HomeMy WebLinkAboutAgreement A-24-594 Amendment I to Master Agreement No. 23-287.pdf Agreement No. 24-594
1 AMENDMENT NO. 1 TO SERVICE AGREEMENT
2 This Amendment No. 1 to Service Agreement ("Amendment No. 1") is dated
3 November 5, 2024 and is between Contractor(s) listed in Revised Exhibit A "List of
4 Contractors" ("Contractor(s)"), and the County of Fresno, a political subdivision of the State of
5 California ("County").
6 Recitals
7 A. On June 20, 2023, the County and the Contractor(s) entered into County Master
8 Agreement No. 23-287 ("Agreement"), for Full Service Partnership (FSP) program sites that
9 provide comprehensive mental health, housing, employment support and community supports
10 to adults and older adults with serious mental illness (SMI). The Agreement superseded County
11 Master Agreement No. 20-216 to make changes necessary for the Department of Health Care
12 Services' (DHCS) implementation of California Advancing and Innovating Medi-Cal (CalAIM),
13 which includes a new billing structure that Contractors must utilize.
14 B. On September 14, 2022, the State passed into law Senate Bill (SB) 1338, known as the
15 Community Assistance, Recovery and Empowerment (CARE) Act. The CARE Act establishes a
16 new civil court process designed to connect persons with untreated schizophrenia or other
17 psychotic disorders to behavioral health services, housing supports, social services and other
18 services. The CARE Act aims to divert and prevent restrictive conservatorships or
19 incarcerations though a court-ordered CARE plan or court-approved CARE agreement that is
20 initiated via a petition to the courts. Pursuant to Section 5970.5(b) of the Welfare and Institutions
21 Code, the County must implement CARE Act processes and services by December 1, 2024.
22 C. Contractor Mental Health Systems, Inc., dba TURN Behavioral Health Services has
23 expertise in navigating the CARE court petition process and providing court-ordered treatment
24 services in San Diego County. Contractor is willing to provide these services for Fresno
25 County's vulnerable population through its existing FSP programs.
26 D. The County and Contractor Mental Health Systems, Inc. now desire to amend the
27 Agreement to add the CARE Act services to the Scope of Work in order for the County to be
28 timely in compliance of CARE Act implementation.
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1 The parties therefore agree as follows:
2 1. Section 4.6 of the Agreement located on Page 10, starting on Line 9 is amended to add
3 the following paragraph at Line 22 before the word "DBH":
4 "(D) CARE Act Administrative Reimbursement Rates: Contractor(s) with
5 programs providing CARE Act services in accordance with all requirements explained in
6 the attached Scopes of Work herein."
7 2. All references to Exhibit B1, et. seq. shall include Revised Exhibit B-3. Revised Exhibit
8 B-3 is attached and incorporated by reference.
9 3. All references to "Exhibit H" shall be deemed references to "Revised Exhibit H."
10 "Revised Exhibit H" is attached and incorporated by this reference.
11 4. All references to "Exhibit H4" shall be deemed references to "Revised Exhibit H4."
12 "Revised Exhibit H4" is attached and incorporated by this reference.
13 5. When both parties have signed this Amendment No. 1, the Agreement, and this
14 Amendment No. 1 together constitute the Agreement.
15 6. The Contractor represents and warrants to the County that:
16 a. The Contractor is duly authorized and empowered to sign and perform its obligations
17 under this Amendment.
18 b. The individual signing this Amendment on behalf of the Contractor is duly authorized
19 to do so and his or her signature on this Amendment legally binds the Contractor to
20 the terms of this Amendment.
21 7. The parties agree that this Amendment may be executed by electronic signature as
22 provided in this section.
23 a. An "electronic signature" means any symbol or process intended by an individual
24 signing this Amendment to represent their signature, including but not limited to (1) a
25 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
26 electronically scanned and transmitted (for example by PDF document) version of an
27 original handwritten signature.
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1 b. Each electronic signature affixed or attached to this Amendment (1) is deemed
2 equivalent to a valid original handwritten signature of the person signing this
3 Amendment for all purposes, including but not limited to evidentiary proof in any
4 administrative or judicial proceeding, and (2) has the same force and effect as the
5 valid original handwritten signature of that person.
6 c. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
7 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part
8 2, Title 2.5, beginning with section 1633.1).
9 d. Each party using a digital signature represents that it has undertaken and satisfied
10 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
11 through (5), and agrees that each other party may rely upon that representation.
12 e. This Amendment is not conditioned upon the parties conducting the transactions
13 under it by electronic means and either party may sign this Amendment with an
14 original handwritten signature.
15 8. This Amendment may be signed in counterparts, each of which is an original, and all of
16 which together constitute this Amendment.
17 9. The Agreement as amended by this Amendment No. 1 is ratified and continued. All
18 provisions of the Agreement and not amended by this Amendment No. 1 remain in full force and
19 effect.
20 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Amendment No. 1 on the date stated in the introductory
2 clause.
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CONTRACTOR(S) COUNTY OF FRESNO
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See Exhibit A "List of Contractors"
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Subsequent signature pages are attached. �z'---- �--�
g Nathan Magsig, Chairman of the Board of
Supervisors of the County of Fresno
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8 Attest:
Bernice E. Seidel
g Clerk of the Board of Supervisors
County of Fresno, State of California
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11 By: 44,�'
Deputy
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For accounting use only:
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Org No.: 56302007
14 Account No.: 7295
Fund No.: 0001
15 Subclass No.: 10000
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1 The parties are executing this Amendment No. 1 to Agreement No. 23-287 on the date
2 stated in the introductory clause.
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4 CONTRACTOR:
5 MENTAL HEALTH SYSTEMS, INC. dba TURN BEHAVIORAL HEALTH SERVICES
6
im Callag an(O 4 6:57 PDT)
7 James C. Callaghan Jr.
8 CEO, President
9
MviiTanner
10 David Tanner(Oct 17,202416:58 PDT)
11 David Tanner
Vice President
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13 9456 Farnham St.
San Diego, CA 92123
14 Attn: James C. Callaghan Jr. CEO
Phone: 858-873-2600 ext. 1101
15 Phone: 858-254-4338 mobile
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Revised Exhibit A
ADULT FULL-SERVICE PARTNERSHIP PROGRAM
LIST OF CONTRACTOR(S)
1. Turning Point of Central California, Inc.
Business Type: Private, non-profit, 501 (c)(3) corporation
Business Address: P.O. Box 7447
Visalia, CA 93290
Contact: Ryan Banks, CEO
ryanbanks@tpocc.org
Target Population: Adult and Older Adult with Serious Mental Illness (SMI)
Level of Care: Outpatient/intensive Case Management and Full-Service
Partnership
2. Mental Health Systems, Inc. dba TURN Behavioral Health Services
Business Type: Private, non-profit, 501 (c)(3) corporation
Business Address: 9465 Farnham Street
San Diego, California 92123
Contact: James C. Callaghan, President & CEO
Icallaghan(cDturnbhs.org
Target Population: Adult and Older Adult with Serious Mental Illness (SMI)
Level of Care: Outpatient/Intensive Case Management and Full-Service
Partnership
REVISED EXHIBIT B3
Page 1 of 29
Scope of Work
Full-Service Partnership (FSP) Program
CARE Act Program
CONTRACTOR: Mental Health Systems, Inc., dba TURN Behavioral Health Services
CONTACT: James C. Callaghan, President & CEO
IcallaghanC@turnbhs.orq
SITE ADDRESS: Program Site#3: DART West FSP & CARE Court
2550 West Clinton Avenue, Bldg. W Fresno, CA 93705
CONTRACT TERM: July 1, 2023 —June 30, 2024
July 1, 2024 —June 30, 2025
PROJECT DESCRIPTION: DART West FSP
CONTRACTOR's Daring to Achieve Recovery Together (DART) West program site will be
recovery oriented, co-occurring disorder capable FSP programs consisting of three (3) levels of
care: FSP, Heightened FSP, and Intensive FSP so that individuals have the support they require to
remain engaged in services with the flexibility of moving from one level to another seamlessly. The
program will provide comprehensive, dual diagnosis services staffed by teams which will be
composed of qualified, culturally diverse professionals who mirror the cultures of the individuals to
be served and who bring a variety of education, experience levels, lived experience, and expertise
in the field of mental illness, substance use disorder recovery, supportive services and housing to
the program.
The program design will provide community-based and culturally competent outpatient
mental health treatment and substance use disorder treatment which increases the likelihood of
individuals becoming productive members of society. DART West will provide the full spectrum of
FSP services 24 hours per day, seven days per week (24/7).
With recovery as the primary goal, services will include a strong focus on skills building.
DART West staff will meet individuals "where they are" and do "whatever it takes" to move the
individuals served through the stages of change to empower each individual to achieve their goals.
The program's philosophy and values include the belief that every person has the potential for
growth, regardless of disability; each Individual Services and Support Plan (ISSP) will be strength-
based focusing on individual and family strengths with the firm belief that all persons served can
achieve recovery goals, gain increased independence, self-sufficiency and achieve community
integration with the necessary individualized supports.
The DART West FSP Program will incorporate a comprehensive array of evidence-based
practices and models including the Housing First model, combined with a harm reduction model
that ensures individuals face the fewest barriers to service as possible. The program will provide a
wide variety of housing services to support the mantra: "it's not if the person served is ready for
housing but is the housing ready for our individual" to ensure the ability to wrap the appropriate
amount of care around each individual thus allowing them to successfully live in housing of their
choice.
REVISED EXHIBIT B3
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The DART West FSP Program will ensure that all services are:
• Recovery oriented;
• Individual-centered and built upon collaborations between each team, individual and
family that emphasize individual ownership of the recovery process;
• Designed to incorporate strengths-based solutions to improve the individual's quality
of life utilizing a broad array of integrated services;
• Linking individuals to supportive services in the community;
• Inclusive of the participation of family members and community support systems;
• Supportive of peer recovery networks; and
• Focused on reducing hospitalizations, incarcerations, homelessness and crisis
episodes.
