/a 4/1/2008 Heritage New $450.00
Date Prepared:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Date Received:
Fixed Asset and Sensitive Item Tracking
EXHIBIT - K
Page 2 of 2
Fi el d Number
Fi el d
Descri pt i on
I nst r uct i on or Comment s
Requi r ed or
Condi t i onal
Header Vendor I ndi cat e t he l egal name of t he agency cont r act ed t o
pr ovi de ser vi ces.
Requi r ed
Header Pr ogr am
I ndi cat e t he t i t l e of t he pr oj ect as descr i bed i n t he
cont r act wi t h t he Count y.
Requi r ed
Header Cont r act #
I ndi cat e t he assi gned Count y cont r act number . I f not
known, Count y st af f can pr ovi de.
Requi r ed
Header Cont act Per son
I ndi cat e t he f i r st and l ast name of t he pr i mar y agency
cont act f or t he cont r act .
Requi r ed
Header Cont act #
I ndi cat e t he most appr opr i at e t el ephone number of t he
pr i mar y agency cont act f or t he cont r act .
Requi r ed
Header Dat e Pr epar ed
I ndi cat e t he most cur r ent dat e t hat t he t r acki ng f or m
was compl et ed by t he vendor .
Requi r ed
a Item I dent i f y t he i t em by pr ovi di ng a commonl y r ecogni zed
descr i pt i on of t he i t em.
Requi r ed
b Make/ Br and I dent i f y t he company t hat manuf act ur ed t he i t em.Requi r ed
c Model I dent i f y t he model number f or t he i t em, i f appl i cabl e.Condi t i onal
d Ser i al #
I dent i f y t he ser i al number f or t he i t em, i f
appl i cabl e.
Condi t i onal
e Fi xed Asset
Mar k t he box wi t h an " X" i f t he cost of t he i t em i s
$5, 000 or mor e t o i ndi cat e t hat t he i t em i s a f i xed
asset .
Condi t i onal
f Sensi t i ve I t em
Mar k t he box wi t h an " X" i f t he i t em meet s t he
cr i t er i a of a sensi t i ve i t em as def i ned by t he Count y.
Condi t i onal
g Dat e Request ed
I ndi cat e t he dat e t hat t he agency submi t t ed a r equest
t o t he Count y t o pur chase t he i t em.
Requi r ed
h Dat e Appr oved
I ndi cat e t he dat e t hat t he Count y appr oved t he r equest
t o pur chase t he i t em.
Requi r ed
i Pur chase Dat e I ndi cat e t he dat e t he agency pur chased t he i t em.Requi r ed
j Locat i on I ndi cat e t he physi cal l ocat i on of t he i t em Requi r ed
k Condi t i on
I ndi cat e t he gener al condi t i on of t he i t em ( New, Good,
Wor n, Bad) .
Requi r ed
l
Fr esno Count y
I nvent or y
Number
I ndi cat e t he FR # pr ovi ded by t he Count y f or t he i t em.Condi t i onal
m Cos t
I ndi cat e t he t ot al pur chase pr i ce of t he i t em
i ncl udi ng sal es t ax and ot her cost s, such as shi ppi ng.
Requi r ed
FI XED ASSET AND SENSI TI VE I TEM TRACKI NG
Exhibit L
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II. Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses of individuals or corporations under “Remarks” on page 2. Identify each item number to be continued.
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? ...................................................................................... ❒ ❒
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution’s, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under “Remarks” on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under “Remarks.”
NAME ADDRESS EIN
B. Type of entity: ❒ Sole proprietorship ❒ Partnership ❒ Corporation
❒ Unincorporated Associations ❒ Other (specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under “Remarks.”
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers. ..........................................................................................................
❒ ❒
NAME ADDRESS PROVIDER NUMBER
Exhibit L
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) Title
Signature Date Remarks
Exhibit M
Page 1 of 2
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.
Exhibit M
Page 2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) 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)
Exhibit N
Page 1 of 2
SELF-DEALING TRANSAC TION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “County Contractor”),
must disclose any self-dealing transactions that they are a party to while providing goods,
performing services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being
made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to
the County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the
transaction; and
b. The nature of the material financial interest in the Corporation’s transaction that
the board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
Exhibit N
Page 2 of 2
(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: