HomeMy WebLinkAboutAgreement A-17-290 with Child Welfare Specialty Mental Health Services.pdfCOUNTY OF FRESNO
Fresno, CA
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MASTER AGREEMENT
This Agreement is made and entered into this ______ day of _____________, 2017, by and
between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
referred to as "COUNTY", and each CONTRACTOR listed in Exhibit A “List of Contractors”,
attached hereto and by this reference incorporated herein, and collectively hereinafter referred to as
“CONTRACTORS”, and such additional CONTRACTOR(S) as may, from time to time during the
term of this Agreement, be added by COUNTY. Reference in this Agreement to “parties” shall be
understood to refer to COUNTY and each individual CONTRACTOR, unless otherwise specified.
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH) and Department
of Social Services (DSS), is in need of qualified agencies to provide outpatient specialty mental health,
court-specific, and community-based support services for children and youth involved in the Child
Welfare Services (CWS) system; and
WHEREAS, COUNTY through its Department of Behavioral Health (DBH) is a Mental Health
Plan as defined in Title 9 of the California Code of Regulations (C.C.R.), section 1810.226; and
WHEREAS, CONTRACTOR(S) are qualified and willing to provide said services pursuant to
the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
hereto agree as follows:
1.SERVICES
A.CONTRACTOR(S) shall perform all services and fulfill all responsibilities
identified in the Summary of Services, attached hereto as Exhibits B-1, et seq. and incorporated herein
by reference.
B.CONTRACTOR shall also perform all services and fulfill all responsibilities
specified in COUNTY’s Request for Proposal (RFP) No. 952-5250, dated February 25, 2014, and
Addendum No. One (1) to COUNTY’s RFP No. 952-5250, dated March 10, 2014, and
CONTRACTOR(S) Response(s) to said Revised RFP No. 952-5250, all incorporated by reference and
herein made part of this Agreement.
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C. In the event of any inconsistency among these documents, the inconsistency shall
be resolved by giving precedence in the following order: 1) to this Agreement, including all Exhibits,
2) to the COUNTY’s Revised RFP No. 952-5250, and 3) to the Response(s) to the COUNTY’s
Revised RFP No. 952-5250. A copy of COUNTY’s Revised RFP No. 952-5250, and
CONTRACTOR(S) Response(s) thereto, shall be retained and made available during the term of this
Agreement by COUNTY’s Purchasing Department.
D. It is acknowledged by all parties hereto that COUNTY’s DBH and DSS
Administrative units shall monitor the services provided by CONTRACTOR(S), as specified herein.
E. CONTRACTOR(S) shall participate in periodic workgroup meetings including
staff from COUNTY’s DSS and DBH Administrative units. The meetings shall be held monthly, or as
needed, to discuss program requirements, data reporting, outcomes measurement, training, policies
and procedures, and overall program operations.
F. It is acknowledged by all parties hereto that upon execution of this Agreement,
CONTRACTOR(S)’ service site shall be as identified in Exhibits B-1 et seq. Any change to
CONTRACTOR(S) location of the service site may be made only upon 30 (thirty) days advance
written notification to COUNTY’s DBH Director and upon written approval from COUNTY’s DBH
Director, or designee.
G. CONTRACTOR(S) shall maintain requirements as Organizational Providers
throughout the term of this Agreement, as described in Section Eighteen (18) of this Agreement. If for
any reason, this status is not maintained, the COUNTY may terminate this Agreement pursuant to
Section Three (3) of this Agreement.
H. CONTRACTOR(S) agree that prior to providing services under the terms and
conditions of this Agreement, CONTRACTOR(S) shall have appropriate staff hired and in place for
program services and operation or COUNTY may, in addition to other remedies it may have, suspend
referrals or terminate this Agreement in accordance with Section Three (3) of this Agreement.
2. TERM
This Agreement shall become effective on the 1st day of July, 2017 and shall terminate
on the 30th day of June, 2018. CONTRACTOR(S) added to this Agreement after the execution date
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shall become part of the Agreement effective upon the date the executed signature page is received
and approved by the COUNTY’s DBH Director, or designee, as set forth in Section Eleven (11) of this
Agreement.
This Agreement may be extended for one (1) additional consecutive twelve (12) month
period subject to satisfactory performance outcomes as identified in Exhibits B-1 et seq., and subject
to State funding each year, upon the same terms and conditions herein set forth, unless written notice
of non-renewal is given by COUNTY, CONTRACTOR(S), or COUNTY’s DBH Director, or
designee, not later than sixty (60) days prior to the close of the then current Agreement term.
The June 30 termination date specified herein shall be the termination date for all
CONTRACTOR(S), regardless of when CONTRACTOR is added to this Agreement. Any twelve
(12) month renewal period of this Agreement for any CONTRACTOR already providing services
under this Agreement shall commence on July 1, 2018.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving the CONTRACTOR(S) thirty (30) days advance written notice.
B. Breach of Contract - The COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of the COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to the COUNTY;
4) Improperly performed service.
In no event shall any payment by the COUNTY constitute a waiver by the
COUNTY of any breach of this Agreement or any default which may then exist on the part of the
CONTRACTOR(S). Neither shall such payment impair or prejudice any remedy available to the
COUNTY with respect to the breach or default. The COUNTY shall have the right to demand of each
CONTRACTOR the repayment to the COUNTY of any funds disbursed to that CONTRACTOR
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under this Agreement, which in the judgment of the COUNTY were not expended in accordance with
the terms of this Agreement. Each CONTRACTOR shall promptly refund any such funds upon
demand or at COUNTY’s option; such repayment shall be deducted from future payments owing to
that CONTRACTOR under this Agreement.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY or COUNTY’s DBH and DSS Directors, or designees, or
one (1) or more CONTRACTOR(S) upon the giving of sixty (60) days advance written notice of an
intention to terminate.
4. COMPENSATION
COUNTY agrees to pay CONTRACTOR(S) and CONTRACTOR(S) agree to receive
compensation in accordance with the budget(s) set forth in Exhibit C-1, et seq., attached hereto and by
this reference incorporated herein and made part of this Agreement.
A. Maximum Contract Amount
For fiscal year (FY) July 1, 2017 through June 30, 2018, in no event shall the
maximum compensation amount under this Agreement exceed Thirteen Million and No/100 Dollars
($13,000,000.00) for all CONTRACTOR(S) combined.
If this Agreement is extended for an additional twelve (12) month renewal period
for FY July 1, 2018 through June 30, 2019, in no event shall the maximum compensation amount
under this Agreement exceed Thirteen Million and No/100 Dollars ($13,000,000.00) for all
CONTRACTOR(S) combined.
The maximum amounts paid to each CONTRACTOR(S) identified in this
Agreement shall be as stated in the individual CONTRACTOR(S)’s “Budget” documents approved by
the COUNTY’s DBH and DSS Directors, or designees, and attached hereto as Exhibits C-1 et seq. and
incorporated herein by this reference.
In no event shall the maximum compensation amount under this Agreement for
FY 2017-18 and FY 2018-19 exceed Twenty-Six Million and No/100 Dollars ($26,000,000.00) for all
CONTRACTOR(S) combined.
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B. It is understood that all expenses incidental to CONTRACTOR(S) performance
of services under this Agreement shall be borne by CONTRACTOR(S). If CONTRACTOR(S) fails to
comply with any provision of this Agreement, COUNTY shall be relieved of its obligation for further
compensation.
C. Payments shall be made by COUNTY to CONTRACTOR(S) in arrears, for
services provided during the preceding month, within forty-five (45) days after the date of receipt and
approval by COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments
shall be made after receipt and verification of actual expenditures incurred by CONTRACTOR(S) for
monthly program costs, as identified in Exhibits C-1 et seq., in the performance of this Agreement in
accordance with Exhibits B-1 et seq. and shall be submitted to COUNTY on a monthly basis by the
tenth (10th) of the month following the month of said expenditures.
D. COUNTY shall not be obligated to make any payments under this Agreement if
the request for payment is received by COUNTY more than sixty (60) days after this Agreement has
terminated or expired.
E. All final invoices and/or any final budget modification requests shall be
submitted by CONTRACTOR(S) within sixty (60) days following the final month of service for which
payment is claimed. No action shall be taken by COUNTY on invoices submitted beyond the sixty
(60) day closeout period. Any compensation which is not expended by CONTRACTOR(S) pursuant
to the terms and conditions of this Agreement shall automatically revert to COUNTY.
F. The services provided by CONTRACTOR(S) under this Agreement are funded
in whole or in part by the State of California. In the event that funding for these services is delayed by
the State Controller, COUNTY may defer payments to CONTRACTOR(S). 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.
G. CONTRACTOR(S) shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR(S) deficiency discovered through the State’s
audit process and COUNTY’s utilization review process during the course of this Agreement. At
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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(S).
CONTRACTOR(S) shall not receive reimbursement for any units of services rendered that are
disallowed or denied by the COUNTY’s Mental Health Plan utilization review process or through the
State Department of Health Care Services (DHCS) cost report audit settlement process for Medi-Cal
eligible clients.
5. INVOICING
A. CONTRACTOR(S) shall invoice COUNTY in arrears by the tenth (10th) of each
month for actual expenses incurred during the prior month to DBHInvoices@co.fresno.ca.us and a
carbon copy to the assigned DBH Mental Health Contracts Staff Analyst. After CONTRACTOR(S)
renders service to referred clients, CONTRACTOR(S) shall invoice COUNTY for payment, certify
the expenditure, and submit electronic claiming into COUNTY’s electronic information system for all
clients, including those eligible for Medi-Cal as well as those that are not eligible for Medi-Cal,
including contracted cost per unit and actual cost per unit. Invoices and reports shall be in such detail
as acceptable to COUNTY’s DBH, as described herein and in Section Fourteen (14) of this
Agreement. Additionally, invoices and supporting documentation may be mailed to: County of
Fresno, Department of Behavioral Health, Contracted Services Division, 3133 N. Millbrook, Fresno,
CA 93703, Attention: CWMH Contract Analyst. No reimbursement for services shall be made until
the invoice and report is received, verified and approved by COUNTY’s DBH. COUNTY’s DBH
must pay CONTRACTOR before submitting claims to DHCS for Federal and State reimbursement for
Medi-Cal eligible clients.
B. CONTRACTOR(S) shall submit to COUNTY by the tenth (10th) of each month
a detailed general ledger (GL) itemizing costs incurred in the previous month. Failure to submit GL
reports and supporting documentation shall be deemed sufficient cause for COUNTY to withhold
payments until there is compliance, as further described in Section Five (5) herein.
C. 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 that portion of the invoice that is incorrect or
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improper after five (5) days prior notice to CONTRACTOR(S). CONTRACTOR(S) agrees to
continue to provide services for a period of ninety (90) days after notification of an incorrect or
improper invoice. If after the ninety (90) day period, the invoice(s) is still not corrected to COUNTY
DBH’s satisfaction, COUNTY’s DBH Director, or designee, may elect to terminate this Agreement,
pursuant to the termination provisions stated in Section Three (3) of this Agreement. In addition, for
invoices received ninety (90) days after the expiration of each term of this Agreement or termination
of this Agreement, at the discretion of COUNTY’s DBH Director, or designee, COUNTY’s DBH shall
have the right to deny payment of any additional invoices received.
D. Monthly invoices shall include a client roster, identifying all clients served along
with Katie A. class and sub-class members indicated, and provide demographic information on clients
served, including any payer of services rendered to client by CONTRACTOR(S)
E. CONTRACTOR(S) shall submit monthly invoices and general ledgers to DBH
that itemize the line item charges for monthly program costs, including the cost per unit calculation
based on the number of clients served within the month, and excluding unallowable costs.
Unallowable costs such as lobbying or political donations must be deducted from the monthly invoice
reimbursements. The invoices and general ledgers will serve as tracking tools to determine if
CONTRACTOR(S)’ program costs are in accordance with its budgeted cost, and cost per unit as
negotiated by service modes, compared to actual cost per unit, as set forth in Exhibit C-1 et seq. The
actual cost per unit will be based upon total costs and total units of service. It will also serve for the
COUNTY to certify the public funds expended for purposes of claiming Federal and State
reimbursement for the cost of Medi-Cal services and activities. CONTRACTOR(S) shall remit to
COUNTY on a quarterly basis, a summary report of total operational costs and volume of service units
to report the actual costs per unit compared to the negotiated rate, as identified in Exhibits C-1 et seq.,
to report interim cost per unit. The quarterly reports will be used by COUNTY to ensure compliance
with Federal and State reimbursements certified public expenditures.
F. CONTRACTOR(S) must report all third party collections from other funding
sources for Medicare, private insurance, client private pay or any other third party. COUNTY
expects the invoice for reimbursement to equal the amount due CONTRACTOR less any funding
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sources not eligible for Federal reimbursement and any other revenues generated by
CONTRACTOR (i.e. private insurance, etc).
G. CONTRACTOR(S) shall provide a monthly activity report with each invoice,
further described in Section Fourteen (14). In addition, each monthly invoice will be in the format as
identified in Exhibits C-1 et seq., showing each budget line item, expenses incurred, and the balance
remaining for each budget line item for all services and items as identified in Exhibits C-1 et seq.
H. CONTRACTOR(S) shall submit monthly staffing reports that identify all direct
service and support staff, applicable licensure/certifications, and full time hours worked to be used as a
tracking tool to determine if CONTRACTOR(S)’s program is staffed according to the services
provided under this Agreement.
H. CONTRACTOR(S) must maintain such financial records for a period of seven
(7) years, or if there a dispute, audit or inspection, until it is resolved, whichever is later.
CONTRACTOR(S) will be responsible for any disallowances related to inadequate documentation.
I. CONTRACTOR(S) is responsible for collection and managing data in a manner
to be determined by DHCS and the COUNTY Mental Health Plan in accordance with applicable rules
and regulations. COUNTY’s electronic information system is a critical source of information for
purposes of monitoring and obtaining reimbursement. CONTRACTOR(S) must attend the COUNTY
DBH’s Business Office training on equipment reporting for assets, intangible and sensitive minor
assets, COUNTY’s electronic information system, and related cost reporting.
J. CONTRACTOR shall submit service data into COUNTY’s electronic
information system within thirty (30) calendar days from the date of services were rendered. Federal
and State reimbursement for Medi-Cal specialty mental health services is based on public expenditures
certified by the CONTRACTOR(S). CONTRACTOR(S) must submit a signed certified public
expenditure report in the monthly invoice. DHCS expects the claim for Federal and State
reimbursement to equal the amount the COUNTY paid the CONTRACTOR(S) for the services
rendered less any funding sources not eligible for Federal reimbursement.
K. CONTRACTOR(S) must provide all necessary data to allow the COUNTY to
bill Medi-Cal, and any other third-party source, for services and meet State and Federal reporting
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requirements. The necessary data can be provided by a variety of means, including but not limited to:
1) direct data entry into COUNTY’s electronic information system; 2) providing an electronic file
compatible with COUNTY’s electronic information system; or 3) integration between COUNTY’s
electronic information system and CONTRACTOR(S)’ information system(s).
L. If a Medi-Cal client has dual coverage, such as other health coverage (OHC) or
Medicare, the CONTRACTOR(S) will be responsible for billing the carrier and obtaining a
payment/denial or have validation of claiming with no response ninety (90) days after the claim was
mailed before the service can be entered into COUNTY’s electronic information system.
CONTRACTOR(S) must report all revenue collected from OHC, third-party, client-pay, or private-
pay in each monthly invoice and in the cost report that is required to be submitted. A copy of
explanation of benefits or CWM 1500 is required as documentation. CONTRACTOR(S) must comply
with all laws and regulations governing 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 Centers for Medicare and Medicaid Services as they relate to participation,
coverage and claiming reimbursement. CONTRACTOR(S) will be responsible for compliance as of
the effective date of each federal, state or local law or regulation specified.
M. Data entry shall be the responsibility of the CONTRACTOR(S). The direct
specialty mental health services data must be reconciled by the CONTRACTOR(S) to the monthly
invoices submitted for payment. COUNTY shall monitor the volume of services and cost of services
entered into the COUNTY’s electronic information system. Any and all audit exceptions resulting
from the provision and reporting of Medi-Cal services by CONTRACTOR(S) shall be the sole
responsibility of the CONTRACTOR(S). CONTRACTOR(S) will comply with all applicable
policies, procedures, directives and guidelines regarding the use of COUNTY’s electronic information
system.
N. Medi-Cal Certification and Mental Health Plan Compliance
CONTRACTOR(S) will establish and maintain Medi-Cal certification or become
certified within ninety (90) days of the start of this Agreement through COUNTY to provide
reimbursable services to Medi-Cal eligible clients. In addition, CONTRACTOR(S) shall work with
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COUNTY’s DBH to execute the process if not currently certified by COUNTY for credentialing of
staff. Service location must be approved by COUNTY’s DBH during the Medi-Cal certification
process. During this process, the CONTRACTOR(S) will obtain a legal entity number established by
DHCS, a requirement for maintaining COUNTY Mental Health Plan organizational provider status
throughout the term of this Agreement. CONTRACTOR(S) will be required to become Medi-Cal
certified prior to providing services to Medi-Cal eligible clients and seeking reimbursement from the
COUNTY. CONTRACTOR(S) will not be reimbursed by COUNTY for any services rendered prior
to certification.
CONTRACTOR(S) shall provide specialty mental health services in accordance
with the COUNTY Mental Health Plan. CONTRACTOR(S) must comply with the “Fresno County
Mental Health Plan Compliance Program and Code of Conduct” set forth in Exhibit D, attached hereto
and incorporated herein by reference.
CONTRACTOR(S) may provide direct specialty mental health services using
unlicensed staff as long as the individual is approved as an Organizational Provider by the COUNTY
Mental Health Plan, is supervised by licensed staff; works within his/her scope, and only delivers
allowable direct specialty mental health services.
It is understood that each service is subject to audit for compliance with Federal
and State regulations and that COUNTY may be making payments in advance of said review. In the
event that a service is disapproved, COUNTY may, at its sole discretion, withhold compensation or
offset from other payments due, the amount of said disapproved services. CONTRACTOR(S) shall be
responsible for audit exceptions to ineligible dates of services or incorrect application of utilization
review requirements.
6. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR(S)
under this Agreement, it is mutually understood and agreed that CONTRACTOR(S), including any
and all of CONTRACTOR(S)’s officers, agents, and employees will at all times be acting and
performing as independent contractors, and shall act in an independent capacity and not as an officer,
agent, servant, employee, joint venture, partner, or associate of COUNTY. Furthermore, COUNTY
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shall have no right to control or supervise or direct the manner or method by which
CONTRACTOR(S) shall perform its work and function. However, COUNTY shall retain the right to
administer this Agreement so as to verify that CONTRACTOR(S) is performing their obligations in
accordance with the terms and conditions thereof. CONTRACTOR(S) and COUNTY shall comply
with all applicable provisions of law and the rules and regulations, if any, of governmental authorities
having jurisdiction over matters which are directly or indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR(S) shall have
absolutely no right to employment rights and benefits available to COUNTY employees.
CONTRACTOR(S) shall be solely liable and responsible for providing to, or on behalf of, its
employees all legally-required employee benefits. In addition, CONTRACTOR(S) shall be solely
responsible and save COUNTY harmless from all matters relating to payment of CONTRACTOR(S’)
employees, including compliance with Social Security, withholding, and all other regulations
governing such matters. It is acknowledged that during the term of this Agreement,
CONTRACTOR(S) may be providing services to others unrelated to COUNTY or to this Agreement.
7. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written
consent of all the parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to services and responsibilities of the
CONTRACTOR(S) and changes to staffing, as needed, to accommodate changes in the law relating to
mental health treatment, as set forth in Exhibits B-1 et seq., may be made with the signed written
approval of COUNTY’s DBH Director, or designee, and CONTRACTOR(S) through an amendment
approved by County Counsel and the COUNTY’s Auditor’s Office.