LOCATION OF SERVICES
To increase the frequency of individuals obtaining needed services within the community,
CONTRACTOR will:
1) Utilize program vehicles to travel to outreach locations in order to provide services to
individuals wherever they are residing or most comfortable;
2) Provide transportation to services, if needed;
3) Provide bus passes or access to Uber Health for those without their own transportation;
4) Provide care packages to meet immediate needs of individuals and to help with their
engagement in services;
5) Each FSP team will provide services in a specific geographic area, with outreach taking
place throughout Fresno in areas where individuals who may be in need of services are known
to congregate;
6) Provide services in the field, including medical/psychiatric, at least 80% of the time;
7) Collaborate with other community agencies in order to connect and engage with potential
individuals;
8) Include peers with lived experience or the experience of having lived with an individual who
has struggled with homelessness, mental health, and/or substance use;
9) Include team members who reflect the demographics of the population;
10) Establish rapport by building relationships—the key to a successful program that effectively
links individuals to needed services and to address common barriers.
REVISED EXHIBIT B3
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DESCRIPTION OF SERVICES: DART West FSP
Outreach and Engagement:
CONTRACTOR will have Peer Support Specialists on each of the Treatment Teams. All
staff will be trained in and will use Motivational Interviewing (MI) to meet individuals where they are,
establish rapport, and help individuals establish baseline goals for improving their circumstances.
All services will be voluntary and individualized based on each individual's unique needs,
challenges and level of functioning; "individual voice and choice" will always be respected.
Outreach and engagement activities will respect the individual as the expert in their own life and
will focus on strengths rather than deficits throughout the process of initial contact, engagement,
and linkage with other providers. The Treatment Teams will work with individuals to establish what
they want and will point them in the direction to achieve their objectives while honoring their
preferences, including how often they wish to be contacted. In addition, CONTRACTOR will
provide education on the choices or services available in the community which will help the
individual and family to attain their goals.
Crisis Intervention:
FSP teams will be trained in crisis de-escalation and will incorporate crisis planning into
each individual's ISSP. In order to best support FSP individuals when they are in crisis,
CONTRACTOR will build upon and keep a strong network of resources available. The Program
Manager (PM) for the DART West site will meet with entities such as the Kings View Crisis
Intervention Team (CIT), and the WestCare Supportive Overnight Stay Program, hospitals and
emergency departments, crisis responders, faith-based and culturally-affiliated organizations
serving specific religious or ethnic populations, as well as the LGBTQ+ community so that
CONTRACTOR is able to coordinate warm handoffs when our individuals are in crisis. In addition,
CONTRACTOR will operate a 24/7 crisis line to ensure that our individuals may always reach an
understanding team member in times of duress.
Needs Assessment:
All individuals enrolled in CONTRACTOR's DART West FSP program will undergo
continuous assessment of needs and strengths through the use of formal assessment tools, self-
report and staff and family/support observations. The Personal Services Coordinator (PSC)
conducts the initial intake and assessment at a location convenient to the individual in order to
meet them where they are in terms of both geography and in terms of defining what they perceive
as their most pressing issues.
Coordination of Services:
One of the primary tasks of the PSC is to coordinate services in order to optimize the
overall health of FSP individuals. CONTRACTOR values such coordination of care, as well as the
linkage of individuals to medical homes, per their service plans. Through strong relationships with
physical healthcare providers CONTRACTOR assures quality coordinated care, integrated
treatment, and bidirectional communication and referrals. Communication is critical for FSP
individuals to receive the most comprehensive care possible. CONTRACTOR's FSP Program will
request mandatory person served/guardian authorization to exchange information with primary
care providers (PCPs) prior to releasing any information; then upon authorization, the program will
communicate with primary care providers as required. Contact, at minimum, is made annually with
each PCP per the individual's needs and contact is documented. Many times, due to the
individual's changing needs, hospitalizations, lab results, or high-risk situations, contact is made
REVISED EXHIBIT B3
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more frequently in the best interest of the individual. CONTRACTOR uses a Care Coordination
form to track referrals to PCPs and the form is kept in the individual's chart. All contacts are
documented, and ongoing evidence of collaboration is maintained in our clinical charts.
Collateral and Family/Peer Support and Education Services:
CONTRACTOR's FSP Treatment Teams will work to integrate family and peers supports
into each individual's recovery to help support ongoing efforts and to assist with reintegration to the
community. Collateral support begins with the assessment process when the PSC works to elicit
information from the individual's natural supports. Throughout the individual's participation in the
FSP program, Treatment Team members engage and teach family through psychoeducational
groups, individual meetings, and by promoting the message of recovery and hope in all interactions
utilizing language that represents their shared experiences rather than labels, diagnoses, and
clinical terminology. This message of hope includes the vision that recovery is a process with no
limitations, including going to school, volunteering, and employment. Through honest and open
communication and sharing, team members assist individuals and family members in
understanding that no matter how challenging the situation, "There is always hope." The presence
of peers on each FSP team helps to reinforce this message, as well as to give individuals and
family a relatable individual who can truly understand their journey.
Individual and Group Therapeutic Services:
CONTRACTOR's DART West FSP program will offer each individual treatment that is
specific to their needs and goals. Individuals may engage in individual therapy sessions with a
licensed or license-eligible clinician. CONTRACTOR will typically use Cognitive Behavioral
Therapy (CBT) as a baseline treatment modality; however, CONTRACTOR's clinicians will use the
most appropriate modalities based on the needs of the individual such as CBT for Psychosis
(CBTp), Trauma-Focused CBT (TF-CBT), and Dialectical Behavior Therapy (DBT) as well as
reinforcing skills learned in groups such as Cognitive Behavioral Social Skills group, DBT group,
Seeking Safety, etc. A variety of group therapy options are offered at each program to include
those focusing on specific therapeutic modalities, trauma, co-occurring disorders, wellness, life
skills, etc. The FSP Program will have its own unique group schedule based on the individual
population's needs and goals.
Treatment and Support for Co-Occurring Disorders:
All CONTRACTOR team members will be trained in co-occurring disorders including
providing a welcoming environment for those with co-occurring disorders so that all individuals can
feel comfortable discussing their substance use with staff. All staff will also be trained to provide
co-occurring disorders services and will be able to provide both individual and group services to
those individuals with co-occurring disorders. Including a Dual Recovery Case Manager and Peer
Support Specialist is an additional strategy to ensure that individuals are comfortable with
disclosing their substance use and feel that staff are empathetic with their experiences both with
the positive and negative effects of substance use. While the goal of services will be to help
individuals achieve an alcohol and drug free lifestyle if that is their choice, the program will also use
harm reduction strategies as individuals move through the stages of change from denial, unless
abstinence is mandated by the Court.
Rehabilitation/Activities of Daily Living:
CONTRACTOR's program rehabilitation services will support individuals in the
improvement, maintenance, or restoration of functional skills, daily living skills, social and leisure
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skills, grooming and personal hygiene skills, obtaining support resources, and medication
education. Services to family members will provide support for those individuals and address the
goals of the ISSP and their role and needed skills or skill development in supporting their family
member. Many skills will be taught by CONTRACTOR team members as they work with individuals
directly "in vivo," in community-based workshops or groups. Rehabilitation services may take place
individually or in groups, and in the home or other community location. Whether in individual
meetings or small groups, team members will work with the individual to develop and use
appropriate skills such as personal hygiene, house cleaning and household chores including
housekeeping and laundry, using community and public transportation, shopping for and
preparing/cooking healthy meals, money management skills, and care of physical health.
Medication Support Services:
CONTRACTOR has a great deal of experience providing comprehensive medication
management and support services and working with Patient Assistance Programs. FSP program
services will include medication evaluation, prescribing, Medication Assisted Treatment (MAT) for
co-occurring disorders, medication education, consultation, prescription delivery, monitoring,
linkage, and support provided at the program site or in the community based on the individual's
wishes.
Personal Service Care Coordination:
Each person served in the CONTRACTOR's FSP program will have an identified single
point of responsibility, the Personal Service Coordinator (PSC) who functions as the Case
Manager to ensure that services are provided as appropriate, available in a timely manner and
individualized. The PSC does initial outreach, engagement, and intake, ensuring that the
individual's basic needs are addressed including food, clothing, and shelter and serves as the
individual's main point of contact for service provision throughout their enrollment in the program.
Linkage and Consultation:
CONTRACTOR works in each community to establish a roadmap of referrals and
linkages necessary to assist individuals in meeting their goals across all life domains both during
and after program participation. Based on individual and family choice, team members will provide
active linkage to community resources (e.g., faith-based, Legal Aid, etc.); other service providers
including those providing primary care, mental health services, and substance use disorder
services; self-help communities; Wellness Recovery Action Plan (WRAP) groups; ethnic
organizations; peer-run programs, including NAMI and Recovery International and Clubhouses;
recreational resources; and health and wellness providers. CONTRACTOR's DART West program
will provide "active linkage" which typically involves a Peer and Family Advocate or other identified
team member going with the individual until the individual feels connected to the resource.
Referrals and linkages are made with a "warm handoff' to ensure that the individual and provider
have made a genuine connection.
Non-Behavioral Health Services and Supports:
Transportation, housing, flexible funds, and representative payee services are all
addressed in each individual's ISSP, coordinated by their PSC.
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HOURS OF OPERATION
CONTRACTOR's FSP program site will be open from 7:00 am to 5:00 pm seven (7) days
per week with after-hours services provided as necessary. When individual intervention is required
between 5:00 pm and 7:00 am, the on-call team member will notify the Supervisor on Call and the
team will respond in person, if necessary. The team members identified as most appropriate to
respond will meet at the individual's location to address the crisis and do "whatever it takes" to
ensure safety and to stabilize the situation. The Consultant Psychiatrist will also be available to
assist, as needed. The team may also respond in the community, if it is determined to be safe, to
transport the individual to another housing location such as the master leased unit set aside for
respite care and late in the day referrals; for example, if the landlord is threatening to evict the
individual that night. Typically, staff will then work with the landlord the next day to resolve the crisis
and try to maintain the individual's housing.
LEVELS OF CARE
CONTRACTOR's FSP Program will utilize a multiple tiered model with three (3) levels of
care to ensure maximum flexibility for individuals to move seamlessly between levels, as clinically
indicated. Provision of these three (3) different levels of service within the FSP model allows for
more individualized treatment and for better engagement and retention. The level system allows for
individuals to move along at a pace that makes sense for them and their specific needs,
incorporating successes in their recovery journey as they step down from one level to another. It
also provides individuals and FSP staff with clear parameters for goal achievement to ensure that
individuals are moving along in treatment at an appropriate pace.
