HomeMy WebLinkAboutAgreement A-25-232 with Pacific Clinics.pdf Agreement No. 25-232
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated June 10, 2025 and is between
3 Pacific Clinics, a Nonprofit California Corporation, ("Contractor"), and the County of Fresno, a
4 political subdivision of the State of California ("County").
5 Recitals
6 A. County is a Behavioral Health Plan (BHP) as defined in Title 9 of the California Code of
7 Regulations (C.C.R.) section 1810.226;
8 B. County is in need of a qualified agency to operate a Vocational and Education Services
9 (VES) program and provide Individual Placement Services (IPS) for transitional aged youth,
10 adults, and older adults with serious mental illnesses living in Fresno County and receiving
11 specialty mental health services from the Department or its contracted providers;
12 C. On December 23, 2024, the County issued request for proposals No. 25-040 for
13 vocational and education services and Pacific Clinics submitted a response to the request;
14 D. On March 12, 2025, after a comprehensive evaluation, Pacific Clinics was determined to
15 be the most responsive, responsible bidder whose proposal has been determined to be the
16 most advantageous to the County.
17 E. The County and Contractor now desire to enter into an Agreement to provide vocational
18 and education services.
19 The parties therefore agree as follows:
20 Article 1
21 Contractor's Services
22 1.1 Scope of Services. The Contractor shall perform all of the services provided in
23 Exhibit A to this Agreement, titled "Fresno County Department of Behavioral Health Scope of
24 Work."
25 1.2 Contractor shall also perform all services and fulfill all responsibilities as specified in
26 County's Request for Proposal (RFP) issued under the name of Vocational Educational
27 Services RFP No. 25-040 dated December 23, 2024 and Addendum No. One (1) to COUNTY's
28 RFP No. 25-040 dated January 8, 2025 (collectively referred to herein as County's Revised
1
1 RFP) and Contractor's response to County's Revised RFP dated January 8, 2025, all
2 incorporated herein by reference and made part of this Agreement. In the event of any
3 inconsistency among these documents, the inconsistency shall be resolved by giving
4 precedence in the following order of priority: (1) to the Agreement, including all Exhibits; (2) to
5 the Revised RFP; and (3) to the Response to the Revised RFP. A copy of County's Revised
6 RFP and Contractor's response thereto shall be retained and made available during the term of
7 this Agreement by County's Department of Behavioral Health (DBH) Plan Administration
8 Division.
9 1.3 Representation. The Contractor represents that it is qualified, ready, willing, and
10 able to perform all of the services provided in this Agreement.
11 1.4 Compliance with Laws. The Contractor shall, at its own cost, comply with all
12 applicable federal, state, and local laws and regulations in the performance of its obligations
13 under this Agreement, including but not limited to workers compensation, labor, and
14 confidentiality laws and regulations. Additionally, Contractor shall comply with laws, regulations,
15 and requirements in Exhibit B to this Agreement, titled "Fresno County Behavioral Health
16 Requirements".
17 Article 2
18 County's Responsibilities
19 2.1 The County shall provide oversight and collaborate with Contractor, other County
20 Departments and community agencies to help achieve program goals and outcomes. In addition
21 to contractor monitoring of program, oversight includes, but not limited to, coordination with
22 Department of Health Care Services (DHCS) in regard to program administration and outcomes.
23 2.2 County shall participate in evaluating the progress of the overall program, levels of
24 care components, and the efficiency of collaboration with the Contractor staff and will be
25 available to Contractor for ongoing consultation. County shall receive and analyze statistical
26 outcome data from Contractor throughout the term of contract. County shall notify the
27 Contractor when additional participation is required. The performance outcome measurement
28 process will not be limited to survey instruments but will also include, as appropriate, persons
2
1 served and staff surveys, chart reviews, and other methods of obtaining required information.
2 Article 3
3 Compensation, Invoices, and Payments
4 3.1 The County agrees to pay, and the Contractor agrees to receive compensation for
5 the performance of its services under this Agreement as described in Exhibit C to this
6 Agreement, titled "Fresno County Department of Behavioral Health Financial Terms and
7 Conditions".
8 3.2 Additional Fiscal Requirements. The Contractor shall comply with all Fiscal
9 requirements in Exhibit C to this Agreement.
10 Article 4
11 Term of Agreement
12 4.1 Term. This Agreement is effective on July 1, 2025 and terminates on June 30, 2028
13 except as provided in section 4.2, "Extension," or Article 6, "Termination and Suspension,"
14 below.
15 4.2 Extension. The term of this Agreement may be extended for no more than two, one-
16 year periods only upon written approval of both parties at least thirty (30) days before the first
17 day of the next one-year extension period. The County's DBH Director or his or her designee is
18 authorized to sign the written approval on behalf of the County based on the Contractor's
19 satisfactory performance. The extension of this Agreement by the County is not a waiver or
20 compromise of any default or breach of this Agreement by the Contractor existing at the time of
21 the extension whether or not known to the County.
22 Article 5
23 Notices
24 5.1 Contact Information. The persons and their addresses having authority to give and
25 receive notices provided for or permitted under this Agreement include the following:
26
For the County:
27 Director, Department of Behavioral Health
County of Fresno
28 1925 E Dakota Avenue
Fresno, CA 93726
3
1
For the Contractor:
2 Chief Legal Officer
Pacific Clinics
3 499 Loma Alta Ave
Los Gatos, CA 95030
4 Kim.wells(a�pacificclinics.org
5 5.2 Change of Contact Information. Either party may change the information in section
6 5.1 by giving notice as provided in section 5.3.
7 5.3 Method of Delivery. Each notice between the County and the Contractor provided
8 for or permitted under this Agreement must be in writing, state that it is a notice provided under
9 this Agreement, and be delivered either by personal service, by first-class United States mail, by
10 an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
11 Document Format (PDF) document attached to an email.
12 (A) A notice delivered by personal service is effective upon service to the recipient.
13 (B) A notice delivered by first-class United States mail is effective three County
14 business days after deposit in the United States mail, postage prepaid, addressed to the
15 recipient.
16 (C)A notice delivered by an overnight commercial courier service is effective one
17 County business day after deposit with the overnight commercial courier service,
18 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
19 the recipient.
20 (D)A notice delivered by telephonic facsimile transmission or by PDF document
21 attached to an email is effective when transmission to the recipient is completed (but, if
22 such transmission is completed outside of County business hours, then such delivery is
23 deemed to be effective at the next beginning of a County business day), provided that
24 the sender maintains a machine record of the completed transmission.
25 5.4 Claims Presentation. For all claims arising from or related to this Agreement,
26 nothing in this Agreement establishes, waives, or modifies any claims presentation
27 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
28 of Title 1 of the Government Code, beginning with section 810).
4
1 Article 6
2 Termination and Suspension
3 6.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
4 contingent on the approval of funds by the appropriating government agency. If sufficient funds
5 are not allocated, then the County, upon at least 30 days' advance written notice to the
6 Contractor, may:
7 (A) Modify the services provided by the Contractor under this Agreement; or
8 (B) Terminate this Agreement.
9 6.2 Termination for Breach.
10 (A) Upon determining that a breach (as defined in paragraph (C) below) has
11 occurred, the County may give written notice of the breach to the Contractor. The written
12 notice may suspend performance under this Agreement, and must provide at least 30
13 days for the Contractor to cure the breach.
14 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
15 time stated in the written notice, the County may terminate this Agreement immediately.
16 (C) For purposes of this section, a breach occurs when, in the determination of the
17 County, the Contractor has:
18 (1) Obtained or used funds illegally or improperly;
19 (2) Failed to comply with any part of this Agreement;
20 (3) Submitted a substantially incorrect or incomplete report to the County; or
21 (4) Improperly performed any of its obligations under this Agreement.
22 6.3 Termination without Cause. In circumstances other than those set forth above, the
23 County may terminate this Agreement by giving at least 30 days advance written notice to the
24 Contractor.
25 6.4 Economic Sanctions. In accordance with Executive Order N-6-22 regarding
26 Economic Sanctions against Russia and Russian entities and individuals, the County may
27 terminate this Agreement if the Contractor is a target of Economic Sanctions or is conducting
28
5
1 prohibited transactions with sanctioned individuals or entities. The County shall provide at least
2 thirty (30) days advance written notice to the Contractor.
3 6.5 No Penalty or Further Obligation. Any termination of this Agreement by the County
4 under this Article 6 is without penalty to or further obligation of the County.
5 6.6 County's Rights upon Termination. Upon termination for breach under this Article
6 6, the County may demand repayment by the Contractor of any monies disbursed to the
7 Contractor under this Agreement that, in the County's sole judgment, were not expended in
8 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
9 demand. This section survives the termination of this Agreement.
10 Article 7
11 Independent Contractor
12 7.1 Status. In performing under this Agreement, the Contractor, including its officers,
13 agents, employees, and volunteers, is at all times acting and performing as an independent
14 contractor, in an independent capacity, and not as an officer, agent, servant, employee,joint
15 venturer, partner, or associate of the County.
16 7.2 Verifying Performance. The County has no right to control, supervise, or direct the
17 manner or method of the Contractor's performance under this Agreement, but the County may
18 verify that the Contractor is performing according to the terms of this Agreement.
19 7.3 Benefits. Because of its status as an independent contractor, the Contractor has no
20 right to employment rights or benefits available to County employees. The Contractor is solely
21 responsible for providing to its own employees all employee benefits required by law. The
22 Contractor shall save the County harmless from all matters relating to the payment of
23 Contractor's employees, including compliance with Social Security withholding and all related
24 regulations.
25 7.4 Services to Others. The parties acknowledge that, during the term of this
26 Agreement, the Contractor may provide services to others unrelated to the County.
27
28
6
1 Article 8
2 Indemnity and Defense
3 8.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
4 County (including its officers, agents, employees, and volunteers) against all claims, demands,
5 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
6 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
7 the performance or failure to perform by the Contractor (or any of its officers, agents,
8 subcontractors, or employees) under this Agreement. The County may conduct or participate in
9 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
10 defend the County.
11 8.2 Survival. This Article 8 survives the termination of this Agreement.
12 Article 9
13 Insurance
14 9.1 The Contractor shall comply with all the insurance requirements in Exhibit D to this
15 Agreement.
16 Article 10
17 Inspections, Audits, and Public Records
18 10.1 Inspection of Documents. The Contractor shall make available to the County, and
19 the County may examine at any time during business hours and as often as the County deems
20 necessary, all of the Contractor's records and data with respect to the matters covered by this
21 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
22 request by the County, permit the County to audit and inspect all of such records and data to
23 ensure the Contractor's compliance with the terms of this Agreement.
24 10.2 State Audit Requirements. If the compensation to be paid by the County under this
25 Agreement exceeds $10,000, the Contractor is subject to the examination and audit of the
26 California State Auditor, as provided in Government Code section 8546.7, for a period of three
27 years after final payment under this Agreement. This section survives the termination of this
28 Agreement.
7
1 10.3 Public Records. The County is not limited in any manner with respect to its public
2 disclosure of this Agreement or any record or data that the Contractor may provide to the
3 County. The County's public disclosure of this Agreement or any record or data that the
4 Contractor may provide to the County may include but is not limited to the following:
5 (A) The County may voluntarily, or upon request by any member of the public or
6 governmental agency, disclose this Agreement to the public or such governmental
7 agency.
8 (B) The County may voluntarily, or upon request by any member of the public or
9 governmental agency, disclose to the public or such governmental agency any record or
10 data that the Contractor may provide to the County, unless such disclosure is prohibited
11 by court order.
12 (C)This Agreement, and any record or data that the Contractor may provide to the
13 County, is subject to public disclosure under the Ralph M. Brown Act (California
14 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
15 (D)This Agreement, and any record or data that the Contractor may provide to the
16 County, is subject to public disclosure as a public record under the California Public
17 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
18 with section 6250) ("CPRA").
19 (E) This Agreement, and any record or data that the Contractor may provide to the
20 County, is subject to public disclosure as information concerning the conduct of the
21 people's business of the State of California under California Constitution, Article 1,
22 section 3, subdivision (b).
23 (F) Any marking of confidentiality or restricted access upon or otherwise made with
24 respect to any record or data that the Contractor may provide to the County shall be
25 disregarded and have no effect on the County's right or duty to disclose to the public or
26 governmental agency any such record or data.
27 10.4 Public Records Act Requests. If the County receives a written or oral request
28 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
8
1 and which the County has a right, under any provision of this Agreement or applicable law, to
2 possess or control, then the County may demand, in writing, that the Contractor deliver to the
3 County, for purposes of public disclosure, the requested records that may be in the possession
4 or control of the Contractor. Within five business days after the County's demand, the
5 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's
6 possession or control, together with a written statement that the Contractor, after conducting a
7 diligent search, has produced all requested records that are in the Contractor's possession or
8 control, or (b) provide to the County a written statement that the Contractor, after conducting a
9 diligent search, does not possess or control any of the requested records. The Contractor shall
10 cooperate with the County with respect to any County demand for such records. If the
11 Contractor wishes to assert that any specific record or data is exempt from disclosure under the
12 CPRA or other applicable law, it must deliver the record or data to the County and assert the
13 exemption by citation to specific legal authority within the written statement that it provides to
14 the County under this section. The Contractor's assertion of any exemption from disclosure is
15 not binding on the County, but the County will give at least 10 days' advance written notice to
16 the Contractor before disclosing any record subject to the Contractor's assertion of exemption
17 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs
18 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption,
19 failure to produce any such records, or failure to cooperate with the County with respect to any
20 County demand for any such records.
21 Article 11
22 Data Security
23 11.1 Contractor shall comply with data security requirements in Exhibit E to this
24 Agreement.
25 Article 12
26 Disclosure of Self-Dealing Transactions
27 12.1 Applicability. This Article 12 applies if the Contractor is operating as a corporation,
28 or changes its status to operate as a corporation.
9
1 12.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
2 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
3 "Self-Dealing Transaction Disclosure Form" (Exhibit F to this Agreement) and submitting it to the
4 County before commencing the transaction or immediately after.
5 12.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
6 a party and in which one or more of its directors, as an individual, has a material financial
7 interest.
8 Article 13
9 Disclosure of Ownership and/or Control Interest Information
10 13.1 Applicability. This provision is only applicable if Contractor is disclosing entities,
11 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
12 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
13 13.2 Duty to Disclose. Contractor must disclose the following information as requested in
14 the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement,
15 Exhibit G:
16 (A) Disclosure of 5% or More Ownership Interest:
17 (1) In the case of corporate entities with an ownership or control interest in the
18 disclosing entity, the primary business address as well as every business location
19 and P.O. Box address must be disclosed. In the case of an individual, the date of
20 birth and Social Security number must be disclosed.
21 (2) In the case of a corporation with ownership or control interest in the
22 disclosing entity or in any subcontractor in which the disclosing entity has a five
23 percent (5%) or more interest, the corporation tax identification number must be
24 disclosed.
25 (3) For individuals or corporations with ownership or control interest in any
26 subcontractor in which the disclosing entity has a five percent (5%) or more interest,
27 the disclosure of familial relationship is required.
28
10
1 (4) For individuals with five percent (5%) or more direct or indirect ownership
2 interest of a disclosing entity, the individual shall provide evidence of completion of a
3 criminal background check, including fingerprinting, if required by law, prior to
4 execution of Contract. (42 C.F.R. § 455.434)
5 (B) Disclosures Related to Business Transactions:
6 (1) The ownership of any subcontractor with whom Contractor has had business
7 transactions totaling more than $25,000 during the 12-month period ending on the
8 date of the request.
9 (2) Any significant business transactions between Contractor and any wholly
10 owned supplier, or between Contractor and any subcontractor, during the 5-year
11 period ending on the date of the request. (42 C.F.R. § 455.105(b).)
12 (C) Disclosures Related to Persons Convicted of Crimes:
13 (1) The identity of any person who has an ownership or control interest in the
14 provider or is an agent or managing employee of the provider who has been
15 convicted of a criminal offense related to that person's involvement in any program
16 under the Medicare, Medicaid, or the Title XXI services program since the inception
17 of those programs. (42 C.F.R. § 455.106.)
18 (2) County shall terminate the enrollment of Contractor if any person with five
19 percent (5%) or greater direct or indirect ownership interest in the disclosing entity
20 has been convicted of a criminal offense related to the person's involvement with
21 Medicare, Medicaid, or Title XXI program in the last 10 years.
22 13.3 Contractor must provide disclosure upon execution of Contract, extension for
23 renewal, and within thirty-five (35) days after any change in Contractor ownership or upon
24 request of County. County may refuse to enter into an agreement or terminate an existing
25 agreement with Contractor if Contractor fails to disclose ownership and control interest
26 information, information related to business transactions and information on persons convicted
27 of crimes, or if Contractor did not fully and accurately make the disclosure as required.
28
11
1 13.4 Contractor must provide the County with written disclosure of any prohibited
2 affiliations under 42 C.F.R. § 438.610. Contractor must not employ or subcontract with providers
3 or have other relationships with providers Excluded from participation in Federal Health Care
4 Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42 C.F.R.
5 §438.610.
6 13.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
7 DBHPlanAdministration(a)fresnocountyca.gov with a copy sent via email to the assigned DBH
8 Contract Analyst. County may deny enrollment or terminate this Agreement where any person
9 with five (5) percent or greater direct or indirect ownership interest in Contractor has been
10 convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid,
11 or Title XXI program in the last ten (10) years. County may terminate this Agreement where any
12 person with five (5) percent or greater direct or indirect ownership interest in the Contractor did
13 not submit timely and accurate information and cooperate with any screening method required
14 in C.F.R, Title 42, Section 455.416
15 Article 14
16 Disclosure of Criminal History and Civil Actions
17 14.1 Applicability. Contractor is required to disclose if any of the following conditions
18 apply to them, their owners, officers, corporate managers, or partners (hereinafter collectively
19 referred to as "Contractor"):
20 (A) Within the three (3) year period preceding the Agreement award, they have been
21 convicted of, or had a civil judgment tendered against them for:
22 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
23 or performing a public (federal, state, or local) transaction or contract under a public
24 transaction;
25 (2) Violation of a federal or state antitrust statute;
26 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
27 or
28 (4) False statements or receipt of stolen property.
12
1 (B) Within a three (3) year period preceding their Agreement award, they have had a
2 public transaction (federal, state, or local) terminated for cause or default.
3 14.2 Duty to Disclose. Disclosure of the above information will not automatically
4 eliminate Contractor from further business consideration. The information will be considered as
5 part of the determination of whether to continue and/or renew this Agreement and any additional
6 information or explanation that Contractor elects to submit with the disclosed information will be
7 considered. If it is later determined that the Contractor failed to disclose required information,
8 any contract awarded to such Contractor may be immediately voided and terminated for
9 material failure to comply with the terms and conditions of the award.
10 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
11 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit H.
12 Additionally, Contractor must immediately advise the County in writing if, during the term of the
13 Agreement: (1) Contractor becomes suspended, debarred, excluded or ineligible for
14 participation in Federal or State funded programs or from receiving federal funds as listed in the
15 excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions
16 become applicable to Contractor. Contractor shall indemnify, defend, and hold County harmless
17 for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility, or other
18 matter listed in the signed Certification Regarding Debarment, Suspension, and Other
19 Responsibility Matters.
20 Article 15
21 General Terms
22 15.1 Modification. Except as provided in Article 6, "Termination and Suspension," this
23 Agreement may not be modified, and no waiver is effective, except by written agreement signed
24 by both parties. The Contractor acknowledges that County employees have no authority to
25 modify this Agreement except as expressly provided in this Agreement.
26 15.2 Notwithstanding the above, non-material changes to services, staffing, and
27 responsibilities of the Contractor, as needed, to accommodate changes in the laws relating to
28 service requirements, may be made with the signed written approval of County's DBH Director,
13
1 or designee, and Contractor through an amendment approved by County's County Counsel and
2 the County's Auditor-Controller/Treasurer-Tax Collector's Office. Said modifications shall not
3 result in any change to the maximum compensation amount payable to Contractor, as stated
4 herein.
5 (A) Budget Modification. Changes to Account/Line Item amounts, which, when
6 aggregated, do not exceed ten percent (10%) of the total maximum compensation
7 payable to Contractor for the entire contract term, may be made with the written approval
8 of Contractor(s) and County's DBH Director or designee. Said modifications are subject
9 to County's DBH review in accordance with the Budget Modification Request Guide
10 available at https://www.fresnocountyca.gov/Departments/Behavioral-
11 Health/Providers/Contract-Provider-Resources/Notifications-Associated-Documents.
12 15.3 Non-Assignment. Neither party may assign its rights or delegate its obligations
13 under this Agreement without the prior written consent of the other party.
14 15.4 Governing Law. The laws of the State of California govern all matters arising from
15 or related to this Agreement.
16 15.5 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
17 County, California. Contractor consents to California jurisdiction for actions arising from or
18 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
19 brought and maintained in Fresno County.
20 15.6 Construction. The final form of this Agreement is the result of the parties' combined
21 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
22 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
23 against either party.
24 15.7 Days. Unless otherwise specified, "days" means calendar days.
25 15.8 Headings. The headings and section titles in this Agreement are for convenience
26 only and are not part of this Agreement.
27 15.9 Severability. If anything in this Agreement is found by a court of competent
28 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
14
1 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
2 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
3 intent.
4 15.10 Nondiscrimination. During the performance of this Agreement, the Contractor shall
5 not unlawfully discriminate against any employee or applicant for employment, or recipient of
6 services, because of race, religious creed, color, national origin, ancestry, physical disability,
7 mental disability, medical condition, genetic information, marital status, sex, gender, gender
8 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
9 all applicable State of California and federal statutes and regulation.
10 Contractor shall take affirmative action to ensure that services to intended Medi-Cal
11 beneficiaries are provided without use of any policy or practice that has the effect of
12 discriminating on the basis of race, color, religion, ancestry, marital status, national origin, ethnic
13 group identification, sex, sexual orientation, gender, gender identity, age, medical condition,
14 genetic information, health status or need for health care services, or mental or physical
15 disability.
16 15.11 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
17 of the Contractor under this Agreement on any one or more occasions is not a waiver of
18 performance of any continuing or other obligation of the Contractor and does not prohibit
19 enforcement by the County of any obligation on any other occasion.
20 15.12 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
21 between the Contractor and the County with respect to the subject matter of this Agreement,
22 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
23 publications, and understandings of any nature unless those things are expressly included in
24 this Agreement. If there is any inconsistency between the terms of this Agreement without its
25 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
26 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
27 exhibits.
28
15
1 15.13 No Third-Party Beneficiaries. This Agreement does not and is not intended to
2 create any rights or obligations for any person or entity except for the parties.
3 15.14 Authorized Signature. The Contractor represents and warrants to the County that:
4 (A) The Contractor is duly authorized and empowered to sign and perform its
5 obligations under this Agreement.
6 (B) The individual signing this Agreement on behalf of the Contractor is duly
7 authorized to do so and his or her signature on this Agreement legally binds the
8 Contractor to the terms of this Agreement.
9 15.15 Electronic Signatures. The parties agree that this Agreement may be executed by
10 electronic signature as provided in this section.
11 (A) An "electronic signature" means any symbol or process intended by an individual
12 signing this Agreement to represent their signature, including but not limited to (1) a
13 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
14 electronically scanned and transmitted (for example by PDF document) version of an
15 original handwritten signature.
16 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
17 equivalent to a valid original handwritten signature of the person signing this Agreement
18 for all purposes, including but not limited to evidentiary proof in any administrative or
19 judicial proceeding, and (2) has the same force and effect as the valid original
20 handwritten signature of that person.
21 (C)The provisions of this section satisfy the requirements of Civil Code section
22 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
23 Part 2, Title 2.5, beginning with section 1633.1).
24 (D) Each party using a digital signature represents that it has undertaken and
25 satisfied the requirements of Government Code section 16.5, subdivision (a),
26 paragraphs (1) through (5), and agrees that each other party may rely upon that
27 representation.
28
16
1 (E) This Agreement is not conditioned upon the parties conducting the transactions
2 under it by electronic means and either party may sign this Agreement with an original
3 handwritten signature.
4 15.16 Counterparts. This Agreement may be signed in counterparts, each of which is an
5 original, and all of which together constitute this Agreement.
6 [SIGNATURE PAGE FOLLOWS]
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
17
ii
Docusign Envelope ID:DB5FE21 E-COED-4F38-A4246DA83E8BAD39
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
PACIFIC CLINICS COUNTY OF FRESNO
3
Signed b
4
5 Kim M. Wells, Chief Legal Officer Ernest Buddy Mend , Chairman of the
6 499 Loma Alta Avenue Board of Supervisors of the County of Fresno
Los Gatos, CA 95030 Attest:
7 Bernice E. Seidel
Clerk of the Board of Supervisors
8 County of Fresno, State of California
9
By: _
10 Deputy
11 For accounting use only:
12 Org No.: 56304533
Account No.: 7295
13 Fund No.: 0001
Subclass No: 10000
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
18
Exhibit A
Page 1 of 5
FRESNO COUNTY
DEPARTMENT OF BEHAVIORAL HEALTH
SCOPE OF WORK
I. PROGRAM NAME
Vocational and Education Services
II. BACKGROUND
The vocational and education services program is an initiative of Fresno County Department
of Behavioral Work (DBH) to provide vocational and educational services to individuals with
serious mental illness and receiving services from DBH or its contracted behavioral health
providers. The program aims to facilitate wellness and recovery through supported
employment and education utilizing the Individual Placement and Support (IPS) evidence-
based model. The program includes vocational and educational services such as employment
services, employment services intake, employment preparation, job development and
placement, employment retention and job coaching.
III. TARGET POPULATION
The target population includes adults of any age and transition age youth (TAY) ages 16-25
who are currently receiving services from Fresno County DBH or a DBH-contracted
behavioral health provider.
The following conditions must be met for individuals referred to the program:
• Documented serious mental illness
• Legal resident of Fresno County
• Must be at least 16 years of age (Under 17 will require a work permit)
• Meet criteria for the California Department of Rehabilitation or Mental Health Services
Act (MHSA)funds
• Must be receiving services from DBH or DBH-contracted behavioral health provider
IV. DESCRIPTION OF SERVICES
A. Services Start Date: July 1, 2025
B. Summary of Services: The program will implement the evidence-based Individual
Placement and Support (IPS) program developed through the IPS Employment Center
Supported Employment and Educational Services at the Rockville Institute under Westat
and sponsored by Substance Abuse and Mental Health Services Administration
(SAMHSA). IPS programs are also able to integrate supported education within the team
approach. Information about the model can be found at the following website:
https://ipsworks.org/
Exhibit A
Page 2of5
C. Location of Services: Services will be provided throughout Fresno County. The program
office will be located near or have easy access to an employment center or educational
center. The initial program will be located at 6051 N. Fresno Street, Suite 201, Fresno,
CA. Services will also be provided in the field to meet individuals where they are and
provide IPS vocational and education services.
D. Hours of Operation: Services must be available during regular business hours Monday
through Friday from 8am-5pm. Service hours should be flexible enough to meet
individuals around times when they are working or after work to provide job support and
avoid job loss or crisis.
E. Schedule of Services: IPS programs provide a hands-on approach to finding competitive
jobs in the community. To serve individuals with behavioral health needs, the program
requires the integration of employment and behavioral health services. All programs must
follow the 8 practice principles of IPS supported employment:
1. Focus on competitive employment
2. Eligibility based on person served choice
3. Integration of rehabilitation and mental health services
4. Attention to worker preferences
5. Personalized benefits counseling
6. Rapid job search
7. Systematic job development
8. Time unlimited and individualized support
The program will provide the following Employment Services:
1. Employment preparation
2. Job development and placement
3. Employment retention
4. Job coaching
The program will follow the IPS fidelity review manual and complete the IPS implementation
plan for guidance on program startup. The program must align with the IPS fidelity scale.
The program will also coordinate with the California Department of Rehabilitation, or its
contracted program, to leverage services for the benefit of the individual.
F. Average Person Served Length of Stay: There is no standard average length of stay,
however, individuals will continue to receive services until they establish job retention and
stabilization. The individual will make the determination as to when they no longer need
support from the program and can be discharged from services.
G. Referral Sources and Referral Process: Referrals will be made by DBH or DBH-contracted
program treatment team members directly to Pacific Clinics. Upon receipt of the approval,
Pacific Clinics staff will contact the individual within 72 hours and provide supported
employment or education services to individuals assisting them in identifying, obtaining,
Exhibit A
Page 3 of 5
and/or retaining employment or educational goals. Pacific Clinics staff will meet regularly
with the mental health treatment team to ensure shared decision making and provide
updates to coordinate care.
Upon referral, staff will complete the following intake activities:
1. Development of a career profile/ individualized plan for employment
2. Review of job choice in relation to an individual's preferences along with the
availability of employers and job postings in the local labor market
3. Analysis of pertinent collateral information and reports of prior work
experiences and performance
4. Inclusion of employment goals within the mental health treatment plan in
coordination with the mental health treatment team.