In addition, changes to line items in the budgets, as appropriate, that do not exceed ten
percent (10%) of the individual CONTRACTOR(S)’ program total maximum compensation payable
to CONTRACTOR(S)’, changes to the volume of units of services/types of service units, and changes
to the service rate to be provided, as set forth in Exhibits C-1 et seq., may be made with the written
approval of COUNTY’s DBH Director, or designee, and the individual CONTRACTOR. Maximum
compensation amounts payable to each CONTRACTOR may be modified with the written approval of
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COUNTY’s DBH Director, or designee. Changes to line items in the budget that exceed ten percent
(10%) of the maximum compensation payable to the CONTRACTOR(S) may be made with the signed
written approval of COUNTY’s DBH Director, or designee, through an amendment approved by
County Counsel and COUNTY’s Auditor’s Office.
Said modifications to budget line items, service volume/types of service units, summary
of services, and maximum compensation amounts payable per CONTRACTOR shall not result in any
change to the total combined maximum compensation amount payable to all CONTRACTORS under
this Master Agreement, as stated herein.
8. NON-ASSIGNMENT
COUNTY and CONTRACTOR(S) shall not assign, transfer or subcontract this
Agreement nor their rights or duties under this Agreement without the prior written consent of
COUNTY and the individual CONTRACTOR seeking to make such assignment.
9. HOLD-HARMLESS
CONTRACTOR(S) agrees to indemnify, save, hold harmless, and at COUNTY's
request, defend the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to
COUNTY in connection with the performance, or failure to perform, by CONTRACTOR(S), its
officers, agents or employees under this Agreement, and from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to
any person, firm or corporation who may be injured or damaged by the performance, or failure to
perform, of CONTRACTOR(S), its officers, agents or employees under this Agreement.
CONTRACTOR(S) agrees to indemnify COUNTY for Federal, State of California and/or
local audit exceptions resulting from noncompliance herein on the part of the CONTRACTOR(S).
10. INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR(S)
or any third parties, CONTRACTOR(S), each CONTRACTOR, at its sole expense, shall maintain in
full force and effect the following insurance policies throughout the term of this Agreement:
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A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than One Million
Dollars ($1,000,000) per occurrence and an annual aggregate of Two Million
Dollars ($2,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverage including completed operations,
product liability, contractual liability, Explosion, Collapse, and Underground
(XCU), fire legal liability or any other liability insurance deemed necessary
because of the nature of the Agreement.
B. Automobile Liability Comprehensive Automobile Liability Insurance with limits for bodily injury of
not less than Two Hundred Fifty Thousand Dollars ($250,000) per person, Five
Hundred Thousand Dollars ($500,000) per accident and for property damages of
not less than Fifty Thousand Dollars ($50,000), or such coverage with a
combined single limit of One Million Dollars ($1,000,000). Coverage should
include owned and non-owned vehicles used in connection with this Agreement.
If CONTRACTOR’(S) employees are not covered by CONTRACTOR’(S)
automobile liability insurance policy, CONTRACTOR shall ensure that each
employee as part of this Agreement procures and maintains their own private
vehicle coverage in force during the term of this Agreement, at the employee’s
sole cost and expense. C. Professional Liability
If CONTRACTOR(S) employs licensed professional staff (e.g. Ph.D., R.N.,
L.C.S.W., L.M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000) per occurrence, Three
Million Dollars ($3,000,000) annual aggregate. CONTRACTOR agrees that it
shall maintain, at its sole expense, in full force and effect for a period of three (3)
years following the termination of this Agreement, one or more policies of
professional liability insurance with limits of coverage as specified herein.
D. Real and Property Insurance
As applicable, CONTRACTOR(S) shall maintain a policy of insurance for all
risk personal property coverage which shall be endorsed naming the County of
Fresno as an additional loss payee. The personal property coverage shall be in
an amount that will cover the total of the COUNTY purchase and owned
property, at a minimum. All Risk Property Insurance
As applicable, CONTRACTOR(S) will provide property coverage for the full
replacement value of the COUNTY’s personal property in possession of
CONTRACTOR(S) and/or used in the execution of this Agreement. COUNTY
will be identified on an appropriate certificate of insurance as the certificate
holder and will be named as an Additional Loss Payee on the Property Insurance
Policy.
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E. Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
F. Child Abuse/Molestation and Social Services Coverage
Each CONTRACTOR shall have either separate policies or an umbrella policy
with endorsements covering Child Abuse/Molestation and Social Services
Liability coverage or have a specific endorsement on their General Commercial
liability policy covering Child Abuse/Molestation and Social Services Liability.
The policy limits for these policies shall be One Million Dollars ($1,000,000) per
occurrence with a Two Million Dollars ($2,000,000) annual aggregate. The
policies are to be on a per occurrence basis.
CONTRACTOR(S) shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under CONTRACTOR(S’) policies herein.
This insurance shall not be cancelled or changed without a minimum of thirty (30) days advance
written notice given to COUNTY.
Within thirty (30) days from the date each CONTRACTOR signs this Agreement,
CONTRACTOR(S) shall provide certificates of insurance and endorsements as stated above for all of
the foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health,
Contracted Services Division, 3133 N. Millbrook Ave, Fresno, California, 93703, Attention: CWMH
Contract Analyst, stating that such insurance coverages have been obtained and are in full force; that
the County of Fresno, its officers, agents and employees will not be responsible for any premiums on
the policies; that such Commercial General Liability insurance names the County of Fresno, its
officers, agents and employees, individually and collectively, as additional insured, but only insofar as
the operations under this Agreement are concerned; that such coverage for additional insured shall
apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its
officers, agents and employees, shall be excess only and not contributing with insurance provided
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under CONTRACTOR(S)’s policies herein; and that this insurance shall not be cancelled or changed
without a minimum of thirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR(S) fails to keep in effect at all times insurance coverage as
herein provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating
of A FSC VII or better.
11. ADDITIONS/DELETIONS OF CONTRACTORS
COUNTY’s DBH Director, or designee, reserves the right at any time during the term of
this Agreement to add new CONTRACTOR(S) to those listed in Exhibit A. It is understood any such
additions will not affect compensation paid to any other CONTRACTOR, and therefore such additions
may be made by COUNTY without notice to or approval of the other CONTRACTOR(S) under this
Agreement. These same provisions shall apply to the deletion of any CONTRACTOR(S) contained in
Exhibit A, except that deletions shall be by written mutual agreement between the COUNTY and the
identified CONTRACTOR to be deleted, or shall be in accordance with the provisions of Section
Three (3) of this Agreement.
12. LICENSES/CERTIFICATES
Throughout the term of this Agreement, CONTRACTOR(S) 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(S) 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(S) and
CONTRACTOR(S)’ staff shall comply with all applicable laws, rules or regulations, as may now exist
or be hereafter changed.
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13. RECORDS
CONTRACTOR(S) shall maintain records in accordance with COUNTY’s
“Documentation Standards for Client Records,” attached hereto as Exhibit E and incorporated herein
by reference. During site visits, COUNTY shall be allowed to review records of services provided,
including the goals and objectives of the treatment plan, and how the therapy provided is achieving the
goals and objectives.
14. REPORTS
A. Activity Reports
CONTRACTOR(S) shall submit to COUNTY’s DBH by the 10th of each month
all monthly activity and budget reports for the preceding month.
B. Cost Report
CONTRACTOR(S) agrees to submit a complete and accurate detailed cost report
on an annual basis for each fiscal year ending June 30th in the format prescribed by the DHCS for the
purposes of Short Doyle Medi-Cal reimbursements and total costs for programs. The cost report will
be the source document for several phases of settlement with the DHCS for the purposes of Short
Doyle Medi-Cal reimbursement. CONTRACTOR(S) shall report costs under their approved legal
entity number established during the Medi-Cal certification process. The information provided applies
to CONTRACTOR(S) for program related costs for services rendered to Medi-Cal and non-Medi-Cal
clients. CONTRACTOR(S) will remit a schedule to provide the required information on published
charges (PC) for all authorized services. The report will serve as a source document to determine their
usual and customary charge prevalent in the public mental health sector that is used to bill the general
public, insurers, or other non-Medi-Cal third party payers during the course of business operations.
CONTRACTOR(S) must report all collections for Medi-Cal/Medicare services and collections. The
CONTRACTOR(S) shall also submit with the cost report a copy of the CONTRACTOR(S)’ general
ledger that supports revenues and expenditures and reconciled detailed report of reported total units of
services rendered under this Agreement to the units of services reported by CONTRACTOR(S) to
COUNTY’S data system.
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Cost Reports must be submitted to the COUNTY as a hard copy with a signed
cover letter and electronic copy of completed DHCS cost report form along with requested support
documents following each fiscal year ending June 30th. During the month of September of each year
this Agreement is effective, COUNTY will issue instructions of the annual cost report which indicates
the training session, DHCS cost report template worksheets, and deadlines to submit, as determined by
State annually. CONTRACTOR(S) shall remit a hard copy of cost report to County of Fresno,
Attention: Cost Report Team, PO BOX 45003, Fresno CA 93718. CONTRACTOR(S) shall remit the
electronic copy and or any inquiries to DBHcostreportteam@co.fresno.ca.us.
All Cost Reports must be prepared in accordance with General Accepted
Accounting Principles (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3)
and 5718(c). Unallowable costs such as lobby or political donations must be deducted on the cost
report and invoice reimbursement.
If the CONTRACTOR(S) does not submit the cost report by the deadline,
including any extension period granted by the COUNTY, the COUNTY may withhold payments of
pending invoicing under compensation until the cost report has been submitted and clears COUNTY
desk audit for completeness.
C. Settlements with State Department of Health Care Services (DHCS)
During the term of this Agreement and thereafter, COUNTY and
CONTRACTOR(S) agree to settle dollar amounts disallowed or settled in accordance with DHCS
audit settlement findings related to the Medi-Cal and EPSDT reimbursements. CONTRACTOR(S)
will participate in the several phases of settlements between COUNTY/CONTRACTOR and DHCS.
The phases are initial cost reporting for settlement, settlement according to State reconciliation of
records for paid Medi-Cal services and audit settlement-State DHCS audit: 1) initial cost reporting -
after an internal review by COUNTY, the COUNTY files cost report with State DHCS on behalf of
the CONTRACTOR’s legal entity for the fiscal year; 2) Settlement –State reconciliation of records for
paid Medi-Cal services, approximately eighteen (18) to thirty-six (36) months following the State
close of the fiscal year, DHCS will send notice for any settlement under this provision will be sent to
the COUNTY; 3) Audit Settlement-State DHCS audit. After final reconciliation and settlement,
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DHCS may conduct a review of medical records, cost reports along with support documents submitted
to COUNTY in initial submission to determine accuracy and may disallow cost and/or unit of service
reported on the CONTRACTOR(S)’ legal entity cost report. COUNTY may choose to appeal and
therefore reserves the right to defer payback settlement with CONTRACTOR(S) until resolution of the
appeal. DHCS audits will follow Federal Medicaid procedures for managing overpayments.
If at the end of the audit settlement process the COUNTY determines that it
overpaid the CONTRACTOR(S), it will require the CONTRACTOR(S) to repay the Medi-Cal
related overpayment.
Funds owed to COUNTY will be due within forty-five (45) days of notification
by the 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
CONTRACTOR(S) under this or any other Agreement.
D. Outcome Reports
CONTRACTOR(S) shall submit to COUNTY’s DBH and DSS service outcome
reports, as requested.
E. Additional Reports
In addition, CONTRACTOR(S) shall also furnish to COUNTY such statements,
records, reports, data, and other information as COUNTY may request pertaining to matters covered
by this Agreement. In the event that CONTRACTOR(S) 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(S) 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.
15. MONITORING
CONTRACTOR(S) agrees to extend to COUNTY’s staff, COUNTY’s DBH Director
and DHCS, or their respective designees, the right to review and monitor records, program or
procedures, at any time, in regard to clients, as well as the overall operation of CONTRACTOR(S)’
program, in order to ensure compliance with the terms and conditions of this Agreement.
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16. REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended
during the term thereof, the parties hereto agree to comply with the amended provision as of the
effective date of such amendment.
17. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR(S) recognizes that COUNTY operates its mental health programs
under an agreement with DHCS, and that under said agreement the State imposes certain requirements
on COUNTY and its subcontractors. CONTRACTOR(S) shall adhere to all State requirements,
including those identified in Exhibit F “State Mental Health Requirements”, attached hereto and by
this reference incorporated herein.
18. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR(S) shall be required to maintain organizational provider certification
by Fresno County. CONTRACTOR(S) must meet Medi-Cal organization provider standards as listed
in Exhibit G, “Medi-Cal Organizational Provider Standards”, attached hereto and by this reference
incorporated herein and made part of this Agreement. It is acknowledged that all references to
Organizational Provider and/or Provider in Exhibit G shall refer to CONTRACTOR(S). In addition,
CONTRACTOR(S) shall inform every client of their rights under the COUNTY’s Mental Health
Plan as described in Exhibit H, “Fresno County Mental Health Plan Grievances and Appeals
Process”, attached hereto and by this reference incorporated herein and made part of this Agreement.
CONTRACTOR shall also file an incident report for all incidents involving clients, following the
Protocol for Completion of Incident of Report and using the Worksheet identified in Exhibit I,
attached hereto and by this reference incorporated herein and made part of this Agreement, or a
protocol and worksheet presented by CONTRACTOR(S) that is accepted by COUNTY’S DBH
Director, or designee.
19. CONFIDENTIALITY
All services performed by CONTRACTOR(S) under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating
to confidentiality.
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20. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR(S) 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 as required by law.
COUNTY and CONTRACTOR(S) acknowledge that the exchange of protected health
information (PHI) between them is only for treatment, payment, and health care operations.
COUNTY and CONTRACTOR(S) intend to protect the privacy and provide for the
security of PHI pursuant to this Agreement in compliance with HIPAA, the Health Information
Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations)
and other applicable laws. As part of the HIPAA Regulations, the Privacy Rule and the Security Rule
require CONTRACTOR(S) to enter into a contract 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 (CFR).
21. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse
of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that
enter into a contractual relationship with the COUNTY for the purpose of providing services under
this Agreement must employ adequate data security measures to protect the confidential information
provided to CONTRACTOR(S) by the COUNTY, including but not limited to the following:
A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR(S) may not connect to COUNTY networks via personally-
owned mobile, wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR(S) has received authorization by COUNTY for
telecommuting purposes;
2) Current virus protection software is in place;
3) Mobile device has the remote wipe feature enabled/ and
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4) A secure connection is used.
B. CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR(S) may not bring CONTRACTOR-owned computers or
computer peripherals into the COUNTY for use without prior authorization from the COUNTY’s
Chief Information Officer, and/or designee(s), including but not limited to mobile storage devices. If
data is approved to be transferred, data must be stored on a secure server approved by the COUNTY
and transferred by means of a Virtual Private Network (VPN) connection, or another type of secure
connection. Said data must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR(S) may not use COUNTY computers or computer peripherals
on non-COUNTY premises without prior authorization from the COUNTY’s Chief Information
Officer, and/or designee(s).
D. CONTRACTOR(S) may not store COUNTY’s private, confidential or sensitive
data on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E. CONTRACTOR(S) shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data
processing systems, data files and data processing equipment which stores or processes COUNTY
data internally and externally.
F. Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
128 BIT or higher. Additionally, a password or passphrase must be utilized.
G. CONTRACTOR(S) is responsible to immediately notify COUNTY of any
violations, breaches or potential breaches of security related to COUNTY’s confidential information,
data maintained in computer files, program documentation, data processing systems, data files and
data processing equipment which stores or processes COUNTY data internally or externally.
H. COUNTY shall provide oversight to CONTRACTOR(S)’ response to all
incidents arising from a possible breach of security related to COUNTY’s confidential client
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information provided to CONTRACTOR(S). CONTRACTOR(S) will be responsible to issue any
notification to affected individuals as required by law or as deemed necessary by COUNTY in its sole
discretion. CONTRACTOR(S) will be responsible for all costs incurred as a result of providing the
required notification.
22. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR(S) shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of
race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
sexual orientation, or military or veteran status, pursuant to all applicable State of California and
Federal statutes and regulations.
23. CONFLICT OF INTEREST
No officer, agent, or employee of COUNTY who exercises any function or
responsibility for planning and carrying out the services provided under this Agreement shall have any
direct or indirect personal financial interest in this Agreement. In addition, no employee of COUNTY
shall be employed by CONTRACTOR(S) to fulfill any contractual obligations with COUNTY.
CONTRACTOR(S) shall also comply with all Federal, State of California, and local conflict of
interest laws, statutes, and regulations, which shall be applicable to all parties and beneficiaries under
this Agreement and any officer, agent, or employee of COUNTY.
24. CHARITABLE CHOICE
CONTRACTOR(S) may not discriminate in its program delivery against a client or
potential client on the basis of religion or religious belief, a refusal to hold a religious belief, or a
refusal to actively participate in a religious practice. Any specifically religious activity or service made
available to individuals by CONTRACTOR(S) must be voluntary as well as separate in time and
location from COUNTY-funded activities and services. CONTRACTOR(S) shall inform COUNTY
as to whether it is faith-based. If CONTRACTOR(S) identifies as faith-based it must submit to
COUNTY’S DBH and DSS a copy of its policy on referring individuals to an alternate treatment
provider, and include a copy of this policy in its client admission forms. The policy must inform
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individuals that they may be referred to an alternative provider if they object to the religious nature of
the program, and include a notice to COUNTY’s DBH and DSS. Adherence to this policy will be
monitored during annual site reviews and reviews of client files. If CONTRACTOR(S) identifies as
faith-based, by July 1 of each year, CONTRACTOR will be required to report to COUNTY’s DBH
and DSS the number of individuals who requested referrals to alternate providers based on religious
objection.
25. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section 1861(v)
(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four (4)
years after the furnishing of services under this Agreement, CONTRACTOR(S) shall make available,
upon written request to the Secretary of the United States Department of Health and Human Services,
or upon request to the Comptroller General of the United States General Accounting Office, or any of
their duly authorized representatives, a copy of this Agreement and such books, documents, and
records as are necessary to certify the nature and extent of the costs of these services provided by
CONTRACTOR(S) under this Agreement. CONTRACTOR(S) further agrees that in the event
CONTRACTOR(S) carries out any of its duties under this Agreement through a subcontract, with a
value or cost of Ten Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month
period, with a related organization, such Agreement shall contain a clause to the effect that until the
expiration of four (4) years after the furnishing of such services pursuant to such subcontract, the
related organizations shall make available, upon written request to the Secretary of the United States
Department of Health and Human Services, or upon request to the Comptroller General of the United
States General Accounting Office, or any of their duly authorized representatives, a copy of such
subcontract and such books, documents, and records of such organization as are necessary to verify
the nature and extent of such costs.
26. SINGLE AUDIT CLAUSE
A. If CONTRACTOR(S) expends Seven Hundred Fifty Thousand and No/100
Dollars ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR(S)
agrees to conduct an annual audit in accordance with the requirements of the Single Audit Standards
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as set forth in Office of Management and Budget (OMB) 2 CFR 200. CONTRACTOR(S) 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(S) must
include a corrective action plan signed by an authorized individual. CONTRACTOR(S) 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 Business Office 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(S). All audit costs related to this Agreement are the sole responsibility of
CONTRACTOR(S).
B. A single audit report is not applicable if CONTRACTOR(S)’s Federal contracts
do not exceed the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
CONTRACTOR(S)’ only funding is through drug-related Medi-Cal. If a single audit is not
applicable, a program audit must be performed and a program audit report with management letter
shall be submitted by CONTRACTOR(S) to COUNTY as a minimum requirement to attest to
CONTRACTOR’s solvency. Said audit report shall be delivered to COUNTY’s DBH Business Office
for review, no later than nine (9) months after the close of the fiscal year in which the funds supplied
through this Agreement are expended. Failure to comply with this act may result in COUNTY
performing the necessary audit tasks or contracting with a qualified accountant to perform said audit.
All audit costs related to this Agreement are the sole responsibility of CONTRACTOR(S) 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 section shall be billed to the
CONTRACTOR(S) at COUNTY’s cost, as determined by COUNTY’s Auditor-Controller/Treasurer-
Tax Collector.
C. CONTRACTOR(S) shall make available all records and accounts for inspection
by COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
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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.
