HomeMy WebLinkAbout24-081 Errata Form and Signed Amendment.pdf co
. County of Fresno
O 1eg6 O
ERRATA FORM
DATE: 2/15/2024 Agenda Item
Board of Supervisors Number:
To: 23
FROM: Susan Holt, Director, Department of Behavioral Health to-
SUBJECT: Correction for Amendment 24-0073 for the ACT contract
The errata form is being submitted to note revisions/changes to the following document(s)
related to the subject agenda item:
❑ Recommendation
❑ Board Agenda Item
* Attachments
SUMMARY OF CHANGES:
The accounting string at the bottom of the signature page contains a typo. It needs to be
changed from 4320 to 4323. Following County Counsel's recommendation, written
permission from the vendor to make this change has been obtained with a copy of the
permission to be kept on file with the amendment for the term of the agreement.
Attached is a redline copy of the amendment along with a clean revised version.
Please feel free to contact my office if you have any questions or need anything further.
Redlined version of the revised materials are attached.
From: Kim Wells «Wm.we|e@ inics.org>
Sent: Thursday, February 15, 202411:42AK4
To: Robinson, Rebecca
Cc; Marilyn S|iney
Subject: KE:ACTAnnendment - ResponseNeeded
[AUTION!!! - EXTERNAL EMAIL-THINK BEFORE YOU CLICK
Thank you for following up. 8y this correspondence, |confirm that | amo amenable 10 your making the correction tothe
document es already signed.
Kim M.Wells(She/He"/Hens)
Chief Legal Officer
Telephone: 916.388.6327
Clinics
--`--~-
From: Robinson, Rebecca«rnxbnson@fnesnocountyca.gov>
Sent:Thursday, February 1S 202411:40AM
To: Kim Wells<kinm.xxeUs@padficcUnics.wrg>
Cc: Marilyn S|iney<nnahkm.s|ineyADpacificc|inks.org>
Subject: RE:ACT Amendment- Response Needed
Hello,
I'm following up regarding the request below to proceed with the signature you provided and correct the cost center to
4333.
The cost center needs to be corrected before the end of the day today.
Rebecca Q. Robinson (She/Her/Hers)
Phone: (559) 600-6733
Staff Analyst
Fresno COUnh/ Department Of Behavioral Health
C0Ot[8{tS Division — Mental Health Services
Stop Mail #277
From: Robinson, Rebecca
Sent:Tuesday, February 13, 2024 1:39 PM
To: Kim Wells<I<im.wells@pacificclinics.org>
Cc: Marilyn Sliney<mariiyn.slineyC@pacificclinics.org>
Subject:ACT Amendment- Response Needed
Good Afternoon,
It has been brought to my attention that the account string on the bottom of the signature page for the ACT amendment
is incorrect.
It is currently 4320.
Since the amendment has been signed already I need your permission to correct the cost center to 4323.
Please let me know if you are comfortable with me changing the cost center on the signature pages from 4320 to 4323
and proceeding with the signature you already provided or if you would prefer to sign an updated copy.
Rebecca Q. Robinson (She/Her/Hers)
Phone: (559) 600-6733
Staff Analyst
Fresno County Department of Behavioral Health
Contracts Division — Mental Health Services
Stop Mail #277
CO
OF) O
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DocuSign Envelope ID:OC601347-9E97-4C08-B5D6-BCCBA774E7B1
REDLINED
(see page 4)
1 AMENDMENT NO. 1 TO SERVICE AGREEMENT
2 This Amendment No. 1 to Service Agreement No. 23-280 is dated the day of
3 , 2024 and is between Pacific Clinics, a California Non-Profit, 501 (c)(3)
4 Corporation ("Contractor"), and the County of Fresno, a political subdivision of the State of
5 California ("County").
6 Recitals
7 A. On June 20, 2023, the County and Contractor entered into County Agreement No. 23-
8 280 ("Agreement"), also referred to as the Adolescent Community Treatment program, for the
9 operation of a Mental Health Services Act (MHSA) funded Children's Services Program which
10 currently provides Full-Service Partnership services for underserved or unserved high-risk
11 children between the ages of 10 to 18 years with Serious Emotional Disturbance (SED) and
12 their families.
13 B. The County and the Contractor now desire to amend the Agreement to fill a community
14 need for Outpatient (OP) and Intensive Case Management (ICM) level of care services for youth
15 ages 10 to 18 years old.
16 The parties therefore agree as follows:
17 1. Page 1 of Exhibit G is deleted in its entirety. References in the Agreement to Exhibit G in
18 section 4.6 on line 24, page 9; in section 25.1 on line 23, page 12; and in section 4.9, on line 24,
19 page 51 shall be deemed references to Exhibit G1 and Exhibit G2. Reference to Exhibit G in
20 section 4.1, line 11, page 8 shall be deemed references to Exhibit G, Exhibit G1, and Exhibit
21 G2. Exhibit G1 and Exhibit G2 are attached and incorporated by this reference.
22 2. All references in the Agreement to "Exhibit A" shall be deemed references to Revised
23 Exhibit A. Revised Exhibit A is attached and incorporated by this reference.
24 3. All references in the Agreement to "Assertive Community Treatment" shall be deemed
25 references to "Adolescent Community Treatment".
26 4. When both parties have signed this Amendment No. 1, the Agreement and this
27 Amendment No. 1 together constitute the Agreement.
28 5. The Contractor represents and warrants to the County that:
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DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
1 a. The Contractor is duly authorized and empowered to sign and perform its obligations
2 under this Amendment.
3 b. The individual signing this Amendment on behalf of the Contractor is duly authorized
4 to do so and his or her signature on this Amendment legally binds the Contractor to
5 the terms of this Amendment.
6 6. The parties agree that this Amendment may be executed by electronic signature as
7 provided in this section.
