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Home My WebLink AboutAgreement A-25-032 Amendment III to Master Agreement No. A-23-284.pdf Agreement No. 25-032 1 AMENDMENT NO. 3 TO SERVICE AGREEMENT 2 This Amendment No. 3 to Service Agreement ("Amendment No. 3") is dated 3 January 28, 2025 and is between MENTAL HEALTH SYSTEMS, INC., dba TURN 4 Behavioral Health Services, a private, Non-Profit, 501 (C) (3) Corporation ("Contractor"), and the 5 County of Fresno, a political subdivision of the State of California ("County"). 6 Recitals 7 A. County, through its Department of Behavioral Health (DBH), is a Mental Health Plan 8 (MHP) as defined in Title 9 of the California Code of Regulations (C.C.R.), Section 1810.226. 9 B. On June 20, 2023, the County and the Contractor entered into County Agreement No. 10 23-284 ("Agreement"), as a qualified agency to operate a recovery-oriented program for Co- 11 Occurring Disorders Program Full-Service Partnership (FSP) services for adults and older 12 adults with active co-occurring disorders and symptoms (severe mental illness and substance 13 use disorders). 14 C. On November 7, 2023, the County and the Contractor entered into Amendment No. 23- 15 597 to the Agreement ("Amendment No. 1"), to reflect the correct scope of work and update the 16 rate sheet to include Supplemental/Add On service codes that were previously added by the 17 DBH Director through her authority in Article 25 of the Agreement to accommodate state 18 mandated rate increases. 19 D. On July 9, 2024, the County and the Contractor entered into Amendment No. 24-369 to 20 the Agreement ('Amendment No. 2"), to increase the specialty mental health services maximum 21 compensation budget amount. 22 E. The County and Contractor now desire to increase the Mental Health Services Act 23 (MHSA) maximum compensation of the Agreement to add housing support funds due to an 24 increase in the number of persons served who lack housing stability and would benefit from 25 housing support services. 26 The parties therefore agree as follows: 27 28 1 1 1. Section 4.3 of the Agreement located on page eight (8), beginning on line twenty-six (26) 2 and ending on page nine (9), line four (4) is deleted in its entirety and replaced with the 3 following: 4 "4.3 Non-Medi-Cal Supports Maximum Compensation. The maximum 5 compensation payable to the Contractor under this Agreement for the period of July 1, 6 2023 through June 30. 2024 for Non-Medi-Cal Supports is Six Hundred Sixty-Five 7 Thousand Nine Hundred Forty-Six and No/100 Dollars ($665,946.00). The maximum 8 compensation payable to the Contractor under this Agreement for the period of July 1, 9 2024 through June 30, 2025 for Non-Medi-Cal Supports is Six Hundred Ninety-Five 10 Thousand Seven Hundred Twenty and No/100 Dollars ($695,720.00)." 11 2. A portion of section 4.5 located on page 9, lines thirteen (13) through sixteen (16) is 12 deleted and replaced with the following: 13 "Total Maximum Compensation. In no event shall the maximum contract amount for 14 all the services provided by the Contractor to County under the terms and conditions of 15 this Agreement be excess of Eight Million Eleven Thousand Six Hundred Sixty-Six and 16 No/100 Dollars ($8,011,666.00) during the entire term of this Agreement." 17 3. All references in the Agreement to Exhibit G1 shall be deemed references to "Revised 18 Exhibit G1," which is attached and incorporated by this reference. 