HomeMy WebLinkAboutAgreement A-25-267 Amendment 1 to Participation Agreement 22-270 with CalMHSA.pdf Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No. 25-267
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
CALIFORNIA MENTAL HEALTH SERVICES AUTHORITY
"CaIMHSA"
PARTICIPATION AGREEMENT AMENDMENT NO. 1
SEMI-STATEWIDE ENTERPRISE HEALTH RECORD PROGRAM
This Participation Agreement Amendment No. 1 ("Amendment No. 1") amends Participation
Agreement No. 1543-EHR-2022-FC,executed on June 29,2022(the"Agreement")and is entered into
by and between the California Mental Health Services Authority ("CaIMHSA") and Fresno County
("Participant").
CaIMHSA and Participant agree to amend the Agreement to incorporate additional purchases and to
establish an approved "Maximum Funding" amount, not to be exceeded, with the intention of
promoting the necessary flexibility and agility to meet Participant's programmatic needs in a timely
manner.
CaIMHSA and Participant agree that the total approved maximum programmatic funding("Maximum
Funding")allocated by Participant in the Agreement to the Semi-Statewide Enterprise Health Record
Program ("EHR")shall not exceed the amount of$10,806,504.00.
The Maximum Funding stated above includes the funding Participant has committed to EHR
program-related components, modules and implementations purchased to date ("Participant-
Specific Committed Funding") in the amount of $9,759,561.70, inclusive of the $297,385.00 in
additional programmatic purchases described in greater detail in the sections below.
CaIMHSA and Participant agree to amend the Agreement by adding or revising the followingterm(s):
Quality Assurance/Quality Improvement Analytics Program Offerings:
CaIMHSA will support Participants in managing essential Quality Assurance and Quality
Improvement ("QA/QI") activities for those utilizing the CaIMHSA SmartCare Electronic Health
Record System. These Program Offerings strive to enhance organizational effectiveness through
structured quality assessment, data-driven insights, and streamlined and standardized operational
processes, strengthen compliance, increase knowledge on policy development, and support
workforce retention.
The table below includes a complete list of the available Program Offerings under this Agreement.
Additional details on each QA/QI Analytics Program Offering are included in the sections that follow.
Each QA/QI Analytics Program Offering listed below are provided beginning the date of execution of
this Amendment No.1 and continuing for a period of twelve (12) months from the date of execution.
Participant may select the Program Offerings in which it would like to participate.
Item Program Offering Description Cost*
Number
1 Policies Development CaIMHSA will conduct a comprehensive $94,000
review and synthesis of 6 newly published
Fresno County—Participation Agreement Amendment No. 1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
Behavioral Health Information Notices
(BHINs) to develop policies that support
county plans' compliance with BHIN
guidance. These policies will incorporate
all necessary elements to facilitate
adherence to regulatory requirements.
Training may include updates to current
workflows, EHR updates or
enhancements, documentation
requirements, and claiming for services.
2 EQRO Audit CaIMHSA will support county plan(s) in $60,700
Preparation preparing for the FY24-25 External Quality
(ISCAT/NAV) Review(EQR)audits related to the SmartCare
EHR by developing required audit reports and
participating in audit sessions as invited by
the county plan(s). Reports will be submitted
to the county plan(s) unless otherwise
specified. CaIMHSA will identify and
complete the portions of the Information
Systems Capability Assessment Tool (ISCAT)
document best responded to by CaIMHSA
and will identify those sections best
completed by county plan(s). CaIMHSA will
liaise with the EQR team as permitted and
participate in virtual audits as needed/invited
by county plans. CaIMHSA will support
document resubmission as needed.
3 DHCS Compliance CaIMHSA will support the county plan in $28,812.50
Audit Preparation and preparation for and response to DHCS
Response compliance audits to facilitate compliance
with regulatory requirements, enhance
operational efficiency, and improve
organizational readiness for audits. CaIMHSA
will develop a gap assessment, prepare
documents for submission, liaise with DHCS
to the extent permitted, attend audit review,
and support the development of corrective
action plans.