5. Development of a job search plan to affirm employment goal consistent with
the individualized plan for employment
H. Care Coordination/Transition Plan: Pacific Clinics will meet regularly with mental health
treatment teams to support the individual, provide updates, and ensure shared decision
making consistent with the individuals employment or educational goals. Pacific Clinics
will work collaboratively with the mental health treatment team when any significant events
(such as hiring, termination, crisis, etc.) occur to support the individual in achieving gainful
employment.
I. Level of Care/Modality of Services: The program provides all phases of the supported
employment and education service in an outpatient setting.
J. Evidence-Based Practice(s): The program will use the Individualized Placement Support
model to deliver services. The program may also use motivational interviewing and other
interventions and tools that support the individual to achieve their identified educational
goals or consistent with their individualized plan for employment.
K. Contractor shall:
1. Review and follow the handbook for IPS peer specialists for guidance on peer
roles
2. Have staff attend the IPS practitioner's skills and supervisor's course
3. Cross train all staff to provide both employment and educational services
4. Base hiring and contracting practices on local data and reflect the needs of the
population to be served
5. Establish teams capable of delivering culturally appropriate services. Staff will
be trained to keep an open mind and maintain non-judgmental interaction with
individuals and their families
6. Train staff on best practices for utilizing interpreters to ensure effective
communication with non-English speaking persons and assist in the delivery of
culturally/linguistically appropriate services
Exhibit A
Page 4 of 5
7. Work with mental health providers across DBH and its contracted providers for
the coordination of care, services, and supports
8. Be familiar with MHSA regulations, policies, and definitions
9. Understand Fresno County's diverse and unique populations.
10. Ensure clinically appropriate leadership and supervision of clinical programs:
i. Strategies to ensure staffing of programs with leadership and care
providers who possess clinical competencies and sufficient experience
to deliver the level of care outlined in the scope or work
ii. Obtain releases of information and memorandums of understanding as
needed for shared caseloads with behavioral health teams which
includes individuals with mental illnesses and co-occurring disorders
iii. Establish regular treatment team meetings
iv. Establish shared documentation, integrating employment goals and
documents within one record per individual
v. Engage new individuals and outreach to community organizations
vi. Engage individuals who are in day treatment or other centers who may
not be engaged in employment conversations
11. Provide education to the community regarding awareness of IPS services
through outreach and employment and recovery outcomes
L. County shall:
1. Provide oversight and collaborate to achieve program goals and outcomes
2. Provide technical assistance towards meeting cultural responsiveness
requirements
3. Evaluate overall program progress and efficiency and be available for
consultation
4. Gather outcome information from the program throughout the term of the
agreement.
V. STAFFING
A. Staffing/Person Served Ratio: A staffing level of 1:20 will remain in effect throughout the
term of the agreement to remain compliant with IPS fidelity standards.
B. Staffing Plan
1. Direct Clinical Services Staff:
a. 1.0 FTE IPS Team Leader/Supervisor
b. 3.00 FTE Employment Specialist
c. 1.00 FTE Educational Support Specialist
d. 2.00 FTE Employment Peer Specialist
e. .50 FTE Customer Service Specialist
f. .50 FTE Program Director
2. Non-Direct Clinical Services Staff:
a. Corporate Director
b. Program Director
Exhibit A
Page 5 of 5
C. Staff Training
a. IPS certification
b. Cultural competency training
c. First aid and CPR
d. Evidence based practices such as: Motivational Interviewing, Seeking Safety,
Wellness and Recovery Action Plan,
VI. OUTCOMES/PERFORMANCE MONITORING
A. To satisfy required state, federal and other funding and reporting requirements and to
successfully administer, assess, and evaluate program outcomes effectiveness, DBH
will require the program to collect data and measures applicable to IPS and vocational
and education services and submit them in a timely manner to the department.
The department will collect data and develop required annual reports. This data is
necessary for the department to successfully complete its reporting and outcome
requirements with appropriate funders which may include local, state, and federal
agencies.
The outcomes will be composed of two sections: a general data requirement for
systemic service delivery oversight and reporting, and a specific data set dependent
on the level of service, age range, modality, funding source requirements, and other
specific measures.
Pacific Clinics is expected to serve a minimum of 100 individuals per fiscal year. A
minimum of 40% of participating individuals are expected to be hired each year, and a
minimum of 60% will maintain employment for a minimum of 90 days. A minimum of
15% of participating individuals will be enrolled in education or vocational training.
Employment and educational support specialists are expected to adhere to the IPS
Model of having a caseload no greater than 20 individuals. Specialists are expected to
work directly with the clinical treatment teams and DOR of participating individuals to
achieve fidelity with the IPS Model. Pacific Clinics is expected to regularly perform and
report IPS fidelity assessments every 6 months, and is expected to achieve a
minimum score of"Good Fidelity" (100+).
Exhibit B
Page 1 of 16
Fresno County Behavioral Health Requirements
I. General Requirements
a. Guiding Principles. Contractor shall align programs, services, and practices with the
vision, mission, and guiding principles of the DBH, as further described in Exhibit B—
Attachment A to this Agreement,titled "Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery."
b. Rights of Persons Served. Contractor shall post signs informing persons served of their
right to file a complaint or grievance, appeals, and expedited appeals. In addition,
Contractor shall inform every person served of their rights as set forth in Exhibit B—
Attachment B to this agreement, titled "Rights of Persons Served".
c. Licenses/Certificates.Throughout the term of this Agreement, Contractor and
Contractor's staff shall maintain all necessary licenses, permits, approvals, certificates,
waivers and exemptions necessary for the provision of the services hereunder and
required by the laws and regulations of the United States of America, State of California,
the County of Fresno, and any other applicable governmental agencies. Contractor shall
notify County immediately in writing of its inability to obtain or maintain such licenses,
permits, approvals, certificates, waivers and exemptions irrespective of the pendency of
any appeal related thereto.Additionally, Contractor and Contractor's staff shall comply
with all applicable laws, rules or regulations, as may now exist or be hereafter changed.
d. Training. Contractor agrees that its employees,volunteers, interns, and student trainees
or subcontractors of Contractor, in each case, are expected to perform professional
services per an agreement with County. Contractor will comply with the training
requirements and expectations referenced in Exhibit B—Attachment C to this
Agreement,titled "Department of Behavioral Health Selected Bidder Training
Requirements Reference Guide".
e. Additional Responsibilities.The parties acknowledge that, during the term of this
Agreement,the Contractor will hire,train, and credential staff, and County will perform
additional staff credentialing to ensure compliance with State and Federal regulations, if
applicable.
Exhibit B
Page 2 of 16
f. Subcontracts. Contractor shall obtain written approval from County's Department of
Behavioral Health Director, or designee, before subcontracting any of the services
delivered under this Agreement. County's Department of Behavioral Health Director, or
designee, retains the right to approve or reject any request for subcontracting services.
Any transferee, assignee, or subcontractor will be subject to all applicable provisions of
this Agreement, and all applicable State and Federal regulations.
Contractor shall be held primarily responsible by County for the performance of
any transferee, assignee, or subcontractor unless otherwise expressly agreed to in
writing by County's Department of Behavioral Health Director, or designee.The use of
subcontractors by Contractor shall not entitle Contractor to any additional compensation
that is provided for under this Agreement.
g. Reports.The Contractor shall submit the following reports and data:
i. Outcome Data. Contractor shall submit to County program performance
outcome data, as requested. Outcome data and outcome requirements are
subject to change at County's discretion.
ii. Additional Reports. Contractor shall also furnish to County such statements,
records, reports, data, and other information as County may request pertaining
to matters covered by this Agreement. In the event that Contractor fails to
provide such reports or other information required hereunder, it shall be
deemed sufficient cause for County to withhold monthly payments until there is
compliance. In addition, Contractor shall provide written notification and
explanation to County within five (5) days of any funds received from another
source to conduct the same services covered by this Agreement.
h. Compliance with Behavioral Health Specific Laws.
i. Contractor shall provide services in conformance with all applicable State and
Federal statutes, regulations and sub regulatory guidance, as from time to time
amended, including but not limited to:
1. California Code of Regulations,Title 9;
2. California Code of Regulations,Title 22;
3. California Welfare and Institutions Code, Division 5;
4. United States Code of Federal Regulations (CFR),Title 42, including but
not limited to Parts 438 and 455;
Exhibit B
Page 3 of 16
5. United States CFR,Title 45;
6. United States Code,Title 42 (The Public Health and Welfare), as
applicable;
7. Balanced Budget Act of 1997;
8. Health Insurance Portability and Accountability Act (HIPAA); and
9. Applicable Medi-Cal laws and regulations, including applicable sub-
regulatory guidance, such as Behavioral Health Information Notices
(BHINs), Mental Health and Substance Use Disorder Services
Information Notices (MHSUDS INs), and provisions of County's, state or
federal contracts governing services for persons served.
ii. In the event any law, regulation, or guidance referred to in this section is
amended during the term of this Agreement,the parties agree to comply with
the amended authority as of the effective date of such amendment without
amending this Agreement.
iii. Contractor recognizes that County operates its behavioral health programs
under an agreement with DHCS, and that under said agreement the State
imposes certain requirements on County and its subcontractors. Contractor shall
adhere to all State requirements, including those identified in Exhibit B—
Attachment D to this Agreement, titled "State Behavioral Health Requirements".
i. Meetings. Contractor shall participate in monthly, or as needed, workgroup meetings
consisting of staff from County's DBH to discuss service requirements, data reporting,
training, policies and procedures, overall program operations and any problems or
foreseeable problems that may arise. Contractor shall also participate in other County
meetings, such as but not limited to quality improvement meetings, provider meetings,
audit meetings, Behavioral Health Board meetings, bi-monthly contractor meetings, etc.
Schedule for these meetings may change based on the needs of the County.
j. Monitoring. Contractor agrees to extend to County's staff, County's DBH and the
California Department of Health Care Services (DHCS), or their designees,the right to
review and monitor records, programs, or procedures, at any time, in regard to persons
served, as well as the overall operation of Contractor's programs, in order to ensure
compliance with the terms and conditions of this Agreement.
k. Generative Artificial Intelligence Technology Use& Reporting
Exhibit B
Page 4 of 16
i. During the term of the Agreement, Contractor must notify the County in writing
if their services or any work under this Agreement includes, or makes available,
any previously unreported Generative Artificial Intelligence (GenAl)technology,
including GenAl from third parties or subcontractors. Contractor must provide
information by submitting a "Generative Artificial Intelligence (GenAl) Reporting
and Factsheet (STD 1000)". In addition, Contractor must notify the County of
any new or previously unreported GenAl technology.At the direction of the
County, Contractor shall discontinue the use of any new or previously
undisclosed GenAl technology that materially impacts functionality, risk or
contract performance, until use of such GenAl technology has been approved by
the County.
ii. Failure to disclose GenAl use to the County and failure to submit the GenAl
Reporting and Factsheet (STD 1000) may be considered a breach of this
Agreement and are grounds for immediate termination in accordance with
Article 6 of this Agreement.
I. Confidentiality.All services performed by Contractor under this Agreement shall be in
strict conformance with all applicable Federal, State of California and/or local laws and
regulations relating to confidentiality.
m. Physical Accessibility. In accordance with the accessibility requirements of section 508
of the Rehabilitation Act and the Americans with Disabilities Act of 1973, Contractor
must provide physical access, reasonable accommodations, and accessible equipment
for Medi-Cal beneficiaries with physical or mental disabilities.
n. Publicity Prohibition.
i. Self-Promotion. None of the funds, materials, property, or services provided
directly or indirectly under this Agreement shall be used for Contractor's
advertising, fundraising, or publicity (i.e., purchasing of tickets/tables, silent
auction donations, etc.)for the purpose of self-promotion.
ii. Public Awareness. Notwithstanding the above, publicity of the services
described in Exhibit A of this Agreement shall be allowed as necessary to raise
public awareness about the availability of such specific services when approved
in advance by County's DBH Director or designee. Communication products
must follow DBH branding standards, including typefaces and colors,to
Exhibit B
Page 5 of 16
communicate our authority and project a unified brand.This includes all media
types, platforms, and all materials on and offline that are created as part of
DBH's efforts to provide information to the public.
o. Child Abuse Reporting Act.
i. Contractor shall establish a procedure acceptable to the County's DBH Director,
or designee,to ensure that all of the Contractor's employees, consultants,
subcontractors or agents described in the Child Abuse Reporting Act, section
1116 et seq. of the Penal Code, and performing services under this Agreement
shall report all known or suspected child abuse or neglect to a child protective
agency as defined in Penal Code section 11165.9.This procedure shall include:
1. A requirement that all Contractor's employees, consultants,
subcontractors or agents performing services shall sign a statement that
they know of and will comply with the reporting requirements as
defined in Penal Code section 11166(a).
2. Establishing procedures to ensure reporting even when employees,
consultants, subcontractors, or agents who are not required to report
child abuse under Penal Code section 11166(a),gain knowledge of or
reasonably suspect that a child has been a victim of abuse or neglect.
II. Assurances
Certification of Non-exclusion or Suspension from Participation in a Federal Health Care
Program.
a. In entering into this Agreement, Contractor certifies that it is not excluded from
participation in Federal Health Care Programs under either Section 1128 or 1128A of the
Social Security Act. Failure to so certify will render all provisions of this Agreement null
and void and may result in the immediate termination of this Agreement.
b. In entering into this Agreement, Contractor certifies,that the Contractor does not
employ or subcontract with providers or have other relationships with providers
excluded from participation in Federal Health Care Programs, including Medi-
Cal/Medicaid or procurement activities, as set forth in 42 C.F.R. §438.610. Contractor
shall conduct initial and monthly exclusion and suspension searches of the following
databases and provide evidence of these completed searches when requested by
County, DHCS or the US Department of Health and Human Services (DHHS):
Exhibit B
Page 6 of 16
i. www.oig.hhs.gov/exclusions-Office of Inspector General's List of Excluded
Individuals/Entities (LEIE) Federal Exclusions
ii. www.sam.gov/content/exclusions -General Service Administration (GSA)
Exclusions Extract
iii. www.Medi-Cal.ca.gov-Suspended & Ineligible Provider List
iv. https://nppes.cros.hhs.gov/#/- National Plan and Provider Enumeration System
(NPPES)
v. Any other database required by DHCS or US DHHS.
c. In entering into this Agreement, Contractor certifies,that Contractor does not employ
staff or individual contractors/vendors that are on the Social Security Administration's
Death Master File. Contractor shall check the database prior to employing staff or
individual contractors/vendors and provide evidence of these completed searches when
requested by the County, DHCS or the US DHHS.
d. Contractor is required to notify County immediately if Contractor becomes aware of any
information that may indicate their(including employees/staff and individual
contractors/vendors) potential placement on an exclusions list.
e. Contractor shall screen and periodically revalidate all network providers in accordance
with the requirements of 42 C.F.R., Part 455, Subparts B and E.
f. Contractor must confirm the identity and determine the exclusion status of all its
providers, as well as any person with an ownership or control interest, or who is an
agent or managing employee of the contracted agency through routine checks of federal
and state databases.This includes the Social Security Administration's Death Master File,
NPPES,the Office of Inspector General's LEIE,the Medi-Cal Suspended and Ineligible
Provider List(S&I List) as consistent with the requirements of 42 C.F.R. §455.436.
g. If Contractor finds a provider that is excluded, it must promptly notify the County as per
42 C.F.R. §438.608(a)(2), (4).The Contractor shall not certify or pay any excluded
provider with Medi-Cal funds, must treat any payments made to an excluded provider as
an overpayment, and any such inappropriate payments may be subject to recovery.
III. Inspection and Audit Requirements
a. Internal Auditing. Contractors shall institute and conduct a Quality Assurance Process
for all services provided hereunder.
Exhibit B
Page 7 of 16
Contractor shall provide County with notification and a summary of any internal
audit exceptions and the specific corrective actions taken to sufficiently reduce the
errors that are discovered through Contractor's internal audit process. Contractor shall
provide this notification and summary to County as requested by the County.
b. Access to Records. Contractor shall provide County with access to all documentation of
services provided under this Agreement for County's use in administering this
Agreement. Contractor shall allow County,the Centers for Medicare and Medicaid
Services (CMS),the Office of the Inspector General,the Controller General of the United
States, and any other authorized Federal and State agencies to evaluate performance
under this Agreement, and to inspect, evaluate, and audit any and all records,
documents, and the premises, equipment and facilities maintained by the Contractor
pertaining to such services at any time and as otherwise required under this Agreement.
IV. Right to Monitor
a. Right to Monitor. County or any subdivision or appointee thereof, and the State of
California or any subdivision or appointee thereof, including the Auditor General, shall
have absolute right to review and audit all records, books, papers, documents, corporate
minutes,financial records, staff information, records of persons served, other pertinent
items as requested, and shall have absolute right to monitor the performance of
Contractor in the delivery of services provided under this Agreement. Full cooperation
shall be given by the Contractor in any auditing or monitoring conducted, according to
this Agreement.
b. Accessibility. Contractor shall make all of its premises, physical facilities, equipment,
books, records, documents, agreements, computers, or other electronic systems
pertaining to Medi-Cal enrollees, Medi-Cal-related activities, services, and activities
furnished under the terms of this Agreement, or determinations of amounts payable
available at any time for inspection, examination, or copying by County, the State of
California or any subdivision or appointee thereof, CMS, U.S. Department of Health and
Human Services (HHS) Office of Inspector General,the United States Controller General
or their designees, and other authorized federal and state agencies.This audit right will
exist for at least ten (10)years from the final date of the Agreement period or in the
event the Contractor has been notified that an audit or investigation of this Agreement
has commenced, until such time as the matter under audit or investigation has been
Exhibit B
Page 8 of 16
resolved, including the exhaustion of all legal remedies, whichever is later(42 CFR
§438.230(c)(3)(I)-(ii)).
The County, DHCS, CMS, or the HHS Office of Inspector General may inspect,
evaluate, and audit the Contractor at any time if there is a reasonable possibility of fraud
or similar risk.The Department's inspection shall occur at the Contractor's place of
business, premises, or physical facilities (42 CFR §438.230(c)(3)(iv))
c. Cooperation. Contractor shall cooperate with County in the implementation, monitoring
and evaluation of this Agreement and comply with any and all reporting requirements
established by County.Should County identify an issue or receive notification of a
complaint or potential/actual/suspected violation of requirements, County may audit,
monitor, and/or request information from Contractor to ensure compliance with laws,
regulations, and requirements, as applicable.
d. Probationary Status. County reserves the right to place Contractor on probationary
status, as referenced in the Probationary Status Article, should Contractor fail to meet
performance requirements; including, but not limited to violations such as failure to
report incidents and changes as contractually required,failure to correct issues,
inappropriate invoicing, untimely and inaccurate data entry, not meeting performance
outcomes expectations, and violations issued directly from the State. Additionally,
Contractor may be subject to Probationary Status or termination if agreement
monitoring and auditing corrective actions are not resolved within specified timeframes.
e. Record Retention. Contractor shall retain all records and documents originated or
prepared pursuant to Contractor's performance under this Agreement, including
grievance and appeal records, and the data, information and documentation specified in
42 CFR parts 438.604,438.606,438.608, and 438.610 for a period of no less than ten
(10)years from the term end date of this Agreement or until such time as the matter
under audit or investigation has been resolved. Records and documents include but are
not limited to all physical and electronic records and documents originated or prepared
pursuant to Contractor's or subcontractor's performance under this Agreement including
working papers, reports,financial records and documents of account, records of persons
served, prescription files, subcontracts, and any other documentation pertaining to
covered services and other related services for persons served.
Exhibit B
Page 9 of 16
f. Facilities and Assistance. Contractor shall provide all reasonable facilities and assistance
for the safety and convenience of the County's representatives in the performance of
their duties.All inspections and evaluations shall be performed in such a manner that
will not unduly delay the work of Contractor.
g. County Discretion to Revoke. County has the discretion to revoke full or partial
provisions of the Agreement, delegated activities or obligations, or application of other
remedies permitted by state or federal law when the County or DHCS determines
Contractor has not performed satisfactorily.
h. Site Inspection. Without limiting any other provision related to inspections or audits
otherwise set forth in this Agreement, Contractor shall permit authorized County, state,
and/or federal agency(ies),through any authorized representative,the right to inspect
or otherwise evaluate the work performed or being performed hereunder including
subcontract support activities and the premises which it is being performed. Contractor
shall provide all reasonable assistance for the safety and convenience of the authorized
representative in the performance of their duties. All inspections and evaluations shall
be made in a manner that will not unduly delay the work of the Contractor.
V. Complaint Logs and Grievances
a. Documentation. Contractor shall log complaints and the disposition of all complaints
from a person served or their family. Contractor shall provide a copy of the detailed
complaint log entries concerning County-sponsored persons served to County at
monthly intervals by the tenth (10th) day of the following month, in a format that is
mutually agreed upon. Contractor shall allow persons served or their representative to
file a grievance either orally, or in writing at any time with the Behavioral Health Plan. In
the event Contractor is notified by a person served or their representative of a
discrimination grievance, Contractor shall report discrimination grievances to the
Behavioral Health Plan within twenty-four(24) hours.The Contractor shall not require a
person served or their representative to file a Discrimination Grievance with the
Behavioral Health Plan before filing the complaint directly with the DHCS Office of Civil
Rights and the U.S. Health and Human Services Office for Civil Rights.
b. Rights of Persons Served. Contractor shall comply with applicable laws and regulations
relating to patients' rights, including but not limited to Wel. & Inst. Code 5325, Cal. Code
Regs.,tit. 9, sections 862 through 868, and 42 CFR §438.100. The Contractor shall
Exhibit B
Page 10 of 16
ensure that its subcontractors comply with all applicable patients' rights laws and
regulations.
c. Incident Reporting. Contractor shall file an incident report for all incidents involving
persons served,following County DBH's Incident Reporting protocol.
VI. Compliance Requirements
a. Internal Monitoring and Auditing
i. Contractor shall be responsible for conducting internal monitoring and auditing
of its agency. Internal monitoring and auditing include, but are not limited to
billing practices, licensure/certification verification and adherence to County,
State and Federal regulations.
1. Contractor shall not submit false, fraudulent, inaccurate or fictitious
claims for payment or reimbursement of any kind.
2. Contractor shall bill only for those eligible services actually rendered
which are also fully documented.
3. Contractor shall ensure all employees/service providers maintain
current I ice nsure/certification/registration/waiver status as required by
the respective licensing/certification Board, applicable governing State
agency(ies) and Title 9 of the California Code of Regulations.
ii. Should Contractor identify improper procedures, actions or circumstances,
including fraud/waste/abuse and/or systemic issue(s), Contractor shall take
prompt steps to correct said problem(s). Contractor shall report to DBH any
overpayments discovered as a result of such problems no later than five (S)
business days from the date of discovery,with the appropriate documentation,
and a thorough explanation of the reason for the overpayment. Prompt
mitigation, corrective action and reporting shall be in accordance with the DBH
Overpayment Policy and PPG Prevention, Detection, Correction of Fraud, Waste
and Abuse which will be provided to Contractor at its request.
b. Compliance Program
i. The County DBH has established a Compliance Office for purposes of ensuring
adherence to all standards, rules and regulations related to the provision of
services and expenditure of funds in Federal and State health care programs.
Contractor shall either adopt DBH's Compliance Plan/Program or establish its
Exhibit B
Page 11 of 16
own Compliance Plan/Program and provide documentation to County DBH to
evaluate whether the Program is consistent with the elements of a Compliance
Program as recommended by the United States Department of Health and
Human Services, Office of Inspector General.
ii. Contractor's Compliance Program must include the following elements:
1. Designation of a compliance officer who reports directly to the Chief
Executive Officer and the Contactor's Board of Directors and compliance
committee comprised of senior management who are charged with
overseeing the Contractor's compliance program and compliance with
the requirements of this account.The committee shall be accountable
to the Contractor's Board of Directors.
iii. Policies and Procedures
1. Contractor shall have written policies and procedures that articulate the
Contractor's commitment to comply with all applicable Federal and
State standards. Contractor shall adhere to applicable County DBH
Policies and Procedures relating to the Compliance Program or develop
its own compliance related policies and procedures.
iv. Contractor shall establish and implement procedures and a system with
dedicated staff for routine internal monitoring and auditing of compliance risks,
prompt response to compliance issues as they arise, investigation of potential
compliance problems as identified in the course of self-evaluation and audits,
correction of such problems promptly and thoroughly(or coordination of
suspected criminal acts with law enforcement agencies)to reduce the potential
for recurrence, and ongoing compliance with the requirements under this
Agreement.
v. Contractor shall implement and maintain written policies for all County DBH-
funded employees, and of any contractor or agent, that provide detailed
information about the False Claims Act and other Federal and State laws,
including information about rights of employees to be protected as
whistleblowers.
vi. Contractor shall maintain documentation,verification or acknowledgement that
the Contractor's employees, subcontractors, interns,volunteers, and members
Exhibit B
Page 12 of 16
of Board of Directors are aware of these Policies and Procedures and the
Contractor's Compliance Program.
vii. Contractor shall have a Compliance Plan demonstrating the seven (7) elements
of a Compliance Plan. Contractor has the option to develop its own or adopt
County DBH's Compliance Plan. Should Contractor develop its own Plan,
Contractor shall submit the Plan prior to implementation for review and
approval to:
Fresno County DBH Compliance Office
1925 E. Dakota Ave. Ste A
Fresno, California 93726
Or send via email to: DBHCompliance@fresnocountyca.gov
c. Program Integrity Requirements
i. As a condition for receiving payment under a Medi-Cal managed care program,
Contractor shall comply with the provisions of Title 42 CFR Sections 438.604,
438.606, 438.608 and 438.610. Contractor must have administrative and
management processes or procedures, including a mandatory compliance plan,
that are designed to detect and prevent fraud,waste or abuse.
ii. If Contractor identifies an issue or receives notification of a complaint
concerning an incident of possible fraud,waste, or abuse, Contractor shall
immediately notify County DBH; conduct an internal investigation to determine
the validity of the issue/complaint; and develop and implement corrective
action if needed.
iii. If Contractor's internal investigation concludes that fraud or abuse has occurred
or is suspected,the issue if egregious, or beyond the scope of the Contractor's
ability to pursue,the Contractor shall immediately report to the County DBH
Compliance Office for investigation, review and/or disposition.
iv. Contractor shall immediately report to DBH any overpayments identified or
recovered, specifying the overpayments due to potential fraud.
v. Contractor shall immediately report any information about changes in
circumstances of the person served that may affect the person's eligibility,
including changes in the residence of the person served or the death of the
individual.
Exhibit B
Page 13 of 16
vi. Contractor shall immediately report any information about a change in
Contractor's or Contractor's staff circumstances that may affect eligibility to
participate in the behavioral health program.
vii. Contractor understands DBH, CMS, or the HHS Inspector General may inspect,
evaluate, and audit the Contractor at any time if there is a reasonable possibility
of fraud or similar risk.
d. Code of Conduct
i. Contractor shall take precautions to ensure that claims are prepared and
submitted accurately,timely and are consistent with all applicable laws,
regulations, rules or guidelines.
ii. Contractor shall ensure that no false,fraudulent, inaccurate or fictitious claims
for payment or reimbursement of any kind are submitted.
iii. Contractor shall bill only for eligible services actually rendered and fully
documented.
iv. Contractor shall act promptly to investigate and correct problems if errors in
claims or billing are discovered.
v. Contractor shall comply with County's Code of Conduct and Ethics and the
County's Compliance Program in accordance with Exhibit B—Attachment E to
this Agreement,titled "Fresno County Mental Health Compliance Program".
VII. Federal and State Laws.
a. Health Insurance Portability and Accountability Act. County and Contractor each consider
and represent themselves as covered entities as defined by the U.S. Health Insurance
Portability and Accountability Act of 1996, Public Law 104-191(HIPAA) and agree to use and
disclose Protected Health Information (PHI) as required by law.
County and Contractor acknowledge that the exchange of PHI between them is only for
treatment, payment, and health care operations.
County and Contractor intend to protect the privacy and provide for the security of PHI
pursuant to this Agreement in compliance with HIPAA, the Health Information Technology
for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
Exhibit B
Page 14 of 16
Contractor to enter into an agreement containing specific requirements prior to the
disclosure of PHI, as set forth in, but not limited to,Title 45, Sections 164.314(a), 164.502(e)
and 164.504(e) of the Code of Federal Regulations.
b. Contractor and County mutually agree to maintain the confidentiality of records and
information of persons served in compliance with all applicable State and Federal statutes
and regulations, including, but not limited to, HIPAA, California Confidentiality of Medical
Information Act (CMIA), and California Welfare and Institutions Code section 5328.The
Parties shall inform all of their employees and agents who perform services under this
Agreement of the confidentiality provisions of all applicable statutes.
c. The County is a "Covered Entity," and the Contractor is a "Business Associate," as these
terms are defined by 45 CFR 160.103. As a Business Associate, Contractor agrees to comply
with the terms of Exhibit B—Attachment F to this Agreement, titled "Health Insurance
Portability and Accountability Act (HIPAA) Business Associate Agreement".