The tiers/levels of care are:
• FSP
• Heightened FSP
• Intensive FSP
Intensive FSP services will be designed to meet FSP fidelity standards, including staffing
levels and frequency/intensity of services. Individuals at the Intensive FSP level of care will have at
least four (4) contacts per week, with group participation as determined by the ISSP. Each
Intensive FSP level individual will receive at least 120 minutes of face-to-face services per week.
Since individuals will typically be working on different areas of the ISSP such as symptom
management, education, etc., each individual will typically be working with more than one team
member in any given week (e.g., the nurse for ongoing medication monitoring, PSC for linkages,
etc.) The Treatment Team will meet with individuals in person and/or on the phone as often as
necessary to maintain them in the community and to avoid hospitalizations or a higher level of
care. The team will work with individuals who are progressing toward the achievement of the goals
in their ISSP to decrease the intensity of services. However, the team will consistently maintain
contact with individuals and each individual will be discussed at the morning meeting. Therefore,
the team will always be able to step in quickly to avoid symptoms worsening and to prevent minor
problems from escalating into crises.
Heightened FSP will be similar to the Intensive FSP level in terms of intensity of services.
Individuals at this level will receive services based on their individual needs with a minimum of
three (3) weekly contacts, at least one of which will be face-to-face for a minimum of 90 minutes of
face-to-face service per week. The frequency of individual services and individual clinical
counseling will thus be less than at the Intensive FSP level of care. Services provided will begin to
lay the groundwork for participation in more and varied types of groups to assist in addressing
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individual-identified issues. For example, an individual may participate in individual counseling at
the Heightened FSP level using Trauma Focused CBT to build a foundation for participation in
Seeking Safety once they have transitioned down to FSP.
FSP individuals will have at least three (3) individual contacts per week, one of which will be
face-to-face for a minimum of 60 minutes per week. Although services will be less frequent than at
the Heightened FSP or Intensive FSP level, intensity and frequency will continue to be
individualized to meet each individual's needs, including identifying the services that the individual
will participate in at the FSP level, and responding promptly to any individual who has a crisis or
event that necessitates immediate response, including increasing services or moving up a level of
care until such time as the individual is re-stabilized and moving forward toward the individual's
ISSP goal attainment.
The primary difference between services provided at the Intensive FSP level of care and
those provided at the Heightened FSP and FSP level of care will be the frequency/intensity of
services which will be decreasing as the individual moves towards the FSP level. The frequency of
individual services and individual clinical counseling will be less intense and there will be more
wraparound services as individuals step down through the levels of services. For example,
individuals in the FSP level will have demonstrated improved capacity toward identifying strengths
and barriers.
Intensive FSP criteria: individuals must meet criteria for a Serious Mental Illness (SMI).
They must meet medical necessity and have significant impairment (e.g., paranoid and hearing
voices, cannot leave the house, etc.) that impair their functioning. The individual must be a
consistent utilizer of emergency or crisis services due to assessed impairments in one (1) of five
(5) domains:
• living arrangement (without permanent safe living situation),
• employment (without regular, sustainable income),
• daily activities (life is organized around survival needs),
• social relationships (estrangement from family/healthy supports), and/or
• health (co-occurring untreated, unmanaged medical conditions).
Heightened FSP criteria: individuals will have a persistent SMI, who are unstable or in
crisis but with less impairment than those at the Intensive FSP level of DART West. They may
have limited social skills, serious impairments across all life domains (including physical health
problems), and histories of trauma. Many will face imminent risk of hospitalization, incarceration,
and homelessness, and/or are frequent utilizers of emergency psychiatric services many of whom
have acute and long-term institutionalization backgrounds who are often difficult to engage in
services, yet can succeed in the community with sufficient linkage, structure, and support.
FSP criteria: Individuals with an SMI who, by moving through the Intensive FSP and
Heightened FSP levels of care, are beginning to explore their needs across all life domains who
are open to exploring the resolution of barriers to a healthier lifestyle such as permanent, safe and
stable housing, education/vocation, daily activities, lack of support system, and less than optimum
health.
Transitions Among Levels of Care:
Individuals in the CONTRACTOR's DART West FSP program will experience seamless
transitions from one level of care to another within the program. It is CONTRACTOR's primary goal
to ensure that individuals remain engaged and on track with pursuit of the individual's ISSP
objectives toward a healthier, more satisfying life. Each individual will be assisted to achieve a level
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of recovery, stability, and independence that will allow them to transition to the least restrictive level
of care possible. Some individuals may remain at the highest level of service for an extended
period, others may demonstrate improvements in functioning that allow them to work with staff to
titrate services down, moving to a lower level of care within the program. Other individuals may be
assigned to a lower level of care within the program based on their initial assessment and
continued evaluation. All services will be tailored to the individual's needs, wishes, and
preferences.
CONTRACTOR's DART West program will re-evaluate every 90 days to determine the
appropriate level of care for all individuals. In addition, staff will monitor individuals during their
regular interactions, at all levels of care, to identify any potential crises or occurrences that may
indicate that the individual needs a higher level of care or conversely is ready for a lower level of
care as they demonstrate increased competency and higher skills levels in living successfully in
the community, managing symptoms, etc.
As individuals move through the levels of care, staff will update the Plan of Care to reflect
the services needed and the frequency and intensity of services with individuals. However,
individuals may not be aware that they are being served in different levels of care; therefore,
transitions should not impact the individual's perspective of where they are in their treatment
trajectory. Individuals will experience working with staff on different services they need as they
increase their competencies and work with staff to titrate down the frequency of services in
preparation for stepping down to a lower level of care. Transitions will thus be seamless throughout
all levels of care with individuals feeling no disruption or anxiety as they transition. Should
individuals need to move to a higher level of service because of an increase in acuity of symptoms
or circumstances, they will experience this as an increase in intensity of services and the addition
of services as needed, rather than a formal transition.
PROGRAM OBJECTIVES AND OUTCOMES
CONTRACTOR will utilize its electronic health systems, including the County's EHR, to collect data
to track metrics which inform individual outcomes.
1. 80% of individuals will demonstrate improved adult stability and decreased incarceration
and psychiatric hospitalization as evidenced by information from Key Event Tracking (KET)
and 3Ms;
2. 95% of individuals will demonstrate a positive individual services experience as evidenced
by annual individual survey data reflecting scores of satisfied and very satisfied with
services received.
4. All participants will have demonstrated decreased criminogenic risks/needs as evidenced
by the Level of Service Inventory-Revised (LSI-R).
For the Intensive FSP tier within the DART West program, CONTRACTOR will meet outcomes in
each of the following domains and has included more than one performance indicator for each of
the domains.
Effectiveness:
1. Individuals served will experience a reduction in recidivism events (incarcerations,
homelessness, crisis or inpatient hospitalization admissions) to no more than six (6) events
within the first six (6) months after admission compared to events prior to admission as
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evidenced by reports of the KETs completed for each individual whenever a key event
takes place.
2. There will be a reduction of key events for recidivism tracked as:
a. A reduction in engagement in three (3) or less key recidivism events (incarcerations,
homelessness, crisis or inpatient hospitalization admissions) during 6-12 months in
the program compared to events prior to admission, as evidenced by reports of the
KETs completed for each individual whenever a key event takes place.
b. A reduction in engagement in no more than one (1) key recidivism event
(incarcerations, homelessness, crisis or inpatient hospitalization admissions) during
13-18 months in the program compared to events prior to admission, as evidenced
by reports of the KETs completed for each individual whenever a key event takes
place.
3. The program will demonstrate at least 75% reduction in inpatient psychiatric
hospitalizations after being admitted to program services compared to inpatient days
utilized the year prior to program admissions, as evidenced by the end of year Data
Collection and Reporting (DCR) system report.
4. The program will demonstrate at least 75% reduction in incarceration days after being
admitted to program services compared to inpatient days utilized the years prior to program
admissions, as evidenced by the end of year DCR report.
5. The program will demonstrate at least 75% reduction in days of homelessness compared to
events prior to admission, unless housing assistance is declined, as evidenced by the end
of year DCR report.
6. The program will show at least 75% reduction in crisis episodes compared to episodes prior
to program admission as evidenced by the end of year DCR report.
7. The program will demonstrate a significant increase in individual functioning, as evidenced
by the above outcomes#3-6.
CONTRACTOR's DART West Program Manager will ensure that reports are run monthly from
the DCR system and will review these reports to ensure that the program is on track to meet
overall outcomes.
Efficiency:
1. The DART West Program direct services productivity rate is expected by CONTRACTOR to
be at a minimum of 65% and will be reported in writing by the Program Manager at regularly
scheduled meetings with DBH. Productivity shall be reviewed during the monthly meeting
between the Program Manager and Program Supervisors/Team Leads.
2. Individuals in independent supportive housing and lower levels of housing such as
Independent Living Homes will develop a plan to provide for their own housing costs. The
team will work with individuals on payment issues. Individuals will assume responsibility for
housing cost, when ready and as appropriate. A report regarding individual plans for
housing costs will be submitted annually.
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3. The program will conduct an assessment within 24 hours of initial appointment to assess for
appropriate level of care and will conduct the ASAM within 72 hours of initial appointment to
assess for the appropriate level of care for individuals with substance use disorder.
Access:
1. Within 24 hours of referral receipt, CONTRACTOR will make contact to schedule intake and
enrollment. Initial appointments will be scheduled within 24 -72 hours from initial contact. If
individual declines contact, CONTRACTOR will document accordingly and notify referral
source, as evidenced by access logs delivered each month to DBH Managed Care.
2. Within 90 days of admission to DART West, at least 95% of individuals who do not have
Supplemental Security Income (SSI) will have completed an SSI application, as evidenced
by progress notes, a receipt in the individual's file, and the tracking log.
3. Within 60 days of admission to DART West, at least 95% of individuals will be linked to
General Relief to establish supplemental income, as evidenced by progress notes, a receipt
in the individual's file, and the tracking log.
4. Within six (6) months of being admitted to DART West, at least 95% of individuals served
will have linkage to and documentation of a Primary Care Physician, as evidenced by the
tracking log.
5. Within 30 days of enrollment, at least 95% of individuals will have participated in forming
their individualized personal service care plan, as evidenced by the personal service care
plan in the individual's file.
