HomeMy WebLinkAboutAgreement A-24-217 Amendment No. 3 to Master Agreement.pdf Agreement No. 24-217
1 AMENDMENT NO. 3 TO SERVICE AGREEMENT
2 This Amendment No. 3 to Service Agreement ("Amendment No. 3") is dated
3 May 21, 2024 and is by and between the County of Fresno, a political subdivision of
4 the State of California ("County"), and each Provider listed in Revised Exhibit A-3, "List of
5 Providers" (collectively referred to as "Provider"). Reference in this Agreement to "party" or
6 "parties" shall be understood to refer to County and each provider, unless otherwise specified.
7 Recitals
8 A. On June 23, 2020, the County and Provider entered into Individual/Group Provider
9 Master Agreement, which is County Agreement number 20-236, for specialty mental health
10 services to County's Medi-Cal beneficiaries; and
11 B. On June 30, 2023, the County and Provider Amended the above service Agreement,
12 which is Agreement number 23-271 to add additional Providers to the Agreement and
13 incorporate a new billing structure due to the implementation of the California Advancing and
14 Innovating Medi-Cal (CalAIM) initiative by the Department of Health Care Services; and
15 C. On January 9, 2024 the County and Provider Amended the above service Agreement,
16 which is Agreement number 24-021 (collectively referred to as "Agreement") to add additional
17 providers to the Agreement; and
18 D. The County now desires to further amend the Agreement to memorialize the removal of
19 Provider Bashful Elephant Counseling due to the death of the Provider, effective December 23,
20 2023; and to add the following Providers to the Agreement: (1) Inspire Psychological Services,
21 Inc., (2) Joint Opportunities, and (3) West Side Church of God, reflected on Revised Exhibit A-3.
22 E. The County now desires to increase the maximum compensation for this Agreement and
23 due to mutual oversight by County and Providers in the rate sheet, revise the billing rates to
24 reflect the correct reimbursement rates that should have been implemented on July 1, 2023;
25 and
26 The parties therefore agree as follows:
27 1. All references to Revised Exhibit A shall be deemed references to Revised Exhibit A-3,
28 effective upon execution. Revised Exhibit A-3 is attached and incorporated by this reference.
1
1 2. All references to Revised Exhibit B shall be deemed references to Revised Exhibit B-2,
2 attached and incorporated by this reference.
3 3. That Paragraph Four (4) — Compensation —of the Agreement, on Page Six (6),
4 beginning on Line Twenty Three (23) with the word "For", and ending on Page Seven (7), Line
5 Three (3) with the word "combined" is deleted and replaced with the following:
6 "For the period effective from July 1, 2023 through June 30, 2024, the maximum
7 compensation amount under this Agreement shall not exceed Seven Million and No/100 Dollars
8 ($7,000,000.00) for all Providers combined.
9 For the period effective from July 1, 2024 through June 30, 2025, the maximum
10 compensation amount under this Agreement shall not exceed Seven Million and No/100 Dollars
11 (7,000,000.00) for all Providers combined.
12 For the entire term of this Agreement, the total maximum compensation amount
13 under this Agreement shall not exceed Twenty-Seven Million, Two Hundred Thirty-Nine
14 Thousand, Eight Hundred Thirty-Eight and No/100 Dollars ($27,239,838.00) for all Providers
15 combined.
16 Contractor shall use Current Procedural Terminology (CPT) or Healthcare Common
17 Procedure Coding System (HCPCS) codes, as provided in the DHCS Billing Manual available at
18 https://www.dhcs.ca.gov/services/MH/Nages/MedUUU-Library.asp , as amended from time
19 to time. Services shall only be based on the units of time assigned to each CPT or HCPCS code
20 multiplied by the practitioner service rates, only for actual minutes documented, in Revised
21 Exhibit B-2."
22 4. This Amendment No. 3 is effective retroactive to July 1, 2023, unless otherwise indicated
23 in this Amendment No. 3.