8 a. An "electronic signature" means any symbol or process intended by an individual
9 signing this Amendment to represent their signature, including but not limited to (1) a
10 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
11 electronically scanned and transmitted (for example by PDF document) version of an
12 original handwritten signature.
13 b. Each electronic signature affixed or attached to this Amendment(1) is deemed
14 equivalent to a valid original handwritten signature of the person signing this
15 Amendment for all purposes, including but not limited to evidentiary proof in any
16 administrative or judicial proceeding, and (2) has the same force and effect as the
17 valid original handwritten signature of that person.
18 c. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
19 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part
20 2, Title 2.5, beginning with section 1633.1).
21 d. Each party using a digital signature represents that it has undertaken and satisfied
22 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
23 through (5), and agrees that each other party may rely upon that representation.
24 e. This Amendment is not conditioned upon the parties conducting the transactions
25 under it by electronic means and either party may sign this Amendment with an
26 original handwritten signature.
27 7. This Amendment may be signed in counterparts, each of which is an original, and all of
28 which together constitute this Amendment.
2
ii
DocuSign Envelope ID:OC601347-9E97-4C08-B5D6-BCCBA774E7B1
1 8. The Agreement as amended by this Amendment No. 1 is ratified and continued,
2 effective upon execution. All provisions of the Agreement and not amended by this Amendment
3 No. 1 remain in full force and effect.
4 [SIGNATURE PAGE FOLLOWS]
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DocuSign Envelope ID:OC601347-9E97-4C08-B5D6-BCCBA774E7B1
1 The parties are signing this Amendment No. 1 on the date stated in the introductory
2 clause.
3
PACIFIC CLINICS COUNTY OF FRESNO
4
DocuSlgnned�by:
6 (Authorized Signature) Nathan Magsig, Chairman of the Board of
Supervisors of the County of Fresno
7
Kim M. Wells chief Legal officer Attest:
8 Print Name & Title Bernice E. Seidel
Clerk of the Board of Supervisors
9 251 Llewellyn Avenue County of Fresno, State of California
10 Campbell, CA 95008
Mailing Address By:
11 Deputy
12
13 For accounting use only:
14 Org No.: 563043203
Account No.: 7295
15 Fund No.: 0001
Subclass No.: 10000
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DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
Adolescent Community Treatment Program
for Children Ages 10 to 18 years
SCOPE OF SERVICES
I.BACKGROUND
The Adolescent Community Treatment(ACT) program brings together the knowledge,skills,expertise,and
resources of an established community-based provider.The program builds upon evidence-based services
and activities to offer an expanded continuum of unduplicated services. Integrated services maximize the
use of resources to broaden the scope, intensity,and accessibility of services and supports to children and
families in rural and metropolitan areas who might otherwise not receive the services they need.
The Contractor's experience with serving culturally and linguistically diverse families has supported
outreach,access and appropriate service delivery to populations that may not be adequately served by
traditional mental health and other support systems.The resulting service delivery system has proven to
be effective in assisting targeted populations with achieving and maintaining wellness and promoting
recovery and resiliency for their young children. Over time,this program has evolved into a best-practice
model of child,adolescent,and family treatment that has the potential to be duplicated in other areas and
has increased capacity to reach out to and engage unserved and underserved populations throughout
Fresno County.
The program includes three(3)distinct levels of care—1)Outpatient(OP)services,2) Intensive Case
Management(ICM),and 3)Full-Service Partnership(FSP).
11.TARGET POPULATION
The ACT program is designed to provide services to youth ages 10-18 with mental health symptoms/needs
that meet medical necessity for specialty mental health services.The target population will include youth
who present with moderate to severe impairment and a diagnosable Serious Emotional Disturbance (SED).
In addition, identified youths'siblings,other relatives,caregivers,and other significant support person may
participate and receive specialty mental health services from this program,to optimize the youth's ability
to reach wellness and recovery.The program will provide a range of services that will be tailored to each
youth's needs for service type, intensity,and duration.Children will therefore be assigned to one (1)of
three(3) levels of care upon completion of the intake/assessment: Outpatient,Intensive Case
Management,or Full-Service Partnership. For children who have mild-to-moderate impairment or need
medications only and do not require specialty mental health services,the Contractor will work with other
programs such as the appropriate Fresno County Department of Behavioral Health(DBH)Wellness
Centers, managed care health plans or other like agencies to develop a collaborative agreement for the
provision or transition of needed services.
Ill. LOCATION OF SERVICES
Services will be provided at the Contractor's clinic site, in the community,at home and education
locations,whichever is most comfortable for the child and family.The Contractor must also be capable of
offering services through telehealth-phone and telehealth-video should the need arise.
IV.DESCRIPTION OF SERVICES
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
Revised Exhibit A
Page 2 of 1.8
The intended benefit of creating a program such as the ACT program with multiple levels of care is for
maximum flexibility to move children seamlessly between levels, as clinically indicated. The Contractor
shall provide a level of service and support that will reflect each child's unique and individual needs.
A. Behavioral Health
1. Contractor shall provide these services to all children in the program. Services will include but
are not limited to the following:
i. Provide support to the child's family and other members of the child's social network
to help them manage the symptoms and illness of the child and reduce the level of
family and social stress associated with the illness.
ii. Make appropriate referrals and linkages to services that are beyond that of the
Contractor's services under this Agreement or as appropriate when
discharging/transitioning a child from the program.
iii. Coordinate services with any other community mental health and non-mental health
providers as well as other medical professionals.
iv. Assist child/family with accessing all entitlements or benefits for which they are
eligible (i.e., Medi-Cal,SSI, Section 8 vouchers, etc.).
v. Develop family support and involvement whenever possible.
vi. Refer child/family to supported education and employment opportunities, as
appropriate.
vii. Provide or link to transportation services when it is critical to initially access a support
service or gain entitlements or benefits.
viii. Provide or refer to peer support activities, as appropriate.
ix. Ensure that clinically appropriate Evidence-Based Practices are utilized in service
delivery at all levels of care—see the table below.
2. Contractor shall deliver a comprehensive specialty mental health program. Behavioral health
services include but are not limited to:
i. Assessment
ii. Treatment or Care planning/Goal setting
iii. Pediatric Symptom Checklist (PSC) 35 and the clinically appropriate version of the Child
and Adolescent Needs and Strengths (CANS) assessment
iv. Individual therapy
v. Group therapy
vi. Family therapy
vii. Case management
viii. Consultation
ix. Collateral
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
x. Linkage to additional services and supports including medication services.
A. Hospitalization/Post Hospitalization Support
3. Contractor will ensure that all services:
i. Be values-driven,strengths based, individual-driven,and co-occurring capable.
ii. Be culturally and linguistically competent.
iii. Be age,culture,gender,and language appropriate.
iv. Include accommodations for children with physical disability(ies)
4. Methods for service coordination and communication between program and other service
providers shall be developed and implemented consistent with Fresno County Mental Health
Plan(MHP)confidentiality rules.
S. Contractor shall maintain up-to-date caseload records of all children enrolled in services, and
provide individual, programmatic,and other demographic information to DBH as requested.
6. Contractor shall ensure billable specialty mental health services meet any/all County,State,
Federal regulations including any utilization review and quality assurance standards and
provide all pertinent and appropriate information in a timely manner to DBH to bill Medi-Cal
services rendered.
7. Staffing should be appropriate for services needed at each level of care,which should include
case managers,therapists,peer support specialists, psychiatrists,and nurses.
B. Evidence-Based Practices
Evidence-based practices(EBP)utilized in the ACT program include Dialectic Behavioral Therapy(DBT),
Managing and Adapting Practices(MAP), Eye Movement Desensitization and Reprocessing(EMDR),
Motivational Interviewing(MI), and Trauma Focused Cognitive Behavioral Therapy(TF CBT).Some
EBPs may be more appropriate for specific populations, based on age,gender,and/or diagnostic
considerations.
The table below clarifies the EBP,description,and target person served sub-group.
Evidence Based Description Target
Treatment Age
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
Revised Exhibit A
Page 4 of 18
Dia►ectic Behavioral A cognitive behavioral treatment that has been Parents of
Therapy(DBT) shown to be effective in treating a wide range of children
disorders such as depression, eating disorders, 0-18 years
PTSD, and substance dependence.
Managing and Coordinates and supplements the use of 0-18 years
Adapting Practices evidence-based programs for children's mental
(MAP) health. The system is not a single treatment
program; rather, it involves several decision and
practice support tools to assist in the selection,
review, adaptation, or construction of empirically
derived common treatment elements to match
particular child characteristics.The three main
features of the MAP system are:
• The PracticeWise Evidence-Based
Services Database
• The Clinical Dashboard
• The Practitioner Guides
EMDR • EMDR is a psychotherapy treatment that was Birth to
originally designed to alleviate the distress adult
associated with traumatic memories (Shapiro,
1989a, 1989b). During EMDR therapy the
client attends to emotionally disturbing
material in brief sequential doses while
simultaneously focusing on an external
stimulus. Therapist directed lateral eye
movements are the most commonly used
external stimulus but a variety of other stimuli
including hand-tapping and audio stimulation
are often used (Shapiro, 1991). Shapiro (1995,
2001) hypothesizes that EMDR therapy
facilitates the accessing of the traumatic
memory network, so that information
processing is enhanced,with new associations
forged between the traumatic memory and
more adaptive memories or information.
These new associations are thought to result
in complete information processing, new
learning, elimination of emotional distress,
and development of cognitive insights. EMDR
therapy uses a three pronged protocol: (1)the
past events that have laid the groundwork for
dysfunction are processed,forging new
associative links with adaptive information; (2)
the current circumstances that elicit distress
DocuSign Envelope ID:OC601347-9E97-4C08-B5D6-BCCBA774E7B1
are targeted,and internal and external triggers
are desensitized;(3)imaginal templates of
future events are incorporated,to assist the
client in acquiring the skills needed for
adaptive functioning.
Trauma Focused Birth-17
Cognitive Behavioral TF-CBT is an evidence-based psych000cial years
Therapy treatment model designed to treat posttraumatic
stress and related emotional and behavioral
problems in children(0-5 [early childhood] and 6-
12 [childhood]),adolescents [13-17 years] and
their caregivers. Initially developed to address the
psychological trauma associated with child sexual
abuse,the model has been adapted for use with
children who have a wide array of traumatic
experiences, including domestic violence,
traumatic loss,and the often multiple
psychological traumas experienced by children
prior to foster care placement.The treatment
model is designed to be delivered by trained
therapists who initially provide parallel individual
sessions with children and their parents(or
guardians),with conjoint parent-child sessions
increasingly incorporated over the course of
treatment.
Motivational Motivational Interviewing(MI) is an evidence-
Interviewing based treatment that addresses ambivalence to
change. MI is a conversational approach designed
to help people discover their own interest in
considering and/or making a change in their life
(e.g.,diet,exercise,managing symptoms of
physical or mental illness, reducing and
eliminating the use of alcohol,tobacco,and other
drugs). It also helps people express in their own
words their desire for change(i.e., "change-talk"),
examine their ambivalence about the change,and
plan for and begin the process of change.
Additional aspects of the treatment include
eliciting and strengthening change-talk,enhancing
people's confidence in taking action and noticing
that even small, incremental changes are
important, and strengthening their commitment
to change.
C. Levels of Treatment
1. Outpatient(OP)
DocuSign Envelope ID:OC601347-9E97-4C08-B5D6-BCCBA774E7B1
Revised Exhibit A
Page 6 of 18
i. The OP level of care focuses primarily on therapeutic appointments for individual and
group treatment as well as case management and medication services,as needed.