6. Within 120 days of enrollment, at least 95% of individuals will be provided/linked to
supported employment activities, if desired, as evidenced by a referral placed in the team
meeting binder and a progress note.
Satisfaction:
1. The program will develop a satisfaction survey that is approved by DBH's MHSA
Coordinator, or designee, and will comply with mandated State performance outcomes and
quality improvement reports/outcomes. At a minimum, 75% percent of individuals will report
their satisfaction with program services provided by the DART West FSP Program twice
annually.
The program will regularly implement Program Satisfaction - Consumer (PS-C) tools
designed to track, measure, and evaluate individual, family, and community-partner
satisfaction. The PS-C will be provided to the individual and family separately every six (6)
months and during the discharge process. The PS-C is a 20-item scaled questionnaire that
asks the individual and family about their experience with the CONTRACTOR's service,
specific providers, ease of use, flexibility and satisfaction of results.
The California Brief Multi-Cultural Competency Scale (CBMCS) will be e-mailed annually to
all staff to complete anonymously and submit to the Program Manager. Results are used to
identify areas of training need, and to update the program's Cultural Competency Plan.
The Program Satisfaction — Community Partner (PS-CP) tool will be provided to partners
who collaborate with the program. The Program Manager regularly reviews these tools,
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recording them no less than quarterly into the Program Satisfaction Report regularly
submitted to CONTRACTOR's Vice President of Clinical Services who collaborates with the
Program Manager to build on identified strengths and mitigate identified concerns.
Outcome Tracking for the FSP levels of care:
Effectiveness
1. Psychiatric Hospitalizations: Frequency of hospitalizations will be reduced for each
individual. Through an individual self-report tool, persons served will show a 70% reduction
in hospitalization after one year of receiving services or upon discharge.
2. Homelessness: Frequency of homelessness will be reduced for each individual. Persons
served will show an 80% reduction in days spent homeless after one year of receiving
services or upon discharge. Each individual will obtain and maintain stable housing after
one year or receiving services or upon discharge.
3. Housing: Each individual will be linked to the appropriate level of housing support, reflective
of their individual needs. Persons served will receive assistance in housing placement and
support, including emergency housing, contingent upon level of need and independent
functioning. Each individual shall have stable and sustained housing upon discharge.
2. Each individual will be assisted to achieve a level of recovery, stability, and independence
that will allow them to transition to the least restrictive level of care possible.
3. Personal wellness goals will be included in each individual's ISSP. Goals will be evaluated,
monitored, and adjusted regularly and written reports will be submitted quarterly.
4. Direct Services Productivity Rate: The DART WEST Program services productivity rate will
be at a minimum of 65%.
5. Supplemental Security Income: Within six (6) months of enrollment, 99% of individuals
without SSI will have made SSI applications and a written report regarding these goals will
be submitted semi-annually.
Efficiency
Cost per person served: The program will efficiently use resources and maintain or minimize
the cost per person served.
Access
Persons served will begin receiving services within 24 hours of being transitioned to or from
any level of care.
Satisfaction
Consumer Perception Survey: The DART West program will gauge satisfaction of individuals
and collect data for service planning and quality improvement. The Consumer Perception
Survey is conducted by DBH every six (6) months over a 1-week period. The program staff will
encourage individuals to participate in completing the survey with the goal of a 75% satisfaction
rate for each domain.
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PROJECT DESCRIPTION: CARE Act
BACKGROUND:
On September 14, 2022, Senate Bill (SB) 1338 established the Community Assistance, Recovery
and Empowerment (CARE) Act, which provides community-based behavioral health services and
supports to Californians living with untreated schizophrenia spectrum or other psychotic
disorders through a new civil court process. The CARE Act is intended to serve as an upstream
intervention for individuals experiencing severe impairment to prevent avoidable psychiatric
hospitalizations, incarcerations, and Lanterman-Petris-Short Mental Health Conservatorships.
The CARE process will provide earlier action, support, and accountability for both CARE clients,
and the local governments responsible for providing behavioral health services to these
individuals. The CARE Act authorizes specified adult persons to petition a civil court to create a
voluntary CARE agreement or a court-ordered CARE plan that may include treatment, housing
resources, and other services.
TARGET POPULATION:
The target population for CARE Act services, as detailed in Welfare & Institutions Code (WIC)
Section 5972, includes any adult (18 years and older) within Fresno County who has a severe
mental illness and a diagnosis of schizophrenia spectrum and other psychotic disorders. The
individual subject to the petition for the CARE process, ("respondent," as defined in WIC Section
5971(o)) must also meet additional criteria (listed below) before CARE Act treatment can be
considered.
The typical characteristics of the target population include the following:
• Having a severe mental illness and a diagnosis of schizophrenia spectrum or other
psychotic disorders (schizophrenia, schizoaffective, schizophreniform, and catatonia);
• Not be clinically stabilized in ongoing voluntary treatment;
• Be unlikely to survive safely in the community without supervision and their condition is
substantially deteriorating or is in need of services and support to prevent a relapse or
deterioration likely to result in grave disability or serious harm to themselves or others;
• Participation in a CARE Act plan or CARE Act agreement is the least restrictive
alternative to ensure recovery and stability; and
• Would likely benefit from participation in a CARE Act plan or CARE Act agreement.
SERVICES START DATE:
The CARE Act services, as identified herein, are mandated to begin on December 1, 2024. DBH
will require CONTRACTOR begin attending meetings with stakeholders as soon as they have
been identified as the awarded provider of services. DBH will lead training and education (as
further defined herein) with collaboration with contractor regarding CARE Act services to the
community stakeholders at the earliest possible date after contract execution.
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LOCATION OF SERVICES:
Services shall be provided wherever the individual is located (e.g., home, community-based
location, or court). Telehealth, mobile services, and co-location in natural supports and gathering
places for the intended population are additional options to increase the frequency of contact
with individuals obtaining needed services. The primary office locations for services are the
Fresno/Clovis metro area and County rural areas. Providers are required to attend CARE Act
hearings with their persons served.
HOURS OF OPERATION:
The hours of operation for the CARE Act services will coincide with the FSP contract's existing
office hours. The proposed hours of operation must ensure availability to individuals and families,
as needed. A minimum of eight (8) hours a day, five (5) days per week is required. Should
individuals/family members require services during non-traditional office hours, the
CONTRACTOR will work to accommodate them in the most appropriate manner. CONTRACTOR
shall provide details of business hours made available outside of traditional business hours. The
hours of operation for the CARE Act services shall be at all times of the day. The intention for
CARE Act services is to engage those typically unwilling to be engaged; therefore, the providers
need to be available any time of the day whenever the individual may be ready to engage. This
falls in line with FSP programs' regulatory requirement for 24 hours/day and 7 days/week (24/7)
access to services. When individual intervention is required between 5:00 pm and 7:00 am, the
on-call team member will notify the Supervisor on Call and the team will respond in person, if
necessary. The team members identified as most appropriate to respond will meet at the
individual's location to address the crisis and do "whatever it takes" to ensure safety and to
stabilize the situation. The Consultant Psychiatrist will also be available to assist, as needed. The
team may also respond in the community, if it is determined to be safe, to transport the individual
to another housing location such as the master leased unit set aside for respite care and late in
the day referrals; for example, if the landlord is threatening to evict the individual that night.
Typically, staff will then work with the landlord the next day to resolve the crisis and try to
maintain the individual's housing. CONTRACTOR shall provide a plan to detail 24/7 coverage
and support, as appropriate for the individuals served. Bidders shall recommend clinic hours for
the highest need for this target population. On-call hours staffed with program staff shall be
proposed; hotlines will not suffice.
DESCRIPTION OF SERVICES:
TRAINING AND EDUCATION PLAN
The training and education plan shall be developed in collaboration with DBH, patient and family
advocacy agencies, County Counsel, and other stakeholders regarding appropriateness of the
training/curriculum, including use of materials and trainings provided by Health Management
Associates (HMA). In addition to the staff training plan, the plan will highlight the potential
partners in CARE Act services. Contractor will support DBH in development of: type of trainings
needed for CARE Act, potential resources, means to inform stakeholders, information on CARE
Act services available, and how training will be provided to various community partners including,
but not limited to, mental health treatment providers, law enforcement officials, cities, fire
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departments and certification hearing officers involved in making treatment and involuntary
commitment decisions. Targeted training and education specific to CARE Act processes in the
County of Fresno shall be developed and delivered to first responders eligible to file petitions,
cities, police departments, and fire departments.
Contractor shall support the County's development of training plans which include, but are not
limited to, the following:
• CARE Act eligibility criteria;
• Eligible Petitioners criteria;
• Petition submission process;
• Information regarding a respondent's rights during the CARE process; and
• Information regarding the difference between a CARE agreement and CARE plan.
• Information relative to legal requirements for detaining a person for involuntary inpatient
and outpatient treatment, including criteria to be considered with respect to determining if
a person is considered to be gravely disabled.
• Methods for ensuring that decisions regarding involuntary treatment directs individuals
toward the most effective treatment. Training shall include an emphasis on each
individual's right to provide informed consent for assistance.
CONTRACTOR is required to use resources and materials available through the CARE Act
Resource Center (https://care-act.org ), DHCS contracted with HMA to provide training and
technical assistance that is necessary in the planning/design, development, and implementation of
CARE Act services. The HMA trainings provided via the CARE Act Resource Center will inform not
just the program design, but process, eligibility, legal considerations, as well as public and system
education, and service evaluation. The County training plan shall inform stakeholders of what
CARE Act is and is not, the eligibility criteria for CARE Act in Fresno County, the referral process in
Fresno County, and alternative resources (info on substance use treatment services, housing
services, crisis, and other supports). General public information will be available as collateral
materials (such as brochures, flyers, and other specific materials in the County's threshold
languages) as developed and/or approved by the County. CONTRACTOR shall work with DBH and
the CARE Act Implementation Team to ensure trainings include information regarding local
processes.