27. COMPLIANCE
CONTRACTOR(S) agrees to comply with the COUNTY’s Contractor Code of Conduct
and Ethics and the COUNTY’s Compliance Program in accordance with Exhibit D. Within thirty (30)
days of entering into this Agreement with the COUNTY, CONTRACTOR(S) shall have all of
CONTRACTOR(S)’ employees, agents and subcontractors providing services under this Agreement
certify in writing, that he or she has received, read, understood, and shall abide by the Contractor Code
of Conduct and Ethics. CONTRACTOR(S) shall ensure that within thirty (30) days of hire, all new
employees, agents and subcontractors providing services under this Agreement shall certify in writing
that he or she has received, read, understood, and shall abide by the Contractor Code of Conduct and
Ethics. CONTRACTOR(S) understands that the promotion of and adherence to the Code of Conduct
is an element in evaluating the performance of CONTRACTOR(S) and its employees, agents and
subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agents and subcontractors providing services under this Agreement shall complete general
compliance training and appropriate employees, agents and subcontractors shall complete
documentation and billing or billing/reimbursement training. All new employees, agents and
subcontractors shall attend the appropriate training within thirty (30) days of hire. Each individual
who is required to attend training shall certify in writing that he or she has received the required
training. The certification shall specify the type of training received and the date received. The
certification shall be provided to the COUNTY’s Compliance Officer at 3133 N. Millbrook Ave,
Fresno, California 93703. CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of
any penalty imposed upon COUNTY by the Federal Government as a result of CONTRACTOR(S)’
violation of the terms of this Agreement.
28. ASSURANCES
In entering into this Agreement, CONTRACTOR(S) certifies that it is not currently
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excluded, suspended, debarred, or otherwise ineligible to participate in the Federal Health Care
Programs: that it has not been convicted of a criminal offense related to the provision of health care
items or services; nor has it been reinstated to participation in the Federal Health Care Programs after
a period of exclusion, suspension, debarment, or ineligibility. If COUNTY learns, subsequent to
entering into a contract, that CONTRACTOR(S) is ineligible on these grounds, COUNTY will remove
CONTRACTOR(S) from responsibility for, or involvement with, COUNTY’s business operations
related to the Federal Health Care Programs and shall remove such CONTRACTOR(S) from any
position in which CONTRACTOR(S)’ compensation, or the items or services rendered, ordered or
prescribed by CONTRACTOR(S) may be paid in whole or part, directly or indirectly, by Federal
Health Care Programs or otherwise with Federal Funds at least until such time as CONTRACTOR(S)
is reinstated into participation in the Federal Health Care Programs.
A. If COUNTY has notice that CONTRACTOR(S) has been charged with a
criminal offense related to any Federal Health Care Program, or is proposed for exclusion during the
term of any contract, CONTRACTOR(S) and COUNTY shall take all appropriate actions to ensure the
accuracy of any claims submitted to any Federal Health Care Program. At its discretion given such
circumstances, COUNTY may request that CONTRACTOR(S) cease providing services until
resolution of the charges or the proposed exclusion.
B. CONTRACTOR(S) agrees that all potential new employees of
CONTRACTOR(S) or subcontractors of CONTRACTOR(S) who, in each case, are expected to
perform professional services under this Agreement, will be queried as to whether: (1) they are now or
ever have been excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
Health Care Programs; (2) they have been convicted of a criminal offense related to the provision of
health care items or services; and or (3) they have been reinstated to participation in the Federal Health
Care Programs after a period of exclusion, suspension, debarment, or ineligibility.
1) In the event the potential employee or subcontractor informs
CONTRACTOR(S) that he or she is excluded, suspended, debarred or otherwise ineligible, or has
been convicted of a criminal offense relating to the provision of health care services, and
CONTRACTOR(S) hires or engages such potential employee or subcontractor, CONTRACTOR(S)
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will ensure that said employee or subcontractor does no work, either directly or indirectly relating to
services provided to COUNTY.
2) Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor
of CONTRACTOR(S) will perform work, either directly or indirectly, relating to services provided to
COUNTY. Such demand for adequate assurance shall be effective upon a timeframe to be
determined by COUNTY to protect the interests of COUNTY consumers.
C. CONTRACTOR(S) shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are expected
to perform professional services under this Agreement: (1) are not currently excluded, suspended,
debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been
convicted of a criminal offense related to the provision of health care items or services; and (3) have
not been reinstated to participation in the Federal Health Care Program after a period of exclusion,
suspension, debarment, or ineligibility. In the event any existing employee or subcontractor informs
CONTRACTOR(S) that he or she is excluded, suspended, debarred or otherwise ineligible to
participate in the Federal Health Care Programs, or has been convicted of a criminal offense relating to
the provision of health care services, CONTRACTOR(S) will ensure that said employee or
subcontractor does no work, either direct or indirect, relating to services provided to COUNTY.
1) CONTRACTOR(S) agrees to notify COUNTY immediately during the
term of this Agreement whenever CONTRACTOR(S) learns that an employee or subcontractor who,
in each case, is providing professional services under this Agreement is excluded, suspended, debarred
or otherwise ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal
offense relating to the provision of health care services.
2) Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor
of CONTRACTOR(S) will perform work, either directly or indirectly, relating to services provided to
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COUNTY. Such demand for adequate assurance shall be effective upon a timeframe to be determined
by COUNTY to protect the interests of COUNTY consumers.
D. CONTRACTOR(S) agrees to cooperate fully with any reasonable requests for
information from COUNTY, which may be necessary to complete any internal or external audits
relating to CONTRACTOR(S)’s compliance with the provisions of this Section.
E. CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of any
penalty imposed upon COUNTY by the Federal Government as a result of CONTRACTOR(S)’
violation of CONTRACTOR(S)’ obligations as described in this Section.
29. PUBLICITY PROHIBITION
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.
Notwithstanding the above, publicity of the services described in Section One (1) 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, and at a cost to be provided in
Exhibits C-1 et seq. for such items as written/printed materials, the use of media (i.e., radio, television,
newspapers) and any other related expense(s).
30. COMPLAINTS
CONTRACTOR(S) shall log complaints and the disposition of all complaints from a
client or a client’s family. CONTRACTOR(S) shall provide a copy of the detailed complaint log
entries concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (l0th)
day of the following month, in a format that is mutually agreed upon. In addition, CONTRACTOR(S)
shall provide details and attach documentation of each complaint with the log. CONTRACTOR(S)
shall post signs informing clients of their right to file a complaint or grievance. CONTRACTOR(S)
shall notify COUNTY of all incidents reportable to State licensing bodies that affect COUNTY clients
within twenty-four (24) hours of receipt of a complaint.
Within ten (10) days after each incident or complaint affecting COUNTY-sponsored
clients, CONTRACTOR(S) shall provide COUNTY with information relevant to the complaint,
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investigative details of the complaint, the complaint and CONTRACTOR(S)’ disposition of, or
corrective action taken to resolve the complaint. In addition, CONTRACTOR(S) shall inform every
client of their rights as set forth in Exhibit H “Grievances and Incident Reporting”.
31. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
INFORMATION
This provision is only applicable if CONTRACTOR(S) is a disclosing entity, fiscal
agent, or managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101
455.104, and 455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR(S) by completing Exhibit J
“Disclosure of Ownership and Control Interest Statement”, attached hereto and by this reference
incorporated herein and made part of this Agreement. CONTRACTOR(S) shall submit this form to
COUNTY’s DBH within thirty (30) days of the effective date of this Agreement. Additionally,
CONTRACTOR(S) shall report any changes to this information within thirty-five (35) days of
occurrence by completing Exhibit J. Submissions shall be scanned pdf copies and are to be sent via
email to COUNTY’s DBH Contracted Services Staff Analyst.
32. DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR(S) is required to disclose if any of the following conditions apply to
them, their owners, officers, corporate managers and partners (hereinafter collectively referred to as
“CONTRACTOR(S)”):
A. Within the three-year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1) 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;
2) Violation of a federal or state antitrust statute;
3) Embezzlement, theft, forgery, bribery, falsification, or destruction of
records; or
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4) False statements or receipt of stolen property.
B. Within the three-year period preceding their Agreement award, they have had a
public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate
CONTRACTOR(S) from further business consideration. The information will be considered as part
of the determination of whether to continue and/or renew the Agreement and any additional
information or explanation that a CONTRACTOR(S) elects to submit with the disclosed information
will be considered. If it is later determined that the CONTRACTOR(S) failed to disclose required
information, any contract awarded to such CONTRACTOR(S) may be immediately voided and
terminated for material failure to comply with the terms and conditions of the award.
CONTRACTOR(S) must sign a “Certification Regarding Debarment, Suspension, and
Other Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit K,
attached hereto and by this reference incorporated herein and made part of this Agreement.
Additionally, CONTRACTOR(S) must immediately advise the COUNTY in writing if, during the
term of this Agreement: (1) CONTRACTOR(S) becomes suspended, debarred, excluded or ineligible
for participation in federal or state funded programs or from receiving Federal funds as listed in the
excluded parties’ list system (http://www.epls.gov); or (2) any of the above listed conditions become
applicable to CONTRACTOR(S). CONTRACTOR(S) shall indemnify, defend and hold the
COUNTY harmless for any loss or damage resulting from a conviction, debarment, exclusion,
ineligibility or other matter listed in the signed Certification Regarding Debarment, Suspension, and
Other Responsibility Matters.
33. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR(S) is operating as a corporation
(a for-profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR(S)
changes its status to operate as a corporation.
Members of the CONTRACTOR(S)’ Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR(S) is providing goods or performing
services under this Agreement. A self-dealing transaction shall mean a transaction to which the
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CONTRACTOR(S) is a party and in which one or more of its directors has a material financial
interest. Members of the Board of Directors shall disclose any self-dealing transactions that they are a
party to by completing and signing a Self-Dealing Transaction Disclosure Form, attached hereto as
Exhibit L and incorporated herein by reference and made part of this Agreement, and submitting it to
the COUNTY prior to commencing with the self-dealing transaction or immediately thereafter.
34. AUDITS AND INSPECTIONS
CONTRACTOR(S) shall at any time during business hours, and as often as the
COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
data with respect to the matters covered by this Agreement. CONTRACTOR(S) shall, upon request
by the COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to
ensure CONTRACTOR(S)’ compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR(S) shall be subject to the examination and audit of the State Auditor General for a
period of three (3) years after final payment under contract (California Government Code section
8546.7).
35. NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY CONTRACTOR(S)
Director, Fresno County SEE EXHIBIT A
Department of Behavioral Health
3133 N. Millbrook Ave.
Fresno, CA 93703
Any and all notices between COUNTY and CONTRACTOR(S) provided for or
permitted under this Agreement or by law shall be in writing and shall be deemed duly served when
personally delivered to one of the parties, or in lieu of such personal service, when deposited in the
United States Mail, postage prepaid, addressed to such party.
36. SEVERABILITY
If any non-material term, provision, covenant, or condition of this Agreement is held by
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a court of competent jurisdiction to be invalid, void or unenforceable, the remainder of the provisions
shall remain in full force and effect, and shall in no way be affected, impaired or invalidated.
37. SEPARATE AGREEMENT
It is mutually understood by the parties that this Agreement does not, in any way, create
a joint venture among the individual CONTRACTORS. By execution of this Agreement,
CONTRACTORS understand that a separate Agreement is formed between each individual
CONTRACTOR and COUNTY.
38. GOVERNING LAW
The parties agree that for the purpose of venue, performance under this Agreement is in
Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
39. SUPERSEDE
This Agreement shall supersede in its entirety and render null and void the Agreements
between the parties for these same services identified in COUNTY Agreement Nos. 14-437, 15-461,
and 15-462, effective July 1, 2017.
40. ENTIRE AGREEMENT
This Agreement, including all Exhibits, COUNTY’s Revised RFP No. 952-5250 and
CONTRACTOR(S) Response(s) to COUNTY’s Revised RFP No. 952-5250 constitutes the entire
agreement between CONTRACTOR(S) and COUNTY with respect to the subject matter hereof and
supersedes all previous agreement negotiations, proposals, commitments, writings, advertisements,
publications, and understandings of any nature whatsoever unless expressly included in this
Agreement.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
year first hereinabove written.
COUNTY OF FRESNO
JL~J._ By ______________________ __
Chairman, Board of Supervisors
Date:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
By ~l .A.SO./n SAsh o:p
f;:le.p~
Date: LD -d-.0 -I J
PLEASE SEE ADDITIONAL
SIGNATURE PAGES ATTACHED
-33 -COUNTY O F FR ESNO
Fres no, CA
Exhibit A
CHILD WELFARE MENTAL HEALTH
MASTER AGREEMENT
VENDOR LIST
1. CALIFORNIA PSYCHOLOGICAL INSTITUTE (Exhibits B-1; C-1)
1470 W. Herndon Avenue, Suite 300
Fresno, CA 93711
Phone #: (559) 256-2000
Contact for Notices: Administrative Director
2. CENTRAL STAR BEHAVIORAL HEALTH (Exhibits B-2; C-2)
1501 Hughes Way, Suite 150
Long Beach, CA 90810
Phone #: (310) 221-6336 ext. 125
Contact for Notices: Senior Vice President
3. UPLIFT FAMILY SERVICES (Exhibits B-3; C-3)
251 Llewellyn Avenue
Campbell, CA 95008
Phone #: (310) 221-6336 ext. 125
Contact for Notices: Chief Administrative Officer
Exhibit B-1
Page 1 of 13
CHILD WELFARE MENTAL HEALTH (CWMH)
SUMMARY OF SERVICES
ORGANIZATION: California Psychological Institute
ADDRESS: 1470 W. Herndon Avenue, Suite #300
Fresno, CA 93711
TELEPHONE: (559) 256-2000
CONTACT PERSON: Michelle Zavala, Administrative Director
CONTRACT PERIOD: July 1, 2017 – June 30, 2019
CONTRACT AMOUNT: $4,000,000 (July 1, 2017 – June 30, 2018);
$4,000,000 (July 1, 2018 – June 30, 2019)
SUMMARY OF SERVICES:
California Psychological Institute, henceforth referred to as CONTRACTOR, will be
responsible for providing medically necessary outpatient specialty mental health services
for children and youth with serious emotional disturbance(s), parents with a serious
mental illness, and court-specific services to children and families in Fresno County’s
Child Welfare Services (CWS) system. The majority of outpatient mental health services,
such as assessments, plan development, therapy, rehabilitation services, crisis
intervention, case management, intensive home based services and intensive care
coordination are expected to be community-based and provided in the family’s home or
in the community, when possible. For those services provided in the office,
CONTRACTOR will work closely with the caregiver to identify and assist, whenever
possible, with any barriers to receiving care (i.e., lack of public/private transportation,
scheduling of appointment days/hours, etc.).
SCHEDULE OF SERVICES:
The CONTRACTOR’S office(s) shall be open Monday through Thursday, 7:30am to
7:00pm and Friday to Saturday, 8:00am to 5:00pm. Clinicians will be available to see
clients and families for in-home appointments during the day, weekend, and evening
hours, up to 7:00 pm. Group services will be provided during the day and evening hours,
up to 7:00 pm, on a scheduled basis, at CONTRACTOR’s offices. The CONTRACTOR’s
office will be located at a site in the metropolitan or rural community that offers public
transportation in close proximity, adequate parking, and in a secure setting. In addition to
the Fresno metropolitan area, CONTRACTOR has agreed to serve the rural areas of
Fresno County as needed. Any addition or change to the location of office-based services
must be approved by the COUNTY in advance of such a change.
Exhibit B-1
Page 2 of 13
TARGET POPULATION:
CONTRACTOR shall provide mental health services to all referred children, youth,
parents, guardians, and foster parents involved with a child’s CWS case. The target
population includes children and youth as referred to in the Katie A. Settlement
Agreement as members of the “class” and “subclass.”
1. Katie A. “Class” is defined as children in California who:
A. Are in foster care or are at imminent risk of foster care placement, and
B. Have a mental illness or condition that has been documented, or would
have been documented had an assessment been conducted, and
C. Need individualized mental health services, including but not limited to,
professionally acceptable assessments, behavioral support, case
management, family support, crisis support, therapeutic foster care, and
other medically necessary services in the home or in a home-like setting, to
treat mental illness or condition.
Imminent Risk of foster care placement means that within the last 180 days, the child has
been participating in voluntary family maintenance services; voluntary family reunification
placements; and/or has been the subject of a referral/report to the Child Protective
Services system regarding suspicions of abuse, neglect or abandonment.
Members of this class include children living with their parents, relatives, or in any variety
of placements, such as group homes or foster homes.
2. Katie A. “Subclass” is identified as children in California who:
A. Have an open child welfare service case; and
B. Are full-scope Medi-Cal (Title XIX) eligible; and
C. Meet the medical necessity criteria for Medi-Cal Outpatient Specialty Mental
Health Services (SMHS) as set forth in CCR, Title 9, Section 1830.205 or
Section 1830.210; and
D. Currently in, or being considered for, wraparound, therapeutic foster care,
specialized care rate due to behavioral health needs or other intensive Early
and Periodic Screening Diagnostic and Treatment (EPSDT) services,
including but not limited to therapeutic behavioral services or crisis
stabilization/intervention; or
E. Currently in, or being considered for, placement in a group home (Rate
Classification 10 or above) or short term residential therapeutic program, as
currently indicated, a psychiatric hospital, 24-hour mental health treatment
facility (e.g., psychiatric inpatient hospital, community residential treatment
Exhibit B-1
Page 3 of 13
facility); or has experienced three (3) or more placements within 24 months
due to behavioral health needs.
I. CONTRACTOR SHALL BE RESPONSIBLE FOR THE FOLLOWING SERVICES:
A. Outpatient Specialty Mental Health Services
1. CONTRACTOR will provide the following array of outpatient specialty
mental health services to all referrals received from the Child Welfare
Mental Health (CWMH) Team. CONTRACTOR shall accept the
adequate number of referrals to meet CWMH demand and to cover
program costs. Since July 2014, referrals have averaged approximately
twenty (20) to twenty-five (25) per week for each vendor.
CONTRACTOR shall provide the following specialty mental health
services for the duration, frequency and intensity based upon the
individual needs of children and families in CWS and as determined to
be clinically appropriate by a licensed/waivered mental health clinician.
It is understood that a child who meets the definition of “Katie A.
Subclass” does not, in and of itself, require a higher level or intensity of
mental health treatment absent a clinical determination by the treating
mental health clinician:
a. Mental Health Assessments
Clinical analysis of the history and current status of a
beneficiary’s mental, emotional, or behavioral disorder;
relevant cultural issues and history; diagnosis; and use of
testing procedures.
b. Therapy
1. A therapeutic intervention that focuses primarily on
symptom reduction as a means to improve functional
impairments. Therapy may be delivered to an individual or
group of beneficiaries (see below) and may include family
therapy at which the beneficiary is present.
a. Individual
b. Collateral
c. Conjoint
d. Family therapy
e. Group therapy
i. Groups will be led by clinicians and
supervised by a licensed clinician. Larger
groups may be co-facilitated by two (2)
unlicensed clinicians. Licensed Clinical
Supervisors will provide in-vivo training, co-
facilitation and supervision to ensure group
facilitation is high quality, clinically effective,
and appropriate.
Exhibit B-1
Page 4 of 13
c. Crisis Intervention
A service lasting less than 24 hours, to or on behalf of a
beneficiary for a condition which requires more timely
response than a regularly scheduled visit. Activities may
include, but are not limited to: assessment, therapy and
service access to any significant support person in the
beneficiary’s life with the intent of improving or maintaining
the mental health status of the beneficiary.
d. Case Management
Any service that assists a beneficiary to access needed
medical, educational, social, prevocational, vocational,
rehabilitative, or other community service. Services may
include, but are not limited to, communication,
coordination, and referral to available resources.
CONTRACTOR will be responsible for monitoring service
delivery to beneficiary by third parties, beneficiary
progress and plan development.
e. Rehabilitation
Any activity that seeks to improve, maintain, or restore a
beneficiary’s functional, daily living, social, leisure,
grooming, personal hygiene, and meal preparation skills
while also providing access to support resources and
medication education.
f. Plan Development
The development of client plans, approval of client plans,
or monitoring of a beneficiary’s progress.
g. Medication Support
Any service that includes prescribing, administering,
dispensing and monitoring psychiatric medications or
biologicals which are necessary to alleviate the symptoms
of mental illness. Services may also include evaluation for
the need of medication, evaluation of clinical effectiveness
and side effects, obtaining informed consent, medication
education and plan development related to the delivery of
the service and/or assessment of the beneficiary.