19 4. When both parties have signed this Amendment No. 3, the Agreement, Amendment No. 20 1, Amendment No. 2, and this Amendment No. 3 together constitute the Agreement. 21 5. The Contractor represents and warrants to the County that: 22 a. The Contractor is duly authorized and empowered to sign and perform its 23 obligations under this Amendment. 24 b. The individuals signing this Amendment on behalf of the Contractor are duly 25 authorized to do so and his or her signature on this Amendment legally binds the 26 Contractor to the terms of this Amendment. 27 6. The parties agree that this Amendment may be executed by electronic signature as 28 provided in this section. 2 1 a. An "electronic signature" means any symbol or process intended by an individual 2 signing this Agreement to represent their signature, including but not limited to 3 (1) a digital signature: (2) a faxed version of an original handwritten signature: or 4 (3) an electronically scanned and transmitted (for example by PDF document) 5 version of an original handwritten signature. 6 b. Each electronic signature affixed or attached to this Agreement (1) is deemed 7 equivalent to a valid original handwritten signature of the person signing this 8 Agreement for all purposes, including but not limited to evidentiary proof in any 9 administrative or judicial proceeding, and (2) has the same force and effect as 10 the valid original handwritten signature of that person. 11 c. The provisions of this section satisfy the requirements of Civil Code section 12 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, 13 Division 3, Part 2, Title 2.5, beginning with section 1633.1). 14 d. Each party using a digital signature represents that it has undertaken and 15 satisfied the requirements of Government Code section 16.5, subdivision (a), 16 paragraphs (1) through (5), and agrees that each other party may rely upon that 17 representation. 18 e. This Agreement is not conditioned upon the parties conducting the transactions 19 under it by electronic means and either party may sign this Agreement with an 20 original handwritten signature. 21 7. The Agreement as amended by this Amendment No. 3 is ratified and continued. All 22 provisions of the Agreement not amended by this Amendment No. 3 remain in full force and 23 effect. This Amendment No. 3 is effective upon execution. 24 [SIGNATURE PAGE FOLLOWS] 25 26 27 28 3 1 The parties are signing this Amendment No. 3 to Agreement No. 23-284 on the date 2 stated in the introductory clause. 3 dental Health Systems, Inc., dba TURN Behavioral Health Services COUNTY OF FRESNO 4 5 6 �rties C:allag"--an Jr 11,2024 15:55 PST) 7 James C. Callaghan Jr., CEO & President Ernest Buddy Mendel, Chairman of the Board of Supervisors of the County of Fresno 8 Attest: 9 � � �►^� Bernice E. Seidel David Tanner(Dec 11,202415:46 PST) Cleric of the Board of Supervisors 10 County of Fresno, State of California David Tanner, VP of Corporate Finance 11 By: 12 9465 Farnham Street Deputy 13 San Diego, CA 92123 14 15 16 For accounting use only: 17 Org No.: 56304562 Account No.: 7295 18 Fund No.: 0001 Subclass No.: 10000 19 20 21 22 23 24 25 26 27 28 4 FY 2023-24 Revised Exhibit G1 Fresno County Department of Behavioral Health Specialty Mental Health Services Outpatient Rates FSP and AOT Provider Rate Provider Type Per Hour sychiatrist/Contracted Psychiatrist $1,140.98 Physicians Assistant $511.73 Nurse Practitioner $567.38 RN $463.45 Certified Nurse Specialist $567,38 LVN $243.47 Pharmacist $546.16 