24 5. The parties agree that upon execution of this Amendment, the Agreement is further
25 revised, updated, and amended to add the following Providers: (1) Inspire Psychological
26 Services, Inc. (2) Joint Opportunities, and (3) West Side Church of God.
27 6. The Provider represents and warrants to the County that:
28
2
1 a. The Provider 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 Provider is duly authorized to
4 do so and his or her signature on this Amendment legally binds the Provider to the
5 terms of this Amendment.
6 7. 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 8. This Amendment may be signed in counterparts, each of which is an original, and all of
28 which together constitute this Amendment.
3
1 9. The Agreement, as previously amended, and as amended by this Amendment No. 3 is
2 ratified and continued. All provisions of the Agreement, as previously amended, and not
3 amended by this Amendment No.3 remain in full force and effect.
4 10. When both parties have signed this Amendment No. 3, the Agreement, Amendment No.
5 1, Amendment No. 2, and this Amendment No. 3 together constitute the Agreement.
6 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Amendment No. 3 on the date stated in the introductory
2 clause.
3
PROVIDERS COUNTY OF FRESNO
4
SEE ATTACHED SIGNATURE PAGES _
-- 4
6 Nathan Magsig, Chairman of the Board of
Supervisors of the County of Fresno
7
Attest:
8 Bernice E. Seidel
Clerk of the Board of Supervisors
9 County of Fresno, State of California
10 -
By: �..: �
11 Deputy
12 For accounting use only:
13 Org No.: 56302666
Account No.: 7223/0
14 Fund No.: 0001
Subclass No.: 10000
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1 PROVIDER (INDIVIDUAL): 1,Wq- r �-I 'T� 37�
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5 Print Name:
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7 Title:
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9 Date: Air- 30 20 2-`f
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (INDIVIDUAL):
�'�;r
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By: Karina Cisneros
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5 Print Name: Karina Cisneros
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Title: LCSW
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Date: 5/1/2024
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COUNTY OF FRESNO
Fresno, CA
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PROVIDER(INDIVIDUAL):
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5 Print Name,-)
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Title:
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Date: ^~�
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000mTx OF rnEomu
Fresno, cx
Judith Ann Dickey
1 PROVIDER (INDIVIDUAL):
By
Judith Ann Dickey
Print Name:
6 LMFT
-7 Title
8 April 30, 2024
9 Date:
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1:
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C07JNTY OF FRESNO
Fresno, CA
1 PROVIDER(INDIVIDUAL): Donald Farris
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3 By.:
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5 Print Name: Donald Farris
6 LGSW
7 Title:
8 _
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Date:
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COUNTY OF FRESNO
Fresno, CA
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1 PROVIDER (INDIVIDUAL.`
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By: dm
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5 Print Name: (, �4 ' ? )
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7 Title:
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9 Date:
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r(YTNTV nF 7RF.4Nn
1 PROVIDER (INDIVIDUAL): La Familia Therapy Services Inc
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By:
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Victoria Montufar
5 Print Name:
6 CEO - LMFT
7 Title:
8 5/30/21
9 Date:
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COUNTY OF FRESNO
Fresno, CA
:
1 PROVIDER (INDIVIDUAL).
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5 Print Name: hL
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7 Title:
9 Date:
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COUNTY OF FRESNO
Fresno, CA
I PROVIDER (INDIVIDUAL): Gerardo Madrigal, MFT
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Dig L3 ly signed by Cera,�o
Gerardo
3 Macnga.LMFT
By: Madrigal, LMFT °a'oo`°=4''"'.°,_51 ,`
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5 Print Name: Gerardo Madrigal
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7 Title: LMFT
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9 Date: 4/30/24
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (INDIVIDUAL): Kannon Nalls PsyD 30861
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3 3
By-
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Kannon Nalls PsyD. 30861
5 Print Name:
6 PsyD 30861
7 Title: .
8 5/1 /2024
9 Date: _
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (INDIVIDUAL): Elsa Quintanilla
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3 j
By: f~
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5 Print Name: Elsa QUlntanllla
6 LMFT
7 Title: _
8 May 1 , 2024
9 Date: _
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDE DIVIDUAL): Juan QUintanilla
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By:
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Juan Quintanilla, LMFT 85170
5 Print Name:
6 Title: LMFT, 85170
7 .