2. CONTRACTOR shall be responsible to provide and appropriately bill for
Katie A. Subclass members if medically necessary and provided within
the California Partners for Permanency (CAPP) and Katie A. Core
Practice Model and in accordance with the “Medi-Cal Manual for
Intensive Care Coordination (ICC), Intensive Home Based Services
(IHBS) & Therapeutic Foster Care (TFC) for Medi-Cal Beneficiaries”:
a. Intensive Home Based Services (IHBS) may include, but are
not limited to:
1. Skill-based interventions for the remediation of behaviors
or improvement of symptoms
Exhibit B-1
Page 5 of 13
2. Development of functional skills to improve self-care, self-
regulation, or other functional impairments by intervening
to decrease or replace non-functional behavior that
interferes with daily living tasks or the avoidance of
exploitation by others
3. Development of skills or replacement behaviors that allow
the child/youth to fully participate in the teaming process
and service plans including but not limited to the plan
and/or child welfare case plan
4. Improvement in self-management of symptoms, including
self-administration of medications as appropriate
5. Education of the child/youth and/or their family or
caregiver(s) about, and how to manage the child/youth’s
mental health disorder or symptoms
6. Support of the development, maintenance and use of
social networks including the use and natural and
community resources
7. Support to address behaviors that interfere with the
achievement of a stable and permanent family life
8. Support to address behaviors that interfere with seeking
and maintaining a job
9. Support to address behaviors that interfere with a
child/youth’s success in achieving educational objectives
in an academic program in the community
b. If it is deemed that the client requires IHBS services but that
those services will be provided by a separate agency which is
concurrently providing services to that client, then the clinical
justification for that decision must be documented in the
client’s record. Clinical justification for this decision will be
reviewed and audited by the Department of Behavioral
Health’s Managed Care Division.
c. Intensive Care Coordination (ICC) that requires active and
ongoing participation in any teaming processes scheduled by
CWS or by the Child Welfare Mental Health Team to insure
coordination of all mental health treatment services that may
involve one or more provider agency(ies), no less than every
ninety (90) days for the child/youth.
d. ICC service components/activities include comprehensive
assessment and periodic reassessment, development and
periodic revision of the plan, referral, monitoring and follow-up
activities and transition.
3. CONTRACTOR will be responsible to provide services in either an
office-based or community-based setting. The location of service
delivery will be determined based on the needs of the client, preference
of the client, and clinical appropriateness. Based on current data, the
expectation is that 70% of clients will prefer or require that their services
be provided in a community-based setting. Location of service delivery
Exhibit B-1
Page 6 of 13
should be clinically justified and documented in the client record. Clinical
justification will be reviewed and audited by the Department of
Behavioral Health’s Managed Care Division.
4. CONTRACTOR will be responsible to work cooperatively and
collaboratively with CWS staff, Child Welfare Mental Health Program
staff and all treatment providers, caregivers, and Foster Family Agencies
to achieve the individual and collective treatment goals and support the
CWS case plan, communicate/resolve barriers to care, provide
continuity and warm hand-offs whenever possible when clients transition
from higher to lower or lower to higher levels of care whether within or
outside of Fresno County.
5. CONTRACTOR will provide its service delivery model for Katie A. Class
and Subclass members from which the revenue projections were
budgeted. This includes the frequency/duration of interventions during
a specified timeframe from which COUNTY will monitor utilization and
potential service capacity.
6. CONTRACTOR will be able to refer to other Fresno County Mental
Health Plan providers, Managed Care Medi-Cal Health Plans and other
community providers as may be appropriate and in concurrence with the
CWMH program.
7. CONTRACTOR will identify evidence-based and/or best practices found
effective in serving this target population. This includes the provision of
training, ongoing sustainability and fidelity to a core competency to
CONTRACTOR’s mental health clinicians. To date, CONTRACTOR
and COUNTY have agreed upon the provision of the following evidence-
based practices: Dialectical Behavioral Therapy (DBT), Motivational
Interviewing (MI), Nurturing Parenting Programs, Circle of Security
(COS), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT),
Trauma-Focused Integrated Play Therapy, Child-Centered Play
Therapy (CCPT), Child-Parent Psychotherapy (CPP), Theraplay,
Attachment-Focused Family Therapy (AFFT), Brief Strategic Family
Therapy, Dyadic Developmental Psychotherapy (DDP), and Filial
Therapy. This does not exclude other evidence-based, best or promising
practice or therapeutic approaches that clinicians may have proficiency
and meets the individualized treatment needs of the client. Any additions
or deletions of previous COUNTY approved evidence-based practice by
CONTRACTOR will require consultation with COUNTY.
8. CONTRACTOR will ensure that the Clinical Supervisors will oversee the
work of the Clinicians, including approving documentation and claiming
in the electronic medical records. The Clinical Supervisor shall be two
(2) years post license and able to provide Board of Behavioral Sciences
(BBS) supervision.
Exhibit B-1
Page 7 of 13
9. If CONTRACTOR has other agreements with COUNTY to provide
mental health treatment services, it will establish criteria and protocols
to insure referral to services are therapeutically appropriate, benefits the
client and caregiver, achieves the client’s treatment goals and supports
the success of the CWS case plan and avoids any potential for
perceived or actual conflict of interest or self-referral.
B. Affordable Care Act and Medi-Cal Managed Care Plan Requirements
1. CONTRACTOR understands that effective January 1, 2014, Medi-Cal
managed care health plans (MCPs) are required to serve Medi-Cal
beneficiaries with mild to moderate impairment of mental, emotional, or
behavioral functioning resulting from a mental health condition defined
by the current Diagnostic and Statistical Manual. Outpatient benefits
available through MCPs include:
a. Individual and group mental health evaluation and treatment
(psychotherapy)
b. Psychological testing, when clinically indicated to evaluate a
mental health condition;
c. Outpatient services for the purposes of monitoring drug
therapy;
d. Psychiatric consultation; and,
e. Outpatient laboratory, drugs, supplies and supplements
(excluding medications as described in the “Medi-Cal
Managed Care Plan Responsibilities for Outpatient Mental
Health Services”, or any updates thereof)
2. CONTRACTOR will comply with all requirements established by the
California Department of Health Care Services, including all new
forthcoming rules and regulations in relation to the Continuum of Care
Reform (CCR), Fresno County Mental Health Plan and Medi-Cal
managed care plans (MCPs) for screening, referral, and coordination of
care when clinically appropriate.
C. Court-Specific Mental Health Services
1. CONTRACTOR will provide the following court-ordered mental health
services to children and families in CWS:
a. Mental Health Assessments
Clinical analysis of the history and current status of a
beneficiary’s mental, emotional, or behavioral disorder;
relevant cultural issues and history; diagnosis; and use of
testing procedures.
b. Psychological and Neuropsychological Evaluations
A structured, analytical interview with the client, minor,
parent, or guardian, which consists of a clinical
assessment, the use of testing instruments, a mental
status examination, and a clinical diagnosis (as
Exhibit B-1
Page 8 of 13
defined/ruled out using the ICD-10) that is performed only
by a Licensed Psychologist with at least five (5) years of
postgraduate experience. Service also includes a review
of CPS and mental health services received to date and
contact with relevant others as necessary/possible. A
second psychological or neuropsychological evaluation
may be ordered and must be performed by a different
Licensed Psychologist and independent of the first
evaluation.
c. Bonding Studies
A structured, forensic, analytic interview that includes a
mental health assessment (define or rule out clinical
diagnosis using the ICD-10) for both parent(s) or
whomever has been identified by the court to participate in
the study, and the child(ren). The study includes
assessment of the interaction between the parent(s) and
the child(ren) and may include the use of testing
instruments (as needed) to more accurately gauge the
strength of the bond between parent and child. It may also
include the current care provider(s) or prospective
adoptive parent(s) when ordered by the court. These
studies are to be performed only by a Licensed Mental
Health Clinician with appropriate experience or a
Waivered Psychologist working under a qualified Licensed
Psychologist. A qualified Clinician will have completed
twenty (20) hours of training in Child Custody as required
by the California Board of Psychology (if the child is 0-36
months), training in the Marshak Interaction Method, and
training or experience in providing forensic evaluations for
the court.
d. Family Psychodynamic Formulation
A structured, analytical interview conducted by a Licensed
Mental Health Clinician or Waivered Psychologist if under
the supervision of a Licensed Psychologist, which consists
of a clinical assessment (define or rule out clinical
diagnosis using the ICD-10) and family session(s) with all
relevant family members, to identify the roles inhabited by
the members and their interactive patterns. Also includes
a review of all available CPS and mental health interviews
with relevant professionals (CPS, school personnel,
therapists, etc.).
e. Attachment Assessments
A structured, analytical interview performed only by a
Licensed Mental Health Clinician with appropriate
experience that includes a clinical assessment of the
interaction between the parent/caregiver(s) and the child.
Infant Family Mental Health (IFMH) training is required if
any of the children are 0-36 months. Testing instruments
Exhibit B-1
Page 9 of 13
may be used as needed to more accurately gauge the
strength and quality of the attachment between parent and
child.
2. CONTRACTOR will be responsible for any court reports and/or
necessary testimony.
a. Court Reports
Documented report of assessment and evaluation
findings, progress in treatment, recommendations for
treatment and service plan regarding reunification,
maintenance and termination of parental rights, and
justification for recommendations.
b. Court Testimony
On-site court testimony of assessment and evaluation
findings, treatment and service plan recommendations
regarding reunification, maintenance and termination of
parental rights, and justification for recommendations.
D. Administrative Meetings
1. CONTRACTOR shall meet with COUNTY staff monthly, or as often as
needed, for monitoring of program services, client capacity, staffing
levels and to exchange pertinent operational information, resolve
problems, and coordinate services.
2. CONTRACTOR shall meet with COUNTY staff and other vendors for
child welfare mental health services quarterly, or as often as needed, for
discussion of program trends and resolution of concerns and problems
across all vendors.
3. CONTRACTOR shall attend bi-monthly Contracted Provider Meetings
held by DBH.
E. Data and Reporting
1. CONTRACTOR shall maintain and provide the COUNTY with statistics
on the number of individuals/families to including but not limited to the
following:
a. Number of clients referred for mental health assessments;
average time between referral and the contact with
caregiver; average time between referral and the
assessment; number completed, number met within
required timeframe number of missed/no show
appointments, number that did not meet Medi-Cal medical
necessity criteria
b. Number of clients referred for court-ordered services
including type of service, average time between referral to
Exhibit B-1
Page 10 of 13
contact with the caregiver to schedule the appointment,
average number of days between the referral and the
court-ordered service, number of missed/no show
appointments
c. Average wait time between assessment and first visit with
assigned therapist
d. Average wait time between referral and provision of
medication evaluation
e. Unique clients served; units and dollars of services billed,
average cost per client
f. Number and reasons for closed cases
g. Current number of active clients in ongoing treatment
h. Current number of inactive cases
i. Number of outpatient specialty mental health services
j. Duration of treatment time for active clients.
This information will be provided to COUNTY on a monthly basis via an
activity report template developed by the COUNTY and due no later than
the 10th of each month.
2. CONTRACTOR shall maintain case files on each individual/family,
including, but not limited to the following information:
a. Documentation of referrals to/from COUNTY, self-referrals and
others;
b. Chronological record of individual and family services provided
including relevant contact dates, incidents, actions taken, and
results; and
c. Case closure summary, indicating the reasons for closure and
the results of the services provided.
3. CONTRACTOR shall maintain secure case files with limited access only
to designated staff to ensure confidentiality.
4. CONTRACTOR shall submit a monthly staffing report, due no later than
the 10th of each month, detailing the total number of positions by
discipline in the approved budget, number of staff hired (including
licensure, ethnicity, bilingual language capability, clinical
training/certification in evidence-based practice(s) and number of
vacancies
II. COUNTY SHALL BE RESPONSIBLE FOR THE FOLLOWING:
A. Provide mental health service referrals to CONTRACTOR for children and
families in CWS.
B. Designate a contact person for CONTRACTOR to communicate with when
necessary.
Exhibit B-1
Page 11 of 13
C. Meet with CONTRACTOR monthly, or as often as needed, to exchange
pertinent information, resolve problems, and work together to coordinate
referrals and services.
D. Support coordination of Intensive Care Coordination meetings initially and
no less than every ninety (90) days for a child/youth identified as requiring
this service.
E. Convene teaming meetings in alignment with California Partners for
Permanency (CAPP), Senate Bill 163 Wraparound, and Katie A. Core
Practice models for which CONTRACTOR will be required to participate,
when appropriate.
F. Provide education and training on CWS, practice models and Medi-Cal
licensing, documentation and billing requirements, as needed.
III. PERFORMANCE MEASUREMENTS
Overall Service Objective:
CONTRACTOR will adhere to the outcome measures developed by COUNTY and any
requirements established by the California Department of Social Services and the
California Department of Health Services.
Services provided by the CONTRACTOR will align and support the principles of Fresno
County’s child welfare practice model, the Katie A Settlement Agreement, and the Senate
Bill 163 Wraparound family-based service program. Mental Health Services will be
integrated, timely, ongoing and uninterrupted in a family-focused, trauma-informed
delivery model that supports the goals of the client plan developed by COUNTY. Intensive
home-based mental health services are expected to provide children and families in the
CWS system with effective treatment, improve outcomes, promote wellness, aid in
resiliency, and maintain family relationships conducive to healthy emotional development.
Performance Outcomes and Measures:
Under the Katie A. Settlement Agreement and Implementation Plan, the California
Departments of Health Care Services (DHCS) and Social Services (CDSS) are working
to adopt statewide use of a data-informed system of performance oversight,
accountability, and communication that efficiently monitors, measures, and evaluates
access, quality, satisfaction, effectiveness, costs, and outcomes at the individual,
program, and system levels.
Performance measurements developed by COUNTY will reflect the information required
by DHCS and CDSS. The outcome measures and indicators provided below represent
program goals to be achieved by CONTRACTOR in addition to CONTRACTOR-
developed outcomes. COUNTY may adjust these outcome measurements, periodically,
so as to best measure the success of clients and program. These outcome
Exhibit B-1
Page 12 of 13
measurements and indicators will continue to be developed in conjunction with
CONTRACTOR, COUNTY, and the State Departments.
A. Timeliness of Service – CONTRACTOR will respond to referrals within the
required timeframes, in order to engage with the clients as soon as possible.
1. Timely access to services from referral to assessment. The timeframe
to contact the client and have the assessment scheduled, is as follows:
a. Crisis referrals: within three (3) days
b. Priority referrals: within fifteen (15) days
c. Standard referrals: within thirty (30) days.
2. 100% of all assessments will be signed/completed within thirty (30)
days.
3. Timely access to service from assessment to ongoing treatment.
4. Timely access to services from referral to medication evaluation, when
appropriate.
B. Access and Engagement – CONTRACTOR will ensure that clients have access
to treatment, that the client is actively involved in treatment, and that every
effort is made to aid the client in successfully completing treatment.
1. CONTRACTOR will provide services in a location determined by the
needs/preference of the client and clinical appropriateness. The
expectation is that 70% of clients will prefer/require services in a
community-based setting.
2. CONTRACTOR will track the number, type, and location of services per
client.
3. CONTRACTOR will actively provide ICC and IHBS services.
4. Clinician attendance at 100% of teaming meetings.
5. CONTRACTOR will track the “no show” rate for treatment. The
expectation is that this “no show” rate will not be more than 10%.
6. CONTRACTOR will track the number and reasons for discharge. The
expectation is that there will be a low number of discharges due to “no
shows” and a low number of discharges in which the client has not
successfully completed treatment.
7. 70% of clients that maintain an open child welfare case will successfully
complete treatment.
C. Wellness, Recovery, and Resiliency Supports – a collaborative approach to
treatment strategies to aid in the successful completion of treatment,
reunification, and reduction in recidivism
1. Improved Child Functioning
Improvement in relationships, behavior, and academic
achievements, as demonstrated through tracking tools
implemented by the CONTRACTOR.
2. Improved Family Functioning
Improvement in ability to provide for and maintain a safe
and stable environment for the child, as demonstrated
Exhibit B-1
Page 13 of 13
through tracking tools implemented by the
CONTRACTOR.
3. Improved Parent Functioning
Improvement in relationships, behavior, and sustaining
basic needs, as demonstrated through tracking tools
implemented by the CONTRACTOR.
4. Effectiveness of discharge planning as demonstrated by referral and
linkage to other COUNTY programs, community providers, and other
community resources.
5. Placement, Stability, & Permanency
a. Number of placement changes while in treatment
b. Permanency status of clients
Exhibit B-2
Page 1 of 13
CHILD WELFARE MENTAL HEALTH SERVICES (CWMH)
SUMMARY OF SERVICES
ORGANIZATION: Central Star Behavioral Health Inc.
ADDRESS: 1501 Hughes Way, Suite 150
Long Beach, CA 90810
TELEPHONE: (310) 221-6336 (x125)
CONTACT PERSON: Kent Dunlap, Senior Vice President
CONTRACT PERIOD: July 1, 2017 – June 30, 2019
CONTRACT AMOUNT: $4,000,000 (July 1, 2017 – June 30, 2018);
$4,000,000 (July 1, 2018 – June 30, 2019)
SUMMARY OF SERVICES:
Central Star Behavioral Health, Inc., henceforth referred to as CONTRACTOR, will be
responsible for providing medically necessary outpatient specialty mental health services
for children and youth with serious emotional disturbance(s), parents with a serious
mental illness, and court-specific services to children and families in Fresno County’s
Child Welfare Services (CWS) system. The majority of outpatient mental health services,
such as assessments, plan development, therapy, rehabilitation services, crisis
intervention, case management, intensive home based services and intensive care
coordination are expected to be community-based and provided in the family’s home or
in the community, when possible. For those services provided in the office,
CONTRACTOR will work closely with the caregiver to identify and assist, whenever
possible, with any barriers to receiving care (i.e., lack of public/private transportation,
scheduling of appointment days/hours, etc.).
SCHEDULE OF SERVICES:
The CONTRACTOR’S office(s) shall be open Monday through Friday, 9:00am to 5:00pm.
Therapists (Mental Health Specialists) will be available to see clients and families for in-
home appointments during the day, weekend, and evening hours, up to 8:00 pm. Group
services will be provided during the day and evening hours, up to 8:00 pm, on a scheduled
basis, at CONTRACTOR’S offices. The CONTRACTOR’s office will be located at a site
in the metropolitan or rural community that offers public transportation in close proximity,
adequate parking, and in a secure setting. In addition to the Fresno metropolitan area,
CONTRACTOR has agreed to serve the rural areas of Fresno County, as needed. Any
addition or change to the location of office-based services must be approved by the
COUNTY in advance of such a change.
Exhibit B-2
Page 2 of 13
TARGET POPULATION:
CONTRACTOR shall provide mental health services to all referred children, youth,
parents, guardians, and foster parents involved with a child’s CWS case. The target
population includes children and youth as referred to in the Katie A. Settlement
Agreement as members of the “class” and “subclass.”
1. Katie A. “Class” is defined as children in California who:
A. Are in foster care or are at imminent risk of foster care placement, and
B. Have a mental illness or condition that has been documented, or would
have been documented had an assessment been conducted, and
C. Need individualized mental health services, including but not limited to,
professionally acceptable assessments, behavioral support, case
management, family support, crisis support, therapeutic foster care, and
other medically necessary services in the home or in a home-like setting, to
treat mental illness or condition.
Imminent Risk of foster care placement means that within the last 180 days, the child has
been participating in voluntary family maintenance services; voluntary family reunification
placements; and/or has been the subject of a referral/report to the Child Protective
Services system regarding suspicions of abuse, neglect or abandonment.
Members of this class include children living with their parents, relatives, or in any variety
of placements, such as group homes or foster homes.
