HomeMy WebLinkAboutAgreement A-23-533 with CLFAS.pdf Agreement No. 23-533
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated October 10, 2023 and is between
3 Centro La Familia Advocacy Services Inc., a Nonprofit Corporation ("Contractor"), and the
4 County of Fresno, a political subdivision of the State of California ("County").
5 Recitals
6 A. The Department of Behavioral Health (DBH) has provided a Consumer/Family advocacy
7 program since 2011 and continues recognize the need for these services from the community
8 stakeholder process that informs the Mental Health Services Act (MHSA) Plan. On the May 17,
9 2022, County Agreement No. 22-206 was executed with Centro La Familia to provide these
10 services.
11 B. County Agreement No. 22-206 expired when written approval for the extension years
12 was not completed timely.
13 C. Contractor is qualified and willing to continue providing these services pursuant to the
14 terms and conditions of this Agreement.
15 D. This Agreement shall replace, restate, and supersede County Agreement No. 22-206 in
16 its entirety.
17 The parties therefore agree as follows:
18 Article 1
19 Contractor's Services
20 1.1 Scope of Services. The Contractor shall perform all of the services provided in
21 Exhibit A to this Agreement, titled "Scope of Services."
22 Contractor shall perform all services and fulfill all responsibilities as identified in
23 County's Request for Proposal (RFP) No. 22-027 dated December 1, 2021, Addendum No. One
24 (1) to County's RFP No. 22-027 dated December 23, 2021 (hereinafter collectively referred to
25 as COUNTY'S Revised RFP No. 22-027), and Contractor's response to Revised RFP No. 22-
26 027 dated January 5, 2022, all incorporated herein by reference and made part of this
27 Agreement. In the event of any inconsistency among these documents, the inconsistency shall
28 be resolved by giving precedence in the following order: 1) to this Agreement, including all
1
1 exhibits and all amendments thereto, 2) to the Revised RFP No. 22-027, and 3) to Contractor's
2 response to the Revised RFP No. 22-027. A copy of County's Revised RFP No. 22-027 and
3 Contractor's response thereto shall be retained and made available during the term of this
4 Agreement by DBH's Contracts Division.
5 1.1 Guiding Principles. Contractor shall align programs, services, and practices with
6 the vision, mission, and guiding principles of the DBH, as further described in Exhibit B to this
7 Agreement, titled "Fresno County Department of Behavioral Health Guiding Principles of Care
8 Delivery."
9 1.2 Representation. The Contractor represents that it is qualified, ready, willing, and
10 able to perform all of the services provided in this Agreement.
11 1.3 Compliance with Laws. The Contractor shall, at its own cost, comply with all
12 applicable federal, state, and local laws and regulations in the performance of its obligations
13 under this Agreement, including but not limited to workers compensation, labor, and
14 confidentiality laws and regulations.
15 1.4 Meetings. Contractor shall participate in periodic workgroup meetings consisting of
16 staff from County's DBH to discuss service requirements, data reporting, outcomes
17 measurement, training, policies and procedures, overall program operations, and any problems
18 or foreseeable problems that may arise.
19 1.5 Branding. It is mutually agreed by all parties to this Agreement, that the program
20 funded under this Agreement shall be identified and subsequently named/branded through the
21 review and approval of DBH Director or designee. All print or media materials, including
22 program branding and program references shall be reviewed and approved by the DBH Director
23 or designee. The program funded under this Agreement shall be identified as a "County of
24 Fresno, Department of Behavioral Health funded program," and operated by the Contractor
25 under the terms and conditions of this Agreement.
26 1.6 Location Changes. Any change to Contractor's location of the service site(s) may
27 be made only upon sixty (60) days advance written notification to DBH Director and upon written
28 approval from the DBH Director or designee.
2
1 1.7 Monitoring. It is acknowledged by all parties hereto that DBH shall monitor the
2 services provided by Contractor, in accordance with Article Eleven (11) of this Agreement.
3
4 Article 2
5 Reporting Requirements
6 2.1 Reports. The Contractor shall submit the following reports:
7 (A) Outcome Reports
8 Contractor shall submit to County clinical program performance outcome reports,
9 as requested.
10 Outcome reports and outcome requirements are subject to change at County's
11 discretion. Contractor shall provide outcomes as stated in Exhibit A and C.
12 (B) Activity Reports
13 Contractor shall submit to Count's DBH by the 10th of each month all monthly activity
14 and budget reports for the preceding month.
15 (C) Staffing Report
16 Contractor shall submit monthly staffing reports due by the 10th of each month
17 that identify all direct service and support staff by first and last name, applicable
18 licensure/certifications, and full-time hours worked to be used as a tracking tool to
19 determine if Contractor's program is staffed according to the requirements of this
20 Agreement.
21 (D) Mental Health Services Act (MHSA) Reporting
22 Contractor shall adhere to MHSA reporting including but not limited to fiscal,
23 outcomes, and demographics as described in Exhibit A.
24 (E) Additional Reports
25 Contractor shall also furnish to County such statements, records, reports, data,
26 and other information as County may request pertaining to matters covered by this
27 Agreement. In the event that Contractor fails to provide such reports or other
28 information required hereunder, it shall be deemed sufficient cause for County to
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1 withhold monthly payments until there is compliance. In addition, Contractor shall
2 provide written notification and explanation to County within five (5) days of any funds
3 received from another source to conduct the same services covered by this Agreement.
4 2.2 Monitoring. Contractor agrees to extend to County's staff, County's DBH and the
5 California Department of Health Care Services (DHCS), or their designees, the right to review
6 and monitor records, programs, or procedures, at any time, in regard to persons served, as well
7 as the overall operation of Contractor's programs, in order to ensure compliance with the terms
8 and conditions of this Agreement.
9 Article 3
10 Compensation, Invoices, and Payments
11 3.1 The County agrees to pay, and the Contractor agrees to receive, compensation for
12 the performance of its services under this Agreement as described in Exhibit D to this
13 Agreement, titled "Program Expenses."
14 3.2 Maximum Compensation. The maximum compensation payable to the Contractor
15 under this Agreement for the period of July 1, 2023 through June 30, 2024 shall not exceed One
16 Hundred Thirteen Thousand Five Hundred Sixty-Eight and No/100 Dollars ($113,568.00). The
17 maximum amount payable to the Contractor for the period of July 1, 2024, through June 30,
18 2025, shall not exceed One Hundred Thirteen Thousand Five Hundred Sixty-Eight and No/100
19 Dollars ($113,568.00). The maximum amount payable to the Contractor for the period of July 1,
20 2025, through June 30, 2026, shall not exceed One Hundred Thirteen Thousand Five Hundred
21 Sixty-Eight and No/100 Dollars ($113,568.00). The maximum amount payable to the Contractor
22 for the period of July 1, 2026, through June 30, 2027, shall not exceed One Hundred Thirteen
23 Thousand Five Hundred Sixty-Eight and No/100 Dollars ($113,568.00). In no event shall the
24 maximum compensation amount under this Agreement for all terms combined (July 1, 2023,
25 through June 30, 2027) exceed Four Hundred Fifty Four Thousand Two Hundred Seventy Two
26 and No/100 Dollars ($454,272.00).
27 The Contractor acknowledges that the County is a local government entity, and does
28 so with notice that the County's powers are limited by the California Constitution and by State
4
1 law, and with notice that the Contractor may receive compensation under this Agreement only
2 for services performed according to the terms of this Agreement and while this Agreement is in
3 effect, and subject to the maximum amount payable under this section. The Contractor further
4 acknowledges that County employees have no authority to pay the Contractor except as
5 expressly provided in this Agreement.
6 3.3 Invoices. The Contractor shall submit monthly invoices to DBH by then tenth (10tn)
7 day of each month for actual expenses incurred during the prior month period electronically to 1)
8 dbhinvoicereview@fresnocountyca.gov, 2) dbh-invoices@fresnocountyca.gov; and 3)
9 dbhcontractedservicesdivision@fresnocountyca.gov with a copy to the assigned DBH Staff
10 Analyst. Invoices and reports shall be in such detail as acceptable to DBH, as described in this
11 Agreement. No reimbursement for costs incurred by Contractor for services delivered under this
12 Agreement shall be made until the invoice and supporting documentation is received, verified,
13 and approved by DBH. The Contractor shall submit each invoice within 60 days after the month
14 in which the Contractor performs services and in any case within 60 days after the end of the
15 term or termination of this Agreement.
16 Contractor shall submit to the County by the tenth (10th) of each month a detailed
17 general ledger (GL), itemizing the costs incurred in the previous month. Failure to submit GL
18 reports and supporting documentation shall be deemed sufficient cause for County to withhold
19 payments.
20 At the discretion of County's DBH Director, or designee, if an invoice is incorrect or is
21 otherwise not in proper form or substance, County's DBH Director, or designee, shall have the
22 right to withhold payment as to only that portion of the invoice that is incorrect or improper after
23 five (5) days prior notice to Contractor. Contractor agrees to continue to provide services for a
24 period of ninety (90) days after notification of an incorrect or improper invoice. If after the ninety
25 (90) day period, the invoice(s) is still not corrected to County DBH's satisfaction, County's DBH
26 Director, or designee, may elect to terminate this Agreement, pursuant to the termination
27 provisions stated in Article Six (6) of this Agreement. In addition, for invoices received ninety
28 (90) days after the expiration of each term of this Agreement or termination of this Agreement,
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1 at the discretion of County's DBH Director, or designee, County's DBH shall have the right to
2 deny payment of any additional invoices received.
3 Contractor shall provide a monthly activity report with each invoice, further described
4 in Article Two (2). In addition, each monthly invoice will be in the format as identified in Exhibit
5 D, showing each budget line item, expenses incurred, and the balance remaining for each
6 budget line item for all services and items as identified in Exhibit D.
7 Contractor shall submit monthly staffing reports that identify all direct service and
8 support staff, applicable licensure/certifications, and full-time hours worked to be used as a
9 tracking tool to determine if Contractor's program is staffed according to the services provided
10 under this Agreement.
11 Contractor must attend County DBH's Business Office training on equipment
12 reporting for assets, intangible and sensitive minor assets.
13 3.4 Travel. Travel shall be reimbursed based on actual expenditures and mileage
14 reimbursement shall be at Contractor's adopted rate per mile, not to exceed the Federal Internal
15 Revenue Services (IRS) published rate.
16 3.5 Payment. The County shall pay each correctly completed and timely submitted
17 invoice within 45 days after receipt. The County shall remit any payment to the Contractor's
18 address specified in the invoice. Payments shall be made after receipt and verification of actual
19 expenditures incurred by Contractor for monthly program costs, as identified in Exhibit D, in the
20 performance of this Agreement in accordance with Exhibit A, and shall be documented to
21 County on a monthly basis by the tenth (10th) of the month following the month of said
22 expenditures.
23 3.6 Funding. The services provided by Contractor under this Agreement are funded in
24 whole or in part by the State of California. In the event that funding for these services is delayed
25 by the State Controller, County may defer payments to Contractor. The amount of the deferred
26 payment shall not exceed the amount of funding delayed by the State Controller to County. The
27 period of time of the deferral by County shall not exceed the period of time of the State
28 Controller's delay of payment to County plus forty-five (45) days.
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1 3.7 Incidental Expenses. The Contractor is solely responsible for all of its costs and
2 expenses that are not specified as payable by the County under this Agreement.
3 Article 4
4 Term of Agreement
5 4.1 Term. This Agreement is effective on July 1, 2023 and terminates on June 30, 2024,
6 except as provided in section 4.2, "Extension," or Article 6, "Termination and Suspension,"
7 below.
8 4.2 Extension. The term of this Agreement may be extended for no more than three,
9 one-year periods only upon written approval of both parties at least 30 days before the first day
10 of the next one-year extension period. The DBH Director or his or her designee is authorized to
11 sign the written approval on behalf of the County based on the Contractor's satisfactory
12 performance. The extension of this Agreement by the County is not a waiver or compromise of
13 any default or breach of this Agreement by the Contractor existing at the time of the extension
14 whether or not known to the County.
15 Article 5
16 Notices
17 5.1 Contact Information. The persons and their addresses having authority to give and
18 receive notices provided for or permitted under this Agreement include the following:
19
For the County:
20 Director, DBH
County of Fresno
21 1925 E. Dakota Ave
Fresno, CA 93726
22
23 For the Contractor:
Executive Director
24 Centro La Familia Advocacy Services Inc.
302 Fresno Street, Suite 102
25 Fresno, CA 93706
26 5.2 Change of Contact Information. Either party may change the information in section
27 5.1 by giving notice as provided in section 5.3.
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1 5.3 Method of Delivery. Each notice between the County and the Contractor provided
2 for or permitted under this Agreement must be in writing, state that it is a notice provided under
3 this Agreement, and be delivered either by personal service, by first-class United States mail, by
4 an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
5 Document Format (PDF) document attached to an email.
6 (A) A notice delivered by personal service is effective upon service to the recipient.
7 (B) A notice delivered by first-class United States mail is effective three County
8 business days after deposit in the United States mail, postage prepaid, addressed to the
9 recipient.
10 (C)A notice delivered by an overnight commercial courier service is effective one
11 County business day after deposit with the overnight commercial courier service,
12 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
13 the recipient.
14 (D)A notice delivered by telephonic facsimile transmission or by PDF document
15 attached to an email is effective when transmission to the recipient is completed (but, if
16 such transmission is completed outside of County business hours, then such delivery is
17 deemed to be effective at the next beginning of a County business day), provided that
18 the sender maintains a machine record of the completed transmission.
19 5.4 Claims Presentation. For all claims arising from or related to this Agreement,
20 nothing in this Agreement establishes, waives, or modifies any claims presentation
21 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
22 of Title 1 of the Government Code, beginning with section 810).
23 Article 6
24 Termination and Suspension
25 6.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
26 contingent on the approval of funds by the appropriating government agency. If sufficient funds
27 are not allocated, then the County, upon at least 30 days' advance written notice to the
28 Contractor, may:
8
1 (A) Modify the services provided by the Contractor under this Agreement; or
2 (B) Terminate this Agreement.
3 6.2 Termination for Breach.
4 (A) Upon determining that a breach (as defined in paragraph (C) below) has
5 occurred, the County may give written notice of the breach to the Contractor. The written
6 notice may suspend performance under this Agreement, and must provide at least 30
7 days for the Contractor to cure the breach.
8 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
9 time stated in the written notice, the County may terminate this Agreement immediately.
10 (C) For purposes of this section, a breach occurs when, in the determination of the
11 County, the Contractor has:
12 (1) Obtained or used funds illegally or improperly;
13 (2) Failed to comply with any part of this Agreement;
14 (3) Submitted a substantially incorrect or incomplete report to the County; or
15 (4) Improperly performed any of its obligations under this Agreement.
16 6.3 Termination without Cause. In circumstances other than those set forth above, the
17 County may terminate this Agreement by giving at least 30 days advance written notice to the
18 Contractor.
19 6.4 No Penalty or Further Obligation. Any termination of this Agreement by the County
20 under this Article 6 is without penalty to or further obligation of the County.
21 6.5 County's Rights upon Termination. Upon termination for breach under this Article
22 6, the County may demand repayment by the Contractor of any monies disbursed to the
23 Contractor under this Agreement that, in the County's sole judgment, were not expended in
24 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
25 demand. This section survives the termination of this Agreement.
26
27
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9
1 Article 7
2 Independent Contractor
3 7.1 Status. In performing under this Agreement, the Contractor, including its officers,
4 agents, employees, and volunteers, is at all times acting and performing as an independent
5 contractor, in an independent capacity, and not as an officer, agent, servant, employee, joint
6 venturer, partner, or associate of the County.
7 7.2 Verifying Performance. The County has no right to control, supervise, or direct the
8 manner or method of the Contractor's performance under this Agreement, but the County may
9 verify that the Contractor is performing according to the terms of this Agreement.
10 7.3 Benefits. Because of its status as an independent contractor, the Contractor has no
11 right to employment rights or benefits available to County employees. The Contractor is solely
12 responsible for providing to its own employees all employee benefits required by law. The
13 Contractor shall save the County harmless from all matters relating to the payment of
14 Contractor's employees, including compliance with Social Security withholding and all related
15 regulations.
16 7.4 Services to Others. The parties acknowledge that, during the term of this
17 Agreement, the Contractor may provide services to others unrelated to the County.
18 7.5 Subcontracts. Contractor shall obtain written approval from County's Department of
19 Behavioral Health Director, or designee before subcontracting any of the services delivered
20 under this Agreement. County's Department of Behavioral Health Director, or designee retains
21 the right to approve or reject any request for subcontracting services. Any transferee, assignee,
22 or subcontractor will be subject to all applicable provisions of this Agreement, and all applicable
23 State and Federal regulations. Contractor shall be held primarily responsible by County for the
24 performance of any transferee, assignee, or subcontractor unless otherwise expressly agreed to
25 in writing by County's Department of Behavioral Health Director, or designee. The use of
26 subcontractors by Contractor shall not entitle Contractor to any additional compensation that is
27 provided for under this Agreement. Contractor shall remain legally responsible for the
28 performance of all terms and conditions of this Agreement.
10
1 Article 8
2 Indemnity and Defense
3 8.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
4 County (including its officers, agents, employees, and volunteers) against all claims, demands,
5 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
6 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
7 the performance or failure to perform by the Contractor (or any of its officers, agents,
8 subcontractors, or employees) under this Agreement. The County may conduct or participate in
9 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
10 defend the County.
11 8.2 Survival. This Article 8 survives the termination of this Agreement.
12 Article 9
13 Insurance
14 9.1 The Contractor shall comply with all the insurance requirements in Exhibit E to this
15 Agreement.
16 Article 10
17 Data Security
18 10.1 Data Security Requirements. Contractor shall comply with data security
19 requirements in Exhibit F to this Agreement.
20
21 Article 11
22 Inspections, Audits, and Public Records
23 11.1 Inspection of Documents. The Contractor shall make available to the County, and
24 the County may examine at any time during business hours and as often as the County deems
25 necessary, all of the Contractor's records and data with respect to the matters covered by this
26 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
27 request by the County, permit the County to audit and inspect all of such records and data to
28 ensure the Contractor's compliance with the terms of this Agreement.
11
1 11.2 State Audit Requirements. If the compensation to be paid by the County under this
2 Agreement exceeds $10,000, the Contractor is subject to the examination and audit of the
3 California State Auditor, as provided in Government Code section 8546.7, for a period of three
4 years after final payment under this Agreement. This section survives the termination of this
5 Agreement.
6 11.3 Public Records. The County is not limited in any manner with respect to its public
7 disclosure of this Agreement or any record or data that the Contractor may provide to the
8 County. The County's public disclosure of this Agreement or any record or data that the
9 Contractor may provide to the County may include but is not limited to the following:
10 (A) The County may voluntarily, or upon request by any member of the public or
11 governmental agency, disclose this Agreement to the public or such governmental
12 agency.
13 (B) The County may voluntarily, or upon request by any member of the public or
14 governmental agency, disclose to the public or such governmental agency any record or
15 data that the Contractor may provide to the County, unless such disclosure is prohibited
16 by court order.
17 (C)This Agreement, and any record or data that the Contractor may provide to the
18 County, is subject to public disclosure under the Ralph M. Brown Act (California
19 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
20 (D)This Agreement, and any record or data that the Contractor may provide to the
21 County, is subject to public disclosure as a public record under the California Public
22 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
23 with section 6250) ("CPRA").
24 (E) This Agreement, and any record or data that the Contractor may provide to the
25 County, is subject to public disclosure as information concerning the conduct of the
26 people's business of the State of California under California Constitution, Article 1,
27 section 3, subdivision (b).
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1 (F) Any marking of confidentiality or restricted access upon or otherwise made with
2 respect to any record or data that the Contractor may provide to the County shall be
3 disregarded and have no effect on the County's right or duty to disclose to the public or
4 governmental agency any such record or data.