8 May 1 ,2024
9 Date:
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COUNTY OF FRESNO
Fresno, CA
PROVIDER (INDIVIDUAL): A A i--.
0qv
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By:
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5 Print Name: ��,�,(" �.�1� YrY:�� ( �,j`
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7 Title:
Date:
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (INDIVIDUAL): Teresa S ROItgen
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3 Z"4By:
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5 Print Name: Teresa S Roltgen
6 LMFT
7 Title:
8 4/30/2024
9 Date:
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COUNTY OF FRESNO
Fresno, CA
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1 PROVIDER(INDIVIDUAL): JORGE A RO M E RO
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3 kto&e�
By:
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5 Print Name: JORGE A ROMERO
6 LMFT
7 Title:
8 : 5I112024
9 Date.
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COUNTY OF FRESNO
Fresno, CA
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PROVIDER (INDIVIDUAL): Michael Tucibat LMFT
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By:
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5 Print Name: Michael Tucibat LMFT
Title:
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Date:
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COUNTY OF FRESNO
Fresno, CA
I PROVIDER (INDIVIDUAL): Zoua Xiong LMFT
2 -11;�A z
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By:
5 Print Name: Zoua Xiong
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7 Title: Licensed Marriage and Family Therapist
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9 Date:
5/1/2024
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COUNTY OF FRESNO
Fresno, CA
l PROVIDER (INDIVIDUAL):
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By:
5 Print Name:I ll eab
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7 Title: c- �P� �T -T"
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9 Date:. OS
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I PROVIDER (GROUP): Allay Psychological Services
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3 I 09,3o,zoz9
By: U
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5 Print Name: Reshale L. Thomas, PsyD
6 Owner/CEO
7 Title:
Chairman of the Board, or
8 President, or any Vice President
9 04/30/2024
10 Date:
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13 By: U\ �/
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15 Print Name: Reshale L. Thomas, PsyD
16 Owner/CEO
Title:
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20 04/30/2024
Date:
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (GROUP): Bio-Behavioral Medical Clinics, Inc.
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Kenneth A. Steinbach, M.D.
5 Print Name:
6 Vice President
7 Title:
Chairman of the Board, or
8 President, or any Vice President
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10 Date:
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12 ��
13 By,
14 Monica Muro
15 Print Name:
16 Title: Administrator & CFO
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20 4/30/2024
Date:
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (GROUP): DN Associates
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By:
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5 Print Name: Curtis Donovan
6 President
7 Title:
Chairman of the Board, or
8 President, or any Vice President
9 05/01 /2024
10 Date:
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By
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15 Print Name:
Jennifer Preston
16 C
Title: r
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20 Date: 05/01 /2024
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (GROUP): J i��-g _
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3 Y /lDi�l�` l
4 • �1��— r�-��
5 Print Name: i
7 Title: ,, _ , �.;�---
Chairmanlof the Bo rd, dr
8 President, or anK ce President
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Date:
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COUNTY OF FRESNO
Fresno, CA
I PROVIDER : Esperanza Family Counseling
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3 By: Q�
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5 Print Name: Sergio Pereyra, PhD, LMFT
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7 Title: CEO, President
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9 Date: 4/30/2024
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (GROUP): Fresno American Indian Health Project
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By:
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5 Print Name: Amber Molina
6 Director of Behavioral Health
7 Title:
Chairman of the Board, or
8 President, or any Vice President
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10 Date: V�/,a 'd
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13 By:
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15 Print Name:
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Title:
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
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Date:
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (GROUP): Fresno New Connection, Inc.
