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Home My WebLink AboutAmendment No. 3 to Master Agt. for Adult FSP Cultural Specific Services.pdf Agreement No. 25-285 1 AMENDMENT NO.3 TO SERVICE AGREEMENT 2 This Amendment No. 3 to Service Agreement No. 25-033 ("Amendment No. 3") is dated 3 June 24, 2025 and is between Contractor(s) listed in 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. County, through its Department of Behavioral Health (DBH), is a Behavioral Health Plan 8 (BHP) as defined in Title 9 of the California Code of Regulations (C.C.R.), Section 1810.226. 9 B. On June 20, 2023 the County and the Contractor entered into County Agreement No. 10 23-285 ("Agreement'), for qualified agencies to operate Full-Service Partnership (FSP) program 11 sites that provide comprehensive mental health, housing, employment support and community 12 supports to adults and older adults with a serious mental illness (SMI). 13 C. On April 9, 2024 the County and the Contractor entered into Agreement No. 24-151 14 ("Amendment No. 1"), which amended the Agreement to increase the specialty mental health 15 services maximum compensation budget amount. 16 D. On January 28, 2025 the County and the Contractor entered into Agreement No. 25-033 17 ("Amendment No. 2"), which amended the Agreement to increase the cost reimbursement 18 maximum compensation budget amount. 19 E. The County and the Contractor now desire to amend the Agreement to increase the 20 maximum compensation due to an increase in billable services which will allow the Contractor to 21 continue to submit claims for services rendered and received through the entire fiscal year and 22 to extend the current term by three-months with an additional optional three-month extension to 23 avoid a disruption in services to the culturally specific population which includes those with 24 severe mental illness. 25 The parties therefore agree as follows: 26 1. Term. This Amendment extends the term of the Agreement through September 30, 27 2025. The term of this Agreement may be extended for no more than one three-month period 28 only upon written approval of both parties at least thirty (30) days before the first day of the 1 1 three-month extension period. The County's DBH Director, or designee, is authorized to sign the 2 written approval on behalf of the County based on the Contractor's satisfactory performance. 3 The extension of this Agreement by the County is not a waiver or compromise of any default or 4 breach of this Agreement by the Contractor(s) existing at the time of the extension whether or 5 not known to the County. 6 2. Subsections 4.2 and 4.3 of the Agreement, beginning on Page 8, Line 22 through Page 7 9, Line 7 are deleted in their entirety and replaced with the following: 8 "4.2 Specialty Mental Health Services Maximum Compensation. The 9 maximum compensation payable to the Contractor(s) under this Agreement for 10 the period of July 1, 2023, through June 30, 2024, is Three Million, Five Hundred 11 Thousand and No/100 Dollars ($3,500,000.00), which is not a guaranteed sum, 12 but shall be paid only for services rendered and received. The maximum 13 compensation payable to the Contractor(s) under this Agreement for the period 14 of July 1, 2024, through June 30, 2025, is Four Million, Five Hundred Thousand 15 and No/100 Dollars ($4,500,000.00), which is not a guaranteed sum, but shall be 16 paid only for services rendered and received. The maximum compensation 17 payable to the Contractor(s) under this Agreement for the period of July 1, 2025, 18 through September 30, 2025, for Specialty Mental Health Services is One Million 19 One Hundred Twenty Five Thousand and No/100 Dollars ($1,125,000.00), which 20 is not a guaranteed sum, but shall be paid only for services rendered and 21 received. The maximum compensation payable to the Contractor(s) under this 22 Agreement for the period of October 1, 2025 through December 31, 2025, for 23 Specialty Mental Health Services is One Million One Hundred Twenty Five 24 Thousand and No/100 Dollars ($1,125,000.00), which is not a guaranteed sum, 25 but shall be paid only for services rendered and received. 