Children at this level receive a minimum of one (1)contact per week with at least one
(1)of those contacts being face-to-face per month.
ii. Caseload
Maximum caseload: 1:40
iii. Length of Stay
Suggested length of stay is twelve(12)to eighteen (18) months,with Contractor
evaluating the needs of each enrolled child on an ongoing basis to ensure that the
level of care is clinically appropriate.
2. Intensive Case Management (ICM)
i. Children at this ICM level of care would benefit from regularly scheduled case
management, individual rehabilitation and/or individual therapy. Children at this level
receive a minimum of one (1)to two (2) mental health contacts per week with one of
those contacts being face-to-face.These mental health contacts can include but are
not limited to individual therapy,family therapy, group therapy, case management,
peer support services and/or medication management.
ii. Caseload
Maximum caseload: 1:30
iii. Length of Stay
Suggested length of stay is twelve(12)to twenty-four(24) months,with Contractor
evaluating the needs of each enrolled child on an ongoing basis to ensure that the
level of care is clinically appropriate.
3. Full-Service Partnership (FSP)
i. This FSP level of care employs the concept of"whatever it takes", which focuses on
innovative approaches to "no fail" services. Children at this level meet the State-
defined FSP criteria and require higher intensity services to meet their needs. FSP
has an increased focus on engagement, collaboration with the youth/family and
stabilization to achieve mutually agreed upon treatment goals. Services at this level
of care shall be accessible 24/7. Children at the FSP level shall receive a minimum of
three (3)face-to-face contacts per week.
ii. Caseload
Maximum caseload: 1:8
iii. Length of Stay
Suggested length of stay is eighteen (18)to twenty-four(24) months,with Contractor
evaluating the needs of each enrolled child on an ongoing basis to ensure that the
level of care is clinically appropriate.
D. Admission,Termination and Discharge
DocuSign Envelope ID:OC601347-9E97-4C08-B5D6-BCCBA774E7B1
1. Entry Criteria
Child must meet at least one(1)of the following criteria for FSP Level services:
L Have a substantial impairment in at least two(2)of the following categories as a result
of a SED:self-care,school functioning,family relationships,and ability to function in
the community.The child must be at risk of,or already removed from,the home;or
the mental disorder and impairments have been present for more than six(6)months
or are likely to continue for more than one year without treatment.
ii. Displays psychotic features, is at risk of suicide, and/or is at risk of violence due to a
mental disorder.
iii. Meets special education eligibility requirements under Chapter 26.5 of the
Government Code.
Child must meet one(1)of the following criteria for the OP and ICM services:
L Has a condition placing them at high-risk for a mental health disorder due to
experience of trauma evidenced by any of the following:scoring in the high-risk range
under a trauma screening tool approved by DBH,involvement in the Child Welfare
system,juvenile justice involvement,or experiencing homelessness.
ii. Meets both of the following requirements:
a. Has at least one(1)of the following:a significant impairment,a reasonable
probability of significant deterioration in an important area of life functioning,
a reasonable probability of not progressing developmentally as appropriate,a
need for specialty mental health services, regardless of presence of
impairment,that are not included within the mental health benefits that a
Medi-Cal managed care plan is required to provide.
b. The youth's condition as described above is due to one(1)of the following:a
diagnosed mental health disorder,a suspected mental health disorder that has
not yet been diagnosed or significant trauma placing the youth at risk of a
future mental health condition, based on the assessment of a licensed mental
health professional.
2. Intake and Initial Assessment
The OP and ICM services are considered access points;therefore,children can be referred
directly to enter the ACT program based on meeting medical necessity for specialty mental
health services.Children may be referred to the program for OP or ICM services through
various sources including, but not limited to DBH,schools, individuals,or other agencies.
Children will be referred to the ACT program for FSP services through DBH's Youth Wellness
Center.Contractors will contact the family of the referred child within twenty-four(24) hours
of receipt of the referral.A face-to-face meeting will be scheduled within three(3) business
days to begin the intake process.
For all levels of care,Contractor shall adhere to the timeliness standards set forth by the state
and County's DBH.An initial mental health assessment will be completed within a clinically
appropriate timeframe. If the timeframe exceeds thirty(30)days,justification for this delay
should be clearly represented in the clinical documentation.
3. Termination and Discharge
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
Revised Exhibit A
Page 8 of 18
Children referred to the ACT program may be denied services if the child does not meet
medical necessity for specialty mental health services, meets medical necessity for a mental
health diagnosis that is not covered by the County's MHP, and/or the child is under the age of
10 at the time of referral. Children who are determined to be ineligible for ACT services will be
linked to other appropriate services and resources.
Discharge is determined on a case-by-case basis depending on the child's progress toward
individualized treatment goals. Reasons for discharge include the child or caregiver refuses or
terminates services;the child is transferred to another program mutually agreed upon by the
child, parent/caregiver, and ACT; mutual agreement that the treatment goals have been met;
and/or the child is 18 years old or older.
V. STAFFING
A. Contractor shall provide the following staffing components, at minimum:
1. Staffing shall be appropriate for services needed at each level of care, which would include
any combination of the following classifications: licensed or license-eligible therapists,
personal service coordinators, and family specialists.
2. Licensed or license-eligible therapists:
a. Provide evidenced-based clinical treatment. At least one (1) of the therapist positions
will be occupied by a former person served or family member with comparable
experience to the child and family receiving services.This position shall be recruited
based on linguistic and cultural needs of the targeted population (e.g., Latino,
Southeast Asian, African American, Native American).
b. Provide linkages and therapeutic services to enrolled children and their caregivers as
identified in the Individual Services and Supports Plan(ISSP), as applicable.