5 11.4 Public Records Act Requests. If the County receives a written or oral request
6 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
7 and which the County has a right, under any provision of this Agreement or applicable law, to
8 possess or control, then the County may demand, in writing, that the Contractor deliver to the
9 County, for purposes of public disclosure, the requested records that may be in the possession
10 or control of the Contractor. Within five business days after the County's demand, the
11 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's
12 possession or control, together with a written statement that the Contractor, after conducting a
13 diligent search, has produced all requested records that are in the Contractor's possession or
14 control, or (b) provide to the County a written statement that the Contractor, after conducting a
15 diligent search, does not possess or control any of the requested records. The Contractor shall
16 cooperate with the County with respect to any County demand for such records. If the
17 Contractor wishes to assert that any specific record or data is exempt from disclosure under the
18 CPRA or other applicable law, it must deliver the record or data to the County and assert the
19 exemption by citation to specific legal authority within the written statement that it provides to
20 the County under this section. The Contractor's assertion of any exemption from disclosure is
21 not binding on the County, but the County will give at least 10 days' advance written notice to
22 the Contractor before disclosing any record subject to the Contractor's assertion of exemption
23 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs
24 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption,
25 failure to produce any such records, or failure to cooperate with the County with respect to any
26 County demand for any such records.
27 11.5 Licenses/Certificates. Throughout each term of this Agreement, Contractor and
28 Contractor's staff shall maintain all necessary licenses, permits, approvals, certificates, waivers
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1 and exemptions necessary for the provision of the services hereunder and required by the laws
2 and regulations of the United States of America, State of California, the County of Fresno, and
3 any other applicable governmental agencies. Contractor shall notify COUNTY immediately in
4 writing of its inability to obtain or maintain such licenses, permits, approvals, certificates, waivers
5 and exemptions irrespective of the pendency of any appeal related thereto. Additionally,
6 Contractor and Contractor's staff shall comply with all applicable laws, rules or regulations, as
7 may now exist or be hereafter changed.
8 11.6 Single Audit Clause. If Contractor expends Seven Hundred Fifty Thousand and
9 No/100 Dollars ($750,000.00) or more in Federal and Federal flow-through monies, Contractor
10 agrees to conduct an annual audit in accordance with the requirements of the Single Audit
11 Standards as set forth in Office of Management and Budget (OMB) 2 CFR 200. Contractor shall
12 submit said audit and management letter to County. The audit must include a statement of
13 findings or a statement that there were no findings. If there were negative findings, Contractor
14 must include a corrective action plan signed by an authorized individual. Contractor agrees to
15 take action to correct any material non-compliance or weakness found as a result of such audit.
16 Such audit shall be delivered to County's DBH Finance Division for review within nine (9)
17 months of the end of any fiscal year in which funds were expended and/or received for the
18 program. Failure to perform the requisite audit functions as required by this Agreement may
19 result in County performing the necessary audit tasks, or at County's option, contracting with a
20 public accountant to perform said audit, or may result in the inability of County to enter into
21 future agreements with Contractor. All audit costs related to this Agreement are the sole
22 responsibility of Contractor.
23 A single audit report is not applicable if Contractor's Federal contracts do not exceed
24 the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
25 Contractor's only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a
26 program audit must be performed and a program audit report with management letter shall be
27 submitted by Contractor to County as a minimum requirement to attest to Contractor solvency.
28 Said audit report shall be delivered to County's DBH Finance Division for review no later than
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1 nine (9) months after the close of the fiscal year in which the funds supplied through this
2 Agreement are expended. Failure to comply with this Act may result in County performing the
3 necessary audit tasks or contracting with a qualified accountant to perform said audit. All audit
4 costs related to this Agreement are the sole responsibility of Contractor who agrees to take
5 corrective action to eliminate any material noncompliance or weakness found as a result of such
6 audit. Audit work performed by County under this paragraph shall be billed to Contractor at
7 County cost, as determined by County's Auditor-Controller/Treasurer-Tax Collector.
8 Contractor shall make available all records and accounts for inspection by County,
9 the State of California, if applicable, the Controller General of the United States, the Federal
10 Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
11 period of at least three (3) years following final payment under this Agreement or the closure of
12 all other pending matters, whichever is later.
13 Article 12
14 Federal and State Laws
15 12.1 Health Insurance Portability and Accountability Act. County and Contractor each
16 consider and represent themselves as covered entities as defined by the U.S. Health Insurance
17 Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and agree to use and
18 disclose Protected Health Information (PHI) as required by law.
19 County and Contractor acknowledge that the exchange of PHI between them is only
20 for treatment, payment, and health care operations.
21 County and Contractor intend to protect the privacy and provide for the security of
22 PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology
23 for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
24 promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
25 Regulations) and other applicable laws.
26 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
27 Contractor to enter into an agreement containing specific requirements prior to the disclosure of
28
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1 PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e)
2 of the Code of Federal Regulations.
3 12.2 Physical Accessibility. In accordance with the accessibility requirements of section
4 508 of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor must
5 provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal
6 beneficiaries with physical or mental disabilities.
7 12.3 References to Laws and Rules. In the event any law, regulation, or policy referred
8 to in this Agreement is amended during the term thereof, the parties hereto agree to comply with
9 the amended provision as of the effective date of such amendment.
10 12.4 Compliance with State Requirements. Contractor recognizes that County operates
11 its mental health programs under an agreement with DHCS, and that under said agreement the
12 State imposes certain requirements on County and its subcontractors. Contractor shall adhere
13 to all State requirements, including those identified in Exhibit G to this Agreement titled,
14 "Behavioral Health Requirements."
15 12.5 Confidentiality. All services performed by Contractor under this Agreement shall be
16 in strict conformance with all applicable Federal, State of California and/or local laws and
17 regulations relating to confidentiality, including all Health Insurance Portability Accounting Act
18 (HIPAA) regulations.
19 12.6 Tax Equity and Fiscal Responsibility Act. To the extent necessary to prevent
20 disallowance of reimbursement under section 1861(v)(1) (I) of the Social Security Act, (42
21 U.S.C. § 1395x, subd. (v)(1)[I1), until the expiration of four (4) years after the furnishing of
22 services under this Agreement, Contractor shall make available, upon written request to the
23 Secretary of the United States Department of Health and Human Services, or upon request to
24 the Comptroller General of the United States General Accounting Office, or any of their duly
25 authorized representatives, a copy of this Agreement and such books, documents, and records
26 as are necessary to certify the nature and extent of the costs of these services provided by
27 Contractor under this Agreement. Contractor further agrees that in the event Contractor carries
28 out any of its duties under this Agreement through a subcontract, with a value or cost of Ten
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1 Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month period, with a
2 related organization, such Agreement shall contain a clause to the effect that until the expiration
3 of four (4) years after the furnishing of such services pursuant to such subcontract, the related
4 organizations shall make available, upon written request to the Secretary of the United States
5 Department of Health and Human Services, or upon request to the Comptroller General of the
6 United States General Accounting Office, or any of their duly authorized representatives, a copy
7 of such subcontract and such books, documents, and records of such organization as are
8 necessary to verify the nature and extent of such costs.
9
10 Article 13
11 Property of County
12 13.1 Fixed Assets. County and Contractor recognize that fixed assets are tangible and
13 intangible property obtained or controlled under County for use in operational capacity and will
14 benefit County for a period more than one (1) year. Depreciation of the qualified items will be
15 on a straight-line basis. For County purposes, fixed assets must fulfill three (3) qualifications:
16 (A) Have life span of over one (1) year;
17 (B) Is not a repair part; and
18 (C) Must be valued at or greater than the capitalization thresholds for the asset type:
19 Asset type Threshold
20 . Land $0
21 . Buildings and Improvements $100,000
22 . Infrastructure $100,000
23 . Tangible $5,000
24 o Equipment
25 o Vehicles
Intangible $100,000
26 o Internally Generated Software
27 o Purchased Software
o Easements
28 o Patents
• And Capital Lease $5,000
17
1
2 Qualified fixed asset equipment is to be reported and approved by County. If it is approved
3 and identified as an asset it will be tagged with a County program number. A Fixed Asset Log
4 will be maintained by County's Asset Management System and inventoried annually until the
5 asset is fully depreciated. During the terms of this Agreement, Contractor's fixed assets may be
6 inventoried in comparison to County's DBH Asset Inventory System.
7 13.2 Sensitive Assets. Certain purchases less than Five Thousand and No/100 Dollars
8 ($5,000.00) but more than One Thousand and No/100 Dollars ($1,000.00) with over a one (1)
9 year life span, and/or are mobile and high risk of theft or loss are sensitive assets. Such
10 sensitive items are not limited to computers, copiers, televisions, cameras, and other sensitive
11 items as determined by County's DBH Director or designee. Contractor shall maintain a
12 tracking system on the items that are not required to be capitalized or depreciated. The items
13 are subject to annual inventory review by the County's DBH for compliance.
14 13.3 Retention and Maintenance. Assets shall be retained by County, as County
15 property, in the event this Agreement is terminated or upon expiration of this Agreement.
16 Contractor agrees to participate in an annual inventory of all County fixed and inventoried
17 assets. Upon termination or expiration of this Agreement, Contractor shall be physically present
18 when fixed and inventoried assets are returned to County possession. Contractor is responsible
19 for returning to County all County owned undepreciated fixed and inventoried assets, or the
20 monetary value of said assets if unable to produce the assets at the expiration or termination of
21 this Agreement. Contractor further agrees to the following:
22 (A) Maintain all items of equipment in good working order and condition, normal wear
23 and tear excepted;
24 (B) Label all items of equipment with County assigned program number, to perform
25 periodic inventories as required by County and to maintain an inventory list showing
26 where and how the equipment is being used in accordance with procedures developed
27 by County. All such lists shall be submitted to County within ten (10) days of any
28 request therefore; and
18
1 (C) Report in writing to County immediately after discovery, the loss or theft of any
2 items of equipment. For stolen items, the local law enforcement agency must be
3 contacted, and a copy of the police report submitted to County.
4 13.4 Equipment Purchase. The purchase of any equipment by Contractor with funds
5 provided hereunder shall require the prior written approval of County's DBH Director or
6 designee, shall fulfill the provisions of this Agreement as appropriate, and must be directly
7 related to Contractor's services or activity under the terms of this Agreement. County's DBH
8 may refuse reimbursement for any costs resulting from equipment purchased, which are
9 incurred by Contractor, if prior written approval has not been obtained from County.
10 13.5 Modification. Contractor must obtain prior written approval from County's DBH
11 whenever there is any modification or change in the use of any property acquired or improved,
12 in whole or in part, using funds under this Agreement. If any real or personal property acquired
13 or improved with said funds identified herein is sold and/or is utilized by Contractor for a use
14 which does not qualify under this Agreement, Contractor shall reimburse County in an amount
15 equal to the current fair market value of the property, less any portion thereof attributable to
16 expenditures of funds not provided under this Agreement. These requirements shall continue in
17 effect for the life of the property. In the event this Agreement expires, the requirements for this
18 Article shall remain in effect for activities or property funded with said funds, unless action is
19 taken by the State government to relieve County of these obligations.
20
21 Article 14
22 Cultural and Linguistic Competency
23 14.1 Equal Access. Contractor shall not discriminate against beneficiaries based on race,
24 color, national origin, sex, disability, or religion. Contractor shall ensure that a limited and/or no
25 English beneficiary is entitled to equal access and participation in federally funded programs
26 through the provision of comprehensive and quality bilingual services pursuant to Title 6 of the
27 Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R. Part 80) and Executive Order
28 12250 of 1979.
19
1 14.2 Policies and Procedures. Contractor shall comply with requirements of policies and
2 procedures for ensuring access and appropriate use of trained interpreters and material
3 translation services for all limited and/or no English proficient beneficiaries, including, but not
4 limited to, assessing the cultural and linguistic needs of the beneficiaries, training of staff on the
5 policies and procedures, and monitoring its language assistance program. Contractor's policies
6 and procedures shall ensure compliance of any subcontracted providers with these
7 requirements.
8 14.3 Interpreter Services. Contractor shall notify its beneficiaries that oral interpretation
9 is available for any language and written translation is available in prevalent languages and that
10 auxiliary aids and services are available upon request, at no cost and in a timely manner for
11 limited and/or no English proficient beneficiaries and/or beneficiaries with disabilities.
12 Contractor shall avoid relying on an adult or minor child accompanying the beneficiary to
13 interpret or facilitate communication; however, if the beneficiary refuses language assistance
14 services, the Contractor must document the offer, refusal, and justification in the beneficiary's
15 file.
16 14.4 Interpreter Qualifications. Contractor shall ensure that employees, agents,
17 subcontractors, and/or partners who interpret or translate for a beneficiary or who directly
18 communicate with a beneficiary in a language other than English (1) have completed annual
19 training provided by County at no cost to Contractor; (2) have demonstrated proficiency in the
20 beneficiary's language; (3) can effectively communicate any specialized terms and concepts
21 specific to Contractor's services; and (4) adheres to generally accepted interpreter ethic
22 principles. As requested by County, Contractor shall identify all who interpret for or provide
23 direct communication to any program beneficiary in a language other than English and identify
24 when the Contractor last monitored the interpreter for language competence.
25 14.5 CLAS Standards. Contractor shall submit to County for approval, within ninety (90)
26 days from date of contract execution, Contractor's plan to address all fifteen (15) National
27 Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by the
28 Office of Minority Health and as set forth in Exhibit H "National Standards on Culturally and
20
1 Linguistically Appropriate Services", attached hereto and incorporated herein by reference and
2 made part of this Agreement. As the CLAS standards are updated, Contractor's plan must be
3 updated accordingly. As requested by County, Contractor shall be responsible for conducting
4 an annual CLAS self-assessment and providing the results of the self-assessment to the
5 County. The annual CLAS self-assessment instruments shall be reviewed by the County and
6 revised as necessary to meet the approval of the County.
7 14.6 Training Requirements. Cultural competency training for Contractor staff should be
8 substantively integrated into health professions education and training at all levels, both
9 academically and functionally, including core curriculum, professional licensure, and continuing
10 professional development programs. As requested by County, Contractor shall report on the
11 completion of cultural competency trainings to ensure direct service providers are completing a
12 minimum of eight (8) hours of cultural competency training annually.
13 14.7 Continuing Cultural Competence. Contractor shall create and sustain a forum that
14 includes staff at all agency levels to discuss cultural competence. County encourages a
15 representative from Contractor's forum to attend County's Cultural Humility Committee.
16
17 Article 15
18 Compliance
19 15.1 Compliance. Contractor agrees to comply with County's Contractor Code of
20 Conduct and Ethics and the County's Compliance Program in accordance with Exhibit I. Within
21 thirty (30) days of entering into this Agreement with County, Contractor shall ensure all of
22 Contractor's employees, agents, and subcontractors providing services under this Agreement
23 certify in writing, that he or she has received, read, understood, and shall abide by the
24 Contractor Code of Conduct and Ethics. Contractor shall ensure that within thirty (30) days of
25 hire, all new employees, agents, and subcontractors providing services under this Agreement
26 shall certify in writing that he or she has received, read, understood, and shall abide by the
27 Contractor Code of Conduct and Ethics. Contractor understands that the promotion of and
28
21
1 adherence to the Contractor Code of Conduct is an element in evaluating the performance of
2 Contractor and its employees, agents, and subcontractors.
3 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
4 employees, agents, and subcontractors providing services under this Agreement shall complete
5 general compliance training, and appropriate employees, agents, and subcontractors shall
6 complete documentation and billing or billing/reimbursement training. All new employees,
7 agents, and subcontractors shall attend the appropriate training within thirty (30) days of hire.
8 Each individual who is required to attend training shall certify in writing that he or she has
9 received the required training. The certification shall specify the type of training received and
10 the date received. The certification shall be provided to County's DBH Compliance Officer at
11 1925 E. Dakota Ave, Fresno, California 93726. Contractor agrees to reimburse County for the
12 entire cost of any penalty imposed upon County by the Federal Government as a result of
13 Contractor's violation of the terms of this Agreement.
14
15 Article 16
16 Assurances
17 16.1 Certification of Non-exclusion or Suspension from Participation in a Federal
18 Health Care Program.
19 (A) In entering into this Agreement, Contractor certifies that it is not excluded from
20 participation in Federal Health Care Programs under either Section 1128 or 1128A of the
21 Social Security Act. Failure to so certify will render all provisions of this Agreement null
22 and void and may result in the immediate termination of this Agreement.
23 (B) In entering into this Agreement, Contractor certifies, that the Contractor does not
24 employ or subcontract with providers or have other relationships with providers excluded
25 from participation in Federal Health Care Programs, including Medi-Cal/Medicaid or
26 procurement activities, as set forth in 42 C.F.R. §438.610. Contractor shall conduct initial
27 and monthly exclusion and suspension searches of the following databases and provide
28
22
1 evidence of these completed searches when requested by County, DHCS or the US
2 Department of Health and Human Services (DHHS):
3 (1) www.oig.hhs.gov/exclusions - Office of Inspector General's List of Excluded
4 Individuals/Entities (LEIE) Federal Exclusions
5 (2) www.sam.gov/content/exclusions - General Service Administration (GSA)
6 Exclusions Extractwww.Medi-Cal.ca.gov - Suspended & Ineligible Provider List
7 (3) https:Hnppes.cros.hhs.gov/#/- National Plan and Provider Enumeration
8 System (NPPES)
9 (4) any other database required by DHCS or US DHHS.
10 (C) In entering into this Agreement, Contractor certifies, that Contractor does not
11 employ staff or individual contractors/vendors that are on the Social Security
12 Administration's Death Master File. Contractor shall check the database prior to
13 employing staff or individual contractors/vendors and provide evidence of these
14 completed searches when requested by the County, DHCS or the US DHHS.
15 (D) Contractor is required to notify County immediately if Contractor becomes aware
16 of any information that may indicate their (including employees/staff and individual
17 contractors/vendors) potential placement on an exclusions list.
18 (E) Contractor shall screen and periodically revalidate all network providers in
19 accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E.
20 (F) Contractor must confirm the identity and determine the exclusion status of all its
21 providers, as well as any person with an ownership or control interest, or who is an
22 agent or managing employee of the contracted agency through routine checks of federal
23 and state databases. This includes the Social Security Administration's Death Master
24 File, NPPES, the Office of Inspector General's LEIE, the Medi-Cal Suspended and
25 Ineligible Provider List (S&I List) as consistent with the requirements of 42 C.F.R. §
26 455.436.
27 (G) If Contractor finds a provider that is excluded, it must promptly notify the County
28 as per 42 C.F.R. § 438.608(a)(2), (4). The Contractor shall not certify or pay any
23
1 Excluded provider with Medi-Cal funds, must treat any payments made to an excluded
2 provider as an overpayment, and any such inappropriate payments may be subject to
3 recovery.
4
5
6 Article 17
7 Publicity Prohibition
8 17.1 Self-Promotion. None of the funds, materials, property, or services provided directly
9 or indirectly under this Agreement shall be used for Contractor's advertising, fundraising, or
10 publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.)for the purpose of self-
11 promotion.
12 17.2 Public Awareness. Notwithstanding the above, publicity of the services described in
13 Article 1 of this Agreement shall be allowed as necessary to raise public awareness about the
14 availability of such specific services when approved in advance by County's DBH Director or
15 designee and at a cost to be provided in Exhibit D for such items as written/printed materials,
16 the use of media (i.e., radio, television, newspapers), and any other related expense(s).
17 Article 18
18 Complaints
19 18.1 Documentation. Contractor shall log complaints and the disposition of all complaints
20 from a client or a client's family. Contractor shall provide a copy of the detailed complaint log
21 entries concerning County-sponsored clients to County at monthly intervals by the tenth (10th)
22 day of the following month, in a format that is mutually agreed upon. Besides the detailed
23 complaint log, Contractor shall provide details and attach documentation of each complaint with
24 the log. Contractor shall notify County of all incidents reportable to state licensing bodies that
25 affect County clients within twenty-four (24) hours of receipt of a complaint. Within ten (10) days
26 after each incident or complaint affecting County clients, Contractor shall provide County with
27 information relevant to the complaint, investigative details of the complaint, the complaint and
28 Contractor's disposition of, or corrective action taken to resolve the complaint.
24
1 18.2 Rights of Persons Served. Contractor shall post signs informing persons served of
2 their right to file a complaint or grievance, appeals, and expedited appeals. In addition,
3 Contractor shall inform every person served of their rights as set forth in Exhibit J.
4 18.3 Incident Reporting. Contractor shall file an incident report for all incidents involving
5 clients, following the protocol identified in Exhibit K.
6 Article 19
7 Disclosure of Ownership and/or Control Interest Information
8 19.1 Applicability. This provision is only applicable if Contractor is disclosing entities,
9 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
10 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
11 19.2 Duty to Disclose. In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105
12 and 455.106(a)(1), (2), the following information must be disclosed by Contractor by completing
13 Exhibit L to this Agreement, titled "Disclosure of Ownership and Control Interest Statement."
14 Contractor shall submit this form to the County's DBH within thirty (30) days of the effective date
15 of this Agreement. Additionally, Contractor shall report any changes to this information within
16 thirty-five (35) days of occurrence by completing Exhibit L. Submissions shall be scanned
17 portable document format (pdf) copies and are to be sent via email to County's DBH assigned
18 Staff Analyst.
19 Contractor is required to submit a set of fingerprints for any person with five (5)
20 percent or greater direct or indirect ownership interest in Contractor. County may terminate this
21 Agreement where any person with five (5) percent or greater direct or indirect ownership interest
22 in the Contractor did not submit timely and accurate information and cooperate with any
23 screening method required in CFR, Title 42, Section 455.416. Submissions shall be scanned
24 pdf copies and are to be sent via email to DBHContractedServices@fresnocountyca.gov.
25 County may deny enrollment or terminate this Agreement where any person with five (5)
26 percent or greater direct or indirect ownership interest in Contractor has been convicted of a
27 criminal offense related to that person's involvement with the Medicare, Medicaid, or Title XXI
28 program in the last ten (10) years.
25
1 Article 20
2 Disclosure of Criminal History and Civil Actions
3 20.1 Applicability. Contractor is required to disclose if any of the following conditions
4 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
5 referred to as "Contractor"):
6 (A) Within the three (3) year period preceding the Agreement award, they have been
7 convicted of, or had a civil judgment tendered against them for:
8 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
9 or performing a public (federal, state, or local) transaction or contract under a public
10 transaction;
11 (2) Violation of a federal or state antitrust statute;
12 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
13 or
14 (4) False statements or receipt of stolen property.
15 (B) Within a three (3) year period preceding their Agreement award, they have had a
16 public transaction (federal, state, or local) terminated for cause or default.
17 20.2 Duty to Disclose. Disclosure of the above information will not automatically
18 eliminate Contractor from further business consideration. The information will be considered as
19 part of the determination of whether to continue and/or renew this Agreement and any additional
20 information or explanation that Contractor elects to submit with the disclosed information will be
21 considered. If it is later determined that the Contractor failed to disclose required information,
22 any contract awarded to such Contractor may be immediately voided and terminated for
23 material failure to comply with the terms and conditions of the award.
24 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
25 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit M attached
26 hereto and by this reference incorporated herein. Additionally Contractor must immediately
27 advise the County's DBH in writing if, during the term of the Agreement: (1) Contractor becomes
28 suspended, debarred, excluded or ineligible for participation in Federal or State funded
26
1 programs or from receiving federal funds as listed in the excluded parties list system
2 (http://www.epls.gov); or (2) any of the above listed conditions become applicable to Contractor.
3 Contractor shall indemnify, defend, and hold County harmless for any loss or damage resulting
4 from a conviction, debarment, exclusion, ineligibility, or other matter listed in the signed
5 Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
6 Article 21
7 Disclosure of Self-Dealing Transactions
8 21.1 Applicability. This Article 11 applies if the Contractor is operating as a corporation,
9 or changes its status to operate as a corporation.
10 21.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
11 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
12 "Self-Dealing Transaction Disclosure Form" (Exhibit N to this Agreement) and submitting it to
13 the County before commencing the transaction or immediately after.
14 21.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
15 a party and in which one or more of its directors, as an individual, has a material financial
16 interest.
17 Article 22
18 General Terms
19 22.1 Modification. Except as provided in Article 6, "Termination and Suspension," this
20 Agreement may not be modified, and no waiver is effective, except by written agreement signed
21 by both parties. The Contractor acknowledges that County employees have no authority to
22 modify this Agreement except as expressly provided in this Agreement.
23 (A) Notwithstanding the above, non-material changes to services, staffing, and
24 responsibilities of the Contractor, as needed, to accommodate changes in the laws
25 relating to service requirements and specialty mental health treatment, may be made
26 with the signed written approval of County's DBH Director, or designee, and Contractor
27 through an amendment approved by County's County Counsel and the County's Auditor-
28
27
1 Controller/Treasurer-Tax Collector's Office. Said modifications shall not result in any
2 change to the maximum compensation amount payable to Contractor, as stated herein.
3 (B) In addition, changes to line items and expense category subtotals, as set forth in
4 Exhibit D, that when added together during the term of the agreement do not exceed ten
5 percent (10%) of the total maximum compensation payable to Contractor, may be made
6 with the written approval of Contractor and County's DBH Director or designee. These
7 changes may not add or alter any other terms or conditions of the Agreement. Said
8 modifications shall not result in any change to the maximum compensation amount
9 payable to Contractor, as stated herein.
10 22.2 Non-Assignment. Neither party may assign its rights or delegate its obligations
11 under this Agreement without the prior written consent of the other party.
12 22.3 Governing Law. The laws of the State of California govern all matters arising from
13 or related to this Agreement.
14 22.4 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
15 County, California. Contractor consents to California jurisdiction for actions arising from or
16 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
17 brought and maintained in Fresno County.
18 22.5 Construction. The final form of this Agreement is the result of the parties' combined
19 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
20 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
21 against either party.
22 22.6 Days. Unless otherwise specified, "days" means calendar days.
23 22.7 Headings. The headings and section titles in this Agreement are for convenience
24 only and are not part of this Agreement.
25 22.8 Severability. If anything in this Agreement is found by a court of competent
26 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
27 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
28
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1 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
2 intent.
3 22.9 Nondiscrimination. During the performance of this Agreement, the Contractor shall
4 not unlawfully discriminate against any employee or applicant for employment, or recipient of
5 services, because of race, religious creed, color, national origin, ancestry, physical disability,
6 mental disability, medical condition, genetic information, marital status, sex, gender, gender
7 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
8 all applicable State of California and federal statutes and regulation.
9 22.10 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
10 of the Contractor under this Agreement on any one or more occasions is not a waiver of
11 performance of any continuing or other obligation of the Contractor and does not prohibit
12 enforcement by the County of any obligation on any other occasion.
13 22.11 Conflict of Interest. No officer, agent, or employee of COUNTY who exercises any
14 function or responsibility for planning and carrying out the services provided under this
15 Agreement shall have any direct or indirect personal financial interest in this Agreement. In
16 addition, no employee of County shall be employed by Contractor to fulfill any contractual
17 obligations with County. Contractor shall also comply with all Federal, State of California, and
18 local conflict of interest laws, statutes, and regulations, which shall be applicable to all parties
19 and beneficiaries under this Agreement and any officer, agent, or employee of County.
20 22.12 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
21 between the Contractor and the County with respect to the subject matter of this Agreement,
22 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
23 publications, and understandings of any nature unless those things are expressly included in
24 this Agreement. If there is any inconsistency between the terms of this Agreement without its
25 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
26 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
27 exhibits.
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1 22.13 No Third-Party Beneficiaries. This Agreement does not and is not intended to
2 create any rights or obligations for any person or entity except for the parties.
3 22.14 Authorized Signature. The Contractor represents and warrants to the County that:
4 (A) The Contractor is duly authorized and empowered to sign and perform its
5 obligations under this Agreement.
6 (B) The individual signing this Agreement on behalf of the Contractor is duly
7 authorized to do so and his or her signature on this Agreement legally binds the
8 Contractor to the terms of this Agreement.
9 22.15 Electronic Signatures. The parties agree that this Agreement may be executed by
10 electronic signature as provided in this section.
11 (A) An "electronic signature" means any symbol or process intended by an individual
12 signing this Agreement to represent their signature, including but not limited to (1) a
13 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
14 electronically scanned and transmitted (for example by PDF document) version of an
15 original handwritten signature.
16 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
17 equivalent to a valid original handwritten signature of the person signing this Agreement
18 for all purposes, including but not limited to evidentiary proof in any administrative or
19 judicial proceeding, and (2) has the same force and effect as the valid original
20 handwritten signature of that person.
21 (C)The provisions of this section satisfy the requirements of Civil Code section
22 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
23 Part 2, Title 2.5, beginning with section 1633.1).
24 (D) Each party using a digital signature represents that it has undertaken and
25 satisfied the requirements of Government Code section 16.5, subdivision (a),
26 paragraphs (1) through (5), and agrees that each other party may rely upon that
27 representation.
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1 (E) This Agreement is not conditioned upon the parties conducting the transactions
2 under it by electronic means and either party may sign this Agreement with an original
3 handwritten signature.
4 22.16 Counterparts. This Agreement may be signed in counterparts, each of which is an
5 original, and all of which together constitute this Agreement.
6 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Centro La Familia Advocacy Services, Inc. County of Fresno
3
4 nod.
5 Marga6la A. Rocha, Executive Director S QA Piero,Vhairman of the Board of
S i the County of Fresno
6 302 Fresno St. 102
Fresno, CA 93706 Attest:
7 Bernice E. Seidel
Clerk of the Board of Supervisors
8 County of Fresno, State of California
9
10 By. Deputy '-,— lr,I' G�
11 For accounting use only:
12 Org No.: 56304710
Account No.: 7295
13 Fund No.: 0001
Subclass No.:
14 10000
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Exhibit A - Page 1
Mental Health Services Act
Consumer/Family Advocacy Services
Scope of Work
Contractor: Centro La Familia Advocacy Services (CLFAS)
302 Fresno St., Suite 102, Fresno, CA 93706
Contract Period: July 1, 2023, through June 30, 2024, with provision of three (3) twelve-month
renewal periods thereafter
Contract Budget: $113,568 annually
Target Population: Unserved and underserved children/youth, transitional age youth, adults, and older
adults and their families/support persons residing in rural and metropolitan areas of
Fresno County who may be experiencing a first break in mental illness or experiencing
early onset of a crisis.
Hours of Operation: Monday— Friday; - 08:30 to 05:OOpm
Consumer/Family Advocacy Program
Provided in accordance with the Mental Health Services Act (MHSA) guidelines and principles, the
Consumer/Family Advocacy program includes the provision of community-based behavioral health support
and stigma reduction education services. In addition, outreach and training shall be provided to educate
persons served, families/support persons, and the community on: mental health, wellness and recovery;
available support and treatment resources; and anti-stigma and suicide prevention. Program goals and
objectives include educating and providing supports and services early in the manifestation of mental illness to
address and alleviate the symptoms of mental illness before they worsen and trigger involvement with law
enforcement, involuntary holds/services, or admission to emergency departments and/or the criminal justice
system. In addition, the program shall facilitate and improve the relationships, service linkages, and mental
health services between individuals/families/support persons and County of Fresno, as well as other
community providers.
Consumer/Family Advocate
Consumer/Family Advocate staff shall serve as consumer/family advocates fully devoted to the needs of
individuals/families/support persons in the community. Staff shall provide community-based responses and
advocacy efforts in places where the unserved/underserved may frequent, such as in the home, community
centers, and other gathering places throughout Fresno County. The Contractor shall develop a community
identity, presence and effective engagement strategies that shall enable the staff to educate, advocate, train
and respond to the behavioral health needs (mental health and substance use disorders) of culturally
diverse individuals, families and groups. The Contractor may serve as a community representative in policy
meetings and committees (Quality Improvement, Cultural Diversity, etc.), and in other community
stakeholder settings, such as commissions, boards, and other provider agencies staff meetings. The
Consumer/ Family Advocates shall work to develop and improve prevention and early intervention strategies
with individuals and families/support persons of individuals who may be experiencing a first break in mental
illness or experiencing early onset of a crisis. Advocates shall provide mental health and wellness and
recovery education to the family/support persons; assist the family/support persons and individual in
developing positive interaction skills and communication techniques; and help build resiliency in the family in
an effort to prevent future mental health crisis.
The Contractor shall provide:
Exhibit A - Page 2
• Family/individual engagement, referrals, linkages and warm handoffs, support services, crisis
services, and follow-up services to ensure needs are addressed;
• Clear and comprehensive communication of services provided to the community and specifically to
the Department of Behavioral Health and its contracted providers through deliberate and regular
contacts, in-service trainings, meetings, etc.;
• Ongoing and thorough complaint/concern component, including review and analysis of quality
improvement goals/objectives sought and achieved, protocols for processing complaints, appropriate
responsiveness, follow-up, etc.;
• Family advocate training and family peer education on mental health and wellness, available
community services and resources, anti-stigma and suicide prevention;
• Resource phone number for family/individuals/providers to call for advocacy and support needs and
services, including protocols for processing calls and coordinating services;
• Community/individual/family education for all age groups, including but not limited to: mental health
and wellness, stigma reduction, Mental Health First Aid and suicide prevention;
• Build resiliency and de-escalation techniques in the family in an effort to prevent future mental health
crisis that requires involuntary psychiatric assessment;
• Community resource collaboration and coordination in rural and metropolitan areas and cities of
Fresno County;
• Outreach and community liaison services coordinated to ensure support services in rural and
metropolitan areas and cities of Fresno County;
• Collaboration and coordination with Fresno County and other community service providers to
enhance and expand awareness of, and access and linkages to available community resources and
services; and
• Outreach, education and in-service presentations to other community providers regarding available
services, and feedback on those services.
Reporting
The Contractor shall provide reports as requested by the County, including, but may not be limited to:
• Outcome Performance Measures - data collection and reporting, including individual/family/support
persons feedback on services, providers, policies and procedures. Data collection includes, but is
not limited to: age group, race, ethnicity, primary language, numbers served (unique and repeat),
gender at birth, current gender identity, sexual orientation, disability, Veteran's status, and duration
of time untreated. Outcomes must be measurable and clearly identify the PEI program type,
individual services, family services, liaison activities and outcomes of contacts and services. The
Contractor shall utilize a computerized tracking system to collect, track and maintain performance
measures and other relevant individual data. Indicators (and data source) are to be reported to the
DBH Analyst on a monthly basis. See Program Outcomes below.
• Individual and family member complaint/concern review process. This complaint review process
would include the review of concerns related to individual and stakeholder identified issues such as
access to, and satisfaction with County mental health services and contracted services. The
complaint/concern review process shall involve continued and active participation on Fresno
County's Quality Improvement Council (QIC). Said complaint/concern review process shall include
Exhibit A - Page 3
creating individual/family member call logs, reporting mechanisms to the DBH, quality improvement
recommendations and additional summaries/reports as needed to DBH designee(s). Informational
material relevant to individual/family member needs and perspective shall be provided to
individuals/family members.
• Monthly staffing reports identifying all staff by classification and FTE.
• Fixed Asset Log shall be submitted upon acquisition of fixed asset(s) and resubmitted each month
there is an addition or deletion of a fixed asset, or upon request by County.
• Monthly expense and revenue invoice and relative General Ledger as described in Article Three (3)
of this Agreement and in alignment with the Budget— Exhibit D.
Program Outcomes
Contractor shall meet or exceed the expectations for data collection and reporting of program outcomes as
identified below and in this Contract.
Scope of Work Component Snapshot
Community- Provide advocacy efforts in places Individuals will be intentionally engaged Sign-in sheets,Pre/Post
based Responses where individuals reside and and have the opportunity to take part in Evaluations.
frequent, including community the program to voice their needs. They
centers, schools,parks,other will have the tools,knowledge,and
community-based organizations, resources to respond positively to
churches, etc. situations.
targeting identified populations with
youth and caregivers.
Family Consumer Family Advocates will Family/individuals will receive Training Sign-In
Advocate participate in Family Advocacy effective,culturally sensitive mental Sheets with topic,
Training and Training focusing on holistic, health services to increase their ability Referral log.
Family Peer culturally sensitive mental health to respond to the behavioral health
Education service delivery. needs(mental health and substance use
disorders)of culturally diverse
Act as liaisons for family/ individuals,families,and groups.
individuals connecting them to
County professional staff and other Stabilize situation by linking
mental health services. family/individuals to appropriate
resources and ensure family/individual
progress.
Exhibit A - Page 4
Community/ Provide community outreach and Consumers and family members will Sign-in sheets,
individual/ presentation to increase public increase awareness of mental health Pre/Post Evaluation.
family awareness on the impact of mental issues to minimize
education illness. stigma/discrimination and increase
familial support and coping skills.
Family/Individua Act as liaison between Increase family/individual level of Case management,
1 Engagement family/individuals connecting them functioning,confidence and coping referral log,Needs
to appropriate mental health services skills and reduce stigma/discrimination Stressor Survey,
that includes linkage,support of mental health. Family Development
services,referrals,and warm Matrix,Outcome
handoffs. Conduct follow-ups to Comparison
ensure needs were met. Tracking Sheet.
Complaint/ Monitor complaint/concems Family/individual will be provided a Complaint Review
Concerns regarding access to and satisfaction secure and confidential process to voice Form.
with mental health services using an their concerns and issues,assuring
established process. prompt follow-up for resolution to
include the
individual,program staff,and
management in the process.
Community Collaborate and coordinate resources Increased staff knowledge of available Log of collaborative
Resource in urban and rural communities in resources for individuals within other meetings and events.
Collaboration Fresno County. institutions,including CBOs,
and Coordination government entitlements,self-help
programs,vocational training,etc.
Outreach and Presentations and health fairs in Residents will grow their understanding Sign in sheets,Case
Communication urban and rural communities of mental health issues to minimize management,referral
of Services including schools,clinics,churches, stigma/discrimination,demystify myths log.
and others;presentations on media; and become aware of available
case management of individuals and resources/services to seek and receive
warm handoff linkage to services assistance.
Exhibit A
Page 5 of 7
Data Collection shall be completed in the program using the following tools, as
referenced above:
Tracking Sheets
1) Sign-in sheets—track individuals reached.
2) Call Log—track calls received and outcomes (sample included in Reports
section).
3) Referral Log—track referrals made and outcomes (sample
included in Reports section).
4) Individual Satisfaction Survey—tracks satisfaction of service delivery
and recommended program improvements, will be implemented during
family/individual engagement, presentations (sample included in
Reports section).
5) Collaborative Meeting and Event Log — Tracks participation by
other community entities.
Individual Measurements
Individual impact outcomes shall be measured using The Needs Survey and The
Family Development Matrix.
The Needs Survey: The purpose of the survey is to identify the stressors a individual is
facing and assist them with resources/services to address the issues. The Needs survey
shall be used to determine appropriate services to be provided individuals by CLFA or by
referral. The Needs (Stressors) Survey shall be used to assess the needs of individuals
related to:
• Basic (food, clothing, shelter)
• Physical & mental
• Needs related to children
• Other (immigration, employment)
The Family Development Matrix (FDM): The CLFA-tailored strengths-based Family
Development Matrix (FDM) tool with 13 indicators is used to assist individuals with
problem solving, goal development, and to stimulate decision-making and action. The
indicators are domestic violence, risk of abuse, the health and safety of the home,
immigration, emotional well-being, purpose for life, access to transportation,
knowledge of community resources, family communication skills, parenting skills, child
development, literacy, and access to health care. Based on responses, areas are
defined as "in crisis," "at risk," "stable," or "self-sufficient." Upon completion, a Family
Empowerment plan is jointly developed with the individual, if she/he is willing. Please
see attached CLFA FDM Assessment Form and Family Empowerment Plan.
Demographic Information and Reporting
Information on family/support persons/individuals served shall be tracked through
CLFA Intake Form, Individual Demographic and Case Activity Report, and Outcome
Comparison. These forms shall be used to compile monthly reports for the Department
of Behavioral Health and shall be updated weekly by staff.
1) CLFA Intake which tracks demographic information, direct service, and
consent to help the individual. Demographics are: individual name, address,
zip code, date of birth, new/existing individual, ethnicity, language, level of
Exhibit A
Page 6 of 7
education, gender, age bracket, # in household, marital status, legal status,
referral source, services provided, high risk, referrals, case status.
2) Individual Demographic and Case Activity Report tracks individual name,
address, zip code, date of birth, new/existing individual, ethnicity, language, level
of education, gender, age bracket, # in household, marital status, legal status,
referral source, services provided, high risk, referrals, case status (sample
included in Reports section).
3) Outcome Comparison (utilized for reports to the county) includes date, individual
name, staff, event type, initial needs assessment, second needs assessment,
follow up/exit assessment, family development matrix outcomes, referrals, and
notes. Assessments are conducted every three months, and when a individual
leaves the program.
The listings below summarize the components of the Centro La Familia Advocacy,
Inc., annual goals.
Measurable Objectives
Overarching Goal 1: Provide direct services for prevention and early
intervention that will keep consumers engaged, feeling motivated,
resilient, and decrease their likelihood of a mental health crisis.
Objective 1: At least 50 individuals will be served the first year, anticipating
20% will be duplicate individuals from this year's program.
Objective 2: At least 60 individuals will be served the second year, anticipating
20% are duplicate individuals from previous year.
Objective 3: At least 70 individuals will be served the third year, anticipating
30% are duplicate individuals from previous year.
Objective 4: At least 70 individuals will be served the fourth year, anticipating
30% are duplicate individuals from previous year.
Objective 5: At least 70 individuals will be served the fifth year, anticipating
30% are duplicates individuals from previous year.
Overarching Goal 2: Provide appropriate linkages/referrals and warm
hand offs (could be more than 1 linkage per individual) to service
providers and support consumers and their support system with system
of care navigation services.
Objective 1: At least 100 linkages will be made per year to service providers.