26 4.3 Cost Reimbursement Maximum Compensation. The maximum 27 compensation payable to the Contractor(s) under this Agreement for the period 28 of July 1, 2023 through June 30, 2024 is Forty Two Thousand and No/100 2 1 Dollars ($42,000.00). The maximum compensation payable to the Contractor(s) 2 under this Agreement for the period of July 1, 2024 through June 30, 2025 is 3 Seventy Two Thousand and No/100 Dollars ($72,000.00). The maximum 4 compensation payable to the Contractor(s) under this Agreement for the period 5 of July 1, 2025 through September 30, 2025, is Eighteen Thousand and No/100 6 Dollars ($18,000.00). The maximum compensation payable to the Contractor(s) 7 under this Agreement for the period of October 1, 2025 through December 31, 8 2025 is Eighteen Thousand and No/100 Dollars ($18,000.00)." 9 3. A portion of Section 4.5 of the Agreement, beginning on Page 9, Line 17 through Line 21 10 is deleted and replaced with the following: 11 "4.5 Total Maximum Compensation. In no event shall the maximum contract 12 amount for all the services provided by the Contractor(s) to County under the 13 terms and conditions of this Agreement be in excess of Ten Million Six Hundred 14 Fifty Thousand and No/100 Dollars ($10,650,000.00) during the entire term of 15 this Agreement." 16 2. All references in the Agreement to Revised Exhibit H-1 shall be deemed refenced to 17 "Revised Exhibit H-2," which is attached and incorporated by this reference. 18 4. When both parties have signed this Amendment No.3, the Agreement, Amendment No. 19 2, Amendment No. 1 and this Amendment No. 3 together constitute the Agreement. 20 5. The Contractor(s) represents and warrants to the County that: 21 a. The Contractor(s) is duly authorized and empowered to sign and perform its 22 obligations under this Amendment. 23 b. The individuals signing this Amendment on behalf of the Contractor(s) are duly 24 authorized to do so and his or her signature on this Amendment legally binds the 25 Contractor(s) to the terms of this Amendment. 26 6. The parties agree that this Amendment may be executed by electronic signature as 27 provide in this section. 28 3 1 a. An "electronic signature" means any symbol or process intended by an individual 2 signing this Agreement to represent their signature, including but not limited to 3 (1) a digital signature; (2) a faxed version of an original handwritten signature; or 4 (3) an electronically scanned and transmitted (for example by PDF document) 5 version of an original handwritten signature. 6 b. Each electronic signature affixed or attached to this Agreement (1) is deemed 7 equivalent to a valid original handwritten signature of the person signing this 8 Agreement for all purposes, including but not limited to evidentiary proof in any 9 administrative or judicial proceeding, and (2) has the same force and effect as 10 the valid original handwritten signature of that person. 11 c. The provisions of this section satisfy the requirements of Civil Code section 12 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, 13 Division 3, Part 2, Title 2.5, beginning with section 1633.1). 14 d. Each party using a digital signature represents that it has undertaken and 15 satisfied the requirements of Government Code section 16.5, subdivision (a), 16 paragraphs (1) through (5), and agrees that each other party may rely upon that 17 representation. 18 e. This Agreement is not conditioned upon the parties conducting the transactions 19 under it by electronic means and either party may sign this Agreement with an 20 original handwritten signature. 21 7. This Amendment may be signed in counterparts, each of which is an original, and all of 22 which together constitute this Amendment. 23 8. The Agreement as amended by this Amendment No. 3 is ratified and continued. All 24 provisions of the Agreement not amended by this Amendment No. 3 remain in full force and 25 effect. This Amendment No. 3 is effective upon execution. 26 [SIGNATURE PAGE FOLLOWS] 27 28 4 1 The parties are signing this Amendment on the date stated in the introductory clause. 2 CONTRACTOR(S) COUNTY OF FRESNO 3 See Exhibit A "List of Contractors" 4 Subsequent signature pages are attached. 5 Ernest Buddy Mendell' Chairman of the Board of Supervisors of the County of Fresno 6 Attest: 7 Bernice E. Seidel Clerk of the Board of Supervisors 8 County of Fresno, State of California 9 By: 10 Deputy 11 12 For accounting use only: 13 Org No.: 56304524/4540 Account No.: 7295 14 Fund No.: 0001 Subclass No.: 10000 15 16 17 18 19 20 21 22 23 24 25 26 27 28 5 1 The parties are signing this Amendment on the date stated in the introductory clause. 2 CONTRACTOR: 3 THE FRESNO CENTER 4 5 7 Pao Yang, President and CEO 8 9 10 Jensen Vang, Chief Financial Officer 11 12 13 14 The Fresno Center 4879 E. Cesar Chavez Boulevard 15 Fresno, CA 93727 16 17 18 19 20 21 22 23 24 25 26 27 28 6 Doc ID: 66fb05b33ada30f32b45aa7594de 4dfcb2f4593 REVISED EXHIBIT H-2 Living Well Center-FSP-Cultural Specific Services The Fresno Center Fiscal Year(FY) 2025-26 (July 1, 2025-September 30, 2025) PROGRAM EXPENSES 1000:SALARIES&BENEFITS Employee Salaries Acct# Position FTE Admin Direct Total 1101 $ - 1102 - - 1103 - - 1104 - - 1105 - - 1106 - - 1107 - - 1108 - - 1109 - - 1110 - - 1111 - - 1112 - - 1113 - - 1114 - - 1115 - - 1116 - - 1117 - - 1118 - - 1119 - - 1120 - - 1121 - - 1122 - - 1123 - - 1124 - - 1125 - - 1126 - - 1127 - - 1128 - - 1129 - - 1130 - - 1131 - - 1132 - - 1133 - - 1134 - - 1135 - - Personnel Salaries Subtotall 0.00 1 $ Employee Benefits Acct# Description Admin Direct Total 1201 Retirement $ - $ $ - 1202 Worker's Compensation - - 1203 Health Insurance - - 1204 1 Other(specify) - - 1205 10ther(specify) - - 1206 1 Other(specify) - - Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020 REVISED EXHIBIT H-2 Employee Benefits Subtotal: $ - $ - $ - Payroll Taxes&Expenses: Acct# Description Admin Direct Total 1301 OASDI $ - $ $ - 1302 FICA/MEDICARE - - 1303 SUI - - 1304 1 Other(specify) - - 1305 10ther(specify) - - 1306 1 Other(specify) - - Payroll Taxes&Expenses Subtotal: $ - $ - $ - EMPLOYEE SALARIES&BENEFITS TOTAL: $ - $ - $ - 2000:CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care $ - 2002 Client Housing Support 15,000 2003 Client Transportation &Support - 2004 IClothing, Food,& Hygiene 625 2005 Education Support - 2006 Employment Support - 2007 Household Items for Clients 375 2008 Medication Supports - 2009 Program Supplies-Medical - 2010 Utility Vouchers - 2011 Other(specify):Client Flexible Support Expenditure Support 1,000 2012 Other(specify) - 2013 Other(specify) - 2014 1 Other(specify) - 2015 Other(specify) - 2016 Other(specify) - DIRECT CLIENT CARE TOTAL $ 17,000 3000:OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ - 3002 Printing/Postage - 3003 Office, Household & Program Supplies - 3004 jAdvertising - 3005 Staff Development&Training - 3006 Staff Mileage - 3007 Subscriptions& Memberships - 3008 Vehicle Maintenance - 3009 Other(specify) - 3010 Other(specify) - 3011 Other(specify) - 3012 Other(specify) - OPERATING EXPENSES TOTAL: $ - 4000: FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ - 4002 Rent/Lease Building - Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020 REVISED EXHIBIT H-2 4003 Rent/Lease Equipment - 4004 Rent/Lease Vehicles - 4005 Security - 4006 Utilities - 4007 Other(specify) - 4008 Other(specify) - 4009 Other(specify) - 4010 Other(specify) - FACILITIES/EQUIPMENT TOTAL: $ - 5000:SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network& Data