Community Stakeholders
The County shall lead efforts in working with Community Stakeholders, including an array of
County and community partners including, but not limited to the following:
• Fresno County Board of Supervisors
• Office of the Fresno County Counsel
• Fresno Superior Court
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• Office of the Public Defender
• County Administrative Office
• Department of Behavioral Health
• Central California Legal Services
• Sheriff's Office
• Department of Probation
• Public Guardian's Office
• Police Departments
• Mobile Crisis Response Teams
• Crisis Intervention Teams
• Cities
• Fire Departments
• First Responders
• NAMI-Fresno
• Patients' Rights Advocates
• Family Advocacy
• FSP Providers
• Crisis Providers
• Family Members and Caregivers
• Peers and Peer Support
• Persons Served
• Behavioral Health Board
Contractor shall work with the County in support of outreach, engagement and training of County
and community partners.
ASSERTIVE OUTREACH AND ENGAGEMENT
CONTRACTOR shall provide Assertive Outreach and Engagement (AOE) to all potential CARE
Act participants. The goal is to motivate the individuals to engage in voluntary services before
any legal proceedings need to be implemented. DBH's definition of AOE is the following:
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"Outreach attempts that are persistent, thorough, and are sensitive to readiness and present
stage of change and acknowledges that individuals might not be ready to engage with the
system of care. Attempts are specific and tailored to the individual and may include attempts to
visit the individual's residence, or other places the individual is known to frequent such as places
of work, leisure, or worship. Outreach may include consulting with wellness centers, crisis
centers/programs, local inpatient units, previous providers, homeless shelters, and other
agencies to determine if the individual has been seen at those locations or in the community. All
efforts and types of attempts are specific to the individual, are clinically based (not protocol-
based), are person-centered and are clearly documented in the chart. The individuals should be
encouraged to accept services and supports that they perceive as beneficial and will be driving
force in planning in their recovery process respecting the stages of change."
Assertive Outreach and Engagement should be initiated immediately upon receiving notice of a
petition being submitted to the court or notice of an initial appearance from the court regarding a
petition submitted for possible CARE Act eligibility and services. Every effort at fostering
engagement should occur prior to the initiation of the CARE Act process.
Assertive Outreach and Engagement shall also include all activities required pursuant to W&I
Code, sections 5977(a)(5)(A) and 5977(c)(2) to engage the respondent and develop a CARE
agreement with the respondent, and outreach done to engage the respondent in jointly preparing a
graduation plan pursuant to 5977.3(a)(3).
Contractor must attempt to make contract in-person, track total number of persons engaged and
monitor staff time for Assertive Outreach and Treatment.
CARE PETITION PROCESSING
Requestors of a CARE Act Petition
Per WIC Section 5974, the following adult individuals are considered a "qualified party" and are
able to submit a CARE Act petition:
• A person with whom the respondent resides.
• A spouse, parent, sibling, child, or grandparent or other individual who stands in
loco parentis to the respondent.
• The director of a hospital, or their designee, in which the respondent is
hospitalized, including hospitalization pursuant to WIC Section 5150 or 5250.
• The director of a public or charitable organization, agency, or home, or their
designee, who has, within the previous 30 days, provided or who is currently
providing behavioral health services to the respondent or in whose institution the
respondent resides.
• A licensed behavioral health professional, or their designee, who is, or has been
within the previous 30 days, either supervising the treatment of, or treating the
respondent for a mental illness.
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• A first responder, including a peace officer, firefighter, paramedic, emergency
medical technician, mobile crisis response worker, or homeless outreach worker,
who has had repeated interactions with the respondent in the form of multiple
arrests, multiple detentions, and transportation pursuant to WIC Section 5150,
multiple attempts to engage the respondent in voluntary treatment, or other
repeated efforts to aid the respondent in obtaining professional assistance.
• The public guardian or public conservator, or their designee, of the county in which
the respondent is present or reasonably believed to be present.
• The director of a county behavioral health agency or their designee ("County
behavioral health agency," as defined in WIC Section 5971(e) and inclusive of
designee), of the county in which the respondent resides or is found.
• The director of county adult protective services, or their designee, of the county in
which the respondent resides or is found.
• The director of a California Indian health services program, California tribal
behavioral health department, or their designee.
• The judge of a tribal court that is located in California, or their designee.
• The respondent.
Pursuant to WIC Section 5978(a), a court may refer an individual from assisted outpatient
treatment (AOT), as well as from conservatorship proceedings to CARE Act proceedings. If an
individual is being referred from AOT, the County behavioral health director or their designee
shall be the petitioner. If an individual is being referred from LPS conservatorship proceedings,
the conservator shall be the petitioner pursuant to WIC Section 5974.
Pursuant to WIC Section 5978(b), a court may refer an individual from misdemeanor proceedings
to CARE Act proceedings.
Petition
Per WIC Section 5975, the petition signed and submitted to the Fresno County Superior Court
shall include the name of the respondent, respondent's address (if known), petitioner's
relationship to respondent, and facts that support the petitioner meets CARE Act criteria.
Additionally, either of the following must be included:
1. An affidavit of a licensed behavioral health professional, stating that the licensed
behavioral health professional or their designee has examined the respondent within 60
days of the submission of the petition, or has made multiple attempts to examine, but has
not been successful in eliciting the cooperation of the respondent to submit to an
examination, within 60 days of the petition, and that the licensed behavioral health
professional had determined that the respondent meets, or has reason to believe,
explained with specificity in the affidavit, that the respondent meets the diagnostic criteria
for CARE Act proceedings.
2. Evidence that the respondent was detained for a minimum of two intensive treatments
pursuant to Article 4 (commencing with Section 5250) of Chapter 2 of Part 1, the most
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recent one within the previous 60 days.
Petition Review
The Court shall promptly review the submitted CARE Act petition to determine if there is
sufficient evidence to proceed to a hearing. CONTRACTOR, acting as the designee of the
behavioral health agency (County behavioral health agency), shall provide notice to the
respondent and submit a written report as described below.
If the Court determines there is sufficient evidence to proceed to a hearing, the Court shall do
one of the following:
1. If the petitioner is the County behavioral health agency, the Court will:
a. Set the matter for an initial appearance on the petition within 14 court days.
b. Appoint a qualified legal services project, as defined in WIC Sections 6213 to
6214.5, inclusive, of the Business and Professions Code, to represent the
respondent. If no legal services project has agreed to accept these
appointments, a public defender or other counsel working in that capacity
shall be appointed to represent the respondent.
c. Determine whether the petition includes all of the following information and, if
it does not, order the County behavioral health agency to submit a written
report with the court within 14 court days that includes all of the following:
i. A determination as to whether the respondent meets, or is likely to
meet, the criteria for the CARE process.
ii. The outcome of efforts made to voluntarily engage the respondent
prior to the filing of the petition.
iii. Conclusions and recommendations about the respondent's ability to
voluntarily engage in services.
d. Order the County behavioral health agency to provide notice to the
respondent, the appointed counsel, and the County behavioral health
agency in the county where the respondent resides, if different from the
county where the CARE process has commenced.
2. If the petitioner is a person other than the County behavioral health agency, the
court will:
a. Order the County behavioral health agency, to investigate, as necessary,
and file a written report with the Court within 14 court days and provide
notice to the respondent and petitioner that a report has been ordered. The
written report shall include all of the following:
i. A determination as to whether the respondent meets, or is likely to
meet, the criteria for the CARE process.
ii. The outcome of efforts made to voluntarily engage the respondent
during the 14-day report period.
iii. Conclusions and recommendations about the respondent's ability to
voluntarily engage in services.
The information, including protected health information, necessary to support the determinations,
conclusions, and recommendations in the report.
Contractor shall monitor staff time for drafting notices and court reports as described in Revised
Exhibit H.
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COURT PROCESSES
There are four (4) main stages to the court processes for CARE Act. CONTRACTOR, acting as
the designee of the behavioral health agency (County behavioral health agency), will be
responsible to walk the individual through each stage (except for the first).
1. Case Initiation
A case is initiated when a person petitions the court to determine a respondent's eligibility and
begin CARE Act proceedings. The statute allows for a range of individuals to file petitions, such
as family members/caregivers, health care or social service providers, or first responders. County
behavioral health agencies may also file petitions.
2. Engagement
Initially, the court will decide if the petition shows that the individual meets, or may meet,
eligibility criteria for CARE Act proceedings (i.e., a prima facie showing). If the petition was filed
by other than the County behavioral health agency, the court will order a county agency to
investigate and submit a report to determine whether the respondent meets, or is likely to meet,
the eligibility criteria. During this time, the County behavioral health agency will attempt to
engage the respondent in voluntary services and report to the court on the outcome of those
efforts.
Activities shall include all outreach and engagement activities required pursuant to W&I Code,
sections 5977(a)(5)(A) and 5977(c)(2) to engage the respondent and develop a CARE
agreement with the respondent, and outreach done to engage the respondent in jointly preparing
a graduation plan pursuant to 5977.3(a)(3).
Contractor shall monitor staff time for Outreach and Engagement activities as described in
Revised Exhibit H.
3. Court Process/Service Connection
If the court finds that the respondent qualifies for CARE Act proceedings, and efforts to engage
the respondent in services was not effective, the case will proceed through the court flow with the
goal of connecting the respondent with services. At this point, the court will appoint an attorney to
represent the respondent throughout the proceedings, at no cost.
At the initial appearance, the petitioner must be present, or the petition may be dismissed. If the
petition was filed by a party other than the County behavioral health agency, the original
petitioner is substituted out, and the County behavioral health agency is appointed. A
representative of the County behavioral health agency must be present during the initial
appearance. Contractor shall be designated representative on behalf of DBH. The respondent
may waive their personal appearance and appear through counsel. If the respondent does not
waive their personal appearance and does not appear at the hearing, the Court may conduct the
hearing in the respondent's absence if the Court makes a finding that reasonable attempts to
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elicit attendance have failed and makes a finding that conducting the hearing without the
presence or participation of the respondent would be in the respondent's best interest. During
this appearance, the respondent has the right to have a supporter be present with them.
The court shall set a hearing on the merits of the petition within 10 days. The hearing on the
merits may be conducted concurrently with the initial appearance on the petition upon stipulation
of the petitioner and respondent and agreement by the court.
The court determines if the respondent meets eligibility criteria under a clear and convincing
standard. If the court finds that the petitioner has shown clear and convincing evidence that the
respondent meets CARE criteria, the court shall order the County behavioral health agency to
work with the respondent, the respondent's counsel, and their supporter to create a voluntary
CARE Act agreement and engage in behavioral health services. The court shall set a case
management hearing within 14 days.