Licensed Psychiatric Technician 5208.72 Psychologist/Pre-licensed Psychologist $458.87 LPHA(MFT LCSW LPCC) Intern or Waivered LPHA(MFT LCSW LPCC) 52%.95 Occupational Therapist $39S.28 Mental Health Rehab Specialist $223.41 Peer Recovery Specialist $234.58 Other Qualified Providers - Other Designated MH staff that bill $223.41 Service Unit Maximum Units that Can be Rate per Unit Billed Interactive Complexity 15 mins per 1 per allowed procedure per $16.50 unit provider per beneficiary Sign Language or Oral Interpretive Services 15 mins per r ariable $30.00 unit FY 2024-25 Revised Exhibit G1 Fresno County Department of Behavioral Health Specialty Mental Health Services Outpatient Rates FSP and AOT Provider Rate Per Provider Type Hour Psychiatrist/Contracted Psychiatrist $1,176.12 Physicians Assistant $527.47 Nurse Practitioner $584.86 RN $477.73 Certified Nurse Specialist $584.86 LVN $250.97 Medical Assistant $172.52 Pharmacist $562.98 Licensed Psychiatric Technician $215.15 Psychologist/Pre-licensed Psychologist $473.00 LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA (MFT LCSW LPCC) $306.09 Occupational Therapist $407.45 Mental Health Rehab Specialist $230.28 Peer Recovery Specialist $241.80 Other Qualified Providers-Other Designated MH staff that bill medical $230.28 Maximum Units That Flat Rate Type Unit Can Be Billed Rate 1 per allowed Interactive Complexity 15 min per unit procedure per $18.32 provider per person Sign Language/Oral Interpretive Services 115 min per unit Ivariable $30.92 Effective 7/1/2024 Revised Exhibit G1 Co-Occurring Full Service Partnership Mental Health Systems Fiscal Year(FY)2023-24 PROGRAM EXPENSES 1000.DIRECT SALARIES&BENEFITS Direct Employee Salaries Acct a Administrative Position FTE Admin Program Total 1101 5 5 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1111 - 1115 Direct Personnel Admin Salaries Subtotal 0.00 $ S Acct a Program Position FTE Admin Program Total 1116 $ $ llll - - 1118 1119 1120 1121 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 Direct Personnel Program Salaries Subtotal 0A0 S S Admin Program Total Direct Personnel Salaries Subtotal 0.00 S S S Direct Employee Benefits E12O4 Description Admin Program Total Retirement S Workers Compensation Health Insurance Other(specify) Other(spec4) Other(specify) Direct Employee Benefits Subtotal: $ $ $ Direct Payroll Taxes&Expenses: Acct4 Description Admin Program Total 1301 OASOI S S 5 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specdy) 1306 Otherlspe Direct Payroll Taxes&Expenses Subtotal: $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total $ $ $ DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program RDIV/01 xDIV/DI Fmsro Carty CeFar71xrt Cd B01-Zo0aral 14cJta Cmfra:2 t?a.eg.9 Acr:dim Riau scd 7�7T;C7C Revised Exhibit G1 2000:DIRECT CLIENT SUPPORT Ac"4 Line Item Description Amount 2001 Child Care 5 571 2002 Client Housing Support $90,490 2003 Client Transportation&Support 30.266 2C04 Clothing,Food,&Hygiene 29,192 2005 Educabon Support $71 2006 1 Employment Support 571 2007 Household Items for Clients 13,714 2008 Medication Supports 2009 Program Supplies-Medical 2010 Utility Vouchers 571 2011 Other(specify) 2012 Other(specify) 2013 1 Other(specify) 2014 Other(specify) 2015 1 Other(specify) 2016 1 Other(specrfy) DIRECT CLIENT CARE TOTAL $ 665,946 3DO0:DIRECT OPERATING EXPENSES Acct ti 1 Line Rem Description Amount 3001 Telecommunications 5 3002 Printing/Postage 3003 Office,Household&Program Supplies 3OD4 