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Agreement A-24-500 Master Agreement for E-ISFC and E-E-ISFC.pdf
Agreement No. 24-500 1 SERVICE AGREEMENT 2 This Service Agreement ("Agreement') is dated September 10, 2024 and is 3 between each Contractor(s) ("Contractor(s)") listed in Exhibit A, "List of Contractor(s)", and the 4 County of Fresno, a political subdivision of the State of California ("County"). 5 Recitals 6 A. Assembly Bill 404 (AB 404), SEC. 125, Chapter 6.3, County is mandated to develop and 7 implement a foster care program to provide specialized programs to serve children with specific 8 needs, including, but not limited to, behavioral and/or specialized health care needs; and 9 B. County has a need for Enhanced Intensive Services Foster Care and Emergency 10 Enhanced Intensive Services Foster Care placement homes; and 11 C. Contractor(s) was selected to provide the services created to support youth with 12 complex needs with home-based care. Contractor(s) represents that it is qualified and willing to 13 provide said services pursuant of the terms and conditions of this Agreement. 14 The parties therefore agree as follows: 15 Article 1 16 Contractor Services 17 1.1 Scope of Services. The Contractor(s) shall perform all of the services provided in 18 Exhibit B to this Agreement, titled "Scope of Services," and pursuant to the staffing patterns and 19 program expenses detailed in Exhibit C, titled "Compensation." 20 1.2 Representation. The Contractor(s) represents that it is qualified, ready, willing, and 21 able to perform all of the services provided in this Agreement. 22 1.3 Compliance with Laws. The Contractor(s) shall, at its own cost, comply with all 23 applicable federal, state, and local laws and regulations in the performance of its obligations 24 under this Agreement, including but not limited to workers compensation, labor, and 25 confidentiality laws and regulations. 26 Contractor(s) shall provide services in conformance with all applicable State and Federal 27 statutes, regulations and subregulatory guidance, as from time to time amended, including but 28 not limited to: 1 1 (A) California Code of Regulations, Title 9; 2 (B) California Code of Regulations, Title 22; 3 (C)California Welfare and Institutions Code, Division 5; 4 (D) United States Code of Federal Regulations, Title 42, including but not limited to 5 Parts 438 and 455; 6 (E) United States Code of Federal Regulations, Title 45; 7 (F) United States Code, Title 42 (The Public Health and Welfare), as applicable; 8 (G)Balanced Budget Act of 1997; 9 (H) Health Insurance Portability and Accountability Act (HIPAA); and 10 (1) Applicable Medi-Cal laws and regulations, including applicable sub-regulatory 11 guidance, such as Behavioral Health Information Notices (BHINs), Mental Health and 12 Substance Use Disorder Services Information Notices (MHSUDS INs), and provisions of 13 County's, state or federal contracts governing services for persons served. 14 In the event any law, regulation, or guidance referred to in this section 1.3 is amended 15 during the term of this Agreement, the parties agree to comply with the amended authority as of 16 the effective date of such amendment without amending this Agreement. 17 Contractor(s) recognizes that County operates its mental health programs under an 18 agreement with DHCS, and that under said agreement the State imposes certain requirements 19 on County and its subcontractor(s). Contractor(s) shall adhere to all State requirements, 20 including those identified in Exhibit D, "Behavioral Health Requirements". 21 1.4 Meetings. Contractor(s) shall participate in monthly, or as needed, workgroup 22 meetings consisting of staff from County's Department of Social Services (DSS), Department of 23 Behavioral Health (DBH), and Probation to discuss service requirements, data reporting, 24 training, policies and procedures, overall program operations and any problems or foreseeable 25 problems that may arise. Contractor(s) shall also participate in other County meetings, such as 26 but not limited to quality improvement meetings, provider meetings, Behavioral Health Board 27 meetings, bi-monthly Contractor meetings, etc. Schedule for these meetings may change based 28 on the needs of the County. 2 1 1.5 Organizational Provider. Contractor(s) shall maintain requirements as a Mental 2 Health Plan (MHP) organizational provider throughout the term of this Agreement, as described 3 in Article 17 of this Agreement. If for any reason, this status is not maintained, County may 4 terminate this Agreement pursuant to Article 7 of this Agreement. 5 1.6 Staffing. Contractor(s) agrees that prior to providing services under the terms and 6 conditions of this Agreement, Contractor(s) shall have staff hired and in place for program 7 services and operations or County may, in addition to other remedies it may have, suspend 8 referrals or terminate this Agreement, in accordance with Article 7 of this Agreement. 9 1.7 Credentialing and Recredentialing. Contractor(s) and their respective staff must 10 follow the uniform process for credentialing and recredentialing of service providers established 11 by County, including disciplinary actions such as reducing, suspending, or terminating provider's 12 privileges. Failure to comply with specified requirements can result in suspension or termination 13 of an individual or provider. 14 Upon request, the Contractor(s) must demonstrate to the County that each of its 15 providers are qualified in accordance with current legal, professional, and technical standards, 16 and that they are appropriately licensed, registered, waivered, and/or certified. 17 Contractor(s) must not employ or subcontract with providers debarred, suspended or 18 otherwise excluded (individually, and collectively referred to as "Excluded") from participation in 19 Federal Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set 20 forth in 42 C.F.R. §438.610. See Article 12 below. 21 Contractor(s) is required to verify and document at a minimum every three (3) years that 22 each network provider that delivers covered services continues to possess valid credentials, 23 including verification of each of the credentialing requirements as per the County's uniform 24 process for credentialing and recredentialing. If any of the requirements are not up-to-date, 25 updated information should be obtained from network providers to complete the re-credentialing 26 process. 27 1.8 Criminal Background Check. Contractor(s) shall ensure that all providers and/or 28 subcontracted providers consent to a criminal background check, including fingerprinting to the 3 1 extent required under state law and 42 C.F.R. § 455.434(a). Contractor(s) shall provide 2 evidence of completed consents when requested by the County, DHCS or the US Department 3 of Health & Human Services (US DHHS). 4 1.9 Guiding Principles. Contractor(s) shall align programs, services, and practices with 5 the vision, mission, and guiding principles of the DBH, as further described in Exhibit E, "Fresno 6 County Department of Behavioral Health Guiding Principles of Care Delivery", attached hereto 7 and by this reference incorporated herein and made part of this Agreement. 8 1.10 Clinical Leadership. Contractor(s) shall send to County upon execution of this 9 Agreement, a detailed plan ensuring clinically appropriate leadership and supervision of their 10 clinical program. Recruitment and retaining clinical leadership with the clinical competencies to 11 oversee services based on the level of care and program design presented herein shall be 12 included in this plan. A description and monitoring of this plan shall be provided. 13 1.11 Timely Access. It is the expectation of the County that Contractor(s) provide timely 14 access to services that meet the State of California standards for care. Contractor(s) shall track 15 timeliness of services to persons served and provide a monthly report showing the monitoring or 16 tracking tool that captures this data. County and Contractor(s) shall meet to go over this 17 monitoring tool, as needed but at least on a monthly basis. County shall take corrective action if 18 there is a failure to comply by Contractor(s)with timely access standards. Contractor(s) shall 19 also provide tracking tools and measurements for effectiveness, efficiency, and persons served 20 satisfaction as further detailed in Exhibit B. 21 1.12 Electronic Health Record. Contractor(s) may maintain its records in County's 22 electronic health record (EHR) system in accordance with Exhibit F, "Documentation Standards 23 for Persons Served Records", as licenses become available. The person served record shall 24 begin with registration and intake, and include person served authorizations, assessments, 25 plans of care, and progress notes, as well as other documents as approved by County. County 26 shall be allowed to review records of all and any services provided. If Contractor(s) determines 27 to maintain its records in the County's EHR, it shall provide County's DBH Director, or designee, 28 with a thirty (30) day notice. If at any time Contractor(s) chooses not to maintain its records in 4 1 the County's EHR, it shall provide County's DBH Director, or designee, with thirty (30) days 2 advance written notice and Contractor(s) will be responsible for obtaining its own system, at its 3 own cost, for electronic health records management. 4 Disclaimer 5 County makes no warranty or representation that information entered into the County's 6 DBH EHR system by Contractor(s) will be accurate, adequate, or satisfactory for Contractor(s)' 7 own purposes or that any information in Contractor(s)' possession or control, or transmitted or 8 received by Contractor(s), is or will be secure from unauthorized access, viewing, use, 9 disclosure, or breach. Contractor(s) is solely responsible for person served information entered 10 by Contractor(s) into the County's DBH EHR system. Contractor(s) agrees that all Private 11 Health Information (PHI) maintained by Contractor(s) in County's DBH EHR system will be 12 maintained in conformance with all HIPAA laws, as stated in section 18.1, "Health Insurance 13 Portability and Accountability Act." 14 1.13 Records. Contractor(s) shall maintain records in accordance with Exhibit F, 15 "Documentation Standards for Person Served Records". All person served records shall be 16 maintained for a minimum of ten (10) years from the date of the end of this Agreement. 17 1.14 Access to Records. Contractor(s) shall provide County with access to all 18 documentation of services provided under this Agreement for County's use in administering this 19 Agreement. Contractor(s) shall allow County, CMS, the Office of the Inspector General, the 20 Controller General of the United States, and any other authorized Federal and State agencies to 21 evaluate performance under this Agreement, and to inspect, evaluate, and audit any and all 22 records, documents, and the premises, equipment and facilities maintained by the Contractor(s) 23 pertaining to such services at any time and as otherwise required under this Agreement. 24 1.15 Quality Improvement Activities and Participation. Contractor(s) shall comply with 25 the County's ongoing comprehensive Quality Assessment and Performance Improvement 26 (QAPI) Program (42 C.F.R. § 438.330(a)) and work with the County to improve established 27 outcomes by following structural and operational processes and activities that are consistent 28 with current practice standards. 5 1 Contractor(s) shall participate in quality improvement (QI) activities, including clinical and 2 non-clinical performance improvement projects (PIPs), as requested by the County in relation to 3 State and Federal requirements and responsibilities, to improve health outcomes and 4 individuals' satisfaction over time. Other QI activities include quality assurance, collection and 5 submission of performance measures specified by the County, mechanisms to detect both 6 underutilization and overutilization of services, individual and system outcomes, utilization 7 management, utilization review, provider appeals, provider credentialing and re-credentialing, 8 and person served grievances. Contractor(s) shall measure, monitor, and annually report to the 9 County its performance. 10 1.16 Rights of Persons Served. Contractor(s) shall comply with applicable laws and 11 regulations relating to patients' rights, including but not limited to Welfare and Institutions Code 12 5325, California Code of Regulations (CCR), sections 862 through 868, and 42 C.F.R. 13 §438.100. The Contractor(s) shall ensure that its subcontractor(s) comply with all applicable 14 patients' rights laws and regulations. 15 Article 2 16 Reporting 17 2.1 Reports. The Contractor(s) shall submit the following reports: 18 (A) Outcome Reports 19 Contractor(s) shall submit to County clinical program performance outcome 20 reports, as requested. 21 Outcome reports and outcome requirements are subject to change at County's 22 discretion. Contractor(s) shall provide outcomes as stated in Exhibit B and I. 23 (B) Staffing Report 24 Contractor(s) shall submit monthly staffing reports due by the 10th of each month 25 that identify all direct service and support staff by first and last name, applicable 26 licensure/certifications, and full-time hours worked to be used as a tracking tool to 27 determine if Contractor(s)' program is staffed according to the requirements of this 28 Agreement. 6 1 (C)Additional Reports 2 Contractor(s) shall also furnish to County such statements, records, reports, 3 data, and other information as County may request pertaining to matters covered by this 4 Agreement. In the event that Contractor(s)fails to provide such reports or other 5 information required hereunder, it shall be deemed sufficient cause for County to 6 withhold monthly payments until there is compliance. In addition, Contractor(s) shall 7 provide written notification and explanation to County within five (5) days of any funds 8 received from another source to conduct the same services covered by this Agreement. 9 2.2 Monitoring. Contractor(s) agrees to extend to County's staff, County's DSS, DBH, 10 and Probation and the California Department of Health Care Services (DHCS), or their 11 designees, the right to review and monitor records, programs, or procedures, at any time, in 12 regard to persons served, as well as the overall operation of Contractor(s)' programs, in order to 13 ensure compliance with the terms and conditions of this Agreement. 14 Article 3 15 County's Responsibilities 16 3.1 The County shall meet all obligations provided in Exhibit B to this Agreement, titled 17 "Scope of Services." 18 3.2 The County shall provide oversight and collaborate with Contractor(s), other County 19 Departments and community agencies to help achieve program goals and outcomes. In addition 20 to Contractor(s) monitoring of program, oversight includes, but not limited to, coordination with 21 Department of Health Care Services (DHCS) in regard to program administration and outcomes. 22 County shall participate in evaluating the progress of the overall program, levels of care 23 components, and the efficiency of collaboration with the Contractor(s) staff and will be available 24 to Contractor(s) for ongoing consultation. 25 County shall receive and analyze statistical outcome data from Contractor(s) throughout 26 the term of contract, on a monthly basis. County shall notify the Contractor(s) when additional 27 participation is required. The performance outcome measurement process will not be limited to 28 7 1 survey instruments but will also include, as appropriate, persons served and staff surveys, chart 2 reviews, and other methods of obtaining required information. 3 Article 4 4 Compensation, Invoices, and Payments 5 4.1 The County agrees to pay, and the Contractor(s)(s) agrees to receive, 6 compensation for the performance of its services under this Agreement as described in Exhibit 7 C to this Agreement, titled "Compensation." 8 4.2 The services provided by the Contractor(s) under this Agreement are funded in 9 whole or in part by the State of California and/or the United States Federal government. In the 10 event that funding for these services is delayed by the State Controller or the Federal 11 government, the County may defer payment to the Contractor(s). The amount of the deferred 12 payment shall not exceed the amount of funding delayed to the County. The period of time of 13 the deferral by the County shall not exceed the period of time of the State Controller's or 14 Federal government's delay of payment to County plus forty-five (45) days. 15 4.3 Maximum Compensation. The maximum compensation payable to the 16 Contractor(s) under this Agreement for the period beginning upon the execution of the contract 17 through June 30, 2025 for actual services provided is Eight Million, Two Hundred Thousand, 18 Eight Hundred Thirty and No/100 Dollars ($8,200,830.00), which is not a guaranteed sum but 19 shall be paid only for services rendered and received. 20 The maximum compensation payable to the Contractor(s) under this Agreement for the 21 period of July 1, 2025 through June 30, 2026 for actual services provided is Ten Million, Thirty- 22 Eight Thousand, Two Hundred Seventy and No/100 Dollars ($10,038,270.00), which is not a 23 guaranteed sum but shall be paid only for services rendered and received. 24 If this Agreement is extended for the first optional 12-month extension period , the 25 maximum compensation payable to the Contractor(s) under this Agreement for the period of 26 July 1, 2026 through June 30, 2027 for actual services provided is Ten Million, Three Hundred 27 Eighty-Nine Thousand, Three Hundred Eighty-Four and No/100 Dollars ($10,389,384.00), which 28 is not a guaranteed sum but shall be paid only for services rendered and received. 8 1 If this Agreement is extended for the second optional 12-month extension period, the 2 maximum compensation payable to the Contractor(s) under this Agreement for the period of 3 July 1, 2027 through June 30, 2028 for actual services provided is Ten Million, Seven Hundred 4 Thirty-Six Thousand, Four Hundred Forty and No/100 Dollars ($10,736,440.00), which is not a 5 guaranteed sum but shall be paid only for services rendered and received. 6 In no event shall the accumulative maximum contract amount for all the services 7 provided by the Contractor(s) to County under the terms and conditions of this Agreement be in 8 excess of Thirty-Nine Million, Three Hundred Sixty-Four Thousand, Nine Hundred Twenty-Four 9 and No/100 Dollars ($39,364,924.00) during the entire term of this Agreement. 10 The Contractor(s) acknowledges that the County is a local government entity and does 11 so with notice that the County's powers are limited by the California Constitution and by State 12 law, and with notice that the Contractor(s) may receive compensation under this Agreement 13 only for services performed according to the terms of this Agreement and while this Agreement 14 is in effect, and subject to the maximum amount payable under this section. The Contractor(s) 15 further acknowledges that County employees have no authority to pay the Contractor(s) except 16 as expressly provided in this Agreement. 17 The Contractor(s) will be compensated for performance of its services under this 18 Agreement as provided in this Article. The Contractor(s) is not entitled to any compensation 19 except as expressly provided in this Agreement. 20 4.4 Medi-Cal Billing 21 Contractor(s), DBH and DSS will review the Medi-Cal revenue billing claims of the 22 Contractor(s) over the first two (2) years of the contract term and will work in coordination with 23 Contractor(s) to determine if transitioning to a hybrid model with DBH paying the Contractor(s) a 24 fee-for-service rate for all Medi-Cal claimable revenue and DSS continuing to reimburse via a 25 revised cost-reimbursement budget would be mutually beneficial to both parties. If a transition is 26 considered appropriate, an amendment will be written to include the new rates and updated 27 budgets. Upon such time, Contractor(s), DBH and DSS shall continuously monitor the programs 28 9 1 and analyze data to review accuracy of rate categories assigned and may only reassign rate 2 categories with the written agreement of both parties pursuant to Article 26. 3 4.5 Specialty Mental Health Services Claiming. Contractor(s) shall enter claims 4 data into the County's billing and transactional database system by the fifteenth (15t") of every 5 month for actual services rendered in the previous month. Contractor(s) shall use Current 6 Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) 7 codes, as provided in the DHCS Billing Manual available at 8 https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx, as from time to time 9 amended. 10 Claims shall be complete and accurate and must include all required information 11 regarding the claimed services. Claims data entry into the County's electronic health record 12 system shall be the responsibility of Contractor(s). County shall monitor the volume of services, 13 billing amounts and service types entered into County's electronic health record/information 14 system. Any and all audit exceptions resulting from the provision and reporting of specialty 15 mental health services by Contractor(s) shall be the sole responsibility of Contractor(s). 16 Contractor(s) will comply with all applicable policies, procedures, directives, and guidelines 17 regarding the use of County's electronic health record/information system. 18 Contractor(s) must provide all necessary data to allow County to bill Medi-Cal, and any 19 other third-party source, for services and meet State and Federal reporting requirements. The 20 necessary data can be provided by a variety of means, including but not limited to: 1) direct data 21 entry into County's electronic health record/information system; 2) providing an electronic file 22 compatible with County's electronic health record/information system; or 3) integration between 23 County's electronic health record/information system and Contractor(s)' information system(s). 24 Contractor(s) shall maximize the Federal Financial Participation (FFP) reimbursement by 25 claiming all possible Medi-Cal services and correcting denied services for resubmission as 26 needed. Contractor(s) will be 100% responsible for denial of Medi-Cal claims due to 27 Contractor(s) administrative errors and oversight in the billing processes. 28 10 1 4.6 Applicable Fees. Contractor(s) shall not charge any persons served or third- 2 party payers any fee for service unless directed to do so by the County's DBH Director, or 3 designee, at the time the individual is referred for services. When directed to charge for 4 services, Contractor(s) shall use the uniform billing and collection guidelines prescribed by 5 DHCS. Contractor(s) will perform eligibility and financial determinations, in accordance with 6 DHCS' Uniform Method of Determining Ability to Pay (UMDAP), for all individuals unless 7 directed otherwise by the County's DBH Director. or designee. Contractor(s) shall not submit a 8 claim to, or demand or otherwise collect reimbursement from, the person served or persons 9 acting on behalf of the person served for any specialty mental health or related administrative 10 services provided under this Contract, except to collect other health insurance coverage, share 11 of cost, and co-payments (Cal. Code Regs., tit. 9, §1810.365(c). 12 The Contractor(s) must not bill persons served, for covered services, any amount 13 greater than would be owed if the County provided the services directly as per and otherwise 14 not bill persons served as set forth in 42 C.F.R. § 438.106. If a person served has dual 15 coverage, such as other health coverage (OHC) or Federal Medicare, Contractor(s) will be 16 responsible for billing the carrier and obtaining a payment/denial or have validation of claiming 17 with no response for ninety (90) days after the claim was mailed before the service can be 18 entered into the County's electronic health record/information system. Contractor(s) must report 19 all third-party collections for Medicare, third-party or client-pay or private-pay in each month. A 20 copy of explanation of benefits or CMS 1500 form is required as documentation. Contractor(s) 21 must comply with all laws and regulations governing the Federal Medicare program, including, 22 but not limited to: 1) the requirement of the Medicare Act, 42 U.S.C. section 1395 et seq; and 2) 23 the regulation and rules promulgated by the Federal Centers for Medicare and Medicaid 24 Services as they relate to participation, coverage and claiming reimbursement. Contractor(s) 25 will be responsible for compliance as of the effective date of each Federal, State or local law or 26 regulation specified. 27 4.7 Invoices. The Contractor(s) shall submit monthly invoices, in arrears by the 28 fifteenth (15th) day of each month, in the format directed by the County. The Contractor(s) shall 11 1 submit invoices electronically to: DSSlnvoices(a)fresnocountyca.gov with a copy to the assigned 2 County's DSS and DBH Staff Analysts. At the discretion of County's DBH and DSS Directors, or 3 their designees, if an invoice is incorrect or is otherwise not in proper form or substance, 4 County's DBH and/or DSS Directors, or their designees, shall have the right to withhold 5 payment as to only the portion of the invoice that is incorrect or improper after five (5) days prior 6 notice to Contractor(s). Contractor(s) agrees to continue to provide services for a period of 7 ninety (90) days after notification of an incorrect or improper invoice. If after the ninety (90) day 8 period, the invoice is still not corrected to County satisfaction, County's DBH Director, or 9 designee, may elect to terminate this Agreement, pursuant to the termination provision stated in 10 Article 7 of this Agreement. 11 4.8 Cost Reimbursement Based Invoices. Contractor(s) shall submit monthly 12 invoices and general ledgers to County that itemize the line item charges for monthly 13 program costs. The Contractor(s) shall submit each invoice within 30 days following the 14 month in which expenses were incurred and services rendered, and in any case within 60 15 days after the end of the term or termination of this Agreement. The invoices and general 16 ledgers will serve as tracking tools to determine if Contractor(s)' costs are in accordance 17 with its budgeted cost. Failure to submit reports and other supporting documentation shall 18 be deemed sufficient cause for County to withhold payments until there is compliance. 19 Contractor(s) must report all revenue collected from a third-party, client-pay or private-pay in 20 each monthly invoice. In addition, Contractor(s) shall submit monthly invoices for 21 reimbursement that equal the amount due less any revenue collected and/or unallowable 22 cost such as lobbying or political donations from the monthly invoice reimbursements. Travel 23 shall be reimbursed based on actual expenditures and reimbursement shall be at 24 Contractor(s)' adopted rate, not to exceed the Federal Internal Revenue Services (IRS) 25 published rate. Any claimable services submitted beyond six (6) months from the month of 26 service may be ineligible for payment. 27 4.9 Corrective Action Plans. Contractor(s) shall enter services into the County's 28 billing and transactional database and submit invoices in accordance with the deadlines listed 12 1 above and information shall be accurate. Failure to meet the requirements set forth above will 2 result in a corrective action plan at the discretion of the County's DBH Director, or designee, and 3 may result in financial penalties or termination of agreement per Article 7. 4 4.10 Payment. The County shall pay each correctly completed and timely submitted 5 invoice within 45 days after receipt. If an invoice is incorrect or otherwise not in proper form or 6 detail, County's DSS Director or designee shall have the right to withhold payment as to only 7 that portion of the invoices that is incorrect or improper, after five (5) days prior written notice or 8 email correspondence to Contractor(s). The County shall remit any payment to the 9 Contractor(s)' address specified in the invoice. Proof of payment may be required for certain 10 funding streams and will be made available by the Subrecipient as requested by the County. 11 Payments shall be made by County to Contractor(s) in arrears, for services provided 12 during the preceding month, within forty-five (45) days after the date of receipt, verification, and 13 approval by County. All final invoices and/or any final budget modification requests shall be 14 submitted by Contractor(s) within sixty (60) days following the final month of service for which 15 payment is claimed. No action shall be taken by County on claims submitted beyond the sixty 16 (60) day closeout period. Any compensation which is not expended by Contractor(s) pursuant to 17 the terms and conditions of this Agreement shall automatically revert to County. 18 4.11 Cost Reimbursement Payments. Payment shall be made upon certification or 19 other proof satisfactory to County that services have actually been performed by Contractor(s) 20 as specified in this Agreement and/or after receipt and verification of actual expenditures 21 incurred by Contractor(s) for monthly program costs, as identified in the budget narratives and 22 budgets identified in Exhibit C, in the performance of this Agreement. County shall not be 23 obligated to make any payments under this Agreement if the request for payment is received by 24 County more than sixty (60) days after this Agreement has terminated or expired. 25 4.12 Recoupments and Audits. County shall recapture from Contractor(s) the value 26 of any services or other expenditures determined to be ineligible based on the County or State 27 monitoring results. The County reserves the right to enter into a repayment agreement with 28 Contractor(s), with total monthly payments not to exceed twelve (12) months from the date of 13 1 the repayment agreement, to recover the amount of funds to be recouped. The County has the 2 discretion to extend the repayment plan up to a total of twenty-four (24) months from the date of 3 the repayment agreement. The repayment agreement may be made with the signed written 4 approval of County's DBH Director, or designee, and respective Contractor(s) through a 5 repayment agreement. The monthly repayment amounts may be netted against the 6 Contractor(s)' monthly billing for services rendered during the month, or the County may, in its 7 sole discretion, forego a repayment agreement and recoup all funds immediately. This remedy 8 is not exclusive, and County may seek requital from any other means, including, but not limited 9 to, a separate contract or agreement with Contractor(s). 10 Contractor(s) shall be held financially liable for any and all future disallowances/audit 11 exceptions due to Contractor(s)' deficiency discovered through the State audit process and 12 County utilization review for services provided during the course of this Agreement. At County's 13 election, the disallowed amount will be remitted within forty-five (45) days to County upon 14 notification or shall be withheld from subsequent payments to Contractor(s). Contractor(s) shall 15 not receive reimbursement for any units of services rendered that are disallowed or denied by 16 the Fresno County MHP utilization review process or through the State of California DHCS audit 17 and review process, cost report audit settlement if applicable, for Medi-Cal eligible beneficiaries. 18 4.13 Incidental Expenses. The Contractor(s) is solely responsible for all of its costs 19 and expenses that are not specified as payable by the County under this Agreement. If 20 Contractor(s) fails to comply with any provision of this Agreement, County shall be relieved of its 21 obligation for further compensation. 22 4.14 Restrictions and Limitations. This Agreement shall be subject to any restrictions, 23 limitations, and/or conditions imposed by County or state or federal funding sources that may in 24 any way affect the fiscal provisions of, or funding for this Agreement. This Agreement is also 25 contingent upon sufficient funds being made available by County, state, or federal funding 26 sources for the term of the Agreement. If the federal or state governments reduce financial 27 participation in the Medi-Cal program, County agrees to meet with Contractor(s) to discuss 28 renegotiating the services required by this Agreement. 14 1 Funding is provided by fiscal year. Any unspent fiscal year appropriation does not roll 2 over and is not available for services provided in subsequent years. 3 In the event that funding for these services is delayed by the State Controller, County 4 may defer payments to Contractor(s). The amount of the deferred payment shall not exceed the 5 amount of funding delayed by the State Controller to the County. The period of time of the 6 deferral by County shall not exceed the period of time of the State Controller's delay of payment 7 to County plus forty-five (45) days. 8 4.15 Additional Financial Requirements. County has the right to monitor the 9 performance of this Agreement to ensure the accuracy of claims for reimbursement and 10 compliance with all applicable laws and regulations. 11 Contractor(s) must comply with the False Claims Act employee training and policy 12 requirements set forth in 42 U.S.C. 1396a(a)(68) and as the Secretary of the United States 13 Department of Health and Human Services may specify. 14 Contractor(s) agrees that no part of any federal funds provided under this Agreement 15 shall be used to pay the salary of an individual per fiscal year at a rate in excess of Level 1 of 16 the Executive Schedule at https://www.opm.gov/ (U.S. Office of Personnel Management), as 17 from time to time amended. 18 Federal Financial Participation is not available for any amount furnished to an Excluded 19 individual or entity, or at the direction of a physician during the period of exclusion when the 20 person providing the service knew or had reason to know of the exclusion, or to an individual or 21 entity when the County failed to suspend payments during an investigation of a credible 22 allegation of fraud [42 U.S.C. section 1396b(i)(2)]. 23 Contractor(s) must maintain financial records for a minimum period of ten (10) years or 24 until any dispute, audit or inspection is resolved, whichever is later. Contractor(s) will be 25 responsible for any disallowances related to inadequate documentation. 26 4.16 Contractor(s) Prohibited from Redirection of Contracted Funds. 27 Contractor(s) may not redirect or transfer funds from one funded program to another funded 28 15 1 program under which Contractor(s) provides services pursuant to this Agreement except 2 through a duly executed amendment to this Agreement. 3 4.17 Financial Audit Report Requirements for Pass-Through Entities. If County 4 determines that Contractor(s) is a "subrecipient" (also known as a "pass-through entity") as 5 defined in 2 C.F.R. § 200 et seq., Contractor(s) represents that it will comply with the applicable 6 cost principles and administrative requirements including claims for payment or reimbursement 7 by County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time to time. 8 Contractor(s) shall observe and comply with all applicable financial audit report requirements 9 and standards. 10 Financial audit reports must contain a separate schedule that identifies all funds included 11 in the audit that are received from or passed through the County. County programs must be 12 identified by Agreement number, Agreement amount, Agreement period, and the amount 13 expended during the fiscal year by funding source. 14 Contractor(s) will provide a financial audit report including all attachments to the report 15 and the management letter and corresponding response within six (6) months of the end of the 16 audit year to the County's DBH Director, or designee. The County's Director, or designee, is 17 responsible for providing the audit report to the County Auditor. 18 Contractor(s) must submit any required corrective action plan to the County 19 simultaneously with the audit report or as soon thereafter as it is available. The County shall 20 monitor implementation of the corrective action plan as it pertains to services provided pursuant 21 to this Agreement. 22 Article 5 23 Term of Agreement 24 5.1 Term. This Agreement is effective upon execution and terminates on June 30, 2026 25 except as provided in section 5.2, "Extension," or Article 7, "Termination and Suspension," 26 below. 27 5.2 Extension. The term of this Agreement may be extended for no more than a two (2) 28 one-year periods only upon written approval of both parties at least thirty (30) days before the 16 1 first day of the next one-year extension period. The County's DSS and/or DBH Director or his or 2 her designee is authorized to sign the written approval on behalf of the County based on the 3 Contractor(s)' satisfactory performance. The extension of this Agreement by the County is not a 4 waiver or compromise of any default or breach of this Agreement by the Contractor(s) existing 5 at the time of the extension whether or not known to the County. 6 Article 6 7 Notices 8 6.1 Contact Information. The persons and their addresses having authority to give and 9 receive notices provided for or permitted under this Agreement include the following: 10 For the County: 11 Director of Department of Social Services County of Fresno 12 205 W. Pontiac Way Clovis, CA 93612 13 Director of Department of Behavioral Health 14 County of Fresno 1925 E. Dakota Avenue 15 Fresno, CA 93726 16 For the Contractor(s): See Exhibit A 17 6.2 Change of Contact Information. Either party may change the information in section 18 6.1 by giving notice as provided in section 6.3. 19 6.3 Method of Delivery. Each notice between the County and the Contractor(s) 20 provided for or permitted under this Agreement must be in writing, state that it is a notice 21 provided under this Agreement, and be delivered either by personal service, by first-class 22 United States mail, by an overnight commercial courier service, by telephonic facsimile 23 transmission, or by a Portable Document Format (PDF) document attached to an email. 24 (A) A notice delivered by personal service is effective upon service to the recipient. 25 (B) A notice delivered by first-class United States mail is effective three County 26 business days after deposit in the United States mail, postage prepaid, addressed to the 27 recipient. 28 17 1 (C)A notice delivered by an overnight commercial courier service is effective one 2 County business day after deposit with the overnight commercial courier service, 3 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to 4 the recipient. 5 (D)A notice delivered by telephonic facsimile transmission or by PDF document 6 attached to an email is effective when transmission to the recipient is completed (but, if 7 such transmission is completed outside of County business hours, then such delivery is 8 deemed to be effective at the next beginning of a County business day), provided that 9 the sender maintains a machine record of the completed transmission. 10 6.4 Claims Presentation. For all claims arising from or related to this Agreement, 11 nothing in this Agreement establishes, waives, or modifies any claims presentation 12 requirements or procedures provided by law, including the Government Claims Act (Division 3.6 13 of Title 1 of the Government Code, beginning with section 810). 14 6.5 Notification of Changes. Contractor(s) shall notify County in writing of any change 15 in organizational name, Head of Service or principal business at least fifteen (15) business days 16 in advance of the change. Contractor(s) shall notify County of a change of service location at 17 least six (6) months in advance to allow County sufficient time to comply with site certification 18 requirements. Said notice shall become part of this Agreement upon acknowledgment in writing 19 by the County, and no further amendment of the Agreement shall be necessary provided that 20 such change of address does not conflict with any other provisions of this Agreement. 21 Contractor(s) must immediately notify County of a change in ownership, organizational 22 status, licensure, or ability of Contractor(s) to provide the quantity or quality of the contracted 23 services and in no event more than fifteen (15) days of the change. 24 Article 7 25 Termination and Suspension 26 7.1 Termination for Non-Allocation of Funds. The terms of this Agreement are 27 contingent on the approval of funds by the appropriating government agency. If sufficient funds 28 18 1 are not allocated, then the County, upon at least thirty (30) days' advance written notice to the 2 Contractor(s), may: 3 (A) Modify the services provided by the Contractor(s) under this Agreement; or 4 (B) Terminate this Agreement. 5 7.2 Termination for Breach. 6 (A) Upon determining that a breach (as defined in paragraph (C) below) has 7 occurred, the County may give written notice of the breach to the Contractor(s). The 8 written notice may suspend performance under this Agreement and must provide at 9 least 30 days for the Contractor(s) to cure the breach. 10 (B) If the Contractor(s)fails to cure the breach to the County's satisfaction within the 11 time stated in the written notice, the County may terminate this Agreement immediately. 12 (C) For purposes of this section, a breach occurs when, in the determination of the 13 County, the Contractor(s) has: 14 (1) Obtained or used funds illegally or improperly; 15 (2) Failed to comply with any part of this Agreement; 16 (3) Submitted a substantially incorrect or incomplete report to the County; or 17 (4) Improperly performed any of its obligations under this Agreement. 18 7.3 Termination without Cause. In circumstances other than those set forth above, the 19 County or Contractor(s) may terminate this Agreement by giving at least thirty (30) days 20 advance written notice to the Contractor(s) or County. 21 7.4 No Penalty or Further Obligation. Any termination of this Agreement by the County 22 under this Article 7 is without penalty to or further obligation of the County. 23 7.5 County's Rights upon Termination. Upon termination for breach under this Article 24 7, the County may demand repayment by the Contractor(s) of any monies disbursed to the 25 Contractor(s) under this Agreement that, in the County's sole judgment, were not expended in 26 compliance with this Agreement. The Contractor(s) shall promptly refund all such monies upon 27 demand. This section survives the termination of this Agreement. 28 19 1 In the event this Agreement is terminated, Contractor(s) shall be entitled to 2 compensation for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant 3 to the terms and conditions of this Agreement through and including the effective date of 4 termination. This provision shall not limit or reduce any damages owed to the County due to a 5 breach of this Agreement by Contractor(s). 6 Article 8 7 Informing Materials for Persons Served 8 8.1 Basic Information Requirements. Contractor(s) shall provide information in a 9 manner and format that is easily understood and readily accessible to the persons served (42 10 C.F.R. § 438.10(c)(1)). Contractor(s) shall provide all written materials for persons served in 11 easily understood language, format, and alternative formats that take into consideration the 12 special needs of individuals in compliance with 42 C.F.R. § 438.10(d)(6). Contractor(s) shall 13 inform the persons served that information is available in alternate formats and how to access 14 those formats in compliance with 42 C.F.R. § 438.10. 15 Contractor(s) shall provide the required information in this section to each individual 16 receiving SMHS under this Agreement and upon request (1915(b) Medi-Cal Specialty Mental 17 Health Services Waiver, § (2), subd. (d), at p. 26., attachments 3, 4; Cal. Code Regs., tit. 9, § 18 1810.360(e)). 19 Contractor(s) shall utilize the County's website that provides the content required in this 20 section and 42 C.F.R. § 438.10 and complies with all requirements regarding the same set forth 21 in 42 C.F.R. §438.10. 22 Contractor(s) shall use the DHCS/County-developed beneficiary handbook and persons 23 served notices.(42 C.F.R. §§ 438.10(c)(4)(ii), 438.62(b)(3)). 24 8.2 Electronic Submission. Persons served information required in this section may 25 only be provided electronically by the Contractor(s) if all of the following conditions are met: 26 (A) The format is readily accessible; 27 (B) The information is placed in a location on the Contractor(s)' website that is 28 prominent and readily accessible; 20 1 (C)The information is provided in an electronic form which can be electronically 2 retained and printed; 3 (D)The information is consistent with the content and language requirements of this 4 Agreement; 5 (E) The individual is informed that the information is available in paper form without 6 charge upon request and the Contractor(s) shall provide it upon request within five (5) 7 business days (42 C.F.R. § 438.10(c)(6)). 8 8.3 Language and Format. Contractor(s) shall provide all written materials, including 9 taglines, for persons served or potential persons served in a font size no smaller than twelve 10 (12) point (42 C.F.R. 438.10(d)(6)(ii)). 11 Contractor(s) shall ensure its written materials that are critical to obtaining services are 12 available in alternative formats, upon request of the person served or potential person served at 13 no cost. 14 Contractor(s) shall make its written materials that are critical to obtaining services, 15 including, at a minimum, provider directories, beneficiary handbook, appeal and grievance 16 notices, denial and termination notices, and the Contractor's mental health education materials, 17 available in the prevalent non-English languages in the County (42 C.F.R. § 438.10(d)(3)). 18 (A) Contractor(s) shall notify persons served, prospective persons served, and 19 members of the public that written translation is available in prevalent languages free of 20 cost and how to access those materials (42 C.F.R. § 438.10(d)(5)(i), (iii); Welfare & Inst. 21 Code § 14727(a)(1); Cal. Code Regs. tit. 9 § 1810.410, subd. (e), para. (4)). 22 Contractor(s) shall make auxiliary aids and services available upon request and free of 23 charge to each person served (42 C.F.R. § 438.10(d)(3)-(4)). 24 Contractor(s) shall make oral interpretation and auxiliary aids, such as Teletypewriter 25 Telephone/Text Telephone (TTY/TDY) and American Sign Language (ASL), available and free 26 of charge for any language in compliance with 42 C.F.R. § 438.10(d)(2), (4)-(5). 27 Taglines for written materials critical to obtaining services must be printed in a conspicuously 28 visible font size, no smaller than twelve (12) point font. 21 1 8.4 Beneficiary Informing Materials. Each person served must receive and have 2 access to the beneficiary informing materials upon request by the individual and when first 3 receiving SMHS from Contractor(s). Beneficiary informing materials include but are not limited 4 to: 5 (A) Consumer Handbook 6 (B) Provider Directory 7 (C)Appeal/Expedited Appeal Form 8 (D)Advance Directives Brochure 9 (E) Change of Provider Form 10 (F) Suggestions Brochure 11 (G)Notice of Privacy Practices 12 (H) Notices of Adverse Benefit Determination (NOABDs — including Denial and 13 Termination Notices) 14 (1) Early & Periodic Screening, Diagnostic and Treatment (EPSDT) poster (if serving 15 individuals under the age of 21) 16 (J) Contractor(s) shall ensure beneficiary informing materials are displayed in the 17 threshold languages of Fresno County at all service sites, including but not limited to the 18 following: 19 (1) Consumer Handbook 20 (2) Provider Directory 21 (3) Grievance Form 22 (4) Appeal/Expedited Appeal Form 23 (5) Advance Directives Brochure 24 (6) Change of Provider Form 25 (7) Suggestions Brochure 26 All beneficiary informing written materials will use easily understood language and 27 format (i.e., material written and formatted at a 6t" grade reading level) and will use a font size 28 no smaller than 12 point. All beneficiary informing written materials shall inform beneficiaries of 22 1 the availability of information in alternative formats and how to make a request for an alternative 2 format. Inventory and maintenance of all beneficiary informing materials will be maintained by 3 the County's DBH Managed Care Division. Contractor(s) will ensure that its written materials 4 include taglines or that an additional taglines document is available. 5 8.5 Beneficiary Handbook. Contractor(s) shall provide each persons served with a 6 beneficiary handbook at the time the individual first accesses services and thereafter upon 7 request. The beneficiary handbook shall be provided to beneficiaries within fourteen (14) 8 business days after receiving notice of enrollment. 9 Contractor(s) shall give each individual notice of any significant change to the 10 information contained in the beneficiary handbook at least thirty (30) days before the intended 11 effective date of change as per BHIN 22-060. 12 8.6 Accessibility. Required informing materials must be electronically available on 13 Contractor(s)' webs ite and must be physically available at the Contractor(s)' facility lobby for 14 individuals' access. 15 Informing materials must be made available upon request, at no cost, in alternate 16 formats (i.e., Braille or audio) and auxiliary aids (i.e., California Relay Service (CRS) 711 and 17 American Sign Language) and must be provided to persons served within five (5) business 18 days. Large print materials shall be in a minimum of eighteen (18) point font size. 19 Informing materials will be considered provided to the individual if Contractor(s) does 20 one or more of the following: 21 (A) Mails a printed copy of the information to the persons served's mailing address 22 before the individual receives their first specialty mental health service; 23 (B) Mails a printed copy of the information upon the individual's request to their 24 mailing address; 25 (C) Provides the information by email after obtaining the persons served's agreement 26 to receive the information by email; 27 (D) Posts the information on the Contractor(s)' webs ite and advises the person 28 served in paper or electronic form that the information is available on the internet and 23 1 includes applicable internet addresses, provided that individuals with disabilities who 2 cannot access this information online are provided auxiliary aids and services upon 3 request and at no cost; or, 4 (E) Provides the information by any other method that can reasonably be expected 5 to result in the person served receiving that information. If Contractor(s) provides 6 informing materials in person, when the individual first receives specialty mental health 7 services, the date and method of delivery shall be documented in the persons served's 8 file. 9 8.7 Provider Directory. Contractor(s) must follow the County's provider directory policy, 10 in compliance with MHSUDS IN 18-020. 11 Contractor(s) must make available to persons served, in paper form upon request and 12 electronic form, specified information about the County provider network as per 42 C.F.R. § 13 438.10(h). The most current provider directory is electronically available on the County website 14 and is updated by the County no later than thirty (30) calendar days after information is received 15 to update provider information. A paper provider directory must be updated at least monthly as 16 set forth in 42 C.F.R. § 438.10(h)(3)(i). 17 Any changes to information published in the provider directory must be reported to the 18 County within two (2)weeks of the change. 19 Contractor(s) will only need to report changes/updates to the provider directory for 20 licensed, waivered, or registered mental health providers. 21 Article 9 22 Independent Contractor(s) 23 9.1 Status. In performing under this Agreement, the Contractor(s), including its officers, 24 agents, employees, and volunteers, is at all times acting and performing as an independent 25 Contractor(s), in an independent capacity, and not as an officer, agent, servant, employee,joint 26 venturer, partner, or associate of the County. 27 H 28 24 1 9.2 Verifying Performance. The County has no right to control, supervise, or direct the 2 manner or method of the Contractor(s)' performance under this Agreement, but the County may 3 verify that the Contractor(s) is performing according to the terms of this Agreement. 4 9.3 Benefits. Because of its status as an independent Contractor(s), the Contractor(s) 5 has no right to employment rights or benefits available to County employees. The Contractor(s) 6 is solely responsible for providing to its own employees all employee benefits required by law. 7 The Contractor(s) shall save the County harmless from all matters relating to the payment of 8 Contractor(s)' employees, including compliance with Social Security withholding and all related 9 regulations. 10 9.4 Services to Others. The parties acknowledge that, during the term of this 11 Agreement, the Contractor(s) may provide services to others unrelated to the County. 12 9.5 Operating Costs. Contractor(s) shall provide all personnel, supplies, and operating 13 expenses of any kind required for the performance of this Agreement. 14 9.6 Additional Responsibilities. The parties acknowledge that, during the term of this 15 Agreement, the Contractor(s)will be performing hiring, training, and credentialing of staff, and 16 County will be performing additional staff credentialing to ensure compliance with State and 17 Federal regulations. 18 9.7 Subcontracts. Contractor(s) shall obtain written approval from County's DSS and 19 DBH Directors, or designees, before subcontracting any of the services delivered under this 20 Agreement. County's DSS and DBH Directors, or designees, retain the right to approve or reject 21 any request for subcontracting services. Any transferee, assignee, or subcontractor(s) will be 22 subject to all applicable provisions of this Agreement, and all applicable State and Federal 23 regulations. Contractor(s) shall be held primarily responsible by County for the performance of 24 any transferee, assignee, or subcontractor(s) unless otherwise expressly agreed to in writing by 25 County's DSS and DBH, or designees. The use of subcontractor(s) by Contractor(s) shall not 26 entitle Contractor(s) to any additional compensation that is provided for under this Agreement. 27 28 25 1 Contractor(s) shall remain legally responsible for the performance of all terms and 2 conditions of this Agreement, including, without limitation, all SMHS provided by third parties 3 under subcontracts, whether approved by the County or not. 4 Article 10 5 Indemnity and Defense 6 10.1 Indemnity. The Contractor(s) shall indemnify and hold harmless and defend the 7 County (including its officers, agents, employees, and volunteers) against all claims, demands, 8 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and 9 liabilities of any kind to the County, the Contractor(s), or any third party that arise from or relate 10 to the performance or failure to perform by the Contractor(s) (or any of its officers, agents, 11 subcontractor(s), or employees) under this Agreement. The County may conduct or participate 12 in its own defense without affecting the Contractor(s)' obligation to indemnify and hold harmless 13 or defend the County. 14 10.2 Survival. This Article 10 survives the termination of this Agreement. 15 Article 11 16 Insurance 17 11.1 The Contractor(s) shall comply with all the insurance requirements in Exhibit H to this 18 Agreement. 19 Article 12 20 Assurances 21 12.1 Certification of Non-exclusion or Suspension from Participation in a Federal 22 Health Care Program. 23 (A) In entering into this Agreement, Contractor(s) certifies that it is not excluded from 24 participation in Federal Health Care Programs under either Section 1128 or 1128A of the 25 Social Security Act. Failure to so certify will render all provisions of this Agreement null 26 and void and may result in the immediate termination of this Agreement. 27 (B) In entering into this Agreement, Contractor(s) certifies, that the Contractor(s) 28 does not employ or subcontract with providers or have other relationships with providers 26 1 excluded from participation in Federal Health Care Programs, including Medi- 2 Cal/Medicaid or procurement activities, as set forth in 42 C.F.R. §438.610. Contractor(s) 3 shall conduct initial and monthly exclusion and suspension searches of the following 4 databases and provide evidence of these completed searches when requested by 5 County, DHCS or the US Department of Health and Human Services (DHHS): 6 (1) www.oig.hhs.gov/exclusions - Office of Inspector General's List of Excluded 7 Individuals/Entities (LEIE) Federal Exclusions 8 (2) www.sam.gov/content/exclusions - General Service Administration (GSA) 9 Exclusions Extractwww.Medi-Cal.ca.gov- Suspended & Ineligible Provider List 10 (3) https://nppes.cros.hhs.gov/#/- National Plan and Provider Enumeration 11 System (NPPES) 12 (4) any other database required by DHCS or US DHHS. 13 (C) In entering into this Agreement, Contractor(s) certifies, that Contractor(s) does 14 not employ staff or individual Contractor(s)/vendors that are on the Social Security 15 Administration's Death Master File. Contractor(s) shall check the database prior to 16 employing staff or individual Contractor(s)/vendors and provide evidence of these 17 completed searches when requested by the County, DHCS or the US DHHS. 18 (D) Contractor(s) is required to notify County immediately if Contractor(s) becomes 19 aware of any information that may indicate their (including employees/staff and individual 20 Contractor(s)/vendors) potential placement on an exclusions list. 21 (E) Contractor(s) shall screen and periodically revalidate all network providers in 22 accordance with the requirements of 42 C.F.R., Part 455, Subparts B and E. 23 (F) Contractor(s) must confirm the identity and determine the exclusion status of all 24 its providers, as well as any person with an ownership or control interest, or who is an 25 agent or managing employee of the contracted agency through routine checks of federal 26 and state databases. This includes the Social Security Administration's Death Master 27 File, NPPES, the Office of Inspector General's LEIE, the Medi-Cal Suspended and 28 27 1 Ineligible Provider List (S&I List) as consistent with the requirements of 42 C.F.R. § 2 455.436. 3 (G) If Contractor(s) finds a provider that is excluded, it must promptly notify the 4 County as per 42 C.F.R. § 438.608(a)(2), (4). The Contractor(s) shall not certify or pay 5 any Excluded provider with Medi-Cal funds, must treat any payments made to an 6 excluded provider as an overpayment, and any such inappropriate payments may be 7 subject to recovery. 8 Article 13 9 Inspections, Audits, Record Maintenance, and Public Records 10 13.1 Inspection of Documents. The Contractor(s) shall make available to the County, 11 and the County may examine at any time during business hours and as often as the County 12 deems necessary, all of the Contractor(s)' records and data with respect to the matters covered 13 by this Agreement, excluding attorney-client privileged communications. The Contractor(s) shall, 14 upon request by the County, permit the County to audit and inspect all of such records and data 15 to ensure the Contractor(s)' compliance with the terms of this Agreement. 16 13.2 State Audit Requirements. If the compensation to be paid by the County under this 17 Agreement exceeds $10,000, the Contractor(s) is subject to the examination and audit of the 18 California State Auditor, as provided in Government Code section 8546.7, for a period of three 19 years after final payment under this Agreement. This section survives the termination of this 20 Agreement. 21 13.3 Internal Auditing. Contractor(s) of sufficient size as determined by County shall 22 institute and conduct a Quality Assurance Process for all services provided hereunder. Said 23 process shall include at a minimum a system for verifying that all services provided and claimed 24 for reimbursement shall meet SMHS definitions and be documented accurately. 25 In addition, Contractor(s) with medication prescribing authority shall adhere to County's 26 medication monitoring review practices. Contractor(s) shall provide County with notification and 27 a summary of any internal audit exceptions and the specific corrective actions taken to 28 28 1 sufficiently reduce the errors that are discovered through Contractor(s)' internal audit process. 2 Contractor(s) shall provide this notification and summary to County as requested by the County. 3 13.4 Confidentiality in Audit Process. Contractor(s) and County mutually agree to 4 maintain the confidentiality of Contractor(s)' records and information of persons served, in 5 compliance with all applicable State and Federal statutes and regulations, including but not 6 limited to HIPAA and California Welfare and Institutions Code, Section 5328. Contractor(s) shall 7 inform all of its officers, employees, and agents of the confidentiality provisions of all applicable 8 statutes. 9 Contractor(s)' fiscal records shall contain sufficient data to enable auditors to perform a 10 complete audit and shall be maintained in conformance with standard procedures and 11 accounting principles. 12 Contractor(s)' records shall be maintained as required by DBH and DHCS on forms 13 furnished by DHCS or the County. All statistical data or information requested by the County's 14 DBH Director, or designee, shall be provided by the Contractor(s) in a complete and timely 15 manner. 16 13.5 Reasons for Recoupment. County will conduct periodic audits of Contractor(s) files 17 to ensure appropriate clinical documentation, high quality service provision and compliance with 18 applicable federal, state and county regulations. 19 Such audits may result in requirements for Contractor(s) to reimburse County for 20 services previously paid in the following circumstances: 21 (A) Identification of Fraud, Waste or Abuse as defined in federal regulation 22 (1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code, 23 section 14107.11, subdivision (d). 24 (2) Definitions for"fraud," "waste," and "abuse" can also be found in the Medicare 25 Managed Care Manual available at https://www.cros.gov/Regulations-and- 26 Guidance/Guidance/Manuals 27 (B) Overpayment of Contractor(s) by County due to errors in claiming or 28 documentation. 29 1 (C) Other reasons specified in the SMHS Reasons for Recoupment document 2 released annually by DHCS and posted on the DHCS BHIN website. 3 Contractor(s) shall reimburse County for all overpayments identified by Contractor(s), 4 County, and/or state or federal oversight agencies as an audit exception within the timeframes 5 required by law or Country or state or federal agency. Funds owed to County will be due within 6 forty-five (45) days of notification by County, or County shall withhold future payments until all 7 excess funds have been recouped by means of an offset against any payments then or 8 thereafter owing to County under this or any other Agreement between the County and 9 Contractor(s). 10 13.6 Cooperation with Audits. Contractor(s) shall cooperate with County in any review 11 and/or audit initiated by County, DHCS, or any other applicable regulatory body. This 12 cooperation may include such activities as onsite program, fiscal, or chart reviews and/or audits. 13 In addition, Contractor(s) shall comply with all requests for any documentation or files 14 including, but not limited to, files for persons served. 15 Contractor(s) shall notify the County of any scheduled or unscheduled external 16 evaluation or site visits when it becomes aware of such visit. County shall reserve the right to 17 attend any or all parts of external review processes. 18 Contractor(s) shall allow inspection, evaluation and audit of its records, documents and 19 facilities for ten (10) years from the term end date of this Agreement or in the event 20 Contractor(s) has been notified that an audit or investigation of this Agreement has been 21 commenced, until such time as the matter under audit or investigation has been resolved, 22 including the exhaustion of all legal remedies, whichever is later pursuant to 42 C.F.R.§§ 23 438.3(h) and 438.2301(3)(i-iii). 24 13.7 Single Audit Clause. If Contractor(s) expends Seven Hundred Fifty Thousand 25 Dollars ($750,000) or more in Federal and Federal flow-through monies annually, Contractor(s) 26 agrees to conduct an annual audit in accordance with the requirements of the Single Audit 27 Standards as set forth in Office of Management and Budget (OMB) Title 2 of the Code of 28 Federal Regulations Part 200. Contractor(s) shall submit said audit and management letter to 30 1 County. The audit must include a statement of findings or a statement that there were no 2 findings. If there were negative findings, Contractor(s) must include a corrective action signed 3 by an authorized individual. Contractor(s) agrees to take action to correct any material non- 4 compliance or weakness found as a result of such audit. Such audit shall be delivered to 5 County's DSS, Administration and Finance, and County's DBH Finance Division for review 6 within nine (9) months of the end of any fiscal year in which funds were expended and/or 7 received for the program. Failure to perform the requisite audit functions as required by this 8 Agreement may result in County performing the necessary audit tasks, or at County's option, 9 contracting with a public accountant to perform said audit, or, may result in the inability of 10 County to enter into future agreements with Contractor(s). All audit costs related to this 11 Agreement are the sole responsibility of Contractor(s). 12 13.8 Program Audit Requirements. A single audit report is not applicable if all 13 Contractor(s)' Federal contracts do not exceed the Seven Hundred Fifty Thousand Dollars 14 ($750,000) requirement or Contractor(s)' funding is through Drug related Medi-Cal. If a single 15 audit is not applicable, a program audit must be performed and a program audit report with 16 management letter shall be submitted by Contractor(s) to County as a minimum requirement to 17 attest to Contractor(s)' solvency. Said audit report shall be delivered to County's DSS, 18 Administration, for review no later than nine (9) months after the close of the fiscal year in which 19 the funds supplied through this Agreement are expended. Failure to comply with this Act may 20 result in County performing the necessary audit tasks or contracting with a qualified accountant 21 to perform said audit. All audit costs related to this Agreement are the sole responsibility of 22 Contractor(s) who agrees to take corrective action to eliminate any material noncompliance or 23 weakness found as a result of such audit. Audit work performed by County under this paragraph 24 shall be billed to the Contractor(s) at County cost, as determined by County's Auditor- 25 Controller/Treasurer-Tax Collector. 26 13.9 Record Establishment and Maintenance. Contractor(s) shall establish and 27 maintain records in accordance with those requirements prescribed by County, with respect to 28 all matters covered by this Agreement. Contractor(s) shall retain all fiscal books, account 31 1 records and client files for services performed under this Agreement for at least five (5) years 2 from date of final payment under this Agreement or until all State and Federal audits are 3 completed for that fiscal year, whichever is later. 4 (A) Cost Documentation. Contractor(s) agrees to maintain records to verify costs 5 under this Agreement including a General Ledger, properly executed payrolls, time 6 records, invoices, vouchers, orders, proof of payment, and any other accounting 7 documents pertaining in whole or in part to this Agreement and they shall be clearly 8 identified and readily accessible. The support documentation must indicate the line 9 budget account number to which the cost is charged. 10 (B) Service Documentation. Contractor(s) agrees to maintain records to verify 11 services under this Agreement including names and addresses of clients served, if 12 applicable, and the dates of service and a description of services provided on each 13 occasion. These records and any other documents pertaining in whole or in part to this 14 Agreement shall be clearly identified and readily accessible. 15 (C) County shall notify Contractor(s) in writing within thirty (30) days of any potential 16 State or Federal audit exception discovered during an examination. Where findings 17 indicate that program requirements are not being met and State or Federal participation 18 in this program may be imperiled in the event that corrections are not accomplished by 19 Contractor(s) within thirty (30) days of receipt of such notice from County, written 20 notification thereof shall constitute County's intent to terminate this Agreement. 21 13.10 Public Records. The County is not limited in any manner with respect to its public 22 disclosure of this Agreement or any record or data that the Contractor(s) may provide to the 23 County. The County's public disclosure of this Agreement or any record or data that the 24 Contractor(s) may provide to the County may include but is not limited to the following: 25 (A) The County may voluntarily, or upon request by any member of the public or 26 governmental agency, disclose this Agreement to the public or such governmental 27 agency. 28 32 1 (B) The County may voluntarily, or upon request by any member of the public or 2 governmental agency, disclose to the public or such governmental agency any record or 3 data that the Contractor(s) may provide to the County, unless such disclosure is 4 prohibited by court order. 5 (C)This Agreement, and any record or data that the Contractor(s) may provide to the 6 County, is subject to public disclosure under the Ralph M. Brown Act (California 7 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950). 8 (D)This Agreement, and any record or data that the Contractor(s) may provide to the 9 County, is subject to public disclosure as a public record under the California Public 10 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning 11 with section 6250) ("CPRA"). 12 (E) This Agreement, and any record or data that the Contractor(s) may provide to the 13 County, is subject to public disclosure as information concerning the conduct of the 14 people's business of the State of California under California Constitution, Article 1, 15 section 3, subdivision (b). 16 (F) Any marking of confidentiality or restricted access upon or otherwise made with 17 respect to any record or data that the Contractor(s) may provide to the County shall be 18 disregarded and have no effect on the County's right or duty to disclose to the public or 19 governmental agency any such record or data. 20 (G) Notwithstanding sections A-F above, any information protected by law shall not 21 be subject to public disclosure. 22 13.7 Public Records Act Requests. If the County receives a written or oral request 23 under the CPRA to publicly disclose any record that is in the Contractor(s)' possession or 24 control, and which the County has a right, under any provision of this Agreement or applicable 25 law, to possess or control, then the County may demand, in writing, that the Contractor(s) 26 deliver to the County, for purposes of public disclosure, the requested records that may be in 27 the possession or control of the Contractor(s). Within five business days after the County's 28 demand, the Contractor(s) shall (a) deliver to the County all of the requested records that are in 33 1 the Contractor's possession or control, together with a written statement that the Contractor(s), 2 after conducting a diligent search, has produced all requested records that are in the 3 Contractor's possession or control, or (b) provide to the County a written statement that the 4 Contractor(s), after conducting a diligent search, does not possess or control any of the 5 requested records. The Contractor(s) shall cooperate with the County with respect to any 6 County demand for such records. If the Contractor(s) wishes to assert that any specific record 7 or data is exempt from disclosure under the CPRA or other applicable law, it must deliver the 8 record or data to the County and assert the exemption by citation to specific legal authority 9 within the written statement that it provides to the County under this section. The Contractor's 10 assertion of any exemption from disclosure is not binding on the County, but the County will give 11 at least 10 days' advance written notice to the Contractor(s) before disclosing any record 12 subject to the Contractor's assertion of exemption from disclosure. The Contractor(s) shall 13 indemnify the County for any court-ordered award of costs or attorney's fees under the CPRA 14 that results from the Contractor's delay, claim of exemption, failure to produce any such records, 15 or failure to cooperate with the County with respect to any County demand for any such records. 16 Article 14 17 Right to Monitor 18 14.1 Right to Monitor. County or any subdivision or appointee thereof, and the State of 19 California or any subdivision or appointee thereof, including the Auditor General, shall have 20 absolute right to review and audit all records, books, papers, documents, corporate minutes, 21 financial records, staff information, records of persons served, other pertinent items as 22 requested, and shall have absolute right to monitor the performance of Contractor(s) in the 23 delivery of services provided under this Agreement. Full cooperation shall be given by the 24 Contractor(s) in any auditing or monitoring conducted, according to this agreement. 25 14.2 Accessibility. Contractor(s) shall make all of its premises, physical facilities, 26 equipment, books, records, documents, agreements, computers, or other electronic systems 27 pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities furnished 28 under the terms of this Agreement, or determinations of amounts payable available at any time 34 1 for inspection, examination, or copying by County, the State of California or any subdivision or 2 appointee thereof, CMS, U.S. Department of Health and Human Services (HHS) Office of 3 Inspector General, the United States Controller General or their designees, and other 4 authorized federal and state agencies. This audit right will exist for at least ten years from the 5 final date of the Agreement period or in the event the Contractor(s) has been notified that an 6 audit or investigation of this Agreement has commenced, until such time as the matter under 7 audit or investigation has been resolved, including the exhaustion of all legal remedies, 8 whichever is later (42 CFR §438.230(c)(3)(I)-(ii)). 9 The County, DHCS, CMS, or the HHS Office of Inspector General may inspect, 10 evaluate, and audit the Contractor(s) at any time if there is a reasonable possibility of fraud or 11 similar risk. The Department's inspection shall occur at the Contractor(s)' place of business, 12 premises, or physical facilities (42 CFR §438.230(c)(3)(iv)). 13 14.3 Cooperation. Contractor(s) shall cooperate with County in the implementation, 14 monitoring and evaluation of this Agreement and comply with any and all reporting requirements 15 established by County. Should County identify an issue or receive notification of a complaint or 16 potential/actual/suspected violation of requirements, County may audit, monitor, and/or request 17 information from Contractor(s) to ensure compliance with laws, regulations, and requirements, 18 as applicable. 19 14.4 Probationary Status. County reserves the right to place Contractor(s) on 20 probationary status, as referenced in the Probationary Status Article, should Contractor(s) fail to 21 meet performance requirements; including, but not limited to violations such as high 22 disallowance rates, failure to report incidents and changes as contractually required, failure to 23 correct issues, inappropriate invoicing, untimely and inaccurate data entry, not meeting 24 performance outcomes expectations, and violations issued directly from the State. Additionally, 25 Contractor(s) may be subject to Probationary Status or termination if agreement monitoring and 26 auditing corrective actions are not resolved within specified timeframes. 27 14.5 Record Retention. Contractor(s) shall retain all records and documents originated 28 or prepared pursuant to Contractor(s)' performance under this Agreement, including grievance 35 1 and appeal records, and the data, information and documentation specified in 42 C.F.R. parts 2 438.604, 438.606, 438.608, and 438.610 for a period of no less than ten years from the term 3 end date of this Agreement or until such time as the matter under audit or investigation has 4 been resolved. Records and documents include but are not limited to all physical and electronic 5 records and documents originated or prepared pursuant to Contractor(s)' or subcontractor(s)' 6 performance under this Agreement including working papers, reports, financial records and 7 documents of account, records of persons served, prescription files, subcontracts, and any 8 other documentation pertaining to covered services and other related services for persons 9 served. 10 14.6 Record Maintenance. Contractor(s) shall maintain all records and management 11 books pertaining to service delivery and demonstrate accountability for agreement performance 12 and maintain all fiscal, statistical, and management books and records pertaining to the 13 program. Records should include, but not be limited to, monthly summary sheets, sign-in 14 sheets, and other primary source documents. Fiscal records shall be kept in accordance with 15 Generally Accepted Accounting Principles and must account for all funds, tangible assets, 16 revenue and expenditures. Fiscal records must also comply with the Code of Federal 17 Regulations (CFR), Title II, Subtitle A, Chapter 11, Part 200, Uniform Administrative 18 Requirements, Cost Principles, and Audit Requirements for Federal Awards. 19 All records shall be complete and current and comply with all Agreement requirements. 20 Failure to maintain acceptable records per the preceding requirements shall be considered 21 grounds for withholding of payments for billings submitted and for termination of Agreement. 22 Contractor(s) shall maintain records of persons served and community service in 23 compliance with all regulations set forth by local, state, and federal requirements, laws, and 24 regulations, and provide access to clinical records by County staff. 25 Contractor(s) shall comply with the Article 19 and Article 1 regarding relinquishing or 26 maintaining medical records. 27 // 28 36 1 Contractor(s) shall agree to maintain and retain all appropriate service and financial 2 records for a period of at least ten (10) years from the date of final payment, the final date of the 3 contract period, final settlement, or until audit findings are resolved, whichever is later. 4 14.7 Financial Reports. Contractor(s) shall submit audited financial reports on an annual 5 basis to the County. The audit shall be conducted in accordance with Generally Accepted 6 Accounting Principles and generally accepted auditing standards. 7 14.8 Agreement Termination. In the event the Agreement is terminated, ends its 8 designated term or Contractor(s) ceases operation of its business, Contractor(s) shall deliver or 9 make available to County all financial records that may have been accumulated by Contractor(s) 10 or subcontractor(s) under this Agreement, whether completed, partially completed or in progress 11 within seven (7) calendar days of said termination/end date. 12 14.9 Facilities and Assistance. Contractor(s) shall provide all reasonable facilities and 13 assistance for the safety and convenience of the County's representatives in the performance of 14 their duties. All inspections and evaluations shall be performed in such a manner that will not 15 unduly delay the work of Contractor(s). 16 14.10 County Discretion to Revoke. County has the discretion to revoke full or partial 17 provisions of the Agreement, delegated activities or obligations, or application of other remedies 18 permitted by state or federal law when the County or DHCS determines Contractor(s) has not 19 performed satisfactorily. 20 14.11 Site Inspection. Without limiting any other provision related to inspections or audits 21 otherwise set forth in this Agreement, Contractor(s) shall permit authorized County, state, and/or 22 federal agency(ies), through any authorized representative, the right to inspect or otherwise 23 evaluate the work performed or being performed hereunder including subcontract support 24 activities and the premises which it is being performed. Contractor(s) shall provide all 25 reasonable assistance for the safety and convenience of the authorized representative in the 26 performance of their duties. All inspections and evaluations shall be made in a manner that will 27 not unduly delay the work of the Contractor(s). 28 37 1 Article 15 2 Complaints and Grievances 3 15.1 Documentation. Contractor(s) shall log complaints and the disposition of all 4 complaints from a person served or their family. Contractor(s) shall provide a copy of the 5 detailed complaint log entries concerning County-sponsored persons served to County at 6 monthly intervals by the tenth (10th) day of the following month, in a format that is mutually 7 agreed upon. Contractor(s) shall allow beneficiaries or their representative to file a grievance 8 either orally, or in writing at any time with the MHP. In the event Contractor(s) is notified by a 9 beneficiary or their representative of a discrimination grievance, subcontractor(s) shall report 10 discrimination grievances to the MHP within twenty-four (24) hours. The Contractor(s) shall not 11 require a beneficiary or their representative to fine a Discrimination Grievance with the MHP 12 before filing a complaint directly with the DHCS Office of Civil Rights and the U.S. Health and 13 Human Services Office for Civil Rights. 14 15.2 Rights of Persons Served. Contractor(s) shall post signs informing persons served 15 of their right to file a complaint or grievance, appeals, and expedited appeals. In addition, 16 Contractor(s) shall inform every person served of their rights as set forth in Exhibit I. 17 15.3 Incident Reporting. Contractor(s) shall file an incident report for all incidents 18 involving persons served, following the protocol identified in Exhibit J. 19 Article 16 20 Property of County 21 16.1 Applicability. Article 16 shall only apply to the program components and services 22 provided under operational costs. 23 16.2 Fixed Assets. County and Contractor(s) recognize that fixed assets are tangible and 24 intangible property obtained or controlled under County for use in operational capacity and will 25 benefit County for a period more than one (1) year. 26 16.3 Agreement Assets. Assets shall be tracked on an agreement by agreement basis. 27 All of these assets shall fall into the "Equipment" category unless funding source allows for 28 38 1 additional types of assets. At a minimum, the following types of items are considered to be 2 assets: 3 (A) Any items over$5,000 or more with a lifespan of at least two (2) years: 4 (1) Computers (desktops and laptops) 5 (2) Copiers, cell phones, tablets, and other devices with any HIPPA data 6 (3) Modular furniture 7 (4) Televisions 8 (5) Washers/Dryers 9 (6) Printers 10 (7) Digital Cameras 11 (8) Other equipment/furniture 12 (9) Items in total when purchased or used as a group fall into one or more of the 13 above categories 14 (B) Items of sensitive nature shall be purchased and allocated to a single agreement. 15 All items containing HIPAA data are considered sensitive. 16 Contractor(s) shall ensure proper tracking for contact assets that include the following 17 asset attributes at a minimum: 18 (A) Description of the asset; 19 (B) The unique identifier of the asset if applicable, i.e., serial number; 20 (C)The acquisition date; 21 (D)The quantity of the asset; 22 (E) The location of the asset or to whom the asset is assigned; 23 (F) The cost of the asset at the time of acquisition; 24 (G)The source of grant funding if applicable; 25 (H)The disposition date, and 26 (1) The method of disposition (surplus, transferred, destroyed, lost) 27 All Contract assets shall be returned to the Department at the end of the agreement 28 period. 39 1 16.4 Retention and Maintenance. Assets shall be retained by County, as County 2 property, in the event this Agreement is terminated or upon expiration of this Agreement. 3 Contractor(s) agrees to participate in an annual inventory of all County fixed and inventoried 4 assets. Upon termination or expiration of this Agreement, Contractor(s) shall be physically 5 present when fixed and inventoried assets are returned to County possession. Contractor(s) is 6 responsible for returning to County all County-owned undepreciated fixed and inventoried 7 assets, or the monetary value of said assets if unable to produce the assets at the expiration or 8 termination of this Agreement. Contractor(s) further agrees to the following: 9 Maintain all items of equipment in good working order and condition, normal wear and 10 tear excepted; 11 Label all items of equipment with County assigned program number, to perform periodic 12 inventories as required by County and to maintain an inventory list showing where and how the 13 equipment is being used in accordance with procedures developed by County. All such lists 14 shall be submitted to County within ten (10) days of any request therefore; and 15 Report in writing to County immediately after discovery, the loss or theft of any items of 16 equipment. For stolen items, the local law enforcement agency must be contacted, and a copy 17 of the police report submitted to County. 18 16.5 Equipment Purchase. The purchase of any equipment by Contractor(s) with funds 19 provided hereunder shall require the prior written approval of County's DSS Director or 20 designee, shall fulfill the provisions of this Agreement as appropriate, and must be directly 21 related to Contractor(s)' services or activity under the terms of this Agreement. County may 22 refuse reimbursement for any costs resulting from equipment purchased, which are incurred by 23 Contractor(s), if prior written approval has not been obtained from County. 24 16.6 Modification. Contractor(s) must obtain prior written approval from County's DSS 25 whenever there is any modification or change in the use of any property acquired or improved, 26 in whole or in part, using funds under this Agreement. If any real or personal property acquired 27 or improved with said funds identified herein is sold and/or is utilized by Contractor(s)for a use 28 which does not qualify under this Agreement, Contractor(s) shall reimburse County in an 40 1 amount equal to the current fair market value of the property, less any portion thereof 2 attributable to expenditures of funds not provided under this Agreement. These requirements 3 shall continue in effect for the life of the property. In the event this Agreement expires, the 4 requirements for this Article shall remain in effect for activities or property funded with said 5 funds, unless action is taken by the State government to relieve County of these obligations. 6 Article 17 7 Compliance 8 17.1 Compliance. Contractor(s) agrees to comply with County's Contractor(s) Code of 9 Conduct and Ethics and the County's Compliance Program in accordance with Exhibit K. Within 10 thirty (30) days of entering into this Agreement with County, Contractor(s) shall ensure all of 11 Contractor(s)' employees, agents, and subcontractor(s) providing services under this 12 Agreement certify in writing, that he or she has received, read, understood, and shall abide by 13 the Contractor(s) Code of Conduct and Ethics. Contractor(s) shall ensure that within thirty (30) 14 days of hire, all new employees, agents, and subcontractor(s) providing services under this 15 Agreement shall certify in writing that he or she has received, read, understood, and shall abide 16 by the Contractor(s) Code of Conduct and Ethics. Contractor(s) understands that the promotion 17 of and adherence to the Contractor(s) Code of Conduct is an element in evaluating the 18 performance of Contractor(s) and its employees, agents, and subcontractor(s). 19 Within thirty (30) days of entering into this Agreement, and annually thereafter, all 20 employees, agents, and subcontractor(s) providing services under this Agreement shall 21 complete general compliance training, and appropriate employees, agents, and subcontractor(s) 22 shall complete documentation and billing or billing/reimbursement training. All new employees, 23 agents, and subcontractor(s) shall attend the appropriate training within thirty (30) days of hire. 24 Each individual who is required to attend training shall certify in writing that he or she has 25 received the required training. The certification shall specify the type of training received and 26 the date received. The certification shall be provided to County's DBH Compliance Officer at 27 1925 E. Dakota Ave, Fresno, California 93726. Contractor(s) agrees to reimburse County for 28 41 1 the entire cost of any penalty imposed upon County by the Federal Government as a result of 2 Contractor(s)' violation of the terms of this Agreement. 