Management) $ - 5002 HMIS(Health Management Information System) - 5003 Contractual/Consulting Services (Specify) - 5004 ITranslation Services - 5005 Other(specify):Student Stipends 1,000 5006 Other(specify) - 5007 Other(specify) - 5008 Other(specify) - SPECIAL EXPENSES TOTAL:1 $ 1,000 6000:ADMINISTRATIVE EXPENSES Acct# Line Item Description Amount 6001 Administrative Overhead $ - 6002 Professional Liability Insurance - 6003 Accounting/Bookkeeping - 6004 1 External Audit - 6005 Insurance(Specify): - 6006 Payroll Services - 6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) - 6008 Other(specify) - 6009 Other(specify) - 6010 Other(specify) - 6011 Other(specify) - 6012 Other(specify) - ADMINISTRATIVE EXPENSES TOTAL $ - 7000: 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 1 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 $ 18,000 Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020 REVISED EXHIBIT H-2 PROGRAM FUNDING SOURCES 8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION) Acct# Line Item Description Service Units Rate Amount 8001 Mental Health Services 0 $ - 8002 Case Management 0 - 8003 Crisis Services 0 - 8004 Medication Support 0 - 8005 Collateral 0 - 8006 Plan Development 0 - 8007 Assessment 0 - 8008 Rehabilitation 0 - 8009 Other(Specify) 0 - 8010 1 Other(Specify) 1 01 1 - Estimated Specialty Mental Health Services Billing Totals: 0 $ Estimated %of Clients who are Medi-Cal Beneficiaries 0% Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries - Federal Financial Participation (FFP)% 1 0% - MEDI-CAL FFP TOTAL $ - 8100-SUBSTANCE USE DISORDER FUNDS Acct# Line Item Description Amount 8101 Drug Medi-Cal $ - 8102 SABG $ - SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acct# Line Item Description Amount 8201 lRealignment $REALIGNMENT TOTAL $ 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports $ 18,000 8302 PEI -Prevention & Early Intervention - 8303 INN -Innovations - 8304 WET-Workforce Education &Training - 8305 ICFTN -Capital Facilities&Technology I I - MHSA TOTAL $ 18,000 8400-OTHER REVENUE Acct# Line Item Description Amount 8401 Client Fees $ - 8402 Client Insurance - 8403 Grants(Specify) - 8404 Other(Specify) - 8405 1 Other(Specify) - OTHER REVENUE TOTAL $ TOTAL PROGRAM FUNDING SOURCES: 1 $ 18,000 NET PROGRAM COST: $ Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020 REVISED EXHIBIT H-2 Living Well Center-FSP-Cultural Specific Services The Fresno Center Fiscal Year(FY)2025-26(July 1,2025-September 30,2025) Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:SALARIES&BENEFITS Employee Salaries 1101 0 1102 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 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 1135 0 Employee Benefits 1201 Retirement 1202 Worker's Compensation 1203 Health Insurance 1204 Other(specify) 1205 Other(specify) 1206 Other(specify) Payroll Taxes&Expenses: 1301 OASDI 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) 2000:CLIENT SUPPORT 17,000 2001 Child Care - 2002 Client Housing Support 15,000 Client Housing Support Expenditures(SFC 70) For cost of providing housing supports.including housing subsidies for permanent, transitional and temporary housing:master leases;motel and other housing vouchers and shelters;rental security deposits:first and last month rental payments;and eviction prevention and other fiscal housing supports.Estimated @$15,000 annually. 2003 Client Transportation&Support - 2004 Clothing,Food,&Hygiene 625 Clothing,Food&Hygiene(SFC 72) To provide supports to clients,which may include food vouchers and other items necessary for daily living(such as,clothing,hygiene,etc.).Estimated @$625. Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 REVISED EXHIBIT H-2 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2005 Education Support 2006 Employment Support 2007 Household Items for Clients 375 Household Items(SFC 72) To provide supports for clients with household items need.Estimated at$375 2008 Medication Supports 2009 Program Supplies-Medical - 2010 Utility Vouchers - 2011 Other(specify):Client Flexible Support 1,000 Client Flexible Support Expenditures Support(SFC 72) Expenditure Support To provide supports to clients and their caregivers,may include vouchers,goods, services,and other family support services.Also maybe use for personal/community integration to assist clients in achieving their treatment goals and in supporting their integration into the larger community.Items may include,but are not limited to socialization and recreational activities.This funding may also be used for medical, dental and optical care,prescriptions,and laboratory tests when the client does not have insurance to pay for such care.Estimated @$1,000 annually. 2012 Other(specify) 2013 Other(specify) 2014 Other(specify) 2015 Other(specify) 2016 1 Other(specify) 3000: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 Other(specify) 4000: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:SPECIAL EXPENSES 1,000 5001 Consultant(Network&Data Management) - 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services - 5005 Other(specify):Student Stipends 1,000 To train 4 graduate students in mental health work force @ 500 per semester for 2 semesters x 4 students=1,000 5006 Other(specify) 5007 Other(specify) 5008 Other(specify) 6000:ADMINISTRATIVE EXPENSES 6001 Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 REVISED EXHIBIT H-2 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 6008 Other(specify) 6009 Other(specify) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 7000:FIXED ASSETS 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) PROGRAM FUNDING SOURCES 8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION) PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED BY THE RFP 8001 Mental Health Services 8002 Case Management 8003 Crisis Services 8004 Medication Support 8005 Collateral 8006 Plan Development 8007 Assessment 8008 Rehabilitation 8009 Other(Specify) 8010 Other(Specify) TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 18,000 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 18,000 BUDGETCHECK: - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 REVISED EXHIBIT H-2 Living Well Center-FSP-Cultural Specific Services The Fresno Center Fiscal Year(FY) 2025-26 (October 1, 2025- December 31,2025) PROGRAM EXPENSES 1000:SALARIES&BENEFITS Employee Salaries Acct# Position FTE Admin Direct Total 1101 $ - 1102 - - 1103 - - 1104 - - 1105 - - 1106 - - 1107 - - 1108 - - 1109 - - 1110 - - 1111 - - 1112 - - 1113 - - 1114 - - 1115 - - 1116 - - 1117 - - 1118 - - 1119 - - 1120 - - 1121 - - 1122 - - 1123 - - 1124 - - 1125 - - 1126 - - 1127 - - 1128 - - 1129 - - 1130 - - 1131 - - 1132 - - 1133 - - 1134 - - 1135 - - Personnel Salaries Subtotall 0.00 1 $ Employee Benefits Acct# Description Admin Direct Total 1201 Retirement $ - $ $ - 1202 Worker's Compensation - - 1203 Health Insurance - - 1204 1 Other(specify) - - 1205 10ther(specify) - - 1206 1 Other(specify) - - Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020 REVISED EXHIBIT H-2 Employee Benefits Subtotal: $ - $ - $ - Payroll Taxes&Expenses: Acct# Description Admin Direct Total 1301 OASDI $ - $ $ - 1302 FICA/MEDICARE - - 1303 SUI - - 1304 1 Other(specify) - - 1305 10ther(specify) - - 1306 1 Other(specify) - - Payroll Taxes&Expenses Subtotal: $ - $ - $ - EMPLOYEE SALARIES&BENEFITS TOTAL: $ - $ - $ - 2000:CLIENT SUPPORT Acct# Line Item Description Amount 2001 Child Care $ - 2002 Client Housing Support 15,000 2003 Client Transportation &Support - 2004 IClothing, Food,& Hygiene 625 2005 Education Support - 2006 Employment Support - 2007 Household Items for Clients 375 2008 Medication Supports - 2009 Program Supplies-Medical - 2010 Utility Vouchers - 2011 Other(specify):Client