HomeMy WebLinkAboutAgreement A-25-586 with Kings View.pdf Agreement No. 25-586
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated November 18, 2025 and is between
3 Kings View, a California non-profit corporation ("Contractor"), and the County of Fresno, a
4 political subdivision of the State of California ("County").
5 Recitals
6 A. County, through its Department of Behavioral Health (DBH) is in need of a qualified
7 agency to operate Community Behavioral Health Crisis Response Services within the Fresno
8 metropolitan and rural areas as specified in this Agreement, to help reduce stigma and
9 discrimination against mental illness and provide mental health crisis intervention services in a
10 working partnership with Fresno metro and rural first responders.
11 B. On June 19,2023, pursuant to Section 14132.57 of Welfare and Institutions Code
12 (W&IC), the California Department of Health Care Services, hereinafter referred to as State or
13 DHCS, released guidance under Behavioral Health Information Notice 23-025 regarding
14 implementation of the Medi-Cal Community-Based Mobile Organized Delivery System (DMC-
15 ODS) by December 31, 2023.
16 C. On March 20, 2025, the County released Request for Proposal (RFP) No. 25-075
17 seeking a qualified Contractor for Community Behavioral Health Crisis Response services.
18 Addendum No. 1 to the RFP was release on April 8, 2025 to provide response to potential
19 bidder questions. RFP No. 25-075 closed on April 18, 2025. After a comprehensive evaluation,
20 Kings View was determined the most responsive bidder based on their extensive knowledge
21 and experience in Mobile Crisis Response and their knowledge of relevant rules, regulations,
22 principles, and guidelines.
23 D. County has determined that Contractor is qualified and willing to operate Community
24 Behavioral Health Crisis Response Services pursuant to the terms and conditions of this
25 Agreement.
26 E. Kings View is currently contracted with the County to provide these services under
27 County Agreement No. 24-148. The parties have agreed to extend their partnership in
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1 Community Behavioral Health Crisis Response to ensure crisis intervention services and mobile
2 crisis services continue within Fresno County metro and rural areas.
3 F. This Agreement will supersede Agreement No. 24-148 as amended by Agreement No.
4 24-439, and Agreement No. 25-223.
5 The parties therefore agree as follows:
6 Article 1
7 Contractor's Services
8 1.1 Scope of Services. The Contractor shall perform all of the services provided in
9 Exhibit A to this agreement, titled "Fresno County Department of Behavioral Health Scope of
10 Work".
11 1.2 The Contractor shall also perform all services and fulfill all responsibilities as
12 specified in County's Request for Proposal (RFP) issued under the name of"Community
13 Behavioral Health Crisis Response Services", RFP No. 25-075 dated March 20, 2025 and
14 Addendum No. One (1) to County's RFP No. 25-075 dated April 8, 2025 (collectively referred to
15 herein as County's Revised RFP) and Contractor's response to County's Revised RFP dated
16 April 18, 2025, all incorporated herein by reference and made part of this Agreement. In the
17 event of any inconsistency among these documents, the inconsistency shall be resolved by
18 giving precedence in the following order of priority: (1) to the Agreement, including all Exhibits;
19 (2) to the Revised RFP; and (3) to the Response to the Revised RFP. A copy of County's
20 Revised RFP and Contractor's response thereto shall be retained and made available during
21 the term of this Agreement by County's Department of Behavioral Health (DBH) Plan
22 Administration Division.
23 1.3 Representation. The Contractor represents that it is qualified, ready, willing, and
24 able to perform all of the services provided in this Agreement.
25 1.4 Compliance with Laws. The Contractor shall, at its own cost, comply with all
26 applicable federal, state, and local laws and regulations in the performance of its obligations
27 under this Agreement, including but not limited to workers compensation, labor, and
28 confidentiality laws and regulations. Additionally, Contractor shall comply with laws, regulations,
2
1 and requirements in Exhibit B to this agreement, titled "Fresno County Behavioral Health
2 Requirements".
3 Article 2
4 County's Responsibilities
5 2.1 The County shall provide oversight and collaborate with Contractor, other County
6 Departments and community agencies to help achieve program goals and outcomes. In addition
7 to contractor monitoring of program, oversight includes, but not limited to, coordination with
8 Department of Health Care Services (DHCS) in regard to program administration and outcomes.
9 2.2 County shall participate in evaluating the progress of the overall program, levels of
10 care components, and the efficiency of collaboration with the Contractor staff and will be
11 available to Contractor for ongoing consultation. County shall receive and analyze statistical
12 outcome data from Contractor throughout the term of contract. County shall notify the
13 Contractor when additional participation is required. The performance outcome measurement
14 process will not be limited to survey instruments but will also include, as appropriate, persons
15 served and staff surveys, chart reviews, and other methods of obtaining required information.
16 Article 3
17 Compensation, Invoices, and Payments
18 3.1 The County agrees to pay, and the Contractor agrees to receive compensation for
19 the performance of its services under this Agreement as described in Exhibit C to this
20 agreement, titled "Fresno County Department of Behavioral Health Financial Terms and
21 Conditions".
22 3.2 Additional Fiscal Requirements. The Contractor shall comply with all additional
23 requirements in Exhibit C to this Agreement.
24 Article 4
25 Term of Agreement
26 4.1 Term. This Agreement is effective on December 1, 2025 and terminates on June 30,
27 2028 except as provided in section 4.2, "Extension," or Article 6, "Termination and Suspension,"
28 below.
3
1 4.2 Extension. The term of this Agreement may be extended for no more than two, one-
2 year periods only upon written approval of both parties at least thirty (30) days before the first
3 day of the next one-year extension period. The County's DBH Director or his or her designee is
4 authorized to sign the written approval on behalf of the County based on the Contractor's
5 satisfactory performance. The extension of this Agreement by the County is not a waiver or
6 compromise of any default or breach of this Agreement by the Contractor existing at the time of
7 the extension whether or not known to the County.
8 Article 5
9 Notices
10 5.1 Contact Information. The persons and their addresses having authority to give and
11 receive notices provided for or permitted under this Agreement include the following:
12
For the County:
13 Director, Department of Behavioral Health
County of Fresno
14 1925 E Dakota Avenue
Fresno, CA 93726
15
For the Contractor:
16 Chief Executive Officer
Kings View
17 1396 W. Herndon Ave.
Fresno, CA 93711
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5.2 Change of Contact Information. Either party may change the information in section
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5.1 by giving notice as provided in section 5.3.
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5.3 Method of Delivery. Each notice between the County and the Contractor provided
21
for or permitted under this Agreement must be in writing, state that it is a notice provided under
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this Agreement, and be delivered either by personal service, by first-class United States mail, by
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an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
24
Document Format (PDF) document attached to an email.
25
(A) A notice delivered by personal service is effective upon service to the recipient.
26
(B) A notice delivered by first-class United States mail is effective three County
27
business days after deposit in the United States mail, postage prepaid, addressed to the
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recipient.
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1 (C)A notice delivered by an overnight commercial courier service is effective one (1)
2 County business day after deposit with the overnight commercial courier service,
3 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
4 the recipient.
5 (D)A notice delivered by telephonic facsimile transmission or by PDF document
6 attached to an email is effective when transmission to the recipient is completed (but, if
7 such transmission is completed outside of County business hours, then such delivery is
8 deemed to be effective at the next beginning of a County business day), provided that
9 the sender maintains a machine record of the completed transmission.
10 5.4 Claims Presentation. For all claims arising from or related to this Agreement,
11 nothing in this Agreement establishes, waives, or modifies any claims presentation
12 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
13 of Title 1 of the Government Code, beginning with section 810).
14 Article 6
15 Termination and Suspension
16 6.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
17 contingent on the approval of funds by the appropriating government agency. If sufficient funds
18 are not allocated, then the County, upon at least thirty (30) days' advance written notice to the
19 Contractor, may:
20 (A) Modify the services provided by the Contractor under this Agreement; or
21 (B) Terminate this Agreement.
22 6.2 Termination for Breach.
23 (A) Upon determining that a breach (as defined in paragraph (C) below) has
24 occurred, the County may give written notice of the breach to the Contractor. The written
25 notice may suspend performance under this Agreement, and must provide at least thirty
26 (30) days for the Contractor to cure the breach.
27 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
28 time stated in the written notice, the County may terminate this Agreement immediately.
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1 (C) For purposes of this section, a breach occurs when, in the determination of the
2 County, the Contractor has:
3 (1) Obtained or used funds illegally or improperly;
4 (2) Failed to comply with any part of this Agreement;
5 (3) Submitted a substantially incorrect or incomplete report to the County; or
6 (4) Improperly performed any of its obligations under this Agreement.
7 6.3 Termination without Cause. In circumstances other than those set forth above, the
8 County may terminate this Agreement by giving at least thirty (30) days advance written notice
9 to the Contractor.
10 6.4 Economic Sanctions. In accordance with Executive Order N-6-22 regarding
11 Economic Sanctions against Russia and Russian entities and individuals, the County may
12 terminate this Agreement if the Contractor is a target of Economic Sanctions or is conducting
13 prohibited transactions with sanctioned individuals or entities. The County shall provide at least
14 thirty (30) days advance written notice to the Contractor.
15 6.5 No Penalty or Further Obligation. Any termination of this Agreement by the County
16 under this Article 6 is without penalty to or further obligation of the County.
17 6.6 County's Rights upon Termination. Upon termination for breach under this Article
18 6, the County may demand repayment by the Contractor of any monies disbursed to the
19 Contractor under this Agreement that, in the County's sole judgment, were not expended in
20 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
21 demand. This section survives the termination of this Agreement.
22 Article 7
23 Independent Contractor
24 7.1 Status. In performing under this Agreement, the Contractor, including its officers,
25 agents, employees, and volunteers, is at all times acting and performing as an independent
26 contractor, in an independent capacity, and not as an officer, agent, servant, employee,joint
27 venturer, partner, or associate of the County.
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1 7.2 Verifying Performance. The County has no right to control, supervise, or direct the
2 manner or method of the Contractor's performance under this Agreement, but the County may
3 verify that the Contractor is performing according to the terms of this Agreement.
4 7.3 Benefits. Because of its status as an independent contractor, the Contractor has no
5 right to employment rights or benefits available to County employees. The Contractor is solely
6 responsible for providing to its own employees all employee benefits required by law. The
7 Contractor shall save the County harmless from all matters relating to the payment of
8 Contractor's employees, including compliance with Social Security withholding and all related
9 regulations.
10 7.4 Services to Others. The parties acknowledge that, during the term of this
11 Agreement, the Contractor may provide services to others unrelated to the County.
12 Article 8
13 Indemnity and Defense
14 8.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
15 County (including its officers, agents, employees, and volunteers) against all claims, demands,
16 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
17 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
18 the performance or failure to perform by the Contractor (or any of its officers, agents,
19 subcontractors, or employees) under this Agreement. The County may conduct or participate in
20 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
21 defend the County.
22 8.2 Survival. This Article 8 survives the termination of this Agreement.
23 Article 9
24 Insurance
25 9.1 The Contractor shall comply with all the insurance requirements in Exhibit D to this
26 Agreement.
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1 Article 10
2 Inspections, Audits, and Public Records
3 10.1 Inspection of Documents. The Contractor shall make available to the County, and
4 the County may examine at any time during business hours and as often as the County deems
5 necessary, all of the Contractor's records and data with respect to the matters covered by this
6 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
7 request by the County, permit the County to audit and inspect all of such records and data to
8 ensure the Contractor's compliance with the terms of this Agreement.
9 10.2 State Audit Requirements. If the compensation to be paid by the County under this
10 Agreement exceeds $10,000, the Contractor is subject to the examination and audit of the
11 California State Auditor, as provided in Government Code section 8546.7, for a period of three
12 (3) years after final payment under this Agreement. This section survives the termination of this
13 Agreement.
14 10.3 Public Records. The County is not limited in any manner with respect to its public
15 disclosure of this Agreement or any record or data that the Contractor may provide to the
16 County. The County's public disclosure of this Agreement or any record or data that the
17 Contractor may provide to the County may include but is not limited to the following:
18 (A) The County may voluntarily, or upon request by any member of the public or
19 governmental agency, disclose this Agreement to the public or such governmental
20 agency.
21 (B) The County may voluntarily, or upon request by any member of the public or
22 governmental agency, disclose to the public or such governmental agency any record or
23 data that the Contractor may provide to the County, unless such disclosure is prohibited
24 by court order.
25 (C)This Agreement, and any record or data that the Contractor may provide to the
26 County, is subject to public disclosure under the Ralph M. Brown Act (California
27 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
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1 (D) This Agreement, and any record or data that the Contractor may provide to the
2 County, is subject to public disclosure as a public record under the California Public
3 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
4 with section 6250) ("CPRA").
5 (E) This Agreement, and any record or data that the Contractor may provide to the
6 County, is subject to public disclosure as information concerning the conduct of the
7 people's business of the State of California under California Constitution, Article 1,
8 section 3, subdivision (b).
9 (F) Any marking of confidentiality or restricted access upon or otherwise made with
10 respect to any record or data that the Contractor may provide to the County shall be
11 disregarded and have no effect on the County's right or duty to disclose to the public or
12 governmental agency any such record or data.
13 10.4 Public Records Act Requests. If the County receives a written or oral request
14 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
15 and which the County has a right, under any provision of this Agreement or applicable law, to
16 possess or control, then the County may demand, in writing, that the Contractor deliver to the
17 County, for purposes of public disclosure, the requested records that may be in the possession
18 or control of the Contractor. Within five (5) business days after the County's demand, the
19 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's
20 possession or control, together with a written statement that the Contractor, after conducting a
21 diligent search, has produced all requested records that are in the Contractor's possession or
22 control, or (b) provide to the County a written statement that the Contractor, after conducting a
23 diligent search, does not possess or control any of the requested records. The Contractor shall
24 cooperate with the County with respect to any County demand for such records. If the
25 Contractor wishes to assert that any specific record or data is exempt from disclosure under the
26 CPRA or other applicable law, it must deliver the record or data to the County and assert the
27 exemption by citation to specific legal authority within the written statement that it provides to
28 the County under this section. The Contractor's assertion of any exemption from disclosure is
9
1 not binding on the County, but the County will give at least ten (10) days' advance written notice
2 to the Contractor before disclosing any record subject to the Contractor's assertion of exemption
3 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs
4 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption,
5 failure to produce any such records, or failure to cooperate with the County with respect to any
6 County demand for any such records.
7 Article 11
8 Data Security
9 11.1 The Contractor shall be responsible for the privacy and security safeguards, as
10 identified in Exhibit E to this agreement, titled "Data Security." To the extent required to carry out
11 the assessment and authorization process and continuous monitoring, to safeguard against
12 threats and hazards to the security, integrity, and confidentiality of any County data collected
13 and stored by the Contractor, the Contractor shall afford the County access as necessary at the
14 Contractor's reasonable discretion, to the Contractor's facilities, installations, and technical
15 capabilities. If new or unanticipated threats or hazards are discovered by either the County or
16 the Contractor, or if existing safeguards have ceased to function, the discoverer shall
17 immediately bring the situation to the attention of the other party.
18 Article 12
19 Disclosure of Self-Dealing Transactions
20 12.1 Applicability. This Article 12 applies if the Contractor is operating as a corporation,
21 or changes its status to operate as a corporation.
22 12.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
23 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
24 "Self-Dealing Transaction Disclosure Form" (Exhibit F to this Agreement) and submitting it to the
25 County before commencing the transaction or immediately after.
26 12.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
27 a party and in which one or more of its directors, as an individual, has a material financial
28 interest.
10
1 Article 13
2 Disclosure of Ownership and/or Control Interest Information
3 13.1 Applicability. This provision is only applicable if Contractor is disclosing entities,
4 fiscal agents, or managed care entities, as defined in Code of Federal Regulations (C.F.R.),
5 Title 42 §§ 455.101, 455.104 and 455.106(a)(1),(2).
6 13.2 Duty to Disclose. Contractor must disclose the following information as requested in
7 the Provider Disclosure Statement, Disclosure of Ownership and Control Interest Statement,
8 Exhibit G:
9 (A) Disclosure of Five Percent (5%) or More Ownership Interest:
10 (1) In the case of corporate entities with an ownership or control interest in the
11 disclosing entity, the primary business address as well as every business location
12 and P.O. Box address must be disclosed. In the case of an individual, the date of
13 birth and Social Security number must be disclosed.
14 (2) In the case of a corporation with ownership or control interest in the
15 disclosing entity or in any subcontractor in which the disclosing entity has a five
16 percent (5%) or more interest, the corporation tax identification number must be
17 disclosed.
18 (3) For individuals or corporations with ownership or control interest in any
19 subcontractor in which the disclosing entity has a five percent (5%) or more interest,
20 the disclosure of familial relationship is required.
21 (4) For individuals with five percent (5%) or more direct or indirect ownership
22 interest of a disclosing entity, the individual shall provide evidence of completion of a
23 criminal background check, including fingerprinting, if required by law, prior to
24 execution of Contract. (42 C.F.R. § 455.434)
25 (B) Disclosures Related to Business Transactions:
26 (1) The ownership of any subcontractor with whom Contractor has had business
27 transactions totaling more than $25,000 during the twelve (12) month period ending
28 on the date of the request.
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1 (2) Any significant business transactions between Contractor and any wholly
2 owned supplier, or between Contractor and any subcontractor, during the five (5)
3 year period ending on the date of the request. (42 C.F.R. § 455.105(b).)
4 (C) Disclosures Related to Persons Convicted of Crimes:
5 (1) The identity of any person who has an ownership or control interest in the
6 provider or is an agent or managing employee of the provider who has been
7 convicted of a criminal offense related to that person's involvement in any program
8 under the Medicare, Medicaid, or the Title XXI services program since the inception
9 of those programs. (42 C.F.R. § 455.106.)
10 (2) County shall terminate the enrollment of Contractor if any person with five
11 percent (5%) or greater direct or indirect ownership interest in the disclosing entity
12 has been convicted of a criminal offense related to the person's involvement with
13 Medicare, Medicaid, or Title XXI program in the last ten (10) years.
14 13.3 Contractor must provide disclosure upon execution of Contract, extension for
15 renewal, and within thirty-five (35) days after any change in Contractor ownership or upon
16 request of County. County may refuse to enter into an agreement or terminate an existing
17 agreement with Contractor if Contractor fails to disclose ownership and control interest
18 information, information related to business transactions and information on persons convicted
19 of crimes, or if Contractor did not fully and accurately make the disclosure as required.
20 13.4 Contractor must provide the County with written disclosure of any prohibited
21 affiliations under 42 C.F.R. § 438.610. Contractor must not employ or subcontract with providers
22 or have other relationships with providers Excluded from participation in Federal Health Care
23 Programs, including Medi-Cal/Medicaid or procurement activities, as set forth in 42 C.F.R.
24 §438.610.
25 13.5 Reporting. Submissions shall be scanned pdf copies and are to be sent via email to
26 DBHPlanAd min istration(a-)_fresnocountyca.go\, with a copy sent via email to the assigned DBH
27 Contract Analyst. County may deny enrollment or terminate this Agreement where any person
28 with five percent (5%) or greater direct or indirect ownership interest in Contractor has been
12
1 convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid,
2 or Title XXI program in the last ten (10) years. County may terminate this Agreement where any
3 person with five percent (5%) or greater direct or indirect ownership interest in the Contractor
4 did not submit timely and accurate information and cooperate with any screening method
5 required in C.F,R, Title 42, Section 455.416
6 Article 14
7 Disclosure of Criminal History and Civil Actions
8 14.1 Applicability. Contractor is required to disclose if any of the following conditions apply
9 to them, their owners, officers, corporate managers, or partners (hereinafter collectively referred
10 to as "Contractor"):
11 (A) Within the three (3) year period preceding the Agreement award, they have been
12 convicted of, or had a civil judgment tendered against them for:
13 (1) Fraud or criminal offense in connection with obtaining, attempting to obtain,
14 or performing a public (federal, state, or local) transaction or contract under a public
15 transaction;
16 (2) Violation of a federal or state antitrust statute;
17 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
18 or
19 (4) False statements or receipt of stolen property.
20 (B) Within a three (3) year period preceding their Agreement award, they have had a
21 public transaction (federal, state, or local) terminated for cause or default.
22 14.2 Duty to Disclose. Disclosure of the above information will not automatically eliminate
23 Contractor from further business consideration. The information will be considered as part of the
24 determination of whether to continue and/or renew this Agreement and any additional
25 information or explanation that Contractor elects to submit with the disclosed information will be
26 considered. If it is later determined that the Contractor failed to disclose required information,
27 any contract awarded to such Contractor may be immediately voided and terminated for
28 material failure to comply with the terms and conditions of the award.
13
1 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
2 Responsible Matters— Primary Covered Transactions" in the form set forth in Exhibit H.
3 Additionally, Contractor must immediately advise the County in writing if, during the term of the
4 Agreement: (1) Contractor becomes suspended, debarred, excluded or ineligible for
5 participation in Federal or State funded programs or from receiving federal funds as listed in the
6 excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions
7 become applicable to Contractor. Contractor shall indemnify, defend, and hold County harmless
8 for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility, or other
9 matter listed in the signed Certification Regarding Debarment, Suspension, and Other
10 Responsibility Matters.
11 Article 15
12 General Terms
13 15.1 Modification. Except as provided in Article 6, "Termination and Suspension," this
14 Agreement may not be modified, and no waiver is effective, except by written agreement signed
15 by both parties. The Contractor acknowledges that County employees have no authority to
16 modify this Agreement except as expressly provided in this Agreement.
17 (A) Notwithstanding the above, non-material changes to services, staffing, and
18 responsibilities of the Contractor, as needed, to accommodate changes in the laws
19 relating to service requirements, may be made with the signed written approval of
20 County's DBH Director, or designee, and Contractor through an amendment approved
21 by County's County Counsel and the County's Auditor-Controller/Treasurer-Tax
22 Collector's Office. Said modifications shall not result in any change to the maximum
23 compensation amount payable to Contractor, as stated herein.
24 15.2 Rate Modification. In addition, changes to service rates on Exhibit C —Attachment
25 A that do not exceed five percent (5%) of the approved rate, or that are needed to
26 accommodate state-mandated rate increases, may be made with the written approval of the
27 DBH Director, or designee, subject to applicable legislation, availability of funds and review of
28 Contractor performance. These rate changes may not add or alter any other terms or conditions
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1 of the Agreement. Said modifications shall not result in any change to the annual maximum
2 compensation amount payable to Contractor, as stated herein.
3 (A) Budget Modification. Changes to Expense Category amounts, which, when
4 aggregated, do not exceed ten percent (10%) of the total maximum compensation
5 payable to Contractor for the entire contract term, may be made with the written approval
6 of Contractor(s) and County's DBH Director or designee. Said modifications are subject
7 to County's DBH review in accordance with the Budget Modification Request Guide
8 available at https://www.fresnocountyca.gov/Departments/Behavioral-
9 Health/Providers/Contract-Provider-Resources/Notifications-Associated-Documents.
10 15.3 Non-Assignment. Neither party may assign its rights or delegate its obligations
11 under this Agreement without the prior written consent of the other party.
12 15.4 Governing Law. The laws of the State of California govern all matters arising from
13 or related to this Agreement.
14 15.5 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
15 County, California. Contractor consents to California jurisdiction for actions arising from or
16 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
17 brought and maintained in Fresno County.
18 15.6 Construction. The final form of this Agreement is the result of the parties' combined
19 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
20 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
21 against either party.
22 15.7 Days. Unless otherwise specified, "days" means calendar days.
23 15.8 Headings. The headings and section titles in this Agreement are for convenience
24 only and are not part of this Agreement.
25 15.9 Severability. If anything in this Agreement is found by a court of competent
26 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
27 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
28
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1 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
2 intent.
3 15.10 Nondiscrimination. During the performance of this Agreement, the Contractor shall
4 not unlawfully discriminate against any employee or applicant for employment, or recipient of
5 services, because of race, religious creed, color, national origin, ancestry, physical disability,
6 mental disability, medical condition, genetic information, marital status, sex, gender, gender
7 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
8 all applicable State of California and federal statutes and regulation.
9 Contractor shall take affirmative action to ensure that services to intended beneficiaries
10 are provided without use of any policy or practice that has the effect of discriminating on the
11 basis of race, color, religion, ancestry, marital status, national origin, ethnic group identification,
12 sex, sexual orientation, gender, gender identity, age, medical condition, genetic information,
13 health status or need for health care services, or mental or physical disability.
14 15.11 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
15 of the Contractor under this Agreement on any one or more occasions is not a waiver of
16 performance of any continuing or other obligation of the Contractor and does not prohibit
17 enforcement by the County of any obligation on any other occasion.
18 15.12 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
19 between the Contractor and the County with respect to the subject matter of this Agreement,
20 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
21 publications, and understandings of any nature unless those things are expressly included in
22 this Agreement. If there is any inconsistency between the terms of this Agreement without its
23 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
24 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
25 exhibits.
26 15.13 No Third-Party Beneficiaries. This Agreement does not and is not intended to
27 create any rights or obligations for any person or entity except for the parties.
28 15.14 Authorized Signature. The Contractor represents and warrants to the County that:
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1 (A) The Contractor is duly authorized and empowered to sign and perform its
2 obligations under this Agreement.
3 (B) The individual signing this Agreement on behalf of the Contractor is duly
4 authorized to do so and his or her signature on this Agreement legally binds the
5 Contractor to the terms of this Agreement.
6 15.15 Electronic Signatures. The parties agree that this Agreement may be executed by
7 electronic signature as provided in this section.
8 (A) An "electronic signature" means any symbol or process intended by an individual
9 signing this Agreement to represent their signature, including but not limited to (1) a
10 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
11 electronically scanned and transmitted (for example by PDF document) version of an
12 original handwritten signature.
13 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
14 equivalent to a valid original handwritten signature of the person signing this Agreement
15 for all purposes, including but not limited to evidentiary proof in any administrative or
16 judicial proceeding, and (2) has the same force and effect as the valid original
17 handwritten signature of that person.
18 (C)The provisions of this section satisfy the requirements of Civil Code section
19 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
20 Part 2, Title 2.5, beginning with section 1633.1).
21 (D) Each party using a digital signature represents that it has undertaken and
22 satisfied the requirements of Government Code section 16.5, subdivision (a),
23 paragraphs (1) through (5), and agrees that each other party may rely upon that
24 representation.
25 (E) This Agreement is not conditioned upon the parties conducting the transactions
26 under it by electronic means and either party may sign this Agreement with an original
27 handwritten signature.
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1 15.16 Counterparts. This Agreement may be signed in counterparts, each of which is an
2 original, and all of which together constitute this Agreement.
3 [SIGNATURE PAGE FOLLOWS]
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Docusign Envelope ID:C564338A-4D8F-443C-BF62-DF998C15AOC7
1 The parties are signing this Agreement on the date stated in the introductory clause.
2
Kings View COUNTY OF FRESNO
3
Signed by:
4 Q... .,.4
5 ,AfAbhftI lugent Divine, PhD, CEO Ernest Buddy Men , Chairman of the
6 1396 W. Herndon Ave. Board of Supervisors of the County of Fresno
Fresno, CA 93711 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.: 56304766 (CIT) 56302254 (MCRT-Y) 56302363 (MCRT)
Account No.: 7295
13 Fund No,: 0001
Subclass No. 10000
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Exhibit A
Page 1 of 15
FRESNO COUNTY
DEPARTMENT OF BEHAVIORAL HEALTH
SCOPE OF WORK
I. PROGRAM NAME —Community Behavioral Health Crisis Response Services
II. BACKGROUND
a. Department of Behavioral Health (DBH) initiated a pilot program in 2017 with
crisis intervention field clinicians providing co-response and co-location with
Fresno Police Department officers dedicated to responding to crisis calls.
Evaluation of the initial phase of the pilot indicated that the need for this type of
Crisis Intervention Team (CIT) services is far greater. The CIT program also
included include outreach and education for emergency first responders, mental
health persons served, and the community at large.
b. The State of California's Department of Health Care Services' Behavioral Health
Information Notice (BHIN) No. 23-025 required Fresno County to establish a
program by January 9, 2024, that delivers non-law enforcement crisis
intervention services around the clock. The program requires teams of two (2)
available 24/7/365, a Mobile Crisis Hotline, and 72-hour case management
follow-up support.
III. TARGET POPULATION
a. CIT: Any individual currently experiencing an acute behavioral health crisis,
including any behavioral health signs and symptoms, requiring immediate crisis
intervention, de-escalation, and triage services within the Fresno metropolitan
(metro) and rural areas. Request for behavioral health response will be from
law enforcement.
b. Mobile Crisis Response Team (MCRT):Any individuals currently experiencing
an acute behavioral health crisis, including any behavioral health signs and
symptoms, requiring immediate crisis intervention, de-escalation, within the
Fresno metropolitan (metro) and rural areas. Mobile Crisis response requires
specific elements to qualify for this service and Contractor shall ensure the
elements are met. If requirements are not met, Contractor shall utilize other
appropriate service designation such as but not limited to crisis intervention.
IV. DESCRIPTION OF SERVICES
Exhibit A
Page 2 of 15
a. Services Start Date: December 1, 2025.
b. Summary of Services:
i. DBH is committed to the ongoing growth and enhancement of its
community behavioral health crisis response services program. The
Contractor will be expected to implement a program that is not only
effective and efficient but also scalable to meet the evolving needs of the
community. The program should incorporate innovative approaches to
crisis response, ensuring that services remain responsive to both current
and future demands. Efforts to streamline processes, improve service
delivery, and enhance person served outcomes will be essential. The
Contractor will also be expected to regularly evaluate program
performance, identify opportunities for continuous improvement, and
introduce new strategies or technologies that foster greater efficiency and
effectiveness in service provision.
ii. Mobile Crisis Services were implemented on January 23, 2024, and
services for Mobile Crisis Services are expected to increase year over
year. Contractor shall ensure to collaborate and advertise the service to
ensure community awareness and encourage the use of mobile crisis
services.
iii. The Contractor shall provide the following services in an individual
centered, recovery oriented, strengths-based, and trauma informed
manner. Individuals shall be served with cultural humility and shall be
supported systematically (family support, physical health, housing
resources, vocational services, etc.)
1. CIT
a. The Contractor shall provide CIT services throughout
Fresno metro and rural areas including areas under Sheriff
Jurisdiction, known as "County Islands".
b. Services will be provided in a unit consisting of field
clinicians and law enforcement officers, providing
compassionate, person/family centered crisis interventions
to persons served and their support systems that are
Exhibit A
Page 3 of 15
experiencing behavioral health signs and symptoms.
c. Services should be flexible to the needs of rural Fresno
County communities and may include other rural cities and
areas between and around the indicated cities that may be
served by Sheriff Jurisdiction.
d. Contractor is expected to coordinate and build
relationships with law enforcement and community
agencies and partners including hospitals, schools, and
behavioral health providers.
e. Contractor and DBH will work with participating law
enforcement agencies to identify appropriate sites where
CIT staff and law enforcement officers shall be co-located
in order to provide co-response for the purpose of
providing rapid, effective, recovery/well-being-oriented
crisis services.Available co-location sites may vary by
agency and may be modified during the term of the
Agreement.
2. Mobile Crisis Response Team (MCRT Adult and Youth)
a. Contractor shall establish a mobile crisis response team to
provide a rapid response, individual assessment and
community-based stabilization to persons served who are
experiencing a behavioral health crisis.
b. MCRT services shall be designed to provide relief to
persons served experiencing a behavioral health crisis,
including through de-escalation and stabilization
techniques; reduce the immediate risk of danger and
subsequent harm; and avoid unnecessary emergency
department care, psychiatric inpatient hospitalizations, and
law enforcement involvement.
c. While mobile crisis services are intended to support an
integrated approach to responding to both mental and
Exhibit A
Page 4 of 15
substance use related crises, and mobile crisis teams will
be carrying, trained, and able to administer naloxone, this
team is not intended to replace emergency medical
services for medical emergencies.
d. Contractor shall not respond with law enforcement unless
special safety concerns warrant inclusion.A law
enforcement officer does not quality as a member of the
mobile crisis team. The goal of MCRT is to provide more
efficient access to crisis services to person served, with the
main goal of deescalating the situation to avoid an
emergency room visit and/or placement within an inpatient
facility.
Dispatch (MCRT Adult and Youth)
i. Crisis Services Hotline: DBH has identified a single
telephone number, (559) 600-6000, to serve as the
crisis services hotline connected to the dispatch of
mobile crisis teams to receive and triage person-
served calls. The County's 24/7 Access Line,
community partners, and other crisis lines such as
the 988 Suicide and Crisis Lifeline, local law
enforcement and 911 systems, and the Family
Urgent Response System (FURS) will be able to
refer calls to the county mobile crisis service
hotline.
ii. Standardized Dispatch Tool: Contractor shall staff
the hotline with operators who shall use a
standardized dispatch tool and procedures to
determine when to dispatch a mobile crisis team,
versus determine when the person served needs
can be addressed via alternative means. These
means include, but are not limited to, de-escalation
by the hotline operator or connection to other
services. The hotline operator may also determine
Exhibit A
Page 5 of 15
that the call needs to be routed to emergency
services if the situation has developed into a safety
risk.
iii. Mobile Crisis Services Providers' Response to
Dispatch Requests: If an individual has been
screened either directly, or through an individual
calling on their behalf to request assistance, and
the dispatch tool has been used to determine that
the individual requires mobile crisis services,
Contractor shall dispatch a team to respond to the
individual. When it is dispatched, the mobile crisis
team shall meet the individual who is experiencing
the behavioral health crisis in the location where
the crisis occurs, unless the individual requests to
be met in an alternate location in the community or
cannot be located.
iv. Standard Response Times: Contractor shall ensure
teams arrive at the community-based location
where the crisis occurs in a timely manner.
Specifically, teams shall arrive:
1. Within 60 minutes of the individual being
determined to require mobile crisis services
in urban areas; and
2. Within 120 minutes of the individual being
determined to require mobile crisis services
in rural areas.
3. Contractor will provide monthly reports to
include response time and work
collaboratively to address barriers.
v. MCRT Team Requirements for Initial Crisis
Response: Contractor shall have teams of at least
two (2) staff available for the duration of the initial
mobile crisis response, per BHIN 23-025.
Exhibit A
Page 6 of 15
1. It is best practice for at least two (2)
providers to be physical present onsite, but
Contractor may allow one of the two
required team members to participate via
telehealth. Contractor may provide services
in this manner only if such an arrangement:
a. Is necessary because it otherwise
would result in a marked delay in a
mobile crisis team's response time;
and
b. The use of such an arrangement
poses no safety concerns for the
individual or the single mobile crisis
team member who is physically
onsite during the initial mobile crisis
response.
2. At least one (1) onsite mobile crisis team
member shall be carrying, trained, and able
to administer naloxone;
3. At least one (1) onsite mobile crisis team
members shall be able to conduct a crisis
assessment;
4. The mobile crisis team providing the initial
mobile crisis response shall include or have
access to a Licensed Practitioner of the
Healing Arts (LPHA) as defined in the
"Substance Use Disorder (SUD)Treatment
Services" or"Expanded SUD Treatment
Services" section of Supplement 3 to
Attachment 3.1-A of the State Plan, or a
Licensed Mental Health Professional,
including a licensed physician, licensed
Exhibit A
Page 7 of 15
psychologist, licensed clinical social worker,
licensed professional clinical counselor,
licensed marriage and family therapist,
registered nurse, licensed vocational nurse,
or licensed psychiatric technician.
3. Community Behavioral Health Crisis Response (CIT and MCRT
Adult and Youth)
The following service requirements are for both program
components.
a. Initial Face to Face Crisis Assessment: Contractor shall
provide a brief, face-to-face crisis assessment to evaluate
the current status of the individual experiencing the
behavioral health crisis with the goal of mitigating any
immediate risk of danger to self or others, determining a
short-term strategy for restoring stability, and identifying
follow-up care, as appropriate.
b. Mobile Crisis Response: The team will intervene to de-
escalate the behavioral health crisis and stabilize the
individual at the location where the crisis occurs, unless
the individual requests to be met in an alternate location in
the community.
i. The mobile crisis response may include, but is not
limited to:
1. Trauma-informed on-site intervention for
immediate de-escalation of behavioral
health crises;
2. Skill development, psychosocial education
and initial identification of resources needed
to stabilize the individual;
3. Immediate coordination with other providers
involved in the individual's care. Immediate
Exhibit A
Page 8 of 15
coordination with other crisis receiving and
stabilization facilities (e.g., sobering centers,
crisis respite, crisis stabilization units,
psychiatric health facilities, psychiatric
inpatient hospitals, general acute care
hospitals, crisis residential treatment
programs, etc.); and
4. Provision of harm reduction interventions,
including the administration of naloxone to
reverse an opioid overdose, as needed.
c. Crisis Planning: The team shall engage individuals and
their significant support collateral(s), as appropriate, in
crisis planning to avert future crises. Crisis planning
includes identifying conditions and factors that contribute
to a crisis, reviewing alternative ways of responding to
such conditions and factors, and identifying steps that the
individual can take to avert or address a crisis
A written crisis safety plan may be developed and should
address potential threats (e.g., firearms, medications),
crisis triggers, response strategies, skill development,
psychiatric directives, and harm reduction strategies.
d. Facilitation of a Warm Handoff: If it is determined a higher
level of care, such as a sobering center, crisis stabilization
unit, or psychiatric facility is required, the team will connect
the person served to the appropriate services by facilitating
a warm handoff. The team shall arrange or provide
transportation to ensure the transfer is smooth and
effective.
e. Referrals to Ongoing Services: Referrals to ongoing
mental health or SUD treatment, community-based
supports, social services, or other resources to reduce the
risk of future crises can be made during the initial crisis
Exhibit A
Page 9 of 15
response or follow-up check-ins as needed. All referrals
must be documented in the person-served progress notes.
Potential referral sources include:
i. Primary care providers
ii. Outpatient behavioral health providers
iii. Medication prescribers for mental health or SUD
iv. Indian Health Care Providers
v. Disability service providers (e.g., Regional Centers)
vi. Programs offering intensive care services
(Intensive Care Coordination, Intensive Home
Based Services, Therapeutic Foster Care)
vii. Crisis stabilization facilities
viii. Community support and mutual aid groups (e.g.,
National Alliance on Mental Illness, Alcoholics
Anonymous, Narcotics Anonymous)
ix. Care coordination services through the individual's
Managed Care Plan (MCP)
x. Housing and community support services
f. Follow Ups and Check In: Contractor must ensure that
individuals receive a follow-up check-in within 72 hours of
the initial crisis response to help continue resolving the
crisis, update the crisis safety plan, and make additional
referrals as necessary.
i. If person served received a referral to ongoing
supports during initial crisis response, the team
shall check on the status of appointments and
assists with scheduling, transportation, and
reminders as needed.
ii. Post crisis services shall be provided for a minimum
of three (3) days and up to thirty(30) days following
crisis response interaction.
1. California Health Facilities Financing
Exhibit A
Page 10 of 15
Authority (CHFFA) requires follow up and
case management for thirty (30) days.
iii. Follow-ups may be conducted in-person or via
telehealth by any trained mobile crisis team
member, including those not involved in the initial
response. If a different team member conducts the
follow-up, they must coordinate with the original
team for relevant information. If the person served
cannot be reached or engaged (e.g., in inpatient
care or unwilling to engage), the team should
document these instances.
g. Coordination with Other Delivery Systems: Contractor
must establish policies to ensure mobile crisis services are
integrated into a whole-person approach to care. These
policies may include:
i. Alerting the individual's behavioral health system
within 48 hours of the crisis, providing basic details
of the encounter.
ii. The behavioral health system informing the mobile
crisis team if the person-served is receiving care
management or other benefits.
iii. Alerting the person-served Managed Care Plan
(MCP) of the crisis, if applicable.
iv. Notifying the person-served care manager, if
involved, and coordinating referrals and follow-up
as needed while maintaining privacy requirements.
h. Transportation: When needed, a mobile crisis team shall
arrange for or provide transportation to an appropriate level
of care or treatment setting. The mobile crisis team may
transport the individual directly as part of providing the
mobile crisis service. If the mobile crisis team cannot
provide transportation itself, or if there are outstanding
Exhibit A
Page 11 of 15
medical or safety concerns, the mobile crisis team shall
coordinate with nonmedical transportation (NMT)
providers, Emergency Medical Services (EMS), or law
enforcement, if necessary, to arrange transportation and
ensure the individual is connected with appropriate care. If
EMS, NMT, or law enforcement is utilized to transport the
individual directly to a higher level of care, the mobile crisis
team shall remain onsite until the transportation provider
arrives. At its discretion, the mobile crisis team may have
one or more team members accompany the individual
inside the vehicle to the higher level of care.
i. Other Health Coverage Claiming Requirements:
i. For persons served who are uninsured, Contractor
shall assist them in Medi-Cal enrollment through
post crisis services. Contractor shall track health
coverage status for all community behavioral health
crisis response services. Contractor shall also
report outcome of claiming for each.
j. Reporting:
i. Contractor shall be in compliance with reporting
requirements associated with each funding source
and state requirements.
c. Location of Services:
i. Community behavioral health crisis response services shall be provided
where the person served is in crisis, or at an alternate location of the
person's choosing. This may include schools, parks, and other community
locations.
ii. For the rural communities with lower call volumes and when the clinician
deems their travel time is detrimental to the individual's wellbeing,
telehealth services may be provided in very limited circumstances.
iii. Services are not to be provided in any facility that employs staff who have
the ability to evaluate for and write a Welfare and Institutions Code 5150
Exhibit A
Page 12 of 15
hold. These facilities include, but are not limited to: hospitals, emergency
departments, the Fresno County jail, inpatient facilities, and mental health
treatment facilities (residential or outpatient). Should the Contractor have
any questions about which facilities are not considered part of community
response, they must immediately request such clarification from DBH and
approval prior to providing services.
iv. Post-crisis follow-up services are to be provided face-to-face, or via tele-
health.
v. For Rural CIT services, Contractor is highly encouraged to continue the
existing collaborations with the Kerman, Firebaugh, Coalinga, Huron,
Sanger, Selma and Kingsburg police departments, and co-locate with
these rural law enforcement agencies as circumstances permit.
vi. Contractor shall locate an office space and seek Medi-Cal site certification
and ensure compliance with DMC-ODS requirements within three months
of agreement execution. If more time is needed to secure location and
meet regulatory requirements, DBH Director or designee may approve
and allow the Contractor to continue utilizing space at the Health and
Wellness Center under current license agreement.
d. Hours of Operation.
i. CIT Services shall be provided from 6:00 AM — 12:00 AM, 7
days a week, 365 days a year.
ii. MCRT Services shall be provided 24 hours a day, 7 days a week, 365
days a year.
iii. Case management services shall be provided 8:00 AM —5:00 PM,
Monday through Friday.
e. Referral Sources and Referral Process:
i. The County's 24/7 Access Line, community partners, and other crisis lines
such as the 988 Suicide and Crisis Lifeline, local law enforcement and 911
systems, and the Family Urgent Response System (FURS) will be able to
refer calls to the county mobile crisis service hotline.
Exhibit A
Page 13 of 15
ii. Law enforcement agencies may request CIT services via dispatcher radio
or cell phone.
f. Care Coordination/Transition Plan:
i. Follow Ups and Check In: Contractor must ensure that individuals receive
a follow-up check-in within 72 hours of the initial crisis response to help
continue resolving the crisis, update the crisis safety plan, and make
additional referrals as necessary.
1. If person served received a referral to ongoing supports during
initial crisis response, the team shall check on the status of
appointments and assists with scheduling, transportation, and
reminders as needed.
2. Post crisis services shall be provided for a minimum of three (3)
days and up to thirty (30) days following crisis response
interaction.
a. CHFFA requires follow up and case management for thirty
(30) days.
3. Follow-ups may be conducted in-person or via telehealth by any
trained mobile crisis team member, including those not involved in
the initial response. If a different team member conducts the
follow-up, they must coordinate with the original team for relevant
information. If the person served cannot be reached or engaged
(e.g., in inpatient care or unwilling to engage), the team should
document these instances.
g. Level of Care/Modality of Services: Mobile Crisis
h. Evidence-Based Practice(s) (EBPs):
i. Contractor shall provide EBPs, including but not limited to the following:
1. Columbia-Suicide Severity Rating Scale (C-SSRS)
2. Applied Suicide Intervention Skills Training (ASIST)
3. Motivational Interviewing (MI)
ii. Contractor shall ensure EBPs utilized by the program are appropriate to
the services and meet the need of the persons served. Contractor may
adjust EBPs to program needs.
Exhibit A
Page 14 of 15
i. County shall:
i. Provide oversight and collaborate with Contracted and other County
Departments and community agencies to help achieve State program
goals and outcomes. Oversight includes, but is not limited to, contract
monitoring and coordination with DHCS and or other oversight agencies
in regard to program administration and outcomes.
ii. Assist Contractor in making linkages with the total mental health system
of care. This will be accomplished through regularly scheduled meetings
as well as formal and informal consultation.
iii. Participate in evaluating overall program progress and efficiency and be
available to Contractor for ongoing consultation.
iv. Gather outcome information from target person served groups and
Contractor throughout each term of the resulting Agreement. County shall
notify Contractor when their participation is required. The performance
outcome measurement process shall not be limited to survey instruments
but will also include, as appropriate, person served and staff interviews,
chart reviews, data analysis and other methods of obtaining required
information. To comply with changing regulations, outcome and data
tracking requirements are expected to change and County will inform and
work with the Contractor to adapt throughout the term of the resulting
agreement.
v. Assist Contractor's efforts toward cultural and linguistic responsiveness
by providing technical assistance regarding cultural responsiveness
requirements.
V. STAFFING
a. Staffing Plan
i. Staffing patterns for the provision of services shall meet all State licensing
and regulatory requirements.All licensed or certified staff must be
licensed or certified within the State of California. Staff shall be reflective
of and responsive to the needs of the target population.
ii. Direct Clinical Services Staff: MCRT Youth-Contractor shall at a minimum
include four (4) case managers and four clinicians who will provide direct
services to the twenty-one and younger population in compliance with
Exhibit A
Page 15 of 15
CHFFA. Contractor will be required to provide necessary supporting
documentation to DBH to receive funds from CHFFA per Cal. Code Regs.
tit. 4, § 7328 (2024).
iii. Contractor shall maintain adequate staffing levels and align with the
needs of the population. Staffing levels shall not jeopardize the quality of
services provided to persons served. It is expected that MCRTs be
dedicated exclusively to mobile crisis response to ensure that teams can
effectively address behavioral health crisis. However, staff may be shared
between CITs and MCRTs as long as it does not compromise the timely
response or quality of services provided.
Exhibit B
Page 1 of 24
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. Records. Contractor shall maintain records in accordance with Exhibit B —
Attachment C to this Agreement, titled "Documentation Standards for Persons
Served Records".All records of the person served shall be maintained for a
minimum of ten (10) years from the date of the end of this Agreement.
d. 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.
e. Organizational Provider. Contractor shall maintain requirements as a
Behavioral Health Plan (BHP) organizational provider throughout the term of this
Agreement. If for any reason, this status is not maintained, County may
terminate this Agreement pursuant to Article 6 of this Agreement.
f. Staffing. Contractor agrees that prior to providing services under the terms and
conditions of this Agreement, Contractor shall have staff hired and in place for
program services and operations or County may, in addition to other remedies it
Exhibit B
Page 2 of 24
may have, suspend referrals or terminate this Agreement, in accordance to
Article 6 of this Agreement.
g. 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
D to this Agreement, titled "Department of Behavioral Health Contractor Training
Requirements Reference Guide".
h. Credentialing and Recredentialing. Each individual Contractor staff shall not
provide any specialty mental health services without an approved credentialing
application from County. Contractor and their respective staff must follow the
uniform process for credentialing and recredentialing of service providers
established by County, including disciplinary actions such as reducing,
suspending, or terminating provider's privileges. Failure to comply with specified
requirements can result in suspension or termination of an individual or provider.
Upon request, the Contractor must demonstrate to the County that each
of its providers are qualified in accordance with current legal, professional, and
technical standards, and that they are appropriately licensed, registered,
waivered, and/or certified.
Contractor must not employ or subcontract with providers debarred,
suspended or otherwise excluded (individually, and collectively referred to as
"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. See
section III below.
Contractor is required to verify and document at a minimum every three
years that each network provider that delivers covered services continues to
possess valid credentials, including verification of each of the credentialing
requirements as per the County's uniform process for credentialing and
recredentialing. If any of the requirements are not up-to-date, updated
information should be obtained from network providers to complete the re-
credentialing process.
i. Criminal Background Check. Contractor shall ensure that all providers and/or
subcontracted providers consent to a criminal background check, including
fingerprinting to the extent required under state law and 42 C.F.R. § 455.434(a).
Exhibit B
Page 3 of 24
Contractor shall provide evidence of completed consents when requested by the
County, DHCS or the US Department of Health & Human Services (US DHHS).
j. Clinical Leadership. Contractor shall send to County upon execution of this
Agreement, a detailed plan ensuring clinically appropriate leadership and
supervision of their clinical program. Recruitment and retaining clinical leadership
with the clinical competencies to oversee services based on the level of care and
program design presented herein shall be included in this plan.A description and
monitoring of this plan shall be provided.
k. 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.
I. 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.
m. 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 listed in Exhibit B —Attachment E to this Agreement, titled "Program
Outcomes and Performance Measurements". 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
Exhibit B
Page 4 of 24
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.
n. Timely Access. It is the expectation of the County that Contractor provide timely
access to services that meet the State of California standards for care.
Contractor shall track timeliness of services to persons served and provide a
monthly report showing the monitoring or tracking tool that captures this data.
County and Contractor shall meet to go over this monitoring tool, as needed but
at least on a monthly basis. County shall take corrective action if there is a failure
to comply by Contractor with timely access standards.
o. 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;
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.
Exhibit B
Page 5 of 24
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 F to this Agreement,
titled "State Behavioral Health Requirements".
p. 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.
q. 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.
r. Electronic Health Record. Contractor shall maintain its records in County's EHR
system in accordance with Exhibit B —Attachment G, "Electronic Health Record
Requirements and Service Data", free of charge as licenses become available.
The person served record shall begin with registration and intake, and include
person served authorizations, assessments, plans of care, and progress notes,
as well as other documents as approved by County. County shall be allowed to
review records of all and any services provided. If Contractor determines to
maintain its records in the County's EHR, it shall provide County's DBH Director,
or designee, with a thirty (30) day notice. If at any time Contractor chooses not to
maintain its records in the County's EHR, it shall provide County's DBH Director,
Exhibit B
Page 6 of 24
or designee, with thirty (30) days advance written notice and Contractor will be
responsible for obtaining its own system, at its own cost, for electronic health
records management.
Disclaimer
County makes no warranty or representation that information entered into
the County's DBH EHR system by Contractor will be accurate, adequate, or
satisfactory for Contractor's own purposes or that any information in Contractor's
possession or control, or transmitted or received by Contractor, is or will be
secure from unauthorized access, viewing, use, disclosure, or breach. Contractor
is solely responsible for person served information entered by Contractor into the
County's DBH EHR system. Contractor agrees that all Private Health Information
(PHI) maintained by Contractor in County's DBH EHR system will be maintained
in conformance with all HIPAA laws, as stated in section VIII, "Federal and State
Laws."
s. Generative Artificial Intelligence Technology Use & Reporting
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.
t. Confidentiality.
Exhibit B
Page 7 of 24
i. The County and the Contractor may have access to information that the
other considers to be a trade secret as defined in California Government
Code section 7924.510(f).
ii. Each party shall use the other's Information only to perform its obligations
under, and for the purposes of, the Agreement. Neither party shall use the
Information of the other Party for the benefit of a third party. Each Party
shall maintain the confidentiality of all Information in the same manner in
which it protects its own information of like kind, but in no event shall
either Party take less than reasonable precautions to prevent the
unauthorized disclosure or use of the Information.
iii. The Contractor shall not disclose the County's data except to any third
parties as necessary to operate the Contractor Products and Services
(provided that the Contractor hereby grants to the County, at no additional
cost, a non-perpetual, noncancelable, worldwide, nonexclusive license to
utilize any data, on an anonymous or aggregate basis only, that arises
from the use of the Contractor Products and Services by the Contractor,
whether disclosed on, subsequent to, or prior to the Effective Date, to
improve the functionality of the Contractor Products and Services and any
other legitimate business purpose, subject to all legal restrictions
regarding the use and disclosure of such information).
iv. Upon termination of the Agreement, or upon a Party's request, each Party
shall return to the other all Information of the other in its possession. All
provisions of the Agreement relating to confidentiality, ownership, and
limitations of liability shall survive the termination of the Agreement.
v. 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, including but not
limited to, California Civil Code, California Welfare and Institutions Code,
California Health and Safety Code, California Code of Regulations, and
the Code of Federal Regulations.
u. 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,
Exhibit B
Page 8 of 24
and accessible equipment for Medi-Cal beneficiaries with physical or mental
disabilities.
v. 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 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.
w. 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.
Exhibit B
Page 9 of 24
II. Informing Materials for Persons Served
a. Basic Information Requirements. Contractor shall provide information in a
manner and format that is easily understood and readily accessible to the
persons served (42 C.F.R. § 438.10(c)(1)). Contractor shall provide all written
materials for persons served in easily understood language, format, and
alternative formats that take into consideration the special needs of individuals in
compliance with 42 C.F.R. § 438.10(d)(6). Contractor shall inform the persons
served that information is available in alternate formats and how to access those
formats in compliance with 42 C.F.R. § 438.10.
Contractor shall provide the required information in this section to each
individual receiving Specialty Mental Health Services (SMHS) under this
Agreement and upon request (1915(b) Medi-Cal Specialty Mental Health
Services Waiver, § (2), subd. (d), at p. 26., attachments 3, 4; Cal. Code Regs., tit.
9, §1810.360(e)).
Contractor shall utilize the County's website that provides the content
required in this section and 42 C.F.R. § 438.10 and complies with all
requirements regarding the same set forth in 42 C.F.R. § 438.10.
Contractor shall use the DHCS/County-developed beneficiary handbook
and persons served notices (42 C.F.R. §§ 438.10(c)(4)(ii), 438.62(b)(3)).
b. Electronic Submission. Persons served information required in this section may
only be provided electronically by the Contractor if all the following conditions are
met:
i. The format is readily accessible;
ii. The information is placed in a location on the Contractor's website
that is prominent and readily accessible;
iii. The information is provided in an electronic form which can be
electronically retained and printed;
iv. The information is consistent with the content and language
requirements of this Agreement;
v. The individual is informed that the information is available in paper
form without charge upon request and the Contractor shall provide
it upon request within five (5) business days (42 C.F.R. §
438.10(c)(6)).
Exhibit B
Page 10 of 24
c. Language and Format. Contractor shall provide all written materials, including
taglines, for persons served or potential persons served in a font size no smaller
than twelve (12) point (42 C.F.R. 438.10(d)(6)(ii)). Contractor shall ensure its
written materials that are critical to obtaining services are available in alternative
formats, upon request of the person served or potential person served at no cost.
Contractor shall make its written materials that are critical to obtaining
services, including, at a minimum, provider directories, beneficiary handbook,
appeal and grievance notices, denial and termination notices, and the
Contractor's mental health education materials, available in the prevalent non-
English languages in the County (42 C.F.R. § 438.1 0(d)(3)).
Contractor notify persons served, prospective persons served, and
members of the public that written translation is available in prevalent languages
free of cost and how to access those materials (42 C.F.R. § 438.10(d)(5)(i), (iii);
Welfare & Inst. Code § 14727(a)(1); Cal. Code Regs. tit. 9 § 1810.410, subd. (e),
para. (4)). Contractor shall make auxiliary aids and services available upon
request and free of charge to each person served (42 C.F.R. § 438.10(d)(3)-(4)).
Contractor shall make oral interpretation and auxiliary aids, such as
Teletypewriter Telephone/Text Telephone (TTY/TDY) and American Sign
Language (ASL), available and free of charge for any language in compliance
with 42 C.F.R. § 438.10(d)(2), (4)-(5).
d. Beneficiary Informing Materials. Each person served must receive and have
access to the beneficiary informing materials upon request by the individual and
when first receiving SMHS from Contractor. Beneficiary informing materials
include but are not limited to:
i. Consumer Handbook
ii. Provider Directory
iii. Grievance form
iv. Appeal/Expedited Appeal form
v. Advance Directives brochure
vi. Change of Provider form
vii. Suggestions brochure
viii. Notice of Privacy Practices
ix. Notice of Adverse Benefit Determination (NOABDs— Including
Denial and Termination notices)
Exhibit B
Page 11 of 24
x. Early & Periodic Screening, Diagnostic and Treatment (EPSDT)
poster (if serving individuals under the age of 21)
xi. Contractor shall ensure beneficiary informing materials are
displayed in the threshold languages of Fresno County at all
service sites, including but not limited to the following:
1. Consumer Handbook
2. Provider Directory
3. Grievance form
4. Appeal/Expedited Appeal form
5. Advance Directives brochure
6. Change of Provider form
7. Suggestions brochure
All beneficiary informing written materials will use easily understood language
and format (i.e. material written and formatted at a 6th grade reading level), and
will use a font size no smaller than twelve (12) point.All beneficiary informing
written materials shall inform beneficiaries of the availability of information in
alternative formats and how to make a request for an alternative format.
Inventory and maintenance of all beneficiary informing materials will be
maintained by the County's DBH Plan Administration Division. Contractor will
ensure that its written materials include taglines or that an additional taglines
document is available.
e. Beneficiary Handbook. Contractor shall provide each person served with a
beneficiary handbook at the time the individual first accesses services and
thereafter upon request. The beneficiary handbook shall be provided to
beneficiaries within fourteen (14) business days after receiving notice of
enrollment. Contractor shall give each individual notice of any significant change
to the information contained in the beneficiary handbook at least thirty (30) days
before the intended effective date of change as per BHIN 22-060.
f. Accessibility. Required informing materials must be electronically available on
Contractor's website and must be physically available at the Contractor's facility
lobby for individuals' access.
Informing materials must be made available upon request, at no cost, in
alternate formats (i.e., Braille or audio) and auxiliary aids (i.e., California Relay
Service (CRS) 711 and American Sign Language) and must be provided to
Exhibit B
Page 12 of 24
persons served within five (5) business days. Large print materials shall be in a
minimum of eighteen (18) point font size.
Informing materials will be considered provided to the individual if
Contractor does one or more of the following:
i. Mails a printed copy of the information to the mailing address of
the person served before the individual receives their first
specialty mental health service;
ii. Mails a printed copy of the information upon the individual's
request to their mailing address;
iii. Provides the information by email after obtaining the agreement
of the person served to receive the information by email;
iv. Posts the information on the Contractor's website and advises the
person served in paper or electronic form that the information is
available on the internet and includes applicable internet
addresses, provided that individuals with disabilities who cannot
access this information online are provided auxiliary aids and
services upon request and at no cost; or,
v. Provides the information by any other method that can reasonably
be expected to result in the person served receiving that
information. If Contractor provides informing materials in person,
when the individual first receives specialty mental health services,
the date and method of delivery shall be documented in the file of
the person served.
g. Provider Directory. Contractor must follow the County's provider directory
policy, in compliance with MHSUDS IN 18-020.
Contractor must make available to persons served, in paper form upon
request and electronic form, specified information about the County provider
network as per 42 C.F.R. §438.10(h). The most current provider directory is
electronically available on the County website and is updated by the County no
later than thirty (30) calendar days after information is received to update
provider information. A paper provider directory must be updated at least monthly
as set forth in 42 C.F.R. § 438.10(h)(3)(i).
Any changes to information published in the provider directory must be
reported to the County within two (2) weeks of the change.