4 Chart Review Tools and CaIMHSA will provide support to County plan $48,685
Coaching in the development and implementation of
chart review tools and training and coaching
Fresno County—Participation Agreement Amendment No. 1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
on conducting chart reviews for compliance
and quality purposes.
5 Performance CaIMHSA will support county plan(s) in $85,543.75
Improvement meeting EQR PIP requirements by providing
Projects' regular PIP coaching, consultation and
writing support. Ca[MHSA will develop
standard SmartCare reports to support
counties in identifying client populations
relevant to each PIP and assist with
interpreting and applying HEDIS measure
descriptive analysis reports to PIPs, as
applicable.
CalMHSA support under this scope of work
applies to federally required Performance
Improvement Projects (PIPs) for Mental
Health Plans (MHPs) and Drug Medi-Cal
Organized Delivery System (DMC-ODS) Plans
per 42 C.F.R. § 438.330(b)(1) and (d)(1).
CaIMHSA support does not apply to other
quality or performance improvement
projects, such as those mandated by DHCS
as part of a Corrective Action Plan (CAP) for
quality performance measures per BHIN 24-
004.
6 Enhanced Analytics- CaIMHSA will provide a suite of individual $94,000
PHI Dashboards county-facing Power BI dashboards to display
SmartCare data relevant to treatment
services, quality/compliance, and fiscal
operations. The initial dashboard will focus
on client demographic and service data,
providing local insights into treatment
populations and the service mix. Subsequent
dashboards willfocus on optimizing EHR data
capture and tracking selected initiatives (e.g.
CARE Act). Dashboard findings will be
reviewed quarterly with county
directors/leadership.
CaIMHSA will provide five (5) complimentary
commercial PowerBI user licenses ("User
Licenses") for the Participant to utilize upon
the execution of this Amendment No. 1.
Fresno County—Participation Agreement Amendment No. 1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
If the Participant wishes to obtain additional
User Licenses, Ca[MHSA will purchase and
maintain User Licenses on behalf of the
Participant at rate of $240.00 per user, for a
12-month user license to support the
Enhanced Analytics — PHI Dashboards
Offering. Participant will designate the
number of User Licenses to be purchased for
their county by utilizing the Order Form
Template (Exhibit E of the Agreement).User
Licenses purchased via Exhibit E will be
invoiced for on an annual basis.
Alternatively, Participant may choose to use
their own commercial PowerBl user licenses
if applicable. Ca[MHSA will not provide any
administrative or technical support related to
PowerBl licenses not purchased through
CaIMHSA
Participant may choose to re-assign user
licenses during the 12-month license period if
needed. Participants will be able to assign or
re-assign a user license via a CaIMHSA
provided registration link that will be sent to
the Participant upon execution of this
Amendment No. 1.
* The Cost for each Program Offering listed in the table above applies to services provided through
December31,2025. For subs equentyears, the Costof each Program Offering,if any,shall be subject
to change and must be agreed upon by the Parties in a separate, written agreement or amendment
**Performance Improvement Projects: HEDIS-based PIP support is only available to counties that
are also participating in the CalMHSA Quality Measures and Performance Improvement Program.
Counties that are not participating in the CalMHSA Quality Measures and Performance Improvement
Program may opt in to PIP-support for those PIPs that have topics other than improving HEDIS
outcomes.
Ca[MHSA QA/QI Analytics Program Offering Obligations:
Ca[MHSA shall provide the following services based on each Program Offering purchased:
1. Policies Development
a. Review, synthesis, and create six (6) policies for newly published ("finalized") Behavioral
Health Information Notices(BHINs).
b. Make policies available on a CaIMHSA platform.
c. Maintain policy controls by making updates to policies based on updated state guidance
(BHINs).
Fresno County—Participation Agreement Amendment No. 1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
d. Develop training geared for direct service providers.
e. Develop training geared toward QA/QI staff or relevant leadership staff members.
f. Make training available on a CaIMHSA platform.
g. Communicate information on trainingvia email.
2. EQRO Audit Preparation
a. Submission Generation:
i. Complete the portion of the required EQR document submission relevant to
CaIMHSA support role for SmartCare EHR to county plan(s).
b. Audit Session Participation
i. Participate in audit sessions as invited by the county plan(s)to address inquiries and
provide support.
ii. Assist County Plan(s)with document re-submission as needed.