Flexible Support Expenditure Support 1,000 2012 Other(specify) - 2013 Other(specify) - 2014 1 Other(specify) - 2015 Other(specify) - 2016 Other(specify) - DIRECT CLIENT CARE TOTAL $ 17,000 3000:OPERATING EXPENSES Acct# Line Item Description Amount 3001 Telecommunications $ - 3002 Printing/Postage - 3003 Office, Household & Program Supplies - 3004 jAdvertising - 3005 Staff Development&Training - 3006 Staff Mileage - 3007 Subscriptions& Memberships - 3008 Vehicle Maintenance - 3009 Other(specify) - 3010 Other(specify) - 3011 Other(specify) - 3012 Other(specify) - OPERATING EXPENSES TOTAL: $ - 4000: FACILITIES&EQUIPMENT Acct# Line Item Description Amount 4001 Building Maintenance $ - 4002 Rent/Lease Building - Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020 REVISED EXHIBIT H-2 4003 Rent/Lease Equipment - 4004 Rent/Lease Vehicles - 4005 Security - 4006 Utilities - 4007 Other(specify) - 4008 Other(specify) - 4009 Other(specify) - 4010 Other(specify) - FACILITIES/EQUIPMENT TOTAL: $ - 5000:SPECIAL EXPENSES Acct# Line Item Description Amount 5001 Consultant(Network& Data Management) $ - 5002 HMIS(Health Management Information System) - 5003 Contractual/Consulting Services (Specify) - 5004 ITranslation Services - 5005 Other(specify):Student Stipends 1,000 5006 Other(specify) - 5007 Other(specify) - 5008 Other(specify) - SPECIAL EXPENSES TOTAL:1 $ 1,000 6000:ADMINISTRATIVE EXPENSES Acct# Line Item Description Amount 6001 Administrative Overhead $ - 6002 Professional Liability Insurance - 6003 Accounting/Bookkeeping - 6004 1 External Audit - 6005 Insurance(Specify): - 6006 Payroll Services - 6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) - 6008 Other(specify) - 6009 Other(specify) - 6010 Other(specify) - 6011 Other(specify) - 6012 Other(specify) - ADMINISTRATIVE EXPENSES TOTAL $ - 7000: 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 1 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 $ 18,000 Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020 REVISED EXHIBIT H-2 PROGRAM FUNDING SOURCES 8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION) Acct# Line Item Description Service Units Rate Amount 8001 Mental Health Services 0 $ - 8002 Case Management 0 - 8003 Crisis Services 0 - 8004 Medication Support 0 - 8005 Collateral 0 - 8006 Plan Development 0 - 8007 Assessment 0 - 8008 Rehabilitation 0 - 8009 Other(Specify) 0 - 8010 1 Other(Specify) 1 01 1 - Estimated Specialty Mental Health Services Billing Totals: 0 $ Estimated %of Clients who are Medi-Cal Beneficiaries 0% Estimated Total Cost of Specialty Mental Health Services Provided to Medi-Cal Beneficiaries - Federal Financial Participation (FFP)% 1 0% - MEDI-CAL FFP TOTAL $ - 8100-SUBSTANCE USE DISORDER FUNDS Acct# Line Item Description Amount 8101 Drug Medi-Cal $ - 8102 SABG $ - SUBSTANCE USE DISORDER FUNDS TOTAL $ 8200-REALIGNMENT Acct# Line Item Description Amount 8201 lRealignment $REALIGNMENT TOTAL $ 8300-MENTAL HEALTH SERVICE ACT(MHSA) Acct# MHSA Component MHSA Program Name Amount 8301 CSS-Community Services&Supports $ 18,000 8302 PEI -Prevention & Early Intervention - 8303 INN -Innovations - 8304 WET-Workforce Education &Training - 8305 ICFTN -Capital Facilities&Technology I I - MHSA TOTAL $ 18,000 8400-OTHER REVENUE Acct# Line Item Description Amount 8401 Client Fees $ - 8402 Client Insurance - 8403 Grants(Specify) - 8404 Other(Specify) - 8405 1 Other(Specify) - OTHER REVENUE TOTAL $ TOTAL PROGRAM FUNDING SOURCES: 1 $ 18,000 NET PROGRAM COST: $ Fresno County Department of Behavioral Health Contract Budget Template Revised 4/10/2020 REVISED EXHIBIT H-2 Living Well Center-FSP-Cultural Specific Services The Fresno Center :al Year(FY)2025-26(October 1,2025-December 31,2025) Budget Narrative PROGRAM EXPENSE ACCT#I LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 1000:SALARIES&BENEFITS Employee Salaries 1101 0 1102 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 