Advertising 3005 Staff Development&Training 3006 Staff Mileage 3007 Subscriptions&Memberships 300B Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(spe DIRECT OPERATING EXPENSES TOTAL $ DIRECT FACILITIES&EQUIPMENT Aca R Line Item Description A11IOQ1t 4001 Building Maintenance 5 4002 Rent/Lease Building 4003 Rent/lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utiities 4007 Other(specify) 4008 Other(specify) 40D9 Other(specify) 4010 Other(spe ) DIRECT FACILITIES/EQUIPMENT TOTAL $ S000_DIRECT SPECIAL EXPENSES Aat A Line Rem Description Amount 50D1 Consultant(Network&Data Management) $ S002 HMIS(Health Management Information System) 5003 Contractual/Consuhing Services(Specify) 50D4 Translation Services S005 Other(spectfy) 5006 Other(specify) 5007 Other(specify) 5008 Other(speti(y) DIRECT SPECIAL EXPENSES TOTAL: $ Fnono Ceuxy Dcp n w.o1 Behroin al Heath CaWa:z BA,egel Narrative Revised 2174020 Revised Exhibit G1 6000:INDIRECT EXPENSES Acct R Line Item Description Amount Administrative Overhead 6001 Use this line and ow*this line for approved indirect cost rate 5 Administrative Overhead 6W2 Professional liability Insurance 6pD3 Aocounting/Booldteeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation tPhiwdnQnW i"e, ell N I.urd for Pnwo P Pwr 60M Personnel iinereasaaon&Bmeks) 6009 Other(specify) 6010 Other(specify) 6011 Other(specify) 6012 Other(sptdfy) 6013 Other(specify) INDIRECT EXPENSES TOTAL $ INDIRECT COST RATE 0. 0% 7060:DIRECT FIXED ASSETS Acct 8 Line Rem Description Amount 7001 s $ 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data 7003 Furniture IS Fixtures 70D4 Leasehold/Tenant/Building Improvements 700S Other Assets over$S00 with Llfespan of 2 Years 7W6 jAssets over$S.WWunit fSpecify) 7007 Other(specify) 7008 1 Other(specify) FIXED ASSETS EXPENSES TOTAL $ TOTAL PROGRAM EXPENSES $ 665,946 PROGRAM FUNDING SOURCES 8100-SUBSTANCE USE DISORDER FUNDS Acct a Line hem Description Amount 8101 Drug Medi-Cal $ 9102 ISABG $ SUBSTANCE USE DISORDER FUNDS TOTAL $ 9200-REALIGNMENT Aca R Line Item Description Amount 8201 lReallgrignent I } REALIGNMENT TOTAL $ $300-MENTAL HEALTH SERVICE ACT(MHSA) AcCtll MHSA Component MHSA Program Name Amount B301 CSS-Community Services&Support-, $ 665,946 9302 PEI-Prevention&Early Intervention 6303 INN-Innovations B304 WET-Workforce Education&Training gaps ICFTN-Capital Facilities&Technology MHSA TOTAL $ 665,946 9400-OTHER REVENUE Acct R line Item Description Amount 9401 Client Fees $ 9402 Client Insurance 8403 Grants(Specify) 8404 Other(Specify) 8405 Other(S ci ) OTHER REVENUE TOTAL $ TOTAL PROGRAM FUNDING SOURCES: $ 665,94C, NET PROGRAM COST: $ Fresno County Depa n.m.o1 Behro nral Heath Ccrtra:i Br-Cyct t ti altm Revised Exhibit G1 Co-Occurring Disorders Full Service Partnership Mental Health Systems Fiscal Year IFY►2023.24 PARTIAL FTE DETAIL For all posltlons with FTE's split among multiple programs/contracts the below must be filled out Position Contract a/Name/Department/County FTE% Total 0-00 Position lContract a/Name/Department/County Total 0.00 Position Contract a/Name/Department/County FTE% Tool 0.00 Position Contract a/Name/Department/County FTE'1 Tatal 0 II(I Position Contraetir/Name/Gepartmrnt/County FTC"ti total 0 X Position Contract a/%ame/Department/County FTt xl Total u •a Pasdlan Contract 11/Vame/Departmrnt/County FTE'X Fresno CarXy Deputrrz,d 8chrrip al Heath C—tra:l r"r•:li•r Fc: i_.. Revised Exhibit G1 Total 0.00 Position lContrao M/Name/Department/County FTE% Total 0.00 Position Contract Y/Name/Department/County FTE% Total 0-OO Position Contract a/Name/Department/County FTE% Total OAO Position lContract it/Name/Department/County FTE% Total 0.00 Position Contract tt/Name/Department/County FTE% Taal o_a0 Position Contract a/Name/Departmrnt/County FTE% Total 0.00 Position lContract it/Name/Orpartment/fountV FTE% Frawo Cow sy Depirrneil of Oehriin al Heath Crn fray F.i.rrrf r'. .At', P 1!1! 