3. DHCS Compliance Audit Preparation and Response
a. Pre-Audit Preparation
i. Review documents provided to County plan(s) by DHCS related to the triennial
review.
ii. Conduct an initial review of current documentation processes and practices.
iii. Develop a detailed report highlighting areas of risk, including recommendations for
addressing identified concerns.
iv. Review documents to be submitted to DHCS using the DHCS request for documents
checklist.
b. Audit Coordination
i. Coordinate with internal teams and external auditors.
ii. Manage timelines and ensure all audit preparation documents and activities are
completed on schedule.
iii. Participate alongside the county plan in the initial and closing conference for the
audit.
c. Audit Response
i. Facilitate smooth communication between auditors and staff.
ii. Prepare and submit required documentation to auditors,to the extent permitted.
iii. Ensure accuracy and completeness of submitted materials.
iv. Assist in managing auditor requests and inquiries.
v. Identify strategies for addressing issues or discrepancies identified during the
preliminary review and audit findings.
vi. Prepare written response to audit findings.
4. Chart Review Tools and Coaching
a. Development of Chart Review Tools:
i. Create chart review tools tailored to the specific compliance with regulatory
requirements for specialty mental health services and state guidance(BHINs).
ii. Tools provided will be user-friendly, align with industry best practices, and meet
regulatory requirements and state guidance.
iii. Make chart review tools accessible for use.
iv. Make necessary updates to chart review tools to keep up-to-date based on state
guidance(BHINs).
Fresno County—Participation Agreement Amendment No. 1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
b. Training on Chart Review Tools:
i. Design training module on the use of the chart review tools.
ii. Training module and material shall be accessible for use.
c. Coaching and Support:
i. Lead five(5)one-hour coaching opportunities on best practices for chart reviews.
ii. Each one-hour coaching session will be available via a live-virtual platform to be
agreed upon prior to coaching dates.
iii. CaIMHSAwill offer real-time guidance and feedback to ensure staff understand how
to apply the tools effectively.
d. Executive Synthesis Session:
i. Provide information on county plan's overall performance.
5. Performance Improvement Projects
a. Provide monthly PIP coaching meetings with county QI staff to discuss PIP development and
implementation,which may include:
i. Understanding the problem;
ii. Identifying interventions;
iii. Selecting key performance indicators(KPIs);
iv. Discussing implementation barriers,solutions, and progress.
b. PIP Writing Support
i. Assistance drafting and revising required EQR PIP forms based on county input and
results of local implementation efforts.
c. Data Support
i. Develop standard SmartCare report identifying client population relevant to each
PIP.
ii. CaIMHSA data subject matter experts (SMEs)will join periodic existing monthly PIP
consultation meeting to review HEDIS measure descriptive analysis reports to
support interpretation and application to PIPs, if relevant.
6. EnhancedAnalytics—PHI Dashboards
a. Develop, publish and maintain county-facing Service and Demographics Dashboard.
b. Develop, publish and maintain additional Power BI dashboards as per above.
c. Provide quarterly executive coaching sessions on dashboard findings/insights.
Participant QA/QI Analytics Program Offering Obligations:
Participant shall provide the following services based on each Program Offering purchased:
1. Policies Development
a. Assign a county plan liaison to facilitate communication on policy development and training
opportunities.
b. Implement changes to County plan(s)'s internal staff workflows that align with new policies.
c. Facilitate staff participation in training.
d. Distribute and communicate policy changes and updates and provide support to
Participant's network providers.
2. EQRO Audit Preparation
a. Primary EQR Liaison
Fresno County—Participation Agreement Amendment No. 1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
i. As the entity subject to EQR audit, the County Plan must take the lead in
communicating and coordinating with the EQR unless otherwise agreed by the EQR.
b. Data and Documentation Provision
i. Provide CaIMHSA with all necessary documents and background information
required for the development of audit reports.
c. Audit Session Support
i. Attend audit sessions, inviting CaIMHSA as needed.
d. Post-Audit Collaboration
i. Provide CaIMHSAwith all necessary follow-up information to comply with post-audit
resubmissions or other deliverables.