Exhibit B
Page 13 of 24
Contractor will only need to report changes/updates to the provider
directory for licensed, waivered, or registered mental health providers.
III. 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):
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:Hnppes.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.
Exhibit B
Page 14 of 24
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.
IV. Inspection and Audit Requirements
a. Internal Auditing. Contractor shall institute and conduct a Quality Assurance
Process for all services provided hereunder.
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.
V. 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
Exhibit B
Page 15 of 24
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 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 should Contractor fail to meet performance requirements;
Exhibit B
Page 16 of 24
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.
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
Exhibit B
Page 17 of 24
duties.All inspections and evaluations shall be made in a manner that will not
unduly delay the work of the Contractor.
VI. 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 County within twenty-four (24) hours.
The Contractor shall not require a person served or their representative to file a
Discrimination Grievance with the County 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 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.
VII. 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, Iicensure/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.
Exhibit B
Page 18 of 24
3. Contractor shall ensure all employees/service providers maintain
current I ice nsu re/certifi cati o n/reg istratio n/wa iver 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 (5) 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 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
Exhibit B
Page 19 of 24
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 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
Exhibit B
Page 20 of 24
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 the
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.
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.
Exhibit B
Page 21 of 24
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 H to this Agreement, titled "Fresno County Behavioral Health
Plan Compliance Program Code of Conduct".
e. Network Adequacy. Contractor shall ensure that all services covered under this
Agreement are available and accessible to persons served in a timely manner
and in accordance with the network adequacy standards required by regulation.
(42 C.F.R. §438.206(a), (c)).
Contractor shall submit, when requested by County and in a manner and
format determined by the County, network adequacy certification information to
the County, utilizing a provided template or other designated format.
Contractor shall submit updated network adequacy information to the
County any time there has been a significant change that would affect the
adequacy and capacity of services.
To the extent possible and appropriately consistent with CCR, Title 9,
§1830.225 and 42 C.F.R. §438.3 (1), the Contractor shall provide a person served
the ability to choose the person providing services to them.
Vill. 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.
Exhibit B
Page 22 of 24
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule
require 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 I to this
Agreement, titled "Health Insurance Portability and Accountability Act (HIPAA)
Business Associate Agreement".
IX. Quality Management Requirements.
a. Reporting.
i. Outcomes Reports. Contractor shall complete Outcomes Reports in the
format set by County. 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
Exhibit B
Page 23 of 24
credentialing and recredentialing, and person served grievances. Contractor shall
measure, monitor, and annually report to the County on its performance.
X. 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 J 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 person 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 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)
Exhibit B
Page 24 of 24
have completed 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 J, "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
Revised 7/17/25
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
Revised 7/17/25
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
Revised 7/17/25
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
Revised 7/17/25
Exhibit B—Attachment B
Page 1 of 2
FRESNO COUNTY BEHAVIORAL HEALTH PLAN
RIGHTS OF PERSONS SERVED
I. 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)
II. 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.
Revised 8/7/25
Exhibit B—Attachment B
Page 2 of 2
a. Informal provider problem resolution process —the provider may first speak
to a Fresno County Department of Behavioral Health (DBH) team member regarding his or her
complaint or concern.
The DBH Team Member 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).
b. 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.
C. 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 ninety (90) calendar days of the date of the receipt of the non-approval of payment.
The BHP shall have sixty (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 DBH Team Member who was not involved in the initial denial or modification
decision to determine the appeal decision.
If the DBH Team Member reverses the appealed decision, the provider will be asked to
submit a revised request for payment within thirty (30) calendar days of receipt of the decision.
d. 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 sixty (60) calendar days
of receipt of the complaint. The decision rendered by the BHP is final.
Revised 8/7/25
Exhibit B—Attachment C
Page 1 of 4
DOCUMENTATION STANDARDS FOR PERSON SERVED RECORDS
The documentation standards are described below under key topics related to care for persons
served. All standards must be addressed in the record of each person served; however, there is
no requirement that the record have a specific document or section addressing these topics. All
medical records shall be maintained for a minimum of 10 years from the date of the end of the
Agreement.
I. Assessments
a. The following areas will be included as a part of a comprehensive record for each
person served:
i. Presenting problems, including impairments in function, and current mental
status exam.
ii. Traumatic incidents which include trauma exposures, trauma reactions, trauma
screenings, and systems involvement if relevant
iii. Behavioral health history including mental health history, substance use/abuse,
and previous services
iv. Medical history including physical health conditions, medications, and
developmental history
v. Psychosocial factors including family, social and life circumstances, cultural
considerations
vi. Strengths, risks, and protective factors, including safety planning
vii. Clinical summary, treatment recommendations, and level of care determination
including diagnostic and clinical impression with a diagnosis
viii. The assessment shall include a typed or legibly printed name, signature of the
service provider and date of signature.
b. Timeliness/Frequency Standard for Assessment
i. The time period to complete an initial assessment and subsequent assessments
for SMHS is up to clinical discretion.
ii. Assessments shall be completed within a reasonable time and in accordance
with generally accepted standards of practice.
II. Problem list
a. The use of a Problem List has largely replaced the use of treatment plans and is
therefore required to be part of the record for each person served. The problem list
Revised 7/31/25
Exhibit B—Attachment C
Page 2 of 4
shall be updated on an ongoing basis to reflect the current presentation of the
person in care.
b. The problem list shall include, but is not limited to, the following:
i. Diagnoses identified by a provider acting within their scope of practice
ii. Problems identified by a provider acting within their scope of practice
iii. Problems or illnesses identified by the person in care and/or significant support
person if any
iv. The name and title of the provider that identified, added, or removed the problem,
and the date the problem was identified, added, or removed
III. Treatment and Care Plan Requirements
a. Targeted Case Management
i. Specifies the goals, treatment, service activities, and assistance to address the
negotiated objectives of the plan and the medical, social, educational, and other
services needed by the person in care
ii. Identifies a course of action to respond to the assessed needs of the person in
care
iii. Includes development of a transition plan when the person in care has achieved
the goals of the care plan
iv. Peer support services must be based on an approved care plan
v. Must be provided in a narrative format in the person's progress notes
vi. Updated at least annually
b. Services requiring Treatment Plans
i. Therapeutic Behavioral Services (TBS)
ii. Must have specific observable and/or specific quantifiable goals
iii. Must identify the proposed type(s) of intervention
iv. Must be signed (or electronic equivalent) by:
1. the person providing the service(s), or
2. a person representing a team or program providing services, or
3. a person representing the MHP providing services when the plan for a
person served is used to establish that the services are provided under the
direction of an approved category of staff, and if the below staff are not the
approved category,
4. a physician
Revised 7/31/25
Exhibit B—Attachment C
Page 3 of 4
5. a licensed/"waivered" psychologist
6. a licensed/"associate" social worker
7. a licensed/ registered/marriage and family therapist or
8. a registered nurse
v. In addition:
1. Plans for each person served will be consistent with the diagnosis, and the
focus of intervention will be consistent with the plan goals for the person
served, and there will be documentation that the person served participated
in and agreed with the plan. Examples of the documentation include, but are
not limited to, reference to the participation by the person served and
agreement by the person served in the body of the plan, the signature of the
person served on the plan, or a description of the participation by the person
served and agreement by the person served in progress notes.
2. The signature on the plan by the person served will be used as the means
by which the Contractor documents the participation of the person served.
When the signature of the person served is required on the plan for the
person served and the person served refuses or is unavailable for signature,
the plan for the person served plan will include a written explanation of the
refusal or unavailability.
3. The Contractor will give a copy of the plan for the person served to the
person served on request.
IV. Progress Notes
a. Providers shall create progress notes for the provision of all SMHS. Each progress
note shall provide sufficient detail to support the service code selected for the service
type as indicated by the service code description. Progress notes shall include:
i. The type of service rendered.
ii. A narrative describing the service, including how the service addressed the
beneficiary's behavioral health need (e.g., symptom, condition, diagnosis, and/or
risk factors).
iii. The date that the service was provided to the beneficiary.
iv. Duration of the service, including travel and documentation time.
v. Location of the beneficiary at the time of receiving the service.
Revised 7/31/25
Exhibit B—Attachment C
Page 4 of 4
vi. A typed or legibly printed name, signature of the service provider and date of
signature.
vii. ICD 10 code
viii. Current Procedural Terminology (CPT) or Healthcare Common Procedure
Coding System (HCPCS) code.
ix. Next steps including, but not limited to, planned action steps by the provider or by
the beneficiary, collaboration with the beneficiary, collaboration with other
provider(s) and any update to the problem list as appropriate.
b. Timeliness/Frequency of Progress Notes
i. Progress notes shall be completed within 3 business days of providing a service,
except for notes for crisis services, which shall be completed within 24 hours.
ii. A note must be completed for every service contact
Revised 7/31/25
Exhibit B—Attachment D
Page 1 of 9
FRESNO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH
CONTRACTOR TRAINING REQUIREMENTS REFERENCE GUIDE
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. Contractor
must consider and include sufficient time and funds for required trainings.
I. Trainings Provided by the Department of Behavioral Health (DBH)
a. 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 the DBH website.
Contractors are given approximately a 60-day window to complete this training from
the training announcement date.
b. Mental Health Documentation & Billing Training
Duration: 1 Hour 30 Minutes
All contracted provider organization employees, subcontractors, volunteers, interns,
and students providing services are to complete Documentation & Billing Training
within 30 business days of hire or contract effective date. If contract effective date is
a renewal, existing staff will not need to retake the training if they have already
Revised 8/8/25
Exhibit B—Attachment D
Page 2 of 9
completed it with their agency. Contractor shall be required to complete this training
as a prerequisite for providing direct services, processing billing, conducting quality
assurance services, clinical supervision, or other similar services under this
agreement. Contractor is expected to contact their assigned contract analysts if they
are unsure about training requirements for any specific classifications.
Documentation & Billing is a training provided at least one time per month.
Registration is completed via Eventbrite for each session; links to register can be
found on the webpage below:
https://www.fresnocountyca.gov/Departments/Behavioral-Health/Providers/Contract-
Provider-Resources/New-Hire-ComPIianceDoc-Billing-Training
The expectation is that Contractor will register their County-funded employees at
least one week in advance of the training date. For any registration issues or other
questions about the training, they can contact
DBHStaffDevelopment(a�_fresnocountyca.gov.
c. 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 H. 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 DBH 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
Revised 8/8/25
Exhibit B—Attachment D
Page 3of9
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.
d. Invoicing Training
Duration: To be Confirmed
Contractor shall be responsible for collection and managing data in a manner to be
determined by the California Department of Health Care Services (DHCS) and
Mental Health Plan in accordance with applicable rules and regulations. DBH's
Electronic Health Record (EHR) is a critical source of information for purposes of
monitoring service volume and obtaining reimbursement. Contractor's staff
responsible for checking Medi-Cal eligibility shall attend DBH's Finance Division
training on equipment reporting for assets, intangible and sensitive minor assets,
DBH's EHR system and related cost reporting.
e. Notice of Adverse Benefit Determination (NOABD) Training
Duration: 8 Minutes
A Notice of Adverse Benefit Determination (NOABD) is a formal mechanism for
notifying a person served of an adverse benefit determination in writing (e.g., denial
or limited authorization of a requested service, denial of payment for a service, or
failure to provide services in a timely manner).
This training outlines usage practices, timelines, and examples for each type of
NOABD. Contractor can find the training in the Announcements section on the
following webpage: https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/Contract-Provider-Resources/Notifications-Associated-Documents.
Contractor shall be responsible for completing this training within 60 days of hire or
contract effective date.
f. SmartCare Full Electronic Health Record New User Mental Health Training*
Duration: 4 Hours
This is a basic training for new users who are direct clinical service providers
employed by Contractors that will be using SmartCare as their full EHR. Participants
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Exhibit B—Attachment D
Page 4 of 9
will have the opportunity to apply CalMHSA's SmartCare training materials and
review relevant SmartCare workflows, clinical documents, and forms.
Training dates and reference material can be found on the following link:
https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.
Although this training is not required, Contractor is responsible for understanding and
utilizing SmartCare as indicated once contracted with County DBH.
g. SmartCare Electronic Health Record New User Front Desk Training*
Duration: 4 Hours
This is a basic training for new users who are employed by Contractors that will be
using SmartCare as their full EHR. Participants will have the opportunity to review
how to navigate SmartCare, perform coverage information set up, error corrections,
set up Appointments, and basic troubleshooting of common issues.
Training dates and reference material can be found on the following link:
https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.
Although this training is not required, Contractor is responsible for understanding and
utilizing SmartCare as indicated once contracted with County DBH.
h. SmartCare Lite Electronic Health Record Mental Health Training* (Provider
Entry Only Training)
Duration: Time may vary
This training is for select Contractors that do not intend to fully use County DBH's
SmartCare EHR system but rather only some functions, otherwise referred to as a
"SmartCare Lite User". This training is intended to supplement and reinforce the
CaIMHSA SmartCare trainings, user guide, and workflow information SmartCare Lite
Users. This supplemental training/technical support is offered by the DBH Planning
and Quality Management Division's Quality Improvement Team upon request.
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Exhibit B—Attachment D
Page 5of9
Required prerequisite material can be found on the following link:
https://www.fresnocountyca.gov/Departments/Behavioral-
Health/Providers/SmartCare
*This training is available to Contractor at no cost and highly recommended.
Although this training is not required, Contractor is responsible for understanding and
utilizing SmartCare as indicated once contracted with County DBH.
II. Trainings for Specialty Mental Health Providers by Specialization
a. Mobile Crisis Services Trainings
Duration: 21 Hours
Any contracted provider providing mobile crisis services shall complete the state-
required training series. For example, the current training series is provided by the
Medi-Cal Mobile Crisis Training and Technical Assistance Center (M-TAC). This ten-
part training series is available on the DBH Relias learning management system. For
assistance with assigning the trainings, please contact
DBHRelias(aD_Fresnocountyca.gov.
b. California Integrated Practice Child &Adolescent Needs & Strengths (CA IP
CANS)
Duration: 6 Hours 30 Minutes
The CA IP CANS is a structured assessment for identifying youth and family
actionable needs and useful strengths. It provides a framework for developing and
communicating about a shared vision and uses youth, ages 6 and youth up to age
20, and family information to inform planning, support decisions, and monitor
outcomes.
DBH provides this training to prepare attendees for certification testing and use of
the tool. For any questions about the training or assistance with registration, please
contact DBHStaffDevelopment(o-)fresnocountyca.gov.
III. For Contractors That Will Provide Services from County-Owned or Leased
PropertV:
a. County DBH's Business Office Training
Duration: Time will vary.
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Exhibit B—Attachment D
Page 6of9
This training provides information on equipment reporting for assets, intangible, and
sensitive minor assets, County's EHR system, and related cost reporting. This
training is required for any Contractors occupying County-owned or County-leased
buildings. Contractor is responsible for collecting and managing data in a manner to
be determined by DHCS and the Mental Health Plan in accordance with applicable
rules and regulations. The County EHR is a critical tool for source of information for
purposes of monitoring service volume and obtaining reimbursement.
IV. Contractor is Responsible for Ensuring and/or Providing These Trainings are
Offered and Completed
a. CaIAIM Behavioral Health Quality Improvement Program (BHQIP) Training
Any contracted clinical provider is required to complete the CalAIM BHQIP Modules
in CaIMHSA's web-based training system, Moodle. Providers are expected to
complete training within 60 days of beginning employment.
CaIMHSA's web-based training system, https://moodle.calmhsalearns.org.
b. 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, 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, 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.
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Exhibit B—Attachment D
Page 7of9
For additional information, Contractors should contact their assigned contract
analyst.
DBH is available to assist Contractor's efforts toward cultural and linguistic
responsiveness by providing the following:
i. Technical assistance regarding culturally responsive training requirements.
ii. Mandatory cultural responsiveness training for Contractor's DBH-
funded staff if training capacity allows.
iii. Technical assistance for translating information into County's threshold
languages (currently Spanish and Hmong and subject to change).
Contractors are responsible for securing translation services and all
associated costs.
c. Health Insurance Portability and Accountability Act (HIPAA) Training
Duration: May vary based on selected training
As a covered entity, or a business associate of a covered entity, providers shall meet
the training requirements described in the HIPAA Privacy Rule 45 CFR §
164.530(b)(1) and the HIPAA Security Rule 45 CFR § 164.308(a)(5). Providers may
use their discretion to select an appropriate HIPAA training. Training shall be
completed by all DBH-funded staff within 30 days of contract execution or hire and
annually thereafter.
d. 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 Contractor's procedures shall include ensuring compliance of
any sub-contracted providers with these requirements.
V. Training Expectations for County-Provided Traininqs
a. 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
Revised 8/8/25
Exhibit B—Attachment D
Page 8of9
otherwise or instructed by Trainers. Attendees are expected to dress in respectful,
culturally inclusive attire.
b. Interested attendees shall register at least one week in advance of the training date.
c. 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.
d. 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.
e. 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 the trainer, attendees shall be
asked to leave the training and return to their work site. Organization will be notified.
f. 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.
g. Attendees shall be expected to complete pre- and/or post-training evaluations, when
available.
h. 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.
VI. Use of DBH Training Facilities
a. 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.
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Exhibit B—Attachment D
Page 9of9
b. 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.
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Exhibit B—Attachment E
Page 1 of 3
PROGRAM OUTCOMES AND PERFORMANCE MEASUREMENTS
SPECIALTY MENTAL HEALTH SERVICES OUTCOMES
Contractor shall adhere to the following outcome elements. Items below indicated with a
single asterisk (*) will be collected via DBH's electronic health record (EHR). Items indicated
with a double asterisk (**) will be collected via DBH's EHR for full users only. Contractors who
opt to not fully utilize DBH's EHR will be responsible for collecting and reporting these additional
data points. DBH will assist Contractor in reviewing the requirements below no more than once
every quarter.
I. Quality of Service
a. Network Adequacy: Timeliness to Service
i. Timeliness from initial crisis response to first follow-up check-in by the
Program
b. Enrollment and Discharge
i. The length of stay for individuals receiving services with the program*
ii. The reason for discharge for individuals discharging from the program*
c. No-Shows and Cancellations
i. The count of services that resulted in a no-show (i.e., less than 24 hours'
notice) by the person served**
ii. The count of services that resulted in a cancellation (i.e., more than 24 hours'
notice) by the person served**
iii. The count of services that resulted in a cancellation by the service provider**
II. Quality of Clinical Care
a. Service Delivery
i. Average number of services provided to an individual by the Program per
length of stay*
ii. Average duration of services provided to an individual by the program*
iii. Utilization of clinical tools, when appropriate**
iv. Utilization of evidence-based practices, when appropriate**
v. Total requests for mobile crisis, determination of appropriateness for mobile
crisis response, total calls in which mobile crisis team was deployed and
outcome, response time (60 minutes in Metro areas and 120 minutes in Rural
areas)
b. Care Coordination
i. Calls received by the Program from DBH and community partner agencies
1. Where the calls are coming from
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Exhibit B—Attachment E
Page 2of3
2. Date of call, type of request, and disposition/outcome of call
3. Response time, if applicable
ii. Referrals written by the program to DBH and community partner agencies
1. Agency receiving referral
2. Reason for referral
III. Safety of Clinical Care
a. Grievances
i. The count, category, and trends of grievances shall be submitted by
individuals regarding services at the program in accordance with current state
requirements
b. Incident Reporting
i. The count, category, and trends of incidents reported regarding individuals
served by the program
c. 5150 Holds
i. Smartcare ID, detainment start date, disposition/reason for hold, facility PS
was referred to
IV. Member Experience
a. Consumer Perception Survey
i. Contractor shall comply with annual Consumer Perception Survey
requirements
b. Feedback and Improvement Groups
i. Contractor shall, in coordination with the DBH Planning and Quality
Management Division, offer persons served the opportunity to participate in
member experience focus groups
V. Population Description
a. Date of Birth/Age*
b. Race/Ethnicity*
c. Primary Language*
d. Gender Identity*
e. Sex Assigned at Birth*
f. Sexual Orientation*
g. Diagnosis*
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Exhibit B—Attachment E
Page 3of3
h. Food Insecurity*
i. Criminal Justice Involvement*
j. Housing Status*
k. Educational Attainment*
Notwithstanding changes and timelines implemented by legislation or Behavioral Health
Information Notices, DBH may also add additional required data elements with thirty (30) days'
notice to the program.
Revised 7/31/2025
Exhibit B—Attachment F
Page 1 of 22
STATE BEHAVIORAL HEALTH REQUIREMENTS
I. CONTROL REQUIREMENTS
The County and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
II. PROFESSIONAL LICENSURE
All (professional level) persons employed by the County Mental 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.
III. 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.
IV. 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
Revised 8/1/25
Exhibit B—Attachment F
Page 2 of 22
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 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.
V. 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
I. 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.)
II. 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.
i. Establish a Drug-Free Awareness Program to inform employees about:
ii. the dangers of drug abuse in the workplace;
iii. the person's or organization's policy of maintaining a drug-free workplace;
iv. any available counseling, rehabilitation and employee assistance
programs; and,
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Exhibit B—Attachment F
Page 3 of 22
v. penalties that may be imposed upon employees for drug abuse violations.
b. Every employee who works on this Agreement will:
i. receive a copy of the company's drug-free workplace policy statement;
and,
ii. 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.)
III. 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.)
IV. 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.
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Exhibit B—Attachment F
Page 4 of 22
V. 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.
VI. 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 determine the
Contractor's compliance with the requirements under paragraph (a).
VII. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractor certifies that
Contractor is in compliance with Public Contract Code Section 10295.3.
Vill. 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.
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Exhibit B—Attachment F
Page 5 of 22
I. 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.
a. Current State Employees (Pub. Contract Code §10410):
i. 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.
ii. No officer or employee shall contract on their own behalf as an
independent Contractor with any state agency to provide goods or
services.
b. Former State Employees (Pub. Contract Code §10411):
i. 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.
ii. 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)
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))
II. 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
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Exhibit B—Attachment F
Page 6 of 22
Contractor affirms to comply with such provisions before commencing the performance
of the work of this Agreement. (Labor Code Section 3700)
III. 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.)
IV. 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.
V. 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.
VI. 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.
VII. 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 pursuant to Section 13301 of the Water Code
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Exhibit B—Attachment F
Page 7 of 22
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.
Vill. PAYEE DATA RECORD FORM STD. 204: This form shall be completed by all
Contractors that are not another state agency or other governmental entity.
IX. 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.
a. 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.
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Exhibit B—Attachment F
Page 8 of 22
CALIFORNIA ADVANCING AND INNOVATING MEDI-CAL (CAL-AIM)
REQUIREMENTS
I. SERVICES AND ACCESS PROVISIONS
a. Certification of Eligibility
i. Contractor will, in cooperation with County, comply with Section
14705.5 of California Welfare and Institutions Code to obtain a
certification of an individual's eligibility for Specialty Mental Health
Services (SMHS) under Medi-Cal.
b. Access to Specialty Mental Health Services
i. In collaboration with the County, Contractor will work to ensure that
individuals to whom the Contractor provides SMHS meet access
criteria, as per Department of Health Care Services (DHCS) guidance
specified in Behavioral Health Information Notice (BHIN) 21-073.
Specifically, the Contractor will ensure that the clinical record for each
individual includes information as a whole indicating that individual's
presentation and needs are aligned with the criteria applicable to their
age at the time of service provision as specified below.
ii. For enrolled individuals under 21 years of age, Contractor shall provide
all medically necessary SMHS required pursuant to Section 1396d(r) of
Title 42 of the United States Code. Covered SMHS shall be provided to
enrolled individuals who meet either of the following criteria, (I) or (II)
below. If an individual under age 21 meets the criteria as described in
(I) below, the beneficiary meets criteria to access SMHS; it is not
necessary to establish that the beneficiary also meets the criteria in (b)
below.
1. The individual has a condition placing them at high risk for a
mental health disorder due to experience of trauma evidenced
by any of the following: scoring in the high-risk range under a
trauma screening tool approved by DHCS, involvement in the
child welfare system, juvenile justice involvement, or
experiencing homelessness.
OR
2. The individual has at least one of the following:
Revised 8/1/25
Exhibit B—Attachment F
Page 9 of 22
a. A significant impairment
b. A reasonable probability of significant deterioration in an
important area of life functioning
c. A reasonable probability of not progressing
developmentally as appropriate.
d. A need for SMHS, regardless of presence of impairment,
that are not included within the mental health benefits that
a Medi-Cal Managed Care Plan (MCP) is required to
provide.
AND the individual's condition as described in subparagraph (II a-d)
above is due to one of the following:
a. A diagnosed mental health disorder, according to the
criteria in the current editions of the Diagnostic and
Statistical Manual of Mental Disorders (DSM) and the
International Classification of Diseases and Related Health
Problems (ICD).
b. A suspected mental health disorder that has not yet been
diagnosed.
c. Significant trauma placing the individual at risk of a future
mental health condition, based on the assessment of a
licensed mental health professional.
iii. For individuals 21 years of age or older, Contractor shall provide
covered SMHS for persons served who meet both of the following
criteria, (a) and (b) below:
1. The individual has one or both of the following:
a. Significant impairment, where impairment is defined as
distress, disability, or dysfunction in social, occupational,
or other important activities.
b. A reasonable probability of significant deterioration in an
important area of life functioning.
2. The individual's condition as described in paragraph (a) is due
to either of the following:
a. A diagnosed mental health disorder, according to the
criteria in the current editions of the DSM and ICD.
Revised 8/1/25
Exhibit B—Attachment F
Page 10 of 22
b. A suspected mental disorder that has not yet been
diagnosed.
c. Additional Clarifications
i. Criteria
1. A clinically appropriate and covered mental health prevention,
screening, assessment, treatment, or recovery service listed
within Exhibit A of this Agreement can be provided and
submitted to the County for reimbursement under any of the
following circumstances:
a. The services were provided prior to determining a
diagnosis, including clinically appropriate and covered
services provided during the assessment process;
b. The service was not included in an individual treatment
plan; or
c. The individual had a co-occurring substance use disorder.
ii. Diagnosis Not a Prerequisite
1. Per BHIN 21-073, a mental health diagnosis is not a
prerequisite for access to covered SMHS. This does not
eliminate the requirement that all Medi-Cal claims, including
SMHS claims, include a current Centers for Medicare &
Medicaid Services (CMS) approved ICD diagnosis code
d. Medical Necessity
i. Contractor will ensure that services provided are medically necessary
in compliance with BHIN 21-073 and pursuant to Welfare and
Institutions Code section 14184.402(a). Services provided to a person
served shall be medically necessary and clinically appropriate to
address the individual's presenting condition. Documentation in each
individual's chart as a whole will demonstrate medical necessity as
defined below, based on the age of the individual at the time of service
provision.
ii. For individuals 21 years of age or older, a service is "medically
necessary" or a "medical necessity" when it is reasonable and
necessary to protect life, to prevent significant illness or significant
Revised 8/1/25
Exhibit B—Attachment F
Page 11 of 22
disability, or to alleviate severe pain as set forth in Welfare and
Institutions Code section 14059.5.
iii. For individuals under 21 years of age, a service is "medically
necessary" or a "medical necessity" if the service meets the standards
set forth in Section 1396d(r)(5) of Title 42 of the United States Code.
e. Coordination of Care
i. Contractor shall ensure that all care, treatment and services provided
pursuant to this Agreement are coordinated among all providers who
are serving the individual, including all other SMHS providers, as well
as providers of Non-Specialty Mental Health Services (NSMHS),
substance use disorder treatment services, physical health services,
dental services, regional center services and all other services as
applicable to ensure a person served-centered and whole-person
approach to services.
ii. Contractor shall ensure that care coordination activities support the
monitoring and treatment of comorbid substance use disorder and/or
health conditions.
iii. Contractor shall include in care coordination activities efforts to
connect, refer and link individual s to community-based services and
supports, including but not limited to educational, social, prevocational,
vocational, housing, nutritional, criminal justice, transportation,
childcare, child development, family/marriage education, cultural
sources, and mutual aid support groups.
iv. Contractor shall engage in care coordination activities beginning at
intake and throughout the treatment and discharge planning
processes.
v. To facilitate care coordination, Contractor will request a HIPAA and
California law compliant person served authorization to share the
individual's information with and among all other providers involved in
the individual's care, in satisfaction of state and federal privacy laws
and regulations.
f. Co-Occurring Treatment and No Wrong Door
i. Per BHIN 22-011, Specialty and Non-Specialty Mental Health Services
can be provided concurrently, if those services are clinically
Revised 8/1/25
Exhibit B—Attachment F
Page 12 of 22
appropriate, coordinated, and not duplicative. When a person served
meets criteria for both NSMHS and SMHS, the individual should
receive services based on individual clinical need and established
therapeutic relationships. Clinically appropriate and covered SMHS
can also be provided when the individual has a co-occurring mental
health condition and substance use disorder.
ii. Under this Agreement, Contractor will ensure that individual s receive
timely mental health services without delay. Services are reimbursable
to Contractor by County even when:
1. Services are provided prior to determination of a diagnosis,
during the assessment or prior to determination of whether
SMHS access criteria are met, even if the assessment
ultimately indicates the individual does not meet criteria for
SMHS.
2. If Contractor is serving an individual receiving both SMHS and
NSMHS, Contractor holds responsibility for documenting
coordination of care and ensuring that services are non-
duplicative.