At the case management hearing, the court shall hear evidence as to whether the parties have
entered, or are likely to enter, into a CARE agreement. If the court finds that the parties have
entered, or are likely to enter, into a CARE agreement, the court shall approve the agreement or
modify the terms of the agreement and approve the agreement as modified by the court,
continue the matter and set a progress hearing for 60 days.
If the court determines a CARE Act agreement is not likely to be reached, the court will order the
County behavioral health agency, through a licensed behavioral health professional, to conduct a
clinical evaluation, unless there is an existing clinical evaluation of the respondent completed
within the last 30 days and the parties stipulate to the use of that evaluation. The Court shall set
a clinical evaluation hearing within 21 days to review the clinical evaluation and other evidence
from the County behavioral health agency, Contractor and the respondent. The court shall order
the County behavioral health agency to file the evaluation with the court and provide the
evaluation to the respondent's counsel no later than five days prior to the scheduled clinical
evaluation hearing. The hearing may be continued for a maximum of 14 days upon stipulation of
the respondent and the County behavioral health agency, unless there is good cause for a longer
extension.
At the clinical evaluation hearing the court will determine if the respondent meets the eligibility
criteria. If the court finds by clear and convincing evidence that the respondent meets the CARE
criteria, the court shall order the County behavioral health agency, the respondent, and the
respondent's counsel and supporter to jointly develop a CARE plan within 14 days and set a date
for the hearing to review and consider approval of the CARE plan. Contractor shall work with
DBH and respondent in developing a CARE plan
At the CARE plan review hearing, the parties shall present their plans to the court. County
behavioral health agency or the respondent, or both, may present their plans. After consideration
of the plans proposed by the parties, the court shall adopt the elements of a CARE plan that
support the recovery and stability of the respondent. The court may issue any orders necessary
to support the respondent in accessing appropriate services and supports, including prioritization
for those services and supports, subject to applicable laws and available funding pursuant to
WIC Section 5982. These orders shall constitute the CARE plan.
The court may order medication if it finds, upon review of the court-ordered evaluation and
hearing from the parties, that, by clear and convincing evidence, the respondent lacks the
capacity to give informed consent to the administration of medically necessary stabilization
medication. To the extent the court orders medically necessary stabilization medication, the
medication shall not be forcibly administered and the respondent's failure to comply with a
REVISED EXHIBIT B3
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medication order shall not result in a penalty, including, but not limited to, contempt or
termination of the CARE plan pursuant to WIC Section 5979.
At this point, the respondent, their attorney, their supporter, and the behavioral health agency
and contractor will work together to create a CARE Act plan that includes services the
respondent is entitled to receive under the CARE Act. These services should be collaboratively
determined, according to the specific needs of the respondent.
Contractor shall monitor time for court hearing activities as described in Revised Exhibit H.
4. Service Delivery and Assessing Next Steps
During service delivery, a respondent will receive services indicated in their CARE Act plan:
behavioral health services (including treatment for substance abuse disorder as applicable),
medically-necessary stabilization medications (as applicable), housing resources & supports, and
funded social services, including those services available to indigent California residents.
Progress will be checked at status review hearings, at intervals set by the court, but not less
frequently than 60 days after the court orders the CARE plan. At month 11, a status review
hearing will be held to determine if the respondent is ready to graduate. The respondent may
voluntarily elect to remain in the CARE Act program, or may be involuntarily reappointed by the
court to remain to the program and continue to receive services under CARE Act, for up to one
year. The behavioral health agency will continue to engage the respondent, work on the CARE
Plan, and attend status hearings. If the respondent is ready to graduate from the program, a
hearing will be set during the 12t" month for presentation of the graduation plan. The behavioral
health agency will work with the respondent, their attorney, and their supporter on a graduation
plan to present to the court.
CARE ACT TREATMENT SERVICES
If CARE Act services are court-ordered, the individual will be assigned to a CARE Act treatment
team of the CONTRACTOR. The treatment services provided to any individual receiving CARE
Act will be at the Full Service Partnership (FSP) treatment level of care. As CARE Act will be a
brand-new civil process within Fresno County, the Department does not know what the true
number of individuals requiring this type of service will be. The CONTRACTOR will initially be
awarded a maximum capacity of twenty (20) CARE Act slots, beginning December 1, 2024.
Should the contracted provider meet milestones for number of persons served, their allotted slots
may increase.
Services Provided:
In addition to the services and processes described in the COURT PROCESSES section above,
CONTRACTOR will continue to provide services as described here.
Once a CARE agreement or plan is approved by the court, respondent shall be assigned to
CONTRACTOR's FSP program and receive FSP services, described herein in Revised Exhibit
B3. CONTRACTOR will provide comprehensive behavioral health services, including mental
health treatment, medication stabilization, housing, and other supports, to their CARE Act-
specific individuals. Additionally, court attendance, participation, and reporting are expected of
the contracted provider.
REVISED EXHIBIT B3
Page 22 of 29
In regard to housing, pursuant to WIC Section 5982(b), CONTRACTOR shall prioritize CARE
process participants for any appropriate bridge housing funded by the Behavioral Health Bridge
Housing program.
The CARE Act treatment services will encompass a unified team approach, in which the provider
shall commit to do "whatever-it-takes" and "meet the individual where they are" to assist them to
reach their personal recovery, resiliency and wellness goals and aim to reduce the number of
days of hospitalization, incarceration and/or homelessness.
Description of Services:
CONTRACTOR shall:
A. Be available to provide the following services, including but not limited to:
• Personal service coordination;
• Supportive counseling;
• Ongoing assessment of the persons served's mental illness symptoms and
response to treatment;
• Education of the person served regarding their mental illness and the effects
(including side effects) of prescribed medications;
• Symptom management efforts directed to helping the persons served identify the
symptoms and their occurrence patterns, and development of methods (internal,
behavioral, adaptive) to lessen their effects; and
• Provision, both on planned and on an "as needed" basis, of such psychological
support as is necessary to help the person served accomplish their personal goals
and cope with the stresses of day-to- day living.
B. Be available to provide crisis assessment and intervention 24/7, including telephone and
face-to-face contacts, as needed. The following crisis response measures shall also be
followed:
• Response to crisis shall be rapid and flexible; and
• When crisis housing is necessary for short-term care and inpatient treatment
(either voluntary or involuntary), the staff shall collaborate whenever possible with
the treatment staff in such facilities. Support shall be provided including beginning
the process of planning with the facility for the persons served discharge to the
community as soon as possible.
C. Provide services in the areas of medication prescription, administration, monitoring, and
documentation.
• The Psychiatrist shall assess each person served mental illness symptoms and
behavior and prescribe appropriate medication, regularly review and document
symptoms as well as the person served response to the prescribed medications,
educate the person served and family members, and monitor, treat and document
any medication side effects;
REVISED EXHIBIT B3
Page 23 of 29
• The Nurse shall establish medication policies and procedures which identify
processes to administer medications, train other team members, and assess
regularly other team members' competency in this area; and
• CARE Act staff shall assess and document the person served's mental illness
symptoms and behavior in response to medication and shall monitor for
medication side-effects during the provision of observed self-administration and
during ongoing face-to-face contacts.
D. Provide whatever direct assistance is necessary and reasonable to ensure that the
person served obtains the basic necessities of daily life, such as food, housing, clothing,
medical services, and other financial support.
E. Ensure that each CARE Act Team member shall have access to an adequate amount of
financial resources to make emergency purchases of food, shelter, clothing, prescriptions,
transportation, or other items for the person served, as needed, during regular working
hours (and appropriate on-call hours). The Team shall have access to larger flexible
funding accounts for assistance with housing deposits, furniture purchases, and other
items, with sound accounting practices for recording and monitoring the use of these
funds.
F. Assist the person served with establishing a payee or payee service. The CARE Act
Team may utilize person served assistance funds to assist the persons served with short-
term loans or grants, as necessary. The team shall link clients to appropriate social
services, provide transportation as necessary, and link the client to appropriate legal
advocacy representation.
G. Provide training, instruction, support and assistance to the persons served in developing
personal skills, including but not limited to, the ability to:
• Carry out personal hygiene tasks;
• Perform household chores, including housekeeping, cooking, laundry and
shopping;
• Develop or improve money management skills;
• Use community transportation; and
• Locate, finance and maintain safe, clean and affordable housing.
H. Develop and support the persons served participation in social interactions, including
when possible: recreation, social activities, and relationships. Priority shall be given to
supporting persons served in establishing positive social relationships in normative
community settings. Such services shall include, but not be limited to, assisting persons
served in:
• Interacting with landlords, neighbors and others effectively and appropriately;
• Developing assertiveness and self-esteem;
• Using existing self-help centers, groups, spiritual, and recreational groups to
combat isolation and withdrawal experienced by many persons coping with severe
mental illness;
REVISED EXHIBIT B3
Page 24 of 29
• Developing social skills and the skills needed to develop meaningful personal
relationships; and
• Planning appropriate and productive use of leisure time including familiarizing
clients with available social and recreational opportunities.
I. Provide alcohol, tobacco and drug use disorder services for co-occurring persons served,
as clinically appropriate and in accordance with harm reduction principles. This will
include, but is not limited to individual and group interventions to assist persons served in:
• Identifying alcohol, tobacco, and drug use effects and patterns;
• Recognizing interactive effects of alcohol, tobacco, and drug use, psychiatric
symptoms and psychotropic medications;
• Developing coping skills and alternatives to minimize alcohol, tobacco and drug
use;
• Achieving periods of abstinence and/or decreased risk behaviors and increased
stability;
• Attending appropriate recovery or self-help meetings; and
• Achieving an alcohol and drug free lifestyle, as desired.
J. Act to minimize the persons served involvement in the criminal justice system, with
services to include, but not be limited to;
• Helping the person served identify precipitants to their own criminal involvement;
• Providing necessary treatment, support and education to help eliminate unlawful
activities or criminal involvement that may be a consequence of the person served'
s 's mental illness; and
• Collaborating with law enforcement, court personnel, and jail/prison officials to
ensure appropriate collaboration and clinical support through the legal processes.
K. Assist the person served, family and other members of the individual person served's
social network to relate in a positive and supportive manner through such means as:
• Education about the person served's severe mental illness and their role in the
therapeutic process and treatment services and supports;
• Supportive counseling;
• Intervention to resolve conflict; and
• Referral, as appropriate, of the family to therapy, self-help and other family support
services.