3. DHCS Compliance Audit Preparation and Response
a. Pre-Audit Preparation
i. Collaborate with CaIMHSA and provide documents necessary to conduct an initial
review of current documentation practices and processes.
b. Audit Coordination:
i. Coordinate with CaIMHSA on requests by DHCS for audit documentation
submission.
ii. Ensure timelines are met and ensure all audit preparation activities are completed
on schedule.
c. Audit Response
i. Ensure smooth communication between auditors and staff.
ii. Ensure accuracy and completeness of submitted materials.
iii. Coordinate with Cal.MHSA to assist in managing auditor requests, inquiries and to
address any issues or discrepancies identified during the audit.
iv. Implement recommended strategies for corrective action plans and monitor
progress.
v. Review the final written response to audit findings.
4. Chart Review Tools and Coaching
a. Staff Coaching
i. Ensure that staff are informed about coaching opportunities and open to feedback
during coaching.
ii. Identify and ensure staff participation in training modules and coaching sessions.
5. Performance Improvement Projects
a. Identify staff person responsible for the development of PI Ps as well as local staff to carry out
PIP interventions. County will provide PIP liaison name/contact information and inform
CaIMHSA of changes to responsible staff liaison
b. Participate actively in the development and implementation of all stages of the PIP process,
including report writing and form submission.
c. Lead the implementation of strategies and document activities and efforts.
d. Submit any supplemental data and/or documents to support the development of PIPs.This
may include,but is not limited to,recommendations from EQRs,County surveys,stakeholder
feedback,QI Committee,etc.
6. Enhanced Analytics—PHI Dashboards
Fresno County—Participation Agreement Amendment No. 1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
a. Identify two authorized staff members to receive dashboard access and maintain current
contact information including the user's first name, last name,e-mail address,and level of
dashboard access.Only authorized staff members will be able to assign and re-assign user
Licenses across Participant staff.
b. Participate in quarterly coaching sessions.
7. Communicate all questions and concerns to CaIMHSA via ManagedCare@calmhsa.org.
Program Restrictions:
1. Timelines and technical requirements may need adjusting due to unique circumstances.
2. HEDIS client level and/or event level data will not be provided to the participant under this
Agreement.
The QA/QI Analytics Program Offering Purchases Include:
1. Purchase of the "Policies Development" program offering. This item is a one-time fee which will be
billed upon execution of this Amendment No. 1.
2. Purchase of the"EQRO Audit Preparation (ISCAT/NAV)"program offering.This item is a one-time fee
which will be billed upon execution of this Amendment No. 1.
3. Purchase of the "Chart Review Tools and Coaching" program offering. This item is a one-time fee
which will be billed upon execution of this Amendment No. 1.
4. Purchase of the"Enhanced Analytics—PHI Dashboards"program offering.This item is a one-time fee
which will be billed upon execution of this Amendment No. 1.
Fresno County—Participation Agreement Amendment No. 1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
Revised Exhibit B,Section V. Fiscal Provisions:
While adhering to,and under no circumstances exceeding,the approved Maximum Funding amount
of $10,806,504.00, Participant's Behavioral Health Department is explicitly authorized to utilize
unallocated Program funds within the approved Maximum Funding amount for the purchase of
additional components, modules and/or implementations related to the EHR program. Any such
purchase shall require the execution of an Order Form (attached as Exhibit E hereto) signed by
Participant's Behavioral Health Director.
Notwithstanding the above, any change in the Maximum Funding amount shall require approval of
the Participant's Board of Supervisors.
Fresno County—Participation Agreement Amendment No.1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
Revised Exhibit C—Participant Specific Committed Funding and Terms:
The table below reflects the additional purchases affected by the Amendment No.1, listed above, and the associated increase of
$297,385.00 in Committed Funding.