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By:
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5 Print Name: Cheryl Whittle
Clinical Director
7 Title:
Chairman of the Board, or
8 President, or any Vice President
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10 Date:
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13 By:
14 Tanisha Garcia
is
Print Name:
16 CFO
Title:
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
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Date:
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (GROUP):
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By:
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5 Print Name:
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7 Title: I'�
Chairman of the Board, or
8 President, or any Vice President
9
10 Date: "I
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12 � W
13 By:
14 Anita Washington
15 Print Name:
16 Title: Secretary
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20 Date: 5/01 /2024
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER(GROUP): _Healing Hope, Inc.
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By: _7Vez A" -
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5 Print Name: Mor X. Popper
6 Exec. Clinical Director
7 Title: _
Chairman of the Board, or
8 President, or any Vice President
9 Date: _05/01 /2024
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13 By: �.
1 Mark D. Popper
1 Print Name: _
16 Title: Clinical Director
_
17 Secretary(of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20 Date: 05/01 /2024
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COUNTY OF FRESNO
Fresno, CA
PROVIDER (GROUP): "�(�,;;; (�� 1 Gi� i co 4't
2
r
4
Print Name:
J •
Title: c �}
Chairman of the Board, or
President, or any Vice President
1 Q Date:
11
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13 By.
14
1 J Print Name:
16
Title:
1; Secretary (of Corporation), or
any Assistant Secretary, or
1 n Chief Financial Officer, or
i
any Assistant Treasurer
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Date:
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L CC--
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S� C
PROVIDER (GROUP).
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By:
4 S 7in.6 x,,wn,
5 Print Name:
6
Title: r e_-TM
7
Chairman of the Board, or
8 President, or any Vice President
10 Date:
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By:
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14 Print Name:
15
16
Title:
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
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21 Date:
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (GROUP): Inspire Psychological Services, Inc.
2
ChenVan Digitally signed by Cheng
9 g, Vang,Ph.D.
3 Date:2024.04 29
By:
Ph.D. 18:13:08-07'00'
4
5 Print Name: Cheng Vang, Ph.D.
6 President/CEO
7 Title: _
Chairman of the Board, or
8 President, or any Vice President
9 04/29/2024
10 Date: _
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (GROUP): Integral Community Solutions Institute
2
Digitally signed by Juan
Juan C.Garcia,PhD C.Garcia,PhD
3 Dale:2024.04.30
By: 15:37.03•07'00'
4
.. v
5 Print Name:.�tf� �' —c..t `�':—
6
7 Title:_�XCG
Chairman of the Board, or
8 President, or any Vice President
9
10
Date:
—
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COUNTY OF FRESNO
Fresno, CA
1
PROVIDER (GROUP): __j
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By:
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5 Print Name:
6
7 Title:
Chairman of the Board, or
8 President, or any Vice President
9
10 Date:
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COUNTY OF FRESNO
Fresno, CA
I PROVIDER(GROUP): _Marjaree Mason Center
2
By: �.
4
5 Print Name: Nicole Linder
6
Title: _ E
7
Chairman of the Board, or
8 President, or any Vice President
9 Date 5/3/24
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COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (GROUP): Omid Counseling Center
2 ,
3 -
By:�Plc �11 14-0
4
5 Print Name: Rol ina Fazil
6 CEO & President
7 Title:
Chairman of the Board, or
8 President, or any Vice President
9 5/01/2024
10 Date:
11
12
13 By:
14 Navjot Grewal
15 Print Name:
16 Title: COO & Secretary of BOD
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20 Date: 5/01/2024
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COUNTY OF FRESNO
Fresno, CA
1
1
l
1 PROVIDER (GROUP): Poverello House
r
3 S
By:
4
5 Print Name: Zac ary aria
6
7 Title: C E O
Chairman of the Board, or
8 President, or any Vice President
9
10 Date:
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COUNTY OF FRESNO
Fresno, CA
LM\tYA\�1��111►\�\�i\i�7�. {L
PRECISION PSYCHIATRIC SERVICES 1
PROVIDER (GROUP):
2
3 G f Q�.-✓
By:
4
DR HARJEET BRAR
5 Print Name:
6 PRESIDENT
7 Title:
Chairman of the Board, or
8 President, or any Vice President
9 Date: 5/1 /2024
1
11
12
13 By: I�
14 MINTY DILLON
15 Print Name:
16 CHIEF EXECUTIVE OFFICER
Title:
17 Secretary(of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20 Date: 5/1 /2024
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COUNTY OF FRESNO
Fresno, CA
I PROVIDER (GROUP): Prodigy Healthcare Inc.