3 17.2 Compliance with State Medi-Cal Requirements. Contractor(s) shall be required to 4 maintain Mental Health Plan organizational provider certification by Fresno County. 5 Contractor(s) must meet Medi-Cal organization provider standards as listed in Exhibit L, 6 "Compliance with State Medi-Cal Requirements". It is acknowledged that all references to 7 Organizational Provider and/or Provider in Exhibit L shall refer to Contractor(s). 8 17.3 Medi-Cal Certification and Mental Health Plan Compliance. Contractor(s) will 9 establish and maintain Medi-Cal certification or become certified within ninety (90) days of the 10 effective date of this Agreement through County to provide reimbursable services to Medi-Cal 11 eligible persons served. In addition, Contractor(s) shall work with the County's DBH to execute 12 the process if not currently certified by County for credentialing of staff. During this process, the 13 Contractor(s) will obtain a legal entity number established by the DHCS, a requirement for 14 maintaining Mental Health Plan organizational provider status throughout the term of this 15 Agreement. Contractor(s) will be required to become Medi-Cal certified prior to providing 16 services to Medi-Cal eligible persons served and seeking reimbursement from the County. 17 Contractor(s) will not be reimbursed by County for any services rendered prior to certification. 18 Contractor(s) shall provide direct specialty mental health services in accordance with the 19 Mental Health Plan. Contractor(s) must comply with the "Fresno County Mental Health Plan 20 Compliance Program and Code of Conduct" set forth in Exhibit K. 21 Contractor(s) may provide direct specialty mental health services using unlicensed staff 22 as long as the individual is approved as a provider by the Mental Health Plan, is supervised by 23 licensed staff, works within his/her scope and only delivers allowable direct specialty mental 24 health services. It is understood that each service is subject to audit for compliance with 25 Federal and State regulations, and that County may be making payments in advance of said 26 review. In the event that a service is disapproved, County may, at its sole discretion, withhold 27 compensation or set off from other payments due the amount of said disapproved services. 28 42 1 Contractor(s) shall be responsible for audit exceptions to ineligible dates of services or incorrect 2 application of utilization review requirements. 3 17.4 Network Adequacy. The Contractor(s) shall ensure that all services covered under 4 this Agreement are available and accessible to persons served in a timely manner and in 5 accordance with the network adequacy standards required by regulation. (42 C.F.R. §438.206 6 (a), (c)). 7 Contractor(s) shall submit, when requested by County and in a manner and format 8 determined by the County, network adequacy certification information to the County, utilizing a 9 provided template or other designated format. 10 Contractor(s) shall submit updated network adequacy information to the County any time 11 there has been a significant change that would affect the adequacy and capacity of services. 12 To the extent possible and appropriately consistent with CCR, Title 9, §1830.225 and 42 13 C.F.R. §438.3 (1), the Contractor(s) shall provide a person served the ability to choose the 14 person providing services to them. 15 17.5 Compliance Program, Including Fraud Prevention and Overpayments. 16 Contractor(s) shall have in place a compliance program designed to detect and prevent fraud, 17 waste and abuse, as per 42 C.F.R. § 438.608(a)(1), that must include: 18 (A) Written policies, procedures, and standards of conduct that articulate the 19 organization's commitment to comply with all applicable requirements and standards 20 under the Agreement, and all applicable federal and state requirements. 21 (B) A Compliance Office (CO) who is responsible for developing and implementing 22 policies, procedures, and practices designed to ensure compliance with the 23 requirements of this Agreement and who reports directly to the CEO and the Board of 24 Directors. 25 (C)A Regulatory Compliance Committee on the Board of Directors and at the senior 26 management level charged with overseeing the organization's compliance program and 27 its compliance with the requirements under the Agreement. 28 43 1 (D)A system for training and education for the Compliance Officer, the organization's 2 senior management, and the organization's employees for the federal and state 3 standards and requirements under the Agreement. 4 (E) Effective lines of communication between the Compliance Officer and the 5 organization's employees. 6 (F) Enforcement of standards through well-publicized disciplinary guidelines. 7 (G)The establishment and implementation of procedures and a system with 8 dedicated staff for routine internal monitoring and auditing of compliance risks, prompt 9 response to compliance issues as they are raised, investigation of potential compliance 10 problems as identified in the course of self-evaluation and audits, corrections of such 11 problems promptly and thoroughly to reduce the potential for recurrence and ongoing 12 compliance with the requirements under the Agreement. 13 (H)The requirement for prompt reporting and repayment of any overpayments 14 identified. 15 17.6 Reporting. Contractor(s) must have administrative and management arrangements 16 or procedures designed to detect and prevent fraud, waste and abuse of federal or state health 17 care funding. Contractor(s) must report fraud and abuse information to the County including but 18 not limited to: 19 (A) Any potential fraud, waste, or abuse as per 42 C.F.R. § 438.608(a), (a)(7), 20 (B) All overpayments identified or recovered, specifying the overpayment due to 21 potential fraud as per 42 C.F.R. § 438.608(a), (a)(2), 22 (C) Information about changes in a persons served's circumstances that may affect 23 the person served's eligibility including changes in their residence or the death of the 24 person served as per 42 C.F.R. § 438.608(a)(3). 25 (D) Information about a change in the Contractor(s)' circumstances that may affect 26 the network provider's eligibility to participate in the managed care program, including 27 the termination of this Agreement with the Contractor(s) as per 42 C.F.R. § 28 438.608(a)(6). 44 1 Contractor(s) shall implement written policies that provide detailed information about the 2 False Claims Act ("Act") and other federal and state laws described in section 1902(a)(68) of the 3 Act, including information about rights of employees to be protected as whistleblowers. 4 Contractor(s) shall make prompt referral of any potential fraud, waste or abuse to County 5 or potential fraud directly to the State Medicaid Fraud Control Unit. 6 17.7 Overpayments. County may suspend payments to Contractor(s) if DHCS or County 7 determine that there is a credible allegation of fraud in accordance with 42 C.F.R. §455.23. (42 8 C.F.R. §438.608 (a)(8)). 9 Contractor(s) shall report to County all identified overpayments and reason for the 10 overpayment, including overpayments due to potential fraud. Contractor(s) shall return any 11 overpayments to the County within sixty (60) calendar days after the date on which the 12 overpayment was identified. (42 C.F.R. § 438.608 (a)(2), (c)(3)). 13 Article 18 14 Federal and State Laws 15 18.1 Health Insurance Portability and Accountability Act. County and Contractor(s) 16 each consider and represent themselves as covered entities as defined by the U.S. Health 17 Insurance Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and agree to 18 use and disclose Protected Health Information (PHI) as required by law. 19 County and Contractor(s) acknowledge that the exchange of PHI between them is only 20 for treatment, payment, and health care operations. 21 County and Contractor(s) intend to protect the privacy and provide for the security of PHI 22 pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for 23 Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated 24 thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations) and 25 other applicable laws. 26 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require 27 Contractor(s) to enter into a agreement containing specific requirements prior to the disclosure 28 45 1 of PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 2 164.504(e) of the Code of Federal Regulations. 3 18.2 Physical Accessibility. In accordance with the accessibility requirements of section 4 508 of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor(s) must 5 provide physical access, reasonable accommodations, and accessible equipment for Medi-Cal 6 beneficiaries with physical or mental disabilities. 7 18.3 Child Abuse Reporting. Contractor(s) shall utilize a procedure acceptable to 8 County to ensure that all of Contractor(s)' employees, volunteers, consultants, subcontractor(s) 9 or agents performing services under this Agreement shall report all known or suspected child 10 abuse or neglect to one or more of the agencies set forth in Penal Code Section 11165.9. This 11 procedure shall include having all of Contractor(s)' employees, volunteers, consultants, 12 subcontractor(s) or agents performing services under this Agreement sign a statement that he 13 or she knows of and will comply with the reporting requirements set forth in Penal Code Section 14 11166. The statement to be utilized by Contractor(s) is set forth in Exhibit M, attached hereto 15 and by this reference incorporated herein. 16 Article 19 17 Medi-Cal Confidentiality and Data Security 18 19.1 Data Security Requirements. Contractor(s) shall comply with data security 19 requirements in Exhibit N to this Agreement. 20 19.2 Conformance with Laws: All services performed by Contractor(s) under this 21 Agreement shall be in strict conformance with all applicable Federal, State of California, and/or 22 local laws and regulations relating to confidentiality. Contractor(s) shall require its employees, 23 agents, officers and subcontractor(s) to comply with the provisions of Sections 10850 and 24 14100.2 of the Welfare and Institutions Code, as well as the California Department of Social 25 Services (CDSS) Manual of Policies and Procedures, Division 19-0000 and the California 26 Department of Health Care Services (DHCS) Medi-Cal Eligibility Procedures Manual, Section 27 2H. These Code sections provide that: 28 46 1 (A) All applications and records concerning any individual made or kept by any public 2 officer or agency in connection with the administration of any provision of the Welfare 3 and Institutions Code relating to Medicaid or any form of public social services for which 4 grants-in-aid are received by the State of California from the United States government 5 shall be confidential, and shall not be open to examination for any purpose not directly 6 connected with the administration of such public social services. 7 (B) No person shall publish or disclose or permit or cause to be published or 8 disclosed any list of persons receiving public social services, except as is provided by 9 law. 10 (C) No person shall publish, disclose, or use, or permit or cause to be published, 11 disclosed, or used any confidential information pertaining to an applicant or recipient, 12 except as is provided by laws. 13 (D) Contractor(s) shall inform all of its employees, agents, officers and 14 subcontractor(s) of the above provisions and that any person knowingly and intentionally 15 violating such provisions is guilty of a misdemeanor. 16 (E) In addition, Contractor(s), its employees, agents, and officers shall comply, and 17 require all of its subcontractor(s) to comply, with (1) the DHCS Medi-Cal Privacy and 18 Security Agreement between the California DHCS and the County of Fresno that is then 19 in effect, and (2) the Privacy and Security Agreement between the CDSS and the 20 County of Fresno that is then in effect, both of which together shall be referred to in this 21 section as "the Agreements" and are incorporated herein by this reference. The current 22 versions of both the DHCS and CDSS Privacy and Security agreements are available 23 upon request or can be viewed at: https://www.fresnocountyca.gov/Departments/Social- 24 Services/DSS-Administration/Privacy-and-Security-Agreements. Contractor(s) shall 25 insure that all personally identifiable information (PII), as defined in the Agreements, 26 concerning program recipients shall be kept confidential and shall not be opened to 27 examination, publicized, disclosed, or used for any purpose not directly connected with 28 the administration of the program. Contractor(s) shall use appropriate administrative, 47 1 physical, and technical safeguards to protect PI I, as set forth in the Agreements. Upon 2 discovery of a breach, security incident, intrusion, or unauthorized access, use, or 3 disclosure of PII, Contractor(s) shall immediately report the incident to the County by 4 calling (559) 600-2300 or emailing the privacy mailbox at 5 dssprivacyincident(a)fresnocountyca.gov. Contractor(s) shall certify that all employees, 6 agents, officers and subcontractor(s) have received privacy and security training before 7 accessing any PH and have received refresher training annually, as required by the 8 Agreements. 9 Article 20 10 Publicity Prohibition 11 20.1 Self-Promotion. None of the funds, materials, property, or services provided directly 12 or indirectly under this Agreement shall be used for Contractor's' advertising, fundraising, or 13 publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self- 14 promotion. 15 20.2 Public Awareness. Notwithstanding the above, publicity of the services described in 16 Article 1 of this Agreement shall be allowed as necessary to raise public awareness about the 17 availability of such specific services when approved in advance by County's DSS and DBH 18 Directors, or designees. Communication products must follow DSS graphic standards, including 19 typefaces and colors, to communicate our authority and project a unified brand. This includes all 20 media types and channels and all materials on and offline that are created as part of DSS's and 21 DBH's efforts to provide information to the public. 22 Article 21 23 Disclosure of Self-Dealing Transactions and Conflict of Interest 24 21.1 Applicability. This Article 21 applies if the Contractor(s) is operating as a 25 corporation or changes its status to operate as a corporation. 26 21.2 Duty to Disclose. If any member of the Contractor(s)' board of directors is party to a 27 self-dealing transaction, he or she shall disclose the transaction by completing and signing a 28 48 1 "Self-Dealing Transaction Disclosure Form" (Exhibit O to this Agreement) and submitting it to 2 the County before commencing the transaction or immediately after. 3 21.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor(s) 4 is a party and in which one or more of its directors, as an individual, has a material financial 5 interest. 6 21.4 Conflict of Interest. No officer, employee or agent of the County who exercises any 7 function or responsibility for planning and carrying out of the services provided under this 8 Agreement shall have any direct or indirect personal financial interest in this Agreement. In 9 addition, no employee of the County shall be employed by the Contractor(s) under this 10 Agreement to fulfill any contractual obligations with the County. The Contractor(s) shall comply 11 with all Federal, State of California and local conflict of interest laws, statutes and regulations, 12 which shall be applicable to all parties and beneficiaries under this Agreement and any officer, 13 employee or agent of the County. 14 Article 22 15 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion- 16 Lower Tier Covered Transactions 17 22.1 County and Contractor(s) recognize that Contractor(s) is a recipient of State or 18 Federal assistance funds under the terms of this Agreement. By signing this Agreement, 19 Contractor(s) agrees to comply with applicable Federal suspension and debarment regulations, 20 including but not limited to: 7 CFR 3016.35, 29 CRF 97.35, 45 CFR 92.35, and Executive Order 21 12549. By signing this Agreement, Contractor(s) attests to the best of its knowledge and belief, 22 that it and its principals: 23 (A) Are not presently debarred, suspended, proposed for debarment, declared 24 ineligible, or voluntarily excluded from participation in this transaction by any Federal 25 department or agency; and 26 (B) Shall not knowingly enter into any lower tier covered transaction with an entity or 27 person who is debarred, suspended, proposed for debarment, declared ineligible, or 28 49 1 voluntarily excluded from participation in this transaction by any Federal department or 2 agency. 3 (C) Contractor(s) shall provide immediate written notice to County if at any time 4 during the term of this Agreement Contractor(s) learns that the representations it makes 5 above were erroneous when made or have become erroneous by reason of changed 6 circumstances. 7 22.2 Contractor(s) shall include a clause titled "Certification Regarding Debarment, 8 Suspension, Ineligibility, and Voluntary Exclusion — Lower Tier Covered Transactions" and 9 similar in nature to this Article 22 in all lower tier covered transactions and in all solicitations for 10 lower tier covered transactions. 11 22.3 Contractor(s) shall, prior to soliciting or purchasing goods and services in excess of 12 $25,000 funded by this Agreement, review and retain the proposed vendor's suspension and 13 debarment status at https:Hsam.gov/SAM/. 14 22.4 The certification in Article 22 of this Agreement is a material representation of fact 15 upon which County relied in entering into this Agreement. 16 Article 23 17 Disclosure of Ownership and/or Control Interest Information 18 23.1 Applicability. This provision is only applicable if Contractor(s) is disclosing entities, 19 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.), 20 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2). 21 23.2 Duty to Disclose. Contractor(s) must disclose the following information as 22 requested in the Provider Disclosure Statement, Disclosure of Ownership and Control Interest 23 Statement, Exhibit P: 24 (A) Disclosure of 5% or More Ownership Interest: 25 (1) In the case of corporate entities with an ownership or control interest in the 26 disclosing entity, the primary business address as well as every business location and P.O. Box address must be disclosed. In the case of an individual, the date of 27 birth and Social Security number must be disclosed. 28 50 1 (2) In the case of a corporation with ownership or control interest in the 2 disclosing entity or in any subcontractor(s) in which the disclosing entity has a five 3 percent (5%) or more interest, the corporation tax identification number must be disclosed. 4 (3) For individuals or corporations with ownership or control interest in any 5 subcontractor(s) in which the disclosing entity has a five percent (5%) or more 6 interest, the disclosure of familial relationship is required. 7 (4) For individuals with five percent (5%) or more direct or indirect ownership 8 interest of a disclosing entity, the individual shall provide evidence of completion of a criminal background check, including fingerprinting, if required by law, prior to 9 execution of Contract. (42 C.F.R. §455.434) 10 (B) Disclosures Related to Business Transactions: 11 (1) The ownership of any subcontractor(s) with whom Contractor(s) has had 12 business transactions totaling more than $25,000 during the 12-month period ending 13 on the date of the request. (2) Any significant business transactions between Contractor(s) and any wholly 14 owned supplier, or between Contractor(s) and any subcontractor(s), during the 5- 15 year period ending on the date of the request. (42 C.F.R. § 455.105(b).) 16 (C) Disclosures Related to Persons Convicted of Crimes: 17 (1) The identity of any person who has an ownership or control interest in the 18 provider or is an agent or managing employee of the provider who has been convicted of a criminal offense related to that person's involvement in any program 19 under the Medicare, Medicaid, or the Title XXI services program since the inception 20 of those programs. (42 C.F.R. § 455.106.) 21 (2) County shall terminate the enrollment of Contractor(s) if any person with five 22 percent (5%) or greater direct or indirect ownership interest in the disclosing entity 23 has been convicted of a criminal offense related to the person's involvement with Medicare, Medicaid, or Title XXI program in the last 10 years. 24 23.3 Contractor(s) must provide disclosure upon execution of Contract, extension for 25 renewal, and within thirty-five (35) days after any change in Contractor(s) ownership or upon 26 request of County. County may refuse to enter into an agreement or terminate an existing 27 agreement with Contractor(s) if Contractor(s)fails to disclose ownership and control interest 28 51 1 information, information related to business transactions and information on persons convicted 2 of crimes, or if Contractor(s) did not fully and accurately make the disclosure as required. 3 23.4 Contractor(s) must provide the County with written disclosure of any prohibited 4 affiliations under 42 C.F.R. § 438.610. Contractor(s) must not employ or subcontract with 5 providers or have other relationships with providers Excluded from participation in Federal 6 Health Care Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42 7 C.F.R. §438.610. 8 23.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to 9 DBHContractedServices@fresnocountyca.gov. County may deny enrollment or terminate this 10 Agreement where any person with five (5) percent or greater direct or indirect ownership interest 11 in Contractor(s) has been convicted of a criminal offense related to that person's involvement 12 with the Medicare, Medicaid, or Title XXI program in the last ten (10) years. County may 13 terminate this Agreement where any person with five (5) percent or greater direct or indirect 14 ownership interest in the Contractor(s) did not submit timely and accurate information and 15 cooperate with any screening method required in CFR, Title 42, Section 455.416 16 Article 24 17 Disclosure of Criminal History and Civil Actions 18 24.1 Applicability. Contractor(s) is required to disclose if any of the following conditions 19 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively 20 referred to as "Contractor(s)"): 21 (A) Within the three (3) year period preceding the Agreement award, they have been 22 convicted of, or had a civil judgment tendered against them for: 23 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain, 24 or performing a public (federal, state, or local) transaction or contract under a public 25 transaction; 26 (2) Violation of a federal or state antitrust statute; 27 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records; 28 or 52 1 (4) False statements or receipt of stolen property. 2 (B) Within a three (3) year period preceding their Agreement award, they have had a 3 public transaction (federal, state, or local) terminated for cause or default. 4 24.2 Duty to Disclose. Disclosure of the above information will not automatically 5 eliminate Contractor(s) from further business consideration. The information will be considered 6 as part of the determination of whether to continue and/or renew this Agreement and any 7 additional information or explanation that Contractor(s) elects to submit with the disclosed 8 information will be considered. If it is later determined that the Contractor(s)failed to disclose 9 required information, any contract awarded to such Contractor(s) may be immediately voided 10 and terminated for material failure to comply with the terms and conditions of the award. 11 Contractor(s) must sign a "Certification Regarding Debarment, Suspension, and Other 12 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit Q. 13 Additionally, Contractor(s) must immediately advise the County in writing if, during the term of 14 the Agreement: (1) Contractor(s) becomes suspended, debarred, excluded or ineligible for 15 participation in Federal or State funded programs or from receiving federal funds as listed in the 16 excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions 17 become applicable to Contractor(s). Contractor(s) shall indemnify, defend, and hold County 18 harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility, 19 or other matter listed in the signed Certification Regarding Debarment, Suspension, and Other 20 Responsibility Matters. 21 Article 25 22 Cultural and Linguistic Competency 23 25.1 General.All services, policies and procedures must be culturally and linguistically 24 appropriate. Contractor(s) must participate in the implementation of the most recent Cultural 25 Competency Plan for the County and shall adhere to all cultural competency standards and 26 requirements. Contractor(s) shall participate in the County's efforts to promote the delivery of 27 services in a culturally competent and equitable manner to all individuals, including those with 28 limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and 53 1 regardless of gender, sexual orientation, or gender identity including active participation in the 2 County's Diversity, Equity and Inclusion Committee. 3 25.2 Policies and Procedures. Contractor(s) shall comply with requirements of policies 4 and procedures for ensuring access and appropriate use of trained interpreters and material 5 translation services for all limited and/or no English proficient beneficiaries, including, but not 6 limited to, assessing the cultural and linguistic needs of the beneficiaries, training of staff on the 7 policies and procedures, and monitoring its language assistance program. Contractor(s)' 8 policies and procedures shall ensure compliance of any subcontracted providers with these 9 requirements. 10 25.3 Interpreter Services. Contractor(s) shall notify its beneficiaries that oral 11 interpretation is available for any language and written translation is available in prevalent 12 languages and that auxiliary aids and services are available upon request, at no cost and in a 13 timely manner for limited and/or no English proficient beneficiaries and/or beneficiaries with 14 disabilities. Contractor(s) shall avoid relying on an adult or minor child accompanying the 15 beneficiary to interpret or facilitate communication; however, if the beneficiary refuses language 16 assistance services, the Contractor(s) must document the offer, refusal, and justification in the 17 beneficiary's file. 18 25.4 Interpreter Qualifications. Contractor(s) shall ensure that employees, agents, 19 subcontractor(s), and/or partners who interpret or translate for a beneficiary or who directly 20 communicate with a beneficiary in a language other than English (1) have completed annual 21 training provided by County at no cost to Contractor(s); (2) have demonstrated proficiency in the 22 beneficiary's language; (3) can effectively communicate any specialized terms and concepts 23 specific to Contractor's services; and (4) adheres to generally accepted interpreter ethic 24 principles. As requested by County, Contractor(s) shall identify all who interpret for or provide 25 direct communication to any program beneficiary in a language other than English and identify 26 when the Contractor(s) last monitored the interpreter for language competence. 27 25.5 CLAS Standards. Contractor(s) shall submit to County for approval, within ninety 28 (90) days from date of contract execution, Contractor's plan to address all fifteen (15) National 54 1 Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by the 2 Office of Minority Health and as set forth in Exhibit R "National Standards on Culturally and 3 Linguistically Appropriate Services". As the CLAS standards are updated, Contractor's plan 4 must be updated accordingly. As requested by County, Contractor(s) shall be responsible for 5 conducting an annual CLAS self-assessment and providing the results of the self-assessment to 6 the County. The annual CLAS self-assessment instruments shall be reviewed by the County 7 and revised as necessary to meet the approval of the County. 8 25.6 Training Requirements. Cultural competency training for Contractor(s) staff should 9 be substantively integrated into health professions education and training at all levels, both 10 academically and functionally, including core curriculum, professional licensure, and continuing 11 professional development programs. As requested by County, Contractor(s) shall report on the 12 completion of cultural competency trainings to ensure direct service providers are completing a 13 minimum of twelve (12) hours of cultural competency training annually. 14 25.7 Continuing Cultural Competence. Contractor(s) shall create and sustain a forum 15 that includes staff at all agency levels to discuss cultural competence. Contractor(s) shall 16 designate a representative from Contractor's team to attend County's Diversity, Equity and 17 Inclusion Committee. 18 Article 26 19 General Terms 20 26.1 Modification. Except as provided in Article 7, "Termination and Suspension," this 21 Agreement may not be modified, and no waiver is effective, except by written consent by both 22 parties. The Contractor(s) acknowledges that County employees have no authority to modify 23 this Agreement except as expressly provided in this Agreement. 24 (A) Notwithstanding the above, non-material changes to services, staffing, and 25 responsibilities of the Contractor(s), as needed, to accommodate changes in the laws 26 relating to service requirements and specialty mental health treatment, may be made 27 with the signed written approval of County's DSS and DBH Directors, or designees, and 28 55 1 Contractor(s). Said modifications shall not result in any change to the maximum 2 compensation amount payable to Contractor(s), as stated herein. 3 (B) In additional, changes to service rates on Exhibit S that do not exceed three 4 percent (3%) of the approved rate, or that are needed to accommodate state-mandated 5 rate increases, may be made with the written approval of the DBH Director, or designee. 6 These rate changes may not add or alter any other terms or conditions of the 7 Agreement. Said modifications shall not result in any change to the annual maximum 8 compensation amount payable to Contractor(s), as stated herein. 9 (C) Changes to line items in the Exhibit C, Compensation, in an amount not to 10 exceed 10% of the maximum annual compensation payable to the Contractor(s) may be 11 made with the written approval of County's DSS and DBH Directors or their designees. 12 Said modifications shall not result in any changes to the maximum compensation 13 amount payable to Contractor(s), as stated in this Agreement. 14 (D) Contractor(s) agrees that reductions to the maximum compensation set forth 15 under Article 3 of this Agreement may be necessitated by a reduction in funding from 16 State or Federal sources. Any such reduction to the maximum compensation may be 17 made with the written approval of County's DSS Director or their designee and 18 Contractor(s). Contractor(s) further understands that this Agreement is subject to any 19 restriction, limitations, or enactments of all legislative bodies which affect the provisions, 20 term, or funding of this Agreement in any manner. If the parties do not provide written 21 approval for modification due to reduced funding, this Agreement may be terminated in 22 accordance with Section 7.1 above. 23 26.2 Contractor's Name Change. An amendment, assignment, or new agreement is 24 required to change the name of Contractor(s) as listed on this Agreement. Upon receipt of legal 25 documentation of the name change, County will process the agreement. Payment of invoices 26 presented with a new name cannot be paid prior to approval of said agreement. 27 26.3 Public Information. Contractor(s) shall disclose County as a funding source in all 28 public information and program materials developed in support of contracted services. 56 1 26.4 Non-Assignment. Neither party may assign its rights or delegate its obligations 2 under this Agreement without the prior written consent of the other party. Any transferee, 3 assignee or subcontractor(s) will be subject to all applicable provisions of this Agreement, and 4 all applicable State and Federal regulations. Contractor(s) shall be held primarily responsible by 5 County for the performance of any transferee, assignee or subcontractor(s) unless otherwise 6 expressly agreed to in writing by County. The use of subcontractor(s) by Contractor(s) shall not 7 entitle Contractor(s) to any additional compensation than provided for under this Agreement. 8 26.5 Governing Law. The laws of the State of California govern all matters arising from 9 or related to this Agreement. 10 26.6 Jurisdiction and Venue. This Agreement is signed and performed in Fresno 11 County, California. Contractor(s) consents to California jurisdiction for actions arising from or 12 related to this Agreement, and, subject to the Government Claims Act, all such actions must be 13 brought and maintained in Fresno County. 14 26.7 Construction. The final form of this Agreement is the result of the parties' combined 15 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be 16 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement 17 against either party. 18 26.8 Days. Unless otherwise specified, "days" means calendar days. 19 26.9 Headings. The headings and section titles in this Agreement are for convenience 20 only and are not part of this Agreement. 21 26.10 Severability. If anything in this Agreement is found by a court of competent 22 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in 23 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of 24 this Agreement with lawful and enforceable terms intended to accomplish the parties' original 25 intent. 26 26.11 Nondiscrimination. During the performance of this Agreement, the Contractor(s) 27 shall not unlawfully discriminate against any employee or applicant for employment, or recipient 28 of services, because of race, religious creed, color, national origin, ancestry, physical disability, 57 1 mental disability, medical condition, genetic information, marital status, sex, gender, gender 2 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to 3 all applicable State of California and federal statutes and regulation. 4 Contractor(s) shall take affirmative action to ensure that services to intended Medi-Cal 5 beneficiaries are provided without use of any policy or practice that has the effect of 6 discriminating on the basis of race, color, religion, ancestry, marital status, national origin, ethnic 7 group identification, sex, sexual orientation, gender, gender identity, age, medical condition, 8 genetic information, health status or need for health care services, or mental or physical 9 disability. 10 (A) Domestic Partners and Gender Identity. For State fund-funded contracts of 11 $100,000 or more, Contractor(s) certifies that it complies with Public Contract Code 12 Section 10295.3. 13 (B) Americans with Disabilities Act. Contractor(s) shall comply with the Americans 14 with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of 15 disability, as well as all applicable regulations and guidelines issued pursuant to the ADA 16 (42 U.S.C. 12101 et seq.). 17 (C) Contractor(s) shall include the non-discrimination and compliance provisions of 18 this section in all subcontracts to perform work under this Agreement. 19 26.12 Limited English Proficiency. Contractor(s) shall provide interpreting and translation 20 services to persons participating in Contractor(s)' services who have limited or no English 21 language proficiency, including services to persons who are deaf or blind. Interpreter and 22 translation services shall be provided as necessary to allow such participants meaningful 23 access to the programs, services and benefits provided by Contractor(s). Interpreter and 24 translation services, including translation of Contractor's "vital documents" (those documents 25 that contain information that is critical for accessing Contractor's services or are required by law) 26 shall be provided to participants at no cost to the participant. Contractor(s) shall ensure that any 27 employees, agents, subcontractor(s), or partners who interpret or translate for a program 28 participant, or who directly communicate with a program participant in a language other than 58 1 English, demonstrate proficiency in the participant's language and can effectively communicate 2 any specialized terms and concepts peculiar to Contractor's services. 3 26.13 Drug-Free Workplace Requirements. For purposes of this paragraph, 4 Contractor(s) will be referred to as the "grantee". By drawing funds against this grant award, the 5 grantee is providing the certification that it is required by regulations implementing the Drug- 6 Free Workplace Act of 1988, 45 CFR Part 76, Subpart F. These regulations require certification 7 by grantees that they will maintain a drug-free workplace. False certification or violation of the 8 certification shall be grounds for suspension of payments, suspension or termination of grants, 9 or government wide suspension or debarment. Contractor(s) shall also comply with the 10 requirements of the Drug-Free Workplace Act of 1990 (California Government Code section 11 8350 et seq.). 12 26.14 Clean Air Act and the Federal Water Pollution Control Act. If the compensation 13 to be paid by the County under this Agreement exceeds One Hundred Fifty Thousand and 14 No/100 Dollars ($150,000) of Federal funding, Contractor(s) agrees to comply with all applicable 15 standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671 q) 16 and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations 17 must be reported to the Federal awarding agency and the Regional Office of the Environmental 18 Protection Agency (EPA). 19 26.15 Procurement of Recovered Materials. If compensation to be paid by the County 20 under this Agreement is funded in whole or in part with Federal funding, In the performance of 21 this Agreement, Contractor(s) shall comply with section 6002 of the Solid Waste Disposal Act, 22 as amended by the Resource Conservation and Recovery Act. The requirements of Section 23 6002 include procuring only items designated in guidelines of the Environmental Protection 24 Agency (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials 25 practicable, consistent with maintaining a satisfactory level of competition, where the purchase 26 price of the item exceeds $10,000 or the value of the quantity acquired during the preceding 27 fiscal year exceeded $10,000; procuring solid waste management services in a manner that 28 59 1 maximizes energy and resource recovery; and establishing an affirmative procurement program 2 for procurement of recovered materials identified in the EPA guidelines. 3 26.16 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation 4 of the Contractor(s) under this Agreement on any one or more occasions is not a waiver of 5 performance of any continuing or other obligation of the Contractor(s) and does not prohibit 6 enforcement by the County of any obligation on any other occasion. 7 26.17 Child Support Compliance Act. If compensation to be paid by the County under 8 this Agreement includes State funding in excess of$100,000, the Contractor(s) acknowledges 9 in accordance with Public Contract Code 7110, that: 10 (A) Contractor(s) recognizes the importance of child and family support obligations 11 and shall fully comply with all applicable state and federal laws relating to child and 12 family support enforcement, including, but not limited to, disclosure of information and 13 compliance with earnings assignment orders, as provided in Chapter 8 (commencing 14 with section 5200) of Part 5 of Division 9 of the Family Code; and 15 (B) Contractor(s) to the best of its knowledge is fully complying with the earnings 16 assignment orders of all employees and is providing the names of all new employees to 17 the New Hire Registry maintained by the California Employment Development 18 Department. 19 26.18 Priority Hiring Considerations. If compensation to be paid by the County under this 20 Agreement includes State funding and services in excess of$200,000, Contractor(s) shall give 21 priority consideration in filling vacancies in positions funded by the Agreement to qualified 22 recipients of aid under Welfare and Institutions Code Section 11200, in accordance with Public 23 Contract Code Section 10353. 24 26.19 Entire Agreement. This Agreement, including its exhibits, is the entire agreement 25 between the Contractor(s) and the County with respect to the subject matter of this Agreement, 26 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements, 27 publications, and understandings of any nature unless those things are expressly included in 28 this Agreement. If there is any inconsistency between the terms of this Agreement without its 60 1 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving 2 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the 3 exhibits. 4 26.20 No Third-Party Beneficiaries. This Agreement does not and is not intended to 5 create any rights or obligations for any person or entity except for the parties. 6 26.21 Authorized Signature. The Contractor(s) represents and warrants to the County 7 that: 8 (A) The Contractor(s) is duly authorized and empowered to sign and perform its 9 obligations under this Agreement. 10 (B) The individual signing this Agreement on behalf of the Contractor(s) is duly 11 authorized to do so and his or her signature on this Agreement legally binds the 12 Contractor(s) to the terms of this Agreement. 13 26.22 Electronic Signatures. The parties agree that this Agreement may be executed by 14 electronic signature as provided in this section. 15 (A) An "electronic signature" means any symbol or process intended by an individual 16 signing this Agreement to represent their signature, including but not limited to (1) a 17 digital signature; (2) a faxed version of an original handwritten signature; or (3) an 18 electronically scanned and transmitted (for example by PDF document) version of an 19 original handwritten signature. 20 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed 21 equivalent to a valid original handwritten signature of the person signing this Agreement 22 for all purposes, including but not limited to evidentiary proof in any administrative or 23 judicial proceeding, and (2) has the same force and effect as the valid original 24 handwritten signature of that person. 25 (C)The provisions of this section satisfy the requirements of Civil Code section 26 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, 27 Part 2, Title 2.5, beginning with section 1633.1). 28 61 1 (D) Each party using a digital signature represents that it has undertaken and 2 satisfied the requirements of Government Code section 16.5, subdivision (a), 3 paragraphs (1) through (5), and agrees that each other party may rely upon that 4 representation. 5 (E) This Agreement is not conditioned upon the parties conducting the transactions 6 under it by electronic means and either party may sign this Agreement with an original 7 handwritten signature. 8 26.23 Counterparts. This Agreement may be signed in counterparts, each of which is an 9 original, and all of which together constitute this Agreement. 10 [SIGNATURE PAGE FOLLOWS] 11 12 13 14 15 16 17 18 19 20 21 // 22 23 24 25 26 // 27 28 62 1 The parties are signing this Agreement on the date stated in the introductory clause. 2 County OF FRESNO 3 4 5 Nathan Magsig, Chairman of the Board of Supervisors of the County of Fresno 6 Attest: 7 Bernice E. Seidel Clerk of the Board of Supervisors 8 County of Fresno, State of California 9 By: _ 10 Deputy 11 12 13 14 15 16 17 For accounting use only: 18 Org No.: 56107480 Account No.: 7870 19 Fund No.: 0001 Subclass No.: 10000 20 21 22 Please see additional 23 signature page attached. 24 25 26 27 28 63 ii Docusign Envelope ID: B61B1631-FD9F-4A68-ADDC-8BDF70347BD7 1 Aspiranet, Inc. 2 DocuSigned by: 3 ✓.mo„ 13 0Km 8/23/2024 4 Vernon Brown, CEO 5 1320 E. Shaw Avenue Suite 140 Fresno, CA 93710 6 7 Signed by: 8 8/23/2024 Kari turgeon, President of the Board of Directors 9 1320 E. Shaw Avenue Suite 140 10 Fresno, CA 93710 11 12 For accounting use only: 13 Org No.: 56107480 Account No.: 7870 14 Fund No.: 0001 Subclass No.: 10000 15 16 17 18 19 20 Please see additional 21 signature page attached. 22 23 24 25 26 27 28 64 1 Promesa Behavioral Health 2 3 4 Lisa Weigant, CEO 5 7120 N. Marks Avenue, Suite 110 Fresno, CA 93711 6 7 8 Erla Zuniga, CFO 9 7120 N. Marks Avenue, Suite 110 10 Fresno, CA 93711 11 12 For accounting use only: 13 Org No.: 56107480 Account No.: 7870 14 Fund No.: 0001 Subclass No: 10000 15 16 17 18 19 20 21 22 23 24 25 26 27 28 65 Exhibit A List of Contractors 1. Aspiranet, Inc. (Exhibit B-1 and C-1) 1320 E. Shaw Avenue, Suite 140 Fresno, CA 93710 Phone#: (559) 222-4969, ext. 2623 Contact for Notices: Program Director 2. Promesa Behavioral Health (Exhibit B-2 and C-2) 7120 N. Marks Avenue, Suite 110 Fresno, CA 93711 Phone#: (559) 439-5437, ext. 593 Contact for Notices: Chief Executive Officer A-1 Exhibit B-1 SCOPE OF SERVICES ORGANIZATION: Aspiranet, Inc. ADDRESS: 1320 E. Shaw Ave Ste. 140 Fresno, CA 93710 SERVICES: Enhanced Intensive Services Foster Care TELEPHONE: 559-222-4969 x 2623 CONTACT: Chad Valorosi, Program Director EMAIL: cvalorosi@aspirnet.org CONTRACT PERIOD: Upon execution - June 30, 2026 with two (2) optional one-year extensions Year 1: Upon execution — June 30, 2025 Year 2: July 1, 2025— June 30, 2026 Year 3: July 1, 2026 —June 30, 2027 Year 4: July 1, 2027 —June 30, 2028 I. BACKGROUND The Fresno County Children's Wellbeing Continuum (CWBC) is designed to offer a seamless service delivery model across multiple service levels and settings for Fresno youth with complex behavioral and emotional needs. CWBC consists of responsive, front-end service provision that supports our child welfare, juvenile probation, and behavioral health infrastructures and is designed to flexibly provide seamless step-up and step-down transition services, ensuring that children and families receive continuity of service provision even as their needs change over time. A key component of this continuum is Fresno County's Enhanced Intensive Services Foster Care (E-ISFC) program. The purpose of the E-ISFC program is to provide safe, supportive, and highly individualized treatment for every youth within the context of a loving home with skilled and caring specialized resource parents. The E-ISFC program offers a family-based alternative for youth who may otherwise be placed in a Short-Term Residential Therapeutic Program (STRTP) or for youth who historically may have had to wait for hours or days in a social worker's office while a suitable placement was identified. The E-ISFC program provides a structured and safe setting promoting stabilization and the development of therapeutic relationships with both specialized resource parents and staff, allowing the multidisciplinary team to complete an accurate assessment of the youth's needs, engage the youth in intensive treatment services, and recommend next steps toward permanency and healing. This Scope of Services is based on the current understanding of the needs of Fresno County (County) youth and the initial conceptualization of program design to best meet the needs of youth. The County and Aspiranet (Contractor) acknowledge that circumstances may arise that necessitate adjustments to the program design. In such cases, both parties agree to work together in good faith to review and, if necessary, revise this Scope of Services. Any changes to B-1-1 Exhibit B-1 this Scope of Services shall be documented in writing and agreed upon by both parties. These changes may include additions, deletions, or modifications to the services originally agreed upon. Any adjustments to this Scope of Services may have an impact on the project timeline and deliverables, which will be discussed and agreed upon by both parties before implementation. II. TARGET POPULATION Persons served will be youth considered eligible for E-ISFC placement by meeting the following criteria: 1. Must be California Welfare and Institutions Code (WIC) 300, 601, or 602; 2. Currently placed, or at risk of being placed in a licensed STRTP, psychiatric health facility or juvenile detention facility; 3. Must be receiving services through Fresno County; and 4. Youth, ages 6-17 years, or siblings sets, who are in between longer-term placements and present with complex mental or behavioral health needs who are either: a. Youth with Complex Needs Experiencing Placement Insecurity: A youth whose placement has been disrupted and who needs an immediate, safe, and affirming placement with Specialized Resource Parent until a longer-term placement/permanency option is secured or b. New Entries: Youth with complex needs, including sibling sets, who have just been removed from their legal caregiver due to abuse and/or neglect and need an immediate, safe, and affirming placement with Specialized Resource Parent until a longer-term placement option is secured. Additional admission criteria may be identified by the County and the Contractor. The Contractor shall accept all cases referred by the County, recognizing that the County may approve exceptions in unique situations. III. LOCATION OF SERVICES Services will be provided at Contractor's clinic site, in the community, at home, and at education locations, whichever is most comfortable for the youth and family. Contractor must also be capable of offering services through telehealth-phone and telehealth-video, should the need arise. IV. HOURS OF OPERATION Contractors' office(s) shall be open Monday through Friday, 8:00 a.m. to 5:00 p.m., with services available on evenings and weekends, if required to meet the unique needs of the youth and family. At least fifty percent (50%) of services will be provided in the community and shall be scheduled on days and times that are convenient for the families, including evenings and weekends. B-1-2 Exhibit B-1 Youth and E-ISFC Specialized Resource Parents also have access to the Contractor's on-call crisis support twenty-four hours a day, seven days a week (24/7). The Contractor's on-call worker, in consultation with a supervisor and Fresno County Child Welfare System (CWS) Supervisor if needed, will determine the level of support needed to address the crisis. Support ranges from telephone support and coaching to an immediate in-person response by staff. V. DESCRIPTION OF SERVICES - CONTRACTOR RESPONSIBILITIES Contractor shall perform all services and fulfill all requirements identified in this Scope of Services. The following are highlights and/or further defined/updated responsibilities applicable to the E-ISFC program. Contractor shall provide a level of service and support that will reflect each youth's unique and individual needs. A. Specialty Mental Health Services 1. Contractor shall provide the following services to all youth in the program. Services will include but are not limited to the following: i. Provide support to the youth's family and other members of the youth's social network to help them manage the symptoms and illness of the youth and reduce the level of family and social stress associated with the illness; ii. Make appropriate referrals and linkages to services that are beyond that of Contractor's services under this Agreement, or as appropriate when discharging/transitioning a youth from the program; iii. Coordinate services with any other community mental health and non-mental health providers as well as other medical professionals; iv. Assist youth/family with accessing all entitlements or benefits for which they are eligible (i.e., Medi-Cal, SSI, Section 8 vouchers, etc.); V. Develop family support and involvement whenever possible; vi. Refer youth/family to supported education and employment opportunities, as appropriate; vii. Provide or link to transportation services when it is critical to initially access a support service or gain entitlements or benefits; and viii. Provide peer support activities, as appropriate. 2. Contractor shall deliver a comprehensive Specialty Mental Health program. Services include, but are not limited to: i. Assessment; ii. Treatment or care planning/goal setting; iii. Pediatric Symptom Checklist (PSC) 35 and the clinically appropriate version of the Child and Adolescent Needs and Strengths (CANS) assessment; B-1-3 Exhibit B-1 iv. Individual therapy; V. Group therapy; vi. Family therapy; vii. Case management; viii. Consultation; ix. Medication support services; X. Hospitalization/Post Hospitalization Support; A. Certified Peer Support Services; and xii. Intensive Home-Based Services (IHBS), as appropriate. 3. Contractor will ensure that all services: i. Are determined in collaboration with youth and family and reflect the voice and choice and cultural practices of the youth and family; ii. Be values-driven, strengths-based, individual-driven, trauma-informed, and co- occurring capable; iii. Be culturally and linguistically competent; iv. Be age, culture, gender, and language appropriate; and V. Include accommodations for youth with physical disability(ies) 4. Methods for service coordination and communication between program and other service providers shall be developed and implemented consistent with Fresno County Mental Health Plan (MHP) confidentiality rules. 5. Contractor shall maintain up-to-date caseload records of all youth enrolled in services, and provide individual, programmatic, and other demographic information to County as requested. 6. Contractor shall ensure billable Specialty Mental Health Services meet any/all County, State, Federal regulations including any utilization review and quality assurance standards and provide all pertinent and appropriate information in a timely manner to Fresno County Department of Behavioral Health (DBH)for the purpose of billing Medi-Cal for services rendered. B. Enhanced Intensive Services Foster Care (E-ISFC) Model 1. Contractor shall provide E-ISFC services for up to eight (8) youth at any given time. Services shall be highly coordinated, individualized, unconditional, and assist youth and families in addressing identified needs. To maintain familial connections, a sibling set, with one (1) youth presenting with complex mental or behavioral health needs, may be eligible for placement in a E-ISFC home with Specialized Resource Parent consent. 2. Services shall emphasize the strengths of the youth and youth's family. B-1-4 Exhibit B-1 3. Ensure that each E-ISFC team provides five (5) phases of effective E-ISFC care coordination and supportive services, including: i. Referral Process: 1) All youth referred to the E-ISFC services will have pre-approval from the County. 2) Ensure that a qualified staff person is available by phone and electronic communication 24 hours/day, 7 days/week to accept referrals from the county. Response time to referral calls will not exceed 15 minutes. 3) Review referral packet and seek any additional information necessary to match the youth with an E-ISFC family. Utilizing referral information, begin developing an initial safety, staffing, and supervision plan. ii. Intake: 1) Complete consent, admission, and intake documentation a. The youth's Social Worker (assigned or placing) will be required to sign all admission/intake documents as required by the provider prior to the commencement of the placement. b. E-ISFC resource parents who are designated as Fresno County E- ISFC homes are to be available to accept placements within 48 hours of referral. 2) Welcome the child to the home and attend to basic needs. a. Contractor and Specialized Resource Parent are to welcome the youth in a way that is unique to the family and is sensitive to the youth's trauma history while also attending to their basic needs such as food, clothing, and hygiene products. 3) Determine Appropriate Intake Staff Support Levels for Placement. a. Prior to commencement of placement, a clinical team member (social worker or clinician) and/or a program administrator (program supervisor, clinical director, assistant director, program director)will review the referral information to determine if the baseline intake staffing level should be increased until the preliminary assessment can be completed. b. The program will ensure robust staffing support for the E-ISFC home for at least the first 24 hours of the placement. One-to-one staffing (or higher) will continue until the social worker or clinician completes a preliminary assessment and treatment plan. Staffing levels may change only after the first 24-hour period. i. A minimum of one E-ISFC staff person will be in the home and awake at all times for at least the first 24 hours. ii. In-home support staff will be responsible for supporting Specialized Resource Parent with care and supervision tasks, establishing rapport with youth, gathering initial intake assessment information, and providing direct behavioral intervention, including crisis intervention if needed. B-1-5 Exhibit B-1 iii. Supervision checks of the youth will be conducted and documented at intervals not to exceed 15 minutes, including while the youth is asleep, for at least the first 24 hours of the placement or until the preliminary assessment completed, whichever is greater. c. Recommendations by the youth's placing agency worker or another member of the youth's CFT for additional staffing above the intake baseline staffing level will be implemented. d. If at any point, the resource parent and/or staff member determines that increased staff support is necessary to ensure the safety and stability of the youth and those around them, additional E-ISFC staff will be sent to the home within 30 minutes. 4) Develop preliminary assessment and preliminary service plan to inform initial service level. a. Within one (1) business day following the date of admission, the E- ISFC clinician will meet face-to-face with the youth to begin to establish rapport and develop a preliminary assessment and service plan for the first 30 calendar days. The service plan may be updated within the first 30 calendar days, as needed. The Contractor shall submit to the County a template of the written preliminary assessment and diagnostic report for review and approval prior to the commencement of service. iii. Assessment: 1) The comprehensive assessment process will include but is not limited to: a clinical analysis of the youth's history, current status of the youth's mental, emotional, or behavioral disorder, relevant cultural issues and history, diagnosis, and use of any testing procedures. 2) The E-ISFC clinician is responsible for completing a CANS for each youth enrolled for more than 7 days. The CANS shall be completed within 30 calendar days of intake or by the discharge date if the discharge occurs prior to the 30th day of the placement. If a youth has had a CANS completed within the past six months prior to admission, the Contractor will be responsible for reviewing the youth's completed CANS, regardless of the anticipated length of stay, and updating as necessary within 30 calendar days of intake or by the date of discharge if discharge occurs prior to the 30th day. iv. Treatment: The E-ISFC treatment model includes four core methods of intervention. 1) Parental care and supervision i. At least one fully trained Specialized Resource Parent is available to accept placements and has the availability to meet all the requirements of providing these intensive services. Integral to a multi-disciplinary team, resource parents provide services in therapeutic home settings for youth in alignment with the E-ISFC placement program as an alternative to congregate, residential care. B-1-6 Exhibit B-1 ii. Specialized Resource Parents engage directly with the youth and the Permanency Specialist to construct a workable, sustainable kinship placement. iii. The Specialized Resource Parent provides structure, routine, and clear expectations to youth placed in their home. iv. The Specialized Resource Parent collaborates with the other E-ISFC team members, including the social worker/clinician and support counselors, to learn and apply behavioral interventions and engage in the youth's treatment needs, as well as the child and family teaming. V. The Specialized Resource Parent supports the youth in meaningful activities and trauma mitigating activities. vi. Support is provided to each Specialized Resource Parent from the clinician and support counselor. vii. Each Specialized Resource Parent is assigned a master's level SW who is responsible for supporting the Specialized Resource Parents through mentorship, training, oversight, encouragement, and collaborative problem-solving. viii. SW will meet with Specialized Resource Parents at least weekly or more as needed. 2) Advanced clinical services i. Specific services provided by the E-E-ISFC Clinician include but are not limited to: assessment, individual therapy, crisis intervention, plan development, collateral services, Child and Family Team participation and facilitation, case management/intensive care coordination, transition planning, and clinical documentation. ii. Medication support services will be provided as needed. iii. E-ISFC clinician will meet with youth in-person at least two times per week and is responsible for guiding the clinical services for the youth. iv. The E-ISFC clinician is responsible for completing a comprehensive services plan (treatment plan) for youth who stay in the program for more than 30 days. 3) Therapeutic behavioral health support and supervision i. Youth will receive a minimum of 21 hours per week of therapeutic behavioral support and supervision. ii. Support counselors are responsible for the implementation of methods outlined in the youth's service plan. B-1-7 Exhibit B-1 iii. Therapeutic behavioral support and supervision may be provided at any hour of the day, any day of the week based on the service plan and needs of the youth. iv. The provider is responsible for documenting direct services and billing for all Specialty Mental Health Services provided. 4) Advancing permanency and connectedness i. The E-ISFC permanency specialist is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. ii. The permanency specialist is responsible for conducting thorough case record review and family finding searches. They will also work with Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact while documents progress according to the Contractors documentation procedures. V. Transition: Key components of the E-ISFC transition planning and support include: 1) The transition plan and goals are addressed in each child and family team meeting. The plan and goals will be updated as needed based on the assessed needs of the youth. 2) The E-ISFC clinician is responsible for reviewing transition goals on the services plan and revising, if necessary, at least monthly. 3) The E-ISFC team is available to support the transition goals for each youth which may include but is not limited to, supervising visits with potential future placements, transporting youth to visitation, and leading or supporting permanency work including family finding. 4) With DBH approval and if clinically appropriate, provide Specialty Mental Health Services (SMHS) until the youth is fully transitioned to the new placement and necessary mental health services. 5) In conjunction with County, develop and implement a discharge policy, in and through which, Contractor shall: i. Agree that the primary goal of the E-ISFC Program is to seek and maintain stability of youth in the lowest level of care placement setting so that they can successfully reach stabilization, no longer require intensive supervision or intensive mental health interventions, and transition to a permanent home setting. ii. Agree to serve any youth who meets eligibility criteria and parameters for placement for the full duration of the placement, regardless of the severity or complexity of their behaviors, accessing and coordinating the necessary B-1-8 Exhibit B-1 services and supports to effectively address the needs of the youth. iii. Agree to maximize communication in transition planning for youth. iv. Agree to utilize innovative approaches and all available resources to make reasonable efforts to stabilize youth in their current placement thereby reducing the likelihood of placement disruption. Consult with the appropriate CWS Division Chief/Probation Assistant Deputy Chief(ADC) to determine if additional services may prevent an unnecessary disruption of placement in the E-ISFC resource home. V. Notify the CWS or Deputy Probation Officer (DPO) and appropriate CWS Division Chief/Probation ADC or designee, via electronic mail as soon as, but not more than 1 business day after the Contractor becomes aware of an issue that may lead to a placement change. vi. Convene or participate in a case conference or CFT meeting to determine how or if the youth may be stabilized in the current E-ISFC placement and if additional services may prevent an unnecessary disruption of placement in the E- ISFC resource home. vii. Contact appropriate CWS Division Chief/Probation ADC or designee to arrange a consultation after the case conference or CFT meeting to discuss the outcome and any updates to the treatment and/or crisis intervention plan. viii. Document in advance of any anticipated placement change efforts made to stabilize and maintain the youth in placement, including provision of existing and additional mental health services and daily E-ISFC Specialized Resource Parent support including telephone check-ins and in-home crisis stabilization services. Contractor shall ensure that the Specialized Resource Parent may not refuse any mental health services determined necessary for the youth by the treatment team. ix. Provide Notice of Intent to Discharge via electronic mail to the CSW, DPO, and appropriate CWS Division Chief/Probation ADC only when all alternatives have been exhausted and after an emergency CFT has occurred, and no less than 14 days prior to the anticipated discharge date, unless it is agreed upon at the CFT that less notice is necessary to ensure the health and safety of the youth or others. X. Refer the Notice of Intent to Discharge to the Supervisor or Division Chief/ADC of the CSW or DPO, and appropriate CWS Program Administrator if the assigned contacts are not responsive to requests to grant authorization or B-1-9 Exhibit B-1 unreasonably delay authorization for the Contractor to discharge a youth. A. Monitor and deliver transitional SMHS and after care services to the youth until a transition to other mental health services have been planned and begun pursuant to DSS contract provisions. 4. Unique Situations: Contractor will ensure that every possible intervention has been exhausted prior to developing an alternative placement plan. While there may be times when it is determined that continued placement in the home is not in the best interest of the youth, we only make this determination after first considering all possible options for stabilizing the youth in the program. The stabilization planning meeting must include representatives from the provider agency and the county department(s)with the authority to make decisions in the moment regarding resources and interventions. 5. For youth dually enrolled in Wraparound and E-ISFC, the youth's CFT will determine which agency and which person is assigned as lead for the following tasks based on existing therapeutic relationships, treatment goals, and transition goals: 1) Advanced clinical services such as therapy, medication support/psychiatry, assessment; 2) Behavioral intervention/rehabilitation; 3) Case coordination such as CFT facilitation, case management, plan development; and 4) Permanency work and family finding. 6. The Contractor's E-ISFC program staff will retain responsibility for at least the following roles: 1) Parental care and supervision; 2) Care and supervision provided by support counselors, which may include rehabilitation and behavioral support aligned with the youth's service plan; 3) Crisis response; and 4) Social work responsibilities including oversight, training, support, guidance for Specialized Resource Parents. The Contractor shall have the flexibility to adjust service levels based on the needs of the youth. When youth are receiving Wraparound services, the Contractor may need to decrease service intensity and corresponding staffing levels to avoid duplication with the Wraparound provider. The Contractor shall also be flexible to increase service intensity levels when needed and as determined by the CFT. 7. Length of Stay: i. The expected length of stay for the E-ISFC is at least thirty (30) calendar days but no longer than twelve (12) months. While stated length of stay reflects general parameters, a youth's ongoing participation beyond twelve (12) months in the E-ISFC program is driven by their demonstrated need. B-1-10 Exhibit B-1 C. Crisis Services 1. Develop and implement a safety planning, response and notification plan, in and through which, Contractor: i. Shall ensure Contractor's E-ISFC staff and Specialized Resource Parents are trained to implement safety and preventive measures to avert and respond to any self- harming and/or other behaviors that pose risk to the youth or others. ii. Shall, if after all relevant safety and preventive measures have been exhausted and youth needs an emergency psychiatric assessment for acute psychiatric hospitalization or exhibits escalating behaviors indicating danger to self or others, contact the Wrap provider in the County. If the behaviors demonstrate immediate danger and safety the Contractor shall contact 911. iii. Shall ensure that E-ISFC staff or other relevant administrator notify the youth's DSS Social Worker (SW) or Deputy Probation Officer (DPO) and appropriate CWS Division Chief/Assistant Deputy Chief, or designees, via email as soon as reasonably possible, but no later than the end of the day for all incidents that indicate a sign of threat or continued risk to the physical or mental health status of the E-ISFC youth including all such incidents that require a Critical Incident Report, as outlined in the following section. iv. In the event of an emergency, Contractor may move the placed youth to another E-ISFC Respite Home of the Contractor without prior authorization from the SW or DPO. For the purposes of this paragraph, an emergency is defined as any situation that threatens the health and safety of the placed youth or others in the E-ISFC home. In the event of an emergency placement change, Contractor shall make every effort to keep the youth in the school they are currently attending. V. As soon as it is reasonably safe to do so, the Contractor shall notify the CWS hotline, the SW, DPO and appropriate CWS Division Chief/Probation ADC, or designees regarding any emergency placement changes. The Contractor shall then follow up with the SW by phone within one business day. vi. Shall discuss the situation that led to the emergency placement change with the SW, DPO or designee and document the conversation and decision in the respective case file. A CFT Meeting will be held as soon as possible after the incident to update the safety plan. vii. Shall comply with the following when youth are referred for psychiatric hospitalization, engage in elopement, experience a juvenile hall stay, or other temporary placement disruptions: viii. Notify the SW or DPO and appropriate CWS Division Chief/Probation ADC as soon as it is reasonably safe to do so, and complete a critical incident report; B-1-11 Exhibit B-1 ix. Participate in case conferences, hospital discharge conference and/or the CFT meetings for the placed youth; X. Continue to provide the services to the extent possible to the placed youth; xi. Ensure the E-ISFC Specialized Resource Parent and/or the E-ISFC staff visit the youth during the hospitalization and maintain contact by telephone unless otherwise directed by the hospital medical staff or County staff; xii. Allow youth to return to the E-ISFC program up to 5 calendar days from the placement disruption, keeping the E-ISFC bed open for 5 calendar days, unless otherwise agreed upon with the County. If, however, the 5-day bed hold expires, Contractor shall collaborate with the SW or DPO and appropriate CWS Division Chief to either extend the hold or close the placement and re-open it when the youth returns. xiii. Initiate a CFT meeting within 24 hours of youth's return to the E-ISFC home. xiv. Exceptions to the above re-admission requirements are allowed only when the CFT, including the SW or DPO, decides not to return the youth to the E-ISFC Resource Home, or when Contractor and the SW or DPO mutually agree that the re-admission jeopardizes the immediate health and safety of the youth or others in the home. In both cases, Contractor shall immediately notify the appropriate CWS Division Chief/Probation ADC or designee by telephone of the decision not to re-admit and follow up with an electronic mail message by the end of the next business day. In both cases, Contractor shall also assist in finding a new caregiver and placement within its licensed programs. 2. Shall report and document all major and/or sensitive incidents ("critical incidents") to the County pursuant to the procedures and timing outlined in Exhibit J. The County, at its sole discretion, may require the Contractor to conduct all necessary follow-up activities after reporting critical incidents. If there is any doubt about whether an incident should be reported, the default shall be for the Contractor to report the incident to the County. i. Notify DSS as soon as possible via Hotline, email and phone, but no later than twenty-four (24) hours from the time the Contractor, or an employee or agent of the Contractor, knows or has reason to believe that a critical incident has occurred or may have occurred. Include the following information in all incident reports: 1) Name and contact information of the submitting individual; 2) Name and email address of the best contact for immediate access to a Contractor staff member who can answer questions regarding the incident; 3) The name of the youth, if involved. 4) A description of the incident to include: 5) Date, time, and location of the incident; 6) Description of the events that took place; 7) Names and job titles of Contractor personnel involved in the incident, if any; 8) Description of law enforcement involvement, if any; B-1-12 Exhibit B-1 9) Description of other emergency response involvement, if any; 10)Description of any action taken by the Contractor in response to the incident; 11)An indication of whether press coverage or negative community response is likely. D. E-ISFC Specialized Resource Parents 1. Contractor will recruit, train, utilize and support ISFC Specialized Resource Parents who shall assume the roles and perform the functions of E-ISFC Specialized Resource Parents in providing the necessary care, services and supports that are identified in the individual needs and services plan. i. Make active and ongoing recruitment efforts a minimum of one (1) time per month to increase capacity for E-ISFC services with a goal to maintain a minimum of eight (8), fully trained Specialized Resource Parents prepared to accept placements, or currently providing E-ISFC services to a youth at any given time. ii. Each home will have at least one dedicated Specialized Resource Parent who is an E-ISFC caregiver, with no competing responsibilities outside the home, who is ISFC certified, and has educational, professional and/or lived experience working with youth that helps them to understand and respond to the needs of the youth placed in care. Furthermore, E-ISFC Specialized Resource Parents shall provide a safe, consistent, and structured home environment for youths 24 hours/day, 7 days/week. iii. Ensure that all recruitment efforts are targeted to individuals/populations who would likely be willing and capable of meeting the needs of children of all ethnicities, ages, sexual orientations and gender identities, immigration statuses, physical abilities, religious or spiritual beliefs, and who have a wide range of trauma histories, developmental capabilities, mental health and/or behavioral needs, and coping skills. iv. Designate a Trainer to develop and deliver pre-service and ongoing E-ISFC Specialized Resource Parent training. 1) The Trainer shall have an educational background in a relevant field (e.g., social work, psychology, child development) and experience working with similar youth in residential or foster care settings. 2) The Trainer shall demonstrate the ability to engage with families, proficiency in teaching and public speaking, and ability to collaborate with members of a team. V. Implement a Training Plan for E-ISFC Specialized Resource Parents, which shall be reviewed and approved by the County prior to implementation. The Training Plan shall specify the training requirements for E-ISFC Specialized Resource Parents that is over and above that which is required for ISFC certified parents. The plan shall include training topics to be covered, the amount of time spent on each topic, and the qualifications of the trainer. The plan shall specify both the requirements for initial training (pre-placement) and annual ongoing training. B-1-13 Exhibit B-1 Subsequent changes to the E-ISFC Specialized Resource Parent Training Plan shall be reviewed and approved by the County. vi. Ensure that E-ISFC Specialized Resource Parents have completed all ISFC and E-ISFC training requirements specified in the Contractor's Training Plan prior to the commencement of an E-ISFC placement. vii. Ensure that all Specialized Resource Parents approved to provide E-ISFC placements reside in Fresno County. Potential Specialized Resource Parents who reside in neighboring counties may provide E-E-ISFC services to Fresno County youth upon County approval. viii. Ensure that Specialized Resource Parents approved to provide E-ISFC placements are screened and selected based on their ability to meet the needs of children of all ethnicities, ages, sexual orientations and gender identities, immigration statuses, physical abilities, religious or spiritual beliefs, and who have a wide range of trauma histories, developmental capabilities, mental health and/or behavioral needs, and coping skills. ix. Ensure that E-ISFC Specialized Resource Parents have met the minimum training requirements of the CDSS for provision of ISFC level care to children/youth. X. Ensure County has an updated and accurate roster of E-ISFC resource families at all times, which reflects the date resource families were approved to provide both ISFC and E-ISFC services. xi. Ensure that E-ISFC Specialized Resource Parents complete all additional trainings identified as necessary by County. E. Additional Responsibilities 1. Maintain responsibility for necessary testimony and/or providing County with information needed to generate court reports, as outlined below: i. Court Reports - Documented reports of assessment and evaluation findings, progress in treatment, recommendations for treatment and service plans regarding reunification, maintenance and termination of parental rights, and justification for recommendations. ii. Court Testimony - Provide care plan updates when a court is considering reunification, maintenance, and/or termination of parental rights. 2. Upon notification of a pending court hearing, Contractor agrees to complete and submit to the County a "Periodic Review Report" twenty-one (21) calendar days prior to the court date or seven (7) calendar days after notification. 3. Maintain electronic health records and supply their own personal computers, Internet access, printers, signature pads and other network devices to meet statistical reporting requirements, report person-served and program outcomes and any State or County data requirements of the Katie A. Implementation Plan. Contractor shall also maintain capability to enter electronic billing data into County's electronic health record system. A computer with Internet access is required for both office and field-based staff. B-1-14 Exhibit B-1 4. Cooperate and participate with the County MHP in Quality Assurance/Improvement and Utilization Review Programs and grievance procedures and comply with all final determinations rendered by County's Quality Assurance/Improvement and Utilization Review Programs, unless the decision is reversed on appeal as set forth in the County MHP Provider Manual, incorporated herein by this reference. County's adverse decisions regarding Contractor's services to persons-served may result in the disallowance of payment for services rendered; or may result in additional controls to the delivery of services; or may result in the termination of this Agreement. County shall have sole discretion in the determination of Quality Assurance/Improvement and Utilization Review outcomes, decisions and actions. 5. Participate in regularly scheduled contract monitoring meetings with the County to discuss program successes and obstacles utilizing a Continuous Quality Improvement (CQI) framework. 6. Obtain signatures, as required, regarding consent: i. Care provider can sign for day trips and other minor miscellaneous items. ii. Court Order should suffice for most other items. 7. Assist with training County staff and the community in E-ISFC Service processes and service options. 8. Develop training curriculum as County identifies a need. This includes but is not limited to training curriculum for E-E-ISFC staff and Specialized Resource Parents as well as training curriculum for SWs and County staff. 9. Participate in County-offered trainings which may include but are not limited to topics such as Quality Parenting Initiative and The Neuro-sequential Model of Therapeutics (NMT). 10. Provide annual Civil Rights training to all staff at the beginning of every calendar year and will provide verification of training completion to DSS. DSS will provide documents needed for annual training and reporting. 11. Have and maintain in good standing an active California Department of Social Services (CDSS) issued license as a Foster Family Agency (FFA). 12. Work collaboratively with other CWBC providers to develop and enter into Memorandum of Understanding or other business agreements between themselves that defines the processes and procedures for provision of services to foster youth, including, but not limited to the: i. Case Planning ii. Care Coordination iii. Intensive Transition Planning iv. Assessment V. Transportation between service settings vi. Information sharing vii. Data collection and dissemination 13. Work with DPO on criminogenic risk factors for probation youth as addressed through contracted services as applicable. VI. STAFFING A. Staffing shall be appropriate and aligned with the E-ISFC service model, and shall include E-ISFC teams which shall be comprised of the following classifications: Specialized B-1-15 Exhibit B-1 Resource Parent(s), Clinician/Social Worker, Lead Support Counselor, Support Counselor, and Permanency Specialist: 1) Specialized Resource Parent(s): One (1) fully trained E-ISFC Resource Parent is available to accept placements and has the availability to meet all the requirements of providing these intensive services. Integral to a multi- disciplinary team, specialized resource parents provide services in therapeutic home settings for youth in alignment with the E-ISFC model as an alternative to congregate, residential care. Specialized Resource Parent collaborates with the other E-ISFC team members, including the Social Worker/Clinician and Support Counselors, to learn and apply behavioral interventions and engage in the youth's treatment needs, as well as the Child and Family Team. The Specialized Resource Parent(s) supports the youth's engagement in meaningful activities and meets with other Team members. The overarching goal is to support the youth's transition to permanency. 2) E-ISFC Social Worker: A Master's level Social Worker is responsible for supporting the parents through mentorship, training, oversight, encouragement, and collaborative problem-solving. Social Workers meet with Specialized Resource Parents at least weekly, or more as needed. Specific services provided by the Social Worker include, but are not limited to: • Support and monitor the resource parent in implementing specific interventions specified in the youth's services plan. • Provide training in the home related to practices such as trauma- informed and behavioral interventions • Monitor the parent's compliance with all regulatory requirements including licensing and accreditation standards. • Facilitate support groups and didactic training with multiple resource parents. • Provide motivational encouragement and emotional support to parents. • Social Worker shall provide a minimum of four (4) direct service hours per week/per youth. 3) E-ISFC Clinician: Supervised by a Clinical Director, the E-ISFC Clinician meets with each youth in-person at least two times per week and is the primary person responsible for guiding the clinical services for each youth. Specific services provided by the Clinician include, but are not limited to: • Assessment • Individual therapy • Family therapy • Crisis intervention • Plan development • Collateral services • Child and Family Team participation and facilitation • Case management/Intensive Care Coordination • Transition planning B-1-16 Exhibit B-1 • Clinical documentation • Clinician shall provide a minimum of four (4) direct service hours per week/per youth. 4) Support Counselor(s): A minimum of two (2) Support Counselors shall meet with the youth to provide one-on-one support, focusing on increasing the frequency of desired behaviors, gaining access to pro-social activities and resources within the community, and developing effective relationship- building skills, emotional regulation, conflict resolution skills. • Support Counselor(s) shall provide a combined minimum of twenty-one (21) direct service hours per week/per youth of therapeutic behavioral support and supervision based on each youth's unique level of need. • Therapeutic behavioral support and supervision may be provided at any hour of the day, any day of the week based on the service plan and needs of the youth. The provider is responsible for documenting direct services and billing for all Specialty Mental Health Services provided. 5) Permanency Specialist: Permanency Specialist has the responsibility of supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. The Permanency Specialist works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress according to the provider's documentation procedures. • Permanency Specialist shall provide a minimum of two (2) direct service hours per week/per youth. 6) Ensure each E-ISFC team has access to: • One (1) Psychiatrist to meet with the Person served to provide evaluation and assessment for psychotropic medication, clinical consultation, and assistance linking the Person served and their Specialized Resource Parent to ongoing psychiatric services and support as needed and prioritizing continuity of care where possible. • Family/Parent Partner, Youth Peer Partner, Individual Therapist, Family Therapist, Nurse, as needed. B. Ensure that direct service staff reimbursed through this contract shall spend at least 65% of their paid work time providing and documenting direct service to clients or on behalf of clients. Administrative staff meetings, supervision meetings, and staff trainings shall not be included in the 65%. B-1-17 Exhibit B-1 C. The Contractor shall ensure its E-ISFC staff meets the State's ISFC qualifications, training, and duty requirements as outlined in WIC 18358 or other statutes relevant to ISFC as well as the County's FFA Master Contract requirements where they are more restrictive than those of the State ISFC regulations. For any waivers or exceptions to these requirements that are allowed by state regulation, Contractor shall submit a request for such approval to DSS before allowing the staff in question to begin delivering the service. VII. COUNTY RESPONSIBILITIES: County shall: A. Assist Contractors' efforts to evaluate the needs of each enrolled youth on an ongoing basis to ensure each youth is receiving clinically appropriate services. B. Provide oversight and collaborate with contractors and other County Departments and community agencies to help achieve State program goals and outcomes. Oversight includes, but is not limited to, contract monitoring and coordination with the State Department of Health Care Services (DHCS) and California Department of Social Services (CDSS) in regard to program administration and outcomes. C. Assist Contractors in making linkages with the total mental health system of care. This will be accomplished through regularly scheduled meetings as well as formal and informal consultation. D. Participate in evaluating overall program progress and efficiency and be available to contractors for ongoing consultation. E. Gather outcome information from target youth groups and Contractors throughout each term of this Agreement. County shall notify contractors when their participation is required. The performance outcome measurement process will not be limited to survey instruments but will also include, as appropriate, youth and staff interviews, chart reviews, and other methods of obtaining required information. F. Assist Contractors' efforts toward cultural and linguistic competency by providing the following to contractors: 1. Technical assistance and training regarding cultural competency requirements at no cost to contractors. 