This revised Exhibit C replaces Exhibit C in the Agreement.The revised amount of Participant-Specific Committed Funding for the program
term is$9,759,561.70, as stated below:
Description Unit(s) Execution- 7/1/22- 7/1/23- 7/1/24- 7/1/25- 7/1/26- 7/1/27- 7/1/28-
6/30/22 6/30/23 6/30/24 6/30/25 6/30/26 6/30/27 6/30/28 3/18/29
Participant Instance installation 1 _ - S 410,030.00 5 - 5 - 5 - 5 - 5 - 5
system Acquisition fee 1 _ - S 192,81424 5 - S - 5 - 5 - 5 - S -
Intlal Development Fee(Costa Zatxxi and SecurRy) 1 5 S 192,814.24 S S S S 5 5
Discretionary DevebpmentBudget 1 5 192,81414 S S S 5 5 5
Professional Services Implementation 1 5 - S 1,033,846.15 5 86,15325 S - 5 - 5 - S - S
Sm irtcare Patient Portal Implementation 1 5 - S 2,400A0 S - S - 5 - S - S - 5
SmartCare HIE/NCO interface via FHlR implementation 1 5 - 5 12,000A0 S - S - s - S - S - $ -
SmartCare lab Interface Implementation 1 $ - 5 15,000.00 S - 5 - 5 - S - S - S -
Disaster Recovery Implementation 1 S S 6,000A0 5 S 5 5 5 S -
SmartcareCaINHSA Padage 1492 S - S 16A,418A0 S 986,51OA0 5 986,510.40 5 986,510.40 5 986,510AO S 986510.40 5 657,673.60
SmartUre Rx Presabers Subscilption 55 S - S 13,156A0 5 78,936.00 5 78,936.00 5 78,936.00 S 78,936.00 $ 78,936.00 S 52,624.00
SmartCare Patient PortalSubsalptan 6000 5 - 5 L104A0 S 6,624AD 5 6.624.00 S 6,624A0 S 6,624,DO S 6.624.00 S 4,416A0
Smartcare HIE/NCO Interface Via FHIRSubsalptl0n 1 S - S 575A0 5 3ASOAD S 3,450.00 S 3,4SOA0 S 3A50.00 S 3A50.00 S 2,300A0
Sm Irtcare Lab Interface Subscription 1 5 - 5 498.75 5 7-93256 S 7 932.56 S 2,93256 S 2,93255 5 2,932.56 5 1.955.04
Disaster Recovery SubscrVtIon 1 5 - S 8,952.00 5 53,712-00 S 53,712.00 5 53,712A0 5 53,712.00 S 53,712.00 S 35,808A0
Annual%3 Fee Increase-Subsalptbn 1 5 - S 5,66022 S 34,304.60 S 35,333,74 S 36,393.75 S 37ASS56 S 3$610.13 S 26,249.79
RAND Evaluation 1 - 5 500,000.00 5 - S - 5 - S - S - 5 -
Policies Development 1 _ - 5 - 5 - S - S 94,000AO 5 - S - S -
EClRO Audit Preparation([SCAT/NA1!) 1 - 5 - S - S 60,700.00 S - 5 - 5 - S -
chart ReAevvToals andcoadrng 1 5 5 S S - 5 48,M,00 S 5 S
Enhanced Analytics—PHI Dashboard 1 5 - 5 - S - 5 - S 94,000A0 S - S I 5 -
Total Amount by Fiscal Year I 5 2,752,04385 5 1,25Z 623.40 I S 1,228,198.70 S 1,405243.71 S 1,169,650.52 5 1.170.775.09 1 5 781AZGA3
Total Participant-SpectFlc Committed Funds S 9,759,561.70
Fresno County—Participation Agreement Amendment No.1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
Revised Exhibit D—Participant Contingency Budget:
Amendment No. 1 revises the Agreement to remove Exhibit D—Participant Contingency Budget and
all references to Exhibit D, Contingency Funds or Contingency Budget throughout the participation
Agreement. Within the approved Maximum Funding, unallocated funds may be utilized by
Participant's Behavioral Health Department for the purchase of additional components, modules
and/or implementations related to the EHR program.
Fresno County—Participation Agreement Amendment No.1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-Al
Semi-Statewide Enterprise Health Record
May 28,2025
All other terms or provisions in the Agreement, not cited in this Amendment No. 1, shall remain
in full force and effect.