II. AUTHORIZATION AND DOCUMENTATION PROVISIONS
a. Service Authorization
i. Contractor will collaborate with County to complete authorization
requests in line with County and DHCS policy.
ii. Contractor shall have in place, and follow, written policies and
procedures for completing requests for initial and continuing
authorizations of services, as required by County guidance.
iii. Contractor shall respond to County in a timely manner when
consultation is necessary for County to make appropriate authorization
determinations.
iv. County shall provide Contractor with written notice of authorization
determinations within the timeframes set forth in BHINs 22-016 and 22-
017, or any subsequent DHCS notices.
v. Contractor shall alert County when an expedited authorization decision
(no later than 72 hours) is necessary due to an individual's specific
Revised 8/1/25
Exhibit B—Attachment F
Page 13 of 22
needs and circumstances that could seriously jeopardize the individual
s life or health, or ability to attain, maintain, or regain maximum
function.
b. Documentation Requirements
i. Contractor will follow all documentation requirements as specified in
Exhibit B -Attachment C, titled "Documentation Standards for Person
Served Records", which includes compliance with federal, state and
County requirements.
ii. All Contractor documentation shall be accurate, complete, and legible,
shall list each date of service, and include the face-to-face time for
each service. Contractor shall document travel and documentation
time for each service separately from face-to-face time and provide this
information to County upon request. Services shall be identified as
provided in-person, by telephone, or by telehealth.
iii. All services shall be documented utilizing County-approved templates
and contain all required elements. Contractor agrees to satisfy the
chart documentation requirements set forth in BHIN 22-019 and the
contract between County and DHCS. Failure to comply with
documentation standards specified in this Article require corrective
action plans.
c. Assessment
i. Contractor shall ensure that all individuals' medical records include an
assessment of each individual's need for mental health services.
ii. Contractor will utilize the seven uniform assessment domains and
include other required elements as identified in BHIN 22-019 and
document the assessment in the individual's medical record.
iii. For individual s aged 6 through 20, the Child and Adolescent Needs
and Strengths (CANS), and for individual s aged 3 through 18, the
Pediatric Symptom Checklist-35 (PSC-35) tools are required at intake,
every six months during treatment, and at discharge, as specified in
DHCS MHSUDS INs 17-052 and 18-048.
iv. The time period for providers to complete an initial assessment and
subsequent assessments for SMHS are up to clinical discretion of
County; however, Contractor's providers shall complete assessments
Revised 8/1/25
Exhibit B—Attachment F
Page 14 of 22
within a reasonable time and in accordance with generally accepted
standards of practice.
d. ICD-10
i. Contractor shall use the criteria set forth in the current edition of the
DSM as the clinical tool to make diagnostic determinations.
ii. Once a DSM diagnosis is determined, the Contractor shall determine
the corresponding mental health diagnosis in the current edition of
ICD. Contractor shall use the ICD diagnosis code(s) to submit a claim
for SMHS to receive reimbursement from County.
iii. The ICD Tabular List of Diseases and Injuries is maintained by CMS
and may be updated during the term of this Agreement. Changes to
the lists of ICD diagnoses do not require an amendment to this
Agreement, and County may implement these changes as provided by
CMS
e. Problem List
i. Contractor will create and maintain a Problem List for each individual
served under this Agreement. The problem list is a list of symptoms,
conditions, diagnoses, and/or risk factors identified through
assessment, psychiatric diagnostic evaluation, crisis encounters, or
other types of service encounters.
ii. Contractor shall document a problem list that adheres to industry
standards utilizing at minimum current SNOMED International,
Systematized Nomenclature of Medicine Clinical Terms (SNOMED
CTO) U.S. Edition, September 2022 Release, and ICD-1 0-CM 2023.
iii. A problem identified during a service encounter may be addressed by
the service provider during that service encounter and subsequently
added to the problem list.
iv. The problem list shall include, but is not limited to, all elements
specified in BHIN 22-019.
v. County does not require the problem list to be updated within a specific
timeframe or have a requirement about how frequently the problem list
should be updated after a problem has initially been added. However,
Contractor shall update the problem list within a reasonable time such
that the problem list reflects the current issues facing the person
Revised 8/1/25
Exhibit B—Attachment F
Page 15 of 22
served, in accordance with generally accepted standards of practice
and in specific circumstances specified in BHIN 22-019.
f. Treatment and Care Plans
i. Contractor is not required to complete treatment or care plans for
persons served under this Agreement, except in the circumstances
specified in BHIN 22-019 and additional guidance from DHCS that may
follow after execution of this Agreement.
g. Progress Notes
i. Contractor shall create progress notes for the provision of all SMHS
services provided under this Agreement.
ii. Each progress note shall provide sufficient detail to support the service
code selected for the service type as indicated by the service code
description.
iii. Progress notes shall include all elements specified in BHIN 22-019,
whether the note be for an individual or a group service.
iv. Contractor shall complete progress notes within three business days of
providing a service, with the exception of notes for crisis services,
which shall be completed within 24 hours.
v. Providers shall complete a daily progress note for services that are
billed on a daily basis, such as residential and day treatment services,
if applicable.
h. Transition of Care Tool
i. Contractor shall use a Transition of Care Tool for any individual whose
existing services will be transferred from Contractor to an Medi-Cal
Managed Care Plan (MCP) provider or when NSMHS will be added to
the existing mental health treatment provided by Contractor, as
specified in BHIN 22-065, in order to ensure continuity of care.
ii. Determinations to transition care or add services from an MCP shall be
made in alignment with County policies and via a person-centered,
shared decision-making process.
iii. Contractor may directly use the DHCS-provided Transition of Care
Tool, found at https://www.dhcs.ca.gov/Pages/Screening-and-
Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-Services.aspx, or
obtain a copy of that tool provided by the County. Contractor may
Revised 8/1/25
Exhibit B—Attachment F
Page 16 of 22
create the Transition of Care Tool in its Electronic Health Record
(EHR). However, the contents of the Transition of Care Tool, including
the specific wording and order of fields, shall remain identical to the
DHCS provided form. The only exception to this requirement is when
the tool is translated into languages other than English.
i. Telehealth
i. Contractor may use telehealth, when it deems clinically appropriate, as
a mode of delivering behavioral health services in accordance with all
applicable County, state, and federal requirements, including those
related to privacy/security, efficiency, and standards of care. Such
services will conform to the definitions and meet the requirements
included in the Medi-Cal Provider Manual: Telehealth, available in the
DHCS Telehealth Resources page at:
https://www.dhcs.ca.gov/provqovpart/Pages/Telehealth Resources.asp
X.
ii. All telehealth equipment and service locations shall ensure that person
served confidentiality is maintained.
iii. Licensed providers and staff may provide services via telephone and
telehealth as long as the service is within their scope of practice.
iv. Medical records for individuals served by Contractor under this
Agreement shall include documentation of written or verbal consent for
telehealth or telephone services if such services are provided by
Contractor. Such consent shall be obtained at least once prior to
initiating applicable health care services and consent shall include all
elements as specified in BHIN 22-019.
v. County may at any time audit Contractor's telehealth practices, and
Contractor shall allow access to all materials needed to adequately
monitor Contractor's adherence to telehealth standards and
requirements.
III. 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
Revised 8/1/25
Exhibit B—Attachment F
Page 17 of 22
DBH Plan Administration Division or other designated persons via a
secure method (e.g., encrypted email or by fax) to allow ample time for
the DBH Plan Administration 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) (I), (3) and (4).
Revised 8/1/25
Exhibit B—Attachment F
Page 18 of 22
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).)
IV. 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:
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.
Revised 8/1/25
Exhibit B—Attachment F
Page 19 of 22
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 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.
Revised 8/1/25
Exhibit B—Attachment F
Page 20 of 22
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 PIED Pave
Portal, include: Licensed Clinical Social Worker (LCSW), Licensed
Marriage and Family Therapist (LMFT), Licensed Professional Clinical
Counselor (LPCC), Psychologist, Licensed Educational Psychologist,
Revised 8/1/25
Exhibit B—Attachment F
Page 21 of 22
Physician (MD and DO), Physician Assistant, Registered
Pharmacist/Pharmacist, Certified Pediatric/Family Nurse Practitioner,
Nurse Practitioner, 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).
V. 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.
Revised 8/1/25
Exhibit B—Attachment F
Page 22 of 22
iv. Contractor entering data into any County electronic systems shall
ensure that staff are trained to enter and maintain data within this
system.
VI. 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
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.
Revised 8/1/25
Exhibit B—Attachment G
Page 1 of 1
ELECTRONIC HEALTH RECORD
REQUIREMENTS AND SERVICE DATA
Contractor will provide accurate and timely input of services provided in the County's
Electronic Health Record (EHR). The current EHR is a web-based application and requires a
computer with a minimum of 16 GB RAM using either Edge or Chrome as the browser, and a
stable high speed internet connection. Additional drivers may be needed to scan documents into
the EHR. Contractor will be responsible for equipment to support the using of the EHR.
Contractor may be required to utilize data entry forms, portals, or related systems for
compliance with County data reporting requirements during the duration of this Agreement.
Data entry shall be the responsibility of the Contractor. The County shall monitor the
number and amount of services entered into the EHR. Any and all audit exceptions resulting
from the provision and billing of Medi-Cal services by the Contractor shall be the sole
responsibility of the Contractor.
Contractor will utilize the County's EHR for all Behavioral Health Plan billing and
reporting functions and may elect to utilize the County's EHR for all clinical documentation, at no
additional cost to Contractor.
If Contractor elects to not use the County's EHR for all clinical documentation, the
Contractor must ensure all necessary requirements involving electronic health information
exchange between the Contractor and the County will be met.
Revised 8/1/25
Exhibit B—Attachment H
Page 1 of 2
FRESNO COUNTY BEHAVIORAL HEALTH PLAN
COMPLIANCE PROGRAM CODE OF CONDUCT
All Fresno County Behavioral/Mental Health Employees, Contractors (including Contractor's
Employees/Subcontractors), Volunteers and Students will:
I. Read, acknowledge, and abide by this Code of Conduct.
II. 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.
III. 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.
IV. Practice good faith in transactions occurring during the course of business and never use or
exploit professional relationships or confidential information for personal purposes.
V. 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.
VI. 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.
VI I. 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.
Vill. 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
Revised 8/7/25
Exhibit B—Attachment H
Page 2of2
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.
IX. 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.
Revised 8/7/25
Exhibit B—Attachment I
Page 1 of 4
HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT (HIPAA)
BUSINESS ASSOCIATE AGREEMENT
I. County is a "Covered Entity," and 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 Contractor will create and/or receive Protected Health Information ("PHI")
from or on behalf of 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, Contractor, as a business associate of
County, may use or disclose Protected Health Information ("PHI") to perform functions, activities
or services for or on behalf of 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 County, as the "Covered Entity" under the HIPAA Rules,
except as authorized for management, administrative or legal responsibilities of Contractor.
II. Contractor shall protect, from unauthorized access, use, or disclosure of names and
other identifying information concerning persons receiving services pursuant to this Agreement,
except where permitted in order to carry out data aggregation purposes for health care
operations. (45 CFR Sections 164.504 (e)(2)(i), 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i).)
This pertains to any and all persons receiving services pursuant to a County funded program.
Contractor shall not use such identifying information for any purpose other than carrying out
Contractor's obligations under this Agreement.
Revised 8/8/25
Exhibit B—Attachment I
Page 2 of 4
III. Contractor shall not disclose any such identifying information to any person or entity,
except as otherwise specifically permitted by this Agreement, authorized by law, or authorized
by the client/patient.
IV. 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 finger or voice print, or a photograph.
V. Contractor shall provide access, at the request of County, and in the time and manner
designated by County, to PHI in a designated record set (as defined in 45 CFR Section
164.501), to an individual or to County in order to meet the requirements of 45 CFR
Section164.524 regarding access by individuals to their PHI.
Contractor shall make any amendment(s) to PHI in a designated record set at the
request of County, and in the time and manner designated by County in accordance with 45
CFR Section 164.526.
Contractor shall provide to County or to an individual, in a time and manner designated
by County, information collected in accordance with 45 CFR Section 164.528, to permit County
to respond to a request by the individual for an accounting of disclosures of PHI in accordance
with 45 CFR Section 164.528.
VI. Contractor shall report to County, in writing, any knowledge or reasonable belief that
there has been unauthorized access, viewing, use, disclosure, or breach of PHI not permitted by
this Agreement, and any breach of unsecured PHI of which it 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 County's Information Security Officer and Privacy
Officer and DBH's 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. 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. Contractor shall investigate such breach and is responsible for all
notifications required by law and regulation or deemed necessary by County and shall provide a
written report of the investigation and reporting required to County's Information Security Officer
and Privacy Officer and DBH's 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:
Revised 8/8/25
Exhibit B—Attachment I
Page 3 of 4
County of Fresno County of Fresno County of Fresno
Department of Public Health Department of Public Health Office of Information Security
HIPAA Representative Privacy Officer Chief Information Security Officer
(559) 600-6439 (559) 600-6405 (559) 600-5810
P.O. Box 11867 P.O. Box 11867 333 W. Pontiac Way
Fresno, California 93775 Fresno, California 93775 Clovis CA, 93612
VII. Contractor shall make its internal practices, books, and records relating to the use and
disclosure of PHI received from County, or created or received by Contractor on behalf of
County, available to the United States Department of Health and Human Services upon
demand.
Vill. Safeguards
Contractor shall implement administrative, physical, and technical safeguards as
required by 45 CFR 164.308, 164.310, and 164.312 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 County; and to prevent access, use or disclosure
of PHI other than as provided for by this Agreement. 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 Contractor's operations and the
nature and scope of its activities. Upon County's request, Contractor shall provide County with
information concerning such safeguards.
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.
IX. Mitigation of Harmful Effects
Contractor shall mitigate, to the extent practicable, any harmful effect that is known to
Contractor of an unauthorized access, viewing, use, disclosure, or breach of PHI by Contractor
or its subcontractors in violation of the requirements of these provisions.
X. Contractor's Subcontractors
Contractor shall ensure that any of its subcontractors, if applicable, to whom Contractor
provides PHI received from or created or received by Contractor on behalf of County, agree to
the same restrictions and conditions that apply to 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 subcontractors.
XI. Effect of Termination
Revised 8/8/25
Exhibit B—Attachment I
Page 4 of 4
Upon termination or expiration of this Agreement for any reason, Contractor shall return
or destroy all PHI received from County (or created or received by Contractor on behalf of
County) that Contractor still maintains in any form, and shall retain no copies of such PHI. If
return or destruction of PHI is not feasible, it 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 shall apply to PHI that is in the
possession of subcontractors or agents, if applicable, of Contractor. If Contractor destroys the
PHI data, a certification of date and time of destruction shall be provided to County by
Contractor.
XII. Interpretation
The terms and conditions in these provisions shall be interpreted as broadly as
necessary to implement and comply with HIPAA, the HIPAA regulations 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 HIPAA and the HIPAA
regulations.
XIII. Regulatory References
A reference in the terms and conditions of these provisions to a section in the HIPAA
regulations means the section as in effect or as amended.
XIV. Survival
The respective rights and obligations of Contractor as stated in this Section shall survive
the termination or expiration of this Agreement.
Revised 8/8/25
Exhibit B -Attachment J
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 J
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 23
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.
I. Compensation
The County agrees to pay, and the Contractor agrees to receive, compensation for the
performance of its services as described below.
a. Crisis Intervention Team Specialty Mental Health Services (SMHS) Maximum
Compensation.
The maximum compensation payable to the Contractor under this Agreement for the
period of December 1, 2025 through June 30, 2026 for SMHS is Two Million, Two Hundred
Sixty-Eight Thousand, Six Hundred Fourteen and No/100 Dollars ($2,268,614.00), 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 for SMHS is Four Million, Five Hundred Twenty-
Two Thousand and No/100 Dollars ($4,522,000.00), 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 for SMHS is Five Million, One Hundred Sixty
Thousand and No/100 Dollars ($5,160,000.00), 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 for SMHS is Five Million, Seven Hundred Ninety-
Six Thousand and No/100 Dollars ($5,796,000.00), 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 for SMHS is Six Million, Four Hundred Thirty
Exhibit C
Page 2 of 23
Thousand and No/100 Dollars ($6,430,000.00), which is not a guaranteed sum but shall be paid
only for services rendered and received.
b. Mobile Crisis Response Team Specialty Mental Health Services (SMHS) Maximum
Compensation.
The maximum compensation payable to the Contractor under this Agreement for the
period of December 1, 2025 through June 30, 2026 for SMHS is One Million, Two Hundred
Thirty-One Thousand, Three Hundred Eighty-Six and No/100 Dollars ($1,231,386.00), 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 for SMHS is Two Million, Four Hundred Seventy-
Eight Thousand and No/100 Dollars ($2,478,000.00), 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 for SMHS is Two Million, Eight Hundred Forty
Thousand and No/100 Dollars ($2,840,000.00), 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 for SMHS is Three Million, Two Hundred Four
Thousand and No/100 Dollars ($3,204,000.00), 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 for SMHS is Three Million, Five Hundred Seventy
Thousand and No/100 Dollars ($3,570,000.00), which is not a guaranteed sum but shall be paid
only for services rendered and received.
c. Crisis Intervention Team Non-Treatment Supports Maximum Compensation
The maximum compensation payable to the Contractor under this Agreement for the
period of December 1, 2025 through February 28, 2026 for Ramp Up is Forty-Eight Thousand,
Ten and No/100 Dollars ($48,010.00), which will be reimbursed base by actual cost in
accordance with the budget in Exhibit C —Attachment B.
The maximum compensation payable to the Contractor under this Agreement for the
period of December 1, 2025 through June 30, 2026 is One Million, One Hundred Sixty-Five
Exhibit C
Page 3 of 23
Thousand, Three Hundred Twenty-Three and No/100 Dollars ($1,165,323.00), which will be
reimbursed base by actual cost in accordance with the budget in Exhibit C —Attachment B.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2026 through June 30, 2027 is One Million, Seven Hundred Ninety-Two
Thousand and No/100 Dollars ($1,792,000.00), which will be reimbursed base by actual cost in
accordance with the budget in Exhibit C —Attachment B.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2027 through June 30, 2028 is One Million, Five Hundred Thirty-Two
Thousand, Eight Hundred and No/100 Dollars ($1,532,800.00), which will be reimbursed base
by actual cost in accordance with the budget in Exhibit C—Attachment B.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2028 through June 30, 2029 is One Million, Two Hundred Ninety-Nine
Thousand, Five Hundred Twenty and No/100 Dollars ($1,299,520.00), which will be reimbursed
base by actual cost in accordance with the budget in Exhibit C—Attachment B.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2029 through June 30, 2030 is One Million, Eighty-Nine Thousand, Five
Hundred Sixty-Eight and No/100 Dollars ($1,089,568.00), which will be reimbursed base by
actual cost in accordance with the budget in Exhibit C —Attachment B.
d. Mobile Crisis Response Team Non-Treatment Supports Maximum Compensation
The maximum compensation payable to the Contractor under this Agreement for the
period of December 1, 2025 through February 28, 2026 for Ramp Up is Twelve Thousand, Two
and No/100 Dollars ($12,002.00), which will be reimbursed base by actual cost in accordance
with the budget in Exhibit C —Attachment C.
The maximum compensation payable to the Contractor under this Agreement for the
period of December 1, 2025 through June 30, 2026 is Two Hundred Ninety-One Thousand,
Three Hundred Thirty-One and No/100 Dollars ($291,331.00), which will be reimbursed base by
actual cost in accordance with the budget in Exhibit C—Attachment C.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2026 through June 30, 2027 is Four Hundred Forty-Eight Thousand and
No/100 Dollars ($448,000.00), which will be reimbursed base by actual cost in accordance with
the budget in Exhibit C—Attachment C.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2027 through June 30, 2028 is Three Hundred Eighty-Three Thousand, Two
Exhibit C
Page 4 of 23
Hundred and No/100 Dollars ($383,200.00), which will be reimbursed base by actual cost in
accordance with the budget in Exhibit C —Attachment C.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2028 through June 30, 2029 is Three Hundred Twenty-Four Thousand, Eight
Hundred Eighty and No/100 Dollars ($324,880.00), which will be reimbursed base by actual cost
in accordance with the budget in Exhibit C—Attachment C.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2029 through June 30, 2030 is Two Hundred Seventy-Two Thousand, Three
Hundred Ninety-Two and No/100 Dollars ($272,392.00), which will be reimbursed base by
actual cost in accordance with the budget in Exhibit C —Attachment C.
e. MCRT Youth Maximum Compensation
The maximum compensation payable to the Contractor under this Agreement for the
period of December 1, 2025 through June 30, 2026 is Six Hundred Forty-One Thousand, Six
Hundred Sixty-Seven and No/100 Dollars ($641,667.00), which will be reimbursed base by
actual cost in accordance with the budget in Exhibit C —Attachment D.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2026 through June 30, 2027 is One Million, One Hundred Thousand and
No/100 Dollars ($1,100,000.00), which will be reimbursed base by actual cost in accordance
with the budget in Exhibit C —Attachment D.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2027 through June 30, 2028 is One Million, One Hundred Thousand and
No/100 Dollars ($1,100,000.00), which will be reimbursed base by actual cost in accordance
with the budget in Exhibit C —Attachment D.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2028 through June 30, 2029 is One Million, One Hundred Thousand and
No/100 Dollars ($1,100,000.00), which will be reimbursed base by actual cost in accordance
with the budget in Exhibit C —Attachment D.
The maximum compensation payable to the Contractor under this Agreement for the
period of July 1, 2029 through June 30, 2030 is One Million, One Hundred Thousand and
No/100 Dollars ($1,100,000.00), which will be reimbursed base by actual cost in accordance
with the budget in Exhibit C —Attachment D.
f. Total Maximum Compensation.
Exhibit C
Page 5 of 23
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 Fifty-
One Million, Two Hundred Thousand, Six Hundred Ninety-Three and No/100 Dollars
($51,200,693.00) during the entire term of this Agreement.
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.
See table below for compensation breakdown by Fiscal Year and Total Maximum
Compensation for this Agreement.
Fiscal Year SMHS Non-Treatment MCRT Youth Total FY
(FY) Maximum FY Maximum FY Maximum FY Maximum
Compensation Compensation Compensation Compensation
FY 25-26 $3,500,000 $1,516,666 $641,667 $5,658,333
(December
1, 2025—
June 30,
2026
FY 26-27 $7,000,000 $2,240,000 $1,100,000 $10,340,000
FY 27-28 $8,000,000 $1,916,000 $1,100,000 $11,016,000
FY 28-29 $9,000,000 $1,624,400 $1,100,000 $11,724,400
FY 29-30 $10,000,000 $1,361,960 $1,100,000 $12,461,960
$51,200,693
g. Fee-For-Service Reimbursement Rate Categories.
The Community Intervention Team services provided by the Contractor under this
Agreement shall be reimbursed according to the Field Based rate schedule as indicated in
Exhibit C —Attachment A, attached hereto and incorporated herein by reference and made part
of this Agreement. The Mobile Crisis Response Team services provided by the Contractor
under this Agreement shall be reimbursed according to the MCRT rate schedule as indicated in
Exhibit C —Attachment A, attached hereto and incorporated herein by reference and made part
of this Agreement.
Exhibit C
Page 6 of 23
i. Field Based: Field based programs shall be defined as programs that provide
more than fifty percent (50%) of services in the field.
1. During the term of this Agreement, Contractor is eligible to submit a
proposal for compensation at the Field Base reimbursement rate category
ninety (90) days prior to each new fiscal year to County's DBH for
consideration. County's DBH will provide a decision to Contractor prior to
the start of the next fiscal year. If approved, County's DBH will issue a
rate change notification according to the modification section of the
agreement and Contractor's performance will be monitored for the Field
Based mode of service delivery requirements as outlined above.
2. If Contractor is deemed eligible to receive compensation at the Field
Based reimbursement rates in accordance with the above paragraph and
Contractor is subsequently unable to meet the mode of service delivery
requirements, as defined above, Contractor will be subjected to
recoupment at County's discretion.
3. County's DBH will complete Field Based mode of service delivery
analysis and recoupment reconciliation for said Contractor within ninety
(90) days following the end of the targeted quarter or within ninety (90)
days after all billable services for the targeted quarter has been entered in
the Electronic Health Record (EHR) by the Contractor, whichever is later.
The recoupment amount will be the difference in value of any services
paid to Contractor throughout the targeted quarter after being reconciled
at the respective fiscal year's Clinic-Site Based rate schedule and after
any claiming adjustments may have been applied, if any. County's DBH
will inform the Contractor of the result and, if necessary, the recoupment
shall be processed and applied based on terms, conditions, and
limitations as set forth herein.
4. If Contractor does not meet the Field Based mode of service delivery
requirements after any targeted quarterly review, County's DBH shall
recommend and reassign the Contractor to the Clinic-Site Based rate
category. Contractor may appeal the rate category reassignment to
Exhibit C
Page 7 of 23
County's DBH within thirty (30) days of receiving notice or the rate
category change will stand with a written notification as set forth below.
ii. 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 for the then current year.
County's DBH shall continuously monitor the Contractor and analyze data to review
accuracy of rate categories assigned. County's DBH Director or designee shall have the
authority to reassign rate categories, and the Contractor will be notified in writing of any such
changes, as outlined in Article 5.
h. Specialty Mental Health Services Fee-For-Service Performance Incentives.
Contractor is eligible to receive performance-based incentives to promote growth,
increase service delivery and overall wellness to our unserved and/or underserved
communities. If the Contractor meets the performance metrics outlined by County's DBH below,
Contractor is eligible to a portion of the Medi-Cal reimbursements received and recorded by
County's DBH.
This opportunity, subject to County's discretion, is only available after the second fiscal
year term of this Agreement for Contractor providing SMHS and reimbursed through the
County's Fee-for-Service reimbursement structure. The initial performance actual claimed
baseline will be set by the Contractor's performance in fiscal year one (1). County's DBH will
use the Contractor's State-approved claimed dollar amount, as received and recorded by
County's DBH, for services that were performed, claimed, and approved by the State in fiscal
year one (1) and adjust it with any subsequent State rate changes, if any, to finalize a
performance baseline for fiscal year two (2). After completing the claiming of services and
receipt of Medi-Cal reimbursements for fiscal year two (2), if the Contractor exceeds the
established performance baseline, the Contractor is eligible to be compensated for eight percent
(8%) of the Medi-Cal reimbursements that were generated above the established performance
baseline amount of fiscal year two (2).
Each subsequent fiscal year's performance baselines will be adjusted annually to either
the prior fiscal year's actual State-approved claimed amount plus adjusted for any subsequent
State rate increases, or any of the previously established performance baseline amounts plus
adjusted for any State rate increases for the upcoming fiscal year, whichever is higher. The new
performance baseline shall always be calculated from the higher value between the State-
Exhibit C
Page 8 of 23
approved claimed amount and the previous fiscal year's performance baseline amount
regardless of projected performance in the upcoming fiscal year. The rate adjustment shall
always be a positive amount and the performance base shall not decrease from one fiscal year
to the next.
The table below illustrates the annual baseline adjustments. This table is an example
only and is not binding. The actual details will be determined and finalized between both parties
at the conclusion of year one (1).
Example:
Fiscal Rate State Amount Additional
Year Increase Baseline Approved Exceeding Amount Paid
Claim Amount Baseline 8%
1 $1,100,000
2 +3.0% $1,133,000 $1,633,000 $500,000 $40,000
3 +1.0% $1,649,330 $1,500,000 $0 $0
4 +2.0% $1,682,317 $1,882,317 $200,000 $16,000
5 +3.5% $1,948,198 $2,048,198 $1001000 $8,000
In addition to meeting the performance-based incentive metrics above, Contractor must
be in satisfactory standing with the Agreement's performance outcomes and reporting
requirements prior to being awarded the incentive payment. At the discretion of County's DBH
Director or designee, if it is determined that the required outcomes are not met and/or reports
are not submitted in full and on time, the Contractor shall be ineligible for performance
incentives or withheld until such requirements are met and/or deemed to be satisfactory by
County's DBH.
County's DBH will calculate and notify Contractor of the award amounts, if any, within
ninety (90) days after all of Contractor's State-approved claimed services are received and
recorded by County's DBH for the targeted fiscal year or within nine (9) months following the
end of the targeted fiscal year, whichever is later. County's payments to Contractor for
performance-based incentives, if any, shall be made within forty-five (45) days after approval by
County.
II. Invoices
To ensure timely payment, the Contractor shall endeavor to submit monthly invoices, in
arrears, by the fifteenth (15th) day of each month, in the format directed by the County. This
submission timeline is intended to facilitate prompt processing but does not supersede the final
submission deadline outlined below. The Contractor shall submit invoices electronically to:
Exhibit C
Page 9 of 23
dbhinvoicereview@fresnocountyca.gov; dbh-invoices@fresnocountyca.gov; and the assigned
County's DBH Staff Analyst.
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, while the issue is
being resolved. 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 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
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 initial invoices shall be submitted by Contractor within sixty (60) calendar days
following the end of the month in which the services were provided. Invoices submitted after this
sixty (60) day period may be rejected and not processed for payment.
If the initial invoice is submitted within this deadline and subsequent adjustments for
corrections are necessary, revised invoices must be submitted by Contractor within one
hundred twenty (120) calendar days following the end of the month in which the services were
provided. All billing related to Other Health Coverage (OHC) must also be completed within one
hundred twenty (120) calendar days following the end of the month in which the services were
provided. The County shall not take action, including processing or payment, on any invoices
submitted more than one hundred and twenty (120) calendar days after the end of the fiscal
year in which services are performed.
If the initial invoice is submitted within this deadline and subsequent adjustments or
corrections are necessary, revised invoices must be submitted by Contractor within one
hundred twenty (120) calendar days following the end of the month in which the services were
provided. All billing related to Other Health Coverage (OHC) must also be completed within one
Exhibit C
Page 10 of 23
hundred twenty (120) calendar days following the end of the month in which the services were
provided. The County shall not take action, including processing or payment, on any invoices
submitted more than one hundred twenty (120) calendar days after the end of the fiscal year in
which services are performed.
a. Specialty Mental Health Claimable Services Invoices.
For specialty mental health services, invoices shall be based on claims entered into the
County's electronic health record (EHR)for the prior month.
Monthly payments for claimable services shall only be based on the units of time
assigned to each CPT or HCPCS code entered in the County's billing and transactional
database multiplied by the practitioner service rates in Exhibit C—Attachment A.