3. Family Partners (or equivalent): Shall be occupied by a former person served or family
member with comparable experience to the child and family receiving services.
4. Personal Service Coordinators (PSC):At least one (1) of the PSC positions shall be occupied by
a former person served or family member with comparable experience to the child and
family receiving services.This position shall be recruited based on linguistic and cultural
needs of the targeted population (e.g., Latino, Southeast Asian,African American, Native
American). A bachelor's degree level is preferred for the requirements of the PSC positions;
however, 12 college units (including psychology, counseling,etc.)with mental health
experience can act as a substitute for the bachelor's degree requirement.
a. Ensure the following is provided by the PSC:
1. Assign a primary PSC to each child served at the FSP level of care.The primary PSC
will work with each child, and family member when appropriate,to develop the
child's ISSP. The ISSP is used to identify the child's goals and describe the array of
services and supports necessary to advance these goals based on the child's needs
and preferences and,when appropriate,the needs and preferences of the child's
family. ISSPs are reviewed by DBH's MHP Managed Care during chart audits.
2. The PSC will act as a single point of responsibility and contact for the delivery of
personal service coordination for each child, as assigned. Personal service
DocuSign Envelope ID:OC601347-9E97-4C08-B5D6-BCCBA774E7B1
coordination is the assistance provided to the child,and the child's family when
appropriate,to access medical, educational,social,vocational, rehabilitative,crisis
intervention,or other community services,when needed.
3. Ensure all children and families that receive personal service coordination services
also receive mental health treatment services when a determination is made by
qualified staff using clinically proven assessment tools that a child and/or family
would benefit from mental health treatment.Contractors shall institute mental
health treatment models to meet the mental health treatment needs of the
children/families engaged in services offered in this Agreement.
VI. HOURS OF OPERATION
The standard hours of operation will be Monday through Friday 8:00 AM until 5:00 PM;additional services
will be provided after 5:00 PM and on weekends,as needed,to address child or family concerns and/or
provide services for children and families who are unavailable for services during standard business hours.
Additionally,Contractors shall provide operational and clinical services in the field, as needed,and
temporarily extend office hours to accommodate and increase timeliness of services.
FSP services will be available to children and their families twenty-four(24) hours a day,seven(7)days a
week.
VII.GOALS/OUTCOMES
Contractor will gather,collect, and submit Mental Health Services Act(MHSA)Full-Service
Partnership data as required by the State Data Collection Reporting system and other data reports
as requested by County,such as the Annual Mental Health Advisory Board Data Report. These data
will be submitted as required and entered into a local database for internal reporting purposes.
Service satisfaction data will be collected for all cross-sectional mental health programs,as required
by the California Department of Health Care Services,at two time periods across the agency for
each twelve(12)month period of the Agreement term. Additionally,the Youth Satisfaction Survey
(YSS) is collected for each child/youth six months post-entry to provide more detailed and relevant
information regarding service satisfaction over time.
Contractor will also participate in the Performance Outcomes and Quality Improvement(POQI)
satisfaction survey.
Contractor will have a unit dedicated to providing outcome and evaluation information pertaining
to the services provided and youths served. Contractor will implement a core set of outcome
measures, permitting comparative and other analyses that add depth and value to the outcomes
obtained by specific programs. Measurement tools used will include
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
Revised Exhibit A
n )n", 10 (j 1R
the Child and Adolescent Needs and Strengths (CANS)and the Pediatric Symptom Checklist (PSC-35)
as primary outcome measures for clinical outcomes, in addition to standard ascertainment of
sociodemographic information related to social determinants of health (e.g., living situation, criminal
justice involvement, etc.). Such indicators will be used to track and report each enrolled child/youth's
progress. In addition,these measurement tools allow Contractor and County to assess treatment
efficacy at person served and systemic levels.
Contractor's electronic health record (EHR)will be used to collect basic system level indicators, upon
program entry and discharge, including standard demographic information, sexual orientation,
gender identity, and ethnicity. Outcome indicators allow the following factors to be assessed in 12-
month time spans:frequency of incarceration (probation involvement),frequency of
hospitalizations,frequency of contacts with the County's Children's Crisis Stabilization Center;
school attendance,school grades and performance,employment, and living situations. Data will be
routinely reported to program staff and agency leadership as a part of ongoing continuous quality
improvement, and to County on a fixed or variable schedule according to County requirements.
The tables below summarize outcome measures used by Contractor. System Level Measures are
somewhat dependent on cross systems collaboration;whereas Practice Level Measures capture data
that are often most directly linked to the work of the practitioner.
A. System Level Measures and Outcomes:
WHAT SOURCE WHEN
1. Living Situation: Recorded by Upon entry, at three
a. Restrictiveness Clinician/Case Manager month intervals, and upon
b. Stability discharge.
c. Permanence
2. Educational Performance: Recorded by Upon entry, at three
a. School Attendance Clinician/Case Manager month intervals, and upon
2. School Performance discharge.
3. Employment (when relevant): Recorded by Upon entry, at three
a. Hours Worked Clinician/Case Manager month intervals, and upon
b. Length of Employment discharge.
4. Juvenile Justice: Recorded by Upon entry, at three
a. Recidivism: arrests and Clinician/Case Manager month intervals, and upon
citations by type of offense discharge.
B. Practice Level Measures and Outcomes:
NHAT SOU WHEN
HEN
1. Functioning, competence, and Caregiver Upon entry, at three
impairment from caregiver, Child/youth month intervals, and upon
child/youth, and clinician Clinician discharge.
perspectives; Child and
Adolescent Needs and Strengths At six month cross-
DocuSign Envelope ID:OC601347-9E97-4COB-B5D6-BCCBA774E7B1
Revised Exhibit A
Page 11 of 18
(CANS) sections and six months
post intake.
2. Satisfaction with Services (YSS) Child/youth Bi-annual sample, at six
month intervals, and upon
discharge.