2
By:
4
5 Print N e: Jagdip Dhanda
6 President
7 Title:
Chairman of the Board, or
8 President, or any Vice President
9 04/30/2024
10 Date:
11
12
By:
13
14 Jagdip Dhanda
15 Print Name:
16
Title: F O
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20 Date: 04/30/2024
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COUNTY OF FRESNO
Fresno, CA
1 P ovider: PROMESA BEHAVIORAL HEALTH
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3
B
4
5 Print Name: iA I _RAEL DER MAAJ Ui,L_
6
7 Ttie:
Chairman of the Board, President, or Vice President
8
9 Date: �2Al2-`-
10
11
12 B
13
P int Name:
14
15 T tie:
16 Secretary (of Corporation), Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer
17 1 j
18 ate: 12-1 1 Zt
19
20
21
22
23
24
25
26
27
28
15
PRODDER(GRPy. �1 A G►�kN-�tibo�
2
ByV:
4
POM Name, e
Ulairman of tom Boarj,or
a Presiderd. or any Vice Pmsidwet
9
10
11 ' =
12
13 PY`
14
15 Print Marne;
1
M07 -
17 Secretary(of Cor or on),or
any Assist amt Secretary! or
113 I Chief Firanci2l Ofter, or
19 any 1 ssisto t Treasurer
20
D :
21
22
29 l
24
25
26
27
28 ,
rrmrrrry nr wnve.rr,
1 PROVIDER (GROUP): Resiliency Center of Fresno
2
3 -
By:
4 U
5 Print Name: Corina Rains
6 Clinical Director
7 Title:
Chairman of the Board, or
8 President, or any Vice President
9 4/30/2024
10 Date:
11
12
13 By: wui
14 Rodney Lowery
15 Print Name:
16
Title: C
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20 Date: 4/30/2024
21
22
23
24
25
26
27
28
COUNTY OF FRESNO
Fresno, CA
2024-05-01 14:17 Ron C Steele & Assoc 5593532009 >> Channel-18 P 2/2
1 PROVIDER (GROUP): _Ron (X I SSOGa`I�l
2
3
By:
4 ,,QQ
5 Print Name: 71YJ/�/S�lfic 6,�or
6
7 Title: —Q W
Chairman of the Board, or
8 President, or any Vice President
9
10 Date:
11
12
13
14
16
17
18
19
20
21
22
23
24
25
26
27
28
COUNTY OF FRESNO
Fresno, CA
1 PROVIDER (GROUP): Simmons and Simmons Wellness Center
2
3
By:
4
Ambe
5 Print Name: r SlmmonS
7
Title: `-'-owner
Chairman of the Board, or
8 President, or any Vice President
10 Date:
05-03-24
11
12
13
14 Amber i ons
15 Print Name:
16 Title: Clinician
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20 Date: 05-03-24
21
22
23
24
25
26
27
28
COUNTY OF FRESNO
Fresno, CA
1 PROVIDER(GROUP): _Sal C ,Qy��bs.
2
3
By:
4
5 Print Name: � LL b�'
6
7 Title: � Vt l 2 Chairga7 of the Board, or
8 President or any Vice President
9
10 Date: t.
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
COUNTY OF FRESNO
Fxesno, CA
1 PROVIDER (GROUP): WeStSlde Church Of God
2
3
B�
4
5 Print Name: ArneSla Williams
6
Vice Chairman of the Board of Westside COG
7 Title:
Chairman of the Board, or
8 President, or any Vice President
9 5/2/2024
10 Date:
11
12
13 By:
14
15 Print Name:
16
Title:
17 Secretary (of Corporation), or
any Assistant Secretary, or
18 Chief Financial Officer, or
19 any Assistant Treasurer
20
Date:
21
22
23
24
25
26
27
28
COUNTY OF FRESNO
Fresno, CA
Page 1 of 3
Revised Exhibit A-3
Individual Providers
Name Address Email
Amato, Dolores 6777 N. Willow Ave Fresno, CA 93710 dgamato@gmail.com
Cisneros, Karina 5150 N. Sixth St Ste 116 Fresno, CA 93710 karicbm22@gmail.com
Cooke,Johanna V. 5100 N. 6th St Fresno, CA 93710, Ste 151 jcooke.lcsw@gmail.com
Dickey,Judith 501 E.Terrace Ave Fresno CA 93704 jstorytellerl@icloud.com
Farris, Donald 3740 Circle Dr. Fresno, CA 93704-4765 donfarris1871@gmail.com
5665 S. Chestnut Ave Spc 61 Fresno CA
Jones, Kimberly M. drkimjones02@gmail.com
93725
La Familia Therapy
4229 E. Clinton, Fresno, CA 93703 lafamiliatherapyservices@gmail.com
Services, Inc.
Lynch, Nasim Nancy 5151 N. Palm Ave#950, Fresno, CA 93704 nancylynch24@hotmail.com
Madrigal, Gerardo 5528 N. Palm Ave Suite#122 Fresno, CA gmadrigal80@gmail.com
93704
Nalls, Kannon E. 739 Meadow Ct., Exeter, CA 93221 knalls@alliant.edu
Quintanilla, Elsa 5588 N. Palm Ave Fresno, CA 93704 quintanillacl2@gmail.com
Quintanilla,Juan 5588 N. Palm Ave Fresno, CA 93704 archaicvegan@outlook.com
Randolph, Michelle 438 E. Shaw Ave#140 Fresno, CA 93710 mneuferlcsw@sbcglobal.net
Roltgen,Teresa 2505 W. Shaw Ave Fresno, CA 93711 teriroltgen@gmail.com
Romero,Jorge 373 E. Shaw Ave# 140, Fresno, CA 93710 ajorgeandrom@aol.com
6777 N. Willow Ave, Suite# 142 Fresno, CA
Tucibat, Michael Mike.Tucibat.LMFT@infinitewebs.net
93710
Vang, Ka Bao 5070 N. Sixth Street Suite 105, Fresno, CA kbadame02@gmail.com
93710
Xiong, Zoua 5588 N. Palm Ave Fresno, CA 93704 zouaxiongmft@gmail.com
Page 2 of 3
Revised Exhibit A-3
Group Providers
Name Address Email
Allay Psychological Services 2900 Fresno St.#108, Fresno, CA 93721 reshale@allaypsych.com
1060 W. Sierra Ave,Suite 105, Fresno, CA
Bio Behavioral Medical Clinics mmuro@bbmc-inc.com
93711
DN Associates 4460 W. Shaw Ave#595, Fresno, CA 93722 cdonovan@coreconditions.org
Erene Soliman Psychologist INC. 5151 N. Palm Ave#500, Fresno, CA 93704 esoliman@att.net
Esperanza Family Counseling 575 E. Locust Ave STE 101, Fresno, CA sergiop.esperanzafc@gmail.com
93720
Fresno American Indian Health 1551 E.Shaw Ave.#139, Fresno, CA 93710 bramirez@faihp.org
Project
Fresno New Connections 4411 N. Cedar Ave, Fresno, CA 93726 rmartin@teamfnc.com
Generational Changes, Inc. 2409 Merced St Ste 106 Fresno, CA 93721 gchanges.inc@gmail.com
1913 N. Gateway Blvd#101, Fresno, CA
Healing Hope, Inc. morxpopper@healinghopeinc.org
93727