L. Coordinate with other community mental health and non-mental health providers, as well
as other medical professionals. Staff shall provide the following functions for all persons
served:
REVISED EXHIBIT B3
Page 25 of 29
• Development of formal and informal affiliations with other human service providers
including, mental health, physical health care, addiction treatment providers, and
inpatient units;
• Involvement of other pertinent agencies, the persons served's family, and
members of the client's social network in the coordination of the assessment, and
in the development, implementation and revision of service plans;
• Advocacy and assistance to person served to obtain needed benefits and
services, such as supplemental security income, general relief, housing subsidies,
food stamps, medical assistance, and legal services;
• Coordination of meetings of the persons served service providers in the
community;
• Maintenance of ongoing communication with all other agencies serving the
individual, including hospitals, primary care physicians, rehabilitation services and
housing providers as required;
• Maintenance of working relationships with other community services, such as
education, law enforcement and social services;
• Maintenance of the clinical treatment relationship with the persons served on a
continuing basis whether the person served t is in the hospital, in the community,
involved with other agencies or the criminal justice system; and
• Methods for service coordination and communication between the team and other
service providers serving the same clients shall be developed and implemented
consistent with Fresno County confidentiality rules.
M. Coordinate with law enforcement and courts services, as needed.
N. Monitor service outcomes to determine if the person served has meaningful use of their
time, stays in school or maintains employment, has reduced numbers of hospitalizations,
incarcerations, and periods of homelessness. DBH will use State identified criteria for
measuring these outcomes. The treatment team will be monitored to ensure appropriate
service delivery and adherence to Mental Health Services Act philosophies.
O. Provide comprehensive services, including intensive mental health treatment,
rehabilitation, and case management with the goal of increasing adaptive functioning in
the community and preventing unnecessary re-admissions to Institutes of Mental Disease
(IMD), acute inpatient facilities, or other higher levels of care.
P. Meet with DBH on a monthly basis, or more often as agreed upon, for contract and
performance monitoring.
Staffing:
The staffing pattern for the provision of CARE Act services shall meet all State licensing and
regulatory requirements for an FSP provider. All licensed or certified staff must be licensed or
REVISED EXHIBIT B3
Page 26 of 29
certified within the State of California. Staff should be reflective of and responsive to the needs of
the target population. Staff shall be comprised of a community-based, multidisciplinary, highly
trained mental health team.
Staffing Plans:
Contractor shall be required to maintain appropriate staffing plans/patterns sufficient to deliver
the necessary levels of services as described in their proposal. Credentialing through DBH's
Managed Care for all staff providing services that requires a license must be completed prior to
billing for Medi-Cal Mental Health services. Clinical Supervisors and the clinical training program
must meet the California Board of Behavioral Sciences and/or California Board of Psychology
standards.
The Contractor will be encouraged to hire and recruit those with lived experience including
clients or family members of clients that have previously received behavioral health services.
Peer support services are required as part of the program design.
The FSP serving CARE Act participants will include (but not be limited to) the following:
o Team Leader/Program Director
o Licensed Mental Health Clinician
o Personal Service Coordinator/Case Manager
o Peer Support Specialist
o Registered Nurse
o Licensed Psychiatrist
o Program Assistant
• Staff-to-Client ratios shall not 1:10 not exceed 1:15 with recommended ratio of one
Full-Time Equivalent staff person for every ten to fifteen persons served. Only
Case Managers should be included in the ratio.
• The Psychiatrist must meet with the persons served on a monthly basis at a
minimum and be available during normal business hours and on-call during off-
hour periods. This position may be subcontracted out.
• Staff members working directly with persons served will provide outreach outside
of the office setting and shall have the capacity to provide as many contacts as
needed with clients to meet their recovery/resiliency and wellness goals.
PERFORMANCE OUTCOMES AND MEASURES:
Outcomes
CONTRACTOR will be required to achieve objectives that fall within the six (6) HEDIS
accreditation domains for the provision of CARE Act services. They are listed below:
REVISED EXHIBIT B3
Page 27 of 29
• Effectiveness of Care
• Access/Availability of Care
• Experience of Care
• Utilization and Risk Adjusted Utilization
• Health Plan Descriptive Information
• Measures Reported Using Electronic Clinical Data Systems
The annual Outcomes Report that the contracted provider submits to DBH for their FSP services
shall include the CARE Act services goals/objectives, indicators, current measures (including
data sources) beginning with the FY 24-25 submittal.
DATA COLLECTION & TRACKING FOR DHCS QUARTERLY REPORTING:
DHCS Data Reporting
County Behavioral Health is required to collect and report data to DHCS through the CARE Act
Data Collection and Reporting Tool (DCRT) in SurveyMonkey or the file transfer mechanism,
MOVEit. The data will be collected on a monthly basis and reported quarterly. CONTRACTOR
shall track data outcomes for the following required elements, pursuant to WIC Section 5985,
subsections (e) through (f), based on information found in Behavioral Health Information Notice
(BHIN) 23-052:
• Basic information of person served
• Demographics
• Services and supports
• Stabilizing medications
• Rates of adherence to medication
• Housing placements
• Substance use and rates of treatment
• Detentions and other LIPS involvement
• Criminal justice involvement of participants
• Deaths and causes of death
• Supporters and psychiatric advance directives (PAD)
REVISED EXHIBIT B3
Page 28 of 29
• CARE Act plan, agreement and graduation
• Hospitalizations and emergency department visits
Data Reporting Requirements Pursuant to WIC Section 5985(e):
• The demographics of participants, including, but not limited to, the age, sex, race,
ethnicity, disability, languages spoken, sexual orientation, gender identity, housing status,
veteran status, immigration status, health coverage status, including Medi-Cal enrollment
status, and county of residence, to the extent statistically relevant data is available.
• The services and supports ordered, the services and supports provided, and the services
and supports ordered but not provided.
• The housing placements of all participants during the program and at least one year
following the termination of the CARE plan, to the extent administrative data are available
to report the latter. Placements include, but are not limited to, transition to a higher level
of care, independent living in the person's own house or apartment, community-based
housing, community-based housing with services, shelter, and no housing.
• Treatments continued and terminated at least one year following termination of the CARE
plan, to the extent administrative data are available.
• Substance use disorder rates and rates of treatment among active CARE plan
participants and former participants at least one year following termination of the CARE
plan, to the extent administrative data are available to report the latter.
• Detentions and other Lanterman-Petris-Short Act involvement for participants with an
active CARE plan and for former participants at least one year following termination of the
CARE plan, to the extent administrative data are available to report the latter.
• Criminal justice involvement of participants with an active CARE plan and for former
participants at least one year following termination of the CARE plan, to the extent
administrative data are available to report the latter.
• Deaths among active participants and for former participants at least one year following
termination of the CARE plan, along with causes of death, to the extent administrative
data are available.
• The number, rates, and trends of petitions resulting in dismissal and hearings.
• The number, rates, and trends of supporters.
• The number, rates, and trends of voluntary CARE agreements.
• The number, rates, and trends of ordered and completed CARE plans.
• Statistics on the services and supports included in CARE plans, including court orders for
stabilizing medications.
• The rates of adherence to medication.
• The number, rates, and trends of psychiatric advance directives created for participants
with active CARE plans.
• The number, rates, and trends of developed graduation plans.
• Outcome measures to assess the effectiveness of the CARE Act model, such as
improvement in housing status, including gaining and maintaining housing, reductions in
emergency department visits and inpatient hospitalizations, reductions in law enforcement
encounters and incarceration, reductions in involuntary treatment and conservatorship,
and reductions in substance use.
• A health equity assessment of the CARE Act to identify demographic disparities based on
demographic data in paragraph (1), and to inform disparity reduction efforts.
REVISED EXHIBIT B3
Page 29 of 29
Contractor must reference and adhere to reporting requirements in the most recent version the
CARE Act Data Dictionary (https://care-act.org/resource/care-act-data-dictionary/) and the Data
Dictionary Flow Chart (https://care-act.org/resource/care-act-data-flowchart) referenced herein
this as Revised Exhibit B-3, as reporting requirements may change pending State legislation.
Contractor shall also collaborate with DBH in implementing changes with reporting requirements.
Contractor must utilize DBH's EHR system to report all mandated data sets as described above.
Contractor shall monitor time for data reporting described above and as described in Revised
Exhibit H.
Additional Reporting
• Data collection and outcomes tracking as required Department of Behavioral
Health (DBH) and collaborative stakeholders.
Revised Exhibit H I FSP-AOT and Care Act Rates
Page 1 of 3
Fresno County Department of Behavioral Health
Specialty Mental Health Services Outpatient Rates
FSP and AOT
Provider Rate
Provider Type Per Hour
Psychiatrist/Contracted Psychiatrist $1,140.98
Physicians Assistant $511.73
Nurse Practitioner $567.38
RN $463.45
Certified Nurse Specialist $567.38
LVN $243.47
Pharmacist $546.16
Licensed Psychiatric Technician $208.72
Psychologist/Pre-licensed Psychologist $458.87
LPHA(MFT LCSW LPCC)/Intern or Waivered LPHA(MFT LCSW LPCC) $296.95
Occupational Therapist $395.28
Mental Health Rehab Specialist $223.41
Peer Recovery Specialist $234.S8
Other Qualified Providers-Other Designated MH staff that bill
medical $223.41
FY23-24 Rates Sheet
Revised Exhibit H I FSP-AOT and Care Act Rates
Page 2 of 3
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
$306.09
(MFT LCSW LPCC)
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 Variable $30.92
FY24-25 Rates Sheet
Revised Exhibit H I FSP-AOT and Care Act Rates
Page 3 of 3
CARE Act Administrative Reimbursement Rates
Fiscal Year: 24-25
Activity Activity Hourly Rate
1 Court Report Activity $114.95
2 Court Hearing Time Activity $91.63
3 Notice Activity $65.40
4 Outreach and Engagement Activity 1 $78.68
5 Data Reporting I $97.08
• Court Hearing Time: Includes activities that occur during court time such as initial hearings, hearings on the
merits, case management hearings, CARE agreement process meetings, clinical evaluation review hearings,
CARE plan review hearings, regular status update hearings, one-year status hearings, evidentiary hearings,
graduation hearings, and reappointment to CARE hearings, and hearings that can occur at any time during
the CARE process to address a change of circumstances.