2. Katie A. “Subclass” is identified as children in California who:
A. Have an open child welfare service case; and
B. Are full-scope Medi-Cal (Title XIX) eligible; and
C. Meet the medical necessity criteria for Medi-Cal Outpatient Specialty Mental
Health Services (SMHS) as set forth in CCR, Title 9, Section 1830.205 or
Section 1830.210; and
D. Currently in, or being considered for, wraparound, therapeutic foster care,
specialized care rate due to behavioral health needs or other intensive Early
and Periodic Screening Diagnostic and Treatment (EPSDT) services,
including but not limited to therapeutic behavioral services or crisis
stabilization/intervention; or
E. Currently in, or being considered, for placement in a group home (Rate
Classification 10 or above) or short term residential therapeutic program, as
currently indicated,, a psychiatric hospital, 24-hour mental health treatment
facility (e.g., psychiatric inpatient hospital, community residential treatment
Exhibit B-2
Page 3 of 13
facility); or has experienced three (3) or more placements within 24 months
due to behavioral health needs
I. CONTRACTOR SHALL BE RESPONSIBLE FOR THE FOLLOWING SERVICES:
A. Outpatient Specialty Mental Health Services
1. CONTRACTOR will provide the following array of outpatient specialty
mental health services to all referrals received from the Child Welfare
Mental Health (CWMH) Team. CONTRACTOR shall accept the
adequate number of referrals to meet CWMH demand and to cover
program costs. Since July 2014, referrals have averaged approximately
twenty (20) to twenty-five (25) per week for each vendor.
CONTRACTOR shall provide the following specialty mental health
services for the duration, frequency and intensity based upon the
individual needs of children and families in CWS and as determined to
be clinically appropriate by a licensed/waivered mental health clinician.
It is understood that a child who meets the definition of “Katie A.
Subclass” does not, in and of itself, require a higher level or intensity of
mental health treatment absent a clinical determination by the treating
mental health clinician:
a. Mental Health Assessments
Clinical analysis of the history and current status of a
beneficiary’s mental, emotional, or behavioral disorder;
relevant cultural issues and history; diagnosis; and use of
testing procedures.
b. Therapy
1. A therapeutic intervention that focuses primarily on
symptom reduction as a means to improve functional
impairments. Therapy may be delivered to an individual or
group of beneficiaries (see below) and may include family
therapy at which the beneficiary is present.
a. Individual
b. Collateral
c. Conjoint
d. Family therapy
e. Group therapy
Groups will be led by clinicians and
supervised by a licensed clinician. Larger
groups may be co-facilitated by two (2)
unlicensed clinicians. Licensed Clinical
Supervisors will provide in-vivo training, co-
facilitation and supervision to ensure group
facilitation is high quality, clinically effective,
and appropriate.
Exhibit B-2
Page 4 of 13
c. Crisis Intervention
A service lasting less than 24 hours, to or on behalf of a
beneficiary for a condition which requires more timely
response than a regularly scheduled visit. Activities may
include, but are not limited to: assessment, therapy and
service access to any significant support person in the
beneficiary’s life with the intent of improving or maintaining
the mental health status of the beneficiary.
d. Case Management
Any service that assists a beneficiary to access needed
medical, educational, social, prevocational, vocational,
rehabilitative, or other community service. Services may
include, but are not limited to, communication,
coordination, and referral to available resources.
CONTRACTOR will be responsible for monitoring service
delivery to beneficiary by third parties, beneficiary
progress and plan development.
e. Rehabilitation
Any activity that seeks to improve, maintain, or restore a
beneficiary’s functional, daily living, social, leisure,
grooming, personal hygiene, and meal preparation skills
while also providing access to support resources and
medication education.
f. Plan Development
The development of client plans, approval of client plans,
or monitoring of a beneficiary’s progress.
g. Medication Support
Any service that includes prescribing, administering,
dispensing and monitoring psychiatric medications or
biologicals which are necessary to alleviate the symptoms
of mental illness. Services may also include evaluation for
the need of medication, evaluation of clinical effectiveness
and side effects, obtaining informed consent, medication
education and plan development related to the delivery of
the service and/or assessment of the beneficiary.
2. CONTRACTOR shall be responsible to provide and appropriately bill for
Katie A. Subclass members if medically necessary and provided within
the California Partners for Permanency (CAPP) and Katie A. Core
Practice Model and in accordance with the “Medi-Cal Manual for
Intensive Care Coordination (ICC), Intensive Home Based Services
(IHBS) & Therapeutic Foster Care (TFC) for Medi-Cal Beneficiaries”:
a. Intensive Home Based Services (IHBS) may include, but are
not limited to:
1. Skill-based interventions for the remediation of behaviors
or improvement of symptoms
Exhibit B-2
Page 5 of 13
2. Development of functional skills to improve self-care, self-
regulation, or other functional impairments by intervening
to decrease or replace non-functional behavior that
interferes with daily living tasks or the avoidance of
exploitation by others
3. Development of skills or replacement behaviors that allow
the child/youth to fully participate in the teaming process
and service plans including but not limited to the plan
and/or child welfare case plan
4. Improvement in self-management of symptoms, including
self-administration of medications as appropriate
5. Education of the child/youth and/or their family or
caregiver(s) about, and how to manage the child/youth’s
mental health disorder or symptoms
6. Support of the development, maintenance and use of
social networks including the use and natural and
community resources
7. Support to address behaviors that interfere with the
achievement of a stable and permanent family life
8. Support to address behaviors that interfere with seeking
and maintaining a job
9. Support to address behaviors that interfere with a
child/youth’s success in achieving educational objectives
in an academic program in the community
b. If it is deemed that the client requires IHBS services but that
those services will be provided by a separate agency which is
concurrently providing services to that client, then the clinical
justification for that decision must be documented in the
client’s record. Clinical justification for this decision will be
reviewed and audited by the Department of Behavioral
Health’s Managed Care Division.
c. Intensive Care Coordination (ICC) that requires active and
ongoing participation in any teaming processes scheduled by
CWS or by the Child Welfare Mental Health Team to insure
coordination of all mental health treatment services that may
involve one or more provider agency(ies), no less than every
ninety (90) days for the child/youth.
d. ICC service components/activities include comprehensive
assessment and periodic reassessment, development and
periodic revision of the plan, referral, monitoring and follow-up
activities and transition.
3. CONTRACTOR will be responsible to provide services in either an
office-based or community-based setting. The location of service
delivery will be determined based on the needs of the client, preference
of the client, and clinical appropriateness. Based on current data, the
expectation is that 70% of clients will prefer or require that their services
be provided in a community-based setting. Location of service delivery
Exhibit B-2
Page 6 of 13
should be clinically justified and documented in the client record. Clinical
justification will be reviewed and audited by the Department of
Behavioral Health’s Managed Care Division.
4. CONTRACTOR will be responsible to work cooperatively and
collaboratively with CWS staff, Child Welfare Mental Health Program
staff, and all treatment providers, caregivers, and Foster Family
Agencies to achieve the individual and collective treatment goals and
support the CWS case plan, communicate/resolve barriers to care,
provide continuity and warm hand-offs whenever possible when clients
transition from higher to lower or lower to higher levels of care whether
within or outside of Fresno County.
5. CONTRACTOR will provide its service delivery model for Katie A. Class
and Subclass members from which the revenue projections were
budgeted. This includes the frequency/duration of interventions during
a specified timeframe from which COUNTY will monitor utilization and
potential service capacity.
6. CONTRACTOR will be able to refer to other Fresno County Mental
Health Plan providers, Managed Care Medi-Cal Health Plans and other
community providers as may be appropriate and in concurrence with the
CWMH program.
7. CONTRACTOR will identify evidence-based and/or best practices found
effective in serving this target population. This includes the provision of
training, ongoing sustainability and fidelity to a core competency to
CONTRACTOR’s mental health clinicians. To date, CONTRACTOR
and COUNTY have agreed upon the provision of the following evidence-
based practices: Cognitive Behavioral Therapy, Alternatives for
Families, Cognitive Behavioral Therapy, and Child Parent
Psychotherapy. This does not exclude other evidence-based, best or
promising practice or therapeutic approaches that clinicians may have
proficiency and meets the individualized treatment needs of the client.
Any additions or deletions of previous COUNTY approved evidence-
based practice by CONTRACTOR will require consultation with
COUNTY.
8. CONTRACTOR will ensure that in the initial year of the Agreement, the
Director will oversee the work of the Mental Health Specialists, including
approving documentation and claiming in the eElectronic medical
records. In FY 15-16, CONTRACTOR will add a Clinical Supervisor
organizationally under the Director as the number of clinicians increase.
The Clinical Supervisor shall be two (2) years post license and able to
provide Board of Behavioral Sciences (BBS) supervision.
9. If CONTRACTOR has other agreements with COUNTY to provide
mental health treatment services, it will establish criteria and protocols
Exhibit B-2
Page 7 of 13
to insure referral to services are therapeutically appropriate, benefits the
client and caregiver, achieves the client’s treatment goals and supports
the success of the CWS case plan and avoids any potential for
perceived or actual conflict of interest or self-referral.
B. Affordable Care Act and Medi-Cal Managed Care Plan Requirements
1. CONTRACTOR understands that effective January 1, 2014, Medi-Cal
managed care health plans (MCPs) are required to serve Medi-Cal
beneficiaries with mild to moderate impairment of mental, emotional, or
behavioral functioning resulting from a mental health condition defined
by the current Diagnostic and Statistical Manual. Outpatient benefits
available through MCPs include:
a. Individual and group mental health evaluation and treatment
(psychotherapy)
b. Psychological testing, when clinically indicated to evaluate a
mental health condition;
c. Outpatient services for the purposes of monitoring drug
therapy;
d. Psychiatric consultation; and,
e. Outpatient laboratory, drugs, supplies and supplements
(excluding medications as described in the forthcoming “Medi-
Cal Managed Care Plan Responsibilities for Outpatient
Mental Health Services, or any updates thereof”)
2. CONTRACTOR will comply with all requirements established by the
California Department of Health Care Services, including all new
forthcoming rules and regulations in relation to the Continuum of Care
Reform (CCR), Fresno County Mental Health Plan and Medi-Cal
managed care plans (MCPs) for screening, referral, and coordination of
care when clinically appropriate.
C. Court-Specific Mental Health Services
1. CONTRACTOR will provide the following court-ordered mental health
services to children and families in CWS:
a. Mental Health Assessments
Clinical analysis of the history and current status of a
beneficiary’s mental, emotional, or behavioral disorder;
relevant cultural issues and history; diagnosis; and use of
testing procedures.
b. Psychological and Neuropsychological Evaluations
A structured, analytical interview with the client, minor,
parent, or guardian, which consists of a clinical
assessment, the use of testing instruments, a mental
status examination, and a clinical diagnosis (as
defined/ruled out using the ICD-10) that is performed only
by a Licensed Psychologist with at least five (5) years of
Exhibit B-2
Page 8 of 13
postgraduate experience. Service also includes a review
of CPS and mental health services received to date and
contact with relevant others as necessary/possible. A
second psychological or neuropsychological evaluation
may be ordered and must be performed by a different
Licensed Psychologist and independent of the first
evaluation.
c. Bonding Studies
A structured, forensic, analytic interview that includes a
mental health assessment (define or rule out clinical
diagnosis using the ICD-10) for both parent(s) or
whomever has been identified by the court to participate in
the study, and the child(ren). The study includes
assessment of the interaction between the parent(s) and
the child(ren) and may include the use of testing
instruments (as needed) to more accurately gauge the
strength of the bond between parent and child. It may also
include the current care provider(s) or prospective
adoptive parent(s) when ordered by the court. These
studies are to be performed only by a Licensed Mental
Health Clinician with appropriate experience or a
Waivered Psychologist working under a qualified Licensed
Psychologist. A qualified Clinician will have completed
twenty (20) hours of training in Child Custody as required
by the California Board of Psychology (if the child is 0-36
months), training in the Marshak Interaction Method, and
training or experience in providing forensic evaluations for
the court.
d. Family Psychodynamic Formulation
A structured, analytical interview conducted by a Licensed
Mental Health Clinician or Waivered Psychologist if under
the supervision of a Licensed Psychologist, which consists
of a clinical assessment (define or rule out clinical
diagnosis using the ICD-10) and family session(s) with all
relevant family members, to identify the roles inhabited by
the members and their interactive patterns. Also includes
a review of all available CPS and mental health interviews
with relevant professionals (CPS, school personnel,
therapists, etc.).
e. Attachment Assessments
A structured, analytical interview performed only by a
Licensed Mental Health Clinician with appropriate
experience that includes a clinical assessment of the
interaction between the parent/caregiver(s) and the child.
Infant Family Mental Health (IFMH) training is required if
any of the children are 0-36 months. Testing instruments
may be used as needed to more accurately gauge the
Exhibit B-2
Page 9 of 13
strength and quality of the attachment between parent and
child.
2. CONTRACTOR will be responsible for any court reports and/or
necessary testimony.
a. Court Reports
Documented report of assessment and evaluation
findings, progress in treatment, recommendations for
treatment and service plan regarding reunification,
maintenance and termination of parental rights, and
justification for recommendations.
b. Court Testimony
On-site court testimony of assessment and evaluation
findings, treatment and service plan recommendations
regarding reunification, maintenance and termination of
parental rights, and justification for recommendations.
D. Administrative Meetings
1. CONTRACTOR shall meet with COUNTY staff monthly, or as often as
needed, for monitoring of program services, client capacity, staffing
levels and to exchange pertinent operational information, resolve
problems, and coordinate services.
2. CONTRACTOR shall meet with COUNTY staff and other vendors for
child welfare mental health services quarterly, or as often as needed, for
discussion of program trends and resolution of concerns and problems
across all vendors.
3. CONTRACTOR shall attend bi-monthly Contracted Provider Meetings
held by DBH.
E. Data and Reporting
1. CONTRACTOR shall maintain and provide the COUNTY with statistics
on the number of individuals/families including, but not limited to the
following:
a. Number of clients referred for mental health assessments;
average time between referral and the contact with
caregiver; average time between referral and the
assessment; number completed, number met within
required timeframe; number of missed/no show
appointments; number that did not meet Medi-Cal medical
necessity criteria
b. Number of clients referred for court-ordered services
including type of service, average time between referral to
contact with the caregiver to schedule the appointment,
Exhibit B-2
Page 10 of 13
average number of days between the referral and the
court-ordered service, number of missed/no show
appointments
c. Average wait time between assessment and first visit with
assigned therapist
d. Average wait time between referral and provision of
medication evaluation
e. Unique clients served; units and dollars of services billed,
average cost per client
f. Number and reasons for closed cases
g. Current number of active clients in ongoing treatment
h. Current number of inactive cases
i. Number of outpatient specialty mental health services
j. Duration of treatment time for active clients
This information will be provided to COUNTY on a monthly basis via an
activity report template developed by the COUNTY and due no later than
the 10th of each month.
2. CONTRACTOR shall maintain case files on each individual/family,
including, but not limited to the following information:
a. Documentation of referrals to/from COUNTY, self-referrals and
others;
b. Chronological record of individual and family services provided
including relevant contact dates, incidents, actions taken, and
results; and
c. Case closure summary, indicating the reasons for closure and
the results of the services provided.
3. CONTRACTOR shall maintain secure case files with limited access only
to designated staff to ensure confidentiality.
4. CONTRACTOR shall submit a monthly staffing report, due no later than
the 10th of each month, detailing the total number of positions by
discipline in the approved budget, number of staff hired (including
licensure, ethnicity, bilingual language capability, clinical
training/certification in evidence-based practice(s), and number of
vacancies.
II. COUNTY SHALL BE RESPONSIBLE FOR THE FOLLOWING:
A. Provide mental health service referrals to CONTRACTOR for children and
families in CWS.
B. Designate a contact person for CONTRACTOR to communicate with when
necessary.
Exhibit B-2
Page 11 of 13
C. Meet with CONTRACTOR monthly, or as often as needed, to exchange
pertinent information, resolve problems, and work together to coordinate
referrals and services.
D. Support coordination of Intensive Care Coordination meetings initially and
no less than every ninety (90) days for a child/youth identified as requiring
this service.
E. Convene teaming meetings in alignment with California Partners for
Permanency (CAPP), Senate Bill 163 Wraparound, and Katie A. Core
Practice models for which CONTRACTOR will be required to participate,
when appropriate.
F. Provide education and training on CWS, practice models and Medi-Cal
licensing, documentation and billing requirements, as needed.
III. PERFORMANCE MEASUREMENTS
Overall Service Objective:
CONTRACTOR will adhere to the outcome measures developed by COUNTY and any
requirements established by the California Department of Social Services and the
California Department of Health Services.
Services provided by the CONTRACTOR will align and support the principles of Fresno
County’s child welfare practice model, the Katie A Settlement Agreement, and the Senate
Bill 163 Wraparound family-based service program. Mental Health Services will be
integrated, timely, ongoing and uninterrupted in a family-focused, trauma-informed
delivery model that supports the goals of the client plan developed by COUNTY. Intensive
home-based mental health services are expected to provide children and families in the
CWS system with effective treatment, improve outcomes, promote wellness, aid in
resiliency, and maintain family relationships conducive to healthy emotional development.
Performance Outcomes and Measures:
Under the Katie A. Settlement Agreement and Implementation Plan, the California
Departments of Health Care Services (DHCS) and Social Services (CDSS) are working
to adopt statewide use of a data-informed system of performance oversight,
accountability, and communication that efficiently monitors, measures, and evaluates
access, quality, satisfaction, effectiveness, costs, and outcomes at the individual,
program, and system levels.
Performance measurements developed by COUNTY will reflect the information required
by DHCS and CDSS. The outcome measures and indicators provided below represent
program goals to be achieved by CONTRACTOR in addition to CONTRACTOR-
developed outcomes. COUNTY may adjust these outcome measurements, periodically,
so as to best measure the success of clients and program. These outcome
Exhibit B-2
Page 12 of 13
measurements and indicators will continue to be developed in conjunction with
CONTRACTOR, COUNTY, and the State Departments.
A. Timeliness of Service – CONTRACTOR will respond to referrals within the
required timeframes, in order to engage with the clients as soon as possible.
1. Timely access to services from referral to assessment. The timeframe
to contact the client and have the assessment scheduled, is as follows:
a. Crisis referrals: within three (3) days
b. Priority referrals: within fifteen (15) days
c. Standard referrals: within thirty (30) days.
2. 100% of all assessments will be signed/completed within thirty (30)
days.
3. Timely access to service from assessment to ongoing treatment.
4. Timely access to services from referral to medication evaluation, when
appropriate.
B. Access and Engagement – CONTRACTOR will ensure that clients have access
to treatment, that the client is actively involved in treatment, and that every
effort is made to aid the client in successfully completing treatment.
1. CONTRACTOR will provide services in a location determined by the
needs/preference of the client and clinical appropriateness. The
expectation is that 70% of clients will prefer/require services in a
community-based setting.
2. CONTRACTOR will track the number, type, and location of services per
client.
3. CONTRACTOR will actively provide ICC and IHBS services.
4. Clinician attendance at 100% of teaming meetings.
5. CONTRACTOR will track the “no show” rate for treatment. The
expectation is that this “no show” rate will not be more than 10%.
6. CONTRACTOR will track the number and reasons for discharge. The
expectation is that there will be a low number of discharges due to “no
shows” and a low number of discharges in which the client has not
successfully completed treatment.
7. 70% of clients that maintain an open child welfare case will successfully
complete treatment.
C. Wellness, Recovery, and Resiliency Supports – a collaborative approach to
treatment strategies to aid in the successful completion of treatment,
reunification, and reduction in recidivism
1. Improved Child Functioning
Improvement in relationships, behavior, and academic
achievements, as demonstrated through tracking tools
implemented by the CONTRACTOR.
Exhibit B-2
Page 13 of 13
2. Improved Family Functioning
Improvement in ability to provide for and maintain a safe
and stable environment for the child, as demonstrated
through tracking tools implemented by the
CONTRACTOR.
3. Improved Parent Functioning
Improvement in relationships, behavior, and sustaining
basic needs, as demonstrated through tracking tools
implemented by the CONTRACTOR.
4. Effectiveness of discharge planning as demonstrated by referral and
linkage to other COUNTY programs, community providers, and other
community resources.