1322 E. Shaw Ave Suite 410, Fresno, CA
House Psychiatric Clinic, Inc. staff@houseclinic.org
93710
Impact Behavioral Health and 1616 W. Shaw Ave BLD B2 Fresno CA, 93711 impactbhrc@gmail.com
Recovery
Inspire Psychological Services, Inc.5807 E. Beck Ave, Fresno, CA 93727 chengvang2004@gmail.com
Integral Community Solutions 1065 S St Building 1, Fresno, CA 93721 jcgarcia@icsi.solutions
Institute
Joint Opportunities 1424 W. California Ave, Fresno, CA 93706 mickievalentine@icloud.com
Marjaree Mason Center 1600 M Street, Fresno, CA 93721 laurae@mmcenter.org
Omid Counseling Center, Inc. 3451 W. Shaw Ave Ste 102, Fresno CA Omidhopecenter@gmail.com
93711
Poverello House Enrichment Isiphongsay@poverellohouse.org;
Center 412 F St Fresno, CA 93706 kmurphy@poverellohouse.org
CAO@precisionpsych.com;
Precision Psychiatric Services, 7850 White Lane, Suite E301, Bakersfield, minty@precisionpsych.com
Inc. CA 93309 bodoh@precisionpsych.com
Prodigy Healthcare Inc. 311 E. Merced St., Fowler CA, 93625 harjas@prodigy-hc.com;jd@prodigy-h
1c.com
Revised Exhibit A-3 Page 3 of 3
JRomero@promesabehavioral.org;
Promesa Behavioral Health 7120 N. Marks Ave, Fresno, CA 93711 Imcclain@promesabehavioral.org;
Iweigant@promesabehavioral.org;
ezuniga@promesabehavioral.org
va eriec@qua ity ami yservices.org;
Quality Group Homes, Inc. 4946 E.Yale Ave, Suite 103, Fresno, CA sarah@qualityfamilyservices.org;
93727 lisac@qualityfamilyservices.org;
duked@qualityfamilyservices.org
referral@fresnorc.org;parrot@fresnorc.org;
Resiliency Center of Fresno 3845 N. Clark St Ste 201 Fresno, CA 93726 rlowrey@fresnorrc.org
Ron Steele and Associates Inc 5150 N. 6th St STE 169, Fresno, CA 93710 roncsteelel@gmail.com
Simmons&Simmons Wellness 2190 N.Winery Ave Suite 102, Fresno, CA ajsimmslmft@gmail.com
Center 93703
SJET Clinical Services 418 N. 6th Street, Fowler, CA 93625 soymejica@verizon.net
West Side Church of God 1424 W. California Ave, Fresno, CA 93706 mickievalentine@icloud.com
Revised Exhibit B-2 Page 1 of 2
Specialty Mental Health Individual and Group Provider Outpatient Rates
Provider Type Rate Per Hour*
Psychiatrist $ 292.95
NP (Nurse Practitioner) $ 279.00
Psychologist (Lice nsed/Registered/Waivered) $ 120.33
LICENSED - LCWS/AWS, LMFT/AMFT, LPCC/APCC, RN - MS $ 120.33
UNLICENSED - LCWS/ASW, LMFT/AMFT, LPCC/APCC, RN- $ 102.60
MS
*Hourly rates are for reference only to demonstrate an example rate per hour for a
service provided and claimed using CPT or HCPCS units that equate, based on actual
minutes documented, to CPT or HCPCS units equating to one hour; actual
reimbursement is based on CPT or HCPCS codes for services rendered, as provided in
the DHCS Billing Manual available at:
https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx
Page 2 of 2
Revised Exhibit B-2
Supplemental/Add-on Codes
Service Unit Maximum Units that Rate per Unit
Can be Billed
1 per allowed
Interactive Complexity 15 mins per unit procedure per $ 16.50
provider per
beneficiary
Sign Language or Oral
15 mins per unit Variable $ 30.00
Interpretive Services