• Court Report: Includes drafting reports such as prima facie county reports, CARE agreement reports,
clinical evaluation reports, CARE plan reports, supplemental reports, regular status update reports for CARE
Act scheduled hearings, one-year status reports, graduation plan reports, and reappointment to CARE
reports.
• Outreach and Engagement: Includes all outreach and engagement activities required pursuant to W&I
Code, sections 5977(a)(5)(A) and 5977(c)(2) to engage the respondent and develop a CARE agreement with
the respondent, and outreach done to engage the respondent in jointly preparing a graduation plan pursuant
to 5977.3(a)(3).
• Notice: Includes drafting notices that may include prima facie respondent county notices, 30 additional days
to engage respondent notices, initial appearance notices, hearing on the merits notices, case management
hearing notices, CARE agreement progress meeting notices, clinical evaluation review hearing notices,
CARE plan review hearing notices, regular status update report (months 3, 5, 7, and 9) notices, one-year
status hearing (month 11) notices, evidentiary hearing notices, graduation hearing notices, and
reappointment to CARE notices.
• Data Reporting: Includes collecting and reporting data measures outlined in BHIN 23-052, including but not
limited to, demographics of participants, housing placements, continuation of treatment information, and other
data as determined by the department and other stakeholders.
FY24-25 Rates Sheet
Revised Exhibit H4 - Compensation
Page 1 of 14
Adult FSP Master Agreement-D.A.R.T.West
Mental Health Systems,Inc.
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 -
Acct# Program Position FTE Admin Program Total
1116 $
1117
1118
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotall 0.00 1 1 $ $
Admin Program Total
Direct Personnel Salaries Subtotall 0.00 $ - $
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $
1202 Worker's Compensation
1203 Health Insurance
1204 Other(Benefits listed under ARPA Grant) - -
1205 Other(specify) - - -
1206 1 Other(specify) - - -
Direct Employee Benefits Subtotal: $ - $ - $ -
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ $
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 1 Other(specify)
Direct Payroll Taxes&Expenses Subtotal: $ $ $
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ $
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
#DIV/0! #DIV/0!
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit H4 - Compensation
Pa e2of14
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care 2,571
2002 Client Housing Support 601,800
2003 Client Transportation&Support 34,731
2004 Clothing,Food,&Hygiene 13,886
2005 Education Support 2,571
2006 Employment Support 2,571
2007 Household Items for Clients 20,429
2008 Medication Supports 487,386
2009 Program Supplies-Medical 8,400
2010 Utility Vouchers 643
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 1,174,988
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ -
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 1 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ -
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
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 Other(specify)
DIRECT FACILITIES/EQUIPMENT TOTAL:j$
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 1 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2f7/2020
Revised Exhibit H4 - Compensation
Pa e3of14
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provide,-Owned Equipment to be Usedfoi Program Funposes)
6008 Personnel(indirect Salaries&Benefits)
6009 Other(Indirect Cost under ARPA Grant)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $
INDIRECT COST RATE 0.00%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ -
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures -
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+ -
7006 Assets over$5,000/unit(Specify) -
7007 Other(specify) -
7008 Other(specify) -
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 1,174,988
PROGRAM FUNDING SOURCES
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 ISABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $ -
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports Turn BHS/MHS D.A.R.T.West Adult FSP $ 1,174,988
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 1,174,988
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $
8402 Client Insurance
8403 Grants(ARPA)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 1,174,988
NET PROGRAM COST: $
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit H4 - Compensation
Page 4 of 14
Adult FSP Master Agreement-D.A.R.T.West
Mental Health Systems,Inc.
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 Employee Benefits
1201 Retirement
1202 Worker's Compensation
1203 Health Insurance
1204 Other(Benefits listed under ARPA Grant)
1205 Other(specify)
1206 Other(specify)
Direct Payroll Taxes&Expenses:
1301 OASDI
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 Other(specify) -
2000:DIRECT CLIENT SUPPORT 1,174,988
2001 Child Care 2,571 Estimated wrap expenses related to child care for clients
2002 Client Housing Support 601,800 Estimated expenses for housing support for clients
2003 Client Transportation&Support 34,731 Cost of transporting clients by staff(mileage reimbursement or gas for vehicles)and bus
passes/cards for client transportation needs.
2004 Clothing,Food,&Hygiene 13,886 Estimated expenses for food&for clothing
2005 Education Support 2,571 Estimated wrap expenses related to education support for clients
2006 Employment Support 2,571 Estimated wrap expenses related to employment support for clients
2007 Household Items for Clients 20,429 Estimated wrap expenses related to household items for clients
2008 Medication Supports 487,386 Estimated wrap expenses related to medication supports(psychiatrist)for clients-
Psychiatrist service expense outside of the MHS,Inc.staff.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit H4 - Compensation
Page 5 of 14
PROGRAM EXPENSE
ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2009 Program Supplies-Medical 8,400 Medical supplies that consist of miscellaneous items such as latex gloves,cotton,
alcohol swipes,etc.,in addition to charges for laboratory tests for clients(i.e.blood
tests).
2010 Utility Vouchers 643 Estimated wrap expenses related to utility vouchers for clients
2011 Other(specify) -
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 1 Other(specify)
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(specify)
3012 1 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 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT 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
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(Indirect Cost under ARPA Grant) Insurance,timekeeping,audit fees,corporate costs for processing invoices
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Revised Exhibit H4 - Compensation
Page 6 of 14
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7007 Other(specify)
7008 Other(specify) -
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,174,988
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,174,988
BUDGET CHECK: -
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2I7I2020
Revised Exhibit H4 - Compensation
Page 7 of 14
Adult FSP Master Agreement-D.A.R.T.West
Mental Health Systems,Inc.
Fiscal Year(FY)2024-2025
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $
1102 $
1103 $
1104 $
1105 $
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116
1117
1118
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 0.00 $ $
Admin Program Total
Direct Personnel Salaries Subtotal 0.00 $ $ $
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $
1202 Worker's Compensation $
Revised Exhibit H4 - Compensation
Page 8 of 14
1203 Health Insurance $ -
1204 Other(Benefits listed under ARPA Grant) $
1205 Other(specify) $
1206 Other(specify) $
Direct Employee Benefits Subtotal: $ $ $
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $
1302 FICA/MEDICARE $
1303 SUI $
1304 Other(specify) $
1305 jOther(specify) i i $
1306 10ther(specify) I 1 1 $
Direct Payroll Taxes&Expenses Subtotal: $ $ $
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ $ -
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
#DIV/0! #DIV/0!
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $ 2,571
2002 Client Housing Support 1,089,186
2003 Client Transportation&Support 34,731
2004 Clothing, Food,&Hygiene 13,886
2005 j Education Support 2,571
2006 Employment Support 2,571
2007 Household Items for Clients 20,429
2008 Medication Supports -
2009 Program Supplies-Medical 8,400
2010 Utility Vouchers 643
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 1,174,988
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications
3002 Printing/Postage
3003 Office, Household&Program Supplies
3004 Advertising
3005 IStaff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
Revised Exhibit H4 - Compensation
Page 9 of 14
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
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 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes)
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(Indirect Cost under ARPA Grant)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
013 6 Other(specify)
INDIRECT EXPENSES TOTAL $
INDIRECT COST RATE 0.00%
Revised Exhibit H4 - Compensation
Page 10 of 14
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ -
37
TOTAL PROGRAM EXPENSES $ 1,174,988
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
Acct# Line Item Description Service Units Rate Amount
8001 Mental Health Services $
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Non-Billable
8010 Other(Specify)
Estimated Specialty Mental Health Services Billing Totals: 0 $
Estimated%of Clients who are Medi-Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries
Federal Financial Participation(FFP)% I -
MEDI-CAL FFP TOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 Drug Medi-Cal $
8102 SABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment $
REALIGNMENT TOTAL $
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports TURN BHS/MHS D.A.R.T.West Adult FSP $ 1,174,988
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
Revised Exhibit H4 - Compensation
Page 11 of 14
MHSA TOTAL $ 1,174,988
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees
8402 Client Insurance
8403
8404
8405
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 1,174,988
NET PROGRAM COST: $
Revised Exhibit H4 - Compensation
Page 12 of 14
Adult FSP Master Agreement-D.A.R.T.West
Mental Health Systems,Inc.
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS
Administrative Positions -
1101
1102
1103
1104
1105
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions -
1116
1117
1118
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134 #REF! -
Direct Employee Benefits -
1201
1202
1203
1204
1205
1206
Direct Payroll Taxes&Expenses: -
1301
1302
1303
1304
1305
1306
2000:DIRECT CLIENT SUPPORT 1,174,988
2001 Child Care 2,571 Estimated wrap expenses related to child care for clients
Revised Exhibit H4 - Compensation
Page 13 of 14
2002 Client Housing Support 1,089,186 Estimated expenses for housing support for clients
2003 Client Transportation&Support 34,731 Cost of transporting clients by staff(mileage reimbursement or gas for vehicles)and
bus
2004 Clothing,Food,&Hygiene 13,886 Estimated expenses for food&for clothing
2005 Education Support 2,571 Estimated wrap expenses related to education support for clients
2006 Employment Support 2,571 Estimated wrap expenses related to employment support for clients
2007 Household Items for Clients 20,429 Estimated wrap expenses related to household items for clients
2008 Medication Supports -
2009 Program Supplies-Medical 8,400 Medical supplies that consist of miscellaneous items such as latex gloves,cotton,
alcohol swipes,etc.,in addition to charges for laboratory tests for clients(i.e.blood
tests).
2010 Utility Vouchers 643 Estimated wrap expenses related to utility vouchers for clients
2011 Other(specify)
2012 Other(specify)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
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/Fuel/Insurance
3009 Recruitment
3010 Other(specify)
3011 Other(specify)
3012 1 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 Minor equipment purchases and equipment
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 O/S Labor Psychiatrist
5006 O/S Labor Counselor
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT 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
Revised Exhibit H4 - Compensation
Page 14 of 14
6008 Personnel(Indirect Salaries&Benefits)
6009 Licenses
6010 Indirect
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$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,174,988
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 1,174,988 0
BUDGET CHECK: TRUE