Any claimable services pending determination from Medicare, OHC, and any other third-
party source will not be reimbursed until Explanation of Benefits (EOB) are processed and the
balance is transferred to the Medi-Cal coverage plan, and ready to claim to the Medi-Cal
coverage plan, or the appropriate coverage plan(s), as deemed appropriate by the Agreement's
funding resources or approval by County's DBH. Claimable services that are pending
determinations must be addressed and invoiced to County's DBH within one hundred and
twenty (120) days following the month of service.Any delays to invoicing must be
communicated to and approved by County's DBH within one hundred and twenty (120) days
following the month of service or the services may be ineligible for payment at County's
discretion.
Contractor must report all revenue collected from a third-party, client-pay or private-pay
for any specialty mental health services rendered in each monthly invoice. In addition,
Contractor shall submit monthly invoices for reimbursement that equal the amount due less any
revenue collected and/or unallowable services, such as services pending determination from
Medicare, OHC, and any other third-party source.
County's payments to Contractor for performance of claimed services are provisional
and subject to adjustment until the completion of all settlement activities. County's adjustments
to provisional payments for claimed services shall be based on the terms, conditions, and
limitations of this Agreement or the reasons for recoupment set forth herein. Any claimable
services entered into the County's EHR beyond four (4) months from the month of service may
be ineligible for payment, subject to the determination of the County.
b. Cost Reimbursement Based Invoices.
Exhibit C
Page 11 of 23
Invoices for cost reimbursement services shall be based on actual expenses incurred in
the month of service. Contractor shall submit monthly invoices and general ledgers to County
that itemize the line item charges for monthly program costs. The invoices and general ledgers
will serve as tracking tools to determine if Contractor's costs are in accordance with its budgeted
cost. Failure to submit reports and other supporting documentation shall be deemed sufficient
cause for County to withhold payments until there is compliance.
Contractor must report all revenue collected from a third-party, client-pay or private-pay
in each monthly invoice. In addition, Contractor shall submit monthly invoices for reimbursement
that equal the amount due less any revenue collected and/or unallowable cost such as lobbying
or political donations from the monthly invoice reimbursements.
c. Corrective Action Plans.
Contractor shall enter services into the County's EHR/billing and transactional database
and submit invoices in accordance with the specified deadlines, ensuring all information is
accurate. Failure to meet the requirements set forth above will result in the implementation of a
corrective action plan at the discretion of the County's DBH Director, or designee, and may
result in financial penalties or termination of Agreement per Article 6 of this Agreement.
III. 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. 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.
a. Incidental Expenses.
Exhibit C
Page 12 of 23
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.
b. Applicable Fees.
Contractor shall not charge any persons served or third-party payers any fee for service
unless directed to do so by the County's DBH Director or designee at the time the individual is
referred for services. When directed to charge for services, Contractor shall use the uniform
billing and collection guidelines prescribed by DHCS.
Contractor will perform eligibility and financial determinations, in accordance with DHCS'
Uniform Method of Determining Ability to Pay (UMDAP), see BHIN 98-13, available at
dhcs.ca.gov, for all individuals unless directed otherwise by the County's DBH Director or
designee.
Contractor shall not submit a claim to, or demand or otherwise collect reimbursement
from, the person served or persons acting on behalf of the person served for any specialty
mental health or related administrative services provided under this Agreement, except to
collect other health insurance coverage, share of cost, and co-payments (California Code of
Regulations, Title 9, §1810.365(c).
The Contractor must not bill persons served, for covered services, any amount greater
than would be owed if the County provided the services directly and otherwise not bill persons
served as set forth in 42 C.F.R. § 438.106.
IV. Specialty Mental Health Services Claiming Responsibilities
Contractor shall enter claims data into the County's EHR/billing and transactional
database system using the California Mental Health Services Authority (CaIMHSA) Smart Care
Procedure Codes (available at nttps://2023.calmhsa.org/procedure-code-definitions/) by the
fifteenth (15th) of every month for actual services rendered in the previous month. County's
EHR/billing and transactional database system will convert the CaIMHSA Procedure Codes to
Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System
(HCPCS) codes, as provided in the DHCS Billing Manual available at
https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx, as from time to time
amended.
Claims shall be complete and accurate and must include all required information
regarding the claimed services. Claims data entry into the County's EHR system shall be the
Exhibit C
Page 13 of 23
responsibility of Contractor. County shall monitor the volume of services, billing amounts and
service types entered into County's EHR system. Any and all audit exceptions resulting from the
provision and reporting of specialty mental health services by Contractor shall be the sole
responsibility of Contractor. Contractor will comply with all applicable policies, procedures,
directives, and guidelines regarding the use of County's EHR/information system.
Contractor must provide all necessary data to allow County to bill Medi-Cal for services
and meet State and Federal reporting requirements. Contractor shall maximize the Federal
Financial Participation (FFP) reimbursement by claiming all possible Medi-Cal services and
correcting denied services for resubmission as needed.
Contractor shall be responsible for claiming all specialty mental health services to any
person served with other health coverage (OHC) and/or Medicare coverage.
If a person served has only OHC and/or only Federal Medicare, or has dual coverage,
such as OHC or Federal Medicare, Contractor will be responsible for billing the carrier and
obtaining a payment/denial or have validation of claiming with no response for ninety (90) days
after the claim was mailed for all specialty mental health services. Contractor must report all
third-party collections for Medicare, third-party or client-pay or private-pay in each month. A
copy of an explanation of benefits or CMS 1500 form (if no response is received from the carrier
after ninety (90) days from date of submission of the CMS 1500) is required as documentation.
Contractor must comply with all laws and regulations governing the Federal Medicare program,
including, but not limited to: 1) the requirement of the Medicare Act, 42 U.S.C. section 1395 et
seq; and 2) the regulation and rules promulgated by the Federal Centers for Medicare and
Medicaid Services as they relate to participation, coverage and claiming reimbursement. To the
extent they are applicable, Contractor will be responsible for compliance as of the effective date
of each Federal, State or local law or regulation specified.
V. 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
Exhibit C
Page 14 of 23
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
contract or agreement with Contractor.
Contractor shall be held financially liable for any and all future disallowances/audit
exceptions due to Contractor's deficiency discovered through the State audit process and
County utilization review for services provided during the course of this Agreement. At County's
election, the disallowed amount will be remitted within forty-five (45) days to County upon
notification or shall be withheld from subsequent payments to Contractor. Contractor shall not
receive reimbursement for any units of services rendered that are disallowed or denied by the
Fresno County MHP utilization review process or claims review process or through the State of
California DHCS audit and review process, cost report audit settlement if applicable, for Medi-
Cal eligible beneficiaries.
a. Reasons for Recoupment.
County will conduct periodic audits of Contractor files to ensure appropriate clinical
documentation, that original third-party source documents support costs invoiced under hybrid
or cost reimbursement agreements, 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:
i. 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
ii. Overpayment of Contractor by County due to errors in claiming or
documentation.
iii. Other reasons specified in the SMHS Reasons for Recoupment document
released annually by DHCS and posted on the DHCS BHIN website.
Exhibit C
Page 15 of 23
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.
b. Internal Audits/Reviews.
Contractor is responsible for ensuring the accuracy of all claims submitted for
reimbursement. This includes, but is not limited to, verifying that the services billed are properly
documented, correctly coded, and align with applicable SMHS definitions and standards.
Contractor must also ensure that all supporting documentation is accurate, complete, and
reflects the services actually rendered.
In addition, Contractors with medication prescribing authority shall adhere to County's
medication monitoring review practices. 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.
c. 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.
d. Cooperation with Audits/Reviews.
Exhibit C
Page 16 of 23
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.
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).
e. Single Audit Clause.
If Contractor expends One Million and No/100 Dollars ($1,000,000.00) 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
One Million and No/100 Dollars ($1,000,000.00) requirement. 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 solvency.
Said audit report shall be delivered to County's DBH Finance Division for review no later than
Exhibit C
Page 17 of 23
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.
f. 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
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
Exhibit C
Page 18 of 23
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.
VI. 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.
a. 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:
i. Computers (desktops and laptops);
ii. Copiers, cell phones, tablets, and other devices with any HIPAA data
iii. Modular furniture
iv. Land
V. Any items over $5,000
vi. Items of$500 or more with a lifespan of at least two (2) years:
1. Televisions
2. Washers/Dryers
3. Printers
4. Digital Cameras;
5. Other equipment/furniture
6. 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:
i. Description of the asset;
ii. The unique identifier of the asset if applicable, i.e., serial number;
Exhibit C
Page 19 of 23
iii. The acquisition date;
iv. The quantity of the asset;
V. The location of the asset or to whom the asset is assigned;
vi. The cost of the asset at the time of acquisition;
vii. The source of grant funding if applicable;
viii. The disposition date, and
ix. The method of disposition (surplus, transferred, destroyed, lost).
b. 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:
i. Maintain all items of equipment in good working order and condition, normal wear
and tear excepted;
ii. 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
iii. 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.
c. 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
Exhibit C
Page 20 of 23
any costs resulting from equipment purchased, which are incurred by Contractor, if prior written
approval has not been obtained from County.
d. Modification of Assets.
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.
VII. Other Financial Requirements
a. 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 the 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.
b. 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, sign-in sheets, and other primary source
documents. Fiscal records shall be kept in accordance with Generally Accepted Accounting
Exhibit C
Page 21 of 23
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 maintain records of persons served and community service in
compliance with all regulations set forth by local, state, and federal requirements, laws, and
regulations, and provide access to clinical records by County staff.
Contractor shall comply with all local, state, and federal laws 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.
c. 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.
d. 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.
e. 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
Exhibit C
Page 22 of 23
Agreement. If the federal or state governments reduce financial participation in the Medi-Cal
program, County agrees to meet with Contractor to discuss renegotiating the services required
by 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.
f. Additional Financial Requirements
County has the right to monitor the performance of this Agreement to ensure the
accuracy of claims for reimbursement and compliance with all applicable laws and regulations.
Contractor shall claim and collect all other available revenues, including but not limited to
Medicare, private insurance, grants, client rent/fees, and any other third-party funds.
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.
Federal Financial Participation is not available for any amount furnished to an Excluded
individual or entity, or at the direction of a physician during the period of exclusion when the
person providing the service knew or had reason to know of the exclusion, or to an individual or
entity when the County failed to suspend payments during an investigation of a credible
allegation of fraud [42 U.S.C. section 1396b(i)(2)].
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.
g. Contractor Prohibited from Redirection of Contracted Funds
Exhibit C
Page 23 of 23
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.
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
FEE-FOR-SERVICE RATE(S)
**Fee-for-Service rates are established by the Department of Health Care Services. Contractor
acknowledges that the provider rates in the table below are all-inclusive rates which account
for program operating expenses. This includes, but is not limited to, staff time spent on direct
patient care, staff time not spent on direct patient care (e.g. time spent on documentation,
travel, and paid time off), total staff compensation (e.g., salaries and wages, benefits, bonuses,
and other incentives), vehicle expenses (e.g. gas, maintenance, insurance), training,
assets/capital assets, utilities, and any direct and indirect overhead and operating costs.
Indirect cost expenses shall be determined by the Contractor under the Fee-for-Service
reimbursement structure.
Field Based
(at least 50% of services are provided in the
field
Provider Rate
Provider Type Per Hour
Licensed Physician $1,050.80
Physicians Assistant $471.28
Nurse Practitioner $522.54
Registered Nurse $426.82
Certified Nurse Specialist $522.54
Licensed Vocational Nurse $224.22
Registered Pharmacist $503.00
Licensed Psychiatric Technician $192.22
Psychologist Licensed or Waivered $422.60
LPHA (MFT LCSW LPCC)/ Intern or Waivered $273.47
LPHA MFT LCSW LPCC
Occupational Therapist $364.04
Mental Health Rehab Specialist $205.75
Peer Support Specialists $216.04
Community Health Worker $210.90
Medical Assistant $154.13
Other Qualified Providers $205.75
Maximum Units
That Can Be
Flat Rate Type Unit Billed Rate
1 per allowed
Interactive Complexity 15 min per unit procedure per $18 89
provider per
person served
Sign Language/Oral Interpretive Services 15 min per unit Variable $31.88
Exhibit C—Attachment A
Rate Per Unit
Service Type
Transportation Mileage - Per Mile $ 0.69
Mobile Crisis - Per Encounter $ 2,476.77
Transportation, staff time - Per 15 Minutes $ 59.90
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-February 28,2026)CIT Standby Time Ramp Up Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 $ $
1117
1118
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 0.00 $ $
Admin Program Total
Direct Personnel Salaries Subtotal 0.00 $ $ $
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ $
1202 Worker's Compensation
1203 Health Insurance
1204 Other(specify)
1205 Other(specify)
1206 Other(specify)
Direct Employee Benefits Subtotal: $ $ $
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ $
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment B
Direct Payroll Taxes&Expenses Subtotal: $ $ $
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ $
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
#DIV/01 I #DIV/01
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 3,819
5002 Software(HMIS,EHR,Microsoft Office,Security) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment B
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 3,819
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $
INDIRECT COST RATE
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 7,997
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 36,194
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 44,191
TOTAL PROGRAM EXPENSES $ 48,010
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 48,010
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 48,010
TOTAL PROGRAM ESTIMATED REVENUES: $ 48,010
NET PROGRAM COST: $
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-February 28,2026)CIT Standby Time Ramp Up Budget FTE Details
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
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
Exhibit C-Attachment B
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
Exhibit C-Attachment B
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
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-February 28,2026)CIT Standby Time Ramp Up Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS
Administrative Positions
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions
1116 0
1117 0
1118 0
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits
1201 Retirement
1202 Worker's Compensation
1203 Health Insurance
1204 Other(specify)
1205 Other(specify)
1206 Other(specify)
Direct Payroll Taxes&Expenses:
1301 OASDI
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT -
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 3,819
5001 Consultant(Network&Data Management) 3,819 Costs related to Kings View Information Technology.Provides comprehensive
hardware and software support to ensure successful data collection,management,and
reporting.Support includes:network&desktop management,project&technology
management,technology procurement,telecommunications support,strategic
technology planning,system documentation,application&data hosting,and 24/7
access&support.This expense will be used for IT setup to ensure necessary systems
are in place and tracking all relative data.This amount was estimated to support setup.
The expense listed will be claimed through the cost reimbursement portion of the
contract only and no other funding sources.
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES
6001 Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 44,191
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7001 Computer Equipment&Software 7,997 Computer equipment for new staff and replacement equipment as needed.Includes
network installation for new building as necessary.Expense is prorated for a partial
year.The expense listed will be claimed through the cost reimbursement portion of
the contract only and no other funding sources.Network installation and computers
must be purchased and in place immediately.The breakdown of cost allocation aligns
closely with total staffing in the program.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 36,194 Cost of essential office furnishings for a new building including cubicle build-outs,
tables,chairs,appliances,desks,whiteboards,storage furnishings,and other
furnishings needed to aid in the program's successful operation.Expense is prorated
for a partial year. The expense listed will be claimed through the cost reimbursement
portion of the contract only and no other funding sources.Furnishings must be
purchased and in place immediately.
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)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 48,010
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-June 30,2026)CIT Standby Time Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinical Program Manager 0.50 $ 62,879 $ 62,879
1117 Clinical Supervisor(UR) 0.50 55,940 55,940
1118 Clinician 6.55 611,375 611,375
1119 Case Manager 1.01 50,768 50,768
1120 Case Manager Supervisor 0.25 22,318 22,318
1121 24/7 Operation Capacity 0.00 7,506 7,506
1122 -
1123
1124 -
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.81 $ 810,786 $ 810,786
Admin Program Total
Direct Personnel Salaries Subtotal 8.81 $ $ 810,786 $ 810,786
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 13,946 $ 13,946
1202 Worker's Compensation 16,676 16,676
1203 Health Insurance 99,889 99,889
1204 Dental Insurance 3,015 3,015
1205 Vision Insurance 641 641
1206 1 Life Insurance 1,791 1,791
Direct Employee Benefits Subtotal: $ $ 135,958 $ 135,958
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ 2,055 $ 2,055
1302 FICA/MEDICARE 62,025 62,025
1303 SUI 2,501 2,501
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment B
Direct Payroll Taxes&Expenses Subtotal: $ $ 66,581 $ 66,581
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ 1,013,325 $ 1,013,325
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0% 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment B
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General&Administartive Overhead 151,998
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 151,998
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $
TOTAL PROGRAM EXPENSES $ 1,165,323
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 1,165,323
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 1,165,323
TOTAL PROGRAM ESTIMATED REVENUES: $ 1,165,323
NET PROGRAM COST: $
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-June 30,2026)CIT Standby Time Budget FTE Details
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%
Clinical Program Manager Fresno County CIT Standby 50%
Fresno County CIT 83%
Total 1.33
Position Contract#/Name/Department/County FTE
Clinical Supervisor(UR) Fresno County CIT Standby 50%
Fresno County CIT 83%
Fresno County MCRT/MCRT Standby 67%
Total 2.00
Position Contract#/Name/Department/County FTE
Clinician Fresno County CIT Standby 655%
Fresno County CIT 1079%
Fresno County MCRT Youth 267%
Fresno County MCRT/MCRT Standby 200%
Total 22.00
Position Contract#/Name/Department/County FTE
Case Manager Fresno County CIT Standby 101%
Fresno County CIT 166%
Fresno County MCRT Youth 267%
Fresno County MCRT/MCRT Standby 267%
Ell
Total 8.00
Position Contract#/Name/Department/County FTE
Case Manager Supervisor Fresno County CIT Standby 25%
Fresno County CIT 41%
Fresno County MCRT Youth 10%
Fresno County MCRT/MCRT Standby 57%
Total 1.34
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment B
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
Exhibit C-Attachment B
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
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-June 30,2026)CIT Standby Time Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,013,325
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 810,786
1116 Clinical Program Manager 62,879 Provide supervision of all staff and direct oversight of program management.Salary
calculation:2080 hours*$68.59 rate*FTE.This FTE is prorated for a partial year.Salary
expense listed will not be claimed through any other funding source.Total cost
reimbursed salaries for CIT standby time are estimated at 27.47474%of total CIT
salaries.80%of the cost reimbursed maximum for the year(excluding MCRT Youth)is
allocated to the cost reimbursed CIT budget,aligning with our projected expenses in
the CIT program.Standby time responsibilities may include:group supervision,
individual supervision,trainings,community resource research,partnership
development,vehicle care and preparation for response,mandatory weekly meetings,
morning and afternoon huddle(briefings,staff assignments,community concerns,
follow ups),and discharges in Smart Care.
1117 Clinical Supervisor(UR) 55,940 Provide supervision of all licensed and unlicensed clinical staff.Salary calculation:2080
hours*$61.02 rate*FTE.This FTE is prorated for a partial year.Salary expense listed
will not be claimed through any other funding source.Total cost reimbursed salaries
for CIT standby time are estimated at 27.47474%of total CIT salaries.80%of the cost
reimbursed maximum for the year(excluding MCRTYouth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT ft LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1118 Clinician 611,375 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*$51.30 rate*FTE.This FTE is prorated for a partial year.Salary expense listed
will not be claimed through any other funding source.Total cost reimbursed salaries
for CIT standby time are estimated at 27.47474%of total CIT salaries.80%of the cost
reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1119 Case Manager 50,768 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*$27.69 rate*FTE.This FTE is prorated for a partial year.
Salary expense listed will not be claimed through any other funding source.Total cost
reimbursed salaries for CIT standby time are estimated at 27.47474%of total CIT
salaries.80%of the cost reimbursed maximum for the year(excluding MCRT Youth)is
allocated to the cost reimbursed CIT budget,aligning with our projected expenses in
the CIT program.Standby time responsibilities may include:group supervision,
individual supervision,trainings,community resource research,partnership
development,vehicle care and preparation for response,mandatory weekly meetings,
morning and afternoon huddle(briefings,staff assignments,community concerns,
follow ups),and discharges in Smart Care.
1120 Case Manager Supervisor 22,318 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculation:2080 hours*$48.69 rate*
FTE.FTE is prorated for a partial year.Salary expense listed will not be claimed through
any other funding source.Total cost reimbursed salaries for CIT standby time are
estimated at 27.47474%of total CIT salaries.80%of the cost reimbursed maximum for
the year(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,
aligning with our projected expenses in the CIT program.Standby time responsibilities
may include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1121 24/7 Operation Capacity 7,506 Overtime costs are included in the budget to ensure continuous,flexible coverage for
CIT,which operates beyond traditional business hours,including evenings,weekends,
holidays,and during high-volume periods.Due to the unpredictable nature of
behavioral health crises,the team must remain responsive and adaptable,often
requiring staff to work beyond their scheduled shifts to ensure client safety and
program effectiveness.Salary expense listed will not be claimed through any other
funding source.CIT OT expense is estimated based on past OT usage.This expense is
prorated for a partial year.The CIT estimated percentage of standby OT is 27.47474%
of total CIT OT.80%of the cost reimbursed maximum for the year(excluding MCRT
Youth)is allocated to the cost reimbursed CIT budget,aligning with our projected
expenses in the CIT program.Standby time responsibilities may include:group
supervision,individual supervision,trainings,community resource research,
partnership development,vehicle care and preparation for response,mandatory
weekly meetings,morning and afternoon huddle(briefings,staff assignments,
community concerns,follow ups),and discharges in Smart Care.
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0 -
Direct Employee Benefits 135,958
1201 Retirement 13,946 Costs related to employee 401k.Estimated at 1.72%of salary expense.
1202 Worker's Compensation 16,676 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 99,889 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 3,015 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 641 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 1,791 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 66,581
1301 OASDI 2,055 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 62,025 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 2,501 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 151,998
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General&Administartive Overhead 151,998 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Calculated at 15%of modified total direct costs(MTDC).In the cost-reimbursed budget,
MTDC are salaries&benefits.The expense listed will be claimed through the cost
reimbursement portion of the contract only and no other funding sources.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,165,323
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2026-27 CIT Standby Time Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinical Program Manager 0.65 $ 96,694 $ 96,694
1117 Clinical Supervisor(UR) 0.65 86,022 86,022
1118 Clinician 8.47 940,157 940,157
1119 Case Manager 1.30 78,072 78,072
1120 Case Manager Supervisor 0.33 34,320 34,320
1121 24/7 Operation Capacity 0.00 11,542 11,542
1122 -
1123
1124 -
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 11.40 $ 1,246,807 $ 1,246,807
Admin Program Total
Direct Personnel Salaries Subtotal 11.40 $ $ 1,246,807 $ 1,246,807
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 21,445 $ 21,445
1202 Worker's Compensation 25,643 25,643
1203 Health Insurance 153,604 153,604
1204 Dental Insurance 4,636 4,636
1205 Vision Insurance 987 987
1206 1 Life Insurance 2,754 2,754
Direct Employee Benefits Subtotal: $ $ 209,069 $ 209,069
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ 3,160 $ 3,160
1302 FICA/MEDICARE 95,379 95,379
1303 SUI 3,845 31845
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment B
Direct Payroll Taxes&Expenses Subtotal: $ $ 102,384 $ 102,384
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ 1,558,260 $ 1,558,260
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment B
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General and Administrative Overhead 233,740
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 233,740
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 jAssets over$5,000/unit(Specify)
7007 1 Other(specify)
7008 IFiscalRocks
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 1,792,000
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 1,792,000
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 1,792,000
TOTAL PROGRAM ESTIMATED REVENUES: $ 1,792,000
NET PROGRAM COST: $
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2026-27 CIT Standby Time Budget FTE Details
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
Clinical Program Manager Fresno County CIT Standby 65%
Fresno County CIT 135%
Total 2.00
Position Contract#/Name/Department/County FTE
Clinical Supervisor(UR) Fresno County CIT Standby 65%
Fresno County CIT 135%
Fresno County MCRT/MCRT Standby 100%
Total 3.00
Position Contract#/Name/Department/County FTE%
Clinician Fresno County CIT Standby 847%
Fresno County CIT 1753%
Fresno County MCRT Youth 400%
Fresno County MCRT/MCRT Standby 300%
Total 33.00
Position Contract#/Name/Department/County FTE%
Case Manager Fresno County CIT Standby 130%
Fresno County CIT 270%
Fresno County MCRT Youth 400%
Fresno County MCRT/MCRT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE
Case Manager Supervisor Fresno County CIT Standby 33%
Fresno County CIT 67%
Fresno County MCRT Youth 15%
Fresno County MCRT/MCRT Standby 84%
Total 1.99
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment B
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
Exhibit C-Attachment B
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
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2026-27 CIT Standby Time Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,558,260
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 1,246,807
1116 Clinical Program Manager 96,694 Provide supervision of all staff and direct oversight of program management.Salary
calculated as:2080 hours*PY wage*1.04 wage increase*FTE.Salary expense listed
will not be claimed through any other funding source.Total cost reimbursed salaries
for CIT standby time are estimated at 32.5847%of total CIT salaries.80%of the cost
reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1117 Clinical Supervisor(LIR) 86,022 Provide supervision of all licensed and unlicensed clinical staff.Salary calculated as
2080 hours*PY wage*1.04 wage increase*FTE. Salary expense listed will not be
claimed through any other funding source.Total cost reimbursed salaries for CIT
standby time are estimated at 32.5847%of total CIT salaries.80%of the cost
reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1118 Clinician 940,157 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculated as:2080 hours
*PY wage*1.04 wage increase*FTE. Salary expense listed will not be claimed
through any other funding source.Total cost reimbursed salaries for CIT standby time
are estimated at 32.5847%of total CIT salaries.80%of the cost reimbursed maximum
for the year(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,
aligning with our projected expenses in the CIT program.Standby time responsibilities
may include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1119 Case Manager 78,072 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculated as:2080 hours*PY wage*1.04 wage increase*FTE.Salary expense
listed will not be claimed through any other funding source.Total cost reimbursed
salaries for CIT standby time are estimated at 32.5847%of total CIT salaries.80%of the
cost reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1120 Case Manager Supervisor 34,320 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculated as 2080 hours*PY wage*
1.04 wage increase*FTE. Salary expense listed will not be claimed through any other
funding source.Total cost reimbursed salaries for CIT standby time are estimated at
32.5847%of total CIT salaries.80%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,aligning with
our projected expenses in the CIT program.Standby time responsibilities may include:
group supervision,individual supervision,trainings,community resource research,
partnership development,vehicle care and preparation for response,mandatory
weekly meetings,morning and afternoon huddle(briefings,staff assignments,
community concerns,follow ups),and discharges in Smart Care.
1121 24/7 Operation Capacity 11,542 Overtime costs are included in the budget to ensure continuous,flexible coverage for
CIT,which operates beyond traditional business hours,including evenings,weekends,
holidays,and during high-volume periods.Due to the unpredictable nature of
behavioral health crises,the team must remain responsive and adaptable,often
requiring staff to work beyond their scheduled shifts to ensure client safety and
program effectiveness. Salary expense listed will not be claimed through any other
funding source.Total cost reimbursed salaries for CIT standby time are estimated at
32.5847%of total CIT salaries.80%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,aligning with
our projected expenses in the CIT program.Standby time responsibilities may include:
group supervision,individual supervision,trainings,community resource research,
partnership development,vehicle care and preparation for response,mandatory
weekly meetings,morning and afternoon huddle(briefings,staff assignments,
community concerns,follow ups),and discharges in Smart Care.
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 209,069
1201 Retirement 21,445 Costs related to employee 401k.Estimated at 1.72%of salary expense.
1202 Worker's Compensation 25,643 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1203 Health Insurance 153,604 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 4,636 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 987 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 2,754 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 102,384
1301 OASDI 3,160 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 95,379 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 3,845 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT -
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES -
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES -
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5006 Other(specify)
5007 Other(specify)
5008 Other(specify) -
6000:INDIRECT EXPENSES 233,740
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General and Administrative Overhead 233,740 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Calculated at 15%of modified total direct costs(MTDC).In the cost-reimbursed budget,
MTDC are salaries&benefits.The expense listed will be claimed through the cost
reimbursement portion of the contract only and no other funding sources.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 FiscalRocks
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,792,000
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2027-28 CIT Standby Time Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinical Program Manager 0.54 $ 82,708 $ 82,708
1117 Clinical Supervisor(UR) 0.54 73,580 73,580
1118 Clinician 6.97 804,171 804,171
1119 Case Manager 1.07 66,779 66,779
1120 Case Manager Supervisor 0.27 29,356 29,356
1121 24/7 Operation Capacity 0.00 9,873 9,873
1122 -
1123
1124 -
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 9.38 $ 1,066,467 $ 1,066,467
Admin Program Total
Direct Personnel Salaries Subtotal 9.38 $ $ 1,066,467 $ 1,066,467
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 18,343 $ 18,343
1202 Worker's Compensation 21,934 21,934
1203 Health Insurance 131,386 131,386
1204 Dental Insurance 3,965 3,965
1205 Vision Insurance 844 844
1206 1 Life Insurance 2,355 2,355
Direct Employee Benefits Subtotal: $ $ 178,827 $ 178,827
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ 2,703 $ 2,703
1302 FICA/MEDICARE 81,583 81,583
1303 SUI 3,289 31289
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment B
Direct Payroll Taxes&Expenses Subtotal: $ $ 87,575 $ 87,575
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ 1,332,869 $ 1,332,869
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment B
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General and Administrative Overhead 199,931
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 199,931
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 1,532,800
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 1,532,800
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 1,532,800
TOTAL PROGRAM ESTIMATED REVENUES: $ 1,532,800
NET PROGRAM COST: $
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2027-28 CIT Standby Time Budget FTE Details
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
Clinical Program Manager Fresno County CIT Standby 54%
Fresno County CIT 146%
Total 2.00
Position Contract#/Name/Department/County FTE
Clinical Supervisor(UR) Fresno County CIT Standby 54%
Fresno County CIT 146%
Fresno County MCRT/MCRT Standby 100%
Total 3.00
Position Contract#/Name/Department/County FTE%
Clinician Fresno County CIT Standby 697%
Fresno County CIT 1903%
Fresno County MCRT Youth 400%
Fresno County MCRT/MCRT Standby 300%
Total 33.00
Position Contract#/Name/Department/County FTE%
Case Manager Fresno County CIT Standby 107%
Fresno County CIT 293%
Fresno County MCRT Youth 400%
Fresno County MCRT/MCRT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE
Case Manager Supervisor Fresno County CIT Standby 27%
Fresno County CIT 73%
Fresno County MCRT Youth 15%
Fresno County MCRT/MCRT Standby 85%
Total 2.00
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment B
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
Exhibit C-Attachment B
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
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2027-28 CIT Standby Time Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,332,869
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 1,066,467
1116 Clinical Program Manager 82,708 Provide supervision of all staff and direct oversight of program management.Salary
calculated as:2080 hours*PY wage*1.04 wage increase*FTE.Salary expense listed
will not be claimed through any other funding source.Total cost reimbursed salaries
for CIT standby time are estimated at 26.79954%of total CIT salaries.80%of the cost
reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1117 Clinical Supervisor(LIR) 73,580 Provide supervision of all licensed and unlicensed clinical staff.Salary calculated as
2080 hours*PY wage*1.04 wage increase*FTE. Salary expense listed will not be
claimed through any other funding source.Total cost reimbursed salaries for CIT
standby time are estimated at 26.79954%of total CIT salaries.80%of the cost
reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1118 Clinician 804,171 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculated as:2080 hours
*PY wage*1.04 wage increase*FTE. Salary expense listed will not be claimed
through any other funding source.Total cost reimbursed salaries for CIT standby time
are estimated at 26.79954%of total CIT salaries.80%of the cost reimbursed maximum
for the year(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,
aligning with our projected expenses in the CIT program.Standby time responsibilities
may include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1119 Case Manager 66,779 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculated as:2080 hours*PY wage*1.04 wage increase*FTE. Salary expense
listed will not be claimed through any other funding source.Total cost reimbursed
salaries for CIT standby time are estimated at 26.79954%of total CIT salaries.80%of
the cost reimbursed maximum for the year(excluding MCRT Youth)is allocated to the
cost reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1120 Case Manager Supervisor 29,356 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculated as 2080 hours*PY wage*
1.04 wage increase*FTE. Salary expense listed will not be claimed through any other
funding source.Total cost reimbursed salaries for CIT standby time are estimated at
26.79954%of total CIT salaries.80%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,aligning with
our projected expenses in the CIT program.Standby time responsibilities may include:
group supervision,individual supervision,trainings,community resource research,
partnership development,vehicle care and preparation for response,mandatory
weekly meetings,morning and afternoon huddle(briefings,staff assignments,
community concerns,follow ups),and discharges in Smart Care.