C. Program Outcomes
At minimum,one performance indicator will be identified for each of the four CARF domains
listed below.
a. Access to care:The ability of youths to receive the right service at the right time.
Examples include:
1. Timeliness of bridging prescriptions
2. Timeliness of identifying youths with a serious mental illness
3. Timeliness between youth referral for assessment and completion of
assessment; assessment to first treatment service; and,first treatment service to
next follow-up
4. Timeliness of subsequent follow-up visits
5. Timeliness of response to sick call/health service requests
b. Effectiveness: Objective results achieved through health care services. Examples include:
1. Effectiveness of crisis interventions
2. Effectiveness of treatment interventions (medical and behavioral health indicators)
3. Effectiveness of discharge planning(such as percentage of youths successfully linked
to County programs, community providers, and/or other community resources after
release)
4. Timely continuity of verified community prescriptions for medication(s), upon youth's
release
5. Effectiveness of transportation coordination, upon release
c. Efficiency:The demonstration of the relationship between results and the resources
used to achieve them.
Examples include:
1. Cost per youth
2. Number of units of services per FTE by discipline
3. Number of youths served per general population
4. Comparison of numbers served against industry standards
d. Satisfaction and Compliance:The degree to which youths, County, and other
stakeholders are satisfied with the services.
Examples include:
1. Audits and other performance and utilization reviews of health care services
and compliance with agreement terms and conditions
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
Revised Exhibit A
Page 12 of 18
Surveys of persons served,family members, other health care providers, and other stakeholders
VIII.TRANSITION OPTIMIZATION FUNDS
One-time Transition Optimization Funds will be available to specialty mental health providers and Drug
Medi-Cal providers within FY 2023-24 to encourage Contractors to identify and implement organization
changes during the first year of CaIAIM Payment Reform to improve outcomes for persons served and
create operational efficiencies. Contractor is expected to utilize the strategies,tools and knowledge
learned to their programming and continue to improve services for the population served.
A. Funding Allocation Methodology
I. Each participating contractor is eligible to apply for an allocation of Transition Optimization
Funds up to the maximum amounts stated in Article 4 of this Agreement and further
described below.Transition Optimization Funds will only be available from July 1, 2023
through June 30, 2024 and payments shall be on a quarterly basis.
2. Payments will be disbursed upon review and approval by DBH of each deliverable described
below. Quarterly progress reports shall be submitted to DBH in order to show progress as
outlined in the submitted plans and deliverables.
3. Payments will be dependent on Contractor demonstrating progress toward meeting
deliverables described in this Revised Exhibit B. Contractors who fail to submit progress
reports by stated deadlines, or who do not demonstrate adequate progress made, may be
determined ineligible for that quarter's payment at the sole discretion of the County.
4. All invoices will be submitted on a quarterly basis within fifteen (15)days following the end
of the quarter. Invoices submitted thereafter may not be eligible for payment.
B. Responsibilities
1. Letter of Intent
Contractor shall submit a letter of intent to DBH by July 31, 2023 identifying the selected
Transition Optimization Activity(ies) and commitment to meet the deliverable deadlines as
described below.The letter shall include all current Medi-Cal billable specialty mental health
and substance use disorder services agreements the Contractor has with the County.
The County shall respond to the Contractor's letter of intent within thirty(30) days.The
County's response shall include a breakdown of anticipated payments, as determined by the
County, depending on the Transition Optimization Activity(ies) chosen and depending on the
number of current Medi-Cal billable specialty mental health and substance use disorder services
agreements the Contractor has with the County.
2. Quarterly Reports
Contractor shall submit quarterly progress reports and invoices. Reports shall be submitted
on the dates indicated in the Schedule of Deliverables below. Invoices are due fifteen (15) days
after the end of each quarter. All activities shall be completed by June 30, 2024.The report shall
DocuSign Envelope ID:OC601347-9E97-4C08-B5D6-BCCBA774E7B1
include updated plans/tools and progress Contractor has made toward the Transition
Optimization Activity(ies) described in each Contractors' letter of intent.
3. Schedule of Deliverables: Equity Gap Analysis, Fiscal Monitoring Tool,and Electronic Health
Record
L Q1 Reports: July-Sept:
1. Letter of Intent: Due July 31,2023
2. Fiscal Monitoring Tool, Equity Gap Analysis,and Electronic Health Record
Implementation Plans (if applicable): Due September 30, 2023
3. Fiscal Monitoring Tool Identified Practices and Strategies (if applicable): Due
September 30,2023
ii. Q2 Report:Oct-Dec: Due January 15,2024
iii. Q3 Report:Jan-Mar: Due April 15,2024
iv. Q4 Report:Apr-June: Due July 15,2024
V. All deliverables will be reviewed and approved by DBH prior to payment.
4. Eligible Transition Optimization Activities
i. Fiscal Monitoring Tools:Contractor shall submit to DBH a draft of their fiscal
monitoring tool that shall be used monthly on an ongoing basis to evaluate fiscal
health of the organization.Tools shall,at a minimum,monitor costs, productivity
targets and identify one or more practice pattern(s)the organization is employing
to increase direct care time to the Medi-Cal population.
1. Fiscal Monitoring Tools and Implementation Plan:Contractor shall develop
fiscal monitoring tools that will be used monthly to ensure their
organizational fiscal health and implementation plan.Fiscal monitoring tools
drafts and implementation plan shall be submitted to DBH by September
30,2023.
i. Identified Practice:Identify at least one process improvement that
shall be modified by September 30,2023.
ii. Quarterly Progress Reports:Quarterly progress reports shall be
submitted including but not limited to a narrative of progress,
obstacles,alternative solutions and outcomes.
iii. Funding for this activity shall be available up to$25,000 for the
initial agreement with Contractor and up to another$10,000 for
each additional agreement.County shall provide further details on
deliverables and payment schedule in County's response to the
Contractor's letter of intent.