5. Placement, Stability, & Permanency
a. Number of placement changes while in treatment
b. Permanency status of clients
Exhibit B-3
Page 1 of 13
CHILD WELFARE SPECIALTY MENTAL HEALTH (CWMH)
SUMMARY OF SERVICES
ORGANIZATION: Uplift Family Services
ADDRESS: 251 Llewellyn Avenue
Campbell, CA 95008-1940
TELEPHONE: (408) 379-3790
CONTACT PERSON: Marilyn Bamford, Executive Director, Central Region
CONTRACT PERIOD: July 1, 2017 – June 30, 2019
CONTRACT AMOUNT: $4,000,000 (July 1, 2017 – June 30, 2018);
$4,000,000 (July 1, 2018 – June 30, 2019)
SUMMARY OF SERVICES:
Uplift Family Services, henceforth referred to as CONTRACTOR, will be responsible for
providing medically necessary outpatient specialty mental health services for children and
youth with serious emotional disturbance(s), parents with a serious mental illness, court-
specific services to children and families in Fresno County’s Child Welfare Services
(CWS) system. The majority of outpatient mental health services, such as assessments,
plan development, therapy, rehabilitation services, crisis intervention, case management,
intensive home based services and intensive care coordination are expected to be
community-based and provided in the family’s home or in the community when possible.
For those services provided in the office, CONTRACTOR will work closely with the
caregiver to identify and assist, whenever possible, with any barriers to receiving care
(i.e., lack of public/private transportation, scheduling of appointment days/hours, etc.).
SCHEDULE OF SERVICES:
The CONTRACTOR’s office(s) shall be open Monday through Friday, 8am-5pm.
Clinicians will be available to see clients and families for in-home appointments during
the day, weekend, and evening hours, up to 8:00 pm. Group services will be provided
during the day and evening hours, up to 8:00 pm, on a scheduled basis, at
CONTRACTOR’s offices. The CONTRACTOR’s office will be located at a site in the
metropolitan or rural community that offers public transportation in close proximity,
adequate parking, and in a secure setting. In addition to the Fresno metropolitan area,
CONTRACTOR has agreed to serve the rural areas of Fresno County as needed. Any
addition or change to the location of office-based services must be approved by the
COUNTY in advance of such a change.
Exhibit B-3
Page 2 of 13
TARGET POPULATION:
CONTRACTOR shall provide mental health services to all referred children, youth,
parents, guardians, and foster parents involved with a child’s CWS case. The target
population includes children and youth as referred to in the Katie A. Settlement
Agreement as members of the “class” and “subclass.”
1. Katie A. “Class” is defined as children in California who:
A. Are in foster care or are at imminent risk of foster care placement, and
B. Have a mental illness or condition that has been documented, or would
have been documented had an assessment been conducted, and
C. Need individualized mental health services, including but not limited to,
professionally acceptable assessments, behavioral support, case
management, family support, crisis support, therapeutic foster care, and
other medically necessary services in the home or in a home-like setting, to
treat mental illness or condition.
Imminent Risk of foster care placement means that within the last 180 days, the child has
been participating in voluntary family maintenance services; voluntary family reunification
placements; and/or has been the subject of a referral/report to the Child Protective
Services system regarding suspicions of abuse, neglect or abandonment.
Members of this class include children living with their parents, relatives, or in any variety
of placements, such as group homes or foster homes.
2. Katie A. “Subclass” is identified as children in California who:
A. Have an open child welfare service case; and
B. Are full-scope Medi-Cal (Title XIX) eligible; and
C. Meet the medical necessity criteria for Medi-Cal Outpatient Specialty Mental
Health Services (SMHS) as set forth in CCR, Title 9, Section 1830.205 or
Section 1830.210; and
D. Currently in, or being considered for, wraparound, therapeutic foster care,
specialized care rate due to behavioral health needs or other intensive Early
and Periodic Screening Diagnostic and Treatment (EPSDT) services,
including but not limited to therapeutic behavioral services or crisis
stabilization/intervention; or
E. Currently in, or being considered for, placement in a group home (Rate
Classification 10 or above) or short term residential therapeutic program, as
currently indicated, a psychiatric hospital, 24-hour mental health treatment
facility (e.g., psychiatric inpatient hospital, community residential treatment
Exhibit B-3
Page 3 of 13
facility); or has experienced three (3) or more placements within 24 months
due to behavioral health needs.
I. CONTRACTOR SHALL BE RESPONSIBLE FOR THE FOLLOWING SERVICES:
A. Outpatient Specialty Mental Health Services
1. CONTRACTOR will provide the following array of outpatient specialty
mental health services to all referrals received from the Child Welfare
Mental Health (CWMH) Team. CONTRACTOR shall accept the
adequate number of referrals to meet CWMH demand and to cover
program costs. Since July 2014, referrals have averaged approximately
twenty (20) to twenty-five (25) per week for each vendor.
CONTRACTOR shall provide the following specialty mental health
services for the duration, frequency and intensity based upon the
individual needs of children and families in CWS and as determined to
be clinically appropriate by a licensed/waivered mental health clinician.
It is understood that a child who meets the definition of “Katie A.
Subclass” does not, in and of itself, require a higher level or intensity of
mental health treatment absent a clinical determination by the treating
mental health clinician:
a. Mental Health Assessments
Clinical analysis of the history and current status of a
beneficiary’s mental, emotional, or behavioral disorder;
relevant cultural issues and history; diagnosis; and use of
testing procedures.
b. Therapy
1. A therapeutic intervention that focuses primarily on
symptom reduction as a means to improve functional
impairments. Therapy may be delivered to an individual or
group of beneficiaries (see below) and may include family
therapy at which the beneficiary is present.
a. Individual
b. Collateral
c. Conjoint
d. Family therapy
e. Group therapy
Groups will be led by clinicians and
supervised by a licensed clinician. Larger
groups may be co-facilitated by two (2)
unlicensed clinicians. Licensed Clinical
Supervisors will provide in-vivo training, co-
facilitation and supervision to ensure group
facilitation is high quality, clinically effective,
and appropriate.
Exhibit B-3
Page 4 of 13
c. Crisis Intervention
A service lasting less than 24 hours, to or on behalf of a
beneficiary for a condition which requires more timely
response than a regularly scheduled visit. Activities may
include, but are not limited to: assessment, therapy and
service access to any significant support person in the
beneficiary’s life with the intent of improving or maintaining
the mental health status of the beneficiary.
d. Case Management
Any service that assists a beneficiary to access needed
medical, educational, social, prevocational, vocational,
rehabilitative, or other community service. Services may
include, but are not limited to, communication,
coordination, and referral to available resources.
CONTRACTOR will be responsible for monitoring service
delivery to beneficiary by third parties, beneficiary
progress and plan development.
e. Rehabilitation
Any activity that seeks to improve, maintain, or restore a
beneficiary’s functional, daily living, social, leisure,
grooming, personal hygiene, and meal preparation skills
while also providing access to support resources and
medication education.
f. Plan Development
The development of client plans, approval of client plans,
or monitoring of a beneficiary’s progress.
g. Medication Support
Any service that includes prescribing, administering,
dispensing and monitoring psychiatric medications or
biologicals which are necessary to alleviate the symptoms
of mental illness. Services may also include evaluation for
the need of medication, evaluation of clinical effectiveness
and side effects, obtaining informed consent, medication
education and plan development related to the delivery of
the service and/or assessment of the beneficiary.
2. CONTRACTOR shall be responsible to provide and appropriately bill for
Katie A. Subclass members if medically necessary and provided within
the California Partners for Permanency (CAPP) and Katie A. Core
Practice Model and in accordance with the “Medi-Cal Manual for
Intensive Care Coordination (ICC), Intensive Home Based Services
(IHBS) & Therapeutic Foster Care (TFC) for Medi-Cal Beneficiaries”:
a. Intensive Home Based Services (IHBS) may include, but are
not limited to:
1. Skill-based interventions for the remediation of behaviors
or improvement of symptoms
Exhibit B-3
Page 5 of 13
2. Development of functional skills to improve self-care, self-
regulation, or other functional impairments by intervening
to decrease or replace non-functional behavior that
interferes with daily living tasks or the avoidance of
exploitation by others
3. Development of skills or replacement behaviors that allow
the child/youth to fully participate in the teaming process
and service plans including but not limited to the plan
and/or child welfare case plan
4. Improvement in self-management of symptoms, including
self-administration of medications as appropriate
5. Education of the child/youth and/or their family or
caregiver(s) about, and how to manage the child/youth’s
mental health disorder or symptoms
6. Support of the development, maintenance and use of
social networks including the use and natural and
community resources
7. Support to address behaviors that interfere with the
achievement of a stable and permanent family life
8. Support to address behaviors that interfere with seeking
and maintaining a job
9. Support to address behaviors that interfere with a
child/youth’s success in achieving educational objectives
in an academic program in the community
b. If it is deemed that the client requires IHBS services but that
those services will be provided by a separate agency which is
concurrently providing services to that client, then the clinical
justification for that decision must be documented in the
client’s record. Clinical justification for this decision will be
reviewed and audited by the Department of Behavioral
Health’s Managed Care Division.
c. Intensive Care Coordination (ICC) that requires active and
ongoing participation in any teaming processes scheduled by
CWS or by the Child Welfare Mental Health Team to insure
coordination of all mental health treatment services that may
involve one or more provider agency(ies), no less than every
ninety (90) days for the child/youth.
d. ICC service components/activities include comprehensive
assessment and periodic reassessment, development and
periodic revision of the plan, referral, monitoring and follow-up
activities and transition.
3. CONTRACTOR will be responsible to provide services in either an
office-based or community-based setting. The location of service
delivery will be determined based on the needs of the client, preference
of the client, and clinical appropriateness. Based on the current data,
the expectation is that 70% of clients will prefer or require that their
services are provided in a community-based setting. Location of service
Exhibit B-3
Page 6 of 13
delivery should be clinically justified and documented in the client record.
Clinical justification will be reviewed and audited by the Department of
Behavioral Health’s Managed Care Division.
4. CONTRACTOR will be responsible to work cooperatively and
collaboratively with CWS staff, Child Welfare Mental Health Program
staff, and all treatment providers, caregivers, and Foster Family
Agencies to achieve the individual and collective treatment goals and
support the CWS case plan, communicate/resolve barriers to care,
provide continuity and warm hand-offs whenever possible when clients
transition from higher to lower or lower to higher levels of care whether
within or outside of Fresno County.
5. CONTRACTOR will provide its service delivery model for Katie A. Class
and Subclass members from which the revenue projections were
budgeted. This includes the frequency/duration of interventions during
a specified timeframe from which COUNTY will monitor utilization and
potential service capacity.
6. CONTRACTOR will be able to refer to other Fresno County Mental
Health Plan providers, Managed Care Medi-Cal Health Plans and other
community providers as may be appropriate and in concurrence with the
CWMH program.
7. CONTRACTOR will identify evidence-based and/or best practices found
effective in serving this target population. This includes the provision of
training, ongoing sustainability and fidelity to a core competency to
CONTRACTOR’s mental health clinicians. To date, CONTRACTOR
and COUNTY have agreed upon the provision of the following evidence-
based practices: Seeking Safety, Motivational Interviewing, Trauma-
Focused Cognitive Behavioral Therapy (TF-CBT), and Psychoanalysis
and Positive Psychology (PPP). This does not exclude other evidence-
based, best or promising practice or therapeutic approaches that
clinicians may have proficiency and meets the individualized treatment
needs of the client. Any additions or deletions of previous COUNTY
approved evidence-based practice by CONTRACTOR will require
consultation with COUNTY.
8. CONTRACTOR will ensure that the Clinical Supervisors will oversee the
work of the Clinicians, including approving documentation and claiming
in the electronic medical records. The Clinical Supervisor shall be two
(2) years post license and able to provide Board of Behavioral Sciences
(BBS) supervision.
9. If CONTRACTOR has other agreements with COUNTY to provide
mental health treatment services, it will establish criteria and protocols
to insure referral to services are therapeutically appropriate, benefits the
client and caregiver, achieves the client’s treatment goals and supports
Exhibit B-3
Page 7 of 13
the success of the CWS case plan and avoids any potential for
perceived or actual conflict of interest or self-referral.
B. Affordable Care Act and Medi-Cal Managed Care Plan Requirements
1. CONTRACTOR understands that effective January 1, 2014, Medi-Cal
managed care health plans (MCPs) are required to serve Medi-Cal
beneficiaries with mild to moderate impairment of mental, emotional, or
behavioral functioning resulting from a mental health condition defined
by the current Diagnostic and Statistical Manual. Outpatient benefits
available through MCPs include:
a. Individual and group mental health evaluation and treatment
(psychotherapy)
b. Psychological testing, when clinically indicated to evaluate a
mental health condition;
c. Outpatient services for the purposes of monitoring drug
therapy;
d. Psychiatric consultation; and,
e. Outpatient laboratory, drugs, supplies and supplements
(excluding medications as described in the forthcoming “Medi-
Cal Managed Care Plan Responsibilities for Outpatient
Mental Health, or any updates thereof”)
2. CONTRACTOR will comply with all requirements established by the
California Department of Health Care Services, including all new
forthcoming rules and regulations in relation to the Continuum of Care
Reform (CCR), Fresno County Mental Health Plan and Medi-Cal
managed care health plans (MCPs) for screening, referral, and
coordination of care when clinically appropriate.
C. Court-Specific Mental Health Services
1. CONTRACTOR will provide the following court-ordered mental health
services to children and families in CWS:
a. Mental Health Assessments
Clinical analysis of the history and current status of a
beneficiary’s mental, emotional, or behavioral disorder;
relevant cultural issues and history; diagnosis; and use of
testing procedures.
b. Psychological and Neuropsychological Evaluations
A structured, analytical interview with the client, minor,
parent, or guardian, which consists of a clinical
assessment, the use of testing instruments, a mental
status examination, and a clinical diagnosis (as
defined/ruled out using the ICD-10) that is performed only
by a Licensed Psychologist with at least five (5) years of
postgraduate experience. Service also includes a review
of CPS and mental health services received to date and
Exhibit B-3
Page 8 of 13
contact with relevant others as necessary/possible. A
second psychological or neuropsychological evaluation
may be ordered and must be performed by a different
Licensed Psychologist and independent of the first
evaluation.
c. Bonding Studies
A structured, forensic, analytic interview that includes a
mental health assessment (define or rule out clinical
diagnosis using the ICD-10) for both parent(s) or
whomever has been identified by the court to participate in
the study, and the child(ren). The study includes
assessment of the interaction between the parent(s) and
the child(ren) and may include the use of testing
instruments (as needed) to more accurately gauge the
strength of the bond between parent and child. It may also
include the current care provider(s) or prospective
adoptive parent(s) when ordered by the court. These
studies are to be performed only by a Licensed Mental
Health Clinician with appropriate experience or a
Waivered Psychologist working under a qualified Licensed
Psychologist. A qualified Clinician will have completed
twenty (20) hours of training in Child Custody as required
by the California Board of Psychology (if the child is 0-36
months), training in the Marshak Interaction Method, and
training or experience in providing forensic evaluations for
the court.
d. Family Psychodynamic Formulation
A structured, analytical interview conducted by a Licensed
Mental Health Clinician or Waivered Psychologist if under
the supervision of a Licensed Psychologist, which consists
of a clinical assessment (define or rule out clinical
diagnosis using the ICD-10) and family session(s) with all
relevant family members, to identify the roles inhabited by
the members and their interactive patterns. Also includes
a review of all available CPS and mental health interviews
with relevant professionals (CPS, school personnel,
therapists, etc.).
e. Attachment Assessments
A structured, analytical interview performed only by a
Licensed Mental Health Clinician with appropriate
experience that includes a clinical assessment of the
interaction between the parent/caregiver(s) and the child.
Infant Family Mental Health (IFMH) training is required if
any of the children are 0-36 months. Testing instruments
may be used as needed to more accurately gauge the
strength and quality of the attachment between parent and
child.
Exhibit B-3
Page 9 of 13
2. CONTRACTOR will be responsible for any court reports and/or
necessary testimony.
a. Court Reports
Documented report of assessment and evaluation
findings, progress in treatment, recommendations for
treatment and service plan regarding reunification,
maintenance and termination of parental rights, and
justification for recommendations.
b. Court Testimony
On-site court testimony of assessment and evaluation
findings, treatment and service plan recommendations
regarding reunification, maintenance and termination of
parental rights, and justification for recommendations.
D. Administrative Meetings
1. CONTRACTOR shall meet with COUNTY staff monthly, or as often as
needed, for monitoring of program services, client capacity, staffing
levels and to exchange pertinent operational information, resolve
problems, and coordinate services.
2. CONTRACTOR shall meet with COUNTY staff and other vendors for
child welfare mental health services quarterly, or as often as needed, for
discussion of program trends and resolution of concerns and problems
across all vendors.
3. CONTRACTOR shall attend bi-monthly Contracted Provider Meetings
held by DBH.
E. Data and Reporting
1. CONTRACTOR shall maintain and provide the COUNTY with statistics
on the number of individuals/families including but not limited to the
following:
a. Number of clients referred for mental health assessments;
average time between referral and the contact with
caregiver; average time between referral and the
assessment; number completed, number met within
required timeframe; number of missed/no show
appointments, number that did not meet Medi-Cal medical
necessity criteria
b. Number of clients referred for court-ordered services
including type of service, average time between referral to
contact with the caregiver to schedule the appointment,
average number of days between the referral and the
court-ordered service, number of missed/no show
appointments
Exhibit B-3
Page 10 of 13
c. Average wait time between assessment and first visit with
assigned therapist
d. Average wait time between referral and provision of
medication evaluation
e. Unique clients served; units and dollars of services billed,
average cost per client
f. Number and reasons for closed cases
g. Current number of active clients in ongoing treatment
h. Current number of inactive cases
i. Number of outpatient specialty mental health services
j. Duration of treatment time for active clients
This information will be provided to COUNTY on a monthly basis via an
activity report template developed by the COUNTY and due no later than
the 10th of each month.
2. CONTRACTOR shall maintain case files on each individual/family,
including, but not limited to the following information:
a. Documentation of referrals to/from COUNTY, self-referrals and
others;
b. Chronological record of individual and family services provided
including relevant contact dates, incidents, actions taken, and
results; and
c. Case closure summary, indicating the reasons for closure and
the results of the services provided.
3. CONTRACTOR shall maintain secure case files with limited access only
to designated staff to ensure confidentiality.
4. CONTRACTOR shall submit a monthly staffing report, due no later than
the 10th of each month, detailing the total number of positions by
discipline in the approved budget, number of staff hired (including
licensure), ethnicity, bilingual language capability, clinical
training/certification in evidence-based practice(s), and number of
vacancies.
II. COUNTY SHALL BE RESPONSIBLE FOR THE FOLLOWING:
A. Provide mental health service referrals to CONTRACTOR for children and
families in CWS.
B. Designate a contact person for CONTRACTOR to communicate with when
necessary.
C. Meet with CONTRACTOR monthly, or as often as needed, to exchange
pertinent information, resolve problems, and work together to coordinate
referrals and services.
Exhibit B-3
Page 11 of 13
D. Support coordination of Intensive Care Coordination meetings initially and
no less than every ninety (90) days for a child/youth identified as requiring
this service.
E. Convene teaming meetings in alignment with California Partners for
Permanency (CAPP), Senate Bill 163 Wraparound, and Katie A. Core
Practice models for which CONTRACTOR will be required to participate,
when appropriate.
F. Provide education and training on CWS, practice models and Medi-Cal
licensing, documentation and billing requirements, as needed.
III. PERFORMANCE MEASUREMENTS
Overall Service Objective:
CONTRACTOR will adhere to the outcome measures developed by COUNTY and any
requirements established by the California Department of Social Services and the
California Department of Health Services.
Services provided by the CONTRACTOR will align and support the principles of Fresno
County’s child welfare practice model, the Katie A Settlement Agreement, and the Senate
Bill 163 Wraparound family-based service program. Mental Health Services will be
integrated, timely, ongoing and uninterrupted in a family-focused, trauma-informed
delivery model that supports the goals of the client plan developed by COUNTY. Intensive
home-based mental health services are expected to provide children and families in the
CWS system with effective treatment, improve outcomes, promote wellness, aid in
resiliency, and maintain family relationships conducive to healthy emotional development.