Vill. Quality Management Requirements.
a. Reporting.
i. Outcomes Reports. Contractor shall complete Outcomes Reports in the form set
forth in Exhibit B—Attachment G to this Agreement. Outcomes reports shall be
submitted to County's DBH for review within thirty(30) days of the end of each
quarter.
b. Quality Improvement Activities and Participation. Contractor shall comply with the
County's ongoing comprehensive Quality Assessment and Performance Improvement
(QAPI) Program (42 CFR. §438.330(a)) and work with the County to improve established
outcomes by following structural and operational processes and activities that are
consistent with current practice standards.
Contractor shall participate in quality improvement(QI) activities, including
clinical and non-clinical performance improvement projects (PIPs), as requested by the
County in relation to State and Federal requirements and responsibilities, to improve
health outcomes and individuals' satisfaction with services over time. Other QI activities
include quality assurance, collection and submission of performance measures specified
by the County, mechanisms to detect both underutilization and overutilization of
services, individual and system outcomes, utilization management, utilization review,
provider appeals, provider credentialing and recredentialing, and person served
Exhibit B
Page 15 of 16
grievances. Contractor shall measure, monitor, and annually report to the County on its
performance.
IX. Cultural and Linguistic Competency
a. General.All services, policies and procedures shall be culturally and linguistically
appropriate. Contractor shall participate in the implementation of the most recent
Cultural Competency Plan for the County and shall adhere to all Culturally and
Linguistically Appropriate Service (CLAS) standards and requirements as set forth in
Exhibit B—Attachment H to this Agreement, titled "National Standards on Culturally and
Linguistically Appropriate Services". Contractor shall participate in the County's efforts to
promote the delivery of services in a culturally responsive and equitable manner to all
individuals, including those with limited English proficiency and diverse cultural and
ethnic backgrounds, disabilities, and regardless of gender, sexual orientation, or gender
identity including active participation in the County's Diversity, Equity and Inclusion
Committee.
b. Policies and Procedures. Contractor shall comply with requirements of policies and
procedures for ensuring access and appropriate use of trained interpreters and material
translation services for all limited and/or no English proficient persons served, including,
but not limited to, assessing the cultural and linguistic needs of the persons served,
training of staff on the policies and procedures, and monitoring its language assistance
program. Contractor's policies and procedures shall ensure compliance of any
subcontracted providers with these requirements.
c. Interpreter Services. Contractor shall notify its persons served that oral interpretation is
available for any language and written translation is available in prevalent languages and
that auxiliary aids and services are available upon request, at no cost and in a timely
manner for limited and/or no English proficient persons served and/or persons served
with disabilities. Contractor shall avoid relying on an adult or minor child accompanying
the person served to interpret or facilitate communication; however, if the person
served refuses language assistance services, the Contractor must document the offer,
refusal, and justification in the file of the person served.
d. Interpreter Qualifications. Contractor shall ensure that employees, agents,
subcontractors, and/or partners who interpret or translate for a person served or who
directly communicate with a person in a language other than English (1) have completed
Exhibit B
Page 16 of 16
annual training provided by County at no cost to Contractor; (2) have demonstrated
proficiency in the language of the person served; (3) can effectively communicate any
specialized terms and concepts specific to Contractor's services; and (4) adheres to
generally accepted interpreter ethic principles. As requested by County, Contractor shall
identify all who interpret for or provide direct communication to any program person
served in a language other than English and identify when the Contractor last monitored
the interpreter for language competence.
e. CLAS Standards. Contractor shall submit to County for approval, within ninety (90) days
from date of contract execution, Contractor's plan to address all fifteen (15) National
Standards for Culturally and Linguistically Appropriate Service (CLAS), as published by
the Office of Minority Health and as set forth in Exhibit B—Attachment H "National
Standards on Culturally and Linguistically Appropriate Services".As the CLAS standards
are updated, Contractor's plan must be updated accordingly. As requested by County,
Contractor shall be responsible for conducting an annual CLAS self-assessment and
providing the results of the self-assessment to the County.The annual CLAS self-
assessment instruments shall be reviewed by the County and revised as necessary to
meet the approval of the County.
f. Training Requirements. Cultural responsiveness training for Contractor staff should be
substantively integrated into health professions education and training at all levels, both
academically and functionally, including core curriculum, professional licensure, and
continuing professional development programs.As requested by County, Contractor
shall report on the completion of cultural responsiveness trainings to ensure direct
service providers are completing annual cultural responsiveness training.
g. Continuing Cultural Responsiveness. Contractor shall create and sustain a forum that
includes staff at all agency levels to discuss cultural responsiveness. Contractor shall
designate a representative from Contractor's team to attend County's Diversity, Equity
and Inclusion Committee.
Exhibit B -Attachment A
Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
1
rev 01-02-2020
Exhibit B -Attachment A
Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
2
rev 01-02-2020
Exhibit B -Attachment A
Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
6. Principle Six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the person's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
3
rev 01-02-2020
Exhibit B -Attachment A
Page 4 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
4
rev 01-02-2020
Exhibit B -Attachment B
Page 1 of 2
FRESNO COUNTY BEHAVIORAL HEALTH PLAN RIGHTS OF PERSONS SERVED
Grievances
Fresno County Behavioral Health Plan (BHP) provides beneficiaries with a grievance
and appeal process and an expedited appeal process to resolve grievances and
disputes at the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the BHP and its fee-for-service
providers give verbal and written information to Medi-Cal beneficiaries regarding the
following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The BHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
the individuals served copies of all current beneficiary information annually at the time
their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Behavioral Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The BHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process—the provider may first speak to a Provider
Relations Specialist (PRS) regarding his or her complaint or concern.
Exhibit C-Attachment B
Page 2 of 2
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the BHP address (listed above).
Formal provider appeal process—the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for BHP
payment authorization, or the process or payment of a provider's claim to the BHP.
Payment authorization issues—the provider may appeal a denied or modified request
for payment authorization or a dispute with the BHP regarding the processing or
payment of a provider's claim to the BHP. The written appeal must be submitted to the
BHP within 90 calendar days of the date of the receipt of the non-approval of payment.
The BHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the decision
that addresses each issue raised by the provider, and any action required by the
provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request, the
BHP utilizes a Managed Care staff who was not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within 30 calendar days of receipt of the decision
Other complaints— if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the BHP. The provider will receive a written response from the BHP within 60 calendar
days of receipt of the complaint. The decision rendered buy the BHP is final.
CO tj Exhibit B—Attachment C
Page 1 of 4
O� g6 Fresno County Department of Behavioral Health
ESQ Contractor Training Requirements Reference Guide
Contractor must consider and include sufficient time and funds for required trainings.
This Training Requirements Reference Guide identifies the required trainings that
Contractor is responsible for offering to all employees, volunteers, interns, and student
trainees of Contractor or its subcontractors who, in each case, are expected to perform
professional services while contracted by County. There are some trainings offered by
the County at no cost to Contractor, and those are identified within this document. The
remaining trainings are the responsibility of Contractor to provide and cover associated
costs. The expectations for Contractor staff attending County-offered trainings are
included within this guide.
I. Trainings Provided by County DBH
DBH Annual General Compliance Refresher Training
Duration: 60 Minutes
General Compliance Refresher Training is an annual requirement for all employees,
contractors, volunteers, interns, and student trainees working in behavioral health
programs who are in their second or more years of service. This training is a
modified version of the self-paced General Compliance Training and Contractor shall
be assigned this training in Quarter 4 of each calendar year.
An announcement from the DBH Compliance Program, DBH Staff Development, or
your Contract Analyst regarding this training will be made prior to the assignment of
this training. Contractor will have the option to complete the training either through
the Relias Learning Management System (LMS) or through Department of
Behavioral Health's website. Contractors are given approximately a 60-day window
to complete this training from the training announcement date.
DBH New Hire General Compliance Training
Duration: 40 Minutes
Contractor shall have their employees, subcontractors, volunteers, interns, and
student trainees who, in each case, are expected to provide services under this
Agreement with County, complete the New Hire Compliance Training within 30
business days of hire or effective date of this Agreement, per Compliance Exhibit B,
Attachment E. If contract effective date is for a renewed agreement, existing staff will
not need to retake the training if the staff member has already completed the training
within the same calendar year as the effective date of the renewed agreement.
New Hire General Compliance is self-paced and can be completed either through
Relias Learning Management System (LMS) or on the Department of Behavioral
Training for Providers of Specialty Mental Health Service
Exhibit B—Attachment C
Page 2 of 4
Health's website. Additional information on how to complete the training can be
found on the following webpage:
https://www.fresnocountyca.gov/Departments/Behavioral-Health/Care-
Services/Behavioral-Health-Compliance/New-Hire-General-Compliance-Training
Contractor shall require its County-funded employees and subcontractors to
complete this compliance training. After completion of this training, participants must
sign the Contractor Acknowledgment and Agreement form and return this form to the
DBH Compliance officer or designee. For additional questions about the training,
please contact your Contract Analyst or the DBH Compliance team at:
DBHCompliance(a�_fresnocountyca.gov.
II. Contractor is Responsible for Ensuring and/or Providing
These Trainings are Offered and Completed
Cultural Responsiveness Trainings
Duration: May vary based on Contractor's training preference
Contracted Provider Organization shall have DBH-funded providers complete annual
trainings on cultural competency, awareness, and diversity as identified by
Contractor(s), and/or via the County's eLearning system. Contractor's DBH-funded
providers shall be appropriately trained in providing services in a culturally sensitive
manner and shall attend civil rights training as identified by Contractor(s), or online
via the County's eLearning system.
Information on annual cultural responsiveness training requirements will be provided
by the DBH Division Manager serving as Ethnic Services Manager and Diversity
Services Coordinator. Both parties are working locally and at the state level to
address the need for thorough training to improve culturally responsive care and to
meet the National Culturally and Linguistically Appropriate Services standards, while
also understanding the impact that the training hours can have on productivity in fee-
for-service programs.
For additional information, they are to contact their assigned contract analyst.
DBH is available to assist Contractor's efforts toward cultural and linguistic
responsiveness by providing the following:
• Technical assistance regarding culturally responsive training requirements.
• Mandatory cultural responsiveness training for Contractor's DBH-funded
staff if training capacity allows.
• Technical assistance for translating information into County's threshold
languages (currently Spanish and Hmong and subject to change). Selected
Contractors are responsible for securing translation services and all
associated costs.
Exhibit B—Attachment C
Page 3 of 4
Language Assistance Program Training
Contractor shall be responsible for implementing policies and procedures and
training staff to ensure access and appropriate use of trained interpreters and
material translation services for all Limited English Proficient (LEP) persons served.
This includes, but is not limited to, assessing the cultural and linguistic needs of its
persons served. The vendor(s) procedures shall include ensuring compliance of any
sub-contracted providers with these requirements.
III. Training Expectations for Contractor Employees when
Attending County-Provided Training
Expectations for Attendees:
1) Attendees are to adhere to wearing business casual attire, broadly defined as
a code of dress that blends traditional business wear with a more relaxed style
that is still professional and appropriate for an office environment, unless
specifically directed otherwise or instructed by Trainers. Attendees are
expected to dress in respectful, culturally inclusive attire.
2) Interested attendees shall register at least one week in advance of the training
date.
3) Attendees shall be expected to be ready and prepared to be engaged by the
training start time. Attendees are also expected to arrive back on time from
breaks, including lunch, and attend the training through completion.
4) Attendees who arrive 15 minutes late, or more, shall be requested to return to
their work site and their organization will be notified. Similarly, attendees may
not leave a training prior to the scheduled end time. Those who miss 15 minutes
or more of training in total throughout the day may be asked to re-enroll for a
later training date if one is available.
5) Personal use of cell phones, laptops and tablets, except for in cases of
emergency, should not be used during training and should be set to silent. Any
calls shall be taken outside of the training space.Attendees shall inform trainers
and/or Staff Development if they are expecting to be contacted for any reason;
this shall be done before the training begins, if possible. Other cell phone use,
such as texting, playing games or browsing the internet shall not permitted
while training is in session. If conduct is deemed disruptive to colleagues and/or
Exhibit B—Attachment C
Page 4 of 4
the trainer, attendees shall be asked to leave the training and return to their
work site. Organization will be notified.
6) At times, attendees shall be required to complete pre- and post-training class
assignments, as part of the learning objectives. Attendees shall be required to
complete assigned activities to receive Continuing Education Credits, and
certification, and training credit, if applicable.
7) Attendees shall be expected to complete pre- and/or post-training evaluations,
when available.
8) Attendees shall notify Staff Development with their supervisor copied at (559)
600-9680 or DBHStaffDevelopment(a-)_fresnocountyca.gov at the earliest
possible date if they can no longer attend a training for which they have
registered.
Use of DBH Training Facilities
Parking
Attendees shall park in undesignated stalls at DBH training sites. Any parking
restrictions shall be communicated prior to the training date or prior to the training start
time.
Use of Facilities
Attendees shall be respectful while occupying the training space, keeping it and the
surrounding area neat and clean. Attendees are encouraged to bring a reusable water
bottle but shall be cognizant of and clean any spills. If the training allows for food,
attendees shall ensure that their area is clean and dispose of any waste prior to leaving
the training space.
Exhibit B —Attachment D
Page 1 of 11
STATE BEHAVIORAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The County and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the County Behavioral Health Plan
(directly or through contract) providing Short-Doyle/Medi-Cal services have met
applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
Contractor shall conform to and County shall monitor compliance with all State of
California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
Contractor shall prepare and make available to County and to the public
all eligibility requirements to participate in the program plan set forth in the
Agreement. No person shall, because of ethnic group identification, age,
gender, color, disability, medical condition, national origin, race, ancestry,
marital status, religion, religious creed, political belief or sexual
preference be excluded from participation, be denied benefits of, or be
subject to discrimination under any program or activity receiving Federal
or State of California assistance.
B. Employment Opportunity
Contractor shall comply with County policy, and the Equal Employment
Opportunity Commission guidelines, which forbids discrimination against
any person on the grounds of race, color, national origin, sex, religion,
age, disability status, or sexual preference in employment practices.
Such practices include retirement, recruitment advertising, hiring, layoff,
termination, upgrading, demotion, transfer, rates of pay or other forms of
compensation, use of facilities, and other terms and conditions of
employment.
C. Suspension of Compensation
If an allegation of discrimination occurs, County may withhold all further
funds, until Contractor can show clear and convincing evidence to the
Exhibit B —Attachment D
Page 2 of 11
satisfaction of County that funds provided under this Agreement were not
used in connection with the alleged discrimination.
D. Nepotism
Except by consent of County's Department of Behavioral Health Director,
or designee, no person shall be employed by Contractor who is related by
blood or marriage to, or who is a member of the Board of Directors or an
officer of Contractor.
5. PATIENTS' RIGHTS
Contractor shall comply with applicable laws and regulations, including but not
limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied
with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f) and
CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-
free workplace by taking the following actions:
A. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is
prohibited and specifying actions to be taken against employees for
violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
C. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and Contractor
may be ineligible for award of any future State agreements if the department
determines that any of the following has occurred: the Contractor has made
false certification, or violated the certification by failing to carry out the
requirements as noted above. (Gov. Code §8350 et seq.)
Exhibit B —Attachment D
Page 3 of 11
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor
certifies that no more than one (1) final unappealable finding of contempt of court
by a Federal court has been issued against Contractor within the immediately
preceding two (2) year period because of Contractor's failure to comply with an
order of a Federal court, which orders Contractor to comply with an order of the
National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to
public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
Contractor agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the
lessor of 30 multiplied by the number of full time attorneys in the firm's offices in
the State, with the number of hours prorated on an actual day basis for any
contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the
meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to
contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel,
garments or corresponding accessories, or the procurement of
equipment, materials, or supplies, other than procurement related to a
public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been
laundered or produced in whole or in part by sweatshop labor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, or with the
benefit of sweatshop labor, forced labor, convict labor, indentured labor
under penal sanction, abusive forms of child labor or exploitation of
children in sweatshop labor. Contractor further declares under penalty of
perjury that they adhere to the Sweatfree Code of Conduct as set forth on
the California Department of Industrial Relations website located at
www.dir.ca.gov, and Public Contract Code Section 6108.
b. Contractor agrees to cooperate fully in providing reasonable access to the
Contractor's records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the
Department of Industrial Relations, or the Department of Justice to
Exhibit B —Attachment D
Page 4 of 11
determine the Contractor's compliance with the requirements under
paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractor
certifies that Contractor is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, Contractor certifies
that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: Contractor needs to be aware of the following
provisions regarding current or former state employees. If Contractor has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency shall be contacted immediately for clarification.
Current State Employees (Pub. Contract Code M 0410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on their own behalf as an
independent Contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date they left state employment, no
former state officer or employee may enter into a contract in which they
engaged in any of the negotiations, transactions, planning, arrangements
or any part of the decision-making process relevant to the contract while
employed in any capacity by any state agency.
b). For the twelve (12) month period from the date they left state
employment, no former state officer or employee may enter into a
contract with any state agency if they were employed by that state agency
in a policy-making position in the same general subject area as the
proposed contract within the twelve (12) month period prior to them
leaving state service.
If Contractor violates any provisions of above paragraphs, such action by
Contractor shall render this Agreement void. (Pub. Contract Code §10420)
Exhibit B —Attachment D
Page 5 of 11
Members of boards and commissions are exempt from this section if they do not
receive payment other than payment of each meeting of the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware
of the provisions which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance with the
provisions, and CONTRACTOR affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it
complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval
of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently
qualified to do business in California in order to ensure that all obligations
due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit.
Although there are some statutory exceptions to taxation, rarely will a
corporate Contractor performing within the state not be subject to the
franchise tax.
C. Both domestic and foreign corporations (those incorporated outside of
California) shall be in good standing in order to be qualified to do
business in California. Agencies will determine whether a corporation is
in good standing by calling the Office of the Secretary of State.
6. RESOLUTION: A County, city, district, or other local public body shall provide
the State with a copy of a resolution, order, motion, or ordinance of the local
governing body, which by law has authority to enter into an agreement,
authorizing execution of the agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
Contractor shall not be: (1) in violation of any order or resolution not subject to
review promulgated by the State Air Resources Board or an air pollution control
district; (2) subject to cease and desist order not subject to review issued
Exhibit B —Attachment D
Page 6 of 11
pursuant to Section 13301 of the Water Code for violation of waste discharge
requirements or discharge prohibitions; or (3)finally determined to be in violation
of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form shall be completed by all
Contractors that are not another state agency or other governmental entity.
9. INSPECTION AND AUDIT OF RECORDS AND ACCESS TO FACILITIES:
The State, CMS, the Office of the Inspector General, the Comptroller General,
and their designees may, at any time, inspect and audit any records or
documents of Contractor or its subcontractors, and may, at any time, inspect the
premises, physical facilities, and equipment where Medicaid-related activities or
work is conducted. The right to audit under this section exists for ten (10) years
from the final date of the contract period or from the date of completion of any
audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State shall
confirm the identity and determine the exclusion status of Contractor, any
subcontractor, as well as any person with an ownership or control interest, or
who is an agent or managing employee of Contractor through routine checks of
Federal databases. This includes the Social Security Administration's Death
Master File, the National Plan and Provider Enumeration System (NPPES), the
List of Excluded Individuals/Entities (LEIE), the System for Award Management
(SAM), and any other databases as the State or Secretary may prescribe. These
databases shall be consulted upon contracting and no less frequently than
monthly thereafter. If the State finds a party that is excluded, it shall promptly
notify the Contractor and take action consistent with § 438.610(c).
The State shall ensure that Contractor with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
Contractor to a network provider, out-of-network provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM)
REQUIREMENTS
1. PROTECTIONS FOR PERSONS SERVED
a. GRIEVANCES, APPEALS AND NOTICES OF ADVERSE BENEFIT
DETERMINATION
i. All grievances (as defined by 42 C.F.R. § 438.400) and complaints
received by Contractor shall be immediately forwarded to the
County's Managed Care Department or other designated persons
via a secure method (e.g., encrypted email or by fax) to allow
Exhibit B —Attachment D
Page 7 of 11
ample time for the Managed Care staff to acknowledge receipt of
the grievance and complaints and issue appropriate responses.
ii. Contractor shall not discourage the filing of grievances and
individual s do not need to use the term "grievance" for a
complaint to be captured as an expression of dissatisfaction and,
therefore, a grievance.
iii. Aligned with MHSUDS IN 18-010E and 42 C.F.R. §438.404, the
appropriate and delegated Notice of Adverse Benefit
Determination (NOABD) shall be issued by Contractor within the
specified timeframes using the template provided by the County.
iv. NOABDs shall be issued to individuals anytime the Contractor has
made or intends to make an adverse benefit determination that
includes the reduction, suspension, or termination of a previously
authorized service and/or the failure to provide services in a timely
manner. The notice shall have a clear and concise explanation of
the reason(s) for the decision as established by DHCS and the
County. The Contractor shall inform the County immediately after
issuing a NOABD.
v. Procedures and timeframes for responding to grievances, issuing
and responding to adverse benefit determinations, appeals, and
state hearings shall be followed as per 42 C.F.R., Part 438,
Subpart F (42 C.F.R. §§ 438.400 —438.424).
vi. Contractor shall provide individuals any reasonable assistance in
completing forms and taking other procedural steps related to a
grievance or appeal such as auxiliary aids and interpreter
services.
vii. Contractor shall maintain records of grievances and appeals and
shall review the information as part of its ongoing monitoring
procedures. The record shall be accurately maintained in a
manner accessible to the County and available upon request to
DHCS.
b. Advanced Directives
i. Contractor shall comply with all County policies and procedures
regarding Advanced Directives in compliance with the
requirements of 42 C.F.R. §§ 422.128 and 438.6(i) (1), (3) and (4).
c. Continuity of Care
i. Contractor shall follow the County's continuity of care policy that is
in accordance with applicable state and federal regulations,
MHSUDS IN 18-059 and any BHINs issued by DHCS for parity in
mental health and substance use disorder benefits subsequent to
the effective date of this Agreement (42 C.F.R. § 438.62(b)(1)-(2).)
2. QUALITY IMPROVEMENT PROGRAM
a. QUALITY IMPROVEMENT ACTIVITIES AND PARTICIPATION
i. Contractor shall implement mechanisms to assess person
served/family satisfaction based on County's guidance. The
Contractor shall assess individual/family satisfaction by:
Exhibit B —Attachment D
Page 8 of 11
1. Surveying person served/family satisfaction with the
Contractor's services at least annually.
2. Evaluating grievances of the person served, appeals and
State Hearings at least annually.
3. Evaluating requests to change persons providing services
at least annually.
4. Informing the County and individuals of the results of
persons served/family satisfaction activities.
ii. Contractor, if applicable, shall implement mechanisms to monitor
the safety and effectiveness of medication practices. This
mechanism shall be under the supervision of a person licensed to
prescribe or dispense prescription drugs, at least annually and as
required by DBH.
iii. Contractor shall implement mechanisms to monitor appropriate
and timely intervention of occurrences that raise quality of care
concerns. The Contractor shall take appropriate follow-up action
when such an occurrence is identified. The results of the
intervention shall be evaluated by the Contractor at least annually
and shared with the County.
iv. Contractor shall assist County, as needed, with the development
and implementation of Corrective Action Plans.
v. Contractor shall collaborate with County to create a QI Work Plan
with documented annual evaluations and documented revisions
as needed. The QI Work Plan shall evaluate the impact and
effectiveness of its quality assessment and performance
improvement program.
vi. Contractor shall attend and participate in the County's Quality
Improvement Committee (QIC) to recommend policy decisions,
review and evaluate results of QI activities, including PIPs,
institute needed QI actions, and ensure follow-up of QI processes.
Contractor shall ensure that there is active participation by the
Contractor's practitioners and providers in the QIC.
vii. Contractor shall participate, as required, in annual, independent
external quality reviews (EQR) of the quality, timeliness, and
access to the services covered under this Contract, which are
conducted pursuant to Subpart E of Part 438 of the Code of
Federal Regulations. (42 C.F.R. §§ 438.350(a) and 438.320)
b. TIMELY ACCESS
i. Timely access standards include:
1. Contractor shall have hours of operation during which
services are provided to Medi-Cal individuals that are no
less than the hours of operation during which the provider
offers services to non-Medi-Cal individual s. If the
Contractor's provider only serves Medi-Cal beneficiaries,
the provider shall provide hours of operation comparable to
the hours the provider makes available for Medi-Cal
services that are not covered by the Agreement or another
County.
2. Appointments data, including wait times for requested
services, shall be recorded and tracked by Contractor, and
Exhibit B —Attachment D
Page 9 of 11
submitted to the County on a monthly basis in a format
specified by the County. Appointments' data should be
submitted to the County's Planning and Quality
Management Division or other designated persons.
3. Urgent care appointments for services that do not require
prior authorization shall be provided to individual s within
48 hours of a request. Urgent appointments for services
that do require prior authorization shall be provided to
persons served within 96 hours of request.
4. Non-urgent non-psychiatry mental health services,
including, but not limited to Assessment, Targeted Case
Management, and Individual and Group Therapy
appointments (for both adult and children/youth) shall be
made available to Medi-Cal individuals within 10 business
days from the date the individual or a provider acting on
behalf of the individual, requests an appointment for a
medically necessary service. Non-urgent psychiatry
appointments (for both adult and children/youth) shall be
made available to Medi-Cal individual s within 15 business
days from the date the person served or a provider acting
on behalf of the individual, requests an appointment for a
medically necessary service.
5. Applicable appointment time standards may be extended if
the referring or treating provider has determined and noted
in the individual's record that a longer waiting period will
not have a detrimental impact on the health of the
individual.
6. Periodic office visits to monitor and treat mental health
conditions may be scheduled in advance consistent with
professionally recognized standards of practice as
determined by the treating licensed mental health provider
acting within the scope of their practice.
c. PROVIDER APPLICATION AND VALIDATION FOR ENROLLMENT
(PAVE)
i. Contractor shall ensure that all of its required clinical staff, who
are rendering SMHS to Medi-Cal individuals on behalf of
Contractor, are registered through DHCS' Provider Application
and Validation for Enrollment (PAVE) portal, pursuant to BHIN 20-
071 requirements, the 21st Century Cures Act and the CMS
Medicaid and Children's Health Insurance Program (CHIP)
Managed Care Final Rule.
ii. SMHS licensed individuals required to enroll via the "Ordering,
Referring and Prescribing" (ORP) PAVE enrollment pathway (i.e.
PAVE application package) available through the DHCS PED
Pave Portal, include: Licensed Clinical Social Worker (LCSW),
Licensed Marriage and Family Therapist (LMFT), Licensed
Professional Clinical Counselor (LPCC), Psychologist, Licensed
Educational Psychologist, Physician (MD and DO), Physician
Assistant, Registered Pharmacist/Pharmacist, Certified
Pediatric/Family Nurse Practitioner, Nurse Practitioner,
Exhibit B —Attachment D
Page 10 of 11
Occupational Therapist, and Speech-Language Pathologist.
Interns, trainees, and associates are not eligible for enrollment.
d. PHYSICIAN INCENTIVE PLAN
i. If Contractor wants to institute a Physician Incentive Plan,
Contractor shall submit the proposed plan to the County which will
in turn submit the Plan to the State for approval, in accordance
with the provisions of 42 C.F.R. § 438.6(c).
3. DATA, PRIVACY AND SECURITY REQUIREMENTS
a. ELECTRONIC PRIVACY AND SECURITY
i. Contractor shall have a secure email system and send any email
containing PII or PHI in a secure and encrypted manner.
Contractor's email transmissions shall display a warning banner
stating that data is confidential, systems activities are monitored
and logged for administrative and security purposes, systems use
is for authorized users only, and that users are directed to log off
the system if they do not agree with these requirements.
ii. Contractor shall institute compliant password management
policies and procedures, which shall include but not be limited to
procedures for creating, changing, and safeguarding passwords.
Contractor shall establish guidelines for creating passwords and
ensuring that passwords expire and are changed at least once
every 90 days.
iii. Any Electronic Health Records (EHRs) maintained by Contractor
that contain PHI or PII for individuals served through this
Agreement shall contain a warning banner regarding the PHI or
PII contained within the EHR. Contractors that utilize an EHR shall
maintain all parts of the clinical record that are not stored in the
EHR, including but not limited to the following examples of person
served signed documents: discharge plans, informing materials,
and health questionnaire.
iv. Contractor entering data into any County electronic systems shall
ensure that staff are trained to enter and maintain data within this
system.