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
Revised Exhibit A
Page 14 of 18
ii. Equity Gap Analysis:Contractor shall produce a report identifying the
race/ethnicity of population served in FY 2022-23 compared to the County's
population as provided by the County. Contractor shall identify key disparities in
both persons served and amount of services and frequency of transitions to other
levels of care received. Contractor shall identify three (3)strategies they shall
employ during FY 2023-24 to reduce the disparities among underserved
population.
1. Report on Underserved Population:Contractor shall submit an Equity Gap
Report to the Department containing including, but not limited to,the
following:
i. Identify if it serves specific population within its program(s)and
identify whom the program(s)currently served based on data.
ii. Staffing/workforce information and demographics. Report the
staffing/workforce supporting the different programs and
populations served by the provider in Fresno County.This data is to
evaluate how the staffing reflects the populations it is serving.
iii. Comparison of the County penetration rates to the demographics of
persons served by the Contractor and program(s)under agreement
with DBH.
iv. Data on retention of persons served by demographics.Total persons
served and the average length of stay by demographics of the
persons served in programs.
i. Which populations are remaining in the programs by
demographics,which ones are having the shortest stays.
ii. How long is the average length of stay by the demographics.
V. Identify what data points the Contractor is missing at this time that
challenges its ability to thoroughly assess its equity gap analysis.
Examples:data is not collected, data that is missing or under
reported, data not captured in its processes,etc.
2. Equity Improvement Implementation Plan: Contractor shall submit an
Equity Improvement Implementation Plan related to improving health
equity by September 30, 2023.The plan shall include the following items at
a minimum:
i. Contractor shall select three(3)strategies from below:
i. Plan shall include specific efforts including, but not limited
to,the following and timelines to increase access to
underserved groups.
DocuSign Envelope ID:OC601347-9E97-4C08-B5D6-BCCBA774E7B1
1. Outreach/Engagement with underserved
communities
2. Active attendance/participation in DBH's Diversity
Equity and Inclusion (DEI)workgroup
3. Plan for retention of persons served in programs
who are under represented
4. Improvement of demographic data collection
including Sexual Orientation Gender Identity
(SOGI)/LGBTQ data.
ii. Plan shall address workforce capacity to render services to
more underserved populations,through:
1. Development of bilingual personnel
2. Recruitment plan for more diverse workforce to
reflect populations served.
3. Training for workforce to increase capacity to be
culturally responsive
4. Development workforce pool for the future that can
be bilingual and bicultural
ii. Timeline for each effort shall be included in the plan.
iii. Contractor shall identify the measurement to be used to
demonstrate successful implementation of plan. Measure may be
identified by the Contractor to best support their plan and goals.
iv. Contractor shall develop and submit policies and procedures to
formally support equity effort.
3. Quarterly Progress Reports: Use available data including but not limited to,
External Quality Review Organization(EQRO)and EHR data to evaluate the
strategies deployed.Quarterly progress reports shall be submitted including
but not limited to a narrative of the progress,obstacles,alternative
solutions and outcomes.The final quarter shall include a comprehensive
final report on the outcomes.
4. Funding for this activity shall be available up to$25,000 for the initial
agreement with Contractor and up to another$10,000 for each additional
agreement.County shall provide further details on deliverables and
payment schedule in County's response to the Contractor's letter of intent.
C. Electronic Health Record(EHR):The implementation and expansion of the SmartCare EHR is an
essential component of improving oversight with the implementation of payment reform.
Furthermore,a standardized EHR will improve continuity of care, create transparency across the
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
Revised Exhibit A
P arrr_. 15 of 1Q
system, remove obstacles for individuals accessing services and improve the overall outcomes for
persons served. For Contractors who plan to opt in to use SmartCare or have previously opted into
DBH's former EHR and intend to transition to SmartCare, user fees and costs shall be waived during
FY 2023-2024 and FY 2024-2025.
1. Option One:Current EHR Users
i. Strategic Plan:Contractors utilizing DBH's EHR as their current EHR, and who will
continue to utilize SmartCare beginning July 1,2023,shall provide a plan,
including, but not limited to, how they will optimize Medi-Cal billing, illustrate
how they will utilize the information in the EHR to improve care for persons
served,and a training plan for their organization by September 30,2023.
i. Quarterly Progress Reports:Quarterly progress reports shall be
submitted, including, but not limited to, a narrative on the progress,
obstacles, alternative solutions and outcomes.
ii. Total compensation for this EHR activity, Option 1,shall not exceed
$50,000.00 split among all current agreements between the
Contractor and the County for Medi-Cal billable specialty mental
health and substance use disorder services. County shall provide
further details on deliverables and payment schedule in County's
response to the Contractor's letter of intent.
2. Option Two: Non-EHR Users
L Contractor shall submit an implementation plan by September 30, 2023 regarding
how they will transition to utilizing the SmartCare EHR by June 30, 2024.The plan
shall include, at a minimum, an identified Go Live Date, plan on how the current
record system will be maintained and utilized,training plan including number of
individuals, and additional supports.The Go Live Date must occur by June 30,
2024 to receive final payment. Contractor shall work closely with DBH to identify
needs,assignments,collaboration opportunities to transition.
ii. For Option 2,the Contractor shall not be reimbursed more than$200,000 split
among all current agreements between the Contractor and the County for Medi-
Cal billable specialty mental health and substance use disorder services.The total
maximum compensation available for this option,shall include costs for
maintaining current electronic health record/record system and additional
supports and training costs per user. Contractor shall transition both specialty
mental health and Drug Medi-Cal programming to the County's EHR and shall be
required to use the County's EHR for future eligibility agreements with DBH.
County shall provide further details on deliverables and payment schedule in
County's response to the Contractor's letter of intent.