7;y:;C Revised Exhibit G1 Total 0.00 Position Icontrao N/Name/Department/County FTE% Total 0.00 Fnano Cauxy DepartneA of 0ehxoinral Heath C roa.i B+,C5e1 Nar atim Revesed 2,7,7020 Revised Exhibit G1 Co-Occurring Full Service Partnership Mental Health Systems Fiscal Year(FY)2023-24 Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:DIRECT SALARIES&BENEFITS Administrative Positions 1101 0 1102 0 1103 0 1104 0 1105 0 1106 0 1107 0 1108 0 1109 0 1110 0 1111 0 1112 0 1113 0 1114 0 1115 0 Program Positions 1116 0 1117 0 1118 0 1119 0 1120 0 1121 0 1122 0 1123 0 1124 0 1125 0 1126 0 1127 0 1128 0 1129 0 1130 0 1131 0 1132 0 1133 0 1134 0 Direct Employet Benefits 1201 Retirement 1202 Workers Compensation 1203 Health Insurance 1204 Other(specify) 1205 Other(specify) 1206 Other(specify) Direct PayroN Taxes&Expenses: 1301 OASDI 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 130S Other(specify) - 13oh Ot-Pr(s ec ) 2000:DIRECT CLIENT SUPPORT 665,946 2001 1 Child Care ,71 wraparound expenses that cover client support/assistance 2002 Client Housing Support 590,490 Master leases at Glenn Apartments,room&board,room&care,and residential/sober living expenses for 3 clients per month. 2003 Client Transportation&Support 30,266 cost of transportation of clients by staff(mileage reimbursement or gas for vehicles), buss passes/cards for client transportation needs 2004 1 Clothing,Food,&Hygiene 29,192 wraparound expenses that cover client support/assistance 200S Education Support 571 wraparound expenses that cover client support/assistance 2006 Employment Support 571 wraparound expenses that ociver client support/assistance 2007 Household Items for CI-rents 13,714 wraparound expenses that cover client support/assistance 200E Medication Supports 2009 Program Supplies-Medical Freero County Department of Behavioral HeeMh Contract Budget Narrative Revised 2 712020 Revised Exhibit G1 PROGRAM EXPENSE ACCT#I UNE ITEM AMT I DETAILED DESCRIPTION Of ITEMS BUDGETED IN EACH ACCOUNT LINE 2010 Utility Vouchers 571 wraparound expenses that cover client support/assistance 2011 Other(specify) - 2012 Otherlspecifyl 2013 Other(specify) 2014 Otherlspecifyl 2015 Other(specify) 2016 Otherls e" l 3000:DIRECT OPERATING EXPENSES 3001 Telecommunications 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 Advertising 3005 Staff Development&Training 3006 Staff Mileage 3007 Subscriptions&Memberships 3008 Vehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other Ispecify) 3012 Other(specify) 4000:DIRECT FACILITIES&EQUIPMENT 4001 Building Maintenance 4002 Rent/Lease Building 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles 4005 Security 4006 Utilities 4007 Other(specify) 4008 Other(specify) 4009 Other(specify) 4010 OtherIspeci(vi 5000:DIRECT SPECIAL EXPENSES 5001 Consultant(Network&Data Management) 5002 HMIS Health Management Information Systeml 5003 Contractual/Consulting Services(Specify) 5004 Translation Services 5005 Other(specify) 5006 Otherjspecirfyj 5007 Other(specify) 5008 Other(specify) 6000:INDIRECT EXPENSES - 6001 Administrative