2. Mandatory cultural competency training for contractors' personnel, on an annual basis, at minimum. 3. Technical assistance for translating information into County's threshold languages (Spanish and Hmong). Translation services and costs associated will be the responsibility of contractors. VIII. REPORTS Contractor shall track data and provide reporting on the following items and send all applicable information and reports to the following distribution list for County staff: DSS Staff Analyst, DSS Division Chief, DSS Social Work Supervisor, and DBH Contract Analyst. 1) Contractors shall be expected to comply with all contract monitoring and compliance protocols, procedures, data collection methods, and reporting requirements conducted by County. B-1-18 Exhibit B-1 2) Contractors will be responsible for meeting with DSS/DBH on a monthly basis, or more often as agreed upon between DSS/DBH and Contractors, for contract, performance, and outcomes monitoring. 3) Contractors will be required to submit monthly reports on performance measures to the County. Report formats will be established through County/Contractor collaboration. Outcome measures may change, based on information or measures needed. Required monthly reports include: a) DSS Monthly Activity Report (MAR); and b) Other reports as established by the County 4) All reports will be due to the County by the 10t" business day of each month and will be reviewed for accuracy. (If the 1011 lands on a weekend or Holiday, reports will be due the next business day). 5) Contractor shall also provide County with additional individualized reports for each youth which may include, but are not limited to: Monthly Progress Report, Discharge Presentation, Individual Child and Family Plan Presentation Outline, and Individual Child and Family Plan (ICFP). 6) Additional reports and outcome information may be requested by County at a later date, as needed. IX. GOALS/OUTCOMES Contractor is required to submit measurable outcomes on a bi-annual basis, as identified in the DBH's Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes Measures. Performance outcome measures must be approved by DBH and DSS and satisfy all State and local mandates. County will consider Contractor performance levels when determining funding recommendations for future agreements. For the contract period, Contractor shall document all direct services to youth, transition planning efforts, permanency planning efforts, and crisis responses. County anticipates an increase in placement stability and permanency, behavioral stability, symptom reduction, strengths and resiliency, and educational stability as a result of these services. The outcomes listed in the table below will measure the success of Contractor's services. These outcomes may be modified at County's discretion. Contractor will report outcomes in each MAR or alternate method determined by County. Outcome measures are included below. Fresno County Enhanced ISFC Contract Performance Expectations Metric Outcome Indicator Retention Improved placement stability. Youth will remain in their No more than 5% of placement for the length of time that aligns with the youth in E-ISFC youth's treatment plan. homes will leave placement without pre-approval Service Decreased wait time for placement. 100% of E-ISFC Availability parents with a vacant bed are available to receive a youth into B-1-19 Exhibit B-1 their home within 48 hours of referral Service Youth in E-ISFC are receiving necessary and clinically Minimum Direct Availability appropriate services from each E-ISFC Team member: Service Hours Per Youth Per Week: Clinician/Social Worker: Advanced clinical services Clinician/Social Support Counselor(s): Therapeutic behavioral support Worker: 4 and supervision Support Counselor(s): Permanency Specialist: Advancing permanency and 21 connectedness Permanency Specialist: 2 Service Determination of youth's immediate safety needs. At least 90% of youth Timeliness enrolled have received a preliminary assessment and service plan completed by the end of the first business day following date of admission. Service Ensure timeliness of comprehensive assessment to A comprehensive Timeliness best capture youth's needs in order to provide an assessment will be individualized treatment plan. completed for 100% of youth enrolled for more than 7 calendar days. 90% of the comprehensive assessments will be completed within 30 calendar days of the date of intake, or by the date of discharge if occurs prior to the 30t" day. Service Delivery Individualized treatment plans developed for every A treatment plan is youth receiving services. completed for 100% of youth enrolled for 30 calendar days or more. B-1-20 Exhibit B-1 Crisis Response Prevention of crisis escalation, stabilization of Provider responds to placement, preservation of Specialized Resource 100% of crises that Parent-youth relationship, avoid unnecessary law require an in-person enforcement involvement, and reduce psychiatric response within 30 hospitalizations. minutes. Crisis Response Avoid re-traumatization of youth, stabilization of Provider stabilizes at placement, preservation of Specialized Resource least 75% of youth in Parent-youth relationship, avoid unnecessary law the home setting enforcement involvement, and reduce psychiatric following an in-person hospitalizations. crisis response Transition Reduction in barriers and increased support for Individualized, trauma- Planning seamless transition between levels of care for youth. informed transition plan is completed prior to discharge for 100% of enrolled youth. Contractor will provide Plan to County within one (1) business day following discharge for 100% of youth. Transition to Increased transitions of youth to the least restrictive 85% of youth enrolled less restrictive setting possible. will be transitioned to placements less restrictive placements. Permanency Youth will demonstrate increased family and natural Planning support connection and/or achievement of permanency. 90% of youth who complete the *Not applicable to youth who receive services for less discharge CANS will than 30 calendar days as a result of securing show improvement in placement or leaving without pre-approval the Permanency module of the CANS. Improved Youth will demonstrate a reduction in action items in the 90% of youth who behavioral/ Behavioral/Emotional Needs Domain, Risk Behaviors complete the emotional needs Domain and the Family Functioning and Living Situation discharge CANS will items in the Life Functioning Domain from the initial show a reduction in CANS. action items in the Behavioral/Emotional *Not applicable to youth who receive services for less Needs Domain, Risk than 30 calendar days as a result of securing Behavior Domain, and placement or leaving without pre-approval the Family Functioning and Living Situation items in the Life Functioning Domain of the CANS. B-1-21 Exhibit B-1 Improved Youth will demonstrate increased knowledge of 80% of youth who strengths emotional regulation and de-escalation skills, increased complete the family functioning and permanency, behavioral and discharge CANS will emotional stability, and decrease in maladaptive show improvement in behaviors. overall CANS score. *Not applicable to youth who receive services for less than 30 calendar days as a result of securing placement or leaving without pre-approval. Academic Youth will demonstrate improvement and increased 90% of enrolled youth Engagement consistency in school attendance will have attended school for at least 85% of the academic year. Persons served Youth will report a positive experience and recognize At least 75% of youth satisfaction (to the benefits of the services provided who completed a be reported on a satisfaction survey will quarterly basis) respond as satisfied with services. In addition to the outcomes above being tracked on the MAR, Contractors shall utilize a computerized tracking system with which performance and outcome measures and other relevant person served data, such as demographics, will be maintained. The data tracking system may be incorporated into the Contractors' electronic health records (EHR) systems or in stand-alone databases (e.g., Access or Excel spreadsheets). County must be afforded read- only access to the data tracking system. County may adjust the performance and outcome measures periodically throughout the duration of the Agreement, as needed, to best measure the program as determined by County and/or CDSS. B-1-22 Exhibit B-1 SCOPE OF SERVICES ORGANIZATION: Aspiranet, Inc. ADDRESS: 1320 E. Shaw Ave Ste. 140 Fresno, CA 93710 SERVICES: Emergency Enhanced Intensive Services Foster Care TELEPHONE: 559-222-4969 x 2623 CONTACT: Chad Valorosi, Program Director EMAIL: cvalorosi@aspirnet.org CONTRACT PERIOD: Upon execution - June 30, 2026 with two (2) optional one-year extensions Year 1: Upon execution — June 30, 2025 Year 2: July 1, 2025— June 30, 2026 Year 3: July 1, 2026 — June 30, 2027 Year 4: July 1, 2027 — June 30, 2028 I. BACKGROUND The Fresno County Children's Wellbeing Continuum (CWBC) is designed to offer a seamless service delivery model across multiple service levels and settings for Fresno youth with complex behavioral and emotional needs. CWBC consists of responsive, front-end service provision that supports our child welfare, juvenile probation, and behavioral health infrastructures and is designed to flexibly provide seamless step-up and step-down transition services, ensuring that children and families receive continuity of service provision even as their needs change over time. A key component of this continuum is Fresno County's Emergency Enhanced Intensive Services Foster Care (E-E-ISFC) program. The purpose of the E-E-ISFC program is to provide prompt, safe, supportive, and highly individualized treatment for every youth within the context of a loving home with skilled and caring resource parents. The E-E-ISFC program offers a family-based alternative for youth who may otherwise be placed in a Short-Term Residential Therapeutic Program (STRTP) or for youth who historically may have had to wait for hours or days in a social worker's office while a suitable placement was identified. The E-E-ISFC program provides a structured and safe setting promoting stabilization and the development of therapeutic relationships with both specialized resource parents and staff, allowing the multidisciplinary team to complete an accurate assessment of the youth's needs, engage the youth in intensive treatment services, and recommend next steps toward permanency and healing. This Scope of Services is based on the current understanding of the needs of Fresno County (County) youth and the initial conceptualization of program design to best meet the needs of youth. The County and Aspiranet (Contractor) acknowledge that circumstances may arise that necessitate adjustments to the program design. In such cases, both parties agree to work together in good faith to review and, if necessary, revise this Scope of Services. Any changes to this Scope of Services shall be documented in writing and agreed upon by both parties. These B-1-23 Exhibit B-1 changes may include additions, deletions, or modifications to the services originally agreed upon. Any adjustments to this Scope of Services may have an impact on the project timeline and deliverables, which will be discussed and agreed upon by both parties before implementation. II. TARGET POPULATION Persons served will be youth considered eligible for E-E-ISFC placement by meeting the following criteria: 1. Must be California Welfare and Institutions Code (WIC) 300, 601, or 602; 2. Currently placed, or at risk of being placed in a licensed STRTP, psychiatric health facility or juvenile detention facility, 3. Must be receiving services through Fresno County; and 4. Youth ages 6-17 years, or siblings sets, who are in between longer-term placements and present with complex mental or behavioral health needs who are either: a. Youth with Complex Needs Experiencing Placement Insecurity: A youth whose placement has been disrupted and who needs an immediate, safe, and affirming placement with Specialized Resource Parent until a longer-term placement/permanency option is secured or b. New Entries: Youth with complex needs, including sibling sets, who have just been removed from their legal caregiver due to abuse and/or neglect and need an immediate, safe, and affirming placement with Specialized Resource Parent until a longer-term placement option is secured. Additional admission criteria may be identified by the County and the Contractor. The Contractor shall accept all cases referred by the County, recognizing that the County may approve exceptions in unique situations. III. LOCATION OF SERVICES Services will be provided at Contractor's clinic site, in the community, at home, and at education locations, whichever is most comfortable for the youth and family. Contractor must also be capable of offering services through telehealth-phone and telehealth-video, should the need arise. IV. HOURS OF OPERATION Contractors' office(s) shall be open Monday through Friday, 8:00 a.m. to 5:00 p.m., with services available on evenings and weekends, if required to meet the unique needs of the youth and family. At least fifty percent (50%) of services will be provided in the community and shall be scheduled on days and times that are convenient for the families, including evenings and weekends. B-1-24 Exhibit B-1 Youth and E-E-ISFC Specialized Resource Parents also have access to the Contractor's on-call crisis support twenty-four hours a day, seven days a week (24/7). The Contractor's on-call worker, in consultation with a supervisor and Fresno County Child Welfare System (CWS) Supervisor if needed, will determine the level of support needed to address the crisis. Support ranges from telephone support and coaching to an immediate in-person response by staff. V. DESCRIPTION OF SERVICES - CONTRACTOR RESPONSIBILITIES Contractor shall perform all services and fulfill all requirements identified in this Scope of Services. Contractor shall provide a level of service and support that will reflect each youth's unique and individual needs. A. Specialty Mental Health Services 1. Contractor shall provide the following services to all youth in the program. Services will include but are not limited to the following: i. Provide support to the youth's family and other members of the youth's social network to help them manage the symptoms and illness of the youth and reduce the level of family and social stress associated with the illness; ii. Make appropriate referrals and linkages to services that are beyond that of Contractor's services under this Agreement, or as appropriate when discharging/transitioning a youth from the program; iii. Coordinate services with any other community mental health and non-mental health providers as well as other medical professionals; iv. Assist youth/family with accessing all entitlements or benefits for which they are eligible (i.e., Medi-Cal, SSI, Section 8 vouchers, etc.); v. Develop family support and involvement whenever possible; vi. Refer youth/family to supported education and employment opportunities, as appropriate; vii. Provide or link to transportation services when it is critical to initially access a support service or gain entitlements or benefits; and viii. Provide peer support activities, as appropriate. 2. Contractor shall deliver a comprehensive Specialty Mental Health program. Services include, but are not limited to: i. Assessment; ii. Treatment or care planning/goal setting; iii. Pediatric Symptom Checklist (PSC) 35 and the clinically appropriate version of the Child and Adolescent Needs and Strengths (CANS) assessment; iv. Individual therapy; B-1-25 Exhibit B-1 v. Group therapy; vi. Family therapy; vii. Case management; viii. Consultation; ix. Medication support services; x. Hospitalization/Post Hospitalization Support; A. Certified Peer Support Services; and xii. Intensive Home-Based Services (IHBS), as appropriate. 3. Contractor will ensure that all services: i. Are determined in collaboration with youth and family and reflect the voice and choice and cultural practices of the youth and family; ii. Be values-driven, strengths-based, individual-driven, trauma-informed, and co- occurring capable; iii. Be culturally and linguistically competent; iv. Be age, culture, gender, and language appropriate; and v. Include accommodations for youth with physical disability(ies) 4. Methods for service coordination and communication between program and other service providers shall be developed and implemented consistent with Fresno County Mental Health Plan (MHP) confidentiality rules. 5. Contractor shall maintain up-to-date caseload records of all youth enrolled in services, and provide individual, programmatic, and other demographic information to County as requested. 6. Contractor shall ensure billable Specialty Mental Health Services meet any/all County, State, Federal regulations including any utilization review and quality assurance standards and provide all pertinent and appropriate information in a timely manner to Fresno County Department of Behavioral Health (DBH) for the purpose of billing Medi-Cal for services rendered. B. Emergency Enhanced Intensive Services Foster Care (E-E-ISFC) 1. Contractor shall provide E-E-ISFC services for up to four (4) youth at any given time. Services shall be highly coordinated, individualized, unconditional, and assist youth and families in addressing identified needs. To maintain familial connections, a sibling set, with one (1) youth presenting with complex mental or behavioral health needs, may be eligible for placement in a E-E-ISFC home with Specialized Resource Parent consent. 2. Services shall emphasize the strengths of the youth and youth's family. B-1-26 Exhibit B-1 3. Ensure that each E-E-ISFC team provides five (5) phases of effective E-E-ISFC care coordination and supportive services, including: i. Referral Process: a) All youth referred to the E-E-ISFC services will have pre-approval from the County. b) Ensure that a qualified staff person is available by phone and electronic communication 24 hours/day, 7 days/week to accept referrals from the county. Response time to referral calls will not exceed 15 minutes. c) Review referral packet and seek any additional information necessary to match the youth with an E-E-ISFC family. Utilizing referral information, begin developing an initial safety, staffing, and supervision plan. ii. Intake: 1. Complete consent, admission, and intake documentation a. The youth's Social Worker (assigned or placing) will be required to sign all admission/intake documents as required by the provider prior to the commencement of the placement. b. E-E-ISFC resource parents who are designated as Fresno County E- E-ISFC homes are to be available to accept placements within 4 hours of referral. 2. Welcome the child to the home and attend to basic needs. a. Contractor and Specialized Resource Parent are to welcome the youth in a way that is unique to the family and is sensitive to the youth's trauma history while also attending to their basic needs such as food, clothing, and hygiene products. 3. Determine Appropriate Intake Staff Support Levels for Placement. a. Prior to commencement of placement, a clinical team member (social worker or clinician) and/or a program administrator (program supervisor, clinical director, assistant director, program director) will review the referral information to determine if the baseline intake staffing level should be increased until the preliminary assessment can be completed. b. The program will ensure robust staffing support for the E-E-ISFC home for at least the first 24 hours of the placement. One-to-one staffing (or higher)will continue until the social worker or clinician completes a preliminary assessment and treatment plan. Staffing levels may change only after the first 24-hour period. i. A minimum of one E-E-ISFC staff person will be in the home and awake at all times for at least the first 24 hours. ii. In-home support staff will be responsible for supporting Specialized Resource Parent with care and supervision tasks, establishing rapport with youth, gathering initial intake B-1-27 Exhibit B-1 assessment information, and providing direct behavioral intervention, including crisis intervention if needed. iii. Supervision checks of the youth will be conducted and documented at intervals not to exceed 15 minutes, including while the youth is asleep, for at least the first 24 hours of the placement or until the preliminary assessment completed, whichever is greater. c. Recommendations by the youth's placing agency worker or another member of the youth's CFT for additional staffing above the intake baseline staffing level will be implemented. d. If at any point, the resource parent and/or staff member determines that increased staff support is necessary to ensure the safety and stability of the youth and those around them, additional E-ISFC staff will be sent to the home within 30 minutes. 4. Develop preliminary assessment and preliminary service plan to inform initial service level. a. Within one (1) business day following the date of admission, the E-E- ISFC clinician will meet face-to-face with the youth to begin to establish rapport and develop a preliminary assessment and service plan for the length of stay. The service plan may be updated within the first seven (7) calendar days, as needed. The Contractor shall submit to the County a template of the written preliminary assessment and diagnostic report for review and approval prior to the commencement of service. iii. Assessment: a) The comprehensive assessment process will include but is not limited to: a clinical analysis of the youth's history, current status of the youth's mental, emotional, or behavioral disorder, relevant cultural issues and history, diagnosis, and use of any testing procedures. b) The E-E-ISFC clinician is responsible for completing a CANS for each youth enrolled for more than 7 days. The CANS shall be completed within seven (7) calendar days of intake or by the discharge date if the discharge occurs prior to the 7th day of the placement. If a youth has had a CANS completed within the past six months prior to admission, the Contractor will be responsible for reviewing the youth's the completed CANS, regardless of the anticipated length of stay, and updating as necessary within seven (7) calendar days of intake or by the date of discharge if discharge occurs prior to the 7th day. iv. Treatment: The E-E-ISFC treatment model includes four core methods of intervention. a) Parental care and supervision i. At least one fully trained Specialized Resource Parent is available to accept placements and has the availability to meet all the requirements of providing these intensive services. Integral to a multi-disciplinary team, Specialized Resource Parent(s) provide services in therapeutic home B-1-28 Exhibit B-1 settings for youth in alignment with the E-E-ISFC placement program as an alternative to congregate, residential care. ii. Specialized Resource Parent(s) engage directly with the youth and the Permanency Specialist to construct a workable, sustainable kinship placement. iii. The Specialized Resource Parent(s) provides structure, routine, and clear expectations to youth placed in their home. iv. The Specialized Resource Parent(s) collaborates with the other E-E-ISFC team members, including the social worker/clinician and support counselors, to learn and apply behavioral interventions and engage in the youth's treatment needs, as well as the child and family teaming. CFT should convene weekly. V. The Specialized Resource Parent(s) supports the youth in meaningful activities and trauma mitigating activities. vi. Support is provided to each Specialized Resource Parent from the clinician and support counselor. vii. Each Specialized Resource Parent(s) is assigned a master's level SW who is responsible for supporting the parents through mentorship, training, oversight, encouragement, and collaborative problem-solving. viii. E-E-ISFC SW will meet with Specialized Resource Parent(s) at least weekly or more as needed. b) Advanced clinical services i. Specific services provided by the E-E-ISFC Clinician include but are not limited to assessment, individual therapy, crisis intervention, plan development, collateral services, Child and Family Team participation and facilitation, case management/intensive care coordination, transition planning, and clinical documentation. ii. Medication support services will be provided as needed. iii. E-E-ISFC clinician will meet with youth in-person at least two times per week and is responsible for guiding the clinical services for the youth. iv. The E-E-ISFC clinician is responsible for completing a comprehensive services plan (treatment plan) for youth who stay in the program for more than 7 days. c) Therapeutic behavioral health support and supervision i. Youth will receive a minimum of 21 hours per week of therapeutic behavioral support and supervision. B-1-29 Exhibit B-1 ii. Support counselors are responsible for the implementation of methods outlined in the youth's service plan. iii. Therapeutic behavioral support and supervision may be provided at any hour of the day, any day of the week based on the service plan and needs of the youth. iv. The provider is responsible for documenting direct services and billing for all Specialty Mental Health Services provided. d) Advancing permanency and connectedness i. The E-E-ISFC permanency specialist is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. ii. The Permanency Specialist is responsible for conducting thorough case record review and family finding searches. They will also work with Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact while documents progress according to the Contractors documentation procedures. v. Transition: Key components of the E-E-ISFC transition planning and support. Youth placed on an emergency basis will have unique transition planning needs given the short-term and urgent nature of the placement. The pre-implementation planning process between the county and the provider(s)will include discussions regarding how the E-E-ISFC staff can best support the county in identifying a suitable placement for the youth and how to best ensure a trauma-informed transition from the E-E-ISFC home to the long-term placement setting. The E-E- ISFC transition procedures will be developed in partnership with the county and provider, and include elements such as but not limited to: a) E-E-ISFC staff collaborate with Fresno County social workers and/or probation officers no less than two times per week throughout the youth's stay in the E-E-ISFC program. Staff provide assessment information that will support the placement unit in developing a plan for the youth's next living situation and/or caregivers. b) The placement unit staff notify the E-E-ISFC clinician/social worker once a placement is identified providing a transition date, if possible. c) The E-E-ISFC resource parent or staff will: i. Inform the youth of the plan and provide emotional and behavioral support to assist in reducing distress. ii. Facilitate a "comfort call" to a support person, as appropriate. iii. When indicated and approved by the county the resource parent or E-E-ISFC staff member may contact the new caregiver to coordinate the logistics of the transition. B-1-30 Exhibit B-1 d) With appropriate releases in place, E-E-ISFC parents and staff provide any updates and/or pertinent information to the new caregiver including but not limited to: i. The youth's current physical and emotional state. ii. Any upcoming appointments with providers. iii. Any helpful information learned about how to help comfort the youth. iv. Any Safety Plans developed. V. Any immediate concerns. e) Specialized Resource Parents or E-E-ISFC staff go over the Personal Belonging Inventory with the child and/or County Social Worker or Probation Officer and return items to the caregiver and youth, accordingly, including any medications. f) E-E-ISFC staff provide the youth with an age-appropriate Client Satisfaction Survey. g) E-E-ISFC staff complete discharge/transition paperwork and distribute it to the youth's authorized representative. h) The transition plan and goals are addressed in each child and family team meeting. The plan and goals will be updated as needed based on the assessed needs of the youth. i) The E-E-ISFC clinician is responsible for reviewing transition goals on the services plan and revising, if necessary, at least weekly. j) The E-E-ISFC team is available to support the transition goals for each youth which may include but is not limited to, supervising visits with potential future placements, transporting youth to visitation, and leading or supporting permanency work including family finding. k) With DBH approval and if clinically appropriate, provide Specialty Mental Health Services (SMHS) until the youth is fully transitioned to the new placement and necessary mental health services. 1) In conjunction with County, develop and implement a discharge policy, in and through which, Contractor shall: i. Agree that the primary goal of the E-E-ISFC Program is to seek and maintain stability of youth in the lowest level of care placement setting so that they can successfully reach stabilization, no longer require intensive supervision or intensive mental health interventions, and transition to a permanent home setting. ii. Agree to serve any youth who meets eligibility criteria and parameters for placement for the full duration of the placement, regardless of the severity or complexity of their behaviors, accessing and coordinating the necessary B-1-31 Exhibit B-1 services and supports to effectively address the needs of the youth. iii. Agree to maximize communication in transition planning for youth. iv. Agree to utilize innovative approaches and all available resources to make reasonable efforts to stabilize youth in their current placement thereby reducing the likelihood of placement disruption. Consult with the appropriate CWS Division Chief/Probation Assistant Deputy Chief(ADC) to determine if additional services may prevent an unnecessary disruption of placement in the E-E-ISFC resource home. V. Notify the CWS or Deputy Probation Officer (DPO) and appropriate CWS Division Chief/Probation ADC or designee, via electronic mail as soon as, but not more than 1 business day after the Contractor becomes aware of an issue that may lead to a placement change. vi. Convene or participate in a case conference or CFT meeting to determine how or if the youth may be stabilized in the current E-E-ISFC placement and if additional services may prevent an unnecessary disruption of placement in the E-E- ISFC resource home. vii. Contact appropriate CWS Division Chief/Probation ADC or designee to arrange a consultation after the case conference or CFT meeting to discuss the outcome and any updates to the treatment and/or crisis intervention plan. viii. Document in advance of any anticipated placement change efforts made to stabilize and maintain the youth in placement, including provision of existing and additional mental health services and daily E-E-ISFC Specialized Resource Parent support including telephone check-ins and in-home crisis stabilization services. Contractor shall ensure that the Specialized Resource Parent may not refuse any mental health services determined necessary for the youth by the treatment team. ix. Provide Notice of Intent to Discharge via electronic mail to the CSW, DPO, and appropriate CWS Division Chief/Probation ADC only when all alternatives have been exhausted and after an emergency CFT has occurred, and no less than 14 calendar days prior to the anticipated discharge date, unless it is agreed upon at the CFT that less notice is necessary to ensure the health and safety of the youth or others. X. Refer the Notice of Intent to Discharge to the Supervisor or Division Chief/ADC of the CSW or DPO, and appropriate CWS Program Administrator if the assigned contacts are not responsive to requests to grant authorization or B-1-32 Exhibit B-1 unreasonably delay authorization for the Contractor to discharge a youth. A. Monitor and deliver transitional SMHS and after care services to the youth until a transition to other mental health services have been planned and begun pursuant to DSS contract provisions. 4. Unique Situations: Contractor will ensure that every possible intervention has been exhausted prior to developing an alternative placement plan. While there may be times when it is determined that continued placement in the home is not in the best interest of the youth, we only make this determination after first considering all possible options for stabilizing the youth in the program. The stabilization planning meeting must include representatives from the provider agency and the county department(s)with the authority to make decisions in the moment regarding resources and interventions. 5. For youth dually enrolled in Wraparound and E-E-ISFC, the youth's CFT will determine which agency and which person is assigned as lead for the following tasks based on existing therapeutic relationships, treatment goals, and transition goals: 1) Advanced clinical services such as therapy, medication support/psychiatry, assessment; 2) Behavioral intervention/rehabilitation; 3) Case coordination such as CFT facilitation, case management, plan development; and 4) Permanency work and family finding. 6. The Contractor's E-E-ISFC program staff will retain responsibility for at least the following roles: 1) Parental care and supervision; 2) Care and supervision provided by support counselors, which may include rehabilitation and behavioral support aligned with the youth's service plan; 3) Crisis response; and 4) Social work responsibilities including oversight, training, support, guidance for resource parents. The Contractor shall have the flexibility to adjust service levels based on the needs of the youth. When youth are receiving Wraparound services, the Contractor may need to decrease service intensity and corresponding staffing levels to avoid duplication with the Wraparound provider. The Contractor shall also be flexible to increase service intensity levels when needed and as determined by the CFT. 7. Length of Stay: i. The approximate length of stay for the E-E-ISFC is thirty (30) calendar days. While stated length of stay reflects general parameters, a youth's ongoing participation in the E-E-ISFC program is driven by their demonstrated need. C. Crisis Services B-1-33 Exhibit B-1 1. Develop and implement a safety planning, response and notification plan, in and through which, Contractor: i. Shall ensure Contractor's E-E-ISFC staff and Specialized Resource Parents are trained to implement safety and preventive measures to avert and respond to any self- harming and/or other behaviors that pose risk to the youth or others. ii. Shall, if after all relevant safety and preventive measures have been exhausted and youth needs an emergency psychiatric assessment for acute psychiatric hospitalization or exhibits escalating behaviors indicating danger to self or others, contact the Wrap provider in the County. If the behaviors demonstrate immediate danger and safety the Contractor shall contact 911. iii. Shall ensure that E-E-ISFC staff or other relevant administrator notify the youth's DSS Social Worker (SW) or Deputy Probation Officer (DPO) and appropriate CWS Division Chief/Assistant Deputy Chief, or designees, via email as soon as reasonably possible, but no later than the end of the day for all incidents that indicate a sign of threat or continued risk to the physical or mental health status of the E-E-ISFC youth including all such incidents that require a Critical Incident Report, as outlined in the following section. iv. In the event of an emergency, Contractor may move the placed youth to another E-E-ISFC Respite Home of the Contractor without prior authorization from the SW or DPO. For the purposes of this paragraph, an emergency is defined as any situation that threatens the health and safety of the placed youth or others in the E-E-ISFC home. In the event of an emergency placement change, Contractor shall make every effort to keep the youth in the school they are currently attending. v. As soon as it is reasonably safe to do so, the Contractor shall notify the CWS hotline, the SW, DPO and appropriate CWS Division Chief/Probation ADC, or designees regarding any emergency placement changes. The Contractor shall then follow up with the SW by phone within one business day. vi. Shall discuss the situation that led to the emergency placement change with the SW, DPO or designee and document the conversation and decision in the respective case file. A CFT Meeting will be held as soon as possible after the incident to update the safety plan. vii. Shall comply with the following when youth are referred for psychiatric hospitalization, engage in elopement, experience a juvenile hall stay, or other temporary placement disruptions: viii. Notify the SW or DPO and appropriate CWS Division Chief/Probation ADC as soon as it is reasonably safe to do so, and complete a critical incident report; ix. Participate in case conferences, hospital discharge conference and/or the CFT meetings for the placed youth; x. Continue to provide the services to the extent possible to the placed youth; A. Ensure the E-E-ISFC Specialized Resource Parent and/or the E-E-ISFC staff visit the youth during the hospitalization and maintain contact by telephone unless otherwise directed by the hospital medical staff or County staff; xii. Allow youth to return to the E-E-ISFC program up to 3 calendar days from the placement disruption, keeping the E-E-ISFC bed open for 3 calendar days, unless otherwise agreed upon with the County. If, however, the 3-day bed hold expires, Contractor shall collaborate with the SW or DPO and appropriate CWS Division B-1-34 Exhibit B-1 Chief to either extend the hold or close the placement and re-open it when the youth returns. xiii. Initiate a CFT meeting within 24 hours of youth's return to the E-E-ISFC home. xiv. Exceptions to the above re-admission requirements are allowed only when the CFT, including the SW or DPO, decides not to return the youth to the E-E-ISFC Resource Home, or when Contractor and the SW or DPO mutually agree that the re-admission jeopardizes the immediate health and safety of the youth or others in the home. In both cases, Contractor shall immediately notify the appropriate CWS Division Chief/Probation ADC or designee by telephone of the decision not to re- admit and follow up with an electronic mail message by the end of the next business day. In both cases, Contractor shall also assist in finding a new caregiver and placement within its licensed programs. 2. Shall report and document all major and/or sensitive incidents ("critical incidents") to the County pursuant to the procedures and timing outlined in Exhibit J. The County, at its sole discretion, may require the Contractor to conduct all necessary follow-up activities after reporting critical incidents. If there is any doubt about whether an incident should be reported, the default shall be for the Contractor to report the incident to the County. i. Notify DSS as soon as possible via Hotline, email and phone, but no later than twenty-four (24) hours from the time the Contractor, or an employee or agent of the Contractor, knows or has reason to believe that a critical incident has occurred or may have occurred. Include the following information in all incident reports: a) Name and contact information of the submitting individual; b) Name and email address of the best contact for immediate access to a Contractor staff member who can answer questions regarding the incident; c) The name of the youth, if involved. d) A description of the incident to include: e) Date, time, and location of the incident; f) Description of the events that took place; g) Names and job titles of Contractor personnel involved in the incident, if any; h) Description of law enforcement involvement, if any; i) Description of other emergency response involvement, if any; j) Description of any action taken by the Contractor in response to the incident; k) An indication of whether press coverage or negative community response is likely. D. E-E-ISFC Specialized Resource Parents 1. Contractor will recruit, train, utilize and support ISFC Specialized Resource Parents who shall assume the roles and perform the functions of E-E-ISFC Specialized Resource Parents in providing the necessary care, services and supports that are identified in the individual needs and services plan. i. Make active and ongoing recruitment efforts a minimum of one (1) time per month to increase capacity for E-E-ISFC services with a goal to maintain a minimum of B-1-35 Exhibit B-1 four (4), fully trained Specialized Resource Parents prepared to accept placements, or currently providing E-E-ISFC services to a youth at any given time. ii. Each home will have at least one dedicated Specialized Resource Parent who is an E-E-ISFC caregiver, with no competing responsibilities outside the home, who is ISFC certified, and has educational, professional and/or lived experience working with youth that helps them to understand and respond to the needs of the youth placed in care. Furthermore, E-E-ISFC Specialized Resource Parents shall provide a safe, consistent, and structured home environment for youths 24 hours/day, 7 days/week. iii. Ensure that all recruitment efforts are targeted to individuals/populations who would likely be willing and capable of meeting the needs of children of all ethnicities, ages, sexual orientations and gender identities, immigration statuses, physical abilities, religious or spiritual beliefs, and who have a wide range of trauma histories, developmental capabilities, mental health and/or behavioral needs, and coping skills. iv. Designate a Trainer to develop and deliver pre-service and ongoing E-E-ISFC Specialized Resource Parent training. a) The Trainer shall have an educational background in a relevant field (e.g., social work, psychology, child development) and experience working with similar youth in residential or foster care settings. b) The Trainer shall demonstrate the ability to engage with families, proficiency in teaching and public speaking, and ability to collaborate with members of a team. v. Implement a Training Plan for E-E-ISFC Specialized Resource Parents, which shall be reviewed and approved by the County prior to implementation. The Training Plan shall specify the training requirements for E-E-ISFC Specialized Resource Parents that is over and above that which is required for ISFC certified parents. The plan shall include training topics to be covered, the amount of time spent on each topic, and the qualifications of the trainer. The plan shall specify both the requirements for initial training (pre-placement) and annual ongoing training. Subsequent changes to the E-E-ISFC Specialized Resource Parent Training Plan shall be reviewed and approved by the County. vi. Ensure that E-E-ISFC Specialized Resource Parents have completed all ISFC and E-E-ISFC training requirements specified in the Contractor's Training Plan prior to the commencement of an E-E-ISFC placement. vii. Ensure that all Specialized Resource Parents approved to provide E-E-ISFC placements reside in Fresno County. Potential Specialized Resource Parents who reside in neighboring counties may provide E-E-ISFC services to Fresno County youth upon County approval. viii. Ensure that Specialized Resource Parents approved to provide E-E-ISFC placements are screened and selected based on their ability to meet the needs of children of all ethnicities, ages, sexual orientations and gender identities, B-1-36 Exhibit B-1 immigration statuses, physical abilities, religious or spiritual beliefs, and who have a wide range of trauma histories, developmental capabilities, mental health and/or behavioral needs, and coping skills. ix. Ensure that E-E-ISFC Specialized Resource Parents have met the minimum training requirements of the CDSS for provision of ISFC level care to children/youth. x. Ensure County has an updated and accurate roster of E-E-ISFC resource families at all times, which reflects the date resource families were approved to provide E- E-ISFC services. A. Ensure that E-E-ISFC Specialized Resource Parents complete all additional trainings identified as necessary by County. E. Additional Responsibilities 1. Maintain responsibility for necessary testimony and/or providing County with information needed to generate court reports, as outlined below: i. Court Reports - Documented reports of assessment and evaluation findings, progress in treatment, recommendations for treatment and service plans regarding reunification, maintenance and termination of parental rights, and justification for recommendations. ii. Court Testimony- Provide care plan updates when a court is considering reunification, maintenance, and/or termination of parental rights. 2. Upon notification of a pending court hearing, Contractor agrees to complete and submit to the County a "Periodic Review Report" twenty-one (21) calendar days prior to the court date or seven (7) calendar days after notification. 3. Maintain electronic health records and supply their own personal computers, Internet access, printers, signature pads and other network devices to meet statistical reporting requirements, report person-served and program outcomes and any State or County data requirements of the Katie A. Implementation Plan. Contractor shall also maintain capability to enter electronic billing data into County's electronic health record system. A computer with Internet access is required for both office and field-based staff. 4. Cooperate and participate with the County MHP in Quality Assurance/Improvement and Utilization Review Programs and grievance procedures and comply with all final determinations rendered by County's Quality Assurance/Improvement and Utilization Review Programs, unless the decision is reversed on appeal as set forth in the County MHP Provider Manual, incorporated herein by this reference. County's adverse decisions regarding Contractor's services to persons-served may result in the disallowance of payment for services rendered; or may result in additional controls to the delivery of services; or may result in the termination of this Agreement. County shall have sole discretion in the determination of Quality Assurance/Improvement and Utilization Review outcomes, decisions and actions. 5. Participate in regularly scheduled contract monitoring meetings with the County to discuss program successes and obstacles utilizing a Continuous Quality Improvement (CQI) framework. 6. Obtain signatures, as required, regarding consent: i. Care provider can sign for day trips and other minor miscellaneous items. B-1-37 Exhibit B-1 ii. Court Order should suffice for most other items. 7. Assist with training County staff and the community in E-ISFC Service processes and service options. 8. Develop training curriculum as County identifies a need. This includes but is not limited to training curriculum for E-E-ISFC staff and Specialized Resource Parents as well as training curriculum for SWs and County staff. 9. Participate in County-offered trainings which may include but are not limited to topics such as Quality Parenting Initiative and The Neuro-sequential Model of Therapeutics (NMT). 10. Provide annual Civil Rights training to all staff at the beginning of every calendar year and will provide verification of training completion to DSS. DSS will provide documents needed for annual training and reporting. 11. Have and maintain in good standing an active California Department of Social Services (CDSS) issued license as a Foster Family Agency (FFA). 12. Work collaboratively with other CWBC providers to develop and enter into Memorandum of Understanding or other business agreements between themselves that defines the processes and procedures for provision of services to foster youth, including, but not limited to the: i. Case Planning ii. Care Coordination iii. Intensive Transition Planning iv. Assessment v. Transportation between service settings vi. Information sharing vii. Data collection and dissemination 13. Work with DPO on criminogenic risk factors for probation youth as addressed through contracted services as applicable. VI. STAFFING A. Staffing shall be appropriate and aligned with the E-E-ISFC service model, and shall include E-E-ISFC teams which shall be comprised of the following classifications: Specialized Resource Parent(s), Clinician/Social Worker, Lead Support Counselor, Support Counselor, and Permanency Specialist: 1) Specialized Resource Parent(s): One (1) fully trained E-E-ISFC Resource Parent is available to accept placements and has the availability to meet all the requirements of providing these intensive services. Integral to a multi-disciplinary team, specialized resource parents provide services in therapeutic home settings for youth in alignment with the E-E-ISFC model as an alternative to congregate, residential care. Specialized Resource Parent collaborates with the other E-E-ISFC team members, including the Social Worker/Clinician and Support Counselors, to learn and apply behavioral interventions and engage in the youth's treatment needs, as well as the Child and Family Team. The Specialized Resource Parent(s) supports the youth's engagement in meaningful activities and meets with other Team members. The overarching goal is to support the youth's transition to permanency. B-1-38 Exhibit B-1 2) E-E-ISFC Social Worker: A Master's level Social Worker is responsible for supporting the parents through mentorship, training, oversight, encouragement, and collaborative problem-solving. Social Workers meet with Specialized Resource Parents at least weekly, or more as needed. Specific services provided by the Social Worker include, but are not limited to: • Support and monitor the resource parent in implementing specific interventions specified in the youth's services plan. • Provide training in the home related to practices such as trauma- informed and behavioral interventions • Monitor the parent's compliance with all regulatory requirements including licensing and accreditation standards. • Facilitate support groups and didactic training with multiple resource parents. • Provide motivational encouragement and emotional support to parents. • Social Worker shall provide a minimum of four (4) direct service hours per week/per youth. 3) E-E-ISFC Clinician: Supervised by a Clinical Director, the E-E-ISFC Clinician meets with each youth in-person at least two times per week and is the primary person responsible for guiding the clinical services for each youth. Specific services provided by the Clinician include, but are not limited to: • Assessment • Individual therapy • Family therapy • Crisis intervention • Plan development • Collateral services • Child and Family Team participation and facilitation • Case management/Intensive Care Coordination • Transition planning • Clinical documentation • Clinician shall provide a minimum of four (4) direct service hours per week/per youth. 4) Support Counselor(s): A minimum of two (2) Support Counselors shall meet with the youth to provide one-on-one support, focusing on increasing the frequency of desired behaviors, gaining access to pro-social activities and resources within the community, and developing effective relationship-building skills, emotional regulation, conflict resolution skills. • Support Counselor(s) shall provide a combined minimum of twenty-one (21) direct service hours per week/per youth of therapeutic behavioral support and supervision based on each youth's unique level of need. • Therapeutic behavioral support and supervision may be provided at any hour of the day, any day of the week based on the service plan and needs of the youth. The provider is responsible for documenting direct services and billing for all Specialty Mental Health Services provided. B-1-39 Exhibit B-1 5) Permanency Specialist: Permanency Specialist has the responsibility of supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. The Permanency Specialist works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress according to the provider's documentation procedures. • Permanency Specialist shall provide a minimum of two (2) direct service hours per week/per youth. • Ensure all permanency planning efforts are documented. 6) Ensure each E-E-ISFC team has access to: • One (1) Psychiatrist to meet with the Person served to provide evaluation and assessment for psychotropic medication, clinical consultation, and assistance linking the Person served and their Specialized Resource Parent to ongoing psychiatric services and support as needed and prioritizing continuity of care where possible. • Family/Parent Partner, Youth Peer Partner, Individual Therapist, Family Therapist, Nurse, as needed. B. Ensure that direct service staff reimbursed through this contract shall spend at least 65% of their paid work time providing and documenting direct service to clients or on behalf of clients. Administrative staff meetings, supervision meetings, and staff trainings shall not be included in the 65%. C. The Contractor shall ensure its E-E-ISFC staff meets the State's ISFC qualifications, training, and duty requirements as outlined in WIC 18358 or other statutes relevant to ISFC as well as the County's FFA Master Contract requirements where they are more restrictive than those of the State ISFC regulations. For any waivers or exceptions to these requirements that are allowed by state regulation, Contractor shall submit a request for such approval to DSS before allowing the staff in question to begin delivering the service. VII. COUNTY RESPONSIBILITIES: County shall: A. Assist Contractors' efforts to evaluate the needs of each enrolled youth on an ongoing basis to ensure each youth is receiving clinically appropriate services. B. Provide oversight and collaborate with contractors and other County Departments and community agencies to help achieve State program goals and outcomes. Oversight includes, but is not limited to, contract monitoring and coordination with the State Department of Health Care Services (DHCS) and California Department of Social Services (CDSS) in regard to program administration and outcomes. C. Assist Contractors in making linkages with the total mental health system of care. This will be accomplished through regularly scheduled meetings as well as formal and B-1-40 Exhibit B-1 informal consultation. D. Participate in evaluating overall program progress and efficiency and be available to contractors for ongoing consultation. E. Gather outcome information from target youth groups and Contractors throughout each term of this Agreement. County shall notify contractors when their participation is required. The performance outcome measurement process will not be limited to survey instruments but will also include, as appropriate, youth and staff interviews, chart reviews, and other methods of obtaining required information. F. Assist Contractors' efforts toward cultural and linguistic competency by providing the following to contractors: 1. Technical assistance and training regarding cultural competency requirements at no cost to contractors. 2. Mandatory cultural competency training for contractors' personnel, on an annual basis, at minimum. 3. Technical assistance for translating information into County's threshold languages (Spanish and Hmong). Translation services and costs associated will be the responsibility of contractors. VIII. REPORTS Contractor shall track data and provide reporting on the following items and send all applicable information and reports to the following distribution list for County staff: DSS Staff Analyst, DSS Division Chief, DSS Social Work Supervisor, and DBH Contract Analyst. 1) Contractors shall be expected to comply with all contracts monitoring and compliance protocols, procedures, data collection methods, and reporting requirements conducted by County. 2) Contractors will be responsible for meeting with DSS/DBH on a monthly basis, or more often as agreed upon between DSS/DBH and Contractors, for contract, performance, and outcomes monitoring. 3) Contractors will be required to submit monthly reports on performance measures to the County. Report formats will be established through County/Contractor collaboration. Outcome measures may change, based on information or measures needed. Required monthly reports include: a) DSS Monthly Activity Report (MAR); and b) Other reports as established by the County. 4) All reports will be due to the County by the 101" of each month and will be reviewed for accuracy. (If the 1011 lands on a weekend or Holiday, reports will be due the next business day). 5) Contractor shall also provide County with additional individualized reports for each youth which may include, but are not limited to: Monthly Progress Report, Discharge Presentation, Individual Child and Family Plan Presentation Outline, and Individual Child and Family Plan (ICFP). 6) Additional reports and outcome information may be requested by County at a later date, as needed. B-1-41 Exhibit B-1 IX. GOALS/OUTCOMES Contractor is required to submit measurable outcomes on a bi-annual basis, as identified in the DBH's Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes Measures. Performance outcome measures must be approved by DBH and DSS and satisfy all State and local mandates. County will consider Contractor performance levels when determining funding recommendations for future agreements. For the contract period, Contractor shall document all direct services to youth, transition planning efforts, permanency planning efforts, and crisis responses. County anticipates an increase in placement stability and permanency, behavioral stability, symptom reduction, strengths and resiliency, and educational stability as a result of these services. The outcomes listed in the table below will measure the success of Contractor's services. These outcomes may be modified at County's discretion. Contractor will report outcomes in each MAR or alternate method determined by County. Outcome measures are included below. Fresno County Enhanced ISFC Contract Performance Expectations Metric Outcome Indicator Retention Improved placement stability. Youth will remain in their No more than 5% of placement for the length of time that aligns with the youth in E-E-ISFC youth's treatment plan. homes will leave placement without pre-approval Service Decreased wait time for placement. 100% of E-E-ISFC Availability parents with a vacant bed are available to receive a youth into their home within 4 hours of referral Service Youth in E-E-ISFC are receiving necessary and Minimum Direct Availability clinically appropriate services from each E-E-ISFC Service Hours Per Team member: Youth Per Week: Clinician/Social Worker: Advanced clinical services Clinician/Social Worker: 4 Support Counselor(s): Therapeutic behavioral support and supervision Support Counselor(s): 21 Permanency Specialist: Advancing permanency and connectedness Permanency Specialist: 2 Service Determination of youth's immediate safety needs. At least 90% of youth Timeliness enrolled have received a preliminary B-1-42 Exhibit B-1 assessment and service plan completed by the end of the first business day following date of admission. Service Ensure timeliness of comprehensive assessment to A comprehensive Timeliness best capture youth's needs in order to provide an assessment will be individualized treatment plan. completed for 100% of youth enrolled for more than 7 calendar days. 90% of the comprehensive assessments will be completed within 7 calendar days of the date of intake, or by the date of discharge if occurs prior to the V1 day. Service Delivery Individualized treatment plans developed for every A treatment plan is youth receiving services. completed for 100% of youth. Crisis Response Prevention of crisis escalation, stabilization of Provider responds to placement, preservation of Specialized Resource 100% of crises that Parent-youth relationship, avoid unnecessary law require an in-person enforcement involvement, and reduce psychiatric response within 30 hospitalizations. minutes. Crisis Response Avoid re-traumatization of youth, stabilization of Provider stabilizes at placement, preservation of Specialized Resource least 75% of youth in Parent-youth relationship, avoid unnecessary law the home setting enforcement involvement, and reduce psychiatric following an in-person hospitalizations. crisis response Transition Reduction in barriers and increased support for Individualized, trauma- Planning seamless transition between levels of care for youth. informed transition plan is completed prior to discharge for 100% of enrolled youth. Contractor will provide Plan to County within one (1) business day B-1-43 Exhibit B-1 following discharge for 100% of youth. Transition to Increased transitions of youth to the least restrictive 85% of youth enrolled less restrictive setting possible. will be transitioned to placements less restrictive placements. Permanency Youth will demonstrate increased family and natural Planning support connection and/or achievement of permanency 90% of youth who complete the *Not applicable to youth who receive services for less discharge CANS will than 30 calendar days as a result of securing show improvement in placement or leaving without pre-approval the Permanency module of the CANS. Improved Youth will demonstrate a reduction in action items in the 90% of youth who behavioral/ Behavioral/Emotional Needs Domain, Risk Behaviors complete the emotional needs Domain, and the Family Functioning and Living discharge CANS will Situation items in the Life Functioning Domain show a reduction in action items in the *Not applicable to youth who receive services for less Behavioral/Emotional than 30 calendar days as a result of securing Needs Domain, Risk placement or leaving without pre-approval. Behavior Domain, and the Family Functioning and Living Situation items in the Life Functioning Domain of the CANS. Improved Youth will demonstrate increased knowledge of 80% of youth who strengths emotional regulation and de-escalation skills, increased complete the family functioning and permanency, behavioral and discharge CANS will emotional stability, and decrease in maladaptive show improvement in behaviors. overall CANS score. Not applicable to youth who receive services for less for less than 30 days as a result of securing placement or leaving without pre-approval. Academic Youth will demonstrate improvement and increased 90% of enrolled youth Engagement consistency in school attendance. will have attended school for at least 85% of the academic year. Persons served Youth will report a positive experience and recognize satisfaction (to the benefits of the services provided B-1-44 Exhibit B-1 be reported on a At least 75% of youth quarterly basis) who completed a satisfaction survey will respond as satisfied with services. In addition to the outcomes above being tracked on the MAR, Contractors shall utilize a computerized tracking system with which performance and outcome measures and other relevant person served data, such as demographics, will be maintained. The data tracking system may be incorporated into the Contractors' electronic health records (EHR) systems or in stand-alone databases (e.g., Access or Excel spreadsheets). County must be afforded read-only access to the data tracking system. DBH and/or DSS may adjust the performance and outcome measures periodically throughout the duration of the Agreement, as needed, to best measure the program as determined by County and/or CDSS. B-1-45 Exhibit B-2 SCOPE OF SERVICES ORGANIZATION: Promesa Behavioral Health ADDRESS: 7120 N. Marks Ave, Suite 110 Fresno, CA 93711 SERVICES: Enhanced Intensive Services Foster Care TELEPHONE: 559-439-5437 x 593 CONTACT: Lisa K. Weigant, CEO EMAIL: Iweigant@promesabehavioral.org CONTRACT PERIOD: Upon execution - June 30, 2026 with two (2) optional one-year extensions Year 1: Upon execution — June 30, 2025 Year 2: July 1, 2025— June 30, 2026 Year 3: July 1, 2026 —June 30, 2027 Year 4: July 1, 2027 —June 30, 2028 (. BACKGROUND The Fresno County Children's Wellbeing Continuum (CWBC) is designed to offer a seamless service delivery model across multiple service levels and settings for Fresno youth with complex behavioral and emotional needs. CWBC consists of responsive, front-end service provision that supports our child welfare, juvenile probation, and behavioral health infrastructures and is designed to flexibly provide seamless step-up and step-down transition services, ensuring that children and families receive continuity of service provision even as their needs change over time. A key component of this continuum is Fresno County's Enhanced Intensive Services Foster Care (E-ISFC) program. The purpose of the E-ISFC program is to provide safe, supportive, and highly individualized treatment for every youth within the context of a loving home with skilled and caring specialized resource parents. The E-ISFC program offers a family-based alternative for youth who may otherwise be placed in a Short-Term Residential Therapeutic Program (STRTP) or for youth who historically may have had to wait for hours or days in a social worker's office while a suitable placement was identified. The E-ISFC program provides a structured and safe setting promoting stabilization and the development of therapeutic relationships with both specialized resource parents and staff, allowing the multidisciplinary team to complete an accurate assessment of the youth's needs, engage the youth in intensive treatment services, and recommend next steps toward permanency and healing. This Scope of Services is based on the current understanding of the needs of Fresno County (County) youth and the initial conceptualization of program design to best meet the needs of youth. The County and Promesa (Contractor) acknowledge that circumstances may arise that necessitate adjustments to the program design. In such cases, both parties agree to work together in good faith to review and, if necessary, revise this Scope of Services. Any changes to B-2-1 Exhibit B-2 this Scope of Services shall be documented in writing and agreed upon by both parties. These changes may include additions, deletions, or modifications to the services originally agreed upon. Any adjustments to this Scope of Services may have an impact on the project timeline and deliverables, which will be discussed and agreed upon by both parties before implementation. II. TARGET POPULATION Persons served will be youth considered eligible for E-ISFC placement by meeting the following criteria: 1. Must be California Welfare and Institutions Code (WIC) 300, 601, or 602; 2. Currently placed, or at risk of being placed in a licensed STRTP, psychiatric health facility or juvenile detention facility; 3. Must be receiving services through Fresno County; and 4. Youth, ages 6-17 years, or siblings sets, who are in between longer-term placements and present with complex mental or behavioral health needs who are either: a. Youth with Complex Needs Experiencing Placement Insecurity: A youth whose placement has been disrupted and who needs an immediate, safe, and affirming placement with Specialized Resource Parent until a longer-term placement/permanency option is secured or b. New Entries: Youth with complex needs, including sibling sets, who have just been removed from their legal caregiver due to abuse and/or neglect and need an immediate, safe, and affirming placement with Specialized Resource Parent until a longer-term placement option is secured. Additional admission criteria may be identified by the County and the Contractor. The Contractor shall accept all cases referred by the County, recognizing that the County may approve exceptions in unique situations. III. LOCATION OF SERVICES Services will be provided at Contractor's clinic site, in the community, at home, and at education locations, whichever is most comfortable for the youth and family. Contractor must also be capable of offering services through telehealth-phone and telehealth-video, should the need arise. IV. HOURS OF OPERATION Contractors' office(s) shall be open Monday through Friday, 8:00 a.m. to 5:00 p.m., with services available on evenings and weekends, if required to meet the unique needs of the youth and family. At least fifty percent (50%) of services will be provided in the community and shall be scheduled on days and times that are convenient for the families, including evenings and weekends. B-2-2 Exhibit B-2 Youth and E-ISFC Specialized Resource Parents also have access to the Contractor's on-call crisis support twenty-four hours a day, seven days a week (24/7). The Contractor's on-call worker, in consultation with a supervisor and Fresno County Child Welfare System (CWS) Supervisor if needed, will determine the level of support needed to address the crisis. Support ranges from telephone support and coaching to an immediate in-person response by staff. V. DESCRIPTION OF SERVICES - CONTRACTOR RESPONSIBILITIES Contractor shall perform all services and fulfill all requirements identified in this Scope of Services. The following are highlights and/or further defined/updated responsibilities applicable to the E-ISFC program. Contractor shall provide a level of service and support that will reflect each youth's unique and individual needs. A. Specialty Mental Health Services 1. Contractor shall provide the following services to all youth in the program. Services will include but are not limited to the following: i. Provide support to the youth's family and other members of the youth's social network to help them manage the symptoms and illness of the youth and reduce the level of family and social stress associated with the illness; ii. Make appropriate referrals and linkages to services that are beyond that of Contractor's services under this Agreement, or as appropriate when discharging/transitioning a youth from the program; iii. Coordinate services with any other community mental health and non-mental health providers as well as other medical professionals; iv. Assist youth/family with accessing all entitlements or benefits for which they are eligible (i.e., Medi-Cal, SSI, Section 8 vouchers, etc.); v. Develop family support and involvement whenever possible; vi. Refer youth/family to supported education and employment opportunities, as appropriate; vii. Provide or link to transportation services when it is critical to initially access a support service or gain entitlements or benefits; and viii. Provide peer support activities, as appropriate. 2. Contractor shall deliver a comprehensive Specialty Mental Health program. Services include, but are not limited to: i. Assessment; ii. Treatment or care planning/goal setting; iii. Pediatric Symptom Checklist (PSC) 35 and the clinically appropriate version of the Child and Adolescent Needs and Strengths (CANS) assessment; B-2-3 Exhibit B-2 iv. Individual therapy; v. Group therapy; vi. Family therapy; vii. Case management; viii. Consultation; ix. Medication support services; x. Hospitalization/Post Hospitalization Support; A. Certified Peer Support Services; and xii. Intensive Home-Based Services (IHBS), as appropriate. 3. Contractor will ensure that all services: i. Are determined in collaboration with youth and family and reflect the voice and choice and cultural practices of the youth and family; ii. Be values-driven, strengths-based, individual-driven, trauma-informed, and co- occurring capable; iii. Be culturally and linguistically competent; iv. Be age, culture, gender, and language appropriate; and v. Include accommodations for youth with physical disability(ies) 4. Methods for service coordination and communication between program and other service providers shall be developed and implemented consistent with Fresno County Mental Health Plan (MHP) confidentiality rules. 5. Contractor shall maintain up-to-date caseload records of all youth enrolled in services, and provide individual, programmatic, and other demographic information to County as requested. 6. Contractor shall ensure billable Specialty Mental Health Services meet any/all County, State, Federal regulations including any utilization review and quality assurance standards and provide all pertinent and appropriate information in a timely manner to Fresno County Department of Behavioral Health (DBH)for the purpose of billing Medi-Cal for services rendered. B. Enhanced Intensive Services Foster Care (E-ISFC) Model 1. Contractor shall provide E-ISFC services for up to eight (8) youth at any given time. Services shall be highly coordinated, individualized, unconditional, and assist youth and families in addressing identified needs. To maintain familial connections, a sibling set, with one (1) youth presenting with complex mental or behavioral health needs, may be eligible for placement in a E-ISFC home with Specialized Resource Parent consent. 2. Services shall emphasize the strengths of the youth and youth's family. B-2-4 Exhibit B-2 3. Ensure that each E-ISFC team provides five (5) phases of effective E-ISFC care coordination and supportive services, including: i. Referral Process: 1) All youth referred to the E-ISFC services will have pre-approval from the County. 2) Ensure that a qualified staff person is available by phone and electronic communication 24 hours/day, 7 days/week to accept referrals from the county. Response time to referral calls will not exceed 15 minutes. 3) Review referral packet and seek any additional information necessary to match the youth with an E-ISFC family. Utilizing referral information, begin developing an initial safety, staffing, and supervision plan. ii. Intake: 1) Complete consent, admission, and intake documentation a. The youth's Social Worker (assigned or placing) will be required to sign all admission/intake documents as required by the provider prior to the commencement of the placement. b. E-ISFC resource parents who are designated as Fresno County E- ISFC homes are to be available to accept placements within 48 hours of referral. 2) Welcome the child to the home and attend to basic needs. a. Contractor and Specialized Resource Parent are to welcome the youth in a way that is unique to the family and is sensitive to the youth's trauma history while also attending to their basic needs such as food, clothing, and hygiene products. 3) Determine Appropriate Intake Staff Support Levels for Placement. a. Prior to commencement of placement, a clinical team member (social worker or clinician) and/or a program administrator (program supervisor, clinical director, assistant director, program director)will review the referral information to determine if the baseline intake staffing level should be increased until the preliminary assessment can be completed. b. The program will ensure robust staffing support for the E-ISFC home for at least the first 24 hours of the placement. One-to-one staffing (or higher) will continue until the social worker or clinician completes a preliminary assessment and treatment plan. Staffing levels may change only after the first 24-hour period. i. A minimum of one E-ISFC staff person will be in the home and awake at all times for at least the first 24 hours. ii. In-home support staff will be responsible for supporting Specialized Resource Parent with care and supervision tasks, establishing rapport with youth, gathering initial intake assessment information, and providing direct behavioral intervention, including crisis intervention if needed. B-2-5 Exhibit B-2 iii. Supervision checks of the youth will be conducted and documented at intervals not to exceed 15 minutes, including while the youth is asleep, for at least the first 24 hours of the placement or until the preliminary assessment completed, whichever is greater. c. Recommendations by the youth's placing agency worker or another member of the youth's CFT for additional staffing above the intake baseline staffing level will be implemented. d. If at any point, the resource parent and/or staff member determines that increased staff support is necessary to ensure the safety and stability of the youth and those around them, additional E-ISFC staff will be sent to the home within 30 minutes. 4) Develop preliminary assessment and preliminary service plan to inform initial service level. a. Within one (1) business day following the date of admission, the E- ISFC clinician will meet face-to-face with the youth to begin to establish rapport and develop a preliminary assessment and service plan for the first 30 calendar days. The service plan may be updated within the first 30 calendar days, as needed. The Contractor shall submit to the County a template of the written preliminary assessment and diagnostic report for review and approval prior to the commencement of service. iii. Assessment: 1) The comprehensive assessment process will include but is not limited to: a clinical analysis of the youth's history, current status of the youth's mental, emotional, or behavioral disorder, relevant cultural issues and history, diagnosis, and use of any testing procedures. 2) The E-ISFC clinician is responsible for completing a Child and Adolescent Needs and Strengths assessment (CANS)for each youth enrolled for more than 7 days. The CANS shall be completed within 30 calendar days of intake or by the discharge date if the discharge occurs prior to the 30th day of the placement. If a youth has had a CANS completed within the past six months prior to admission, the Contractor will be responsible for reviewing the youth's completed CANS, regardless of the anticipated length of stay, and updating as necessary within 30 calendar days of intake or by the date of discharge if discharge occurs prior to the 30th day. iv. Treatment: The E-ISFC treatment model includes four core methods of intervention. 1) Parental care and supervision i. At least one fully trained Specialized Resource Parent is available to accept placements and has the availability to meet all the requirements of providing these intensive services. Integral to a multi-disciplinary team, resource parents provide services in therapeutic home settings for youth in alignment with the E-ISFC placement program as an alternative to congregate, residential care. B-2-6 Exhibit B-2 ii. Specialized Resource Parents engage directly with the youth and the Permanency Specialist to construct a workable, sustainable kinship placement. iii. The Specialized Resource Parent provides structure, routine, and clear expectations to youth placed in their home. iv. The Specialized Resource Parent collaborates with the other E-ISFC team members, including the social worker/clinician and support counselors, to learn and apply behavioral interventions and engage in the youth's treatment needs, as well as the child and family teaming. V. The Specialized Resource Parent supports the youth in meaningful activities and trauma mitigating activities. vi. Support is provided to each Specialized Resource Parent from the clinician and support counselor. vii. Each Specialized Resource Parent is assigned a master's level SW who is responsible for supporting the Specialized Resource Parents through mentorship, training, oversight, encouragement, and collaborative problem-solving. viii. SW will meet with Specialized Resource Parents at least weekly or more as needed. 2) Advanced clinical services i. Specific services provided by the E-E-ISFC Clinician include but are not limited to assessment, individual therapy, crisis intervention, plan development, collateral services, Child and Family Team participation and facilitation, case management/intensive care coordination, transition planning, and clinical documentation. ii. Medication support services will be provided as needed. iii. E-ISFC clinician will meet with youth in-person at least two times per week and is responsible for guiding the clinical services for the youth. iv. The E-ISFC clinician is responsible for completing a comprehensive services plan (treatment plan) for youth who stay in the program for more than 30 days. 3) Therapeutic behavioral health support and supervision i. Youth will receive a minimum of 21 hours per week of therapeutic behavioral support and supervision. ii. Support counselors are responsible for the implementation of methods outlined in the youth's service plan. B-2-7 Exhibit B-2 iii. Therapeutic behavioral support and supervision may be provided at any hour of the day, any day of the week based on the service plan and needs of the youth. iv. The provider is responsible for documenting direct services and billing for all Specialty Mental Health Services provided. 4) Advancing permanency and connectedness i. The E-ISFC permanency specialist is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. ii. The permanency specialist is responsible for conducting thorough case record review and family finding searches. They will also work with Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact while documents progress according to the Contractors documentation procedures. v. Transition: Key components of the E-ISFC transition planning and support include: 1) The transition plan and goals are addressed in each child and family team meeting. The plan and goals will be updated as needed based on the assessed needs of the youth. 2) The E-ISFC clinician is responsible for reviewing transition goals on the services plan and revising, if necessary, at least monthly. 3) The E-ISFC team is available to support the transition goals for each youth which may include but is not limited to, supervising visits with potential future placements, transporting youth to visitation, and leading or supporting permanency work including family finding. 4) With DBH approval and if clinically appropriate, provide Specialty Mental Health Services (SMHS) until the youth is fully transitioned to the new placement and necessary mental health services. 5) In conjunction with County, develop and implement a discharge policy, in and through which, Contractor shall: i. Agree that the primary goal of the E-ISFC Program is to seek and maintain stability of youth in the lowest level of care placement setting so that they can successfully reach stabilization, no longer require intensive supervision or intensive mental health interventions, and transition to a permanent home setting. ii. Agree to serve any youth who meets eligibility criteria and parameters for placement for the full duration of the placement, regardless of the severity or complexity of their behaviors, accessing and coordinating the necessary B-2-8 Exhibit B-2 services and supports to effectively address the needs of the youth. iii. Agree to maximize communication in transition planning for youth. iv. Agree to utilize innovative approaches and all available resources to make reasonable efforts to stabilize youth in their current placement thereby reducing the likelihood of placement disruption. Consult with the appropriate CWS Division Chief/Probation Assistant Deputy Chief(ADC) to determine if additional services may prevent an unnecessary disruption of placement in the E-ISFC resource home. V. Notify the CWS or Deputy Probation Officer (DPO) and appropriate CWS Division Chief/Probation ADC or designee, via electronic mail as soon as, but not more than 1 business day after the Contractor becomes aware of an issue that may lead to a placement change. vi. Convene or participate in a case conference or CFT meeting to determine how or if the youth may be stabilized in the current E-ISFC placement and if additional services may prevent an unnecessary disruption of placement in the E- ISFC resource home. vii. Contact appropriate CWS Division Chief/Probation ADC or designee to arrange a consultation after the case conference or CFT meeting to discuss the outcome and any updates to the treatment and/or crisis intervention plan. viii. Document in advance of any anticipated placement change efforts made to stabilize and maintain the youth in placement, including provision of existing and additional mental health services and daily E-ISFC Specialized Resource Parent support including telephone check-ins and in-home crisis stabilization services. Contractor shall ensure that the Specialized Resource Parent may not refuse any mental health services determined necessary for the youth by the treatment team. ix. Provide Notice of Intent to Discharge via electronic mail to the CSW, DPO, and appropriate CWS Division Chief/Probation ADC only when all alternatives have been exhausted and after an emergency CFT has occurred, and no less than 14 days prior to the anticipated discharge date, unless it is agreed upon at the CFT that less notice is necessary to ensure the health and safety of the youth or others. X. Refer the Notice of Intent to Discharge to the Supervisor or Division Chief/ADC of the CSW or DPO, and appropriate CWS Program Administrator if the assigned contacts are not responsive to requests to grant authorization or B-2-9 Exhibit B-2 unreasonably delay authorization for the Contractor to discharge a youth. A. Monitor and deliver transitional SMHS and after care services to the youth until a transition to other mental health services have been planned and begun pursuant to DSS contract provisions. 4. Unique Situations: Contractor will ensure that every possible intervention has been exhausted prior to developing an alternative placement plan. While there may be times when it is determined that continued placement in the home is not in the best interest of the youth, we only make this determination after first considering all possible options for stabilizing the youth in the program. The stabilization planning meeting must include representatives from the provider agency and the county department(s)with the authority to make decisions in the moment regarding resources and interventions. 5. For youth dually enrolled in Wraparound and E-ISFC, the youth's CFT will determine which agency and which person is assigned as lead for the following tasks based on existing therapeutic relationships, treatment goals, and transition goals: 1) Advanced clinical services such as therapy, medication support/psychiatry, assessment; 2) Behavioral intervention/rehabilitation; 3) Case coordination such as CFT facilitation, case management, plan development; and 4) Permanency work and family finding. 6. The Contractor's E-ISFC program staff will retain responsibility for at least the following roles: 1) Parental care and supervision; 2) Care and supervision provided by support counselors, which may include rehabilitation and behavioral support aligned with the youth's service plan; 3) Crisis response; and 4) Social work responsibilities including oversight, training, support, guidance for Specialized Resource Parents. The Contractor shall have the flexibility to adjust service levels based on the needs of the youth. When youth are receiving Wraparound services, the Contractor may need to decrease service intensity and corresponding staffing levels to avoid duplication with the Wraparound provider. The Contractor shall also be flexible to increase service intensity levels when needed and as determined by the CFT. 7. Length of Stay: i. The expected length of stay for the E-ISFC is at least thirty (30) calendar days but no longer than twelve (12) months. While stated length of stay reflects general parameters, a youth's ongoing participation beyond twelve (12) months in the E- ISFC program is driven by their demonstrated need. B-2-10 Exhibit B-2 C. Crisis Services 1. Develop and implement a safety planning, response and notification plan, in and through which, Contractor: i. Shall ensure Contractor's E-ISFC staff and Specialized Resource Parents are trained to implement safety and preventive measures to avert and respond to any self- harming and/or other behaviors that pose risk to the youth or others. ii. Shall, if after all relevant safety and preventive measures have been exhausted and youth needs an emergency psychiatric assessment for acute psychiatric hospitalization or exhibits escalating behaviors indicating danger to self or others, contact the Wrap provider in the County. If the behaviors demonstrate immediate danger and safety the Contractor shall contact 911. iii. Shall ensure that E-ISFC staff or other relevant administrator notify the youth's DSS Social Worker (SW) or Deputy Probation Officer (DPO) and appropriate CWS Division Chief/Assistant Deputy Chief, or designees, via email as soon as reasonably possible, but no later than the end of the day for all incidents that indicate a sign of threat or continued risk to the physical or mental health status of the E-ISFC youth including all such incidents that require a Critical Incident Report, as outlined in the following section. iv. In the event of an emergency, Contractor may move the placed youth to another E-ISFC Respite Home of the Contractor without prior authorization from the SW or DPO. For the purposes of this paragraph, an emergency is defined as any situation that threatens the health and safety of the placed youth or others in the E-ISFC home. In the event of an emergency placement change, Contractor shall make every effort to keep the youth in the school they are currently attending. v. As soon as it is reasonably safe to do so, the Contractor shall notify the CWS hotline, the SW, DPO and appropriate CWS Division Chief/Probation ADC, or designees regarding any emergency placement changes. The Contractor shall then follow up with the SW by phone within one business day. vi. Shall discuss the situation that led to the emergency placement change with the SW, DPO or designee and document the conversation and decision in the respective case file. A CFT Meeting will be held as soon as possible after the incident to update the safety plan. vii. Shall comply with the following when youth are referred for psychiatric hospitalization, engage in elopement, experience a juvenile hall stay, or other temporary placement disruptions: viii. Notify the SW or DPO and appropriate CWS Division Chief/Probation ADC as soon as it is reasonably safe to do so, and complete a critical incident report; B-2-11 Exhibit B-2 ix. Participate in case conferences, hospital discharge conference and/or the CFT meetings for the placed youth; x. Continue to provide the services to the extent possible to the placed youth; xi. Ensure the E-ISFC Specialized Resource Parent and/or the E-ISFC staff visit the youth during the hospitalization and maintain contact by telephone unless otherwise directed by the hospital medical staff or County staff; xii. Allow youth to return to the E-ISFC program up to 5 calendar days from the placement disruption, keeping the E-ISFC bed open for 5 calendar days, unless otherwise agreed upon with the County. If, however, the 5-day bed hold expires, Contractor shall collaborate with the SW or DPO and appropriate CWS Division Chief to either extend the hold or close the placement and re-open it when the youth returns. xiii. Initiate a CFT meeting within 24 hours of youth's return to the E-ISFC home. xiv. Exceptions to the above re-admission requirements are allowed only when the CFT, including the SW or DPO, decides not to return the youth to the E-ISFC Resource Home, or when Contractor and the SW or DPO mutually agree that the re-admission jeopardizes the immediate health and safety of the youth or others in the home. In both cases, Contractor shall immediately notify the appropriate CWS Division Chief/Probation ADC or designee by telephone of the decision not to re- admit and follow up with an electronic mail message by the end of the next business day. In both cases, Contractor shall also assist in finding a new caregiver and placement within its licensed programs. 2. Shall report and document all major and/or sensitive incidents ("critical incidents") to the County pursuant to the procedures and timing outlined in Exhibit J. The County, at its sole discretion, may require the Contractor to conduct all necessary follow-up activities after reporting critical incidents. If there is any doubt about whether an incident should be reported, the default shall be for the Contractor to report the incident to the County. i. Notify DSS as soon as possible via Hotline, email and phone, but no later than twenty-four (24) hours from the time the Contractor, or an employee or agent of the Contractor, knows or has reason to believe that a critical incident has occurred or may have occurred. Include the following information in all incident reports: 1) Name and contact information of the submitting individual; 2) Name and email address of the best contact for immediate access to a Contractor staff member who can answer questions regarding the incident; 3) The name of the youth, if involved. 4) A description of the incident to include: 5) Date, time, and location of the incident; 6) Description of the events that took place; 7) Names and job titles of Contractor personnel involved in the incident, if any; 8) Description of law enforcement involvement, if any; 9) Description of other emergency response involvement, if any; B-2-12 Exhibit B-2 10)Description of any action taken by the Contractor in response to the incident; 11)An indication of whether press coverage or negative community response is likely. D. E-ISFC Specialized Resource Parents 1. Contractor will recruit, train, utilize and support ISFC Specialized Resource Parents who shall assume the roles and perform the functions of E-ISFC Specialized Resource Parents in providing the necessary care, services and supports that are identified in the individual needs and services plan. i. Make active and ongoing recruitment efforts a minimum of one (1) time per month to increase capacity for E-ISFC services with a goal to maintain a minimum of eight (8), fully trained Specialized Resource Parents prepared to accept placements, or currently providing E-ISFC services to a youth at any given time. ii. Each home will have at least one dedicated Specialized Resource Parent who is an E-ISFC caregiver, with no competing responsibilities outside the home, who is ISFC certified, and has educational, professional and/or lived experience working with youth that helps them to understand and respond to the needs of the youth placed in care. Furthermore, E-ISFC Specialized Resource Parents shall provide a safe, consistent, and structured home environment for youths 24 hours/day, 7 days/week. iii. Ensure that all recruitment efforts are targeted to individuals/populations who would likely be willing and capable of meeting the needs of children of all ethnicities, ages, sexual orientations and gender identities, immigration statuses, physical abilities, religious or spiritual beliefs, and who have a wide range of trauma histories, developmental capabilities, mental health and/or behavioral needs, and coping skills. iv. Designate a Trainer to develop and deliver pre-service and ongoing E-ISFC Specialized Resource Parent training. 1) The Trainer shall have an educational background in a relevant field (e.g., social work, psychology, child development) and experience working with similar youth in residential or foster care settings. 2) The Trainer shall demonstrate the ability to engage with families, proficiency in teaching and public speaking, and ability to collaborate with members of a team. v. Implement a Training Plan for E-ISFC Specialized Resource Parents, which shall be reviewed and approved by the County prior to implementation. The Training Plan shall specify the training requirements for E-ISFC Specialized Resource Parents that is over and above that which is required for ISFC certified parents. The plan shall include training topics to be covered, the amount of time spent on each topic, and the qualifications of the trainer. The plan shall specify both the requirements for initial training (pre-placement) and annual ongoing training. B-2-13 Exhibit B-2 Subsequent changes to the E-ISFC Specialized Resource Parent Training Plan shall be reviewed and approved by the County. vi. Ensure that E-ISFC Specialized Resource Parents have completed all ISFC and E-ISFC training requirements specified in the Contractor's Training Plan prior to the commencement of an E-ISFC placement. vii. Ensure that all Specialized Resource Parents approved to provide E-ISFC placements reside in Fresno County. Potential Specialized Resource Parents who reside in neighboring counties may provide E-E-ISFC services to Fresno County youth upon County approval. viii. Ensure that Specialized Resource Parents approved to provide E-ISFC placements are screened and selected based on their ability to meet the needs of children of all ethnicities, ages, sexual orientations and gender identities, immigration statuses, physical abilities, religious or spiritual beliefs, and who have a wide range of trauma histories, developmental capabilities, mental health and/or behavioral needs, and coping skills. ix. Ensure that E-ISFC Specialized Resource Parents have met the minimum training requirements of the CDSS for provision of ISFC level care to children/youth. x. Ensure County has an updated and accurate roster of E-ISFC resource families at all times, which reflects the date resource families were approved to provide both ISFC and E-ISFC services. xi. Ensure that E-ISFC Specialized Resource Parents complete all additional trainings identified as necessary by County. E. Additional Responsibilities 1. Maintain responsibility for necessary testimony and/or providing County with information needed to generate court reports, as outlined below: i. Court Reports - Documented reports of assessment and evaluation findings, progress in treatment, recommendations for treatment and service plans regarding reunification, maintenance and termination of parental rights, and justification for recommendations. ii. Court Testimony- Provide care plan updates when a court is considering reunification, maintenance, and/or termination of parental rights. 2. Upon notification of a pending court hearing, Contractor agrees to complete and submit to the County a "Periodic Review Report" twenty-one (21) calendar days prior to the court date or seven (7) calendar days after notification. 3. Maintain electronic health records and supply their own personal computers, Internet access, printers, signature pads and other network devices to meet statistical reporting requirements, report person-served and program outcomes and any State or County data requirements of the Katie A. Implementation Plan. Contractor shall also maintain capability to enter electronic billing data into County's electronic health record system. A computer with Internet access is required for both office and field-based staff. 4. Cooperate and participate with the County MHP in Quality Assurance/Improvement and Utilization Review Programs and grievance procedures and comply with all final B-2-14 Exhibit B-2 determinations rendered by County's Quality Assurance/Improvement and Utilization Review Programs, unless the decision is reversed on appeal as set forth in the County MHP Provider Manual, incorporated herein by this reference. County's adverse decisions regarding Contractor's services to persons-served may result in the disallowance of payment for services rendered; or may result in additional controls to the delivery of services; or may result in the termination of this Agreement. County shall have sole discretion in the determination of Quality Assurance/Improvement and Utilization Review outcomes, decisions and actions. 5. Participate in regularly scheduled contract monitoring meetings with the County to discuss program successes and obstacles utilizing a Continuous Quality Improvement (CQI) framework. 6. Obtain signatures, as required, regarding consent: i. Care provider can sign for day trips and other minor miscellaneous items. ii. Court Order should suffice for most other items. 7. Assist with training County staff and the community in E-ISFC Service processes and service options. 8. Develop training curriculum as County identifies a need. This includes but is not limited to training curriculum for E-E-ISFC staff and Specialized Resource Parents as well as training curriculum for SWs and County staff. 9. Participate in County-offered trainings which may include but are not limited to topics such as Quality Parenting Initiative and The Neuro-sequential Model of Therapeutics (NMT). 10. Provide annual Civil Rights training to all staff at the beginning of every calendar year and will provide verification of training completion to DSS. DSS will provide documents needed for annual training and reporting. 11. Have and maintain in good standing an active California Department of Social Services (CDSS) issued license as a Foster Family Agency (FFA). 12. Work collaboratively with other CWBC providers to develop and enter into Memorandum of Understanding or other business agreements between themselves that defines the processes and procedures for provision of services to foster youth, including, but not limited to the: i. Case Planning ii. Care Coordination iii. Intensive Transition Planning iv. Assessment v. Transportation between service settings vi. Information sharing vii. Data collection and dissemination 13. Work with DPO on criminogenic risk factors for probation youth as addressed through contracted services as applicable. VI. STAFFING A. Staffing shall be appropriate and aligned with the E-ISFC service model, and shall include E-ISFC teams which shall be comprised of the following classifications: Specialized Resource Parent(s), Clinician/Social Worker, Lead Support Counselor, Support Counselor, and Permanency Specialist: B-2-15 Exhibit B-2 1) Specialized Resource Parent(s): One (1) fully trained E-ISFC Resource Parent is available to accept placements and has the availability to meet all the requirements of providing these intensive services. Integral to a multi- disciplinary team, specialized resource parents provide services in therapeutic home settings for youth in alignment with the E-ISFC model as an alternative to congregate, residential care. Specialized Resource Parent collaborates with the other E-ISFC team members, including the Social Worker/Clinician and Support Counselors, to learn and apply behavioral interventions and engage in the youth's treatment needs, as well as the Child and Family Team. The Specialized Resource Parent(s) supports the youth's engagement in meaningful activities and meets with other Team members. The overarching goal is to support the youth's transition to permanency. 2) E-ISFC Social Worker: A Master's level Social Worker is responsible for supporting the parents through mentorship, training, oversight, encouragement, and collaborative problem-solving. Social Workers meet with Specialized Resource Parents at least weekly, or more as needed. Specific services provided by the Social Worker include, but are not limited to: • Support and monitor the resource parent in implementing specific interventions specified in the youth's services plan. • Provide training in the home related to practices such as trauma- informed and behavioral interventions • Monitor the parent's compliance with all regulatory requirements including licensing and accreditation standards. • Facilitate support groups and didactic training with multiple resource parents. • Provide motivational encouragement and emotional support to parents. • Social Worker shall provide a minimum of four (4) direct service hours per week/per youth. 3) E-ISFC Clinician: Supervised by a Clinical Director, the E-ISFC Clinician meets with each youth in-person at least two times per week and is the primary person responsible for guiding the clinical services for each youth. Specific services provided by the Clinician include, but are not limited to: • Assessment • Individual therapy • Family therapy • Crisis intervention • Plan development • Collateral services • Child and Family Team participation and facilitation • Case management/Intensive Care Coordination • Transition planning • Clinical documentation B-2-16 Exhibit B-2 • Clinician shall provide a minimum of four (4) direct service hours per week/per youth. 4) Support Counselor(s): A minimum of two (2) Support Counselors shall meet with the youth to provide one-on-one support, focusing on increasing the frequency of desired behaviors, gaining access to pro-social activities and resources within the community, and developing effective relationship- building skills, emotional regulation, conflict resolution skills. • Support Counselor(s) shall provide a combined minimum of twenty-one (21) direct service hours per week/per youth of therapeutic behavioral support and supervision based on each youth's unique level of need. • Therapeutic behavioral support and supervision may be provided at any hour of the day, any day of the week based on the service plan and needs of the youth. The provider is responsible for documenting direct services and billing for all Specialty Mental Health Services provided. 5) Permanency Specialist: Permanency Specialist has the responsibility of supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. The Permanency Specialist works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress according to the provider's documentation procedures. • Permanency Specialist shall provide a minimum of two (2) direct service hours per week/per youth. 6) Ensure each E-ISFC team has access to: • One (1) Psychiatrist to meet with the Person served to provide evaluation and assessment for psychotropic medication, clinical consultation, and assistance linking the Person served and their Specialized Resource Parent to ongoing psychiatric services and support as needed and prioritizing continuity of care where possible. • Family/Parent Partner, Youth Peer Partner, Individual Therapist, Family Therapist, Nurse, as needed. B. Ensure that direct service staff reimbursed through this contract shall spend at least 65% of their paid work time providing and documenting direct service to clients or on behalf of clients. Administrative staff meetings, supervision meetings, and staff trainings shall not be included in the 65%. B-2-17 Exhibit B-2 C. The Contractor shall ensure its E-ISFC staff meets the State's ISFC qualifications, training, and duty requirements as outlined in WIC 18358 or other statutes relevant to ISFC as well as the County's FFA Master Contract requirements where they are more restrictive than those of the State ISFC regulations. For any waivers or exceptions to these requirements that are allowed by state regulation, Contractor shall submit a request for such approval to DSS before allowing the staff in question to begin delivering the service. VII. COUNTY RESPONSIBILITIES: County shall: A. Assist Contractors' efforts to evaluate the needs of each enrolled youth on an ongoing basis to ensure each youth is receiving clinically appropriate services. B. Provide oversight and collaborate with contractors and other County Departments and community agencies to help achieve State program goals and outcomes. Oversight includes, but is not limited to, contract monitoring and coordination with the State Department of Health Care Services (DHCS) and California Department of Social Services (CDSS) in regard to program administration and outcomes. C. Assist Contractors in making linkages with the total mental health system of care. This will be accomplished through regularly scheduled meetings as well as formal and informal consultation. D. Participate in evaluating overall program progress and efficiency and be available to contractors for ongoing consultation. E. Gather outcome information from target youth groups and Contractors throughout each term of this Agreement. County shall notify contractors when their participation is required. The performance outcome measurement process will not be limited to survey instruments but will also include, as appropriate, youth and staff interviews, chart reviews, and other methods of obtaining required information. F. Assist Contractors' efforts toward cultural and linguistic competency by providing the following to contractors: 1. Technical assistance and training regarding cultural competency requirements at no cost to contractors. 2. Mandatory cultural competency training for contractors' personnel, on an annual basis, at minimum. 3. Technical assistance for translating information into County's threshold languages (Spanish and Hmong). Translation services and costs associated will be the responsibility of contractors. VIII. REPORTS Contractor shall track data and provide reporting on the following items and send all applicable information and reports to the following distribution list for County staff: DSS Staff Analyst, DSS Division Chief, DSS Social Work Supervisor, and DBH Contract Analyst. 1) Contractors shall be expected to comply with all contract monitoring and compliance protocols, procedures, data collection methods, and reporting requirements conducted by County. B-2-18 Exhibit B-2 2) Contractors will be responsible for meeting with DSS/DBH on a monthly basis, or more often as agreed upon between DSS/DBH and Contractors, for contract, performance, and outcomes monitoring. 3) Contractors will be required to submit monthly reports on performance measures to the County. Report formats will be established through County/Contractor collaboration. Outcome measures may change, based on information or measures needed. Required monthly reports include: a) DSS Monthly Activity Report (MAR); and b) Other reports as established by the County 4) All reports will be due to the County by the 10t" of each month and will be reviewed for accuracy. (If the 101" lands on a weekend or Holiday, reports will be due the next business day). 5) Contractor shall also provide County with additional individualized reports for each youth which may include, but are not limited to: Monthly Progress Report, Discharge Presentation, Individual Child and Family Plan Presentation Outline, and Individual Child and Family Plan (ICFP). 6) Additional reports and outcome information may be requested by County at a later date, as needed. IX. GOALS/OUTCOMES Contractor is required to submit measurable outcomes on a bi-annual basis, as identified in the DBH's Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes Measures. Performance outcome measures must be approved by DBH and DSS and satisfy all State and local mandates. County will consider Contractor performance levels when determining funding recommendations for future agreements. For the contract period, Contractor shall document all direct services to youth, transition planning efforts, permanency planning efforts, and crisis responses. County anticipates an increase in placement stability and permanency, behavioral stability, symptom reduction, strengths and resiliency, and educational stability as a result of these services. The outcomes listed in the table below will measure the success of Contractor's services. These outcomes may be modified at County's discretion. Contractor will report outcomes in each MAR or alternate method determined by County. Outcome measures are included below. Fresno County Enhanced ISFC Contract Performance Expectations Metric Outcome Indicator Retention Improved placement stability. Youth will remain in their No more than 5% of placement for the length of time that aligns with the youth in E-ISFC youth's treatment plan. homes will leave placement without pre-approval Service Decreased wait time for placement. 100% of E-ISFC Availability parents who have a vacant bed are available to receive a B-2-19 Exhibit B-2 youth into their home within 48 hours of referral Service Youth in E-ISFC are receiving necessary and clinically Minimum Direct Availability appropriate services from each E-ISFC Team member: Service Hours Per Youth Per Week: Clinician/Social Worker: Advanced clinical services Clinician/Social Support Counselor(s): Therapeutic behavioral support Worker: 4 and supervision Support Counselor(s): Permanency Specialist: Advancing permanency and 21 connectedness Permanency Specialist: 2 Service Determination of youth's immediate safety needs. At least 90% of youth Timeliness enrolled have received a preliminary assessment and service plan completed by the end of the first business day following date of admission. Service Ensure timeliness of comprehensive assessment to A comprehensive Timeliness best capture youth's needs in order to provide an assessment will be individualized treatment plan. completed for 100% of youth enrolled for more than 7 calendar days. 90% of the comprehensive assessments will be completed within 30 calendar days of the date of intake, or by the date of discharge if occurs prior to the 30t" day. Service Delivery Individualized treatment plans developed for every A treatment plan is youth receiving services. completed for 100% of youth enrolled for 30 days or more. B-2-20 Exhibit B-2 Crisis Response Prevention of crisis escalation, stabilization of Provider responds to placement, preservation of Specialized Resource 100% of crises that Parent-youth relationship, avoid unnecessary law require an in-person enforcement involvement, and reduce psychiatric response within 30 hospitalizations. minutes. Crisis Response Avoid re-traumatization of youth, stabilization of Provider stabilizes at placement, preservation of Specialized Resource least 75% of youth in Parent-youth relationship, avoid unnecessary law the home setting enforcement involvement, and reduce psychiatric following an in-person hospitalizations. crisis response Transition Reduction in barriers and increased support for Individualized, trauma- Planning seamless transition between levels of care for youth. informed transition plan is completed prior to discharge for 100% of enrolled youth. Contractor will provide Plan to County within one (1) business day following discharge for 100% of youth. Transition to Increased transitions of youth to the least restrictive 85% of youth enrolled less restrictive setting possible. will be transitioned to placements less restrictive placements. Permanency Youth will demonstrate increased family and natural Planning support connection and/or achievement of permanency. 90% of youth who complete the *Not applicable to youth who receive services for less discharge CANS will than 30 calendar days as a result of securing show improvement in placement or leaving without pre-approval the Permanency module of the CANS. Improved Youth will demonstrate a reduction in action items in the 90% of youth who behavioral/ Behavioral/Emotional Needs Domain, Risk Behaviors complete the emotional needs Domain and the Family Functioning and Living Situation discharge CANS will items in the Life Functioning Domain from the initial show a reduction in CANS. action items in the Behavioral/Emotional *Not applicable to youth who receive services for less Needs Domain, Risk than 30 calendar days as a result of securing Behavior Domain, and placement or leaving without pre-approval the Family Functioning and Living Situation items in the Life Functioning Domain of the CANS. B-2-21 Exhibit B-2 Improved Youth will demonstrate increased knowledge of 80% of youth who strengths emotional regulation and de-escalation skills, increased complete the family functioning and permanency, behavioral and discharge CANS will emotional stability, and decrease in maladaptive show improvement in behaviors. overall CANS score. *Not applicable to youth who receive services for less than 30 calendar days as a result of securing placement or leaving without pre-approval. Academic Youth will demonstrate improvement and increased 90% of enrolled youth Engagement consistency in school attendance will have attended school for at least 85% of the academic year. Persons served Youth will report a positive experience and recognize At least 75% of youth satisfaction (to the benefits of the services provided who completed a be reported on a satisfaction survey will quarterly basis) respond as satisfied with services. In addition to the outcomes above being tracked on the MAR, Contractors shall utilize a computerized tracking system with which performance and outcome measures and other relevant person served data, such as demographics, will be maintained. The data tracking system may be incorporated into the Contractors' electronic health records (EHR) systems or in stand-alone databases (e.g., Access or Excel spreadsheets). County must be afforded read-only access to the data tracking system. County may adjust the performance and outcome measures periodically throughout the duration of the Agreement, as needed, to best measure the program as determined by County and/or CDSS. B-2-22 Exhibit B-2 SCOPE OF SERVICES ORGANIZATION: Promesa Behavioral Health ADDRESS: 7120 N. Marks Ave, Suite 110 Fresno, CA 93711 SERVICES: Emergency Enhanced Intensive Services Foster Care TELEPHONE: 559-439-5437 x 593 CONTACT: Lisa K. Weigant, CEO EMAIL: Iweigant@promesabehavioral.org CONTRACT PERIOD: Upon execution - June 30, 2026 with two (2) optional one-year extensions Year 1: Upon execution — June 30, 2025 Year 2: July 1, 2025— June 30, 2026 Year 3: July 1, 2026 —June 30, 2027 Year 4: July 1, 2027 —June 30, 2028 (. BACKGROUND The Fresno County Children's Wellbeing Continuum (CWBC) is designed to offer a seamless service delivery model across multiple service levels and settings for Fresno youth with complex behavioral and emotional needs. CWBC consists of responsive, front-end service provision that supports our child welfare, juvenile probation, and behavioral health infrastructures and is designed to flexibly provide seamless step-up and step-down transition services, ensuring that children and families receive continuity of service provision even as their needs change over time. A key component of this continuum is Fresno County's Emergency Enhanced Intensive Services Foster Care (E-E-ISFC) program. The purpose of the E-E-ISFC program is to provide prompt, safe, supportive, and highly individualized treatment for every youth within the context of a loving home with skilled and caring resource parents. The E-E-ISFC program offers a family-based alternative for youth who may otherwise be placed in a Short-Term Residential Therapeutic Program (STRTP) or for youth who historically may have had to wait for hours or days in a social worker's office while a suitable placement was identified. The E-E-ISFC program provides a structured and safe setting promoting stabilization and the development of therapeutic relationships with both specialized resource parents and staff, allowing the multidisciplinary team to complete an accurate assessment of the youth's needs, engage the youth in intensive treatment services, and recommend next steps toward permanency and healing. This Scope of Services is based on the current understanding of the needs of Fresno County (County) youth and the initial conceptualization of program design to best meet the needs of youth. The County and Promesa (Contractor) acknowledge that circumstances may arise that necessitate adjustments to the program design. In such cases, both parties agree to work B-2-23 Exhibit B-2 together in good faith to review and, if necessary, revise this Scope of Services. Any changes to this Scope of Services shall be documented in writing and agreed upon by both parties. These changes may include additions, deletions, or modifications to the services originally agreed upon. Any adjustments to this Scope of Services may have an impact on the project timeline and deliverables, which will be discussed and agreed upon by both parties before implementation. II. TARGET POPULATION Persons served will be youth considered eligible for E-E-ISFC placement by meeting the following criteria: 1. Must be California Welfare and Institutions Code (WIC) 300, 601, or 602; 2. Currently placed, or at risk of being placed in a licensed STRTP, psychiatric health facility or juvenile detention facility, 3. Must be receiving services through Fresno County; and 4. Youth ages 6-17 years, or siblings sets, who are in between longer-term placements and present with complex mental or behavioral health needs who are either: a. Youth with Complex Needs Experiencing Placement Insecurity: A youth whose placement has been disrupted and who needs an immediate, safe, and affirming placement with Specialized Resource Parent until a longer-term placement/permanency option is secured or b. New Entries: Youth with complex needs, including sibling sets, who have just been removed from their legal caregiver due to abuse and/or neglect and need an immediate, safe, and affirming placement with Specialized Resource Parent until a longer-term placement option is secured. Additional admission criteria may be identified by the County and the Contractor. The Contractor shall accept all cases referred by the County, recognizing that the County may approve exceptions in unique situations. III. LOCATION OF SERVICES Services will be provided at Contractor's clinic site, in the community, at home, and at education locations, whichever is most comfortable for the youth and family. Contractor must also be capable of offering services through telehealth-phone and telehealth-video, should the need arise. IV. HOURS OF OPERATION Contractors' office(s) shall be open Monday through Friday, 8:00 a.m. to 5:00 p.m., with services available on evenings and weekends, if required to meet the unique needs of the youth and family. At least fifty percent (50%) of services will be provided in the community and shall be scheduled on days and times that are convenient for the families, including evenings and weekends. B-2-24 Exhibit B-2 Youth and E-E-ISFC Specialized Resource Parents also have access to the Contractor's on-call crisis support twenty-four hours a day, seven days a week (24/7). The Contractor's on-call worker, in consultation with a supervisor and Fresno County Child Welfare System (CWS) Supervisor if needed, will determine the level of support needed to address the crisis. Support ranges from telephone support and coaching to an immediate in-person response by staff. V. DESCRIPTION OF SERVICES - CONTRACTOR RESPONSIBILITIES Contractor shall perform all services and fulfill all requirements identified in this Scope of Services. Contractor shall provide a level of service and support that will reflect each youth's unique and individual needs. A. Specialty Mental Health Services 1. Contractor shall provide the following services to all youth in the program. Services will include but are not limited to the following: i. Provide support to the youth's family and other members of the youth's social network to help them manage the symptoms and illness of the youth and reduce the level of family and social stress associated with the illness; ii. Make appropriate referrals and linkages to services that are beyond that of Contractor's services under this Agreement, or as appropriate when discharging/transitioning a youth from the program; iii. Coordinate services with any other community mental health and non-mental health providers as well as other medical professionals; iv. Assist youth/family with accessing all entitlements or benefits for which they are eligible (i.e., Medi-Cal, SSI, Section 8 vouchers, etc.); v. Develop family support and involvement whenever possible; vi. Refer youth/family to supported education and employment opportunities, as appropriate; vii. Provide or link to transportation services when it is critical to initially access a support service or gain entitlements or benefits; and viii. Provide peer support activities, as appropriate. 2. Contractor shall deliver a comprehensive Specialty Mental Health program. Services include, but are not limited to: i. Assessment; ii. Treatment or care planning/goal setting; iii. Pediatric Symptom Checklist (PSC) 35 and the clinically appropriate version of the Child and Adolescent Needs and Strengths (CANS) assessment; iv. Individual therapy; B-2-25 Exhibit B-2 v. Group therapy; vi. Family therapy; vii. Case management; viii. Consultation; ix. Medication support services; x. Hospitalization/Post Hospitalization Support; A. Certified Peer Support Services; and xii. Intensive Home-Based Services (IHBS), as appropriate. 3. Contractor will ensure that all services: i. Are determined in collaboration with youth and family and reflect the voice and choice and cultural practices of the youth and family; ii. Be values-driven, strengths-based, individual-driven, trauma-informed, and co- occurring capable; iii. Be culturally and linguistically competent; iv. Be age, culture, gender, and language appropriate; and v. Include accommodations for youth with physical disability(ies) 4. Methods for service coordination and communication between program and other service providers shall be developed and implemented consistent with Fresno County Mental Health Plan (MHP) confidentiality rules. 5. Contractor shall maintain up-to-date caseload records of all youth enrolled in services, and provide individual, programmatic, and other demographic information to County as requested. 6. Contractor shall ensure billable Specialty Mental Health Services meet any/all County, State, Federal regulations including any utilization review and quality assurance standards and provide all pertinent and appropriate information in a timely manner to Fresno County Department of Behavioral Health (DBH) for the purpose of billing Medi-Cal for services rendered. B. Emergency Enhanced Intensive Services Foster Care (E-E-ISFC) 1. Contractor shall provide E-E-ISFC services for up to four (4) youth at any given time. Services shall be highly coordinated, individualized, unconditional, and assist youth and families in addressing identified needs. To maintain familial connections, a sibling set, with one (1) youth presenting with complex mental or behavioral health needs, may be eligible for placement in a E-E-ISFC home with Specialized Resource Parent consent. 2. Services shall emphasize the strengths of the youth and youth's family. B-2-26 Exhibit B-2 3. Ensure that each E-E-ISFC team provides five (5) phases of effective E-E-ISFC care coordination and supportive services, including: i. Referral Process: a) All youth referred to the E-E-ISFC services will have pre-approval from the County. b) Ensure that a qualified staff person is available by phone and electronic communication 24 hours/day, 7 days/week to accept referrals from the county. Response time to referral calls will not exceed 15 minutes. c) Review referral packet and seek any additional information necessary to match the youth with an E-E-ISFC family. Utilizing referral information, begin developing an initial safety, staffing, and supervision plan. ii. Intake: 1. Complete consent, admission, and intake documentation a. The youth's Social Worker (assigned or placing) will be required to sign all admission/intake documents as required by the provider prior to the commencement of the placement. b. E-E-ISFC resource parents who are designated as Fresno County E- E-ISFC homes are to be available to accept placements within 4 hours of referral. 2. Welcome the child to the home and attend to basic needs. a. Contractor and Specialized Resource Parent are to welcome the youth in a way that is unique to the family and is sensitive to the youth's trauma history while also attending to their basic needs such as food, clothing, and hygiene products. 3. Determine Appropriate Intake Staff Support Levels for Placement. a. Prior to commencement of placement, a clinical team member (social worker or clinician) and/or a program administrator (program supervisor, clinical director, assistant director, program director) will review the referral information to determine if the baseline intake staffing level should be increased until the preliminary assessment can be completed. b. The program will ensure robust staffing support for the E-E-ISFC home for at least the first 24 hours of the placement. One-to-one staffing (or higher)will continue until the social worker or clinician completes a preliminary assessment and treatment plan. Staffing levels may change only after the first 24-hour period. i. A minimum of one E-E-ISFC staff person will be in the home and awake at all times for at least the first 24 hours. ii. In-home support staff will be responsible for supporting Specialized Resource Parent with care and supervision tasks, establishing rapport with youth, gathering initial intake B-2-27 Exhibit B-2 assessment information, and providing direct behavioral intervention, including crisis intervention if needed. iii. Supervision checks of the youth will be conducted and documented at intervals not to exceed 15 minutes, including while the youth is asleep, for at least the first 24 hours of the placement or until the preliminary assessment completed, whichever is greater. c. Recommendations by the youth's placing agency worker or another member of the youth's CFT for additional staffing above the intake baseline staffing level will be implemented. d. If at any point, the resource parent and/or staff member determines that increased staff support is necessary to ensure the safety and stability of the youth and those around them, additional E-ISFC staff will be sent to the home within 30 minutes. 4. Develop preliminary assessment and preliminary service plan to inform initial service level. a. Within one (1) business day following the date of admission, the E-E- ISFC clinician will meet face-to-face with the youth to begin to establish rapport and develop a preliminary assessment and service plan for the length of stay. The service plan may be updated within the first seven (7) calendar days, as needed. The Contractor shall submit to the County a template of the written preliminary assessment and diagnostic report for review and approval prior to the commencement of service. iii. Assessment: a) The comprehensive assessment process will include but is not limited to: a clinical analysis of the youth's history, current status of the youth's mental, emotional, or behavioral disorder, relevant cultural issues and history, diagnosis, and use of any testing procedures. b) The E-E-ISFC clinician is responsible for completing a CANS for each youth enrolled for more than 7 days. The CANS shall be completed within seven (7) calendar days of intake or by the discharge date if the discharge occurs prior to the 7th day of the placement. If a youth has had a CANS completed within the past six months prior to admission, the Contractor will be responsible for reviewing the youth's the completed CANS, regardless of the anticipated length of stay, and updating as necessary within seven (7) calendar days of intake or by the date of discharge if discharge occurs prior to the 7th day. iv. Treatment: The E-E-ISFC treatment model includes four core methods of intervention. a) Parental care and supervision i. At least one fully trained Specialized Resource Parent is available to accept placements and has the availability to meet all the requirements of providing these intensive services. Integral to a multi-disciplinary team, Specialized Resource Parent(s) provide services in therapeutic home B-2-28 Exhibit B-2 settings for youth in alignment with the E-E-ISFC placement program as an alternative to congregate, residential care. ii. Specialized Resource Parent(s) engage directly with the youth and the Permanency Specialist to construct a workable, sustainable kinship placement. iii. The Specialized Resource Parent(s) provides structure, routine, and clear expectations to youth placed in their home. iv. The Specialized Resource Parent(s) collaborates with the other E-E-ISFC team members, including the social worker/clinician and support counselors, to learn and apply behavioral interventions and engage in the youth's treatment needs, as well as the child and family teaming. CFT should convene weekly. V. The Specialized Resource Parent(s) supports the youth in meaningful activities and trauma mitigating activities. vi. Support is provided to each Specialized Resource Parent from the clinician and support counselor. vii. Each Specialized Resource Parent(s) is assigned a master's level SW who is responsible for supporting the parents through mentorship, training, oversight, encouragement, and collaborative problem-solving. viii. E-E-ISFC SW will meet with Specialized Resource Parent(s) at least weekly or more as needed. b) Advanced clinical services i. Specific services provided by the E-E-ISFC Clinician include but are not limited to assessment, individual therapy, crisis intervention, plan development, collateral services, Child and Family Team participation and facilitation, case management/intensive care coordination, transition planning, and clinical documentation. ii. Medication support services will be provided as needed. iii. E-E-ISFC clinician will meet with youth in-person at least two times per week and is responsible for guiding the clinical services for the youth. iv. The E-E-ISFC clinician is responsible for completing a comprehensive services plan (treatment plan) for youth who stay in the program for more than 7 days. c) Therapeutic behavioral health support and supervision i. Youth will receive a minimum of 21 hours per week of therapeutic behavioral support and supervision. B-2-29 Exhibit B-2 ii. Support counselors are responsible for the implementation of methods outlined in the youth's service plan. iii. Therapeutic behavioral support and supervision may be provided at any hour of the day, any day of the week based on the service plan and needs of the youth. iv. The provider is responsible for documenting direct services and billing for all Specialty Mental Health Services provided. d) Advancing permanency and connectedness i. The E-E-ISFC permanency specialist is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. ii. The Permanency Specialist is responsible for conducting thorough case record review and family finding searches. They will also work with Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact while documents progress according to the Contractors documentation procedures. v. Transition: Key components of the E-E-ISFC transition planning and support. Youth placed on an emergency basis will have unique transition planning needs given the short-term and urgent nature of the placement. The pre-implementation planning process between the county and the provider(s)will include discussions regarding how the E-E-ISFC staff can best support the county in identifying a suitable placement for the youth and how to best ensure a trauma-informed transition from the E-E-ISFC home to the long-term placement setting. The E-E- ISFC transition procedures will be developed in partnership with the county and provider, and include elements such as but not limited to: a) E-E-ISFC staff collaborate with Fresno County social workers and/or probation officers no less than two times per week throughout the youth's stay in the E-E-ISFC program. Staff provide assessment information that will support the placement unit in developing a plan for the youth's next living situation and/or caregivers. b) The placement unit staff notify the E-E-ISFC clinician/social worker once a placement is identified providing a transition date, if possible. c) The E-E-ISFC resource parent or staff will: i. Inform the youth of the plan and provide emotional and behavioral support to assist in reducing distress. ii. Facilitate a "comfort call" to a support person, as appropriate. iii. When indicated and approved by the county the resource parent or E-E-ISFC staff member may contact the new caregiver to coordinate the logistics of the transition. B-2-30 Exhibit B-2 d) With appropriate releases in place, E-E-ISFC parents and staff provide any updates and/or pertinent information to the new caregiver including but not limited to: i. The youth's current physical and emotional state. ii. Any upcoming appointments with providers. iii. Any helpful information learned about how to help comfort the youth. iv. Any Safety Plans developed. V. Any immediate concerns. e) Specialized Resource Parents or E-E-ISFC staff go over the Personal Belonging Inventory with the child and/or County Social Worker or Probation Officer and return items to the caregiver and youth, accordingly, including any medications. f) E-E-ISFC staff provide the youth with an age-appropriate Client Satisfaction Survey. g) E-E-ISFC staff complete discharge/transition paperwork and distribute it to the youth's authorized representative. h) The transition plan and goals are addressed in each child and family team meeting. The plan and goals will be updated as needed based on the assessed needs of the youth. i) The E-E-ISFC clinician is responsible for reviewing transition goals on the services plan and revising, if necessary, at least weekly. j) The E-E-ISFC team is available to support the transition goals for each youth which may include but is not limited to, supervising visits with potential future placements, transporting youth to visitation, and leading or supporting permanency work including family finding. k) With DBH approval and if clinically appropriate, provide Specialty Mental Health Services (SMHS) until the youth is fully transitioned to the new placement and necessary mental health services. 1) In conjunction with County, develop and implement a discharge policy, in and through which, Contractor shall: i. Agree that the primary goal of the E-E-ISFC Program is to seek and maintain stability of youth in the lowest level of care placement setting so that they can successfully reach stabilization, no longer require intensive supervision or intensive mental health interventions, and transition to a permanent home setting. ii. Agree to serve any youth who meets eligibility criteria and parameters for placement for the full duration of the placement, regardless of the severity or complexity of their behaviors, accessing and coordinating the necessary B-2-31 Exhibit B-2 services and supports to effectively address the needs of the youth. iii. Agree to maximize communication in transition planning for youth. iv. Agree to utilize innovative approaches and all available resources to make reasonable efforts to stabilize youth in their current placement thereby reducing the likelihood of placement disruption. Consult with the appropriate CWS Division Chief/Probation Assistant Deputy Chief(ADC) to determine if additional services may prevent an unnecessary disruption of placement in the E-E-ISFC resource home. V. Notify the CWS or Deputy Probation Officer (DPO) and appropriate CWS Division Chief/Probation ADC or designee, via electronic mail as soon as, but not more than 1 business day after the Contractor becomes aware of an issue that may lead to a placement change. vi. Convene or participate in a case conference or CFT meeting to determine how or if the youth may be stabilized in the current E-E-ISFC placement and if additional services may prevent an unnecessary disruption of placement in the E-E- ISFC resource home. vii. Contact appropriate CWS Division Chief/Probation ADC or designee to arrange a consultation after the case conference or CFT meeting to discuss the outcome and any updates to the treatment and/or crisis intervention plan. viii. Document in advance of any anticipated placement change efforts made to stabilize and maintain the youth in placement, including provision of existing and additional mental health services and daily E-E-ISFC Specialized Resource Parent support including telephone check-ins and in-home crisis stabilization services. Contractor shall ensure that the Specialized Resource Parent may not refuse any mental health services determined necessary for the youth by the treatment team. ix. Provide Notice of Intent to Discharge via electronic mail to the CSW, DPO, and appropriate CWS Division Chief/Probation ADC only when all alternatives have been exhausted and after an emergency CFT has occurred, and no less than 14 calendar days prior to the anticipated discharge date, unless it is agreed upon at the CFT that less notice is necessary to ensure the health and safety of the youth or others. X. Refer the Notice of Intent to Discharge to the Supervisor or Division Chief/ADC of the CSW or DPO, and appropriate CWS Program Administrator if the assigned contacts are not responsive to requests to grant authorization or B-2-32 Exhibit B-2 unreasonably delay authorization for the Contractor to discharge a youth. A. Monitor and deliver transitional SMHS and after care services to the youth until a transition to other mental health services have been planned and begun pursuant to DSS contract provisions. 4. Unique Situations: Contractor will ensure that every possible intervention has been exhausted prior to developing an alternative placement plan. While there may be times when it is determined that continued placement in the home is not in the best interest of the youth, we only make this determination after first considering all possible options for stabilizing the youth in the program. The stabilization planning meeting must include representatives from the provider agency and the county department(s)with the authority to make decisions in the moment regarding resources and interventions. 5. For youth dually enrolled in Wraparound and E-E-ISFC, the youth's CFT will determine which agency and which person is assigned as lead for the following tasks based on existing therapeutic relationships, treatment goals, and transition goals: 1) Advanced clinical services such as therapy, medication support/psychiatry, assessment; 2) Behavioral intervention/rehabilitation; 3) Case coordination such as CFT facilitation, case management, plan development; and 4) Permanency work and family finding. 6. The Contractor's E-E-ISFC program staff will retain responsibility for at least the following roles: 1) Parental care and supervision; 2) Care and supervision provided by support counselors, which may include rehabilitation and behavioral support aligned with the youth's service plan; 3) Crisis response; and 4) Social work responsibilities including oversight, training, support, guidance for resource parents. The Contractor shall have the flexibility to adjust service levels based on the needs of the youth. When youth are receiving Wraparound services, the Contractor may need to decrease service intensity and corresponding staffing levels to avoid duplication with the Wraparound provider. The Contractor shall also be flexible to increase service intensity levels when needed and as determined by the CFT. 7. Length of Stay: i. The approximate length of stay for the E-E-ISFC is thirty (30) calendar days. While stated length of stay reflects general parameters, a youth's ongoing participation in the E-E-ISFC program is driven by their demonstrated need. C. Crisis Services B-2-33 Exhibit B-2 1. Develop and implement a safety planning, response and notification plan, in and through which, Contractor: i. Shall ensure Contractor's E-E-ISFC staff and Specialized Resource Parents are trained to implement safety and preventive measures to avert and respond to any self- harming and/or other behaviors that pose risk to the youth or others. ii. Shall, if after all relevant safety and preventive measures have been exhausted and youth needs an emergency psychiatric assessment for acute psychiatric hospitalization or exhibits escalating behaviors indicating danger to self or others, contact the Wrap provider in the County. If the behaviors demonstrate immediate danger and safety the Contractor shall contact 911. iii. Shall ensure that E-E-ISFC staff or other relevant administrator notify the youth's DSS Social Worker (SW) or Deputy Probation Officer (DPO) and appropriate CWS Division Chief/Assistant Deputy Chief, or designees, via email as soon as reasonably possible, but no later than the end of the day for all incidents that indicate a sign of threat or continued risk to the physical or mental health status of the E-E-ISFC youth including all such incidents that require a Critical Incident Report, as outlined in the following section. iv. In the event of an emergency, Contractor may move the placed youth to another E-E-ISFC Respite Home of the Contractor without prior authorization from the SW or DPO. For the purposes of this paragraph, an emergency is defined as any situation that threatens the health and safety of the placed youth or others in the E-E-ISFC home. In the event of an emergency placement change, Contractor shall make every effort to keep the youth in the school they are currently attending. v. As soon as it is reasonably safe to do so, the Contractor shall notify the CWS hotline, the SW, DPO and appropriate CWS Division Chief/Probation ADC, or designees regarding any emergency placement changes. The Contractor shall then follow up with the SW by phone within one business day. vi. Shall discuss the situation that led to the emergency placement change with the SW, DPO or designee and document the conversation and decision in the respective case file. A CFT Meeting will be held as soon as possible after the incident to update the safety plan. vii. Shall comply with the following when youth are referred for psychiatric hospitalization, engage in elopement, experience a juvenile hall stay, or other temporary placement disruptions: viii. Notify the SW or DPO and appropriate CWS Division Chief/Probation ADC as soon as it is reasonably safe to do so, and complete a critical incident report; ix. Participate in case conferences, hospital discharge conference and/or the CFT meetings for the placed youth; x. Continue to provide the services to the extent possible to the placed youth; A. Ensure the E-E-ISFC Specialized Resource Parent and/or the E-E-ISFC staff visit the youth during the hospitalization and maintain contact by telephone unless otherwise directed by the hospital medical staff or County staff; xii. Allow youth to return to the E-E-ISFC program up to 3 calendar days from the placement disruption, keeping the E-E-ISFC bed open for 3 calendar days, unless otherwise agreed upon with the County. If, however, the 3-day bed hold expires, Contractor shall collaborate with the SW or DPO and appropriate CWS Division B-2-34 Exhibit B-2 Chief to either extend the hold or close the placement and re-open it when the youth returns. xiii. Initiate a CFT meeting within 24 hours of youth's return to the E-E-ISFC home. xiv. Exceptions to the above re-admission requirements are allowed only when the CFT, including the SW or DPO, decides not to return the youth to the E-E-ISFC Resource Home, or when Contractor and the SW or DPO mutually agree that the re-admission jeopardizes the immediate health and safety of the youth or others in the home. In both cases, Contractor shall immediately notify the appropriate CWS Division Chief/Probation ADC or designee by telephone of the decision not to re- admit and follow up with an electronic mail message by the end of the next business day. In both cases, Contractor shall also assist in finding a new caregiver and placement within its licensed programs. 2. Shall report and document all major and/or sensitive incidents ("critical incidents") to the County pursuant to the procedures and timing outlined in Exhibit J. The County, at its sole discretion, may require the Contractor to conduct all necessary follow-up activities after reporting critical incidents. If there is any doubt about whether an incident should be reported, the default shall be for the Contractor to report the incident to the County. i. Notify DSS as soon as possible via Hotline, email and phone, but no later than twenty-four (24) hours from the time the Contractor, or an employee or agent of the Contractor, knows or has reason to believe that a critical incident has occurred or may have occurred. Include the following information in all incident reports: a) Name and contact information of the submitting individual; b) Name and email address of the best contact for immediate access to a Contractor staff member who can answer questions regarding the incident; c) The name of the youth, if involved. d) A description of the incident to include: e) Date, time, and location of the incident; f) Description of the events that took place; g) Names and job titles of Contractor personnel involved in the incident, if any; h) Description of law enforcement involvement, if any; i) Description of other emergency response involvement, if any; j) Description of any action taken by the Contractor in response to the incident; k) An indication of whether press coverage or negative community response is likely. D. E-E-ISFC Specialized Resource Parents 1. Contractor will recruit, train, utilize and support ISFC Specialized Resource Parents who shall assume the roles and perform the functions of E-E-ISFC Specialized Resource Parents in providing the necessary care, services and supports that are identified in the individual needs and services plan. i. Make active and ongoing recruitment efforts a minimum of one (1) time per month to increase capacity for E-E-ISFC services with a goal to maintain a minimum of B-2-35 Exhibit B-2 four (4), fully trained Specialized Resource Parents prepared to accept placements, or currently providing E-E-ISFC services to a youth at any given time. ii. Each home will have at least one dedicated Specialized Resource Parent who is an E-E-ISFC caregiver, with no competing responsibilities outside the home, who is ISFC certified, and has educational, professional and/or lived experience working with youth that helps them to understand and respond to the needs of the youth placed in care. Furthermore, E-E-ISFC Specialized Resource Parents shall provide a safe, consistent, and structured home environment for youths 24 hours/day, 7 days/week. iii. Ensure that all recruitment efforts are targeted to individuals/populations who would likely be willing and capable of meeting the needs of children of all ethnicities, ages, sexual orientations and gender identities, immigration statuses, physical abilities, religious or spiritual beliefs, and who have a wide range of trauma histories, developmental capabilities, mental health and/or behavioral needs, and coping skills. iv. Designate a Trainer to develop and deliver pre-service and ongoing E-E-ISFC Specialized Resource Parent training. a) The Trainer shall have an educational background in a relevant field (e.g., social work, psychology, child development) and experience working with similar youth in residential or foster care settings. b) The Trainer shall demonstrate the ability to engage with families, proficiency in teaching and public speaking, and ability to collaborate with members of a team. v. Implement a Training Plan for E-E-ISFC Specialized Resource Parents, which shall be reviewed and approved by the County prior to implementation. The Training Plan shall specify the training requirements for E-E-ISFC Specialized Resource Parents that is over and above that which is required for ISFC certified parents. The plan shall include training topics to be covered, the amount of time spent on each topic, and the qualifications of the trainer. The plan shall specify both the requirements for initial training (pre-placement) and annual ongoing training. Subsequent changes to the E-E-ISFC Specialized Resource Parent Training Plan shall be reviewed and approved by the County. vi. Ensure that E-E-ISFC Specialized Resource Parents have completed all ISFC and E-E-ISFC training requirements specified in the Contractor's Training Plan prior to the commencement of an E-E-ISFC placement. vii. Ensure that all Specialized Resource Parents approved to provide E-E-ISFC placements reside in Fresno County. Potential Specialized Resource Parents who reside in neighboring counties may provide E-E-ISFC services to Fresno County youth upon County approval. viii. Ensure that Specialized Resource Parents approved to provide E-E-ISFC placements are screened and selected based on their ability to meet the needs of children of all ethnicities, ages, sexual orientations and gender identities, B-2-36 Exhibit B-2 immigration statuses, physical abilities, religious or spiritual beliefs, and who have a wide range of trauma histories, developmental capabilities, mental health and/or behavioral needs, and coping skills. ix. Ensure that E-E-ISFC Specialized Resource Parents have met the minimum training requirements of the CDSS for provision of ISFC level care to children/youth. x. Ensure County has an updated and accurate roster of E-E-ISFC resource families at all times, which reflects the date resource families were approved to provide E- E-ISFC services. A. Ensure that E-E-ISFC Specialized Resource Parents complete all additional trainings identified as necessary by County. E. Additional Responsibilities 1. Maintain responsibility for necessary testimony and/or providing County with information needed to generate court reports, as outlined below: i. Court Reports - Documented reports of assessment and evaluation findings, progress in treatment, recommendations for treatment and service plans regarding reunification, maintenance and termination of parental rights, and justification for recommendations. ii. Court Testimony- Provide care plan updates when a court is considering reunification, maintenance, and/or termination of parental rights. 2. Upon notification of a pending court hearing, Contractor agrees to complete and submit to the County a "Periodic Review Report" twenty-one (21) calendar days prior to the court date or seven (7) calendar days after notification. 3. Maintain electronic health records and supply their own personal computers, Internet access, printers, signature pads and other network devices to meet statistical reporting requirements, report person-served and program outcomes and any State or County data requirements of the Katie A. Implementation Plan. Contractor shall also maintain capability to enter electronic billing data into County's electronic health record system. A computer with Internet access is required for both office and field-based staff. 4. Cooperate and participate with the County MHP in Quality Assurance/Improvement and Utilization Review Programs and grievance procedures and comply with all final determinations rendered by County's Quality Assurance/Improvement and Utilization Review Programs, unless the decision is reversed on appeal as set forth in the County MHP Provider Manual, incorporated herein by this reference. County's adverse decisions regarding Contractor's services to persons-served may result in the disallowance of payment for services rendered; or may result in additional controls to the delivery of services; or may result in the termination of this Agreement. County shall have sole discretion in the determination of Quality Assurance/Improvement and Utilization Review outcomes, decisions and actions. 5. Participate in regularly scheduled contract monitoring meetings with the County to discuss program successes and obstacles utilizing a Continuous Quality Improvement (CQI) framework. 6. Obtain signatures, as required, regarding consent: i. Care provider can sign for day trips and other minor miscellaneous items. B-2-37 Exhibit B-2 ii. Court Order should suffice for most other items. 7. Assist with training County staff and the community in E-ISFC Service processes and service options. 8. Develop training curriculum as County identifies a need. This includes but is not limited to training curriculum for E-E-ISFC staff and Specialized Resource Parents as well as training curriculum for SWs and County staff. 9. Participate in County-offered trainings which may include but are not limited to topics such as Quality Parenting Initiative and The Neuro-sequential Model of Therapeutics (NMT). 10. Provide annual Civil Rights training to all staff at the beginning of every calendar year and will provide verification of training completion to DSS. DSS will provide documents needed for annual training and reporting. 11. Have and maintain in good standing an active California Department of Social Services (CDSS) issued license as a Foster Family Agency (FFA). 12. Work collaboratively with other CWBC providers to develop and enter into Memorandum of Understanding or other business agreements between themselves that defines the processes and procedures for provision of services to foster youth, including, but not limited to the: i. Case Planning ii. Care Coordination iii. Intensive Transition Planning iv. Assessment v. Transportation between service settings vi. Information sharing vii. Data collection and dissemination 13. Work with DPO on criminogenic risk factors for probation youth as addressed through contracted services as applicable. VI. STAFFING A. Staffing shall be appropriate and aligned with the E-E-ISFC service model, and shall include E-E-ISFC teams which shall be comprised of the following classifications: Specialized Resource Parent(s), Clinician/Social Worker, Lead Support Counselor, Support Counselor, and Permanency Specialist: 1) Specialized Resource Parent(s): One (1) fully trained E-E-ISFC Resource Parent is available to accept placements and has the availability to meet all the requirements of providing these intensive services. Integral to a multi-disciplinary team, specialized resource parents provide services in therapeutic home settings for youth in alignment with the E-E-ISFC model as an alternative to congregate, residential care. Specialized Resource Parent collaborates with the other E-E-ISFC team members, including the Social Worker/Clinician and Support Counselors, to learn and apply behavioral interventions and engage in the youth's treatment needs, as well as the Child and Family Team. The Specialized Resource Parent(s) supports the youth's engagement in meaningful activities and meets with other Team members. The overarching goal is to support the youth's transition to permanency. B-2-38 Exhibit B-2 2) E-E-ISFC Social Worker: A Master's level Social Worker is responsible for supporting the parents through mentorship, training, oversight, encouragement, and collaborative problem-solving. Social Workers meet with Specialized Resource Parents at least weekly, or more as needed. Specific services provided by the Social Worker include, but are not limited to: • Support and monitor the resource parent in implementing specific interventions specified in the youth's services plan. • Provide training in the home related to practices such as trauma- informed and behavioral interventions • Monitor the parent's compliance with all regulatory requirements including licensing and accreditation standards. • Facilitate support groups and didactic training with multiple resource parents. • Provide motivational encouragement and emotional support to parents. • Social Worker shall provide a minimum of four (4) direct service hours per week/per youth. 3) E-E-ISFC Clinician: Supervised by a Clinical Director, the E-E-ISFC Clinician meets with each youth in-person at least two times per week and is the primary person responsible for guiding the clinical services for each youth. Specific services provided by the Clinician include, but are not limited to: • Assessment • Individual therapy • Family therapy • Crisis intervention • Plan development • Collateral services • Child and Family Team participation and facilitation • Case management/Intensive Care Coordination • Transition planning • Clinical documentation • Clinician shall provide a minimum of four (4) direct service hours per week/per youth. 4) Support Counselor(s): A minimum of two (2) Support Counselors shall meet with the youth to provide one-on-one support, focusing on increasing the frequency of desired behaviors, gaining access to pro-social activities and resources within the community, and developing effective relationship-building skills, emotional regulation, conflict resolution skills. • Support Counselor(s) shall provide a combined minimum of twenty-one (21) direct service hours per week/per youth of therapeutic behavioral support and supervision based on each youth's unique level of need. • Therapeutic behavioral support and supervision may be provided at any hour of the day, any day of the week based on the service plan and needs of the youth. The provider is responsible for documenting direct services and billing for all Specialty Mental Health Services provided. B-2-39 Exhibit B-2 5) Permanency Specialist: Permanency Specialist has the responsibility of supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. The Permanency Specialist works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress according to the provider's documentation procedures. • Permanency Specialist shall provide a minimum of two (2) direct service hours per week/per youth. • Ensure all permanency planning efforts are documented. 6) Ensure each E-E-ISFC team has access to: • One (1) Psychiatrist to meet with the Person served to provide evaluation and assessment for psychotropic medication, clinical consultation, and assistance linking the Person served and their Specialized Resource Parent to ongoing psychiatric services and support as needed and prioritizing continuity of care where possible. • Family/Parent Partner, Youth Peer Partner, Individual Therapist, Family Therapist, Nurse, as needed. B. Ensure that direct service staff reimbursed through this contract shall spend at least 65% of their paid work time providing and documenting direct service to clients or on behalf of clients. Administrative staff meetings, supervision meetings, and staff trainings shall not be included in the 65%. C. The Contractor shall ensure its E-E-ISFC staff meets the State's ISFC qualifications, training, and duty requirements as outlined in WIC 18358 or other statutes relevant to ISFC as well as the County's FFA Master Contract requirements where they are more restrictive than those of the State ISFC regulations. For any waivers or exceptions to these requirements that are allowed by state regulation, Contractor shall submit a request for such approval to DSS before allowing the staff in question to begin delivering the service. VII. COUNTY RESPONSIBILITIES: County shall: A. Assist Contractors' efforts to evaluate the needs of each enrolled youth on an ongoing basis to ensure each youth is receiving clinically appropriate services. B. Provide oversight and collaborate with contractors and other County Departments and community agencies to help achieve State program goals and outcomes. Oversight includes, but is not limited to, contract monitoring and coordination with the State Department of Health Care Services (DHCS) and California Department of Social Services (CDSS) in regard to program administration and outcomes. C. Assist Contractors in making linkages with the total mental health system of care. This will be accomplished through regularly scheduled meetings as well as formal and B-2-40 Exhibit B-2 informal consultation. D. Participate in evaluating overall program progress and efficiency and be available to contractors for ongoing consultation. E. Gather outcome information from target youth groups and Contractors throughout each term of this Agreement. County shall notify contractors when their participation is required. The performance outcome measurement process will not be limited to survey instruments but will also include, as appropriate, youth and staff interviews, chart reviews, and other methods of obtaining required information. F. Assist Contractors' efforts toward cultural and linguistic competency by providing the following to contractors: 1. Technical assistance and training regarding cultural competency requirements at no cost to contractors. 2. Mandatory cultural competency training for contractors' personnel, on an annual basis, at minimum. 3. Technical assistance for translating information into County's threshold languages (Spanish and Hmong). Translation services and costs associated will be the responsibility of contractors. VIII. REPORTS Contractor shall track data and provide reporting on the following items and send all applicable information and reports to the following distribution list for County staff: DSS Staff Analyst, DSS Division Chief, DSS Social Work Supervisor, and DBH Contract Analyst. 1) Contractors shall be expected to comply with all contracts monitoring and compliance protocols, procedures, data collection methods, and reporting requirements conducted by County. 2) Contractors will be responsible for meeting with DSS/DBH on a monthly basis, or more often as agreed upon between DSS/DBH and Contractors, for contract, performance, and outcomes monitoring. 3) Contractors will be required to submit monthly reports on performance measures to the County. Report formats will be established through County/Contractor collaboration. Outcome measures may change, based on information or measures needed. Required monthly reports include: a) DSS Monthly Activity Report (MAR); and b) Other reports as established by the County. 4) All reports will be due to the County by the 101" of each month and will be reviewed for accuracy. (If the 1011 lands on a weekend or Holiday, reports will be due the next business day). 5) Contractor shall also provide County with additional individualized reports for each youth which may include, but are not limited to: Monthly Progress Report, Discharge Presentation, Individual Child and Family Plan Presentation Outline, and Individual Child and Family Plan (ICFP). 6) Additional reports and outcome information may be requested by County at a later date, as needed. B-2-41 Exhibit B-2 IX. GOALS/OUTCOMES Contractor is required to submit measurable outcomes on a semi-annual basis, as identified in the DBH's Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes Measures. Performance outcome measures must be approved by DBH and DSS and satisfy all State and local mandates. County will consider Contractor performance levels when determining funding recommendations for future agreements. For the contract period, Contractor shall document all direct services to youth, transition planning efforts, permanency planning efforts, and crisis responses. County anticipates an increase in placement stability and permanency, behavioral stability, symptom reduction, strengths and resiliency, and educational stability as a result of these services. The outcomes listed in the table below will measure the success of Contractor's services. These outcomes may be modified at County's discretion. Contractor will report outcomes in each MAR or alternate method determined by County. Outcome measures are included below. Fresno County Enhanced ISFC Contract Performance Expectations Metric Outcome Indicator Retention Improved placement stability. Youth will remain in their No more than 5% of placement for the length of time that aligns with the youth in E-E-ISFC youth's treatment plan. homes will leave placement without pre-approval Service Decreased wait time for placement. 100% of E-E-ISFC Availability parents who have a vacant bed are available to receive a youth into their home within 4 hours of referral Service Youth in E-E-ISFC are receiving necessary and Minimum Direct Availability clinically appropriate services from each E-E-ISFC Service Hours Per Team member: Youth Per Week: Clinician/Social Worker: Advanced clinical services Clinician/Social Worker: 4 Support Counselor(s): Therapeutic behavioral support and supervision Support Counselor(s): 21 Permanency Specialist: Advancing permanency and connectedness Permanency Specialist: 2 Service Determination of youth's immediate safety needs. At least 90% of youth Timeliness enrolled have received B-2-42 Exhibit B-2 a preliminary assessment and service plan completed by the end of the first business day following date of admission. Service Ensure timeliness of comprehensive assessment to A comprehensive Timeliness best capture youth's needs in order to provide an assessment will be individualized treatment plan. completed for 100% of youth enrolled for more than 7 calendar days. 90% of the comprehensive assessments will be completed within 7 calendar days of the date of intake, or by the date of discharge if occurs prior to the 711 day. Service Delivery Individualized treatment plans developed for every A treatment plan is youth receiving services. completed for 100% of youth. Crisis Response Prevention of crisis escalation, stabilization of Provider responds to placement, preservation of Specialized Resource 100% of crises that Parent-youth relationship, avoid unnecessary law require an in-person enforcement involvement, and reduce psychiatric response within 30 hospitalizations. minutes. Crisis Response Avoid re-traumatization of youth, stabilization of Provider stabilizes at placement, preservation of Specialized Resource least 75% of youth in Parent-youth relationship, avoid unnecessary law the home setting enforcement involvement, and reduce psychiatric following an in-person hospitalizations. crisis response Transition Reduction in barriers and increased support for Individualized, trauma- Planning seamless transition between levels of care for youth. informed transition plan is completed prior to discharge for 100% of enrolled youth. Contractor will provide Plan to County within B-2-43 Exhibit B-2 one (1) business day following discharge for 100% of youth. Transition to Increased transitions of youth to the least restrictive 85% of youth enrolled less restrictive setting possible. will be transitioned to placements less restrictive placements. Permanency Youth will demonstrate increased family and natural Planning support connection and/or achievement of permanency 90% of youth who complete the *Not applicable to youth who receive services for less discharge CANS will than 30 calendar days as a result of securing show improvement in placement or leaving without pre-approval the Permanency module of the CANS. Improved Youth will demonstrate a reduction in action items in the 90% of youth who behavioral/ Behavioral/Emotional Needs Domain, Risk Behaviors complete the emotional needs Domain, and the Family Functioning and Living discharge CANS will Situation items in the Life Functioning Domain show a reduction in action items in the *Not applicable to youth who receive services for less Behavioral/Emotional than 30 calendar days as a result of securing Needs Domain, Risk placement or leaving without pre-approval. Behavior Domain, and the Family Functioning and Living Situation items in the Life Functioning Domain of the CANS. Improved Youth will demonstrate increased knowledge of 80% of youth who strengths emotional regulation and de-escalation skills, increased complete the family functioning and permanency, behavioral and discharge CANS will emotional stability, and decrease in maladaptive show improvement in behaviors. overall CANS score. Not applicable to youth who receive services for less for less than 30 days as a result of securing placement or leaving without pre-approval. Academic Youth will demonstrate improvement and increased 90% of enrolled youth Engagement consistency in school attendance. will have attended school for at least 85% of the academic year. B-2-44 Exhibit B-2 Persons served Youth will report a positive experience and recognize satisfaction (to the benefits of the services provided At least 75% of youth be reported on a who completed a quarterly basis) satisfaction survey will respond as satisfied with services. In addition to the outcomes above being tracked on the MAR, Contractors shall utilize a computerized tracking system with which performance and outcome measures and other relevant person served data, such as demographics, will be maintained. The data tracking system may be incorporated into the Contractors' electronic health records (EHR) systems or in stand-alone databases (e.g., Access or Excel spreadsheets). County must be afforded read-only access to the data tracking system. DBH and/or DSS may adjust the performance and outcome measures periodically throughout the duration of the Agreement, as needed, to best measure the program as determined by County and/or CDSS. B-2-45 Exhibit C 1 Compensation 2 The Contractor(s) will be compensated for performance of its services under this 3 Agreement as provided in this Exhibit C. The Contractor(s) is not entitled to any compensation 4 except as expressly provided in this Exhibit C. 5 Contractor(s) is expected to work with the County and County partners to evaluate non- 6 medical billable services for opportunities in billing within the new opportunities presented 7 through CalAIM as well as coordinated mental health care planning. 8 In the event that the Contractor's capacity of Enhanced Intensive Services Foster Care 9 and/or Emergency Enhanced Intensive Services Foster Care homes is lower than the full 10 capacity stated in the Scope of Services, the maximum cost reimbursement amount shall be 11 prorated based on the actual average home capacity for the month. The proration shall be 12 calculated by dividing the maximum allowable costs stated in the budget by home capacity in 13 the summary of services and multiplying that result by the average capacity of actual homes for 14 the month. The Contractor's monthly invoice shall clearly state the average actual home 15 capacity used to calculate the proration. The abovementioned proration is not applicable to the 16 three (3) month startup period. Startup costs will be reimbursed, up to budget line maximum, 17 regardless of actual home capacity. "Actual home capacity" is defined as approved and trained 18 homes that have an active placement and homes that do not have an active placement but are 19 ready and available to accept a placement per the terms of this contract. 20 In the event that the Contractor(s) has vacancies that the County cannot fill, and the 21 Contractor(s) wishes to use that capacity for another county, Contractor(s) must request prior 22 approval, in writing, from the County no less than three (3) days in advance. In the event that 23 Contractor(s) accepts a youth from another county, the County is released from obligation to 24 pay for capacity and any associated service, and operational costs incurred by vendor. 25 // 26 // 27 28 C-1 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet,Inc. Page 1 of 94 Startup Budget-FY 2024-2025(Upon Execution-November 30,2024) Budget Categories Total Proposed Budget Direct Admin. Direct Program Total Cost Line Item Description(Must be Itemized) FTE% Support Cost Cost PERSONNEL SALARIES: 0001 Director of Program 0.25 6,188 6,188 0002 Associate Division Director 0.25 5,980 5,980 0003 Clinical Director 0.50 13,125 13,125 0004 Program Manager 1.00 21,250 21,250 0005 Clincian/Social Worker 1.00 13,000 13,000 0006 Family Developer 0.50 8,499 8,499 0007 Dedicated Program Trainer 0.25 4,095 4,095 0008 Lead Support Counselor 1.00 15,600 15,600 0009 Support Counselor 2.00 16,640 16,640 0010 Program Assistant 0.50 4,167 4,167 0011 OA Billing and Compliance Manager 0.50 4,167 4,167 0012 Parent Partner 0.50 3,350 3,350 0013 Family Finder 1.00 10,833 10,833 0014 Staff On-Call - Stipends/Overtime Salary Total 9.25 8,333 118,560 126,893 Payroll Taxes 0030 OASDI 517 7,351 7,867 0031 FICA/MEDICARE 121 1,719 1,840 0032 SUI 163 2,312 2,474 PAYROLL TAX TOTAL 800 11,382 12,182 EMPLOYEE BENEFITS: 0040 Retirement 125 1,778 1,903 0041 Workers Compensation 166.67 2,371 2,538 0042 Health Insurance(Medical,Vision,Life,Dental) 800.00 11,382 12,182 0042 Fringe Benefits 192 2,727 2,919 EMPLOYEE BENEFITS TOTAL 1,283 18,258 19,542 SALARY&BENEFITS GRAND TOTAL(Benefits @ 25%of payroll,Including Payroll Taxes) 158,616 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 20,800 1011 Rent/Lease Equipment 5,400 1012 Utilities 1,759 1013 Building Maintenance 152 1014 Equipment Purchase 1,124 FACILITY/EQUIPMENT/TOTAL 29,235 OPERATING EXPENSES 1060 Staff Recruitment 15,729 1061 Staff Training 9,009 1062 Communications 6,426 1063 Office Supplies 5,400 1064 Staff Mileage Reimbursement 3,401 1065 Clothing 1066 Program and Treatment Supplies 1067 Emergency Flex Fund 1068 Respite 1069 Other-Start Up 62,826 1070 Advertising Expense 4,500 1071 Education Conference/Meeting 1072 Postage and Printing 405 1073 Contract Services-Psychiatric,Nursing,Consulting 1074 Resource Family Payment @ 2,500 per bed per month 1075 Resource Family Payment Prorated Placement @ 5,000 per month 1076 Supervised Activities 1077 Family Support 1078 Maintenance Payments 1079 Parent Training 1,500 1080 Liability Insurance 3,135 1081 IT Services 12,150 OPERATING EXPENSES TOTAL 124,481 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping-Covered in Allocable Fiscal Services 1083 External Audit-Covered in Allocable Fiscal Services 1084 Payroll Services-Covered in Allocable Fiscal Services 1085 Fiscal Services-Included in Allocable 1086 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including 1087 HR,IT,Accounting,Prof.Liability,CIA Leadership,Executive Leadership,Exp. 31,233 TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10%OF DIRECT COST. $31,233 TOTAL PROGRAM EXPENSE $343,565 ESTIMATED MENTAL HEALTH BILLABLE TO MENTAL HEALTH CONTRACT $ - ESTIMATED NON MEDI-CAL BILLABLE COST $ 343,565 Total Cost/Day/Youth MH Cost Per Day $ - Daily Foster Care State Approved ICM Rate Per Youth Remaining ISFC Rate Per day/Youth MEDI-CAL REVENUE: Provider Type Hours Hourly rate Amount Exhibit C-1 Mental Health Services(Therapy) LPHA $265.28 - Page 2 of 94 Case Management(ICC) Other Qualified Provider $199 58 - Crisis Services LPHA $265 28 - Medication Support Pyschiatrist $1,019 30 - Plan Development Other Qualified Provider $199.58 - Assessment Other Qualified Provider $199.58 - Rehabilitation Other Qualified Provider $199.58 - Peer Support Peer Support Specialist $209.56 - IHBS Other Qualified Provider $199.58 - 0 $ OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL PROGRAM REVENUE $343,565 Total Medi-Cal Revenue $0 00 Total Medi-Cal Units 0.00 Averaged Medi-Cal cost per unit $0 00 Non Medi-Cal Billable Service Cost $343,565 Total Non Medi-Cal Billable Units 1 96 Non Medi-Cal cost per unitl $3,579 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 3 of 93 Budget Narrative—Startup FY 24-25 Year 1 Startup — FY 2024-2025 (Upon Execution — November 30, 2024) PROGRAM EXPENSE Total: $343,565 Medi-Cal Portion: $0 CW Portion: $343,565 Staff Expenses Director of Program Under the supervision of the Division Director, the Director of Program maintains operational, fiscal, and programmatic oversight of one or more identified core programs. The Director of Program works with staff, community agencies, and other entities to provide quality services. Position is shared position with other RFA Programs. This is a salaried position. 