4. PROGRAM INTEGRITY
a. Credentialing and Re-credentialing of Providers
i. Contractor shall ensure that all of their network providers
delivering covered services, sign and date an attestation
statement on a form provided by County, in which each provider
attests to the following:
1. Any limitations or inabilities that affect the provider's ability
to perform any of the position's essential functions, with or
without accommodation;
2. A history of loss of license or felony convictions;
3. A history of loss or limitation of privileges or disciplinary
activity;
4. A lack of present illegal drug use; and
Exhibit B —Attachment D
Page 11 of 11
5. The application's accuracy and completeness
ii. Contractor shall file and keep track of attestation statements,
credentialing applications and credentialing status for all of their
providers and shall make those available to the County upon
request at any time.
iii. Contractor is required to sign an annual attestation statement at
the time of Agreement renewal in which they will attest that they
will follow County's Credentialing Policy and MHSUDS IN 18-019
and ensure that all of their rendering providers are credentialed as
per established guidelines.
Exhibit B -Attachment E
Page 1 of 1
Fresno County Mental Health Plan
Compliance Program
CODE OF CONDUCT:
All Fresno County Behavioral/Mental Health Employees, Contractors (including Contractor's
Employees/Subcontractors), Volunteers and Students will:
1. Read, acknowledge, and abide by this Code of Conduct.
2. Be responsible for reviewing and understanding Compliance Program policies and procedures including
the possible consequences for failure to comply or failure to report such non-compliance.
3. NOT engage in any activity in violation of the County's Compliance Program, nor engage in any other
conduct which violates any applicable law, regulation, rule, or guideline. Conduct yourself honestly,
fairly, courteously, and with a high degree of integrity in your professional dealings related to their
employment/contract with the County and avoid any conduct that could reasonably be expected to
reflect adversely upon the integrity of the County and the services it provides.
4. Practice good faith in transactions occurring during the course of business and never use or exploit
professional relationships or confidential information for personal purposes.
5. Promptly report any activity or suspected violation of the Code of Conduct, the polices and procedures
of the County, the Compliance Program, or any other applicable law, regulation, rule or guideline. All
reports may be made anonymously. Fresno County prohibits retaliation against any person making a
report. Any person engaging in any form of retaliation will be subject to disciplinary or other
appropriate action by the County.
6. Comply with not only the letter of Compliance Program and mental health policies and procedures, but
also with the spirit of those policies and procedures as well as other rules or guidelines adopted by the
County. Consult with you supervisor or the Compliance Office regarding any Compliance Program
standard or other applicable law, regulation, rule or guideline.
7. Comply with all laws governing the confidentiality and privacy of information. Protect and retain
records and documents as required by County contract/standards, professional standards,
governmental regulations, or organizational policies.
8. Comply with all applicable laws, regulations, rules, guidelines, and County policies and procedures
when providing and billing mental health services. Bill only for eligible services actually rendered and
fully documented. Use billing codes that accurately describe the services provided. Ensure that no false,
fraudulent, inaccurate, or fictitious claims for payment or reimbursement of any kind are prepared or
submitted. Ensure that claims are prepared and submitted accurately and timely and are consistent
with all applicable laws, regulations, rules and guidelines. Act promptly to investigate and correct
problems if errors in claims or billings are discovered.
9. Immediately notify your supervisor, Department Head, Administrator, or the Compliance Office if you
become or may become an Ineligible/Excluded Person and therefore excluded from participation in the
Federal health care programs.
1
Exhibit B —Attachment F
Page 1 of 9
Health Insurance Portability and Accountability Act (HIPAA)
Business Associate Agreement
1. The County is a "Covered Entity," and the Contractor is a "Business Associate,"
as these terms are defined by 45 CFR 160.103. In connection with providing services under the
Agreement, the parties anticipate that the Contractor will create and/or receive Protected Health
Information ("PHI") from or on behalf of the County. The parties enter into this Business
Associate Agreement (BAA) to comply with the Business Associate requirements of HIPAA, to
govern the use and disclosures of PHI under this Agreement. "HIPAA Rules" shall mean the
Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Parts 160 and 164.
The parties to this Agreement shall be in strict conformance with all applicable federal
and State of California laws and regulations, including, but not limited to California Welfare and
Institutions Code sections 5328, 10850, and 14100.2 et seq.; 42 CFR 2; 42 CFR 431; California
Civil Code section 56 et seq.; the Health Insurance Portability and Accountability Act of 1996, as
amended ("HIPAA'), including, but not limited to, 45 CFR Parts160, 45 CFR 162, and 45 CFR
164; the Health Information Technology for Economic and Clinical Health Act ("HITECH")
regarding the confidentiality and security of patient information, including, but not limited to 42
USC 17901 et seq.; and the Genetic Information Nondiscrimination Act ("GINA") of 2008
regarding the confidentiality of genetic information.
Except as otherwise provided in this Agreement, the Contractor, as a business associate
of the County, may use or disclose Protected Health Information ("PHI") to perform functions,
activities or services for or on behalf of the County, as specified in this Agreement, provided that
such use or disclosure shall not violate HIPAA Rules. The uses and disclosures of PHI may not
be more expansive than those applicable to the County, as the "Covered Entity" under the
HIPAA Rules, except as authorized for management, administrative or legal responsibilities of
the Contractor.
2. The Contractor, including its subcontractors and employees, shall protect from
unauthorized access, use, or disclosure of names and other identifying information, including
genetic information, concerning persons receiving services pursuant to this Agreement, except
Exhibit B —Attachment F
Page 2of9
where permitted in order to carry out data aggregation purposes for health care operations [45
CFR §§ 164.504(e)(2)(i), 164.504(e)(2)(ii)(A), and 164.504(e)(4)(i)]. This pertains to any and all
persons receiving services pursuant to a County-funded program. This requirement applies to
electronic PHI. The Contractor shall not use such identifying information or genetic information
for any purpose other than carrying out the Contractor's obligations under this Agreement.
3. The Contractor, including its subcontractors and employees, shall not disclose
any such identifying information or genetic information to any person or entity, except as
otherwise specifically permitted by this Agreement, authorized by Subpart E of 45 CFR Part 164
or other law, required by the Secretary of the United States Department of Health and Human
Services ("Secretary"), or authorized by the person served in writing. In using or disclosing PHI
that is permitted by this Agreement or authorized by law, the Contractor shall make reasonable
efforts to limit PHI to the minimum necessary to accomplish intended purpose of use, disclosure
or request.
4. For purposes of the above sections, identifying information shall include, but not
be limited to, name, identifying number, symbol, or other identifying particular assigned to the
individual, such as fingerprint or voiceprint, or photograph.
5. For purposes of the above sections, genetic information shall include genetic
tests of family members of an individual or individual(s), manifestation of disease or disorder of
family members of an individual, or any request for or receipt of genetic services by individual or
family members. Family member means a dependent or any person who is first, second, third,
or fourth degree relative.
6. The Contractor shall provide access, at the request of the County, and in the time
and manner designated by the County, to PHI in a designated record set (as defined in 45 CFR
§ 164.501), to an individual or to COUNTY in order to meet the requirements of 45 CFR §
164.524 regarding access by individuals to their PHI. With respect to individual requests,
access shall be provided within thirty (30) days from request. Access may be extended if the
Contractor cannot provide access and provides the individual with the reasons for the delay and
Exhibit B —Attachment F
Page 3 of 9
the date when access may be granted. PHI shall be provided in the form and format requested
by the individual or the County.
The Contractor shall make any amendment(s) to PHI in a designated record set at the
request of the County or individual, and in the time and manner designated by the County in
accordance with 45 CFR § 164.526.
The Contractor shall provide to the County or to an individual, in a time and manner
designated by the County, information collected in accordance with 45 CFR § 164.528, to permit
the County to respond to a request by the individual for an accounting of disclosures of PHI in
accordance with 45 CFR § 164.528.
7. The Contractor shall report to the County, in writing, any knowledge or
reasonable belief that there has been unauthorized access, viewing, use, disclosure, security
incident, or breach of unsecured PHI not permitted by this Agreement of which the Contractor
becomes aware, immediately and without reasonable delay and in no case later than two (2)
business days of discovery. Immediate notification shall be made to the County's Information
Security Officer and Privacy Officer and the County's Department of Public Health ("DPH")
HIPAA Representative, within two (2) business days of discovery. The notification shall include,
to the extent possible, the identification of each individual whose unsecured PHI has been, or is
reasonably believed to have been, accessed, acquired, used, disclosed, or breached. The
Contractor shall take prompt corrective action to cure any deficiencies and any action pertaining
to such unauthorized disclosure required by applicable federal and State laws and regulations.
The Contractor shall investigate such breach and is responsible for all notifications required by
law and regulation or deemed necessary by the County and shall provide a written report of the
investigation and reporting required to the County's Information Security Officer and Privacy
Officer and the County's DPH HIPAA Representative.
This written investigation and description of any reporting necessary shall be
postmarked within the thirty (30) working days of the discovery of the breach to the addresses
below:
County of Fresno County of Fresno County of Fresno
Department of Public Health Department of Public Health Department of Internal
Exhibit B —Attachment F
Page 4 of 9
HIPAA Representative Privacy Officer Services
(559) 600-6439 (559) 600-6405 Information Security Officer
P.O. Box 11867 P.O. Box 11867 (559) 600-5800
Fresno, California 93775 Fresno, California 93775 2048 North Fine Street
Fresno, California 93727
8. The Contractor shall make its internal practices, books, and records relating to
the use and disclosure of PHI received from the county, or created or received by the Contractor
on behalf of the County, in compliance with Parts the HIPAA Rules. The Contractor shall make
its internal practices, books, and records relating to the use and disclosure of PHI received from
the County, or created or received by the Contractor on behalf of the County, available to the
Secretary upon demand.
The Contractor shall cooperate with the compliance and investigation reviews conducted
by the Secretary. PHI access to the Secretary must be provided during the Contractor's normal
business hours; however, upon exigent circumstances access at any time must be granted.
Upon the Secretary's compliance or investigation review, if PHI is unavailable to the Contractor
and in possession of a subcontractor of the Contractor, the Contractor must certify to the
Secretary its efforts to obtain the information from the subcontractor.
9. Safeguards
The Contractor shall implement administrative, physical, and technical safeguards as
required by the HIPAA Security Rule, Subpart C of 45 CFR Part 164, that reasonably and
appropriately protect the confidentiality, integrity, and availability of PHI, including electronic
PHI, that it creates, receives, maintains or transmits on behalf of the County and to prevent
unauthorized access, viewing, use, disclosure, or breach of PHI other than as provided for by
this Agreement. The Contractor shall conduct an accurate and thorough assessment of the
potential risks and vulnerabilities to the confidentiality, integrity and availability of electronic PHI.
The Contractor shall develop and maintain a written information privacy and security program
that includes administrative, technical and physical safeguards appropriate to the size and
complexity of the Contractor's operations and the nature and scope of its activities. Upon the
County's request, the Contractor shall provide the County with information concerning such
safeguards.
Exhibit B —Attachment F
Page 5 of 9
The Contractor shall implement strong access controls and other security safeguards
and precautions in order to restrict logical and physical access to confidential, personal (e.g.,
PHI) or sensitive data to authorized users only. Said safeguards and precautions shall include
the following administrative and technical password controls for all systems used to process or
store confidential, personal, or sensitive data:
A. Passwords must not be:
(1) Shared or written down where they are accessible or recognizable by anyone
else; such as taped to computer screens, stored under keyboards, or visible
in a work area;
(2) A dictionary word; or
(3) Stored in clear text
B. Passwords must be:
(1) Eight (8) characters or more in length;
(2) Changed every ninety (90) days;
(3) Changed immediately if revealed or compromised; and
(4) Composed of characters from at least three (3) of the following four (4)
groups from the standard keyboard:
a) Upper case letters (A-Z);
b) Lowercase letters (a-z);
c) Arabic numerals (0 through 9); and
d) Non-alphanumeric characters (punctuation symbols).
The Contractor shall implement the following security controls on each workstation or
portable computing device (e.g., laptop computer) containing confidential, personal, or sensitive
data:
1. Network-based firewall and/or personal firewall;
2. Continuously updated anti-virus software; and
3. Patch management process including installation of all operating system/software
vendor security patches.
Exhibit B —Attachment F
Page 6 of 9
The Contractor shall utilize a commercial encryption solution that has received FIPS
140-2 validation to encrypt all confidential, personal, or sensitive data stored on portable
electronic media (including, but not limited to, compact disks and thumb drives) and on portable
computing devices (including, but not limited to, laptop and notebook computers).
The Contractor shall not transmit confidential, personal, or sensitive data via e-mail or
other internet transport protocol unless the data is encrypted by a solution that has been
validated by the National Institute of Standards and Technology (NIST) as conforming to the
Advanced Encryption Standard (AES) Algorithm. The Contractor must apply appropriate
sanctions against its employees who fail to comply with these safeguards. The Contractor must
adopt procedures for terminating access to PHI when employment of employee ends.
10. Mitigation of Harmful Effects
The Contractor shall mitigate, to the extent practicable, any harmful effect that is
suspected or known to the Contractor of an unauthorized access, viewing, use, disclosure, or
breach of PHI by the Contractor or its subcontractors in violation of the requirements of these
provisions. The Contractor must document suspected or known harmful effects and the
outcome.
11. The Contractor's Subcontractors
The Contractor shall ensure that any of its contractors, including subcontractors, if
applicable, to whom the Contractor provides PHI received from or created or received by the
Contractor on behalf of the County, agree to the same restrictions, safeguards, and conditions
that apply to the Contractor with respect to such PHI and to incorporate, when applicable, the
relevant provisions of these provisions into each subcontract or sub-award to such agents or
subcontractors.
Nothing in this section 11 or this exhibit authorizes the Contractor to perform services
under this Agreement using subcontractors.
12. Employee Training and Discipline
The Contractor shall train and use reasonable measures to ensure compliance with the
requirements of these provisions by employees who assist in the performance of functions or
Exhibit B —Attachment F
Page 7 of 9
activities on behalf of the County under this Agreement and use or disclose PHI, and discipline
such employees who intentionally violate any provisions of these provisions, which may include
termination of employment.
13. Termination for Cause
Upon the County's knowledge of a material breach of these provisions by the Contractor,
the County will either:
A. Provide an opportunity for the Contractor to cure the breach or end the
violation, and the County may terminate this Agreement if the Contractor does not cure the
breach or end the violation within the time specified by the County; or
B. Immediately terminate this Agreement if the Contractor has breached a
material term of this exhibit and cure is not possible, as determined by the County.
C. If neither cure nor termination is feasible, the County's Privacy Officer will
report the violation to the Secretary of the U.S. Department of Health and Human Services.
14. Judicial or Administrative Proceedings
The County may terminate this Agreement if: (1) the Contractor is found guilty in a
criminal proceeding for a violation of the HIPAA Privacy or Security Laws or the HITECH Act; or
(2) there is a finding or stipulation in an administrative or civil proceeding in which the Contractor
is a party that the Contractor has violated a privacy or security standard or requirement of the
HITECH Act, HIPAA or other security or privacy laws.
15. Effect of Termination
Upon termination or expiration of this Agreement for any reason, the Contractor shall
return or destroy all PHI received from the County (or created or received by the Contractor on
behalf of the County) that the Contractor still maintains in any form, and shall retain no copies of
such PHI. If return or destruction of PHI is not feasible, the Contractor shall continue to extend
the protections of these provisions to such information, and limit further use of such PHI to those
purposes that make the return or destruction of such PHI infeasible. This provision applies to
PHI that is in the possession of subcontractors or agents, if applicable, of the Contractor. If the
Contractor destroys the PHI data, a certification of date and time of destruction shall be
Exhibit B —Attachment F
Page 8 of 9
provided to the County by the Contractor.
16. Compliance with Other Laws
To the extent that other state and/or federal laws provide additional, stricter and/or more
protective privacy and/or security protections to PHI or other confidential information covered
under this BAA, the Contractor agrees to comply with the more protective of the privacy and
security standards set forth in the applicable state or federal laws to the extent such standards
provide a greater degree of protection and security than HIPAA Rules or are otherwise more
favorable to the individual.
17. Disclaimer
The County makes no warranty or representation that compliance by the Contractor with
these provisions, the HITECH Act, or the HIPAA Rules, will be adequate or satisfactory for the
Contractor's own purposes or that any information in the Contractor's possession or control, or
transmitted or received by the Contractor, is or will be secure from unauthorized access,
viewing, use, disclosure, or breach. The Contractor is solely responsible for all decisions made
by the Contractor regarding the safeguarding of PHI.
18. Amendment
The parties acknowledge that Federal and State laws relating to electronic data security
and privacy are rapidly evolving and that amendment of this exhibit may be required to provide
for procedures to ensure compliance with such developments. The parties specifically agree to
take such action as is necessary to amend this agreement in order to implement the standards
and requirements of the HIPAA Rules, the HITECH Act and other applicable laws relating to the
security or privacy of PHI. The County may terminate this Agreement upon thirty (30) days
written notice in the event that the Contractor does not enter into an amendment providing
assurances regarding the safeguarding of PHI that the County in its sole discretion, deems
sufficient to satisfy the standards and requirements of the HIPAA Rules, and the HITECH Act.
19. No Third-Party Beneficiaries
Nothing expressed or implied in the provisions of this exhibit is intended to confer, and
nothing in this exhibit does confer, upon any person other than the County or the Contractor and
Exhibit B —Attachment F
Page 9 of 9
their respective successors or assignees, any rights, remedies, obligations or liabilities
whatsoever.
20. Interpretation
The provisions of this exhibit shall be interpreted as broadly as necessary to implement
and comply with the HIPAA Rules, and applicable State laws. The parties agree that any
ambiguity in the terms and conditions of these provisions shall be resolved in favor of a meaning
that complies and is consistent with the HIPAA Rules.
21. Regulatory References
A reference in the terms and conditions of these provisions to a section in the HIPAA
Rules means the section as in effect or as amended.
22. Survival
The respective rights and obligations of the Contractor as stated in this exhibit survive
the termination or expiration of this Agreement.
23. No Waiver of Obligation
Change, waiver or discharge by the County of any liability or obligation of the Contractor
under this exhibit on any one or more occasions is not a waiver of performance of any
continuing or other obligation of the Contractor and does not prohibit enforcement by the County
of any obligation on any other occasion.
Exhibit B —Attachment G
Page 1 of 1
Program-Specific Outcomes and Performance Measurements
Vocational and Educational Services
Contractor shall adhere to the following outcome elements each fiscal year, unless otherwise noted:
1. Number of individuals referred to the program
a. Include both successful and unsuccessful admissions
2. Time to first contact after referral is received
3. Number of individuals served by the program
4. Number of individuals linked to employment
a. Include both successful and unsuccessful linkages
5. Number of individuals linked to education or vocational training
a. Include both successful and unsuccessful linkages
6. Number of days individuals are employed
a. Additionally include number of individuals that are employed for a minimum of 90 days
7. Wages and benefits information for employed individuals (if available)
8. Demographics of individuals participating in the program
a. Including but not limited to: Age, ethnicity, race, gender, living status
9. Program satisfaction
a. Provided via satisfaction survey
10. Cost per individual served by the program
11. Agencies and companies to which individuals are referred to for employment
a. Include number of successful employments at each agency and company
12. IPS Model / Supported Employment Fidelity Scale review and score
Exhibit B -Attachment H
Page 1 of 2
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by establishing a blueprint for health and health care organizations to:
Principal Standard:
1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse
cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,
practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are
responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and
practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at
no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,
verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals
and/or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the
populations in the service area.
Engagement, Continuous Improvement, and Accountability:
9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them
throughout the organization's planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into
measurement and continuous quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health
equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement
services that respond to the cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural
and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent,
and resolve conflicts or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and
the general public.
THINK
O M H U.&DeDaf wntof www.ThinkCulturalHealth.hhs.gov CULTURAL —
HeoM and Human Ser0cae •
Office Of Mlno'V HeaRn HEALTH
Exhibit B -Attachment H
Page 2 of 2
The Case for the Enhanced National CLAS Standards
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
—Dr. Martin Luther King, Jr.
Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human
Services [HHS] Office of Minority Health, 2011). Currently, individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of
health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease Prevention
and Health Promotion, 2010). Though health inequities are directly related to the existence of historical and current
discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate
services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of
all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely
affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but
also a public health concern. In the United States, it has been estimated that the combined cost of health disparities and
subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin, & Richard, 2009).
Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care
and services (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CLAS Standards will improve an organization's ability to address
health care disparities.
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities
(HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to
End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide
collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the
enhanced National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and
linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the
United States.
Bibliography:
Beach,M.C.,Cooper,L.A.,Robinson,K.A.,Price,E.G.,Gary,T.L.,Jenckes,M.W.,Powe,N.R.(2004).Strategies for improving minority healthcare quality.(AHRQ
Publication No.04-E008-02).Retrieved from the Agency of Healthcare Research and Quality website:
http://www.a h rq.gov/down loads/pub/evidence/pdf/m i nq ua l/m i nq ua I.pdf
Goode,T.D.,Dunne,M.C.,&Bronheim,S.M.(2006).The evidence base for cultural and linguistic competency in health care.(Commonwealth Fund Publication No.962).
Retrieved from The Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
LaVeist,T.A.,Gaskin,D.J.,&Richard,P.(2009).The economic burden of health inequalities in the United States.Retrieved from the Joint Center for Political and Economic
Studies website: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
National Partnership for Action to End Health Disparities.(2011).National stakeholder strategy for achieving health equity.Retrieved from U.S.Department of Health and
Human Services,Office of Minority Health website:http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
U.S.Department of Health and Human Services.(2011).HHS action plan to reduce racial and ethnic health disparities:A nation free of disparities in health and health care.
Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
U.S.Department of Health and Human Services,Office of Disease Prevention and Health Promotion.(2010).Healthy people 2020:Social determinants of health.Retrieved
from http://www.healthypeople.gov/2020/topicsobjectives2O2O/overview.aspx?topicid=39
U.S.Department of Health and Human Services,Office of Minority Health(2011).National Partnership for Action to End Health Disparities.Retrieved from
http://minorityhealth.hhs.gov/npa
World Health Organization.(2012).Social determinants of health.Retrieved from http://www.who.int/social_determinants/en/
1 THINK
loz—O M H U. DepoftwHof �+ww.ThinkCulturalHealth.hhs.gov CULTURAL
HeoM and Human Ser0cae HEALTH •
Office of Nno'V HeoRn
Exhibit C
Page 1 of 10
Fresno County Department of Behavioral Health Financial Terms and Conditions
Fresno County Department of Behavioral Health is committed to ensuring timely and
accurate compensation for the delivery of services in our communities and fulfilling all
associated responsibilities of the funding sources related to this Agreement. This document
provides guidance on this Agreement's financial terms and conditions, responsibilities of each
party, which includes but not limited to, maximum compensation, compensation structure,
invoicing, payments, billing, recoupments, audits, reviews, examinations, and other fiscal related
requirements.
Compensation
The County agrees to pay, and the Contractor agrees to receive, compensation in accordance
with the budget set forth in this Exhibit C—Attachment A.
1. Maximum Compensation
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2025 through June 30, 2026 is One Million Twenty Eight Thousand Five
Hundred Sixty Four and No/100 Dollars ($1,028,564.00), which is not a guaranteed sum but
shall be paid only for services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2026 through June 30, 2027 is One Million Twenty Eight Thousand Five
Hundred Sixty Four and No/100 Dollars ($1,028,564.00), which is not a guaranteed sum but
shall be paid only for services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2027 through June 30, 2028 is One Million Twenty Eight Thousand Five
Hundred Sixty Four and No/100 Dollars ($1,028,564.00), which is not a guaranteed sum but
shall be paid only for services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2028 through June 30, 2029 is One Million Twenty Eight Thousand Five
Hundred Sixty Four and No/100 Dollars ($1,028,564.00), which is not a guaranteed sum but
shall be paid only for services rendered and received.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2029 through June 30, 2030 is One Million Twenty Eight Thousand Five
Hundred Sixty Four and No/100 Dollars ($1,028,564.00), which is not a guaranteed sum but
shall be paid only for services rendered and received.
2. Total Maximum Compensation
In no event shall the maximum contract amount for all the services provided by the
Contractor to County under the terms and conditions of this Agreement be in excess of Five
Million One Hundred Forty Two Thousand Eight Hundred Twenty and No/100 Dollars
($5,142,820) during the entire term of this Agreement.
Exhibit C
Page 2 of 10
The Contractor acknowledges that the County is a local government entity, and does so
with notice that the County's powers are limited by the California Constitution and by State law,
and with notice that the Contractor may receive compensation under this Agreement only for
services performed according to the terms of this Agreement and while this Agreement is in
effect, and subject to the maximum amount payable under this section.
The Contractor further acknowledges that County employees have no authority to pay
the Contractor except as expressly provided in this Agreement.
Travel shall be reimbursed based on actual expenditures and mileage reimbursement
shall be at Contractor's adopted rate per mile, not to exceed the Federal Internal Revenue
Services (IRS) published rate.
Invoices
The Contractor shall submit monthly invoices to, in arrears by the fifteenth (151") day
of each month, in the format directed by County. The Contractor shall submit invoices
electronically to:
1) dbhinvoicereview@fresnocountyca.gov;
2) dbh-invoices@fresnocountyca.gov; and
3) the assigned County's DBH Staff Analyst.
Invoices for cost reimbursement services shall be based on actual expenses incurred in
the month of service. Monthly invoices shall include a person served roster, identifying volume
reported by payer group persons served (including third party payer of services) by month and
year-to-date, including percentages. Contractor shall also submit a detailed general ledger (GL),
itemizing costs incurred in the previous month. Failure to submit GL reports and supporting
documentation shall be deemed sufficient cause for County to withhold payments until there is
compliance.
Contractor shall submit monthly staffing reports that identify all direct service and
support staff, applicable licensure/certifications, and full-time hours worked to be used as a
tracking tool to determine if Contractor's program is staffed according to the services provided
under this Agreement
At the discretion of County's DBH Director or designee, if an invoice is incorrect or is
otherwise not in proper form or substance, County's DBH Director, or designee, shall have the
right to withhold payment as to only the portion of the invoice that is incorrect or improper after
five (5) days prior notice to Contractor. Contractor agrees to continue to provide services for a
period of ninety (90) days after notification of an incorrect or improper invoice. If after the ninety
(90) day period, the invoice is still not corrected to County's satisfaction, County's DBH Director,
or designee, may elect to terminate this Agreement, pursuant to the termination provisions
stated in Article 6 of this Agreement. If County's DBH does not provide notice of incorrect or
otherwise improper invoices and causes delay in the reimbursement process, Contractor(s) will
follow the escalation process through the County's DBH Finance Division's Invoice Review
Team, up to the DBH Finance Division Manager, and including the County's DBH Director
and/or designee for the timely reimbursement of payment to Contractor.
Withholdings to an invoice by County's DBH shall be addressed by the Contractor and/or
Exhibit C
Page 3 of 10
Contractor shall communicate any delays in resolving the incorrect or improper form with
County's DBH within ninety (90) days of receiving notice or the withholdings will stand in
perpetuity, or subject to County's discretion.
All final invoices for any fiscal year shall be submitted by Contractor within one hundred
and twenty (120) days following the final month for which payment is claimed in that fiscal year.
No action may be taken by County on any invoices submitted after one hundred and twenty
(120) days of the end of the fiscal year where services are performed.
Payment
Payments shall be made by County to Contractor in arrears, for services provided during
the preceding month, within forty-five (45) days after the date of receipt, verification, and
approval by County. Payments shall be made after receipt and verification of actual
expenditures incurred by Contractor for monthly program costs, as identified in Exhibit C —
Attachment A, in the performance of this Agreement. All final invoices shall be submitted by
Contractor within one hundred and twenty (120) days following the final month of service for
which payment is claimed for each fiscal year. No action shall be taken by County on claims
submitted beyond the one hundred and twenty (120) day closeout period of each fiscal year.
Any compensation which is not expended by Contractor pursuant to the terms and conditions of
this Agreement shall automatically revert to County.
Payments shall be made upon certification or other proof satisfactory to the County that
services have been performed or actual expenditures incurred by the Contractor, as specified in
this Agreement.
1. Incidental Expenses.
The Contractor is solely responsible for all of its costs and expenses that are not
specified as payable by the County under this Agreement. If Contractor fails to comply with any
provision of this Agreement, County shall be relieved of its obligation for further compensation.
Recoupments, Audits, Reviews, and Examinations
County shall recapture from Contractor the value of any services or other expenditures
determined to be ineligible based on the County or State monitoring results. The County
reserves the right to enter into a repayment agreement with Contractor, with the term of the
repayment agreement not to exceed twelve (12) months from the date of the repayment
agreement, to recover the amount of funds to be recouped. The County has the discretion to
extend the term of repayment plan up to a total of twenty-four (24) months from the date of the
repayment Agreement. The repayment agreement may be made with the signed written
approval of County's DBH Director, or designee, and respective Contractor through a
repayment Agreement. The monthly repayment amounts may be netted against the Contractor's
monthly billing for services rendered during the month, or the County may, in its sole discretion,
forego a repayment agreement and recoup all funds immediately. This remedy is not exclusive,
and County may seek requital from any other means, including, but not limited to, a separate
agreement with Contractor.