Overhead 6002 Professional Liability Insurance 6003 Aocounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify); 6006 Payroll Services 6007 Depreciation(Provider-Owned Equipment to be Used 6008 Personnel(Indirect Salaries&Benefits) 6009 Other(specify) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 6013 Other►specify) 7000:DIRECT FIXED ASSETS 7001 Computer Equipment&Software 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA 7003 Furniture&Fixtures 7004 Leasehold/Tenant/Building Improvements 7005 Other Assets over$500 with Lifespan of 2 Years+ 7006 Assets over 55,000/unit(Specify) 7007 Other(specify) 7008 Other(specify) Fresro Courry Department 0 Behavorat Health Contract Boiaget Narraove Revsed 27,12020 Revised Exhibit G1 PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 665,9" TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 665,946 BUDGET CHECK: Fresro Courty DepaRment 0 Behavorat Health Contract Boiaget Narraove Reosed 2,712020 Revised Exhibit G1 Co-Occuring Full Service Partnership MHS Fresno Impact Fiscal Year(FY)2024-25 PROGRAM EXPENSES 1000:SALARIES&BENEFITS Employee Salaries Acct# Position FTE Admin Direct Total 1101 - 1102 1103 1104 - - 1105 1106 1107 - - 1108 - 1109 1110 - - 1111 1112 1113 - - 1114 1115 1116 - - 1117 1118 1119 - - - 1120 - 1121 1122 - - - 1123 - - 1124 1125 - - - 1126 - - - 1127 1128 - - - 1129 - - - 1130 1131 - - - 1132 - - 1133 1134 - - - 1135 - Personnel Salaries Subtotall 0.00 1 Employee Benefits Acct# Description Admin Direct Total 1201 Retirement $ - $ - $ - 1202 Worker's Compensation - 1203 Health Insurance 1204 Other(specify) - - - 1205 Other(specify) - - 1206 Other(specify) - - - Fresno County Department of Behavioral Health Contract Budget Template Revised 4/1012020 Revised Exhibit G1 Employee Benefits Subtotal: Payroll Taxes&Expenses: Acct# Description Admin Direct Total 1301 OASDI - 1302 FICA/MEDICARE 1303 SUI 1304 1 Other(specify) - 1305 Other(specify) 1306 10ther(specify) Payroll Taxes&Expenses Subtotal: EMPLOYEE SALARIES&BENEFITS TOTAL: $ $ $ 2000:CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care $ 571 2002 Client Housing Support 620,264 2003 Client Transportation&Support 30,266 2004 Clothing, Food,&Hygiene 29,192 2005 Education Support 571 2006 Employment Support 571 2007 Household Items for Clients 13,714 2008 Medication Supports - 2009 Program Supplies-Medical - 2010 Utility Vouchers 571 2011 10ther(specify) - 2012 10ther(specify) 2013 Other(specify) 2014 Other(specify) - 2015 Other(specify) 2016 Other(specify) DIRECT CLIENT CARE TOTAL $ 695,720 3000:OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ 3002 Printing/Postage 3003 Office,Household&Program Supplies 3004 lAdvertising 3005 IStaff Development&Training 3006 IStaff Mileage 3007 ISubscriptions&Memberships 3008 IVehicle Maintenance 3009 Other(specify) 3010 Other(specify) 3011 Other(specify) 3012 Other(specify) OPERATING EXPENSES TOTAL: $ - 4000: FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ - 4002 Rent/Lease Building Fresno County Department of Behavioral Health Contract Budget Template Revised 4/1012020 Revised Exhibit G1 4003 Rent/Lease Equipment 4004 Rent/Lease Vehicles - 400S Security - 4006 Utilities 4007 Other(specify) - 4008 Other(specify) 4009 Other(specify) 4010 Other(specify) FACILITIES/EQUIPMENT TOTAL: $ - 5000:SPECIAL EXPENSES Acct q Line Item Description Amount 5001 Consultant(Network&Data Management) $ S002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services SOOS Other(specify) 5006 Other(specify) 5007 Other(specify) 5008 Other(specify) SPECIAL EXPENSES TOTAL: $ - 6000:ADMINISTRATIVE EXPENSES Acct q Line Item Description Amount 6001 Administrative Overhead $ 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 1 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation(Provider-Owned Equipment to be Used for Progrom Purposes) - 6008 Other(specify) 6009 Other(specify) 6010 Other(specify) - 6011 Other(specify) 6012 Other(specify) - ADMINISTRATIVE EXPENSES TOTAL $ 7000: FIXED ASSETS Acct q I Line Item Description Amount 7001 Computer Equipment&Software $ 7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data 7003 Furniture& Fixtures 7004 Leasehold/Tenant/Building Improvements 7005 10ther Assets over$500 with Lifespan of 2 Years+ 7006 Assets over$5,000/unit(Specify) 7007 Other(specify) 7008 Other(specify) FIXED ASSETS EXPENSES TOTAL $ TOTAL PROGRAM EXPENSES $ 695,720 Fresno County Department of Behavioral Health Contract Budget Template Revisec 4;10 2020 Revised Exhibit G1 PROGRAM FUNDING SOURCES 8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION) Aect# Line Item Description Service Units Rate Amount 8001 Mental Health Services 0 8002 Case Management 0 8003 Crisis Services 0 8004 IMedication Support 0 800S Collateral 0 - 8006 Plan Development 0 8007 Assessment 0 - 8008 Rehabilitation 0 8009 Other(Specify) 0 8010 10ther(Specify) 0 Estimated Specialty Mental Health Services Billing Totals: 0 $ Estimated%of Clients who are Medi-Cal Beneficiaries Ors Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries - Federal Financial Participation(FFP)%T 0% MEDI-CAL FFP TOTAL $ 8100 - SUBSTANCE USE DISORDER FUNDS Aeet# Line Item Description Amount 8101 Drug Medi-Cal S 8102 SABG S SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200- REALIGNMENT Acet# Line Item Description Amount 8201 lRealignment REALIGNMENT TOTAL $ 8300- MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 ICSS-Community Services&Supports S 69S,720 8302 PEI-Prevention&Early Intervention 8303 INN-Innovations 8304 WET-Workforce Education&Training 830S CFTN-Capital Facilities&Technology MHSA TOTAL $ 695,720 8400 - OTHER REVENUE Aeet# Line Item Description Amount 8401 Client Fees 5 8402 Client Insurance 8403 Grants(Specify) 8404 10ther(Specify) 8405 10ther(Specify) OTHER REVENUE TOTAL $ TOTAL PROGRAM FUNDING SOURCES: 5 695,720 NET PROGRAM COST: $ Fresno County Department of Behavioral Health Contract Budget Template Revised Exhibit G1 Co-Occuring Full Service Partnership MHS Fresno Impact Fiscal Year (FY) 2024-25 Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000: SALARIES& BENEFITS - Employee Salaries - 1101 0 1102 10 - 1103 0 - 1104 10 - 1105 0 - 1106 0 - I 1107 10 1108 0 - 1109 0 - 1110 0 - 1111 0 1112 0 - 1113 10 - 1114 0 - 1115 0 - 1116 0 - 1117 0 - 1118 0 - I 1119 10 - 1120 10 - 1121 0 - 1122 0 - 1123 0 - I 1124 0 - 1125 10 - 1126 10 - 1127 10 - 1128 0 - 1129 0 - 1130 0 - 1131 0 - 1132 0 - 1133 0 - 1134 0 - 1135 0 - f Employee Benefits - 1201 Retirement - 1202 Worker's Compensation - 1203 Health Insurance - 1204 Other(specify) - 1205 Other(specify) - 1206 Other (specify) - Payroll Taxes& Expenses: - 1301 OASDI _ - 1302 FICA/MEDICARE - 1303 SUI - 1304 Other(specify) 1305 Other(specify) - 1306 Other(specify) 2000: CLIENT SUPPORT 695,720 2001 Child Care 571 Estimated wrap expenses related to child care for clients 2002 Client Housing Support 620,264 Estimated expenses for housing support for clients 2003 Client Transportation &Support 30,266 ICost of transporting clients by staff (mileage reimbursement or gas for vehicles)and bus passes/cards for client transportation needs. 