Ca[MHSA: DocuSigned by:
Signed: F,4E-F-941;;�C94
�it, t�l4tr Name (Printed): Dr.Arnie Miller, Psy.D., MFT
W
Title: Executive Director
Date: 7/2/2025
Participant:
Signed Name(Printed):Ernest Buddy Mendes
Chairman of the Boa of Supervisors
Title: of the County of Fresno Dater & —a741 —aDo2s
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
By_ Deputy
Fresno County—Participation Agreement Amendment No.1
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
Agreement No.: 1543-EHR-2022-FC-A2
Semi-Statewide Enterprise Health Record
May 28, 2025
EXHIBIT E
CALIFORNIA MENTAL HEALTH SERVICES AUTHORITY
"CaIMHSA"
TEMPLATE-ORDER FORM NO.
SEMI-STATEWIDE ENTERPRISE HEALTH RECORD
CaIMHSA and Fresno County ("Participant") entered into Participation Agreement No. 1543-EHR-
2022-FC executed on June 29, 2022(the "Participation Agreement").
Participant intends to purchase additional components, modules and/or services ("Additional
Purchases") as allowed in Revised Exhibit B of Participation Agreement Amendment No. 1 and as
specified below. The Additional Purchases and corresponding Committed Funding modifications
are implemented as follows:
ADDITIONAL PURCHASES:
This Order Form No. _ incorporates additional component purchases totaling in
additional Committed Funding. Payment terms for each Additional Purchase can be found in
Exhibit E-1, below.
The additional component purchases include:
1. Purchase of a subscription to use the [component, module or service purchased]. This
item is an annual application subscription,which will be invoiced on a monthly basis.
2. Purchase of professional services to implement the [component, module or service
purchased]. This fee is a one-time charge to be invoiced upon execution of this Order Form
No.
This Order Form No. _ adds $ in additional Committed Funding. The total Maximum
Funding amount for the Agreement remains$ inclusive of the increase,for the
program term as specified in the Participation Agreement.
Fresno County—Exhibit E-Order Form No.
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Agreement No.: 1543-EHR-2022-FC-A2
Semi-Statewide Enterprise Health Record
May 28, 2025
EXHIBIT E-1 -ADDITIONAL COMPONENT PURCHASE DESCRIPTION AND PAYMENT TERMS
The table below describes the Additional Purchases incorporated by this Order Form No._, effective as of the date this Order
Form No. 1 is signed.The Additional Purchases listed are in addition to those included in the Participation Agreement and all
subsequent Amendments and Order Forms, if any,that preceded this Order Form No._.
Description Fee Type Description Payment Term
[Component, module or service] One-Time Fee associated with The fee for this implementation service shall
Implementation. the implementation efforts to be due upon execution of this Order Form No.
support[component, module or
service purchased].
[Component, module or service The annual subscription amount shall be
[Component, module or service] subscription description]. invoiced on a monthly basis. Monthly
Subscription. payments shall be due upon receipt of
invoice.
Fresno County-Exhibit E-1 Additional Component Purchase Description and Payment Terms
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Agreement No.: 1543-EHR-2022-FC-A2
Semi-Statewide Enterprise Health Record
May 28, 2025
All otherterms or provisions in the Participation Agreement and all subsequent Amendments and
Order Forms, if any, that preceded this Order Form No. _, not cited herein, shall remain in full
force and effect.
CaIM HSA:
Signed: Name (Printed): Dr.Amie Miller, Psy.D., MFT
Title: Executive Director Date:
Participant:
Signed: Name (Printed):
Title: Date:
Fresno County—Exhibit E-1 Additional Component Purchase Description and Payment Terms
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Docusign Envelope ID:95F34800-24ED-48EF-976E-70C7A5AE731B
AMENDMENT NO. 1 TO THE PARTICIPATION AGREEMENT
BETWEEN THE COUNTY OF FRESNO
AND
CALIFORNIA MENTAL HEALTH SERVICES AUTHORITY
FOR FRESNO COUNTY ACCOUNTING USE ONLY:
Fund/Subclass: 0001/10000
Organization: 5630
Account/Program: 7295/0