1. Reasons for Recoupment.
Exhibit C
Page 4 of 10
County will conduct periodic audits of Contractor files to ensure appropriate high quality
service provision and compliance with applicable federal, state and county or other funding
source regulations.
Such audits may result in requirements for Contractor to reimburse County for services
previously paid in the following circumstances:
(A) Identification of Fraud, Waste or Abuse as defined in federal regulation
(1) Fraud and abuse are defined in C.F.R. Title 42, § 455.2 and W&I Code,
section 14107.11, subdivision (d).
(2) Definitions for"fraud," "waste," and "abuse" can also be found in the
Medicare Managed Care Manual available at https://www.cros.gov/Regulations-
and-Guidance/Guidance/Manuals
(B) Overpayment of Contractor by County due to errors in documentation.
Contractor shall reimburse County for all overpayments identified by Contractor, County,
and/or state or federal oversight agencies as an audit exception within the timeframes required
by law or Country or state or federal agency. Funds owed to County will be due within forty-five
(45) days of notification by County, or County shall withhold future payments until all excess
funds have been recouped by means of an offset against any payments then or thereafter owing
to County under this or any other Agreement between the County and Contractor.
2. Confidentiality in Audit/Review Process.
Contractor and County mutually agree to maintain the confidentiality of Contractor's
records and information of persons served, in compliance with all applicable State and Federal
statutes and regulations, including but not limited to HIPAA and California Welfare and
Institutions Code, Section 5328. Contractor shall inform all of its officers, employees, and agents
of the confidentiality provisions of all applicable statutes.
Contractor's fiscal records shall contain sufficient data to enable auditors to perform a
complete audit and shall be maintained in conformance with standard procedures and
accounting principles.
Contractor's records shall be maintained as required by DBH and DHCS on forms
furnished by DHCS or the County. All statistical data or information requested by the County's
DBH Director, or designee shall be provided by the Contractor in a complete and timely manner.
3. Cooperation with Audits/Reviews.
Contractor shall cooperate with County in any review and/or audit initiated by County,
DHCS, or any other applicable regulatory body. This cooperation may include such activities as
onsite program, fiscal, or chart reviews and/or audits.
In addition, Contractor shall comply with all requests for any documentation or files
including, but not limited to, files for persons served and personnel files.
Contractor shall notify the County of any scheduled or unscheduled external evaluation
or site visits when it becomes aware of such visit. County shall reserve the right to attend any or
all parts of external review processes.
Exhibit C
Page 5 of 10
Contractor shall allow inspection, evaluation and audit of its records, documents and
facilities for ten (10) years from the term end date of this Agreement or in the event Contractor
has been notified that an audit or investigation of this Agreement has been commenced, until
such time as the matter under audit or investigation has been resolved, including the exhaustion
of all legal remedies, whichever is later pursuant to 42 C.F.R.§§ 438.3(h) and 438.2301(3)(i-iii).
4. Single Audit Clause
If Contractor expends Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00)
or more in Federal and Federal flow-through monies, Contractor agrees to conduct an annual
audit in accordance with the requirements of the Single Audit Standards as set forth in Office of
Management and Budget (OMB) 2 CFR 200. Contractor shall submit said audit and
management letter to County. The audit must include a statement of findings or a statement that
there were no findings. If there were negative findings, Contractor must include a corrective
action plan signed by an authorized individual. Contractor agrees to take action to correct any
material non-compliance or weakness found as a result of such audit. Such audit shall be
delivered to County's DBH Finance Division for review within nine (9) months of the end of any
fiscal year in which funds were expended and/or received for the program. Failure to perform
the requisite audit functions as required by this Agreement may result in County performing the
necessary audit tasks, or at County's option, contracting with a public accountant to perform
said audit, or may result in the inability of County to enter into future agreements with
Contractor. All audit costs related to this Agreement are the sole responsibility of Contractor.
A single audit report is not applicable if Contractor's Federal contracts do not exceed the
Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or Contractor's
only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a program audit
must be performed and a program audit report with management letter shall be submitted by
Contractor to County as a minimum requirement to attest to Contractor's solvency. Said audit
report shall be delivered to County's DBH Finance Division for review no later than nine (9)
months after the close of the fiscal year in which the funds supplied through this Agreement are
expended. Failure to comply with this Act may result in County performing the necessary audit
tasks or contracting with a qualified accountant to perform said audit. All audit costs related to
this Agreement are the sole responsibility of Contractor who agrees to take corrective action to
eliminate any material noncompliance or weakness found as a result of such audit. Audit work
performed by County under this paragraph shall be billed to Contractor at County cost, as
determined by County's Auditor-Controller/Treasurer-Tax Collector.
Contractor shall make available all records and accounts for inspection by County, the
State of California, if applicable, the Controller General of the United States, the Federal Grantor
Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other
pending matters, whichever is later.
5. Financial Audit Report Requirements for Pass-Through Entities
If County determines that Contractor is a "subrecipient" (also known as a "pass-through
entity") as defined in 2 C.F.R. § 200 et seq., Contractor represents that it will comply with the
applicable cost principles and administrative requirements including claims for payment or
reimbursement by County as set forth in 2 C.F.R. § 200 et seq., as may be amended from time
to time. Contractor shall observe and comply with all applicable financial audit report
Exhibit C
Page 6 of 10
requirements and standards.
Financial audit reports must contain a separate schedule that identifies all funds included
in the audit that are received from or passed through the County. County programs must be
identified by Agreement number, Agreement amount, Agreement period, and the amount
expended during the fiscal year by funding source.
Contractor will provide a financial audit report including all attachments to the report and
the management letter and corresponding response within six months of the end of the audit
year to the County's DBH Director or designee. The County's Director or designee is
responsible for providing the audit report to the County Auditor.
Contractor must submit any required corrective action plan to the County simultaneously
with the audit report or as soon thereafter as it is available. The County shall monitor
implementation of the corrective action plan as it pertains to services provided pursuant to this
Agreement.
In the event this Agreement is terminated, Contractor shall be entitled to compensation
for all Specialty Mental Health Services (SMHS) satisfactorily provided pursuant to the terms
and conditions of this Agreement through and including the effective date of termination. This
provision shall not limit or reduce any damages owed to the County due to a breach of this
Agreement by Contractor.
Property of County
This section shall only apply to the program components and services provided under
Cost Reimbursement. County and Contractor recognize that fixed assets are tangible and
intangible property obtained or controlled under County for use in operational capacity and will
benefit County for a period more than one (1) year.
1. Agreement Assets
Assets shall be tracked on an agreement-by-agreement basis. All assets shall fall into
the "Equipment" category unless funding source allows for additional types of assets. Items of
sensitive nature shall be purchased and allocated to a single agreement. All items containing
Health Insurance Portability and Accountability Act (HIPAA)/Protected Health Information (PHI)
data are considered sensitive. At a minimum, the following types of items are considered to be
assets:
a. Computers (desktops and laptops);
b. Copiers, cell phones, tablets, and other devices with any HIPAA data
c. Modular furniture
d. Land
e. Any items over $5,000
f. Items of$500 or more with a lifespan of at least two (2) years:
i. Televisions
ii. Washers/Dryers
iii. Printers
Exhibit C
Page 7 of 10
iv. Digital Cameras;
v. Other equipment/furniture
vi. Items in total when purchased or used as a group fall into one or more of
the above categories
Contractor shall ensure proper tracking for contact assets that include the following
asset attributes at a minimum:
a. Description of the asset;
b. The unique identifier of the asset if applicable, i.e., serial number;
c. The acquisition date;
d. The quantity of the asset;
e. The location of the asset or to whom the asset is assigned;
f. The cost of the asset at the time of acquisition;
g. The source of grant funding if applicable;
h. The disposition date, and
i. The method of disposition (surplus, transferred, destroyed, lost).
2. Retention and Maintenance
Assets shall be retained by County, as County property, in the event this Agreement is
terminated or upon expiration of this Agreement. Contractor agrees to participate in an annual
inventory of all County fixed and inventoried assets. Upon termination or expiration of this
Agreement, Contractor shall be physically present when fixed and inventoried assets are
returned to County possession. Contractor is responsible for returning to County all County
owned undepreciated fixed and inventoried assets, or the monetary value of said assets if
unable to produce the assets at the expiration or termination of this Agreement. Contractor
further agrees to the following:
a. Maintain all items of equipment in good working order and condition, normal wear
and tear excepted;
b. Label all items of equipment with County assigned program number, to perform
periodic inventories as required by County and to maintain an inventory list
showing where and how the equipment is being used in accordance with
procedures developed by County. All such lists shall be submitted to County
within ten (10) days of any request therefore; and
c. Report in writing to County immediately after discovery, the loss or theft of any
items of equipment. For stolen items, the local law enforcement agency must be
contacted, and a copy of the police report submitted to County.
3. Equipment Purchase
The purchase of any equipment by Contractor with funds provided hereunder shall
require the prior written approval of County's DBH Director or designee, shall fulfill the
provisions of this Agreement as appropriate, and must be directly related to Contractor's
services or activity under the terms of this Agreement. County may refuse reimbursement for
any costs resulting from equipment purchased, which are incurred by Contractor, if prior written
approval has not been obtained from County.
4. Modification of Assets
Exhibit C
Page 8 of 10
Contractor must obtain prior written approval from County's DBH whenever there is any
modification or change in the use of any property acquired or improved, in whole or in part,
using funds under this Agreement. If any real or personal property acquired or improved with
said funds identified herein is sold and/or is utilized by Contractor for a use which does not
qualify under this Agreement, Contractor shall reimburse County in an amount equal to the
current fair market value of the property, less any portion thereof attributable to expenditures of
funds not provided under this Agreement. These requirements shall continue in effect for the
life of the property. In the event this Agreement expires, the requirements for this paragraph
shall remain in effect for activities or property funded with said funds, unless action is taken by
the State government to relieve County of these obligations.
Other Financial Requirements
1. Notification of Changes
Contractor shall notify County in writing of any change in organizational name, Head of
Service or principal business at least fifteen (15) business days in advance of the change.
Contractor shall notify County of a change of service location at least six (6) months in advance
to allow County sufficient time to comply with site certification requirements. Said notice shall
become part of this Agreement upon acknowledgment in writing by the County, and no further
amendment of this Agreement shall be necessary provided that such change of address does
not conflict with any other provisions of this Agreement.
Contractor must immediately notify County of a change in ownership, organizational
status, licensure, or ability of Contractor to provide the quantity or quality of the contracted
services in no event more than fifteen (15) days of the change.
2. Record Maintenance
Contractor shall maintain all records and management books pertaining to service
delivery and demonstrate accountability for agreement performance and maintain all fiscal,
statistical, and management books and records pertaining to the program. Records should
include, but not be limited to, monthly summary sheets and other primary source documents.
Fiscal records shall be kept in accordance with Generally Accepted Accounting
Principles and must account for all funds, tangible assets, revenue and expenditures. Fiscal
records must also comply with the Code of Federal Regulations (CFR), Title II, Subtitle A,
Chapter 11, Part 200, Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards.
All records shall be complete and current and comply with all requirements in this
Agreement. Failure to maintain acceptable records per the preceding requirements shall be
considered grounds for withholding of payments for billings submitted and for termination of this
Agreement.
Contractor shall comply with all Federal, State and County laws, rules and regulations
regarding relinquishing or maintaining medical records.
Contractor shall agree to maintain and retain all appropriate service and financial
records for a period of at least ten (10) years from the date of final payment, the final date of this
Agreement, final settlement, or until audit findings are resolved, whichever is later.
Exhibit C
Page 9 of 10
3. Financial Reports
Contractor shall submit audited financial reports on an annual basis to the County. The
audit shall be conducted in accordance with Generally Accepted Accounting Principles and
generally accepted auditing standards.
4. Agreement Termination
In the event this Agreement is terminated, ends its designated term, or Contractor
ceases operation of its business, Contractor shall deliver or make available to County all
financial records that may have been accumulated by Contractor or subcontractor under this
Agreement, whether completed, partially completed or in progress within seven (7) calendar
days of said termination/end date.
5. Restrictions and Limitations
This Agreement shall be subject to any restrictions, limitations, and/or conditions
imposed by County or state or federal funding sources that may in any way affect the fiscal
provisions of, or funding for this Agreement. This Agreement is also contingent upon sufficient
funds being made available by County, state, or federal funding sources for the term of this
Agreement.
Funding is provided by fiscal year. Any unspent fiscal year appropriation does not roll
over and is not available for services provided in subsequent years.
In the event that funding for these services is delayed by the State Controller, County
may defer payments to Contractor. The amount of the deferred payment shall not exceed the
amount of funding delayed by the State Controller to the County. The period of time of the
deferral by County shall not exceed the period of time of the State Controller's delay of payment
to County plus forty-five (45) days.
6. Additional Financial Requirements
Contractor must comply with the False Claims Act employee training and policy
requirements set forth in 42 U.S.C. 1396a(a)(68) and as the Secretary of the United States
Department of Health and Human Services may specify.
Contractor agrees that no part of any federal funds provided under this Agreement shall
be used to pay the salary of an individual per fiscal year at a rate in excess of Level 1 of the
Executive Schedule at https://www.opm.gov/ (U.S. Office of Personnel Management), as from
time to time amended.
Contractor must maintain financial records for a minimum period of ten (10) years or until
any dispute, audit or inspection is resolved, whichever is later. Contractor will be responsible for
any disallowances related to inadequate documentation.
7. Contractor Prohibited from Redirection of Contracted Funds
Contractor may not redirect or transfer funds from one funded program to another
funded program under which Contractor provides services pursuant to this Agreement except
through a duly executed amendment to this Agreement.
Exhibit C
Page 10 of 10
Contractor may not charge services delivered to an eligible person served under one
funded program to another funded program unless the person served is also eligible for services
under the second funded program.
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLNICS
Fiscal Year(FY)2025-26
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Regional Executive Director 0.10 $ 17,299 $ 17,299
1102 Crp Dir of Comm Integ Services 0.30 34,501 34,501
1103 - -
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.40 $ 51,800 $ 51,800
Acct# Program Position FTE Admin Program Total
1116 IPS Team Leader/Supervisor 1.00 $ 87,360 $ 87,360
1117 Employment Specialist 3.00 168,480 168,480
1118 Educational Support Specialist 1.00 56,160 56,160
1119 Employment Peer Specialist 2.00 99,840 99,840
1120 Customer Service Specialist 0.50 21,840 21,840
1121 Program Director 0.50 47,110 47,110
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
Direct Personnel Program Salaries Subtotal 8.00 $ 480,790 $ 480,790
Admin Program Total
Direct Personnel Salaries Subtotal 8.40 $ 51,800 $ 480,790 $ 532,590
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ - $ 19,232 $ 19,232
1202 Worker's Compensation 4,808 4,808
1203 Health Insurance 72,118 72,118
1204 ARAAwards 1,963 1,963
1205 Regional Retirement 2,072 2,072
1206 Regional Worker's Comp 518 518
1207 Regional Health Insurance 7,770 7,770
1208 Regional ARA Awards 500 500
Direct Employee Benefits Subtotal: $ 10,860 $ 98,121 $ 108,981
Direct Payroll Taxes&Expenses:
r
Description Admin Program Total
OASDI $ - $ - $ -
FICA/MEDICARE 36,780 36,780
FUTA+SUI 2,413 2,413
RegionalOASDI - -
RegionalFICA/MEDICARE 3,963 3,963
1306 Regional FUTA+SUI 696 696
Direct Payroll Taxes&Expenses Subtotal: $ 4,659 $ 39,193 $ 43,852
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 67,319 $ 618,104 $ 685,423
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
10% 90%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 13,174
2004 Clothing,Food,&Hygiene 17,965
2005 Education Support
2006 Employment Support 11,977
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Client Program Expense
2012 Contractual/Consulting Services(Psychiatrist)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 43,116
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ -
3002 Printing/Postage 3,500
3003 Office,Household&Program Supplies 2,900
3004 Advertising
3005 jStaff Development&Training 29,130
3006 Staff Mileage 26,000
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 General Liability Insurance -
3010 Direct Shared Allocated Regional Cost 4,799
3011 Other(specify)
3012 1 Other(specify) -
DIRECTOPERATINGEXPENSESTOTAL: $ 66,329
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Occupancy(Rent,Utilities,Janitorial svcs,security Fees) $ 69,715
4002 Facility Operation and Maintenance $ 9,653
4003 Rent/Lease Equipment $ 15,360
4004 Security $ -
4005 Utilities $
4006 Other(specify) $
4007 Other(specify) $
4008 Other(specify) $
4009 Other(specify) $
4010 Other(specify) $
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 94,728
5000:DIRECT SPECIAL EXPENSES
F
Line Item Description Amount
ultant(Network&Data Management) $(HealthManagement Information System) $ 4,808
actual/Consulting Services(Specify) $ -
(Specify) $
(specify) $
(specify) $
5008 10ther(specify) $ -
DIRECT SPECIAL EXPENSES TOTAL. $ 4,808
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 134,160
Administrative Overhead
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation/Provideromed Equipment to be Used for Program Purposes/ -
6008 Person net(indirect Salaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 134,160
INDIRECT COST RATE 15.00%
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/BuildingImprovements $
7005 Other Assets over$500 with Lifespan of 2 Years+ $
7006 jAssetsover$5,000/unit(Specify) $
7007 Other(specify) $
7008 Other(specify) $
FIXED ASSETS EXPENSES TOTAL $
TOTAL PROGRAM EXPENSES $ 1,028,564
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 Other(Specify) 0
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 ISABG $
SUBSTANCE USE DISORDER FUNDS TOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lReaLignment $ 235,601
REALIGNMENT TOTAL $ 235,601
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSAComponent MHSA Program Name Amount
8301 CSS-CommunityServices&Supports Vocational and Educational Services $ 792,963
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-CapitalFacilities&Technology -
MHSATOTAL $ 792,963
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 1,028,564
NET PROGRAM COST: $ (0)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2025-26
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled out
Position Contract#/Name/Department/County FTE%
Part-Time Customer Service Specialist 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.50
Program Director 1 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.50
Program Director I Hollywood 2.0 Supported Employment and Education 0.50
Crp Dir of Comm Integ Services 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.30
Crp Dir of Comm Integ Services Ventura Tay Club Houses 0.35
Crp Dir of Comm Integ Services DMH Supported Employment Individual Placement&Support Services 0.35
Regional Executive Director 25-040 CFNTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.10
Regional Executive Director Fresno Bright Beginnings 0.23
Regional Executive Director Fresno Hope 0.23
Regional Executive Director Tulare Tay Crossroads 0.23
Regional Executive Director Fresno ACT 0.23
Total 3.50
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
il6iii
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2/7/2020
Exhibit C-Attachment A
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLNICS
Fiscal Year(FY)2025-26 Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 685,423
Administrative Positions 51,800
1101 Regional Executive Director 17,299 The Regional Executive Director provides leadership,strategic direction and operational
oversight for the Region.Leads the development,implementation,and expansion of the
Region's services,quality of care,program operations and fiscal viability.Is responsible
to lead and ensure effective clinical change processes,continuous quality improvement,
and risk management throughout the Region.Serves as a source of vision and innovation
for staff and customers.
1102 Crp Dir of Comm Integ Services 34,501 The position of Corporate Director of Community Integration Services oversees a variety
of departments that ensure Pacific Clinics'consumers and theirfamily members are
provided with opportunities to integrate successfully into the community and achieve
their recovery goals.Specifically,the position oversees Pacific Clinics'
programs/services/functions related to employment,health navigation,and benefits
establishment.
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Program Positions 480,790
1116 IPS Team Leader/Supervisor 87,360 The Team Supervisor coordinates and supervises case managers,housing staff,peers,
Family Specialists,Behavior Specialists,Family Finders,LVNS,LPTs,Clubhouse and/or
other staff as assigned bythe Program Director.Coordinates cases with the*Department
of Mental Health(DMH)and in some counties Behavioral Health and/or other funding
sources/agencies and ensures the delivery of integrated behavioral healthcare.
1117 Employment Specialist 168,480 Carries out the services of the Supported Employment program by assisting clients to
obtain and maintain employment that is consistent with their vocational goals.
Responsible for providing employment preparation and job search skills training as well
as job coaching to adults with psychiatric disabilities at off-site employment locations
and program facilities.Provides support for schooling and technical training for career
advancement.
1118 Educational Support Specialist 56,160 Works within the vision,mission and philosophy of the agency.Provides assistance in
helping students complete their vocational and educational goals and requirements,
accessing community resources,facilitating educational/vocational activities,educating
clients and families on graduation requirements and supporting preparations for job and
career development.Is responsible for assisting students with their study and
rehabilitation skills in an effort to help them meet their education and career goals.
1119 Employment Peer Specialist 99,840 Works within the vision,mission,and philosophy of the agency and framework of the
Certified Community Behavioral Health Clinic.Under direct supervision,the Peer Partner
provides peer-to-peer support and counseling drawing on shared experiences as a peer to
validate the consumer's experience.Provides guidance and encouragement to
consumers to take responsibility and actively participate in their own recovery.This
position models competency in recovery and serves as a mentorfor consumers in a
clinic,community,or Wellness Center/Drop-In setting.
1120 Customer Service Specialist 21,840 Working within the vision,mission and philosophy of the agency,the Customer Service
Specialist is responsible for processing and completing internal and external referrals,
acts as primary liaison between external agencies and internal agency departments and
completes all required administrative paperwork and data entryfor customer records.
Coordinates all activities related to initial intake,level of care screening,insurance
verification and payment coordination. Regularly interfaces face-to-face and by
telephone with customers as well as with all agency and County electronic systems
connected to client care and billing.
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1121 Program Director 1 47,110 Program Directorto oversee thewhole program and maintain fidelitytothe modelwhich
includes but not limited to conducting ongoing program supervision and technical
support,continuing vocational training&education to the program after IPS Certification,
Conducting Quarterly IPS Fidelity Reviews and Annual Outcomes Report,providing
technical support to DOR,directly operated and contracted clinics staff on how to use
and navigate IPS services.This individual will provide coverage for the whole program
after hours.
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131 -
Direct Employee Benefits 98,121
1201 Retirement 19,232 Calculated at4%of salaries
1202 Worker's Compensation 4,808 Calculated at 1%of salaries
1203 Health Insurance 72,118 Calculated at 15%of salaries
1204 ARA Awards 1,963 This is a Incentive and Recognition Program to recognize the dedication within which
employees perform their responsibilities to retain long-term employees.The cost is$250
per Employee.
1207 Regional Health Insurance 7,770 Regional Health Insurance;15%of Salaries.
1208 Regional ARA Awards 500 This is a Incentive and Recognition Program to recognize the dedication within which
employees perform their responsibilities to retain long-term employees.The cost is$250
per Employee.
Direct Payroll Taxes&Expenses: 43,852
1301 OASDI -
1302 FICA/MEDICARE 36,780 FICA calculated at 6.2%of salaries,MEDICARE calculated at 1.45%of salaries
1303 FUTA+SUI 2,413 Calculated at3.4%of salaries
1304 RegionalOASDI -
1305 Regional FICA/MEDICARE 3,963 FICA calculated at 6.2%of salaries,MEDICARE calculated at 1.45%of salaries
1306 Regional FUTA+SUI 696 Calculated at3.4%of salaries
2000:DIRECT CLIENT SUPPORT 43,116
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 13,174 Client Expenses:Transportation—Bus Passes,Lyft vouchers,mileage
2004 Clothing,Food,&Hygiene 17,965 Client Expenses:Clothes,shoes and hygiene products
2005 Education Support -
2006 Employment Support 11,977 Client Expenses:Work supplies,internetforjob search,employment support supplies
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Client Program Expense
2012
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3000:DIRECT OPERATING EXPENSES 66,329
3001 Telecommunications -
3002 Printing/Postage 3,500 Duplication,postage,and printing costs may include,but shall not be limited to,self-
addressed envelopes,appointment cards,business cards,letterhead stationery,
laminating,binding,cooperative program forms,master applications,job applications,
resumes,cover letters,paper employment-related flyers,portfolio folders and pamphlets
and other programmatic printed needs.These expenses will allowfor program staff to
communicate effectivelywith partners,participants and their support network and
employers.Additionally,programmatic copier maintenance fees and supplies are an
allowable expense.
3003 Office,Household&Program Supplies 2,900 Consumable office supplies necessaryfor staff required in the provision of program
services under the contract to be used duringthe contract period.Items to be purchased
include but are not limited to binder clips,binders,calculator tape,envelopes,file
folders,markers,paper clips,pencils,pens,post-it notes,printer cartridges,staples,
staplers,and stationary.This line item may also include items for the safety of personnel
and participants such as Personal Protective Equipment(PPE)and safety equipment
necessary.May include but not limited to masks,gloves,hand sanitizers,disinfectant
spray,Plexiglass barriers,first aid kits,fire extinguishers and temperature screeners.
3004 Advertising -
3005 Staff Development&Training 29,130 Includes training in the Evidence-Based Practices of Wellness and Recovery Action Plan,
Motivational Interviewing,and Seeking Safety,organ izationaltoots,team/organizational
psychology,philosophy of client based services,integration of roles/team dynamics,
assessment and individualized treatment planning,general services,organizing
admissions and individualized treatment planning associated with the EBPs.Also
includes CARF certification and other mandatorytrainings such as first aid and CPR.
3006 Staff Mileage 26,000 Mileage reimbursement is paid atthe prevailing federal rate(currently$0.70 per mile)to
program service staff and program administrative staff.
3007 Subscriptions&Memberships - Co-op Department of Rehabilitation contract,agencies providing vocational rehabilitation
services,particularly those offering work-oriented programs,must be accredited bythe
Commission on Accreditation of Rehabilitation Facilities(CARF)in the primary program
emphasis of the services offered,with exceptions for certain facilities.
3008 Vehicle Maintenance
3009 General Liability Insurance -
3010 Direct Shared Allocated Regional Cost 4,799 These costs have been allocated to the program based on current year overhead
expenses and is limited by the program contract.This included all Shared Direct Expense
including Regional Copiers,Tablets,Occupancy Pool,Training Pool,and JEDI.
3011 Other(specify) -
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 94,728
4001 Occupancy(Rent,Utilities,Property Taxes/Local Fees) 69,715 This includes building rent or depreciation,storage and file storage unit rental payments
and all the costs associated with storing and retrieving of client,personnel or otherfiles or
records.Costs are allocated between programs on the basis of payroll dollars and have
been estimated based on historical trends and the utilization of the Agency's existing
office in Fresno.
4002 Facility Operation and Maintenance 9,653 This includes common area maintenance on leased building charges,
maintenance/building repair charges,HVAC maintenance and repair,landscaping,
janitorial services,confidential paper shredding services,in-house or outside equipment
repair and labor.Costs are allocated between programs on the basis of payroll dollars
and have been estimated based on historical trends and the utilization of the Agency's
existing office in Fresno.
4003 Rent/Lease Equipment 15,360 Equipment/Parts/Hosted Apps/Lic IT-Leased Laptops
4004 Security -
4005 Utilities
4006 Other(specify)
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2f7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#1 LINE ITEM ANT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5000:DIRECTSPECIAL EXPENSES 4,808
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 4,808 This also includes lease or purchase of equipment such as networking equipment,
system&software user licenses and maintenance.
5003 Contractual/Consulting Services(Specify) -
5004 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 134,160
6001 Administrative Overhead 134,160 Represents the indirect costs of the Agency's general and administrative shared support
services such as finance,accounting,billing,human resources,clinical administration,
information technology,professional fees,HIPPA compliance and clinical record audits,
risk management and program fidelity,recruiting and human resources support,MIS
infrastructure&QI/UM department support and oversight as well as executive
management.Costs that cannot be specifically charged to a program are allocated to
programs on the basis of direct labor program costs prior to the addition of taxes and
benefits.Indirect costs have been budgeted at 15%of total program expenses.
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
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software This includes rental payments for equipment including leased copiers,postage
machines,phone systems,laptops or other communication,office or facility equipment.
Costs are allocated between programs on the basis of payroll dollars and have been
estimated based on historical trends and the utilization of the Agency's existing office in
Fresno.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Cell phones,Land Lines,DSL,fax charges,phone system;wireless cards for laptop
Data computers enabling UFS to maintain a fullyfunctional mobile work force to deliver in-
home/in the community services.Costs have been estimated based on historical trends
and space usage
7003 Furniture&Fixtures
7004 Leasehold/Tenant/BuildingImprovements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2f7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services The Department of Behavioral Health to provide recovery,vocational and educational
services and to promote wellness through supported employment and education in a
welcoming,accessible,recovery-oriented system where people with serious mental
illness and/or co-occurring disorders can achieve hope,healing,and a meaningful Life
within their community.