2004 Clothing, Food, & Hygiene 29,192 Estimated expenses for food &for clothing 2005 Education Support 571 Estimated wrap expenses related to education support for clients 2006 Employment Support 571 Estimated wrap expenses related to employment support for clients _ 2007 Household Items for Clients 13,714 Estimated wrap expenses related to household items for clients 2008 1 Medication Supports - 2009 Program Supplies- Medical - 2010 Utility Vouchers 571 Estimated wrap expenses related to utility vouchers for clients 2011 Other (specify) - 2012 Other (specify) - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 21712020 Revised Exhibit G1 PROGRAM EXPENSE ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2013 Other(specify) - 2014 Other(specify) 2015 Other (specify) - 2016 Other(specify) - 13000: OPERATING EXPENSES - 3001 Telecommunications - 3002 Printing/Postage - 3003 Office,Household& Program Supplies - 3004_Advertising - 3005 Staff Development&Training - 3006 Staff Mileage - 3007 Subscriptions& Memberships - _30_08 Vehicle Maintenance - I 3009 Other(specify) - 3010 Other(specify) - 3011 Other(specify) - 3012 Other(specify) - 4000: FACILITIES& EQUIPMENT 4001 Building Maintenance - 4002 Rent/Lease Building - I 4003 Rent/Lease Equipment - 4004 Rent/Lease Vehicles - 400S Security - 4006 Utilities - 4007 Other(specify) - 4008 Other(specify) - 4009 Other(specify) - 4010 Other(specify) - S000: SPECIAL EXPENSES 5001 Consultant(Network & Data Management) _ - 5002 HMIS (Health Management Information - I ,System) _ 5003 Contractual/Consulting Services (Specify) - 5004 Translation Services _ - 5005 Other(specify) - 5006 Other(specify) - 5007 Other(specify) - 5008 Other(specify) - 6000: ADMINISTRATIVE EXPENSES - 6001 Administrative Overhead 6002 Professional Liability Insurance - 6003 Accounting/Bookkeeping - 6004 External Audit _ - 6005 Insurance(Specify): - 6006 Payroll Services - 6007 Depreciation (Provider-Owned Equipment to be Used for Program Purposes) 6008 Other(specify) - 6009 Other(specify) - 6010 10ther(specify) - 6011 'Other(specify) _ - 6012 Other(specify) - 7000: FIXED ASSETS - 7001 Computer Equipment &Software - _I 7002 Copiers, Cell Phones, Tablets, Devices to - Contain HIPAA Data 7003 Furniture & Fixtures - 7004 Leasehold/Tenant/Building Improvements - 7005 Other Assets over$500 with Lifespan of 2 - Years+ 7006 Assets over$5,000/unit(Specify) - 7007 Other(specify) - 7008 Other(specify) - Fresno County Depaiiment of Behavioral Health Contract Budget Narrative Revised 21712020 Revised Exhibit G1 PROGRAM EXPENSE 1 ACCT HI LINE ITEM 1 AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE PROGRAM FUNDING SOURCES 8000- SHORT/DOYLE MEDI-CAL (FEDERAL FINANCIAL PARTICIPATION) PROVIDE DETAILS OF METHODOLOGY(IES) USED IN DETERMINING MEDI-CAL ACCT 9 LINE ITEM SERVICE RATES AND/OR SERVICE UNITS, IF APPLICABLE AND/OR AS REQUIRED BY THE RFP 8001 Mental Health Services 8002 Case Management 8003 Crisis Services 8004 Medication Support 800S Collateral 8006 Plan Development 8007 Assessment 8008 Rehabilitation 8009 10ther(Specify) I 8010 10ther(Specify) TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 695,720 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 695,720 BUDGET CHECK: Fresno County Department of Behavioral Health Contract Budget Narrative Revised 217/2020