IX. REPORTS
A. Contractor shall prepare an evaluation report annually,which will be submitted to County's DBH and
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
made available to partnering and interested local agencies and organizations(e.g., project
collaborators,other community agencies,and mental health treatment providers).Annual
evaluation reports will include the following information:demographics of the target population
served,services provided to each participant, number of hospitalizations,enrollment in school,
results of data analysis compared to planned process,output and outcome measures, barriers to
program implementation and measures taken to overcome those barriers,accomplishments of
program participants, lessons learned,and the final result of any and all satisfaction survey(s).
B. Contractor shall comply with all contract monitoring and compliance protocols, procedures,data
collection methods,and reporting requirements conducted by County.
C. Additional reports and outcome information may be requested by County at a later date,as needed.
D. Additional Reporting Requirements
Contractors will be responsible for meeting with DBH on a monthly basis,or more often as agreed
upon between DBH and Contractors,for contract and performance monitoring.
Contractors will be required to submit monthly reports to the County that will include, but not be
limited to:the number of persons served served/anticipated to be served;utilization of services by
persons served;and staff composition.These reports will be due within thirty(30)days after the last
day of the previous month or payments may be delayed.
Additional reporting is required for FSPs by DHCS. DHCS uses the FSP Data Collection and Reporting
(DCR)system to ensure adequate research and evaluation, regarding the effectiveness of services
being provided and the achievement of the outcome measures. Contractors will need to report
individual/partner information and outcomes of the FSP program directly into the DCR system. Data
will be submitted through an online interface using specific forms.The Partnership Assessment
Form gathers baseline information about the partner and is completed once the partnership is
established. Key Event Tracking provides a snapshot of changes in key quality of life areas and is
tracked on a continuous basis throughout the course of the FSP.The Quarterly Assessment collects
updated information about changes in quality of life areas and is completed every three(3) months
from the date the partnership is established.
Continuous improvement is a core tenant of the Department and the Mental Health Services Act
(MHSA).As a result of a multi-year statewide FSP evaluation project that the County DBH
participated in,another question has been added to the State required DCR data as follows:
"How often do you get the social and emotional support that you need?" Response options will be:
"always, usually,sometimes, rarely,or never".
X.COUNTY RESPONSIBILITIES:
COUNTY shall:
A. Assist Contractor's efforts to evaluate the needs of each enrolled child on an ongoing basis to
ensure that the level of care each child is receiving is clinically appropriate.
DocuSign Envelope ID:OC601347-9E97-4C08-B5D6-BCCBA774E7B1
Revised Exhibit A
Page 18 of 18
B. Provide oversight and collaborate with contractors and other County Departments and
community agencies to help achieve State program goals and outcomes. Oversight includes,
but is not limited to, contract monitoring and coordination with the State Department of
Health Care Services in regard to program administration and outcomes.
C. Assist Contractors in making linkages with the total mental health system of care. This will be
accomplished through regularly scheduled meetings as well as formal and informal
consultation.
D. Participate in evaluating overall program progress and efficiency and be available to
contractors for ongoing consultation.
E. Gather outcome information from target person served groups and Contractors throughout each
term of this Agreement. County shall notify contractor when their participation is required. The
performance outcome measurement process will not be limited to survey instruments but will
also include, as appropriate, person served and staff interviews, chart reviews, and other
methods of obtaining required information.
F. Assist Contractor's efforts toward cultural and linguistic competency by providing the
following to contractors:
1. Technical assistance and training regarding cultural competency requirements at no
cost to contractor.
2. Mandatory cultural competency training for contractor's personnel, on an annual
basis, at minimum.
3. Technical assistance for translating information into County's threshold languages
(Spanish and Hmong). Translation services and costs associated will be the responsibility
of contractors.
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
Exhibit G1
Fresno County Department of Behavioral Health
Specialty Mental Health Services Outpatient Rates
FSP and AOT
Provider Rate
Provider Type Per Hour
Psychiatrist/Contracted Psychiatrist $1,140.98
Physicians Assistant $S11.73
Nurse Practitioner $567.38
RN $463.45
Certified Nurse Specialist $567.38
LVN $243.47
Pharmacist $546.16
Licensed Psychiatric Technician $208.72
Psychologist/Pre-licensed Psychologist $458.87
LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA(MFT LCSW LPCC) $296.95
Occupational Therapist $395.28
Mental Health Rehab Specialist $223.41
Peer Recovery Specialist $234.58
Other Qualified Providers-Other Designated MH staff that bill
medical $223.41
DocuSign Envelope ID:OC601347-9E97-4CO8-B5D6-BCCBA774E7B1
Exhibit G2
Fresno County Department of Behavioral Health
Specialty Mental Health Services Outpatient Rates
Field Based
(at least SO%of services are provided in the field)
Provider Rate
Provider Type Per Hour
Psychiatrist/Contracted Psychiatrist $988.85
Physicians Assistant $443.50
Nurse Practitioner $491.73
RN $401.65
Certified Nurse Specialist $491.73
LVN $211.00
Pharmacist $473.34
Licensed Psychiatric Technician $180.89
Psychologist/Pre-licensed Psychologist $397.68
LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA(MFT LCSW LPCC) $257.35
Occupational Therapist $342.58
Mental Health Rehab Specialist $193.62
Peer Recovery Specialist $203.30
Other Qualified Providers-Other Designated MH staff that bill
medical $193.62
DocuSign
Certificate Of Completion
Envelope Id:OC6013479E974C08B5D6BCCBA774E7B1 Status:Completed
Subject:Complete with DocuSign:County of Fresno#23-280 Amendment 1 MHS ACT
Source Envelope:
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Certificate Pages:4 Initials:0 Araceli Flores
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Envelopeld Stamping:Enabled Arcadia,CA 91006
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