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: 1,028,564
TOTAL PROGRAM EXPENSES FROM BUDGETTEMPLATE: 1,028,564
BUDGET CHECK: -
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2026-27
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Regional Executive Director 0.10 $ 17,818 $ 17,818
1102 Crp Dir of Comm Integ Services 0.30 35,536 35,536
1103 - -
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.40 $ 53,354 $ 53,354
Acct# Program Position FTE Admin Program Total
1116 IPS Team Leader/Supervisor 1.00 $ 89,981 $ 89,981
1117 Employment Specialist 3.00 173,534 173,534
1118 Educational Support Specialist 1.00 57,845 57,845
1119 Employment Peer Specialist 2.00 102,835 102,835
1120 Customer Service Specialist 0.50 22,495 22,495
1121 Program Director I 0.50 48,523 48,523
1122 - -
1123
1124
1125
1126
1127
1128
1129
1130
1131
Direct Personnel Program Salaries Subtotal 8.00 $ 495,214 $ 495,214
Admin Program Total
Direct Personnel Salaries Subtotal 8.40 1 $ 53,354 $ 495,214 1 $ 548,568
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 19,809 $ 19,809
1202 Worker's Compensation 4,952 4,952
1203 Health Insurance 74,282 74,282
1204 ARA Awards 1,963 1,963
1205 Regional Retirement 2,134
1206 Regional Worker's Comp 534
1207 Regional Health Insurance 8,003 8,003
1208 Regional ARA Awards 500 500
Direct Employee Benefits Subtotal: $ 11,171 $ 101,006 $ 112,177
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE $ $ 37,884 $ 37,884
1303 FUTA+SUI 2,427 2,427
1304 Regional OASDI - -
1305 Regional FICA/MEDICARE 4,082 4,082
1306 Regional FUTA+SUI 697 697
Direct Payroll Taxes&Expenses Subtotal: $ 4,779 $ 40,311 $ 45,090
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 69,304 $ 636,531 $ 705,835
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
10% 90%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 13,614
2004 Clothing,Food,&Hygiene 18,564
2005 Education Support
2006 Employment Support 12,376
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Client Program Expense
2012 Contractual/ConsultingServices(Psychiatrist)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 44,554
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ -
3002 Printing/Postage 3,500
3003 Office,Household&Program Supplies 956
3004 Advertising -
3005 Staff Development&Training 21,445
3006 Staff Mileage 12,475
3007 Subscriptions&Memberships 520
3008 Vehicle Maintenance -
3009 General Liability Insurance -
3010 Direct Shared Allocated Regional Cost 4,978
3011 Other(specify) -
3012 Other(specify) -
DIRECT OPERATING EXPENSES TOTAL: $ 43,874
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Occupancy(Rent,Utilities,Property Taxes/Local Fees) $ 71,806.00
4002 Facility Operation and Maintenance $ 9,943.00
4003 Rent/Lease Equipment $ 13,440.00
4004 Security $ -
4005 Utilities $
4006 Other(specify) $
4007 Other(specify) $
4008 Other(specify) $
4009 Other(specify) $
4010 Other(specify) $
DIRECT FACI LITI ES/EQUI PM E NIT TOTAL: $ 95,189
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) $ 4,952.00
5003 Contractual/ConsultingServices(Specify) $ -
5004 Other(specify)
5006 Other(specify) $
5007 Other(specify) $
5008 Other(specify) $ -
DIRECT SPECIAL EXPENSES TOTAL: $ 4,952
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and onlythis line for approved indirect cost rate $ 134,161
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 Person net(Indi—tSalaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 134,161
INDIRECT COST RATE 15.00%
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 $ 1,028,564
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 Other(Specify) 0
Estimated Spec!aLty 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)% 0%
MEDI-CAL FFP TOTAL $ -
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 DrugMedi-Cal $
8102 ISABG $
SUBSTANCE USE DISORDER FUNDSTOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 Realignment
REALIGNMENT TOTAL $ -
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-CommunityServices&Supports Vocational and Educational Services $ 1,028,564
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 1,028,564
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTALI$ -
TOTAL PROGRAM FUNDING SOURCES: $ 1,028,564
NET PROGRAM COST: 1 $ 0
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2026-27
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled out
Position Contract#/Name/Department/County FTE%
Part-Time Customer Service Specialist 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.50
Program Director 1 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.50
Program Director I Hollywood 2.0 Supported Employment and Education 0.50
Crp Dir of Comm Integ Services 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.30
Crp Dir of Comm Integ Services Ventura Tay Club Houses 0.35
Crp Dir of Comm Integ Services DMH Supported Employment Individual Placement&Support Services 0.35
Regional Executive Director 25-040 CFNTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.10
Regional Executive Director Fresno Bright Beginnings 0.23
Regional Executive Director Fresno Hope 0.23
Regional Executive Director Tulare Tay Crossroads 0.23
Regional Executive Director Fresno ACT 0.23
Total 3.50
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2026-27 Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 705,835
Administrative Positions 53,354
1101 Regional Executive Director 17,818 The Regional Executive Director provides leadership,strategic direction and operational
oversight for the Region.Leads the development,implementation,and expansion of the
Region's services,quality of care,program operations and fiscal viability.Is responsible
to lead and ensure effective clinical change processes,continuous quality improvement,
and risk management throughout the Region.Serves as a source of vision and innovation
for staff and customers.
1102 Crp Dir of Comm Integ Services 35,536 The position of Corporate Director of Community Integration Services oversees a variety
of departments that ensure Pacific Clinics'consumers and theirfamily members are
provided with opportunities to integrate successfully into the community and achieve
their recovery goals.Specifically,the position oversees Pacific Clinics'
programs/services/functions related to employment,health navigation,and benefits
establishment.
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Program Positions 495,214
1116 IPS Team Leader/Supervisor 89,981 The Team Supervisor coordinates and supervises case managers,housing staff,peers,
Family Specialists,Behavior Specialists,Family Finders,LVNS,LPTs,Clubhouse and/or
other staff as assigned bythe Program Director.Coordinates cases with the*Department
of Mental Health(DMH)and in some counties Behavioral Health and/or other funding
sources/agencies and ensures the delivery of integrated behavioral healthcare.
1117 Employment Specialist 173,534 Carries out the services of the Supported Employment program by assisting clients to
obtain and maintain employment that is consistent with their vocational goals.
Responsible for providing employment preparation and job search skills training as well
as job coaching to adults with psychiatric disabilities at off-site employment locations
and program facilities.Provides support for schooling and technical training for career
advancement.
1118 Educational Support Specialist 57,845 Works within the vision,mission and philosophy of the agency.Provides assistance in
helping students complete their vocational and educational goals and requirements,
accessing community resources,facilitating educational/vocational activities,educating
clients and families on graduation requirements and supporting preparations for job and
career development.Is responsible for assisting students with their study and
rehabilitation skills in an effort to help them meet their education and career goals.
1119 Employment Peer Specialist 102,835 Works within the vision,mission,and philosophy of the agency and framework of the
Certified Community Behavioral Health Clinic.Under direct supervision,the Peer Partner
provides peer-to-peer support and counseling drawing on shared experiences as a peer to
validate the consumer's experience.Provides guidance and encouragement to
consumers to take responsibility and actively participate in their own recovery.This
position models competency in recovery and serves as a mentorfor consumers in a
clinic,community,or Wellness Center/Drop-In setting.
1120 Customer Service Specialist 22,495 Working within the vision,mission and philosophy of the agency,the Customer Service
Specialist is responsible for processing and completing internal and external referrals,
acts as primary liaison between external agencies and internal agency departments and
completes all required administrative paperwork and data entryfor customer records.
Coordinates all activities related to initial intake,level of care screening,insurance
verification and payment coordination. Regularly interfaces face-to-face and by
telephone with customers as well as with all agency and County electronic systems
connected to client care and billing.
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1121 Program Director 1 48,523 Program Directorto oversee thewhole program and maintain fidelitytothe modelwhich
includes but not limited to conducting ongoing program supervision and technical
support,continuing vocational training&education to the program after IPS Certification,
Conducting Quarterly IPS Fidelity Reviews and Annual Outcomes Report,providing
technical support to DOR,directly operated and contracted clinics staff on how to use
and navigate IPS services.This individual will provide coverage for the whole program
after hours.
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
#REF! #REF!
#REF! #REF!
#REF! #REF!
Direct Employee Benefits 112,177
1201 Retirement 19,809 Calculated at4%of salaries
1202 Worker's Compensation 4,952 Calculated at 1%of salaries
1203 Health Insurance 74,282 Calculated at 15%of salaries
1204 ARAAwards 1,963 $250 per Employee
1207 Regional Health Insurance 8,003 Regional Health Insurance;15%of Salaries.
1208 Regional ARA Awards 500 $250 per Employee
Direct Payroll Taxes&Expenses: 45,090
1301 OASDI -
1302 FICA/MEDICARE 37,884 FICA calculated at 6.2%of salaries,MEDICARE calculated at 1.45%of salaries
1303 FUTA+SUI 2,427 Calculated at3.4%of salaries
1304 Regional OASDI -
1305 Regional FICA/MEDICARE 4,082 FICA calculated at 6.2%of salaries,MEDICARE calculated at 1.45%of salaries
1306 Regional FUTA+SUI 697 Calculated at 3.4%of salaries
2000:DIRECT CLIENTSUPPORT 44,554
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 13,614 Client Expenses:Transportation—Bus Passes,Lyft vouchers,mileage
2004 Clothing,Food,&Hygiene 18,564 Client Expenses:Clothes,shoes and hygiene products
2005 Education Support -
2006 Employment Support 12,376 Client Expenses:Work supplies,internet for job search,employment support supplies
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Client Program Expense
2012 Contractual/ConsultingServices(Psychiatrist)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2f7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3000:DIRECT OPERATING EXPENSES 43,874
3001 Telecommunications -
3002 Printing/Postage 3,500 Duplication,postage,and printing costs may include,but shall not be limited to,self-
addressed envelopes,appointment cards,business cards,letterhead stationery,
laminating,binding,cooperative program forms,master applications,job applications,
resumes,cover letters,paper employment-related flyers,portfolio folders and pamphlets
and other programmatic printed needs.These expenses will allowfor program staff to
communicate effectivelywith partners,participants and their support network and
employers.Additionally,programmatic copier maintenance fees and supplies are an
allowable expense.
3003 Office,Household&Program Supplies 956 Supports for these basic needs operational needs to conduct daily operation.
3004 Advertising -
3005 Staff Development&Training 21,445 Includes training in the Evidence-Based Practices of Wellness and Recovery Action Plan,
Motivational Interviewing,and Seeking Safety,organ izationaltoots,team/organizational
psychology,philosophy of client based services,integration of roles/team dynamics,
assessment and individualized treatment planning,general services,organizing
admissions and individualized treatment planning associated with the EBPs.Also
includes CARF certification and other mandatorytrainings such as first aid and CPR.
3006 Staff Mileage 12,475 Mileage reimbursement is paid at the prevailing federal rate(currently$0.70 per mile)to
program service staff and program administrative staff.
3007 Subscriptions&Memberships 520 Co-op Department of Rehabilitation contract,agencies providing vocational rehabilitation
services,particularly those offering work-oriented programs,must be accredited bythe
Commission on Accreditation of Rehabilitation Facilities(CARF)in the primary program
emphasis of the services offered,with exceptions for certain facilities.
L3010
Vehicle Maintenance
General Liability Insurance
Direct Shared Allocated Regional Cost 4,978 These costs have been allocated to the program based on current year overhead
expenses and is limited by the program contract.This included all Shared Direct Expense
including Regional Copiers,Tablets,Occupancy Pool,Training Pool,and JEDI.
Other(specify)
Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 95,189
4001 Occupancy(Rent,Utilities,Property Taxes/Local Fees) 71,806 This includes building rent or depreciation,storage and file storage unit rental payments
and all the costs associated with storing and retrieving of client,personnel or otherfiles or
records.Costs are allocated between programs on the basis of payroll dollars and have
been estimated based on historical trends and the utilization of the Agency's existing
office in Fresno.
4002 Facility Operation and Maintenance 9,943 This includes common area maintenance on leased building charges,
maintenance/building repair charges,HVAC maintenance and repair,landscaping,
janitorial services,confidential paper shredding services,in-house or outside equipment
repair and labor.Costs are allocated between programs on the basis of payroll dollars
and have been estimated based on historical trends and the utilization of the Agency's
existing office in Fresno.
4003 Rent/Lease Equipment 13,440 Equipment/Parts/Hosted Apps/Lic IT-Leased Laptops
4004 Security -
4005 Utilities
4006 Other(specify)
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5000:DIRECTSPECIAL EXPENSES 4,952
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 4,952 This also includes lease or purchase of equipment such as networking equipment,
system&software user licenses and maintenance.
5003 Contractual/Consulting Services(Specify) -
5004 Other(specify)
5006 Other(specify)
5007 1 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 134,161
6001 Administrative Overhead 134,161 Represents the indirect costs of the Agency's general and administrative shared support
services such as finance,accounting,billing,human resources,clinical administration,
information technology,professional fees,HIPPA compliance and clinical record audits,
risk management and program fidelity,recruiting and human resources support,MIS
infrastructure&QI/UM department support and oversight as well as executive
management.Costs that cannot be specifically charged to a program are allocated to
programs on the basis of direct labor program costs prior to the addition of taxes and
benefits.Indirect costs have been budgeted at 15%of total program expenses.
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
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software This includes rental payments for equipment including leased copiers,postage
machines,phone systems,laptops or other communication,office or facility equipment.
Costs are allocated between programs on the basis of payroll dollars and have been
estimated based on historical trends and the utilization of the Agency's existing office in
Fresno.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Cell phones,Land Lines,DSL,fax charges,phone system;wireless cards for laptop
Data computers enabling UFS to maintain a fullyfunctional mobile work force to deliver in-
home/in the community services.Costs have been estimated based on historical trends
and space usage.
7003 Furniture&Fixtures
7004 Leasehold/Tenant/BuildingImprovements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2f7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BYTHE RFP
8001 Mental Health Services The Department of Behavioral Health to provide recovery,vocational and educational
services and to promote wellness through supported employment and education in a
welcoming,accessible,recovery-oriented system where people with serious mental
illness and/or co-occurring disorders can achieve hope,healing,and a meaningful life
within their community.
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: 1,028,564
TOTAL PROGRAM EXPENSES FROM BUDGETTEMPLATE: 1,028,564
BUDGETCHECK: -
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2f7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2027-28
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Regional Executive Director 0.10 $ 18,353 $ 18,353
1102 Crp Dir of Comm Integ Services 0.30 36,602 36,602
1103 - -
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.40 $ 54,955 $ 54,955
Acct# Program Position FTE Admin Program Total
1116 IPS Team Leader/Supervisor 1.00 $ 92,680 $ 92,680
1117 Employment Specialist 3.00 178,740 178,740
1118 Educational Support Specialist 1.00 1 59,580 59,580
1119 Employment Peer Specialist 2.00 105,920 105,920
1120 Customer Service Specialist 0.50 23,170 23,170
1121 Program Director I 0.50 49,979 49,979
1122 - -
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries SubtotaLi 8.00 1 $ 510,069 1 $ 510,069
Admin Program Total
Direct Personnel Salaries SubtotaLl 8.40 1 $ 54,955 $ 510,069 $ 565,024
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 20,403 $ 20,403
1202 Worker's Compensation 5,101 5,101
1203 Health Insurance 76,511 76,511
1204 ARAAwards 1,962 1,962
1205 Regional Retirement 2,198
1206 Regional Worker's Comp 550
1207 Regional Health Insurance 8,243 1 1 8,243
1208 Regional ARA Awards 500 1 1 500
Direct Employee Benefits Subtotal: $ 11,491 $ 103,977 $ 115,468
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 39,020 39,020
1303 FUTA+SUI 2,442 2,442
1304 Regional OASDI - -
1305 Regional FICA/MEDICARE 4,204 4,204
1306 Regional FUTA+SUI 699 699
Direct Payroll Taxes&Expenses Subtotal: $ 4,903 $ 41,462 $ 46,365
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 71,349 $ 655,508 $ 726,857
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
10% 90%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 7,730
2004 Clothing,Food,&Hygiene 10,541
2005 Education Support
2006 Employment Support 7,028
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Client Program Expense
2012 Contractual/ConsultingServices
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 25,299
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2f7/2020
Exhibit C-Attachment A
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ -
3002 Printing/Postage $ 2,000.00
3003 Office,Household&Program Supplies $ 425.00
3004 Advertising $ -
3005 Staff Development&Training $ 21,029.00
3006 Staff Mileage $ 10,369.00
3007 Subscriptions&Memberships $ 520.00
3008 Vehicle Maintenance $ -
3009 General Liability Insurance $ -
3010 Direct Shared Allocated Regional Cost $ 5,162.00
3011 Other(specify) $ -
3012 Other(specify) $ -
DIRECT OPERATING EXPENSES TOTAL: $ 39,505
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Occupancy(Rent,Utilities,Property Taxes/Local Fees) $ 73,960.00
4002 Facility Operation and Maintenance $ 10,241.00
4003 Rent/Lease Equipment $ 13,440.00
4004 Security $ -
4005 Utilities $
4006 Other(specify) $
4007 Other(specify) $
4008 Other(specify) $
4009 Other(specify) $
4010 Other(specify) $
DIRECT FACI LITI ES/EQUI PM E NIT TOTAL: $ 97,641
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ -
5002 HMIS(Health Management Information System) $ 5,101.00
5003 Contractual/ConsultingServices(Specify) $ -
5004 Other(specify) $
5006 Other(specify) $
5007 Other(specify) $
5008 Other(specify) $ -
DIRECT SPECIAL EXPENSES TOTAL: $ 5,101
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and onlythis line for approved indirect cost rate $ 134,160
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 Person net(indirect 8alaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify) -
INDIRECT EXPENSES TOTAL $ 134,160
INDIRECT COST RATE 15.00%
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 $ 1,028,564
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 Other(Specify) 0
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)% 0%
MEDI-CALFFPTOTAL $
8100-SUBSTANCE USE DISORDER FUNDS
Acct# Line Item Description Amount
8101 DrugMedi-Cal $
8102 ISABG $
SUBSTANCE USE DISORDER FUNDSTOTAL $ -
8200-REALIGNMENT
Acct# Line Item Description Amount
8201 lRealignment
REALIGNMENT TOTAL $ -
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-CommunityServices&Supports Vocational and Educational Services $ 1,028,564
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology -
MHSA TOTAL $ 1,028,564
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTALI$ -
TOTAL PROGRAM FUNDING SOURCES: $ 1,028,564
NET PROGRAM COST: 1 $ (0)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2027-28
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled out
Position Contract#/Name/Department/County FTE%
Part-Time Customer Service Specialist 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.50
Program Director 1 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.50
Program Director I Hollywood 2.0 Supported Employment and Education 0.50
Crp Dir of Comm Integ Services 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.30
Crp Dir of Comm Integ Services Ventura Tay Club Houses 0.35
Crp Dir of Comm Integ Services DMH Supported Employment Individual Placement&Support Services 0.35
Regional Executive Director 25-040 CFNTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.10
Regional Executive Director Fresno Bright Beginnings 0.23
Regional Executive Director Fresno Hope 0.23
Regional Executive Director Tulare Tay Crossroads 0.23
Regional Executive Director Fresno ACT 0.23
Total 3.50
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2f7/2020
Exhibit C-Attachment A
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2027-28 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 726,857
Administrative Positions 58,301
1101 Regional Executive Director 18,353 The Regional Executive Director provides leadership,strategic direction and operational
oversight for the Region.Leads the development,implementation,and expansion of the
Region's services,quality of care,program operations and fiscal viability.Is responsible
to lead and ensure effective clinical change processes,continuous quality improvement,
and risk management throughout the Region.Serves as a source of vision and innovation
for staff and customers.
1102 Crp Dir of Comm Integ Services 36,602 The position of Corporate Director of Community Integration Services oversees a variety
of departments that ensure Pacific Clinics'consumers and their family members are
provided with opportunities to integrate successfully into the community and achieve
their recovery goals.Specifically,the position oversees Pacific Clinics'
programs/services/functions related to employment,health navigation,and benefits
establishment.
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Program Positions 510,069
1116 IPS Team Leader/Supervisor 92,680 The Team Supervisor coordinates and supervises case managers,housing staff,peers,
Family Specialists,Behavior Specialists,Family Finders,LVNS,LPTs,Clubhouse and/or
other staff as assigned bythe Program Director.Coordinates cases with the*Department
of Mental Health(DMH)and in some counties Behavioral Health and/or other funding
sources/agencies and ensures the delivery of integrated behavioral healthcare.
1117 Employment Specialist 178,740 Carries out the services of the Supported Employment program by assisting clients to
obtain and maintain employment that is consistent with their vocational goals.
Responsible for providing employment preparation and job search skills training as well
as job coachingto adults with psychiatric disabilities at off-site employment locations
and program facilities.Provides support for schooling and technical training for career
advancement.
1118 Educational Support Specialist 59,580 Works within the vision,mission and philosophy of the agency.Provides assistance in
helping students complete their vocational and educational goals and requirements,
accessing community resources,facilitating educational/vocational activities,educating
clients and families on graduation requirements and supporting preparations for job and
career development.Is responsible for assisting students with their study and
rehabilitation skills in an effort to help them meet their education and career goals.
1119 Employment Peer Specialist 105,920 Works within the vision,mission,and philosophy of the agency and framework of the
Certified Community Behavioral Health Clinic.Under direct supervision,the Peer Partner
1120 Customer Service Specialist 23,170 Workingwithin the vision,mission and philosophy of the agency,the Customer Service
Specialist is responsible for processing and completing internal and external referrals,
acts as primary liaison between external agencies and internal agency departments and
completes all required administrative paperwork and data entryfor customer records.
Coordinates all activities related to initial intake,level of care screening,insurance
verification and payment coordination. Regularly interfaces face-to-face and by
telephone with customers as well as with all agency and County electronic systems
connected to client care and billing.
1121 Program Director) 49,979 Program Director to oversee the whole program and maintain fidelity to the model which
includes but not limited to conducting ongoing program supervision and technical
support,continuing vocational training&education to the program after IPS Certification,
Conducting Quarterly IPS Fidelity Reviews and Annual Outcomes Report,providing
technical support to DOR,directly operated and contracted clinics staff on how to use
and navigate IPS services.This individual will provide coverage for the whole program
after hours.
1122
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 217/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1123
1124
1125
1126
1127
1128
1129
1130
1131
Direct Employee Benefits 115,468
1201 Retirement 20,403 Calculated at4%of salaries
1202 Worker's Compensation 5,101 Calculated at 1%of salaries
1203 Health Insurance 76,511 Calculated at15%of salaries
1204 ARAAwards 1,962 This is a Incentive and Recognition Program to recognize the dedication within which
employees perform their responsibilities to retain long-term employees.The cost is$250
per Employee.
1207 Regional Health Insurance 8,243 Regional Health Insurance;15%of Salaries.
1208 Regional ARA Awards - This is a Incentive and Recognition Program to recognize the dedication within which
employees perform their responsibilities to retain long-term employees.The cost is$250
per Employee.
Direct Payroll Taxes&Expenses: 46,365
1301 OASDI -
1302 FICA/MEDICARE 39,020 FICA calculated at 6.2%of salaries,MEDICARE calculated at 1.45%of salaries
1303 FUTA+SUI 2,442 Calculated at3.4%of salaries
1304 Regional OASDI -
1305 Regional FICA/MEDICARE 4,204 FICA calculated at 6.2%of salaries,MEDICARE calculated at 1.45%of salaries
1306 Regional FUTA+SUI 699 Calculated at 3.4%of salaries
2000:DIRECT CLIENT SUPPORT 25,299
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 7,730 Client Expenses:Transportation_Bus Passes,Lyft vouchers,mileage
2004 Clothing,Food,&Hygiene 10,541 Client Expenses:Clothes,shoes and hygiene products
2005 Education Support -
2006 Employment Support 7,028 Client Expenses:Work supplies,internet for job search,employment support supplies
2007 Household Items for Clients
2008 Medication Supports -
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Client Program Expense
2012 Contractual/ConsultingServices
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3000:DIRECT OPERATING EXPENSES 39,505
3001 Telecommunications -
3002 Printing/Postage 2,000 Duplication,postage,and printing costs may include,but shall not be limited to,self-
addressed envelopes,appointment cards,business cards,letterhead stationery,
laminating,binding,cooperative program forms,master applications,job applications,
resumes,cover letters,paper employment-related flyers,portfolio folders and pamphlets
and other programmatic printed needs.These expenses will allowfor program staff to
communicate effectivelywith partners,participants and their support network and
employers.Additionally,programmatic copier maintenance fees and supplies are an
allowable expense.
3003 Office,Household&Program Supplies 425 Supports for these basic needs operational needs to conduct daily operation.
3004 Advertising -
3005 Staff Development&Training 21,029 Includes training in the Evidence-Based Practices of Wellness and Recovery Action Plan,
Motivational Interviewing,and Seeking Safety,organizationaltools,team/organizational
psychology,philosophy of client based services,integration of roles/team dynamics,
assessment and individualized treatment planning,general services,organizing
admissions and individualized treatment planning associated with the EBPs.Also
includes CARF certification and other mandatorytrainings such as first aid and CPR.
3006 Staff Mileage 10,369 Mileage reimbursement is paid at the prevailing federal rate(currently$0.70 per mile)to
program service staff and program administrative staff.
3007 Subscriptions&Memberships 520 Co-op Department of Rehabilitation contract,agencies providing vocational rehabilitation
services,particularly those offering work-oriented programs,must be accredited bythe
Commission on Accreditation of Rehabilitation Facilities(CARF)in the primary program
emphasis of the services offered,with exceptions for certain facilities.
3008 Vehicle Maintenance
3009 General Liability Insurance -
3010 Direct Shared Allocated Regional Cost 5,163 These costs have been allocated to the program based on current year overhead
expenses and is limited by the program contract.This included all Shared Direct Expense
including Regional Copiers,Tablets,Occupancy Pool,Training Pool,and JEDI.
3011 Other(specify)
3012 Other (specify)
4000:DIRECT FACILITIES&EQUIPMENT 97,641
4001 Occupancy(Rent,Utilities,Property Taxes/Local Fees) 73,960 This includes building rent or depreciation,storage and file storage unit rental payments
and all the costs associated with storing and retrieving of client,personnel or other files or
records.Costs are allocated between programs on the basis of payroll dollars and have
been estimated based on historical trends and the utilization of the Agency's existing
office in Fresno.
4002 Facility Operation and Maintenance 10,241 This includes common area maintenance on leased building charges,
maintenance/building repair charges,HVAC maintenance and repair,landscaping,
janitorial services,confidential paper shredding services,in-house or outside equipment
repair and labor.Costs are allocated between programs on the basis of payroll dollars
and have been estimated based on historical trends and the utilization of the Agency's
existing office in Fresno.
4003 Rent/Lease Equipment 13,440 Equipment/Parts/Hosted Apps/Lic IT-Leased Laptops
4004 Security -
4005 Utilities
4006 Other(specify)
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2f7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5000:DIRECT SPECIAL EXPENSES 5,101
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 5,101 This also includes lease or purchase of equipment such as networking equipment,
system&software user licenses and maintenance.
5003 Contractual/ConsultingServices(Specify)
5004 Other(specify) -
5006 Other(specify)
5008 Oth07 Other(specify)
50er(specify)
6000:INDIRECT EXPENSES 134,160
6001 Use this line and only this line for approved indirect cost rate 134,160 Represents the indirect costs of the Agency's general and administrative shared support
services such as finance,accounting,billing,human resources,clinical administration,
information technology,professional fees,HIPPA compliance and clinical record audits,
risk management and program fidelity,recruiting and human resources support,MIS
infrastructure&QI/UM department support and oversight as well as executive
management.Costs that cannot be specifically charged to a program are allocated to
programs on the basis of direct labor program costs prior to the addition of taxes and
benefits.Indirect costs have been budgeted at 15%of total program expenses.
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
6008 Personnel(indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 1Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software This includes rental payments for equipment including leased copiers,postage
machines,phone systems,laptops or other communication,office or facility equipment.
Costs are allocated between programs on the basis of payroll dollars and have been
estimated based on historical trends and the utilization of the Agency's existing office in
Fresno.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data Cell phones,Land Lines,DSL,fax charges,phone system;wireless cards for laptop
computers enabling UFS to maintain a fullyfunctional mobile work force to deliver in-
home/in the community services.Costs have been estimated based on historical trends
and space usage.
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)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BYTHE RFP
8001 Mental Health Services The Department of Behavioral Health to provide recovery,vocational and educational
services and to promote wellness through supported employment and education in a
welcoming,accessible,recovery-oriented system where people with serious mental
illness and/or co-occurring disorders can achieve hope,healing,and a meaningful life
within their community.