Objective 2: Families will report an increased level of satisfaction as evident by
the individual satisfaction survey.
Objective 3: The strengths of individuals and their support system will be
acknowledged and recognized.
Objective 4: As per assessment, individuals' wellness, resiliency, self-efficacy,
and self- management skills will be evident and established for long-term
success.
Objective 5: CLFA's internal Family Development Matrix (FDM) system will
provide an independent measurement to show improvement levels on all 13
Exhibit A
Page 7 of 7
unique indicators.
Overarching Goal 4: Host/Participate in outreach events in both rural and metro
Fresno County.
Objective 1: Attend a minimum of 12 outreach events per year to reach at least 250
individuals.
Objective 2: Engage with media (television/radio/print) and social media
platforms (Facebook Live, WhatsApp, Twitter, and others to reach at least
25,000 individuals.
Objective 3: Provide information to schools, clinics, community-based
organizations, and other entities.
Overarching Goal 5: Conduct presentations and trainings.
Objective 1: Implement a minimum of 8 educational
trainings/presentations each year to reach at least 250 individuals.
Objective 2: Cover various topical sessions including: what is mental
illness, stress management, anxiety, suicide prevention, stigma reduction,
wellness, trauma-informed, among others.
Objective 3: Provide opportunity for individuals to build their knowledge and
skills related to the topic presented.
Exhibit B
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
1
rev 01-02-2020
B-1
Exhibit B
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
2
rev 01-02-2020
B-2
Exhibit B
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
6. Principle six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
3
rev 01-02-2020
B-3
Exhibit B
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
4
rev 01-02-2020
B-4
Exhibit C
coU 7epartment of Behavioral Health
Policy and Procedure Guide
O 1856 O 1r
PPG 1.2.7
Section: Mental Health
Effective Date: 05/30/2017 Revised Date: 05/30/2017
Policy Title: Performance Outcome Measures
Approved by: Dawan Utecht(Director of Behavioral Health), Francisco Escobedo (Sr.Staff Analyst-QA), Kannika
Toonnachat(Division Manager-Technology and Quality Management)
POLICY: It is the policy of Fresno County Department of Behavioral Health and the
Fresno County Mental Health Plan (FCMHP) to ensure procedures for
developing performance measures which accurately reflect vital areas of
performance and provide for systematic, ongoing collection and analysis
of valid and reliable data. Data collection is not intended to be an
additional task for FCMHP programs/providers but rather embedded within
the various non-treatment, treatment and clinical documentation.
PURPOSE: To determine the effectiveness and efficiency of services provided by
measuring performance outcomes/results achieved by the persons served
during service delivery or following service completion, delivery of service,
and of the individuals' satisfaction. This is a vital management tool used to
clarify goals, document the efforts toward achieving those goals, and thus
measure the benefit the service delivery to the persons served.
Performance measurement selection is part of the planning and
developing process design of the program. Performance measurement is
the ongoing monitoring and reporting of progress towards pre-established
objectives/goals.
REFERENCE: California Code of Regulations, Title 9, Chapter 11, Section
1810.380(a)(1): State Oversight
DHCS Service, Administrative and Operational Requirements
Mental Health Services Act (MHSA), California Code of Regulations, Title
9, Section 3320, 3200.050, and 3200.120
Commission on Accreditation of Rehabilitation Facilities (CARF)
DEFINITIONS:
1. Indicator: Qualitative or quantitative measure(s) that tell if the outcomes have been
accomplished. Indicators evaluate key performance in relation to objectives. It indicates
what the program is accomplishing and if the anticipated results are being achieved.
MISSION STATEMENT
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,families and communities in Fresno County who are affected by,or are at risk
of,mental illness and/or substance use disorders through cultivation of strengths toward promoting recovery in the least restrictive environment.
Template Review Date 3128116
1
C-1
Exhibit C
coU EFe artment of Behavioral Health
t Policy and Procedure Guide
O 1s56 O
F1zEs� Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7
Policy Title: Performance Outcome Measures
2. Intervention: A systematic plan of action consciously adapted in an attempt to address
and reduce the causes of failure or need to improve upon system.
3. Fresno County Mental Health Plan (FCMHP): Fresno County's contract with the State
Department of Health and Human Services that allows for the provision of specialty
mental health services. Services may be delivered by county-operated programs,
contracted organizational, or group providers.
4. Objective (Goal): Intended results or the impact of learning, programs, or activities.
5. Outcomes: Specific results or changes achieved as a consequence of the program or
intervention. Outcomes are connected to the objectives/goals identified by the program
or intervention.
PROCEDURE:
I. Each FCMHP program/provider shall engage in measurement of outcomes in order
to generate reliable and valid data on the effectiveness and efficiency of programs or
interventions. Programs/providers will establish/select objectives (goals), decide on
a methodology and timeline for the collection of data, and use an appropriate data
collection tool. This occurs during the program planning and development process.
Outcomes should be in alignment with the program/provider goals.
II. Outcomes should be measureable, obtainable, clear, accurately reflect the expected
result, and include specific time frames. Once the measures have been selected, it
is necessary to design a way to gather the information. For each service delivery
performance indicator, FCMHP program/provider shall determine: to whom the
indicator will be applied; who is responsible for collecting the data; the tool from
which data will be collected; and a performance target based on an industry
benchmark, or a benchmark set by the program/provider.
III. Performance measures are subject to review and approval by FCMHP
Administration.
IV. Performance measurement is the ongoing monitoring and reporting of progress
towards pre-established objectives/goals. Annually, each FCMHP program/provider
must measure service delivery performance in each of the areas/domains listed
below. Dependent on the program/provider service deliverables, exceptions must be
approved by the FCMHP Administration.
2 1 P a g e
C-2
Exhibit C
coU EFe artment of Behavioral Health
t Policy and Procedure Guide
O 1s56 O
F1zEs� Section: Mental Health Effective Date:05/30/2017 PPG 1.2.7
Policy Title:Performance Outcome Measures
a. Effectiveness of services — How well programs performed and the results
achieved. Effectiveness measures address the quality of care through
measuring change over time. Examples include but are not limited to: reduction
of hospitalization, reduction of symptoms, employment and housing status, and
reduction of recidivism rate and incidence of relapse.
b. Efficiency of services —The relationship between the outcomes and the
resources used. Examples include but are not limited to: service delivery cost per
service unit, length of stay, and direct service hours of clinical and medical staff.
c. Services access — Changes or improvements in the program/provider's capacity
and timeliness to provide services to those who request them. Examples include
but are not limited to: wait/length of time from first request/referral to first service
or subsequent appointment, convenience of service hours and locations, number
of clients served by program capacity, and no-show and cancellation rates.
d. Satisfaction and feedback from persons served and stakeholders— Changes or
increased positive/negative feedback regarding the experiences of the persons
served and others (families, referral sources, payors/guarantors, etc.).
Satisfaction measures are usually oriented toward clients, family members,
personnel, the community, and funding sources. Examples include but are not
limited to: did the organization/program focus on the recovery of the person
served, were grievances or concerns addressed, overall feelings of satisfaction,
and satisfaction with physical facilities, fees, access, service effectiveness, and
efficiency.
V. Each FCMHP program/provider shall use the following templates to document the
defined goals, intervention(s), specific indicators, and outcomes.
1. FCMHP Outcome Report template (see Attachment A)
2. FCMHP Outcome Analysis template (see Attachment C)
3 1 P a g e
C-3
Exhibit D-Page 1 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Program Manager 0.05 $ 2,400 $ 2,400
1102 -
1103 - -
1104 -
1105 - -
1106 -
1107 - -
1108 -
1109 - -
1110 -
1111 - -
1112 -
1113 - -
1114 -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.05 $ 2,400 $ 2,400
Acct# Program Position FTE Admin Program Total
1116 Consumer Family Advocate 1.00 $ 39,000 $ 39,000
1117 Consumer Family Advocate 0.75 $ 29,250 29,250
1118 - -
1119 - -
1120 -
1121 - -
1122 -
1123 - -
1124 -
1125 - -
1126 -
1127 - -
1128 -
1129 - -
1130 -
1131 - -
1132 -
1133 - -
1134 -
Direct Personnel Program Salaries Subtotall 1.75 1 $ 68,250 1 $ 68,250
Admin Program Total
Direct Personnel Salaries Subtotal 1.80 $ 2,400 $ 68,250 $ 70,650
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 72 $ 2,048 $ 2,120
1202 Worker's Compensation 17 485 502
1203 Health Insurance 270 9,450 9,720
1204 Other(specify) - - -
1205 10ther(specify) - - -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 2 of 44
1206 10ther(specify) - - I -
Direct Employee Benefits Subtotal: $ 359 $ 11,983 $ 12,342
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 183 5,221 5,404
1303 SUI 13 466 479
1304 Other(specify) - - -
1305 10ther(specify) - -
1306 10ther(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 196 $ 5,687 $ 5,883
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 2,955 $ 85,920 $ 88,875
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
3%1 97%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support -
2003 Client Transportation&Support 500
2004 Clothing, Food,&Hygiene 3,500
2005 jEclucation Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 Other(specify) -
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 4,000
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 2,100
3002 Printing/Postage 300
3003 Office,Household&Program Supplies 2,733
3004 Advertising -
3005 Staff Development&Training -
3006 Staff Mileage 1,755
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 355
3009 Other(specify) -
3010 Other(specify) -
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 7,243
4000: DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Pa e 3 of 44
Acct# Line Item Description Amount
4001 Building Maintenance $ -
4002 Rent/Lease Building 5,700
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 900
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j $ 6,600
5000: DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services-Dr Juan C.Garcia Cultrual Awareness/Mental Health Training 3,000
5004 Translation Services -
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES T0TAL:1 $ 3,000
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 760
6003 Accounting/Bookkeeping 2,700
6004 External Audit 390
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify) -
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 3,850
INDIRECT COST RATE 3.51%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 4 of 44
7008 Other(specify) -
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 113,568
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 -
8007 Assessment 0 - -
8008 Rehabilitation 0 -
8009 Other(Specify) 0 -
8010 10ther(Specify) 0 -
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 77
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ -
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 113,568
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 113,568
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
8404 Other(Specify) -
8405 10ther(Specify) -
OTHER REVENUE TOTAL $ -
TOTAL PROGRAM FUNDING SOURCES: $ 113,568
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 5 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year (FY) 2023-24
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Program Manager 68/Differential Response-NRC 93706/DSS/Fresno 1 0.95
Total 0.95
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 6 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 7 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 8 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Exhibit D-Page 9 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year(FY)2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 88,875
Administrative Positions 2,400
1101 Program Manager 2,400 Provide administrative oversight to the program and direct supervision of the
Consumer Family Advocates @.05 FTE($4,000 per mo x 12 mo x.05%=$2,400)
1102 0 -
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10 -
Program Positions 68,250
1116 Consumer Family Advocate 39,000 Provide direct services in the program including one-on-ones,linkages,support groups,
outreach education,presentations,phone calls,and media education($3,250 per
month x 12 months=$39,000)
1117 Consumer Family Advocate 29,250 Provide direct services in the program including one-on-ones,linkages,support groups,
outreach education,presentations,phone calls,and media education($3,250 per
month x 12 months x.75 FTE=929.2501
1118 0
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 12,342
1201 Retirement 2,120 Fringe benefits provided to the program staff @ 3%of total salary
1202 Worker's Compensation 502 Budgeted on current salary expenses:@[(.71 per$100)x$2,400]+[(.71 per$100)x
$68,250]
1203 Health Insurance 9,720 Health Insurance for staff in program.Rate$450 mo X 1.80 FTE X 12 mo
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 5,883
1301 OASDI -
1302 FICA/MEDICARE 5,404 Required Federal and State contribution @ 7.65%of total salary
1303 SUI 479 Required Federal and State contribution calculated @ 3.8%of each staff members
salary for the first$7,000[(.050000)x.0381+[(1.75x7000)x.038
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 4,000
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 500 Provide clients with bus passes to get to and from appointments for mental health
services.Rate$1.25 per bus pass x 400
2004 Clothing,Food,&Hygiene 3,500 Provide clients with emergency support such as hygiene supplies,clothing,etc.as
needed to help address immediate needs.Rate$100 per client x 35 clients
2005 Education Support -
2006 Employment Support
2007 Household Items for Clients
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 10 of 44
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 7,243
3001 Telecommunications 2,100 Cost of cell phone per month to conduct client services and communications at$50 x
12 months x 2 FTE_$1,200+Shared cost of Internet,Landlines(VOIP,PRI)rated at
$2500/month x 12 months x 3%=$900
3002 Printing/Postage 300 Postage to mail correspondences to clients at$25 per month x 12 months
3003 Office,Household&Program Supplies 2,733 Office supplies such as pens,paper,desktop items at$227.53 per mo x 12 mo
3004 Advertising -
3005 Staff Development&Training -
3006 Staff Mileage 1,755 Travel for program related activities such as client services,outreach events,meetings,
trainings,presentations,etc.at.585 per mile x 250 miles per month x 12 months=
$1,755
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 355 Shared cost of charging and storage of E-Vehicles used for transportation of clients.
3009 Other(specify) -
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 6,600
4001 Building Maintenance -
4002 Rent/Lease Building 5,700 Office space for staff to conduct services at$1.25 per square foot x 380 square feet x
12 months=$5,700
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 900 Utility services for staff office space at$2,500 per month x 12 months x 3%=$900
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 3,000
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services (Specify) 3,000 Staff training on Cultural Awareness and Mental Health conducted by Dr.Juan Garcia,
LMFT.Occu ring bi-monthly at$500 per training x 6 months=$3,000
5004 Translation Services
5005 Other(specify) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 3,850
6001 Administrative Overhead -
6002 Professional Liability Insurance 760 Cost for general liability insurance services includes Cyber,D&O,Property,Employee
Dishonesty,Auto,Professional.Annual Rate$25,337x 3%=$760
6003 Accounting/Bookkeeping 2,700 Cost for contracted accounting services through Industry Standards,Inc.Rate @$7,500
per mo x 12 mo x 3%=$2,700
6004 External Audit 390 cost for annual external auditing services provided by CPA.Rate$13,000 x 3%=$390
6005 Insurance(Specify): -
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 11 of 44
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 1 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 113,568
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 113,568
BUDGETCHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 12 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Program Manager 0.05 $ 2,500 $ 2,500
1102 -
1103 - -
1104 -
1105 - -
1106 -
1107 - -
1108 -
1109 - -
1110 -
1111 - -
1112 -
1113 - -
1114 -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.05 $ 2,500 $ 2,500
Acct# Program Position FTE Admin Program Total
1116 Consumer Family Advocate 1.00 $ 40,200 $ 40,200
1117 Consumer Family Advocate 0.75 $ 30,150 30,150
1118 -
1119 - -
1120 -
1121 - -
1122 -
1123 - -
1124 -
1125 - -
1126 -
1127 - -
1128 -
1129 - -
1130 - -
1131 - -
1132 - -
1133 - -
1134 - -
Direct Personnel Program Salaries Subtotall 1.75 1 $ 70,350 $ 70,350
Admin Program Total
Direct Personnel Salaries Subtotal 1.80 $ 2,500 $ 70,350 $ 72,850
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 75 $ 2,111 $ 2,186
1202 Worker's Compensation 18 499 517
1203 Health Insurance 270 9,450 9,720
1204 Other(specify) - - -
1205 10ther(specify) - - -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 13 of 44
1206 10ther(specify) - - I -
Direct Employee Benefits Subtotal: $ 363 $ 12,060 $ 12,423
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 191 5,382 5,573
1303 SUI 13 466 479
1304 Other(specify) - - -
1305 10ther(specify) - -
1306 10ther(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 204 $ 5,848 $ 6,052
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 3,067 $ 88,258 $ 91,325
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
3%1 97%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support -
2003 Client Transportation&Support 400
2004 Clothing, Food,&Hygiene 3,500
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 10ther(specify) -
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 3,900
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 2,100
3002 Printing/Postage 300
3003 Office,Household&Program Supplies 994
3004 Advertising -
3005 Staff Development&Training -
3006 Staff Mileage 1,200
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 299
3009 Other(specify) -
3010 Other(specify) -
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 4,893
4000: DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Pa e 14 of 44
Acct# Line Item Description Amount
4001 Building Maintenance $ -
4002 Rent/Lease Building 5,700
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 900
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j $ 6,600
5000: DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services-Dr Juan C.Garcia Cultrual Awareness/Mental Health Training 3,000
5004 Translation Services -
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES T0TAL:1 $ 3,000
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 760
6003 Accounting/Bookkeeping 2,700
6004 External Audit 390
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify) -
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 3,850
INDIRECT COST RATE 3.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 15 of 44
7008 Other(specify) I -
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 113,568
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 -
8007 Assessment 0 - -
8008 Rehabilitation 0 -
8009 Other(Specify) 0 -
8010 10ther(Specify) 0 -
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 77
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ -
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 113,568
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 113,568
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
8404 Other(Specify) -
8405 10ther(Specify) -
OTHER REVENUE TOTAL $ -
TOTAL PROGRAM FUNDING SOURCES: $ 113,568
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 16 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year (FY) 2024-25
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Program Manager 68/Differential Response-NRC 93706/DSS/Fresno 1 0.95
Total 0.95
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 17 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 18 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 19 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Exhibit D-Page 20 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
91,325
Administrative Positions 2,500
1101 Program Manager 2,500 Provide administrative oversight to the program and direct supervision of the
Consumer Family Advocates @.05 FTE($4,166.66 per mo x 12 mo x.05%=$2,500)
1102 0 -
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 70,350
1116 Consumer Family Advocate 40,200 Provide direct services in the program including one-on-ones,linkages,support groups,
outreach education,presentations,phone calls,and media education($3,350 per
month x 12 months=$40,200)
1117 Consumer Family Advocate 30,150 Provide direct services in the program including one-on-ones,linkages,support groups,
outreach education,presentations,phone calls,and media education($3,350 per
month x 12 months x.75 FTE=$30,150)
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 12,423
1201 Retirement 2,186 Fringe benefits provided to the program staff @ 3%of total salary
1202 Worker's Compensation 517 Budgeted on current salary expenses:@[(.71 per$100)x$2,500]+[(.71 per$100)x
$70,3501
1203 Health Insurance 9,720 Health Insurance for staff in program.Rate$450 mo X 1.80 FTE X 12 mo
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 6,052
1301 OASDI -
1302 FICA/MEDICARE 5,573 Required Federal and State contribution @ 7.65%of total salary
1303 SUI 479 Required Federal and State contribution calculated @ 3.8%of each staff members
salary for the first$7,000[(.050000)x.038]+[(1.75x7000)x.038
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 3,900
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 400 Provide clients with bus passes to get to and from appointments for mental health
services.Rate$1.25 per bus pass x 320 clients=$400
2004 Clothing,Food,&Hygiene 3,500 Provide clients with emergency support such as hygiene supplies,clothing,etc.as
needed to help address immediate needs.Rate$100 per client x 35 clients
2005 Education Support -
2006 Employment Support
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 21 of 44
PROGRAM EXPENSE
ACCTft LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 4,893
3001 Telecommunications 2,100 Cost of cell phone per month to conduct client services and communications at$50 x
12 months x 2 FTE_$1,200+Shared cost of Internet,Landlines(VOIP,PRI)rated at
$2500/month x 12 months x 3%=$900
3002 Printing/Postage 300 Postage to mail correspondences to clients at$25 per month x 12 months
3003 Office,Household&Program Supplies 994 Office supplies such as pens,paper,desktop items at$82.83 per mo x 12 mo
3004 Advertising -
3005 Staff Development&Training -
3006 Staff Mileage 1,200 Travel for program related activities such as client services,outreach events,meetings,
trainings,presentations,etc.at.585 per mile x 171 miles per month x 12 months=
$1,200
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 299 Shared cost of charging and storage of E-Vehicles used for transportation of clients.
3009 Other(specify) -
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 6,600
4001 Building Maintenance
4002 Rent/Lease Building 5,700 Office space for staff to conduct services at$1.25 per square foot x 380 square feet x
12 months=$5,700
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 900 Utility services for staff office space at$2,500 per month x 12 months x 3%=$900
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 3,000
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services-Dr Juan C.Garcia 3,000 Staff training on Cultural Awareness and Mental Health conducted by Dr.Juan Garcia,
Cultrual Awareness/Mental Health Training LMFT.Occuring bi-monthly at$500 per training x 6 months=$3,000
5004 Translation Services -
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 3,850
6001 Use this line and only this line for approved indirect -
6002 Professional Liability Insurance 760 Cost for general liability insurance services includes Cyber,D&O,Property,Employee
Dishonesty,Auto,Professional.Annual Rate$25,337x 3%=$760
6003 Accounting/Bookkeeping 2,700 Cost for contracted accounting services through Industry Standards,Inc.Rate @$7,500
per mo x 12 mo x 3%=$2,700
6004 External Audit 390 Cost for annual external auditing services provided by CPA.Rate$13,000 x 3%=$390
6005 Insurance(Specify): -
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 22 of 44
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 1 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 113,568
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 113,568
BUDGETCHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 23 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Program Manager 0.05 $ 2,500 $ 2,500
1102 -
1103 - -
1104 -
1105 - -
1106 -
1107 - -
1108 -
1109 - -
1110 -
1111 - -
1112 -
1113 - -
1114 -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.05 $ 2,500 $ 2,500
Acct# Program Position FTE Admin Program Total
1116 Consumer Family Advocate 1.00 $ 40,200 $ 40,200
1117 Consumer Family Advocate 0.75 $ 30,150 30,150
1118 -
1119 - -
1120 -
1121 - -
1122 -
1123 - -
1124 -
1125 - -
1126 -
1127 - -
1128 -
1129 - -
1130 - -
1131 - -
1132 - -
1133 - -
1134 - -
Direct Personnel Program Salaries Subtotall 1.75 1 $ 70,350 $ 70,350
Admin Program Total
Direct Personnel Salaries Subtotal 1.80 $ 2,500 $ 70,350 $ 72,850
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 75 $ 2,111 $ 2,186
1202 Worker's Compensation 18 499 517
1203 Health Insurance 270 9,450 9,720
1204 Other(specify) - - -
1205 10ther(specify) - - -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 24 of 44
1206 10ther(specify) - - I -
Direct Employee Benefits Subtotal: $ 363 $ 12,060 $ 12,423
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 191 5,382 5,573
1303 SUI 13 466 479
1304 Other(specify) - - -
1305 10ther(specify) - -
1306 10ther(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 204 $ 5,848 $ 6,052
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 3,067 $ 88,258 $ 91,325
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
3%1 97%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support -
2003 Client Transportation&Support 400
2004 Clothing, Food,&Hygiene 3,500
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 10ther(specify) -
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 3,900
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 2,100
3002 Printing/Postage 300
3003 Office,Household&Program Supplies 994
3004 Advertising -
3005 Staff Development&Training -
3006 Staff Mileage 1,200
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 299
3009 Other(specify) -
3010 Other(specify) -
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 4,893
4000: DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Pa e 25 of 44
Acct# Line Item Description Amount
4001 Building Maintenance $ -
4002 Rent/Lease Building 5,700
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 900
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j $ 6,600
5000: DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services-Dr Juan C.Garcia Cultrual Awareness/Mental Health Training 3,000
5004 Translation Services -
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES T0TAL:1 $ 3,000
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 760
6003 Accounting/Bookkeeping 2,700
6004 External Audit 390
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify) -
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 3,850
INDIRECT COST RATE 3.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 26 of 44
7008 Other(specify) I -
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 113,568
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 -
8007 Assessment 0 - -
8008 Rehabilitation 0 -
8009 Other(Specify) 0 -
8010 10ther(Specify) 0 -
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 77
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $ -
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 113,568
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 113,568
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
8404 Other(Specify) -
8405 10ther(Specify) -
OTHER REVENUE TOTAL $ -
TOTAL PROGRAM FUNDING SOURCES: $ 113,568
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 27 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year (FY) 2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Program Manager 68/Differential Response-NRC 93706/DSS/Fresno 1 0.95
Total 0.95
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 28 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 29 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 30 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Exhibit D-Page 31 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
91,325
Administrative Positions 2,500
1101 Program Manager 2,500 Provide administrative oversight to the program and direct supervision of the
Consumer Family Advocates @.05 FTE($4,166.66 per mo x 12 mo x.05%=$2,500)
1102 0 -
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10 -
Program Positions 70,350
1116 Consumer Family Advocate 40,200 Provide direct services in the program including one-on-ones,linkages,support groups,
outreach education,presentations,phone calls,and media education($3,350 per
month x 12 months=$40,200)
1117 Consumer Family Advocate 30,150 Provide direct services in the program including one-on-ones,linkages,support groups,
outreach education,presentations,phone calls,and media education($3,350 per
month x 12 months x.75 FTE=$30,150)
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 12,423
1201 Retirement 2,186 Fringe benefits provided to the program staff @ 3%of total salary
1202 Worker's Compensation 517 Budgeted on current salary expenses:@[(.71 per$100)x$2,500]+[(.71 per$100)x
$70,3501
1203 Health Insurance 9,720 Health Insurance for staff in program.Rate$450 mo X 1.80 FTE X 12 mo
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 6,052
1301 OASDI -
1302 FICA/MEDICARE 5,573 Required Federal and State contribution @ 7.65%of total salary
1303 SUI 479 Required Federal and State contribution calculated @ 3.8%of each staff members
salary for the first$7,000[(.050000)x.038]+[(1.75x7000)x.038
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 3,900
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 400 Provide clients with bus passes to get to and from appointments for mental health
services.Rate$1.25 per bus pass x 320 clients=$400
2004 Clothing,Food,&Hygiene 3,500 Provide clients with emergency support such as hygiene supplies,clothing,etc.as
needed to help address immediate needs.Rate$100 per client x 35 clients
2005 Education Support -
2006 Employment Support
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 32 of 44
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 4,893
3001 Telecommunications 2,100 Cost of cell phone per month to conduct client services and communications at$50 x
12 months x 2 FTE_$1,200+Shared cost of Internet,Landlines(VOIP,PRI)rated at
3002 Printing/Postage 300 Postage to mail correspondences to clients at$25 per month x 12 months
3003 Office,Household&Program Supplies 994 Office supplies such as pens,paper,desktop items at$82.83 per mo x 12 mo
3004 Advertising -
3005 Staff Development&Training -
3006 Staff Mileage 1,200 Travel for program related activities such as client services,outreach events,meetings,
trainings,presentations,etc.at.585 per mile x 171 miles per month x 12 months=
$1,200
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 299 Shared cost of charging and storage of E-Vehicles used for transportation of clients.
3009 Other(specify) -
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 6,600
4001 Building Maintenance -
4002 Rent/Lease Building 5,700 Office space for staff to conduct services at$1.25 per square foot x 380 square feet x
12 months=$5,700
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 900 Utility services for staff office space at$2,500 per month x 12 months x 3%=$900
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 3,000
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services-Dr Juan C.Garcia 3,000 Staff training on Cultural Awareness and Mental Health conducted by Dr.Juan Garcia,
Cultrual Awareness/Mental Health Training LMFT.Occuring bi-monthly at$500 per training x 6 months=$3,000
5004 Translation Services -
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 3,850
6001 Use this line and only this line for approved indirect -
6002 Professional Liability Insurance 760 Cost for general liability insurance services includes Cyber,D&O,Property,Employee
Dishonesty,Auto,Professional.Annual Rate$25,337x 3%=$760
6003 Accounting/Bookkeeping 2,700 Cost for contracted accounting services through Industry Standards,Inc.Rate @$7,500
per mo x 12 mo x 3%=$2,700
6004 External Audit 390 Cost for annual external auditing services provided by CPA.Rate$13,000 x 3%=$390
6005 Insurance(Specify): -
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 33 of 44
PROGRAM EXPENSE
ACCT# LINE ITEM ANT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 1 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 113,568
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 113,568
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 34 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year(FY)2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Program Manager 0.05 $ 2,500 $ 2,500
1102 -
1103 - -
1104 -
1105 - -
1106 -
1107 - -
1108 -
1109 - -
1110 -
1111 - -
1112 -
1113 - -
1114 -
1115 - -
Direct Personnel Admin Salaries Subtotal 0.05 $ 2,500 $ 2,500
Acct# Program Position FTE Admin Program Total
1116 Consumer Family Advocate 1.00 $ 41,400 $ 41,400
1117 Consumer Family Advocate 0.75 $ 31,050 31,050
1118 - -
1119 - -
1120 -
1121 - -
1122 -
1123 - -
1124 -
1125 - -
1126 -
1127 - -
1128 -
1129 - -
1130 -
1131 -
1132 -
1133 -
1134 -
Direct Personnel Program Salaries Subtotall 1.75 1 $ 72,450 1 $ 72,450
Admin Program Total
Direct Personnel Salaries Subtotal 1.80 $ 2,500 $ 72,450 $ 74,950
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 75 $ 2,174 $ 2,249
1202 Worker's Compensation 18 514 532
1203 Health Insurance 270 9,450 9,720
1204 Other(specify) - - -
1205 10ther(specify) - - -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 35 of 44
1206 10ther(specify) - - I -
Direct Employee Benefits Subtotal: $ 363 $ 12,138 $ 12,501
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 191 5,542 5,733
1303 SUI 13 466 479
1304 Other(specify) - - -
1305 10ther(specify) - -
1306 10ther(specify) - - -
Direct Payroll Taxes&Expenses Subtotal: $ 204 $ 6,008 $ 6,212
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 3,067 $ 90,596 $ 93,663
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
3%1 97%
2000: DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ -
2002 Client Housing Support -
2003 Client Transportation&Support 400
2004 Clothing, Food,&Hygiene 2,500
2005 Education Support -
2006 Employment Support -
2007 Household Items for Clients -
2008 Medication Supports -
2009 Program Supplies-Medical -
2010 Utility Vouchers -
2011 Other(specify) -
2012 Other(specify) -
2013 Other(specify) -
2014 Other(specify) -
2015 10ther(specify) -
2016 10ther(specify) -
DIRECT CLIENT CARE TOTAL $ 2,900
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 1,155
3002 Printing/Postage 300
3003 Office,Household&Program Supplies 1,020
3004 Advertising -
3005 Staff Development&Training -
3006 Staff Mileage 900
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 180
3009 Other(specify) -
3010 Other(specify) -
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 3,555
4000: DIRECT FACILITIES&EQUIPMENT
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Pa e 36 of 44
Acct# Line Item Description Amount
4001 Building Maintenance $ -
4002 Rent/Lease Building 5,700
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles -
4005 Security -
4006 Utilities 900
4007 Other(specify) -
4008 Other(specify) -
4009 Other(specify) -
4010 10ther(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:j $ 6,600
5000: DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services-Dr Juan C.Garcia Cultrual Awareness/Mental Health Training 3,000
5004 Translation Services -
5005 Other(specify) -
5006 Other(specify) -
5007 Other(specify) -
5008 Other(specify) -
DIRECT SPECIAL EXPENSES T0TAL:1 $ 3,000
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ -
Administrative Overhead
6002 Professional Liability Insurance 760
6003 Accounting/Bookkeeping 2,700
6004 External Audit 390
6005 Insurance(Specify): -
6006 Payroll Services -
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) -
6008 Personnel(Indirect Salaries&Benefits) -
6009 Other(specify) -
6010 Other(specify) -
6011 Other(specify) -
6012 Other(specify) -
6013 10ther(specify) -
INDIRECT EXPENSES TOTAL $ 3,850
INDIRECT COST RATE 2.23%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 37 of 44
7008 Other(specify) I -
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 113,568
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services 0 - $ -
8002 Case Management 0 - -
8003 Crisis Services 0 - -
8004 Medication Support 0 - -
8005 Collateral 0 - -
8006 Plan Development 0 -
8007 Assessment 0 - -
8008 Rehabilitation 0 -
8009 Other(Specify) 0 -
8010 10ther(Specify) 0 -
Estimated Specialty Mental Health Services Billing Totals: 0 $ -
Estimated%of Clients who are Medi-Cal Beneficiaries 77
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries -
Federal Financial Participation(FFP)% 1 0%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $ -
8102 SABG $ -
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $ 113,568
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations -
8304 WET-Workforce Education&Training -
8305 JCFTN-Capital Facilities&Technology -
MHSA TOTAL $ 113,568
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance -
8403 Grants(Specify) -
8404 Other(Specify) -
8405 10ther(Specify) -
OTHER REVENUE TOTAL $ -
TOTAL PROGRAM FUNDING SOURCES: $ 113,568
NET PROGRAM COST: $ -
Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020
Exhibit D-Page 38 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year (FY) 2026-27
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled
out
Position Contract#/Name/Department/County FTE
Program Manager 68/Differential Response-NRC 93706/DSS/Fresno 1 0.95
Total 0.95
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 39 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 40 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit D-Page 41 of 44
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Exhibit D-Page 42 of 44
Consumer Family Advocacy Services
Centro La Familia Advocacy Services
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#I LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
93,663
Administrative Positions 2,500
1101 Program Manager 2,500 Provide administrative oversight to the program and direct supervision of the
Consumer Family Advocates @.05 FTE($4,166.66 per mo x 12 mo x.05%=$2,500)
1102 0 -
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10 -
Program Positions 72,450
1116 Consumer Family Advocate 41,400 Provide direct services in the program including one-on-ones,linkages,support groups,
outreach education,presentations,phone calls,and media education($3,450 per
month x 12 months=$41,400)
1117 Consumer Family Advocate 31,050 Provide direct services in the program including one-on-ones,linkages,support groups,
outreach education,presentations,phone calls,and media education($3,450 per
month x 12 months x.75 FTE=$31,050)
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 12,501
1201 Retirement 2,249 Fringe benefits provided to the program staff @ 3%of total salary
1202 Worker's Compensation 532 Budgeted on current salary expenses:@[(.71 per$100)x$2,500]+[(.71 per$100)x
$72,4501
1203 Health Insurance 9,720 Health Insurance for staff in program.Rate$450 mo X 1.80 FTE X 12 mo
1204 Other(specify) -
1205 Other(specify)
1206 Other(specify) -
Direct Payroll Taxes&Expenses: 6,212
1301 OASDI -
1302 FICA/MEDICARE 5,733 Required Federal and State contribution @ 7.65%of total salary
1303 SUI 479 Required Federal and State contribution calculated @ 3.8%of each staff members
salary for the first$7,000[(.050000)x.038]+[(1.75x7000)x.038
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT 2,900
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 400 Provide clients with bus passes to get to and from appointments for mental health
services.Rate$1.25 per bus pass x 320 clients=$400
2004 Clothing,Food,&Hygiene 2,500 Provide clients with emergency support such as hygiene supplies,clothing,etc.as
needed to help address immediate needs.Rate$100 per client x 25 clients
2005 Education Support -
2006 Employment Support
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 43 of 44
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 1 Other(specify)
3000:DIRECT OPERATING EXPENSES 3,555
3001 Telecommunications 1,155 Cost of cell phone per month to conduct client services and communications at$50 x
12 months x 2 FTE=$1,200+Shared cost of Internet,Landlines(VOIP,PRI)rated at
$2500/month x 12 months x 3%=$900.Requesting less due to limited budget.
3002 Printing/Postage 300 Postage to mail correspondences to clients at$25 per month x 12 months
3003 Office,Household&Program Supplies 1,020 Office supplies such as pens,paper,desktop items at$85 per mo x 12 mo
3004 Advertising -
3005 Staff Development&Training -
3006 Staff Mileage 900 Travel for program related activities such as client services,outreach events,meetings,
trainings,presentations,etc.at.585 per mile x 128.21 miles per month x 12 months=
$900
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 180 Shared cost of charging and storage of E-Vehicles used for transportation of clients.
3009 Other(specify) -
3010 Other(specify)
3011 Other(specify)
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 6,600
4001 Building Maintenance -
4002 Rent/Lease Building 5,700 Office space for staff to conduct services at$1.25 per square foot x 380 square feet x
12 months=$5,700
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 900 Utility services for staff office space at$2,500 per month x 12 months x 3%=$900
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 3,000
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) -
5003 Contractual/Consulting Services-Dr Juan C.Garcia 3,000 Staff training on Cultural Awareness and Mental Health conducted by Dr.Juan Garcia,
Cultrual Awareness/Mental Health Training LMFT.Occuring bi-monthly at$500 per training x 6 months=$3,000
5004 Translation Services -
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 3,850
6001 Use this line and only this line for approved indirect -
6002 Professional Liability Insurance 760 Cost for general liability insurance services includes Cyber,D&O,Property,Employee
Dishonesty,Auto,Professional.Annual Rate$25,337x 3%=$760
6003 Accounting/Bookkeeping 2,700 Cost for contracted accounting services through Industry Standards,Inc.Rate @$7,500
per mo x 12 mo x 3%=$2,700
6004 External Audit 390 Cost for annual external auditing services provided by CPA.Rate$13,000 x 3%=$390
6005 Insurance(Specify): -
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit D-Page 44 of 44
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 1 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 113,568
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 113,568
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020
Exhibit E
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1)the retroactive date must
be prior to the date on which services began under this Agreement; (2)the Contractor
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
E-1
Exhibit E
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Contractor.
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under Article 10
and Exhibit F of this Agreement; (iv) system failure; (v) data recovery; (vi) failure to
timely disclose data breach or Security Breach; (vii) failure to comply with privacy policy;
(viii) payment card liabilities and costs; (ix) infringement of intellectual property, including
but not limited to infringement of copyright, trademark, and trade dress; (x) invasion of
privacy, including release of private information; (xi) information theft; (xii) damage to or
destruction or alteration of electronic information; (xiii) cyber extortion; (xiv) extortion
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; (xv) fraudulent instruction; (xvi) funds
transfer fraud; (xvii) telephone fraud; (xviii) network security; (xix) data breach response
costs, including Security Breach response costs; (xx) regulatory fines and penalties
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; and (xxi) credit monitoring expenses.
If the Contractor is a governmental entity, it may satisfy the policy requirements above through a
program of self-insurance, including an insurance pooling arrangement or joint exercise of
powers agreement.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement,
and at any time during the term of this Agreement as requested by the County's Risk
Manager or the County Administrative Office, the Contractor shall deliver, or cause its
broker or producer to deliver, to the County Risk Manager, at 2220 Tulare Street, 16th
Floor, Fresno, California 93721, or HRRiskManagement@fresnocountyca.gov, and by
mail or email to the person identified to receive notices under this Agreement,
certificates of insurance and endorsements for all of the coverages required under this
Agreement.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and (3) the
Contractor has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned. The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
E-2
Exhibit E
shall be excess only and not contributing with insurance provided under the
Contractor's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this Agreement.
(v) The cyber liability insurance certificate must also state that it is endorsed, and
include an endorsement, to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited
to information or data) that is in the care, custody, or control of the Contractor.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VI I.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, the Contractor shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, the Contractor shall, or shall
cause the insurer to, provide written notice to the County not less than 30 days in
advance of cancellation or change. The County in its sole discretion may determine that
the failure of the Contractor or its insurer to timely provide a written notice required by
this paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance
with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Contractor shall deliver, or cause its broker or producer
to deliver, to the County's Risk Manager certificates of insurance and endorsements for
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E) Waiver of Subrogation. The Contractor waives any right to recover from the County, its
officers, agents, employees, and volunteers any amounts paid under the policy of
worker's compensation insurance required by this Agreement. The Contractor is solely
responsible to obtain any policy endorsement that may be necessary to accomplish that
waiver, but the Contractor's waiver of subrogation under this paragraph is effective
whether or not the Contractor obtains such an endorsement.
(F) County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep
in effect at all times any insurance coverage required under this Agreement, the County
may, in addition to any other remedies it may have, suspend or terminate this
E-3
Exhibit E
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Contractor. The County may offset such
charges against any amounts owed by the County to the Contractor under this
Agreement.
(G)Subcontractors. The Contractor shall require and verify that all subcontractors used by
the Contractor to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement. This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
E-4
Exhibit F
Data Security
1. Definitions
Capitalized terms used in this Exhibit have the meanings set forth in this section 1.
(A) "Authorized Employees" means the Contractor's employees who have access to
Personal Information.
(B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all
of the Contractor's subcontractors, representatives, agents, outsourcers, and
consultants, and providers of professional services to the Contractor, who have access
to Personal Information and are bound by law or in writing by confidentiality obligations
sufficient to protect Personal Information in accordance with the terms of this Exhibit L.
(C)"Director" means the County's Director of the Department of Behavioral Health or his or
her designee.
(D)"Disclose" or any derivative of that word means to disclose, release, transfer,
disseminate, or otherwise provide access to or communicate all or any part of any
Personal Information orally, in writing, or by electronic or any other means to any person.
(E) "Person" means any natural person, corporation, partnership, limited liability company,
firm, or association.
(F) "Personal Information" means any and all information, including any data, provided, or
to which access is provided, to the Contractor by or upon the authorization of the
County, under this Agreement, including but not limited to vital records, that: (i) identifies,
describes, or relates to, or is associated with, or is capable of being used to identify,
describe, or relate to, or associate with, a person (including, without limitation, names,
physical descriptions, signatures, addresses, telephone numbers, e-mail addresses,
education, financial matters, employment history, and other unique identifiers, as well as
statements made by or attributable to the person); (ii) is used or is capable of being used
to authenticate a person (including, without limitation, employee identification numbers,
government-issued identification numbers, passwords or personal identification numbers
(PINs), financial account numbers, credit report information, answers to security
questions, and other personal identifiers); or (iii) is personal information within the
meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision
(e). Personal Information does not include publicly available information that is lawfully
made available to the general public from federal, state, or local government records.
(G)"Privacy Practices Complaint" means a complaint received by the County relating to
the Contractor's (or any Authorized Person's) privacy practices, or alleging a Security
Breach. Such complaint shall have sufficient detail to enable the Contractor to promptly
investigate and take remedial action under this Exhibit N.
(H) "Security Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by the Contractor (or any Authorized
Persons) that relate to the protection of the security, confidentiality, value, or integrity of
Personal Information. Security Safeguards shall satisfy the minimal requirements set
forth in section 3(C) of this Exhibit N.
F-1
Exhibit F
(1) "Security Breach" means (i) any act or omission that compromises either the security,
confidentiality, value, or integrity of any Personal Information or the Security Safeguards,
or (ii) any unauthorized Use, Disclosure, or modification of, or any loss or destruction of,
or any corruption of or damage to, any Personal Information.
(J) "Use" or any derivative of that word means to receive, acquire, collect, apply,
manipulate, employ, process, transmit, disseminate, access, store, disclose, or dispose
of Personal Information.
2. Standard of Care
(A) The Contractor acknowledges that, in the course of its engagement by the County under
this Agreement, the Contractor, or any Authorized Persons, may Use Personal
Information only as permitted in this Agreement.
(B) The Contractor acknowledges that Personal Information is deemed to be confidential
information of, or owned by, the County (or persons from whom the County receives or
has received Personal Information) and is not confidential information of, or owned or by,
the Contractor, or any Authorized Persons. The Contractor further acknowledges that all
right, title, and interest in or to the Personal Information remains in the County (or
persons from whom the County receives or has received Personal Information)
regardless of the Contractor's, or any Authorized Person's, Use of that Personal
Information.
(C)The Contractor agrees and covenants in favor of the Country that the Contractor shall:
(i) keep and maintain all Personal Information in strict confidence, using such
degree of care under this section 2 as is reasonable and appropriate to avoid a
Security Breach;
(ii) Use Personal Information exclusively for the purposes for which the Personal
Information is made accessible to the Contractor pursuant to the terms of this
Exhibit N;
(iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal
Information for the Contractor's own purposes or for the benefit of anyone other
than the County, without the County's express prior written consent, which the
County may give or withhold in its sole and absolute discretion; and
(iv) not, directly or indirectly, Disclose Personal Information to any person (an
"Unauthorized Third Party") other than Authorized Persons pursuant to this
Agreement, without the Director's express prior written consent.
(D) Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it,
or any Authorized Person, is required to disclose Personal Information to government
regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be
required by applicable law, Contractor shall (i) immediately notify the County of the
specific demand for, and legal authority for the disclosure, including providing County
with a copy of any notice, discovery demand, subpoena, or order, as applicable,
received by the Contractor, or any Authorized Person, from any government regulatory
authorities, or in relation to any legal proceeding, and (ii) promptly notify the County
F-2
Exhibit F
before such Personal Information is offered by the Contractor for such disclosure so that
the County may have sufficient time to obtain a court order or take any other action the
County may deem necessary to protect the Personal Information from such disclosure,
and the Contractor shall cooperate with the County to minimize the scope of such
disclosure of such Personal Information.
(E) The Contractor shall remain liable to the County for the actions and omissions of any
Unauthorized Third Party concerning its Use of such Personal Information as if they
were the Contractor's own actions and omissions.
3. Information Security
(A) The Contractor covenants, represents and warrants to the County that the Contractor's
Use of Personal Information under this Agreement does and will at all times comply with
all applicable federal, state, and local, privacy and data protection laws, as well as all
other applicable regulations and directives, including but not limited to California Civil
Code, Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song-
Beverly Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3,
beginning with section 1747). If the Contractor Uses credit, debit or other payment
cardholder information, the Contractor shall at all times remain in compliance with the
Payment Card Industry Data Security Standard ("PCI DSS") requirements, including
remaining aware at all times of changes to the PCI DSS and promptly implementing and
maintaining all procedures and practices as may be necessary to remain in compliance
with the PCI DSS, in each case, at the Contractor's sole cost and expense.
(B) The Contractor covenants, represents and warrants to the County that, as of the
effective date of this Agreement, the Contractor has not received notice of any violation
of any privacy or data protection laws, as well as any other applicable regulations or
directives, and is not the subject of any pending legal action or investigation by, any
government regulatory authority regarding same.
(C)Without limiting the Contractor's obligations under section 3(A) of this Exhibit N, the
Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than
accepted industry practices and, at a minimum, include the following:
(i) limiting Use of Personal Information strictly to the Contractor's and Authorized
Persons' technical and administrative personnel who are necessary for the
Contractor's, or Authorized Persons', Use of the Personal Information pursuant to
this Agreement;
(ii) ensuring that all of the Contractor's connectivity to County computing systems
will only be through the County's security gateways and firewalls, and only
through security procedures approved upon the express prior written consent of
the Director;
(iii) to the extent that they contain or provide access to Personal Information, (a)
securing business facilities, data centers, paper files, servers, back-up systems
and computing equipment, operating systems, and software applications,
including, but not limited to, all mobile devices and other equipment, operating
systems, and software applications with information storage capability; (b)
F-3
Exhibit F
employing adequate controls and data security measures, both internally and
externally, to protect (1) the Personal Information from potential loss or
misappropriation, or unauthorized Use, and (2) the County's operations from
disruption and abuse; (c) having and maintaining network, device application,
database and platform security; (d) maintaining authentication and access
controls within media, computing equipment, operating systems, and software
applications; and (e) installing and maintaining in all mobile, wireless, or
handheld devices a secure internet connection, having continuously updated
anti-virus software protection and a remote wipe feature always enabled, all of
which is subject to express prior written consent of the Director;
(iv) encrypting all Personal Information at advance encryption standards of Advanced
Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile
devices, including but not limited to hard disks, portable storage devices, or
remote installation, or (b) transmitted over public or wireless networks (the
encrypted Personal Information must be subject to password or pass phrase, and
be stored on a secure server and transferred by means of a Virtual Private
Network (VPN) connection, or another type of secure connection, all of which is
subject to express prior written consent of the Director);
(v) strictly segregating Personal Information from all other information of the
Contractor, including any Authorized Person, or anyone with whom the
Contractor or any Authorized Person deals so that Personal Information is not
commingled with any other types of information;
(vi) having a patch management process including installation of all operating system
and software vendor security patches;
(vii) maintaining appropriate personnel security and integrity procedures and
practices, including, but not limited to, conducting background checks of
Authorized Employees consistent with applicable law; and
(viii) providing appropriate privacy and information security training to Authorized
Employees.
(D) During the term of each Authorized Employee's employment by the Contractor, the
Contractor shall cause such Authorized Employees to abide strictly by the Contractor's
obligations under this Exhibit N. The Contractor shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
(E) The Contractor shall, in a secure manner, backup daily, or more frequently if it is the
Contractor's practice to do so more frequently, Personal Information received from the
County, and the County shall have immediate, real time access, at all times, to such
backups via a secure, remote access connection provided by the Contractor, through the
Internet.
(F) The Contractor shall provide the County with the name and contact information for each
Authorized Employee (including such Authorized Employee's work shift, and at least one
alternate Authorized Employee for each Authorized Employee during such work shift)
who shall serve as the County's primary security contact with the Contractor and shall be
F-4
Exhibit F
available to assist the County twenty-four (24) hours per day, seven (7) days per week
as a contact in resolving the Contractor's and any Authorized Persons' obligations
associated with a Security Breach or a Privacy Practices Complaint.
(G)The Contractor shall not knowingly include or authorize any Trojan Horse, back door,
time bomb, drop dead device, worm, virus, or other code of any kind that may disable,
erase, display any unauthorized message within, or otherwise impair any County
computing system, with or without the intent to cause harm.
4. Security Breach Procedures
(A) Immediately upon the Contractor's awareness or reasonable belief of a Security Breach,
the Contractor shall (i) notify the Director of the Security Breach, such notice to be given
first by telephone at the following telephone number, followed promptly by email at the
following email addresses: incidents(a)fresnocountyca.gov, 559-600-5900, (559) 600-
4645, dbh contracted services(@fresnocountyca.gov,
dbhforensicservices(a�fresnocountyca.gov (which telephone number and email address
the County may update by providing notice to the Contractor), and (ii) preserve all
relevant evidence (and cause any affected Authorized Person to preserve all relevant
evidence) relating to the Security Breach. The notification shall include, to the extent
reasonably possible, the identification of each type and the extent of Personal
Information that has been, or is reasonably believed to have been, breached, including
but not limited to, compromised, or subjected to unauthorized Use, Disclosure, or
modification, or any loss or destruction, corruption, or damage.
(B) Immediately following the Contractor's notification to the County of a Security Breach, as
provided pursuant to section 4(A) of this Exhibit N, the Parties shall coordinate with each
other to investigate the Security Breach. The Contractor agrees to fully cooperate with
the County, including, without limitation:
(i) assisting the County in conducting any investigation;
(ii) providing the County with physical access to the facilities and operations
affected;
(iii) facilitating interviews with Authorized Persons and any of the Contractor's other
employees knowledgeable of the matter; and
(iv) making available all relevant records, logs, files, data reporting and other
materials required to comply with applicable law, regulation, industry standards,
or as otherwise reasonably required by the County.
To that end, the Contractor shall, with respect to a Security Breach, be solely
responsible, at its cost, for all notifications required by law and regulation, or deemed
reasonably necessary by the County, and the Contractor shall provide a written report of
the investigation and reporting required to the Director within 30 days after the
Contractor's discovery of the Security Breach.
(C) County shall promptly notify the Contractor of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint, and upon the Contractor's receipt of that
notification, the Contractor shall promptly address such Privacy Practices Complaint,
F-5
Exhibit F
including taking any corrective action under this Exhibit N, all at the Contractor's sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
In the event the Contractor discovers a Security Breach, the Contractor shall treat the
Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractor's
receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the
County whether the matter is a Security Breach, or otherwise has been corrected and
the manner of correction, or determined not to require corrective action and the reason
for that determination.
(D)The Contractor shall take prompt corrective action to respond to and remedy any
Security Breach and take mitigating actions, including but not limiting to, preventing any
reoccurrence of the Security Breach and correcting any deficiency in Security
Safeguards as a result of such incident, all at the Contractor's sole expense, in
accordance with applicable privacy rights, laws, regulations and standards. The
Contractor shall reimburse the County for all reasonable costs incurred by the County in
responding to, and mitigating damages caused by, any Security Breach, including all
costs of the County incurred relation to any litigation or other action described section
4(E) of this Exhibit N.
(E) The Contractor agrees to cooperate, at its sole expense, with the County in any litigation
or other action to protect the County's rights relating to Personal Information, including
the rights of persons from whom the County receives Personal Information.
5. Oversight of Security Compliance
(A) The Contractor shall have and maintain a written information security policy that
specifies Security Safeguards appropriate to the size and complexity of the Contractor's
operations and the nature and scope of its activities.
(B) Upon the County's written request, to confirm the Contractor's compliance with this
Exhibit N, as well as any applicable laws, regulations and industry standards, the
Contractor grants the County or, upon the County's election, a third party on the
County's behalf, permission to perform an assessment, audit, examination or review of
all controls in the Contractor's physical and technical environment in relation to all
Personal Information that is Used by the Contractor pursuant to this Agreement. The
Contractor shall fully cooperate with such assessment, audit or examination, as
applicable, by providing the County or the third party on the County's behalf, access to
all Authorized Employees and other knowledgeable personnel, physical premises,
documentation, infrastructure and application software that is Used by the Contractor for
Personal Information pursuant to this Agreement. In addition, the Contractor shall
provide the County with the results of any audit by or on behalf of the Contractor that
assesses the effectiveness of the Contractor's information security program as relevant
to the security and confidentiality of Personal Information Used by the Contractor or
Authorized Persons during the course of this Agreement under this Exhibit N.
(C)The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit N. that apply to the
Contractor with respect to such Personal Information by incorporating the relevant
provisions of these provisions into a valid and binding written agreement between the
F-6
Exhibit F
Contractor and such Authorized Persons, or amending any written agreements to
provide same.
6. Return or Destruction of Personal Information. Upon the termination of this Agreement,
the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the County
all Personal Information, whether in written, electronic or other form or media, in its possession
or the possession of such Authorized Persons, in a machine readable form used by the County
at the time of such return, or upon the express prior written consent of the Director, securely
destroy all such Personal Information, and certify in writing to the County that such Personal
Information have been returned to the County or disposed of securely, as applicable. If the
Contractor is authorized to dispose of any such Personal Information, as provided in this Exhibit
N, such certification shall state the date, time, and manner (including standard) of disposal and
by whom, specifying the title of the individual. The Contractor shall comply with all reasonable
directions provided by the Director with respect to the return or disposal of Personal Information
and copies of Personal Information. If return or disposal of such Personal Information or copies
of Personal Information is not feasible, the Contractor shall notify the County according,
specifying the reason, and continue to extend the protections of this Exhibit N to all such
Personal Information and copies of Personal Information. The Contractor shall not retain any
copy of any Personal Information after returning or disposing of Personal Information as
required by this section 6. The Contractor's obligations under this section 6 survive the
termination of this Agreement and apply to all Personal Information that the Contractor retains if
return or disposal is not feasible and to all Personal Information that the Contractor may later
discover.
7. Equitable Relief. The Contractor acknowledges that any breach of its covenants or
obligations set forth in this Exhibit N may cause the County irreparable harm for which monetary
damages would not be adequate compensation and agrees that, in the event of such breach or
threatened breach, the County is entitled to seek equitable relief, including a restraining order,
injunctive relief, specific performance and any other relief that may be available from any court,
in addition to any other remedy to which the County may be entitled at law or in equity. Such
remedies shall not be deemed to be exclusive but shall be in addition to all other remedies
available to the County at law or in equity or under this Agreement.
8. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its
officers, employees, and agents, (each, a "County Indemnitee")from and against any and all
infringement of intellectual property including, but not limited to infringement of copyright,
trademark, and trade dress, invasion of privacy, information theft, and extortion, unauthorized
Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage
to, Personal Information, Security Breach response and remedy costs, credit monitoring
expenses, forfeitures, losses, damages, liabilities, deficiencies, actions, judgments, interest,
awards, fines and penalties (including regulatory fines and penalties), costs or expenses of
whatever kind, including attorneys' fees and costs, the cost of enforcing any right to
indemnification or defense under this Exhibit N and the cost of pursuing any insurance
providers, arising out of or resulting from any third party claim or action against any County
Indemnitee in relation to the Contractor's, its officers, employees, or agents, or any Authorized
Employee's or Authorized Person's, performance or failure to perform under this Exhibit N or
arising out of or resulting from the Contractor's failure to comply with any of its obligations under
this section 8. The provisions of this section 8 do not apply to the acts or omissions of the
F-7
Exhibit F
County. The provisions of this section 8 are cumulative to any other obligation of the Contractor
to, defend, indemnify, or hold harmless any County Indemnitee under this Agreement. The
provisions of this section 8 shall survive the termination of this Agreement.
9. Survival. The respective rights and obligations of the Contractor and the County as stated
in this Exhibit N shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit N
is intended to confer, nor shall anything in this Exhibit N confer, upon any person other than the
County or the Contractor and their respective successors or assignees, any rights, remedies,
obligations or liabilities whatsoever.
11. No County Warranty. The County does not make any warranty or representation whether
any Personal Information in the Contractor's (or any Authorized Person's) possession or control,
or Use by the Contractor (or any Authorized Person), pursuant to the terms of this Agreement is
or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint.
F-8
Exhibit G
BEHAVIORAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The County and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the County Mental Health Plan
(directly or through contract) providing Short-Doyle/Medi-Cal services have met
applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
Contractor shall conform to and County shall monitor compliance with all State of
California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
Contractor shall prepare and make available to County and to the public
all eligibility requirements to participate in the program plan set forth in the
Agreement. No person shall, because of ethnic group identification, age,
gender, color, disability, medical condition, national origin, race, ancestry,
marital status, religion, religious creed, political belief or sexual
preference be excluded from participation, be denied benefits of, or be
subject to discrimination under any program or activity receiving Federal
or State of California assistance.
B. Employment Opportunity
Contractor shall comply with County policy, and the Equal Employment
Opportunity Commission guidelines, which forbids discrimination against
any person on the grounds of race, color, national origin, sex, religion,
age, disability status, or sexual preference in employment practices.
Such practices include retirement, recruitment advertising, hiring, layoff,
termination, upgrading, demotion, transfer, rates of pay or other forms of
compensation, use of facilities, and other terms and conditions of
employment.
G-1
Exhibit G
C. Suspension of Compensation
If an allegation of discrimination occurs, County may withhold all further
funds, until Contractor can show clear and convincing evidence to the
satisfaction of County that funds provided under this Agreement were not
used in connection with the alleged discrimination.
D. Nepotism
Except by consent of County's Department of Behavioral Health Director,
or designee, no person shall be employed by Contractor who is related by
blood or marriage to, or who is a member of the Board of Directors or an
officer of Contractor.
5. PATIENTS' RIGHTS
Contractor shall comply with applicable laws and regulations, including but not
limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied
with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f) and
CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-
free workplace by taking the following actions:
A. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is
prohibited and specifying actions to be taken against employees for
violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
C. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
G-2
Exhibit G
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and Contractor
may be ineligible for award of any future State agreements if the department
determines that any of the following has occurred: the Contractor has made
false certification, or violated the certification by failing to carry out the
requirements as noted above. (Gov. Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor
certifies that no more than one (1) final unappealable finding of contempt of court
by a Federal court has been issued against Contractor within the immediately
preceding two (2) year period because of Contractor's failure to comply with an
order of a Federal court, which orders Contractor to comply with an order of the
National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to
public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
Contractor agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the
lessor of 30 multiplied by the number of full time attorneys in the firm's offices in
the State, with the number of hours prorated on an actual day basis for any
contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the
meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to
contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel,
garments or corresponding accessories, or the procurement of
equipment, materials, or supplies, other than procurement related to a
public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been
laundered or produced in whole or in part by sweatshop labor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, or with the
benefit of sweatshop labor, forced labor, convict labor, indentured labor
under penal sanction, abusive forms of child labor or exploitation of
children in sweatshop labor. Contractor further declares under penalty of
perjury that they adhere to the Sweatfree Code of Conduct as set forth on
G-3
Exhibit G
the California Department of Industrial Relations website located at
www.dir.ca.gov, and Public Contract Code Section 6108.
b. Contractor agrees to cooperate fully in providing reasonable access to the
Contractor's records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the
Department of Industrial Relations, or the Department of Justice to
determine the Contractor's compliance with the requirements under
paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractor
certifies that Contractor is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, Contractor certifies
that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: Contractor needs to be aware of the following
provisions regarding current or former state employees. If Contractor has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code M 0410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent Contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he
or she engaged in any of the negotiations, transactions, planning,
arrangements or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency.
G-4
Exhibit G
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a
contract with any state agency if he or she was employed by that state
agency in a policy-making position in the same general subject area as
the proposed contract within the twelve (12) month period prior to his or
her leaving state service.
If Contractor violates any provisions of above paragraphs, such action by
Contractor shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not
receive payment other than payment of each meeting of the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware
of the provisions which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance with the
provisions, and CONTRACTOR affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it
complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval
of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently
qualified to do business in California in order to ensure that all obligations
due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit.
Although there are some statutory exceptions to taxation, rarely will a
corporate Contractor performing within the state not be subject to the
franchise tax.
C. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do
business in California. Agencies will determine whether a corporation is
in good standing by calling the Office of the Secretary of State.
G-5
Exhibit G
6. RESOLUTION: A County, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local
governing body, which by law has authority to enter into an agreement,
authorizing execution of the agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
Contractor shall not be: (1) in violation of any order or resolution not subject to
review promulgated by the State Air Resources Board or an air pollution control
district; (2) subject to cease and desist order not subject to review issued
pursuant to Section 13301 of the Water Code for violation of waste discharge
requirements or discharge prohibitions; or (3)finally determined to be in violation
of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
Contractors that are not another state agency or other governmental entity.
9. INSPECTION AND AUDIT OF RECORDS AND ACCESS TO FACILITIES:
The State, CMS, the Office of the Inspector General, the Comptroller General,
and their designees may, at any time, inspect and audit any records or
documents of Contractor or its subcontractors, and may, at any time, inspect the
premises, physical facilities, and equipment where Medicaid-related activities or
work is conducted. The right to audit under this section exists for ten (10) years
from the final date of the contract period or from the date of completion of any
audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must
confirm the identity and determine the exclusion status of Contractor, any
subcontractor, as well as any person with an ownership or control interest, or
who is an agent or managing employee of Contractor through routine checks of
Federal databases. This includes the Social Security Administration's Death
Master File, the National Plan and Provider Enumeration System (NPPES), the
List of Excluded Individuals/Entities (LEIE), the System for Award Management
(SAM), and any other databases as the State or Secretary may prescribe. These
databases must be consulted upon contracting and no less frequently than
monthly thereafter. If the State finds a party that is excluded, it must promptly
notify the Contractor and take action consistent with § 438.610(c).
The State must ensure that Contractor with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
Contractor to a network provider, out-of-network provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
G-6
Exhibit G
CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM)
REQUIREMENTS
1. SERVICES AND ACCESS PROVISIONS
a. CERTIFICATION OF ELIGIBILITY
i. Contractor will, in cooperation with County, comply with Section
14705.5 of California Welfare and Institutions Code to obtain a
certification of an individual's eligibility for Specialty Mental Health
Services (SMHS) under Medi-Cal.
b. ACCESS TO SPECIALTY MENTAL HEALTH SERVICES
i. In collaboration with the County, Contractor will work to ensure
that individuals to whom the Contractor provides SMHS meet
access criteria, as per Department of Health Care Services
(DHCS) guidance specified in BHIN 21-073. Specifically, the
Contractor will ensure that the clinical record for each individual
includes information as a whole indicating that individual's
presentation and needs are aligned with the criteria applicable to
their age at the time of service provision as specified below.
ii. For enrolled individuals under 21 years of age, Contractor shall
provide all medically necessary SMHS required pursuant to
Section 1396d(r) of Title 42 of the United States Code. Covered
SMHS shall be provided to enrolled individuals who meet either of
the following criteria, (1) or (11) below. If an individual under age 21
meets the criteria as described in (1) below, the beneficiary meets
criteria to access SMHS; it is not necessary to establish that the
beneficiary also meets the criteria in (b) below.
1. The individual has a condition placing them at high risk for
a mental health disorder due to experience of trauma
evidenced by any of the following: scoring in the high-risk
range under a trauma screening tool approved by DHCS,
involvement in the child welfare system, juvenile justice
involvement, or experiencing homelessness.
OR
2. The individual has at least one of the following:
a. A significant impairment
b. A reasonable probability of significant deterioration
in an important area of life functioning
c. A reasonable probability of not progressing
developmentally as appropriate.
d. A need for SMHS, regardless of presence of
impairment, that are not included within the mental
health benefits that a Medi-Cal Managed Care Plan
(MCP) is required to provide.
AND the individual's condition as described in subparagraph
(11 a-d) above is due to one of the following:
G-7
Exhibit G
a. A diagnosed mental health disorder, according to
the criteria in the current editions of the Diagnostic
and Statistical Manual of Mental Disorders (DSM)
and the International Classification of Diseases and
Related Health Problems (ICD).
b. A suspected mental health disorder that has not yet
been diagnosed.
c. Significant trauma placing the individual at risk of a
future mental health condition, based on the
assessment of a licensed mental health
professional.
iii. For individuals 21 years of age or older, Contractor shall provide
covered SMHS for clients who meet both of the following criteria,
(a) and (b) below:
1. The individual has one or both of the following:
a. Significant impairment, where impairment is defined
as distress, disability, or dysfunction in social,
occupational, or other important activities.
b. A reasonable probability of significant deterioration
in an important area of life functioning.
2. The individual's condition as described in paragraph (a) is
due to either of the following:
a. A diagnosed mental health disorder, according to
the criteria in the current editions of the DSM and
ICD.
b. A suspected mental disorder that has not yet been
diagnosed.
c. ADDITIONAL CLARIFICATIONS
i. Criteria
1. A clinically appropriate and covered mental health
prevention, screening, assessment, treatment, or recovery
service listed within Exhibit A of this Agreement can be
provided and submitted to the County for reimbursement
under any of the following circumstances:
a. The services were provided prior to determining a
diagnosis, including clinically appropriate and
covered services provided during the assessment
process;
b. The service was not included in an individual
treatment plan; or
c. The individual had a co-occurring substance use
disorder.
ii. Diagnosis Not a Prerequisite
1. Per BHIN 21-073, a mental health diagnosis is not a
prerequisite for access to covered SMHS. This does not
eliminate the requirement that all Medi-Cal claims,
including SMHS claims, include a current Centers for
G-8
Exhibit G
Medicare & Medicaid Services (CMS) approved ICD
diagnosis code
d. MEDICAL NECESSITY
i. Contractor will ensure that services provided are medically
necessary in compliance with BHIN 21-073 and pursuant to
Welfare and Institutions Code section 14184.402(a). Services
provided to a client must be medically necessary and clinically
appropriate to address the individual's presenting condition.
Documentation in each individual's chart as a whole will
demonstrate medical necessity as defined below, based on the
client's age at the time of service provision.
ii. For individuals 21 years of age or older, a service is "medically
necessary" or a "medical necessity" when it is reasonable and
necessary to protect life, to prevent significant illness or significant
disability, or to alleviate severe pain as set forth in Welfare and
Institutions Code section 14059.5.
iii. For individuals under 21 years of age, a service is "medically
necessary" or a "medical necessity" if the service meets the
standards set forth in Section 1396d(r)(5) of Title 42 of the United
States Code.
e. COORDINATION OF CARE
i. Contractor shall ensure that all care, treatment and services
provided pursuant to this Agreement are coordinated among all
providers who are serving the individual, including all other SMHS
providers, as well as providers of Non-Specialty Mental Health
Services (NSMHS), substance use disorder treatment services,
physical health services, dental services, regional center services
and all other services as applicable to ensure a client-centered
and whole-person approach to services.
ii. Contractor shall ensure that care coordination activities support
the monitoring and treatment of comorbid substance use disorder
and/or health conditions.
iii. Contractor shall include in care coordination activities efforts to
connect, refer and link individual s to community-based services
and supports, including but not limited to educational, social,
prevocational, vocational, housing, nutritional, criminal justice,
transportation, childcare, child development, family/marriage
education, cultural sources, and mutual aid support groups.
iv. Contractor shall engage in care coordination activities beginning
at intake and throughout the treatment and discharge planning
processes.
v. To facilitate care coordination, Contractor will request a HIPAA
and California law compliant client authorization to share the
individual's information with and among all other providers
involved in the individual's care, in satisfaction of state and federal
privacy laws and regulations.
f. CO-OCCURRING TREATMENT AND NO WRONG DOOR
G-9
Exhibit G
i. Per BHIN 22-011, Specialty and Non-Specialty Mental Health
Services can be provided concurrently, if those services are
clinically appropriate, coordinated, and not duplicative. When a
client meets criteria for both NSMHS and SMHS, the individual
should receive services based on individual clinical need and
established therapeutic relationships. Clinically appropriate and
covered SMHS can also be provided when the individual has a co-
occurring mental health condition and substance use disorder.
ii. Under this Agreement, Contractor will ensure that individual s
receive timely mental health services without delay. Services are
reimbursable to Contractor by County even when:
1. Services are provided prior to determination of a diagnosis,
during the assessment or prior to determination of whether
SMHS access criteria are met, even if the assessment
ultimately indicates the individual does not meet criteria for
SMHS.
2. If Contractor is serving a individual receiving both SMHS
and NSMHS, Contractor holds responsibility for
documenting coordination of care and ensuring that
services are non-duplicative.
2. AUTHORIZATION AND DOCUMENTATION PROVISIONS
a. SERVICE AUTHORIZATION
i. Contractor will collaborate with County to complete authorization
requests in line with County and DHCS policy.
ii. Contractor shall have in place, and follow, written policies and
procedures for completing requests for initial and continuing
authorizations of services, as required by County guidance.
iii. Contractor shall respond to County in a timely manner when
consultation is necessary for County to make appropriate
authorization determinations.
iv. County shall provide Contractor with written notice of authorization
determinations within the timeframes set forth in BHINs 22-016
and 22-017, or any subsequent DHCS notices.
v. Contractor shall alert County when an expedited authorization
decision (no later than 72 hours) is necessary due to an
individual's specific needs and circumstances that could seriously
jeopardize the individual s life or health, or ability to attain,
maintain, or regain maximum function.
b. DOCUMENTATION REQUIREMENTS
i. Contractor will follow all documentation requirements as specified
in Article 4.2-4.8 inclusive in compliance with federal, state and
County requirements.
ii. All Contractor documentation shall be accurate, complete, and
legible, shall list each date of service, and include the face-to-face
time for each service. Contractor shall document travel and
documentation time for each service separately from face-to-face
time and provide this information to County upon request.
G-10
Exhibit G
Services must be identified as provided in-person, by telephone,
or by telehealth.
iii. All services shall be documented utilizing County-approved
templates and contain all required elements. Contractor agrees to
satisfy the chart documentation requirements set forth in BHIN 22-
019 and the contract between County and DHCS. Failure to
comply with documentation standards specified in this Article
require corrective action plans.
c. ASSESSMENT
i. Contractor shall ensure that all individuals' medical records
include an assessment of each individual's need for mental health
services.
ii. Contractor will utilize the seven uniform assessment domains and
include other required elements as identified in BHIN 22-019 and
document the assessment in the individual's medical record.
iii. For individual s aged 6 through 20, the Child and Adolescent
Needs and Strengths (CANS), and for individual s aged 3 through
18, the Pediatric Symptom Checklist-35 (PSC-35) tools are
required at intake, every six months during treatment, and at
discharge, as specified in DHCS MHSUDS INs 17-052 and 18-
048.
iv. The time period for providers to complete an initial assessment
and subsequent assessments for SMHS are up to clinical
discretion of County; however, Contractor's providers shall
complete assessments within a reasonable time and in
accordance with generally accepted standards of practice.
d. ICD-10
i. Contractor shall use the criteria set forth in the current edition of
the DSM as the clinical tool to make diagnostic determinations.
ii. Once a DSM diagnosis is determined, the Contractor shall
determine the corresponding mental health diagnosis in the
current edition of ICD. Contractor shall use the ICD diagnosis
code(s) to submit a claim for SMHS to receive reimbursement
from County.
iii. The ICD Tabular List of Diseases and Injuries is maintained by
CMS and may be updated during the term of this Agreement.
Changes to the lists of ICD diagnoses do not require an
amendment to this Agreement, and County may implement these
changes as provided by CMS
e. PROBLEM LIST
i. Contractor will create and maintain a Problem List for each
individual served under this Agreement. The problem list is a list of
symptoms, conditions, diagnoses, and/or risk factors identified
through assessment, psychiatric diagnostic evaluation, crisis
encounters, or other types of service encounters.
ii. Contractor must document a problem list that adheres to industry
standards utilizing at minimum current SNOMED International,
G-11
Exhibit G
Systematized Nomenclature of Medicine Clinical Terms
(SNOMED CTO) U.S. Edition, September 2022 Release, and ICD-
10-CM 2023.
iii. A problem identified during a service encounter may be addressed
by the service provider during that service encounter and
subsequently added to the problem list.
iv. The problem list shall include, but is not limited to, all elements
specified in BHIN 22-019.
v. County does not require the problem list to be updated within a
specific timeframe or have a requirement about how frequently the
problem list should be updated after a problem has initially been
added. However, Contractor shall update the problem list within a
reasonable time such that the problem list reflects the current
issues facing the client, in accordance with generally accepted
standards of practice and in specific circumstances specified in
BHIN 22-019.
f. TREATMENT AND CARE PLANS
i. Contractor is not required to complete treatment or care plans for
clients under this Agreement, except in the circumstances
specified in BHIN 22-019 and additional guidance from DHCS that
may follow after execution of this Agreement.
g. PROGRESS NOTES
i. Contractor shall create progress notes for the provision of all
SMHS services provided under this Agreement.
ii. Each progress note shall provide sufficient detail to support the
service code selected for the service type as indicated by the
service code description.
iii. Progress notes shall include all elements specified in BHIN 22-
019, whether the note be for an individual or a group service.
iv. Contractor shall complete progress notes within three business
days of providing a service, with the exception of notes for crisis
services, which shall be completed within 24 hours.
v. Providers shall complete a daily progress note for services that
are billed on a daily basis, such as residential and day treatment
services, if applicable.
h. TRANSITION OF CARE TOOL
i. Contractor shall use a Transition of Care Tool for any individual
whose existing services will be transferred from Contractor to an
Medi-Cal Managed Care Plan (MCP) provider or when NSMHS
will be added to the existing mental health treatment provided by
Contractor, as specified in BHIN 22-065, in order to ensure
continuity of care.
ii. Determinations to transition care or add services from an MCP
shall be made in alignment with County policies and via a person-
centered, shared decision-making process.
iii. Contractor may directly use the DHCS-provided Transition of Care
Tool, found at https://www.dhcs.ca.gov/Pages/Screening-and-
G-12
Exhibit G
Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-
Services.aspx, or obtain a copy of that tool provided by the
County. Contractor may create the Transition of Care Tool in its
Electronic Health Record (EHR). However, the contents of the
Transition of Care Tool, including the specific wording and order of
fields, shall remain identical to the DHCS provided form. The only
exception to this requirement is when the tool is translated into
languages other than English.
i. TELEHEALTH
i. Contractor may use telehealth, when it deems clinically
appropriate, as a mode of delivering behavioral health services in
accordance with all applicable County, state, and federal
requirements, including those related to privacy/security,
efficiency, and standards of care. Such services will conform to
the definitions and meet the requirements included in the Medi-Cal
Provider Manual: Telehealth, available in the DHCS Telehealth
Resources page at:
https://www.dhcs.ca.gov/provqovpart/Pages/TelehealthResources
.aspx.
ii. All telehealth equipment and service locations must ensure that
client confidentiality is maintained.
iii. Licensed providers and staff may provide services via telephone
and telehealth as long as the service is within their scope of
practice.
iv. Medical records for individuals served by Contractor under this
Agreement must include documentation of written or verbal
consent for telehealth or telephone services if such services are
provided by Contractor. Such consent must be obtained at least
once prior to initiating applicable health care services and consent
must include all elements as specified in BHIN 22-019.
v. County may at any time audit Contractor's telehealth practices,
and Contractor must allow access to all materials needed to
adequately monitor Contractor's adherence to telehealth
standards and requirements.
3. CLIENT PROTECTIONS
a. GRIEVANCES, APPEALS AND NOTICES OF ADVERSE BENEFIT
DETERMINATION
i. All grievances (as defined by 42 C.F.R. § 438.400) and complaints
received by Contractor must be immediately forwarded to the
County's Managed Care Department or other designated persons
via a secure method (e.g., encrypted email or by fax) to allow
ample time for the Managed Care staff to acknowledge receipt of
the grievance and complaints and issue appropriate responses.
ii. Contractor shall not discourage the filing of grievances and
individual s do not need to use the term "grievance" for a
complaint to be captured as an expression of dissatisfaction and,
therefore, a grievance.
G-13
Exhibit G
iii. Aligned with MHSUDS IN 18-010E and 42 C.F.R. §438.404, the
appropriate and delegated Notice of Adverse Benefit
Determination (NOABD) must be issued by Contractor within the
specified timeframes using the template provided by the County.
iv. NOABDs must be issued to individuals anytime the Contractor has
made or intends to make an adverse benefit determination that
includes the reduction, suspension, or termination of a previously
authorized service and/or the failure to provide services in a timely
manner. The notice must have a clear and concise explanation of
the reason(s) for the decision as established by DHCS and the
County. The Contractor must inform the County immediately after
issuing a NOABD.
v. Procedures and timeframes for responding to grievances, issuing
and responding to adverse benefit determinations, appeals, and
state hearings must be followed as per 42 C.F.R., Part 438,
Subpart F (42 C.F.R. §§ 438.400 —438.424).
vi. Contractor must provide individuals any reasonable assistance in
completing forms and taking other procedural steps related to a
grievance or appeal such as auxiliary aids and interpreter
services.
vii. Contractor must maintain records of grievances and appeals and
must review the information as part of its ongoing monitoring
procedures. The record must be accurately maintained in a
manner accessible to the County and available upon request to
DHCS.
b. Advanced Directives
i. Contractor must comply with all County policies and procedures
regarding Advanced Directives in compliance with the
requirements of 42 C.F.R. §§ 422.128 and 438.6(i) (1), (3) and (4).
c. Continuity of Care
i. Contractor shall follow the County's continuity of care policy that is
in accordance with applicable state and federal regulations,
MHSUDS IN 18-059 and any BHINs issued by DHCS for parity in
mental health and substance use disorder benefits subsequent to
the effective date of this Agreement (42 C.F.R. § 438.62(b)(1)-(2).)
4. QUALITY IMPROVEMENT PROGRAM
a. QUALITY IMPROVEMENT ACTIVITIES AND PARTICIPATION
i. Contractor shall implement mechanisms to assess person
served/family satisfaction based on County's guidance. The
Contractor shall assess individual/family satisfaction by:
1. Surveying person served/family satisfaction with the
Contractor's services at least annually.
2. Evaluating person served's grievances, appeals and State
Hearings at least annually.
3. Evaluating requests to change persons providing services
at least annually.
G-14
Exhibit G
4. Informing the County and individuals of the results of
client/family satisfaction activities.
ii. Contractor, if applicable, shall implement mechanisms to monitor
the safety and effectiveness of medication practices. This
mechanism shall be under the supervision of a person licensed to
prescribe or dispense prescription drugs, at least annually and as
required by DBH.
iii. Contractor shall implement mechanisms to monitor appropriate
and timely intervention of occurrences that raise quality of care
concerns. The Contractor shall take appropriate follow-up action
when such an occurrence is identified. The results of the
intervention shall be evaluated by the Contractor at least annually
and shared with the County.
iv. Contractor shall assist County, as needed, with the development
and implementation of Corrective Action Plans.
v. Contractor shall collaborate with County to create a QI Work Plan
with documented annual evaluations and documented revisions
as needed. The QI Work Plan shall evaluate the impact and
effectiveness of its quality assessment and performance
improvement program.
vi. Contractor shall attend and participate in the County's Quality
Improvement Committee (QIC) to recommend policy decisions,
review and evaluate results of QI activities, including PIPs,
institute needed QI actions, and ensure follow-up of QI processes.
Contractor shall ensure that there is active participation by the
Contractor's practitioners and providers in the QIC.
vii. Contractor shall participate, as required, in annual, independent
external quality reviews (EQR) of the quality, timeliness, and
access to the services covered under this Contract, which are
conducted pursuant to Subpart E of Part 438 of the Code of
Federal Regulations. (42 C.F.R. §§ 438.350(a) and 438.320)
b. TIMELY ACCESS
i. Timely access standards include:
1. Contractor must have hours of operation during which
services are provided to Medi-Cal individuals that are no
less than the hours of operation during which the provider
offers services to non-Medi-Cal individual s. If the
Contractor's provider only serves Medi-Cal clients, the
provider must provide hours of operation comparable to
the hours the provider makes available for Medi-Cal
services that are not covered by the Agreement or another
County.
2. Appointments data, including wait times for requested
services, must be recorded and tracked by Contractor, and
submitted to the County on a monthly basis in a format
specified by the County. Appointments' data should be
submitted to the County's Quality Management
Department or other designated persons.
G-15
Exhibit G
3. Urgent care appointments for services that do not require
prior authorization must be provided to individual s within
48 hours of a request. Urgent appointments for services
that do require prior authorization must be provided to
clients within 96 hours of request.
4. Non-urgent non-psychiatry mental health services,
including, but not limited to Assessment, Targeted Case
Management, and Individual and Group Therapy
appointments (for both adult and children/youth) must be
made available to Medi-Cal individuals within 10 business
days from the date the individual or a provider acting on
behalf of the individual, requests an appointment for a
medically necessary service. Non-urgent psychiatry
appointments (for both adult and children/youth) must be
made available to Medi-Cal individual s within 15 business
days from the date the client or a provider acting on behalf
of the individual, requests an appointment for a medically
necessary service.
5. Applicable appointment time standards may be extended if
the referring or treating provider has determined and noted
in the individual's record that a longer waiting period will
not have a detrimental impact on the health of the
individual.
6. Periodic office visits to monitor and treat mental health
conditions may be scheduled in advance consistent with
professionally recognized standards of practice as
determined by the treating licensed mental health provider
acting within the scope of their practice.
c. PROVIDER APPLICATION AND VALIDATION FOR ENROLLMENT
(PAVE)
i. Contractor shall ensure that all of its required clinical staff, who
are rendering SMHS to Medi-Cal individuals on behalf of
Contractor, are registered through DHCS' Provider Application
and Validation for Enrollment (PAVE) portal, pursuant to BHIN 20-
071 requirements, the 21st Century Cures Act and the CMS
Medicaid and Children's Health Insurance Program (CHIP)
Managed Care Final Rule.
ii. SMHS licensed individuals required to enroll via the "Ordering,
Referring and Prescribing" (ORP) PAVE enrollment pathway (i.e.
PAVE application package) available through the DHCS PED
Pave Portal, include: Licensed Clinical Social Worker (LCSW),
Licensed Marriage and Family Therapist (LMFT), Licensed
Professional Clinical Counselor (LPCC), Psychologist, Licensed
Educational Psychologist, Physician (MD and DO), Physician
Assistant, Registered Pharmacist/Pharmacist, Certified
Pediatric/Family Nurse Practitioner, Nurse Practitioner,
Occupational Therapist, and Speech-Language Pathologist.
Interns, trainees, and associates are not eligible for enrollment.
G-16
Exhibit G
d. PHYSICIAN INCENTIVE PLAN
i. If Contractor wants to institute a Physician Incentive Plan,
Contractor shall submit the proposed plan to the County which will
in turn submit the Plan to the State for approval, in accordance
with the provisions of 42 C.F.R. § 438.6(c).
5. DATA, PRIVACY AND SECURITY REQUIREMENTS
a. ELECTRONIC PRIVACY AND SECURITY
i. Contractor shall have a secure email system and send any email
containing PII or PHI in a secure and encrypted manner.
Contractor's email transmissions shall display a warning banner
stating that data is confidential, systems activities are monitored
and logged for administrative and security purposes, systems use
is for authorized users only, and that users are directed to log off
the system if they do not agree with these requirements.
ii. Contractor shall institute compliant password management
policies and procedures, which shall include but not be limited to
procedures for creating, changing, and safeguarding passwords.
Contractor shall establish guidelines for creating passwords and
ensuring that passwords expire and are changed at least once
every 90 days.
iii. Any Electronic Health Records (EHRs) maintained by Contractor
that contain PHI or PII for individuals served through this
Agreement shall contain a warning banner regarding the PHI or
PII contained within the EHR. Contractors that utilize an EHR shall
maintain all parts of the clinical record that are not stored in the
EHR, including but not limited to the following examples of client
signed documents: discharge plans, informing materials, and
health questionnaire.
iv. Contractor entering data into any County electronic systems shall
ensure that staff are trained to enter and maintain data within this
system.
6. PROGRAM INTEGRITY
a. Credentialing and Re-credentialing of Providers
i. Contractor shall ensure that all of their network providers
delivering covered services, sign and date an attestation
statement on a form provided by County, in which each provider
attests to the following:
1. Any limitations or inabilities that affect the provider's ability
to perform any of the position's essential functions, with or
without accommodation;
2. A history of loss of license or felony convictions;
3. A history of loss or limitation of privileges or disciplinary
activity;
4. A lack of present illegal drug use; and
5. The application's accuracy and completeness
G-17
Exhibit G
ii. Contractor must file and keep track of attestation statements,
credentialing applications and credentialing status for all of their
providers and must make those available to the County upon
request at any time.
iii. Contractor is required to sign an annual attestation statement at
the time of Agreement renewal in which they will attest that they
will follow County's Credentialing Policy and MHSUDS IN 18-019
and ensure that all of their rendering providers are credentialed as
per established guidelines.
G-18
Exhibit H
1
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help
eliminate health care disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1. Provide effective,equitable,understandable,and respectful quality care and services that are responsive to diverse cultural health beliefs and
practices,preferred languages,health literacy,and other communication needs.
Governance,Leadership,and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,practices,and
allocated resources.
3. Recruit,promote,and support a culturally and linguistically diverse governance,leadership,and workforce that are responsive to the population in
the service area.
4. Educate and train governance,leadership,and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs,at no cost to them,to facilitate
timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,verbally and in writing.
7. Ensure the competence of individuals providing language assistance,recognizing that the use of untrained individuals and/or minors as interpreters
should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
Engagement,Continuous Improvement,and Accountability:
9. Establish culturally and linguistically appropriate goals,policies,and management accountability,and infuse them throughout the organization's
planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous
quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to
inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the
cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design,implement,and evaluate policies,practices,and services to ensure cultural and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify,prevent,and resolve conflicts
or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders,constituents,and the general public.
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H-1
Exhibit H
2
The Case for the National CLAS Standards
Health equity is the attainment of the highest level of health for all people.'Currently,individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons,including the social determinants of health,or those conditions in which
individuals are born,grow,live,work,and age,2 such as socioeconomic status,education level,and the availability of health services.3
Though health inequities are directly related to the existence of historical and current discrimination
and social injustice,one of the most modifiable factors is the lack of culturally and linguistically
appropriate services,broadly defined as care and services that are respectful of and responsive to
the cultural and linguistic needs of all individuals.
Of all the forms of
Health inequities result in disparities that directly affect the quality of life for all individuals. Health
disparities adversely affect neighborhoods,communities,and the broader society,thus making inequality, injustice in
the issue not only an individual concern but also a public health concern. In the United States,it health care is the most
has been estimated that the combined cost of health disparities and subsequent deaths due to shocking and inhumane.
inadequate and/or inequitable care is$1.24 trillion.4
Culturally and linguistically appropriate services are increasingly recognized as effective in improving —Dr. Martin Luther King,Jr.
the quality of care and services.5,6 By providing a structure to implement culturally and linguistically
appropriate services,the National CLAS Standards will improve an organization's ability to address
health care disparities.
The National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities'and the National Stakeholder Strategy for
Achieving Health Equity,8 which aim to promote health equity through providing clear plans and strategies to guide collaborative efforts that address racial
and ethnic health disparities across the country.
Similar to these initiatives,the National CLAS Standards are intended to advance health equity,improve quality,and help eliminate health care disparities
by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.Adoption of
these Standards will help advance better health and health care in the United States.
Bibliography
1. U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from http://minorityhealth.hhs.gov/npa
2.World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
3. U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved from http://www.
hea lthypeopl e.gov/2020/to picsobjectives2O20/overvi ew.as px?topicid=39
4. LaVeist,T A.,Gaskin,D.J.,&Richard,P(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic Studies website:http://www.
jointeenter.org/sites/default/files/upload/research/files/The%20Economic%2 OBurden%20of%2OHealth%201nequalities%20in%20the%2OUnited%2OStates.pdf
5. Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ Publication No.04-EO08-02).Retrieved
from the Agency of Healthcare Research and Quality website:http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minquai.pdf
6.Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).Retrieved from The
Commonwealth Fund website:http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultiinguisticcomp_962.pdf
7. U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.Retrieved from http://
minorityhealth.hhs.gov/npa/f les/Plans/HHS/H HS_Plan_complete.pdf
8. National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and Human Services,Office of
Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
��� 1 Think Cultural Health
F
S(_ U.S.Deportment of https://www.thinkculturalhealth.hhs.gov/
1O M H Health and Human Services
Office of Minority Health contact@thinkculturalhealth.hhs.gov
o��
H-2
Exhibit I
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws, regulations,
rules and guidelines that apply to the provision and payment of mental health services. Mental
health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its
employees and subcontractors to attend a compliance training that will be provided by Fresno
County. After completion of this training, Contractor, Contractor' employees and subcontractors must
sign the Contractor Acknowledgment and Agreement form and return this form to the Compliance
Officer or designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and
billing for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in
their professional dealing related to their contract with the County and avoid any
conduct that could reasonably be expected to reflect adversely upon the integrity of the
County.
3. Treat County employees, persons served, and other mental health contractors fairly
and with respect.
4. NOT engage in any activity in violation of the County's Compliance Program, nor
engage in any other conduct which violates any applicable law, regulation, rule or
guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely
and are consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or
reimbursement of any kind are submitted.
1-1
Exhibit 1
7. Bill only for eligible services actually rendered and fully documented. Use billing codes
that accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in claims or billing are
discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of
Conduct and Ethics by County employees or other mental health contractors, or report
any activity that they believe may violate the standards of the Compliance Program, or
any other applicable law, regulation, rule or guideline. Fresno County prohibits
retaliation against any person making a report. Any person engaging in any form of
retaliation will be subject to disciplinary or other appropriate action by the County.
Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or
guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible
person and therefore excluded from participation in the Federal Health Care Programs.
1-2
Exhibit I
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:
1-3
Exhibit J
FRESNO COUNTY MENTAL HEALTH PLAN
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance and
appeal process and an expedited appeal process to resolve grievances and disputes at
the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-for-service
providers give verbal and written information to Medi-Cal beneficiaries regarding the
following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
the individuals served copies of all current beneficiary information annually at the time
their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process—the provider may first speak to a Provider
Relations Specialist (PRS) regarding his or her complaint or concern.
J-1
Exhibit J
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process—the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for MHP
payment authorization, or the process or payment of a provider's claim to the MHP.
Payment authorization issues—the provider may appeal a denied or modified request
for payment authorization or a dispute with the MHP regarding the processing or
payment of a provider's claim to the MHP. The written appeal must be submitted to the
MHP within 90 calendar days of the date of the receipt of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the decision
that addresses each issue raised by the provider, and any action required by the
provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request, the
MHP utilizes a Managed Care staff who was not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within 30 calendar days of receipt of the decision
Other complaints— if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the MHP. The provider will receive a written response from the MHP within 60 calendar
days of receipt of the complaint. The decision rendered buy the MHP is final.
J-2
Exhibit K
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
The Incident Report must be completed for all incidents involving individuals served through
DBH's current incident reporting portal, Logic Manager, at
https:Hfresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182beOc5cdcd5072bb1864cdee
4d3d6e
• The reporting portal is available 24 hours a day, every day.
• Any employee of the Contractor can submit an incident using the reporting portal at
any time. No login is required.
• The designated administrator of the Contractor can add information to the follow up
section of the report after submission.
• When an employee submits an incident within 24 hours from the time of the incident
or first knowledge of the incident, the Contractor's designated administrator, the
assigned contract analyst and the Incident Reporting email inbox will be notified
immediately via email from the Logic Manager system that there is a new incident to
review.
• Meeting the 24 hour incident reporting requirements will be easier as there are no
signatures to collect.
• The user guide attached identifies the reporting process and the reviewer process,
and is subject to updates based on DBH's selected incident reporting portal system.
• Employees involved in a crisis incident should be offered appropriate Employee
Assistance Program (EAP) or similar related wellness and recovery assistance. In
conjunction with the DBH's Guiding Principles of Care Delivery and wellness of the
workforce, Contractor shall align their practices around this vision and ensure
needed debriefing services are offered to all employees involved in a crisis incident.
Employees shall be afforded all services to strengthen their recovery and wellness
related to the crisis incident. Appropriate follow-up with the employee shall be carried
out and a plan for workforce wellness shall be submitted to DBH.
Questions about incident reporting, how to use the incident reporting portal, or
designating/changing the name of the administrator who will review incidents for the Contractor
should be emailed to DBHlncidentReporting@fresnocountyca.gov and the assigned contract
analyst.
K-1
Exhibit K
co�,� Mental Health Plan (MHP) and Substance Use Disorder(SUD) services
Incident Reporting System
INCIDENT REVIEWER ROLE — User Guide
Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted
providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete
a written report of any incidents compromising the health and safety of persons served, employees, or
community members.
Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's
an easier way for any employee to report an incident at any time. A few highlights:
• No supervisor signature is immediately required.
• Additional information can be added to the report by the program supervisor/manager without
having to resubmit the incident.
• When an incident is submitted, the assigned contract analyst, program supervisor/manager,
clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email
notification of a new incident and can log in any time to review the incident. Everything that
was on the original paper/electronic form matches the online form.
• Do away with submitting a paper version with a signature.
• This online submission allows for timely action for the health and safety of the persons-served,
as well as compliance with state reporting timelines when necessary.
As an Incident Reviewer,the responsibility is to:
• Log in to Logic Manager and review incident submitted within 48 hours of notification of incident.
• Review incident for clarity, missing information and add in additional information deemed
appropriate.
• Notify DBHlncidentReporting@fresnocountVca.gov if there is additional information to be report
after initial submission
• Contact.DBHlncidentReporting@fresnocountVca.gov if there are any concerns, questions or
comments with Logic Manager or incident reporting.
Below is the link to report incidents
https://fresnodbh.logicmanager.com/incidents/?t=9&p=1&k=182be0c5cdcd5072bbl864cdee4d3d6e
The link will take employees to the reporting screen to begin incident submission:
K-2
Exhibit K
E 0 Q Y fresnodbh.IogicmanagecmmAncidents/?t=9&p=l&k=182be0c5cdcd5072bbl8Wdee4d3d,,_
LogicManager
Incident Report
Please complete this form
Client Information
Name of Facility'
Name of Reporting Party'
Facility Address'
Facility Phone Number'
i
Mental Health or Substance Use Disorder Program?'
Client First Name'
Client Last Name-
F4 C 4 .,, .. t I .. :.. ..... ...
i
Client Date of Bi rth
Client Address
Client I
Gender'
County of Origin'
Summary
Subject O
Incident(check all that apply)'
If Other-specify(i.e.fire,poisoning,epidemic outbreaks,other catastrophes/events that jeopardize the welfare and safety of clients,staff and/or members of the community):
Description of the incident'
K-3
Exhibit K
Similar to the paper version, multiple incident categories can be selected
Incident(check all that apply)'
Medical Emergency x Deathof Client x
Homicide/Homicide Attempt
AWOL/Elopement from locked facility
Violence/Abuse/Assault(toward others,client and/or property
Attempted Suicide(resulting in serious injury)
Injury(self-Inflicted or by accident)
Medication Error
<— C 4 A fresnodbh.logicmaoegeccom/incidents/?t=9&p=1&k=182be0c5cdcd5072bbl864cdee4d3d6e
Date of Incident'
Time of Incident'
Etereexi
i
Location of Incident'
Enter=xt
Key People Directly Involved in Incident(witnesses,staff)'
F,-
Did the Injured Party seek Medical Attention?
Select ontio r
Attach any additional details
B Add File or Drop File Here
Reported By Name'
Enterexl
Reported By Email'
Fnter zxt
i
Reported On
10/30/2019
K-4
Exhibit K
As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on
Add File to upl ad a file.
0 fresnodbh.logicmanageccom mcl - =1&k=182beOc5cdcd5072bb1864cdee4d3d6e
B Add File or Drop File Here
Reported By Name'
Reported By Email'
Reported On
10/30/2019
Follow Up
Action Taken(check all that apply)'
Please specify if other
Description of Action Taken'
msr te:.,
Outcome
Similar to the paper version, multiple Action Taken categories can be selected.
Follow Up
Action Taken(check all that apply)'
Law Enforcement Contacted% Called 911/EMS%
Consulted with Physician
First Aid/CPR Administered
Client removed from building
Parent/Legal Guardian Contacted
Other
When done entering all the information, simply click submit.
Any fields that have a red asterisk, require information an will prevent submission of the form if left blank.
K-5
Exhibit K
A "Thank you for your submission" statement will pop up if an incident is successfully submitted. Click"Reload the
Form"to submit another incident.
LogicManager
Thank you for your submission
r
RELOAD THE FORM
A Notification email will be received when a new incident is reported, or a new comment has been made regarding
an incident. Click on "Open this incident in Logic Manager" and the Logic Manager login screen will show.
Wed 10/3(12n1911 SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@logicmanager.com>
QNotification-
To O DBH Incident Reporting
0If there are problems with how this message is displayed,click here to view it in a web
Click here to download pictures.To help protect your privacy,Outlook prevented autom ocrdownload of some pictures in this message.
CAUTIONM-EXTERNAL EMAIL-THINK BEFORE YOU CLICK
x�right-cfrk>dp and Auld hnem dwnbd Picwr-.Tu Arb �tVdr
Outlmk Prevtled aumnvtic danbd dei PiWnfmntlx
Lv,eH ,Inc.
Hi Mila Arevalo,
You have received a notification through LogicManager.Please see the details
below.
Type:Incident Report
Subject:102:
Notification To:Mila Arevalo
Ocen this incident in LoaicManaaer
If using Internet Explorer,click here to open the notification
This email was generated by LogicManager.If you have any technical issues,
please email su000rtliffioaicmanauercom.
K-6
Exhibit K
Enter in email address and password. First time users will be prompted to set up a password.
C Q O fresnodbh.my.logicmanager.com/login
LogicManager
Forgot your password?
Once logged in,the main screen will show reviewer task(incidents to review). Click on analyst/supervisor follow up
to view the incident.
A
Your Task List
a
TASK NAME SOURCE STATUS ASSIGNEDTO ASSIGNED BY DUE DATE-
Analyst Follow Up In Progress —dhi[ SYSTEM-,V,Managci
K-7
Exhibit K
This screen below will then pop up. There are 5 tabs to navigate through. Client information will show the client and
facility information. No edits can be made to this section.
Analyst Follow Up
Task Detailz Client lnkrmaxon
AA TEST FACI III
nameof facility'
xame WaeportinBpaxy'
sacillry AEErcas'
sacniry vhone xumx.'
The next tab is Sum ary: No edits can be made to this section.
Analyst Follow Up
Task Deta ils Client Information Summ ry Follow Up Doan
bj t 0
Inclbenl(check all that apply)•
Oeath of Dllmt lc
If Other specify(Ia fire,po�sonm6.epbemx outbreaks,oVIk,—Urtropkes/ewntslhalleopardlk,the xrclhrcan0 safety olcllenb,uAff,.E/or membefsoflhe c —ly)
De criptlon aflhe ind—t'
B I / u $ ❑ — — — le E B Q
D.A.lnclEent'
10130121013
Time onneiaent'
f
k«auon ormBlaenr
f
Task ID:3135ource:103:null « B 3 CANCEL
K-8
Exhibit K
The next tab is Follow up: This section can be edited. Add to th areas below or make corrections to these fields. Be
sure to E w en edits are made.Then Cancel to Exi ut of the incident.
Analyst Follow Up
Task Details CI—tlnformatmn Summary Follow Up Documents
Action Taken(check all that apply)'
Law Enforcement Contacted X
Pleasespecifyifother
D—,,poon of Action Taken'
f
Outcome'
f
added inrormadon
cause of deem-cancer per caroner 10-31-19�
Task ID:313 Source:—null �c c t� CANC
The next tab is Documents: View and add attachments to the incident. Be sure to click SAVE when adding
documents.Then Cancel to Exit out of the incident.
Analyst Follow Up
Task Details Client Information Summary Follow Up Documents
---�' ® Add Document "
Name Type Source Upload Date Uploaded By
CAi
No documents yet.
Drop files here or click on the Add Document dmpdown.
< 5 > » CA 11 C E L
Task ID:313 Source:103:null
If all tasks are followed up with and the incident no longer needs further review/information, click SUBMIT. Once
submitted,the incident will be removed from the task list and no further edits can be made. Notice the SUBMIT
button is on every tab. If further information needs to be included, email
DBHlncidentReporting@fresnocountycagov
K-9
Exhibit K
To get back to the home view, click on the Lo is Manager icon at any time. Any incidents that still need review will
show on this screen, click o c incident and start the review process again.
Lr
,icManager pi—
Your Task List
4
TASK NAME SOURCE STATUS ASSIGNEDTO ASSIGNED BY DUE DATE
M,W F,11—Up MPmgezz meE hzf SYSTEM.,M—g,
K-10
Exhibit L
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.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVIII, XIX, or XX? ......................................................................................................................... o 0
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVI 11, XIX, or XX?...................................................................................... n n
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)........... o 71
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: n Sole proprietorship n Partnership o Corporation
71 Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... >
71
NAME ADDRESS PROVIDER NUMBER
L-1
Exhibit L
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... n n
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... n n
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
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
L-2
Exhibit M
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
M-1
Exhibit M
(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)
M-2
Exhibit N
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno ("County"), members of a
contractor's board of directors ("County Contractor"), must disclose any self-dealing transactions
that they are a party to while providing goods, performing services, or both for the County. A
self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest."
The definition above will be used for purposes of completing this disclosure form.
Instructions
(1) Enter board member's name, job title (if applicable), and date this disclosure is being
made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction;
and
b. The nature of the material financial interest in the Corporation's transaction that
the board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
The form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
N-1
Exhibit N
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a
party to)
(4) Explain why this self-dealing transaction is consistent with the requirements of
Corporations Code § 5233 (a)
(5) Authorized Signature
Signature: Date:
N-2