1121 24/7 Operation Capacity 9,873 Overtime costs are included in the budget to ensure continuous,flexible coverage for
CIT,which operates beyond traditional business hours,including evenings,weekends,
holidays,and during high-volume periods.Due to the unpredictable nature of
behavioral health crises,the team must remain responsive and adaptable,often
requiring staff to work beyond their scheduled shifts to ensure client safety and
program effectiveness. Salary expense listed will not be claimed through any other
funding source.Total cost reimbursed salaries for CIT standby time are estimated at
26.79954%of total CIT salaries.80%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,aligning with
our projected expenses in the CIT program.Standby time responsibilities may include:
group supervision,individual supervision,trainings,community resource research,
partnership development,vehicle care and preparation for response,mandatory
weekly meetings,morning and afternoon huddle(briefings,staff assignments,
community concerns,follow ups),and discharges in Smart Care.
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 10
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 178,827
1201 Retirement 18,343 Costs related to employee 401k.Estimated at 1.72%of salary expense.
1202 Worker's Compensation 21,934 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1203 Health Insurance 131,386 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 3,965 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 844 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 2,355 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 87,575
1301 OASDI 2,703 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 81,583 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 3,289 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT -
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES -
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES -
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5006 Other(specify)
5007 Other(specify)
5008 Other(specify) -
6000:INDIRECT EXPENSES 199,931
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General and Administrative Overhead 199,931 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Calculated at 15%of modified total direct costs(MTDC).In the cost-reimbursed budget,
MTDC are salaries&benefits.The expense listed will be claimed through the cost
reimbursement portion of the contract only and no other funding sources.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,532,800
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2028-29 CIT Standby Time Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinical Program Manager 0.44 $ 70,121 $ 70,121
1117 Clinical Supervisor(UR) 0.44 62,382 62,382
1118 Clinician 5.68 681,782 681,782
1119 Case Manager 0.87 56,616 56,616
1120 Case Manager Supervisor 0.22 24,888 24,888
1121 24/7 Operation Capacity 0.00 8,370 8,370
1122 -
1123
1124 -
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 7.65 $ 904,159 $ 904,159
Admin Program Total
Direct Personnel Salaries Subtotal 7.65 $ $ 904,159 $ 904,159
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 15,551 $ 15,551
1202 Worker's Compensation 18,595 18,595
1203 Health Insurance 111,389 111,389
1204 Dental Insurance 3,362 3,362
1205 Vision Insurance 716 716
1206 1 Life Insurance 1,997 1,997
Direct Employee Benefits Subtotal: $ $ 151,610 $ 151,610
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ 2,292 $ 2,292
1302 FICA/MEDICARE 69,167 69,167
1303 SUI 2,789 2,789
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment B
Direct Payroll Taxes&Expenses Subtotal: $ $ 74,248 $ 74,248
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ 1,130,017 $ 1,130,017
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0% 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment B
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General and Administrative Overhead 169,503
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 169,503
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 1,299,520
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 1,299,520
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 1,299,520
TOTAL PROGRAM ESTIMATED REVENUES: $ 1,299,520
NET PROGRAM COST: $
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2028-29 CIT Standby Time Budget FTE Details
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
Clinical Program Manager Fresno County CIT Standby 44%
Fresno County CIT 156%
Total 2.00
Position Contract#/Name/Department/County FTE
Clinical Supervisor(UR) Fresno County CIT Standby 44%
Fresno County CIT 156%
Fresno County MCRT/MCRT Standby 100%
Total 3.00
Position Contract#/Name/Department/County FTE
Clinician Fresno County CIT Standby 568%
Fresno County CIT 2032%
Fresno County MCRT Youth 400%
Fresno County MCRT/MCRT Standby 300%
Total 33.00
Position Contract#/Name/Department/County FTE
Case Manager Fresno County CIT Standby 87%
Fresno County CIT 313%
Fresno County MCRT Youth 400%
Fresno County MCRT/MCRT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE
Case Manager Supervisor Fresno County CIT Standby 22%
Fresno County CIT 78%
Fresno County MCRT Youth 15%
Fresno County MCRT/MCRT Standby 85%
Total 2.00
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment B
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
Exhibit C-Attachment B
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
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2028-29 CIT Standby Time Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 1,130,017
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 904,159
1116 Clinical Program Manager 70,121 Provide supervision of all staff and direct oversight of program management.Salary
calculated as:2080 hours*PY wage*1.04 wage increase*FTE.Salary expense listed
will not be claimed through any other funding source.Total cost reimbursed salaries
for CIT standby time are estimated at 21.847%of total CIT salaries.80%of the cost
reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1117 Clinical Supervisor(LIR) 62,382 Provide supervision of all licensed and unlicensed clinical staff.Salary calculated as
2080 hours*PY wage*1.04 wage increase*FTE. Salary expense listed will not be
claimed through any other funding source.Total cost reimbursed salaries for CIT
standby time are estimated at 21.847%of total CIT salaries.80%of the cost
reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1118 Clinician 681,782 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculated as:2080 hours
*PY wage*1.04 wage increase*FTE. Salary expense listed will not be claimed
through any other funding source.Total cost reimbursed salaries for CIT standby time
are estimated at 21.847%of total CIT salaries.80%of the cost reimbursed maximum
for the year(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,
aligning with our projected expenses in the CIT program.Standby time responsibilities
may include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1119 Case Manager 56,616 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculated as:2080 hours*PY wage*1.04 wage increase*FTE.Salary expense
listed will not be claimed through any other funding source.Total cost reimbursed
salaries for CIT standby time are estimated at 21.847%of total CIT salaries.80%of the
cost reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1120 Case Manager Supervisor 24,888 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculated as 2080 hours*PY wage*
1.04 wage increase*FTE.Salary expense listed will not be claimed through any other
funding source.Total cost reimbursed salaries for CIT standby time are estimated at
21.847%of total CIT salaries.80%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,aligning with
our projected expenses in the CIT program.Standby time responsibilities may include:
group supervision,individual supervision,trainings,community resource research,
partnership development,vehicle care and preparation for response,mandatory
weekly meetings,morning and afternoon huddle(briefings,staff assignments,
community concerns,follow ups),and discharges in Smart Care.
1121 24/7 Operation Capacity 8,370 Overtime costs are included in the budget to ensure continuous,flexible coverage for
CIT,which operates beyond traditional business hours,including evenings,weekends,
holidays,and during high-volume periods.Due to the unpredictable nature of
behavioral health crises,the team must remain responsive and adaptable,often
requiring staff to work beyond their scheduled shifts to ensure client safety and
program effectiveness. Salary expense listed will not be claimed through any other
funding source.Total cost reimbursed salaries for CIT standby time are estimated at
21.847%of total CIT salaries.80%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,aligning with
our projected expenses in the CIT program.Standby time responsibilities may include:
group supervision,individual supervision,trainings,community resource research,
partnership development,vehicle care and preparation for response,mandatory
weekly meetings,morning and afternoon huddle(briefings,staff assignments,
community concerns,follow ups),and discharges in Smart Care.
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 151,610
1201 Retirement 15,551 Costs related to employee 401k.Estimated at 1.72%of salary expense.
1202 Worker's Compensation 18,595 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1203 Health Insurance 111,389 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 3,362 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 716 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 1,997 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 74,248
1301 OASDI 2,292 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 69,167 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 2,789 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT -
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES -
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES -
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5006 Other(specify)
5007 Other(specify)
5008 Other(specify) -
6000:INDIRECT EXPENSES 169,503
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General and Administrative Overhead 169,503 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Calculated at 15%of modified total direct costs(MTDC).In the cost-reimbursed budget,
MTDC are salaries&benefits.The expense listed will be claimed through the cost
reimbursement portion of the contract only and no other funding sources.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,299,520
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2029-30 CIT Standby Time Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinical Program Manager 0.35 $ 58,792 $ 58,792
1117 Clinical Supervisor(UR) 0.35 52,303 52,303
1118 Clinician 4.58 571,633 571,633
1119 Case Manager 0.70 47,469 47,469
1120 Case Manager Supervisor 0.18 20,867 20,867
1121 24/7 Operation Capacity 0.00 7,018 7,018
1122 -
1123
1124 -
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 6.16 $ 758,082 $ 758,082
Admin Program Total
Direct Personnel Salaries Subtotal 6.16 $ $ 758,082 $ 758,082
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 13,039 $ 13,039
1202 Worker's Compensation 15,591 15,591
1203 Health Insurance 93,394 93,394
1204 Dental Insurance 2,819 2,819
1205 Vision Insurance 600 600
1206 1 Life Insurance 1,674 1,674
Direct Employee Benefits Subtotal: $ $ 127,117 $ 127,117
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ 1,921 $ 1,921
1302 FICA/MEDICARE 57,992 57,992
1303 SUI 2,338 2,338
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment B
Direct Payroll Taxes&Expenses Subtotal: $ $ 62,251 $ 62,251
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ 947,450 $ 947,450
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0% 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment B
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General and Administrative Overhead 142,118
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 142,118
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 1,089,568
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 1,089,568
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 1,089,568
TOTAL PROGRAM ESTIMATED REVENUES: $ 1,089,568
NET PROGRAM COST: $
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2029-30 CIT Standby Time Budget FTE Details
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
Clinical Program Manager Fresno County CIT Standby 35%
Fresno County CIT 165%
Total 2.00
Position Contract#/Name/Department/County FTE
Clinical Supervisor(UR) Fresno County CIT Standby 35%
Fresno County CIT 165%
Fresno County MCRT/MCRT Standby 100%
Total 3.00
Position Contract#/Name/Department/County FTE
Clinician Fresno County CIT Standby 458%
Fresno County CIT 2142%
Fresno County MCRT Youth 400%
Fresno County MCRT/MCRT Standby 300%
Total 33.00
Position Contract#/Name/Department/County FTE
Case Manager Fresno County CIT Standby 70%
Fresno County CIT 330%
Fresno County MCRT Youth 400%
Fresno County MCRT/MCRT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE
Case Manager Supervisor Fresno County CIT Standby 18%
Fresno County CIT 82%
Fresno County MCRT/MCRT Standby 100%
Total 2.00
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment B
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
Exhibit C-Attachment B
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
Exhibit C-Attachment B
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2029-30 CIT Standby Time Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 947,450
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 758,082
1116 Clinical Program Manager 58,792 Provide supervision of all staff and direct oversight of program management.Salary
calculated as:2080 hours*PY wage*1.04 wage increase* FTE.Salary expense listed
will not be claimed through any other funding source.Total cost reimbursed salaries
for CIT standby time are estimated at 17.6128%of total CIT salaries.80%of the cost
reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1117 Clinical Supervisor(LIR) 52,303 Provide supervision of all licensed and unlicensed clinical staff.Salary calculated as
2080 hours*PY wage*1.04 wage increase*FTE. Salary expense listed will not be
claimed through any other funding source.Total cost reimbursed salaries for CIT
standby time are estimated at 17.6128%of total CIT salaries.80%of the cost
reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1118 Clinician 571,633 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculated as:2080 hours
*PY wage*1.04 wage increase*FTE.Salary expense listed will not be claimed
through any other funding source.Total cost reimbursed salaries for CIT standby time
are estimated at 17.6128%of total CIT salaries.80%of the cost reimbursed maximum
for the year(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,
aligning with our projected expenses in the CIT program.Standby time responsibilities
may include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1119 Case Manager 47,469 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculated as:2080 hours*PY wage*1.04 wage increase*FTE. Salary expense
listed will not be claimed through any other funding source.Total cost reimbursed
salaries for CIT standby time are estimated at 17.6128%of total CIT salaries.80%of the
cost reimbursed maximum for the year(excluding MCRT Youth)is allocated to the cost
reimbursed CIT budget,aligning with our projected expenses in the CIT program.
Standby time responsibilities may include:group supervision,individual supervision,
trainings,community resource research,partnership development,vehicle care and
preparation for response,mandatory weekly meetings,morning and afternoon huddle
(briefings,staff assignments,community concerns,follow ups),and discharges in
Smart Care.
1120 Case Manager Supervisor 20,867 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculated as 2080 hours*PY wage*
1.04 wage increase*FTE. Salary expense listed will not be claimed through any other
funding source.Total cost reimbursed salaries for CIT standby time are estimated at
17.6128%of total CIT salaries.80%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,aligning with
our projected expenses in the CIT program.Standby time responsibilities may include:
group supervision,individual supervision,trainings,community resource research,
partnership development,vehicle care and preparation for response,mandatory
weekly meetings,morning and afternoon huddle(briefings,staff assignments,
community concerns,follow ups),and discharges in Smart Care.
1121 24/7 Operation Capacity 7,018 Overtime costs are included in the budget to ensure continuous,flexible coverage for
CIT,which operates beyond traditional business hours,including evenings,weekends,
holidays,and during high-volume periods.Due to the unpredictable nature of
behavioral health crises,the team must remain responsive and adaptable,often
requiring staff to work beyond their scheduled shifts to ensure client safety and
program effectiveness. Salary expense listed will not be claimed through any other
funding source.Total cost reimbursed salaries for CIT standby time are estimated at
17.6128%of total CIT salaries.80%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed CIT budget,aligning with
our projected expenses in the CIT program.Standby time responsibilities may include:
group supervision,individual supervision,trainings,community resource research,
partnership development,vehicle care and preparation for response,mandatory
weekly meetings,morning and afternoon huddle(briefings,staff assignments,
community concerns,follow ups),and discharges in Smart Care.
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 10 1 -
Direct Employee Benefits 127,117
1201 Retirement 13,039 Costs related to employee 401k.Estimated at 1.72%of salary expense.
1202 Worker's Compensation 15,591 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1203 Health Insurance 93,394 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 2,819 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 600 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 1,674 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 62,251
1301 OASDI 1,921 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 57,992 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 2,338 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT -
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 142,118
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General and Administrative Overhead 142,118 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Calculated at 15%of modified total direct costs(MTDC).In the cost-reimbursed budget,
MTDC are salaries&benefits.The expense listed will be claimed through the cost
reimbursement portion of the contract only and no other funding sources.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
Exhibit C-Attachment B
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,089,568
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-February 28,2026)MCRT Standby Time Ramp Up Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 $ $
1117
1118
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 0.00 $ $
Admin Program Total
Direct Personnel Salaries Subtotal 0.00 $ $ $
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ $
1202 Worker's Compensation
1203 Health Insurance
1204 Other(specify)
1205 Other(specify)
1206 1 Other(specify)
Direct Employee Benefits Subtotal: $ $ $
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ $
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 Other(specify)
Exhibit C-Attachment C
Direct Payroll Taxes&Expenses Subtotal: $ $ $
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ $
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
#DIV/01 I #DIV/01
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 955
5002 Software(HMIS,EHR,Microsoft Office,Security) -
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment C
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 9SS
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate $
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries Benefits) -
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $
INDIRECT COST RATE
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 1,999
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data -
7003 Furniture&Fixtures 9,048
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 11,047
TOTAL PROGRAM EXPENSES $ 12,002
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 12,002
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 12,002
TOTAL PROGRAM ESTIMATED REVENUES: $ 12,002
NET PROGRAM COST: $
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-February 28,2026)MCRT Standby Time Ramp Up Budget FTE Details
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
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
Exhibit C-Attachment C
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
Exhibit C-Attachment C
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
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-February 28,2026)MCRT Standby Time Ramp Up Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS
Administrative Positions
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10
Program Positions
1116 0
1117 0
1118 0
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits
1201 Retirement
1202 Worker's Compensation
1203 Health Insurance
1204 Other(specify)
1205 Other(specify)
1206 Other(specify)
Direct Payroll Taxes&Expenses:
1301 OASDI
1302 FICA/MEDICARE
1303 SUI
1304 Other(specify)
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT -
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 955
5001 Consultant(Network&Data Management) 955 Costs related to Kings View Information Technology.Provides comprehensive
hardware and software support to ensure successful data collection,management,and
reporting.Support includes:network&desktop management,project&Technology
management,technology procurement,telecommunications support,strategic
technology planning,system documentation,application&data hosting,and 24/7
access&support.This expense will be used for IT setup to ensure necessary systems
are in place and tracking all relative data. Amount was estimated to support setup.
The expense listed will be claimed through the cost reimbursement portion of the
contract only and no other funding sources.
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES
6001 Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits)
6009 Other(specify)
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS 11,047
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7001 Computer Equipment&Software 1,999 Computer equipment for new staff and replacement equipment as needed.Includes
network installation for new building as necessary.The expense listed will be claimed
through the cost reimbursement portion of the contract only and no other funding
sources.Network installation and computers must be purchased and in place
immediately.The breakdown of cost allocation aligns closely with total staffing in the
program.
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 9,048 Cost of essential office furnishings for a new building including cubicle build-outs,
tables,chairs,appliances,desks,whiteboards,storage furnishings,and other
furnishings needed to aid in the program's successful operation.The expense listed will
be claimed through the cost reimbursement portion of the contract only and no other
funding sources.Furnishings must be purchased and in place immediately.
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)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 12,002
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-June 30,2026)MCRT Standby Time Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinical Supervisor(UR) 0.16 $ 17,502 $ 17,502
1117 Clinician 1.10 102,997 102,997
1118 Case Manager 1.26 63,536 63,536
1119 Case Manager Supervisor 0.16 13,965 13,965
1120 24/7 Operation Capacity 0.00 4,697 4,697
1121 -
1122
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 2.68 $ 202,697 $ 202,697
Admin Program Total
Direct Personnel Salaries Subtotal 2.68 $ $ 202,697 $ 202,697
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 3,487 $ 3,487
1202 Worker's Compensation 4,168 4,168
1203 Health Insurance 24,973 24,973
1204 Dental Insurance 754 754
1205 Vision Insurance 160 160
1206 1 Life Insurance 448 448
Direct Employee Benefits Subtotal: $ $ 33,990 $ 33,990
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ 514 $ 514
1302 FICA/MEDICARE 15,506 15,506
1303 SUI 625 625
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment C
Direct Payroll Taxes&Expenses Subtotal: $ $ 16,645 $ 16,645
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ 253,332 $ 253,332
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment C
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General&Administrative Overhead 37,999
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 37,999
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $
TOTAL PROGRAM EXPENSES $ 291,331
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 291,331
8002 Client Fees
8003 Client Insurance -
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 291,331
TOTAL PROGRAM ESTIMATED REVENUES: $ 291,331
NET PROGRAM COST: $
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-June 30,2026)MCRT Standby Time Budget FTE Details
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%
Clinical Supervisor(UR) Fresno County MCRT Standby 16%
Fresno County MCRT 51%
Fresno County CIT/CIT Standby 133%
Total 2.00
Position Contract#/Name/Department/County FTE%
Clinician Fresno County MCRT Standby 110%
Fresno County MCRT Youth 267%
Fresno County MCRT 90%
Fresno County CIT/CIT Standby 1733%
Total 22.00
Position Contract#/Name/Department/County FTE%
Case Manager Fresno County MCRT Standby 126%
Fresno County MCRT Youth 267%
Fresno County MCRT 141%
Fresno County CIT/CIT Standby 267%
Total 8.00
Position Contract#/Name/Department/County FTE%
Case Manager Supervisor Fresno County MCRT Standby 16%
Fresno County MCRT Youth 10%
Fresno County MCRT 41%
Fresno County CIT/CIT Standby 67%
Total 1.33
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Exhibit C-Attachment C
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
Exhibit C-Attachment C
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
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-June 30,2026)MCRT Standby Time Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 253,332
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 202,697
1116 Clinical Supervisor(UR) 17,502 Provide supervision of all licensed and unlicensed clinical staff.Salary calculation:2080
hours*$61.02 rate*FTE.This FTE is prorated for a partial year.Salary expense listed
will be claimed for the cost reimbursed portion of the contract only and no other
funding sources.Total cost reimbursed salaries for MCRT standby time are estimated
at 17.192%of total MCRT salaries.20%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed MCRT budget,aligning
with our projected expenses in the MCRT program.Standby time responsibilities may
include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
1117 Clinician 102,997 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*$51.30 rate*FTE.This FTE is prorated for a partial year.Salary expense listed
will be claimed for the cost reimbursed portion of the contract only and no other
funding sources.Total cost reimbursed salaries for MCRT standby time are estimated
at 17.192%of total MCRT salaries.MCRT salaries.20%of the cost reimbursed
maximum for the year(excluding MCRT Youth)is allocated to the cost reimbursed
MCRT budget,aligning with our projected expenses in the MCRT program.Standby
time responsibilities may include:group supervision,individual supervision,trainings,
community resource research,partnership development,vehicle care and preparation
for response,mandatory weekly meetings,morning and afternoon huddle(briefings,
staff assignments,community concerns,follow ups),and discharges in Smart Care.
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1118 Case Manager 63,536 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*$27.69 rate*FTE.This FTE is prorated for a partial year.
Salary listed will only be claimed for reimb MCRT salaries.20%of the cost reimbursed
maximum for the year(excluding MCRT Youth)is allocated to the cost reimbursed
MCRT budget,aligning with our projected expenses in the MCRT program.Standby
time responsibilities may include:group supervision,individual supervision,trainings,
community resource research,partnership development,vehicle care and preparation
for response,mandatory weekly meetings,morning and afternoon huddle(briefings,
staff assignments,community concerns,follow ups),and discharges in Smart Care.
Salary expense listed will be claimed for the cost reimbursed portion of the contract
only and no other funding sources.Total cost reimbursed salaries for MCRT standby
time are estimated at 17.192%of total MCRT salaries.
1119 Case Manager Supervisor 13,965 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculation:2080 hours*$48.69 rate*
FTE.FTE is prorated for a partial year.Salary expense listed will be claimed for the cost
reimbursed portion of the contract only and no other funding sources.Total cost
reimbursed salaries for MCRT standby time are estimated at 17.192%of total MCRT
salaries.
1120 24/7 Operation Capacity 4,697 Overtime costs are included in the budget to ensure continuous,flexible coverage for
MCRT,which operates beyond traditional business hours,including evenings,
weekends,holidays,and during high-volume periods.Due to the unpredictable nature
of behavioral health crises,the team must remain responsive and adaptable,often
requiring staff to work beyond their scheduled shifts to ensure client safety and
program effectiveness.This expense is prorated for a partial year.Salary expense listed
will be claimed for the cost reimbursed portion of the contract only and no other
funding sources.MCRT OT expense is estimated based on past OT usage.The MCRT
estimated percentage of standby OT is 17.192%of total MCRT OT.MCRT salaries.20%
of the cost reimbursed maximum for the year(excluding MCRT Youth)is allocated to
the cost reimbursed MCRT budget,aligning with our projected expenses in the MCRT
program.Standby time responsibilities may include:group supervision,individual
supervision,trainings,community resource research,partnership development,
vehicle care and preparation for response,mandatory weekly meetings,morning and
afternoon huddle(briefings,staff assignments,community concerns,follow ups),and
discharges in Smart Care.
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 33,990
1201 Retirement 3,487 Costs related to employee 401k.Estimated at 1.72%of salary expense.
1202 Worker's Compensation 4,168 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 24,973 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 754 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1205 Vision Insurance 160 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 448 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 16,645
1301 OASDI 514 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 15,506 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 625 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 37,999
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General&Administrative Overhead 37,999 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Calculated at 15%of modified total direct costs(MTDC).In the cost-reimbursed budget,
MTDC are salaries&benefits.The expense listed will be claimed through the cost
reimbursement portion of the contract only and no other funding sources.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 291,331
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2026-27 MCRT Standby Time Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinical Supervisor(UR) 0.20 $ 26,914 $ 26,914
1117 Clinician 1.43 158,386 158,386
1118 Case Manager 1.63 97,704 97,704
1119 Case Manager Supervisor 0.20 21,475 21,475
1120 24/7 Operation Capacity 0.00 7,222 7,222
1121 -
1122
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 3.47 $ 311,701 $ 311,701
Admin Program Total
Direct Personnel Salaries Subtotal 3.47 $ $ 311,701 $ 311,701
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 5,361 $ 5,361
1202 Worker's Compensation 6,411 6,411
1203 Health Insurance 38,401 38,401
1204 Dental Insurance 1,159 1,159
1205 Vision Insurance 247 247
1206 1 Life Insurance 688 688
Direct Employee Benefits Subtotal: $ $ 52,267 $ 52,267
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ 790 $ 790
1302 FICA/MEDICARE 23,845 23,845
1303 SUI 962 962
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment C
Direct Payroll Taxes&Expenses Subtotal: $ $ 25,597 $ 25,597
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ 389,565 $ 389,565
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment C
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General and Administrative Overhead 58,435
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 58,435
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 jAssets over$5,000/unit(Specify)
7007 1 Other(specify)
7008 IFiscalRocks
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 448,000
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 448,000
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 448,000
TOTAL PROGRAM ESTIMATED REVENUES: $ 448,000
NET PROGRAM COST: $
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2026-27 MCRT Standby Time Budget FTE Details
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
Clinical Supervisor(UR) Fresno County MCRT Standby 20%
Fresno County MCRT 80%
Fresno County CIT/CIT Standby 200%
Total 3.00
Position Contract#/Name/Department/County FTE
Clinician Fresno County MCRT Standby 143%
Fresno County MCRT Youth 400%
Fresno County MCRT 157%
Fresno County CIT/CIT Standby 2600%
Total 33.00
Position Contract#/Name/Department/County FTE
Case Manager Fresno County MCRT Standby 163%
Fresno County MCRT Youth 400%
Fresno County MCRT 237%
Fresno County CIT/CIT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE
Case Manager Supervisor Fresno County MCRT Standby 20%
Fresno County MCRT Youth 15%
Fresno County MCRT 64%
Fresno County CIT/CIT Standby 100%
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment C
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
Exhibit C-Attachment C
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
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2026-27 MCRT Standby Time Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 389,565
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 311,701
1116 Clinical Supervisor(UR) 26,914 Provide supervision of all licensed and unlicensed clinical staff.Salary calculation:2080
hours*PY rate*1.04 rate increase*FTE.Salary expense listed will be claimed for the
cost reimbursed portion of the contract only and no other funding sources.Total cost
reimbursed salaries for MCRT standby time are estimated at 20.3894%of total MCRT
salaries. 20%of the cost reimbursed maximum for the year(excluding MCRT Youth)is
allocated to the cost reimbursed MCRT budget,aligning with our projected expenses in
the MCRT program.Standby time responsibilities may include:group supervision,
individual supervision,trainings,community resource research,partnership
development,vehicle care and preparation for response,mandatory weekly meetings,
morning and afternoon huddle(briefings,staff assignments,community concerns,
follow ups),and discharges in Smart Care.
1117 Clinician 158,386 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*PY rate*1.04 rate increase*FTE.Salary expense listed will be claimed for the
cost reimbursed portion of the contract only and no other funding sources.Total cost
reimbursed salaries for MCRT standby time are estimated at 20.3894%of total MCRT
salaries. 20%of the cost reimbursed maximum for the year(excluding MCRT Youth)is
allocated to the cost reimbursed MCRT budget,aligning with our projected expenses in
the MCRT program.Standby time responsibilities may include:group supervision,
individual supervision,trainings,community resource research,partnership
development,vehicle care and preparation for response,mandatory weekly meetings,
morning and afternoon huddle(briefings,staff assignments,community concerns,
follow ups),and discharges in Smart Care.
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1118 Case Manager 97,704 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*PY rate*1.04 rate increase*FTE.Salary expense listed
will be claimed for the cost reimbursed portion of the contract only and no other
funding sources.Total cost reimbursed salaries for MCRT standby time are estimated
at 20.3894%of total MCRT salaries. 20%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed MCRT budget,aligning
with our projected expenses in the MCRT program.Standby time responsibilities may
include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
1119 Case Manager Supervisor 21,475 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculation:2080 hours*PY rate*FTE.