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Other(Specify)
8010 1 Other(Specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,028,564
TOTAL PROGRAM EXPENSES FROM BUDGETTEMPLATE: 1,028,564 0
BUDGETCHECK: -
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2/7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2028-29
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Regional Executive Director 0.10 $ 18,903 $ 18,903
1102 Crp Dir of Comm Integ Services 0.30 37,700 37,700
1103 - -
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.40 $ 56,603 $ 56,603
Acct# Program Position FTE Admin Program Total
1116 IPS Team Leader/Supervisor 1.00 $ 95,461 $ 95,461
1117 Employment Specialist 3.00 184,103 184,103
1118 Educational Support Specialist 1.00 61,368 61,368
1119 Employmentt Peer Specialist 2.00 109,098 109,098
1120 Customer Service Specialist 0.50 23,865 23,865
1121 Program Director I 0.40 41,183 41,183
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
Direct Personnel Program Salaries Subtotal 7.90 $ 515,078 $ 515,078
Admin Program Total
Direct Personnel Salaries Subtotal 8.30 $ 56,603 $ 515,078 $ 571,681
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 20,603 $ 20,603
1202 Worker's Compensation 5,151 5,151
1203 Health Insurance 77,261 77,261
1204 ARAAwards 1,963 1,963
1205 Regional Retirement 2,264
1206 Regional Worker's Comp 566
1207 Regional Health Insurance 8,490 8,490
1208 Regional ARA Awards 500 500
Direct Employee Benefits Subtotal: $ 11,820 $ 104,978 $ 116,798
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 39,403 39,403
1303 FUTA+SUI 2,447 2,447
1304 Regional OASDI - -
1305 RegionalFICA/MEDICARE 4,330 4,330
1306 Regional FUTA+SUI 701 - 701
Direct Payroll Taxes&Expenses Subtotal: $ 5,031 $ 41,850 $ 46,881
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 73,454 $ 661,906 $ 735,360
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
10% 90%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support 5,419
2004 Clothing,Food,&Hygiene 7,389
2005 Education Support
2006 Employment Support 4,926
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Client Program Expense
2012 Contractual/Consulting Services(Psychiatrist)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify) -
DIRECT CLIENT CARE TOTAL $ 17,734
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ -
3002 Printing/Postage 2,000
3003 Office,Household&Program Supplies 425
3004 Advertising -
3005 Staff Development&Training 21,225
3006 Staff Mileage 10,235
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance
3009 General Liability Insurance -
3010 Direct Shared Allocated Regional Cost 3,807
3011 Other(specify) -
3012 1 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 37,692
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Occupancy(Rent,Utilities,Property Taxes/Local Fees) $ 74,686
4002 Facility Operation and Maintenance 10,342.00
4003 Rent/Lease Equipment 13,440.00
4004 Security -
4005 Utilities
4006 Other(specify)
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify) -
DIRECT FACILITIES/EQUIPM ENT TOTAL: $ 98,468
5000:DIRECT SPECIAL EXPENSES
V
Line Item Description Amount
ultant(Network&Data Management) $ -
(HealthManagement Information System) $ 5,151
actual/Consulting Services(Specify)(specify)
(specify)
(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 5,151
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 134,161
Administrative Overhead
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation/Provideromed Equipment to be Used for Program Purposes/ -
6008 Person net(indirect Salaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 134,161
INDIRECT COST RATE 15.00%
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/BuildingImprovements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssetsover$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 1,028,564
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 Other(Specify) 0
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)% 0%
MEDI-CALFFPTOTAL $ -
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
REALIGNMENTTOTAL $ -
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSAComponent MHSA Program Name Amount
8301 CSS-CommunityServices&Supports Vocational and Educational Services $ 1,028,564
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-CapitalFacilities&Technology -
MHSATOTAL $ 1,028,564
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 1,028,564
NET PROGRAM COST: $ 0
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2028-29
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled out
Position Contract#/Name/Department/County FTE%
Part-Time Customer Service Specialist 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.50
Program Director 1 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.50
Program Director I Hollywood 2.0 Supported Employment and Education 0.50
Crp Dir of Comm Integ Services 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.30
Crp Dir of Comm Integ Services Ventura Tay Club Houses 0.35
Crp Dir of Comm Integ Services DMH Supported Employment Individual Placement&Support Services 0.35
Regional Executive Director 25-040 CFNTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.10
Regional Executive Director Fresno Bright Beginnings 0.23
Regional Executive Director Fresno Hope 0.23
Regional Executive Director Tulare Tay Crossroads 0.23
Regional Executive Director Fresno ACT 0.23
Total 3.50
Regional Executive Director Fresno ACT 0.23
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2028-29 Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 735,360
Administrative Positions 56,603
1101 Regional Executive Director 18,903 The Regional Executive Director provides leadership,strategic direction and operational
oversight for the Region.Leads the development,implementation,and expansion of the
Region's services,quality of care,program operations and fiscal viability.Is responsible
to lead and ensure effective clinical change processes,continuous quality improvement,
and risk management throughout the Region.Serves as a source of vision and innovation
for staff and customers.
1102 Crp Dir of Comm Integ Services 37,700 The position of Corporate Director of Community Integration Services oversees a variety
of departments that ensure Pacific Clinics'consumers and theirfamily members are
provided with opportunities to integrate successfully into the community and achieve
their recovery goals.Specifically,the position oversees Pacific Clinics'
programs/services/functions related to employment,health navigation,and benefits
establishment.
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Program Positions 515,078
1116 IPS Team Leader/Supervisor 95,461 The Team Supervisor coordinates and supervises case managers,housing staff,peers,
Family Specialists,Behavior Specialists,Family Finders,LVNS,LPTs,Clubhouse and/or
other staff as assigned bythe Program Director.Coordinates cases with the*Department
of Mental Health(DMH)and in some counties Behavioral Health and/or other funding
sources/agencies and ensures the delivery of integrated behavioral healthcare.
1117 Employment Specialist 184,103 Carries out the services of the Supported Employment program by assisting clients to
obtain and maintain employment that is consistent with their vocational goals.
Responsible for providing employment preparation and job search skills training as well
as job coaching to adults with psychiatric disabilities at off-site employment locations
and program facilities.Provides support for schooling and technical training for career
advancement.
1118 Educational Support Specialist 61,368 Works within the vision,mission and philosophy of the agency.Provides assistance in
helping students complete their vocational and educational goals and requirements,
accessing community resources,facilitating educational/vocational activities,educating
clients and families on graduation requirements and supporting preparations for job and
career development.Is responsible for assisting students with their study and
rehabilitation skills in an effort to help them meet their education and career goals.
1119 Employment Peer Specialist 109,098 Works within the vision,mission,and philosophy of the agency and framework of the
Certified Community Behavioral Health Clinic.Under direct supervision,the Peer Partner
provides peer-to-peer support and counseling drawing on shared experiences as a peer to
validate the consumer's experience.Provides guidance and encouragement to
consumers to take responsibility and actively participate in their own recovery.This
position models competency in recovery and serves as a mentorfor consumers in a
clinic,community,or Wellness Center/Drop-In setting.
1120 Customer Service Specialist 23,865 Working within the vision,mission and philosophy of the agency,the Customer Service
Specialist is responsible for processing and completing internal and external referrals,
acts as primary liaison between external agencies and internal agency departments and
completes all required administrative paperwork and data entryfor customer records.
Coordinates all activities related to initial intake,level of care screening,insurance
verification and payment coordination. Regularly interfaces face-to-face and by
telephone with customers as well as with all agency and County electronic systems
connected to client care and billing.
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1121 Program Director) 41,183 Program Director to oversee the whole program and maintain fidelity to the model which
includes but not limited to conducting ongoing program supervision and technical
support,continuing vocational training&education to the program after IPS Certification,
Conducting Quarterly IPS Fidelity Reviews and Annual Outcomes Report,providing
technical support to DOR,directly operated and contracted clinics staff on how to use
and navigate IPS services.This individual will provide coverage for the whole program
after hours.
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
Direct Employee Benefits 116,798
1201 Retirement 20,603 Calculated at4%of salaries
1202 Worker's Compensation 5,151 Calculated at 1%of salaries
1203 Health Insurance 77,261 Calculated at 15%of salaries
1204 ARA Awards 1,963 This is a Incentive and Recognition Program to recognize the dedication within which
employees perform their responsibilities to retain long-term employees.The cost is$250
per Employee.
1207 Regional Health Insurance 8,490 Regional Health Insurance;15%of Salaries.
1208 Regional ARA Awards 500 This is a Incentive and Recognition Program to recognize the dedication within which
employees perform their responsibilities to retain long-term employees.The cost is$250
per Employee.
Direct Payroll Taxes&Expenses: 46,881
1301 OASDI -
1302 FICA/MEDICARE 39,403 FICA calculated at 6.2%of salaries,MEDICARE calculated at 1.45%of salaries
1303 FUTA+SUI 2,447 Calculated at3.4%of salaries
1304 Regional OASDI -
1305 Regional FICA/MEDICARE 4,330 FICA calculated at 6.2%of salaries,MEDICARE calculated at 1.45%of salaries
1306 Regional FUTA+SUL 701 Calculated at3.4%of salaries
2000:DIRECT CLIENT SUPPORT 17,734
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support 5,419 Client Expenses:Transportation_Bus Passes,Lyft vouchers,mileage
2004 Clothing,Food,&Hygiene 7,389 Client Expenses:Clothes,shoes and hygiene products
2005 Education Support -
2006 Employment Support 4,926 Client Expenses:Work supplies,internet for job search,employment support supplies
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Client Program Expense
2012 Contractual/Consulting Services(Psychiatrist)
2013 Other(specify)
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3000:DIRECT OPERATING EXPENSES 37,692
3001 Telecommunications -
3002 Printing/Postage 2,000 Duplication,postage,and printing costs may include,but shall not be limited to,self-
addressed envelopes,appointment cards,business cards,letterhead stationery,
laminating,binding,cooperative program forms,master applications,job applications,
resumes,cover letters,paper employment-related flyers,portfolio folders and pamphlets
and other programmatic printed needs.These expenses will allowfor program staff to
communicate effectivelywith partners,participants and their support network and
employers.Additionally,programmatic copier maintenance fees and supplies are an
allowable expense.
3003 Office,Household&Program Supplies 425 Supports for these basic needs operational needs to conduct daily operation.
3004 Advertising -
3005 Staff Development&Training 21,225 Includes training in the Evidence-Based Practices of Wellness and Recovery Action Plan,
Motivational Interviewing,and Seeking Safety,organ izationaltoots,team/organizational
psychology,philosophy of client based services,integration of roles/team dynamics,
assessment and individualized treatment planning,general services,organizing
admissions and individualized treatment planning associated with the EBPs.Also
includes CARF certification and other mandatorytrainings such as first aid and CPR.
3006 Staff Mileage 10,235 Mileage reimbursement is paid at the prevailing federal rate(currently$0.70 per mile)to
program service staff and program administrative staff.
3007 Subscriptions&Memberships - Co-op Department of Rehabilitation contract,agencies providing vocational rehabilitation
services,particularly those offering work-oriented programs,must be accredited bythe
Commission on Accreditation of Rehabilitation Facilities(CARF)in the primary program
emphasis of the services offered,with exceptions for certain facilities.
L3010
Vehicle Maintenance
General Liability Insurance
Direct Shared Allocated Regional Cost 3,807 These costs have been allocated to the program based on current year overhead
expenses and is limited by the program contract.This included all Shared Direct Expense
including Regional Copiers,Tablets,Occupancy Pool,Training Pool,and JEDI.
Other(specify)
Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 98,468
4001 Occupancy(Rent,Utilities,Property Taxes/Local Fees) 74,686 This includes building rent or depreciation,storage and file storage unit rental payments
and all the costs associated with storing and retrieving of client,personnel or otherfiles or
records.Costs are allocated between programs on the basis of payroll dollars and have
been estimated based on historical trends and the utilization of the Agency's existing
office in Fresno.
4002 Facility Operation and Maintenance 10,342 This includes common area maintenance on leased building charges,
maintenance/building repair charges,HVAC maintenance and repair,landscaping,
janitorial services,confidential paper shredding services,in-house or outside equipment
repair and labor.Costs are allocated between programs on the basis of payroll dollars
and have been estimated based on historical trends and the utilization of the Agency's
existing office in Fresno.
4003 Rent/Lease Equipment 13,440 Equipment/Parts/Hosted Apps/Lic IT-Leased Laptops
4004 Security -
4005 Utilities
4006 Other(specify)
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2f7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#1 LINE ITEM ANT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5000:DIRECTSPECIAL EXPENSES 5,151
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 5,151 This also includes lease or purchase of equipment such as networking equipment,
system&software user licenses and maintenance.
5003 Contractual/Consulting Services(Specify) -
5004 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 134,161
6001 Administrative Overhead 134,161 Represents the indirect costs of the Agency's general and administrative shared support
services such as finance,accounting,billing,human resources,clinical administration,
information technology,professional fees,HIPPA compliance and clinical record audits,
risk management and program fidelity,recruiting and human resources support,MIS
infrastructure&QI/UM department support and oversight as well as executive
management.Costs that cannot be specifically charged to a program are allocated to
programs on the basis of direct labor program costs prior to the addition of taxes and
benefits.Indirect costs have been budgeted at 15%of total program expenses.
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
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software This includes rental payments for equipment including leased copiers,postage
machines,phone systems,laptops or other communication,office or facility equipment.
Costs are allocated between programs on the basis of payroll dollars and have been
estimated based on historical trends and the utilization of the Agency's existing office in
Fresno.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Cell phones,Land Lines,DSL,fax charges,phone system;wireless cards for laptop
Data computers enabling UFS to maintain a fullyfunctional mobile work force to deliver in-
home/in the community services.Costs have been estimated based on historical trends
and space usage.
7003 Furniture&Fixtures
7004 Leasehold/Tenant/BuildingImprovements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2f7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM FUNDING SOURCES
8000-SHORT/DOYLE MEDI-CAL(FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI-CAL
ACCT# LINE ITEM SERVICE RATES AND/OR SERVICE UNITS,IF APPLICABLE AND/OR AS REQUIRED
BY THE RFP
8001 Mental Health Services The Department of Behavioral Health to provide recovery,vocational and educational
services and to promote wellness through supported employment and education in a
welcoming,accessible,recovery-oriented system where people with serious mental
illness and/or co-occurring disorders can achieve hope,healing,and a meaningful Life
within their community.
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: 1,028,564
TOTAL PROGRAM EXPENSES FROM BUDGETTEMPLATE: 1,028,564
BUDGET CHECK: -
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2029-30
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 Regional Executive Director 0.10 $ 19,470 $ 19,470
1102 Crp Dir of Comm Integ Services 0.30 38,831 38,831
1103 - -
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.40 $ 58,301 $ 58,301
Acct# Program Position FTE Admin Program Total
1116 IPS Team Leader/Supervisor 1.00 $ 98,324 $ 98,324
1117 Employment Specialist 3.00 189,626 189,626
1118 Educational Support Specialist 1.00 63,209 63,209
1119 Employmentt Peer Specialist 2.00 112,371 112,371
1120 Customer Service Specialist 0.50 24,581 24,581
1121 Program Director I 0.35 37,116 37,116
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
Direct Personnel Program Salaries Subtotal 7.85 $ 525,227 $ 525,227
Admin Program Total
Direct Personnel Salaries Subtotal 8.25 $ 58,301 $ 525,227 $ 583,528
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 21,009 $ 21,009
1202 Worker's Compensation 5,252 5,252
1203 Health Insurance 78,784 78,784
1204 ARAAwards 1,963 1,963
1205 Regional Retirement 2,332
1206 Regional Worker's Comp 583
1207 Regional Health Insurance 8,745 8,745
1208 Regional ARA Awards 500 500
Direct Employee Benefits Subtotal: $ 12,160 $ 107,008 $ 119,168
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ - $ - $ -
1302 FICA/MEDICARE 40,180 40,180
1303 FUTA+SUI 2,457 2,457
1304 Regional OASDI - -
1305 RegionalFICA/MEDICARE 4,460 4,460
1306 Regional FUTA+SUI 702 - 702
Direct Payroll Taxes&Expenses Subtotal: $ 5,162 $ 42,637 $ 47,799
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ 75,623 $ 674,872 $ 750,495
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
10% 90%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001 Child Care $
2002 Client Housing Support -
2003 Client Transportation&Support(Mileage) 229
2004 Clothing,Food,&Hygiene 312
2005 Education Support
2006 Employment Support 208
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Client Program Expense
2012 Contractual/Consulting Services(Psychiatrist)
2013 Program Telecommunication
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
DIRECT CLIENT CARE TOTAL $ 750
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ -
3002 Printing/Postage 1,799
3003 Office,Household&Program Supplies 425
3004 Advertising -
3005 Staff Development&Training 21,624
3006 Staff Mileage 10,235
3007 Subscriptions&Memberships 520
3008 Vehicle Maintenance -
3009 General Liability Insurance -
3010 Direct Shared Allocated Regional Cost 3,161
3011 Other(specify)
3012 1 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $ 37,764
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Occupancy(Rent,Utilities,Property Taxes/Local Fees) $ 76,158
4002 Facility Operation and Maintenance 10,546
4003 Rent/Lease Equipment 13,440
4004 Security -
4005 Utilities
4006 Other(specify)
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify) -
DIRECT FACILITIES/EQUIPMENT TOTAL:1$ 100,144
5000:DIRECT SPECIAL EXPENSES
r
Line Item Description Amount
Consultant(Network&Data Management) $ -
HMIS(Health Management Information System) $ 5,252
Contractual/Consulting Services(Specify) -
Other(specify)
Other(specify)
5007 Other(specify)
5008 Other(specify)
DIRECT SPECIAL EXPENSESTOTAL:1$ 5,252
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $ 134,158
Administrative Overhead
6002 Professional Liability Insurance -
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation/Provideromed Equipment to be Used for Program Purposes/ -
6008 Person net(indirect Salaries&Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 134,158
INDIRECT COST RATE 15.00%
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/BuildingImprovements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssetsover$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 1,028,563
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 Other(Specify) 0
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)% 0%
MEDI-CALFFPTOTAL $ -
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
REALIGNMENTTOTAL $ -
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSAComponent MHSA Program Name Amount
8301 CSS-CommunityServices&Supports Vocational and Educational Services $ 1,028,564
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations
8304 WET-Workforce Education&Training
8305 CFTN-CapitalFacilities&Technology -
MHSATOTAL $ 1,028,564
8400-OTHER REVENUE
Acct# Line Item Description Amount
8401 Client Fees $ -
8402 Client Insurance
8403 Grants(Specify)
8404 Other(Specify)
8405 Other(Specify)
OTHER REVENUE TOTAL $
TOTAL PROGRAM FUNDING SOURCES: $ 1,028,564
NET PROGRAM COST: $ (0)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2029-30
PARTIAL FTE DETAIL
For all positions with FTE's split among multiple programs/contracts the below must be filled out
Position Contract#/Name/Department/County FTE%
Part-Time Customer Service Specialist 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.50
Program Director 1 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.50
Program Director I Hollywood 2.0 Supported Employment and Education 0.50
Crp Dir of Comm Integ Services 25-040 CENTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.30
Crp Dir of Comm Integ Services Ventura Tay Club Houses 0.35
Crp Dir of Comm Integ Services DMH Supported Employment Individual Placement&Support Services 0.35
Regional Executive Director 25-040 CFNTRAL/FRESNO/VOCATIONAL EDUCATION SERVICES 0.10
Regional Executive Director Fresno Bright Beginnings 0.23
Regional Executive Director Fresno Hope 0.23
Regional Executive Director Fresno Bright Beginnings 0.23
Regional Executive Director Fresno Hope 0.23
Total 3.50
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
FRESNO VOCATIONAL EDUCATIONAL SERVICES
PACIFIC CLINICS
Fiscal Year(FY)2029-30 Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 750,495
Administrative Positions 58,301
1101 Regional Executive Director 19,470 The Regional Executive Director provides leadership,strategic direction and operational
oversight for the Region.Leads the development,implementation,and expansion of the
Region's services,quality of care,program operations and fiscal viability.Is responsible
to lead and ensure effective clinical change processes,continuous quality improvement,
and risk management throughout the Region.Serves as a source of vision and innovation
for staff and customers.
1102 Crp Dir of Comm Integ Services 38,831 The position of Corporate Director of Community Integration Services oversees a variety
of departments that ensure Pacific Clinics'consumers and theirfamily members are
provided with opportunities to integrate successfully into the community and achieve
their recovery goals.Specifically,the position oversees Pacific Clinics'
programs/services/functions related to employment,health navigation,and benefits
establishment.
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Program Positions 525,227
1116 IPS Team Leader/Supervisor 98,324 The Team Supervisor coordinates and supervises case managers,housing staff,peers,
Family Specialists,Behavior Specialists,Family Finders,LVNS,LPTs,Clubhouse and/or
other staff as assigned bythe Program Director.Coordinates cases with the*Department
of Mental Health(DMH)and in some counties Behavioral Health and/or other funding
sources/agencies and ensures the delivery of integrated behavioral healthcare.
1117 Employment Specialist 189,626 Carries out the services of the Supported Employment program by assisting clients to
obtain and maintain employment that is consistent with their vocational goals.
Responsible for providing employment preparation and job search skills training as well
as job coaching to adults with psychiatric disabilities at off-site employment locations
and program facilities.Provides support for schooling and technical training for career
advancement.
1118 Educational Support Specialist 63,209 Works within the vision,mission and philosophy of the agency.Provides assistance in
helping students complete their vocational and educational goals and requirements,
accessing community resources,facilitating educational/vocational activities,educating
clients and families on graduation requirements and supporting preparations for job and
career development.Is responsible for assisting students with their study and
1119 Employment Peer Specialist 112,371 Works within the vision,mission,and philosophy of the agency and framework of the
Certified Community Behavioral Health Clinic.Under direct supervision,the Peer Partner
provides peer-to-peer support and counseling drawing on shared experiences as a peer to
validate the consumer's experience.Provides guidance and encouragement to
consumers to take responsibility and actively participate in their own recovery.This
position models competency in recovery and serves as a mentorfor consumers in a
clinic,community,or Wellness Center/Drop-In setting.
1120 Customer Service Specialist 24,581 Working within the vision,mission and philosophy of the agency,the Customer Service
Specialist is responsible for processing and completing internal and external referrals,
acts as primary liaison between external agencies and internal agency departments and
completes all required administrative paperwork and data entryfor customer records.
Coordinates all activities related to initial intake,level of care screening,insurance
verification and payment coordination. Regularly interfaces face-to-face and by
telephone with customers as well as with all agency and County electronic systems
connected to client care and hitting.
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1121 Program Director) 37,116 Program Director to oversee the whole program and maintain fidelity to the model which
includes but not limited to conducting ongoing program supervision and technical
support,continuing vocational training&education to the program after IPS Certification,
Conducting Quarterly IPS Fidelity Reviews and Annual Outcomes Report,providing
technical support to DOR,directly operated and contracted clinics staff on how to use
and navigate IPS services.This individual will provide coverage for the whole program
after hours.
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
Direct Employee Benefits 119,168
1201 Retirement 21,009 Calculated at4%of salaries
1202 Worker's Compensation 5,252 Calculated at 1%of salaries
1203 Health Insurance 78,784 Calculated at 15%of salaries
1204 ARA Awards 1,963 This is a Incentive and Recognition Program to recognize the dedication within which
employees perform their responsibilities to retain long-term employees.The cost is$250
per Employee.
1207 Regional Health Insurance 8,745 Regional Health Insurance;15%of Salaries.
1208 Regional ARA Awards 500 This is a Incentive and Recognition Program to recognize the dedication within which
employees perform their responsibilities to retain long-term employees.The cost is$250
per Employee.
Direct Payroll Taxes&Expenses: 47,799
1301 OASDI -
1302 FICA/MEDICARE 40,180 FICA calculated at 6.2%of salaries,MEDICARE calculated at 1.45%of salaries
1303 FUTA+SUI 2,457 Calculated at3.4%of salaries
1304 Regional OASDI -
1305 Regional FICA/MEDICARE 4,460 FICA calculated at 6.2%of salaries,MEDICARE calculated at 1.45%of salaries
1306 Regional FUTA+SUI 702 Calculated at 3.4%of salaries
2000:DIRECT CLIENT SUPPORT 750
2001 Child Care -
2002 Client Housing Support -
2003 Client Transportation&Support(Mileage) 229 Client Expenses:Transportation_Bus Passes,Lyft vouchers,mileage
2004 Clothing,Food,&Hygiene 312 Client Expenses:Clothes,shoes and hygiene products
2005 Education Support -
2006 Employment Support 208 Client Expenses:Work supplies,internet for job search,employment support supplies
2007 Household Items for Clients -
2008 Medication Supports
2009 Program Supplies-Medical
2010 Utility Vouchers
2011 Client Program Expense
2012 Contractual/Consulting Services(Psychiatrist)
2013 Program Telecommunication
2014 Other(specify)
2015 Other(specify)
2016 Other(specify)
3000:DIRECT OPERATING EXPENSES 37,764
3001 Telecommunications -
3002 Printing/Postage 1,799 Duplication,postage,and printing costs may include,but shall not be limited to,self-
addressed envelopes,appointment cards,business cards,letterhead stationery,
laminating,binding,cooperative program forms,master applications,job applications,
resumes,cover Letters,paper employment-related flyers,portfolio folders and pamphlets
and other programmatic printed needs.These expenses will allowfor program staff to
communicate effectivelywith partners,participants and their support network and
employers.Additionally,programmatic copier maintenance fees and supplies are an
allowable expense.
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3003 Office,Household&Program Supplies 425 Consumable office supplies necessaryfor staff required in the provision of program
services under the contract to be used duringthe contract period.Items to be purchased
include but are not limited to binder clips,binders,calculator tape,envelopes,file
folders,markers,paper clips,pencils,pens,post-it notes,printer cartridges,staples,
staplers,and stationary.This line item may also include items for the safety of personnel
and participants such as Personal Protective Equipment(PPE)and safety equipment
necessary.May include but not limited to masks,gloves,hand sanitizers,disinfectant
spray,Plexiglass barriers,first aid kits,fire extinguishers and temperature screeners.
3004 Advertising -
3005 Staff Development&Training 21,624 Includes training in the Evidence-Based Practices of Wellness and Recovery Action Plan,
Motivational Interviewing,and Seeking Safety,organ izationaltoots,team/organizational
psychology,philosophy of client based services,integration of roles/team dynamics,
assessment and individualized treatment planning,general services,organizing
admissions and individualized treatment planning associated with the EBPs.Also
includes CARF certification and other mandatorytrainings such as first aid and CPR.
3006 Staff Mileage 10,235 Mileage reimbursement is paid at the prevailing federal rate(currently$0.70 per mile)to
program service staff and program administrative staff.
3007 Subscriptions&Memberships 520 Co-op Department of Rehabilitation contract,agencies providing vocational rehabilitation
services,particularly those offering work-oriented programs,must be accredited bythe
Commission on Accreditation of Rehabilitation Facilities(CARF)in the primary program
emphasis of the services offered,with exceptions for certain facilities.
L3010
Vehicle Maintenance
General Liability Insurance
Direct Shared Allocated Regional Cost 3,161 These costs have been allocated to the program based on current year overhead
expenses and is limited by the program contract.This included all Shared Direct Expense
including Regional Copiers,Tablets,Occupancy Pool,Training Pool,and JEDI.
Other(specify)
Other(specify) -
4000:DIRECT FACILITIES&EQUIPMENT 100,144
4001 Occupancy(Rent,Utilities,Property Taxes/Local Fees) 76,158 This includes building rent or depreciation,storage and file storage unit rental payments
and all the costs associated with storing and retrieving of client,personnel or otherfiles or
records.Costs are allocated between programs on the basis of payroll dollars and have
been estimated based on historical trends and the utilization of the Agency's existing
office in Fresno.
4002 Facility Operation and Maintenance 10,546 This includes common area maintenance on leased building charges,
maintenance/building repair charges,HVAC maintenance and repair,landscaping,
janitorial services,confidential paper shredding services,in-house or outside equipment
repair and labor.Costs are allocated between programs on the basis of payroll dollars
and have been estimated based on historical trends and the utilization of the Agency's
existing office in Fresno.
4003 Rent/Lease Equipment 13,440 Equipment/Parts/Hosted Apps/Lic IT-Leased Laptops
4004 Security -
4005 Utilities
4006 Other(specify)
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify) -
5000:DIRECT SPECIAL EXPENSES 5,252
5001 Consultant(Network&Data Management) -
5002 HMIS(Health Management Information System) 5,252 This also includes lease or purchase of equipment such as networking equipment,
system&software user licenses and maintenance.