0.25 FTE x 0001 $99,000/ ear rate/12 x 3. = $6,187.50 $6,188 Associate Division Director Assists Division Director in supporting local Program Directors/ Supervisors with hiring, training, performance managing staff, program oversight, QA, compliance, productivity oversight, and TJC accreditation standards. This is a 0002 salaried position. 0.25 FTE x $95,680/ ear rate/12 x 3. =$5,979.99 $5,980 Clinical Director The Clinical Director provides clinical oversight and supervision to all staff and program components after hours/weekends or in the absence of the Program Manager. The Clinical Director reports to the Program Director and can also assist in the field with the mobile response team. California Licensed Marriage Family Therapist or Licensed Clinical Social Worker. Meets the BBS qualifications to provide clinical supervision. Ability to develop and provide training; Ability to supervise evidence-based practices utilized by the agency (must be trained in the EB practices). Two years of experience providing clinical supervision to staff in family or child mental health or related fields. This 0003 is a salaried position. 0.50 FTE x $105,000/ ear rate/12 x 3. $13,125 Program Manager The Core Program Manager (CPM 1) is responsible for hiring, training, supervising, and evaluating staff, inclusive of performance management. The CPM I has oversight of the program(s) budget and reports and interfaces with funder partners. The CPM I is responsible for program(s) oversight, including quality assurance and program compliance, including required documentation to federal, state, and funder, and Agency standards. The CPM I is also responsible for budgetary and strategic planning related to the program(s) they oversee. CPM I is responsible for upholding and supervising the Agency's operational, financial, personnel and practice rules, policies and procedures. This is a salaried position. Only 1 of 1.75 FTE will be joining in months 1-3. 0004 1.00 FTE x $85,000/ ear rate/12 x 3mos. $21,250 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 4 of 93 Budget Narrative—Startup FY 24-25 Clinician/Social Worker Provides individual and/or family therapy; provides assessment, development, implementation, and evaluation of mental health Treatment Plans; promotes and ensures collaboration and ongoing communication with program team members. They are also the main point of contact for family and referring agency; schedules/facilitates CFTs; provides assessment, development, implementation, and evaluation of Service Plans; ensures collaboration and ongoing communication between program team members. This is a salaried position. 1 FTE will be joining in months 2-3. 0005 1.0 FTE x $78,000/ ear rate/12 x 2mos. $13,000 Family Developer The Family Developer is responsible for recruiting, assessing, training, and approving specialized resource families, which provide Intensive Foster Care Services (ISFC). In addition, the Family Developer identifies community groups, delivers presentations with the goal of identifying potential resource families, and supports resource family applicants through the approval and training processes. This is a salaried position. 0.50 FTE x $67,992/year rate/12 0006 x 3 = $8,499. $8,499 Dedicated Program Trainer The Trainer conducts prece rtifi cation parent training and initial screening for potential foster families and consults with the Core Program Director and/or Supervisor regarding a family's preparedness to move forward in the assessment and screening process. This is an hourly position. 0.25 FTE x 0007 $65,520/ ear rate/12 x 3 = $4,095. $4,095 Lead Support Counselor Under the supervision of the CPD/CPM/CPS and/or ACDD, the Lead Support Counselor is responsible for training and supporting all Support Counselors at both the local program and division level within the ISFC program. At the local program level, the Lead Support Counselor will regularly meet with the Support Counselors for supervision and to monitor their implementation of identified components of the approved support plan. The Lead Support Counselor may also maintain a small caseload of ISFC children/youth. At the Division level, the Lead Support Counselor serves as Division lead for initial and on-going training of support counselors. The Lead Support Counselor will also facilitate regularly scheduled Support Counselor group calls. Additional responsibilities include completion of written documentation of weekly activities per agency 0008 standards. This is an hourly position. 1.00 FTE x $62,400/ ear rate/12 x 3. $15,600 Support Counselor Meets directly one-on-one with the child/youth at home, school, or community, including behavior modification, communication skills, social skills, CRM, anger management skills, and role play/role modeling; Identifies/ accesses community resources. This is an hourly position. 2.00 FTE x $49,920/year 0009 rate/12 x 2mos. There will be 8 total beginning in month 4. $16,640 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 5 of 93 Budget Narrative—Startup FY 24-25 Program Administrative Assistant Provides administrative support to Program Director, management team, and employees. Assist with daily program operations, completing employee safety and environment of care, data entry, filing, database management, and providing customer service to clients, community partners, and the public. This is an hourly position. 0.50 FTE x $50,000/year rate/12 x 2mos. This staff will 0010 begin in month 2-3. $4,167 QA Billing and Compliance Manager Assures that the program complies with all County contractual requirements, including submission of required data, budget reviews, and federal and state laws. Implements county and agency QA policy and procedures for the Wraparound program. Ensures utilization reviews and audits are completed, and data collected is shared and used to increase the efficacy of staff and program compliance. Provides ongoing support to staff with compliance expectations associated with documentation and billing. This is an hourly position. 0.50 FTE x $50,000/year rate12 x 2mos. This staff will begin in month 0011 2-3. $4,167 Parent Partner Bridge to services and supports while sharing their own lived experience advocating for their own child who was involved with either child welfare, probation, mental health, regional center, or IEP services; help parents/caregivers navigate systems; provide support, validation, and encouragement; accompany to community group meetings; coordinate respite and other stress-reducing measures; organize Parent Cafes. This is an hourly position. 0.50 FTE x $40,200/year rate/12 x 2mos. This staff will begin in 0012 month 2-3. $3,350 Family Finder The Family Finding and Engagement Social Worker is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. The Family Finder works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress. This is a salaried position. 1.00 FTE x $65,000/year rate/12 x 2mos. This staff 0013 will begin in month 2-3. $10,833 Staff On-Call 0014 None until clients are placed. $0 Stipends/Overtime None until clients are placed. $0 Payroll Taxes 0030 OASDI 6.2% $7,867 0031 FICA/MEDICARE 1.45% $1,840 0032 SUI 1.95% $2,474 PAYROLL TAX TOTAL $12,182 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 6 of 93 Budget Narrative—Startup FY 24-25 EMPLOYEE BENEFITS: 0040 Retirement 1.5% $1,903 0041 Workers Compensation 2% $2,538 0042 Health Insurance Medical, Vision, Life, Dental 9.6% $12,182 0042 Fringe Benefits 2.3% $2,919 EMPLOYEE BENEFITS TOTAL T $19,542 SALARY& BENEFITS GRAND TOTAL (Benefits @ 25% of payroll, including $158,616 Payroll Taxes) FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building - $5,200/mo. x2 for first and last rent amount in month $20,800 1, then $5,200/mo. thereafter. For cost of building lease. This space will include offices for staff and conference rooms for staff and client meetings. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1011 Rent/Lease Equipment - $1,800/mo. x 3 $5,400 Leases and rentals of equipment, furniture, and fixtures. Includes taxes and other items included with the lease. Excludes maintenance contracts on leased items which are charged to building and equipment contract. Includes short- term and long -term equipment leases. Examples include water coolers, copiers, mail machines, etc. Joint costs associated with shared equipment in offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1012 Utilities - $586.25/mo. x 3 = $1,758.75 $1,759 Includes cost of VOIP phone serves, monthly charge for cost of cell phones used by staff to maintain communication in the field, and cost of gas, electric, water and sewer for leased office space. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll cost incurred by each grant, contract, or program as the base most appropriate. 1013 Building Maintenance - $50.75/mo. x 3 =$152.25. $152 Covers the cost of janitorial services. Items needed to maintain and/or repair facilities. 1014 Equipment Purchase - $374.50/mo. x 3 = $1,123.50 $1,124 Includes furnishing and technology equipment beyond the start-up costs. FACILITY/EQUIPMENT/TOTAL $29,235 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 7 of 93 Budget Narrative—Startup FY 24-25 OPERATING EXPENSES 1060 Staff Recruitment - Includes physical exam, fingerprinting fee for $15,729 background check, and advertising costs for new program staff and ongoing due to staff turnover. Recruitment of licensure and registered staff= $3,500 per staff for advertising and as needed sign-on bonuses. $500-1,000 for all other positions. 1061 Staff Training - Includes cost of evidence-based ARC training. $9,009 ARC (3 days), LSCI (5 Days), MI (1 day with follow-up consultation) training provided for new staff. 1062 Communications - Covers the monthly charge for cost of cell phones used $6,426 by staff to maintain communication in the field at $50/line x 11 FTE _ $550/mo. x 3 mos. = $1,650. Internet and service desk estimated at $1,592/mo. x 3 mos. = $4,776. 1063 Office Supplies - $1,800/mo. x 3 $5,400 Includes all office materials relevant to operating the program including pens, paperclips, paper, notepads, filing supplies, etc. 1064 Staff Mileage Reimbursement - Reimbursement for employee mileage @ $3,401 .56 cents/mile. Covers cost of mileage reimbursement for filed based activity of Aspiranet program staff. Estimated at $5,668.25/mo. for 15.75 driving staff. (An average of 642+/- miles per month per employee.) then reduced by 80% during start-up due to not seeing clients yet in first 3 mos. =$3,400.95. 1065 Clothing - None until clients are placed. $0 1066 Program and Treatment Supplies - None until clients are placed. $0 1067 Emergency Flex Fund - None until clients are placed. $0 1068 Respite - None until clients are placed. $0 1069 Other - Start Up — $62,826 Furniture COST PER QUANTITY ITEM UNIT TOTAL 16.5 Desk/cubicle $1,721.40 $28,403.10 0.75 Admin Desk $1,065.58 $799.19 21 Desk Chairs $100.00 $2,100.00 1 File Cabinets $300.00 $300.00 1.75 Bookshelves $200.00 $350.00 0.5 Fridge $1,200.00 $600.00 Signage $1,000.00 $0.00 2 Lobby furniture 4 chairs $200.00 $400.00 1 Lobby furniture side tables $100.00 $100.00 0.5 Conference table $750.00 $375.00 TOTAL $33,427.29 Tech Equipment COST PER QUANTITY ITEM UNIT TOTAL 0 Monitor 24" $224.99 $0.00 17 Monitor 27" $339.99 $5,779.83 Thick Client $1,011.45 $0.00 1.25 Laptop w/standard build $1,097.80 $1,372.25 Laptop w/advance build $1,414.74 $0.00 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 8 of 93 Budget Narrative—Startup FY 24-25 17 Laptop Carrying Bag $21.99 $373.83 17 Docking Station $187.02 $3,179.34 15.75 Cell $700.00 $11,025.00 3.75 Desk phones $48.99 $183.71 0.5 Admin Desk Phone $119.99 $60.00 0.25 IT hookup $3,900.00 $975.00 15 Chromebook Touch Screen $430.00 $6,450.00 TOTAL $29,398.96 1070 Advertising Expense - $1,500/mo. x 3 $4,500 Includes advertising for Resource Parents. Advertising costs include Google advertising, targeted marketing, and marketing materials. 1071 Education Conference/Meeting —will occur in remaining 9 mos. of year 1. $0 1072 Postage and Printing — estimated at $135/mo. (halved due to no clients $405 placed) = $67.50/mo. x 3 mos. Includes stamps, certification fees, overnight delivery services, and the cost of professional photocopying services. 1073 Contract Services - Psychiatric, Nursing, Consulting — $0 None until clients are placed. 1074 Resource Family Payment - None until clients are placed. $0 1075 Supervised Activities - None until clients are placed. $0 1076 Family Support - None until clients are placed. $0 1077 Maintenance Payments - None until clients are placed. $0 1078 Parent Training - Ongoing outside training for Resource Parents and $1,500 Respite Parents. $62.50 per family per month x 8 families. Liability Insurance $3,135 Liability Insurance covers liability insurance based on the program's percentage of overall agency insurance costs. Insurance needed for a particular program is charged directly to the program requiring the coverage. Other insurance coverage that benefits all programs is allocated based on the ratio of each program's expenses to total expenses. Estimated at $1,045/mo. x 3 IT Services $12,150 Calculated based on the program's percentage of overall agency IT costs. The technology cost for Aspiranet provides complete support of all IT and telecommunications systems used by Aspiranet. Support includes, but is not limited to, the following: Network & Server monitoring and ongoing maintenance, data hosting, equipment repair and refurbishment, 24/7 user Helpdesk support, application development, application and hardware user support, application and equipment training, mobile device configuration and staff support, on-boarding and off-boarding staff, network peripherals, including multifunction devices, printers and other equipment, staff remote portal access to internet and email, and workstation configuration. Estimated to be $4,050/mo. x 3 OPERATING EXPENSES TOTAL $124,481 FINANCIAL SERVICES EXPENSES: 1080 Accounting/Bookkeeping - Covered in Allocable Fiscal Services 1081 External Audit - Covered in Allocable Fiscal Services 1082 Payroll Services - Covered in Allocable Fiscal Services 1083 Contract Bed Rate - E homes 8 2.43% 1084 Fiscal Services - Included in Allocable ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 9 of 93 Budget Narrative—Startup FY 24-25 1085 Allocable Overhead - includes Staff and Associated Exp. that benefit all programs, Including HR, IT, Accounting, Prof. Liability, QA Leadership, Executive $31,233 Leadership, Exp. Calculated at 10%. The indirect rate is calculated based on the cost trends wherein the headquarters cost allocation is 10% of costs. All headquarters activities involve executive level oversight of division staff, statewide networking and advocacy and fractional portions of rent, postage, equipment leases, phones, and office supplies required by executive staff engaged in the services benefiting the program. These costs include all payroll, accounts receivable and accounts payable, audits, banking, human resources, risk management, legal, program direction and other functions carried out by headquarters administrative staff. TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10% OF DIRECT $31,233 COST TOTAL PROGRAM EXPENSE $343,565 ENHANCED INTENSIVE SERVICES FOSTER CARE ExhibitC-1 ASpirainet,Inc. Page 10 of 94 FY 2024-2025(December 1,2024-June 30,2025) Budget Categories Total Proposed Budget Direct Admin. Direct Program Total Cost Line Item Description(Must be Itemized) FTE% Support Cost Cost PERSONNEL SALARIES: 0001 Director of Program 0.25 18,563 18,563 0002 Associate Division Director 0.25 17,940 17,940 0003 Clinical Director 0.50 39,375 39,375 0004 Program Manager 1.00 63,750 63,750 0005 Clinician/Social Worker 1.75 102,375 102,375 0006 Family Developer 0.50 25,497 25,497 0007 Dedicated Program Trainer 0.25 12,285 12,285 0008 Lead Support Counselor 2.00 93,600 93,600 0009 Support Counselor 8.00 299,520 299,520 0010 Program Assistant 0.50 18,750 18,750 0011 CIA Billing and Compliance Manager 0.50 18,750 18,750 0012 Parent Partner 0.50 15,075 15,075 0013 Family Finder 1.00 48,750 48,750 0014 Staff On-Call 7,800 7,800 Stipends/Overtime 1 15,480 15,480 Salary Total 17.00 37,500 760,009 797,509 Payroll Taxes 0030 OASDI 2,325 47,121 49,446 0031 FICA/MEDICARE 544 11,020 11,564 0032 SUI 731 14,820 15,551 PAYROLL TAX TOTAL 3,600 72,961 76,561 EMPLOYEE BENEFITS: 0040 Retirement 563 11,400 11,963 0041 Workers Compensation 750.00 15,200 15,950 0042 Health Insurance(Medical,Vision,Life,Dental) 3,600.00 72,961 76,561 0042 Fringe Benefits 1 863 1 17,480 18,343 EMPLOYEE BENEFITS TOTAL 5,775 117,041 122,816 SALARY&BENEFITS GRAND TOTAL(Benefits @ 25%of payroll,Including Payroll Taxes) 996,887 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 46,800 1011 Rent/Lease Equipment 16,200 1012 Utilities 5,276 1013 Building Maintenance 457 1014 Equipment Purchase 3,371 FACILITY/EQUIPMENT/TOTAL 72,104 OPERATING EXPENSES 1060 Staff Recruitment 1061 Staff Training 1062 Communications 19,278 1063 Office Supplies 16,200 1064 Staff Mileage Reimbursement 51,014 1065 Clothing 5,400 1066 Program and Treatment Supplies 12,600 1067 Emergency Flex Fund 14,400 1068 Respite 68,607 1069 Other-Start Up 1070 Advertising Expense 13,500 1071 Education Conference/Meeting 10,092 1072 Postage and Printing 1,215 1073 ContractServices-Psychiatric,Nursing,Consulting 44,213 1074 Resource Family Payment @ 2,500 per bed per month 180,000 1075 Resource Family Payment Prorated Placement @ 5,000 per month 360,000 1076 Supervised Activities 10,800 1077 Family Support 2,700 1078 Maintenance Payments 9,000 1079 Parent Training 4,500 1080 Liability Insurance 9,405 1081 IT Services 36,450 OPERATING EXPENSES TOTAL 869,373 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping-Covered in Allocable Fiscal Services 1083 External Audit-Covered in Allocable Fiscal Services 1084 Payroll Services-Covered in Allocable Fiscal Services 1085 Fiscal Services-Included in Allocable 1086 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including 1087 HR,IT,Accounting,Prof.Liability,CIA Leadership,Executive Leadership,Exp. 193,836 TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10%OF DIRECT COST. $193,836 TOTAL PROGRAM EXPENSE $2,132,200 ESTIMATED MENTAL HEALTH BILLABLE TO MENTAL HEALTH CONTRACT $1,114,298 ESTIMATED NON MEDI-CAL BILLABLE COST $1,017,902 ii Total Cost/Day/Youth $ 730 MH Cost Per Day $ 370 Daily Foster Care State Approved ICM Rate Per Youth $ 501 Remaining ISFC Rate Per day/Youth $ - MEDI-CAL REVENUE: Provider Type Hours Hourly rate Amount Mental Health Services(Therapy) LPHA 624 $265.28 165,534.72 Case Management(ICC) Other Qualified Provider 468 $199.58 93,403.44 Criss Services LPHA 72 $265.28 19,100.16 Medication Support Psychiatrist 72 $1,019.30 73,389.60 Plan Development Other Qualified Provider 312 $199.58 62,268.96 Assessment Other Qualfied Provider 144 $199.58 28,739.52 Rehabilitation Other Qualfied Provider 2,184 $199.58 435,882.72 Peer Support Peer Support Specialist 398 $209.56 83,300.10 IHES 1 Other Qualified Provider 765 $19958 152,678.70 5,039 $ 1,114,298 OTHER REVENUE: Exhibit C-1 Page 11 of 94 4000 Other-(Ident 4100 Other-(Idenbly) 4200 Other-(Idenhly) 4300 Other-(Identdy) OTHER REVENUE TOTAL TOTAL PROGRAM REVENUE $2,132,200 Total Medi•Cal Revenue $111147298 Total Medi•Cal Units 51039 Averaged Mod!-Cal cost per unit $221 Non Medical Billable Service Cost $1,017,902 Total Non Metli•Cal Billable Units 96 Non Metli•Cal cast per unit $107803 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 12 of 94 Budget Narrative— FY 24-25 Year 1 — FY 2024-2025 (December 1, 2024 — June 30, 2025) Serving 8 Clients PROGRAM EXPENSE Total: $2,132,200 Medi-Cal Portion: $1,114,298 CWS Portion: $1,017,902 Staff Expenses Director of Program Under the supervision of the Division Director, the Director of Program maintains operational, fiscal, and programmatic oversight of one or more identified core programs. The Director of Program works with staff, community agencies, and other entities to provide quality services. Position is shared position with other RFA Programs. This is a salaried position. 0.25 FTE x 0001 $99,000/ ear rate/12. $18,563 Associate Division Director Assists Division Director in supporting local Program Directors/ Supervisors with hiring, training, performance managing staff, program oversight, QA, compliance, productivity oversight, and TJC accreditation standards. This is a 0002 salaried position. 0.25 FTE x $95,680/ ear rate/12. $17,940 Clinical Director The Clinical Director provides clinical oversight and supervision to all staff and program components after hours/weekends or in the absence of the Program Manager. The Clinical Director reports to the Program Director and can also assist in the field with the mobile response team. California Licensed Marriage Family Therapist or Licensed Clinical Social Worker. Meets the BBS qualifications to provide clinical supervision. Ability to develop and provide training; Ability to supervise evidence-based practices utilized by the agency (must be trained in the EB practices). Two years of experience providing clinical supervision to staff in family or child mental health or related fields. This 0003 is a salaried position. 0.50 FTE x $105,000/ ear rate /12. $39,375 Program Manager The Core Program Manager (CPM 1) is responsible for hiring, training, supervising, and evaluating staff, inclusive of performance management. The CPM I has oversight of the program(s) budget and reports and interfaces with funder partners. The CPM I is responsible for program(s) oversight, including quality assurance and program compliance, including required documentation to federal, state, and funder, and Agency standards. The CPM I is also responsible for budgetary and strategic planning related to the program(s) they oversee. CPM I is responsible for upholding and supervising the Agency's operational, financial, personnel and practice rules, policies and procedures. 0004 This is a salaried position. 1.00 FTE x $85,000/ ear rate/12. $63,750 Clinician/Social Worker Provides individual and/or family therapy; provides assessment, development, implementation, and evaluation of mental health Treatment Plans; promotes 0005 and ensures collaboration and ongoing communication with program team $102,375 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 13 of 93 Budget Narrative— FY 24-25 members. They are also the main point of contact for family and referring agency; schedules/facilitates CFTs; provides assessment, development, implementation, and evaluation of Service Plans; ensures collaboration and ongoing communication between program team members. This is a salaried position. 1.75 FTE x $78,000/ ear rate/12. Family Developer The Family Developer is responsible for recruiting, assessing, training, and approving specialized resource families, which provide Intensive Foster Care Services (ISFC). In addition, the Family Developer identifies community groups, delivers presentations with the goal of identifying potential resource families, and supports resource family applicants through the approval and training processes. This is a salaried position. 0.50 FTE x $67,992/year 0006 rate/12. $25,497 Dedicated Program Trainer The Trainer conducts prece rtifi cation parent training and initial screening for potential foster families and consults with the Core Program Director and/or Supervisor regarding a family's preparedness to move forward in the assessment and screening process. This is an hourly position. 0.25 FTE x 0007 $65,520/ ear rate/12. $12,285 Lead Support Counselor Under the supervision of the CPD/CPM/CPS and/or ACDD, the Lead Support Counselor is responsible for training and supporting all Support Counselors at both the local program and division level within the ISFC program. At the local program level, the Lead Support Counselor will regularly meet with the Support Counselors for supervision and to monitor their implementation of identified components of the approved support plan. The Lead Support Counselor may also maintain a small caseload of ISFC children/youth. At the Division level, the Lead Support Counselor serves as Division lead for initial and on-going training of support counselors. The Lead Support Counselor will also facilitate regularly scheduled Support Counselor group calls. Additional responsibilities include completion of written documentation of weekly activities per agency 0008 standards. This is an hourly position. 2.00 FTE x $62,400/ ear rate/12. $93,600 Support Counselor Meets directly one-on-one with the child/youth at home, school, or community, including behavior modification, communication skills, social skills, CRM, anger management skills, and role play/role modeling; Identifies/ accesses community resources. This is an hourly position. 8.00 FTE x $49,920/year rate 0009 /12. $299,520 Program Administrative Assistant Provides administrative support to Program Director, management team, and employees. Assist with daily program operations, completing employee safety and environment of care, data entry, filing, database management, and providing customer service to clients, community partners, and the public. This 0010 is an hourly position. 0.50 FTE x $50,000/ ear rate/12. $18,750 QA Billing and Compliance Manager Assures that the program complies with all County contractual requirements, including submission of required data, budget reviews, and federal and state laws. Implements county and agency QA policy and procedures for the 0011 Wraparound program. Ensures utilization reviews and audits are completed, $18,750 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 14 of 93 Budget Narrative— FY 24-25 and data collected is shared and used to increase the efficacy of staff and program compliance. Provides ongoing support to staff with compliance expectations associated with documentation and billing. This is an hourly position. 0.50 FTE x $50,000/year rate/12. Parent Partner Bridge to services and supports while sharing their own lived experience advocating for their own child who was involved with either child welfare, probation, mental health, regional center, or IEP services; help parents/caregivers navigate systems; provide support, validation, and encouragement; accompany to community group meetings; coordinate respite and other stress-reducing measures; organize Parent Cafes. This is an hourly 0012 position. 0.50 FTE x $40,200/ ear rate/12. $15,075 Family Finder The Family Finding and Engagement Social Worker is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. The Family Finder works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress. 0013 This is a salaried position. 1.00 FTE x $65,000/year rate/12. $48,750 Staff On-Call This is a stipend for employees who field after-hour crisis calls, working on a 0014 rotating basis. $200/week x 52 weeks/12. $7,800 Stipends/Overtime Due to the 24/7 nature of the work, overtime and extra duty stipends will occur at times to cover unfilled shifts. This line item accounts for as needed 50-100 shift stipends needed to fill hard to fill shifts typically overnight, weekends and holidays along with overtime. $20,640 yearly cost/12. $15,480 Payroll Taxes 0030 OASDI 6.2% $49,446 0031 FICA/MEDICARE 1.45% $11,564 0032 SUI 1.95% $15,551 PAYROLL TAX TOTAL $76,561 EMPLOYEE BENEFITS: 0040 Retirement 1.5% $11,963 0041 Workers Compensation 2% $15,950 0042 Health Insurance Medical, Vision, Life, Dental 9.6% $76,561 0042 Fringe Benefits 2.3% $18,343 EMPLOYEE BENEFITS TOTAL $122,816 SALARY& BENEFITS GRAND TOTAL (Benefits @ 25% of payroll, including $996,887 Payroll Taxes FACILITIES/EQUIPMENT EXPENSES: 1010 1 Rent/Lease Building - $5,200/mo. $46,800 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 15 of 93 Budget Narrative— FY 24-25 For cost of building lease. This space will include offices for staff and conference rooms for staff and client meetings. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1011 Rent/Lease Equipment - $1,800/mo. $16,200 Leases and rentals of equipment, furniture, and fixtures. Includes taxes and other items included with the lease. Excludes maintenance contracts on leased items which are charged to building and equipment contract. Includes short- term and long -term equipment leases. Examples include water coolers, copiers, mail machines, etc. Joint costs associated with shared equipment in offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1012 Utilities - $586.25/mo. $5,276 Includes cost of VOIP phone serves, monthly charge for cost of cell phones used by staff to maintain communication in the field, and cost of gas, electric, water and sewer for leased office space. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll cost incurred by each grant, contract, or program as the base most appropriate. 1013 Building Maintenance - $50.75/mo. $457 Covers the cost of janitorial services. Items needed to maintain and/or repair facilities. 1014 Equipment Purchase - $374.50/mo. $3,371 Includes furnishing and technology equipment beyond the start-up costs. FACILITY/EQU I P M E NT/TOTAL $72,104 OPERATING EXPENSES 1060 Staff Recruitment-occurred in 3 month start-up $0 1061 Staff Training - occurred in 3 month start-up $0 1062 Communications - Covers the monthly charge for cost of cell phones used $19,278 by staff to maintain communication in the field at $50/line x 11 FTE _ $550/mo. = $4,950/year. Internet and service desk estimated at $1,592/mo. = $14,328/ ear. 1063 Office Supplies - $1,800/mo. $16,200 Includes all office materials relevant to operating the program including ens, paperclips, paper, notepads, filing supplies, etc. 1064 Staff Mileage Reimbursement - Reimbursement for employee mileage @ $51,014 .56 cents/mile. Covers cost of mileage reimbursement for filed based activity of Aspiranet program staff. Estimated at $5,668.25/mo. for 15.75 driving staff. An average of 642+/- miles per month per employee.)/12. 1065 Clothing - $75/mo. per child (for 8 children) $5,400 Clothing allowance per child to purchase new needed clothing items. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 16 of 93 Budget Narrative— FY 24-25 1066 Program and Treatment Supplies - Includes items for the clients to use $12,600 including games, books, toys, and various recreational items. Estimated at an average of$1,400/mo. 1067 Emergency Flex Fund - $200/mo. per child for 8 children. Flexible pool that $14,400 is utilized according to flex fund policies. Dually enrolled youth will also be able to access flex funds through Wrap. This covers children's needs only. 1068 Respite - $68,607 *2 respite families available 24/7 *Each family provides 8 days/month of respite. *$7,500/mo. rate is paid only for nights with a child in the home (8 days total per family) *$2,500/mo. rate is paid for nights with no child in the home, when family is "on call" for respite placements. 1069 Other - Start Up — $0 None. Occurred in 3 mos. start-up. 1070 Advertising Expense - $1,500/mo. $13,500 Includes advertising for Resource Parents. Advertising costs include Google advertising, targeted marketing, and marketing materials. 1071 Education Conference/Meeting — Costs are allocated to the program $10,092 benefiting from the training, conferences, or seminars. Costs that benefit more than one program will be allocated to those programs based on the ratio of each program's expenses to the total of such expenses. Costs that benefit all programs will be allocated based on the ratio of each program's expenses to total expenses. $593.65/trainin x 17 staff= $10,092 1072 Postage and Printing —estimated at $135/mo. $1,215 Includes stamps, certification fees, overnight delivery services and the cost of professional photocopying services. 1073 Contract Services - Psychiatric, Nursing, Consulting — $44,213 Includes any outside contracted services needed such as identified professional services below. Clinical Supervision: Group Clinical Supervision $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical Supervision for all registered staff$150/hr. x 1.75 hours/week x 52 = $13,650/year. Clinical consultation for non- licensure track staff$150/hr. x .5hours/week x $3,900/year. Total Clinical Supervision = $25,350. Clinical supervision cost is split between E and EEISFC. Psychiatrist: $275/hour x 8 hours/month x 12 = $26,400 Nursing consultation $150/hr. x 4hrs/mo. for any special healthcare related needs = $600/mo. x 12mos. = $7,200/ ear. 1074 Resource Family Payment - $2,500/mo. per family for 8 families. $180,000 Direct reimbursement for Resource Family and Respite family for care and supervision of client. 1075 Resource Family Payment Prorated Placement prorated placement $360,000 estimated at 8 days/month at $5,000/mo. 1076 Supervised Activities - $1,200/mo. Includes those activities as identified $10,800 per the client's needs and services plan. Can include such activities as tutoring, social groups, reactional teams, and other extracurricular activities such as music or sports, etc. Avg. $150/child/x 8 children x 12mos = $14,400/12. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 17 of 93 Budget Narrative— FY 24-25 1077 Family Support - Includes assisting a family with items needed to support $2,700 the household. Estimated at $300/mo. or$37.50 per family to cover as needed expenses associated with supporting the family to support the child. Could include a 1 x cleaning service or dinner delivery during critical times. 1078 Maintenance Payments - Includes maintenance and repair needs for $9,000 Resource Family homes. Covers repairs needed due to damages resulting from behavioral episodes. Estimated at $1,000/mo. 1079 Parent Training - Ongoing outside training for Resource Parents and $4,500 Respite Parents. $62.50 per family per month x 8 families. 1080 Liability Insurance $9,405 Liability Insurance covers liability insurance based on the program's percentage of overall agency insurance costs. Insurance needed for a particular program is charged directly to the program requiring the coverage. Other insurance coverage that benefits all programs is allocated based on the ratio of each program's expenses to total expenses. Estimated at $1,045/mo. 1081 IT Services $36,450 Calculated based on the program's percentage of overall agency IT costs. The technology cost for Aspiranet provides complete support of all IT and telecommunications systems used by Aspiranet. Support includes, but is not limited to, the following: Network & Server monitoring and ongoing maintenance, data hosting, equipment repair and refurbishment, 24/7 user Helpdesk support, application development, application and hardware user support, application and equipment training, mobile device configuration and staff support, on-boarding and off-boarding staff, network peripherals, including multifunction devices, printers and other equipment, staff remote portal access to internet and email, and workstation configuration. Estimated to be $4,050/mo. OPERATING EXPENSES TOTAL $869,373 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping - Covered in Allocable Fiscal Services 1083 External Audit - Covered in Allocable Fiscal Services 1084 Payroll Services - Covered in Allocable Fiscal Services 1085 Fiscal Services - Included in Allocable 1086 Allocable Overhead - includes Staff and Associated Exp. that benefit all programs, Including 1087 HR, IT, Accounting, Prof. Liability, QA Leadership, Executive $193,836 Leadership, Exp. Calculated at 10%. The indirect rate is calculated based on the cost trends wherein the headquarters cost allocation is 10% of costs. All headquarters activities involve executive level oversight of division staff, statewide networking and advocacy and fractional portions of rent, postage, equipment leases, phones, and office supplies required by executive staff engaged in the services benefiting the program. These costs include all payroll, accounts receivable and accounts payable, audits, banking, human resources, risk management, legal, program direction and other functions carried out by headquarters administrative staff. TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10% OF DIRECT $193,836 COST ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 18 of 93 Budget Narrative— FY 24-25 TOTAL PROGRAM EXPENSE $2,132,200 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet,Inc. Page 19 of 94 FY 2025-2026 Budget Categories Total Proposed Budget Direct Admin. Direct Program Total Cost Line Item Description(Must be Itemized) FTE% Support Cost Cost PERSONNEL SALARIES: 0001 Director of Program 0.25 25,988 25,988 0002 Associate Division Director 0.25 25,116 25,116 0003 Clinical Director 0.50 55,125 55,125 0004 Program Manager 1.00 89,250 89,250 0005 Clincian/Social Worker 1.75 143,325 143,325 0006 Family Developer 0.50 35,696 35,696 0007 Dedicated Program Trainer 0.25 17,199 17,199 0008 Lead Support Counselor 2.00 131,040 131,040 0009 Support Counselor 8.00 419,328 419,328 0010 Program Assistant 0.50 26,250 26,250 0011 CIA Billing and Compliance Manager 0.50 26,250 26,250 0012 Parent Partner 0.50 21,105 21,105 0013 Family Finder 1.00 68,250 68,250 0014 Staff On-Call 10,400 10,400 Stipends/Overtime 20,640 20,640 Salary Total 17.00 52,500 1,062,461 1,114,961 Payroll Taxes 0030 OASDI 3,255 65,873 69,128 0031 FICA/MEDICARE 761 15,406 16,167 0032 SUI 1,024 20,718 21,742 PAYROLL TAX TOTAL 5,040 101,996 107,036 EMPLOYEE BENEFITS: 0040 Retirement 788 15,937 16,725 0041 Workers Compensation 1,050 21,249 22,299 0042 Health Insurance(Medical,Vision,Life,Dental) 5,040 101,996 107,036 0042 Fringe Benefits 1,208 24,437 25,644 EMPLOYEE BENEFITS TOTAL 8,085 163,619 171,704 SALARY&BENEFITS GRAND TOTAL(Benefits @ 25%of payroll,Including Payroll Taxes) 1,393,702 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 64,272 1011 Rent/Lease Equipment 22,248 1012 Utilities 7,246 1013 Building Maintenance 627 1014 Equipment Purchase 4,629 FACILITY/EQUIPMENT/TOTAL 99,022 OPERATING EXPENSES 1060 Staff Recruitment 16,201 1061 StaffTraining 9,279 1062 Communications 26,475 1063 Office Supplies 6,000 1064 Staff Mileage Reimbursement 70,060 1065 Clothing 7,416 1066 Program and Treatment Supplies 17,304 1067 Emergency Flex Fund 19,776 1068 Respite 94,220 1069 Other-Start Up - 1070 Advertising Expense 18,540 1071 Education Conference/Meeting 10,395 1072 Postage and Printing 1,669 1073 Contract Services-Psychiatric,Nursing,Consulting 60,719 1074 Resource Family Payment @ 2,500 per bed per month 240,000 1075 Resource Family Payment Prorated Placement 480,000 1076 Supervised Activities 14,832 1077 Family Support 3,708 1078 Maintenance Payments 12,360 1079 Parent Training 6,180 1080 Liability Insurance 12,916 1081 IT Services 50,058 OPERATING EXPENSES TOTAL 1,178,107 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping-Covered in Allocable Fiscal Services 1083 External Audit-Covered in Allocable Fiscal Services 1084 Payroll Services-Covered in Allocable Fiscal Services 1085 Fiscal Services-Included in Allocable 1086 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including 1087 HR,IT,Accounting,Prof.Liability,CIA Leadership,Executive Leadership,Exp. 267,083 TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10%OF DIRECT COST. $267,083 TOTAL PROGRAM EXPENSE $2,937,913 ESTIMATED MENTAL HEALTH BILLABLE TO MENTAL HEALTH CONTRACT 1,569,065 ESTIMATED NON MEDI-CAL BILLABLE COST $1,368,848 Total Cost/Day/Youth $ 1,006 MH Cost Per Day $ 521 Daily Foster Care State Approved ICM Rate Per Youth $ 501 Remaining ISFC Rate Per day/Youth $ - MEDI-CAL REVENUE: Provider Type Hours Hourly to Amount Exhibit C-1 Mental Health Services(Therapy) LPHA 832 $265 28 220,712 96 page 20 of 94 Case Management(ICC) Other Qualified Provider 624 $199.58 124,537.92 Crisis Services LPHA 96 $265.28 25,466.88 Medication Support Pyschiatnst 96 $1,019.30 97,852.80 Plan Development Other Qualified Provider 416 $199.58 83,025.28 Assessment Other Qualified Provider 192 $199.58 38,319.36 Rehabilitation Other Qualified Provider 2,619 $199.58 522,700.02 Peer Support Pear Support Specialist 593 $209 56 124,348 71 IHBS Other Qualified Provider 1,664 $199.58 332,101.12 7,1321 $ 1,569,065 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL PROGRAM REVENUE $2,937,913 Total Medl-Cal Revenue $1,569,065.00 Total Medi-Cal Units 7,132 Averaged Medi-Cal cost per unit $220 Non Medi-Cal Billable Service Cost $1,368,848 Total Non Medi-Cal Billable Units 96 Non Medi-Cal cost per unit $14,259 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 21 of 94 Budget Narrative— FY 25-26 Year 2 — FY 2025-2026 (July 1, 2025 — June 30, 2026) Serving 8 Clients PROGRAM EXPENSE Total: $2,937,913 Medi-Cal Portion: $1,569,065 CWS Portion: $1,368,848 Expenses All Personnel related expenses are increased by 5% over prior year Operational expenses are increased by 3% Staff Expenses Director of Program Under the supervision of the Division Director, the Director of Program maintains operational, fiscal, and programmatic oversight of one or more identified core programs. The Director of Program works with staff, community agencies, and other entities to provide quality services. Position is shared position with other RFA Programs. This is a salaried position. 0.25 FTE x 0001 $103,950/ ear rate = $25,988. $25,988 Associate Division Director Assists Division Director in supporting local Program Directors/ Supervisors with hiring, training, performance managing staff, program oversight, QA, compliance, productivity oversight, and TJC accreditation standards. This is a 0002 salaried position. 0.25 FTE x $100,464/ ear rate = $25,116. $25,116 Clinical Director The Clinical Director provides clinical oversight and supervision to all staff and program components after hours/weekends or in the absence of the Program Manager. The Clinical Director reports to the Program Director and can also assist in the field with the mobile response team. California Licensed Marriage Family Therapist or Licensed Clinical Social Worker. Meets the BBS qualifications to provide clinical supervision. Ability to develop and provide training; Ability to supervise evidence-based practices utilized by the agency (must be trained in the EB practices). Two years of experience providing clinical supervision to staff in family or child mental health or related fields. This 0003 is a salaried position. 0.50 FTE x $110,250/ ear rate = $55,125. $55,125 Program Manager The Core Program Manager (CPM 1) is responsible for hiring, training, supervising, and evaluating staff, inclusive of performance management. The CPM I has oversight of the program(s) budget and reports and interfaces with funder partners. The CPM I is responsible for program(s) oversight, including quality assurance and program compliance, including required documentation to federal, state, and funder, and Agency standards. The CPM I is also responsible for budgetary and strategic planning related to the program(s) they oversee. CPM I is responsible for upholding and supervising the Agency's operational, financial, personnel and practice rules, policies, and procedures. 0004 This is a salaried position. 1.00 FTE x $89,250/year rate = $89,250 $89,250 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 22 of 93 Budget Narrative— FY 25-26 Clinician/Social Worker Provides individual and/or family therapy; provides assessment, development, implementation, and evaluation of mental health Treatment Plans; promotes and ensures collaboration and ongoing communication with program team members. They are also the main point of contact for family and referring agency; schedules/facilitates CFTs; provides assessment, development, implementation, and evaluation of Service Plans; ensures collaboration and ongoing communication between program team members. This is a salaried 0005 position. 1.75 FTE x $81,900/ ear rate = $143,325. $143,325 Family Developer The Family Developer is responsible for recruiting, assessing, training, and approving specialized resource families, which provide Intensive Foster Care Services (ISFC). In addition, the Family Developer identifies community groups, delivers presentations with the goal of identifying potential resource families, and supports resource family applicants through the approval and training processes. This is a salaried position. 0.50 FTE x $71,392/year rate = 0006 $35,696. $35,696 Dedicated Program Trainer The Trainer conducts prece rtifi cation parent training and initial screening for potential foster families and consults with the Core Program Director and/or Supervisor in regard to a family's preparedness to move forward in the assessment and screening process. This is an hourly position. 0.25 FTE x 0007 $68,796/ ear rate = $17,199. $17,199 Lead Support Counselor Under the supervision of the CPD/CPM/CPS and/or ACDD, the Lead Support Counselor is responsible for training and supporting all Support Counselors at both the local program and division level within the ISFC program. At the local program level, the Lead Support Counselor will regularly meet with the Support Counselors for supervision and to monitor their implementation of identified components of the approved support plan. The Lead Support Counselor may also maintain a small caseload of ISFC children/youth. At the Division level, the Lead Support Counselor serves as Division lead for initial and on-going training of support counselors. The Lead Support Counselor will also facilitate regularly scheduled Support Counselor group calls. Additional responsibilities include completion of written documentation of weekly activities per agency standards. This is an hourly position. 2.00 FTE x $65,520/year rate = 0008 $131,040. $131,040 Support Counselor Meets directly one-on-one with the child/youth at home, school, or community, including behavior modification, communication skills, social skills, CRM, anger management skills, and role play/role modeling; Identifies/ accesses community resources. This is an hourly position. 8.00 FTE x $52,416/year rate 0009 = $419,328. $419,328 Program Administrative Assistant Provides administrative support to Program Director, management team, and employees. Assist with daily program operations, completing employee safety and environment of care, data entry, filing, database management, and providing customer service to clients, community partners, and the public. This 0010 is an hourly position. 0.50 FTE x $52,500/ ear rate = $26,250. $26,250 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 23 of 93 Budget Narrative— FY 25-26 QA Billing and Compliance Manager Assures that the program complies with all County contractual requirements, including submission of required data, budget reviews, and federal and state laws. Implements county and agency QA policy and procedures for the Wraparound program. Ensures utilization reviews and audits are completed, and data collected is shared and used to increase the efficacy of staff and program compliance. Provides ongoing support to staff with compliance expectations associated with documentation and billing. This is an hourly 0011 position. 0.50 FTE x $52,500/ ear rate = $26,250. $26,250 Parent Partner Bridge to services and supports while sharing their own lived experience advocating for their own child who was involved with either child welfare, probation, mental health, regional center, or IEP services; help parents/caregivers navigate systems; provide support, validation, and encouragement; accompany to community group meetings; coordinate respite and other stress-reducing measures; organize Parent Cafes. This is an hourly 0012 position. 0.50 FTE x $42,210/ ear rate = $21,105. $21,105 Family Finder The Family Finding and Engagement Social Worker is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin or natural supports of identified youth. The Family Finder works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress. 0013 This is a salaried position. 1.00 FTE x $68,250/ ear rate = $68,250. $68,250 Staff On-Call This is a stipend for employees who field after-hour crisis calls, working on a 0014 rotating basis. $200/week x 52 weeks = $10,400. $10,400 Stipends/Overtime Due to the 24/7 nature of the work, overtime and extra duty stipends will occur at times to cover unfilled shifts. This line item accounts for as needed 50-100 shift stipends needed to fill hard to fill shifts typically overnight, weekends and holidays along with overtime. $20,640 Payroll Taxes 0030 OASDI 6.2% $69,128 0031 FICA/MEDICARE 1.45% $16,167 0032 SUI 1.95% $21,742 PAYROLL TAX TOTAL $107,036 EMPLOYEE BENEFITS: 0040 Retirement 1.5% $16,725 0041 Workers Compensation 2% $22,299 0042 Health Insurance Medical, Vision, Life, Dental 9.6% $107,036 0042 Fringe Benefits 2.3% $25,644 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 24 of 93 Budget Narrative— FY 25-26 EMPLOYEE BENEFITS TOTAL $171,704 SALARY& BENEFITS GRAND TOTAL (Benefits @ 25% of payroll, including $1,393,702 Payroll Taxes FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building - $5,200/mo. x 103% x 12 mos. = $64,272 $64,272 For cost of building lease. This space will include offices for staff and conference rooms for staff and client meetings. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1011 Rent/Lease Equipment - $1,800/mo. x 103% x 12 mos. = $22,248 $22,248 Leases and rentals of equipment, furniture, and fixtures. Includes taxes and other items included with the lease. Excludes maintenance contracts on leased items which are charged to building and equipment contract. Includes short- term and long -term equipment leases. Examples include water coolers, copiers, mail machines, etc. Joint costs associated with shared equipment in offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1012 Utilities - $586.25/mo. x 103% x 12 mos. = $7,246 $7,246 Includes cost of VOIP phone serves, monthly charge for cost of cell phones used by staff to maintain communication in the field, and cost of gas, electric, water and sewer for leased office space. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll cost incurred by each grant, contract, or program as the base most appropriate. 1013 Building Maintenance - $50.75/mo. x 103% x 12 mos. = $627 $627 Covers the cost of janitorial services. Items needed to maintain and/or repair facilities. 1014 Equipment Purchase - $374.50/mo. x 103% x 12 mos. = $4,629 $4,629 Includes furnishing and technology equipment beyond the start-up costs. FACILITY/EQUIPMENT/TOTAL $99,022 OPERATING EXPENSES 1060 Staff Recruitment - Includes physical exam, fingerprinting fee for $16,201 background check, and advertising costs for new program staff and ongoing due to staff turnover. Recruitment of licensure and registered staff= $3,500 per staff for advertising and as needed sign-on bonuses. $500-1,000 for all other positions. Increased by 3% from Year 1. 1061 Staff Training - Includes cost of evidence-based ARC training. $9,279 ARC (3 days), LSCI (5 Days), MI (1 day with follow-up consultation) training provided up to 2 times per year as needed for new staff. Increased by 3% from Year 1. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 25 of 93 Budget Narrative— FY 25-26 1062 Communications - Covers the monthly charge for the cost of cell phones $26,475 used by staff to maintain communication in the field at $50/line x 11 FTE _ $550/mo. x 12 mos. = $6,600/year. Internet and VOIP service estimated at $1,592/mo. x 12 mos. _ $19,104/ ear. Then increased by 3% from Year 1. 1063 Office Supplies — decreases to $500/mo. x 12mos. = $6,000 $6,000 Includes all office materials relevant to operating the program including ens, paper clips, paper, notepads, filing supplies, etc. 1064 Staff Mileage Reimbursement - Reimbursement for employee mileage @ $70,060 .56 cents/mile. Covers cost of mileage reimbursement for filed based activity of Aspiranet program staff. Estimated at $5,668.25/mo. for 15.75 driving staff. (An average of 642+/- miles per month per employee.) with an increase of 3% from Year 1. 1065 Clothing - $75/mo. per child x 8 children x 12 = $7,200, then increased by $7,416 3% from Year 1. Clothing allowance per child to purchase new needed clothing items. 1066 Program and Treatment Supplies - Includes items for the clients to use $17,304 including games, books, toys, and various recreational items. Estimated at an average of$1,400/mo. x 12mos. x 103% = $17,304. 1067 Emergency Flex Fund - $200/mo. per child for 8 children. Flexible pool that $19,776 is utilized according to flex fund policies. Dually enrolled youth will also be able to access flex funds through Wrap. This covers children's needs only. Increase by 3% from Year 1. 1068 Respite - $94,220 *2 respite families available 24/7 *Each family provides 8 days/month of respite. *$7,500/mo. rate is paid only for nights with a child in the home (8 days total per family) *$2,500/mo. rate is paid for nights with no child in the home, when family is "on call" for respite placements. With an increase of 3% from Year 1. 1069 Other - Start Up — Not needed in subsequent years 1070 Advertising Expense - $1,500/mo. x 12 mos. x 103% from Year 1 = $18,540 $18,540. Includes advertising for Resource Parents. Advertising costs include Goo le advertising, targeted marketing, and marketing materials. 1071 Education Conference/Meeting — Costs are allocated to the program $10,395 benefiting from the training, conferences, or seminars. Costs that benefit more than one program will be allocated to those programs based on the ratio of each program's expenses to the total of such expenses. Costs that benefit all programs will be allocated based on the ratio of each program's expenses to total expenses. 103% from Year 1 $611.46/training x 17 staff= $10,395. 1072 Postage and Printing —estimated at $135/mo. x 12 mos. x 103% from $1,669 Year 1 = $1,669. Includes stamps, certification fees, overnight delivery services and the cost of professional photocopying services. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 26 of 93 Budget Narrative— FY 25-26 1073 Contract Services - Psychiatric, Nursing, Consulting — $60,719 Includes any outside contracted services needed such as identified professional services below. Clinical Supervision: Group Clinical Supervision $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical Supervision for all registered staff$150/hr. x 1.75hours/week x 52 = $13,650/year. Clinical consultation for non- licensure track staff$150/hr. x .5hours/week x $3,900/year. Total Clinical Supervision = $25,350. Psychiatrist: $275/hour x 8 hours/month x 12 = $26,400 Nursing consultation $150/hr. x 4hrs/mo. for any special healthcare related needs = $600/mo. x 12mos. = $7,200/year. All categories listed above are subject to 3% increase from Year 1. 1074 Resource Family Payment - $2,500/mo. per family for 8 families $240,000 Direct reimbursement for Resource Family and Respite family for care and su ervision of client. 1075 Resource Family Payment Prorated Placement @ 5,000 per month $480,000 1076 Supervised Activities - $1,200/mo. Includes those activities as identified $14,832 per the client's needs and services plan. Can include such activities as tutoring, social groups, reactional teams, and other extracurricular activities such as music or sports, etc. Avg. $150/child/x 8 children x 12mos = $14,400 x 103% from Year 1. 1077 Family Support - Includes assisting a family with items needed to support $3,708 the household. Estimated at $300/mo. or$37.50 per family to cover as needed expenses associated with supporting the family to support the child. Could include a 1 x cleaning service or dinner delivery during critical times. With an increase of 3% from Year 1. 1078 Maintenance Payments - Includes maintenance and repair needs for $12,360 Resource Family homes. Covers repairs needed due to damages resulting from behavioral episodes. Estimated at $1,000/mo. With an increase of 3% from Year 1. 1079 Parent Training - Ongoing outside training for Resource Parents and $6,180 Respite Parents. $62.50 per family per month x 8 families. With an increase of 3% from Year 1. 1080 Liability Insurance $12,916 Liability Insurance covers liability insurance based on the program's percentage of overall agency insurance costs. Insurance needed for a particular program is charged directly to the program requiring the coverage. Other insurance coverage that benefits all programs is allocated based on the ratio of each program's expenses to total expenses. Estimated at $1,045/mo. x 12 mos. = $12,540/ ear. With an increase of 3% from Year 1. 1081 IT Services $50,058 Calculated based on the program's percentage of overall agency IT costs. The technology cost for Aspiranet provides complete support of all IT and telecommunications systems used by Aspiranet. Support includes, but is not limited to, the following: Network & Server monitoring and ongoing maintenance, data hosting, equipment repair and refurbishment, 24/7 user Helpdesk support, application development, application and hardware user support, application and equipment training, mobile device configuration and staff support, on-boarding and off-boarding staff, network peripherals, ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 27 of 93 Budget Narrative— FY 25-26 including multifunction devices, printers and other equipment, staff remote portal access to internet and email, and workstation configuration. Estimated to be $4,050/mo. x 12 mos. = $48,600/year. With an increase of 3% from Year 1. OPERATING EXPENSES TOTAL $1,178,107 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping - Covered in Allocable Fiscal Services 1083 External Audit - Covered in Allocable Fiscal Services 1084 Payroll Services - Covered in Allocable Fiscal Services 1085 Fiscal Services - Included in Allocable 1086 Allocable Overhead - includes Staff and Associated Exp. that benefit all programs, Including 1087 HR, IT, Accounting, Prof. Liability, QA Leadership, Executive $267,083 Leadership, Exp. Calculated at 10%. The indirect rate is calculated based on the cost trends wherein the headquarters cost allocation is 10% of costs. All headquarters activities involve executive level oversight of division staff, statewide networking and advocacy and fractional portions of rent, postage, equipment leases, phones, and office supplies required by executive staff engaged in the services benefiting the program. These costs include all payroll, accounts receivable and accounts payable, audits, banking, human resources, risk management, legal, program direction and other functions carried out by headquarters administrative staff. TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10% OF DIRECT $267,083 COST TOTAL PROGRAM EXPENSE $2,937,913 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet,Inc. Page 28 of 94 FY 2026-2027 Budget Categories Total Proposed Budget Direct Admin. Direct Program Total Cost Line Item Description(Must be Itemized) FTE% Support Cost Cost PERSONNEL SALARIES: 0001 Director of Program 0.25 27,225 27,225 0002 Associate Division Director 0.25 26,312 26,312 0003 Clinical Director 0.50 57,750 57,750 0004 Program Manager 1.00 93,500 93,500 0005 Clincian/Social Worker 1.75 150,150 150,150 0006 Family Developer 0.50 37,396 37,396 0007 Dedicated Program Trainer 0.25 18,018 18,018 0008 Lead Support Counselor 2.00 137,280 137,280 0009 Support Counselor 8.00 439,296 439,296 0010 Program Assistant 0.50 27,500 27,500 0011 CIA Billing and Compliance Manager 0.50 27,500 27,500 0012 Parent Partner 0.50 22,110 22,110 0013 Family Finder 1.00 71,500 71,500 0014 Staff On-Call 10,400 10,400 Stipends/Overtime 20,640 20,640 Salary Total 17.00 55,000 1,111,577 1,166,577 Payroll Taxes 0030 OASDI 3,410 68,918 72,328 0031 FICA/MEDICARE 798 16,118 16,915 0032 SUI 1,073 21,676 22,748 PAYROLL TAX TOTAL 5,280 106,711 111,991 EMPLOYEE BENEFITS: 0040 Retirement 825 16,674 17,499 0041 Workers Compensation 1,100 22,232 23,332 0042 Health Insurance(Medical,Vision,Life,Dental) 5,280 106,711 111,991 0042 Fringe Benefits 1,265 25,566 26,831 EMPLOYEE BENEFITS TOTAL 8,470 171,183 179,fi53 SALARY&BENEFITS GRAND TOTAL(Benefits @ 25%of payroll,Including Payroll Taxes) 1,458,221 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 66,144 1011 Rent/Lease Equipment 22,896 1012 Utilities 7,457 1013 Building Maintenance 646 1014 Equipment Purchase 4,764 FACILITY/EQUIPMENT/TOTAL 101,906 OPERATING EXPENSES 1060 Staff Recruitment 16,673 1061 StaffTraining 9,550 1062 Communications 27,246 1063 Office Supplies 6,000 1064 Staff Mileage Reimbursement 72,100 1065 Clothing 7,632 1066 Program and Treatment Supplies 17,808 1067 Emergency Flex Fund 20,352 1068 Respite 96,964 1069 Other-Start Up - 1070 Advertising Expense 19,080 1071 Education Conference/Meeting 10,698 1072 Postage and Printing 1,717 1073 Contract Services-Psychiatric,Nursing,Consulting 62,487 1074 Resource Family Payment @ 2,500 per bed per month 240,000 1075 Resource Family Payment Prorated Placement 480,000 1076 Supervised Activities 15,264 1077 Family Support 3,816 1078 Maintenance Payments 12,720 1079 Parent Training 6,360 1080 Liability Insurance 13,292 1081 IT Services 51,516 OPERATING EXPENSES TOTAL 1,191,275 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping-Covered in Allocable Fiscal Services 1083 External Audit-Covered in Allocable Fiscal Services 1084 Payroll Services-Covered in Allocable Fiscal Services 1085 Fiscal Services-Included in Allocable 1086 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including 1087 HR,IT,Accounting,Prof.Liability,CIA Leadership,Executive Leadership,Exp. 275,140 TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10%OF DIRECT COST. $275,140 TOTAL PROGRAM EXPENSE $3,026,542 ESTIMATED MENTAL HEALTH BILLABLE TO MENTAL HEALTH CONTRACT 1,626,943 ESTIMATED NON MEDI-CAL BILLABLE COST $1,399,599 Total Cost/Day/Youth $ 1,036 MH Cost Per Day $ 541 Daily Foster Care State Approved ICM Rate Per Youth $ 501 Remaining ISFC Rate Per day/Youth $ - MEDI-CAL REVENUE: Provider Type Hours Hourly to Amount Exhibit C-1 Mental Health Services(Therapy) LPHA 832 $265 28 220,712 96 Page 29 of 94 Case Management(ICC) Other Qualified Provider 624 $199.58 124,537.92 Crisis Services LPHA 96 $265.28 25,466.88 Medication Support Pyschiatnst 96 $1,019.30 97,852.80 Plan Development Other Qualified Provider 416 $199.58 83,025.28 Assessment Other Qualified Provider 192 $199.58 38,319.36 Rehabilitation Other Qualified Provider 2,909 $199.58 580,578.22 Peer Support Peer Support Specialist 593 $209 56 124,348 71 IHBS Other Qualified Provider 1,664 $199.58 332,101.12 7,422 $ 1,626,943 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL PROGRAM REVENUE $3,026,542 Total Medl-Cal Revenue $1,626,943 Total Medi-Cal Units 7,422 Averaged Medi-Cal cost per unit $219 Non Medi-Cal Billable Service Cost $1,399,599 Total Non Medi-Cal Billable Units 96 Non Medi-Cal cost per unit $14,579 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 30 of 94 Budget Narrative— FY 26-27 Year 3 — FY 2026-2027 (July 1, 2026 — June 30, 2027) Serving 8 Clients PROGRAM EXPENSE Total: $3,026,542 Medi-Cal Portion: $1,626,943 CWS Portion: $1,399,599 All Personnel related expenses are increased by 5% over prior year Operational expenses are increased by 3% Staff Expenses Director of Program Under the supervision of the Division Director, the Director of Program maintains operational, fiscal, and programmatic oversight of one or more identified core programs. The Director of Program works with staff, community agencies, and other entities to provide quality services. Position is shared position with other RFA Programs. This is a salaried position. 0.25 FTE x 0001 $108,900/ ear rate = $27,225. $27,225 Associate Division Director Assists Division Director in supporting local Program Directors/ Supervisors with hiring, training, performance managing staff, program oversight, QA, compliance, productivity oversight, and TJC accreditation standards. This is a 0002 salaried position. 0.25 FTE x $105,248/ ear rate = $26,312. $26,312 Clinical Director The Clinical Director provides clinical oversight and supervision to all staff and program components after hours/weekends or in the absence of the Program Manager. The Clinical Director reports to the Program Director and can also assist in the field with the mobile response team. California Licensed Marriage Family Therapist or Licensed Clinical Social Worker. Meets the BBS qualifications to provide clinical supervision. Ability to develop and provide training; Ability to supervise evidence-based practices utilized by the agency (must be trained in the EB practices). Two years of experience providing clinical supervision to staff in family or child mental health or related fields. This 0003 is a salaried position. 0.50 FTE x $115,500/ ear rate = $57,750. $57,750 Program Manager The Core Program Manager (CPM 1) is responsible for hiring, training, supervising, and evaluating staff, inclusive of performance management. The CPM I has oversight of the program(s) budget and reports and interfaces with funder partners. The CPM I is responsible for program(s) oversight, including quality assurance and program compliance, including required documentation to federal, state, and funder, and Agency standards. The CPM I is also responsible for budgetary and strategic planning related to the program(s) they oversee. CPM I is responsible for upholding and supervising the Agency's operational, financial, personnel and practice rules, policies, and procedures. 0004 This is a salaried position. 1.00 FTE x $93,500/ ear rate = $93,500. $93,500 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 31 of 93 Budget Narrative— FY 26-27 Clinician/Social Worker Provides individual and/or family therapy; provides assessment, development, implementation, and evaluation of mental health Treatment Plans; promotes and ensures collaboration and ongoing communication with program team members. They are also the main point of contact for family and referring agency; schedules/facilitates CFTs; provides assessment, development, implementation, and evaluation of Service Plans; ensures collaboration and ongoing communication between program team members. This is a salaried 0005 position. 1.75 FTE x $85,800/ ear rate = $150,150. $150,150 Family Developer The Family Developer is responsible for recruiting, assessing, training, and approving specialized resource families, which provide Intensive Foster Care Services (ISFC). In addition, the Family Developer identifies community groups, delivers presentations with the goal of identifying potential resource families, and supports resource family applicants through the approval and training processes. This is a salaried position. 0.50 FTE x $74,791/year rate = 0006 $37,396. $37,396 Dedicated Program Trainer The Trainer conducts prece rtifi cation parent training and initial screening for potential foster families and consults with the Core Program Director and/or Supervisor regarding a family's preparedness to move forward in the assessment and screening process. This is an hourly position. 0.25 FTE x 0007 $72,072/ ear rate = $18,018. $18,018 Lead Support Counselor Under the supervision of the CPD/CPM/CPS and/or ACDD, the Lead Support Counselor is responsible for training and supporting all Support Counselors at both the local program and division level within the ISFC program. At the local program level, the Lead Support Counselor will regularly meet with the Support Counselors for supervision and to monitor their implementation of identified components of the approved support plan. The Lead Support Counselor may also maintain a small caseload of ISFC children/youth. At the Division level, the Lead Support Counselor serves as Division lead for initial and on-going training of support counselors. The Lead Support Counselor will also facilitate regularly scheduled Support Counselor group calls. Additional responsibilities include completion of written documentation of weekly activities per agency standards. This is an hourly position. 2.00 FTE x $68,640/year rate = 0008 $137,280. $137,280 Support Counselor Meets directly one-on-one with the child/youth at home, school, or community, including behavior modification, communication skills, social skills, CRM, anger management skills, and role play/role modeling; Identifies/ accesses community resources. This is an hourly position. 8.00 FTE x $54,912/year rate 0009 = $439,296. $439,296 Program Administrative Assistant Provides administrative support to Program Director, management team, and employees. Assist with daily program operations, completing employee safety and environment of care, data entry, filing, database management, and providing customer service to clients, community partners, and the public. This 0010 is an hourly position. 0.50 FTE x $55,000/ ear rate = $27,500. $27,500 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 32 of 93 Budget Narrative— FY 26-27 QA Billing and Compliance Manager Assures that the program complies with all County contractual requirements, including submission of required data, budget reviews, and federal and state laws. Implements county and agency QA policy and procedures for the Wraparound program. Ensures utilization reviews and audits are completed, and data collected is shared and used to increase the efficacy of staff and program compliance. Provides ongoing support to staff with compliance expectations associated with documentation and billing. This is an hourly 0011 position. 0.50 FTE x $55,000/ ear rate = $27,500. $27,500 Parent Partner Bridge to services and supports while sharing their own lived experience advocating for their own child who was involved with either child welfare, probation, mental health, regional center, or IEP services; help parents/caregivers navigate systems; provide support, validation, and encouragement; accompany to community group meetings; coordinate respite and other stress-reducing measures; organize Parent Cafes. This is an hourly 0012 position. 0.50 FTE x $44,220/ ear rate = $22,110. $22,110 Family Finder The Family Finding and Engagement Social Worker is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin or natural supports of identified youth. The Family Finder works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress. 0013 This is a salaried position. 1.00 FTE x $71,500/ ear rate = $71,500. $71,500 Staff On-Call This is a stipend for employees who field after-hour crisis calls, working on a 0014 rotating basis. $200/week x 52 weeks = $10,400. $10,400 Stipends/Overtime Due to the 24/7 nature of the work, overtime and extra duty stipends will occur at times to cover unfilled shifts. This line item accounts for as needed 50-100 shift stipends needed to fill hard to fill shifts typically overnight, weekends and holidays along with overtime. $20,640 Payroll Taxes 0030 OASDI 6.2% $72,328 0031 FICA/MEDICARE 1.45% $16,915 0032 SUI 1.95% $22,748 PAYROLL TAX TOTAL $111,991 EMPLOYEE BENEFITS: 0040 Retirement 1.5% $17,499 0041 Workers Compensation 2% $23,332 0042 Health Insurance Medical, Vision, Life, Dental 9.6% $111,991 0042 Fringe Benefits 2.3% $26,831 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 33 of 93 Budget Narrative— FY 26-27 EMPLOYEE BENEFITS TOTAL $179,653 SALARY& BENEFITS GRAND TOTAL (Benefits @ 25% of payroll, including $1,458,221 Payroll Taxes FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building - $5,200/mo. x 106% x 12 mos. = $66,144. $66,144 For cost of building lease. This space will include offices for staff and conference rooms for staff and client meetings. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1011 Rent/Lease Equipment - $1,800/mo. x 106% x 12 mos. = $22,896. $22,896 Leases and rentals of equipment, furniture, and fixtures. Includes taxes and other items included with the lease. Excludes maintenance contracts on leased items which are charged to building and equipment contract. Includes short- term and long -term equipment leases. Examples include water coolers, copiers, mail machines, etc. Joint costs associated with shared equipment in offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1012 Utilities - $586.25/mo. x 106% x 12 mos. = $7,457. $7,457 Includes cost of VOIP phone serves, monthly charge for cost of cell phones used by staff to maintain communication in the field, and cost of gas, electric, water and sewer for leased office space. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll cost incurred by each grant, contract or program as the base most appropriate. 1013 Building Maintenance - $50.75/mo. x 106% x 12 mos. = $646 $646 Covers the cost of janitorial services. Items needed to maintain and/or repair facilities. 1014 Equipment Purchase - $374.50/mo. x 106% x 12 mos. = $4,764 $4,764 Includes furnishing and technology equipment beyond the start-up costs. FACILITY/EQUIPMENT/TOTAL $101,906 OPERATING EXPENSES 1060 Staff Recruitment - Includes physical exam, fingerprinting fee for $16,673 background check, and advertising costs for new program staff and ongoing due to staff turnover. Recruitment of licensure and registered staff= $3,500 per staff for advertising and as needed sign-on bonuses. $500-1,000 for all other positions. Increased by 6% from Year 1. 1061 Staff Training - Includes cost of evidence-based ARC training. $9,550 ARC (3 days), LSCI (5 Days), MI (1 day with follow-up consultation) training provided up to 2 times per year as needed for new staff. Increased by 6% from Year 1. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 34 of 93 Budget Narrative— FY 26-27 1062 Communications - Covers the monthly charge for the cost of cell phones $27,246 used by staff to maintain communication in the field at $50/line x 11 FTE _ $550/mo. x 12 mos. = $6,600/year. Internet and VOIP service estimated at $1,592/mo. x 12 mos. _ $19,104/ ear. Then increased by 6% from Year 1. 1063 Office Supplies — decreases to $500/mo. x 12mos. = $6,000 $6,000 Includes all office materials relevant to operating the program including ens, paper clips, paper, notepads, filing supplies, etc. 1064 Staff Mileage Reimbursement - Reimbursement for employee mileage @ $72,100 .56 cents/mile. Covers cost of mileage reimbursement for filed based activity of Aspiranet program staff. Estimated at $5,668.25/mo. for 15.75 driving staff. (An average of 642+/- miles per month per employee.) with an increase of 6% from Year 1. 1065 Clothing - $75/mo. per child x 8 children x 12 = $7,200, then increased by $7,632 6% from Year 1. Clothing allowance per child to purchase new needed clothing items. 1066 Program and Treatment Supplies - Includes items for the clients to use $17,808 including games, books, toys, and various recreational items. Estimated at an average of$1,400/mo. x 12mos. x 106% = $17,304. 1067 Emergency Flex Fund - $200/mo. per child for 8 children. Flexible pool that $20,352 is utilized according to flex fund policies. Dually enrolled youth will also be able to access flex funds through Wrap. This covers children's needs only. Increase by 6% from Year 1. 1068 Respite - $96,964 *2 respite families available 24/7 *Each family provides 8 days/month of respite. *$7,500/mo. rate is paid only for nights with a child in the home (8 days total per family) *$2,500/mo. rate is paid for nights with no child in the home, when family is "on call" for respite placements. With an increase of 6% from Year 1. 1069 Other - Start Up — Not needed in subsequent years 1070 Advertising Expense - $1,500/mo. x 12 mos. x 106% from Year 1 = $19,080 $18,450. Includes advertising for Resource Parents. Advertising costs include Goo le advertising, targeted marketing, and marketing materials. 1071 Education Conference/Meeting — Costs are allocated to the program $10,698 benefiting from the training, conferences, or seminars. Costs that benefit more than one program will be allocated to those programs based on the ratio of each program's expenses to the total of such expenses. Costs that benefit all programs will be allocated based on the ratio of each program's expenses to total expenses. 106% from Year 1, $629.27/training x 17 staff= $10,697.57. 1072 Postage and Printing —estimated at $135/mo. x 12 mos. x 106% from $1,717 Year 1 = $1,669. Includes stamps, certification fees, overnight delivery services and the cost of professional photocopying services. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 35 of 93 Budget Narrative— FY 26-27 1073 Contract Services - Psychiatric, Nursing, Consulting — $62,487 Includes any outside contracted services needed such as identified professional services below. Clinical Supervision: Group Clinical Supervision $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical Supervision for all registered staff$150/hr. x 1.75hours/week x 52 = $13,650/year. Clinical consultation for non- licensure track staff$150/hr. x .5hours/week x $3,900/year. Total Clinical Supervision = $25,350. Psychiatrist: $275/hour x 8 hours/month x 12 = $26,400 Nursing consultation $150/hr. x 4hrs/mo. for any special healthcare related needs = $600/mo. x 12mos. = $7,200/year. All categories listed above are subject to 6% increase from Year 1. 1074 Resource Family Payment - $2,500/mo. per family for 8 families $240,000 Direct reimbursement for Resource Family and Respite family for care and su ervision of client. 1075 Resource Family Payment Prorated Placement @ 5,000 per month $480,000 1076 Supervised Activities - $1,200/mo. Includes those activities as identified $15,264 per the client's needs and services plan. Can include such activities as tutoring, social groups, reactional teams, and other extracurricular activities such as music or sports, etc. Avg. $150/child/x 8 children x 12mos = $14,400 x 106% from Year 1. 1077 Family Support - Includes assisting a family with items needed to support $3,816 the household. Estimated at $300/mo. or$37.50 per family to cover as needed expenses associated with supporting the family to support the child. Could include a 1 x cleaning service or dinner delivery during critical times. With an increase of 6% from Year 1. 1078 Maintenance Payments - Includes maintenance and repair needs for $12,720 Resource Family homes. Covers repairs needed due to damages resulting from behavioral episodes. Estimated at $1,000/mo. With an increase of 6% from Year 1. 1079 Parent Training - Ongoing outside training for Resource Parents and $6,360 Respite Parents. $62.50 per family per month x 8 families. With an increase of 6% from Year 1. 1080 Liability Insurance $13,292 Liability Insurance covers liability insurance based on the program's percentage of overall agency insurance costs. Insurance needed for a particular program is charged directly to the program requiring the coverage. Other insurance coverage that benefits all programs is allocated based on the ratio of each program's expenses to total expenses. Estimated at $1,045/mo. x 12 mos. = $12,540/ ear. With an increase of 6% from Year 1. 1081 IT Services $51,516 Calculated based on the program's percentage of overall agency IT costs. The technology cost for Aspiranet provides complete support of all IT and telecommunications systems used by Aspiranet. Support includes, but is not limited to, the following: Network & Server monitoring and ongoing maintenance, data hosting, equipment repair and refurbishment, 24/7 user Helpdesk support, application development, application and hardware user support, application and equipment training, mobile device configuration and staff support, on-boarding and off-boarding staff, network peripherals, ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 36 of 93 Budget Narrative— FY 26-27 including multifunction devices, printers and other equipment, staff remote portal access to internet and email, and workstation configuration. Estimated to be $4,050/mo. x 12 mos. = $48,600/year. With an increase of 6% from Year 1. OPERATING EXPENSES TOTAL $1,191,275 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping - Covered in Allocable Fiscal Services 1083 External Audit - Covered in Allocable Fiscal Services 1084 Payroll Services - Covered in Allocable Fiscal Services 1085 Fiscal Services - Included in Allocable 1086 Allocable Overhead - includes Staff and Associated Exp. that benefit all programs, Including 1087 HR, IT, Accounting, Prof. Liability, QA Leadership, Executive $275,140 Leadership, Exp. Calculated at 10%. The indirect rate is calculated based on the cost trends wherein the headquarters cost allocation is 10% of costs. All headquarters activities involve executive level oversight of division staff, statewide networking and advocacy and fractional portions of rent, postage, equipment leases, phones, and office supplies required by executive staff engaged in the services benefiting the program. These costs include all payroll, accounts receivable and accounts payable, audits, banking, human resources, risk management, legal, program direction and other functions carried out by headquarters administrative staff. TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10% OF DIRECT $275,140 COST TOTAL PROGRAM EXPENSE $3,026,542 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet,Inc. Page 37 of 94 FY 2027-2028 Budget Categories Total Proposed Budget Direct Admin. Direct Program Total Cost Line Item Description(Must be Itemized) FTE% Support Cost Cost PERSONNEL SALARIES: 0001 Director of Program 0.25 28,463 28,463 0002 Associate Division Director 0.25 27,508 27,508 0003 Clinical Director 0.50 60,375 60,375 0004 Program Manager 1.00 97,750 97,750 0005 Clincian/Social Worker 1.75 156,975 156,975 0006 Family Developer 0.50 39,095 39,095 0007 Dedicated Program Trainer 0.25 18,837 18,837 0008 Lead Support Counselor 2.00 143,520 143,520 0009 Support Counselor 8.00 459,264 459,264 0010 Program Assistant 0.50 28,750 28,750 0011 CIA Billing and Compliance Manager 0.50 28,750 28,750 0012 Parent Partner 0.50 23,115 23,115 0013 Family Finder 1.00 74,750 74,750 0014 Staff On-Call 10,400 10,400 Stipends/Overtime 20,640 20,640 Salary Total 17.00 57,500 1,160,692 1,218,192 Payroll Taxes 0030 OASDI 3,565 71,963 75,528 0031 FICA/MEDICARE 834 16,830 17,664 0032 SUI 1,121 22,633 23,755 PAYROLL TAX TOTAL 5,520 111,426 116,946 EMPLOYEE BENEFITS: 0040 Retirement 863 17,410 18,273 0041 Workers Compensation 1,150 23,214 24,364 0042 Health Insurance(Medical,Vision,Life,Dental) 5,520 111,426 116,946 0042 Fringe Benefits 1,323 26,696 28,019 EMPLOYEE BENEFITS TOTAL 8,8d 178,747 187,602 SALARY&BENEFITS GRAND TOTAL(Benefits @ 25%of payroll,Including Payroll Taxes) 1,522,740 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 68,016 1011 Rent/Lease Equipment 23,544 1012 Utilities 7,668 1013 Building Maintenance 664 1014 Equipment Purchase 4,898 FACILITY/EQUIPMENT/TOTAL 104,790 OPERATING EXPENSES 1060 Staff Recruitment 17,145 1061 StaffTraining 9,820 1062 Communications 28,017 1063 Office Supplies 6,000 1064 Staff Mileage Reimbursement 74,141 1065 Clothing 7,848 1066 Program and Treatment Supplies 18,312 1067 Emergency Flex Fund 20,928 1068 Respite 99,708 1069 Other-Start Up - 1070 Advertising Expense 19,620 1071 Education Conference/Meeting 11,000 1072 Postage and Printing 1,766 1073 Contract Services-Psychiatric,Nursing,Consulting 64,256 1074 Resource Family Payment @ 2,500 per bed per month 240,000 1075 Resource Family Payment Prorated Placement 480,000 1076 Supervised Activities 15,696 1077 Family Support 3,924 1078 Maintenance Payments 13,080 1079 Parent Training 6,540 1080 Liability Insurance 13,669 1081 IT Services 52,974 OPERATING EXPENSES TOTAL 1,204,443 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping-Covered in Allocable Fiscal Services 1083 External Audit-Covered in Allocable Fiscal Services 1084 Payroll Services-Covered in Allocable Fiscal Services 1085 Fiscal Services-Included in Allocable 1086 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including 1087 HR,IT,Accounting,Prof.Liability,CIA Leadership,Executive Leadership,Exp. 283,197 TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10%OF DIRECT COST. $283,197 TOTAL PROGRAM EXPENSE $3,115,170 ESTIMATED MENTAL HEALTH BILLABLE TO MENTAL HEALTH CONTRACT $ 1,684,821 ESTIMATED NON MEDI-CAL BILLABLE COST $1,430,349 Total Cost/Day/Youth $ 1,067 MH Cost Per Day $ 560 Daily Foster Care State Approved ICM Rate Per Youth $ 501 Remaining ISFC Rate Per day/Youth $ 6 MEDI-CAL REVENUE: Provider Type Hours Hourly to Amount Exhibit C-1 Mental Health Services(Therapy) LPHA 832 $265 28 220,712 96 Page 38 of 94 Case Management(ICC) Other Qualified Provider 624 $199.58 124,537.92 Crisis Services LPHA 96 $265.28 25,466.88 Medication Support Pyschiatnst 96 $1,019.30 97,852.80 Plan Development Other Qualified Provider 416 $199.58 83,025.28 Assessment Other Qualified Provider 192 $199.58 38,319.36 Rehabilitation Other Qualified Provider 3,199 $199.58 638,456.42 Peer Support Peer Support Specialist 593 $209 56 124,348 71 IHBS Other Qualified Provider 1,664 $199.58 332,101.12 7,712 $ 1,684,821 OTHER REVENUE: 4000 Other-Allocated Program Expenses not covered by EPSDT(Salary,Operations,Financial&Special Expense,Facilities/Equip) $1,480,672 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL $1,480,672 TOTAL PROGRAM REVENUE $3,115,170 Total Medi-Cal Revenue $ 1,694,821 Total Medi-Cal Units 7,712 Averaged Medi-Cal cost per unit $218 Non Medi-Cal Billable Service Cost $1,480,672 Total Non Medi-Cal Billable Units 96 Non Medi-Cal cost per unit $15,424 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 39 of 94 Budget Narrative— FY 27-28 Year 4 — FY 2027-2028 (July 1, 2027 — June 30, 2028) Serving 8 Clients PROGRAM EXPENSE Total: $3,115,170 Medi-Cal Portion: $1,684,821 CW Portion: $1,430,349 All Personnel related expenses are increased by 5% over prior year Operational expenses are increased by 3% Staff Expenses Director of Program $28,463 Under the supervision of the Division Director, the Director of Program maintains operational, fiscal, and programmatic oversight of one or more identified core programs. The Director of Program works with staff, community agencies, and other entities to provide quality services. Position is shared position with other RFA Programs. This is a salaried position. 0.25 FTE x 0001 $113,850/ ear rate = $28,463. Associate Division Director $27,508 Assists Division Director in supporting local Program Directors/ Supervisors with hiring, training, performance managing staff, program oversight, QA, compliance, productivity oversight, and TJC accreditation standards. This is a 0002 salaried position. 0.25 FTE x $110,032/ ear rate = $27,508. Clinical Director $60,375 The Clinical Director provides clinical oversight and supervision to all staff and program components after hours/weekends or in the absence of the Program Manager. The Clinical Director reports to the Program Director and can also assist in the field with the mobile response team. California Licensed Marriage Family Therapist or Licensed Clinical Social Worker. Meets the BBS qualifications to provide clinical supervision. Ability to develop and provide training; Ability to supervise evidence-based practices utilized by the agency (must be trained in the EB practices). Two years of experience providing clinical supervision to staff in family or child mental health or related fields. This 0003 is a salaried position. 0.50 FTE x $120,750/ ear rate = $60,375. Program Manager $97,750 The Core Program Manager (CPM 1) is responsible for hiring, training, supervising, and evaluating staff, inclusive of performance management. The CPM I has oversight of the program(s) budget and reports and interfaces with funder partners. The CPM I is responsible for program(s) oversight, including quality assurance and program compliance, including required documentation to federal, state, and funder, and Agency standards. The CPM I is also responsible for budgetary and strategic planning related to the program(s) they oversee. CPM I is responsible for upholding and supervising the Agency's operational, financial, personnel and practice rules, policies and procedures. 0004 This is a salaried position. 1.00 FTE x $97,750/ ear rate = $97,750. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 40 of 93 Budget Narrative— FY 27-28 Clinician/Social Worker $156,975 Provides individual and/or family therapy; provides assessment, development, implementation, and evaluation of mental health Treatment Plans; promotes and ensures collaboration and ongoing communication with program team members. They are also the main point of contact for family and referring agency; schedules/facilitates CFTs; provides assessment, development, implementation, and evaluation of Service Plans; ensures collaboration and ongoing communication between program team members. This is a salaried 0005 position. 1.75 FTE x $89,700/ ear rate = $156,975. Family Developer $39,095 The Family Developer is responsible for recruiting, assessing, training, and approving specialized resource families, which provide Intensive Foster Care Services (ISFC). In addition, the Family Developer identifies community groups, delivers presentations with the goal of identifying potential resource families, and supports resource family applicants through the approval and training processes. This is a salaried position. 0.50 FTE x $78,191/year rate = 0006 $39,095. Dedicated Program Trainer $18,837 The Trainer conducts prece rtifi cation parent training and initial screening for potential foster families and consults with the Core Program Director and/or Supervisor regarding a family's preparedness to move forward in the assessment and screening process. This is an hourly position. 0.25 FTE x 0007 $75,348/ ear rate = $18,837. Lead Support Counselor $143,520 Under the supervision of the CPD/CPM/CPS and/or ACDD, the Lead Support Counselor is responsible for training and supporting all Support Counselors at both the local program and division level within the ISFC program. At the local program level, the Lead Support Counselor will yearly meet with the Support Counselors for supervision and to monitor their implementation of identified components of the approved support plan. The Lead Support Counselor may also maintain a small caseload of ISFC children/youth. At the Division level, the Lead Support Counselor serves as Division lead for initial and on-going training of support counselors. The Lead Support Counselor will also facilitate regularly scheduled Support Counselor group calls. Additional responsibilities include completion of written documentation of weekly activities per agency standards. This is an hourly position. 2.00 FTE x $71,760/year rate = 0008 $143,520. Support Counselor $459,264 Meets directly one-on-one with the child/youth at home, school, or community, including behavior modification, communication skills, social skills, CRM, anger management skills, and role play/role modeling; Identifies/ accesses community resources. This is an hourly position. 8.00 FTE x $57,408/year rate 0009 = $459,264. Program Administrative Assistant $28,750 Provides administrative support to Program Director, management team, and employees. Assist with daily program operations, completing employee safety and environment of care, data entry, filing, database management, and providing customer service to clients, community partners, and the public. This 0010 is an hourly position. 0.50 FTE x $57,500/ ear rate = $28,750. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 41 of 93 Budget Narrative— FY 27-28 QA Billing and Compliance Manager $28,750 Assures that the program complies with all County contractual requirements, including submission of required data, budget reviews, and federal and state laws. Implements county and agency QA policy and procedures for the Wraparound program. Ensures utilization reviews and audits are completed, and data collected is shared and used to increase the efficacy of staff and program compliance. Provides ongoing support to staff with compliance expectations associated with documentation and billing. This is an hourly 0011 position. 0.50 FTE x $57,500/ ear rate = $28,750. Parent Partner $23,115 Bridge to services and supports while sharing their own lived experience advocating for their own child who was involved with either child welfare, probation, mental health, regional center, or IEP services; help parents/caregivers navigate systems; provide support, validation, and encouragement; accompany to community group meetings; coordinate respite and other stress-reducing measures; organize Parent Cafes. This is an hourly 0012 position. 0.50 FTE x $46,230/ ear rate = $23,115. Family Finder $74,750 The Family Finding and Engagement Social Worker is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin or natural supports of identified youth. The Family Finder works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress. 0013 This is a salaried position. 1.00 FTE x $74,750/ ear rate = $74,750. Staff On-Call This is a stipend for employees who field after-hour crisis calls, working on a 0014 rotating basis. $200/week x 52 weeks = $10,400. $10,400 Stipends/Overtime Due to the 24/7 nature of the work, overtime and extra duty stipends will occur at times to cover unfilled shifts. This line item accounts for as needed 50-100 shift stipends to back fill hard to fill shifts typically overnight, weekends and holidays along with overtime. $20,640 Payroll Taxes 0030 OASDI 6.2% $75,528 0031 FICA/MEDICARE 1.45% $17,664 0032 SUI 1.95% $23,755 PAYROLL TAX TOTAL $116,946 EMPLOYEE BENEFITS: 0040 Retirement 1.5% $18,273 0041 Workers Compensation 2% $24,364 0042 Health Insurance Medical, Vision, Life, Dental 9.6% $116,946 0042 Fringe Benefits 2.3% $28,019 EMPLOYEE BENEFITS TOTAL $187,602 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 42 of 93 Budget Narrative— FY 27-28 SALARY& BENEFITS GRAND TOTAL (Benefits @ 25% of payroll, including $1,522,740 Payroll Taxes FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building - $5,200/mo. x 109% x 12 mos. = $68,016. $68,016 For cost of building lease. This space will include offices for staff and conference rooms for staff and client meetings. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1011 Rent/Lease Equipment - $1,800/mo. x 109% x 12 mos. = $23,544. $23,544 Leases and rentals of equipment, furniture, and fixtures. Includes taxes and other items included with the lease. Excludes maintenance contracts on leased items which are charged to building and equipment contract. Includes short- term and long -term equipment leases. Examples include water coolers, copiers, mail machines, etc. Joint costs associated with shared equipment in offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1012 Utilities - $586.25/mo. x 109% x 12 mos. = $7,668. $7,668 Includes cost of VOIP phone serves, monthly charge for cost of cell phones used by staff to maintain communication in the field, and cost of gas, electric, water and sewer for leased office space. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll cost incurred by each grant, contract, or program as the base most appropriate. 1013 Building Maintenance - $50.75/mo. x 109% x 12 mos. = $664 $664 Covers the cost of janitorial services. Items needed to maintain and/or repair facilities. 1014 Equipment Purchase - $374.50/mo. x 109% x 12 mos. = $4,898 $4,898 Includes furnishing and technology equipment beyond the start-up costs. FACILITY/EQUIPMENT/TOTAL $104,790 OPERATING EXPENSES 1060 Staff Recruitment - Includes physical exam, fingerprinting fee for $17,145 background check, and advertising costs for new program staff and ongoing due to staff turnover. Recruitment of licensure and registered staff= $3,500 per staff for advertising and as needed sign-on bonuses. $500-1,000 for all other positions. Increased by 9% from Year 1. 1061 Staff Training - Includes cost of evidence-based ARC training. $9,820 ARC (3 days), LSCI (5 Days), MI (1 day with follow-up consultation) training provided up to 2 times per year as needed for new staff. Increased by 9% from Year 1. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 43 of 93 Budget Narrative— FY 27-28 1062 Communications - Covers the monthly cost of cell phones used by staff to $28,017 maintain communication in the field at $50/line x 11 FTE = $550/mo. x 12 mos. = $6,600/year. Internet and VOIP service estimated at $1,592/mo. x 12 mos. _ $19,104/ ear. Then increased by 9% from Year 1. 1063 Office Supplies — decreases to $500/mo. x 12mos. = $6,000 $6,000 Includes all office materials relevant to operating the program including ens, paperclips, paper, notepads, filing supplies, etc. 1064 Staff Mileage Reimbursement - Reimbursement for employee mileage @ $74,141 .56 cents/mile. Covers cost of mileage reimbursement for filed based activity of Aspiranet program staff. Estimated at $5,668.25/mo. for 15.75 driving staff. (An average of 642+/- miles per month per employee.) with an increase of 9% from Year 1. 1065 Clothing - $75/mo. per child x 8 children x 12 = $7,200, then increased by $7,848 9% from Year 1. Clothing allowance per child to purchase new needed clothing items. 1066 Program and Treatment Supplies - Includes items for the clients to use $18,312 including games, books, toys, and various recreational items. Estimated at an average of$1,400/mo. x 12mos. x 109% = $17,304. 1067 Emergency Flex Fund - $200/mo. per child for 8 children. Flexible pool that $20,928 is utilized according to flex fund policies. Dually enrolled youth will also be able to access flex funds through Wrap. This covers children's needs only. Increase by 9% from Year 1. 1068 Respite - $99,708 *2 respite families available 24/7 *Each family provides 8 days/month of respite. *$7,500/mo. rate is paid only for nights with a child in the home (8 days total per family) *$2,500/mo. rate is paid for nights with no child in the home, when family is "on call" for respite placements. With an increase of 9% from Year 1. 1069 Other - Start Up — Not needed in subsequent years 1070 Advertising Expense - $1,500/mo. x 12 mos. x 109% from Year 1 = $19,620 $18,450. Includes advertising for Resource Parents. Advertising costs include Goo le advertising, targeted marketing, and marketing materials. 1071 Education Conference/Meeting — Costs are allocated to the program $11,000 benefiting from the training, conferences, or seminars. Costs that benefit more than one program will be allocated to those programs based on the ratio of each program's expenses to the total of such expenses. Costs that benefit all programs will be allocated based on the ratio of each program's expenses to total expenses. 109% increase from Year 1 $647.08/training x 17 staff= 11,000. 1072 Postage and Printing —estimated at $135/mo. x 12 mos. x 109% from $1,766 Year 1 = $1,669. Includes stamps, certification fees, overnight delivery services and the cost of professional photocopying services. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 44 of 93 Budget Narrative— FY 27-28 1073 Contract Services - Psychiatric, Nursing, Consulting — $64,256 Includes any outside contracted services needed such as identified professional services below. Clinical Supervision: Group Clinical Supervision $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical Supervision for all registered staff$150/hr. x 1.75hours/week x 52 = $13,650/year. Clinical consultation for non- licensure track staff$150/hr. x .5hours/week x $3,900/year. Total Clinical Supervision = $25,350. E and EEISFC will share the cost of supervision. Psychiatrist: $275/hour x 8 hours/month x 12 = $26,400 Nursing consultation $150/hr. x 4hrs/mo. for any special healthcare related needs = $600/mo. x 12mos. = $7,200/year. All categories listed above are subject to 9% increase from Year 1. 1074 Resource Family Payment - $2,500/mo. per family for 8 families $240,000 Direct reimbursement for Resource Family and Respite family for care and su ervision of client. 1075 Resource Family Payment Prorated Placement @ 5,000 per month $480,000 1076 Supervised Activities - $1,200/mo. Includes those activities as identified $15,696 per the client's needs and services plan. Can include such activities as tutoring, social groups, reactional teams, and other extracurricular activities such as music or sports, etc. Avg. $150/child/x 8 children x 12mos = $14,400 x 109% from Year 1. 1077 Family Support - Includes assisting a family with items needed to support $3,924 the household. Estimated at $300/mo. or$37.50 per family to cover as needed expenses associated with supporting the family to support the child. Could include a 1 x cleaning service or dinner delivery during critical times. With an increase of 9% from Year 1. 1078 Maintenance Payments - Includes maintenance and repair needs for $13,080 Resource Family homes. Covers repairs needed due to damages resulting from behavioral episodes. Estimated at $1,000/mo. With an increase of 9% from Year 1. 1079 Parent Training - Ongoing outside training for Resource Parents and $6,540 Respite Parents. $62.50 per family per month x 8 families. With an increase of 9% from Year 1. 1080 Liability Insurance $13,669 Liability Insurance covers liability insurance based on the program's percentage of overall agency insurance costs. Insurance needed for a particular program is charged directly to the program requiring the coverage. Other insurance coverage that benefits all programs is allocated based on the ratio of each program's expenses to total expenses. Estimated at $1,045/mo. x 12 mos. = $12,540/ ear. With an increase of 9% from Year 1. 1081 IT Services $52,974 Calculated based on the program's percentage of overall agency IT costs. The technology cost for Aspiranet provides complete support of all IT and telecommunications systems used by Aspiranet. Support includes, but is not limited to, the following: Network & Server monitoring and ongoing maintenance, data hosting, equipment repair and refurbishment, 24/7 user Helpdesk support, application development, application and hardware user support, application and equipment training, mobile device configuration and staff support, on-boarding and off-boarding staff, network peripherals, ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 45 of 93 Budget Narrative— FY 27-28 including multifunction devices, printers and other equipment, staff remote portal access to internet and email, and workstation configuration. Estimated to be $4,050/mo. x 12 mos. = $48,600/year. With an increase of 9% from Year 1. OPERATING EXPENSES TOTAL $1,204,443 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping - Covered in Allocable Fiscal Services 1083 External Audit - Covered in Allocable Fiscal Services 1084 Payroll Services - Covered in Allocable Fiscal Services 1085 Fiscal Services - Included in Allocable 1086 Allocable Overhead - includes Staff and Associated Exp. that benefit all programs, Including 1087 HR, IT, Accounting, Prof. Liability, QA Leadership, Executive $283,197 Leadership, Exp. Calculated at 10%. The indirect rate is calculated based on the cost trends wherein the headquarters cost allocation is 10% of costs. All headquarters activities involve executive level oversight of division staff, statewide networking and advocacy and fractional portions of rent, postage, equipment leases, phones, and office supplies required by executive staff engaged in the services benefiting the program. These costs include all payroll, accounts receivable and accounts payable, audits, banking, human resources, risk management, legal, program direction and other functions carried out by headquarters administrative staff. TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10% OF DIRECT $283,197 COST TOTAL PROGRAM EXPENSE $3,115,170 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet,Inc. Page 46 of 94 Startup Budget-FY 2024-2025(Upon Execution-November 30,2024) Budget Categories Total Proposed Budget Direct Admin. Direct Program Total Cost Line Item Description(Must be Itemized) FTE% Support Cost Cost PERSONNEL SALARIES: 0001 Director of Program 0.25 6,188 6,188 0002 Associate Division Director 0.25 5,980 5,980 0003 Clinical Director 0.50 13,125 13,125 0004 Program Manager 1.00 14,167 14,167 0005 Clincian/Social Worker 1.00 13,000 13,000 0006 Family Developer 0.50 8,499 8,499 0007 Dedicated Program Trainer 0.25 4,095 4,095 0008 Lead Support Counselor 1.00 15,600 15,600 0009 Support Counselor 2.00 16,640 16,640 0010 Program Assistant 0.50 4,167 4,167 0011 CIA Billing and Compliance Manager 0.50 4,167 4,167 0012 Parent Partner 0.50 3,350 3,350 0013 Family Finder 1.00 10,833 10,833 0014 Staff On-Call - Stipends/Overtime Salary Total 9.25 8,333 111,476 119,810 Payroll Taxes 0030 OASDI 517 6,912 7,428 0031 FICA/MEDICARE 121 1,616 1,737 0032 SUI 163 2,174 2,336 PAYROLL TAX TOTAL 800 10,702 11,502 EMPLOYEE BENEFITS: 0040 Retirement 125 1,672 1,797 0041 Workers Compensation 166.67 2,230 2,396 0042 Health Insurance(Medical,Vision,Life,Dental) 800.00 10,702 11,502 0042 Fringe Benefits 192 2,564 2,756 EMPLOYEE BENEFITS TOTAL 1,283 17,167 18,451 SALARY&BENEFITS GRAND TOTAL(Benefits @ 25%of payroll,Including Payroll Taxes) 149,762 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 13,724 1011 Rent/Lease Equipment 3,543 1012 Utilities 1,172 1013 Building Maintenance 101 1014 Equipment Purchase 749 FACILITY/EQUIPMENT/TOTAL 19,290 OPERATING EXPENSES 1060 Staff Recruitment 10,486 1061 Staff Training 6,006 1062 Communication 4,284 1063 Office Supplies 3,585 1064 Staff Mileage Reimbursement 2,267 1065 Clothing 1066 Program and Treatment Supplies 1067 Emergency Flex Fund-Child-related costs 1068 Respite 1069 Other-Start Up 42,752 1070 Advertising Expense 4,500 1071 Education Conference/Meeting 1072 Postage and Printing 203 1073 Contract Services-Psychiatric,Nursing,Consulting 1074 Resource Family Payment @ 2,500 per bed per month 1075 Resource Family Payment Prorated Placement @ 5,000 per month 1076 Supervised Activities 1077 Family Support 1078 Maintenance Payments 1079 Parent Training 1,500 1080 Liability Insurance 2,075 1081 IT Services 8,041 OPERATING EXPENSES TOTAL 85,697 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping-Covered in Allocable Fiscal Services 1083 External Audit-Covered in Allocable Fiscal Services 1084 Payroll Services-Covered in Allocable Fiscal Services 1085 Fiscal Services-Included in Allocable 1086 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including HR,IT,Accounting,Prof.Liability,CIA Leadership,Executive Leadership,Exp. 25,475 TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10%OF DIRECT COST. $25,475 TOTAL PROGRAM EXPENSE $280,225 ESTIMATED MENTAL HEALTH BILLABLE TO MENTAL HEALTH CONTRACT $0 ESTIMATED NON MEDI-CAL BILLABLE COST $280,225 Total Cost/Day/Youth $ - MH Cost Per Day/Youth $ - Daily Foster Care State Approved ICM Rate Per Youth $ - Remaining ISFC Rate Per day/Youth $ - MEDI-CAL REVENUE Exhibit C-1 Service Provider Type Hours Hourly Rate Amount Page 47 of 94 Mental Health Services(Therapy) LPHA $265.28 $0.00 Case Management(ICC) Other Qualified Provider $199.58 $0.00 Crisis Services LPHA $265.28 $0.00 Medication Support Pyschiatrist $1,019.30 $0.00 Plan Development Other Qualified Provider $199.58 $0.00 Assessment Other Qualified Provider $199.58 $0.00 Rehabilitation Other Qualified Provider $199.58 $0.00 Peer Support Peer Support Specialist $209.56 $0.00 IHBS Other Qualified Provider $199.58 $0.00 0 $0.00 OTHER REVENUE: 4000 Other-Allocated Program Expenses not covered by EPSDT(Salary,Operations,Financial&Special Expense,FacilitiesrEquip) $280,225 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL $280,225 TOTAL PROGRAM REVENUE $280,225 Total Mod!-Cal Revenue Total Medl-Cal Units 0.00 Averaged Mod!-Cal cost per unit $0.00 Non Mod!-Cal Billable Service Cost $280,225 Total Non Medi-Cal Billable Units 48 Non Mod!-Cal cost per unit $5,838 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 48 of 93 Budget Narrative—Startup FY 24-25 Year 1 Startup — FY 2024-2025 (Upon Execution — November 30, 2024) PROGRAM EXPENSE Total: $280,225 Medi-Cal Portion: $0 CWS Portion: $280,225 Staff Expenses Director of Program Under the supervision of the Division Director, the Director of Program maintains operational, fiscal, and programmatic oversight of one or more identified core programs. The Director of Program works with staff, community agencies, and other entities to provide quality services. Position is shared position with other RFA Programs. This is a salaried 0001 position.0.25 FTE x $99,000/ ear rate/12 x 3. $6,188 Associate Division Director Assists Division Director in supporting local Program Directors/ Supervisors with hiring, training, performance managing staff, program oversight, QA, compliance, productivity oversight, and TJC accreditation standards. This is a salaried position. 0.25 FTE x $95,680/year rate = 0002 $23,920/12 x 3. $5,980 Clinical Director The Clinical Director provides clinical oversight and supervision to all staff and program components after hours/weekends or in the absence of the Program Manager. The Clinical Director reports to the Program Director and can also assist in the field with the mobile response team. California Licensed Marriage Family Therapist or Licensed Clinical Social Worker. Meets the BBS qualifications to provide clinical supervision. Ability to develop and provide training; Ability to supervise evidence-based practices utilized by the agency (must be trained in the EB practices). Two years of experience providing clinical supervision to staff in family or child mental health or related fields. This is a salaried 0003 position. 0.50 FTE x $105,000/ ear rate/12 x 3. $13,125 Program Manager The Core Program Manager (CPM 1) is responsible for hiring, training, supervising and evaluating staff, inclusive of performance management. The CPM I has oversight of the program(s) budget and reports and interfaces with funder partners. The CPM I is responsible for program(s) oversight, including quality assurance and program compliance, including required documentation to federal, state, and funder, and Agency standards. The CPM I is also responsible for budgetary and strategic planning related to the program(s) they oversee. CPM I is responsible for upholding and supervising the Agency's operational, financial, personnel and practice rules, policies and procedures. This is a salaried position. 1.00 FTE x $85,000/year rate/12 x 2mos. This staff will 0004 start in month 2. $14,167 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 49 of 93 Budget Narrative—Startup FY 24-25 Clinician/Social Worker Provides individual and/or family therapy; provides assessment, development, implementation, and evaluation of mental health Treatment Plans; promotes and ensures collaboration and ongoing communication with program team members. They are also the main point of contact for family and referring agency; schedules/facilitates CFTs; provides assessment, development, implementation, and evaluation of Service Plans; ensures collaboration and ongoing communication between program team members. This is a salaried position. 1.0 FTE x $78,000/year rate/12 x 2 mos. This staff will start in 0005 month 2. $13,000 Family Developer The Family Developer is responsible for recruiting, assessing, training, and approving specialized resource families, which provide Intensive Foster Care Services (ISFC). In addition, the Family Developer identifies community groups, delivers presentations with the goal of identifying potential resource families, and supports resource family applicants through the approval and training processes. This is a salaried position. 0006 0.50 FTE x $67,992/ ear rate/12 x 3. $8,499 Dedicated Program Trainer The Trainer conducts precertifi cation parent training and initial screening for potential foster families and consults with the Core Program Director and/or Supervisor regarding a family's preparedness to move forward in the assessment and screening process. This is an hourly position. 0007 0.25 FTE x $65,520/ ear rate/12 x 3. $4,095 Lead Support Counselor Under the supervision of the CPD/CPM/CPS and/or ACDD, the Lead Support Counselor is responsible for training and supporting all Support Counselors at both the local program and division level within the ISFC program. At the local program level, the Lead Support Counselor will regularly meet with the Support Counselors for supervision and to monitor their implementation of identified components of the approved support plan. The Lead Support Counselor may also maintain a small caseload of ISFC children/youth. At the Division level, the Lead Support Counselor serves as Division lead for initial and on-going training of support counselors. The Lead Support Counselor will also facilitate regularly scheduled Support Counselor group calls. Additional responsibilities include completion of written documentation of weekly activities per agency standards. This is an hourly position. 1.0 FTE x 0008 $62,400/year rate/12 x 3. $15,600 Support Counselor Meets directly one-on-one with the child/youth at home, school, or community, including behavior modification, communication skills, social skills, CRM, anger management skills, and role play/role modeling; Identifies/ accesses community resources. This is an hourly position. 0009 2.0 FTE x $49,920/year rate/12 x 2mos. These staff will start in month 2. $16,640 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 50 of 93 Budget Narrative—Startup FY 24-25 Program Administrative Assistant Provides administrative support to Program Director, management team, and employees. Assist with daily program operations, completing employee safety and environment of care, data entry, filing, database management, and providing customer service to clients, community partners, and the public. This is an hourly position.0.50 FTE x 0010 $50,000/ ear rate/12 x 2 mos. This staff will start in month 2. $4,167 QA Billing and Compliance Manager Assures that the program complies with all County contractual requirements, including submission of required data, budget reviews, and federal and state laws. Implements county and agency QA policy and procedures for the Wraparound program. Ensures utilization reviews and audits are completed, and data collected is shared and used to increase the efficacy of staff and program compliance. Provides ongoing support to staff with compliance expectations associated with documentation and billing. This is an hourly position. 0.50 FTE x 0011 $50,000/ ear rate/12 x 2 mos. This staff will start in month 2. $4,167 Parent Partner Bridge to services and supports while sharing their own lived experience advocating for their own child who was involved with either child welfare, probation, mental health, regional center, or IEP services; help parents/caregivers navigate systems; provide support, validation, and encouragement; accompany to community group meetings; coordinate respite and other stress-reducing measures; organize Parent Cafes. This is an hourly position. 0.50 FTE x $40,200/year rate/12 x 2 mos. This staff 0012 will start in month 2. $3,350 Family Finder The Family Finding and Engagement Social Worker is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin or natural supports of identified youth. The Family Finder works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress. This is a salaried position. 1.00 FTE x $65,000/year rate/12 x 2 mos. This staff will start in 0013 month 2. $10,833 Staff On-Call 0014 None until clients are placed. $0 Stipends/Overtime None until clients are placed. $0 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 51 of 93 Budget Narrative—Startup FY 24-25 Payroll Taxes 0030 OASDI 6.2% $7,428 0031 FICA/MEDICARE 1.45% $1,737 0032 SUI 1.95% $2,336 PAYROLL TAX TOTAL $11,502 EMPLOYEE BENEFITS: 0040 Retirement 1.5% $1,797 0041 Workers Compensation 2% $2,396 0042 Health Insurance (Medical, Vision, Life, 9.6% $11,502 Dental 0042 Fringe Benefits 2.3% $2,756 EMPLOYEE BENEFITS TOTAL $18,451 SALARY & BENEFITS GRAND TOTAL (Benefits @ 25% of payroll, including $149,762 Payroll Taxes) FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building - $3,431/mo. x 4 (double rent in month 1 due $13,724 to first and last rent due with regular rent amount in mos. 2-3) For cost of building lease. This space will include offices for staff and conference rooms for staff and client meetings. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1011 Rent/Lease Equipment - $1,181/mo. x 3 $3,543 Leases and rentals of equipment, furniture, and fixtures. Includes taxes and other items included with the lease. Excludes maintenance contracts on leased items which are charged to building and equipment contract. Includes short- term and long - term equipment leases. Examples include water coolers, copiers, mail machines, etc. Joint costs associated with shared equipment in offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1012 Utilities - $390.83/mo. x 3 $1 ,172 Includes cost of VOIP phone serves, monthly charge for cost of cell phones used by staff to maintain communication in the field, and cost of gas, electric, water and sewer for leased office space. Joint EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 52 of 93 Budget Narrative—Startup FY 24-25 costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll cost incurred by each grant, contract or program as the base most appropriate. 1013 Building Maintenance - $33.83/mo. x 3 $101 Covers the cost of janitorial services. Items needed to maintain and/or repair facilities. 1014 Equipment Purchase - $249.67/mo. x 3 $749 Includes furnishing and technology equipment beyond the start-up costs. FACILITY/EQUIPMENT/TOTAL $19,290 OPERATING EXPENSES 1060 Staff Recruitment - Includes physical exam, fingerprinting fee for $10,486 background check, and advertising costs for new program staff and ongoing due to staff turnover. Recruitment of licensure and registered staff = $3,500 per staff for advertising and as needed sign-on bonuses. $500-1,000 for all other positions. 1061 Staff Training - Includes cost of evidence-based ARC training. $6,006 ARC (3 days), LSCI (5 Days), MI (1 day with follow-up consultation) training provided up to 2 times per year as needed for new staff. 1062 Communications - Covers the monthly charge for the cost of cell $4,284 phones used by staff to maintain communication in the field at $50/line x 10.25 FTE = $512.50/mo. x 3 mos. = $1,537.50/year. Internet and VOIP service estimated at $915.50/mo. x 3 mos. _ $2,746.50/year. 1063 Office Supplies - $1,195/mo. x 3 $3,585 Includes all office materials relevant to operating the program including pens, paper clips, paper, notepads, filing supplies, etc. 1064 Staff Mileage Reimbursement - Reimbursement for employee $2,267 mileage @ .56 cents/mile. Covers cost of mileage reimbursement for filed based activity of Aspiranet program staff. Estimated at $3,778.83/mo. for 10.25 driving staff. (An average of 368.67+/- miles per month per employee.) then reduced by 80% during start- up due to not seeing clients yet in first 3 mos. 1065 Clothing - None until clients are placed. $0 1066 Program and Treatment Supplies - None until clients are placed. $0 1067 Emergency Flex Fund - None until clients are placed. $0 1068 Respite - None until clients are placed. $0 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 53 of 93 Budget Narrative-Startup FY 24-25 1069 Other - Start Up - $42,752 Furniture COST PER QUANTITY ITEM UNIT TOTAL 10.75 Desk/cubicle $1,721.40 $18,505.05 0.75 Admin Desk $1,065.58 $799.19 15 Desk Chairs $100.00 $1,500.00 1 File Cabinets $300.00 $300.00 1.75 Bookshelves $200.00 $350.00 0.5 Fridge $1,200.00 $600.00 Si na a $1,000.00 $0.00 2 Lobby furniture 4 chairs $200.00 $400.00 1 Lobby furniture side tables $100.00 $100.00 0.5 conference table $750.00 $375.00 TOTAL $22,929.24 Tech Equipment COST PER QUANTITY ITEM UNIT TOTAL Monitor 24" $224.99 $0.00 11 Monitor 27 $339.99 $3,739.89 Thick Client $1,011.45 $0.00 1.25 Laptop w/standard build $1,097.80 $1,372.25 Laptop w/advance build $1,414.74 $0.00 11 Laptop Carrying Bag $21.99 $241.89 11 Docking Station $187.02 $2,057.22 10 Cell $700.00 $7,000.00 3.75 Desk phones $48.99 $183.71 0.5 Admin Desk Phone $119.99 $60.00 0.25 IT hookup $3,900.00 $975.00 9.75 Chromebook Touch Screen $430.00 $4,192.50 TOTAL $19,822.46 1070 Advertising Expense - $1,500/mo. x 3 $4,500 Includes advertising for Resource Parents. Advertising costs include Goo le advertising, targeted marketing, and marketing materials. 1071 Education Conference/Meeting - will occur in remaining 9 mos. of $0 ear 1. 1072 Postage and Printing - estimated at $135/mo. (halved due to no $203 clients placed) = $67.50/mo. x 3 mos. Includes stamps, certification fees, overnight delivery services, and the cost of professional photocopying services. 1073 Contract Services - Psychiatric, Nursing, Consulting - None $0 until clients are placed. 1074 Resource Family Payment - None until clients are placed. $0 1075 Resource Family Payment - None until clients are placed. $0 1076 Supervised Activities - None until clients are placed. $0 1077 1Family Support - None until clients are placed. 1 $0 1079 Maintenance Payments - None until clients are placed. 1 $0 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 54 of 93 Budget Narrative— FY 24-25 1079 Parent Training - Ongoing outside training for Resource Parents $1 ,500 and Respite Parents. $125 per family per month x 4 families. 1080 Liability Insurance $2,075 Liability Insurance covers liability insurance based on the program's percentage of overall agency insurance costs. Insurance needed for a particular program is charged directly to the program requiring the coverage. Other insurance coverage that benefits all programs is allocated based on the ratio of each program's expenses to total expenses. Estimated at $691 .50/mo. x 3 mos. 1081 IT Services $8,041 Calculated based on the program's percentage of overall agency IT costs. The technology cost for Aspiranet provides complete support of all IT and telecommunications systems used by Aspiranet. Support includes, but is not limited to, the following: Network & Server monitoring and ongoing maintenance, data hosting, equipment repair and refurbishment, 24/7 user Helpdesk support, application development, application and hardware user support, application and equipment training, mobile device configuration and staff support, on-boarding and off-boarding staff, network peripherals, including multifunction devices, printers and other equipment, staff remote portal access to internet and email, and workstation configuration. Estimated to be $2,680.17/mo. x 3 mos. OPERATING EXPENSES TOTAL $85,697 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping - Covered in Allocable Fiscal Services 1083 External Audit - Covered in Allocable Fiscal Services 1084 Payroll Services - Covered in Allocable Fiscal Services 1085 Fiscal Services - Included in Allocable 1086 Allocable Overhead - includes Staff and Associated Exp. that benefit all programs, Including HR, IT, Accounting, Prof. Liability, QA Leadership, Executive $25,475 Leadership, Exp. Calculated at 10%. The indirect rate is calculated based on the cost trends wherein the headquarters cost allocation is 10% of costs. All headquarters activities involve executive level oversight of division staff, statewide networking and advocacy and fractional portions of rent, postage, equipment leases, phones, and office supplies required by executive staff engaged in the services benefiting the program. These costs include all payroll, accounts receivable and accounts payable, audits, banking, human resources, risk management, legal, program direction and other functions carried out by headquarters administrative staff. TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10% OF $25,475 DIRECT COST TOTAL PROGRAM EXPENSE $280,225 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE ExhibitC-1 Aspiranet,Inc. Page 55 of 94 FY 2024-2025(December 1,2024-June 30,2025) Budget Categories Total Proposed Budget Direct Admin. Direct Program Total Cost Line Item Description(Must be Itemized) FTE is Support Cost Cost PERSONNEL SALARIES: 0001 Director of Program 0.25 18,563 18,563 0002 Associate Division Director 0.25 17,940 17,940 0003 Clinical Director 0.50 39,375 39,375 0004 Program Manager 1.00 63,750 63,750 0005 Clincian/Social Worker 1.00 58,500 58,500 0006 Family Developer 0.50 25,497 25,497 0007 Dedicated Program Trainer 0.25 12,285 12,285 0008 Lead Support Counselor 1.00 46,800 46,800 0009 Support Counselor 4.00 149,760 149,760 0010 Program Assistant 0.50 18,750 18,750 0011 CIA Billing and Compliance Manager 0.50 18,750 18,750 0012 Parent Partner 0.50 15,075 15,075 0013 Family Finder 1.00 48,7SO 48,750 0014 Staff On-Call 7,800 7,800 Stipends/Overtime 15,480 15,480 Salary Total 11.25 37,500 519,574 557,074 Payroll Taxes 0030 OASDI 2,325 32,214 34,539 0031 FICA/MEDICARE 544 7,534 8,078 0032 SUI 731 10,132 10,863 PAYROLL TAX TOTAL 3,600 49,879 53,479 EMPLOYEE BENEFITS: 0040 Retirement 563 7,794 8,356 0041 Workers Compensation 750.00 10,391 11,141 0042 Health Insurance(Medical,Vision,Life,Dental) 3,600.00 49,879 53,479 0042 Fringe Benefits 863 11,950 12,813 EMPLOYEE BENEFITS TOTAL 5,77S 80,014 85,789 SALARY&BENEFITS GRAND TOTAL(Benefits @ 25%of payroll,Including Payroll Taxes) 696,343 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 30,879 1011 Rent/Lease Equipment 10,629 1012 Utilities 3,518 1013 Building Maintenance 304 1014 Equipment Purchase 2,247 FACILITY/EQUIPMENT/TOTAL 47,577 OPERATING EXPENSES 1060 Staff Recruitment 1061 StaffTraining 1062 Communication 12,852 1063 Office Supplies 10,755 1064 Staff Mileage Reimbursement 34,010 1065 Clothing 9,000 1066 Program and Treatment Supplies 12,600 1067 Emergency Flex Fund-Child-related costs 7,200 1068 Respite 34,303 1069 Other-Start Up 1070 Advertising Expense 13,500 1071 Education Conference/Meeting 6,679 1072 Postage and Printing 1,215 1073 Contract Services-Psychiatric,Nursing,Consulting 32,175 1074 Resource Family Payment @ 2,500 per bed per month 90,000 1075 Resource Family Payment Prorated Placement @ 5,000 per month 180,000 1076 Supervised Activities 10,800 1077 Family Support 2,700 1078 Maintenance Payments 9,000 1079 Parent Training 4,500 1080 Liability Insurance 6,224 1081 IT Services 24,122 OPERATING EXPENSES TOTAL 501,633 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping-Covered in Allocable Fiscal Services 1083 External Audit-Covered in Allocable Fiscal Services 1084 Payroll Services-Covered in Allocable Fiscal Services 1085 Fiscal Services-Included in Allocable 1086 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including HR,IT,Accounting,Prof.Liability,CIA Leadership,Executive Leadership,Exp. 124,555 TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10%OF DIRECT COST. $124,555 TOTAL PROGRAM EXPENSE $1,370,109 ESTIMATED MENTAL HEALTH BILLABLE TO MENTAL HEALTH CONTRACT $710,2 ESTIMATED NON MEDI-CAL BILLABLE COST I!,;I 911 Total Cost/Day/Youth $ 1,259 MH Cost Per Day/Youth $ 472 Daily Foster Care State Approved ICM Rate Per Youth $ 535 Remaining ISFC Rate Per day/Youth $ 252 MEDI-CAL REVENUE: Exhibit C-1 Service Provider Type Hours Hourly Rate Amount Page 56 of 94 Mental Health Services(Therapy) LPHA 369 $265 28 $97,888.32 Case Management(ICC) Other Qualified Provider 624 $199.58 $124,537.92 Crisis Services LPHA 36 $26528 $9,550.08 Medication Support Pyschiatrist 36 $1,019.30 $36,694.80 Plan Development Other Qualified Provider 156 $19958 $31,134.48 Assessment Other Qualified Provider 360 $199.58 $71,848.80 Rehabilitation Other Qualified Provider 608 $199.58 $121,244.85 Peer Support Peer Support Specialist 295 $20956 $61,720.66 IHBS Other Qualified Provider 780 $199.58 $155,672.40 3,263 $710,292 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL PROGRAM REVENUE $1,370,109 Total Medi-Cal Revenue $710,292 Total Medi-Cal Units 3,263.03 Averaged Medi-Cal cost per unit $218 Non Medical Billable Service Cost $659,817 Total Non Medi-Cal Billable Units 48 Non Medi-Cal cost per unit $13,746 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 57 of 94 Budget Narrative— FY 24-25 Year 1 — FY 2024-2025 (December 1, 2024 — June 30, 2025) Serving 4 Clients PROGRAM EXPENSE Total: $1,370,109 Medi-Cal Portion: $710,292 CWS Portion: $659,817 Staff Expenses Director of Program Under the supervision of the Division Director, the Director of Program maintains operational, fiscal, and programmatic oversight of one or more identified core programs. The Director of Program works with staff, community agencies, and other entities to provide quality services. Position is shared position with other RFA Programs. This is a salaried 0001 position. 0.25 FTE x $99,000/ ear rate/12 x 9. $18,563 Associate Division Director Assists Division Director in supporting local Program Directors/ Supervisors with hiring, training, performance managing staff, program oversight, QA, compliance, productivity oversight, and TJC accreditation standards. This is a salaried position. 0.25 FTE x $95,680/year rate/12 x 0002 9. $17,940 Clinical Director The Clinical Director provides clinical oversight and supervision to all staff and program components after hours/weekends or in the absence of the Program Manager. The Clinical Director reports to the Program Director and can also assist in the field with the mobile response team. California Licensed Marriage Family Therapist or Licensed Clinical Social Worker. Meets the BBS qualifications to provide clinical supervision. Ability to develop and provide training; Ability to supervise evidence-based practices utilized by the agency (must be trained in the EB practices). Two years of experience providing clinical supervision to staff in family or child mental health or related fields. This is a salaried 0003 position. 0.50 FTE x $105,000/ ear rate /12 x 9. $39,375 Program Manager The Core Program Manager (CPM 1) is responsible for hiring, training, supervising, and evaluating staff, inclusive of performance management. The CPM I has oversight of the program(s) budget and reports and interfaces with funder partners. The CPM I is responsible for program(s) oversight, including quality assurance and program compliance, including required documentation to federal, state, and funder, and Agency standards. The CPM I is also responsible for budgetary and strategic planning related to the program(s) they oversee. CPM I is responsible for upholding and supervising the Agency's operational, financial, personnel and practice rules, policies and procedures. This is 0004 a salaried position. 1.00 FTE x $85,000/year rate/12 x 9. $63,750 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 58 of 93 Budget Narrative— FY 24-25 Clinician/Social Worker Provides individual and/or family therapy; provides assessment, development, implementation, and evaluation of mental health Treatment Plans; promotes and ensures collaboration and ongoing communication with program team members. They are also the main point of contact for family and referring agency; schedules/facilitates CFTs; provides assessment, development, implementation, and evaluation of Service Plans; ensures collaboration and ongoing communication between program team members. This is a salaried 0005 position. 1.0 FTE x $78,000/year rate/12 x 9. $58,500 Family Developer The Family Developer is responsible for recruiting, assessing, training, and approving specialized resource families, which provide Intensive Foster Care Services (ISFC). In addition, the Family Developer identifies community groups, delivers presentations with the goal of identifying potential resource families, and supports resource family applicants through the approval and training processes. This is a salaried position. 0006 0.50 FTE x $67,992/year rate/12 x 9. $25,497 Dedicated Program Trainer The Trainer conducts precertifi cation parent training and initial screening for potential foster families and consults with the Core Program Director and/or Supervisor regarding a family's preparedness to move forward in the assessment and screening process. This is an hourly position. 0.25 0007 FTE x $65,520/year rate/12 x 9. $12,285 Lead Support Counselor Under the supervision of the CPD/CPM/CPS and/or ACDD, the Lead Support Counselor is responsible for training and supporting all Support Counselors at both the local program and division level within the ISFC program. At the local program level, the Lead Support Counselor will regularly meet with the Support Counselors for supervision and to monitor their implementation of identified components of the approved support plan. The Lead Support Counselor may also maintain a small caseload of ISFC children/youth. At the Division level, the Lead Support Counselor serves as Division lead for initial and on-going training of support counselors. The Lead Support Counselor will also facilitate regularly scheduled Support Counselor group calls. Additional responsibilities include completion of written documentation of weekly activities per agency standards. This is an hourly position. 1.00 FTE x 0008 $62,400/ ear rate /12 x 9. $46,800 Support Counselor Meets directly one-on-one with the child/youth at home, school, or community, including behavior modification, communication skills, social skills, CRM, anger management skills, and role play/role modeling; Identifies/ accesses community resources. This is an hourly position. 0009 4.00 FTE x $49,920/ ear rate /12 x 9. $149,760 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 59 of 93 Budget Narrative—FY 24-25 Program Administrative Assistant Provides administrative support to Program Director, management team, and employees. Assist with daily program operations, completing employee safety and environment of care, data entry, filing, database management, and providing customer service to clients, community partners, and the public. This is an hourly position. 0.50 FTE x 0010 $50,000/ ear rate/12 x 9. $18,750 QA Billing and Compliance Manager Assures that the program complies with all County contractual requirements, including submission of required data, budget reviews, and federal and state laws. Implements county and agency QA policy and procedures for the Wraparound program. Ensures utilization reviews and audits are completed, and data collected is shared and used to increase the efficacy of staff and program compliance. Provides ongoing support to staff with compliance expectations associated with documentation and billing. This is an hourly position. 0.50 FTE x 0011 $50,000/ ear rate/12 x 9. $18,750 Parent Partner Bridge to services and supports while sharing their own lived experience advocating for their own child who was involved with either child welfare, probation, mental health, regional center, or IEP services; help parents/caregivers navigate systems; provide support, validation, and encouragement; accompany to community group meetings; coordinate respite and other stress-reducing measures; organize Parent Cafes. 0012 This is an hourly position. 0.50 FTE x $40,200/ ear rate/12 x 9. $15,075 Family Finder The Family Finding and Engagement Social Worker is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin, or natural supports of identified youth. The Family Finder works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress. 0013 This is a salaried position. 1.00 FTE x $65,000/ ear rate/12 x 9. $48,750 Staff On-Call This is a stipend for employees who field after-hour crisis calls, working 0014 on a rotating basis. $200/week x 52 weeks/12 x 9. $7,800 Stipends/Overtime Due to the 24/7 nature of the work, overtime and extra duty stipends will occur at times to cover unfilled shifts. This line item accounts for as needed 50-100 shift stipends needed to fill hard to fill shifts typically overnight, weekends and holidays along with overtime. $20,640 yearly cost/12 x 9. $15,480 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 60 of 93 Budget Narrative— FY 24-25 Payroll Taxes 0030 OASDI 6.2% $34,539 0031 FICA/MEDICARE 1.45% $8,078 0032 SUI 1.95% $10,863 PAYROLL TAX TOTAL $53,479 EMPLOYEE BENEFITS: 0040 Retirement 1.5% $8,356 0041 Workers Compensation 2% $11,141 0042 Health Insurance (Medical, Vision, Life, 9.6% $53,479 Dental) 0042 Fringe Benefits 2.3% $12,813 EMPLOYEE BENEFITS TOTAL $85,789 SALARY & BENEFITS GRAND TOTAL (Benefits @ 25% of payroll, including $696,343 Payroll Taxes FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building - $3,431/mo. x9 $30,879 For cost of building lease. This space will include offices for staff and conference rooms for staff and client meetings. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1011 Rent/Lease Equipment - $1,181/mo. x 9 $10,629 Leases and rentals of equipment, furniture, and fixtures. Includes taxes and other items included with the lease. Excludes maintenance contracts on leased items which are charged to building and equipment contract. Includes short- term and long -term equipment leases. Examples include water coolers, copiers, mail machines, etc. Joint costs associated with shared equipment in offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1012 Utilities - $390.83/mo. x 9 $3,518 Includes cost of VOIP phone serves, monthly charge for cost of cell phones used by staff to maintain communication in the field, and cost of gas, electric, water and sewer for leased office space. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll cost incurred by each grant, contract, or program as the base most appropriate. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 61 of 93 Budget Narrative— FY 24-25 1013 Building Maintenance - $33.83/mo. x 9 $304 Covers the cost of janitorial services. Items needed to maintain and/or repair facilities. 1014 Equipment Purchase - $249.67/mo. x 9 $2,247 Includes furnishing and technology equipment beyond the start-up costs. FACILITY/EQUIPMENT/TOTAL $47,577 OPERATING EXPENSES 1060 Staff Recruitment—occurred in 3 month start-up $0 1061 Staff Training - occurred in 3 month start-up $0 1062 Communications - Covers the monthly charge for cost of cell phones $12,852 used by staff to maintain communication in the field at $50/line x 10.25 FTE = $550/mo. x 9 mos. = $4,612.50/year. Internet and service desk estimated at $915.50/mo. x 9 mos. = $8,239.50/ ear. 1063 Office Supplies - $1,195/mo. x 9 $10,755 Includes all office materials relevant to operating the program including pens, paperclips, paper, notepads, filing supplies, etc. 1064 Staff Mileage Reimbursement - Reimbursement for employee mileage $34,010 @ .56 cents/mile. Covers cost of mileage reimbursement for filed based activity of Aspiranet program staff. Estimated at $5,668.25/mo. for 10.25 driving staff. (An average of 642+/- miles per month per employee.) /12 x 9mos. 1065 Clothing - $250/mo. per child (for 4 children) x 9 mos. $9,000 Clothing allowance per child to purchase new needed clothing items. 1066 Program and Treatment Supplies - Includes items for the clients to use $12,600 including games, books, toys, and various recreational items. Estimated at an average of $1,400/mo. x 9 mos. 1067 Emergency Flex Fund - $200/mo. per child for 4 children x 9 mos. $7,200 Flexible pool that is utilized according to flex fund policies. Dually enrolled youth will also be able to access flex funds through Wrap. This covers children's needs only. 1068 Respite - $34,303 *1 respite family available 24/7 *Each family provides 8 days/month of respite. *$7,500/mo. rate is paid only for nights with a child in the home (8 days total per family) *$2,500/mo. rate is paid for nights with no child in the home, when family is "on call" for respite placements. Divided by 12 mos. x 9 mos. 1069 Other - Start Up — $0 None. Occurred in 3 mos. start-up. 1070 Advertising Expense - $1,500/mo. x 9 $13,500 Includes advertising for Resource Parents. Advertising costs include Google advertising, targeted marketing, and marketing materials. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 62 of 93 Budget Narrative— FY 24-25 1071 Education Conference/Meeting — Costs are allocated to the program $6,679 benefiting from the training, conferences, or seminars. Costs that benefit more than one program will be allocated to those programs based on the ratio of each program's expenses to the total of such expenses. Costs that benefit all programs will be allocated based on the ratio of each program's expenses to total expenses. $593.65/training x 11 .25 staff. 1072 Postage and Printing — estimated at $135/mo. x 9 $1,215 Includes stamps, certification fees, overnight delivery services, and the cost of professional photocopying services. 1073 Contract Services - Psychiatric, Nursing, Consulting — $32,175 Includes any outside contracted services needed such as identified professional services below. Clinical Supervision: Group Clinical Supervision $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical Supervision for all registered staff $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical consultation for non-licensure track staff $150/hr. x .5hours/week x $3,900/year. Total Clinical Supervision = $19,500. Psychiatrist: $275/hour x 6 hours/mo. x 12 = $19,800 Nursing consultation $150/hr. x 3hrs/mo. for any special healthcare related needs = $300/mo. x 12mos. = $3,600/year. All costs above divided by 12 x 9 mos. 1074 Resource Family Payment - $2,500/mo. per family for 4 families $90,000 Direct reimbursement for Resource Family and Respite family for care and supervision of client. For 9 months. 1075 Resource Family Payment Prorated Placement @ $5,000 per month 180,000 for 4 families. For 9 months. 1076 Supervised Activities - $1,200/mo. Includes those activities as $10,800 identified per the client's needs and services plan. Can include such activities as tutoring, social groups, reactional teams, and other extracurricular activities such as music or sports, etc. Avg. $150/child/x 8 children x 12mos = $14,400/12 x 9. 1077 Family Support - Includes assisting a family with items needed to $2,700 support the household. Estimated at 9 mos. at $300/mo. or $75 per family to cover as needed expenses associated with supporting the family to support the child. Could include a 1 x cleaning service or dinner delivery during critical times. 1078 Maintenance Payments - Includes maintenance and repair needs for $9,000 Resource Family homes. Covers repairs needed due to damages resulting from behavioral episodes. Estimated at $1,000/mo. x9 mos. 1079 Parent Training - Ongoing outside training for Resource Parents and $4,500 Respite Parents. $62.50 per family per month x 8 families x 9 mos. 1080 Liability Insurance $6,224 Liability Insurance covers liability insurance based on the program's percentage of overall agency insurance costs. Insurance needed for a EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 63 of 93 Budget Narrative— FY 24-25 particular program is charged directly to the program requiring the coverage. Other insurance coverage that benefits all programs is allocated based on the ratio of each program's expenses to total expenses. Estimated at $1 ,045/mo. x 9 mos. 1081 IT Services $24,122 Calculated based on the program's percentage of overall agency IT costs. The technology cost for Aspiranet provides complete support of all IT and telecommunications systems used by Aspiranet. Support includes, but is not limited to, the following: Network & Server monitoring and ongoing maintenance, data hosting, equipment repair and refurbishment, 24/7 user Helpdesk support, application development, application and hardware user support, application and equipment training, mobile device configuration and staff support, on-boarding and off-boarding staff, network peripherals, including multifunction devices, printers and other equipment, staff remote portal access to internet and email, and workstation configuration. Estimated to be $4,050/mo. x 9 mos. OPERATING EXPENSES TOTAL $501,633 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping - Covered in Allocable Fiscal Services 1083 External Audit - Covered in Allocable Fiscal Services 1084 Payroll Services - Covered in Allocable Fiscal Services 1085 Fiscal Services - Included in Allocable 1086 Allocable Overhead - includes Staff and Associated Exp. that benefit all programs, Including HR, IT, Accounting, Prof. Liability, QA Leadership, Executive $124,555 Leadership, Exp. Calculated at 10%. The indirect rate is calculated based on the cost trends wherein the headquarters cost allocation is 10% of costs. All headquarters activities involve executive level oversight of division staff, statewide networking and advocacy and fractional portions of rent, postage, equipment leases, phones, and office supplies required by executive staff engaged in the services benefiting the program. These costs include all payroll, accounts receivable and accounts payable, audits, banking, human resources, risk management, legal, program direction and other functions carried out by headquarters administrative staff. TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10% OF $124,555 DIRECT COST TOTAL PROGRAM EXPENSE $1,370,108 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE ExhibitC-1 Aspiranet,Inc. Page 64 of 94 FY 2025-2026 Budget Categories Total Proposed Budget Direct Admin. Direct Program Total Cost Line Item Description(Must be Itemized) FTE% Support Cost Cost PERSONNEL SALARIES: 0001 Director of Program 0.25 25,988 25,988 0002 Associate Division Director 0.25 25,116 25,116 0003 Clinical Director 0.50 55,125 55,125 0004 Program Manager 1.00 89,250 89,250 0005 Clincian/Social Worker 1.00 81,900 81,900 0006 Family Developer 0.50 35,696 35,696 0007 Dedicated Program Trainer 0.25 17,199 17,199 0008 Lead Support Counselor 1.00 65,520 65,520 0009 Support Counselor 4.00 209,664 209,664 0010 Program Assistant 0.50 26,250 26,250 0011 CIA Billing and Compliance Manager 0.50 26,250 26,250 0012 Parent Partner 0.50 21,105 21,105 0013 Family Finder 1.00 68,250 68,250 0014 Staff On-Call 10,400 10,400 Stipends/Overtime 20,640 20,640 Salary Total 11.25 52,500 725,852 778,352 Payroll Taxes 0030 OASDI 3,255 45,003 48,258 0031 FICA/MEDICARE 761 10,525 11,286 0032 SUI 1,024 14,154 15,178 PAYROLL TAX TOTAL 5,040 69,682 74,722 EMPLOYEE BENEFITS: 0040 Retirement 788 10,888 11,675 0041 Workers Compensation 1,050 14,517 15,567 0042 Health Insurance(Medical,Vision,Life,Dental) 5,040 69,682 74,722 0042 Fringe Benefits 1,208 16,695 17,902 EMPLOYEE BENEFITS TOTAL 8,085 111,781 119,866 SALARY&BENEFITS GRAND TOTAL(Benefits @ 25%of payroll,Including Payroll Taxes) 972,940 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 42,407 1011 Rent/Lease Equipment 14,597 1012 Utilities 4,831 1013 Building Maintenance 418 1014 Equipment Purchase 3,086 FACILITY/EQUIPMENT/TOTAL 65,339 OPERATING EXPENSES 1060 Staff Recruitment 10,801 1061 Staff Training 6,186 1062 Cellular Phones 17,650 1063 Office Supplies 4,800 1064 Staff Mileage Reimbursement 46,706 1065 Clothing 12,360 1066 Program and Treatment Supplies 17,304 1067 Emergency Flex Fund 9,888 1068 Respite 46,706 1069 Other-Start Up - 1070 Advertising Expense 18,540 1071 Education Conference/Meeting 6,879 1072 Postage and Printing 1,669 1073 Contract Services-Psychiatric,Nursing,Consulting 44,187 1074 Resource Family Payment @ 2,500 per bed per month 120,000 1075 Resource Family Payment Prorated Placement 240,000 1076 Supervised Activities 14,832 1077 Family Support 3,708 1078 Maintenance Payments 12,360 1079 Parent Training 6,180 1080 Liability Insurance 8,547 1081 IT Services 33,127 OP ERATING EXPENSES TOTAL 682,430 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping-Covered in Allocable Fiscal Services 1083 External Audit-Covered in Allocable Fiscal Services 1084 Payroll Services-Covered in Allocable Fiscal Services 1085 Fiscal Services-Included in Allocable 1086 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including HR,IT,Accounting,Prof.Liability,CIA Leadership,Executive Leadership,Exp. 172,071 TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10%OF DIRECT COST. $172,071 TOTAL PROGRAM EXPENSE $1,892,780 ESTIMATED MENTAL HEALTH BILLABLE TO MENTAL HEALTH CONTRACT 978,481 ESTIMATED NON MEDI-CAL BILLABLE COST $914,299 Total Cost/Day/Youth $ 1,296 MH Cost Per Day/Youth $ 650 Daily Foster Care State Approved ICM Rate Per Youth $ 535 Remaining ISFC Rate Per day/Youth $ 111 MEDI-CAL REVENUE: Exhibit C-1 Service Provider Type Hours Hourly Rate Amount Page 65 of 94 Mental Health Services(Therapy) LPHA 624 $265.28 $165,534.72 Case Management(ICC) Other Qualified Provider 832 $199 58 $166,050.56 Crisis Services LPHA 48 $265.28 $12,733.44 Medication Support Pyschiatrist 48 $1,01930 $48,926.40 Plan Development Other Qualified Provider 208 $199.58 $41,512.64 Assessment Other Qualified Provider 480 $199 58 $95,798.40 Rehabilitation Other Qualified Provider 876 $19958 $174,832.08 Peer Support Peer Support Specialist 313 $209.56 $65,529.41 IHBS Other Qualified Provider 1,040 $199 58 $207,563.20 4,469 $978,481 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL PROGRAM REVENUE $1,892,780 Total Medi-Cal Revenue $978,481 Total Medi-Cal Units 4,468.70 Averaged Medl-Cal cost per unit $219 Non Medi-Cal Billable Service Cost $914,299 Total Non Medi-Cal Billable Units 48 Non Medi-Cal cost per unit $19,048 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 66 of 94 Budget Narrative— FY 25-26 Year 2 — FY 2025-2026 (July 1, 2025 — June 30, 2026) Serving 4 Clients PROGRAM EXPENSE Total: $1,892,780 Medi-Cal Portion: $978,481 CWS Portion: $914,299 Expenses Personnel expenses include a 5% increase over prior year Operational Expenses have increased by 3% over the prior year. Staff Expenses Director of Program Under the supervision of the Division Director, the Director of Program maintains operational, fiscal, and programmatic oversight of one or more identified core programs. The Director of Program works with staff, community agencies, and other entities to provide quality services. Position is shared position with other RFA Programs. This is a salaried 0001 position. 0.25 FTE x $103,950/year rate = $25,988. $25,988 Associate Division Director Assists Division Director in supporting local Program Directors/ Supervisors with hiring, training, performance managing staff, program oversight, QA, compliance, productivity oversight, and TJC accreditation standards. This is a salaried position. 0.25 FTE x $100,464/year rate = 0002 $25,116. $25,116 Clinical Director The Clinical Director provides clinical oversight and supervision to all staff and program components after hours/weekends or in the absence of the Program Manager. The Clinical Director reports to the Program Director and can also assist in the field with the mobile response team. California Licensed Marriage Family Therapist or Licensed Clinical Social Worker. Meets the BBS qualifications to provide clinical supervision. Ability to develop and provide training; Ability to supervise evidence-based practices utilized by the agency (must be trained in the EB practices). Two years of experience providing clinical supervision to staff in family or child mental health or related fields. This is a salaried 0003 position. 0.50 FTE x $110,250/year rate = $55,125. $55,125 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 67 of 93 Budget Narrative— FY 25-26 Program Manager The Core Program Manager (CPM 1) is responsible for hiring, training, supervising, and evaluating staff, inclusive of performance management. The CPM I has oversight of the program(s) budget and reports and interfaces with funder partners. The CPM I is responsible for program(s) oversight, including quality assurance and program compliance, including required documentation to federal, state, and funder, and Agency standards. The CPM I is also responsible for budgetary and strategic planning related to the program(s) they oversee. CPM I is responsible for upholding and supervising the Agency's operational, financial, personnel and practice rules, policies, and procedures. This is 0004 a salaried position. 1.00 FTE x $89,250/year rate = $89,250 $89,250 Clinician/Social Worker Provides individual and/or family therapy; provides assessment, development, implementation, and evaluation of mental health Treatment Plans; promotes and ensures collaboration and ongoing communication with program team members. They are also the main point of contact for family and referring agency; schedules/facilitates CFTs; provides assessment, development, implementation, and evaluation of Service Plans; ensures collaboration and ongoing communication between program team members. This is a salaried 0005 position. 1.0 FTE x $81,900/year rate = $81,900. $81,900 Family Developer The Family Developer is responsible for recruiting, assessing, training, and approving specialized resource families, which provide Intensive Foster Care Services (ISFC). In addition, the Family Developer identifies community groups, delivers presentations with the goal of identifying potential resource families, and supports resource family applicants through the approval and training processes. This is a salaried position. 0006 0.50 FTE x $71 ,392/year rate = $35,696. $35,696 Dedicated Program Trainer The Trainer conducts precertifi cation parent training and initial screening for potential foster families and consults with the Core Program Director and/or Supervisor regarding a family's preparedness to move forward in the assessment and screening process. This is an hourly position. 0.25 0007 FTE x $68,796/year rate = $17,199. $17,199 Lead Support Counselor Under the supervision of the CPD/CPM/CPS and/or ACDD, the Lead Support Counselor is responsible for training and supporting all Support Counselors at both the local program and division level within the ISFC program. At the local program level, the Lead Support Counselor will regularly meet with the Support Counselors for supervision and to monitor their implementation of identified components of the approved 0008 support plan. The Lead Support Counselor may also maintain a small $65,520 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 68 of 93 Budget Narrative— FY 25-26 caseload of ISFC children/youth. At the Division level, the Lead Support Counselor serves as Division lead for initial and on-going training of support counselors. The Lead Support Counselor will also facilitate regularly scheduled Support Counselor group calls. Additional responsibilities include completion of written documentation of weekly activities per agency standards. This is an hourly position. 1.00 FTE x $65,520/ ear rate = $65,520. Support Counselor Meets directly one-on-one with the child/youth at home, school, or community, including behavior modification, communication skills, social skills, CRM, anger management skills, and role play/role modeling; Identifies/ accesses community resources. This is an hourly position. 0009 4.00 FTE x $52,416/ ear rate = $209,664. $209,664 Program Administrative Assistant Provides administrative support to Program Director, management team, and employees. Assist with daily program operations, completing employee safety and environment of care, data entry, filing, database management, and providing customer service to clients, community partners, and the public. This is an hourly position. 0.50 FTE x 0010 $52,500/year rate = $26,250. $26,250 QA Billing and Compliance Manager Assures that the program complies with all County contractual requirements, including submission of required data, budget reviews, and federal and state laws. Implements county and agency QA policy and procedures for the Wraparound program. Ensures utilization reviews and audits are completed, and data collected is shared and used to increase the efficacy of staff and program compliance. Provides ongoing support to staff with compliance expectations associated with documentation and billing. This is an hourly position. 0.50 FTE x 0011 $52,500/year rate = $26,250. $26,250 Parent Partner Bridge to services and supports while sharing their own lived experience advocating for their own child who was involved with either child welfare, probation, mental health, regional center, or IEP services; help parents/caregivers navigate systems; provide support, validation, and encouragement; accompany to community group meetings; coordinate respite and other stress-reducing measures; organize Parent Cafes. This 0012 is an hourly position. 0.50 FTE x $42,210/year rate = $21 ,105. $21,105 Family Finder The Family Finding and Engagement Social Worker is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin or natural supports of identified youth. The Family Finder works closely with a youth's County representative and Child and Family Team to identify connections the youth has lost contact with due to 0013 placement in foster care. They are responsible for conducting thorough case $68,250 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 69 of 93 Budget Narrative— FY 25-26 record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress. This is a salaried position. 1.00 FTE x $68,250/year rate = $68,250. Staff On-Call This is a stipend for employees who field after-hour crisis calls, working 0014 on a rotating basis. $200/week x 52 weeks = $10,400 $10,400 Stipends/Overtime Due to the 24/7 nature of the work, overtime and extra duty stipends will occur at times to cover unfilled shifts. This line item accounts for as needed 50-100 shift stipends as needed to fill hard to fill shifts typically overnight, weekends and holidays along with overtime. $20,640 Payroll Taxes 0030 OASDI 6.2% $48,258 0031 FICA/MEDICARE 1.45% $11,286 0032 SUI 1.95% $15,178 PAYROLL TAX TOTAL $74,722 EMPLOYEE BENEFITS: 0040 Retirement 1.5% $11,675 0041 Workers Compensation 2% $15,567 0042 Health Insurance (Medical, Vision, Life, 9.6% $74,722 Dental 0042 Fringe Benefits 2.3% $17,902 EMPLOYEE BENEFITS TOTAL $119,866 SALARY & BENEFITS GRAND TOTAL (Benefits @ 25% of payroll, including $972,940 Payroll Taxes) FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building - $3,431/mo. x 103% x 12 mos. = $42,407. $42,407 For cost of building lease. This space will include offices for staff and conference rooms for staff and client meetings. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1011 Rent/Lease Equipment - $1,181/mo. x 103% x 12 mos. = $14,597. $14,597 Leases and rentals of equipment, furniture, and fixtures. Includes taxes and other items included with the lease. Excludes maintenance contracts on leased items which are charged to EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 70 of 93 Budget Narrative— FY 25-26 building and equipment contract. Includes short- term and long - term equipment leases. Examples include water coolers, copiers, mail machines, etc. Joint costs associated with shared equipment in offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1012 Utilities - $390.83/mo. x 103% x 12 mos. = $4,831. $4,831 Includes cost of VOIP phone serves, monthly charge for cost of cell phones used by staff to maintain communication in the field, and cost of gas, electric, water and sewer for leased office space. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll cost incurred by each grant, contract or program as the base most appropriate. 1013 Building Maintenance - $33.83/mo. x 103% x 12 mos. = $418 $418 Covers the cost of janitorial services. Items needed to maintain and/or repair facilities. 1014 Equipment Purchase - $249.67/mo. x 103% x 12 mos. = $3,086. $3,086 Includes furnishing and technology equipment beyond the start-up costs. FACILITY/EQUIPMENT/TOTAL $65,339 OPERATING EXPENSES 1060 Staff Recruitment - Includes physical exam, fingerprinting fee for $10,801 background check, and advertising costs for new program staff and ongoing due to staff turnover. Recruitment of Iicensure and registered staff = $3,500 per staff for advertising and as needed sign-on bonuses. $500-1,000 for all other positions. Increased by 3% from Year 1. 1061 Staff Training - Includes cost of evidence-based ARC training. $6,186 ARC (3 days), LSCI (5 Days), MI (1 day with follow-up consultation) training provided up to 2 times per year as needed for new staff. Increased by 3% from Year 1. 1062 Communications - Covers the monthly charge for the cost of cell $17,650 phones used by staff to maintain communication in the field at $50/line x 10.25 FTE = $512.50/mo. x 12 mos. = $6,150/year. Internet and VOIP service estimated at $915.50/mo. x 12 mos. _ $10,986/year. Then increased by 3% from Year 1. 1063 Office Supplies - decreases to $400/mo. x 12mos. = $4,800 $4,800 Includes all office materials relevant to operating the program including pens, paper clips, paper, notepads, filing supplies, etc. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 71 of 93 Budget Narrative— FY 25-26 1064 Staff Mileage Reimbursement - Reimbursement for employee $46,706 mileage @ .56 cents/mile. Covers cost of mileage reimbursement for filed based activity of Aspiranet program staff. Estimated at $3,778.83/mo. for 10.25 driving staff. (An average of 368.67+/- miles per month per employee.) with an increase of 3% from Year 1. 1065 Clothing - $250/mo. per child x 4 children x 12, then increased by $12,360 3% from Year 1. Clothing allowance per child to purchase new needed clothing items. 1066 Program and Treatment Supplies - Includes items for the clients $17,304 to use including games, books, toys, and various recreational items. Estimated at an average of$1,400/mo. x 12mos. x 103% _ $17,304. 1067 Emergency Flex Fund - $200/mo. per child for 4 children. Flexible $9,888 pool that it utilized according to flex fund policies. Dually enrolled youth will also be able to access flex funds through Wrap. This covers children's needs only. Increase by 3% from Year 1. 1068 Respite - $46,706 *1 respite family available 24/7 (1 respite family rather than 2 seems reasonable for a 4-client short term program) *Family provides 8 days/month of respite. *$7500/mo. rate is paid only for nights with a child in the home (8 days total per family) *$2500/mo. rate is paid for nights with no child in the home, when the family is "on call" for respite placements. With an increase of 3% from Year 1. 1069 Other - Start Up — None after Year 1. 1070 Advertising Expense - $1,500/mo. x 12 mos. x 103% from Year 1 $18,540 = $18,540. Includes advertising for Resource Parents. Advertising costs include Google advertising, targeted marketing, and marketing materials. 1071 Education Conference/Meeting — Costs are allocated to the $6,879 program benefiting from the training, conferences, or seminars. Costs that benefit more than one program will be allocated to those programs based on the ratio of each program's expenses to the total of such expenses. Costs that benefit all programs will be allocated based on the ratio of each program's expenses to total expenses. $593.65/training x 11.25 staff = $6,678.56 x 103% from Year 1 = $6,879. 1072 Postage and Printing — estimated at $135/mo. x 103% from Year 1 $1,669 = $1,669. Includes stamps, certification fees, overnight delivery services and the cost of professional photocopying services. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 72 of 93 Budget Narrative— FY 25-26 1073 Contract Services - Psychiatric, Nursing, Consulting — $44,187 Includes any outside contracted services needed such as identified professional services below. Clinical Supervision: Group Clinical Supervision $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical Supervision for all registered staff $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical consultation for nonlicensure track staff $150/hr. x .5hours/week x $3,900/year. Total Clinical Supervision = $19,500. Psychiatrist: $275/hour x 6 hours/mo. x 12 = $19,800 Nursing consultation $150/hr x 3hrs/mo. for any special healthcare related needs = $300/mo. x 12mos. = $3,600/year. All categories listed above are subject to 3% increase from Year 1. 1074 Resource Family Payment - $2,500/mo. per family for 4 families $120,000 Direct reimbursement for Resource Family and Respite family for care and supervision of client. 1075 Resource Family Payment Prorated Placement @ $5,000 per $240,000 month for 4 families. 1076 Supervised Activities - $1,200/mo. Includes those activities as $14,832 identified per the client's needs and services plan. Can include such activities as tutoring, social groups, reactional teams, and other extracurricular activities such as music or sports, etc. Avg. $300/child/x 4 children x 12mos = $14,400 x 103% from Year 1. 1077 Family Support - Includes assisting a family with items needed to $3,708 support the household. Estimated at $300/mo. or $75 per family to cover as needed expenses associated with supporting the family to support the child. Could include a 1 x cleaning service or dinner delivery during critical times. With an increase of 3% from Year 1 . 1078 Maintenance Payments - Includes maintenance and repair needs $12,360 for Resource Family homes. Covers cost of repairs needed as a result of damages resulting from behavioral episodes. Estimated at $1,000/mo. With an increase of 3% from Year 1. 1079 Parent Training - Ongoing outside training for Resource Parents $6,180 and Respite Parents. $125 per family per month x 4 families. With an increase of 3% from Year 1. 1080 Liability Insurance $8,547 Liability Insurance covers liability insurance based on the program's percentage of overall agency insurance costs. Insurance needed for a particular program is charged directly to the program requiring the coverage. Other insurance coverage that benefits all programs is allocated based on the ratio of each program's expenses to total expenses. Estimated at $691 .50/mo. x 12 mos. = $8,298/year. With an increase of 3% from Year 1. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 73 of 93 Budget Narrative— FY 25-26 1081 IT Services $33,127 Calculated based on the program's percentage of overall agency IT costs. The technology cost for Aspiranet provides complete support of all IT and telecommunications systems used by Aspiranet. Support includes, but is not limited to, the following: Network & Server monitoring and ongoing maintenance, data hosting, equipment repair and refurbishment, 24/7 user Helpdesk support, application development, application and hardware user support, application and equipment training, mobile device configuration and staff support, on-boarding and off-boarding staff, network peripherals, including multifunction devices, printers and other equipment, staff remote portal access to internet and email, and workstation configuration. Estimated to be $2,680.17/mo. x 12 mos. = $32,162/year. With an increase of 3% from Year 1. OPERATING EXPENSES TOTAL $682,430 FINANCIAL SERVICES EXPENSES: 1080 Accounting/Bookkeeping - Covered in Allocable Fiscal Services 1081 External Audit - Covered in Allocable Fiscal Services 1082 Payroll Services - Covered in Allocable Fiscal Services 1083 Fiscal Services - Included in Allocable 1084 Allocable Overhead - includes Staff and Associated Exp. that benefit all programs, Including HR, IT, Accounting, Prof. Liability, QA Leadership, Executive $172,071 Leadership, Exp. Calculated at 10%. The indirect rate is calculated based on the cost trends wherein the headquarters cost allocation is 10% of costs. All headquarters activities involve executive level oversight of division staff, statewide networking and advocacy and fractional portions of rent, postage, equipment leases, phones, and office supplies required by executive staff engaged in the services benefiting the program. These costs include all payroll, accounts receivable and accounts payable, audits, banking, human resources, risk management, legal, program direction and other functions carried out by headquarters administrative staff. TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10% OF $172,071 DIRECT COST TOTAL PROGRAM EXPENSE $1,892,780 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE ExhibitC-1 Aspiranet,Inc. Page 74 of 94 FY 2026-2027 Budget Categories Total Proposed Budget Direct Admin. Direct Program Total Cost Line Item Description(Must be Itemized) FTE% Support Cost Cost PERSONNEL SALARIES: 0001 Director of Program 0.25 27,225 27,225 0002 Associate Division Director 0.25 26,312 26,312 0003 Clinical Director 0.50 57,750 57,750 0004 Program Manager 1.00 93,500 93,500 0005 Clincian/Social Worker 1.00 85,800 85,800 0006 Family Developer 0.50 37,396 37,396 0007 Dedicated Program Trainer 0.25 18,018 18,018 0008 Lead Support Counselor 1.00 68,640 68,640 0009 Support Counselor 4.00 219,648 219,648 0010 Program Assistant 0.50 27,500 27,500 0011 CIA Billing and Compliance Manager 0.50 27,500 27,500 0012 Parent Partner 0.50 22,110 22,110 0013 Family Finder 1.00 71,500 71,500 0014 Staff On-Call 10,400 10,400 Stipends/Overtime 20,640 20,640 Salary Total 11.25 55,000 758,939 8131939 Payroll Taxes 0030 OASDI 3,410 47,054 50,464 0031 FICA/MEDICARE 798 11,005 11,802 0032 SUI 1,073 14,799 15,872 PAYROLL TAX TOTAL 5,280 72,858 78,138 EMPLOYEE BENEFITS: 0040 Retirement 825 11,384 12,209 0041 Workers Compensation 1,100 15,179 16,279 0042 Health Insurance(Medical,Vision,Life,Dental) 5,280 72,858 78,138 0042 Fringe Benefits 1,265 17,456 18,721 EMPLOYEE BENEFITS TOTAL 8,470 116,877 125,347 SALARY&BENEFITS GRAND TOTAL(Benefits @ 25%of payroll,Including Payroll Taxes) 1,017,423 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 43,642 1011 Rent/Lease Equipment 15,022 1012 Utilities 4,971 1013 Building Maintenance 430 1014 Equipment Purchase 3,176 FACILITY/EQUIPMENT/TOTAL 67,242 OPERATING EXPENSES 1060 Staff Recruitment 11,115 1061 Staff Training 6,366 1062 Cellular Phones 18,164 1063 Office Supplies 4,800 1064 Staff Mileage Reimbursement 48,067 1065 Clothing 12,720 1066 Program and Treatment Supplies 17,808 1067 Emergency Flex Fund 10,176 1068 Respite 48,482 1069 Other-Start Up - 1070 Advertising Expense 19,080 1071 Education Conference/Meeting 7,079 1072 Postage and Printing 1,717 1073 Contract Services-Psychiatric,Nursing,Consulting 45,474 1074 Resource Family Payment @ 2,500 per bed per month 120,000 1075 Resource Family Payment Prorated Placement 240,000 1076 Supervised Activities 15,264 1077 Family Support 3,816 1078 Maintenance Payments 12,720 1079 Parent Training 6,360 1080 Liability Insurance 8,796 1081 IT Services 34,092 OPERATING EXPENSES TOTAL 692,096 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping-Covered in Allocable Fiscal Services 1083 External Audit-Covered in Allocable Fiscal Services 1084 Payroll Services-Covered in Allocable Fiscal Services 1085 Fiscal Services-Included in Allocable 1086 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including HR,IT,Accounting,Prof.Liability,CIA Leadership,Executive Leadership,Exp. 177,676 TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10%OF DIRECT COST. $177,676 TOTAL PROGRAM EXPENSE $11954,437 ESTIMATED MENTAL HEALTH BILLABLE TO MENTAL HEALTH CONTRACT 1,040,550 ESTIMATED NON MEDI-CAL BILLABLE COST $913,887 Total Cost/Day/Youth $ 1,339 MH Cost Per Day/Youth $ 691 Daily Foster Care State Approved ICM Rate Per Youth $ 535 Remaining ISFC Rate Per day/Youth $ 112 MEDI-CAL REVENUE: Exhibit C-1 Service Provider Type Hours Hourly Rate Amount Page 75 of 94 Mental Health Services(Therapy) LPHA 624 $265.28 $165,534.72 Case Management(ICC) Other Qualified Provider 832 $199 58 $166,050.56 Crisis Services LPHA 48 $265.28 $12,733.44 Medication Support Pyschiatrist 48 $1,01930 $48,926.40 Plan Development Other Qualified Provider 208 $199.58 $41,512.64 Assessment Other Qualified Provider 480 $199 58 $95,798.40 Rehabilitation Other Qualified Provider 1,187 $19958 $236,901.46 Peer Support Peer Support Specialist 313 $209.56 $65,529.41 IHBS Other Qualified Provider 1,040 $199 58 $207,563.20 4,780 $1,040,550 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL PROGRAM REVENUE $1,954,437 Total Medi-Call Revenue $1.141,550 Total Medi-Cal Units 4,780 Averaged Medl-Cal cost per unit $218 Non Medi-Cal Billable Service Cost $913,887 Total Non Medical Billable Units 48 Non Medi-Cal cost per unit $19,039 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 76 of 94 Budget Narrative— FY 26-27 Year 3 — FY 2026-2027 (July 1, 2026 — June 30, 2027) Serving 4 Clients PROGRAM EXPENSE Total: $1,954,437 Medi-Cal Portion: $1,040,550 CWS Portion: $913,887 Expenses Personnel expenses include a 5% increase over prior year Operational Expenses have increased by 3% over the prior year. Staff Expenses Director of Program Under the supervision of the Division Director, the Director of Program maintains operational, fiscal, and programmatic oversight of one or more identified core programs. The Director of Program works with staff, community agencies, and other entities to provide quality services. Position is shared position with other RFA Programs. This is a salaried 0001 position. 0.25 FTE x $108,900/year rate = $27,225. $27,225 Associate Division Director Assists Division Director in supporting local Program Directors/ Supervisors with hiring, training, performance managing staff, program oversight, QA, compliance, productivity oversight, and TJC accreditation standards. This is a salaried position. 0.25 FTE x $105,248/year rate = 0002 $26,312. $26,312 Clinical Director The Clinical Director provides clinical oversight and supervision to all staff and program components after hours/weekends or in the absence of the Program Manager. The Clinical Director reports to the Program Director and can also assist in the field with the mobile response team. California Licensed Marriage Family Therapist or Licensed Clinical Social Worker. Meets the BBS qualifications to provide clinical supervision. Ability to develop and provide training; Ability to supervise evidence-based practices utilized by the agency (must be trained in the EB practices). Two years of experience providing clinical supervision to staff in family or child mental health or related fields. This is a salaried 0003 position. 0.50 FTE x $115,500/year rate = $57,750. $57,750 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 77 of 93 Budget Narrative— FY 26-27 Program Manager The Core Program Manager (CPM 1) is responsible for hiring, training, supervising, and evaluating staff, inclusive of performance management. The CPM I has oversight of the program(s) budget and reports and interfaces with funder partners. The CPM I is responsible for program(s) oversight, including quality assurance and program compliance, including required documentation to federal, state, and funder, and Agency standards. The CPM I is also responsible for budgetary and strategic planning related to the program(s) they oversee. CPM I is responsible for upholding and supervising the Agency's operational, financial, personnel and practice rules, policies, and procedures. This is 0004 a salaried position. 1.00 FTE x $93,500/year rate = $93,500. $93,500 Clinician/Social Worker Provides individual and/or family therapy; provides assessment, development, implementation, and evaluation of mental health Treatment Plans; promotes and ensures collaboration and ongoing communication with program team members. They are also the main point of contact for family and referring agency; schedules/facilitates CFTs; provides assessment, development, implementation, and evaluation of Service Plans; ensures collaboration and ongoing communication between program team members. This is a salaried 0005 position. 1.0 FTE x $85,800/year rate = $85,800. $85,800 Family Developer The Family Developer is responsible for recruiting, assessing, training, and approving specialized resource families, which provide Intensive Foster Care Services (ISFC). In addition, the Family Developer identifies community groups, delivers presentations with the goal of identifying potential resource families, and supports resource family applicants through the approval and training processes. This is a salaried position. 0006 0.50 FTE x $74,791/year rate = $37,396. $37,396 Dedicated Program Trainer The Trainer conducts precertifi cation parent training and initial screening for potential foster families and consults with the Core Program Director and/or Supervisor regarding a family's preparedness to move forward in the assessment and screening process. This is an hourly position. 0.25 0007 FTE x $72,072/year rate = $18,018. $18,018 Lead Support Counselor Under the supervision of the CPD/CPM/CPS and/or ACDD, the Lead Support Counselor is responsible for training and supporting all Support Counselors at both the local program and division level within the ISFC program. At the local program level, the Lead Support Counselor will regularly meet with the Support Counselors for supervision and to monitor their implementation of identified components of the approved 0008 support plan. The Lead Support Counselor may also maintain a small $68,640 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 78 of 93 Budget Narrative— FY 26-27 caseload of ISFC children/youth. At the Division level, the Lead Support Counselor serves as Division lead for initial and on-going training of support counselors. The Lead Support Counselor will also facilitate regularly scheduled Support Counselor group calls. Additional responsibilities include completion of written documentation of weekly activities per agency standards. This is an hourly position. 1.00 FTE x $68,640/ ear rate = $68,640. Support Counselor Meets directly one-on-one with the child/youth at home, school, or community, including behavior modification, communication skills, social skills, CRM, anger management skills, and role play/role modeling; Identifies/ accesses community resources. This is an hourly position. 0009 4.00 FTE x $54,912/ ear rate = $209,664. $219,648 Program Administrative Assistant Provides administrative support to Program Director, management team, and employees. Assist with daily program operations, completing employee safety and environment of care, data entry, filing, database management, and providing customer service to clients, community partners, and the public. This is an hourly position. 0.50 FTE x 0010 $55,000/year rate = $27,500. $27,500 QA Billing and Compliance Manager Assures that the program complies with all County contractual requirements, including submission of required data, budget reviews, and federal and state laws. Implements county and agency QA policy and procedures for the Wraparound program. Ensures utilization reviews and audits are completed, and data collected is shared and used to increase the efficacy of staff and program compliance. Provides ongoing support to staff with compliance expectations associated with documentation and billing. This is an hourly position. 0.50 FTE x 0011 $55,000/year rate = $27,500. $27,500 Parent Partner Bridge to services and supports while sharing their own lived experience advocating for their own child who was involved with either child welfare, probation, mental health, regional center, or IEP services; help parents/caregivers navigate systems; provide support, validation, and encouragement; accompany to community group meetings; coordinate respite and other stress-reducing measures; organize Parent Cafes. This 0012 is an hourly position. 0.50 FTE x $44,220/year rate = $22,110. $22,110 Family Finder The Family Finding and Engagement Social Worker is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin or natural supports of identified youth. The Family Finder works closely with a youth's County 0013 representative and Child and Family Team to identify connections the $71,500 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 79 of 93 Budget Narrative— FY 26-27 youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress. This is a salaried position. 1.00 FTE x $71 ,500/year rate = $71,500. Staff On-Call This is a stipend for employees who field after-hour crisis calls, working 0014 on a rotating basis. $200/week x 52 weeks = $10,400 $10,400 Stipends/Overtime Due to the 24/7 nature of the work, overtime and extra duty stipends will occur at times to cover unfilled shifts. This line item accounts for as needed 50-100 shift stipends as needed to fill hard to fill shifts typically overnight, weekends and holidays along with overtime. $20,640 Payroll Taxes 0030 OASDI 6.2% $50,464 0031 FICA/MEDICARE 1.45% $11,802 0032 SUI 1.95% $15,872 PAYROLL TAX TOTAL $78,138 EMPLOYEE BENEFITS: 0040 Retirement 1.5% $12,209 0041 Workers Compensation 2% $16,279 0042 Health Insurance (Medical, Vision, Life, 9.6% $78,138 Dental) 0042 Fringe Benefits 2.3% $18,721 EMPLOYEE BENEFITS TOTAL $125,347 SALARY & BENEFITS GRAND TOTAL (Benefits @ 25% of payroll, including $1,017,423 Payroll Taxes FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building - $3,431/mo. x 106% x 12 mos. = $43,642. $43,642 For cost of building lease. This space will include offices for staff and conference rooms for staff and client meetings. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 80 of 93 Budget Narrative— FY 26-27 1011 Rent/Lease Equipment - $1,181/mo. x 106% x 12 mos. = $15,022. $15,022 Leases and rentals of equipment, furniture, and fixtures. Includes taxes and other items included with the lease. Excludes maintenance contracts on leased items which are charged to building and equipment contract. Includes short- term and long - term equipment leases. Examples include water coolers, copiers, mail machines, etc. Joint costs associated with shared equipment in offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1012 Utilities - $390.83/mo. x 106% x 12 mos. = $4,971. $4,971 Includes cost of VOIP phone serves, monthly charge for cost of cell phones used by staff to maintain communication in the field, and cost of gas, electric, water and sewer for leased office space. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll cost incurred by each grant, contract or program as the base most appropriate. 1013 Building Maintenance - $33.83/mo. x 106% x 12 mos. = $430. $430 Covers the cost of janitorial services. Items needed to maintain and/or repair facilities. 1014 Equipment Purchase - $249.67/mo. x 106% x 12 mos. = $3,176. $3,176 Includes furnishing and technology equipment beyond the start-up costs. FACILITY/EQUIPMENT/TOTAL $67,242 OPERATING EXPENSES 1060 Staff Recruitment - Includes physical exam, fingerprinting fee for $11,115 background check, and advertising costs for new program staff and ongoing due to staff turnover. Recruitment of Iicensure and registered staff = $3,500 per staff for advertising and as needed sign-on bonuses. $500-1,000 for all other positions. Increased by 6% from Year 1 . 1061 Staff Training - Includes cost of evidence-based ARC training. $6,366 ARC (3 days), LSCI (5 Days), MI (1 day with follow-up consultation) training provided up to 2 times per year as needed for new staff. Increased by 6% from Year 1. 1062 Communications - Covers the monthly charge for the cost of cell $18,164 phones used by staff to maintain communication in the field at $50/line x 10.25 FTE = $512.50/mo. x 12 mos. = $6,150/year. Internet and VOIP service estimated at $915.50/mo. x 12 mos. _ $10,986/year. Then increased by 6% from Year 1. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 81 of 93 Budget Narrative— FY 26-27 1063 Office Supplies - decreases to $400/mo. x 12mos. = $4,800 $4,800 Includes all office materials relevant to operating the program including pens, paper clips, paper, notepads, filing supplies, etc. 1064 Staff Mileage Reimbursement - Reimbursement for employee $48,067 mileage @ .56 cents/mile. Covers cost of mileage reimbursement for filed based activity of Aspiranet program staff. Estimated at $3,778.83/mo. for 10.25 driving staff. (An average of 368.67+/- miles per month per employee.) with an increase of 6% from Year 1 . 1065 Clothing - $250/mo. per child x 4 children x 12, then increased by $12,720 6% from Year 1. Clothing allowance per child to purchase new needed clothing items. 1066 Program and Treatment Supplies - Includes items for the clients $17,808 to use including games, books, toys, and various recreational items. Estimated at an average of$1,400/mo. x 12mos. x 106% _ $17,304. 1067 Emergency Flex Fund - $200/mo. per child for 4 children. Flexible $10,176 pool that it utilized according to flex fund policies. Dually enrolled youth will also be able to access flex funds through Wrap. This covers children's needs only. Increase by 6% from Year 1. 1068 Respite - $48,482 *1 respite family available 24/7 (1 respite family rather than 2 seems reasonable for a 4-client short term program) *Family provides 8 days/month of respite. *$7500/mo. rate is paid only for nights with a child in the home (8 days total per family) *$2500/mo. rate is paid for nights with no child in the home, when the family is "on call" for respite placements. With an increase of 6% from Year 1. 1069 Other - Start Up — None after Year 1. 1070 Advertising Expense - $1,500/mo. x 12 mos. x 106% from Year 1 $19,080 = $18,540. Includes advertising for Resource Parents. Advertising costs include Google advertising, targeted marketing, and marketing materials. 1071 Education Conference/Meeting — Costs are allocated to the $7,079 program benefiting from the training, conferences, or seminars. Costs that benefit more than one program will be allocated to those programs based on the ratio of each program's expenses to the total of such expenses. Costs that benefit all programs will be allocated based on the ratio of each program's expenses to total expenses. $593.65/training x 11.25 staff = $6,678.56 x 103% from Year 1 = $7,079. 1072 Postage and Printing — estimated at $135/mo. x 106% from Year 1 $1 ,717 = $1,669. Includes stamps, certification fees, overnight delivery services and the cost of professional photocopying services. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 82 of 93 Budget Narrative— FY 26-27 1073 Contract Services - Psychiatric, Nursing, Consulting — $45,474 Includes any outside contracted services needed such as identified professional services below. Clinical Supervision: Group Clinical Supervision $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical Supervision for all registered staff $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical consultation for non-licensure track staff $150/hr. x .5hours/week x $3,900/year. Total Clinical Supervision = $19,500. Psychiatrist: $275/hour x 6 hours/mo. x 12 = $19,800 Nursing consultation $150/hr x 3hrs/mo. for any special healthcare related needs = $300/mo. x 12mos. = $3,600/year. All categories listed above are subject to 6% increase from Year 1. 1074 Resource Family Payment - $2,500/mo. per family for 4 families $120,000 Direct reimbursement for Resource Family and Respite family for care and supervision of client. 1075 Resource Family Payment Prorated Placement @ $5,000 per $240,000 month for 4 families. 1076 Supervised Activities - $1,200/mo. Includes those activities as $15,264 identified per the client's needs and services plan. Can include such activities as tutoring, social groups, reactional teams, and other extracurricular activities such as music or sports, etc. Avg. $300/child/x 4 children x 12mos = $14,400 x 106% from Year 1. 1077 Family Support - Includes assisting a family with items needed to $3,816 support the household. Estimated at $300/mo. or $75 per family to cover as needed expenses associated with supporting the family to support the child. Could include a 1 x cleaning service or dinner delivery during critical times. With an increase of 6% from Year 1 . 1078 Maintenance Payments - Includes maintenance and repair needs $12,720 for Resource Family homes. Covers cost of repairs needed as a result of damages resulting from behavioral episodes. Estimated at $1,000/mo. With an increase of 6% from Year 1. 1079 Parent Training - Ongoing outside training for Resource Parents $6,360 and Respite Parents. $125 per family per month x 4 families. With an increase of 6% from Year 1. 1080 Liability Insurance $8,796 Liability Insurance covers liability insurance based on the program's percentage of overall agency insurance costs. Insurance needed for a particular program is charged directly to the program requiring the coverage. Other insurance coverage that benefits all programs is allocated based on the ratio of each program's expenses to total expenses. Estimated at $691 .50/mo. x 12 mos. = $8,298/year. With an increase of 6% from Year 1. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 83 of 93 Budget Narrative— FY 26-27 1081 IT Services $34,092 Calculated based on the program's percentage of overall agency IT costs. The technology cost for Aspiranet provides complete support of all IT and telecommunications systems used by Aspiranet. Support includes, but is not limited to, the following: Network & Server monitoring and ongoing maintenance, data hosting, equipment repair and refurbishment, 24/7 user Helpdesk support, application development, application and hardware user support, application and equipment training, mobile device configuration and staff support, on-boarding and off-boarding staff, network peripherals, including multifunction devices, printers and other equipment, staff remote portal access to internet and email, and workstation configuration. Estimated to be $2,680.17/mo. x 12 mos. = $32,162/year. With an increase of 6% from Year 1. OPERATING EXPENSES TOTAL $692,096 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping - Covered in Allocable Fiscal Services 1083 External Audit - Covered in Allocable Fiscal Services 1084 Payroll Services - Covered in Allocable Fiscal Services 1085 Fiscal Services - Included in Allocable 1086 Allocable Overhead - includes Staff and Associated Exp. that benefit all programs, Including 1087 HR, IT, Accounting, Prof. Liability, QA Leadership, Executive $177,676 Leadership, Exp. Calculated at 10%. The indirect rate is calculated based on the cost trends wherein the headquarters cost allocation is 10% of costs. All headquarters activities involve executive level oversight of division staff, statewide networking and advocacy and fractional portions of rent, postage, equipment leases, phones, and office supplies required by executive staff engaged in the services benefiting the program. These costs include all payroll, accounts receivable and accounts payable, audits, banking, human resources, risk management, legal, program direction and other functions carried out by headquarters administrative staff. TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10% OF $177,676 DIRECT COST TOTAL PROGRAM EXPENSE $1,954,437 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE ExhibitC-1 Aspiranet,Inc. Page 84 of 94 FY 2027-2028 Budget Categories Total Proposed Budget Direct Admin. Direct Program Total Cost Line Item Description(Must be Itemized) FTE% Support Cost Cost PERSONNEL SALARIES: 0001 Director of Program 0.25 28,463 28,463 0002 Associate Division Director 0.25 27,508 27,508 0003 Clinical Director 0.50 60,375 60,375 0004 Program Manager 1.00 97,750 97,750 0005 Clincian/Social Worker 1.00 89,700 89,700 0006 Family Developer 0.50 39,095 39,095 0007 Dedicated Program Trainer 0.25 18,837 18,837 0008 Lead Support Counselor 1.00 71,760 71,760 0009 Support Counselor 4.00 229,632 229,632 0010 Program Assistant 0.50 28,750 28,750 0011 CIA Billing and Compliance Manager 0.50 28,750 28,750 0012 Parent Partner 0.50 23,115 23,115 0013 Family Finder 1.00 74,750 74,750 0014 Staff On-Call 10,400 10,400 Stipends/Overtime 20,640 20,640 Salary Total 11.25 57,500 792,025 849,525 Payroll Taxes 0030 OASDI 3,565 49,106 52,671 0031 FICA/MEDICARE 834 11,494 12,318 0032 SUI 1,121 15,444 16,566 PAYROLL TAX TOTAL 5,520 76,034 81,554 EMPLOYEE BENEFITS: 0040 Retirement 863 11,880 12,743 0041 Workers Compensation 1,150 15,840 16,991 0042 Health Insurance(Medical,Vision,Life,Dental) 5,520 76,034 81,554 0042 Fringe Benefits 1,323 18,217 19,539 EMPLOYEE BENEFITS TOTAL 8,855 121,972 130,827 SALARY&BENEFITS GRAND TOTAL(Benefits @ 25%of payroll,Including Payroll Taxes) 1,061,906 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 44,877 1011 Rent/Lease Equipment 15,447 1012 Utilities 5,112 1013 Building Maintenance 443 1014 Equipment Purchase 3,266 FACILITY/EQUIPMENT/TOTAL 69,145 OPERATING EXPENSES 1060 Staff Recruitment 11,430 1061 Staff Training 6,547 1062 Cellular Phones 18,678 1063 Office Supplies 4,800 1064 Staff Mileage Reimbursement 49,427 1065 Clothing 13,080 1066 Program and Treatment Supplies 18,312 1067 Emergency Flex Fund 10,464 1068 Respite 49,854 1069 Other-Start Up - 1070 Advertising Expense 19,620 1071 Education Conference/Meeting 7,280 1072 Postage and Printing 1,766 1073 Contract Services-Psychiatric,Nursing,Consulting 46,761 1074 Resource Family Payment @ 2,500 per bed per month 120,000 1075 Resource Family Payment Prorated Placement 240,000 1076 Supervised Activities 15,696 1077 Family Support 3,924 1078 Maintenance Payments 13,080 1079 Parent Training 6,540 1080 Liability Insurance 9,045 1081 IT Services 35,057 OPERATING EXPENSES TOTAL 701,360 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping-Covered in Allocable Fiscal Services 1083 External Audit-Covered in Allocable Fiscal Services 1084 Payroll Services-Covered in Allocable Fiscal Services 1085 Fiscal Services-Included in Allocable 1086 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including HR,IT,Accounting,Prof.Liability,CIA Leadership,Executive Leadership,Exp. 183,241 TOTAL FINANCIALAND ALLOCABLE OVERHEAD AT 10%OF DIRECT COST. $183,241 TOTAL PROGRAM EXPENSE $2,015,653 ESTIMATED MENTAL HEALTH BILLABLE TO MENTAL HEALTH CONTRACT 1,079,269 ESTIMATED NON MEDI-CAL BILLABLE COST $936,384 Total Cost/Day/Youth $ 1,381 MH Cost Per Day/Youth $ 717 Daily Foster Care State Approved ICM Rate Per Youth $ 535 Remaining ISFC Rate Per day/Youth $ 128 MEDI-CAL REVENUE: Exhibit C-1 Service Provider Type Hours Hourly Rate Amount Page 85 of 94 Mental Health Services(Therapy) LPHA 624 $265 28 $165,534.72 Case Management(ICC) Other Qualified Provider 832 $199.58 $166,050.56 Crisis Services LPHA 48 $26528 $12,733.44 Medication Support Pyschiatrist 48 $1,019.30 $48,926.40 Plan Development Other Qualified Provider 208 $19958 $41,512.64 Assessment Other Qualified Provider 480 $199.58 $95,798.40 Rehabilitation Other Qualified Provider 1,381 $199.58 $275,619.98 Peer Support Peer Support Specialist 313 $209 56 $65,529.41 IHBS Other Qualified Provider 1,040 $199.58 $207,563.20 4,974 $1,079,269 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL PROGRAM REVENUE $2,015,653 Total Medi-Cal Revenue $1,079,269 Total Medi-Cat Units 4,974 Averaged Mad!-Cal cost per unit $217 Non Medical Billable Service Cost $936,384 Total Non Medi-Cal Billable Units 48 Non Medl-Cal cost per unit $19,508 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 86 of 94 Budget Narrative— FY 27-28 Year 4 — FY 2027-2028 (July 1, 2027 — June 30, 2028) Serving 4 Clients PROGRAM EXPENSE Total: $2,015,653 Medi-Cal Portion: $1,079,269 CWS Portion: $938,384 Expenses Personnel expenses include a 5% increase over prior year Operational Expenses have increased by 3% over the prior year. Staff Expenses Director of Program $28,463 Under the supervision of the Division Director, the Director of Program maintains operational, fiscal, and programmatic oversight of one or more identified core programs. The Director of Program works with staff, community agencies, and other entities to provide quality services. Position is shared position with other RFA Programs. This is a salaried 0001 position. 0.25 FTE x $113,850/year rate = $28,463. Associate Division Director $27,508 Assists Division Director in supporting local Program Directors/ Supervisors with hiring, training, performance managing staff, program oversight, QA, compliance, productivity oversight, and TJC accreditation standards. This is a salaried position. 0.25 FTE x $110,032/year rate = 0002 $27,508. Clinical Director $60,375 The Clinical Director provides clinical oversight and supervision to all staff and program components after hours/weekends or in the absence of the Program Manager. The Clinical Director reports to the Program Director and can also assist in the field with the mobile response team. California Licensed Marriage Family Therapist or Licensed Clinical Social Worker. Meets the BBS qualifications to provide clinical supervision. Ability to develop and provide training; Ability to supervise evidence-based practices utilized by the agency (must be trained in the EB practices). Two years of experience providing clinical supervision to staff in family or child mental health or related fields. This is a salaried 0003 position. 0.50 FTE x $120,750/year rate = $60,375. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 87 of 93 Budget Narrative— FY 27-28 Program Manager $97,750 The Core Program Manager (CPM 1) is responsible for hiring, training, supervising, and evaluating staff, inclusive of performance management. The CPM I has oversight of the program(s) budget and reports and interfaces with funder partners. The CPM I is responsible for program(s) oversight, including quality assurance and program compliance, including required documentation to federal, state, and funder, and Agency standards. The CPM I is also responsible for budgetary and strategic planning related to the program(s) they oversee. CPM I is responsible for upholding and supervising the Agency's operational, financial, personnel and practice rules, policies, and procedures. This is 0004 a salaried position. 1.00 FTE x $97,750/year rate = $97,750. Clinician/Social Worker $89,700 Provides individual and/or family therapy; provides assessment, development, implementation, and evaluation of mental health Treatment Plans; promotes and ensures collaboration and ongoing communication with program team members. They are also the main point of contact for family and referring agency; schedules/facilitates CFTs; provides assessment, development, implementation, and evaluation of Service Plans; ensures collaboration and ongoing communication between program team members. This is a salaried 0005 position. 1.0 FTE x $89,700/year rate = $89,700. Family Developer $39,095 The Family Developer is responsible for recruiting, assessing, training, and approving specialized resource families, which provide Intensive Foster Care Services (ISFC). In addition, the Family Developer identifies community groups, delivers presentations with the goal of identifying potential resource families, and supports resource family applicants through the approval and training processes. This is a salaried position. 0006 0.50 FTE x $78,191/year rate = $39,095. Dedicated Program Trainer $18,837 The Trainer conducts precertifi cation parent training and initial screening for potential foster families and consults with the Core Program Director and/or Supervisor regarding a family's preparedness to move forward in the assessment and screening process. This is an hourly position. 0.25 0007 FTE x $75,348/year rate = $18,837. Lead Support Counselor $71 ,760 Under the supervision of the CPD/CPM/CPS and/or ACDD, the Lead Support Counselor is responsible for training and supporting all Support Counselors at both the local program and division level within the ISFC program. At the local program level, the Lead Support Counselor will regularly meet with the Support Counselors for supervision and to monitor their implementation of identified components of the approved 0008 support plan. The Lead Support Counselor may also maintain a small EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 88 of 93 Budget Narrative— FY 27-28 caseload of ISFC children/youth. At the Division level, the Lead Support Counselor serves as Division lead for initial and on-going training of support counselors. The Lead Support Counselor will also facilitate regularly scheduled Support Counselor group calls. Additional responsibilities include completion of written documentation of weekly activities per agency standards. This is an hourly position. 1.00 FTE x $71,760/ ear rate = $71,760. Support Counselor $229,632 Meets directly one-on-one with the child/youth at home, school, or community, including behavior modification, communication skills, social skills, CRM, anger management skills, and role play/role modeling; Identifies/ accesses community resources. This is an hourly position. 0009 4.00 FTE x $57,408/ ear rate = $229,632. Program Administrative Assistant $28,750 Provides administrative support to Program Director, management team, and employees. Assist with daily program operations, completing employee safety and environment of care, data entry, filing, database management, and providing customer service to clients, community partners, and the public. This is an hourly position. 0.50 FTE x 0010 $57,500/year rate = $28,750. QA Billing and Compliance Manager $28,750 Assures that the program complies with all County contractual requirements, including submission of required data, budget reviews, and federal and state laws. Implements county and agency QA policy and procedures for the Wraparound program. Ensures utilization reviews and audits are completed, and data collected is shared and used to increase the efficacy of staff and program compliance. Provides ongoing support to staff with compliance expectations associated with documentation and billing. This is an hourly position. 0.50 FTE x 0011 $57,500/year rate = $28,750. Parent Partner $23,115 Bridge to services and supports while sharing their own lived experience advocating for their own child who was involved with either child welfare, probation, mental health, regional center, or IEP services; help parents/caregivers navigate systems; provide support, validation, and encouragement; accompany to community group meetings; coordinate respite and other stress-reducing measures; organize Parent Cafes. This 0012 is an hourly position. 0.50 FTE x $46,230/year rate = $23,115. Family Finder $74,750 The Family Finding and Engagement Social Worker is responsible for supporting the Child Welfare Agency's identified permanency plan by searching for family members, fictive kin or natural supports of identified youth. The Family Finder works closely with a youth's County 0013 representative and Child and Family Team to identify connections the EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 89 of 93 Budget Narrative— FY 27-28 youth has lost contact with due to placement in foster care. They are responsible for conducting thorough case record reviews and family finding searches to identify family members and other meaningful people who can provide positive support and a permanent lifelong connection to the youth being served. They then work closely with the Child Welfare Agency and other providers to prepare the youth for initial and ongoing contact and communicate and document all progress. This is a salaried position. 1.00 FTE x $74,750/year rate = $74,750. Staff On-Call This is a stipend for employees who field after-hour crisis calls, working 0014 on a rotating basis. $200/week x 52 weeks = $10,400 $10,400 Stipends/Overtime Due to the 24/7 nature of the work, overtime and extra duty stipends will occur at times to cover unfilled shifts. This line item accounts for as needed 50-100 shift stipends as needed to fill hard to fill shifts typically overnight, weekends and holidays along with overtime. $20,640 Payroll Taxes 0030 OASDI 6.2% $52,671 0031 FICA/MEDICARE 1.45% $12,318 0032 SUI 1.95% $16,566 PAYROLL TAX TOTAL $81,554 EMPLOYEE BENEFITS: 0040 Retirement 1.5% $12,743 0041 Workers Compensation 2% $16,991 0042 Health Insurance (Medical, Vision, Life, 9.6% $81 ,554 Dental) 0042 Fringe Benefits 2.3% $19,539 EMPLOYEE BENEFITS TOTAL $130,827 SALARY & BENEFITS GRAND TOTAL (Benefits @ 25% of payroll, including $1,061,906 Payroll Taxes FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building - $3,431/mo. x 109% x 12 mos. = $44,877. $44,877 For cost of building lease. This space will include offices for staff and conference rooms for staff and client meetings. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 90 of 93 Budget Narrative— FY 27-28 1011 Rent/Lease Equipment - $1,181/mo. x 109% x 12 mos. = $15,447. $15,447 Leases and rentals of equipment, furniture, and fixtures. Includes taxes and other items included with the lease. Excludes maintenance contracts on leased items which are charged to building and equipment contract. Includes short- term and long - term equipment leases. Examples include water coolers, copiers, mail machines, etc. Joint costs associated with shared equipment in offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll costs incurred by each grant, contract, or program as the base most appropriate. This methodology allows for automatic adjustment of costs charged based on the program or grant mix for each accounting period. 1012 Utilities - $390.83/mo. x 109% x 12 mos. = $5,112. $5,112 Includes cost of VOIP phone serves, monthly charge for cost of cell phones used by staff to maintain communication in the field, and cost of gas, electric, water and sewer for leased office space. Joint costs associated with operation and maintenance of offices are divided and charged individually as direct costs to each category, program, or grant using the direct payroll cost incurred by each grant, contract or program as the base most appropriate. 1013 Building Maintenance - $33.83/mo. x 109% x 12 mos. = $443 $443 Covers the cost of janitorial services. Items needed to maintain and/or repair facilities. 1014 Equipment Purchase - $249.67/mo. x 109% x 12 mos. = $3,266. $3,266 Includes furnishing and technology equipment beyond the start-up costs. FACILITY/EQUIPMENT/TOTAL $69,145 OPERATING EXPENSES 1060 Staff Recruitment - Includes physical exam, fingerprinting fee for $11,430 background check, and advertising costs for new program staff and ongoing due to staff turnover. Recruitment of licensure and registered staff = $3,500 per staff for advertising and as needed sign-on bonuses. $500-1,000 for all other positions. Increased by 9% from Year 1 . 1061 Staff Training - Includes cost of evidence-based ARC training. $6,547 ARC (3 days), LSCI (5 Days), MI (1 day with follow-up consultation) training provided up to 2 times per year as needed for new staff. Increased by 9% from Year 1. 1062 Communications - Covers the monthly charge for the cost of cell $18,678 phones used by staff to maintain communication in the field at $50/line x 10.25 FTE = $512.50/mo. x 12 mos. = $6,150/year. Internet and VOIP service estimated at $915.50/mo. x 12 mos. _ $10,986/year. Then increased by 9% from Year 1. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 91 of 93 Budget Narrative— FY 27-28 1063 Office Supplies - decreases to $400/mo. x 12mos. = $4,800 $4,800 Includes all office materials relevant to operating the program including pens, paper clips, paper, notepads, filing supplies, etc. 1064 Staff Mileage Reimbursement - Reimbursement for employee $49,427 mileage @ .56 cents/mile. Covers cost of mileage reimbursement for filed based activity of Aspiranet program staff. Estimated at $3,778.83/mo. for 10.25 driving staff. (An average of 368.67+/- miles per month per employee.) with an increase of 9% from Year 1 . 1065 Clothing - $250/mo. per child x 4 children x 12, then increased by $13,080 9% from Year 1. Clothing allowance per child to purchase new needed clothing items. 1066 Program and Treatment Supplies - Includes items for the clients $18,312 to use including games, books, toys, and various recreational items. Estimated at an average of$1,400/mo. x 12mos. x 109% _ $17,304. 1067 Emergency Flex Fund - $200/mo. per child for 4 children. Flexible $10,464 pool that it utilized according to flex fund policies. Dually enrolled youth will also be able to access flex funds through Wrap. This covers children's needs only. Increase by 9% from Year 1. 1068 Respite - $49,854 *1 respite family available 24/7 (1 respite family rather than 2 seems reasonable for a 4-client short term program) *Family provides 8 days/month of respite. *$7500/mo. rate is paid only for nights with a child in the home (8 days total per family) *$2500/mo. rate is paid for nights with no child in the home, when the family is "on call" for respite placements. With an increase of 9% from Year 1. 1069 Other - Start Up — None after Year 1. 1070 Advertising Expense - $1,500/mo. x 12 mos. x 109% from Year 1 $19,620 = $18,540. Includes advertising for Resource Parents. Advertising costs include Google advertising, targeted marketing, and marketing materials. 1071 Education Conference/Meeting — Costs are allocated to the $7,280 program benefiting from the training, conferences, or seminars. Costs that benefit more than one program will be allocated to those programs based on the ratio of each program's expenses to the total of such expenses. Costs that benefit all programs will be allocated based on the ratio of each program's expenses to total expenses. $593.65/training x 11.25 staff = $6,678.56 x 109% from Year 1 = $7,280. 1072 Postage and Printing — estimated at $135/mo. x 109% from Year 1 $1 ,766 = $1,669. Includes stamps, certification fees, overnight delivery services, and the cost of professional photocopying services. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 92 of 93 Budget Narrative— FY 27-28 1073 Contract Services - Psychiatric, Nursing, Consulting — $46,761 Includes any outside contracted services needed such as identified professional services below. Clinical Supervision: Group Clinical Supervision $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical Supervision for all registered staff $150/hr. x 1 hour/week x 52 = $7,800/year. Clinical consultation for non-licensure track staff $150/hr. x .5hours/week x $3,900/year. Total Clinical Supervision = $19,500. Psychiatrist: $275/hour x 6 hours/mo. x 12 = $19,800 Nursing consultation $150/hr x 3hrs/mo. for any special healthcare related needs = $300/mo. x 12mos. = $3,600/year. All categories listed above are subject to 9% increase from Year 1. 1074 Resource Family Payment - $2,500/mo. per family for 4 families $120,000 Direct reimbursement for Resource Family and Respite family for care and supervision of client. 1075 Resource Family Payment Prorated Placement @ $5,000 per $240,000 month for 4 families. 1076 Supervised Activities - $1,200/mo. Includes those activities as $15,696 identified per the client's needs and services plan. Can include such activities as tutoring, social groups, reactional teams, and other extracurricular activities such as music or sports, etc. Avg. $300/child/x 4 children x 12mos = $14,400 x 109% from Year 1. 1077 Family Support - Includes assisting a family with items needed to $3,924 support the household. Estimated at $300/mo. or $75 per family to cover as needed expenses associated with supporting the family to support the child. Could include a 1 x cleaning service or dinner delivery during critical times. With an increase of 9% from Year 1 . 1078 Maintenance Payments - Includes maintenance and repair needs $13,080 for Resource Family homes. Covers cost of repairs needed as a result of damages resulting from behavioral episodes. Estimated at $1,000/mo. With an increase of 9% from Year 1. 1079 Parent Training - Ongoing outside training for Resource Parents $6,540 and Respite Parents. $125 per family per month x 4 families. With an increase of 9% from Year 1. 1080 Liability Insurance $9,045 Liability Insurance covers liability insurance based on the program's percentage of overall agency insurance costs. Insurance needed for a particular program is charged directly to the program requiring the coverage. Other insurance coverage that benefits all programs is allocated based on the ratio of each program's expenses to total expenses. Estimated at $691 .50/mo. x 12 mos. = $8,298/year. With an increase of 9% from Year 1. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-1 Aspiranet, Inc. Page 93 of 93 Budget Narrative— FY 27-28 1081 IT Services $35,057 Calculated based on the program's percentage of overall agency IT costs. The technology cost for Aspiranet provides complete support of all IT and telecommunications systems used by Aspiranet. Support includes, but is not limited to, the following: Network & Server monitoring and ongoing maintenance, data hosting, equipment repair and refurbishment, 24/7 user Helpdesk support, application development, application and hardware user support, application and equipment training, mobile device configuration and staff support, on-boarding and off-boarding staff, network peripherals, including multifunction devices, printers and other equipment, staff remote portal access to internet and email, and workstation configuration. Estimated to be $2,680.17/mo. x 12 mos. = $32,162/year. With an increase of 9% from Year 1. OPERATING EXPENSES TOTAL $701,360 FINANCIAL SERVICES EXPENSES: 1082 Accounting/Bookkeeping - Covered in Allocable Fiscal Services 1083 External Audit - Covered in Allocable Fiscal Services 1084 Payroll Services - Covered in Allocable Fiscal Services 1085 Fiscal Services - Included in Allocable 1086 Allocable Overhead - includes Staff and Associated Exp. that benefit all programs, Including 1087 HR, IT, Accounting, Prof. Liability, QA Leadership, Executive $183,241 Leadership, Exp. Calculated at 10%. The indirect rate is calculated based on the cost trends wherein the headquarters cost allocation is 10% of costs. All headquarters activities involve executive level oversight of division staff, statewide networking and advocacy and fractional portions of rent, postage, equipment leases, phones, and office supplies required by executive staff engaged in the services benefiting the program. These costs include all payroll, accounts receivable and accounts payable, audits, banking, human resources, risk management, legal, program direction and other functions carried out by headquarters administrative staff. TOTAL FINANCIAL AND ALLOCABLE OVERHEAD AT 10% OF $183,241 DIRECT COST TOTAL PROGRAM EXPENSE $2,015,653 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 1 of 46 Startup Budget FY 2024-2025(Upon Execution - November 30,2024) Budget Categories- Program Start Up Allocation Line Item Description(Must be itemized) FTE% Total Salary Total Start Up Combined E-ISFC PERSONNEL SALARIES: 0002 Administrator 0.45 42,500 3,542 1,771 0003 Program Director 1.00 180,000 15,000 7,500 0004 Clinical Director 1.00 157,500 9,844 4,922 0005 Program Supervisor 2.00 190,000 11,875 5,938 0006 Clinician 2.00 225,000 18,750 9,375 0007 Social Worker 1.50 112,500 9,375 4,688 0008 Counselors 12.00 540,000 55,000 27,500 0009 Lead Counselor 3.00 350,000 29,167 14,584 0011 Program Assistant 1.00 240,000 8,125 4,063 0012 Recruitment Specialist 1.00 97,500 5,000 2,500 0013 Permanency Specialist 2.00 60,000 5,208 2,604 0015 Health Information Specialist 1.00 125,000 4,063 2,032 SALARY TOTAL 27.95 174,949 $ 87,475 PAYROLL TAX TOTAL - 0030 OASDI 0031 Fica/Medicare 13,384 6,692 0032 Payroll Tax Total 5,248 2,624 Total Payroll Taxes 18,632 9,316 EMPLOYEE BENEFITS: - 0040 Retirement 8,747 4,374 0041 Workers Compensation 12,246 6,123 0042 Health Insurance(Medical,Vission,Life,Dental) 14,871 7,435 0042 Fringe Benefits - - Employee Benefits Total 35,865 17,932 Salary&Benefits Grand Total(Benefits @25%) 229,446 $ 114,723 FACILITIES/EQUIPMENT EXPENSES: - 1010 Rent/Lease Building 2,200 1,100 1012 Utilites 370 185 1014 Equipment purchase/Lease 1,750 875 FACILITY/EQUIPMENT TOTAL 4,320 $ 2,160 OPERATING EXPENSES: 1060 Staff Recruitment/On Boarding 5,000 2,500 1061 Staff Training 10,000 5,000 1062 Cellular Phones - - 1063 Office 4,000 2,000 1067 Resource Family Recruiting 22,500 11,250 1070 Advertising - - 1072 Furniture&Fixtures 4,500 2,250 OPERATING EXPENSES TOTAL 46,000 $ 23,000 1096 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including - HR,IT,Accounting,Prof.Liability,0A Leadership,Executive Leadership 27,977 13,988 27,977 $ 13,988 307,742 $ 153,871 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 2 of 26 Startup Budget Narrative— FY 24-25 (Upon Execution — November 30, 2024) The Promesa start up budget for Enhanced Intensive Services Foster Care (E-ISFC) is designed to successfully implement and support the goals of the E-ISFC program. This start up budget is for onboarding and training the teams below, as well as recruiting and training Specialized Resource Parents so youth can be accepted into the program immediately following the ramp-up period. Payroll Expense The budget reflects the full annual salary of each staff, the title of each position, the FTE that will be provided and charged to the contract, identifies the Direct Administrative and Direct Program Costs, and the full annual amount paid for each position. The following section of this narrative will discuss the direct administrative and treatment team presented in this budget section. Administrative Team: This team will include the Program Administrator, Program Assistant. This team will work together to ensure that the administrative systems are in place to support the program team. This will include, but may not be limited to, ensuring that communications from the executive leadership team are shared in a timely manner and accurately delivered, that timesheets and requests for staff reimbursements are properly reviewed and submitted in a timely manner, that account payable invoices have been reviewed and submitted, that email questions referred to this team are resolved, and generally will ensure that reasonable support systems are in place. Treatment Team: This team includes the Program Director, Clinical Director, Program Supervisor, Clinician, Social Worker, BA Level Counselors, which includes Counselors dedicated to awake overnight in the event a youth is in need of supervision, Lead Counselor, Recruitment Specialist, Permanency Specialist, and a Health Information Specialist responsible for the review and accurate billing of all Medi-Cal Services. Leadership Treatment Team: This includes the Program Director, Clinical Director, and the Program Supervisor. This team will work together to ensure that the Treatment Team is meeting its goals and operating as effectively and efficiently as possible. The Program Assistant and the Health Information Specialist will work with this team as required and provide support as needed. The Program Director bears responsibility for the entire E-ISFC program and works closely with the Leadership Team to ensure that this unit operates as a cohesive unit. The Director will meet with this team at least weekly and as needed, delegate when necessary, ensure that all CCL Licensing and Mental Health regulations are followed, liaison with HR staff as needed, conduct trainings with staff when necessary, meet and participate in any functions with county staff as requested, and generally ensure that the program is well staffed, grounded and serving the youth and families to the best of their ability. The Director will supervise the members of the Leadership team, including the Program Assistant and the Health Information Specialist. The Clinical Director is responsible for the Clinician and as well as the direction and implementation of the clinical program. The Clinical Director will ensure that the Medi-Cal ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 3 of 26 Startup Budget Narrative— FY 24-25 (Upon Execution — November 30, 2024) program is in compliance with the standards, that clinical staff understand the Medi-Cal service continuum and that the required documentation is completed accurately and on time. This includes daily notes as well as initial treatment plans and assessments as required. The Clinician will implement the treatment plan, and report to the Clinical Director. Social Work type services may also be provided by the clinician, but mental health services will be documented and invoiced on a daily basis. The Permanency Specialist will work with the clinician, youth and prospective resource parents so that the youth will be able to transition as smoothly as possible. The Permanency Specialist will report to the Clinical Director. The Program Supervisor is responsible for the day-to-day operations. It is anticipated that the majority of their time will be working in the houses, meeting and/or working with the counselors, parents and youth in the program. These Supervisors will be either master level, or very senior counselors with the skills required to program solve and work effectively with the counselors and house parents and youth. The Clinician and Social Worker will work with treatment team, youth, foster resource parent and prospective resource parents to ensure that the needs of each are processed and resolved. Benefits include both mandated and discretionary benefits, as broken out in the budget. The overall benefit ration is 25% of payroll expense. This includes FICA, SUI, Retirement contribution, Workers Compensation and Health, Vision, Life and Dental Insurance. Total Payroll and Benefits is: $114,723 Facilities/Equipment Expense includes an office lease, minor equipment expense, utilities and Building Maintenance. The total cost is $2,160. Office lease is allocated for Startup at $1,100, Leased equipment is $875, and Utilities is budgeted at $185. These costs are allocated to this contract based upon square footage of total space and numbers of staff in each program. Operating Expenses reflect those costs that are normal and customary. All other costs in this category are based upon historical costs and estimates. The total cost is $23,000. Overhead includes the indirect cost calculated at 10% of total cost. These expenses total $13,988 for startup. Total Program Expense Summary Total Program Expense: $153,871 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 4 of 46 FY 2024-2025(December 1, 2024-June 30,2025) Budget Categories- Total Direct Budget Line Item Description(Must be itemized) FTE% Admin.-Direct Direct Total Direct PERSONNEL SALARIES: 0002 Administrator 0.25 15,938 15,938 0003 Program Director 0.50 45,000 45,000 0004 Clinical Director 0.50 39,375 39,375 0005 Program Supervisor 1.00 71,250 71,250 0006 Clinician 1.00 67,500 67,500 0007 Social Worker 1.00 56,250 56,250 0008 Counselors 8.00 360,000 360,000 0009 Lead Counselor 2.00 105,000 105,000 0011 Program Assistant 0.50 24,375 24,375 0012 Recruitment Specialist 0.50 22,500 22,500 0013 Permanency Specialist 1.00 48,750 48,750 0015 Health Information Specialist 0.50 24,375 24,375 Overnight/Overtime Stipends 15,000 15,000 SALARY TOTAL 16.75 $15,938 $879,375 $895,313 PAYROLL TAXES: 0030 OASDI 0031 FICA/MEDICARE 1,219.2 67,272.2 68,491 0032 SUI 478.1 26,381.3 26,859 PAYROLL TAX TOTAL $1,697 $93,653 $95,351 EMPLOYEE BENEFITS: 0040 Retirement 797 43,969 44,766 0041 Workers Compensation 223 61,556 61,779 Health Insurance(medical,vision,life, 0042 dental) 1,355 1 74,747 1 76,102 EMPLOYEE BENEFITS TOTAL 31.05% $2,375 $180,272 $182,647 SALARY&BENEFITS GRAND TOTAL $20,010 $1,153,300 $1,173,310 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 45,000 45,000 1011 Rent/Lease Equipment - 1012 Utilities 3,996 3,996 1013 Building Maintenance 5,850 5,850 1014 Equipment purchase FACILITY/EQUIPMENT TOTAL 1 $54,846 1 $54,846 OPERATING EXPENSES: 1060 Telephone 7,500 7,500 1061 Accreditation 3,006 3,006 1062 Conference,Meetings,In-Service Training 18,563 18,563 1063 Dues,Membership,and Subscriptions 3,225 3,225 1064 Recruitment 7,500 7,500 1065 Licenses and Permits 3,750 3,750 1066 Office Supplies&printing 4,500 4,500 1067 Resource Family Payment Bed Fee@$2,500/month 180,000 180,000 1068 Resource Family Payment 360,000 360,000 1069 External Audit 3,750 3,750 1070 Professional Liability Insurance - 1071 Transportation of Clients 48,750 48,750 1072 Computers&Software - 1073 Furniture&Fixtures 11,250 11,250 1074 Respite 68,607 68,607 OPERATING EXPENSES TOTAL $ 9,981.00 $ 710,419.06 $ 720,400 Exhibit C-2 Page 5 of 46 CHILDREN RELATED EXPENSES: 1080 Food $7,200 7,200 1081 Clothing $2,700 2,700 1082 Personal Incidentals $2,700 2,700 1083 School Supplies $1,800 1,800 1084 Outside Activities $3,600 3,600 1085 Child related transportation - 1086 Internet Services - 1087 Supplies - 1088 Emergency Flex Funds $14,400 14,400 1089 Treatment Supplies $3,750 3,750 1090 Medication Non-Medical $3,750 3,750 1091 Family Support $4,500 4,500 CHILD AND FAMILY RELATED SERVICES $44,400 SPECIAL EXPENSES(Consultant/Etc.): 1092 Nurse Consultant 21,600 21,600 1093 Psychiatrist Consultant 43,200 43,200 1094 Peer Mentor(Certified) 13,500 13,500 1096 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including HR,IT,Accounting,Prof.Liability,QA Leadership,Executive Leadership 207,126 207,126 SPECIAL EXPENSES TOTAL $285,4261 $285,426 FIXED ASSETS: 1196 Computers&Software 1197 Furniture&Fixtures 1198 Other-(Identify) 1199 Other-(Identify) FIXED ASSETS TOTAL $0 $0 TOTAL PROGRAM EXPENSES1 $2,278,381 MEDI-CAL REVENUE: Service Provider Hours Rate $Amount Mental Health Services(Therapy) LPHA 702 $265.28 $186,226.56 Case Management(ICC) Other Qualified Provider 407 $265.28 $107,968.96 Case Management(ICC) Other Qualified Provider 217 $199.58 $43,308.86 Crisis Services LPHA 72 $265.28 $19,100.16 Medication Support Pyschiatrist 72 $1,019.30 $73,389.60 Plan Development Other Qualified Provider 359 $199.58 $71,609.30 Assessment Other Qualified Provider 235 $199.58 $46,963.67 Rehabilitation Other Qualified Provider 1,270 $199.58 $253,528.97 Peer Support Peer Support Specialist 390 $209.56 $81,728.40 IHBS Other Qualified Provider 1 936 1 $199.58 1 $186,806.88 DIRECT MH SERVICE REVENUE 4,660 $1,070,631 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL MENTAL HEALTH PROGRAM COSTS $1,070,631 ESTIMATED NON MEDI-CAL BILLABLE COST 1,207,750 TOTAL ISFC PROGRAM COSTS $2,278,381 TOTAL DAILY FOSTER CARE STATE APPROVED IMC RATE Per Youth $535 ADDITIONAL DAILY ISFC COST $19 TOTAL MH DAILY RATE $367 Combined Daily Rate $1,039 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 6 of 46 Budget Narrative— FY 24-25 (December 1, 2024—June 30, 2025) The Promesa budget for Enhanced Intensive Services Foster Care (E-ISFC) is designed to successfully implement and support the goals of the E-ISFC program. The program will accept youth in need of stabilization, followed by placement in a more permanent home setting. The expected length of stay is not to exceed one year, unless there is an agreement between Fresno County and Promesa that an extension is in the best interests of the child and identified family. The treatment team will work with both a prospective family and the child, to ensure a smooth and lasting transition to the next placement setting. Payroll Expense The attached budget reflects the full annual salary of each staff, the title of each position, the FTE that will be provided and charged to the contract, identifies the Direct Administrative and Direct Program Costs, and the full annual amount paid for each position. This information is also available, and clearly presented, in the attached budget. The following section of this narrative will discuss the direct administrative and treatment team presented in this budget section. There are a total of 16.75 FTE. Administrative Team: This team will include the Program Administrator (0.25 FTE), Program Assistant (0.5 FTE). This team will work together to ensure that the administrative systems are in place to support the program team. This will include, but may not be limited to, ensuring that communications from the executive leadership team are shared in a timely manner and accurately delivered, that timesheets and requests for staff reimbursements are properly reviewed and submitted in a timely manner, that account payable invoices have been reviewed and submitted, that email questions referred to this team are resolved, and generally will ensure that reasonable support systems are in place. Treatment Team: This team includes the Program Director (0.5 FTE), Clinical Director (0.5 FTE), Program Supervisor (1.0 FTE), Clinician (1.0 FTE), Social Worker (1.0 FTE), BA Level Counselors (8.0 FTE, which includes 4.0 FTE overnight counselors), Lead counselors (2.0 FTE), Recruitment Specialist (0.5 FTE) Permanency Specialist (1.0 FTE), and a Health Information Specialist (0.5 FTE) responsible for the review and accurate billing of all Medi-Cal Services. Note that several positions will work together with the E-E ISFC program to ensure maximum efficiency. Leadership Treatment Team: This includes the Program Director, Clinical Director, and the Program Supervisor. This team will work together to ensure that the Treatment Team is meeting its goals and operating as effectively and efficiently as possible. The Program Assistant (0.5 FTE) and the Health Information Specialist will work with this team as required and provide support as needed. The Program Director bears responsibility for the entire E-ISFC program and works closely with the Leadership Team to ensure that this unit operates as a cohesive unit. The Director will meet with this team at least weekly and as needed, delegate when necessary, ensure that all CCL Licensing and Mental Health regulations are followed, liaison with HR staff as needed, conduct ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 7 of 46 Budget Narrative— FY 24-25 (December 1, 2024—June 30, 2025) trainings with staff when necessary, meet and participate in any functions with county staff as requested, and generally ensure that the program is well staffed, grounded and serving the youth and families to the best of their ability. The Director will supervise the members of the Leadership team, including the Program Assistant and the Health Information Specialist. The Clinical Director is responsible for the Clinicians as well as the direction and implementation of the clinical program. The Clinical Director will ensure that the Medi-Cal program is in compliance with the standards, that clinical staff understand the Medi-Cal service continuum and that the required documentation is completed accurately and on time. This includes daily notes as well as initial treatment plans and assessments as required. The Clinicians will implement the treatment plan, and report to the Clinical Director. Social Worker(1 FTE) will provide family and youth counseling, as needed to ensure transitional services are adequate and in place. Mental health services will be documented and invoiced by the clinicians. The Permanency Specialist will work with the clinicians, youth and prospective resource parents so that the youth will be able to transition as smoothly as possible. The Permanency Specialist will report to the Clinical Director. The Program Supervisor(1 FTE) is responsible for the day-to-day operations. It is anticipated that the majority of the time will be working in the houses, meeting and/or working with the counselors, parents and youth in the program. These Supervisors will be either master level, or very senior counselors with the skills required to problem solve and work effectively with the counselors, house parents and youth. Benefits include both mandated and discretionary benefits, as broken out in the budget. The overall benefit ratio is 31 .05% of payroll expense. This includes FICA, SUI, Retirement contribution, Workers Compensation and Health, Vision, Life and Dental Insurance. Total Payroll and Benefits is: $1,173,310 Facilities/Equipment Expense includes an office lease, utilities and Building Maintenance. The total cost is $54,846. Office lease is allocated to this contract for FY 24-25 at $45,000, Utilities is budgeted at $3,996 and Building Maintenance at $5,850. These are annual costs, allocated to this contract based upon square footage of total space and numbers of staff in each program. Operating Expenses reflect those costs that are normal and customary, with the exception of the Resource Family Payment. This payment is based upon the county payment of$2500 per month guaranteed each month to the parent. The remaining fee of$5000 per month will be passed through to the parent, depending upon the daily bed occupancy for each home. These payment amounts are based on rates that require State approval on an annual basis and therefore may be subject to change. All other costs in this category are based upon historical costs and estimates. The total cost is $720,400. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 8 of 46 Budget Narrative— FY 24-25 (December 1, 2024—June 30, 2025) Child Related Expenses There is a total of$44,400 now listed in this category. These costs are intended to cover costs that may be an extra ordinary expense, when a new child enters the program, or a child has a specific situation causing the need to supplement the parent fee. $4,500 of this fund is now dedicated to the Family Support Line, in the event that the child's family has an emergency so that we can assist. Special Expenses are primarily those costs associated with the Contract Psychiatrist and Nurse Consultant. These contractors will provide direct services to youth and consultation to the treatment team, as needed. Included in this section is a Peer Mentor to work with the youth, as needed. Also included in this section is the indirect cost calculated at 10% of total cost. These expenses total $285,426 for the year. Total Program Expense Summary Total Program Expense: $2,278,381 Mental Health Expense: $1,070,631 CWS Expense: $1,207,750 Combined Daily Rate: $1,039 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 9 of 46 FY 2025-2026(July 1,2025-June 30,2026) Budget Categories- Total Direct Budget Line Item Description(Must be itemized) FTE% Admin.-Direct Direct Total Direct PERSONNEL SALARIES: 0002 Administrator 0.25 22,313 22,313 0003 Program Director 0.50 63,000 63,000 0004 Clinical Director 0.50 55,125 55,125 0005 Program Supervisor 1.00 99,750 99,750 0006 Clinician 1.00 94,500 94,500 0007 Social Worker 1.00 78,750 78,750 0008 Counselors 8.00 504,000 504,000 0009 Lead Counselor 2.00 147,000 147,000 0011 Program Assistant 0.50 34,125 34,125 0012 Recruitment Specialist 0.50 31,500 31,500 0013 Permanency Specialist 1.00 68,250 68,250 0015 Health Information Specialist 0.50 32,500 32,500 Overnight/Overtime Stipends 20,000 20,000 SALARY TOTAL 16.75 $22,313 $1,228,500 $1,250,813 PAYROLL TAXES: 0030 OASDI 0031 FICA/MEDICARE 1,706.9 93,980.3 95,687.2 0032 SUI 669.4 36,855.0 37,524.4 PAYROLL TAX TOTAL $2,376 $130,835 $133,212 EMPLOYEE BENEFITS. 0040 Retirement 1,116 61,425 62,541 0041 Workers Compensation 312 85,995 86,307 Health Insurance(medical,vision,life, 0042 dental) 1,897 104,423 106,319 EMPLOYEE BENEFITS TOTAL 31.05%1 $3,3251 $251,8431 $255,167 SALARY&BENEFITS GRAND TOTAL $28,013 $1,611,178 $1,639,191 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 63,000 63,000 1011 Rent/Lease Equipment - 1012 Utilities 5,872 5,872 1013 Building Maintenance 8,190 8,190 1014 Equipment purchase FACILITY/EQUIPMENT TOTAL $77,062 $77,062 OPERATING EXPENSES: 1060 Telephone 10,500 10,500 1061 Accreditation 4,208 4,208 1062 Conference,Meetings, In-Service Training 25,988 25,988 1063 Dues,Membership,and Subscriptions 4,500 4,500 1064 Recruitment 10,500 10,500 1065 Licenses and Permits 5,250 5,250 1066 Office Supplies&printing 6,300 6,300 1067 Resource Family Payment Bed Fee@$2,500/month 240,000 240,000 1068 Resource Family Payment 480,000 480,000 1069 External Audit 5,250 5,250 1070 Professional Liability Insurance - 1071 Transportation of Clients 68,250 68,250 1072 Computers&Software - 1073 Furniture&Fixtures 15,750 15,750 1074 Respite 96,049 96,049 OPERATING EXPENSES TOTAL 13,958 958,587 $ 972,545 Exhibit C-2 Page 10 of 46 CHILDREN RELATED EXPENSES: 1080 Food $10,080 17080 1081 Clothing $3,780 3,780 1082 Personal Incidentals $3,780 3,780 1083 School Supplies $2,520 2,520 1084 Outside Activities $5,040 5,040 1085 Child related transportation - 1086 Internet Services 1087 Supplies - 1088 Emergency Flex Funds $20,160 20,160 1089 Treatment Supplies $5,250 5,250 1090 Medication Non-Medical $5,250 5,250 1091 Family Support 1 1 $6,300 6,300 CHILD AND FAMILY RELATED SERVICES $62,160 SPECIAL EXPENSES(Consultant/Etc.): 1092 Nurse Consultant 30,336 30,336 1093 Psychiatrist Consultant 60,480 60,480 1094 Peer Mentor(Certified) 18,900 18,900 1096 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including HR,IT,Accounting,Prof.Liability,QA Leadership,Executive Leadership 286,067 286,067 SPECIAL EXPENSES TOTAL $395,7831 $395,783 FIXED ASSETS: 1196 Computers&Software 1197 Furniture&Fixtures 1198 Other-(Identify) 1199 Other-(Identify) FIXED ASSETS TOTAL $0 $0 TOTAL PROGRAM EXPENSES1 $3,146,741 MEDI-CAL REVENUE: Service Provider Hours Rate $Amount Mental Health Services(Therapy) LPHA 936 $265.28 $248,302.08 Case Management(ICC) LPHA 541 $265.28 $143,516.48 Case Management(ICC) Other Qualified Provider 291 $199.58 $58,077.78 Crisis Services LPHA 96 $265.28 $25,466.88 Medication Support Pyschiatrist 96 $1,019.30 $97,852.80 Plan Development Other Qualified Provider 478 $199.58 $95,479.07 Assessment Other Qualified Provider 314 $199.58 $62,618.23 Rehabilitation Other Qualified Provider 2,823 $199.58 $563,484.99 Peer Support Peer Support Specialist 520 $209.56 $108,971.20 IHBS Other Qualified Provider 1,319 $199.58 $263,190.14 DIRECT MH SERVICE REVENUE 7,414 $1,666,960 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL MENTAL HEALTH PROGRAM COSTS $1,666,960 ESTIMATED NON MEDI-CAL BILLABLE COST 1,479,782 TOTAL ISFC PROGRAM COSTS $3,146,741 TOTAL DAILY FOSTER CARE STATE APPROVED IMC RATE Per Youth $535 ADDITIONAL DAILY ISFC COST $0 TOTAL MH DAILY RATE $571 Combined Daily Rate $1,078 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 11 of 46 Budget Narrative— FY 25-26 (July 1, 2025—June 30, 2026) The Promesa budget for Enhanced Intensive Services Foster Care (E-ISFC) is designed to successfully implement and support the goals of the E-ISFC program. The program will accept youth in need of stabilization, followed by placement in a more permanent home setting. The expected length of stay is not to exceed one year, unless there is an agreement between Fresno County and Promesa that an extension is in the best interests of the child and identified family. The treatment team will work with both a prospective family and the child, to ensure a smooth and lasting transition to the next placement setting. Payroll Expense The attached budget reflects the full annual salary of each staff, the title of each position, the FTE that will be provided and charged to the contract, identifies the Direct Administrative and Direct Program Costs, and the full annual amount paid for each position. This information is also available, and clearly presented, in the attached budget. The following section of this narrative will discuss the direct administrative and treatment team presented in this budget section. There are a total of 16.75 FTE. Administrative Team: This team will include the Program Administrator (0.25 FTE), Program Assistant (0.5 FTE). This team will work together to ensure that the administrative systems are in place to support the program team. This will include, but may not be limited to, ensuring that communications from the executive leadership team are shared in a timely manner and accurately delivered, that timesheets and requests for staff reimbursements are properly reviewed and submitted in a timely manner, that account payable invoices have been reviewed and submitted, that email questions referred to this team are resolved, and generally will ensure that reasonable support systems are in place. Treatment Team: This team includes the Program Director (0.5 FTE), Clinical Director (0.5 FTE), Program Supervisor (1.0 FTE), Clinician (1.0 FTE), Social Worker (1.0 FTE), BA Level Counselors (8.0 FTE, which includes 4.0 FTE overnight counselors), Lead counselors (2.0 FTE), Recruitment Specialist (0.5 FTE) Permanency Specialist (1.0 FTE), and a Health Information Specialist (0.5 FTE) responsible for the review and accurate billing of all Medi-Cal Services. Note that several positions will work together with the E-E ISFC program to ensure maximum efficiency. Leadership Treatment Team: This includes the Program Director, Clinical Director, and the Program Supervisor. This team will work together to ensure that the Treatment Team is meeting its goals and operating as effectively and efficiently as possible. The Program Assistant (0.5 FTE) and the Health Information Specialist will work with this team as required and provide support as needed. The Program Director bears responsibility for the entire E-ISFC program and works closely with the Leadership Team to ensure that this unit operates as a cohesive unit. The Director will meet with this team at least weekly and as needed, delegate when necessary, ensure that all CCL Licensing and Mental Health regulations are followed, liaison with HR staff as needed, conduct ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 12 of 46 Budget Narrative— FY 25-26 (July 1, 2025—June 30, 2026) trainings with staff when necessary, meet and participate in any functions with county staff as requested, and generally ensure that the program is well staffed, grounded and serving the youth and families to the best of their ability. The Director will supervise the members of the Leadership team, including the Program Assistant and the Health Information Specialist. The Clinical Director is responsible for the Clinicians as well as the direction and implementation of the clinical program. The Clinical Director will ensure that the Medi-Cal program is in compliance with the standards, that clinical staff understand the Medi-Cal service continuum and that the required documentation is completed accurately and on time. This includes daily notes as well as initial treatment plans and assessments as required. The Clinicians will implement the treatment plan, and report to the Clinical Director. Social Worker(1 FTE) will provide family and youth counseling, as needed to ensure transitional services are adequate and in place. Mental health services will be documented and invoiced by the clinicians. The Permanency Specialist will work with the clinicians, youth and prospective resource parents so that the youth will be able to transition as smoothly as possible. The Permanency Specialist will report to the Clinical Director. The Program Supervisor(1 FTE) is responsible for the day-to-day operations. It is anticipated that the majority of the time will be working in the houses, meeting and/or working with the counselors, parents and youth in the program. These Supervisors will be either master level, or very senior counselors with the skills required to problem solve and work effectively with the counselors, house parents and youth. Benefits include both mandated and discretionary benefits, as broken out in the budget. The overall benefit ratio is 31 .05% of payroll expense. This includes FICA, SUI, Retirement contribution, Workers Compensation and Health, Vision, Life and Dental Insurance. Total Payroll and Benefits is: $1,639,191 Facilities/Equipment Expense includes an office lease, utilities and Building Maintenance. The total cost is $77,062. Office lease is allocated to this contract for FY 25-26 at $63,000, Utilities is budgeted at $5,872 and Building Maintenance at $8,190. These are annual costs, allocated to this contract based upon square footage of total space and numbers of staff in each program. Operating Expenses reflect those costs that are normal and customary, with the exception of the Resource Family Payment. This payment is based upon the county payment of$2500 per month guaranteed each month to the parent. The remaining fee of$5000 per month will be passed through to the parent, depending upon the daily bed occupancy for each home. These payment amounts are based on rates that require State approval on an annual basis and therefore may be subject to change. All other costs in this category are based upon historical costs and estimates. The total cost is $972,545. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 13 of 46 Budget Narrative— FY 25-26 (July 1, 2025—June 30, 2026) Child Related Expenses There is a total of$62,160 now listed in this category. These costs are intended to cover costs that may be an extra ordinary expense, when a new child enters the program, or a child has a specific situation causing the need to supplement the parent fee. $6,300 of this fund is now dedicated to the Family Support Line, in the event that the child's family has an emergency so that we can assist. Special Expenses are primarily those costs associated with the Contract Psychiatrist and Nurse Consultant. These contractors will provide direct services to youth and consultation to the treatment team, as needed. Included in this section is a Peer Mentor to work with the youth, as needed. Also included in this section is the indirect cost calculated at 10% of total cost. These expenses total $395,783 for the year. Total Program Expense Summary Total Program Expense: $3,146,741 Mental Health Expense: $1,666,960 CWS Expense: $1,479,782 Combined Daily Rate: $1,078 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 14of46 FY 2026-2027(July 1,2026-June 30,2027) Budget Categories- Total Direct Budget Line Item Description(Must be itemized) FTE% Admin.-Direct Direct Total Direct PERSONNEL SALARIES: 0002 Administrator 0.25 23,428 23,428 0003 Program Director 0.50 66,150 66,150 0004 Clinical Director 0.50 57,881 57,881 0005 Program Supervisor 1.00 104,737 104,737 0006 Clinician 1.00 99,225 99,225 0007 Social Worker 1.00 82,687 82,687 0008 Counselors 8.00 529,200 529,200 0009 Lead Counselor 2.00 154,350 154,350 0011 Program Assistant 0.50 35,831 35,831 0012 Recruitment Specialist 0.50 33,075 33,075 0013 Permanency Specialist 1.00 71,662 71,662 0015 Health Information Specialist 0.50 32,500 32,500 Overnight/Overtime Stipends 21,000 21,000 SALARY TOTAL 16.75 $23,428 $1,288,298 $1,311,726 PAYROLL TAXES: 0030 OASDI 0031 FICA/MEDICARE 1,792.2 98,554.8 100,347.0 0032 SUI 702.8 38,648.9 39,351.8 PAYROLL TAX TOTAL $2,495 $137,204 $139,699 EMPLOYEE BENEFITS: 0040 Retirement 1,171 64,415 65,586 0041 Workers Compensation 328 90,181 90,509 Health Insurance(medical,vision,life, 0042 dental) 1,991 1 109,505 1 111,497 EMPLOYEE BENEFITS TOTAL 31.05%1 $3,4911 $264,1011 $267,592 SALARY&BENEFITS GRAND TOTAL $29,414 $1,689,603 $1,719,017 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 66,150 66,150 1011 Rent/Lease Equipment - 1012 Utilities 6,166 6,166 1013 Building Maintenance 8,600 8,600 1014 Equipment purchase FACILITY/EQUIPMENT TOTAL 1 $80,915 1 $80,915 OPERATING EXPENSES: 1060 Telephone 11,025 11,025 1061 Accreditation 4,418 4,418 1062 Conference,Meetings,In-Service Training 26,408 26,408 1063 Dues,Membership,and Subscriptions 2,363 2,363 1064 Recruitment 11,025 11,025 1065 Licenses and Permits 5,513 5,513 1066 Office Supplies&printing 6,615 6,615 1067 Resource Family Payment Bed Fee@$2,500/month 240,000 240,000 1068 Resource Family Payment 480,000 480,000 1069 External Audit 5,513 5,513 1070 Professional Liability Insurance - 1071 Transportation of Clients 71,663 71,663 1072 Computers&Software - 1073 Furniture&Fixtures 18,638 18,638 1074 Respite 100,852 100,852 OPERATING EXPENSES TOTAL 12,293 971,737 $ 984,030 Exhibit C-2 Page 15 of 46 CHILDREN RELATED EXPENSES: 1080 Food $10,584 10,584 1081 Clothing $3,969 3,969 1082 Personal Incidentals $3,969 3,969 1083 School Supplies $2,646 2,646 1084 Outside Activities $5,292 5,292 1085 Child related transportation - 1086 Internet Services - 1087 Supplies - 1088 Emergency Flex Funds $21,120 21,120 1089 Treatment Supplies $5,408 5,408 1090 Medication Non-Medical $5,408 5,408 1091 Family Support $6,615 6,615 CHILD AND FAMILY RELATED SERVICES $65,010 SPECIAL EXPENSES(Consultant/Etc.): 1092 Nurse Consultant 31,853 31,853 1093 Psychiatrist Consultant 63,504 63,504 1094 Peer Mentor(Certified) 19,845 19,845 1095 Contract Bed Fee @ 2.43% - - 1096 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including HR,IT,Accounting,Prof.Liability,QA Leadership,Executive Leadership 296,417 1 296,417 SPECIAL EXPENSES TOTAL $411,6191 $411,619 FIXED ASSETS: 1196 Computers&Software 1197 Furniture&Fixtures 1198 Other-(Identify) 1199 Other-(Identify) FIXED ASSETS TOTAL $0 $0 TOTAL PROGRAM EXPENSES1 $3,260,591 MEDI-CAL REVENUE: Service Provider Hours Rate $Amount Mental Health Services(Therapy) LPHA 936 $265.28 $248,302.08 Case Management(ICC) LPHA 541 $265.28 $143,516.48 Case Management(ICC) Other Qualified Provider 291 $199.58 $58,077.78 Crisis Services LPHA 96 $265.28 $25,466.88 Medication Support Pyschiatrist 96 $1,019.30 $97,852.80 Plan Development Other Qualified Provider 478 $199.58 $95,479.07 Assessment Other Qualified Provider 314 $199.58 $62,618.23 Rehabilitation Other Qualified Provider 2,877 $199.58 $574,253.53 Peer Support Peer Support Specialist 520 $209.56 $108,971.20 IHBS Other Qualified Provider 1 1,673 1 $199.58 1 $333,844.65 DIRECT MH SERVICE REVENUE 7,822 $1,748,383 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL MENTAL HEALTH PROGRAM COSTS $1,748,383 ESTIMATED NON MEDI-CAL BILLABLE COST 1,512,208 TOTAL ISFC PROGRAM COSTS $3,260,591 TOTAL DAILY FOSTER CARE STATE APPROVED IMC RATE Per Youth $535 ADDITIONAL DAILY ISFC COST $0 TOTAL MH DAILY RATE $599 Combined Daily Rate $1,117 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 16 of 46 Budget Narrative— FY 26-27 (July 1, 2026—June 30, 2027) The Promesa budget for Enhanced Intensive Services Foster Care (E-ISFC) is designed to successfully implement and support the goals of the E-ISFC program. The program will accept youth in need of stabilization, followed by placement in a more permanent home setting. The expected length of stay is not to exceed one year, unless there is an agreement between Fresno County and Promesa that an extension is in the best interests of the child and identified family. The treatment team will work with both a prospective family and the child, to ensure a smooth and lasting transition to the next placement setting. Payroll Expense The attached budget reflects the full annual salary of each staff, the title of each position, the FTE that will be provided and charged to the contract, identifies the Direct Administrative and Direct Program Costs, and the full annual amount paid for each position. This information is also available, and clearly presented, in the attached budget. The following section of this narrative will discuss the direct administrative and treatment team presented in this budget section. There are a total of 16.75 FTE. Administrative Team: This team will include the Program Administrator (0.25 FTE), Program Assistant (0.5 FTE). This team will work together to ensure that the administrative systems are in place to support the program team. This will include, but may not be limited to, ensuring that communications from the executive leadership team are shared in a timely manner and accurately delivered, that timesheets and requests for staff reimbursements are properly reviewed and submitted in a timely manner, that account payable invoices have been reviewed and submitted, that email questions referred to this team are resolved, and generally will ensure that reasonable support systems are in place. Treatment Team: This team includes the Program Director (0.5 FTE), Clinical Director (0.5 FTE), Program Supervisor (1.0 FTE), Clinician (1.0 FTE), Social Worker (1.0 FTE), BA Level Counselors (8.0 FTE, which includes 4.0 FTE overnight counselors), Lead counselors (2.0 FTE), Recruitment Specialist (0.5 FTE) Permanency Specialist (1.0 FTE), and a Health Information Specialist (0.5 FTE) responsible for the review and accurate billing of all Medi-Cal Services. Note that several positions will work together with the E-E ISFC program to ensure maximum efficiency. Leadership Treatment Team: This includes the Program Director, Clinical Director, and the Program Supervisor. This team will work together to ensure that the Treatment Team is meeting its goals and operating as effectively and efficiently as possible. The Program Assistant (0.5 FTE) and the Health Information Specialist will work with this team as required and provide support as needed. The Program Director bears responsibility for the entire E-ISFC program and works closely with the Leadership Team to ensure that this unit operates as a cohesive unit. The Director will meet with this team at least weekly and as needed, delegate when necessary, ensure that all CCL Licensing and Mental Health regulations are followed, liaison with HR staff as needed, conduct ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 17 of 46 Budget Narrative— FY 26-27 (July 1, 2026—June 30, 2027) trainings with staff when necessary, meet and participate in any functions with county staff as requested, and generally ensure that the program is well staffed, grounded and serving the youth and families to the best of their ability. The Director will supervise the members of the Leadership team, including the Program Assistant and the Health Information Specialist. The Clinical Director is responsible for the Clinicians as well as the direction and implementation of the clinical program. The Clinical Director will ensure that the Medi-Cal program is in compliance with the standards, that clinical staff understand the Medi-Cal service continuum and that the required documentation is completed accurately and on time. This includes daily notes as well as initial treatment plans and assessments as required. The Clinicians will implement the treatment plan, and report to the Clinical Director. Social Worker(1 FTE) will provide family and youth counseling, as needed to ensure transitional services are adequate and in place. Mental health services will be documented and invoiced by the clinicians. The Permanency Specialist will work with the clinicians, youth and prospective resource parents so that the youth will be able to transition as smoothly as possible. The Permanency Specialist will report to the Clinical Director. The Program Supervisor(1 FTE) is responsible for the day-to-day operations. It is anticipated that the majority of the time will be working in the houses, meeting and/or working with the counselors, parents and youth in the program. These Supervisors will be either master level, or very senior counselors with the skills required to problem solve and work effectively with the counselors, house parents and youth. Benefits include both mandated and discretionary benefits, as broken out in the budget. The overall benefit ratio is 31 .05% of payroll expense. This includes FICA, SUI, Retirement contribution, Workers Compensation and Health, Vision, Life and Dental Insurance. Total Payroll and Benefits is: $1,719,017 Facilities/Equipment Expense includes an office lease, utilities and Building Maintenance. The total cost is $80,915. Office lease is allocated to this contract for FY 26-27 at $66,150, Utilities is budgeted at $6,166 and Building Maintenance at $8,600. These are annual costs, allocated to this contract based upon square footage of total space and numbers of staff in each program. Operating Expenses reflect those costs that are normal and customary, with the exception of the Resource Family Payment. This payment is based upon the county payment of$2500 per month guaranteed each month to the parent. The remaining fee of$5000 per month will be passed through to the parent, depending upon the daily bed occupancy for each home. These payment amounts are based on rates that require State approval on an annual basis and therefore may be subject to change. All other costs in this category are based upon historical costs and estimates. The total cost is $984,030. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 18 of 46 Budget Narrative— FY 26-27 (July 1, 2026—June 30, 2027) Child Related Expenses There is a total of$65,010 now listed in this category. These costs are intended to cover costs that may be an extra ordinary expense, when a new child enters the program, or a child has a specific situation causing the need to supplement the parent fee. $6,615 of this fund is now dedicated to the Family Support Line, in the event that the child's family has an emergency so that we can assist. Special Expenses are primarily those costs associated with the Contract Psychiatrist and Nurse Consultant. These contractors will provide direct services to youth and consultation to the treatment team, as needed. Included in this section is a Peer Mentor to work with the youth, as needed. Also included in this section is the indirect cost calculated at 10% of total cost. These expenses total $411,619 for the year. Total Program Expense Summary Total Program Expense: $3,260,591 Mental Health Expense: $1,748,383 CWS Expense: $1,512,208 Combined Daily Rate: $1,117 ENHANCED INTENSIVE SERVICES FOSTER CARE ExhibitC-2 Promesa Behavioral Health Page 19 of 46 FY 2027-2028(July 1, 2027-June 30, 2028) Budget Categories- Total Direct Budget Line Item Description(Must be itemized) FTE% Admin.-Direct Direct Total Direct PERSONNEL SALARIES: 0002 Administrator 0.25 24,600 24,600 0003 Program Director 0.50 69,458 69,458 0004 Clinical Director 0.50 60,775 60,775 0005 Program Supervisor 1.00 109,974 109,974 0006 Clinician 1.00 104,186 104,186 0007 Social Worker 1.00 86,821 86,821 0008 Counselors 8.00 555,664 555,664 0009 Lead Counselor 2.00 162,068 162,068 0011 Program Assistant 0.50 37,623 37,623 0012 Recruitment Specialist 0.50 34,729 34,729 0013 Permanency Specialist 1.00 75,245 75,245 0015 Health Information Specialist 0.50 32,500 32,500 Overnight/Overtime Stipends 21,000 21,000 SALARY TOTAL 16.75 $24,600 $1,350,042 $1,374,642 PAYROLL TAXES: 0030 OASDI 0031 FICA/MEDICARE 1,881.9 103,278.2 105,160.1 0032 SUI 738.0 40,501.3 41,239.2 PAYROLL TAX TOTAL $2,620 $143,779 $146,399 EMPLOYEE BENEFITS: 0040 Retirement 1,230 67,502 68,732 0041 Workers Compensation 344 94,503 94,847 Health Insurance(medical,vision,life, 0042 dental) 12,091 1 114,754 1 116,845 EMPLOYEE BENEFITS TOTAL 31.05%1 $3,6651 $276,7591 $280,424 SALARY&BENEFITS GRAND TOTAL $30,885 $1,770,580 $1,801,465 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 68,135 68,135 1011 Rent/Lease Equipment - 1012 Utilities 6,472 6,472 1013 Building Maintenance 9,028 9,028 1014 Equipment purchase FACILITY/EQUIPMENT TOTAL $83,635 $83,635 OPERATING EXPENSES: 1060 Telephone 11,576 11,576 1061 Accreditation 4,639 4,639 1062 Conference, Meetings, In-Service Training 27,665 27,665 1063 Dues, Membership,and Subscriptions 4,500 4,500 1064 Recruitment 11,576 11,576 1065 Licenses and Permits 5,789 5,789 1066 Office Supplies&printing 6,946 6,946 1067 Resource Family Payment Bed Fee@$2,500/month 240,000 240,000 1068 Resource Family Payment 480,000 480,000 1069 External Audit 5,789 5,789 1070 Professional Liability Insurance - 1071 Transportation of Clients 75,246 75,246 1072 Computers&Software - 1073 Furniture&Fixtures 19,570 19,570 1074 Respite 103,106 103,106 OPERATING EXPENSES TOTAL 14,928 981,474 $ 996,401 Exhibit C-2 Page 20 of 46 CHILDREN RELATED EXPENSES: 1080 Food $11,113 11,113 1081 Clothing $4,167 4,167 1082 Personal Incidentals $4,167 4,167 1083 School Supplies $2,646 2,646 1084 Outside Activities $5,557 5,557 1085 Child related transportation - 1086 Internet Services - 1087 Supplies - 1088 Emergency Flex Funds $22,176 22,176 1089 Treatment Supplies $5,788 5,788 1090 Medication Non-Medical $5,677 5,677 1091 Family Support 1 1 $6,946 6,946 CHILD AND FAMILY RELATED SERVICES $68,237 SPECIAL EXPENSES(Consultant/Etc.): 1092 Nurse Consultant 33,466 33,466 1093 Psychiatrist Consultant 66,528 66,528 1094 Peer Mentor(Certified) 20,836 20,836 1095 Contract Bed Fee @ 2.43% - - 1096 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including HR,IT,Accounting,Prof.Liability,QA Leadership,Executive Leadership 307,057 307,057 SPECIAL EXPENSES TOTAL $427,887 $427,887 FIXED ASSETS: 1196 Computers&Software 1197 Furniture&Fixtures 1198 Other-(Identify) 1199 Other-(Identify) FIXED ASSETS TOTAL $0 $0 TOTAL PROGRAM EXPENSES1 $3,377,624 MEDI-CAL REVENUE: Service Provider Hours Rate $Amount Mental Health Services(Therapy) LPHA 936 $265.28 $248,302.08 Case Management(ICC) LPHA 541 $265.28 $143,516.48 Case Management(ICC) Other Qualified Provider 291 $199.58 $58,077.78 Crisis Services LPHA 96 $265.28 $25,466.88 Medication Support Pyschiatrist 96 $1,019.30 $97,852.80 Plan Development Other Qualified Provider 478 $199.58 $95,479.07 Assessment Other Qualified Provider 314 $199.58 $62,618.23 Rehabilitation Other Qualified Provider 3,338 $199.58 $666,259.91 Peer Support Peer Support Specialist 520 $209.56 $108,971.20 IHBS Other Qualified Provider, 1,673 $199.58 1 $333,844.65 DIRECT MH SERVICE REVENUE 1 8,283 $1,840,389 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL MENTAL HEALTH PROGRAM COSTSI $1,840,389 ESTIMATED NON MEDI-CAL BILLABLE COST 1,537,235 TOTAL ISFC PROGRAM COSTS $3,377,624 TOTAL DAILY FOSTER CARE STATE APPROVED IMC RATE Per Youth $535 ADDITIONAL DAILY ISFC COST $0 TOTAL MH DAILY RATE $630 Combined Daily Rate $1,157 ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 21 of 46 Budget Narrative— FY 27-28 (July 1, 2027—June 30, 2028) The Promesa budget for Enhanced Intensive Services Foster Care (E-ISFC) is designed to successfully implement and support the goals of the E-ISFC program. The program will accept youth in need of stabilization, followed by placement in a more permanent home setting. The expected length of stay is not to exceed one year, unless there is an agreement between Fresno County and Promesa that an extension is in the best interests of the child and identified family. The treatment team will work with both a prospective family and the child, to ensure a smooth and lasting transition to the next placement setting. Payroll Expense The attached budget reflects the full annual salary of each staff, the title of each position, the FTE that will be provided and charged to the contract, identifies the Direct Administrative and Direct Program Costs, and the full annual amount paid for each position. This information is also available, and clearly presented, in the attached budget. The following section of this narrative will discuss the direct administrative and treatment team presented in this budget section. There are a total of 16.75 FTE. Administrative Team: This team will include the Program Administrator (0.25 FTE), Program Assistant (0.5 FTE). This team will work together to ensure that the administrative systems are in place to support the program team. This will include, but may not be limited to, ensuring that communications from the executive leadership team are shared in a timely manner and accurately delivered, that timesheets and requests for staff reimbursements are properly reviewed and submitted in a timely manner, that account payable invoices have been reviewed and submitted, that email questions referred to this team are resolved, and generally will ensure that reasonable support systems are in place. Treatment Team: This team includes the Program Director (0.5 FTE), Clinical Director (0.5 FTE), Program Supervisor (1.0 FTE), Clinician (1.0 FTE), Social Worker (1.0 FTE), BA Level Counselors (8.0 FTE, which includes 4.0 FTE overnight counselors), Lead counselors (2.0 FTE), Recruitment Specialist (0.5 FTE) Permanency Specialist (1.0 FTE), and a Health Information Specialist (0.5 FTE) responsible for the review and accurate billing of all Medi-Cal Services. Note that several positions will work together with the E-E ISFC program to ensure maximum efficiency. Leadership Treatment Team: This includes the Program Director, Clinical Director, and the Program Supervisor. This team will work together to ensure that the Treatment Team is meeting its goals and operating as effectively and efficiently as possible. The Program Assistant (0.5 FTE) and the Health Information Specialist will work with this team as required and provide support as needed. The Program Director bears responsibility for the entire E-ISFC program and works closely with the Leadership Team to ensure that this unit operates as a cohesive unit. The Director will meet with this team at least weekly and as needed, delegate when necessary, ensure that all CCL Licensing and Mental Health regulations are followed, liaison with HR staff as needed, conduct ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 22 of 46 Budget Narrative— FY 27-28 (July 1, 2027—June 30, 2028) trainings with staff when necessary, meet and participate in any functions with county staff as requested, and generally ensure that the program is well staffed, grounded and serving the youth and families to the best of their ability. The Director will supervise the members of the Leadership team, including the Program Assistant and the Health Information Specialist. The Clinical Director is responsible for the Clinicians as well as the direction and implementation of the clinical program. The Clinical Director will ensure that the Medi-Cal program is in compliance with the standards, that clinical staff understand the Medi-Cal service continuum and that the required documentation is completed accurately and on time. This includes daily notes as well as initial treatment plans and assessments as required. The Clinicians will implement the treatment plan, and report to the Clinical Director. Social Worker(1 FTE) will provide family and youth counseling, as needed to ensure transitional services are adequate and in place. Mental health services will be documented and invoiced by the clinicians. The Permanency Specialist will work with the clinicians, youth and prospective resource parents so that the youth will be able to transition as smoothly as possible. The Permanency Specialist will report to the Clinical Director. The Program Supervisor(1 FTE) is responsible for the day-to-day operations. It is anticipated that the majority of the time will be working in the houses, meeting and/or working with the counselors, parents and youth in the program. These Supervisors will be either master level, or very senior counselors with the skills required to problem solve and work effectively with the counselors, house parents and youth. Benefits include both mandated and discretionary benefits, as broken out in the budget. The overall benefit ratio is 31 .05% of payroll expense. This includes FICA, SUI, Retirement contribution, Workers Compensation and Health, Vision, Life and Dental Insurance. Total Payroll and Benefits is: $1,801,465 Facilities/Equipment Expense includes an office lease, utilities and Building Maintenance. The total cost is $83,635. Office lease is allocated to this contract for FY 27-28 at $68,135, Utilities is budgeted at $6,472 and Building Maintenance at $9,028. These are annual costs, allocated to this contract based upon square footage of total space and numbers of staff in each program. Operating Expenses reflect those costs that are normal and customary, with the exception of the Resource Family Payment. This payment is based upon the county payment of$2500 per month guaranteed each month to the parent. The remaining fee of $5000 per month will be passed through to the parent, depending upon the daily bed occupancy for each home. These payment amounts are based on rates that require State approval on an annual basis and therefore may be subject to change. All other costs in this category are based upon historical costs and estimates. The total cost is $996,401. ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 23 of 46 Budget Narrative— FY 27-28 (July 1, 2027—June 30, 2028) Child Related Expenses There is a total of$68,237 now listed in this category. These costs are intended to cover costs that may be an extra ordinary expense, when a new child enters the program, or a child has a specific situation causing the need to supplement the parent fee. $6,946 of this fund is now dedicated to the Family Support Line, in the event that the child's family has an emergency so that we can assist. Special Expenses are primarily those costs associated with the Contract Psychiatrist and Nurse Consultant. These contractors will provide direct services to youth and consultation to the treatment team, as needed. Included in this section is a Peer Mentor to work with the youth, as needed. Also included in this section is the indirect cost calculated at 10% of total cost. These expenses total $427,887 for the year. Total Program Expense Summary Total Program Expense: $3,377,624 Mental Health Expense: $1,840,389 CWS Expense: $1,537,235 Combined Daily Rate: $1,157 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 24 of 46 Startup Budget FY 2024-2025 (Upon Execution- November 30,2024) Budget Categories- Program Start Up Allocation Line Item Description(Must be itemized) FTE% Total Salary Total Start Up Combined E-E-ISFC PERSONNEL SALARIES: 0002 Administrator 0.45 42,500 3,542 1,771 0003 Program Director 1.00 180,000 15,000 7,500 0004 Clinical Director 1.00 157,500 9,844 4,922 0005 Program Supervisor 2.00 190,000 11,875 5,938 0006 Clinician 2.00 225,000 18,750 9,375 0007 Social Worker 1.50 112,500 9,375 4,688 0008 Counselors 12.00 540,000 55,000 27,500 0009 Lead Counselor 3.00 350,000 29,167 14,584 0011 Program Assistant 1.00 240,000 8,125 4,063 0012 Recruitment Specialist 1.00 97,500 5,000 2,500 0013 Permanency Specialist 2.00 60,000 5,208 2,604 0015 Health Information Specialist 1.00 125,000 4,063 2,032 SALARY TOTAL 27.95 174,949 $ 87,475 PAYROLLTAXTOTAL - 0030 OASDI 0031 Fica/Medicare 13,384 6,692 0032 Payroll Tax Total 5,248 2,624 Total Payroll Taxes 18,632 9,316 EMPLOYEE BENEFITS: - 0040 Retirement 8,747 4,374 0041 Workers Compensation 12,246 6,123 0042 Health Insurance(Medical,Vission,Life,Dental) 14,871 7,435 0042 Fringe Benefits - - Employee Benefits Total 35,865 17,932 Salary&Benefits Grand Total(Benefits @25%) 229,446 $ 114,723 FACILITIES/EQUIPMENT EXPENSES: - 1010 Rent/Lease Building 2,200 1,100 1012 Utilites 370 185 1014 Equipment purchase/Lease 1,750 875 FACILITY/EQUIPMENT TOTAL 4,320 $ 2,160 OPERATING EXPENSES: 1060 Staff Recruitment/On Boarding 5,000 2,500 1061 Staff Training 10,000 5,000 1062 Cellular Phones - - 1063 Office 4,000 2,000 1067 Resource Family Recruiting 22,500 11,250 1070 Advertising - - 1072 Furniture&Fixtures 4,500 2,250 OPERATING EXPENSES TOTAL 46,000 $ 23,000 1096 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs,Including - HR,IT,Accounting,Prof.Liability,QA Leadership,Executive Leadership 27,977 13,988 27,977 $ 13,988 307,742 $ 153,871 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 25 of 46 Startup Budget Narrative— FY 24-25 (Upon execution — November 30, 2024) The Promesa start up budget for Emergency Enhanced Intensive Services Foster Care (E-E- ISFC) is designed to successfully implement and support the goals of the E-E-ISFC program. This start up budget is for onboarding and training the teams below, as well as recruiting and training Specialized Resource Parents so youth can be accepted into the program immediately following the ramp-up period. Payroll Expense The budget reflects the full annual salary of each staff, the title of each position, the FTE that will be provided and charged to the contract, identifies the Direct Administrative and Direct Program Costs, and the full annual amount paid for each position. The following section of this narrative will discuss the direct administrative and treatment team presented in this budget section. Administrative Team: This team will include the Program Administrator, Program Assistant. This team will work together to ensure that the administrative systems are in place to support the program team. This will include, but may not be limited to, ensuring that communications from the executive leadership team are shared in a timely manner and accurately delivered, that timesheets and requests for staff reimbursements are properly reviewed and submitted in a timely manner, that account payable invoices have been reviewed and submitted, that email questions referred to this team are resolved, and generally will ensure that reasonable support systems are in place. Treatment Team: This team includes the Program Director, Clinical Director, Program Supervisor, Clinician, Social Worker, BA Level Counselors, which includes Counselors dedicated to awake overnight in the event a youth is in need of supervision, Lead Counselor, Recruitment Specialist, Permanency Specialist, and a Health Information Specialist responsible for the review and accurate billing of all Medi-Cal Services. Leadership Treatment Team: This includes the Program Director, Clinical Director, and the Program Supervisor. This team will work together to ensure that the Treatment Team is meeting its goals and operating as effectively and efficiently as possible. The Program Assistant and the Health Information Specialist will work with this team as required and provide support as needed. The Program Director bears responsibility for the entire E-E-ISFC program and works closely with the Leadership Team to ensure that this unit operates as a cohesive unit. The Director will meet with this team at least weekly and as needed, delegate when necessary, ensure that all CCL Licensing and Mental Health regulations are followed, liaison with HR staff as needed, conduct trainings with staff when necessary, meet and participate in any functions with county staff as requested, and generally ensure that the program is well staffed, grounded and serving the youth and families to the best of their ability. The Director will supervise the members of the Leadership team, including the Program Assistant and the Health Information Specialist. The Clinical Director is responsible for the Clinician and as well as the direction and implementation of the clinical program. The Clinical Director will ensure that the Medi-Cal EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 26 of 46 Startup Budget Narrative— FY 24-25 (Upon execution — November 30, 2024) program is in compliance with the standards, that clinical staff understand the Medi-Cal service continuum and that the required documentation is completed accurately and on time. This includes daily notes as well as initial treatment plans and assessments as required. The Clinician will implement the treatment plan, and report to the Clinical Director. Social Work type services may also be provided by the clinician, but mental health services will be documented and invoiced on a daily basis. The Permanency Specialist will work with the clinician, youth and prospective resource parents so that the youth will be able to transition as smoothly as possible. The Permanency Specialist will report to the Clinical Director. The Program Supervisor is responsible for the day-to-day operations. It is anticipated that the majority of their time will be working in the houses, meeting and/or working with the counselors, parents and youth in the program. These Supervisors will be either master level, or very senior counselors with the skills required to program solve and work effectively with the counselors and house parents and youth. The Clinician and Social Worker will work with treatment team, youth, foster resource parent and prospective resource parents to ensure that the needs of each are processed and resolved. Benefits include both mandated and discretionary benefits, as broken out in the budget. The overall benefit ration is 25% of payroll expense. This includes FICA, SUI, Retirement contribution, Workers Compensation and Health, Vision, Life and Dental Insurance. Total Payroll and Benefits is: $114,723 Facilities/Equipment Expense includes an office lease, minor equipment expense, utilities and Building Maintenance. The total cost is $2,160. Office lease is allocated for Startup at $1,100, Leased equipment is $875, and Utilities is budgeted at $185. These costs are allocated to this contract based upon square footage of total space and numbers of staff in each program. Operating Expenses reflect those costs that are normal and customary. All other costs in this category are based upon historical costs and estimates. The total cost is $23,000. Overhead includes the indirect cost calculated at 10% of total cost. These expenses total $13,988 for startup. Total Program Expense Summary Total Program Expense: $153,871 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE ExhibitC-2 Promesa Behavioral Health Page 27 of 46 FY 2024-2025(December 1,2024-June 30, 2025) Budget Categories- Total Direct Budget Line Item Description(Must be itemized) FTE% Admin.-Direct Direct Total Direct PERSONNEL SALARIES: 0002 Administrator 0.20 12,750 12,750 0006 Program Director 0.50 45,000 45,000 0005 Clinical Director 0.50 39,375 39,375 0006 Program Supervisor 1.00 71,250 71,250 0007 Clinician 1.00 67,500 67,500 0008 Social Worker 0.50 28,125 28,125 0009 Counselors 4.00 180,000 180,000 0010 Lead Counselor 1.00 52,500 52,500 0012 Program Assistant 0.50 24,375 24,375 0013 Recruitment Specialist 0.50 22,500 22,500 0014 Permanency Specialist 1.00 48,750 48,750 0016 Health Information Specialist 0.50 24,375 24,375 Overnight/Overtime Stipends 9,375 9,375 SALARY TOTAL 11.20 $12,750 $613,125 $625,875 PAYROLL TAXES: 0030 OASDI 0031 FICA/MEDICARE 975 46,904 47,879 0032 SUI 383 18,394 18,776 PAYROLL TAX TOTAL $1,358 $65,298 $66,656 EMPLOYEE BENEFITS: 0040 Retirement 638 30,656 31,294 0041 Workers Compensation 179 42,919 43,097 0042 Health Insurance(medical,vision,life,dental) 1,084 52,116 53,199 EMPLOYEE BENEFITS TOTAL 31.04%1 $1,900 $125,691 $127,590 SALARY&BENEFITS GRAND TOTAL $16,008 $804,113 $820,121 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 22,500 22,500 1011 Rent/Lease Equipment 900 900 1012 Utilities 1,998 1,980 3,978 1013 Building Maintenance 2,925 2,700 5,625 1014 Equipment purchase/Lease FACILITY/EQUIPMENT TOTAL 1 $28,3231 $4,6801 $33,003 OPERATING EXPENSES: 1060 Telephone 8,568 8,568 1061 Accreditation 1,503 1,503 1062 Conference,Meetings, In-Service Training 17,100 17,100 1063 Dues,Membership,and Subscriptions 2,700 2,700 1064 Recruitment 19,500 19,500 1065 Licenses and Permits 2,250 2,250 1066 Office Supplies&printing 10,080 10,080 1067 Resource Family Payment Bed Fee @$2,500/month 90,000 90,000 1068 Resource Family Payment 180,000 180,000 1069 External Audit 1,800 1,800 1070 Professional Liability Insurance 1071 Transportation of Clients 28,875 28,875 1072 Computers&Software 1073 Furniture&Fixtures 5,625 5,625 1074 Respite $34,580 $34,580 OPERATING EXPENSES TOTAL $1,503 $401,078 $402,581 Exhibit C-2 Page 28 of 46 CHILDREN RELATED EXPENSES: 1080 Food 7,200 7,200 1081 Clothing 9,000 9,000 1082 Personal Incidentals 2,700 2,700 1083 School Supplies 1,800 1,800 1084 Outside Activities 3,600 3,600 1085 Child related transportation 5,625 5,625 1086 Internet Services - 1087 Supplies - 1088 Emergency Flex Funds 7,200 7,200 1089 Speicalized Treatment Supplies 3,750 3,750 1090 Medication Non-Medical 3,750 3,750 1091 Family Support 3,000 3,000 CHILD AND FAMILY RELATED SERVICES $0 $47,6251 $47,625 SPECIAL EXPENSES(Consultant/Etc.): 1092 Nurse Consultant 21,600 21,600 1093 Psychiatrist Consultant 21,600 21,600 1094 Peer Mentor(Certified) 6,750 6,750 1095 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs, Including HR,IT,Accounting,Prof. Liability,QA Leadership, Executive Leadership 135,328 135,328 SPECIAL EXPENSES TOTAL $185,2781 $185,278 FIXED ASSETS: 1196 Computers&Software 1197 Furniture&Fixtures 1198 Other-(Identify) FIXED ASSETS TOTAL $0 $0 TOTAL PROGRAM EXPENSES $1,488,608 MEDI-CAL REVENUE: Service Provider Type Hours Hourly Rate $Amount Mental Health Services(Therapy) LPHA 312 $265.28 $82,767.36 Case Management(ICC) LPHA 407 $265.28 $107,968.96 Case Management(ICC) Other Qualified 1 217 $199.58 $43,308.86 Crisis Services LPHA 36 $265.28 $9,550.08 Medication Support Pyschiatrist 36 $1,019.30 $36,694.80 Plan Development Other Qualified 156 $199.58 $31,134.48 Assessment Other Qualified 360 $199.58 $71,848.80 Rehabilitation Other Qualified 682 $199.58 $136,156.47 Peer Support Peer Support S 52 $209.56 $10,881.00 IHBS Other Qualified 738 $199.58 $147,376.86 DIRECT MH SERVICE REVENUE $677,688 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL MENTAL HEALTH PROGRAM REVENUEJ $677,688 ESTIMATED NON MEDI-CAL BILLABLE COST 810,920 TOTAL ISFC PROGRAM COSTS $1,488,608 TOTAL DAILY FOSTER CARE STATE APPROVED IMC RATE Per Youth $ 535 ADDITIONAL DAILY ISFC COST $ 20 TOTAL MH DAILY RATE $ 464 Combined Daily Rate $ 1,020 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 29 of 46 Budget Narrative— FY 24-25 (December 1, 2024—June 30, 2025) The Promesa budget for Emergency Enhanced Intensive Services Foster Care (E-E-ISFC) is designed to successfully implement and support the goals of the E-E-ISFC program. The program will accept youth in need of short-term stabilization, followed by placement in a more permanent home setting. The expected length of stay will not exceed one month, unless there is an agreement between Fresno County and Promesa that an extension is in the best interests of the child and identified family. The treatment team will work with both the prospective family and the child, to ensure a smooth and lasting transition to the next placement setting. Payroll Expense The attached budget reflects the full annual salary of each staff, the title of each position, the FTE that will be provided and charged to the contract, identifies the Direct Administrative and Direct Program Costs, and the full annual amount paid for each position. This information is also available, and clearly presented, in the attached budget. The following section of this narrative will discuss the direct administrative and treatment team presented in this budget section. There is a total of 11.20 FTE. Administrative Team: This team will include the Program Administrator (0.2 FTE), Program Assistant (0.5 FTE). This team will work together to ensure that the administrative systems are in place to support the program team. This will include, but may not be limited to, ensuring that communications from the executive leadership team are shared in a timely manner and accurately delivered, that timesheets and requests for staff reimbursements are properly reviewed and submitted in a timely manner, that account payable invoices have been reviewed and submitted, that email questions referred to this team are resolved, and generally will ensure that reasonable support systems are in place. Treatment Team: This team includes the Program Director (0.5 FTE), Clinical Director (0.5 FTE), Program Supervisor (1.0 FTE), Clinician (1.0 FTE) Social Worker (0.5 FTE), BA Level Counselors (4.0 FTE, which includes 2.0 FTE dedicated to awake overnight in the event a youth is in need of supervision), Lead Counselor (1.0 FTE), Recruitment Specialist (0.5 FTE), Permanency Specialist (1.0 FTE), and a Health Information Specialist (0.5 FTE) responsible for the review and accurate billing of all Medi-Cal Services. Leadership Treatment Team: This includes the Program Director, Clinical Director, and the Program Supervisor. This team will work together to ensure that the Treatment Team is meeting its goals and operating as effectively and efficiently as possible. The Program Assistant (0.5 FTE) and the Health Information Specialist will work with this team as required and provide support as needed. The Program Director bears responsibility for the entire E-E-ISFC program and works closely with the Leadership Team to ensure that this unit operates as a cohesive unit. The Director will meet with this team at least weekly and as needed, delegate when necessary, ensure that all CCL Licensing and Mental Health regulations are followed, liaison with HR staff as needed, EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 30 of 46 Budget Narrative— FY 24-25 (December 1, 2024—June 30, 2025) conduct trainings with staff when necessary, meet and participate in any functions with county staff as requested, and generally ensure that the program is well staffed, grounded and serving the youth and families to the best of their ability. The Director will supervise the members of the Leadership team, including the Program Assistant and the Health Information Specialist. The Clinical Director is responsible for the Clinician and as well as the direction and implementation of the clinical program. The Clinical Director will ensure that the Medi-Cal program is in compliance with the standards, that clinical staff understand the Medi-Cal service continuum and that the required documentation is completed accurately and on time. This includes daily notes as well as initial treatment plans and assessments as required. The Clinician will implement the treatment plan, and report to the Clinical Director. Social Work type services may also be provided by the clinician, but mental health services will be documented and invoiced on a daily basis. The Permanency Specialist will work with the clinician, youth and prospective resource parents so that the youth will be able to transition as smoothly as possible. The Permanency Specialist will report to the Clinical Director. The Program Supervisor is responsible for the day-to-day operations. It is anticipated that the majority of their time will be working in the houses, meeting and/or working with the counselors, parents and youth in the program. These Supervisors will be either master level, or very senior counselors with the skills required to program solve and work effectively with the counselors and house parents and youth. The Clinician and Social Worker will work with treatment team, youth, foster resource parent and prospective resource parents to ensure that the needs of each are processed and resolved. Benefits include both mandated and discretionary benefits, as broken out in the budget. The overall benefit ration in 31.4% of payroll expense. This includes FICA, SUI, Retirement contribution, Workers Compensation and Health, Vision, Life and Dental Insurance. Total Payroll and Benefits is: $820,121 Facilities/Equipment Expense includes an office lease, minor equipment expense, utilities and Building Maintenance. The total cost is $33,003. Office lease is allocated to this contract for FY 24-25 at $22,500, Leased equipment is $900, Utilities is budgeted at $3,978 and Building Maintenance at $5,625. These costs are allocated to this contract based upon square footage of total space and numbers of staff in each program. Operating Expenses reflect those costs that are normal and customary, with the exception of the Resource Family Payment. This payment is based upon the county payment of$2500 per month guaranteed each month to the parent. The remaining fee of $5000 per month will be passed through to the parent, depending upon the daily bed occupancy for each home. These payment amounts are based on rates that require State approval on an annual basis and therefore may be subject to change. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 31 of 46 Budget Narrative— FY 24-25 (December 1, 2024—June 30, 2025) All other costs in this category are based upon historical costs and estimates. The total cost is $402,581. Child Related Expenses There is a total of$47,625 listed in this category. These costs are intended to cover costs that may be an extraordinary expense, when a new child enters the program, or a child has a specific situation causing the need to supplement the parent fee. $3,000 of this fund is dedicated to the Family Support Line, in the event that the child's family has an emergency so that we can assist. Special Expenses are primarily those costs associated with the Contract Psychiatrist and Nurse Consultant. These contractors will provide direct services to youth and consultation to the treatment team, as needed. Included in this section is a Peer Mentor to work with the youth, as needed. Also included in this section is the indirect cost calculated at 10% of total cost. These expenses total $185,278 for the year. Total Program Expense Summary Total Program Expense: $1,488,608 Mental Health Expense: $677,688 CWS Expense: $810,920 Combined Daily Rate: $1,020 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 32 of 46 FY 2025-2026(July 1,2025-June 30,2026) Budget Categories- Total Direct Budget Line Item Description(Must be itemized) FTE% Admin.-Direct Direct Total Direct PERSONNEL SALARIES: 0002 Administrator 0.20 17,850 17,850 0006 Program Director 0.50 63,000 63,000 0005 Clinical Director 0.50 55,125 55,125 0006 Program Supervisor 1.00 99,750 99,750 0007 Clinician 1.00 94,500 94,500 0008 Social Worker 0.50 39,375 39,375 0009 Counselors 4.00 252,000 252,000 0010 Lead Counselor 1.00 73,500 73,500 0012 Program Assistant 0.50 32,500 32,500 0013 Recruitment Specialist 0.50 31,500 31,500 0014 Permanency Specialist 1.00 68,250 68,250 0016 Health Information Specialist 0.50 34,125 34,125 Overnight/Overtime Stipends 12,500 12,500 SALARY TOTAL 11.20 $17,850 $856,125 $873,975 PAYROLLTAXES: 0030 OASDI 0031 FICA/MEDICARE 1,366 65,494 66,859 0032 SUI 536 25,684 26,219 PAYROLL TAX TOTAL $1,901 $91,177 $93,078 EMPLOYEE BENEFITS: 0040 Retirement 893 42,806 43,699 0041 Workers Compensation 250 59,929 60,179 0042 Health Insurance(medical,vision,life,dental) 1,517 72,771 74,288 EMPLOYEE BENEFITS TOTAL 31.04%1 $2,660 $175,506 $178,165 SALARY&BENEFITS GRAND TOTAL $22,411 $1,122,808 $1,145,219 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 31,500 31,500 1011 Rent/Lease Equipment 1,260 1,260 1012 Utilities 2,798 2,798 5,596 1013 Building Maintenance 4,095 4,095 8,190 1014 Equipment purchase/Lease FACILITY/EQUIPMENT TOTAL 1 $39,6531 $6,8931 $46,546 OPERATING EXPENSES: 1060 Telephone 11,995 11,995 1061 Accreditation 2,104 2,104 1062 Conference,Meetings,In-Service Training 23,940 23,940 1063 Dues, Membership,and Subscriptions 3,780 3,780 1064 Recruitment 27,300 27,300 1065 Licenses and Permits 3,150 3,150 1066 Office Supplies&printing 14,112 14,112 1067 Resource Family Payment Bed Fee @$2,500/month 120,000 120,000 1068 Resource Family Payment 240,000 240,000 1069 External Audit 2,520 2,520 1070 Professional Liability Insurance 1071 Transportation of Clients 40,425 40,425 1072 Computers&Software 1073 Furniture&Fixtures 7,875 7,500 1074 Respite $48,412 $48,412 OPERATING EXPENSES TOTAL $2,104 $543,509 $545,238 Exhibit C-2 Page 33 of 46 CHILDREN RELATED EXPENSES: 1080 Food 10,080 10,080 1081 Clothing 12,576 12,576 1082 Personal Incidentals 3,780 3,780 1083 School Supplies 2,520 2,520 1084 Outside Activities 5,040 5,040 1085 Child related transportation 7,875 7,875 1086 Internet Services - 1087 Supplies - 1088 Emergency Flex Funds 10,080 10,080 1089 Speicalized Treatment Supplies 5,250 5,250 1090 Medication Non-Medical 5,250 5,250 1091 Family Support 4,200 4,200 CHILD AND FAMILY RELATED SERVICES $0 $66,6511 $66,651 SPECIAL EXPENSES(Consultant/Etc.): 1092 Nurse Consultant 30,144 30,144 1093 Psychiatrist Consultant 30,240 30,240 1094 Peer Mentor(Certified) 9,450 9,450 1095 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs, Including HR, IT,Accounting,Prof.Liability,QA Leadership, Executive Leadership 187,349 187,349 SPECIAL EXPENSES TOTAL $257,1831 $257,183 FIXED ASSETS: 1196 Computers&Software 1197 Furniture&Fixtures 1198 Other-(Identify) FIXED ASSETS TOTAL $0 $0 TOTAL PROGRAM EXPENSESI $2,060,836 MEDI-CAL REVENUE: Service Provider Type Hours Hourly Rate $Amount Mental Health Services(Therapy) LPHA 686 $265.28 $182,088.19 Case Management(ICC) LPHA 541 $265.28 $143,516.48 Case Management(ICC) Other Qualified 1 291 $199.58 $58,077.78 Crisis Services LPHA 48 $265.28 $12,733.44 Medication Support Pyschiatrist 48 $1,019.30 $48,926.40 Plan Development Other Qualified 208 $199.58 $41,512.64 Assessment Other Qualified 480 $199.58 $95,798.40 Rehabilitation Other Qualified 1,411 $199.58 $281,639.31 Peer Support Peer Support S 260 $209.56 $54,485.60 IHBS Other Qualified 942 $199.58 $188,000.37 DIRECT MH SERVICE REVENUE $1,106,779 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL MENTAL HEALTH PROGRAM REVENUE1 $1,106,779 ESTIMATED NON MEDI-CAL BILLABLE COST 954,058 TOTAL ISFC PROGRAM COSTS $2,060,836 TOTAL DAILY FOSTER CARE STATE APPROVED IMC RATE Per Youth $ 535 ADDITIONAL DAILY ISFC COST $ 118 TOTAL MH DAILY RATE $ 758 Combined Daily Rate $ 1,412 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 34 of 46 Budget Narrative— FY 25-26 (July 1, 2025—June 30, 2026) The Promesa budget for Emergency Enhanced Intensive Services Foster Care (E-E-ISFC) is designed to successfully implement and support the goals of the E-E-ISFC program. The program will accept youth in need of short-term stabilization, followed by placement in a more permanent home setting. The expected length of stay will not exceed one month, unless there is an agreement between Fresno County and Promesa that an extension is in the best interests of the child and identified family. The treatment team will work with both the prospective family and the child, to ensure a smooth and lasting transition to the next placement setting. Payroll Expense The attached budget reflects the full annual salary of each staff, the title of each position, the FTE that will be provided and charged to the contract, identifies the Direct Administrative and Direct Program Costs, and the full annual amount paid for each position. This information is also available, and clearly presented, in the attached budget. The following section of this narrative will discuss the direct administrative and treatment team presented in this budget section. There is a total of 11.20 FTE. Administrative Team: This team will include the Program Administrator (0.2 FTE), Program Assistant (0.5 FTE). This team will work together to ensure that the administrative systems are in place to support the program team. This will include, but may not be limited to, ensuring that communications from the executive leadership team are shared in a timely manner and accurately delivered, that timesheets and requests for staff reimbursements are properly reviewed and submitted in a timely manner, that account payable invoices have been reviewed and submitted, that email questions referred to this team are resolved, and generally will ensure that reasonable support systems are in place. Treatment Team: This team includes the Program Director (0.5 FTE), Clinical Director (0.5 FTE), Program Supervisor (1.0 FTE), Clinician (1.0 FTE) Social Worker (0.5 FTE), BA Level Counselors (4.0 FTE, which includes 2.0 FTE dedicated to awake overnight in the event a youth is in need of supervision), Lead Counselor (1.0 FTE), Recruitment Specialist (0.5 FTE), Permanency Specialist (1.0 FTE), and a Health Information Specialist (0.5 FTE) responsible for the review and accurate billing of all Medi-Cal Services. Leadership Treatment Team: This includes the Program Director, Clinical Director, and the Program Supervisor. This team will work together to ensure that the Treatment Team is meeting its goals and operating as effectively and efficiently as possible. The Program Assistant (0.5 FTE) and the Health Information Specialist will work with this team as required and provide support as needed. The Program Director bears responsibility for the entire E-E-ISFC program and works closely with the Leadership Team to ensure that this unit operates as a cohesive unit. The Director will meet with this team at least weekly and as needed, delegate when necessary, ensure that all CCL Licensing and Mental Health regulations are followed, liaison with HR staff as needed, EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 35 of 46 Budget Narrative— FY 25-26 (July 1, 2025—June 30, 2026) conduct trainings with staff when necessary, meet and participate in any functions with county staff as requested, and generally ensure that the program is well staffed, grounded and serving the youth and families to the best of their ability. The Director will supervise the members of the Leadership team, including the Program Assistant and the Health Information Specialist. The Clinical Director is responsible for the Clinician and as well as the direction and implementation of the clinical program. The Clinical Director will ensure that the Medi-Cal program is in compliance with the standards, that clinical staff understand the Medi-Cal service continuum and that the required documentation is completed accurately and on time. This includes daily notes as well as initial treatment plans and assessments as required. The Clinician will implement the treatment plan, and report to the Clinical Director. Social Work type services may also be provided by the clinician, but mental health services will be documented and invoiced on a daily basis. The Permanency Specialist will work with the clinician, youth and prospective resource parents so that the youth will be able to transition as smoothly as possible. The Permanency Specialist will report to the Clinical Director. The Program Supervisor is responsible for the day-to-day operations. It is anticipated that the majority of their time will be working in the houses, meeting and/or working with the counselors, parents and youth in the program. These Supervisors will be either master level, or very senior counselors with the skills required to program solve and work effectively with the counselors and house parents and youth. The Clinician and Social Worker will work with treatment team, youth, foster resource parent and prospective resource parents to ensure that the needs of each are processed and resolved. Benefits include both mandated and discretionary benefits, as broken out in the budget. The overall benefit ration in 31.4% of payroll expense. This includes FICA, SUI, Retirement contribution, Workers Compensation and Health, Vision, Life and Dental Insurance. Total Payroll and Benefits is: $1,145,219 Facilities/Equipment Expense includes an office lease, minor equipment expense, utilities and Building Maintenance. The total cost is $46,546. Office lease is allocated to this contract for FY 25-26 at $31,500, Leased equipment is $1,260, Utilities is budgeted at $5,596 and Building Maintenance at $8,190. These costs are allocated to this contract based upon square footage of total space and numbers of staff in each program. Operating Expenses reflect those costs that are normal and customary, with the exception of the Resource Family Payment. This payment is based upon the county payment of$2500 per month guaranteed each month to the parent. The remaining fee of $5000 per month will be passed through to the parent, depending upon the daily bed occupancy for each home. These payment amounts are based on rates that require State approval on an annual basis and therefore may be subject to change. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 36 of 46 Budget Narrative— FY 25-26 (July 1, 2025—June 30, 2026) All other costs in this category are based upon historical costs and estimates. The total cost is $545,238. Child Related Expenses There is a total of$66,651 listed in this category. These costs are intended to cover costs that may be an extraordinary expense, when a new child enters the program, or a child has a specific situation causing the need to supplement the parent fee. $4,200 of this fund is dedicated to the Family Support Line, in the event that the child's family has an emergency so that we can assist. Special Expenses are primarily those costs associated with the Contract Psychiatrist and Nurse Consultant. These contractors will provide direct services to youth and consultation to the treatment team, as needed. Included in this section is a Peer Mentor to work with the youth, as needed. Also included in this section is the indirect cost calculated at 10% of total cost. These expenses total $257,183 for the year. Total Program Expense Summary Total Program Expense: $2,060,836 Mental Health Expense: $1,106,779 CWS Expense: $954,058 Combined Daily Rate: $1,412 Attachment C 5 of 8 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 37 of 46 FY 2026-2027(July 1,2026-June 30,2027) Budget Categories- Total Direct Budget Line Item Description(Must be itemized) FTE% Admin.-Direct Direct Total Direct PERSONNEL SALARIES: 0002 Administrator 0.20 18,743 18,743 0006 Program Director 0.50 66,150 66,150 0005 Clinical Director 0.50 57,881 57,881 0006 Program Supervisor 1.00 104,738 104,738 0007 Clinician 1.00 99,225 99,225 0008 Social Worker 0.50 41,344 41,344 0009 Counselors 4.00 264,600 264,600 0010 Lead Counselor 1.00 77,175 77,175 0012 Program Assistant 0.50 35,831 35,831 0013 Recruitment Specialist 0.50 33,075 33,075 0014 Permanency Specialist 1.00 71,663 71,663 0016 Health Information Specialist 0.50 35,831 35,831 Overnight/Overtime Stipends 13,125 13,125 SALARY TOTAL 11.20 $18,743 $900,638 $919,380 PAYROLL TAXES: 0030 OASDI 0031 FICA/MEDICARE 1,434 68,899 70,333 0032 SUI 562 27,019 27,581 PAYROLL TAX TOTAL $1,996 $95,918 $97,914 EMPLOYEE BENEFITS: 0040 Retirement 937 45,032 45,969 0041 Workers Compensation 262 63,045 63,307 0042 Health Insurance(medical,vision,life,dental) 1,593 76,554 78,147 EMPLOYEE BENEFITS TOTAL 31.04%1 $2,7931 $184,631 $187,42-1 SALARY&BENEFITS GRAND TOTAL $23,531 $1,181,186 $1,204,717 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 33,075 33,075 1011 Rent/Lease Equipment 1,323 1,323 1012 Utilities 2,931 2,931 5,862 1013 Building Maintenance 4,300 4,300 8,600 1014 Equipment purchase/Lease FACILITY/EQUIPMENT TOTAL 1 $41,6291 $7,2311 $48,860 OPERATING EXPENSES: 1060 Telephone 12,499 12,499 1061 Accreditation 2,210 2,210 1062 Conference,Meetings,In-Service Training 25,126 25,126 1063 Dues, Membership,and Subscriptions 3,969 3,969 1064 Recruitment 28,665 28,665 1065 Licenses and Permits 3,307 3,307 1066 Office Supplies&printing 14,784 14,784 1067 Resource Family Payment Bed Fee @$2,500/month 120,000 120,000 1068 Resource Family Payment 240,000 240,000 1069 External Audit 2,646 2,646 1070 Professional Liability Insurance 1071 Transportation of Clients 42,446 42,446 1072 Computers&Software 1073 Furniture&Fixtures 8,269 8,269 1074 Respite $52,061 $52,061 OPERATING EXPENSES TOTAL $2,210 $553,772 $555,982 Attachment C 6 of 8 Exhibit C-2 Page 38 of 46 CHILDREN RELATED EXPENSES: 1080 Food 10,584 10,584 1081 Clothing 13,152 13,152 1082 Personal Incidentals 3,969 3,969 1083 School Supplies 2,646 2,646 1084 Outside Activities 5,292 5,292 1085 Child related transportation 8,269 8,269 1086 Internet Services - 1087 Supplies - 1088 Emergency Flex Funds 10,560 10,560 1089 Speicalized Treatment Supplies 5,513 5,513 1090 Medication Non-Medical 5,513 5,513 1091 Family Support 4,410 4,410 CHILD AND FAMILY RELATED SERVICES $0 $69,9081 $69,908 SPECIAL EXPENSES(Consultant/Etc.): 1092 Nurse Consultant 31,488 31,488 1093 Psychiatrist Consultant 31,680 31,680 1094 Peer Mentor(Certified) 9,923 9,923 1095 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs, Including HR, IT,Accounting,Prof.Liability,QA Leadership, Executive Leadership 195,256 195,256 SPECIAL EXPENSES TOTAL $268,3471 $268,347 FIXED ASSETS: 1196 Computers&Software 1197 Furniture&Fixtures 1198 Other-(Identify) FIXED ASSETS TOTAL $0 $0 TOTAL PROGRAM EXPENSESI $2,147,814 MEDI-CAL REVENUE: Service Provider Type Hours Hourly Rate $Amount Mental Health Services(Therapy) LPHA 718 $265.28 $190,364.93 Case Management(ICC) LPHA 545 $265.28 $144,577.60 Case Management(ICC) Other Qualified 1 297 $199.58 $59,275.26 Crisis Services LPHA 48 $265.28 $12,733.44 Medication Support Pyschiatrist 48 $1,019.30 $48,926.40 Plan Development Other Qualified 208 $199.58 $41,512.64 Assessment Other Qualified 480 $199.58 $95,798.40 Rehabilitation Other Qualified 1,593 $199.58 $317,958.88 Peer Support Peer Support S 260 $209.56 $54,485.60 IHBS Other Qualified 992 $199.58 $197,963.40 DIRECT MH SERVICE REVENUE $1,163,597 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL MENTAL HEALTH PROGRAM REVENUEJ $1,163,597 ESTIMATED NON MEDI-CAL BILLABLE COST 984,217 TOTAL ISFC PROGRAM COSTS $2,147,814 TOTAL DAILY FOSTER CARE STATE APPROVED IMC RATE Per Youth $ 535 ADDITIONAL DAILY ISFC COST $ 139 TOTAL MH DAILY RATE $ 797 Combined Daily Rate $ 1,471 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 39 of 46 Budget Narrative— FY 26-27 (July 1, 2026—June 30, 2027) The Promesa budget for Emergency Enhanced Intensive Services Foster Care (E-E-ISFC) is designed to successfully implement and support the goals of the E-E-ISFC program. The program will accept youth in need of short-term stabilization, followed by placement in a more permanent home setting. The expected length of stay will not exceed one month, unless there is an agreement between Fresno County and Promesa that an extension is in the best interests of the child and identified family. The treatment team will work with both the prospective family and the child, to ensure a smooth and lasting transition to the next placement setting. Payroll Expense The attached budget reflects the full annual salary of each staff, the title of each position, the FTE that will be provided and charged to the contract, identifies the Direct Administrative and Direct Program Costs, and the full annual amount paid for each position. This information is also available, and clearly presented, in the attached budget. The following section of this narrative will discuss the direct administrative and treatment team presented in this budget section. There is a total of 11.20 FTE. Administrative Team: This team will include the Program Administrator (0.2 FTE), Program Assistant (0.5 FTE). This team will work together to ensure that the administrative systems are in place to support the program team. This will include, but may not be limited to, ensuring that communications from the executive leadership team are shared in a timely manner and accurately delivered, that timesheets and requests for staff reimbursements are properly reviewed and submitted in a timely manner, that account payable invoices have been reviewed and submitted, that email questions referred to this team are resolved, and generally will ensure that reasonable support systems are in place. Treatment Team: This team includes the Program Director (0.5 FTE), Clinical Director (0.5 FTE), Program Supervisor (1.0 FTE), Clinician (1.0 FTE) Social Worker (0.5 FTE), BA Level Counselors (4.0 FTE, which includes 2.0 FTE dedicated to awake overnight in the event a youth is in need of supervision), Lead Counselor (1.0 FTE), Recruitment Specialist (0.5 FTE), Permanency Specialist (1.0 FTE), and a Health Information Specialist (0.5 FTE) responsible for the review and accurate billing of all Medi-Cal Services. Leadership Treatment Team: This includes the Program Director, Clinical Director, and the Program Supervisor. This team will work together to ensure that the Treatment Team is meeting its goals and operating as effectively and efficiently as possible. The Program Assistant (0.5 FTE) and the Health Information Specialist will work with this team as required and provide support as needed. The Program Director bears responsibility for the entire E-E-ISFC program and works closely with the Leadership Team to ensure that this unit operates as a cohesive unit. The Director will meet with this team at least weekly and as needed, delegate when necessary, ensure that all CCL Licensing and Mental Health regulations are followed, liaison with HR staff as needed, EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 40 of 46 Budget Narrative— FY 26-27 (July 1, 2026—June 30, 2027) conduct trainings with staff when necessary, meet and participate in any functions with county staff as requested, and generally ensure that the program is well staffed, grounded and serving the youth and families to the best of their ability. The Director will supervise the members of the Leadership team, including the Program Assistant and the Health Information Specialist. The Clinical Director is responsible for the Clinician and as well as the direction and implementation of the clinical program. The Clinical Director will ensure that the Medi-Cal program is in compliance with the standards, that clinical staff understand the Medi-Cal service continuum and that the required documentation is completed accurately and on time. This includes daily notes as well as initial treatment plans and assessments as required. The Clinician will implement the treatment plan, and report to the Clinical Director. Social Work type services may also be provided by the clinician, but mental health services will be documented and invoiced on a daily basis. The Permanency Specialist will work with the clinician, youth and prospective resource parents so that the youth will be able to transition as smoothly as possible. The Permanency Specialist will report to the Clinical Director. The Program Supervisor is responsible for the day-to-day operations. It is anticipated that the majority of their time will be working in the houses, meeting and/or working with the counselors, parents and youth in the program. These Supervisors will be either master level, or very senior counselors with the skills required to program solve and work effectively with the counselors and house parents and youth. The Clinician and Social Worker will work with treatment team, youth, foster resource parent and prospective resource parents to ensure that the needs of each are processed and resolved. Benefits include both mandated and discretionary benefits, as broken out in the budget. The overall benefit ration in 31.4% of payroll expense. This includes FICA, SUI, Retirement contribution, Workers Compensation and Health, Vision, Life and Dental Insurance. Total Payroll and Benefits is: $1,204,717 Facilities/Equipment Expense includes an office lease, minor equipment expense, utilities and Building Maintenance. The total cost is $48,860. Office lease is allocated to this contract for FY 26-27 at $33,075, Leased equipment is $1,323, Utilities is budgeted at $5,682 and Building Maintenance at $8,600. These costs are allocated to this contract based upon square footage of total space and numbers of staff in each program. Operating Expenses reflect those costs that are normal and customary, with the exception of the Resource Family Payment. This payment is based upon the county payment of$2500 per month guaranteed each month to the parent. The remaining fee of $5000 per month will be passed through to the parent, depending upon the daily bed occupancy for each home. These payment amounts are based on rates that require State approval on an annual basis and therefore may be subject to change. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 41 of 46 Budget Narrative— FY 26-27 (July 1, 2026—June 30, 2027) All other costs in this category are based upon historical costs and estimates. The total cost is $55,982. Child Related Expenses There is a total of$69,908 listed in this category. These costs are intended to cover costs that may be an extraordinary expense, when a new child enters the program, or a child has a specific situation causing the need to supplement the parent fee. $4,410 of this fund is dedicated to the Family Support Line, in the event that the child's family has an emergency so that we can assist. Special Expenses are primarily those costs associated with the Contract Psychiatrist and Nurse Consultant. These contractors will provide direct services to youth and consultation to the treatment team, as needed. Included in this section is a Peer Mentor to work with the youth, as needed. Also included in this section is the indirect cost calculated at 10% of total cost. These expenses total $268,347 for the year. Total Program Expense Summary Total Program Expense: $2,147,814 Mental Health Expense: $1,163,597 CWS Expense: $984,217 Combined Daily Rate: $1,471 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 42 of 46 FY 2027-2028(July 1,2027-June 30,2028) Budget Categories- Total Direct Budget Line Item Description(Must be itemized) FTE% Admin.-Direct Direct Total Direct PERSONNEL SALARIES: 0002 Administrator 0.20 19,680 19,680 0006 Program Director 0.50 69,458 69,458 0005 Clinical Director 0.50 60,776 60,776 0006 Program Supervisor 1.00 109,974 109,974 0007 Clinician 1.00 104,186 104,186 0008 Social Worker 0.50 43,411 43,411 0009 Counselors 4.00 277,832 277,832 0010 Lead Counselor 1.00 81,034 81,034 0012 Program Assistant 0.50 37,623 37,623 0013 Recruitment Specialist 0.50 34,729 34,729 0014 Permanency Specialist 1.00 75,246 75,246 0016 Health Information Specialist 0.50 37,623 37,623 Overnight/Overtime Stipends 13,125 13,125 SALARY TOTAL 11.20 $19,680 $945,016 $964,696 PAYROLL TAXES: 0030 OASDI 0031 FICA/MEDICARE 1,505 72,294 73,799 0032 SUI 590 28,350 28,941 PAYROLL TAX TOTAL $2,096 $100,644 $102,740 EMPLOYEE BENEFITS: 0040 Retirement 984 47,251 48,235 0041 Workers Compensation 276 66,151 66,427 0042 Health Insurance(medical,vision,life,dental) 1,673 80,326 81,999 EMPLOYEE BENEFITS TOTAL 31.04%1 $2,9321 $193,728 $196,661 SALARY&BENEFITS GRAND TOTAL $24,708 $1,239,388 $1,264,096 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building 34,728 34,728 1011 Rent/Lease Equipment 1,389 1,389 1012 Utilities 3,078 3,078 6,156 1013 Building Maintenance 4,514 4,514 9,028 1014 Equipment purchase/Lease FACILITY/EQUIPMENT TOTAL 1 $43,7091 $7,5921 $51,301 OPERATING EXPENSES: 1060 Telephone 13,171 13,171 1061 Accreditation 2,319 2,319 1062 Conference,Meetings,In-Service Training 26,387 26,387 1063 Dues, Membership,and Subscriptions 4,167 4,167 1064 Recruitment 30,098 30,098 1065 Licenses and Permits 3,473 3,473 1066 Office Supplies&printing 15,456 15,456 1067 Resource Family Payment Bed Fee @$2,500/month 120,000 120,000 1068 Resource Family Payment 240,000 240,000 1069 External Audit 2,778 2,778 1070 Professional Liability Insurance 1071 Transportation of Clients 44,568 44,568 1072 Computers&Software 1073 Furniture&Fixtures 8,682 8,682 1074 Respite $48,412 $48,412 OPERATING EXPENSES TOTAL $2,319 $557,192 $559,511 Exhibit C-2 Page 43 of 46 CHILDREN RELATED EXPENSES: 1080 Food 11,113 11,113 1081 Clothing 13,824 13,824 1082 Personal Incidentals 4,167 4,167 1083 School Supplies 2,778 2,778 1084 Outside Activities 5,556 5,556 1085 Child related transportation 8,862 8,862 1086 Internet Services - 1087 Supplies - 1088 Emergency Flex Funds 11,088 11,088 1089 Speicalized Treatment Supplies 5,788 5,788 1090 Medication Non-Medical 5,788 5,788 1091 Family Support 4,630 4,630 CHILD AND FAMILY RELATED SERVICES $0 $73,5941 $73,594 SPECIAL EXPENSES(Consultant/Etc.): 1092 Nurse Consultant 33,216 33,216 1093 Psychiatrist Consultant 33,312 33,312 1094 Peer Mentor(Certified) 10,418 10,418 1095 Allocable Overhead-includes Staff and Associated Exp.that benefit all programs, Including HR, IT,Accounting,Prof.Liability,QA Leadership, Executive Leadership 202,545 202,545 SPECIAL EXPENSES TOTAL $279,491 $279,491 FIXED ASSETS: 1196 Computers&Software 1197 Furniture&Fixtures 1198 Other-(Identify) FIXED ASSETS TOTAL $0 $0 TOTAL PROGRAM EXPENSESI $2,227,993 MEDI-CAL REVENUE: Service Provider Type Hours Hourly Rate $Amount Mental Health Services(Therapy) LPHA 718 $265.28 $190,364.93 Case Management(ICC) LPHA 674 $265.28 $178,798.72 Case Management(ICC) Other Qualified 1 363 $199.58 $72,447.54 Crisis Services LPHA 48 $265.28 $12,733.44 Medication Support Pyschiatrist 48 $1,019.30 $48,926.40 Plan Development Other Qualified 208 $199.58 $41,512.64 Assessment Other Qualified 480 $199.58 $95,798.40 Rehabilitation Other Qualified 1,560 $199.58 $311,372.74 Peer Support Peer Support S 260 $209.56 $54,485.60 IHBS Other Qualified 992 $199.58 $197,963.40 DIRECT MH SERVICE REVENUE $1,204,404 OTHER REVENUE: 4000 Other-(Identify) 4100 Other-(Identify) 4200 Other-(Identify) 4300 Other-(Identify) OTHER REVENUE TOTAL TOTAL MENTAL HEALTH PROGRAM REVENUE1 $1,204,404 ESTIMATED NON MEDI-CAL BILLABLE COST 1,023,590 TOTAL ISFC PROGRAM COSTS $2,227,993 TOTAL DAILY FOSTER CARE STATE APPROVED IMC RATE Per Youth $ 535 ADDITIONAL DAILY ISFC COST $ 166 TOTAL MH DAILY RATE $ 825 Combined Daily Rate $ 1,526 EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 44 of 46 Budget Narrative— FY 27-28 (July 1, 2027—June 30, 2028) The Promesa budget for Emergency Enhanced Intensive Services Foster Care (E-E-ISFC) is designed to successfully implement and support the goals of the E-E-ISFC program. The program will accept youth in need of short-term stabilization, followed by placement in a more permanent home setting. The expected length of stay will not exceed one month, unless there is an agreement between Fresno County and Promesa that an extension is in the best interests of the child and identified family. The treatment team will work with both the prospective family and the child, to ensure a smooth and lasting transition to the next placement setting. Payroll Expense The attached budget reflects the full annual salary of each staff, the title of each position, the FTE that will be provided and charged to the contract, identifies the Direct Administrative and Direct Program Costs, and the full annual amount paid for each position. This information is also available, and clearly presented, in the attached budget. The following section of this narrative will discuss the direct administrative and treatment team presented in this budget section. There is a total of 11.20 FTE. Administrative Team: This team will include the Program Administrator (0.2 FTE), Program Assistant (0.5 FTE). This team will work together to ensure that the administrative systems are in place to support the program team. This will include, but may not be limited to, ensuring that communications from the executive leadership team are shared in a timely manner and accurately delivered, that timesheets and requests for staff reimbursements are properly reviewed and submitted in a timely manner, that account payable invoices have been reviewed and submitted, that email questions referred to this team are resolved, and generally will ensure that reasonable support systems are in place. Treatment Team: This team includes the Program Director (0.5 FTE), Clinical Director (0.5 FTE), Program Supervisor (1.0 FTE), Clinician (1.0 FTE) Social Worker (0.5 FTE), BA Level Counselors (4.0 FTE, which includes 2.0 FTE dedicated to awake overnight in the event a youth is in need of supervision), Lead Counselor (1.0 FTE), Recruitment Specialist (0.5 FTE), Permanency Specialist (1.0 FTE), and a Health Information Specialist (0.5 FTE) responsible for the review and accurate billing of all Medi-Cal Services. Leadership Treatment Team: This includes the Program Director, Clinical Director, and the Program Supervisor. This team will work together to ensure that the Treatment Team is meeting its goals and operating as effectively and efficiently as possible. The Program Assistant (0.5 FTE) and the Health Information Specialist will work with this team as required and provide support as needed. The Program Director bears responsibility for the entire E-E-ISFC program and works closely with the Leadership Team to ensure that this unit operates as a cohesive unit. The Director will meet with this team at least weekly and as needed, delegate when necessary, ensure that all CCL Licensing and Mental Health regulations are followed, liaison with HR staff as needed, EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 45 of 46 Budget Narrative— FY 27-28 (July 1, 2027—June 30, 2028) conduct trainings with staff when necessary, meet and participate in any functions with county staff as requested, and generally ensure that the program is well staffed, grounded and serving the youth and families to the best of their ability. The Director will supervise the members of the Leadership team, including the Program Assistant and the Health Information Specialist. The Clinical Director is responsible for the Clinician and as well as the direction and implementation of the clinical program. The Clinical Director will ensure that the Medi-Cal program is in compliance with the standards, that clinical staff understand the Medi-Cal service continuum and that the required documentation is completed accurately and on time. This includes daily notes as well as initial treatment plans and assessments as required. The Clinician will implement the treatment plan, and report to the Clinical Director. Social Work type services may also be provided by the clinician, but mental health services will be documented and invoiced on a daily basis. The Permanency Specialist will work with the clinician, youth and prospective resource parents so that the youth will be able to transition as smoothly as possible. The Permanency Specialist will report to the Clinical Director. The Program Supervisor is responsible for the day-to-day operations. It is anticipated that the majority of their time will be working in the houses, meeting and/or working with the counselors, parents and youth in the program. These Supervisors will be either master level, or very senior counselors with the skills required to program solve and work effectively with the counselors and house parents and youth. The Clinician and Social Worker will work with treatment team, youth, foster resource parent and prospective resource parents to ensure that the needs of each are processed and resolved. Benefits include both mandated and discretionary benefits, as broken out in the budget. The overall benefit ration in 31.4% of payroll expense. This includes FICA, SUI, Retirement contribution, Workers Compensation and Health, Vision, Life and Dental Insurance. Total Payroll and Benefits is: $1,264,096 Facilities/Equipment Expense includes an office lease, minor equipment expense, utilities and Building Maintenance. The total cost is $51 ,301. Office lease is allocated to this contract for FY 27-28 at $34,728, Leased equipment is $1,389, Utilities is budgeted at $6,156 and Building Maintenance at $9,028. These costs are allocated to this contract based upon square footage of total space and numbers of staff in each program. Operating Expenses reflect those costs that are normal and customary, with the exception of the Resource Family Payment. This payment is based upon the county payment of$2500 per month guaranteed each month to the parent. The remaining fee of $5000 per month will be passed through to the parent, depending upon the daily bed occupancy for each home. These payment amounts are based on rates that require State approval on an annual basis and therefore may be subject to change. EMERGENCY ENHANCED INTENSIVE SERVICES FOSTER CARE Exhibit C-2 Promesa Behavioral Health Page 46 of 46 Budget Narrative— FY 27-28 (July 1, 2027—June 30, 2028) All other costs in this category are based upon historical costs and estimates. The total cost is $559,511. Child Related Expenses There is a total of$73,594 listed in this category. These costs are intended to cover costs that may be an extraordinary expense, when a new child enters the program, or a child has a specific situation causing the need to supplement the parent fee. $4,630 of this fund is dedicated to the Family Support Line, in the event that the child's family has an emergency so that we can assist. Special Expenses are primarily those costs associated with the Contract Psychiatrist and Nurse Consultant. These contractors will provide direct services to youth and consultation to the treatment team, as needed. Included in this section is a Peer Mentor to work with the youth, as needed. Also included in this section is the indirect cost calculated at 10% of total cost. These expenses total $279,491 for the year. Total Program Expense Summary Total Program Expense: $2,227,993 Mental Health Expense: $1,204,404 CWS Expense: $1,023,590 Combined Daily Rate: $1,526 Exhibit D 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. D-1 Exhibit D 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. D-2 Exhibit D 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 D-3 Exhibit D 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 M0410), 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 M 0411). 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. D-4 Exhibit D 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. D-5 Exhibit D 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. D-6 Exhibit D CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM) REQUIREMENTS 1. SERVICES AND ACCESS PROVISIONS a. CERTIFICATION OF ELIGIBILITY i. Contractor will, in cooperation with County, comply with Section 14705.5 of California Welfare and Institutions Code to obtain a certification of an individual's eligibility for Specialty Mental Health Services (SMHS) under Medi-Cal. b. ACCESS TO SPECIALTY MENTAL HEALTH SERVICES i. In collaboration with the County, Contractor will work to ensure that individuals to whom the Contractor provides SMHS meet access criteria, as per Department of Health Care Services (DHCS) guidance specified in BHIN 21-073. Specifically, the Contractor will ensure that the clinical record for each individual includes information as a whole indicating that individual's presentation and needs are aligned with the criteria applicable to their age at the time of service provision as specified below. ii. For enrolled individuals under 21 years of age, Contractor shall provide all medically necessary SMHS required pursuant to Section 1396d(r) of Title 42 of the United States Code. Covered SMHS shall be provided to enrolled individuals who meet either of the following criteria, (1) or (II) below. If an individual under age 21 meets the criteria as described in (1) below, the beneficiary meets criteria to access SMHS; it is not necessary to establish that the beneficiary also meets the criteria in (b) below. 1. The individual has a condition placing them at high risk for a mental health disorder due to experience of trauma evidenced by any of the following: scoring in the high-risk range under a trauma screening tool approved by DHCS, involvement in the child welfare system, juvenile justice involvement, or experiencing homelessness. OR 2. The individual has at least one of the following: a. A significant impairment b. A reasonable probability of significant deterioration in an important area of life functioning c. A reasonable probability of not progressing developmentally as appropriate. d. A need for SMHS, regardless of presence of impairment, that are not included within the mental health benefits that a Medi-Cal Managed Care Plan (MCP) is required to provide. AND the individual's condition as described in subparagraph (II a-d) above is due to one of the following: D-7 Exhibit D 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 D-8 Exhibit D 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 D-9 Exhibit D 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. D-10 Exhibit D 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 individuals aged 6 through 21, 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, D-11 Exhibit D Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) U.S. Edition, September 2022 Release, and ICD- 10-CM 2023. iii. A problem identified during a service encounter may be addressed by the service provider during that service encounter and subsequently added to the problem list. iv. The problem list shall include, but is not limited to, all elements specified in BHIN 22-019. v. County does not require the problem list to be updated within a specific timeframe or have a requirement about how frequently the problem list should be updated after a problem has initially been added. However, Contractor shall update the problem list within a reasonable time such that the problem list reflects the current issues facing the client, in accordance with generally accepted standards of practice and in specific circumstances specified in BHIN 22-019. f. TREATMENT AND CARE PLANS i. Contractor is not required to complete treatment or care plans for clients under this Agreement, except in the circumstances specified in BHIN 22-019 and additional guidance from DHCS that may follow after execution of this Agreement. g. PROGRESS NOTES i. Contractor shall create progress notes for the provision of all SMHS services provided under this Agreement. ii. Each progress note shall provide sufficient detail to support the service code selected for the service type as indicated by the service code description. iii. Progress notes shall include all elements specified in BHIN 22- 019, whether the note be for an individual or a group service. iv. Contractor shall complete progress notes within three business days of providing a service, with the exception of notes for crisis services, which shall be completed within 24 hours. v. Providers shall complete a daily progress note for services that are billed on a daily basis, such as residential and day treatment services, if applicable. h. TRANSITION OF CARE TOOL i. Contractor shall use a Transition of Care Tool for any individual whose existing services will be transferred from Contractor to an Medi-Cal Managed Care Plan (MCP) provider or when NSMHS will be added to the existing mental health treatment provided by Contractor, as specified in BHIN 22-065, in order to ensure continuity of care. ii. Determinations to transition care or add services from an MCP shall be made in alignment with County policies and via a person- centered, shared decision-making process. iii. Contractor may directly use the DHCS-provided Transition of Care Tool, found at https://www.dhcs.ca.gov/Pages/Screening-and- D-12 Exhibit D 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.ciov/r)rovgovr)art/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. D-13 Exhibit D 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. D-14 Exhibit D 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 County's 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. D-15 Exhibit D 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. D-16 Exhibit D 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 PI 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 PI 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 D-17 Exhibit D 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. D-18 Exhibit E 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 E-1 Exhibit E 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 E-2 Exhibit E 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 E-3 Exhibit E 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 C-E Exhibit F DOCUMENTATION STANDARDS FOR PERSON SERVED RECORDS The documentation standards are described below under key topics related to care for persons served. All standards must be addressed in the person served's record; however, there is no requirement that the record have a specific document or section addressing these topics. All medical records shall be maintained for a minimum of 10 years from the date of the end of the Agreement. A. Assessments 1. The following areas will be included as a part of a comprehensive person served's record: • Presenting problems, including impairments in function, and current mental status exam. • Traumatic incidents which include trauma exposures, trauma reactions, trauma screenings, and systems involvement if relevant • Behavioral health history including mental health history, substance use/abuse, and previous services • Medical history including physical health conditions, medications, and developmental history • Psychosocial factors including family, social and life circumstances, cultural considerations • Strengths, risks, and protective factors, including safety planning • Clinical summary, treatment recommendations, and level of care determination including diagnostic and clinical impression with a diagnosis • The assessment shall include a typed or legibly printed name, signature of the service provider and date of signature. 2. Timeliness/Frequency Standard for Assessment • The time period to complete an initial assessment and subsequent assessments for SMHS is up to clinical discretion. • Assessments shall be completed within a reasonable time and in accordance with generally accepted standards of practice. B. Problem list The use of a Problem List has largely replaced the use of treatment plans and is therefore required to be part of the person served's record. The problem list shall be updated on an ongoing basis to reflect the current presentation of the person in care. The problem list shall include, but is not limited to, the following: • Diagnoses identified by a provider acting within their scope of practice • Problems identified by a provider acting within their scope of practice • Problems or illnesses identified by the person in care and/or significant support person if any • The name and title of the provider that identified, added, or removed the problem, and the date the problem was identified, added, or removed Rev 04/2023 F-1 Exhibit F C. Treatment and Care Plan Requirements 1. Targeted Case Management • Specifies the goals, treatment, service activities, and assistance to address the negotiated objectives of the plan and the medical, social, educational, and other services needed by the person in care • Identifies a course of action to respond to the assessed needs of the person in care • Includes development of a transition plan when the person in care has achieved the goals of the care plan • Peer support services must be based on an approved care plan • Must be provided in a narrative format in the person's progress notes • Updated at least annually 2. Services requiring Treatments Plans • Intensive Home-Based Services (IHBS) • Intensive Care Coordination (ICC) • Therapeutic Behavioral Services (TBS) • Must have specific observable and/or specific quantifiable goals • Must identify the proposed type(s) of intervention • Must be signed (or electronic equivalent) by: ➢ the person providing the service(s), or ➢ a person representing a team or program providing services, or ➢ a person representing the MHP providing services ➢ when the person served's plan is used to establish that the services are provided under the direction of an approved category of staff, and if the below staff are not the approved category, ➢ a physician ➢ a licensed/ "waivered" psychologist ➢ a licensed/"associate" social worker ➢ a licensed/ registered/marriage and family therapist or ➢ a registered nurse • In addition, ➢ Person served's plans will be consistent with the diagnosis, and the focus of intervention will be consistent with the person served's plan goals, and there will be documentation of the person served's participation in and agreement with the plan. Examples of the documentation include, but are not limited to, reference to the person served's participation and agreement in the body of the plan, person served's signature on the plan, or a description of the person served's participation and agreement in progress notes. ➢ Person served's signature on the plan will be used as the means by which the Contractor documents the participation of the person served. When the person served's signature is required on the person served's plan and the person Rev 04/2023 F-2 Exhibit F served refuses or is unavailable for signature, the person served's plan will include a written explanation of the refusal or unavailability. ➢ The Contractor will give a copy of the person served's plan to the person served on request. D. Progress Notes 1. Providers shall create progress notes for the provision of all SMHS. Each progress note shall provide sufficient detail to support the service code selected for the service type as indicated by the service code description. Progress notes shall include: • The type of service rendered. • A narrative describing the service, including how the service addressed the beneficiary's behavioral health need (e.g., symptom, condition, diagnosis, and/or risk factors). • The date that the service was provided to the beneficiary. • Duration of the service, including travel and documentation time. • Location of the beneficiary at the time of receiving the service. • A typed or legibly printed name, signature of the service provider and date of signature. • ICD 10 code • Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code. • Next steps including, but not limited to, planned action steps by the provider or by the beneficiary, collaboration with the beneficiary, collaboration with other provider(s) and any update to the problem list as appropriate. 2. Timeliness/Frequency of Progress Notes • Progress notes shall be completed within 3 business days of providing a service, except for notes for crisis services, which shall be completed within 24 hours. • A note must be completed for every service contact Rev 04/2023 F-3 Exhibit G coU epartment of Behavioral Health Policy and Procedure Guide O 1856 O FRESH 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 td,wenwi illness ond/ai substance use diso,dej s th,augh cultivation of st,ength.tow.,d pnormatft I ECOVe,V it,th-le-V I_t.ictim enzkann2ent Template Review Date 3128116 1 � age G-1 Exhibit G coWU��� ��epartment of Behavioral Health . Policy and Procedure Guide 0 185�0 FRE`� 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. 21 G-2 Exhibit G coWU��� ��epartment of Behavioral Health . Policy and Procedure Guide 0 185�0 FRE`� 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 � G-3 Exhibit H Insurance Requirements 1. Required Policies Without limiting the County's right to obtain indemnification from the Contractor(s) or any third parties, Contractor(s), 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(s) 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(s) 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(s) 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, 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(s). H-1 Exhibit H Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security Breach, which may include Disclosure of Personal Information to an Unauthorized Third Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under [identify the Article, section, or exhibit containing data security obligations] of this Agreement; (iv) system failure; (v) data recovery; (vi) failure to timely disclose data breach or Security Breach; (vii) failure to comply with privacy policy; (viii) payment card liabilities and costs; (ix) infringement of intellectual property, including but not limited to infringement of copyright, trademark, and trade dress; (x) invasion of privacy, including release of private information; (xi) information theft; (xii) damage to or destruction 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. (i) 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. (ii) The technology professional liability insurance certificate must also state that coverage encompasses all of the Contractor's obligations under this Agreement, including but not limited to claims involving Cyber Risks, as that term is defined in this Agreement. (iii) 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(s). (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(s) 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(s) 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(s) 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(s) or its insurer to timely provide a written notice required by this paragraph is a breach of this Agreement. H-2 Exhibit H (D) County's Entitlement to Greater Coverage. If the Contractor(s) 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(s) 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(s) 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(s) 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(s) obtains such an endorsement. (F) County's Remedy for Contractor(s)' Failure to Maintain. If the Contractor(s) fails to keep in effect at all times any insurance coverage required under this Agreement, the County may, in addition to any other remedies it may have, suspend or terminate this Agreement upon the occurrence of that failure, or purchase such insurance coverage, and charge the cost of that coverage to the Contractor(s). The County may offset such charges against any amounts owed by the County to the Contractor(s) under this Agreement. (G)Subcontractor(s). The Contractor(s) shall require and verify that all subcontractor(s) used by the Contractor(s) to provide services under this Agreement maintain insurance meeting all insurance requirements provided in this Agreement. This paragraph does not authorize the Contractor(s) to provide services under this Agreement using subcontractor(s). H-3 Exhibit I 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 at intake and annually thereafter. 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. 1-1 Exhibit I 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. 1-2 Exhibit J 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://fresnodbh.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. J-1 Exhibit J Mental Health Plan (MHP) and Substance Use Disorder(SUD) services Incident Reporting System 0 1560 56 0 INCIDENT REVIEWER ROLE — User Guide Fresno County Department of Behavioral Health (DBH) requires all of its county-operated and contracted providers (through the Mental Health Plan (MHP) and Substance Use Disorder (SUD) services) to complete a written report of any incidents compromising the health and safety of persons served, employees, or community members. Yes! Incident reports will now be made through an on online reporting portal hosted by Logic Manager. It's an easier way for any employee to report an incident at any time. A few highlights: • No supervisor signature is immediately required. • Additional information can be added to the report by the program supervisor/manager without having to resubmit the incident. • When an incident is submitted, the assigned contract analyst, program supervisor/manager, clinical supervisor and the DBHlncidentReporting mailbox automatically receives an email notification of a new incident and can log in any time to review the incident. Everything that was on the original paper/electronic form matches the online form. • Do away with submitting a paper version with a signature. • This online submission allows for timely action for the health and safety of the persons-served, as well as compliance with state reporting timelines when necessary. As an Incident Reviewer, the responsibility is to: • Log in to Logic Manager and review incident submitted within 48 hours of notification of incident. • Review incident for clarity, missing information and add in additional information deemed appropriate. • Notify.DBHlncidentReporting@fresnocountyca.gov if there is additional information to be report after initial submission • Contact DBHlncidentReporting@fresnocountyca.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=182be0c5cdcd5072bb1864cdee4d3d6e The link will take employees to the reporting screen to begin incident submission: J-2 Exhibit J E C 4 O fresnodbh.logicmanageccom/incidents/?t=9&p=i&k=182beOc5cdcd5072bb1864cdeMd3db LogicManager Incident Report Please complete this form Client Information Name of Facility' Name of Reporting Party' Facility Address' Facility Phone Number' Mental Health or Substance Use Disorder Program?' Client First Name' Client Last Name' Client Date of Birth Client Address ClientlD 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' 1-3 Exhibit J Similar to the paper version, multiple incident categories can be selected Incident(check all that apply)' Medical Emergency x Death of Client x I - Homicide/Homicide Attempt AWOL/Elopement from locked facility Violence/Abuse/Assault(toward others,client and/or property Attempted Suicide(resulting in seriousinjury) Injury(self-inflicted or by accident) Medication Error O fresnodbh.logicmanager.com/incidents/?t=9&p=l&k=182be0c5cdcd5072bbl864cdee4d3d6e Date of Incident' Time of Incident' Location of Incident- ./ Key People Directly Involved in Incident(witnesses,staff)' Did the Injured Party seek Medical Attention? Attach any additional details B Add File or Drop File Here Reported 8y Name' Reported By Email' i Reported On 10/30/2019 J-4 Exhibit J As another bonus feature, either drag files (such as a copy of a UOR, additional statements/document) or click on Add File to upload a file. E C 4 A fresnodbh.iogicmanag—mrn inn - =18tk=1826e0c5cdcd50726618Fi4cdee4d3dbe ♦ Add E11E 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' Outcome' Similar to the paper version, multiple Action Taken categories can be selected. - Follow Up Action Taken(check all that apply)' Law Enforcement Contacted x Called 911/EMS x Consulted with Physician First Aid/CPR Administered Client removed from building Pa rent/Legal Guardian Contacted Other When done entering all the information, simply click submit. I Any fields that have /a red asterisk, require information ano will prevent submission of the form if left blank. e r J-5 Exhibit J A"Thank you for your submission" statement will pop up if an incident is successfully submitted. Click"Reload the Form"to subgit another incident. •• .•- \\ Thank you for your submissions RELOAD THE FOT?M A Notification email will be received when a new incident is reported, or a new comment has been made regarding an incident. Click on "Open this incident in Logic Manager" and the Logic Manager login screen will show. Wed 10/30/2019 10:40 AM SYSTEM LogicManager via custom r.support@logicmanager.com <customer.support@logicmanager.com> Notification- Ta OBN Incident Reporting ©If there are problems with how this message is displayed,click hereto view din a web owser. Click here to download pictures.To help protect your privacy,Outlook prevented autom is download of some pictures in this message. CAUTION11l-EXTERNAL EMAIL-THINK BEFORE YOU CLICK IhyAlck:k a by and Add Are W dw.i,ed pmrn.—p pr—t Ou•.ok prnmYd eubnkc dwmlmd dMo picW re lion Mew lq•Wana}>.Inc. HI MIIa Arevalo, You have received a notification through LogicManager Please see the details below_ Type:Incident Report Subject:102_ Notification To:li Arevalo •fin this incident in LogicManager incident in LogicManager If using Internet Explorer,dick here to open the notification. This email was generated by LogicManager.If you have any technical issues, please email supOort�IoOicmanager conin J-6 Exhibit J Enter in email address and password. First time users will be prompted to set up a password. O fresnnlbh.my.lo4jicmanager.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. Your Task List # Q TASKNAME 50U8 E STATUS ASSIGNEDTO ASSIGNED BY DUE DATE- A-yrt Folbv. In Progress metl test SYSTEM LogicManager J-7 Exhibit J 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 'ask Detailz CI I.ntlnformaton ,I..p -_... Ym-fS+anu Hi nn GumtuYYnea �rstlbinrl 'sYlD:its EanwlaYw41 uY[.s . The next tab is Sum ary: No edits can be made to this section. Analyst Follow Up Task Detailz Ll—Inform t— Summ ry Follow Up D—I IettO Inca ent(check all shatapply)• DaCtl«ltlYN� - IfDtM1eripeciry(ie.hre,ppispning,eD�demit put0reaks.pthere«aiwplres/erentslhatlepDarEiEttM1e welfare and salery of Clients,«alf and/pr memherspl the tpmmuniry7: Oe«nptipn of tM1eln<iEent' t —.I IMIbM' 10/30/— nmeakY«knr f IeeamY.l Inufeer «Y<tk J-8 Exhibit J The next tab is Follow up: This section can be edited. Add to the areas below or make corrections to these fields. Be —lc to click Sr V'E wflen edits are made. Then Cancel to Exit out of the incident. Analyst Follow Up 'ask Details Clientlnformahon Summary Fallow Up Documents A<uon Taken cM1eck all[M1at applyl' Law Enfortem.nt Canbcbtl M Please spenfy uother Descrlpuon of Action Taken' 1 Outwmr r added iaformalmn cause of death-cancer per coroner 10-31 t j Task ID:313 source.103:null — .ANC O f 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 O „uu Document � Name Type Upload Date Uploaded By SAL No documents yet. Drop files here or click on the Add Document dropdown. Task ID:313 Source:103:null 1 1' CANCEL SAVE 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 DBHlncidentReportingncidentReporting@fresnocountycagov J-9 Exhibit J 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. Your Task List G TASK NAME SOURCE STATUS ASSIGNED TO ASSIGNED BY DUEDATE A-Ipt Fallow Up Ia Progress SYSTEM LO111M-11 J-10 Exhibit K 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. K-1 Exhibit K 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. K-2 Exhibit K 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: K-3 Exhibit L COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS Contractor shall be required to maintain organizational provider certification by the host county. A copy of this renewal certificate must be furnished to County within thirty (30) days of receipt of certificate from host county. The Contractor must meet Medi-Cal organization provider standards as stated below. It is acknowledged that all references to Organizational Provider and/or Provider below shall refer to the Contractor. Medi-Cal Organizational Provider Standards 1. The organizational provider possesses the necessary license to operate, if applicable, and any required certification. 2. The space owned, leased or operated by the provider and used for services or staff meets local fire codes. 3. The physical plant of any site owned, leased, or operated by the provider and used for services or staff is clean, sanitary and in good repair. 4. The organizational provider establishes and implements maintenance policies for any site owned, leased, or operated by the provider and used for services or staff to ensure the safety and well-being of beneficiaries and staff. 5. The organizational provider has a current administrative manual which includes: personnel policies and procedures, general operating procedures, service delivery policies, and procedures for reporting unusual occurrences relating to health and safety issues. 6. The organizational provider maintains client records in a manner that meets applicable state and federal standards. 7. The organization provider has staffing adequate to allow the COUNTY to claim federal financial participation for the services the Provider delivers to beneficiaries, as described in Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable. 8. The organizational provider has as head of service a licensed mental health professional or other appropriate individual as described in Title 9, CCR, Sections 622 through 630. 9. For organizational providers that provide or store medications, the provider stores and dispenses medications in compliance with all pertinent state and federal standards. In particular: A. All drugs obtained by prescription are labeled in compliance with federal and state laws. Prescription labels are altered only by persons legally authorized to do so. B. Drugs intended for external use only or food stuffs are stored separately from drugs for internal use. C. All drugs are stored at proper temperatures, room temperature drugs at 59-86 degrees F and refrigerated drugs at 36-46 degrees F. L-1 Exhibit L D. Drugs are stored in a locked area with access limited to those medical personnel authorized to prescribe, dispense or administer medication. E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and initialed when opened. F. A drug log is maintained to ensure the provider disposes of expired, contaminated, deteriorated and abandoned drugs in a manner consistent with state and federal laws. G. Policies and procedures are in place for dispensing, administering and storing medications. 10. The County may accept the host county's site certification and reserves the right to conduct an on-site certification review at least every three years. The County may also conduct additional certification reviews when: • The provider makes major staffing changes. • The provider makes organizational and/or corporate structure changes (example: conversion from a non-profit status). • The provider adds day treatment or medication support services when medications shall be administered or dispensed from the provider site. • There are significant changes in the physical plant of the provider site (some physical plant changes could require a new fire clearance). • There is change of ownership or location. • There are complaints against the provider. • There are unusual events, accidents, or injuries requiring medical treatment for clients, staff or members of the community. L-2 Exhibit M NOTICE OF CHILD ABUSE REPORTING LAW The undersigned hereby acknowledges that Penal Code section 11166 and the contractual obligations between County of Fresno (COUNTY) and [NAME OF CONTRACTORI (PROVIDER) related to provision of [TYPE OF SERVICESI services for COUNTY's dependent children, requires that the undersigned report all known or suspected child abuse or neglect to one or more of the agencies set forth in Penal Code (P.C.) section (§) 11165.9. For purposes of the undersigned's child abuse reporting requirements, "child abuse or neglect" includes physical injury inflicted by other than accidental means upon a child by another person, sexual abuse as defined in P.C. §11165.1, neglect as defined in P.C. §11165.2, willful cruelty or unjustifiable punishment as defined in P.C. §11165.3, and unlawful corporal punishment or injury as defined in P.C. §11165.4. A child abuse report shall be made whenever the undersigned, in his or her professional capacity or within the scope of his or her employment, has knowledge of or observes a child whom the undersigned knows or reasonably suspects has been the victim of child abuse or neglect. (P.0 §11166.) The child abuse report shall be made to any police department or sheriff's department (not including a school district police or security department), or to any county welfare department, including Fresno County Department of Social Services' 24 Hour CARELINE. (See PC §11165.9.) For purposes of child abuse reporting, a "reasonable suspicion" means that it is objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing, when appropriate, on his or her training and experience, to suspect child abuse or neglect. The pregnancy of a child does not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse. (P.C. §11166(a)(1).) Substantial penalties may be imposed for failure to comply with these child abuse reporting requirements. Further information and a copy of the law may be obtained from the department head or designee. I have read and understand the above statement and agree to comply with the child abuse reporting requirements. SIGNATURE DATE 0872fcfx Exhibit N 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 N. (C)"Director" means the County's Director of the Department of Social Services 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. N-1 Exhibit N (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 N-2 Exhibit N 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) N-3 Exhibit N 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 N-4 Exhibit N 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@fresnocountyca.gov, 559-600-5900, dssprivacyincident@fresnocountyca.gov, 559-600-2300 (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, N-5 Exhibit N 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 N-6 Exhibit N 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 N-7 Exhibit N 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. N-8 Exhibit O 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). O-1 Exhibit O (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: O-2 Exhibit P 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 byTitles 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 XVIII, XIX, or XX?...................................................................................... o 0 C. Are there any individuals currently employed by the institution, agency, or organization in a managerial, accounting, auditing, or similar capacity who were employed by the institution's, organization's, or agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 0 III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are related to each other, this must be reported under"Remarks." NAME ADDRESS EIN B. Type of entity: o Sole proprietorship o Partnership o Corporation o Unincorporated Associations o Other(specify) C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations under"Remarks." D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities? (Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses of individuals, and provider numbers........................................................................................................... o 0 NAME ADDRESS PROVIDER NUMBER P-1 Exhibit P YES NO IV. A. Has there been a change in ownership or control within the last year?....................................................... o 0 If yes, give date. B. Do you anticipate any change of ownership or control within the year?....................................................... o 0 If yes, when? C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0 If yes, when? V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0 If yes, give date of change in operations. VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0 VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0 dyes, 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 P-2 Exhibit Q 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; Q-1 Exhibit Q (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) Q-2 Exhibit R 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. � =1 1 Think Cultural Health OMHU.S.Deportment of https-://www.thinkculturalhealth.hhs.gov/ Health and Human Services Office of Minority Health contact@thinkculturalhealth.hhs.gov R-1 Exhibit R 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.° 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,"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. Nbrld 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 lthypeo ple.gov/2020/topicsobjectives2O20/ove rvi 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. jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2 OBurden%20of%2OHealth%201nequalities%20in%20the%2OUnited%20States.pdf 5. Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ Publication No.04-EO08-02).Retrieved from the Agency of Healthcare Research and Quality website:http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minqual.pdf 6. Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).Retrieved from The Commonwealth Fund website:http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultiinguisticcomp_962.pdf 7. U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.Retrieved from http:// minorityhealth.hhs.gov/npa/files/Plans/H HS/H HS_Plan_complete.pdf S. 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 ��y,ssx��as s LThink Cultural Health 10MHU.S.Department of https://www.thinkculturalhealth.hhs.gov/ Health and Human Services Office of Minority Health contact@thinkculturalhealth.hhs.gov R-2 Exhibit S Fresno County Department of Behavioral Health Specialty Mental Health Services Outpatient Rates Field Based (at least 50%of services are provided in the field) Provider Type Provider Rate Per Hour Psychiatrist/Contracted Psychiatrist $988.85 Physicians Assistant $443.50 Nurse Practitioner $491.73 RN $401.65 Certified Nurse Specialist $491.73 LVN $211.00 Pharmacist $473.34 Licensed Psychiatric Technician $180.89 Psychologist/Pre-licensed Psychologist $397.68 LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA (MFT LCSW $257.35 LPCC) Occupational Therapist $342.58 Mental Health Rehab Specialist $193.62 Peer Recovery Specialist $203.30 Other Qualified Providers-Other Designated MH staff that bill $193.62 medical