Salary expense listed will be claimed for the cost reimbursed portion of the contract
only and no other funding sources.Total cost reimbursed salaries for MCRT standby
time are estimated at 20.3894%of total MCRT salaries. 20%of the cost reimbursed
maximum for the year(excluding MCRT Youth)is allocated to the cost reimbursed
MCRT budget,aligning with our projected expenses in the MCRT program.Standby
time responsibilities may include:group supervision,individual supervision,trainings,
community resource research,partnership development,vehicle care and preparation
for response,mandatory weekly meetings,morning and afternoon huddle(briefings,
staff assignments,community concerns,follow ups),and discharges in Smart Care.
1120 24/7 Operation Capacity 7,222 Overtime costs are included in the budget to ensure continuous,flexible coverage for
MCRT,which operates beyond traditional business hours,including evenings,
weekends,holidays,and during high-volume periods.Due to the unpredictable nature
of behavioral health crises,the team must remain responsive and adaptable,often
requiring staff to work beyond their scheduled shifts to ensure client safety and
program effectiveness.Salary expense listed will be claimed for the cost reimbursed
portion of the contract only and no other funding sources.MCRT OT expense is
estimated based on past OT usage.The MCRT estimated percentage of standby OT is
20.3894%of total MCRT OT. 20%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed MCRT budget,aligning
with our projected expenses in the MCRT program.Standby time responsibilities may
include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 52,267
1201 Retirement 5,361 Costs related to employee 401k.Estimated at 1.72%of salary expense.
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1202 Worker's Compensation 6,411 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 38,401 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 1,159 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 247 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 688 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 25,597
1301 OASDI 790 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 23,845 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 962 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 58,435
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General and Administrative Overhead 58,435 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Calculated at 15%of modified total direct costs(MTDC).In the cost-reimbursed budget,
MTDC are salaries&benefits.The expense listed will be claimed through the cost
reimbursement portion of the contract only and no other funding sources.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 FiscalRocks
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 448,000
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2027-28 MCRT Standby Time Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinical Supervisor(UR) 0.17 $ 23,021 $ 23,021
1117 Clinician 1.17 135,477 135,477
1118 Case Manager 1.34 83,572 83,572
1119 Case Manager Supervisor 0.17 18,370 18,370
1120 24/7 Operation Capacity 0.00 6,178 6,178
1121 -
1122
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 2.85 $ 266,618 $ 266,618
Admin Program Total
Direct Personnel Salaries Subtotal 2.85 $ $ 266,618 $ 266,618
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 4,586 $ 4,586
1202 Worker's Compensation 5,484 5,484
1203 Health Insurance 32,847 32,847
1204 Dental Insurance 991 991
1205 Vision Insurance 211 211
1206 1 Life Insurance 589 589
Direct Employee Benefits Subtotal: $ $ 44,708 $ 44,708
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ 676 $ 676
1302 FICA/MEDICARE 20,396 20,396
1303 SUI 822 822
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment C
Direct Payroll Taxes&Expenses Subtotal: $ $ 21,894 $ 21,894
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ 333,220 $ 333,220
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment C
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General and Administrative Overhead 49,980
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 49,980
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 383,200
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 383,200
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 383,200
TOTAL PROGRAM ESTIMATED REVENUES: $ 383,200
NET PROGRAM COST: $
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2027-28 MCRT Standby Time Budget FTE Details
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
Clinical Supervisor(UR) Fresno County MCRT Standby 17%
Fresno County MCRT 83%
Fresno County CIT/CIT Standby 200%
Total 3.00
Position Contract#/Name/Department/County FTE
Clinician Fresno County MCRT Standby 117%
Fresno County MCRT Youth 400%
Fresno County MCRT 183%
Fresno County CIT/CIT Standby 2600%
Total 33.00
Position Contract#/Name/Department/County FTE
Case Manager Fresno County MCRT Standby 134%
Fresno County MCRT Youth 400%
Fresno County MCRT 266%
Fresno County CIT/CIT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE%
Case Manager Supervisor Fresno County MCRT Standby 17%
Fresno County MCRT Youth 15%
Fresno County MCRT 68%
Fresno County CIT/CIT Standby 100%
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment C
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
Exhibit C-Attachment C
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
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2027-28 MCRT Standby Time Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 333,220
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 266,618
1116 Clinical Supervisor(UR) 23,021 Provide supervision of all licensed and unlicensed clinical staff.Salary calculation:2080
hours*PY rate*1.04 rate increase*FTE.Salary expense listed will be claimed for the
cost reimbursed portion of the contract only and no other funding sources.Total cost
reimbursed salaries for MCRT standby time are estimated at 16.7695%of total MCRT
salaries. 20%of the cost reimbursed maximum for the year(excluding MCRT Youth)is
allocated to the cost reimbursed MCRT budget,aligning with our projected expenses in
the MCRT program.Standby time responsibilities may include:group supervision,
individual supervision,trainings,community resource research,partnership
development,vehicle care and preparation for response,mandatory weekly meetings,
morning and afternoon huddle(briefings,staff assignments,community concerns,
follow ups),and discharges in Smart Care.
1117 Clinician 135,477 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*PY rate*1.04 rate increase*FTE.Salary expense listed will be claimed for the
cost reimbursed portion of the contract only and no other funding sources.Total cost
reimbursed salaries for MCRT standby time are estimated at 16.7695%of total MCRT
salaries. 20%of the cost reimbursed maximum for the year(excluding MCRT Youth)is
allocated to the cost reimbursed MCRT budget,aligning with our projected expenses in
the MCRT program.Standby time responsibilities may include:group supervision,
individual supervision,trainings,community resource research,partnership
development,vehicle care and preparation for response,mandatory weekly meetings,
morning and afternoon huddle(briefings,staff assignments,community concerns,
follow ups),and discharges in Smart Care.
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1118 Case Manager 83,572 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*PY rate*1.04 rate increase*FTE.Salary expense listed
will be claimed for the cost reimbursed portion of the contract only and no other
funding sources.Total cost reimbursed salaries for MCRT standby time are estimated
at 16.7695%of total MCRT salaries. 20%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed MCRT budget,aligning
with our projected expenses in the MCRT program.Standby time responsibilities may
include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
1119 Case Manager Supervisor 18,370 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculation:2080 hours*PY rate*FTE.
Salary expense listed will be claimed for the cost reimbursed portion of the contract
only and no other funding sources.Total cost reimbursed salaries for MCRT standby
time are estimated at 16.7695%of total MCRT salaries. 20%of the cost reimbursed
maximum for the year(excluding MCRT Youth)is allocated to the cost reimbursed
MCRT budget,aligning with our projected expenses in the MCRT program.Standby
time responsibilities may include:group supervision,individual supervision,trainings,
community resource research,partnership development,vehicle care and preparation
for response,mandatory weekly meetings,morning and afternoon huddle(briefings,
staff assignments,community concerns,follow ups),and discharges in Smart Care.
1120 24/7 Operation Capacity 6,178 Overtime costs are included in the budget to ensure continuous,flexible coverage for
MCRT,which operates beyond traditional business hours,including evenings,
weekends,holidays,and during high-volume periods.Due to the unpredictable nature
of behavioral health crises,the team must remain responsive and adaptable,often
requiring staff to work beyond their scheduled shifts to ensure client safety and
program effectiveness.Salary expense listed will be claimed for the cost reimbursed
portion of the contract only and no other funding sources.MCRT OT expense is
estimated based on past OT usage.The MCRT estimated percentage of standby OT is
16.7695%of total MCRT OT. 20%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed MCRT budget,aligning
with our projected expenses in the MCRT program.Standby time responsibilities may
include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 44,708
1201 Retirement 4,586 Costs related to employee 401k.Estimated at 1.72%of salary expense.
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1202 Worker's Compensation 5,484 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 32,847 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 991 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 211 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 589 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 21,894
1301 OASDI 676 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 20,396 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 822 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 49,980
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General and Administrative Overhead 49,980 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Calculated at 15%of modified total direct costs(MTDC).In the cost-reimbursed budget,
MTDC are salaries&benefits.The expense listed will be claimed through the cost
reimbursement portion of the contract only and no other funding sources.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 383,200
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2028-29 MCRT Standby Time Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinical Supervisor(UR) 0.14 $ 19,517 $ 19,517
1117 Clinician 0.96 114,858 114,858
1118 Case Manager 1.09 70,853 70,853
1119 Case Manager Supervisor 0.14 15,574 15,574
1120 24/7 Operation Capacity 0.00 5,238 5,238
1121 -
1122
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 2.32 $ 226,040 $ 226,040
Admin Program Total
Direct Personnel Salaries Subtotal 2.32 $ $ 226,040 $ 226,040
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 3,888 $ 3,888
1202 Worker's Compensation 4,649 4,649
1203 Health Insurance 27,848 27,848
1204 Dental Insurance 840 840
1205 Vision Insurance 179 179
1206 1 Life Insurance 499 499
Direct Employee Benefits Subtotal: $ $ 37,903 $ 37,903
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ 573 $ 573
1302 FICA/MEDICARE 17,292 17,292
1303 SUI 697 697
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment C
Direct Payroll Taxes&Expenses Subtotal: $ $ 18,562 $ 18,562
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ 282,505 $ 282,505
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment C
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General and Administrative Overhead 42,375
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 42,375
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 324,880
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 324,880
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 324,880
TOTAL PROGRAM ESTIMATED REVENUES: $ 324,880
NET PROGRAM COST: $
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2028-29 MCRT Standby Time Budget FTE Details
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
Clinical Supervisor(UR) Fresno County MCRT Standby 14%
Fresno County MCRT 86%
Fresno County CIT/CIT Standby 200%
Total 3.00
Position Contract#/Name/Department/County FTE
Clinician Fresno County MCRT Standby 96%
Fresno County MCRT Youth 400%
Fresno County MCRT 204%
Fresno County CIT/CIT Standby 2600%
Total 33.00
Position Contract#/Name/Department/County FTE
Case Manager Fresno County MCRT Standby 109%
Fresno County MCRT Youth 400%
Fresno County MCRT 291%
Fresno County CIT/CIT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE
Case Manager Supervisor Fresno County MCRT Standby 14%
Fresno County MCRT Youth 15%
Fresno County MCRT 71%
Fresno County CIT/CIT Standby 100%
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment C
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
Exhibit C-Attachment C
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
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2028-29 MCRT Standby Time Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 282,505
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 226,040
1116 Clinical Supervisor(UR) 19,517 Provide supervision of all licensed and unlicensed clinical staff.Salary calculation:2080
hours*PY rate*1.04 rate increase*FTE.Salary expense listed will be claimed for the
cost reimbursed portion of the contract only and no other funding sources.Total cost
reimbursed salaries for MCRT standby time are estimated at 13.6705%of total MCRT
salaries. 20%of the cost reimbursed maximum for the year(excluding MCRT Youth)is
allocated to the cost reimbursed MCRT budget,aligning with our projected expenses in
the MCRT program.Standby time responsibilities may include:group supervision,
individual supervision,trainings,community resource research,partnership
development,vehicle care and preparation for response,mandatory weekly meetings,
morning and afternoon huddle(briefings,staff assignments,community concerns,
follow ups),and discharges in Smart Care.
1117 Clinician 114,858 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*PY rate*1.04 rate increase*FTE.Salary expense listed will be claimed for the
cost reimbursed portion of the contract only and no other funding sources.Total cost
reimbursed salaries for MCRT standby time are estimated at 13.6705%of total MCRT
salaries. 20%of the cost reimbursed maximum for the year(excluding MCRT Youth)is
allocated to the cost reimbursed MCRT budget,aligning with our projected expenses in
the MCRT program.Standby time responsibilities may include:group supervision,
individual supervision,trainings,community resource research,partnership
development,vehicle care and preparation for response,mandatory weekly meetings,
morning and afternoon huddle(briefings,staff assignments,community concerns,
follow ups),and discharges in Smart Care.
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1118 Case Manager 70,853 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*PY rate*1.04 rate increase*FTE.Salary expense listed
will be claimed for the cost reimbursed portion of the contract only and no other
funding sources.Total cost reimbursed salaries for MCRT standby time are estimated
at 13.6705%of total MCRT salaries. 20%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed MCRT budget,aligning
with our projected expenses in the MCRT program.Standby time responsibilities may
include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
1119 Case Manager Supervisor 15,574 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculation:2080 hours*PY rate*FTE.
Salary expense listed will be claimed for the cost reimbursed portion of the contract
only and no other funding sources.Total cost reimbursed salaries for MCRT standby
time are estimated at 13.6705%of total MCRT salaries. 20%of the cost reimbursed
maximum for the year(excluding MCRT Youth)is allocated to the cost reimbursed
MCRT budget,aligning with our projected expenses in the MCRT program.Standby
time responsibilities may include:group supervision,individual supervision,trainings,
community resource research,partnership development,vehicle care and preparation
for response,mandatory weekly meetings,morning and afternoon huddle(briefings,
staff assignments,community concerns,follow ups),and discharges in Smart Care.
1120 24/7 Operation Capacity 5,238 Overtime costs are included in the budget to ensure continuous,flexible coverage for
MCRT,which operates beyond traditional business hours,including evenings,
weekends,holidays,and during high-volume periods.Due to the unpredictable nature
of behavioral health crises,the team must remain responsive and adaptable,often
requiring staff to work beyond their scheduled shifts to ensure client safety and
program effectiveness.Salary expense listed will be claimed for the cost reimbursed
portion of the contract only and no other funding sources.MCRT OT expense is
estimated based on past OT usage.The MCRT estimated percentage of standby OT is
13.6705%of total MCRT OT. 20%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed MCRT budget,aligning
with our projected expenses in the MCRT program.Standby time responsibilities may
include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 37,903
1201 Retirement 3,888 Costs related to employee 401k.Estimated at 1.72%of salary expense.
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1202 Worker's Compensation 4,649 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 27,848 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 840 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 179 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 499 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 18,562
1301 OASDI 573 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 17,292 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 697 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 42,375
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General and Administrative Overhead 42,375 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Calculated at 15%of modified total direct costs(MTDC).In the cost-reimbursed budget,
MTDC are salaries&benefits.The expense listed will be claimed through the cost
reimbursement portion of the contract only and no other funding sources.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 324,880
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2029-30 MCRT Standby Time Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $ $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinical Supervisor(UR) 0.11 $ 16,364 $ 16,364
1117 Clinician 0.77 96,302 96,302
1118 Case Manager 0.88 59,406 59,406
1119 Case Manager Supervisor 0.11 13,057 13,057
1120 24/7 Operation Capacity 0.00 4,391 4,391
1121 -
1122
1123 -
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 1.87 $ 189,520 $ 189,520
Admin Program Total
Direct Personnel Salaries Subtotal 1.87 $ $ 189,520 $ 189,520
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ $ 3,260 $ 3,260
1202 Worker's Compensation 3,898 3,898
1203 Health Insurance 23,349 23,349
1204 Dental Insurance 705 705
1205 Vision Insurance 150 150
1206 1 Life Insurance 419 419
Direct Employee Benefits Subtotal: $ $ 31,781 $ 31,781
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ $ 480 $ 480
1302 FICA/MEDICARE 14,498 14,498
1303 SUI 585 585
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment C
Direct Payroll Taxes&Expenses Subtotal: $ $ 15,563 $ 15,563
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ 236,864 $ 236,864
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
Exhibit C-Attachment C
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General and Administrative Overhead 35,528
6010 Other(specify) -
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 35,528
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 272,392
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 272,392
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 272,392
TOTAL PROGRAM ESTIMATED REVENUES: $ 272,392
NET PROGRAM COST: $
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2029-30 MCRT Standby Time Budget FTE Details
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
Clinical Supervisor(UR) Fresno County MCRT Standby 11%
Fresno County MCRT 89%
Fresno County CIT/CIT Standby 200%
Total 3.00
Position Contract#/Name/Department/County FTE
Clinician Fresno County MCRT Standby 77%
Fresno County MCRT Youth 400%
Fresno County MCRT 223%
Fresno County CIT/CIT Standby 2600%
Total 33.00
Position Contract#/Name/Department/County FTE%
Case Manager Fresno County MCRT Standby 88%
Fresno County MCRT Youth 400%
Fresno County MCRT 312%
Fresno County CIT/CIT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE
Case Manager Supervisor Fresno County MCRT Standby 11%
Fresno County MCRT 89%
Fresno County CIT/CIT Standby 100%
Total 2.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
0
Exhibit C-Attachment C
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
Exhibit C-Attachment C
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
Exhibit C-Attachment C
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2029-30 MCRT Standby Time Budget Narrative
PROGRAM EXPENSE
ACCT#J LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 236,864
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 189,520
1116 Clinical Supervisor(UR) 16,364 Provide supervision of all licensed and unlicensed clinical staff.Salary calculation:2080
hours*PY rate*1.04 rate increase*FTE.Salary expense listed will be claimed for the
cost reimbursed portion of the contract only and no other funding sources.Total cost
reimbursed salaries for MCRT standby time are estimated at 11.021%of total MCRT
salaries. 20%of the cost reimbursed maximum for the year(excluding MCRT Youth)is
allocated to the cost reimbursed MCRT budget,aligning with our projected expenses in
the MCRT program.Standby time responsibilities may include:group supervision,
individual supervision,trainings,community resource research,partnership
development,vehicle care and preparation for response,mandatory weekly meetings,
morning and afternoon huddle(briefings,staff assignments,community concerns,
follow ups),and discharges in Smart Care.
1117 Clinician 96,302 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*PY rate*1.04 rate increase*FTE.Salary expense listed will be claimed for the
cost reimbursed portion of the contract only and no other funding sources.Total cost
reimbursed salaries for MCRT standby time are estimated at 11.021%of total MCRT
salaries. 20%of the cost reimbursed maximum for the year(excluding MCRT Youth)is
allocated to the cost reimbursed MCRT budget,aligning with our projected expenses in
the MCRT program.Standby time responsibilities may include:group supervision,
individual supervision,trainings,community resource research,partnership
development,vehicle care and preparation for response,mandatory weekly meetings,
morning and afternoon huddle(briefings,staff assignments,community concerns,
follow ups),and discharges in Smart Care.
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1118 Case Manager 59,406 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*PY rate*1.04 rate increase*FTE.Salary expense listed
will be claimed for the cost reimbursed portion of the contract only and no other
funding sources.Total cost reimbursed salaries for MCRT standby time are estimated
at 11.021%of total MCRT salaries. 20%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed MCRT budget,aligning
with our projected expenses in the MCRT program.Standby time responsibilities may
include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
1119 Case Manager Supervisor 13,057 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculation:2080 hours*PY rate*FTE.
Salary expense listed will be claimed for the cost reimbursed portion of the contract
only and no other funding sources.Total cost reimbursed salaries for MCRT standby
time are estimated at 11.021%of total MCRT salaries. 20%of the cost reimbursed
maximum for the year(excluding MCRT Youth)is allocated to the cost reimbursed
MCRT budget,aligning with our projected expenses in the MCRT program.Standby
time responsibilities may include:group supervision,individual supervision,trainings,
community resource research,partnership development,vehicle care and preparation
for response,mandatory weekly meetings,morning and afternoon huddle(briefings,
staff assignments,community concerns,follow ups),and discharges in Smart Care.
1120 24/7 Operation Capacity 4,391 Overtime costs are included in the budget to ensure continuous,flexible coverage for
MCRT,which operates beyond traditional business hours,including evenings,
weekends,holidays,and during high-volume periods.Due to the unpredictable nature
of behavioral health crises,the team must remain responsive and adaptable,often
requiring staff to work beyond their scheduled shifts to ensure client safety and
program effectiveness.Salary expense listed will be claimed for the cost reimbursed
portion of the contract only and no other funding sources.MCRT OT expense is
estimated based on past OT usage.The MCRT estimated percentage of standby OT is
11.021%of total MCRT OT. 20%of the cost reimbursed maximum for the year
(excluding MCRT Youth)is allocated to the cost reimbursed MCRT budget,aligning
with our projected expenses in the MCRT program.Standby time responsibilities may
include:group supervision,individual supervision,trainings,community resource
research,partnership development,vehicle care and preparation for response,
mandatory weekly meetings,morning and afternoon huddle(briefings,staff
assignments,community concerns,follow ups),and discharges in Smart Care.
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 O
Direct Employee Benefits 31,781
1201 Retirement 3,260 Costs related to employee 401k.Estimated at 1.72%of salary expense.
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1202 Worker's Compensation 3,898 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 23,349 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 705 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 150 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 419 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 15,563
1301 OASDI 480 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 14,498 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 585 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Advertising
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 HMIS(Health Management Information System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services
5005 Other(specify)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 35,528
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General and Administrative Overhead 35,528 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Calculated at 15%of modified total direct costs(MTDC).In the cost-reimbursed budget,
MTDC are salaries&benefits.The expense listed will be claimed through the cost
reimbursement portion of the contract only and no other funding sources.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
Exhibit C-Attachment C
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 272,392
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-June 30,2026)MCRT-Y Services Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinician 2.67 $ 248,976 $ 248,976
1117 Case Manager 2.67 134,389 134,389
1118 Case Manager Supervisor 0.10 9,098 9,098
1119 -
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 5.44 $ 392,463 $ 392,463
Admin Program Total
Direct Personnel Salaries Subtotal 5.44 $ $ 392,463 $ 392,463
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 6,750 $ 6,750
1202 Worker's Compensation 8,072 8,072
1203 Health Insurance 48,352 48,352
1204 Dental Insurance 1,459 1,459
1205 Vision Insurance 311 311
1206 1 Life Insurance 867 867
Direct Employee Benefits Subtotal: $ $ 65,811 $ 65,811
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 995 $ 995
1302 FICA/MEDICARE 30,023 30,023
1303 SUI 1,210 1,210
1304 Other(specify) - -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment D
Direct Payroll Taxes&Expenses Subtotal: $ $ 32,228 $ 32,228
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ 490,502 $ 490,502
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 3,600
3002 Printing/Postage 275
3003 Office,Household&Program Supplies 1,078
3004 Staff Recruitment&Retention 1,999
3005 Staff Development&Training 2,151
3006 Staff Mileage 25
3007 Subscriptions&Memberships 7
3008 Vehicle Maintenance 9,138
3009 Other(specify) -
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 18,273
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ 3,097
4002 Rent/Lease Building 10,051
4003 Rent/Lease Equipment 172
4004 Rent/Lease Vehicles 5,733
4005 Security -
4006 Utilities 2,792
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 21,845
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 12,535
5002 Software(HMIS,EHR,Microsoft Office,Security) 3,910
5003 Contractual/Consulting Services (Physician Fees) 2075,
5004 Translation Services 35
5005 Insurance(Liability and Auto) 8,900
Exhibit C-Attachment D
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 27,455
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General&Administrative Overhead 78,851
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 78,851
INDIRECT COST RATE 14.01%
7000:DIRECT FIXED ASSETS
Acct# Line Item Description Amount
7001 Computer Equipment&Software $ 830
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA Data
7003 Furniture&Fixtures 3,911
7004 Leasehold/Tenant/Building Improvements -
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $ 4,741
TOTAL PROGRAM EXPENSES $ 641,667
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 641,667
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 641,667
TOTAL PROGRAM ESTIMATED REVENUES: $ 641,667
NET PROGRAM COST: $
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-June 30,2026)MCRT-Y Services Budget FTE Details
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%
Clinician Fresno County MCRT Youth 267%
Fresno County MCRT Standby 16%
Fresno County MCRT 184%
Fresno County CIT/CIT Standby 1733%
Total 22.00
Position Contract#/Name/Department/County FTE%
Case Manager Fresno County MCRT Youth 267%
Fresno County MCRT Standby 126%
Fresno County MCRT 141%
Fresno County CIT/CIT Standby 267%
Total 8.00
Position Contract#/Name/Department/County FTE
Case Manager Supervisor Fresno County MCRT Youth 10%
Fresno County MCRT Standby 16%
Fresno County MCRT 41%
Fresno County CIT/CIT Standby 67%
Total 1.33
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment D
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
Exhibit C-Attachment D
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
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2025-26(December 1,2025-June 30,2026)MCRT-Y Services Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 490,502
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 0
Program Positions 392,463
1116 Clinician 248,976 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*$51.30 rate*FTE.This FTE is prorated for a partial year.
1117 Case Manager 134,389 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*$27.69 rate*FTE.This FTE is prorated for a partial fiscal
year.
1118 Case Manager Supervisor 9,098 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculation:2080 hours*$48.69 rate*
FTE.FTE is prorated for a partial year.
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 65,811
1201 Retirement 6,750 Costs related to employee 401k.Estimated at 1.72%of salary expense.
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1202 Worker's Compensation 8,072 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 48,352 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 1,459 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 311 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 867 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 32,228
1301 OASDI 995 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 30,023 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 1,210 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES 18,273
3001 Telecommunications 3,600 Portion of total cost of mobile communication tools necessary to support field-based
operations for the MCRT program.It includes the purchase of cell phones,monthly
cellular service,data connectivity to enable secure communication and access to
electronic health records in the field,and protective accessories to ensure the
longevity and functionality of the device during mobile crisis response activities.Cost
listed will not be claimed through any other funding source.
3002 Printing/Postage 275 Portion of total printing and postage costs.Printing costs include the production of
client-facing materials essential for engaging clients,ensuring informed participation,
and supporting post-crisis follow-up.Postage costs cover the mailing of important
documents as well as the costs of shipping supplies&equipment.Cost listed will not
be claimed through any other funding source.
3003 Office,Household&Program Supplies 1,078 Portion of cost of essential office administrative supplies and minor equipment
necessary for the daily operations of the program.Office supplies may include items
such as paper,pens,folders,clipboards,printer ink,and other materials required for
documentation,client engagement,and administrative tasks.This category includes
minor office equipment and basic housewares to support a functional and comfortable
work environment for staff can include small appliances such as a coffee makers,
refrigerator,microwave,toaster,dishes,and utensils to accommodate staff working
long or overnight shifts,particularly those supporting 24/7 operations such as the
MCRT.Cost listed will not be claimed through any other funding source.
3004 Staff Recruitment&Retention 1,999 Portion of costs associated with recruitment efforts necessary to attract and retain
qualified personnel.Includes recruitment bonuses offered to qualified candidates to
appeal to experienced staff being hired for critical roles.Also includes job
advertisements to promote open positions through professional networks.Includes
the costs of pre-employment screenings.Cost listed will not be claimed through any
other funding source.
3005 Staff Development&Training 2,151 Portion of costs associated with the comprehensive devlopment and training for MCRT
personnel essential to maintaining high standards of care,ensuring compliance with
regulatory requirements,and fostering a well-prepared,trauma-informed,culturally
competent workforce.Includes trainings for peer support specialists,clinicians,case
managers,and professional development opportunities.Also includes the cost of
regularly-scheduled team meetings for program improvement and initiatives.Cost
listed will not be claimed through any other funding source.
3006 Staff Mileage 25 Portion of mileage reimbursement for staff who utilize their personal vehicles to
perform duties related to MCRT.Reimbursement will be provided in accordance with
the standard mileage rate established by the Internal Revenue Service(IRS)and
organizational policy.This ensures staff are fairly compensated for work-related travel,
supports program flexibility,and allows the team to maintain timely and responsive
services throughout the region.Cost listed will not be claimed through any other
funding source.
3007 Subscriptions&Memberships 7 Portion of dues for clinical and peer staff to join relevant professional associations
which provide access to continuing education,best practices,and professional
development resources.Subscriptions to clinical,behavioral health,and crisis
intervention journals to support evidence-based practice and inform staff of emerging
trends and research.Access to digital platforms that offer training,resource libraries,
certification programs,or crisis intervention tools relevant to the roles of clinicians,
case managers,and peer specialists.Cost listed will not be claimed through any other
funding source.
3008 Vehicle Maintenance 9,138 Portion of costs of essential vehicle maintenance for all vehicles assigned to MCRT
Youth.Includes routine maintenance,minor auto repairs,fuel,car washes,GPS
installation and monitoring,and DMV fees.Cost listed will not be claimed through any
other funding source.
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 1 Other(specify)
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
4000:DIRECT FACILITIES&EQUIPMENT 21,845
4001 Building Maintenance 3,097 Portion of costs associated with the maintenance including janitorial services,facility
repairs and routine maintenance,hardware maintenance,and facility supplies.Cost
listed will not be claimed through any other funding source.
4002 Rent/Lease Building 10,051 Portion of cost of leasing building space for employees to work from.Cost listed will
not be claimed through any other funding source.
4003 Rent/Lease Equipment 172 Portion of cost of renting a highly efficient copy/print/fax machine.Cost listed will not
be claimed through any other funding source.
4004 Rent/Lease Vehicles 5,733 Portion of cost of leasing vehicles to be used for the program.Cost listed will not be
claimed through any other funding source.
4005 Security -
4006 Utilities 2,792 Portion of cost of utilities.Cost listed will not be claimed through any other funding
source.
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 1 Other(specify)
5000:DIRECT SPECIAL EXPENSES 27,455
5001 Consultant(Network&Data Management) 12,535 Portion of costs related to Kings View Information Technology.Provides
comprehensive hardware and software support to ensure successful data collection,
management,and reporting.Support includes:network&desktop management,
project&Technology management,technology procurement,telecommunications
support,strategic technology planning,system documentation,application&data
hosting,and 24/7 access&support.Cost listed will not be claimed through any other
funding source.
5002 Software(HMIS,EHR,Microsoft Office,Security) 3,910 Portion of costs of necessary software to carry out program objectives including
Credible,Smartcare,Microsoft Office,panic buttons,dispatch software,and security.
Cost listed will not be claimed through any other funding source.
5003 Contractual/Consulting Services (Physician Fees) 2,075 Portion of cost of telepsychiatrist,as needed by the program.Cost listed will not be
claimed through any other funding source.
5004 Translation Services 35 Portion of cost of translation services to allow program to overcome language barriers
to support clients.Cost listed will not be claimed through any other funding source.
5005 Insurance(Liability and Auto) 8,900 Portion of cost of general liability insurance and auto insurance including roadside
assistance.Cost listed will not be claimed through any other funding source.
5006 Other(specify) -
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 78,851
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General&Administrative Overhead 78,851 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Cost listed will not be claimed through any other funding source.15%of modified total
direct costs(modified total direct costs exclude furnishings,computers,software,KVIT,
and rentals/leases).
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS 4,741
7001 Computer Equipment&Software 830 Portion of cost of computer equipment for new staff and replacement equipment as
needed.Includes network installation for new building as necessary.Cost listed will
not be claimed through any other funding source.
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA -
7003 Furniture&Fixtures 3,911 Portion of cost of essential office furnishings for a new building including cubicle build-
outs,tables,chairs,appliances,desks,whiteboards,storage furnishings,and other
furnishings needed to aid in the program's successful operation. Cost listed will not be
claimed through any other funding source.
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 641,667
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2026-27 MCRT-Y Services Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinician 4.00 $ 443,872 $ 443,872
1117 Case Manager 4.00 239,616 239,616
1118 Case Manager Supervisor 0.15 16,221 16,221
1119 -
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.15 $ 699,709 $ 699,709
Admin Program Total
Direct Personnel Salaries Subtotal 8.15 $ $ 699,709 $ 699,709
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 12,035 $ 12,035
1202 Worker's Compensation 14,391 14,391
1203 Health Insurance 86,204 86,204
1204 Dental Insurance 2,602 2,602
1205 Vision Insurance 554 554
1206 1 Life Insurance 1,545 1,545
Direct Employee Benefits Subtotal: $ $ 117,331 $ 117,331
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 1,773 $ 1,773
1302 FICA/MEDICARE 53,528 53,528
1303 SUI 2,158 2,158
1304 Other(specify) -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment D
Direct Payroll Taxes&Expenses Subtotal: $ $ 57,459 $ 57,459
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ 874,499 $ 874,499
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 9,490
3002 Printing/Postage -
3003 Office,Household&Program Supplies 1,210
3004 Staff Recruitment 3,659
3005 Staff Development&Training 2,831
3006 Staff Mileage -
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 13,673
3009 Other(specify) -
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 30,863
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance $ -
4002 Rent/Lease Building
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles 15,152
4005 Security -
4006 Utilities 7,379
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 22,531
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 31,017
5002 Software(HMIS,EHR,Microsoft Office,Security) -
5003 Contractual/Consulting Services (Physician Fees) 3,634
5004 Translation Services -
5005 Insurance(Liability and Auto)
Exhibit C-Attachment D
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 34,651
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General&Administrative Overhead 137,456
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 137,456
INDIRECT COST RATE 14.28%
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 jAssets over$5,000/unit(Specify)
7007 1 Other(specify)
7008 IFiscalRocks
FIXED ASSETS EXPENSES TOTAL $ -
TOTAL PROGRAM EXPENSES $ 1,100,000
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 1,100,000
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 1,100,000
TOTAL PROGRAM ESTIMATED REVENUES: $ 1,100,000
NET PROGRAM COST: $
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2026-27 MCRT-Y Services Budget FTE Details
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
Clinician Fresno County MCRT Youth 400%
Fresno County MCRT Standby 143%
Fresno County MCRT 157%
Fresno County CIT/CIT Standby 2600%
Total 33.00
Position Contract#/Name/Department/County FTE%
Case Manager Fresno County MCRT Youth 400%
Fresno County MCRT Standby 163%
Fresno County MCRT 237%
Fresno County CIT/CIT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE%
Case Manager Supervisor Fresno County MCRT Youth 15%
Fresno County MCRT Standby 20%
Fresno County MCRT 64%
Fresno County CIT/CIT Standby 100%
Total 2.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment D
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
Exhibit C-Attachment D
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
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2026-27 MCRT-Y Services Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 874,499
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 O
Program Positions 699,709
1116 Clinician 443,872 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*PYrate*1.04*FTE.
1117 Case Manager 239,616 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*PY rate*1.04*FTE.
1118 Case Manager Supervisor 16,221 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculation:2080 hours*PY rate*
1.04*FTE.
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 O
Direct Employee Benefits 117,331
1201 Retirement 12,035 Costs related to employee 401k.Estimated at 1.72%of salary expense.
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1202 Worker's Compensation 14,391 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 86,204 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 2,602 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 554 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 1,545 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 57,459
1301 OASDI 1,773 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 53,528 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 2,158 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES 30,863
3001 Telecommunications 9,490 Portion of total cost of mobile communication tools necessary to support field-based
operations for the MCRT program.It includes the purchase of cell phones,monthly
cellular service,data connectivity to enable secure communication and access to
electronic health records in the field,and protective accessories to ensure the
longevity and functionality of the device during mobile crisis response activities.Cost
listed will not be claimed through any other funding source.
3002 Printing/Postage -
3003 Office,Household&Program Supplies 1,210 Portion of cost of essential office administrative supplies and minor equipment
necessary for the daily operations of the program.Office supplies may include items
such as paper,pens,folders,clipboards,printer ink,and other materials required for
documentation,client engagement,and administrative tasks.This category includes
minor office equipment and basic housewares to support a functional and comfortable
work environment for staff can include small appliances such as a coffee makers,
refrigerator,microwave,toaster,dishes,and utensils to accommodate staff working
long or overnight shifts,particularly those supporting 24/7 operations such as the
MCRT.Cost listed will not be claimed through any other funding source.
3004 Staff Recruitment 3,659 Portion of costs associated with recruitment efforts necessary to attract and retain
qualified personnel.Includes recruitment bonuses offered to qualified candidates to
appeal to experienced staff being hired for critical roles.Also includes job
advertisements to promote open positions through professional networks.Includes
the costs of pre-employment screenings.Cost listed will not be claimed through any
other funding source.
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3005 Staff Development&Training 2,831 Portion of costs associated with the comprehensive devlopment and training for MCRT
personnel essential to maintaining high standards of care,ensuring compliance with
regulatory requirements,and fostering a well-prepared,trauma-informed,culturally
competent workforce.Includes trainings for peer support specialists,clinicians,case
managers,and professional development opportunities.Also includes the cost of
regularly-scheduled team meetings for program improvement and initiatives.Cost
listed will not be claimed through any other funding source.
3006 Staff Mileage
3007 Subscriptions&Memberships -
3008 Vehicle Maintenance 13,673 Portion of costs of essential vehicle maintenance for all vehicles assigned to MCRT
Youth.Includes routine maintenance,minor auto repairs,fuel,car washes,GPS
installation and monitoring,and DMV fees.Cost listed will not be claimed through any
other funding source.
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 22,531
4001 Building Maintenance -
4002 Rent/Lease Building
4003 Rent/Lease Equipment -
4004 Rent/Lease Vehicles 15,152 Portion of cost of leasing vehicles to be used for the program.Cost listed will not be
claimed through any other funding source.
4005 Security -
4006 Utilities 7,379 Portion of cost of utilities.Cost listed will not be claimed through any other funding
source.
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES 34,651
5001 Consultant(Network&Data Management) 31,017 Portion of costs related to Kings View Information Technology.Provides
comprehensive hardware and software support to ensure successful data collection,
management,and reporting.Support includes:network&desktop management,
project&Technology management,technology procurement,telecommunications
support,strategic technology planning,system documentation,application&data
hosting,and 24/7 access&support.Cost listed will not be claimed through any other
funding source.
5002 Software(HMIS,EHR,Microsoft Office,Security) -
5003 Contractual/Consulting Services (Physician Fees) 3,634 Portion of cost of telepsychiatrist,as needed by the program.Cost listed will not be
claimed through any other funding source.
5004 Translation Services -
5005 Insurance(Liability and Auto)
5006 1 Other(specify)
5007 Other(specify)
5008 Other(specify)
6000:INDIRECT EXPENSES 137,456
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General&Administrative Overhead 137,456 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Cost listed will not be claimed through any other funding source.15%of modified total
direct costs(modified total direct costs exclude furnishings,computers,software,WIT,
and rentals/leases).
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 FiscalRocks
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,100,000
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2027-28 MCRT-Y Services Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinician 4.00 $ 461,594 $ 461,594
1117 Case Manager 4.00 249,184 249,184
1118 Case Manager Supervisor 0.15 16,871 16,871
1119 -
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.15 $ 727,649 $ 727,649
Admin Program Total
Direct Personnel Salaries Subtotal 8.15 $ $ 727,649 $ 727,649
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 12,515 $ 12,515
1202 Worker's Compensation 14,966 14,966
1203 Health Insurance 89,647 89,647
1204 Dental Insurance 2,706 2,706
1205 Vision Insurance 576 576
1206 1 Life Insurance 1,607 1,607
Direct Employee Benefits Subtotal: $ $ 122,017 $ 122,017
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 1,844 $ 1,844
1302 FICA/MEDICARE 55,665 55,665
1303 SUI 2,244 2,244
1304 Other(specify) -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment D
Direct Payroll Taxes&Expenses Subtotal: $ $ 59,753 $ 59,753
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ 909,419 $ 909,419
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications $ 1,723
3002 Printing/Postage -
3003 Office,Household&Program Supplies 1,220
3004 Staff Recruitment 3,689
3005 Staff Development&Training 2,854
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL:j$ 9,486
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 7,441
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 7,441
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 30,529
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Physician Fees) 3,629
5004 Translation Services
5005 Insurance(Liability and Auto)
Exhibit C-Attachment D
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $ 34,1S8
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General&Administrative Overhead 139,496
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 139,496
INDIRECT COST RATE 14.52%
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $
TOTAL PROGRAM EXPENSES $ 1,100,000
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 1,100,000
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 1,100,000
TOTAL PROGRAM ESTIMATED REVENUES: $ 1,100,000
NET PROGRAM COST: $
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2027-28 MCRT-Y Services Budget FTE Details
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
Clinician Fresno County MCRT Youth 400%
Fresno County MCRT Standby 117%
Fresno County MCRT 183%
Fresno County CIT/CIT Standby 2600%
Total 33.00
Position Contract#/Name/Department/County FTE%
Case Manager Fresno County MCRT Youth 400%
Fresno County MCRT Standby 134%
Fresno County MCRT 266%
Fresno County CIT/CIT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE%
Case Manager Supervisor Fresno County MCRT Youth 15%
Fresno County MCRT Standby 17%
Fresno County MCRT 68%
Fresno County CIT/CIT Standby 100%
Total 2.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment D
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
Exhibit C-Attachment D
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
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2027-28 MCRT-Y Services Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 909,419
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 O
Program Positions 727,649
1116 Clinician 461,594 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*PYrate*1.04*FTE.
1117 Case Manager 249,184 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*PY rate*1.04*FTE.
1118 Case Manager Supervisor 16,871 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculation:2080 hours*PY rate*
1.04*FTE.
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 O
Direct Employee Benefits 122,017
1201 Retirement 12,515 Costs related to employee 401k.Estimated at 1.72%of salary expense.
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1202 Worker's Compensation 14,966 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 89,647 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 2,706 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 576 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 1,607 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 59,753
1301 OASDI 1,844 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 55,665 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 2,244 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES 9,486
3001 Telecommunications 1,723 Portion of total cost of mobile communication tools necessary to support field-based
operations for the MCRT program.It includes the purchase of cell phones,monthly
cellular service,data connectivity to enable secure communication and access to
electronic health records in the field,and protective accessories to ensure the
longevity and functionality of the device during mobile crisis response activities.Cost
listed will not be claimed through any other funding source.
3002 Printing/Postage -
3003 Office,Household&Program Supplies 1,220 Portion of cost of essential office administrative supplies and minor equipment
necessary for the daily operations of the program.Office supplies may include items
such as paper,pens,folders,clipboards,printer ink,and other materials required for
documentation,client engagement,and administrative tasks.This category includes
minor office equipment and basic housewares to support a functional and comfortable
work environment for staff can include small appliances such as a coffee makers,
refrigerator,microwave,toaster,dishes,and utensils to accommodate staff working
long or overnight shifts,particularly those supporting 24/7 operations such as the
MCRT.Cost listed will not be claimed through any other funding source.
3004 Staff Recruitment 3,689 Portion of costs associated with recruitment efforts necessary to attract and retain
qualified personnel.Includes recruitment bonuses offered to qualified candidates to
appeal to experienced staff being hired for critical roles.Also includes job
advertisements to promote open positions through professional networks.Includes
the costs of pre-employment screenings.Cost listed will not be claimed through any
other funding source.
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
3005 Staff Development&Training 2,854 Portion of costs associated with the comprehensive devlopment and training for MCRT
personnel essential to maintaining high standards of care,ensuring compliance with
regulatory requirements,and fostering a well-prepared,trauma-informed,culturally
competent workforce.Includes trainings for peer support specialists,clinicians,case
managers,and professional development opportunities.Also includes the cost of
regularly-scheduled team meetings for program improvement and initiatives.Cost
listed will not be claimed through any other funding source.
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 1 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 7,441
4001 Building Maintenance
4002 Rent/Lease Building -
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 7,441 Portion of cost of utilities.Cost listed will not be claimed through any other funding
source.
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify) -
5000:DIRECT SPECIAL EXPENSES 34,158
5001 Consultant(Network&Data Management) 30,529 Portion of costs related to Kings View Information Technology.Provides
comprehensive hardware and software support to ensure successful data collection,
management,and reporting.Support includes:network&desktop management,
project&Technology management,technology procurement,telecommunications
support,strategic technology planning,system documentation,application&data
hosting,and 24/7 access&support.Cost listed will not be claimed through any other
funding source.
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Physician Fees) 3,629 Portion of cost of telepsychiatrist,as needed by the program.Cost listed will not be
claimed through any other funding source.
5004 Translation Services
5005 Insurance(Liability and Auto) -
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 139,496
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General&Administrative Overhead 139,496 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Cost listed will not be claimed through any other funding source.15%of modified total
direct costs(modified total direct costs exclude furnishings,computers,software,WIT,
and rentals/leases).
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,100,000
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2028-29 MCRT-Y Services Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinician 4.00 $ 480,064 $ 480,064
1117 Case Manager 4.00 259,168 259,168
1118 Case Manager Supervisor 0.15 17,547 17,547
1119 -
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.15 $ 756,779 $ 756,779
Admin Program Total
Direct Personnel Salaries Subtotal 8.15 $ $ 756,779 $ 756,779
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 13,016 $ 13,016
1202 Worker's Compensation 15,565 15,565
1203 Health Insurance 93,235 93,235
1204 Dental Insurance 2,814 2,814
1205 Vision Insurance 599 599
1206 1 Life Insurance 1,671 1,671
Direct Employee Benefits Subtotal: $ $ 126,900 $ 126,900
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 1,918 $ 1,918
1302 FICA/MEDICARE 57,894 57,894
1303 SUI 2,334 2,334
1304 Other(specify) -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment D
Direct Payroll Taxes&Expenses Subtotal: $ $ 62,146 $ 62,146
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ 945,825 $ 945,825
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Staff Recruitment
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities 7,503
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $ 7,503
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management) $ 3,673
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Physician Fees)
5004 Translation Services
5005 Insurance(Liability and Auto)
Exhibit C-Attachment D
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify) -
DIRECT SPECIAL EXPENSES TOTAL: $ 3,673
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General&Administrative Overhead 142,999
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 142,999
INDIRECT COST RATE 14.94%
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $
TOTAL PROGRAM EXPENSES $ 1,100,000
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 1,100,000
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 1,100,000
TOTAL PROGRAM ESTIMATED REVENUES: $ 1,100,000
NET PROGRAM COST: $
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2028-29 MCRT-Y Services Budget FTE Details
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
Clinician Fresno County MCRT Youth 400%
Fresno County MCRT Standby 96%
Fresno County MCRT 204%
Fresno County CIT/CIT Standby 2600%
Total 33.00
Position Contract#/Name/Department/County FTE%
Case Manager Fresno County MCRT Youth 400%
Fresno County MCRT Standby 109%
Fresno County MCRT 291%
Fresno County CIT/CIT Standby 400%
Total 12.00
Position Contract#/Name/Department/County FTE%
Case Manager Supervisor Fresno County MCRT Youth 15%
Fresno County MCRT Standby 14%
Fresno County MCRT 71%
Fresno County CIT/CIT Standby 100%
Total 2.00
Position Contract#/Name/Department/County FTE%
Total 0.00
Position Contract#/Name/Department/County FTE
Total 0.00
Position Contract#/Name/Department/County FTE
Exhibit C-Attachment D
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
Exhibit C-Attachment D
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
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2028-29 MCRT-Y Services Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 945,825
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 O
Program Positions 756,779
1116 Clinician 480,064 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*PYrate*1.04*FTE.
1117 Case Manager 259,168 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*PY rate*1.04*FTE.
1118 Case Manager Supervisor 17,547 This position is responsible for overseeing the training and scheduling of Case
Managers,while also participating in co-response activities and client follow-up in
alignment with the responsibilities of other Case Managers.Additional duties include
managing timecards,processing time-off requests,conducting interviews,hiring,
onboarding,credentialing,training,and performance evaluations.The role also
supports administrative functions such as purchasing,asset tracking,and oversight of
fleet maintenance.Responsibilities extend to coordinating stakeholder surveys,
collaborating with the Quality Improvement(QI)team,attending relevant meetings,
and facilitating team-building activities.Salary calculation:2080 hours*PY rate*
1.04*FTE.
1119 0
1120 0
1121 0
1122 0
1123 0
1124 0
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 O
Direct Employee Benefits 126,900
1201 Retirement 13,016 Costs related to employee 401k.Estimated at 1.72%of salary expense.
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1202 Worker's Compensation 15,565 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 93,235 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 2,814 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 599 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 1,671 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Direct Payroll Taxes&Expenses: 62,146
1301 OASDI 1,918 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 57,894 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 2,334 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Staff Recruitment
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT 7,503
4001 Building Maintenance
4002 Rent/Lease Building -
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security -
4006 Utilities 7,503 Portion of cost of utilities.Cost listed will not be claimed through any other funding
source.
4007 Other(specify) -
4008 Other(specify)
4009 Other(specify)
4010 Other(specify) -
S000:DIRECT SPECIAL EXPENSES 3,673
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
5001 Consultant(Network&Data Management) 3,673 Portion of costs related to Kings View Information Technology.Provides
comprehensive hardware and software support to ensure successful data collection,
management,and reporting.Support includes:network&desktop management,
project&Technology management,technology procurement,telecommunications
support,strategic technology planning,system documentation,application&data
hosting,and 24/7 access&support.Cost listed will not be claimed through any other
funding source.
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Physician Fees)
5004 Translation Services
5005 Insurance(Liability and Auto)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 142,999
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General&Administrative Overhead 142,999 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Cost listed will not be claimed through any other funding source.15%of modified total
direct costs(modified total direct costs exclude furnishings,computers,software,KVIT,
and rentals/leases).
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over$500 with Lifespan of 2 Years+
7006 Assets over$5,000/unit(Specify)
7007 Other(specify)
7008 1 Other(specify)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,100,000
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2029-30 MCRT-Y Services Budget
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
1101 $
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
Direct Personnel Admin Salaries Subtotal 0.00 $ $
Acct# Program Position FTE Admin Program Total
1116 Clinician 4.00 $ 499,283 $ 499,283
1117 Case Manager 4.00 269,568 269,568
1118 -
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
Direct Personnel Program Salaries Subtotal 8.00 $ 768,851 $ 768,851
Admin Program Total
Direct Personnel Salaries Subtotal 8.00 $ $ 768,851 $ 768,851
Direct Employee Benefits
Acct# Description Admin Program Total
1201 Retirement $ 13,224 $ 13,224
1202 Worker's Compensation 15,813 15,813
1203 Health Insurance 94,722 94,722
1204 Dental Insurance 2,859 2,859
1205 Vision Insurance 609 609
1206 1 Life Insurance 1,698 1,698
Direct Employee Benefits Subtotal: $ $ 128,925 $ 128,925
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
1301 OASDI $ 1,949 $ 1,949
1302 FICA/MEDICARE 58,817 58,817
1303 SUI 2,371 2,371
1304 Other(specify) -
1305 Other(specify)
1306 1 Other(specify)
Exhibit C-Attachment D
Direct Payroll Taxes&Expenses Subtotal: $ $ 63,137 $ 63,137
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ - $ 960,913 $ 960,913
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
2000:DIRECT CLIENT SUPPORT
Acct# Line Item Description Amount
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
DIRECT CLIENT CARE TOTAL $
3000:DIRECT OPERATING EXPENSES
Acct# Line Item Description Amount
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Staff Recruitment
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
DIRECT OPERATING EXPENSES TOTAL: $
4000:DIRECT FACILITIES&EQUIPMENT
Acct# Line Item Description Amount
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
DIRECT FACILITIES/EQUIPMENTTOTAL: $
5000:DIRECT SPECIAL EXPENSES
Acct# Line Item Description Amount
5001 Consultant(Network&Data Management)
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Physician Fees)
5004 Translation Services
5005 Insurance(Liability and Auto)
Exhibit C-Attachment D
5006 Other(specify)
5007 10ther(specify)
5008 10ther(specify)
DIRECT SPECIAL EXPENSES TOTAL: $
6000:INDIRECT EXPENSES
Acct# Line Item Description Amount
Administrative Overhead
6001 Use this line and only this line for approved indirect cost rate
Administrative Overhead
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Usedfor Progrom Purposes) -
6008 Personnel(indirect Salaries&Benefits) -
6009 General&Administrative Overhead 139,087
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 Other(specify)
INDIRECT EXPENSES TOTAL $ 139,087
INDIRECT COST RATE 14.47%
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 jAssets over$5,000/unit(Specify)
7007 Other(specify)
7008 Other(specify)
FIXED ASSETS EXPENSES TOTAL $
TOTAL PROGRAM EXPENSES $ 1,100,000
PROGRAM FUNDING SOURCES
8000:TOTAL PROGRAM REVENUES
Acct# Line Item Description Amount
8001 Revenue Allocated by DBH $ 1,100,000
8002 Client Fees -
8003 Client Insurance
8004 Grants(Specify)
8005 Other(Specify)
8006 1 Other(Specify)
TOTAL PROGRAM REVENUES $ 1,100,000
TOTAL PROGRAM ESTIMATED REVENUES: $ 1,100,000
NET PROGRAM COST: $
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2029-30 MCRT-Y Services Budget FTE Details
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
Clinician Fresno County MCRT Youth 400%
Fresno County MCRT Standby 77%
Fresno County MCRT 223%
Fresno County CIT/CIT Standby 2600%
Total 33.00
Position Contract#/Name/Department/County FTE%
Case Manager Fresno County MCRT Youth 400%
Fresno County MCRT Standby 88%
Fresno County MCRT 312%
Fresno County CIT/CIT Standby 400%
Total 12.00
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
Exhibit C-Attachment D
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
Exhibit C-Attachment D
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
Exhibit C-Attachment D
COMMUNITY BEHAVIORAL HEALTH CRISIS RESPONSE SERVICES
Kings View
FY 2029-30 MCRT-Y Services Budget Narrative
PROGRAM EXPENSE
ACCT#j LINE ITEM I AMT I DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 960,913
Administrative Positions -
1101 0
1102 0
1103 0
1104 0
1105 0
1106 0
1107 0
1108 0
1109 0
1110 0
1111 0
1112 0
1113 0
1114 0
1115 10 1 -
Program Positions 768,851
1116 Clinician 499,283 Provide support in managing the client's illness and minimizing its impact on their daily
life,including making appropriate referrals to relevant services.Services will
encompass crisis assessments,suicide risk evaluations,development of safety plans,
dissemination of information,and linkage to behavioral health and community
resources.Additionally,post-crisis case management and care coordination will be
provided.Services may also include assistance with securing stable housing,organizing
care coordination meetings,and collaborating with various stakeholders such as school
personnel,foster family agencies,Regional Center representatives,primary care
providers,inpatient and residential facilities,social workers,substance use disorder
treatment providers,and parole or probation officers.Salary calculation:2080
hours*PYrate*1.04*FTE.
1117 Case Manager 269,568 Serves as a co-responder alongside Clinicians and is responsible for delivering post-
crisis case management and care coordination services across all program disciplines.
Salary calculation:2080 hours*PY rate*1.04*FTE.
1118 0 -
1119 0
1120 0
1121 0
1122 0
1123 0
1124 10
1125 0
1126 0
1127 0
1128 0
1129 0
1130 0
1131 0
1132 0
1133 0
1134 0
Direct Employee Benefits 128,925
1201 Retirement 13,224 Costs related to employee 401k.Estimated at 1.72%of salary expense.
1202 Worker's Compensation 15,813 Costs related to workers'compensation insurance.Estimated at 2.0567%of salary
expense.
1203 Health Insurance 94,722 Costs related to employee medical insurance.Estimated at 12.32%of salary expense.
1204 Dental Insurance 2,859 Costs related to employee dental insurance.Estimated at 0.3718%of salary expense.
1205 Vision Insurance 609 Costs related to employee vision insurance.Estimated at 0.0792%of salary expense.
1206 Life Insurance 1,698 Costs related to employee life insurance.Estimated at 0.2209%of salary expense.
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT#j LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
Direct Payroll Taxes&Expenses: 63,137
1301 OASDI 1,949 Costs related to disability insurance.Estimated at 0.2535%of salary expense.
1302 FICA/MEDICARE 58,817 Costs related to FICA/Medicare.Estimated at 7.65%of salary expense.
1303 SUI 2,371 Costs related to unemployment insurance.Estimated at 0.3084%of salary expense.
1304 Other(specify) -
1305 Other(specify)
1306 Other(specify)
2000:DIRECT CLIENT SUPPORT
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
2012
2013
2014
2015
2016
3000:DIRECT OPERATING EXPENSES
3001 Telecommunications
3002 Printing/Postage
3003 Office,Household&Program Supplies
3004 Staff Recruitment
3005 Staff Development&Training
3006 Staff Mileage
3007 Subscriptions&Memberships
3008 Vehicle Maintenance
3009 Other(specify)
3010 Other(specify)
3011 Other(specify)
3012 Other(specify)
4000:DIRECT FACILITIES&EQUIPMENT
4001 Building Maintenance
4002 Rent/Lease Building
4003 Rent/Lease Equipment
4004 Rent/Lease Vehicles
4005 Security
4006 Utilities
4007 Other(specify)
4008 Other(specify)
4009 Other(specify)
4010 Other(specify)
5000:DIRECT SPECIAL EXPENSES
5001 Consultant(Network&Data Management)
5002 Software(HMIS,EHR,Microsoft Office,Security)
5003 Contractual/Consulting Services (Physician Fees)
5004 Translation Services
5005 Insurance(Liability and Auto)
5006 Other(specify)
5007 Other(specify)
5008 1 Other(specify)
6000:INDIRECT EXPENSES 139,087
6001 Administrative Overhead -
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping
6004 External Audit
6005 Insurance(Specify):
6006 Payroll Services
6007 Depreciation(Provider-Owned Equipment to be Used
6008 Personnel(Indirect Salaries&Benefits) -
6009 General&Administrative Overhead 139,087 This expense supports essential administrative infrastructure,including corporate
management,fiscal oversight,payroll processing,human resources services,accounts
payable,and other core administrative functions necessary for program operations.
Cost listed will not be claimed through any other funding source.Typically calculated
as 15%of modified total direct costs(modified total direct costs exclude furnishings,
computers,software,WIT,and rentals/leases),however,the amount was reduced to
stay within the annual maximum.
6010 Other(specify)
6011 Other(specify)
6012 Other(specify)
6013 1 Other(specify)
7000:DIRECT FIXED ASSETS
7001 Computer Equipment&Software
7002 Copiers,Cell Phones,Tablets,Devices to Contain HIPAA
7003 Furniture&Fixtures
Exhibit C-Attachment D
PROGRAM EXPENSE
ACCT# LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
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)
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 1,100,000
Exhibit D
Page 1 of 4
INSURANCE REQUIREMENTS
I. 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. All-Risk Property Insurance. All-Risk Property Insurance with no coinsurance penalty
provision in an amount that will cover the total of County purchased and owned property
in possession of Contractor(s) and/or used in the execution of this Agreement.
Contractor must name the County as an Additional Loss Payee
d. Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
e. 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.
f. 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
Exhibit D
Page 2 of 4
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.
g. 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.
h. 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.
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.
II. 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
Exhibit D
Page 3 of 4
Contractor shall deliver, or cause its broker or producer to deliver, to the County of
Fresno, Department of Behavioral Health —Attention Plan Administration, 1925 E
Dakota Ave, Fresno, CA 93726 or electronically to DBHPlanAdmin(a�_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.
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 any insurance
policy required by this Agreement. The Contractor is solely responsible to obtain any
policy endorsement that may be necessary to accomplish that waiver, but the
Exhibit D
Page 4 of 4
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.
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 10
DATA SECURITY
I. Definitions
Capitalized terms used in this Exhibit have the meanings set forth in this section I.
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.
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Exhibit E
Page 2 of 10
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 Ill.c of this Exhibit.
i. "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.
II. 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 as is reasonable and appropriate to avoid a Security
Breach;
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Exhibit E
Page 3 of 10
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
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.
III. 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
Revised 8/7/25
Exhibit E
Page 4 of 10
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 Ill.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) 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
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Exhibit E
Page 5 of 10
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
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Exhibit E
Page 6 of 10
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.
IV. 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(Dfresnocountyca.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 IV.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
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Exhibit E
Page 7 of 10
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.
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
IV.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.
V. 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
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Exhibit E
Page 8 of 10
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.
VI. 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 survive the termination of this Agreement and
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Exhibit E
Page 9 of 10
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.
VII. 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.
Vill. 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. The provisions of this section do not
apply to the acts or omissions of the County. The provisions of this section 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 shall survive the
termination of this Agreement.
IX. Survival. The respective rights and obligations of the Contractor and the County as stated
in this Exhibit shall survive the termination of this Agreement.
X. 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
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Exhibit E
Page 10 of 10
County or the Contractor and their respective successors or assignees, any rights,
remedies, obligations or liabilities whatsoever.
XI. 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.
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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)