5003 Contractual/Consulting Services(Specify) -
5004 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit C-Attachment A
PROGRAM EXPENSE
ACCT#j LINE ITEM ANT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6000:INDIRECT EXPENSES 134,158
6001 Administrative Overhead 134,158 Represents the indirect costs of the Agency's general and administrative shared support
services such as finance,accounting,billing,human resources,clinical administration,
information technology,professional fees,HIPPA compliance and clinical record audits,
risk management and program fidelity,recruiting and human resources support,MIS
infrastructure&QI/UM department support and oversight as well as executive
management.Costs that cannot be specifically charged to a program are allocated to
programs on the basis of direct labor program costs prior to the addition of taxes and
benefits.Indirect costs have been budgeted at 15%of total program expenses.
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
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software This includes rental payments for equipment including leased copiers,postage
machines,phone systems,laptops or other communication,office or facility equipment.
Costs are allocated between programs on the basis of payroll dollars and have been
estimated based on historical trends and the utilization of the Agency's existing office in
Fresno.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Cell phones,Land Lines,DSL,fax charges,phone system;wireless cards for laptop
Data computers enabling UFS to maintain a fullyfunctional mobile work force to deliver in-
home/in the community services.Costs have been estimated based on historical trends
and space usage.
7003 Furniture&Fixtures
7004 Leasehold/Tenant/BuildingImprovements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 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
BYTHE RFP
8001 Mental Health Services The Department of Behavioral Health to provide recovery,vocational and educational
services and to promote wellness through supported employment and education in a
welcoming,accessible,recovery-oriented system where people with serious mental
illness and/or co-occurring disorders can achieve hope,healing,and a meaningful life
within their community.
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: 1,028,563
TOTAL PROGRAM EXPENSES FROM BUDGETTEMPLATE: 1,028,563
BUDGETCHECK: -
Fresno County Department of Behavioral Health Budget Template with Narrative Revised 2l7/2020
Exhibit D
Page 1 of 4
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1)the retroactive date must
be prior to the date on which services began under this Agreement; (2)the Contractor
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Contractor.
Exhibit D
Page 2 of 4
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under Article 11
of this Agreement; (iv) system failure; (v) data recovery; (vi) failure to timely disclose
data breach or Security Breach; (vii) failure to comply with privacy policy; (viii) payment
card liabilities and costs; (ix) infringement of intellectual property, including but not
limited to infringement of copyright, trademark, and trade dress; (x) invasion of privacy,
including release of private information; (xi) information theft; (xii) damage to or
destruction or alteration of electronic information; (xiii) cyber extortion; (xiv) extortion
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; (xv)fraudulent instruction; (xvi) funds
transfer fraud; (xvii) telephone fraud; (xviii) network security; (xix) data breach response
costs, including Security Breach response costs; (xx) regulatory fines and penalties
related to the Contractor's obligations under this Agreement regarding electronic
information, including Personal Information; and (xxi) credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement,
and at any time during the term of this Agreement as requested by the County, the
Contractors shall mail and email, or cause its broker or producer to mail and email, to
the County of Fresno, Department of Behavioral Health -Attention Plan Administration,
1925 E Dakota Ave, Fresno CA 93726, or electronically to
DBHPlanAdmin@fresnocountyca.gov with a copy to the assigned County's DBH Staff
Analyst, certificates of insurance and endorsements for all of the coverages required
under this Agreement.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and (3) the
Contractor has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned. The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
shall be excess only and not contributing with insurance provided under the
Contractor's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
Exhibit D
Page 3 of 4
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this Agreement.
(v) The cyber liability insurance certificate must also state that it is endorsed, and
include an endorsement, to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited
to information or data) that is in the care, custody, or control of the Contractor.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VI I.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, the Contractor shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, the Contractor shall, or shall
cause the insurer to, provide written notice to the County not less than 30 days in
advance of cancellation or change. The County in its sole discretion may determine that
the failure of the Contractor or its insurer to timely provide a written notice required by
this paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance
with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Contractor shall deliver, or cause its broker or producer
to deliver, to the County's Risk Manager certificates of insurance and endorsements for
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E) Waiver of Subrogation. The Contractor waives any right to recover from the County, its
officers, agents, employees, and volunteers any amounts paid under the policy of
worker's compensation insurance required by this Agreement. The Contractor is solely
responsible to obtain any policy endorsement that may be necessary to accomplish that
waiver, but the Contractor's waiver of subrogation under this paragraph is effective
whether or not the Contractor obtains such an endorsement.
(F) County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep
in effect at all times any insurance coverage required under this Agreement, the County
may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Contractor. The County may offset such
charges against any amounts owed by the County to the Contractor under this
Agreement.
Exhibit D
Page 4 of 4
(G)Subcontractors. The Contractor shall require and verify that all subcontractors used by
the Contractor to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement. This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
Exhibit E
Page 1 of 8
Data Security
1. Definitions
Capitalized terms used in this Exhibit have the meanings set forth in this section 1.
(A) "Authorized Employees" means the Contractor's employees who have access to
Personal Information.
(B) "Authorized Persons" means: (i) any and all Authorized Employees; and (ii) any and all
of the Contractor's subcontractors, representatives, agents, outsourcers, and
consultants, and providers of professional services to the Contractor, who have access
to Personal Information and are bound by law or in writing by confidentiality obligations
sufficient to protect Personal Information in accordance with the terms of this Exhibit.
(C)"Director" means the County's Director of the Department of Behavioral Health or his or
her designee.
(D) "Disclose" or any derivative of that word means to disclose, release, transfer,
disseminate, or otherwise provide access to or communicate all or any part of any
Personal Information orally, in writing, or by electronic or any other means to any person.
(E) "Person" means any natural person, corporation, partnership, limited liability company,
firm, or association.
(F) "Personal Information" means any and all information, including any data, provided, or
to which access is provided, to the Contractor by or upon the authorization of the
County, under this Agreement, including but not limited to vital records, that: (i) identifies,
describes, or relates to, or is associated with, or is capable of being used to identify,
describe, or relate to, or associate with, a person (including, without limitation, names,
physical descriptions, signatures, addresses, telephone numbers, e-mail addresses,
education, financial matters, employment history, and other unique identifiers, as well as
statements made by or attributable to the person); (ii) is used or is capable of being used
to authenticate a person (including, without limitation, employee identification numbers,
government-issued identification numbers, passwords or personal identification numbers
(PINs), financial account numbers, credit report information, answers to security
questions, and other personal identifiers); or (iii) is personal information within the
meaning of California Civil Code section 1798.3, subdivision (a), or 1798.80, subdivision
(e). Personal Information does not include publicly available information that is lawfully
made available to the general public from federal, state, or local government records.
(G)"Privacy Practices Complaint" means a complaint received by the County relating to
the Contractor's (or any Authorized Person's) privacy practices, or alleging a Security
Breach. Such complaint shall have sufficient detail to enable the Contractor to promptly
investigate and take remedial action under this Exhibit.
(H) "Security Safeguards" means physical, technical, administrative or organizational
security procedures and practices put in place by the Contractor (or any Authorized
Persons) that relate to the protection of the security, confidentiality, value, or integrity of
Personal Information. Security Safeguards shall satisfy the minimal requirements set
forth in section 3(C) of this Exhibit.
Exhibit E
Page 2of8
(1) "Security Breach" means (i) any act or omission that compromises either the security,
confidentiality, value, or integrity of any Personal Information or the Security Safeguards,
or (ii) any unauthorized Use, Disclosure, or modification of, or any loss or destruction of,
or any corruption of or damage to, any Personal Information.
(J) "Use" or any derivative of that word means to receive, acquire, collect, apply,
manipulate, employ, process, transmit, disseminate, access, store, disclose, or dispose
of Personal Information.
2. Standard of Care
(A) The Contractor acknowledges that, in the course of its engagement by the County under
this Agreement, the Contractor, or any Authorized Persons, may Use Personal
Information only as permitted in this Agreement.
(B) The Contractor acknowledges that Personal Information is deemed to be confidential
information of, or owned by, the County (or persons from whom the County receives or
has received Personal Information) and is not confidential information of, or owned or by,
the Contractor, or any Authorized Persons. The Contractor further acknowledges that all
right, title, and interest in or to the Personal Information remains in the County (or
persons from whom the County receives or has received Personal Information)
regardless of the Contractor's, or any Authorized Person's, Use of that Personal
Information.
(C)The Contractor agrees and covenants in favor of the Country that the Contractor shall:
(i) keep and maintain all Personal Information in strict confidence, using such
degree of care under this section 2 as is reasonable and appropriate to avoid a
Security Breach;
(ii) Use Personal Information exclusively for the purposes for which the Personal
Information is made accessible to the Contractor pursuant to the terms of this
Exhibit;
(iii) not Use, Disclose, sell, rent, license, or otherwise make available Personal
Information for the Contractor's own purposes or for the benefit of anyone other
than the County, without the County's express prior written consent, which the
County may give or withhold in its sole and absolute discretion; and
(iv) not, directly or indirectly, Disclose Personal Information to any person (an
"Unauthorized Third Party") other than Authorized Persons pursuant to this
Agreement, without the Director's express prior written consent.
(D) Notwithstanding the foregoing paragraph, in any case in which the Contractor believes it,
or any Authorized Person, is required to disclose Personal Information to government
regulatory authorities, or pursuant to a legal proceeding, or otherwise as may be
required by applicable law, Contractor shall (i) immediately notify the County of the
specific demand for, and legal authority for the disclosure, including providing County
with a copy of any notice, discovery demand, subpoena, or order, as applicable,
received by the Contractor, or any Authorized Person, from any government regulatory
authorities, or in relation to any legal proceeding, and (ii) promptly notify the County
Exhibit E
Page 3 of 8
before such Personal Information is offered by the Contractor for such disclosure so that
the County may have sufficient time to obtain a court order or take any other action the
County may deem necessary to protect the Personal Information from such disclosure,
and the Contractor shall cooperate with the County to minimize the scope of such
disclosure of such Personal Information.
(E) The Contractor shall remain liable to the County for the actions and omissions of any
Unauthorized Third Party concerning its Use of such Personal Information as if they
were the Contractor's own actions and omissions.
3. Information Security
(A) The Contractor covenants, represents and warrants to the County that the Contractor's
Use of Personal Information under this Agreement does and will at all times comply with
all applicable federal, state, and local, privacy and data protection laws, as well as all
other applicable regulations and directives, including but not limited to California Civil
Code, Division 3, Part 4, Title 1.81 (beginning with section 1798.80), and the Song-
Beverly Credit Card Act of 1971 (California Civil Code, Division 3, Part 4, Title 1.3,
beginning with section 1747). If the Contractor Uses credit, debit or other payment
cardholder information, the Contractor shall at all times remain in compliance with the
Payment Card Industry Data Security Standard ("PCI DSS") requirements, including
remaining aware at all times of changes to the PCI DSS and promptly implementing and
maintaining all procedures and practices as may be necessary to remain in compliance
with the PCI DSS, in each case, at the Contractor's sole cost and expense.
(B) The Contractor covenants, represents and warrants to the County that, as of the
effective date of this Agreement, the Contractor has not received notice of any violation
of any privacy or data protection laws, as well as any other applicable regulations or
directives, and is not the subject of any pending legal action or investigation by, any
government regulatory authority regarding same.
(C)Without limiting the Contractor's obligations under section 3(A) of this Exhibit, the
Contractor's (or Authorized Person's) Security Safeguards shall be no less rigorous than
accepted industry practices and, at a minimum, include the following:
(i) limiting Use of Personal Information strictly to the Contractor's and Authorized
Persons' technical and administrative personnel who are necessary for the
Contractor's, or Authorized Persons', Use of the Personal Information pursuant to
this Agreement;
(ii) ensuring that all of the Contractor's connectivity to County computing systems
will only be through the County's security gateways and firewalls, and only
through security procedures approved upon the express prior written consent of
the Director;
(iii) to the extent that they contain or provide access to Personal Information, (a)
securing business facilities, data centers, paper files, servers, back-up systems
and computing equipment, operating systems, and software applications,
including, but not limited to, all mobile devices and other equipment, operating
systems, and software applications with information storage capability; (b)
Exhibit E
Page 4 of 8
employing adequate controls and data security measures, both internally and
externally, to protect (1) the Personal Information from potential loss or
misappropriation, or unauthorized Use, and (2) the County's operations from
disruption and abuse; (c) having and maintaining network, device application,
database and platform security; (d) maintaining authentication and access
controls within media, computing equipment, operating systems, and software
applications; and (e) installing and maintaining in all mobile, wireless, or
handheld devices a secure internet connection, having continuously updated
anti-virus software protection and a remote wipe feature always enabled, all of
which is subject to express prior written consent of the Director;
(iv) encrypting all Personal Information at advance encryption standards of Advanced
Encryption Standards (AES) of 128 bit or higher (a) stored on any mobile
devices, including but not limited to hard disks, portable storage devices, or
remote installation, or (b) transmitted over public or wireless networks (the
encrypted Personal Information must be subject to password or pass phrase, and
be stored on a secure server and transferred by means of a Virtual Private
Network (VPN) connection, or another type of secure connection, all of which is
subject to express prior written consent of the Director);
(v) strictly segregating Personal Information from all other information of the
Contractor, including any Authorized Person, or anyone with whom the
Contractor or any Authorized Person deals so that Personal Information is not
commingled with any other types of information;
(vi) having a patch management process including installation of all operating system
and software vendor security patches;
(vii) maintaining appropriate personnel security and integrity procedures and
practices, including, but not limited to, conducting background checks of
Authorized Employees consistent with applicable law; and
(viii) providing appropriate privacy and information security training to Authorized
Employees.
(D) During the term of each Authorized Employee's employment by the Contractor, the
Contractor shall cause such Authorized Employees to abide strictly by the Contractor's
obligations under this Exhibit. The Contractor shall maintain a disciplinary process to
address any unauthorized Use of Personal Information by any Authorized Employees.
(E) The Contractor shall, in a secure manner, backup daily, or more frequently if it is the
Contractor's practice to do so more frequently, Personal Information received from the
County, and the County shall have immediate, real time access, at all times, to such
backups via a secure, remote access connection provided by the Contractor, through the
Internet.
(F) The Contractor shall provide the County with the name and contact information for each
Authorized Employee (including such Authorized Employee's work shift, and at least one
alternate Authorized Employee for each Authorized Employee during such work shift)
who shall serve as the County's primary security contact with the Contractor and shall be
Exhibit E
Page 5 of 8
available to assist the County twenty-four (24) hours per day, seven (7) days per week
as a contact in resolving the Contractor's and any Authorized Persons' obligations
associated with a Security Breach or a Privacy Practices Complaint.
(G)The Contractor shall not knowingly include or authorize any Trojan Horse, back door,
time bomb, drop dead device, worm, virus, or other code of any kind that may disable,
erase, display any unauthorized message within, or otherwise impair any County
computing system, with or without the intent to cause harm.
4. Security Breach Procedures
(A) Immediately upon the Contractor's awareness or reasonable belief of a Security Breach,
the Contractor shall (i) notify the Director of the Security Breach, such notice to be given
first by telephone at the following telephone number, followed promptly by email at the
following email addresses: incidents(a)fresnocountyca.gov, 559-600-5900, (which
telephone number and email address the County may update by providing notice to the
Contractor), and (ii) preserve all relevant evidence (and cause any affected Authorized
Person to preserve all relevant evidence) relating to the Security Breach. The notification
shall include, to the extent reasonably possible, the identification of each type and the
extent of Personal Information that has been, or is reasonably believed to have been,
breached, including but not limited to, compromised, or subjected to unauthorized Use,
Disclosure, or modification, or any loss or destruction, corruption, or damage.
(B) Immediately following the Contractor's notification to the County of a Security Breach, as
provided pursuant to section 4(A) of this Exhibit, the Parties shall coordinate with each
other to investigate the Security Breach. The Contractor agrees to fully cooperate with
the County, including, without limitation:
(i) assisting the County in conducting any investigation;
(ii) providing the County with physical access to the facilities and operations
affected;
(iii) facilitating interviews with Authorized Persons and any of the Contractor's other
employees knowledgeable of the matter; and
(iv) making available all relevant records, logs, files, data reporting and other
materials required to comply with applicable law, regulation, industry standards,
or as otherwise reasonably required by the County.
To that end, the Contractor shall, with respect to a Security Breach, be solely
responsible, at its cost, for all notifications required by law and regulation, or deemed
reasonably necessary by the County, and the Contractor shall provide a written report of
the investigation and reporting required to the Director within 30 days after the
Contractor's discovery of the Security Breach.
(C) County shall promptly notify the Contractor of the Director's knowledge, or reasonable
belief, of any Privacy Practices Complaint, and upon the Contractor's receipt of that
notification, the Contractor shall promptly address such Privacy Practices Complaint,
including taking any corrective action under this Exhibit, all at the Contractor's sole
expense, in accordance with applicable privacy rights, laws, regulations and standards.
Exhibit E
Page 6 of 8
In the event the Contractor discovers a Security Breach, the Contractor shall treat the
Privacy Practices Complaint as a Security Breach. Within 24 hours of the Contractor's
receipt of notification of such Privacy Practices Complaint, the Contractor shall notify the
County whether the matter is a Security Breach, or otherwise has been corrected and
the manner of correction, or determined not to require corrective action and the reason
for that determination.
(D)The Contractor shall take prompt corrective action to respond to and remedy any
Security Breach and take mitigating actions, including but not limiting to, preventing any
reoccurrence of the Security Breach and correcting any deficiency in Security
Safeguards as a result of such incident, all at the Contractor's sole expense, in
accordance with applicable privacy rights, laws, regulations and standards. The
Contractor shall reimburse the County for all reasonable costs incurred by the County in
responding to, and mitigating damages caused by, any Security Breach, including all
costs of the County incurred relation to any litigation or other action described section
4(E) of this Exhibit.
(E) The Contractor agrees to cooperate, at its sole expense, with the County in any litigation
or other action to protect the County's rights relating to Personal Information, including
the rights of persons from whom the County receives Personal Information.
5. Oversight of Security Compliance
(A) The Contractor shall have and maintain a written information security policy that
specifies Security Safeguards appropriate to the size and complexity of the Contractor's
operations and the nature and scope of its activities.
(B) Upon the County's written request, to confirm the Contractor's compliance with this
Exhibit, as well as any applicable laws, regulations and industry standards, the
Contractor grants the County or, upon the County's election, a third party on the
County's behalf, permission to perform an assessment, audit, examination or review of
all controls in the Contractor's physical and technical environment in relation to all
Personal Information that is Used by the Contractor pursuant to this Agreement. The
Contractor shall fully cooperate with such assessment, audit or examination, as
applicable, by providing the County or the third party on the County's behalf, access to
all Authorized Employees and other knowledgeable personnel, physical premises,
documentation, infrastructure and application software that is Used by the Contractor for
Personal Information pursuant to this Agreement. In addition, the Contractor shall
provide the County with the results of any audit by or on behalf of the Contractor that
assesses the effectiveness of the Contractor's information security program as relevant
to the security and confidentiality of Personal Information Used by the Contractor or
Authorized Persons during the course of this Agreement under this Exhibit.
(C)The Contractor shall ensure that all Authorized Persons who Use Personal Information
agree to the same restrictions and conditions in this Exhibit. that apply to the Contractor
with respect to such Personal Information by incorporating the relevant provisions of
these provisions into a valid and binding written agreement between the Contractor and
such Authorized Persons, or amending any written agreements to provide same.
Exhibit E
Page 7 of 8
6. Return or Destruction of Personal Information. Upon the termination of this Agreement,
the Contractor shall, and shall instruct all Authorized Persons to, promptly return to the County
all Personal Information, whether in written, electronic or other form or media, in its possession
or the possession of such Authorized Persons, in a machine readable form used by the County
at the time of such return, or upon the express prior written consent of the Director, securely
destroy all such Personal Information, and certify in writing to the County that such Personal
Information have been returned to the County or disposed of securely, as applicable. If the
Contractor is authorized to dispose of any such Personal Information, as provided in this Exhibit,
such certification shall state the date, time, and manner (including standard) of disposal and by
whom, specifying the title of the individual. The Contractor shall comply with all reasonable
directions provided by the Director with respect to the return or disposal of Personal Information
and copies of Personal Information. If return or disposal of such Personal Information or copies
of Personal Information is not feasible, the Contractor shall notify the County according,
specifying the reason, and continue to extend the protections of this Exhibit to all such Personal
Information and copies of Personal Information. The Contractor shall not retain any copy of any
Personal Information after returning or disposing of Personal Information as required by this
section 6. The Contractor's obligations under this section 6 survive the termination of this
Agreement and apply to all Personal Information that the Contractor retains if return or disposal
is not feasible and to all Personal Information that the Contractor may later discover.
7. Equitable Relief. The Contractor acknowledges that any breach of its covenants or
obligations set forth in this Exhibit may cause the County irreparable harm for which monetary
damages would not be adequate compensation and agrees that, in the event of such breach or
threatened breach, the County is entitled to seek equitable relief, including a restraining order,
injunctive relief, specific performance and any other relief that may be available from any court,
in addition to any other remedy to which the County may be entitled at law or in equity. Such
remedies shall not be deemed to be exclusive but shall be in addition to all other remedies
available to the County at law or in equity or under this Agreement.
8. Indemnity. The Contractor shall defend, indemnify and hold harmless the County, its
officers, employees, and agents, (each, a "County Indemnitee") from and against any and all
infringement of intellectual property including, but not limited to infringement of copyright,
trademark, and trade dress, invasion of privacy, information theft, and extortion, unauthorized
Use, Disclosure, or modification of, or any loss or destruction of, or any corruption of or damage
to, Personal Information, Security Breach response and remedy costs, credit monitoring
expenses, forfeitures, losses, damages, liabilities, deficiencies, actions, judgments, interest,
awards, fines and penalties (including regulatory fines and penalties), costs or expenses of
whatever kind, including attorneys' fees and costs, the cost of enforcing any right to
indemnification or defense under this Exhibit and the cost of pursuing any insurance providers,
arising out of or resulting from any third party claim or action against any County Indemnitee in
relation to the Contractor's, its officers, employees, or agents, or any Authorized Employee's or
Authorized Person's, performance or failure to perform under this Exhibit or arising out of or
resulting from the Contractor's failure to comply with any of its obligations under this section 8.
The provisions of this section 8 do not apply to the acts or omissions of the County. The
provisions of this section 8 are cumulative to any other obligation of the Contractor to, defend,
indemnify, or hold harmless any County Indemnitee under this Agreement. The provisions of
this section 8 shall survive the termination of this Agreement.
Exhibit E
Page 8 of 8
9. Survival. The respective rights and obligations of the Contractor and the County as stated
in this Exhibit shall survive the termination of this Agreement.
10. No Third Party Beneficiary. Nothing express or implied in the provisions of in this Exhibit is
intended to confer, nor shall anything in this Exhibit confer, upon any person other than the
County or the Contractor and their respective successors or assignees, any rights, remedies,
obligations or liabilities whatsoever.
11. No County Warranty. The County does not make any warranty or representation whether
any Personal Information in the Contractor's (or any Authorized Person's) possession or control,
or Use by the Contractor (or any Authorized Person), pursuant to the terms of this Agreement is
or will be secure from unauthorized Use, or a Security Breach or Privacy Practices Complaint.
Exhibit F
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County'),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit F
Page 2 of 2
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3)Disclosure(Please describe the nature of the self-dealing transaction you are a party to)
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a)
(5)Authorized Signature
Signature: Date:
Exhibit G
Page 1 of 3
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of Entity D/B/A
Address(number,street) City State ZIP Code
CILIA Number Taxpayer ID Number(EIN)/Social Security Number Telephone Number
( )
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list all names
and addresses (primary, every business location, and P.O. Box address)of individuals or corporations under"Remarks"on
page 2. Identify each item number to be continued.
A. Are there any individuals or organizations having a direct or indirect ownership or control interest YES No
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVIII, XIX, or XX?......................................................................................................................... n n
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX?...................................................................................... o 0
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... o 0
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses (primary, every business location, and P.O. Box address) under "Remarks" on page 2. If more than
one individual is reported and any of these persons are related to each other, this must be reported under"Remarks."
NAME DOB ADDRESS EIN
B. Type of entity: o Sole proprietorship o Partnership o Corporation
o Unincorporated Associations o Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... o 0
NAME DOB ADDRESS PROVIDER
Exhibit G
Page 2 of 3
YES NO
IV. A. Has there been a change in ownership or control within the last year?....................................................... n n
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... n n
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o n
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name FIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
Exhibit G
Page 3 of 3
INSTRUCTIONS FOR COMPLETING DISCLOSURE OF CONTROL AND INTEREST STATEMENT
Please answer all questions as of the current date. If the yes block for any item is checked,list requested additional information under
the Remarks Section on page 2,referencing the item number to be continued. If additional space is needed use an attached sheet.
DETAILED INSTRUCTIONS
These instructions are designed to clarify certain questions on the form.Instructions are listed in question order for easy reference.No
instructions have been given for questions considered self-explanatory.
IT IS ESSENTIAL THAT ALL APPLICABLE QUESTIONS BE ANSWERED ACCURATELY AND THAT ALL INFORMATION
BE CURRENT.
Item I-Under"Identifying Information"specify in what capacity the entity is doing business as(DBA)(e.g.name of trade or
corporation).
Item II- Self-explanatory
Item III-List the names of all individuals and organizations having direct or indirect ownership interests,or controlling interest
separately or in combination amounting to an ownership interest of 5 percent or more in the disclosing entity.
Direct ownership interest-is defined as the possession of stock,equity in capital or any interest in the profits of the disclosing entity.
A disclosing entity is defined as a Medicare provider or supplier,or other entity that furnishes services or arranges for furnishing
services under Medicaid or the Maternal and Child Health program,or health related services under the social services program.
Indirect ownership interest-is defined as ownership interest in an entity that has direct or hospital-based home health agencies,are not
indirect ownership interest in the disclosing entity. The amount of indirect ownership in the disclosing entity that is held by any other
entity is determined by multiplying the percentage of ownership interest at each level. An indirect ownership interest must beds in the
facility now and the previous be reported if it equates to an ownership interest of 5 percent or more in the disclosing entity.Example:
if A owns 10 percent of the stock in a corporation that owns 80 percent of the stock of the disclosing entity,A's interest equates to an 8
percent indirect ownership and must be reported.
Controlling interest-is defined as the operational direction or management of disclosing entity which may be maintained by any or all
of the following devices:the ability or authority,expressed or reserved,to amend or change the corporate identity(i.e.,joint venture
agreement,unincorporated business status)of the disclosing entity;the ability or authority to nominate or name members of the Board
of Directors or Trustees of the disclosing entity;the ability or authority,expressed or reserved,to amend or change the by-laws,
constitution,or other operating or management direction of the disclosing entity;the right to control any or all of the assets or other
property of the disclosing entity upon the sale or dissolution of that entity;the ability or authority,expressed or reserved,to control the
sale of any or all of the assets,to encumber such assets by way of mortgage or other indebtedness,to dissolve the entity or to arrange
for the sale or transfer of the disclosing entity to new ownership or control.
Item IV-VII-(Changes in Provider Status)For Items IV-VII,if the yes box is checked,list additional information requested under
Remarks. Clearly identify which item is being continued.
Change in provider status-is defined as any change in management control. Examples of such changes would include;a change in
Medical or Nursing Director,a new Administrator,contracting the operation of the facility to a management corporation,a change in
the composition of the owning partnership which under applicable State law is not considered a change in ownership, or the hiring or
dismissing of any employees with 5 percent or more financial interest in the facility or in an owning corporation,or any change of
ownership.
Item IV-(A&B)If there has been a change in ownership within the last year or if you anticipate a change,indicate the date in the
appropriate space.
Item V-If the answer is yes,list name of the management firm and employer identification number(EIN),or the name of the leasing
organization.A management company is defined as any organization that operates and manages a business on behalf of the owner of
that business,with the owner retaining ultimate legal responsibility for operation of the facility.
Item VI-If the answer is yes,identify which has changed(Administrator,Medical Director,or Director of Nursing)and the date the
change was made. Be sure to include name of the new Administrator,Director of Nursing or Medical Director,as appropriate.
Item VII-A chain affiliate is any free-standing health care facility that is either owned,controlled,or operated under lease or contract
by an organization consisting of two or more free-standing health care facilities organized within or across State lines which is under
the ownership or through any other device,control and direction of a common party. Chain affiliates include such facilities whether
public,private,charitable or proprietary. They also include subsidiary organizations and holding corporations. Provider-based
facilities,such as hospital-based home health agencies,are not considered to be chain affiliates.
Exhibit H
1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not
necessarily result in denial of participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide the certification set out
below. The certification or explanation will be considered in connection with the
department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation
shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which
reliance was placed when the department or agency determined to enter into this
transaction. If it is later determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency may terminate this transaction for
cause or default.
4. The prospective primary participant shall provide immediate written notice to
the department or agency to which this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant,
person, primary covered transaction, principal, proposal, and voluntarily excluded, as
used in this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may contact the
department or agency to which this proposal is being submitted for assistance in
obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment
of a system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
Exhibit H
2 of 2
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief,
that it, its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) (d) Have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(2) Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation
to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or
Company)