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 1135 0 Employee Benefits 1201 Retirement 1202 Worker's Compensation 1203 Health Insurance 1204 Other(specify) 1205 Other(specify) 1206 Other(specify) Payroll Taxes&Expenses: 1301 OASDI 1302 FICA/MEDICARE 1303 SUI 1304 Other(specify) 1305 Other(specify) 1306 Other(specify) 2000:CLIENT SUPPORT 17,000 2001 Child Care - 2002 Client Housing Support 15,000 Client Housing Support Expenditures(SFC 70) For cost of providing housing supports.including housing subsidies for permanent, transitional and temporary housing:master leases;motel and other housing vouchers and shelters;rental security deposits:first and last month rental payments;and eviction prevention and other fiscal housing supports.Estimated @$15,000 annually. 2003 Client Transportation&Support - 2004 Clothing,Food,&Hygiene 625 Clothing,Food&Hygiene(SFC 72) To provide supports to clients,which may include food vouchers and other items necessary for daily living(such as,clothing,hygiene,etc.).Estimated @$625. Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 REVISED EXHIBIT H-2 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 2005 Education Support 2006 Employment Support 2007 Household Items for Clients 375 Household Items(SFC 72) To provide supports for clients with household items need.Estimated at$375 2008 Medication Supports 2009 Program Supplies-Medical - 2010 Utility Vouchers - 2011 Other(specify):Client Flexible Support 1,000 Client Flexible Support Expenditures Support(SFC 72) Expenditure Support To provide supports to clients and their caregivers,may include vouchers,goods, services,and other family support services.Also maybe use for personal/community integration to assist clients in achieving their treatment goals and in supporting their integration into the larger community.Items may include,but are not limited to socialization and recreational activities.This funding may also be used for medical, dental and optical care,prescriptions,and laboratory tests when the client does not have insurance to pay for such care.Estimated @$1,000 annually. 2012 Other(specify) 2013 Other(specify) 2014 Other(specify) 2015 Other(specify) 2016 1 Other(specify) 3000: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 Other(specify) 4000: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:SPECIAL EXPENSES 1,000 5001 Consultant(Network&Data Management) - 5002 HMIS(Health Management Information System) 5003 Contractual/Consulting Services (Specify) 5004 Translation Services - 5005 Other(specify):Student Stipends 1,000 To train 4 graduate students in mental health work force @ 500 per semester for 2 semesters x 4 students=1,000 5006 Other(specify) 5007 Other(specify) 5008 Other(specify) 6000:ADMINISTRATIVE EXPENSES 6001 Administrative Overhead 6002 Professional Liability Insurance 6003 Accounting/Bookkeeping 6004 External Audit 6005 Insurance(Specify): 6006 Payroll Services 6007 Depreciation(Provider-Owned Equipment to be Used for Program Purposes) Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020 REVISED EXHIBIT H-2 PROGRAM EXPENSE ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE 6008 Other(specify) 6009 Other(specify) 6010 Other(specify) 6011 Other(specify) 6012 Other(specify) 7000:FIXED ASSETS 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) PROGRAM FUNDING SOURCES 8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION) PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED BY THE RFP 8001 Mental Health Services 8002 Case Management 8003 Crisis Services 8004 Medication Support 8005 Collateral 8006 Plan Development 8007 Assessment 8008 Rehabilitation 8009 Other(Specify) 8010 Other(Specify) TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 18,000 TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 18,000 BUDGETCHECK: - Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020