Performance Outcomes and Measures:
Under the Katie A. Settlement Agreement and Implementation Plan, the California
Departments of Health Care Services (DHCS) and Social Services (CDSS) are working
to adopt statewide use of a data-informed system of performance oversight,
accountability, and communication that efficiently monitors, measures, and evaluates
access, quality, satisfaction, effectiveness, costs, and outcomes at the individual,
program, and system levels.
Performance measurements developed by COUNTY will reflect the information required
by DHCS and CDSS. The outcome measures and indicators provided below represent
program goals to be achieved by CONTRACTOR in addition to CONTRACTOR-
developed outcomes. COUNTY may adjust these outcome measurements, periodically,
so as to best measure the success of clients and program. These outcome
measurements and indicators will continue to be developed in conjunction with
CONTRACTOR, COUNTY, and the State Departments.
Exhibit B-3
Page 12 of 13
A. Timeliness of Service – CONTRACTOR will respond to referrals within the
required timeframes, in order to engage with the clients as soon as possible.
1. Timely access to services from referral to assessment. The timeframe
to contact the client and have the assessment scheduled, is as follows:
a. Crisis referrals: within three (3) days
b. Priority referrals: within fifteen (15) days
c. Standard referrals: within thirty (30) days.
2. 100% of all assessments will be signed/completed within thirty (30)
days.
3. Timely access to service from assessment to ongoing treatment.
4. Timely access to services from referral to medication evaluation, when
appropriate.
B. Access and Engagement – CONTRACTOR will ensure that clients have access
to treatment, that the client is actively involved in treatment, and that every
effort is made to aid the client in successfully completing treatment.
1. CONTRACTOR will provide services in a location determined by the
needs/preference of the client and clinical appropriateness. The
expectation is that 70% of clients will prefer/require services in a
community-based setting.
2. CONTRACTOR will track the number, type, and location of services per
client.
3. CONTRACTOR will actively provide ICC and IHBS services.
4. Clinician attendance at 100% of teaming meetings.
5. CONTRACTOR will track the “no show” rate for treatment. The
expectation is that this “no show” rate will not be more than 10%.
6. CONTRACTOR will track the number and reasons for discharge. The
expectation is that there will be a low number of discharges due to “no
shows” and a low number of discharges in which the client has not
successfully completed treatment.
7. 70% of clients that maintain an open child welfare case will successfully
complete treatment.
C. Wellness, Recovery, and Resiliency Supports – a collaborative approach to
treatment strategies to aid in the successful completion of treatment,
reunification, and reduction in recidivism
1. Improved Child Functioning
Improvement in relationships, behavior, and academic
achievements, as demonstrated through tracking tools
implemented by the CONTRACTOR.
2. Improved Family Functioning
Improvement in ability to provide for and maintain a safe
and stable environment for the child, as demonstrated
Exhibit B-3
Page 13 of 13
through tracking tools implemented by the
CONTRACTOR.
3. Improved Parent Functioning
Improvement in relationships, behavior, and sustaining
basic needs, as demonstrated through tracking tools
implemented by the CONTRACTOR.
4. Effectiveness of discharge planning as demonstrated by referral and
linkage to other COUNTY programs, community providers, and other
community resources.
5. Placement, Stability, & Permanency
a. Number of placement changes while in treatment
b. Permanency status of clients
Exhibit C-1
Page: 1 of 2
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinical Director 1.00 $125,000 $125,000
0002 Psychiatrist 0.60 $160,524 $160,524
0003 Clinicians (Licensed)6.00 $468,915 $468,915
0004 Psychologist 0.50 $30,000 $30,000
0005 Clinicians( Interns)15.00 $840,458 $840,458
0006 Case Management /Rehab 10.00 $464,373 $464,373
0007 Support Staff/Admin 10.00 $633,400 $633,400
SALARY TOTAL 43.10 $633,400 $2,089,270 $2,722,670
PAYROLL TAXES:
0030 OASDI $158,853
0031 FICA/MEDICARE $37,151
0032 U.I./FUTA $18,576
PAYROLL TAX TOTAL $0 $0 $214,580
EMPLOYEE BENEFITS:
0040 Retirement/Incentive $169,837
1170 Workers Compensation $25,000
0041 $212,838
EMPLOYEE BENEFITS TOTAL $0 $0 $407,675
SALARY & BENEFITS GRAND TOTAL $3,344,925
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $266,075
1030 Rent/Lease Equipment $1,000
1050 Utilities $32,000
1052 Janitorial $30,000
1051 Maintenance (facility)$20,000
FACILITY/EQUIPMENT TOTAL $349,075
OPERATING EXPENSES:
1060 $32,000
1062 $1,500
1070 $7,500
1071 $0
1072 $13,000
1080 Office Supplies & Equipment $18,000
1090 $11,000
1100 Food $8,500
1120 Program Supplies $15,000
1121 Program Supplies - Psych Testing $3,000
1130 $500
1140 $65,000
1141 $15,000
1075 $0
1076 Licenses/Taxes $5,000
OPERATING EXPENSES TOTAL $195,000
FINANCIAL SERVICES EXPENSES:
Line Item Description (Must be itemized)
Child Welfare Mental Health Services
California Psychological Institute
July 1, 2017 to June 30, 2018
Budget Categories - Total Proposed Budget
Staff Training/Registration
Health Insurance (medical vision, life, dental)
Telephone/Internet
Postage
Printing/Reproduction
Publications
Legal Notices/Advertising
Household Supplies
Transportation of Clients
Staff Mileage/Vehicle Maintenance
Lodging
Exhibit C-1
Page: 2 of 2
Child Welfare Mental Health Services
California Psychological Institute
July 1, 2017 to June 30, 2018
1160 Accounting/Bookkeeping $5,000
1171 Liability Insurance $29,000
1072 Payroll Processing $12,000
FINANCIAL SERVICES TOTAL $46,000
SPECIAL EXPENSES (Consultant/Etc.):
1153 Consultant (network & data management)$15,000
1180 Translation Services $5,000
1085 Electronic Health Record $25,000
SPECIAL EXPENSES TOTAL $45,000
FIXED ASSETS:
2001 Computers & Software $10,000
2002 Furniture & Fixtures $10,000
FIXED ASSETS TOTAL $20,000
TOTAL PROGRAM EXPENSES $4,000,000
DIRECT SERVICE REVENUE:
Vol/Units of
Svc Rate $ Amt.
3000 Mental Health Services 1,201,297 $2.84 $3,411,683
(Assessment, Plan of Care, Individual/Family/Group Therapy, Rehab)
3100 Case Management, Linkage/Brokerage 107,682 $2.21 $237,977
3200 Crisis Intervention 440 $4.15 $1,826
3300 Medication Support 22,905 $5.25 $120,251
3400 Collateral 13,017 $2.84 $36,968
3700 ICC 31,389 $2.21 $69,370
3800 IHBS 21,494 $2.84 $61,043
DIRECT SERVICE REVENUE TOTAL 1,398,224 $3,939,119
$1,969,559
$1,575,648
$393,912
$3,939,119
Cost Per Unit $2.82
Social Services Revenue $60,881
OTHER REVENUE:
3600 Psychological evaluation 3,848 2.84$ $10,928
3500 Court Documentation, Report, Appearance 660 64.30$ $42,438
4000 Bonding Studies 2,646 2.84$ $7,515
OTHER REVENUE/SOCIAL SERVICES TOTAL $60,881
Medi-cal Revenue - 50% FFP
Medi-cal Revenue - 40% EPSDT
Medi-cal Revenue - 10% CGF
Medi-cal Revenue
Exhibit C-1
Page: 1 of 2
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Clinical Director 1.00 $125,000 $125,000
0002 Psychiatrist 0.60 $160,524 $160,524
0003 Clinicians (Licensed)6.00 $468,915 $468,915
0004 Psychologist 0.50 $30,000 $30,000
0005 Clinicians( Interns)15.00 $840,458 $840,458
0006 Case Management /Rehab 10.00 $464,373 $464,373
0007 Support Staff/Admin 10.00 $633,400 $633,400
SALARY TOTAL 43.10 $633,400 $2,089,270 $2,722,670
PAYROLL TAXES:
0030 OASDI $158,853
0031 FICA/MEDICARE $37,151
0032 U.I./FUTA $18,576
PAYROLL TAX TOTAL $0 $0 $214,580
EMPLOYEE BENEFITS:
0040 Retirement/Incentive $169,837
1170 Workers Compensation $25,000
0041 $212,838
EMPLOYEE BENEFITS TOTAL $0 $0 $407,675
SALARY & BENEFITS GRAND TOTAL $3,344,925
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $266,075
1030 Rent/Lease Equipment $1,000
1050 Utilities $32,000
1052 Janitorial $30,000
1051 Maintenance (facility)$20,000
FACILITY/EQUIPMENT TOTAL $349,075
OPERATING EXPENSES:
1060 $32,000
1062 $1,500
1070 $7,500
1071 $0
1072 $13,000
1080 Office Supplies & Equipment $18,000
1090 $11,000
1100 Food $8,500
1120 Program Supplies $15,000
1121 Program Supplies - Psych Testing $3,000
1130 $500
1140 $65,000
1141 $15,000
1075 $0
1076 Licenses/Taxes $5,000
OPERATING EXPENSES TOTAL $195,000
FINANCIAL SERVICES EXPENSES:
Line Item Description (Must be itemized)
Child Welfare Mental Health Services
California Psychological Institute
July 1, 2018 to June 30, 2019
Budget Categories - Total Proposed Budget
Staff Training/Registration
Health Insurance (medical vision, life, dental)
Telephone/Internet
Postage
Printing/Reproduction
Publications
Legal Notices/Advertising
Household Supplies
Transportation of Clients
Staff Mileage/Vehicle Maintenance
Lodging
Exhibit C-1
Page: 2 of 2
Child Welfare Mental Health Services
California Psychological Institute
July 1, 2018 to June 30, 2019
1160 Accounting/Bookkeeping $5,000
1171 Liability Insurance $29,000
1072 Payroll Processing $12,000
FINANCIAL SERVICES TOTAL $46,000
SPECIAL EXPENSES (Consultant/Etc.):
1153 Consultant (network & data management)$15,000
1180 Translation Services $5,000
1085 Electronic Health Record $25,000
SPECIAL EXPENSES TOTAL $45,000
FIXED ASSETS:
2001 Computers & Software $10,000
2002 Furniture & Fixtures $10,000
FIXED ASSETS TOTAL $20,000
TOTAL PROGRAM EXPENSES $4,000,000
DIRECT SERVICE REVENUE:
Vol/Units of
Svc Rate $ Amt.
3000 Mental Health Services 1,201,297 $2.84 $3,411,683
(Assessment, Plan of Care, Individual/Family/Group Therapy, Rehab)
3100 Case Management, Linkage/Brokerage 107,682 $2.21 $237,977
3200 Crisis Intervention 440 $4.15 $1,826
3300 Medication Support 22,905 $5.25 $120,251
3400 Collateral 13,017 $2.84 $36,968
3700 ICC 31,389 $2.21 $69,370
3800 IHBS 21,494 $2.84 $61,043
DIRECT SERVICE REVENUE TOTAL 1,398,224 $3,939,119
$1,969,559
$1,575,648
$393,912
$3,939,119
Cost Per Unit $2.82
Social Services Revenue $60,881
OTHER REVENUE:
3600 Psychological evaluation 3,848 2.84$ $10,928
3500 Court Documentation, Report, Appearance 660 64.30$ $42,438
4000 Bonding Studies 2,646 2.84$ $7,515
4100 Non Medi-Cal contribution $0
OTHER REVENUE/SOCIAL SERVICES TOTAL $60,881
Medi-cal Revenue - 50% FFP
Medi-cal Revenue - 40% EPSDT
Medi-cal Revenue - 10% CGF
Medi-cal Revenue
Exhibit C-2
Page:1 of 2
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Administrator 0.40 $52,582 $0 $52,582
0002 Supervisor 4.00 $0 $343,305 $343,305
0003 Psychologist 0.20 $0 $25,502 $25,502
0004 Mental Health Specialist II 24.00 $0 $1,234,066 $1,234,066
0005 Psychiatrist 0.20 $0 $119,170 $119,170
0006 Training Coordinator 1.00 $59,051 $0 $59,051
0007 Training Assistant 0.50 $15,735 $0 $15,735
0008 Human Resources Coordinator 0.50 $25,813 $0 $25,813
0009 Quality Assurance Coordinator 1.50 $94,068 $0 $94,068
0010 Case Manager 4.00 $0 $144,775 $144,775
0011 Community Services Clerk 3.50 $116,265 $0 $116,265
0012 Starlight Allocated Wages (benefits below)1.00 $70,049 $0 $70,049
SALARY TOTAL 40.80 $433,563 $1,866,818 $2,300,382
PAYROLL TAXES:
0030 FICA/MEDICARE $33,168 $142,812 $175,979
0031 SUI $3,080 $12,320 $15,400
0032 FUTA $4,480 $17,920 $22,400
PAYROLL TAX TOTAL $40,728 $173,052 $213,779
EMPLOYEE BENEFITS:
0040 Retirement $9,538 $41,070 $50,608
0041 Workers Compensation $13,007 $56,005 $69,011
0042 $58,748 $252,020 $310,768
EMPLOYEE BENEFITS TOTAL $81,293 $349,095 $430,390
SALARY & BENEFITS GRAND TOTAL $2,944,552
FACILITIES/EQUIPMENT EXPENSES:
1010 Facility Rent $84,596
1011 Leased Equipment $18,299
1012 Utilities $25,002
1013 Maintenance (facility)$28,049
FACILITY/EQUIPMENT TOTAL $155,946
OPERATING EXPENSES:
1060 $30,106
1061 $37,232
1062 $6,238
1063 $16,300
1064 $58,839
1065 Centralized Program Services $130,802
1066 $8,060
OPERATING EXPENSES TOTAL $287,577
FINANCIAL SERVICES EXPENSES:
1080 Centralized Services $269,874
1081 Centralized fiscal service .05 $200,000
1082 Insurance $19,547
FINANCIAL SERVICES TOTAL $489,421
Staff Mileage
Child Welfare Mental Health Services
Central Star Behavioral Health
July 1, 2017 to June 30, 2018
Budget Categories - Total Proposed Budget
Line Item Description (Must be itemized)
Health Insurance (medical, vision, life, dental)
Telephone
Education and Training
Licenses
Office Supplies
Food Snacks
Exhibit C-2
Page:2 of 2
Child Welfare Mental Health Services
Central Star Behavioral Health
July 1, 2017 to June 30, 2018
SPECIAL EXPENSES (Consultant/Etc.):
1087 Professional Fees $17,313
1088 Purchased Services $73,721
1089 Recruitment $5,033
1090
SPECIAL EXPENSES TOTAL $96,067
FIXED ASSETS:
2000 IT Minor Equipment $18,940
2001 Furniture $7,500
FIXED ASSETS TOTAL $26,440
TOTAL PROGRAM EXPENSES $4,000,000
DIRECT SERVICE REVENUE:
Vol/Units of
Svc Rate $ Amt.
3000 Mental Health Services 746,297 $2.81 $2,097,097
(Assessment, Plan of Care, Individual/Family/Group Therapy, Rehab)
3100 Case Management, Linkage/Brokerage 113,472 $2.17 $246,234
3200 Crisis Intervention 0 $4.17 $0
3300 Medication Support 39,744 $5.18 $205,874
3400 Collateral 296,069 $2.81 $831,955
3500 ICC 92,196 $2.17 $200,065
3600 IHBS 84,151 $2.81 $236,464
DIRECT SERVICE REVENUE TOTAL 1,371,929 $3,817,688
$1,908,844
$1,527,075
$381,769
$3,817,688
Cost Per Unit $2.78
Social Services Revenue $182,312
OTHER REVENUE:
3700 Psychological Evaluations 12,400 $2.81 $34,844
3800 Bonding Studies 6,400 $2.81 $17,984
3900 Court Documentation, Reports 23,040 $2.81 $64,742
4000 Court Appearance 23,040 $2.81 $64,742
OTHER REVENUE/SOCIAL SERVICES TOTAL $182,312
TOTAL PROGRAM REVENUE $4,000,000
Medi-cal Revenue
Medi-cal Revenue - 50% FFP
Medi-cal Revenue - 10% CGF
Medi-cal Revenue - 40% EPSDT
Exhibit C-2
Page:1 of 2
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 Administrator 0.40 $52,582 $0 $52,582
0002 Supervisor 4.00 $0 $343,305 $343,305
0003 Psychologist 0.20 $0 $25,502 $25,502
0004 Mental Health Specialist II 24.00 $0 $1,234,066 $1,234,066
0005 Psychiatrist 0.20 $0 $119,170 $119,170
0006 Training Coordinator 1.00 $59,051 $0 $59,051
0007 Training Assistant 0.50 $15,735 $0 $15,735
0008 Human Resources Coordinator 0.50 $25,813 $0 $25,813
0009 Quality Assurance Coordinator 1.50 $94,068 $0 $94,068
0010 Case Manager 4.00 $0 $144,775 $144,775
0011 Community Services Clerk 3.50 $116,265 $0 $116,265
0014 Starlight Allocated Wages (benefits below)1.00 $70,049 $0 $70,049
SALARY TOTAL 40.80 $433,563 $1,866,818 $2,300,382
PAYROLL TAXES:
0030 FICA/MEDICARE $33,168 $142,812 $175,979
0031 SUI $3,080 $12,320 $15,400
0032 FUTA $4,480 $17,920 $22,400
PAYROLL TAX TOTAL $40,728 $173,052 $213,779
EMPLOYEE BENEFITS:
0040 Retirement $9,538 $41,070 $50,608
0041 Workers Compensation $13,007 $56,005 $69,011
0042 $58,748 $252,020 $310,768
EMPLOYEE BENEFITS TOTAL $81,293 $349,095 $430,390
SALARY & BENEFITS GRAND TOTAL $2,944,552
FACILITIES/EQUIPMENT EXPENSES:
1010 Facility Rent $84,596
1011 Leased Equipment $18,299
1012 Utilities $25,002
1013 Maintenance (facility)$28,049
FACILITY/EQUIPMENT TOTAL $155,946
OPERATING EXPENSES:
1060 $30,106
1061 $37,232
1062 $6,238
1063 $16,300
1064 $58,839
1065 Centralized Program Services $130,802
1066 $8,060
OPERATING EXPENSES TOTAL $287,577
FINANCIAL SERVICES EXPENSES:
1080 Centralized Services $269,874
1081 Centralized fiscal service .05 $200,000
1082 Insurance $19,547
FINANCIAL SERVICES TOTAL $489,421
Food Snacks
Staff Mileage
Child Welfare Mental Health Services
Central Star Behavioral Health
July 1, 2018 to June 30, 2019
Budget Categories - Total Proposed Budget
Line Item Description (Must be itemized)
Health Insurance (medical, vision, life, dental)
Telephone
Education and Training
Licenses
Office Supplies
Exhibit C-2
Page:2 of 2
Child Welfare Mental Health Services
Central Star Behavioral Health
July 1, 2018 to June 30, 2019
SPECIAL EXPENSES (Consultant/Etc.):
1087 Professional Fees $17,313
1088 Purchased Services $73,719
1089 Recruitment $5,033
1090
SPECIAL EXPENSES TOTAL $96,065
FIXED ASSETS:
2000 IT Minor Equipment $18,940
2001 Furniture $7,500
FIXED ASSETS TOTAL $26,440
TOTAL PROGRAM EXPENSES $4,000,000
DIRECT SERVICE REVENUE:
Vol/Units of
Svc Rate $ Amt.
3000 Mental Health Services 746,297 $2.81 $2,097,097
(Assessment, Plan of Care, Individual/Family/Group Therapy, Rehab)
3100 Case Management, Linkage/Brokerage 113,472 $2.17 $246,234
3200 Crisis Intervention 0 $4.17 $0
3300 Medication Support 39,744 $5.18 $205,874
3400 Collateral 296,069 $2.81 $831,955
3500 ICC 92,196 $2.17 $200,065
3600 IHBS 84,151 $2.81 $236,464
DIRECT SERVICE REVENUE TOTAL 1,371,929 $3,817,688
$1,908,844
$1,527,075
$381,769
$3,817,688
Cost Per Unit $2.78
Social Services Revenue $182,312
OTHER REVENUE:
3700 Psychological Evaluations 12,400 $2.81 $34,844
3800 Bonding Studies 6,400 $2.81 $17,984
3900 Court Documentation, Reports 23,040 $2.81 $64,742
4000 Court Appearance 23,040 $2.81 $64,742
OTHER REVENUE/SOCIAL SERVICES TOTAL $182,312
TOTAL PROGRAM REVENUE $4,000,000
Medi-cal Revenue
Medi-cal Revenue - 50% FFP
Medi-cal Revenue - 10% CGF
Medi-cal Revenue - 40% EPSDT
Exhibit C-3
Page:1 of 3
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 19.00 $995,776 $995,776
0002 4.00 $221,006 $221,006
0003 Family Specialist 3.00 $105,682 $105,682
0004 1.00 $83,985 $83,985
0005 4.00 $285,169 $285,169
0006 1.00 $76,268 $76,268
0007 1.00 $44,410 $44,410
0008 4.94 $259,372 $259,372
SALARY TOTAL 37.94 $259,372 $1,812,296 $2,071,668
PAYROLL TAXES:
0030 OASDI $16,004 $111,853 $127,857
0031 FICA/MEDICARE $3,743 $26,159 $29,902
0032 U.I.$2,581 $18,036 $20,617
PAYROLL TAX TOTAL $22,328 $156,048 $178,376
EMPLOYEE BENEFITS:
0040 Retirement $10,328 $72,156 $82,484
0041 Workers Compensation $3,872 $27,060 $30,932
0042 $64,533 $451,008 $515,541
EMPLOYEE BENEFITS TOTAL $78,733 $550,224 $628,957
SALARY & BENEFITS GRAND TOTAL $2,879,001
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $114,386
1011 Rent/Lease Equipment $31,829
1012 Utilities $0
1013 Janitorial $0
1014 Maintenance (facility)$9,216
1015 Security $0
1016 Maintenance (durable medical equipment) $0
1017 Depreciation $6,554
FACILITY/EQUIPMENT TOTAL $161,985
OPERATING EXPENSES:
1060 $56,633
1061 $0
1062 $2,452
1063 $0
1064 $450
1065 $0
1066 $10,458
1067 $0
1068 $0
1069 $53,576
1070 $0
1071 $0
1072 $72,381
1073 Staff Travel (Out of County)$0
Transportation of Clients
Staff Mileage/Vehicle Maintenance
Program Supplies - Medical
Health Insurance (medical vision, life, dental)
Telephone
Answering Service
Postage
Printing/Reproduction
Publications
Legal Notices/Advertising
Office Supplies & Equipment
Household Supplies
Food
Program Supplies - Therapeutic
Program Shared Staff
Clinician I
Clinician II
Associate Director
Clinical Program Manager
Clinical Coordinator
Client Service Coordinator
Line Item Description (Must be itemized)
Child Welfare Mental Health Services
Uplift Family Services
July 1, 2017 to June 30, 2018
Budget Categories - Total Proposed Budget
Exhibit C-3
Page:2 of 3
Child Welfare Mental Health Services
Uplift Family Services
July 1, 2017 to June 30, 2018
1074 $44,350
1075 Lodging $0
OPERATING EXPENSES TOTAL $240,300
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $3,015
1082 Liability Insurance $19,779
1083 Other - Administrative Overhead $600,000
FINANCIAL SERVICES TOTAL $622,794
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant (network & data management)$43,600
1088 Translation Services $0
1089 Medication Supports $52,320
1090 Food Service $0
1091 Laundry Service $0
1092 Medical Waste Disposal $0
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultant $0
1096 Medical Services $0
1097 On Call Staff $0
SPECIAL EXPENSES TOTAL $95,920
FIXED ASSETS:
2000 Computers & Software $0
2001 Furniture & Fixtures $0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $4,000,000
DIRECT SERVICE REVENUE:
Vol/Units of
Svc Rate $ Amt.
3000 Mental Health Services 1,030,790 $2.61 $2,690,362
(Assessment, Plan of Care, Individual/Family/Group Therapy, Rehab)
3100 Case Management, Linkage/Brokerage 169,445 $2.02 $342,279
3200 Crisis Intervention 0 $3.88 $0
3300 Medication Support 14,120 $4.82 $68,058
Staff Training/Registration
Exhibit C-3
Page:3 of 3
Child Welfare Mental Health Services
Uplift Family Services
July 1, 2017 to June 30, 2018
3400 Collateral 84,722 $2.61 $221,124
3500 ICC 28,242 $2.02 $57,049
3600 IHBS 84,723 $2.61 $221,127
DIRECT SERVICE REVENUE TOTAL 1,412,042 $3,600,000
$1,800,000
$1,440,000
$360,000
$3,600,000
Cost Per Unit $2.55
Social Services Revenue $400,000
OTHER REVENUE:
4000 Court Documentation, Report, Appearance 673 59.41$ $40,000
4100 Psychological Evaluations 14,400 2.89$ $41,616
4200 Child Welfare System $318,384
OTHER REVENUE/SOCIAL SERVICES TOTAL $400,000
TOTAL PROGRAM REVENUE $4,000,000
Medi-cal Revenue
Medi-cal Revenue - 50% FFP
Medi-cal Revenue - 40% EPSDT
Medi-cal Revenue - 10% CGF
Exhibit C-3
Page:1 of 3
FTE %Admin.Direct Total
PERSONNEL SALARIES:
0001 19.00 $1,025,513 $1,025,513
0002 4.00 $227,606 $227,606
0003 Family Specialist 3.00 $108,838 $108,838
0004 1.00 $86,493 $86,493
0005 4.00 $293,685 $293,685
0006 1.00 $78,546 $78,546
0007 1.00 $45,736 $45,736
0008 4.94 $266,337 $266,337
SALARY TOTAL 37.94 $266,337 $1,866,417 $2,132,754
PAYROLL TAXES:
0030 OASDI $16,436 $115,208 $131,644
0031 FICA/MEDICARE $3,844 $26,944 $30,788
0032 U.I.$2,651 $18,576 $21,227
PAYROLL TAX TOTAL $22,931 $160,728 $183,659
EMPLOYEE BENEFITS:
0040 Retirement $10,602 $74,328 $84,930
0041 Workers Compensation $3,979 $27,876 $31,855
0042 $66,275 $483,120 $549,395
EMPLOYEE BENEFITS TOTAL $80,856 $585,324 $666,180
SALARY & BENEFITS GRAND TOTAL $2,982,593
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $114,268
1011 Rent/Lease Equipment $15,348
1012 Utilities $0
1013 Janitorial $0
1014 Maintenance (facility)$2,006
1015 Security $0
1016 Maintenance (durable medical equipment) $0
1017 Depreciation $6,547
FACILITY/EQUIPMENT TOTAL $138,169
OPERATING EXPENSES:
1060 $56,625
1061 $0
1062 $2,450
1063 $0
1064 $449
1065 $0
1066 $10,243
1067 $0
1068 $0
1069 $12,879
1070 $0
1071 $0
1072 $72,375
1073 Staff Travel (Out of County)$0
Client Service Coordinator
Child Welfare Mental Health Services
Uplift Family Services
July 1, 2018 to June 30, 2019
Budget Categories - Total Proposed Budget
Line Item Description (Must be itemized)
Clinician I
Clinician II
Associate Director
Clinical Program Manager
Clinical Coordinator
Program Supplies - Therapeutic
Program Shared Staff
Health Insurance (medical vision, life, dental)
Telephone
Answering Service
Postage
Printing/Reproduction
Publications
Legal Notices/Advertising
Office Supplies & Equipment
Household Supplies
Food
Program Supplies - Medical
Transportation of Clients
Staff Mileage/Vehicle Maintenance
Exhibit C-3
Page:2 of 3
Child Welfare Mental Health Services
Uplift Family Services
July 1, 2018 to June 30, 2019
1074 $22,506
1075 Lodging $0
OPERATING EXPENSES TOTAL $177,527
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $3,015
1082 Liability Insurance $19,776
1083 Other - Administrative Overhead $600,000
FINANCIAL SERVICES TOTAL $622,791
SPECIAL EXPENSES (Consultant/Etc.):
1087 Consultant (network & data management)$26,600
1088 Translation Services $0
1089 Medication Supports $52,320
1090 Food Service $0
1091 Laundry Service $0
1092 Medical Waste Disposal $0
1093 Nutritionist Services $0
1094 X-ray and EKG Services $0
1095 Pharmaceutical Consultant $0
1096 Medical Services $0
1097 On Call Staff $0
SPECIAL EXPENSES TOTAL $78,920
FIXED ASSETS:
2000 Computers & Software $0
2001 Furniture & Fixtures $0
FIXED ASSETS TOTAL $0
TOTAL PROGRAM EXPENSES $4,000,000
DIRECT SERVICE REVENUE:
Vol/Units of
Svc Rate $ Amt.
3000 Mental Health Services 1,030,790 $2.61 $2,690,362
(Assessment, Plan of Care, Individual/Family/Group Therapy, Rehab)
3100 Case Management, Linkage/Brokerage 169,445 $2.02 $342,279
3200 Crisis Intervention 0 $3.88 $0
3300 Medication Support 14,120 $4.82 $68,058
Staff Training/Registration
Exhibit C-3
Page:3 of 3
Child Welfare Mental Health Services
Uplift Family Services
July 1, 2018 to June 30, 2019
3400 Collateral 84,722 $2.61 $221,124
3500 ICC 28,242 $2.02 $57,049
3600 IHBS 84,723 $2.61 $221,127
DIRECT SERVICE REVENUE TOTAL 1,412,042 $3,600,000
$1,800,000
$1,440,000
$360,000
$3,600,000
Cost Per Unit $2.55
Social Services Revenue $400,000
OTHER REVENUE:
4000 Court Documentation, Report, Appearance 673 59.41$ $40,000
4100 Psychological Evaluations 14,400 2.89$ $41,616
4200 Child Welfare System $318,384
OTHER REVENUE/SOCIAL SERVICES TOTAL $400,000
TOTAL PROGRAM REVENUE $4,000,000
Medi-cal Revenue - 10% CGF
Medi-cal Revenue
Medi-cal Revenue - 50% FFP
Medi-cal Revenue - 40% EPSDT
Exhibit D
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health services.
Mental health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its employees
and subcontractors to attend a compliance training that will be provided by Fresno County. After
completion of this training, each contractor, contractor’s employee and subcontractor must sign the
Contractor Acknowledgment and Agreement form and return this form to the Compliance officer or
designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and billing
for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their
professional dealing related to their contract with the County and avoid any conduct that could
reasonably be expected to reflect adversely upon the integrity of the County.
3. Treat County employees, consumers, and other mental health contractors fairly and with
respect.
4. 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
5. Take precautions to ensure that claims are prepared and submitted accurately, timely and are
consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement
of any kind are submitted.
7. Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
Exhibit D
Page 2 of 3
8. Act promptly to investigate and correct problems if errors in claims or billing are discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of Conduct
and Ethics by County employees or other mental health contractors, or report any activity that
they believe may violate the standards of the Compliance Program, or any other applicable
law, regulation, rule or guideline. 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. Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible person
and therefore excluded from participation in the Federal Health Care Programs.
Exhibit D
Page 3 of 3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print): _____________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Signature :________________________________ Date : ___/____/___
For Group or Organizational Providers
Group/Org. Name (print): _______________________________________
Employee Name (print): ________________________________________
Discipline: Psychiatrist Psychologist LCSW LMFT
Other:___________________________________________
Job Title (if different from Discipline): ___________________________
Signature: _________________________________ Date: ____/___/____
Exhibit E
Page 1 of 3
Documentation Standards for Client Records
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the record
have a specific document or section addressing these topics.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client record.
• Relevant physical health conditions reported by the client will be prominently identified
and updated as appropriate.
• Presenting problems and relevant conditions affecting the client’s physical health and
mental health status will be documented, for example: living situation, daily activities,
and social support.
• Documentation will describe client’s strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently
documented and updated as appropriate.
• Documentations will include medications that have been described by mental health plan
physicians, dosage of each medication, dates of initial prescriptions and refills, and
documentations of informed consent for medications.
• Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
• A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data, relevant
family information and relevant results of relevant lab tests and consultations reports.
• For children and adolescents, pre-natal and perinatal events and complete developmental
history will be documented.
• Documentations will include past and present use of tobacco, alcohol, and caffeine, as
well as illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A DSM-5 diagnosis, or a diagnosis from the most current ICD, will be documented,
consistent with the presenting problems, history mental status evaluation and/or other
assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document changes in
the client’s condition.
• Client conditions will be assessed at least annually and, in most cases, at more frequent
intervals.
Exhibit E
Page 2 of 3
B. Client Plans
1. Client plans will:
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent) by:
the person providing the service(s), or
a person representing a team or program providing services, or
a person representing the MHP providing services
when the client plan 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,
a physician
a licensed/ “waivered” psychologist
a licensed/ “associate” social worker
a licensed/ registered/marriage and family therapist or
a registered nurse
• In addition,
client plans will be consistent with the diagnosis, and the focus of intervention will be
consistent with the client plan goals, and there will be documentation of the client’s
participation in and agreement with the plan. Examples of the documentation include,
but are not limited to, reference to the client’s participation and agreement in the body
of the plan, client signature on the plan, or a description of the client’s participation
and agreement in progress notes.
client signature on the plan will be used as the means by which the
CONTRACTOR(S) documents the participation of the client
when the client’s signature is required on the client plan and the client refuses or is
unavailable for signature, the client plan will include a written explanation of the
refusal or unavailability.
• The CONTRACTOR(S) will give a copy of the client plan to the client on request.
2. Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for the
individual elements of the client plan described in item 1.
C. Progress Notes
1. Items that must be contained in the client record related to the client’s progress in treatment
include:
• The client record will provide timely documentation of relevant aspects of client care
• Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
Exhibit E
Page 3 of 3
• All entries in the client record will include the signature of the person providing the
service (or electronic equivalent); the person’s professional degree, licensure or job title;
and the relevant identification number, if applicable
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge summary
2. Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated below:
A. Every Service Contact
• Mental Health Services
• Medication Support Services
• Crisis Intervention
Exhibit F
Page 1 of 2
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business and
Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with
all State of California and Federal statutes and regulations regarding
confidentiality, including but not limited to confidentiality of information
requirements at 42, Code of Federal Regulations sections 2.1 et seq; California
Welfare and Institutions Code, sections 14100.2, 11977, 11812, 5328; Division
10.5 and 10.6 of the California Health and Safety Code; Title 22, California Code
of Regulations, section 51009; and Division 1, Part 2.6, Chapters 1-7 of the
California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer,
Exhibit F
Page 2 of 2
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.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights
Exhibit G
Page 1 of 2
Medi-Cal Organizational Provider Standards
1. The organizational provider possesses the necessary license to operate, if applicable, and any
required certification.
2. The space owned, leased or operated by the provider and used for services or staff meets
local fire codes.
3. The physical plant of any site owned, leased, or operated by the provider and used for
services or staff is clean, sanitary and in good repair.
4. The organizational provider establishes and implements maintenance policies for any site
owned, leased, or operated by the provider and used for services or staff to ensure the safety
and well being of beneficiaries and staff.
5. The organizational provider has a current administrative manual which includes: personnel
policies and procedures, general operating procedures, service delivery policies, and
procedures for reporting unusual occurrences relating to health and safety issues.
6. The organizational provider maintains client records in a manner that meets applicable state
and federal standards.
7. The organization provider has staffing adequate to allow the County to claim federal
financial participation for the services the Provider delivers to beneficiaries, as described in
Division 1, Chapter 11, Subchapter 4 of Title 9, CCR, when applicable.
8. The organizational provider has written procedures for referring individuals to a psychiatrist
when necessary, or to a physician, if a psychiatrist is not available.
9. The organizational provider has as head of service a licensed mental health professional of
other appropriate individual as described in Title 9, CCR, Sections 622 through 630.
10. For organizational providers that provide or store medications, the provider stores and
dispenses medications in compliance with all pertinent state and federal standards. In
particular:
A. All drugs obtained by prescription are labeled in compliance with federal and state laws.
Prescription labels are altered only by persons legally authorized to do so.
B. Drugs intended for external use only or food stuffs are stored separately from drugs for
internal use.
C. All drugs are stored at proper temperatures, room temperature drugs at 59-86 degrees F
and refrigerated drugs at 36-46 degrees F.
Exhibit G
Page 2 of 2
D. Drugs are stored in a locked area with access limited to those medical personnel
authorized to prescribe, dispense or administer medication.
E. Drugs are not retained after the expiration date. IM multi-dose vials are dated and
initialed when opened.
F. A drug log is maintained to ensure the provider disposes of expired, contaminated,
deteriorated and abandoned drugs in a manner consistent with state and federal laws.
G. Policies and procedures are in place for dispensing, administering and storing
medications.
11. For organizational providers that provide day treatment intensive or day rehabilitation,
the provider must have a written description of the day treatment intensive and/or day
treatment rehabilitation program that complies with State Department of Health Care
Service’s day treatment requirements. The COUNTY shall review the provider’s written
program description for compliance with the State Department of Health Care Service’s
day treatment requirements.
12. The COUNTY may accept the host county’s site certification and reserves the right to
conduct an on-site certification review at least every three years. The COUNTY may also
conduct additional certification reviews when:
• The provider makes major staffing changes.
• The provider makes organizational and/or corporate structure changes (example:
conversion from a non-profit status).
• The provider adds day treatment or medication support services when medications
shall be administered or dispensed from the provider site.
• There are significant changes in the physical plant of the provider site (some physical
plant changes could require a new fire clearance).
• There is change of ownership or location.
• There are complaints against the provider.
• There are unusual events, accidents, or injuries requiring medical treatment for
clients, staff or members of the community.
Exhibit H
Page 1 of 2
Fresno County Mental Health Plan
Grievances and Appeals Process
Grievances
The Fresno County Mental Health Plan (MHP) 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 MHP and its fee-for-
service providers to 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 MHP 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
their clients 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 Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Exhibit H
Page 2 of 2
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process – the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process – the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for MHP
payment authorization, or the process or payment of a provider’s claim to the MHP.
Payment authorization issues – the provider may appeal a denied or modified request
for payment authorization or a dispute with the MHP regarding the processing or
payment of a provider’s claim to the MHP. The written appeal must be submitted to the
MHP within ninety (90) calendar days of the date of the receipt of the non-approval of
payment.
The MHP 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
MHP utilizes Managed Care staff who were not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within thirty (30) calendar days of receipt of the
decision
Other complaints – if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the MHP. The provider will receive a written response from the MHP within sixty (60)
calendar days of receipt of the complaint. The decision rendered buy the MHP is final.
Exhibit I
Page 1 of 2
FFRREESSNNOO CCOOUUNNTTYY MMEENNTTAALL HHEEAALLTTHH PPLLAANN
GGRRIIEEVVAANNCCEESS AANNDD IINNCCIIDDEENNTT RREEPPOORRTTIINNGG
PPRROOTTOOCCOOLL FFOORR CCOOMMPPLLEETTIIOONN OOFF IINNCCIIDDEENNTT RREEPPOORRTT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit I
Page 2 of 2
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) Where did this happen?
Name/DMH #
1. Background information of the incident:
2. Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
3. Preliminary findings: How did it happen? Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent inconsequential consequential death not applicable unknown
4. Response: a) corrective action, b) Plan of Action, c) other
Completed by (print name)
Completed by (signature) Date completed
Reviewed by Supervisor (print name)
Supervisor Signature Date
Exhibit J
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II. Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses 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
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
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
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? ...................................................................................... ❒ ❒
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) ........... ❒ ❒
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 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 ADDRESS EIN
B. Type of entity: ❒ Sole proprietorship ❒ Partnership ❒ Corporation
❒ Unincorporated Associations ❒ 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. ..........................................................................................................
❒ ❒
NAME ADDRESS PROVIDER NUMBER
Exhibit J
Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
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?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(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 EIN
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 K
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 K
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)
Exhibit L
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 L
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: